Neglected Tropical Diseases and WASH Strategies
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Questions and Answers

Which strategic intervention is NOT part of the core strategies to achieve the WHO roadmap 2020-2030?

  • Elective surgery (correct)
  • Veterinary public health
  • Preventive chemotherapy
  • WASH (water, sanitation and hygiene)

    • Which of the following is true about the global access to sanitation facilities?

  • 2.4 billion people lack access to adequate sanitation (correct)
  • 3 billion people have access to private toilets
  • 885 million people lack access to adequate sanitation
  • 946 million people have access to improved latrines

    • What percentage of people requiring preventative chemotherapy for NTDs need treatment for three or more diseases?

  • 43% (correct)
  • 50%
  • 27%
  • 57%

    • Which disease associated with inadequate WASH is responsible for more than 1.5 million deaths annually?

    <p>Diarrheal illnesses (B)</p> Signup and view all the answers

    What percentage of those requiring preventative chemotherapy for NTDs are treated for one or two diseases?

    <p>57% (C)</p> Signup and view all the answers

    What is the primary reason neglected tropical diseases were historically not addressed by pharmaceutical companies?

    <p>Economic considerations (B)</p> Signup and view all the answers

    Which regions are most affected by neglected tropical diseases?

    <p>Africa, Asia, South and Central America (B)</p> Signup and view all the answers

    When did the WHO and partners consolidate various disease initiatives under the NTD "brand"?

    <p>2007 (C)</p> Signup and view all the answers

    What is a key characteristic that makes certain diseases candidates for control and elimination under the NTD category?

    <p>Transmission characteristics (D)</p> Signup and view all the answers

    Which of the following is a neglected tropical disease caused by bacteria?

    <p>Leprosy (A)</p> Signup and view all the answers

    What were neglected tropical diseases originally caused by?

    <p>Infectious agents (C)</p> Signup and view all the answers

    What major purpose does the term 'neglected tropical diseases' serve?

    <p>Increasing lobbying power (A)</p> Signup and view all the answers

    Which of the following diseases is NOT classified under neglected tropical diseases?

    <p>Malaria (A)</p> Signup and view all the answers

    What are common early symptoms of Schistosomiasis infection?

    <p>Blood in stools and irregular bowel movement (A)</p> Signup and view all the answers

    What potential long-term effect can Schistosomiasis have on children?

    <p>Chronic ill health and cognitive impairment (D)</p> Signup and view all the answers

    What condition can Schistosomiasis cause in females?

    <p>Female genital schistosomiasis (D)</p> Signup and view all the answers

    Which organ is affected along with the liver in hepatosplenomegaly caused by Schistosomiasis?

    <p>Spleen (B)</p> Signup and view all the answers

    Which of the following is a severe complication that can arise from Schistosomiasis?

    <p>Bladder cancer (D)</p> Signup and view all the answers

    What is a potential impact of Schistosomiasis on schooling?

    <p>Lost years of schooling (A)</p> Signup and view all the answers

    How can Schistosomiasis affect male fertility?

    <p>Male fertility defects (C)</p> Signup and view all the answers

    At what age do children in endemic areas generally get their first Schistosomiasis infection?

    <p>2 years old (D)</p> Signup and view all the answers

    What is a significant barrier to the development of new diagnostics for neglected tropical diseases (NTDs)?

    <p>Limited market and investment recovery time (D)</p> Signup and view all the answers

    Why is high-sensitivity and high-specificity essential for diagnostics in diseases nearing elimination?

    <p>To prevent false negatives and false positives (C)</p> Signup and view all the answers

    Which technology is considered outdated for 21st-century diagnostic programs?

    <p>Microscopic observation of feces (B)</p> Signup and view all the answers

    Which type of test relies on the detection of antibodies?

    <p>ELISA (C)</p> Signup and view all the answers

    What is a key component needed for molecular diagnostic tests?

    <p>A biomarker (D)</p> Signup and view all the answers

    During a lateral flow antigen test, what occurs at the conjugate pad?

