Intestinal Worm ResearchNeglected Tropical Diseases (NTDs) are parasitic, viral and bacterial diseases that largely affect the world’s most impoverished countries. The group of diseases derives its name from the lack of attention NTDs receive in comparison to other diseases. NTDs are most common in regions where people do not have ready access to clean water and proper sanitation as well as adequate healthcare. The National Institute of Allergies and Infectious Diseases (NIH) estimates that more than one billion of the global population suffers from at least one NTD. Intestinal worm infections are among the most common NTDs. For this reason, intestinal worm research can play an important role in eradicating this specific NTD.

Intestinal Worms

Also known as “soil-transmitted helminths,” intestinal worms affect those that come in contact with soil and water contaminated by human defecation and urine. Intestinal worms, such as hookworm, roundworm and whipworm, initially inhabit the intestines of infected individuals. The eggs pass to the ground through human waste. The populations of an estimated 103 countries are affected by intestinal worms. Women of reproductive age and young children are the most susceptible to intestinal worms.

The symptoms for those infected with intestinal worms vary from mild to severe, with some individuals showing close to no symptoms at all. Individuals that display more severe symptoms may develop further conditions such as anemia, malnutrition and stunted growth. Studies currently show that the effects of intestinal worms can be long-term. With the possibilities of “impairment of physical and mental growth” as well as “delayed educational advancement,” cases of intestinal worms can negatively impact a country’s economy by affecting human capital.

Successful Intestinal Worm Research Study

Young children carry a high risk of infection. The health problems that arise as a result of intestinal worms affect more than just a child’s physical life. International Child Support in partnership with the Busia District Ministry of Health conducted a study from 1997-2001 in the Busia district of Kenya.

The study finds that “One-quarter of Kenyan student absenteeism is attributed to abdominal pains that are likely due to intestinal helminth infections.” Furthermore, older children often take time off school to care for younger siblings with intestinal worms.

As part of the study, schools with more than 50% of students infected with intestinal worms received deworming drugs on a six-month schedule. Alongside the medicine, the schools received “public health lectures” and training on prevention methods such as washing hands, “wearing shoes and not swimming in the lake.”

Promising Results

Results showed that treating the intestinal worms decreased primary school absences by nearly 25%. Overall, deworming efforts proved to be a cost-effective way to raise school participation rates. Researchers monitoring the children over a span of 20 years found that the treated children received “13% higher hourly wages” compared to children who did not receive treatment.

Overall, deworming treatment ensured the children remain in school to receive an education, impacting their overall life outcomes with improved economic opportunities to enable them to rise out of poverty. The results of the study have informed humanitarian health-focused efforts, indicating the importance of intestinal worm research. Recognizing the “return on investment,” nations such as India, Nigeria and Pakistan treat hundreds of millions of children affected by intestinal worms every year.

Looking Ahead

Intestinal worms are among the most common neglected tropical diseases, prompting an increased need for further research into the most effective treatments. Results from the study in Kenya show that deworming efforts carry more benefits than harm. Investing in intestinal worm research and treatment can increase the health of those in poverty, allowing children to remain in school, eventually acquiring the tools and knowledge to lift themselves out of poverty.

– Grace Ingles
Photo: Flickr

Chagas Disease in BrazilMore than 1 billion people in developing countries are sick and require treatment for Neglected Tropical Diseases, or NTDs. These are infectious diseases that have very little attention and donor funding compared to diseases like malaria, HIV and tuberculosis. NTDs can have debilitating results such as malnutrition, blindness, weakening mental development and more. They also tend to go hand in hand with poverty, because less access to clean water and sanitation allows these diseases to thrive. One of these diseases, Chagas disease, also known as “the kissing bug disease,” exists in the areas of Brazil where poverty is prominent.

“NTDs are not prioritized in wealthier, developed countries because they do not experience the same living conditions that affected populations are in, said Jadie Moon, a representative from NGO De-Neglect. “Diseases like HIV and tuberculosis are more prevalent in developed countries and attract more attention. Additionally, the public tends to focus more on diseases that kill such as malaria. However, NTDs are more likely to disfigure and affect [the] daily lives of individuals.”

History of Chagas Disease in Brazil

Chagas disease exists in the Americas, mainly in rural areas of Latin America where poverty is prevalent. It was first reported in Brazil by Brazilian physician Carlos Chagas in 1909. A parasite called Trypanosoma cruzi, which is transferred from the waste of triatomine bugs, or kissing bugs, causes the disease. The disease can also be spread through food that has been contaminated by the bug’s feces, infected blood transfusions and organ donations. This disease affects 8 million people today, and 20,000 people die from it every year.

