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PubMed2006

Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries.

BACKGROUND: Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries. The WHO estimates that one in eight pregnancy-related deaths result from unsafe abortions. The social stigma and legal restrictions associated with abortion in many countries means that data on the magnitude of this problem are scarce; this article estimates the rate and numbers of hospital admissions resulting from unsafe abortions in developing countries to help quantify the problem. METHODS: National estimates of abortion-related hospital admissions in women aged 15-44 years were compiled for 13 developing countries: Africa (Egypt, Nigeria, and Uganda), Asia (Bangladesh, Pakistan, and the Philippines), and Latin America and the Caribbean (Brazil, Chile, Colombia, Dominican Republic, Guatemala, Mexico, and Peru). These data were combined with supplementary data from five countries in sub-Saharan Africa (Burkina Faso, Ghana, Kenya, Nigeria, and South Africa) to give estimates for the three world regions. FINDINGS: The annual hospitalisation rate varies from a low of about 3 per 1000 women in Bangladesh to a high of about 15 per 1000 in Egypt and Uganda. Nigeria, Pakistan, and the Philippines have rates of 4-7 per 1000, and two countries in Latin America with recent data have rates of almost 9 per 1000. In the developing world as a whole, an estimated five million women are admitted to hospital for treatment of complications from induced abortions each year. This equates to an average rate of 5.7 per 1000 women per year in all developing regions, excluding China. By comparison, in developed countries complications from abortion procedures or hospitalisation are rare. INTERPRETATION: These results help quantify the magnitude of the adverse health effects of unsafe abortion in developing countries and highlight the need for improved access to post-abortion care. The provision of abortion services is changing to include the drug misoprostol and this could reduce the severity of abortion complications and the number of women who are hospitalised. Researchers will need to monitor these changes to provide countries with up-to-date information on illness and death from unsafe abortion. Improved contraceptive services are necessary to prevent unintended pregnancy. However, increasing access to safe abortion services is the most effective way of preventing the burden of unsafe abortion, and remains a high priority for developing countries.

Abortion, Illegal↗

PubMed2006

Technology transfer of Sabin-IPV to new developing country markets.

The Netherlands Vaccine Institute (NVI) developed the micro-carrier technology for large-scale production of IPV in the late 1960s and has used this technology successfully to produce IPV as well as DTP-IPV for the national immunization program in the Netherlands. As a public sector organization, and as one of the Millennium Development Goals, NVI has supported over the years access to vaccine technology like DTP and Hib for vaccine manufacturers in developing countries. In line with this role as a resource institute, NVI has recently been approached by a number of vaccine manufacturers, predominantly from developing countries, for transfer of IPV technology to meet the anticipated increase in demand for IPV following OPV cessation. Since WHO encourages new manufacturers to use the attenuated Sabin virus instead of wild polio strains in the production of IPV, NVI decided to respond positively to this WHO policy. The existing NVI experience in large-scale production of IPV and OPV using Vero cell based micro-carrier technology and its experience with experimental Sabin-IPV is an attractive start for the development of Sabin-IPV. This paper discusses the approach followed and the experience already gained in the project, as well as factors critical to its success.

Animals↗

PubMed1993

The use of quinolones in developing countries.

The size of the antibiotic market in developing countries is double that seen in developed countries. There are some valid reasons for this difference, one of which is the higher frequency of diverse infections in the developing world. However, other factors are involved: for example, antibiotics are available without prescription, package insert information is poor, and there is no national antibiotic usage programme, all of which encourage inappropriate antibacterial use. When an antibiotic becomes widely prescribed by physicians, this is interpreted by the general public as meaning that the antibiotic is useful for all types of infections and the process of automedication begins. The newer quinolones, other new antibiotics, and indeed all antimicrobials should be available only by prescription. A package insert that includes all pertinent information should be provided, and each country should implement a comprehensive national antibiotic usage programme. Only through these measures will bacterial resistance be controlled and the effectiveness of each antibiotic class be maintained.

4-Quinolones↗

PubMed2000

Distance learning--an educational tool for developing countries.

Many anaesthetists in small hospitals and developing countries have poor access to educational materials. The use of electronic means of publication and distribution, combined with the concepts of distance learning, can lead to better levels of knowledge and clinical practice. A project based on these principles has been set up in Zimbabwe, and is proving helpful to both trainers and trainees. All District Hospitals have been visited, and trainees in them identified. A survey has been completed to identify the subject areas in which training is most necessary. Trainees have been provided with reference materials on CD-ROM which they can access by computer (each hospital has a computer). Specialist anaesthesiologists in the country are producing interactive tutorials which can be sent out by e-mail to every hospital, and these are backed up by a programme of regular visits, seminars and clinical teaching. The programme is proving helpful to both trainees and tutors, and has the potential to be used in the future in other developing countries.

