Abstract
Currently in sub-Saharan Africa, most patients with surgical problems that are routinely treatable in high-income countries never reach a health facility, or are treated at a facility with inadequate human or physical resources. These conditions lead to premature death or physical disability with a significant economic burden. Meanwhile, the last decade has seen the emergence of numerous “neglected tropical disease” (NTD) initiatives in global public health. As surgeons working with clinicians in sub-Saharan Africa, the momentum for NTDs causes us to ask: Shouldn't surgical conditions also be considered “neglected”? This article compares NTDs and surgical conditions in sub-Saharan Africa, considering their estimated burden and the cost-effectiveness of treatment, the scope of these conditions and associated global health disparities, and the effect of donor priorities on provision of surgical services. Lessons from NTD initiatives are analyzed among possible solutions to improving access to surgical services in sub-Saharan Africa.
Highlights
The development of human resources for surgical services and perioperative care has been neglected, and innovative strategies addressing clinician migration and capacitybuilding are needed
Injuries account for the greatest burden of surgical disease worldwide (63 million disability-adjusted life year (DALY)) and in Africa (10 million DALYs), and are followed by obstetric complications (4 million DALYs in Africa), malignancies, congenital anomalies, and perinatal conditions
Provision of emergency obstetric care has been highlighted as a Millennium Development Goal, with the United Nations calling for a 75% reduction in maternal mortality from 1990 to 2015
Summary
The “Other” Neglected Diseases in Global Public Health: Surgical Conditions in SubSaharan Africa. In sub-Saharan Africa, most patients with surgical problems that are routinely treatable in highincome countries never reach a health facility, or are treated at a facility with inadequate human or physical resources. These conditions lead to premature death or physical disability with a significant economic burden. Defined [1,2], NTDs are primarily parasitic and bacterial infectious diseases—excluding the “big three” infections (HIV, tuberculosis, and malaria)—that affect the world’s rural poor in low-income countries (LICs) and can be cheaply addressed [1,2] Despite their significant, primarily chronic disease burden, they are sidelined as “other diseases” in the Millennium Development Goals. The Neglected Diseases section focuses attention either on a specific disease or describes a novel strategy for approaching neglected health issues in general
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