The poorest people on the globe, the bottom billion, live on less than $1.25 a day making them highly vulnerable to diseases. This is especially true for simple worm (
helminths) infestations like hookworm and roundworm, which are transmitted from the soil or by faecal-oral route.
Globally, about 600-800 million people, mostly children, are infected with soil-transmitted helminth infections. Hookworm infection causes childhood and maternal anaemia and results in great disability. Among neglected tropical diseases (NTDs), it causes the highest burden of disease.
What can be done to help young children who are infected with these worms, which in turn lead to malnutrition and anaemia? Improved sanitation is important, but this is a long-term process. In the meantime, mass drug administration (MDA), such as the use of the effective, anti-worm drug, albendazole, for whole communities may be a simple answer. MDA utilises the concept that a certain disease is so common in the community that individual tests and diagnosis are unnecessary. Hence everyone is treated regardless of their infection status.
MDA for neglected tropical diseases like helminth infestation provides some of the highest rates of economic return in any public health program. Importantly, this kind of campaign also addresses fundamental human rights issues concerning health. For example, drug companies working with the World Health Organisation, World Bank, and other UN agencies help provide MDA like albendazole to millions of people every year. Not unsurprisingly, this has led to control and, in some cases, elimination of some of these diseases.
Nowhere is this kind of campaign better known than in sub-Saharan Africa, where a network of more than 16,200 community-based drug distributors administered mass treatment with not only albendazole, but also provided vitamin A, childhood vaccinations, and anti-malarial bednets. There was also a national surveillance and monitoring system in place which improved operational research and even laboratory services in these impoverished areas. Clearly, this was a tremendous boost to the health services in sub-Saharan Africa.
The concept of MDA is certainly not new in Nepal, but perhaps the campaign needs to be more widespread. The best known MDA program here is with the drug diethylcarbamazine that is used to fight against filariasis (the disease that causes elephantiasis or ‘hattipaila’) carried out in certain districts across the country. Currently, MDA against filariasis has been stopped to conduct post-MDA surveillance.
There is every reason to think that this surveillance will show positive results as has been the case in other parts of the world where this MDA campaign has been instituted against filariasis. For example, 173 districts in India have completed more than five rounds of MDA against filariasis and have reached a rate of less than one per cent for that disease in the community. Many other diseases lend themselves to MDA. Trachoma, which is a very common bacterial infection of the eye that may lead to devastating complications, can be treated with the drug azithromycin. MDA campaigns against trachoma have been sporadically carried out in Nepal with good results.
Unfortunately, there are many other neglected tropical diseases in Nepal that cannot be controlled or eliminated by MDA. For example, WHO data shows that of the almost 55,000 cases of rabies worldwide, 22,000 (about 40 per cent) take place in the Indian subcontinent. A strong public health drive possibly including vaccines may be the only way to prevent this fatal and untreatable disease.
One of the most potent reinforcements of the poverty trap is the neglected tropical diseases and hopefully the new Nepali government will tackle these diseases with renewed enthusiasm and commitment.