Of the 183 million children with malaria symptoms treated by public health clinics in 2007, only 43 percent were diagnosed with malaria, but many more most likely received anti-malarial medication. ”Malaria is still routinely made as the diagnosis of convenience in response to paediatric fever,” the study’s lead researcher, Peter Gething, told IRIN. “This in part stems fromofficial guidelines that have only recently been updated, and in part because often the only treatments available in front-line clinics are anti-malarials.” In 2006 the World Health Organization (WHO) recommended that health workers in countries with a high number of suspected cases of malaria treat children with fevers - the main clinical symptom of malaria - for the disease, even without a diagnosis. There was little else to do at the time, said WHO expert Peter Olumese. “The probability was high that the fevers were from malaria, the disease could turn fatal quickly and there was no time to lose, and there were no proven diagnostic tools,” he told IRIN. Since then, rapid diagnostic testing for malaria has become available, making it possible to confirm diagnoses without health workers, a microscope or a laboratory. In 2008, 11.5 million of these tests were distributed in Africa; in 2009, the Global Fund to Fight AIDS, Tuberculosis and Malaria financed 74 million tests, and another 105 million in 2010, according to the Roll Back Malaria Partnership. People in communities have been trained to test one another for malaria. In Senegal, people of all ages are treated for malaria in government-funded health centres only once there is a positive result from a laboratory or rapid test. In sub-Saharan Africa 31 countries have a policy of “universal diagnostic testing”, while another 15 countries in the region have set a goal of testing before treatment in children aged five and older, judging it too risky to delay treatment in younger patients.

More on malaria from IRIN

BURKINA FASO: When is malaria not malaria?

GLOBAL: Spoonfuls of sugar could save malaria patients

MALI: Combating malaria misdiagnosis

TIMOR-LESTE: Rebuilding infrastructure poses challenge to tackling malaria

Yet it can be equally risky to treat someone for malaria based only on the assumption that they have the disease, the director of WHO’s global malaria programme, Robert Newman, told IRIN. ”You might be wasting ACT [anti-malarial artemisinin-based Combination Therapy], while increasing the risk for drug resistance; also, you are not treating the underlying febrile disease and the drug delay can be fatal. If you treat bacterial pneumonia with anti-malarials, you still have a problem.” On Kinaserom, one of the islands in Lake Chad, health workers recently started using rapid tests to check patients suspected of having malaria. Mahamat Boukar Moussa, the head nurse at a clinic on the island, told IRIN he gave patients malaria medication even when test results were negative. “The tests are not accurate and we cannot risk inaction.” Raoul Ngarhounoum, the regional health director overseeing the rollout of malaria rapid testing, told IRIN he agreed with the health workers’ scepticism. “These are malaria-endemic areas, and just because a test says it is not malaria does not mean it is not.” Gething said that besides quality control, “Simply supplying RDT [rapid diagnostic testing] universally is likely to be less effective if it is not accompanied by sufficient training for front-line health workers.” The Foundation for Innovative New Diagnostics, which works with WHO to create quality control standards for rapid tests, recommends spot checking in each batch of tests ordered to ensure the tests were not poorly manufactured, or had been damaged in transit or storage. Malaria treatment would not change overnight, said Gething. “In an ideal world, all fevers reaching clinics in Africa would be tested for malaria, using a reliable diagnostic test … As always, the reality on the ground is more complex. For years the advice has been to treat all fevers as malaria, and changing that dogma is likely to take time.” 

Source: IRIN

According to the Angolan News Agency, the Institute had been hoping to screen more people for the disease this year. However, after screening just 3.7% of the population at risk, activities were halted due to a lack of funds. In 2008, 12% of the population were screened and the goal was set to raise this figure to 80% by 2012.

This is a first attempt to chart the distribution of these neglected diseases and is based on published epidemiological data. Let the maps cycle, or click on each disease name at the top to see where in the world that disease can be found. We welcome feedback, updates and suggestions on ways to improve the information provided.

The interactive map on the TropIKA.net home page shows 10 diseases - some with names few can pronounce- that have been identified by the Unicef/UNDP/World Bank/WHO Special Programme for Research & Training (TDR) as the most neglected of infectious diseases, hampering the health and development of the world’s poorest people.

The diseases: Chagas, dengue fever, human African trypanosomiasis (HAT) onchocerciasis, leishmaniasis, leprosy, lymphatic filariasis, malaria, tuberculosis and schistosomiasis are still endemic in much of the world, particularly tropical regions.

Their distribution and effects differ from disease to disease but their burden remains heavy. Africa, South America and Asia all contain countries affected by at least one of these neglected diseases of poverty.

Not only do these diseases disproportionately affect impoverished populations, they reduce economic activity. The annual economic loss in Africa due to malaria has been estimated as $12 billion, representing a crippling 1.3 percent annual loss in GDP growth in endemic countries.

Schistosomiasis and malaria lower child survival, while onchocerciasis and schistosomiasis hamper children’s school performance. Lymphatic filariasis interferes with agricultural productivity as does onchocerciasis and schistosomiasis [1].

Leishmaniasis, human African trypanosomiasis and lymphatic filariasis are associated with an economic burden of a different kind as infected people pay excessive amounts for treatment and seek inappropriate of ineffective care [1].

Leprosy leads to social isolation and stigmatization, particularly among women who may not present for diagnosis due to fear of loss of marriage opportunities.

TDR is working to identify the needs, gaps and potential for action in research for infectious diseases of poverty, including the ten that appear on this map. A think tank made of 125 experts from around the world is examining the research, debating the issues and developing options for action. Their findings will feed into the Global Report for research on infectious diseases of poverty, due to be published in 2011.

