Abstracts

Introduction

Neglected tropical diseases (NTDs) are diseases/health conditions that have a significant impact on poorer people and resource-poor communities, with high morbidity and mortality, affecting more than 1 billion people worldwide. They cause serious consequences to physical and mental health and economic impacts ¹1. World Health Organization. Control of neglected tropical diseases. https://www.who.int/teams/control-of-neglected-tropical-diseases (accessed on 03/Feb/2024).
https://www.who.int/teams/control-of-neg... .

The high burden of NTDs in marginalized populations is usually associated with different contexts of vulnerability, such as low levels of education, migration, gender, and black or Indigenous populations ²2. Molyneux D. Maladies tropicales négligées. https://www.cehjournal.org/wp-content/uploads/maladies-tropicales-negligees.pdf (accessed on 03/Feb/2024).
https://www.cehjournal.org/wp-content/up... . NTDs are also associated with inadequate access to drinking water, sanitation, basic hygiene, lack of access to healthcare services, and food insecurity ³3. The Lancet. Neglected tropical diseases: ending the neglect of populations. Lancet 2022; 399:411.. The incidence of such diseases can reduce cognitive ability and productivity, affect physical health, and limit full human potential and purchasing power ²2. Molyneux D. Maladies tropicales négligées. https://www.cehjournal.org/wp-content/uploads/maladies-tropicales-negligees.pdf (accessed on 03/Feb/2024).
https://www.cehjournal.org/wp-content/up... . These aspects perpetuate cycles of vulnerability in a family’s different generations.

The World Health Organization (WHO) has included 21 NTDs in its priority list, which can be grouped according to their causative agents: bacteria (leprosy, trachoma, Buruli ulcer, noma and yaws), viruses (dengue fever, chikungunya, rabies), ectoparasites (scabies, tungiasis, pediculosis, myiasis, cutaneous larvae migrans), protozoa (Chagas disease, leishmaniasis, human African trypanosomiasis), helminths (schistosomiasis, soil-transmitted helminthiases, ancylostomiasis, lymphatic filariasis, onchocerciasis, echinococcosis, dracunculiasis, fascioliasis), fungi (mycetoma, histoplasmosis, cryptococcosis), and snakebite envenoming, recognized as a situation requiring prevention and control measures ⁴4. World Health Organization. Neglected tropical diseases. https://www.who.int/health-topics/neglected-tropical-diseases#tab=tab_1 (accessed on 25/May/2024).
https://www.who.int/health-topics/neglec... .

In Latin America and the Caribbean, about 201 million people (32.1% of the population of 626.2 million) live below the poverty line ⁵5. Comisión Económica para América Latina y el Caribe. Panorama social de América Latina y el Caribe. https://www.cepal.org/es/publicaciones/48518-panorama-social-america-latina-caribe-2022-la-transformacion-la-educacion-como (accessed on 03/Feb/2024).
https://www.cepal.org/es/publicaciones/4... , and about 200 million people are affected by NTDs. Regarding prevalence and years of healthy life lost due to disability, soil-transmitted helminthiases and Chagas disease are the most important NTDs in this region, followed by dengue, schistosomiasis, leishmaniasis, trachoma, leprosy, and lymphatic filariasis ⁶6. Hotez PJ, Bottazzi ME, Franco-Paredes C, Ault SK, Periago MR. The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis 2008; 2:e300..

NTDs in Latin America and the Caribbean are characterized by two main patterns of distribution. First, there is generalized endemicity, as observed for soil-transmitted helminth infections, Chagas disease, and dengue fever ⁷7. Fontecha G, Sánchez A, Ortiz B. Publication trends in neglected tropical diseases of Latin America and the Caribbean: a bibliometric analysis. Pathogens 2021; 10:356.. Second, there is geographically restricted endemicity resulting from planned public health interventions and ecological conditions, such as that observed for onchocerciasis, lymphatic filariasis, and schistosomiasis in parts of the Caribbean, including Haiti ⁷7. Fontecha G, Sánchez A, Ortiz B. Publication trends in neglected tropical diseases of Latin America and the Caribbean: a bibliometric analysis. Pathogens 2021; 10:356..

