The Neglected Tropical Diseases of Latin America and the Caribbean: A Review of Disease Burden and Distribution and a Roadmap for Control and Elimination

Abstract

The neglected tropical diseases (NTDs) represent some of the most common infections of the poorest people living in the Latin American and Caribbean region (LAC).Because they primarily afflict the disenfranchised poor as well as selected indigenous populations and people of African descent, the NTDs in LAC are largely forgotten diseases even though their collective disease burden may exceed better known conditions such as of HIV/AIDS, tuberculosis, or malaria.Based on their prevalence and healthy life years lost from disability, hookworm infection, other soil-transmitted helminth infections, and Chagas disease are the most important NTDs in LAC, followed by dengue, schistosomiasis, leishmaniasis, trachoma, leprosy, and lymphatic filariasis.On the other hand, for some important NTDs, such as leptospirosis and cysticercosis, complete disease burden estimates are not available.The NTDs in LAC geographically concentrate in 11 different sub-regions, each with a distinctive human and environmental ecology.In the coming years, schistosomiasis could be eliminated in the Caribbean and transmission of lymphatic filariasis and onchocerciasis could be eliminated in Latin America.However, the highest disease burden NTDs, such as Chagas disease, soil-transmitted helminth infections, and hookworm and schistosomiasis co-infections, may first require scale-up of existing resources or the development of new control tools in order to achieve control or elimination.Ultimately, the roadmap for the control and elimination of the more widespread NTDs will require an inter-sectoral approach that bridges public health, social services, and environmental interventions. The Neglected Tropical Diseases in the Latin American and the Caribbean RegionThe neglected tropical diseases (NTDs), a group of chronic, debilitating, and poverty-promoting parasitic, bacterial, and some viral and fungal infections, are among the most common causes of illness of the poorest people living in developing countries [1].Their control and elimination is now recognized as a priority for achieving United Nations Millennium Development Goals (MDGs) and targets for sustainable poverty reduction [1-3].Approximately 40% of the estimated 556 million people living in the Latin American and the Caribbean region (LAC) live below the poverty line, including 47 million people who live on less than US$1 per day, and another 74 million people who live on less than US$2 per day [4,5].Relative to sub-Saharan Africa and Asia, where NTDs also occur, the character of poverty in LAC is unique.In terms of income distribution, LAC exhibits the highest inequality anywhere [6], with the richest one-tenth of the population earning 48% of total income and the poorest tenth earning only 1. 6% [7].Of LAC's estimated 213 million impoverished people, approximately one-third live in rural poverty as subsistence farmers, ranchers, and fishermen [8], typically in communities of indigenous and African descent where they face a high level of social exclusion and social inequity [9], including lack of access to safe water and health care services [10,11].Two-thirds of the region's poor live in favelas, asentamientos pobres, barrios pobres, turgurias, and a ´reas perife ´ricas, i.e., urban and peri-urban communities where poverty combines with the conditions of unsafe water, poor sanitation, and the proliferation of rodent animal reservoirs and vectors [8,12].Poverty is not the only major determinant for risk of acquiring NTDs in LAC.Instead, it combines with other inequities related to ethnicity (e.g., indigenous groups and people of African descent), age and gender (i.e., children and women), and a patchwork of unique ecological niches to establish sometimes highly focal epidemiological NTD ''hot spots.''This has important implications for the control of NTDs in LAC, which may differ from the integrated NTD control currently being advocated for and tested in sub-Saharan Africa and elsewhere [1].Here, we focus on some of the unique aspects of NTD disease burden and endemicity in the LAC region, as well as the prospects for NTD control and elimination in the region.The review of the literature was conducted using the online database PubMed from 2000 to 2007 with United States National Library of Medicine Medical Subject Headings, the specific diseases listed as neglected tropical diseases