2. Introduction
• Neglected tropical diseases (NTDs) are a diverse group of 20 condition
tropical infections that are common in low-income populations
in developing regions of Africa, Asia, and the Americas. They are caused by
a variety of pathogens, such as viruses, bacteria, protozoa, and parasitic
worms (helminths).
• “These diseases cause devastating health, social and economic
consequences to more than one billion people.” BY WHO.
• The epidemiology of NTDs is complex and often related to environmental
conditions. Many of them are vector-borne, have animal reservoirs and are
associated with complex life cycles. All these factors make their public-
health control challenging.
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4. Global Burden
• Over 1 billion people worldwide are affected by one or more
NTDs, with the majority residing in tropical and subtropical
regions.
• The most common NTDs include soil-transmitted helminth
infections, schistosomiasis, lymphatic filariasis, onchocerciasis,
and trachoma.
• NTDs are prevalent in 149 countries, affecting the world's
poorest populations, particularly in sub-Saharan Africa, Asia,
and the Americas.
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5. In the Context of Nepal
• The Nepal health research Council (NHRC) with the support of
the WHO organized a workshop on NTDs agreed that Nepal is
already endemic for eight NTDs.
• These are LF, trachoma, STH, DF, Kalazar, Leprosy, rabies,
Cysticercosis.
• They also agreed that snakebite envenoming is an important NTD
in Nepal whose morbidity and mortality burden in the country
may exceed that total collective burden of all other NTDs in
Nepal.
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6. Why are they called neglected
tropical diseases?
• Almost absent from the global health agenda.
• Even today, when the focus is on Universal Health Coverage,
NTDs have very limited resources
• Ignored by global funding agencies.
• NTDs are diseases of neglected populations that perpetuate a
cycle of poor educational outcomes and limited professional
opportunities; in addition, are associated with stigma and
social exclusion.
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7. Global initiatives to control and prevent
NTD
1. 2006 ESAID launched its NTD program.
2. In 2007, WHO launched a “global plan to combat Neglected Tropical Diseases.’’
3. In 2010, the first WHO report on neglected tropical diseases “working to overcome the
global impact of neglected tropical disease” was released.
Which recommended 5 combinable key strategies:
• Preventive chemotherapy
• Intensified case management
• Vector control
• Safe water, sanitation and hygiene (WASH)
• Veterinary Public health
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8. Global initiatives to control and
prevent NTD
4. In 2013, second report on neglected tropical disease, "sustaining
the drives to overcome the global impact of neglected tropical
diseases’’ was released.
5. WHO published its Third (2015), and –very recently- Fourth
report on NTDs (2017).
6. In SDG the NTDs are explicitly mention under target 3.3
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9. Global initiatives to control and
prevent NTD
7. WHO’s New Roadmap for 2021–2030:
This is a blueprint to drive global efforts in the fight against NTDs in the context of the United
Nations Sustainable Development Goals.
The overarching 2030 global targets are:
• Reduce by 90% the number of people requiring treatment for NTD.
• Reduce by 75% the disability-adjusted life years (DALYs) related to NTD.
• Eliminate at least one NTD from 100 countries
• Eradicate two diseases (dracunculiasis and yaws) globally
8. London Declaration on NTDs: It was adopted on 30th January, 2012 to recognize the
global burden of NTDs.
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10. Control and Prevention of NTD in Nepal
1. EDCD formulated a National Kala-azar Elimination Program
Goal: The goal of kala-azar elimination program is to contribute to mitigation of poverty in
kala-azar endemic districts of Nepal by reducing the morbidity and mortality of the disease
and assisting in the development of equitable health systems.
Target: Reduce the incidence of kala-azar to less than 1 case per 10,000 populations at district
level.
Objectives
• Reduce the incidence of kala-azar in endemic communities with special emphasis on poor,
vulnerable and unreached populations.
• Reduce case fatality rates from kala-azar to ZERO.
• Detect and treat Post-Kala-azar Dermal Leishmaniasis (PKDL) to reduce the parasite
reservoir.
• Prevent and manage Kala-azar HIV–TB co-infections.
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11. 2. The EDCD formulated a National Plan of Action for the
Elimination of Lymphatic Filariasis in Nepal (2003-2020).
Goal: Elimination of Lymphatic Filariasis from Nepal by the year 2030 as a
public health problem by reducing the level of the disease in population to a
point where transmission no longer occurs.
Objectives
• To interrupt the transmission of lymphatic Filariasis
• To reduce and prevent morbidity
• To provide de-worming benefit using Albendazole to endemic
communities To reduce mosquito vectors through application of suitable
and available vector control measures (Integrated Vector Management)
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12. Targets:
• To cover with MDA in all endemic districts by 2014
• To eliminate lymphatic filariasis as a public health problem by the
year 2030 by reducing the microfilaria rate to below 1 percent (OR
Antigenemia less than 2%).
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Contd….
13. 3. Nepal’s Dengue Control Programme
Goal: To reduce the morbidity and mortality due to dengue fever, dengue
hemorrhagic fever (DHF) and dengue shock syndrome (DSS).
Objectives:
• To develop an integrated vector management (IVM) approach for prevention
and control.
• To develop capacity on diagnosis and case management of dengue fever, DHF
and DSS.
• To intensify health education and IEC activities.
