New Delhi: Neglected Tropical Diseases (NTDs) are a diverse group of 20 conditions/diseases that are mainly prevalent in tropical areas. These include Guinea worm, Chikungunya, Dengue, Kala Azar (Visceral Leishmaniasis), and Elephantiasis (Lymphatic Filariasis), among others, and India is home to about 12 NTDs. According to the World Health Organization’s (WHO) 2023 Global Report on NTDs, nearly 47 countries had eliminated at least one NTD, including India, which got rid of Guinea Worm. However, in 2021 and 2022, there was an NTD outbreak that affected several countries, including India, where high cases of Dengue were reported, which prompted a response by the WHO – the launch of the roadmap for NTDs 2021−2030 to attain the Sustainable Development Goals.
As the world marks World Neglected Tropical Diseases Day on January 30, the NDTV-Dettol Banega Swasth India team delved deep into India’s progress in eradicating and bringing some of them to the elimination stage, with Dr NK Ganguly, Former Director General Indian Council of Medical Research (ICMR).
Talking about the prevalence of Neglected Tropical Diseases (NTDs) in India, Dr Ganguly said,
At present, the total NTD susceptible population in India is about 700 million and 1.7 billion worldwide are affected. Out of the 20 NTDs, about 11-12 are prevalent in India and the top three NTDs present in the country are Kala Azar (Leishmaniasis), Elephantiasis (Lymphatic Filariasis), Leprosy.
Causes Behind The Spread of Neglected Tropical Diseases
Dr Ganguly highlighted that climate change is the single best determination in the spread of NTDs. He said that with the changes to weather patterns like temperature, rainfall, and humidity, influences the spread of NTDs, especially Dengue. The expert detailed,
The vector density increases with the increase in the temperature. Due to the rise in temperature, the vectors are able to fly more than 1,000 feet above where they are. Besides, water accumulation, rapid urbanisation, and extreme weather events such as floods also contribute to the rise of diseases, especially Dengue. They act as a breeding ground for mosquitoes, and the warmer temperatures enhance the virus replication within the mosquitoes’ bodies.
How Far Has India Come In Combating Neglected Tropical Diseases?
India has been successful in eliminating some of the major tropical diseases, Dr Ganguly said. The country eliminated Guinea worms in 2000 and got rid of Leprosy as a public health problem in 2005. The expert further added,
In 2017, we almost got the infective trachoma to the elimination stage. Speaking of Kala Azar, 90 per cent of the endemic districts in the country removed the disease as a threat. Now, there are only six districts left – four in Jharkhand and two in Bihar. So, this is huge progress which we have made. For Elephantiasis (Lymphatic Filariasis), one of the major NTDs prevalent in India, we have stopped the mass drug administration in about 133 districts.
Have We Achieved The 2023 Goal Of Eradicating Kala Azar From India?
Kala Azar (Visceral Leishmaniasis) is a chronic and potentially fatal parasitic disease of the viscera (the internal organs, particularly the liver, spleen, bone marrow and lymph nodes) caused by the parasite called Leishmania Donovani. It is majorly present in parts of Uttar Pradesh, Bihar, Jharkhand and West Bengal. As of November 2023, none of the endemic areas in India reported incidents more than 1 case per 10,000 population of Kala Azar, according to the Union Health Ministry. Dr Ganguly said that with 1 case per 10,000 population it can be considered that the country has almost eliminated the disease.
Breakthroughs In The Treatment And Elimination Strategies for NTDs
Dr Ganguly listed down some of the major breakthroughs that have taken place and the ones in the process:
For Kala Azar, a combo drug has been introduced, apart from one medicine that was provided to the patients, known as Liposomal Amphotericin B .Combo drugs like Miltefosine and Amphotericin B, has come as a very big breakthrough in India.
For Elephantiasis (Lymphatic Filariasis), there has been an addition of another drug. Previously, the doctors were using Diethylcarbamazine and Albendazole, but now in some of the cases where there has been no response to these two drugs, the health experts have added Ivermectin. This has also helped accelerate the disease elimination process.
Efforts are being made to add Diethylcarbamazine (DEC) in the salt, as a low-cost and effective strategy to eliminate transmission of Elephantiasis.
For Leprosy, India has Minocycline and Clindamycin as additional drugs, for patients who have not responded to the existing ones.
For Dengue, the healthcare sector is looking at using NIH/Butantan vaccine. The vaccine is being developed by three Indian companies – Panacea Biotec, Biological E and the Serum Institute of India (SII). Currently, it is in an advanced stage of preparation and will be in the market in one or two years, Dr Ganguly informed.
Dengue, Dr Ganguly said, is one of the major threats in the NTD family in India, because 92,400 cases have been reported till September 2023, with Kerala reporting the maximum cases and deaths.
Talking about the interventions that India needs in order to eradicate NTDs, Dr Ganguly emphasised:
- Having an integrated approach for vector control because for each vector, we cannot design a separate control measure.
- Identifying the drugs, either preventive or curative, and providing them to the carriers.
- Ensuring the accessibility of the drugs to the vulnerable population.
- Diagnosing at a very early stage so that the timely treatment can be provided, and the transmission can be stopped.
- Focusing on mass communication programmes to raise awareness about NTDs among the vulnerable, along with appropriate partnerships financing.
- Ensuring the utilisation of funds and reaching out to the vulnerable population
- Ensuring community participation to reach out to the people living in the remote areas of the country.
- Ensuring access to WASH (Wash, Sanitation and Hygiene) facilities among the poor.
- Strengthen surveillance to identify the major hotspots.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which in its Season 10 is helmed by Campaign Ambassador Ayushmann Khurrana. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In a world post COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental well-being, self-care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.