One size won't fit all in tackling tropical disease

Globally at least 1 billion people suffer from or are at risk from neglected tropical diseases but 'one-size-fits-all' mass medication programmes don't work, warns research from Brunel.

Brunel medical anthropologist Dr Melissa Parker’s ground-breaking 16-month fieldwork in Tanzania and Uganda revealed that while 10 years of mass drug administration (MDA) schemes have produced some worthwhile outcomes, a tendency to make assumptions when unaware about local realities reveals some serious flaws.

Endemic diseases like elephantiasis and bilharzia are curable and internationally-funded projects to provide free treatment have gained huge momentum in the last decade.

But Dr Parker’s work, and that of Prof Tim Allen from the London School of Economics, has forced a radical re-think in the way MDAs are now being administered and monitored.

In Uganda, along the shores of the River Nile, most villagers who lived on the banks were successfully treated for bilharzia but families of fishermen living on islands were ignored. As the latter use the river as a latrine, successfully treated villagers were highly susceptible to reinfection.

While in Tanzania there were violent riots when rumours spread that treatments administered at schools to children were a plot to bring about mass sterilisation. The authorities had assumed parents would want their children protected without consulting them or obtaining consent.

The research-led approach has now almost universal acceptance among funders of MDAs. Only with those programmes that are locally sensitive and well-communicated is there a realistic prospect of permanently defeating these diseases.