Academic journal article Bulletin of the World Health Organization

Communicable Diseases in the South-East Asia Region of the World Health Organization: Towards a More Effective Response/ Maladies Transmissibles Dans la Region De l'Asie Du Sud-Est De l'Organisation Mondiale De la Sante : Vers Une Reponse Plus Efficace/ Enfermedades Transmisibles En la Region De Asia Sudoriental De la Organizacion Mundial De la Salud: Hacia Una Respuesta Mas Efectiva

Academic journal article Bulletin of the World Health Organization

Communicable Diseases in the South-East Asia Region of the World Health Organization: Towards a More Effective Response/ Maladies Transmissibles Dans la Region De l'Asie Du Sud-Est De l'Organisation Mondiale De la Sante : Vers Une Reponse Plus Efficace/ Enfermedades Transmisibles En la Region De Asia Sudoriental De la Organizacion Mundial De la Salud: Hacia Una Respuesta Mas Efectiva

Article excerpt

Introduction

Although disease patterns change constantly, communicable diseases remain the leading cause of mortality and morbidity in least and less developed countries. Despite decades of economic growth and development in countries that belong to the World Health Organization (WHO) South-East Asia Region (http://www.who.int/about/regions/searo), most countries in this region still have a high burden of communicable diseases. This raises some urgent concerns. The first is that despite policies and interventions to prevent and control communicable diseases, most countries have failed to eradicate vaccine-preventable diseases. Second, sustainable financing to scale up interventions is lacking, especially for emerging and re-emerging diseases that can produce epidemics. Finally, in the present global economic and political context, it is important to understand how international aid agencies and donors prioritize their funding allocations for the prevention, control and treatment of communicable diseases. Prioritization is especially critical if one accepts the global public good character of communicable diseases. (1,2)

This paper analyses the current burden of communicable diseases in the region and explores whether the current levels and trends in funding suffice to meet the needs for their control, prevention and treatment. Our analysis considers the health Millennium Development Goals (MDGs) and individual countries' economic progress. We attempt to understand whether the current focus of disease prevention is appropriate and to ascertain what changes in direction might enable national and global policy-making to deal more effectively with communicable diseases.

Communicable diseases

Disease burden

Although communicable diseases can be categorized in different ways, WHO uses three guiding principles for prioritization: (i) diseases with a large-scale impact on mortality, morbidity and disability, such as human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), tuberculosis (TB) and malaria; (ii) diseases that can potentially cause epidemics, such as influenza and cholera; and (iii) diseases that can be effectively controlled with available cost-effective interventions, such as diarrhoeal diseases and TB. (3) According to WHO data on the global burden of disease and the distribution of diseases among -countries, communicable diseases contribute slightly more to the total disability-adjusted life years (DALYs) lost in the region (42%) than in the world as a whole (40%). (4)

According to WHO, (5) low-income countries currently have a relatively higher share of deaths from: (i) HIV infection, TB and malaria, (ii) other infectious diseases, and (iii) maternal, perinatal and nutritional causes compared with high- and middle-income countries. Although these three causes combined pose a lesser burden than noncommunicable diseases, they will remain important causes of mortality in the next 25 years in low-income countries. In 2004, all countries of the region except for Indonesia, Maldives, Sri Lanka and Thailand were classified as low-income by The World Bank.

Fig. 1 shows the share of the region's contributions to world DALYs lost due to infectious and parasitic diseases. The region bears a disproportionate share of diseases such as Japanese encephalitis, leprosy and dengue, which have been eliminated from most of the world. Countries of the region also contribute a higher share of DALYs due to childhood cluster and tropical cluster diseases than the rest of the world. WHO estimates that the region contributes 27% of the global burden of infectious and parasitic diseases, 30% of respiratory infections, 33% of maternal conditions, 37% of perinatal conditions and 35% of nutritional deficiencies. If the first two categories are included under communicable diseases, the region's contribution to the global communicable disease burden is disproportionately high. …

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