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PubMed2003

Feasibility and safety of day care laparoscopic cholecystectomy in a developing country.

BACKGROUND: Although day care laparoscopic cholecystectomy (DCLC) has been shown to be safe in centres with adequate infrastructure for day care surgery, its feasibility and safety in developing countries has never been studied. Because of differences in the quality of health care delivery, western guidelines for day care surgery cannot be universally applied to developing countries. PATIENTS AND METHODS: Patients less than 65 years who were graded I and II on the American Society of Anesthesiologists physical status score, irrespective of their educational status, living within 20 km, and willing to make their own arrangements for a return to hospital in case of problems were selected for DCLC. Follow up was done by patients calling the hospital the morning after surgery. RESULTS: 50% of the eligibility criteria were new; 313/383 patients were suitable for DCLC. The commonest cause for rejection was that the patient lived out of the defined area (50%). Altogether 92% were discharged within eight hours of surgery. The reasons for failure to discharge were the presence of abdominal drains in four (2%), nausea and vomiting in nine (3%), and conversion to open surgery in five (2%). Ten patients (3%) were readmitted; of these only two (<1%) had complications needing re-exploration. Analysis of results showed that the inclusion and discharge criteria were valid and that the readmission and complication rates as well as the ease and accuracy of follow up were comparable to published data. DCLC reduced waiting times and increased patient turnover and may have a positive impact on resident training. CONCLUSIONS: DCLC is safe, feasible, and has potential benefits for health care delivery in developing countries. Each surgical service needs to develop their own guidelines based on local patient demography.

Adolescent↗
PubMed1992

Towards a sustainable livestock production in developing countries and the importance of animal health strategy therein.

Livestock and animal health development projects have not always led to substantial increases in animal productivity or in farmers' welfare. Some have even resulted in unsustainable systems, when they were not based on an understanding of (livestock) production systems. The multipurpose functions of livestock and complex relationships between the biological, technical and social components require a systems approach, whereby nutrition, animal health, breeding, biotechnology knowhow, inputs and technologies are used to optimise resource use. The challenge for developed and developing countries is to reverse the current degradation of the environment, and arrive at sustainable increases in crop and livestock production to secure present and future food supplies. For rural development, governments should show long term commitment and political will to support the rural population in development programmes, because smallholders (including women and landless livestock keepers) represent a large labour force in developing countries. Different systems need different approaches. Pastoral systems must focus on effective management of grazing pressure of the rangelands. Communal rangelands management involves not only the development and application of technologies (e.g. feedlots, vaccination campaigns), but also land tenure policies, institutional development, economic return and a reduction in the number of people depending upon livestock. Smallholder mixed farms must aim at intensification of the total production system, in which external inputs are indispensable, but with the emphasis on optimum input-output relationships by reducing resource losses due to poor management. Resource-poor farming systems must aim at the improved management of the various livestock species in backyards and very small farms, and proper packages for cattle, buffaloes, sheep, goats, rabbits and poultry should be developed. Specialised commercial livestock farming systems (poultry, pigs, dairy or meat) can only be sustainable with adequate marketing, supply of quality feed, veterinary services, labour, management and control of pollution. Animal health programmes play a keyrole in the proposed system approach.

Agriculture↗
PubMed2003

Evaluation of pressure and durability of a low-cost wheelchair cushion designed for developing countries.

Pressure sores are a medical problem for wheelchair users worldwide. In developing countries this problem is more critical because of lack of access to specialized technologies and medical assessment. Seat cushions to relieve pressure represent one of best ways to prevent pressure sores for people with spinal cord injury, amputation, cerebral palsy, and other disabilities that require use of wheelchairs for long periods of time. The purpose of this study was to evaluate the performance of a low cost cushion, called the Tuball, designed for low-income communities in developing countries. The Tuball is made from bicycle inner tubes and plastic balls. Its durability and pressure-relieving characteristics were compared with the ROHOTM cushion and the foam cushions now used in Brazil. A sample of 30 participants tested the three cushions: 15 persons with paraplegia and 15 matched able-bodied persons evaluated the capacity of the cushions to distribute pressure. This study also addressed the use of samples of persons without disabilities to test wheelchair cushions.The Tuball cushion provided significantly better pressure distribution than the foam cushion. A t-test was used to compare disabled persons and non-disabled persons as samples in testing cushions. No difference between pressure distribution between non-disabled and disabled participants was found in testing the ROHO cushion or the foam cushion. However, both capacities of pressure distribution and HICPR varied between non-disabled and disabled participants for the Tuball cushion. To determine the useful life of the Tuball cushion, a fatigue test was conducted to simulate sitting and transfer. Both the Tuball and ROHO cushions withstood the equivalent of at least 1 year of use, whereas the foam cushion broke down.

