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PubMedDate not supplied

Gynecological cancers in developing countries: the challenge of chemotherapy in low-resources setting.

The epidemiologic pattern of cancers in developing countries differs in many aspects from that of industrialized nations. Cancer natural history, microbiologic environment, patient's immune system, and drug availability may differ as well. Four of five new cases of cervical cancer and most of cervical cancer deaths occur in developing countries. Where chemoradiation and supportive care facilities are unavailable, it would be logical to consider an inexpensive effective drug. In locally advanced cases, neoadjuvant chemotherapy followed by surgery should be considered the treatment of choice. For ovarian cancer, it may be reasonable to maintain a secure supply of platinum and/or taxanes. For endometrial cancer, platinum compounds are proved active chemotherapic single agents. Oral medroxyprogesterone acetate (MPA) may represent a good chance for treating an advanced or recurrent disease. For vulvar/vaginal cancer, the role of chemotherapy alone is currently considered limited, and it is mostly used as palliative treatment in advanced or recurrent cases. Whenever possible, standard western chemotherapic regimens should be applied in developing countries as well. When standard therapies are unavailable, drugs of choice should be easily accessible, inexpensive, and effective. The most commonly used drugs are cisplatin, cyclophosphamide, and MPA.

Antineoplastic Agents↗

PubMed1994

Destructive operations still have a place in developing countries.

OBJECTIVES: To determine the place of destructive operations in developing countries in patients arriving late in labor with a dead fetus and advanced infection, and to compare them with LSCS for patients with similar indications. METHODS: A total of 56 cases of destructive operations were carried out on patients with obstructed labor and intrauterine fetal death (IUFD) from the labor wards of Smt. S.K. Hospital from January 1985 to December 1991. These were compared with 27 cases of LSCS done for similar indications during the years 1989 to 1990. RESULTS: Patients treated with destructive operations had no maternal deaths, had very few complications and required a short hospital stay. Patients treated by LSCS, however, had one maternal death and complications such as post-partum hemorrhage, incidence of blood transfusion, post-operative shock, post-operative pyrexia and duration of hospital stay were more frequent. CONCLUSIONS: It is felt that in some properly selected cases presenting late with obstructed labor, IUFD and intrauterine sepsis, destructive operations should be performed as first choice. Thus, destructive operations still have a limited place in developing countries and are safer than LSCS for these patients.

Adult↗

PubMed1976

[Tuberculosis in developing countries compared to europe (author's transl)].

It is relatively easy to obtain a survey of the tuberculosis situation in the geographically demarcated countries of Europe. On the other hand it is impossible to acquire reliable and representative information on the majority of developing countries. Also the concept of a developing country cannot be accurately defined: the geographical, ethnic and cultural conditions predominating there may be diametrically different. In addition the paper is intended not only to take into account the present tuberculosis situation, but also to say something on the future development of tuberculosis in Europe and the developing countries during the next few years.

Adult↗

PubMed2006

Delayed umbilical cord clamping for reducing anaemia in low birthweight infants: implications for developing countries.

BACKGROUND: Cheap and effective interventions are needed to reduce the risk of infant anaemia in developing countries. Delayed cord clamping (DCC) has been shown to be a simple, safe and cost-free delivery procedure that augments red cell mass in appropriate-for-gestational-age term and preterm infants. It is not known, however, whether DCC is similarly safe and effective in small-for-gestational-age (SGA) infants. We analysed the available evidence to generate a balanced inference on the use of DCC in developing countries. OBJECTIVES: To examine the short- and long-term effects in SGA infants of DCC compared with immediate clamping, and to assess the relationship between time of clamping and the potential postnatal haematological complications of DCC in SGA infants. SEARCH STRATEGY: PubMed (1966 to January 2006), EMBASE (1988 to January 2006) and The Cochrane Library (Issue 1, 2006) were searched. Reference lists of published trials were examined and major journals of perinatal and tropical medicine were hand-searched. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing delayed with immediate cord clamping in infants born between 30 and 42 completed weeks of gestation and which included a proportion of SGA infants. DATA COLLECTION AND ANALYSIS: Three reviewers assessed eligibility and trial quality. MAIN RESULTS: To date, no trials have specifically reported the effects of DCC in SGA infants. Three trials were included, of 190 term and 40 preterm infants, a proportion of whom were SGA. DCC was associated with higher haemoglobin levels in term infants at follow-up [two trials, 127 infants, weighted mean difference (WMD) 9.17 g/L, 95% confidence interval (CI) 5.94-12.40]. In preterm infants, the proportion who required a blood transfusion in the 1st 6 weeks after birth was lower after DCC (one trial, 38 infants, RR 0.56, 95% CI 0.34-0.94). It was not possible to infer from the available data whether SGA infants were at greater risk of adverse effects in the early neonatal period. CONCLUSIONS: DCC in a group that contains both AGA and SGA infants was associated with higher haemoglobin levels at 2-3 months of age in term infants and a reduction in the number of blood transfusions needed in the 1st 4- 6 weeks of life in preterm infants. No reliable conclusions could be drawn about the potential adverse effects of DCC. The paucity of information on DCC in SGA infants justifies further research, especially in developing countries where the baseline risk for polycythaemia-hyperviscosity syndrome is likely to be lower than in industrialised countries.

