Abstract
BackgroundLess is known about mass drug administration [MDA] for neglected tropical diseases [NTDs] than is suggested by those so vigorously promoting expansion of the approach. This paper fills an important gap: it draws upon local level research to examine the roll out of treatment for two NTDs, schistosomiasis and soil-transmitted helminths, in Uganda.MethodsEthnographic research was undertaken over a period of four years between 2005-2009 in north-west and south-east Uganda. In addition to participant observation, survey data recording self-reported take-up of drugs for schistosomiasis, soil-transmitted helminths and, where relevant, lymphatic filariasis and onchocerciasis was collected from a random sample of at least 10% of households at study locations. Data recording the take-up of drugs in Ministry of Health registers for NTDs were analysed in the light of these ethnographic and social survey data.ResultsThe comparative analysis of the take-up of drugs among adults revealed that although most long term residents have been offered treatment at least once since 2004, the actual take up of drugs for schistosomiasis and soil-transmitted helminths varies considerably from one district to another and often also within districts. The specific reasons why MDA succeeds in some locations and falters in others relates to local dynamics. Issues such as population movement across borders, changing food supply, relations between drug distributors and targeted groups, rumours and conspiracy theories about the 'real' purpose of treatment, subjective experiences of side effects from treatment, alternative understandings of affliction, responses to social control measures and historical experiences of public health control measures, can all make a huge difference. The paper highlights the need to adapt MDA to local circumstances. It also points to specific generalisable issues, notably with respect to health education, drug distribution and more effective use of existing public health legislation.ConclusionWhile it has been an achievement to have offered free drugs to so many adults, current standard practices of monitoring, evaluation and delivery of MDA for NTDs are inconsistent and inadequate. Efforts to integrate programmes have exacerbated the difficulties. Improved assessment of what is really happening on the ground will be an essential step in achieving long-term overall reduction of the NTD burden for impoverished communities.
Highlights
Global aspirations to achieve the Millennium Development Goals by ‘making poverty history’ and alleviating the suffering of ‘the bottom billion’ has generated unprecedented attention on a range of predominantly parasitic and bacterial infections endemic in large parts of sub-Saharan Africa
Ivermectin has been distributed on an annual basis in Moyo and Adjumani districts since the early part of 2000 and it has been distributed in Panyimur, Nebbi district since August 2008
Self-reported uptake of drugs in Panyimur sub-county, Nebbi District To start with Panyimur: it was possible to use Ministry of Health registers in Panyimur to gauge the proportion of adults that were re-treated for schistosomiasis and soil-transmitted helminths in 2007, compared to 2004 and 2005
Summary
Global aspirations to achieve the Millennium Development Goals by ‘making poverty history’ and alleviating the suffering of ‘the bottom billion’ has generated unprecedented attention on a range of predominantly parasitic and bacterial infections endemic in large parts of sub-Saharan Africa. A great deal of optimism surrounds mass drug administration [MDA] programmes Numerous publications emphasise their potential to alleviate sickness and suffering (see, for example, Brady et al [1]; Engel et al [2]; Fenwick et al [3]; Fenwick [4]; Molyneux et al [5]; Molyneux et al [6]; Manderson et al [7]; Hotez [8]; Hotez et al [9]) and the majority of reported results are presented in a positive light (see, for example, Kabatereine et al [10]; Kabatereine et al [11]; Knopp et al [12]; Standley et al [13]; Yu et al [14].) In its first major report on NTDs, published in 2010, the Director-General of the World Health Organisation claims that nearly 670 million people had been reached with preventive chemotherapy by the end of 2008. This paper fills an important gap: it draws upon local level research to examine the roll out of treatment for two NTDs, schistosomiasis and soil-transmitted helminths, in Uganda
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