https://orcid.org/0000-0001-9552-9529
Figures
Abstract
Background
Neglected tropical diseases (NTDs) affect about 1.7 billion people worldwide, with the highest burden in sub-Saharan Africa. While global initiatives have reduced infection prevalence, the chronic impacts of NTDs, including morbidity, disability, and disfigurement, remain severely neglected, perpetuating poverty, social exclusion, and mental health challenges. This study aimed to identify gaps in care and management for individuals living with chronic NTD-related disabilities and to validate the situational analysis findings through participatory workshops.
Methodology/Principal Findings
A mixed-methods approach was employed, comprising a situational analysis of national policies, healthcare services, and control strategies across the World Health Organization (WHO) African Region, complemented by participatory workshops, including focus group discussions (FGDs) and in-depth interviews (IDIs) with affected individuals and stakeholders, in Zimbabwe and Tanzania. Qualitative data were thematically analysed to capture key challenges, including healthcare access barriers, stigma, and gaps in care and management. The situational analysis revealed critical gaps in chronic NTD care, including lack of comprehensive policies for NTD disability management, fragmented health services, limited access to rehabilitation and mental health support, and where available at all, weak integration of morbidity management into national health systems. Findings from FGDs and IDIs corroborated these findings, highlighting barriers to healthcare access, policy deficiencies, socioeconomic burden, deep-rooted stigma, and psychological distress. Participants emphasised the urgency of integrating chronic care into national health systems, strengthening service delivery, and ensuring financial protection.
Conclusions/Significance
Current NTD programs prioritise infection control and disease elimination while neglecting long-term disability management. To ensure end-to-end health service provision, it is imperative to integrate morbidity management, disability support, psychosocial support, and rehabilitation into existing healthcare frameworks, informed directly by the voices of those affected. Ultimately, by bridging the gaps between policy, healthcare, and community engagement, and mainstreaming NTD morbidity management, we can ensure that individuals affected by NTDs receive comprehensive, long-term support, and that progress in disease control translates into sustained improvements in well-being.
Author summary
Neglected tropical diseases (NTDs) affect about 1.7 billion people globally, with the highest burden in sub-Saharan Africa. While efforts to control infections have achieved important milestones, less attention has been given to the long-term effects of NTDs, such as disability, disfigurement, and mental health conditions, which can persist long after treatment. These long-term consequences often go unrecognised in national health systems, leaving affected individuals to face stigma, poverty, and limited access to care. We reviewed national health policies in the World Health Organisation (WHO) African Region and conducted interviews and focus group discussions with people living with NTD-related chronic morbidity, healthcare workers, and other key stakeholders in Tanzania and Zimbabwe. We identified major gaps in care, including limited access to rehabilitation and mental health services, and poor integration of disability care into routine health services. Participants described facing social exclusion, stigma, and significant financial burdens that compounded the burden of living with diasbility from NTDs. Our study calls for a shift in NTD programmes to go beyond infection control and include long-term support and care. Strengthening health systems to provide rehabilitation, mental health care, and social protection, alongside engaging affected communities to shape inclusive policies and services that address their long-term needs, is essential to improving the long-term well-being.
Citation: Pfavayi LT, Osakunor DNM, Chiombola CE, Mutapi F (2025) Identifying gaps in the care and management of NTD morbidity, disability and disfigurement in Africa. PLoS Negl Trop Dis 19(12): e0013834. https://doi.org/10.1371/journal.pntd.0013834
Editor: Francesca Tamarozzi, IRCCS Sacro Cuore Don Calabria Hospital, ITALY
Received: June 25, 2025; Accepted: December 7, 2025; Published: December 11, 2025
Copyright: © 2025 Pfavayi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript.
Funding: The study received funding from the Academy of Medical Sciences (NSGR1S2\1031)(https://acmedsci.ac.uk/), Scottish Funding Council (https://www.sfc.ac.uk/) and Aspen Global Innovators Programme (Awarded to FM) (https://www.aspenglobalinnovators.org/). LP is funded by Thrasher Research Fund 02195 (https://www.thrasherresearch.org/), and DO is a Royal Society Newton International Fellow NIF\R1\221825 (https://royalsociety.org/grants/newton-international/). The funders had no role in the conception, study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Neglected tropical diseases (NTDs) are a diverse group of 21 disabling, avoidable, and debilitating conditions that continue to affect about 1.7 billion people worldwide [1,2], primarily in impoverished communities in tropical and subtropical regions [3]. Despite their high prevalence, NTDs are classified as “neglected” because they disproportionately impact the poor, and the regions affected have historically received limited attention and resources compared to other global health priorities [4,5].
NTDs are prevalent in vulnerable and marginalised communities where limited access to essential resources like safe water, sanitation, and healthcare exacerbate the burden [3,5]. While global efforts in prevention and control have led to a decline in the number of individuals affected, the chronic manifestations of NTDs, including morbidity, disability, and disfigurement, continue to affect millions, particularly in sub-Saharan Africa [6]. For many, the lifelong effects are not only physically debilitating but also socially isolating, compromising mental well-being, economic stability, and social integration [7].
Chronic NTDs account for an estimated 19 million disability-adjusted life years (DALYs) lost annually [3]. However, this figure likely underestimates their true impact, as it does not fully consider long-term chronic morbidities, the stigma, social exclusion, and the psychological toll that accompany these diseases [8–10]. For instance, in the case of lymphatic filariasis (LF), studies show that when depression is included, the total DALY burden nearly doubles, indicating that previous estimates have significantly underestimated the true impact of the disease [11]. Similarly, for cutaneous leishmaniasis, the burden is substantially higher when major depressive disorder is taken into account [12]. Moreover, DALYs primarily do not account for patient perspectives, chronic complications, as well as shared disabilities in the presence of comorbidities or concurrent infections in NTD-endemic areas [8]; thus, their actual impact on health and quality of life may be significantly higher than often reported.
The World Health Organization (WHO) has emphasised in the 2024 Global report on NTDs that “It is not yet possible to assess the value of this indicator after the launch of the road map as the latest available data refer to 2019” [13], highlighting that multiple limitations affect the tracking of DALYs for NTDs [10]. Some of these limitations include the lack of DALY estimates for some NTDs (e.g., Buruli ulcer, chikungunya, mycetoma) and for others (e.g., dracunculiasis and scabies), a lack of inclusion in the Global Health Estimates (GHE). Moreover, there is need to update methodologies and ensure that DALY estimates by GHE coincide with the latest WHO NTD Road map’s reporting requirements of every 4–5 years [10,13]. Many NTDs, particularly those with visible symptoms, such as LF, onchocerciasis, leprosy, Buruli ulcer, schistosomiasis, and trachoma, cause lifelong disability, disfigurement and pain, exacerbating social and economic hardships [5]. To illustrate this, Fig 1 summarises the five Preventive chemotherapy-targeted NTDs (PC-NTDs), and their associated chronic morbidities, emphasising the long-term health and socioeconomic burdens they impose.
This Figure shows the chronic morbidities associated with Lymphatic filariasis (LF) [14], Onchocerciasis [15], schistosomiasis [16–20], soil-transmitted helminthiases [21] and trachoma [22] as well as their long-term consequences [23]. This figure was produced in PowerPoint.
While Fig 1 is not exhaustive of all NTDs included in this study, it demonstrates how chronic manifestations contribute to long-term health and socioeconomic burdens. For example, 1.2–5.5 million cases of snakebite envenoming have been reported annually, with more than 125,000 deaths and three to four times as many cases resulting in permanent disability or disfigurement [24–27]. In sub-Saharan Africa alone, annual incidence is estimated at 435,000–580,000 cases [28–30]; a regional analysis across 41 African countries reported approximately 1.03 million DALYs associated with snakebite, including 268,471 cases, 12,290 deaths, 14,766 amputations and around 55,332 cases of post-traumatic stress disorder [29,31]. However, the true burden, is likely higher as many incidents occur in rural areas where people affected often first seek treatment from traditional healers rather than formal health facilities, leading to poor documentation and substantial under-reporting in national health systems [29,32–34]. Given this significant but underrepresented burden, and the high snakebite envenoming prevalence in the study areas, there is a need to capture context-specific information to inform integrated NTD management approaches [35,36].
