Welcome to Health Challenges Affecting Billions Blog

This site will highlight the challenges faced by over 1 billion people and how these challenges relate to poverty, healthcare and livelihoods.

More than 1 billion people  live in extreme poverty and hardship in various regions of the world. These billions struggle to access safe drinking water, food, primary healthcare and sustain their livelihoods.

This blog will feature;

  1. Case analysis from various regions of the world,
  2. The various challenges faced by populations in resource poor countries,
  3. How these challenges affect the health and livelihood of these populations,
  4. What is being done to tackle these challenges


  1. Mphande-Fig1.1-Poverty Health Livelihoods
Source: Mphande 2016, Infectious Diseases and Rural Livelihood in Developing Countries

What the World Needs to Know about Tungiasis

Neglected tropical diseases (NTDs) are caused by different types of organisms including viruses, bacteria, and parasites. Diseases that are caused by parasites are known as parasitic diseases. Parasites that infect humans through infestation and or penetration from the external environment are known as ectoparasites and those that are often ingested and find their way into the internal organs are known as endoparatsites. In simple terms, endoparasites live within the host while ectoparasites live on or in the skin of the host.

Today we are going highlight one of the NTDs known as Tungiasis. Tungiasis is a parasitic disease caused by the sand flea Tunga penetrans.

Tunga penetrans is an ectoparasite which burrows and penetrates the skin of their host with its back exposed to the outside allowing it to breathe and lay eggs. The parasite grows within the host, feeding on the host’s blood and lays eggs which are released to the environment. These eggs can penetrate a new host through broken skin, usually hands or feet.

Originally from Americas, Tungiasis has spread to other regions including sub-Saharan Africa

So why should the world know about Tungiasis?

  1. It causes disability– Tungiasis is  a debilitating disease that results in discomfort, disfigurement, psychological trauma and social exclusion in infected individuals.
  2. Could develop complications through secondary infections– When the parasite infects the skin, it causes inflammation and itchiness. As such people try to remove the parasite with non-sterile crude tools which may result in bursting of the flea, and secondary infection by bacteria.
  3. Inability to perform regular tasks– Secondary infections further complicate the disease and as the infection progresses, the infected individual struggles to walk and perform other tasks due to disfigurement of fingers and toes (Fig1).
  4. Stigma and social exclusion– The changes to the skin due to infection and the disfigurement that ensues is an immense source of stigma in affected communities
Figure 1: Tungiasis infection showing embedded fleas

Tungiasis affects populations living in utter poverty and in poor living conditions. Being a zoonotic disease, Tungiasis can be passed on from animals to humans. Studies have shown that animal reservoirs could increase the prevalence and burden of the disease in humans. Several publications on the topic highlight the impact of Tungiasis in affected populations (Figure 2). Please find the publication links below for further reading.

Together We Can Stop NTDs.

Figure 2: Tungiasis, facts, impacts and our role

Further Reading

Njau, N. N., Wanzala, P., Mutugi, M., Ariza, L., & Heukelbach, J. (2012). Tungiasis (jigger infestation) in Rural Kenya, an emerging infectious disease. Retrovirology. https://doi.org/10.1186/1742-4690-9-S1-P37

Feldmeier, H., Sentongo, E., & Krantz, I. (2013). Tungiasis (sand flea disease): A parasitic disease with particular challenges for public health. European Journal of Clinical Microbiology and Infectious Diseases, Vol. 32, pp. 19–26. https://doi.org/10.1007/s10096-012-1725-4

Wiese, S., Elson, L., Reichert, F., Mambo, B., & Feldmeier, H. (2017). Prevalence, intensity and risk factors of tungiasis in Kilifi County, Kenya: I. Results from a community-based study. PLoS Neglected Tropical Diseases. https://doi.org/10.1371/journal.pntd.0005925

Feldmeier, Hermann, Eisele, M., Sabóia-Moura, R. C., & Heukelbach, J. (2003). Severe tungiasis in underprivileged communities: Case series from Brazil. Emerging Infectious Diseases, 9(8), 949–955. https://doi.org/10.3201/eid0908.030041

