Goal 6: Communicable disease prevention and control

Context

• Other major diseases, often called "neglected tropical diseases", affect at least one billion people.
• Neglected tropical diseases cause immense suffering, lifelong disabilities and contribute significantly to the vicious cycle of poverty, but rarely kill.
• People living in remote areas, conflict zones or urban slums with little or no access to clean water and services are most at risk.

“Neglected tropical diseases” mainly include Buruli ulcer, Chagas disease, lymphatic filariasis (elephantiasis), schistosomiasis, intestinal parasites, leprosy, leishmaniasis, human african trypanosomiasis (sleeping sickness), onchocerciasis, dracunculiasis (guinea-worm disease) and trachoma.

These diseases are referred to as neglected diseases because they lack both international attention and resources. They thrive in resource poor settings and tend to affect poor and marginalized groups, most often those living in rural parts of low-income countries. They have remained low on countries’ public health agendas and do not receive the level of attention afforded to high mortality diseases.

Illness and disability caused by the neglected tropical diseases have a tremendous social and economic impact. In the developing world, these diseases cause the most severe health related impairment of social and economic activities and they do so in the poorest populations.

WHO's work

Many of these diseases can be controlled using low-cost technologies that are safe, rapidly effective and easy to administer in resource poor settings.

Efforts to achieve the MDGs should prioritize intensified control of neglected tropical diseases. This will contribute directly to the reduction of the communicable disease burden (Goal 6) and indirectly to efforts to reduce poverty and hunger (Goal 1).

Guinea-worm disease- typically disables subsistence farmers at precisely the time they need to work most, in the middle of harvest season. The worker fails to harvest enough food, increasing poverty and hunger. Children need to replace the affected adult worker in the fields, taking them away from school. Lack of education kills all hope for sustainable disease prevention.

Lymphatic filariasis (LF)- is the second leading cause of permanent and long-term disability. Loss of productivity plus the cost of care doubles the economic hardship for families and societies of victims. In 2005, between five and 10 million children will become infected and one to two million of them will become disabled and disfigured. Elimination of LF will benefit the poorest 20% of the world's population. This will improve the overall wealth and nutritional status of the world's people and have enormous impact on the depth of poverty.

Schistosomiasis and soil-transmitted helminths- The treatment of these parasites is known to increase work capacity and productivity and is important to promote and maintain good nutritional status, especially in children and women of childbearing age. The World Food Programme is now incorporating the once-a-year treatment into its school feeding programmes so that children can actually benefit from the food they are being provided.

Buruli ulcer- affects the poorest communities in developing countries who live on less than US$ 1 per day. The high cost of treatment drives families further into poverty, with the average cost reaching US$ 700 in Ghana today. Avoidance of treatment leads to amputation of limbs and permanent disability and further economic loss.

Dengue- particularly affects populations in unplanned urban and rural settlements with inadequate water, sanitation and solid waste services. Dengue Haemorrhagic Fever is largely a childhood disease in Asian countries and is a leading cause of hospitalization and death in several of those countries with many of the deaths in the under-five age group. Better control of this disease would help to reduce the under-five mortality rate in these countries. High costs of intensive care for dengue haemorrhagic fever leave many families deeply indebted. Epidemics severely disrupt health services and impact on economies.

Diarrhoeal diseases- Reducing these (e.g. cholera and foodborne diseases) will reduce malnutrition and mortality associated with all other diseases.

Deworming- contributes to better nutritional status and physical development. Regular treatment of children can prevent malnutrition caused by worms, and thereby reduce under-five mortality rates. Regular treatment of women of childbearing age will result in higher birth weights and lower infant mortality rates.

Future directions

Many of these diseases can be controlled using low-cost technologies that are safe, rapidly effective and easy to administer in resource poor setting. When applied on a large scale, control strategies can interrupt transmission helping to reduce the risk of onward infection for a limited time. These population-wide interventions (such as vector control and mass drug administration) do not discriminate between poor and non-poor, reducing the risk that excluded groups are further marginalized.

Efforts to achieve the MDGs should priorize control of neglected tropical diseases. This will contribute directly to the reduction of the communicable disease burden (Goal 6) and indirectly to efforts to reduce poverty and hunger (Goal 1).

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