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PubMed2004

Cleaner technology development--some practical steps for developing countries.

Cleaner technologies often originate from developed countries. Little developmental work is continued on the products sourced from developing countries. These products are by and large low value products generating large quantities of hazardous waste per unit of production. Methodology is proposed for phasing out such dirty technologies! products. The development of cleaner technologies is proposed for utilizing large quantity of hazardous waste generated from identified manufacturing process.

Developing Countries↗

PubMed2004

The influence of context on the success of adoptive breastfeeding: developing countries and the west.

It is commonly believed that adoptive mothers in developing countries are more successful breastmilk producers than women in the west. A review of published research supports this assertion. However, an examination of the practice of adoptive breastfeeding in developing countries and in the west via the literature reveals differences that may explain the variation in success. Adoptive mothers in developing countries may have greater milk production than mothers in the west because they are more knowledgeable about breastfeeding, practice frequent breastfeeding, remain in close physical contact with their children and live in cultures that are supportive of breastfeeding. They also have reproductive and breastfeeding histories that may make breastfeeding easier, though they are less likely to have pharmaceutical galactagogues available. Adoptive mothers in the west should be encouraged to maximise their milk supply by emulating the mothering styles of women in developing countries and developing a strong support network for breastfeeding. It may be that most adoptive mothers are physically capable of producing sufficient breastmilk for their child but that in the west, sociocultural factors act as preventatives.

Adoption↗

PubMed2004

Policy analysis: an essential research tool for the introduction of vaccines in developing countries.

To address the unacceptable levels of disease in developing countries and the lack of vaccines to address infectious diseases, the public sector has been expanding its funding for, and involvement in, vaccine research and development. The public sector is becoming a full participant in the spectrum of translational research taking candidates from the laboratory to use in national immunization programmes. As these programmes and the continuing work of the private sector achieve success, an extensive analysis of policy will be needed to support the introduction of vaccines. Based on the early experience with the introduction of hepatitis B vaccine in several developing countries, there is a defined framework for the introduction of vaccines. This framework lays out five essential overlapping and complementary elements of introduction of vaccines in developing countries. Each element requires a clear understanding of policy-related issues. There is a pressing need to include and expand policy analysis on a wide range of topics to ensure that the poor in developing countries can have access to the fruits of modern biotechnology.

Developing Countries↗

PubMed2005

Private health insurance: implications for developing countries.

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage.

Developing Countries↗

PubMed1990

Antenatal care in developing countries.

The problem of antenatal care in developing countries may be considered from two aspects: (a) areas where antenatal facilities are absent or are inadequate, and (b) areas where antenatal facilities are adequate but for some reasons are not adequately utilized. The solution to the first part of the problem would appear to be simple. The governments concerned should provide the required facilities. This obviously is not an easy task in many areas of the world, especially with the present profound economic depression in many developing countries. The people just have to use the facilities available to their best advantage, or do without the facilities. The second part of the problem presents more difficulties. Where antenatal facilities are available, inadequate utilization has been shown to be due to a number of factors: 1. The facilities are too distant or too expensive. It has been shown how the Nigerian authorities dealt with this problem in the Ibarapa district. However, it is a very expensive solution and few governments will be able to afford this. 2. Illiteracy or ignorance. The obvious solution to this difficulty is to educate the masses and a few governments have already embarked on these commendable programmes. Unfortunately, this procedure is expensive, may take a long time and, as already pointed out, even literate women may not use the antenatal services. 3. Traditional and cultural beliefs and prejudices. It has already been shown that this factor is a very important one in the population in developing countries, even among literate patients. The saying that 'old habits die hard' is probably apt here. Probably, with time, education and closer contact with the developed world, these prejudices will disappear. From the above observations, it would appear that an inexpensive short-term solution to the two parts of the problem mentioned above is for governments to train and use the TBAs who are already 'in our midst' and who already enjoy the confidence of the masses. The authorities, however, have to be very careful in integrating the TBAs into the health system. It has to be done very judiciously and tactfully, otherwise antagonism and unhealthy rivalry will be created between the TBAs and other members of the health team. They must be made to realize that they are a part of the health team.