Anesthesiology↗

PubMed2001

Rehabilitation of the hospital infrastructure in a developing country.

Mongolia is in fact not a developing country at all but a country of transitional economy (since 1990) with a fairly comprehensive health care infrastructure. However, the health care is facing great difficulties comparable to those in a developing country. Hospital infrastructure rehabilitation was a part of a wider health sector development project with 3 remote aimags (provinces) as the target areas. The Mongolian system of health care has been built up over many years as a country-wide network of community-based feldschers and doctors, supported by a hierarchy of hospitals and mobile emergency teams. Health standards are also impacted by many factors (better housing, water supplies, better roads and rail links) outside the control of the Ministry of Health, and of health care providers. The majority of the rural hospitals lack the basic facilities. There are operating theatres without running water, hospitals with electricity only from 8 to 10 in the evening etc. The hygienic standard is unacceptable. Central heating systems do not function. Many of the facilities are underutilised and in poor condition due an ongoing lack of maintenance. The project aimed for a network that would offer services for all people, including nomadic people. The number of rural hospitals was slightly reduced and some of them were upgraded to first referral unit with basic clinical services. Approximately one third of the rural hospitals had to be rebuilt. The project recommended and started multiphased long-term master planning for those 3 aimag hospitals, all of which displayed difficulties similar to the rural hospitals.

Delivery of Health Care↗

PubMed1999

A new model for collaboration--making emergency contraceptives available in developing countries.

Private/public-sector collaboration in contraceptive research and development offers a fresh opportunity to consider a holistic approach to making emergency contraception (EC) available in developing countries. Emergency contraception has been available since the 1970s but has remained under-utilized. Emergency contraception may be used by women who want to prevent a pregnancy and therefore has a specific use, in a specific situation. This paper highlights the distinct and reciprocal advantages of a collaborative approach between the Consortium for Emergency Contraception (the public sector) and a pharmaceutical company (the private sector), to the introduction of EC in developing countries. The importance of cultivating a public/private-sector collaborative approach, which serves the interests of both parties concerned, in order to foster progress in this important initiative, is highlighted.

Contraceptive Agents, Female↗

PubMedDate not supplied

Pertussis in developing countries: definition of the problem and prospects for control.

Pertussis is a distinct clinical syndrome caused by Bordetella pertussis. The disease has been well characterized and largely controlled in the industrialized countries. Studies of pertussis in developing countries have been much more limited, in large part because of difficulty in culturing the organisms. Conventional whole-cell vaccine is being widely used in developing countries but without clear epidemiologic measures of efficacy. The introduction of new acellular pertussis vaccines has focused attention on the need to define the impact of pertussis in the developing world and to explore the optimal approach to control of this illness.

Child↗

PubMed1996

Telemedicine and developing countries.

A committee was established by the International Telecommunication Union in 1994 to study telemedicine, with particular reference to developing countries. A questionnaire was used to gather data. Fifty-eight responses were received, two-thirds from developing countries. In most developing countries the user did not pay for the telemedicine service, at least not directly. There were few instances of a commercial telemedicine service, and in most countries the telemedicine service was subsidized by the government or another party. The telemedicine 'value chain' describes how equipment suppliers, telecommunications operators and health-care professionals deliver their products or services to the client, who is eventually the ultimate user. Quite different configurations are conceivable, and an analysis of what could be a sustainable, cost-effective value chain in developing countries is required. It is clear that the rapidly growing interest in telemedicine challenges the leaders of the medical establishment to rethink the ways they provide their services and to address the medical needs of areas where such services are absent or in short supply.

Cost-Benefit Analysis↗

PubMed2002

When do developing countries adopt managed care policies and technologies? Part I: Policies, experience, and a framework of preconditions.

OBJECTIVE: For developing countries with constrained economic resources, managed care holds out the promise of being able to control healthcare costs and reduce unnecessary utilization. However, little empirical evidence has been gathered about when managed care techniques can be applied to these countries and no framework considers the macroeconomic context. We propose a straightforward method to evaluate the economic and policy environment of a developing country to assess when managed care might be introduced. STUDY DESIGN AND METHODS: Analysis of available developing country health system and healthcare spending data, review of the available literature, and authors' experience evaluating healthcare reforms in developing countries. RESULTS: Many countries have implemented managed care techniques, which are driven by policy efforts to increase quality or to control costs. Successful implementation of managed care, however, appears to depend on five major preconditions. One precondition is an adequately developed formal wage sector in which patients have a sufficient ability to pay for healthcare services. Another is an adequate labor supply of trained professionals to support managed care administration, foster competition, and use available information technology. CONCLUSIONS: Although managed care encompasses a range of incentives and arrangements, implementation in developing countries appears to depend on attaining macroeconomic preconditions.

