Marc Anthony Minicozzi

Geog 1

Professor Rizzuto

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12/09/17

 

 

Neglected Tropical Diseases in Sub
Saharan Africa and South Asia

Neglected Tropical Diseases are a diverse group of
diseases that affect most of the poor populations across the world primarily in
Sub Saharan Africa and South Asia. These diseases thrive in these regions of
the world due to the fact that they are uneducated, lack a central government,
and don’t have the resources  to keep
their people healthy. The reason theses tropical diseases are characterized as
neglected is due to the fact that these disease only affect the poor, so when
these regions try to reach out to more developed countries, their pleas are
usually brushed off or ignored because they aren’t affected at all. The more
developed countries would rather focus on the diseases that are affecting their
regions not a place that has no affect to them what so ever.  It’s important to analyze the prevalence of
NTDs in Sub Saharan Africa and South Asia, why these` diseases are thriving in
these regions, and what steps global heath institutions are taking to combat
these diseases.

Neglected tropical diseases usually reside in
extremely poor economic regions and “world’s
greatest concentration of poverty occurs in Sub-Saharan Africa” (Hotez &
Kamath, 2009). Sub-Saharan Africa can attribute its extreme level of poverty to
three main factors, which include: lack of economic diversification, poor
governance, and inequality in distribution. Sub-Saharan Africa only invests a
large amount of its economy into the oil produced and not into other economic
investments. This can be primarily shown in Nigeria where “the oil sector which
only constituted 1 percent of the country’s export revenue in 1958 rose to 97
percent by 1984 and has since then not gone below 90 percent” (Mendy, 2016). Due to
this lack of diversification in the economy the Sub-Saharan African government
has no need to create new jobs since there are no other exports being traded.
This leaves those in poverty with no way to make money to improve their living
and health conditions. This also creates a major rich for the Sub-Saharan
African economy in general if another region creates a more appealing offer for
their gas and oil. The next factor attributed to the increasing poverty in
Sub-Saharan Africa is the corrupt form of government established there which
can be shown “in the form of
corruption, dysfunctional public services, and unfair tax assessments amongst
other issues” (Mendy, 2016). No
programs are enacted to help those in poverty and because of this those facing
tough times economically are given no benefits which include health care, food,
and shelter. This is due to the fact that setting up these programs and
enacting those costs money which the government tries to avoid to improve their
own wealth. As the old saying goes, those who are rich stay rich if they don’t
share their riches. The final factor that is attributed to the poverty in
Sub-Saharan Africa is the inequality among distribution. The distribution in
Sub-Saharan Africa has been shown been shown to have one of the largest
inequalities in the world due to the fact that the top income percentages of
people control a majority of the income in the region. As time goes on this
wealth continues to increase over time as it’s passed down from generation to
generation leaving a smaller amount for the working middle class and an almost
non-existent amount for those in poverty. Usually wealth is distributed between
those of different social classes through taxes as the wealthier would pay a
higher amount of taxes compared to those in poverty that wouldn’t pay that much
in taxes. This ideal is non-existent in Sub-Sahran Africa as those of higher
wealth pay little to no taxes on their incomes increasing the gap between the
wealthy and poor more and more over time. The result of this wealth inequality
can lead to “an increase in economic and social problems such as violence”
(Mendy 2016). This result can also attribute to the increase in poverty as well
as violence would lead to property damage and force those out of their homes
that really have no homes to begin with.