Gaps in NTD care and management
Despite global progress in NTD control, significant challenges remain in managing the chronic sequelae of this group of diseases. Most affected individuals live in remote or rural areas with limited healthcare infrastructure, complicating access to diagnosis, treatment, and rehabilitation services. Additionally, local and national healthcare systems, often strained by other public health demands, are frequently ill-equipped to address the complex, long-term care needs of NTD patients [37–39].
While PC through mass drug administration (MDA) has successfully reduced transmission rates [40], it does not fully address the chronic pathology, disability, stigma, and mental health challenges faced by individuals with chronic NTD-related conditions [41]. It is thus not surprising that as of 2019, the latest NTD-related DALYs data show a global reduction of only 11% between 2015 and 2019, far from the 75% target set to be achieved by 2030 [10,42]. Additionally, issues of equity, autonomy and sustainability have been highlighted as domains with the most pressing ethical concerns in relation to the MDA for NTDs [43]. To help bridge this gap, initiatives such as the WHO’s Minimum Package of Care (MPC) and Morbidity Management and Disability Prevention (MMDP) programs have aimed to improve long-term patient outcomes by providing essential care for conditions such as lymphedema, elephantiasis, and hydrocele [44]. However, the extent of integration of these programs into national health systems remains inconsistent across many African countries; WHO provides toolkits and conducts workshops to support national programs in implementing MMDP services [45,46].
Furthermore, some PC programs to target specific at-risk groups (e.g., school-aged children) while others target the whole community [47,48].While this approach has reduced infection prevalence and morbidity in target populations, other at-risk adults, preschool-aged children, and marginalised groups often remain untreated, creating reservoirs of infection that sustain transmission [49]. These untreated populations not only perpetuate endemicity but also endure chronic infections, leading to severe, long-term pathologies that undermine broader disease elimination goals.
At the community level, support structures are often inadequate or non-existent, leading to further isolation of individuals living with NTD-related disabilities [43,50]. This isolation contributes to poor mental health outcomes, as affected individuals struggle with social stigma, loss of economic productivity, and limited opportunities for education or employment [51,52]. The cumulative effect of NTD-related morbidity, disability, and disfigurement perpetuates cycles of poverty and inequality, limiting the ability of affected individuals to contribute to their communities [53].
The need for a situational analysis
Current NTD control frameworks must move beyond a vertical approach of infection control and morbidity reduction to a holistic and inclusive approach that addresses multiple chronic infections and their associated disabilities. Strengthening health systems to integrate NTD services across the entire patient journey, promoting sustainable surveillance mechanisms, and improving community engagement are crucial to achieving equitable healthcare access. Without such shifts, the burden of chronic NTD-related complications will continue to disproportionately affect neglected populations, reinforcing cycles of poverty and health disparity.
Therefore, understanding the gaps in NTD care and management in endemic areas from both a regional health system perspective and the lived experiences of affected individuals and healthcare providers is crucial. We conducted, a comprehensive situational analysis of the current healthcare services, policies, and existing data in NTD-endemic countries, to identify gaps in the care and management of individuals with chronic NTDs. Through focus group discussions and interviews this research also captures the lived experiences of individuals affected by the debilitating impacts of NTDs, highlighting inequities in healthcare access, and informing strategies for improving long-term support and social inclusion for individuals affected by NTDs. This study aimed to 1) conduct a situational analysis of health service provision for chronic NTD sufferers and identify gaps in care and management across WHO AFRO countries b) Validate situational analysis findings through focus group discussions (FGD) and in-depth interviews (IDIs) in 2 African countries.
Methodology
Study design
This study adopted a qualitative, mixed-methods approach to assess health service provision for chronic NTDs and identify gaps in care, management, and policy. This included 1) Situational analysis: a comprehensive review of healthcare services, policies, and existing data to identify gaps in the care and management of individuals with chronic NTDs in WHO AFRO countries, and 2) Consultative workshops: participatory workshops in Tanzania and Zimbabwe involving FGD, IDIs, and stakeholder presentations to validate the situational analysis findings and incorporate perspectives from NTD-affected individuals, healthcare providers, policymakers, and researchers/ academics. This mixed approach allowed for a comprehensive understanding of current healthcare provisions while integrating first-hand experiences of affected individuals and healthcare providers.
Situational analysis
The situational analysis examined broader regional trends across the WHO AFRO region to map general trends and systemic gaps. Data sources included websites and repositories of the main NTD actors in the WHO African region such as the WHO Regional Office for Africa (WHO AFRO; https://www.afro.who.int), WHO AFRO’s Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN; https://espen.afro.who.int/regions/who-african-region-afro), Uniting to Combat NTDs (https://unitingtocombatntds.org/en/), national NTD master plans (https://espen.afro.who.int/tools-resources/documents) as well as published peer-reviewed literature on chronic NTD-related morbidity, disability, and social impact.
Additional information including data on 1) health service provision, 2) control strategies for the five PC-targeted NTDs (Lymphatic filariasis (LF), Trachoma, Onchocerciasis, Schistosomiasis and Soil transmitted helminthiases (STH)), 3) chronic care and management for the five PC-NTDs 4) chronic care and management for other NTDs outside of the five PC-targeted ones, 5) gaps in chronic care and management, were also extracted from the literature and additional sources.
Consultative workshops
The consultative workshops focused specifically on Tanzania and Zimbabwe and prioritised the four most prevalent NTDs in both countries that also cause the highest prevalence of disability or disfigurement [54–56]. The workshops included FGDs, IDIs and stakeholder presentations to validate and expand on the findings from the situational analysis.
Ethical approval.
Ethical and institutional approval was obtained from the Medical Research Council of Zimbabwe (MRCZ/A/3030) and the National Ethical Review Committee board of Tanzania (NIMR/HQ/R.8a/Vol.IX/3590 and NIMR/HQ/R.8 C/Vol.I/1973). Written, informed consent was obtained from all participants. In the case of the two participating children aged 11 and 13, formal written consent was obtained from their parent/guardian.
Study areas.
Primary data were collected through two participatory workshops held in the two countries of the TIBA partnership (https://tiba-partnership.org). The first workshop took place in Bindura, Zimbabwe (December 2023). Bindura, located in Mashonaland Province in the northeast of Zimbabwe, was selected due to its proximity to NTD-endemic districts, ensuring many affected people could attend the workshop.
The second workshop was held in Zanzibar, Tanzania (March 2024). Zanzibar, an archipelago off the eastern coast of Tanzania, was selected for its accessibility and its known endemicity to lymphatic filariasis and schistosomiasis among other NTDs.
Tanzania has made significant progress towards the elimination of LF and Trachoma, with 89% and 90% of the initially at-risk population, respectively, no longer requiring regular MDA [57]. Although the prevalence of schistosomiasis and STH has declined through school- based MDA conducted for over a decade, persistent transmission remains in some areas [58,59]. Similarly, Zimbabwe has achieved notable reductions in schistosomiasis and STH prevalence through multiple rounds of MDA, though persistent hotspots remain [60]. LF is now reported to be non-endemic in 32 out of the 39 districts previously identified as endemic, indicating a significant decline in endemicity [61]. Trachoma has also markedly improved, with the number of endemic districts dropping from 21 to just 3 in recent years [62]. In both countries, the prevalence of snakebite envenoming is high but remains an underrepresented burden [35,36].
Study Participants and Sampling.
Participants were selected using purposive sampling to include two key groups:
- i. Affected voices, i.e., people living with the conditions or with lived experiences of the conditions associated with NTDs, and
- ii. Various stakeholders involved in implementation of NTD control efforts. This included community health workers, nurses, clinicians, ministry of health policymakers, development partners, researchers from multiple universities, and local media.
Affected individuals were identified through recent programme involvement and community health worker networks, including consultation with the District Medical Officer (DMO), District Environmental Health Officer (DEHO), and District Nursing Officer (DNO). A list of eligible participants was compiled, and individuals were approached at home, provided with study information, and invited to participate. Those who consented were enrolled and interviewed. Stakeholders were invited based on their direct involvement in NTD control and service delivery.
