Saturday, October 22, 2016

(LML) Multiplying investment

Leprosy Mailing List – October 23,  2016

Ref.:  (LML)  Multiplying investment

From:  Joel Almeida, Mumbai and London



Dear Pieter,



Thanks to Ben Naafs for his kind words (LML, October 21, 2016).


I think the challenge is to expand the cake of financing, so that every slice gets larger. Otherwise we have various segments squabbling over crumbs, and trying to pull down some other segment. It works better if we are inclusive and encouraging.


We can expand the cake by:


1) Using YLD (years lost to disability) to express the burden of leprosy in globally standardized terms.


2) Publicizing the increasing trend of leprosy in India, as shown by the rising trend in the incidence rate of newly detected cases with visible deformity at diagnosis.


3) Demonstrating what effective interventions can do in the short term, e.g. in terms of protecting people against the devastating nerve damage of leprosy.


4) Making a plan for improving outcomes, including through developing human resources and filling important gaps in knowledge. This global plan needs to have budgetary implications attached. Then the gap in financing becomes evident.


5) Being careful not to claim victory, or pretend that it is inevitable. A long war with M. leprae still lies ahead of us.


We need to inspire the world with our plans to cope with the current situation, and to keep improving. Other people working on leprosy are not our enemy, even if they are doing things we consider sub-optimal. We have one common enemy: M. leprae. All our energy and ingenuity needs to flow together like tributaries of a river, which gradually wears down rocks over a long period.


This is a marathon, not a sprint. All of us can play a useful role, according to our abilities and circumstances. Let's be grateful that those of us doing action research are doing it on leprosy rather than something else.




LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<


Friday, October 21, 2016

(LML) Multiplying investment


Leprosy Mailing List – October 21,  2016

Ref.:  (LML)  Multiplying investment

From:  Ben Naafs, Munnekesburen, the Netherlands

Dear Pieter,

I fully agree with Joel Almeida on his LML letter of October 18Th. But there is one snag if money goes to a health project; there are many people who have arguments to use the money. It should go in basic research and to the patient and his caretakers. Both are forgotten in the past years when applied research got all the attention.

With regards,



LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<




(LML) WHO Goodwill Ambassador’s Newsletter No 81

Leprosy Mailing List – October 21,  2016

Ref: (LML) WHO Goodwill Ambassador's Newsletter No 81


From: Hiroe Soyagimi, Tokyo, Japan 




Dear Dr Schreuder and Friends,


Warm greetings from Sasakawa Memorial Health Foundation in Tokyo. We have uploaded our latest edition of "WHO Goodwill Ambassador's Newsletter No.81 Issue" to our website. Please visit  to obtain electronic version of this issue. 

In this issue we feature articles about ...

Message:     Religion's Reach

Symposium:   An Interfaith Call to Action

                      Conclusions and Recommendations                         

Ambassador's journal: In the Forests of Cameroon

News: P&G Progress Report

From the Editors:   A Hoped-For outcome  


We hope you enjoy our latest Newsletter!


Hiroe Soyagimi 


Sasakawa Memorial Health Foundation


Sasakawa Memorial Health Foundation




visit our website at


LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<



Thursday, October 20, 2016

(LML) Workshop "Clinical Problems in Leprosy", International Leprosy Congress, Beijing, September 2016


Leprosy Mailing List – October 20,  2016

Ref.:    (LML) Workshop “Clinical Problems in Leprosy”, International Leprosy Congress, Beijing, September 2016

From:  Ben Naafs, Munnekesburen, the Netherlands


Lectori salute,


Herewith, as promised, though a little bit late, my report about the clinical questions session during the World Leprosy congress in Beijing.


The meeting was a success according the participants. It was appreciated that the questions and the answers were discussed, everybody could have his and her say. It was assumed that the accumulated knowledge among the participants was more than that of selected “experts”. The meeting went very disciplined not in the least thanks to the chairing of prof Rao. We hope that the discussion will continue on LML.


The number of questions which were asked before the meeting showed to be too many, particular when during the meeting new questions were asked.

We will discuss the questions which were not discussed on LML.


My understanding of the answers are given here;


1 How to manage chronic recurrent ENL when there is no access to thalidomide?

It was emphasized that in 1929 it was published that nearly all ENL last less than a month, and that it was episodic.


