Helminth elimination in the pursuit of sustainable development goals: a "worm index" for human development.

NTDs in the Heart of Darkness: The Democratic Republic of Congo's Unknown Burden of Neglected Tropical Diseases

Neglected Tropical Diseases in the Ebola-Affected Countries of West Africa.

Helminth Infections in Children.

An Interfaith Dialogue on the Neglected Tropical Diseases

Research and development for neglected diseases: more is still needed, and faster.

In 2011, the World Health Organization (WHO) determined that more than 700 million people were treated with at least one essential medicine for neglected tropical diseases (NTDs) under the auspices of a global preventive chemotherapy initiative [1,2]. However, a total of at least 1.9 billion people require annual preventive chemotherapy [1,2], so these efforts will need to be greatly expanded in order to meet NTD control and elimination targets as outlined in the 2012 London Declaration and the 2013 World Health Assembly resolution for these diseases [3]. The original ‘‘rapid-impact’’ package of NTD interventions targeted up to seven NTDs highly endemic to sub-Saharan Africa, including the three soil-transmitted helminthiases, schistosomiasis, lymphatic filariasis, onchocerciasis, and trachoma, and was comprised of up to four essential NTD medicines that could include a benzimidazole anthelminthic drug (i.e., mebendazole or albendazole), ivermectin, praziquantel, and/or azithromycin [4,5]. However, it was quickly noted that either the entire rapid-impact package or some component thereof had applicability outside of Africa (with modifications depending on the specific NTDs being targeted) [6]. By controlling or eliminating the seven major NTDs, this approach could potentially effect a global disease burden reduction almost as important as HIV/ AIDS, tuberculosis, or malaria control [7,8]. As global preventive chemotherapy efforts expanded, it also became apparent that they could produce important collateral public health benefits that were not originally anticipated, including overall reductions in child mortality from the azithromycin component [9] and coverage for additional NTDs such as food-borne trematodiases, scabies, and yaws [3,10,11]. There are equally important efforts underway to broaden the interventions to include water, sanitation, and hygiene (WASH) initiatives [12]. Thus, in the decade since rapid impact was originally proposed, there are new uses and approaches for preventive chemotherapy. In the last year, two important studies were published that could alter how we think about current preventive chemotherapy approaches. The first, known as the Global Enteric Multicenter Study (GEMS) for diarrheal diseases, made the surprising finding that cryptosporidiosis is one of the most important causes of infectious diarrhea in children in developing countries [13]. The second is the Global Burden of Disease Study 2010 (GBD 2010), which found that, together, cryptosporidiosis and amoebiasis exceed the disease burden–as measured in disability-adjusted life years (DALYs) or in deaths—of any helminth infection now currently being targeted for preventive chemotherapy (Table 1) [14,15]. Although there are important disagreements in the NTD community about whether the DALYs for helminth infections (and other NTDs) were underestimated [16], both GEMS and GBD 2010 provide important information to our community that we need to consider in deciding whether it is possible to add coverage for cryptosporidiosis and amoebiasis as part of global preventive chemotherapy efforts. A potential candidate drug for use in mass drug administration programs to target intestinal protozoa is the nitrothiazole benzamide drug, nitazoxanide (Figure 1) [17]. The development program for nitazoxanide was led by Jean Francois Rossignol in the 1970s, initially as a veterinary anthelminthic agent, but the drug was subsequently shown to be active against intestinal protozoa and some human helminths, as well as anaerobic bacteria [17]. It was approved in 2002 by the United States Food and Drug Administration, initially as an oral suspension for pediatric use (100 mg/5 ml) against cryptosporidiosis and giardiasis, and subsequently as 500 mg tablets for adults [17]. According to The Medical Letter, the recommended therapeutic dosage is administered over three days [18]. Although the initial indication for nitazoxanide was for cryptosporidiosis and giardiasis, subsequent investigative research has revealed that the drug is effective for amoebiasis caused by Entamoeba histolytica and could be used to treat both invasive intestinal amoebiasis and colonization with E. histolytica [19]. Moreover, nitazoxanide is active against a number of nonprotozoan parasites, including the