A total of 53 participants took part in the workshop in Zimbabwe, and 37 participated in the workshop in Tanzania. Participant numbers, age ranges and sex distribution by group and country are summarised in Table 1. Affected voices participants had lived with one of four NTDs (trachoma, snakebite envenoming, LF, and schistosomiasis) for approximately 7–20 years and shared first-hand experiences of their chronic manifestations and socio-economic impacts.
Data collection.
Data were collected through IDIs, FGDs, and stakeholder presentations. All sessions were conducted in English, Shona, and Kiswahili, ensuring inclusive participation and accurate data collection.
In-depth interviews (IDIs) and FGDs.
A semi-structured interview guide was developed and pilot tested before data collection commenced. IDIs explored participants’ lived experiences of chronic NTDs, community-level management strategies, and access to health services. Interviews were conducted by teams of two trained facilitators, with one researcher leading the discussion and the second acting as a co-facilitator. The co-facilitator was responsible for taking observational notes, monitoring participant engagement, and providing language interpretation as needed. Interviews lasted between 20 and 30 minutes. FGDs explored shared experiences, perceptions of stigma, barriers to healthcare access, and recommendations for improving NTD-related services. A total of six FGDs, each comprising 8–12 participants, were conducted, with sessions lasting between 60 and 90 minutes.
Stakeholder presentations.
During a three-day workshop in Zimbabwe and a two-day event in Zanzibar, all participants delivered short presentations on their lived experiences or professional experiences with chronic NTDs. These sessions were followed by facilitated discussions to explore key issues in more depth. A designated pair of note-takers, one from each country, was tasked with recording main points during presentations and discussions. These notes complemented the audio recordings and were later used to cross-verify themes during the analysis process.
The aspects reported here were part of a larger programme on amplifying the voices of NTD affected people that involved a series of research studies, workshops and public engagement activities [63,64].
For this study we focused on the participant’s experiences of affected people and their health workers in health services in their communities and countries.
Data analysis.
All sessions were audio-recorded with participants’ consent, transcribed verbatim, and translated into English where necessary. Data were analysed using thematic analysis following an inductive approach, allowing patterns and themes to emerge from the data. MAXQDA (version 24, VERBI Software, Berlin, Germany) was used to support data organisation, coding, and retrieval. The coding process began with open coding; these initial codes were iteratively refined and grouped into broader categories through constant comparison. Emerging codes were reviewed, and final themes were collaboratively agreed upon by the research team. The thematic analysis focused on identifying recurring patterns across participant narratives. This structured yet flexible approach enabled the research team to manage the complexity of the data while preserving the richness of participant voices and minimising researcher bias [65].
Results
Findings from situational analysis
Existing policy.
The situational analysis provided critical insights into the current landscape of health service provision for chronic NTD sufferers across the WHO AFRO region. While countries employ a variety of standard control measures, the integration of care and management for chronic NTD manifestations remains limited. Fig 2 shows the status of national NTD masterplans and policies for managing the chronic manifestations of NTDs across African countries. Using data from both the Global NTD Annual Reporting Form (GNARF) and from national NTD Master Plans, findings showed that only a few countries have strategies in place to address the chronic long-term management of individuals affected by NTDs. Significant gaps persist in policies, healthcare service delivery, and strategically planned long-term management strategies, highlighting the ongoing challenges in ensuring comprehensive and sustained care for chronic NTD sufferers. These findings also highlight inconsistencies in policy frameworks across the continent, emphasising the need for strengthened integration of chronic NTD management into national plans.
Data visualised using the Datawrapper platform: (base layer of the map: https://www.datawrapper.de/_/KFzxy/) b) Data from National NTD Master Plans (https://espen.afro.who.int/tools-resources/documents); countries with NTD masterplans and whether they include policies for managing chronic NTD manifestations. Base layer of the map: https://www.datawrapper.de/_/SGrvz/?v=6. Terms of Use available at: https://www.datawrapper.de/terms.
Standard NTD control approaches.
Most countries rely on a combination of standardised control strategies to manage NTDs, tailored to the specific disease burden in their regions. These include: Preventative chemotherapy (PC), Case Identification and Management, Water, Sanitation, and Hygiene (WASH), Vector Control [66] and Surgery, Antibiotics, Facial cleanliness, and Environmental improvements (SAFE; strategy particularly in trachoma control). While these approaches have been successful in reducing disease prevalence and transmission rates, they largely focus on short-term outcomes and disease elimination, often neglecting the long-term disabilities and chronic conditions that persist after initial treatment.
Status of chronic NTD management integration into health systems.
The situational analysis highlighted significant variability in the availability of integrated care and management strategies for chronic NTD manifestations across the WHO AFRO region, with only a few countries having strategies in place for integrated care and management [67–85]. As shown in Fig 3, rehabilitation is the most widely implemented strategy, with ten countries providing structured care, particularly for leprosy. However, other critical interventions, such as psychosocial support and socio-professional reintegration, remain largely absent for most NTD-related disabilities, particularly for conditions like lymphatic filariasis, onchocerciasis, [13] and other PC-NTDs. Additionally, mental health and social support interventions which are essential to reduce the social stigma associated with NTDs need to be scaled up [13].
The WHO global report on neglected tropical diseases 2024 [13] highlights that while progress has been made in integrating NTD services into national health plans (28 countries) and providing guidance for managing NTD-related disabilities (19 countries), these efforts remain inconsistent across regions. Implementation of these strategies is inconsistent within countries and remains limited in scale due to financial constraints. While some treatments are provided free of charge, long waiting lists prevent timely access. In most of these countries, integrated care is being implemented but not at full scale, with services available only in select regions or counties, leaving significant gaps in coverage [77,82]. These findings highlight the fragmented and inconsistent approach to chronic NTD care, emphasising the urgent need for broader, standardised, and integrated management strategies across endemic regions.
Policy gaps and deficiencies in healthcare services.
Despite global efforts towards integrated healthcare for NTDs, policy implementation remains inconsistent and inadequate. The WHO NTD 2024 report indicates that only 13 out of 49 African countries have established guidelines or policies that address over 75% of the prevalent disabilities associated with NTDs [13]. Notably, only six of the 184 countries considered endemic for at least one NTD had interventions included in national packages of essential services and were budgeted for [13], demonstrating a major gap in policy alignment and integration. While national NTD master plans exist for some countries, their implementation is often limited by weak country ownership, insufficient coordination, inefficient resource use, and slow adoption of new interventions [13].
This policy gap translates into significant unmet needs within healthcare systems, where resources for managing NTD disabilities, such as diagnostics, mental health support, and rehabilitative care, are often lacking [86]. The absence of these essential services exacerbates neglect, preventing individuals with chronic NTDs and related disabilities who require long-term management and support from being fully integrated into mainstream healthcare systems and perpetuating inequalities in access to essential health services.
In addition to policy gaps, systemic barriers continue to hinder the effective management of chronic NTDs. Key challenges include limited diagnostic resources, fragmented policies, and inadequate access to specialised care, leaving many individuals without essential support. Fig 4 provides a summary of the policy gaps identified from policy guidelines across NTD-endemic countries [67–85,87–108].
Social and economic impact.
The economic impact of chronic NTDs remains a major challenge, exacerbating poverty and limiting financial resilience among affected populations. Many individuals affected by NTDs experience catastrophic health expenditures, particularly in resource-limited settings where healthcare services are not covered by insurance schemes. In 2021, an estimated 12.6% of the global population at risk of NTDs encountered catastrophic health spending (i.e., health expenditure exceeding 10%–25% of total household expenditure) allocating a significant portion of their income to treatment costs [13]. Despite efforts to improve financial protection, many endemic regions lack mechanisms at the country level to track household health expenditures, making it difficult to assess the full extent of economic hardship [13]. Therefore, NTD-related disabilities can contribute to long-term unemployment and reduced economic productivity, particularly for individuals with lymphatic filariasis, leprosy, and onchocerciasis, who suffer from mobility restrictions and social stigma [9,86].
Findings from focus group discussions and in-depth interviews
General observations.
