World Neglected Tropical Diseases Day (NTD) is observed every year on 30 January. The day is commemorated to reflect on the suffering caused by NTDs, and to reiterate the commitment of governments, national and international organizations, and communities to tackle NTDs. This year, the day is being commemorated on the global theme of ‘Unite, Act, and Eliminate NTDs’ to improve the health and wellbeing of over 1.6 billion people worldwide suffering from NTDs. The day is also an opportunity to call on everyone to support the growing momentum for the control, elimination and eradication of these diseases.
Neglected tropical diseases (NTDs) are a diverse group of conditions caused by a variety of pathogens (including viruses, bacteria, parasites, fungi and toxins) and are associated with devastating health, social and economic consequences for individuals and societies. These conditions impact upon normal life routine of individuals through the life-course, trapping communities in cycles of poverty and inequity. People affected by disabilities and impairments caused by NTDs often experience stigma within their communities, hindering their access to needed care and leading to social isolation.
Global situation
In 2021, WHO launched a global road map entitled ‘Ending the neglect to attain the Sustainable Development Goals: for neglected tropical diseases 2021–2030’. This is a high-level strategic document and advocacy tool, aimed at strengthening programmatic response to NTDs through shared goals and disease specific targets backed by smarter investments.
The overarching global targets set under the road map include a 90% reduction in the number of people requiring treatment for NTDs by 2030; a 75% reduction in Disability Adjusted Life Years (DALYs) related to NTDs; at least 100 countries eliminating at least one NTD; and the eradication of two diseases (dracunculiasis and yaws) by 2030.
The road map calls for cross cutting actions that focus on integrated approaches, multisectoral coordination, universal health coverage and country ownership. A further set of targets have been devised to measure progress against individual diseases.
WHO recommends five core strategies to tackle the burden of NTDs: preventive chemotherapy, individual disease management, vector control, veterinary public health and water, sanitation and hygiene (WASH) within a systemic and cross-cutting approach.
By mainstreaming the NTDs in the national health agendas, the road map aims to push for:
- Stronger accountability – shifting from process to impact indicators and accelerating programmatic action to improve scientific understanding, planning and logistics, advocacy and funding, collaboration & multisectoral action.
- Intensified cross-cutting approaches - integrating delivery platforms; mainstreaming with local health systems; coordinating beyond health; strengthening country capacity; mobilizing regional & global resources.
- A change in operating model and culture – stronger country ownership, improved roles of stakeholders, clearer roles and responsibilities to deliver on 2030 targets.
Situation of NTDs in Sri Lanka
Several NTDs have been prevalent in Sri Lanka. Out of which the country has achieved elimination of leprosy in 1995 and filariasis in 2016. However, several diseases continue to be of national concern, including annual dengue outbreaks island wide, and regional outbreaks of leishmaniasis and rabies. The Ministry of Health has established national programs for control and management of Dengue, Leishmaniasis, Leprosy, Filariasis, and Rabies.
Dengue continues to be a challenge for Sri Lanka. The country has been successful in bringing down the case fatality rate over the last two decades, from 5% in 1996 to 0.07% in 2023. However, the country experiences rising cases during the rainy seasons in June-July and October-December every year. During the last quarter of 2023, almost all districts of the country have reported dengue cases, with Colombo, Gampaha and Kalutara districts in the Western Province having the highest case detection rates during this year.
Sri Lanka achieved Leprosy elimination target in 1995 (defined as prevalence of less than 1 per 10 000 population). Around 1000 new cases are reported every year, 10% of which are among children. Sri Lanka has been recognized by WHO as one of 23 “global priority countries” for leprosy, emphasizing the need for targeted efforts to sustain elimination status and a final push towards ending leprosy in the country. The case detection rate was fluctuating between 7-12 new cases per 100 000 population with grade 2 disability rate been 6-8% and childhood leprosy rate been stagnant around 10% during the last two decades.
In 2016, Sri Lanka was recognized to have eliminated lymphatic filariasis as a public health problem following successful mass drug administration conducted from 2002 to 2008. Sri Lanka has achieved the WHO target of reduction of microfilaria rate (mf rate) of less than 1% by 2016. However, lymphatic filariasis continues to be an endemic in eight districts (Colombo, Kalutara, Gampaha, Galle, Matara, Hambantota, Puttalam, and Kurunegala).
Rabies also continues to be of concern in Sri Lanka, responsible for 20 to 30 deaths occurring annually mainly due to bites from infected dogs and delays in post exposure treatment. Lives could be saved with timely treatment of the bite wounds and anti-rabies serum and vaccine injections that are freely available at the designated government hospitals with rabies treatment units.
Current NTD programmes being supported by WHO Sri Lanka
WHO Sri Lanka continues to work with the Ministry of Health and UN partners in achieving the national NTD treatment and elimination targets.
WHO has continued to support the National Dengue Control Programme for preparedness and surveillance and control of the disease. During 2023, WHO supported four special mosquito control campaigns covering high-risk Medical Officer of Health areas, with the participation of the Police, Tri-forces, and other stakeholders. Training of Medical Officers and Nurses attached to high burden hospitals island wide was conducted to strengthen the clinical management of Dengue cases in collaboration with the National Institute for Infectious Diseases. Also, Dengue program reviews, entomological reviews and assessments were conducted in “high-risk” districts on outbreak situation and control. WHO is also currently supporting a dengue modeling and prediction activity to forecast and predict the case burden and to carry out the development of the Dengue National Strategic Plan 2024- 2028.
To strengthen the activities of the Anti-Leprosy Campaign, WHO supported historical contact tracing in high-risk districts to screen the contacts of Leprosy patients who were identified in the year 2017. WHO also helped review the antimicrobial resistance protocols, Standard Operational Procedures (SOP) for contact tracing and provision of quality service delivery for leprosy patients.
WHO supported the National Anti-Filariasis Campaign to combat lymphatic filariasis in endemic districts, by conducting a transmission assessment survey in Kurunegala in 2023. The national programme was assisted in development of National Strategic Plan on Interruption of Transmission of Lymphatic Filariasis in Sri Lanka 2023-2027 and training of sub-national Anti-Filariasis Unit staff was conducted across the country.
The Anti-Rabies campaign was also strengthened by capacity building on Field Anti Rabies Mass Dog Vaccination Program & Training on effective rabies Post Exposure Prophylaxis, emphasizing the importance of Integrated Bite-Case Management (IBCM). To improve rabies surveillance, the real time data system of the Ministry of Health Public Health Veterinary Services was updated. Plans are in place to support dog population survey to be done during the current year.
Leishmaniasis control has also been supported with situational review and the development of the first National Strategic Plan for Prevention and Control of Leishmaniasis (2023-2027).
Moving forward WHO Sri Lanka aims to continue supporting the country by mainstreaming the priority NTDs in the national health agendas for stronger preparedness, surveillance, and control, to deliver on the 2030 global targets for NTD control.