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PubMed1995

Meeting the changing health needs of women in developing countries.

Demographic, epidemiological and socio-economic trends in developing countries are creating new mortality and morbidity patterns for both women and men. Women's health needs will increasingly include problems beyond reproduction, and health interventions must take into consideration the important characteristics of women's lives that affect their ability to address these problems. Meeting the changing health needs of women in developing countries will require more comprehensive health interventions guided by innovative, interdisciplinary research. A broader conceptualization of women's health needs, and the constraints and opportunities associated with meeting those needs, is necessary to avoid overly simplistic assigning of responsibility, which can lead to blaming organizations, disciplines and individuals, including women themselves, for persistent health problems and underutilization of existing services.

Developing Countries↗

PubMed1989

Alcohol advertising in developing countries.

Alcohol consumption appears to be increasing in some developing countries. Groups who previously did not drink alcohol, such as young people and women, are now increasingly beginning to drink. Recent anecdotal observations by researchers in Lesotho suggest that aggressive advertising may play a part in encouraging drinking among the young. This commentary suggests that surveys of alcohol advertising and youthful drinking in developing countries would be particularly useful in monitoring the influence of alcohol advertising in rapidly expanding markets. Recent studies have described simple measures of awareness and appreciation of alcohol advertising which discriminate between under-age drinkers and non-drinkers. These measures could be readily adapted by researchers responsible for the design of surveys of youthful drinking.

Advertising↗

PubMed2005

Antibodies among healthy population of developing countries against enterohaemorrhagic Escherichia coli O157:H7.

In Thailand, no reports are available on Escherichia coli serotype O157:H7, a causative agent of severe bloody diarrhoea, sometimes associated with haemolytic-uraemic syndrome and thrombotic thrombocytopenic purpura. The reason for the non-identification of infection due to E. coli O157 in this country and in other developing countries has not been rigorously discussed. The aim of this study was to determine the humoral response against the infectious organism. The IgM and IgG antibody responses against E. coli O157 lipopolysaccharide were studied using indirect enzyme-linked immunosorbent assay. Three hundred and thirty-two serum samples obtained from healthy blood donors and patients with diseases unrelated to diarrhoea were investigated. With a cut-off value of mean +2 SDs for each age-group, the frequency of the IgM and IgG responses to O157 lipopolysaccharide was 11.74% (39 of 332 samples) and 22.59% (75 of 332 samples) respectively. Furthermore, agglutination test of 173 subjects revealed titres ranging from 10 to 40 in all the samples. The results suggest possible exposure of the Thai population to cross-reacting antigens from other intestinal organisms in addition to infection due to E. coli O157:H7.

Adolescent↗

PubMed2004

Health promotion through self-care and community participation: elements of a proposed programme in the developing countries.

BACKGROUND: The concepts of health promotion, self-care and community participation emerged during 1970s, primarily out of concerns about the limitation of professional health system. Since then there have been rapid growth in these areas in the developed world, and there is evidence of effectiveness of such interventions. These areas are still in infancy in the developing countries. There is a window of opportunity for promoting self care and community participation for health promotion. DISCUSSION: A broad outline is proposed for designing a health promotion programme in developing countries, following key strategies of the Ottawa Charter for health promotion and principles of self care and community participation. Supportive policies may be framed. Self care clearinghouses may be set up at provincial level to co-ordinate the programme activities in consultation with district and national teams. Self care may be promoted in the schools and workplaces. For developing personal skills of individuals, self care information, generated through a participatory process, may be disseminated using a wide range of print and audio-visual tools and information technology based tools. One such potential tool may be a personally held self care manual and health record, to be designed jointly by the community and professionals. Its first part may contain basic self care information and the second part may contain outlines of different personally-held health records to be used to record important health and disease related events of an individual. Periodic monitoring and evaluation of the programme may be done. Studies from different parts of the world indicate the effectiveness and cost-effectiveness of self care interventions. The proposed outline has potential for health promotion and cost reduction of health services in the developing countries, and may be adapted in different situations. SUMMARY: Self care, community participation and health promotion are emerging but dominant areas in the developed countries. Elements of a programme for health promotion in the developing countries following key principles of self care and community participation are proposed. Demonstration programmes may be initiated to assess the feasibility and effectiveness of this programme before large scale implementation.