Attitude to Health↗

PubMed2004

Biotechnology to improve health in developing countries -- a review.

The growing health disparities between the developing and the developed world call for urgent action from the scientific community. Science and technology have in the past played a vital role in improving public health. Today, with the tremendous potential of genomics and other advances in the life sciences, the contribution of science to improve public health and reduce global health disparities is more pertinent than ever before. Yet the benefits of modern medicine still have not reached millions of people in developing countries. It is crucial to recognize that science and technology can be used very effectively in partnership with public health practices in developing countries and can enhance their efficacy. The fight to improve global health needs, in addition to effective public health measures, requires rapid and efficient diagnostic tools; new vaccines and drugs, efficient delivery methods and novel approaches to therapeutics; and low-cost restoration of water, soil and other natural resources. In 2002, the University of Toronto published a report on the "Top 10 Biotechnologies for Improving Health in Developing Countries". Here we review these new and emerging biotechnologies and explore how they can be used to support the goals of developing countries in improving health.

Biotechnology↗

PubMed2004

Potent analgesics are more expensive for patients in developing countries: a comparative study.

Opioids are some of the most important analgesic medications for the management of both moderate to severe pain and several are included on the World Health organization (WHO) list of essential drugs. Opioid costs in developing countries have been reported to be higher than those in developed nations. This study documents retail prices and availability of several potent opioids in a number of developing and developed countries. Pain and Palliative Care specialists currently working in their countries were asked to collect data on the retail cost of a 30 day supply of 15 different opioid preparations in 5 developing and 7 developed countries. Data were analyzed to compare costs and costs as a percentage of gross national product (GNP) per capita per month. Opioid costs and availability varied widely in both developing and developed countries. Forty five of 75 opioid preparations were available in developing countries (40% of medications studied were not available) and 76 of 105 preparations were available in the developed countries (28% not available). In US dollars, the median cost of opioids differed between developed and developing countries ($53 and $112 respectively) The median costs of all opioid preparations as a percentage of GNP per capita per month were 36% for developing and 3% for developed nations; the difference was statistically significant (p < 0.001). In developing countries 23 of 45 (51%) of opioid dosage forms cost more than 30% of the monthly GNP per capita, versus only three of 76 (4%) in developed countries. The relative cost of opioids to income is higher in developing countries. Our data suggest that in developing countries opioid access for the majority of patients is likely to be limited by cost, and development of palliative care programs will require heavy or total subsidization of opioid costs.

Analgesics, Opioid↗

PubMed2005

[Helicobacter pylori infection in children of developing countries].

A characteristic feature of Helicobacterpylori infection in developing countries is early acquisition of the bacteria during childhood. Recent study has documented the frequency of transient infection in young children in particular during the first year following eradication therapy. Children living in developing countries present several risk factors for acquisition including crowding, young age, and recurrent gastroenteritis. The risk of infection increases significantly in function of the number of infected persons in a child's family. Using molecular biology techniques based on gene sequencing, we have shown that strains in different members of the same family were identical not only between parents and children but also between siblings. The relationship between chronic diarrhoea, retarded growth, iron-deficient anaemia, and Helicobacter pylori infection in children especially from developing countries remains controversial. Gram staining of biopsy smears to detect Helicobacter pylori is an efficient diagnostic method and can be a good alternative when culture is unfeasible. Respiratory testing and detection of antigens in stools are effective and appear to be well suited to diagnosis of Helicobacter pylori infection. In developing countries Helicobacter pylori is a common infectious agent warranting further study to gain insight into clinical presentation, epidemiological features, and treatment requirements including sensitivity to antibiotics

Adolescent↗

PubMed1995

Otitis media in developing countries.