Pulse treatment with high dose steroids, treat as long as the ENL is active. You may ad MTX (Methotrexate) to the steroids once a week for a few months.

In India there is a good experience with 100 mg dexamethasone in 500 ml dextrose three days a month with 50 mg azathioprine daily.


Clofazimine added to the treatment  is still advocated.


Pentoxyphilline is not advised, it works against oedema and strongly TNF-@ but not against ENL. It is thus likely that Thalidomide works different than just anti TNF-@. The use of TNF@ blockers may help, but there action is still questionable in the light of previous remarks. .


It was mentioned that particular M. vaccae worked protecting against ENL, some of the other vaccines did as well. But this is mostly forgotten.


2 How long to continue steroid treatment for reversal reaction with nerve damage?

The 12 weeks advocated by the WHO may be useful for a minority of the patients. According to most 20 weeks treatment is better, but should not go lower than 10-15mg. Most think a maintenance dose of 15-20 mg for many months.


Starting dose in India 40mg, in Brazil 1mg/kg. According others 40 mg for BT and 30 mg for BL. Then go down 5 mg every 1-2 weeks. It is considered best to do a good follow-up and at least graded ST and VMT. The duration then is BT 3-4 months, BB 4-6 months and BL and LLs 5-9 months or (sometimes) longer.


3 Does histoid leprosy signifies drug resistance?

It can be related, but all patient may have it, it is a rare but normal form of leprosy. It can also point at HIV infection. But again: it may.


4 Treatment regimen in a patient of a leprosy reaction on anti TB treatment.

It was remarked that use of steroids happens regularly in TB, especially  in the treatment of meningeal TB  there is a lot of experience and this makes it clear that the combination is not by forehand contraindicated.  When the TB is treated it can certainly be used to combat a  reaction in leprosy. For anti-mycobacterial treatment for leprosy use during tb treatment, dapsone or if MB lamprene too. When daily  Rifampicin in anti TB treatment stops, continue it once a month according WHO MDT. Also do not hesitate to take the opinion of pulmonologist whenever needed.


5 What are the indications for nerve decompression. When do we do nerve surgery.

When steroid decompression not works (steroids for more than 3 months), but you must be sure that there is compression. Pain could be an indication, but anti-neuropathic pain medication should be tried first. When there is a nerve-abscess. Surgery should be done by someone experienced. Some think you do not have to wait the full 3 months.


6 Can we issue certificates for of cure to MB and PB patients? If so when?

Some are of the opinion that this increased the stigma. Others indicate that most patients harbour persisters. So you can only say, as the patient is also immunological inactive, he is in remission. But you should act tailored to the situation.  The patient first.


7 How soon after starting MDT is the risk of transmission zero?

After 4 months there is no take in mouse footpad. Single dose of rifampicin reduces the load of living  bacteria 92%. Remenber that all contacts are already exposed and that a treated patients is a minimal risk.


8 Is MRI and ultrasound of peripheral nerves in leprosy useful?

They are certainly more than able to replace the in many hands unreliable nerve palpation. MRI is useful for diagnosis  and probably for the follow-up. But is very expensive and need X-rays. Ultrasound is proving its usefulness but though it is relatively cheap it, needs experienced personal.  Colour Doppler seems to be able to diagnose reactions. Some were of the opinion that electrophysiology can give more information, but it is expensive and mildly painful.


9 Does anyone knows of evidence from trials on appropriate steroid dose for young children?

There are hardly studies done. Some featured a child for more than 4-5 months on 1 mg/kg. Basically there was no reaction in the audience. But one should weigh site-effects against benefits. For Type 1 easier than type 2.


10 Since the dapsone syndrome can be killing particular in remotes societies in Nepal, Bangladesh and China, why not change dapsone in ofloxacin?

It indeed should be considered, also because of the haemolytic effect. However dapsone protects against type 1 reaction and Ofloxacin has a lot of site effects particular for children and elderly people. (Dapsone syndrome may be between 2-3 %, but could be underestimated).


11 There is  a Koch postulate for infectious diseases why is this not fulfilled for leprosy.

M. leprae can not be cultured. But it not important any more as we have many animal models.


12 BBC news : Vaccine brings hope to India’s largest leprosy colony? How true?

It concerns the old well known Talwar’s vaccine which showed in the past not better than M. vaccae, M. icrc, M.w, or even In the past all these vaccines have been used for prevention trials and treatment trials. They all were able to give some protection against leprosy and were working against ENL. It is thought that it is a political claim, with commercial background.


