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PubMed1991

Tuberculosis and HIV-infection in developing countries.

Tuberculosis is a major public health problem in developing countries. In recent years, a (cost-)effective intervention has been developed in the national programmes of Tanzania and other developing countries. HIV transmission in populations with a high background prevalence of tuberculosis infection will increase the incidence of tuberculosis disease substantially. World Health Organization and World Bank are currently formulating new strategies to revitalise the global efforts against tuberculosis.

Adolescent↗

PubMed1991

The needs of developing countries and the resources required.

Nosocomial infections in developing countries represent a major public health problem that is not universally recognized. In Latin America rates for nosocomial infections range from 10 to 26% with a severe impact on morbidity and mortality and a consequent economic burden. The fundamental needs are: (1) to recognize the importance of this problem; (2) to modify the attitude of government authorities in the sense that hospital care could be improved; (3) to teach medical personnel the importance of infection control at the beginning of their training; and (4) to increase the awareness of the population of its right to better health care. From an international point of view we should establish the following guidelines: (1) the World Health Organisation should establish a worldwide programme on nosocomial infections; (2) medical and nursing schools should include regular courses on infection control; (3) international organizations should support training and research programmes in developing countries, focusing on the regional needs for infection control.

Cross Infection↗

PubMed1996

Health learning materials support in South Africa compared with other developing countries.

Actions to promote media use for education at all levels in developing countries have to cope with a number of deterrents like the lack of appropriate audiovisual materials and a media support infrastructure. In the early eighties the World Health Organization and United Nations Development Programme initiated a capacity building project to enable developing countries to generate sufficient instructional and learning materials for medical and health education. Since South Africa is still a non-participator in the programme, this article presents the findings of a recent survey to get a global picture of health learning materials support in developing countries as a possible model for South Africa.

Developing Countries↗

PubMed1991

[Vaccines and developing countries].

Infectious diseases are the main cause of mortality and morbidity in developing countries. The Expanded Programme on Immunization, initiated by WHO in 1974, now reaches 60 mill. a year at a cost of less than 2 US $ per immunized child, and saves 2.2 mill. lives annually. The present vaccines, however, have significant shortcomings. Measles vaccine is given too late to prevent the large number of deaths occurring in the first year of life. Attenuated polio vaccine has to be given three times and inherits the risk of "vaccine palsy" and revertion to virulence. Tetanus vaccine given to children does not prevent neonatal tetanus, the main cause of tetanus casualties. BCG does not control spread of tuberculosis. Vaccines given parenterally involve some risk of spread of HIV, and some potentially useful vaccines are too expensive for developing countries. By only modest investments modern gene technology could give improved and new vaccines which would potentially save 20 mill. lives a year. Particularly promising is the recent development of multi-vaccine-vectors. However, poor prospects for profit in developing countries and patent "swapping" by commercial producers severely hamper development in the vaccine field.

Developing Countries↗

PubMed1997

Environmental factors affecting nutritional status in urban areas of developing countries.

The demographic and economic transition that many developing countries are undergoing is producing important changes in diet and lifestyle that greatly impact on disease risks. Among the risk behaviors associated with socioeconomic transition and urbanization are excessive dietary fat intake, sedentary lifestyle, smoking, and environmental contamination. Combined with a reduced infant mortality and increased life expectancy, those risk factors lead to an increasing prevalence of chronic disease like non-insulin dependent diabetes and coronary heart disease. This disease. This disease profile is a relatively new phenomenon in developing countries, where health programs have traditionally focused on "acute" interventions such as immunization or oral rehydration. A new approach will be needed to address chronic diseases, which frequently demand a life-long and technically complex medical management, and may have significant impact on the quality of life and productivity of the population. Efforts to address this situation should focus on a) expanding the information base on diet, nutritional status and lifestyle changes in populations migrating to urban areas; b) developing and evaluating approaches for improving diet quality in urban populations, including fortification and community-based supplementation programs; c) understanding better the social and behavioral determinants of nutritional status in the urban poor; and d) defining the role of the food industry and of agricultural production for improving the quality of the food supply in urban areas.

Asia↗

PubMed1991

The development of traffic and traffic safety in six developed countries.

