Importance of neglected tropical diseases (NTDs) in the global context

Influenced by certain ecological conditions and transmitted through various vectors and animals, Neglected Tropical Diseases (NTDs) are a heterogeneous group of some 17 parasitic, bacterial, viral and fungal infections that burden the poor and marginalized in developing countries where they cause much human suffering and poverty. The impact of these infectious pathogens is often difficult to quantify due to under-reporting, focal clustering, poly-parasitism, diverse morbidity, stigmatization and multifaceted influences on local livelihoods. The main challenges involve both technical questions about the efficacy of existing tools as well as operational issues in moving global health interventions from international boardrooms into socio-economically and politically marginalized communities. NTDs are both drivers and manifestations of poverty as they reflect not only individual risk factors, but larger structural inequalities in access to health services, infrastructure, food security, education, political voice and markets that drive poverty and maintain social and economic exclusion. [1]

Even though heavy implementation on projects and multiple levels of funding have been allocated over the years, most of the bodies involved in alleviating NTDs have criticized the structure and approach of action as most root-level issues have remained unaddressed and instead have inflicted a certain drug dependency through the implementation programs brought about.

Studies show that despite trends towards decentralisation in local government in many endemic countries, feedback and responsiveness to local needs within the general health systems are limited.

There is much scope for disease-specific interventions to engage broadly with poverty and marginalisation, especially if we conceptualise NTD control not from the short project cycle but, as Zhang et al. [144] noted, based on a long-term commitment. This requires a shift in donor funding that emphasises engaging in larger societal and developmental processes. [1]

In the context of COVID-19, already existing diseases and epidemics have naturally been affected, more so with the disruption of healthcare services in local interior regions. To mitigate through such impacts, WHO took steps to implement measures comprising of development of several guidance documents and online resources; advocacy, consolidation of leadership, webinars, dissemination of information and provision of tailored technical advice to Member States and partners; advice on adapting NTD platforms to accommodate COVID-19 activities, including community handwashing, contact tracing, raising awareness, addressing misinformation and providing sanitation supplies; monitoring of production, shipment, delivery and distribution of NTD medicines and other medical consumables; and modelling to assess the impact on achieving targets.[2]

REFERENCES:

1. Bardosh, K. Global aspirations, local realities: the role of social science research in controlling neglected tropical diseases. Infect Dis Poverty3, 35 (2014). //doi.org/10.1186/2049-9957-3-35 //link.springer.com/article/10.1186/2049-9957-3-35#citeas
2. //www.who.int/news/item/24-09-2021-neglected-tropical-diseases-2020-preventive-chemotherapy-treatment-coverage-declines-due-to-covid-19-disruptions

Importance of Neglected Tropical Diseases (NTDs) in the global context

NTDs are a set of 13 major debilitating diseases that are among the most common chronic infections among the world's poorest people. A blueprint for controlling or eliminating the seven most common neglected tropical diseases — ascariasis, trichuriasis, hookworm infection, schistosomiasis, lymphatic filariasis, trachoma, and onchocerciasis — has been developed by a group of private, public, and international organisations in collaboration with pharmaceutical partners and national ministries of health. Partnerships are coordinating their actions through the newly established Global Network for Neglected Tropical Diseases. The World Health Organization (WHO) has produced updated recommendations for medicine administration to launch a more integrated attack on these illnesses. If new resources are made available, as the Commission for Africa has advised, a scaled-up approach to modest initiatives could result in long-term poverty reduction in some of the world's poorest countries. These reductions would be a significant victory for the Millennium Declaration of the United Nations. ^[1]

Reference

1. Hotez PJ, Molyneux DH, Fenwick A, Kumaresan J, Sachs SE, Sachs JD, Savioli L. Control of neglected tropical diseases. New England journal of medicine. 2007 Sep 6;357(10):1018-27.

//www.nejm.org/doi/full/10.1056/nejmra064142

Interesting Articles

1. World Health Organization. Working to overcome the global impact of neglected tropical diseases: first WHO report on neglected tropical diseases. World Health Organization; 2010.

//apps.who.int/iris/bitstream/handle/10665/44440/9789241564090_eng.pdf

2. Mathers CD, Ezzati M, Lopez AD. Measuring the burden of neglected tropical diseases: the global burden of disease framework. PLoS neglected tropical diseases. 2007 Nov 7;1(2):e114.

//journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000114

Neglected tropical diseases (NTDs) include various parasitic, viral, and bacterial diseases that can cause substantial illness. These are highly preventable, even without vaccines. WASH strategies such as using Clean water, sanitary food handling, and good hygiene can prevent NTDs  diseases such as schistosomiasis, soil-transmitted helminthiasis, guinea-worm disease and trachoma etc. Vector-borne NTDs that spread specially by mosquitoes, worms, flies can be prevented through control of the vectors themselves by mass spraying of insecticides in the breeding areas. The release of genetically modified vectors into the population to not host the parasite and spread disease will aid in prevention of NTDs.

Creating awareness, controlling environmental factors and educating the vulnerable population is also an important aspect of NTD prevention. For example, eliminating standing water areas, where mosquitoes can breed, sleeping under an insecticidal bed net, wearing protective clothing, using bug repellant will reduce the risk of mosquito borne diseases.

Public health services focus on alternative strategies to retain the gains of NTD control and elimination programmes. Future potential strategies will include reconsideration of determinants of health in NTDs and come up with a multi-sectorial approach involving the medical, animal and human, developmental, environmental, agricultural communications, public-private sectors, bilateral agencies and information technology sectors etc. To improve coverage of the vulnerable population, accelerated elimination of the disease, advocacy must be intensified in affected countries, including raising awareness about new and upcoming diagnostic strategies, targeting specific national authorities, healthcare workers and communities.

References:

1. //www.niaid.nih.gov/research/neglected-tropical-diseases-prevention
2. //idpjournal.biomedcentral.com/articles/10.1186/s40249-020-00701-7
3. //www.cdc.gov/globalhealth/ntd/index.html
4. //www.finddx.org/wp-content/uploads/2016/02/NTD_Strategy_WEB.pdf

We have safe, effective treatments and control methods to fight some NTDs. But the challenge remains to reach poor and hard-to-reach areas where people have little access to health care. NTDs affects primarily marginalized communities in low- and middle-income countries (LMICs), mainly rural and deprived urban communities. To combat the NTDs we need to reconsider the determinants of health in NTDs. Additionally, there is a need for a multi-sectorial approach involving the medical, animal and human, developmental, environmental, agricultural, education, economy, anthropology, communications, public, private sectors, bilateral agencies and information technology sectors. Health services and disease surveillance needs to be advanced to find more effective ways of coping with emerging and re-emerging diseases in the future. 

Ehrenberg, J.P., Zhou, XN., Fontes, G. et al. Strategies supporting the prevention and control of neglected tropical diseases during and beyond the COVID-19 pandemic. Infect Dis Poverty 9, 86 (2020). //doi.org/10.1186/s40249-020-00701-7

Interesting read : This article introduces and describes how Mozzify an integrated mHealth app can address the challenges in the prevention and management of dengue fever. It includes features such as  real-time dengue fever case reporting and mapping system, health communication such as real-time worldwide news and chat forum/timeline,  educational videos, links to local and international health agency websites, interactive signs and symptoms checker, and a hospital directions system, and behavior modification including reminders alert program on the preventive practices against dengue fever.

Herbuela, V., Karita, T., Francisco, M. E., & Watanabe, K. (2020). An Integrated mHealth App for Dengue Reporting and Mapping, Health Communication, and Behavior Modification: Development and Assessment of Mozzify. JMIR formative research, 4(1), e16424. //doi.org/10.2196/16424

Due to present scenario of pandemic in global context there is a lot of overlap in global world ought to address neglected tropical diseases and COVID-19 .Both can be tackled through improvements in water ,sanitation and hygiene and through behavioral health campaigns stressing the importance of washing hands with clean water and soap . This "hybrid approach " predicted on hand washing and improved  sanitation can be used as a part of comprehensive set of interventions to prevent NTDs while concurrently mitigating the spread of COVID -19. NTDs 

           GLOBAL NTDs PROGRAMS :- Global Neglected Diseases programs focus on identifying regions and countries where NTDs present and working to control or when possible to eliminate them . The WHO global programs to eliminate lymphatic filariasis was launched in 2000 GPELF aims to stop transmission alleviate the suffering of those already affected by the diseases .In areas with a high number of individuals at risk , anti parasitic drugs are given to the entire population once a year for atleast 5 years to stop the affect of infection . Health education efforts is provided lesson the severity and number of leg infections in people already infected who has swollen legs . Expanding the availability of surgery for men with hydrocele due to lymphatic filariasis is also an aim of the program . The goal set by the most recent WHO road map is to eliminate lymphatic filariasis as a public health problems in atleast 58 countries by 2030. The burden of schiostosomiasis  in affected communities is measured by identifying areas where many school aged children or to entire community usually as a early dose . The medicine kills adult parasite and reduces the severity of diseases . Since 2006 the united states agencies for international development USAID has supported 33 developing countries in their efforts to control and eliminate five of the most prevalent NTDs - lymphatic filariasis ,trachoma , onchocerciasis , schistosomiasis ,and soil transmission helminths (hookworm ,roundworm and whipworm ).

