Christopher F.L. Saarnak

Toward an Open-Access Global Database for Mapping, Control, and Surveillance of Neglected Tropical Diseases

Background After many years of general neglect, interest has grown and efforts came under way for the mapping, control, surveillance, and eventual elimination of neglected tropical diseases (NTDs). Disease risk estimates are a key feature to target control interventions, and serve as a benchmark for monitoring and evaluation. What is currently missing is a georeferenced global database for NTDs providing open-access to the available survey data that is constantly updated and can be utilized by researchers and disease control managers to support other relevant stakeholders. We describe the steps taken toward the development of such a database that can be employed for spatial disease risk modeling and control of NTDs. Methodology With an emphasis on schistosomiasis in Africa, we systematically searched the literature (peer-reviewed journals and ‘grey literature’), contacted Ministries of Health and research institutions in schistosomiasis-endemic countries for location-specific prevalence data and survey details (e.g., study population, year of survey and diagnostic techniques). The data were extracted, georeferenced, and stored in a MySQL database with a web interface allowing free database access and data management. Principal Findings At the beginning of 2011, our database contained more than 12,000 georeferenced schistosomiasis survey locations from 35 African countries available under http://www.gntd.org. Currently, the database is expanded to a global repository, including a host of other NTDs, e.g. soil-transmitted helminthiasis and leishmaniasis. Conclusions An open-access, spatially explicit NTD database offers unique opportunities for disease risk modeling, targeting control interventions, disease monitoring, and surveillance. Moreover, it allows for detailed geostatistical analyses of disease distribution in space and time. With an initial focus on schistosomiasis in Africa, we demonstrate the proof-of-concept that the establishment and running of a global NTD database is feasible and should be expanded without delay.

Taenia solium taeniosis/cysticercosis and the co-distribution with schistosomiasis in Africa

BackgroundThis study aimed to map the distribution of Taenia solium taeniosis/cysticercosis and the co-distribution with schistosomiasis in Africa. These two major neglected tropical diseases are presumed to be widely distributed in Africa, but currently the level of co-distribution is unclear.MethodsA literature search on T. solium taeniosis/cysticercosis was performed to compile all known studies on the presence of T. solium and apparent prevalence of taeniosis and porcine cysticercosis in Africa. Studies were geo-referenced using an online gazetteer. A Bayesian framework was used to combine the epidemiological data on the apparent prevalence with external information on test characteristics to estimate informed district-level prevalence of taeniosis and porcine cysticercosis. Districts with T. solium taeniosis/cysticercosis presence were cross-referenced with the Global Neglected Tropical Diseases Database for schistosomiasis presence.ResultsThe search strategies identified 141 reports of T. solium in Africa from 1985 to 2014 from a total of 476 districts in 29 countries, 20 with porcine cysticercosis, 22 with human cysticercosis, and 16 with taeniosis, in addition to 2 countries identified from OIE reports. All 31 countries were considered, on national scale, to have co-distribution with schistosomiasis. Presence of both parasites was confirmed in 124 districts in 17 countries. The informed prevalence of taeniosis and porcine cysticercosis were estimated for 14 and 41 districts in 10 and 13 countries, respectively.ConclusionsWith the paucity of data, T. solium infection is grossly under-reported and expected to be more widespread than this study suggests. In areas where co-distribution occurs there is a need for increased emphasis on evaluation of integrated intervention approaches for these two helminth infections and allocation of resources for evaluating the extent of adverse effects caused by mass drug administration.

Collection, verification, sharing and dissemination of data: the CONTRAST experience

The scientific community is charged with growing demands regarding the management of project data and outputs and the dissemination of key results to various stakeholders. We discuss experiences and lessons from CONTRAST, a multidisciplinary alliance that had been funded by the European Commission over a 4-year period, in order to optimize schistosomiasis control and transmission surveillance in sub-Saharan Africa. From the start, project partners from Europe and Africa set out an ambitious goal: to sample data following standard protocols at all field sites and then sharing the data in a way that would enable all project partners to have access through a password-protected Internet-based data portal. This required anonymous agreement on several common standardized sample forms, ranging from the mundane but important issue of using the same units of measurement to more complex challenges, for instance agreeing on the same protocols for double-treatment of praziquantel in different settings. With the experiences gained by the CONTRAST project, this paper discusses issues of data management and sharing in research projects in the light of the current donor demand, and offers advice and specific suggestions for similar interdisciplinary research projects.