In Haiti, the poorest country in the Western Hemisphere, NTDs cause high levels of morbidity and mortality ⁸8. Alsan MM, Westerhaus M, Herce M, Nakashima K, Farmer PE. Poverty, global health, and infectious disease: lessons from Haiti and Rwanda. Infect Dis Clin North Am 2011; 25:611-22.. Some diseases have been recognized as a public health problem by the Haitian Ministry of Public Health, which has set control program goals by 2030 for a range of NTDs, including lymphatic filariasis, soil-transmitted intestinal helminthiasis, arboviruses, and human rabies, as well as neglected bacterial skin infections (carbuncle) and mansonellosis, which are not included in the list of NTDs made by the WHO ⁹9. Raccurt CP, Boncy J, Jean-Baptiste RMA, Honoré R, Andrecy LL, Dély P, et al. Update of knowledge on neglected diseases in Haiti: mansonelliasis, tungiasis, leprosy, and anthrax. Bull Soc Pathol Exot 2018; 111:17-23.^,1010. Hast MA, Javel A, Denis E, Barbre K, Rigodon J, Robinson K, et al. Positive-case follow up for lymphatic filariasis after a transmission assessment survey in Haiti. PLoS Negl Trop Dis 2022; 16:e0010231.. In 2018, the Haitian Ministry of Public Health sought to advance the mass drug distribution campaign in 28 priority areas of the country, reaching more than 3 million beneficiaries ⁹9. Raccurt CP, Boncy J, Jean-Baptiste RMA, Honoré R, Andrecy LL, Dély P, et al. Update of knowledge on neglected diseases in Haiti: mansonelliasis, tungiasis, leprosy, and anthrax. Bull Soc Pathol Exot 2018; 111:17-23.. However, for some of NTDs of public health importance, such as cysticercosis, there are no consistent estimates of the burden of disease in Haiti ⁶6. Hotez PJ, Bottazzi ME, Franco-Paredes C, Ault SK, Periago MR. The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis 2008; 2:e300..

Human rabies is a major health risk in Haiti and it is estimated that up to 130 people die each year from dog-transmitted rabies ¹¹11. Wallace RM, Etheart MD, Doty J, Monroe B, Crowdis K, Dilius Augustin P, et al. Dog-mediated human rabies death, Haiti, 2016. Emerg Infect Dis 2016; 22:1963-5.. In 2009, the Pan American Health Organization (PAHO) identified the Republic of Haiti as a priority Caribbean country for rabies control. In 2014, it was estimated that 95,000 animal bites occur in Haiti each year. However, only 6,500 bites (6.8%) were reported via the national surveillance program ¹²12. Osinubi MOV, Fenelon N, Dyer JL, Franka R, Etheart M, Ali A, et al. Meeting the urgent need for rabies education in Haiti. Zoonoses Public Health 2018; 65:662-8.. Despite the diligent efforts of the national authorities to eliminate this disease, it remains a threat to the population ¹³13. Hampson K, Coudeville L, Lembo T, Sambo M, Kieffer A, Attlan M, et al. Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis 2015; 9:e0003709.^,1414. Lemoine JF, Desormeaux AM, Monestime F, Fayette CR, Desir L, Direny AN, et al. Controlling neglected tropical diseases (NTDs) in Haiti: implementation strategies and evidence of their success. PLoS Negl Trop Dis 2016; 10:e0004954.^,1515. Millien MF, Pierre-Louis JB, Wallace R, Caldas E, Rwangabgoba JM, Poncelet JL, et al. Control of dog mediated human rabies in Haiti: no time to spare. PLoS Negl Trop Dis 2015; 9:e0003806..

Therefore, the context of NTDs in Haiti calls for strong control measures based on scientific evidence. Scientometric surveys are a well-established research method in the information sciences to analyze trends and knowledge development in different fields ¹⁶16. Blake RM, Adams J. Global research report ? neglected tropical diseases. https://www.conncoll.edu/media/website-media/images/content/chemistry/illuminatingdiseasepdfs/neglectedtropicaldiseases.pdf (accessed on 03/Feb/2024).
https://www.conncoll.edu/media/website-m... ^,1717. Malecela MN. Reflections on the decade of the neglected tropical diseases. Int Health 2019; 11:338-40.. Given the endemic contexts of Haiti, Latin America and Asia, most publications on NTDs may not reflect the real need to create evidence for the development of control interventions ⁶6. Hotez PJ, Bottazzi ME, Franco-Paredes C, Ault SK, Periago MR. The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis 2008; 2:e300.^,77. Fontecha G, Sánchez A, Ortiz B. Publication trends in neglected tropical diseases of Latin America and the Caribbean: a bibliometric analysis. Pathogens 2021; 10:356.. Scientific research in Haiti has been limited and restricted to a few conditions ⁷. From this perspective, scientometrics is relevant to better understand the profile of research on NTDs in the country. This article aims to analyze the scientometric profile of scientific publications on NTDs in Haiti from 1923 to 2022.

