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PubMed2006

Women's health in developing countries.

Healthcare priorities are different in developing and developed countries. A more effective resource allocation, complemented by efforts to implement only those practices that are effective, should be a priority for improving reproductive health services in developing countries. A large burden of gynaecological disease exists in developing countries and it is difficult to envisage serious reforms and improvements without an increase in public-sector spending. However, communities themselves could assume some responsibility for women's health in ways that prioritize women's own perceptions and primary needs. In this chapter we have compiled existing evidence regarding various gynaecological problems faced by women in developing countries. To name a few: sexual health issues, abortion, subfertility, cancer, and genital fistulae. We believe that there is a large knowledge gap in the area of women's health in developing countries, and there is an urgent need to conduct appropriately designed studies.

Abortion, Induced↗

PubMed1998

Therapeutic and preventive effects of zinc on serious childhood infectious diseases in developing countries.

In children in developing countries, zinc deficiency may be common and associated with immune impairment and increased risk of serious infectious diseases such as diarrhea, pneumonia, and malaria. Studies have evaluated the therapeutic effects of zinc supplementation during acute or persistent diarrhea. In studies of acute diarrhea, the illness duration has been found to be 9-23% shorter in zinc-supplemented than in control children. Diarrhea was also less severe in zinc-supplemented children. In studies of persistent diarrhea, the effect sizes were similar but were often not statistically significant, perhaps because of the small number of children participating in these studies. Trials that provided continuous daily zinc supplementation for 5-15 mo evaluated effects on the incidence of diarrhea and in some studies acute lower respiratory infections and malaria. The reduction in the incidence of diarrhea in the zinc-supplemented group in these studies ranged from 8% to 45%. A study that gave 2 wk of zinc supplementation found preventive effects against diarrhea for the 3 mo of surveillance. More limited data also suggest that the incidence of acute lower respiratory infection and clinical attacks of malaria may also be reduced by zinc supplementation. If these results are confirmed by meta-analysis of the existing trials and additional research, improvement of zinc nutriture should become a priority intervention to reduce the high burden of serious infectious disease in children in developing countries.

Child↗

PubMed1977

Specialist training and medical research in developing countries of tropical Africa: a case for the establishment of postgraduate medical schools.

Developing countries like developed ones need highly skilled medical personnel, referred to as 'specialists'. In the case of developing countries, the training of these specialists abroad is expensive to the sponsoring governments, imposes a lot of hardship on the doctors and, above all, the course-content of such training takes little or no cognizance of the environment in which these doctors would later practise. The developing countries also cannot afford the loss of years in valuable services which the training abroad entails. Attempts are now being made to train specialists wholly or partly at home, in some developing countries. The approach is still not much divorced from what obtains in Britain and North America, that is, one of being trained on the job, with the onus for self-education being placed on the prospective students. Such students in most developing countries of tropical Africa have little or no facilities for further education outside their places of work. It is proposed that purpose-designed postgraduate medical schools may provide a temporary solution to specialist training in developing countries of tropical Africa. Such schools would in addition provide highly skilled medical service as well as obviate the need and the expense for the setting up of government sponsored medical research and training institutes.

Africa, Western↗

PubMed1995

Early detection of breast cancer in industrially developing countries.

Although the incidence of breast cancer is lower in industrially developing countries than in developed ones, half the global toll of breast cancer is in developing countries. As in the West, the incidence of breast cancer is rising in developing countries, and strategies for controlling breast cancer need to be defined taking into account the prevailing socio-economic realities. Mammography is unlikely to be a cost-effective approach to early detection. Because most breast cancers in developing countries occur in women below the age of 50, mammography is also likely to be less effective. The success of breast self-examination (BSE) requires strong motivation and the recognition that breast cancer is a potential hazard. Both these requirements are unlikely to be met in developing countries and, consequently, compliance will be low and BSE will not be performed properly. Nevertheless, the teaching of BSE may be used as a medium for increasing awareness about breast cancer. Physical examination (PE) of the breast conducted by female health workers is likely to be the most appropriate approach to early detection in developing countries. To be cost-effective, PE should be integrated into already existing health care programmes which reach women in their homes. The effectiveness of PE in the early detection of breast cancer has been underestimated, and evidence is reviewed which suggests that it may be a simple and inexpensive alternative to mammography screening even in developing countries.

