Current issues in the Control of Neglected Tropical Diseases (NTDs)

LIST OF NTDs
1.       Buruli ulcer                                                         2.   Hydatidosis
2.       Cholera                                                                                4.   Leishmaniasis
5.       Cysticercosis                                                      6.   Lymphatic filariasis
7.       Dracunculiasis                                                    8.   Onchocerciasis
9.       Foodborne trematode infections             10.  Schistosomiasis
11.   Dengue haemorrhagic fever                       12.  STHs
13.   African  Trypanosomiasis

l  Affect approx. 1 billion people or 1/6 of world popn (1 in 6)
l  Affect poorest and most vulnerable popns
l  Mainly tropical & sub-tropical areas
l  Life-long infections (morbidity,  physical disability, gross disfigurement)
l  Acute infections (transient, severe, fatal)
l  Social stigmatization and abuse

l  Available effective, inexpensive or donated drugs for their prevention & control (e.g. leprosy, trachoma, LF, onchocerciasis, schistosomiasis, STHs;
l  Simple diagnostic tools & safe, effective treatment give prospects (Buruli ulcer, cholera, Afr. Trypanosomiasis, leishmaniasis)
l  Vector control tools

WHO strategies
          Preventive Chemotherapy & Transmission Control
          Innovative & Intensified Disease Management
          Disease Control in Humanitarian Emergencies
          Vector Control Management

Global Buruli Ulcer Initiative (GBUI)
          Raising awareness
          Improving access to early diagnosis, treatment & prevention of disability
          Strengthening surveillance systems
          Priority research 

Cholera
Treatment: ORS or IVF (severe)
Prevention & control:
1.       Case management – rehydration
2.       Surveillance systems (IHR)
3.       Multisectoral approach
4.       Water supply & sanitation
5.       Personal hygiene, food safety, HE
6.       Oral cholera vaccines

Dracunculiasis - Eradication Programme
          Effective case containment measures
          Community-based surveillance
          Target specific interventions
          Epidemiological mapping
          Sustain advocacy
          Certification of disease eradication

Lymphatic filariasis (elephantiasis) GPELF strategies:
1.       MDA (DEC+albendazole; ivermectin + albendazole)
2.       Mapping
3.       Care & prevention of LF-related disability

Onchocerciasis (River blindness)
          CDTI
          Vector control (in some African countries)

Schistosomiasis & STHs
 Reasons for new control strategy:
1.       Reduced drug costs
2.       Goal of the programme: Reduce intensity

Strategy: Piggy-backed into existing networks:
1.       School system
2.       Involving non-medical people
3.       Special health campaigns
4.       Stocking local health posts & pharmacies with drugs

Benefits:
1.       Reduce cost delivery & treatment
2.       Stable programme
3.       Long lasting
4.       Improve health status (children & pregnant women
)
Leprosy
Final Push to Eliminate Leprosy:
1.       Diagnosis & treatment (free)
2.       Capacity building of health workers
3.       Increased awareness of early signs & motivating people to seek treatment
4.       Ensuring treatment of all affected

MDT regimens
PB adult treatment (PB adult blister pack - Green): 6 packs
Once a month: Day 1
-          2 capsules of rifampicin (300mgx2)
-          1 tablet of dapsone (100mg)
Once a day: Days 2-28

- 1 tablet of dapsone (100mg)

PB child treatment 10-14 yrs (PB child blister pack - Blue): 6 packs
Once a month: Day 1
-          2 capsules of rifampicin (300mg+150mg)
-          1 tablet of dapsone (50mg)
Once a day: Days 2-28
- 1 tablet of dapsone (50mg)

MB adult treatment (MB adult blister pack - Purple): 12 packs
Once a month: Day 1
-          2 capsules of rifampicin (300mgx2)
-          3 capsules of clofazimine (100mgx3)
-          1 tablet of dapsone (100mg)
Once a day: Days 2-28
- 1 capsule of clofazimine (50mg)
- 1 tablet of dapsone (100mg)

MB child treatment 10-14 yrs (MB child blister pack - Brown): 12 packs
Once a month: Day 1
-          2 capsules of rifampicin (300mg+150mg)
-          3 capsules of clofazimine (50mgx3)
-          1 tablet of dapsone (50mg)
Once a day: Days 2-28
- 1 capsule of clofazimine every other day (50mg)
- 1 tablet of dapsone (50mg)







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