RESISTING CONTROL OF NEGLECTED TROPICAL DISEASES: DILEMMAS IN THE MASS TREATMENT OF SCHISTOSOMIASIS AND SOIL-TRANSMITTED HELMINTHS IN NORTH-WEST UGANDA

SummaryA strong case has recently been made by academics and policymakers to develop national programmes for the integrated control of Africa’s ‘neglected tropical diseases’. Uganda was the first country to develop a programme for the integrated control of two of these diseases: schistosomiasis and soil-transmitted helminths. This paper discusses social responses to the programme in Panyimur, north-west Uganda. It shows that adults are increasingly rejecting free treatment. Resistance is attributed to a subjective fear of side-effects; divergence between biomedical and local understandings of schistosomiasis/bilharzia; as well as inappropriate and inadequate health education. In addition, the current procedures for distributing drugs at a district level are problematic. Additional research was carried out in neighbouring areas to explore the generalizability of findings. Comparable problems have arisen. It is concluded that the national programme will not fulfil its stated objectives of establishing a local demand for mass treatment unless it can establish more effective delivery strategies and promote behavioural change in socially appropriate ways. To do so will require new approaches to social, economic and political aspects of distribution. There are reasons why populations infected with the ‘neglected tropical diseases’ are themselves neglected. Those reasons cannot just be wished away.

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Mass Drug Administration and Integrated Control for the World's High-Prevalence Neglected Tropical Diseases

Clinical Pharmacology & Therapeutics ◽

10.1038/clpt.2009.16 ◽

2009 ◽

Vol 85 (6) ◽

pp. 659-664 ◽

Cited By ~ 142

Author(s):

PJ Hotez

Keyword(s):

Drug Administration ◽

Mass Drug Administration ◽

Neglected Tropical Diseases ◽

Integrated Control ◽

Tropical Diseases ◽

High Prevalence

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Rapid mapping of schistosomiasis and other neglected tropical diseases in the context of integrated control programmes in Africa

Parasitology ◽

10.1017/s0031182009005940 ◽

2009 ◽

Vol 136 (13) ◽

pp. 1707-1718 ◽

Cited By ~ 95

Author(s):

S. BROOKER ◽

N. B. KABATEREINE ◽

J. O. GYAPONG ◽

J. R. STOTHARD ◽

J. UTZINGER

Keyword(s):

High Risk ◽

Neglected Tropical Diseases ◽

Integrated Control ◽

Sampling Technique ◽

Epidemiological Data ◽

Tropical Diseases ◽

Survey Tool ◽

Rapid Mapping ◽

Effective Manner ◽

Risk Communities

SUMMARYThere is growing interest and commitment to the control of schistosomiasis and other so-called neglected tropical diseases (NTDs). Resources for control are inevitably limited, necessitating assessment methods that can rapidly and accurately identify and map high-risk communities so that interventions can be targeted in a spatially-explicit and cost-effective manner. Here, we review progress made with (1) mapping schistosomiasis across Africa using available epidemiological data and, more recently, climate-based risk prediction; (2) the development and use of morbidity questionnaires for rapid identification of high-risk communities of urinary schistosomiasis; and (3) innovative sampling-based approaches for intestinal schistosomiasis, using the lot quality assurance sampling technique. Experiences are also presented for the rapid mapping of other NTDs, including onchocerciasis, loiasis and lymphatic filariasis. Future directions for an integrated rapid mapping approach targeting multiple NTDs simultaneously are outlined, including potential challenges in developing an integrated survey tool. The lessons from the mapping of human helminth infections may also be relevant for the rapid mapping of malaria as its control efforts are intensified.

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An integrated approach to assess Knowledge, Attitude and Practices (KAP) regarding major Neglected Tropical Diseases endemic in the Mbengwi health district (North West Region, Cameroon)

10.1101/658849 ◽

2019 ◽

Author(s):

Laurentine Sumo ◽

Cédric G Lenou-Nanga ◽

Ngum H Ntonifor ◽

Nicanor Chenkumo-Kengmoni ◽

Vanessa T Amana-Bokagne ◽

...

Keyword(s):

