Poverty

BACKGROUND

The word "poverty" is derived from the Latin word "pauper," which means poor. Poverty, according to the World Bank, is defined as the lack of sufficient income and other basic needs, such as food, clothing, shelter, health, and education, which are necessary to lead a healthy life.

Poverty is generally distinguished into absolute or extreme poverty and relative poverty. Absolute or extreme poverty, the most severe state of poverty, is a condition characterized by the deprivation of basic human necessities, such as food, shelter, safe drinking water and sanitation, healthcare, and education. Relative poverty is a condition where in the person's level of income is lower than a fixed proportion of average national income. In relative poverty, the basic human necessities for survival are met but to a minimal extent.

The poverty line, or poverty threshold, is the minimum level of income necessary to satisfy the basic needs of life. The value could differ with place and time; each country sets a specific poverty line depending on its level of development, economy, and societal norms and values. The national poverty line in Cambodia for 2004 was 1,826 riels (equivalent to about $0.45, as per the 2004 exchange rate) per person per day. In order to assess poverty globally, an international poverty line is established, which is the average of poverty lines for the 15 poorest countries worldwide. The international poverty line is expressed as a common unit across countries. The World Bank, according to the 2005 economy, has set a common international poverty line of US$1.25 a day. Poverty threshold was invented in 1965 by Mollie Orshansky, an American economist and statistician.

Some of the major underlying causes of poverty include economic crisis, illness and diseases, illiteracy, unemployment, natural calamities (such as drought, earthquakes, and floods), warfare, and lack of good governance. Poverty could again lead to hunger and poor health, illiteracy, unemployment, and exert a significant negative impact on the economic growth of the country. The causes and effects of poverty are thereby interrelated.

Poverty and ill health are closely interconnected to one other, as poor health is one of the key contributors to poverty, and maintaining good health is one of the means to prevent or overcome poverty worldwide. Some of the major poverty-associated diseases include malaria, tuberculosis, HIV/AIDS, measles, malnutrition and nutritional deficiency disorders, mental illnesses (such as depression, schizophrenia, and anxiety disorders), and diarrheal diseases. Most of these diseases are a result of poverty, while some may also be a cause of poverty due to their high treatment costs. Malnutrition is a medical condition caused by inadequate intake of essential nutrients required for the normal functioning of the body.

Low socioeconomic status imparts a significant negative influence on the lives of children. Poverty may diminish the physical and mental health of children and may increase their risk of injury, hospitalization, and death.

The incidence of poverty has significantly reduced from 52% to 26% of the global population, between 1981 and 2005. According to a recent global estimate done by the World Bank, about 1.4 billion people were living below the international poverty line of US$1.25 a day in 2005. Poverty is highest in the African continent followed by Asia.

One of the major initiatives taken to reduce poverty and its related problems was the signing of the United Nations Millennium Declaration in September 2000, by 189 nations across the world. The declaration includes eight goals, called the millennium development goals (MDGs), which are to be achieved by 2015. The eight goals include eradicating extreme poverty and hunger, achieving of universal primary education, promoting gender equality and empowering women, reducing child mortality, improving maternal health, combating infectious diseases (such as HIV/AIDS, malaria, and tuberculosis), ensuring environmental sustainability, and developing a global partnership for development. The International Day for the eradication of poverty is observed yearly on October 17.

TECHNIQUE

General: Poverty and health are closely interrelated. Measuring the impact of a particular disease in a population helps to evaluate various factors, such as the quality and access to healthcare facilities, public health practices, socioeconomic conditions, and in turn the status of poverty in that population. Some of the important indicators that are commonly adopted to evaluate health status are described below.

