Neglected tropical diseases in sub-saharan Africa: review of their prevalence, distribution, and disease burden

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Term Occurence Count Dictionary
cystic echinococcosis 1 infectiousdiseases
malaria 9 infectiousdiseases
amebiasis 4 infectiousdiseases
dengue hemorrhagic fever 1 infectiousdiseases
intestinal schistosomiasis 1 infectiousdiseases
trachoma 13 infectiousdiseases
yaws 2 infectiousdiseases
trichuriasis 10 infectiousdiseases
ascariasis 10 infectiousdiseases
cysticercosis 2 infectiousdiseases
dracunculiasis 2 infectiousdiseases
ivermectin 1 infectiousdiseasesdrugs
onchocerciasis 11 infectiousdiseases
toxoplasmosis 6 infectiousdiseases
loiasis 2 infectiousdiseases
schistosomiasis 22 infectiousdiseases
sleeping sickness 1 infectiousdiseases
visceral leishmaniasis 2 infectiousdiseases
yellow fever 5 infectiousdiseases
Rift Valley fever 4 infectiousdiseases
filarial elephantiasis 1 infectiousdiseases
rabies 3 infectiousdiseases
leprosy 5 infectiousdiseases
paragonimiasis 1 infectiousdiseases
strongyloidiasis 1 infectiousdiseases
taeniasis 1 infectiousdiseases
tuberculosis 9 infectiousdiseases
urinary schistosomiasis 1 infectiousdiseases
AIDS 8 infectiousdiseases
African tick-bite fever 3 infectiousdiseases
diarrhea 3 infectiousdiseases
echinococcosis 1 infectiousdiseases
salmonellosis 4 infectiousdiseases
trypanosomiasis 5 infectiousdiseases
abscess 1 infectiousdiseases
filariasis 5 infectiousdiseases
spotted fever 1 infectiousdiseases
typhoid fever 6 infectiousdiseases

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Select Drug Character Offset Drug Term Instance
ivermectin 26781 the subcutaneous tissues, but the greatest concern about the infection is the risk associated with ivermectin treatments for onchocerciasis co-infections [98]. Angola, Cameroon, and DRC exhibit the highest rates
Select Disease Character Offset Disease Term Instance
AIDS 1327 of the world's number of cases and possibly associated with increased horizontal transmission of HIV/ AIDS . Lymphatic filariasis (46–51 million cases) and onchocerciasis (37 million cases) are also widespread
AIDS 12787 estimates.10.1371/journal.pntd.0000412.t006Table 6Ranking by Disease Burden (DALYs) and Comparison of Total NTDs with HIV/ AIDS , Tuberculosis, and Malaria.DiseaseDisease Burden in SSA (DALYs)ReferenceHIV/AIDS64.0 million[45]Malaria40.9
AIDS 12868 Total NTDs with HIV/AIDS, Tuberculosis, and Malaria.DiseaseDisease Burden in SSA (DALYs)ReferenceHIV/ AIDS 64.0 million[45]Malaria40.9 million[45]NTDs8.6–21.2 millionHelminth infections5.4–18.3 millionTuberculosis9.3
AIDS 20645 dysfunction and infertility [75]. Genital schistosomiasis also promotes the horizontal transmission of HIV/ AIDS in SSA [76]. Intestinal schistosomiasis from S. mansoni causes most of the remaining cases in SSA. An
AIDS 30999 anthroponotic infection [103],[104]. VL is also an important opportunistic infection associated with HIV/ AIDS in East Africa [41], especially in the Tigray region on the Sudan–Eritrea border where soldiers and
AIDS 32332 West Africa [109] indicate a high seroprevalence in children. Toxoplasmosis is considered a common AIDS defining illness in Ethiopia [110], Nigeria [111], and presumably elsewhere in SSA.Bacterial InfectionsThe
AIDS 43058 that NTDs may be responsible for as much as one-half and one-third of the region's malaria and HIV/ AIDS disease burden, respectively, helminth control should continue to be prioritized by public health experts,
AIDS 44822 all Africa's NTDs is an essential step towards prioritizing these conditions relative to ongoing HIV/ AIDS and malaria control efforts supported by private foundations and the Group of Eight nations
African tick-bite fever 11453 tuberculosisDengue feverPodoconiosisTaeniaisisToxoplasmosisTick-borne relapsing feverRift Valley feverParagonimiasis African tick-bite fever ChikungunyaOesophagostomiasisTyphoid feverRabiesNon-typhoidal salmonellosisYaws10.1371/journal.pntd.0000412.t005Table
African tick-bite fever 37329 personnel have inadequate awareness of this infection and frequently confuse it with malaria [124]. African tick-bite fever . African tick-bite fever is a spotted fever group rickettsiosis caused by Rickettsia africae and transmitted
African tick-bite fever 37354 inadequate awareness of this infection and frequently confuse it with malaria [124].African tick-bite fever. African tick-bite fever is a spotted fever group rickettsiosis caused by Rickettsia africae and transmitted by Amblyomma ticks
Rift Valley fever 6756 fever and non-typhoidal salmonellosis), the tick-borne zoonoses, and yaws; and viral infections such as Rift Valley fever , for which there is insufficient information available in order to estimate their prevalence in SSA.
