Innovating to better target those affected by neglected tropical diseases in Ethiopia

Badege lives with his wife Koyne and their six children on a farm in the lush hills of Bench-Maji Zone of Southwest Ethiopia, in what is known as the birthplace of coffee.

The idyllic setting, however, belies a harsh reality. Badege, Koyne and at least two of their six children have been feeling sick and their symptoms suggest they could have schistosomiasis.

“My family and I are suffering from stomach and body aches,” said Badege. “I am not sure what is causing it, as we haven’t gone for a check-up. But they will give me medicine for it at the pharmacy.”

According to Ethiopia’s Ministry of Health, close to 75 million people in Ethiopia are affected by a set of mostly parasitic diseases collectively categorised as Neglected Tropical Diseases (NTDs). Prominent among these are schistosomiasis and soil transmitted helminthiasis (STH) (hookworm, roundworm and whipworm) which are endemic in Bench-Maji.

“I am familiar with Dache (local name for schistosomiasis). I know people who have had it. I’ve had it myself. My wife has also had it, and my son, Yunus.”

A new strategy for interruption of transmission of disease

Since 2015 the Ethiopian Federal Ministry of Health, with the support of The END Fund and the SCI Foundation, has been prioritising the treatment of these NTDs through mass drug administration campaigns in highly affected areas like Bench Maji Zone where Badege lives. Badege’s children have been receiving praziquantel (for fighting schistosomiasis) and mebendazole (for treating helminths and other intestinal worms) at school.

In 2020, the Federal Ministry of Health prepared the third National Neglected Tropical Diseases masterplan that calls for the interruption of transmission of schistosomiasis and soil transmitted helminthiasis by 2025. To ensure an effective and efficient implementation of the plan, teams of health workers have been trained to conduct a geostatistical survey designed to assess the prevalence and distribution of schistosomiasis and soil transmitted helminthiasis.

Badege and his family live in one of the sub-districts where the survey is being conducted in collaboration with the END Fund, the SCI Foundation and the London School of Hygiene and Tropical Medicine.

“The people who came today took stool samples to look for diseases and to get us medicine to treat them,” said Badege. “They are testing for Dache.”

How the geostatistical survey works

Bekele, a nurse, is a member of the survey team that has been assigned to Bench Maji zone. He is part of a team responsible for mapping the village and collecting stool samples, which they will give to the sample analysis team that set up a mobile laboratory in the town’s school.

“Today our first stop was a primary school,” said Bekele. “We took the GPS reading for the Primary School. We then counted the number of homes along our route – we went all the way to the edge of the town and entered the endpoint GPS reading into the mobile device. The mobile device then calculates and tells us the interval between homes that we should work in.”

In the town, the mobile device (which is linked in real time with the overall survey management team at the London School of Hygiene and Tropical Medicine) informed Bekele’s team they needed to conduct interviews and collect samples from every tenth household. Badege’s family is the second that they visited.

“When we enter an individual’s home the first thing that we do is introduce ourselves, tell them where we have come from and why,” said Bekele. “If the family is willing to take part in the survey, they sign a digital consent form on the phone. We count how many people are in the home and their level of education.”

“We record what kind of things they have in their home, for example if they have chairs, a radio, television, electric power, if they have a latrine and the type of facility it is. Their source of water, things related to sanitation. Do they have cattle in their home – chickens, goats, horses.

We then record the names and ages of their children and what grade they are in at school – and if they have received praziquantel medication at school or not. We then take stool samples, differentiating who has received medication for schistosomiasis and other intestinal parasites. We record all this information on the mobile phone, and we collect 90 samples in each kebele [town].”

Reaching remote communities

Most of the districts where the survey is being conducted are remote and can be challenging for the survey teams. Conducting the survey during the COVID-19 pandemic has also added to the workload. Bekele and his team are masked up as they make their way through the towns. They maintain as much distance as possible when conducting interviews and collecting samples, and make sure all items that pass between them and the survey participants are sanitised.

“The work is tiring – it can be hard,” said Bekele. “There is a lot of information that we collect from each household, and it has to be complete. We take a vaccine carrier with us to each household (to store samples). The geography of the area is challenging.

Some of the towns aren’t even accessible by motorcycle, let alone a car. We have to go on foot – up and down hills and across rivers. And there is the rain. Our plan today was to go to one of the more distant sites, but we were worried about the rain.  It rained yesterday and the roads were muddy making the [town] inaccessible. But we are determined to push on.”

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Bench Maji Zone in Ethiopia’s Southern Nations Nationalities and Peoples’ Region is one of eight areas SCI Foundation is conducting the Parameter Validation Survey in to map the prevalence and incidence of schistosomiasis, and soil-transmitted helminthiasis.