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Professor Mustafa Idris . Elbashir. MD, PhD. Faculty of Medicine. University of Khartoum, Sudan. mustidris@hotmail.com. mustafa@uofk.edu.sd. Good health is important for building vibrant and productive communities, stronger economies, safer nations, and better world. .

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Professor Mustafa Idris



Faculty of Medicine

University of Khartoum, Sudan



Good health is important for building vibrant and productive communities, stronger economies, safer nations, and better world. Endemic tropical diseases are the highest contributors to the socioeconomic burden of disease in Africa.

ED and socioeconomic


Years of life lost from premature death, and years of life lived in less than full health

High mother

, infant, and child


Decreased life expectancy

indicators for the huge socioeconomic burden of


in Africa Slide4

Many Africans seek care from several health care providers: Substandard public hospitals

run under prevailing weak

public healthcare systems


level treatment providers such as barefaced medicine dealers, wandering drug sellers, and traditional medicine dealers These dealers diagnose and treat endemic diseases

ED are maltreated in AfricaSlide5

People in need of health care might wander between unauthorized practitioners without getting cure for their illnesses for long time.


preference of healthcare provider is usually determined by

affordability, nearness to homes, striking unsubstantiated propaganda and advocacy

for sold drugs, and the prompt attention and attitudes of service providersED are maltreated in AfricaSlide6

The “big three” endemic diseases in Africa are malaria

, tuberculosis TB, and



have serious direct costs in terms of treatment, treatment seeking, absenteeism from work and school, and funeral expenses in the event of death which is a very common consequence. Morbidity and mortality from these three diseases have a major socio-economic impact on individuals, communities and nations

Major EDs in AfricaSlide7

Endemic diseases in Africa also include a group of diseases called, collectively, neglected tropical diseases (NTDs)….The concept of


emerged recently and has been recognized as a valid way to categorize diseases that affect the poorest


NTDs can be transmitted by viruses, bacteria or parasites.Major EDs in AfricaSlide8

They include multi-cellular helminths that are visible to the naked eye or microscopic

single-celled protozoa



are many NTDs, but we concentrate on the 18 that have been given priority by WHO. Many others…cholera…





Interventions exist to prevent and control ED with very gratifying results in some African countries.However, the coverage still remains


in the face of many challenges including;

shortage of finance,

antimicrobial resistance, political instability, poor health facilities and medical records….

Existing efforts to combat EDSlide10

Brief account on the socioeconomic burden of the NTDS, HIV/AIDS, TB and malaria in Africa.

Highlight the

collective progress

made in the fight against these endemic diseases

through partnerships and the existing challenges to be faced.

The presentation scopeSlide11

I propose the scale up of NGOs role, including the Federation of Islamic Medical Associations (FIMA) and

Turkish government and Foundations,

in building capacity of local communities in Africa, to empower community-based delivery of medical and health services, and probably the establishment of

centers of excellence

for basic and applied research on endemic diseases in Africa.. Role for FIMA and Turkish foundationsSlide12

This is to be delivered in close collaboration with official bodies involved in health service provision, and with other stakeholders already exerting appreciable efforts to control or eradicate endemic diseases in Africa… such as

Carter Center

Partnership with other stakeholdersSlide13

Socioeconomic burden of (NTDs)Slide14

They are defined as a group of infections strongly associated with poverty in tropical and subtropical environments and they are diverse in biological and transmission characteristics



spread in

149 countries, affecting more than one billion people, costing developing economies billions of dollars every year. Socioeconomic burden of



NTDs blind, mutilate, disfigure and debilitate hundreds of millions of people in the poorest parts of the world, mainly in



They are

now almost restricted to tropical and sub-tropical regions with unsafe water, inadequate hygiene and sanitation

, and

poor housing conditions.

Socioeconomic burden of (NTDs)Slide16

More than 70% of countries and territories that report the presence of NTDs are low or lower-middle income



limited access to health

services. There is great need in the fight against NTDs in these countries for health education, affordable products in the areas of diagnostics, effective drugs, and insecticides

Socioeconomic burden of (NTDs)Slide17

Challenges such as insecurity and weak health systems continue to prevail in many of these poor countries, inhibiting progress in scaling up

control or eradication


The following is brief summary of the socioeconomic burden of each of the

18 NTDs selected by WHO.Socioeconomic burden of (NTDs)Slide18

Dengue is a systemic viral infection transmitted between humans by Aedes


It has been estimated that there are

390 million

dengue infections per year and up to 100m infections are estimated to manifest annually in more than 100 endemic countries.


It causes flu-like symptoms, joint pains and rashes and is potentially fatal for some patientsVector


programs have


to contain the disease and worst of all, no specific treatment is available at the moment, and no licensed effective vaccines yet. WHO target: Reduce cases by more than 25% and deaths by 50% by

2020…public health..

No specific treatment or licensed vaccine for dengueSlide20

Dog-mediated rabies is a cause for more than 95 per cent of human deaths from the disease


virus is transmitted in the saliva of rabid animals and generally enters the body via a wound or bite.

There are two forms:

furious and paralytic. Furious is the most common form in humans. It causes hyperactivity, hydrophobia, aerophobia, and death by cardio-respiratory arrest within days.

2-Rabies Slide21

Paralytic rabies causes a slow progression from paralysis to coma to death.

Rabies is one of the most feared human diseases, estimated to cause some

55,000 deaths each year,

95 per cent of them among children from rural poor people in Asia and Africa

Rabies: fearful killerSlide22

The global burden estimates for rabies 931,600 disability-adjusted life years (DALYs)


DALY (disability-adjusted life year) can be thought of as

one lost year of “healthy” life.