Rift Valley fever 11422 ConditionsStrongyloidiasisAmebiasisBovine tuberculosisDengue feverPodoconiosisTaeniaisisToxoplasmosisTick-borne relapsing fever Rift Valley fever ParagonimiasisAfrican tick-bite feverChikungunyaOesophagostomiasisTyphoid feverRabiesNon-typhoidal salmonellosisYaws10.1371/journal.pntd.0000412.t005Table
Rift Valley fever 39274 of the disease.Viral InfectionsArboviral infections, including yellow fever, dengue, Chikungunya and Rift Valley fever [136], and rabies stand out as the most important viral NTDs. As with the bacterial infections, there
Rift Valley fever 40586 Cameroon, CAR, Kenya, Namibia, Nigeria, Senegal, South Africa, Tanzania, Uganda, and Zimbabwe [125]. Rift Valley fever is a bunyavirus infection transmitted by mosquitoes, which is a problem not only for humans but also
abscess 31992 been observed that invasive E. histolytica infection is associated more commonly with amebic liver abscess than colitis [105].ToxoplasmosisThe study of toxoplasmosis has also been neglected in SSA, although
amebiasis 1973 million cases). However, there are little or no data on some very important protozoan infections, e.g., amebiasis and toxoplasmosis; bacterial infections, e.g., typhoid fever and non-typhoidal salmonellosis, the tick-borne
amebiasis 6558 as shown in Table 4, there are more than a dozen important NTDs, including the protozoan infections, amebiasis and toxoplasmosis; bacterial infections such as Salmonella infections (both typhoid fever and non-typhoidal
amebiasis 31472 Burkina Faso capital [41], and in Sudanese refugee camps in Chad [43].AmebiasisThe epidemiology of amebiasis is poorly understood in SSA because few studies differentiate true infection caused by Entamoeba histolytica
amebiasis 31771 Based on seroprevalence studies in Sudan, Cote d'Ivoire, and South Africa, however, the distribution of amebiasis is believed to be widespread [105]. Amebiasis has also been reported from Nigeria [106]. In South Africa
ascariasis 13052 infections5.4–18.3 millionTuberculosis9.3 million[45]Helminth InfectionsSTH infections (hookworm infection, ascariasis , trichuriasis)Since the global prevalence of STH infections was first estimated by Stoll over 60 years
ascariasis 13645 estimated 181 million school-aged children in SSA, almost one-half (89 million) are infected with hookworm, ascariasis , trichuriasis, or some combination of these STH infections [4]. Typically, children exhibit higher STH
ascariasis 16975 in SSA with Ascaris and Trichuris, respectively, with 36 million school-aged children infected with ascariasis and 44 million with trichuriasis [4]. For both infections the largest number of cases occurs in Nigeria,
ascariasis 17256 millions of cases are also found in Ethiopia, DRC, and South Africa (Table 3). Compared to hookworm, both ascariasis and trichuriasis exhibit a more patchy distribution in SSA, with the highest prevalence occurring in
ascariasis 17483 Central and West Africa, eastern Madagascar, and southeast Africa [4]. In contrast to the high rates of ascariasis and trichuriasis in South Africa [63],[64], hookworm is less common except in KwaZulu-Natal [52]. Moreover,
ascariasis 17629 [63],[64], hookworm is less common except in KwaZulu-Natal [52]. Moreover, higher prevalence rates of ascariasis and trichuriasis are often present in Africa's urban areas compared to rural areas, unlike hookworm,
ascariasis 17949 eggs to survive in urban environments, so that increased urbanization in SSA may promote emergence of ascariasis and trichuriasis in the future.Other STH infectionsStrongyloidiasis causes diarrhea and malnutrition
ascariasis 24432 DALYs lost annually from LF rank it third or fourth behind hookworm and schistosomiasis (and possibly ascariasis ) as the most important NTD in SSA (Table 5). LF is also associated with huge economic losses, impairing
ascariasis 41865 estimated to have the highest prevalence of helminth infections such as hookworm, schistosomiasis, ascariasis , trichuriasis, and LF in SSA, as well as the second highest registered prevalence of leprosy (Table
ascariasis 42431 infection and trichuriasis (and possibly LF), and the third highest prevalence of schistosomiasis and ascariasis (Table 3). Together, Nigeria and DRC account for approximately one-third of the helminth infections
cystic echinococcosis 23132 cysticercosis in SSA remains largely unstudied. Both taeniasis caused by the beef tapeworm Taenia saginata and cystic echinococcosis are highly prevalent in East Africa, especially in Ethiopia and Sudan [89],[90].Filarial infections
cysticercosis 22767 elsewhere in eastern Africa [84], southern Africa [85],[86], and Cameroon [87]. It has been suggested that cysticercosis may account for the presence of subcutaneous nodules that erroneously have been linked with onchocerciasis
cysticercosis 23021 seizures following mass drug administration with anthelminthics [88]. However, the full disease burden of cysticercosis in SSA remains largely unstudied. Both taeniasis caused by the beef tapeworm Taenia saginata and cystic
dengue hemorrhagic fever 40360 [137]. All four dengue viral types have been reported from Africa, although to date no epidemic of dengue hemorrhagic fever has been reported [138]. Epidemics of Chikungunya fever have also been reported in Angola, Burundi,
diarrhea 18035 emergence of ascariasis and trichuriasis in the future.Other STH infectionsStrongyloidiasis causes diarrhea and malnutrition in SSA, although there is little information on its distribution or disease burden
diarrhea 18274 the difficulties in diagnosing this infection. In one study, strongyloidiasis accounted for 5.3% of diarrhea in malnourished Nigerian children [65]. Two other intestinal nematode infections are focally endemic.