From 2001 to 2018, 5,184 cases of acute Chagas disease were found in Brazil. The rate of infection recorded in Brazil annually was “0.16 per 100,000 inhabitants.” Studies show a rapid increase in records of Chagas disease before 2005. Though there was a drop from 2005 to 2009, there was another increase in infections after 2009.

Symptoms and Warning Signs of Chagas Disease

Though many NTDs are not considered life-threatening, the results of Chagas disease can be. The acute phase of the disease has minor symptoms. They include fever, swelling at the infection site, rash, nausea and enlargement of the liver or spleen. These symptoms will usually go away on their own, but if left untreated the disease can advance to the chronic phase.

The chronic phase is more serious and may occur 10 to 20 years after the infection. The parasites hide in the heart and digestive muscles, leading to cardiac and digestive or neurological disorders. Chronic symptoms include an irregular heartbeat, esophagus enlargement, difficulty swallowing, an enlarged colon and heart failure.

Around 20 to 30% of individuals who are in the chronic phase of Chagas disease eventually develop clinical disease. Usually, the clinical disease that develops is cardiac. Chagas disease is often discovered in an individual years after the infection in late stages, and once established it can cause severe, even deadly cardiac and digestive disorders.

“Because of the commonly asymptomatic or mildly symptomatic acute phase of infection, Chagas disease is difficult to diagnose, and often leads to missing the best time frame of treatment,” said De-Neglect members Jesse Chen and Helen Lee.

Prevention and De-Neglecting Chagas Disease in Brazil

One of the key methods in protecting people from Chagas disease – like any other NTD – is prevention. Methods of prevention in areas that are high-risk include:

  • Using bed nets that have been soaked with insecticide
  • Avoid sleeping in a mud, thatch or adobe house
  • Making home improvements to prevent bug infestation
  • Screening pregnant mothers, blood donations and testing organ/tissue/cell donations (as an infected individual can spread the disease to a healthy individual that way)
  • Washing, checking and cooking food well so there is no bug feces

De-Neglect

One of the best ways of preventing Chagas disease in Brazil is educating the public that lives in high-risk areas. A social media concentrated NGO in California called De-Neglect has a mission of doing just that. The organization has been around since 2018, formed by a group of UC Berkeley students and alumni. De-Neglect’s mission is to raise awareness and education about NTDs like Chagas disease, and how they affect communities in poverty. De-Neglect works to accomplish this goal through research, educating the public in health and participating in “community-based mobilization.” Their members are in contact with individuals and organizations from around the world and use their media platforms to raise awareness for NTDs like Chagas that affect areas like the rural communities in Brazil.

“I know someone who passed away due to Chagas disease almost 3 years ago in Brazil,” said De-Neglect team member Paula Serpa. “It is suspected that my friend acquired the infection due to his poor living conditions and, while playing a pickup soccer game, he suffered a heart attack and passed away.”

Growing the Organization

De-Neglect Team member Jessica Tin recounts the feat it took to form De-Neglect and build their network of collaborators. They faced certain roadblocks about finding accurate and up-to-date info for some NTDs. “Recently, we reached our next milestone with the release of our “What is scabies?” video and a social media campaign for World NTD Day, said Tin. “This was our first major moment in getting our name and mission out to the NTDs community as well as to our personal circles, where most of our friends and family had never even heard of NTDs before. Seeing our impact has given us extra momentum to continue our mission by expanding our network and educating the community.”

Lessening the Impact of Chagas in the Future

“Given that NTDs are concentrated in developing, poverty-stricken countries, their management often takes up most of a person’s existing and potential wealth,” said De-Neglect Team Member Jessica Yescas. “By providing solutions, such as medication and accessibility to medical care — as well as raising awareness through education — the possibility of alleviating the perpetuation of poverty due to NTDs can become a reality.”

Those infected with Chagas disease in Brazil face additional challenges if they already struggle with poverty. If not provided reliable, affordable medication the results could cost them dearly. They can miss out on work and educational opportunities, pushing them further into poverty. Raising awareness for Chagas disease and other NTDs in areas impacted by poverty and putting them in the spotlight creates more opportunities to instill solutions, not allowing them to be neglected anymore.

Celia Brocker
Photo: Flickr

 Address Neglected Tropical DiseasesOn November 12, 2020, members of the World Health Organization (WHO) voted overwhelmingly to adopt a bold set of plans to address the threat of neglected tropical diseases (NTDs) throughout the next decade. With this vote, the WHO endorsed a “road map” written by the Control of Neglected Tropical Diseases team to address neglected tropical diseases in the world’s most vulnerable regions. The decade-long project aims to establish global programs with international partners, stakeholders and private organizations. These partnerships will work to accomplish an ambitious set of goals that will end the spread of certain neglected tropical diseases and improve the quality of human life in regions susceptible to neglected tropical diseases.

