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PubMed2002

Looking at the future of geriatric care in developing countries.

During the next 20 years, many less developed countries (LDC) will have age structures approaching those of the present time in more developed countries (MDC). This is occurring more rapidly in the LDC of Asia and Latin America. The future of aging populations in LDC is dependent on the degree of poverty in these countries. Poverty is a major determinant of disability and mortality in older persons. With the march of globalization, diseases in LDC are changing from infectious to noncommunicable diseases, such as diabetes. Nevertheless, infections such as tuberculosis still take a major toll on the elderly. The epidemiological transition in LDC has created a need for health care transitions from systems based on cure to ones that highlight prevention and long-term care. LDC have the opportunity to develop systems that differ from those in MDC by capitalizing on the lack of infrastructure to produce more home-based rather than institution-based long-term care systems. Involvement of the elderly in the planning of their own futures is of paramount importance. Appropriate planning now will decide the future of the elderly in LDC during the next 20 to 40 years.

Aged↗
PubMed2002

Women's perceptions of iron deficiency and anemia prevention and control in eight developing countries.

The World Health Organization estimates that 58% of pregnant women in developing countries are anemic. In spite of the fact that most ministries of health in developing countries have policies to provide pregnant women with iron in a supplement form, maternal anemia prevalence has not declined significantly where large-scale programs have been evaluated. During the period 1991-98, the MotherCare Project and its partners conducted qualitative research to determine the major barriers and facilitators of iron supplementation programs for pregnant women in eight developing countries. Research results were used to develop pilot program strategies and interventions to reduce maternal anemia. Across-region results were examined and some differences were found but the similarity in the way women view anemia and react to taking iron tablets was more striking than differences encountered by region, country or ethnic group. While women frequently recognize symptoms of anemia, they do not know the clinical term for anemia. Half of women in all countries consider these symptoms to be a priority health concern that requires action and half do not. Those women who visit prenatal health services are often familiar with iron supplements, but commonly do not know why they are prescribed. Contrary to the belief that women stop taking iron tablets mainly due to negative side effects, only about one-third of women reported that they experienced negative side effects in these studies. During iron supplementation trials in five of the countries, only about one-tenth of the women stopped taking the tablets due to side effects. The major barrier to effective supplementation programs is inadequate supply. Additional barriers include inadequate counseling and distribution of iron tablets, difficult access and poor utilization of prenatal health care services, beliefs against consuming medications during pregnancy, and in most countries, fears that taking too much iron may cause too much blood or a big baby, making delivery more difficult. Facilitators include women's recognition of improved physical well being with the alleviation of symptoms of anemia, particularly fatigue, a better appetite, increased appreciation of benefits for the fetus, and subsequent increased demand for prevention and treatment of iron deficiency and anemia.

Adult↗
PubMed2002

Designing a carbon market that protects forests in developing countries.