diarrhea 20809 causes most of the remaining cases in SSA. An estimated 4.4 million people with S. mansoni have bloody diarrhea and bowel ulceration, and 8.5 million develop hepatomegaly and/or associated periportal liver fibrosis,
dracunculiasis 23288 Africa, especially in Ethiopia and Sudan [89],[90].Filarial infections (LF, onchocerciasis, loiasis, and dracunculiasis )LF. Approximately 40% of the world's 120 million cases of LF occur in SSA (approximately 46–51 million
dracunculiasis 27280 as a spatial model based on environmental factors [98].Dracunculiasis. All of the world's cases of dracunculiasis occur in SSA. In 2007, only 9,585 cases were reported (Table 2), a 99% reduction in the number of cases
echinococcosis 23139 SSA remains largely unstudied. Both taeniasis caused by the beef tapeworm Taenia saginata and cystic echinococcosis are highly prevalent in East Africa, especially in Ethiopia and Sudan [89],[90].Filarial infections
filarial elephantiasis 24735 resulting from the disability linked to hydrocele in men [95],[96]. In addition to LF, endemic non- filarial elephantiasis (podoconiosis) is widespread in SSA, with the areas of highest prevalence in the highlands of East Africa
filariasis 1343 number of cases and possibly associated with increased horizontal transmission of HIV/AIDS. Lymphatic filariasis (46–51 million cases) and onchocerciasis (37 million cases) are also widespread in SSA, each disease
filariasis 3154 most common NTDs, such as the soil-transmitted helminth (STH) infections, schistosomiasis, lymphatic filariasis (LF), trachoma, and onchocerciasis together affecting more than 500 million people [3], [6]–[8]. Because
filariasis 8464 million25%93%[21]Ascariasis173 million25%a21%2b[3],[24]Trichuriasis162 million24%a27%b[3],[24]Lymphatic filariasis 46–51 million6%–9%37%–44%c[25]–[28]Onchocerciasis37 million5%>99%[15],[29]Active trachoma30 million3%48%[30]Loiasis≤13
filariasis 10175 million)Nigeria 34 millionDR Congo 26 millionSouth Africa 22 millionEthiopia 21 million[24]Lymphatic filariasis (382–394 million at risk)Nigeria 106 million at riskDR Congo 49 million at riskTanzania 31 million
filariasis 11967 million93%1.6–4.2 million[21],[45],[47]Ascariasis1.8–10.5 million21%0.4–2.2 million[46]–[48]Lymphatic filariasis 5.8 million35%2.0 million[45]Trichuriasis1.8–6.4 million27%0.5–1.7 million[46]–[48]Human African
intestinal schistosomiasis 21071 mansoni infection, with approximately 130,000 deaths [22],[73]. S. intercalatum causes a second form of intestinal schistosomiasis , but with a restricted distribution in West and Central Africa [77].In addition to the organ-specific
leprosy 35382 bodies of water, and age less than 15 years [37],[38].Leprosy. In Africa, the number of new cases of leprosy has declined every year since 2001 [35]. At the beginning of 2008, approximately 30,055 cases of leprosy
leprosy 35487 leprosy has declined every year since 2001 [35]. At the beginning of 2008, approximately 30,055 cases of leprosy were registered in Africa with 31,037 new cases in 2007 (Table 2) [35]. These represent approximately
leprosy 41961 schistosomiasis, ascariasis, trichuriasis, and LF in SSA, as well as the second highest registered prevalence of leprosy (Table 3). In addition, arboviral and other zoonotic infections are common in Nigeria, including yellow
leprosy 42260 southeastern areas of the country [142]. Similarly, DRC exhibits the highest prevalence of HAT and leprosy in SSA, as well as the second highest prevalence of hookworm infection and trichuriasis (and possibly
leprosy 42546 (Table 3). Together, Nigeria and DRC account for approximately one-third of the helminth infections and leprosy in SSA, as well as up to one-fifth of the cases of HAT. A targeted approach for these two countries
loiasis 23275 in East Africa, especially in Ethiopia and Sudan [89],[90].Filarial infections (LF, onchocerciasis, loiasis , and dracunculiasis)LF. Approximately 40% of the world's 120 million cases of LF occur in SSA (approximately
loiasis 27164 clinical history of eyeworm infection and known as RAPLOA is in use to evaluate local prevalence of loiasis , as well as a spatial model based on environmental factors [98].Dracunculiasis. All of the world's cases
malaria 788 Africa (SSA), and together produce a burden of disease that may be equivalent to up to one-half of SSA's malaria disease burden and more than double that caused by tuberculosis. Approximately 85% of the NTD disease
malaria 7528 determined that the total burden of NTDs in SSA is possibly as high as one-half the disease burden caused by malaria and twice the disease burden caused by tuberculosis in SSA (Table 6), suggesting that the NTDs represent
malaria 15752 million school-aged children with hookworm are at risk for coincident co-infection with falciparum malaria [5],[55]. Both Necator americanus and Ancylostoma duodenale are found in SSA, with the former representing
malaria 22290 lead to severe anemia [78]–[80]. A relationship has also been proposed between schistosomiasis and malaria [81].Among the other platyhelminth infections in SSA, paragonimiasis has been reported from eastern
