NEGLECTED TROPICAL DISEASES (NTDS)

The World Health Organization's recent report, "Global Report on Neglected Tropical Diseases 2024," has brought renewed attention to neglected tropical diseases (NTDs)

About Report

1.Reduction in the Need for Interventions:

1. • The goal is to reduce the percentage of people requiring interventions against NTDs by 90% by 2030.
   • In 2022, 1.62 billion people needed such interventions, reflecting a 26% decrease since 2010. This shows substantial progress towards the target, although more work is needed to reach the 90% reduction goal.
2. Decrease in Vector-Borne Disease Deaths:
   • The aim is to cut vector-borne NTD-related deaths by 75% by 2030.
   • However, the number of deaths from vector-borne diseases increased by 22% in 2022 compared to 2016. This indicates a setback in efforts to control these diseases and highlights the need for renewed focus and strategies.
3. Access to Basic Water, Sanitation, and Hygiene (WASH):
   • The target is to ensure 100% access to at least basic WASH services in areas endemic to NTDs by 2030.
   • Currently, 85.8% of people in NTD-endemic countries have access to water, sanitation, and hygiene facilities. However, only 63% of those requiring NTD interventions have access to these services, suggesting significant gaps in coverage.

Findings Related to India:

1. High Proportion of People Requiring Interventions:
   • India has approximately 40% of the global population requiring NTD interventions, the highest proportion of any country. This underscores the scale of the challenge in India.
2. Achievements in Disease Elimination:
   • India has been certified by WHO as free of Guinea Worm disease (since 2000) and Yaws (since 2016). These certifications reflect significant achievements in controlling and eliminating specific NTDs within the country.

What Are NTDs?

NTDs are a diverse range of conditions caused by various pathogens including viruses, bacteria, parasites, fungi, and toxins. These diseases are typically prevalent in areas with high levels of poverty, poor sanitation, and inadequate healthcare systems.

Reasons for Neglect

• Low Global Funding: NTDs often receive minimal funding compared to other major diseases like malaria or tuberculosis. This lack of financial support limits research, prevention, and treatment efforts.
• Stigma and Social Exclusion: Many NTDs are associated with stigma and social exclusion, which further hampers efforts to address them. Affected individuals and communities may face discrimination, which can discourage seeking treatment and exacerbate the disease burden.
• Global Health Agenda: Historically, NTDs have been marginalized in global health policy discussions. They only gained significant attention in 2015 with the inclusion of SDG target 3.3, which aims to end the epidemics of NTDs by 2030.

NTDs in India

India bears a significant burden of NTDs, with the world's largest absolute number of cases for several of these diseases. Major NTDs in India include:

• Hookworm: A parasitic infection caused by hookworm species, leading to anemia and nutritional deficiencies.
• Dengue: A viral illness transmitted by mosquitoes, causing severe flu-like symptoms and potentially leading to dengue hemorrhagic fever.
• Lymphatic Filariasis: Caused by parasitic worms transmitted by mosquitoes, leading to lymphatic system damage and severe swelling of limbs.
• Leprosy: A bacterial infection that causes skin lesions, nerve damage, and muscle weakness.
• Kala-Azar: Also known as visceral leishmaniasis, this parasitic disease affects internal organs, including the spleen and liver.
• Rabies: A viral infection typically transmitted through animal bites, leading to severe neurological symptoms and, if untreated, death.
• Ascariasis: A parasitic infection caused by the roundworm Ascaris lumbricoides, leading to abdominal discomfort and nutritional deficiencies.
• Trichuriasis: Caused by the whipworm Trichuris trichiura, resulting in gastrointestinal symptoms and potential growth retardation in children.
• Trachoma: A bacterial infection of the eye that can lead to blindness if untreated.
• Cysticercosis: Caused by the larval stage of the pork tapeworm Taenia solium, leading to neurological and other systemic symptoms.

Importance of Addressing NTDs

Addressing NTDs is crucial for improving global health outcomes and achieving sustainable development goals. Effective management requires:

• Increased Funding: Allocating more resources for research, treatment, and prevention.
• Public Awareness: Reducing stigma and increasing awareness about these diseases.
• Strengthened Health Systems: Improving healthcare infrastructure and access in affected regions.