Despite the availability of effective vaccines and messaging tools, rabies will not be sustainably controlled in the near future …

Rabies: lingering global

burden Slide23

Yaws is an infectious, debilitating and disfiguring disease of poverty that mainly affects children in rural communities in tropical areas.


is caused by the spirochete bacteria


pallidum3-Yaws Slide24

Yaws is usually contracted in childhood (75% of cases occur before age 15) and infectious lesions are infrequent after the age of 30 It

is characterized by highly contagious primary and secondary cutaneous lesions and non-contagious tertiary

destructive lesions of the bones

Yaws: bone destructionSlide25

Painful and itching lesions commonly appear on the upper and lower limbs, fingers, toes, soles of the feet, face, genital areas, and buttocks The tertiary stage

is characterized

by destruction of tissue,

bone, and cartilage resulting in disfigurement and

disabilityWHO target: Eradication of yaws by 2020 Yaws: disfigurement and disabilitySlide26

Buruli ulcer is the third most common mycobacterial infection worldwide and it is related to the ones that cause leprosy and tuberculosis



is endemic in tropical, subtropical, and temperate climates and has been identified in at least

33 countries in Africa.4- Buruli


The infection starts as a small nodule that later ulcerates, giving rise to an unsightly ulcer with undermining edges and a cotton wool-like appearance, and thickening and darkening of the skin surrounding the lesion


ulcer: unsightly ulcerSlide28

Mycobacterium ulcerans produces a toxin, mycolactone, which destroys tissue resulting in large ulcers causing

debilitating skin disease


ugly morbidity

, often requiring reconstructive surgery.WHO target: 70% cases cured with antibiotics in all endemic countries by 2020.Buruli ulcer: debilitating skin diseaseSlide29

Chlamydia trachomatis, an obligate intraocular bacteria causing trachomaIt was the leading cause of blindness

in the last century

worldwideTrachoma infection afflicts predominantly young children.


sub-Saharan Africa region currently bears the largest burden



Trachoma: blindness leader Slide31

In 1990, the WHO reported that 146 million individuals across the globe had active trachoma, 10 millions

were in need of surgery

, and


millions were blind due to trachoma. In 2002, ~3.6% of the total visual impairment was due to trachoma,

and it

was the

fourth major cause of

blindness globally.

Trachoma: from number one to number four blinderSlide32

The Carter Center's Trachoma Control Program was established in 1998. As a global leader in the fight against trachoma, the Center and partners


the World Health Organization endorsed


, Antibiotics, Facial cleanliness, and Environmental (SAFE) strategy

for trachoma control

Trachoma: thanks to Carter Center Slide33

In 2015, seven countries

, three of them are Africans (China,

Gambia, Ghana

, the Islamic Republic of Iran,

Morocco, Myanmar, and Oman) had submitted reports to WHO of achieving 100% elimination goals of trachomaIn Ethiopia, repeated mass antibiotic distributions

dramatically reduced infection after 3 to 4 years of treatment

Trachoma can be eliminatedSlide34

Mycobacterium leprae, was the first bacterium to be identified

as causing disease in


Leprosy is

a disease that mainly affects the skin, nerves, upper respiratory tract and eyes.Currently, worldwide, more than 200,000new cases of leprosy are detected annually,many in India, Brazil, Indonesia and sub-Saharan Africa.

6-leprosy more than 200000 cases annuallySlide35

Earlier World Health Assembly set a goal for “elimination of leprosy as a public health problem”, defined as a prevalence of less than 1 per 10,000, by the year 2000.


recently, the WHO

has formulated new targets for

leprosy reduction of grade-2 disabilities in newly detected cases to below 1 per million population at global level by 2020Progress in leprosy controlSlide36

These are caused by an infection with T. solium or




and Swine are the intermediate hosts of T. solium , whereas cattle are the intermediate hosts for T. saginata. Taeniasis, and


have been ranked as

the most important food-borne parasitic diseases of humans in terms of public health,


and trade impact.






They are transmitted by eating raw or insufficiently cooked pork or beef containing infective larvae.It was estimated that approximately 300,000 individuals were infected with




globally, resulting in over 28,000 deaths in 2010. Between 2.5 and 5 millions people are estimated to harbor adult tapeworms of T. solium





In humans, the symptoms of taeniasis are subtle and mild and include abdominal distension, abdominal pain, digestive disorders and anal pruritis but humans can also develop


from the tapeworm

larvae in multiple tissues and organs, which can be fatalTaeniasis and



In neurocysticercosis (NCC) the symptoms and signs include

headaches, blindness, convulsions or epileptic seizures, paralysis,



or cardiac lesions may also be present or even death. WHO target: Scaled-up interventions in selected countries for control and elimination by 2020.





Dracunculiasis, known as guinea-worm disease,

is a crippling disease caused by the parasite


medinensis. It is long threadlike worm which grows up to a meter in


It is transmitted exclusively when people drink water that has been contaminated with parasite-infected

water fleas.



(Guinea worm disease) Slide42

The female Guinea worm migrates through the body under the skin, causing severe pain, and eventually emerges from the body (usually from the feet), causing an ulcer, fever, nausea and


Larvae are released

into the water and begin the cycle of infection all over

again through water fleasDracunculiasis (Guinea worm disease) transmissionSlide43

Guinea worm disease was

devastating used to incapacitate

people for extended periods of time, making them unable to care for themselves, work, grow food for their families, or attend


In 1986, the disease afflicted an estimated 3.5 million people a year in 21 countries in Africa and AsiaDracunculiasis

(Guinea worm disease)


heavy burden in AfricaSlide44

There is no known curative medicine or vaccine to prevent Guinea worm disease

When Ernesto Ruiz-

Tiben, the head of Carter


against guinea worm, began his work to eradicate guinea worm disease more than 30 years ago, he felt “it was going to be like dragging a dead elephant through a swamp by its tail.”


(Guinea worm disease)

and Carter CenterSlide45

Guinea worm disease is set to become the second human disease in history, after smallpox, to be eradicated. It will be



first parasitic disease to be

eradicated, and the first disease to be eradicated without the use of a vaccine or medicine ….public health measures…Thanks to the Carter center…story of successDracunculiasis

(Guinea worm disease)


Through his non-governmental organization, former US President Jimmy Carter championed the cause to eradicate guinea worm disease with corporates and heads of states. He kept

up pressure and accountability by visiting affected countries, even brokering a ceasefire in Sudan in the 1990s to allow health workers access to those at

risk in

South Sudan.

Extensive collaborative efforts to eradicate Guinea worm disease Slide48

The Center with ministries of health almost stopped the spread of Guinea worm disease by providing health education and helping to maintain political will, in addition to



water filters and dogged determination.Carter program helped cut incidence of the disease in 2016 to just 25 cases reported

in only

four countries







, and


Simple measures with high impactSlide49

As stated earlier the incidence of the disease was estimated to be 3.5

million in


The success has been

achieved through community-based interventions; education and change of behavior:Teaching people to filter all drinking water and preventing transmission by keeping anyone with an emerging worm from entering water sources.



STH are caused by intestinal worms including roundworm, whipworm and hookworm They are

among the most common infections

worldwide and tend to affect the

most deprived communities.

