Applicability of working abroad for physicians with a specialization in Global Health and Tropical Medicine.

BACKGROUND: In The Netherlands, physicians specialized in global health and tropical medicine (Ps-GHTM) are trained to work in low-resource settings (LRS) after their training program of 27 months. After working for a period of time in LRS, many Ps-GHTM continue their careers in the Dutch healthcare system. While there is limited evidence regarding the value of international health experience for medical students and residents, it is unknown to what extent this applies to Ps-GHTM and to their clinical practice in the Netherlands. METHODS: In this qualitative study we conducted semi-structured interviews and focus group discussions (FGDs) with Ps-GHTM to explore the perceived applicability of their experience abroad for their subsequent return to the Netherlands. Topic guides were developed using literature about the applicability of working abroad. Findings from the interviews served as a starting point for FGDs. The interviews and FGDs were analysed using directed content analysis. RESULTS: 15 themes are described relating experience abroad to healthcare delivery in The Netherlands: broad medical perspective, holistic perspective, adaptive communication skills, creativity, flexibility, cultural awareness, self-reliance, clinical competence, cost awareness, public health, leadership, open-mindedness, organization of care, self-development, and teamwork. Highlighting the variety in competencies and the complexity of the topic, not all themes were recognized by all respondents in the FGDs nor deemed equally relevant. Flexibility, cultural awareness and holistic perspective are examples of important benefits to work experience in LRS. CONCLUSION: Ps-GHTM bring their competencies to LRS and return to the Netherlands with additionally developed skills and knowledge. These may contribute to healthcare delivery in the Netherlands. This reciprocal value is an important factor for the sustainable development of global health. Identifying the competencies derived from work experience in LRS could give stakeholders insight into the added value of Ps-GHTM and partly help in refining the specialization program.

Recognising the potential of neglected tropical disease programmes as a platform for pandemic preparedness: the Ascend experience.

Living in an increasingly interconnected world, epidemics and pandemics are increasingly likely to be a vista for the future. This, coupled with the likely devastating effects of climate change, means that humanitarian crises are likely to increase. Now, more than ever before, is the time to scale up investment in prevention and preparedness strategies, and to review our current approaches to delivering health services, including those that address neglected tropical diseases. The Ascend West and Central Africa programme has illustrated the importance of innovation, multisector partnerships, resilience and the opportunity for change.

Impact of digital transformation on tropical health / Impacto de la transformación digital en la salud tropical

La Transformación Digital (TD) es todo un proceso que busca optimizar la relación usuario­organización, mejorando así los procesos y el desempeño. Con la llegada de la pandemia COVID-19 a principios del año 2020, cuando fue necesario acelerar la inclusión de las Tecnologías de Información y Comunicación (TIC) para continuar ofreciendo los servicios sanitarios, se constituye el sistema peruano de TD como un sistema funcional; con normas, principios y procedimientos; y con técnicas e instrumentos para ordenar las actividades del sector público y con miras a su optimización. Se planteó una investigación de carácter descriptivo para conocer el impacto de la transformación digital en la salud tropical del Perú. Para ello se determinaron el impacto en la gestión de datos, gobernanza, e intercambio de conocimiento e innovación digital de 4 enfermedades metaxénicas y 3 zoonóticas seleccionadas a partir del análisis de los distintos componentes de la sala virtual de situación de salud del Centro Nacional de Epidemiología, Prevención y Control de Enfermedades del Perú. Los datos fueron analizados bajo el Sistema de Información para la Salud (IS4H) de la OPS que permitió valorar la interoperabilidad de los procesos relacionados con la categorización de estas nosologías. Para todos los factores evaluados: gestión de datos, innovación, gestión y gobernanza y gestión e intercambio de conocimiento, los resultados, en general, estuvieron alrededor de la media (3 puntos, en una escala del 1 al 5), siendo el valor más alto (3,3 puntos) para la gestión y gobernanza, y el valor más bajo (2,7 puntos) para la innovación. Se necesita un enfoque más holístico en la salud pública para asegurarse de que se proporcione una respuesta eficaz frente a las enfermedades tropicales. Si los sistemas de salud se colocan en el medio de la acción, esto permitiría tener mayores posibilidades de hacer frente a estas enfermedades mediante el uso adecuado de las herramientas modernas que logren complementar el enfoque tradiciona(AU)

