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Eliminating Neglected Tropical Diseases in Urban Areas: A Review of Challenges, Strategies and Research Directions for Successful Mass Drug Administration

Department of International Health, Georgetown University, Reservoir Road NW, Washington, DC 20057, USA
Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
Family Health International 360 (FHI360) Ghana Country Office, 1st Floor Marvel House 48A Giffard Road, Accra, Ghana
RTI International, 701 13th St NW, Suite 750, Washington, DC 20005, USA
Office of Infectious Diseases, Global Health Bureau, U.S. Agency for International Development, 1300 Pennsylvania Ave NW, Washington, DC 20352, USA
Institutional affiliation: Ministry of Health and Population, Delmas 60, Rue Lemercier #2, Port-au-Prince, Haiti
Ministry of Health Mali, BP: 233, Bamako, Mali
Authors to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2018, 3(4), 122;
Received: 28 September 2018 / Revised: 6 November 2018 / Accepted: 17 November 2018 / Published: 21 November 2018
(This article belongs to the Special Issue Slum Health: Diseases of Neglected Populations)
Since 1950, the global urban population grew from 746 million to almost 4 billion and is expected to reach 6.4 billion by mid-century. Almost 90% of this increase will take place in Asia and Africa and disproportionately in urban slums. In this context, concerns about the amplification of several neglected tropical diseases (NTDs) are warranted and efforts towards achieving effective mass drug administration (MDA) coverage become even more important. This narrative review considers the published literature on MDA implementation for specific NTDs and in-country experiences under the ENVISION and END in Africa projects to surface features of urban settings that challenge delivery strategies known to work in rural areas. Discussed under the thematics of governance, population heterogeneity, mobility and community trust in MDA, these features include weak public health infrastructure and programs, challenges related to engaging diverse and dynamic populations and the limited accessibility of certain urban settings such as slums. Although the core components of MDA programs for NTDs in urban settings are similar to those in rural areas, their delivery may need adjustment. Effective coverage of MDA in diverse urban populations can be supported by tailored approaches informed by mapping studies, research that identifies context-specific methods to increase MDA coverage and rigorous monitoring and evaluation. View Full-Text
Keywords: neglected tropical diseases; mass drug administration; urban health neglected tropical diseases; mass drug administration; urban health
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Adams, A.M.; Vuckovic, M.; Birch, E.; Brant, T.A.; Bialek, S.; Yoon, D.; Koroma, J.; Direny, A.; Shott, J.; Lemoine, J.F.; Dembele, M.; Baker, M.C. Eliminating Neglected Tropical Diseases in Urban Areas: A Review of Challenges, Strategies and Research Directions for Successful Mass Drug Administration. Trop. Med. Infect. Dis. 2018, 3, 122.

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