An unknown among unknown diseases, podoconiosis (podo for short) is a devastating type of elephantiasis spread by long-term exposure to minerals found in volcanic soil. Unlike lymphatic filariasis, podo is not infectious. Podo has been reported in more than 15 countries across Africa, Southeast Asia and Latin America, and affects more than 4 million people in highland tropical Africa.
A three-minute animated video, “Best Foot Forward,” depicts the source, treatment and prevention of podo. The video was created by Footwork: The International Podoconiosis Initiative, in partnership with Ripple Effect Images, a group of National Geographic contributing photojournalists, to raise awareness of this neglected disease.
As the video movingly illustrates, subsistence farmers in remote rural areas contract this devastating disease while working barefoot. Podo causes progressive swelling of the lower legs and makes it difficult to walk. In addition to physical suffering, superstitions about the causes of podo lead to shaming and even banishing of podo sufferers, particularly women.
Yet, podo is treatable. Podo’s severe swelling can be significantly reduced with simple hygiene. Low-cost foot care and shoes can ameliorate symptoms and prevent the occurrence of podo. Funding is urgently needed to support these treatments and educate local populations about prevention.
To learn more about Footwork and podo, visit www.podo.org.
About Footwork Footwork: The International Podoconiosis Initiative is a project of New Venture Fund, a 501(c) 3 public charity. Our vision is a world free of podoconiosis in our lifetime. Our mission is to bring together public and private partners to support prevention and treatment of, and advocacy for, podoconiosis. Footwork is active in Ethiopia, Cameroon and Uganda. It encourages integration of podoconiosis control into efforts to eliminate other NTDs, and works with organizations active in other related diseases of the foot and leg.
The Headline: The Inter-agency and Expert Group on the Sustainable Development Goals (IAEG-SDGs) has approved the inclusion of an indicator for neglected tropical diseases (NTDs).
What are the Sustainable Development Goals?
The Sustainable Development Goals (SDGs) are a set of 17 global targets that will define and guide the international community’s efforts to end extreme poverty, fight inequality and injustice, and create a healthier environment by 2030. They are essentially the world’s to-do list, and they were adopted by the United Nations (UN) General Assembly in September.
A bit of history: The SDGs replace the eight Millennium Development Goals (MDGs), which were established in 2000 and expire this year. The MDGs accelerated progress in many of their target areas, unifying the global community behind common goals.
What’s all this about an indicator?
In addition to “targets” that establish broad objectives, the SDGs include indicators to measure success on the targets. The indicators serve as a rallying point for the global community. With so many issues competing for resources, measurable, attainable goals are critical to command attention.
For this very reason, the NTD community has been pushing for an indicator to measure global NTD progress. More than 1.4 billion people around the world are infected with at least one NTD, but because of their low mortality rate, these diseases don’t get much attention on the global stage. However, treating NTDs is necessary to ensure that efforts to improve nutrition, education, health and economic productivity are successful. Controlling and eliminating NTDs is critical to ending extreme poverty.
The indicator, “number of people requiring interventions against NTDs,” got the green light at a meeting of the IAEG-SDG in October.
How did this happen?
NTD advocates have been pushing for an indicator for months. NTDs were little more than a footnote in the MDGs, so the NTD community has been working hard to secure some much-deserved attention in the SDGs.
The Global Network worked closely with the NTD community to advocate for this indicator, through correspondence with IAEG-SDGs members, an oral statement urging the inclusion of an indicator during a high-level meeting at the UN’s Economic and Social Council, and a community letter to all IAEG-SDGs members. END7, the Global Network’s advocacy campaign, also led three advocacy petitions urging the UN to prioritize NTDs in the SDGs.
So, we’re all good now, right?
Not quite. Once the IAEG-SDGs finishes its work, it will submit its proposed recommendations for the indicator and monitoring framework to the UN Statistical Commission. More unified advocacy from the NTD community will be needed to ensure that the final document is adopted in March 2016 without change.
When we talk about the effects of neglected tropical diseases (NTDs), we have a tendency to focus on the physical and economic impacts alone, ignoring a major side effect of these conditions. In recognition of World Mental Health Day on October 10, we are taking a look at the unseen consequences of one of the most devastating NTDs.
