the slides is all about neglected tropical disease in the world, Africa and Ethiopia

1. Zewdu assefa edea(bsc health officer)
Ethiopian field epidemiology resident at SPHMMC
Surveillance intelligence officer at ephi-phem
E-mail:zedhiwot05@gmail.com
May 15, 2015
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2. Presentation outline
 Overview of NTD
 Epidemiology and economic burden
 Public health strategies
 Achievements
 Challenges
 Way forward
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3. Objectives
 At the end of the presentation the residents are able to
 Describe what is NTD
 Explain disease included in NTD with their respective targets
 Know epidemiology and disease burden of NTD
 Describe the public health strategies, challenges and achievements of
NTDs nationally, regionally and globally
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4. What is NTD?
 Group of communicable diseases which thrive in impoverished settings and
blight the lives of around one billion people worldwide, while threatening
the health of millions more.
 Of the world’s poorest 2.7 billion people (defined as those who live on less
than US$ 2.00 a day), more than 1 billion are affected by one or more
neglected tropical disease.
 These diseases not only survive and spread in conditions of poverty, they
also exacerbate and perpetuate the poverty of affected communities.
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5. Figure 1. overlapping NTDs
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Source: NTD hidden success and opportunities (WHO/CDS/NTD/2009)

6.  Thrive in areas where
 water supply, housing and sanitation are inadequate,
 nutrition is poor,
 literacy rates are low,
 health systems are rudimentary and
 insects and other disease vectors are constant household and
occupational companions
 Neglected at community, national and international level
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7.  International attention is currently focused on HIV/AIDS, malaria and
tuberculosis, as well as on global health security(WHO)
 Currently, only 10% of global funding for research goes towards diseases
that affect 90% of the world’s population(WHO, Berlin report 2006)
 Less than 1% of the 1393 new drugs registered during 1975–1999 was for
tropical diseases.
 Less than 0.001% of the US$ 60–70 billion went towards developing new
and urgently needed treatments for tropical diseases(WHO)
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8. Common features
 A proxy for poverty and disadvantage
 Affect populations with low visibility and little political voice
 Do not travel widely
 Cause stigma and discrimination, especially of girls and women
 Have an important impact on morbidity and mortality
 Are relatively neglected by research
 Can be controlled, prevented and possibly eliminated using effective and
feasible solutions
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9. Table 1. targeted NTD as adopted by WHO Department of NTD,
May 2013
NTDs Target Year
Dengue Reduce mortality by 50%
Reduce morbidity by 25%
2020
Rabies Eliminate in Latin America 2015
Eliminate in South-East Asia and Western Pacific regions 2020
Blinding trachoma Eliminate 2020
Buruli ulcer Develop oral antibiotic therapy 2015
Yaws Eradication 2020
Leprosy Reduce grade-2 disabilities (visible deformities)
Chagas disease Interrupt transmission through blood in the Region of the Americas ( 2015
Interrupt vectorial intradomiciliary transmission in the Region of the
Americas
2020
Human african trypanosomiasis
(sleeping sickness)
Eliminate in 80% of foci) 2015
Global 2020
Leishmaniases Eliminate South-East Asia Region 2020
Reduce morbidity and mortality in East Africa and South America
Detect and manage >70% cutaneous Leishmaniasis cases in Eastern
Mediterranean Region
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10. Taeniasis/cysticercosis
Validate strategy for control and elimination 2015
Scale up interventions in selected countries to control and
eliminate
2020
Dracunculiasis (guinea-worm
disease)
Eradication 2015
Echinococcosis
Validate control strategy in selected countries through pilot
project
2015
Validate control strategy and scale up interventions in
selected countries
2020
Foodborne trematodiases Include in mainstream preventive
chemotherapy strategy and Reach 75% at-risk
population
2020
Lymphatic filariasis elimination 2020
Onchocerciasis (river
blindness)
Elimination in Latin America 2015
Elimination in selected countries of Africa(23/31) 2020
Elimination in Yemen 2015
Schistosomiasis Elimination in Mediterranean,Caribbean,Indonesia 2015
Americas and western Pacific 2020
Selected African countries 2020
Soil transmitted helminthiasis Achieve 75%,100% coverage in pre and school aged
children respectively
2020
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11. Epidemiology and NTD burden
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Source: Peter J Hotez et al .www.thelancet.com
Vol 373 May 2, 2009
Bhutta et al. Infectious Diseases of Poverty 2014,
3:21

