CBM supports Neglected Tropical Disease (NTD) programmes in areas where these diseases are identified as a public health problem. By building on our long experience and existing strengths we aim to achieve sustainable and effective community-owned NTD programmes that are comprehensive, integrated and inclusive.
A barrier to inclusive development
Neglected Tropical Diseases (NTDs) present a largely hidden burden affecting the most marginalised and voiceless communities living in poverty and conflict zones. These diseases disproportionately affect children, women and persons with disability and flourish under conditions characterised by poor housing and sanitation, unsafe water, and limited access to basic health care.
Negatively impacting on virtually all of the United Nations Sustainable Development Goals, NTDs hinder development, keeping individuals and communities trapped in a cycle of poverty.
The 17 goals of the SDGs reflect the global pledge to “leave no one behind”. In this context and for the first time NTDs have been included with a specific indicator. Under the health target 3.3 “By 2030, end the epidemics of AIDS, TB, malaria and Neglected Tropical Diseases and combat hepatitis, water-borne diseases and other communicable diseases” we now have the specific NTD indicator “A 90% reduction in the number of people requiring NTD interventions”.
The SDG target on Universal Health Coverage (UHC) 3.8 is also especially relevant for NTDs as it highlights the need for equitable and quality services for all: “Achieve UHC, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. Both targets and respective indicators are promoting health system strengthening for sustainability.
NTDs are also linked to almost all other SDGs such as those related to poverty (SDG 1), hunger (SDG 2), quality education (SDG 4), water and sanitation (SDG 6), climate change (SDG 13) and global partnership (SDG 17).
What are the NTDs?
Neglected Tropical Diseases (NTDs) are primarily parasitic, bacterial or viral infections that thrive amongst the poorest and most marginalized people, families and communities. They are spread by human contact, insects, contaminated water and soil infested with the eggs or larvae of worms.
Transmission cycles are perpetuated under conditions of environmental contamination, protracted by poor standards of living and hygiene. Once widely dispersed, NTDs now persist in settings of extreme poverty, urban slums and conflict zones.
Though diverse in terms of causes and effects, NTDs frequently affect the same communities. They are responsible for about 500,000 deaths per year but chiefly are causing pain, disfigurement and chronic disability, impairing childhood growth and mental development and hindering economic growth – trapping people, families and entire communities in a cycle of poverty.
The following diseases are responsible for about 90% of the global NTD burden (the “big-5”):
- Onchocerciasis (river blindness): This is a parasitic disease transmitted by river-breeding blackflies and caused by the baby-worms (larvae) of a thread like roundworm (Onchocerca volvulus) living for many years in often palpable nodules of infected persons. It is the world's second-leading infectious cause of blindness with 800,000 people believed to have visual impairment and 270,000 to be blind due to the disease. More than 100 million people are at risk and 37 million are thought to be infected. It is mainly endemic in Africa (26 countries; almost 99% of all people at risk). In Latin America Columbia, Ecuador and Mexico have been certified to have eliminated the disease and Guatemala is anticipated to be certified in 2016; due to successful elimination efforts there are now only six known endemic communities in the remote and difficult to reach border area between Venezuela and Brazil with ongoing treatment activities in the region. Yemen – the only country outside Africa or Latin America to have Onchocerciasis - is also expected to achieve elimination soon.
- Lymphatic Filariasis (LF; also known as elephantiasis): This is caused by parasitic threat like worms (Wuchereria bancrofti) transmitted by mosquitoes. Long-term infection can lead to the painful and disfiguring swelling of limbs also known as “elephantiasis” and the male genital (hydrocele). Globally more than one billion people are at risk, 120 million are infected and 44 million people have symptoms from the disease One third live in 40 known endemic countries in Africa.
- Trachoma: This is a bacterial eye disease (Chlamydia trachomatis) and the leading cause of global blindness due to infection. 137 million people live in trachoma endemic areas and are at risk of trachoma blindness. It is responsible for the blindness or visual impairment of about 1.9 million people, and causes about 1.4% of all blindness worldwide. To eliminate the disease as a public health problem WHO recommends the comprehensive SAFE strategy (acronym for Surgery for trichiasis, Antibiotic therapy, Facial cleanliness, and Environmental improvement). The WHO led Global Alliance for the Elimination of Trachoma by 2020 (GET2020) is intensifying efforts to achieve their goal.
- Soil-transmitted helminths (STH): Soil-transmitted helminth infections are caused by different species of parasitic worms (including roundworm, hookworm and whipworm). They are transmitted by eggs present in human feces, which contaminate the soil in areas where sanitation is poor. More than 850 million children are estimated to be at risk. In children, severe STH infections can lead to malnutrition, anemia, stunting and impaired cognitive development. In both adults and children, they can cause fatigue, intense abdominal pain and chronic diarrhea.