Neglected Tropical Diseases (NTDs)

Neglected tropical diseases are commonly defined by global health organizations such as the WHO and the National Institute of Allergy and Infectious Diseases as a group of diseases that primarily affect those living in tropical and subtropical climates and disproportionately spread in remote areas or regions afflicted by poverty. Among the 20 diseases that the WHO categorizes as neglected tropical diseases are dengue, rabies, leprosy, intestinal worm and sleeping sickness.

Tropical and subtropical regions include Central America and the northern half of South America in the Western Hemisphere, most of sub-Saharan Africa as well as island nations in the Indian and Pacific Oceans. Many of the countries in this range are developing or impoverished nations. A lack of development and healthcare infrastructure in nations that lie in tropical regions, such as lack of access to clean water and health education, creates a more fertile breeding ground for the spread of dangerous diseases.

The reason that these diseases are considered “neglected” is that regions where neglected tropical diseases cause the most damage are populated by people with little political power or voice, a result of widespread poverty, location and other socioeconomic factors. As such, the spread of these diseases goes largely unnoticed and there is little incentive at the international level to take measures to combat these ailments. Though NTDs do not receive high-profile attention in the larger medical community, the WHO estimates that more than one billion people are affected by NTDs. The WHO sees the urgency to address neglected tropical diseases.

WHO’s 2021-2030 Road Map

The WHO outlined a set of “overarching global targets” that it will pursue over the course of the next decade in work with foreign governments, community organizations and NGOs. These overarching goals, to be accomplished through achieving a number of “cross-cutting targets” are the primary effects the WHO hopes to achieve by 2030:

  1. Reduce number of people requiring treatment for NTDs by 90%. To attain a 90% reduction rate of those requiring treatment for neglected tropical diseases, the WHO altered its approach to disease treatment from a vertical, single disease eradication method to a horizontal, cooperative effort across several countries. This would require 100% access to water supply, greater international investment in healthcare and action at the federal level to collect and report data on infection.
  2. Eliminate at least one NTD in 100 countries. There are a number of neglected tropical diseases that the WHO lists as “targeted for elimination”: human African trypanosomiasis, leprosy and onchocerciasis. In the WHO’s road map, elimination of a disease means complete interruption of transmission, effectively stopping a disease’s spread. For eliminating diseases such as leprosy, the WHO hopes to assist 40 countries to adopt epidermal health strategies in their healthcare systems.
  3. Completely eradicate two NTDs. The two diseases listed as “targeted for eradication” by the WHO are yaws, a chronic skin condition, and dracunculiasis, an infection caused by parasitic worms in unclean water. Both diseases are, according to the WHO, either easily treatable or on the verge of eradication. Dracunculiasis, for which there is currently no vaccine or medical treatment, only affected a reported 54 people in 2019. Yaws is still endemic in 15 nations but can be treated with a single dose of antibiotics.
  4. Reduce by 75% the disability-adjusted life years (DALYs) related to NTDs. The implementation of increased prevention, intervention and treatment can increase the quality of human life in tropical and subtropical countries. This final overarching goal aims to create nationwide efforts to alleviate or eliminate the chronic symptoms of those infected with neglected tropical diseases as well as prevent the further spread of debilitating neglected tropical diseases.

Ending Neglected Diseases

To address neglected tropical diseases, the fulfillment of the goals outlined in the WHO’s road map will require a multilateral and thorough implementation as well as cooperation and leadership from each of the partner countries affected. The WHO seeks to encourage each tropical and subtropical nation to take ownership of their healthcare programs, which will create a sustainable, international network to strengthen global health in some of the world’s most vulnerable regions. Putting the fight against neglected tropical diseases in the spotlight as well as dedicating time and resources to taking on these diseases, can remove the “neglected” from neglected tropical diseases and put the global community on a course toward eradicating these diseases.

– Kieran Graulich
Photo: Flickr

the END FundNeglected tropical diseases (NTDs) are a group of diseases caused by a variety of pathogens that are common in low-income regions. The World Health Organization WHO) and the Centers for Disease Control and Prevention (CDC) categorize 20 diseases as NTDs. They affect more than one billion people around the world, with more than a third of people affected by NTDs living in Africa. While about one-sixth of the world’s population suffers from at least one NTD, more attention is often brought to other diseases, such as HIV/AIDS and malaria. While these other diseases require a high level of attention, NTDs need prioritization too. The effects of NTDs can last for decades if proper care is not sought out as many have the ability to bring on permanent blindness and disfigurement. It is of the utmost importance that NTDs are addressed and one such organization putting in the work is the END Fund.

