Implementing preventive chemotherapy through an integrated National Neglected Tropical Disease Control Program in Mali

Abstract

Background: Mali is endemic for all five targeted major neglected tropical diseases (NTDs). As one of the five 'fast-track' countries supported with the United States Agency for International Development (USAID) funds, Mali started to integrate the activities of existing disease-specific national control programs on these diseases in 2007. The ultimate objectives are to eliminate lymphatic filariasis, onchocerciasis and trachoma as public health problems and to reduce morbidity caused by schistosomiasis and soil-transmitted helminthiasis through regular treatment to eligible populations, and the specific objectives were to achieve 80% program coverage and 100% geographical coverage yearly. The paper reports on the implementation of the integrated mass drug administration and the lessons learned.

Methodology/principal findings: The integrated control program was led by the Ministry of Health and coordinated by the national NTD Control Program. The drug packages were designed according to the disease endemicity in each district and delivered through various platforms to eligible populations involving the primary health care system. Treatment data were recorded and reported by the community drug distributors. After a pilot implementation of integrated drug delivery in three regions in 2007, the treatment for all five targeted NTDs was steadily scaled up to 100% geographical coverage by 2009, and program coverage has since been maintained at a high level: over 85% for lymphatic filariasis, over 90% for onchocerciasis and soil-transmitted helminthiasis, around 90% in school-age children for schistosomiasis, and 76-97% for trachoma. Around 10 million people have received one or more drug packages each year since 2009. No severe cases of adverse effects were reported.

Conclusions/significance: Mali has scaled up the drug treatment to national coverage through integrated drug delivery involving the primary health care system. The successes and lessons learned in Mali can be valuable assets to other countries starting up their own integrated national NTD control programs.

Figure 1. The NTD control program coordination structure in Mali.

Figure 2. Endemic situation shown as number of major target NTDs in each district in Mali.

LF: lymphatic filariasis; ONCH: onchocerciasis; SCH: schistosomiasis; STH: soil-transmitted helminthiasis; TRA: trachoma. In Kidal region, the endemicity level of schistosomiasis in each district is not yet clear and further mapping is planned.

Figure 3. Drug packages required for each district according to the WHO PCT guidelines.

MDA1: ivermectin+albendazole; T2: praziquantel, ZTM: Zithromax. In Kidal region the endemicity level of schistosomiasis in each district is not yet clear and further mapping is planned.

Figure 4. Percentage expenditure of the NTD program activities for the first four rounds of MDA.