Girma, M., Astatkie, A., & Asnake, S. (2018). Prevalence and risk factors of tungiasis among children of Wensho district, southern Ethiopia. BMC Infectious Diseases. https://doi.org/10.1186/s12879-018-3373-5

Karunamoorthi, K. (2013). Tungiasis: A neglected epidermal parasitic skin disease of marginalized populations – A call for global science and policy. Parasitology Research. https://doi.org/10.1007/s00436-013-3551-8 Tropical Diseases. https://doi.org/10.1371/journal.pntd.0004126

Mutebi, F., Krücken, J., von Samson-Himmelstjerna, G., Waiswa, C., Mencke, N., Eneku, W., … Feldmeier, H. (2018). Animal and human tungiasis-related knowledge and treatment practices among animal keeping households in Bugiri District, South-Eastern Uganda. Acta Tropica. https://doi.org/10.1016/j.actatropica.2017.10.003

Mphande, F.A. (2020). Skin disorders in vulnerable populations, causes, impacts and challenges. Springer publications. https://www.springer.com/gp/book/9789811538780

Wafula, S. T., Ssemugabo, C., Namuhani, N., Musoke, D., Ssempebwa, J., & Halage, A. A. (2016). Prevalence and risk factors associated with tungiasis in Mayuge district, Eastern Uganda. The Pan African Medical Journal, 24. https://doi.org/10.11604/pamj.2016.24.77.8916

What you Need to Know about Chagas Disease (American Trypanosomiasis)

Continuing in the quest to highlight and ignite conversation on Neglected Tropica diseases (NTDs), this week’s focus is on Chagas disease. Chagas disease also known as American Trypanosomiasis is a parasitic disease affecting affecting millions of people. Caused by the parasite Trypanosoma cruzi, the disease is spread by Triatomine bugs (kissing bugs) with high prevalence in Latin America. https://www.paho.org/en/topics/chagas-disease.

The disease is endemic in 21 countries and is one of the vector borne diseases threatening populations in the Americas region including malaria and dengue (Figure 1). In the past decade the disease has been detected outside the region including Africa, Europe, East Mediterranean and Western Pacific regions.

Figure 1: Vector borne diseases in the Americas region https://ais.paho.org/phip/viz/cha_cd_vectorborndiseases.asp

Chagas disease affects both children and adults with newborns infected during pregnancy as well as during child birth. Here are 5 important things you need to know about Chagas disease (Figure 2).

Figure 2: What you need to know about Chagas Disease

5 Things You Need to Know about Buruli Ulcer

In the quest to ignite conversations on Neglected Tropical Diseases, commonly known as NTDs; Buruli ulcer will be the disease of focus this week. What is Buruli ulcer? Where is it found? How does it affect people around the world? To answer these questions here are the 5 things you need to know.

Do you know anyone who has been affected by Buruli ulcer? Please share your experiences and continue the conversation.


World NTD Day 2021 #notoNTDs

I was privileged to watch the launch of
A road map for neglected tropical diseases
2021–2030. It was a wonderful occasion.

The road map aims at,

The speeches, commitments and achievements highlighted by several stakeholders not only showed the hard work to fight these diseases affecting the most vulnerable, poor and marginalized populations but also the achievements attained thus far.

So what are Neglected Tropical Diseases or NTDs (in short)? WHO defines NTDs as “ancient diseases of poverty that impose a devastating human, social and economic burden on more than 1 billion people worldwide, predominantly in tropical and subtropical areas among the most vulnerable, marginalized populations.”

In the coming weeks, various NTDs will be highlighted on this forum to bring awareness and ignite conversations on NTDs as the world strives to achieve the goals set in the 2021-2030 road map.

Please join the conversation, together we can say No to NTDs.

World AIDS Day, 2020

Every year on December 1st the world commemorates World AIDS Day. A Day to reflect on the challenges brought about by the epidemic and the ongoing work to fight the disease.

1st December, 2020, Raising Awareness on HIV/AIDS

Let us remember;

  • The millions that are still living with the disease
  • The millions whose lives have changed because of the availability of Anti retro viral treatments worldwide
  • The millions who have got a chance to see their children grow
  • The millions who have seen their children born free from HIV
  • The researchers, public health workers and health personnel, volunteers, Non- governmental organisations, and governments who are working tirelessly for an HIV free world.
  • All of us for taking responsibility to stop HIV in its tracks

HIV can infect anyone no matter their race, gender, age, nationality, religion and beliefs.