Due to the lack of
health amongst those in poverty and the other issues attributed to the increase
the amount of those who are poor, disease start to thrive and grown. The major
neglected tropical diseases affecting the poverty of Sub-Saharan Africa
include: Hookworm, Ascariasis, Trichuriasis, and Schistosomiasis. Hookworm is contracted from stepping in feces left on the
ground or swimming in feces. The hookworm enters the body and gains nutrients
from its host due to its parasitic behavior which can “cause intestinal blood loss due to iron deficiency as well as
anemia and morbidity” (Hotez & Kamath, 2009). Due to the fact that Sub-Saharan Africa has a
lack of sanitation, most inhabitants defecate on the ground around there homes
or different areas among the region which when combined from the lack of foot
wear amongst those in poverty, hook worm continues to grow and be spread
amongst different inhabitants of Sub-Saharan Africa living with poor economic
standings. It has been shown that “approximately one-third of the world’s hookworm today occurs in
Sub-Saharan Africa mostly among the regions of Nigeria (38 million) and the
Democratic Republic of Congo (DRC, 31 million), followed by Angola, Ethiopia,
and Cote d’Ivoire (10–11 million)” (Hotez & Kamath, 2009). Ascariasis and
Trichuriasia as different types of parasitic worms that are transmitted into
the body by ingesting contaminated soil which can result in intestinal problems
as well as signs of weakness and malnutrition. If we compare Hookworm to
Ascariasis and Trichurasia then I would be shown that a “higher prevalence rates
of Ascariasis and Trichuriasis are often present in Africa’s urban areas
compared to rural areas, unlike hookworm, which is more evenly distributed” (Hotez & Kamath, 2009). Schistosomiasis or
snail fever affects those who swim, bay, do laundry, or other activities in
rivers or other bodies of water that contains snails with the virus. Among the
millions affected by Schistosomiasis, “93% occur in Sub-Saharan Africa (192
million), with the largest number in Nigeria (29 million) followed by United
Republic of Tanzania (19 million), and DRC and Ghana (15 million each)” (Hotez
& Kamath, 2009). It has also been suggested that the true disease burden
for schistososomiasis may be several fold higher than previous estimates,
possibly making this infection the most important NTD in SSA (Hotez &
Kamath, 2009).

Although these different diseases are
characterized as neglected The World Health Organization has been trying its
best to either control or eradicate these different neglect tropical diseases
through continued research, drug donations, and creating different necessities
that the people living in poverty in Sub-Saharan Africa definitely need sooner
rather than later. Since 1997, The World Health Organization has been
“developing national plans leading to the eliminations of numerous diseases as
well as monitoring and evaluating program activities to strengthen local
programs and their integration, particularly at community level, in order to
implement simple, affordable, acceptable, and sustainable activities based on
community wide treatment strategies, but supplemented where feasible by vector
control and improved sanitation” (Neglected
Tropical Diseases – Sub-Saharan Africa, pages 2-4). The biggest problem the
World Health Organization faces however is how to “deliver these different
interventions through a health system in the midst of serve human resource
constraints and other health system challenges” (Neglected Tropical Diseases – Sub-Saharan Africa, pages 5 – 7).
Drug Donations also face numerous problems as well that restricts them from
being obtained by those suffering in poverty in Sub-Saharan Africa. The drug
needs to first be made by a licensed pharmaceutical company and tested in the
field before mass production of the drug can occur. Even after the drug has
been made there are the pricing restrictions made by the Sub-Saharan African
government which inhibits people in poverty from actually obtaining these
drugs. Even with these different restrictions however, The World Health
Organization continues to do research on these different diseases would have
played a big part in the development of different programs and drugs that can
be implemented to help the infected people in Sub-Saharan Africa that are not
only suffering, but have no means to ease some of the suffering as well. The
potential programs trying to be executed by The World Health Organization
“coupled with drug donations by pharmaceutical companies and financial support
from the internal community sets the scene for success on the fight against
these different neglected tropical diseases” (Neglected Tropical Diseases – Sub-Saharan Africa, pages 10 – 12).

South Asia attributes its poverty to two main
factors which include: “population strain on limited land and other resources, and
weak economic development caused by faulty government policies and corruption”
(Wheeling
Jesuit University/Center for Educational Technologies, 2002). Most if not all the countries in South Asia have
populations that are growing at an alarming rate. Due to this rapid growth,
there aren’t enough resources or land to support this massive population. For
example, “Bangladesh is the second most densely populated country in the world and
has an average of 950 persons per square kilometer” (Wheeling Jesuit
University/Center for Educational Technologies, 2002). Bangladesh’s other issue is that over time the
land is slowly being covered by water pushing the population closer and closer
together limiting the resources and land even more. The other issue increasing
the poverty in South Asia is the corrupt governments in place. These government
at first sought to decrease the poverty in their countries by impending
different plans to tackle this problem and intervene in any way to make their
plans run smoother. These policies however are only a ruse that misleads people
into believing that their plans will eradicate poverty. Once their plans show
some signs of decreasing the amount of people in poverty, the government pats
themselves on the back and moves on without continuing with their plan. The
people are then surprised when they are kicked from office and replaced with
someone else when all they need to do is look around and notice the lack of
health care, sanitation, and basic needs they require to live.

