Scaling up schistosomiasis and soil-transmitted helminthiasis control
14―15 December 2006, Salle B, WHO/HQ Geneva, Switzerland -
Conclusions and recommendations
Members of the Partners for Parasite Control (PPC), including national programme managers, representatives of the pharmaceutical industry, international and non-governmental organizations, convened in Geneva from 14 to 15 December 2006 to review progress towards meeting the target of the World Health Assembly resolution 54.19, to treat, by 2010, at least 75% of children of school age at risk of morbidity due to schistosomiasis and soil-transmitted helminthiasis. The WHA resolution gave new impetus to global helminth control and led to the implementation of several new national programmes and international initiatives. The group noted, with appreciation, that the Mebendazole Donation Initiative will significantly increase the amount of drugs available for treating children for soil-transmitted helminthiasis.
The meeting also noted that resolution WHA 54.19, along with the 2010 target for helminth control, calls for comprehensive public health interventions for sustaining control activities in low transmission areas, access to anthelmintic drugs in all health services, promotion of access to safe water, sanitation and health education, incorporation of preventive health measures in development activities, and that resources should be mobilized to sustain control activities.
Progress towards the 2010 target of the WHA resolution needs to be accelerated. Deworming campaigns are known to be in progress in many countries where schistosomiasis and soil-transmitted helminthiasis are endemic. Ministries of Health, national and international Non-governmental organizations, Faith-based Organizations and other agencies are active in these deworming campaigns. WHO/CDS/NTD has established a mechanism for receiving and processing deworming statistics, but not all campaigns are reported. Problems exist in the estimation of denominators, the calculation of population coverage and the reliability of reporting. As a result of these inconsistencies, the best estimate is that at least 10% of the overall school-age population at risk of morbidity is receiving regular treatment. There is an urgent need for standardized data collection, accurate identification of high risk populations, and a unified system for reporting in line with WHO guidelines.
Achievement of the 2010 target will need sustained access to drug supply which is free to beneficiaries. Access to adequate and reliable supplies of high quality anthelminthic drugs was identified as essential for realistic scaling up. Given the number of school-age children at risk of morbidity, the meeting agreed that the current supply of anthelmintic drugs is insufficient to meet the need, particularly in the case of praziquantel. Donations exist for albendazole for the control of lymphatic filariasis, and now for mebendazole for control of soil-transmitted helminthiasis. In addition to continuous funding, the meeting identified the need for the establishment of a global anthelmintic drug facility.
The meeting reviewed country-level experiences where integrated programmes for the control of lymphatic filariasis, schistosomiasis and soil-transmitted helminthiasis are already being implemented or are at a planning stage. It is expected that the strategy for preventive chemotherapy for helminth control will be adopted in integrated health programmes undertaken in different countries. As a first step, WHO has developed guidelines on current best practice in the coordinated use of anthelmintic drugs, and countries are encouraged to implement interventions appropriate to their epidemiological and programmatic situations and to deliver them through existing health systems. Even without integration, many people infected with soil-transmitted helminthiasis have benefited from LF control where donated albendazole is co-administered with either diethylcarbamazine or ivermectin. The drive towards integration and the coordinated use of a set of drugs to relieve morbidity due to multiple helminth infections, preventive chemotherapy, provides new opportunities for scaling-up coverage, integrated data management and in-country resource mobilization for implementation. The meeting concluded that six operational issues require urgent attention for scaling up to achieve the 2010 target of reaching at least 75% of school age children at risk of morbidity.
Accordingly, the WHO and its partners are requested to:
- Ensure the sustained availability of high quality drugs at no cost for beneficiaries, together with the establishment of a global drug procurement facility;
- Develop stable funding systems with continuity, promote government commitment and ownership, and explain the need for the timely distribution of allocated government funds if scaling up is to be achieved;
- Identify children at risk of morbidity; application of rapid mapping techniques should facilitate this need;
- Develop standardized data collection and a unified reporting system, including linkage with established information platforms, to monitor treatment coverage, programme impact and drug efficacy;
- Encourage multi-sectoral coordination of in-county activities, particularly between Ministries of Health and Ministries of Education, including planning, training, and progress reporting;
- Coordinate different delivery mechanisms, ensure integration within existing health systems and with other control programmes based on preventive chemotherapy.