The term essentially encompasses a group of neglected tropical diseases (NTDs). Their characteristic feature is that they almost only affect poor people with poor heath and that research funds are virtually non-existent. In addition, they tend to be chronic conditions, in contrast to the acute tropical diseases such as Ebola or West Nile Fever. Although many of these diseases could be combated with simple measures, there is no money to distribute medicines and knowledge to the affected people.
The seven most important NTDs in terms of incidence are: the worm infections ascariasis, trichuriasis and hookworm (soil-transmitted helminth infections), bilharzia of the bladder and gut (schistosomiasis), elephantiasis (lymphatic filariosis), trachoma and river blindness (onchocerciasis). Other neglected diseases include: Leishmaniasis, the South American Chagas disease and the African sleeping sickness (both trypanosomiasis-type diseases), leprosy, Buruli ulcer and Guinea worm (dracunculiasis). An extended list also includes Dengue fever, diseases caused by treponematodes, leptospirosis, stronglyoidiasis, trematode infections, neurocysticercosis, scabies and other chronic tropical diseases.
The neglected tropical diseases are typical diseases of poverty. They rank among the most common infections among the almost 3 billion people who have less than 2 USD a day on which to live. These diseases are mainly to be found in the poor rural areas and the urban slums of Africa, Asia and Latin America. The worst-affected area is Sub-Saharan Africa. Almost all neglected tropical diseases are rampant at the same time and what is more, health programmes to provide preventative treatment are virtually non-existent.
In the Ivory Coast we have started in 2007 two projects targeted specifically at neglected diseases among 40'000 children and adults. In Cameroon and the Central African Republic, we include these diseases in all our community and basic health projects, and in India, they are an important focal point of the slum projects. Moreover, all of our measures against leprosy and Buruli ulcer form part of the fight against neglected diseases.
In order to be able to say how many people are affected, one can either look to see how many people are at acute risk of infection (population at risk) or count the number of people actually infected at a specific time (prevalence). As many as 4 billion people are at risk from the neglected diseases (especially ascariasis). The disease with the lowest distribution is Chagas disease with only 25 million people at risk. The disease with the highest prevalence, that is to say the disease with the largest number of sufferers is worm infection, affecting 600 to 800 million children. The least common neglected disease is Guinea worm. With only around 10,000 active cases of the disease left, it may soon be close to eradication.
Today there are effective and inexpensive medicines available for the majority of tropical diseases. These can be used both for healing purposes as well as for preventive chemotherapy. Deworming a child or treating a case of bilharzia twice a year costs less than one Swiss franc. Through the use of so-called rapid-impact packages, several diseases can be combated simultaneously with a single preventative treatment. A particularly effective form is mass drug administration, during which a whole section of the population is treated as completely as possible with medicines, thereby reducing the incidence of the disease by a large number. However, if the disease has caused disabilities such as paralysis, crippling or blindness, the sufferers’ quality of life can only be restored through complex measures (surgery, rehabilitation).
The neglected diseases for which there are effective medicines against their cause could in theory be eradicated by means of mass treatments with combined medicines (see preceding question). In practice, however, there will be always a residual number of untreated cases after this type of treatment and there will be always a few incompletely eliminated pathogens due to the fact that the medicines are not 100% effective. As a consequence, there is always an increase in infections after a period of time. For the above reasons, these types of mass drug administration have to be repeated on a regular basis (once or twice a year) for a long time in order to keep people healthy and the disease at bay in the longer term.
Eradication of the disease generally calls for a vaccine that totally prevents it. Another means of eradication is to interrupt the transmission route. This applies to Guinea worm for example. Since it needs open areas of water to spread, enclosed wells or pumps interrupt the infection cycle. The pathogen can also be easily filtered out of the drinking water. However, the best way to eradicate all neglected diseases is to eliminate the poverty from which the people suffer and is the cause of their poor social, hygiene and health-related living conditions.
DALY stands for disability adjusted life years. It is a measurement technique used to estimate a person’s number of healthy years of life lost due to disability. It provides a way of measuring the impact of chronic diseases and disabilities. For example: a healthy person and one severely disabled by leprosy might have the same life expectancy of 55 in a particular African country. As a result of the disability, however, the leprosy victim is deprived of many years of healthy life, so that he may possibly have only 30 "normal" years and looses 25 DALYs in comparison to a healthy person. Leprosy has therefore cost him 25 DALYs. It is estimated that leprosy causes the loss of 200,000 DALYs each year, a figure that expresses the suffering of some two to three million leprosy victims.
The Millennium Development Goals (MDGs) were adopted by the United Nations in 2000. They set out 8 goals to be applied in the fight against poverty, disease and environmental destruction together with the worldwide promotion of development in the years up to 2015. The 8 goals are supplemented by 18 targets, each of which has accorded measurement values (indicators). The MDGs are to be implemented by the world community by 2015. The baseline for the indicators are the basic data for 1990.
2007 marked the halfway point in the achievement of the millennium goals. At the present moment, it appears as though many South American and Asian countries will be able to reach the goals. As far as Africa is concerned, the prognoses are rather gloomy. Real improvement has only been achieved in a few countries (among them Ghana and Tanzania); in many there has even been significant deterioration compared to 1990 (such as Zimbabwe and the DR Congo).
The Ottawa Charter for health promotion was adopted by the World Health Organisation WHO in 1986. Health promotion is not early detection or simply the prevention of diseases, but describes a process which actively promotes health.
The concept "Enable, mediate, advocate" which describes how healthy living environments are to be created and maintained is of central importance in health promotion. Living conditions can either make and keep people healthy or make them ill. Here, healthy living environments are characterised by empowering the individuals and the community to maintain good health (Enable). Healthy living environments for the people can only be achieved in close collaboration between all the responsible state sectors (education, health, work, urban planning, security, etc.) as well as with the non-governmental organisations (Mediate). Finally, people should receive assistance in their own endeavours to create healthy living conditions and also become actively involved through codetermination in their society (Advocate).
Since its adoption, the Ottawa Charter has prompted many follow-up initiatives. Agenda 21 on sustainable development is just one of them. And the worldwide Medicus Mundi network is an offspring of this movement.
As far as our project work is concerned, health promotion means that we concentrate on people’s living conditions and work together with them to find ways in which they can improve and maintain their health themselves. Community-based health care is one of the focal points of our project work. We also help people to stand up more effectively for their rights to good health. The aim is not to combat an individual disease as quickly as possible by means of external specialists, but rather to empower the people to define their problems for themselves and find their own ways to achieve a better and healthier life. While this process may take longer than a quick external intervention, it has a better chance of achieving a sustained improvement in quality of life.