Digital Transformation (TD) is a whole process that seeks to optimize the user-organization relationship, thus improving processes and performance. With the arrival of the COVID-19 pandemic at the beginning of 2020, when it was necessary to accelerate the inclusion of Information and Communication Technologies (ICT) to continue offering health services, the Peruvian DT system was established as a functional system; with norms, principles and procedures; and with techniques and instruments to order the activities of the public sector and with a view to their optimization. A descriptive investigation was proposed to know the impact of digital transformation on tropical health in Peru. For this, the impact on data management, governance, and exchange of knowledge and digital innovation of 4 metaxenic and 3 zoonotic diseases selected from the analysis of the different components of the virtual health situation room of Centro Nacional de Epidemiología, Prevención y Control de Enfermedades of Peru. The data were analyzed under PAHO's Information System for Health (IS4H), which made it possible to assess the interoperability of the processes related to the categorization of these nosologies. For all the factors evaluated: data management, innovation, management and governance, and knowledge management and exchange, the results, in general, were around the average (3 points, on a scale from 1 to 5), with the highest value being highest (3.3 points) for management and governance, and the lowest value (2.7 points) for innovation. A more holistic approach to public health is needed to ensure that an effective response to tropical diseases is provided. If health systems are placed in the middle of the action, this would allow them to have greater possibilities of dealing with these diseases through the appropriate use of modern tools that manage to complement the traditional approach(AU)

Evaluating and mitigating the potential indirect effect of COVID-19 on control programmes for seven neglected tropical diseases: a modelling study.

BACKGROUND: In line with movement restrictions and physical distancing essential for the control of the COVID-19 pandemic, WHO recommended postponement of all neglected tropical disease (NTD) control activities that involve community-based surveys, active case finding, and mass drug administration in April, 2020. Following revised guidance later in 2020, and after interruptions to NTD programmes of varying lengths, NTD programmes gradually restarted in the context of an ongoing pandemic. However, ongoing challenges and service gaps have been reported. This study aimed to evaluate the potential effect of the programmatic interruptions and strategies to mitigate this effect. METHODS: For seven NTDs, namely soil-transmitted helminths, schistosomiasis, lymphatic filariasis, onchocerciasis, trachoma, visceral leishmaniasis, and human African trypanosomiasis, we used mathematical transmission models to simulate the effect of programme interruptions on the dynamics of each of these diseases in different endemic settings. We also explored the potential benefit of implementing mitigation strategies, primarily in terms of minimising the delays to control targets. FINDINGS: We show that the effect of the COVID-19-induced interruption in terms of delay to achieving elimination goals might in some cases be much longer than the duration of the interruption. For schistosomiasis, onchocerciasis, trachoma, and visceral leishmaniasis, a mean delay of 2-3 years for a 1-year interruption is predicted in areas of highest prevalence. We also show that these delays can largely be mitigated by measures such as additional mass drug administration or enhanced case-finding. INTERPRETATION: The COVID-19 pandemic has brought infectious disease control to the forefront of global consciousness. It is essential that the NTDs, so long neglected in terms of research and financial support, are not overlooked, and remain a priority in health service planning and funding. FUNDING: Bill & Melinda Gates Foundation, Medical Research Council, and the UK Foreign, Commonwealth & Development Office.

A framework for assessing the impact of disease treatment.