    <p>Antigen binding to labelled antibodies (C)</p> Signup and view all the answers

    What percentage of research and development investment is directed towards diagnostics for NTDs?

    <p>5% (D)</p> Signup and view all the answers

    Which diagnostic method requires minimal training and is aimed at being fast and affordable?

    <p>LAMP (B)</p> Signup and view all the answers

    Which statement best describes the miracidium's movement?

    <p>It whizzes around using cilia to find a snail host. (B)</p> Signup and view all the answers

    Which species are definitively affected by Schistosomiasis?

    <p>Humans and other mammals (B)</p> Signup and view all the answers

    In which regions is schistosomiasis considered endemic?

    <p>Asia, Africa, and parts of South America (A)</p> Signup and view all the answers

    What is the primary factor determining the geographic range of schistosomiasis?

    <p>The presence of a specific snail species (D)</p> Signup and view all the answers

    How are human hosts primarily infected by the Schistosoma parasite?

    <p>Through contact with contaminated water (D)</p> Signup and view all the answers

    What is the primary role of snails in the lifecycle of Schistosoma worms?

    <p>Intermediate host (B)</p> Signup and view all the answers

    What percentage of people affected by schistosomiasis live in Africa?

    <p>90% (B)</p> Signup and view all the answers

    What do cercaria use to locate a new host?

    <p>Positive phototropism and chemoattractants (A)</p> Signup and view all the answers

    How many deaths were attributed to schistosomiasis in the year 2000?

    <p>55,000 (A)</p> Signup and view all the answers

    How long is the Schistosoma lifecycle in humans?

    <p>6-7 weeks (C)</p> Signup and view all the answers

    Which factor contributed to a decrease in schistosomiasis deaths from 2000 to 2016?

    <p>Better availability of treatments (B)</p> Signup and view all the answers

    In terms of severity, where does schistosomiasis rank among parasitic diseases?

    <p>Second, after malaria (C)</p> Signup and view all the answers

    Where do most Schistosoma species reside in their human hosts?

    <p>In the mesenteric vein system near the guts (C)</p> Signup and view all the answers

    How many people worldwide are at risk of contracting schistosomiasis?

    <p>779 million (C)</p> Signup and view all the answers

    What is the key challenge faced during eradication of Dracunculus medinensis in mammals?

    <p>Manifestation of challenges in the last stage of eradication (C)</p> Signup and view all the answers

    What part of the Schistosoma lifecycle is still not fully understood?

    <p>Egg migration to the gut lumen (B)</p> Signup and view all the answers

    How long do miracidia have to find a suitable snail host?

    <p>A few hours (D)</p> Signup and view all the answers

    What determines which type of Schistosoma eggs are released by humans?

    <p>The species of Schistosoma (D)</p> Signup and view all the answers

    Flashcards

    Neglected Tropical Diseases (NTDs)

    Diseases that mainly affect impoverished and marginalized populations, often overlooked in global health.

    WASH

    Water, Sanitation, and Hygiene; essential services that prevent disease and promote health.

    Preventive chemotherapy

    Medication given to entire populations at risk for NTDs to prevent infection or disease.

    Diarrheal illnesses

    Diseases caused by inadequate water and sanitation that lead to severe dehydration and illness, especially in children.

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    Open defecation

    Practicing defecation in open spaces rather than in proper sanitation facilities, a major sanitary issue globally.

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    First coined by WHO

    The term NTD was first used by WHO to group 17 infectious diseases together.

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    Causes of NTDs

    NTDs are caused by infectious agents like bacteria, viruses, and parasites.

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    Economic considerations

    NTDs are often neglected due to lack of financial incentive for drug development.

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    Health impact measurement

    NTDs' effects on health can be quantitatively assessed through various methods.

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    Vector-borne transmission

    Many, but not all, NTDs are transmitted through vectors (like mosquitoes).

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    Examples of NTDs

    Buruli ulcer and Chagas disease are specific examples of neglected tropical diseases.

