This blog post was written by Nathaly Aya Pastrana, Maria Kathia Cárdenas, María Amalia Pesantes, L. Suzanne Suggs, Silvana Pérez León, for the COHESION Project
The global burden of both non-communicable diseases (NCDs) and neglected tropical diseases (NTDs) represent major challenges to low and middle-income countries (LMICs) and to vulnerable populations with limited access to healthcare services and basic sanitation. The increased recognition of these diseases and their inclusion in the sustainable development goals (SDGs), provides an opportunity to reduce inequality gaps and improve the development of countries and the quality of life of their populations.
In 2012, NCDs were responsible for 38 million (68%) of the world’s 56 million deaths, 28 million of which occurred in LMICs . Furthermore, the people living in these countries are also affected by NTDs. More than one billion people worldwide are infected with at least one NTD and in 2014, 1.1 billion people required mass or individual treatment and care for these infections . Individuals may suffer from NTDs and from NCDs at the same time, resulting in a double burden of disease, which can result in more adverse symptoms and poor clinical outcomes. Furthermore, these comorbidities may enforce the poverty trap among vulnerable populations.
The link between NCDs and infectious diseases, including NTDs has been explored. For example, studies have investigated the effects of NTDs in mental health  and the potential complications of diseases such as schistosomiasis in bladder cancer [4, 5]. However, there is a need to better understand the effects of the double burden of NCDs and NTDs in the context of health systems and the community. It will be important to engage with stakeholders at the policy, health system, and community levels. In recognition of this need, the COHESION project was established.
The research for development (r4d) project aims to inform the development of sustainable, gender and context appropriate interventions into primary healthcare (PHC), to address the double burden of disease in Mozambique, Nepal and Peru. However, it will first be important to understand the barriers and enablers of the diagnosis, management and care of NCDs and NTDs at the policy, health system and community level.
Ongoing baseline research, includes global and national policy analyses, health system assessments and community health perception studies. In Peru, preliminary analyses show different levels of awareness of various chronic conditions at the community level. At the PHC level, health workers show a high commitment to the health problems of the communities, but lack sufficient training and the necessary technologies to manage patients with chronic conditions. At the policy level, the country lacks a national strategy for neurocysticercosis. These, and other findings to date, have already helped to inform ongoing community engagement strategies, where participants have identified the need for more information about the diseases, the importance of making diagnostic tests available at the PHC, and the value of providing examples of well-balanced meals and sanitation practices.
It is hoped that by introducing interventions that address these components, it will be possible to reduce the double burden of NCDs and NTDs in these countries, which will be important for enabling the development of these LMICs and improving the health of their populations.
1. WHO. Global status report on noncommunicable diseasess 2014. 2014. http://www.who.int/mediacentre/factsheets/fs355/en/.
2. Bangert M, Molyneux DH, Lindsay SW, Fitzpatrick C, Engels D. The cross-cutting contribution of the end of neglected tropical diseases to the sustainable development goals. Infect Dis Poverty. 2017;6:73.
3. Litt E, Baker MC, Molyneux D. Neglected tropical diseases and mental health: a perspective on comorbidity. Trends Parasitol. 2012;28:195–201.
4. Uniting to Combat NTDs. The Third Report: Country Leadership and Collaboration on NTDs. 2015. http://unitingtocombatntds.org/report/third-report-country-leadership-and-collaboration-ntds. Accessed 25 Jul 2016.
5. WHO. Report of the first meeting of WHO Strategic and Technical Advisory Group on Neglected Tropical Diseases. 2007. http://www.who.int/neglected_diseases/resources/who_cds_ntd_2007.2/en/. Accessed 25 Jul 2016.
The COHESION (COmmunity HEalth System InnovatiON) Project is funded by the Swiss National Science Foundation and the Swiss Development Cooperation under the Swiss Program for Research on Global Issues for Development. For more information on the progress of the COHESION project, please go to: www.cohestionproject.info
Nathaly Aya Pastrana and L. Suzanne Suggs:
Institute for Public Communication, Università della Svizzera italiana, Switzerland
Maria Kathia Cárdenas, María Amalia Pesantes, Silvana Pérez León:
CRONICAS Center of Excellence in Chronic Diseases – Universidad Peruana Cayetano Heredia, Peru