OBJECTIVES: To address ongoing pandemics and epidemics, policy makers need good data not only on the need for treatments but also on new interventions' impacts. We present a mathematical model of medicines' health consequences using disease surveillance data to inform health policy and scientific research that can be extended to address the current public health crisis. METHODS: The Global Health Impact index calculates the amount of mortality and morbidity averted by key medicines for malaria, TB, HIV/AIDS and several Neglected Tropical Diseases (NTDs) using data on outcomes in the absence of treatment, treatment effectiveness and access to needed treatment. Country-level data were extracted from data repositories maintained by the Global Burden of Disease study, Global Health Observatory, WHO, UNICEF and a review of the scientific literature. RESULTS: The index aggregates drug impact by country, disease, company and treatment regimen to identify the spatial and temporal patterns of treatment impact and can be extended across multiple diseases. Approximately 62 million life-years were saved by key drugs that target malaria, TB, HIV/AIDS and NTDs in our latest model year. Malaria and TB medicines together were responsible for alleviating 95% of this burden, while HIV/AIDS and NTD medicines contribute 4% and 1%, respectively. However, the burden of disease in the absence of treatment was nearly evenly distributed among malaria, TB and HIV/AIDS. CONCLUSIONS: A common framework that standardises health impact across diseases and their interventions can aid in identifying current shortcomings on a global scale.

Resuming NTD activities in the context of COVID-19: an investigation into the advantages of risk assessment processes to mitigate the transmission of COVID-19 during NTD delivery.

BACKGROUND: The neglected tropical disease (NTD) sector is adapting to the uncertain circumstances of coronavirus disease 2019 (COVID-19). The development of the Risk Assessment and Mitigation Action (RAMA) tool was driven by partners of the programme Accelerating the Sustainable Control and Elimination of NTDs (hereafter called Ascend) to enable countries to recommence NTD activities following the World Health Organization advisories of April and July 2020. This article explores the advantages of the RAMA process for NTD delivery. METHODS: The analysis used interview transcripts with NTD practitioners in Cote d'Ivoire, Guinea, Liberia and Nigeria and results from the monitoring of compliance with COVID-19 mitigation measures in Nigeria. RESULTS: Three themes emerged from the results: adaptability and innovation, collaboration and government ownership and preparedness. CONCLUSIONS: The advantages of the RAMA tool suggest its importance in mitigating the transmission of COVID-19 during NTD delivery. There is the potential for the tool to be adapted for use throughout future pandemics.

The Connection between Climate Change, Surgical Care and Neglected Tropical Diseases.

The surgical burden of neglected tropical diseases (NTDs) is set to rise alongside average temperatures and drought. NTDs with surgical indications, including trachoma and lymphatic filariasis, predominantly affect people in low- and middle-income countries where the gravest effects of climate change are likely to be felt. Vectors sensitive to temperature and rainfall will likely expand their reach to previously nonendemic regions, while drought may exacerbate NTD burden in already resource-strained settings. Current NTD mitigation strategies, including mass drug administrations, were interrupted by COVID-19, demonstrating the vulnerability of NTD progress to global events. Without NTD programming that meshes with surgical systems strengthening, climate change may outpace current strategies to reduce the burden of these diseases.

[Collateral effects of the COVID-19 pandemic on the practice of tropical and travel medicine]. / Effets de la pandémie de Covid-19 sur la pratique de médecine tropicale et des voyages.

Undoubtedly, the COVID-19 pandemic has had impacts in many areas, including travel and by extension on daily practice in tropical and travel medicine. The intercontinental travelers in decline have been replaced by a new population of travelers who previously did not require specific consultations. SARS-CoV-2 has earned its place in the pre-travel consultation in view of the medical and administrative implications. Furthermore, the global health effects of the pandemic are broader than its direct medical consequences and should not be underestimated. The increase in malaria mortality worldwide is just one example. Preventive measures prior to exposure are more important than ever.

Indubitablement, la pandémie de Covid-19 a eu des impacts dans de nombreux domaines, notamment les voyages, et par extension sur la pratique quotidienne en médecine tropicale et des voyages. Les voyageurs intercontinentaux en diminution ont été remplacés par une nouvelle population de voyageurs qui ne nécessitait pas jusqu'alors de consultations particulières. Le SARS-CoV-2 a gagné sa place dans la consultation prévoyage au vu des implications médicales et administratives. Par ailleurs, les effets de la pandémie sur la santé globale sont plus larges que ses conséquences médicales directes et ne devraient pas être sous-estimés. L'augmentation de la mortalité due à la malaria dans le monde n'en est qu'un exemple. Les mesures préventives avant exposition sont plus que jamais d'actualité.

Increasing efficiencies from integrating control and elimination programmes for soil-transmitted helminths and schistosomiasis.

