Impact of conflict on the elimination targets of lymphatic filariasis, schistosomiasis and soil-transmitted helminths in Cabo Delgado province, Mozambique

Background Mozambique has one of the highest burdens of neglected tropical diseases in Africa. Lymphatic filariasis, schistosomiasis and soil-transmitted helminths are being targeted for elimination as part of integrated mass drug administration campaigns. The progress made towards interruption of transmission has been affected by recent conflict in Cabo Delgado province. The aim of this paper was to determine the potential impact of this crisis on the neglected tropical diseases programme and the challenges in reaching the elimination goals of 2030.Methodology A desk-based secondary data analysis was conducted on publicly available sources of neglected tropical diseases, conflict incidents, internally displaced persons and geographical access between 2020 and 2022. Data were summarised and mapped using GIS software. A combined risk stratified assessment at district level was developed with five classifications i) Very high-risk; ii) High-risk; iii) Medium to high-risk; iv) Medium risk; and v) Not at risk due to conflict absence but co-endemic.Results Lymphatic filariasis, schistosomiasis and soil-transmitted helminths were co-endemic in 115 out of 156 (74%) districts. Between 2020 and 2022 a total of 1,653 conflict-related incidents were reported, most of them in Cabo Delgado province (n = 1,397, 85%). A five-fold increase of internally displaced persons was recorded from April 2020 (n = 172,186) to November 2022 (n = 935,130). Geographical accessibility also deteriorated across the province with an increase from five (29%) in 2021 to seven (41%) districts in 2022 classified as hard-to-reach. The combined risk stratification identified that most districts (n = 7; 41%) in Cabo Delgado province had medium to high-risk; very high-risk (n = 5, 29%); medium risk (n = 3, 18%); high-risk (n = 2, 12%).Conclusion Most of the districts of Cabo Delgado were considered to be at risk of not meeting the neglected tropical diseases road map 2021-2030 targets due to the humanitarian crisis ongoing. There is the need for practical strategies and funding to overcome these hostile challenges. Neglected tropical diseases (NTDs) are a group of diseases that usually affect the most vulnerable population in tropical countries. Mozambique has been tackling lymphatic filariasis, schistosomiasis and soil-transmitted helminths for two decades with the aim of eliminating them through large-scale distribution of drugs to interrupt transmission. In recent years, internal conflict has emerged and led to an escalating humanitarian crisis in the endemic province of Cabo Delgado which has hampered elimination efforts. This study aimed to shed light on the situation and to determine the potential impact on the Mozambique NTDs' programme.We used a range of open-source data on NTDs, conflict, internally displaced persons and geographical access to summarise, describe, and map the situation at the district level in the most affected province. We used this data to also examine their geographical overlap and to develop a risk assessment tool to highlight the high risk and most vulnerable areas. We found that between 2021-2022 more than 1,300 conflict incidents occurred, and almost 1 million people were displaced in Cabo Delgado province with many districts having limited geographical access which impacted the NTDs programme's ability to work.The study highlights the important challenges of conflict and displacement of vulnerable populations, and the need for support and set of guidelines for NTDs endemic programmes to use to help to overcome key barriers and meet the targets of elimination set by the World Health Organization for 2030.