Elimination Of Neglected Tropical Diseases Research Articles

Toward the elimination of NTDs: application of cost-effective and sensitive molecular environmental surveillance tools—a pilot study

Neglected tropical diseases (NTDs) affect over a billion people worldwide. The 2021–2030 NTD road map calls for innovative and highly efficient interventions to eliminate or significantly reduce the burden of NTDs. These include sensitive and cost-effective diagnostic techniques for disease surveillance. Environmental surveillance has been employed effectively in this regard to measure and track infectious diseases such as polio on a population-wide scale. In this study, environmental surveillance was used as a cost-effective tool for the detection of soil-transmitted helminths (STHs) in Accra, Ghana, in an area that is populated by urban vegetable farmers. The activities of urban farmers expose them to the risk of STH infection, as well as impact the transmission in urban areas since leafy vegetables could carry infective stages of STHs. A total of 32 wastewater samples were collected from eight points on the Nima Creek (the main source of irrigation for the farmers) over a 7-week period. Real-time PCR and melt peak analysis were used to screen four STHs (i.e., Ascaris lumbricoides, Necator americanus, Ancylostoma duodenale, and Trichuris trichiura). This study revealed that A. lumbricoides (17 out of 32 wastewater samples, 53.3%) was the most prevalent STH, followed by A. duodenale (31.2%), T. trichiura (21.9%), and N. americanus (12.5%). Environmental surveillance helps in the detection of the types of STH pathogens circulating within the community and in the design of mass drug administration (MDA) strategies. This surveillance technique can also provide preliminary information for environmental modifications to help reduce STH transmission in line with the One Health approach recommended in the 2021–2030 NTD road map.

African institutions will lead on the road to end neglected tropical diseases

Globally, more than one billion people suffer from one or more neglected tropical diseases (NTDs). These diseases create enormous suffering, rob individuals of social and economic opportunities, and set-back countries’ development efforts. It is now clear that transmission and elimination of many NTDs is attainable in our lifetime. The elimination of NTDs will not happen without a concerted effort and plan to ensure that the most affected countries have a robust clinical, public health, laboratory, pharmaceutical, and research capacity to ensure that the last mile towards reaching elimination is not only reached, but sustained. This means increasing strategic investments to develop and strengthen the NTD health workforce, develop and integrate innovative diagnostic approaches, effective treatments, and responsive surveillance systems. Equally important is ensuring that people living with lifelong disabilities resulting from NTDs receive the care and support they need to live healthy, productive, and fulfilling lives. African-based national non-governmental organizations, the private sector, research institutions, and governments play a vital role as they work to attain ambitious NTD elimination and control goals put forward by the global health community. The recent elimination of onchocerciasis in Niger, trachoma in Burundi and Malawi as well as ongoing progress to eliminate lymphatic filiariasis in Kenya and other sub-Saharan Africa countries demonstrate the capacity of African leadership in NTD control and elimination efforts.

Leveraging mRNA Platform Technology to Accelerate Development of Vaccines for Some Emerging and Neglected Tropical Diseases Through Local Vaccine Production

The mRNA vaccine technology platform may enable rapid response to some emerging infectious diseases (EIDs), as demonstrated through the COVID-19 pandemic. Beyond the role it could play in future EID response, mRNA technology also could have an important role in accelerating the development of, and access to, vaccines for some neglected tropical diseases (NTDs), which occur mainly in impoverished regions of the world. Despite their significant disease burden, few vaccines against NTDs have been developed, in part because of the uncertain market and return on investment. In addition, the probability of technical and regulatory success is considered to be low for developing vaccines against multicellular parasites, or organisms that have sophisticated mechanisms for evading immunological surveillance, such as many of the NTD pathogens. The global 2021-2030 road map for neglected tropical diseases sets ambitious targets for the eradication, elimination, and control of NTDs. For some, effective interventions exist but are underutilized. For others, vaccines need to be developed or their use expanded to meet global targets on control and elimination. This article discusses the application of the mRNA technology platform to the development of vaccines for NTDs as well as EIDs, highlights the challenges in bringing these products to the market, and indicates potential areas which could be explored, including leveraging investment for vaccines with a more profitable market potential and enabling local manufacturing in regions where NTDs are endemic. Such regional production could include collaborations with the mRNA vaccine technology transfer hubs that are being established with the support of WHO and COVAX partners.