malaria 37021 remitting fever, and in some parts of Senegal and elsewhere in West Africa this infection is second only to malaria as the most common cause of outpatient visits [124]. However, detailed information on the precise incidence
malaria 37315 underdiagnosed and medical personnel have inadequate awareness of this infection and frequently confuse it with malaria [124].African tick-bite fever. African tick-bite fever is a spotted fever group rickettsiosis caused
malaria 38546 bacteremia typically presents in children less than 3 years of age, especially those with coincident anemia, malaria , malnutrition, and HIV infection [131]–[133]. Among adults, NTS is most commonly associated with advanced
malaria 43042 (Table 6). Given that NTDs may be responsible for as much as one-half and one-third of the region's malaria and HIV/AIDS disease burden, respectively, helminth control should continue to be prioritized by public
malaria 44831 Africa's NTDs is an essential step towards prioritizing these conditions relative to ongoing HIV/AIDS and malaria control efforts supported by private foundations and the Group of Eight nations
onchocerciasis 1382 with increased horizontal transmission of HIV/AIDS. Lymphatic filariasis (46–51 million cases) and onchocerciasis (37 million cases) are also widespread in SSA, each disease representing a significant cause of disability
onchocerciasis 3185 soil-transmitted helminth (STH) infections, schistosomiasis, lymphatic filariasis (LF), trachoma, and onchocerciasis together affecting more than 500 million people [3], [6]–[8]. Because of their adverse effects on
onchocerciasis 6093 Helminth infections, especially the STH infections, schistosomiasis, and the filarial infections LF and onchocerciasis , are the most common NTDs in SSA, followed by trachoma and other bacterial infections [3], [21]–[38].
onchocerciasis 22873 cysticercosis may account for the presence of subcutaneous nodules that erroneously have been linked with onchocerciasis and may be responsible for seizures following mass drug administration with anthelminthics [88]. However,
onchocerciasis 23259 highly prevalent in East Africa, especially in Ethiopia and Sudan [89],[90].Filarial infections (LF, onchocerciasis , loiasis, and dracunculiasis)LF. Approximately 40% of the world's 120 million cases of LF occur in SSA
onchocerciasis 24978 some West African countries [97].Onchocerciasis. More than 99% of the estimated 37 million cases of onchocerciasis occur in SSA (Table 2) [15], distributed in a wide belt that extends from Senegal in the west to Ethiopia
onchocerciasis 25225 in the north to Angola and Malawi in the south [15],[29]. Based on rapid epidemiological mapping of onchocerciasis (REMO), a non-invasive and practical tool for distribution and disease prevalence, it is estimated that
onchocerciasis 25950 (also known as “troublesome itching”) [29]. In hyperendemic communities where the prevalence of onchocerciasis exceeds 60%, blindness can occur in 10% or more of some savanna populations, while OSD can affect more
onchocerciasis 26251 disability as well as severe socioeconomic consequences. It is estimated that 40% of the DALYs lost from onchocerciasis result from blindness, while 60% are from OSD [29].Loiasis. The African eyeworm has a high prevalence
onchocerciasis 26807 but the greatest concern about the infection is the risk associated with ivermectin treatments for onchocerciasis co-infections [98]. Angola, Cameroon, and DRC exhibit the highest rates of co-endemicity and consequently,
onchocerciasis 42860 indicates that helminth infections, especially the three major STH infections, schistosomiasis, LF, and onchocerciasis , account for up to 85% of the disease burden caused by NTDs in SSA (Table 6). Given that NTDs may be
paragonimiasis 22352 proposed between schistosomiasis and malaria [81].Among the other platyhelminth infections in SSA, paragonimiasis has been reported from eastern Nigeria and southwestern Cameroon [82], although there are no estimates
rabies 39303 InfectionsArboviral infections, including yellow fever, dengue, Chikungunya and Rift Valley fever [136], and rabies stand out as the most important viral NTDs. As with the bacterial infections, there are few estimates
rabies 41013 in the Indian and Pacific Oceans [139].RabiesFollowing India, the greatest number of cases of human rabies transmitted from dogs occurs in SSA [140]. In Limpopo Province (South Africa) alone, 100 cases occurred
rabies 42080 In addition, arboviral and other zoonotic infections are common in Nigeria, including yellow fever, rabies , and toxoplasmosis [134], while Buruli ulcer is found in the southern and southeastern areas of the
salmonellosis 2062 infections, e.g., amebiasis and toxoplasmosis; bacterial infections, e.g., typhoid fever and non-typhoidal salmonellosis , the tick-borne bacterial zoonoses, and non-tuberculosis mycobaterial infections; and arboviral infections.