Adult↗

PubMed1988

Vaginal delivery after caesarean section: is it safe in a developing country?

Many studies from developed countries have shown that a trial of vaginal delivery after a Caesarean section can be a safe alternative to repeated Caesarean section when certain criteria are fulfilled. However, few data are available from developing countries where, in most cases, there is no electronic fetal heart rate monitoring, no information about the prior section and no X-ray pelvimetry. At Gweru Hospital, 401 patients with a scarred uterus have been managed according to a standard protocol and 288 were allowed to have a trial of scar. The results show that the trial was successful in 235 mothers (82%) and there were only 2 uterine ruptures (0.7%). Postpartum morbidity was higher after Caesarean section than after vaginal delivery.

Adult↗

PubMed2002

Separating potential source exposure from background exposure in subsistence populations in developing countries.

Risk assessment methods of developed countries have prescribed exposure assumptions for calculating health risks that are generally inappropriate for developing countries because of population, cultural, and social differences. For example, populations in developing countries are often subsistence users of natural resources with a more outdoor-oriented lifestyle. Assessments should thus measure specific dietary intake rates and contact rates with environmental media. Chemical analyses of food, environmental media, and any biomarkers of exposure should include a carefully matched reference population to distinguish between exposures due to naturally occurring metals in more mineralized areas and potential anthropogenic sources. Without a reference group, one might predict excess risk associated with the external source, even though exposure is due to background levels. For example, subsistence populations often have a simple diet with high ingestion rates of a few food types (e.g. 200 g/day wet weight of fish; 500 g/day of rice). These foods can be naturally elevated in arsenic (fish and rice) and mercury (fish). Conservative risk assessments that extrapolate toxicity from high to low doses can predict elevated risks for these naturally occurring elements (e.g. greater than 1 in 10,000 cancer risk for arsenic). Whether the calculated risks are actually indicative of harm to subsistence populations should be considered in light of the beneficial properties of the diet and the lack of alternative food choices.

Animals↗

PubMed1989

Implementing change in medical education in developing countries.

Medical schools in developing countries are constantly faced with the problem of adapting an inherited style of education to suit local needs and constraints. Often these needs have changed considerably since the curriculum was first established. Yet the difficulty of bringing about curricular changes, especially in conventional medical schools, is well known. This paper attempts to guide innovators in developing countries, but many of the suggestions are appropriate to all innovators. The issue of international standards is closely scrutinised, and their hypothetical nature revealed. The detrimental effect of national licensing examinations on curricular innovation is discussed. The futility of ad hoc changes and the need for a carefully thought out philosophy of change which leads logically to new ways of educating future professionals are stressed. Guidelines for maintaining an innovation and for evaluating its short- and long-term outcomes are developed.

Communication Barriers↗

PubMed2006

An integrated approach to modeling resource utilization for rural communities in developing countries.

Resource consumption in developing countries has been the focus of a considerable amount of research. What has been understudied however, has been the feedback affects of resource consumption on resource availability to both households and communities. Heavy reliance on natural resources and intensive smallholder agriculture common to many rural communities in developing countries has forced people to fulfill short-term needs to the detriment of long-term ecological and livelihood sustainability. This paper introduces a conceptual framework to examine how individuals and households fulfill daily caloric needs and the aggregate effects on resource availability and consumption. Data were collected from a large number of published case studies of rural land-use dynamics, growth and yield models, and human livelihoods were reviewed from scientific journals, reports published by NGOs, and government reports. Using inputs defined by the user, the model tracks annual fuelwood and agricultural land use based on meeting individual energy demands. A case-study-based analysis was patterned after smallholder agriculturalists at the family and community level. Three scenarios are presented in this paper using data from Uganda to illustrate the application of this model.

Adult↗

PubMed2006

Frequency of twin births in developed countries.

