Pablos-Mendez et al., in their October 2005 editorial in the Bulletin entitled: Knowledge translation in global health (1) argued that research must be part of a strategic process that moves evidence-based, cost-effective interventions to true practice. Barriers to the implementation of effective interventions lead to what the authors called the "know-do" gap. Research should help us to understand those barriers that prevent bringing what we know to the logical conclusion of action in the field and resultant better health or better health services. The Carter Center-assisted mass treatment programmes in Nigeria (2) provided an opportunity to demonstrate how differences in mass treatment guidelines and resources create a know-do gap presenting a barrier to the integration of programmes that should logically work together synergistically.
Community-based annual mass drug administration (MDA) with safe and effective oral drugs is the principal strategy for the control of onchocerciasis, lymphatic filariasis (LF) and schistosomiasis) Annual treatment with microfilaricide ivermectin (Mectizan, donated by Merck & Co., Inc.) prevents the severe eye and skin manifestations ofonchocerciasis. Transmission of LF by mosquitoes can be interrupted in Africa by annual single-dose combination therapy with ivermectin (also donated by Merck & Co.) and albendazole (donated by GlaxoSmithKline). (4) Schistosomiasis in Africa is usually caused by Schistosorna mansoni or S. haernatobiurn. School-aged children are the most heavily infected, and the most frequent symptom of urinary schistosomiasis (infection with S. haematobiurn) is blood in the urine. Mass distribution of praziquantel can significantly reduce schistosomiasis morbidity. (5,6) However, unlike ivermectin and albendazole, praziquantel is not donated and costs approximately US$ 0.20 per treatment.
Context of the translation of knowledge: is there a know--do gap in the integration of mass drug administration?
When the Global Alliance to Eliminate LF (GAELF) was launched in 1998, we noted the potential synergy and cost savings to be made in Nigeria from linking the LF activities to those being supported by the African Programme for Onchocerciasis Control (APOC). (6,7) Both WHO initiatives were based on World Health Assembly-approved strategies of annual MDA and health education; both were working in many of the same countries; both had access to donated drugs; and both used ivermectin. This was an excellent opportunity to link the two multicountry WHO programmes in Nigeria. The approach taken was to launch the LF programme from within the mature APOC-supported programme. Albendazole tablets would be given concurrently with the ivermectin tablets already being delivered, together with additional health education.
But we hoped for more than the obvious linkage of onchocerciasis and LE Efforts to control schistosomiasis were (and are) lagging behind the LF and onchocerciasis initiatives in Nigeria. The Schistosomiasis Control Initiative, (4) another large regional initiative similar to APOC and GAELF, had not chosen Nigeria as a one of its programme countries. We wondered if linking the LF and onchocerciasis programmes with urinary schistosomiasis control could invigorate this MDA programme as well. A successful know--do programme with three drugs for three diseases in "triendemic areas" might show national and global decision-makers how they could expand integrated helminthic disease control to include schistosomiasis and therefore stimulate new thinking, new policy, new investments and partnerships, and perhaps even a donation of praziquantel.
The large-scale integration project is a combined effort by the Federal Ministry of Health and The Carter Center and is situated in Plateau and Nasarawa States, an area which has an estimated population of 4 million inhabitants and comprises 30 administrative districts (local government areas (LGAs)), all of which were mapped for onchocerciasis in the early 1990s. …