NOVEMBER 2012
This document serves as an update to “Out of the Dark”, a report published by MSF in October 2011, highlighting the need to prioritise the long-neglected area of paediatric tuberculosis (TB). This update will outline the key improvements and setbacks—the ‘highlights’ and ‘...lowlights’—that have occurred over the last year.
more
This guide is a resource for future health professionals who want to learn about and engage in abortion issues. Abortion is a critical but often neglected area of women’s rights, women’s health and health science education. The guide ences students was developed for health sciences students -inc...luding students in medicine, nursing, midwifery, pharmacology, public health and other related fields
more
The One Health Commission is a globally focused organization dedicated to implementing One Health and One Health actions around the world.
The goal of the One Health Research, Education and Outreach Centre in Africa (OHRECA) is to improve the health of humans, animals and ecosystems through capacit...y building, strengthening of local, regional and global networks and provision of evidence-based policy advice on One Health in sub-Saharan Africa. The centre has four thematic areas: control of neglected tropical zoonotic diseases; emerging infectious diseases; food safety and informal markets; and prevention and control of antimicrobial resistance.
more
Contains data from World Health Organization's data portal covering the following categories:
Mortality and global health estimates, Sustainable development goals, Millennium Development Goals (MDGs), Health systems, Malaria, Tuberculosis, Child health, Infectious diseases, Neglected Tropical Disea...ses, World Health Statistics, Health financing, Tobacco, Substance use and mental health, Injuries and violence, HIV/AIDS and other STIs, Public health and environment, Nutrition, Urban health, Noncommunicable diseases, Noncommunicable diseases CCS, Negelected tropical diseases, Infrastructure, Essential health technologies, Medical equipment, Demographic and socioeconomic statistics, Health inequality monitor, Health Equity Monitor, Child malnutrition, TOBACCO, Neglected tropical diseases, International Health Regulations (2005) monitoring framework, 0, Insecticide resistance, Oral health, Universal Health Coverage, Global Observatory for eHealth (GOe)
more
MEDBOX Issue Brief 26. Cholera is an acute diarrhoeal infection caused by eating or drinking food or water that is contaminated with the
bacterium Vibrio cholerae. Cholera remains a global threat to public health and is an indicator of inequity and lack of
social development. Researchers have esti...mated that every year, there are 1.3 to 4.0 million cases of cholera, and 21
000 to 143 000 deaths worldwide due to the infection.
However, cholera remains a neglected and underreported disease. Many cases are not recorded due to limitations in
surveillance systems and fears of potential impact on trade or tourism.
Today cholera affects 47 countries across the globe. Almost every developing country faces cholera outbreaks or
the threat of cholera. Major ongoing outbreaks are being reported from Afghanistan, Bangladesh, Democratic
Republic of Congo, Ethiopia and Nigeria. Major outbreaks are currently in Syria and Haiti.
Therefore, MEDBOX decided to produce issue briefs on cholera and available resources in Arabic, English and
French.
more
In 1997, the Fiftieth World Health Assembly adopted resolution WHA50.29 on the elimination of
lymphatic filariasis as a public health problem. Preliminary guidance from WHO printed in 2011 referred to “verification” as the official process by which the achievements of the Global Programme to El...iminate Lymphatic Filariasis (GPELF) would be confirmed. For the sake of harmonization, the terminology now used for elimination of lymphatic filariasis as a public health problem is “validation”. In 2015, the WHO Strategic and Technical Advisory Group for Neglected Tropical Diseases endorsed standardized processes for confirming and acknowledging success for all neglected tropical diseases targeted for eradication, elimination of transmission, or elimination as a public health problem.
more
This publication represents a key step forward in translating Control of the leishmaniases (WHO Technical Report Series, No. 949) into a more practical tool for health personnel directly involved in the case management of cutaneous leishmaniasis. With this manual, countries will have, for the first ...time, standardized diagnosis and treatment protocols, case definitions and indicators to enable them to easily track progress on cutaneous leishmaniasis case management across the Region. It will provide support to professionals in charge of cutaneous leishmaniasis, in order to alleviate the suffering of affected populations from this appalling disfiguring and stigmatizing neglected tropical disease.
more
Chagas is a complex, multidimensional phenomenon in which political, economic, environmental, biomedical, epidemiological, psychological, and sociocultural factors intersect. Nonetheless, the hegemonic conceptualisation has long envisioned Chagas as primarily a biomedical question, while ignoring or... downplaying the other dimensions, and this limited view has reinforced the disease’s long neglect. Integrating the multiple dimensions of the problem into a coherent approach adapted to field realities and needs represents an immense challenge, but the payoff is more effective and sustainable experiences, with higher social awareness, increased case detection and follow-up, improved adherence to care, and integrated participation of various actors from multiple action levels. Information, Education, and Communication (IEC) initiatives have great potential for impact in the implementation of multidimensional programs of prevention and control successfully customised to the diverse and complex contexts where Chagas disease persists.
