The huge number of sufferers shows the danger posed by negelcted tropical diseases (NTDs). With over billion people in 154 countries having one NTD or the other, the Federal Government has woken up to the challenge of tackling the problem.
The target NTDs are: Onchocerciasis (Riverblindness), Chistosomiasis (Blood in the urine),Lymphatic Flariasis (Elephantiasis), Trachoma (Blindness) andIntestinal worm.The Nigeria 2012 Neglected Tropical Disease (NTD) Master Plan indicates the country accounts for 25 percent of the seven major NTDs in sub-Saharan Africa.
To ensure that the country eliminates five of these NTDs, the government is collaborating with COUNTDOWN, a research consortium dedicated to investigating cost-effective, scale-up and sustainable solutions, necessary to control and eliminate the seven most common NTDs by 2020. Sightsaver, an indigenous non-governmental organisation, Ogun and Kaduna Ministries of Health are also involved in the project.
At a meeating of the NTDs Lagos, Ifeoma Anagbogu who is the Federal Ministry of Health COUNTDOWN Nigeria Lead said: “This is all about meeting the World Health Organisation global targets for NTDs control and elimination by 2020.
“So in the true spirit of partnership, COUNTDOWN will conduct research alongside the established national NTD agenda with the Federal Ministry of Health, the Ogun and Kaduna State Ministries of Health. Research activities will be undertaken and supervised by in-country partner – Sightsavers Nigeria.”
Mrs Anagbogu said: “The COUNTDOWN Project comes to Nigeria at an auspicious moment in her efforts to achieve the Year 2020 target for the elimination of the NTDs as a public health problem. The Nigerian government is therefore delighted to collaborate with the COUNTDOWN team in devising innovative ways towards fast-tracking the attainment of this target through implementation research. We are indeed committed to the success of this veritable project.”
She said Kaduna and Ogun states were selected for the programme based on their differing phases of NTD control as well as to achieve variation in socio-demographic and geographic contexts.
“COUNTDOWN will be conducting applied research which is multidisciplinary and involves a team of social scientists, health economists, clinicians and parasitologists; aimed at improving NTD interventions for major NTDs such as Schistosomiasis, Soil-Transmitted Helminthiasis (STH), Onchocerciasis, Lymphatic Filariasis and Trachoma,”she explained.
“Compared to Ogun, Kaduna has received extensive support from Non-governmental development organisations and therefore is more advanced on its NTD programme. Kaduna launched its NTD Master Plan last December.
“The Nigeria programme will also join partners in three other African countries (Cameroon, Ghana and Liberia), Fhi360 USA and Liverpool School of Tropical Medicine UK, to make up the COUNTDOWN consortium,” she said.
Mrs Anagbogu said preventive measures can be taken to forestall some of these NTDs like sleeping under treated mosquito nets. “Plateau and Nasarawa have exterminated Lymphatic Flariasis (Elephantiasis) through the use of nets. Poor infrastructure such as lackof good housing, poor water supply, poor hygiene and sanitation contribute to the plethora of these diseases. These diseases are common among poor people. Nigeria is not a poor country, at all. We are free from Guinea worm, but we are not resting on our oars, we even pick up animals with hanging worms such as dogs because they also harbour guinea worms.”
She said reasons for the neglect are prevalent in poor developing countries hence they are easily overlooked; major resources mobilised for three big diseases-HIV/AIDS, malaria, and TB because of their higher mortality and public awareness.
She added the fact that many NTDs are without symptoms and have long incubation period, coupled with the fact that NTDs have traditionally ranked low on national and international health agenda.
“We are working assiduously through collation of evidences to prove that we have these diseases. Then review strategies in combating the diseases and strengthen the system as well sustain the success we have achieved in eliminating them. We are going to explore multi-system approach of mass drug administration use, provision and maintenance of safe water sources, environmental management and also health education for behaviourial change. Vector control is equally applicable. Importantly we will come up with our recommendation so as to meet the 20-20 target of elimination of NTDs.
According to the Country Director, Sightsavers , Dr. Sunday Isiyaku, the Nigerian government has set the year 2020/2025 for elimination of NTDs in Nigeria. The COUNTDWON project is coming at a time when evidence-based research is required to determine the critical factors required to achieve this. “Sightsavers is committed to the elimination of NTDs in Nigeria and believes that the outcome of the project would be a watershed in elimination of NTDs in the country.”
