Monday, June 28, 2010

Let's intensify strategies for fighting NTDs

For many years, much is known about many tropical diseases and several preventive practices have evolved in poor countries. However, unlike many other life-threatening diseases where the patients would pay for relief or cure, much less attention has been paid to these diseases as those affected are largely poor and have limited capacities to afford expensive treatment costs Diseases such as Ascariasis, Lymphatic Filariasis, Leishmaniasis, Hookworm infection, Leprosy and Tuberculosis are spreading in poor areas of India including the cities and the rural areas. Dengue and Japanese encephalitis spread during the time when mosquito bites increase in specific seasons. In some parts of India Trypanosomiasis and Schistosomiasis infect the rural poor. These diseases and some others (not very rampant in India) have been termed as neglected tropical diseases (NTDs).

The fundamentals of the preventive practices for the control of many of the NTDs are already known. But they are not effectively practiced. Good hygienic practices should be promoted through public media like broadcasting, telecasting etc., more often with scientific illustrations that are easily understandable and appealing to the common folks. This would enable continued recapitulations and adaptation of the good practices on a sustainable basis. People tend to forget or avoid practicing the art. The usefulness of maintaining cost-effective standard operating procedures (SOPs) for maintaining good hygiene are not unknown for most of the NTDs. Practicing them all the time is lacking however. Neglecting good hygienic practices promote infection and re-infection. Continuously educating the target masses is a fundamental component for success. Educating the masses is a social responsibility of the government, which should do this task uninterruptedly through public media. Where the assistance of the rich countries is available, these should be availed of. Cheap but effective medicines are available to treat some of these diseases; these should be distributed to the infected. Feed back information about the effectiveness and cure should be generated. All these efforts shall contribute to minimize the spread of NTDs. The increase in the number of healthy poor people shall contribute to economic gain of the country.

Once infected, the curing of many of these diseases is not easy. There are effective drugs for the treatment for some of the diseases. But they are expensive and administration needs hospitalization (liposomal amphotericin –B for treating leishmaniasis for example), which tells upon the abilities of the resource poor societies, where the infections are more rampant. Death occurs in many such patients. Public infrastructure must be strengthened to deal with the situation.

We have been hearing about the need to prevent and conquer the NTDs for the last fifty years in India. There have been improvements in the situation, driven mostly by the discovery and utilization of appropriate and cost-effective sanitation technologies, hygienic practices, use of safer drinking water and distribution of free or subsidized medicines. But many of these public utility goods and services (clean toilets, urinals especially for women and safe drinking water) are grossly in short supply even in the mega cities. We can construct, maintain and propagate public utility goods and services if there is a burning desire.

Governments have the lion’s share of responsibilities in this struggle. Besides strengthening the existing infrastructure, new avenues for conducting intensive research for developing more effective medicines and preventive practices have to be created. Funds for these have to be deliberately allocated at any cost. Many rich countries are also willing to provide some funds, access to which can be explored. Creative managers who have a flair for such public utilities should be in place. The funding philosophy for allocating resources from the private sectors for these activities do not fit in too well except for some philanthropic NGOs. Together, a judicious balance between preaching and practicing of the existing knowledge along with developing new therapeutics and practices through research, where the government pilots the programs shall have more mileage than taking any one-lane approach.

In the midst of multiple adversities and with severe resource constraints all around, the mankind has to travel many more miles to reach the stage of “concurring” any of these conditions, especially in the poor societies. But efforts can’t stop and must be continued.