13 Bacilli are changing, most other bacilli require new medication, but the treatment against leprosy MDT goes on since the 1980th. Are there new drugs in the pipeline?

Up till to date the present MDT seems quite effective and multi drug resistance is rare.


Ofloxacin, Clarithromycin, Minocycline are less active, Moxifloxacin may be better even than Rifa. But is not free available. A new drug Nitazoxanide, a broad-spectrum antiparasitic and broad-spectrum antiviral drug showed to be effective for intracellular infections. May be for leprosy too.


14 Do we need to revise the 3 cardinal signs for leprosy?

The 3 are: 1. Loss of sensation in a skin patch; 2. Enlarged peripheral nerves; 3. Positive skin smear.


Having only one may give suspicion , but it is not enough for a definite diagnosis. For each of the single criteria we have another diagnosis too. We have to realize that we need two out of three of them to have a definitive diagnosis of leprosy. If we have only one we can try to use other methods in support like electrophysiology, Ultra sound, biopsy, PCR, anti PGL1 and so on.


There was no time to answer more questions. We will try to bring them in discussion in coming LML’s. Look forward to further discussion.







Ben Naafs

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:


Tuesday, October 18, 2016

(LML) InfoNTD| Information on cross-cutting issues in NTDs October 2016

Leprosy Mailing List – October 18,  2016

Ref.:  (LML) InfoNTD| Information on cross-cutting issues in NTDs

October 2016

From:   Ilse Egers and Evelien Dijkkamp, Amsterdam, the Netherlands 

Dear Pieter,


Greetings from InfoNTD!
In this newsletter you will find a selection of news items and recent publications on cross-cutting issues in NTDs. Feel free to contact us with any questions or to receive the full text versions if a link to the full text is not included (

Kind regards,
Ilse Egers & Evelien Dijkkamp
InfoNTD Information officers






News from African Research Network for Neglected Tropical Diseases (ARNTD).
Since the launch of the World Health Organization (WHO) 2020 roadmap to eradicate NTDs and the signing of the London Declaration in 2012, several pharmaceutical companies, funding agencies, institutions, and other groups in North America and Europe have prioritized research and advocacy for NTD control and elimination. However, involvement of indigenous African entities has been limited, although over 85% of the global NTD burden is borne by the continent.
To address the absence of indigenous African entities at the global level, the African Research Network for Neglected Tropical Diseases (ARNTD) was formally created in 2013. The objectives of the ARNTD are: (1) to build a sustainable collaborative network comprised of NTD researchers, policy makers and implementers, including clinicians;(2) to promote the need for NTD research, control and eradication in Africa through advocacy and fund raising ;(3) to stimulate research and strengthen the capacity required in Africa and (4) to make information on NTDs and related research widely available in Africa, particularly within the health care sector.

Huffington Post
Neglected Tropical Diseases: A Best Buy in Global Health
4 October 2016
One of the lesser known success stories in global health is about the progress we have made over the past decade in controlling and eliminating neglected tropical diseases or NTDs. And yes, the term “neglected” is there for a reason: because these diseases affect the poorest of the poor and have endured largely due to indifference and neglect.
Read more

News from the WHO
Neglected tropical diseases: unprecedented 979 million people treated in 2015.
30 September 2016 ¦ Geneva
The World Health Organization (WHO) has released data for 2015 showing that a record 979 million people benefited from large-scale treatment of at least one neglected tropical disease in 2015 alone. This unprecedented achievement may be the first time that so many people have been treated globally as part of a public health intervention in one single year.



