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PubMed1977

The role of drug information centres for improving patient care in Pakistan and other developing countries.

Relevant and uptodate information about drugs in common use is either unavailable or scarce, in Pakistan and other developing countries. Developed countries inspite of all the facilities available for learning have recognised the limitation of human memory. Drug information centres have therefore been established for repeated reminder and continued education for the practicing doctors in prescribing drugs and early recognition of adverse reactions to them. The proposal for establishing such drug information centres in Pakistan and other developing countries for further improving the patient care and early reporting of adverse reaction to drugs in this paper is based on the encouraging response to and beneficial experience by such centres in the western world. There is every reason that it will succeed in improving the health of the people of Pakistan.

Developing Countries↗
PubMed1991

Paediatric oncology in developing countries.

Paediatric oncology in developing countries is a specialty in its own right that has so far been largely neglected by the western medical profession. It has specific features of genetic cancer predisposition and of external factors influencing phenotypic cancer manifestations. We point out here some of the specific features of cancer presentation in children of developing countries.

Child↗
PubMed1977

Specialist training and medical research in developing countries of tropical Africa: a case for the establishment of postgraduate medical schools.

Developing countries like developed ones need highly skilled medical personnel, referred to as 'specialists'. In the case of developing countries, the training of these specialists abroad is expensive to the sponsoring governments, imposes a lot of hardship on the doctors and, above all, the course-content of such training takes little or no cognizance of the environment in which these doctors would later practise. The developing countries also cannot afford the loss of years in valuable services which the training abroad entails. Attempts are now being made to train specialists wholly or partly at home, in some developing countries. The approach is still not much divorced from what obtains in Britain and North America, that is, one of being trained on the job, with the onus for self-education being placed on the prospective students. Such students in most developing countries of tropical Africa have little or no facilities for further education outside their places of work. It is proposed that purpose-designed postgraduate medical schools may provide a temporary solution to specialist training in developing countries of tropical Africa. Such schools would in addition provide highly skilled medical service as well as obviate the need and the expense for the setting up of government sponsored medical research and training institutes.

Africa, Western↗
PubMed1990

Soak-away systems and possible groundwater pollution problems in developing countries.

People in the developing countries do not have adequate sanitation and everyone defaecates somewhere. Those who do not have a toilet or latrine have to resort to indiscriminate defaecation either in the sea shore such as in the Lagos lagoon in Nigeria, or vacant plots and open drains as in Iddo area of Lagos and sides of rural footpaths. Water closets (W.C.s) are the most accepted sanitation system, but the cost of operating and maintaining them is high. As a result sewerage is not appropriate for the majority of people in developing countries whose greater population live in rural areas and small towns. The majority of people in urban areas use septic tanks and very often most of these septic tanks are not properly designed or sometimes located too close to sources of water supply, which then become contaminated. It is generally believed that systems like septic tanks, pit latrines and aqua privies are capable of totally eliminating these pathogens. There are many problems associated with the physical, chemical and biological processes that may result in groundwater pollution from septic tanks. Many experiments have shown that faecal organisms do not travel any significant distance radially as a result of concentration gradient. They are, however, carried with groundwater flow. The task is to prevent pathogens from getting into the aquifer. This paper attempts to highlight the ability of some enteric viruses to survive septic tank wastewater treatment.

Developing Countries↗
PubMed1991

Chemicals and environmentally caused diseases in developing countries.

This chapter discusses international aspects of diseases resulting from exposure to chemical pollutants in the environment, with an emphasis on developing countries. These countries share many of the same problems of air, water, and pesticide pollution that face the more industrialized countries. In developing countries, however, the problems are compounded by a number of unique situations, viz., economic priorities, high burden of infectious diseases, impoverishment, and absence of a regulatory framework for the disposal of toxic chemicals. This discussion emphasizes the importance of interactions among toxicants, malnutrition, and infectious diseases for both urban and rural populations insofar as these interactions contribute to disease. Toxicants not only produce disease directly but also exacerbate diseases with other causes. Specific examples from developing countries demonstrate how human health effects from exposures to environmental chemicals can be assessed. While they do not strictly fall under the rubric of "developing countries," the public health consequences of inadequate control of environmental pollution in the East European countries should demonstrate the magnitude of the problem, except that in developing countries the public health consequence of environmental chemicals will be aggravated by the widespread malnutrition and high prevalence of infectious diseases. Much needs to be done before we can adequately quantify the contribution of environmental chemicals to morbidity and mortality in developing countries with the level of sophistication now evident in the charting of infectious diseases in these countries.