Twinning rates in developed countries have recently registered an increase. At the end of the 1970s, the change in mother's age structure has partially contributed to the growth in the proportion of multiple births. In fact, the evolution of twinning rates is related to the calendar of maternity since, comparatively to younger mothers, older women more frequently have twins. Moreover, the growing frequency of multiple births also depends on fertility treatments, which are largely used in the developed countries. National data from the civil birth registration systems are taken into account in order to describe, in a comparative study, the main trends of twinning rates in the 20th century.

Birth Rate↗

PubMedDate not supplied

Royal Society of Tropical Medicine and Hygiene meeting at Manson House, London 17 January 2002. Cervical cancer in developing countries.

The public health importance of cervical cancer is now increasingly appreciated as a means to improve the general health of women in many developing countries. Developing countries account for 80% of the world burden, mostly due to the lack of effective control programmes. Infection with oncogenic types of human papillomaviruses (HPV) has been established as the central cause for cervical cancer. Thus, vaccination against HPV is a potentially useful strategy for prevention, but this may take several years to become a reality. Currently, early detection and treatment is the most effective approach to control cervical cancer. Cervical cancer may be controlled through improving awareness and accessibility to diagnostic and treatment services. Cytology-based screening is beyond the capacity of health services in many developing countries, hence, alternative methods to cytology are being investigated. Visual inspection of the cervix after application of 3-5% acetic acid (VIA) seems to be a promising screening test, with a similar sensitivity to that of cytology, but lower specificity. Currently, it is being evaluated for its cost-effectiveness in reducing cervical cancer incidence and mortality in randomized trials. Information from the ongoing studies will be valuable for evolving cervical cancer control policies and programmes in low-resource settings.

Age Distribution↗

PubMedDate not supplied

[Nutritional transition and non-communicable diet-related chronic diseases in developing countries].

It is increasingly recognized that developing countries are undergoing an epidemiologic transition similar to that which occurred in industrialized countries in previous centuries. While infectious diseases are still the main cause of morbidity and mortality, there is a marked increase in chronic non-communicable diseases, particularly in the most advanced developing countries, and these diseases are expected to take the lead in a decade or two. Most of these diseases, above all coronary heart diseases, stroke and diabetes, are related to diet and lifestyles, for example tobacco and alcohol consumption. As a matter of fact, these societies are also facing a growing epidemic of overweight and obesity, due to the frequent energetic imbalance between energy-dense food consumption and reduced daily physical expenditure. This health transition, favoured by demographic changes towards aging populations, is occurring at an increased pace in urban societies widely exposed to the modernization of lifestyle, sedentary occupation, and to lipid- and sugar-rich food, often poor in fibre and micronutrients. Increased world access to cheaper vegetable oil is thought to have triggered off this accelerated and generalized trend, though animal food, rich in saturated fat, and imported or locally-made industrialized food also play a role. While increased national and household incomes facilitate the initial change, as the transition advances poor people progressively become the main victims, as has been observed in the more advanced developing countries. Metabolic imprinting due to intra-uterine and infant malnutrition, which are still common in these societies, is also thought to play a significant role in the increase in the expression of insulin resistance, obesity and chronic diseases when these children are exposed to abundant food and modern lifestyle, later in life. Treatment and secondary prevention of nutrition-related chronic diseases and associated disabilities have an ever rising cost in industrialized countries, which is far beyond the means of the still fragile economies of developing countries. This double burden of infectious diseases and undernutrition that still exist, and of non-communicable diseases and overnutrition represents a threat to the frequently unprepared health care services in developing countries. There is a clear need to focus health policies on the prevention of chronic diseases through primary health care services, the use of mass media for communication and education about healthy nutrition and lifestyle, and the adaptation of public policies. Nutritionists must also adapt to this changing nutritional situation which may result in apparently contradictory nutritional status findings within societies if not even within households.

Chronic Disease↗

PubMed1990

Soak-away systems and possible groundwater pollution problems in developing countries.

