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PubMed2002

Telemedicine and neurosciences in developing countries.

It is a universally accepted fact that the number of neurosurgeons in developing countries is woefully inadequate. It is also unrealistic to expect this limited number to work in professional isolation, in suburban and rural areas, without adequate infrastructure. Therefore, this has resulted in concentration of neurosurgeons in developing countries, in metropolitan areas, even at the risk of being underemployed. The phenomenal advances in communications and information technology in India are resulting in a new look at how secondary and tertiary health care can be provided to the underprivileged masses. Following a proof of concept validation ISRO (Indian Space Research Organization) in conjunction with the Apollo Hospitals, is ready to use satellite technology to provide specialist care not only to suburban and rural India but to other countries as well, by using the large number of highly qualified and trained specialists in urban India. The implications of these developments for the delivery of neurosurgical care to suburban and rural India is briefly reviewed.

Developing Countries↗
PubMed2002

Oral lesions of HIV infection in developing countries.

HIV infection has spread rapidly within developing countries since it was first recognized in the early 1980s. The purpose of this paper is to review the prevalence of oral lesions associated with HIV infection (oral HIV) in the developing world, and to identify additional factors that may complicate the presentation of these lesions. Direct comparison of regional and local prevalence studies within Africa, India and Thailand is speculative because there are few reports available. Furthermore, inherent differences in study design, data collection, standardization and calibration of health workers make any inferences inconclusive. Additional prevalence studies of oral HIV lesions associated with systemic disease or social conditions, such as poverty or malnutrition, are needed. In order to provide a basis for the diagnosis and treatment of HIV-associated oral lesions in the developing world, it is important to recognize any confounding factors that may impact on their presentation and management. Elucidation of these various factors may provide a basis for treatment within the developing and developed world.

Africa↗
PubMedDate not supplied

Pesticide usage and health consequences for women in developing countries: out of sight, out of mind?

Pesticide exposures of women in developing countries are aggravated by economic policy changes associated with structural adjustment programs and globalization. Women in these countries, particularly in the agricultural sector, are increasingly exposed. Since they are concentrated in the most marginal positions in the formal and informal workforces, and production is organized in a gender-specific way, opportunities for women to control their exposures are limited. Data from developing countries show that: 1) women's exposures to pesticides are significantly higher than is recognized; 2) poisonings and other pesticide-related injuries are greatly underestimated for women; 3) for a given adverse outcome from exposure, the experience of that outcome is gender-discriminatory; 4) erroneous risk perception increases women's exposures. The hiatus in knowledge of gender-specific exposures and effects is related to gender biases in the nature of epidemiologic inquiry and in the literature, and the gendered nature of health workers' practices and surveillance. Recommendations are made for strong, independent organizations that provide opportunities for women to control their environments, and the factors affecting their health, as well as gender-sensitive research to address the particularities of women's pesticide exposures.

Adolescent↗
PubMed1998

Care of human immunodeficiency virus-infected children in developing countries. International Working Group on Mother-to-Child Transmission of HIV.

CONTEXT: There is urgent need to strengthen the area of pediatric HIV/AIDS care in developing countries. Clinical research in this area is also scarce. METHODOLOGY: A literature review and a postal survey were used to obtain updated information on mortality, morbidity and current standards of care of children born to HIV-infected mothers in developing countries. A 2-day workshop was organized to review the available data and to identify the key areas where clinical research should be conducted. MAIN FINDINGS: Rates of mortality and morbidity were very different from one study to another but generally higher than in industrialized countries. Prognostic studies for HIV-1-infected children in developing countries were not available. Based on the report of 14 teams from 11 countries, specific protocols for HIV-infected children with persistent diarrhea or severe malnutrition were documented in fewer than one-half of the cases. Secondary antimicrobial prophylaxis after interstitial pneumonia or recurrent infections was still infrequent, as primary prophylaxis of opportunistic infections. The following list of clinical research priorities was identified by the workshop participants: primary prophylaxis of opportunistic and bacterial infections; case management of persistent diarrhea; reassessment of the performance of p24 antigen for diagnostic and prognosis use; studies on the etiology of pulmonary infections; long term observational pediatric cohorts; current weaning practices and duration of breast-feeding; counseling and HIV testing of children and families; prevention of HIV sexual transmission in children and adolescents.