The global statistics on HIV & AIDS according to UNAIDS 2020 are available on this link https://www.unaids.org/en/resources/fact-sheet and summarized in Table 1.

People (Aproximately)Activity
26 millionAccessed ART as of end June, 2020
38 millionLiving with HIV (2019)
1.7 millionNewly infected with HIV worldwide (2019);
62% of new HIV infections globally
99% of new HIV infections in eastern Europe and central Asia
97% of new HIV infections in the Middle East and North Africa
96% of new HIV infections in western and central Europe and North America
98% of new HIV infections in Asia and the Pacific
77% of new HIV infections in Latin America
69% of new HIV infections in western and central Africa
60% of new HIV infections in the Caribbean
28% of new HIV infections in eastern and southern Africa
690,000died from AIDS related illnesses (2019)
75.7 millionhave been infected since the beginning of the epidemic (2019)
32.7 millionHave died from AIDS related illnesses since the beginning of the epidemic (2019)
Table 1. A summary of HIV Statistics as presented by UNAIDS. For a full report on HIV & AIDS Statistics please visit https://www.unaids.org/en/resources/fact-sheet

Together We Can, let us join the fight against HIV & AIDS.

Leprosy in Wild Chimpanzees- Should we be worried?

On 11th November, 2020 an article in science reported the first confirmed cases of Leprosy in wild chimpanzees ( https://www.sciencemag.org/news/2020/11/leprosy-ancient-scourge-humans-found-assail-wild-chimpanzees ).

Leprosy is one of the oldest infectious diseases reported in history and is on the WHO list of neglected tropical diseases. It is highly infectious that in ancient times when there was no cure, quarantine was the only way of preventing the spread of the infection within communities. Leprosy colonies were established where any person infected with the disease was sent to spend the rest of their life and were restricted to contact with non infected individuals. Today, the picture of leprosy has changed, the disease is rare and those infected are treated with antibiotics. With treatment the infected individual is expected not to be infectious and can not spread the disease to others. According to WHO official figures from 159 countries, there were 208 619 new leprosy cases registered globally in 2018.

Leprosy (Hansen’s disease), is caused by Mycobacterium leprae. It is a chronic disease which affects the mucosal surfaces of the upper respiratory tract, skin, peripheral nerves, and the eyes (https://www.who.int/health-topics/leprosy#tab=tab_1).

Leprosy affects people of all ages, even though in ancient times the disease was incurable, today leprosy is curable, with early treatment believed to prevent disability. Transmission of leprosy is likely through close and frequent contact with an infected individual via droplets from the nose and mouth.

In 2018, there were 184212 cases of leprosy giving a prevalence of 0.2/10 000. Over the last two decades over 16 million people have been treated for leprosy. In 2015, the distribution of new leprosy cases is shown in Figure 1.

WHO | Epidemiology
Figure 1: Global distribution of leprosy, 2015

Why should we be concerned with leprosy being found in Chimpanzees?

In 2005 a comprehensive comparison of the human and chimpanzee genome showed that these genomes were 99% identical with 96% perfect identity (https://www.nature.com/articles/nature04072). This close identity between the genomes implies that genetically there are things that are shared between humans and chimpanzees, including diseases. One example is Monkeypox disease which has been reported in wild chimpanzees in Taï National Park, Ivory Coast (https://www.nature.com/articles/s41564-020-0706-0), but also has caused several human outbreaks in several parts of Africa including Ivory Coast (Figure 2).

Figure 2; Distribution of Monkeypox disease

Could the discovery of Leprosy in Chimpanzees indicate a new turn in human leprosy? After an individual is infected by M. leprae, symptoms may occur within 1 year or may take up to 20 years or or over in others.

  1. Is it possible that some of these strains are already circulating in humans?
  2. Is the Chimpanzee leprosy strain going to jump to humans?
  3. If it does jump to humans will it be able to cause disease?
  4. If yes, how severe would the disease be?

