Tag Archives: NTDs

Using community dialogues to prevent and control NTDs

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By Eder Ismael

blogNeglected tropical diseases (NTDs) constitute a serious obstacle to socio-economic development, quality of life and reducing poverty. In Mozambique, NTD rates are extremely high; the most common NTDs include schistosomiasis (or bilharzia), trachoma, intestinal parasites, lymphatic filariasis (LF) and onchocerciasis. Mass treatment campaigns have been implemented in recent years, but so far, efforts to involve the affected communities have been limited.

Malaria Consortium has been supporting the Provincial Health Directorate of Nampula to implement an approach that will increase community participation in the prevention and control of these diseases. Community participation is essential in the timely identification of patients and the promotion of preventive practices, such as hygiene and the handling of water. The community dialogue approach is a form of social mobilisation which improves knowledge, attitudes and practices at the community level and promotes ownership of health issues.

The approach has been tested in four districts of Nampula province and has been successful in raising the level of knowledge about the disease schistosomiasis.

The Provincial Health Directorate of Nampula and Malaria Consortium, with support from the Centre for NTDs at the Liverpool School of Tropical Medicine, are also testing how the approach can provide a mechanism to facilitate community initiatives for better home care of people suffering from the disease caused by LF.dr-jive

We interviewed the head of the NTD Programme of Nampula Province, Dr. Solomon Ercílio Jive, to gather his views

on the situation of these diseases in the province and the partnership with Malaria Consortium in the fight against NTDs.

Tell us about your job?
My role is to monitor, evaluate and implement community interventions for the prevention and control of NTDs as a whole, with an emphasis on diseases that are preventable through chemotherapy such as, LF, onchocerciasis, shistosomiasis, intestinal parasites and trachoma. Under the partnership between the Provincial Health Directorate and Malaria Consortium, I am the focal point of the community dialogues for the filariasis project, which is a continuation of the project of community dialogues on schistosomiasis (or bilharzia), which ended in March 2016.

What are the main challenges for the NTD programme?
We have specific targets to control the diseases, and to eliminate some, especially LF and trachoma by 2020. To achieve these objectives we must:
• Achieve greater population coverage in preventive chemotherapy campaigns
• Seek funding and support for the control of other tropical diseases that are not preventable by chemotherapy, as there are 17 diseases in total and so far only four of these benefit from direct funding
• Intensify awareness and social mobilisation efforts so that all rural communities have better understanding of tropical diseases, through radio spots, lectures, debates, community dialogues, and greater distribution of information and educational material
• Extend the community dialogues regarding LF and schistosomiasis to all districts of the province and if possible integrate other NTDs

What are the main challenges for the community dialogues approach?
We believe in the potential of the community dialogue approach to improve community participation in the prevention and control of diseases. However, we need more support and funds to cover more districts and to train community facilitators who will contribute to the intensification of social mobilisation and the dissemination of information on diseases, how to prevent and how to treat them.

blog-4What do you expect to accomplish with this project?
This year, the province conducted a mass treatment campaign for LF in the 23 endemic districts, which saw more than three million people treated. For the treatment of hydrocele cases (complication caused by LF), surgeries are performed in seven operating theatres throughout the province, with financial support from the Centre for Neglected Tropical Diseases at the Liverpool School of Tropical Medicine.

The community dialogue project can complement these efforts by triggering community mobilisation to improve the therapeutic coverage of preventive chemotherapy campaigns against LF, as well as identify patients with chronic conditions caused by LF. Community support for those with life-long conditions caused by LF can help alleviate suffering and possibly stigma . However, there is still no community based system in Mozambique to identify and provide appropriate assistance to patients in their villages. This requires identification of viable and affordable solutions at community level that the Ministry of Health could implement in a sustainable way.
The Memorandum of Understanding between the Provincial Directorate of Nampula Health and Malaria Consortium aims to provide one of those solutions, through the creation of community dialogues on LF, representing a commitment to support the Ministry of Health in efforts to fight communicable tropical diseases. The lessons drawn from this project will help to develop more effective interventions.

What is the most valuable part of this project?
Community dialogues serve to fill information gaps on health among community members, identifying problems and helping communities to take collective decisions for improvement of health practices. These help in the formation of new habits, particularly in relation to timely care-seeking, and thus contribute to achieving the goals outlined in the economic and social development plan of the province.