Firmly incorporated into the Kyoto Protocol, market mechanisms offer an innovative and cost-effective means of controlling atmospheric concentrations of greenhouse gases. However, as with markets for many other goods and services, a carbon market may generate negative environmental externalities. Possible interpretations and application of Kyoto provisions under COP-6bis and COP-7 raise concerns that rules governing forestry with respect to the Kyoto carbon market may increase pressure on native forests and their biodiversity in developing countries. In this paper, we assess the following two specific concerns with Kyoto provisions for forestry measures. First, whether, under the Clean Development Mechanism (CDM), by restricting allowable forestry measures to afforestation and reforestation, and explicitly excluding protection of threatened native forests, the Kyoto Protocol will enhance incentives for degradation and clearing of forests in developing countries; second, whether carbon crediting for forest management in Annex I (industrialized) regions under Article 3.4 creates a dynamic that can encourage displacement of timber harvests from Annex I countries to developing nations. Given current timber extraction patterns in developing regions, additional harvest pressure would certainly entail a considerable cost in terms of biodiversity loss. In both cases, we find that the concerns about deleterious impacts to forests and biodiversity are justified, although the scale of such impacts is difficult to predict. Both to ensure reliable progress in managing carbon concentrations and to avoid unintended consequences with respect to forest biodiversity, the further development of the Kyoto carbon market must explicitly correct these perverse incentives. We recommend several steps that climate policymakers can take to ensure that conservation and restoration of biodiversity-rich natural forests in developing countries are rewarded rather than penalized. To correct incentives to clear natural forests through CDM crediting for afforestation and reforestation, we recommend for the first commitment period that policymakers establish an early base year, such as 1990, such that lands cleared after that year would be ineligible for crediting. We further recommend an exception to this rule for CDM projects that are explicitly designed to promote natural forest restoration and that pass rigorous environmental impact review. Restoration efforts are typically most effective on lands that are adjacent to standing forests and hence likely to have been recently cleared. Thus, we recommend for these projects establishing a more recent base year, such as 2000. For the second and subsequent commitment periods, we recommend that climate policymakers act to restrain inter-annex leakage and its impacts by ensuring that crediting for forest management in industrialized countries is informed by modelling efforts to anticipate the scale of leakage associated with different Annex I 'Land use, land-use change and forestry' policy options, and coupled with effective measures to protect natural forests in developing countries. The latter should include expanding the options permitted under the CDM to carbon crediting for projects that protect threatened forests from deforestation and forest degradation. Ultimately, carbon market incentives for forest clearing can be reduced and incentives for forest conservation most effectively strengthened by fully capturing carbon emissions associated with deforestation and forest degradation in developing countries under a future emissions cap. Finally, we note that these recommendations have broader relevance to any forest-based measures to reduce greenhouse-gas emissions developed outside of the specific context of the Kyoto Protocol.

Air Pollution↗
PubMed2005

Health Risks Associated with Visiting Friends and Relatives in Developing Countries.

An increasingly large proportion of immigrants to developed countries is arriving from less developed countries in Africa, Asia, and Latin America. When these immigrants return to their country of origin to visit friends and relatives, they are at high risk of acquiring tropical infections, compared with other travelers. Immigrants who return to their country of origin to visit friends and relatives (VFRs) are more likely to travel to rural areas for long periods of time, to consume contaminated food and beverages, and to have more prolonged, intimate contact with local populations. As a group, they are less likely to seek pretravel advice or take antimalarial chemoprophylaxis. This article discusses the increased risk of tuberculosis, malaria, food- and waterborne illnesses, hepatitis A, and HIV and other sexually transmitted infections in VFRs.

Journal Article↗
PubMed2005

Hyperphosphatemia among end-stage renal disease patients in developing countries: a forgotten issue?

The prevalence of hyperphosphatemia and increased calcium-phosphorus product has never been evaluated in a large multicenter study in a developing country. Our aim is to study the prevalence of hyperphosphatemia in 38 HD centers in Egypt (as an example of a developing country) and to correlate it with different co-morbid conditions and the patient's demographic data. This is a cross-sectional study conducted on 1005 chronic kidney disease stage 5 patients (CKD-stage 5) on HD for a period of more than 1 year in 38 dialysis centers in Egypt. All patients were receiving calcium-based salts as a phosphate binder. Hyperphosphatemia and increased calcium-phosphorus product were evaluated and correlated with different parameters including age, sex, knowledge by diet parameters, HD session duration, the frequency of HD per week, the type of dialysis membrane, the surface area of the dialyzer, dialyzer phosphorus clearance (phosphorus KoA), and the type of dialysate. Other co-morbid medical conditions and evidence of IHD were also investigated. Hyperphosphatemia was present in 69.1% of cases and a high calcium-phosphorus product was present in 30.2%. A higher calcium-phosphorus product was found among males. 83.2% of those with a poor knowledge by diet parameters had hyperphosphatemia compared with 67.6% in patients with a satisfactory knowledge by diet parameters. 72.3% of patients using a membrane with low-to-medium clearance had hyperphosphatemia, compared with 67.2% using a membrane with a high clearance. Seventy-two percent of patients with IHD were hyperphosphatemic compared with 67.6% of the non-ischemic patients. Hyperphosphatemia is a major problem in dialysis patients in developing countries, reflecting differences from developed countries regarding dietary habits, ethnic factors, dialysis quality, types of dialysis membranes, as well as economic factors hampering the use of the more expensive phosphate binders. Extended dialysis hours may be a good alternative solution in developing countries.

