Neglected Tropical Diseases are a diverse group ofdiseases that affect most of the poor populations across the world primarily inSub Saharan Africa and South Asia.
NTD’s thrive in these regions of the worlddue to the fact that they are uneducated, lack a central government, and do nothave the resources to keep their people healthy. The reason theses tropicaldiseases are characterized as neglected is due to the fact that these diseaseonly affect the poor, so when these vulnerable regions try to reach out to moredeveloped countries, their pleas are usually brushed off or ignored becausethey are not affected at all. The more developed countries would rather focuson the diseases that are affecting their country not a region that has noaffect to them.
It is important toaccentuate the prevalence of NTDs in Sub Saharan Africa and South Asia, why thediseases are thriving in these regions, and what steps global heathinstitutions are taking to combat these NTDs.Neglected tropical diseases tend to reside inextremely poor economic regions and “world’sgreatest concentration of poverty occurs in Sub-Saharan Africa” (Hotez , 2009). Sub-Saharan Africa can attribute its extreme level of poverty tothree main factors: lack of economic diversification, poor governance, andinequality in distribution. Sub-Saharan Africa only invests a large amount ofits economy into the oil produced and not into other economic investments. Thiscan be primarily shown in Nigeria where “the oil sector which only constituted 1 percentof the country’s export revenue in 1958 rose to 97 percent by 1984 and hassince then not gone below 90 percent” (Mendy, 2016). Due to this lack ofdiversification in the economy the Sub-Saharan African government has no needto create new jobs since there are no other exports being traded. This leavesthose in poverty with no way to make money to improve their living and health conditions.
This also creates a major problem for the Sub-Saharan African economy ingeneral if another region creates a more appealing offer for their gas and oil.The next factor attributed to the increasing poverty in Sub-Saharan Africa isthe corrupt form of government which can be shown “in the form of corruption, dysfunctional publicservices, and unfair tax assessments amongst other issues” (Mendy, 2016). No programs are enacted to help those inpoverty and because of this those facing tough times economically are given nobenefits which include health care, food, and shelter. This is because enactingand retaining these programs costs moneywhich the government tries to avoid to improve their own wealth. As the oldsaying goes, those who are rich stay rich if they don’t share their riches. Thefinal factor that is attributed to the poverty in Sub-Saharan Africa is theinequality among distribution. The distribution in Sub-Saharan Africa has beenshown to have one of the largest inequalities in the world because the topincome percentages of people control a majority of the income in the region.
Astime goes on this wealth continues to increase over time as it’s passed downfrom generation to generation leaving a smaller amount for the working middleclass and an almost non-existent amount for those in poverty. Usually wealth isdistributed between those of different social classes through taxes as thewealthier would pay a higher amount of taxes compared to those in poverty thatwould not pay as much in taxes. This ideal is non-existent in Sub-Sahran Africaas those of higher wealth pay little to no taxes on their incomes, increasingthe gap between the wealthy and poor. The result of this wealth inequality canlead to “an increase in economic and social problems such as violence”(Mendy 2016). This result can also attribute to the increase in poverty as wellas violence would lead to property damage and force those out of their homesthat really have no homes to begin with. The lack of healthamongst those in poverty and other issues attributed to the increase the amountof those who are poor, disease start to thrive and grown. The major NeglectedTropical Diseases affecting the vulnerable communities in of Sub-Saharan Africainclude: Hookworm, Ascariasis, Trichuriasis, and Schistosomiasis.
Hookworm is contracted from stepping in feces left on theground or swimming in feces. The hookworm enters the body and gains nutrientsfrom its host due to its parasitic behavior which can “cause intestinal blood loss due to iron deficiency as well asanemia and morbidity” (Hotez & Kamath, 2009). Sub-Saharan Africa has a lack of sanitation,most inhabitants defecate openly around there homes or different areas amongthe region which when combined from the lack of foot wear amongst those inpoverty, hook worm continues to grow and be spread amongst differentinhabitants of Sub-Saharan Africa living with poor economic standings. It hasbeen shown that “approximatelyone-third of the world’s hookworm today occurs in Sub-Saharan Africa mostly amongthe regions of Nigeria (38 million) and the Democratic Republic of Congo (DRC,31 million), followed by Angola, Ethiopia, and Cote d’Ivoire (10–11 million)” (Hotez & Kamath, 2009). Ascariasis and Trichuriasia as differenttypes of parasitic worms that are transmitted into the body by ingestingcontaminated soil which can result in intestinal problems as well as signs ofweakness and malnutrition. If we compare Hookworm to Ascariasis and Trichurasiathen it would be shown that a “higher prevalence rates of Ascariasis and Trichuriasis areoften present in Africa’s urban areas compared to rural areas, unlike hookworm,which is more evenly distributed” (Hotez & Kamath, 2009). Schistosomiasis or snail fever affects thosewho swim, bay, do laundry, or other activities in rivers or other bodies ofwater that contains snails with the virus. Among the millions affected bySchistosomiasis, “93% occur in Sub-Saharan Africa (192 million), with thelargest number in Nigeria (29 million) followed by United Republic of Tanzania(19 million), and DRC and Ghana (15 million each)” (Hotez & Kamath, 2009).