Why Nigeria Must Care for, Eliminate and Eradicate Neglected Tropical Diseases (NTDs)

This paper thoroughly reviewed why Nigeria needs to care for, eliminate, and eradicate the neglected tropical disease (NTDs). The paper relied on the review of related literature to sufficiently expound on intervention, accomplishments, disadvantages, and techniques of eradication and elimination of NTDs in Nigeria. It has been documented that NTDs affect about two billion people worldwide, accounting for a quarter of the world's population, with Africa accounting for over 40% of those affected. Although neglected tropical diseases are preventable and treatable, a significant amount of funds has been invested to eradicate and eliminate them. NTDs are diseases of the poor, according to reports, and efforts to eradicate them must address the causes of poverty as NTDs can cause a variety of problems. This paper suggested ways to eradicate NTDs in Nigeria including strengthening public health systems and supporting governments in the elimination of NTDs and limiting the transmission of disease pathogens by effective vector control among others.

Community perceptions and acceptability of mass drug administration for the control of neglected tropical diseases in Asia-Pacific countries: A systematic scoping review of qualitative research.

BackgroundPreventative chemotherapy and mass drug administration have been identified as effective strategies for the prevention, treatment, control and elimination of several NTDs in the Asia-Pacific region. Qualitative research can provide in-depth insight into the social dynamics and processes underlying effective implementation of and adherence to mass drug administration programs. This scoping review examines published qualitative literature to examine factors influencing community perceptions and acceptability of mass drug administration approaches to control NTDs in the Asia-Pacific region.MethodologyTwenty-four peer reviewed published papers reporting qualitative data from community members and stakeholders engaged in the implementation of mass drug administration programs were identified as eligible for inclusion.FindingsThis systematic scoping review presents available data from studies focussing on lymphatic filariasis, soil-transmitted helminths and scabies in eight national settings (India, Indonesia, Philippines, Bangladesh, Laos, American Samoa, Papua New Guinea, Fiji). The review highlights the profoundly social nature of individual, interpersonal and institutional influences on community perceptions of willingness to participate in mass drug administration programs for control of neglected tropical diseases (NTD). Future NTD research and control efforts would benefit from a stronger qualitative social science lens to mass drug administration implementation, a commitment to understanding and addressing the social and structural determinants of NTDs and NTD control in complex settings, and efforts to engage local communities as equal partners and experts in the co-design of mass drug administration and other efforts to prevent, treat, control and eliminate NTDs.ConclusionFor many countries in the Asia-Pacific region, the “low hanging fruit has been picked” in terms of where mass drug administration has worked and transmission has been stopped. The settings that remain–such as remote areas of Fiji and Papua New Guinea, or large, highly populated, multi-cultural urban settings in India and Indonesia–present huge challenges going forward.

Improving anthelmintic treatment for schistosomiasis and soil-transmitted helminthiases through sharing and reuse of individual participant data.

The Infectious Diseases Data Observatory (IDDO, https://www.iddo.org) has launched a clinical data platform for the collation, curation, standardisation and reuse of individual participant data (IPD) on treatments for two of the most globally important neglected tropical diseases (NTDs), schistosomiasis (SCH) and soil-transmitted helminthiases (STHs). This initiative aims to harness the power of data-sharing by facilitating collaborative joint analyses of pooled datasets to generate robust evidence on the efficacy and safety of anthelminthic treatment regimens. A crucial component of this endeavour has been the development of a Research Agenda to promote engagement with the SCH and STH research and disease control communities by highlighting key questions that could be tackled using data shared through the IDDO platform. Here, we give a contextual overview of the priority research themes articulated in the Research Agenda-a 'living' document hosted on the IDDO website-and describe the three-stage consultation process behind its development. We also discuss the sustainability and future directions of the platform, emphasising throughout the power and promise of ethical and equitable sharing and reuse of clinical data to support the elimination of NTDs.