Lymphatic filariasis (LF) is a disease transmitted by mosquitoes that leads to painful, debilitating swelling of the limbs or genitalia, inspiring the disease’s other name, elephantiasis. Though LF is easily prevented with medication, if left untreated, the severe swelling is irreversible. Individuals suffering from advanced LF are often unable to work and can suffer social stigma as a result of the disfiguring disease. Many are ostracized or even shunned by their communities.
The connection between LF and mental health has not received much attention in the scientific literature. A new paper released this summer by David H. Molyneux, Charles Mackenzie and Thanh G.N. Ton is the first to estimate the global psychological burden caused by the disease. Based on the few studies that exist on the topic, they estimate that 50 percent of clinical LF patients suffer from depression – roughly 18.1 million people. This is a conservative estimate, given that a study in India, which bears the largest burden of LF in the world, found that 97 percent of LF patients suffer from depressive illness.
When calculating the true burden of LF, Molyneux and his colleagues argue that the psychological effects on caregivers, which have not previously been quantified, need to be factored in as well. Based on a study of caregivers of blind individuals, which found that 48 percent had depression, they estimate 25 percent of caregivers of individuals with severe LF to be depressed, for an estimated total of 1.25 million people. That brings the total number of individuals suffering from depression as a result of LF to 19.35 million.
In 2013, the Global Network’s Emily Conron traveled to Lèogâne, Haiti, to interview patients with advanced LF. “These individuals told me over and over again that the hardest part of their condition was their isolation from family and friends and the shame they felt when they went out in public, where strangers would stare at their affected limb and make cruel comments,” Emily writes. In a country with one psychiatrist for every 200,000 people, access to traditional mental health care in Haiti is a near impossibility.
The feelings of social isolation have medical implications as well as psychological. A 2007 study conducted in Sri Lanka found that those suffering with severe LF avoided clinical treatment due to the embarrassment of being seen in public with the condition.
When it comes to tackling NTDs, treatment must address psychological challenges as well as physical symptoms. Though the World Health Organization began testing support programs for LF patients in 1998, such programs are still not widespread. Morbidity management – a basic package of services aimed at preventing disability in individuals already infected with advanced LF, ideally including measures to prevent disability from the mental health implications of LF – has not been scaled up to meet the needs of patients. Despite the fact that WHO’s Global Programme to Eliminate Lymphatic Filariasis, launched in 2000, includes LF morbidity management as a twin strategic goal of preventive chemotherapy to prevent new LF cases, only about one-third of national LF programs have established morbidity management measures.
Patients with advanced LF are, sadly, some of the most neglected patients of all those affected by neglected tropical diseases. Much more should be done to ensure that patients for whom the goal of eliminating LF transmission will be realized too late receive the healthcare they need for the physical and psychosocial effects of LF.
More and more, leaders from endemic and donor countries alike are recognizing the importance of neglected tropical diseases (NTDs). NTDs, the most common diseases of the world’s poor, are on the agenda for this week’s G7 summit in Germany, where leaders from the G7 countries, along with representatives from the European Union and leaders from six African countries, will discuss key issues of economic, foreign, security and development policy.
At the World Health Assembly last month in Geneva, German Chancellor Angela Merkel declared that NTDs will be a top priority for the group, stating, “With relatively little material effort, the suffering of hundreds of millions of people could be combated.” Merkel also stressed the importance of close collaboration with affected countries.
The G7’s support will hopefully result in a much-needed boost to investment in NTD treatment and prevention efforts, and certainly raise the global profile of NTDs. The G7’s influence could be instrumental, as well, in ensuring that specific indicators for NTDs are incorporated into the United Nations post-2015 development framework and the final Sustainable Development Goals.
Established more than 15 years ago, the United Nations Millennium Development Goals (MDGs) set out measurable accomplishments to improve the world by 2015. Despite crippling health effects and evidence that NTDs perpetuate poverty, hunger and poor education outcomes, NTDs were lumped into MDG 6 under “other diseases,” lacking specific indicators to measure success or rally sufficient resources.
As the MDG deadline nears and the Sustainable Development Goals are finalized, an important opportunity presents itself to set clear mileposts for NTDs that were missing from the MDGs, catapult support for NTD programs, and help lift millions of the world’s most neglected people out of poverty. Watch our video to see why this is so important: