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prioritizing integrated approaches to reducing suffering, psychosocial impact, and stigmatization
The World Health Organization (WHO) advocates an integrated approach to the control of neglected tropical skin diseases (so-called Skin NTDs)1) and improve early detection, timely treatment, morbidity management and disability prevention.
NTD skin predominates in environments characterized by fragile health systems and can lead to psychosocial problems, stigmatization, exclusion, and distress.
The WHO October 21 webinar on combating NTDs to achieve the 2030 roadmap targets addressed this long-neglected aspect of NTDs, unanimously calling for decisive action.
First panel: Solving gaps
Roderick Hay, counselor, International Foundation of Dermatology, UK, said nearly a billion people have skin diseases caused mainly by six or seven common skin diseases. NTD skins represent visible skin changes, and since many of them occur in the same settings and have similar manifestations, common approaches and resources can be used to detect and address the problems they create. Integration also benefits partners who support work on the control and prevention of these diseases.
Giorgio Cometto, Head of Unit, World Health Organization’s Department of Human Resources for Health, noted the role and importance of community health workers in providing primary health care interventions, as demonstrated in campaigns against HIV / AIDS and tuberculosis. He referred to a study that assessed the role of health professionals in improving community care and supporting many interventions against NTD.
Victoria Williams, an assistant professor at the University of Pennsylvania, USA, explained how the technology can be used to detect and diagnose skin NTD at an early stage. Today, visual health education can be provided through a variety of devices, including smartphones that can be used online and offline, even in rural environments. She also mentioned the use of WHO on cutaneous NTDs and artificial intelligence as tools for clinical support and potential teledermatology.
Pauline Kleinitz, Technical Adviser, WHO Rehabilitation and Training Unit, commented on the WHO plan to develop a disability strategy that would include skin NTDs to promote equality in access to health services. She stressed the importance of rehabilitation, care and case management at the primary and secondary levels of health, especially for NTDs resulting in chronic health conditions.
Panel two: the role of partnership and research
Claire Fuller, president of the International Dermatology Foundation in the UK, recalled that the new roadmap puts people at the heart of healthcare delivery through inclusive, comprehensive, integrated interventions. She said inclusion is crucial to combating cutaneous NTDs through dermatological care and acknowledged the support of the relatively new organization GLODERM in helping to improve NTD dermatology.
Isra Cruz, Head of the National School of Public Health, Instituto de Salud Carlos III, Spain, spoke about integrated approaches and the need for appropriate tools for diagnosing diseases, especially cutaneous NTDs, and the creation of a WHO Technical Advisory Group for Diagnostics, which there is a subgroup working on cutaneous NTDs. He looked at innovative ways to combat many cutaneous NTDs, including yawning and ulcers of Buruli, and public-private partnerships to develop tools for diseases like mycetoma.
Christian Johnson, medical advisor, Raoul Follereau Foundation, France, said the integration of the program represents a unique opportunity to strengthen and improve the effectiveness of current interventions. Ownership of programs in the country can generate investment in training and capacity building – factors that can strengthen the morale of health workers.
Sahar Bakhiet, Head, Research Units, Mycetoma Research Center, Khartoum, Sudan explained how a holistic approach to the Center has allowed it to diversify its business, bringing services closer to people in villages affected by mycetoma and allowing early detection and timely access to treatment in many cases. She also spoke about software training for different categories of health professionals, which facilitated the exchange of valuable data.
Chandrakant Revankar, Public Health Advisor, USA described a WHO strategic framework document being developed to help guide work on integrated control of cutaneous NTDs and a huge response to initial research (more than 250 respondents from 58 countries gave their ideas) . Integration is already happening in many countries, but more work may be needed in areas such as social mobilization and addressing stigma.
Panel three: integrate to maximize impact at the country level
Yves Barogui, chief physician of the Buruli Ulcer Treatment Center, Benin explained that interventions against cutaneous non-inflammatory diseases, including Buruli ulcer, leprosy, cutaneous leishmaniasis, lymphatic filariasis and yawning, have been carried out in Benin and Ivory Coast since 2015. of 16,000 people. One in 10 cases showed a manifestation of NTD, while most of the examined dermal cases were not NTD. Among the most common manifestations of NTD on the skin were scabies, followed by buruli ulcer and leprosy. He also highlighted the challenges of applying an integrated approach to skin NTDs.
Julian Trujillo, Coordinator, Ministry of Health and Social Welfare, Colombia spoke about control activities in Colombia, the problems faced by other countries, and the challenges and gaps in overcoming them, including access to remote communities that mainly suffer from NTDs. He also addressed the challenges posed by scarce resources, lack of capacity and lack of tools and diagnostics.
Mourad Mokni, head of the dermatology department at La Rabta Hospital, Tunisia, reported that research in the WHO region for the eastern Mediterranean, which included eight NTDs on the skin, clearly showed cutaneous leishmaniasis with the highest load. Other skin diseases that are prevalent in the region include fungal diseases and scabies. The research also found that the challenges facing skin NTD integration are poor oversight, drug costs, and stigma associated with NTDs.
Prima Yosephine, head of the national program for leprosy and wounds, the Indonesian Ministry of Health described the challenges Indonesia faces in working with NTDs. Recently, leprosy removal and yawning activities have been integrated to include active case detection and case checking at school. She also referred to the ongoing cooperation between different ministries and administrations of health services in solving skin problems and other NTDs.
Aya Yajima, technical officer, WHO Regional Office for the Western Pacific, described how Vanuatu’s success against NTDs resulted in the removal of “fatigue” in populations undergoing major treatment programs. Indonesia is now integrating NTD screening for noncommunicable diseases. Although the population welcomed this innovative approach, it meant retraining staff and producing additional materials. All in all, it is still a model of intervention.
Concluding remarks
Oriol Mitja, Associate Professor, German Trias I Pujol Hospital, Barcelona, Spain spoke about the importance of integration in providing interventions, which can also be very cost-effective and timely. He spoke about his experience in dealing with multiple diseases in Papua New Guinea and the important role of rural health workers. He praised the efforts of many attendees at the webinar that have led to integrated approaches to NTDs since 2017. Although it started slowly, he noted that some countries are adopting an approach and allocating resources to address these skin NTDs.
Mwelecele Ntuli Malecela, Director of the WHO’s Department of Neglected Tropical Diseases Control, stressed the importance of holistic, integrated approaches in addressing physical, mental suffering and distress caused by NTDs of the skin and integration in almost all its aspects, including diagnostics, technology and capacity building . She also spoke about the importance of working with sectors outside health such as water, sanitation, hygiene and education. Most important of all is land ownership. She said leather NTDs are now an integral part of the new roadmap and that the shifts envisaged there speak to the co-operation of everyone – from ground level to national programs.
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1Cutaneous NTDs include Buruli ulcer, cutaneous leishmaniasis, dermal leishmaniasis after kala-azar, leprosy, lymphatic filariasis (lymphedema and hydrocele), mycetoma, onchocerciasis, scabies, yawning, and fungal diseases.
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