Posts or Comments 01 March 2021

Monthly Archive for "March 2017"

Asia &ITNs &Treatment Bill Brieger | 29 Mar 2017

Myanmar – update on malaria indicators

Myanmar is one of the countries at the epicenter of the developing resistance of malaria parasites to artemisinin based drugs. This means there is a strong need for prompt, appropriate and thorough diagnosis and treatment of febrile illnesses and malaria as well as the regular use of effective malaria preventive technologies. The 2015-16 Demographic and Health Survey for the country is thus a timely source of information to improve malaria interventions. Highlights from the DHS follow.

The first major concern is both lack of insecticide treated nets as well as low use of those available as the pie chart from the DHS makes clear. Ironically 97% of households have some kind of net, but 73% do not have an insecticide treated one. Although the Global Fund has supported distribution of 4.3 million ITNs in the country, there are over 56 million people living there. The US President’s Malaria Initiative has procured nearly 900,000 ITNs for the country. Although low across all economic strata, the lowest wealth quintile have the highest ITN possession (35%).

The 2013 concept note submitted by Myanmar to Global Fund under the new funding mechanism identifies many of the challenges: “Factors that may cause inequity to services for treatment and prevention: There are several population groups, which are poorly served by the health system and malaria services such as those living in remote border areas, migrant populations, forest workers and miners where malaria transmission is intense. Many of them are internal and external migrants who usually have limited access to malaria prevention and control. Major factors include distance from health facilities and poor awareness of malaria and its prevention.”

Key strategies in the Global Fund Concept Note do address quality malaria diagnostics and appropriate treatment. Unfortunately DHS results do not yet show the impact of improved diagnosis and treatment. “Overall, 16% of children under age 5 had a fever in the 2 weeks before the survey. Advice or treatment was sought for 65% of these children with recent fever, and 3% had blood taken from a finger or heel, presumably for diagnostic testing.” A variety of public and private sources were used to seek fever treatment, but “Only 1% of children received antimalarial drugs for treatment of fever in the 2 weeks preceding the survey.”

In addition to formal donors, there are coalitions and consortia who provide encouragement, technical assistance, advocacy and capacity building for eliminating malaria in the Asia-Pacific region. While the country needs to take stronger leadership in malaria elimination, all groups need to come together and strengthen the malaria interventions in Myanmar as these have implications for eliminating the disease in the region as a whole.

Integration &NTDs &Tuberculosis Bill Brieger | 24 Mar 2017

World Tuberculosis Day: United We Can End TB and Tropical Diseases

The theme of World TB Day is to Unite to end TB: leave no one behind. The communities affected by TB are also ones where tropical diseases like onchocerciasis and malaria are endemic. A successful strategy to control one disease should ideally be “united” with all basic primary health care interventions, thereby truly leaving no one behind.

While the causative agents differ between TB and tropical diseases such as malaria, lymphatic filariasis and Dengue, control of these diseases shares a common goal – “an urgent need to develop new vaccines for HIV/AIDS, malaria, and tuberculosis, as well as for respiratory syncytial virus and those chronic and debilitating (mostly parasitic) infections known as neglected tropical diseases (NTDs).” In addition to prevention, there is also need for integrated “treatment pipelines directed at NTDs, Malaria, tuberculosis (TB), and human immunodeficiency virus (HIV)/AIDS,” according to Asada.

There is also a need for integrated primary health care (PHC) programming. In the Journal of Infectious Diseases. Simon reports on linkages showing that, “Recent research suggests that NTDs can affect HIV and AIDS, tuberculosis (TB), and malaria disease progression. A combination of immunological, epidemiological, and clinical factors can contribute to these interactions and add to a worsening prognosis for people affected by HIV/AIDS, TB, and malaria.”

The possibility of integrating directly observed treatment (DOT) for TB treatment into community health worker (CHW)/PHC programs that addressed malaria treatment and onchocerciasis control was tested by the Tropical Disease Research Program (TDR) some years ago. CHWs in a few of the study sites were able to successfully include DOT for TB in their community duties, but in other sites community and health worker fears about stigma inhibited action.

TB, malaria and NTDs are among the conditions referred to as the infectious diseases of poverty. We will not eliminate poverty by tackling these diseases one-by-one. A “United” and integrated approach from national to community level is needed.

NTDs &Vector Control &water Bill Brieger | 22 Mar 2017

World Water Day: Water and Neglected Tropical Diseases

The United Nations introduces us to the challenges of water. “Water is the essential  building block of life. But it is more than just essential to quench thirst or protect health; water is vital for creating jobs and supporting economic, social, and human development.” Unfortunately, “Today, there are over 663 million people living without a safe water supply close to home, spending countless hours queuing or trekking to distant sources, and coping with the health impacts of using contaminated water.”

