Integration of Management Strategies for Skin-Related Neglected Tropical Diseases.

The concept of skin neglected tropical diseases has been widely adopted into the policy and strategy of various organizations, governments, nongovernmental organizations, and health agencies. By pooling information and resources across different diseases, whose primary manifestations affect the skin, it is possible to deliver integrated surveillance and control programs and promote advocacy and reduction of disability and stigma. A further key part of the skin neglected tropical diseases program is the development and validation of training methods for front-line health workers. Networks that allow those involved in this work to share and compare expertise are being developed through various organizations.

[Management of a global health crisis: first COVID-19 disease feedback from Overseas and French-speaking countries medical biologists]. / Gestion d'une crise sanitaire mondiale : premiers retours d'expérience de biologistes médicaux d'Outre-mer et de francophonie face au COVID-19.

The French society of clinical biology "Biochemical markers of COVID-19" has set up a working group with the primary aim of reviewing, analyzing and monitoring the evolution of biological prescriptions according to the patient's care path and to look for markers of progression and severity of the disease. This study covers all public and private sectors of medical biology located in metropolitan and overseas France and also extends to the French-speaking world. This article presents the testimonies and data obtained for the "Overseas and French-speaking countries" sub-working group made up of 45 volunteer correspondents, located in 20 regions of the world. In view of the delayed spread of the SARS-CoV-2 virus, the overseas regions and the French-speaking regions have benefited from feedback from the first territories confronted with COVID-19. Thus, the entry of the virus or its spread in epidemic form could be avoided, thanks to the rapid closure of borders. The overseas territories depend very strongly on air and/or sea links with the metropolis or with the neighboring continent. The isolation of these countries is responsible for reagent supply difficulties and has necessitated emergency orders and the establishment of stocks lasting several months, in order to avoid shortages and maintain adequate patient care. In addition, in countries located in tropical or intertropical zones, the diagnosis of COVID-19 is complicated by the presence of various zoonoses (dengue, Zika, malaria, leptospirosis, etc.).

The gender responsiveness of social marketing interventions focused on neglected tropical diseases.

Background: Gender is a determinant of health that intersects with other social stratifiers to shape the health and well-being of populations. Despite the recognition of gender in the global health agenda, limited evidence exists about the integration of gender considerations in interventions, including social marketing interventions, for the prevention and control of neglected tropical diseases. Social marketing is an ethical approach to behavior change aiming to benefit individuals, communities, and society. Since behaviors are gendered and affect disease transmission and healthcare patterns, one would expect social marketing interventions to be gender responsive.Objective: This study aims to understand the extent to which social marketing interventions focusing on neglected tropical diseases are gender responsive.Methods: This study uses data from social marketing interventions collected in a systematic review, this study examined 20 interventions addressing eight neglected tropical diseases in 13 countries. A modified version of the World Health Organization Gender Assessment Tool (GAT) was used to determine the gender responsiveness of the interventions, which was complemented by coding for intersectional sex and gender data. These results are presented in 12 themes.Results: One schistosomiasis intervention implemented in China was assessed as gender responsive. It was not possible to answer many questions from the GAT due to limited data reported in the publications describing the interventions. Despite this, strengths and limitations were found in all the interventions in relation to the use of sex and gender concepts, the disaggregation of data, the consideration of environmental factors, and the involvement of women or men in the different stages of the interventions.Conclusions: Many interventions showed positive actions towards gender responsiveness. However, only one was classified as gender responsive. Others failed to supply enough data for assessment. Recommendations about how sex and gender could be integrated into social marketing interventions are provided.

Health inequality in the tropics and its costs: a Sustainable Development Goals alert.

BACKGROUND: It is known that health impacts economic performance. This article aims to assess the current state of health inequality in the tropics, defined as the countries located between the Tropic of Cancer and the Tropic of Capricorn, and estimate the impact of this inequality on gross domestic product (GDP). METHODS: We constructed a series of concentration indices showing between-country inequalities in disability-adjusted life years (DALYs), taken from the Global Burden of Disease Study. We then utilized a non-linear least squares model to estimate the influence of health on GDP and counterfactual analysis to assess the GDP for each country had there been no between-country inequality. RESULTS: The poorest 25% of the tropical population had 68% of the all-cause DALYs burden in 2015; 82% of the communicable, maternal, neonatal and nutritional DALYs burden; 55% of the non-communicable disease DALYs burden and 61% of the injury DALYs burden. An increase in the all-cause DALYs rate of 1/1000 resulted in a 0.05% decrease in GDP. If there were no inequality between countries in all-cause DALY rates, most high-income countries would see a modest increase in GDP, with low- and middle-income countries estimated to see larger increases. CONCLUSIONS: There are large and growing inequalities in health in the tropics and this has significant economic cost for lower-income countries.

