text: In December 1974, Shange performed the first incarnation of her choreopoem with four other artists at a women's bar outside Berkeley, California. After moving to New York City, she continued work on "for colored girls...", which went on to open at the Booth Theatre in 1976, becoming the second play by a black woman to reach Broadway, preceded by Lorraine Hansberry's "A Raisin in the Sun" in 1959. Shange updated the original choreopoem in 2010, by adding the poem "positive" and referencing the Iraq War and PTSD.


title: For Colored Girls Who Have Considered Suicide / When the Rainbow Is Enuf

text: "for colored girls..." has been performed Off-Broadway as well as on Broadway, and was adapted as a book (first published in 1976 by Shameless Hussy Press), a 1982 television film, and a 2010 theatrical film. The 1976 Broadway production was nominated for the Tony Award for Best Play.


text: "for colored girls who have considered suicide/when the rainbow is enuf" is a piece of work inspired by events of Shange's own life. Shange admitted publicly to having attempted suicide on four occasions. In a phone interview conducted with CNN, she explained how she came to the title of her choreopoem: "I was driving the No. 1 Highway in northern California and I was overcome by the appearance of two parallel rainbows. I had a feeling of near death or near catastrophe. Then I drove through the rainbow and I went away. Then I put that together to form the title." The colors of the rainbow then became the essence of the women in the choreopoem.


text: Shange also explains that she chose to use the word "colored" in the title of her choreopoem so that her grandmother would be able to understand it.


text: Structurally, "for colored girls" is a series of 20-22 poems, depending on whether "my love is too" and "positive" are included in the list, collectively called a "choreopoem." Shange's poetry expresses many struggles and obstacles that African-American women may face throughout their lives and is a representation of sisterhood and coming of age as an African-American woman. The poems are choreographed to music that weaves together interconnected stories. The choreopoem is performed by a cast of seven nameless women only identified by the colors they are assigned. They are the lady in red, lady in orange, lady in yellow, lady in green, lady in blue, lady in brown, and lady in purple. Subjects from rape, abandonment, abortion, and domestic violence are tackled. By the end of the play these women come together in a circle, symbolizing the unity they have found sharing their stories.


text: The prologue of the choreopoem "dark phrases" begins with the lady in brown describing the "dark phrases of womanhood". All she hears are screams and promises. Each woman states where she is from, by stating they are outside their respective cities. The lady in brown proclaims that this piece is all for "colored girls who have considered suicide / but moved to the ends of their own rainbows". The women then begin to sing children's nursery rhymes, "mama's little baby likes shortnin, shortnin". Then all the ladies start to dance to the song "Dancing in the Street".


text: The lady in yellow says it was graduation night and she was the only virgin. She was out driving around with her male friends who she has known since the seventh grade in a black Buick, laughing about graduation. After a fight breaks out, the lady in yellow and Bobby leave and end up having sex in the back of the Buick. The other ladies start talking about their sexual preferences.


text: The lady in blue talks about how she used to participate in dance marathons frequently. One night she refused to dance with anyone that only spoke English. Throughout the monologue she intertwines English and Spanish. During this time she discovered blues clubs. She says she became possessed by the music. She ends her monologue by calling it her poem "thank-you for music," to which she states: "I love you more than poem". She repeats "te amo mas que," and the other women join her, softly chanting.


text: The lady in red addresses an ambiguous "you" throughout the monologue. She has loved this "you" strongly and passionately "for 8 months, 2 wks, & a day" without any encouragement. She decides to end this affair and leaves a note attached to a plant that she has watered every day since she met this person.


text: The lady in orange begins by saying she does not want to write in neither English nor Spanish, but she only wants to dance. She forgets all about words when she starts to dance. She says "we gotta dance to keep form cryin and dyin" and the other ladies repeat her words. The lady in orange then claims that she is a poet "who writes in english / come to share the worlds witchu".


text: The lady in blue talks about how hard it is to press charges against a friend. The other women begin to ponder and ask questions. They say that maybe it was a misunderstanding, or the woman caused it, and they ask her if she was drinking. The lady in red states that society only believes someone is a rapist if they are a perverted stranger. The women talk about male friends of theirs who have nice smiles and buy them dinner but end up raping women. The women all share the experience of having been violated by a man they knew while being on the lookout for “the stranger we always thot it wd be” The lady in red states that the "nature of rape has changed." The lights change, the women react to an imaginary slap.


text: The lady in blue sets the scene with tubes, tables, white washed windows, and her legs spread open. She couldn't bear to have people looking at her while she got an abortion so she is all alone.


text: The lady in purple describes Sechita's life in the bayou, while lady in green dances out Sechita's life. She is dressed up for the Creole carnival celebration. She embodies the spirit of her namesake, Sechita, the Egyptian goddess of creativity, love, beauty and filth from the 2nd millennium.


text: The lady in brown describes falling in love with Toussaint L'Ouverture finding Toussaint in the library near the train tracks. The lady in brown talks about entering a contest to see which "colored child" could read 15 books in three weeks and the lady in brown won, but she was disqualified because she went into the adult reading room and read about Toussaint instead of reading the children's books. The lady in brown became obsessed with Toussaint despite the fact that he was dead. He was her "secret lover at age 8". The lady in brown wanted to run away to go to Haiti with Toussaint. On her journey the lady in brown meets a young boy whose name is Toussaint Jones. The lady in brown feels likes she's met her real-life Toussaint and she leaves with him.


text: The lady in red enters begins by describing a beautiful woman wearing orange butterflies, silk roses, and aqua sequins. This woman is deliberate in all her actions. Although she walked slowly to allow men to gaze at her, she never returned their interest with a smile or acknowledging their catcalls. She was "hot / a deliberate coquette". Her goal was to be unforgettable. She takes "those especially schemin/ tactful suitors" to go home with her. In the morning, she becomes her ordinary self by washing off the glitter and the grime from the night before. She asks her lovers to leave. The men would leave in a hurry, and then she cleaned up and put her roses away. She would write about her exploits in her diary and then, cry herself to sleep.


text: The lady in blue begins her monologue by explaining that she used to live in the world but now only lives in Harlem, and her universe is only six blocks. She used to walk all over the world and now her world is small and dirty. The lady in blue says that when she used to live in the world where she was nice and sweet but now, now she cannot bring herself to be nice to anyone in this "six blocks of cruelty / piled up on itself".


text: The lady in purple joins the ladies in blue, yellow, and orange. She starts by describing them as three friends who shared every aspect of their lives. They remember a time when they all were attracted to the same man, but he only could choose one of them. The one who he chose loved him, but worried if her friends could hold out. One day she found the rose she left on his pillow on her friend's desk. The friend said she did not know what was going on, because the man said he was free. The three friends did not want to hurt one another but they know how wonderful this man could be. The friends hug and cry and go to confront the man, whom they find with another woman. The women cry and comfort each other like sisters.


text: The lady in orange discusses a relationship that left her heartbroken. She says that ever since she realized that someone would call a "colored girl an evil woman a bitch or a nag" (56) she has tried not to be that person. She tries to not only give joy, but to receive it as well. She finds herself in what she believes to be a real and honest relationship. Yet, the guy keeps going back to his ex-lover. The lady in orange tried to move on by finding another lover, but she wasn't satisfied. She tried to avoid sadness, but she found herself heartbroken by this man. She could not stand being "sorry & colored at the same time / it’s so redundant in the modern world".


text: The lady in purple speaks about her relationship to dance and men. She deliberately chooses to dance with men who don't speak English, pops pills, and uses dance as an escape from reality. Then she meets a man who she gave everything: dance, fear, hope and scars. She admits she was ready to die, but now is ready to be herself and accept love. She pleads, "lemme love you just like i am / a colored girl/ i'm finally bein real".


text: The lady in blue proclaims that they all deal with too much emotion and that it might be easier to be white. That way they could make everything "dry & abstract wit no rhythm & no / reelin for sheer sensual pleasure". The lady in blue states that they should try to control their feelings and she is going to take the first step by masturbating. However, she finds that this makes her feel lonely and doesn't know where to look to feel whole.


text: The lady in yellow claims to have lost touch with reality because she used to think she was immune to emotional pain, but she realized she is not. She gave her dance, but her dance was not enough. She says "bein alive & bein a woman & bein colored is a metaphysical / dilemma / i haven't conquered yet".


text: The other women come and each repeats, "my love is too...delicate/beautiful/sanctified/magic/saturday nite/complicated/music to have thrown back in my face." The ladies begin dancing and chanting together.


text: The lady in green says that someone has taken all of her "stuff". She feels that she is the only one that knows and can appreciate the value of her stuff. She describes her stuff as the way she sits with her legs open sometimes, her chewed up fingernails, her rhythm, her voice, her talk, her "delicate leg and whimsical kiss". The person who stole her stuff is a man. She made too much room for this man who has run off with her stuff, especially because he doesn't even know that he has it. By the end of the monologue she demands her stuff back from this man.


text: The ladies start talking about all the apologies they've received from men. Some examples include: he is sorry because he does not know how she got your number, sorry because he was high, sorry because he is only human, and sorry because he thought she could handle it. The lady in blue then declares that she does not need any more apologies. She goes on to say that men should keep their apologies for themselves, because she does not need them to soothe her soul and she cannot use them. Rather than accepting apologies, she is going to do whatever she wants: yell, scream, and break things. And she will not apologize for any of it.


text: Lady in yellow, purple, brown, red participate in reciting the next poem about contracting HIV/AIDS; they share the lines and all speak to one woman's experience. The ladies argue about suspicions of cheating in the relationship. The lady in yellow tells her friends how happy she is in her relationship and her friend tells her, they've seen her lover outside the gay bars. The lady in yellow protests, but her friend tells her to get tested. The lady in yellow goes to get tested to put the whole issue to bed. Two weeks later, the doctor calls the lady in yellow with her patient number (#7QYG9) to inform her that she is HIV positive. The lady in yellow confronts her lover who furiously tells her he is not gay and accuses her of cheating on him. She tells him to get tested but he gets angrier and violent. He throws her to the ground and when she wakes up he is gone and she says, "& i was positive / & not positive at all".