They are transmitted by eggs present in human feces, which in turn contaminate the soil in areas where sanitation is poor and sewage is left untreated

9- Soil-transmitted


(STH) transmission Slide51

Infected children are physically, nutritionally and cognitively impaired. It is estimated that

576-740 million individuals

are infected with hookworms worldwide.


the infected individuals, about 80 million are severely affected. STH burdenSlide52






أجسـاد الأطفـالSlide53

The major hookworm infections are due Necator


which is found in the Americas, sub-Saharan Africa, and

Asia and

Ancylostoma duodenale which is found in more scattered focal environments, namely Europe and the MediterraneanThe WHO policy for control of the


largely centers on two groups, preschool aged children (pre-SAC), and school-aged children (SAC).

WHO policy for control of STH Slide55

WHO aims to scale up mass drug administration (MDA) for STH, so that by 2020, 75 % of the pre-SAC and SAC in need will be treated regularly.


2013, global coverage of those in need was 39 % for SAC and 49 % for


WHO policy for control of STH Slide56

In 2015, STH moved from yellow to green in the progress score card chart (recently developed by Uniting to Combat NTDs), in part due to better coordination between UNICEF and WHO which has led to an improvement in reporting of coverage for pre-SAC

WHO policy for control of STHSlide58

Foodborne trematodiases are a group of infections caused by trematode worms (known as flatworms or flukes



become infected by

eating raw or poorly cooked fish, crustaceans and vegetables that harbor the minute larvae of the parasites. 10- Foodborne trematodiasesSlide60

Recent estimates indicate that at least 56 million people suffer from one or more foodborne trematode infections (




, fascioliasis, paragonimiasis and others).

Cases of


have been reported from more than

70 countries worldwide.




Tropical fasciolosis caused by Fasciola gigantica infection is one of the major diseases infecting ruminants in the tropical regions of Asia and



causes a significant

economic loss in livestock industry in developing and underdeveloped countries for more than 3.2 billion US dollars per annum. Foodborne trematodiases burdenSlide62

The WHO has been aiming to control morbidity due to foodborne trematodiases by the inclusion of these infections in the mainstream preventive chemotherapy strategy with the necessary veterinary public-health support





By 2020:75% of the at-risk population will have been reached by preventive chemotherapy


associated with foodborne


infections will be under control in 100% of the endemic countries FT- WHO targetSlide64

Lymphatic filariasis (LF) commonly known as elephantiasis, is a mosquito-transmitted parasitic disease caused by infection with Wuchereria



malayi, or B. timori, in tropical and subtropical regionsPeople of all ages can be infected and symptoms of an infection in childhood can appear much later in life.

11- Lymphatic


The worms live in, and cause blockage of, the lymphatic system that normally returns fluids in our extremities to the circulatory system.


blockage results in fluid collection in the tissues (most commonly the legs and genitalia), severe swellings, and periodic fevers from bacterial infections of the collected fluids.



A long-standing infection with lymphatic filariasis results in an irreversible condition called elephantiasis, in which there is a marked enlargement and hardening of the limbs so that they resemble those of an elephant, and patients suffer from persistent recurring fevers



Approximately 120 million people are infected by lymphatic filariasis, and 1.1 billion are at risk

of infection



endemic communities as many as 10 percent of women and men can be affected with swollen limbs, and 50 percent of men can suffer from the mutilating disease of their genitals





داء الـفـيــــــــــل


These physical disfigurations result in social stigma with significant social and economic consequences for patients, families, and communities




The global LF elimination strategy includes stopping the spread of infection through annual Mass Drug Administration( MDA) of albendazole together with either ivermectin



(DEC) to eligible individuals in affected areas for 4-6 years, and alleviation of suffering through morbidity management and disability prevention (MMDP).

Global strategy for elimination of LFSlide72

MDA has been implemented in 63 of the 73 endemic countries. 556 million people in 39 countries were treated

during 2015, the cumulative total of treatments since 2000 now exceeds 6.2 billion

Thank to the


arter center……Merck,…. GlaxoSmithKline.. very gratifying results.. Eliminated in some non African countries

… Nigeria good progress??

Good progress in control of LFSlide73

Human onchocerciasis or river blindness is caused by the filarial nematode Onchocerca


and transmitted by the

tiny black flies that live by fast-flowing water from person to personOnce inside the body, the larvae of the worms migrate to the skin, eyes and other organs, where they grow into adult worms that can live in the body for up to 15 years




عمـي الأنهــار

Onchocerciasis Slide75

The disease causes skin lesions, severe itching and visual impairment, including permanent blindness, reduces an individual's ability to work and learn, and can shorten life expectancy by up to 15 years.More than

99 per cent

of infected people live in


countries in sub-Saharan AfricaOnchocerciasis burdenSlide76

It is earmarked for elimination by the WHO as articulated by the 2012 Roadmap and the London

Declaration on

Neglected Tropical Diseases

The principal strategy to achieve elimination is

mass drug administration (MDA) with ivermectin …..Prof Mamoun…..Carter center.


strategy for eliminationSlide77

Good progress towards elimination has also been made in Africa which bears 99% of the onchocerciasis burden, with notable successes in regions of Mali, Senegal, Nigeria, Sudan and eastern Uganda…


progress towards eliminationSlide78

The Carter Center and its partners have successfully broken river blindness transmission in Uganda and Sudan by providing twice per year Mectizan treatments…


from Colombia (2013)

Ecuador (2014), Mexico (2015), and Guatemala (2016).


good progress towards eliminationSlide79

عمـي الأنهــار

Onchocerciasis Slide80

Schistosomiasis or bilharzia is a water-borne parasitic infection. There are two major types of schistosomiasis disease manifestations:



(most prevalent in Africa) caused by

Schistosoma haematobium, and intestinal schistosomiasis, caused by, depending on the tropical region of the world, either S.





, S.


, S.


or S.


13-Schistosomiasis urogenital or intestinalSlide81

People are infected during routine agricultural, domestic, occupational and recreational activities which expose them to infested water. It is caught through fresh water that contains the larvae of worms



parasite can live for years in the veins near the bladder or intestines,

laying eggs that pass out of the body in urine or feces and reinfect water sources..

