MEDICAL CARE COMMUNITY
For a broad humanitarian impact, work of the Else Kröner Center goes beyond academic relations and hospital based medicine to integrate approaches that directly target the population.
Our initial focus is put on schistosomiasis, a parasitic disease caused by contact with contaminated fresh water. Schistosomiasis is a major public health burden and exerts dramatic economic impact in the lake region. Life threatening morbidities caused by Schistosoma infection remain a common cause of hospitalisation and death among adult individuals. Up to now, the only control intervention by the national control program is mass drug administration (MDA) of Praziquantel. However, stand-alone MDA programs can only achieve a reduction in related morbidities, but will not interrupt the transmission cycle. Moreover, the current design of national MDA campaigns is selectively focused on school children and does not include any other highrisk group.
An interdisciplinary approach combining medical care, education, and hygiene and sanitation behaviour is essential to successfully fight schistosomiasis. Therefore, a pilot study initiated by MI, DAHW and CUHAS/BMC was performed. In this multimodal approach including health education, repeated treatment cycles and improvement of infrastructure, we could demonstrate that elimination of the disease is achievable. Bases on this pilot project, the Else Kröner Center integrates an expanded program to improve population health.
A particular focus is put on the communities of Ukerewe island, who almost entirely live on fishing activities and are as such largely dependent on the lake. This in turn renders them highly vulnerable for contracting schistosomiasis. To achieve a sustainable impact on schistosomiasis control, the Else Kröner Center adds important components to the current MDA strategy: We build capacity by training community health care workers, lab technical assistants, and community drug distributors. The training courses are held by experienced staff from CUHAS/BMC aided by partners from the Tanzanian Institute for Medical Research and Würzburg. The courses are offered in Ukerewe health centers and cover clinical presentation, diagnosis, treatment, prevention of schistosomiasis, and standard tools for laboratory diagnosis. Through these measures, the Else Kröner Center enables communities to effectively provide access to MDA for all vulnerable at-risk-groups. To create additional ownership and self-responsibility among the targeted population, we also organize community-based campaigns that create awareness and sensitize about the disease, its causes (e.g. hygiene behaviour) and its consequences.
In parallel, a treatment documentation system to document and monitor individual patients and avoid over- as well as undertreatment will be established. To record the baseline disease burden as well as the impact of the MDA program, test and treat campaigns are conducted. These data are essential to adjust MDA strategies in close cooperation with the existing governmental program. As part of community outreach activities, mobile clinics bring diagnostic expertise and ultrasound screening to the people. This enables us to visualize spatial distribution and monitor local epidemiology of chronic morbidity. The mobile clinics are also an important prerequisite to guide patients towards hospital based care.
Within this interdisciplinary approach to fight schistosomiasis, we cooperate with local administrative organs as well as national programs. Accordingly, the program activities will be implemented in agreement with the local authorities and the national control program. The Tanzania National Institute for Medical Research in Mwanza is supporting partner of the program.
On a long term basis, these structures built within the Else Kröner Center program will directly be useful to target other communicable and non-communicable diseases in a community-based approach.
© Sascha Montag