Neglected tropical diseases (NTDs) impact nearly 1.7 billion people each year, causing serious illness or lifelong disability among many—often leading to stigma and exclusion—and killing an estimated 200,000. The vast majority of sufferers live in the world’s poorest countries.
The World Health Organization’s NTD roadmap 2021-2030 aims to address 20 tropical diseases through prevention, control, elimination, and/or eradication. But despite some progress, reaching all its targets will take better, far more accessible diagnostics and treatments along with more robust strategies, political commitment and resources.
To mark World NTD Day 2024, the Collection linked below spotlights work by MSF and collaborators on improving approaches to snakebite envenoming, kala azar and noma. One study presents an innovative artificial intelligence-based snakebite diagnostic tool, while others evaluate shorter, less toxic drug regimens or different models of care. Several commentaries advocate for national/regional strategies adapted to contexts ranging from remote villages to active conflict zones. Another crucial factor is the climate crisis, which is intensifying the transmission and geographic spread of many NTDs.
10 result(s)
Journal Article > CommentaryFull Text
PLoS Negl Trop Dis. 2023 March 23; Volume 17 (Issue 3); e0011188.
Boodman C, van Griensven J, Gupta N, Diro EGJ, Ritmeijer KKD
PLoS Negl Trop Dis. 2023 March 23; Volume 17 (Issue 3); e0011188.
Journal Article > CommentaryFull Text
Toxicon: X. 2023 February 26; Volume 18; 100152.
Dalhat MM, Potet J, Mohammed A, Chotun N, Tesfahunei HA, et al.
Toxicon: X. 2023 February 26; Volume 18; 100152.
Africa remains one of the regions with the highest incident and burden of snakebite. The goal of the World Health Organization to halve the global burden of snakebite by 2030 can only be achieved if sub-optimal access to antivenoms in the most affected regions is addressed. We identified upstream, midstream, and downstream factors along the antivenom value chain that prevent access to antivenoms in the African region. We identified windows of opportunities that could be utilized to ensure availability, accessibility, and affordability for snakebite endemic populations in Africa. These include implementation of multicomponent strategies such as intensified advocacy, community engagement, healthcare worker trainings, and leveraging the institutional and governance structure provided by African governments to address the challenges identified.
Journal Article > CommentaryFull Text
Toxicon: X. 2022 December 21; Volume 17; 100146.
Potet J, Singh SN, Ritmeijer KKD, Sisay K, Alcoba G, et al.
Toxicon: X. 2022 December 21; Volume 17; 100146.
The medical humanitarian organization Médecins Sans Frontières (MSF) provides medical care in more than 70 countries and admits more than 7000 cases of snakebite in its facilities each year.
We describe our activities against snakebite in three African countries: Central African Republic, South Sudan and Ethiopia, in which different models of care have been developed. A standard protocol using two different antivenoms depending on the patient's syndrome has been introduced, and a simple blood coagulation test is performed to detect venom-induced coagulopathy. Other services, including surgery for necrotizing wounds, are offered in the facilities where MSF admits a large number of snakebite patients. All services, including provision of antivenom, are offered free-of-charge in MSF-supported facilities. Community-based activities focusing on preventive measures and prompt transport to hospital have been developed in a few MSF projects.
The provision of quality care and treatment, including effective antivenoms, without out-of-pocket payments by the patients, probably explains why MSF has admitted an increasing number of snakebite victims over the last years. This model requires significant resources and monitoring, including regular training of healthcare workers on treatment protocols and a considerable budget for antivenom procurement.
We describe our activities against snakebite in three African countries: Central African Republic, South Sudan and Ethiopia, in which different models of care have been developed. A standard protocol using two different antivenoms depending on the patient's syndrome has been introduced, and a simple blood coagulation test is performed to detect venom-induced coagulopathy. Other services, including surgery for necrotizing wounds, are offered in the facilities where MSF admits a large number of snakebite patients. All services, including provision of antivenom, are offered free-of-charge in MSF-supported facilities. Community-based activities focusing on preventive measures and prompt transport to hospital have been developed in a few MSF projects.
The provision of quality care and treatment, including effective antivenoms, without out-of-pocket payments by the patients, probably explains why MSF has admitted an increasing number of snakebite victims over the last years. This model requires significant resources and monitoring, including regular training of healthcare workers on treatment protocols and a considerable budget for antivenom procurement.