Targeting mosquito larvae through Integrated Vector Management

Malaria Consortium is piloting a project on integrated vector management to assess the effectiveness of various control strategies to prevent the transmission of dengue. The study is being conducted in Kampong Cham province, Cambodia and is funded by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH commissioned by the Federal Ministry for Economic Cooperation and Development (BMZ) and UK aid from the UK government.

There has been a marked rise in dengue in the country during 2015. According to a recent  National Malaria Center report, health workers recorded 12,218 cases during the first 41 weeks of 2015. This is an increase of 9,284 compared to the same period in 2014.

Kampong Cham is one of the high-risk provinces, recording several dengue outbreaks in recent years. Cases can skyrocket, especially during the rainy season, where the environment provides mosquitos with more breeding sites and human movements play a major role in the spread of the disease.

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A sample adult mosquito was analysed in the laboratory. Species identification was made using a compound microscope.

“We have tripled the number of cases this year,” said Dr Hay Ra, Dengue Supervisor in Kampong Cham province. “So far, we have recorded 1,556 dengue cases including eight deaths. The most at-risk group is the population under age 15. The high density of population and climate change contributes substantially to these dengue epidemics. This area has high density of population of approximately 200 people per square metre. The rainy season also has changed – last year we had the rainy season start from April and last for seven months, while this year it started in July.”

“In this region the average flight distance for mosquitoes is about 100-200 metres,” explained John Hustedt, Malaria Consortium’s Senior Technical Officer who is leading the project. “In highly dense areas, mosquitoes can spread around the disease more widely as mosquitoes can bite more people in one area.”

At the health centre near the Ou Svay Commune, 20 of the 500 litre water jars containing various colourful guppy fish have been set up. Guppy fish have been used to reduce the mosquito larvae and this place is known by the village health volunteers as ‘the guppy fish bank’ where they can come to collect the guppy fish and provide it to the villagers. It has been under the supervision of the Health Centre Chief, Jeng Meng Hong. “We are responsible for two communes and 20 villages and each village has two health volunteers,” he explained. “So we have about 40 health volunteers who will visit our health centre and collect the fish. Each month, we have a monthly meeting to ensure all their assigned households have guppies in all large containers, and replace them if necessary.”

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Malaria Consortium’s staff inspected the number and condition of guppy fish in water jars at the village health volunteer household.

The fish collected from the guppy bank will be allocated to each household and released in their large water containers. It has been found in previous projects to be effective and acceptable by the local villagers.

Muchh Kounthea is one of the villagers who adopted the practice. The 56 year-old farmer has seven jars in her house, five of which contain the guppies. “I am fine with these fish. I just hope we do not have dengue in the village,” she said. Although she has never had dengue before, she knows about it and can recognise the period of dengue outbreaks. “Dengue usually occurs during rainy season around May to October. I know one child who got really sick because of dengue and had to seek the treatment at the private referral hospital.”

Although there is evidence suggesting the use of guppy fish can be beneficial in dengue vector control, no cluster randomised trials to evaluate their effectiveness nor a proper evaluation of their impact on adult mosquito densities have been conducted.

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Guppy fish are bred and nurtured at the guppy bank at the health centre.

To understand and evaluate the impact of a guppy fish and a combination of new vector control tools to sustainably reduce the Aedes mosquitoes, Malaria Consortium’s pilot project also implemented an entomological survey in the villages. In cooperation with the National Dengue Control Programme (NDCP), the entomological team was deployed to collect larvae, pupae, and adult mosquitoes from the targeted villages. All containers around selected houses were inspected and all samples were taken to the laboratory for further analyses. The survey received a lot of attention from the villagers.

At the same time, a survey on the knowledge, attitudes, and practices surrounding water use and vector-borne disease prevention was also conducted. This separate survey aims to guide and evaluate communication and behaviour change interventions to reduce dengue transmission.

Following the survey, training in behaviour change communication and health education was provided for the community health workers. The vector control intervention started in late November will last a year until the same period in 2016.

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Sample larvae and pupae were collected during the entomological survey.

Wanweena Tangsathianraphap is External Communications Officer for Asia