- Schistosomiasis (SCH; also known as snail fever or bilharzia): At least 258 million people require preventive treatment through MDA for schistosomiasis; it is estimated that at least 90% of them live in Africa. People are infected during agricultural, domestic, occupational and recreational activities such as swimming and fishing which expose them to water infested with parasitic blood flukes. There are two major forms of Schistosomiasis – intestinal and urogenital – caused by different species of blood flukes. Infection can manifest itself as acute and often chronic disease that can damage internal organs and, in children, impair growth and cognitive development.
More than 1 billion people - one-sixth of the world’s population - are affected or at risk by one or often more of these chronic and disabling diseases - presenting a unique platform for scaling CBM’s comprehensive disability, inclusion and development work.
Anchoring individuals and communities in a cycle of poverty, NTDs cause great human misery, often aggravated by social stigmatisation and discrimination, especially for women. They cause pain, disfigurement, and disability (mental and physical), and result in about half a million deaths each year.
Disease development is typically insidious and severe impairment often occurs after years of silent infection, leaving patients unaware of the need to seek care.
NTDs are primarily diseases of “neglected people”. Being endemic in countries with limited resources and competing with high-visibility and high-mortality diseases such as HIV/AIDS, malaria and tuberculosis, NTDs are – despite significant progress in recent years - often still considered low priority in national health programs and are neglected in health agendas, budgets, research and product development (“neglected diseases”).
The five major NTDs are also called ‘tool ready’ as there exist relatively simple diagnostic tools and safe, inexpensive or free drugs, which can be distributed by trained non-medical staff through Mass Drug Administration (MDA).
The average costs of treatment are estimated at 50 US cents per person per year. For most programmes based on preventive chemotherapy (PCT) the drugs donated by pharmaceutical companies can be co-implemented improving effectiveness and efficiency.
CBM has been successfully involved in the prevention of blindness from onchocerciasis and trachoma for more than 20 years and supports the work of the new WHO African Regional Office (AFRO) entity, the “Special Program for the Elimination of NTDs” (ESPEN), in eliminating Onchocerciasis, Lymphatic Filariasis, Trachoma, Soil Transmitted Helminths and Schistosomiasis in Africa in line with the WHO NTD Road Map.
- Onchocerciasis (river blindness): CBM supports the annual treatment with Ivermectin mainly through a community directed approach. Alternative and innovative approaches (e.g. MDA more than once per year) are supported in line with WHO and national programs where required and feasible. CBM is mainly active with partners in DRC, Nigeria, South Sudan, CAR and Burundi. River blindness is now controlled in 34 endemic countries. Reports from 10 West African countries (previously the most severely affected areas) indicate, there has been prevention of 600,000 cases of blindness and 25 million hectares of land are now safe for cultivation and resettlement. As a founding member of the NGDO Group for the Elimination of Onchocerciasis, CBM has been working closely with the African Program for Onchocerciasis Control (APOC), which came to a closure by the end of 2015.
- Trachoma: CBM supports a comprehensive SAFE strategy (see above) with expertise mainly in trichiasis-surgery and increasingly close collaboration with WASH sector expert organisations for effective F and E work. CBM is mainly active with partners in Ethiopia, Nigeria, Uganda, Kenya, Tanzania, Pakistan and India. CBM actively participates in the development and implementation of preferred practises of the International Coalition for Trachoma Control (ICTC), WHO and national guidelines.
- NTD programmes: In 2007 CBM, in collaboration with the Ministry of Health and other partners, started our first comprehensive NTD control programme in Burundi. This successful approach has now been expanded in line with WHO recommendations and national policies to similar comprehensive and integrated programs in Nigeria and DRC; CAR and South Sudan are planned to follow as it becomes feasible.
The primary focus in many current NTD programmes is on the important prevention and treatment as a public health problem through preventive chemotherapy (PCT) using Mass Drug Administration (MDA).
However, it is important to recognise the need for the systematic inclusion of a comprehensive continuum of care for all people already affected, in order to reduce their suffering from the disease, stigma and poverty, and enable full participation in family and community life. In this context – and in line with the SDGs – CBM promotes fully comprehensive, integrated and inclusive (accessible, barrier free) NTD programs that build on effective intersectorial collaboration. CBM’s and our partners’ strong experience in eye health, community based rehabilitation (CBR), mental health, self-help groups and livelihood results in the availability of unique technical expertise in these often-neglected areas. To further promote, support and mainstream this approach CBM actively participates in the “Disease Management, Disability and Inclusion” (DMDI) working group of the NTD-NGDO-Network (NNN).