Maternal mortality rate: Maternal mortality is the death of women during pregnancy, childbirth, or shortly after childbirth. Maternal mortality rate (MMR) is defined as the number of maternal deaths occurring in a population divided by the number of live births in the same population. MMR helps to analyze the risk of maternal death in relation to the number of live births in a specific population. Some of the major causes of maternal mortality include bacterial infections, severe bleeding, high blood pressure, unsafe pregnancy termination (abortion), complications during delivery, unaffordable or poor healthcare facilities, and unavailability of skilled health professionals. Maternal mortality shows huge disparities among countries and is highly prevalent in low-income countries. One in every seven women has a high risk of dying due to pregnancy-related complications in Nigeria, while only one in 17,400 in Sweden. According to the World Health Organization (WHO), about 536,000 maternal deaths were recorded globally in 2005, of which 99% deaths (533,000) occurred in the developing countries. Sub-Saharan Africa and south Asia accounted for 86% of the global maternal deaths.

Infant mortality: Infant mortality refers to the death of infants, aged one year or less. Infant mortality rate (IMR), also known as infant death rate, is the probability of a child dying before the age of one. It is expressed as the number of fatalities per 1,000 live births. The major causes of infant mortality include genetic abnormalities, low-birth weight, sudden infant death syndrome (SIDS), pneumonia, diarrhea, complications during pregnancy, and malnutrition.

Diarrhea is one of the common causes of infant mortality worldwide. It is characterized by frequent passing of loose or watery stools that could result in excessive loss of water (dehydration) and essential salts and nutrients from the body. Dehydration is potentially serious in infants and children as they lose relatively high amounts of fluid quickly, which could be lethal if not treated at the earliest.

Sudden infant death syndrome (SIDS), also known as crib death, is a disease associated with sudden and unexplained death of an infant.

Malnutrition is a medical condition, wherein the child does not get sufficient nutritional requirements necessary to stay healthy and lead a healthy life. According to a report provided by the U.S. Center for Disease Control and Prevention (CDC), the infant mortality rate in the 2004 was 6.8 in the United States; 2.8 in Japan; and 11.5 per 1,000 live births in the Russian Federation.

Disease prevalence: Disease prevalence is defined as the total number of existing disease cases in a particular population during a specific period. It is generally used to estimate how common a condition is within a particular population at a particular time and is expressed as a percentage. For instance, according to the CDC, nearly 1,106,400 adults and adolescents were living with HIV (human immunodeficiency virus) infection in the United States, in 2006.

Disease incidence: Disease incidence is a measure of frequency of new cases of disease or medical conditions in a particular population in a specified period (usually a year). For example, nearly 56,000 new HIV infections were detected in the United States, in the year 2006.

Life expectancy (LE): LE may be defined as the number of years a person is expected to live in a given society. LE evaluation considers the present mortality (death) rates in a particular population group or place. According to the 2002 World Health Report provided by the WHO, life expectancy at birth was 44.3 years in South Africa; 70.6 years in the United Kingdom; and 69.3 years in the United States.

Healthy life expectancy (HALE): HALE is defined as the average number of years a newborn or a person is expected to live in good health. Estimation of HALE considers the quality of life, current death rates of a particular disease or condition, and the distribution of health conditions in a particular population. According to the 2002 World Health Report provided by the WHO, healthy life expectancy at birth was 69.3 years in the United States, 70.6 years in the United Kingdom, and 37.4 years in the Central African Republic.

THEORY/EVIDENCE

Factors associated with poverty :

General: There are multiple factors associated with poverty, which may negatively affect a person's health and well-being. Examples include poor access to healthcare services, lack of skilled health professionals, unaffordable medical treatments, poor sanitation and hygiene, and unavailability of nutritious food and clean drinking water.

Economic crisis: The rise in the prices of food and other commodities may lead to hunger, malnutrition and related illness among poor people. According to World Bank, about 1.4 billion people globally were living below the international poverty line of $1.25 a day, in 2005. World Bank estimates that the current global economic slowdown would trap over 53 million more people living in the developing countries into poverty in 2009. The amount that people need to earn in order to escape from poverty should be equivalent to or more than the poverty threshold/poverty line specified by a particular country. The amount varies across countries.

