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At least 613 records · Page 34Linked to original sources
PubMed2004

A developing country perspective on vaccine-associated paralytic poliomyelitis.

When the Expanded Programme on Immunization was established and oral poliovirus vaccine (OPV) was introduced for developing countries to use exclusively, national leaders of public health had no opportunity to make an informed choice between OPV and the inactivated poliovirus vaccine (IPV). Today, as progress is made towards the goal of global eradication of poliomyelitis attributable to wild polioviruses, all developing countries where OPV is used face the risk of vaccine-associated paralytic poliomyelitis (VAPP). Until recently, awareness of VAPP has been poor and quantitative risk analysis scanty but it is now well known that the continued use of OPV perpetuates the risk of VAPP. Discontinuation or declining immunization coverage of OPV will increase the risk of emergence of circulating vaccine-derived polioviruses (cVDPV) that re-acquire wild virus-like properties and may cause outbreaks of polio. To eliminate the risk of cVDPV, either very high immunization coverage must be maintained as long as OPV is in use, or IPV should replace OPV. Stopping OPV without first achieving high immunization coverage with IPV is unwise on account of the possibility of emergence of cVDPV. Increasing numbers of developed nations prefer IPV, and manufacturing capacities have not been scaled up, so its price remains prohibitively high and unaffordable by developing countries, where, in addition, large-scale field experience with IPV is lacking. Under these circumstances, a policy shift to increase the use of IPV in national immunization programmes in developing countries is a necessary first step; once IPV coverage reaches high levels (over 85%), the withdrawal of OPV may begin.

Child↗
PubMed1990

Problems of drug therapy of epilepsy in developing countries.

Unavailability of drug therapy to patients with epilepsy in developing countries is probably the most important obstacle to effective primary care of epilepsy in these countries. At the recent international Merritt-Putnam Symposium in New Delhi, poor availability of drug supply and poor access to drug therapy were identified as major constraints to availability of drug therapy. The extent and magnitude of the problems are examined in this communication and methods of improving drug therapy of epilepsy in developing countries are suggested.

Anticonvulsants↗
PubMed1980

[Strategies for extending mental health services to developing countries. I. Description of the project].

Mental Disorders constitute a severe Public Health problem in developing countries due to inadequate resources specially in terms of trained personnel; furthermore, Mental Health care is given out only in specialized Institutions where it has not been possible to provide coverage for more than a small part of the population. In this context the Collaborative Study on Strategies for the Extension of Mental Health Care has been planned, using as its guiding principle the recommendations of the WHO Expert Committee on Organization of Mental Health Services in Developing Countries (W.H.O. 1975). The objectives of the study are to determine the feasibility of introducing Mental Health Care directed toward defined priority conditions into general health services, to develop methods of selection for interventions in Mental Health Care as well as methods for task oriented training for health workers, to evaluate effectiveness of alternative low cost methods and to develop and evaluate ways of simulating community response to problems related to mental disorders. The areas selected are representative of the range of environments in developing countries in terms of overall socioeconomic and health status. In each area, actions will be directed towards making baseline observations and towards provision of care (planning, training, supervision and provision of referral channels). Specific interventions in the Cali area are described in regard to the training of the Health Center personnel in Mental Health, the provision of psychotropic drugs at the peri-urban level and provision of Mental Health Care by Primary Health Workers under the supervision of Health Center physicians and nurses.

Allied Health Personnel↗
PubMed1993

Using survey data to assess neonatal tetanus mortality levels and trends in developing countries.

Demographic and health surveys are a useful source of information on the levels and trends of neonatal mortality in developing countries. Such surveys provide data on mortality occurring at 4-14 days of life, which is a sensitive indicator of neonatal tetanus mortality. We analyze birth history data from 37 national surveys in developing countries to assess the quality of neonatal mortality data and to estimate levels and trends in mortality occurring at 4-14 days. It is shown that mortality at 4-14 days has declined considerably during the last decade in most developing countries, concomitant with development and expansion of programs to reduce neonatal tetanus. These declines show that reductions in neonatal tetanus mortality probably have been an important contributor to the decline of neonatal and infant mortality during the 1980s.

