CWW News

New! CWW systematic review of global soil-transmitted helminthiasis prevalence and intensity studies

CWW is pleased to share a systematic literature review1 titled, “Qualitative systematic literature review of global soil-transmitted helminthiasis prevalence and intensity studies.” The literature review was undertaken to assess the availability and quality of STH data starting from 2006, when several STH endemic countries began implementing mass drug administration for STH control.

The literature review included 209 studies published between 2006 and 2018 that fit the inclusion criteria. Findings from the literature review indicated that the available STH epidemiological data are “fragmented, mostly of questionable quality, and minimally useful for regional or global program decisions.” The authors recommend a standardized approach to gathering STH program data, based on a comprehensive global monitoring and evaluation framework that will allow for pooling of information across countries and regions to guide global policy and progress.

1Diaz, Michael R., et al. (2020) Qualitative systematic literature review of global soil-transmitted helminthiasis prevalence and intensity studies.

 

 

 

Read Article →

New paper co-authored by CWW team member on strengthening the NTD Supply Chain through partnerships

new paper1 published in PLOS NTDs describes the complex supply chain systems necessary for the delivery of preventive chemotherapy for neglected tropical diseases (NTD) interventions. The paper notes that the supply chains established to support NTD operations are complex and that the Coronavirus Disease 2019 (COVID-19) pandemic has further highlighted the need for strong supply chains for health system strengthening.

Cassandra Holloway, Children Without Worms (CWW) Program Support Specialist, is an author on this publication and CWW is one of the 17 partner organizations that make up the NTD Supply Chain Forum.

CWW supports the NTD Supply Chain Forum, a public-private partnership whose vision is to support endemic countries in controlling and eliminating NTDs. As the host of the Forum, CWW helped develop and pilot the NTDeliver database mentioned extensively in this recent publication.

 

1Souza AA, Holloway C, Williams T (2020) The NTD Supply Chain Forum—Strengthening the backbone of NTD programs. PLoS Negl Trop Dis 14(11): e0008818. https://doi.org/10.1371/journal.pntd.0008818

 

 

Read Article →

Children Without Worms (CWW) hosts the Neglected Tropical Diseases (NTD) Supply Chain Forum (SCF) meeting

CWW hosted the second of the bi-annual meetings of the NTD SCF in September 2020. Participants included representatives from national Ministries of Health, the WHO, implementing partner organizations, and pharmaceutical donors such as Merck Healthcare KGaA, Merck Sharp & Dohme Corp., J&J, GSK, Eisai,  and Pfizer. (Access meeting report here.)

Spread over the course of three days via a virtual platform, the meeting included updates from representatives of pharmaceutical donors and the various working groups set up to solve supply chain management challenges in delivering pharmaceutical products to endemic countries.

Attendees participate in the virtual meeting

 

The supply chain forum was particularly relevant this year, as CWW encouraged dialogue and creative solutions to COVID-19 challenges. Participants identified that with the reduction of flights, border closures and restrictions, the delivery of NTD medications has posed many challenges. Further, mass drug administrations (MDA) have decreased because of COVID-19 restrictions such as school closures. Participants noted that missed MDAs may also trigger the need for an additional MDA in 2021 to keep the programs on track.

To overcome such challenges, NTD SCF participants proposed concise measures for ensuring the delivery of medicines to affected communities. Several recommendations were made at the end of the three-day meeting, including next steps to guide the future of the NTD SCF.

The next virtual forum meeting is scheduled for February 23-24, 2021.

Cassandra Holloway, Children Without Worms (CWW) Program Support Specialist, presents at the NTD SCF

 

Access meeting report here.

Read Article →

STH Control in Bangladesh: A Photo Essay

CWW has been working with the Ministry of Health, Bangladesh and other partners to strengthen national NTD program monitoring and data management through use of the Integrated Community-Based Survey for Program Monitoring (ICSPM). Click through the slideshow below to learn more about ICSPM in Bangladesh and our collaborative progress towards elimination of STH as a public health problem among children.