Illiteracy: Illiteracy, poverty, and poor health have been associated with each other. Illiteracy, one of the major causes of unemployment and poverty, negatively affects health, as there are higher chances of poor understanding of written or spoken medical advice, and lack of knowledge about health and well-being. Literacy rate depicts the growth and economic status of a country. Literacy rates are generally lower in developing and low-income countries compared to industrialized and wealthy countries. For instance, in 2007, the literacy rate of a population aged 15-24 years was 72.1% in Sub-Saharan Africa and 97% in Latin America and Caribbean.

Environmental factors: Damage to natural resources, such as plants or crops, water bodies, and forests by natural disasters (including floods, drought, hurricanes, and earthquakes) may threaten the livelihood of people who solely depend on them. The calamities may create food shortages and increase the occurrence and spread of infectious diseases. For instance, exhaustion of soil fertility due to intensive farming may reduce agricultural yields and potentially increase poverty.

Warfare: Massive human destruction and damage to infrastructure during wars may displace millions of people from their homes, leading to hunger emergencies. For instance, the Nigerian-Biafran war (1967-1970), which occurred due to economic, religious, and cultural differences among the people of Nigeria, is estimated to have claimed the lives of about two million civilians.

Prevalence of poverty-related illnesses :

General: Poverty, one of the major causes of ill health and diseases, claims millions of lives globally, especially in the low-income and developing countries. A brief outline of the prevalence of poverty-related illnesses worldwide is given below.

Hunger and malnutrition: Hunger and malnutrition are thought to pose the greatest health risks. According to the 2008 statistics provided by Food and Agriculture Organization (FAO), about 963 million people globally are hungry or undernourished (i.e., one in every seven people in the world do not get adequate food to stay healthy and lead healthy lives). Undernourishment is caused by improper intake of essential nutrition or lack of availability of sufficient food. Malnutrition is a medical condition caused by inadequate intake of essential nutrients required for the normal functioning of the body and is considered a large contributor to ill health. More than half of the undernourished population is in the Asian and Pacific regions and about a quarter live in Sub-Saharan Africa. It is estimated that one child dies every six seconds due to malnutrition and related causes.

Food dumping is a process wherein one country exports a product to another at a price lower than the cost of production. Food dumping by developed countries helps poorer nations reduce food crisis and help maintain poverty. For instance, in 2002, the United States exported wheat to markets in the Global South at a price that was 28% lower than the cost of production.

Nutritional deficiency is a condition where an individual's intake of nutrients is insufficient for normal functioning of the body. Vitamins and minerals are substances necessary for normal growth, development, and functioning of the body. According to the statistics provided by the United Nations Children's Fund (formerly United Nations International Children's Emergency Fund/UNICEF), vitamin A deficiency has been linked to more than one million infant deaths annually. Iodine deficiency is the single largest cause of brain damage and intellectual disability and affects nearly 780 million people worldwide. Iron deficiency, one of the most prevalent forms of malnutrition, affects about two million people globally and impairs the mental development of more than 40-60% children in low-income countries. Iron, zinc, and vitamin A deficiencies are among the World Health Organization's top-10 leading causes of death through disease in developing nations.

Infectious diseases: Human immunodeficiency virus (HIV) infection/AIDS (acquired immune deficiency syndrome), malaria, and tuberculosis are the three major poverty-associated infectious diseases worldwide. According to the United Nations (UN), about 7,500 people are infected with HIV and 5,500 die from AIDS every day. Most HIV-infected people are from African countries. AIDS is a deadly viral infection caused by HIV. The virus primarily attacks the immune defense system, making the patient vulnerable to other infections. It is estimated that malaria is responsible for about one million deaths every year, 80% of which are children belonging to African countries. Malaria is caused by parasites of the genus Plasmodium that are spread from one individual to another through the bites of infected mosquitoes. Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis. It is estimated that nearly two million people annually from TB, of which about 98% occur in developing countries.

