This article was written by Emily Toubali and Claire Coveney from HKI and was originally published in the March/April 2013 article of USAID’s Frontlines (scroll to second article).
After flipping tens of thousands of eyelids and spending countless hours peering into a microscope, a critical step toward the control and elimination of five neglected tropical diseases (NTDs) in Cameroon has been reached.
“This means that public health workers now have a clear understanding of disease distribution throughout the country, equipping them to make progress in eliminating three NTDs and controlling two others by 2020—goals of the NTD program in Cameroon”, says Julie Akame, NTD coordinator at Helen Keller International’s Cameroon office.
Situated on the western coast of central Africa, Cameroon has a population of over 21 million people living in 181 health districts. The country is endemic for five of these little-known but often devastating diseases, including lymphatic filariasis (LF, the mosquito-borne disease that can lead to elephantiasis), onchocerciasis (river blindness), schistosomiasis (snail fever), soil transmitted helminthes (intestinal worms) and trachoma (a type of eye infection). Mapping out the reach of the five diseases—an exercise that took three years and included over 100 public health staff at all levels—was seen as the crucial first step to combating them.
“Mapping a disease allows decision makers at the Ministry of Public Health to understand the prevalence of a particular disease in health districts, and to develop a strategy to drive down the disease burden. Without mapping, there can be no treatment and millions of people suffer from diseases that are actually treatable and preventable,” said Dr. Achille Kabore, senior NTD adviser for USAID partner RTI International.
The mapping process is different for each disease. For example, a trachoma infection will show on the inside of a person’s upper eyelid. As the disease progresses, so does the person’s chance for blindness. Blood samples are screened for LF to search for an antigen that indicates exposure to the parasite. If left untreated, LF can cause abnormal swelling of the limbs, breast and scrotum that can lead to severe disability, with frequent episodes of painful inflammation of the affected limbs.
When mapping for river blindness, people living in areas with a high possibility of infection, such as those living along river basins where the fly vector breeds, are examined for nodules on the surface of their skin that contain the parasite. Urine and stool samples are screened to look for the tiny worms that cause snail fever, a disease that stunts the growth of children and can damage vital organs. At the same time, the stool samples are also examined for the presence of the three soil-transmitted helminthes: hookworm, whipworm and roundworm.
“If these studies sound complicated and time-consuming, that’s because they are,” says Ann Tarini, country director of Helen Keller International’s Cameroon office.
Sometimes up to two weeks are needed to map the needs of a given district for just one disease, not to mention data entry and analysis. The vital exercise can quickly become an overwhelming endeavor.
USAID, through RTI International, has supported Helen Keller International’s work with the National NTD Control Program of Cameroon since 2009. The initial mapping effort was coupled with scaled-up treatments for the five target diseases. Now that the mapping is complete, the program will focus on distributing medicines to combat and control the diseases and measuring their effectiveness. Some of that monitoring is already underway.
The results from these studies have given the National NTD Control Program the evidence needed to triple its treatments from 11 million in 2010 to just under 30 million in 2012. It is estimated that the country will be free of LF, river blindness and trachoma by 2020, while control efforts will remain for snail fever and intestinal worms—an ambitious but achievable benchmark.
“There have been efforts in Cameroon to tackle NTDs for over 15 years,” said Angela Weaver, USAID’s senior technical adviser for NTDs. “This milestone represents a major accomplishment for a country as large as Cameroon. With new and invigorated support for NTDs in the African region, more and more countries will be reaching this milestone.”
She also admitted that there is still much work to be done before 2020, and now focus must be shifted to scaling up NTD treatments to all at-risk communities. For example, midnight blood samples to determine the parasite load for LF and other assessments must continue, even as the treatments start to work.
Says Emily Wainwright, USAID senior operations adviser for NTDs, “Now that the complex mapping process is complete in Cameroon, the real work, providing treatment to millions of people in the country and keeping Cameroon free of disease, can continue full-force.”