Methods

Study design

Publications indexed in the Scopus database and accessed via the Federated Academic Community of the Brazilian Coordination for the Improvement of Higher Education Personnel (CAFe-CAPES) (https://www.scopus.com/home.uri) accessed by Federal University of Ceará were analyzed. All types of scientific production on NTDs conducted in Haiti were included, as well as: original articles, reviews, book chapters, conference papers, letters, notes, editorials, and short surveys.

Study area

Haiti is located in the Caribbean and shares the island of Hispaniola with the Dominican Republic to the east. It has a territorial area of 27,750 km². The territory of the Republic of Haiti includes the western part of Hispaniola and the adjacent islands: Gonâve, Tortue, Ile à Vache, Caimites, Navase, Grande Cayenne, and other islands in the territorial sea. It borders the Dominican Republic to the east, the Atlantic Ocean to the north, and the Caribbean Sea to the south and west ¹⁸18. République d'Haïti. 1987 Constitution de la République d'Haïti. https://pdba.georgetown.edu/Constitutions/Haiti/haiti1987.html (accessed on 03/Feb/2024).
https://pdba.georgetown.edu/Constitution... .

The country is divided into 10 departments (equivalent to regions in other countries), 42 districts, 144 municipalities (equivalent to districts, the unit of programmatic implementation for all health programs), 64 neighborhoods and 571 communal (municipal) sections. The geographical departments are North, North-East, North-West, Centre, Artibonite, South, South-East, Nippes, Grand’Anse, and West, with the metropolitan area comprising the urban areas of the six communes of the West department, including the country’s capital, Port-au-Prince ¹⁹19. Institut Haïtien de Statistique et d'Informatique. Les comptes economiques en 2022. https://budget.gouv.ht/storage/app/uploads/public/63a/a24/901/63aa2490187ad312120265.pdf (accessed on 03/Feb/2024).
https://budget.gouv.ht/storage/app/uploa... .

The country’s population is estimated to reach 11.9 million in 2021, an increase of 13% in ten years. The population density is 404 inhabitants/km²¹⁹19. Institut Haïtien de Statistique et d'Informatique. Les comptes economiques en 2022. https://budget.gouv.ht/storage/app/uploads/public/63a/a24/901/63aa2490187ad312120265.pdf (accessed on 03/Feb/2024).
https://budget.gouv.ht/storage/app/uploa... . Demographically, the Haitian population is predominantly young and is undergoing an intense and disorganized urbanization process ²⁰20. United Nations Children's Fund. Country office annual report 2019: Haiti. https://www.unicef.org/media/90526/file/Haiti-2019-COAR.pdf (accessed on 03/Feb/2024).
https://www.unicef.org/media/90526/file/... .

It is the poorest country in the Western Hemisphere, with around a quarter of the population living in extreme poverty, particularly in rural areas. Poverty is reflected in precarious socioeconomic indicators such as high maternal and neonatal mortality, high illiteracy, gender inequality, and low life expectancy ²¹21. The World Bank. Haiti: data. https://data.worldbank.org/country/haiti (accessed on 03/Feb/2024).
https://data.worldbank.org/country/haiti... . The country’s location remains conducive to recurrent environmental disasters, with political-institutional instability and increased violence ²²22. Charles R, Oliveira RC, Coltri PP, São José RV. The vulnerability of Haiti in front of climate variability. Revista de Geografia 2020; 10:40-59.^,2323. Programme des Nations Unies pour l'Environnement; Ministere de l'Environnement d'Haiti; l'Université Quisqueya. État et perspectives de l'environnement. GEO Haïti 2010. https://wedocs.unep.org/rest/bitstreams/12260/retrieve (accessed on 03/Feb/2024).
https://wedocs.unep.org/rest/bitstreams/... . Climate change in recent years also had a significant impact on increasing food insecurity in the country and on the incidence of NTDs. A significant proportion of the population still do not have direct access to electricity, drinking water, basic sanitation, or comprehensive healthcare ²⁰20. United Nations Children's Fund. Country office annual report 2019: Haiti. https://www.unicef.org/media/90526/file/Haiti-2019-COAR.pdf (accessed on 03/Feb/2024).
https://www.unicef.org/media/90526/file/... ^,2424. World Food Programme. Haiti: annual country report 2022. https://docs.wfp.org/api/documents/WFP-0000147957/download/?_ga=2.243448583.363758093.1697297539-1811710917.1697297539 (accessed on 01/Feb/2024).
https://docs.wfp.org/api/documents/WFP-0... .

