Ramya Madhireddi: The underestimated burden of NTDs in India

ramya-madhireddiNeglected tropical diseases (NTDs) are a diverse group of conditions that affect more than a billion people worldwide. With India bearing one of the heaviest burdens of NTDs in the world (58% of leprosy cases, 40% of lymphatic filariasis cases, and 34% of cases of dengue fever), it needs to give them their due share of attention alongside diseases such as tuberculosis (TB), HIV/AIDS, or malaria.

Although the mortality rate for NTDs is not as high as for the aforementioned conditions, one study estimated that NTDs cause 56.6 million disability adjusted life years (DALYs). The multidimensional impact of NTDs takes an economic, social, and psychological toll on those affected.

study by Babu and Nayak about treatment expenditure and loss of work time in patients with lymphatic filariasis found that patients spent 92 rupees on average per acute episode, with 68.7% of the total amount spent on medicine, followed by travel for treatment (10.9%), and consultation fees (8.6%), etc. Since NTDs typically affect people on low incomes, the cost of treatment, drugs, travel, and management of the condition can have huge implications for families with limited means. Babu and Nayak also concluded that 88% of patients in their study with acute episodes could not perform any productive work.

Loss of working days due to NTDs is a major economic threat, which plunges families into a vicious cycle of debt, poverty, and sickness. PJ Hotez and colleagues have pointed out certain features of various NTDs that trap those affected into poverty by hampering the health of their children (for example, through impairment of child growth and development, severe anaemia during pregnancy, low birth weight babies) or by impeding their ability to work (for example, blindness).

NTDs with unpleasant physical manifestations can plunge the individual into self-stigmatisation and depression, with many experiencing discrimination. The toll such conditions can take on patients’ mental health remains a major yet hidden issue.

The conditions in which people affected by NTDs often live—without an adequate supply of water, without sanitation facilities, and with unhygienic surroundings—propagate the growth and transmission of NTDs and their vectors.

The global burden of disease study (2010) brought to light another hidden burden in the form of indirect mortality, as NTDs are linked to many noncommunicable diseases too including cancers, cardiovascular disease, liver disease, etc. A new concept called  “Blue Marble Health,” put forth by Hotez, states that it’s not only poorer nations that harbour the highest burden of NTDs now, but that there has been a substantial shift of NTDs to poor and vulnerable communities within wealthier nations.

NTDs are emerging as a major barrier to India achieving its health goals. India has been incorporating the five strategies from the 2012 WHO roadmap to control, eliminate, and eradicate NTDs into its various national programmes, such as the National Vector Borne Disease Control Programme (NVBDCP)—which looks into dengue, filariasis, kala-azar, chikungunya, Japanese encephalitis, and malaria—and the National Leprosy Elimination Programme (NLEP), but more needs to be done.

Much of the burden of NTDs comes from chronic patients and India needs more than ever to focus on the morbidity management of NTDs in its programmes. India has been successful in reducing the infant mortality rate, maternal mortality rate, and has even achieved the Millennium Development Goals in the above mentioned indicators in states such as Kerala and Tamil Nadu, with equally successful campaigns for AIDS, malaria, etc. This has been possible with the impetus provided by greater funding, innovative schemes, and community and mass media participation. Similar practices need to be replicated in India’s NTD programmes as well.

The National Health Policy 2015 draft states that better management of vector borne diseases will help integrate the preventive and curative services within India’s health systems. It talks about dedicated, sustainable, and sensitive health systems, which are capable of early detection, treatment, and management so that the elimination of NTDs such as leprosy, and other vector borne diseases becomes a reality.

NTDs have also been included in the Sustainable Development Goals (target 3.3), with the understanding that the eradication of NTDs will help achieve not only that particular health goal, but many other goals linked to poverty, education, gender equality, etc.

The impact of NTDs is far reaching and a daunting task for any nation to estimate and manage. Comprehensive national NTD programmes with strategic planning, effective implementation, and synergistic partnerships, in addition to a focus on improving sociodemographic conditions, will help India develop a viable platform to achieve the SDGs and eliminate preventable and needless suffering in the form of NTDs. The neglect of these diseases and those that have them needs to end now.

Dr Ramya Madhireddi, a student on a public health management course at the Institute of Public Health, Bengaluru, is currently pursuing hospital management at the Administrative Staff College of India, Hyderabad.

Competing interests: None declared.