Sexually transmitted diseases impose a huge health burden across the world. Some 236 million people are estimated to have trichomoniasis, with 94 million new cases a year. Chlamydial infections affect some 162 million people, with 97 million new cases annually. An estimated 32 million new cases of genital warts occur each year, and there are some 78 million new cases of gonorrhoea. Genital herpes infects 21 million people a year, and syphilis 19 million. More than 9 million people are infected with chancroid each year.
Many, if not all, STDs could be avoided if condoms were used. Most STDs can be treated effectively and cheaply - the cost of treating genital ulcer disease, for instance being between US $0.5 and US $4 per person. But thereare problems in the supply and accessibility of services, compounded by fear of stigma on the part of patients and the attitude of some service providers.
HIV and AIDS continue to spread relentlessly. WHO estimates that in 1994 HIV prevalence among adults worldwide was over 13 million. Some 6 000 people are becoming infected each day. In parts of Africa and Asia the virus is advancing rapidly. In southern and south-eastern Asia HIV infections were estimated at 2.5 million - a million more than in 1993.
In 1993, 2 065 cases of human plague (with 191 deaths) recorded in 10 countries in Africa, Asia and the Americas were notified to WHO. That numberexceeded the 1992 total and the annual average for the previous 10 years. The outbreak was a stern reminder to the world that a dreaded disease, often regarded as a scourge of the past, still exists.
Noncommunicable diseases such as those of the circulatory system account for10 million deaths globally, with more than 5 million due to heart disease and another 4 million due to cerebrovascular conditions (such as stroke). These and other noncommunicable diseases that primarily affect adults are also emerging as a major cause of death in the developing world. Although until recently heart disease and stroke were perceived as problems of the developed countries, about 44% of total deaths from these causes now occur in the developing world. Cancer accounts for 6 million or 12% of deaths globally - with the majority of them, 58%, in the developing world.
Among the other noncommunicable diseases, chronic obstructive pulmonary diseases such as chronic bronchitis and emphysema killed nearly 2.9 million adults in 1993, representing about 6% of total deaths. The number of sufferers in the world from these diseases is put at 600 million. This is the second largest known category of persons with a single disorder recorded by WHO. At the same time there are believed to be 275 million asthma sufferers in the world, although WHO has no data on the number of deaths due to this condition.
Diabetes mellitus is a growing public health problem in both developed and developing countries. A recent WHO expert group estimated that more than 100 million people will suffer from diabetes by the end of this century - 85-90% with the non-insulin dependent form. In Europe the prevalence of diabetes is 2-5% per cent of the adult population. In India a quarter of the populationis affected by the age of 60, and 1 in 5 North Americans will acquire thedisease by the age of 70. One recent estimate put the cost of diabetes in the USA alone, both direct and indirect, at US $92 billion a year.
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