Neglected Tropical Diseases ◽

Health District ◽

Tropical Diseases ◽

Cross Sectional ◽

North West ◽

Attitudes And Practices ◽

West Region ◽

Knowledge Attitudes And Practices ◽

Soil Transmitted Helminthiasis ◽

Main Strategy

AbstractBackgroundPreventive chemotherapy (PCT) is the main strategy currently used to control and/or eliminate onchocerciasis (Oncho), lymphatic filariasis (LF) and Soil Transmitted Helminthiasis (STH), and community participation (through implementation of MDA or adherence to PCT) is critical to achieve this goal. However, these Neglected Tropical Diseases (NTDs) are still persisting in most endemic areas as a consequence of sub-optimal treatment coverage, the presence of systematic non-compliers in communities … This study aimed at investigating whether the knowledge, attitudes and practices of populations about these NTDs can explain the poor trends towards elimination.MethodologyA cross-sectional survey was carried out in the Mbengwi Health District (North West Region, Cameroon) using the cluster sampling technique. Clusters were selected using the Probability Proportionate to Estimate Size strategy. In each cluster, the random walk technique was used for the selection of households, and a structure questionnaire was administered to 2-3 of its members.Principal FindingsA total of 254 households from 26 clusters were visited, and 514 individuals were interviewed. The sex ratio of interviewees (1.08) was unbiased, and their ages ranged between 10 and 99 years old. Though most of the respondents declared having already heard of these NTDs (41.2%, 73.7% and 89.9% for Oncho, LF and STH respectively), only a minority of them were aware of correct response of how they are acquired/transmitted (3.7%, 6.8% and 12.5% for Oncho, LF and STH respectively), and prevented (23.1%, 18.9% and 47.2% for Oncho, LF and STH respectively). Even when respondents were aware that medicines were useful to prevent and/or treat these NTDs, almost none of them knew the drug used or the treatment frequency.Conclusion/SignificanceThis study reveals that interviewees exhibit poor knowledge, attitudes and practices as regards to these NTDs, although they are endemic in the study area and PCTs given yearly since a while. These misconceptions can seriously affect the adherence and contribution of populations to the success of PCTs, and it appears compulsory to improve individual knowledge, with a focus on the importance and rationale behind MDA, to optimize their attitudes and practices, especially community participation to PCTs.Author summaryThe control and/or elimination of Neglected Tropical Diseases (NTDs) are currently on top of the agenda of endemic countries’ control programs and stakeholders. Ivermectin- and Albendazole/Mebendazole-based mass distribution is currently the main strategy to control/interrupt transmission of onchocerciasis, lymphatic filariasis and soil-transmitted helminthiasis, and adherence of communities is compulsory for the success of this approach. Despite the success registered in the fight against these diseases, the trend towards elimination remains unsatisfactory in many endemic areas. This study was carried out to assess whether the perceptions, attitudes, and practices of the Mbengwi health district (North West Region, Cameroon) populations regarding these three parasitic diseases can explain the poor trend towards elimination. A cross-sectional study revealed important misconceptions about these NTDs amongst most of the respondents, which can clearly affect their adherence and contribution to the success of preventive chemotherapies, and seriously slower the momentum towards elimination.

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An Integrated Approach to Assess Knowledge/Perceptions and Attitudes/Practices (KAP) Regarding Major Neglected Tropical Diseases Endemic in the Mbengwi Health District, North West Region, Cameroon

Journal of Epidemiology and Global Health ◽

10.1007/s44197-021-00010-8 ◽

2021 ◽

Vol 11 (4) ◽

pp. 426-434

Author(s):

Laurentine Sumo ◽

Ngum H. Ntonifor ◽

Cédric G. Lenou-Nanga ◽

Nicanor Chenkumo-Kengmoni ◽

Vanessa T. Amana-Bokagne ◽

...

Keyword(s):

Community Participation ◽

Neglected Tropical Diseases ◽

Health District ◽

Cluster Sampling ◽

Structure Questionnaire ◽

Tropical Diseases ◽

Cross Sectional Survey ◽

Preventive Chemotherapy ◽

North West ◽

West Region

Abstract Background and objectives Preventive chemotherapy (PCT) is the main strategy currently used to control and/or eliminate onchocerciasis, lymphatic filariasis (LF) and soil transmitted helminthiasis (STH), and community participation (through implementation or adherence to PCT) is critical. This study aimed at investigating knowledge/perceptions of populations of the Mbengwi health district (North West Region, Cameroon), in relation to their attitudes/practices regarding the most prevalent neglected tropical diseases (NTDs). Methods A household-based cross-sectional survey was carried out in the Mbengwi health district (North West Region, Cameroon) using the cluster sampling technique. Clusters were selected using the probability proportionate to estimate size strategy. In each cluster, the random walk technique was used for the selection of households, and a structure questionnaire was administered to 2–3 of its members. Results A total of 254 households from 26 clusters were visited, and 514 individuals were interviewed. The sex ratio of interviewees (1.08) was unbiased, and their ages ranged between 10 and 99 years old. Though most of the respondents declared having already heard of these NTDs (41.6%, 73.9% and 90.5% for onchocerciasis, LF and STH, respectively), only a minority of them were aware of how they are acquired/transmitted (8.9%, 9.2% and 32.7% for onchocerciasis, LF and STH, respectively), or prevented (23.1%, 18.9% and 47.2% for onchocerciasis, LF and STH, respectively). Conclusions This study revealed poor knowledge/perceptions and wrong attitudes/practices of interviewees as regards to these NTDs, and these misconceptions can seriously affect the adherence and contribution of populations to the success of PCTs. It appears compulsory to reinforce information, education, and communication, with a focus on the rationale and importance behind PCTs, to optimize/improve community participation.

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