                    REFERENCES:- //oepa.net/ external iconphatic Filariasis: Elimination in the Americaspdf icon [PDF, 370 KB, 4 pages] //www.cdc.gov/globalhealth/ntd/global_program.html#:~:text=https%3A//espen.afro,external%20icon //www.who.int/onchocerciasis/en/ external icon

//www.cdc.gov/parasites/guineaworm/index.html

 neglecteddiseases.govexternal icon.

Most importantly what are the global fundings for neglected tropical diseases (NTD)?

The term NEGLECTED TROPICAL DISEASE was coined by Peter Hotez and colleagues in 2003, with the intention of propelling political momentum.

Ending Neglected Tropical Diseases is a Necessity for global health. most of the NTDs are life-altering and can affect individuals with complete family, community, society also can cause disfigurement, blindness, and long-term health adverse condition. 

I found this as a good read paper NTD and SDG 

//gh.bmj.com/content/4/1/e001334

It is estimated that nearly 2 billion people can get affected by Neglected tropical diseases (NTDs) at the turn of millennium. So it is important to fill the knowledge gaps in the area of implementation of frameworks. A focused attention is needed for the new products development. There is a need of evidence based science and laboratories for NTDS. Collective global response is required to address the  NTDs issue

Read here: //idpjournal.biomedcentral.com/articles/10.1186/s40249-020-0630-9

Overall seventeen NTDs (neglected tropical diseases) have been identified by the World Health Organization (WHO). It is estimated that worldwide 1 billion people are infected with NTDs, with a further 1 billion at risk. The majority of NTDs occur in the tropics and sub-tropics and have particular characteristics in common:

1. They besiege the poorest people – those without access to the safe water, sanitation, and elementary health services demanded in order to fend themselves against infection by bacteria, bacteria and other pathogens. High- income groups are rarely affected.

2. Multifold are confirmed, sluggishly developing conditions that go inchmeal worse if undetected and natural. The damage they do can be irremediable.

3. They can bring about severe pain and life-long disabilities, with long- term consequences for the person and also for family members who have to mind for the person.

4. People with NTDs are hourly stigmatized and barred from society, and this can affect their inner health.

The individual diseases are very different, and one person can be affected by more than one disease at the same time.

The birth diversity of NTDs means that the control or elimination strategies also are really disparate.

Several NTDs can be controlled by medicament treatment ( precautionary chemotherapy), on a country or community scale, via mass medicament administration programmes. Other NTDs challenge different approaches and strategies for control or elimination, including specialized medicaments and/ or vector control ( limiting or eradicating insects-e.g. files and bugs-that transmit the pathogens).
Despite the diversity of the strategies, notwithstanding, there are good openings for comprehensive NTD elimination and control programmes.

Reference: //www.ncbi.nlm.nih.gov/pmc/articles/PMC3756642/

Neglected Tropical Diseases (NTDs) are prevalent in tropical areas of Africa, Asia and Latin America that have limited access to clean water and safe disposal of faecal matter (1). Many of these can be prevented and eliminated with diverse public health, health promotion and medical interventions. This scoping review (2) provides an overview of the NTD interventions along with recommendations for best practice going forward. The paper talks about four components of best practices: programmatic interventions, multi sectoral and multi-level interventions, adopting a social and ecological model and clearly defining ‘community.

References

1. //www.cdc.gov/globalhealth/ntd/diseases/index.html
2. //journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0009278

NTD has a massive toll on global health. NTDs are called “neglected “ because they affect the world’s poor and it has not gotten much attention. It mostly affects those who have no access to quality water, sanitation, and health care. According to WHO, more than one million people suffer from at least one NTD and they can cause disability that lasts for a lifetime which includes disfigurement, blindness, etc. In terms of DALYs, NTD has a high disease burden that exceeds even tuberculosis and is almost equal to HIV/AIDS.  Those who are suffering from NTD’s, are unable to work, miss schools, and show shame to seek medical care. All these can affect the most disadvantaged population and lead to poverty.

Reference: //www.niaid.nih.gov/research/neglected-tropical-diseases