Air Pollution↗
PubMed1990

Reproductive epidemiologic research in developing countries.

This paper discusses the scientific rationale for carrying out reproductive epidemiologic research in developing countries, and the generalizability of results of research done in developed countries to developing countries. Practical problems encountered in doing research in developing countries include limited resources, overcommitted researchers, cost, and study monitoring. Cultural differences that affect the design and conduct of research activities in developing countries are also discussed.

Anemia, Sickle Cell↗
PubMed1991

Public and private donor financing for health in developing countries.

Among the many variables that influence the outcome of national health status in both developed and developing countries, the availability and efficiency of financing is critical. For 148 developing countries, annual public and private expenditures from domestic sources (1983) were estimated to be approximately $100 billion. For the United States alone, annual public and private costs for medical care are almost five times larger ($478 billion, 1988). In contrast to domestic expenditures, the total flow of donor assistance for health in 1986 was estimated to be $4 billion, approximately 5% of total current domestic expenditures by developing countries. Direct donor assistance for development purposes by the United States Government approximates 0.5% of the US federal budget (1988). Approximately 10% of all United States development assistance is allocated for health, nutrition, and population planning purposes. While the total health sector contribution is on the order of $500 million annually, the US contribution represents about 13% of health contributions by all external donors. In sub-Saharan Africa, all donor health allocations only reach 3.4% of total development assistance. While available data suggest that private and voluntary organizations contribute approximately 20% of total global health assistance, data reporting methods from private agencies are not sufficiently specific to provide accurate global estimates. Clearly, developing countries as a whole are dependent on the efficient use of their own resources because external financing remains a small fraction of total domestic financing. Nevertheless, improvement in health sector performance often depends on the sharing of western experience and technology, services available through external donor cooperation. In this effort, the available supply of donor financing for health is not restricted entirely by donor policy, but also by the official demand for external financing as submitted by developing countries. In perspective, the supply of financing for health greatly exceeds the receipt of well-articulated and officially approved proposals from developing countries. The major constraints that produce this imbalance are unfamiliarity of ministries of health with potential donor sources; passive approaches to external financing; unfamiliarity with proposal preparation; increasing competition within developing countries by competing sectors, such as industry and agriculture; limited numbers of trained personnel; and absence of an international system which is able to support developing countries in mobilizing external financing. Tested solutions to these issues have been applied in one geographic region.(ABSTRACT TRUNCATED AT 400 WORDS)

Delivery of Health Care↗
PubMed1991

The role of clinical epidemiology in establishing essential national health research capabilities in developing countries.

Health research directly relevant to the needs of the people of developing countries is essential for equity in development as well as for improving health planning and management. the international Commission on Health Research for Development has stressed the need to strengthen the capacity of developing countries, no matter how poor, to carry out essential national health research (ENHR). Clinical epidemiologists in developing countries can significantly contribute to the manpower available for ENHR. They play a major role in the provision and practice of appropriate health care by contributing to the critical assessment of priority health problems and by carrying out scientific evaluation of new and conventional intervention tools. In clinical epidemiology units in developing countries, transdisciplinary collaboration with social scientists and health economics has enhanced the capacity to do research that would influence decision-making and health policy, even as links with ministries of health and other ENHR-committed networks are being strengthened. The potential for carrying out ENHR will be multiplied as national and regional training centers for clinical epidemiology in selected developing countries are established.

Delivery of Health Care↗
PubMed1991

Child psychiatry in developing countries.

Child psychiatry in developing countries has recently attained the status of an established specialty. This review looks at available epidemiological data, and factors contributing to similarities and differences in rates of disorder. The relevance of child psychiatry to child health in these countries has service, training and research implications.

Adolescent↗
PubMed1991

[Clinical medicine in developing countries].

Clinical medicine in developing countries is often restricted in several ways due to factors such as lack of funds, trained personnel, diagnostic facilities and appropriate drugs. Clinical judgement, knowledge of the local epidemiological pattern and simple diagnostic and therapeutic procedures are crucial under such circumstances. Based on his own experience under primitive conditions in Ethiopia, the author gives some symptom-oriented differential diagnostic reflections and guidelines for simplified management of some major health problems in the tropics.

