NEGLECTED TROPICAL DISEASES: THE HIDDEN PANDEMIC

BY FAGBENRO WINIFRED OLAJUMOKE

Healthcare keeps getting better over the years. Whether by developing more potent drugs, new vaccines and efficient surgical procedures, scientists strive to prevent, control and eradicate aliments to ensure longevity of the human race. Despite all efforts, resources are not evenly distributed between regions. Thus means that as more diseases are being tackled, providing the relief needed for patients, some other illness cause havoc to communities on a daily basis.

Neglected tropical diseases according to the WHO are a diverse group of 20 conditions that are mainly prevalent in tropical areas, affecting impoverished populations. NTDs have been existing for centuries with some being referenced in historical texts, e.g. leprosy infecting important figures in the Bible. NTDs flourish mainly in rural areas, in conflict zones and hard-to-reach regions. They thrive in areas worsened by climate change and where access to clean water and sanitation is scarce. Furthermore, NTDs tend to affect regions without quality health care, leaving poor populations vulnerable to these often debilitating diseases and newly emerging threats.

THE THREATS

1. ONCHOCERCIASIS: this is a parasitic infection caused by Onchocerca volvulus, a filarial nematode worm which is spread to humans via the bite of an infected female blackfly. Because the blackfly develops and breeds in flowing waters, and people are more likely to be infected near rivers or streams, the disease is dubbed River blindness.

When a blackfly bites an infected person, it consumes the immature worm(microfilariae) from the skin. The microfilaria develop in the blackfly into the larvae. The infected blackfly bites a healthy person, passing on the larvae through a bite wound on the skin, then mature into adult worms over 6 to 12 months. Adult worms live for 10-15 years, producing millions of microfilariae. Symptoms appear upon the death of microfilariae, so the disease worsen the longer you are infected.

Symptoms may include

The most widely used treatment for Mass Drug Administration  is Ivermectin.

2. TRYPANOSOMIASIS: Also known as ‘African Sleeping Sickness’, this illness is endemic to Sub-Saharan Africa. Although cases have been steadily reducing since 2000, it remains a major health concern in Tanzania, Guinea, Central African Republic and Malawi

It is caused by the flagellate protozoan Trypanosoma brucei, which exists in morphologically identical subspecies transmitted to human hosts by bites of infected tsetse flies;

  1. Trypanosomabrucei rhodesiense (East African trypanosomiasis); usually zoological and vector is Glossina morsitans
  2. Trypanosoma brucei gambiense (West African trypanosomiasis); Infects humans and vector is Glossina palpalis

Trypanosomes have a two-host life cycle: mammalian and arthropod. The life cycle starts when the trypanosomes are ingested during a blood meal by the tsetse fly from either a human reservoir (West African trypanosomiasis) or an animal reservoir (East African trypanosomiasis). The trypanosomes multiply over a period of 2-3 weeks in the fly midgut; then, the trypanosomes migrate to the salivary gland. T brucei injects the protozoans into the skin fly bite, leading to a painful skin ulcer at the site 5-15 days later. The injected parasites further mature and divide in the blood and lymphatic system, causing malaise, intermittent fever, rash, and wasting. Eventually, the parasitic invasion reaches the central nervous system (CNS), causing behavioral and neurologic changes (e.g., encephalitis and coma) and if left untreated, death.

The disease develops when they acquire resistance to apolipoprotein L-1 (APOL1), which provides innate immunity by lysis of the trypanosomes

Symptoms may be grouped into 2 stages

WHY ARE THEY CALLED ‘NEGLECTED‘

By now, you may wonder why these kinds of diseases are classified as ‘neglected’ despite being around for so long and devastating billions of people. Well, the answer isn’t far-fetched as they have been absent from most health agendas It occurs due to some factors

Environment: People vulnerable to these diseases usually live in conflict-ruined zones or remote villages far from urban areas and health facilities, making it challenging to get the necessary treatment and awareness against them.

Economy: NTDs usually affect populations who live in extreme poverty and are unable to afford treatment. Also, with the high cost of treatment and low financial return for the drugs, many pharmaceutical companies shy away from designing and developing new drugs for NTDs.

People and society: Most NTDs like Onchocerciasis may lead to disabilities rather than death, accounting for 57million disability-adjusted life years lost*. Their clinical presentation often lead to social isolation and stigmatization from community members, fueling up the neglect.

TACKLING THE NEGLECT

So how can we solve the problem of NTDs?

  1. Promoting sanitation: Providing good clean water, encouraging good hygiene can go a long way in prevent such infections. Sanitation practices also ensure eradication of vectors that spread NTDs
  2. Medical research; Advances in medical research, including the development of novel therapeutics, vaccines, and diagnostic tools, offer promising avenues for combating NTDs. Evidence-based insights that inform public and regulatory frameworks help policymakers to address societal challenges, manage risks, and make informed decisions to promote the wellbeing of communities and contribute to a safe  environment.
  3. Mass Drug Administration; MDA is one of the largest public health interventions globally and is implemented in vulnerable communities worldwide. It requires the coordinated work of health care administrators, professionals and field workers for the successful implementation of these programs to reduce infections.

PROGRESS MADE

CALL TO ACTION

The prevalence and attitude towards NTDs reflect the inequality present in the health sector. Due to lack of awareness and facilitates required to combat NTDs, millions are left to suffer in science. Fortunately, through the actions of NGOs, WHO and government organizations, the prevalence of NTDs have significantly reduced, some being completely eradicated from most nations.

But the fight is not over yet. To have a world free from NTDs, it starts with us. The little things we can do like volunteering, telling someone about NTDs, and joining discussion forums can go a long way to ending the neglect and eliminating the hidden epidemic.

REFERENCES

*One DALY represents the loss of the equivalent of one year of full health.

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