Developing Countries↗

PubMed1994

Immunization coverage and infant mortality rate in developing countries.

We examined whether immunization coverage (IMC) is one of the predictors of infant mortality rate (IMR), as a single indicator representing the availability of primary health care (PHC) services in developing countries. Multiple regression analysis showed that partial correlation coefficients for IMR with immunization coverage (-0.224), logarithm of per capita GNP (-0.294), total fertility rate (0.269), and adult literacy rate (-0.325) were all statistically significant (p < 0.001) in 97 developing countries which make up more than 97% of the population in all the developing countries of the world. Multiple correlation coefficients of IMR with these four variables in 97 countries was 0.921. Thus, more than 80% of variation of IMR in developing countries were explained by the variation of the four variables. The study also showed that IMC was well correlated (simple correlation) with the four indicators of the availability of primary health care services; access to local care (0.730), care of pregnant women (0.603), delivery care (0.666), and infant care (0.553), all of which were statistically significant (p < 0.001) in the 48 developing countries which make up 42% of the population of all developing countries. Multiple correlation coefficients of these four variables was 0.787. About 60% of the variation of IMC will be explained by the variation of the four variables. Thus we conclude that immunization coverage is one of the main predictors of the infant mortality rate. It represents one of the health intervention components which can be used as a proxy indicator of the availability of PHC service in developing countries.

Adult↗

PubMedDate not supplied

Simple analytic procedures for rapid microcomputer-assisted cluster surveys in developing countries.

Surveys are often deemed necessary in developing countries when routine sources of data are not considered adequate to answer important policy-related questions. Although field work often goes smoothly, many surveys become bogged down in the analysis stage. With the availability of microcomputers and contemporary software, investigators in developing countries can use rapid survey methodology (RSM) to process, analyze, and report survey findings more quickly than ever before. Presented in this paper are three simple analytic procedures for planning and doing two-stage, rapid cluster surveys. All were successfully used in three rapid surveys in rural regions of Burma and Thailand. By use of a spreadsheet and graphics software package, the three procedures (a) derive the first-stage selection of 30 cluster sites with probability proportionate to size, (b) calculate variance estimates and confidence limits for the parameters of interest and graphically present the findings as 90, 95, and 99 percent confidence intervals, and (c) estimate the necessary sample size for planning two-stage, rapid cluster surveys. The procedures can be used both in the field and in teaching workshops or courses on survey methods. Examples are given from three rapid surveys conducted in Hlegu Township, Burma, and Sisaket Province, Thailand. In both countries, local health professionals were first taught the methods in a 1-week workshop before they used the procedure for conducting the rapid computer-assisted surveys.

Analysis of Variance↗

PubMed1997

The need for research on dementia in developing countries.

Dementia is one of the commonest and most disabling late-life mental disorders. Its prevalence and incidence have been assessed in developed countries, and show little geographical variation between countries and regions. Although most older people live in developing countries, little research has been carried out in those settings. There is some evidence that age-specific prevalence rates for dementia in developing countries may be relatively low. More research is needed to allow developing countries to estimate the current extent, type and cost of medical and social service provision, and to make confident predictions of future need. Research in different cultures with different levels of economic and industrial development will also increase the variance of environmental exposure, facilitating the identification of environmental risk factors and gene-environment interactions for dementia. Research methodologies need to be adapted to the different circumstances of developing countries, with implications for sampling, cognitive screening and definitive dementia diagnosis.

Dementia↗

PubMed1990

Supporting cancer care in the developing countries: role of IAEA/WHO.

Cancer management can be expensive and constitutes a major problem in many developing countries where management standards are poor due to many factors, including non-availability of sufficient funds, equipment, and trained personnel. The incidence of cancer is rising worldwide. This is more so in the developing countries, many of whom are less equipped to deal with the problems. Radiation therapy is one of the major treatment modalities for cancer, and it is estimated that about 60% of all cancer patients require this treatment at one time or another during the course of their disease. Unfortunately, radiotherapy facilities are lacking or grossly inadequate in many developing countries. Over the past 8 years the IAEA and WHO have shown more interest in the problem and treatment of cancer in the developing countries. This paper reviews the role of these international organizations, with emphasis on research activities, education (seminars, workshops, training courses), and technical assistance programs. These include establishment or upgrading of radiotherapy facilities, provision of experts, etc. Scientific papers are published with a view to disseminating current information and research findings in the developing countries. The achievements up to date are assessed and discussed.

Africa↗

PubMed2002

Options for prevention of HIV transmission from mother to child, with a focus on developing countries.

