Neglected Tropical Diseases (NTDs) have both high prevalence, and significant detrimental implications on these effected Indigenous Australian communities.  It is clear that this is a significant issue in Australia, however, what is the most effective way to address this issue?

Mass Drug Administration (MDA), the treatment of an entire geographical population without testing for infection, is a global technique being used to combat NTDs. Although no comprehensive data was collected, in the 1990’s MDAs to treat hookworm in some heavily affected Aboriginal communities appears to have been effective in reducing hookworm prevalence. More recently, MDAs us oral amithromycin to treat Australian communities with severe trachoma has provided some insight into the effectiveness of MDAs. Community wide treatments in severely effected populations (15-44% prevalence) lead to reductions in prevalence of between 8-31% per year. Similar strategies in moderately effected populations (5-19% prevalence) created absolute reductions in prevalence of 8-10%. Integration of MDA programs into primary care of Indigenous Australians living in effected areas could prove an effective way to address NTDs.

MDA of albendazole in the Northern Territory has been found to be ineffective at reducing the prevelnce of Hymenolepis nana showing that MDAs isn’t the only answer to addressing the issue of all NTD. Furthermore, it is easy to forget that NTDs have been eradicated in most areas of Australia without requiring any MDA. Sustainable control of NTDs requires the core of the problem to be solved and to eliminate the environmental determinates of the infections.  Access to adequate health care, raising living conditions, improving education and providing clean water and sanitation to every community in Australia is crucial to eliminating all NTDs from Australia.

Australia must continue to address the health problems facing Indigenous Australia and end third world diseases from affecting our citizens. Australia must lead the way in taking the Neglected out of NTDs.

References

Kline, K, McCarthy, JS, Pearson, M, Loukas, A & Hotez, PJ 2013, 'Neglected Tropical Diseases of Oceania: Review of Their Prevalence, Distribution, and Opportunities for Control', PLOS Neglected Tropical Diseases, vol. 7, no. 1, p. e1755. Available from: http://dx.doi.org/10.1371%2Fjournal.pntd.0001755.

Liu, B, Cowling, C, Hayen, A, Watt, G, Mak, DB, Lambert, S, Taylor, H & Kaldor, JM 2016, 'Relationship between Community Drug Administration Strategy and Changes in Trachoma Prevalence, 2007 to 2013', PLOS Neglected Tropical Diseases, vol. 10, no. 7, p. e0004810. Available from: http://dx.doi.org/10.1371%2Fjournal.pntd.0004810.

'Mass Drug Administration for Scabies Control' 2016, New England Journal of Medicine, vol. 374, no. 17, pp. 1689-1690. Available from: http://dx.doi.org/10.1056/NEJMc1600495. [2017/02/26].

Neglected Tropical Diseases (NTDs) indicate poverty due to the socioeconomic factors that contribute to their prevalence. However, not only are NTDs impacted by poverty, but NTDs themselves are heavily contributing to poverty around the world.

Poverty amongst some Indigenous populations is a significant problem facing Australia. An essential component of eliminating poverty in some Indigenous populations cannot be done without addressing the issue of NTDs as they contribute to the cycle of poverty. NTDs, as suggested by their names, are often forgotten by governments however to make progress in creating better economic equality amongst Indigenous Australians the issue of NTDs can no longer be neglected.

NTD’s have been shown to be barriers to the Millennial Development Goals (MDGs) with at least 8 of these goals impacted. The MDG to ‘Eradicate extreme poverty and hunger’ is significantly impacted by NTDs. NTDs have a direct impact on nutrition as, for example, parasites often take up many key nutrients, and indirect impacts such as the considerable impact on farmers, a group prone to infection due to soil contact, abilities to work. The NTDs also have a significant impact on the economic development of an infected population as not only does the physical and mental impact of the diseases decrease the ability of the workforce to work but it also has a significant increase on health care related costs. Evidence shows this effect continues at a household level where a study from Kenya suggests that people targeted by deworming campaigns results in a 29% average increase in their future earnings. 

It is important to make NTDs a national issue as not only will taking the ‘Neglected’ out of NTDs improve the health and quality of life in effected Indigenous communities, but, it is an integral component in breaking cycles of poverty.