12. 5/16/2015 12
“People
make
fun of me”
“I am a fisherman. I can’t work continuously. I am
ill every other week with renewed
pain.”

13. Figure 2. overlapping threats to NTD
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Source: NTD hidden success and opportunities (WHO/CDS/NTD/2009)

14.  DALYs measure only direct health loss and do not consider the economic
impact of the NTDs that results from detrimental effects on
 school attendance and child development,
 agriculture (especially from zoonotic NTDs), and
 overall economic productivity nor do DALYs account for
 direct costs of treatment, surveillance, and prevention measures
 important elements of social stigma and the spillover effects to family and community
members ,
 loss of tourism, and
 health system overload (e.g., during dengue outbreaks)
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15. Source: Peter J Hotez et al. www.thelancet.com Vol 373 May 2, 2009
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Table 2: High-prevalence and other vector-borne neglected tropical diseases

16. Source: Peter J. Hotez et al. Neglected Tropical Diseases in Sub-Saharan Africa www.plosntds.orgAugust 2009
Volume 3 Issue 8
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Table 3. Ranking of neglected tropical disease in SSA by
prevalence and disease burden

17. Source: www.plosntds.orgAugust 2009 Volume 3 Issue 8
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Table 4. geographic distribution and estimated burden of major
helminthes NTDs in SSA

18. Table 5. Disease Burden (DALYs) in SSA Resulting from the
NTDs.
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Source: www.plosntds.orgAugust 2009 Volume 3 Issue 8

19. Table 6. Economic costs of selected neglected tropical
diseases(data are the latest available)
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Source: Working to overcome the global impact of neglected tropical diseases ,WHO. 2010

20.  In Ethiopia, most of the NTDs in the WHO list are present except for
probably dengue fever, Chagas disease and yaws(Deribe et al. Parasites &
Vectors 2012)
 hinder economic development,
 cause chronic life-long disability,
 impair childhood development
 reduce child survival, educational attainment and
 agricultural productivity, and
 result in significant treatment costs
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21. Table 7. Summary of burden of neglected tropical disease in
Ethiopia, 2012
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Source:Deribe et al. Parasites & Vectors 2012, 5:240

22. Figure 4. Overlap between five common NTDs (soil-transmitted helminth
infections; lymphatic filariasis; schistosomiasis; trachoma and
onchocerciasis) in Ethiopia as reported by health providers and maps
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Source:Deribe et al. Parasites & Vectors 2012, 5:240

23. Table 8. Burden of neglected tropical disease in Ethiopia and
relative contribution and rank within Sub-Saharan Africa,
2012
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Source:Deribe et al. Parasites & Vectors 2012, 5:240