• To strengthen the surveillance system for prediction, early detection,
preparedness and early response to dengue outbreaks.
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14. Leprosy free Nepal
Goal
• Elimination of leprosy (interruption of transmission of leprosy) at
the sub-national (municipality)
• National leprosy strategy 2016-2020 (2073- 2077) develop and
endorsed.
• Revised leprosy guide line in the line with national leprosy strategy
and global leprosy strategy.
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15. National Trachoma Program
• NTP has completed the implementation of the SAFE program
activities in 20 trachoma endemic districts of Nepal from 2002
to 2015.
Component of SAFE program are:
• Surgery
• Antibiotics
• Face washing
• Environmental improvement.
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16. National Zoonosis Control
Programme
Rabies
Goal
• No people dies of rabis or poisonous snake bites due to the
unavailability of anti- rabies vaccine (ARV) or anti- snake venom
serum or timely health care services.
• To prevent, control and manage outbreak.
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17. National NTD program
• A national plan of action for the integrated control of three
disease (STH, TRA, LF) was drafted in 2009 with the support of
WHO.
• The GoN also has established the NTD steering Committee and a
technical working Group (TWG) for management of NTDs in
Nepal.
• In district co-endemic for LF and STH, MDA is conducted.
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18. NTD and WASH policy in Nepal
• Nepal has not yet publicly launched a National Master Plan
for the NTDs.
• Once developed, this document will provide national targets
for controlling the NTDs, including integration of WASH
activities into disease control efforts.
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19. Constrain and Challenges
• Addressing climate change and curbing Aedes spread in urban
environment: Dengue identified as global threat.
• Securing funding to support mapping, mass treatment and surveillance.
• Networking with dermatologists for confirmation of PKDL cases.
• Contribution of varied factors like- local transmission and lack of
epidemiological evidence leading to Kala-azar infections.
• The biggest challenges for LF is the persistent high prevalence in some
districts despite completing the recommendation rounds of MDA.
• Emerging parasite resistance against albendazole and mebendazole.
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21. Soil-Transmitted Helminths (STH)
Examples: Roundworm (Ascaris
lumbricoides), Hookworm (Necator
americanus, Ancylostoma duodenale),
Whipworm (Trichuris trichiura).
Transmission: Contaminated soil
containing parasitic larvae.
Impact: Malnutrition, anemia, impaired
growth, and cognitive development in
children.
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22. Schistosomiasis (Bilharzia)
Examples: Schistosoma mansoni,
Schistosoma haematobium, Schistosoma
japonicum.
Transmission: Contact with water infested
with parasitic larvae.
Impact: Chronic and acute morbidity,
affecting the urinary and gastrointestinal
systems.
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26. Chagas Disease
Causative Agent: Trypanosoma cruzi.
Transmission: Triatomine bug bites,
blood transfusion, and congenital
transmission.
Impact: Cardiovascular and
gastrointestinal complications
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27. Dengue Fever
Causative Agent: Dengue virus
(DENV).
Transmission: Aedes mosquitoes
(particularly Aedes aegypti).
Impact: High fever, severe joint pain,
bleeding, and, in severe cases, organ
failure.
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28. Leishmaniasis
Causative Agents: Various
Leishmania species.
Transmission: Sandfly bites.
Impact: Cutaneous,
mucocutaneous, and visceral
forms, affecting the skin, mucous
membranes, and internal organs.
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29. Leprosy
Leprosy, also known as Hansen's disease.
Causative agent: Bacterium Mycobacterium
leprae.
It primarily affects: The skin, peripheral
nerves, mucosa of the upper respiratory tract,
and the eyes.
Transmission: Respiratory droplets, usually
from untreated, prolonged contact with an
infected person.
Clinical Manifestations:
leading to skin lesions, nodules, and sensory
loss.
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30. Rabies
There are two forms of rabies: furious and
paralytic.
Causative agent: It is caused by
a lyssavirus transmitted through wounds or
bites from infected animals.
Transmission
• Through the bite of an infected animal, with
dogs being the primary source of human
rabies deaths globally.
• Other animals that can transmit rabies
include bats, raccoons, skunks, and foxes.
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31. Scabies
Causative agent: Sarcoptes scabiei mite.
Transmission: Through prolonged, skin-to-
skin contact with an infected person.
Infested clothing, bedding, or furniture,
though the mites cannot survive away from
the human body for an extended period.
Treatment: topical creams or lotions
containing scabicides such as permethrin or
ivermectin.
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32. References
• Neglected tropical diseases [WWW Document], n.d. URL https://www.who.int/news-
room/questions-and-answers/item/neglected-tropical-diseases (accessed 1.2.24).
• Upadhyaya, B.P., Shakya, G., Adhikari, S., Rijal, N., Acharya, J., Maharjan, L., Marasini, B.R., 2016.
Scrub Typhus: An Emerging Neglected Tropical Disease in Nepal. J. Nepal Health Res. Counc. 14,
122–127.
• EDCD|Zoonoses Control Program [WWW Document], n.d. URL
https://www.edcd.gov.np/section/zoonoses-control-program (accessed 1.2.24).
• https://www.who.int/news-room/questions-and-answers/item/neglected-tropical-diseases
• https://en.wikipedia.org/wiki/Neglected_tropical_diseases
• (“Neglated tropcal diseases ppt hari kafle - Google Search,” n.d- slide share.
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