Maternal and infant mortality: According to UNICEF, about 500,000 women die every year due to pregnancy-related complications, and around 20 million suffer from pregnancy-related illness after childbirth. Every day, about 10,000 infants die within the first month of their birth and around the same number of them are not alive at the time of birth. Maternal death or maternal mortality is the death of a woman during or shortly after childbirth. Infant mortality is the death of infants, aged one year or less.

HEALTH IMPACT/SAFETY

General: Poverty may impact individuals, societies, and countries. Some of the major implications of poverty include ill health, illiteracy, low productivity and economic growth, and violence. Poor sanitation, hunger, unavailability of nutritious food and clean drinking water, and lack of knowledge about hygiene and health issues could increase the occurrence of nutritional deficiencies, infectious and chronic diseases, psychological disorders, and other illnesses among poor population.

Nutritional deficiencies :

General : Malnutrition is a medical condition, wherein the person does not get sufficient nutritional requirements necessary to stay healthy. An extended period of malnutrition may cause nutritional deficiency disorders, impair physical and mental development, weaken infection-fighting ability, and increase the risk of infectious diseases like tuberculosis and malaria.

Nutritional deficiency is a condition where an individual's intake of nutrients is insufficient for normal functioning of the body. The nutritional requirement of a person varies according to age, gender, body size, physical activity, and to some extent, climate. On an average, a healthy adult requires about 2,100 kilocalories daily to lead a healthy life.

The first and foremost millennium development goal, as set by the United Nations member states in 2000, aims to eradicate hunger and extreme poverty by: promoting free food programs in schools; providing employment opportunities especially for women and young people; supporting research and development in the field of agriculture to enhance crop yield; and forming partnerships with non-governmental organizations and private sectors for rural and urban development.

A brief overview of some of the common nutrition deficiency disorders prevalent among poor populations in low-income countries is described below

Vitamin deficiencies: Vitamins are a group of substances necessary for normal growth, development, and functioning of the body.

Vitamin A plays an important role in bone growth, vision, fighting infections and diseases, cell division, and reproduction. Deficiency of vitamin A may cause xerophthalmia (dry eye), night blindness, or total blindness and increase to the risk of infections. Some of the vitamin A-rich foods include whole eggs, fish, beef liver, dark-colored fruits and vegetables, and milk and other dairy products. According to the Office of Dietary Supplements at the National Institutes of Health (NIH), the recommended dietary allowances (RDAs) for vitamin A are: 300mg/day (1,000 IU) for children (1-3 years); 400mg/day (1,320 IU) for children (4-8 years); 600mg/day (2,000 IU) for children (9-13 years); 900mg/day (3,000 IU) for adolescents (14-18 years); 900mg/day (3,000 IU) for men (18 and above); 700mg/day (2,300 IU) for women (18 and above); 770mg/day (2,600 IU) for pregnant women (19 years and older); and 1,300mcg/day(4,300 IU) for lactating women (19 years and older).

Vitamin B1 (also known as thiamine) is important for the normal functioning of muscles and nervous system, and carrying out multiple chemical reactions within the body. Deficiency of vitamin B1 causes beriberi. The symptoms of beriberi include shortness of breath, mental confusion, strange eye movements, increased heart rate, difficulty in walking, and loss of muscle function in legs. Some of the vitamin B1-rich foods include fortified breads, cereals, whole grains, lean meat, fish, dried beans, peas and soybeans. According to the Office of Dietary Supplements at the National Institutes of Health (NIH), the recommended dietary allowances (RDAs) for vitamin B1 are: 0.5mg for children 1-3 years old; 0.6mg for children 4-8 years old; 0.9mg children 9-13 years old; 1.2mg for males (14 years and older); 1mg for females (14-18 years); 1.1mg for females (19 years and older); and 1.4mg for pregnant or lactating women of any age.