Factors influencing mass drug administration adherence and community drug distributor opportunity costs in Liberia: a mixed-methods approach

BackgroundPreventive chemotherapy delivered via mass drug administration (MDA) is essential for the control of neglected tropical diseases (NTDs), including lymphatic filariasis (LF), schistosomiasis and onchocerciasis. Successful MDA relies heavily on community drug distributor (CDD) volunteers as the interface between households and the health system. This study sought to document and analyse demand-side (households) and supply-side (health system) factors that affect MDA delivery in Liberia.MethodsWorking in two purposively selected counties, we conducted a household MDA access and adherence survey; a CDD survey to obtain information on direct and opportunity costs associated with MDA work; an observational survey of CDDs; and key informant surveys (KIS) with community-level health workers. Data from the CDD survey and Liberian minimum wage rates were used to calculate the opportunity cost of CDD participation per MDA round. The observational data were used to calculate the time spent on individual household-level tasks and CDD time costs per house visited. KIS data on the organisation and management of the MDA in the communities, and researcher reflections of open-ended survey responses were thematically analysed to identify key demand- and supply-side challenges.ResultsMore respondents were aware of MDA than NTD in both counties. In Bong, 39% (103/261) of respondents reported taking the MDA tablet in the last round, with “not being informed” as the most important reason for non-adherence. In Maryland, 56% (147/263) reported taking MDA with “being absent” at the time of distribution being important for non-adherence. The mean cost per CDD of participating in the MDA round was −$11.90 (median $5.04, range −$169.62 to $30.00), and the mean time per household visited was 17.14 min which equates to a mean opportunity cost of $0.03 to $0.05 per household visited. Thematic analysis identified challenges, including shortages of and delays in medicine availability; CDD frustration over costs; reporting challenges; and household concerns about drug side effects.ConclusionsImproved adherence to MDA and subsequent elimination of NTDs in Liberia would be supported by an improved medicine supply chain, financial compensation for CDDs, improved training, healthcare workforce strengthening, greater community involvement, capacity building, and community awareness.Graphical

Community-directed distributors-The "foot soldiers" in the fight to control and eliminate neglected tropical diseases.

The neglected tropical diseases (NTDs) affect hundreds of millions of people, predominantly in rural, often difficult-to-access areas, poorly served by national health services. Here, we review the contributions of 4.8 million community-directed distributors (CDDs) of medicines over 2 decades in 146,000 communities in 27 sub-Saharan African countries to control or eliminate onchocerciasis and lymphatic filariasis (LF). We examine their role in the control of other NTDs, malaria, HIV/AIDS interventions, immunisation campaigns, and support to overstretched health service personnel. We are of the opinion that CDDs as community selected, trained, and experienced “foot soldiers,” some of whom were involved in the Ebola outbreak responses at the community level in Liberia, if retrained, can assist community leaders and support health workers (HWs) in the ongoing Coronavirus Disease 2019 (COVID-19) crisis. The review highlights the improved treatment coverage where there are women CDDs, the benefits and lessons from the work of CDDs, their long-term engagement, and the challenges they face in healthcare delivery. It underscores the value of utilising the CDD model for strong community engagement and recommends the model, with some review, to hasten the achievement of the NTD 2030 goal and assist the health system cope with evolving epidemics and other challenges. We propose that, based on the unprecedented progress made in the control of NTDs directly linked to community engagement and contributions of CDDs “foot soldiers,” they deserve regional and global recognition. We also suggest that the World Health Organization (WHO) and other international stakeholders promote policy and guidance for countries to adapt this model for the elimination of NTDs and to strengthen national health services. This will enhance the accomplishment of some Sustainable Development Goals (SDGs) by 2030 in sub-Saharan Africa.

