1. Where we could be by 2015 and how to get there
NTDs in Southern Sudan
Where we could be by 2015
and how to get there
Jan Kolaczinski

2. Parasite Disease (Common Name) Etiologic Agent Protozoan
Human African Trypanosomiasis
Trypanosoma gambiense
T. rhodesiense
Leishmaniasis
Leishmania spp.
Bacterial
Buruli ulcer
Mycobacterium ulcerans
Leprosy
Mycobacterium leprae
Trachoma
Chlamydia trachomitis
Helminth
(Worms)
Onchocerciasis
(River Blindness)
Onchocerca volvulus
Lymphatic filariasis
(Elephantiasis)
Wuchereria bancrofti
Soil-transmitted helminths
Ascaris lumbricoides
Trichuris trichiura
Hookworm
Schistosomiasis
(Bilharziasis)
Schistosoma haematobium
S. mansoni
Loiasis
Loa loa
Dracunculiasis
(Guinea Worm)
Dracunculus medinensis
Unknown
Nodding Syndrome
Unknown. Seems associated with onchocerciasis

3. Integrated NTD Control
Intuitively appealing, because:
Large areas of co-endemicity
Safe and free/cheap treatment available
Treatments can be co-administered using mass drug administration (MDA)
Trachoma LF
Schisto
STH
Oncho
 Potential cost saving of up to 46% when compared to stand alone programmes
Integration should not become the goal, but may provide the means to achieve them

4. Goals Disease Targeted Program Goal Trachoma
Elimination of blinding trachoma as a public health problem by 2020
Onchocerciasis
Establishment of community-based sustainable yearly treatment in areas with moderate/high transmission by 2010
Lymphatic filariasis
Elimination as public health problem by 2020
Soil-Transmitted Helminths
Regular treatment of 75% of at-risk school-age population by 2010
Schistosomiasis
Elimination
Table adapted from Brady et al. 2006, Trends in Parasitology 22

5. Drug Intervention Disease Targeted Drug regimen Age range targeted
Trachoma
Azithromycin & tetracycline
6 months – 80 years
Onchocerciasis
Ivermectin
5 years – 80 years
Lymphatic filariasis
Ivermectin + albendazole
Soil-Transmitted Helminths
Albendazole
6 years – 15 years
Schistosomiasis
Praziquantel ✔
Ivermectin + albendazole ✔
Lymphatic filariasis tends to be distributed over the largest geographical area
Table adapted from Brady et al. 2006, Trends in Parasitology 22

6. Where should we be by 2015?
Main graph from Ottesen et al. 2008, PLoS Negl Trop Dis 2: e317: Effect of MDA on Mf prevalence in all sentinel sites

7. How to get there?
Complete LF mapping using integrated mapping approach (i.e. including schisto & STH)
Strengthen community-based delivery (CDTI & guinea worm network)
Use these to deliver drugs + complementary interventions for other NTDs

9. Conclusion
Lymphatic filariasis elimination is the ideal driver for integrated NTD control:
Provides clear goal achievable within 5 – 7 years
Prospect of little to no further investment once elimination has been achieved
Controls onchocerciasis, STH, lice and scabies
Strengthens health systems in the process

10. Acknowledgements MoH-GoSS – Leadership, commitment, facilitation
COMDIS/DfID – NTD Situation Analysis
USAID/RTI – Current Funding of NTD Programme
NGO Partners – CBM, The Carter Center
World Health Organization
Mectizan Donation Programme
LSHTM/KEMRI – Operational Research Support