text: The lady in orange begins the story of Willie Brown by saying there is no air. Beau Willie is all tied up in the sheets, wishing a friend would come over and bring him some blow or any other kind of drug. The lady in red continues the story, saying that Beau Willie claims there is nothing wrong with him. Beau Willie tried to get veterans' benefits but he cannot read, so he starts driving a cab around the city but the cops always give him a hard time and he is not making any money. The lady in orange and red say that Crystal is pregnant again and Beau beats Crystal almost to death when he hears about her pregnancy. Beau Willie has wanted to marry Crystal since she was 14, but now she laughs in his face saying she will never marry him. She has the baby and there are now two kids, Naomi and Kwame. Crystal ends up getting a court order to keep Beau away from her and the children. Beau Willie comes to the house despite the court order and while he is there he becomes apologetic saying he just wants to marry her and give her things. The two children run to their father as Crystal watches. Suddenly, he grabs the kids and pushes the screen out of the window. Beau Willie tells Crystal she has to agree to marry him. Naomi and Kwame scream and Crystal, at the moment, can only whisper. Beau Willie drops the kids out of the window and they die.


text: The ladies begin the last poem saying that they are missing something: a "layin on of hands". The hands are strong, cool, moving, and make them whole and pure. The lady in blue says she feels the gods coming into her, laying her open to herself. She goes on to say that she knows about laying her body open for a man, but still she was missing something. Finally, all the ladies repeat the lines she says, "i found god in myself / & i loved her / I loved her fiercely". They sing to each other and then the audience, and close into a tight circle with each other. The choreopoem ends with lady in brown modifying her earlier statement: "& this is for colored girls who have considered suicide/ but are movin to the ends of their own rainbows."


text: "for colored girls..." was first performed by Shange with four other artists at the Bacchanal, a women's bar, outside Berkeley, California. About six months after performing the work in California, Shange and her collaborator, Paula Moss, decided to move across the country determined to perform it in New York City's downtown alternative spaces. At the age of 27, Shange moved to New York, where, in July 1975, the reworked "for colored girls" was professionally produced in New York City at Studio Rivbea in 1975. East coast audiences were soon able to experience Shange’s performance piece at other venues including the Old Reliable, and DeMonte's beginning in July 1975 and then starting in March 1976 at the Henry Street Settlement’s New Federal Theatre. The show grew increasingly popular, especially among African-American and Latino audiences. As a result, "for colored girls who have considered suicide/when the rainbow is enuf" opened at The Public Theater in June 1976. Three months later, in September, the show was performed at the Booth Theater on Broadway, where it was continued until July 1978 and ran for 742 shows. Shange performed as the "lady in orange" at the Broadway opening. It was also published in book form in 1977 by Macmillan Publishing, followed by a Literary Guild edition in October 1977 and Bantam Books editions beginning in 1980. A cast recording was also released by Buddah Records.


text: From February to July 1978 the production, presented by the Adelaide Festival Centre Trust and several American entrepreneurs, toured Australia. It was staged first at Her Majesty's in Adelaide, South Australia, as part of the 10th Adelaide Festival of Arts, before touring to Melbourne, Sydney, Townsville, Cairns, and Brisbane, for two- to four-week runs. Original cast members Alfre Woodard, Aku Kadogo, Carol Maillard, and Lynn Whitfield featured in the show, while it was directed by Oz Scott.


text: In 1982 "for colored girls..." was adapted for television on WNET-TV, PBS, as part of The American Playhouse series. Although "for colored girls" went from a play production to television one, this production was dubbed a "telefilm" instead of a teleplay as the performance on WNET-TV was seen as a serious departure from the Broadway production.


text: In 2009 Tyler Perry announced that he would produce Shange's "for colored girls who have considered suicide/when the rainbow is enuf". The film was the first project for 34th Street Films, Perry's new production company housed in Lionsgate The cast included Loretta Devine, Kimberly Elise, Whoopi Goldberg, Janet Jackson, Phylicia Rashād, Anika Noni Rose, Kerry Washington and Thandie Newton. Originally using the play's full title, the film's title was shortened to "For Colored Girls" in September 2010.


text: In the fall of 2019, The Public Theater revived the play. The production was directed by Leah C. Gardiner, with choreography by Camille A. Brown and featured a Deaf actress in the role of "Lady in Purple." On July 29, 2021, it was announced the Public Theater's staging of the play would be produced on Broadway in 2022. It was later announced that the production would be directed and choreographed by Brown. It began previews on April 1, 2022 and officially opened on April 20 at the Booth Theatre. On May 3, it was confirmed that the revival would close on May 22, several months ahead of schedule; it was subsequently extended to June 5. The cast features D. Woods, Amara Granderson, Tendayi Kuumba, Kenita R. Miller, Okwui Okpokwasili, Stacey Sargeant, and Alexandria Wailes.


text: In 1982 the play was adapted for television on PBS station WNET-TV, as part of the "American Playhouse". The adaptation, directed by Oz Scott, was seen as a serious departure from the Broadway production. A review by "The New York Times" states: "What Miss Shange prefers to call a "choreopoem" has been expanded into realistic settings that too often resemble the sanitized atmosphere of an episode of "Good Times". The net result has been a considerable reduction in the work's emotional impact." As a result, the televised production is often seen as a diluted version of the original choreopoem.


text: On March 25, 2009, the film industry magazine "Variety" reported that Nzingha Stewart, a black female director, had acquired the feature film rights to "for colored girls who have considered suicide/when the rainbow is enuf" from Shange and that Lionsgate had signed Stewart to create a screenplay adaptation and direct the film version of the play.


text: Stewart, at Lionsgate's direction, approached Tyler Perry about producing the film. However, Perry told Lionsgate that if he produced it, he also wanted to write and direct it. Perry then usurped the project from Stewart and scrapped her script. The shift prompted controversy over whether Perry had the skill and consciousness to properly depict an iconic feminist work. Stewart remained on in the token position of executive producer of the film. Among those critics were Oprah Winfrey, who expressed doubts over whether the book should be made into a film at all. Others had reservations based on Perry's position at the helm of such an important book in African American literature, particularly considering the controversies raised by "", a film he lent his name to.


text: On September 3, 2009, Lionsgate announced it had acquired the distribution rights to Tyler Perry's 34th Street Films adaptation of the play, with principal photography originally scheduled to take place in Atlanta, Georgia, in November and December 2009. The film, which was retitled "For Colored Girls", was released on November 5, 2010, and was written, directed and produced by Perry. The cast includes Thandie Newton, Loretta Devine, Kimberly Elise, Whoopi Goldberg, Janet Jackson, Phylicia Rashad, Anika Noni Rose, Kerry Washington, Tessa Thompson, Michael Ealy, Macy Gray and Omari Hardwick. Mariah Carey had also been cast, but pulled out in May 2010, citing medical reasons.


text: When asked if she held reservations about Perry's adaptation of her work, Shange responded: "I had a lot of qualms. I worried about his characterizations of women as plastic." In reference to the film post-production, she stated that "I think he did a very fine job, although I'm not sure I would call it a finished film."


text: In addition to receiving several accolades, the play has been described as a landmark piece in African American literature and black feminism. It has since become a cornerstone of black feminist writing and 20th-century drama.


text: The title of "For Colored Boys Who Have Considered Suicide When the Rainbow is Still Not Enough: Coming of Age, Coming Out, and Coming Home", a 2012 anthology of essays edited by Keith Boykin, was based on the title of Shange's play. Shange's work has also been transformed using different forms of media. It has been continually performed in colleges and universities, art spaces, and theaters throughout the world. It has been set in beauty shops, prisons, and other historical time periods. A Brazilian production dropped the word "color" in the title, and a group of women in Kentucky made it about class instead of race. In a Season Four episode of "A Different World", Freddie (Cree Summer) performs a segment from the play during an audition for the fictionalized Hillman College theater production, where show director Whitley (Jasmine Guy) rejects the piece, sarcastically commenting, "Now I know "why" colored girls consider suicide."


text: The poster for the play and book (as pictured above) are by the New York-based graphic artist, Paul Davis.


title: San Luis Obispo County, California

text: San Luis Obispo County (), officially the County of San Luis Obispo, is a county on the Central Coast of California. As of the 2020 census, the population was 282,424. The county seat is San Luis Obispo.


title: San Luis Obispo County, California

text: Junípero Serra founded the Mission San Luis Obispo de Tolosa in 1772, and San Luis Obispo grew around it. The small size of the county's communities, scattered along the beaches, coastal hills, and mountains of the Santa Lucia range, provides a wide variety of coastal and inland hill ecologies to support fishing, agriculture, and tourist activities.


title: San Luis Obispo County, California

text: California Polytechnic State University has almost 20,000 students. Tourism, especially for the wineries, is popular. Grapes and other agriculture products are an important part of the economy. San Luis Obispo County is the third largest producer of wine in California, surpassed only by Sonoma and Napa counties. Strawberries are the largest agricultural crop in the county.


title: San Luis Obispo County, California

text: The town of San Simeon is located at the foot of the ridge where newspaper publisher William Randolph Hearst built Hearst Castle. Other coastal towns (listed from north to south) include Cambria, Cayucos, Morro Bay, and Los Osos -Baywood Park. These cities and villages are located northwest of the city of San Luis Obispo. To the south are Avila Beach and the Five Cities region. The Five Cities originally were: Arroyo Grande, Grover Beach (then known as Grover City), Oceano, Fair Oaks and Halcyon. Today, the Five Cities region consists of Pismo Beach, Grover Beach, Arroyo Grande, Oceano, and Halcyon (basically the area from Pismo Beach to Oceano). Just south of the Five Cities, San Luis Obispo County borders northern Santa Barbara County. Inland, the cities of Paso Robles, Templeton, and Atascadero lie along the Salinas River, near the Paso Robles wine region. San Luis Obispo lies south of Atascadero and north of the Five Cities region.


title: San Luis Obispo County, California

text: The prehistory of San Luis Obispo County is strongly influenced by the Chumash people. There has been significant settlement here at least as early as the Millingstone Horizon thousands of years ago. Important settlements existed in coastal areas such as Morro Bay and Los Osos.


title: San Luis Obispo County, California

text: Mission San Luis Obispo de Tolosa was founded on September 1, 1772 in the area that is now the city of San Luis Obispo. The namesake of the mission, city and county is Saint Louis of Toulouse, the young bishop of Toulouse ("Obispo" and "Tolosa" in Spanish) in 1297.