People in the developing countries do not have adequate sanitation and everyone defaecates somewhere. Those who do not have a toilet or latrine have to resort to indiscriminate defaecation either in the sea shore such as in the Lagos lagoon in Nigeria, or vacant plots and open drains as in Iddo area of Lagos and sides of rural footpaths. Water closets (W.C.s) are the most accepted sanitation system, but the cost of operating and maintaining them is high. As a result sewerage is not appropriate for the majority of people in developing countries whose greater population live in rural areas and small towns. The majority of people in urban areas use septic tanks and very often most of these septic tanks are not properly designed or sometimes located too close to sources of water supply, which then become contaminated. It is generally believed that systems like septic tanks, pit latrines and aqua privies are capable of totally eliminating these pathogens. There are many problems associated with the physical, chemical and biological processes that may result in groundwater pollution from septic tanks. Many experiments have shown that faecal organisms do not travel any significant distance radially as a result of concentration gradient. They are, however, carried with groundwater flow. The task is to prevent pathogens from getting into the aquifer. This paper attempts to highlight the ability of some enteric viruses to survive septic tank wastewater treatment.

Developing Countries↗

PubMed2000

Comparison of BACTEC MYCO/F LYTIC and WAMPOLE ISOLATOR 10 (lysis-centrifugation) systems for detection of bacteremia, mycobacteremia, and fungemia in a developing country.

In less-developed countries, studies of bloodstream infections (BSI) have been hindered because of the difficulty and costs of culturing blood for bacteria, mycobacteria, and fungi. During two study periods (study period I [1997] and study period II [1998]), we cultured blood from patients in Malawi by using the BACTEC MYCO/F LYTIC (MFL), ISOLATOR 10 (Isolator), Septi-Chek AFB (SC-AFB), and Septi-Chek bacterial (SC-B) systems. During study period I, blood was inoculated at 5 ml into an MFL bottle, 10 ml into an Isolator tube for lysis and centrifugation, and 10 ml into an SC-B bottle. Next, 0.5-ml aliquots of Isolator concentrate were inoculated into an SC-AFB bottle and onto Middlebrook 7H11 agar slants, chocolate agar slants, and Inhibitory Mold Agar (IMA) slants. During study period II, the SC-B and chocolate agar cultures were discontinued. MFL growth was detected by fluorescence caused by shining UV light (lambda = 365 nm) onto the indicator on the bottom of the bottle. During study period I, 251 blood cultures yielded 44 bacterial isolates. For bacteremia, the MFL was similar to the Isolator concentrate on chocolate agar (34 of 44 versus 27 of 44; P, not significant [NS]), but more sensitive than the SC-B bottle (34 of 44 versus 24 of 44; P = 0.05). For both study periods combined, 486 blood cultures yielded 37 mycobacterial and 13 fungal isolates. For mycobacteremia, the sensitivities of the MFL and Isolator concentrate in the SC-AFB bottle were similar (30 of 37 versus 29 of 37; P, NS); the MFL bottle was more sensitive than the concentrate on Middlebrook agar (30 of 37 versus 15 of 37; P = 0.002). For fungemia, the MFL bottle was as sensitive as the SC-B bottle or Isolator concentrate on chocolate agar or IMA slants. We conclude that the MFL bottle, inoculated with just 5 ml of blood and examined under UV light, provides a sensitive and uncomplicated method for comprehensive detection of BSI in less-developed countries.

Adult↗

PubMed2002

Renal osteodystrophy in developing countries.

There are distinct differences between developing and developed countries regarding the pathogenesis and management of renal osteodystrophy. Such differences are due to ethnic factors, dialysis quality, types of membranes, dialysate water, lack of technical facilities to perform bone biopsies, beta2-microglobulin, aluminium and strontium toxicity, and iron overload as well as economic factors hampering the use of effective yet more expensive phosphate binders and active vitamin D. The prevalence of renal osteodystrophy in developing countries is higher than in developed countries. It ranges from 24.4% to 63%. Aluminium related bone disease is a common cause. High strontium levels and iron overload in developing countries play a major role in the development of renal bone disease among dialysis patients.

Chronic Kidney Disease-Mineral and Bone Disorder↗

PubMed1996

Environmental toxicants in developing countries.