Graphics: Priya Palani

Text: Rachel Wallace

Read Article →

New study led by STH Advisory Committee members with contributions from CWW on STH Diagnostics

new paper1 published in PLOS NTDs demonstrates the feasibility and challenges of an international external quality assessment scheme (EQAS) to test and ensure the quality of molecular diagnostic testing for parasitic worms such as soil-transmitted intestinal worms.

Facilitated by Children Without Worms (CWW), the study piloted an international EQAS for the diagnosis of parasitic worms involving 15 laboratories in Africa, Asia, Australia, Europe, and North America. Findings showed that while most laboratories performed well, some laboratories may need to improve their test protocol.

Commenting on the findings, Rubina Imtiaz, CWW Director, said, “this timely publication highlights the development of  molecular testing methodology (qPCR) for STH and additional parasites. It also draws attention to the need for standardizing testing approaches across laboratories around the world so that test results are comparable. Findings from this study serve as an important first step in that direction.”

As a regular contributor to STH policy  and a leader in innovation, CWW continues to advocate for investments in STH diagnostics and works with key stakeholders such as the World Health Organization and the STH Advisory Committee and others to promote a “use-case focused” collaboration on NTD diagnostics.

 

1Cools P, van Lieshout L, Koelewijn R, Addiss D, Ajjampur SSR, et al. (2020) First international external quality assessment scheme of nucleic acid amplification tests for the detection of Schistosoma and soil-transmitted helminths, including Strongyloides: A pilot study. PLOS Neglected Tropical Diseases 14(6): e0008231. https://doi.org/10.1371/journal.pntd.0008231

 

 

Read Article →

CWW in Kenya: A Photo Essay

CWW has been working with the Ministry of Health, Kenya and other partners to strengthen national NTD epidemiology and data management. Click through the slideshow below to see how our collaborative efforts have progressed since 2019.

Graphics: Priya Palani

Text: Girija Sankar

Read Article →

All Hands on Deck: A synchronized approach to fighting COVID-19

In a new paper published in the International Journal of Infectious Diseases, Rubina Imtiaz, MBBS, CWW Director, and other global public health experts called for a unified response to the coronavirus pandemic. Calling it an ‘all-hands-on-deck’ approach, the experts proposed a list of tools and institutional mechanisms to advance the unified approach. The publication drew on experiences from previous epidemic outbreaks like the Ebola outbreaks and the successes of multilateral platforms like the NTD Supply Chain Forum, facilitated by CWW, to form a global, COVID-19 mitigation framework with tools for a collaborative pandemic response. Reflecting on the role of institutions, the authors offered the following example:

“[T]he Task Force for Global Health convened a virtual meeting across 46 global entities representing pharmaceutical commodity donors, implementing partners and shippers, under WHO leadership to assess and respond to anticipated interruptions in critical supply chain of deworming drugs. This rapid consultation across multilaterals and private sector entities helped rapidly access existing platforms such as the DHL Control Tower for Humanitarian Supply Chain to assist the movement of medical supplies and other essential drugs from China to the rest of the world.” (Ebrahim, Zhou, et al. 2020).

Dr. Imtiaz added that “examples like the NTD Supply Chain Forum, facilitated by CWW, show us the importance of a multilateral approach in mitigating global, public health crises by helping to rapidly adapt existing and new platforms and mechanisms for a response. During a global crisis like COVID-19, our response should not be the sole responsibility of one sector, but the responsibility of all sectors to work together.”

CWW has also been working with partners to assess delays to deworming, and other NTD campaigns. CWW is supporting national deworming programs to focus on those activities that can continue during the pandemic per WHO interim guidelines on community- and facility-based care.

Reference:

Ebrahim, S. H., Zhuo, J., Gozzer, E., Ahmed, Q. A., Imtiaz, R., Ahmed, Y., Doumbia, S., Rahman, N., Elachola, H., Wilder-Smith, A., & Memish, Z. A. (2020). All Hands on Deck: A Synchronized Whole-of-World Approach for COVID-19 Mitigation. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, S1201-9712(20)30484-7. Advance online publication. https://doi.org/10.1016/j.ijid.2020.06.049

Read Article →

Essential ingredients: a framework for STH control programming

By Grace Hollister, Evidence Action (STH Coalition partner)

Parasitic worm infection, or soil-transmitted helminthiasis (STH), is one of the most prevalent causes of illness among the world’s poorest and most vulnerable populations, especially children. Close to a quarter of the world’s population is infected with at least one STH species, and globally an estimated 870 million children are at risk of infection[1].