Schistosomiasis transmission Slide82

Snails are infected when fresh water is contaminated by eggs excreted in human urine or feces.Infected snails release larvae that infect humans when they expose their skin to water contaminated by the snails

Schistosomiasis transmission Slide83

It results in a debilitating chronic disease with extensive morbidity and organ pathology.


is endemic in

76 countries worldwide, with about 207 million people infected of which 123 million are children. The

majority (88%)

of the people infected with


live on the

African continent

Schistosomiasis burden Slide84

Schistosomiasis is implicated in several clinical conditions including bladder cancer leading to death, liver periportal fibrosis, cirrhosis



, reproductive complications

, and human immunodeficiency virus (HIV) transmission and fast progression to acquired immune deficiency syndrome (AIDS) in adultsSchistosomiasis burden Slide85

It is the most deadly of the neglected tropical diseases and it is the second most common parasitic disease, after malaria.

In terms of

socioeconomic and public health impact,

schistosomiasis is second only to malaria as the most devastating parasitic disease in tropical countries Schistosomiasis burdenSlide86

Nigeria is the most endemic country for schistosomiasis, with approximately 20 million people, mostly children, needing treatment.



, main control strategy is

preventive chemotherapy (prazequantel) in which several countries in Africa have now embarked…..

Schistosomiasis control Slide87


داء المنشقـات


Human echinococcosis is a zoonotic disease caused by

tapeworms of the genus


. It occurs in 4 forms: cystic echinococcosis, also known as hydatid

disease or



caused by infection with






, caused by infection with






, caused by infection with



; and



, caused by infection with






zoonotic diseaseSlide89

The two most important forms of medical and public health relevance in humans, are cystic echinococcosis

(CE) and alveolar



The disease has the highest incidence in countries where sheep are raised with the help of dogs


: two major forms Slide90

In endemic regions, human incidence for HD can reach >50/100,000

person per year

, and prevalence levels as high as


may occur in parts of East Africa, Central Asia China, Argentina, and PeruBoth cystic echinococcosis and alveolar echinococcosis represent a substantial disease burden.



More than 1 million people are affected with echinococcosis at any one time.



often expensive and complicated to treat, and may require extensive surgery and/or prolonged drug therapy.Many of the patients will be experiencing severe clinical syndromes which are life-threatening if left untreated.



Even with treatment, people often face reduced quality of life.The most common


cyst sites in humans are the


60%–70% of cases, followed by lung and brain In livestock, the prevalence of cystic echinococcosis found in slaughterhouses in hyperendemic areas of South America varies from

20%–95% of slaughtered animals



The 2015 WHO Foodborne Disease Burden Epidemiology Reference Group (FERG) estimated echinococcosis to be the cause of 19300

deaths and around

871 000 disability-adjusted

life years

(DALYs) globally, each year.Annual costs associated with cystic echinococcosis are estimated to be US$ 3 billion for treating cases and losses to the livestock industry.


burden Slide94

It is also known as American trypanosomiasis, and it is potentially life-threatening illness.


etiologic agent that causes Chagas

disease is the protozoan parasite

Trypanosoma cruzi (T.




The parasite is transmitted by


known as the

kissing bug


disease epidemiologySlide96

In humans, Chagas disease manifests in acute and chronic phases.


acute phase has mild symptoms that may last for approximately two months.


the chronic phase, the majority of cases are of the asymptomatic indeterminate form, which may last a lifetime Chagas disease: clinicalSlide97

The parasite can move to the muscles of the heart or bowels, where it can cause severe damage to organsThe most important health consequence of


disease is


, which over a lifetime occurs in 20 to 40% of infected persons with an incidence of 1.85% persons per year.Estimates of mortality attributable to Chagas disease vary considerably

(between 0.2% and 19.2% annually)


disease: pathologySlide98

Estimates of the number of infected individuals in the world have decreased from approximately 20 million in 1981, to 7-8 million in 2014. The

majority of infected individuals live

in 21


of Central and South America.The disease has spread to other continents over the past century as global population movements have increased.


disease burdenSlide99

Leishmaniasis is a parasitic disease caused by

intracellular protozoan parasite,


and transmitted by the bite of a certain

female sandflies of Phlebotomus and Lutzomyia species.Leishmaniasis

is classified as

cutaneous (CL), visceral (VL),





clinical manifestations and it is among the world’s

six major tropical diseases





It ranks third in disease burden in disability-adjusted life years (DALY) caused by neglected tropical diseases, and

is the second most frequent cause of parasite-related


after malaria.

It is endemic in 98 countries and causes significant morbidity and mortality mainly Eastern Africa

which is

the second-highest-burdened region, after the Indian subcontinent.



Overall, annual prevalence is 12 million and the population at risk is approximately 350 million. The global burden of visceral


(VL) alone is estimated at

0.2 to 0.4 million

cases, resulting in 50,000 deaths every year, if left untreated, the fatality rate of VL is as high as 100%; in some areas. Leishmaniasis

burden Slide102

Combined WHO’s Roadmap and the London declaration have accelerated interventions since 2012 with significant levels of progress. There was 82% reduction in reported cases of visceral


(VL) in Bangladesh, India and Nepal.


target is the elimination of the visceral form on the Indian subcontinent, not Africa, by 2020


: control progressSlide103



Known as human African trypanosomiasis



It is

transmitted by the bite of the Glossina, commonly known as the tsetse fly. Trypanosomes cause a variety of diseases in man and domestic animals in Africa, Latin America and Asia.





T. b.


cause human African


17- Sleeping

sickness Slide105

Infected people typically suffer fevers, headaches and joint pains followed by confusion, poor co-ordination, numbness and trouble sleeping.



population are at risk of getting HAT

Sleeping sickness burdenSlide106

مـرض النـوم

Trypanosomiasis Slide107

Significant progress after HAT has been included in the WHO NTD roadmap (2012) as one of the diseases targeted for elimination as a public health problem by 2020.


progress has been demonstrated by

89% drop in new HAT cases between 2000 and 2015.


sickness control progressSlide109

It can be caused by bacteria actinomycetoma, or fungi



and typically affects poor communities in many tropical and subtropical regions. It is an infection of subcutaneous tissues resulting in mass and sinus formation and a discharge that contains grains. The lesion is usually on the foot but all parts of the body can be affected.




Despite its distressing deformities, disability, high morbidly, and negative socioeconomic impacts on patients, communities, and health authorities it enjoys meagre

national and international attention and


A major problem in

mycetoma is that most of the patients are of poor socio-economic and health education status and hence the late presentation, poor treatment compliance and high follow-up dropout rates. Mycetoma burdenSlide113

It is still challenging and hard to treat patients with mycetoma; in particular eumycetoma.


current treatment is still

not optimal and disappointing. To cure, this disease both extensive and destructive surgery and prolonged antifungals treatment are necessary.