Conference Material > Video (talk)
McIver L
MSF Paediatric Days 2022. 2022 December 1
Conference Material > Abstract
Ajamah S, Tanaka M, De Vore K, Vogiazou Y, Joseph S, et al.
MSF Paediatric Days 2022. 2022 November 26
BACKGROUND AND AIMS
The Noma hospital in Sokoto State, Nigeria, provides specialised care for noma, a rapidly progressive and often fatal necrotising bacterial disease, which continues to be neglected. This project was initiated and is led by the Noma project team in collaboration with the Sapling Nursery fund (MSF UK) who provide resources and support. Through community-based exploratory assessments, it was found that caregivers do not have enough resources, knowledge and overall capacity to continue with the necessary treatment and care after discharge. Patients are too often re-admitted in worse condition than before. This highlights a serious gap in the continuity of care, which the Noma Discharge Toolkit (NDT) aims to improve.
METHODS
Person-centered design methodologies aiming to improve quality of care were central to toolkit development. Individual interviews and group sessions led to the identification of needs and challenges, while also exploring potential solutions. The resulting NDT contains four components to support care after discharge:
--Locally sourced food items (Kwash-pap) and RUTF (Plumpy-nut);
--Non-food items for hygiene and transport/storage;
--Medication and treatment;
--Knowledge/engagement booklet.
The feasibility of the NDT was investigated using qualitative data collection methods to understand the perceived benefit by caregivers and hospital staff.
RESULTS
The pilot is in an early stage and distribution data will be gathered and analysed in autumn 2022, but the NDT’s preliminary results are promising. It has been welcomely integrated within the team’s regular processes. Initial feedback is positive, highlighting how the kit gives necessary resources, while increasing engagement, knowledge and focus on quality of care. For the upcoming distribution data collection and analysis, formal ethics approval will be sought.
CONCLUSIONS
The process is this project’s strength – it demonstrates what can be accomplished when co-designing with community and hospital staff, while concretely showing the potential of person-centred design methodologies.
The Noma hospital in Sokoto State, Nigeria, provides specialised care for noma, a rapidly progressive and often fatal necrotising bacterial disease, which continues to be neglected. This project was initiated and is led by the Noma project team in collaboration with the Sapling Nursery fund (MSF UK) who provide resources and support. Through community-based exploratory assessments, it was found that caregivers do not have enough resources, knowledge and overall capacity to continue with the necessary treatment and care after discharge. Patients are too often re-admitted in worse condition than before. This highlights a serious gap in the continuity of care, which the Noma Discharge Toolkit (NDT) aims to improve.
METHODS
Person-centered design methodologies aiming to improve quality of care were central to toolkit development. Individual interviews and group sessions led to the identification of needs and challenges, while also exploring potential solutions. The resulting NDT contains four components to support care after discharge:
--Locally sourced food items (Kwash-pap) and RUTF (Plumpy-nut);
--Non-food items for hygiene and transport/storage;
--Medication and treatment;
--Knowledge/engagement booklet.
The feasibility of the NDT was investigated using qualitative data collection methods to understand the perceived benefit by caregivers and hospital staff.
RESULTS
The pilot is in an early stage and distribution data will be gathered and analysed in autumn 2022, but the NDT’s preliminary results are promising. It has been welcomely integrated within the team’s regular processes. Initial feedback is positive, highlighting how the kit gives necessary resources, while increasing engagement, knowledge and focus on quality of care. For the upcoming distribution data collection and analysis, formal ethics approval will be sought.
CONCLUSIONS
The process is this project’s strength – it demonstrates what can be accomplished when co-designing with community and hospital staff, while concretely showing the potential of person-centred design methodologies.
Journal Article > ResearchFull Text
Clin Infect Dis. 2022 October 15; Volume 75 (Issue 8); 1423-1432.
Burza S, Mahajan R, Kazmi S, Alexander N, Kumar D, et al.
Clin Infect Dis. 2022 October 15; Volume 75 (Issue 8); 1423-1432.
BACKGROUND
Visceral leishmaniasis (VL) in patients living with Human-Immunodeficiency-Virus (HIV) present an increasingly important patient cohort in areas where both infections are endemic. Evidence for treatment is sparce, with no high-quality studies from the Indian sub-continent.
