Alan Fenwick

Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV/AIDS, tuberculosis, and malaria

Hotez et al. argue that achieving success in the global fight against HIV/AIDS, tuberculosis, and malaria may well require a concurrent attack on the neglected tropical diseases.

Rescuing the bottom billion through control of neglected tropical diseases

Here we outline low-cost opportunities to control the neglected tropical diseases through preventive chemotherapy, and propose fi nancial innovations to provide poor individuals with essential drugs.13 parasitic (helminthic and protozoan) and bacterial tropical infections, and dengue are the highest-burden neglected tropical diseases; another 20 include fungal, viral, and ectoparasitic infections (panel 2).

Rapid-impact interventions: how a policy of integrated control for Africa's neglected tropical diseases could benefit the poor.

Controlling seven tropical infections in Africa would cost just 40 cents per person per year, and would permanently benefit hundreds of millions of people.

Schistosomiasis: challenges for control, treatment and drug resistance.

Purpose of review Schistosomiasis is a parasitic disease that has recently attracted increased focus and funding for control. Despite shifts in global health policy towards the implementation of mass chemotherapeutic control programmes at the national scale in sub-Saharan Africa, however, many challenges still exist. Recent findings Publications reviewed for this article cover: the development of treatment strategies; the planning, implementation and impact of control programmes; the re-evaluation of the burden of schistosomiasis; improved tools for control; new drugs; the safety of treatment during pregnancy; and the development of resistance against praziquantel. Summary The morbidity due to schistosomiasis has been shown to be greater than was previously thought. The reduction in morbidity of schistosomiasis by control programmes has been demonstrated, while new tools include a validated dose pole for delivering the correct treatment, geographical information systems mapping for determining high-risk areas, and Lot Quality Assurance Sampling for determining treatment strategies at the local level. Sustainability and future funding are issues to be addressed. Despite some positive results, myrrh is apparently ineffective against schistosomiasis, but fortunately no resistance to praziquantel has developed. We predict the impact of schistosomiasis control will be a healthier generation of children within 5 years.

Bayesian spatial analysis and disease mapping: tools to enhance planning and implementation of a schistosomiasis control programme in Tanzania

Objective  To predict the spatial distributions of Schistosoma haematobium and S. mansoni infections to assist planning the implementation of mass distribution of praziquantel as part of an on‐going national control programme in Tanzania.

Neglected Tropical Diseases of the Middle East and North Africa: Review of Their Prevalence, Distribution, and Opportunities for Control

The neglected tropical diseases (NTDs) are highly endemic but patchily distributed among the 20 countries and almost 400 million people of the Middle East and North Africa (MENA) region, and disproportionately affect an estimated 65 million people living on less than US

Impact of a national helminth control programme on infection and morbidity in Ugandan schoolchildren

2 per day. Egypt has the largest number of people living in poverty of any MENA nation, while Yemen has the highest prevalence of people living in poverty. These two nations stand out for having suffered the highest rates of many NTDs, including the soil-transmitted nematode infections, filarial infections, schistosomiasis, fascioliasis, leprosy, and trachoma, although they should be recognized for recent measures aimed at NTD control. Leishmaniasis, especially cutaneous leishmaniasis, is endemic in Syria, Iran, Iraq, Libya, Morocco, and elsewhere in the region. Both zoonotic (Leishmania major) and anthroponotic (Leishmania tropica) forms are endemic in MENA in rural arid regions and urban regions, respectively. Other endemic zoonotic NTDs include cystic echinococcosis, fascioliasis, and brucellosis. Dengue is endemic in Saudi Arabia, where Rift Valley fever and Alkhurma hemorrhagic fever have also emerged. Great strides have been made towards elimination of several endemic NTDs, including lymphatic filariasis in Egypt and Yemen; schistosomiasis in Iran, Morocco, and Oman; and trachoma in Morocco, Algeria, Iran, Libya, Oman, Saudi Arabia, Tunisia, and the United Arab Emirates. A particularly noteworthy achievement is the long battle waged against schistosomiasis in Egypt, where prevalence has been brought down by regular praziquantel treatment. Conflict and human and animal migrations are key social determinants in preventing the control or elimination of NTDs in the MENA, while local political will, strengthened international and intersectoral cooperative efforts for surveillance, mass drug administration, and vaccination are essential for elimination.

Schistosomiasis in Africa: an emerging tragedy in our new global health decade.

OBJECTIVE We aimed to assess the health impact of a national control programme targeting schistosomiasis and intestinal nematodes in Uganda, which has provided population-based anthelmintic chemotherapy since 2003. METHODS We conducted longitudinal surveys on infection status, haemoglobin concentration and clinical morbidity in 1871 randomly selected schoolchildren from 37 schools in eight districts across Uganda at three time points - before chemotherapy and after one year and two years of annual mass chemotherapy. FINDINGS Mass treatment with praziquantel and albendazole led to a significant decrease in the intensity of Schistosoma mansoni - 70% (95% confidence interval (CI): 66-73%) after one year and 82% (95% CI: 80-85%) after two years of treatment. Intensity of hookworm infection also decreased (75% and 93%; unadjusted). There was a significant increase in haemoglobin concentration after one (0.135 g/dL (95% CI: 0.126-0.144)) and two years (0.303 g/dL (95% CI: 0.293-0.312)) of treatment, and a significant decrease in signs of early clinical morbidity. The impact of intervention on S. mansoni prevalence and intensity was similar to that predicted by mathematical models of the impact of chemotherapy on human schistosomiasis. Improvements in haemoglobin concentration were greatest among children who were anaemic or harbouring heavy S. mansoni infection at baseline. CONCLUSION Anthelmintic treatment delivered as part of a national helminth control programme can decrease infection and morbidity among schoolchildren and improve haemoglobin concentration.

Waterborne infectious diseases--could they be consigned to history?

African trypanosomiasis, are also being targeted for elimination. Unfortunately, other NTDs have not fared so well in terms of coverage. Today it is believed that fewer than 10% of eligible populations living in endemic regions of Africa, Asia, and the Americas are receiving annual treatments for their schistosomiasis, intestinal helminth infections, and/or trachoma [2]. The World Health Organization (WHO) and several leading public private partnerships and non-governmental development organizations are actively working to correct this situation and to steadily increase global coverage to the levels of LF and onchocerciasis. Of these, we believe that the single largest gap in mass drug administration for a serious NTD has to be the almost nonexistent global coverage for schistosomiasis.

The neglected tropical diseases: the ancient afflictions of stigma and poverty and the prospects for their control and elimination.

The development of water resources, particularly in Africa, has changed the face of the continent, opening up land for agriculture, providing electric power, encouraging settlements adjacent to water bodies, and bringing prosperity to poor people. Unfortunately, the created or altered water bodies provide ideal conditions for the transmission of waterborne diseases and a favorable habitat for intermediate hosts of tropical parasitic infections that cause disease and suffering. The recent progress in control of these waterborne and vector-borne diseases, such as guinea worm, schistosomiasis, lymphatic filariasis, and onchocerciasis, suggests that many of them could be controlled effectively by 2015, which is the target for reaching the Millennium Development Goals. Donations of safe and effective drugs by several pharmaceutical companies, funds for delivering these donated drugs from foundations and bilateral donors, and effective global health partnerships should make these diseases history.