New publications



Somalia: A nation at the crossroads of extreme poverty, conflict, and neglected tropical diseases.
Jaffer A, Hotez PJ. PLoS Negl Trop Dis. 2016; 10(9):e0004670.
Abstract NTDs and other tropical infections remain widespread in the extremely fragile nation-state Somalia. Until there are significant improvements in Somalia’s chronic complex emergency status, it is unlikely that this situation will experience substantial changes anytime soon. Learning from the active role the government of post-conflict Rwanda took to achieve remarkable gains in health, there is room for the leadership of Somalia and possibly Somaliland and Puntland to one day rebuild its health systems and infrastructure.
Download PDF

Burden assessment of podoconiosis in Wayu Tuka woreda, east Wollega zone, western Ethiopia: a community-based cross-sectional study.
Bekele K, Deribe K, Amberbir T, et al. BMJ Open. 2016; 6(9):e012308.
Abstract A relatively high prevalence of podoconiosis, frequent ALA episodes and considerable decreases in daily activities were identified in this district. Footwear use and daily foot hygiene were associated with decreased odds of ALA. We recommend prevention and morbidity management interventions to address this developmental challenge.
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Detecting and staging podoconiosis cases in North West Cameroon: positive predictive value of clinical screening of patients by community health workers and researchers.
Wanji S, Kengne-Ouafo JA, Datchoua-Poutcheu FR, et al. BMC Public Health. 2016; 16:997.
Abstract Podoconiosis being a stigmatized disease, the use of CHIs who are familiar to the community appears appropriate for identifying cases through clinical diagnosis. However, to improve their effectiveness and accuracy, more training, supervision and support are required. More emphasis must be given in identifying early clinical stages and in health districts with relatively lower positive predicted values (PPVs).
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Dual perspectives on stigma: reports of experienced and enacted stigma by those affected and unaffected by podoconiosis.
Ayode D, Tora A, Farrell D, et al. Journal of Public Health Research. 2016; 5.
Abstract If stigma reduction interventions are to be successful, culturally tailored, gender inclusive and innovative health education programs are required, directed at the general community as well as individuals affected by inherited diseases.
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Experiences and perspectives of community health workers from implementing treatment for schistosomiasis using the community directed intervention strategy in an informal settlement in Kisumu City, western Kenya.
Odhiambo GO, Musuva RM, Odiere MR, et al. BMC Public Health. 2016; 16:986.
Abstract Findings from this study support the feasibility of using CDI for implementing MDA for schistosomiasis in informal settlements of urban areas. Extensive community sensitization and provision of incentives may help address the aforementioned challenges associated with implementing MDA using the CDI strategy. Opportunities highlighted in this study may be of value to other programmes that may be considering the adoption of the CDI strategy for rolling out interventions in the urban setting.
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The role of nurses and community health workers in confronting neglected tropical diseases in Sub-Saharan Africa: A systematic review.
Corley AG, Thornton CP, Glass NE. PLoS Negl Trop Dis. 2016; 10(9):e0004914.
Abstract Successful disease control requires deep and meaningful engagement with local communities. Expanding the role of nurses and community health workers will be required if sub-Saharan African countries are to meet neglected tropical disease treatment goals and eliminate the possibility future disease transmission. Horizontal or multidisease control programs can create complimentary interactions between their different control activities as well as reduce costs through improved program efficiencies-benefits that vertical programs are not able to attain.
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Neglected tropical diseases: progress towards addressing the chronic pandemic.
Molyneux DH, Savioli L, Engels D. Lancet. 2016.
Abstract The Lancet published a review of the progress made in addressing, as lead author David Molyneux calls it, the chronic pandemic of neglected tropical diseases (NTDs). The authors looked at the progress made in terms of the donated medicines which are used in mass drug administration (MDA) interventions, which represent something in the region of one billion treatments a year. They also highlighted some of the challenges that need to be addressed to ensure the massive impact of NTDs is fully mitigated.
Read abstract

Experiences of pain and expectations for its treatment among former Buruli ulcer patients.
Woolley RJ, Velink A, Phillips RO, et al. Am. J. Trop. Med. Hyg. 2016.
Abstract The objective of this study was to explore patients' experiences of pain and their expectations for its treatment. Patients wanted to receive pain relief; however, many were unable to name a medication. Nonpharmaceutical options were cited as being an alternative. Many BU patients experience pain; however, former patients and community members alike appear to have a limited knowledge about available pain relief. A low-cost alternative to medication may be the use of nonpharmaceutical means for pain relief. Routine pain assessment may reduce patients' fear and unwillingness to express pain. Awareness of such issues will be valuable when implementing a BU pain relief guideline.
Read abstract

