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Exploring gender dimensions of treatment programmes for neglected tropical diseases in Uganda

July 11, 2013

TORONTO, ON — Males and females face dif­fer­ent chal­lenges in access­ing treat­ment for neglect­ed trop­i­cal dis­eases (NTDs), accord­ing to a new study from researchers at the Uni­ver­si­ty of Toron­to Dal­la Lana School of Pub­lic Health, Ugan­da Min­istry of Health and Impe­r­i­al Col­lege Lon­don. The study, to be pub­lished by PLOS Neglect­ed Trop­i­cal Dis­eases on July 11, explores the role of gen­der in access to treat­ment in the Ugan­da Nation­al Neglect­ed Trop­i­cal Dis­ease Con­trol Pro­gram.

NTDs are a group of par­a­sitic, viral and bac­te­r­i­al dis­eases that affect at least a bil­lion peo­ple world­wide. Pre­dom­i­nant­ly seen in rur­al and under­served com­mu­ni­ties in Africa, the Mid­dle East and South­east Asia, NTDs can pose sig­nif­i­cant health risks for both male and female pop­u­la­tions. Inter­na­tion­al donors have been fund­ing mass-drug dis­tri­b­u­tion pro­grams to treat neglect­ed trop­i­cal dis­eases for over a decade.

“For females, NTDs, such as schis­to­so­mi­a­sis and soil trans­mit­ted helminths (worms), can cause preg­nan­cy com­pli­ca­tions,” says lead author Heather Rilkoff. “On the oth­er hand, NTDs are thought to be some­what more preva­lent in males because men are more like­ly to have occu­pa­tion­al roles, such as farm­ing and fish­ing, which increase their expo­sure to the dis­eases.”

The study sug­gest­ed that men tend to have more dif­fi­cul­ty access­ing treat­ment, which is typ­i­cal­ly dis­trib­uted annu­al­ly house-to-house, as they may spend lit­tle or no time at home dur­ing the day due to occu­pa­tion­al roles such as farm­ing, trad­ing or truck dri­ving, which take place away from the house­hold. Females, on the oth­er hand, tend to be home more often and are more like­ly to receive treat­ment.

How­ev­er, the study also found that women who were preg­nant or breast­feed­ing at the time of the annu­al dis­tri­b­u­tion, and the com­mu­ni­ty health work­ers who dis­trib­uted the med­i­cines, were often unaware of which med­i­cines were safe to take, when it was safe to take them, and where women could find access to the med­i­cines once they were no longer preg­nant or lac­tat­ing. WHO guide­lines advise not pro­vid­ing two of the four med­i­cines used in the pro­gram to preg­nant or breast­feed­ing women until sev­er­al months after deliv­ery. In some com­mu­ni­ties, preg­nant women were not giv­en any treat­ments at all, even though they could still poten­tial­ly receive treat­ments for schis­to­so­mi­a­sis and helminth infec­tions. This might lead to a large pro­por­tion of women who con­sis­tent­ly miss treat­ment every year.

“This could have impli­ca­tions both for the indi­vid­ual women and the long term impact of the pro­gram. In these com­mu­ni­ties, a woman might spend 50% of her repro­duc­tive years preg­nant or breast­feed­ing. Unless women are aware of when they’re allowed to take the med­i­cines, and where to access treat­ment once the annu­al mass treat­ment is over, large pro­por­tions of women will go untreat­ed year after year,” says Rilkoff.

Mass-treat­ment pro­grams, which train com­mu­ni­ty mem­bers to dis­trib­ute med­i­cines with­in their com­mu­ni­ties, have been iden­ti­fied as an effec­tive strat­e­gy to treat affect­ed pop­u­la­tions. How­ev­er, lim­it­ed evi­dence is avail­able to dis­cuss chal­lenges to treat­ment access, adher­ence, deliv­ery and mon­i­tor­ing at the com­mu­ni­ty lev­el.

“While there were often sim­i­lar­i­ties across com­mu­ni­ties involved in the study in terms of gen­der-based chal­lenges to access­ing treat­ment, there were dif­fer­ences as well. Ensur­ing that there is health edu­ca­tion and effec­tive train­ing of com­mu­ni­ty health work­ers in each com­mu­ni­ty will def­i­nite­ly help, but the nuances we see between com­mu­ni­ties also sug­gests that each com­mu­ni­ty should be sup­port­ed to cre­ate their own solu­tions to these issues.”

The study sug­gests a more com­pre­hen­sive under­stand­ing of the nuances and chal­lenges of com­mu­ni­ty-based treat­ment pro­grammes is need­ed to address gen­der-relat­ed chal­lenges and ensure future suc­cess of the pro­grammes.

“The inter­na­tion­al com­mu­ni­ty have put in sig­nif­i­cant efforts to estab­lish these pro­grams. But because the pro­grams are com­mu­ni­ty-based, there real­ly needs to be more resources devot­ed to sup­port­ing the vol­un­teer health work­ers who admin­is­ter the med­i­cines to address the gen­der-relat­ed chal­lenges that they face, and to ensure that they are able to car­ry out their duties with­out tak­ing time away from their own liveli­hoods,” says Rilkoff.

This study was co-authored by Heather Rilkoff, of the Dal­la Lana School of Pub­lic Health, Uni­ver­si­ty of Toron­to, Edri­dah Muhe­ki Tuka­heb­wa, of the Ugan­da Min­istry of Health, Fiona Flem­ing and Jacque­line Leslie, of the Schis­to­so­mi­a­sis Con­trol Ini­tia­tive, Impe­r­i­al Col­lege Lon­don and Don­ald C. Cole, of the Dal­la Lana School of Pub­lic Health, Uni­ver­si­ty of Toron­to.


For more infor­ma­tion, please con­tact:

Heather Rilkoff, MPH
Dal­la Lana School of Pub­lic Health
Uni­ver­si­ty of Toron­to

Jele­na Dam­janovic
Uni­ver­si­ty of Toron­to
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