Poorer African nations rank high in disease-fighters’ league table 

(Addis Ababa, Ethiopia:  

Children enjoy lollipops following eye exams.

Children enjoy lollipops following eye exams.

Image by RTI Fights NTDs


NTDs such as blinding trachoma, the leading cause of infectious blindness, or intestinal worms that can stunt growth in children, are endemic in poor communities without access to clean water and with inadequate sewerage systems. The diseases affect 1.6 billion people worldwide – that’s one in five on the planet – including over 600 million people in Africa.

The league table ranks the countries according to their performance in reaching everyone in need with the necessary treatment, across the five most common NTDs in Africa that are amenable to mass treatment. The countries treating the highest proportion of those in need across all five diseases rank highest in the table.

The table shows that three countries with modest national incomes - Malawi, Sierra Leone and Togo – have, for the third year running, reported high treatment levels to those in need across the five diseases.  The WHO reckons that if countries consistently treat and protect more than 75% of people needing care, across the five diseases, they are on track to beating the diseases. Malawi, Sierra Leone and Togo all reached the 75% average target.

All three nations are in the ‘lower income’ bracket of the UN Human Development Index, a broad measure of national wealth.

Richer African countries with a higher UN Human Development Index such as South Africa and Equatorial Guinea (both ‘medium income’ by the UN measure), or Gabon and Botswana (both ‘higher income’ according to the UN) were all ranked in the bottom third of the disease fighters’ league table.

However, Botswana looks set to change this with its late 2018 pledge to use its own domestic resources to eliminate all neglected tropical diseases found within its borders, starting in 2019.

Botswana joins Mozambique which made a commitment at the same time, in its case, to allocate US$6M of domestic resources to fight NTDs. Most endemic countries receive outside help for their elimination programmes. We hope to see an increase in the levels of funding coming from domestic sources for fighting these diseases.

The highest-ranking country in this year’s disease-fighters league table is eSwatini (the former Swaziland).  While the number of people in need of treatment in eSwatini is much smaller than, say, Nigeria, eSwatini still scores highly because of its commitment to reach every individual in need of treatment.

The five most common NTDs amenable to mass treatment are: blinding trachoma; intestinal worms; the mosquito-borne elephantiasis; snail-borne bilharzia; and river blindness.  All five can be prevented or treated with medicines that are donated for free to endemic countries by pharmaceutical companies.

NTDs rarely make headline news because they tend to afflict the poorest and most marginalised communities. However African Heads of State have put a spotlight on them at the current AU Summit through the African Leaders Malaria Alliance (ALMA), a forum that tracks the fight against malaria and, since 2018, also reviews the fight against NTDs.  

NTDs were once prevalent throughout the world, including in western countries. But they are now almost exclusively endemic in developing nations. They are known as diseases of poverty because they thrive in communities with few resources and also perpetuate low income by limiting the ability of individuals to work and go to school. They cause disability and stigma and can even lead to death.

However, considerable progress has been made against NTDs. In 2018, Ghana passed a milestone:

“In 2018, we became the first sub-Saharan African country to eliminate blinding trachoma, a painful and debilitating disease”, said President Nana Akufo-Addo;

“We cannot achieve the Sustainable Development Goals without addressing the needs of the poorest members of our society who are disproportionately affected by neglected tropical diseases. I urge my fellow African leaders to prioritise ending these diseases of poverty on the continent”, President Akufo-Addo added, concluding;

“We have shown it can be done.”   

The number of people in need of treatment for NTDs has fallen since 2015, the year heads of state adopted the sustainable development goals in which NTDs were specifically mentioned as a target. Over the same period, the proportion of people receiving treatment compared to those in need, has risen.

In Sub-Saharan Africa alone, there were 630 million people in need of treatment for at least one NTD in 2015. By 2017 this had fallen to 605 million – a drop of 25 million in just three years, showing that treatments for NTDs are effective.

This is a step in the right direction towards meeting the sustainable development goal for NTDs, which is to reduce the number of people in need of treatment for NTDs by 90% by the end of 2030.

In 2015 the proportion of the 630 million people in need of treatment in Sub Saharan Africa who received it, was just over half, or 51%. By 2017 this proportion had risen – 68% of the 605 million people in need were getting the drugs they required.

The success is due, in large part, to the commitment and leadership of the WHO Regional Director for Africa, Dr Rebecca Matshidiso Moeti, who set up a dedicated project in the regional office called the Expanded Special Project for the Elimination of Neglected Tropical Diseases (ESPEN) which has been working with countries, providing technical and implementation support.   

But despite these successes, the number of countries in Africa that are being validated by WHO for achieving elimination of these diseases is still far below the rest of the world. There is real potential for Africa to take leadership in this area and succeed. Unless this is done, NTDs will continue to cause pain, disability, disfigurement and stigma for millions of people in Africa, and will continue to rob developing economies of billions of dollars-worth of productivity gains.  

Uniting to Combat NTDs 'league table', based on WHO data

Country

2017 rank out of 49 countries with Index score in 2017

Index Score - Average of coverage of the five NTDs amenable to mass treatment  calculated using the geometric mean

Number of people requiring treatment for at least one disease ('000s)

Eswatini (Swaziland)

1st

92

201

Malawi

2nd

91

11,772

Mali

3rd

90

6,842

Burkina Faso

Joint 4th

88

6,531

United Republic of Tanzania

Joint 4th

88

26,709

Algeria

Joint 6th

86

5

Guinea

Joint 6th

86

7,620

Sierra Leone

8th

85

7,001

Togo

9th

84

5,376

Cameroon

10th

83

16,222

Lesotho

11th

80

388

Comoros

12th

79

454

Rwanda

13th

78

5,329

Benin

14th

77

5,910

Cote d'Ivoire

15th

75

20,480

Ethiopia

16th

73

69,803

Gambia

17th

72

161

Liberia

18th

71

2,591

Uganda

19th

68

22,879

Senegal

20th

66

12,006

Eritrea

Joint 21st

64

1,077

Niger

Joint 21st

64

14,069

Nigeria

23rd

60

133,973

Zambia

24th

56

11,600

Democratic Republic of the Congo

25th

54

55,564

Kenya

Joint 26th

40

11,626

Somalia

Joint 26th

40

2,532

Ghana

28th

37

16,389

Congo

29th

30

1,784

Guinea-Bissau

30th

20

1,349

Burundi

31st

17

4,926

Mozambique

Joint 32nd

12

23,455

Sudan

Joint 32nd

12

11,031

Zimbabwe

Joint 32nd

12

10,661

Angola

Joint 35th

10

14,740

Egypt

Joint 35th

10

5,022

Madagascar

37th

9

20,216

Mauritania

38th

3

855

Botswana

Joint 39th

2

262

South Africa

Joint 39th

2

19,335

Central African Republic

Joint 41st

1

3,765

Chad

Joint 41st

1

4,853

South Sudan

Joint 41st

1

9,500

Cabo Verde

Joint 49th

No report

146

Djibouti

Joint 49th

No report

111

Equatorial Guinea

Joint 49th

No report

429

Gabon

Joint 49th

No report

694

Namibia

Joint 49th

No report

1,104

Sao Tome and Principe

Joint 49th

No report

193

Libya - not applicable / not endemic




Mauritius - not applicable / not endemic




Morocco - not applicable / not endemic




Seychelles - not applicable / not endemic




Tunisia - not applicable / not endemic





Index colours by WHO definitions


On track


Progressing


Not on track


Country not reported

 

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