title: San Luis Obispo County, California

text: San Luis Obispo County was one of the original counties of California, created in 1850 at the time of statehood.


title: San Luis Obispo County, California

text: The Salinas River Valley, a region that figures strongly in several John Steinbeck novels, stretches north from San Luis Obispo County.


title: San Luis Obispo County, California

text: According to the U.S. Census Bureau, the county has a total area of , of which is land and (comprising 8.8%) is water.


title: San Luis Obispo County, California

text: San Luis Obispo County has three main climate types. BSk climate can mainly be found in the eastern portions of the county, along with certain smaller areas in the north. Csa climate can mainly be found in the central portions of the counties, in communities such as Paso Robles. The rest of the county is made up of the Csb climate type.


title: San Luis Obispo County, California

text: "Note: the US Census treats Hispanic/Latino as an ethnic category. This table excludes Latinos from the racial categories and assigns them to a separate category. Hispanics/Latinos can be of any race."


title: San Luis Obispo County, California

text: The 2010 United States Census reported that San Luis Obispo County had a population of 269,637. The racial makeup of San Luis Obispo County was 222,756 (82.6%) White, 5,550 (2.1%) African American, 2,536 (0.9%) Native American, 8,507 (3.2%) Asian (1.0% Filipino, 0.6% Chinese, 0.4% Japanese, 0.3% Indian, 0.3% Korean, 0.2% Vietnamese), 389 (0.1%) Pacific Islander, 19,786 (7.3%) from other races, and 10,113 (3.8%) from two or more races. Hispanic or Latino of any race were 55,973 persons (20.8%); 17.7% of San Luis Obispo County is Mexican, 0.3% Puerto Rican, and 0.2% Salvadoran.


title: San Luis Obispo County, California

text: As of the census of 2000, there were 246,681 residents, 92,739 households, and 58,611 families in the county. The population density was 75 people per square mile (29/km). There were 102,275 housing units at an average density of 31 per square mile (12/km). The racial makeup of the county was 84.6% White, 2.0% Black or African American, 1.0% Native American, 2.7% Asian, 0.1% Pacific Islander, 6.2% from other races, and 3.4% from two or more races. 16.3% of the population were Hispanic or Latino of any race. 13.9% were of German, 11.4% English, 9.7% Irish, 6.1% American and 5.7% Italian ancestry according to Census 2000. 85.7% spoke English and 10.7% Spanish as their first language.


title: San Luis Obispo County, California

text: There were 92,739 households, out of which 28.2% had children under the age of 18 living with them, 50.40% were married couples living together, 9.1% had a female householder with no husband present, and 36.8% were non-families. 26.0% of all households were made up of individuals, and 10.3% had someone living alone who was 65 years of age or older. The average household size was 2.49 and the average family size was 3.01.


title: San Luis Obispo County, California

text: In the county, the population was spread out, with 21.7% under the age of 18, 13.6% from 18 to 24, 27.0% from 25 to 44, 23.3% from 45 to 64, and 14.5% who were 65 years of age or older. The median age was 37 years. For every 100 females there were 105.6 males. For every 100 females age 18 and over, there were 105.2 males.


title: San Luis Obispo County, California

text: The median income for a household in the county was $42,428, and the median income for a family was $52,447. Males had a median income of $40,726 versus $27,450 for females. The per capita income for the county was $21,864. About 6.8% of families and 12.8% of the population were below the poverty line, including 11.4% of those under age 18 and 5.9% of those age 65 or over.


title: San Luis Obispo County, California

text: The mainstays of the economy are California Polytechnic State University with its almost 20,000 students, tourism, and agriculture.


title: San Luis Obispo County, California

text: San Luis Obispo County's economy is primarily a service economy. Service jobs account for 38% of the County's jobs, government jobs accounts for 20.7%, and manufacturing jobs represent 6% of the County's jobs.


title: San Luis Obispo County, California

text: San Luis Obispo County is the third largest producer of wine in California, surpassed only by Sonoma and Napa counties. Wine grapes are the second largest agricultural crop in the county (after strawberries), and the wine production they support creates a direct economic impact and a growing wine country vacation industry.


title: San Luis Obispo County, California

text: The county led the state in hemp cultivation in 2018 as hundreds of acres of the crop were grown in research partnerships. In 2019, nine agricultural research permits were still active. Sixteen commercial permits were issued before a temporary ban on new applications running through June 2020 was passed by the Board of Supervisors.


title: San Luis Obispo County, California

text: San Luis Obispo County leaned toward the Republican Party in presidential and congressional elections during the most of the 20th century; it has, however, become more Democratic starting in the 2000s. In 2008, Barack Obama won the county with 51.2 percent of the vote. Prior to 2008, the last Democrat to win a majority in the county was Lyndon Johnson in 1964, although Bill Clinton won a plurality in 1992. In 2012, Obama again won the county, this time with a slim plurality of the vote. Hillary Clinton won with a larger plurality in 2016; and in 2020, Joe Biden won a solid 55% of the vote, the largest for any Democrat since Lyndon Johnson in 1964.


title: San Luis Obispo County, California

text: County voters supported Republican Meg Whitman in 2010 and Democrat Jerry Brown in 2014. The previous Democrat to carry the county in a gubernatorial election was Gray Davis in 1998.


title: San Luis Obispo County, California

text: With respect to the United States House of Representatives, San Luis Obispo County is in . From 2003 until 2013, the county was split between the Bakersfield-based 22nd district, which was represented by Republican Kevin McCarthy and included Paso Robles and most of the more conservative inland areas of the county, and Lois Capps' 23rd district, a strip which included most of the county's more liberal coastal areas as well as coastal areas of Santa Barbara and Ventura counties.


title: San Luis Obispo County, California

text: With respect to the California State Senate, the county is in . With respect to the California State Assembly, the county is in .


title: San Luis Obispo County, California

text: In April 2008, the California Secretary of State reported that there were 147,326 registered voters in San Luis Obispo County. Of those voters, 61,226 (41.6%) were registered Republicans, 52,586 (35.7%) were registered Democratic, 8,030 (5.4%) are registered with other political parties, and 25,484 (17.3%) declined to state a political preference. The cities of Grover Beach, Morro Bay, and San Luis Obispo had pluralities or majorities of registered Democratic voters, whereas the rest of the county's towns, cities, and the unincorporated areas have a plurality or majority of registered Republican voters.


title: San Luis Obispo County, California

text: The following table includes the number of incidents reported and the rate per 1,000 persons for each type of offense.


title: San Luis Obispo County, California

text: The San Luis Obispo Regional Transit Authority provides countywide service along US 101 as well as service to Morro Bay, Los Osos, Cambria and San Simeon.


title: San Luis Obispo County, California

text: In the future, SR 46 may be considered for a possible westward expansion of Interstate 40 via SR 58 from Barstow to Bakersfield, from Bakersfield to I-5 via Westside Parkway, and then following SR 46 to Paso Robles. SR 46 is slowly being upgraded to Interstate standards, minus overpasses between Interstate 5 and US Route 101.


title: Penang International Airport

text: Penang International Airport is an airport in northern Malaysia. The airport is located near Bayan Lepas at the southeastern tip of Penang Island, south of the city centre.


title: Penang International Airport

text: Penang International Airport is the third-busiest airport in Malaysia in terms of passenger traffic and the second-busiest in terms of cargo tonnage. The airport is also one of the hubs of the Malaysian low-cost carriers, AirAsia and Firefly.


title: Penang International Airport

text: The airport, then named Bayan Lepas International Airport, was completed in 1935, when Penang was part of the British crown colony of the Straits Settlements.


title: Penang International Airport

text: In the 1970s, a major expansion of the airport was carried out, during which a terminal building of Minangkabau architecture was built and the runway extended to accommodate Boeing 747s, then the largest passenger jet aircraft. Upon the completion of the expansion works in 1979, the airport was renamed Penang International Airport.


title: Penang International Airport

text: In December 2019, MAHB announced a RM800 million expansion plan for the airport, with work on 4 phases starting in March 2020 and to be completed by 2024. This would raise the capacity of the airport from 6.5 million passengers yearly, to 12 million a year. This compares with actual passenger numbers of 9.5 million. However, in May 2020, Chief Minister of Penang Chow Kon Yeow says the planned expansion of the airport might well be by between six months to a year due as a result of the COVID-19.


title: Penang International Airport

text: On 5 April 2020, Chief Minister Chow Kon Yeow said that all international flights into Penang had ceased, although domestic flights continued.


title: Penang International Airport

text: The airport became a source of contention between the Penang state government and the Malaysian federal government in recent years, as transportation infrastructure throughout Malaysia falls under the purview of the latter authority. Calls by the Penang state government to expand the airport largely went unheeded by the Malaysian federal government, even though the airport has exceeded its maximum capacity of 6.5 million passengers. In 2017, the federal authorities finally announced plans to expand the airport to accommodate 12 million passengers per year by 2029. The airport expansion was stalled from 2020-2022 due to issues with land acquisition and funding however the Malaysian Transport Ministry has reaffirmed its expansion plans.


title: Penang International Airport

text: Penang International Airport is the third busiest airport in the country in terms of passenger traffic after Kuala Lumpur International Airport and Kota Kinabalu International Airport, and handles the second largest cargo tonnage of all Malaysian airports after Kuala Lumpur International Airport. , the airport posted a record 7.23 million tourist arrivals.


title: Penang International Airport

text: Notably, Malaysia Airlines subsidiary, Firefly, has made Penang International Airport one of its main hubs. AirAsia, another domestic budget airliner, also operates out of Penang International Airport as one of its secondary hubs.


title: Penang International Airport

text: Rapid Penang has provided four bus routes to and from Penang International Airport, connecting the airport with various parts of Penang Island.


title: Penang International Airport

text: In addition, as of December 2020, the state government is planning a light-rail project that will connect Penang International Airport and Komtar with 27 intermediate stations.


