In his opening remarks commented that the burden of NTD was high in South Asia ; 40% of Neglected tropical diseases being in India afflicting the poor. He emphasized hence that we have a moral duty to address the issue.
A former WHO Consultant and the Organizer of this colloquium welcomed the delegates who had come from the length and breadth of the country and beyond.
wished the program all success through a Video message
chaired the scientific sessions on the first day
Opened the scientific sessions describing the community based lymph edema management program being run in Orissa by an organization called CASA. He attributed the success of the organization in its endeavor to control lymphatic filariasis to being sensitive about the needs of patients and families especially the practice of washing lymph edema affected legs with bare hands. He pointed out people work in isolation even when there is a scope to work together for example with Malaria and Kala Azar in Jharkand.
Elaborated on the various National programmes which addressed NTDs namely Integrated Disease Surveillance Project, National Vector Borne Disease Control Programme and NLEP. She highlighted how the architectural corrections in government system brought about by NRHM helped in improving the quality of services in health sector. The surveillance system in the state is now robust through IDSP. She also discussed how ward health and sanitation committee along with Total sanitation campaign is working together for source reduction for the control of dengue at village level .She also said about the biannual distribution of albendazol being conducted for high school &higher secondary students for the control of helminthiasis. She pointed out the gross reduction in microfilaria rate that kerala was able to achieve in 5 districts since the introduction of MDA. She pointed out the low consumption rate of DEC as a major challenge in the state .In the discussion that followed, several participants opined that the fear of side effects was a major reason for poor consumption of DEC. Dr Panicker shared his experience of successful community led MDA programme through a peoples movement called -FILCO movement where bread was distributed along with DEC by over 8000 volunteers at Shertallai for Brugian Filariasis Elimination. The discussion wound up with the suggestion that sensitizing the community with proper messages is the key to a successful MDA programme.
Enlightened the forum with Podoconiosis also known as mossy foot.She began with the research story of Podoconiosis which is an endemic non-filarial elephentiasis. She elaborated on its epidemiology, prevention and rehabilitation. She hoped that the disease can be eradicated as simple treatment is effective. However the tradition of not wearing shoes and the stigma associated with the disease in endemic areas such as Ethiopia stand as barriers in the way ahead.
Gave a comprehensive picture about Lymphatic Filariasis which is targeted for elimination from the country by 2015.He discussed how we could bring down the mf rate from 1.24% to 0.45 % by 2012.He pointed out the challenges in front such as persistent MF rate > 1% in some areas , post MDA surveillance and morbidity management. In the discussion that followed the operational difficulty of DEC medicated salt in place of MDA was discussed. Dr Showkath Ali pointed out that gross unawareness among the implementers including doctors about the extent of the problem pose a threat. He also stressed the need to prepare the field before distribution of MDA. Hence it was emphasized that the medical fraternity be sensitized about MDA so that consumption rate can be increased. Dr Leelamoni also agreed with the observation.
The chairperson took over the next session which was on Dengue. She pointed out the rapid geographic expansion of the disease in 128 countries due to urbanization.. She highlighted that since vaccine trial for dengue did not translate to protective efficacy, dengue is here to stay and integrated vector management targeting breeding sites, massive programme for solid waste management and water supply remain crucial in controlling dengue. The discussion ensued saw Dr Jambulingam share the experiences about a similar disease, Chikungunya. At this point Dr Panicker mentioned about the gene mutation that has taken place in the Chikungynya virus. He also pointed out about the tilt in the population density of Aedes in favour of Aedes albopictus in Kerala.
Discussed Leishmaniasis as a public health agenda, and the constraints. He emphasized that leishmaniasis is the most neglected of NTDs, because it is tool-deficient. He also mentioned that recent developments on the availability of rapid diagnostic tests applicable for screening large populations, especially in the Indian sub-continent, is encouraging. Further, he highlighted that indoor residual spraying with DDT could be an effective tool that can be combined with active surveillance to control Leishmaniasis in the Indian sub-continent. This is in contrast to the sub-sahara African situation, where proven vector control approaches are lacking and the performance of rapid diagnostic tests has so far been unsatisfactory. He stated that case management is still a major challenge, and could constrain efforts of control and elimination, because treatment regimens are still protracted over many days. He concluded by pointing out the need for high impact interventions for controlling Leishmaniasis and the needs to invest on R&D pertaining to leishmaniasis. A discussion on the current scenario of the disease in India followed where Dr Panicker commented that Leishmaniasis control was achieved as a byproduct of malaria control operations. It was remarked that in view of high migrant labourers from northeast, Kerala is prone to have a foci of Leishmaniasis.
Deliberated on the milestones of Leprosy Elimination in India. He highlighted the role played by Modified leprosy elimination campaigns and MDT in reducing case loads substantially to elimination of the disease at national level by 2005. However he pointed out that the progress towards eradication of leprosy is a difficult task to achieve as the skill to diagnose the disease is disappearing. He concluded by stating that Leprosy is a victim of its own success
Discussed how malnutrition among children is a cross cutting concern in NTD by pointing out that the pace of decline in child malnutrition in India is less than 1%.He showed the statistics of high prevalence of anemia among children and adolescents in India. He highlighted the burden of soil transmitted helminthes in preschool and school aged children attributing it to the poor co-ordination between primary care and school health services. He remarked that reaching the marginalized population, identifying operational bottlenecks of programmes and intersect oral support are the key challenges in childhood malnutrition.
