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PubMed1991

The WHO Collaborative Study of Neoplasia and Steroid Contraceptives: the influence of combined oral contraceptives on risk of neoplasms in developing and developed countries.

A hospital-based case-control study was conducted in eight developing and three developed countries to determine whether use of combined oral contraceptives alters risks of various cancers. An observed trend of increasing risk of invasive cervical cancer with duration of use may not represent a causal relationship and is the subject of further study. Decreased risks of ovarian and endometrial carcinomas in users likely indicate a protective effect of oral contraceptives, the degree of which was similar in developing and developed countries. A small increase in risk of breast cancer in recent and current users was found to be somewhat greater in developing than developed countries. Both causal and non-causal interpretations of this finding have been offered. No associations were found between oral contraceptives and in situ cervical, hepatocellular, cholangio, or gallbladder carcinomas, or uterine sarcomas; but the power of this study to detect alterations in risks of these neoplasms in long-term users was low.

Breast Neoplasms↗

PubMed1991

Tuberculosis and HIV-infection in developing countries.

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

Adolescent↗

PubMed1991

The needs of developing countries and the resources required.

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

Cross Infection↗

PubMed1996

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

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

Developing Countries↗

PubMed2002

Registry based trauma outcome: perspective of a developing country.

OBJECTIVE: To report trauma outcome from a developing country based on the Trauma and Injury Severity Scoring (TRISS) method and compare the outcome with the registry data from Major Trauma Outcome Study (MTOS). DESIGN: Registry based audit of all trauma patients over two years. SETTING: Emergency room of a teaching university hospital. SUBJECTS: 279 injured patients meeting trauma team activation criteria including all deaths in the emergency room. OUTCOME MEASURES: TRISS methodology to compare expected and observed outcome. STATISTICAL ANALYSIS: W, M, and Z statistics and comparison with MTOS data. RESULTS: 279 patients meeting the trauma triage criteria presented to the emergency room, 235 (84.2%) were men and 44 (15.8%) women. Blunt injury accounted for 204 (73.1%) and penetrating for 75 (26.9%) patients. Seventy two patients had injury severity score of more than 15. Only 18 (6.4%) patients were transported in an ambulance. A total of 142 (50.9%) patients were transferred from other hospitals with a mean prehospital delay of 7.1 hours. M statistic of our study subset was 0.97, indicating a good match between our patients and MTOS cohort. There were 18 deaths with only one unexpected survivor. The expected number of deaths based on MTOS dataset should have been 12. CONCLUSIONS: Present injury severity instruments using MTOS coefficients do not accurately correlate with observed survival rates in a developing country.

Adolescent↗

PubMed2005

Brain drain from developing countries: how can brain drain be converted into wisdom gain?

Brain drain is defined as the migration of health personnel in search of the better standard of living and quality of life, higher salaries, access to advanced technology and more stable political conditions in different places worldwide. This migration of health professionals for better opportunities, both within countries and across international borders, is of growing concern worldwide because of its impact on health systems in developing countries. Why do talented people leave their countries and go abroad? What are the consequences of such migrations especially on the educational sector? What policies can be adopted to stem such movements from developing countries to developed countries? This article seeks to raise questions, identify key issues and provide solutions which would enable immigrant health professionals to share their knowledge, skills and innovative capacities and thereby enhancing the economic development of their countries.

Clinical Competence↗

PubMed2005

Can we use contingent valuation to assess the demand for childhood immunisation in developing countries?: a systematic review of the literature.

Childhood immunisation is one of the most cost-effective public health interventions, yet its population coverage in low- and middle-income countries is severely limited by the fiscal constraints that health services face. A recent proposal suggested that commitments to purchase vaccines and make them available to developing countries for modest co-payments could solve the problem. However, this is dependent on communities being willing and able to share the cost in this way, which is difficult to assess. One possible method to assess this demand is contingent valuation (CV). This article evaluates the usefulness of using CV in this way, by reviewing applications of CV in developing countries against current 'standards' for CV of immunisation in the literature. A structured review was adopted with reference to the standard frameworks for methodological evaluation. A set of five criteria were developed for evaluating an 'acceptable' CV study: (i) response rate; (ii) association between willingness to pay (WTP) and socioeconomic status (SES); (iii) sensitivity of WTP to benefit scale/scope; (iv) predictive validity; and (v) reliability in elicitation formats. Two strands of literature search were conducted using electronic databases (MEDLINE, EMBASE, HEALTHSTAR and Econlit) from 1966 to 2003, one for CV studies of immunisation and one for CV studies in developing countries. Twelve CV studies of vaccination and 13 CV studies undertaken within developing countries were identified and reviewed. The quality of existing CV studies conducted in developing countries exceeded the benchmark standard set by studies of immunisation in the developed world in four of the five criteria. WTP estimates appeared both internally valid (i.e. associations with SES) and externally valid (i.e. predictive validity), reliability in developing countries was no less than that of the benchmark level in the existing literature, and the high response rates suggested that CV can be administered to a rural, and perhaps less literate, population. Only sensitivity to scale/scope was not well demonstrated. Our assessment indicated that the CV technique offers a promising tool to estimate the demand for childhood immunisation in low- and middle-income countries. International agencies are therefore encouraged to devote resources to such an application when designing their support to the immunisation programmes.