OBJECTIVE: This article reviews the available information concerning the disease burden, epidemiology, and etiology of otitis media in developing countries and the likelihood that case management with appropriate antibiotic therapy can reduce the burden of this disease. METHODOLOGY: The available literature was reviewed to determine the extent to which otitis media impacts mortality and morbidity in developing countries. EPIDEMIOLOGY: In community studies, perforation was present in 0.4% to 33.3% of children and youth; otorrhea occurred in 0.4% to 6.1%; and mastoiditis occurred in 0.19% to 0.74%. In school surveys, perforation was identified in 1.3% to 6.24% of students, and otorrhea was found in 0.6% to 4.4%. Mastoiditis was diagnosed in 18% of children and youth who presented to a hospital ear, nose, and throat (ENT) clinic in Uganda. The proportion of patients presenting to ENT clinics with mastoiditis regardless of their initial symptoms varied from 1.7% to 5%. Patients presenting to these ENT clinics with mastoiditis often experience severe complications, including subperiosteal abscess, labyrinthitis, facial palsy, meningitis, and brain abscess. Hearing impairment was a major public health problem compromising the quality of life in approximately one third of the population of developing countries. ETIOLOGY: The pathogens isolated from ear aspirates in children with acute otitis media and chronic suppurative otitis (CSOM) carried out in developing countries are similar to those isolated in studies carried out in developed countries. CASE MANAGEMENT: Historical data supports the effectiveness of antibiotic therapy in reducing the frequencies of mastoiditis and CSOM complicating acute otitis media. In addition, the introduction of primary care services targeted at otitis media for high-risk populations living in developed countries may have reduced the prevalence of mastoiditis and CSOM. However, it is not clear whether there is a causal relationship between these programs and the reduction because of the use of historical controls. CONCLUSIONS: International research organizations should support controlled intervention studies to document the impact of case management of otitis in developing countries. In addition, the efficacy of a conjugated pneumococcal vaccine to prevent otitis and its complications should be evaluated in a developing country site. Pending the results of studies, developing countries should develop primary care case management programs to diagnose and treat otitis and its associated complications.

Acute Disease↗

PubMed2003

Strategy to improve road safety in developing countries.

OBJECTIVE: To review the road safety situation in developed and developing countries compared with the Arabian Gulf countries and suggest a strategy to improve it. The role of road engineers in reducing accidents is highlighted. METHODS: This is a retrospective study of road traffic accidents (RTAS) for a period from 1988 to 1998 in Arabian Gulf Countries. The data was taken from the Directorate of Traffic and Ministry of Health records in Gulf Countries. Additional data was obtained from other sources including the World Health Organizations Statistics Annuals, International Road Federation, Transport Road Research Laboratory and accident facts publications. Overall fatality and injury rates of RTAs were calculated. RESULTS: The lack of reliable data is a serious problem in most of the developing countries. It is quite reasonable to assume that the incidence of accidents is much larger than actually reported. A comparison of vehicle ownership levels and safety parameters in both developed and developing countries is presented to highlight the relative seriousness of the road safety situation in different countries. The fatality rates (per population and per vehicles) are selected for comparison purposes from developed and developing countries. CONCLUSION: Road traffic accidents continue to be a major cause of mortality and morbidity in the Arabian Gulf Countries leading to substantial wastage of life and national resources. Further investigation is essential and will require close inter-sectoral collaboration between, traffic police, health, law, and transport authorities. Developing a research strategy for prevention will reduce casualties and death on the road.

Accidents, Traffic↗

PubMed1984

[Hemoglobinopathies in developing countries].

The most important haemoglobinopathies in developing countries are reviewed in the light of new results elicited with modern research approaches. It has been shown that the sickle mutation originating in a localized region in West Africa arose independently of the mutation in East Africa and Asia. The frequency of alpha-thalassaemia has been underestimated in mediterranean and African countries. The inherited resistance to Plasmodium falciparum in the sickle cell disorders and thalassaemia has been elucidated to a large extent. The heterogeneity of alpha- and beta-thalassaemia has been investigated at the molecular level of the globin genes. Clinical management with repeated blood transfusions and regular iron chelation has markedly improved life expectation of the patient with thalassaemia major. Screening and educational programmes on a large scale in combination with facilities for genetic counselling, prenatal diagnosis and therapeutic abortion have already reduced the incidence of serious haemoglobinopathies in several developed countries. However, these methods will not be available for the population of developing areas until these countries reach a generally higher level, both economically and socially.

Africa↗

PubMed2006

Cost of tracheoesophageal prostheses in developing countries. Facing the problem from an internal perspective.