METHODS
This is a randomised open label, parallel arm phase-3 trial conducted within a single hospital in Patna, India. 150 patients aged =18 years with serologically confirmed HIV and parasitologically confirmed VL were randomly allocated to one of two treatment arms, either a total 40mg/kg intravenous liposomal amphotericin B(AmBisome) administered in 8 equal doses over 24-days, or a total 30mg/kg intravenous liposomal amphotericin B(AmBisome) administered in 6 equal doses given concomitantly with a total 1.4g oral miltefosine administered through two daily doses of 50mg over 14-days. The primary outcome was ITT relapse-free-survival at day-210, defined as absence of signs and symptoms of VL, or if symptomatic negative parasitological investigations.
FINDINGS
Among 243 patients assessed for eligibility, 150 were recruited between 2nd January 2017 and 5th April 2018, with no loss-to-follow-up. Relapse free survival at day-210 was 85%, (64/75; 95%CI 77-100) in the monotherapy arm, and 96%, (72/75;95%CI 90-100) in the combination arm. 19%(28/150) were infected with concurrent tuberculosis, divided equally between arms. Excluding those with concurrent tuberculosis, relapse free survival at day-210 was 90%, (55/61;95%CI 82-100) in the monotherapy and 97%, (59/61;95%CI 91-100) in the combination therapy arm. Serious adverse events were uncommon and similar in each arm.
CONCLUSIONS
Combination therapy appears to be safe, well tolerated and effective, and halves treatment duration of current recommendations.
Visceral leishmaniasis (VL) in patients living with Human-Immunodeficiency-Virus (HIV) present an increasingly important patient cohort in areas where both infections are endemic. Evidence for treatment is sparce, with no high-quality studies from the Indian sub-continent.
METHODS
This is a randomised open label, parallel arm phase-3 trial conducted within a single hospital in Patna, India. 150 patients aged =18 years with serologically confirmed HIV and parasitologically confirmed VL were randomly allocated to one of two treatment arms, either a total 40mg/kg intravenous liposomal amphotericin B(AmBisome) administered in 8 equal doses over 24-days, or a total 30mg/kg intravenous liposomal amphotericin B(AmBisome) administered in 6 equal doses given concomitantly with a total 1.4g oral miltefosine administered through two daily doses of 50mg over 14-days. The primary outcome was ITT relapse-free-survival at day-210, defined as absence of signs and symptoms of VL, or if symptomatic negative parasitological investigations.
FINDINGS
Among 243 patients assessed for eligibility, 150 were recruited between 2nd January 2017 and 5th April 2018, with no loss-to-follow-up. Relapse free survival at day-210 was 85%, (64/75; 95%CI 77-100) in the monotherapy arm, and 96%, (72/75;95%CI 90-100) in the combination arm. 19%(28/150) were infected with concurrent tuberculosis, divided equally between arms. Excluding those with concurrent tuberculosis, relapse free survival at day-210 was 90%, (55/61;95%CI 82-100) in the monotherapy and 97%, (59/61;95%CI 91-100) in the combination therapy arm. Serious adverse events were uncommon and similar in each arm.
CONCLUSIONS
Combination therapy appears to be safe, well tolerated and effective, and halves treatment duration of current recommendations.
Journal Article > ResearchFull Text
Clin Infect Dis. 2022 September 27; Online ahead of print; ciac643.
Musa AM, Mbui J, Mohammed R, Olobo J, Ritmeijer KKD, et al.
Clin Infect Dis. 2022 September 27; Online ahead of print; ciac643.
BACKGROUND
This study aimed to determine whether paromomycin plus miltefosine (PM/MF) is noninferior to sodium stibogluconate plus paromomycin (SSG/PM) for treatment of primary visceral leishmaniasis in eastern Africa.
METHODS
An open-label, phase 3, randomized, controlled trial was conducted in adult and pediatric patients at 7 sites in eastern Africa. Patients were randomly assigned to either 20 mg/kg paromomycin plus allometric dose of miltefosine (14 days), or 20 mg/kg sodium stibogluconate plus 15 mg/kg paromomycin (17 days). The primary endpoint was definitive cure after 6 months.