Brazil↗
PubMed1995

Strategic issues in preventing cataract blindness in developing countries.

Cataract blindness is a public health problem of major proportions in developing countries. Intracapsular cataract extraction with aphakic spectacles has been the standard surgical technique for restoring sight. Because of image magnification in the operated eye, however, the result in unilaterally blind patients is less than satisfactory. Fortunately, with the availability of low-cost intraocular lenses (IOL) and ophthalmologists trained in extracapsular surgery, it is now practical to intervene successfully in the unilateral case. The need for increased attention on the quality of the visual high prevalence of cataract blindness in developing countries and an increasing cataract incidence due to an aging population require substantial increases in surgical volume. The third issue relates to cost. If significant increases in surgical volume and quality of outcomes are to be realized without an increased need for external funding, service delivery must be made more efficient. The expansion of IOL surgery for unilateral blindness is a favourable trend in ensuring financial sustainability of delivery systems; patients can be operated on while still economically productive and able to pay rather than waiting for bilateral blindness and a less favourable economic and social impact. If the quality, volume, and cost issues are to be successfully addressed, operational and structural changes to eye care delivery systems are necessary. These changes can be effected through training, technology introduction, management of facilities, social marketing, organizational partnerships, and evaluation. With improved understanding of the critical factors in successful models their widespread replication will be facilitated.

Blindness↗
PubMedDate not supplied

Zoonotic tuberculosis due to Mycobacterium bovis in developing countries.

The World Health Organization (WHO) estimates that human tuberculosis (TB) incidence and deaths for 1990 to 1999 will be 88 million and 30 million, respectively, with most cases in developing countries. Zoonotic TB (caused by Mycobacterium bovis) is present in animals in most developing countries where surveillance and control activities are often inadequate or unavailable; therefore, many epidemiologic and public health aspects of infection remain largely unknown. We review available information on zoonotic TB in developing countries, analyze risk factors that may play a role in the disease, review recent WHO activities, and recommend actions to assess the magnitude of the problem and control the disease in humans and animals.

Animals↗
PubMed2001

Do national medicinal drug policies and essential drug programs improve drug use?: a review of experiences in developing countries.

Increasing concerns regarding access to and appropriateness of medicinal drug use have led many governments in developing countries to develop national policies and regulations intended to increase the affordability, supply, safety, and rational use of pharmaceuticals. However, little is known about the intended and unintended impacts of these social experiments on actual drug use. We conducted a critical review and synthesis of the international literature in an attempt to define the current state of knowledge regarding drug policy effects on drug use, and to extract from the evidence important lessons for future policy and research. Literature sources included the archives and computerized databases, articles published in medical and pharmacy journals, as well as published annotated bibliographies. The evaluated interventions included three broad categories: (1) multi-component national drug policies including essential drug programs; (2) drug supply and cost-sharing programs; and (3) regulatory measures. Most of these studies utilized weak research designs that evaluated programs solely on the basis of post-intervention measures. Only two studies measured pre-policy utilization, but did not include a control group. Thus, none of the results are conclusive, and the findings represent, at best, hypotheses for more rigorous studies of policy impacts. Some suggestive findings include an association between increases in the supply of essential drugs (combined with training) and more appropriate use of medications in primary care settings. In addition, preliminary data suggest some unintended effects of de-registration of drugs or upward reclassification of specific medicines. Similarly, loosening restrictions have sometimes been accompanied by increased dispensing of specific drugs by unqualified personnel. The available studies focused only on a few categories of national and regulatory policies. Because of poor study design, the results do not provide valid data to determine whether national drug policies improve drug use. Moreover, no studies have evaluated the effects of major and recent changes, such as increased use of product patents, national pharmaceutical insurance policies, and increased privatization of pharmaceutical products and services. Future studies need to explore the consequences of these emerging developments on drug access and use. Despite the difficulties inherent in evaluation of national policies, stronger research designs can and should be carried out. Interrupted time-series analysis and other more rigorous designs should become standard designs for policy evaluation in the same way that standard treatment guidelines are intended to guide medical practice.

Developing Countries↗
PubMed2006

A package of interventions to reduce school dropout in public schools in a developing country. A feasibility study.

