Don’t be alone, don’t be afraid: Partnerships fostered between the NTD Programme and Communities in Liberia

by Karsor Kollie, Laura Dean, Anna Wickenden and Sally Theobald

This was an exciting and historic event to celebrate World Leprosy Day.  It was the first-time that people affected by these diseases came together to increase awareness of the integrated approach to morbidity management and launch the LF/Onchocerciasis MDA programme in Liberia. This created an important space for patients to meet many others for the first time, and further strengthen these exchanges with each other will have impact on many levels.

Patients in Attendance

Ma Grace, Pa Abraham and Pastor Joseph stood strong to tell their testimonies of life with either Lymphatic filariasis (big foot) or leprosy in Maryland County, Liberia. Their inspiring journeys of overcoming challenges and being part of community life meant that they were important advocates for the NTD programme, bringing much needed visibility and inclusion of people affected. Their key educational messages to their peers – others from Maryland with lymphoedema or leprosy, school children and community health volunteers and community health workers were:

  1. Don’t be alone, don’t be afraid, speak to others;
  2. Visit the health centre and
  3. Take your drugs.

Zero disability

Community health volunteers and community health workers play a critical interface role in NTD and other health programmes, linking communities and health systems. One community health support supervisor, shared her experiences of contributing to “Ending the Neglect and Stigma: to achieve zero disabilities in girls and boys affected by NTDs” (the theme of the day’s event). They also explained how they provide psychosocial and medication support. This important cadre of “foot soldiers” was appropriately celebrated. They also demonstrated how to measure clients and distribute medicine.

Karsor Kollie, director of the NTD programme and COUNTDOWN country manager, provided awareness and education on the different focus NTDs such as Buruli ulcer (everlasting sore), lymphatic filariasis (big foot/big water bag), Leprosy and Onchocerciasis. He broke down complex concepts into clear digestible chunks and the audience were really engaged. We also heard from Dr Evelyn Kandakai, ambassador for the NTD programme and former Minister of Education in Liberia. She began by thanking the audience for maintaining peace in the recent elections. She then had three key messages 1. Be a friend to people affected by NTDs, 2. Cooperate with programme work and 3. Make Liberia environmentally friendly. She asked the audience to “put their arms around the Ministry of Health and Karsor Kollie”.

Dr. David Ross, CEO – Task Force on Global health, launched the CNTD-supported, DFID-funded, Mass Drug Administration against Lymphatic Filariasis/Onchocerciasis in Maryland County. This included several participants including the NTD Director, former Deputy Chief Medical Officer (DCMO) and Director of Community Health taking part. They were measured using the height pole, given the appropriate number of pills, and swallowed the mectizan and albendazole to demonstrate that the medicines are safe, and everyone can safely take them.

Reflecting on the day, it was great to see partnerships celebrated at different levels of health systems. The emphasis on the critical role of patients, communities and Community Health Volunteers (CHVs) and the importance of their ownership and agency was refreshing and important. Strengthening these partnerships will be critical in meeting the challenges ahead.

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Onchocerciasis in Three Decades: Through the Lens of Prof. Samuel Wanji

By Prof Samuel Wanji & Pamela Bongkiyung

Prof. Samuel Wanji is Head of Department for Microbiology and Parasitology at the University of Buea, Cameroon. He is also Executive Director of the Research Foundation in Tropical Diseases and Environment, Buea. He heads the COUNTDOWN programme’s partnership with the University of Buea. He has worked extensively on Onchocerciasis control and been instrumental in its control. We caught up with him while he was on a visit to the Liverpool School of Tropical Medicine.

Pamela: Hello Prof. Wanji. Thank you for taking the time to talk to us. How long have you worked on Onchocerciasis?

Prof. Wanji:  My journey with onchocerciasis started as far back as 1988. We could be talking of almost 30 years of research in onchocerciasis. Everything started with an experimental model when I was doing my postgraduate studies in Paris, France. And later on, I remained within Filariasis/Onchocerciasis for my research and university career. So actually, it has been a very faithful relationship with research and onchocerciasis throughout my life as a student and a worker both for teaching and research.

P: In the almost three decades that you have worked on various projects in relation to onchocerciasis, what changes have you observed?

