High Hopes in Terms of Defeating 'Neglected' Tropical Diseases

Juba — Health workers in the world's newest country are hoping that the pledge by pharmaceutical companies and world leaders to combat "neglected" tropical diseases will finally help to have an impact on South Sudan's appalling health indicators.

The London Declaration on Neglected Tropical Diseases in January pledged to ensure the supply of drugs and other interventions to eradicate dracunculiasis (Guinea worm) by 2015 and eliminate lymphatic Filariasis (elephantiasis), leprosy, human African trypanosomiasis (sleeping sickness), and blinding trachoma by 2020.

It also pledged to control Schistosomiasis (bilharzia), soil transmitted helminthes, Chagas disease, visceral leishmaniasis (kala-azar), and Onchocerciasis (river blindness) by 2020.

The UK Minister for International Development, Stephen O'Brien, said the initiative would "help make guinea worm the second human disease ever to be eradicated in history by 2015, help secure the elimination of elephantiasis and river blindness, and protect millions more from bilharzia".

Decades of war, neglect, and lack of development have left South Sudan with nine out of 10 of these key neglected tropical diseases - all but Chagas disease, which is endemic to South America.

Only one in four people in South Sudan is able to access healthcare. About 90 percent of rural women are illiterate, leaving the nascent state with among the world's highest rates of maternal and infant mortality.

According to the World Health Organization, the country is the chief reservoir of guinea worm disease, with 944 of the world's 969 remaining cases. The other 25 patients are in Ethiopia, Chad and Niger.

David Sylvester, medical director of Nimule hospital and one of the few trained South Sudanese doctors working in the country, says it has "some of the world's worst health indicators due to its history of conflict and the fact that there has been no health system in place for decades.

"There have also been continuing large-scale movements of populations spreading different diseases, and almost total lack of education, sanitation and clean water."

He points out that since the end of the war in 2005, "the lack of government capacity to tackle health issues has remained the most serious challenge, as has the desperate lack of trained health workers".

He says people's lack of experience of healthcare means they seek other explanations for diseases such as sleeping sickness, as they are liable to blame its symptoms on witchcraft and only seek medical attention as a last resort.

Elizeous Suror, sleeping sickness programme manager at Nimule's hospital, run by medical charity Merlin and one of the only facilities in the country able to treat the disease, warns that "delays in seeking treatment mean that people often present with late stage sleeping sickness which requires hospitalization and highly toxic drugs and often leaves such patients with irreparable brain damage".

He says South Sudan has the third-highest incidence of sleeping sickness in the world, after Angola and Democratic Republic of Congo, and points out that "all three countries have seen decades of conflict that have devastated their healthcare systems".

He says the only way to eradicate the disease is to recommence active screening of the population.

Decades of war, neglect, and lack of development have left South Sudan with nine out of 10 of these key neglected diseases

At the Médecins Sans Frontières-run Leer hospital, one of the key facilities combating the kala-azar epidemic, public health expert Koert Ritmeijer said the neglected disease initiative was "very encouraging".

However, he is concerned that "most of the attention and resources are focused on the worm diseases, for which elimination is more feasible through preventive mass drug administration at community level. Much more difficult is the control of the 'killing' neglected tropical diseases: kala-azar, sleeping sickness, and Chagas disease."

He says "effective control and eventual elimination of these diseases require development of new diagnostics and treatments, in order to roll out simple, effective, and safe diagnostic and treatment services to peripheral health facilities in remote endemic regions. It also requires a scale-up of national programmes [treatment services and surveillance] in endemic regions, which are typically lacking functional basic healthcare services."

He is concerned that "in the absence of an effective vaccine against kala-azar, and considering the lack of practical feasibility and effectiveness of vector control measures to control transmission of the disease in East Africa (e.g. spraying and bed nets), elimination of kala-azar is not within reach, and recurrent epidemics may be expected every six to 10 years".

He says the current epidemic in South Sudan, which started at end-2009, may be further exacerbated by "the increased insecurity in the kala-azar endemic regions [Unity, northern Jonglei and Upper Nile States], resulting in displacement and movement into the affected areas; increased numbers of non-immune returnees from the North, deteriorating food security in South Sudan, resulting in increased malnutrition and susceptibility for kala-azar; and limited access to care due to increased insecurity".

He maintains this will be a "major challenge for South Sudan, where the healthcare system is still very poorly developed, especially in the remote and isolated regions endemic for kala-azar, sleeping sickness, and other neglected diseases.

"It is the poverty, malnutrition, poor water and sanitary conditions, insecurity, and a general lack of access to healthcare in these regions that enhance transmission and maintain such high prevalence of these neglected tropical diseases."

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