Data source and organization

The database search in June 2023 was based on specific criteria in the advanced search function, using specific author, title, and abstract descriptors, combining specific terms to each NTD (Box 1). The NTDs were selected based on a group of 20 diseases defined by the WHO.

All publications from January 1923 to December 2022 were included. All authors (with their country of origin and institutional affiliation) included in the scientific publications were considered and the health descriptors in each publication were extracted and analyzed. The number and proportion of identified scientific publications on NTDs over time was assessed.

The analysis of the data was conducted using the scientometric visualization software VOSviewer 1.6.16 (https://www.vosviewer.com/), based on the structuring of the bibliographic networks and the specifics of the references associated with each record, as well as the author’s descriptor data and the arrangement of the most frequent terms in the publications.

The descriptive analysis covered the entire period (1923-2022), with the construction of graphs to characterize the evolution of scientific production over time. Subsets of data relating to the number and proportion of publications on the different NTDs in Haiti were also analyzed, identifying such diseases with the highest proportion of scientific publications. Tables were created to show the ten most common types of scientific products, as well as authors, descriptors, affiliations, and countries.

Analysis of the bibliometric profile

Graphical representations were made of the relationships (maps) between authors, countries, institutions and descriptors (nodes), the strength between these relationships (thickness of arcs), and the number of their total contributions (node size). The VOSviewer “Thesaurus” tool was used to consolidate the terms. The parameters were defined with a maximum of 25 and a minimum of 2 for the scientometric identification items for each unit of analysis: (1) coauthorship by author, (2) coauthorship by country, (3) coauthorship by organization, and (4) cooccurrence of author keywords, linked to the network of the bibliographic production relationship and aggregated over the entire study period.

Ethical aspects

This study was based on publications on NTDs indexed in the Scopus database, which is free and open access, via CAFe-CAPES, to which the Federal University of Ceará has access. According to Brazilian guidelines there is no need to submit the study to a research ethics committee.

Results

A total of 281 publications were identified, with an increase of 66.8% (127/281, annual average of 12.7 publications) in the last decade (2013-2022), compared to the first five decades (1923-1972, annual average of 0.19 publications) (Figure 1).

Original articles were the most common type of publication, accounting for 87.9% (n = 247) of all publications, followed by systematic reviews (8.7%; n = 22) (Table 1).

The authors with the highest number of publications were: Lammie PJ (n = 51), Eberhard ML (n = 29), Wallace RM (n = 25), and Addis DG (n = 22). Authors came from 65 countries, most from the United States (n = 195), followed by Haiti (n = 83) and France (n = 23) (Table 1).

A total of 83 institutions were associated with the productions (coauthors versus organizations), with the Centers for Disease Control and Prevention (CDC; United States) having the largest representation (n = 86), followed by the Haitian Ministry of Public Health (n = 22), the University of Florida (United States) (n = 18), the CDC Haiti (n = 15), and the Haitian Ministry of Agriculture, Rural Development and Natural Resources (n = 15) (Table 1).

Of the total number of publications, 65.8% (n = 185) were developed by institutions in Haiti, with most studies conducted in the West Department (n = 75; 40.5%). The most published NTDs were: filariasis (78; 27.8%), dengue fever (40; 14.2%) and rabies (33; 11.7%). Overall, 328 descriptors were identified in these publications and the term “dengue” (n = 13) was the most frequently used keyword, followed by “rabies” (n = 12) (Table 1).

The coauthorship to author ratio identified 1,113 authors, of which 219 were selected for analysis, organized into ten clusters, with cluster 1 having a total of 31 authors, followed by cluster 2 with 29 authors, and cluster 3 with 24 authors. The authors with the most connections were Lammie PJ, Wallace RM and Crowdis K; Lammie PJ also stands out as the author with the most citations and connections with Addiss DG and Eberhard ML (Figure 2a).

The relationship between coauthorship and country indicates publications in institutions in the Americas (n = 13), Europe (n = 9), Asia (n = 5), Africa (n = 4), and Oceania (n = 3). The main relationship was the United States-Haiti interface. The analysis identified 9 clusters, with 8 countries in the main cluster, 6 in the second cluster, and 5 in the third cluster (Figure 2b).

