Bi-national Commission on Health Guyana Suriname Neglected Tropical Diseases Dr. Shamdeo Persaud Chief Medical Officer GUYANA

NTD Control Guyana on 1 of four in the Americas where LF still endemic and 3 other NTD Development of National Plan Identification of Priorities – LF – Targeted for elimination by 2016 – STH – Targeted for control by 2015 – Chagas – Elimination of vertical and Blood Transfusion transmission; control of Oral and vector transmission – Leprosy – Elimination – ONCO and SCH not transmitted – Dengue, Leptospirosis and Malaria remain endemic in selected Regions

RegionNeglected Diseases Region 1 – Barima WineChagas, Malaria, STH Region 2 – Pomoroon/SupernameChagas, STH, LF, Leprosy, Rabies Region 3 – West Demerara/EssequiboLF, STH, Leprosy, Dengue, Leptospirosis Region 4 – East Bank DemeraraLF, STH, Leprosy, Dengue, Leptospirosis Region 4 – East Coast DemeraraLF, STH, Leprosy, Dengue, leptospirosis Region 4 – GeorgetownLF, STH, Leprosy, Dengue, Leptospirosis Region 5 – West Berbice/MahaicaLF, STH, Leprosy Region 6 – East Berbice CorentyneLF, STH, Leprosy, Rabies Region 7 – Cuyune/MazuriniMalaria, STH, Malaria, LF Region 8 – Pataro/SepuriniMalaria, STH Region 9 – Upper Essequibo/Upper Takatu Malaria, STH, LF, Dengue Region 10 – Upper Demerara/Upper Berbice STH, LF, Malaria, Leprosy, Dengue

SEROLOGY PREVALENCE OF LF ANTIGEN Ministry of Health, Guyana Key: Prevalence Red=20%-50% Yellow=4-20% Green< 4%

Plan for Transmission Interruption Phase one (2003 – 2007) – Social Mobilization – Develop, distribute, promote and use DEC salt – Monitoring and evaluation progress at sentinel sites Phase two (2008 – 2015) – Synergies with other neglected diseases – Evaluation of Phase one – Identify “Hot Spots” using surveillance information – Implement MDA with DEC and Albendazole – Monitor and evaluation progress at sentinel and spot check sites Ministry of Health, Guyana

Endemic LF IUs in Guyana Ministry of Health, Guyana Region /province Total population Source of population data Year of first round of MDA Current Status Region II49,254Cencus DEC Salt DEC/Alb 2009 Eliminated Region III103,061“2003-DEC SaltEndemic Region IV310,320“2003-DEC Salt 2012– DEC/ALB Endemic Region V52,428“2003-DEC Salt 2008–DEC/Alb Endemic Region VI123,694“2003-DEC Salt DEC/Alb 2009 Eliminate Region X41,112“2003-DEC SaltEndemic Other Ares11,000Estimated2003 – DEC Salt Eliminate Total690,869

Phase one Salt Fortification Adding beneficial chemical to salt Does not alter taste or other qualities of salt To combat public health problems (IDD, Dental Caries, Malaria, LF) Iodine Deficiency Disorder (IDD) Inadequate iodine in the body Disease observed as enlarged thyroid, Mental retardation and Cretinism, but several stages of physical sluggishness, learning disability, growth retardation and childhood morbidity Iodized Salt- successful in eliminating these problems Ministry of Health, Guyana

DEC-Salt for Mass Treatment Program Launched in July 2003 – 2003 to early tons imported Hurricane in Jamaica disrupted production, New plant commissioned in March 2005 Salt became blue in 2006 Production recommenced in August 2005 – 2005 – 49 tons – 2006 – 80 tons – 2007 – 290 tons Production stop in August 2007 Ministry of Health, Guyana

Phase II Mass Drug Administration Region 5 – Annually form ◦ Population - 52,428 ◦ Eligible Pop – 47,000 ◦ Population Treated - (2008 =81.7) (2010 =84%) Region 2 – one round 2009 Region 6 – one round 2010 Region 4 – Georgetown/East Bank/East Coast 360,000* Eligible 300,000* Ministry of Health, Guyana