Integrating evidence from research into decision-making for controlling endemic tropical diseases in South East Nigeria: perceptions of producers and users of evidence on barriers and solutions.

BACKGROUND: Endemic tropical diseases (ETDs) constitute a significant health burden in resource-poor countries. Weak integration of research evidence into policy and practice poses a major challenge to the control of ETDs. This study was undertaken to explore barriers to the use of research evidence in decision-making for controlling ETDs. It also highlights potential strategies for addressing these barriers, including the gaps in research generation and utilisation in the context of endemic disease control. METHODS: Information on barriers and solutions to integrating research evidence into decision-making for controlling ETDs in Anambra State, Nigeria, was collected from 68 participants (producers and users of evidence) during structured discussions in a workshop. Participants were purposively selected and allocated to groups based on their current involvement in endemic disease control and expertise. Discussions were facilitated with a topic guide and detailed notes were taken by an appointed recorder. Outputs from the discussions were synthesised and analysed manually. RESULTS: Cross-cutting barriers include a weak research linkage between producers and users of evidence and weak capacity to undertake health policy and systems research (HPSR). Producers of evidence were purported to conceptualise and frame their research questions based on their academic interests and funders' focus without recourse to the decision-makers. Conversely, poor demand for research evidence was reported among users of evidence. Another user barrier identified was moribund research units of the Department of Planning Research and Statistics within the State Ministry of Health. Potential solutions for addressing these barriers include creation of knowledge networks and partnerships between producers and users of evidence, institutionalisation of sustainable capacity-building of both parties in HPSR and revival of State research units. CONCLUSIONS: Evidence-informed decision-making for controlling ETDs is limited by constraints in the interactions of some factors between the users (supply side) and producers (demand side) of evidence. These constraints could be solved through stronger research collaborations, institutionalisation of HPSR, and frameworks for getting research into policy and practice.

Reflections on the decade of the neglected tropical diseases.

Neglected tropical diseases (NTDs) are a group of diseases that disproportionately affect the poorest of the poor. While for years attention has focused on single diseases within this group, efforts during the past decade have resulted in their being grouped together to highlight that they are fundamentally diseases of neglected populations. The formation of a World Health Organization department to address these diseases consolidated the efforts of the many stakeholders involved. In the past decade, focus has shifted from the Millennium Development Goals (MDGs), where NTDs are not mentioned, to the Sustainable Development Goals (SDGs), where NTDs are not only mentioned, but clear indicators are provided to measure progress. It has also been a decade where many NTD programmes have scaled up rapidly thanks to work by affected countries through their master plans, the commitment of partners and the unprecedented donations of pharmaceutical manufacturers. This decade has also seen the scaling down of programmes and acknowledgement of the elimination of some diseases in several countries. Given the successes to date, the challenges identified over the past decade and the opportunities of the coming decade, the NTD Programme at the WHO is working with partners and stakeholders to prepare the new NTD roadmap for 2021 to 2030. The focus is on three major paradigm shifts: a change of orientation from process to impact, a change in technical focus from diseases to delivery platforms and a change from an external-based agenda and funding to a more country-led and funded implementation within health systems. This article reviews the past decade and offers a glimpse of what the future might hold for NTDs as a litmus test of SDG achievements.

The time is now: a call for action to translate recent momentum on tackling tropical snakebite into sustained benefit for victims.

Like the other WHO-listed Neglected Tropical Diseases (NTDs), snakebite primarily affects rural, impoverished tropical communities that lack adequate health resources. The annual 138 000 deaths and 400 000 disabilities suffered by these subsistence farming communities means that snakebite is an additional cause and consequence of tropical poverty. Unlike most of the NTDs, however, snakebite is a medical emergency, and requires rapid treatment in a hospital equipped with effective antivenom, beds and appropriately trained staff. The lack of such facilities in the remote areas most affected by snakebite, and the high treatment costs, explains why most victims, particularly in sub-Saharan Africa, consult traditional healers rather than seek hospital care. Whilst affordable, there is no evidence that traditional treatments are effective. The number of snakebite victims that die, unregistered, in the community is threefold higher than hospital-recorded deaths. After decades of inertia, WHO benefitted from advocacy interventions and the support of key agencies, including Médecins Sans Frontières, the Wellcome Trust, the Kofi Annan Foundation and the Global Snakebite Initiative, to recently institute transformative actions for reducing the public health burden of tropical snakebite. It is imperative that WHO and the other stakeholders now gain the support and investment of governments, research funders and donor agencies to ensure that this recent momentum for change is translated into sustained benefit to snakebite victims.

