Researchers partially supported by the European Union have come up with a framework for the development of an integrated monitoring and evaluation system which aids in the effort to combat neglected tropical diseases (NTDs). Published online in The Lancet, the research team compared disease-specific protocols for mapping, monitoring and surveillance; they also examined the integration of mitigation efforts and detailed innovative solutions being proposed, and offered a conceptual framework. The work has been supported by the CONTRAST ('A multidisciplinary alliance to optimize schistosomiasis control and transmission surveillance in sub-Saharan Africa') project. Funded under the Sixth Framework Programme (FP6) to the tune of EUR 2.9 million, CONTRAST brings together key skills and expertise from research institutes and the private sector to generate new knowledge on biological, environmental and socioeconomic factors relating to schistosomiasis in sub-Saharan Africa. The report says that detailed mapping information is needed to allow planning for implementation, and the authors identify several successful mapping strategies that have incorporated quick, simple and cheap methodology. For example, the African Programme for Onchocerciasis Control developed a rapid epidemiological mapping instrument for risk assessment. Onchocerciasis is the world's second leading infectious cause of blindness, and the tool measures the basis of the proximity of probable breeding sites for insects that can carry the infection. 'These issues include identification of the most cost-effective ways to rapidly map areas at high risk of neglected tropical diseases, establishment of the most appropriate monitoring systems and development of post-intervention surveillance strategies as the programmes for lymphatic filariasis, onchocerciasis, and trachoma reach the elimination phase,' say the researchers, who hail from Niger, Sierra Leone, the United Kingdom and the United States. The researchers also highlighted several innovative approaches for mapping integration. In Cameroon, rapid assessment procedures for loiasis, a skin and eye disease caused by infection, and rapid epidemiological assessment surveys for onchocerciasis were co-implemented. In Ethiopia, combined malaria and trachoma surveys have shown that prevalence estimates, indicators, and risk factors for both diseases could be obtained for the cost of undertaking one disease survey. Trachoma, an infectious eye disease, is the leading cause of the world's infection-related blindness. For monitoring, the authors say progress towards integration lies in standardisation of definitions of coverage and creation of agreed common reporting forms that will enable comparability of data across countries and diseases. They also call for new indicators to be created so that donors can closely monitor programme success, as measured by the total number of treatments delivered through the preventive chemotherapy approach and the percentage of people at risk of these diseases reached: such data would be useful for advocacy purposes. Surveillance is clearly vital in declaring any NTD programme's success. The authors highlight as an example the lymphatic filariasis programmes, in which a card test is the recommended instrument for assessment of progress towards disease elimination, such as that used to assess groups of children born since intervention efforts began. This approach has been used in Egypt, and will be widely implemented as other countries seek to move away from mass drug administration and towards surveillance. 'Although full integration of all elements of mapping, monitoring, and surveillance strategies for the diseases targeted through the preventive chemotherapy approach is not feasible, there could be many opportunities for integrated strategies when integration is the best option,' the authors conclude.
Nigeria, Sierra Leone, United Kingdom, United States