Phase II Mass Drug Administration Region 3 – Annual 2012 – 2016 ◦ Population - 103,061 ◦ Eligible Pop – 91,000 ◦ Region 10 – Annual 2012 – 2016 ◦ Population – 41,112 ◦ Eligible Pop – 37,200

Integrated NTD Program Background The Georgetown Sanitation Improvement Project (GSOP) was developed by the Government of Guyana to improve the sanitation in the Capital City Project was supported by Inter-American Development Bank (IDB) Guyana Water Incorporated is the executing Agency a

Sentinel Monitoring Ministry of Health, Guyana Sentinel Site Microfilaria % Antigen (ICT) % YEAR Lodge Region NA Tucbur Region NA NA Spot Check Sites Melanie Region 4 NA 1.727NA 7.9 Bush Lot Region 5 NA3,7NA 14.6NA

GSIP The aims of the program are: i.Improve the operational performance of the Georgetown sewerage system through the reconstruction of its most critical components; ii.Strengthen GWI operational and financial performance by improving asset management and decreasing energy consumption; iii.Limit the transmission of the water-related diseases lymphatic filariasis and intestinal helminthiasis.

Results of Baseline Study Sentinel Site SampleICT Prevalence Microfilara STH (KATOKAT) Lodge Melanie Damishana Totals q.9

Training Develop MDA guidelines in accordance with the Program Managers Guidelines Procure all essential medicines (DEC, albendazole) and supplies Training and orientation of health workers Requirement and training of community volunteers and supervisors

Mass Drug Administration Packaging of medication Implement MDA (door to door, Booths at Health Centers and Outreach teams) Collect and analysis program data on Coverage Conduct Coverage survey (post treatment survey)

Mass Drug Administration Implementation Unit – Demerara/Mahaica (Region IV) – Population – 310, 320 (41.3% Guyana's Population) – Eligible population – 301,000 – Divided into 3 areas The City of Georgetown – Prevalence 28% (ICT) East Coast Demerara – Prevalence 16.5 % (ICT) East Bank Demerara – Prevalence -10.8% (ICT)

Age/heightALBDEC By age group 2-5 years400mg (1 tablet) 100mg (2 tablets) 6-15 years400mg (1 tablet) 200mg (4 tablets) > 15 years400mg (1 tablet) 300mg (6 tablets) Guyana Mass Treatment Chart NTD (LF/STH)

Coverage – Region IV Year 1 Treatment Area Target population Household Targets AdultsChildrenTotal East CoastA-57,000 C-8,000 T-65,000 15,47639,4826,10945,591 (70.1%) East BankA-41,000 C-6,000 T-47,000 11,19027,9214,97732,898 (70%) GeorgetownA-152,000 C-15,600 T-167,000 39,76187,13411,92499, TotalA-250,000 C-19,000 T-269,000 66,427154,53723,010177, %

Monitoring and evaluation – Program coverage – Data management – Survey coverage – Post treatment cluster surveys – Morbidity – Reporting IDB and GWI National and Regional Programs – Impact evaluation Surveillance National feedback

Challenges Capacity – Technical and administrative (PAHO/WHO and MOH assisted), Training (University Interns) Supervision and Data management – PAHO supported training and coordination Administrative and Logistic Support – Transport, Office space, Medicine storage and packaging (MOH provided all support) Procurement and supplies chain – DEC Procurements from Brazil, ALB donation from GSK Social Mobilization – Mass Media program was late and did not reach target population, MOH and GWI used their individual to enhance SM and HW conducted community Mobilization

Innovations Training of Volunteers from Community and Faith Based Organization Target large employers – Ministries, work places and Institutions Establishment of Distribution Points mainly at Health facilities Special Outreaches and “Mop-up” Exercises Public Education – opportunities to “talk health” Integrated Vector management.

Leprosy situation at national level,2011 Prevalence 0.9 per 10,000 pop Number of new cases 24 % of multibacillary cases amongst new cases 70.8% % of cases with grade 2 disability amongst new cases 4.2% % of cases in children under 15 amongst new cases 12.5% Detection rate (x population) 3.2 x 100,000

Prevalence at first sub-national administrative level, 2011

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