Integrated strategies for controlling and eliminating Neglected Tropical Diseases in Sub-Saharan Africa: a review of approaches, challenges, and opportunities

Abstract

Neglected Tropical Diseases (NTDs) are a significant global health issue, affecting over a billion people and hindering progress in economically disadvantaged areas, particularly in Sub-Saharan Africa. This study explores the complex relationship between socioeconomic factors and health inequalities in the region, highlighting the diverse impacts of NTDs and offering forward-looking recommendations. Despite global efforts to combat these diseases, significant gaps remain in achieving eradication in endemic areas. Key strategies for progress include expanding educational initiatives, engaging broader global health communities, and addressing the stigma faced by NTD victims. Therefore, recognizing the multifaceted impact of NTDs, it is essential to integrate intersectionality into health policies and action plans to tackle the challenges these diseases pose in Sub-Saharan Africa and globally.

Introduction

Neglected Tropical Diseases (NTDs) encompass a range of parasitic, viral, bacterial, fungal, and non-communicable illnesses, impacting over one billion individuals worldwide [1]. NTDs hinder both physical and cognitive development, increase the vulnerability of mothers and children to illness and mortality, impede farming and livelihoods, and curtail productivity in the workplace (1). Despite commendable strides in advancing the health of citizens living below the poverty line, Sub-Saharan Africa bears a disproportionately weighty burden of NTDs [2]. The communities endemic to NTDs in this region often grapple with a cycle of very low socioeconomic status, compounded by severely limited access to essential health services, clean water and people live in close proximity to animals and vectors that spread infectious diseases, such as remote rural areas, informal settlements, or conflict zones [2].

In the early 2000s, the World Health Organization (WHO) managed a portfolio of 17 Neglected Tropical Diseases (NTDs), encompassing a diverse range of communicable diseases caused by bacteria, helminths, protozoa, or viruses [3]. These included conditions such as Buruli ulcer, Chagas disease, dengue, dracunculiasis (guinea-worm disease), echinococcosis, foodborne trematodiasis, human African trypanosomiasis (sleeping sickness), leishmaniasis, leprosy, lymphatic filariasis (elephantiasis), onchocerciasis (river blindness), rabies, schistosomiasis (snail fever), soil-transmitted helminthiasis (intestinal worms), taeniasis/cysticercosis (pork tapeworm), blinding trachoma, and yaws. This list was expanded to include three additional groups of diseases including mycetoma, chromoblastomycosis, and other deep mycoses; scabies and other ectoparasites; and snakebite envenoming, bringing the total to 20 NTDs or groups of NTDs since 2016 [3]. The WHO recognized Noma (cancrumoris or gangrenous stomatitis), an aggressive gangrenous disease affecting the mouth and face, predominantly targets undernourished young children, typically between 2 and 6 years of age, in areas characterized by extreme poverty and mostly found in sub-Saharan Africa as the 21st NTDs as shown in Fig. 1. This was recommended by the 17th meeting of the Strategic and Technical Advisory Group for Neglected Tropical Diseases (STAG-NTD) [4].

Fig. 1.

WHO’s list of the 21 Neglected Tropical Diseases. Figure was originally created by authors with Biorender

Noma’s designation as the 21st NTD highlights the dynamic nature of the situation and the need for a comprehensive approach to treat these conditions in order to reduce their socioeconomic effects and advance global health equity. By synthesizing existing knowledge and evidence, this review seeks to inform policymakers, healthcare professionals, and researchers about the current state of NTD control efforts in Sub-Saharan Africa. Furthermore, it aims to highlight areas where integrated approaches have shown promise and areas where innovative solutions are needed to overcome persistent challenges [5, 6].

Methodology

This review employed a comprehensive approach to examine integrated strategies for controlling and eliminating neglected tropical diseases (NTDs) in sub-Saharan Africa. A comprehensive literature search was conducted across multiple databases, including PubMed, Web of Science, Scopus, and Google Scholar, to identify relevant articles published between 1990 and 2024. Keywords and Boolean operators such as “neglected tropical diseases,” “integrated strategies,” “control,” “elimination,” “sub-Saharan Africa,” and “challenges and opportunities” were used to refine the search. Only peer-reviewed articles, reports, and reviews written in English were included to ensure the quality and relevance of the data. A total of 215 articles were initially retrieved, of which 80 were deemed relevant after title and abstract screening. Inclusion criteria focused on studies that discussed integrated approaches to NTD control in sub-Saharan Africa, specifically those addressing the combined use of mass drug administration (MDA), vector control, water, sanitation, and hygiene (WASH) initiatives, community engagement, and health system strengthening. Articles examining single-disease interventions, theoretical perspectives without implementation details, or studies conducted outside sub-Saharan Africa were excluded.

