This presentation was given my Margaret Gyapong at the Coalition for Operational Research on Neglected Tropical Diseases (NTDs) (COR-NTD) meeting in 2015. She raises critical questions about the links between gender, equity, disability and NTDs.

1. Gender, Equity, Disability and
NTD’s
Margaret Gyapong, Sally Theobold, Kate Hawkins
COUNTDOWN

2. Background
Addressing bottlenecks
in scale-up
and
acceleration towards
2020 targets
?
Programme of implementation research to
inform the effective and sustainable scaling-up
of integrated Neglected Tropical Disease (NTD)
control initiatives

3. Integrated
Complementary
Strategy Theme
ICST 1
ICST 2
Rationale for research themes and approaches
Liberia GhanaCameroon
MDA Scale-up Themes (MST 1 – 3)
control elimination
Country & context-specific setting of MDA
MST 1: Evidence synthesis
Paul Garner and Cochrane group
MST 2: Applied social science
Sally Theobald and Margaret Gyapong
MST 3: Health economics
Louis Niessen
ICST 1: ‘Hotspots’ and SAEs
Mark Taylor, Lisa Riemer
Nana Biritwum and Sam Wanji
ICST 2: Access to MDA and CLTS
Russ Stothard, Emily Adams,
Louis Tchuem-Tchuente and Nana Biritwum
scale-up in Nigeria

4. Context
• Gender, equity and disability interact with NTDs in various ways.
• Deeply rooted in local sociocultural contexts, the interventions need to be
adapted to those contexts
• Infected individuals incur added burdens due to stigma, isolation and other
negative consequences
• FGS
• MGS
• Reduce the acceptability of health services, leading to differential health care
outcomes
• Health care providers are unaware of issues arising from gender-based
inequity in access to health care
• Affect marginalised populations who have a right to be heard in various ways
• Out of school children
• Pregnant women
• People living with disability
.

5. “They are hiding their skin so that people cannot see them. I have not heard of anyone
who wants others to know about it. No one will allow them to lead, and many people
ignore them. They are considered dangerous. People fear contact with them. I feel sorry
for them. Even me, I feared that from staying and meeting them we could get the disease
… They find it hard to marry, and marriages can break because of this condition.” (25 year
old Ugandan woman in an oncho endemic area) Weiss et al (2008)
• Men are key decision makers
• Women are not invited to meetings where issues of MDA are discussed and major decisions are taken
Case one

6. Case two
• Adolescent girls and women with FGS experience
• Bleeding and unpleasant discharge from the vagina,
• Genital lesions,
• Nodules in the vulva,
• General discomfort and pain during sex.
• Sub-fertility, miscarriage and can affect vulnerability to HIV and the Human Papilloma Virus;
• Symptoms of MGS in adolescent boys and men include
• Bleeding and egg deposition within semen,
• Yellow discoloration in semen and lumpy semen, the implications of which are poorly
understood (Mbabazi et al 2011).
• FGS and MGS are sensitive, private, and possibly stigmatising.
• How men and women experience symptoms, their treatment seeking pathways
and the impact on their livelihoods and well-being are poorly understood
• How health care providers recognise, diagnose and treat these conditions is not
well known and documented

7. Filling the gap
• Understanding contexts
• Understanding the physical, socio economic and cultural context within
which these interventions are delivered
• Understanding the health system within which these interventions are
delivered
• Key stakeholders and institutions needed to ensure the effective delivery
of the interventions
• Understand the issues at stake from the perspective of the
• Patients and their networks
• Unaffected people and their networks
• Health care providers operating in a complex and under funded system