Diseases of Poverty: Neglected Tropical Skin Diseases in a Dermatologic Clinic in South- South Nigeria

Background: Neglected tropical diseases (NTDs) are a diverse group of communicable diseases that are present.
 In tropical and subtropical countries. They predominantly occur in developing countries, but may also be found in some developed countries; often associated with poverty, inadequate sanitation and living in close contact with infectious vectors and domestic animals and livestock. The World Health Organization (WHO) has set targets for elimination and eradication of NTDs, as this would improve the conditions of living in affected communities.
 A number of neglected tropical diseases have skin manifestations, thus the dermatologist has a key role to play in their elimination and eradication.  This study at the dermatologic clinic of University of Port-Harcourt Teaching Hospital, aims to identify the types and prevalence of these diseases.
 Materials and Methods: This is a retrospective descriptive study in which the records of patients presenting with neglected tropical skin diseases (NTSDs) in the dermatologic clinic of University of Port-Harcourt Teaching Hospital from January 2015 to April 2018 were obtained and analysed.
 Results: One thousand five hundred and eighteen (1518) patients who visited the dermatology clinic during the study period were assessed. Number of 115 cases of NTSDs were identified, which represents 7.57% of the total population.  There were more males (60.87%), with vast majority of cases being in their third decade. Five NTDs were identified, scabies being the most prevalent (80.87%) followed by Hansen’s disease (15.65%).  These diseases affected the productive age groups, therefore possessing the potential of perpetuating poverty in the community.
 Conclusion: Neglected tropical skin diseases are common in the dermatologic clinic, Scabies and Hansen’s disease were most prevalent cases recorded. Interestingly scabies was found more in males, in the third decade of life.
 This is when men are quite productive, and therefore has the possibility of perpetuating poverty.

NTD Diagnostics for Disease Elimination: A Review.

Neglected Tropical Diseases (NTDs) marked out for disease elimination provide a lens through which to explore the changing status of diagnosis in global health. This paper reports on the findings of a scoping review, which set out to explore the main debates around diagnosis for the elimination of NTDs, including the multiple roles diagnostic technologies are being ascribed and the ideal characteristics of tests. It also attempts to summarise the state of diagnosis for three NTDs with elimination goals. The review places special emphasis on point-of-care testing in acknowledgement of the remote and underserved areas where NTDs proliferate. Early NTD campaigns were largely focused on attack phase planning, whereby a similar set of interventions could be transplanted anywhere. Now, with elimination goals in sight, strategies must be tailored to local settings if they are to attain and sustain success. Diagnostic data helps with local adaptation and is increasingly used for programmatic decision-making. The review finds that elimination goals reframe whom diagnosis is for and the myriad roles diagnostics can play. The exigencies of elimination also serve to highlight deficiencies in the current diagnostic arsenal and development pipeline for many NTDs. Moving forward, a guiding framework is needed to drive research and stimulate investment in diagnosis to support NTD goals.

People are neglected, not diseases: the relationship between disability and neglected tropical diseases.

People with disabilities and the neglected tropical diseases (NTDs) are separately receiving increased focus. In light of this positive development, and the similarities and intersections between the negative impacts experienced by both people with disabilities and people with NTDs, we believe now is the right time to focus attention on the overlap between the two. Both people with NTDs and people with disabilities experience a myriad of overlapping negative health, financial and socio-cultural consequences. Despite this, we believe that disability is not yet properly prioritised on the development agenda, and that there are multiple opportunities to make NTD programming more inclusive, to the benefit of those at this neglected intersection and beyond. There are both opportunities and need to scale up, integrate, and invest in inclusive, health system-focused NTD programming. Realisation of the Sustainable Development Goals, Universal Health Coverage, and the control and elimination of NTDs all rely on ensuring people with disabilities are not left behind.

Helen Keller International and its contribution to elimination of neglected tropical diseases

