UK Coalition against NTDs: Annual Report

Transcription

1 This Report was authored with the support of the UK Coalition against Neglected Tropical Diseases and printing funded by GlaxoSmithKline UK Coalition against NTDs: Annual Report Report for the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases House of Commons The All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG)

2 UK Coalition against NTDs: Annual Report Report for the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases Chairman: Jeremy Lefroy MP Vice Chairmen: Pauline Latham OBE MP; Lord Rea; Kevin Barron MP; Baroness Hayman GBE, PC Secretary: Fiona Bruce MP Treasurer: Andrew George MP Coordinator: Susan Dykes

3 Contents Chairman s foreword...i Abbreviations...iii Acknowledgements...iv The future of NTDs post-2015 Equity, access and inclusion... 1 Recommendations... 3 A post-2015 vision for NTDs... 4 NTD spotlight: Blinding Trachoma... 5 NTD spotlight: Leprosy... 7 Data and surveillance... 9 Research and Development (R&D) to advance efforts against NTDs...10 Control and elimination...12 Factsheet on common NTDs...13

4 Chairman s foreword House Of Commons The All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases This devastating disease which, at the time of strong health systems with universal coverage. the health workers, who are at the front line of to the memory of all those who have given Strong health systems and dedicated health cleanliness, Environmental hygiene) strategy Surgical interventions, antibiotic distribution and health promotion activities need to be delivered through a health system in order to reach trachoma endemic communities. However, many trachoma-endemic countries have a weak health system with even weaker primary healthcare, as well as little capacity to work across ministries and sectors to deliver components such as water, sanitation and hygiene. The current momentum in reinvigorating primary healthcare with integration of eye care and health system strengthening provides a real opportunity in the drive towards trachoma elimination. Currently only 13 per cent of people receive the treatment they require for this disease. (Report: Para 68). And what is true for trachoma is true for on our recent visit to Sierra Leone, we heard that a shortage of doctors, nurses and midwives was a major obstacle to health system improvement. We heard that a scarcity of specialist expertise was a major obstacle to tackling conditions such as neglected tropical diseases. The Global Health Workforce Alliance (GWHA) estimates that more than seven million additional health workers are that could rise to 13 million by 2035 because of projected population growth. (Report: Para 56). But these continuing challenges should not Chairman: Jeremy Lefroy MP Vice Chairmen: Pauline Latham OBE MP; Lord Rea; Kevin Barron MP; Baroness Hayman GBE, PC Secretary: Fiona Bruce MP Treasurer: Andrew George MP Coordinator: Susan Dykes susanmdykes@gmail.com i

5 House Of Commons The All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases The donors themselves have shown a greater this momentum, or will we see attention drawn I would like to thank my parliamentary colleagues, Hayman, Lord Rea, Lord Trees and Lord Stone for their constant support over the past year. Coordinator of the APPG, has masterminded over the years. We will miss her work greatly but she will always be part of this group. Rt Hon Stephen O Brien MP, the founder of the group, has as always shown great support and encouragement. The work we have done together would not have been possible without the generous support of our donors who are listed in this report and on our website. Finally, I am most grateful to Helen Hamilton, Chair of the who has coordinated the production of this report. There is no silver bullet remedy to helping a country break the cycle of poverty, but investing in the health of its population offers one of the best options for unlocking economic potential. With full support both from national governments and from the global community, we can put an end to NTDs on the African continent [and beyond]. His Excellency John Kufuor, President of the Republic of Ghana ( ). Jeremy Lefroy MP Chairman: Jeremy Lefroy MP Vice Chairmen: Pauline Latham OBE MP; Lord Rea; Kevin Barron MP; Baroness Hayman GBE, PC Secretary: Fiona Bruce MP Treasurer: Andrew George MP Coordinator: Susan Dykes susanmdykes@gmail.com ii

6 Abbreviations APPG... CALL... DALY... DFID... Department For International Development GTMP... MDA... Mass Drug Administration MDG... NNN... NTD... SAFE... SDG... STH... Soil-transmitted helminths UKCNTD... WASH... Water, Sanitation and Hygiene WHA... WHO... World Health Organization iii

7 Acknowledgements We would like to thank GlaxoSmithKline Malaria Consortium iv

8 Introduction House Of Commons The All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases The future of NTDs post-2015 Equity, access and inclusion and one on health system strengthening. their social inclusion and their economic is a moment to take stock and recognise the Government. Throughout this Parliament the This year we ve seen the harrowing effects of health workers, and inadequate surveillance equity is at the heart of the wider efforts families and communities live with the devastating generation chance to address this issue, and get education, nutrition, water and sanitation, maternal and child health and economic growth. session for it s recognition and commitment Rt Hon Andrew Mitchell MP and Rt. Hon Helen Hamilton 1