title: One Sweet Day

text: "One Sweet Day" is a song recorded by American singer-songwriter Mariah Carey and vocal group Boyz II Men. The song was released on as the second single from Carey's fifth studio album, "Daydream" (1995) by Columbia Records. The artists co-wrote the song with Walter Afanasieff, who co-produced it with Carey. Lyrically, the song speaks about the death of a loved one, how the protagonist took their presence for granted and misses them, and finally about seeing the person in heaven. Both Carey and Boyz II Men wrote the song about specific people in their lives, being inspired by sufferers of the AIDS epidemic, which was globally prevalent at the time.


title: One Sweet Day

text: "One Sweet Day" received universal acclaim from music critics, many of whom praised its lyrical content and vocals while calling it a standout track on "Daydream". It was ranked first in "Rolling Stone"s reader's poll for the Best Collaboration of All Time. The song spent 16 weeks atop the "Billboard" Hot 100 in the United States, becoming the longest-running number-one song in the chart's history at the time, a record held for 23 years. The song ranked first on "Billboard's" Hot 100 decade-end chart. Subsequently, the publication ranked it as the ninth best charting single of the 1990s with post-90s sales and streaming figures incorporated. Internationally, the song topped the charts in Canada and New Zealand; and reached the top-ten in Australia, Belgium, Denmark, France, Ireland, the Netherlands, Norway, Panama, Sweden and the United Kingdom.


title: One Sweet Day

text: Carey performed "One Sweet Day" live alongside Boyz II Men at the 38th Grammy Awards ceremony, held on February 26, 1996. Additionally, the song was performed at Princess Diana's memorial service in September 1997. "One Sweet Day" was part of the set list on several of Carey's succeeding tours, making its debut during the album's accompanying set of concerts, the Daydream World Tour. It is featured on her compilation albums, "#1's" (1998), "Greatest Hits" (2001), "The Ballads" (2008), and "#1 to Infinity" (2015).


title: One Sweet Day

text: The music video for "One Sweet Day" was filmed in February 1995, and features snippets of Carey and Boyz II Men in and around the studio, and recording the song. The busy schedule of both acts did not allow time to shoot a proper video. Carey later said that she was content a real music video was never filmed, fearing that no video could truly capture the song's strong lyrical message. Critics felt the video choice was wise, and agreed that the simple concept paid homage to the song's selfless message.


title: One Sweet Day

text: "One Sweet Day" was a song that Carey wrote with the R&B group Boyz II Men. After Carey's friend and past collaborator David Cole (of C&C Music Factory) died, she began writing and developing a song that would pay homage to him and all the friends and family her fans had lost along life's journey. Carey had the idea and chorus composed, and after meeting with Boyz II Men, they realized they too had a similar idea in development. Together, using Carey's chorus and idea, as well as the melody they had produced, they wrote and composed the song. The song was produced by Carey and Afanasieff, who built on the song's melody and added various grooves and beats. Carey expressed how the song was "meant to be" and how all the pieces fit into place:


title: One Sweet Day

text: I wrote the initial idea for 'One Sweet Day' with Walter, and I had the chorus...and I stopped and said, 'I really wanna do this with Boyz II Men,' because...obviously I'm a big fan of theirs and I just thought that the work was crying out for them, the vocals that they do, so I put it away and said, 'Who knows if this could ever happen, but I just don't wanna finish this song because I want it to be our song if we ever do it together. [The] whole idea of when you lose people that are close to you, it changes your life and changes your perspective. When they came into the studio, I played them the idea for the song and when [it] was finished, they looked at each other, a bit stunned, and told me that Nathan "Nate" Morris had written a song for his road manager who had passed away. It had basically the same lyrics and fitted over the same chord changes. It was really, really weird, we finished the song right then and there. We were all kinda flipped about it ourselves. Fate had a lot to do with that. I know some people won't believe it, but we wouldn't make up such a crazy story.


title: One Sweet Day

text: After they began working on the song, Carey began to incorporate other lyrics into the chorus, trying to make the song relatable to the AIDS epidemic that was in full force in the mid-1990s. Additionally, Mariah's sister Alison Carey had been diagnosed with HIV in 1988 when she was 27, an event that ruined their relationship and tore them apart. Carey has stated that she wrote the song hoping that all her fans that have lost someone could relate to "One Sweet Day" and maybe help ease the pain of the loss. Carey described the song as "[the] whole idea of when you lose people that are close to you, it changes your life and changes our perspective."


title: One Sweet Day

text: "One Sweet Day" is a "big" R&B ballad. It incorporates organ instrumentation and different contemporary grooves and beats into its primary arrangement, adding percussion and synthesizers as well, while incorporating "flourishes and harmonies" from both Carey and Boyz II Men. The song is set in the time signature common time and moves at a slow tempo of 64 beats per minute. It is written in the key of A major and features a basic chord progression of A–D–A–D–G, while the basic melodic line spans roughly an octave and a half from E to A; the piano in the piece ranges from D to A. The song contains choral lyrics written by Carey, who also arranged and co-produced the song alongside Walter Afanasieff. Author Chris Nickson complimented the song's instrumentation and arrangement, calling its use of synthesizers "wise" and "efficient." Additionally, he claimed Afanasieff's production and Carey's vocal and production arrangement helped the song's vocals and lyrical content flow together. The song finishes with the last chorus and coda in the key of B major.


title: One Sweet Day

text: "One Sweet Day" has been met with universal acclaim from contemporary music critics. AllMusic's Stephen Thomas Erlewine praised the song for its craft and writing, commenting that "[in] "One Sweet Day," a duet with Boyz II Men, Carey appeals to both audiences equally because of the sheer amount of craft and hard work she puts into her albums. Steve Baltin from "Cash Box" wrote, "This single could be thrown at the bottom of the 99 cents bin, buried under the Partridge Family and Starlite Vocal Band, and it would still find its way into the hands of fans. This is as big a guaranteed hit as anything that’s come out in some time". He added, "You will never find a surer bet than whether this song will make number one." James Masterton for Dotmusic demed it as "a saccharine piece of American soul slush." Ken Tucker from "Entertainment Weekly" felt the song truly highlighted the album, "[One Sweet Day] radiates a breezy sexiness that Carey, for all the brazen hussiness of her public persona, rarely permits herself to reveal in song. In 2018, the magazine noted, "Goosebumps, every time. Carey's heavenly vocals, combined with the song's universal message and the sweet harmonies of Boyz II Men." Stephen Holden from "The New York Times" shared similar sentiments and wrote "On 'One Sweet Day,' the singer joins forces with Boyz II Men, those masters of pleading post-doo-wop vocal harmonies, for a tender eulogy that suggests that the singers have been personally touched by the AIDS crisis." A reviewer from "People" magazine felt the song was a "stand-out track" and called Carey's vocal performance "bravura belting."


title: One Sweet Day

text: "One Sweet Day" won many prestigious awards throughout 1996. At the Blockbuster Entertainment Awards, the song won the award for "Favorite Adult Contemporary Single Female 'One Sweet Day'". "One Sweet Day" also won the award for "Song of the Year" at the BMI Awards and a "Special Award for 16 weeks at #1" at the Billboard Music Awards. Together, "Daydream" and "One Sweet Day" were nominated for six Grammy Awards at the 38th annual ceremony, however, to Carey's surprise, also to the surprise of many critics, they lost all of the nominations. In a readers' poll conducted by "Rolling Stone", the song was ranked first for the category of the Best Collaboration of All Time.


title: One Sweet Day

text: "One Sweet Day" became Carey's tenth chart topping single on the "Billboard" Hot 100 and Boyz II Men's fourth, debuting at the top spot. "One Sweet Day" became the fourth song to debut at number one after Michael Jackson's "You Are Not Alone", Carey's own "Fantasy", and Whitney Houston's "Exhale (Shoop Shoop)". The song remained at the peak for a record-breaking 16 consecutive weeks, from December 2, 1995, to March 16, 1996. It remained the only song to stay at number one on the chart for 16 weeks until 2017, when the record was tied by Luis Fonsi and Daddy Yankee's "Despacito", featuring Justin Bieber. The record would remain until Lil Nas X's "Old Town Road", featuring Billy Ray Cyrus, broke the record in 2019, spending nineteen weeks atop the "Billboard" Hot 100. It still remains as the only number one debut to spend sixteen consecutive weeks at number one. No other song that debuted at number one spent 16 weeks at the top .


title: One Sweet Day

text: Boyz II Men had previously held this record twice, with "End of the Road" (1992) spending 13 weeks at the top and "I'll Make Love to You" (1994) spending 14. The former song shares this record with Brandy and Monica's "The Boy Is Mine", and the latter song shared its record with Whitney Houston's "I Will Always Love You". Carey's 2005 song "We Belong Together", The Black Eyed Peas's 2009 "I Gotta Feeling" and Mark Ronson's 2014 track, "Uptown Funk", managed to stay at number one for 14 weeks as well. Being the fourth single in history to debut at number one on the Billboard Hot 100, "One Sweet Day" also made Boyz II Men the first group to have a single debut at number one.


title: One Sweet Day

text: "One Sweet Day" unseated "Exhale (Shoop Shoop)" by Whitney Houston at number one on the "Billboard" Hot 100, and was knocked off by Celine Dion's "Because You Loved Me". With the single's debut at number one, it made Carey the first artist to have more than one number-one debut, and one of the four artists ever to have two consecutive singles debut at the top of the chart, along with Britney Spears, with "3" (2009) and "Hold It Against Me" (2011), and Drake, with "God's Plan" (2018) and "Nice for What" (2018) and Ariana Grande, with "Thank U, Next" (2018) and "7 Rings" (2019). "One Sweet Day" was the third best-selling single of 1995 in the US, with sales of over 1,300,000, with the second best-selling single being Carey's "Fantasy". The song spent 26 weeks in the top 40, was certified double platinum by the Recording Industry Association of America (RIAA) and was ranked number nine on "Billboard"s Hot 100-decade retrospective.


title: One Sweet Day

text: Outside the U.S., "One Sweet Day" was not as successful but did manage to reach the top-ten in over 13 countries and topped the charts in Canada and New Zealand, where it was certified platinum. In Canada, the song debuted on the "RPM" Singles Chart at number 89 on the "RPM" issue dated December 4, 1995, and reached the top of the chart on January 22, 1996. It was present on the chart for a total of 24 weeks, and ranked 12th on the "RPM" Year-end chart for 1996. It reached the top-two in Australia (platinum) and the Netherlands; the top-five in France (silver) and Ireland and the top-ten in Belgium, Norway (platinum), Sweden and the United Kingdom (gold). In the UK, it is one of Carey's best-selling singles, with estimated sales of over 400,000.


