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Ukraine

Making every school a health-promoting school: global standards and indicators

Credits

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Outcome

Improved access to quality essential health services irrespective of gender, age or disability status

[COUNTRY STORY]

Timor-Leste Initiates Integrated Programme to Control and Eliminate Neglected Tropical Diseases, Backed by WHO and KOICA

Timor-Leste

Photo: Cirilo Danis, WHO Timor Leste Deworming tablets are distributed at a primary school in in Dili during an MDA drive in October 2022.

Timor-Leste Launches Integrated NTD Control and Elimination Programme

Neglected Tropical Diseases (NTDs) including lymphatic filariasis (LF) are mainly prevalent in tropical regions. Commonly known as elephantiasis, LF causes pain and disfigurement, and patients can suffer mental, social, and financial losses that contribute to stigma and poverty. In 2012, it was estimated that LF prevalence ranged, according to the national survey, from 10 to 35 percent in children aged 7 to 16 years, while the prevalence of another NTD, soil-transmitted helminthiases (STH), ranged from 4 to 55 percent [1]. Since 2014, the WHO has provided technical and financial support to Timor-Leste’s government to eliminate NTDs through Mass Drug Administration (MDA) targeted at LF and STH (although one of the drugs administered is also active against scabies) and building health provider capacity to detect and treat NTDs. The quality of life for people affected by LF was improved through Morbidity Management and Disability Prevention (MMDP) activities. A large-scale WHO Transmission Assessment Survey (TAS) conducted in 2020-2021 showed that the programme had successfully reduced cases of LF to near elimination (no cases were found in 11 292 children), and that STH had decreased to range between 2 and 50 percent. Scabies prevalence was estimated at approximately 0.5 percent [2], a big decrease from its 22.4 percent prevalence in a 2016 survey. No yaws cases have been found since 2018.

Key WHO Contributions

Procurement of drugs for dissemination along with communications material
Adaption of WHO global guidance and materials for in-country trainings
Delivery of clinical trainings for health care professionals on care and treatment

How did Timor-Leste, with the support of the WHO Secretariat, achieve this?

NTDs are considered ‘neglected’ as they have historically been absent from the global health agenda. To generate awareness, NTDs were made one of WHO’s Regional Flagship Priorities in 2014 and, in the same year, the government of Timor-Leste launched an integrated NTD control and elimination programme. WHO Timor-Leste provided comprehensive technical support to the NTD and school nutrition teams. Expertise, guidelines, and tools were also provided by WHO Regional Office and headquarters. The Korean International Cooperation Agency (KOICA) provided funding until June 2022, when WHO Timor-Leste began funding the programme directly.

Between 2015 and 2022, four MDA drives were conducted in 13 municipalities. The first three MDA rounds targeted LF and STH using medicines Diethylcarbamazine citate (DEC) and Albendazole, while a third medicine, ivermectin (which is active against scabies), was added in the fourth round. WHO Timor-Leste facilitated medicine donation in collaboration with WHO Regional Office and headquarters. To spread awareness and encourage increased uptake among the community, WHO created pamphlets and broadcasted messages on television and radio spots. MDA reached 100 percent of schools, and each of the four rounds exceeded the 65 percent target threshold with coverage rates of 67, 78, 82, and 76 percent respectively.

In 2019 and 2020, through WHO’s MMDP initiative, periodic LF patient monitoring was established in all 71 Community Health Centres (CHCs) in Timor-Leste. To develop trainings for healthcare providers, WHO Timor-Leste adapted WHO’s global guidelines, training materials, and advocacy materials into the local language, Tetum. In collaboration with the Ministry of Health (MoH), in October 2021, 155 focal points and heads of the CHCs and District Public Health Officers received training on disease identification, data collection, setting up treatment protocols, and patient follow-up. Then, from November 2021 until May 2022, the MoH and WHO Timor-Leste jointly reviewed the case registration books and provided on-the-job training to 61 CHC focal points. WHO Timor-Lesteand the MoH also trained 1 650 doctors, nurses, and laboratory technicians on the detection and examination of LF patients. Consequently, all 499 suspected LF cases were re-evaluated, registered, and visited by CHC focal points, who trained LF patients on daily self-care, provided medication, and monitored disease progress. Cases of hydrocele were referred to a national hospital for surgical treatment. After the sixth follow-up, in June 2022, 435 patients remained in the registry (38 had died, 4 were relocated, 2 refused follow-up, 12 were confirmed as non-LF, and 14 new cases were added).

^{A man receives care for lymphatic filariasis during a Morbidity Management and Disability Prevention visit in 2022.}Photo credit: Cirilo Danis, WHO Timor Leste.

To ensure active case detection and targeted treatment of yaws and scabies, healthcare workers conduct visual skin inspections and send blood samples of those suspected of the conditions for testing. WHO and the MoH introduced protocols and surveillance systems and have trained staff in CHC to do this over many years.

Timor-Leste’s MoH had launched its very first LF elimination programme in 2005, but after two rounds of MDA in 2006 and 2007, implementation stalled due to lack of funds, resulting in high NTD prevalence. This renewed effort, launched by the WHO Timor-Leste and the MoH in 2014, has lowered the prevalence of NTDs despite the COVID-19 pandemic which delayed implementation and made procurement, transport, and storage challenging. LF and yaws are close to elimination and STH and scabies are under control, however advancing NTDs further towards elimination requires sustained technical and financial support from the WHO and donors. There is an inadequate commitment on funding to end NTDs. WHO will continue to provide technical assistance to build capacities for the national team, but sustained funding from other development partners will be critical for successfully sustaining the programme going forward.

“To end NTDs, WHO Timor-Leste is committed to supporting the MoH in organizing Mass Drug Administration (MDA) drives, vector control activities to prevent dengue, Morbidity Management and Disability Prevention (MMDP) for lymphatic filariasis, and in strengthening surveillance for these neglected diseases”

- Dr Arvind Mathur, WHO Representative to Timor-Leste.

References

Timor-Leste National Parasite Survey 2012
Korte LM, Bowen AC, Draper ADK, Davis K, Steel A, Teodora I, Mascarenhas I, Dingle B, Francis JR. Scabies and impetigo in Timor-Leste: A school screening study in two districts. PLoS Negl Trop Dis. 2018 May 31;12(5):e0006400.