The END Fund

The END Fund is a nonprofit organization that seeks to protect the lives of people at risk of NTDs. It delivers treatments by working with local partners, understanding that these groups have regional expertise and know the needs of their area best.

The END Fund helps its partners design programs so that they can expand their capacity to collect important data regarding NTDs. Further, the END Fund provides technical support and monitors progress so its partners can fight disease in the most effective way possible.

It also collaborates with non-governmental organizations and seeks to involve all stakeholders in order to improve the lives of those at risk of contracting NTDs. The END Fund is active across many countries in sub-Saharan Africa as well as India and Afghanistan. It has programs in Nigeria, Ethiopia, the Democratic Republic of the Congo, Somalia and others.

NTDs in Nigeria

The country with the greatest prevalence of NTDs in Africa is Nigeria. With a population of 195 million people, five of the most common NTDs are present: intestinal worms, lymphatic filariasis, river blindness, schistosomiasis and trachoma. These diseases can cause severe pain that inhibits people from going about their daily lives. Children miss out on their education and adults miss out on economic opportunities. NTDs can cause the already impoverished to sink even deeper into poverty.

In 2013, the END Fund arrived in Nigeria. Two years later, it partnered with Helen Keller International to support local partners, the Amen Foundation and Mission to Save the Helpless (MITOSATH). It has since helped build the capacity of these groups so that they can respond to the issue of NTDs even stronger. It engaged with local leaders across many levels to make people aware of the treatment plans that are available. Among traditional groups, leaders took medication in front of many people to show that it was safe.

The End Fund’s Impact

In 2019 alone, the END Fund was able to treat 121 million people. The END Fund also trained 2.7 million healthcare workers between 2012 and 2019. Its workers have performed almost 31,000 surgeries during that same time period, with the treatments valued at more than $1 billion.

NTDs pose a great threat to people in developing countries. The END Fund has been able to accomplish a lot through its collaborative projects in Nigeria and across other countries. The END Fund will continue to work toward its vision of ensuring that people at risk of NTDs can live healthy lives.

– Evan Driscoll
Photo: Flickr

countries that have eliminated trachoma

Neglected tropical diseases (NTDs) affect more than 1.4 billion people in 149 countries. These diseases flourish in areas of the world where there is a lack of basic sanitation, which means that the global poor have the highest risk of contracting them. These diseases are preventable and treatable, but due to a lack of resources and aid, millions of people still suffer from these diseases that can cause them to be disfigured, disabled and may even result in death.

However, with the help of several different organizations and national campaigns, many countries have successfully eliminated some NTDs, including trachoma, which is the leading cause of blindness in the world. Trachoma is a bacterial eye infection that affects the eyes and eyelids, causing the eyelashes to turn inward toward the eye leaving patients blind.

Here are three countries that have eliminated trachoma.

3 Countries That Have Eliminated Trachoma

  • Ghana – In 2018, Ghana became the first country in West Africa to eliminate blinding trachoma. Three groups were instrumental in this effort: FHI 360 – a nonprofit human development organization; END in Africa Project (financed by USAID) and Ghana Health Service’s NTD program. Working together, the three organizations eliminated blinding trachoma over an eight-year period. From 2010 to 2018, the END in Africa Project supported the global distribution of more than 464 million NTD Program treatments for trachoma and other diseases. They also mapped disease distribution, treated at-risk populations and monitored treatment impact while also documenting successes along the road to eliminating this terrible disease. FHI 360 provided technical and financial assistance for trachoma post-treatment surveillance, which will help with further prevention of the disease. The program’s long surveillance and treatment of patients is a testament to its dedication and commitment to ending NTDs.
  • Laos – In 2017, Laos became the fifth endemic country in the world to eliminate blinding trachoma as a public health problem. Blinding trachoma was especially common among young children. The United States government had been supporting Laos since 2012 through several USAID projects, such as END in Asia and ENVISION. These projects assisted the Ministry of Health in collecting reliable data on the status of trachoma, which helped determine the correct approach to eradicate the disease. Laos was able to place ophthalmologists at national, provincial and district levels to detect and operate on cases of patients with the disease. The projects also trained primary health care workers to screen patients for trachoma, and they gave patients with less severe conditions the antibiotic eye treatments they needed. Nongovernmental organizations also helped train health volunteers in villages on ways to prevent trachoma. Education ministries invited volunteers to come to their schools and educate their students on facial cleanliness and showed how the infection spread from person to person. Laos achieved amazing success with its partners, working to not only diagnose and treat the disease but also to educate people on how to prevent trachoma.
  • Mexico – Mexico became the first country in the Americas and the third country in the world to officially eliminate trachoma in April 2017. In 2004, the Secretary of Health of the state of Chiapas formed a group of health professionals called Trachoma Brigades to implement SAFE, the strategy recommended by the World Health Organization to eliminate the disease. In their fight against this disease, Mexico provided surgery for people at imminent risk of blindness, administered antibiotics in affected communities to reduce infection in children as well as to stop transmission, promoted personal hygiene and improved environmental conditions. The SAFE strategy’s 4 interventions have been especially successful in the state of Chiapas. Trachoma was endemic in 246 communities in the state and affected over 146,000 citizens. Trachoma Brigades, alongside national, state and community efforts and international partners, eradicated this disease. Trachoma Brigades visited communities several times a year to conduct surveys, eye examinations, identify cases, administer antibiotics, educate children about proper hygiene and perform surgeries.

