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A research collaboration between Brunel University and LSE has demonstrated that large-scale programmes to control Neglected Tropical Diseases (NTDs) through Mass Drug Administration (MDA) can be ineffective, primarily because of flawed assumptions about local realities in developing countries. The research findings have helped shift the terms of debate and consolidate pressure for existing strategies to be revised. They have been discussed in the UK Parliament, the biomedical literature, and the news media. In addition, detailed fieldwork has facilitated treatment for specific groups of people in Tanzania and Uganda who would otherwise have been overlooked.
Scientists at the Liverpool School of Tropical Medicine (LSTM) have proven that targeting an essential bacterial symbiont, Wolbachia, with a course of antibiotics cures patients of their parasitic worms and improves disease pathology. This discovery in 1999 offers superior efficacy compared to existing anti-filarial drugs delivering prophylaxis, transmission blocking, safe macrofilaricidal activity and improved case management therapy. This approach has been endorsed by WHO elimination programmes for onchocerciasis, (Onchocerciasis Elimination Programme for the Americas, OEPA) and lymphatic filariasis (Global Programme to Eliminate Lymphatic Filariasis, GPELF). The Centre for Disease Control (CDC), also recommends this new strategy for elimination and morbidity management.
Impact: Health and welfare and public healthcare policy; demonstrating that community-directed treatment of onchocerciasis with doxycycline is effective where ivermectin is contra-indicated.
Significance: 12,936 onchocerciasis patients were treated safely and protected for at least 4 years. The treatment regime has been adopted by the US Centers for Disease Control and Prevention, the World Health Organization and governments.
Beneficiaries: Patients with onchocerciasis; governments and policy-makers.
Attribution: Studies performed by a long-standing African-European partnership formed and led by Taylor (UoE).
Reach: International; up to 8 million people in the Congo basin; onchocerciasis patients in Africa where ivermectin is not appropriate plus those in South America participating in focal eradication campaigns.
Impact on health and public policy: The World Health Organisation (WHO) now recommends that children under 6 years, who had hitherto been excluded from drug treatment, should be included in schistosome control programmes, following research by UoE that reversed previous assumptions about schistosomiasis infection rates in pre-school children (1-5 year olds) and demonstrated the safety and efficacy of Praziquantel (PZQ) treatment in this age group.
Beneficiaries: WHO policy change affects children under the age of 6 years in countries affected by schistosomiasis (up to 10 million children). 350,000 pre-school children in Zimbabwe have so far been treated with PZQ, with a further 1.2 million already identified by the Ministry of Health for inclusion in the next round of MDA to start in October 2013
Significance and Reach: 5-10 million pre-school children in Africa (WHO estimates) now merit treatment. Urogenital schistosomiasis affects more than 100 million people in Africa; in affected populations, children carry the heaviest burden of the disease. Following the recommendations from the WHO on preschool children, 4 countries (Niger, Malawi, Uganda and Zimbabwe) have so far included pre-school children in their schistosome control policies with Zimbabwe currently implementing this.
Attribution: Dr Francisca Mutapi led the research at UoE establishing the evidence base for the safety and efficacy of PZQ. The study was collaborative with UoE leading the research and conducting the laboratory studies, while collaborators at the University of Zimbabwe and National Institutes of Health Research in Zimbabwe organised the fieldwork.
Trachoma, caused by ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness. Research by Professors David Mabey and Robin Bailey, LSHTM, has shown that a single oral dose of azithromycin is an effective, feasible mass treatment and could eliminate trachoma from affected communities. As a result, the manufacturer Pfizer agreed to donate azithromycin to trachoma control programmes for as long as necessary and WHO established an Alliance for the Global Elimination of Blinding Trachoma by 2020. Since 2008, 205m azithromycin doses have been donated, and WHO elimination targets have been achieved in nine countries.