Intestinal worm infections cause a range of symptoms, including intestinal blood loss resulting in anemia, and impaired cognitive and physical development. Indeed, by interfering with nutrient uptake, worm infections undermine children’s health and ability to learn, preventing them from reaching their full potential.

Mass drug administration, long the cornerstone of STH control efforts, is the use of deworming drugs to treat an entire population in a given geographic area, regardless of each individual’s infection status. Deworming drugs are safe, efficacious, and available free of charge for school-age children through generous pharmaceutical donations coordinated by the World Health Organization (WHO). Treatment reduces morbidity, particularly in heavily-infected children, and is strongly associated with improved health, learning potential, and long-term productivity. However, to ensure these positive effects, treatment coverage must be sufficient and occur regularly.

The good news is that increased investments in STH control are paying off. Between 2011 and 2015 (the most recent year for which data is available), treatment coverage doubled among school-age children, reaching 63%.[2][3]And that progress has put within reach the target set by the World Health Organization: 75% treatment coverage for school-age children globally by the year 2020.

STH Coalition partners are contributing to this work in a variety of ways. In collaboration with country governments, they’re supporting school-based treatment programs, integrating deworming with other NTD treatments, and, in the case of preschool-age children, combining deworming with the provision of nutritional supplementation.

Still, lest this good news lead to complacency, consider that measures of progress at a global level mask variability among and within countries. Some countries have yet to scale their treatment programs to all at-risk areas, while others have fallen short of their coverage targets. In addition, many deworming treatments are effectively provided through the administration of albendazole as part of treatment for lymphatic filariasis (LF), given the overlap in drugs between the two diseases. Many countries are successfully reaching their LF elimination goals, meaning that as LF efforts stop, treatment gaps may emerge.

It’s imperative that these gaps are immediately addressed, and three key objectives can help us, as a community, maintain focus on the outcome of interest: reduced morbidity from worms for those who stand to lose the most when infected.

  • Ensure consistent drug treatment coverage and compliance within countries by strengthening and maintaining scaled programs.
  • Increase understanding of the impact of programs on morbidity control through regular parasitologic monitoring.
  • Develop a comprehensive framework for sustained control efforts, containing the essential ingredients to enable quality programming in all at-risk areas.

We propose that a framework for quality programming should include:

  • Evidence of what works: Findings from further operational and implementation-focused research must feed back into program strategy and decision-making to ensure an evidence-based approach is widely implemented.
  • A supportive policy environment: Programs backed by solid policies can maintain political support over time. Policies should extend beyond the health sector alone to engage education and environmental issues such as access to safe water and sanitation.
  • Standard practices and tools: Key tools for specific programmatic aspects including training, program monitoring, and evaluation support for program scale up. Standard processes and procedures can support replication of promising practices across many countries.
  • Tailored modalities: There is not a one-size-fits-all approach; multiple models from which countries can choose and adapt to the local context should be developed.
  • Common metrics and measurement methodologies: Key indicators and agreed methodologies will facilitate collection of high quality coverage and epidemiological data and encourage data sharing to monitor progress.
  • Technical capacity: Effective morbidity control efforts require the use of mathematical modelling and epidemiologic assessment to track the intensity of infection. Building this technical capacity may require training within countries that have achieved some success with mass drug administration.
  • Financial and human resources: A lack of financial resources can impede scale up, hence the need for continued support to sustain long-term treatment strategies. Domestic resources alone are insufficient.
  • Partnerships: Strong relationships within and between all stakeholders are needed to leverage resources and expertise for maximum impact.

Aligning partners on the framework their potential related roles can help to keep STH control on track to meet the 2020 goals – and most importantly to ensure that at-risk children receive the treatment they deserve to lead healthy, productive lives.