Two models are presented, describing the development of traffic and traffic safety. Traffic volumes, measured by the total amount of vehicle kilometers per year, are expected to follow a sigmoid saturation curve over time. The logistic function is used to model this development. The fatality rate, the number of fatalities per vehicle kilometer, is chosen to measure safety. The (negative) exponential function is selected to model the fatality rates over time. It is argued that these two aspects of the traffic system are fundamental and that the development of the number of fatalities results by multiplication. Given this assumption, the fall in the number of fatalities, noticed in almost all developed countries after a steady increase until 1970, does not need a special explanation. It follows from the combination of the monotonically increasing traffic volumes and the monotonically decreasing fatality rates. The two parsimonious models fit the data fairly well for six developed countries. The parameters differ substantially between countries, but also show common features. It is found from the parameters of the logistic function, that for all countries the points of maximum increase in traffic volume coincide just after 1970, the moment of the energy crisis. It is concluded from this finding that the energy crisis was caused by the cumulating demands of the oil-consuming countries, resulting in a reaction of the oil-producing countries. From the parameters of the exponential function, it is found that there also is a common point of intersection for fatality rates around 1980. It is shown that the development of safety is directly related to the development of traffic. The ten-year delay is interpreted as the time necessary for planning and implementation of safety measures. Finally, a striking relation is found between the volume parameters and the fatality-rate parameters, suggesting that the number of fatalities is a function of the derivative of the amount of traffic in the mathematical sense.

Accidents, Traffic↗

PubMed1998

Malignancy is the most common cause of gastric outlet obstruction even in a developing country.

BACKGROUND AND STUDY AIMS: It has recently been reported that in developed countries gastric outlet obstruction now predicts gastric malignancy. The aim of this study was to find out if this is the case in a developing country like India. PATIENTS AND METHODS: Seventy-four patients with gastric outlet obstruction underwent upper gastrointestinal endoscopy and biopsy specimens were obtained from any suspicious looking lesions or from the most distal point at which the endoscope could be positioned. RESULTS: In 56 patients (76%) the cause of the gastric outlet obstruction was malignant. On clinical and endoscopic appearance three patients were wrongly diagnosed as having malignancy when the cause, on endoscopic biopsy, was benign (tuberculosis n = 2, and immunoproliferative small intestinal disease n = 1). Twelve of the 18 patients with benign gastric outlet obstruction were managed conservatively with drugs and endoscopic balloon dilatation. CONCLUSION: Even in a developing country like India, malignancy is the commonest cause of gastric outlet obstruction and endoscopic biopsy specimens should be obtained in all patients with gastric outlet obstruction because the occasional benign lesions can be managed conservatively.

Adenocarcinoma↗

PubMedDate not supplied

Immunizations in developing countries.

The WHO Expanded Programme on immunization has greatly improved the prevention of 6 major diseases of infants in developing countries, but a number of other immunizations are left aside. They concern diseases which are either specific to tropical countries or common to both developed and developing countries. Preventive immunization programmes against these diseases are often non-existent and countries rely on "fire-fighting" immunization campaigns whenever an outbreak occurs. This deficiency is the result of logistic difficulties, most of which could be overcome. Recent progress in research will bring improved classical vaccines and new vaccines which are eagerly awaited. However, logistic problems in developing countries will have to be solved to make the best use of multiple antigens which will soon be at hand.

Developing Countries↗

PubMed1994

Observations on health information in developing countries.

Based on personal experiences, observations are offered on health information in developing countries, ways in which information systems can be strengthened, and opportunities for health-information science graduates. Although data collection consumes a significant portion of the health worker's day, information systems are often a low priority in developing countries. Health-information systems can be strengthened by focusing on local solutions, by building skills in health workers, by utilizing appropriate technology, and by integrating information systems into health programs. Health-information science graduates can assist in improving systems in developing countries, but this will require a broad and flexible definition of health information science, which is much more than computing technology; it is supporting health workers to define, manage, and apply the information they need.

Developing Countries↗

PubMed1994

Human immunization in developing countries: practical and theoretical problems and prospects.

While measles, pertussis and tetanus were responsible during the early 1990s for nearly two million deaths in developing countries, no deaths were attributable to them in industrialized countries. More than 96% of global deaths by communicable diseases were also from developing countries. Respiratory infections ranked first in communicable morbidity at all ages. Even though vaccines of bacterial or viral origin or a prophylactic for passive immunization are produced in 24, 16 and 15 developing countries, respectively, none of the developing countries manufactures a plasma-derived prophylactic or biological response modifier. Nearly every country relies on import of one or more vaccines. The suboptimal performance of otherwise meritorious products has been due to faulty vaccine administration practices. Expanding populations, poverty and lack of education, cold-chain defects, and inadequate facilities for transport of vaccines to target populations in remote areas have been responsible for the poor performance of vaccines in the community. Mounting foreign debts and budgetary strains resulting from the care and prevention of AIDS/HIV have considerably strained national and international efforts to offer routine vaccinations in childhood and pregnancy. This dismal situation could be tackled through research to obtain environmentally stable products for prophylactic use and monoclonal antibody formulations for passive immunization, and through international financial and technical support. All countries should exercise some technical control of the quality of imported and indigenous vaccines during their use for curative or prophylactic purposes. The involvement of private clinicians in immunizations would strengthen national efforts for control of communicable diseases including AIDS, but this is not enough if the local factors cited above are not improved.