The ten member states of the Association of Southeast Asian Nations (ASEAN) constitute an economic powerhouse, yet these countries also harbor a mostly hidden burden of poverty and neglected tropical diseases (NTDs). Almost 200 million people live in extreme poverty in ASEAN countries, mostly in the low or lower middle-income countries of Indonesia, the Philippines, Myanmar, Viet Nam, and Cambodia, and many of them are affected by at least one NTD. However, NTDs are prevalent even among upper middle-income ASEAN countries such as Malaysia and Thailand, especially among the indigenous populations. The three major intestinal helminth infections are the most common NTDs; each helminthiasis is associated with approximately 100 million infections in the region. In addition, more than 10 million people suffer from either liver or intestinal fluke infections, as well as schistosomiasis and lymphatic filariasis (LF). Intestinal protozoan infections are widespread, while leishmaniasis has emerged in Thailand, and zoonotic malaria (Plasmodium knowlesi infection) causes severe morbidity in Malaysia. Melioidosis has emerged as an important bacterial NTD, as have selected rickettsial infections, and leptospirosis. Leprosy, yaws, and trachoma are still endemic in focal areas. Almost 70 million cases of dengue fever occur annually in ASEAN countries, such that this arboviral infection is now one of the most common and economically important NTDs in the region. A number of other arboviral and zoonotic viral infections have also emerged, including Japanese encephalitis; tick-borne viral infections; Nipah virus, a zoonosis present in fruit bats; and enterovirus 71 infection. There are urgent needs to expand surveillance activities in ASEAN countries, as well as to ensure mass drug administration is provided to populations at risk for intestinal helminth and fluke infections, LF, trachoma, and yaws. An ASEAN Network for Drugs, Diagnostics, Vaccines, and Traditional Medicines Innovation provides a policy framework for the development of new control and elimination tools. Together with prominent research institutions and universities, the World Health Organization (WHO), and its regional offices, these organizations could implement important public health improvements through NTD control and elimination in the coming decade.

Research purpose. There is some empirical evidence of the relationship between economic and human development at a country level. Human development is most frequently proxied by the Human Development Index (HDI). Considering the fact that HDI is a measure covering the fields of several Sustainable Development Goals (SDGs), the overwhelming idea of the research is to determine the impact of sector economic development on the achievement of SDGs. The research goal is to establish if there is a relationship between economic development, using Latvian sector statistics, and the human development of Latvia. Design / Methodology / Approach. The paper uses different types of regression analyses of the longitudinal data to determine if there is a relationship between HDI and economic development indicators in different sectors of the Latvian economy. The sample includes industry-level data on eight industries and HDI data collected from 2010 to 2020. The regression analysis was applied to HDI as a dependent variable, and a selected set of industry variables was assessed as a group of independent variables (both individual for industries and aggregated on the country level). The set included the indicators of the turnover of companies, number of companies, added value, total personal costs and number of employees in full-time employment. Findings. The findings partly support the proposal that economic development relates to human development because some factors of economic growth have formed a statistically strong relationship with HDI (added value, total personal costs, and the number of employees in full-time employment), while others have not (turnover and number of companies). The fact that some statistically proven relationships had a positive while others had a negative direction suggests that the relationship between economic development and human development is bidirectional depending on specific indicators. Originality / Value / Practical implications. There is an obvious research gap in the investigated field in Latvia and even in the Baltics. The current paper contributes to the knowledge base about factors affecting human development and enlarges the statistical data basis. Besides, this study contributes to the development of national strategic plans by determining which sectors and which indicators have a significant impact on HDI. Research information will be useful for the NAP report after 2027 for assessing the level of achievement of strategic goals, especially in the priorities “Strong families, healthy and active people”, “Knowledge and skills for personal and national growth”, and “Competitiveness and material well-being of companies”.