Ithas also been suggested that the true disease burden for schistososomiasis maybe several fold higher than previous estimates, possibly making this infectionthe most important NTD in SSA (Hotez & Kamath, 2009). Although these different diseases arecharacterized as neglected The World Health Organization has been trying itsbest to either control or eradicate these different neglect tropical diseasesthrough continued research, drug donations, and creating different necessitiesthat the people living in poverty in Sub-Saharan Africa definitely need soonerrather than later. Since 1997, The World Health Organization has been”developing national plans leading to the eliminations of numerous diseases aswell as monitoring and evaluating program activities to strengthen localprograms and their integration, particularly at community level, in order toimplement simple, affordable, acceptable, and sustainable activities based oncommunity wide treatment strategies, but supplemented where feasible by vectorcontrol and improved sanitation” (NeglectedTropical Diseases – Sub-Saharan Africa, pages 2-4). The biggest problem theWorld Health Organization faces however is how to “deliver these differentinterventions through a health system in the midst of serve human resourceconstraints and other health system challenges” (Neglected Tropical Diseases – Sub-Saharan Africa, pages 5 – 7).
Drug Donations also face numerous problems as well that restricts them frombeing obtained by those suffering in poverty in Sub-Saharan Africa. The drugneeds to first be made by a licensed pharmaceutical company and tested in thefield before mass production of the drug can occur. Even after the drug hasbeen made there are the pricing restrictions made by the Sub-Saharan Africangovernment which inhibits people in poverty from actually obtaining thesedrugs.
Even with these different restrictions however, The World HealthOrganization continues to do research on different diseases that play a significantrole in the development of different programs and drugs that can be implementedto help the infected people in Sub-Saharan Africa that are not only suffering,but have no resources to treat their diseases as well. The potential programsexecuted by The World Health Organization “coupled with drug donations bypharmaceutical companies and financial support from the internal community setsthe scene for success on the fight against these different neglected tropicaldiseases” (Neglected Tropical Diseases –Sub-Saharan Africa, pages 10 – 12). In order to sustain the efforts tocombat NTDs in Sub-Saharan Africa it is crucial for governmental institutions,external institutions, and community health care professionals to work togetherto eliminate the persistence of diseases within the region.Contrary to Sub-Saharan Africa, South Asia attributesits poverty to two main factors which include: “population strain on limited land and otherresources, and weak economic development caused by faulty government policiesand corruption” (Wheeling Jesuit University/Center for Educational Technologies, 2002). Most if not all the countries in South Asia havepopulations that are growing at an alarming rate.
Due to this rapid growth,there are not enough resources or land to support this massive population. Forexample, “Bangladesh is the second most densely populated country in the world andhas an average of 950 persons per square kilometer” (Wheeling JesuitUniversity/Center for Educational Technologies, 2002). Bangladesh’s other issue is that over time theland is slowly being covered by water pushing the population closer and closertogether limiting the resources and land even more. The other issue increasingthe poverty in South Asia is the corrupt governments in place. These governmentat first sought to decrease the poverty in their countries by impendingdifferent plans to tackle this problem and intervene in any way to make theirplans run smoother. These policies however are only a ruse that misleads peopleinto believing that their plans will eradicate poverty. Once their plans showsome signs of decreasing the amount of people in poverty, the government ignoresthe long term effects and progresses without continuing with their plan. Thepeople are then surprised when they are kicked from office and replaced withsomeone else when all they need to do is look around and notice the lack ofhealth care, sanitation, and basic needs they require to live.