It showed relationships with an established pattern between coauthors and organizations, identifying 600 institutions, of which 75 were selected for scientometric analysis. The main relationship identified was between the CDC and the Department of Agriculture, Rural Development and Natural Resources. This analysis identified 12 clusters, with the main cluster containing 11 institutions, followed by a cluster with 9 institutions, and the third cluster with 7 institutions (Figure 2c).

In the analysis of the cooccurrence relationship with author keywords, 328 keywords were identified, of which 50 were selected for analysis, organized in 6 clusters. The main cluster had 11 items, followed by cluster 2 with 9 items, and cluster 3 with 8 items. The most prominent terms were “dengue”, “rabies”, “chikungunya”, and “Aedes aegypti”, with direct relationships between terms related to arboviruses (Figure 2d).

Discussion

This unprecedented study shows that there are only a limited number of studies on NTDs in Haiti, despite the high social vulnerability associated with this group of diseases. Furthermore, most publications related to such studies have been produced by foreign researchers. Despite a century of publications, only 281 publications on NTDs were identified, demonstrating the lack of research in the country, which reduces the possibility of human and social development based on the diseases recognition to plan and implement evidence-based control measures ²⁵25. Maciel AMS, Ramos Jr. AN, Ferreira AF, Almeida NMGS, Gomes VS, Gómez DVF, et al. Scientometric analysis of research on trachoma in Brazil, 2000-2020. Rev Saúde Pública 2022; 56:97..

The increase of almost 70% in the annual average number of publications since 1970 is probably related to the process of indexing article abstracts in the Scopus database, indicating increasing mobilization over time. Despite the observed upward trend, critical gaps remain and may reaffirm the nature of NTDs ²⁶26. Bai J, Li W, Huang YM, Guo Y. Bibliometric study of research and development for neglected diseases in the BRICS. Infect Dis Poverty 2016; 5:89., not only because of scientific failures but also because of failures of the public policy in national health systems ²⁷27. Mahoney RT, Morel CM. A Global Health Innovation System (GHIS). Innovation Strategy Today 2006; 2:1-12..

The involvement of 75 institutions with effective participation in publications by authors from 35 countries highlights the global nature of NTD research. There is a clear predominance of researchers from the United States, indicating the country’s strong involvement in Haitian research from different perspectives related to NTDs. This is evidenced by their identification among the top ten most productive authors such as Patrick. J. Lammie of the Cell Biology Branch of the CDC. Such researchers establish broad and significant links globally, in diverse collaborations, to conduct studies in institutions that have potential access to financial resources to support research ²⁸28. González-Alcaide G, Salinas A, Ramos JM. Scientometrics analysis of research activity and collaboration patterns in Chagas cardiomyopathy. PLoS Negl Trop Dis 2018; 12:e0006602.. Relationships between coauthors and organizations reveal a pattern between institutions over the period 1923-2022.

The U.S. influence on Haiti dates back long before the World War I ²⁹29. Coggiola O. História do capitalismo: das origens até a Primeira Guerra Mundial. Santiago: Ariadna Ediciones; 2016.. Haiti was the second country in the Americas to achieve their independence, but the United States did not recognize it until more than half a century later, fearing that achieving their independence via a slave revolution could cause internal instability in the country. As a result, its process of domination has continued unabated into the 20th and 21st centuries ³⁰30. Andrade EO. A primeira ocupação militar dos EUA no Haiti e as origens do totalitarismo haitiano. Revista Eletrônica da ANPHLAC 2016; (20):173-96.. The U.S. dominance in the context of academic research in Haiti may reflect its strong political, social, and economic influence on the scientific field, as well as its strategic sphere of influence in the country ³¹31. Bissindé CA. The relations between Haiti and the United States: dependence and hegemony. Hoplos 2023; 7:108-24..