BackgroundNeglected tropical diseases (NTDs) account for a large disease burden in sub-Saharan Africa. While the general cost-effectiveness of NTD interventions to improve health outcomes has been assessed, few studies have also accounted for the financial and education gains of investing in NTD control.MethodsWe built on extended cost-effectiveness analysis (ECEA) methods to assess the health gains (e.g. infections, disability-adjusted life years or DALYs averted), household financial gains (out-of-pocket expenditures averted), and education gains (cases of school absenteeism averted) for five NTD interventions that the government of Madagascar aims to roll out nationally. The five NTDs considered were schistosomiasis, lymphatic filariasis, and three soil-transmitted helminthiases (Ascaris lumbricoides, Trichuris trichiura, and hookworm infections).ResultsThe estimated incremental cost-effectiveness for the roll-out of preventive chemotherapy for all NTDs jointly was USD125 per DALY averted (95% uncertainty range: 65–231), and its benefit-cost ratio could vary between 5 and 31. Our analysis estimated that, per dollar spent, schistosomiasis preventive chemotherapy, in particular, could avert a large number of infections (176,000 infections averted per $100,000 spent), DALYs (2,000 averted per $100,000 spent), and cases of school absenteeism (27,000 school years gained per $100,000 spent).ConclusionThis analysis incorporates financial and education gains into the economic evaluation of health interventions, and therefore provides information about the efficiency of attainment of three Sustainable Development Goals (SDGs). Our findings reveal how the national scale-up of NTD control in Madagascar can help address health (SDG3), economic (SDG1), and education (SDG4) goals. This study further highlights the potentially large societal benefits of investing in NTD control in low-resource settings.

This study aimed to examine if there is an interaction between alcohol use and human development in terms of their associations with alcohol-attributable health harms. Statistical modelling of global country- and region-specific data from 2016. Global. The units of the analyses were countries (n=180) and regions (n=4) based on their Human Development Index (HDI). Alcohol-attributable harms [deaths, years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life years (DALYs) lost] and risk relations were based on a recent study using World Health Organization (WHO) estimates for 2016. Human development was measured using the HDI, a summary score of life expectancy, education and gross national income from the United Nations Development Programme. Interactions between HDI and adult per-capita consumption (APC) affecting alcohol-attributable harms were assessed using likelihood ratio tests. Differences in alcohol-attributable harms per litre of APC between HDI groups were assessed using regression analyses and a reference group of low HDI. APC is associated with alcohol-attributable deaths, YLL, YLDs and DALYs lost, while HDI is associated with alcohol-attributable deaths, YLL and DALYs lost. Statistical analyses indicated there is an interaction between HDI and APC in their associations with alcohol-attributable deaths, YLL and DALYs lost per 100 000 people. The alcohol-attributable burden was highest in low HDI countries, with 11.65 [95% confidence interval (CI)=10.75, 12.40] deaths and 495.61 (95% CI=461.83, 569.23) DALYs lost per 100 000 people per litre of APC, and lowest in very high HDI countries, with 4.15 (95% CI=2.46, 5.71) deaths and 200.31 (95% CI=122.78, 265.10) DALYs lost per 100 000 people per litre of APC. However, no statistical differences between low and very high HDI groupings for these burdens were observed. There appears to be an interaction between the Human Development Index and alcohol use in their associations with alcohol-attributable deaths, years of life lost and disability-adjusted life years lost but not with alcohol-attributable years lived with disability. Alcohol appears to have a stronger harmful impact per litre of alcohol consumed in lesser developed countries than in developed countries.

