Neglected Tropical Diseases Control Program
At least three million people in Rwanda are afflicted and stigmatized by disfiguring and life-threatening parasitic and bacterial infections. These neglected tropical diseases (NTDs) can be easily treated, but prevent a significant proportion of Rwanda’s population from building a better future for themselves and their families. The disabling effects of NTDs have an enormous impact on the work force and consequently the productivity of Rwanda, preventing children from attending school, reducing future earnings and in some cases ostracizing people from their own communities.
Controlling a range of diseases – not just HIV, malaria and TB – is a critical step to meeting the Millennium Development Goals (MDGs) set forth by the world’s countries to halve poverty by 2015. The NTD Control Program is working with the Government of Rwanda to eliminate five of the most prevalent NTDs, connecting health centers across the country with the research, interventions and training needed to fight NTDs on a national scale. For more information on this initiative, please go to http://gnntdc.sabin.org/fieldrwanda.html.
Objectives:
Rwanda currently lacks a national disease control plan to combat the most common NTDs. Furthermore, there is a lack of information on the types of disease strains, and how large numbers of displaced individuals affect transmission of disease. The NTD Control Program is working with the Ministry of Health, the Ministry of Education and the World Health Organization to develop a national plan for carrying out necessary interventions at the district level. This partnership aims to reduce morbidity of five diseases: Soil transmitted helminth infections, schistosomiasis, onchocerciasis (river blindness), lymphatic filariasis and trachoma. This national plan comprises the following components:
- Identify target groups and priority areas through situational analysis and baseline mapping
- Identify district priorities and constraints
- Identify entry points such as schools and health centers for integrated delivery of interventions
- Procure equipment, transport and drugs
- Provide training to build capacity in the areas of disease control and elimination
Target diseases
Treating NTDs has a rapid impact on the health, school performance and economic productivity of a community. With medications available for as little as $0.50 (US) per person per year, it takes very little to make a big difference. The failure to provide treatment hampers child development, yields a generation of adults disadvantaged by infection, and compromises economic development.
Soil Transmitted Helminths – More than 75% of children in Rwanda are believed to be infected with intestinal worms. These children are often physically and intellectually compromised by anemia, leading to attention deficits, learning disabilities, school absenteeism and higher drop-out rates. Deworming has also been shown to represent a major strategy for improving pregnancy outcome, reducing maternal morbidity and mortality, and improving the chances of surviving severe malaria. This disease is prevalent throughout all of Rwanda.
Schistosomiasis – Schistosomiasis, or bilharzia, is a parasitic disease caused by trematode worms (flukes). Five species are known to cause disease in humans. In Rwanda, intestinal schistosomiasis is known to be prevalent in many areas where fresh water breeds water snails that host the parasites. Although it has a low mortality rate, schistosomiasis can be very debilitating, causing liver and intestinal damage (intestinal schistosomiasis), and bladder damage (urinary schistosomiasis). Together with soil-transmitted helminthiasis, schistosomiasis is the leading cause of physical growth retardation in children and also neuropsychiatric disturbances, such as cognition problems and memory loss. In Rwanda, this disease is mainly prevalent around lakes and swampy areas where rice and sugar cane are grown.
Onchocerciasis – More commonly known a river blindness, onchocerciasis is transmitted via black flies most prevalent in riverside areas, which carry parasitic worms that can reside in the human body for up to 14 years. Onchocerciasis is the world’s second leading infectious cause of blindness, and causes a variety of conditions aside from visual impairment, which include skin rashes, lesions, intense itching, skin depigmentation, and general debilitation. In Rwanda, this disease is more prevalent in southwest part of the country.
Lymphatic Filariasis – Commonly referred to as elephantiasis, the most obvious manifestations of this disease are the enlargement of the entire leg or arm, the genitals, vulva and breasts. The psychological and social stigma associated with these aspects of the disease is immense. However, the disease also causes internal damage to the kidneys and lymphatic system. Lymphatic filariasis is transmitted by mosquitoes carrying parasitic filial worms that live in the body for four to six years, producing millions of minute larvae that circulate in the blood. In Rwanda, this disease is more prevalent in the southwest part of the country.
Trachoma – Caused by Chlamydia trachomatis, trachoma is a highly contagious eye disease, which may result in blindness. It is spread by direct contact with eye, nose, and throat secretions from infected individuals, or contact with objects, such as towels and/or washcloths, that have had similar contact with these secretions. It may be carried by flies that have been in contact with discharge from the eyes or nose of an infected person. Trachoma tends to occur in clusters, often infecting entire families and communities. In Rwanda, it is more prevalent in the eastern part of the country.