Bacterial Vaccines↗

PubMed1995

[Cancer in developing countries. Illness in a diseased world].

In Third World countries, cancer is mainly a risk for the future generations. Without achieving adequate cancer control in developing countries, much of the progress in the fight against infections will be lost. While the industrialized countries are more and more concerned to avoid cancer risk factors and, thus, decrease the frequency of cancer, only few such steps can be seen in developing countries. Based on the actual cancer mortality and demographic projections in the year 2000, cancer mortality in the whole world will be 8 to 10 millions (2 to 3 millions in industrialized countries, 6 to 7 millions in developing countries). But while 60% of the world's new cancer patients are in the Third World, the developing countries dispose only 5% of the world's total anticancer resources. The cancer situation in the Third World indicates that in spite of many humanitarian efforts and many previous statements the fight against suffering in the world often stagnates. Therefore, it seems to be justified to call the world "sick". However the suffering of the Third World is curable. However we have to accept that the present world is not functioning very well, we have to explore the reasons for that and to solve existing problems.

Adolescent↗

PubMed1998

Veterinary diagnostic laboratories in developing countries: the challenge of credibility.

The problems facing veterinary diagnostic laboratories in developing countries range from simple problems, such as limited funds to keep good personnel or obtain equipment, supplies, reagents or training, to the more complex problems of designing and executing appropriate sample collection schemes for disease surveillance of evaluating the performance characteristics of a new diagnostic assay. While many developing countries are addressing these problems independently and a number of international and national organisations provide various forms of external support, the Office International des Epizooties (OIE) must continue in its critical role to provide guidelines for the most appropriate diagnostic assays for trade purposes and the development of the primary reference reagents for these assays. In addition, the OIE should take the lead in development of quality management guidelines for veterinary diagnostic testing laboratories. Without these guidelines and standards, diagnostic laboratories in developing countries will have difficulty in gaining the credibility necessary to help improve the positions of their countries in the international trade of livestock and livestock commodities.

Animal Diseases↗

PubMed1992

[Epidemiological studies on viral hepatitis among long-term sojourners in the developing countries and evaluation of preventive measures].

It is known that acute viral hepatitis is very common among sojourners in developing countries. In order to conduct effective health control, epidemiological studies were made on viral hepatitis which occurred among Japanese staying in developing countries, and evaluations were carried out on preventive measures. The subjects of present study were a group of Japanese people staying in developing countries for two years. Mid year population of the group was 1732 in 1988. Period of the present study is ten years from 1979 to 1988. The study was conducted based on the reports from offices in each country, survey trips and serological studies on the subjects. In 1979, frequency of hepatitis A (HA) was very high showing 79% of total hepatitides. However after starting of inoculation of human immune serum globulin (ISG), the frequency of HA declined remarkably. Statistical significance was recognized in the efficacy of ISG. Among 35 cases of hepatitis B (HB) (34 males and 1 female), 2 derived from HBe antigen carrier while the remaining 34 were regarded as infected during their stay in developing countries. No cases of HB were recognized among those who received injections of HB vaccine. The rate of people whose HB marker turned positive during their stay is showing a tendency of increase (4.2% in 1987). The frequency of infection with HB virus is especially high in Asian and African countries where the carrier rates of native people were also high. Ten cases of non-A non-B hepatitis were recognized. Among them 7 were infected in Asia, 1 in Africa and 1 in Central America.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Patterns of infant weight gain in developing countries.

Data relating to weight of infants from 23 developing countries and two western industrialized populations taken from the literature were compared. Growth in the developing countries was extremely variable, but was poor compared to western standards such that by 12 months of age mean weight in all 23 populations was below the NCHS 50th percentile (P < 0.001) and in 11 populations mean weight was below the 10th percentile. Birth weight was not related to growth increment in the first 3 months. Multiple regression analysis showed birth weight and growth increments in the first four 3-month periods post-partum to be highly significantly related to weight at 12 months (P < 0.0001 in all cases). Growth increment in the first 3 months had the greatest effect out of these variables; the effect of the other four variables was similar. These patterns demonstrate the variable impact of environmental factors on growth in the first year of life.

Age Factors↗

PubMed1997

Outcome in schizophrenia and related disorders compared between developing and developed countries. A recursive partitioning re-analysis of the WHO DOSMD data.