Attention is now beginning to focus on implementation of the new WHO NTD Roadmap (2021-2030), which presents single disease alliances and coalitions with an opportunity to consider novel ways to integrate and adapt control and elimination programmes to meet the new goals. This discussion piece links the parasitic worm diseases, caused by soil-transmitted helminths and schistosomes, highlighting that neglected tropical disease-control programmes could potentially benefit from greater cohesion and innovation, especially when increasing efforts to achieve elimination goals.

Safely resuming neglected tropical disease control activities during COVID-19: Perspectives from Nigeria and Guinea.

Since its early spread in early 2020, the disease caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Coronavirus Disease 2019 (COVID-19) has caused mass disruptions to health services. These have included interruptions to programs that aimed to prevent, control, and eliminate neglected tropical diseases (NTDs). In March 2020, the World Health Organization (WHO) released interim guidelines recommending the temporary cessation of mass drug administration (MDA), community-based surveys, and case detection, while encouraging continuation of morbidity management and vector control where possible. Over the course of the following months, national programs and implementing partners contributed to COVID-19 response efforts, while also beginning to plan for resumption of NTD control activities. To understand the challenges, opportunities, and recommendations for maximizing continuity of disease control during public health emergencies, we sought perspectives from Nigeria and Guinea on the process of restarting NTD control efforts during the COVID-19 pandemic. Through semistructured interviews with individuals involved with NTD control at the local and national levels, we identified key themes and common perspectives between the 2 countries, as well as observations that were specific to each. Overall, interviewees stressed the challenges posed by COVID-19 interruptions, particularly with respect to delays to activities and related knock-on impacts, such as drug expiry and prolonged elimination timelines, as well as concerns related to funding. However, respondents in both countries also highlighted the benefits of a formal risk assessment approach, particularly in terms of encouraging information sharing and increasing coordination and advocacy. Recommendations included ensuring greater availability of historical data to allow better monitoring of how future emergencies affect NTD control progress; continuing to use risk assessment approaches in the future; and identifying mechanisms for sharing lessons learned and innovations between countries as a means of advancing postpandemic health systems and disease control capacity strengthening.

Uche Amazigo: neglected tropical diseases in the pandemic.

Uche Amazigo talks to Andreia Azevedo Soares about the impact of the pandemic on NTD-related activities and the prospects for regaining momentum on the global NTD agenda.

Improving timeliness in the neglected tropical diseases preventive chemotherapy donation supply chain through information sharing: A retrospective empirical analysis.

BACKGROUND: Billions of doses of medicines are donated for mass drug administrations in support of the World Health Organization's "Roadmap to Implementation," which aims to control, eliminate, and eradicate Neglected Tropical Diseases (NTDs). The supply chain to deliver these medicines is complex, with fragmented data systems and limited visibility on performance. This study empirically evaluates the impact of an online supply chain performance measurement system, "NTDeliver," providing understanding of the value of information sharing towards the success of global health programs. METHODS: Retrospective secondary data were extracted from NTDeliver, which included 1,484 shipments for four critical medicines ordered by over 100 countries between February 28, 2006 and December 31, 2018. We applied statistical regression models to analyze the impact on key performance metrics, comparing data before and after the system was implemented. FINDINGS: The results suggest information sharing has a positive association with improvement for two key performance indicators: purchase order timeliness (ß = 0.941, p = 0.003) and-most importantly-delivery timeliness (ß = 0.828, p = 0.027). There is a positive association with improvement for three variables when the data are publicly shared: shipment timeliness (ß = 2.57, p = 0.001), arrival timeliness (ß = 2.88, p = 0.003), and delivery timeliness (ß = 2.82, p = 0.011). CONCLUSIONS: Our findings suggest that information sharing between the NTD program partners via the NTDeliver system has a positive association with supply chain performance improvements, especially when data are shared publicly. Given the large volume of medicine and the significant number of people requiring these medicines, information sharing has the potential to provide improvements to global health programs affecting the health of tens to hundreds of millions of people.

The impact of COVID-19 on clinical research for Neglected Tropical Diseases (NTDs): A case study of bubonic plague.

