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PubMedDate not supplied

Pertussis in developing countries: definition of the problem and prospects for control.

Pertussis is a distinct clinical syndrome caused by Bordetella pertussis. The disease has been well characterized and largely controlled in the industrialized countries. Studies of pertussis in developing countries have been much more limited, in large part because of difficulty in culturing the organisms. Conventional whole-cell vaccine is being widely used in developing countries but without clear epidemiologic measures of efficacy. The introduction of new acellular pertussis vaccines has focused attention on the need to define the impact of pertussis in the developing world and to explore the optimal approach to control of this illness.

Child↗

PubMed1991

Disease control priorities in developing countries: health policy responses to epidemiological change.

Health systems in developing countries are facing major challenges in the 1990s and beyond because of a growing epidemiological diversity as a consequence of rapid economic development and declining fertility. The infectious and parasitic diseases of childhood must remain a priority at the same time the chronic diseases among adults are emerging as a serious problem. Health policymakers must engage in undertaking an epidemiological and economic analysis of the major disease problems, evaluating the cost-effectiveness of alternative intervention strategies; designing health care delivery systems; and, choosing what governments can do through persuasion, taxation, regulation, and provision of services. The World Bank has commissioned studies of over two dozen diseases in developing countries which have confirmed the priority of child survival interventions and revealed that interventions for many neglected and emerging adult health problems have comparable cost-effectiveness. Most developing countries lack information about most major diseases among adults, reflecting lack of national capacities in epidemiological and economic analyses, health technology assessment, and environmental monitoring and control. There is a critical need for national and international investment in capacity building and essential national health research to build the base for health policies.

Acquired Immunodeficiency Syndrome↗

PubMed1991

[Epidemiology of sexually transmissible diseases in developing countries in the era of AIDS].

Recent developments in the epidemiology of sexual transmitted diseases (STD) in developing countries are reviewed. STD are very frequent in the tropics, particularly in large urban areas. They put a heavy burden on public health because they affect the economically most important age groups and because their sequellae may be fatal. Pelvic inflammatory disease and its consequences, and morbidity during pregnancy and the neonatal period are among the most important causes of mother and child morbidity. STD favour sexual transmission of HIV and may therefore explain the explosive AIDS epidemics in many developing countries. Antimicrobial resistance has made treatment of gonorrhoea and chancroid more difficult and more expensive. STD and HIV infection may be responsible for up to 17% of productive years lost to disease in certain regions. Strategies to control STD should be developed and linked with the AIDS programs. Both should be integrated in the primary health care system.

Developing Countries↗

PubMed1978

Patterns of fertility decline in developing countries, 1950-75.

Since 1965 there have been substantial declines in the crude birth rates of many countries in the developing world, particularly the largest countries. This auspicious trend is shown clearly in an analysis of population figures for the last 25 years, despite the fact that there are deficiencies in the data. In 1950 the average crude birth rate for developing countries was 42 per thousand per year. Over the next 15 years, declines in the crude birth rate were limited to a relatively few, and for the most part small, countries. After 1965, however, for the 13 developing countries with a population numbering 35 million and over, there have been declines in the crude birth rate averaging 13 percent, with declines of over 12 percent in 9 of them. The effects of a number of sociodemographic factors on crude birth rates are examined, and the analysis shows that increases in the age at marriage and decreases in marital fertility were the principal factors affecting declines since 1965.

Adolescent↗

PubMed1978

Physician importation--a solution to developing countries' rural health care problems?

Developing countries almost universally suffer from severe health service shortages, particularly in rural areas. Manpower problems are the most critical aspect of the shortages. Iran has recently begun a massive program to increase physician supply in its rural areas by importation of physicians from India, Pakistan, and the Philippines. The present study investigated two questions: What are physicians' reasons for accepting a post in a rural area of another country, and what are the attitudes of residents in such rural areas toward foreign physicians? Results of a questionnaire survey of foreign physicians indicate that the most common reasons for physician acceptance of the posts were higher salaries and the desire to go eventually to a Western country. Results of an interview survey of Iranian consumers indicate that residents of rural areas were far more likely to prefer Iranian auxiliaries than non-Iranian physicians.

Consumer Behavior↗

PubMed1991

Nutritional problems of developing countries.

The nutritional problems of developing countries are conditioned by poverty, near exclusive reliance on plant sources of nutrients, and high rates of infections. Common deficiency diseases include protein-energy malnutrition, nutritional anemias, vitamin A deficiency, iodine deficiency, and possibly others. Population subgroups at particularly high risk are the children and women of poor families. Control of these nutritional diseases requires systematic diagnosis of the existing situation and appropriate intervention strategies such as targeted food and specific micronutrient supplementation, food fortification, nutrition education, and reductions in infections as well as general improvements in economic conditions and social equity.