Clinical Medicine↗
PubMed1978

Potential contribution of primary-school teachers to the health of a developing country.

Like many other developing countries, Kenya gives higher priority to primary education than to health services. Thus, in rural areas primary schools are evenly distributed, well attended, and staffed by well-qualified teachers whereas health centres are thinly scattered, inaccessible to many, and staffed largely by people of low educational attainment. The public-health knowledge of school teachers exceeds that of many health workers. It is suggested that teachers of health science, in particular, represent a valuable resource for preventive and promotive medicine which can be exploited at little cost.

Allied Health Personnel↗
PubMed1991

[Utilization of health statistics in peripheral structures in developing countries].

Health information in developing countries serves mostly to diseases notification and activity registration, but rarely is it used for analyzing the health status of populations or the results of health intervention. Moreover, it is stored at a national level, mainly to fill monthly or yearly reports, and very seldom at a peripheral level where it would be probably more helpful. On the basis of experiences realized in Senegal and Nepal, we try to answer the two following questions: how to make health statistics utilizable, i.e. which criteria of relevance and quality recommend and how to utilize them concretely where they are produced, taking into account their well known limits?

Data Interpretation, Statistical↗
PubMed1990

Clinical pilot study on new dental filling materials and preparation procedures in developing countries.

Conservative dentistry in developing countries often poses a problem because of lack of expensive dental equipment. This survey was undertaken to test two more appropriate filling materials in vivo. In 94 secondary school students (in Mzuzu, Malawi) with two or more cavities, one cavity was prepared in the conventional way using drilling equipment and then filled with amalgam, and one cavity was prepared using hand instruments only and filled with either cermet ionomer or "miracle mix". Models of the filled teeth (99 amalgam, 53 "miracle mix", 54 cermet ionomer; all of them Class 1) were made and evaluated by three examiners after 6 months and after 1 yr. The fillings were given a score on a four-point scale. One year later all types of filling materials had significantly decreased in quality, but only five fillings (one amalgam, one "miracle mix", and three cermet ionomer) needed replacement. Compared to the amalgam filling in the same mouth, more cermet ionomer and "miracle mix" fillings performed poorly, but these differences were not statistically significant after 1 yr. Both cermet ionomer and "miracle mix" are very promising alternatives for Class I tooth cavities in areas without dental equipment.

Adolescent↗
PubMed1976

Ergonomics for occupational hygienists in developing countries with examples from Sri Lanka.

Occupational health problems in developing countries, especially those situated in the tropical zone, are difficult to define. The conditions are more adverse in unorganized small-scale industries. The application of ergonomic principles in the practice of occupational health in developing countries must be subject to all aspects of community health and impact of industrialization as well. Ergonomics offers a broad concept to health scientists in developing countries. "Systems ergonomics" is not applicable. On the contrary, the fact that ergonomics conveys a different meaning to those in developing countries is highlighted by a few examples from Sri Lanka. The author presents his view for consideration in the development of international instruments to prescribe the sale of guarded machinery to developing countries and the limitation of incentive schemes for performing arduous tasks leading to occupational illnesses.

Accidents, Occupational↗
PubMed1990

Antenatal care in developing countries.

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

Attitude to Health↗
PubMed1990

[Hodgkin's disease in developing countries].

The presentation of Hodgkin's disease (HD) is not the same in western countries and in developing countries. In the latter HD remains a severe disease partly because of a delayed diagnosis. Pathology is less favorable, stages are more advanced. Young patients are even more afflicted. Despite difficulties to treat patients, oncologists have to move to treat as well as possible potentially curable disease in order to save many years of active life. HD would be a good model to promote multidisciplinary centers where patients could be cared and cured in the best conditions.

Adolescent↗
PubMed1990

The engine or the caboose: health policy in developing countries.

A discussion of health policy in developing countries is presented. It argues that developing countries must adopt a progressive approach to health policy which rejects the two-tiered system of public and private health care. However, it also points out that ideology is not sufficient to maintain support. A progressive health system must utilize administrative and social and behavioral sciences to achieve effectiveness and efficiency in health care delivery. It cannot ignore these goals any more than a private health care system can.

Delivery of Health Care↗