Eliminating Neglected Tropical Diseases (NTDs) is critically important for several compelling reasons:

1. Widespread Impact:
   • Global Reach: Over 1 billion people worldwide are affected by NTDs, with 1.6 billion requiring preventive or curative measures.
   • Disproportionate Effect on Poorer Nations: About 80% of the burden falls on low- and middle-income countries, where healthcare resources are often limited.
2. Socioeconomic Benefits:
   • Cost Savings: Achieving the elimination of NTDs by 2030 could save over $342 billion in healthcare costs and productivity losses. This financial relief can significantly boost the economies of affected regions.
3. Indicator of Universal Health Coverage:
   • Public Health Milestone: Interventions against NTDs are crucial in advancing towards universal health coverage by 2030. These efforts often represent the initial steps in strengthening overall health systems.
4. Impact on Gender Equality:
   • Women’s Health: NTDs, such as female genital schistosomiasis, disproportionately affect women, leading to serious health complications like increased HIV risk and organ damage. Addressing NTDs can improve women’s health outcomes and economic productivity.
5. High Return on Investment:
   • Economic Efficiency: Investment in NTD control is highly cost-effective. For instance, the 2017 NTD investment case found that every $1 spent on preventive chemotherapy treatments could generate $25 in benefits, demonstrating a high return on investment.

In summary, eliminating NTDs is not only a crucial step towards improving global health equity and economic stability but also a key indicator of progress towards universal health coverage and gender equality.

Global Efforts:

1. Global NTD Annual Reporting Form (GNARF):
   • Purpose: A standardized document for reporting progress on NTDs by countries participating in the Global NTD Programme.
   • Introduced: By WHO in 2023.
   • Goal: To streamline data collection and reporting, enabling better tracking and management of NTDs.
2. Global Vector Control Response 2017–2030 (GVCR):
   • Purpose: A strategic framework to enhance vector control efforts worldwide.
   • Components:
     • Increased Capacity: Strengthening resources and infrastructure.
     • Improved Surveillance: Enhancing monitoring and data collection.
     • Better Coordination: Integrating actions across different sectors and diseases.
     • Integrated Action: Coordinated efforts across various diseases and sectors to improve vector control.
3. Other Global Initiatives:
   • Kigali Declaration on NTDs (2022): Emphasizes commitment to combating NTDs and improving health outcomes in affected regions.
   • Strengthening NTD Structures and Cross-Sectoral Collaboration: Focuses on building robust systems and enhancing cooperation across different sectors.
   • Public–Private Partnerships: Encourages collaboration between governments, private sector, and other stakeholders to address NTDs effectively.

Efforts in India:

1. National Vector Borne Diseases Control Programme (NVBDCP):
   • Purpose: To prevent and control major vector-borne diseases including Malaria, Japanese Encephalitis, Dengue, Chikungunya, Kala-azar, and Lymphatic Filariasis.
   • Strategies:
     • Surveillance and Control Measures: Monitoring and managing vector-borne diseases through various interventions.
2. Other Vector-Control Measures:
   • Indoor Residual Spraying (IRS): Regular rounds of spraying insecticides inside homes to kill disease-carrying vectors.
   • Wage Compensation Schemes: Financial support for Kala-azar patients, provided by both state and central governments to alleviate the burden of the disease and encourage treatment.

Key Recommendations

1. Accelerate Programmatic Action (Pillar 1)
   • Objective: Reduce the incidence, prevalence, morbidity, disability, and mortality associated with NTDs.
   • Actions: Intensify existing interventions and explore new ones. Integrate NTD-related services with other health programs and enhance coordination across various initiatives.
2. Intensify Cross-Cutting Approaches (Pillar 2)
   • Objective: Address NTDs through a holistic approach.
   • Actions:
     • Integration: Link NTD interventions with broader health and development programs.
     • Mainstream Services: Incorporate NTD care into existing health services.
     • Coordination: Enhance collaboration among stakeholders and programs.
3. Change Operating Models and Culture (Pillar 3)
   • Objective: Foster greater national ownership and align stakeholders’ roles to achieve 2030 targets.
   • Actions: Reform operational models to enhance country-level engagement and accountability. Align roles and responsibilities to improve efficiency and effectiveness.