more
After 100 years of chemotherapy with impractical and toxic drugs, an oral cure for human African trypanosomiasis (HAT) is available: Fexinidazole. In this case, we review the history of drug discovery for HAT with special emphasis on the discovery, pre-clinical development, and operational challenge...s of the clinical trials of fexinidazole. The screening of the Drugs for Neglected Diseases initiative (DNDi) HAT-library by the Swiss TPH had singled out fexinidazole, originally developed by Hoechst (now Sanofi), as the most promising of a series of over 800 nitroimidazoles and related molecules. In cell culture, fexinidazole has an IC50 of around 1 µM against Trypanosoma brucei and is more than 100-fold less toxic to mammalian cells. In the mouse model, fexinidazole cures both the first, haemolymphatic, and the second, meningoencephalitic stage of the infection, the latter at 100 mg/kg twice daily for 5 days. In patients, the clinical trials managed by DNDi and supported by Swiss TPH mainly conducted in the Democratic Republic of the Congo demonstrated that oral fexinidazole is safe and effective for use against first- and early second-stage sleeping sickness. Based on the positive opinion issued by the European Medicines Agency in 2018, the WHO has released new interim guidelines for the treatment of HAT including fexinidazole as the new therapy for first-stage and non-severe second-stage sleeping sickness caused by Trypanosoma brucei gambiense (gHAT). This greatly facilitates the diagnosis and treatment algorithm for gHAT, increasing the attainable coverage and paving the way towards the envisaged goal of zero transmission by 2030.
more
Female Genital Schistosomiasis (FGS) is a gynaecological disease caused by Schistosoma haematobium, a parasitic worm that is acquired by skin contact with freshwater contaminated by schistosome cerceriae. Communities in which the infection is most endemic have limited access to clean water and healt...hcare services. Up to 150 million adolescent girls and women are estimated to be at risk of FGS and about 16–56 milion womens are living with FGS, with the majority of these in sub-Saharan Africa. The variability of these estimates points to the fact that this neglected tropical disease is not well studied and frequently not prioritized by local, regional, and global health policy makers.
more
Human African trypanosomiasis (HAT) has been an alarming global public health issue. The disease affects mainly poor and marginalized people in low-resource settings and is caused by two subspecies of haemoflagellate parasite, Trypanosoma brucei and transmitted by tsetse flies. Progress made in HAT ...control during the past decade has prompted increasing global dialogue on its elimination and eradication. The disease is targeted by the World Health Organization (WHO) for elimination as a public health problem by 2020 and to terminate its transmission globally by 2030, along-side other Neglected Tropical Diseases (NTD). Several methods have been used to control tsetse flies and the disease transmitted by them. Old and new tools to control the disease are available with constraints.
Currently, there are no vaccines available. Efforts towards intervention to control the disease over the past decade have seen considerable progress and remarkable success with incidence dropping progressively, reversing the upward trend of reported cases. This gives credence in a real progress in its elimination. This study reviews various control measures, progress and a highlight of control issues, vector and parasite barriers that may have been hindering progress towards its elimination.
more
Leishmaniasis is a parasitic disease caused by the Leishmania parasite. This parasite typically lives in infected sand flies. You can contract leishmaniasis from a bite of an infected sand fly.
The sand flies that carry the parasite typically reside in tropical and subtropical environments. Fatal... epidemics have occurred in areas of Asia, East Africa, and South America.
Affected regions are often remote and unstable, with limited resources for treating this disease. Doctors Without Borders calls leishmaniasis one of the most dangerous neglected tropical diseases. The organization also states this disease is second only to malaria in parasitic causes of death.
more
Cutaneous leishmaniasis (CL) is a parasitic disease caused by infection with a vector-borne protozoan parasite of the genus Leishmania spp. The parasite is transmitted by the bite of an infected phlebotomine sand fly. Infection results in skin lesions which take a long time to heal and may leave per...manent, disfiguring scars (de Vries et al. 2015). CL is classified as a neglected tropical disease (NTD), and in common with several other NTDs, is associated with psychosocial effects including stigma, social exclusion, and declining mental health (Bailey et al. 2019; Bennis et al. 2018; Wenning et al. 2022). Emerging evidence suggests that people with CL are at a higher risk of experiencing anxiety, depression, decreased body satisfaction, loss of social status, and lower quality of life (Bennis et al. 2018; Yanik et al. 2004). The global mean age-standardised disability-adjusted life years (DALYs) lost by CL was 0.58 per 100,000 people (Karimkhani et al. 2016). Notably, this statistic only considers the physical effects of the lesions and does not account for the potentially considerable psychological and social effects of CL (Bailey et al. 2017; Bailey et al. 2019; Wenning et al. 2022).