Developing Countries↗
PubMed1987

Rehabilitation of chronic schizophrenics in a developing country.

Mental health services in Pakistan, as in most developing countries, have not advanced beyond elementary level. Considering the population size, there are few beds in psychiatric wards or hospitals for those in need, and little, if any, opportunity for mentally ill individuals to receive aid and assistance in the community. One model which provides a comprehensive array of services for chronic mental patients in the community is known as the 'Clubhouse'. Since 1971, Fountain House has provided social, vocational, and residential services to chronic schizophrenics in Lahore, based on the concept of mental patients as members of a club receiving self-help through mutual cooperation. Equally basic to the model is the concept of family structure. Based on 14 years of experience, it has been found that the Clubhouse model can be initiated, grow, and thrive in a developing country. Essential to this process has been full involvement of the community. The model can be fully incorporated with adaptations reflecting local conditions and circumstances in other developing countries.

Community Mental Health Centers↗
PubMed1983

The founding of a cancer registry in a developing country.

The Netherlands Antilles is among the less developed countries lacking data on incidence and distribution of cancer. Therefore, a retrospective case-finding survey was started in 1977 to retrieve all cases of cancer occurring in the period 1968-1977, simultaneously initiating a regular continuous registry for newly occurring cancers. The survey consisted of five phases, designed to ferret out cases from pathology and hospital files, out-patient files, and other sources, and to systematically check the validity of compiled data. The design was based on the absence of specific files of coded diagnoses, the active participation of a pathologist in the search for cases, and the central position of the Pathology Department and the St Elisabeth Hospital. The survey eventually covered a population of 180 000. The work was done in spare time, due to lack of funds, and was yet completed in 2 years. The total cost was 20 specialist-hours and 50 clerk-hours per 100 000 population per year to be covered. The recovery was complete for the 5 most recent years and 85% for earlier years. As to the latter, the main reason for incompleteness appeared to be the deficiency in filing records in out-patient departments. It is concluded that the retrospective active case-finding survey is highly feasible, rapid and cheap, and it is proposed as an alternative to the regular continuous cancer registry, for countries with limited facilities and funds, or when the rapid availability of incidence data is required. Conditions prevailing in developing countries, and with a possible impact on the outcome of the survey, are amply discussed.

Costs and Cost Analysis↗
PubMed2006

Economic evaluations of non-communicable disease interventions in developing countries: a critical review of the evidence base.

BACKGROUND: Demographic projections suggest a major increase in non-communicable disease (NCD) mortality over the next two decades in developing countries. In a climate of scarce resources, policy-makers need to know which interventions represent value for money. The prohibitive cost of performing multiple economic evaluations has generated interest in transferring the results of studies from one setting to another. This paper aims to bridge the gap in the current literature by critically evaluating the available published data on economic evaluations of NCD interventions in developing countries. METHODS: We identified and reviewed the methodological quality of 32 economic evaluations of NCD interventions in developing countries. Developing countries were defined according to the World Bank classification for low- and lower middle-income countries. We defined NCDs as the 12 categories listed in the 1993 World Bank report Investing in Health. English language literature was searched for the period January 1984 and January 2003 inclusive in Medline, Science Citation Index, HealthStar, NHS Economic Evaluation Database and Embase using medical subheading terms and free text searches. We then assessed the quality of studies according to a set of pre-defined technical criteria. RESULTS: We found that the quality of studies was poor and resource allocation decisions made by local and global policy-makers on the basis of this evidence could be misleading. Furthermore we have identified some clear gaps in the literature, particularly around injuries and strategies for tackling the consequences of the emerging tobacco epidemic. CONCLUSION: In the face of poor evidence the role of so-called generalised cost-effectiveness analyses has an important role to play in aiding public health decision-making at the global level. Further research is needed to investigates the causes of variation among cost, effects and cost-effectiveness data within and between settings. Such analyses still need to take a broad view, present data in a transparent manner and take account of local constraints.

