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PubMed2004

PneumoADIP: an example of translational research to accelerate pneumococcal vaccination in developing countries.

Historically, the introduction of new vaccines in developing countries has been delayed due to lack of a coordinated effort to address both demand and supply issues. The introduction of vaccines in developing countries has been plagued by a vicious cycle of uncertain demand leading to limited supply, which keeps prices relatively high and, in turn, further increases the uncertainty of demand. The Pneumococcal Vaccines Accelerated Development and Introduction Plan (PneumoADIP) is an innovative approach designed to overcome this vicious cycle and to help assure an affordable, sustainable supply of new pneumococcal vaccines for developing countries. Translational research will play an important role in achieving the goals of PneumoADIP by establishing the burden of pneumococcal disease and the value of pneumococcal vaccines at global and country levels. If successful, PneumoADIP will reduce the uncertainty of demand, allow appropriate planning of supply, and achieve adequate and affordable availability of product for the introduction of pneumococcal vaccines. This model may provide a useful example and valuable lessons for how a successful public-private partnership can improve global health.

Developing Countries↗

PubMed1987

General practice research from developing countries: health or medicine?

At the 11th WONCA conference in June 1986 13% of the first authors of presentations came from developing countries. Presentations from or about developing countries were analysed in an attempt to compare the external resources with those in industrial countries, and to find out how primary care physicians in the developing countries see themselves, their work and the health care system. Solo works were presented equally often from authors in industrial and developing countries, but groups from industrial countries were more often multidisciplinary and larger. Most studies from developing countries were done in urban surroundings. Half of the presentations studied material from primary health care, while 44% were oriented more narrowly toward medical care. Most of the techniques described were suitable for primary care. Teamwork and intersectoral collaboration were discussed in half of the studies coming from primary health care, while traditional medicine was mentioned only occasionally.

Developing Countries↗

PubMed1998

Hormone replacement therapy in the developing countries.

The sales data of oestrogen replacement products for 8 developing countries from 1993 to 1995 were analyzed. The data from Malaysia, Pakistan, Taiwan, Thailand, Indonesia, Philippines and South Korea showed the increasing use of oestrogen replacement products. The total usage however varied widely, from only US$11,153 (Philippines in 1993) to as much as US$6,306,717 (Taiwan in 1995). In Singapore, where oestrogen replacement is an accepted and established form of therapy for the postmenopausal woman, there has been an increase in the usage of the nonoestrogen replacement products. There are multiple reasons for the increasing sales of hormone replacement products in the developing countries and these are explored in this article. In some of the developing countries, for example China and India, hormone replacement therapy has just been introduced. However, in those developing countries in which hormone replacement therapy is already available, sales figures show increasing usage. The future augurs well for hormone replacement therapy.

Adult↗

PubMed1984

The optimization of nuclear medicine procedures for the diagnosis and management of thyroid disorders in developing countries.

Thyroid disease is common in developing countries and its management is based on the measurement of thyroid function and the investigation of thyroid masses. This report discusses techniques and outlines a strategy for the measurement of thyroid function using radioimmunoassays of thyroid-related hormones in the blood. It makes proposals for the evaluation of thyroid morphology using echography, pertechnetate imaging and fine needle biopsy. Note is taken of the difficulties facing laboratories in developing countries and the International Atomic Energy Agency is concerned with the practical assessment of these recommendations and of any alternative proposals in this field.

Biopsy↗

PubMed2006

[The effectiveness of mental health care in developing countries. Intervention and policy options at several levels].

BACKGROUND: In developing countries psychiatric disorders are a major cause of disability and reduced economic productivity. AIM: To present an overview of intervention and policy options in mental health care in developing countries. METHOD: We searched the literature using PubMed, supplementing our finding with what we have learned from experience in the field. RESULTS: Research data, though very limited, indicate that psychiatric disorders can be treated effectively in developing countries. Mental health care can be provided at three different levels: at the level of the existing health care system, at primary care level and at community level. We discuss interventions at each of these levels on the basis of three cases. CONCLUSION: More research is needed into the efficacy and cost-effectiveness of mental health care interventions in developing countries; research must be accompanied by the actual implementation of mental health programmes in these countries.

Community Mental Health Services↗

PubMed2004

Rare facial clefts: treatment during charity missions in developing countries.

During 10 charity missions in developing countries, 14 patients of a total of 374 children with cleft lip and palate deformities were treated for rare facial clefts. There were three midline clefts (Tessier no. 0 cleft, n = 1; Tessier no. 14 cleft, n = 2), four oblique facial clefts (Tessier no. 3 cleft, n = 2; Tessier no. 5 cleft, n = 2), and seven lateral facial clefts (Tessier no. 7 cleft). Surgical treatment focused on cleft repair by soft-tissue reconstruction apart from two Tessier no. 14 clefts, in which the bony gap was also closed using bone grafts from the iliac crest. The postoperative course was uneventful except for one local wound infection that was treated successfully using oral antibiotics. This article summarizes the authors' experience with the surgical management of these malformations and considers the limitations under conditions of charity missions in developing countries. Furthermore, some rare forms of cleft formation are added to the existing literature.

