Cross-cutting issues in NTDs
The burden of NTDs across the globe is extensive. They cause widespread mortality and inflict suffering by causing life-long disabilities, impairments, reduced economic productivity, social stigma and the resulting social exclusion.
Effective control and prevention of disabilities associated with the NTDs can be achieved when several public health approaches are combined. Improved access to safe water, sanitation and hygiene (WASH) is an example of a key intervention within the global NTD roadmap. It is critical in the prevention and the provision of care for the majority of the NTDs, especially for lymphatic filariasis, trachoma, STHs, schistosomiasis and dracunculiasis.
WASH in NTDs
Primary prevention, control of NTDs and management of NTD-related disabilities relies heavily on access to safe water, sanitation, and hygiene (WASH). There are numerous NTD transmission routes that can be interrupted with improved WASH, including trachoma, schistosomiasis, soil-transmitted helminthiasis (STH) and Guinea worm. In addition, improved WASH is vital to NTD-related wound and morbidity management and disability prevention, for example in leprosy, lymphatic filariasis and Buruli ulcer. Therefore, as endorsed by the WHO roadmap for NTDs, access to safe WASH services are key for the prevention, intensified control, management and elimination of NTDs by 2020. Though, there is still a great need for operational research on the feasibility and effectiveness of pairing specific WASH interventions with specific NTDs.
Prevention of Disability
Management of disease complications (also called morbidity) and disability prevention (MDDP) are vital components for NTD programs. They should be fully integrated into the health system to ensure sustainability. One of the pillars for LF elimination is the management of morbidity and disability prevention (MMDP) among those with lymphatic filarial disease. Several of the roadmaps and global strategies for eliminating NTDs have included strategies and guidelines for MDDP.
Inclusion is the concept of everybody – irrelevant of being marginalised or having any kind of (dis)ability – being accepted into society with the same rights and opportunities as everyone else.
People affected by NTDs are often poor and already marginalised. NTD-related impairments, activity limitation and/or stigma and discrimination may aggravate this and may lead to various forms of social exclusion.
It affects all people with NTDs who are poor, but especially those persons who suffer from stigmatised conditions, like Buruli ulcer, Chagas disease, lymphatic filariasis, podoconiosis, leishmaniasis, leprosy, onchocerciasis and schistosomiasis.
Stigma & mental well being
Stigma is a widely recognised term, and defined as a social process that is “experienced or anticipated, characterized by exclusion, rejection, blame or devaluation, that results from experience, perception, or reasonable anticipation of an adverse social judgment about a person or group”. Prejudice, negative attitudes and discrimination are part of stigma.
Stigma and discrimination, and its mental health consequences affect many NTDs. The prejudice, stigmatization and discrimination that people experience can be more limiting than the condition itself. It may have social, psychological and health-related consequences. Social exclusion is a common consequence, including reduced education and work opportunities, which in turn lead to or may aggravate poverty and may reduce marriage prospects, for example. One common consequence is an effect on mental health, which may include low self-esteem, depression and even suicide.