Neglected tropical diseases (NTDs) are a group of 20 different diseases that occur in many countries around the world. They are called neglected diseases because despite the high burden they cause to affected people and society, historically they have not been given much priority by health systems and global donors. As many as one out of every 7 persons in the
world may be suffering from one or more NTDs. NTDs mainly affect the world’s poorest people, who live in hard-to-reach areas or rural and urban areas where access to safe water, sanitation, and essential medicines is lacking. Many NTDs significantly affect the skin, which can lead to implications for mental health, long term disability and stigma if left untreated. Affected people often attend for treatment at health facilities at the later stages of disease when symptoms become severe. Many cases of NTDs are hidden in communities, often due to lack of awareness of the conditions and their associated stigma. Early case detection of skin NTDs is important to minimize the negative health impacts that delays in diagnosis can cause.

The NTDs that affect the skin, that are of focus within this manual are:

• Leprosy
• Buruli Ulcer
• Lymphedema
• Hydrocele
• Yaws
• Onchocerciasis

The World Health Organisation (WHO) Department for the Control of NTDs has proposed integrating programme implementation for more effective and efficient management of skin NTDs by focusing on multiple diseases simultaneously. This was first rolled out in Liberia in 2016 in Maryland, Bong, Nimba, Bomi and Lofa counties. Buruli ulcer, Leprosy, and clinical manifestations of Lymphatic Filariasis, specifically lymphedema and hydrocele (due to lymphatic filariasis), yaws and onchocerciasis are six skin NTDs being prioritised for integrated case management in Liberia. This means providing services for all diseases through one programme and delivering activities within existing health systems infrastructure as far as possible. These are the 5 NTD conditions have been selected as they fall under the remit of case management that are endemic to Liberia. They also all have in common that they affect the skin.

This guide explains the integrated approach in Liberia and is designed to support health workers to identify, diagnose, treat and support persons affected by NTDs (specifically leprosy, Buruli ulcer, lymphedema, hydrocele, onchocerciasis and yaws) within the existing patent care pathway. It also includes a focus on how to help persons whose mental wellbeing is affected as a consequence of having (had) an NTD.