Journal Article↗
PubMedDate not supplied

[Access to essential drugs in developing countries].

Every year infectious diseases kill about 13 million people, about 30.000 deaths a day. Almost half of the victims are children younger than 5 years old, most of them belong to developing countries. Most of the premature deaths and the incapacity cases associated to infectious diseases could be avoided if the poor had access to medicines. In the developing world, the poverty of the families, the inappropried public expense and the lack of sanitary infrastructures get together to leave out of the reach of the poor the possibility of an adequate medical treatment. According to World Health Organization (WHO) in the developing countries about 2,000 million people lack access to essential medicines. The new patent rules of the World Trade Organization (WTO) will reduce even more access to essential medicines to the poor. Granting trade exclusivity rights to the owners of the patents for a period of at least 20 years limits the right of the governments to allow production, trade and importation of low cost copies (generics) of patented drugs. It is not a theoretical or far away menace. The application of these more strict rules has all ready caused serious problems to developing countries producers of generics as India or Brazil or to importers of these as South Africa or Kenya. They have been press, taken to court and threaten of sanctions by the pharmaceutical industry and some developed countries governments. The decision of some developing countries to fight for their most needed people's health added to the international campaign for the access to essential medicines defended by some non governmental organizations like Act Up, Treatment Action Campaign, Doctors Without Borders and Intermon Oxfam have implied small victories on behalf of the poor countries access to medicines. But deeper changes in the patent rules and the investigation of the diseases of the developing world are needed to improve health in the developing countries.

Adult↗
PubMed2006

Perinatal research in developing countries--is it possible?

Maternal mortality remains the health statistic for which there is the greatest disparity between developing and developed countries. The risk of stillbirth or neonatal death is also high in developing countries. The inequality of research funding between rich and poor countries is dramatic, with only 10% of research funding directed towards diseases which contribute 90% of the global burden of disease. The need for high-quality, relevant perinatal research in developing countries is compelling. There are many examples of good perinatal research in developing countries. Nevertheless, significant challenges remain and are being tackled. We need better information about maternal and perinatal health, and about performance of the health services, we need more evaluation of what helps and what harms within the existing health services, and we need improved strategies for implementation of research findings.

Biomedical Research↗
PubMedDate not supplied

Report of an International Network of Cancer Treatment and Research workshop on non-Hodgkin's lymphoma in developing countries.

The International Network of Cancer Treatment and Research (INCTR) recently organized a workshop on non-Hodgkin lymphomas (NHLs) in selected developing countries with the purpose of examining existing information relating to the pathology and management of these neoplasms, and identifying potential areas for research. This report provides a summary of the information presented and is focused primarily on the pathology of NHLs in children and adults. In most countries, the WHO classification of lymphomas was used and most participating centers included immunohistochemistry using a wide array of lymphoid antibodies as part of routine diagnosis. Some of the series had been reviewed by an external panel of experts. B-cell lymphomas accounted for 82-88% of all NHLs. The proportions of chronic lymphatic leukemia (4-6%), mantle cell lymphoma (MCL, 3-5%), and plasmacytoma (2-4%) were similar in the series presented. However, there was a significant variation in the proportion of follicular lymphoma (FL), which accounted for 15% and 11% in India and Kuwait, but less than 5% in Pakistan and Egypt. All of these frequencies are significantly lower than those reported in Western series. Diffuse large B-cell lymphoma accounted for about 35% of cases in India but for more 50% in other countries, but this difference was not accounted for by an increased incidence in a single lymphoma subtype in India, but rather an apparent paucity of several subtypes (such as mantle cell and marginal zone lymphomas (MZL)) in other series. There were relatively high frequencies of Burkitt lymphoma in Egypt (7%) and precursor T-cell lymphoblastic lymphoma in India (6-7%). Peripheral T-cell lymphomas (PTCLs) (not otherwise specified and angioimmunoblastic subtypes) accounted for 3-5% of NHLs, and extranodal lymphoma of T/NK cell type was rare (<1%). These differences in the relative proportions of NHL subtypes among developing countries and between developing countries and the rest of the world presumably arise from differences in environmental and genetic factors that influence lymphomagenesis and strongly suggest that more research in developing countries would provide valuable insights into the pathogenesis of lymphoid neoplasms.