Organization of oversight for integrated control of neglected tropical diseases within Ministries of Health.

BACKGROUND: Neglected tropical diseases (NTDs) are communicable diseases that impact approximately 1 billion people, but receive relatively little research, funding, and attention. Many NTDs have similar treatments, epidemiology, and geographic distribution, and as a result, the integration of control efforts can improve accountability, efficiency, and cost-effectiveness of programs. Here, we examine the landscape of efforts towards NTD integration across countries with the highest burden of disease, and review the administrative management of integration in order to identify approaches and pathways for integration. METHODOLOGY AND PRINCIPAL FINDINGS: We utilized a standardized system to score countries for NTD endemnicity to create a list of 25 countries with the highest overall burden of NTDs. We then conducted a literature review to characterize the NTD control programs in the focus countries. Six countries were selected for key informant interviews to validate literature review results and gather additional data on opportunities and obstacles to NTD integration, from an administrative perspective. The majority of countries included in the study were located in Africa, with the remainder from Asia, North America, and South America. Multiple models and pathways were observed for the integration of NTD programs, in combination with other NTD programs, other diseases, or other health programs. Substantial heterogeneity existed with respect to the NTD control programs, and no country had integrated all of their NTD control efforts into a single program. NTDs that can be treated with preventative chemotherapy were frequently integrated into a single program. Leprosy control was also frequently integrated with those of other communicable diseases, and notably tuberculosis. Barriers to NTD integration may result from internal administrative obstacles or external obstacles. CONCLUSIONS: Although many countries have begun to integrate NTD control efforts, additional work will be required to realize the full benefits of integration in most of the countries examined here. Moving forward, NTD integration efforts must ensure that administrative structures are designed to maximize the potential success of integrated programs and account for existing administrative processes.

Addressing Inequity: Neglected Tropical Diseases and Human Rights.

Twenty neglected tropical diseases (NTDs) are currently recognized by the World Health Organization. They affect over one billion people globally and are responsible for significant morbidity, mortality, poverty, and social stigmatization. In May 2013, the World Health Assembly adopted a resolution calling on member states to intensify efforts to address NTDs, with the goal of reaching previously established targets for the elimination or eradication of 11 NTDs. The resolution also called for the integration of NTD efforts into primary health services. NTDs were subsequently included in Sustainable Development Goal (SDG) 3, which calls for an end to the "epidemics of AIDS, tuberculosis, malaria and NTDs" by 2030. While both the World Health Assembly resolution and SDG 3 provide a strong framework for action, neither explicitly references the human right to the highest attainable standard of health or describes a rights-based approach to NTDs' elimination. This article identifies key human rights relevant to NTD control and elimination efforts and describes rights-based interventions that address (1) inequity in access to preventive chemotherapy and morbidity management; (2) stigma and discrimination; and (3) patients' rights and non-discrimination in health care settings. In addition, the article describes how human rights mechanisms at the global, regional, and national levels can help accelerate the response to NTDs and promote accountability for access to universal health care.

[Consult Online: digital resource for tropical doctors]. / Consult Online: digitale vraagbaak voor tropenartsen.

Consult Online is a Dutch telemedicine system for physicians who work in international healthcare and tropical medicine (formerly known as 'tropical doctors'). It provides specialist advice for complicated cases where local specialist services are lacking. Eighty-nine experts from 25 different specialties are available for advice via www.troie.nl/consult-online. Most of these experts have worked in low resource settings for years before becoming specialists in other disciplines. Since its inception in 2008, Consult Online has received 639 consultations from 41 different countries. On average, a consultation resulted in 2.3 reactions. Consult Online is not the only telemedicine service for low resource settings, but it offers Dutch physicians the unique opportunity to liaise with specialists from their home country, who understand their background, training and limitations. A decade later, it continues to be available to anyone in need of tailor-made specialist advice for patients in low resource settings.