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in terms of treatment and lost working days. This easily perpetuates the vicious cycle of poverty and infection. 14 Why research infectious diseases of poverty? Chapter 1 Global Report for Research on Infectious Diseases of Poverty 15 Why research infectious diseases of poverty? Why research infectious diseases of poverty? 15 table 1.1. Relationship between infectious diseases and poverty Infectious diseases Risks …are a proxy for poverty and disadvantage (7) Risk factors are shaped by the conditions in which people live and work, particularly poverty, conflict, gender and education levels (8, 9). Infectious diseases contribute to lifelong disadvantage in already disadvantaged groups. For example, the often-devastating effects on learning ability of worm infections and schistosomiasis acquired at an early age have lifelong detrimental consequences (10, 11). …affect populations with low visibility and little political voice (7) Infectious diseases are prevalent among populations living in conflict and war zones, internally displaced populations, refugees and those affected by the consequences of natural disasters. …cause stigma and discrimination (7) People suffering from infectious diseases (such as Buruli ulcer) often experience stigma and ostracization from society. Reasons for this can include fear of the disease or the belief that it is self-inflicted. This stigmatization can have broad economic consequences for an affected individual, particularly if that person is unable to get work as a result. …impose a heavy health and economic burden Infectious diseases place a substantial health and economic burden on poor populations in Africa, Asia and Latin America (12, 13). For example, malaria is the leading cause of mortality in children under five years of age in Africa, constituting one tenth of the continent’s overall disease burden. In areas with high malaria transmission it accounts for 40% of public health expenditure, 30–50% of inpatient admissions and up to 50% of outpatient visits (14) 2 . Diarrhoeal diseases, respiratory infections and malaria are all closely associated with childhood mortality (11, 15, 16, 17). Each year, rotavirus, a common cause of childhood diarrhoea, kills over half a million children under the age of five. Most of these deaths occur in the world’s poorest countries (15). …are low on many research funders’ agendas While there is an urgent need for innovative new tools and technologies to combat infectious diseases, the perceived absence of a market means that limited funding has been available to develop them. Of 1393 new chemical entities introduced between 1975 and 1999, only 16 targeted “tropical diseases” or tuberculosis (18). An updated study in 2010 found that while there had been progress for some diseases (such as malaria), not a single new product had been approved in the previous nine years in disease categories that include Buruli ulcer, dengue, trachoma, rheumatic fever and typhoid and paratyphoid fevers (19). …have greater impact where health systems are weak Health systems in many disease endemic countries are noticeably weak. Patients either cannot afford or do not have access to adequate drugs, while human and other resources are overburdened by the volume of needs. …burden caregivers and families Lost labour time due to illness often means a reduction in household capacity to earn income, particularly at a time when the household needs additional money to pay for treatment (20). As a result, money to pay for treatments is often diverted from other expenses, such as school fees. Source: adapted from reference (7), with selected examples summarized from the multiple references cited above. 14 5 Why research infectious diseases of poverty? Why research infectious diseases of poverty? 15 Chapter 1 Global Report for Research on Infectious Diseases of Poverty The consequences of infectious diseases are not limited to the families whose members become infected.