The Neglected Tropical Diseases and Their Devastating Health and Economic Impact on the Member Nations of the Organisation of the Islamic Conference

Founded in 1969, the Organisation of the Islamic Conference (OIC) is comprised of 57 nations that together represent the second largest international organization after the United Nations [1]. According to their Web site, the OIC serves as the ‘‘collective voice of the Muslim world,’’ both protecting its interests and settling conflicts and disputes between member states [1]. In addition to several important and prosperous oiland gas-producing nations in the Middle East, the OIC nations also include some of the world’s poorest countries as well as large middle-income countries with regions of great poverty (Figure 1). In these geographic areas of poverty are also found some of the highest infection rates and endemicity of the neglected tropical diseases (NTDs). Shown in Table 1 is the estimated prevalence of six of the most common NTDs among the most populous OIC member states [2–8]. Each of the 28 countries listed has a population that exceeds 10 million people; together they account for more than 90% of the populations living in the OIC. The information in Table 1 portrays a devastating burden of disease from NTDs in the Islamic world. Unlike better known infections that occur in North America and Europe, the NTDs represent the most common infections of poor people living in developing countries, causing chronic and debilitating conditions that result in impaired childhood growth and developmental delays, poor pregnancy outcome, and reductions in agricultural worker productivity [5,9,10]. As a result, the NTDs not only adversely affect health, but they also represent a major reason why poor people living in the OIC and elsewhere cannot escape poverty [9,10]. For example, between 200 and 300 million people living in OIC countries are infected with one or more intestinal helminth infections, i.e., ascariasis, trichuriasis, and hookworm. Approximately one-half of these cases occur in Indonesia and Bangladesh, two of the most populous OIC countries [5], followed by Nigeria and other African nations [5,11]. In addition, high rates of intestinal helminth infections occur in Malaysia [12]. Together, the OIC member states account for up to 40% of the global burden of intestinal helminth infections. Children living in the affected countries on average harbor the largest number of intestinal helminths compared to any other age group, and as a result suffer growth stunting, reductions in physical fitness, and developmental and delays [5,9,13]. Intestinal helminths impair the ability of a child to learn in school [9,13], which probably accounts for the observation that chronic hookworm infection in childhood reduces future wage-earning [14]. High rates of hookworm infection also occur during pregnancy, and represent a major cause of anemia among African women [15,16]. It has been noted that Sahelian nations exhibit higher rates of hookworm infection compared to other intestinal helminthiases, possibly as a result of the high thermal tolerance of hookworm larvae in the soil [15,17]. This observation likely accounts for the high prevalence rates of hookworm infection in the OIC nations of Burkina Faso, Chad, Mali, Niger, and Sudan. Schistosomiasis is also a common NTD in the Islamic world. Almost one-half of the world’s schistosome infections occur in OIC member states, especially in Nigeria, Mozambique, Burkina Faso, Mali, and Cote d’Ivoire [6]. Many of these cases are urinary tract schistosomiasis caused by Schistosoma haematobium [18,19]. In addition to the end-organ pathology to the bladder, ureters, and kidneys [20], S. haematobium infection is associated with reductions in child growth and development similar to those caused by the intestinal helminths [21]. According to some estimates, the disease burden resulting from schistosomiasis may exceed that of malaria [21]. In addition to the intestinal helminth infections and schistosomiasis, both lymphatic filariasis and onchocerciasis are highly prevalent NTDs in the OIC member countries. The bacterial NTDs are also prominent. Approximately 20% of the world’s 213,000 registered cases of leprosy [7] and 21% of the world’s cases of blinding trachoma [8] occur in OIC countries. Blinding trachoma exhibits the highest prevalence in the Sahelian countries of Sudan (almost 4 million cases), Niger (2 million), and Burkina Faso and Mali (1 million cases each) [8], where the dry and dusty conditions there combine with extreme poverty, inadequate sanitation, and poor access to clean water to ensure high rates of transmission [22]. In