The analysis of scientific production also highlighted the participation of more active institutions, with leadership in NTD research, such as the CDC (United States/Haiti) and the Haitian Ministry of Public Health ³²32. Elbadry MA, Al-Khedery B, Tagliamonte MS, Yowell CA, Raccurt CP, Existe A, et al. High prevalence of asymptomatic malaria infections: a cross-sectional study in rural areas in six departments in Haiti. Malar J 2015; 14:510.. The CDC is a U.S. institution that has been present in Haiti since 2002. Its work has enabled Haiti’s national surveillance network to expand from 51 sites in 2010 to 652 sites in 2018, covering more than 60% of the country’s health facilities. CDC has supported the Haitian Ministry of Public Health to strengthen public health interventions in the country ¹⁴14. Lemoine JF, Desormeaux AM, Monestime F, Fayette CR, Desir L, Direny AN, et al. Controlling neglected tropical diseases (NTDs) in Haiti: implementation strategies and evidence of their success. PLoS Negl Trop Dis 2016; 10:e0004954.^,3333. Centers for Disease Control and Prevention. CDC in Haiti. https://www.cdc.gov/globalhealth/countries/haiti/default.htm (accessed on 03/Feb/2024).
https://www.cdc.gov/globalhealth/countri... . The strong collaboration between Haiti and countries such as the United States, France, Brazil, and the United Kingdom also demonstrates the importance of international cooperation in NTDs control and global health research ⁴4. World Health Organization. Neglected tropical diseases. https://www.who.int/health-topics/neglected-tropical-diseases#tab=tab_1 (accessed on 25/May/2024).
https://www.who.int/health-topics/neglec... .

Keyword cooccurrence analysis highlights terms such as “dengue”, “rabies”, “chikungunya”, and “lymphatic filariasis”, reflecting the focus of research during the analyzed period. Some NTDs defined by the WHO are recognized as a public health problem in Haiti, with a list of around ten diseases, many of which are already subject of control programs under the country’s health plan (Plan Directeur de Santé; PDS) up to 2030 ⁴4. World Health Organization. Neglected tropical diseases. https://www.who.int/health-topics/neglected-tropical-diseases#tab=tab_1 (accessed on 25/May/2024).
https://www.who.int/health-topics/neglec... , such as lymphatic filariasis, rabies, and helminthiases ³⁴34. Oscar R, Lemoine JF, Direny AN, Desir L, Beau de Rochars VEM, Poirier MJP, et al. Haiti National Program for the Elimination of Lymphatic Filariasis: a model of success in the face of adversity. PLoS Negl Trop Dis 2014; 8:e2915.. Although all these diseases are considered prevalent in Haiti, limitations in research development and knowledge generation remain a critical constraint for their epidemiological control ⁹9. Raccurt CP, Boncy J, Jean-Baptiste RMA, Honoré R, Andrecy LL, Dély P, et al. Update of knowledge on neglected diseases in Haiti: mansonelliasis, tungiasis, leprosy, and anthrax. Bull Soc Pathol Exot 2018; 111:17-23..

Arboviruses and human rabies have been the most common in published studies. In fact, up to 130 people die each year in Haiti from dog-transmitted rabies ¹³13. Hampson K, Coudeville L, Lembo T, Sambo M, Kieffer A, Attlan M, et al. Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis 2015; 9:e0003709.^,3535. Carvalho MF, Vigilato MAN, Pompei JA, Rocha F, Vokaty A, Molina-Flores B, et al. Rabies in the Americas: 1998-2014. PLoS Negl Trop Dis 2018; 12:e0006271.^,3636. Ma X, Blanton JD, Millien MF, Medley AM, Etheart MD, Fénelon N, et al. Quantifying the risk of rabies in biting dogs in Haiti. Sci Rep 2020; 10:1062.. Despite disease control measures taken by the national authorities, rabies remains a public health problem in the country ¹⁴14. Lemoine JF, Desormeaux AM, Monestime F, Fayette CR, Desir L, Direny AN, et al. Controlling neglected tropical diseases (NTDs) in Haiti: implementation strategies and evidence of their success. PLoS Negl Trop Dis 2016; 10:e0004954..

The social determinants present in Haiti create the potential for a high incidence of several NTDs. The population is socially vulnerable (59% of citizens live below the poverty line) and programmatically vulnerable, with limited access to diagnosis and treatment in the national health system. There is a significant under-five mortality rate of 76 per 1,000 live births, and only half of the population has access to piped water ³⁷37. The World Bank. Haiti. https://financesapp.worldbank.org/countries/Haiti/ (accessed on 03/Feb/2024).
https://financesapp.worldbank.org/countr... ^,3838. World Health Organization. The Global Health Observatory. Haiti. https://www.who.int/data/gho/data/countries/country-details/GHO/haiti (accessed on 03/Feb/2024).
https://www.who.int/data/gho/data/countr... .