Adolescent↗
PubMed1997

Epilepsy in developing countries.

On June 6th and 7th, 1996, an international workshop on specific aspects of epilepsy in the developing world was organized in Geneva by the chairman of the ILAE Commission of Epilepsy in Developing Countries, P. Jallon, involving members of the ILAE, the World Health Organization (WHO), and a network of people who work with epilepsy patients in developing countries. Those taking part included all the members of the ILAE Commission on Epilepsy in Developing Countries, the chairmen of the ILAE Commissions on Tropical Diseases, Epidemiology, Education, Economics, and Drugs, as well as the president, treasurer, and past president of the ILAE; and the president of the IBE, Hanneke de Boer. There were representatives from Eastern European countries (Russia, Slovenia, Turkey), South America (Brazil, Colombia, Uruguay, Ecuador, Venezuela), Africa (Ethiopia, Senegal, South Africa, Togo, Tunisia), and Asia (India, Indonesia, Pakistan, Sri Lanka, The Philippines and China). Representatives from WHO joined the meeting on the last day (Drs. L. Prilipko, A. Janca, and C. L. Bolis). Three major topics were considered--epidemiology, medical assessment, and therapeutic aspects as well as some economic and social aspects of the disease. A second mission of this meeting was to work with WHO representatives to develop a program for action to care for people with epilepsy in these countries.

Adolescent↗
PubMedDate not supplied

Contraceptive use during lactation in developing countries.

Contraceptive use by breastfeeding women in developing countries has led to concern about potentially harmful effects of steroid contraceptives on the health of breastfed children. In this paper, breastfeeding women's use of the pill and hormonal injections is investigated using survey data from 17 Latin American, Asian, and African countries. The results indicate that while the proportions of breastfeeding women who use these methods were small in most countries at the time of the surveys, the proportion using the pill was not inconsequential. In general, younger lactating women with higher education and more live births who live in urban areas are more likely to use the pill than other breastfeeding women.

Breast Feeding↗
PubMed2005

Burden of osteoporosis and fractures in developing countries.

The burden of osteoporosis in developing countries is increasing dramatically with the aging of the population and demographic trends; however, there is a lack of direct epidemiologic data. There are clear differences at present between and within populations that limits the validity of many estimates and more data is needed. Existing data and estimates are considered in terms of bone mass, bone structure, 10-year and lifetime probability of fracture, numbers sustaining fractures, the outcome of fracture, importance of differences in fracture management, and risk factors for their occurrence and outcome. Future trends are also considered.

Bone Density↗
PubMed1994

Violence against women: a neglected public health issue in less developed countries.

Violence against women is a significant public health issue in countries of both the industrialized and less developed world. This paper describes the magnitude and health consequences of domestic violence and rape, with an emphasis on developing countries; it recognizes, however, that there is a dearth of documentation regarding the wide range of activity opposing violence against women which is taking place in less developed countries. It briefly explores the factors that perpetuate violence against women and the strategies that have evolved to respond to the problem. It analyses the constellation of factors that may assist violence to emerge as a legitimate public health concern, and explores opportunities and obstacles to further progress in this field. Particular attention is devoted to the role of research in the policy-making process; research areas which may assist those opposing violence against women in all its forms are tentatively suggested.

Battered Women↗
PubMed1996

Delivery of primary neurosurgical care in developing countries--scope for mutual cooperation.

As with other specialized services there is an ever increasing gap in neurosurgical care between developed and developing countries. The need for neurosurgery has always been present in developing countries, but the recent introduction of computed tomography has identified many previously undetected cases, increasing the number of patients seeking treatment. However, developing countries suffer severe shortages of trained manpower, proper equipment, and expertise to initiate the services to meet this demand. In contrast, some developed nations are experiencing a surplus of neurosurgeons leading to problems in case exposure. A well-designed cooperative project between these countries can answer some of these problems, becoming an ideal example of mutual benefit.

Delivery of Health Care↗
PubMed1979

Nutritional problems in developing countries.

Nutritional problems in children constitute the major health problem in developing countries. Impact of a factors leading to different kinds of nutritional problems in developing countries are reviewed. Prevention and treatment of some special disease states are discussed. Outlines for some solutions to the greatest nutritional problems are presented.