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    WHO's target NTDs

    WHO has identified 20 specific Neglected Tropical Diseases to focus on for intervention.

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    Role of Diagnostics

    Identifying and managing cases to reduce infection sources and morbidity.

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    Investment in NTD Diagnostics

    Only about 5% of R&D for NTDs, less than medicines and vaccines.

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    Public-Private Initiatives

    Collaborative efforts crucial for addressing diagnostics needs in NTDs.

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    Current Diagnostic Technology

    Many diagnostics use outdated methods unsuitable for today’s needs.

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    Molecular Diagnostics

    Fast, accurate, and cost-effective tests using biomarkers.

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    Types of Molecular Tests

    Includes antigen, antibody, and nucleic acid tests for various diagnostics.

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    Lateral Flow Antigen Test

    A diagnostic method using sample flow through labeled antibodies.

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    Biomarker Identification

    First step in lateral flow tests, often the target pathogen antigen.

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    Kidney Dysfunction

    Impaired kidney function causing symptoms like blood in urine and burning.

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    Hepatosplenomegaly

    Swelling of the liver and spleen, often relating to chronic infections.

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    Chronic Bilharzia Effects

    Long-term effects of bilharzia include severe health issues like cancer.

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    Female Genital Schistosomiasis (FGS)

    Infection affecting women that can complicate pregnancy and increase HIV risk.

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    Under-nutrition

    Poor nutritional status linked to infections leading to growth issues and cognitive problems.

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    Fertility Defects

    Infections can lead to male and female fertility issues.

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    Age of First Infection

    Children in endemic areas often infected by age 2.

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    Cognitive Impairment

    Mental difficulties commonly associated with chronic health conditions from infections.

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    Miracidium

    The larval stage of a trematode, highly motile, found in water.

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    Cercariae

    The free-swimming larval form of a trematode that penetrates host skin.

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    Schistosomiasis

    A parasitic disease caused by trematodes, affecting millions worldwide.

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    Endemic countries

    Countries where schistosomiasis is continuously present due to specific snails.

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    Global impact

    Schistosomiasis affects 240 million people worldwide, mostly in Africa.

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    DALYs

    Disability-Adjusted Life Years; a measure of overall disease burden.

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    Deaths due to schistosomiasis

    Strong increase in mortality from schistosomiasis over time; 55,000 (2000) to 24,000 (2016).

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    Second after malaria

    Schistosomiasis is ranked as the second most impactful parasitic disease globally.

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    Lifecycle of Schistosomiasis

    Includes stages in both humans and snails, with a complex cycle.

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    Definitive host

    The host where the parasite reaches maturity and reproduces, such as humans.

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    Intermediate host

    The host where the parasite undergoes development, primarily snails.

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    Contact transmission

    Infection occurs through skin contact with contaminated water.

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    Egg excretion

    Humans excrete schistosome eggs in urine or feces, depending on the species.

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    Mesenteric vein

    Veins near the gut where adult schistosome worms reside.

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    Lifecycle duration

    The complete lifecycle of Schistosomiasis in humans takes about 6-7 weeks.

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    Study Notes

    Neglected Tropical Diseases (NTDs)

    • NTDs are diseases that affect people in developing regions of Africa, Asia, and South and Central America.
    • Many NTDs are spread by vectors.
    • Neglected diseases are often overlooked by pharmaceutical companies due to economic considerations.
    • WHO and partners brought together various disease initiatives under the umbrella of the NTD "brand" in 2007.
    • NTDs are good candidates for control and elimination. Key characteristics include their transmission features and treatment opportunities.
    • WHO has designated 20 Neglected Tropical Diseases.