Charities↗

PubMed2002

Is mental health economics important in geriatric psychiatry in developing countries?

BACKGROUND: limited healthcare budgets and a seamless demand for resources suggests that a formula for allocating resources is needed. Economic evaluation can assist in developing this formula. METHOD: mental health economic studies (cost minimisation, cost-effectiveness, cost-utility, cost-benefit and cost of illness analysis) in geriatric psychiatry from developed and developed countries were examined along with all mental health economic studies in developed countries. RESULTS: there were no health economic studies in geriatric psychiatry from developing countries against a background of many such studies in developed countries. There were a greater number of health economic studies in other areas of psychiatry in developing countries. Several reasons for the paucity of such studies, the feasibility of undertaking these studies and their significance are discussed. CONCLUSION: mental health economic studies in geriatric psychiatry in developing countries are feasible, realistic and may well have an important part to play in the allocation of resources. Also, data sets necessary for such studies are emerging from many developing countries.

Cost-Benefit Analysis↗

PubMed2006

Biomechanical and surface physico-chemical analyses of used osteosynthesis plates and screws--potential for reuse in developing countries?

Reprocessing of single-use devices is an upcoming issue in the Western world, but has been for many years in developing countries. In developing countries, the number of bone fractures due to traffic or industrial accidents is high. Patients often need an osteosynthesis with plates and screws, but most patients, however, cannot afford this because of the costs involved and have to rely on the application of used plates and screws. This study aims to determine whether used plates can be safely reused in another patient from a biomechanical, surface physico-chemical, and biological point-of-view. Osteosynthesis plates weakened in a predictable way during use, regardless of the history, presumably because tests were conducted under extreme conditions in the absence of clinically applied load-sharing between bone and plate. Surface physico-chemical analyses indicated that used plates and screws were more hydrophilic than new ones; had increased amounts of calcium-phosphates at their surfaces; and possessed higher number of scratches. Pitting corrosion could be seen on SEM micrographs. Simple cleaning methods, as available in developing countries, including toothbrush, water, detergent and bleach yielded elemental surface compositions, and hydrophobicities similar to those of new ones, while biologically thus cleaned screws were not cytotoxic according to ISO-10993-5 and endotoxin release according to USP-27-NF-22 was within the requirements of the FDA. It is concluded that the reuse of osteosynthesis plates and screws is not necessarily unsafe, although preferably a register should be kept of all previous users to limit the number of reuses as mechanical weakening does occur.

Adolescent↗

PubMed2001

Enhanced efficiency of female-to-male HIV transmission in core groups in developing countries: the need to target men.

BACKGROUND: The spread of heterosexual HIV in developing countries is heterogeneous. Factors that explain the wide diversity of HIV prevalences in different countries are undetermined. International aid organizations currently appear to be focusing activities mainly on women rather than on men. GOAL: To identify critical determinants contributing to the high rates of heterosexual HIV transmission in developing countries through a review of studies investigating HIV per-act transmission rates, and to discuss how these factors might be prioritized through HIV-prevention interventions. STUDY DESIGN: Studies investigating the per-act HIV transmission rate were identified through a MEDLINE search and a review of the abstracts of the Annual International AIDS Conferences. RESULTS: When the summary mean per-act HIV transmission rates were calculated, the ratio of female-to-male HIV transmission in developing countries compared with that in the developed world was 341, whereas that for male-to-female transmission was 2.9. CONCLUSION: Enhanced female-to-male HIV transmission in male core groups is a critical determinant of high-prevalence HIV epidemics among heterosexuals in developing countries. In addition to condom promotion, there is a need for an increased emphasis on HIV-prevention activities in men to decrease their susceptibility in developing countries, particularly in the countries most affected by the epidemic.

Condoms↗

PubMed1988

Epilepsy in developing countries: a review of epidemiological, sociocultural, and treatment aspects.