Anemia↗

PubMed2003

Training subspecialty nurses in developing countries: methods, outcome, and cost.

BACKGROUND: As infections are controlled in developing countries, other pediatric subspeciality programs such as oncology become increasingly important. A major impediment to the development of such programs is a lack of trained nurses. Therefore, education of pediatric subspecialty nurses becomes a priority. PROCEDURE: We describe three models we have used for education of pediatric oncology nurses: a short series of classes or lectures with additional training of key nurses, an expanded 12 week series of classes at centers combining didactic and clinical instruction and a regional residential school offering regular 12 week courses in theory and clinical practice. RESULTS: Cost analysis showed that the cost per nurse trained was, respectively, 3,700; 4,350; and 5,500 US dollars. Early effectiveness indicators show that retention rates are high, home institutions are satisfied, and nurses trained shared their knowledge with other nurses and improved nursing practices. CONCLUSIONS: Programs to teach subspecialty nursing in developing countries are effective and can improve medical care. Such programs should be based on past experience and evaluated as to cost and effectiveness.

Developing Countries↗

PubMed2005

Deficiencies in drinking water distribution systems in developing countries.

Rapidly growing populations and migration to urban areas in developing countries has resulted in a vital need for the establishment of centralized water systems to disseminate potable water to residents. Protected source water and modern, well-maintained drinking water treatment plants can provide water adequate for human consumption. However, ageing, stressed or poorly maintained distribution systems can cause the quality of piped drinking water to deteriorate below acceptable levels and pose serious health risks. This review will outline distribution system deficiencies in developing countries caused by: the failure to disinfect water or maintain a proper disinfection residual; low pipeline water pressure; intermittent service; excessive network leakages; corrosion of parts; inadequate sewage disposal; and inequitable pricing and usage of water. Through improved research, monitoring and surveillance, increased understanding of distribution system deficiencies may focus limited resources on key areas in an effort to improve public health and decrease global disease burden.

Developing Countries↗

PubMed2001

The future of transgenic plants in developing countries.

Whatever their own policies may be, developing countries will inevitably be affected by the development of genetically-modified organisms in industrialized countries. While maintaining a cautious attitude, most of these countries wish to keep their options open, thus protecting themselves from the risk of being deprived of future technologies that might allow them to achieve self-sufficiency in food production, to resolve certain problems confronting their most vulnerable populations and to preserve the international competitiveness of their products. Companies should see that it is in their interest to help these countries implement their own policies, notably through an open attitude to industrial property. If the value of genetic engineering is thus confirmed, then it perhaps in this manner that GMOs will earn the legitimacy required to make them acceptable to the people of Northern countries where the majority of solvent markets are located.

Agriculture↗

PubMedDate not supplied

Control of hypertension in the population. Strategies in affluent and developing countries.

Control of hypertension in population. Strategies in affluent and developing countries. The control of hypertension encompasses primary prevention, early detection and adequate treatment of high blood pressure. Primary prevention involves action at the population level to reduce obesity, alcohol and salt consumption, and to increase physical activity. The management of hypertension involves diagnostic work-up, assessment of overall cardiovascular disease risk, non-pharmacological and pharmacological treatment. The majority of community control programmes emphasized detection and treatment, rather than primary prevention. There are limitations to pharmacological treatment of hypertension, as shown by various studies, where a significant proportion of hypertensives have not been controlled by the treatment applied. In addition, the blood pressure-cardiovascular risk relationship is continuous and progressive and, even within the conventionally defined "normotensive" range, complications occur with escape control. Developing countries will encounter the problem of prohibitive costs of care and drug treatment for hypertension. Therefore greater emphasis must be put on primary prevention in population control of hypertension.

