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Archive for the ‘NTDs’ Category

The Global Program to Eliminate Lymphatic Filariasis

In NTDs on April 28, 2014 at 9:22 pm

Global Health Africa contributor, Patrick Saunders Hastings, draws attention to lymphatic filariasis, a neglected tropical disease also known as elephantiasis.

Lymphatic filariasis (LF) is a neglected tropical disease (NTD) caused by three species of thread-like nematode worms. The clinical symptoms of the infection involve skin fissures and painful swelling of the legs, genitals, and breasts. The second most common global cause of long-term disability, LF is endemic in 82 countries in Africa, Asia, South America, and the Pacific, afflicting over 120 million people. Severe morbidity arises from acute episodes of inflammation called adenolymphangitis, while social and economic well-being are severely compromised by stigmatization resulting from the debilitating and disfiguring nature of the disease. Manifestations of such exclusion include limited marriage and employment prospects, while shame associated with affliction can reduce motivation to seek treatment. These issues further reduce the economic independence of patients, perpetuating the cycle of poverty faced by those afflicted with LF.

Figure 1. LF results in painful swelling of the legs, genitals, and breasts.

In 1997, the World Health Organization (WHO) classified LF as one of six infectious maladies where there was sufficient diagnostic and treatment capability to potentially eradicate the disease. In response to this, the Global Program to Eliminate Lymphatic Filariasis (GPELF) was set up in 2000, aiming to “eliminate LF as a public health problem by 2020”. This goal was to be accomplished through a “two-pillar” system, combining the interruption of transmission through annual mass drug administration (MDA) covering at least 80% of the at-risk population for at least five years, and morbidity management through the provision of care for those already infected. Elimination programs are conducted on national scales, operating at the community level to improve local relevance, drug coverage, and compliance.

To date, over one billion treatments have been given, with the annual number gradually increasing over time. Around 64% of endemic countries have begun MDA, while another 12% have low levels of transmission that are unlikely to require MDA. In 2008, 695 million people were offered MDA, and 496 million participated. Since 2000,  millions of people have been protected from LF infection, resulting in pronounced benefits including savings of approximately 24.2 billion USD. Educational and awareness campaigns have also been effective in increasing knowledge, reducing stigma, and improving practices associated with the disease. Moreover, this initiative has promoted country and community ownership and empowerment, and served as a platform for integration with other health programs such as control of other NTDs

Figure 2. African LF-endemic countries and territories by MDA (2007)

Figure 2. African LF-endemic countries and territories by MDA (2007)

However, despite the successes of the MDA program, many countries have not been able to achieve sufficient drug coverage to interrupt disease transmission, even after implementing the recommended annual MDA for over 5 years. Meanwhile, 16 of the 19 countries that require MDA, but have not begun, are located in Africa. Key barriers and challenges include co-endemicity with other diseases, fragile infrastructures, and post-conflict situations. In addition, morbidity management has been largely neglected in favor of MDA, with only 35% of endemic countries implementing any sort of disability service. While celebration of past successes is warranted, recognition of short-comings and anticipation of current and future challenges is vital to achieving success over the next six years. Although significant progress has been made, there is still much to be done

References

Addiss, D. (2010). The 6th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis: A half-time review of lymphatic filariasis elimination and its integration with the control of other neglected tropical diseases. Parasites and Vectors 3(1), 100.

Bangoura, O. (2008) “Health system approaches to NTD control”. 5th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis. Arusha, Tanzania pp. 36-40.

Bockarie, M. & Deb, R. (2010). Elimination of lymphatic filariasis: do we have the drugs to complete the job? Current Opinion in Infectious Diseases 23(6), 617-20.

El-Setouchy, M. (2003). Stigma reduction and improved knowledge and attitudes towards filariasis using a comic book for children. Journal of the Egyptian Society of Parisitology, 33, 55-65

Molyneux, D. (2003). Lymphatic Filariasis (Elephantiasis) Elimination: A public health success and development opportunity. Filaria Journal2, 13.

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Footwork: Working to Eradicate Podoconiosis

In NTDs on February 15, 2014 at 3:50 pm

Global Health Africa contributor, Patrick Saunders Hastings, draws attention to Podoconiosis, a neglected tropical disease, and to Footwork, an initiative that offers hope of eradicating the disease.

podo1

Neglected tropical diseases (NTDs) represent a group of medical conditions that affect over one billion people in developing regions of Africa, Asia, and the Americas. These diseases, which almost exclusively affect the poor, also exacerbates poverty and constrains development by limiting education opportunities, social well-being, and economic productivity.

Despite this, NTDs receive little attention in comparison to the “Big Three”: HIV/AIDS, tuberculosis, and malaria. For instance, in 2010, less than 1% of United States global health spending was allocated towards NTD initiatives, whereas HIV/AIDS accounted for 70%. Experts have identified NTD interventions as “amongst the most cost effective in global health”, and this is an area where action has potential for huge impact.

One largely overlooked NTD is podoconiosis, a form of elephantiasis that affects an estimated four million people worldwide, most of whom live in Ethiopia. Podoconiosis develops primarily among subsistence farmers as a result of walking barefoot on irritant red clay soil formed by the disintegration of lava. With symptoms very similar to lymphatic filariasis, podoconiosis results in progressive swelling of the legs, painful episodes, social exclusion, and productivity losses of about 45% of total annual working days. Podoconiosis can be entirely prevented through consistent use of shoes and socks. Unfortunately, it is widespread in poor areas of Africa, Central America, and India, and is considered a public health problem in 10 African countries.