The progress in control or elimination of NTDs Slide115

The WHO has been the major actor and coordinator of efforts to fight against NTDs.It succeeded to bring many global stakeholders together in one forum.


first global partners’ meeting on NTDs was held in


, and adopted the theme, “Collaborate. Accelerate. Eliminate”. Global partners for control of NTDsSlide116

Following the meeting a variety of local and international stakeholders have worked alongside

ministries of health in endemic countries

to deliver quality-assured medicines, and provide people with care and long-term management.

Global partners for control of NTDsSlide117

In 2012 and inspired by the declared WHO NTDs Roadmap, partners signed the London Declaration on Neglected Tropical Diseases through which they pledged to support WHO in the control and elimination of 10 neglected tropical diseases by


Roadmap and London declaration 2012Slide118

The most recent Global Partners’ Meeting on NTDs was held in Geneva, 19 April



WHO presented the

fourth report which showed remarkable achievements in the fight against NTDs. Representatives of Member States, donor agencies, foundations, the private sector, academia and various stakeholders attended the meeting.

Global partners meeting 2017Slide119

The fourth report reflected the achievements of the past decade, and declared to sustain support towards the 2020 WHO Roadmap targets.Partners were called to facilitate availability of resources needed beyond 2020

Among the achievements of the past decade an estimated

1 billion people received treatment in 2015 alone


Progress in one decade 2007-2017Slide120

“WHO has observed record-breaking progress towards bringing ancient scourges like sleeping sickness and elephantiasis to their knees,” said WHO EX-Director-General, Dr Margaret Chan. “Over the past 10 years, millions of people have been rescued from




Thanks to one of the most effective global partnerships in modern public health”.Dr Margaret Chan-EX WHO directorSlide121

In a recently published WHO report (2017), Integrating neglected tropical diseases in global health and development, it has been clearly demonstrated how strong political support, generous donations of medicines, and improvements in living conditions

have led to sustained expansion of disease control programs in countries where these diseases are most


WHO report (2017)Slide122

One billion people were treated for at least one neglected tropical disease in 2015 alone.one

billion people in 88 countries

have benefited from

preventive chemotherapy

in 2014.Five hundred and fifty six million people received preventive treatment for lymphatic filariasis


and more than

114 million people received treatment for


(river blindness);

62% of those requiring it.

Achievements in figuresSlide123

Only 25 human cases of Guinea-worm disease were reported in 2016, putting eradication within reach.Cases of human African trypanosomiasis

(sleeping sickness) have been reduced from

37000 new cases in 1999 to well under 3000 cases in


Achievements in figuresSlide124

Trachoma, the world’s leading infectious cause of blindness has been eliminated as a public health problem in Mexico, Morocco, and Oman. More

than 185 000 trachoma patients had surgery for



More than 56 million people received antibiotics in 2015 alone

Achievements in figuresSlide125

Concerning visceral leishmaniasis in 2015,

the target for

elimination was achieved in 82% of sub-districts in India, in 97% of sub-districts in Bangladesh, and in 100% of districts in Nepal.

Only 12 reported human deaths were attributable to rabies in the WHO Region of the Americas in 2015, bringing the region close to its target of eliminating rabies in humans by 2015.

Achievements in figuresSlide126

The partners meeting 2017 also stressed the importance of integrating NTDs in the Global Health and Development (GHD), and to be part of the

Universal Health Coverage (UHC) policy

which has been recommended in the 58th World Health Assembly resolution in


Important new recommendation 2017Slide127

UHC means all people receiving the health services they need, including health initiatives designed to promote better health (such as



, prevent illness (such as

vaccinations), and to provide treatment, rehabilitation, and palliative care (such as end-of-life care) of sufficient quality to be effective while at the same time ensuring that the use of these services does not expose the user to financial hardship.

Universal Health Coverage(UHC)Slide128

In 2013, the World Health Assembly approved Resolution WHA 66.12, which defined strategies for NTDs with clear targets and milestones for 17 NTDs, and endorsed the WHO NTDs-Roadmap goals linking NTDs to (UHC).


, countries were encouraged to plan for stepping-up implementation of the UHC which entails integration of NTDs into regular health

services with improved quality.

Universal Health Coverage(UHC)Slide129

Thus, in this setting NTDs are to be addressed through five strategies:preventive chemotherapy, intensified disease management, vector control, veterinary public health measures for zoonotic neglected diseases, and through improved water and


Five strategies for addressing NTDsSlide130

In the fight against NTDs emphasis is placed on building partnerships for change among international agencies, governments, nongovernmental organizations, corporations, national ministries of health, and most of all, with people at the grass roots.

People at the

grass root level

are helped to acquire the tools, knowledge, and resources they need to transform their own lives…Effective partnership

in the fight against


The WHO Carter Center Health ProgramsDrug companies such as Merck

Bill & Melinda Gates


Thanks to those and othersSlide132

Since 1986, The Carter Center has led the international campaign to eradicate Guinea worm disease, working closely with ministries of health and local communities, the U.S. Centers for Disease Control and Prevention, the WHO, UNICEF, and many others.



arter CenterSlide133

Inspired by the successful eradication of smallpox in 1977, the International Task Force for Disease Eradication (ITFED) has been formed at The Carter Center in 1988 to evaluate disease control and prevention and to see the potential for eradicating other infectious diseases.