Shared the picture of Soil Transmitted Helminthiasis in India highlighting it as a disease related to poor sanitation. She elaborated on the impact of STH and the strategies for its control. She suggested that integrating the deworming programme with existing national programmes such as MDA,school health programme and nutritional prophylaxis programme would improve its operational efficiency. She pointed out that the lack of state specific data on STH ,an accurate method for estimating STH and the lower priority given to the disease as major challenges. She emphasized that interruption of the transmission by improving sanitation was the best strategy to address STH.
Gave an enthusiastic talk on Prevention and Control of Rabies.He presented the three strategies for prevention of rabies namely animal birth control, immunization and wound management. He highlighted, how with the introduction of Intradermal rabies vaccine, there was a substantial decline in the number of rabies deaths in India .The cost effective four dose Intra dermal rabies vaccination which is now available free of cost from government institutions has improved the access to post exposure prophylaxis following animal bites especially to the rural poor who are often the victims of animal bites. He suggested that preexposure prophylaxis be promoted for school children in India. Dr Annelis questioned its feasibility pointing out its cost benefitness compared with other national priorities in India.
Made an interesting presentation on the seriousness of snake bite in India and Kerala. He described the statistics of snake bite and pointed out the lack of accurate data related to the problem. He emphasized how long the bite to needle time make a victim’s prognosis critical. This delay is brought about due to rural people seeking traditional healers and the limited availability and accessibility of ante snake venom. In the discussion that followed it was suggested that spreading awareness among the community and making ASV available in all district hospitals could improve the survival of victims of snake bite.
The day ended with an open discussion led by the Medical Director, Dr Prem Nair, on prospects and objective of the colloquium. Dr Panicker stressed the need to have a sustained follow up of this colloquium. Suggestions from the participants ranged from starting a South Asian chapter of NTD in collaboration with GNNTD to making everyone from Government to NGOs to industries , NTD friendly by providing skills to stakeholders and generating data on NTDs.
The second day of the Colloquium was chaired by Dr K.Leelamoni, Professor and HOD, Dept of Community Medicine, AIMS.
Summarized the proceedings of the previous day by stating that community participation is the starting point for NTD control , NGOs are unignorable partners and data needs to be generated on NTDs in India.
“Deworm the World “opened the scientific sessions of the day by elaborating the work of the Deworm the world initiative in India. She showed the successful implementation of school based deworming programs in the three states of India namely Bihar, Delhi and Rajasthan.
Shared a Medical Anthropologist’s View on NTDs. She reminded the group that NTDs are diseases of neglected people and hence all interventions should not target biological factors alone but addressing the socio economic factors as well. She cautioned that the top down implementation of a programme can result in non compliance .She reminded that contextual factors are important for weaving sustainable interventions and that joining of the forces of academia, policy makers and medical anthropologists are essential. She concluded by saying that the key to success is being sensitive and flexible.
Elaborated on the current picture of Schistosomiasis. He stated that schistosomiasis is not reported among humans in Kerala ;however it is occasionally reported from primates and cattle. He remarked that the difficulty in diagnosis and presence of animal reservoirs of the infection are major challenge in Schistosomiasis control.
Gave a comprehensive picture of Echinococossis describing the epidemiology and management strategies of the disease. He suggested that Echinococcus control could be integrated with rabies control since dogs are the common reservoirs for both infections. He also pointed out the lack of accurate data on the disease as a major challenge in its control.
Discussed about the status of Trachoma in India which is slated for global elimination by 2020.She discussed the statistics of trachoma over the decades and illustrated that India was able to significantly reduce the burden of preventable blindness due to trachoma. She cautioned against a possibility for rapid re emergence as high endemic pockets still existed in the Car-Nicobar Island. In the discussion that followed, the high rate of the disease among women was raised and Dr.Alexander attributed it to the tradition of applying kajal in the eyes by women.
Discussed about the first disease targeted for eradication - Yaws. He highlighted the epidemiological factors that favor its eradication. He pointed out that though India was declared yaws free in 2006, the lack of a surveillance mechanism is a major issue since yaws is targeted for global elimination by 2020.
Dealt with the last but not the least important disease on the agenda- Scabies. He emphasized the renal morbidity and mortality that followed scabies. He highlighted the major issues in scabies control as the deficiency of research, poor supply of medicines and lack of an accurate estimate of global burden of scabies.
The conclusion of the day’s proceedings was by passing the following resolution put forward by Dr K N Panicker
We, the participants of the International Colloquium on Neglected Tropical Diseases held at Amrita Institute of Medical Sciences on 25th and 26th, February, 2014 unanimously recommend that
The colloquium concluded with the vote of thanks proposed by Dr.Leyanna Susan George, Assistant Professor of the Dept.Of Community Medicine who whole heartedly thanked all the participants for their enthusiastic participation and acknowledged the support of Indian Council of Medical Research, New Delhi, Kerala State council for science, Technology, Environment Thiruvananthapuram and above all the Global Network for Neglected Tropical Diseases, Sabin Institute USA