Neglected Tropical Diseases (NTDs)

© CBM

Measuring the Mectizan dose needed for treatment of this person during a Mass Drug Administration campaign in Burundi, 2010

CBM supports Neglected Tropical Disease (NTD) programmes in areaswhere these diseases are identified as a public health problem. By building on our long experience and existing strengths, and by developing alliances and networks, we aim to achieve sustainable community-owned NTD programmes.

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 Millennium Development Goals (MDGs), NTDs hinder development, keeping individuals and communities trapped in a cycle of poverty.

who are the NTD'S?

Neglected Tropical Diseases are primarily parasitic and bacterial infections that thrive in impoverished settings, especially in the heat and humidity of tropical climates. They are spread by 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 causing pain and chronic disability, impairing childhood growth and mental development and hindering economic growth.

The following diseases are responsible for about 90% of the global NTD burden:

• Lymphatic filariasis (elephantiasis) – affecting 120 million people – is caused by parasitic worms transmitted by mosquitoes and can lead to the swelling of limbs also known as “elephantiasis”.
• Onchocerciasis (river blindness) – affecting 37 million people – is a parasitic disease caused by a roundworm and is the world's second-leading infectious cause of blindness. Read more on WHO website.
• Soil-transmitted helminths (3 types) – affecting 600-800 million people – are parasites found in soil that can cause a wide range of problems such as diarrhoea, abdominal pain, anaemia and general weakness; sever infection can impair growth and cognitive development.
• Trachoma – affecting 21 million people – is an infectious eye disease, and the leading cause of global infectious blindness. Read about - and download - the September 2013 CBM Trachoma Fact Sheet.
• Schistosomiasis (snail fever, also known as bilharzia) – affecting 200 million people – is caused by a parasitic worm; it can damage internal organs and, in children, impair growth and cognitive development.

Who is affected by NTDS?

More than 1 billion people - one-sixth of the world’s population - are affected by one or more NTDs (see WHO website). Another 2 billion people are at risk, mainly in the tropics and sub-tropics.

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 insidious and severe impairment often occurs after years of silent infection, leaving patients unaware of the need to seek care.

Why are NTDs affected?

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 often considered low priority in national health programmes and are neglected in health agendas and budgets.

The often low priority of NTDs at national and international level is also reflected in low research and development activities.

How does CBM combat NTDs?

The five major NTDs (elephantiasis, river blindness, soil-transmitted helminths, trachoma and snail fever) are also called ‘tool ready’ as there exist 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. Programmes based on preventive chemotherapy (most drugs donated by pharmaceutical companies) for the first four of the above diseases can be co-implemented improving effectiveness and efficiency.

CBM has been successfully involved in prevention of blindness from onchocerciasis and trachoma for more than 20 years.

• Onchocerciasis (river blindness) - CBM supports the annual treatment with Ivermectin through community directed implementation approach. CBM is mainly active with partners in CAR, Nigeria, DRC, Southern Sudan 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 Onchocerciasis Control, CBM was involved in the founding of the African Program for Onchocerciasis Control (APOC).
• Trachoma - CBM supports a comprehensive SAFE strategy (acronym for Surgery for trichiasis, Antibiotic therapy, Facial cleanliness, andEnvironmental improvement) with expertise mainly in trichiasis-surgery. CBM is mainly active with partners in Ethiopia, Myanmar, Pakistan, India, Tanzania, Vietnam, Afghanistan, Kenya, China, Cameroon and Nigeria. The number of people affected by blinding trachoma has fallen from 360 million people in 1985 to approximately 21 million people today.
• NTD programme - In 2007 CBM, in collaboration with the Ministry of Health and other partners, started a comprehensive NTD control programme in Burundi with financial support from Geneva Global. This is now focusing on impact surveys and integration into National Health Services for sustainability.

The primary focus in current NTD programmes is on prevention and treatment. However, it is important to recognise the need for continuum of care for people affected, in order to reduce suffering from morbidity, stigma and poverty, and enable participation in family and community life.

CBM’s and the partners’ strong experience in community based rehabilitation (CBR), self-help groups and livelihood results in the availability of unique technical expertise in this often-neglected area.