Benchmarking↗

PubMed2003

Thinking downstream to accelerate the introduction of new vaccines for developing countries.

Introduction of new vaccines into public health programs in developing countries requires 'translational research', initiated even during the phase of vaccine development, to generate the evidence base necessary for rational public health decision-making. Translational research encompasses assessments of the local disease burden, demonstration projects of vaccines in realistic public health programs, analysis of the economic impact of vaccine introduction, assessment of community and policy-maker perceptions about the importance of a disease and the need to vaccinate against it, and identification of distribution channels and financial mechanisms for deploying and paying for a new vaccine. In the absence of this background information, even a successful vaccine may risk substantial difficulties and delays in its introduction into programs for the poor in developing countries.

Developing Countries↗

PubMed2006

History and development of trauma registry: lessons from developed to developing countries.

BACKGROUND: A trauma registry is an integral component of modern comprehensive trauma care systems. Trauma registries have not been established in most developing countries, and where they exist are often rudimentary and incomplete. This review describes the role of trauma registries in the care of the injured, and discusses how lessons from developed countries can be applied toward their design and implementation in developing countries. METHODS: A detailed review of English-language articles on trauma registry was performed using MEDLINE and CINAHL. In addition, relevant articles from non-indexed journals were identified with Google Scholar. RESULTS: The history and development of trauma registries and their role in modern trauma care are discussed. Drawing from past and current experience, guidelines for the design and implementation of trauma registries are given, with emphasis on technical and logistic factors peculiar to developing countries. CONCLUSION: Improvement in trauma care depends on the establishment of functioning trauma care systems, of which a trauma registry is a crucial component. Hospitals and governments in developing countries should be encouraged to establish trauma registries using proven cost-effective strategies.

Journal Article↗

PubMed1991

[Vaccines and developing countries].

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

Developing Countries↗

PubMed2006

Is the outcome of schizophrenia really better in developing countries?

That schizophrenia has a better prognosis in non-industrialized societies has become an axiom in international psychiatry; the evidence most often cited comes from three World Health Organization (WHO) cross-national studies. Although a host of socio-cultural factors have been considered as contributing to variation in the course of schizophrenia in different settings, we have little evidence from low-income countries that clearly demonstrates the beneficial influence of these variables. In this article, we suggest that the finding of better outcomes in developing countries needs re-examination for five reasons: methodological limitations of the World Health Organization studies; the lack of evidence on the specific socio-cultural factors which apparently contribute to the better outcomes; increasing anecdotal evidence describing the abuse of basic human rights of people with schizophrenia in developing countries; new evidence from cohorts in developing countries depicting a much gloomier picture than originally believed; and, rapid social and economic changes are undermining family care systems for people with schizophrenia in developing countries. We argue that the study of the long-term course of this mental disorder in developing countries is a major research question and believe it is time to thoroughly and systematically explore cross-cultural variation in the course and outcome of schizophrenia.

Cultural Characteristics↗

PubMed1997

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

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

Asia↗

PubMed2005

Management of von Willebrand disease in developing countries.

A variety of treatment options are available at present for patients with von Willebrand disease (vWD), some of which are affordable for patients in developing countries. For most patients who have type 1 vWD, desmopressin acetate (DDAVP) is the treatment of first choice, at least for minor bleedings and for prophylaxis. It is advisable, however, to use a test dose first to note the patient's response. DDAVP is safe to use, affordable, and easy to administer. However, most patients with type 2 vWD and all patients with type 3 fail to respond to DDAVP. For these patients, other options are used. Almost all patients with vWD will benefit from fresh frozen plasma and from cryoprecipitate, and these are viable options for developing countries. Both have certain disadvantages, but they can, depending upon the circumstances and facilities, be produced in developing countries. In developed countries, factor VIII/von Willebrand factor concentrates are widely used, especially for major bleedings and for surgeries on these patients. These concentrates are safe and virus inactivated, but costly. Ancillary treatment modalities such as antifibrinolytic agents and certain hormones are usually given in conjunction with other modalities. The treatment of patients with antibodies to vWF is also described, and monitoring needs during therapy are reviewed.

