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      Neglected tropical diseases activities in Africa in the COVID-19 era: the need for a “hybrid” approach in COVID-endemic times

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          Abstract

          With the coronavirus disease 2019 (COVID-19) pandemic showing no signs of abating, resuming neglected tropical disease (NTD) activities, particularly mass drug administration (MDA), is vital. Failure to resume activities will not only enhance the risk of NTD transmission, but will fail to leverage behaviour change messaging on the importance of hand and face washing and improved sanitation—a common strategy for several NTDs that also reduces the risk of COVID-19 spread. This so-called “hybrid approach” will demonstrate best practices for mitigating the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by incorporating physical distancing, use of masks, and frequent hand-washing in the delivery of medicines to endemic communities and support action against the transmission of the virus through water, sanitation and hygiene interventions promoted by NTD programmes. Unless MDA and morbidity management activities resume, achievement of NTD targets as projected in the WHO/NTD Roadmap (2021–2030) will be deferred, the aspirational goal of NTD programmes to enhance universal health coverage jeopardised and the call to ‘leave no one behind’ a hollow one. We outline what implementing this hybrid approach, which aims to strengthen health systems, and facilitate integration and cross-sector collaboration, can achieve based on work undertaken in several African countries.

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          The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries

          The ongoing COVID-19 pandemic poses a severe threat to public health worldwide. We combine data on demography, contact patterns, disease severity, and health care capacity and quality to understand its impact and inform strategies for its control. Younger populations in lower income countries may reduce overall risk but limited health system capacity coupled with closer inter-generational contact largely negates this benefit. Mitigation strategies that slow but do not interrupt transmission will still lead to COVID-19 epidemics rapidly overwhelming health systems, with substantial excess deaths in lower income countries due to the poorer health care available. Of countries that have undertaken suppression to date, lower income countries have acted earlier. However, this will need to be maintained or triggered more frequently in these settings to keep below available health capacity, with associated detrimental consequences for the wider health, well-being and economies of these countries.
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            Rescuing the bottom billion through control of neglected tropical diseases.

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              The cross-cutting contribution of the end of neglected tropical diseases to the sustainable development goals

              The Sustainable Development Goals (SDGs) call for an integrated response, the kind that has defined Neglected Tropical Diseases (NTDs) efforts in the past decade. NTD interventions have the greatest relevance for SDG3, the health goal, where the focus on equity, and its commitment to reaching people in need of health services, wherever they may live and whatever their circumstances, is fundamentally aligned with the target of Universal Health Coverage. NTD interventions, however, also affect and are affected by many of the other development areas covered under the 2030 Agenda. Strategies such as mass drug administration or the programmatic integration of NTD and WASH activities (SDG6) are driven by effective global partnerships (SDG17). Intervention against the NTDs can also have an impact on poverty (SDG1) and hunger (SDG2), can improve education (SDG4), work and economic growth (SDG8), thereby reducing inequalities (SDG10). The community-led distribution of donated medicines to more than 1 billion people reinforces women’s empowerment (SDG5), logistics infrastructure (SDG9) and non-discrimination against disability (SDG16). Interventions to curb mosquito-borne NTDs contribute to the goals of urban sustainability (SDG11) and resilience to climate change (SDG13), while the safe use of insecticides supports the goal of sustainable ecosystems (SDG15). Although indirectly, interventions to control water- and animal-related NTDs can facilitate the goals of small-scale fishing (SDG14) and sustainable hydroelectricity and biofuels (SDG7). NTDs proliferate in less developed areas in countries across the income spectrum, areas where large numbers of people have little or no access to adequate health care, clean water, sanitation, housing, education, transport and information. This scoping review assesses how in this context, ending the epidemic of the NTDs can impact and improve our prospects of attaining the SDGs. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0288-0) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                david.molyneux@lstmed.ac.uk
                Journal
                Infect Dis Poverty
                Infect Dis Poverty
                Infectious Diseases of Poverty
                BioMed Central (London )
                2095-5162
                2049-9957
                4 January 2021
                4 January 2021
                2021
                : 10
                : 1
                Affiliations
                [1 ]GRID grid.48004.38, ISNI 0000 0004 1936 9764, Department of Tropical Diseases Biology, Centre for Neglected Tropical Diseases, , Liverpool School of Tropical Medicine, ; Pembroke Place, Liverpool, L3 5QA UK
                [2 ]Neglected Tropical Diseases, Sightsavers, Airport, P O Box KIA18190, Accra, Ghana
                [3 ]GRID grid.469385.5, ISNI 0000 0001 0033 499X, Neglected Tropical Diseases (Ascend West and Central Africa), Sightsavers, ; 35 Perrymount Rd, Haywards Heath, RH16 3BZ UK
                [4 ]Neglected Tropical Diseases, Sightsavers, 23 Beverly Dr., Durham, NC 27707 USA
                [5 ]Programme Operations, Sightsavers, Nigeria Country Office-No 1 Golf Course Road, P.O. Box 503, Kaduna, Nigeria
                [6 ]Neglected Tropical Diseases, Sightsavers, Benin Country Office-3rd Floor of the Riveria Golf Building, Akpakpa, Lot 4002 F, Old Bridge, Republic of Benin
                [7 ]GRID grid.469385.5, ISNI 0000 0001 0033 499X, Neglected Tropical Diseases, Sightsavers, ; 35, Perrymount Rd, Haywards Heath, RH16 3BZ UK
                [8 ]M&C Saatchi World Services, 36 Golden Square, London, W 9EE UK
                Author information
                http://orcid.org/0000-0001-8537-7947
                Article
                791
                10.1186/s40249-020-00791-3
                7779653
                33397494
                1b633398-3233-49fa-9524-aea2fad9e47c
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 26 November 2020
                : 21 December 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000617, Foreign and Commonwealth Office;
                Award ID: PO 8476
                Award Recipient :
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                © The Author(s) 2021

                covid-19,neglected tropical diseases,mass drug administration,morbidity management,communities,water,sanitation and hygiene,behaviour change

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