Deficiency of vitamin B3 (also known as niacin) causes pellagra, which is characterized by dermatitis (skin disease), diarrhea, and dementia (a mental illness commonly associated with memory loss). Some of the sources of vitamin B3 include milk, yeast, meat, fish, eggs, green vegetables and cereal grains. Sufficient safety data are not available to recommend niacin in children in amounts greater than found in foods. The Food and Nutrition Board at the Institute of Medicine recommends 14-18mg of niacin (in the form of niacin equivalents, 1mg niacin = 60mg tryptophan) daily for adults.

Vitamin B12 is essential for maintaining healthy nerve cells and red blood cells and to make deoxyribonucleic acid (DNA), the genetic material present in the cells of most living organisms. Deficiency of vitamin B12 causes megaloblastic anemia, abnormal neurological and psychiatric symptoms, such as muscle weakness, weight loss, hypotension (low blood pressure), vision problems, numbness of hands and feet, depression, confusion, and poor memory. Megaloblastic anemia is blood disorder characterized by larger than normal and dysfunctional red blood cells (RBCs) and decreased hemoglobin (called anemia). RBCs are disc-shaped cells found in the liquid content of blood. Hemoglobin is iron-containing red pigment within the RBCs that carries oxygen from lungs to all other body parts, and carbon dioxide (waste product) from the cells back to lungs. Some of the sources of vitamin B12 include eggs, poultry, yogurt, and raisin bran. The recommended dietary allowances (RDAs) for vitamin B12 have not been established for pediatric age groups; therefore, Adequate Intake (AI) levels are taken into account: 0.4mcg for infants (0-6 months) and 0.5mcg s for infants (7-12 months). The recommended dietary allowances (RDAs) are: 0.9mcg for children (1-3 years); 1.2mcg for children (4-8 years); 1.8mcg for children (9-13 years); 2.4mcg for adults and adolescents aged 14 years and older; 2.6mcg for adult and adolescent pregnant women; and 2.8mcg for adult and adolescent lactating women.

Vitamin C (also known as ascorbic acid) is important for the formation of collagen in bones, muscles, and blood vessels. Deficiency of vitamin C may cause scurvy, which is mainly characterized by weakness, anemia, and gum diseases. Collagen is a fibrous protein abundantly found in humans and other animals. Citrus fruits such as oranges are a rich source of vitamin C. The Food and Nutrition Board at the Institute of Medicine recommends the following doses of vitamin C: 40mg/day for infants (0-6 months); 50mg/day for infants (7-12 months); 15mg/day for children (1-3 years); 25mg/day for children (4-8 years); 45mg/day for children (9-13 years); 65mg/day for adolescent girls (14-18 years); 75mg/day for adolescent boys (14-18 years); 90mg/day and 75mg/day for men and women who are 19 years or older, respectively. There is insufficient information available regarding vitamin C dosage for pregnant and breastfeeding women.

Vitamin D is essential for maintaining normal levels of calcium and phosphorus in the blood. It is essential for calcium absorption and the formation and maintenance of strong bones. Vitamin D deficiency may cause rickets in children and osteomalacia in adults, two disorders associated with softening of bones, muscle aches and weakness, bone pain, and increased risk of bone fractures. Some food sources of vitamin D include fish, cod liver oil, beef liver, cheese, egg yolks, and fortified milk. The Food and Nutrition Board at the Institute of Medicine recommends: 5mcg (200 IU) daily for all individuals (males, female, pregnant/lactating women) younger than 50 years old; 10mcg daily (400 IU) for all individuals 50-70 years old; and 15mcg (600 IU) for individuals who are older than 70 years.

Protein deficiencies: Proteins are the fundamental components of a cell, and are essential for the building of bones, muscle, skin, and hair. Inadequate intake of protein could cause protein deficiencies, such as kwashiorkor and marasmus.