References

Development Progress. 'Why neglected tropical diseases matter in reducing poverty' July 2013. Available from: http://www.developmentprogress.org/sites/developmentprogress.org/files/resource-document/why_neglected_tropical_diseases_matter_in_reducing_poverty.pdf 

World Health Organization (2010) Working to Overcome the Global Impact of Neglected Tropical Disease, First WHO Report on Neglected Tropical Diseases, Geneva:WHO. http://www.gsk.com/media/downloads/ WHO-report-on-NTD.PDF

 
Conteh L, Engels T, Molyneux DH. Socioeconomic aspects of neglected tropical diseases. The Lancet.375(9710):239-47. 

Scabies – More than just scabs

 In this age of social media and global communication, numerous crippling diseases have gained worldwide infamousness and with it, the attention of the public. Nowadays these crippling diseases have immensely better prognoses from the attention and resources that have been put into combating them. However, there exists a group of diseases that are physiologically and socially crippling yet receive little to no attention from the global community. These diseases are called Neglected Tropical Diseases (NTDs) and cover a wide range of diseases such as numerous parasitic infections and bacterial infections.

 One such NTD that is particularly endemic in Australia is scabies. Scabies is a skin infection disorder caused by mites burrowing into the top layer of the skin. This causes severe itching to the patient and several burrow tracks in the form of blisters or bumps on the skin. Although scabies by itself may not pose a severe health risk, the itchiness caused by the mites are often so severe that patients scratch through their skin, opening the pathway for a whole host of other infectious diseases. The most common diseases contracted in this manner are impetigo, cellulitis, and abscess; all are which have high mortality rates in rural areas where scabies are most commonly rampant.

 The main issue with scabies, however, is that the disease is incredibly infectious. In Australia, some rural communities have estimated rates of scabies of up to 50%, meaning that one of two people have scabies. Add that to the fact that scabies can often be hard to diagnose and we can begin to understand the difficulty in trying to control this endemic disease.

 Fortunately, scabies is incredibly treatable if discovered early, and only requires some topical ointments in early stages. The burden of this disease can be lowered substantially if preventive measures are taken to stop the disease in its early stages, and this can be achieved relatively easily by providing endemic areas with the necessary medication for this disease. Scabies has also been starting to receive some of the attention it needs, as group called the International Alliance for the Control of Scabies (IACS) has recently been formed and is dedicated to the eradication of scabies worldwide.

 Like most NTDs, scabies is a very treatable, though crippling, disease that is burdened only by its limited awareness. We hope that we can raise some awareness of these neglected diseases through this blog and help lower the burden of these diseases.

Resources

Engelman D, Kiang K, Chosidow O, McCarthy J, Fuller C, Lammie P, et al. Toward the Global Control of Human Scabies: Introducing the International Alliance for the Control of Scabies. PLoS Neglected Tropical Diseases. 2013;7(8):e2167. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738445/

Brook I. Microbiology of secondary bacterial infection in scabies lesions. Journal of Clinical Microbiology. 1995;33(8):2139-40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC228350/

Parasites and NTDs– Things that shouldn't be a problem 101

Rather than a single illness, NTDs cover a wide range of possible diseases and ailments; a major one of which are parasitic infections.

 Parasites are organisms that infect and live off other organisms, called hosts, in order to survive and can often cause their hosts to become sick or even die as a result. Parasites are issues in mainly tropical and subtropical regions such as Southeast Asia, South America, and parts of Africa; however, a number of parasites are endemic right here in Australia and neglected.

 Before going into the neglected parasites in Australia, let’s talk about the main ways people can contract these unwelcome guests. Many parasites dwell in water or animal meat, and the most common ways people contract parasites are through ingesting these contaminated food or drinks. In tropical and sub tropical areas, mosquitoes also play a large role in spreading parasites, the most infamous of which is malaria. Contact with fecal matter is another route of parasitic infection in some rural areas. Parasites can be transmitted in any number of ways, but all require the person coming into physical contact with the actual parasite., whether through ingestion or open wounds.

 Now that we have a basic understanding of parasite transmission, let’s look at the main parasite-related NTDs in Australia: amebiasis, balantidiasis, and cryptosporidiosis. All three of these parasites can cause severe diarrhea, vomiting, abdominal pain, and fevers in patients. And in the dry desert of the Northern Territory where the above parasites are most common, these symptoms can quickly prove to be deadly if left untreated. In addition, balantidiasis can potentially cause stomach ulcers in patients, which can then allow the parasite to infect the patient’s blood, an incredibly deadly condition.

