Local tips, global impact: community-driven measures as avenues of promoting inclusion in the control of neglected tropical diseases: a case study in Kenya

Background:Neglected tropical diseases(NTDs)affect poor populations with little or no’’political voice’to influence control activities.While most NTDs have interventions that work,the biggest challenge remains in delivering targeted interventions to affected populations residing in areas experiencing weak health systems.Despite the upward development trends in most countries of sub-Saharan Africa(SSA),the healthcare worker to population ratio remains exceptionally low,with some areas not served at all;thus,there is a need to involve other personnel for school and community-based healthcare approaches.Nonetheless,the current community-based programs suffer from inconsistent community participation due to a lack of coordinated response,and an expanded intervention agenda that lacks context-specific solutions applicable to rural,urban,and marginalized areas.Methods:This research investigated the capacity of local communities to address the burden of NTDs.Informed by the social theory of human capability,the research collected primary qualitative data by conducting key informant interviews and focus group discussions of people infected or affected by NTDs.The interview data were collected and transcribed verbatim for thematic analysis using Nvivo version 12.Results:Our findings reveal,first,a need for intersectoral collaboration between governments and affected populations for inclusive and sustainable NTD solutions.Second,a’’bottom-up’approach that enhances capacity building,sensitization,and behaviour change for improved uptake of NTD interventions.Third,the enforcement of Public Health Legislative Acts that mandates the reporting and treatment of NTDs such as leprosy.Fourth,the establishment of support groups and counseling services to assist persons suffering from debilitating and permanent effects of NTDs.Conclusions:Our research demonstrates the importance of human agency in encouraging new forms of participation leading to the co-production of inclusive and sustainable solutions against NTDs.

Evaluation of morbidity in Schistosoma mansoni-positive primary and secondary school children after four years of mass drug administration of praziquantel in western Kenya

Background:World Health Organization guidelines recommend preventive chemotherapy with praziquantel to control morbidity due to schistosomiasis.The primary aim of this cross-sectional study was to determine if 4 years of annual mass drug administration(MDA)in primary and secondary schools lowered potential markers of morbidity in infected children 1 year after the final MDA compared to infected children prior to initial MDA intervention.Methods:Between 2012 and 2016 all students in two primary and three secondary schools within three kilometers of Lake Victoria in western Kenya received annual mass praziquantel administration.To evaluate potential changes in morbidity we measured height,weight,mid-upper arm circumference,hemoglobin levels,abdominal ultrasound,and quality of life in children in these schools.This study compared two cross-sectional samples of Schistosoma mansoni egg-positive children:one at baseline and one at year five,1 year after the fourth annual MDA.Data were analyzed for all ages(6–18 years old)and stratified by primary(6–12 years old)and secondary(12–18 years old)school groups.Results:The prevalence of multiple potential morbidity markers did not differ significantly between the egg-positive participants at baseline and those at 5 years by Mann Whitney nonparametric analysis and Fisher’s exact test for continuous and categorical data,respectively.There was a small but significantly higher score in school-related quality of life assessment by year five compared to baseline by Mann Whitney analysis(P=0.048)in 13–18 year olds where malaria-negative.However,anemia was not positively impacted by four annual rounds of MDA,but registered a significant negative outcome.Conclusions:We did not detect differences in morbidity markers measured in a population of those infected or re-infected after multiple MDA.This could have been due to their relative insensitivity or a failure of MDA to prevent morbidity among those who remain infected.High malaria transmission in this area and/or a lack of suitable methods to measure the more subtle functional morbidities caused by schistosomiasis could be a factor.Further research is needed to identify and develop well-defined,easily quantifiable S.mansoni morbidity markers for this age group.