Stolk Wilma A, Kulik Margarete C, le Rutte Epke A, Jacobson Julie, Richardus Jan Hendrik, de Vlas Sake J, Houweling Tanja A J
Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, United States of America.
PLoS Negl Trop Dis. 2016 May 12;10(5):e0004560. doi: 10.1371/journal.pntd.0004560. eCollection 2016 May.
The World Health Organization (WHO) has set ambitious time-bound targets for the control and elimination of neglected tropical diseases (NTDs). Investing in NTDs is not only seen as good value for money, but is also advocated as a pro-poor policy since it would improve population health in the poorest populations. We studied the extent to which the disease burden from nine NTDs (lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths, trachoma, Chagas disease, human African trypanosomiasis, leprosy, visceral leishmaniasis) was concentrated in the poorest countries in 1990 and 2010, and how this would change by 2020 in case the WHO targets are met.
Our analysis was based on 1990 and 2010 data from the Global Burden of Disease (GBD) 2010 study and on projections of the 2020 burden. Low and lower-middle income countries together accounted for 69% and 81% of the global burden in 1990 and 2010 respectively. Only the soil-transmitted helminths and Chagas disease caused a considerable burden in upper-middle income countries. The global burden from these NTDs declined by 27% between 1990 and 2010, but reduction largely came to the benefit of upper-middle income countries. Achieving the WHO targets would lead to a further 55% reduction in the global burden between 2010 and 2020 in each country income group, and 81% of the global reduction would occur in low and lower-middle income countries.
The GBD 2010 data show the burden of the nine selected NTDs in DALYs is strongly concentrated in low and lower-middle income countries, which implies that the beneficial impact of NTD control eventually also largely comes to the benefit of these same countries. While the nine NTDs became increasingly concentrated in developing countries in the 1990-2010 period, this trend would be rectified if the WHO targets were met, supporting the pro-poor designation.
世界卫生组织（WHO）已为控制和消除被忽视的热带病（NTDs）设定了雄心勃勃的限时目标。对NTDs进行投资不仅被视为具有成本效益，而且还被倡导为一项扶贫政策，因为它将改善最贫困人群的健康状况。我们研究了1990年和2010年9种NTDs（淋巴丝虫病、盘尾丝虫病、血吸虫病、土壤传播的蠕虫病、沙眼、恰加斯病、非洲人类锥虫病、麻风病、内脏利什曼病）的疾病负担在最贫穷国家中的集中程度，以及如果实现WHO的目标，到2020年这种情况将如何变化。
我们的分析基于《2010年全球疾病负担》（GBD 2010）研究中的1990年和2010年数据以及2020年负担的预测。低收入和中低收入国家在1990年和2010年分别占全球负担的69%和81%。只有土壤传播的蠕虫病和恰加斯病在中高收入国家造成了相当大的负担。这些NTDs的全球负担在1990年至2010年期间下降了27%，但减少的主要受益者是中高收入国家。实现WHO的目标将导致每个国家收入组在2010年至2020年期间全球负担进一步减少55%，全球减少量的81%将发生在低收入和中低收入国家。
GBD 2010数据显示，选定的9种NTDs的伤残调整生命年（DALYs）负担高度集中在低收入和中低收入国家，这意味着NTD控制的有益影响最终也主要惠及这些国家。虽然在1990 - 2010年期间，这9种NTDs在发展中国家的集中程度越来越高，但如果实现WHO的目标，这种趋势将得到纠正，这支持了其扶贫的特性。
