Neglected Tropical Diseases - Sub-Saharan Africa

421 Pages·2016·10.93 MB·English

by  John Gyapong

Neglected Tropical Diseases
John Gyapong
Boakye Boatin Editors
Neglected
Tropical
Diseases -
Sub-Saharan Africa
Neglected Tropical Diseases
Series editor
Peter J. Hotez , MD, PhD
Dean, National School of Tropical Medicine,
Texas Children’s Hospital Endowed Chair of Tropical Pediatrics,
Professor of Pediatrics and Molecular Virology and Microbiology,
Baylor College of Medicine,
Houston , Texas , USA
President, Sabin Vaccine Institute,
Washington, District of Columbia, USA,
Houston , Texas , USA
University Professor of Biology, Baylor University,
Waco , Texas , USA
Baker Institute Fellow in Disease and Poverty, Rice University,
Houston , Texas , USA
More information about this series at
http://www.springer.com/series/11165
John Gyapong (cid:129) Boakye Boatin
Editors
Neglected Tropical
Diseases - Sub-Saharan
Africa
Editors
John Gyapong Boakye Boatin
Research, Innovation and Development Lymphatic Filariasis Support Centre
University of Ghana University of Ghana
Accra Accra
Ghana Ghana
ISSN 2194-8275 ISSN 2194-8283 (electronic)
Neglected Tropical Diseases
ISBN 978-3-319-25469-2 ISBN 978-3-319-25471-5 (eBook)
DOI 10.1007/978-3-319-25471-5
Library of Congress Control Number: 2015958883
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2016
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Foreword
Today, Sub-Saharan Africa represents one of the most important global “hotspots”
for highly endemic neglected tropical diseases (NTDs). First and foremost, NTDs
are the major affl ictions of profound poverty, and such levels of poverty are perva-
sive on the African continent. According to the World Bank, more than 900 million
people live in Sub-Saharan Africa with approximately one-half living on less than
$1.25 per day.
NTDs thrive under these circumstances. The World Health Organization (WHO)
has now determined the numbers of people who require mass drug administration
for their NTDs, and indeed these numbers are disturbing. Overall 658.7 million
people in WHO’s African region require mass drug administration for NTDs,
including 468.4 million people for lymphatic fi lariasis, 324.2 million for soil-
transmitted helminth infections, 240.7 million for schistosomiasis, and 168.8 mil-
lion for onchocerciasis. Overall, the WHO African region accounts for less than
15 % of the world’s population, but almost 40 % of the people requiring treatment
for their NTDs.
A nother feature of Sub-Saharan Africa is its (unwelcome) exclusivity for some spe-
cifi c NTDs. Today, the region accounts for all of the world’s cases of loiasis and human
African trypanosomiasis (HAT), and (again according to the WHO) 92 and 99 % of
the world’s population that requires mass treatment for schistosomiasis and onchocer-
ciasis, respectively. Most of the planet’s podoconiosis and Buruli ulcer, and possibly
trachoma and yaws, are also found in Sub-Saharan Africa.
T he impact of this massive load of NTDs is felt at different levels. These diseases
produce deleterious and direct negative consequences for public health through
their long-term effects on disability, or in some cases by causing death (especially
for HAT and leishmaniasis). In addition there are important indirect effects. For
example, urogenital schistosomiasis (which is responsible for roughly two-thirds of
the schistosomiasis) has now been shown to be a major co-factor in Africa’s HIV/
AIDS epidemic, while malaria, together with hookworm infection and schistoso-
miasis, greatly exacerbate anemia. Both of these indirect effects represent important
causes of ill health for Africa’s girls and women.
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In addition to their health impact, Africa’s NTDs also exhibit important links
to social forces. They promote poverty, as they make people too sick to work and
impair child development. They are also inextricably linked to Africa’s civil and
international wars. During the 1970s, 1980s, and 1990s in Angola, Democratic
Republic of Congo, and Sudan, HAT may have killed annually ten times more
people than those who died in the 2014–2015 West African Ebola virus infection
outbreak. Just as the NTDs help promote poverty, diseases such as HAT may also
cause destabilization and further promote confl ict on the African continent.
Solving Africa’s NTD problem will require a multi-pronged approach including
social scientists to design culturally sensitive interventions. We must expand mass
treatments, especially for diseases such as schistosomiasis, a disease for which only