The findings from the FGDs and interviews strongly aligned with the situational analysis, further amplifying the identified gaps in chronic NTD care and management. Participants’ first-hand experiences, along with insights from healthcare workers, highlighted persistent challenges, including barriers to healthcare access, policy deficiencies, socioeconomic burden, deep-rooted stigma, and the psychological distress faced by individuals living with these conditions. Their testimonies underscored the urgent need for comprehensive, patient-centred strategies to address these issues.
Access to care and treatment.
Participants highlighted critical deficiencies in healthcare service provision, particularly the limited availability of medications, inadequate diagnostic tools, and financial constraints that prevent timely and effective treatment. Particularly, healthcare workers also pointed out the shortage of essential diagnostic tools, limiting their ability to offer effective treatment.
“Our clinics lack the necessary medications for some of these diseases. We need both medications and comprehensive treatments to effectively help those suffering from these conditions” (41-year-old female; healthcare worker; FGD, Zimbabwe).
“Diagnostic tools for diseases like Malaria and HIV are readily available in clinics; the same should be done for LF” (26-year-old female; LF; IDI, Zimbabwe).
Additionally, participants pointed out structural inefficiencies within the healthcare system, mirroring the policy gaps and healthcare fragmentation highlighted in the situational analysis.
“Developing a chart for diagnostic criteria and clinical presentations could help clinicians order the right investigations by linking symptoms to likely conditions” (healthcare worker; Tanzania).
“The fact that diseases are called neglected diseases, highlights that they should be highly considered” (40-year-old male: Schistosomiasis; FGD: Tanzania).
Healthcare workers also pointed out that late presentation of cases due to financial difficulties and lack of awareness further complicates effective treatment.
“Most individuals only go to the hospital/clinic at a later stage when their condition has progressed, often due to lack of funds” (29-year-old female; healthcare worker; FGD, Zimbabwe).
Healthcare workers recommended community-based interventions to improve early identification and access to treatment.
“Our NTD control program should be community-based, encompassing the entire population. This approach ensures we catch the little ones early enough to intervene and prevent the progression of pathology from infection” (47-year-old healthcare worker; FGD; Zimbabwe).
Need for a stronger health system support.
Policy weaknesses and lack of funding were consistently raised as barriers to NTD management. Participants called for stronger government action, clearer treatment pathways, and increased financial allocation to ensure sustainable NTD care.
“Government should increase budget allocation for management of NTDs” (57-year-old male; District environmental health officer; FGD, Zimbabwe).
Additionally, the need for clearer treatment protocols and referral pathways was emphasised.
“There is a need to provide clear treatment plans and clear referral pathways so that individuals do not go around in a maze trying to get help” (Academic/Researcher; FGD, Tanzania).
Stigma and social exclusion.
Stigma and discrimination were recurring themes, with affected individuals expressing frustration over being marginalised in their communities. This provided a deeper context into the lived realities of exclusion and discrimination highlighted by the situational analysis.
“People in the village sometimes laugh at me, but those who understand my condition offer me comfort and support” (26-year-old female; LF; IDI, Zimbabwe).
“People often dismiss us in discussions, viewing us as useless because we don’t have children” (32-year-old female; Schistosomiasis; FGD; Zimbabwe).
Others highlighted how stigma extended to employment and social opportunities, limiting their ability to contribute to society.
“I have always dreamed of proving my worth to society and achieving something meaningful. However, due to our conditions, we are neglected, and I’ve never truly had the chance to show what I can do or fully enjoy being part of this society” (22-year-old male; LF; IDI; Zimbabwe).
Economic burden and financial hardship.
Participants also highlighted the financial toll of NTDs, including lost income, reduced ability to work, and high out-of-pocket costs. Many participants reported that NTD-related disabilities severely impact their ability to work, leading to financial instability and dependency.
“I’m not able to carry out most activities that help raise funds for my school-going children. Before the illness, I was farming, but ever since I got sick, I don’t have much energy to do anything, including carrying a bucket of water” (41-year-old female; Schistosomiasis; IDI; Tanzania).
“National Health Insurance Fund should be accessible for NTD patients who find it difficult to afford healthcare. I was hospitalised for three months, an experience that was not only expensive but also kept me out of work” (42-year-old male; LF; IDI, Tanzania).
“Ever since I was bitten by a snake there is nothing, I am able to do. I am always at home- I wish I could work and be productive like others” (39-year-old female; snake envenoming; IDI; Zimbabwe).
Reproductive health consequences.
The impact of NTDs on reproductive health emerged as a critical but often overlooked issue. Some participants shared their experiences with infertility linked to untreated infections.
“For years after my marriage, I was not able to conceive. It wasn’t until I participated in a bilharzia research project where they found bilharzia eggs in my uterus. I was treated, and later on, I was able to conceive. Now, I have two children” (57-year-old female; Schistosomiasis; IDI; Zimbabwe).
Discussion
This study identifies the persistent gaps in the care and management of chronic NTD-related morbidity and disability in endemic regions. As of May 2025, 56 countries [109] have eliminated at least one NTD. This is tremendous progress in the control of NTDs. However, this progress will not be felt uniformly across the NTD disease profile. This study highlights the inadequacies of healthcare systems in providing long-term support for individuals who have been failed by prevention and treatment and are now consequently living with chronic manifestations of NTDs. Our situational analysis across WHO AFRO countries, all NTD-endemic, revealed deficiencies in policy and policy implementation, fragmented healthcare services, and systemic underfunding, as well as social and economic impact on affected individuals. Our ground-truthing interviews with individuals affected by chronic NTDs in Zimbabwe and Tanzania, along with primary and tertiary healthcare workers and Ministry of Health policymakers, confirmed these gaps in care. The testimonies shared by the participants illustrated not only the persistent barriers to care but also the deep-rooted stigma and psychological distress experienced by those living with these conditions. This systemic neglect perpetuates cycles of poverty, social stigma, and psychological distress, leaving millions of affected individuals without access to comprehensive care and support.
Health system gaps and policy deficiencies.
A key finding from our study was the inconsistent implementation of NTD policies, particularly regarding chronic morbidity management. While some countries have developed national NTD master plans, their execution remains fragmented and underfunded. The weak integration of morbidity management and disability prevention (MMDP) programs further exacerbates the issue, leaving many individuals without access to rehabilitative care, specialised treatment, or mental health support.
Healthcare workers in our study confirmed that diagnostic limitations, lack of referral pathways, and shortages of essential medicines severely hinder effective NTD management. There is evidence that most NTD-endemic regions lack point-of-care diagnostics and that healthcare professionals are often not equipped to recognise and manage chronic NTD-related disabilities [110,111]. For instance, while diagnostic tools for diseases like HIV and malaria are widely available and integrated into primary healthcare systems, point-of-care diagnostics for chronic NTD conditions such as lymphatic filariasis, schistosomiasis, and snakebite envenoming remain scarce [110]. The absence of standardised treatment guidelines and referral mechanisms further contributes to delays in care, worsening disease outcomes.
A major limitation in addressing chronic NTD-related disabilities is the lack of integration within national health systems [13]. Current morbidity management approaches operate in disease-specific silos, prioritising short-term interventions over long-term patient-centred care. This has the potential to undermine the sustainability of NTD programs. A few countries have set positive examples of sustainability for national NTD programmes. For example, as commitment to achieving universal health coverage, Ghana has developed a comprehensive costing framework to guide the inclusion of NTD services within the national health insurance scheme (NHIS) benefits packages, and revised all NTD management protocols to serve as the basis for the revision of Ghana’s Essential Medicines List and NHIS’ benefits package [42]. To reduce dependence on donor support and boost the sustainability journey towards achieving the WHO road map 2030 targets, Uganda has initiated domestic resource mobilisation, with three districts allocating budgets for NTDs, and plans to increase domestic financing of the total NTD budget from 12% in 2020 to 30% by 2025 [42].
Another critical gap that is key to improving NTD care and management is the lack of education and awareness among both affected individuals and healthcare providers. Significant lack of understanding about NTDs often leads to delays in seeking treatment, and in recognition and diagnosis of NTDs by healthcare workers. As a result, many individuals develop preventable complications that further impair mobility, productivity, and social participation. By providing culturally appropriate health education, this knowledge gap can be bridged. For example, educational campaigns that emphasise the role of adequate WASH practices, as well as preventive medications can significantly reduce diseases such as schistosomiasis and soil-transmitted helminthiasis [112]. Additionally, self-care programs when implemented have been proven to significantly lower costs of care, reduced disability status, and improved quality of life scores [113]. Additionally, community-led peer support networks, as demonstrated with leprosy control and elimination programs [114], should be expanded to other NTDs to foster knowledge-sharing and stigma reduction.
