Dr Sam Adjei, Chief Executive Officer of Ghana’s Centre for Health and Social Services, said there was a need to integrate onchocerciasis control with the control of other infections, such as schistosomiasis, elephantiasis and Buruli ulcer. Fragmented health systems should be strengthened to ensure comprehensive and integrated care.

APOC’s Director, Uche Amazigo, said it was important to empower communities through education. This would require time, and she urged health providers and developmental NGOs and donors to exercise patience with the process.

Deputy Minister of Health, Mr Rojo Mettle-Nunoo, told the meeting that there was a need for innovative public education on the causes and treatment of onchocerciasis. This was necessary because of the re-emergence of the disease in some communities in Ghana.

The meeting included field trips to onchocerciasis-endemic villages in Ghana’s Eastern Region.

An IRIN News report describes the situation in Bornu State, Nigeria, which has the highest rate of trachoma in the country. A survey by Helen Keller International (HKI) concluded that, “Poor sanitation, lack of personal hygiene and acute water shortages are major causes of this disturbing health problem”. HKI staff have constructed ventilated pit latrines for primary schools in 10 villages and trained teachers to detect early signs of trachoma. Trachoma rates in these schools have since declined, but HKI is worried that the children are still at risk when they are at home. The government is said to be doing little to combat trachoma in Bornu, which also has the misfortune to have Nigeria’s highest prevalence of another infectious cause of blindness - onchocerciasis or river blindness.

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

The second edition of Sources and prices of selected medicines for children lists sources and prices for 75% of the 612 formulations needed for the 240 medicines in the Essential Medicines List for Children.

WHO and UNICEF note that more than half of the nine million preventable deaths in children annually are caused by diseases which could be treated with safe essential child-specific medicines: acute respiratory infections - pneumonia (17%), diarrhoeal diseases (17%), neonatal severe infections (9%), malaria (7%), and HIV/AIDS (2%).
The number of sources for the paediatric treatment of diarrhoea and HIV/AIDS is, however, limited and there is a serious challenge to obtain child-specific medicines to treat tropical infections endemic in Africa and Asia. There are few manufacturers who produce child-specific medicines to treat infections such as filariasis, schistosomiasis and soil-transmitted helminthiases.

A commentator on the website Essentialdrugs.org notes that, “UNICEF and WHO could not find a manufacturer for 144 of the 612 needed formulations. Is it lack of commercial markets? Or is it that there is not yet enough demand? Here is a good opportunity for the pharmaceutical industry to show some corporate social responsibility!”

The first of four papers reviews elimination and control programmes. Subsequent papers will describe the integration, mapping, and financing of international control initiatives. The series is introduced by a commentary article from David Molyneux of the Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, who is well known as an active campaigner for action against NTDs to be stepped up. A podcast and a profile of Professor Molyneux also form part of the series.

The Lancet is not an open-access journal. However, as with many of its articles on global health topics, the series may be viewed freely online. (Registration is required.)

But we can find no further references to the existence of World Filariasis Day. TropIKA.net readers who have heard something about it are asked to let us know.

The TropIKA.net blog has often commented on the rapidly growing number of special “Days” held in an attempt to focus attention on particular diseases. (The most recent was World Pneumonia Day - 2nd Nov.) It could be argued that there are already more than enough such Days. But lymphatic filariasis (and onchocerciasis, which is also caused by filarial worms) are severely neglected diseases. Would a World Filariasis Day help to bring an end to this neglect?

Two infectious diseases are important causes of blindness in many parts of Africa - trachoma and onchocerciasis. The sampling used for the Nigerian study included clusters in areas where these diseases are known to be endemic. However, neither disease was found to be a significant cause of blindness. Overall, trachoma was responsible for 4.2% of blindness and onchocerciasis for 1.1%. To quote the authors:

“There are several possible explanations for our findings: First, both onchocerciasis and trachoma are focal diseases, and the clusters selected even in endemic areas may, by chance, have not included areas with the highest endemicity. Second, there may have been misclassification: For example, corneal scarring from trachoma may have been misclassified as nontrachomatous, but this seems unlikely, and corneal opacity, chorioretinitis and optic atrophy may not have been attributed to onchocerciasis. Third, the findings may reflect a genuine decline in blindness from these two diseases, particularly that due to onchocerciasis as a consequence of the Africa Onchocerciasis Control Programme (APOC).”

While the findings of the study suggest that there are fewer cases of blindness due to infection in Nigeria than might have been predicted, the blindness situation in the country is of great concern. The researchers conclude that blindness is increasing and that the number of visually impaired adults will increase by 40% in the next decade. They highlight the issue of poor access to health services as a major factor. The vast majority of causes are either preventable or treatable and groups with less access to health care were found to be particularly vulnerable to preventable visual impairment. The authors recommended vision care plans that target women, rural residents and the less educated.

However, the article also makes it clear that , drawing on the lessons learnt with onchocerciasis, there is now a need for further research to develop new treatments for other infectious diseases of poverty.