The selected studies were subjected to full-text review and thematic analysis. Data were extracted and categorized under core themes: (1) implementation of integrated strategies, (2) health system capacities and challenges, (3) community participation, (4) policy and funding mechanisms, and (5) opportunities for innovation. Emphasis was placed on identifying synergistic effects of integrated approaches, barriers to their implementation, and opportunities for scaling successful interventions. Critical appraisal tools such as the Mixed Methods Appraisal Tool (MMAT) were used to assess the methodological quality of the included studies. Both qualitative and quantitative data were synthesized to provide a comprehensive understanding of the subject matter. Where applicable, statistical data were aggregated to evaluate trends and outcomes associated with integrated interventions. The findings were interpreted in light of the current global health landscape and aligned with the WHO’s roadmap for NTDs. By employing this method, the review offers a robust and balanced analysis of integrated strategies for controlling and eliminating NTDs in sub-Saharan Africa, highlighting actionable insights for policymakers, researchers, and public health practitioners.

Prevalence and distribution of NTDs in Sub-Saharan Africa

More than a billion people are affected by neglected tropical diseases globally. Africa accounts for nearly 40% (400 million people) of the global burden [5]. There is a widespread geographical distribution of NTDs across sub-Saharan Africa, with some countries bearing a higher burden than others. The Expanded Special Project for the Elimination of Neglected Tropical Diseases ESPEN) a World Health Organization (WHO) initiative launched in 2016, identified the number of NTDs requiring preventive Chemotherapy across countries in the African region (Fig. 2). This measures the burden of NTDs with a score ranging from 0 to 5. Many counties in SSA have more than 3 NTDs requiring preventive chemotherapy, highlighting the huge burden of NTDs in the region [6, 7].

Fig. 2.

Expanded special project for elimination of Neglected Tropical Diseases (ESPEN) distribution of Neglected Tropical Diseases (NTDs) requiring preventive chemotherapy (PC) across African countries

The prevalence and distribution of Neglected Tropical Diseases (NTDs) are deeply influenced by geographic, socio-economic, and infrastructural variables, many of which vary dramatically between and even within countries. Currently, many global assessments of NTDs rely on regional aggregates or modeled estimates, which are useful for broad overviews but often obscure important local disparities and epidemiological patterns [8]. These regional snapshots may flatten the reality on the ground, where prevalence can vary not only between countries but also among districts, states, and even communities. By incorporating detailed country-specific statistics, researchers and policymakers gain the ability to see where diseases are most entrenched, which populations are most vulnerable, and how well current control strategies are working.

For instance, Nigeria bears one of the highest global burdens for multiple NTDs, including lymphatic filariasis, onchocerciasis, and schistosomiasis [9]. Yet even within Nigeria, prevalence rates can differ widely between northern and southern states, influenced by environmental conditions, poverty levels, access to water and sanitation, and health system performance [10]. Similarly, Ethiopia and the DRC face significant challenges with trachoma, soil-transmitted helminth infections, andleishmaniasis, among others [11]. However, the internal distribution of these diseases is shaped by conflict zones, migratory patterns, and regional disparities in healthcare access. Without disaggregated data from such countries, it becomes difficult to design interventions that are truly responsive to need.

In addition to illuminating regional inequities, country-specific data also provides valuable insights into the effectiveness of national disease control programs. For example, Ethiopia has made major strides in its trachoma elimination efforts through the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvement), and Nigeria has been a leader in the mass drug administration (MDA) approach to combat onchocerciasis [12]. Highlighting successes and ongoing challenges through robust, localized data strengthens the manuscript by anchoring it in real-world progress and gaps, giving readers a more tangible understanding of what strategies are working, where, and why.

The vicious cycle of poverty and infection

The control of NTDs is challenging in SSA, as it affects a large population of people living below the poverty line [9]. NTDs are the most common infections in the region, with 79% of African countries being co-endemic with at least five NTDs [10, 11]. NTD-affected areas, marked by poverty and limited healthcare, face both suffering and significant economic strains. Research in sub-Saharan Africa suggests stigmatized NTDs like lymphatic filariasis (LF) may have underestimated economic impacts, affecting family income through reduced agricultural productivity due to job cessation [12]. The prevalence of NTDs in SSA can be attributed to several factors, including inadequate access to essential resources such as water, housing, toilets, soap, and literacy, which facilitate the existence of NTDs in developing nations [13].

