02374nas a2200229 4500000000100000008004100001653002200042653001300064653001100077653001800088653003300106653003300139653002600172653001800198653001200216100001300228245009000241300001000331490000600341520178300347022001402130 2009 d10aTropical Medicine10aTrachoma10aHumans10aHelminthiasis10aDrug Administration Schedule10aCommunicable Disease Control10aAnti-Bacterial Agents10aAnthelmintics10aAnimals1 aSmits HL00aProspects for the control of neglected tropical diseases by mass drug administration. a37-560 v73 a

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.

 

 

 

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