    Examples of NTDs

    • Bacteria: Buruli ulcer, Leprosy, Trachoma, Yaws
    • Viruses: Dengue, Chikungunya, Rabies
    • Others: Mycetoma, chromoblastomycosis, scabies, snakebite envenoming, deep mycoses
    • Protozoa: Chagas disease, Human African trypanosomiasis, leishmaniasis
    • Parasitic Worms: Dracunculiasis, Echinococcosis, Foodborne trematodiases, Elephantitis/Lymphatic filariasis, River blindness/Onchocerciasis, Schistosomiasis, Soil-transmitted helminthiases, Taeniasis and cysticercosis

    NTD Spread

    • Mosquitos (Dengue, Chikungunya, Lymphatic filariasis)
    • Flies (African Sleeping Sickness, Leishmaniasis, river blindness, Trachoma)
    • Water fleas (Dracunculiasis)
    • Mites (Scabies)
    • Snails (Schistosomiasis)
    • Biting dogs (Rabies)
    • Contaminated food (Foodborne trematodiases, Taeniasis and cysticercosis)
    • Contaminated soil (Echinococcosis, Soil-transmitted helminthiases)
    • Person-to-person (Leprosy, Trachoma, Yaws)
    • Unknown transmission mechanisms (Buruli ulcer, Mycetoma, chromoblastomycosis)

    Measuring Health Impact of NTDs

    • Mortality: Number of deaths
    • Morbidity: Disability-Adjusted Life Years (DALYs) - Years of Life Lost (YLLs) + Years Lived with Disability (YLDs)
    • At risk: Number of people living in endemic areas who are at risk of infection and disease.

    2016 NTD Data

    • Approximately 1 billion people were infected with an NTD.
    • Another 1–2 billion people were at risk.
    • More than 186,000 people died from NTDs.
    • Over 18.6 million DALYs resulted from NTDs.

    Economic Reasons for NTD Prevention

    • Spending on NTD interventions is a "best buy" in global public health.
    • Improves population health and well-being.
    • Improves financial well-being of disadvantaged citizens.
    • Increases productivity.
    • Every US dollar spent on NTD chemotherapy returns up to $25.
    • Reduced medical expenses and lost productivity.
    • 30% annualized return on investment over 12 years.
    • Improved water and sanitation return >$5 for every $1 invested.
    • Reduced healthcare costs and increased productivity.

    NTD Funding

    • Funding for NTDs has been static at about $300 million per year recently.

    WHO Roadmap 2012–2020

    • A series of goals and strategies to combat NTDs.

    2012–2020 Progress

    • Vector control established in 10 endemic priority countries.
    • Control and surveillance systems established in 5 of 6 WHO regions.
    • Schistosomiasis: 67% preventative chemotherapy coverage in school-aged children.
    • Soil-transmitted helminthiases: 59% of school-aged children received necessary treatment.
    • Trachoma: Over 1 million surgical treatments provided.
    • New treatment approaches (e.g. ivermectin for lymphatic filariasis)
    • New diagnostic tool development (e.g. rapid diagnostic tests for onchocerciasis).

    Impact of 2012 Roadmap

    • 600 million fewer people requiring interventions against NTDs than in 2010.
    • 42 countries eliminated at least one NTD by 2020.
    • 66% preventive coverage in 2019 for populations at risk, increasing from 42% in 2012.

    Key Definitions

    • Eradication: Permanent reduction to zero worldwide of a pathogen.
    • Elimination: Reduction to zero of an infection's incidence in a defined region, minimal risk of reintroduction.
    • Elimination as a public health problem: Reduction to measurable WHO targets, to advance interruption of transmission.
    • Control: Reduction of morbidity, mortality and prevalence to locally acceptable levels, requires continued intervention.

    Impacts on Specific NTDs

    • Dracunculiasis: On the verge of eradication, only 54 human cases reported in 2019.
    • Human African trypanosomiasis: Eliminated as a public health problem.
    • Leprosy: New cases have declined by 1% per year since 2010.
    • Lymphatic filariasis: 43% reduction in the population requiring preventative chemotherapy.
    • Yaws: Eliminated as a public health problem in 17 countries (eliminated in India)

    2020 Targets Missed

    • Leishmaniasis (cutaneous)
    • Lymphatic filariasis
    • Rabies
    • Schistosomiasis
    • Soil-transmitted helminthiases
    • Trachoma
    • Yaws
    • Leprosy

    WHO Roadmap 2021–2030 Targets

    • 90% reduction in people needing NTD interventions.
    • 75% reduction in DALYs associated with NTDs.
    • 100 countries eliminate at least one NTD.
    • Eradication of 2 NTDs.
    • Disease-specific targets include Dracunculiasis and Yaws eradication and elimination/control for additional diseases.