Raising the political profile of the neglected zoonotic diseases : three complementary European Commission-funded projects to streamline research, build capacity and advocate for control

The World Health Organisation identifies eight Neglected Zoonotic Diseases (NZDs) as major causes of ill health to both humans and domestic animals in many countries across the world [1–3]. Although largely controlled or eradicated in industrialised nations, these eight NZDs—anthrax, brucellosis, bovine tuberculosis (bTB), Taenia solium cysticercosis, cystic echinococcus, leishmaniasis, rabies, and human African trypanosomiasis (HAT)—still cause significant health problems in many low resource settings in developing nations [1–7]. The poor remain disproportionately affected by NZDs through a combination of close contact with domestic animals (particularly in rural settings), and the difficulties of accessibility, affordability, and capacity of local health centres. Aside from the significant human mortality and morbidity caused by NZDs, their added impact on livestock productivity—including decreased fecundity, poor growth rates, lowered draft power outputs, decreased carcass value, and deadly epidemics—further contribute to the burden of NZDs on poor livelihoods. NZD control offers a powerful opportunity to simultaneously save lives and secure livelihoods, contributing to poverty alleviation within affected communities [2]. History provides compelling evidence that the effect of zoonoses in humans can be mitigated through targeted interventions in animal reservoirs; the successful eradication of brucellosis, porcine cysticercosis, bTB, and rabies from a number of countries has all been done this way [8–10]. However, given the significant benefits of NZD control and prevention to the broader human health and development sectors, the financial and logistical responsibility for zoonoses control should not just fall on the shoulders of the veterinary sector alone. Confusion over roles and responsibilities, often resulting from the perception that the NZDs are beyond the mandate of either the human or animal health sectors, currently impede concerted efforts towards their control [11]. Vast underreporting, often as a result of poor advocacy, diagnostic difficulties and disease clustering that may be missed in broad-based epidemiological surveys, further compounds their political “neglect.” At the local level, primary healthcare workers and local veterinary officers faced with poor infrastructural investments in both health and veterinary services, lack the information, knowledge, and tools for NZD diagnosis and control. Moreover, the societal value of livestock and lack of compensation programmes render standard control methods utilised in industrialised nations, such as test and slaughter, unimplementable and unacceptable in much of Africa, Asia, and Latin America [12]. Despite the multiple benefits of control, coordinated efforts to collectively address the NZDs is generally lacking. With recent estimations that broader Neglected Tropical Disease (NTD) funding represents just 0.6% of total international development assistance [13], funding for the NZDs has been estimated at around one-tenth of this figure; a mere 0.06% of global assistance for health [3]. The need to identify and quantify the impact of endemic zoonoses in developing regions, evaluate and prioritise control approaches, and build national and local capacity and leadership is imperative. The European Commission, through their Seventh Framework Programme (FP7), has funded three complementary projects to address these issues on a large scale in Africa; i) Integrated Control of Neglected Zoonoses in Africa (ICONZ), ii) training of the One Health Next Scientific Generation in the Sahel and Maghreb (OH-NEXTGEN), and iii) Advocacy for Neglected Zoonotic Diseases (ADVANZ). Through simultaneously generating evidence, building capacity, and advocating for control, these three programmes promote coordination and collaboration for increasing the political visibility of this important, but underfunded, group of diseases (Table 1). The remainder of this article highlights the objectives and activities of these three projects, and discusses the policy implications for NZD control expected to arise from their outputs. Table 1 Major deliverable thematic areas highlighting complementary areas. ICONZ (www.iconzafrica.org) Concept and Objectives The ICONZ project has been specifically designed to generate an evidence base for the promotion of integrated control packages for the eight NZDs in seven African International Partner Cooperation Countries (ICPCs): Morocco, Mali, Nigeria, Uganda, Tanzania, Mozambique, and Zambia. Integrated control refers to interprogrammatic and intersectoral approaches based on stratification of risk to reach marginalized populations or geographic areas, rather than promoting vertical strategies that address each disease independently [14,15]. Scientific innovation and public engagement remain two important cornerstones to the ICONZ approach; locally-appropriate strategies are mindful of the wider existing policy frameworks of affected countries, with sustainability of these approaches ensured through the training of almost 70 postgraduate students (Masters and PhD) from both Africa and Europe to date. Whilst African countries have been the focus of ICONZ, given that it is the only continent affected by all eight zoonoses targeted by the FP7 call, it is anticipated that the strategies and experience resulting from ICONZ research can help form recommendations and advise other countries suffering similar burdens of disease, particularly in Asia and Latin America. The overall strategic objective of ICONZ is to mitigate the human and animal health impacts of NZDs, whilst contributing to poverty alleviation and the Millennium Development Goals. In order to achieve this, twelve Work Packages (WPs) incorporating 21 European and African partners have joined forces to determine the current disease burdens on communities, and subsequently identify innovative approaches for NZD identification and control tailored to different settings (Fig. 1). The ICONZ approach has emphasised the need to communicate research evidence to the highest possible number of beneficiaries and decision makers within each ICPC, to maximise impact on the local and national scale. Fig 1 Overview of ICONZ WPs. Overview of ICONZ WPs ICONZ WPs 1–4: Project management and gap analyses These four WPs align to ensure the effective management of interactions between the project partners, donors, and beneficiaries (WP1), create a database of concurrent NZD research in other parts of the world (WP2), cost and standardise methodologies for evaluating disease burden (WP3), and validate currently available diagnostic tools (WP4). Through fulfilling the deliverables of each of these WPs, it is anticipated that a clear analysis of the evidence gaps, and appropriate methodologies to address these, will be available to guide the activities of the remaining eight WPs.