Adult↗
PubMed2006

[Deficient information in developing countries: Internet alone is no solution].

Health-care personnel in developing countries have poor access to information, partly because the books are out of date and journals and Internet access are lacking, and partly because the information that is available is not appropriate for the local situation. There is too little research aimed at the problems of the Third World. This is due to a lack of interest in Western countries and because local scientists have done too little research. Internet solves the problem of access to information for health-care personnel in large hospitals and institutes, but there is still a shortage of relevant information for them as well. The editorial boards of professional journals could make a contribution by facilitating the publication of relevant research. Health-care personnel in rural areas will remain dependent upon basic books. This basic component of the provision of information should continue to receive attention. For the time being, Internet will remain inaccessible for rural health-care personnel. One of the initiatives being undertaken in order to improve the provision of information to health-care personnel in developing countries is the distribution of the 'blue trunk library' of the WHO with a selection of more than 100 basic books in every trunk. A number of journals have also taken action: the BMJ Publishing Group offers access to its journals free of charge to the 118 poorest countries and the Canadian Medical Association Journal provides free copies to libraries in developing countries. Moreover, a number ofwebsites have been started with a view to enlarging the information for health-care personnel in the Third World.

Books↗
PubMed2006

A review of international and UK-based ethical guidelines for researchers conducting nontherapeutic genetic studies in developing countries.

Initiation and implementation of nontherapeutic genetic research projects, sponsored by developed countries and conducted in developing countries, requires careful consideration and awareness of procedures that ensure ethical research. This article reviews, and discusses controversies surrounding, the ethical principles established internationally and recommended by institutions in the UK for designing and implementing nontherapeutic genetic research studies. Before project commencement, the researcher should submit proposals to appropriate ethics committees and, wherever possible, seek guidance from experienced researchers. The researcher must also be aware of his/her responsibilities when conducting research with human participants. Responsibilities include respecting autonomy, privacy and confidentiality of participants, respecting social and cultural differences, providing appropriate information to participants, obtaining informed consent and offering appropriate compensation for participation. Finally, researchers involved in human genetics studies must also consider specific issues and public concerns when collecting biological samples. This includes using anonymised samples, considering future use of samples and ensuring confidentiality of results.

Community Participation↗
PubMed2007

Developmental potential in the first 5 years for children in developing countries.

Many children younger than 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and unstimulating home environments, which detrimentally affect their cognitive, motor, and social-emotional development. There are few national statistics on the development of young children in developing countries. We therefore identified two factors with available worldwide data--the prevalence of early childhood stunting and the number of people living in absolute poverty--to use as indicators of poor development. We show that both indicators are closely associated with poor cognitive and educational performance in children and use them to estimate that over 200 million children under 5 years are not fulfilling their developmental potential. Most of these children live in south Asia and sub-Saharan Africa. These disadvantaged children are likely to do poorly in school and subsequently have low incomes, high fertility, and provide poor care for their children, thus contributing to the intergenerational transmission of poverty.

Adolescent↗
PubMed1996

Priorities in neonatal care in developing countries.