However, there is reason for optimism. March of 2012 saw the launch of Footwork: the International Podoconiosis Initiative, a disease-specific health program with the goal of “a world free of podoconiosis within our lifetime”. Bringing together a variety of public and private partners, Footwork will pursue podoconiosis control and eradication through three strategic pillars: increased advocacy and awareness, new research and data collection, and the propagation of effective control interventions. By identifying best practices in the fight against podoconiosis, Footwork offers hope to some of the most disenfranchised.

Learn more about Footwork here

References

Department for International Development. (2012). UK to protect 140 million people from tropical diseases. http://www.dfid.gov.uk/News/Latest-  news/2012/Britain-to-protect-more-than-140-million-in-global-effort-to-rid-the-world-of- neglected-tropical-diseases

Desta, K., Ashine, M., & Davey, G. (2003). Prevalence of podoconiosis (endemic non-filarial elephantiasis) in Wolaitta, Southern Ethiopia. Tropical Doctor, 33, 217–220.

Footwork: The International Podoconiosis Initiative. (2012). www.podo.org

Gustavsen, K., Bradley, M., & Wright, A. (2009) GlaxoSmithKline and Merck: private-sector collaboration for the elimination of lymphatic filariasis. Annals of  Tropical Medicine and Parasitology, 103(1), 11-15.

Price, E. (1990) Podoconiosis: Non-filarial elephantiasis. Oxford: Oxford Medical Publications.

Tekola, F., Mariam, D., & Davey, G. (2006). Economic costs of endemic non-filarial elephantiasis in Wolaita Zone, Ethiopia. Tropical Medicine and International Health11(7), 1136-44.

Poverty and Neglected Tropical Diseases (NTDs)

In NTDs on January 19, 2013 at 5:04 am

Two years ago, the Global Health Council organized the 4th Annual Beth Waters Memorial Lecture in Philadelphia, PA. I had the opportunity to attend the lecture after my participation in the American Society of Tropical Medicine and Hygiene Annual Meeting. The featured speaker, Dr. Peter Hotez, President of the Sabin Vaccine Institute, delivered an engaging and passionate lecture on neglected tropical diseases (NTDs), poverty and drug availability.

According to Dr. Hotez, NTDs are the common infections of the world’s poorest people. He emphasized the availability of drugs to reduce burden of disease for 50 cents a person per year. This is considered one of the very best buys of global public health, said Dr. Hotez. He stated that this network was launched at the Clinton Global Initiative because President Clinton decided that NTDs needed attention. Moreover, Dr. Hotez stressed that nobody is really dying from NTDs which is a difficult message to convey to global health policy makers and get NTDs more attention.

Since NTDs affect the world’s poorest people, they subsequently keep these people trapped in a cycle of poverty. In addition to providing treatment and prevention drugs to millions affected by NTDs, poverty needs to be confronted in these communities. There is no reason why a person should not have access to clean drinking water or inexpensive medications. I am always amazed at the lives of two people from different socioeconomic backgrounds in the same country. Both people contact the same disease but one dies from it due to inadequate resources. While vaccine development is important, organizations should find ways to alleviate poverty from these communities. You can watch the lecture here:

UN Launches De-worming Effort In West Africa

In NTDs on November 2, 2012 at 3:51 am

The recent hunger crisis in West Africa`s Sahel region has spurred a series of intestinal-worm and other Neglected Tropical Diseases (NTDs) that have spread in the wake of regional flooding. In response to the problem, the United Nations just launched a de-worming effort in West Africa. According to the UN World Health Organization (WHO), simple de-worming interventions will ensure that people can fully benefit from the food aid distributed. The concern is that malnourished children and adults are very susceptible to contracting these NTDs, transmitted via contaminated water, soil and parasites. NTDs are a group of poverty-associated chronic infectious diseases “such as bilharzia, roundworms, hookworms and whipworms” that are endemic in poor and rural populations in the developing countries of Africa, America and Asia, according to WHO. The diseases affect over 1.4 billion people worldwide, and cause severe morbidity and mortality. They are transmitted by insect bites, flies, water contact or worms in the soil, and are easily spread in areas of poor sanitation.

Dr Luis Gomes Sambo, WHO`s African Regional Director, reported that the flooding created the ideal breeding ground for contracting NTDs and worm-like diseases in the Sahel region. As a consequence, people are now more at risk of malnutrition because of the rise in the number of NTD cases. Despite the Sahel flooding, NTD cases are always on the rise because of low quality drinking water and inadequate latrine coverage. This, in addition to the flooding, creates a sad reality for the people living in these areas. Integrating de-worming activities is “feasible and cost-effective” costing less than 50 cents to treat a person for a year, according to WHO. Since de-worming activities is feasible and cost-effective, I wonder why treatment is still rare in the affected countries. It is time for more humanitarian agencies, public and private sectors, and even lay persons to know about NTDs and get involved in any capacity. This video highlights the current work in Tanzania.

Culled from UN News Center

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