Kwashiorkor affects children between 1 and 4 years old and is characterized by stunted growth, swelling of feet and other body parts, protruding abdomen, weakened immune system, thinning of the hair, and skin rashes. Severe deficiency may result in physical and mental disabilities. Marasmus also primarily affects children and is associated with symptoms like stunted growth, dry skin, weight loss, and swelling of feet and other body parts.

A balanced diet consisting of appropriate amounts of protein (12% of the total calories), fat (at least 10% of total calories), and carbohydrates may help prevent protein deficiency.

Mineral deficiencies: Minerals are chemical compounds that are required in minute amounts to carry out normal functioning of different parts of the body, such as the brain, heart, muscles, and bones.

Iron is an essential component of hemoglobin, a protein involved in transporting oxygen to cells. It is also important for the regulation of cell growth and differentiation. Iron deficiency causes anemia, which limits oxygen delivery to cells and results in symptoms of fatigue, poor work performance, and weakened immune system. Meat, fish, poultry, beans, lentils, cereals, leafy greens, asparagus, peas, nuts, and dried fruits are some food sources of iron. The Recommended Dietary Allowance (RDA) of iron, according to the Food and Nutrition Board at the Institute of Medicine, is: 11mg for infants (7-12 months); 7mg for children (1-3 years); 10mg for children (4-8 years); 8mg for males and females (9-13 years); 11mg for males (14-18 years); 15mg for females (14-18 years); 27mg for pregnant females (all ages); 10mg for breastfeeding females (14-18 years); 9mg for breastfeeding women (19 years and older); 8mg for males (19- 50 years); 18mg per day for females (19- 50 years); 8mg for adults (51 years and older).

Iodine is essential for the production of thyroid hormones (triiodothyronine/T3 hormone and thyroxine/T4 hormone), which regulate the growth, development, and differentiation of all cells in the body. Iodine deficiency may cause goiter, growth retardation, cretinism, impaired movement, intellectual disability, as well as speech and hearing problems. Goiter is the abnormal enlargement of the thyroid gland, a butterfly-shaped organ in the neck, which produces thyroid hormones. Cretinism is a medical condition associated with severely impaired physical and mental development. Seafood is a well-known source of iodine. The Recommended Dietary Allowance (RDA) for iodine is: 50mcg for infants (from birth-12 months); 90mcg for children (1-8 years); 120mcg for children (9-13 years); 150mcg for adolescents (14-18 years); 150mcg for adults (18 and older); 220mcg daily for pregnant women; and 290mcg for breastfeeding women.

Zinc plays an important role in fighting infections and diseases, cell division, protein and DNA synthesis, wound healing, and functioning of over 100 different enzymes. Zinc deficiency is characterized by growth retardation, impaired infection-fighting ability, susceptibility to infections, loss of appetite, hair loss, delayed sexual maturation, weight loss, delayed healing of wounds, taste abnormalities, and mental lethargy. Some of the sources of zinc include oysters, beans, nuts, whole grains, fortified breakfast cereals, and dairy products. The Recommended Dietary Allowance (RDA) for zinc, according to the Food and Nutrition Board at the Institute of Medicine is: 2mg for infants (from birth -6 months); 3mg for children (7 months- 3 years); 5mg for children (4-8 years); 8mg for children (9-13 years); 11mg for males (14 years and above); 9mg for females (14-18 years); and 8mg for females (19 years and above).

Infectious diseases :

General : Poor hygiene, unavailability of clean drinking water, lack of awareness about the disease spread, and means of preventing infections may increase the rate of infectious diseases among poor populations.

HIV/AIDS: AIDS (acquired immune deficiency syndrome) is a viral infection caused by the human immunodeficiency virus (HIV). The virus primarily attacks the immune system, making the patient vulnerable to other infections. HIV is transmitted via bodily fluids, including blood, semen, vaginal secretions, and breast milk.

Currently, there is no cure for HIV/AIDS; antiviral drugs are usually given to suppress the virus, which subsequently helps boost the immune system. Blood transfusion is a process of transferring blood from one person to the other person's blood stream. Lack of knowledge about the disease spread, poor access to drugs and treatment makes poor people more vulnerable to HIV/AIDS.