Haiti: Importance of Water to prevent STH

Many of the infectious health challenges known as Neglected Tropical Diseases (NTDs) have issues of water associated with their transmission. This may relate to scarcity of water and subsequent hygiene problems. It may relate to water quality and contamination. It may also relate to water in the lifecycle of vectors that carry some of the diseases.

Even though water is crucial to the control of many NTDs, it is not often the feature of large scale interventions. The largest current activity against five NTDs is mass drug administration (MDA) on an annual or more frequent basis to break the transmission cycle.  Known as diseases that respond to preventive chemotherapy (PCT) through MDA, these include lymphatic filariasis (LF), trachoma, onchocerciasis, schistosomiasis and soil transmitted helminths (STH) has been undertaken for over 10 years.

We have recently passed the Fifth Anniversary of the London Declaration on NTDs, which calls for the control of ten of the many these scourges The Declaration calls for “the elimination “by 2020 lymphatic filariasis, leprosy, sleeping sickness (human African trypanosomiasis) and blinding trachoma.” Another water-borne NTD, guinea worm, should be eradicated soon. Two of the elimination targets are part of MDA efforts, LF and trachoma.

Cameroon: mapping the community to detect NTD transmission sites

Ministries of Health and their donor and NGO partners who deliver MDA against the 5 diseases in endemic countries express interest in coordinating with water and sanitation for health (WASH) programs. People do recognize the value of collaboration between NTD MDA efforts and WASH projects, but these may be located in other ministries and organizations.

The long term implementation of WASH efforts is seen as a way to prevent resurgence of trachoma, for example, and  strongly compliment efforts to control STH and schistosomiasis. Hopefully before the 10th Anniversary of the London Declaration the vision of “ensuring access to clean water and basic sanitation,” can also be achieved.

Finally as a reminder our present tools for the control of Zika and Dengue fevers relies almost entirely on safe and protected household and community sources of water to prevent breeding of disease carrying Aedes aegypti mosquitoes. If we neglect water, we will continue to experience neglected tropical diseases. Hopefully the topic of water and NTDs will feature prominently at next months global partners meeting hosted by the World Health Organization.


Women &Zika Bill Brieger | 15 Mar 2017

Zika and Access to Reproductive Health Services in Brazil

Twice a year students in the Johns Hopkins Bloomberg School of Public Health write blog postings as part of the course “Social and Behavioral Foundations of Primary Health Care.” We often share blog posts that relate to tropical health issues.  Below is a posting by class members Linda Cho, Linda Chyr, Rebecca Earnest, and Sarah Rosenberg on Zika, family planning, and reproductive health in Brazil.

In the 1960s, the Brazilian government adopted a laissez-faire attitude, which lead to the predominance of private organizations in the provision of family planning services. Since then, Brazil has witnessed one of the most dramatic reductions in family size in modern history in part due to increased access to family planning services. (Photo New York Times: Members of the Union of Mothers of Angels.)

However, in early 2015, the widespread epidemic of the Zika fever caused by the Zika virus in Brazil caused persisting gaps in access to contraception to resurface. Since it was first detected it has instilled fear and uncertainty in pregnant women whose fetuses could be at risk of Zika-related birth defects like microcephaly should the virus be contracted during pregnancy. This makes access to comprehensive reproductive health services and education a critical need for women who are pregnant or considering becoming pregnant.

While contraceptive use is fairly high in Brazil with 75.2% of women using modern forms of contraception, barriers to access remain. Some women face challenges, some of which include but are not limited to incomplete insurance coverage or lack of reimbursement for long-acting reversible contraceptives (LARCs), high up-front costs, low number of contraceptive service sites, and/or a lack of supply of the implants in the public sector . This may be one driver behind why LARCs only make up 0.5% of all contraceptive sales. Furthermore, 55% of all pregnancies in Brazil estimated to be unplanned and 20% of all lives births are attributed to teenage girls, indicating that there may be substantial reproductive knowledge gaps  in how to effectively prevent pregnancy.

Amid the spread of a virus that poses unique health risks to pregnant women and their fetuses, there is an urgent need to address these gaps in reproductive health access and education. First, the Brazilian National Health System, which laudably provides most contraceptives free of charge to about 74% of the population, needs to reevaluate existing policies that may be still limiting access to contraceptive services. Secondly, organizations like the Brazilian Society for Family Welfare (BENFAM), which provides reproductive health services and education to underserved Brazilian communities, need greater financial and political support from policymakers, civil society, and even organizations traditionally opposed to such services like the Catholic Archdiocese.

Despite Brazil’s great strides to improve access to contraception and reproductive health education in recent years, Zika’s arrival highlighted gaps in the existing system that must be addressed through policy reform and greater political and financial support. Especially in the time of Zika, Brazilian women deserve no less.