Abstract
Since 1950, the global urban population grew from 746 million to almost 4 billion and is expected to reach 6.4 billion by mid-century. Almost 90% of this increase will take place in Asia and Africa and disproportionately in urban slums. In this context, concerns about the amplification of several neglected tropical diseases (NTDs) are warranted and efforts towards achieving effective mass drug administration (MDA) coverage become even more important. This narrative review considers the published literature on MDA implementation for specific NTDs and in-country experiences under the ENVISION and END in Africa projects to surface features of urban settings that challenge delivery strategies known to work in rural areas. Discussed under the thematics of governance, population heterogeneity, mobility and community trust in MDA, these features include weak public health infrastructure and programs, challenges related to engaging diverse and dynamic populations and the limited accessibility of certain urban settings such as slums. Although the core components of MDA programs for NTDs in urban settings are similar to those in rural areas, their delivery may need adjustment. Effective coverage of MDA in diverse urban populations can be supported by tailored approaches informed by mapping studies, research that identifies context-specific methods to increase MDA coverage and rigorous monitoring and evaluation.
Highlights
Between 1950 and 2014, the global urban population grew from 746 million to almost 4 billion and is expected to reach 6.4 billion by mid-century
A narrative review of the literature on mass drug administration (MDA) implementation and the experiences of neglected tropical diseases (NTDs) programs supported by the ENVISION and END in Africa projects revealed several features unique to urban areas that challenge MDA delivery strategies known to work in rural areas
Recent study suggests that MDA for lymphatic filariasis (LF) may not be necessary in many West African cities [26] where levels of infection are low and where the disease is transmitted by Culex spp., much less effective vectors for Wuchereria bancrofti than the Anopheles spp. common in rural areas [26]
Summary
Between 1950 and 2014, the global urban population grew from 746 million to almost 4 billion and is expected to reach 6.4 billion by mid-century. A subset are considered ‘preventive chemotherapy and transmission control’ or PCT NTDs as they can be controlled or eliminated through periodic MDA campaigns in eligible populations without requiring individual diagnosis [5] These include lymphatic filariasis (LF), onchocerciasis, schistosomiasis, trachoma and the soil-transmitted helminth infections (STHs; roundworms, hookworms and whipworms), which account for more disability adjusted life-years than malaria. In this narrative review we consider unpublished national program experiences and the limited published literature to highlight urban-specific implementation challenges as well as promising strategies to increase MDA coverage in these settings Many of these strategies are based on reports from program implementors as few pre-post evaluations of programmatic adaptations are available. Emerging from this discussion is a proposed research agenda to more effectively direct urban MDA investments towards globally endorsed disease control and prevention or elimination objectives
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