more
The Africa Centres for Disease Control and Prevention (Africa CDC) was established in 2017, after the west Africa Ebola virus disease outbreak. Upon creation, the
role of Africa CDC was to mandate strengthening of the capacity of public health institutions in Africa to prevent, detect, and respond ...to disease threats, based on science, policy, and data-driven interventions and programmes, as envisaged by the Abuja Declaration. The inaugural strategic plan was focused on building health systems for emergency preparedness and response. However, from its inception, the organisation recognised the concomitant need to comprehensively strengthen systems to prevent and manage noncommunicable diseases (NCDs) and injuries, and to face the neglected issue of mental health disorders. The division dedicated to these issues was conceptualised, but operationalisation was deferred to a future date.
more
Background: The last decade has seen a dramatic increase in international and domestic funding for malaria control, coupled with important declines in malaria incidence and mortality in some regions of the world. As the ongoing climate of financial uncertainty places strains on investment in global ...health, there is an increasing need to audit the origin, recipients and geographical distribution of funding for malaria control relative to populations at risk of the disease. Methods: A comprehensive review of malaria control funding from international donors, bilateral sources and national governments was undertaken to reconstruct total funding by country for each year 2006 to 2010. Regions at risk from Plasmodium falciparum and/or Plasmodium vivax transmission were identified using global risk maps for 2010 and funding was assessed relative to populations at risk. Those nations with unequal funding relative to a regional average were identified and potential explanations highlighted, such as differences in national policies, government inaction or donor neglect.
more
Prior research has considered donor funding for developing world health by recipient and donor country but not by disease. Examining funding by disease is critical since diseases may be in competition with one another for priority and donors may be making allocation decisions in ways that do not cor...respond to developing world need. In this study I calculate donor funding for 20 historically high-burden communicable diseases for the years 1996 to 2003 and examine factors that may explain variance in priority levels among diseases. I consider funding for developing world health from 42 major donors, classifying grants according to the communicable disease targeted. Data show that funding does not correspond closely with burden. Acute respiratory infections comprise more than a quarter of the burden among these diseases but receive less than 3% of direct aid. Malaria also stands out as a high-burden neglected disease.
more
Significant progress has been made in the eradication of three priority diseases in the African Region, as a result of extensive collaboration between the Regional Office, WHO country offices and countries. For example, in August 2020, the region was certified free of wild poliovirus. In the area of... neglected tropical diseases, Guinea worm disease is on the verge of eradication, and 12 member states are within reach of being certified as having eradicated yaws by the end of this year.
more
Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests t...hat SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations.
more
WHO has published the first-ever guidance on the clinical management of diphtheria. The only previously available guidance was an operational protocol. The new guidance followed the rigorous process for developing guidance at WHO.
It addresses the use of Diphtheria Antitoxin (DAT) in the treatmen...t of diphtheria. There is a worldwide shortage of DAT and evidence based recommendations on the use of DAT were requested by many Member States.
The guidance also includes new recommendations on antibiotics. In patients with suspected or confirmed diphtheria, WHO recommends using macrolide antibiotics (azithromycin, erythromycin) rather than penicillin antibiotics.
This clinical practice guideline has been rapidly developed recognizing the global increase in diphtheria outbreaks. Outbreaks of diphtheria in Nigeria, Guinea and neighbouring countries in 2023 have highlighted the urgent need for evidence-based clinical practice guidelines for the treatment of diphtheria. Given the sporadic nature of outbreaks, many clinicians in the affected regions have never managed acute diphtheria and its related complications. Diphtheria remains a neglected disease and vaccination is the top priority. At the same time, for patients with diphtheria, access to antibiotics, DAT and supportive care can be lifesaving.
more
Just under 2.5 million people die annually due to alcohol use. This global estimate, however, excludes most of the health burden
borne by others than the alcohol user. Alcohol’s harm to others includes a multitude of conditions, such as trauma from traffic crashes, fetal disorders due to prenatal... exposure to alcohol, as well as interpersonal and intimate partner violence. While alcohol’s causal role in these conditions is well-established, alcohol’s harm to others’ contribution to the overall health burden of alcohol remains unknown. This knowledge gap leads to a situation in which alcohol policy and prevention strategies largely focus on the reduction of alcohol’s detrimental health harms on the alcohol users, neglecting affected others and population groups most vulnerable to these harms, including women and children. In this article, we seek to elucidate why estimates for alcohol’s harm to others are lacking and offer guidance for future research. We also argue that a full assessment of the alcohol health burden that includes the harm caused by others’ alcohol use would enhance the visibility and public awareness of such harms, and advancing the evaluation of policy interventions to mitigate them.
more