Untapped Potential: How Schools Play A Critical Role In Fighting NTDs

Dr. Neeraj Mistry – April 16, 2012

17 major chronic parasitic and related infectious diseases

They cause high morbidity and disability but low mortality

NTDs affect one in six people worldwide, primarily those in developing countries

Subsistence farmers, their families and urban slum dwellers are commonly affected

What Are NTDs?2

7 of the 17 diseases cause 90 percent of the global health burden

Ascariasis(Roundworm)

1.2 billion

Trichuriasis (Whipworm)

795 million

Hookworm

740 million

Lymphatic Filariasis

(Elephantiasis)

120 million

Schistosomiasis(Snail Fever/

Bilharzia)

240 million

Trachoma

41 million

Onchocerciasis(River Blindness)

26 million

Soil-transmitted helminthes (STH, Intestinal Worms)

3

7 NTDs Cause Most of the Burden

Health—Can cause blindness, horrible swelling of the limbs, and even death.

Education—Children with NTDs are often too sick to attend or perform well in school.

Economic Development—NTDs are debilitating and prevent adults from working and caring for their families.

Hunger and Nutrition—Anemia and malnutrition are common side effects of several NTDs.

Women’s Empowerment—Most NTDs have more severe effects on women and girls.

NTDs and their Impact4

Then: NTDs Addressed in Silos5

The NTD community is now moving towards integrated control because the diseases:

Frequently overlap

Are concentrated in under-served communities

Share many features that make integrated technical guidance both feasible and cost-effective

Integration is an opportunity for more efficient use of financial resources, staff, delivery systems, and opportunities for contact with populations

Now: Integrated NTD Community6

Current Methods for NTD Control Fight All 7 Diseases

7

Mass Drug Administration

DONATED DRUGS

+ Delivery

+ Training

+ Community mobilization

+ Monitoring and evaluation

USD $0.50 / per person per year

Pharmaceutical partners have donated billions of pills

Company Commitment Target(s)

Eisai Co. Ltd.2.2 billion tablets of Diethylcarbamazine

(DEC) for 2014-2020Lymphatic filariasis

Sanofi/Eisai/BMGF 120 million DEC tablets 2012-2013 Lymphatic filariasis

GlaxoSmithKlineOver 2 billion tablets of Albendazole since

1998; 1 billion tablets annually

Lymphatic filariasis and

Soil-transmitted helminthes

Johnson & Johnson

50 million tablets of Mebendazole yearly

since 2007; now increased to 200 million

annually

Soil-transmitted helminthes

Merck & Co., Inc.Unlimited supply of Mectizan; Over 2.9

billion tablets donated since 1987

Onchocerciasis and lymphatic

filariasis

Merck KGaA200 million tablets of praziquantel for

2008-2020Schistosomiasis

Pfizer, Inc.Unlimited supply of azithromycin; Over 145

million tablets of azithromycin since 1998Trachoma

8

Many endemic countries do not have strong health infrastructure at the community level

Geographic and socio-economic challenges make reaching the most marginalized and at-risk communities difficult

How do we scale up this solution to NTD control?

The Challenge: Bringing NTD Control to Scale

9

Schools are Already Playing a Critical Role in Fighting NTDs

10

“Children cannot go to school when they have worm infections, even if they do come to school, they cannot follow the lessons and leave early.”

- Teacher at the Musekera Primary School , Rwanda

Schools are Already Playing a Critical Role in Fighting NTDs

11

Deworming Programs Improve Physical Growth

12

97

75

50

25

3

17

16

15

14

13

12

11

10

9

8

7

6

5

4

3

20 3 6 9 12 15 18 21 24 27

Weig

ht (kg

)

Thiabenazole for 2 days

90

Age (months)

Percentiles

10

Age (months)

0 3 6 9 12 15 18 21 24 27

17

16

15

14

13

9

12

11

10

8

7

6

5

4

3

2

PERCENTILES

Treatment for 2 days

Weigh

t (kg)

Controlling intestinal worms is estimated will help prevent 200 million years of lost primary schooling A study in Malaysia found that school absenteeism went down

by 16% among Aboriginal children after a deworming campaign

Controlling intestinal worms will also help children perform better in school A study in India among school children found hookworm

infection was linked to lower cognitive function, even when controlling for socio-eco factors

A study in Jamaica found that children who were treated against worms improved their scores on cognitive functions test to the level of children who were not infected within nine weeks.

Deworming Programs Improve School Attendance

13

A study found that down the road the economic performance of children who received treatment is significantly greater

At ages 20-26, children who had received deworming treatment worked 5.2 more hours per week, missed less work days do to sickness, had three more meals per month, and held higher wage professions.

Deworming Programs Lead to Positive Economic Outcomes

14

International stakeholders have established programs and policies to include deworming

FRESH Framework—WHO, World Bank, UNICEF, UNESCO, PCD, Save the Children

Global Partnership for Education (GPE)

World Food Programme (WFP)

Small NGOs and Faith-based Groups

Ministries of Education

Partners Buy into Deworming15

Deworming Programs: Nepal’s Story of Success

16

The Ministry’s “Vitamin A Plus Programme” coupled deworming and vitamin A with remarkable results:

Anemia fell 77%

Moderate/severe anemia fell 90%

Opportunity to leverage school infrastructure to control more diseases

Using the school system for NTD treatment campaigns means reaching more children and entire communities with needed interventions

Existing collaboration between MOH and MOE could become a platform for broader school health programs

What’s Next?17