AIDS Serodiagnosis↗
PubMed1999

Patients view of the anaesthetist in a developing country.

OBJECTIVE: The objective of this study was to assess patients regarding their knowledge and perception of the anaesthetists' role in patient care in a developing country. SETTING: The audit was conducted at the Aga Khan University Hospital, Karachi. METHODS: Two hundred surgical and 102 medical out-patients were included in the audit prospectively who filled a detailed questionnaire. RESULTS: Fifty-six percent of the patients knew that anaesthetists were medically qualified but only 20% and 27% had an idea about their role in the intraoperative and immediate postoperative period. 14.6% were aware of the anaesthetists role outside the operating room. No difference was observed between the two groups of patients except that a higher percentage of surgical patients were interested in having more information regarding anaesthesia and wanted to choose their anaesthetist if the need arose. Gender difference was observed in answer to two questions only. A higher percentage of males know the role of anaesthetist in the recovery room whereas a greater number of females who had surgery before remembered their anaesthetist postoperatively. CONCLUSION: The results of this audit show a poor perception of the anaesthetists role both inside and outside the operating room. Although public knowledge surveys have been carried out in developed countries there is a pressing need to repeat these in developing countries since the image as perceived by public may have a direct bearing on the recruitment of young doctors into an already shortage specialty in these less affluent countries.

Anesthesia↗
PubMed1987

Psychiatric morbidity in primary health care. A two-stage screening procedure in developing countries: choice of instruments and cost-effectiveness.

The use in two developing countries of a two-stage psychiatric screening procedure with an emphasis on minor morbidity is described. This was the first use of the Self-Reporting Questionnaire and Clinical Interview Schedule in conjunction. Health auxiliaries with limited training administered the first-stage screening instrument. In comparison with other psychiatric screening techniques used in developing countries, the procedure described may prove to be more cost-effective in primary care and community surveys, and more appropriate for assessing the wide range of minor psychiatric morbidity commonly encountered in such settings.

Brazil↗
PubMed1983

An algorithmic method for management of mental health problems in developing countries.

A new problem-oriented cross-cultural method has been developed to identify the appropriate management of mental health problems in primary-care settings. It is designed to be used by multipurpose health workers in out-patient clinics in many developing countries. Presenting mental health problems in many cultural settings can be placed into one or more of eight behaviourally determined categories. After this initial categorization an algorithmic process is used to determine the sequence of observations which must be made in order to identify the appropriate management. The system allows for variations in available resources and local constraints. We outline the design principles of this algorithmic method and the rules for using it, and describe a training programme developed to teach people to adapt it and use it effectively. The evaluation studies that have been done in different developing countries confirm that the method is acceptable and efficient, and gives management decisions with a high degree of repeatability.

Community Health Workers↗
PubMed1999

Health information systems in developing countries: benefits, problems, and prospects.

Health information systems are important support tools in the management of health care services delivery in both developed and less developed countries. An adequate health information system is vital not only for assessing the health needs of populations and groups, but also for planning and implementation of health interventions. It is equally important in the evaluation of programmes from both the perspectives of effectiveness and coverage. This paper examines the practical difficulties of health care provision amidst inadequate statistics to inform decisions. Major obstacles to the introduction of effective health information systems in developing countries are examined, and practical suggestions on measures to overcome them discussed. It is concluded that the establishment of well co-ordinated information collection systems at the various levels of the health care system in developing countries, using appropriate staff, could contribute greatly to improvements in health care delivery.

Data Collection↗
PubMed1985

Manpower and the future role of dentistry in developing countries.

The latest information from the WHO Global Data Bank confirms that oral disease prevalence figures are deteriorating for most of the developing countries. Although, oral diseases are preventable, inadequate application of preventive measures and inappropriate establishment of oral health care delivery systems including the employment of unsuitable oral health personnel categories, may have led to the ineffective control of these problems. There is now a need to consider the types of oral health services actually needed in developing countries and the future role dentistry will need to adopt to ensure that manpower resources adequately meet the requirements of the population. An analysis of the extent and severity of oral diseases and the demands of populations in these countries reveals that the majority of the services required are fundamentally restorative, rehabilitative and preventive. These services could be carried out by various types of dental auxiliaries and non-dental personnel. This approach complies with the strategy of the universal three-level model which will operate by a referral system based on full community involvement at the primary health care level. In this way the ratio of members of the oral health team to population may be calculated on the basis of the most relevant information. Under the supervision of the Oral Health Unit, WHO and the Intercountry Centre for Oral Health, Thailand, health service research is being undertaken to test the possible application of the primary health care approach to the design of an effective oral health delivery system for developing countries.