title: One Sweet Day

text: The song's accompanying music video was directed by Larry Jordan. When Carey and Boyz II Men got together to record "One Sweet Day", they did not have enough time to re-unite and film a video. Instead, a filming crew was present during the song's recording, and filmed bits of Carey and Boyz recording the song. Walter Afanasieff later told Fred Bronson that shooting the video was "crazy", stating, "They had film crews and video guys, while I'm at the board trying to produce. And these guys were running around having a ball, because Mariah and them are laughing and screaming and they're being interviewed. And I'm tapping people on the shoulder. 'We've got to get to the microphone!' They're gone in a couple of hours, so I recorded everything they did, praying that it was enough." After the song's release, Carey expressed her contentment with the video, that she was happy a real music video was never filmed, fearing that no video could truly capture the song's "precious message." Critics agreed, feeling that the song was a perfect match for the video and its message. Aside from the recording sessions, the video also shared bits of Carey and Boyz bonding and sharing their ideas in the studio, where Carey felt they "bonded." On August 13, 2020, the music video of "One Sweet Day" reached 200 million views on YouTube.


title: One Sweet Day

text: "One Sweet Day" was performed at the 38th Annual Grammy Awards, held on February 28, 1996. During the performance, Carey wore a long black dress and matching sleeveless blouse, while the group wore white jackets and black pants. After the song's bridge, a choir of male and female vocalists took place on the rafters placed over the stage, all wearing white gowns. The song was also performed at the memorial service for Princess Diana in September 1997, where other performers included Elton John. During the service and song recital, Carey wore a conservative long black sheer gown, with long golden curls. Boyz II Men all wore similar matching dark suit and garments. The song became part of Carey's BET Christmas special in 2001, where she sang the song alongside Boyz II Men. During the special, Carey wore a red gown in honor of the show's holiday theme, and featured a long golden hairstyle. One of the male vocalists had already been switched, as one of the group members had already resigned.


title: One Sweet Day

text: Aside from live television appearances, the song was performed on many of Carey's tours. "One Sweet Day" was performed at every show on her Daydream World Tour (1996), where Boyz II Men were featured on a large projection screen. The footage was taken from Carey's filmed concert at Madison Square Garden in late 1995, and was played in sync with Carey's verses. A similar concept was used for her Butterfly World Tour (1998), with the addition of several live back up vocalists joining on stage. Additionally, the song was performed on select dates on her The Adventures of Mimi tour (2006). During the tour's filmed show in Anaheim California, the group joined Carey live on stage and performed the song together. For the segment of the show, Carey wore a long turquoise gown, with several slits and cuts fashioned into the sides. During the Angels Advocate Tour in 2010, Carey performed a snippet of the song in Singapore, with Trey Lorenz filling in for the group's verses.


title: One Sweet Day

text: Carey also performed the song as a part of her 2015 Las Vegas residency, Mariah Carey Number 1's, with Lorenz reprising his role as well as Daniel Moore. She also performed the song as a part of her 2018–20 Las Vegas residency, The Butterfly Returns alongside Lorenz and Moore.


title: One Sweet Day

text: "One Sweet Day" was performed by the seven finalists on the seventh season of "American Idol". The performance was taped due to the "Mariah Carey" themed week, where all the competitors sang songs from Carey's repertoire. The song was additionally sung on the fifth season of the UK TV show "The X Factor", by the British boy-band JLS. Their performance received praise from all four judges, who commented how it was an "impossibly hard song to sing" because it was a "Mariah song." The song was also performed by John Adeleye during the seventh season "The X Factor". The theme of the night was "#1 songs." Shannon Magrane performed the song on the eleventh season of "American Idol" the week the contestants performed songs from their birth years. Andy Williams released a version in 2007 on his album, "I Don't Remember Ever Growing Up".


title: Neglected tropical diseases

text: Neglected tropical diseases (NTDs) are a diverse group of tropical infections that are common in low-income populations in developing regions of Africa, Asia, and the Americas. They are caused by a variety of pathogens, such as viruses, bacteria, protozoa, and parasitic worms (helminths). These diseases are contrasted with the "big three" infectious diseases (HIV/AIDS, tuberculosis, and malaria), which generally receive greater treatment and research funding. In sub-Saharan Africa, the effect of neglected tropical diseases as a group is comparable to that of malaria and tuberculosis. NTD co-infection can also make HIV/AIDS and tuberculosis more deadly.


title: Neglected tropical diseases

text: Some treatments for NTDs are relatively inexpensive. For example, the treatment for schistosomiasis is US$0.20 per child per year. Nevertheless, in 2010 it was estimated that control of neglected diseases would require funding of between US$2 billion and $3 billion over the subsequent five to seven years. Some pharmaceutical companies have committed to donating all the drug therapies required, and mass drug administration efforts (for example, mass deworming) have been successful in several countries. While preventive measures are often more accessible in the developed world, they are not universally available in poorer areas.


title: Neglected tropical diseases

text: Within developed countries, neglected tropical diseases affect the very poorest in society. In the United States, there are up to 1.46 million families, including 2.8 million children, living on less than two dollars a day. In developed countries, the burdens of neglected tropical diseases are often overshadowed by other public health issues. However, many of the same issues put populations at risk in developed as well as in developing nations. For example, other problems can stem from poverty which expose individuals to the vectors of these diseases, such as lack of adequate housing.


title: Neglected tropical diseases

text: Twenty neglected tropical diseases are prioritized by the World Health Organization (WHO), though other organizations define NTDs differently. Chromoblastomycosis and other deep mycoses, scabies and other ectoparasites, and snakebite envenomation were added to the list in 2017. These diseases are common in 149 countries, affecting more than 1.4 billion people (including more than 500 million children) and costing developing economies billions of dollars every year. They resulted in 142,000 deaths in 2013—down from 204,000 deaths in 1990.


title: Neglected tropical diseases

text: The importance of neglected tropical diseases has been underestimated since many are asymptomatic and have long incubation periods. The connection between a death and a neglected tropical disease that has been latent for a long period of time is not often realized. Areas of high endemicity are often in geographically isolated areas, making treatment and prevention much more difficult.


title: Neglected tropical diseases

text: These diseases have been overlooked because they mainly affect the poorest countries of the developing world and because of recent emphasis on decreasing the prevalence of HIV/AIDS, tuberculosis, and malaria. Far more resources are given to the "big three" diseases (HIV/AIDS, tuberculosis, and malaria) because of their higher mortality and public awareness rates. Neglected tropical diseases do not have a prominent cultural figure to champion the cause.


title: Neglected tropical diseases

text: Neglected tropical diseases are often associated with social stigma, making their treatment more complex. Public health research has only recently begun to focus on stigma as a component of the issue. From the 1960s onward, approximately one citation a year related to social stigma. In 2006, there were 458. Disease control is greatly affected by this stigma, as it decreases help-seeking and treatment adherence. Disease control programs, starting as early as the 1980s, have begun to integrate stigma mitigation into their offerings. In India, the leprosy program prioritized the message that "leprosy is curable, not hereditary" in order to inspire optimism in highly affected communities. The goal was to make leprosy a disease "like any other", so as to reduce stigma. At the same time, medical resources available in the area were optimized to fulfill the curable promise made.


title: Neglected tropical diseases

text: Neglected tropical diseases are not commercial, and consequently, patents and profit play no role in stimulating innovation. Like all non-commercial areas, these diseases are the responsibility of governments and philanthropy (including industry philanthropy). Currently, the pharmaceutical industry views research and development as highly risky. For this reason, resources are not often put into the field of NTDs (as diseases of the poor) and new chemical products are often expensive. A review of public and private initiatives found that of the 1393 new chemical products that were marketed in the period of 1975 and 1999, only 16 related to tropical diseases and tuberculosis. The same review additionally found that there was a 13-fold greater chance of a drug entering the market being for central nervous system disorders or cancer than an NTD.


title: Neglected tropical diseases

text: Due to a lack of economic incentives for the pharmaceutical industry, successful NTD treatment programs have often relied on donations. The Mectizan Donation Program has donated over 1.8 billion tablets of ivermectin. While developed countries will often rely on government-run and private partnerships to fund such projects, developing nations frequently have significantly lower per-person spending on these diseases.


title: Neglected tropical diseases

text: Since 2008, the concept of "neglected diseases of poverty" has been developed and explored. This group of diseases overlaps with the neglected tropical diseases, which also pose a threat to human health in developed nations. In the United States alone, there are at least 12 million people with these neglected parasitic infections. They make up a hidden disease burden among the poorest of wealthy societies. In developed nations, lack of knowledge in the healthcare industry and lack of conclusive diagnostic tests perpetuate the neglect of this group of diseases.


title: Neglected tropical diseases

text: In the United States, high rates of parasitic infection can be distributed along geographic, racial, and socio-economic lines. Within the African-American community, there may be up to 2.8 million cases of toxocariasis. Rates of toxocariasis, trichomoniasis, and other neglected infections occur in the United States at the same rate as in Nigeria. Within the Hispanic community, neglected infections are concentrated near the US–Mexico border. Vector-borne illnesses are especially high, with some rates approaching those of Latin America. Chagas disease was found in the US as early as the 1970s. However, in the developed world, diseases that are associated with poverty are often not addressed comprehensively. This may be due to lack of economic incentives and public policy failings. Here, a lack of awareness prevents effective policy generation and leaves health care services unequipped to address the issue. Additionally, there is little effort put into taking and maintaining large data sets on neglected diseases in the United States and other developed nations. The first summit on the issue was held by the Adler Institute on Social Exclusion in the United States in 2009.


title: Neglected tropical diseases

text: In Europe, a similar trend is seen. Neglected tropical diseases are concentrated in eastern and southern Europe, where poverty levels are the highest. The most prevalent diseases in this region are ascariasis, trichuriasis, zoonotic helminth infections, and visceral leishmaniasis. Migration paths to Europe, most notably to Spain, have brought diseases to Europe as well. As many as 6,000 cases of Chagas disease have been introduced via this method. In response to a growing awareness of the burden on these populations, the European Centre for Disease Prevention and Control has laid out ten public health guidelines. They cover a variety of topics, from health education and promotion to community partnerships and the development of a minority healthcare workforce.