Introduction. The relationship between the Human Development Index, life expectancy and the level of innovative development of the economy as a whole for the countries of the world and separately for 85 subjects of the Russian Federation is considered. Materials and methods. The source of information for assessing the level of development of the innovative economy in the countries of the world was the Global Innovation Index for 2019, and in the regions of Russia – the data of the Association of Innovative Regions of Russia. The Human Development Report 2020 published by the United Nations Development Program was used to obtain information on Human Development Indices in the countries of the world. The source of information on Human Development Indices in the regions of Russia was the Analytical Note “Human Development Index in Russia: Regional Differences”, published by the Analytical Center under the Government of the Russian Federation in 2021. The source of information on the life expectancy of the population of 85 regions of Russia is the collections of Rosstat. Correlation and non-parametric analysis of variance was used to assess the relationship between the studied indicators. Results. It is shown that the Spearman correlation coefficient between the Global Innovation Index (GII) and the Human Development Index (HDI) according to the data for the countries of the world is 0.905 (significance level – <0.0001), the correlation coefficients between GII and life expectancy, both average and separately for men and women, are quite high: 0.834; 0.794 and 0.852 respectively. The correlation coefficient between the Innovative Economy Development Index (IEDI) and the HDI according to data for 85 regions of the Russian Federation is 0.578 (significance level is < 0.0001), the correlation coefficients between the IEDI and average life expectancy and separately for men are not statistically significant, but for the female population – 0.233 (significance level – 0.033). Conclusion. In the world, with the development of an innovative economy, the Human Development Index is growing, which, in turn, accelerates the development of the economy. In the world, with the growth of the level of development of the innovative economy, the average life expectancy is growing. In Russia, the relationship between the Human Development Index and the level of development of the innovative economy is rather linear, and the correlation coefficient between these indicators is much lower compared to the correlation coefficient for the countries of the world. In Russia, there is a significant positive correlation between the Innovative Economy Development Index and life expectancy only for the female population.

Neoclassical economics has traditionally posited that the process of development entails changes in incomes over time. Larger income levels achieved via positive economic growth, appropriately discounted for population growth, would constitute higher levels of development. As many have noted, however, the income measure fails to adequately reflect development in that per-capita income, in terms of its levels or changes to it, does not sufficiently correlate with measures of (human) development, such as life expectancy, child/infant mortality and literacy. The United Nations Development Programme’s (UNDP) human development index (HDI) constitutes an improved measure for development. HDI has been modified to be gender-sensitive with variants that reflect gender inequality. Various measures reflecting Sen’s “capability” concept, such as civil and political rights, have also been incorporated. Countries where the level of poverty is relatively large tend also to exhibit low values of human development, thus lowering the mean values of the development measures. Where inequalities of development indicators are very large, however, the average values may not sufficiently reflect the conditions of the poor, requiring the need to concentrate on poverty per se. The most recognized indicator of (income) poverty is the headcount ratio, which simply measures the proportion of the population considered to earn an income less than the standard required for basic needs (the other poverty measures are those for the depth and severity of poverty). This poverty line may vary from country to country and over time. However, to simplify comparability across countries and over time, the poverty line has been standardized as a daily income of US$ 1 at international standards. As an indicator of extreme poverty, this poverty rate is also the yardstick for Goal 1 of the Millennium Development Goals (MDGs). The above measures do not necessarily reflect deprivation in human development. Thus in 1997 the UNDP introduced the human poverty index (HPI) for developing countries. This measure is intended to reflect deprivations in the three indexes of human development: long and healthy life, knowledge and a decent standard of living. For more developed countries, HPI is further modified to reflect social exclusion. Despite the myriad criticisms levelled against such measures of development and poverty, these indicators provide us with reasonable pictures of how well various countries are performing beyond mere income growth. What the evidence shows is that countries that rank at the bottom of the HDI scale tend also to exhibit the largest HPI values. Hence, these measures are useful in that they at least signal specific countries that may require special attention. Both indices are needed, however, to gauge the nature of the development challenge. For example, a relatively low HDI value despite a high per-capita income suggests that growth is not being efficiently transformed into human development. Similarly, if both HDI and HPI are high, then the achievement in human development is not being sufficiently shared by those at the bottom, suggesting the need to address the human-development distribution picture. Ideally, HDI should be high and HPI low. What policies are considered pro-poor or pro-development? Employment generation is a particularly salient linchpin between economic growth on the one hand, and poverty reduction and development on the other. Policies that augment the demand for labour are therefore likely to produce desirable social-impact outcomes for developing economies.1 Thus, appropriate policies are generally those that increase employment in sectors with reasonable levels of productivity, as well as those that provide essential public goods. The nature of the sociopolitical environment is a particularly salient determinant of the effectiveness of transforming growth to development or poverty reduction. Higher levels of inequality, for instance, lower the effectiveness of growth in reducing poverty.2,3 Similarly, greater rates of political instability tend to retard the rate at which growth is transformed to human development.4 Health is critical. Impaired health exacerbates poverty and undermines development, whether directly or indirectly via lowering growth.5 Malaria, historically one of the deadliest diseases in the tropics, has been deleterious to development and has contributed considerably to poverty, especially in Africa,6 as has HIV/AIDS more recently.7 Both morbidity and mortality are important contributors to the above development and poverty woes emanating from diminished health.8 Health standards, as exemplified by Goal 6 of the MDGs for instance, are essential for attaining poverty eradication and development success. The Bulletin, in conjunction with over 230 other journals, is participating this month in a Global Theme Issue on Poverty and Human Development (see: http://councilscienceeditors.org/globalthemeissue.cfm) by publishing a number of papers on this topic. ■

