Neglected Diseases

Neglected Diseases PLOS Medicine's Neglected Diseases section began with the launch of the journal in October 2004. Up until February 2008, the section focused on tropical infectious diseases, such as Buruli ulcer, trachoma, and hookworm. A list of the 21 articles published from October 2004 to February 2008 can be found in the Supporting Information section of our February 2008 Editorial. With the launch of PLOS Neglected Tropical Diseases in October 2007, the focus of the Neglected Diseases section of PLOS Medicine shifted from tropical diseases to other health problems that could be considered neglected and that have a significant global burden (such as reproductive and maternal health problems, mental illness in low- and middle-income countries, road traffic injuries, and health problems related to migration and conflict.). Read the February 2008 Editorial for information about the section.

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The “Other” Neglected Diseases in Global Public Health: Surgical Conditions in Sub-Saharan Africa

  • Doruk Ozgediz mail,

    To whom correspondence should be addressed. E-mail:

  • Robert Riviello
  • Published: June 03, 2008
  • DOI: 10.1371/journal.pmed.0050121

Reader Comments (2)

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Surgery should not be left alone in its struggle to cope with surgical conditions in Sub-Saharan Africa!

Posted by plosmedicine on 31 Mar 2009 at 00:27 GMT

Author: Martin Dünser
Position: MD
Institution: Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck/Austria
Additional Authors: Wolfgang Lederer, MD
Submitted Date: June 16, 2008
Published Date: June 19, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Dear Sir,
We want to thank and congratulate Drs. Ozgediz and Riviello for addressing a so far neglected topic in global public health (1). The authors conclude that surgical conditions in tropical countries are low valued compared to infectious diseases. We would like to amend their suggestions to improve perioperative patient care in resource-limited areas. Hereby, not only capacity-building measures regarding surgery need to be taken into account, it is of great importance to focus also on perioperative anaesthesia care when trying to reduce perioperative morality. Investment in anaesthesia services is vital to assure safer surgery and obstetric care, particularly in low income countries (2). Comparable to the situation of surgery (1), anaesthesia is a significantly under-resourced specialty in Sub-Saharan Africa (2-4). Prevention of upper airway obstruction, tracheal aspiration and hypoxia as well as adequate perioperative fluid management can dramatically reduce the number of perioperative complications and deaths (2, 5-8). Accordingly, global or local initiatives to assure essential supplies for surgery should also include basic anaesthetic devices such as a source of oxygen (e.g. an oxygen concentrator), a pulseoxymeter, and a simple device to administer volatile anaesthetics (e.g. a draw over vaporizer). Most anaesthetists in Sub-Saharan Africa countries are non-physicians (2-4). Basic training of nurses, medical officers/assistants and physicians in general and particularly regional anaesthetic techniques will rapidly increase the quality and safety of anaesthesia and perioperative care. In addition, more physicians must jointly be attracted to become surgeons or anaesthetists under desirable working conditions. After all, when outlining the complex pathway to reduce death and disability-adjusted life years from surgical conditions in Sub-Saharan Africa further essential points such as injury prevention, adequate prenatal care and basic emergency medical services need to be approached.

1. Ozgediz D, Riviello R (2008) The “Other” Neglected Diseases in Global Public Health: Surgical Conditions in Sub-Saharan Africa. PLoS Med. 5: 121.
2. Walker IA, Wilson IH (2008) Anaesthesia in developing countries – a risk for patients. Lancet. 37: 968-969.
3. Jochberger S, Ismailova F, Lederer W, Mayr VD, Luckner G, et al. (2008) Anesthesia and its allied disciplines in the developing world: a nationwide survey of the Republic of Zambia. Anesth Analg. 106: 942-948.
4. Hodges SC, Mijumbi C, Okello M, McCormick BA, Walker IA et al. (2007) Anaesthesia services in developing countries: defining the problems. Anaesthesia. 62: 4-11.
5. Megafu U (1985) Factors influencing maternal survival in ruptured uterus. Int J Gynaecol Obstet. 23: 475-480.
6. Oji A (1986) Intensive care in a developing country: a review of the first 100 cases. Ann R Coll Surg Engl. 68: 122-124.
7. Khan M, Khan FA (2007) Anesthetic deaths in a developing country. Middle East J Anesthesiol 19: 159-172.
8. Mock C, Visser L, Denno D, Maier R (1995) Aggressive fluid resuscitation and broad spectrum antibiotics decrease mortality from typhoid ileal perforation. Trop Doct 25: 115-117.

No competing interests declared.