salmonellosis 6676 toxoplasmosis; bacterial infections such as Salmonella infections (both typhoid fever and non-typhoidal salmonellosis ), the tick-borne zoonoses, and yaws; and viral infections such as Rift Valley fever, for which there
salmonellosis 11538 feverParagonimiasisAfrican tick-bite feverChikungunyaOesophagostomiasisTyphoid feverRabiesNon-typhoidal salmonellosis Yaws10.1371/journal.pntd.0000412.t005Table 5Disease Burden (DALYs) in SSA Resulting from the NTDs.DiseaseEstimated
salmonellosis 32558 bacterial NTDs are trachoma, mycobacterial infections, tick-borne zoonoses, typhoid fever and non-typhoidal salmonellosis , and yaws. With the exception of trachoma, data on the regional prevalence and/or incidence of these
schistosomiasis 3127 in SSA [3]–[6], with the most common NTDs, such as the soil-transmitted helminth (STH) infections, schistosomiasis , lymphatic filariasis (LF), trachoma, and onchocerciasis together affecting more than 500 million people
schistosomiasis 6041 with the highest prevalence of each of the NTDs. Helminth infections, especially the STH infections, schistosomiasis , and the filarial infections LF and onchocerciasis, are the most common NTDs in SSA, followed by trachoma
schistosomiasis 7145 of estimates for the NTDs in SSA is provided in Table 5. DALY estimates for the STH infections and schistosomiasis were obtained by adjusting a wide range of available global estimates according to the percentage of
schistosomiasis 12428 million[45]Total NTDs≤56.6 million15%–37%8.6 million–21.2 million[47]DALY estimates for STH infections and schistosomiasis were obtained by adjusting a wide range of available global estimates according to the percentage of
schistosomiasis 18618 Zimbabwe [67].Schistosomiasis and other platyhelminthiasesOf the world's 207 million estimated cases of schistosomiasis , 93% occur in SSA (192 million) (Table 2), with the largest number in Nigeria (29 million) followed
schistosomiasis 19169 examples where the infection has emerged or where there has been a dramatic rise in the prevalence of schistosomiasis as a result of irrigation project construction [21],[71]. Climate change and global warming may also
schistosomiasis 19350 change and global warming may also be factors [72].The highest prevalence and intensities of human schistosomiasis occur in school-aged children, adolescents, and young adults who also suffer from the highest morbidity
schistosomiasis 19514 young adults who also suffer from the highest morbidity and mortality. There are two major forms of schistosomiasis found in SSA. Approximately two-thirds of the schistosomiasis cases are due to infection caused by Schistosoma
schistosomiasis 19576 mortality. There are two major forms of schistosomiasis found in SSA. Approximately two-thirds of the schistosomiasis cases are due to infection caused by Schistosoma haematobium, which represents an important cause of
schistosomiasis 20170 [73]. Renal failure accounts for a large percentage of the estimated 150,000 deaths from urinary tract schistosomiasis in SSA, and there is also a significant association between major bladder wall pathology and squamous
schistosomiasis 20364 pathology and squamous cell carcinoma [74]. A significant percentage of women and men with urinary schistosomiasis acquire genital ulcers and other lesions [22]. In the former, urogenital schistosomiasis is a significant
schistosomiasis 20453 with urinary schistosomiasis acquire genital ulcers and other lesions [22]. In the former, urogenital schistosomiasis is a significant cause of poor reproductive health, including sexual dysfunction and infertility [75].
schistosomiasis 20580 significant cause of poor reproductive health, including sexual dysfunction and infertility [75]. Genital schistosomiasis also promotes the horizontal transmission of HIV/AIDS in SSA [76]. Intestinal schistosomiasis from S.
schistosomiasis 20674 Genital schistosomiasis also promotes the horizontal transmission of HIV/AIDS in SSA [76]. Intestinal schistosomiasis from S. mansoni causes most of the remaining cases in SSA. An estimated 4.4 million people with S. mansoni
schistosomiasis 21082 infection, with approximately 130,000 deaths [22],[73]. S. intercalatum causes a second form of intestinal schistosomiasis , but with a restricted distribution in West and Central Africa [77].In addition to the organ-specific
schistosomiasis 21669 fitness, and impaired cognitive development [22],[23]. The current disease burden calculations for schistosomiasis range between 1.7 and 4.5 million DALYs lost annually (1.6 and 4.2 million DALYs in SSA) (Table 5),
schistosomiasis 22270 common in SSA and can lead to severe anemia [78]–[80]. A relationship has also been proposed between schistosomiasis and malaria [81].Among the other platyhelminth infections in SSA, paragonimiasis has been reported from
schistosomiasis 24402 SSA. The estimated 2.0 million DALYs lost annually from LF rank it third or fourth behind hookworm and schistosomiasis (and possibly ascariasis) as the most important NTD in SSA (Table 5). LF is also associated with huge
schistosomiasis 41848 burden. Nigeria is estimated to have the highest prevalence of helminth infections such as hookworm, schistosomiasis , ascariasis, trichuriasis, and LF in SSA, as well as the second highest registered prevalence of leprosy
schistosomiasis 42411 prevalence of hookworm infection and trichuriasis (and possibly LF), and the third highest prevalence of schistosomiasis and ascariasis (Table 3). Together, Nigeria and DRC account for approximately one-third of the helminth
schistosomiasis 42835 information presented here indicates that helminth infections, especially the three major STH infections, schistosomiasis , LF, and onchocerciasis, account for up to 85% of the disease burden caused by NTDs in SSA (Table 6).
