Crohn’s Disease among the Poorest Billion - Report finds higher burden than previously indicated

A first-ever global study of Crohn’s disease in low- and lower-middle-income countries (LLMICs) found a severe lack of research and data, but concluded, based on a survey of care providers, that the burden of the disease is higher than is indicated in the sparse literature that exists. The study, conducted under the auspices of the Lancet NCDI Poverty Commission, included a literature review, a survey of providers, and visits to several facilities in countries with concentrations of people living in extreme poverty.

Crohn’s Disease (CD) is a highly disabling type of inflammatory bowel disease, in which any portion of the gastrointestinal tract may be inflamed in a non-contiguous pattern. While the epidemiology of CD is well established in the high-income countries of North America and Europe, its burden elsewhere is unclear due to challenges in diagnosis, treatment, surveillance, and monitoring. Under the auspices of the Lancet NCDI Poverty Commission, Dr. Ruma Rajbhandari and colleagues launched the Crohn’s Disease Among the Poorest Billion project.

This research project encompassed a scoping review of existing literature on CD in LLMICs, as well as a survey of gastroenterology providers currently practicing in LLMICs. Dr. Rajbhandari and her team also made several visits to endoscopy facilities in sub-Saharan Africa and South Asia, where 90 percent of the world’s poorest billion people live. This project was funded by the Helmsley Charitable Trust and involved a multidisciplinary team from the Program in Global NCDs and Social Change in Harvard Medical School’s Department of Global Health and Social Medicine, Brigham and Women’s Hospital Division of Global Health Equity, and the NCD Synergies project at Partners in Health.  

Based on the results of the scoping review and provider survey, Dr. Rajbhandari and colleagues found that the burden of CD in LLMICs is higher than previously indicated in the literature. This project illuminates a need for population- and even facility-based disease registries in low-income settings so that the true burden of CD can be studied in greater depth. Moreover, this project brought attention to the many challenges faced by both Crohn’s patients and providers, including a lack of robust gastroenterology services, minimal pathology support, difficulty in differentiating CD from intestinal tuberculosis, poor access to biologics, and other accessibility and affordability concerns.

Given these results, the Crohn’s Disease Among the Poorest Billion Report offers a number of key recommendations to improve CD diagnosis, care, and surveillance in low- and lower-middle-income settings. These include the decentralization of gastroenterology care to lower-level facilities, establishment of CD registries, further research into global CD epidemiology, increased human resources for health, and cost-reduction initiatives for biologic therapy. Read the full report to learn more about Crohn’s disease among the world’s Poorest Billion.