Reference

1. Hotez PJ, Fenwick A, Savioli L, Molyneux DH (2009). Rescuing the bottom billion through control of neglected tropical diseases. Lancet; 373:1570-1575

Writing in PLoS Neglected Tropical Diseases, Peter Hotez, President of the Sabin Vaccine Institute and Distinguished Research Professor of The George Washington University Medical Center, and Bernard Pecoul, Executive Director of Drugs for Neglected Diseases initiative (DNDi), outline in eight points why the global community should increase financial support for NTD control and elimination efforts and research and development.

The manifesto states that:

·      All NTDs are “tool ready” with cost-efficient and effective interventions that could be implemented now, even if for some diseases such tools are far from being perfect or complete.

·      At the same time that NTDs are tool ready they are also tool deficient, signifying that the tools are incomplete, or inadequate, to sustain elimination efforts.

·      NTDs have received little attention from the international community during the past ten years despite their large disease burden.

·      Increasing evidence indicates an association between NTD prevalence and conflict and violation of human rights.

·      NTDs can be particularly destabilizing and disrupt agricultural productivity and food security. Many poor societies with high NTD burdens have been recently engaged in a civil or international conflict or are currently at war.

·      Sustained involvement by the WHO and other international health agencies is crucial for current and future NTD control and elimination efforts.

·      Nothing is more important to the success of global NTD control than the involvement of communities themselves and disease-endemic countries’ health ministries.

·      Achievement of Millennium Development Goal 8 (”develop a global partnership for development”) will rest with stakeholders — health ministries, affected communities, public–private partnerships, large and small non-governmental organizations, etc. — establishing a well-functioning international strategy for NTD control.

While acknowledging that policymakers are “slowly beginning to appreciate the importance of NTDs” — evidenced by the creation of a new department of Neglected Tropical Diseases at the World Health Organization; TDR’s 10-year strategic plan; and the identification, by NIH’s Francis Collins, of neglected diseases as a research priority, among other developments — Hotez and Pecoul argue that the challenge of NTDs calls for a manifesto — “a public declaration of motives by a government or by a person or group regarded as having some public importance.”

Moreover, they add, by doing more to tackle NTDs, the global health community can make progress toward Millennium Development Goals.

“[NTD control] activities have facilitated the delivery of additional interventions such as insecticide-treated bed nets, antimalarial drugs, micronutrients, and childhood immunizations,” they write.

The authors urge scientists working on NTDs to increase collaboration and identify funding opportunities and cost-efficient interventions.

“By highlighting important challenges in the fight against NTDs, this ‘manifesto’ calls on the global community for urgent, renewed, and innovative efforts.”

Reference
1. Spiegel JM, Dharamsi S, Wasan KM, Yassi A, Singer B, et al. (2010) Which New Approaches to Tackling Neglected Tropical Diseases Show Promise? PLoS Med 7(5): e1000255. Available from: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000255

Welcome news therefore is that a colloquium “Neglected Protozoan Diseases” is to be held in Paris on 24th September 2010. The meeting, to be held at the Institut Pasteur, will discuss the prevention, treatment and control of all three diseases. Conference sessions will be as follows:
• vaccines for leishmaniasis
• new diagnostic for protozoan diseases
• innovative drug discovery
• control of leishmaniasis
• epidemiology of neglected protozoan diseases.

Further details of the event are available on the Insitut Pasteur website. The deadline for registration is 30th June.

Programmes, partnerships, and governance for elimination and control of neglected tropical diseases
Bernhard Liese, Mark Rosenberg, Alexander Schratz

Integration of control of neglected tropical diseases into health-care systems: challenges and opportunities
John O Gyapong, Margaret Gyapong, Nathaniel Yellu, Kwadwo Anakwah, George Amofah, Moses Bockarie, Sam Adjei

Mapping, monitoring, and surveillance of neglected tropical diseases: towards a policy framework
MC Baker, E Mathieu, FM Fleming, M Deming, JD King, A Garba, JB Koroma, M Bockarie, A Kabore, DP Sankara, DH Molyneux

Socioeconomic aspects of neglected tropical diseases
Lesong Conteh, Thomas Engels, David H Molyneux

Also recently published in the journal’s Seminar section is an update on human African trypanosomiasis (sleeping sickness).

The story also describes a veterinary project in Uganda which seeks to reduce levels of infection with the trypanosome parasite in cattle. (In this part of Africa, cattle are the main reservoir of the parasite responsible for sleeping sickness in humans.) The innovative project involves private, community-based vets.

Web Ghana says the search was conducted under the auspices of the Pan African Tsetse and Trypanosomiasis Eradication Campaign (PATTEC). Over 10,000 blood samples were taken in Western and Upper West regions but the Trypanosoma brucei parasite was found to be present in only 24 samples.

Thomas Azurago, Ghana’s HAT Programme Officer, said 57 tsetse flies were trapped during the survey in four communities in the Western Region and eight of them tested positive for the parasite. He also cautioned that there was a low awareness of the disease amongst health personnel, which could hold back efforts to complete the elimination of the disease from Ghana.

Efforts to improve the diagnosis of neglected infections such as HAT have been few and far between. The Foundation for Innovative New Diagnostics (FIND) is, however, making progress. It is evaluating a low-cost microscope suitable for field use and attempting to develop a molecular detection kit hat does not require a sophisticated lab or specialized personnel. More details are provided by IRIN, in an interview with Joseph Ndung’u, head of trypanosomiasis at FIND.