schistosomiasis 43259 health experts, health ministries, and global policy makers. In addition, based on revised estimates for schistosomiasis that fully consider the morbidities of chronic infection including effects on anemia, malnutrition,
sleeping sickness 29042 HAT is a zoonosis transmitted from cattle and other mammals, which produces an acute and fulminating sleeping sickness [39],[100]. Populations in the age group between 15 and 45 years and living in remote rural areas are
spotted fever 37383 and frequently confuse it with malaria [124].African tick-bite fever. African tick-bite fever is a spotted fever group rickettsiosis caused by Rickettsia africae and transmitted by Amblyomma ticks [125]. It is known
strongyloidiasis 18235 disease burden (Table 4), in part because of the difficulties in diagnosing this infection. In one study, strongyloidiasis accounted for 5.3% of diarrhea in malnourished Nigerian children [65]. Two other intestinal nematode
taeniasis 23074 anthelminthics [88]. However, the full disease burden of cysticercosis in SSA remains largely unstudied. Both taeniasis caused by the beef tapeworm Taenia saginata and cystic echinococcosis are highly prevalent in East Africa,
toxoplasmosis 1987 However, there are little or no data on some very important protozoan infections, e.g., amebiasis and toxoplasmosis ; bacterial infections, e.g., typhoid fever and non-typhoidal salmonellosis, the tick-borne bacterial
toxoplasmosis 6572 Table 4, there are more than a dozen important NTDs, including the protozoan infections, amebiasis and toxoplasmosis ; bacterial infections such as Salmonella infections (both typhoid fever and non-typhoidal salmonellosis),
toxoplasmosis 27865 protozoan infections in SSA, accounting for almost 2 million DALYs lost annually (Table 5). Amebiasis and toxoplasmosis are also highly endemic in SSA, but there are few estimates of their prevalence, incidence, or disease
toxoplasmosis 32045 is associated more commonly with amebic liver abscess than colitis [105].ToxoplasmosisThe study of toxoplasmosis has also been neglected in SSA, although investigations conducted in Sudan [107] and Burkina Faso [108]
toxoplasmosis 42092 arboviral and other zoonotic infections are common in Nigeria, including yellow fever, rabies, and toxoplasmosis [134], while Buruli ulcer is found in the southern and southeastern areas of the country [142]. Similarly,
toxoplasmosis 44285 prevalence, incidence, and disease burden estimates for many of the non-helminth NTDs. Amebiasis and toxoplasmosis stand out as both common and serious protozoan infections for which we have very little information.
trachoma 1820 almost 100,000 people, primarily in areas of conflict in SSA where they cause high mortality, and where trachoma is the most prevalent bacterial NTD (30 million cases). However, there are little or no data on some
trachoma 3171 such as the soil-transmitted helminth (STH) infections, schistosomiasis, lymphatic filariasis (LF), trachoma , and onchocerciasis together affecting more than 500 million people [3], [6]–[8]. Because of their
trachoma 6154 schistosomiasis, and the filarial infections LF and onchocerciasis, are the most common NTDs in SSA, followed by trachoma and other bacterial infections [3], [21]–[38]. Human African trypanosomiasis (HAT) and leishmaniasis
trachoma 8563 filariasis46–51 million6%–9%37%–44%c[25]–[28]Onchocerciasis37 million5%>99%[15],[29]Active trachoma 30 million3%48%[30]Loiasis≤13 million1%–2%100%[31],[32]Yellow fever180,0000.02%90%[33],[34]Human
trachoma 32469 [110], Nigeria [111], and presumably elsewhere in SSA.Bacterial InfectionsThe major bacterial NTDs are trachoma , mycobacterial infections, tick-borne zoonoses, typhoid fever and non-typhoidal salmonellosis, and yaws.