9 1 6 in children are at risk of NTDs NTDs affect people in 149countries Neglected tropical diseases affect the world s poorest communities. They must remain a global health priority post billion 245 million WASHeducationnutrition disabilityhealth 140 million Credit: Kate Ixer / LEPRA 2

10 Recommendations 2015 is a pivotal year for NTDs. As we approach the UK general election, it is crucial that all UK parties make NTDs a development priority for the next UK Government to ensure there is strong cross-party support. The investment made in combatting these diseases to date is paying off and we are starting to make strong progress. It s now crucial that we protect these successes and continue to build on them in an equitable way. diagnosis, treatment and care for marginalised communities, including women and children, related SDGs such as those tied to WASH and nutrition. 3

11 A post-2015 vision for NTDs The international community is moving into the health outcomes and sustains achievements such as inadequate access to health services, equity in access to health services and cement agenda, alongside universal health coverage. health coverage. Actions to secure universal access to WASH. This is vital to safeguard alleviation efforts and for universal health national health services must meet the health other interventions, such as ensuring access management would ensure that where A woman leaves the clinic, walking on her own after her eye surgery in Nasir in Upper Nile, South Sudan Credit: Adriane Ohanesian / Sightsavers. Aagaard-Hansen J, Lise Chaignat C (2010) Neglected tropical diseases: equity and social determinants In Blas E, and Sivasankara Kurup A, (eds) Equity, social determinants and public health, World Health Organization p

12 NTD spotlight: Blinding Trachoma Mapping trachoma getting the full picture In late 2012 the Global Trachoma Mapping Project (GTMP) was launched. Funded by the UK Department for International Development (DFID), it is the largest infectious disease mapping project ever launched. The project uses innovative mobile technology to map the global prevalence of trachoma and some of its determinants, and represents a vital trachoma the world s leading infectious cause of blindness. It addresses one of the common barriers to effective disease control lack of good quality data. data and information to guide efforts to tackle the disease. To achieve trachoma elimination Africa, Asia, Eastern Mediterranean, South and is guiding efforts to eliminate the disease. Mapping the disease and its determinants The WASH and trachoma sectors have a common communities, as trachoma is endemic where services for health and WASH, and as a result they The WHO-endorsed SAFE strategy for the strongly linked to inadequate access to water and sanitation. Due to this link, the GTMP collects data Halima Suleiman is a Grader in Nigeria for the Global Trachoma Mapping Project, she is responsible for carrying out eye examinations to check for signs of trachoma. Credit: Tom Saater / Sightsavers 5

13 An innovative approach it is sent to a secure server for cleaning, automated analysis and managers with all the information necessary, trachoma-affected countries, as well as within them. laid the foundations for quality health services to quality data. Trachoma stakeholders are united Delivering accurate, detailed and timely trachoma and WASH stakeholders to 6

14 NTD spotlight: Leprosy Equity, access and inclusion: CALLing for change focused on immediate medical interventions to and treatment. However, there are millions of they are often denied equity, access and inclusion. that although they had seen changes around them,. Social Implications treated and are non-infectious. Such discrimination means that those affected often withdraw from their community, suffer feelings of worthlessness and lack them aware of their rights and entitlements, and to Noorjhahan lives in the Kusht Ashsam Kharabad leprosy colony in the Sitapur district of Uttar Pradesh, India. Her hands are clearly disabled by leprosy. Recently a bus driver refused to allow her to board because of this and as a result of the CALL project making her more aware of her rights, she successfully challenged him and is now able to travel by bus. Arulanantham, S (2014) Addressing inequality and exclusion, Leprosy Review, 85,

15 generation to access education and skills training, also worked with the surrounding community using resulted in new roads, electricity connections, clean to change legislation that discriminates against them. Their successes have drawn the interest of other Leaving No One Behind Credit: The Leprosy Mission England & Wales. 8

16 Data and surveillance governmental organisations; international civil society; and community organisations; academic Sensitivity - surveillance systems need to individuals with low levels of infection. Attribution changes in outcomes are due to the intervention and not other factors. Community buy-in communities themselves that are receiving neglected in monitoring and evaluating. Measurability common metric to measure changes in essential that high-quality data is made of transmission) and thus interventions the re-emergence of transmission. Cost for risk assessment Cost for random surveys and straightforward way and can easily highlight where resources and interventions are most ongoing efforts to strengthen health systems. Beself Abera is part of a team surveying people in Ethiopia for the neglected tropical disease trachoma. 9