Community Health Workers↗

PubMedDate not supplied

Maintenance dialysis in patients from developing countries: the experience of an Italian center.

BACKGROUND: There are few studies concerning the clinical problems of patients from developing countries undergoing dialysis in European countries. This retrospective study aimed to describe the main clinical features of a group of these patients who happened to be on maintenance dialysis in our unit. METHODS: Analysis of the clinical features at presentation and at follow-up of a group of patients from developing countries who entered chronic dialysis in our unit over an 8 year period. RESULTS: From April 1994 to December 2001, 12 patients (eight males and four females, mean age 38.2 +/- 7.9 yrs) from developing countries (the Philippines (n=5); Egypt (n=4); Morocco (n=1); Mauritius (n=1); Sri-Lanka (n=1)) entered maintenance dialysis in our unit (six hemodialysis (HD) patients, six continuous ambulatory peritoneal dialysis (CAPD) patients). The cause of renal failure was severe/very severe hypertension in five patients (four of whom presented with very advanced end-stage renal disease (ESRD)), chronic glomerulonephritis in four patients, amyloidosis, type 2 diabetic nephropathy, and unknown causes in three patients. After a mean follow-up of 45.3 +/- 32.0 months (median 33, range 18-111), five patients continued on HD, two patients were on CAPD, whilst four patients received a renal transplant and one patient a renal and liver transplant. An important feature of our patients was the high infection rate (67%), such as tuberculosis (n=3), B and/or C viral hepatitis (n=4) and schistosomiasis (n=1). Of note were the clinical problems that developed after visits to the patients' native countries, during which the patients were dialyzed locally. After 5/20 visits (25%), three patients experienced a worsening of anemia (four incidences) and active hepatitis C development (one incidence). CONCLUSIONS: Our study demonstrates that patients from developing countries on maintenance dialysis differ from our local Italian dialysis population in several respects. These are young age, causes of renal failure, frequently late referral, high infection rates, and the clinical complications due to patients' visits to their native countries.

Adult↗

PubMed1994

Research on patient compliance in developing countries.

Patient compliance with health care provider advice is a subject of particular importance in developing countries, one that has not been sufficiently studied. This article begins by explaining why this type of research is important and describing the various methodologies used to examine patient compliance in developed nations--notably self-reporting by the patient, collateral reporting by friends or relatives, pill or bottle counting, review of the patient's clinic attendance, review of clinical outcomes, and use of biochemical tracers. The applicability of each of these methods to scenarios commonly found in developing countries is then considered, and the results of the limited compliance research performed in developing countries are described. In general, it is suggested that self-reporting, collateral reporting, and pill or bottle counting can be employed effectively in many Third World situations. The article also notes the importance of standardizing research procedures, provides logistic advice about applying various compliance research methods in Third World conditions, and points up the need to validate the accuracy of the methods used.

Attitude to Health↗

PubMed2006

Provider-specific report cards: a tool for health sector accountability in developing countries.

In most health care systems in most countries, providers are not adequately held accountable - by governments, purchasers, provider professional associations or civil society - for the quality of care. One approach to improve provider accountability that is being debated and implemented in a subset of developed countries and a smaller group of developing countries is provider-specific comparative performance reporting. This review discusses universal design options for report cards, summarizes the evidence base, presents developing country examples, reviews challenges and outlines implementation steps. The ultimate aim is to provoke thoughtful debate about if and how comparative performance reporting fits within a developing country's broader framework of strategies to promote quality of care.

Delivery of Health Care↗

PubMed2000

Prevalence and trends of overweight among preschool children in developing countries.