BACKGROUND: Data on the two-year pattern of course of illness have been collected in the WHO study of the Determinants of Outcomes of Severe Mental Disorder (DOSMD). These data are reanalysed using recursive partitioning, a method not yet applied to psychiatric data to test the hypothesis that subjects from participating centres in developing countries had better outcomes than those in developed countries. METHOD: Subjects were those from the DOSMD study for whom two-year follow-up data were available (n = 1056). The classification and regression trees recursive partitioning technique was used to examine the predictor variables associated with the outcome variable two year pattern of course. RESULTS: Pattern of course was best predicted by centre, but two developed centres (Prague and Nottingham) grouped with the developing country centres excluding Cali, having better outcomes than in the remaining developed country centres and Cali. Type of onset (insidious v. non-insidious) was the next strongest predictor, but its effect differed across these two centre groupings. Effects for some groups were modified by other predictor variables, including age, child and/or adolescent problems, and gender. CONCLUSIONS: The predominant predictor effects on two-year pattern of course continued to be centre and type of onset, but complex interactions between these variables and other predictor variables are seen in specific centre groupings not strictly defined by 'developing' and 'developed'.

Developed Countries↗

PubMed1990

Appropriate training in paediatric nephrology for developing countries: hypothesis and proposals.

Appropriate training in paediatric nephrology is a comprehensive approach designed to develop skills and capabilities to deal with the following basic components of medical care: (1) medical competence for clinical and research activities; (2) interpersonal relationships directed at maintaining patients' freedom and autonomy; and (3) adequate incorporation of technological, financial and managerial aspects of paediatric nephrology services. Inappropriate training causes frequent, dramatic and paradoxical negative feedback in developing countries: shortage of functioning medical equipment, skilled manpower and trained paediatric nephrologists co-exist with unused high-cost medical equipment and loss of skilled health care professionals. Appropriate training, tailored to the needs and resources of developing countries, could be an efficient way to develop high-quality paediatric nephrology care. Efficient training must develop self-reliant, self-sufficient and skilled health care professionals in the local economic, educational, technological and political context. Regional and international co-operation is essential to promote adequate training in paediatric nephrology. Developing countries lack an effective and accurate information communication network for selecting modern technology for paediatric nephrology. The development of this network through international co-operation, is an urgent requirement.

Developing Countries↗

PubMedDate not supplied

Ongoing research in occupational health and environmental epidemiology in developing countries.

Research in occupational health and environmental epidemiology can play an important role in furthering our understanding of occupational and environmental health problems. Research guides us in the recognition, management, and prevention of health problems. However, in developing countries, where rates of occupational and environmental illnesses and injuries are higher and where these problems are often more severe than in developed countries, research capabilities are less developed. In mid-1990, a project was undertaken to (a) document ongoing research in occupational health and environmental epidemiology in developing countries, (b) facilitate the exchange of information among researchers in this field, (c) stimulate research, and (d) avoid unnecessary duplication among researchers in this field. A questionnaire was mailed, the purpose of which was to learn the current status of research in developing countries and to develop a directory of such ongoing research. The questionnaire was sent to 1,528 individuals. Of the 500 research projects identified, 77% were investigating chemical hazards; 26%, physical hazards; 10%, biological hazards; and 10%, psychosocial hazards (some projects addressed multiple hazards). The chemical hazards studied most frequently were dusts, pesticides, and lead. The greatest number of research projects were identified in China, India, Brazil, Korea, and Thailand. Most projects were descriptive or cross-sectional epidemiologic studies or industrial hygiene or exposure-assessment studies. The World Health Organization has published a directory of the specific research projects that were identified in this survey.

Developing Countries↗

PubMed1978

[Problems in production, control and utilization of veterinary vaccines in the developing countries].

For a whole series of reasons, most of which are political, the developing countries are following a policy of national self-sufficiency in veterinary vaccines. They are faced with problems at various levels: (1) at the level of logistic distribution, the developing countries suffer from a shortage of trained personnel, frequently lacking in enthusiasm, an often chronic shortage of funds; poorly equipped premises; poor maintenance of sophisticated but indispensable equipment (e.g. freeze-driers); a lack of facilities for cold storage and of distribution channels; field personnel with limited experience; (2) at the level of production, they must contend with difficulties in obtaining supplies of flasks and glassware; irregular supplies of water and electricity; difficulties in obtaining susceptible animals for quality control. The developing countries have found basically pragmatic solutions to these problems, such as the strict separation of the sites, materials and personnel involved in routine diagnosis and those involved in production; temporary foreign technical assistance, with or without financial aid; the use of simple, unsophisticated techniques, which are known to be reliable, even if somewhat outdated; manufacturing in bulk in multiple-dose bottles; research into the thermostabilisation of vaccine strains and the development of thermoprotective diluents for freeze-drying and reconstitution; the extensive use of combined vaccines; the establishment of production and control standards under the auspices of the WHO/FAO/OIE. In spite of these obstacles, the cost price is particularly low (from 0.20 to 0.35 francs per dose), which compares favourably with that of foreign private industry.

Africa↗