title: Neglected tropical diseases

text: There is some debate among the WHO, CDC, and infectious disease experts over which diseases are classified as neglected tropical diseases. Feasey, a researcher in neglected tropical diseases, notes 13 neglected tropical diseases: ascariasis, Buruli ulcer, Chagas disease, dracunculiasis, hookworm infection, human African trypanosomiasis, Leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma, and trichuriasis. Fenwick recognizes 12 "core" neglected tropical diseases: the same as above, excluding hookworm.


title: Neglected tropical diseases

text: These diseases result from four different classes of causative pathogens: (i) protozoa (for Chagas disease, human African trypanosomiasis, and leishmaniases); (ii) bacteria (for Buruli ulcer, leprosy, trachoma, and yaws), (iii) helminths or metazoan worms (for cysticercosis/taeniasis, dracunculiasis, echinococcosis, foodborne trematodiases, lymphatic filariasis, onchocerciasis, schistosomiasis, and soil-transmitted helminthiasis); and (iv) viruses (dengue and chikungunya, rabies).


title: Neglected tropical diseases

text: The World Health Organization's 2010 report dedicated to neglected tropical diseases offers an expanded list including dengue, rabies, yaws, cysticercosis, echinococcosis, and foodborne trematode infections.


title: Neglected tropical diseases

text: Buruli ulcer is caused by the bacterium "Mycobacterium ulcerans". It is related to the family of organisms that cause tuberculosis and leprosy, but "Mycobacterium ulcerans" produces a toxin, mycolactone, that destroys tissue. The prevalence of Buruli ulcer is unknown. The risk of mortality is low, although secondary infections can be lethal. Morbidity takes the form of deformity, disability, and skin lesions, which can be prevented through early treatment and treated with antibiotics and surgery. It is found in Africa, Asia, and Latin America.


title: Neglected tropical diseases

text: Chagas disease is also known as American trypanosomiasis. There are approximately 15 million people infected with Chagas disease. Morbidity rates are higher for immuno-compromised individuals, children, and elderly, but can be very low if treated early. Chagas disease does not kill victims rapidly, instead causing years of debilitating chronic symptoms. It is caused by a vector-borne protozoa and spread by contact with "Trypanosoma cruzi"-infected feces of the triatomine (assassin) bug. The protozoan can enter the body via the bug's bite, skin breaks, or mucous membranes. Infection can result from eating infected food and coming into contact with contaminated bodily fluids. There are two phases of Chagas disease. The acute phase is usually asymptomatic. The first symptoms are usually skin chancres, unilateral purplish orbital oedema, local lymphoadenopathies, and fever accompanied by a variety of other symptoms depending on the infection site. The chronic phase occurs in 30 percent of total infections and can take three forms, which are asymptomatic (most prevalent), cardiac, and digestive lesions.


title: Neglected tropical diseases

text: Chagas disease can be prevented by avoiding insect bites through insecticide spraying, home improvement, bed nets, hygienic food, medical care, laboratory practices, and testing. It can be treated with medication, although these may have severe side effects. It can be diagnosed through a serological test, although the test is not very accurate.


title: Neglected tropical diseases

text: There are 50–100 million dengue virus infections annually. Dengue fever is usually not fatal, but infection with one of four serotypes can increase later susceptibility to other serotypes, resulting in a potentially fatal disease called severe dengue. Dengue fever is caused by a flavivirus, and is spread mostly by the bite of the "Aedes aegypti" mosquito. No treatment for either dengue or severe dengue exists beyond palliative care. The symptoms are high fever and flu-like symptoms. It is found in Asia, Latin America, and Northern Australia.


title: Neglected tropical diseases

text: Chikungunya is an arboviral disease transmitted by "A. albopictus" and "A. aegypti" mosquitoes. The virus was first isolated from an outbreak in Tanzania in 1952. Chikungunya virus is a member of the genus "Alphavirus" and family "Togaviridae". The word "chikungunya" is from the Makonde language and means "that which bends up", referring to the effect of the debilitating joint pain on the patient. Symptoms, generally appearing 5–7 days after exposure, can be confused with dengue and include fever, rash, headache, joint pain, and swelling. The disease mainly occurs in Africa and Asia.


title: Neglected tropical diseases

text: Dracunculiasis is also known as Guinea-worm disease. In 2019, 53 cases were reported across four countries, a substantial decrease from 3,500,000 cases in 1986. It is not fatal, but can cause months of inactivity. It is caused by drinking water contaminated by water fleas infected with guinea-worm larvae. Approximately one year after infection, a painful blister forms and one or more worms emerge. Worms can be up to 1 metre long.


title: Neglected tropical diseases

text: It is usually treated by World Health Organization volunteers who clean and bandage wounds caused by worms and return daily to pull the worm out a few more inches. Dracunculiasis is preventable by water filtration, immediate case identification to prevent the spread of disease, health education, and treating ponds with larvicide. An eradication program has been able to reduce prevalence. , the four endemic countries are Chad, Ethiopia, Mali, and South Sudan.


title: Neglected tropical diseases

text: The rate of echinococcosis is higher in rural areas, and there are more than one million people infected currently. Untreated alveolar echinococcosis is fatal. It is caused by ingesting parasites in animal feces. There are two versions of the disease: cystic and alveolar. Both versions involve an asymptomatic incubation period of several years. In the cystic version, liver cysts cause abdominal pain, nausea, and vomiting while cysts in the lungs cause chronic cough, chest pain, and shortness of breath. In alveolar echinococcosis, a primary cyst develops, usually in the liver, in addition to weight loss, abdominal pain, general feeling of ill health, and signs of liver failure.


title: Neglected tropical diseases

text: Surgery and drugs can both be used to treat echinococcosis. It can be prevented by deworming dogs, sanitation, proper disposal of animal feces, health education, and livestock vaccination. Cystic echinococcosis is found in the eastern portion of the Mediterranean region, northern Africa, southern and eastern Europe, the southern portion of South America, and central Asia. Alveolar echinococcosis is found in western and northern China, Russia, Europe, and northern North America. It can be diagnosed through imaging techniques and serological tests.


title: Neglected tropical diseases

text: There are limited data available on the prevalence of yaws, although it primarily affects children. The mortality risk is very low, but the disease causes disfigurement and disability if untreated. The most common symptom is skin lesions. It is a chronic bacterial infection, transmitted by skin contact, and caused by the spirochete bacterium "Treponema pallidum pertenue". It is treated with antibiotics and can be prevented through improved hygiene and sanitation. Yaws is most prevalent in the warm, moist, tropical regions of the Americas, Africa, Asia, and the Pacific.


title: Neglected tropical diseases

text: The foodborne trematode infections include clonorchiasis, opisthorchiasis, fascioliasis, and paragonimiasis. These infections are all zoonotic, primarily affecting domestic or wild animals, but can also be transmitted to humans. They are acquired by eating food, such as raw fish, contaminated with the larval stages of the parasites. At least 40 million people are thought to be infected.


title: Neglected tropical diseases

text: African trypanosomiasis (African sleeping sickness) is a somewhat rare protozoal disease as there are fewer than 10,000 cases currently. Human African trypanosomiasis is vector-borne and spreads through the bite of the tsetse fly. The most common symptoms are fever, headache, lymphadenopathy, nocturnal sleeping pattern, personality changes, cognitive decline, and coma. The disease is always fatal if untreated. The current forms of treatment are highly toxic and ineffective as resistance is spreading. It is diagnosed through an inexpensive serological test.


title: Neglected tropical diseases

text: The three forms of leishmaniasis, a protozoal disease, are visceral (Kala-azar), cutaneous, and mucocutaneous. There are an estimated 12 million people infected. It is fatal if untreated and 20,000 deaths from visceral leishmaniasis occur annually. It is a vector-borne disease that is caused by the bite of sandflies. At least 90 percent of visceral leishmaniasis occurs in Bangladesh, Brazil, Ethiopia, India, South Sudan, and Sudan. Cutaneous leishmaniasis occurs in Afghanistan, Algeria, Brazil, Colombia, Iran, Pakistan, Peru, Saudi Arabia, and Syria. Around 90 percent of mucocutaneous leishmaniasis occurs in Bolivia, Brazil, and Peru.


title: Neglected tropical diseases

text: The only method of prevention is a vaccine that is under development and prevention of sandfly bites. Diagnosis can be made by identifying clinical signs, serological tests, or parasitological tests. Leishmaniasis can be treated with expensive medications.


title: Neglected tropical diseases

text: According to recent figures from the WHO, 208,619 new cases of leprosy were reported in 2018 from 127 countries. It is most prevalent in India (69% of cases), Brazil, Indonesia, Nigeria, the Democratic Republic of the Congo, Madagascar, and East Africa, from Mozambique to Ethiopia, with the highest relative incidence in India, Brazil, and Nepal. There are one to two million individuals currently disabled or disfigured due to past or present leprosy. It is caused by bacteria and transmitted through droplets from the mouth and nose of infected individuals.


title: Neglected tropical diseases

text: Leprosy causes disfigurement and physical disabilities if untreated. It is curable if treated early. Treatment requires multidrug therapy. The BCG vaccine has some preventative effect against leprosy. Leprosy has a 5–20 year incubation period, and the symptoms are damage to the skin, nerves, eyes, and limbs.


title: Neglected tropical diseases

text: Lymphatic filariasis is also known as elephantiasis. There are approximately 120 million individuals infected and 40 million with deformities. Approximately two-thirds of cases are in Southwest Asia and one-third in Africa. Lymphatic filariasis is rarely fatal. Lymphatic filariasis has lifelong implications, such as lymphoedema of the limbs, genital disease, and painful recurrent attacks. Most people are asymptomatic, but have lymphatic damage. Up to 40 percent of infected individuals have kidney damage. It is a vector-borne disease, caused by nematode worms that are transmitted by mosquitoes.


title: Neglected tropical diseases

text: It can be treated with cost-effective antihelminthic treatments, and washing skin can slow or even reverse damage. It is diagnosed with a finger-prick blood test.