The Carter CenterSlide134

Thus, in addition to sponsoring and hosting the ITFDE meetings, Carter Center health programs address two of the diseases currently identified by the ITFDE for eradication, dracunculiasis and lymphatic


, and three diseases identified for elimination or better control,


,, trachoma, and schistosomiasis. The center uses health education and simple, low-cost methods

The Carter CenterSlide135

Scientists and notable international health organizations serving on the task force have identified additional diseases that potentially could be eradicated, thereby dramatically and permanently improving the quality of life for many millions of the world's poorest people. These diseases include

poliomyelitis, mumps, rubella, measles, and yaws

The Carter CenterSlide136

The socioeconomic burden of three big endemic diseases in AfricaHIV/AIDS, TB and malariaSlide137

HIV infection represents a global health concern.It has an extremely uneven geographical distribution, with Sub-Saharan Africa bearing more than two-thirds of the global burden


HIV/AIDS is by far the leading cause of

premature mortality

in sub-Saharan Africa and the fourth-biggest killer worldwide

HIV/AIDS burdenSlide138

In sub- Saharan Africa, HIV prevalence among adults had reached around 7.4%, rising to over 20% in some


At the end of


an estimated 39 million people globally were living with HIV, and there were 3.1 million AIDS deaths, including 510,000 children

HIV/AIDS burden Slide139

In 2011, 34 million people were living with HIV globally, 3.3 million were children under 15 years and 16.7 million were women

In 2015, the UNAIDS Program estimated


36.7 million people

were living with HIV globally, and 1.1 million people died in the same year from AIDS resulting from HIV infection….39….34….37…..ART…

HIV/AIDS burden Slide140

Progress has been made on some fronts. Provision of millions of people living with HIV in LMICs with antiretroviral treatment (ART)




18.2 million, or 49% of people living with HIV (PLHIV), were taking ART

HIV/AIDS: progress in control Slide141

The United Nations Program on HIV/AIDS (UNAIDS) World AIDS Day Report 2012, reported a 50% reduction

in HIV incidence


25 LMICs between 2001 and 2011

In Sub- Saharan Africa, the number of newly infected children declined by 24% between 2009 and 2011

…new strategy…..

HIV/AIDS: progress in control


The importance of accelerating access to diagnosis, treatment,


viral suppression

as significant elements in ending the epidemic has prompted the

UNAIDS in 2014 to release the HIV 90-90-90 target. The 90-90-90 target states that by 2020, 90% of individuals living with HIV will know their HIV status, 90% of people with diagnosed HIV infection will receive antiretroviral treatment (ART), and 90% of those taking ART will be virally suppressed.

New strategy for AIDS controlSlide143

Data has been obtained from 82 countries between 2010 - 2016, representing

33.8 million (92%) of the 2015 global estimate of PLHIV



the 82 countries, only Sweden has achieved the 90-90-90 target. Data on PLHIV diagnosed

were available for

51 of 82

countries, data for those on


indicator for

80 of 82

countries, and data for

viral suppression


53 of 82





Care continua with viral suppression estimates were available in the public domain from only nine countries in sub-Saharan Africa (Kenya, Malawi, Mauritius, Namibia, Rwanda, South Africa, Swaziland, Uganda, and Zimbabwe), representing only

35% of the 2015 HIV



More effective initiatives are needed for Sub Saharan Africa ….The 90-90-90 target in AfricaSlide145

Tuberculosis is the second greatest killer worldwide due to a single infectious agent

after HIV/AIDS


kills nearly

1.7 million people annually, most of them in their prime productive years. Over 95% of TB deaths occur in LMICs with the highest burden in Africa and Asia.

Socioeconomic burden of tuberculosis (TB) in Afri



Africa has 24% of the world’s TB cases, and the

highest rates of cases and deaths per capita


The emergence of

drug resistant strains, the spread of HIV/AIDS, enhanced susceptibility to tuberculosis, as well as

the growing number of

refugees and displaced


TB burden in AfricaSlide147

Although the MDG target to halt and reverse the TB epidemic by


is already achieved, the disease burden remains enormous with


in many areas due to HIV/AIDS.An estimated 13% of the TB cases in 2011 were co-infected with HIV and 430,000 deaths were among the HIV-positive population

Deadly combination: TB and HIV/AIDSlide149

The burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis has evolved in several tuberculosis-endemic countries. Approximately 20% of tuberculosis isolates globally are estimated to be resistant to at least

one major drug

(first-line or group A or B second-line), with approximately 10% resistant to isoniazid.

MDR and XDR burdenSlide150

WHO has defined multidrug-resistant (MDR) tuberculosis as resistance to at least isoniazid and rifampicin, when first-line therapy is unlikely to cure the disease and a switch to a second-line drug regimen is recommended.


TB is defined as


or totally drug-resistant tuberculosis. MDR and XDR burdenSlide151

Malaria continues to have a severe socioeconomic impact in Sub Saharan Africa and a major impediment to health, where it frequently takes its greatest toll on very young children and pregnant women.


child dies every minute

from malaria in Africa where it is estimated that

9 out of 10 malaria deaths occur.The socioeconomic burden of Malaria in


The consensus view of recent studies and reviews is that malaria causes at least 20% of all deaths in children under- 5 years of age in Africa


can also be spread to the fetus during pregnancy as well as before and/or during

childbirth resulting the so

called congenital malaria which can cause infant death and low birth weight.

20% of all child death in AfricaSlide153

First, an overwhelming acute infection, which frequently presents as seizures or coma (cerebral malaria), Second, repeated malaria infections contribute to the development of




which substantially increases the risk of death. Third, low birth weight, frequently the consequence of malaria infection in pregnant women, is the major risk factor for death in the first month of life.

How does it kill childrenSlide154

Repeated malaria infections make young children more susceptible to other common childhood illnesses, such as diarrhoea and respiratory infections

, and thus contribute indirectly to


How does it kill childrenSlide155

It is one of the causes of household poverty because it results in absenteeism from the daily activities of productive living and income generationMalaria also continues to prevent many

school children from attending school due to illness,

diminishing their capacity to realize their full potential.


who survive malaria may suffer long-term consequences of the infection. Perpetuate poverty and ignoranceSlide156

Demographic and health surveys (DHS) indicate that less than 40% of malaria morbidity and mortality is seen in formal health

facilities in



In 2013, there were 528 000 deaths from malaria and about 78% of these were children under 5 years of age. In 2015, 88% of global cases and 90% of global deaths were still in the Africa

uncontainable burden in AfricaSlide157

In all malaria-endemic countries in Africa, 25–40% of all outpatient clinic visits had been for malaria.


these same countries, between

20% and 50% of all hospital admissions

are a consequence of malaria uncontainable burden in AfricaSlide158

factors accounting for the continued malaria burden in Africa, include:Climate

changes, poverty, weak

health and public infrastructures,

emerging drug and insecticide resistance, massive population and demographic shifts, and high costs of containment and therapy.