PW: Yes, there have been changes. I started almost when Ivermectin was introduced as a new tool for the control of Onchocerciasis. And we witnessed the huge impact Ivermectin has made in the control of Onchocerciasis through the African Programme for Onchocerciasis Control – APOC. We were among the researchers involved in mapping the disease across Africa for the implementation of the control. We also witnessed the decline of the disease in many of foci where the endemicity was really high.

But what has been my major contribution for the control of onchocerciasis came from another filarial parasite Loa Loa. Originally, nobody knew that Loa Loa could cause a problem for the onchocerciasis control. So, when it was established that some people taking Ivermectin could develop severe adverse events and could even die, the link was established with Loa Loa and it became a priority to know those places where the endemicity of Loa Loa that is dangerous for the intake of Ivermectin was.

We participated in those early days around 2000 to develop the rapid assessment procedure for Loa Loa which was later on extended to 15 African countries, where we coordinated the mapping exercises in those countries, to generate the first map for Loa Loa in Africa. This map was operationally very useful in saying this place is very dangerous, this place is safe. And that is how we contributed heavily to the control of onchocerciasis in those areas where there was co-endemicity with Loa Loa.

Besides that, at the level of the laboratory we developed an experimental model in baboons to understand the mechanisms of encephalopathy due to Loa Loa with the treatment we have with Ivermectin. Today we know that the microfilaria are massively killed and they block the micro capillary of the brain and that is how people almost get killed. People become withdrawn and they go into coma because of such. We know that mechanism and we even have an idea of how such things could be prevented with ivermectin and aspirin. We have worked a lot through Loa Loa to see how the control of onchocerciasis could be safe in the forested areas of Africa.

P: What are the major impediments to controlling Onchocerciasis not just in Cameroon as you seem to have worked extensively across Africa, but also how does Loa Loa add to these impediments that you might have encountered in your work?

PW: As we know Onchocerciasis is a Neglected Tropical Disease. So just by that fact, it is already an impediment in controlling such disease. Less attention was paid to it. Fortunately for the past ten years there has been a lot of momentum around Neglected Tropical Diseases and Onchocerciasis has also benefitted from that.

As you can imagine that for almost 30years, the only drug that has been used for the control of Onchocerciasis has been Ivermectin. Ivermectin does not kill adult Onchocerciasis besides of the fact that it creates problems with Loa Loa in areas where the two diseases co-exist, Ivermectin kills only Microfilaria, the children of filarial of Onchocerca Volvulus (O. Volvulus).

So you need to take the drug for longer than 15years, to expect getting rid of the disease. And that is a very long time because people can easily go into fatigue. If the resources are not properly mobilised people may not have resources to sustain such long term control.

One probable consequence of such impediment has been the suspicion (and I will call it suspicion because there has been a lot of controversy around it) of sub-optimal response of the worms to Ivermectin. That means when you have a long term pressure of the same one medication on a parasite, the parasite may develop a strategy to not be sensitive to that drug anymore. And that has been a very shortcoming of onchocerciasis control to know that instead of having two or three drugs to play with, only one drug exists.

It is only of recent that there is a lot of work going on to develop microfilaria drug that will kill the adult worm. That is why in many areas we are really doubting how the elimination will be feasible. Those areas where the transmission was very high or is very high, we are almost sure that Ivermectin alone cannot do the job. We need alternative strategies. That is why you have been hearing about Doxycycline which was developed recently. Doxycycline can kill adult Onchocerca Volvulus but it needs at least 4weeks to do that job. The four weeks treatment is far better than 15years yearly treatments because with 15yrs yearly treatment you may have fatigue effect more than 4wks continuous treatment. At the level of the public health people think it is not suitable to have a regimen of 4wks, they insist on shorter regimens.

Here at the Liverpool School of Tropical Medicine, we have the AWOL consortium which is developing a shorter regimen of Anti-Wolbachia. Doxycycline is an anti-wolbachia. It is a drug that kills the bacteria that lives in a worm. Because that bacteria is starkly associated to the worm, they exchange some functions. So if you kill the bacteria, the worm also dies. It is an indirect effect. So the AWOL consortium is developing a shorter regimen of antibiotics that can do the same job like doxycycline. We hope that doxycycline will play its own role in the elimination of onchocerciasis or anti-wolbachia drugs globally. But we are expecting contributions from other drugs like Flubendazole which is in the pipeline.