Antihypertensive Agents↗

PubMed1986

Population redistribution towards core areas of less developed countries, 1950-1980.

"This paper presents estimates of the rate of population redistribution to the core areas of 44 developing countries over the period 1950-80. Particular attention is given to the period 1970-80, a time during which the core areas of developed countries experienced substantial declines in their rates of net inmigration. The principal finding is that the core areas of most developing countries are still experiencing high and, in a number of cases, increasing rates of net inmigration." The author contends that "this finding confirms the developmental model of spatial concentration and dispersal and should lay to rest other explanations of deconcentration, including arguments that focus on diseconomies of absolute size in the core area or on fluctuations in the aggregate economy." The difference between the population growth rates of entire nations and of core areas is used as a measure of interregional migration. Data for the 44 countries and information on the data sources are included in appendixes.

Demography↗

PubMed2000

[Improvement of tuberculosis diagnosis by the Mycobacteria Growth Indicator Tube (MGIT) in a developing country laboratory].

In order to improve tuberculosis diagnosis in a developing country (Senegal), we evaluated a new liquid-based medium and nonradioactive system, Mycobacteria Growth Indicator Tube (MGIT), with individual clinical specimens collected in Dakar. The main purpose was to compare the time to detection and the rate of recovery of Mycobacterium tuberculosis complex and to determine its importance with respect to Lowenstein-Jensen (LJ), a liquid-based-medium for isolation of M. tuberculosis complex. 531 specimens were processed with Mycoprep kit containing NaOH-N-acetyl L-cystein and inoculated on both LJ and MGIT and incubated at 37 degrees C for 60 days. For each medium, the recovery rate and the time to detection were recorded. Among the 531 specimens, of which 121 smears were positive, 32.5% (173/531) grew the M. tuberculosis complex. Of these, 103 were smear positive (S+) and 70 smear negative (S-). LJ recovered 54.9% (95/173) and MGIT recovered 91.9% (159/173). Disagreements were observed with 92 isolates, LJ failed to recover 78 while MGIT failed to recover 14. The overall mean time to detection was 20.1 days for LJ and 10.5 days for MGIT. MGIT has shown a better sensitivity in isolation with significant reduction in reporting culture for M. tuberculosis complex. As a simple and a nonradiometric system, it could be used in conjunction with egg-based media in developing countries laboratories.

Bacteriological Techniques↗

PubMed1998

The first clinical and epidemiological programme on renal disease in Bolivia: a model for prevention and early diagnosis of renal diseases in the developing countries.

BACKGROUND: The prevalence and incidence of renal diseases in developing countries are not known. This lack of knowledge is an obstacle to the adoption of preventive measures which may be of great value in a social and economic environment where treatment options for end-stage renal failure are simply not available to the vast majority of the population. Urinalysis, a simple and inexpensive test, remains a cornerstone in the evaluation of the kidney and may also be easily employed in mass screening for renal abnormalities in a developing country. METHODS: An educational campaign on renal diseases was conducted in three selected areas of Bolivia. Urine samples were collected and sent to one of 21 participating clinical centers. Fresh urine specimens were screened using a dipstick for chemical analysis and by microscopic urinalysis after centrifugation. In those patients in whom urinary abnormalities were found, further investigations were carried out in order to define the diagnosis; these patients were enrolled in a 3-year follow-up program. RESULTS: Apparently healthy subjects (n = 14,082) were referred to the First Clinical and Epidemiological Program of Renal Diseases from rural and metropolitan areas in Bolivia. Urinary abnormalities were detected in 4261 subjects at first screening. The most common form of urinary abnormality was hematuria, which was found in 2010 (47% of positively screened subjects). Other renal abnormalities were leukocyturia (41%) and proteinuria (11%). Confirmatory tests and further clinical studies were then carried out in 1019 people. On a second screening 35% of the subjects had no urinary abnormalities; in the remaining people the following diagnosis were made: asymptomatic urinary-tract infection (48.4%), isolated benign hematuria (43.9%), chronic renal failure (1.6%), renal tuberculosis (1.6%). Other diagnosis were: renal stones 1.3%, diabetic nephropathy 1% and polycystic kidney diseases 1.9%. CONCLUSIONS: This study helped define for the first time the frequency of asymptomatic renal diseases in Bolivia. It shows that it is possible to screen a large population of patients at relatively low cost, providing the framework for further action that may help in the prevention and timely diagnosis of renal diseases.