 Unfortunately, these parasites have received very little attention, and no large-scale studies have been done to assess their effects and distribution. However, the good news is that these infections are very treatable provided that patients receive prompt and proper medication. These infections can also be largely prevented by providing clean water for everyday use and education on the dangers of uncooked meat. Parasitic infections are very treatable and preventable issues if the proper resources have been allocated to combat them, we hope that by raising awareness for these NTDs that the burden of these diseases will be lowered.

References

Barwell, J, Yu, Y. Amebiasis [Internet]. Healthline; 2015. Available from: http://www.healthline.com/health/amebiasis

Chijide, V 2015. Balantidiasis [Internet]. Medscape; 2015. Available from: http://emedicine.medscape.com/article/213077-overview

Davis, C. Cryptosporidiosis [Internet]. Medicinenet; 2015. Available from: http://www.medicinenet.com/cryptosporidiosis/article.htm

Hotez PJ, Kamath A. Neglected Tropical Diseases in Sub-Saharan Africa: Review of Their Prevalence, Distribution, and Disease Burden. PLOS Neglected Tropical Diseases. 2009;3(8):e412.Available from: http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000412 

Sriskantharajah. Neglected Tropical Diseases - not just a danger for the tropics [Internet]. BioMed Central; 2014. Available from: https://blogs.biomedcentral.com/on-medicine/2014/08/04/neglected-tropical-diseases-not-just-a-danger-for-the-tropics/

Trachoma – Now you see me…

Neglected Tropical Diseases, or NTDs, are a group of diseases responsible for the most common infections among people living in extreme poverty. While the majority of NTDs occur in tropical and subtropical undeveloped countries, they are by no means limited to those regions. Australia, for example, is a first world country that suffers considerably from NTDs; and of those NTDs, trachoma in particular is a huge health issue.  

 Trachoma, or sandy blight, is one of the leading causes of preventable blindness worldwide. Trachoma is caused by the bacteria Chlamydia trachomatis; the bacteria can create swelling under the inner eyelid, potentially leading to scarring. The scarring can cause the eyelashes to curl inward and scratch the surface of the eye, which if left untreated, will lead to irreversible blindness.

 Unfortunately, trachoma is also very highly infectious, and can be easily spread through infected nose or eye secretions. Unlike other bacterial infections, a single episode of trachoma produces few uncomfortable symptoms and can often be confused with a simple runny nose. However, the issue comes with repeated infections. Studies have shown that children living in rural areas can be infected up to 30 – 40 times in their childhoods, and each reinfection progressively leads to the scarring in their eyes getting worse and worse, eventually leading to blindness if left untreated.

 Luckily, trachoma is very treatable if proper care and preventive measures have been taken. The World Health Organization (WHO) suggests a SAFE strategy to combat trachoma. The surgical component (“S”) of the strategy involves using surgery to reduce eyelid swelling and scarring, thereby reducing the likelihood of blindness. Antibiotics (“A”) are the first line of defense for any trachoma infection and can be used to destroy the bacteria before any harm is done. Facial hygiene (“F”) and Environmental improvement (“E”) are concerned with preventing the spread of the disease through improving personal and environmental hygiene. This strategy has proven to be effective in trachoma treatments, countries like China, Morocco, Iran, and Mexico have eradicated trachoma using this guideline.

 Australia is the only first world country where trachoma is still an issue; in some areas of rural Australia, 4% of children are contracted with this crippling disease. However, there is good news in that the government is actively trying to combat this disease. Millions of dollars have been spent fighting trachoma and the rates of trachoma in rural communities have dropped enormously from 21% in 2008 to just above 5% in 2015. Trachoma, like all other NTDs, are very treatable given the proper resources have been allocated to combat them; we hope that in the near future, these diseases will receive the attention that they so deserve.          

References

Gambhir M, Basáñez M-G, Burton MJ, Solomon AW, Bailey RL, Holland MJ, et al. The Development of an Age-Structured Model for Trachoma Transmission Dynamics, Pathogenesis and Control. PLOS Neglected Tropical Diseases. 2009;3(6):e462.Available from: http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000462

Rostami, S, Medscape [Internet] 2016 [cited 2017 Feb 20]. Available from: http://emedicine.medscape.com/article/1202088-treatment#d9

Cowling, C,Liu, B, Snelling, T, Ward, J, Kaldo, J & Wilson, P 2013. Australian trachoma surveillance annual report, 2013. Australian Government: The Department of Health. Available from: http://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdi4002j.htm