Collaborative research to tackle neglected tropical diseases in East Africa

Neglected tropical diseases (NTDs) are a group of chronic infectious diseases that affect people in many low and middle income countries. Although they are preventable and often treatable, knowledge of NTDs within healthcare systems is limited and more than 1 billion people worldwide suffer extensive pain, disfigurement and disability. People affected by NTDs can often face discrimination and social stigma, contributing to a cycle of poverty in affected areas.

Led by Melanie Newport, Professor in Infectious Diseases and Global Health at Brighton and Sussex Medical School (BSMS), and in partnership with Addis Ababa University, Ethiopia, and the Mycetoma Research Centre at the University of Khartoum, Sudan, the Unit’s main goals from 2017–21 have been to: 

• improve countries’ abilities to diagnose, prevent and treat podoconiosis - a progressive and disabling lower leg infection caused by exposure to red clay soil
• develop tools to prevent mycetoma
• strengthen the ability of low-income countries to respond to scabies outbreaks.

These have been achieved through seven workstreams and their key outputs and impacts are summarised below.

1. The Unit’s 'Excellence in Disability Prevention Integrated across NTDs' (EnDPoINT) Consortium investigated how physical and mental health could be improved by providing community-level care to treat and support people with podoconiosis, lymphatic filariasis and leprosy. They found that social and psychological interventions, alongside treatment for physical symptoms, markedly improved people’s health and wellbeing. After 12 months’ follow-up they recorded significant reduction in recurrent leg infections, lower limb swelling, disability, depression and stigma, resulting in marked improvements in quality of life.

The care package will inform the Ministry of Health in Ethiopia’s existing plans to expand integrated foot care and psychosocial support nationally for patients with lymphoedema (swelling of the lower leg) and enable the research team to develop similar care packages for other endemic settings.

2.  Another research team tested a simple, non-invasive 3D imaging method to measure lower limb volume in 100 patients in Ethiopia to assess the effect of treatment over time. They found that the device, Lymphatech®, could provide a reliable, portable and more hygienic alternative to existing methods.

3.  The Unit has also made progress identifying biological markers of podoconiosis that could lead to the development of a diagnostic test and help target care to those most at risk.

4.  A team in Ethiopia discovered that a high percentage of bacteria isolated from wounds in patients with lymphoedema were resistant to the most commonly-used antibiotics. They investigated the use of native plants used in traditional medicine as a source of alternative antibiotics for the management of wound infections.

5. Mycetoma is a slow-growing, destructive infection of the skin, underlying tissues and bone for which there is no effective treatment. The team carried out DNA sequencing of family members in an affected area of Sudan and found that a person’s genes may influence their susceptibility to mycetoma.

6.  The team also carried out a large household survey in a mycetoma-endemic region of Sudan to inform prevention and control strategies in the community.

7.  Scabies is a profoundly irritating infectious skin condition caused by tiny mites burrowing into the skin. Scabies infection can be complicated by bacterial infections which can lead to septicaemia. The Unit’s team found that mass drug treatment of communities where 10% of people were infected was cost-effective, and based on this finding have recommended the Ministry of Health in Ethiopia lowers the threshold for treatment from 15% to 10%.

By addressing issues directly relevant to national and global NTD programmes, the Unit’s research has delivered real health benefits for patients and impact for policy makers in Ethiopia and Sudan, the Unit’s research has been widely published and shared at conferences, helping to create an evidence base for prevention and treatment of NTDs. For example, in December 2020 its researchers contributed several articles to a special issue on podoconiosis in the Transactions of the Royal Society for Tropical Medicine and Hygiene, in which key priorities for research and its implementation were raised.  

Shortly after the Unit was established it hosted the First International Podoconiosis Conference in Addis Ababa. This was a milestone event that raised global awareness of podoconiosis and joined government representatives, researchers, and policy makers in a declaration to eliminate the disease. Since then, the team has contributed to numerous international events to present their research and support networks working towards eradication of NTDs. For example, in her role as the Unit’s co-director, Professor Gail Davey delivered a keynote presentation on global awareness of neglected skin disease to the British Association of Dermatologists 2021 conference. Her colleagues, Dr Maya Semrau at BSMS and Dr Asrat at CDT-Africa, later led a session at the Coalition for Operational Research on NTDs 2021 conference explaining their work developing a strategy to manage skin-related NTDs.

Professor Davey has supported other events by acting as chair for a range of meetings, including a UK All-Party Parliamentary Group based on the World Health Organization’s (WHO) 2021-2030 road map to manage NTDs, which helped demonstrate the impact of investment for NTDs. The joint meeting of the London Centre for NTDs and Royal Society of Tropical Medicine and Hygiene, also chaired by Professor Davey, gave researchers a platform to discuss how researchers and implementers can take a more people-centred approach to manage NTDs.

Countries are encouraged to develop 5-year master plans to outline their strategies to eradicate NTDs. Professor Davey has been heavily involved with the development of Ethiopia’s third NTD master plan, with Dr Asrat taking an advisory role and representing the Unit at their national meetings.

Following a successful discussion about the development of a skin-NTD master plan, the Unit’s EnDPoINT research team and WHO representative Dr Daniel Dagne have helped Ethiopian representatives identify research questions to inform their own master plan. These questions are expected to lead to research projects including recording areas commonly affected by NTDs, the distribution of mass drug treatments and how to manage NTDs.

In 2021, the Unit received a further £7 million grant from the NIHR to progress Phase 2 of their research, which is now expanding to include the University of Rwanda and the Rwanda Biomedical Centre. The new 5-year programme comprises 12 research projects, focusing on the causes of disease, geospatial mapping, diagnostics and drug development, and understanding how interventions can be implemented in real world settings.

Explaining the impact of the 5-year funding commitment, Professor Newport said:

“This grant will enable us to continue our work on these debilitating and stigmatising conditions that affect millions of the world’s poorest people.”

“Central to our approach is to train and empower future researchers from Ethiopia, Sudan and Rwanda, and strengthen capacity to do similar research in all three countries that will lead to the elimination of diseases and improve the health and wealth of affected populations.”

Professor Abebaw Fekadu, co-principal investigator and head of CDT-Africa at Addis Ababa University, also commented: 

“I am really excited about this grant. It is an opportunity to build on our excellent work over the past four years, in which we have been able to demonstrate that effective care for these highly stigmatising and neglected conditions can be provided through integrated healthcare.”

The study was funded by NIHR’s Global Health Research Units Programme.

More information about the study is available on the NIHR’s Funding & Awards website for Phase 1 and Phase 2 research programmes.