The Haiti population potentially lives in areas at risk of filariasis and helminthiases. The development of health interventions, including NTDs control plans, is organized at the commune level ³⁹39. Losonczy LI, Barnes SL, Liu S, Williams SR, McCurdy MT, Lemos V, et al. Critical care capacity in Haiti: a nationwide cross-sectional survey. PLoS One 2019; 14:e0218141.. However, this process is complex, as approximately 60% of the population lives in rural areas and 40% in four large urban areas, the largest of which is the capital, Port-au-Prince (population 2.5 million) ¹⁴14. Lemoine JF, Desormeaux AM, Monestime F, Fayette CR, Desir L, Direny AN, et al. Controlling neglected tropical diseases (NTDs) in Haiti: implementation strategies and evidence of their success. PLoS Negl Trop Dis 2016; 10:e0004954..

The country has faced major challenges in advancing its economic and social development ⁸8. Alsan MM, Westerhaus M, Herce M, Nakashima K, Farmer PE. Poverty, global health, and infectious disease: lessons from Haiti and Rwanda. Infect Dis Clin North Am 2011; 25:611-22.. Examples of political and institutional crises include hurricanes and a 7.2 magnitude earthquake (August 2021) that hit the southern region of the country (where approximately 1.6 million people live), followed by a significant cholera outbreak in the region ³⁴34. Oscar R, Lemoine JF, Direny AN, Desir L, Beau de Rochars VEM, Poirier MJP, et al. Haiti National Program for the Elimination of Lymphatic Filariasis: a model of success in the face of adversity. PLoS Negl Trop Dis 2014; 8:e2915.. In addition, political instability negatively affects, among other things, the implementation of the national health policy, contributing to the emergence and persistence of NTDs ⁴⁰40. Biermann F, Hickmann T, Sénit CA, Beisheim M, Bernstein S, Chasek P, et al. Scientific evidence on the political impact of the Sustainable Development Goals. Nat Sustain 2022; 5:795-800.. Amid this scenario, the country has also faced high population growth, with accelerated and disorganized urbanization, which has also influenced the growth of cities, generally associated with extreme poverty, unemployment, inadequate housing, subnormal agglomerations with a strong presence of vector-borne diseases, environmental degradation, and pollution ⁴¹41. Mahtta R, Fragkias M, Güneralp B, Mahendra A, Reba M, Wentz EA, et al. Urban land expansion: the role of population and economic growth for 300+ cities. NPJ Urban Sustain 2022; 2:5..

Knowledge production keeps facing challenges related to epistemological, geopolitical, economic and social development issues, and that the localization of such diseases is entirely linked to colonial and capitalist dynamics, highlighting the fact that policies are still conceived in an asymmetrical way between peoples and nations. This study indirectly reveals the historical vulnerability of the Haitian population in knowledge production and puts into perspective the need for a global health agenda that understands the dimension of neglected bodies and populations, going beyond the health perspective and considering analyses that integrate political, social, and economic contexts ⁴²42. Oliveira RG. Meanings of neglected diseases in the global health agenda: the place of populations and territories. Ciênc Saúde Colet 2018; 23:2291-302..

As a result, most publications in Haiti continue to be published by researchers from high-income countries. However, there are established links between Haitian authors and institutions in other Latin American countries, Europe, Oceania, and Asia. The under-representation of low- and middle-income countries in scientific production implies an understanding of endemic diseases that may not reflect local realities. The limited number of publications limits attempts to develop global strategies based on consistent evidence that are effective. In addition, there are scientific, market, and public health failures to achieve disease control in these places ⁴³43. Khulbe Y, Chandani Y, Kamaraj B, Agrawal V. Under-representation of low-income countries in the literature - targeting the bummock of neglected tropical diseases. Trop Doct 2023; 53:345-6..