RESULTS
Of 439 randomized patients, 424 completed the trial. Definitive cure at 6 months was 91.2% (155 of 170) and 91.8% (156 of 170) in the PM/MF and SSG/PM arms in primary efficacy modified intention-to-treat analysis (difference, 0.6%; 97.5% confidence interval [CI], -6.2 to 7.4), narrowly missing the noninferiority margin of 7%. In the per-protocol analysis, efficacy was 92% (149 of 162) and 91.7% (155 of 169) in the PM/MF and SSG/PM arms (difference, -0.3%; 97.5% CI, –7.0 to 6.5), demonstrating noninferiority. Treatments were well tolerated. Four of 18 serious adverse events were study drug–related, and 1 death was SSG-related. Allometric dosing ensured similar MF exposure in children (< 12 years) and adults.
CONCLUSIONS
PM/MF and SSG/PM efficacies were similar, and adverse drug reactions were as expected given the drugs safety profiles. With 1 less injection each day, reduced treatment duration, and no risk of SSG-associated life-threatening cardiotoxicity, PM/MF is a more patient-friendly alternative for children and adults with primary visceral leishmaniasis in eastern Africa.
CLINICAL TRIALS REGISTRATION
NCT03129646.
This study aimed to determine whether paromomycin plus miltefosine (PM/MF) is noninferior to sodium stibogluconate plus paromomycin (SSG/PM) for treatment of primary visceral leishmaniasis in eastern Africa.
METHODS
An open-label, phase 3, randomized, controlled trial was conducted in adult and pediatric patients at 7 sites in eastern Africa. Patients were randomly assigned to either 20 mg/kg paromomycin plus allometric dose of miltefosine (14 days), or 20 mg/kg sodium stibogluconate plus 15 mg/kg paromomycin (17 days). The primary endpoint was definitive cure after 6 months.
RESULTS
Of 439 randomized patients, 424 completed the trial. Definitive cure at 6 months was 91.2% (155 of 170) and 91.8% (156 of 170) in the PM/MF and SSG/PM arms in primary efficacy modified intention-to-treat analysis (difference, 0.6%; 97.5% confidence interval [CI], -6.2 to 7.4), narrowly missing the noninferiority margin of 7%. In the per-protocol analysis, efficacy was 92% (149 of 162) and 91.7% (155 of 169) in the PM/MF and SSG/PM arms (difference, -0.3%; 97.5% CI, –7.0 to 6.5), demonstrating noninferiority. Treatments were well tolerated. Four of 18 serious adverse events were study drug–related, and 1 death was SSG-related. Allometric dosing ensured similar MF exposure in children (< 12 years) and adults.
CONCLUSIONS
PM/MF and SSG/PM efficacies were similar, and adverse drug reactions were as expected given the drugs safety profiles. With 1 less injection each day, reduced treatment duration, and no risk of SSG-associated life-threatening cardiotoxicity, PM/MF is a more patient-friendly alternative for children and adults with primary visceral leishmaniasis in eastern Africa.
CLINICAL TRIALS REGISTRATION
NCT03129646.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2022 August 15; Volume 16 (Issue 8); e0010647.
Bolon I, Picek L, Durso AM, Alcoba G, Chappuis F, et al.
PLoS Negl Trop Dis. 2022 August 15; Volume 16 (Issue 8); e0010647.
BACKGROUND
Snakebite envenoming is a neglected tropical disease that kills an estimated 81,000 to 138,000 people and disables another 400,000 globally every year. The World Health Organization aims to halve this burden by 2030. To achieve this ambitious goal, we need to close the data gap in snake ecology and snakebite epidemiology and give healthcare providers up-to-date knowledge and access to better diagnostic tools. An essential first step is to improve the capacity to identify biting snakes taxonomically. The existence of AI-based identification tools for other animals offers an innovative opportunity to apply machine learning to snake identification and snakebite envenoming, a life-threatening situation.
METHODOLOGY
We developed an AI model based on Vision Transformer, a recent neural network architecture, and a comprehensive snake photo dataset of 386,006 training photos covering 198 venomous and 574 non-venomous snake species from 188 countries. We gathered photos from online biodiversity platforms (iNaturalist and HerpMapper) and a photo-sharing site (Flickr).
