Kelly-Hope Louise A, Sanders Angelia M, Harding-Esch Emma, Willems Johan, Ahmed Fatima, Vincer Fiona, Hill Rebecca
Liverpool School of Tropical Medicine, Liverpool, UK.
The Carter Center, Atlanta, USA.
Confl Health. 2021 Mar 31;15(1):18. doi: 10.1186/s13031-021-00356-7.
Complex emergencies resulting from conflict and political instability are a major challenge for national neglected tropical diseases (NTDs) control and elimination programmes, especially in sub-Saharan Africa. Currently, there are no formal guidelines for national programmes to use and plan activities in these humanitarian situations, therefore the aim of this study was to develop a new methodological approach for making decisions about the implementation of safe and effective mapping and mass drug administration (MDA) intervention strategies.
The study focussed on the 47 World Health Organization's African Region (AFR) countries. NTD data were based on five diseases controlled by preventive chemotherapy (PC; i.e. lymphatic filariasis, onchocerciasis, schistosomiasis, soil transmitted helminths, trachoma), obtained from the WHO data portals and The Global Trachoma Atlas for 2018. Data on complex emergencies were obtained from the Armed Conflict Location and Event Data Project for 2018-2019. NTD and conflict data were summarised and mapped. A decision tree was developed using NTD mapping, endemicity, MDA and implementing partners data, together with conflict status information at district level. South Sudan was used as a case study, given its current nexus of high NTD prevalence, incidences of conflict, and the presence of a national NTD programme and supporting partners.
For the five NTDs, between 26 and 41 countries required PC, 69.2-212.7 million people were treated with coverage between 54.8-71.4%. In total 15,273 conflict events were reported including high rates of violence against civilians (29.4%), protests (28.8%), and battles (18.1%). The decision tree process included four main steps including i) information gathering ii) determine a disease mapping strategy iii) determine an MDA implementation strategy and iv) create a disease and conflict database. Based on these steps, risk maps were created. The South Sudan case study on onchocerciasis found the majority of the districts requiring mapping or MDA had a conflict event, and required specialised methods adapted to context and risk, with support from implementation partners in selected areas.
The paper presents a new methodological approach for implementing safe and effective mapping and intervention strategies in NTD endemic countries with ongoing complex emergencies, which will help to address challenges and make progress toward the NTD Roadmap targets of 2030.
冲突和政治不稳定引发的复杂紧急情况，对各国的被忽视热带病（NTD）控制及消除计划构成重大挑战，在撒哈拉以南非洲地区尤为如此。目前，尚无国家计划在这些人道主义情况下开展活动及进行规划的正式指南，因此本研究的目的是开发一种新的方法，用于就实施安全有效的绘图及大规模药物给药（MDA）干预策略做出决策。
该研究聚焦于世界卫生组织非洲区域（AFR）的47个国家。NTD数据基于预防性化疗（PC）所控制的五种疾病（即淋巴丝虫病、盘尾丝虫病、血吸虫病、土壤传播的蠕虫病、沙眼），数据取自世界卫生组织数据门户网站及《2018年全球沙眼地图集》。复杂紧急情况的数据取自2018 - 2019年武装冲突地点和事件数据项目。对NTD和冲突数据进行了汇总和绘图。利用NTD绘图、地方病流行情况、MDA及实施伙伴数据，以及地区层面的冲突状况信息，开发了一个决策树。以南苏丹作为案例研究，因其当前NTD高流行率、冲突发生率并存，且有国家NTD计划及支持伙伴。
对于这五种NTD，有26至41个国家需要进行PC，接受治疗的人数为6920万至2.127亿，覆盖率在54.8%至71.4%之间。共报告了15273起冲突事件，包括针对平民的高暴力发生率（29.4%）、抗议活动（28.8%）和战斗（18.1%）。决策树过程包括四个主要步骤，即i）信息收集；ii）确定疾病绘图策略；iii）确定MDA实施策略；iv）创建疾病和冲突数据库。基于这些步骤，创建了风险地图。南苏丹盘尾丝虫病案例研究发现，大多数需要绘图或MDA的地区都发生过冲突事件，需要采用适合具体情况和风险的专门方法，并在选定地区得到实施伙伴的支持。
本文提出了一种新的方法，用于在持续存在复杂紧急情况的NTD流行国家实施安全有效的绘图和干预策略，这将有助于应对挑战，并朝着2030年NTD路线图目标取得进展。