Bottle Feeding↗
PubMed1992

Advertising for all by the year 2000: public health implications for less developed countries.

This paper argues that the development of global advertising has significant implications for the public health of less developed countries. These implications can be seen in three areas. First, it is clear that advertising and marketing of lethal or health-compromising products like alcohol and tobacco not only can increase the level of death and disease, but can also produce serious indirect effects upon families, communities, and entire societies. Second, advertising promotes a consumption ethic which can have far-reaching effects that go beyond individual behavior, significantly altering social relationships, and influencing public policies and allocation of scarce resources. Third, advertising can restrict the public's knowledge about health issues by substituting distorted and manipulative sales messages for vital, accurate health information. In addition, revenues from advertising are a primary support for many mass media systems and this further limits the presentation of critical information.

Advertising↗
PubMedDate not supplied

Health problems in a large cohort of Americans traveling to developing countries.

BACKGROUND: Millions of Americans visit developing countries each year, however, little is known about their health during travel. This study describes health problems in a large cohort of American travelers during and after their trip. METHODS: A 2-year survey of 784 travelers (95% follow-up) was conducted for persons traveling for < or = 90 days. At the pretravel visit, travelers were given a postcard to record adverse health events. Following travel, standardized telephone interviews were performed for any positive responses, or if the card was not returned. All travelers were contacted 2 months after return to determine late occurring illness and compliance with antimalarials. RESULTS: Travelers had a mean age of 44 years, a median duration of 19 days, and visited 123 countries. An illness was reported by 64% (1.6 illnesses per traveler). Ill travelers were more often female, and traveled longer than those who were not ill; depending upon destination, each day of travel increased by 3 to 4% the chance of becoming ill. Diarrhea was most common, occurring in 46%; 34% met a strict definition for traveler's diarrhea. Respiratory illness occurred in 26%, skin disorders in 8%, acute mountain sickness in 6%, motion sickness in 5%, accidents and injuries in 5%, and isolated febrile episodes in 3%. Medical care was sought by 8% of all travelers and 12% of those reporting illness. On return, 26% of travelers were ill, 56% of whom became ill after return. Diarrhea, respiratory illness, skin disorders, and febrile syndromes were most common, and 46% of those who were ill sought medical care. Complete compliance with antimalarials was 80%. Noncompliant individuals usually discontinued medications on return. Side effects were reported by 4% of those taking chloroquine, 11% of those taking chloroquine plus proguanil, and 14% of those taking mefloquine, with half of these neuropsychiatric. The incidence of documented malaria was 3.8 cases per 1,000 travelers. CONCLUSIONS: Many travelers experience adverse health events during and after travel to the developing world. Attention to the prevention and therapy of traveler's diarrhea, prophylaxis of malaria, management of respiratory illness, personal safety, and access to medical care during travel, and, recognition of clinical syndromes after return, will help to improve the traveler's health.

Adolescent↗
PubMed1996

Epidemiology & management of persistent diarrhoea in children of developing countries.

Diarrhoea that begins acutely but lasts longer than two weeks is defined to be persistent. Revised estimates in developing countries including India showed that acute diarrhoea accounts for 35 per cent, dysentery 20 per cent and non-dysenteric persistent diarrhoea (PD) for 45 per cent of total diarrhoeal deaths. PD also often changes marginal malnutrition to more severe forms. Factors that increase the risk of acute diarrhoea becoming persistent have been identified in India and other developing countries. These include antecedent malnutrition, micronutrient deficiency particularly for zinc and vitamin A, transient impairment in cell mediated immunity, infection with entero aggregative Escherichia coli and cryptosporidium, sequential infection with different pathogens and lack of exclusive breast feeding during the initial four months of life particularly use of bovine milk. Several issues regarding the management of persistent diarrhoea in hospitalized children in India have been resolved. Diets providing modest amounts of milk mixed with cereals are well tolerated. In those who fail on such diets providing carbohydrate as a mixture of cereals and glucose or sucrose hasten recovery. The role of antimicrobial agents and individual micronutrients in PD is currently being investigated. A management algorithm appropriate for India and other developing countries has been developed and found to substantially reduce case fatality in hospital settings to about 2-3 per cent. Recent epidemiological and clinical research related to persistent diarrhoea is also reviewed.

