Progress in the Fight against Neglected Tropical Diseases, Uganda
Uganda NTD Program Partners Planning Meeting
Country Lake Resort in Entebbe, Uganda
June 15-17, 2016
Prepared by Dr. Philip Downs
RTI International
Neglected No Longer: Progress in the Fight against Neglected Tropical Diseases
For millions of Ugandans the threat of contracting a neglected tropical disease (NTD) has decreased thanks to effective control strategies coordinated by the Ministry of Health’s Vector Control Division and supported by USAID. During a three day Partners Planning meeting held June 15-17,th2016 at the Country Lake Resortin Entebbe, national program managers shared with partners and donors how the integrated strategy of delivering preventative medicines to at-risk communities is reducing prevalence of fiveNeglected Tropical Diseases, including Onchocerciasis (River Blindness), Lymphatic Filariasis (Elephantiasis), Schistosomiasis (Bilharzia), Trachoma, and soil-transmitted helminthiasis. Three of these diseases - Onchocerciasis, Lymphatic Filariasis, and Trachoma – are on track for elimination as a public health problem, meaning that key disease control interventions could stop once disease prevalence falls below a certain level.
The meeting was chaired by the National NTD Coordinator, Dr. EdridahM. Tukahebwa, who reminded participants that maintaining success during a period of transition requires greater focusonensuring quality interventionsand involving support from a wider range of stakeholders. Indeed, the success of the national program has meant that for several districts, annual or biannual treatmentscan stop because disease is no longer a public health problem;basic improvements in infrastructure and disease surveillance are now expected to prevent reinfection. However, since not all districts have achieved the disease elimination finish line, the program must continue to stay focused on reaching the people who are still at-risk for disease. RTI International is the lead partner on the USAID supported ENVISION project in Uganda and is working closely with the NTD Department of the Ministry of Health, as well as other implementing partners like The Carter Center, to ensure evidence-based solutions are being applied to each stage of the disease control and elimination process. The approach to date has been working.
Status of Diseases
The National Trachoma Control Coordinator,Dr. Patrick Turyaguma, reported thatout of the 41 endemic districts that were originally identified to be a public health problem for trachoma, 21 districts (51%) have stopped community-based treatments – 6.6 million people are now no longer at risk for blindness related to trachoma. The program is now looking to expand support for surgical outreach to prevent blindness in individuals with advanced stages of trachoma (trichiasis) which can only be addressed through corrective eyelid surgery.
Dr. Tom Lakwo,National Coordinator for Onchocerciasis Elimination, reported that themagnitude of onchocerciasishas been reduced from 70% in 1993 to below 7% among 17 disease foci. This has resulted in 13 districts declaringinterruption of transmission; among these districts 6 have completely eliminated,or are close to eliminating, blackflies, which transmits the disease parasites.
After five rounds of medicines for lymphatic filariasis among 54 endemic districts in Uganda, 33 districts (60%) have assessed that treatments are no longer needed in communities. Mr. Gabriel Matwari, Lymphatic Filariasis Elimination Program Manager, reportedeightadditional districts will conduct impact assessments by the end of 2016. All remaining districts will be assessed by 2017 before entering into a surveillance period to prevent reinfection in the population.
The Road Ahead
During the meeting certain populations were identified that continue to struggle with maintaining high medicine coverage; if not appropriately addressed low coverage in these groupscould jeopardize the progress made so for. Many of the remaining endemic communities aresome of the most isolated in Uganda, located in parts of the country that require additional time, funding, and human resources to conduct quality activities. This is particularly true in the Karamoja sub-region where population coverage with medicine has often been inadequate. A relaunch of the NTD program is now planned for the Karamoja sub-region in October, 2016. Program supervisors are expected to increase the frequency of visits and to closely monitor and address indicators that may lead to low coverage like inadequate drug supply or poor timing if the distributions. Dr. Kagwa Paul, Assistant Commissioner for Health Services, encouraged the program to also review their communication strategies and ensure that appropriate messages are being crafted and delivered in a way that reaches the target population and brings about the desired change in behavior. Participants acknowledged that additional information would be collected through knowledge, attitude, and practice surveys before the next MDA to inform the strategy going forward.
In addition to maintaining high coverage of preventative treatments, many districtsmust alsoensure a robust disease surveillance system and identify patients with chronic forms of the disease to ensure they are properly managed; e.g. hydrocele, lymphedema, and trichiasis.Ultimately, when districts transition into a surveillance phase, national programs need to ensure a stable cadre of health workers will be able to detect, respond, and report on a given number of disease indicators. Dr. Christopher Oleke, Principal Health Educationist from the Department of Community Health, presented on the Ministry’s vision to establish an effective and sustainable community health structure that empowers communities to take responsibility for improving their own health. This vision has lead the Ministry towards establishing a new level of Community Health Extension Workers (CHEWs) to improve the equitable delivery of quality preventive, promotive, and basic curative health services at the community level. Participants discussed the promising role the CHEWs could play in assisting with health education and disease surveillance for NTDs. Developing a sustainable mechanism for extending health services and disease surveillance is particularly needed along the border areas, where the Ministry of Health is taking a leading role in facilitating cross-border coordination with Kenya and South Sudan to prevent recrudescence of onchocerciasis, LF, and trachoma.
For other NTDs the road ahead is still long. Control programs like SCH and STH, which have benefitted from reaching school-age children and at-risk adults through the integrated distribution platforms, now face the challenge of sustaining medicine distributions for many more years as a single platform. The transition to a single disease control program has significant long term cost implications and may require the program to reevaluate current distribution platforms and explore other opportunities for sustaining high treatment coverage. The National Coordinator welcomed further discussion on a more substantial transition plan for these diseases in the coming year. RTI is working to develop with the Ministry a transition plan that will identify the capacity strengthening needs and additional cross-sector collaboration needed to also better manage these long term control diseases.
NTD programming is supported by the government of Uganda through multiple donor and partners. Uganda receives USAID support for integrated treatment of all 5 NTDs through the USAID supported ENVISION project lead by RTI International and The Carter Center in Uganda.
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