 

 

[1] World Health Organization. Soil-transmitted helminthiases: Situation and trends. Global Health Observatory data. 2015.
[2]Weekly Epidemiological Record Nos. 49/50, 2016, 91, 585-600
[3]Weekly Epidemiological Record No. 14, 2013, 88, 145-152

Read Article →

Progress, Partners and Promise: Mapping the Way Forward

It’s an oft-quoted adage that “if you can’t measure it, you can’t manage it.”

Nowhere is that maxim more firmly embraced than among the constellation of STH Coalition as they collectively advance the global goal of “elimination of STH as a public health problem.”

The WHO defines elimination of STH as a public health problem as achieving a prevalence of moderate-to-heavy STH infection of less than 1% among pre-school age children (1-4 years) and school-age children (5-14 years), key at-risk populations. Adoption of the goal of eliminating STH as a public health problem has in turn prompted changes in the way STH programs operate. Indeed, while STH programs have traditionally relied on the coverage of preventive chemotherapy as the measure of programmatic achievement, it’s clear that this intervention indicator does not measure the impact on STH. Going forward, and following years of deworming, countries are urged to implement regular parasitologic monitoring – a measure of the prevalence of infection intensity in a given area and population.

Last year, CWW partnered with the Government of Bangladesh to conduct parasitologic monitoring at the community level. The effort marks a major step forward for STH control in the country, allowing the government to address gaps in programmatic data and to strengthen decision-making around a range of interventions.

“Previously, we measured the prevalence of STH among the school-age children,” says Dr. Mohammed Jahirul Karim, Deputy Program Manager of the Filariasis Elimination and STH Control program in the Bangladesh Ministry of Health. “The WHO recommendation is still to survey this group. But we are taking a new approach – we are measuring the burden of disease in the population.”

That’s important, he says, because “if you do not assess the parasitologic burden in the community, in the entire population, then you will not be able to understand whether the reservoir is there.” If there is a transmission reservoir within the community – a continuous source of infection – “deworming will not be effective,” says Karim. “So we have to measure this, because we cannot do deworming indefinitely.”

One possible source of infection could be the use of open latrines in a community. That was the case in one upzilla in Bandarban district, one of two districts where community-wide parasitologic monitoring has already been implemented. “We found a 50% infection rate, so we took immediate action there. We instructed civil servant to close the latrines and improve sanitation.” Parasitologic surveys, supported by STH Coalition member Nutrition International, are planned for four additional districts in 2017.

For Bangladesh, eliminating STH remains a top priority, says Karim. “If a child is infected, she could have many complications, and the child is the future of the nation. We must be successful.”

Read Article →

STH Coalition to Provide Opportunities for Strengthening National STH Programs

STH Coalition partners, and increasingly ministry of health-led national STH programs it supports, aim to achieve the WHO-defined goal of eliminating STH as a public health problem by 2020. To achieve this important goal, the Coalition advocates for a comprehensive approach to STH control. Such an approach relies, in part, on clear governmental policies. These policies may be directly related to STH control; for example, a policy on child health clearly states the government’s goal for STH control. While other necessary policies may address important contributing factors such as the provision of sanitation facilities in schools and homes.

To assist endemic country governments, and partners supporting them, to establish an enabling policy environment, CWW as the STH Coalition secretariat, drafted a tool to assess the existing national policy environment and identify clear gaps to address.

The Coalition will present a draft of the instrument during a session of the Neglected Tropical Disease NGO Network (NNN) annual meeting in September 2017.  We encourage interested national STH program managers and STH Coalition partners to attend the session.  In addition, we seek to identify national programs that are interested in providing input or piloting the assessment. For additional information please contact the STH Coalition secretariat at STHCoaliton@taskforce.org.

A second NNN workshop will explore specific opportunities for improving data collection, analysis, and use. National STH programs increasingly recognize the essentiality of appropriate program monitoring to guide decision making and demonstrate progress toward the goal of elimination of STH as public health problem. STH Coalition partners, including national STH programs, will discuss their experiences in shifting from school-based to community-based program monitoring surveys. Additionally, they will describe data issues related to unprogrammed or private sector deworming – particularly for the preschool-age population.

We look forward to the participation of a wide range of STH Coalition partners at these workshops.

Read Article →