By FRED OLUOCH

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The Executive Director of Uniting to Combat Neglected Tropical Diseases Thoko Elphick-Pooley spoke to Fred Oluoch about the impact of NTDs in Africa combating them.

What is the prevalence of NTDs in Eastern Africa?

Neglected Tropical Diseases are a group of 20 preventable and treatable diseases that affect over one billion people globally. They include Buruli ulcer, Chagas disease, dengue, and chikungunya, Dracunculiasis (Guinea-worm disease), echinococcosis, food-borne trematodiases and human African trypanosomiasis (sleeping sickness).

They are considered ‘neglected’ because of a lack of awareness about them, as well as a lack of concerted global action and financing to tackle them. Insufficient resources for control, elimination, and eradication of NTDs have been a significant issue.

NTDs are endemic in almost all African countries, affecting more than 600 million people. This accounts for over a third of the global NTD burden. Overall, NTDs in East Africa are about 15 percent of the global burden and 40 percent of the burden in Africa.

The Democratic Republic of the Congo, Ethiopia, Tanzania, and Uganda are amongst the top ten high-burden countries in Africa. Almost every country in East Africa is endemic for NTDs.

Visceral leishmaniasis and sleeping sickness are fatal if not treated, with two-thirds of the global VL cases found in East Africa and close to 90 percent of sleeping sickness found in only DRC.

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Is there a common African plan on tackling NTDs?

There is a lack of leadership and representation at the highest decision-making organs on the African continent in regard to NTDs. But we are seeing some leadership at the level of Heads of State in moving forward the NTD agenda.

This is why we were pleased to see heads of state endorse the Continental Framework, which has the vision to free Africa of NTDs by 2030. It provides guidance on key approaches that should be implemented, as well as the Common African Position that recommends how to address NTDs.

But we must continue lobbying for increased financial support, stronger political commitment, and better tools to prevent, diagnose and treat the diseases.

The WHO has targeted 13 NTDs for elimination by 2030 and elimination of at least one in 100 countries.

So far, 21 countries in Africa (out of 50 globally) have eliminated at least one NTD with several countries eliminating two, three, or four NTDs.

Recently, we celebrated Benin and Ghana eliminating three NTDs each, whiet Togo is currently the only country to have eliminated four.

This momentum needs to be sustained for us to achieve a continent free of NTDs. Elimination is possible, but as we have seen, it requires political leadership, sustainable financing to provide treatment to all that require it, and investment in diagnostic and robust disease surveillance systems.

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Rwanda leads the region in combating NTDs. What is their approach?

Rwanda has deployed people-centred approaches for eliminating NTDs, decentralising and integrating NTDs control in health and non-health sectors (including governance and education sectors). It was the first country to implement mass drug administration without external operational funds, through integration within its health and non-health platforms.

It is also contributing 30 percent of drugs needed for mass deworming against soil-transmitted helminthiasis, including for adults, with the government having set a target to cover 100 percent of drug costs by 2028.

Who are the most vulnerable to NTDs?

Women bear a disproportionate burden on NTDs. Certain NTDs, such as schistosomiasis and soil-transmitted helminths, have severe reproductive health implications for women, including anaemia during pregnancy, premature birth, increased blood loss during childbirth, infertility, and a significantly higher risk of HIV. An estimated one in three pregnant women in sub-Saharan Africa is infected with hookworm.

In some settings, hookworm is responsible for 54 percent of anaemia cases during pregnancy. Anaemia is one the highest risk factors for maternal health in Africa, accounting for at least 20 percent of maternal deaths.

Schistosomiasis can lead to female genital schistosomiasis in women, which can triple the risk of HIV and cause damage to reproductive organs, resulting in infertility, ectopic pregnancy, and even maternal death.

FGS is frequently misdiagnosed as a sexually transmitted infection, exacerbating the stigma, which leads to social exclusion, and often the breakdown of relationships. In Sub-Saharan Africa, it is estimated that up to 56 million women and girls currently suffer from FGS.

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Additionally, vertical transmission is common with some NTDs, such as Chagas, leishmaniasis, and STH. Fortunately, treatments for these diseases exist.

What are the conditions that lead to the prevalence of NTDs?

NTDs are more acute for communities living in remote and underserved regions.

The diseases thrive in areas with inadequate sanitation, poor access to clean water, and limited healthcare infrastructure.

By most commonly affecting some of the most vulnerable people in the world, NTDs create cycles of poverty, costing an estimated $33 billion each year in out-of-pocket health expenditures and lost wages.

The prevalence of NTDs is also influenced by environmental factors. As climate patterns shift, the risk of increased spread and transmission of the diseases grows. Changing temperature, rainfall patterns, relative humidity, and other climatic variables affect the habitats of disease vectors.