Integrated Neglected Tropical Diseases Control Research Articles

Looking for NTDs in the skin; an entry door for offering patient centered holistic care.

The majority of neglected tropical diseases (NTDs) have established primary skin manifestations or associated clinical feature. Skin NTDs often result in physical impairment and disfigurement, which can lead to disability. Skin diseases have been proposed as an entry point for integrated NTDs control. However, the magnitude and overlap of skin NTDs is poorly understood. An institution-based cross-sectional study was done using medical records of dermatology patients between July 2017 and June 2018 in a dermatology service in Northeast Ethiopia. A total of 661 patient records were selected using simple random sampling. A total of 656 complete records were included in analysis. Skin NTDs constituted 17.2% (n = 113) of the overall of skin diseases. Of skin NTDS, cutaneous leishmaniasis (n = 40; 35.4%), leprosy (n = 38; 33.6%), and scabies (n = 31; 27.4%) were the most common. Additionally, there were four cases of mycetoma. Of the non NTDs, poverty-related infections such as superficial fungal (n = 118; 21.1%) and bacterial (n = 33; 5.2%) infections were also frequent. Tinea capitis was the most common superficial fungal infections. Impetigo and cellulitis were the predominant bacterial infections. Skin NTDsand other poverty related skin infections were common at the dermatology service. Dermatological services could act as a good entry point for integrated management of skin NTDs. Future studies should assess how different preventive strategies like contact tracing, early diagnosis and mass drug administration can be integrated.

The Neglected Tropical Disease Non-governmental Development Organization Network (NNN): the value and future of a global network aiming to control and eliminate NTDs.

The Neglected Tropical Disease Non-governmental Development Organization Network (NNN) (www.ntdngdonetwork.org) is a global forum for non-governmental development organizations (NGDOs) working to control or eliminate neglected tropical diseases (NTDs): currently including, leprosy, lymphatic filariasis (LF), onchocerciasis, schistosomiasis (SCH), soil-transmitted helminthiasis (STH) and trachoma. Each of these diseases has elimination as a target where feasible and each receives generous donations of medicines from the pharmaceutical industry. The NNN was formed at a meeting in Accra, Ghana, in September 2009 when several existing NTD-specific coordination groups combined forces following a general trend towards integrated NTD control and elimination. Today, the NNN is composed of five NTD-specific NGDO coordination groups: the LF NGDO Network; the International Coalition for Trachoma Control (ICTC) (http://www.trachomacoalition.org/node/873); the NGDO Coordination Group for Onchocerciasis Elimination; the SCH/STH NGDO Coordination Group; and the International Federation of Anti-Leprosy Associations (ILEP) (http://www.ilepfederation.org/ about-us/history-of-ilep/). In addition to these five diseasecoordination groups, the NNN has two thematic working groups: 1. Water, Sanitation, and Hygiene (WASH), and 2. Disease Management, Disability and Inclusion (DMDI). These working groups allow NNN members to address key cross-cutting issues that are common to the targeted NTDs. Together, these coordinating and working groups (Figure 1 and Table 1) comprise nearly 80 NGDO members of the NNN, working directly to support the world’s most underserved populations suffering from the NTDs by:

Global trends in neglected tropical disease control and elimination: impact on child health

The neglected tropical diseases (NTDs) are a group of 17 lesser known chronic infections which predominantly affect poor and disenfranchised communities. There are a number of NTDs that cause significant...

Enlarging the “Audacious Goal”: Elimination of the world's high prevalence neglected tropical diseases

The high prevalence neglected tropical diseases (NTDs) exhibit a global disease burden that exceeds malaria, tuberculosis, and other better known global health conditions; they also represent a potent force in trapping the world's poorest people in poverty. Through extremely low cost national programs of disease mapping and mass drug administration (MDA) for the seven most common NTDs, integrated NTD control and elimination efforts are now in place in more than 14 countries through the support of the United States Agency for International Development (USAID), the British Department for International Development (DFID), and the Global Network for NTDs and its partners. The World Health Organization (WHO) estimates that in 2008 some 670 million people in 75 countries received NTD treatments through these and other sponsored programs. With continued successes the next decade could witness the global elimination of blinding trachoma, human Africa trypanosomiasis (HAT), lymphatic filariasis (LF), onchocerciasis, trachoma, and leprosy as public health problems, in addition to the eradication of dracunculiasis. For other high prevalence NTDs, including hookworm infection, schistosomiasis, Chagas disease and leishmaniasis, new drugs and vaccines may still be required. Increasingly it is recognized that the high prevalence NTDs exhibit extensive geographic overlap and polyparasitism is commonly found throughout the world's low income countries. Therefore, global elimination will also require integrated packages of drugs together with vaccine-linked chemotherapy. Ultimately, the global elimination of the high prevalence NTDs will require continued large-scale support from the U.S. Government and selected European governments, however, the emerging market economies, such as Brazil, China, India, Mexico, and Nigeria, and wealthy countries in the Middle East will also have to substantially contribute.