These three countries worked for years to eradicate this trachoma and improve their citizens’ quality of life. The combined efforts of multiple organizations and governments brought medication, surgeries and public education to these countries toward achieving this goal. In addition to Ghana, Laos and Mexico, countries such as Cambodia, Togo, The Marshall Islands, Oman and Morocco have also made progress against this disease.

It is a U.S. foreign policy objective to support the treatment, control and elimination of Neglected Tropical Diseases (NTDs). The World Health Organization recognizes 17 NTDs which currently afflict 1.4 billion people around the globe. Urge Congress to support the End Neglected Tropical Diseases Act to advance U.S. foreign policy interests and safeguard national security.

Email Congress to End NTDs

Jannette Aguirre
Photo: WHO

End Neglected Tropical Diseases ActApproximately one billion people are affected every year by Neglected Tropical Diseases (NTDs) in an estimated 149 countries. In tropical and subtropical areas, NTDs abound in a variety of 17 communicable diseases, including Chagas disease, dengue fever, leprosy, river blindness, rabies, worms (round, whip and hook) and trachoma to name a few. This is why the End Neglected Tropical Diseases Act was created.

Rep. Christopher Smith introduced the End Neglected Tropical Diseases Act to the U.S. House of Representatives on Jan. 28, 2019. The proposed bill addresses international development regarding NTDs as well as provides funding for those who strive to help end NTDs. The bill also states that it will expand the U.S. Agency for International Development’s Neglected Tropical Diseases program and the Global Fund. Here are five facts that explain the primary objectives of the End Neglected Tropical Diseases Act.

Five Facts About the End Neglected Tropical Diseases Act

  1. The bill proposes that USAID help individuals suffering from or at risk for contracting NTDs by providing drug treatment packages. Rep. Smith also urges beginning similar programs that target large at-risk communities, particularly children five and up. These programs will have a high impact with relatively low costs.
  2. These programs will also attempt to coordinate with USAID and its development sectors. Specifically, the program aims to organize with USAID regarding aspects such as “education (including primary and pre-primary education), food and nutrition security, maternal and child health and water, sanitation and hygiene.”
  3. The End Neglected Tropical Diseases Act addresses the need for the Global Fund to start recognizing and working with NTDs. The Global Fund is a public-private entity that focuses on assisting people with AIDS, Tuberculosis and Malaria. The bill urges the Global Fund to focus on female genital schistosomiasis in addition to providing treatment for HIV/AIDS.
  4. Rep. Smith’s proposed bill also addresses the need for a center of excellence. This section of the bill addresses the provisions for obtaining a cooperative agreement or a grant. The grant can be given to either a public or private nonprofit organization. It will fund the basics costs needed to create the centers in order to “conduct research into, training in and development of diagnosis, prevention, control and treatment methods for neglected tropical diseases.” These funds can be used for basic operating costs such as staffing and administrative duties as well as patient care costs. The grant funds may also be used for the training and continued education of health professionals as well as for establishing programs to educate the public on NTDs.
  5. The bill would create a panel for worm infections. The Secretary of Health and Human Services would use this panel to research worm infections and deworming solutions and medicines. It will also develop five strategies for preventing recurrent infections, providing sanitation solutions, developing safer, better medicines and improving the cost-efficiency of the existing programs regarding worm infections.

The End Neglected Tropical Diseases Act aims to produce programs that will help eliminate tropical diseases that are rampant in developing countries. If it passes, it could bring much-needed hope for approximately one billion people in developing countries around the world.

– Logan Derbes
Photo: Flickr