The Invisible Hurdle: Neglected Tropical Diseases
You’ve probably never heard of leishmaniasis
Leishmaniasis, among many other diseases, belong under the umbrella of ‘neglected tropical diseases’- diseases that affect more than 1 billion worldwide, especially developing countries in Asia and Africa. Many of them, such as ascariasis, can be treated with accessible mediation, such as albedazole. As the name implies, they do not receive much attention from policy-makers, despite being an unavoidable hurdle to achieve the Sustainable Development Goals - 17 goals set by the UN in 2015, which includes eradicating abject poverty and hunger, while developing education, sanitation, and gender equality.
(Source: Foundation for Neglected Disease Research)
Although subtle, it is undeniable that NTDs have broad linkages and effects, connected to a large number of aforementioned goals. Therefore, with the goal of alleviating NTDs, one would be accelerating progress in a number of other developmental areas, such as poverty, as a strong and healthy population is essential for economic development. NTDs such as leishmaniasis can cause severe disfigurement, withholding victims from working and providing for their families, while burdening their families with medical costs. Many countries with a high prevalence of NTDs are low-income or developing, such as South Sudan, ergo the government can’t support free healthcare, exacerbating the problem.
On a local level, this might lead to generations locked within an incessant cycle of poverty, due to medical bills and few providers. On a nationwide level, this might lead to significant economic losses- a study of elephantiasis (a parasitic disease that leads to extreme swelling and disfigurement) in India showed that the economy lost $842 million per annum, due to treatment costs and reduced working hours.
It is indisputable that some parasitic NTDs are directly linked to malnutrition, such as ascariasis, caused by a species of parasitic roundworm. The worms tend to reside within the host’s small intestine, and absorbs all the nutrients, while simultaneously depriving their host of them. Deprivation of nutrients can lead to various unpleasant consequences- for example, a person deprived of protein will contract Kwashiorkor’s disease, in which fluid causes swelling under the skin, and an enlarged belly. The effect of NTDs on hunger is furthered by the fact that many countries possess agriculture as a major industry. With debilitated farmers, production will decrease, causing an increase in food prices, and widespread hunger.
Education Mandela once said, ‘Education is the most powerful weapon which you can use to change the world.’ Educational outcomes are extremely limited for children affected by any debilitating disease, and some might have to opt out of school in order to care for others affected by the spread of NTDs. Many of NTDs are caused by parasitic worms, which can be controlled by annual, school-based deworming- a process which decreases absenteeism by 25%, while being affordable, as it costs 50 cents per child. A higher population of educated people is correlated with better employment, therefore improved economic development, advancing a country on a nationwide scale.
Women are disproportionately affected by poverty, lack of education, lack of political power and land ownership, due to reasons tied to traditional roles and stigma, which leads to a higher proportion of women in traditional household positions. In a household role, women are expected to perform tasks, such as washing clothes and gathering water, that could expose them to water-borne parasites like schistosomiasis/bilharzia- an infection that causes extensive organ damage. As mentioned before, many NTDs cause disfigurement and scarring, which could lead to prejudice, unemployment and even abandonment by spouses and family, while they are in need of care. By reducing NTDs, millions could be saved from stigma and disfigurement, while stimulating social and economic progression.
Improvement in water, sanitation and hygiene is critical in the development of living conditions, the eradication of NTDs, and diseases in general. The lack of clean and reliable water and sanitation, especially in communities that share a common water source, could facilitate the spread of water-borne diseases and infections. This is the core of many NTDs, so improving them could reduce NTDs by significant margins - trachoma, an infectious disease that caused the blindness of almost 2 million, was predicted to decrease by 27%. Trachoma is spread via discharge from the eyes or nose of an infected person, so good hygiene is essential to limit widespread infection.
(Source: Aid for Africa)
Similarly, ensuring the safety of drinking water, such as reinforcing protected wells and installing boreholes has been fundamental in the elimination of guinea worm disease (dracunculiasis), caused by a water-borne parasite that lives within water fleas, but can be transmitted to humans that drink the infected water. The infection causes immense pain, incapacitating people and limiting their ability to care for themselves, attend school, and work. Extraction is highly painful and performed manually, consisting of winding the worm around a stick or gauze, and pulling the worm out. The global effort to eradicate guinea worm disease has been hugely successful, decreasing from 3.5 million global cases in 1986, to 28 in 2018. The Guinea Worm Eradication Campaign educates communities to filter drinking water, and prevents further spread by urging the infected to avoid entering water sources. By doing this, the Guinea Worm Eradication Campaign was predicted to have saved 80 million potential victims from the disease.
What about other, arguably more devastating diseases?
Take malaria as a prime example - half the globe is at risk of malaria, with 202 million reported cases in 2015, and an estimated 429,000 deaths- approximately the same amount that NTDs are responsible for. However, unlike NTDs, malaria is not an umbrella term, but a singular disease, and due to the international interest and support that malaria receives, it is not defined as a NTD. The effects of malaria are devastating, with some cases resulting in death, unlike many NTDs, which are largely chronic conditions that impair rather than kill. Due to its mortality rate and prevalence, some argue that diseases such as malaria should be prioritised.
(Source: Centre for Disease Control and Prevention)
It is paramount to remember that malaria is lethal and widespread, but methods of malarial and NTD prevention can overlap- encouraging better hygiene can limit the spread of malaria through blood transfusions and sharing needles, while limiting the spread of NTDs through poor hygiene such as trachoma. To achieve the Sustainable Development Goals, no one should forget, or undermine the importance or prevalence of diseases, well-known or not, and the hurdle that it constructs.