Use of antiretroviral drugs among HIV-infected pregnant women in many developed countries has significantly reduced rates of mother-to-child HIV transmission, demonstrating that this route of transmission is amenable to intervention. Prevention of transmission in developing countries has proved to be more difficult, although recent advances in short-course antiretroviral drug interventions have made it an immediate possibility, rather than a distant hope as it was seen to be in the recent past. Non-antiretroviral drug interventions, including washing of the birth canal with antiseptic solution and micronutrient supplementation, have not been found to be effective at interrupting mother-to-child HIV transmission, but may have other benefits for maternal and child health. An important issue for developing countries is prevention of postnatal HIV transmission through breast feeding. In most developing countries, formula feeding is not a reasonable option, given the higher rates of mortality from diarrheal and respiratory disease associated with avoidance of all breast feeding. A promising new line of research has recently been broached with the findings from a study in South Africa, which demonstrated that exclusive breast feeding is associated with a significant reduction in postnatal transmission of HIV.

Anti-HIV Agents↗

PubMed1994

Occupational exposures to carcinogens in developing countries.

There have been very few studies of exposure to occupational carcinogens in developing countries, and even fewer studies of the health consequences of such exposures. However, all industrial chemicals, occupations and industrial processes classified by the International Agency for Research on Cancer (IARC) as Group 1 or Group 2A (carcinogenic or possibly carcinogenic to humans) have been described in developing countries, and there is growing concern that the health impact of many chemicals used in the developing world has been underestimated. In all regions a very large workforce is employed in the construction industry, in which substantial exposure to asbestos may occur, and there has been a rapid increase in production in countries such as Brazil and India. There is, for instance, a similar pattern for tyre production with a large increase in production in developing countries in the 1980s. Thus, the number of workers in industries entailing a carcinogenic risk is increasing in developing countries, partly as a result of the transfer of hazardous industry from industrialized countries. There is much that could be achieved in the prevention of occupational cancer in developing countries, and there have been a number of successful initiatives. However, the greatest progress in the prevention of occupational cancer in developing countries is most likely to come from political and economic changes.

Carcinogens↗

PubMed2003

Influenza vaccination in 2000: recommendations and vaccine use in 50 developed and rapidly developing countries.

Influenza vaccination is becoming an increasingly important aspect of public health programs in developed and rapidly developing countries. In 2000, most of these countries had national recommendations to vaccinate elderly people and those with high-risk conditions. Levels of vaccine use, however, varied widely and several rapidly developing countries had higher levels than those seen in many developed countries. More than one-third of all influenza vaccinations occurred in countries outside North America, western Europe and Australia and New Zealand. With increasing vaccine use, all countries will be better prepared for the next pandemic. Nonetheless, those countries that use but do not produce influenza vaccine will find it difficult to obtain supplies of pandemic vaccine.

Developed Countries↗

PubMed2001

A review of the literature from developed and developing countries relating to the effects of hospitalization on children and parents.

There is a literature base about the care of children in hospital in developed nations, but little from, or about, developing countries. The aim of this review was to critically examine publications relating to the effect of hospitalization on children and their parents. 'Parents', in this context, were considered as the child's natural or adoptive parents, step-parents or any other context of parent-child relationship, in other words, the primary care-giver to the child. Most of the work reviewed from developed countries was sourced from the nursing literature, while in developing countries, the available literature was largely from medicine. Conclusions from developed countries indicated that parents should be allowed to stay in hospital with their child, and that care must be developmental-stage appropriate. Furthermore, staff need to be educated about special needs of children, children should be prepared for hospital admission (if possible) and parents' needs met. In developing countries, the meagre literature available suggested that recognition of the important role parents play in a child's hospitalization is starting to become recognized.

Adaptation, Psychological↗

PubMed1991

Disease control priorities in developing countries: health policy responses to epidemiological change.

Health systems in developing countries are facing major challenges in the 1990s and beyond because of a growing epidemiological diversity as a consequence of rapid economic development and declining fertility. The infectious and parasitic diseases of childhood must remain a priority at the same time the chronic diseases among adults are emerging as a serious problem. Health policymakers must engage in undertaking an epidemiological and economic analysis of the major disease problems, evaluating the cost-effectiveness of alternative intervention strategies; designing health care delivery systems; and, choosing what governments can do through persuasion, taxation, regulation, and provision of services. The World Bank has commissioned studies of over two dozen diseases in developing countries which have confirmed the priority of child survival interventions and revealed that interventions for many neglected and emerging adult health problems have comparable cost-effectiveness. Most developing countries lack information about most major diseases among adults, reflecting lack of national capacities in epidemiological and economic analyses, health technology assessment, and environmental monitoring and control. There is a critical need for national and international investment in capacity building and essential national health research to build the base for health policies.

Acquired Immunodeficiency Syndrome↗