Willingness to pay for footwear, and associated factors related to podoconiosis in northern Ethiopia.
Tsegay G, Tamiru A, Amberbir T, et al. Int Health. 2016; 8(5):345-53.
Abstract There is substantial willingness to pay for footwear. The expressed willingness to pay indicates demand for footwear in the community, suggesting an opportunity for shoe companies. There are still a substantial proportion of individuals not willing to pay for footwear. This requires intensified public education and social transformation to bring about change in behavior towards footwear use if elimination of podoconiosis within our generation is to be achieved.
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Lymphatic filariasis: knowledge, attitude and practices among inhabitants of an irrigation project community, North Central Nigeria.
Amaechi EC, Ohaeri CC, Ukpai OM, et al. Asian Pacific Journal of Tropical Disease. 2016; 6(9).
Abstract Many of the participants had a poor knowledge of lymphatic filariasis, the mode of transmission and symptoms of the disease. For proper understanding of lymphatic filariasis in the community, there is need for effective and realistic health education campaigns targeted at the grassroots.
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Water, sanitation and hygiene related risk factors for soil-transmitted helminth and Giardia duodenalis infections in rural communities in Timor-Leste.
Campbell SJ, Nery SV, D'Este CA, et al. Int. J. Parasitol. 2016.
Abstract In this first known assessment of community-based prevalence and associated risk factors in Timor-Leste, STH infections were highly prevalent, indicating a need for STH control. Few associations with WASH were evident, despite WASH being generally poor. In our RCT we will investigate implications of improving WASH on STH infection in impoverished communities.
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The importance of socio-economic versus environmental risk factors for reported dengue cases in Java, Indonesia.
Wijayanti SPM, Porphyre T, Chase-Topping M, et al. PLoS Negl Trop Dis. 2016; 10(9):e0004964.
Abstract Data suggest that dengue infections are triggered by indoor transmission events linked to socio-economic factors (employment type, economic status). Preventive measures in this area should therefore target also specific environments such as schools and work areas to attempt and reduce dengue burden in this community. This study can advise preventive measures in areas with similar patterns of reported dengue cases and environment.
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Management of HIV infected patients with active Buruli ulcer in tropical regions, a new therapeutic challenge: A review.
Kassi K, Serge E, Jean-Marie K. Journal of Dermatological Research. 2016; 1:27-31.
Abstract We conducted a literature review based on current scientific articles and practice experiences to summarize information and guidance principles to make these following suggestions to health care practitioner: Before commencing BU treatment and before starting ART, all HIV/MU co-infected patients should be actively screened for tuberculosis. BU treatment should be commenced before commencing ART and provided for 8 weeks duration. And for the common sense, based on TB management experience HIV, TB and BU control programs should work together in a cooperative framework, mainly in tropical and subtropical regions where the prevalence of these 3 diseases seems high. As, HIV/BU co-infection is increasing in tropical regions, more study should be initiated to determine the cumulative effect of IRIS and paradoxical reactions in BU/HIV co-infected patients on ART and anti-mycobacterial agents, in order to set up recommendation as it was done in TB/HIV co-infection for proper management.
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Comparison of attitudes toward disability and people with disability among caregivers, the public, and people with disability: findings from a cross-sectional survey.
Zheng Q, Tian Q, Hao C, et al. BMC Public Health. 2016; 16(1):1024.
Abstract This study was to investigate and compare the attitudes of PWD, caregivers, and the public toward disability and PWD in China, to identify discrepancies in attitude among the three groups and to examine potential influencing factors of attitude within each group.
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Conceptualisation of community-based rehabilitation in Southern Africa: A systematic review.
M'kumbuzi VRP, Myezwa H. South African Journal of Physiotherapy. 2016; 72(1):1-8.
Abstract The article sought to determine how CBR is conceptualised and understood in the literature from Southern Africa. Interest is centered on to what extent the literature could inform policy makers and practitioners in the region. Conclusion: in isolated cases, the literature is aligned to components of the CBR matrix. However, consistent with previous criticism of CBR, the literature is meagre, as is the evidence to inform policy makers and practitioners in Southern Africa.
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Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis.
McVeigh J, MacLachlan M, Gilmore B, et al. Global Health. 2016; 12(1):1-18.
Abstract Alongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts.
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Community-based rehabilitation for people with disabilities.
Blanchett K, Iemmi V, Kuper H. 2016. Report.
Abstract People with disabilities are often excluded from education, health, employment and other aspects of daily life, and are generally poorer. It is therefore widely argued that the Millennium Development Goals and the post-2015 targets cannot be achieved without integrating disability issues into the agenda. We conducted a systematic search for evidence on the effects of community-based rehabilitation (CBR) on health, education, livelihoods, social and empowerment outcomes.
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Wound care

