Neglected tropical diseases (NTDs) are a group of illnesses that affect more than one billion people around the world. It has also been established that NTDs disproportionately affect women, who bear the largest burden of infection and consequence, from eyesight loss to swollen limbs—the effects can be debilitating, if not fatal. NTDs often affect communities that live in rural and remote regions, and far from healthcare centres. Female genital schistosomiasis (FGS) is a waterborne NTD affecting 56 million African women and girls, yet it remains widely under-reported, and misdiagnosed and largely untreated. According to data published by Uniting to Combat NTDs, a collective of dedicated partners working together to defeat neglected tropical diseases, and reported by countries to World Health Organization (WHO), over 1.7 billion people are impacted by neglected tropical diseases. Schistosomiasis, commonly known as bilharzia, is prevalent in 51 countries and 128 million people are at risk of contracting the parasitic disease. Findings from PLOS Global Public Health show that people in Rwanda’s northern and western regions are at high risk of schistosomiasis. PLOS Global Public Health is a global forum for public health research that reaches across disciplines and regional boundaries to address some of the biggest health challenges and inequities facing society today. Thoko Elphick-Pooley, Executive Director of Uniting to Combat Neglected Tropical Diseases based in London, says schistosomiasis hinders women’s reproductive and sexual health, for instance, it puts women three times more at risk of contracting HIV and more likely to die in childbirth due to a complication caused by the disease. To bring more attention to the condition, she says women living with NTDs often suffer social stigma and isolation due to disfigurement and disability. This can lead to depression and mental illness. In older age, Pooley says the affected people face sight loss from blinding trachoma or river blindness and lymphoedema (a long-term (chronic) condition that causes swelling in the body’s tissues) meaning that they are unable to work or care for their families. “All these hurdles are faced by women who are already part of the most vulnerable groups in communities. Addressing NTDs ensures that these women have the chance to be stronger, more productive, and able to enjoy their lives. We cannot achieve gender equality without ending the neglect of neglected tropical diseases,” she says. From female-specific diseases such as female genital schistosomiasis (FGS) to the attached stigma and the resulting loss of social opportunities, such as employability or marriage, many women are forced into social exclusion or must depend on their families for life. Women and girls of all ages experience the impact of these diseases throughout their entire life cycle, albeit in different ways. According to a 2016 report by Uniting to Combat Neglected Tropical Diseases, two-thirds of water collection is performed by women and girls, which puts them at a higher risk for contracting water-borne NTDs, such as schistosomiasis, in endemic areas. Even if a girl hasn’t been diagnosed with an NTD herself, she may still suffer economic and social consequences from a family member becoming ill. For instance, girls are often expected to drop out of school to take care of sick family members. This can have long-term effects as keeping girls in school improves their likelihood of job prospects later in life, empowering their economic independence. In Rwanda, the treatment coverage for bilharzia decreased from 73 per cent in 2018 to 70 per cent in 2019, according to PLO Global Public Health. For school-aged children, 1.62 million need treatment for bilharzia while 1.14 million are receiving treatment. The way forward When it comes to NTDs, Prof Leon Mutesa, professor of Human Genetics at the University of Rwanda and a medic at University Teaching Hospital of Kigali, says early treatment is essential and can frequently cure and even break transmission. He goes on to note that NTD interventions can help improve productivity, decrease disability, decrease the risk of social stigma and subsequent mental health issues, improve birth outcomes and save lives. Meanwhile, WHO recommends integrated vector management to prevent transmission of vector-borne diseases as well as facilitating access to safe water, better sanitation and hygiene, and, veterinary public health for diseases which affect humans and animals. WHO also prioritises 20 diverse NTDs, they represent a mix of parasitic and bacterial infections that are transmitted through a range of vectors, such as mosquitos, worms, snails, and sand flies. In order to put an end to these diseases, women’s involvement will be key.