In this report, aspects of epilepsy that differ in developing and in developed countries are reviewed. This is inevitably an incomplete and impressionistic survey, because data on many aspects in developing countries are scarce, and because it is difficult to generalise meaningfully about the enormous diversity of countries and populations that make up the developing world. Epidemiological studies of prevalence and incidence are reviewed with an emphasis on the problems inherent in work in this area in developing countries. Data concerning seizure type, aetiology, and severity of seizures in the Third World are contrasted with those from developed countries. Sociocultural aspects of epilepsy have been poorly studied, and yet are fundamental to effective medical management. The social effects of epilepsy and the local perceptions of cause and of treatment are discussed from work in Africa, Asia, and South America. The principles and success of treatment in the Third World may differ considerably in developing and developed countries. In the Third World, medical manpower is scarce, and epilepsy is managed essentially by primary care resources, without specialised investigations or personnel. The principles of drug therapy may not be understood by patients, and the supply of drugs is often erratic; and these are major reasons for poor compliance with treatment. World Health Organisation (WHO) initiatives have stressed the extensive use of paramedical personnel and of an essential drugs list, but this emphasis may be misdirected, and in practice neither proposal has achieved much success. The recommendation that phenobarbital be extensively used in the Third World, because of its cheapness and efficacy, is also of doubtful merit, as there are well-known and major drawbacks to the widespread use of this drug. Computations of treatment gap figures in three developing countries suggest that between 80-94% of patients with active epilepsy are not receiving anticonvulsant therapy, and cost is only one of a number of reasons for this. The key to improvements in medical treatment lie with a better understanding of the patients' cultural concepts of epilepsy and its treatment, improved drug supply and availability, and efforts to improve education amongst general practitioners and other primary care medical personnel.

Anticonvulsants↗

PubMed2004

Application of ICT in strengthening health information systems in developing countries in the wake of globalisation.

Information Communication Technology (ICT) revolution brought opportunities and challenges to developing countries in their efforts to strengthen the Health Management Information Systems (HMIS). In the wake of globalisation, developing countries have no choice but to take advantage of the opportunities and face the challenges. The last decades saw developing countries taking action to strengthen and modernise their HMIS using the existing ICT. Due to poor economic and communication infrastructure, the process has been limited to national and provincial/region levels leaving behind majority of health workers living in remote/rural areas. Even those with access do not get maximum benefit from ICT advancements due to inadequacies in data quality and lack of data utilisation. Therefore, developing countries need to make deliberate efforts to address constraints threatening to increase technology gap between urban minority and rural majority by setting up favourable policies and appropriate strategies. Concurrently, strategies to improve data quality and utilisation should be instituted to ensure that HMIS has positive impact on people's health. Potential strength from private sector and opportunities for sharing experiences among developing countries should be utilised. Short of this, advancement in ICT will continue to marginalise health workers in developing countries especially those living in remote areas.

Computer Communication Networks↗

PubMed2006

Sanitary and phytosanitary measures and food safety: challenges and opportunities for developing countries.

Because of fast-growing demand, export markets can absorb high value added products and offer high returns; for many developing countries export market development is thus a key requirement for rural income generation and rural growth. Although developing countries face increasingly strict sanitary and phytosanitary standards in their export markets, they can maintain and improve market access--and improve domestic food safety and agricultural productivity--by adopting a strategic approach to food safety, agricultural health and trade. High-income countries should increase development flows to help developing countries build the capacity to plan and execute the necessary strategies. The first proposal in this paper is to make two existing sets of guidelines widely available to interested parties, in particular through the World Bank and the World Organisation for Animal Health (OIE). The first covers the broad process of problem assessment, strategy development and action plan formulation; the second set deals with institutional analysis and training of staff of the official sanitary control services. The second proposal is that interested countries and donors should speed up the ongoing development of guidelines, computer software tools and training material to help countries quantify the importance and impact of food safety issues. The focus here is on a 'multipurpose agricultural data analysis and modelization system'. The third proposal is to carry out a case study to help demonstrate that a number of animal health issues related to food safety should be treated as relating to 'global public goods' and thus require intervention on a global scale. Possible candidates are foot and mouth disease and highly pathogenic avian influenza.

Agriculture↗

PubMed1988

Hypertension in developing countries.

Population surveys carried out since the 1970s in 15 developing countries including 23 population groups show that the prevalence of hypertension ranges from as low as 1% in some African countries to over 30% in Brazil. A trend analysis of the mortality statistics for 35-74 year-olds from 16 countries in which data are available shows a downward trend in mortality from hypertension and cerebrovascular diseases in most of these countries. In spite of the current low prevalence in some countries, the total number of hypertensives in the developing world is high, and a cost assessment of possible antihypertensive drug treatment indicates that developing countries cannot afford the same drug treatment levels as developed countries.

Adult↗

PubMed2005

Clarifying efficiency-equity tradeoffs through explicit criteria, with a focus on developing countries.

Expenditures on health in many developing countries are being disproportionately spent on health services that have a low overall health impact, and that disproportionately benefit the rich. Without explicit consideration of priority setting, this situation is likely to remain unchanged: resource allocation is too often dictated by historical patterns, and maintains vested interests. This paper explores how prioritization between different health interventions can be rationalised by the use of clearly defined criteria. A number of key efficiency and equity criteria are examined, in particular analysing how potential tradeoffs could be incorporated into the decision making process.