BACKGROUND: Obesity during childhood is a matter of growing concern. Several reports show increasing rates of obesity in developed countries, whereas the extent of the problem in developing countries remains unknown. OBJECTIVE: The aim of this study was to fill this gap by quantifying the prevalence and trends of overweight among preschool children in developing countries. DESIGN: One hundred sixty nationally representative cross-sectional surveys from 94 countries were analyzed in a standardized way to allow comparisons across countries and over time. Overweight was defined as a weight-for-height >2 SDs from the National Center for Health Statistics/World Health Organization international reference median. Prevalences of wasted children (< -2 SDs) are also presented to enable comparisons between both ends of the distribution. RESULTS: The global prevalence of overweight was 3.3%. Some countries and regions, however, had considerably higher rates, and overweight was shown to increase in 16 of 38 countries with trend data. Countries with the highest prevalences of overweight are located mainly in the Middle East, North Africa, and Latin America. Rates of wasting were generally higher than those of overweight; Africa and Asia had wasting rates 2.5-3.5 times higher than overweight rates. Countries with high wasting rates tended to have low overweight rates and vice versa. CONCLUSIONS: These estimates show that attention should be paid to monitoring levels and trends of overweight in children. This, however, should not be done at the expense of decreasing international commitments to alleviating undernutrition. The data presented confirm that undernutrition remains a major public health problem worldwide.

Africa, Northern↗

PubMedDate not supplied

General internal medicine and technologically less developed countries.

OBJECTIVE: To assess the international health activities of departments of medicine, divisions of general medicine, and general medicine faculty and the interest among departments of medicine in joint international health ventures. DESIGN: 15-item, mailed questionnaire. PARTICIPANTS: 100 chiefs of divisions of general medicine associated with training programs in internal medicine. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Completed questionnaires were returned by 87 division chiefs representing 1,355 general medicine faculty. 49% of division had faculty with six weeks' experience in less developed countries. 8.5% of general medicine faculty had six weeks' experience in less developed countries. 7.6% of general medicine faculty were interested in spending extended time in less developed countries. 19% of departments had formal collaborations with schools in less developed countries. 45% of departments were interested in affiliations with U.S. institutions for the purpose of joint international health ventures. CONCLUSIONS: The international health interests of current general medicine faculty may not be satisfied. Departmental and divisional encouragement of international interests would increase the number of U.S. general internists participating in less developed countries. The authors discuss the potential for greater involvement of general medicine faculty in international health.

Attitude of Health Personnel↗

PubMed1998

Telemedicine and developing countries. A report of study group 2 of the ITU Development Sector.

While there are significant potential advantages and benefits from telemedicine, the evidence of its cost-effectiveness and sustainability is meagre. This is because much of the telemedicine activity so far has been in the form of pilot projects of demonstrations in universities and hospitals with subsidized funding from government or other sources. The number of self-sustaining, commercial applications of telemedicine is still very small. Telemedicine undoubtedly yields cost savings in certain circumstances, but often the savings and benefits accrue to those who do not have to pay for the service. Thus, few service providers have found a way to recover their costs (and make a profit) from those to whom they provide their service. Even fewer countries have actually budgeted for the provision of telemedicine as a service widely available to their citizens. Nevertheless, with the rapidly declining cost in hardware and telecommunications, the level of interest and the corresponding activity in telemedicine is rising rapidly. Most of the telemedicine experience to date has been in the industrialized world. It is apparent that the first requirement of developing countries is for more information about telemedicine, what it is, and how it might be able to help solve some of the shortages in medical and health care. Given the potential of telemedicine to facilitate the provision of medical information and health care in rural areas, it seems useful for developing countries to undertake pilot projects in order to evaluate its potential and cost-benefits. The results of such pilot projects could be part of the development of a national health for all policy which takes telemedicine into account. In view of the other priorities of developing countries, especially those of the least developed countries, financing telemedicine activity is likely to remain a challenge for some time to come. Funding from external donor agencies may well be necessary, but local commitment and participation in pilot projects is essential if the project is to have a chance of success. As telemedicine requires a multidisciplinary approach, the active participation of telecommunication operators must be assured. Despite some false starts in the deployment of telemedicine as a continuing service to the general population--as opposed to a few well-to-do clients--telemedicine has great potential to improve access to health care and to contain costs in developing countries.