CONCLUSIONS: All the discussants of our questionnaire agreed that the price of tracheoesophageal (TE) prostheses was too expensive for developing countries. The problem could be addressed in terms of international laws regarding companies' patent rights. TE prosthesis manufacturers from rich countries could move their manufacturing in part to developing countries. High production standards could allow TE prostheses to be exported to developed countries. Another approach to the problem may be based on a partnership between non-profit-making Western laryngological societies with specific medical and technical prosthetic know-how and local manufacturers. The aim of this cooperation could be the low-cost production of advanced TE prostheses in the developing countries. OBJECTIVES: In communities in the developing world, most laryngeal and hypopharyngeal carcinomas are diagnosed at advanced stages and require total laryngectomy. Prosthetic TE voice restoration is the method of choice for voice rehabilitation after total laryngectomy in developed countries. Unacceptably high costs are a significant limitation to Third World use of TE voice prostheses. The aims of this paper are to discuss the consequences of the high costs of TE prostheses in developing countries with head and neck surgeons working in Third World hospitals and to propose how European and American laryngological societies can promote TE speech in the developing countries. MATERIAL AND METHODS: A questionnaire was given to a group of expert head and neck surgeons working in developing countries and their answers and suggestions discussed.

Costs and Cost Analysis↗

PubMed2004

Regionalized perinatal care in developing countries.

Neonatal-perinatal ill health and mortality are overwhelmingly a burden of the developing world. As many as 90% of births, 98% of fetal deaths and 98% of neonatal deaths occur in less developed countries. Regionalized perinatal services were introduced in developed countries when most neonatal mortality was confined to very-low-birthweight babies who required intensive perinatal care to survive. A large proportion of newborn morbidity and mortality in developing countries, however, continues to occur among full-term and moderate-sized low-birthweight neonates who can be managed well in the community and at small hospitals. The model of regionalized perinatal care as practiced in developed countries is, at present, neither affordable nor relevant to the needs of many developing countries. It is possible to achieve considerably lower neonatal mortality rates in resource-poor settings by implementing home-based newborn care delivered by community health workers, and by promoting institutional perinatal care at simple facilities provided by trained midwives.

Developing Countries↗

PubMed1998

Exporting hazards to developing countries.

The health of people in developing countries is threatened by the importation of hazardous products, wastes and industrial processes from the developed world. Combating this menace is a facet of environmental protection and management of the planet's resources.

Commerce↗

PubMed2002

Communication in health care delivery in developing countries: which way out?

Most governments in developing countries have adopted frameworks for health development which stressed community based initiatives and intervention at all levels of the health pyramid (WHO, 1992). But even today, most of the rural communities in these countries are still not developed in terms of available health facilities. What then is/are responsible for these failures? Various authors have come up with various reasons, principal amongst which are inadequate resources, lack of planning, insincerity/non-commitment of the governments, lack of modern information technology, etc. This paper examines some of these factors in relation to how they accentuate or hamper healthcare delivery in developing countries, using African rural communities as a study field. The resultant suggestions are a consortium of varying factors, some of which are economic in nature, policy changes, human resources development, and re-orientation of social and government attitudes towards achieving meaningful results in healthcare delivery, particularly in the rural communities.

Africa↗

PubMed2003

Recommendations for cervical cancer screening programs in developing countries. The need for equity and technological development.