Globally to answer your question, the impediment has come from the fact that we are dealing with only one tool, for the control of onchocerciasis.

To be continued…

Future directions in Neglected Tropical Diseases

By Eleanor MacPherson, Liverpool School of Tropical Medicine

On the 14th June I attended a meeting of the All-Party Parliamentary Group (APPG) on Malaria and Neglected Tropical Diseases (NTDs). It brought together a panel of four men to discuss Neglected Tropical Diseases and the Sustainable Development Goals. The panel included three members from the World Health Organisation: Dirk Engels (Director of NTDs), Christopher Fitzpatrick (Economist for NTDs), Bruce Gordon (NTD-WASH strategy) and Mr Andy Wright from GSK Uniting to Combat NTDs. The meeting was chaired by Jeremy Lefroy the MP for Stafford and coordinator for the APPG on Malaria and Neglected Tropical Diseases.

Here are five reflections on our discussions:

  1. Including women in community led mass drug administration can improve women’s standing within communities. Dirk Engles talked about the different ways that tackling NTDs could help meet the 17 Sustainable Development Goals but this one stood out. He described how including women as community drug distributors could be empowering for women because by taking a leadership role they were challenging gender norms. However, I would love to broaden this out to highlight the multiple ways gender shapes women and girls’ experiences of NTDs. These include the way social norms within communities often mean that women and girls are expected to interact with infected water sources on a near constant basis. Women can experience greater stigma from living with the clinical manifestations of NTDs. For instance, women living with swelling in their legs can lead to greater stigmatisation both within their families and in the communities more broadly. Expectations around who provides care in households can also mean that women and girls care for those living with the symptoms of NTDs. Making sure we highlight the diverse ways gender power relations shape vulnerability and experiences of living with the diseases is vital. One step to doing this would be the inclusion of women and girls voices in the design health and social programmes to ensure their needs are not overlooked.
  2. Despite free drugs being available not all countries request them: Understanding why countries do not request free drugs is important. Health systems in resource limited settings are often overburdened. Provision of free drugs is only part of a health programme. Many bottlenecks obviously exist that prevent countries from requesting and delivering these programmes. Taking a health systems approach that asks stakeholders what challenges governments face that stops them from requesting drugs could provide important insights.
  3. We need to look beyond just giving drugs: Where people live, whether they have access to safe water, whether they have access to health care, and what they do for a living can all affect their vulnerability to NTDs. Giving preventative chemotherapy has to be seen as a strategy that goes hand in hand with other interventions that aim to prevent people becoming infected in the first place. These include vector controls as well as Water, Sanitation and Hygiene (WASH).
  4. WASH is not always easy but it is necessary: WASH’s start-up and maintenance costs can be expensive but given the very real ways it can prevent illness and suffering investment should be made.
  5. Let’s not leave anyone behind: Millions of people, and their families, continue to be affected by NTDs. Making sure that these people’s health and social needs are considered and addressed within NTD programmes is of the upmost importance.

It was heartening to see the successes of NTD interventions such as the lymphatic filariasis programme from the last decade. However, it is clear that many challenges still remain if we are to live in a world free of NTDs.

Photo credit: Lake Malawi by Eleanor MacPherson

Building links with polio surveillance in Ghana

By Lucas Cunningham

The COUNTDOWN team in Ghana completed a successful qPCR workshop and I stayed on in Accra and with Dr Mike Osei-Atweneboana to help consolidate research links with The Noguchi Memorial Institute for Medical Research (NMIMR).  During the week I started to implement the practical skills learnt and develop laboratory protocols for our qPCR diagnostic assays acquired during our workshop.

The NMIMR was founded in 1979 as a memorial to the Japanese scientist Hideyo Noguchi who died in Accra from yellow fever in 1928. The NMIMR is part of the University of Ghana and is a world leading biomedical research facility in West Africa. The NMIMR includes the Ghanaian national polio laboratory, which is part of the global polio laboratory network (GPLN). The Ghanaian polio laboratory receives over 1000 faecal samples from across the country of suspected polio cases. Typically the samples have come from individuals presenting with acute flaccid paralysis, a classic sign of acute polio.