    WHO Roadmap 2020–2030: Strategies

    • Integrate NTDs into national healthcare systems of affected countries.
    • Integrated NTD approach possible for 57% of 1.7 billion people requiring NTD preventative treatment.
    • 43% need treatment for 3 or more diseases.
    • Core strategic interventions include preventative chemotherapy, WASH (water, sanitation and hygiene), vector control, veterinary public health, and case management.

    Water, Sanitation, and Hygiene (WASH)

    • 785 million people lack access to basic drinking water.
    • 663 million people lack access to adequate water sources.
    • 2.4 billion people lack access to adequate sanitation facilities.
    • 946 million people practice open defecation.
    • 2 billion people lack private toilets or improved latrines.
    • Diarrheal illnesses: leading cause of preventable illness.
    • Soil-transmitted helminthiases: associated with severe disease in children.
    • Dracunculiasis: solely spread by contaminated water.
    • Trachoma: a leading cause of blindness.
    • Schistosomiasis: severe disease impacting lives.

    Schistosomiasis (Bilharzia)

    • Caused by 6 parasitic worm species (blood flukes).
    • Humans are the definitive host. Infected via contaminated freshwater containing miracidia.
    • Snails are the intermediate host.
    • Lifecycle includes miracidia, sporocysts, cercaria, and adult worms.
    • Adult worms form male-female pairs in human veins.
    • Infections cause initial rash and chronic disease (e.g., weakness, fatigue, abdominal pain, fibrosis, etc.).

    Dracunculiasis (Guinea Worm Disease)

    • A parasitic disease caused by Dracunculus medinensis.
    • Humans infected when drinking contaminated water.
    • The definitive host develops a blister on the skin which releases the larvae to re-infect water.
    • Eradication program has been successful, with only 28 cases reported in 2018.
    • Important factors include WASH interventions, education, and preventing infected animals from accessing water sources.

    Role of Diagnostics

    • Improve treatment and reduce infection's transmission.
    • Monitor disease trends and control program effectiveness.
    • Diagnostics for disease nearing elimination need to be high-sensitivity and high-specificity to reduce false positive/negative cases.
    • Investment in new diagnostics has been limited.

    Types of Diagnostics

    • Many are 19th-century technology.
    • Need for fast, accurate, and affordable molecular diagnostics that require minimal training.
    • Molecular tests rely on biomarkers (antigen, antibody, lateral flow test, nucleic acid, PCR, LAMP).

    Diagnostics – Sensitivity and Specificity

    • Sensitivity: Proportion of people with the disease who test positive.
    • Specificity: Proportion of people without the disease who test negative.
    • Diagnostics need high specificity when disease incidence is low.

    NTD Challenges

    • Political instability:
    • Gaps in governance of NTD interventions
    • Diversion of funding
    • Infrastructure disruptions
    • Restricted access to populations
    • Migration and population movement
    • Climate change affecting vector-borne diseases.
    • Antimicrobial and insecticide resistance.
    • Zoonotic diseases endangering human populations.

    Important Note

    Much of the provided information is complex and should be further researched for more depth and understanding. This summary is meant to be a study aid, and may not contain all details necessary for academic study.

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    Description

    Test your knowledge on the core strategies outlined in the WHO roadmap for neglected tropical diseases (NTDs) for 2020-2030. This quiz covers the impact of WASH (Water, Sanitation, and Hygiene) on global health and the challenges in access to sanitation facilities. Challenge yourself with questions about the history, characteristics, and statistics related to NTDs and their control.

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