Health effects from environmental toxicants may be a more serious problem in developing countries compared with developed countries because the problem is potentiated by other factors: a) the lack of or failure to enforce regulations, which allows human exposures to genotoxic agents; b) undernourishment of the lower economic and social classes that comprise the most exposed populations from industrial and agricultural activities; and c) parasitic infections that afflict a wide range of populations in both urban and rural areas. Data on the genotoxic effects of different types of exposures, including environmental exposes (natural and industrial), occupational exposures, and infections and medical treatments, are presented and discussed with the point of view that all these factors must be taken into account with respect to regulation and the protection of human health. Occupational exposures in developing countries are higher than in developed countries due to lack of stringent regulations, lack of knowledge of the risks involved, and the negligence of workers. General pollution is another important issue since developed countries have established strict regulations and risky industrial processes are being exported to developing countries, along with banned substances and dangerous industrial wastes. It should be emphasized that stringent regulations in developed countries will not prevent exposures in the long term because toxic substances that are released into the environment will ultimately reach all our future generations.

Animal Population Groups↗

PubMed2001

Agricultural biotechnology in developing countries.

After a slow start many developing countries are now investing in agricultural biotechnology. Although these countries face several constraints, efforts are being made to promote biotechnology that requires high investment with long term returns. A number of donor agencies are providing incentives to stimulate biotechnology in the developing countries. There is however a major debate towards the development of biotechnology, especially genetically modified organisms, in the developing countries and there is a need for them to address biosafety issues and proper monitoring systems. The concern of intellectual property rights is a major issue in the developing countries in order to have access to the technologies that are often owned by multinational corporations in the industrialized countries.

Agriculture↗

PubMed1995

Population concentration in less developed countries: new evidence.

Economic theory associates the increase in population concentration, i.e., the proportion of national population residing in the core economic region, with scale and agglomeration economies. Wheaton and Shishido (1981) estimated that these persist until real per capita national income reaches 5000 1985 US dollars (USD). After this point in a country's economic development, they predicted, population redistribution towards the core region will cease and the proportion of national population residing in the core region will commence to decline. The experience of developed countries (DCs) in the 1970s and 1980s broadly conformed to this pattern, albeit with exceptions. Evidence from less developed countries (LDCs) through the 1980 round of censuses led Vining (1986) to propose a weakened version of the USD 5000 rule in which this point is characterized only by a slowing of rate of population re-distribution towards the core, not by an outright reversal. This paper updates previously reported trends in population redistribution in LDCs and reports on many new countries. Taken as a whole, post-war data reinforce the need for caution of the sort expressed by Vining. While there is a weak negative correlation between the rate of net migration into the core region and per capita income, the share of population residing in the core region may continue to rise even when per capita income has grown to well beyond USD 5000.

Demography↗

PubMed2006

The last mile: earthquake risk mitigation assistance in developing countries.

Over the past few decades, we have seen many joint programmes between developed countries and developing countries to help the latter in managing their earthquake risks. These programmes span the whole spectrum of disciplines from seismology and geology to engineering, social science and economics. Many of these programmes have been effective in raising awareness, in urging governments to work towards risk reduction and in spawning an 'industry' of disaster management in many of the developing countries. However, even as these efforts proceed, we have seen death and destruction due to earthquake after earthquake in developing countries, strongly suggesting that the problems for which those assistance programmes were developed are not so effective. Therefore, it is natural to ask why this is happening. Are the assistance programmes reaching the right people? Maybe we are reaching the right people and doing the right type of things in these countries, but we have not allowed enough time for our actions to take effect. Maybe we are reaching the right people and doing the right actions for most of the miles we need to cover in helping communities mitigate their earthquake risks. However, the issue could be whether we are reaching people who represent the 'last mile' on this pathway. Here, I explore whether the work that many organizations and countries have done towards earthquake risk reduction over the past few decades in developing countries is appropriate or not. Why do we keep seeing the catastrophes of Sumatra, Chi Chi, Bhuj, Turkey, Algeria and on and on? I will articulate what I think is the problem. My contribution is intended to generate discussions, self-analysis of our approaches, what we are doing right and what we are not doing right. Hopefully such discussions will result in a better connection between the last mile and programmes around the world which are working towards earthquake risk mitigation.

Developed Countries↗