BACKGROUND: Among the many collaterals of the COVID-19 pandemic is the disruption of health services and vital clinical research. COVID-19 has magnified the challenges faced in research and threatens to slow research for urgently needed therapeutics for Neglected Tropical Diseases (NTDs) and diseases affecting the most vulnerable populations. Here we explore the impact of the pandemic on a clinical trial for plague therapeutics and strategies that have been considered to ensure research efforts continue. METHODS: To understand the impact of the COVID-19 pandemic on the trial accrual rate, we documented changes in patterns of all-cause consultations that took place before and during the pandemic at health centres in two districts of the Amoron'I Mania region of Madagascar where the trial is underway. We also considered trends in plague reporting and other external factors that may have contributed to slow recruitment. RESULTS: During the pandemic, we found a 27% decrease in consultations at the referral hospital, compared to an 11% increase at peripheral health centres, as well as an overall drop during the months of lockdown. We also found a nation-wide trend towards reduced number of reported plague cases. DISCUSSION: COVID-19 outbreaks are unlikely to dissipate in the near future. Declining NTD case numbers recorded during the pandemic period should not be viewed in isolation or taken as a marker of things to come. It is vitally important that researchers are prepared for a rebound in cases and, most importantly, that research continues to avoid NTDs becoming even more neglected.

Progress towards control and elimination of neglected tropical diseases targeted by preventive chemotherapy in São Tomé e Príncipe.

The São Tomé e Príncipe government is committed to achieving neglected tropical disease (NTD) control and elimination as a public health problem by 2025. In 2014, the Ministry of Health led a national survey to determine the prevalence of soil-transmitted helminths (STHs) and schistosomiasis across the country. Following this survey, a preventive chemotherapy (PC) campaign with mebendazole and praziquantel reached 31 501 school-age children in 2015. A follow-up 2017 survey to determine the impact of the intervention showed success in controlling schistosomiasis, as no infections were found, but limited impact on STHs, with prevalence similar to pretreatment levels. The survey also investigated the prevalence of a third NTD, lymphatic filariasis (LF), which was found to be endemic in the country. Since then the Ministry of Health has developed the Strategic Plan for the Fight Against Neglected Tropical Diseases 2019-2025 and identified gaps to be addressed. This narrative review systematises the existing literature reporting on the epidemiology of NTDs for which there are PC programs in São Tomé e Príncipe. PubMed was searched for relevant papers that measured the prevalence of LF, schistosomiasis and STHs. Additionally, data provided by the Ministry of Health surveys were analysed. Finally, we discuss current NTD control, including the impact of the coronavirus disease 2019 pandemic and identify priorities for program strengthening and operational research.

Towards global control of parasitic diseases in the Covid-19 era: One Health and the future of multisectoral global health governance.

Human parasitic infections-including malaria, and many neglected tropical diseases (NTDs)-have long represented a Gordian knot in global public health: ancient, persistent, and exceedingly difficult to control. With the coronavirus disease (Covid-19) pandemic substantially interrupting control programmes worldwide, there are now mounting fears that decades of progress in controlling global parasitic infections will be undone. With Covid-19 moreover exposing deep vulnerabilities in the global health system, the current moment presents a watershed opportunity to plan future efforts to reduce the global morbidity and mortality associated with human parasitic infections. In this chapter, we first provide a brief epidemiologic overview of the progress that has been made towards the control of parasitic diseases between 1990 and 2019, contrasting these fragile gains with the anticipated losses as a result of Covid-19. We then argue that the complementary aspirations of the United Nations Sustainable Development Goals (SDGs) and the World Health Organization (WHO)'s 2030 targets for parasitic disease control may be achieved by aligning programme objectives within the One Health paradigm, recognizing the interdependence between humans, animals, and the environment. In so doing, we note that while the WHO remains the preeminent international institution to address some of these transdisciplinary concerns, its underlying challenges with funding, authority, and capacity are likely to reverberate if left unaddressed. To this end, we conclude by reimagining how models of multisectoral global health governance-combining the WHO's normative and technical leadership with greater support in allied policy-making areas-can help sustain future malaria and NTD elimination efforts.