PRINCIPAL FINDINGS
The model macro-averaged F1 score, which reflects the species-wise performance as averaging performance for each species, is 92.2%. The accuracy on a species and genus level is 96.0% and 99.0%, respectively. The average accuracy per country is 94.2%. The model accurately classifies selected venomous and non-venomous lookalike species from Southeast Asia and sub-Saharan Africa.
CONCLUSIONS
To our knowledge, this model’s taxonomic and geographic coverage and performance are unprecedented. This model could provide high-speed and low-cost snake identification to support snakebite victims and healthcare providers in low-resource settings, as well as zoologists, conservationists, and nature lovers from across the world.
Snakebite envenoming is a neglected tropical disease that kills an estimated 81,000 to 138,000 people and disables another 400,000 globally every year. The World Health Organization aims to halve this burden by 2030. To achieve this ambitious goal, we need to close the data gap in snake ecology and snakebite epidemiology and give healthcare providers up-to-date knowledge and access to better diagnostic tools. An essential first step is to improve the capacity to identify biting snakes taxonomically. The existence of AI-based identification tools for other animals offers an innovative opportunity to apply machine learning to snake identification and snakebite envenoming, a life-threatening situation.
METHODOLOGY
We developed an AI model based on Vision Transformer, a recent neural network architecture, and a comprehensive snake photo dataset of 386,006 training photos covering 198 venomous and 574 non-venomous snake species from 188 countries. We gathered photos from online biodiversity platforms (iNaturalist and HerpMapper) and a photo-sharing site (Flickr).
PRINCIPAL FINDINGS
The model macro-averaged F1 score, which reflects the species-wise performance as averaging performance for each species, is 92.2%. The accuracy on a species and genus level is 96.0% and 99.0%, respectively. The average accuracy per country is 94.2%. The model accurately classifies selected venomous and non-venomous lookalike species from Southeast Asia and sub-Saharan Africa.
CONCLUSIONS
To our knowledge, this model’s taxonomic and geographic coverage and performance are unprecedented. This model could provide high-speed and low-cost snake identification to support snakebite victims and healthcare providers in low-resource settings, as well as zoologists, conservationists, and nature lovers from across the world.
Journal Article > ReviewFull Text
Lancet Global Health. 2021 December 1; Volume 9 (Issue 12); e1763-e1769.
Alvar J, den Boer ML, Dagne DA
Lancet Global Health. 2021 December 1; Volume 9 (Issue 12); e1763-e1769.
East Africa is the world region most affected by visceral leishmaniasis, accounting for 45% of cases globally that were reported to WHO in 2018, with an annual incidence that is only slightly decreasing. Unlike southeast Asia, east Africa does not have a regional approach to achieving elimination of visceral leishmaniasis as a public health problem. The goal of the WHO 2021-30 Neglected Tropical Diseases road map is to reduce mortality caused by the disease to less than 1%. To achieve this goal in east Africa, it will be necessary to roll out diagnosis and treatment at the primary health-care level and implement evidence-based personal protection methods and measures to reduce human-vector contact. Investment and collaboration to develop the necessary tools are scarce. In this Health Policy paper, we propose a strategic framework for a coordinated regional approach in east Africa for the elimination of visceral leishmaniasis as a public health problem.
Journal Article > CommentaryFull Text
Trop Med Int Health. 2021 June 3; Volume 26 (Issue 9); 1088-1097.
Isah S, Amirtharajah M, Farley ES, Adetunji AS, Samuel J, et al.
Trop Med Int Health. 2021 June 3; Volume 26 (Issue 9); 1088-1097.
The Nigerian Ministry of Health has been offering care for noma patients for many years at the Noma Children's Hospital (NCH) in Sokoto, northwest Nigeria, and Médecins Sans Frontières has supported these initiatives since 2014. The comprehensive model of care consists of four main components: acute care, care for noma sequelae, integrated hospital-based services and community-based services. The model of care is based on the limited evidence available for prevention and treatment of noma and follows WHO's protocols for acute patients and best practice guidelines for the surgical treatment of noma survivors. The model is updated continually as new evidence becomes available, including evidence generated through the operational research studies performed at NCH. By describing the model of care, we wish to share the lessons learned with other actors working in the noma and neglected tropical disease sphere in the hope of guiding programme development.
