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Zewdu assefa edea(bsc health officer)Ethiopian field epidemiology resident at SPHMMCSurveillance intelligence officer at ephi-phemE-mail:zedhiwot05@gmail.com May 15, 2015

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Presentation outline

Overview of NTD

Epidemiology and economic burden

Public health strategies

Achievements

Challenges

Way forward

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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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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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Figure 1. overlapping NTDs

Source: NTD hidden success and opportunities (WHO/CDS/NTD/2009)

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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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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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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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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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Taeniasis/cysticercosisValidate strategy for control and elimination 2015

Scale up interventions in selected countries to control and eliminate

2020

Dracunculiasis (guinea-worm disease)

Eradication 2015

EchinococcosisValidate 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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Epidemiology and NTD burden

Source: Peter J Hotez et al .www.thelancet.com Vol 373 May 2, 2009

Bhutta et al. Infectious Diseases of Poverty 2014, 3:21

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“People makefun of me”

“I am a fisherman. I can’t work continuously. I am ill every other week with renewedpain.”

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Figure 2. overlapping threats to NTD

Source: NTD hidden success and opportunities (WHO/CDS/NTD/2009)

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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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Source: Peter J Hotez et al. www.thelancet.com Vol 373 May 2, 2009

Table 2: High-prevalence and other vector-borne neglected tropical diseases

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Source: Peter J. Hotez et al. Neglected Tropical Diseases in Sub-Saharan Africa www.plosntds.orgAugust 2009 Volume 3 Issue 8

Table 3. Ranking of neglected tropical disease in SSA by prevalence and disease burden

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Source: www.plosntds.orgAugust 2009 Volume 3 Issue 8

Table 4. geographic distribution and estimated burden of major helminthes NTDs in SSA

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Table 5. Disease Burden (DALYs) in SSA Resulting from the NTDs.

Source: www.plosntds.orgAugust 2009 Volume 3 Issue 8

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Table 6. Economic costs of selected neglected tropical diseases(data are the latest available)

Source: Working to overcome the global impact of neglected tropical diseases ,WHO. 2010

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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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Table 7. Summary of burden of neglected tropical disease in Ethiopia, 2012

Source:Deribe et al. Parasites & Vectors 2012, 5:240

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Figure 4. Overlap between five common NTDs (soil-transmitted helminth infections; lymphatic filariasis; schistosomiasis; trachoma andonchocerciasis) in Ethiopia as reported by health providers and maps

Source:Deribe et al. Parasites & Vectors 2012, 5:240

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Table 8. Burden of neglected tropical disease in Ethiopia and relative contribution and rank within Sub-Saharan Africa,

2012

Source:Deribe et al. Parasites & Vectors 2012, 5:240

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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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Strategies

Preventive chemotherapy;

Intensified case-management;

Vector control;

Provision of safe water, sanitation and hygiene; and

Veterinary public health

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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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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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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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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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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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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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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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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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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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SWOT analysis of the master plan

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