Western Region, Ghana- In the quiet coastal village of Butri in Ghana's Western Region, a young student's curiosity sparked a journey that changed the world’s understanding of neglected tropical diseases (NTDs). “During a lymphatic filariasis (LF) project, I observed a puzzling phenomenon: almost everyone examined at the time harbored microfilaria—baby worms that cause elephantiasis and hydrocele in their blood—yet only a small percentage exhibited symptoms of elephantiasis or hydrocele, Prof. Alexander Debrah, Professor of Parasitology at the Kwame Nkrumah University of Science and Technology, recounted.
The student, Debrah, asked his German mentor, Prof. Buttner, why so few people developed these symptoms despite widespread infection. Prof. Buttner responded, “Mr. Debrah, I don’t know. When you become a Professor of Parasitology, you can then answer that question.” This response ignited Debrah’s lifelong quest to unravel the mystery.
Neglected Tropical Diseases (NTDs) affect about 1.3 billion people worldwide, primarily in poor tropical and subtropical regions. These diseases, including lymphatic filariasis (elephantiasis) and onchocerciasis (river blindness), thrive in conditions of poverty, poor sanitation, and limited access to healthcare.
In Ghana, available literature shows elephantiasis was present in at least 98 out of the then 200 districts and river blindness alone affects about 2 million people in at least 100 districts; all of whom require some form of treatment or intervention.
To attain the Agenda 2030 target of the United Nations Sustainable Development Goals (SDGs), the World Health Assembly Agrees on a Roadmap for Ending Neglected Tropical Diseases. This includes a 90% reduction in the number of people needing treatment for neglected tropical diseases, and eliminating at least one NTD in 100 countries.
However, there are obstacles hampering this achievement. In Ghana, efforts to control and eliminate filarial diseases and hydrocele face significant challenges. Traditional treatments like ivermectin and albendazole used for treatment target only baby worms, leaving adult worms in the patients requiring prolonged medication for 10-15 years until the adult worms die naturally. This, experts say, complicates treatment strategies and hinders effective disease management.
A Breakthrough in Treatment
After two decades of searching for a drug that could kill this bacteria called Wolbachia, within the Wuchereria bancrofti and Onchocerca volvulus,- the parasites that cause elephantiasis and river blindness, respectively, Prof. Debrah’s clinical trials with an affordable antibiotic known as doxycycline showed remarkable results. Doxycycline eradicated the Wolbachia, leading to the death of adult worms after a year. This breakthrough meant that both adult and baby worms could be eliminated with doxycycline treatment.
“What this outcome means is that, now, an infected person takes doxycycline for 4-5 weeks and both the adult and the baby worms that cause river blindness, elephantiasis and hydrocele will die and the person will be free forever.”
Atta Baido, a 65-year-old from Butri, has been battling elephantiasis for nearly 20 years. "I have had this condition for close to 20 years now, I can’t work or do anything for a living. I have over the years depended on my family, and they’re even fed up with me. But now the drug has helped me to recover, it's a new hope for me. I never thought this day would come while alive.”
Hope for the Future
Prof. Debrah's research has made significant progress in the fight against NTDs. “As a Professor of Parasitology, I remain committed to answering the questions that sparked my journey and bringing hope to those affected by these neglected diseases”.
Expanding Treatment and Research
With a €3.5 million grant from the German Ministry of Education and Research under the TAKeOFF project, Prof. Debrah’s team scaled up treatment and incorporated simple foot hygiene practices recommended by the WHO. In addition, multi-country trials showed that in regions where elephantiasis transmission had ceased, simple foot hygiene alone was sufficient for managing the condition.
Innovative Reporting Solutions
To address the lack of effective tools for reporting elephantiasis morbidity, the team deployed the use of mobile technology to train Community Health Volunteers to use a web-based system via mobile phones to report available cases for treatment. This approach led to a significant increase in reported cases, enabling better management and policy decisions.
Policy Recommendations
In his inaugural professorial lecture, under the theme “ Eliminating filarial diseases, a new hope for an old battle” Prof. Debrah is advocating for the inclusion of elephantiasis and hydrocele management in the National Health Insurance Scheme to enable NTD sufferers access to care. He called on the sector players to leverage digital technologies for case identification, promoting community engagement and education, and ensuring continuous monitoring and evaluation of control programs.
“Through dedicated research and innovative solutions, we’re transforming the landscape of neglected tropical disease management, bringing hope and healing to those affected’.