Why Uganda carries heavy burden of neglected tropical diseases

The neglected tropical diseases (NTDs) are the most common infections of the world’s poorest people living in developing countries. Uganda, which is listed among the developing countries, is highly endemic to NTDs which pose a heavy burden on poor rural communities.

The effect of NTDs may lead to chronic ill-health such as disability, deformity, blindness, and retarded physical or mental growth. If not treated, they will lead to death.
World Health Organisation (WHO) observes that NTDs affect more than one billion people globally, and also lists 171 diseases as NTDs.
Dr Monique Wasunna, the director, Drugs for Neglected Diseases initiative (DNDi), Africa Regional Office, says most NTDs have been wiped out in parts of the world with good living conditions and hygiene. These diseases, however, still affect the world’s poorest populations, with little visibility and little voice.

Dr Patrick Turyaguma, one of the programme managers at the National NTD Secretariat, Ministry of Health, says, “Until recently, NTDs had limited attention from the sufferers themselves, the communities where they live, national governments, and the international community.

There have been inadequate resources allocated towards their treatment, control and elimination. That is why they are called neglected tropical diseases.”

“These NTDs run a chronic course because they are slow killers. Most times victims only seek attention when they feel pain. These factors make them neglected diseases,” Dr Turyaguma adds.

Both the cause and the result of poverty and neglected diseases are responsible for billions of dollars in loss of productivity each year worldwide.

Why elimination is necessary
“Controlling and eliminating these diseases is a vital part of alleviating poverty,” says Prof Joseph O. Olobo, a lecturer at the Immunology Department, College of Health Sciences, Makerere University, adding: “However, this is not an easy task. Finding adapted treatments is part of the solution.”

“However, in Africa, for patients to be diagnosed and treated, they have to leave their house, village, to walk, sometimes for days, to the closest health facility. There, they will need to stay up to several weeks to receive the treatment. All this time, they will not work and not earn money to feed their families, hence the burden on productivity. This is why the ultimate objective is to develop a treatment that can be a pill, taken directly at the community level,” Prof Olobo says.

Dr Miriam Nanyunja, the focal person for NTD control at the WHO Country Office believes effective interventions that could be deployed to eliminate most NTDs are available, but there is limited global funding to scale up these interventions.

Research shows that in Uganda, like elsewhere in Africa, many sufferers rely on traditional medicine for treatment, even when traditional medicine has not been proved to cure NTDs.
Prof Olobo says, “Patients affected by Kala-azar (a chronic and potentially fatal parasitic disease) have been known to use traditional medicine. However, studies show that these herbs are not effective.”

According to National Master Plan for Neglected Tropical Diseases Programme 2013-2017, Uganda continues to carry a heavy burden of NTDs due to a number of factors which include shortage of medical personnel, inequitable funding of the health sector, lack of interest by pharmaceutical industries to develop drugs for NTDs and a low literacy rate.

The government admits the shortage of medical personnel has greatly compromised the delivery of quality health services.
The ratio of medical doctor to population ranges from 1:12,500 to 1:50,000 in Uganda and that of nurse to population is 1:5,000.

The inequitable distribution of human resources particularly affects NTD areas that are generally hard-to-reach and hard-to-stay for health workers.

Assessing interventions
To bridge this gap, the government makes use of Village Health Teams/community medicine distributors for mass drug administration. But still this does not fill the void of qualified health workers.

Dr Turyaguma admits: “When you have shortage of human resource, you are not going to properly execute your plans. ”
Information from ministry of Health indicates that about $30 - $40 (Shs76,000- Shs102,000) per capita and an an increase on the health budget to at least 15 per cent over the next years to adequately fund the implementation of the Uganda minimal healthcare package.
However, the health financing is overwhelmed by the major killers malaria, HIV/Aids and tuberculosis and leaving little funding for NTDs.

A 2008 report by the Ministry of Health showed that on average, only 28 per cent of the health facilities in Uganda have a constant supply of medicines and health supplies throughout the year.

Inadequate financial and human resources, capital investment and management issues have resulted in the public sector being unable to fulfill its mandate of providing medicines to meet the requirement of universal access to health care.

Weaknesses in supply chain management such as poor quantification, delays in procurement, inappropriate and late deliveries, late orders from facilities and poor record keeping contribute to shortage and wastage of medicines in the public sector and do not help the cause.

“The other problem is the working figures, especially district populations that vary, making it difficult to have accurate estimates of the required drugs,” Dr Turyaguma says.
“For some of the diseases, for instance, sleeping sickness, the drugs available for treatment are quite toxic and very old, with no new or recent research ongoing to find less toxic drugs.

Pharmaceutical industries have not shown much interest in developing new products or drugs for such diseases, yet new medicines for malaria, HIV, among others, are being worked on all the time,” Dr Nanyunja observed.

PLANS TO ELIMINATE NTDs IN UGANDA

The government has a goal of eliminating Neglected Tropical Diseases (NTDs) as a public health problem by 2020.
It has developed the “National Master Plan for Neglected Tropical Diseases Programme 2013-2017” focusing on scaling up NTD control efforts with the eventual aim of achieving prevention, control, elimination and/or eradication of these diseases in line with the WHO roadmap for elimination of NTDs in Africa by 2020.

Currently, the focus is on eliminating bilharzia, elephantiasis and hydrocele, river blindness, trachoma and intestinal worms.

“We have advocacy and promotional activities that aim at encouraging populations at risk, to seek medical attention in time but also to come and receive drugs during MDA activities,” Turyaguma says.

Turyaguma observes that like other health programmes, there are misconceptions about the drugs that are given out.
He says the support for NTD control and elimination is mainly donor driven. He, however quickly adds that the government also supports the cause.

Asked whether Uganda will eradicate NTDs by 2020, Turyaguma says: “The target for elimination of NTDs is still 2020. However, this is likely to be undermined by insufficient resources, changing priorities, and emerging situations that may require urgent attention.”
As to how WHO rates Uganda’s efforts to eliminate NTDs, the focal person for NTD control at the WHO Country Office, Dr Miriam Nanyunja commends the strides the country has taken to eliminate NTDs.

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