Helen Keller International (HKI) is a non-governmental organization, established in 1915. The mission is to save and improve the sight and lives of the world’s vulnerable by combatting the causes and consequences of blindness, poor health and malnutrition. HKI’s work on neglected tropical diseases (NTDs) dates back to 1950s with a pilot program to eliminate blinding trachoma in Taiwan. HKI’s work on trachoma in Tanzania in 1980s and in Morocco in 1990s contributed to the development of the World Health Organization-endorsed SAFE strategy (Surgery, Antibiotics, Facial cleanliness and Environmental improvement) and the creation of the International Trachoma Initiative dedicated to the elimination of trachoma. HKI is a leader in the control and elimination of onchocerciasis (river blindness) in Africa and played an important role in developing an innovative strategy: community-directed treatment with ivermectin (CDTI) to control onchocerciasis. For its multi-country support to control and eliminate onchocerciasis, HKI was awarded the AGFUND International Prize for Pioneering Development Projects for its “Sustainable Control of Onchocerciasis” program in Africa in 2009. With funding from donors such as USAID, DFID, the END Fund and many others, HKI currently supports 10 African countries to control and eliminate one or more of five major NTDs: lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminthiasis (STH) and trachoma which includes leveraging medicines procured or donated from pharmaceutical companies. HKI aims to build the capacity of Ministries of Health to conduct community mobilization, mass drug administration campaigns, morbidity management, monitoring and evaluation. Over the past 10 years, through its integrated NTD programs, HKI has successfully supported Burkina Faso, Cameroon, Guinea, Mali, Niger, Nigeria, and Sierra Leone to complete NTD mapping, initiate MDA, scale up to national coverage, monitor the progress, evaluate the impact and scale down (stopping MDA) once objectives have been met. In 2017 alone, across Africa HKI supported the distribution of over 110 million MDA treatments for NTDs as well as the screening of nearly one million individuals for surgery including follow-up surgery for 36000 affected individuals. By 2018, stopping MDA criteria had been achieved for trachoma nationwide in Burkina Faso, Cameroon and Mali and in most endemic districts in Niger, and for LF nationwide in Mali and nearly in Cameroon and in most endemic districts in Burkina Faso, Niger and Sierra Leone. Prevalence levels for onchocerciasis, schistosomiasis and STH have also been significantly reduced in these countries. Moving forward, HKI will continue to collaborate with partners to support African governments to achieve NTD elimination goals and sustain the gains through mobilizing resources, building the capacity of Ministries of Health and strengthening existing health systems to integrate NTD activities. Joining this Alliance opens the door for HKI to collaborate with more partners on research and elimination of NTDs.

Neglected tropical diseases—Challenges and opportunities in India

Abstract Neglected Tropical Diseases (NTDs) are a major public health problem globally as well as in India. The World Health Organization recognizes seventeen (17) major parasitic and related infections as the neglected tropical diseases (NTDs) out of which the common ones in India are Lymphatic filariasis (LF), Visceral Leishmaniasis (VL) , Leptospirosis ,Rabies, Soil-Transmitted Helminthic Infections (STH) and Dengue. Most of the NTDs are highly disabling and many are chronic in nature. India is home to millions of people who are poor and live in impoverished environments, and hence, are at risk of these diseases. As per WHO‘s 2020 roadmap to eliminate at least 10 of NTDs ,India is committed to provide the necessary resources to remove the primary risk factors for NTDs –poverty and exposure by ensuring access to clean water and basic sanitation ,integrated vector control, health education and improved living conditions. The present article reviews the common NTDs in India, their magnitude, current status of interventions for control, and challenges and opportunities for the elimination of NTDs.

Re-imagining the future of diagnosis of Neglected Tropical Diseases

Neglected Tropical Diseases (NTDs) affect an estimated 1 billion people in 149 countries. The World Health Organization (WHO) prioritised 17 NTDs for control and elimination by 2020 and defined a Road Map to help countries reach these goals. Improved diagnostics for NTDs are essential for guiding treatment strategies at different thresholds of control, interruption of transmission, elimination and post-elimination surveillance. While substantial progress has been made in the last decade with chemotherapy, the same cannot be said of diagnostics, largely due to the perceived lack of a commercially viable market for NTD diagnostics.New sample in-answer out nucleic acid amplification technologies that can be performed at the point-of-care offer improved performance over current technologies and the potential to test for multiple pathogens using a single specimen. Finding commonalities for different NTDs in terms of geographic overlap, sentinel populations and treatment strategy will allow NTD programs to leverage these innovations to build cost-effective multiplex surveillance platforms. Connectivity solutions linking data from diagnostic laboratories and POC test readers/devices provide opportunities for automated surveillance systems to make health systems more efficient, improving patient outcomes and assessing impact of interventions in real time. New models of public–private product development partnerships are critical in leveraging diagnostic innovation in other priority area for better diagnosis, control and elimination of NTDs.

Indicators of improved water access in the context of schistosomiasis transmission in rural Eastern Region, Ghana.