Yemen is a low-income country on the Arabian Peninsula (Fig. 1) with a human development index equivalent to that of Nigeria or Madagascar [1]. It is also a nation beset by violence because of a southern secessionist movement and, most recently, an escalating level of civil unrest in the capital of Sana′a [2]. In addition to rising levels of violence fueled by ongoing tribal conflicts and the presence of an Al-Qaeda insurgency, the country is faced with rising levels of unemployment (estimated overall unemployment is 17.34% [3] and youth unemployment is 34.8% [4]) and poverty (52.5% of the population live in multidimensional poverty [5]), and a growing youth population (in 2012 the fertility rate was 4.2 and the annual population growth rate was 3.2 [6]). Figure 1 Map of Yemen. As we have seen previously in some sub-Saharan African countries, such as South Sudan and Central African Republic, neglected tropical diseases (NTDs) are known to flourish in this setting of poverty and instability. Today, Yemen has some of the highest concentrations of NTDs in the Middle East [7]. According to the World Health Organization (WHO), more than one-third of the people of Yemen require regular treatment for schistosomiasis [8], an important cause of urogenital disease, especially among girls and women (who develop female genital schistosomiasis), as well as bladder cancer (Table 1). More than 10 million Yemeni children require treatment for intestinal worms, which cause malnutrition and cognitive delays [9]. River blindness and trachoma, each requiring preventive chemotherapy, are endemic [7],[10], as are cutaneous leishmaniasis and dengue fever [11],[12]. Table 1 The major neglected tropical diseases of Yemen. An important reason why we need to care about NTDs is that these conditions are often chronic and debilitating and actually cause or reinforce poverty through their long-term effects on children and heads of households. They disproportionately strike girls and women. As a result, NTDs can also destabilize communities and possibly even further help to promote conflict [13]. Thus, NTD control and elimination represent important critical steps to help stabilize the nation of Yemen and to promote its economic development. In late 2009, the World Bank approved an important project (the Yemen Schistosomiasis Project [YSP]) to eliminate schistosomiasis-related morbidity and control intestinal worms throughout Yemen [14]. This six-year project is implemented by the Yemen Ministry of Public Health and Population (MoPHP) [15] and involves collaborative partnerships with the World Bank, the WHO, the London-based Schistosomiasis Control Initiative (SCI) [16], and the END Fund [17], pharmaceutical donation programs, and several local universities and non-governmental organizations. After treating 4 million children and adults between late 2010 and early 2011, the program was disrupted by civil and political unrest resulting from “the Arab Spring” in 2011. However, activities subsequently re-commenced, and in May/June of 2012, over 2 million people were treated. In 2013, almost 10 million people received treatments for schistosomiasis, intestinal worm infections, or both (Fig. 2). Figure 2 Schistosomiasis treatment campaign. Though the cause of the success of Yemen's National Schistosomiasis Control Program (YNSCP) cannot be pinpointed to any one factor alone, the mechanisms that fostered the environment that have enabled the program to grow and mature include a system-wide commitment to reduce NTD burden and strong collaborative partnerships. The commitment and drive of the partners working to support NTD control in Yemen (the MoPHP, the YNSCP, the World Bank's YSP, and SCI) have all contributed to the success of the program. Though the in-country NTD teams have faced many challenging situations due to general insecurity throughout many parts of the country, they remain committed to ensuring control efforts targeting schistosomiasis and soil-transmitted helminths reach those in need. Along with the MoPHP's Director General of Disease Control and Surveillance, YNSCP's manager, the in-country WHO NTD coordinator, and other key partners, SCI's resident Program Manager Dr. Dhekra Annuzaili has made an especially important contribution to the country's NTD control efforts. Dr. Annuzaili is responsible for providing technical assistance and programmatic support to the YNSCP within the MoPHP. Dr. Annuzaili is based full-time