The analyzed productions were developed in different contexts in the ten departments of Haiti, with the West Department standing out as the one where lymphatic filariasis is the most recognized disease in scientific research in the region ⁴⁴44. Oliveira M, Castro E, Pisco Pacheco H, Frederico A, Candeias R, Calvo I, et al. TROP7 lesions kystiques musculaires. Ne pas oublier l'echinococcose granulosus primitive. J Radiol (Paris) 2005; 86:1587.^,4545. Drexler N, Washington CH, Lovegrove M, Grady C, Milord MD, Streit T, et al. Secondary mapping of lymphatic filariasis in Haiti: definition of transmission foci in low-prevalence settings. PLoS Negl Trop Dis 2012; 6:e1807.. This may be related to the production of research targeting marginalized populations in filariasis-endemic contexts ⁴⁵45. Drexler N, Washington CH, Lovegrove M, Grady C, Milord MD, Streit T, et al. Secondary mapping of lymphatic filariasis in Haiti: definition of transmission foci in low-prevalence settings. PLoS Negl Trop Dis 2012; 6:e1807.^,4646. Champetier de Ribes G, Fline M, Désormeaux AM, Eyma E, Montagut P, Champagne C, et al. Helminthoses intestinales en milieu scolaire en Haïti en 2002. Bull Soc Pathol Exot 2005; 98:127-32., and highlights the need for greater recognition of data from other regions to support and inform decision making in surveillance programes ³⁵35. Carvalho MF, Vigilato MAN, Pompei JA, Rocha F, Vokaty A, Molina-Flores B, et al. Rabies in the Americas: 1998-2014. PLoS Negl Trop Dis 2018; 12:e0006271.^,4646. Champetier de Ribes G, Fline M, Désormeaux AM, Eyma E, Montagut P, Champagne C, et al. Helminthoses intestinales en milieu scolaire en Haïti en 2002. Bull Soc Pathol Exot 2005; 98:127-32.. In addition to filariasis, diseases such as dengue and rabies are also among the most studied NTDs.

The Scopus database was chosen as the reference for this study because it has the largest collection of publications on endemic NTDs in Haiti. This database considers the development of research in other Latin American countries, in which dengue is highly represented, followed by leishmaniasis, trachoma, leprosy, lymphatic filariasis, Chagas disease, and schistosomiasis ⁴⁷47. Ferreira AF, Heukelbach J, Costa CHN, Souza EA, Maciel AMS, Correia D, et al. Scientometric review of research on neglected tropical diseases: a 31-year perspective from the Journal of the Brazilian Society of Tropical Medicine. Rev Soc Bras Med Trop 2023; 56:e0403-2022.. The fact that the Scopus database takes a broader perspective in this context made it possible to identify NTDs with a greater number of publications, including those that are well-established public health problems for the country ⁶6. Hotez PJ, Bottazzi ME, Franco-Paredes C, Ault SK, Periago MR. The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis 2008; 2:e300..

The presence of the term “NTD” as a descriptor may be related to the common and established use of this nomenclature for this group of diseases. In addition, the availability of the term as a scientific descriptor in the main databases for indexing publications, such as Embase, Cochrane Library, DARE, MEDLINE, and PubMed Health, reflects the performance of each database. A combination of databases showed an increase in sensitivity, with Embase being superior to Cochrane Library ⁴⁸48. Zhang D, Song Q, Zheng Q. Optimizing literature search in systematic reviews: is MEDLINE sufficient for identifying effect studies on corneal properties and glaucoma? Arq Bras Oftalmol 2017; 80:406..

The limitations of this study are related to the scope of the data collection and the indexing process of the Scopus indexing database. Despite the broad coverage, with indexing of a significant number of articles and scientific journals and other websites publishing research, note that no single database was able to identify all relevant systematic reviews published on NTDs. The limited amount of data published in Haiti may contribute to a lack of understanding of the incidence and social determinants of endemic diseases in the country, thus limiting evidence for the adoption of more effective control measures.

Conclusion

There has been a limited number of scientific publications on NTDs in Haiti over the past 100 years, despite a relative increase in the last decade. Such publications are concentrated among foreign authors, with limited national coauthorship, and do not cover all endemic areas or even all the most prevalent diseases in the country.

The persistence of NTDs as a public health problem in Haiti highlights the need for greater investment in science, technology, and innovation. Our study reinforces the need to expand local knowledge production in specific contexts and regions, with a strong focus on global articulation. To this end, national agendas need to increase investment and effective international collaboration for the sustainability of actions in national institutions that support the national response to NTDs.

Acknowledgments

M. Glesil is a Master’s student with a Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES) scholarship from the Alliance for Education and Training program (Bolsas Brasil ₋ PAEC OEA-GCUB). T. L. Silva is a Master’s student with a scholarship from the Ceará Foundation for the Support of Scientific and Technological Development (FUNCAP). A. M. S. Maciel and A. F. Ferreira are PhD students with a CAPES grant. J. Heukelbach and A. N. Ramos Jr. are research productivity grant holders from the Brazilian National Research Council (CNPq).

References

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