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60 5 India With almost 1.3 billion people, India has the world’s second-­ largest population , but it is projected to overtake China in the coming years. India also has a large economy, with a GDP of almost $2 trillion, ranked eleventh among the G20 nations and the European Union. However, there is room and promise for enormous economic growth, with some projections indicating that by the year 2035, the size of India’s economy might be exceeded only by the United States and China [1]. Included among the major sectors of this economic growth are agricultural production (currently India ranks second worldwide in this category); industry (fossil fuels and energy, engineering, pharmaceuticals, mining, and textiles); and information technology [1]. Then there is the hidden and largely forgotten India. The country hosts a crushing level of poverty, with approximately one-­ quarter of its population—roughly 300 million people—who live on virtually nothing, that is, below the 2005–14 World Bank poverty figure of $1.25 per day [2]. More than one-­ half of the population—almost 750 million people—lives on less than $2 per day [3]. Although poverty is widespread and even pervasive in India [4], as noted in chapter 3, it is particularly severe in the northeastern parts of the country, especially in states such as Bihar, Uttar Pradesh, and Orissa, as well as in Assam [5]. It has also been noted that poverty in India sorts out along a rural versus urban divide [1], although certainly there is also horrific poverty in India’s urban slums. Such profound poverty, toWhile India has tremendous economic potential, it still has three-­quarters of a billion people who live on less than $2 per day and 300 million who live on essentially no money. Hotez.indb 60 6/22/16 11:02 AM India 61 gether with explosive population growth, may threaten India’s future economic growth [1]. Overview of India’s NTDs NTDs flourish in the midst of India’s rural poverty [4]. Despite its economic potential, India has the sixth-­ highest worm index of any of the G20 nations, with some of the largest numbers of people living with intestinal helminth infections or LF anywhere in the world [6]. Malnutrition is also pervasive in India, in part because of the widespread prevalence of intestinal helminth infections, together with intestinal protozoan infections and diarrheal diseases (including rotavirus and bacterial gastrointestinal infections). Shown in table 5.1 is an earlier analysis from 2011 of the major NTDs in India [4], when we estimated that there were almost 285 million cases of ascariasis, Table 5.1. The major NTDs in India and South Asia, ranked by prevalence Disease Number of cases in India (% of global disease burden) Number of cases in India and South Asia (% of global disease burden) Estimated number of DALYs in South Asia Ascariasis 140 million (17%) 237 million (29%) 0.4–3.0 million Trichuriasis 73 million (12%) 147 million (24%) 0.5–1.5 million Hookworm infection 71 million (12%) 130 million (23%) 0.6–5.6 million Lymphatic filariasis 36%) Not determined Japanese encephalitis 1,500–4,000 (incidence) 1,000–3,000 (incidence: Nepal); 100–200 (incidence: Sri Lanka) 0.3 million Dengue Not determined Not determined 0.4 million Total 5.6–14.8 million Source: [4], doi:10.1371/journal.pntd.0001222.t002. Hotez.indb 61 6/22/16 11:02 AM 62 Blue Marble Health trichuriasis, and hookworm infection in that country. Beyond these intestinal helminth infections and LF, the major illnesses also include leprosy, kala-­ azar (visceral leishmaniasis), dengue fever and other arboviral infections, rabies, snake envenomation, cholera, and other diarrheal diseases. In addition , although they are not classified as NTDs, falciparum malaria and tuberculosis both also represent important neglected diseases in India. Intestinal Helminth Infections India has the world’s largest number of people, especially children and women of reproductive age, suffering from ascariasis, trichuriasis, and hookworm infection. These intestinal helminth infections have plagued India since ancient times, and even Mohandas Gandhi was said to suffer from hookworm infection toward the end of his life [7]. According to WHO’s PCT database, India has more than 200 million children who require frequent and regular deworming for their intestinal helminth infections [8]. How­ever, India’s most impoverished northeast region likely suffers from the highest prevalence rates. According to one recent study, the overall prevalence of intestinal helminth infections among children living in Bihar state is 68%, led...


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