Dr Isiyaku said: “The diseases have been long there because we did not put the required effort in the past to get rid of them. For instance, simple de-worming is no longer done as required throughout the federation. So also for these tropical diseases like onchocerchiasis, which a single dose of Ivermectin can treat, elephantiasis which is transmitted from human to human via the female mosquito when it takes a blood meal. The parasite grows into an adult worm that lives in the lymphatic system of humans. All these happen mostly in the rural areas. It is obvious that most experts in research, health, treatment and service providers are no longer up and doing. Over one billion people suffer from these diseases globally, while Nigeria will rank among the first fives with the worst cases. That is why Nigeria is a priority country. That is why WHO has put up this NTD programme with the target to eliminate or control them. More so, the interventions for these are quite simple. Simple practices such as on hygiene, water treatment can prevent these diseases.”
Chairperson of the steering committee on NTDs, Prof Adenike Abiose, stated the main focus of the collaboration to be Onchocerciasis (River blindness), Schistosomiasis (Blood in the urine), Lymphatic Flariasis (Elephantiasis), Trachoma (Blindness) and Intestinal worm adding that Nigeria is to scale up intervention against NTDs in Kaduna and Ogun state.
Director, Countdown, Prof Russell Stothard of Liverpool School of Tropical Medicine said the COUNTDOWN consortium was formed in 2014 and is a research programme consortium funded by The Research and Evidence Division (RED) of The Department for International Development (DFID).
Prof Stothard said NTD researchers, policy makers, practitioners and Implementation Research (IR) specialists, from the UK, USA and Africa, have come together to generate knowledge about the realities of increasing the reach of NTD treatment, in different contexts.
“To do this, we will conduct research in some African countries. Each country reflects a different level of health expenditure, diversity in disease ecologies and NTD skills, experience and programme implementation. By focusing our research on different contexts, including complex ones where there is conflict and/or unstable social and environmental conditions, we will generate transferable knowledge that can help improve NTD programmes in other countries. In the latter stages of our programme, we will use our findings to help develop a scale-up NTD programme in Nigeria, where there is a high prevalence of NTDs, and that is where we are.”
Another member of the committee, Director Public Health, Nigeria Institute of Medical Research Yaba, Lagos, Dr. Margaret A. Mafe said there are three major burdens facing the elimination of NTDs: the burden of the tropical diseases, effects on children and funding.
She explained: “Nigeria accounts for the highest rate for this and it affects virtually all age groups. Ultimately it has effect on our economic growth. For instance, in a community where the citizens are blinded by onchocerchiasis, also known as river blindness, which is a disease, caused by infection with the parasitic worm Onchocerca volvulus. Symptoms include severe itching, bumps under the skin, and blindness. It is the second most common cause of blindness due to infection, after trachoma. So when a person suffers from that his contribution to national growth through farming is affected.
“The other is on children. If you look at onchocerchiasis because of poor infrastructure and lack of good hygiene children are affected. This is occasioned by highly contaminated water. Also occupational hazard as seen in those who must compulsorily have contact with the contaminated waters for agricultural or fishing reasons. And they will still mingle with children who have low immunity. But there is hope. Globally not just in Nigeria, there is a global effort to ensure the 20-20 target of halting transmission of NTDs is achieved. That is why every stakeholder is joining hand to ensure every drug is seen being utilised by the end users. Elephantiasis is an infection from the filarial worm, which is transmitted from human to human via the female mosquito when it takes a blood meal. The parasite grows into an adult worm that lives in the lymphatic system of humans.
The drug for this a combination of albendazole and ivermectin is generally used, and can also be deployed for River blindness treatment. So we are focusing on Mass drug administration for these neglected tropical diseases. There is focus on them all so they can be eliminated.”
On funding, Dr Mafe said there is global funding to drive this effort, whereby drugs are made available to countries in need of such drugs. Transmission, debilitating condition of people will reduce as well, overtime.
“This particular collaboration is a count-down race which is to generate evidence of statistics of all interventions. This is because as we drive on with the intervention at hand, there may be need to review the approach or strategy. For instance, on onchocerchiasis, we are considering now, twice a year treatment compared with once a year. That will help us to fast track the 20-20 target. Ogun and Kaduna represent two opposite situations within the same country. Kaduna has a lot of experience, technical support and commitment to rid this disease. We know that in the area of our laboratory analyses, Kaduna will come out clean. Other states like Ogun serve as a call for us to know where to bridge through generated evidences. In terms of its performance, Ogun has had challenges in terms of performance/achievements, donor support, and finance.Count down is about the time remaining to achieve a clean slate on those neglected tropical diseases which is the first quarter of 2018,” said Mrs Mafe.