Neglected Tropical Diseases and the 2012 US Presidential Election

Neglected Tropical Diseases and the 2012 US Presidential Election

The Cost of Antibiotic Mass Drug Administration for Trachoma Control in a Remote Area of South Sudan

BackgroundMass drug administration (MDA) of antibiotics is a key component of the so-called “SAFE” strategy for trachoma control, while MDA of anthelminthics provides the cornerstone for control of a number of other neglected tropical diseases (NTDs). Simultaneous delivery of two or more of these drugs, renowned as “integrated NTD control,” is being promoted to reduce costs and expand intervention coverage. A cost analysis was conducted alongside an MDA campaign in a remote trachoma endemic area, to inform budgeting for NTD control in South Sudan.Methods and FindingsA first round of antibiotic MDA was conducted in the highly trachoma endemic county of Mayom, Unity state, from June to August 2010. A core team of seven staff delivered the intervention, including recruitment and training of 44 supervisors and 542 community drug distributors. Using an ingredients approach, financial and economic costs were captured from the provider perspective in a detailed costing database. Overall, 123,760 individuals were treated for trachoma, resulting in an estimated treatment coverage of 94%. The economic cost per person treated was USD 1.53, excluding the cost of the antibiotic azithromycin. Ninety four per cent of the delivery costs were recurrent costs, with personnel and travel/transport costs taking up the largest share.ConclusionsIn a remote setting and for the initial round, MDA of antibiotics was considerably more expensive than USD 0.5 per person treated, an estimate frequently quoted to advocate for integrated NTD control. Drug delivery costs in South Sudan are unlikely to decrease substantially during subsequent MDA rounds, as the major cost drivers were recurrent costs. MDA campaigns for delivery of one or more drugs in South Sudan should thus be budgeted at around USD 1.5 per person treated, at least until further costing data for delivery of other NTD drugs, singly or in combination, are available.

How to (or Not to) Integrate Vertical Programmes for the Control of Major Neglected Tropical Diseases in Sub-Saharan Africa

Combining the delivery of multiple health interventions has the potential to minimize costs and expand intervention coverage. Integration of mass drug administration is therefore being encouraged for delivery of preventive chemotherapy (PCT) to control onchocerciasis, lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, and trachoma in sub-Saharan Africa, as there is considerable geographical overlap of these neglected tropical diseases (NTDs). With only a handful of countries having embarked on integrated NTD control, experience on how to develop and implement an efficient integrated programme is limited. Historically, national and global programmes were focused on the control of only one disease, usually through a comprehensive approach that involved several interventions including PCT. Overcoming the resulting disease-specific structures and thinking, and ensuring that the integrated programme is embedded within the existing health structures, pose considerable challenges to policy makers and implementers wishing to embark on integrated NTD control. By sharing experiences from Uganda, Tanzania, Southern Sudan, and Mozambique, this symposium article aims to outlines key challenges and solutions to assist countries in establishing efficient integrated NTD programmes.

Integrated Mapping of Neglected Tropical Diseases: Epidemiological Findings and Control Implications for Northern Bahr-el-Ghazal State, Southern Sudan

BackgroundThere are few detailed data on the geographic distribution of most neglected tropical diseases (NTDs) in post-conflict Southern Sudan. To guide intervention by the recently established national programme for integrated NTD control, we conducted an integrated prevalence survey for schistosomiasis, soil-transmitted helminth (STH) infection, lymphatic filariasis (LF), and loiasis in Northern Bahr-el-Ghazal State. Our aim was to establish which communities require mass drug administration (MDA) with preventive chemotherapy (PCT), rather than to provide precise estimates of infection prevalence.Methods and FindingsThe integrated survey design used anecdotal reports of LF and proximity to water bodies (for schistosomiasis) to guide selection of survey sites. In total, 86 communities were surveyed for schistosomiasis and STH; 43 of these were also surveyed for LF and loiasis. From these, 4834 urine samples were tested for blood in urine using Hemastix reagent strips, 4438 stool samples were analyzed using the Kato-Katz technique, and 5254 blood samples were tested for circulating Wuchereria bancrofti antigen using immunochromatographic card tests (ICT). 4461 individuals were interviewed regarding a history of ‘eye worm’ (a proxy measure for loiasis) and 31 village chiefs were interviewed regarding the presence of clinical manifestations of LF in their community. At the village level, prevalence of Schistosoma haematobium and S. mansoni ranged from 0 to 65.6% and from 0 to 9.3%, respectively. The main STH species was hookworm, ranging from 0 to 70% by village. Infection with LF and loiasis was extremely rare, with only four individuals testing positive or reporting symptoms, respectively. Questionnaire data on clinical signs of LF did not provide a reliable indication of endemicity. MDA intervention thresholds recommended by the World Health Organization were only exceeded for urinary schistosomiasis and hookworm in a few, yet distinct, communities.ConclusionThis was the first attempt to use an integrated survey design for this group of infections and to generate detailed results to guide their control over a large area of Southern Sudan. The approach proved practical, but could be further simplified to reduce field work and costs. The results show that only a few areas need to be targeted with MDA of PCT, thus confirming the importance of detailed mapping for cost-effective control.

