During the last week of March, nearly 4 million children were treated for the two most prevalent and debilitating parasitic infections in Rwanda in the course of just four days. If that sounds like a major undertaking, it is.
The Herculean nature of this task can’t be underestimated: Distributing drugs to 1,998 different sites across a country characterized by steep hills and few paved roads is a logistical feat in itself.
But getting the word out; convincing parents to take days away from their field work to bring their children to a health center; training teachers to administer the drugs in thousands of schools; convincing children to swallow pills that may cause temporary side effects, which include stomach pain and itchy skin: All this required an ambitious and broad communication campaign and a small army of dedicated people to skillfully carry it out.
It is about time this happened. Little was known about the prevalence and intensity of parasitic and bacterial infections in Rwanda just two years ago, but the crippling nature of these disorders was graphically demonstrated on a daily basis.
In fact, until 2005, little attention was paid by the global health community to the parasitic and bacterial infections that are the most common chronic infections among the world’s poorest people.
As a result, 13 of these infections have been labeled “Neglected Tropical Diseases” or NTDs.
These ailments, which include schistosomiasis and soil-transmitted helminthes (intestinal worms) -– the diseases treated during Rwanda’s recent four-day campaign -– lead not only to pain, discomfort and the distended bellies you often see in pictures of poor, malnourished children; they also cripple entire generations.
Infections reach maximum intensity in the age range of five to 14 years, effectively stunting both physical and mental development at the most critical time in the victims’ lives.
Recognizing the tremendous toll these diseases take on entire countries’ ability to pull themselves out of poverty, and understanding the relative ease with which these scourges can be treated, a group of private, public and international organizations banded together.
Their cooperation has resulted in the launch of an integrated assault on NTDs, focused on the rural areas of low-income sub-Saharan Africa, Asia and Latin America, where they primarily occur.
Rwanda has been one of the beneficiaries of the efforts of this Global Network for Neglected Tropical Diseases.
As a result of the 2007 grant to control or eliminate neglected tropical diseases in Rwanda, Columbia University’s Access Project conducted a nationwide survey in partnership with the nation’s Ministry of Health.
The results were staggering. The survey determined that intestinal worm infections had an average prevalence of 66% among children, with some districts reporting prevalence as high as 95%.
Schistosomiasis had an overall prevalence rate of 2.7%, but prevalence among children living in close proximity to lakes exceeded 70%.
These infections can devastate entire communities if left untreated, which up until recently had almost always been the case. This devastation is not dramatic and visible –- as in the examples of AIDS, TB or malaria — but it is more subtle and, arguably, even more damaging.
Consolata Nduwamariya, the head teacher at Remera Primary School in Musanze District, told our staff of the wrath of NTDs: “Children are often absent from school because they don’t feel well. Some have stunted growth, especially those under 10 years, and often appear weak. Sometimes, even when they are in school, they can’t pay attention and have trouble concentrating and learning.” It’s not uncommon to see a child of 12 who looks 8 years old because of the severe anemia caused by untreated schistosomiasis.
Rwanda has an ambitious program for development. The Ministry of Finance and Economic Planning has set out to transform Rwanda’s economy into a middle-income country, with a per capita income of about 1000 USD per year –- up from 290 USD today — by 2020.
A mentally and physically strong workforce is of paramount importance in achieving these objectives. This workforce cannot exist unless NTDs are eliminated.
Japan’s successful de-worming programs of the 1950s are considered one reason for the country’s subsequent economic boom.
A study in the American South showed that the improvements in intellectual development and cognition that follow de-worming have a substantial impact on income levels later in life.
In that study, the value of a worm-free childhood was estimated at 45% of adult wages. Applied to Rwanda, that means an increase in per capital income from today’s $290 to $420.
And with a cost of approximately 50 cents per child, per year, de-worming may offer a better return on investment than any other single development intervention.
De-worming campaigns like the one conducted in March are a testament to what can be done when government, non-profit and industry players work together. Awareness was raised, volunteers mobilized and drugs administered.
Of course, prevention is always better than a cure, and neglected tropical diseases are no exception. Even with twice-yearly mass drug administration, some morbidity remains and productivity is lost.
In the long run, the country must invest in latrines and clean water so the cycle of infection and re-infection can be broken and these diseases can be wiped out entirely.
Until Rwanda develops that infrastructure, however, mass drug administration is an effective way to prevent many of the debilitating consequences of these highly prevalent and pernicious diseases.
Josh Ruxin is a Columbia University expert on public health who has spent the last few years living in Rwanda. He’s an unusual mix of academic expert and mud-between-the-toes aid worker.