title: Neglected tropical diseases

text: Onchocerciasis is also known as "river blindness". There are 20.9 million people infected and prevalence is higher in rural areas. Over 99 percent of cases are in sub-Saharan Africa. It causes blindness, skin rashes, lesions, intense itching, and skin depigmentation. It is a vector-borne disease, caused by filarial worm infected blackflies.


title: Neglected tropical diseases

text: It can be treated with ivermectin. It can be prevented by insecticide spraying or preventative dosing with ivermectin. The symptoms are generally itching and skin lesions.


title: Neglected tropical diseases

text: There are two forms of rabies: furious and paralytic. There are 60,000 deaths from rabies annually. It is mostly found in Asia and Africa. There is a higher prevalence in rural areas and it disproportionately affects children. Rabies is fatal after symptoms develop. It is caused by a lyssavirus transmitted through wounds or bites from infected animals. The first symptoms are fever and pain near the infection site, which occur after a one to three month incubation period. Furious (more common type) rabies causes hyperactivity, hydrophobia, and aerophobia; death by cardio-respiratory arrest occurs within days. Paralytic rabies causes a slow progression from paralysis to coma to death.


title: Neglected tropical diseases

text: It can be prevented in dogs by vaccination and cleaning and disinfecting bite wounds (post-exposure prophylaxis). Rabies is undiagnosable before symptoms develop. It can be detected through tissue testing after symptoms develop.


title: Neglected tropical diseases

text: There are over 200 million cases of schistosomiasis. Approximately 85 percent of cases are in sub-Saharan Africa. The disease can be fatal by causing bladder cancer and hematemesis. "Schistosoma" species have a complex life cycle that alternates between humans and freshwater snails. Infection occurs when skin comes into contact with contaminated fresh water in which the snails that carry the parasite are living. Symptoms for schistosomiasis are not caused by the worms but by the body's reaction to the eggs. The eggs that do not pass out of the body can become lodged in the intestine or bladder, causing inflammation or scarring. Children who are repeatedly infected can develop anemia, malnutrition, and learning difficulties. The symptoms are usually haematuria, bladder obstruction, renal failure, bladder cancer, periportal fibrosis, bladder fibrosis, liver fibrosis, portal hypertension, cervical lesions, ascites, and esophageal varices.


title: Neglected tropical diseases

text: Inexpensive praziquantel can be used to treat individuals with schistosomiasis, but cannot prevent reinfection. The cost of prevention is US$0.32 per child per year. Mass deworming treatment with praziquantel, better access to safe water, sanitation, and health education can all be used to prevent schistosomiasis. Vaccines are under development. It can be diagnosed through a serological test, but it often produces false negatives.


title: Neglected tropical diseases

text: Soil-transmitted helminthiasis is the most prevalent neglected tropical disease. The three major worm species responsible for soil-transmitted helminthiasis are "Ascaris" (roundworms), "Trichuris" (whipworm), the hookworms "Necator americanus" and "Ancylostoma duodenale", and "Strongyloides stercoralis". There are 1.5 billion people currently infected. Soil-transmitted heminthiasis occurs in sub-Saharan Africa, the Americas, China, and east Asia. The mortality risk is very low. The most common symptoms are anemia, stunted growth, intestinal problems, lack of energy, and compromised physical and cognitive development. Infected children often fall behind in schooling. The severity of symptoms depends on the number of worms in the body.


title: Neglected tropical diseases

text: Parasitic worms are generally transmitted via exposure to infected human feces and soil that are spread in the environment, for example, due to open defecation. The most common treatment is medicine. It can be prevented through hygienically prepared food and clean water, improved sanitation, periodic deworming, and health education. The World Health Organization recommends mass deworming without prior diagnosis.


title: Neglected tropical diseases

text: Cysticercosis is a tapeworm larvae infection, while taeniasis is infection with adult tapeworms. Both are found in Asia, Africa, and Latin America, particularly on farms in which pigs are exposed to human excrement.


title: Neglected tropical diseases

text: Cysticercosis is the most common preventable cause of epilepsy in the developing world. Cysticercosis occurs after ingestion of contaminated food, water, or soil. Cysts and lesions can cause headaches, blindness, seizures, hydrocephalus, meningitis, and dementia. Neurocysticercosis, or the parasitic infection of the nervous system, can be fatal. Taeniasis is not fatal. It is usually contracted after eating undercooked contaminated pork. Taeniasis has mild symptoms, including abdominal pain, nausea, diarrhea, or constipation.


title: Neglected tropical diseases

text: Drugs are used to treat both diseases. Infection can be prevented through stricter meat-inspection standards, livestock confinement, improved hygiene and sanitation, health education, safe meat preparation, and identifying and treating human and pig carriers.


title: Neglected tropical diseases

text: There are 21.4 million people infected with trachoma, of whom 2.2 million are partially blind and 1.2 million are blind. It is found in Africa, Asia, Central and South America, the Middle East, and Australia. The disease disproportionately affects women and children. The mortality risk is very low, although multiple re-infections eventually lead to blindness. The symptoms are internally scarred eyelids, followed by eyelids turning inward. Trachoma is caused by a micro-organism that spreads through eye discharges (on hands, cloth, etc.) and by "eye-seeking flies".


title: Neglected tropical diseases

text: Snakebite was added to the list in 2017, after years of criticism of the WHO by activists for not making it a priority. The greatest burden of snakebite morbidity is in India and Southeast Asia. Globally, there are an estimated 421,000 envenomings each year (about 1 in 4 snakebites) and 20,000 deaths, but snakebites often go unreported.


title: Neglected tropical diseases

text: Several NTDs, such as leprosy, cause severe deformities that result in social stigma. Stigma is considered to be the "hidden burden" of neglected tropical diseases and is not accounted for in measures such as disability-adjusted life years (DALYs). Other NTDs that carry heavy social stigma include onchocerciasis, lymphatic filariasis, plague, Buruli ulcer, leishmaniasis, and Chagas disease. Lymphatic filariasis, for example, causes severe deformities that can result in denial of marriage and inability to work. Studies in Ghana and Sri Lanka have demonstrated that support groups for patients with lymphatic filariasis can increase participants' self-esteem, quality of life, and social relations through social support and providing practical advice on how to manage their illness. The social effects of neglected tropical diseases have been shown to affect men and women in different ways. Men are socially stigmatized in a way that detrimentally affects their economic prospects. Women are more likely to be affected in the areas of marriage and family.


title: Neglected tropical diseases

text: A 2012 review found that infection with a neglected tropical disease predisposes individuals to poor mental health. This is partially due to the social stigma that surrounds NTDs, but is also likely caused by the subsequent lack of access to health and social services. Overall, being a member of the infected community was found to cut individuals off from multiple aspects of society via civic rights, educational opportunities, and employment. A high prevalence of post-traumatic stress disorder (PTSD) and depression was found in those affected with snakebite survivors. There is a need for more research be directed to understanding the psychological aspects of neglected tropical diseases in order to fully untangle their co-effects and on how they can be dealt with better in health systems in countries where mental health professionals are scarce.


title: Neglected tropical diseases

text: NTDs disproportionately affect women and children. There is also the added risk of hookworm infection during pregnancy and the potential to transfer diseases such as Chagas during pregnancy. A study in Uganda found that women were more easily able to obtain treatment because they had fewer occupational responsibilities than men and were more trusting of treatment, but ignorance of the effects of medicines on pregnant women prevented adequate care. The paper concludes that gender should be considered when designing treatment programs in Uganda. Additionally, women often bear a heavier social stigma in relation to the pressure to marry.


title: Neglected tropical diseases

text: The cost of treatment of some of these diseases, such as Buruli ulcer, can amount to over twice the yearly income of an average household in the lowest income quartile, while for the highest income quartile, the burden is slightly less than the average household income. These enormous financial costs often cause deferral of treatment and financial ruin, but there is inequality between the wealthy and poor in terms of economic burden. These diseases also cost the government in terms of health care and lost worker productivity through morbidity and shortened life spans. In Kenya, for example, deworming is estimated to increase average adult income by 40 percent, which is a benefit-to-cost ratio of 100. Each untreated case of Trachoma is estimated to cost US$118 in lost productivity. Each case of schistosomiasis causes a loss of 45.4 days of work per year. Most of the diseases cost the economies of various developing countries millions of dollars. Large-scale prevention campaigns are predicted to increase agricultural output and education levels.


title: Neglected tropical diseases

text: The low cost of treatment for NTDs can be attributed to the large scale of the programs, free provision of drugs by pharmaceutical companies, delivery modes of drugs, and the unpaid volunteers who distribute the drugs. The economic burden of NTDs is undervalued and therefore the corresponding economic effect and cost-effectiveness of a decreased prevalence of NTDs is underestimated. The investment return on measures to control neglected tropical diseases is estimated to be between 14 and 30 percent, depending on the disease and region.


title: Neglected tropical diseases

text: Coinfection is a major concern with neglected tropical diseases, making NTDs more damaging than their mortality rates might portray. Because the factors that support neglected tropical diseases (poverty, inadequate healthcare, inadequate sanitation practices, etc.) support all NTDs, they are often found in overlapping distributions. Helminth infections, as the most common infection of humans, are often found to be in multi-infection systems. For example, in Brazil, low socioeconomic status contributes to overcrowded housing. In these same areas, connection by "Necator americanus" and "Schistosoma mansoni" is common. The effect of each worm weakens the immune system of those infected, making infection from the other easier and more severe. For this reason, coinfection carries a higher risk of mortality. NTDs may also play a role in infection with other diseases, such as malaria, HIV/AIDS, and tuberculosis. The ability of helminths to manipulate the immune system may create a physiological environment that could exacerbate the progression of HIV/AIDS. Some evidence from Senegal, Malawi, and Thailand has shown that helminth infections raise the risk of malarial infection.