Social and Economic Consequences of Chronic NTDs.
The socio-economic impact of NTDs remains profound. Chronic NTD-related disabilities disproportionately affect low-income households, trapping affected individuals in cycles of poverty and social exclusion. Participants reported high health expenditures, particularly where healthcare services are not covered by insurance, in line with recent WHO estimates suggests that 12.6% of the global population at risk of NTDs incurs catastrophic health spending [13].
Chronic complications such as mobility impairments, organ damage, and vision loss often lead to permanent disability, limiting individuals’ ability to work, pursue education, or participate in social activities [86]. However, beyond clinical management, rehabilitation services for PC-NTDs are often lacking [115]; the absence of physical therapy, assistive devices, and vocational rehabilitation programs forces many affected individuals into dependence on family members or community support, further deepening economic hardship and social isolation. Integrating disability support programs into existing healthcare structures could significantly enhance functional independence and quality of life [115].
The psychosocial impact of NTD-related disabilities is another critical yet neglected area. Many affected individuals report experiencing stigma, discrimination, and exclusion, particularly those with visible disabilities or mobility impairments [7,51]. Lymphoedema or advanced stages of lymphoedema from lymphatic filariasis, visible skin lesions from leprosy, or blindness from onchocerciasis can lead to ostracization, discrimination, and loss of social status within their communities [116,117]. These experiences are not merely anecdotal; they reflect a broader societal pattern wherein individuals with NTD-related disabilities are marginalised and treated as burdens. Participants in our study recounted instances of being mocked, shunned, and excluded from social and economic activities, leading to profound psychological distress. Yet, mental health services remain largely absent from NTD programs across Africa [51]. Integrating psychological support through counselling, peer-led support groups, and community sensitisation campaigns would help mitigate the psychosocial burden of these diseases and promote greater social inclusion [41,118–120].
Proposed solutions and way forward
To address the critical gaps identified in this study, we propose a multi-faceted, integrated approach that enhances policy implementation, strengthens healthcare systems, and prioritises community-based interventions.
Strengthening policy and health system integration.
National NTD Master Plans should include chronic morbidity management of NTDs. Countries must update their NTD strategies to explicitly incorporate guidelines for managing long-term NTD-related disabilities, including mental health services, rehabilitation programs, and disability-inclusive social protection measures. Governments should also increase domestic health budgets to reduce reliance on external donors and ensure sustainable financing for chronic NTD management. Furthermore, essential NTD services, including treatment for chronic disabilities, should be incorporated into national health insurance schemes to reduce financial barriers to care [14,15].
Integrated management of NTDs.
Transitioning from vertical, disease-specific approaches to integrated, person-centred strategies is essential for effectively managing NTDs. Evidence shows that integrating NTD services into existing health systems can improve efficiency and sustainability. For example, incorporating NTD control programs into well-established public health initiatives, such as those targeting HIV/AIDS, malaria, maternal and child health, and WASH, can enhance resource utilisation and service delivery and is more sustainable [121]. The Liberian NTD programme exemplifies this shift by developing an ‘Integrated Case Management Strategy’ that addresses multiple NTDs and their associated morbidities, such as Buruli ulcer, lymphoedema, hydrocele, leprosy, and yaws [122].
Enhancing healthcare service delivery.
Building capacity for healthcare workers through expanding NTD-focused training programs can equip health workers with the necessary skills to diagnose and manage chronic conditions more effectively. Alongside this, scaling up affordable, point-of-care diagnostic tools for NTDs will enable earlier detection and treatment, particularly in underserved communities. To ensure comprehensive care, it is also essential that government and non-governmental organisations invest in community-based rehabilitation programs and mental health services to support individuals living with chronic disabilities.
Addressing social and economic barriers.
Addressing the social and economic barriers linked to NTDs requires a multi-faceted approach. Public awareness campaigns should focus on reducing stigma and misconceptions surrounding NTDs, particularly through school-based and media-driven interventions. In parallel, economic empowerment initiatives including providing livelihood opportunities, vocational training, and financial support programs for individuals affected by NTD-related disabilities can help mitigate economic hardships. Additionally, integrating reproductive health into NTD programs is critical, particularly through improved screening and treatment for conditions such as Female genital schistosomiasis (FGS), which remain underdiagnosed and neglected within health systems.
Call to action from affected voices and stakeholders.
During the FGDs, workshop participants, including affected individuals, health workers, policymakers, ministries of health, and development partners, formulated five key calls to action aimed at improving the management of chronic NTD-related disabilities. These calls emphasise the need for policy recommendations, community advocacy, innovation, systemic integration, and community engagement to ensure inclusive and sustainable interventions for NTDs. Key priorities include developing national guidelines for chronic NTD care, improving healthcare accessibility, enhancing cross-sector collaboration, and strengthening community-driven advocacy efforts. Additionally, the participants highlighted the importance of inclusive decision-making, urging affected individuals to be directly involved in shaping policies that impact their health and well-being. A detailed description of this call to action, along with actionable recommendations to achieve these, will be published separately, providing a comprehensive roadmap to guide stakeholders in implementing these crucial interventions.
Conclusions
This study highlights the urgent need for a more holistic and integrated approach to NTD management, particularly for chronic disabilities that persist long after initial treatment. Strengthening policy implementation, expanding healthcare infrastructure, and addressing socio-economic barriers are essential steps toward improving the quality of life for individuals living with chronic NTDs. A key priority is ensuring that morbidity management becomes a core component of NTD control programs, breaking the cycle of disability, poverty, and social exclusion.
By adopting patient-centred strategies that incorporate medical, psychological, and social support, NTD-endemic countries can move closer to achieving the WHO NTD Roadmap 2021–2030 [40] and the Sustainable Development Goals (SDGs), particularly Goal 3 (Ensure healthy lives and promote well-being for all at all ages).
Ultimately, by bridging the gaps between policy, healthcare, and community engagement, and prioritising NTD morbidity management, we can ensure that individuals affected by NTDs receive comprehensive, long-term support, and that progress in disease control translates into sustained improvements in well-being.
Acknowledgments
We thank all the workshop participants as well as the research teams from the Universities of Edinburgh and Zimbabwe, National Institute for Medical Research, Tanzania, Catholic University of Health, and Allied Sciences, Mwanza, Tanzania and Ibn Sina University, Sudan. We also thank all the members of the Parasite Immunoepidemiology Group at the University of Edinburgh for their valuable comments in preparing this manuscript.
References
- 1. Uniting to Combat NTDs. Disease Directory. https://unitingtocombatntds.org/en/neglected-tropical-diseases/disease-directory/ 2025 October 30.
- 2. Uniting to Combat NTDs. Powering our partnership to fight all 20 neglected tropical diseases. https://unitingtocombatntds.org/en/news-and-views/powering-our-partnership-to-fight-all-20-neglected-tropical-diseases 2025 October 30.
- 3. World Health Organization. Neglected tropical diseases. https://www.who.int/health-topics/neglected-tropical-diseases#tab=tab_12025 March 18.
