Neglected Infectious Disease in the Perspective of Global

8/2/2019 Neglected Infectious Disease in the Perspective of Global

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Neglected Infectious

Diseases in The

Perspective of Global

Health

dr. Bintari Dwihardiani, MPH

Center for Tropical Medicine,Gadjah Mada University


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Definition

Infectious diseases which attack the poorestpopulation in the developing countries


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Neglected Infectious Diseases


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Neglected Infectious Diseases


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Neglected Infectious DiseasesCore: Soil transmitted helminthes

infection (STH) lymphatic filariasis Onchocerciasis Dracunculiasis Schistosomiasis Leishmaniasis chagas disease Human African

trypanasomiasis (HAT) buruli ulcer Leprosy trachoma

Others: Strongyloidiasis,

toxocariasis, loiasis,taeniasis, echinococcosis

Amoebiasis, giardiasis,

balantidiasis Bartonellosis, bovine

tuberculosis, leptospirosis,relapsing fever, rheumaticfever, treponematosis

Dengue fever, yellow fever,Japanese encephalitis,rabies, haemorrhagic fever

Mycetoma,paracoccidiomycosis

Scabies, myiasis, tungiasis


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Neglected?

There are effective control strategies but are not implementedglobally

Inadequate effort to develop diagnostics, drugs, or vaccines, andsecond line medicines

Inadequate research into pathogens biology and the bodysresponse

R & D expense in 2007 (estimates 2.56 billion): HIV/AIDS, TB,malaria spent 75% of total expense; helminthes, leprosy, buruliulcer, trachoma, chagas, leishmaniasis, trypanasomiasis spent

7.3%

Failure to put the issues in the national or international policy level


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Determinants

Geographically concentrated

Extreme poverty

Poor hygiene and sanitationPoor access to clean water

Non stable health system (in conflict)


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Burden


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Burden

Affect 1.2 billion people who earn less than 2$/day Disability: blindness, limb dysfunction, face

disfiguration

Impaired childrens growth, development, andphysical fitness

Pain, blood loss, liver and bladder disease Estimates for 2002: 177,000 deaths worldwide and

20 million DALYs (1.3% of the global burden ofdisease) Economic lost


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Estimates for Indonesia (2003)

Diseases People affected (prevalence)

Ascariasis 90 million (42%)

Trichuriasis 95 million (44%)

Hookworm 62 million (28%)

Schistosomiasis < 0.1 million (< 1%)

Leprosy 21,430


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Current Control strategy

Mass drugs administration (for helminthes infections)

Challenge: low coverage, drug resistance, re-infection, long termprogram, sustainability

Case management

Challenge: inadequate medicine and diagnosis methods, accessto medicine

Vector control

Challenge: resistance to insecticide, low coverage Sanitation and hygiene improvement

Challenge: funding limitation Lymphatic filariasis, leprosy, onchocerciasis, and chagas

diseases are targeted for elimination

Elimination is possible


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International Initiatives and

Partnership

Global Network for Neglected TropicalDiseases

Global Alliance to eliminate lymphatic

filariasisOnchocerciasis Elimination Program for the

America

Partners for parasite controlSchistosomiasis control initiative International trachoma initiative


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International Initiatives and

Partnership

Mectizan donation programme for fightingriver blindness

Bill and Melinda Gates FoundationDrugs for neglected diseases initiatives

Carter center


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New strategies elements

1. a comprehensive, multifaceted, community-based programusing all available control tools

2. well-articulated, transparent, and independent monitoring andevaluation

3. intensification ofbasic investigation of NTDs4. discovery and development ofnew diagnostic, therapeutic,

and preventive approaches;

5. expanded and qualified human capacity to guide, lead, andimplement these strategies at the local level.

6. As the presence of the diseases related to development, itwould be sustainable to integrate the control of the diseasesand development action


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Millennium Development Goal

End poverty and hunger

Universal education

Gender equality

Child health

Maternal health

Combat HIV/AIDS, malaria, and other diseases

Environmental sustainability Global partnership


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In Relation with Millennium

Development Goal

The disabling impact of NID lead to poverty: reduce thepossibility to earn income and the productivity.

STH and schistosomiasis impair childrens growth,development, and physical fitness

Hookworm and schistosomiasis cause anemia duringpregnancy

Infected pregnant women pass parasite antigens to thefetus, affecting the childs immune system so the

vaccination is less effective Female genital schistosomiasis infection increases HIV

risk STH, shistosomiasis, lymphatic filariasis promote

susceptibility to other diseases including TB andHIV/AIDS


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Reference List

1. Hotez PJ, Molyneux DH, Fenwick A, Kumaresan J, Sachs SE, Sachs JD etal. Control of neglected tropical diseases. N Engl J Med 2007;357(10):1018-1027.

2. Hotez PJ. The neglected tropical diseases and their devastating health andeconomic impact on the member nations of the Organisation of the IslamicConference. PLoS Negl Trop Dis 2009; 3(10):e539.

3. Hotez PJ, Fenwick A, Savioli L, Molyneux DH. Rescuing the bottom billionthrough control of neglected tropical diseases. Lancet 2009373(9674):1570-1575.

4. Mahmoud A, Zerhouni E. Neglected tropical diseases: moving beyond massdrug treatment to understanding the science. Health Aff (Millwood ) 2009;28(6):1726-1733.

5. Musgrove P, Hotez PJ. Turning neglected tropical diseases into forgottenmaladies. Health Aff (Millwood ) 2009; 28(6):1691-1706.

6. Moran M, Guzman J, Ropars AL, McDonald A, Jameson N, Omune B et al.Neglected disease research and development: how much are we reallyspending? PLoS Med 2009; 6(2):e30.

7. Mathers CD, Ezzati M, Lopez AD. Measuring the burden of neglectedtropical diseases: the global burden of disease framework. PLoS Negl TropDis 2007; 1(2):e114.

8. www.dndi.org

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Neglected Infectious Disease in the Perspective of Global