COUNTDOWN will carry out a preliminary screening of the faecal collections to test the possibility of tapping into the vast resources of the global polio surveillance programme to co-screen for worm infections. Along with schistosomiasis, these diseases are collectively grouped within the soil-transmitted helminth and make up a considerable public health burden in Ghana and across the developing world, ranking that of other, more infamous diseases such as malaria and TB.

Using the TaqMan® qPCR assay, the team at NMIMR will screen for the six major helminth parasites associated with poor sanitation and hygiene, Ascaris lumbricoides, Trichuris trichuria, Strongyloides stercoralis plus the two hookworm species Necator americanus and Ancylostoma duodenale. In addition, faecal samples will be screened for Schistosoma spp.. Several of Mike’s staff from Council for Scientific and Industrial Research (CSIR) were part of the visit to NMIMR which provided another opportunity for crosstalk between two of the research centres focal to COUNTDOWN in Ghana.

In total seven collaborators from both institutes took part, including two members of NMIMR’s parasitological department. Dealing with a smaller group allowed for a more informal approach to the optimisation and testing of the compatibility of the reagents with the specific equipment in the polio lab. Our adapted assays were carried out efficiently, resulting in an effective triplex assay, where three species of parasite can be detected simultaneously in each tube. Armed with this new tool we were then able to screen 15 faecal DNA extracts obtained from a recent pilot survey undertaken at a Lake Weij. The test results were surprising. Although all 15 samples were negative for the five soil transmitted helminths (STH) they all tested highly positive for Schistosoma s.l., indicating a heavy egg load in the faecal samples.

Having carried out the work at NMIMR we were able to reinforce the methods developed in the workshop and also leave behind enough laboratory materials for our colleagues at both the CSIR and NMIMR to practice and perfect their qPCR assays and hone their TaqMan® skills. We have also shown the importance of the COUNTDOWN consortium in bringing together different silos within Neglected Tropical Disease work and helping with the capacity building and thereby control of some the most neglected of NTDs.

Our experiences and successes in Ghana were recently broadcast to a wider audience at the British Society for Parasitology’s Spring Meeting (@BSPparasitology, #BSP2016). There I provided an overview and account of our recent activities in Accra during a well-attended session dedicated to research on NTDs and I hoped to show how our interdisciplinary research links have been strengthened. In short I outlined how the second year of COUNTDOWN research is shaping up, so watch this space!

Photo credit: Our teams from CSIR and NMIMR by the Noguchi memorial plaque, from left to right: Buhari Hamid, Linda Boatemaa, Edward Tettevi, Deborah Pratt, Millicent Opoku, Nana Pels and Nana Asante-Ntim

Learning from the Neglected Tropical Disease NGDO Network

By Suzy Campbell,

Over the past few years it has been exciting to see momentum building to address integration and health systems strengthening beyond the traditional vertical approaches of funding and delivery of single disease strategies. A recent supplementary issue of International Health, a journal of the Royal Society of Tropical Medicine and Hygiene has a strong focus on health systems strengthening, and should be essential reading for anyone with interest in addressing NTDs.

The supplement has been largely coordinated by the Neglected Tropical Disease (NTD) Non-governmental Development Organisations Network (NNN), and is refreshingly dedicated to partnering across the entire sector to continue addressing the challenging issues pertaining to prevention, treatment and management of NTDs.

Intersectoral and transdisciplinary cooperation and learning

Of particular note is the article by Hopkins who describes the new project framework developed by the World Health Organization (WHO) Africa Region to replace the African Programme for Onchocerciasis Control (APOC). APOC ceased in 2015 yet has been widely recognised for its contributions towards health systems strengthening, as it has enabled infrastructure development and mobilisation via community health workers, thereby facilitating access to chemotherapeutic drugs by people who have otherwise been truly unable to reach them. The new framework, the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), will be introduced throughout 2016 and will extend beyond onchocerciasis to coordinate all NTD activities in the African region. Together with the current focus on intersectoral, transdisciplinary cooperation and learning, ESPEN will provide an unprecedented opportunity to drive impetus for integrated health system strengthening activities. This does set a new support structure for integrated NTD control and elimination, and we look forward to its further development with great interest.