Factors accounting for the continued burdenSlide159

However, due to concerted and highly scaled efforts in the fight against malaria between 2000 and 2015, the number of malaria cases declined by


while the malaria death rate declined by


in the Africa.Despite these successes made by new effective measures the malaria burden is still startling

Recent progress in controlSlide160

The reduction of malaria burden is due to:Improved

availability and use of

insecticide-treated nets (ITNs)

, Diagnosis-based treatment with artemisinin-based combination therapy (ACT),


of communities in malaria



capacity in vector control

New effective measuresSlide161

Insecticide-treated nets (INTs) are highly effective in reducing malaria mortality in young children. They are low- cost and highly effective way of reducing the incidence of malaria in people who sleep under them, and they have been conclusively shown in a series of trials to substantially reduce child mortality in malaria-endemic areas of Africa

Insecticide-treated nets (INTs)Slide162

Almost all malaria-endemic African countries now have active programs under way to encourage ITN use, and most of these countries support a variety of different mechanisms to increase net coverage.


and the insecticide to treat them can now be purchased in small shops and markets and even on street corners in many endemic African countries.

Insecticide-treated nets (INTs)Slide164

Major efforts are now being made in several African countries to provide subsidized ITNs to the most vulnerable groups, young children and pregnant women. New technological developments promise nets that will retain insecticidal activity for many years,

and novel ways of encouraging regular net treatment with insecticide should make it possible to increase the proportion of nets that are effectively treated

Insecticide-treated nets (INTs)Slide165

WHO prompted industry to develop long-lasting insecticidal nets (LLINs), ready-to-use, factory-pretreated nets that require no further treatment during their expected lifespan of 4–5 years.


is already commercially available and the

current price

is around US$ 5 per net, The Roll Back Malaria (RBM) partnership is facilitating technology transfer and stimulating local production of LLINs in Africa

long-lasting insecticidal nets (LLINs


Antimalarial drug resistance has become one of the greatest challenges in malaria treatment.Since the


parasite resistance to


, the cheapest and most widely available antimalarial drug, has emerged as a major challenge since it has lost its clinical effectiveness in most parts of Africa….

Antimalarial drug resistanceSlide167

Unfortunately, resistance to the most common replacement drug, sulfadoxine–


, has also emerged, especially in Eastern and Southern


WHO recommends artemisinin-based combination therapy (ACT), which is highly efficacious and promises to delay emergence of resistance….??. Antimalarial drug resistanceSlide168

Home-based management of fever (HBMF) is a promising strategy for improving the coverage of prompt effective treatmentRecent studies indicate that home treatment, supported by public information and pre- packaging (as an aid, to ensure that patients take the full treatment course at the right time), can help to reduce malaria mortality in


Many publications…

Home-based management of fever (HBMF)Slide169

One of the adopted approaches is mass drug administration (MDA) which involves the time-limited distribution of drugs to a target population, irrespective of infection status. It

has been used

only sporadically

against malaria in most settings, and cluster-randomized trials

Mass drug administration (MDA)Slide170

In September, 2015, WHO’s Malaria Policy Advisory Committee recommended for the first time the use of MDA in specific circumstances: When

transmission is close to being interrupted, vector control, effective surveillance, and access to case management are at high coverage, and importation of infection is minimal

Mass drug administration (MDA)Slide171

It can also be applied in areas which are under threat of multidrug resistance, or for malaria epidemics or during complex


Mass drug administration (MDA)Slide172

During the last thirty years scientists have been working hard to get long lasting vaccines for malaria without any real success so far. Recently

, a

partially protective vaccine candidate, RTS,S,

has been in

trialsPhase IIb trial in Mozambique found that the vaccine offered partial protection for young children, cutting their risk of severe malaria by 58%.....

Malaria vaccinesSlide173

P. falciparum infection during pregnancy is estimated to cause an estimated 75 000 to 200 000 infant deaths each year. Despite

the toll that malaria exacts on pregnant women and their infants, this was,

until recently, a relatively neglected problem, with less than 5% of pregnant women having access to effective

interventions in Africa.

Malaria burden during pregnancySlide174

For many years WHO recommended that pregnant women in malaria endemic areas should receive an initial antimalarial treatment dose on their first contact with antenatal services, followed by weekly chemoprophylaxis…

Malaria burden during pregnancySlide175

In 2000, the WHO Expert Committee on Malaria recommended that intermittent preventive treatment (IPT)

with an effective, preferably

one- dose

, antimalarial drug, should be made available as

a routine part of antenatal care to women in their first and second pregnancies in highly endemic areas.Malaria burden during pregnancySlide176

This strategy provides at least two treatment doses of an effective antimalarial at routine antenatal clinics to all pregnant women living in areas at risk of endemic falciparum malaria

At present,


pyrimethamine (SP), given at a therapeutic dose, is the single- dose antimalarial with the best overall effectiveness for prevention of malaria in pregnancy in areas with high transmission, and low resistance to SP.


preventive treatment (IPT)Slide177

Studies in Kenya and Malawi have shown that IPT with at least two treatment doses of SP is highly effective in reducing the proportion of women with anaemia and placental malaria infection at delivery.

intermittent preventive treatment (IPT)Slide178

Government annual spending on all health care is low in most African countries, typically less than US$ 15 per person



costs of

malaria control are high: artemisinin-based combination drugs to treat resistant malaria are likely to cost US$ 1–3 per treatment, and ITNs cost around US$ 5.

Most of the costs of preventing and treating malaria in Africa today are in fact borne by people themselves which may contribute to


High cost managementSlide179

During the 1950s and 1960s, the malaria eradication campaign successfully eliminated the disease in countries with temperate climates and in some countries where malaria transmission was low or moderateThe emergence of

drug and insecticide resistance,

coupled with concerns about the feasibility and sustainability of tackling malaria in areas with

weak infrastructure and high transmission

, brought an end to the eradication era…….control…

Control versus eradicationSlide180

In the last three decades the international community began to appreciate that the malaria burden was unacceptably high and worsening, particularly in Africa

, and that real reductions in malaria mortality and morbidity were possible with

existing but

under used

tools and strategies.Malaria controlSlide181

Many stakeholders have already been involved in malaria control.Formal partnerships have been created and a statement of intent issued, indicating what will be achieved, and how. Resources

have been mobilized from partners and systems are set up to monitor achievements in

rolling back malaria


Malaria control alliancesSlide182

In 1992, malaria control was re-established as a global health priority by a Conference of Ministers of Health held in AmsterdamBetween1991-1998 malaria control expertise and capacity were expanded and strengthened, particularly in Africa, especially through the project for

Accelerated Implementation of Malaria Control

Partnership on malaria controlSlide183

The Multilateral Initiative on Malaria formed by WHO/TDR in 1997 ….