- 4. Hotez P, Ottesen E, Fenwick A, Molyneux D. The neglected tropical diseases: the ancient afflictions of stigma and poverty and the prospects for their control and elimination. Adv Exp Med Biol. 2006;582:23–33. pmid:16802616
- 5. Ca J, Kumar P VB, Kandi V, N G, K S, Dharshini D, et al. Neglected Tropical Diseases: A Comprehensive Review. Cureus. 2024;16(2):e53933. pmid:38468991
- 6. Mitra AK, Mawson AR. Neglected Tropical Diseases: Epidemiology and Global Burden. Trop Med Infect Dis. 2017;2(3):36. pmid:30270893
- 7. Hofstraat K, van Brakel WH. Social stigma towards neglected tropical diseases: a systematic review. Int Health. 2016;8 Suppl 1:i53-70. pmid:26940310
- 8. King CH, Bertino A-M. Asymmetries of poverty: why global burden of disease valuations underestimate the burden of neglected tropical diseases. PLoS Negl Trop Dis. 2008;2(3):e209. pmid:18365036
- 9. King CH, Dickman K, Tisch DJ. Reassessment of the cost of chronic helmintic infection: a meta-analysis of disability-related outcomes in endemic schistosomiasis. Lancet. 2005;365(9470):1561–9. pmid:15866310
- 10. Abruzzi A, Fried B. Coinfection of Schistosoma (Trematoda) with bacteria, protozoa and helminths. Adv Parasitol. 2011;77:1–85. pmid:22137582
- 11. Ton TGN, Mackenzie C, Molyneux DH. The burden of mental health in lymphatic filariasis. Infect Dis Poverty. 2015;4:34. pmid:26229599
- 12. Bailey F, Mondragon-Shem K, Haines LR, Olabi A, Alorfi A, Ruiz-Postigo JA, et al. Cutaneous leishmaniasis and co-morbid major depressive disorder: A systematic review with burden estimates. PLoS Negl Trop Dis. 2019;13(2):e0007092. pmid:30802261
- 13.
World Health Organization. Global report on neglected tropical diseases 2024. Geneva: World Health Organization. 2024.
- 14. Taylor MJ, Hoerauf A, Bockarie M. Lymphatic filariasis and onchocerciasis. Lancet. 2010;376(9747):1175–85. pmid:20739055
- 15. Van Cutsem G, Siewe Fodjo JN, Hadermann A, Amaral L-J, Trevisan C, Pion S, et al. Onchocerciasis-associated epilepsy: Charting a path forward. Seizure. 2024;:S1059-1311(24)00123-7. pmid:38677953
- 16. Bustinduy AL, Randriansolo B, Sturt AS, Kayuni SA, Leustcher PDC, Webster BL, et al. An update on female and male genital schistosomiasis and a call to integrate efforts to escalate diagnosis, treatment and awareness in endemic and non-endemic settings: The time is now. Adv Parasitol. 2022;115:1–44. pmid:35249661
- 17. McManus DP, Dunne DW, Sacko M, Utzinger J, Vennervald BJ, Zhou X-N. Schistosomiasis. Nat Rev Dis Primers. 2018;4(1):13. pmid:30093684
- 18. Barsoum RS, Esmat G, El-Baz T. Human schistosomiasis: clinical perspective: review. J Adv Res. 2013;4(5):433–44. pmid:25685450
- 19. Osakunor DNM, Woolhouse MEJ, Mutapi F. Paediatric schistosomiasis: What we know and what we need to know. PLoS Negl Trop Dis. 2018;12(2):e0006144. pmid:29420537
- 20. Roure S, Vallès X, Pérez-Quílez O, López-Muñoz I, Valerio L, Soldevila L, et al. Morbidity burden of imported chronic schistosomiasis among West African migrants. Journal of Infection. 2024;89(4).
- 21. Pabalan N, Singian E, Tabangay L, Jarjanazi H, Boivin MJ, Ezeamama AE. Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: A systematic review and meta-analysis. PLoS Negl Trop Dis. 2018;12(1):e0005523. pmid:29329288
- 22. Solomon AW, Burton MJ, Gower EW, Harding-Esch EM, Oldenburg CE, Taylor HR, et al. Trachoma. Nat Rev Dis Primers. 2022;8(1):32. pmid:35618795
- 23. Kuper H. Neglected tropical diseases and disability-what is the link?. Trans R Soc Trop Med Hyg. 2019;113(12):839–44. pmid:30892653
- 24. Chippaux J-P. Snakebite envenomation turns again into a neglected tropical disease!. J Venom Anim Toxins Incl Trop Dis. 2017;23:38. pmid:28804495
- 25. The Lancet. Snakebite-emerging from the shadows of neglect. Lancet. 2019;393(10187):2175. pmid:31162065
- 26. Berg P, Theart F, van Driel M, Saaiman EL, Mavoungou L-B. Snakebite envenoming in Africa remains widely neglected and demands multidisciplinary attention. Nat Commun. 2024;15(1):9598. pmid:39505859
- 27. Afroz A, Siddiquea BN, Chowdhury HA, Jackson TN, Watt AD. Snakebite envenoming: A systematic review and meta-analysis of global morbidity and mortality. PLoS Negl Trop Dis. 2024;18(4):e0012080. pmid:38574167
- 28. Francis MF, Vianney SJ-M, Heitz-Tokpa K, Kreppel K. Risks of snakebite and challenges to seeking and providing treatment for agro-pastoral communities in Tanzania. PLoS One. 2023;18(2):e0280836. pmid:36763599
- 29. Zacharia A, Kinabo C, Omary H, Mustafa U-K, Athuman Y, Joseph M, et al. Snakebite incidence, knowledge and practices among rural subsistence farmers in Pwani Region, Tanzania: a cross-sectional study. BMJ Public Health. 2025;3(2):e002407. pmid:40969860
- 30. Chippaux J-P, Massougbodji A, Habib AG. The WHO strategy for prevention and control of snakebite envenoming: a sub-Saharan Africa plan. SciELO Brasil. 2019;:e20190083.
- 31. Halilu S, Iliyasu G, Hamza M, Chippaux J-P, Kuznik A, Habib AG. Snakebite burden in Sub-Saharan Africa: estimates from 41 countries. Toxicon. 2019;159:1–4. pmid:30594637
- 32. Iddi S, Justin J, Hamasaki K, Konje ET, Kongola GW. Assessment of snakebite management practices at Meserani Juu in Monduli District, Northern Tanzania. PLoS One. 2022;17(12):e0278940. pmid:36548357
- 33. Abubakar SB, Habib AG, Mathew J. Amputation and disability following snakebite in Nigeria. Trop Doct. 2010;40(2):114–6. pmid:20305111
- 34.
Tagwirei D, Nhachi C, Ball D. Snakebite admissions in Zimbabwe: pattern, clinical presentation and management. 2011.
- 35. Margono F, Outwater AH, Lowery Wilson M, Howell KM, Bärnighausen T. Snakebite Treatment in Tanzania: Identifying Gaps in Community Practices and Hospital Resources. Int J Environ Res Public Health. 2022;19(8):4701. pmid:35457571
- 36. Pomerai WP, Gundidza BM. Epidemiology of envenomings in Zimbabwe 2022 to 2025. Clin Rev Cases. 2025;7(1):1–3.
- 37.
Nonvignon J, Baatiema L, da Costa Vroom FB, Mensah E, Gyapong JO. The role of health systems in the control of neglected tropical diseases in Sub-Saharan Africa. Neglected Tropical Diseases-Sub-Saharan Africa. Springer. 2024. p. 523–48.
- 38. Sun N, Amon JJ. Addressing Inequity: Neglected Tropical Diseases and Human Rights. Health Hum Rights. 2018;20(1):11–25. pmid:30008549
- 39. Macpherson EE, Adams ER, Bockarie MJ, Hollingsworth TD, Kelly-Hope LA, Lehane M, et al. Mass Drug Administration and beyond: how can we strengthen health systems to deliver complex interventions to eliminate neglected tropical diseases?. BMC Proc. 2015;9(Suppl 10):S7. pmid:28281705
- 40.
World Health Organization. Ending the neglect to attain the sustainable development goals: a rationale for continued investment in tackling neglected tropical diseases 2021–2030. World Health Organization. 2022.
- 41. Koschorke M, Al-Haboubi YH, Tseng P-C, Semrau M, Eaton J. Mental health, stigma, and neglected tropical diseases: A review and systematic mapping of the evidence. Front Trop Dis. 2022;3.
- 42. World Health Organization. Global health estimates: life expectancy and leading cause of death and disability. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates. 2023.
- 43. Hoefle-Bénard J, Salloch S. Mass drug administration for neglected tropical disease control and elimination: a systematic review of ethical reasons. BMJ Glob Health. 2024;9(3):e013439. pmid:38485140
- 44.
World Health Organization. Managing morbidity and preventing disability in the global programme to eliminate lymphatic filariasis: WHO position statement. 2011.