24. Global plan
 Vision
 A world free of neglected tropical diseases and zoonoses
 Goal
 to prevent, control, eliminate or eradicate NTDs
 Targets
 To eliminate or eradicate those diseases targeted in resolutions of the World Health Assembly
and regional committees.
 To reduce significantly the burden of other tool-ready diseases through current interventions.
 To ensure that interventions using novel approaches are available, promoted and accessible for
tool-deficient diseases.
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25.  Strategies
 Preventive chemotherapy;
 Intensified case-management;
 Vector control;
 Provision of safe water, sanitation and hygiene; and
 Veterinary public health
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26. Acheivements
 Lymphatic filariasis,
 treatment was delivered at an increased rate in 48 out of the 81 endemic
countries.
 Since 2000, more than a billion treatments have been delivered,
significantly reducing the prevalence and intensity of the disease and
preventing infection in millions of children.
 In 2007 alone, 546 million people were treated.
 In August 2007, China became the first country declared to have eliminated
, followed by the Republic of Korea in March 2008.
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27.  Leprosy
 On the verge of elimination as a public health problem from almost all the countries in the world
 According to data received from 121 countries, the global prevalence of leprosy at the beginning of
2009 stood at 213 036 , while the number of new cases detected during 2008 was 249 007.
 The number of new cases detected globally has fallen by 9126, representing a decrease of 4% during
2008 compared with 2007.
 GWD
 Only 4619 cases in 2008, compared with an estimated 3.5 million in 1986.
 The total number of countries since the 1980s dropped from 20 to only six in 2008.
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28.  More than 1 million school-aged children were treated for schistosomiasis in
Madagascar between June and October 2008, compared with just over 110 000
between 1999 and 2006.
 A similar campaign in the Nigerian states of Nasarawa and Plateau treated 846
696 out of 926 913 school children.
 Transmission of Chagas disease has successfully been reduced in many Latin
American countries.
 Onchocerciasis has been eliminated as a public health problem and as a disease
of socioeconomic importance from 10 West African countries
 Morocco eliminated trachoma as a public health problem in 2007
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29. Challenges
 procurement and supply of anthelminthic medicines;
 quantification of the burden of NTDs among neglected populations;
 provision of treatment and other interventions free of charge to
communities in need;
 a system for delivery of medicines to cover the entire at risk population;
 delivery of multi-intervention packages;
 urgent development of diagnostic tools, medicines and pesticides;
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30. Africa: strategies
 Four intervention strategies
 Preventive chemotherapy (PCT) through MDA
 Intensified disease management (IDM)
 focuses on improving access to specialized care through disease surveillance and case-
finding, and helps to reduce the burden of mortality and morbidity associated with these
illnesses
 Vector control
 Environmental factors
 Measures to improve sanitation, food and water safety, and personal hygiene
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31. Achievements
 The region has significantly reduced the burden of Guinea worm disease
throughout the region and has nearly eliminated the diseases.
 The incidence of leprosy and human african trypanosomiasis have dropped in
some areas
 Intensive preventive chemotherapy campaigns have reduced the prevalence of
lymphatic filariasis
 Elimination is a feasible goal, with 28 countries having reported controlling or
eliminating one or more NTD
 APOC has averted the loss of about one million DALYs, prevented 800
thousand cases of blindness, and reduced the prevalence of onchocerciasis
about 73 percent in the 19 countries in which it is active
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32. Challenges
 Weak coordination among partners
 The need to scale up advocacy and visibility of NTD programs at regional,
national and sub-national levels;
 Weak government ownership and national program capacity
 NTD programs still do not receive the required priority in government funding allocations;
 The need to direct more funds to high burden countries and villages, which
are not always the priorities of many partner and donors;
 Effectively and rapidly scaling up interventions; and
 Weak government systems and NTD program management capacities
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33. Public health Strategies in Ethiopia
 NTDs continued to debilitate, deform, blind and kill sizeable proportions of
the population either as mono-infections or as co-infections with major
killers such as HIV/AIDS
 Data on the burden of NTDs and their distribution is incomplete
 access to preventive and curative services is inadequate and not well integrated
 Recently, NTDs have received more attention and were included in the 5-
year Health Sector Development Program (HSDP-IV)
 NTD prevention and control is largely community-based intervention
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34.  Goal
 Realizing a sustainable integrated national NTDs control program that is capable of
achieving the goals of individual programs that would enable the country to
meaningfully address NTDs as public health problem in the future by 2015.
 Four strategic priorities
 Strengthening government ownership, advocacy, coordination and partnerships,
 Enhancing planning for results and development of policy guidelines,
 Community empowerment, scaling up access to NTD interventions, treatment and
service delivery capacities, and
 Enhancing NTD monitoring and evaluation, surveillance and operational research.
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35. SWOT analysis of the master plan
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36. 5/16/2015 36