世界卫生状况英文报告(2)

Health of adults

　　Globally about 51 million people of all ages died in 1993, about three-quarters of them adults. Some 39 million deaths took place in the developing world and about 12 million in the developed. Poor countries had three times more deaths than rich ones.

　　Communicable diseases such as tuberculosis and respiratory infections as well as maternal, perinatal and neonatal conditions account for about 20 million, or about 40%, of the 51 million global deaths; and 99% of these occur in the developing world.

　　Noncommunicable diseases such as cancer and heart disease account for about 19 million deaths, or 36% of the global total, divided more or less equally between the developing and the developed world. The great majority of such deaths are among adults.

　　External causes such as accidents and violence account for about 4 million deaths, or some 8% of the total, again mostly among adults. Developing countries have nearly four times the number of deaths from these causes as the developed world. Other and unknown causes account for the  remaining 16% of deaths worldwide.

　　Maternal complications claim another 508 000 lives a year.

　　Of the 20 million deaths due to communicable diseases more than 16 million, or about 80%, are due to infectious and parasitic diseases. Tuberculosis kills about 3 million people, malaria around 2 million and hepatitis B possibly 1 million.

　　Among the major communicable diseases, tuberculosis was responsible for more than 5% of the global total of deaths - over 7 000 a day - and it is estimated that there will be 8.8 million new cases in 1995 - equal to more than 1 000 new cases every hour of every day. Drug treatment, in most cases costing as little as US $13-30 per person for a six-month course, can cure people; but providing the drugs to those who need them, and ensuring that patients take them for the required period, is a major public health challenge.

　　Meanwhile the lethal relationship of tuberculosis with HIV is making the death toll many times worse. During the next 10 years in Asia alone it is estimated that tuberculosis and AIDS together will kill more people than the entire populations of the cities of Singapore, Beijing, Yokohama and  Tokyo combined.

　　Malaria, directly or in association with acute respiratory infections and anaemia, causes around 2 million deaths a year, the vast majority among young children, and some 400 million cases annually. Globally more than 2 billion people are threatened. The estimated direct and indirect cost of the disease in Africa alone is expected to reach US $1.8 billion by 1995.

　　Cholera has become endemic in many countries in Africa, Asia and Latin America. In 1993 there were 377 000 new cases reported and only 6 800 deaths. Nevertheless, the number of cases and deaths remain at far higher levels than those reported earlier.

　　Among the other communicable diseases, dengue and dengue haemorrhagic fever are now the most important and rapidly rising arbovirus infections in the world. There are millions of cases annually, with approximately 500 000 people needing hospital treatment, and thousands of deaths. The ancient scourge of leprosy still causes 600 000 new cases a year. Between 2 and 3 million people are disabled by the disease, including those who have been cured but crippled in some way prior to treatment. Onchocerciasis (river blindness) infects 18 million people in 34 countries, while dracunculiasis (guinea- worm disease) causes terrible suffering and disability among 3 million of the world s most deprived people who have no access to safe water. Chagas disease affects 17 million people in 21 countries in Latin America and causes 45 000 deaths and 400 000 cases of heart and  stomach disease annually. African trypanosomiasis (sleeping  sickness), kills an estimated 55 000 people a year. Schistosomiasis  (bilharziasis or snailfever) affects 200 million people in 74 countries  in the Americas, Africa and Asia and kills perhaps 200 000 people. Leishmaniasis infects about 13million people. Visceral leishmaniasis,  also known as kala-azar, is the most severe form. Almost always fatal  if untreated, it causes some 500 000 cases and more than 80 000  deaths a year. Lymphatic filariasis (elephantiasis)affects around 100  million people, while Ascaris causes clinical symptoms in as many as  214 million people, Trichuris in 133 million and hookworm in 96  million.

　　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.

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