Cost-Benefit Analysis↗

PubMed2005

Expanding hemophilia care in developing countries.

The World Federation of Haemophilia (WFH) estimates that worldwide, approximately 70% of patients with hemophilia are underdiagnosed and untreated. Most live in developing countries. Although in developed countries the life expectancy of hemophiliacs is close to that of healthy persons, this is not the case in developing countries. Great disparity also exists in the treatment of hemophiliacs, especially when this relates to available factor concentrates. There are many reasons for the inadequate care of hemophilic patients: the perception of rarity of the disease; lack of laboratory facilities to diagnose the disorder; lack of understanding of the disorder by patients, their relatives, and even healthcare providers; poorly developed blood bank facilities; and lack of adequate factor supply are just some examples. The WFH attempts to address many of these issues by establishing hemophilia care programs and by educating and training healthcare practitioners so that a healthcare team can be organized that attempts to ameliorate these problems and provides treatment options. In the last few years, a considerable number of developing countries have been organized to deliver at least a minimum of care, and attempts have been made to obtain support from appropriate governmental sources.

Delivery of Health Care↗

PubMed2006

Primary prevention of type-2 diabetes in developing countries.

Although diabetes is now a worldwide epidemic, the rate of increase in its prevalence in developing countries is alarming. By the year 2025, more than three-quarters of all persons with diabetes will reside in developing countries. India and China are leading this surge in diabetes, and sub-Saharan Africa is currently at a lower prevalence rate. However, the estimated increase is substantial among African descendants in the Americas, West Indies and throughout the diaspora. There are compelling reasons why aggressive efforts must be directed toward primary prevention of diabetes in developing countries. Once diabetes develops, the cost of caring for patients is prohibitive. Poorly managed diabetes leads to several complications (e.g., end-stage renal failure, blindness, amputation and heart disease) that many developing countries are ill equipped to tackle. In landmark trials, lifestyle modification approaches are more efficacious than expensive medications in the prevention of diabetes. This is fortunate because lifestyle modification can be implemented locally, whereas medications often need to be imported at high cost. The first task is the education of policymakers on the urgent need for timely action to prevent the looming epidemic of diabetes. Once governments become convinced of its critical value, the translation of diabetes prevention through dietary modification and increased physical activity would require careful planning, extensive piloting and creativity in the allocation of scant resources. External support, foreign aid, debt forgiveness and other forms of creative financing will almost certainly be needed to implement widespread diabetes prevention programs in developing countries.

Developing Countries↗

PubMed1998

Hospital based survey of lung cancer in Turkey, a developing country, where smoking is highly prevalent.

While the trend of cigarette consumption in some developed countries is on the decline, it has been noted that in many developing countries, smoking is on the increase. Compared to developed countries, there are more male smokers than female smokers in these countries. The aim of this study was to investigate the prevalence and characteristics of the smoking habit in patients having lung cancer (LC) and to find out if there is any relationship with the smoking habit and the pathological diagnosis in our patient population. This hospital-based study was carried out between 1990 and 1996 in two major medical centres. LC was diagnosed in 1046 patients, 966 of whom were males (93%), and the remaining 80 (7%) of whom were females. Upon diagnosing the male patients, it was noted that 83% were current smokers (CS), 12% were ex-smokers (ES defined as abstinence from smoking at least for 1 year), and the remaining 5% were non-smokers (NS). In the female population the findings were as follows, 16% were CS; 8% were ES, and 76% were NS. The period of abstinence in the ES was 10 years or less in 77% of the patients. Among the male patients, squamous cell carcinoma was the most common tumor type seen in the CS group (46%) while adenocarcinoma (45%) was the most commonly seen tumor in the NS group. On the other hand, in the females, CS, the most commonly noted tumor types were small cell (54%), and adenocarcinoma (39%) was most frequently found in NS group. These results indicate that ES patients having LC in this study was quite low. On the other hand, in contrast to the findings of many other studies, from developed countries, the majority of male LC patients were in the CS group, however the majority of female LC patients were in the NS group. This smoking habit data obtained from our LC patients suggests that, similar to underdeveloped or developing countries, smoking cessation rates are very low in men during the past decade, and interestingly smoking rates may increase in women in the near future in our country.

Aged↗

PubMed2005

Pharmaceutical innovation and the burden of disease in developing and developed countries.

I perform two analyses of the relationship across diseases between pharmaceutical innovation and the burden of disease in developed and developing countries. Both analyses indicate that the amount of pharmaceutical innovation is positively related to the burden of disease in developed countries but not to the burden of disease in developing countries. The most plausible explanation for the lack of a relationship between the burden of disease in developing countries and the amount of pharmaceutical innovation is that incentives for firms to develop medicines for diseases primarily afflicting people in developing countries have been weak or nonexistent.

Developed Countries↗