Manuka honey in wound management: greater than the sum of its parts?
White R. Journal of Wound Care. 2016; 25:539-543.
Abstract The purpose of this brief review is to summarize the ongoing chemical, biochemical and microbiological research and to correlate it with clinical outcomes. The purpose being to present the enquiring clinician with an evidence summary with which clinical choices may be made. While much of the early research was into generic honeys, one particular source, manuka, appears especially effective, and as such this has been the focus of recent studies.
Read abstract

Depressive symptoms in patients with wounds: A cross sectional study.
Zhou K, Jia P. Wound Repair and Regeneration. 2016
Abstract Depression slows wound healing in patients with chronic wounds. The prevalence of depressive symptoms differs in the literature and the current understandings of factors related to depression in patients with wounds have been limited. To investigate the prevalence of depressive symptoms and the associated factors in patients with wounds, we performed this retrospective study in which depressive symptoms were evaluated with the Patient Health Questionnaire 9-item (PHQ-9).
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An RCT to determine an effective skin regime aimed at improving skin barrier function and quality of life in those with podoconiosis in Ethiopia.
Brooks J. 2016. Thesis
Abstract The aim of this randomised control trial (RCT) was to evaluate the effectiveness of a low-cost evidence-based skin care intervention to improve the SBF in the legs/feet and enhance disease related quality of life. The study indicates the very positive effect on skin barrier function (SBF) of adding 2% glycerine and less disinfectant to the current treatment. This finding offers a significant contribution to the body of knowledge on the management of the disease. The addition of 2% glycerine to treatment regimens may also have positive effects on other skin diseases with compromised SBF.
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COR-NTD 2016
The annual meeting for the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) will take place on November 10-11, prior to the American Society of Tropical Medicine and Hygiene (ASTMH) Meeting in Atlanta, Georgia, USA.
 The goal of the COR-NTD meeting is to strengthen the community of researchers, program implementers and their supporters to address knowledge gaps in a coordinated way, thus informing the agenda of future research and facilitating the global efforts of the World Health Organization and endemic countries to overcome NTDs.

ISNTD Water 2016
ISNTD Water 2016 will bring together the main stakeholders, researchers, NGOs and policy makers involved in the development of safe water, sanitation infrastructure and hygiene programmes for improved public health and reduced burden of disease by NTDs. Takes place November 1st 2016 at the Institute of Child Health in London.

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<



(LML) Multiplying investment

Leprosy Mailing List – October 18,  2016

Ref.:  (LML)  Multiplying investment

From:  Joel Almeida, Mumbai and London


Dear Pieter,


The Indian government is multiplying its investment in several major health initiatives (e.g. TB - the investment is going from under $100 million per year to $300 million per year).®ion=top-news&WT.nav=top-news&_r=0


Let's do our best to encourage such boosts in investment for leprosy too. Let's also vigorously encourage noble-minded individuals in affluent countries to contribute more. We need to expand the cake of financing, instead of leaving people partly unprotected against devastating nerve damage.


In the past we have pretended that leprosy is declining in India, or that it is bound to decline, or that we cannot afford to protect people against the devastating nerve damage of leprosy, or that investment should go to other problems first. That is not a friendly or helpful way to behave towards the people at risk of leprosy. Let not our careless words and concepts discourage investment in leprosy services.


Instead, let's ensure that the low-hanging fruit is plucked: notably, protection of nerves during the first two years after the start of MDT; and prolonged anti-microbial protection for polar lepromatous patients. Let's build a demonstration of highly effective interventions in one population, regardless of cost. Costs per outcome decline when effective interventions are scaled up. Let's speak boldly about what boosted investment can do. 


We can be good friends to the population at risk. We can join our voices to civil society and affected people, by pressing for "timely access to quality services". Ordinary people in India took the government to court to press for adequate staffing of leprosy services. Their efforts have started bearing fruit. But we professionals could help by measuring our words.


Let's stand shoulder to shoulder with the workers on the front lines, and the population at risk. That's where nerves are protected and lives are transformed. 






LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link:

Contact: Dr Pieter Schreuder <<