Malaria: Malaria is caused by parasites belonging to the genus Plasmodium, and is usually spread from one person to another through the bites of infected Anopheles mosquitoes. The disease could also be transmitted through pregnant woman to her fetus, and transfusion of blood from infected persons.

Drugs such as chloroquine, sulfadoxine-pyrimethamine, mefloquine, quinine, and doxycycline are available for treating malaria. The prevalence of malaria is still high in developing regions of the world, such as Sub-Saharan Africa, due to lack of successful disease control programs, poor sanitation, and limited access to drugs and treatment.

Tuberculosi s : Tuberculosis (TB) is an airborne, bacterial infection caused by Mycobacterium tuberculosis. The bacterium primarily infects lungs and slowly damages other body parts as well. Symptoms include chronic cough, fever, weakness, chest pain, and coughing up bloody sputum (saliva). Antitubercular drugs like isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin are available for treating tuberculosis. Limited access to cost-effective drugs and treatment is one of the major factors for increased prevalence of tuberculosis in low developing countries.

Millennium development goal six, one of the eight goals signed by the member states of United Nations that are to be achieved by 2015, aims to halt and reduce the incidence of HIV/AIDS and other major diseases like malaria and tuberculosis by creating awareness about the spread and means of preventing infections; ensuring the availability of medications for treatment; providing access to primary healthcare systems for all, including the poor; promoting funding for carrying out research and development of effective drugs and vaccines, and assigning additional funding so as to enter into partnerships with other countries to purchase affordable essential drugs.

Neglected tropical diseases (NTDs) :

General: Neglected tropical diseases (NTDs) are a group of 13 or more different bacterial, viral, and parasitic infections that are common in the developing countries in tropical regions. These diseases typically affect people living in rural or underserved urban areas who are poor and do not have access to safe drinking water, basic health services, and essential medicines. Although NTDs are medically diverse, individuals may be simultaneously infected with several of these diseases. Effective therapies exist for most NTDs. Some of the most common NTDs include soil-transmitted helminthiasis (STH) and schistosomiasis.

Soil-transmitted helminthiasis (STH): Soil-transmitted helminthiasis (STH) is caused by the infection of parasitic worms like Ascaris lumbricoides (roundworm), Ancylostoma duodenale (hookworm) and Necator americanus (hookworm), and Trichuris trichiura (whipworm). The roundworm and whipworm infections occur through ingestion of fecal-contaminated water or food, while hookworm infection is caused by skin contact with contaminated soil or stool. Helminthiasis causes a wide range of symptoms, such as diarrhea, abdominal pain, and weakness; hookworms may cause chronic intestinal blood loss, which over an extended period of time could lead to anemia. STH could impair the physical and mental development of children. Drugs like albendazole and mebendazole are used to treat STH.

Schistosomiasis (SCH): Schistosomiasis (SCH), also known as bilharzias, is a parasitic disease caused by worms belonging to the genus Schistosoma. Schistosoma mansoni, Schistosoma mekongi, Schistosoma japonicum, and Schistosoma intercalatum cause intestinal schistosomiasis. Schistosoma haematobium causes urinary schistosomiasis. Infection occurs through skin contact with contaminated water. Common symptoms include fever, fatigue, cough, abdominal pain, diarrhea (which may be bloody), enlargement of spleen and liver (called hepatosplenomeagaly), and anemia. Schistosomiasis is usually treated with the drug praziquantel.

Psychological disorders :

General: Studies have suggested a potential link between poverty and mental illnesses, such as depression and anxiety disorders. Poverty may also delay the recovery time from episodes of mental disorders. Depression is associated with symptoms such as forgetfulness, loss of interest, poor concentration, lack of motivation, poor sleep, tiredness, and irritability. Anxiety disorders are characterized by symptoms like fearful feeling, worries, increased heart rate, tingling sensations, headaches, and chest pain.