Adult↗
PubMed2001

Mortality among epilepsy patients attending a tertiary referral center in a developing country.

Epilepsy is associated with excess mortality of two to three times in developed countries. Precise epidemiological data on mortality and cause of death are not available from India or most other developing countries. This study was carried out to estimate the mortality rates and to identify the demographic and clinical characteristics associated with mortality in a hospital based cohort of epilepsy patients. A cohort of patients enrolled in the epilepsy clinic in 1985 was followed up till 1997 (12 years). The mortality rate, demographic and clinical correlate of mortality were analysed for 246 patients (men 161, women 85) who had complete data. Cause of death was not examined in this study. Eighteen (men 15, women 3) of the 246 patients (7.3%) had died during the follow up period of 12 years. The crude death rate for the state of Kerala for the year 1990 (mid period of the study) was 5.9 per thousand population. The demographic and clinical characteristics of those who died (corresponding figures for survivors are given in brackets) were as follows: mean age 33.6 years (22.8 years), presence of abnormal neurological examination 38.9% (15.4%), mental retardation 33.3% (12.8%), abnormal CT scan 38% (21.5%). Regarding the seizure frequency at the time of enrollment and eventual mortality, there were no deaths among patients who had an Engel's seizure score of less than or equal to 4 (no seizures or nocturnal seizures only). The mortality was 5% for an Engel's score of 5 or 6 and 11% for an Engel's score greater than 6. Within the group with epilepsy, higher seizure frequency at the time of initial evaluation was associated with excess mortality. Abnormality on neurological examination, older age group and male sex were other factors that correlated with excess mortality.

Adolescent↗
PubMed1998

Dental caries in developing countries. Preventive and restorative approaches to treatment.

The rate of dental caries in developing countries is rising. Because more than 80 percent of the world's children live in these countries, this alarming trend is of great concern from a public health standpoint. Currently, most dental care in developing nations consists of dental surgery in urban areas. Decay is usually left untreated until it becomes so extensive and/or painful that extraction is the only option. Traditional approaches to treating carious lesions have met with marginal success. There is a need for widespread implementation of preventive strategies, which have proven extremely effective in industrialized nations. Also, promising new techniques and materials are being developed that are enabling dentists and dental personnel to make less costly treatment of dental caries more readily available to underserved populations.

Adolescent↗
PubMed2003

Policy and ethical issues in applying medical biotechnology in developing countries.

A brief review of some of the key issues in policy relating to the ethical issues raised by medical biotechnology in developing countries is presented, using India as an example. A series of some key issues is discussed, including information obtained from interviewing Indian government policy makers. Some of the issues discussed include: Economic and social incentives to encourage biotechnology; Health policy and ethics review; Patents on drugs; Medical genetics; Relationship to traditional medical practices; Positive public attitudes to biotechnology; Limited public participation; Infrastructural hurdles; Indian progress in stem cell research; and dilemmas of expensive technologies. The results show that although the needs of developing countries are different to those of rich countries, government policy utilizing guidelines and ethics committees has evolved as mechanisms to aid ethical health care delivery in India. In all countries there may be some of these concerns that are raised here, however, the integration of traditional medicine and advanced medical technology, and access to medical services by people in need, are particularly important challenges in developing countries. Better public involvement in policy making will require education and infrastructural organization as well as mutual willingness on the part of policy makers and citizens.

Attitude to Health↗
PubMed1998

Measuring lay people's perceptions of the quality of primary health care services in developing countries. Validation of a 20-item scale.

