title: Developing an integrated implementation plan for control and elimination of NTDs: Nationwide mapping surveys for lymphatic filariasis, schistosomiasis and soil-transmitted helminthiasis in Zambia
Creators: name: Nsakashalo-Senkwe, Mutale
Publisher: name: University of Liverpool Repository
Year: 2023

description: Zambia, like most countries in Southern Africa, is non-endemic for onchocerciasis. However, this also means that, unlike many African countries experienced in community-directed delivery of medicines for helminthiasis, Zambia is relatively naive to preventive chemotherapy and associated delivery strategies, such as community-based mass drug administration (MDA). The current integrated approach the WHO is promoting for control of neglected tropical diseases (NTDs) targets conditions that are amenable to preventive chemotherapy using ivermectin (IVM) or diethylcarbamazine (DEC) with albendazole (ALB) for lymphatic filariasis (LF), ivermectin for onchocerciasis, praziquantel (PZQ) for schistosomiasis (SCH) and ALB or mebendazole (MBD) for soil-transmitted helminthiasis (STH) is recommended for Zambia. Recent advancements and external assistance to the country has supported the initiation of these programmes. In areas free of onchocerciasis, the WHO guidelines for helminth control advise intervention through community-directed MDA strategies using DEC and ALB for LF. The first plan recommended for SCH and STHs control is co-administration of PZQ and ALB through targeted large-scale distribution using a school-based treatment delivery system targeting all school-age children. Following several sporadic studies, Zambia is a developing country that has produced evidence of LF, SCH and STH, which are widespread and amenable to MDA and controlled on the same platform. Past and current information outlines that active transmission of these NTDs is ongoing and needs urgent intervention to control morbidity. In six chapters addressing specific topics, this PhD study will be in line with the WHO Global Programmes for the control of NTDs using an integrated strategy including capacity development for mapping and monitoring and evaluation as central to this project. The aim is to review the national policies on NTDs and construct solutions to address the main gaps and challenges as the country plan to scale up integrated interventions for control and elimination of specific NTDs based on the study findings. With evidence from nationwide mapping surveys for LF, SCH and STH in Zambia. A significant decrease in LF prevalence from the years 2003–2005 (11.5% CI95 6.6; 16.4) to 2012–2014 (0.6% CI95 0.03; 1.1); a significant scale-up of ITNs across the country from 0.2% (CI95 0.0; 0.3) to 76.1% (CI95 71.4; 80.7), respectively. ITN coverage was a better predictor of LF prevalence than a year alone with a significant Spearman’s correlation of -.462 at the 0.01 level (2-tailed), R²= 0.1878 (year alone) And 0.2837 (year and ITN coverage). Thirty-nine thousand nine hundred four children tested for SCH and STH in 1349 schools. The overall prevalence of schistosomiasis is 16.6 %, while STH was 22.0 %. The highest prevalence was reported in Lusaka (65.3 %) and Northwestern (41.9 %) for SCH and STH, respectively. Most participants were aged 10-12 years and had the highest prevalence of S. haematobium, followed by 13-15 years who had the highest prevalence of hookworm. Pearson Chi-Square test on age group indicated statistically significant difference at 4 degrees of freedom X²=372.766 (S. mansoni), X²=353.108, (hookworm) and X²=94.965 (A. lumbricoides) at p&lt;0.0005. Univariate and multivariate analysis revealed a correlation on the independent environmental and climatic predictors with SCH and STH prevalence. The general information collected from this research will be used for policy development and provide direction for the National Neglected Tropical Diseases programme in line with the National Health Strategic Plan 2017- 2021 that focuses on primary health care and community health approaches. Currently, no nationwide MDA campaigns for SCH and STH is implemented, but LF MDAs have been going on since 2012/13 and have already reached the fifth round in one province. Therefore, the MoH NTD policy or strategic plan will be comprehensively revised to highlight the national NTD goals, strategic objectives, and key performance indicators for the next five years and beyond. The putative synergy of LF prevalence with vector control has provided evidence that helped to put Zambia on track to meet national and global goals of LF elimination by 2020. The distribution of SCH and STH is widespread, with varying risks of transmission. The maps produced will provide evidence on the areas targeted for interventions in Zambia.