Animals↗
PubMed1995

The safe practice of anesthesia in developing countries.

Nurse anesthetists providing services in developing countries must be aware of the hazards inherent in such a mission. Proper planning and preparation are essential to insure safe, quality anesthesia care. Working conditions are austere; electrical supplies may be erratic, oxygen sources inconsistent, and up-to-date monitoring systems nonexistent. Medications and supplies will be limited, mandating conservation, reuse, and strict adherence to infection control procedures. Safe, reliable anesthesia delivery systems, preferably with the ability to scavenge waste anesthetics are required. Patients frequently have diseases endemic to the area and language barriers cause confusion and misunderstandings. The nurse anesthetist's role in these situations is multifaceted. This article describes how the nurse anesthetist must be creative, adaptable, and self-reliant to provide a high standard of anesthetic care and prevent mishaps in austere environments.

Anesthesia↗
PubMed2000

Improving prenatal nutrition in developing countries: strategies, prospects, and challenges.

In developing countries, the health and nutrition of females throughout their entire life is affected by complex and highly interrelated biological, social, cultural, and health service-related factors. Rather than focusing exclusively on the prenatal period, we describe a life cycle approach to improving maternal nutrition, which goes beyond the traditional provision of nutrition services during pregnancy, by addressing risk factors that are present well before pregnancy, even before childbearing age. This approach involves specific policy initiatives and a "minimum package" program that is targeted at females. Policy actions and the components for effective implementation of the program are described. The prospects and challenges to be overcome-which include translating scientific knowledge into action, removing conceptual and implementational constraints, identifying biologically meaningful indicators for problem identification, and improving understanding of physiologic and social adaptation mechanisms-are discussed, as are persistent problems with health care delivery systems.

Developing Countries↗
PubMed2005

[Should mechanical ventilation be used in ICU patients in developing countries?].

The purpose of this monocentric prospective cohort study was to assess mortality in intensive care unit (ICU) patients requiring more than 6 hours of mechanical ventilation (MV) in a developing country. The study setting was a 10-bed polyvalent ICU at the Centre Hospitalier Régiona1 in El Maarouf, Comoros Islands. The study population included a total of 106 patients requiring MV out of 633 consecutive patients admitted to the ICU over a 10-month period. Study parameters included demographic data, simplified acute physiology score version 2 (SAPS II), reason for admission, urgency of MV, duration of MV, complications of MV need for sedation and mortality in hospital and at one year. In-hospital mortality was 59%. Mortality was significantly higher in patients presenting elevated SAPS II and requiring myorelaxant drugs. Age, gender, reason of admission, emergency, sedation, complications of MV, duration of MV were not correlated with mortality. The best prognosis was associated with the following indications: severe malaria, meningitis, eclampsia and poisoning. All patients who left the ICU (41) were alive at one year. Mortality associated with use of MV for resuscitation in a developing country was similar to that observed in developed countries. The young age of patients, acute nature of manifestations and reversibility of diseases encountered may explain the favorable outcome observed in this study. The initial diagnosis and associated risk factors (using a severity score if necessary) must be taken into account in deciding the indication for starting and stopping MV. The results of this study show that MV is feasible and effective in a developing country, but requires experience, inventiveness and realism.

Adult↗
PubMed2003

Medical and radiation oncology for breast cancer in developing countries with particular reference to locally advanced breast cancer.

The first part of this review outlines the extent of the problem of breast cancer in developing countries, with particular reference to the difficulties surrounding breast cancer treatment in these countries. The second part is devoted to discussion of chemotherapy, hormonal therapy, and radiotherapy treatments suitable for developing countries. The goals of the review are to show how treatment strategies can be adapted in poorer countries and how oncologists from the developed world can play a role in developing countries. This review should be relevant to the developing world in general, but as the author comes from South Africa, many of the examples are from that country which has features of the developed and developing world.

Antineoplastic Agents, Hormonal↗