INTRODUCTION: Methodologies that have been developed and validated in accordance with accepted scientific standards are needed to monitor and assess the quality of primary health care in developing countries. OBJECTIVE: To present the results of reliability and validity testing of a new instrument of measurement intended to document the user's opinion on the quality of primary health care services. METHODS: The 20-item scale includes three subscales related to health care delivery personnel and facilities. There were 241 people in one city and two villages in Upper Guinea who responded to the questionnaire. An item analysis preceded the test of psychometric properties of the three subscales and of the total score. Reliability was estimated by analyses of internal consistency and the Cronbach's alpha coefficient. A variety of statistical procedures were used to test factorial validity, trait validity (convergent and discriminant) and nomological validity. RESULTS: The reliability of the subscales ranged from 0.71 to 0.88. The validity analyses supported the initial dimensionality and suggested good construct validity. CONCLUSION: Results confirm the value of the use of the scale developed and highlight the need to take into account the diversity of how quality is perceived by lay people in developing countries. It is suggested that the process of formalization of this type of measurement scale be pursued.

Adult↗
PubMed1996

Hepatitis E virus seroprevalence in acute viral hepatitis in a developed country confirmed by a supplemental assay.

Hepatitis E virus (HEV) infection is prevalent among cases of acute viral hepatitis in young adults in developing countries. HEV infection is not restricted to endemic areas, but would appear to be worldwide in distribution. In order to document the incidence of HEV infection in acute hepatitis cases in a developed country, IgG and IgM anti-HEV antibodies and HEV RNA were tested in 101 Caucasian patients with acute viral hepatitis; 92 of these cases had markers of acute viral hepatitis other than HEV. Forty-seven (46.5%) cases had IgG anti-HEV; IgM anti-HEV and HEV viremia were not detected. As the incidence of anti-HEV was higher than would be expected, the possibility of the occurrence of false positive results was subsequently investigated. Supplemental antibody testing, using a broadly reactive epitope region, reduced the frequency of anti-HEV to 17%. Therefore, supplemental antibody testing confirms the hepatitis E virus seroprevalence in a developed country. Since IgM anti-HEV and HEV viremia were not detected, persons with IgG anti-HEV may be "subclinical HEV cases," or have long-lived antibodies in their circulation.

Acute Disease↗
PubMed2000

Priority setting for health research: lessons from developing countries. The Working Group on Priority Setting.

Research resources for addressing health problems of developing countries remain disproportionately low compared with the tremendous disease burdens borne by these countries. There is a need to focus these scarce resources on research that will optimize health benefits and lead to equity. This paper reviews processes and methods that have been used for setting research priorities. Past and current processes have focused on expert-driven research agenda, emphasizing scientific autonomy and global analyses. Methods for setting priorities have focused on the metrics of disease burdens, while less attention has been placed on who sets priorities and how choices are made. The paper proposes a strategy of priority setting, based on lessons learned from essential national health research (ENHR) approaches attempted in several developing countries. With equity in health and development as its goal, the proposed model is demand-driven, and involves multi-dimensional inputs and multiple stakeholders. Various steps of the process are discussed: getting participants involved; gathering evidence and information; determining criteria for priority setting; and implementation and evaluation. The paper concludes with a discussion of the gap between national research priorities and the research agenda set at regional and global levels, an issue that needs to be satisfactorily addressed in the future.

Developing Countries↗
PubMed2005

Drug discovery and developments in developing countries: bottlenecks and way forward.

Infectious and parasitic diseases continue to threaten the health of million of people throughout the world, with the major burden being in developing countries. Many of the currently available drugs for the treatment of these diseases face setbacks such as insufficient efficacy, increasing loss of effectiveness due to emergence of resistance, high levels of toxicity, inaccessibility and/or high costs. The driving force for drug discovery and development by pharmaceutical firms has been the foreseeable profit from drug sells. Since most infectious diseases prevail in developing countries and the fact that people living in these countries have poor purchasing power, the market for such drugs are unattractive to these firms. Thus, there has been reluctance for the pharmaceutical companies to engage in the development of drugs addressing diseases that mainly affect developing countries. Although a lot of research to discover new effective and cheap drugs is in progress in the disease endemic countries, it is not yet possible to fully develop leads and drug candidates from natural products, hence people in these countries continue to rely on traditional medicines. Poor economies and technological capabilities, lack of human resources and good management in these countries are the major constraints to progress in research and development work for new drugs. This paper discusses these major bottlenecks in drug discovery and development and suggests the way forward.

Communicable Diseases↗