WORLD NTD DAY: What are neglected tropical diseases and how is Africa successfully eliminating them?

A display of the current standard treatment for kala-azar, the most fatal parasitic disease after Malaria in Kacheliba, Kenya. Photo Courtesy: Lameck Ododo.

Edith Magak, bird story agency

As the world observes the 5th annual Neglected Tropical Diseases Day on January 30, 2024, Africa’s commitment and progress in combating these devastating forgotten diseases is one of its greatest achievements. According to the World Health Organization (WHO), out of the 50 countries globally that have eliminated at least one neglected tropical disease as a public health problem, 21 are in Africa.

Neglected tropical diseases (NTDs), a set of 21 preventable and treatable conditions, affect over a billion people worldwide, with Africa bearing nearly 40% of the global burden. These diseases cause loss of life, severe pain, disabilities, disfigurement, malnutrition, and stunted growth. Among them are bilharzia, elephantiasis, mycetoma, leprosy, river blindness, sleeping sickness, Guinea worm disease, and kala-azar.

“What they have in common is that they (NTD’s) don’t feature enough on the global health agenda, receive little funding, and have historically been ignored by pharmaceutical research because drug development today is primarily skewed to areas with the greatest commercial return rather than those with the greatest public health needs,” said Monique Wasunna, the Africa Ambassador for the Drugs for Neglected Diseases initiative and an infectious disease specialist.

Tablets of Fexinidazole, a drug that was used in the DNDi-FEX-07-HAT clinical study in Malawi.

Despite not garnering sufficient global health attention, Africa has made significant progress in the fight against NTDs.

“In 2022, Togo became the first country globally to receive WHO certification for eliminating four NTDs – namely, Guinea-worm disease, elephantiasis, sleeping sickness, and trachoma. In the same year, Malawi also eliminated trachoma, while the Democratic Republic of the Congo eliminated guinea-worm disease and Rwanda and Uganda eliminated sleeping sickness” said Wasunna, who has been working in the sector for over 20 years.

Africa made further progress In 2023 when Benin eliminated Trachoma and Ghana achieved a significant milestone by eliminating sleeping sickness, bringing each country’s total to three eliminated diseases. Other nations making noteworthy progress include Mali, Malawi, Cote d’Ivoire, Gambia and Kenya.

DNDi Africa ambassador Dr Monique Wasunna at her Office in Nairobi, Kenya. Photo Courtesy: Rowan Pybus.

Kenya has already eliminated guinea worm disease and is currently working to present documents to WHO to have the country declared free from sleeping sickness. Kenya also hopes to be visceral leishmaniasis (kala-azar) -free by 2030.

“We have made remarkable progress against visceral leishmaniasis, also known as kala-azar and I believe elimination is possible by 2030,” said Chege Kimani, the medical superintendent at Kacheliba Hospital in Kacheliba, a small town in Kenya close to the Ugandan border, where Kala-azar is endemic.

Over the past year, the hospital has treated over 650 people diagnosed with this fatal neglected disease, the largest parasitic killer after malaria. It is transmitted by female sandflies and causes fever, weight loss, spleen and liver enlargement, and, if not treated, death.

“We have been conducting awareness campaigns and also active case searches in the communities. We also have better diagnostic tools and new treatments are in the pipeline, including an all-oral drug that will hopefully dispense with the need for hospitalisation. Here in the region, treatment has been brought closer to communities by establishing an additional leishmaniasis treatment facility in Sigor. This means we can respond effectively to outbreaks and guarantee access to treatment to everyone,” added Kimani.

Collectively, Africa is also demonstrating leadership, committing to ending NTDs by 2030 through the African Union.

“There is clarity of vision as well as growing demand and energy in Africa to see the continent free of NTDs. Political commitment has been sustained and energised through the Kigali Declaration, and through the Continental Framework and Common Africa Position on NTDs. Neglected tropical diseases cause suffering to millions, and we simply cannot afford to neglect them any longer,” said Julius Maada Bio, President of Sierra Leone at a forum hosted by the global health initiative, Reaching the Last Mile, during COP28 in Dubai last December.

A display of the current standard treatment for kala-azar, the most fatal parasitic disease after Malaria in Kacheliba, Kenya. Photo Courtesy: Lameck Ododo.

Antoinette Mpono Bukoy with Dr Victor Kande, being examined at Masi Manimba Hospital and receiving fexinidazole treatment for sleeping sickness in DRC. Photo Courtesy: Xavier Vahed, DNDi.

On the frontlines are African scientists, clinicians and communities who have spearheaded the critical mission of finding innovative treatments for neglected diseases that disproportionately affect the region. These have resulted in the development of treatments for some of these diseases.

Some of the scientists include:

**Ahmed Hassan Fahal:** A Sudanese Professor of Surgery at the University of Khartoum, who specialises in Mycetoma, one of the most neglected diseases in the world. Fahal founded the Mycetoma Research Centre (MRC) at the University of Khartoum in 1991 and today, the centre is recognised globally as a world leader and authoritative source of advice on mycetoma management and research. In 2015, WHO designated it as a Collaborating Centre. The MRC cares treats mycetoma patients mainly from rural Sudan but also from several other countries, including Chad and Yemen.

**Victor Kande Betu Kumesu:** Known as the father of sleeping sickness, this Congolese doctor has spent the last 40 years of his life working to combat sleeping sickness and led clinical trials for fexinidazole, the first oral-only drug that is expected to accelerate the elimination of the disease in Sub-Saharan Africa. As the former director of the DRC’s sleeping sickness program, Kande spent decades treating patients with sleeping sickness when the only available drug was melarsoprol, an older, arsenic-based medicine that kills one in every 20 patients.

A display of the current standard treatment for kala-azar, the most fatal parasitic disease after Malaria in Kacheliba, Kenya. Photo Courtesy: Lameck Ododo.

A display of the current standard treatment for kala-azar, the most fatal parasitic disease after Malaria in Kacheliba, Kenya. Photo Courtesy: Lameck Ododo.

**Monique Wasunna:** The Kenyan-based Ugandan-born physician, infectious disease and tropical medicine specialist, was the Eastern Africa Director for the Drugs for Neglected Diseases initiative from 2003 to 2023 and now serves as the organisation’s Africa Ambassador. In 2020, she was awarded the National Order of Merit (Officier de l’ordre national du mérite) by the government of France in recognition of her exemplary research on neglected tropical diseases and advocacy for better treatments for neglected patients in Africa.

**Mwele Ntuli Malecela:** Malecela, a Tanzanian, served as the Director of the Department of Control of Neglected Tropical Diseases at the World Health Organization from 2018 until her passing in February 2022. Her short time as Director of the Department of Control of Neglected Tropical Diseases culminated most notably in the development of the new NTD road map for 2021-2030.

According to Kimani, collaboration and teamwork is key to the eradication of neglected diseases.

“It is important that we work together to form partnerships, invest in sustainable financing for medical research and programs, and continue to develop and make accessible new treatments. By doing so, we can reach the global targets and milestones set by the WHO road map, and by 2030, we can finally eliminate NTDs,” concluded Kimani.

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