Computer Communication Networks↗

PubMed1998

[Prevalence of intestinal parasites among Japanese residents in developing countries].

We examined fecal specimens of Japanese residents in developing countries in order to know the prevalence of intestinal parasites in the group. One fecal specimen was collected from each 981 (in 1995) and 1275 (in 1996) Japanese living in Asia, the Middle East, Europe, Africa and Latin America. The specimens were fixed with 10% formalin in each area, and were examined in Japan by concentration method (formalin-ether sedimentation) to find protozoan cysts or helminth eggs. The infection rate of intestinal parasites was 3.0% in 1995 and 2.4% in 1996. The rate was high in Africa (1995: 5.7%, 1996: 4.7%) and Asia (1995: 3.8%, 1996: 3.0%). Regarding to the species of the parasites, Giardia lamblia (17 cases), Trichuris trichiura (14) and Ascaris lumbricoides (11) were detected frequently. Additionally, 7 cases of Heterophyes heterophyes infection were found in Asia and the Middle East. The infection rate was higher in adults than that in children, and a positive relationship between the infection rate and duration of stay was observed. Among the Japanese infected with intestinal parasites, abdominal symptoms such as diarrhea or abdominal pain were common (36.8%). It is also noteworthy that 28.1% of the Japanese infected had a history of gastric diseases such as gastric ulcer. Although the infection rate of intestinal parasites among Japanese residents in developing countries was low, compared to that of the natives in the countries, the rate is still higher than that in Japanese living in the home country. It is necessary to continue preventive measures such as health education in order to eradicate intestinal parasitic infections from this group.

Adolescent↗

PubMed1998

The International Telecommunication Union's report on Telemedicine and Developing Countries.

This paper reviews some of the main conclusions and recommendations from the Report on Telemedicine and Developing Countries, which was prepared for the International Telecommunication Union (ITU). The report is the result of three years' effort by a group of experts in telecommunications and telemedicine from around the world. It provides an extensive survey of the telemedicine experience of various countries. It discusses the different types and applications of telemedicine, the technologies used, costs and benefits, trends, prospects for global standards, and provides guidelines and recommendations to developing countries for implementation of telemedicine services. The ITU study group which prepared the report is expected to begin some new tasks in 1998, including the identification of a set of pilot telemedicine projects for developing countries.

Developing Countries↗

PubMed2003

Clinical experience of medical students in a developing country.

OBJECTIVE: This paper compares the clinical experience in acute conditions of the undergraduate students of a medical school from a developing country (Malaysia) with those from a developed country (UK). METHODS: This study was conducted at the School of Medical Sciences, Universiti Sains Malaysia (USM). Through questionnaire survey enquiry was made about 27 acute medical conditions (i.e. conditions related to internal medicine, paediatrics, and psychiatry), 15 acute surgical conditions (i.e. conditions related to general surgery, orthopaedics, ophthalmology, otorhinolaryngology, gynaecology and obstetrics), 15 surgical operations and 26 practical procedures. The results obtained were compared with published data from the UK. RESULTS: Acute medical conditions were seen by higher number of the USM students but with less frequency than the British students. The USM students saw practical procedures more frequently than the British students did, but almost an equal number performed these procedures independently. The British students attended surgical operations more frequently than the USM students did. CONCLUSION: Given the limitations of comparison (epidemiological, cultural and geographical differences, conventional curriculum (in the British medical schools) vs. problem based learning curriculum (in the Malaysian medical school)) the overall clinical experience of the medical students in the USM and the UK was comparable. The USM students had more opportunities to observe cases and procedures but "hands on" experience was similar to that of the British students.

Acute Disease↗

PubMed2002

Care of the frail elderly in developed and developing countries: the experience and the challenges.