It is evidenced in research that schistosomiasis, soil-transmitted helminths, and trachoma are prevalent NTDs in this region could be avoided with better access to resources [13]. Approximately 93% of the world’s estimated cases of schistosomiasis occur in Sub-Saharan Africa, with an estimated 192 million cases in the region [13]. The most common species of schistosomiasis in Sub-Saharan Africa is S. haematobium [13]. Moreover, approximately 76% of the population in Sub-Saharan Africa lives near contaminated water bodies that are home to snail intermediate hosts, making them particularly vulnerable to schistosomiasis [14]. Nigeria has the largest number of schistosomiasis cases in Sub-Saharan Africa, with an estimated 29 million cases, followed by United Republic of Tanzania, DRC, and Ghana [14]. Construction of irrigation projects in Sub-Saharan Africa has led to a significant rise in the prevalence of schistosomiasis [14]. People living near dam reservoirs in Sub-Saharan Africa are at particular risk of schistosomiasis [14].

Furthermore, climate change and global warming may also be contributing factors to the prevalence of NTDs in Sub-Saharan Africa, including schistosomiasis [14]. Schistosomiasis is just one example of the many NTDs that are prevalent in Sub-Saharan Africa. The region is also home to approximately 90% of the world’s 200,000 cases of yellow fever, with epidemics reported in various countries, including Cameroon, Central African Republic, Cote d’Ivoire, Ghana Guinea, Mali, and Togo [15]. Rift Valley fever is another problem for humans, sheep, goats, and cattle in Sub-Saharan Africa, with epidemics and epizootics occurring after periods of heavy rains [16].

Impact of coinfections on NTDs

NTDs co-infect with other diseases like Human immunodeficiency virus (HIV) [17], hepatitis [18], COVID-19 [19], malaria [20], and malnutrition [21], leading to a more severe clinical outcome. Chronic Hepatitis B and C virus coinfection with schistosomiasis is linked to more severe liver damage [18]. Strongyloides infection can raise the risk of immunological reconstitution syndrome and strongyloideshyperinfection in HIV-positive individuals under certain conditions, such as those receiving corticosteroids for toxoplasmosis or Pneumocystis carinii pneumonia [17]. Given this, knowledge about the incidence rates of NTD coinfections is required to put in place suitable programs for public health and educate healthcare professionals about understanding the issues related to health. Schistosomiasis and chronic HBV coinfection affected 4.7% of sub-Saharan Africa, while 0.6% of participants also had schistosomiasis and HIV coinfection [22]. Schistosomiasis can raise the risk of HIV transmission and promote the course of HIV infection, and speeds up the development of liver fibrosis when associated with HBV or HCV infections [23].

When NTDs, such as schistosomiasis, trypanosomiasis, onchocerciasis, and others, are prevalent in an area, soil-transmitted helminths (STHs) may become endemic there [24]. There have been reports of co-endemicity between schistosomiasis and STH infections in several developing nations, with a 0.4% to 2.2% incidence of co-infection in the general population [25]. Risk factors for schistosomiasis infections are linked to hygiene-related behaviors that are linked to STH infections. These include overcrowding, poor sanitation, limited access to clean water, shoe-wearing, nail cutting, and handwashing [26]. The majority of control efforts target school-aged children since they have the highest risk profile. Schistosomiasis malaria coinfections are particularly prevalent in areas where transmission zones overlap thus making the control of the disease challenging [26]. Additionally, visceral leishmaniasis-HIV coinfections have been a significant public health challenge, most notably in East Africa where coinfected patients present higher disease severity and higher mortality [27]. It is noteworthy that adult populations, such as those employed in agricultural settings, are more likely to be infected with hookworm and Strongyloides, as a result, treatment approaches designed for school-age children may not be beneficial for adults who are at risk [27].

The severity of COVID-19 has been linked to pre-existing medical disorders that often deteriorate as people age [28]. In considerably younger populations, a number of NTDs can have chronic health outcomes if untreated. For instance, acute Trypanosomacruzi infection is often missed and neglected because it usually presents with no symptoms or a mild, self-limiting disease [29]. However, 20–30% of those with a chronic T. cruzi infection experience cardiac symptoms in their early or middle adult years, most typically complicated dilated cardiomyopathy [30], Also, anemia from STH infections can happen [31]; if anemia, as previously said, puts people at risk for worse outcomes, then coinfection of STHs and SARS-CoV-2 in kids and expectant mothers is a concern [31].

