Neglected Infectious Diseases Integrated Approach
A study to map diseases of poverty in Latin America and the Caribbean in the fight to eliminate them
Latin America and the Caribbean (LAC) continue to suffer from the fact that an exorbitant number of people—nearly 50 million—live in a state of extreme poverty (with an income of less than one dollar a day). Beyond numbers and averages, the lives and hopes of each of these individual men, women, and children are what keep us awake at night in their appeal for us to make ever greater efforts to improve their health and quality of life.
The majority of these people live in conditions favoring a greater burden of disease, many of which are neglected for a variety of reasons. Usually, these neglected diseases affect uncared-for populations and vulnerable groups such as indigenous populations, rural inhabitants, the elderly, women living in poverty, and children. This situation needs to be changed for the better. This PAHO study contains epidemiological profiles on the major neglected diseases affecting the Americas, using secondary data from the countries. By providing data disaggregated by first subnational level showing maps of areas within the countries, it puts forth the unfinished agenda for certain diseases that should no longer exist as a public health problem in the Region—showing epidemiological 'hot spots' and how these diseases overlap in specific areas where greater efforts and integrated actions could be targeted.
With this work, we hope to contribute to achieving cost-effective actions focused specifically on the most vulnerable populations and groups and directed in a concrete way at fighting diseases related to poverty that, albeit continuing to cause great damage and enormous harm in terms of human suffering, as well as a huge financial burden, are euphemistically categorized under the heading of ‘forgotten’ or ‘neglected.
Full text (123 pp)
In Latin America and the Caribbean, some 127 million people live in a state of poverty (under two dollars per day), and 50 million in extreme poverty (under one dollar per day). The majority of these people—including traditionally vulnerable groups such as indigenous populations, rural inhabitants, the elderly, and impoverished women and children—live in conditions that favor a greater burden of disease. A number of these diseases exist with high possibilities for achieving their reduction to levels that no longer represent a public health problem—a reason that merits additional efforts towards their elimination. The availability of new technologies and strategies and the improvement of the health service infrastructure—particularly rising support for primary care—make their control and eventual elimination feasible. The objective of this study is to explore which countries in the Region—and, if possible, which geopolitical units at the first subnational level—show evidence of the presence of selected poverty-related diseases, as well as the overlapping of these diseases; gather and synthesize the available epidemiological information and existing plans for control; and identify where information gaps exist. This study was done using secondary data. Regional profiles were developed that included geo-process mapping of the selected diseases, showing all countries of the Region. According to the availability of information at the time of the study, some diseases were analyzed at the first subnational level (lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma, and human rabies transmitted by dogs); and others, at country level (soil-transmitted helminths, Chagas disease, leprosy, congenital syphilis, and neonatal tetanus). This study allows us to view where we may find the diseases that constitute the unfinished agenda in the Region, such as lymphatic filariasis, onchocerciasis and human rabies transmitted by dogs. Also, the study suggests where information gaps exist and further studies are needed—such as for trachoma, where endemic regions border on non-endemic countries. Country profiles provide information on the epidemiology of the diseases and the coverage status of primary strategies. These were developed for all countries with evidence of the presence of one or more of the following neglected diseases: lymphatic filariasis, onchocerciasis, schistosomiasis, and trachoma (11 countries)—as well as PAHO’s priority countries, as defined by their socioeconomic status, for a total of 14 countries in all. Due to time constraints, these diseases were prioritized, however a further study could be done to include other diseases. While a considerable amount of information is available, further epidemiological information is needed to establish better baselines for many of the selected diseases. There is a disparity among the information available on country websites. Most of the strategies encountered for the control of these diseases included drug administration and intersectoral approaches. An overlapping analysis was conducted for five diseases (lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma, and human rabies transmitted by dogs), for which information was available at the first subnational level throughout the Region. Considering the population of Latin America and the Caribbean—some 580 million people— it is noteworthy that almost half (230 million) live in areas at the first subnational level (states/departments/provinces) where at least one of these five diseases is present. Of the total of 275 administrative units included in the study, one unit was found to contain four of the five selected diseases, two units were found to contain three of the five selected diseases (all in Brazil); 33 units were found to have two of the five diseases; and 66 of the 275 units reported only one of the selected neglected diseases. In the overlapping maps it can be observed that each disease is present in the administrative unit. The overlapping analysis suggests that many subnational units exist with more than one of the selected diseases present, implying that these areas could be considered a priority (as ‘hot spots’) and an integrated approach could be applied. It should also be taken into consideration that only five diseases were chosen for the overlapping study, but that the other neglected diseases—such as soil-transmitted helminths—are likely to be present throughout the Region.
In conclusion, a considerable amount of information exists for most of the diseases studied, particularly those for which there are established elimination targets and easily identifiable symptoms. However, for diseases with goals of achieving prevalence levels where they are no longer considered a public health problem, or diseases for which it is more difficult to measure prevalence, there is a great need for further studies on the epidemiological situation of these diseases—ones that are up-to-date, contain information at the local level, and use standardized criteria.