1) Nepal is endemic for 8 neglected tropical diseases including lymphatic filariasis (LF), trachoma, soil-transmitted helminths (STH), dengue fever (DF), kala-azar, leprosy, rabies, and cysticercosis. Dengue cases in Nepal have increased significantly in 2019. 2) Nepal has developed national plans and programs to control and eliminate several NTDs, including kala-azar elimination by 2020, LF elimination by 2020, and trachoma elimination through the SAFE strategy. Integrated preventative chemotherapy is conducted for LF and STH. 3) Major challenges for NTD control in Nepal include addressing climate change and den

1. Seminar on
Neglected tropical diseases: current scenario, policy option for prevention and
control and constrain and challenges in Nepal
Under the cordial guidance of
Hari Prasad Kafle
Associate Professor (Public Health)
By
Sushmi Acharya
Exam. Roll. No.: 16370168
At
Faculty of Health Sciences
SHAS, Pokhara University
2019
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2. Introduction
• Neglected tropical disease is umbrella term for a large group of
diseases
• “Chronically endemic and epidemic-prone tropical diseases, which
have a very significant negative impact on the lives of poor population
and remain critically neglected in the global public health” By WHO
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3. 3

4. 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, kala-azar, 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 the total collective burden of all other NTDs in Nepal
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5. Common Features of NTDs
• Proxy for poverty and disadvantage
• Predominantly affect populations with low visibility and little political
voice
• Do not travel widely
• Cause stigma and discrimination, especially of girls and women
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6. Contd..
• Impact on morbidity and mortality
• Relatively neglected by research
• Can be controlled, prevented and possibly eliminated using effective
and feasible solutions.
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7. Scenario
• NTDs affect more than 1.5 billion of the poorest, most marginalized
communities worldwide
• 149 countries and territories are affected by at least one neglected
tropical disease
• More than 70% of cases are affected by two or more diseases
• SEA region is the second among WHO region with largest burden of
NTDs
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8. 8

9. Dengue in Nepal
• 4,000 dengue cases have been identified since the beginning of the
outbreak of 2019
• According to Epidemiology and Disease Control Division, Teku,
number of people suffering from dengue reached 1,537 from July 17
till August 28
• According to EDCD, over 60 people contracted dengue in Kathmandu
valley as of August 28
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10. डेंगु रोगको अद्यावजिक अवस्था २०७६।७७ (भाद्र
11 गते सम्म)
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11. Kala-azar
• In 2074/75, there has been slight increase in reported cases (239 Kala-
azar cases) compared to previous year
• The case fatality rate was 2.93 percent in 2074/75 at national level
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12. Global initiatives to control and prevent NTD
• 2006 USAID launched its NTD program
• In 2007, WHO lunched a “global plan to combat Neglected Tropical
Diseases”
• In 2010, the first WHO report on neglected tropical diseases “working
to overcome the global impact of neglected tropical diseases” was
released
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13. Contd..
Which recommended 5 combinable key strategies:
(i) Preventive chemotherapy
(ii) Intensified case management
(iii)Vector control
(iv) Safe water, sanitation, and hygiene (WASH)
(v) Veterinary public health
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14. Contd..
• In 2013, second report on neglected tropical diseases, “sustaining the
drives to overcome the global impact of neglected tropical diseases”
was released
• WHO published its Third (2015), and—very recently—Fourth Report
on NTDs (2017)
• In SDG the NTDs are explicitly mention under target 3.3
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15. Control and prevention of NTD in Nepal
1. EDCD formulated a National Plan for Eliminating Kala-azar
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.
• Reduce case fatality rates to ZERO.
• Detect and treat (PKDL) to reduce the parasite reservoir.
• Prevent and manage Kala-azar HIV–TB co-infections
• The national plan was revised in 2010 as the National Strategic Guideline
on Kala-Azar Elimination in Nepal
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16. Contd..
2. The EDCD formulated a National Plan of Action for the Elimination of
Lymphatic Filariasis in Nepal (2003–2020)
Targets:
• To scale up MDA to all endemic districts
• Achieve <1% prevalence in endemic districts
Objectives:
• To eliminate LF as a public health problem by 2020
• To interrupt the transmission of lymphatic filariasis
• To reduce and prevent morbidity
• To provide deworming through albendazole to endemic communities
especially to children
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17. Contd..
3. Dengue Control Programme
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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18. Contd..
Leprosy control program
• National Leprosy Strategy 2016-2020 ( 2073-2077) develop and
endorsed.
• Revised leprosy guide line in line with national leprosy strategy and
global leprosy strategy.
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19. Contd..
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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20. National zoonosis control programme
Goal
• No people dies of rabies 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 outbreaks
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21. National NTD Program
• A national plan of action for the integrated control of three disease
(STH, TRA, LF) was drafted in 2009 with 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 districts co-endemic for LF and STH, MDA is conducted
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22. 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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23. Constrain and Challenges
• Addressing climate change and curbing Aedes spread in urban
environments; dengue identified as global threat in 2019
• 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.
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24. Contd..
• The biggest challenge for LF is the persistent high prevalence in some
districts despite completing the recommended rounds of MDA
• Emerging parasite resistance against albendazole and mebendazole
• Insufficient activities in low endemic districts for reducing the disease
burden
• To maintain access and quality service at HF level
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25. Contd..
• Late detection of cases still involves 30% of all patients, resulting in
costly treatment
• Accelerating elimination of congenital transmission through active,
systematic screening of girls and women
• Sustaining high rates of treatment coverage over many years
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26. Contd..
• To maintain access and quality of services in low endemic mountain
and hill district
• To assess the magnitude of disability due to leprosy
• To further reduce stigma and discrimination against affected persons
and their families
• Strengthening of index case & contact surveillance, recording and
reporting system
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27. Bibliography
• World Health Organization. Defeating neglected tropical diseases:
progress, challenges and opportunities. World Health Organization,
2019.
• World Health Organization. Tuberculosis, HIV, malaria and neglected
tropical diseases: strengthening collaboration to prevent and manage
antimicrobial resistance. 2019.
• World Health Organization. Integrating neglected tropical diseases into global
health and development. 2017 2019
• Dengue in Kathmandu threat of large outbreak. The Himalayan Times.
2019.
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28. Contd..
• Annual report 2074/75, MoHP
• Jai p Narain et al. “Neglected tropical disease in the WHO south East Asian
region”bull world health organization 2010.
• World Health Organization. First WHO report on neglected tropical
diseases. Working to overcome the global impact of neglected tropical
diseases. Geneva, Switzerland: WHO, 2010.
• World Health Organization. Fourth WHO report on neglected tropical
diseases. Integrating neglected tropical diseases into global health and
development. Geneva, Switzerland: WHO, 2017.
• Fürst T, Salari P, Llamas LM, Steinmann P, Fitzpatrick C, Tediosi F. Global
health policy and neglected tropical diseases: Then, now, and in the years to
come. PLoS neglected tropical diseases. 2017 Sep 14;11(9):e0005759.
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29. THANK YOU!
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