Subsequently, innovative approaches to reduce co-infections have been proposed. These include pediatric ivermectin formulations for controlling infections in children and adults; community-directed treatment for onchocerciasis; household-level conditions like improved water and sanitation; vaccines; intensive disease management; bed nets; and vector control [32]. The necessity for coordinated and closely related intervention methods centered on enhancing access to basic services and promoting good hygiene practices is evident in the control and elimination prospects for co-infections with other NTDs, despite ongoing hurdles.

Health impacts and socio-economic burden of NTDs

Social, political, and educational impacts of NTDs

Communities that are particularly vulnerable must have their needs met both locally and internationally as nations adopt and strive to achieve the Sustainable Development Goals (SDGs). Over 57 million Disability Adjusted Life Years are accounted for by NTDs, the majority of which are quite crippling (DALYs) [33], this leads to persistent prevalence in less developed regions, with higher disability burdens than tuberculosis and malaria. Limited access to medicine worsens the prolonged impact of NTDs [34]. Though, Sub-Saharan Africa (SSA) had remarkable economic growth over the past ten years, leadership, commodities, and warfare, capital differs greatly throughout African governments.

A study in five NTD-endemic Kenyan counties examined political, economic, social, and cultural factors influencing NTDs and their impact on health, findings revealed that social and ecological systems intersect across temporal and spatial scales, affecting human well-being [35]. Politics dictates how the constitution works; once sovereignty is dispersed erratically, it opens the door for the impoverished to be exploited and maintains existing disparities, increased incidence of unemployment, ignorance, poor hygiene, gender discrimination, violence, and warfare are the results of inequal power dynamics [36]. In SSA, three of the six nations with the highest non-traumatic depression rates experience ongoing violent conflicts [37]. Table 1 summarizes the social, political, economic and educational impacts of NTDs.

Table 1.

Social, political, economic and educational impacts of NTDs

Social	Political	Economic	Educational
NTDs cause permanent disability, deformation, stigmatization, impairment of physiological and psychological, and social discrimination.	Government services become less decentralized as a result of NTDs leading to bad budgetary appointments, insufficient funding, lack of political will, and denial of NTDs.	In sub-Saharan Africa, NTDs have a major economic impact on people and communities, hence sustaining the cycles of hunger and poverty.	NTDs decrease school attendance rates.
NTDs promote the isolation of people who are stigmatized.	NTDs causes political instability, border tensions and conflicts, violence and clashes.	It reduces capacity for earning a living and employment opportunities.	NTDs restrict the impacted people’s access to education.
NTD victims were subjected to execution, torture, and other cruel punishment.	NTDs politicalize necessary resources.	NTDs raise rates of poverty and reduce agricultural production.	Growth stunting and decreased cognitive learning are some NTD cases outcomes.
NTDs causes marital domestic conflict.		NTDs cause disabilities in heads of homes who are working-aged men and women. The total number of days that one can work in a year is reduced.
Leprosy is one example of an NTD that is considered a curse in some tribes.		It impacts the patients’ capacity to engage in any form of economic activities.
		It affects the ability of patients to participate in any economic activity.

Health impacts and economic burden

Neglected Tropical Diseases (NTDs) pose a health challenge in sub-Saharan Africa impacting millions of people and causing a socio-economic impact on communities. The diverse clinical nature of neglected diseases not only undermines individual health but also places an additional burden on healthcare systems already struggling with limited resources [38]. According to the WHO, the financial burden of neglected diseases (NTDs) weighs heavily on households affected by them [39]. Each year these households suffer a loss of $33 billion (USD) due to both the expenses incurred for healthcare out of pocket and the wages that are forfeited because of NTDs [39]. In total, the advantages of eradicating NTDs for individuals impacted are estimated to surpass $342 billion, between 2015 and 2030 encompassing savings in and out-of-pocket health costs and regained productivity [40]. The unfair distribution and lack of access to resources like water, housing, toilets, soap, and education contribute to the persistence of NTDs such as Schistosomiasis, soil-transmitted helminths, and trachoma [41].

According to the World bank, individuals with NTDs are burdened during their productive working years, which lowers income and productivity. NTD-related illnesses and disabilities reduce economic activity and increase poverty. For biological, cultural, and socioeconomic causes, NTDs disproportionately impact women and girls, and this hinders women’s ability to break out from the cycle of poverty and leads to gender inequality [42]. Nery et al. [43] found that individuals with no income or per capita income below 0.25 times the minimum wage have a 40% higher chance of contracting leprosy, a common NTD, compared to those receiving the minimum wage. Regions with high poverty rates in the North, Northeast, and Midwest exhibit an eightfold higher incidence of the disease than the South. Other poverty-related factors, including low education levels and poor housing conditions, double the risk of acquiring leprosy and other NTDs. People living with these ailments often face stigmatization and discrimination, further increasing the social impact they experience [44]. The stigma associated with these conditions creates challenges in society leading to social exclusion, a decrease in overall quality of life, and negative impacts, on mental well-being [44].