NTD morbidity

Much valuable work has been done over the last 15 years to map various NTDs and enable resource prioritisation via chemotherapy. Yet the sheer scale, and varying morbidity, of NTDs means that, in addition to the important prevalence and treatment coverage statistics, it is equally important to capture data on additional morbidity measures. Having sound knowledge of the disease burden from these diseases does facilitate advocacy for their control. There are several articles in the supplement that highlight the importance of capturing data on NTD morbidity, including the importance and measurement of coverage statistics, and a research agenda for the NNN to identify common indicators that can be shared across NTDs.

Integration

Integration, as it is directly influenced by NTD control and elimination strategies, needs to be strengthened with inclusion of structural system enhancements delivered as part of the universal health coverage agenda. For many NTDs, this does require consideration beyond chemotherapy to include “multi-component integration”. However, it is clearly acknowledged that more evidence is required, that it is expensive and logistically challenging, and that it requires strong cross-sectoral collaboration. In the supplement, Waite et al. provide a comprehensive review of the progress that has been achieved in, and opportunities to prioritise, integrating water, sanitation and hygiene (WASH) with NTD programmes. Integrated WASH and NTD control contributes simultaneously to several Sustainable Development Goals and every opportunity needs to be taken to further promulgate this.

What’s next?

The international health community does need to determine what a truly integrated universal health coverage agenda should encompass. The NNN has contributed heavily to driving this agenda, as have other organisations. Looking beyond NTDs, this is in direct alignment with macro-political strategies as set by the World Bank, the WHO and other parties. By necessity, a universal health coverage agenda must be broader than NTDs, however NTDs are a major part of this (having been referred to by the WHO as a “litmus test”). As NTD practitioners and researchers we therefore have a major opportunity to collectively share knowledge and in so doing propose critical requirements of integrated health care.

We at COUNTDOWN are delighted to see this supplement published and are wholehearted in our support of its messages.

 

Launch of the Ross Fund at LSTM

By Russell Stothard
This Monday LSTM hosted The UK Chancellor of the Exchequer, the Rt Hon George Osborne MP and the philanthropist Bill Gates who came to announce the launch of the Ross Fund.

Named in Honour of Sir Ronald Ross, The Ross Fund is a new international initiative to stem the spread of antimicrobial resistance, move towards elimination of malaria and control several Neglected Tropical Diseases. The Fund is a portfolio of programmes led by the Department for International Development (DFID) or the UK Department of Health.

At the launch, they both gave their opinions about the importance of the Ross Fund and discussed key challenges in global health. They also drew attention to the importance of existing international research networks and how these are set to expand and respond. The discussions were captured on video and illustrate how interventions against malaria and Neglected Tropical Diseases (NTDs) are top priorities.

The Rt Hon Justine Greening, the Secretary of State for Department for DFID, who joined George Osborne and Bill Gates on a tour of the LSTM laboratories, discussing NTD research with Professor Mark Taylor and Dr Joe Turner, from the COUNTDOWN team.
In short, the 25th January was an excellent opportunity to demonstrate to the world the importance of translating the best laboratory findings into the most appropriate public health policies, to transform the lives of those with NTDs by supporting better health for all.

Come see COUNTDOWN at the Prince Mahidol Award Conference

We’re delighted to be attending this year’s Prince Mahidol Award Conference which is focused on the theme of Universal Health Coverage. We’ll be represented by Kate Hawkins, Sally Theobald and Louis-Albert Tchuem Tchuenté.

At the conference we’ll be presenting our poster on progress on control and elimination of Neglected Tropical Diseases (NTDs) as the ‘litmus test’ for Universal Health Coverage (UHC). Mass Drug Administration (MDA) has been successful in reaching high numbers of people affected by NTDs resulting in progress toward the control and elimination of NTDs in many contexts. However, numerous bottlenecks still remain for the scale-up of MDA if the WHO 2020 targets are to be met. If UHC is to be achieved these aspects need to be addressed and the health system strengthened. We outline the challenges that are being faced under the six health systems building blocks – financing, workforce, information and research, service delivery, leadership and governance, and medical products and technologies – and suggest some ways forward.

If you are attending the conference do come and find us. It would be good to connect.

Update from Coalition for Operational Research on Neglected Tropical Diseases and the American Society of Tropical Medicine and Hygiene conferences

By Russell Stothard

Several COUNTDOWN staff travelled to Philadelphia, USA to attend two important events, the meetings of the COR-NTD 22-23rd October and the ASTMH 25-29th October.