title: Neglected tropical diseases

text: Prevention and eradication are important because "of the appalling stigma, disfigurement, blindness and disabilities caused by NTDs." The possibility of eliminating or eradicating dracunculiasis, leprosy, lymphatic filariasis, onchocerciasis, trachoma, sleeping sickness, visceral leishmaniasis, and canine rabies within the next ten years was the principal aim of the London Declaration on Neglected Tropical Diseases, which is a collaborative effort involving the WHO, the World Bank, the Bill & Melinda Gates Foundation, the world's 13 leading pharmaceutical companies, and government representatives from the US, UK, United Arab Emirates, Bangladesh, Brazil, Mozambique, and Tanzania. It was launched in January 2012.


title: Neglected tropical diseases

text: While the current era has had a noticeable uptick in biological research into neglected tropical diseases, prevention may be supplemented by social and development outreach. Spiegal and his coauthors advocated for this to take the form of "social offset". Social offset entails the delegation of some of the funding for biotechnological research to social programs. The attempts to alleviate some of the surrounding factors (such as poverty, poor sanitation, overcrowding, poor healthcare, etc.) that greatly exacerbate the conditions brought on by neglected tropical diseases. Projects such as these also strengthen the goal of sustained eliminations rather than quickly addressing symptoms.


title: Neglected tropical diseases

text: There are many prevention and eradication campaigns funded, for example, by the World Health Organization, US Agency for International Development, Bill and Melinda Gates Foundation, and UK Department for International Development.


title: Neglected tropical diseases

text: Sustainable Development Goal 3 has this target to eradicate NTDs: "By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases."


title: Neglected tropical diseases

text: In 2012, WHO published an NTD "roadmap", which contained milestones for 2015 and 2020 and specified targets for eradication, elimination, and intensified control of the different NTDs. For example:


title: Neglected tropical diseases

text: The U.S. Food and Drug Administration priority review voucher is an incentive for companies to invest in new drugs and vaccines for tropical diseases. A provision of the Food and Drug Administration Amendments Act (HR 3580) awards a transferable "priority review voucher" to any company that obtains approval for a treatment for one of the listed diseases. The voucher can later be used to accelerate the review of an unrelated drug. This program is for all tropical diseases and includes medicines for malaria and tuberculosis. The first voucher given was for Coartem, a malaria treatment. It does not use or define the term "neglected", though most of the diseases listed are often included on lists of neglected diseases.


title: Neglected tropical diseases

text: The prize was proposed by Duke University faculty Henry Grabowski, Jeffrey Moe, and David Ridley in their 2006 "Health Affairs" paper "Developing Drugs for Developing Countries". In 2007, United States Senators Sam Brownback (R-KS) and Sherrod Brown (D-OH) sponsored an amendment to the Food and Drug Administration Amendments Act of 2007. President George W. Bush signed the bill in September 2007.


title: Neglected tropical diseases

text: Deworming treatments in infected children may have some nutritional benefit, as worms are often partially responsible for malnutrition. However, in areas where these infections are common, there is strong evidence that mass deworming campaigns do not have a positive effect on children's average nutritional status, levels of blood haemoglobin, cognitive abilities, performance at school, or survival. To achieve health gains in the longer term, improvements in sanitation and hygiene behaviours are also required, together with deworming treatments.


title: Neglected tropical diseases

text: The effect of mass deworming on school attendance is disputed. It has been argued that mass deworming has a positive effect on school attendance. The long-term benefits of deworming include a decrease in school absenteeism by 25 percent and an increase in adult earnings by 20 percent. A systematic review, however, found that there is little or no difference in attendance in children who receive mass deworming compared to children who did not. One study found that boys were enrolled in primary school for more years than boys who were in schools that did not offer such programs. Girls in the same study were about a quarter more likely to attend secondary school if they received treatment. Both groups went on to participate in more skilled sectors of the labor market. The economic growth generated from school programs such as this may balance out the actual expenses of the program. However, the results of this study are disputed (i.a. due to a high risk of bias in the study), and the positive long-term outcomes of mass deworming remain unclear.


title: Neglected tropical diseases

text: Inclusion of NTDs into initiatives for malaria, HIV/AIDS, and tuberculosis, as well as integration of NTD treatment programs, may have advantages given the strong link between these diseases and NTDs. Some neglected tropical diseases share common vectors (sandflies, black flies, and mosquitos). Both medicinal and vector control efforts may be combined.


title: Neglected tropical diseases

text: A four-drug rapid-impact package has been proposed for widespread proliferation. Administration may be made more efficient by targeting multiple diseases at once, rather than separating treatment and adding work to community workers. This package is estimated to cost US$0.40 per patient. When compared to stand-alone treatment, the savings are estimated to be 26–47%. While more research must be done in order to understand how NTDs and other diseases interact in both the vector and the human stages, safety assessments have so far produced positive results.


title: Neglected tropical diseases

text: Many neglected tropical diseases and other prevalent diseases share common vectors, creating another opportunity for treatment and control integration. One such example of this is malaria and lymphatic filariasis. Both diseases are transmitted by the same or related mosquito vectors. Vector control, through the distribution of insecticide-treated nets, reduces human contact with a wide variety of disease vectors. Integrated vector control may also alleviate pressure on mass drug administration, especially with respect to rapidly evolving drug resistance. Combining vector control and mass drug administration deemphasizes both, making each less susceptible to resistance evolution.


title: Neglected tropical diseases

text: Water, sanitation, and hygiene (WASH) interventions are essential in preventing many NTDs, such as soil-transmitted helminthiasis. Mass drug administrations alone will not protect people from re-infection. A more holistic and integrated approach to NTDs and WASH efforts will benefit both sectors along with the communities they are aiming to serve. This is especially true in areas that are endemic with more than one NTD.


title: Neglected tropical diseases

text: In August 2015, the World Health Organization unveiled a global strategy and action plan to integrate WASH with other public health interventions in order to accelerate the elimination of NTDs. The plan aims to intensify control or eliminate certain NTDs in specific regions by 2020 and refers to the NTD "roadmap" milestones from 2012 that include, for example, eradication of dracunculiasis by 2015 and of yaws by 2020, elimination of trachoma and lymphatic filariasis as public health problems by 2020, and intensified control of dengue, schistosomiasis, and soil-transmitted helminthiases.


title: Neglected tropical diseases

text: Closer collaboration between WASH and NTD programmes can lead to synergies. They can be achieved through collaborative planning, delivery, and evaluation of programmes, strengthening and sharing of evidence, and using monitoring tools to improve the equity of health services.


title: Neglected tropical diseases

text: Biotechnology companies in the developing world have targeted neglected tropical diseases due to a need to improve global health.


title: Neglected tropical diseases

text: Mass drug administration is considered a possible method for eradication, especially for lymphatic filariasis, onchocerciasis, and trachoma, although drug resistance is a potential problem. According to Fenwick, Pfizer donated 70 million doses of drugs in 2011 to eliminate trachoma through the International Trachoma Initiative. Merck has helped The African Programme for the Control of Onchocerciasis (APOC) and Oncho Elimination Programme for the Americas to greatly diminish the effect of onchocerciasis by donating ivermectin. Merck KGaA pledged to give 200 million tablets of praziquantel over 10 years, the only cure for schistosomiasis. GlaxoSmithKline has donated two billion tablets of medicine for lymphatic filariasis and pledged 400 million deworming tablets per year for five years in 2010. Johnson & Johnson has pledged 200 million deworming tablets per year. Novartis has pledged leprosy treatment, and EISAI pledged two billion tablets to help treat lymphatic filariasis.


title: Neglected tropical diseases

text: Non-governmental organizations that focus exclusively on NTDs include the Schistosomiasis Control Initiative, Deworm the World, and the END Fund. Despite under-funding, many neglected diseases are cost-effective to treat and prevent. The cost of treating a child for infection of soil-transmitted helminths and schistosomes (some of the main causes of neglected diseases) is less than US$0.50 per year when administered as part of school-based mass deworming by Deworm the World. This programme is recommended by Giving What We Can and the Copenhagen Consensus Centre as one of the most efficient and cost-effective solutions. The efforts of the Schistosomiasis Control Initiative to combat neglected diseases include the use of rapid-impact packages: supplying schools with packages including four or five drugs, and training teachers in how to administer them.


title: Neglected tropical diseases

text: Health Action International based in Amsterdam worked with the WHO to get snakebite envenoming on the list of neglected tropical diseases.


title: Neglected tropical diseases

text: An alternative to the profit-driven drug development model emerged in 2000 to address the needs of these neglected patients. Product development partnerships (PDPs) aim at implementing and accelerating the research and development (R&D) of safe and effective health tools (diagnostics, vaccines, drugs) to combat neglected diseases. Drugs for Neglected Disease initiative (DNDi) is one of these PDPs that has already developed new treatments for NTDs.


title: Neglected tropical diseases

text: The Sabin Vaccine Institute, founded in 1993, works to address the issues of vaccine-preventable diseases as well as NTDs. They run three main programs: Sabin Vaccine Development, Global Network for Neglected Tropical Diseases, and Vaccine Advocacy and Education. Their product development partnership affiliates them with the Texas Children's Hospital as well as the Baylor College of Medicine. Their major campaign, End7, aims to end seven of the most common NTDs (elephantiasis, river blindness, snail fever, trachoma, roundworm, whipworm, and hookworm) by 2020. Through End7, college campuses undertake fundraising and educational initiatives for the broader goals of the campaign.


title: Neglected tropical diseases

text: WIPO Re:Search was established in 2011 by the World Intellectual Property Organization in collaboration with BIO Ventures for Global Health (BVGH) and with the active participation of leading pharmaceutical companies and other private and public sector research organizations. It allows organizations to share their intellectual property, compounds, expertise, facilities, and know-how royalty-free with qualified researchers worldwide working on new solutions for NTDs, malaria, and tuberculosis.


title: Neglected tropical diseases

text: In 2013, the Government of Japan, five Japanese pharmaceutical companies, the Bill and Melinda Gates Foundation, and the UNDP established a new public–private partnership, the Global Health Innovative Technology Fund. They pledged over US$100 million to the fund over five years, to be awarded as grants to R&D partnerships across sectors in Japan and elsewhere, working to develop new drugs and vaccines for 17 neglected diseases, in addition to HIV, malaria, and tuberculosis. Affordability of the resulting drugs and vaccines is one of the key criteria for grant awards.


title: Neglected tropical diseases

text: An open-access journal dedicated to neglected tropical diseases called "PLoS Neglected Tropical Diseases" first began publication in 2007.