“Leaving no one behind” is the central promise of the 2030 Agenda for Sustainable Development, the United Nations action plan of seventeen Sustainable Development Goals (SDGs). These range from eradicating poverty to promoting policies that promote economic growth and meet social needs such as education and health care, as well as combating climate change and protecting the environment.
One of the goals of SDG 3 (Health and Well-Being) is to end the epidemic of neglected tropical diseases (NTDs), whose World Day is celebrated on 30 January. It is a diverse group of diseases that occur primarily in tropical regions and in poverty-stricken settings. They affect more than one billion people and have negative social, economic and health consequences. And yet little is said about them.
Buruli ulcer primarily affects children in sub-Saharan Africa.
Buruli ulcer is one of the most neglected NTDs. The incidence is highest in sub-Saharan Africa and is caused by bacteria (Mycobacterium ulcers
), which destroys the skin. In severe cases, it can reach the bones and cause disability and stigma in affected people.This burden of disease is associated with difficulties in maintaining education and access to work, which slows progress towards SDG 4 (Quality Education), SDG 8 (Decent Work and Economic Growth) and SDG 1 (No Poverty).
Another consequence of this vicious cycle of poverty and disease is malnutrition, which is addressed under SDG 2 (Zero Hunger), and can weaken the immune system, causing more aggressive forms of disease.
On the other hand, Buruli ulcer disproportionately affects women due to the roles and responsibilities assigned in their communities, hindering progress towards SDG 5 (Gender Equality). The role of guardians and accompanying patients, in most cases minors, during visits to the treatment center and hospitalization is assumed by mothers and sisters. As patients, women suffer more stigma, discrimination and loneliness than men, making it difficult for them to access health services.
It is still unclear how it is transmitted
There are many unknowns about the transmission of Buruli ulcer. It is usually associated with contact with standing or slowly flowing water masses and degradation of ecosystems; arthropods could also participate in its spread. It therefore seems clear that improving access to clean water and sanitation (SDG 6) and caring for terrestrial ecosystems (SDG 15) will help reduce the impact of this disease.
In the absence of specific control mechanisms, two key aspects of Buruli ulcer management are early identification of cases before they develop severe disease and ensuring they are treated. However, modern diagnostic tools are not always available in remote communities where the disease is commonly found. To make matters worse, the 8 weeks required for treatment means that some patients who start treatment end up giving up.
BULABNET and BLMs4BU are two examples of alliances aimed at addressing these diagnostic and treatment challenges, respectively. Likewise, progress in the fight against this disease requires sustainable and resilient infrastructures that guarantee access to basic and quality health services for all communities (SDG 9-Industry, innovation and infrastructure
SDG 11-Sustainable cities and communities).Ultimately, fighting Buruli ulcer requires collaboration, research and ongoing investment to strengthen health systems. Not forgetting communities, whose role is key in combating these diseases through activities such as case finding, health education and social support to reduce stigma.
Action needs to be taken
In line with the SDGs, the World Health Organization (WHO) proposes a roadmap for ending NTDs, which highlights the need to address global health challenges in the most vulnerable communities, where lack of resources and adequate care contribute to their spread and worsening. , contrary to SDG 10, maintain inequality.
NTDs have been compared to global health landmines. Actions to control and eliminate it will therefore contribute to reducing health inequalities and achieving many other SDGs, relieving nearly an eighth of humanity from enormous suffering and socio-economic burden.