The social consequences of NTDs such as the ones that cause severe disability like Buruli ulcer, leprosy, lymphatic filariasis, and onchocerciasis are truly devastating [45]. The stigma surrounding these diseases often leads to exclusion, rejection, blame, and social judgment. In Saharan Africa, women who suffer from schistosomiasis tend to hide their health issues and avoid discussing their condition due, to concerns about how it may affect their marriage and social standing [46]. Also, young children who have legs caused by lymphatic filariasis may face ridicule at school [47].

Similarly, individuals with leprosy often hesitate to seek help due to the fear of being stigmatized and socially excluded. Apart, from the psychological impacts, stigma related to health can hinder the management and control of the illness in various aspects, including seeking healthcare accepting treatment, following treatment plans, and gaining political support for disease control [48]. This can have implications, for healthcare outcomes and public health initiatives.

Furthermore, the stigma surrounding diseases can have an impact on how patients receive and follow their treatment. Due to the fear of being judged or discriminated against individuals with stigmatized conditions may choose to travel distances or even stop their treatment altogether to avoid revealing their condition. This can result in lower-quality interactions between patients and healthcare providers. For example, in many tropical regions, several skin NTDs such as Buruli ulcer, leprosy, scabies are coendemic [49]. Skin symptoms are very noticeable which not only leads to stigmatization and exacerbate poverty, but also impacts mental health and can lead to suicidal thoughts, depression and anxiety [50]. Additionally, healthcare professionals themselves might stigmatize patients, which can negatively impact the quality of healthcare services and limit access, to diagnosis and treatment [51].

Current strategies for NTDs control and elimination

The World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), USAID and field implementation teams continue to strive toward the ultimate goal of a world free from the burden of Neglected Tropical Diseases (NTDs) ​ [52]​. The prevention of NTDs has saved many lives in Africa, nevertheless, obstacles continue to exist, as these illnesses typically strike underprivileged populations in remote, dangerous, and difficult-to-access locations ​ [53]​. To accelerate the prevention and eradication of neglected tropical diseases (NTDs), efforts have focused on “innovating and intensifying disease management”.

Nearly two decades ago, this approach aimed to create and implement new tools while expanding access to existing ones. In Ethopia, mentor mobile clinics enhance accessibility to leishmaniosis diagnosis and treatment, alleviating suffering and fostering inclusion for individuals with lesions ​ [54]. Currently, the chemotherapy of American trypanosomiasis remains a serious problem due to the limitations of old drugs, which present an important drawback [55]. Pharmaceutical companies have little financial incentive given its correlation with impoverished population. Thus, the government and/or academic institutions must devote their resources to the creation of new medications.

A key cross-cutting initiative, vector control, focuses on preventing certain NTDs whose transmission cycle depends on vectors or intermediate hosts in order to maximize the impact of other strategic initiatives ​ [53]​. Selective spraying of cattle to control the acute zoonotic form of human African sleeping sickness has been effective ​ [56]. Despite being a crucial part of the overall schistosomiasis management approach, snail control has been proven to provide some significant difficulties. This is particularly true in regions where schistosomiasis transmission continues as a zoonosis, such as the People’s Republic of China [57].

The relationship between animal, human, and environmental health is recognized by the idea of “one health.” This approach has also been acknowledged as a key tactic for controlling zoonotic diseases and has been applied with success in a number of disease areas, including the prevention of sleeping sickness in Ugandans and the control of rabies in people in Latin America, KwaZulu-Natal, the Philippines, and Bali through the use of canine rabies vaccinations [58]​. Provision of Safe water, adequate sanitation, and hygiene (WASH) constitute one of the five major public health approaches to managing, getting rid of, or eradicating NTDs. To varying degrees, WASH is essential to the management and prevention of all NTDs. In addition to improving access to water, sanitation, hygiene, and education, developing strong monitoring and evaluation systems to assess the efficacy of integrated NTD control programs will enhance the well-being of vulnerable populations, which are appropriate links to many of the Sustainable Development Goals (SDGs). Table 2 provides a summary of control strategies, and challenges associated with eradication of NTDs in sub-Saharan Africa and future recommendations.

Table 2.

