A Research Agenda for Helminth Diseases of Humans: Health Research and Capacity Building in Disease-Endemic Countries for Helminthiases Control

Capacity building in health research generally, and helminthiasis research particularly, is pivotal to the implementation of the research and development agenda for the control and elimination of human helminthiases that has been proposed thematically in the preceding reviews of this collection. Since helminth infections affect human populations particularly in marginalised and low-income regions of the world, they belong to the group of poverty-related infectious diseases, and their alleviation through research, policy, and practice is a sine qua non condition for the achievement of the United Nations Millennium Development Goals. Current efforts supporting research capacity building specifically for the control of helminthiases have been devised and funded, almost in their entirety, by international donor agencies, major funding bodies, and academic institutions from the developed world, contributing to the creation of (not always equitable) North–South “partnerships”. There is an urgent need to shift this paradigm in disease-endemic countries (DECs) by refocusing political will, and harnessing unshakeable commitment by the countries' governments, towards health research and capacity building policies to ensure long-term investment in combating and sustaining the control and eventual elimination of infectious diseases of poverty. The Disease Reference Group on Helminth Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), was given the mandate to review helminthiases research and identify research priorities and gaps. This paper discusses the challenges confronting capacity building for parasitic disease research in DECs, describes current capacity building strategies with particular reference to neglected tropical diseases and human helminthiases, and outlines recommendations to redress the balance of alliances and partnerships for health research between the developed countries of the “North” and the developing countries of the “South”. We argue that investing in South–South collaborative research policies and capacity is as important as their North–South counterparts and is essential for scaled-up and improved control of helminthic diseases and ultimately for regional elimination

Hansen's disease: The need for increased healthcare provider awareness and re-training

CONTEXT: Leprosy continues to be a challenge worldwide. In 2009, the World Health Organisation (WHO) reported 244,796 new cases worldwide. Of this, South East Asia, South Americas and Africa have the highest number of new cases. OBJECTIVE: To highlight misdiagnosis of Hansen's disease as a drawback to eradication of leprosy.MATERIALS:  A retrospective study of cases of Hansen's disease misdiagnosed by clinicians who were seen in the skin clinics of two tertiary institutions in South-East Nigeria over a one year period.RESULTS: Of the nine misdiagnosed cases, three were females while six were males. Apart from one child of six years old, the rest of the patients were adults. Referring diagnoses included chronic osteomyelitis, acromegaly, dermatitis and depression.  One of the patients presented with a reversal reaction (erythema nodosum leprosum) following treatment in a peripheral health facility. Confirmation of the diagnosis was based on slit skin smears for Acid Fast Bacilli carried out in the side laboratory of skin clinic UNTH, Ituku-Ozalla, Enugu state (four patients) and mile four hospital, Abakaliki, Ebonyi State( three patients). All the smears were positive. Patients were commenced on multi drug therapy and all showed marked clinical improvement following drug therapy. CONCLUSION: Eradication of leprosy may not be feasible if health care providers are ignorant of the different presentations of the disease. A high index of suspicion for leprosy is needed among health care workers in endemic areas. Development of tools for early diagnosis and detection of infection, improvement in existing tools for data collection, provision of guidelines and training materials on vital information for leprosy control will all contribute to the continued success of the National Tuberculosis and Leprosy Control Programme in Nigeria.KEYWORDS: Hansen's disease, leprosy, early detection, drug therap

African Programme for Onchocerciasis Control 1995-2015: Model-Estimated Health Impact and Cost

Background: Onchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated annual mass treatment with ivermectin in 16 countries. In this study, we estimate the health impact of APOC and the associated costs from a program perspective up to 2010 and provide expected trends up to 2015