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Neglected Infectious
Diseases in The
Perspective of Global
Health
dr. Bintari Dwihardiani, MPH
Center for Tropical Medicine,Gadjah Mada University
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Definition
Infectious diseases which attack the poorestpopulation in the developing countries
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Neglected Infectious Diseases
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Neglected Infectious Diseases
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Neglected Infectious DiseasesCore: Soil transmitted helminthes
infection (STH) lymphatic filariasis Onchocerciasis Dracunculiasis Schistosomiasis Leishmaniasis chagas disease Human African
trypanasomiasis (HAT) buruli ulcer Leprosy trachoma
Others: Strongyloidiasis,
toxocariasis, loiasis,taeniasis, echinococcosis
Amoebiasis, giardiasis,
balantidiasis Bartonellosis, bovine
tuberculosis, leptospirosis,relapsing fever, rheumaticfever, treponematosis
Dengue fever, yellow fever,Japanese encephalitis,rabies, haemorrhagic fever
Mycetoma,paracoccidiomycosis
Scabies, myiasis, tungiasis
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Neglected?
There are effective control strategies but are not implementedglobally
Inadequate effort to develop diagnostics, drugs, or vaccines, andsecond line medicines
Inadequate research into pathogens biology and the bodysresponse
R & D expense in 2007 (estimates 2.56 billion): HIV/AIDS, TB,malaria spent 75% of total expense; helminthes, leprosy, buruliulcer, trachoma, chagas, leishmaniasis, trypanasomiasis spent
7.3%
Failure to put the issues in the national or international policy level
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Determinants
Geographically concentrated
Extreme poverty
Poor hygiene and sanitationPoor access to clean water
Non stable health system (in conflict)
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Burden
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Burden
Affect 1.2 billion people who earn less than 2$/day Disability: blindness, limb dysfunction, face
disfiguration
Impaired childrens growth, development, andphysical fitness
Pain, blood loss, liver and bladder disease Estimates for 2002: 177,000 deaths worldwide and
20 million DALYs (1.3% of the global burden ofdisease) Economic lost
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Estimates for Indonesia (2003)
Diseases People affected (prevalence)
Ascariasis 90 million (42%)
Trichuriasis 95 million (44%)
Hookworm 62 million (28%)
Schistosomiasis < 0.1 million (< 1%)
Leprosy 21,430
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Current Control strategy
Mass drugs administration (for helminthes infections)
Challenge: low coverage, drug resistance, re-infection, long termprogram, sustainability
Case management
Challenge: inadequate medicine and diagnosis methods, accessto medicine
Vector control
Challenge: resistance to insecticide, low coverage Sanitation and hygiene improvement
Challenge: funding limitation Lymphatic filariasis, leprosy, onchocerciasis, and chagas
diseases are targeted for elimination
Elimination is possible
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International Initiatives and
Partnership
Global Network for Neglected TropicalDiseases
Global Alliance to eliminate lymphatic
filariasisOnchocerciasis Elimination Program for the
America
Partners for parasite controlSchistosomiasis control initiative International trachoma initiative
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International Initiatives and
Partnership
Mectizan donation programme for fightingriver blindness
Bill and Melinda Gates FoundationDrugs for neglected diseases initiatives
Carter center
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New strategies elements
1. a comprehensive, multifaceted, community-based programusing all available control tools
2. well-articulated, transparent, and independent monitoring andevaluation
3. intensification ofbasic investigation of NTDs4. discovery and development ofnew diagnostic, therapeutic,
and preventive approaches;
5. expanded and qualified human capacity to guide, lead, andimplement these strategies at the local level.
6. As the presence of the diseases related to development, itwould be sustainable to integrate the control of the diseasesand development action
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Millennium Development Goal
End poverty and hunger
Universal education
Gender equality
Child health
Maternal health
Combat HIV/AIDS, malaria, and other diseases
Environmental sustainability Global partnership
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In Relation with Millennium
Development Goal
The disabling impact of NID lead to poverty: reduce thepossibility to earn income and the productivity.
STH and schistosomiasis impair childrens growth,development, and physical fitness
Hookworm and schistosomiasis cause anemia duringpregnancy
Infected pregnant women pass parasite antigens to thefetus, affecting the childs immune system so the
vaccination is less effective Female genital schistosomiasis infection increases HIV
risk STH, shistosomiasis, lymphatic filariasis promote
susceptibility to other diseases including TB andHIV/AIDS
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Reference List
1. Hotez PJ, Molyneux DH, Fenwick A, Kumaresan J, Sachs SE, Sachs JD etal. Control of neglected tropical diseases. N Engl J Med 2007;357(10):1018-1027.
2. Hotez PJ. The neglected tropical diseases and their devastating health andeconomic impact on the member nations of the Organisation of the IslamicConference. PLoS Negl Trop Dis 2009; 3(10):e539.
3. Hotez PJ, Fenwick A, Savioli L, Molyneux DH. Rescuing the bottom billionthrough control of neglected tropical diseases. Lancet 2009373(9674):1570-1575.
4. Mahmoud A, Zerhouni E. Neglected tropical diseases: moving beyond massdrug treatment to understanding the science. Health Aff (Millwood ) 2009;28(6):1726-1733.
5. Musgrove P, Hotez PJ. Turning neglected tropical diseases into forgottenmaladies. Health Aff (Millwood ) 2009; 28(6):1691-1706.
6. Moran M, Guzman J, Ropars AL, McDonald A, Jameson N, Omune B et al.Neglected disease research and development: how much are we reallyspending? PLoS Med 2009; 6(2):e30.
7. Mathers CD, Ezzati M, Lopez AD. Measuring the burden of neglectedtropical diseases: the global burden of disease framework. PLoS Negl TropDis 2007; 1(2):e114.
8. www.dndi.org
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