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Global surgery and the neglected tropical diseases

Karun V, Hotez PJ, Rosengart TK (2017) Global surgery and the neglected tropical diseases. PLoS Negl Trop Dis 11(9): e0005563.
Abstract / Summary: 
At the sunset of the Millennium Development Goals there was a global awakening that hundreds of millions of people living in resource-poor countries lacked safe and equitable access to even basic surgeries. In response, a Lancet Commission on Global Surgery was launched... highlighting that an astonishing 5 billion people lack accessible surgical care and that investing in scaling up surgical services until 2030 is necessary and cost effective. We bring to attention 2 examples in which surgical care best complements MDA [mass drug administration] — lymphatic filariasis (LF) and trachoma. Surgical interventions in trachoma have been an integral part of the framework, supported by the World Health Organization (WHO) Alliance for Global Elimination of Blinding Trachoma by the year 2020 (GET 2020) [6]. They have been implemented globally as SAFE: surgery for trachomatous trichiasis (TT); antibiotic treatment to clear ocular infection; facial cleanliness to reduce the transmission of ocular Chlamydia trachomatis; and environmental improvement, particularly access to water and sanitation... There is currently an estimated backlog of 5 million cases of trichiasis surgery. Over the past 15 years (2000–2015), since the inception of the Global Programme to Eliminate Lymphatic Filariasis (GPELF), more than 97 million estimated cases of LF have been prevented or cured predominantly through MDA [10]. However, as many as 36 million hydrocele and lymphedema cases remain [10]. More recent Global Burden of Disease Study 2015 estimates show that, for the 38.46 million people living with LF, approximately 19.71 million show evidence of detectable microfilariae, while 18.76 million exhibit complications that could require surgical intervention... What needs to happen? Trachoma: ... Some of the barriers to low uptake that have been identified are lack of awareness, direct and indirect costs, and distance to services. Thus, local promotion strategies, such as using village leaders to encourage patients to seek care at health facilities, have been proposed as strategies to increase surgical access... LF: ... The involvement of members at the rural level who can help identify and promote individuals to seek proper surgical care in a timely manner could also aid in surgical uptake...
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