The cervical cancer screening programs (CCSP) have not been very efficient in the developing countries. This explains the need to foster changes on policies, standards, quality control mechanisms, evaluation and integration of new screening alternatives considered as low and high cost, as well as to regulate colposcopy practices and the foundation of HPV laboratories. Cervical cancer (CC) is a disease most frequently found in poverty-stricken communities and reflecting a problem of equity at both levels gender and regional, and this, is not only due to social and economic development inequalities, but to the infrastructure and human resources necessary for primary care. For this reason, the CCSP program must be restructured, a) to primarily address unprivileged rural and urban areas; b) to foster actions aimed at ensuring extensive coverage as well as a similar quality of that coverage in every region; c) to use screening strategies in keeping with the availability of health care services. In countries with a great regional heterogeneity, a variety of screening procedures must be regulated and standardized, including a combination of assisted visual inspection, cervical cytology and HPV detection; d) regional community intervention must be set up to assess the effectiveness of using HPV detection as an strategy in addition to cervical cytology (pap smear); e) the practice of colposcopy must be regulated to prevent the use of it in healthy women at a population level, thus preventing unnecessary diagnosis and treatment which not only are expensive but also causes unnecessary anxiety to women at risk; f) the operation of those clinical laboratories using HPV as a detection strategy must likewise be accredited and regulated and g) the CCSP program for assuring health care quality should meet the expectations of its beneficiaries, and increase the knowledge in cervical cancer related matters. Finally, though a variety of clinical tests on prophylactic and therapeutic vaccines against HPV are recently being developed worldwide; it will take at least from 5 to 10-years time to have them available in the market. For this reason, it will be necessary to intensify the CCSP programs. All these reasons lay emphasis on the need to reinforce actions for CCSP programs. This paper is available too at: http://www.insp.mx/salud/index.html.

Developing Countries↗

PubMed2005

Financial requirements of immunisation programmes in developing countries: a 2004-2014 perspective.

Vaccines are a key contributor to public health, especially in developing countries. Despite numerous demonstrations of the cost-effectiveness of immunisation, vaccines spending accounted for only 1.7% of the total pharmaceutical market in 2002, when UNICEF estimated that 34 million children were not reached by routine immunisation, most of them in developing countries. Several international organizations or initiatives, like the Global Alliance for Vaccines and Immunisation (GAVI), have defined a long-term goal of universal immunisation in developing countries. There is an urgent need to estimate the financial resources required to meet this goal. The objective of this study was to anticipate the funding needs for childhood immunisation in developing countries over the 2004-2014 period. The study scope includes all the 75 countries eligible for support from GAVI, and covers existing vaccines that are considered as a priority for GAVI (DTP (diphtheria, tetanus, pertussis), hepatitis B, Haemophilus influenzae type b (as a stand alone presentation or in combination with DTP) and yellow fever) as well as future vaccines (meningitis A and C, rotavirus, human papilloma virus (HPV), malaria, Streptococcus pneumoniae and tuberculosis) likely to be available within the 10-year period. We developed a methodology to estimate the number of doses required, based on disease prevalence and incidence, target populations, introduction dates of new vaccines, coverage dynamics and dosing regimen. The introduction price and price evolution of vaccines over time were modelled, taking into account the type of vaccine, the expected return on investment from vaccine manufacturers and the competitive landscape. Non-vaccine costs (capital costs and non-vaccine recurrent costs) were estimated based on the number of people immunised and number of doses dispensed, using available case studies as a reference. According to the optimal scenario that would consider the provision of all vaccines to all relevant developing countries as soon as they are available, funding requirements to cover the associated total costs over the 10-year period were estimated to be about US$ 30 billion. Vaccines-related costs represent the largest share, with estimated costs of US$ 21 billion (among which 18 billion for new vaccines), the remaining needs being split between capital costs and other recurrent costs. Accounting for the main imponderables (such as delay in vaccines launch compared to industry plans) as well as probable phasing of vaccine introduction in countries, the total costs of immunisation would be reduced to US$ 14-17 billion over the same period. Vaccines-related costs represent the largest share (US$ 7.1-9.3 billion, among which 4.3-6.5 billion for new vaccines). This study advocates for the anticipation of the substantial financial resources needed to (a) purchase and introduce these vaccines in the developing countries in order to reduce the time lag between availability in industrialised and developing countries; and (b) stimulate vaccine researchers and manufacturers to continue research and development of much needed vaccines for the developing world.

Costs and Cost Analysis↗

PubMed2004

Research in family medicine in developing countries.

The output of family medicine research in developing countries varies vastly from country to country and also within countries. Most research originates from academic departments of family medicine or from collaborative initiatives with researchers in developed countries. There is generally a paucity of researchers, resources, and expertise. Many factors affecting the research output in primary care internationally applies in developing countries, but there are also factors that are unique to these countries. Solutions require financial resources and international goodwill. Wonca could play a major role in enhancing research in family medicine in the developing world.

Biomedical Research↗