The COR-NTD meeting brought together over 350 international delegates interested in research and control activities surrounding neglected tropical diseases (NTDs). In a combination of plenary lectures, panel discussions and themed break-out sessions, the state-of-the-art and future funding landscape was assessed and explored. COUNTDOWN researchers played significant roles at COR-NTD by organising two break-out sessions dedicated to addressing gender-related inequities and expanded access to praziquantel/albendazole.

The equity session was organised by Margaret Gyapong and Samantha Page, and chaired by Charles MacKenzie, and I was delighted that Camilla Ducker, of DFID joined the panel. The session drew attention to several current gender-related inequities that ranged from a variety of levels from the international to the community. Even within this audience there was confusion over the formal use of various de-worming drugs in pregnancy, and we simply don’t know the current gender composition of community health workers. Better knowledge of each has significant bearing on the management of several NTDs in women and exploration of new drug delivery channels that specific provide access to currently overlooked groups.

This theme of control of NTDs in pregnancy was again picked up in the session I organised with David Addiss where we discussed expanded access to praziquantel and albendazole in groups outside that of school-aged children. In the first presentation, Evan Secor did a remarkable job in setting the ground so well where key gaps were. If these gaps are not filled soon then several WHO 2020 targets for schistosomiasis and soil-transmitted helminthiasis will not be met. The WHO desk officer for schistosomiasis Amadou Garba, highlighted a pertinent point that many women will still have female genital schistosomiasis and will have continued illness unless praziquantel campaigns can be effectively scaled-up. Future COUNTDOWN work was discussed by Sam Wanji identifying current access gaps in Cameroon. Moving towards biannual treatment with praziquantel is needed and Dan Colley (the Director of SCORE) discussed this benefit with regard to our current understanding of disease-inflammation and morbidity.

slide for the astmh blog

Concerning soil-transmitted helminthiasis, recent results from the TUMIKIA project  were highlighted which also have some bearings on the recent #wormwars debate on twitter. Similarly, Hugo Turner and Deirdre Hollingsworth drew attention to a clutch of NTD modelling papers – “Quantitative analysis of strategies to achieve the 2020 goals for neglected tropical diseases: where are we now?”. Here expanded access to treatment was discussed in relation to future reduction of parasite transmission, and hopefully COUNTDOWN will pave the way forward on how to do it.

Other disease-specific highlights at the COR-NTD meeting included evidence that triple combination therapy of ivermectin/albendazole/DEC could more sharply curtail microfilaraemia and transmission of lymphatic filariasis. In addition, a new initiative concerning research on soil-transmitted helminthiasis was announced by Judd Walson as to be supported by Bill & Melinda Gates Foundation and based at the Natural History Museum, London.

During the following week, there was a much larger attendance at the ASTMH. I was happy to attend a WHO and USAID chaired symposium on “Global NTD elimination: the spring towards the 2020 goals – five years out”. Perspectives from major health stakeholder were aired. It is very clear that a significant future bottleneck will be in disease diagnostics and NTD surveillance. Increasing access to state-of-the-art diagnostics is needed now and will be critical to mobilise the diagnostic sector in a similar manner in which industrial philanthropy within the pharmaceutical sector has taken place with drug donations. To identify these diagnostic gaps and encourage actions, COUNTDOWN is set to explore the best interface and find synergy with polio-disease surveillance systems, so watch this space.

Some reflections on #wormwars from a communications perspective

By Kate Hawkins, Pamoja Communications

As a communication person who spends my day grappling with how to get people in power to take some notice of the evidence that my projects are generating it is strange to be connected to a piece of research that ‘goes viral’. When I opened up Twitter to see that my feed had been taken over by the hash tag #wormwars I had that horrible stomach lurching reaction. The volume of tweets and opinion pieces on the recent systematic review and reanalysis of a pivotal piece of research on de-worming in Kenya has been difficult to keep up with.

On the one hand this is a great opportunity for people in the Neglected Tropical Disease world. Worms are, well neglected, and so it is heartening to see them the subject of debate and media attention. On the other hand there is inevitably some misinformation flying around, for example that deworming is ineffective when of course deworming stops people having worms which is undoubtedly a good thing.