Different genotypes of M.leprae have been sequenced, the 3I genotype from humans, nine banded armadillos and red squirels; the 2F genotype from Chimpanzees (Ivory Coast) and the 4N/O strain from Chimpanzees (Guinea Bissau) (Figure 3).

Figure 3; Genotypes of M. leprae in humans and Chimpanzee

What Were the Most Reported Infectious Diseases Between July and September 2020?

With a lot of information being shared on various social media platforms, knowing which information is true or false is a challenge.

When it comes to infectious disease outbreaks and reports, one of the platforms I have relied on is ProMed mail https://promedmail.org

With ProMed mail one is able to get email updates on various infectious disease outbreaks of plants, humans and animals as they occur around the world.

If you are interested in infectious disease outbreaks, when and where they happened, ProMed mail could be one place to start.

To answer the question I posed in the title of this post, please look at the map below, courtesy of ISID and ProMed mail https://twitter.com/isid_org/status/1321129563401969667?s=21

Figure 1. COVID-19, and Measles were the most reported diseases between July and September 2020. Notice West Nile Virus, Rabies, Zika Virus, Dengue, HIV/AIDS, Anthrax , and chlamydia.

In Figure 1. Reports of various diseases are shown in each continent with the size of the words representing the number of reports.

Explore the world of infectious diseases with ISID and ProMed mail.

People, Pandemics and Epidemics (PPE)

The year 2020 will go down in history for a lot of reasons but outstanding will be the COVID-19 pandemic.

From the onset of the pandemic ( disease outbreak affecting many countries), COVID-19 has exposed challenges in the existing healthcare systems including preparedness to deal with a pandemic both in wealthy and poor countries.

Death toll from the disease is enormous and the effect on people all over the world immeasurable. Lives have been lost, livelihoods shuttered and families broken. At the same time the pandemic has also shown how people can adapt and strive to manage the circumstances.

Some of the human characteristics from this pandemic include:

Survival: people have been looking for ways to survive the pandemic. For example scientists have been working around the clock to develop vaccines against COVID-19. People have adapted a new way of life, use of face covering such as masks and shields as well as keeping a safe distance between each other to reduce the spread of the virus. Some countries have endured lockdowns while others have been finding ways to minimize movement of populations.

Adaptation: People had to learn new things in a short period of time. Closure of schools led to home schooling including a shift to online learning. These adaptations revealed socioeconomic gaps between those who could afford this new shift in a short period of time and those who couldn’t even in the long term.

Introduction of face masks and facial covering meant extra expenses for families and an extra burden for those already struggling to make ends meet.

Starting over: What’s next is the question, what’s next for those who have lost their families and livelihoods? What’s next for the indigenous communities which have been hit hard by the pandemic? What’s next for limited resource countries struggling to manage existing public health challenges on top of this pandemic?

What’s next?

Lessons from Madagascar and the UK


It is plague season again in Madagascar and I wanted to reflect on the previous epidemic.  In 2017, Madagascar experienced one of the worst bubonic and pneumonic plague epidemics with over 2300 confirmed cases and more than 200 deaths. The disease spread into urban areas making it more challenging to control. The epidemic which started in August was successfully controlled by the end of November 2017.

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Humans are infected by plague following a bite from infected fleas which introduce the bacteria Yersinia pestis in the body. There are three forms of plague infections , the first is bubonic plague, if left untreated it can spread into the blood stream resulting into septicemic plague. The only form of plague spread from person to person is pneumonic plague which spreads through droplets and has a shorter incubation period. Pneumonic plague is almost always fatal without swift antibiotic treatment.

 The lessons learned from the 2017 outbreak seem to have resulted in better preparedness and control of the disease thus far.

Efforts to Control the Outbreak

During the outbreak, the Madagascar government applied the following efforts to control the outbreak:

  1.  Focus on strengthening the identification and treatment of patients and their contacts
  2.  Increased control of rodents and fleas
  3.  Practiced safe and dignified burials

Comparing cases during August to September 2017 and the same period in 2018, there were already 54 confirmed cases in 2017 compared to 5 confirmed cases (with 13 suspected cases and 4 deaths) in 2018 http://outbreaknewstoday.com/plague-reported-eight-madagascar-districts-46345/.
Infectious diseases that were once confined to certain regions are now appearing in places people never expected to see or hear about them.