Control of the Neglected Tropical Diseases in sub-Saharan Africa: the unmet needs

The neglected tropical diseases (NTDs) are widespread in sub-Saharan Africa with several infecting many millions of individuals. Various integrated control programmes against up to seven NTDs are now being implemented in a few countries in sub-Saharan Africa, but the total coverage is estimated to be only a quarter of the population in need of treatment. We estimate that approximately $200+ million per year is needed to fully implement the proposed integrated NTD control programmes in the rural populations in all the countries in sub-Saharan Africa, and an annual sum for 5-7 years would be needed to reduce morbidity to below public health importance. To date, the Bill & Melinda Gates Foundation, the United States Agency for International Development, the British Government, Geneva Global (an international philanthropic organisation) and other donors have committed some funds for NTD control; however, more effort is needed from a broader spectrum of donors to reach our targets. Unless more funds are committed and concerted actions are taken across all the sub-Saharan African countries, NTDs will be controlled in some but still be a major public health problem for the foreseeable future in the majority of countries.

Conceptualizing Integration: A Framework for Analysis Applied to Neglected Tropical Disease Control Partnerships

The timely and sustained delivery of effective health interventions to communities in developing countries is one of the greatest challenges in global health. Millions of the world's poorest citizens continue to be afflicted by bacterial, viral, and parasitic infections that have persisted, mainly in the tropics—the so-called neglected tropical diseases (NTDs)—despite the availability of safe and cost-effective interventions for the control and elimination of many of these diseases. Access to these interventions (or control tools) remains low and inadequate, particularly in sub-Saharan Africa [1],[2]. The NTDs, including onchocerciasis, schistosomiasis, lymphatic filariasis, trachoma, and soil-transmitted helminthiasis, have been shown to affect the poorest of the poor disproportionately. Addressing the NTDs, therefore, will be an essential element in poverty alleviation programs [3],[4]. A number of important international single-disease control partnerships have been developed over the last few decades [5]–[7]. To date, however, there has been little integration among these partnerships [3]. Integration refers to the creation of linkages among existing programs to improve the delivery of health interventions given existing commitments and resources. The presence of many common elements and general arguments about economies of scale provide strong reasons to believe that integration amongst partnerships can help improve both efficiency and effectiveness. Interest in integration is currently at an all-time high, due in part to new funding for integration (the Bill & Melinda Gates Foundation has announced research grants to investigate integration of NTDs, and the United States Agency for International Development [USAID] has awarded operational grants to scale-up integrated NTD control programs), the creation of the Global Network for Neglected Tropical Diseases Control (GNNTDC; http://gnntdc.sabin.org/), and high-level political commitment to address these scourges [8]. In addition, reports of successful national control programs for single diseases supported by these partnerships (such as trachoma control in Morocco and lymphatic filariasis control in Egypt) bolster the case that integration be prioritized in affected countries. While there has been significant discussion about the integration of single-disease partnerships [9]–[11] and the potential usefulness of such approaches in helping to tackle the burden of NTDs, there is limited experience in implementing integration and even less experience in conducting systematic analysis of these experiences. Recently, a number of articles have discussed potential challenges and opportunities, and have estimated potential benefits, including cost savings [12]–[14]. The lack of a common understanding of integration for disease control programs may be a significant impediment towards implementing integration, despite significant interest in the topic. This article presents a conceptual framework to help guide the discussion about integration of NTD control partnerships. It then provides specific examples of potential opportunities and actual cases of integration of NTDs, and places these examples within the conceptual framework. The main purpose of this article is to provide a tool for thinking about integration—to aid the development, implementation, and evaluation of future efforts at integrating NTD control programs. This framework could also be used for assessing other forms of integration among service-oriented programs. This article does not provide lessons from ongoing NTD integration efforts, because the existing attempts are at too early a stage to generate results.

Recent progress in integrated neglected tropical disease control

Three years have passed since the publication of the first of a series of policy papers, which first highlighted the under-appreciated global burden of the neglected tropical diseases (NTDs) and then outlined a rationale for linking vertical control strategies for the seven most prevalent NTDs in a cost-effective pro-poor package of preventive chemotherapy. Since then, global advocacy for these conditions has increased and, with it, new funds for scale-up of integrated NTD control in sub-Saharan Africa. Recent speeches by the Director General of the World Health Organization at regional meetings have referred to NTDs as important global health priorities (www.who.int/dg/speeches/2007). Outlined here is a summary of the recent progress in global efforts to integrate NTD control, with an emphasis on the challenges that lie ahead.

Potential for integrated control of neglected tropical diseases in Ethiopia

Ethiopia is one of the poorest and least developed countries in the world, endemic for many neglected tropical diseases (NTDs). The Ministry of Health is successfully controlling onchocerciasis through community-directed treatment with ivermectin and has implemented health system changes that would allow extension of integrated NTD control to schistosomiasis, lymphatic filariasis, soil-transmitted helminthiasis and trachoma. Funds are now needed to gain a better understanding of the endemicity and co-endemicity of these diseases and to formulate and pilot integrated packages for mass drug administration (MDA). Based on the experience gained, MDA may then be scaled-up to all NTD-endemic areas.