Adolescent↗

PubMed1998

The affordability of antiretroviral therapy in developing countries: what policymakers need to know.

OBJECTIVE: The objective of this paper is to assist policymakers in developing countries and international donors by providing an outline of economic information needed to make a decision regarding the purchase of drugs to provide highly active antiretroviral therapy (HAART). DESIGN: The following paper: (i) reviews existing experiences of policymakers in developing countries regarding the purchase of drugs needed for HAART, (ii) identifies issues that would need to be addressed and data that would be required to make more informed decisions regarding this issue, (iii) develops a cost-benefit model that could be utilized in designing an economic research project evaluating the economic costs and benefits of HAART, and (iv) performs a preliminary test of this model with data from Costa Rica. RESULTS: A review of experiences with this issue reveals that there are growing political, legal and budgetary pressures for countries to make tenable decisions regarding the purchase of drugs for HAART. An economic model describing the costs and benefits of HAART is proposed, although much of the required data for using such a model is currently neither available or in the process of being collected. CONCLUSIONS: It is imperative that economic data be collected to better inform policymakers in developing countries about their decision regarding the purchase of these drugs. It is recommended that such economic data be collected as organizations such as the United Nations Joint Programme on HIV/ AIDS (UNAIDS) initiate their medical assessments of HAART in developing countries.

Anti-HIV Agents↗

PubMed2005

A randomized trial on sodium reduction in two developing countries.

Hypertension remains the most common cardiovascular risk factor in developing countries, yet the majority of patients have no access to pharmacological therapy. Population-wide preventive strategies, such as salt restriction, are an attractive alternative, but experience in resource-poor settings is limited. To address this question, we conducted a randomized crossover study of salt restriction in adults living in Nigeria and Jamaica in order to estimate the mean blood pressure (BP) response. After a 4-week run-in period to determine willingness to adhere to a low-salt diet, 56 Jamaicans and 58 Nigerians completed an 8-week crossover study of low-salt and high-salt intake. Baseline BPs were in the normotensive range (systolic=125 mmHg in Jamaica, 114 mmHg in Nigeria). Baseline urinary sodium excretion was 86.8 and 125.6 mEq/day in Nigeria and Jamaica, respectively. The mean difference between urinary sodium excretion at baseline and at the end of the 3-week low-sodium phase was 33.6 mEq/day in Nigeria and 57.5 mEq/day in Jamaica. During the high-sodium phase, mean change in urinary sodium excretion from baseline to week 3 was 35.0 and 5.5 mEq/day in Nigeria and Jamaica, respectively. The mean change in systolic BP ('high' vs 'low' sodium phase) was approximately 5 mmHg in both groups. This study suggests that the efficacy of sodium reduction in developing countries equals those noted in more affluent cultures. If promoted on a wide scale, sodium reduction could be used to treat persons with established hypertension, and more importantly, to prevent age-related increases in BP in poor communities.

Adult↗

PubMed2001

Decision-making: initiation and withdrawing life support in the asphyxiated infants in developing countries.

The issues of life support in the asphyxiated infant are not only whether cardiopulmonary resuscitation or CPR will be successful, but also whether if successful, the infant will be severely damaged. This is particularly important in the developing countries because the damaged infants may burden the society. The country has to allocate huge financial and human resources to look after them. When it comes to decisions in initiation and withdrawal of life support, there are differences between the East and the West. Physicians are searching for reliable predictors of outcome of term asphyxiated infants to enable early decision-making, initiation and withdrawal life support, as well as counselling and planning appropriate level of treatment including trials of cerebroprotective therapies. Markers commonly used to identify birth asphyxia are not good predictors of brain injury or death. There is a myriad of reports on clinical or laboratory tests, some using single parameter, to help determine neurological outcome of asphyxiated term infants. Much frequently used equipment in developed countries can be expensive and inaccessible to developing countries. There is an urgent need to look for relevant, simple and inexpensive methods. A combination of measurements may look promising in the early selection of at-risk neonates for decision and counselling. Recently measurement of urinary lactate: creatinine ratio to identify early newborn infants at risk for HIE was proposed. Withdrawal of life support is an ethical issue. In withdrawing life support of the severely asphyxiated infants, one must be aware of the differences of approach. There are differences in religion and culture; in beliefs and philosophies, between the East and West The importance of neonatal resuscitation should be emphasised. Some regions still adhere to obsolete resuscitation methods. Neonatal Resuscitation Program (NRP) should be promulgated and organised resuscitation should be introduced. There is an urgent need to train the trainers in CPR in the developing countries.