about 10–15 % of children have access to praziquantel, together with case detection
and treatment for NTDs such as HAT and leishmaniasis. Mass treatment needs to be
accompanied by intersectoral approaches that embrace sanitation, clean water, and
other environmental measures. In parallel, vector control will be needed for leish-
maniasis, HAT, and other NTDs. The good news is that through these approaches
we are beginning to see declines in the number of cases of lymphatic fi lariasis,
onchocerciasis, and HAT, such that it is now possible to realistically discuss the
potential for eliminating these NTDs. For others, we are going to need to enlarge
programs of research and development, which must include capacity enhancement
for African scientists.
I am very excited about this new volume. Dr. John Owusu Gyapong and Dr.
Boakye Boatin have assembled a top-fl ight team of African authors and scientists
with direct fi rst-hand knowledge about these diseases. In this respect, this volume is
practically unique – a book about disease and poverty in Africa written by scientists
and public health experts from Africa. I would like to congratulate Drs. Gyapong
and Boatin and the authors of each of the important book chapters, and Springer for
creating this important series on NTDs!
Houston, TX, USA Peter J. Hotez , MD, PhD
Pref ace
T his book sets out the neglected tropical diseases (NTDs) through the lens of sub-
Saharan Africa (SSA). Twelve of the major NTDs are presented. They include
Buruli ulcer, Guinea worm, human African trypanosomiasis, leishmaniasis, leprosy,
Loa loa, and lymphatic fi lariasis. Others are onchocerciasis, podoconiosis, schisto-
somiasis, soil-transmitted helminths, trachoma, and yaws. Additional areas which
transcend all the NTDs such as health systems and their role in NTDs, the social and
economic impact as well as vector control, an often less talked about area in recent
times in the control of NTDs are also discussed.
T he disease specifi c chapters are written following a theme which is common to
all, but there are important variations on the theme within the structured sections.
Each chapter therefore can be read independently on its own but read together with
the chapters on health systems and social and economic implications will make
them even more complete. Areas that have received detailed attention include diag-
nostics especially for those diseases that are targeted for elimination, future control
tools including drugs as well as critical research needed to help overcome the chal-
lenges that have been identifi ed for each disease.
A s expected most the challenges that have been identifi ed for the diseases cut
across many of them, but some challenges are very disease specifi c. With this in
mind, a section on the expected situation for each disease in the next decade is high-
lighted for each of the chapters.
The authors were drawn almost entirely from African research scientists and
individuals who have either worked in their respective ministries of health, have
come face to face with the realities of the ravages of NTDs in their countries, or
have experience in the control of the diseases.
I n taking on this assignment it was clear that there would be diffi culties in trying
to work with so many contributors; however, the task was made less arduous by the
willingness of the authors to work as a team and in close collaboration with each
other. Many people who are not listed in the chapters helped in many ways to get the
manuscripts together. Their contributions are well acknowledged.
I t is our wish that this book, apart from providing some basic information on the
specifi c NTDs and the special ways that NTDs present in SSA, will also be a good
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viii Preface
source of a wide range of references on NTDs to readers. In a word, this book will
be a useful read for all who are interested in doing something about NTDs in SSA.
Accra, Ghana John O. Gyapong, MD, MPH, PhD
Boakye A. Boatin, MD, MPH
Acknowledgments
The editorial team is grateful to Ms Grace Annan, a Senior Research and
Administrative Assistant of the Offi ce of Research Innovation and Development of
the University of Ghana, for her secretarial support.
T he work was partly supported by a grant (Grant Number: G1001337) from the
UK Medical Research Council (MRC) and the UK Department for International
Development (DFID) under the MRC/DFID Concordat agreement, through the
Liverpool School of Tropical Medicine Council and managed by the School of
Public Health, University of Ghana.
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