Oral health :

General: Poor hygiene, malnutrition, inadequate access to oral healthcare services and dentists, and lack of knowledge about oral health may increase the risk of oral health problems, such as tooth decay (called dental caries), infections of the tissues supporting the mouth (called periodontal disease), tooth loss, and oral cancer.

Pregnancy complications :

General: It has been suggested that poor sanitation, malnutrition, and lack of proper healthcare systems and trained healthcare workers may increase pregnancy complications, including maternal and/or infant death.

Millennium development goal five aims to improve maternal health by strengthening healthcare systems; ensuring the availability of trained health workers for providing quality and timely healthcare services during and after pregnancy and childbirth; ensuring access to family planning services and contraception; providing free maternity care for poor families; and educating individuals about sexual and reproductive health, family planning, and risk factors associated with early pregnancy.

Millennium development goal four aims to improve infant and child health by promoting effective vaccination programs and the importance of cleanliness, ensuring adequate nourishment for infants and children from poor families despite hikes in food prices, and strengthening healthcare systems for child care.

Medical complications :

General: Limited affordability to skilled healthcare personnel, basic healthcare facilities, and drugs and treatments may increase the chances of ill health among the poor. The U.S. government provides health assistance programs such as Medicare and Medicaid to help people get access to healthcare services.

FUTURE RESEARCH OR APPLICATIONS

General: Researchers are addressing poverty-associated illnesses and diseases by developing multinutrient-food supplements and vaccinations.

Ready-to-use therapeutic foods (RUTFs): These are instant nutritional foods consisting of milk powder, peanut butter, sugar, vitamins, minerals, and vegetable oil, which are found to effectively treat severely malnourished children. RUTFs are energy-rich, resistant to microbial contamination, and do not require cooking or refrigeration.

Fortified blended foods (FBFs): FBFs are a combination of partially precooked and powdered soya, beans, pulses, and cereals that are rich in proteins, vitamins, and minerals. It may also contain vegetable oil or milk powder. FBFs are cooked as porridge, by mixing it with water. Corn soya blend (CSB), and wheat soya blends (WSB) are generally being used as food aid by World Health Programs (WHPs) to help prevent or treat nutritional deficiencies. FBSs, per 100 gram, contain protein (18%), energy (380 Kcal), fat (6%), and minerals (66%).

Spirulina: Several studies have proposed the use of spirulina extract as a nutritional supplement to fight malnutrition. Spirulina is a cyanobacteria, or blue-green algae, belonging to the genus Arthrospira, and is a rich source of protein (60%); vitamins A, B, and E; pigments (such as chlorophyll and beta carotene), and numerous minerals. Cyanobacteria are minute, aquatic, bacteria-like organisms that prepare their own food. Spirulina supplements are available in many forms, such as powder, capsules, and tablets. Several members of the United Nations (UN) have formed the Intergovernmental Institution for the use of Micro-algae Spirulina Against Malnutrition (IIMSAM). The members are working towards making spirulina a key nutritional supplement to eradicate malnutrition across the world.

Anti-poverty vaccines and drugs: Researchers are developing vaccines against neglected tropical diseases (NTDs), a group of 13 or more different worm and bacterial infections, which are common in the developing countries in tropical regions. NTDs have been associated with poverty because they produce long-lasting effects. For instance, the Sabin Vaccine Institute, through the Human Hookworm Vaccine Initiative, is developing vaccines for both schistosomiasis and hookworm infection to help prevent the poverty-illness-poverty cycle. They also plan to combine these vaccines to offer protection against multiple parasitic infections.

Efforts are being made to identify efficient oral treatments that effectively target multiple. For instance, in one human study, a pyrantel-oxantel drug combination was shown to be effectively treat three worm infections: hookworm, roundworm, and whipworm.

AUTHOR INFORMATION

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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