within the MoPHP and works directly with her counterparts to provide guidance to the disease control officials in the 23 governorates. In a recent interview with Dr. Annuzaili, her commitment to improving the health of the Yemeni population, even in times of conflict, was made very clear: “It is very risky and very dangerous [in Yemen], but we have to [remain] positive to [ensure] we perform well and reduce [the burden] of these diseases.” She is a public health professional who is successfully supporting disease control efforts in a country where even central-level health authorities have lowered the achievement goals of their health priorities and many international partners have assigned their experts to work remotely [18]. As a woman working in a country with one of the highest gender inequality rankings in the world [19], Dr. Annuzaili has been confronted with many obstacles because of her gender, but her commitment to improving the overall health outcomes in Yemen, to collaborating with her NTD peers and other partners, along with her drive to eliminate NTDs, have enabled her to build strong relationships and contribute to reducing the burden of these devastating diseases. The achievements of Yemen's NTD control efforts are not solely due to Dr. Annuzaili's personal commitment but also to the contributions of all the partners working to reduce the burden of these diseases of poverty. However, it is important to note that over the course of the many years that Dr. Annuzaili has been working to serve her Yemeni countrymen, she has gathered a wealth of knowledge of how to work in difficult situations. Dr. Annuzaili's tips for NTD peers that are either working in precarious situations or are just launching control efforts include (1) don′t give up—stay committed; (2) prioritize actions; (3) ensure that all parties are responsible for results; (4) search for the truth; (5) social media is a tool that can be useful, but it needs to be managed properly; and (6) be action oriented. These tips, along with an understanding of the importance of strong partner collaboration, can be used by other NTD control programs to strengthen their efforts to reduce the burden of these parasitic and bacterial diseases. Yemen's MoPHP and NTD partners are now exploring how the successful schistosomiasis and intestinal worm control program can be extended to also include other NTDs, such as onchocerciasis and trachoma. In 2014, the END Fund provided seed funds to support the country's shift from individual case treatment to mass treatment with ivermectin in areas endemic for onchocerciasis—the first step towards the elimination of this disease in Yemen by 2020. Other partners are actively engaged with identifying funding opportunities for trachoma control in the country. The success of Yemen's NTD control efforts provides important lessons for conducting disease control activities in the face of civil unrest, extreme instability, and poverty.

Stigma: The Stealth Weapon of the NTD

The Human Development Index is a composite index to measure the development of human resources in each country and four indicators of life expectancy; income per capita, the average number of years studying and hope to the number of years of education will be formed. Countries, according to the Department of Human Development Index, with high human development, countries with high human development, and human development countries with medium and low human development are divided. The development goal is to create conditions where people can live a long and healthy life and benefit in knowledge. The Human Resource Development Index is one of the important indicators of economic development for each country and is considered to have an effective role in economic development. The importance of the Human Development Index is put to review on the Indian economy. Trends change each of the three human resource development indexes during the 30-year period from 1980 to 2010. In this article, we will consider the relationship between GDP and three indicators of human resources in India. In addition, we will evaluate the relationship and mutual effects of each of the three indicators of human resource development in the Indian economy using the latest (2010) formula provided by the United Nations. In this study, GDP or income act as the dependent variables and the three indicators of long life, health and education act as independent variables.