Analytical summary - Neglected tropical diseases
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Neglected tropical diseases remain a major concern in Sierra Leone. The rapidity with which they can cause deaths and the possibility of them becoming more widespread over the years make them diseases of major concern. However, because of their neglect, reliable data on the incidence and mortality from these diseases are scarce. Soil-transmitted helminths, onchocerciasis, lymphatic filariasis and yaws are the most important neglected tropical diseases in Sierra Leone.
Yaws has recently re-emerged as a significant disease in some districts of the Northern Region, requiring public health intervention. There has been no survey done on yaws and so no data are available at present, but the Ministry of Health and Sanitation, in collaboration with WHO, is planning to conduct a survey in the known epidemic district of Bombali.
Human African trypanosomiasis and leishmaniasis are yet to be investigated in Sierra Leone.
Surveillance is continuing for Buruli ulcer, though this is not proven to be endemic at present.
WHO granted eradication status for dracunculiasis (also known as guinea worm disease) to Sierra Leone in 2007 and active surveillance was started and is continuing. There has been no case detected since 2006. All suspected cases reported were incompatible with dracunculiasis on investigation.
Leprosy remains a disease of public health importance in Sierra Leone. The main thrusts of the National Leprosy and Tuberculosis Control Programme are the integration of tuberculosis (TB) and leprosy services into the primary health care systems and the reduction of the TB and leprosy burden by effective diagnosis and treatment until the diseases cease to be public health problems.
The Ministry of Health and Sanitation, in collaboration with WHO and other partners, has developed the National Leprosy and Tuberculosis Control Programme Strategic Plan 2007–2011. The focus of this plan includes:
- expansion of DOTS (the basic package that underpins the Stop TB Strategy) implementation and multidrug therapy services;
- drug supply for anti-TB and antileprosy drugs;
- strengthening surveillance, monitoring and evaluation for multidrug-resistant TB;
- strengthening laboratory networks, services and operational research for TB and leprosy control.
All districts in Sierra Leone are endemic for lymphatic filariasis. The control of lymphatic filariasis was integrated into the Onchocerciasis Control Programme in 2006. The Ministry has put in place a mass drug administration mechanism for the control of lymphatic filariasis as well as for onchocerciasis.
Schistosomiasis is an emerging disease in six districts (Bo, Kailahun, Kenema, Koinadugu, Kono and Tonkolili) and has become a disease of public health concern. WHO is supporting the Ministry to scale-up the study to include the remaining six districts, including the Western Area, and utilize this information to target the high prevalence areas in order to develop a plan of action for treatment of schoolchildren. The Ministry of Agriculture, Forestry and Food Security is also mapping out the areas infested by schistosomiasis as part of occupational hazard prevention for their workers in rice swamp farms. The Ministry is also implementing mass drug administration for the control of schistosomiasis country wide.
The scale of infection with intestinal helminthiasis is enormous. WHO is providing funding and technical support towards mapping of the types of worm in the districts, while the Ministry of Health and Sanitation is implementing mass drug administration for the control of soil-transmitted helminths country wide.
Trachoma prevalence is below 1%, therefore mass drug administration is not recommended and individual cases are treated by the eye care programme.
The surveillance status for neglected tropical diseases in Sierra Leone is as follows:
- completed mapping for lymphatic filariasis, onchocerciasis, soil-transmitted helminths, trachoma and schistosomiasis, and achieved 100% geographic coverage in 2010;
- first impact assessment survey conducted in June 2011;
- second impact assessment survey planned for 2013;
- transmission assessment survey planned for 2014–2015;
- Buruli ulcer – surveillance is continuing, not proven endemic in Sierra Leone at present;
- Guinea worm – surveillance is continuing;
- trachoma prevalence is below 1%.