- 45. World Health Organization. Building capacity of national programmes to implement WHO recommended strategies. 2025. https://www.who.int/activities/building-capacity-of-national-programmes-to-implement-who-recommended-strategies
- 46. World Health Organization. Morbidity management and disability prevention (MMDP). https://www.who.int/teams/control-of-neglected-tropical-diseases/interventions/strategies/Innovative-and-intensified-disease-management/morbidity-management-and-disability-prevention. 2025. 2025 March 28.
- 47. Turner HC, Stolk WA, Solomon AW, King JD, Montresor A, Molyneux DH, et al. Are current preventive chemotherapy strategies for controlling and eliminating neglected tropical diseases cost-effective?. BMJ Glob Health. 2021;6(8):e005456. pmid:34385158
- 48.
Crompton DWT. Preventive chemotherapy in human helminthiasis: coordinated use of anthelminthic drugs in control interventions: a manual for health professionals and programme managers. World Health Organization. 2006.
- 49.
World Health Organization. Towards universal coverage for preventive chemotherapy for neglected tropical diseases: guidance for assessing “who is being left behind and why”: working draft for further piloting during 2018-2019. 2017.
- 50. Dean L, Ozano K, Adekeye O, Dixon R, Fung EG, Gyapong M, et al. Neglected Tropical Diseases as a “litmus test” for Universal Health Coverage? Understanding who is left behind and why in Mass Drug Administration: Lessons from four country contexts. PLoS Negl Trop Dis. 2019;13(11):e0007847. pmid:31751336
- 51. Kuper H. Disability, mental health, stigma and discrimination and neglected tropical diseases. Trans R Soc Trop Med Hyg. 2021;115(2):145–6. pmid:33313930
- 52. Makin S. Mental health: The invisible effects of neglected tropical diseases. Nature. 2023;:10.1038/d41586-023-02973-z. pmid:37828213
- 53. Samuels F, Pose RR. Why neglected tropical diseases matter in reducing poverty. JSTOR. 2022.
- 54. Expanded Special Project for the Elimination of Neglected Tropical Diseases (ESPEN). https://espen.afro.who.int/maps-data/countries/tanzania-mainland#overview--introduction 2025 October 30.
- 55. Expanded Special Project for the Elimination of Neglected Tropical Diseases (ESPEN). https://espen.afro.who.int/maps-data/countries/zimbabwe#overview--introduction 2025 October 30.
- 56. Expanded Special Project for the Elimination of Neglected Tropical Diseases (ESPEN). https://espen.afro.who.int/maps-data/countries/tanzania-zanzibar#overview--introduction 2025 October 30.
- 57. Tanzania’s Innovative Fight Against Neglected Tropical Diseases. https://unitingtocombatntds.org/en/news-and-views/tanzanias-innovative-fight-against-ntds/ 2025 November 15.
- 58. Mazigo HD, Uisso C, Kazyoba P, Nshala A, Mwingira UJ. Prevalence, infection intensity and geographical distribution of schistosomiasis among pre-school and school aged children in villages surrounding Lake Nyasa, Tanzania. Sci Rep. 2021;11(1):295. pmid:33432079
- 59. Mbugi NO, Laizer H, Chacha M, Mbega E. Prevalence of human schistosomiasis in various regions of Tanzania Mainland and Zanzibar: A systematic review and meta-analysis of studies conducted for the past ten years (2013-2023). PLoS Negl Trop Dis. 2024;18(9):e0012462. pmid:39250468
- 60. Mduluza T, Jones C, Osakunor DNM, Lim R, Kuebel JK, Phiri I, et al. Six rounds of annual praziquantel treatment during a national helminth control program significantly reduced schistosome infection and morbidity levels in a cohort of schoolchildren in Zimbabwe. PLoS Negl Trop Dis. 2020;14(6):e0008388. pmid:32569278
- 61. Midzi N, Mutsaka-Makuvaza MJ, Phiri I, Palatio K, Bakajika D, Zouré HM, et al. Shrinking the lymphatic filariasis map of Zimbabwe: Reassessing the population requiring treatment through confirmatory mapping. Int J Infect Dis. 2025;152:107791. pmid:39880359
- 62. Sightsavers. Three years closer to banishing trachoma in Zimbabwe: Will you become part of the journey of eliminating trachoma in Zimbabwe?. https://www.sightsavers.org/appeals/zimbabwe-trachoma-elimination/. 2025 November 8.
- 63. Tackling Infections to Benefit Africa (TIBA) Partnership. World NTD Day 2025: Amplifying Affected Voices Highlights. https://tiba-partnership.org/news/world-ntd-day-2025-amplifying-affected-voices-highlights. 2025 April 15.
- 64. World NTD Day 2025: A Powerful Call to Unite, Act, and Eliminate Neglected Tropical Diseases. Uniting to Combat Neglected Tropical Diseases. https://unitingtocombatntds.org/en/news-and-views/world-neglected-tropical-diseases-day-2025/ 2025 April 15.
- 65. Sinkovics RR, Alfoldi EA. Progressive Focusing and Trustworthiness in Qualitative Research. Manag Int Rev. 2012;52(6):817–45.
- 66. World Health Organization. The five public health strategic interventions to prevent, control, eliminate and eradicate NTDs. https://www.who.int/teams/control-of-neglected-tropical-diseases/interventions/strategies. 2025 April 15.
- 67.
Ministére de santé B. Cadre programatique du plan quinquennal de lutte contre les maladies tropicales négligées 2023-2027. Bénin: Ministére de santé. 2023.
- 68.
Ministere de la sante BF. Plan strategique de lutte contre les maladies tropicales negligees 2016-2020. Burkina Faso: Ministere de la sante. 2016.
- 69.
Ministre de la Santé C. Plan directeur de lutte contre les maladies tropicales négligées (MTN) 2016-2020. Chad: Ministère de la Santé. 2016.
- 70.
Ministre de la Santé C. Plan cadre national sur les maladies tropicales négligées (MTN). Comores: Ministre de la Santé. 2016.
- 71.
Ministry of Health Eritrea. Eritrea National Neglected Tropical Diseases Master Plan 2022 - 2026.
- 72.
Ministry of Health of the Federal Democratic Republic of Ethiopia. The Third National Neglected Tropical Diseases Strategic Plan 2021-2025 (2013/14 – 2018/19 E.C.). Ministry of Health. 2021.
- 73.
Ghana Health Service. Ghana NTD Master Plan 2021 - 2025.
- 74.
Ministère de la Santé - Guinea. Plan directeur de lutte contre les maladies tropicales négligées en Guinée (2017-2020). Ministère de la Santé, Direction Nationale de la Prévention et de la Santé Communautaire. 2017.
- 75.
Ministério da saude publica G-B. Plan directeur de lutte contre les maladies tropicales négligées en Guinée Bissau (2014 – 2020). Ministério da saude publica, Direcçao geral da saude publica. 2014.
- 76.
Ministry of Health Kenya. Kenya National Master Plan for the Elimination of Neglected Tropical Diseases, 2023 - 2027. Nairobi: Ministry of Health, Division of Vector Borne and Neglected Tropical Diseases. 2022.
- 77.
Ministry of Health Liberia. Master Plan for Neglected Tropical Diseases. Ministry of Health, The Republic of Liberia. 2023.
- 78.
Ministère de la Santé Publique Madagascar. Plan directeur de lutte contre les maladies tropicales négligées (MTN) 2023-2027. Ministère de la Santé Publique, Madagascar. 2023.
- 79.
Ministere de la sante et du developpement social - Mali. Plan strategique integre de lutte contre les maladies tropicales negligee (MTN) 2022-2026. Ministere de la sante et du developpement social, direction generale de la sante et de l’hygiene publique. 2022.
- 80.
Ministry of Public Health Niger. Plan directeur de lutte contre les maladies tropicales négligées Niger 2016-2020. Ministere de la Sante Publique, Direction des Etudes et de la Programmation. 2016.
- 81.
Ministry of Health Rwanda. Neglected Tropical Diseases Strategic Plan 2019-2024. Ministry of Health, Rwanda. 2019.
- 82.