Blood Coagulation Factors↗

PubMed1991

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

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

Accidents, Traffic↗

PubMed1998

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

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

Adenocarcinoma↗

PubMed2000

Dementia in developing countries. A consensus statement from the 10/66 Dementia Research Group.

Less than one-tenth of all population-based research into dementia is directed towards the two-thirds or more of cases living in developing parts of the world. The 10/66 Dementia Research Group has been formed to redress this imbalance, encouraging active research collaboration between centres in different developing countries and between developed and developing countries. The 10/66 group consisted initially of researchers attending a symposium on dementia research in developing countries, held at the 1998 Alzheimer's Disease International conference. They noted a growing interest in this area, with many active researchers and others wishing to start new studies. There was felt to be an urgent need for more research: quantifying prevalence and incidence, exploring regional variations in international collaborations using harmonized methodologies, describing care arrangements for people with dementia, quantifying the impact on caregivers and evaluating the effectiveness of any newly implemented services. Methodological problems need to be addressed, particularly development of culture- and education-fair dementia diagnostic procedures. Good-quality research can generate awareness, pioneer service development and influence policy.

Cost of Illness↗

PubMed2004

Pneumonia in HIV-infected and HIV-uninfected children in developing countries: epidemiology, clinical features, and management.

PURPOSE OF REVIEW: Pneumonia is a leading cause of illness and death in children younger than 5 years in developing countries, accounting for approximately 20% of childhood deaths. The HIV epidemic has sharply increased the incidence, severity, and mortality of childhood pneumonia in the developing world, particularly in sub-Saharan Africa. This article reviews recent findings on the epidemiology, clinical features, and management of HIV-infected and -uninfected children with pneumonia in developing countries. RECENT FINDINGS: Bacterial infection remains a major cause of pneumonia mortality; in HIV-infected children, a broader spectrum of pathogens including gram-negative infections and Pneumocystis jiroveci occurs. Mycobacterium tuberculosis is an important cause of acute pneumonia among children from high tuberculosis prevalence areas. Use of case management guidelines substantially reduces neonatal, infant, and under-5 mortality and pneumonia-specific mortality in developing countries. New advances in therapy include the use of short-course antibiotics and high-dose amoxicillin twice daily for ambulatory treatment of HIV-negative children with pneumonia. New preventive interventions include the development of conjugate vaccines against Streptococcus pneumoniae and Haemophilus influenzae, but these are not widely affordable nor available in developing countries. Despite a lower efficacy in HIV-infected children, these vaccines still protect against disease in a significant proportion of children. Available preventive interventions including micronutrient supplementation with zinc and vitamin A, and immunization as contained in the WHO Expanded Program of Immunization can substantially reduce the burden of childhood pneumonia. SUMMARY: Urgent measures to implement existing available, effective interventions for prevention and treatment of childhood pneumonia and achieve high coverage rates in developing countries are needed.

AIDS-Related Opportunistic Infections↗

PubMed2003

Ectopic pregnancy in African developing countries.

OBJECTIVE: We have reviewed the scientific literature on ectopic pregnancy (EP) in African countries published over the past 20 years and available from several databases (MEDLINE, EMBASE, POPLINE, and Cochrane Fertility Regulation Group), with the aim of painting a complete picture of the situation (incidence, risk factors, diagnosis, treatment, and complications). RESULTS: Although hospital-based African studies indicate EP incidence has probably increased in Africa in recent decades, major methodological limitations in the published literature make it impossible to draw formal conclusions concerning the incidence of EP in Africa in recent years. As in industrialized countries, pelvic inflammatory disease (PID) associated with sexually transmitted diseases (STDs) must be considered as the most important risk factor for EP in developing countries. In African developing countries, a majority of hospital-based studies have reported EP case fatality rates of around 1-3%, 10 times higher than that reported in industrialized countries. Late diagnosis, leading in almost all cases to major complications, and emergency surgical treatments are key elements accounting for such high fatality rates in women suffering from EP in Africa. CONCLUSION: EP should be considered a relevant public health indicator in developing countries, providing an overall picture of the capacity of a health system to deal with the diagnosis and treatment of emergency situations, especially in the field of obstetrics and gynecology.

Africa↗