Summary of control strategies, challenges associated with eradication of NTDs in Sub-Saharan Africa and future recommendations

Control Strategies	Challenges	Future Recommendations
Preventive chemotherapy targets NTDs like STH, lymphatic filariasis, schistosomiasis, and onchocerciasis. The key approach involves regularly providing at-risk populations with affordable, safe, and effective donated medications without prior individual diagnoses.	The emergence of antimicrobial resistance affects some of the treatments used to tackle NTDs.	Mass drug administration campaigns.
Intensified disease management is used for NTDs including Chagas disease, Buruli ulcer, human African trypanosomiasis, and leishmaniasis, for which there are no appropriate or widely used control methods.	Diseases designated for intensified disease management typically have intrinsic barriers in diagnosis, treatment, and follow-up, making them more costly and challenging to manage.	Standardizing the diagnostic tools and the monitoring and evaluation processes for NTD programs is necessary, thus it is crucial to look into and address the execution of NTD control programs in the areas.
For many years, vector control has been a crucial part of NTD programs. Successful control strategies have helped to effectively manage NTDs such lymphatic filariasis, visceral leishmaniasis, onchocerciasis, and Chagas’ disease.	Insufficient tools and techniques hinder Aedesaegypti mosquito control, transmitting Chikungunya and Dengue. Growing resistance to pyrethroid insecticides poses a threat to lymphatic filariasis and other insect-borne NTD elimination programs in Africa.	The impact of existing resources can be maximized by a more integrated approach, as opposed to concentrating on specific diseases.
One Health highlights the link between human health, animal health, and the environment. This method has been effectively applied in a number of disease areas and is acknowledged as an essential strategy for controlling zoonotic diseases.	Little knowledge about the One Health approach in Africa affect its successful usage for NTDs control.	Creating centres of excellence in the region or scholarly collaborations could be effective.
Sanitation, cleanliness, and access to clean and safe water are essential for the management and eradication of NTDs such as schistosomiasis and helminthiases. The inclusion of NTDs in this framework and the involvement of the water, sanitation, and hygiene sectors demonstrate a comprehensive policy approach within the SDG targets.	It can be difficult to provide clean, safe water in some remote locales where these NTDs are most common, thus support from other sectors is crucial.	Given that these significant subpopulations may serve as a source of re-emergence or recrudescence as nations work to block transmission, more attention is required to NTD elimination, eradication, and control efforts among remote, mobile, or displaced communities.

Innovative approaches and technologies

The weakness in global efforts to monitor, control, and eradicate neglected tropical diseases (NTDs) is inadequate and nonintegrated diagnostics [59]. Although treatment is often available, NTDs are prevalent among marginalized populations due to the lack or insufficiency of diagnostic tests, resulting in empirical misdiagnoses [59]. Prompt diagnosis at the point-of-care (PoC) is essential for NTD patients hence, the World Health Organization (WHO) recommends that low and middle-income countries develop non-laboratory-based diagnosis and control policies with cost-effective ways to prevent, diagnose, and treat the diseases [60]. To address this, diverse Point-of-Care (PoC) diagnostics have been developed to detect NTDs through various biomolecular methods.

The utilization of digital health technologies, including mobile phone messages/reminders, eHealth, mHealth, and electronic health records, is an emerging and promising method for enhancing disease prevention, diagnosis, case detection, treatment delivery, and patient follow-up, as well as facilitating health facility appointments, thereby improving overall health outcomes [61]. These digital health technologies are devices that utilize computing platforms and sensors to facilitate connectivity for healthcare and related issues, and are primarily used by healthcare providers [61]. There are some innovations that provide community-led solutions. One example of the latter is the wooden dose pole, an ingenious and innovative solution to adjust drug dosing that is low cost, reproducible on a local and global scale and a vital tool to help fight disease [62].

In the period since 2010, notable progress has been achieved in the fight against neglected tropical diseases (NTDs) in sub-Saharan Africa (SSA), thanks to the 2008–2015 roadmap [63, 64]. Many community partnerships have been established with the goal of promoting fair and efficient NTD control methods [65]. There has been some progress made in development of new point-of-care diagnostic and innovative approaches due to continued engagement of key partners. For example, the pharmaceutical company donated resources for research and development of biomarkers for soil-transmitted helminthiases and schistosomiasis [66, 67]. There is also increased development of diagnostic platforms, such as rapid diagnostic tests for human African trypanosomiasis (gambiense).

