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Invisible mental health effects of NTDs

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By Abraham Adekunle

Psychological burden of disability and stigma due to the diseases overlooked.

The story of a retired superintendent in the Nigeria Customs Service (NCS) is incredible. Some people told him that he was cursed. However, the truth was that he was just unfortunate to be bitten by a mosquito. The mosquito in question was carrying the larvae of Filarioidea worms. The parasites developed inside his lymphatic vessels, weakened his immune system and caused his right leg to swell. More than 30 years later, his life is still shaped by lymphatic filariasis.

Drugs can help to prevent the parasites from spreading to other body parts. However, there is no cure for the condition. Managing the swelling with surgery and skin grafts requires him to take regular, expensive trips to Nigerian capital, Abuja. He said that the skin grafting breaks off after some time, so he has been going to hospital for dressing. But it’s not just the physical effects of the condition that he must manage; he must also deal with other people’s reactions and attitudes.

These diseases affect the poorest and receive little global attention.

He said that some friends sympathize, but some run from him because they fear to be close to him. He said that he became so demoralized. Despite some difficulty walking, he insisted that he could still work, but his employers did not agree. His 19 years’ of service did not qualify him for a pension that is sufficient to pay for his treatment and support his family. Instead, he is dependent on help from other people.

Sadly, the devastating effect that lymphatic filariasis and its associated stigma have had on his life is common among people with neglected tropical diseases (NTD). These conditions are caused by a range of pathogens, including bacteria, viruses, fungi and toxins. They are united by the fact that they affect some of the poorest people on the planet and receive relatively little global attention. Most NTDs do not kill people, but many do cause severe scarring and disability.

Programs to tackle it has made gains but without mental health support.

Numerous studies have demonstrated links between various NTDs and mental health. The full mental-health burden of NTDs is still unknown, however. Julian Eaton, a psychiatrist at the London School of Hygiene and Tropical Medicine, acknowledged that any clinician will say that it is a massive issue. “We see it every time someone walks into our clinic and they’ve lost their job, or their husband, or had stones thrown at them by children,” she said. She said that the research is really underinvested in at the moment.

Although programs to prevent, control and eliminate NTDs have made some tremendous gains, mental-health support has not formed a significant part of these efforts. “One of the unintended consequences of an exciting elimination agenda is that the needs of people already affected by these conditions were completely overlooked,” Eaton says. In order to strengthen the case for incorporating interventions targeted at them into elimination programs, some researchers are trying to build a clearer picture of the burden of mental-health issues caused by NTDs.

NGOs were established to tackle the stigma associated with the disease.

Some interventions are already being tested and seem to be effective. However, because NTDs typically affect people in countries with limited healthcare resources, particularly regarding mental-health care, implementation will be a challenge. In 2018, Eaton helped to establish the Stigma and Mental Wellbeing task group under the NTD NGO Network, a coalition of around 90 NGOs. The task group collaborated with the World Health Organization (WHO) to develop a manual, which was published in 2020, that outlined recommendations for integrating mental health into NTD management.

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