ADVANZ: Establishing a Pan-African platform for neglected zoonotic disease control through a One Health approach

Advocacy for neglected zoonotic diseases (ADVANZ) is a One Health Neglected Zoonotic Diseases (NZDs) project, funded by the European Commission through its 7th framework programme. The initiative aims at persuading decision makers and empowering stakeholders at local, regional, and international levels towards a coordinated fight against NZDs. ADVANZ is establishing an African platform to share experiences in the prevention and control of NZDs. The platform will compile and package existing knowledge or data on NZDs and generate evidence-based algorithms for improving surveillance and control with the ultimate aim of eliminating and eradicating these diseases. The platform will serve as a forum for African and international stakeholders, as well as existing One Health and NZD networks and harness and consolidate their efforts in the control and prevention of NZDs. The platform had its first meeting in Johannesburg, South Africa in March 2013.

A Local-Scale Study of the Trace Gas Emissions from Vegetation Burning around the Village of Dalun, Ghana, with Respect to Seasonal Vegetation Changes and Burning Practices

The annual trace gas emissions from a West African rural region were calculated using direct observations of gas emissions and burning practices, and the findings compared to the guidelines published by the IPCC. This local-scale study was conducted around the village of Dalun in the Northern Region of Ghana, near the regional capital of Tamale. Two types of fires were found in the region – agricultural fires andwildfires. Agricultural fires are intentionally set in order to remove shrub and crop residues; wildfires are mostly ignited by herders to remove inedible grasses and to promote the growth of fresh grass. An agricultural fire is ignited with a fire front moving against the wind (backfire), whereas a wildfire moves with the wind (headfire). Gas emissions (CO2, CO and NO) weremeasured by burning eight experimental plots, simulating both headfires and backfires. A common method of evaluating burning conditions is to calculate modified combustion efficiency (MCE), which expresses the percentage of the trace gases released as CO2. Modified combustion efficiency was95% in the wildfires burned as headfires, but only 90% in the backfires.The burned area in the study region was determined by classifying a SPOT HRV satellite image taken about two months into the dry season. Fires were classified as either old burned areas or new burned areas as determined by the gradient in moisture content in the vegetation from the onset of the dry season. Classified burned areas were subsequently divided into two classes depending on whether the location was in the cultivated area or in the rangeland area, this sub-classification thus indicating whether the fire had been burned as a backfire or headfire. Findings showed that the burned area was 48% of the total region, and that the ratio of lowland wildfiresto agricultural fires was 3:1. The net trace gas release from the classified vegetation burnings were extrapolated to 26–46×108 gCO2, 78–302×106 g CO,17–156×105 g CH4,16–168×105 g NMHC and 11–72×103 NOx. Calculation of the emissionsusing proposed IPCC default values on burned area and average biomass resulted in a net emission 5 to 10 times higher than the measured emission values. It was found that the main reason for this discrepancy was not the emission factorsused by the IPCC, but an exaggerated fuel load estimate.