Overpopulation and
corrupt governments result in the rapid growth of poverty in South Asia which
results in lack of sanitation and basic health care. This helps different
diseases thrive and grow amongst the poor because they is no way available
methods to cure these diseases and there are no systems in place to prevent the
spread of different disease. These diseases affecting most of South Asia
include: Ascariasis, Trichuriasis, Hookworm, Lymphatic Filariasis, and Visceral Leishmaniasis.
Ascariasis, Trichuriasis, and Hookworm are contracted from stepping on infected
soil without any proper footwear. It has been seen that in Pakistan the waste
water used for agriculture has been shown to have large amounts of hook worms. Research shows that “South Asia accounts for
approximately one-quarter of the world’s cases soil-transmitted helminthiases,
with the largest number of cases in India, followed by Bangladesh” (Hotez,
2011).  Lymphatic Filariasis is
a type of round worm that infects a person from an infected mosquito. The
mosquito sucks that blood of the first infected person and then becomes
infected itself. Upon sucking the blood of the second person, the disease is
transmitted from the mosquito to the second person and so on. It has been shown
that “the disease is poverty-related and predominantly affects poor and
marginalized groups. LF-associated disabilities and deformities result in heavy
economic losses and loss of livelihood” (Hotez, 2011). Visceral Leishmaniasis
is transmitted to humans from the bite of a female sandfly which are very
prominent in moist/humid conditions where they are hard to get rid of. The
disease itself “lowers immunity, causes persistent fever, pancytopenia, and
enlargement of the spleen and liver, and leads to very high mortality in
untreated cases” (Hotez, 2011). Visceral Leishmaniasis acutally leads to
poverty with the decrease of productivity due to the number of people get
infected as well as causes people to go into poverty because most people spend
most if not all their money for different treatments and medications to cure
the disease.

The World Health
Organization has taken different actions to help cure and prevent these
different neglected tropical diseases from spreading or reoccurring. For Ascariasis,
Trichuriasis, and Hookworm The World Health Organization strategy to attack these
diseases is to administer drags on a massive scale once or twice every year “using the drug
mebendazole or albendazole as a single dose, with a drug delivery system
relying heavily on schools and schoolteachers administering the drugs” (Hotez,
2011). Most of the countries in the South Asia region has reached their
deworming goals, but some are restricted due to government interventions with
how much these deworming procedures would cost. A hookworm vaccine is also in
the works to prevent the disease from resurfacing after the patient had already
been giving the proper treatment to cure it. For Lymphatic Filariasis, The World Health
Organizations has developed two main strategies to eliminate Lymphatic Filariasis
by 2020. These two strategies include: “annual MDA with two drugs, DEC and albendazole,
to the entire eligible population for 5–6 years, and home-based disability
alleviation and prevention” (Hotez, 2011). These strategies have been accepted
greatly especially in India and even in Sri Lanka the MDAs have been completed
and stopped entirely. The attack on Visceral Leishmaniasis needed to be a joint
venture since the epidemic was so large. The main strategies of this joint
action include: “early
diagnosis wherever possible, with the rapid diagnostic test rk-39 and prompt
treatment with the oral drug miltefosine, injectable paromomycin, or liposomal
amphotericin B; integrated vector management, which includes bed nets and
indoor residual spraying with DDT and other agents; effective disease
surveillance; social mobilization and partnerships; and clinical and
operational research” (Hotez, 2011). The only challenges that are faced with
this joint action is that some patients held a potent source of the disease in
their bodies which required intense, prolong treatments. Also different
vaccines for Visceral Leishmaniasis are also in development to prevent the disease
from occurring in treated patients or to help prevent the disease in patients
that have never been exposed to the disease.

In conclusion,
Neglected Tropical Diseases are a diverse
group of diseases thrive in large areas of poverty which are primarily located
in Sub Saharan Africa and South Asia. These diseases spread due to government
corruption, wealth inequality, over population with a lack of resources, and a
lack of necessities which include proper sanitation, housing, and basic health
care. Due to these issues, these diseases remain prominent with no sign of
decreasing especially in Sub-Saharan Africa. The World Health Organization have
taken some actions to eradicate these diseases and to prevent them from
reoccurring again. Although some regions take these policies in open arms, some
countries resist these plans due to cost and how it resides in its non-existent
healthcare plan. Overall, these different diseases are sometimes neglected by
outside sources, but primarily attributed to internal issues. These issues will
need to be resolved before proper care can be implemented in these regions
which is easier said than done.

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