Neglected Tropical Diseases in South Asian Region

What is the issue?

South Asian region has recorded a notable progress in eliminating and containing various diseases.
However, the status of neglected tropical diseases (NTDs) in the South Asian region calls for a last-mile push.

What are the health achievements in South Asia?

Maternal and neonatal tetanus has been eliminated.
HIV, TB and malaria epidemics have been halted and reversed after decades of struggle.
These will hopefully be ended altogether in the coming years.
Regional - India is now yaws-free.
Maldives, Sri Lanka and Thailand have eliminated lymphatic filariasis as a public health problem.
Nepal is in the process of validating the elimination of trachoma as a public health problem.
Nepal also maintained the elimination target for kala-azar for more than 3 consecutive years.
By the end of 2017, 100% of sub-districts in Bangladesh and 90% of blocks in India had done the same.
As a whole, the region remains responsible for the world’s largest preventive chemotherapy campaign.

What are the shortfalls?

NTDs include diseases like leprosy, trachoma, lymphatic filariasis and kala-azar.
As the name suggests, NTDs take their most severe toll on the poor and marginalised communities.
The political influence of these sections is limited and their health needs are often overlooked.
Evidently, South Asian region has eliminated leprosy as a public health problem.
But the disease continues to circulate among vulnerable communities.
They accounts for more than 60% of leprosy-caused grade two disabilities worldwide.
Similarly, several member countries have eliminated lymphatic filariasis.
However, its burden continues to haunt communities in remote and hard-to-reach areas elsewhere.
Region-wide, 53% of all people require mass drug administration to stay free of this disfiguring disease.

What is the way forward?

No member country of the South Asian region can be complacent as one of the 20 NTDs is endemic to each of them.
Stable domestic funding for national programmes is central to taking forward the progress achieved so far.
Member countries must ensure programming is both dynamic and flexible i.e. pursuing large-scale campaigns as well as working creatively across sectors.
Going for mass drug administration where appropriate and strengthening NTD-related services at the primary level are essential.
Simultaneously, specific efforts such as roping in agro-engineers in the battle against schistosomiasis can be taken up.
Similarly, vector control must be actively pursued and harnessed by programmes at the local level.
These can have immediate and substantial impact on disease transmission in NTD-affected areas.
Importantly, member countries should take full advantage of innovations in research and technology.
The effective use of rapid diagnostics can facilitate swift and accurate diagnosis of a range of NTDs.
IT infrastructure should be integrated with existing surveillance systems to allow programme managers to gather, analyse and act on real-time data.
Ensuring all communities have access to health services and the benefits they provide is essential to make them free of NTDs.

Source: Business Line

Quick Fact

Preventive Chemotherapy Campaign

This is a public health strategy recommended by WHO against a set of Neglected Tropical Diseases.
Preventive Chemotherapy consists of the regular, large-scale administration of drugs, either alone or in combination.
It is administered to entire population groups, with the aim of reducing transmission and associated morbidity.

Lymphatic filariasis

Lymphatic filariasis is commonly known as elephantiasis.
It is caused by infection with parasites classified as nematodes (roundworms), which are transmitted to humans through mosquitoes.
Mosquitoes are infected with microfilariae by ingesting blood when biting an infected host.
Infection is usually acquired in childhood causing hidden damage to the lymphatic system.
Its visible manifestations may occur later in life, causing temporary or permanent disability.

Schistosomiasis

Schistosomiasis is an acute and chronic disease caused by parasitic worms.
People are infected during routine agricultural, domestic, occupational, and recreational activities, which expose them to infested water.
Water contamination due to excreta containing parasite eggs, which hatch in water, is also a mode of transmission.

Trachoma

Trachoma is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis.
It causes blindness or visual impairment. It is the cause for about 1.4% of all blindness worldwide.
Blindness from trachoma is irreversible.
Environmental risk factors influencing the transmission of the disease include:

Kala-azar

Visceral leishmaniasis (VL), also known as kala-azar, is caused by the protozoan Leishmania parasites.
It is transmitted to humans through infected sandflies.
The parasite migrates to the internal organs such as the liver, spleen, and bone marrow; if left untreated, it may result in death.
It is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia.
It is endemic to the Indian subcontinent in 119 districts in four countries (Bangladesh, Bhutan, India and Nepal).