Controlling NTDs can improve reproductive health and rights of women in poor countries

Public Library of ScienceDec 2 2009

Controlling neglected tropical diseases (NTDs) in developing countries would help improve the reproductive health and rights of girls and women in the poorest countries of Africa, Asia, Latin America, and the Caribbean, according to a new editorial published November 24 in the open-access journal PLoS Neglected Tropical Diseases. The analysis demonstrates that NTDs are "important factors that impair reproductive health in developing countries; increase the transmission of sexually transmitted infections (STIs); and promote stigma and gender inequality."

Anemia is a common condition linked to NTDs, with dangerous potential consequences among women in developing countries. The editorial notes that an estimated 20% of maternal deaths in Africa are attributed to anemia, which is also a key risk factor for infant mortality and low birth weight. Schistosomiasis is an important contributor to anemia and infertility, and likely contributes to increased maternal morbidity and low birth weight. Human hookworm infection, one of the most common NTDs, adds significantly to iron loss and anemia in pregnancy, and also contributes to infertility. An estimated 44 million pregnant women are infected with hookworm at any one time.

Peter Hotez, President of the Sabin Vaccine Institute and Distinguished Research Professor at the George Washington University School of Medicine and author of the article, states that "not surprisingly, deworming during pregnancy has major beneficial effects in terms of reduced maternal morbidity and mortality, as well as improved perinatal outcome."

Adding to their negative impact on reproductive health, several NTDs are either also STIs or may promote susceptibility to other STIs. Trichomoniasis is the former, and is now recognized as one of the most common STIs in Africa and elsewhere. Female genital schistosomiasis has been identified as an important co-factor in HIV transmission in rural areas of Africa.

Furthermore, numerous studies have demonstrated the stigma of NTDs carries social and economic consequences. Many women are ostracized and sometimes prevented from seeking medical attention due to their disfigurations; those who seek medical attention may be restricted to examination of their arms and legs. In Afghanistan, cutaneous leishmaniasis prevents mothers from holding their children; in Colombia, this disease is grounds for spousal abandonment.

In the analysis, Hotez concludes that "because of the dramatic impact of NTDs on the health of women, especially girls and women in their child-bearing years, it is critically important that these populations are included in current and proposed large-scale interventions for NTDs," and calls for specific actions to help control and eliminate NTDs and improve the health of women.