Overpopulation andcorrupt governments result in the rapid growth of poverty in South Asia whichresults in lack of sanitation and basic health care. This helps differentdiseases thrive and grow amongst the poor because they is no way availablemethods to cure these diseases and there are no systems in place to prevent thespread of different disease. These diseases affecting most of South Asiainclude: Ascariasis, Trichuriasis, Hookworm, Lymphatic Filariasis, and Visceral Leishmaniasis.Ascariasis, Trichuriasis, and Hookworm are contracted from stepping on infectedsoil without any proper footwear. It has been seen that in Pakistan the wastewater used for agriculture has been shown to have large amounts of hook worms. Research shows that “South Asia accounts forapproximately one-quarter of the world’s cases soil-transmitted helminthiases,with the largest number of cases in India, followed by Bangladesh” (Hotez,2011).
Lymphatic Filariasis isa type of round worm that infects a person from an infected mosquito. Themosquito sucks that blood of the first infected person and then becomesinfected itself. Upon sucking the blood of the second person, the disease istransmitted from the mosquito to the second person and so on. It has been shownthat “the disease is poverty-related and predominantly affects poor andmarginalized groups.
LF-associated disabilities and deformities result in heavyeconomic losses and loss of livelihood” (Hotez, 2011). Visceral Leishmaniasisis transmitted to humans from the bite of a female sandfly which are veryprominent in moist/humid conditions where they are hard to get rid of. Thedisease itself “lowers immunity, causes persistent fever, pancytopenia, andenlargement of the spleen and liver, and leads to very high mortality inuntreated cases” (Hotez, 2011). Visceral Leishmaniasis acutally leads topoverty with the decrease of productivity due to the number of people getinfected and causes people to go into poverty because most people spend most ifnot all their money for different treatments and medications to cure the disease.
The World HealthOrganization has taken different actions to help treat and prevent thesedifferent neglected tropical diseases from spreading or reoccurring. For Ascariasis,Trichuriasis, and Hookworm The World Health Organization strategy to attack thesediseases is to administer drags on a massive scale once or twice every year “using the drugmebendazole or albendazole as a single dose, with a drug delivery systemrelying heavily on schools and schoolteachers administering the drugs” (Hotez,2011). Most of the countries in the South Asia region has reached theirdeworming goals, but some are restricted due to government interventions withhow much these deworming procedures would cost. A hookworm vaccine is also inthe works to prevent the disease from resurfacing after the patient had alreadybeen giving the proper treatment to cure it. For Lymphatic Filariasis, The World HealthOrganizations has developed two main strategies to eliminate Lymphatic Filariasisby 2020.
These two strategies include: “annual MDA with two drugs, DEC and albendazole,to the entire eligible population for 5–6 years, and home-based disabilityalleviation and prevention” (Hotez, 2011). These strategies have been greatly accepted,in India and Sri Lanka the MDAs have been completed and stopped entirely. Theattack on Visceral Leishmaniasis needed to be a joint venture since the epidemicwas so large. The main strategies of this joint action include: “early diagnosis wherever possible, with therapid diagnostic test rk-39 and prompt treatment with the oral drugmiltefosine, injectable paromomycin, or liposomal amphotericin B; integratedvector management, which includes bed nets and indoor residual spraying withDDT and other agents; effective disease surveillance; social mobilization andpartnerships; and clinical and operational research” (Hotez, 2011). The onlychallenges that are faced with this joint action is that some patients held apotent source of the disease in their bodies which required intense, prolongtreatments.
Also different vaccines for Visceral Leishmaniasis are also in development toprevent the disease from occurring in treated patients or to help prevent thedisease in patients that have never been exposed to the disease. In conclusion,Neglected Tropical Diseases are a diversegroup of diseases thrive in large areas of poverty which are primarily locatedin Sub Saharan Africa and South Asia. These diseases spread due to governmentcorruption, wealth inequality, over population with a lack of resources, and alack of necessities which include proper sanitation, housing, and basic healthcare. Due to these issues, these diseases remain prominent with no sign ofdecreasing especially in Sub-Saharan Africa.
The World Health Organization hastaken some actions to eradicate these diseases and to prevent them fromreoccurring again. However, The World Health Organization has limited fundingwhich tends to be utilized for more visible such HIV, Aids, and Tuberculosis. Althoughsome regions take these policies in open arms, some countries resist theseplans due to cost and how it resides in its non-existent healthcare plan.
Overall, these different diseases are sometimes neglected by outside sources,but primarily attributed to internal issues. These issues will need to beresolved before proper care can be implemented in these regions which is easiersaid than done.