Tailoring mass drug administration to context: implementation research is critical in achieving equitable progress in the control and elimination of helminth neglected tropical diseases in sub-Saharan Africa
Country Manager: Louis-Albert Tchuem-Tchuenté
Cameroon is situated in Central Africa and has a population of nearly 23 million and an annual growth rate of 2.6%. It is divided into 10 regions with 181 health districts, which form the implementation unit for all health activities. The country has Schistosomiasis, Soil Transmitted Helminths, Onchocerciasis, Trachoma and Lymphatic Filariasis. These diseases have been fully mapped throughout the country. They have many districts with all major Neglected Tropical Diseases and a wide range of co-endimicity.
Cameroon has six Neglected Tropical Disease programmes for: Onchocerciasis; Human African Trypanosomiasis, Buruli Ulcer, Yaws, Leishmaniasis, Leprosy, schistosomiasis, Soil Transmitted Helminths, Lymphatic Filariasis and Trachoma. These are coordinated by a central unit that was created in 2013. Cameroon has a Neglected Tropical Disease Master Plan which runs from 2012 – 2016. Its vision is to reduce Neglected Tropical Diseases so that they are no longer a socio-economic impediment in the country. Guinea Worm has been eradicated and a surveillance programme remains.
Cameroon has an integrated campaign for all the diseases and a joint planning process at national, regional, and district levels. Funding comes from the state, USAID, RTI, ENVISION and Helen Keller International. There are three main strategies: school-based interventions for Schistosomiasis and Soil Transmitted Helminths; community based interventions for Onchocerciasis, Lymphatic Filariasis and Trachoma; and deworming pre-school age children during vaccination campaigns.
This requires cross-sectoral collaboration within government and there is a Memorandum of Understanding between the Ministry of Health, the Ministry of Education, the Ministry for Secondary Education, and the United Councils of Cameroon. Non-governmental organisations support national leadership and are coordinated through Helen Keller International.
Challenges persist in the implementation of the Neglected Tropical Disease programme. There is insufficient funding for supervision and monitoring and evaluation of campaigns which affects data collection. There is insufficient funding for impact studies and no standard data capture platform (mobile or e-tools) or centralised database.
There are difficulties related to the health workforce. For example, Community Drug Distributors paid by treatment. However, there are delays in payment which decreases motivation and leads to attrition. There is competition for community health workers with other health programmes who can often pay more.
In some districts they have decided to treat with praziquantel twice a year because there are high re-infection rates.
There is an absence of vector controls. Bed net distribution has mainly been targeted at pregnant women. There needs to be more awareness raised within communities, that bed nets are also helpful for Lymphatic Filariasis .
There is a need to scale up integrated access to preventive chemotherapy and Community-Led Total Sanitation for schistosomiasis and Soil-Transmitted Helminths; whilst promoting equitable access for pre-school aged children, out of school children and adults. Cameroon also needs strategies for hot spots where there is Onchocerciasis and Loa Loa co-endemicity.