Child↗

PubMed1992

Mortality from tobacco in developed countries: indirect estimation from national vital statistics.

Prolonged cigarette smoking causes even more deaths from other diseases than from lung cancer. In developed countries, the absolute age-sex-specific lung cancer rates can be used to indicate the approximate proportions due to tobacco of deaths not only from lung cancer itself but also, indirectly, from vascular disease and from various other categories of disease. Even in the absence of direct information on smoking histories, therefore, national mortality from tobacco can be estimated approximately just from the disease mortality statistics that are available from all major developed countries for about 1985 (and for 1975 and so, by extrapolation, for 1995). The relation between the absolute excess of lung cancer and the proportional excess of other diseases can only be approximate, and so as not to overestimate the effects of tobacco it has been taken to be only half that suggested by a recent large prospective study of smoking and death among one million Americans. Application of such methods indicates that, in developed countries alone, annual deaths from smoking number about 0.9 million in 1965, 1.3 million in 1975, 1.7 million in 1985, and 2.1 million in 1995 (and hence about 21 million in the decade 1990-99: 5-6 million European Community, 5-6 million USA, 5 million former USSR, 3 million Eastern and other Europe, and 2 million elsewhere, [ie, Australia, Canada, Japan, and New Zealand]). More than half these deaths will be at 35-69 years of age: during the 1990s tobacco will in developed countries cause about 30% of all deaths at 35-69 (making it the largest single cause of premature death) plus about 14% of all at older ages. Those killed at older ages are on average already almost 80 years old, however, and might have died soon anyway, but those killed by tobacco at 35-69 lose an average of about 23 years of life. At present just under 20% of all deaths in developed countries are attributed to tobacco, but this percentage is still rising, suggesting that on current smoking patterns just over 20% of those now living in developed countries will eventually be killed by tobacco (ie, about a quarter of a billion, out of a current total population of just under one and a quarter billion).

Adult↗

PubMed1992

The magnitude of mortality from acute respiratory infections in children under 5 years in developing countries.

This article reviews the available evidence of mortality from acute respiratory infections (ARI) among children aged under 5 years in contemporary developing countries and compares the findings with European populations before 1965. In European populations before 1965, the level of mortality was found to be a determinant of the proportion of deaths due to ARI. There were marked differences according to regional patterns of mortality. Deaths from ARI played a smaller role after 1950, when the use of antibiotics became generalized. In developing countries, the role of ARI mortality seems to be similar to the European experience. The age pattern is very marked. In absolute values, ARI mortality is highest in the neonatal period and decreases with age. In relative values, ARI mortality is highest in the postneonatal period. ARI, mainly pneumonia, accounts for about 18% of underlying causes of death in developing countries. Pneumonia and other ARI are frequent complications of measles and pertussis; ARI is also commonly found after other infections and in association with severe malnutrition. Virtually no data are available in developing countries to provide final estimates of the role of ARI in mortality of children aged under 5 years. However, the WHO figure of 1 out of 3 deaths due to--or associated with--ARI may be close to the real range of the ARI-proportional mortality in children of developing countries. Results are discussed in light of the definitions of ARI used in various studies, the difficulties in ascertaining and coding multiple causes of death and the quality of data from some sources.

Acute Disease↗

PubMed1991

Oral health manpower projection methods and their implications for developing countries: the case of Zimbabwe.

Manpower projections for oral health are generally held to be more accurate than those for other health sectors since the diseases involved and their treatment times can be predicted more precisely. Nevertheless most oral health manpower projections are either overestimates or are not in line with the resources of individual countries, especially in developing countries. Zimbabwe was taken as the study case, and oral health manpower projections were made using two of the most commonly employed methods and one new approach. The projections obtained using the three methods were all different, and even the lowest projection is beyond the resources of the country. It is recommended that in making oral health manpower projections, the facilities available to accommodate these personnel should also be taken into account.

Dental Hygienists↗

PubMed1991

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

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

Breast Neoplasms↗

PubMed1991

Tuberculosis and HIV-infection in developing countries.

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

Adolescent↗

PubMed1991

The needs of developing countries and the resources required.

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

Cross Infection↗

PubMed1991

[Vaccines and developing countries].

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

Developing Countries↗

PubMed1991

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

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

Accidents, Traffic↗

PubMed1992

[Epidemiological studies on viral hepatitis among long-term sojourners in the developing countries and evaluation of preventive measures].