Populations with poor access to water, sanitation and hygiene (WASH) infrastructure are disproportionately affected by the neglected tropical diseases (NTDs). As a result, WASH has gained increasing prominence in integrated control and elimination of NTDs, including schistosomiasis. In order to identify underserved populations, relevant measures of access to WASH infrastructure at sub-national or local levels are needed. We conducted a field survey of all public water sources in 74 rural communities in the Eastern Region of Ghana and computed indicators of water access using two methods: one based on the design capacity and another on the spatial distribution of water sources. The spatial method was applied to improved and surface water sources. According to the spatial method, improved water sources in the study area were well-distributed within communities with 95% (CI95%: 91, 98) of the population having access within 500m when all, and 87% (CI95%: 81, 93) when only functional water sources were considered. According to the design capacity-based method, indicator values were lower: 63% (CI95%: 57, 69) for all and 49% (CI95%: 43, 55) for only functional sources. Surface water access was substantial with 62% (CI95%: 54, 71) of the population located within 500m of a perennial surface water source. A negative relationship was observed between functional improved water access and surface water access within 300m. In this context, perceived water quality of the improved sources was also important, with a 17% increase in surface water access in towns with one reported water quality problem as compared to towns with no problems. Our study offers a potential methodology to use water point mapping data to identify communities in need of improved water access to achieve schistosomiasis risk reduction.

Study of polymorphism of GCPII gene in neural tube defect

Neglected Tropical Diseases (NTDs) affect an estimated 1 billion people in 149 countries. The World Health Organization (WHO) prioritised 17 NTDs for control and elimination by 2020 and defined a Road Map to help countries reach these goals. Improved diagnostics for NTDs are essential for guiding treatment strategies at different thresholds of control, interruption of transmission, elimination and post-elimination surveillance. While substantial progress has been made in the last decade with chemotherapy, the same cannot be said of diagnostics, largely due to the perceived lack of a commercially viable market for NTD diagnostics.New sample in-answer out nucleic acid amplification technologies that can be performed at the point-of-care offer improved performance over current technologies and the potential to test for multiple pathogens using a single specimen. Finding commonalities for different NTDs in terms of geographic overlap, sentinel populations and treatment strategy will allow NTD programs to leverage these innovations to build cost-effective multiplex surveillance platforms. Connectivity solutions linking data from diagnostic laboratories and POC test readers/devices provide opportunities for automated surveillance systems to make health systems more efficient, improving patient outcomes and assessing impact of interventions in real time. New models of public–private product development partnerships are critical in leveraging diagnostic innovation in other priority area for better diagnosis, control and elimination of NTDs.

[Current Trend of Drug Development for Neglected Tropical Diseases (NTDs)].

EBOLA hemorrhagic fever, a typical emerging infectious disease, began in December 2013 in the southern part of Guinea, and killed more than 11000 people by the end of June, 2015. In addition to emerging/re-emerging diseases and the 3 major infectious diseases i.e. HIV/AIDS, tuberculosis and malaria, neglected tropical diseases (NTDs) have recently become important tropical diseases of the poor. It is remarkable that Japan succeeded in the eradication of malaria and other tropical diseases, which include lymphatic filariasis and schistosomiasis. However, despite these achievements, it is important to sustain our efforts when we consider global health. This review highlights the significance of elimination and/or control of NTDs, and then introduces the current situation of drug development activities in Japan, which are aimed towards combating tropical infectious diseases. They include studies on a novel drug target, the "mitochondrial NADH-fumarate reductase system (Fumarate respiration)" composed of complex I, rhodoquinone and complex II, which plays an important role in the anaerobic energy metabolism of many helminths such as Ascaris suum. An additional interesting finding highlighted herein is that ascofuranone, a recently developed anti-African trypanosome drug, shows specific inhibition of fumarate respiration in Echinococcus multilocularis mitochondria.

Who Neglects Neglected Tropical Diseases? - Korean Perspective.