OBJECTIVE: School dropout rates are staggeringly high in developing countries, even for elementary school children. This study aims to assess the feasibility and initial efficacy of a package of interventions tailored to reduce school dropout in public schools in an urban city in Brazil. METHOD: Two public schools with similar high rates of dropout in elementary grades were selected. In one of them, a package of universal preventive interventions was implemented during a school year, including two workshops with teachers, five informative letters to parents, three meetings with parents at school, a telephone helpline at school, and a 1-day cognitive intervention. For children who stayed ten consecutive days out of school without reason, mental health assessment and referral to mental health services in the community were offered. In the second school, no intervention was implemented. RESULTS: After this 1-year intervention, there were significant differences between the two schools in rates of both dropout (P < 0.001) and absenteeism in the last trimester (P < 0.05; effect size = 0.64). In the intervention school, 18 (45%) youths returned to school after intervention among the 40 at-risk students. Moderate engagement of school staff was the main logistic problem. CONCLUSIONS: Our findings suggest that programs combining universal primary preventive strategies and interventions focused on at-risk students can be implemented and useful in developing countries to reduce school dropout.

Adolescent↗
PubMed1980

A problem-oriented approach to management of mental illness in developing countries.

A new problem-orientated method has been developed to identify the appropriate management of mental illnesses in cross-cultural primary care settings. It is designed to be used by intermediate level health workers in outpatient clinics in many different developing countries. The research undertaken to develop and evaluate this new method is described, and its implications for improving the quality of mental health care are discussed.

Decision Making↗
PubMed2002

Some ethical issues in community-based rehabilitation initiatives in developing countries.

PURPOSE: This commentary provides both theoretical and practical insights into the concept of community-based rehabilitation (CBR) and its application in developing countries. In doing so it explores current practices in CBR and the debate surrounding them, namely the ethical question and how this may impact on future CBR. The main argument in this account is that disability is a development issue; with widespread poverty, inequality and violation of human rights, and should be addressed within the broader context of community development which may include strategies such as CBR. METHOD: A review and analysis of recent literature on CBR has been conducted including the review of a number of empirical research documents from various CBR initiatives in developing countries. RESULTS: CBR has increasingly been under scrutiny in terms of the extent to which these have succeeded in delivering rehabilitation services to those in need in the community as well as the permitted level of participation and control of disabled people over the rehabilitation process. Many programmes have been unsustainable and it has been difficult to evaluate their full usefulness to disabled people. These issues raise an ethical question about CBR being an appropriate strategy for the rehabilitation of people with impairments in developing countries. CONCLUSION: This background emphasizes that new directions in CBR need to be put in place in order to maximize the realization of the ultimate goal: the greatest participation for disabled people in all spheres of life. Effective rehabilitation programmes should allow people with disability to have greater control in the nature of their rehabilitation and that the role of professionals and other stakeholders is one of allies and resources in the rehabilitation process. Moreover, the participation of community members in the rehabilitation policy should be assured.

Adult↗
PubMed1989

Correlates of fertility in selected developing countries.

The impact of differentials in key socioeconomic variables on fertility levels in 32 developing countries is assessed through multiple regression analysis of aggregate-level data on 27 developing countries for 3 recent guinguennia, grouped into 4 categories according to region (Latin America vs Asia/Oceania/Africa) and stage of fertility transition (recent vs relatively prolonged fertility decline). The results demonstrate the substantial impact of differences in child survival and educational attainment on the intercountry variance of fertility rate ranges from 46-84%), while economic indicators (per capita gross national product and % labor force in agriculture) have slight net impact.

Asia↗
PubMed1996

Applications and transfer of information technology in veterinary research in developing countries: the Nigerian experience.

An overview and analysis of the current status of information technology (IT) and its role in animal health research and development (R & D) projects in developing countries have been undertaken. This study is based mainly, but not exclusively, on the Nigerian situation and experience, which are considered to be typical of those in the majority of developing countries where IT is still in its infancy, and few individuals and institutions engaged in R & D projects have access to computing and modern, reliable telecommunications facilities. The analysis has emphasised the following: the limited impact of IT on large-scale field projects; the major factors militating against its successful acquisition, application and transfer; short- and long-term needs and priorities for IT; IT inputs for effective implementation of field projects and exchange of R & D information. Of the numerous factors which have hindered the growth and transfer of IT in much of the developing world, the most important are: (1) weak science and technology (S & T) base; (2) shortage of highly skilled front-line scientists, technologists and information professionals; (3) inadequate financial resources. Experience gained from three field projects highlighted the fact that although IT inputs, such as computers, are vital for the efficient management and rapid communication of research information, careful planning of projects, adequate financial and logistic support, availability of skilled manpower and basic infrastructural facilities are indispensable for the effective utilisation of the inputs. A promising and cost-effective method of transfer of IT inputs to those countries which can hardly afford them at present is through the establishment of institutional research links between developed and developing countries. Successful partnerships usually provide, among other things, computing facilities and manpower training for the latter and opportunity for genuine research collaboration. This form of IT transfer is an important step towards increased application of IT inputs in R & D projects, creation of the much needed inventory of databases and information systems on animal health projects in developing countries. Only then can meaningful exchange of R & D information, in an acceptable format and at affordable price, be realised within and between them. A possible role is envisaged for the major international organisations such as the Food and Agriculture Organization of the United Nations and the United Nations Educational, Scientific and Cultural Organization in ensuring the success and sustainability of these developments.

