Competition for multi-million pound grants to tackle debilitating parasitic diseases in the developing world means that serious concerns about whether current drug programmes actually work are being side-lined says Dr Melissa Parker, Director of CRIMA (Centre for Research in International Medical Anthropology) at Brunel University, in a letter published in The Lancet today [Monday 30 January 2012].
Dr Parker and Professor Tim Allen, Professor in Development Anthropology at the London School of Economics (LSE), write that mass drug administration programmes (MDAs) – such as those supported by the UK Government – are often designed without taking into account local political, economic and social issues.
They explain that sending vital drugs for neglected tropical diseases (NTDs), such as bilharzia and elephantiasis, to countries that need them, does not necessarily mean that affected communities in Africa will actually be treated.
Their research in East Africa shows that current systems of distribution may work quite well in one village, but largely fail in the next. Re-infection of those treated is very likely.
Communicating with communities about the reasons for the mass drug programmes has not been made a priority. This allows rumours and local conspiracy theories which question the real purposes of free drug administration to flourish in some locations.
In 2008 there were protests in Tanzania by parents who were convinced that tablets that were being given out in schools for bilharzia had been sent to poison their children.
Professor Allen says: "There is a growing tendency for those promoting mass drug administration programmes to overlook evidence concerning how effective they really are.
“Responding to complex health problems requires a richly textured understanding of the lives of the people being targeted. We need a better approach that combines the expertise of scientists with social scientists.
“Closing off debate and critical analysis of what is actually happening on the ground is profoundly unhelpful. There is also a need to complement and support sustainable national systems.”
Allen and Parker point out that large internationally funded drug distribution programmes can weaken already over-stretched health-care systems.
Dr Parker says: “For mass drug administration programmes to be more effective, there has to be flexibility in the system to move away from a ‘one size, fits all’ approach and to adapt to local realities.”
Professor Allen and Dr Parker also draw attention to medical research which indicates that the long term effects of mass treatment and the combinations of medication to treat multiple infections require much better surveillance and monitoring, particularly when given to already weak and malnourished people.
On January 21 2012 the UK Department for International Development announced that it was boosting its support to £245 million, a five-fold increase, for programmes to combat neglected tropical diseases (NTDs).
Professor Allen said: “Providing free and subsidised drugs creates a window of opportunity to make a massive difference. But the availability of tablets is not enough – dealing with these diseases will involve a number of factors, not least of which will be behavioural change.”
Dr Parker adds: "We are obviously in favour of treating people for debilitating parasitic diseases. We are also not against mass drug administration programmes so long as they are implemented effectively and monitored appropriately. However, in their current form, they will not, as some are claiming, make poverty history.”
Around 800 million people suffer from neglected tropical diseases. These include elephantiasis (Lymphatic Filariasis) which causes extreme swelling of the limbs or other parts of the body and bilharzia (schistosomiasis) which can result in life-threatening damage to the urinary system and liver and bladder and bowel cancers.
The letter in The Lancet is based on extensive research undertaken by Professor Allen and Dr Parker in East Africa, with assistance from a number of MSc Medical Anthropology and PhD students from Brunel University.
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