Lower perinatal and neonatal mortality have been achieved in the developed countries following advancement of neonatal care, introduction of high technologies, and better knowledge of pathophysiology of the newborn infants. Other contributing factors are organised delivery room care with skillful resuscitative techniques as well as risk identification and efficient transport of the sick infants including in utero transfer of the fetus, etc. It cannot be assumed that similar results can be attained in developing countries where financial and human resources are the problems. With limited resources, it is necessary to prioritize neonatal care in the developing countries. It is essential to collect minimum meaningful perinatal data to define the problems of each individual country. This is crucial for monitoring, auditing, evaluation, and planning of perinatal health care of the country. The definition and terminology in perinatology should also be uniform and standardised for comparative studies. Paediatricians should be well trained in resuscitation and stabilisation of the newborn infants. Resuscitation should begin in the delivery room and a resuscitation team should be formed. This is the best way to curtail complication and morbidity of asphyxiated births. Nosocomial infections have been the leading cause of neonatal deaths. It is of paramount importance to prevent infections in the nursery. Staff working in the nursery should pay attention to usage of sterilised equipment, isolation of infected babies and aseptic procedures. Paediatricians should avoid indiscriminate use of antibiotics. Most important of all, hand-washing before examination of the baby is mandatory and should be strictly adhered to. Other simpler measures include warming devices for maintenance of body temperature of the newborn babies, blood glucose monitoring, and antenatal steroid for mothers in premature labour. In countries where neonatal jaundice is prevalent, effective management to prevent kernicterus is essential. Simple assisted ventilatory device such as nasal continuous positive airway pressure (nCPAP) is also useful.

Developing Countries↗
PubMed1992

Mortality from tobacco in developed countries: indirect estimation from national vital statistics.

Prolonged cigarette smoking causes even more deaths from other diseases than from lung cancer. In developed countries, the absolute age-sex-specific lung cancer rates can be used to indicate the approximate proportions due to tobacco of deaths not only from lung cancer itself but also, indirectly, from vascular disease and from various other categories of disease. Even in the absence of direct information on smoking histories, therefore, national mortality from tobacco can be estimated approximately just from the disease mortality statistics that are available from all major developed countries for about 1985 (and for 1975 and so, by extrapolation, for 1995). The relation between the absolute excess of lung cancer and the proportional excess of other diseases can only be approximate, and so as not to overestimate the effects of tobacco it has been taken to be only half that suggested by a recent large prospective study of smoking and death among one million Americans. Application of such methods indicates that, in developed countries alone, annual deaths from smoking number about 0.9 million in 1965, 1.3 million in 1975, 1.7 million in 1985, and 2.1 million in 1995 (and hence about 21 million in the decade 1990-99: 5-6 million European Community, 5-6 million USA, 5 million former USSR, 3 million Eastern and other Europe, and 2 million elsewhere, [ie, Australia, Canada, Japan, and New Zealand]). More than half these deaths will be at 35-69 years of age: during the 1990s tobacco will in developed countries cause about 30% of all deaths at 35-69 (making it the largest single cause of premature death) plus about 14% of all at older ages. Those killed at older ages are on average already almost 80 years old, however, and might have died soon anyway, but those killed by tobacco at 35-69 lose an average of about 23 years of life. At present just under 20% of all deaths in developed countries are attributed to tobacco, but this percentage is still rising, suggesting that on current smoking patterns just over 20% of those now living in developed countries will eventually be killed by tobacco (ie, about a quarter of a billion, out of a current total population of just under one and a quarter billion).

Adult↗
PubMed1992

The magnitude of mortality from acute respiratory infections in children under 5 years in developing countries.

This article reviews the available evidence of mortality from acute respiratory infections (ARI) among children aged under 5 years in contemporary developing countries and compares the findings with European populations before 1965. In European populations before 1965, the level of mortality was found to be a determinant of the proportion of deaths due to ARI. There were marked differences according to regional patterns of mortality. Deaths from ARI played a smaller role after 1950, when the use of antibiotics became generalized. In developing countries, the role of ARI mortality seems to be similar to the European experience. The age pattern is very marked. In absolute values, ARI mortality is highest in the neonatal period and decreases with age. In relative values, ARI mortality is highest in the postneonatal period. ARI, mainly pneumonia, accounts for about 18% of underlying causes of death in developing countries. Pneumonia and other ARI are frequent complications of measles and pertussis; ARI is also commonly found after other infections and in association with severe malnutrition. Virtually no data are available in developing countries to provide final estimates of the role of ARI in mortality of children aged under 5 years. However, the WHO figure of 1 out of 3 deaths due to--or associated with--ARI may be close to the real range of the ARI-proportional mortality in children of developing countries. Results are discussed in light of the definitions of ARI used in various studies, the difficulties in ascertaining and coding multiple causes of death and the quality of data from some sources.

Acute Disease↗