Ministère de la Santé et de l’Action Sociale - Sénégal. Plan stratégique national de lutte contre les maladies tropicales négligées 2022 - 2025. Ministère de la Santé et de l’Action Sociale, Sénégal. 2022.
- 83.
Ministry of Health Community Development Gender Elderly and Children. Strategic master plan for the neglected tropical diseases control program July 2021- June 2026 Tanzania mainland. Ministry of Health, Community Development, Gender, Elderly and Children, The United Republic of Tanzania. 2021.
- 84.
Ministère de la Santé Togo. Plan Stratégique National de Lutte Intégrée contre les Maladies Tropicales Négligées au Togo 2022 – 2023. Ministère de la Santé, de l’Hygiène Publique et de l’Accès Universel aux Soins. 2022.
- 85.
Ministry of Health Uganda. Uganda Neglected Tropical Diseases Master Plan 2023-2027.
- 86. Hamill LC, Haslam D, Abrahamsson S, Hill B, Dixon R, Burgess H, et al. People are neglected, not diseases: the relationship between disability and neglected tropical diseases. Trans R Soc Trop Med Hyg. 2019;113(12):829–34. pmid:31111941
- 87.
Direcção Nacional de Saúde Publica DNSP. Plano Estratégico Nacional das Doenças Tropicais Negligenciadas (PEN-DTNs) 2021-2025. Luanda, Angola: Ministério da Saúde, Angola. 2022.
- 88.
Ministry of Health Botswana. Botswana Neglected Tropical Diseases (NTDs) Master Plan 2023-2027. Botswana: Ministry of Health. 2023.
- 89.
Ministere de la santé et bien etre social EG. Plan directeur de lutte contre les maladies tropicales négligées (MTN) 2018-2022. Ministere de la santé et bien etre social. 2017.
- 90.
Ministry of Health Eswatini. Eswatini Neglected Tropical Diseases Master Plan 2023 – 2027. Ministry of Health, Eswatini. 2022.
- 91.
Ministry of Health Ethopia. Ethiopia Sustainability Action Plan for NTD Control, Elimination and Eradication 2021-2025. Federal Ministry of Health. 2021.
- 92.
Ministere de la Sante Republique Gabonaise. Plan directeur de lutte contre les maladies tropicales négligées. Gabon: Ministere de la Sante. 2012.
- 93.
Ministry of health Malawi. Malawi Neglected Tropical Diseases Master Plan 2023 - 2030.
- 94.
Ministry of Health and Social Services - Namibia. Neglected Tropical Diseases Master Plan 2023-2027. Ministry of Health and Social Services, Namibia. 2022.
- 95.
Federal Ministry of Health - Nigeria. Nigeria master plan for neglected tropical diseases (NTDs) 2023-2027.
- 96.
Ministry of Health Zambia. Zambia Neglected Tropical Diseases Master Plan 2022 – 2026.
- 97. Ministere de la sante et de la population Republic of Congo. Plan Directeur de lutte Contre les Maladies Tropicales Negligees (MTN) 2023- 2027. Ministere de la sante et de la population, unite de coordination des programmes et projects.
- 98.
Ministere de la sante publique Republique Democratique du Congo. Plan stratégique de lutte contre le maladies tropicales négligées à chimiothérapie préventive 2016-2020. 2016.
- 99.
Ministério da Saúde São Tomé et Principe. Plan directeur de lutte le maladies tropicales négligées 2016-2020. 2016.
- 100.
Morel L, Hotive D. Seychelles Neglected Tropical Diseases Master Plan 2015-2020. Seychelles: Ministry of Health. 2014.
- 101.
Ministry of Health and Sanitation SL. Sierra Leone NTD Master Plan 2023-2027.
- 102.
National Department of Health, National Department of Basic Education. South Africa National Master Plan for the Elimination of Neglected Tropical Diseases 2019 - 2025. Ministry of Health. 2019.
- 103.
Ministry of Health Republic of South Sudan. South Sudan Neglected Tropical Diseases (NTDs) Master Plan 2023-2027. Ministry of Health. 2023.
- 104.
Ministry of Health Republic of Gambia. Neglected Tropical Diseases Master Plan 2023–2027. The Gambia: Ministry of Health. 2023.
- 105.
Ministry of Health Zanzibar. Zanzibar Neglected Tropical Diseases (NTDs) Master Strategic Plan 2023-2027. 2023.
- 106. Doorgapersad SV, Chiware M. Performance management challenges in the Ministry of Health and Child Care in Zimbabwe. IJMP. 2023;1(1):1.
- 107.
Ministere de las sante C d’ Ivoire. Plan directeur de la lutte contre les maladies tropicales négligées 2021-2025. Côte d’Ivoire: Ministere de las sante, de l’hygiène publique et de la couverture maladie universelle.
- 108.
Ministere de la sante publique et de la lutte contre le sida Burundi. Plan directeur de lutte contre les maladies tropicales négligées au Burundi 2022-2027. 2022.
- 109. Uniting to Combat NTDs. Progress. https://unitingtocombatntds.org/en/neglected-tropical-diseases/progress/ 2025 May 31.
- 110. Bharadwaj M, Bengtson M, Golverdingen M, Waling L, Dekker C. Diagnosing point-of-care diagnostics for neglected tropical diseases. PLoS Negl Trop Dis. 2021;15(6):e0009405. pmid:34138846
- 111.
Lammie P. Diagnostic needs for NTD programs. The causes and impacts of neglected tropical and zoonotic diseases: Opportunities for integrated intervention strategies. 2011. p. 346.
- 112. Hotez PJ, Molyneux DH, Fenwick A, Ottesen E, Ehrlich Sachs S, Sachs JD. Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV/AIDS, tuberculosis, and malaria. PLoS Med. 2006;3(5):e102. pmid:16435908
- 113. Eze CC, Ekeke N, Alphonsus C, Lehman L, Chukwu JN, Nwafor CC, et al. Effectiveness of self-care interventions for integrated morbidity management of skin neglected tropical diseases in Anambra State, Nigeria. BMC Public Health. 2021;21(1):1748. pmid:34563162
- 114. Fastenau A, Willis M, Vettel C, Stuetzle SCW, Penna S, Chahal P, et al. Integrating Community Engagement in Zero Leprosy Efforts: A Pathway to Sustainable Early Detection, Control and Elimination. Trop Med Infect Dis. 2024;9(12):296. pmid:39728823
- 115. Kuper H. Neglected tropical diseases and disability-what is the link?. Trans R Soc Trop Med Hyg. 2019;113(12):839–44. pmid:30892653
- 116. Yotsu RR, Fuller LC, Murdoch ME, van Brakel WH, Revankar C, Barogui MYT, et al. A global call for action to tackle skin-related neglected tropical diseases (skin NTDs) through integration: An ambitious step change. PLoS Negl Trop Dis. 2023;17(6):e0011357. pmid:37319139
- 117. Alderton DL, Ackley C, Trueba ML. The psychosocial impacts of skin-neglected tropical diseases (SNTDs) as perceived by the affected persons: A systematic review. PLoS Negl Trop Dis. 2024;18(8):e0012391. pmid:39093848
- 118. Benbow C, Tamiru T. The experience of self-care groups with people affected by leprosy: ALERT, Ethiopia. Lepr Rev. 2001;72(3):311–21. pmid:11715277
- 119. Leite SCC, Caldeira AP. Therapeutic workshops and psychosocial rehabilitation for institutionalised leprosy patients. Cien Saude Colet. 2015;20(6):1835–42. pmid:26060961
- 120. Rahmawati I, Yuniarti EV. The influence of cognitive behaviour therapy to decrease the level of depression for leprosy sufferer. IJNMS. 2017;1(1):69–73.
- 121. Banda GT, Deribe K, Davey G. How can we better integrate the prevention, treatment, control and elimination of neglected tropical diseases with other health interventions? A systematic review. BMJ Glob Health. 2021;6(10):e006968. pmid:34663634
- 122. Dean L, Tolhurst R, Nallo G, Kollie K, Bettee A, Theobald S. A health-systems journey towards more people-centred care: lessons from neglected tropical disease programme integration in Liberia. Health Res Policy Syst. 2023;21(1):29. pmid:37055758