The UK

In the UK, two cases of imported Monkey pox disease have been reported. Both patients had traveled to Nigeria and were returning to the UK https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.38.1800509. These two cases highlight how easy and quickly infectious diseases can be imported from one part of the world to another. A number of health care workers were exposed to the disease before it was confirmed to be monkeypox. One of the healthcare workers has contracted the disease and is undergoing treatment http://www.cidrap.umn.edu/news-perspective/2018/09/uk-monkeypox-case-exposed-health-workers-officials-say.

Infectious diseases can be imported from one part of the world to another

Rapid diagnosis using multiple molecular assays and confirmation by sequencing were used. Direct and indirect contacts are being traced both in the UK and outside the UK with active and passive surveillance in place.

The period between suspicion and diagnosis/confirmation of a case is a window of exposure for healthcare workers, and the community.

The two scenarios above on plague and monkey pox incidence highlight a number of factors to consider when tackling outbreak prone infectious diseases.

1. Vigilance:

For countries where certain infectious diseases are endemic, keeping a watchful eye on a possible case, following up the case and taking all precautionary measures necessary to control and prevent the spread of the disease is paramount. Monitoring vectors and identifying cases as early as possible could reduce the risk of spread of disease.

2. Collaboration:

Sharing information between public health agencies around the globe is essential in following up cases, contact tracing as well as ensuring up to date information is shared to all stakeholders involved in infectious disease control and prevention.

3. Think outside the box:

As the world is more connected than ever through travel and migration, infectious diseases that were once confined to certain regions are now appearing in places people never expected to see or hear about them. Hence keeping an open mind and careful consideration of history of travel and activities before the onset of symptoms is valuable.

Experimental Drugs and Vulnerable Populations

I read a very interesting and thought provoking article this week by Fiston Mahamba, a freelance journalist in Beni ( https://reliefweb.int/report/democratic-republic-congo/congo-becomes-testing-ground-experimental-drugs-it-fights-ebola ). His article was on the current Ebola outbreak in the Democratic Republic of Congo and outlines a number of experimental drugs approved to treat people with Ebola.

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The current outbreak is a conflict zone, this makes it difficult for the health personnel to reach the people who need treatment and protection from Ebola as well as control the spread of the disease. Reading through his article, the word that came to mind was ACCESS. The people in the conflict zone need access to healthcare, while the healthcare providers are struggling to access the populations that require their services.

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Access is a word that has several meanings. Today I will use some of the meanings as outlined by the Cambridge dictionary.

Meaning 1: The method or possibility of getting near to a place or a person.

Meaning 2: The right or opportunity to use or look at something

Meaning 3: To open a computer file in order to look or change information in it

Meaning 4: The right or opportunity to receive something

From the current Ebola outbreak in the Democratic of Congo, access is the key word. The medical personnel are struggling to access the affected populations due to the security situation in the area. The affected people are struggling to access the much needed healthcare. The people in the affected regions are lacking access to information crucial to their survival with regard to disease prevention, control and treatment.

Map of Congo showing North Kivu Province, Ituri Province, Butembo, Beni, Mangina and latest ebola outbreak information as of 7 August 2018

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The people in the affected areas are vulnerable and in a very difficult situation, trying to survive a conflict and a deadly disease that is wiping out families. Most of them are living in poor rural communities lacking infrastructure and healthcare services.

A number of experimental drugs  have been approved for use to treat people in the affected areas so as to combat the outbreak. Being experimental drugs, a lot is yet to be known with regard to side effects, be it severe, mild or adverse. One area of concern is that these drugs are being used in this difficult to access population, will their be any follow up to understand the effectiveness as well as any other outcomes as a result of the drugs? What is the criteria being used regarding the health and safety of the people receiving these drugs?You Deserve a Vacation!

Ebola has a mortality rate in some cases as high as 80-90%, and the need to contain, treat and control the disease is of utmost importance. It is worth considering also the long term effects of such kind of treatment on populations, especially vulnerable rural populations and in this case in conflict zones who may have little chance of follow up or treatment should any complications arise in the short and or long term.