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NTD SUCCESS STORY: HAITI Location: Caribbean Population: 10 million First Lady of Haiti, Mrs. Sophia Martelly, stands by as a schoolgirl receives a dose of medicine to prevent NTDs as part of a mass drug administration in St. Louis-du-Sud. Photo: Christopher Glass/IMA World Health Endemic NTDs: (trichuriasis) Whipworm Hookworm Roundworm (ascariasis) Lymphatic filariasis (elephantiasis) The challenge: The poorest country in the Western hemisphere, with the highest infant mortality and lowest life expectancy, Haiti is a country with many challenges. Nearly the entire population is at risk of contracting the NTD lymphatic filariasis (LF), a mosquito-borne disease. Caused by thread-like parasitic filarial worms that live in the lymphatic system, LF causes extreme swelling of the extremities (a condition known as elephantiasis) and genitals (a condition known as hydrocele). The high prevalence of NTDs in Haiti persists, in large part, because of poor access to water and sanitation. About nine out of ten Haitians in rural areas do not have access to clean, safe water, and almost half lack access to adequate sanitation facilities. These circumstances were compounded in the wake of the 2010 earthquake that killed at least 200,000 people and destroyed much of the nation’s infrastructure. Despite these challenges, Haiti is making incredible progress against NTDs and expanding its national NTD control program in an effort to eliminate LF. The approach: Under the leadership of the Haitian government, a range of partners have assisted with the annual distribution of drugs to help prevent the spread of four NTDs: LF, whipworm, hookworm and roundworm. A critical aspect of the success of these efforts has been the training of more than 30,000 local community leaders to organize, promote, and carry out mass drug administration (MDA) campaigns, distributing medicine to everyone in at-risk communities. Until the 2010 earthquake, Haiti’s Neglected Tropical Disease Control Program conducted MDAs only in the areas of the country where LF was most prevalent. The crowded capital city of Port-au-Prince, with relatively low levels of LF infection, was thought to be too difficult a setting to carry out MDA. But after two million people were left homeless in the aftermath of the earthquake and internal migration threatened to redistribute the disease, the goal of MDA became national treatment coverage – with the aim of eliminating the disease from Haiti altogether. www.globalnetwork.org www.end7.org Key successes: By late 2011, at least one round of MDA had been conducted in all endemic areas of Haiti except the capital, Port-au-Prince. From November 2011–February 2012, an MDA was conducted for the first time in the crowded metropolitan area. More than 80% of the population has now been reached by MDA, a tremendous accomplishment in a country facing many health and development challenges. In May of 2014, the U.S. Agency for International Development, a major partner of the Haitian government’s NTD program, delivered its one billionth treatment worldwide at a ceremony in SaintLouis-du-Sud, Haiti, a testament to the country’s commitment and progress in the fight against NTDs. Haiti is also an example of an integrated approach to combating NTDs, having successfully integrated its LF and soil-transmitted helminth (STH) control programs, which previously operated in separate units at the Ministry of Health. The country is also scaling up efforts to fortify table salt with medicine to prevent LF, an approach that has helped countries like China eliminate the disease, and to address the needs of Haitians already incapacitated by elephantiasis and hydrocele as a result of LF infection. The road ahead: Haiti is one of just four countries in the Americas where lymphatic filariasis remains endemic, accounting for 80% of people at risk of the disease in the region. If the country can succeed in their effort to eliminate LF by 2020, it would be a major step in the global effort to end the disease. As Dr. Patrick Lammie, an immunologist with the Centers for Disease Control and Prevention, put it, “If a country like Haiti, with all of the challenges that they’ve faced over the last few years, is able to achieve full national coverage, I think that is as an important example for other countries, which are struggling to scale up their programs as well.” Partners in progress: The Haitian Ministry of Health has been combating NTDs in Haiti for years. Many agencies and organizations, including the Pan American Health Organization, the Inter-American Development Bank, the U.S. Centers for Disease Control, the U.S. Agency for International Development, the University of Notre Dame Haiti Program, IMA World Health, and CBM have partnered with the Ministry of Health to provide technical assistance and implement a program to combat NTDs since 2000. IN THE NEWS: • Washington Post: Haiti takes on dreaded disease elephantiasis one mouth at a time • NPR: Haiti Moves A Step Closer Toward Eradicating Elephantiasis • CNN: 5 years on, hope for Haiti LEARN MORE: • MMWR: Mass Drug Administration for the Elimination of Lymphatic Filariasis — Port-au-Prince, Haiti, 2011–2012 • USAID: Haiti’s NTD Program Overview • PLOS: Haiti National Program for the Elimination of Lymphatic Filariasis—A Model of Success in the Face of Adversity Young girls from the École Saint Patrick in St. Louis-du-Sud, Haiti, line up at a ceremony to celebrate USAID’s delivery of the one billionth NTD treatment in May of 2014. Photo: Christopher Glass/IMA World Health www.globalnetwork.org www.end7.org