NTD Research Perspectives: Insights from Young Professionals on Optimizing NTD Prevention & Treatment Strategies

Deborah Ola, our NTD SYP Ambassador spoke with Anuja Jani and Fathema Ghare to learn more about their research on optimizing NTD prevention and treatment strategies

Deborah: Can you tell us a little bit about yourselves, what you do, and how you got involved with NTD research?

Fathema: Anuja and I are Master of Public Health graduates from the University of Western Ontario and I am currently doing my internship at the World Federation of Public Health Associations. While we were completing our public health program, we had the opportunity to work on a project related to infectious diseases, and we were working on African Sleeping Sickness, which is an NTD. So we both became very interested in this topic.

Anuja: I am currently working as a health promoter with Public Health Sudbury & Districts, and I’ve briefly worked with the Canadian Red Cross where I had the chance to volunteer on other global projects. Also, during COVID, I worked in India and started my project related to [COVID-19] surveillance in rural areas.

Deborah: Do you mind telling me a bit more about the kind of research you’re doing currently?

Fathema: We worked on a literature review where we worked on a couple of NTDs. We focused on dracunculiasis, lymphatic filariasis, schistosomiasis, trachoma, onchocerciasis, and soil-transmitted helminthiasis, and we wanted to know the kind of interventions that were currently being implemented to prevent these diseases. Through a preliminary search of the literature, we found that these diseases [with the exception of dracunculiasis] are usually controlled through preventative chemotherapy, and this is implemented through Mass Drug Administration (MDA), an intervention where medication is distributed to entire populations [in areas endemic for each NTD to treat, prevent and eliminate infection]. This is usually done through members of the community, so we were interested in learning what kind of barriers and challenges were faced at the local level. We performed an in-depth analysis and identified several community-level barriers and presented our abstract ‘Optimizing Implementation Strategies to Reduce NTD Burden in the African Continent’ at the 2022 Canadian Conference for Global Health. We are currently preparing a manuscript for publication.

Deborah: How did you carry out this specific research?

Anuja: …We started with a scoping review, and scanned fields we thought were relevant. NTDs aren’t isolated to the African continent, but we decided to focus on this region as it is more extensively researched. From there, we identified some of the challenges, barriers, stakeholder views, and solutions that are presented by the researchers.

Deborah: What have you learned throughout your research?

Anuja: NTDs impact over a billion people, we’re stressing that because the issue is quite huge. [Lots of] work has been done so far but research and program funding still remain limited. Some of the barriers we identified were first and foremost the general lack of infrastructure and capacity to perform disease mapping and surveillance, and the way this impacts the communities when these drug administration projects are implemented. Another barrier we came across is [motivation among community] drug distributors … and inadequate supervision. This is a systemic problem, if these workers aren’t getting paid, they’re not getting trained, they don’t have adequate PPE, or they have to travel far, this can lead to burnout and fatigue. We [program implementers] want these workers to feel that they’re doing an important job and are adequately supported.

Other barriers we came across were community mistrust, misinformation, low health literacy, and resource scarcity. When we are giving out these drugs, we are not addressing underlying problems such as lack of sanitation, or healthy behavior issues faced by the community, so once the drug treatment is done these diseases are still reappearing. MDAs are cost-effective and make huge advancements in controlling NTDs in several countries, but we’re not addressing some of the underlying issues that are faced by these communities. Lastly, there is a lack of accounting for socio-economic and contextual factors that these communities are facing. For example, school [mass] drug administration efforts would miss children who don’t attend school or are attending schools elsewhere and come back to the community during breaks.

Fathema: I just wanted to add that when you think about all of these barriers, you also realize that these barriers are varied. So, having different interventions that target these barriers and target these issues would be more comprehensive and more effective as a supplementary component to MDA. We need to understand the local context, what are the social, economic, or political circumstances in the communities? By understanding these determinants, we can implement much more comprehensive interventions that address the social determinants of health and have a more equitable approach to implementation. We need to include community members to implement these programs so we can understand how to enhance our programs and coverage. Community members can act as advocates for these interventions and there is a higher chance families and communities will be more accepting of these drugs.

Anuja: To add to that, some of the research also talked about gender roles. There are some women who show interest in participating in drug distribution and educating the community in the benefits of taking these drugs and what needs to be done to prevent NTDs. It was quite nice that program implementers take that into consideration, to build [community] leaders and increase more participation of women in decision-making.

Deborah: What would you like Canadians to know about the work that you do?

Fathema: One of the things we realized is that NTD prevention can’t have a one-size-fits-all approach because interventions are implemented in communities that are dynamic and are influenced by socio-cultural factors. This is where further research can help us understand these complex factors and how we can improve them. We also need international agencies to support capacity building. We need to focus on underlying factors like sanitation and we need a more comprehensive approach to interventions.

Deborah: How do you think youth and young professionals can play a role in NTD elimination?

Fathema: The best way youth can get involved is by raising awareness to help increase the understanding of these diseases and encouraging people to take action towards it. We can do this by participating in advocacy campaigns, using social media to raise awareness, or speaking to our peers about these diseases. We also need the involvement of youth from different sectors to allow for a more collaborative approach and bring in diverse perspectives and opinions on how to tackle this problem.

Deborah: Thank you so much! Is there anything you would like to add about your involvement in NTDs?

Anuja: We want to speak more about some of the solutions that were proposed during our research. One of them is enhanced program management and staff retention. Workers are quite demotivated, so implementors and local health care systems need to ensure that workers are getting appropriate support. Another thing that has come up is focusing on risk assessment and strategic planning. There needs to be a plan drafted beforehand so when situations such as disease outbreaks, conflict, and climate change arise, there is capacity to adequately respond to these situations. An issue with MDA is antibiotic resistance which is an area that needs strong advocacy…[and] awareness. Other approaches also include governance within these countries and addressing when competing priorities result in the voice of the community getting sidetracked. Sometimes there are internal biases within local stakeholders where they think the sanitation situation will always be bad or there is no hope of improvement so, “why bother?” These are some of the issues that need to be addressed, and we can do this by building local capacity and creating local and community leaders.