Anaemia: A Useful Indicator of Neglected Disease Burden and Control

1285 The world’s neglected tropical diseases (NTDs; Table 1) are becoming less neglected. Many millions of dollars and drugs are now committed to their control, and an open-access journal dedicated to NTDs, PLoS Neglected Tropical Diseases, has been launched (http://www.plosntds.org/). NTDs are characterised by their prevalence in rural areas of low-income countries and fragile states, their tendency to promote poverty, and the absence of commercial markets for tools that would control them, even though such tools exist and their success has been demonstrated [1]. NTD programmes are effective development investments because interventions can be delivered for less than $US1 per person per year and economic rates of return are 15%–30% [2]. In addition, individual NTD programmes are often able to share activities such as drug distribution because of geographical overlap between their target populations [1,3,4]. These benefi ts were cited in the World Health Assembly resolution WHA 54.19, which recommends the provision of essential drugs against schistosomiasis and soil-transmitted helminthiasis for 100% of school children at risk by 2010 [5]. NTD programmes need to be able to demonstrate that they have met their objectives [6]. In general, each programme has established its own monitoring and evaluation system, such as microscopic counting of eggs in urine or faeces for schistosomiasis or hookworm, night blood fi lms for microfi laria, or skin snips for onchocerciasis. Apart from the diffi culties of obtaining samples and transporting them to a laboratory or setting up microscopy services within communities, the high day-to-day variability of biological measurements within individuals makes such methods of monitoring tedious and insuffi cient on their own. These indicators evaluate infection rather than morbidity [6], and David Molyneux and colleagues have suggested that wellbeing and equity would be more appropriate indicators to evaluate changes in public health [1]. Prevalence of anaemia could be added to this choice of indicators because: (1) such prevalence is objective and quantifi able; (2) anaemia is a major complication of several NTDs; (3) it can be measured even in the most remote areas; and (4) it changes in a predictable fashion with alterations in disease burden. Because the prevalence of anaemia increases with worsening socio-economic status [7], it can be used to assess whether an intervention has reached the poorest communities in areas where NTDs are a major cause of anaemia.