Animals↗
PubMed1982

Seasonality and nutritional status. A review of findings from developed and developing countries.

Studies of seasonality and growth from developed nations demonstrate distinct effects on weight and height gains according to the season. When maximal group gains in height are recorded, minimal weight gains are detected. Only a quarter and a third of all children had their minimal and maximal height gains respectively, in the same period as minimal and maximal group gains occurred. Rain and pre-harvest months are usually associated separately with the disease incidence peaks and with lower energy and nutrient intake. In most areas of the developing world, however, rainy months with a higher incidence of diseases coincide with the lean or hungry pre-harvest months. Some communities have devised certain mechanisms which are likely to buffer negative seasonal effects (rainy or pre-harvest months) on health and nutritional status. Thus, either as a result of lower intakes of energy and nutrients and/or less efficient utilization of energy and nutrients, one is likely to find important seasonal effects in poor agricultural communities of developing countries. The importance of adequate knowledge about seasonal effects to support the better use of existing resources allocated to health and nutrition programs is discussed.

Body Weight↗
PubMedDate not supplied

National health accounts in developing countries: appropriate methods and recent applications.

Better information on the financing of the health sector is an essential basis for wise policy change in the area of health sector reform. Analysis of health care financing should begin with sound estimates of national health expenditure--total spending, the contributions to spending from different sources and the claims on spending by different uses of the funds. The member countries of the OECD have successfully established such comparative health expenditure accounts in terms of standardized definitions of the uses of funds and breakdowns by public and private sector sources. This has resulted in important research on health system differences which could explain variations in the level and composition of financing. The United States has developed a more detailed approach called National Health Accounts, which expands the OECD method into a more disaggregated 'sources and uses' matrix. In the developing countries, analysis of health expenditures has been much less systematic, despite several decades of calls by international researchers for more attention. This paper reviews previous work done in developing countries and proposes renewed attention to national health expenditures, adapting the recent experience of the United States. Because most developing countries have more pluralistic health financing structures than are found in most industrialized countries, an enhanced and adapted version of the 'sources and uses' matrix method is proposed. This method should be modified to address the relevant categories of expenditures prevalent in the developing countries. Examples of recent applications of such 'national health accounts' from the Philippines, Egypt, India, Mexico, Colombia and Zambia are presented. Experience to date suggests that development of sound estimates using this method in low and middle income countries is feasible and affordable. National health accounts estimates can significantly influence policy. They provide decision makers with a holistic picture of the health sector, showing the actual emphasis of spending and the roles of different payers. They also provide a consistent framework for modelling reforms and for monitoring the effects of changes in financing and provision. An easy to use software tool has been developed for training and data management. Regional networks of collaborating national groups are proposed as a first step in expanding use of the method and to gain both national and cross-national comparative benefits.

Accounting↗
PubMed1990

Abortion policy and women's health in developing countries.

The World Health Organization estimates that almost half a million women in developing countries die in pregnancy and childbirth every year. Unsafe induced abortion is responsible for perhaps one-quarter of these deaths. In this article, the author reviews the legal, medical, and social contexts in which women in developing countries resort to clandestine abortion. Despite intensified international concern with reducing high rates of maternal mortality and morbidity, national policy makers and participants at international conferences on maternal health--with a few important exceptions--have not recommended that safe, legal services for terminating unwanted pregnancies be offered as an essential element of basic reproductive health care. United States international policy on funding abortion-related activities in maternal health and family planning programs is especially restrictive. A new policy approach is clearly needed if unacceptably high rates of maternal morbidity and mortality in many countries are to be reduced.

Abortion, Illegal↗
PubMedDate not supplied

Effects of agricultural pesticides on humans, animals, and higher plants in developing countries.

Undesirable side effects that result from the indiscriminate use of agricultural pesticides in developing countries are widespread. This has captured the attention of health workers, governments, and environmental protection agencies. In fact, the potential health effects of long-term exposure to humans, animals, and higher plants are of great concern. This study examines the effects of agricultural pesticides on such living forms and explores modes of action, and presents strategies to minimize the deleterious effects of pesticides to living forms in developing countries.

Animals↗