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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. NTD’s thrive in these regions of the world
due to the fact that they are uneducated, lack a central government, and do not
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 vulnerable regions try to reach out to more
developed countries, their pleas are usually brushed off or ignored because
they are not affected at all. The more developed countries would rather focus
on the diseases that are affecting their country not a region that has no
affect to them.  It is important to
accentuate the prevalence of NTDs in Sub Saharan Africa and South Asia, why the
diseases are thriving in these regions, and what steps global heath
institutions are taking to combat these NTDs.

Neglected tropical diseases tend to 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: 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 problem 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 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 because enacting
and retaining  these programs 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 to have one of the largest inequalities in the world because 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
would not pay as 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. 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.

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The lack of health
amongst those in poverty and 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 vulnerable communities in 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). Sub-Saharan Africa has a lack of sanitation,
most inhabitants defecate openly 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 it 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 different diseases that play a significant
role 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 resources to treat their diseases as well. The potential programs
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). In order to sustain the efforts to
combat NTDs in Sub-Saharan Africa it is crucial for governmental institutions,
external institutions, and community health care professionals to work together
to eliminate the persistence of diseases within the region.

Contrary to Sub-Saharan Africa, 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 are not 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 ignores
the long term effects and progresses 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 and 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 treat 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 greatly accepted,
in India and 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 has
taken some actions to eradicate these diseases and to prevent them from
reoccurring again. However, The World Health Organization has limited funding
which tends to be utilized for more visible such HIV, Aids, and Tuberculosis. 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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