An ongoing and inclusive discussion

Let’s be clear, there is no ‘last word’ when it comes to the evidence base on worms. This is an evolving discussion which involves stakeholders around the world, not least those people whose kids are grievously effected. To prevent this iteration of the #wormwars being a flash in the pan is going to require some concerted efforts to foster a sensible, sustainable, and ongoing debate. Crucially this needs to include people from countries where large scale deworming programmes are ongoing (planning them, implementing them and benefiting from them).

This has been notably absent from the discussion so far with one exception.

Enough with all the machismo already

The strength of evidence is an important thing to debate. There’s no doubt about that. It is also true that when it comes to uptake decision makers and citizens need a whole range of evidence to draw on. That’s because we are working in diverse settings and there are very particular real world challenges that need to be dealt with – and sometimes these are very localised.

This means that we really have no alternative but to work in multi-disciplinary teams and bring a plurality of voices and opinions into the way that we frame research questions, the methods that we use, and the way that we communicate the evidence (including its applicability to the challenges that people are grappling with).

This approach is really at odds with a style of evidence generation that assumes that there is one answer to a complex social, ecological, political, and ethical issue such as Neglected Tropical Disease. I find a very adversarial approach to discussing the evidence base very off putting. Some people love a row, I am not one of them.

I am particularly concerned about the metaphor of war being used in research communication. I have friends and family in Syria dealing with food shortages, shelling, snipers, ransom demands for kidnapped relatives, prolonged family separation, post-traumatic stress, and the terror of sending their sons off on the long journey across continents through barbed wire and multiple law enforcement agencies to a precarious safety in countries of relative stability (and extreme racism and Islamophobia). That is a war folks. Let’s be clear that what we are dealing with is a disagreement between academics and try and get a sense of proportion.

So over the next couple of YEARS we promise that we will keep feeding you news and new evidence on worms. We hope that some of those people who got caught up in the excitement of a hash tag war will continue to engage. Watch this space.

Photo credit: Omar Chatriwala Continue reading

The official launch of the COUNTDOWN programme in Ghana

By Adriana Opong

On Thursday, 15th October 2015, the Neglected Tropical Disease (NTD) Programme under the Public Health Division of the Ghana Health Service officially launched the COUNTDOWN Programme in Ghana. In attendance were key stakeholders and the NTD national Ambassador Dr. Joyce Aryee as the chair for the launch. The Director-General of the Ghana Health Service and a representative of the Minister of Health were also present.

In Sub-Saharan Africa, Ghana’s commitment to the elimination and management of NTDs is in an advance stage. The NTD Programme treats over 12 million people for onchocerciasis and lymphatic filariasis and over 4 million school – aged children for schistomiasis and soil helminthiasis annually. But there still remain cases and issues of hotspots areas of infection for both lymphatic filariasis and onchocerciasis, access to medication for some of the diseases is still limited and a more integrated approach to a single programme is required.

In the her acceptance speech, Dr. Joyce Aryee, the chair explained that NTDs are a class of diseases that can be eliminated, and that the launch of COUNTDOWN represents the last lap towards riding Ghana off the NTD burden of morbidity and mortality.

Within the COUNTDOWN Programme, the project activities in Ghana’s will include:

  • Filling the gap with Implementation Research
  • Integration at the different levels of health systems, NTDs programmes within and beyond the health sectors
  • Assessing and informing the equity, efficiency and sustainability of current NTD approaches
  • Looking for strategies on dealing with the issue of hotspots
  • Linking research to policy through dialogue and consultation

The implementing partners in the COUNTDOWN Project Ghana, are the NTD Programme of the Ghana Health Service, The Dodowa Health Research Centre (DHRC), and the Ghana Health Service and the Water Research Institute of the Council for Scientific and Industrial Research (CSIR). The Ghana management team is under the leadership of Dr Nana- Kwadwo Biritwum, the Programme Manager, Dr. Margaret Gyapong the Director of the Dodowa Health Research Centre and Dr. Mike Osei- Atweneboana.

Dr. Ebenezer Appiah-Denkyira in his welcome address said,  “We need not wait for Neglected Tropical Diseases to create epidemics before we take action on Neglected Tropical Diseases  this will no longer be neglected”. A representative of the Minister of Health delivered the keynote address for the launch. The overview of the COUNTDOWN programme and a message from the Director, COUNTDOWN was presented by Julie Irving.