Neglected Tropical Diseases, SoilTransmitted Helminths, and Development May 30, 2012

Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

Effects of NTDs
Human suffering Chronic morbidity Stigma Unrealized potential Health Nutrition Education Development
China targeted schistosomiasis and filariasis in its 1956 agricultural development act

Cycle of poverty

Soil-Transmitted Helminths (intestinal worms)

A case study
Ascaris (roundworm)
1 billion

Trichuris (whipworm)
795 million

Hookworm
740 million

Soil-Transmitted Helminths (STH)

(intestinal worms) Transmission
Fecal contamination of the environment (soil)

Poor sanitation Inadequate hygiene

Why Treat? Benefits of Deworming

Physical Growth Learning and education Long-run economic benefits

Weight gain in children after one round of deworming: Cochrane review results

Learning and Education Benefits

Treated children improved in cognitive scores over those who remained infected (Source:
Nokes, McGregor, and Bundy, 1992)

The longer the school deworming was maintained, the greater the improvements in cognitive skills and the quicker mastery of the skills (Source: Grigorenko et al. 2007)

Deworming decreased absenteeism by 25%

Long-Term Benefits of Deworming

Kenya Life Panel Survey (1998-2009)

7,530 people in baseline deworming sample

By 2007-2009 survey round, most 20-26 years old

85% effective tracking rate among those still alive

Source: Baird et al. 2011

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Long-Term Benefits
Self-reported health improved

Primary school participation, 1998-2001, increased by 0.13 years (p<0.01) Among wage earners, average adult earnings was 2129% greater in those who had received deworming
Source: Baird et al. 2011
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The troubling return of infection and morbidity over 24 months

Hatz, et al., AJTMH 1998

STH Control Strategy

Preventive chemotherapy treatment
School-age children: school-based MDA Preschool children: child health days, immunizations, vitamin A distribution

Sanitation and hygiene prevention

Availability of sanitation facilities was associated with significant protection against STH infection (OR=0.54, 95% CI 0.44-0.61)
Ziegelbauer et al, PLoS Medicine 2012

Johnson & Johnson Mebendazole Donations

2007-2012 (in millions)
100 90 80 70 60 50 40 30 20 10 0 14 31.8

11 8 4 20.7 2007 32.7 31 31.2 8 7 10.75 67

30.7

2008

2009

2010

2011

2012

Original Countries

New Countries

Expanded Drug Donations for STH in School-Age Children 2010

J&J expanded mebendazole donation for STH from 30 million to 200 million per year GSK pledged 400 million doses of albendazole per year for STH

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The WASHED Approach

Water - Access to potable water Sanitation - Sanitary latrines Hygiene Education - Personal and environmental hygiene Deworming - Deworming with broadspectrum anthelminthic drugs

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Safe Water Supply MDG and equity

Neglected tropical diseases or Diseases of neglected people?

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London Declaration
On January 30th, 2012, representatives of countries, development partners and pharmaceutical companies renewed and expanded a partnership to eliminate NTDs World Health Organization roadmap

Pharmaceutical companies have agreed to donate the drugs needed

Merck & Co.: Onchocerciasis and Lymphatic Filariasis GlaxoSmithKline: Lymphatic Filariasis and intestinal worms in school-aged children Pfizer: Blinding Trachoma Johnson & Johnson: Intestinal worms in school-age children Merck-Serono: Schistosomiasis
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World Bank committed to strengthening health systems to combat NTDs in Africa January 30, 2012
Extended World Bank financing (IDA / HSS Trust Fund) and technical support to help countries build stronger community health systems that will integrate NTD elimination and control Pledged to work with other partners to expand the trust fund of the African Program for Onchocerciasis Control (APOC) to support the elimination or control of NTDs in Africa

2016 Elimination Goals Asia Pacific NTD Programme

Lymphatic filariasis - 18 countries Blinding trachoma - 6 countries Schistosomiasis - 4 countries Yaws - all 5 countries Leprosy 3 countries Leishmaniasis - 5 countries Morbidity due to soil-transmitted helminths in school age-children 16 countries
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Thank you!

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