Neglected tropical diseases (NTDs) are a group of tropical infectious diseases of poorest people. Of 17 NTDs managed by WHO, two, guinea worm disease (by 2015) and yaws (by 2020) are targeted for eradication, and four (blinding trachoma, human African trypanosomiasis, leprosy, and lymphatic filariasis) for elimination by 2020. The goals look promising but 11 others are still highly prevalent. Soil-transmitted helminths (STHs) are one NTD which prevail over the world including temperate zones. They had been highly prevalent in Korea but are mostly disappearing at present through systematic and sustainable control activity. The successful experience of STH control enables Korean experts to develop many programs of NTD control in developing countries. Several programs of both official development aid and non-governmental organizations are now targeting NTDs. Most NTDs are low in health priority compared to their health threats because they are chronic, insidious, and of low mortality. No one, including the victims, raised priority of NTD control with a loud voice in the endemic field of the diseases. After the millennium development goals declared disease control over the world, NTDs are becoming less neglected globally. Even with limited resources, beginning a sustainable national program is the key for the control and elimination of NTDs. No more neglect, especially no more self-neglect, can eliminate diseases and upgrade quality of life of the neglected people.

Neglected tropical diseases: now more than just 'other diseases'--the post-2015 agenda.

Neglected tropical diseases (NTDs) have become recognised as important health problems facing at least a billion people in the low-income countries and the poorest communities in middle-income countries. WHO plays a leading role in developing strategies to address these diseases, pharmaceutical companies provide drug donations to treat or control the NTDs and many partners from different constituencies have become increasingly committed to their control or elimination. This review looks to the post-2015 agenda and emphasises that despite the progress made over recent years, if the targets established are to be achieved, then not only will additional financial resources be required to up-scale treatments and increase access, but increased applied and operational research will be necessary to address problems and human capacity in NTD skills will need to be strengthened. Continuing advocacy for the relevance of control or elimination of NTDs must be placed in the context of universal health coverage and access to donated essential medicines for the poor as a right. The evidence that investment in NTD interventions are cost-effective and impact not only on health, but also to enhance socio-economic development, must be refined and promulgated. The global burden of disease attributable to NTDs requires reassessment to appropriately define the true burden, while the potential for unexpected events, political, climatic, environmental as well as biological, have the potential to reduce future progress towards the agreed post-2015 targets. NTD progress towards the WHO Roadmap targets and the fulfilment of the World Health Assembly Resolution 66.12 of 2013 demand continued commitment from all partner constituencies when challenges emerge.

Developing eradication investment cases for onchocerciasis, lymphatic filariasis, and human African trypanosomiasis: rationale and main challenges.

The global health community pays renewed attention to evaluating the feasibility of elimination and eradication of certain communicable diseases [1,2] besides continuing to reduce the burden of ill-health. Eradication depends on both the availability of tools to interrupt transmission, the capacity of health systems to implement these solutions effectively across all populations concerned, the required resources, and sustained political will. While the health and economic benefits of disease elimination and subsequent eradication may be substantial, elimination initiatives represent resourceintensive efforts with associated opportunity costs [3,4]. Given the increasingly intense competition for global health resources, the decision to commit to national/regional elimination or eventual global eradication initiatives needs to be based upon robust analysis of benefits, risks, and costs. Following an initial proposal of the Ernst Strungmann Forum, convened in 2010 to explore the prospects, feasibility, and challenges of disease eradication [2], a working group developed a Guide to Preparing an Eradication Investment Case (EIC) [5]. The Guide proposes a generic approach applicable to any potentially eradicable disease. Among the diseases tentatively identified as amenable to eradication are several neglected tropical diseases (NTDs) [6]. The vision of eliminating and eradicating selected NTDs has gathered momentum over recent years. In 2011, the WHO Strategic and Technical Advisory Group for Neglected Tropical Diseases and its partners adopted a roadmap for the control, elimination, and eradication of many NTDs. The global financial support for NTDs control and elimination is still comparatively low but has recently started to substantially increase. Following major pledges by the US Agency for International Development (USAID) (350 million USD for the period 2009–2013) and the UK’s Department for International Development (DfID) for 2011–2015 (245 million GBP), the Bill and Melinda Gates Foundation (BMFG) donated 363 million USD for NTDs control and elimination in January 2012 (London Declaration, http://endtheneglect. org/2012/01/ntds-take-spotlight-at-londondeclaration-meeting/).