trachoma 32605 tick-borne zoonoses, typhoid fever and non-typhoidal salmonellosis, and yaws. With the exception of trachoma , data on the regional prevalence and/or incidence of these diseases area severely lacking, as are disease
trachoma 32944 [112]–[114], and the most important bacterial infection in SSA. Of the 63 million cases of active trachoma globally (although some estimates indicate 84 million cases worldwide), 48% occur in SSA (30 million)
trachoma 33123 worldwide), 48% occur in SSA (30 million) (Table 2) [115]. Nearly half of the global disease burden of active trachoma and a quarter of end-stage trichiasis are concentrated in ten countries alone, with six of these located
trachoma 33267 trichiasis are concentrated in ten countries alone, with six of these located in SSA [116]. Geographically, trachoma is distributed mainly in the savannah areas of East and Central Africa and the Sahel of West Africa
trachoma 33588 Kenya, and Niger (2.0–2.1 million each) (Table 3). Approximately one-half of the 2.3 million global trachoma disease burden in DALYs is attributed to SSA (Table 4). Like the other NTDs, trachoma is sustained in
trachoma 33674 million global trachoma disease burden in DALYs is attributed to SSA (Table 4). Like the other NTDs, trachoma is sustained in a setting of poverty. Additional risk factors for trachoma transmission include crowding
trachoma 33749 4). Like the other NTDs, trachoma is sustained in a setting of poverty. Additional risk factors for trachoma transmission include crowding and household clustering, insufficient access to water, poor sanitation
trachoma 34130 day, and only 27% have access to water and 16% to improved sanitation conditions, the prevalence of trachoma is ranked among the highest worldwide [117],[118]. Hyper-endemic areas in SSA have been found to have
trichuriasis 13064 millionTuberculosis9.3 million[45]Helminth InfectionsSTH infections (hookworm infection, ascariasis, trichuriasis )Since the global prevalence of STH infections was first estimated by Stoll over 60 years ago [31], the
trichuriasis 13657 million school-aged children in SSA, almost one-half (89 million) are infected with hookworm, ascariasis, trichuriasis , or some combination of these STH infections [4]. Typically, children exhibit higher STH intensities
trichuriasis 16702 burden in SSA reflects its importance as a cause of maternal and child anemia (Table 5).Ascariasis and trichuriasis . The highest intensity Ascaris and Trichuris infections occur in school-aged children [4]. It is estimated
trichuriasis 17006 Trichuris, respectively, with 36 million school-aged children infected with ascariasis and 44 million with trichuriasis [4]. For both infections the largest number of cases occurs in Nigeria, where co-infections with hookworm
trichuriasis 17271 also found in Ethiopia, DRC, and South Africa (Table 3). Compared to hookworm, both ascariasis and trichuriasis exhibit a more patchy distribution in SSA, with the highest prevalence occurring in equatorial Central
trichuriasis 17498 Africa, eastern Madagascar, and southeast Africa [4]. In contrast to the high rates of ascariasis and trichuriasis in South Africa [63],[64], hookworm is less common except in KwaZulu-Natal [52]. Moreover, higher prevalence
trichuriasis 17644 hookworm is less common except in KwaZulu-Natal [52]. Moreover, higher prevalence rates of ascariasis and trichuriasis are often present in Africa's urban areas compared to rural areas, unlike hookworm, which is more evenly
trichuriasis 17964 in urban environments, so that increased urbanization in SSA may promote emergence of ascariasis and trichuriasis in the future.Other STH infectionsStrongyloidiasis causes diarrhea and malnutrition in SSA, although
trichuriasis 41877 to have the highest prevalence of helminth infections such as hookworm, schistosomiasis, ascariasis, trichuriasis , and LF in SSA, as well as the second highest registered prevalence of leprosy (Table 3). In addition,
trichuriasis 42343 prevalence of HAT and leprosy in SSA, as well as the second highest prevalence of hookworm infection and trichuriasis (and possibly LF), and the third highest prevalence of schistosomiasis and ascariasis (Table 3). Together,
trypanosomiasis 1665 There is a dearth of information on Africa's non-helminth NTDs. The protozoan infections, human African trypanosomiasis and visceral leishmaniasis, affect almost 100,000 people, primarily in areas of conflict in SSA where
trypanosomiasis 6226 common NTDs in SSA, followed by trachoma and other bacterial infections [3], [21]–[38]. Human African trypanosomiasis (HAT) and leishmaniasis are the most common serious protozoan infections, especially in areas of conflict
trypanosomiasis 8680 million3%48%[30]Loiasis≤13 million1%–2%100%[31],[32]Yellow fever180,0000.02%90%[33],[34]Human African trypanosomiasis 50,000–70,000 (17,000 new cases annually)<0.01%100%[39],[40]Leprosy30,055 (registered prevalence);
trypanosomiasis 10637 5 reported cases in 2006Cameroon, CAR, Ghana, and Guinea 1 case each in 2006[33],[34]Human African trypanosomiasis (50,000–70,000)DR Congo 10,369Angola 2,280Sudan 1,766Congo 839[39]Leprosy (30,055)DR Congo 6,502Nigeria
trypanosomiasis 12080 million35%2.0 million[45]Trichuriasis1.8–6.4 million27%0.5–1.7 million[46]–[48]Human African trypanosomiasis 1.5 million100%1.5 million[45]Trachoma2.3 million52%1.2 million[45]Onchocerciasis0.5 million99%0.5 million[45]Leishmaniasis2.1
tuberculosis 847 be equivalent to up to one-half of SSA's malaria disease burden and more than double that caused by tuberculosis . Approximately 85% of the NTD disease burden results from helminth infections. Hookworm infection occurs
tuberculosis 2120 infections, e.g., typhoid fever and non-typhoidal salmonellosis, the tick-borne bacterial zoonoses, and non- tuberculosis mycobaterial infections; and arboviral infections. Thus, the overall burden of Africa's NTDs may be
tuberculosis 7575 possibly as high as one-half the disease burden caused by malaria and twice the disease burden caused by tuberculosis in SSA (Table 6), suggesting that the NTDs represent a formidable public health challenge in the region.
