Abstract
The term “neglected tropical diseases” (NTDs) is commonly used to refer to a “baker's dozen” of infectious conditions prevalent in resource-poor tropical countries. The 13 core diseases in the NTD group include ascariasis, dracunculiasis, hookworm, lymphatic filariasis, onchocerciasis, schistosomiasis, trichuriasis, Chagas disease, human African trypanosomiasis, Buruli ulcer, leprosy, and trachoma [1]. The World Health Organization has expanded the list to 17 conditions (http://www.who.int/neglected_diseases/en/), and some authors add another 20 or so fungal, viral, and ectoparasitic infections to the list [1]. Here I argue that obstetric fistula should be classified as an NTD because it, like the infectious conditions listed above, is also a preventable, treatable malady responsible for much suffering, stigmatization, and lost productivity among the impoverished “bottom billion” of the world's population.
Highlights
The entities traditionally classified as NTDs all have an infectious etiology. They are caused by exotic pathogens that flourish largely in tropical climates. This common biological underpinning is important, it should not cause us to overlook other, non-infectious pathologies that are prevalent in poor countries and which produce enormous human suffering, because not all human pathology is infectious in origin and not all human suffering can be treated with antimicrobial agents
Because much human illness is due to derangements in physiological functioning rather than the tissue changes traditionally studied by pathologists under the microscope or what a culture plate grows in a microbiology lab, medical textbooks are shifting their perspective towards discussion of ‘‘disorders’’ of various organ systems rather than limiting themselves to the more traditional discussion of ‘‘diseases.’’ We need to think of NTDs not as neglected tropical diseases but rather as neglected tropical disorders, recognizing that they occur primarily in the tropics they are often linked more directly to poverty, economic insecurity, social instability, and institutional mismanagement than they are to climatic conditions
The classification of podoconiosis—a debilitating form of elephantiasis that mimics the classical infection produced by Wuchereria bancrofti—as an NTD is evidence of this type of paradigm shift [2,3]
Summary
The entities traditionally classified as NTDs all have an infectious etiology. They are caused by exotic pathogens that flourish largely (but not exclusively) in tropical climates. Because much human illness is due to derangements in physiological functioning rather than the tissue changes traditionally studied by pathologists under the microscope or what a culture plate grows in a microbiology lab, medical textbooks are shifting their perspective towards discussion of ‘‘disorders’’ of various organ systems rather than limiting themselves to the more traditional discussion of ‘‘diseases.’’ We need to think of NTDs not as neglected tropical diseases but rather as neglected tropical disorders, recognizing that they occur primarily in the tropics they are often linked more directly to poverty, economic insecurity, social instability, and institutional mismanagement than they are to climatic conditions. Once prevalent in Western countries, obstetric fistula is today largely confined to the cultures of tropical poverty.
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