Demographic and epidemiological changes will result in dramatic changes in the health needs of the world's populations. Everywhere there is a steep increase in the need for management of chronic diseases and for long-term care. Therefore, the search for effective policies to care for the frail elderly in general and long-term care (LTC) policies in particular, is one of the most pressing challenges facing modern society. There is no single converging paradigm and countries are experimenting with a number of different approaches. This section of the Monograph presents the experience in several developed and developing countries: Canada, United States, Italy, Germany, Sweden, Japan, Thailand and Chile. This effort is important because there is much to be learned from the experience of developed and developing countries in defining the range of policy options and in identifying successful and unsuccessful practices. In-depth understanding of the existing situations in developed and developing countries, and the nature of the variance among countries are important to provide insight for development of care policies by learning from what already exists. This article focuses on LTC, that is, on addressing the needs of the functionally disabled elderly. Our reflections are based on an international initiative to develop a decision-making framework for LTC policies launched by the World Health Organization (WHO) with the JDC-Brookdale Institute leading this effort.

Aged↗

PubMedDate not supplied

Rapid diagnosis of tuberculosis: laboratory techniques applicable in developing countries.

New technologies for the rapid diagnosis of tuberculosis that can be applied in developing countries where the prevalence of tuberculosis is high are based on methods that permit recognition of either mycobacterial products in clinical specimens or specific host responses to mycobacteria. Mycobacterial antigens can be identified by immunoassays based on the enzyme-linked immunosorbent assay (ELISA). Mycobacterial DNA or rRNA can be identified with the use of single-stranded DNA probes. Both techniques are potentially suitable for use in developing countries, although there remain technical problems associated with the use of sputum samples. Serodiagnosis by ELISA is a promising technique based on recognition of the IgG antibody response of the host. The technique is ready for early application and can be used in developing countries. However, high specificity depends on the use of antigens that are not now generally available. The predictive accuracy of any newly proposed diagnostic technique must be compared with that of direct microscopic examination of sputum.

DNA Probes↗

PubMed1994

Current role of vaccination in preventing acute respiratory infections in children in developing countries.

Acute respiratory infections (ARI) cause more than four million childhood deaths each year in developing countries. In addition to standard case management, vaccines have a great potential for reducing these deaths. Immunization against measles and pertussis, already reaching more than 70% of infants in developing countries, contributes to the prevention of more than one million childhood deaths. New conjugate vaccines against Haemophilus influenzae type b, if shown to be effective against pneumonia in developing countries, could reduce acute lower respiratory infection (ALRI) deaths by 4%. A further 10% reduction could be obtained by the availability of an effective conjugate vaccine against Streptococcus pneumoniae. A safe vaccine against respiratory syncytial virus could also prevent 10% of ALRI deaths. The potential role of other bacterial and viral vaccines needs to be clarified.

Acute Disease↗

PubMed2003

Recommendations for introducing genetics services in developing countries.

Many concerned scientists believe that developments in the medical application of genomics will widen the gap between the developed and the developing world. We argue that most developing countries now urgently need to incorporate genetic approaches (including DNA diagnosis) into their health services, and that many are able to do so. DNA diagnosis is relatively inexpensive, helps to develop skills in molecular biology and provides a basis for developing national expertise in genomics.

Cost of Illness↗

PubMed2005

[Genomic medicine: a privilege of developed countries?].

Genomic medicine is defined as the application of the knowledge originating from the Human Genome Project in health sciences. It has a vertiginous advance in developed countries, but its use in developing regions is scanty. This contributes to global health inequalities, stressing one of the greatest ethical problems that mankind is facing. In a study leaded by the University of Toronto Center of Bioethics, 28 highly qualified scientists elaborated a list of the ten most important biotechnologies to improve public health in developing countries. Several of these technologies are successfully applied in countries such as China, Cuba and Mexico. The factors that are hindering the application of such technologies in Chile, are briefly discussed.

Biotechnology↗