Implementation challenges and barriers

Infrastructural limitations

Approximately 400 million Africans suffer from NTDs, but political, economic, and socio-cultural factors hinder effective preventive, diagnostic, and services [68]. Challenges include political instability, insufficient budgets, resource politicization, NTD denial, and funding shortages, posing barriers to integrated approaches for NTD control in Sub-Saharan Africa. Therefore, investigating how political, sociocultural, and economic systems influence health and well-being is crucial [68, 69]. These diseases stem from poverty, leaving individuals unable to afford self-care during illness. Absences from work result to the decline in earnings, creating a significant hurdle for Sub-Saharan Africans in allocating sufficient funds for extensive initiatives to control NTDs [70]. Water is used in campaigns to penalize people who don’t support a certain political candidate. Due to these reasons water, sanitation, and hygiene practices are also compromised which are basic techniques for the prevention of diseases.

Socio-cultural factors influencing interventions

Economic activities like fishing, crop farming, and livestock rearing can make communities more vulnerable to NTDs like schistosomiasis, leishmaniasis, and Human African Trypanosomiasis (HAT) [71]. Norms and practices are among the cultural factors that impact the transmission of NTDs. For instance, in nomadic communities residing in semi-arid and arid regions, there exist customs that forbid women and children from consuming animal proteins, this results in protein deficiencies and malnourishment among women and children. Furthermore, stigmatization associated with certain NTDs can lead to social isolation and discrimination, discouraging affected individuals from seeking treatment or participating in control programs. Additionally, the acceptance and adoption of contemporary healthcare interventions are hampered by traditional beliefs and practices.

Health system constraints

Insufficient funding, lack of integration of NTDs control and elimination programs into mainstream health programs, and inadequate government ownership of these initiatives are the main health system challenges. It can be difficult to apply integrated approaches successfully if there is insufficient infrastructure for healthcare, including medical facilities, transportation, and communication systems [72]. Restricted access to medicine, incomplete or inaccurate health data systems, poor diagnosis, and limited diagnostic tools impede the effective diagnosis, monitoring, and evaluation of NTDs [73]. NTDs often coexist and share similar risk factors, making it difficult to design and implement integrated strategies that address multiple diseases simultaneously. Treatment discontinuity has been observed due to various factors such as side effects, lack of education, and cultural beliefs [74].

Community engagement and empowerment in eliminating NTDs in Sub-Saharan Africa

For many years, community engagement has always been a key to eradicating global health challenges [75]. Onchocerciasis Control Program (OCP), launched in 1974 by WHO, World Bank and others, was one of the earliest international initiatives to address a neglected tropical disease [76]. A similar program, African Program for Onchocerciasis Control (APOC), was later established in 1995 to control the disease using mass drug administration (MDA) and community drug distributors to reach communities without regular health system [77]. Evidence from the APOC proved the need for community-directed programs for having a greater control for NTDs [78]. The Universal Health Coverage by the UN advocates providing communities with high-quality supportive, preventive and palliative health services to ensure effectiveness and minimizing financial difficulties [78].

Community engagement depends, particularly, on the compliance and resistance to interventions by members of the community [79]. Community Health Workers (CHWs) working in their locality promote compliance being familiar they serve [79]. A study about MDA for lymphatic filariasis (LF) also identified taking the drugs by the CHWs themselves around the community members and household visitation before the drug distribution, as a key to building trust and subsequent increment of compliance [80]. On the other hand, community resistance has also been reported severally. Sociopolitical background of a community influences how its members react to interventions [80]. Misunderstanding of the disease, relationships between the community and their leaders combined with the past experiences with similar programs are often the mediating roles in many communities [80].

Community engagement is intertwined with educational sector in especially rural communities. Primary schools connect CHWs with vulnerable people, particularly children. They provide public spaces where awareness campaign about NTD prevention and control can be given. More importantly, schools can serve as an avenue where MDA can be done efficiently. Educational projects, under the supervision of nominated teachers, focusing on WASH will further prevent NTDs related to poor hygiene practices [81]. Inter-ministerial coordination between Ministries of Health and Education can be utilized to established community-based program for more awareness. Religious and community leaders such as district head, and knowledgeable and influential local people should also need to be galvanized into creating awareness among their fellows about the NTDs and the potential ways to prevent and combat them [81].

