Ending NTDs is not a one-man job, it takes a community

Rumbidzayi Zinyuke Health Buzz

Kids running naked along the banks of the river before they dive head first into the cooling water is not an unusual site in rural Zimbabwe.

After a long, hot day spent herding cattle, swimming in the river will be the ultimate way to cool down and have fun.

Not many people who have been to the rural homes would say they have never experienced this.

The unbridled joy! With no care in the world!

Of course, for the smaller ones who cannot join the others, just playing in the water close to the banks as the mothers do their laundry nearby is the best they can do.

But they know their time will come to enjoy the deeper waters without limitations.

And any of these legends will tell you a thing or two about bilharzia.

Most of them have experienced it at one point in their lives. They have been told how they got infected in the water, but who can resist that refreshing feeling?

They always go back to swim.

The same will probably also tell you about the roundworms or the hookworms and many other parasitic worms that have infected them before.

While many of our communities do not really consider these as diseases to be worried about, there is a lot that they do not know.

Schistosomiasis (bilharzia) and soil transmitted helminths (roundworms, whipworms and hookworms) and Lymphatic filariasis (elephantiasis) are among the 20 Neglected Tropical Diseases (NTD) identified by the World Health Organisation.

Neglected tropical diseases (NTDs) are a diverse group of conditions that are mainly prevalent in tropical zones, where they affect people who live in disadvantaged communities.

They are caused by a variety of pathogens including viruses, bacteria, parasites, fungi and toxins. These diseases cause devastating health, social and economic consequences to more than one billion people in the world.

According to experts, these conditions are chemotherapy preventable NTDs of public health importance in Zimbabwe and join others that have been specified, that include rabies, anthrax, snakebites, leprosy, sleeping sickness and scabies.

These are diseases which have been around for years and years. We all know them.

But sometimes it seems like we forget about them because there have been many others that have demanded more attention and resources from Governments.

Talk about HIV, Malaria, Covid-19, Cancer, the list goes on and on.

But work has been ongoing to eliminate these NTDs.

This week, the National Institute of Health Research (NIHR) had a workshop where they were disseminating the results of the National Schistosomiasis, soil transmitted helminths reassessment survey and the confirmatory survey for Lymphatic filariasis which was also done in line with the new guidelines from WHO.

The surveys were done by the Ministry of Health and Child Care through the NIHR with technical and financial support from the WHO Expanded Special Project for Elimination of Neglected Tropical Diseases (WHO-ESPEN), the END FUND and Higher Life Foundation.

The results showed that bilharzia continues to be a public health threat in the country.

With more than 5 million people (35,6 percent of the total population) in Zimbabwe being in need of Mass Drug Administration against the disease, it shows that the country’s endemicity to bilharzia is still high despite efforts that have been made to eliminate it.

However, the annual mass drug administration exercise has been concentrating on children of school going age.

But the study showed that about 20,9 percent of adults aged 15 years and above also need treatment for the disease, while 9,6 percent of children aged 5-14 years and 5,1 percent of children below the age of five were in need of the treatment as well.

It is no longer just the children who we need to worry about.

But even those women who do chores such as laundry and fetching water from sources where the contaminated snails exist are also at high risk.

Ministry of Health and Child Care chief director public health Dr Munyaradzi Dobbie, who was representing Secretary for Health Dr Jasper Chimedza at the dissemination workshop, noted that dealing with NTDs was a complex matter that needed combined effort.

“The epidemiology of NTDs is complex and often related to environmental conditions. Many of them are vector-borne, have animal reservoirs and are associated with complex life cycles. All these factors make their public-health control challenging and thus, require multi-sectoral collaboration for their control and elimination.

“It is anticipated that a multi-sectoral and multi stakeholder collaboration among the health sector researchers, partners, NTD programme, WASH, and agriculture sectors, will be strengthened, attaching the importance of the one health concept that brings together human, animal and environmental health,” he said.

Oftentimes interventions to some public health concerns have been left for the Ministry of Health and this has meant that part of the answers to solving the problems were left out.

But with all sectors working together, positive results will begin to be seen.

According to president of Eco Health International Professor Moses Chimbari, the elimination of NTDs would definitely need a multi-pronged approach to be successful.

He says the one health approach is surely the way to go.

“When we now look at the diseases particularly NTDs, these are diseases of poverty that are exacerbated by anthropogenic activities, which are human related activities. If we want to tackle them we can bring in the veterinary people because of what we call zoonosis, diseases that are shared between people and animals. We bring in those who have specialised in human medicines and also people who are concerned about the environment. That way we come up with a total solution for attempting to reduce the burden of the diseases,” he said.

He said it was important to look at stakeholder participation, hence to fight NTDs there was a need to also bring the people on board.

Another angle to be looked at was social and gender equity, because studies established that women were more likely to be affected than men because of the duties they carry out, as are the children and people with disabilities.

“At the moment our challenge is that we are not comprehensive enough. We are focusing on treatment for which we know that if we talk of a disease like schistosomiasis, you treat and people get re-infected. The treatment does not protect you, it is not a vaccine; we do not have a vaccine yet. So if someone goes to the river they extract it (the parasite) and that is why we are saying for us to do better we also need to look at the streams and deal with the snail components. But there is a limitation there in what we can do because activists do not like us to temper with chemicals in the water because of the implications that it might have on the biota,” Prof Chimbari said.

He contends that a buy-in from all stakeholders in terms of Water, Sanitation and Hygiene (WASH) is the way to go.

If people have access to enough potable water, and good sanitation, it means they might not need to go to the river where they can get infected.

Hence, they would have cut the transmission cycle.

“For any disease we look at the life cycle and we want to attack it from the weakest point. For these NTDs, if you cure the person, it means you have stopped or disrupted transmission. The next place you can go is to attack the snail because if you do that, you have cut the transmission cycle. You can also take the people away from the river so that they do everything from their house. So these are three cardinal points to help us have a programme that is sustainable,” Prof Chimbari.

Of course there is still a lot of work to do before we can safely say that Zimbabwe has totally tackled NTDs.

But there is a clear light at the end of the tunnel. The work that is already in place will eventually yield the desired result. But it needs the buy-in of the communities.

As long as people continue getting infected and re-infected, diseases like bilharzia will continue to be with us.

Government and its partners cannot work alone; it needs the people in the societies to take a stand. To be willing to make some changes.

They need to be aware of why it is important for them to play a part in the elimination of these age-old diseases.

Only then can we see the change we want.

It takes a community!

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