• NTDs on the prowl in poor communities
From Fred Ezeh, Abuja
Nigeria, last week, joined global community to commemorate the World Neglected Tropical Diseases (NTDs), which has continued to kill the poor in poor communities and countries of the world, hence the need to raise global awareness on the devastating impact of NTDs.
NTDs are set of communicable diseases associated with poverty. They are prevalent in isolated areas with poor nutrition, sanitation, unsafe water supply and substandard housing condition. They are caused by a variety of pathogens including viruses, bacteria, parasites, fungi and toxins, and associated with devastating health, social and economic consequences.
Globally, there are over 20 NTDs ravaging poor communities. Some of the diseases include; Lymphatic Filariasis (Elephantiasis); Onchocerciasis (River Blindness); Schistosomiasis (Snail Fever); Soil Transmitted Helminthes (Intestinal Worms); Buruli Ulcers, Leishmaniasis, Dengue, Guinea Worm Disease, Trachoma, Leprosy, Rabies, Yaws, Macetoma, Snakebite and Noma.
In Nigeria, the Federal Ministry of Health identified 13 NTDs, notably, river blindness, elephantises, rabies, snakebike envenoming, leprosy, guinea worm, noma, buruli ulcer, helminthis (soil transmitted parasitic worn) and several others, most of which are of public health importance in Nigeria, with negative impact on socio-economic development.
Records at the ministry indicated that all the 36 states are endemic for one or more NTDs killing and inflicting pains on the people, knowingly or unknowingly, hence the World NTD day with the theme, “Unite, Act, Eliminate Neglected Tropical Diseases” provided an opportunity to remind the global community that these set of diseases are still in existence, and the lives of people in poor environments are still being threatened, hence they should receive adequate medical attention that they might require.
It was also an opportunity to remind everyone of the need to support the growing momentum for the control, elimination and eradication of the remaining NTDs in some poor populations in developing countries.
Unfortunately, these set of people are abandoned to their fate, as little or no attention or support is received from world leaders regarding the fate of poor communities of NTDs. Sadly, World Health Organisation (WHO) described the situation as a clear reminder of the inequalities in world.
State of NTDs in Nigeria
Records indicated that Nigeria is combating the NTDs with the support of the development partners. While some of the NTDs like Guinea worm have been eradicated, fight has been intensified on others using the Nigeria Master Plan for NTDs (2023-2027), and the recently developed 10 years roadmap by WHO.
National Coordinator, NTD Programme, Mr Fatai Oyediran, said there were positive signs as regards NTD response in Nigeria, even as the country races for the 2030 target of eliminating NTDs across the world.
He disclosed: “NTDs affect an estimated 1.6 billion people worldwide, majority of whom live in developing countries. Sadly, Nigeria is laden with 25 per cent of about all NTDs in Africa, with millions of persons at risk of infections. But every state is endemic for one or more NTDs.
“For instance, Trachoma is endemic in 122 LGs with 26.8million people at risk; Onchocerciasis is endemic in 481 LGs with 51.4 million people at risk; Schistosomiasis is endemic in 582 LGs with 41 million (SAC) and 1.4 million (adult) at risk; while Soil Transmitted Helminths is endemic in 429 LGs with 44.5 million (SAC) and 27.4 million (preSAC) at risk.”
Oyediran, however, confirmed that significant achievements were made over the years: “Control and elimination of the NTDs in Nigeria will contribute significantly towards attainment of the Sustainable Development Goals (SDGs) 3 as well as poverty reduction. All hands must be on the deck to achieve the objective.
Intervention strategies
“We initiated mass administration of drugs that have proven to be effective in the treatment of NTDs, and these include; Albendazole, Ivermectin, Praziquantel, Tetracycline, Azithromycin, Mebendazole, among others that come in tablets.
“However, the target is to eliminate NTD through the reduction of morbidity and mortality rate to the bearest minimum, and also ensure that governments at all levels are involved in the response.”
Achieved successes
Document obtained from the Federal Ministry of Health, indicated that substantial progress has been made over the last decade (10 years), and these include removing of 35 million people of ivermectin treatment in 10 transmission zones (States) in the country; elimination of Onchocerciasis in two States (Plateau, Nasarawa) and interruption of transmission in additional eight States (Kaduna, Kebbi, Zamfara, Delta, Imo, Abia, Enugu, Anambra).
Similarly, there was LF transmission interruptions in 185 LGAs across 22 states and FCT, while about 39.5 million people across 20 States and FCT no longer require elephantiasis or lymphatic filariasis treatment; a reduction of prevalence in at-risk population of trachoma infection by 84 per cent; among others.
Also, there was eradication of Guinea Worm disease in 2013, and a launch of a project to Integrate Mental Health with NTDs supported by Anesvad Foundation. There was also a special intervention to Scale up impact assessment in nine states for Onchocerciasis and Lymphatic Filariasis supported by Bill and Melinda Gates Foundation. This was aimed at determining states where mass administration of medicines will stop.
Meanwhile, National Policy and Training Manuals on Snakebite management was recently approved at the last NCH in Ekiti along with procurement of Anti-Snake venom (ASV) and Anti rabies vaccines which have been distributed to designated Health Facilities/States in six (6) geo political zones.
WHO intervention
WHO maintained its commitment to any cause that would help in eradication of NTDs in Nigeria and beyond, making reference to several commitments of WHO to the task of eradicating NTDs.
WHO Regional Director for Africa, Dr. Matshidiso Moeti, sympathised with communities with these diseases: “I feel the severe effects these diseases have on the wellbeing and livelihoods of billions around the globe.
“It’s a time to reflect on the progress made in fighting these diseases, and to recognize the urgent need for global and national authorities to reinforce their commitment and mobilize resources to accelerate elimination of NTDs globally and in Africa.
“Myself and fellow leaders across Africa and the world, ask that we unite to tackle these devastating diseases that affect the most vulnerable of our communities. The presence of NTDs is a constant reminder of the inequalities in our world today.
“Let’s build a world where no-one lives with river blindness; shunned by society because they are living with the ancient disease of leprosy; and debilitated by anaemia because they are infected with soil-transmitted worms.
“Progress against NTDs is one of Africa’s greatest achievements. I am proud of the headway made by the WHO Regional Office for Africa, and by the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), as well as the enormous support we have received from partners and governments.
“Together, we have made huge strides against these diseases. 19 countries in Africa have eliminated at least one NTD. Togo achieved a world first by eliminating four of these diseases, namely, river blindness, elephantiasis, sleeping sickness and Guinea worm disease. Yaws is on the verge of being eliminated.
“Ending these diseases is a ‘best buy’ for funding from partners, donors and regional governments. A key contributor to the successes we have seen so far has been successful public-private partnerships. Non-governmental development organizations and the Neglected Tropical Disease NGO Network (NNN) have played a crucial role through their advocacy, by developing and upholding best practices, and by contributing to WHO guidelines on NTD response.
“The donation of medications for mass drug administration by pharmaceutical companies has also been key. Research, development and innovation are vital enablers of the success of NTD elimination programmes, providing the foundation on which effective interventions can be designed and delivered.
“In recent times, increased awareness of NTDs has led to better diagnosis and treatment for people living with the diseases, and prevention by controlling the vectors that carry NTDs, notably, tse-tse flies, snails, worms and the animal reservoirs. Providing safe water supplies and sanitation is another essential action to prevent NTDs, which at the same time, improves people’s overall quality of life.
“However, even with all this progress, Africa bears 40 per cent of the global burden of NTD cases. We need to overcome the persistent challenges that are slowing progress in eliminating these diseases.”