Neglected Tropical Diseases: An Update From the WHO

Distribution of soil-transmitted helminths (STHs) and proportion
of children requiring preventive chemotherapy; where we practice
in Honduras STHs are a major problem (www.who.int)

The World Health Organization (WHO) just released its second report on Neglected Tropical Diseases (NTDs); this is a 152 page document outlining the global response to combatting NTDs. The WHO also released a one page summary of this report's findings which can be found here.

As I have previously noted, NTDs include a group of seventeen tropical infections, mostly worms, that are associated with high morbidity (things such as poor growth and mental development in children, pregnancy complications) but low mortality. Despite their major negative effects on health they do not receive much "press" (as opposed to better known diseases such as malaria, HIV and tuberculosis). It is estimated that 1 in 6 people in the world currently suffer from an NTD. 

Global improvements in access to STH therapy have occurred over
the past few years (www.who.int)

In our work in Honduras we focus on decreasing the burden of NTDs, specifically, soil-transmitted helminths (intestinal worms). We estimate that somewhere between 30-70% of the patients we see are infected with one or more of these worms. We provide anti-helminthic therapy according to WHO guidelines, with the hopes of decreasing the overall burden of these infections in the population at large. According to the WHO, "deworming school-aged children is probably the most economically efficient public health activity that can be implemented in any low-income country."

Overall the WHO document is positive, noting recent improvements in combatting NTDs globally. Two diseases have been targeted for elimination, including guinea worm disease in 2015 and yaws in 2020. Global coverage for many other NTDs has improved in recent years, as well. Although there have been significant advances over the past few years, there is still a great deal of work to be done. 

The report also highlights the global dengue problem; the incidence of this disease has increased 30-fold in the past 50 years, and sustainable preventive measures need to be adopted globally to prevent continued spread of this mosquito-borne illness. 

VCU's Global Health & Health Disparities Program Sets Off for Honduras

Drs. Mason, Stevens and Bearman meeting with community
leaders and the minister of health, Olanchito, Honduras,
January 2012

Today our team leaves to meet with community leaders and the ministry of health in Yoro, Honduras. 

Traveling to La Hicaca

Since 2008 we have been serving people across a series of 17 villages in and around the La Hicaca area of rural Honduras. There are approximately 2,000 people in this area, most of whom have extremely limited access to healthcare (see here for a study we did in 2011 looking at people’s ability to access care in this area). We have a large-scale water filter program in the area, and participate in direct medical care, as well. We work closely with our community partners to support health projects they identify as being high yield (some past examples of such projects include a water chlorination education campaign, an anemia point prevalence survey and a survey project examining indoor air pollution).

Drs. Mason, Bearman and Stevens working on the
water filter program, La Hicaca

Every January a small group of us goes down to meet with our community partners and the ministry of health. Our purpose with these trips is three-fold: to prepare for our (larger) June medical trip, to identify new ways in which we can support the people we serve, and to report back on our findings from the previous trip’s work. This year we will be presenting our data from the anemia point prevalence survey, from our survey project on indoor air pollution, and from our study examining the clinical and microbiologic efficacy of our water filter program. Of note, the 2 lead student researchers on the two latter studies just presented their data at yesterday's Virginia ACP Associates' meeting. 

Working on the anemia point prevalence survey, La Hicaca,
June 2012

Since the inception of our program (the VCU Global Health & Health Disparities Program, or GH2DP), we have had over 8,000 direct medical and pediatric encounters, and have distributed over 200 water filters (each of which will provide clean drinking water to an entire family for 2+ years). We also provide de-worming therapy and have been involved in numerous other projects since 2008.

Providing clinical care, La Hicaca, June 2012

For anyone interested in our work, please consider following along as we conduct our planning trip. I will attempt to blog "from the field," and will provide updates in as close to real-time as I am able.

Neglected Tropical Diseases: Becoming Less Neglected?

Ascaris lumbricoides (the "large common roundworm"),
a soil-transmitted helminth; cdc.gov

Here is a nice article outlining the global problem of neglected tropical diseases, or "NTDs." These are a group of seventeen tropical infections, mostly worms, that are associated with high morbidity (things such as poor growth and mental development in children, pregnancy complications) but low mortality. Despite their major negative effects on health they do not receive much "press" (as opposed to better known diseases such as malaria, HIV and tuberculosis).

It is estimated that 1 in 6 people in the world currently suffer from an NTD. 

The article links to the "END7" campaign that has some great resources about NTDs, including a two minute long YouTube video that is worth checking out. Some nice general information about the seven most common NTDs can be found here.

In our work in Honduras we focus on decreasing the burden of NTDs, specifically, soil-transmitted helminths (intestinal worms). We estimate that somewhere between 30-70% of the patients we see are infected with one or more of these worms. We provide anti-helminthic therapy according to WHO guidelines, with the hopes of decreasing the overall burden of these infections in the population at large. According to the WHO, "deworming school-aged children is probably the most economically efficient public health activity that can be implemented in any low-income country."

The overall tone of the Guardian article is hopeful, noting that the movement to combat NTDs has gained momentum. However, as emphasized in the article, efforts to combat these diseases should be inter-disciplinary and address both environmental health issues in addition to eradicating disease at the individual level.