|
Burden of
Communicable Diseases
According to WHO, infectious and parasitic diseases cause
every year around
10.9 million deaths and result in a loss of an estimated 350
million DALYs. Of these about 56% deaths are caused
by HIV/AIDS, TB and malaria (World Health Report 2004). In the countries of
SEA Region, an estimated 2.62 million deaths are caused by infectious and
parasitic diseases. In the Region an estimated 89 million DALYs
are lost as a result of infectious diseases. The distribution of infectious
diseases globally conforms to the distribution of poverty.
Each year, 250 000 children in the region die of measles
and 750 000 adults of TB. More than 6.5 million people are living with
HIV/AIDS and 250 million are at risk for malaria. In addition, epidemics of infectious
diseases occur frequently and in new areas; many of them are predictable but
some of them take health system by surprise. SARS, avian influenza and Nipah virus are recent examples of such surprises and are
capable of causing enormous socio-economic hardship across countries beyond
national borders. Avian influenza is now anticipated to assume pandemic
proportions and requires global comprehensive and multisectoral
efforts to minimize its impact on human health and economy.
Other examples are Dengue/DHF and the new strain of
cholera spreading to areas where these were not found earlier. Age-old
diseases like leprosy and Kala-azar still cause
considerable suffering and misery and psycho-social disruption, particularly
in this region. Drug resistance is also a serious and an emerging threat.
Vulnerability of
region
The Region has about 30% of the population living below an
income of 1 USD per day. The interactions between infectious diseases,
poverty and undernutrition are strong. This poses a
special challenge to the effective control of infectious diseases in the
Region. The countries in the region are faced with the burden of non
communicable disease in addition to the infectious disease burden. This would
place a heavy strain on the fragile and overstretched health system in the
countries of the Region. Evidence is also linking to the occurrence of cancer
and degenerative diseases to infectious diseases
The scenario of infectious diseases is shaped by many
factors. There is a dramatic threat of resurgence of infectious diseases.
This is attributable to the natural behaviour of
the microbes which are complex and constantly evolving. They take advantage
of every opportunity to multiply, mutate, migrate, adapt and become resistant
to commonly used medicines and insecticides. H5N1 virus is the most striking
and recent example of this behaviour.
During the last few decades, while the arsenal of
antimicrobials is not expanding, the appearance and spread of antimicrobial
resistance is closing down the limited number of windows available for the
control of infectious diseases. The specter of emergence of drug resistance
is threatening to undermine the gains achieved. The countries in the region
are becoming the epicenter for antimalarial drug
resistance with more than 30% of the population at risk. TB drug resistance
is manifested by the hot spots. The resistance to chloramphenicol
in enteric fever and to penicillin in gonococcal
infection is a matter of concern. Treatment of drug resistant TB is more than
100 times the cost of DOTS medicines in the developing countries.
Success Stories
There is however many success stories too which indicate
that if effective approaches are scaled up both in coverage and quality along
with high level commitment and political will, we could overcome these
problems. For example, Guineaworm disease and small
pox have been eradicated from the countries in the Region. Polio is on the
verge of eradication and leprosy elimination is on the horizon. Much progress
has been made towards increasing the access to DOTS strategy and the
achievement of targets in Lymphatic filariasis (LF)
elimination programme is encouraging.
The political commitment made in recent years, the
participation of academic institutions, networking, intercountry
cooperation and planning are contributing to the success. The partnerships to
tackle communicable diseases are expanding. This trend has to be sustained.
The countries in the Region have been successful in mobilizing substantial
funds from GFATM to be able to scale up their response to the control of
HIV/AIDS, TB and Malaria.
Despite the bad news, there are many success stories
indicating that despite the challenges, these problems can be overcome with
sustained efforts. For example, guineaworm disease
has been eradicated, polio is on the verge of eradication and leprosy
elimination targets are likely to be achieved by the year 2005. Much progress
has been made in the implementation of DOTS strategy for the control of TB
and in mass drug treatment in elimination of lymphatic filariasis.
With the support of WHO, the countries in the region have succeeded in
mobilizing more than 1 billion US Dollars from GFATM for scaling up the
control of HIV/AIDS, TB and malaria.
|
