Prime
Uganda’s NTD risk remains high despite progress
Some diseases such as schistosomiasis, also known as bilharzia, are infections caused by a parasitic worm that live in fresh water in subtropical and tropical regions. PHOTO | COURTESY
More than 39 million people in Uganda (close to 87 percent), are at risk of suffering from one or more neglected tropical disease (NTDs), a diverse group of diseases and conditions prevalent mainly in Africa and other developing countries where they affect more than one billion people.
Africa is hardest hit and bears about half the global burden of NTDs. Although treatable and preventable, NTDs cause more than 500,000 deaths annually. Their worst impact is not in the relatively low mortality but the huge public health burden they place on poor countries such as Uganda.
The latest list of NTDs adopted by the World Health Organisation (WHO) African region includes Buruli ulcer, dengue, dracunculiasis, endemic treponematoses (yaws and bejel), human African trypanosomiasis, leishmaniasis, leprosy, lymphatic filariasis, Onchocerciasis, rabies, schistosomiasis, snakebite envenoming910, soil-transmitted helminthiases, taeniasis and neurocysticercosis and trachoma.
Without proper treatment, these infections can cause blindness, disfigurement, chronic pain, cognitive impairment and other long-term disability and irreversible damage that create obstacles to education, employment, economic growth, stigmatisation with disastrous social exclusions by family, community, society and overall development. Reducing the burden of mortality and morbidity caused by NTDs is integral to improving the health of the world’s poorest people.
The poorest and most marginalised suffer the most from NTDs which has earned them the title of diseases of poverty. The diseases are associated with inadequate housing, adverse environmental conditions such as poor water and sanitation services, and lack of access to healthcare services.
Some, such as leprosy and lymphatic filariasis, lead to disability and disfigurement, subjecting those affected to stigma and exclusion while also affecting their mental health and livelihoods. Others, such as parasitic infections can cause longterm health and educational outcomes, making it difficult to earn a living and limiting productivity in school and at work.
Over the past decade, Uganda has made significant progress in the elimination, control and eradication of NTDs yet the country still has a high burden of the diseases. These mainly affect the rural poor, resulting in low productivity and socioeconomic development of these populations.
Uganda has in place “The overall goal of the Uganda NTD Control Programme Sustainability Plan 2020-2025” which aims to bring together other sectors on board to strengthen mechanisms that will enable the Ministry of Health to sustain NTD efforts and strengthen the health system to provide sustainable, accessible, equitable and quality NTD services to the population.
The most prevalent NTDs in Uganda according to Dr Henry Mwebesa, the director general Health Services at the Ministry of Health, include River blindness, Trachoma, Lymphatic filariasis (Elephantiasis), Bilharzia, Worms, Sleeping sickness, Kala-azar.
Uganda aims to eliminate River blindness, Trachoma and Elephantiasis by 2025 while Bilharzia, worms, Kala-azar and sleeping sickness are targeted for elimination as public health problems by 2030.
Resolution
In 2018, during the 30th African Union Heads of State Summit, the African Leaders Malaria Alliance (ALMA) added NTDs to its annual scorecard on disease progress. The scorecard is personally reviewed by African heads of state every year, putting NTDs alongside malaria and maternal and child health as top health priorities for the continent.
At the Kigali summit, leaders are expected to launch the Kigali Declaration on NTDs - a high-level, political declaration which aims to mobilise political will and secure commitments to achieve the Sustainable Development Goal 3 (SDG3) target on NTDs and to deliver the targets set out in the WHO’s Neglected Tropical Disease Roadmap (2021-2030).
The summit will be pushing for investment in fighting these debilitating diseases. Beating NTDs means countries, such as Uganda, can be able to build more resilient health systems, improve pandemic preparedness and prevention, and support healthier populations.
The “No to NTDs,” a grassroots movement launched in 2019 by Speak Up Africa, a strategic communications and advocacy organisation, aims at increasing awareness, prioritisation, and national commitment to accelerate the control and elimination of NTDs in Africa
In April 2021, Speak Up Africa and a group of likeminded organisations launched “March to Kigali,” an integrated campaign aimed at securing commitments from national and sub-national stakeholders to eliminate both NTDs and malaria. The “March to Kigali” specifically calls for the integration of malaria and NTD programmes, with a particular focus on strengthening data and surveillance systems to improve timely deployment of malaria and NTD interventions and on multi-sectoral collaboration.
More than 150 civil society and local organisations, media outlets, and individuals across the sub-region have signed the “March to Kigali” call to action, which demonstrates the incredible engagement and leadership that exists at the country level to end these diseases.
Some of the approaches developed by the WHO to detect, prevent, control, eliminate and eradicate NTDs include preventive chemotherapy (mass treatment); innovative and intensified disease management; vector ecology and management; provision of clean water and sanitation, hygiene and veterinary public health to protect and improve human health.
Uganda’s progress
(i) River blindness: Transmission has been eliminated in 11 out of 17 foci covering more than 4.8 million people who are no longer at risk. Transmission has been interrupted in four additional foci.
(ii) Trachoma: Out of 51 endemic districts, 46 have reached the recommended low infection levels and have stopped mass treatment. Only five districts of Moroto, Nakapiripirit, Nabilatuk, Amudat and Buliisa still require treatment. These districts have been undergoing mass treatment for several years but there are persistent and repeated high infection levels.
(iii) Elephantiasis: All the 66 endemic districts have reached the elimination threshold and have stopped mass treatment. Surgeries and elephantiasis management have been done in 18 districts and this is still on-going.
(iv) Bilharzia and Intestinal Worms: Bilharzia is endemic in 95 districts while Intestinal Worms are everywhere in the country. Despite the persistent challenge of high infection of both diseases over the years, substantial reduction has been realised in some districts. From recent surveys of December 2021 conducted in 38 selected districts, 41.8 percent have reduced infection levels, 14.3 percent had increased levels while 44 percent sustained the previous infection levels.
(v) Sleeping sickness: There are two types in Uganda, one found in West Nile (gambiense) and another in Eastern Uganda (rhodesiense). Uganda has reached WHO elimination target for gambiense type and application for verification from WHO is in the process. Surveillance for both types is done in the endemic areas and cases are treated from designated health facilities.
(vi) Kala-azar: The disease is reported in nine endemic districts of Karamoja region. Whereas there was only one treatment centre at Amudat Hospital, recently interventions have been scaled up to all the nine districts. Moroto hospital has been supported to become another treatment centre in the region. So far, 160 Health facility workers from 74 facilities in 4 districts of Karenga, Abim. Kotido and Kaabong have been trained on Kala-azar diagnosis and treatment.
Source: Dr Henry Mwebesa/ Ministry of Health