17 Research and Development (R&D) to advance efforts against NTDs Why is R&D for NTDs needed? to control and eliminate them are hindered to good housing, clean water and sanitation; transmitted helminths (STH) and trachoma, are as schistosomiasis and STH, investment in new London Declaration targets for these diseases. disease, and visceral leishmaniasis, vaccines, medicines and diagnostic tests (collectively with further commitments to research and the challenge of drug resistance, and enhance Saharan Africa, diagnostic tools are inadequate intravenous infusions. For visceral leishmaniasis, invasive diagnostics, long treatment duration capacity of technical staff in country to undertake clinical trials and improve implementation of new tools. Credit: Sabin Vaccine Institute journals.plos.org/plosntds/article?id= /journal.pntd http://journals.plos. org/plosntds/article?id= /journal.pntd Trypanosoma brucei gambiense trypanosomiasis: a multicentre, randomised, phase III, Reviews 2006;19(1): doi: /cmr

18 Research and Development (R&D) to advance efforts against NTDs. African eye worm) 8. Moreover, current the adults worms, which continue to infect new drugs and diagnostics are also necessary. Gaps in NTD R&D As there is no market for new tools that affect to deliver new health technologies for diseases from regulators to introduce them widely. role for medical intervention against these diseases to date is not squandered and the momentum need is maintained. These new technologies for encourage other donors to invest in innovative Making headway Through PDPs, new vaccines are under infection, leishmaniasis and schistosomiasis. the WHO s Essential Medicines List for children), tre/factsheets/fs340/enhttp:// who.int/mediacentre/factsheets/fs340/en. 8 Treatment of Onchocerciasis in Loa loa Endemic Areas: Operational Considerations, 11

19 Control and elimination Map to illustrate areas identifi ed for control and elimination of NTDs 12

20 Factsheet on common NTDs NTD Symptoms / disability Number of people at risk globally 1 Global DALY burden Chagas disease through contact with the faeces of an insect, known as the kissing transmitted through Without treatment, is cardiac and intestinal are at risk worldwide Chagas disease countries across Latin America and growing in nonendemic countries States, Australia, and migration.. Cysticercosis/ Taeniasis eating of infected (taeniosis) in the gut of humans causing invade other organs (cysticercosis) including the nervous systems and cause neurological worldwide are affected cysticercosis causes an estimated Current Method of treatment and prevention have an unsatisfactory cure rate and can There is a great need treatments for this disease. Treatment is with anti- neurological conditions and niclosamide for and increased food Target for control elimination and target year to be eliminated Percentage of at risk population WASH: receiving treatment 2 Disease prevention of regional elimination of intradomiciliary transmission in the region of the Only a small The vector, the triatomine ( kissing ) housing. Although vector control is the also recommended to infection. cysticercosis. Only a small Prevention requires regimens, health education, thorough hygiene, and adequate to human waste. WASH: Care and disability 13

21 Dengue from mild fever, to with severe headache, and rash. and fatigue. Human African trypanosomiasis (sleeping sickness) invades the nervous system and causes mental deterioration and other neurologic without treatment. at risk from dengue. This WHO estimate are lost. There is no vaccine for dengue fever. Patients should seek medical advice, rest down fever and reduce the only method to transmission of dengue vector mosquitoes. Treatment for severe dengue consists of the disease can save lives. Maintenance of volume is critical to severe dengue care. countries.. treatments for stage treatment for HAT in to reduce mortality and Only a small of country elimination in Only a small As the dengue virustransmitting Aedes containers, vector control measures include covering, cleaning of domestic water storage to outdoor water storage containers. requires clean water at home and in healthcare facilities. control of the disease. However, common forests, and vegetation water collection sites Advanced disease makes water affected individuals rely on assistance from others (often children who are taking care of their 14

22 Factsheet on common NTDs NTD Symptoms / disability Leishmaniases to infection is called Leishmania and is Leishmaniasis has several different forms; visceral leishmaniasis, (which is fatal without treatment) and cutaneous leishmaniasis are the most common and stigma. Leprosy (Hansen disease) The disease is caused affects the skin and nerves and can lead hands, feet and eyes. Number of people at risk globally 1 Global DALY burden living at risk worldwide Leishmaniasis occurs worldwide cases of cutaneous diseases annually; Syria and Afghanistan due to civil unrest.. non-governmental federation for anti- estimates that several million cases worldwide currently remaining undetected. countries account for is one of the reasons cases have reduced. There is ongoing discussion on Previous estimates are now recognised to severely underestimate the of late treatment. recognise the need to ensure that residual and addressed. with WHO Grade Current Method of treatment and prevention Target for control elimination and target year to be eliminated Percentage of at risk population WASH: receiving treatment 2 Disease prevention costly Drug resistance is also There is a great need treatments for this disease. of Regional elimination for visceral Leishmaniasis on the Only a small Poor housing and sanitation conditions management and resting sites of sand transmits the disease- Early diagnosis and Prevention Bacillus Calmette-Guérin and trials are also underway to roll out for close contacts. A are due to commence However, there are still countries with endemic and recommendation key target as reduction of Bangkok Declaration calls of reducing the occurrence of new cases with Grade treated since the introduction of MDT coverage with MDT for all new cases is Even once treated, many remain at risk of and discrimination. Although the cause mode of transmission to more hygienic health, and therefore WASH conditions may make communities and individuals less WASH: Care and disability Limited access to water and sanitation cleanliness and care, to the isolation and water and hygiene at health facilities and homes for wound management. to skin, nerves, make tasks such as carrying water over Wound management through self-care using clean water community, and can water and sanitation facilities. Limited access to water and sanitation can lead to to isolation and 15

