Controlling Neglected Tropical Diseases

Children waiting for drug administration at health center.
In 2007, the Access Project partnered with the Rwanda Ministry of Health (MOH) to launch Rwanda’s first program to control neglected tropical diseases (NTDs). NTDs are a group of parasitic and bacterial infections that are among the most common chronic infections among the world’s poorest people. NTDs can cause chronic illness and malnutrition, disfigurement, and other long-term consequences such as retarded childhood growth and development, adverse pregnancy outcomes, and even death. As a result, NTDs can cripple entire communities, making it impossible for people to engage in productive activity to lift themselves out of poverty.

Program Foundations

Adult mass drug administration.
Prior to the launch of the Access Project/MOH NTD program, no national NTD control efforts existed and little was known about the prevalence or intensity of such infections. In partnership with TRACPlus at the MOH and with financial support from Geneva Global through the Sabin Vaccine Institute, the Access Project spearheaded the most extensive mapping of NTDs ever undertaken in Rwanda. The mapping determined the distribution, prevalence, and intensity of the four NTDs most likely to be a public health problem. The mapping revealed that:

    Intestinal worms removed from child patient.
  • Soil-transmitted helminth infections (STH), more commonly known as intestinal worms, are a major public health problem throughout the country, with a prevalence of 66% among school-aged children. Rates are highest in the northern and western provinces, and prevalence surpasses 70% in 15 of Rwanda’s 30 districts
  • Schistosomiasis (also known as snail fever or bilharzia) affects 3% of Rwandan schoolchildren overall, but was found to affect up to 70% of schoolchildren in areas near lakes or swamps. Prevalence rates are highest around lakes Ruhondo, Muhazi, Burera, and Kivu
  • Trachoma, an eye infection that can lead to blindness, is not a major public health problem in Rwanda. However, the prevalence is approximately 1% overall among children aged 1 to 9 years in Gatsibo and Nyaruguru districts, and is as high as 13% in five villages
  • Lymphatic filariasis, also known as elephantiasis, is not prevalent in any part of Rwanda and therefore not a public health problem

NTDs flourish under conditions of poverty – environments with poor sanitation, dirty water, substandard housing, and lack of access to health services. Since early 2008, the Access Project has partnered with national and local government as well as non-governmental organizations and community-based organizations, to advocate for measures to prevent and treat NTDs.

NTD Control Efforts

Child receiving deworming pill.
Critical NTD control measures in Rwanda include improved water and sanitation infrastructure, heightened hygiene practices, increased capacity for rapid diagnosis of infection, and access to effective treatment. All measures are informed by operational and epidemiological research. In its first three years of existence, the Rwanda NTD Control Program:

  • Trained 230 lab technicians to diagnose STH and schistosomiasis and equipped labs with necessary equipment in areas of high prevalence
  • Trained 13 medical doctors and16 ophthalmological clinic officers
  • Trained 3,439 primary school teachers, 10,288 community health workers, 707 health workers and 108 local authorities and journalists in the identification, prevention, and treatment of STH and schistosomiasis
  • Administered two rounds of preventive chemotherapy to four million adults and children
  • Developed and launched mass media education campaigns based on knowledge, attitude, and practice surveys

During Year Four, the Rwanda NTD Control Program trained health workers and Community Health Workers (CHWs) in five districts that were not covered during the previous three years. 

In total:

  • 1,658 people were trained on STH, schistosomiasis treatment and prevention
  • 4,174,923 people were treated in deworming campaignsduring the MDA in December 2010
  • 4,174,923 NTD treatments were delivered
  • 8,245 IEC materials were produced
  • 916 Individuals were surveyed during a schistosomiasis screening

Children washing hands after mass drug administration.
The NTD impact research conducted in 2009 showed that awareness of NTDs among government stakeholders, the health care community, and vulnerable adults and children had increased and is now at a relatively high level.

A monitoring and evaluation survey conducted in 2010 demonstrated that the intensity of STH and schistosomiasis infections had decreased in areas where the Access Project and partners implemented interventions.

Program Future

In 2011, the Government of Rwanda assumed implementation ownership of the national NTD program. The Access Project worked with TRAC Plus to ensure a smooth transition of the NTD Program and supported the development of a comprehensive NTD Master Plan to guide the program for the next five years.The strategic plan will be used to guide the mobilization of funds and to strengthen Government oversight of the program. The Rwandan Ministry of Health seeks to fully integrate NTD control efforts into district-level health systems to ensure that NTD control programs are ongoing and that Rwandan children and adults no longer suffer from disability and death as a result of NTDs.