In1998 the

Roll Back Malaria (RBM)

Partnership was launched and

consensus on the core technical strategies for tacking malaria establishedIn 2000 the United Nations declared 2001–2010 the Decade to Roll Back Malaria in developing countries, particularly in Africa

The Multilateral Initiative on


WHO/TDR Slide184

The goal of Roll Back Malaria has been to halve the burden of malaria by 2010.



specific intervention strategies

were established at the Abuja Malaria Summit, April 2000, attended by heads of states in a historic meeting,Heads of states expressed their personal commitments

to tackling malaria and to establish targets for implementing the technical strategies to Roll Back Malaria.

Roll Back MalariaSlide185

Roll Back Malaria has been supporting efforts to improve the early recognition of, and effective and timely response to, malaria epidemics


residual spraying

which plays an important role in malaria vector control, especially in the control of epidemics. Roll Back MalariaSlide186

Malaria early warning systems have been established in Southern Africa to improve outbreak detection and response and are being developed in other epidemic-prone parts of Africa. Prompt

access to effective treatment, Insecticide-treated nets (ITNs), Prevention and control of malaria in pregnant women, Malaria epidemic and emergency response

Roll Back MalariaSlide187

The African heads of states participating in the Abuja Summit agreed that by the year 2005 at least 60% of those suffering from malaria should have

prompt access to and be

able to use correct, affordable, and appropriate treatment within 24 hours of the onset of


Abuja Summit commitmentSlide188

Back Malaria (RBM) targets to achieve a 75% reduction in malaria cases by 2015, as compared to those in 2000. Fifteen epidemic-prone countries have developed a preparedness plan of action.

Very good progress was made through

RBM simple strategies in most malaria endemic countries

New targets….

2017 onwards….RBM targets 2000-2015Slide189

The new targets of RBM Partners declared shall be to work together to support achievement of the following goals


by 2020:


mortality rates and incidence is reduced by at least 40% compared with 2015. Malaria does not re-emerge in countries that were malaria-free in 2015.



targets of RBM

Partners (2017)Slide190

Malaria is eliminated in a further 10 countries in 2020 compared to 2015




incidence and mortality rates are reduced globally by at least 90% compared with 2015 levels



targets of RBM Partners (


In 2030 elimination of malaria from at least 35 countries in which malaria was transmitted in 2015,


re-establishment of malaria

in all countries

that are malaria freeThe new targets of RBM Partners (


The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) was established 2001It is a major new source of grant funding

for tackling malaria in



endemic countries have been awarded a total of US$ 256 million for an initial two years to scale up malaria control activities….Malinda and Gate foundation….

The Global Fund to Fight AIDS, Tuberculosis and Malaria (


1- WHO estimates that 2.4 billion people still lack basic sanitation facilities such as toilets and latrines, while more than 660 million

continue to drink water from “unimproved” sources, such as surface water


2-The lack of robust, sustained international and domestic financingChallenges in fight against EDsSlide194

3- Inadequate performance of health systems in most of affected African countries


4- Many

of the people who harbor infections remain

asymptomatic or undiagnosed and act as potential reservoirs. 5- In some parts of Africa, vector-control tools cannot effectively protect against a disease given the diversity of vectors and the differences in their behaviors

Challenges in fight against EDsSlide195

6- The emergence of resistance to medicines and insecticides is major concern. New combinations of drugs and innovative, faster-acting medicines with fewer side-effects are needed. The

lack of financial incentives for pharmaceutical companies has tended to discourage research and development in the area of endemic

diseases in poor countries..

Challenges in fight against EDsSlide196

7- Lack of capacity to implement effective surveillance and monitoring compromises getting reliable data which is needed to expose coverage inequities, and to make sure whether people receive the services they need, and also takes into account the quality of services provided, and

the ultimate impact on health.

Challenges in fight against EDsSlide197

8- Disruptive armed conflicts in many African countries9-


to accessing needed health services that range from


to stigmatization.10- Once you move towards elimination, communities

forget the burden of the contained disease.

We have to remind the community to

remain alert and report cases to make sure that the diseases could not come back.

Challenges in fight against EDsSlide198

11- Eliminating transmission of NTDs and ensuring that the delivery of health services meets the needs of those still living with NTD-related disease.



of a strong political voice

. People affected by endemic diseases in Africa are generally overlookedChallenges in fight against EDsSlide199

13- How to overcome endemic zoonotic diseases through strategies of veterinary public health activities and the One Health approach which recognizes that the health of people is connected to the health of animals and the environment.

Challenges in fight against EDsSlide200

NGOs including the Federation of Islamic Medical Associations (FIMA) and Turkish Foundations can have influential role in

building capacity

of local communities in Africa to fight endemic diseases.


can be involved in programs to empower community-based delivery of medical and health services

Role of NGOs and Turkish GovernmentSlide201

This is to be achieved in close collaboration with official bodies involved in health service provision, and with other stakeholders already exerting appreciable efforts to control or eradicate endemic diseases in Africa

Role of NGOs and Turkish GovernmentSlide202

The Turkish government can help in establishing centers of excellence for research and training on endemic diseases control in several African countries. These

centers can carry

epidemiological studies on prevalence, vulnerability and spread of endemic diseases in Africa using modern technological tools


Centers of excellence for research and training in AfricaSlide203

Such studies can give solid data on the magnitude and perception of the burden of the endemic diseases in Africa. The centers can help in

the design and availability of effective and practical interventions to combat endemic disease



of excellence for research and training in AfricaSlide204

Such interventions could include research on vaccines or other primary preventive measures,

curative treatments with new effective drugs

, or new means of

eliminating vectors

. Ideally, interventions should be effective, safe, inexpensive, long-lasting, and easily deployed. C


of excellence for research and

training in AfricaSlide205

Carter center has demonstrated feasibility of elimination of endemic diseases by mobilizing efforts of many stakeholders. Also

the generous funding by

The Bill & Melinda Gates Foundation

has made real appreciable difference in the fight against endemic diseases in Africa

.KAMRI, AMRI, Nogouchi institute….

Carter Center and othersSlide206

Many Islamic countries are active in relief operations to disasters in poor countries...It is better to prevent disasters before they occur and prevail….Thus, I call upon

relatively wealthy Islamic countries such Turkey to make a


in collaboration with FIMA and others to establish centers of excellence in Africa bearing in mind the majority of the affected people in Africa are Muslims.

FIMA and Turkish GovernmentSlide207

Thank you for listening