One of world’s poorest countries makes “remarkable” progress on tropical diseases, report says

BMJ 2014; 348 doi: (Published 05 June 2014) Cite this as: BMJ 2014;348:g3752
  1. Anne Gulland
  1. 1London

Sierra Leone’s “rapid achievements” in tackling neglected tropical diseases are “nothing short of remarkable,” concludes a report from the Overseas Development Institute, a UK independent think tank on international development and humanitarian issues.1

Despite being one of the poorest countries in the world and undergoing a brutal civil war from 1991 to 2002, Sierra Leone has seen a 60% decrease in the incidence of onchocerciasis (river blindness) between 2007 and 2009, a 90% decrease in the number of cases of lymphatic filariasis (elephantiasis) between 2007 and 2011, and a 66% decrease in the incidence of schistosomiasis (snail fever) between 2009 and 2012.

Sierra Leone is doing much better than its richer neighbours, with the number of people treated for schistosomiasis nearly trebling between 2009 and 2012—from 562 000 people to 1.4 million, equivalent to 99% of the population needing treatment, the report found. In Nigeria, Africa’s richest nation, just 5% of the eligible population was treated for the disease in 2012.

“Not only does Sierra Leone stand out in West Africa but it also provides a tangible model for the successful implementation of strategies to eliminate and control NTDs [neglected tropical diseases] in other parts of the world,” the report said.

It said that Sierra Leone had made good use of a growing focus on tropical diseases over the past decade by the international community and of millions of dollars worth of free drugs from manufacturers. There had also been a large scale community mobilisation, with 29 000 volunteers working to raise awareness and deliver drugs.

Healthcare changes had also been a key driver, with the government providing free health services for all children under 5 years old and for pregnant and breastfeeding women since 2010.

The country carried out its first comprehensive national mapping of all major neglected tropical diseases between 2005 and 2009 and then introduced a mass drug administration campaign on four target diseases: onchocerciasis, lymphatic filariasis, schistosomiasis, and soil transmitted helminths.

Treatment coverage for onchocerciasis is now at 100%, up from just 28% in 2004, and scientists estimate that in 2020 transmission will have stopped. There is also 100% treatment coverage of lymphatic filariasis, and the “progress made so far suggests that it is possible to eliminate [the disease] in Sierra Leone by 2020.” The authors added that soil transmitted helminths were on the verge of being controlled and that the country would soon interrupt the transmission of schistosomiasis.

However, the authors admitted that some challenges remained, including widespread movement of people to and from neighbouring countries that did not have such strong control of these diseases. This problem has been highlighted by the outbreak of Ebola virus in neighbouring Guinea, and the World Health Organization has reported a total of 79 suspected cases of the disease, including six deaths, in Sierra Leone.

Another problem in the control of neglected tropical diseases is the fact that Sierra Leone’s programme is almost entirely funded by external sources. Although it is unlikely that “donors will suddenly pull the plug,” the country needs to “mobilise its domestic resources,” the report said.

Fiona Samuels, an Overseas Development Institute research fellow, said, “Sierra Leone’s achievements mean a child born today is far less likely to be disabled by these diseases. These common illnesses are still a defining factor in the current cycle of poverty, ill health, and underdevelopment in too many African countries.”


Cite this as: BMJ 2014;348:g3752


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