Spectrum of skin NTDs
Skin NTDs are a group of diseases for which the primary presentations are changes in the skin (lumps or swelling, ulcers, swollen limbs and patches on the face or body). These diseases, if not diagnosed and treated early, can lead to long-term disfigurement, disability, stigmatization and socioeconomic problems.
The skin NTDs include:
- Buruli ulcer
- cutaneous leishmaniasis
- post-kala-azar dermal leishmaniasis
- lymphatic filariasis (lymphoedema and hydrocele)
- fungal diseases
Other common diseases of the skin in communities and schools should be treated or referred during active case searches.
The distribution of skin NTDs varies in countries, regions, districts and communities.
Rationale for integration
In the context of skin NTDs, integration is defined as the implementation of two or more activities simultaneously in the same communities in order to optimize the use of limited resources.
The rationale for integration includes several factors:
- Skin NTDs are often co-endemic in many countries, districts, and communities.
- Skin NTDs may have some common manifestations and approaches to detection. Examination of the skin therefore serves as an opportunity to identify multiple conditions in a single intervention and also to improve case detection. For example, post-kala-azar dermal leishmaniasis can be detected during leprosy case detection campaigns, or vice versa.
- Skin NTDs are often underreported or are not included in routine surveillance systems. An integrated approach offers opportunities for active screening in communities and in schools.
- Skin NTDs are associated with stigmatization, discrimination and socioeconomic problems.
- Integrated morbidity management for two or more skin NTDs enables increased access to health and rehabilitative services as well as social support.
- Integrated training of health workers and community volunteers can be expanded to cover a number of skin NTDs.
- Combined activities to control skin NTDs improves understanding of their total related burden and of the need for greater advocacy and optimal and efficient use of human, material and financial resources.
- An integrated approach to skin NTDs makes a compelling case for their prevention and control as donors, nongovernmental organizations and professional groups share similar elimination objectives.
- Integration optimizes the use of common laboratory and case management infrastructure to address many of these diseases.
- Community participation and motivation for control and surveillance can be enhanced as progress is made and visible results of treatment are achieved.
Opportunities for integration
The skin NTDs present many opportunities for integration, including:
- Quicker identification of affected communities and mapping of cases and identification of areas of co-endemicity, leading to integrated and targeted control activities and cost–effective approaches.
- Use of a single platform to screen populations and faster detection of cases in settings often characterized by fragile health systems.
- One-to-one contact, leading to better dissemination of information, education and health promotion as well as opportunities to address sociocultural issues and overcome traditional beliefs.
- Horizontal health approaches for improved coordination of community activities and community participation and better village-based surveillance.
- Value-added clinical management including surgical treatment, wound care and prevention and management of disabilities.
- Stronger health systems by training more health workers, school teachers and community volunteers.
- Development of common services for rehabilitation, addressing stigmatization, discrimination or mental health consequences.
Factors underlying successful integration
The following factors could support the successful integration of skin NTDs:
- Robust political support and leadership combined with cross-sectoral collaboration with various ministries.
- Sustained WHO advocacy and relevant, easy-to-use and aligned technical guidance (skin NTD manual, online course and integrated data collection/analysis tool).
- Cooperation and support of donors and partners of vertical programmes, combining mapping, training and social mobilization.
- Resources and funding for a more integrated health system providing a higher quality of care.
- Integration into the primary healthcare system and/or with other (more prominent) public health problems such as tuberculosis, HIV/AIDS or diabetes mellitus.
- Access to diagnosis and treatment and ability to address the cultural dimension of skin diseases.