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The sub-Saharan African (SSA) region is home to more than 230 million females of reproductive age who face multiple intersecting health, social, gender and economic challenges [1]. Neglected tropical diseases (NTDs) are a group of chronic disabling, almost exclusively communicable diseases affecting the poorest of the poor, especially in Africa, which alone bears about 40% of the global burden of NTDs [2- 4]. While both men and women are impacted, biological and sociocultural biases mean that NTDs disproportionately affect women and girls [5]. In recent decades, there has been a global shift from communicable toward non-communicable diseases (NCDs), which cause almost 32 million deaths in low-and lower- middle- income countries (LMIC) [6]. It is expected that by 2030, 85% of NCD-related deaths among women will occur in LMICs, including many countries of SSA region [7]. For women older than 50, NCDs are the leading cause of both death and disability-adjusted life years (DALYs) [8]. Important disparities persist in access to maternal and reproductive health services both within and between countries in SSA [9]; it is estimated that almost half of the women in SSA do not have access to essential health care during pregnancy and childbirth. In 2017, SSA accounted for roughly two-thirds of all maternal deaths in the world [10]. Hence, it is evident that many, if not most, women and girls in SSA carry a triple burden of vulnerability to NTDs, NCDs and poor reproductive health outcomes. Here, we report on the outcomes of an integrative, multistakeholder workshop held in Gabon, Central Africa, to help develop a framework for synergistic, sustainable and gender- and context-appropriate interventions to manage the NTD-NCD complex and additionally reproductive health.
An integrative, multistakeholder workshop was organized in Gabon as an explorative method to investigate how such an approach across the three key themes (with the three tracer clinical conditions) could be mastered. More specifically, we aimed to: The workshop was designed and developed by the HelmVit consortium (funded by the DFG, with additional assistance from the DZIF) to explore the effects of Schistosomiasis-associated pregnancy on vitamin D metabolism. The coordination team was sited at the Technical University of Munich (TUM), Germany in close collaboration with partners at the University of Tübingen (UKT), Germany and Centre de Recherches Médicales de Lambaréné (CERMEL), Gabon. An equitable representation of experts from from Europe (Germany, Switzerland and United Kingdom) and Africa (Gabon, Mozambique, Kenya and Cameroon) presented over the course of two-and-a half days. A detailed list of presenters is given in Appendix S1 in the Online Supplementary Document. Presentations given by international experts included an overview of the global and local picture in Gabon about the three key themes through their tracer disease-conditions, the current available epidemiological data and disease burden and the gaps in knowledge and research. Four sessions of in-depth plenaries covered the three key themes by lectures and open dialogue among participants via round tables and panel discussions. A general ‘women’s health’ plenary aimed to integrate expertise across the academic, community, industry and policy and governance spectrum. Two practical teaching modules allowed hands-on training for midwives, nurses and gynaecologists, and introduced innovative digital health applications for field diagnosis and awareness generation. A further collaborative session allowed all participants to generate reflections for knowledge exchange. A detailed agenda is reproduced in Appendix S2 in the Online Supplementary Document. The workshop was run in English to facilitate the full compendium of participants and researchers from diverse language backgrounds and contexts. However, since the operational language of the nurses and midwives was French, English-to-French translation facilitators were on hand for support. All English presentations were pre-translated into French and distributed as handouts to all participants. During the round-table sessions, in which participants discussed competencies, both French and English were supported options. The coordination team recorded all sessions in documentary and video format.
