Neglected tropical diseases (NTD) are so named for the obvious reason they rarely make news in a world continually under siege by terrifying diseases and outbreaks. In 2017 alone, outbreaks of yellow fever, Middle-East respiratory syndrome coronavirus (MERS-CoV), meningococcal disease, Lassa fever, Seoul virus, Hepatitis E, outbreaks of A (H7N9) influenza in humans and plague have been confirmed across continents by the World Health Organisation (WHO).
Being overshadowed by calamitous outbreaks is just a part of the problem. NTDs also remain underreported because they affect the poorest and the most marginalised with little or no access to diagnosis, treatment and cure. If untreated, these “diseases of poverty” cause severe illness, disability, disfigurement and cognitive impairment. As a result, this group of 17 chronic parasitic, bacterial and viral infections that threaten 1.6 billion people across 149 countries, continue to aggravate poverty by hurting pregnancy outcomes, slowing child development and lowering productivity. According to Lancet Commission on Investing in Health report, NTDs “elimination (less than one case per 10,000 population) for such low costs… represent(s) very good value for money.”
In 2012, The London Declaration on NTDs accelerated push towards elimination by getting together donors, pharmaceutical companies, affected nations and government organisations to take free diagnosis and treatment to more than one billon people in 2015, up by 36% over 2011. Drug companies donated 1.5 billion treatments and boosted new drug development – 14 promising drug candidates to treat NTDs are in the pipeline – to help meet the Sustainable Development Goal of effectively controlling and eliminating NTDs.
India, where more than half of the population is at risk of NTDs, has stepped up efforts to contain and eliminate visceral leishmaniasis and lymphatic filariasis by 2017. Here is how India is dealing with its four biggest under-reported threats to health.
Parasitic helminths (hookworms, roundworms, whipworms) infect through contaminated food, water and soil. The most common infections are Ascariasis (roundworms), Hookworm, and Trichuriasis (whipworm), which live and replicate in the gastrointestinal tract. Worm infections rarely cause death, but the repeated bouts of bloody diarrhea, abdominal pain and loss of appetite they cause lowers haemoglobin, cognitive abilities and productivity.
India is home to a fourth of the 220.6 million children worldwide who need preventive doses of the de-worming medicines Albendazole or Mebendazole to stop worm infection, but re-infection makes it difficult to eliminate worm infections. Since 2015, India has dewormed close to 300 million children at risk of infections.
Kala Azar (visceral leishmaniasis)
India’s on track in the road to elimination. The sandfly (genus Phlebotomus argentipes) spreads kala-azar (black fever), which is endemic in the north and eastern states of Bihar, Jharkhand, Uttar Pradesh and West Bengal. More than 165 million people across 48 districts in these four states are at risk of this parasitic infection, which can be treated with a single-day single-dose Liposomal Amphotericin (AmBisome).
Rapid diagnostic tests and treatment, incentivising health volunteer to get the sick treated, using synthetic pyrethroid for vector control in 21 high-endemic districts in Bihar (15 districts), Jharkhand (4 districts) and West Bengal (2 districts), and a monthly review of Kala-azar elimination by the Prime Minister’s Office and the Ministry of Health & Family Welfare have resulted in 502 (82%) of 625 endemic sub-districts reporting less than one case per 10,000 population in 2015.
Spread by mosquitoes between people, lymphatic filariasis (LF, or elephantiasis) causes painful enlargement and disfigurement of limbs, tissues and other body parts, leading to disability and social stigma. The disease is caused by a parasitic worm that lodges inside a person’s lymphatic system and affects the regulation of body fluids. Mass administration of the de-worming drugs diethylcarbamazine (DEC) and albendazole to kill the worm circulating in the bloodstream and prevent the infection from spreading has led to LF being eliminated in six countries last year, including in Sri Lanka and Maldives.
With a target to eliminate lymphatic filariasis by the end of 2017, India has had success in 72 districts and now expanding treatment to include harder-to-reach areas in the eastern states of West Bengal and Odisha. Using triple drug therapy (Ivermectin, DEC, and Albendazole) can kill the adult worm and significantly lower the rounds of treatment.
While partnerships to provide affordable products (diagnostics, drugs and insecticides) have led to more than one billion people being treated for at least one NTD in 2015, weak health infrastructure remains the biggest hurdle to scaling up and stamping out these treatable illnesses.
On April19, the WHO will host a Global Partners Meeting on NTDs to review progress and ensure support towards the WHO Roadmap targets of eliminating many diseases and eradicating at least two -- Dracunculiasis (guinea-worm disease) and Endemic treponematoses (yaws) -- by 2020. Both these diseases have been eradicated in India.
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