Progress, Partners and Promise: Mapping the Way Forward
It’s an oft-quoted adage that “if you can't measure it, you can't manage it.”
Nowhere is that maxim more firmly embraced than among the constellation of STH Coalition as they collectively advance the global goal of “elimination of STH as a public health problem.”
The WHO defines elimination of STH as a public health problem as achieving a prevalence of moderate-to-heavy STH infection of less than 1% among pre-school age children (1-4 years) and school-age children (5-14 years), key at-risk populations. Adoption of the goal of eliminating STH as a public health problem has in turn prompted changes in the way STH programs operate. Indeed, while STH programs have traditionally relied on the coverage of preventive chemotherapy as the measure of programmatic achievement, it’s clear that this intervention indicator does not measure the impact on STH. Going forward, and following years of deworming, countries are urged to implement regular parasitologic monitoring – a measure of the prevalence of infection intensity in a given area and population.
Last year, CWW partnered with the Government of Bangladesh to conduct parasitologic monitoring at the community level. The effort marks a major step forward for STH control in the country, allowing the government to address gaps in programmatic data and to strengthen decision-making around a range of interventions.
“Previously, we measured the prevalence of STH among the school-age children,” says Dr. Mohammed Jahirul Karim, Deputy Program Manager of the Filariasis Elimination and STH Control program in the Bangladesh Ministry of Health. “The WHO recommendation is still to survey this group. But we are taking a new approach – we are measuring the burden of disease in the population.”
That’s important, he says, because “if you do not assess the parasitologic burden in the community, in the entire population, then you will not be able to understand whether the reservoir is there.” If there is a transmission reservoir within the community – a continuous source of infection – “deworming will not be effective,” says Karim. “So we have to measure this, because we cannot do deworming indefinitely.”
One possible source of infection could be the use of open latrines in a community. That was the case in one upzilla in Bandarban district, one of two districts where community-wide parasitologic monitoring has already been implemented. “We found a 50% infection rate, so we took immediate action there. We instructed civil servant to close the latrines and improve sanitation.” Parasitologic surveys, supported by STH Coalition member Nutrition International, are planned for four additional districts in 2017.
For Bangladesh, eliminating STH remains a top priority, says Karim. “If a child is infected, she could have many complications, and the child is the future of the nation. We must be successful.”