tuberculosis 11337 InfectionsProtozoan InfectionsBacterial InfectionsViral InfectionsOther ConditionsStrongyloidiasisAmebiasisBovine tuberculosis Dengue feverPodoconiosisTaeniaisisToxoplasmosisTick-borne relapsing feverRift Valley feverParagonimiasisAfrican
tuberculosis 35977 cases occured in DRC (8,820), Nigeria (46,650), Ethiopia (4,187), and Mozambique (2,610) [35].Bovine tuberculosis . Tuberculosis is a major opportunistic infection among HIV-infected populations in SSA and it is estimated
tuberculosis 36149 HIV-infected populations in SSA and it is estimated that 70% (6 million) of the people co-infected with tuberculosis and HIV live in SSA [122]. The proportion of African tuberculosis due to Mycobacterium bovis is unknown
tuberculosis 36215 million) of the people co-infected with tuberculosis and HIV live in SSA [122]. The proportion of African tuberculosis due to Mycobacterium bovis is unknown [123], although it is estimated that approximately 50% of African
tuberculosis 36420 of African cattle live in countries without control measures for the disease [122]. In SSA, bovine tuberculosis frequently passes from livestock to wildlife, while human populations become infected through the consumption
tuberculosis 36635 consumption of raw milk and raw meat (including bushmeat) [122]. The prevalence and incidence of bovine tuberculosis in SSA has not been established.Tick-borne zoonosesTick-borne relapsing fever (TBRF). TBRF is an acute
typhoid fever 2030 very important protozoan infections, e.g., amebiasis and toxoplasmosis; bacterial infections, e.g., typhoid fever and non-typhoidal salmonellosis, the tick-borne bacterial zoonoses, and non-tuberculosis mycobaterial
typhoid fever 6644 protozoan infections, amebiasis and toxoplasmosis; bacterial infections such as Salmonella infections (both typhoid fever and non-typhoidal salmonellosis), the tick-borne zoonoses, and yaws; and viral infections such as Rift
typhoid fever 32526 SSA.Bacterial InfectionsThe major bacterial NTDs are trachoma, mycobacterial infections, tick-borne zoonoses, typhoid fever and non-typhoidal salmonellosis, and yaws. With the exception of trachoma, data on the regional prevalence
typhoid fever 37812 North America [125],[126].Salmonella and other enteric infectionsAlthough well-publicized outbreaks of typhoid fever (Salmonella typhi infection) have been reported from Kenya [127], the overall incidence of culture-proven
typhoid fever 37932 (Salmonella typhi infection) have been reported from Kenya [127], the overall incidence of culture-proven typhoid fever may be lower than 1/100,000 person years [128]. In SSA, S. typhi infection has been noted to occur in
typhoid fever 38141 occur in association with schistosome infections [129]. Of concern is the emergence of drug-resistant typhoid fever [129],[130]. Similarly, nontyphoidal salmonella (NTS) infection and bacteremia (some of which are caused
urinary schistosomiasis 20356 bladder wall pathology and squamous cell carcinoma [74]. A significant percentage of women and men with urinary schistosomiasis acquire genital ulcers and other lesions [22]. In the former, urogenital schistosomiasis is a significant
visceral leishmaniasis 1685 information on Africa's non-helminth NTDs. The protozoan infections, human African trypanosomiasis and visceral leishmaniasis , affect almost 100,000 people, primarily in areas of conflict in SSA where they cause high mortality,
visceral leishmaniasis 29524 SSA, with the former producing serious disease associated with high mortality. Most of the cases of visceral leishmaniasis (VL) occur in the Horn of Africa, i.e., the East African countries of Sudan, Eritrea, Ethiopia, Kenya,
yaws 6721 Salmonella infections (both typhoid fever and non-typhoidal salmonellosis), the tick-borne zoonoses, and yaws ; and viral infections such as Rift Valley fever, for which there is insufficient information available
yaws 32577 trachoma, mycobacterial infections, tick-borne zoonoses, typhoid fever and non-typhoidal salmonellosis, and yaws . With the exception of trachoma, data on the regional prevalence and/or incidence of these diseases
yellow fever 39236 although there are no published estimates of the disease.Viral InfectionsArboviral infections, including yellow fever , dengue, Chikungunya and Rift Valley fever [136], and rabies stand out as the most important viral NTDs.
yellow fever 39519 their incidence or disease burden.Arobviral infectionsApproximately 90% of the world's 200,000 cases of yellow fever (and 30,000 deaths) occur in SSA [33]. Especially in Francophone West Africa, transmission of yellow
yellow fever 39626 fever (and 30,000 deaths) occur in SSA [33]. Especially in Francophone West Africa, transmission of yellow fever is maintained by high densities of Aedes aegypti mosquitoes in close proximity to unvaccinated human
yellow fever 39965 Africa was established in 2002 in order to strengthen capacity for diagnosis [34]. In 2006, cases of yellow fever were reported in Cameroon, Central African Republic, Cote d'Ivoire, Ghana Guinea, Mali, and Togo [34].
yellow fever 42066 leprosy (Table 3). In addition, arboviral and other zoonotic infections are common in Nigeria, including yellow fever , rabies, and toxoplasmosis [134], while Buruli ulcer is found in the southern and southeastern areas

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