Bangladesh on track

In its fight against neglected tropical diseases (NTD), Bangladesh remains on track in terms of treatment and elimination of Kala-azar and lymphatic filariasis, but it remains a potentially risk country for leprosy in the 11 nations of WHO South-East Asia region.

More than a billion people across the world, mostly living in the low- and lower-middle-income countries, are affected by NTDs such as lymphatic filariasis, visceral leishmaniasis, leprosy, schistosomiasis and yaws, according to a presentation in Colombo, Sri Lanka, by Dr Mohamed Jamsheed yesterday.

He is the regional adviser, neglected tropical diseases, of the WHO South-East Asia Regional Office.

His presentation to journalists from the 11 countries of the region came a day before the health ministers and officials of the region as well as WHO experts sit for the annual regional committee meeting in the Sri Lankan capital today to discuss the health priority of the region. 

At least one NTD is endemic in each of the 11 member states of the region. The region bears the second highest burden of these debilitating infections in the world, according to the WHO.

The high densities of population, rapid urbanisation, significant cross-border movements, and poor access to sanitation and hygiene have made the region more vulnerable to these diseases.

NTDs are caused by various parasites, bacterium and viruses. 

Nine countries in the region, with the exception of Bhutan and the Democratic People's Republic of Korea, are endemic for lymphatic filariasis (LF).

Bangladesh has primarily eliminated LF in 18 out of the 19 endemic districts and is likely to achieve elimination in the remaining district, said Prof Be-Nazir Ahmed of the National Institute of Preventative and Social Medicine in an email yesterday.

Dr Jamsheed said Bangladesh was now under surveillance after it achieved the initial target.  

Kala-azar, or visceral leishmaniasis, is endemic in three countries in the Region -- Bangladesh, India and Nepal.

The region reported 8,138 kala-azar cases and 8 deaths in 2015, witnessing the lowest dip in the history of the disease in the region.

As of July this year, about 200 cases were reported in Bangladesh, which means the country has nearly reached the target and is working to eliminate it by 2017, said Prof Be-Nazir.  

While some of the neglected tropical diseases are fatal, if not treated, almost all of them are associated with permanent disfigurement and disability.

Failure to treat or control these diseases can lead to a vicious cycle of stigma and poverty with a significant economic burden on these marginalised populations and by extension to the entire country, according to the WHO. 

In 2014, the WHO South-East Asia Region contributed 72 percent of the global new leprosy cases and 74 percent of the new child leprosy cases reported, indicating ongoing transmission.

Six countries -- Bangladesh, India, Indonesia, Myanmar, Nepal and Sri Lanka, are considered high-endemic, contributing 99.8 percent of new cases from the region in 2014.

Bangladesh eliminated leprosy at the national level in 1998 but challenges to rural elimination persist, WHO says. 

Last year, there were only two high-endemic areas, including Nilphamari.

WHO's NTD roadmap, endorsed by the Sixty-sixth World Health Assembly has identified specific NTDs with the aim to control, eliminate and, in select few cases, eradicate these diseases with specific time-bound targets.

NTDs are also incorporated in the Sustainable Development Goals (SDGs) and find clear mention in SDG 3.3 extending the focus on their elimination beyond 2020.

The NTDs targeted for elimination in the region are lymphatic filariasis, visceral leishmaniasis, leprosy and schistosomiasis, while yaws is targeted for eradication at the global level.