It is known that acute viral hepatitis is very common among sojourners in developing countries. In order to conduct effective health control, epidemiological studies were made on viral hepatitis which occurred among Japanese staying in developing countries, and evaluations were carried out on preventive measures. The subjects of present study were a group of Japanese people staying in developing countries for two years. Mid year population of the group was 1732 in 1988. Period of the present study is ten years from 1979 to 1988. The study was conducted based on the reports from offices in each country, survey trips and serological studies on the subjects. In 1979, frequency of hepatitis A (HA) was very high showing 79% of total hepatitides. However after starting of inoculation of human immune serum globulin (ISG), the frequency of HA declined remarkably. Statistical significance was recognized in the efficacy of ISG. Among 35 cases of hepatitis B (HB) (34 males and 1 female), 2 derived from HBe antigen carrier while the remaining 34 were regarded as infected during their stay in developing countries. No cases of HB were recognized among those who received injections of HB vaccine. The rate of people whose HB marker turned positive during their stay is showing a tendency of increase (4.2% in 1987). The frequency of infection with HB virus is especially high in Asian and African countries where the carrier rates of native people were also high. Ten cases of non-A non-B hepatitis were recognized. Among them 7 were infected in Asia, 1 in Africa and 1 in Central America.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Ongoing research in occupational health and environmental epidemiology in developing countries.

Research in occupational health and environmental epidemiology can play an important role in furthering our understanding of occupational and environmental health problems. Research guides us in the recognition, management, and prevention of health problems. However, in developing countries, where rates of occupational and environmental illnesses and injuries are higher and where these problems are often more severe than in developed countries, research capabilities are less developed. In mid-1990, a project was undertaken to (a) document ongoing research in occupational health and environmental epidemiology in developing countries, (b) facilitate the exchange of information among researchers in this field, (c) stimulate research, and (d) avoid unnecessary duplication among researchers in this field. A questionnaire was mailed, the purpose of which was to learn the current status of research in developing countries and to develop a directory of such ongoing research. The questionnaire was sent to 1,528 individuals. Of the 500 research projects identified, 77% were investigating chemical hazards; 26%, physical hazards; 10%, biological hazards; and 10%, psychosocial hazards (some projects addressed multiple hazards). The chemical hazards studied most frequently were dusts, pesticides, and lead. The greatest number of research projects were identified in China, India, Brazil, Korea, and Thailand. Most projects were descriptive or cross-sectional epidemiologic studies or industrial hygiene or exposure-assessment studies. The World Health Organization has published a directory of the specific research projects that were identified in this survey.

Developing Countries↗

PubMed1978

[Problems in production, control and utilization of veterinary vaccines in the developing countries].

For a whole series of reasons, most of which are political, the developing countries are following a policy of national self-sufficiency in veterinary vaccines. They are faced with problems at various levels: (1) at the level of logistic distribution, the developing countries suffer from a shortage of trained personnel, frequently lacking in enthusiasm, an often chronic shortage of funds; poorly equipped premises; poor maintenance of sophisticated but indispensable equipment (e.g. freeze-driers); a lack of facilities for cold storage and of distribution channels; field personnel with limited experience; (2) at the level of production, they must contend with difficulties in obtaining supplies of flasks and glassware; irregular supplies of water and electricity; difficulties in obtaining susceptible animals for quality control. The developing countries have found basically pragmatic solutions to these problems, such as the strict separation of the sites, materials and personnel involved in routine diagnosis and those involved in production; temporary foreign technical assistance, with or without financial aid; the use of simple, unsophisticated techniques, which are known to be reliable, even if somewhat outdated; manufacturing in bulk in multiple-dose bottles; research into the thermostabilisation of vaccine strains and the development of thermoprotective diluents for freeze-drying and reconstitution; the extensive use of combined vaccines; the establishment of production and control standards under the auspices of the WHO/FAO/OIE. In spite of these obstacles, the cost price is particularly low (from 0.20 to 0.35 francs per dose), which compares favourably with that of foreign private industry.

Africa↗

PubMed1991

[Dentistry in developing countries].

The author presents different approaches to dental activities in developing countries. The general prevalence of dental caries and periodontitis in developing countries is low. The limited resources for health programmes, and for oral health in particular, underscore the need to make priorities in order to improve the health of the inhabitants. To promote oral health, it is necessary to focus on improving knowledge about the major oral diseases and the possibility of developing community-based programmes of intervention and prevention. The integration of oral health into general health programmes is a major goal in the prevention and combat of oral diseases. Knowledge and research in fields of oral medicine, preventive oral programmes as well as in fluoride toxicology as part of water programmes is important.

Dental Care↗