Asphyxia Neonatorum↗

PubMed2003

Palliative care in developing countries: why research is needed.

Contemporary medical knowledge is sufficient to control the suffering of most of the millions of terminally patients in the world if applied appropriately. However, palliative care is still unavailable to most patients in developing countries. Effective models of palliative care delivery that have been tested in developed countries seldom apply to the developing world where poverty, extended families, and insufficient health infrastructure require the adaptation of such care to local cultures and circumstances. Research from developing countries is therefore needed to develop, implement, and monitor the delivery of palliative care in ways that are feasible in resource-poor settings and acceptable to local populations. Palliative care research shares most of the obstacles common to health research in the developing world. Additional obstacles include a lack of consideration of palliative care as part of cancer control strategies and the low political acceptability of such care because it involves the use of opioid analgesics. Coordinated research efforts through active networking and common protocols would increase the visibility of the discipline, provide answers relevant to the local contexts, and assist in expanding palliative care services across the developing world.

Developing Countries↗

PubMed2006

[The design and establishment of epidemiological surveillance systems for high-risk diseases in developed countries].

In animal pathology, epidemiological surveillance has, over the last two decades, gradually become a top priority in developed countries, due to progress made in fighting major animal diseases. The management of effective epidemiological surveillance networks for high-risk animal diseases in developed countries is based on general rules governing epidemiological surveillance networks, but involves certain specificities. This article first of all sets out the requirements for the optimal functioning of epidemiological surveillance networks. It then describes and analyses the qualities expected of high-risk animal disease surveillance networks: detection sensitivity and specificity, simplicity and adaptability, and good cost efficiency. Finally, it illustrates these general concepts via four examples of animal disease epidemiological surveillance in developed countries: foot and mouth disease in Europe, West Nile virus in the United States of America and France, and bluetongue in France.

Animal Diseases↗

PubMed2002

Retinal detachment in developing countries.

Treatment of retinal detachment has been a low priority in developing countries. It is thought to be less common in India and Africa than in Europe and N America. The aetiology and presentation of retinal detachment in the Third World are affected by genetic and environmental factors. In general, patients are more likely to present late, and complex detachments are relatively more common. Despite these problems, the results of surgery are encouraging, with more than 80% final anatomical success, and over 60% of re-attached retinas obtaining vision of 6/60 or better. The management of retinal detachment in developing countries can be improved by strengthening training programmes and by developing and equipping centres to carry out retinal surgery.

Developing Countries↗

PubMed1998

Perinatal infections--problems in developing countries.

The transmission of infections from the biologic mother to her offspring is popularly known as perinatal infection (PI). It is not synonymous to infections during the perinatal or neonatal period. Physicians should avoid focusing attention only on the TORCH agents in the evaluation of suspected PI. Perinatal period begins from 28 weeks of gestation. Would one consider in utero infections in the first or second trimester of pregnancy as PIs? Developing countries have difficulty in collecting reliable and accurate data of PIs. These data are useful to define the magnitude of the problems, to monitor the trends, to recognise the mode of spread, and to find a solution of PIs. Most PIs are asymptomatic and diagnosis is extremely difficult. Developing countries need rapid, easy-to-operate, simple, and cheap diagnostic tools urgently. Access to health care in the remote city is limited. Newer drugs are too expensive and very few patients can benefit from these. Each developing country should prioritize its PI problems and tackle those that have serious public health problems and socio-economic impact. Most developing countries should focus on HIV (human immunodeficiency virus) and HBV (hepatitis B virus) infections. Other countries where ophthalmia, malaria or tuberculosis are prevalent or endemic, should focus on these. Developing countries are more willing to allocate the budget for prevention of diseases than for treatment. There may be problem of promulgating the information on prevention of diseases because of illiteracy, multi-lingual community. Vaccines where available, should be affordable. Other effective prevention guidelines should be workable in poorer nations. The government should play an important role in enforcing immunisation program by intensive promotion program or by legislation.

Developing Countries↗