Implementing Preventive Chemotherapy through an Integrated National Neglected Tropical Disease Control Program in Mali

Abstract

BackgroundMali is endemic for all five targeted major neglected tropical diseases (NTDs). As one of the five ‘fast-track’ countries supported with the United States Agency for International Development (USAID) funds, Mali started to integrate the activities of existing disease-specific national control programs on these diseases in 2007. The ultimate objectives are to eliminate lymphatic filariasis, onchocerciasis and trachoma as public health problems and to reduce morbidity caused by schistosomiasis and soil-transmitted helminthiasis through regular treatment to eligible populations, and the specific objectives were to achieve 80% program coverage and 100% geographical coverage yearly. The paper reports on the implementation of the integrated mass drug administration and the lessons learned.Methodology/Principal FindingsThe integrated control program was led by the Ministry of Health and coordinated by the national NTD Control Program. The drug packages were designed according to the disease endemicity in each district and delivered through various platforms to eligible populations involving the primary health care system. Treatment data were recorded and reported by the community drug distributors. After a pilot implementation of integrated drug delivery in three regions in 2007, the treatment for all five targeted NTDs was steadily scaled up to 100% geographical coverage by 2009, and program coverage has since been maintained at a high level: over 85% for lymphatic filariasis, over 90% for onchocerciasis and soil-transmitted helminthiasis, around 90% in school-age children for schistosomiasis, and 76–97% for trachoma. Around 10 million people have received one or more drug packages each year since 2009. No severe cases of adverse effects were reported.Conclusions/SignificanceMali has scaled up the drug treatment to national coverage through integrated drug delivery involving the primary health care system. The successes and lessons learned in Mali can be valuable assets to other countries starting up their own integrated national NTD control programs.

A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa

“…Sodahlon et al, 2013 [39]/Togo/2000–2009LF programme reportNationalTo describe the elements that proved successful in the national strategy to address LF in Togo.Identified various factors required for national LF programme success:Sustained political commitment, integration with existing interventions, innovative resource mobilization in environment totally lacking resources and building of very strong partnerships (internal and external)Successful implementation, programme sustainability and coverage8. Dembele et al, 2012 [37]/Mali/2005–2011Integrated NTD control programme reportNationalTo report on the progress made by the integrated national NTD control programme in Mali, drawing from objectives achieved, documented experiences and pertinent lessons learned of the program from 2007 to 2011, and focusing on only aspects of integrated MDA activities.For the long-term sustainability, NTD programmes require to be integrated into primary healthcare systems at local level.Delays in drugs reaching the country resulted in MDA postponement, which not only increased the difficulty in the campaign but also minimized the impact of MDA.Local collaborations with the African Programme for Onchocerciasis Control (APOC) and the Onchocerciasis Control Programme (OCP) was essential to sustaining the Mali NTD integration programme.Achieved Improved national geographical coverage achieved for LF from 25% in 2006 to 100% in 2009.Community participation, programme sustainability and coverage9. Hodges et al, 2012 [23]/Sierra Leone/June 2010–2011Programme evaluation11,824 participants interviewed in the end process evaluation of hard to reach (HTR) sites.(Urban and rural settings)12 districts and 4 large towns from southern, eastern and northern provinces.To identify the challenges to effective mass drug administration implementation for LF and the corrective measures taken.Challenges affecting MDA for implementation included: late country delivery of ivermectin, the availability and motivation of unpaid CHVs, remuneration for CHWs, rapid urbanization and employment seeking population migrations.‘In process’ monitoring ensured modifications of LF MDA were made in a timely manner to ensure effective coverage was finally attained in HTR locations.Community participation and Coverage10.…”

“…West and East AfricaGhana, Kenya, Mali, Nigeria, Sierra Leone and TanzaniaInvolvement of key health systems representatives and local leaders in health education. ( n  = 7) [22, 23, 25, 34, 36, 37, 41]. West and East AfricaGhana, Kenya, Mali, Sierra Leone and Tanzania.Selection, training and financial incentives provided to CDDs ( n  = 5) [22, 25, 34, 35, 37, 45], and provision of mobile phones and other forms of motivation [45] ( n  = 1) …”

“…For example, Mali and Nigeria’s integrated neglected tropical diseases (NTDs) control programmes had developed and harmonized disease specific health education messages every year, through community led health education programmes [36, 37]. These community led programmes ensured successful community mobilization and participation. Engagement of key health systems representatives and local leaders in health education Sustained political commitment from various government departments at both district and national levels towards community health education programmes was cardinal for the success of MDA for LF implementation [37, 39, 40]. Advocacy meetings with health systems representatives at local levels helped to facilitate MDA for LF programme implementation, by bringing these key stakeholders on board and encouraging them to be agents for change in their institutions [22, 23, 25, 34, 36, 37].…”

Efficacy and safety of two closely spaced doses of praziquantel against Schistosoma haematobium and S. mansoni and re-infection patterns in school-aged children in Niger

“…With regard to the control of schistosomiasis and other helminthiases, since 2006, the World Health Organization (WHO) promotes a strategy phrased "preventive chemotherapy", which relies on the regular administration of anthelminthic drugs to at-risk populations (WHO, 2006(WHO, , 2010. In the meantime, several national integrated NTD control programmes have been launched in Africa (Brady et al, 2006;Lammie et al, 2006;Kolaczinski et al, 2007;Kabatereine et al, 2010;Dembélé et al, 2012). These programmes are supported by international organisations such as the Bill & Melinda Gates Foundation and the United States Agency of International Development (USAID).…”

Preventive chemotherapy for schistosomiasis and soil-transmitted helminthiasis by cotreatment with praziquantel and albendazole

“…This is at the onset of a national control program implementing PC as part of its strategic plan and temporal road map of possible interventions to be taken through time [44]. Here, it should also be noted that surveillance of schistosomiasis and STH does not operate alone and for it is, or should be, incorporated within the geographical landscape for surveillance of other NTDs, for example for lymphatic filariasis and onchoceriasis [29,45].…”