23 Lymphatic Onchocerciasis (river blindness) Severe intermittent fever. Clinical manifestations include hydrocele (severe swelling of the scrotum) conditions including intense itching and skin living at risk worldwide. at risk worldwide and an estimated.. citrate (DEC) or ivermectin in countries co-endemic for onchocerciasis for a through hygiene of hydrocele surgery. is the vector and malaria is co- endemic risk currently receive started surveillance; have not reached all endemic areas. MDA countries considered eliminate LF. Poorly constructed latrines facilitating mosquito vector, which transmits the causing worms from Treatment of communities at risk of transmission annual community directed treatment with ivermectin. For elimination there is a need to roll out treatment to areas of low endemicity formerly untreated. a target of elimination of transmission using selected African countries and in the endemic foci in Latin America achieved in Equador and all transmission in Africa of currently receive treatment. streams. The main control measure is insecticide treatment countries for vector Severe forms of the disease include swelling of the of the scrotum, as well as thickening of the skin leading All can lead to to maintain rigorous using large quantities with LF are often further challenges to accessing WASH. Chronic skin disease may lead to sores and wounds; clean water and hygiene are essential for good wound management, at health facility level and at home. individuals rely on assistance from (often children who going to school 16

24 Factsheet on common NTDs NTD Symptoms / disability Podoconiosis Schistosomiasis haematuria, anaemia, stunted growth and learn, leading to severe damage of the liver and urogenital tract in advanced cases. Soil-transmitted helminthiases are collectively referred to as soil-transmitted is related to the light infections usually Heavier infections can cause a range of intestinal manifestations and weakness, and Hookworms cause loss that can result in anaemia. Number of people at risk globally 1 Global DALY burden Current Method of treatment and prevention Estimates are still areas conducive worldwide. to soil through use of management through hygiene of affected and footwear. require treatment worldwide, at least living in at risk areas.. Reducing disease large-scale treatment school-aged children to entire communities living in highly endemic transmission through access to safe water, hygiene education and snail control. living at risk worldwide. Preventative sanitation and hygiene. Target for control elimination and target year to be eliminated lifetime. Strategy for schistosomiasis to eliminate schistosomiasis transmission in selected regions, and in selected countries in the African Strategy for soil-transmitted living in endemic areas. The school-age children at risk of illness from soil-transmitted measured against this target. Percentage of at risk population WASH: receiving treatment 2 Disease prevention treatment. treatment require access to clean water for foot hygiene. received treatment in infested freshwater during agricultural, and recreational activities. Control measures include snail control in freshwater sanitation; increased access to safe water; hygiene education to change to reduce contamination of, and contact with, unsafe water. school-aged children at risk of currently receive treatment. eliminate contaminated faeces and urine from reaching surface water can reduce or eliminate transmission, eggs in faeces and urine from entering through animal (cow, of freshwater from contact. WASH: Care and disability 17

25 Trachoma infections can turn the eyelid inwards making the eyelashes scratch the surface of Prolonged scratching eyelashes can lead to Trachoma is the world s leading infectious cause trachoma-endemic. The WHO recommended SAFE strategy-surgery of treat the community Facial cleanliness to reduce transmission and Environmental into contact with. The WHO recommends oral azithromycin and tetracycline eye ointment. a target of elimination of currently receive Facial cleanliness and environmental SAFE strategy for trachoma elimination. Face washing removes from eyes and and fomites. This requires access to water. Environmental Trachomatous Trichiasis (the severe form of the disease, in which surgery is needed) surgery for requires clean water and hygienic conditions; visually- rely on assistance (often children who going to school 18

26 The pharmaceutical industry has the supported the London Declaration: Bayer HealthCare Eisai Gilead Sciences Merck KGaA MSD

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