Neglected Tropical Diseases in the Catholic World

Roughly one-quarter of the world’s most common neglected tropical diseases and almost all of the cases of Chagas disease occur in the Catholic majority countries of Africa, Asia, and Latin America. This finding highlights new opportunities to lift the poorest Catholics in developing countries out of poverty. The neglected tropical diseases (NTDs) are the most common infections of the world’s poorest people living in developing countries. Through their impact on child growth and development, pregnancy outcome, and worker productivity, the NTDs cause a massive global disease burden and have also been shown to promote poverty and economic underdevelopment [1]. In previous analyses, I have suggested that the NTDs are not evenly distributed throughout the developing countries of the tropics [2,3]. Instead, approximately 30%–50% of the most common NTDs, such as intestinal helminth infections, schistosomiasis, and trachoma, occur in the nations that comprise the Organisation of the Islamic Conference, especially the poorest Islamic countries in Asia and Africa [2]. Another 20%–30% of these high prevalence NTDs are found among the poorest people who live in large middle-income countries such as India, China, Pakistan, and Iran. Despite their huge disparities of income and levels of poverty, ironically, these same countries also have tremendous scientific prowess, including the capacity to produce and maintain nuclear arsenals [3]. The next largest category of countries with a high prevalence of NTDs is countries with Catholic majorities. Listed in Table 1 (and shown in Figure 1) are the nations where most of the world’s 1.1 billion Catholics live [4]. Only countries with Catholic majorities are included (in addition to Canada and Uganda, each with more than 40% of its population Catholic). Not included are large NTD diseaseendemic nations such as India, Indonesia, Kenya, Nigeria, and Vietnam that contain sizeable Catholic minority populations. At least 5 million Catholics live in each of the 31 countries in Table 1, and together the 818 million Catholics living in these countries comprise three-quarters of the world’s Catholic population. Seventeen of the countries are in the Latin American and Caribbean region, led by Brazil and Mexico (the most populous Catholic countries with 146 million and 123 million Catholics each, respectively), followed by the Philippines, as the only Asian country on the list (70 million), and the European nations of Italy and France. Four subSaharan African countries are listed in Table 1, including the Democratic Republic of Congo (DRC) with 30 million Catholics, Angola and Uganda (10–11 million each), and Burundi (5 million). While none of the eight European countries (or Canada) in Table 1 suffer from widespread NTDs, all of the Latin American nations listed, as well as the African Catholic countries and the Philippines, are highly endemic for such conditions. Together, these 22 nations comprise a significant percentage of the world’s NTDs (Table 1), including almost 100% of the Chagas cases, which are found overwhelmingly in Latin America [5], and 21%–27% of the world’s intestinal helminth infections, led by Brazil in Latin America, the Philippines in Asia, and DRC in sub-Saharan Africa [6,7]. The 22 most populous NTD-endemic Catholic countries also account for 14%–16% of the world’s 207 million cases of schistosomiasis [8,9], and lymphatic filariasis (LF), onchocerciasis, or both of these infections are transmitted in 13 of the 22 nations [10,11]. A critical policy implication of these findings is that the major Catholic charities and perhaps even the Catholic Church has a unique opportunity to promote NTD control in several of the 22 most endemic Catholic majority countries. Today, several Catholic charities are making significant contributions to global public health, including efforts to promote ‘‘deworming’’, i.e., mass drug administration for human intestinal helminth infections. Catholic Relief Services has assisted poor and vulnerable populations for over 60 years [12,13], with specific efforts to provide deworming treatments for school-aged children in Benin [14], Ghana [15], and presumably elsewhere in over 30 African countries where they work [16], while also operating community health programs in 26 countries that serve 3.5 million people [17]. Similarly, the Catholic Medical Mission Board, which was founded in 1928 by Dr. Paluel Flagg after a visit to Haiti to help leprosy patients, has provided support to health care programs in developing countries since 1966 and today distributes hundreds of millions of dollars worth of medicines annually [18]. Many local archdioceses, including the Roman Catholic Archdiocese of Manila through its Caritas Manila program, for example, also provide deworming treatments [19]. Of interest is the finding that many Catholic organizations operate in countries both with and without Catholic majority populations, recognizing health as a fundamental right for people of all denominations [16,17]. The important work of the major Catholic charities and the Church could ultimately be expanded to support national programs of NTD control and elimination. Currently, the United States Agency for International Development (USAID) is supporting integrated control of the seven most common NTDs through low-cost