Future perspectives and recommendations

NTDs pose a significant public health challenge in sub-Saharan Africa, requiring integrated approaches for effective control and elimination. Envisioning a roadmap for NTD elimination necessitates a multifaceted strategy, and to this effect, a new roadmap for NTDs spanning from 2021 to 2030 was introduced in January 2021, comprising global objectives and milestones aimed at preventing, controlling and eliminating at least 20 NTDs, along with cross-cutting targets that align with the Sustainable Development Goals (SDGs) [71]. This includes reducing the population requiring NTD treatment by 90%, eradicate one or more NTDs in 100 countries, eliminating two specific diseases (yaws and dracunculiasis), and ensuring a 75% reduction in the disability-adjusted life years (DALYs) linked to NTDs [82]. In order to achieve these targets, multiple NTD elimination strategies are crucial, of which the establishment of holistic NTD surveillance systems is a key focus area.

Innovative technologies, such as mobile health applications and satellite imaging, can enhance real-time monitoring and reporting of NTD cases, as demonstrated by the success of the Global Trachoma Mapping Project, which utilizes the cloud storage and analysis of data on the prevalence of trachoma and trichiasis across over 34 countries worldwide [83]. Furthermore, community engagement and empowerment play a pivotal role in NTD elimination, as indigenously tailored health education campaigns help to foster community ownership, making NTD interventions more sustainable. Initiatives such as the Community-Directed Treatment with Ivermectin (CDTI) strategy for onchocerciasis control [84], and Mass drug administration (MDA) with praziquantel (PZQ) against schistosomiasis [85], are community-based chemotherapy interventions against NTDs, however, it is vital to supplement such interventions with other approaches such as public health education, promotion of water, sanitation and hygiene (WASH) measures, and vector control.

There is a need to integrate NTD programs with existing health initiatives, such as cross-cutting collaborations with maternal and child health services, immunization programs, and water and sanitation projects. For instance, the co-administration of deworming medications during routine vaccination campaigns is an increasingly regular practice in various SSA countries, and can be accompanied by additional strategies such as vector control measures (like snail elimination in the case of schistosomiasis), to improve NTD eradication while enhancing other public health outcomes. Collaborative efforts in research and development are also important, as research projects focused on drug formulations, diagnostic tools, and vector control methods can provide breakthroughs in NTD eradication. This is evidenced by the widespread impact of the Drugs for Neglected Diseases initiative (DNDi), internationally established by seven founding partners, which has developed 13 treatments for 6 deadly neglected diseases so far [86].

Another pivotal aspect of NTD elimination is the role of policymakers and stakeholders. Advocacy for increased domestic and international funding dedicated to NTD programs is crucial, in order to facilitate the establishment of infrastructure, healthcare worker training, and integration of NTD services into primary healthcare. Several countries in SSA have set up national plans for the elimination of NTDs, including Ghana, Kenya, Ethiopia, Tanzania, etc [87, 88]. It is important to ensure that such elimination programs are sustained by a robust funding structure through adequate health budgetary allocations. In addition, collaborations between SSA countries with varying levels of NTD prevalence can facilitate knowledge exchange and capacity building.

A major step in this direction was taken in March 2022 by the establishment of a Memorandum of Understanding (MoU) between the African Union (AU) and the Uniting to Combat NTDs initiative [89]. This commitment is aimed at strengthening stakeholder collaborations to eliminate 20 NTDs across all AU member states by 2030. Such approach will solidify the efforts and impact of platforms such as the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD), which consolidate the NTD research agenda by facilitating collaborative research and experience-sharing among researchers, country partners and program implementers worldwide.

Conclusion

NTDs are a global concern that impacts billions of the world’s low-middle-income countries, mostly in Sub-Saharan Africa. They pose a threat to global health since one of its goals is to provide equitable access to healthcare, even for the most impoverished people. While the efforts of numerous groups, businesses, NGOs, and government organizations are commendable, more must be done to promote the total eradication of these diseases in the Sub-Saharan African regions where they are endemic. Numerous programs that educate millions of people about their involvement in attaining global health goals and the need to avoid stigmatizing NTD victims should be supported. Because the effects of NTDs are multidirectional and frequently overlooked when health policies are being developed, intersectionality is necessary in action planning.

Author contributions

G.Y.S., R.O.A. , A.T.A., O.J.O., conceptualized the current study. G.Y.S., R.O.A. , A.T.A., O.J.O, ATA. wrote the first draft of the manuscript P.B., E.E.E., M.K., A.N.A., A.A.O., T.N.L.S., H.L.J., A.D.M., E.A.K.,T.T.O., S.C.O and A.L.O. edited and reviewed the manuscript. All authors have read and agreed to the published version of the manuscript.

Funding

Authors declare that no funds, grants, or other support was received for this research.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

This article does not contain any studied with human participants or animals performed by any of the authors.

Informed consent

Not applicable.

Competing interests

The authors declare no competing interests.