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PubMed1990

Epidemiology of HIV infections. Design options with special reference to developing countries.

Health research and planning need valid data for decision making. In a developing country cost-effectiveness in research design is of special significance. In such situations, population-based data are needed. This paper reviews the literature on HIV/AIDS studies published during 1982-88 with respect to epidemiological methods and study designs and with special relevance to developing countries. A methodological taxonomy is presented based on this review illustrating the special need for analytic epidemiology. The paper also presents experiences and results from an ongoing collaborative project on HIV infections between Tanzanian and Swedish researchers. The project, which was launched in 1987 in the Kagera region where the first AIDS cases were seen in 1983, applies both epidemiological and behavioural methods.

Acquired Immunodeficiency Syndrome↗

PubMed1992

The WHO programme for the Prevention of Blindness and cataract in developing countries.

In 1990, the WHO Programme for the Prevention of Blindness estimated that there were 13.5 million unoperated cases of cataract in the world. More than 95% of this backlog is found in developing countries. A conservative estimate of incidence of blindness due to cataract as 1/1000 population/year demonstrates that most developing countries are still unable to provide cataract surgery to the annual load of new cases. The situation is particularly worrying in Africa, south of the Sahara, where only one out of ten cataract ever gets operated on. The WHO Programme has developed a primary health care strategy for the large-scale management of cataract. Identification of cases requiring surgery should be possible at the community level, through training of auxiliary staff. Referral for surgery at the district or province hospital level is possible in most cases, given manpower development. This implies a need for training of cataract surgeons in many developing countries. There should be one cataract surgeon per 250,000 population. Increasing surgical 'productivity' of existing ophthalmologists should be considered as well as improving management of intervention programmes.

Africa↗

PubMed1998

Asbestos: current issues related to cancer and to uses in developing countries.

Asbestos is one of the main occupational carcinogens recognized and studied in the literature. Its uses have undergone major changes in recent decades, with severe restrictions on commercial amphiboles according to different patterns: in developed countries asbestos is strictly controlled or banned, except in Japan, while in developing countries consumption has leveled off or increased. As an example, Brazil is one the seven world leaders in asbestos production and consumption. Although there is a clear excess of mesotheliomas linked to amphibole exposure, mainly to crocidolite, there is no evidences that chrysotile is harmless to the pleura. Also, the relationship between fibrogenesis and carcinogenesis is not sufficiently understood to defend the concept that there are protective exposure limits to both diseases. "Controlled use" policy may be effective at the occupational level in a select group of companies, representing only a fraction of the exposed population. In developing countries subject to economic pressures, these issues merit proper discussion to avoid unnecessary disease and death.

Asbestos↗

PubMed2000

Young people's health in developing countries: a neglected problem and opportunity.

Although the number of young people in developing countries is increasing, their health has not been considered a priority. This is partly because of their lower mortality relative to other age groups, but also because of a lack of appropriate data collection and analysis. However, the burden of disease in young people is not trivial, and most importantly, it is during adolescence that long-term health-related behaviours are formed. Most research investigating health problems in young people has tended to concentrate on a narrow conception of problem areas, such as those relating to reproduction and substance abuse. However, in many developing countries diseases such as schistosomiasis and intestinal parasites may also have a disproportionate impact on young people's health. Young people often have radically different perceptions and priorities in terms of health and disease to those of health planners. Successful programmes will need to incorporate the views of young people themselves. Interventions targeted at young people have enormous potential for primary and secondary prevention of a huge range of health problems and present an opportunity that should not be ignored.

Adolescent↗

PubMed1998

[Value of anterior chamber lenses in developing countries. Results of a clinical study].

UNLABELLED: There are estimated to be 20 million people blinded by cataracts, 80-90% of whom live in rural areas of developing countries where expert surgical resources are scarce. The majority of all cataract operations are still intracapsular extractions (ICCE). Aphakic correction using spectacles is problematical in developing countries. This study was undertaken to evaluate the safety of multiflex open loop anterior chamber intraocular lenses (AC IOLs). METHODS: A total of 2000 people attending Lahan Eye Hospital, South-east Nepal, with bilateral cataract were randomly allocated to receive in their first eye either ICCE with AC IOL (AC IOL group) or ICCE with aphakic correction (control group). All operations were performed by two ophthalmologists using a standardized technology and 4.5 x operating loupe magnification. Functional and best corrected vision was recorded. The primary outcome measure was poor vision after surgery, which was defined as a visual acuity of less than 6/60 at 1 year follow-up (WHO definition for severe visual impairment and blindness). FINDINGS: The median time needed to perform ICCE was 4.1 min and to perform ICCE with AC IOL 6 min. Of all study patients 91% were examined after 1 year. Five percent of the AC IOL group and 5.4% of the control group had a functional visual acuity of less than 6/60. Causes of reduced vision in the AC IOL group versus the control group were: correctable refractive error (22 vs 29), uveitis/secondary glaucoma (13 vs 2), endophthalmitis (4 vs 7), pre-existing eye diseases (4 vs 5), retinal detachment (0 vs 4), and corneal decompensation (0 vs 1). Of the control group, 24 patients were found to be functionally blind in the operated eye (vision < 3/60) because they did not wear their aphakic spectacles. Normal vision (WHO definition: > or = 6/18) was achieved best corrected in 89.9% of the AC IOL group and 93.2% of the control group. Analysis of additional long-term follow-ups (2-5 years post-operatively) has not yet been completed. INTERPRETATION: This study provides evidence that in developing countries well-manufactured multiflex open loop AC IOLs can be implanted safely by experienced ophthalmologists after routine ICCE, avoiding the disadvantages of aphakic spectacle correction.

Anterior Chamber↗

PubMed1992

Care for AIDS patients in developing countries: a review.

As an ever increasing number of HIV-infected persons develop AIDS, treating the manifestations associated with HIV infection has become a new challenge to health sectors in developing countries. Given resource constraints of health systems before the AIDS epidemic, there is an urgent need to start examining ways in which health care can be delivered to the large number of AIDS patients, without infringing on other primary health care activities. This paper reviews current experience with AIDS patient care management in developing countries and determines some of the areas where further research is crucial. The main issues identified are: (1) that reliable data on standardized treatment schemes for AIDS patients are scarce; (2) that there is an urgent need for research on low-cost supportive treatment of AIDS patients, comparing costs and outcomes; (3) that outpatient and home-based care can be a valuable alternative to hospital-based care, but that cost-efficiency of these alternative treatment strategies should be examined more closely; and finally, that (4) the potential benefit of using HIV/AIDS patients to promote prevention of HIV transmission should be acknowledged.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Malnutrition and nutritional therapy of chronic kidney disease in developing countries: the Asian perspective.

There is a paucity of data regarding the prevalence and clinical consequences of protein-energy malnutrition (PEM) in the chronic renal failure, maintenance dialysis, and renal transplant population in developing countries. Malnutrition, which is reported to be present in 42% to 77% of the end-stage renal disease population in developing countries, is strongly associated with morbidity and mortality. Many religious practices in developing countries promote abstinence from meat, fish, and eggs. Both a vegetarian dietary pattern, which is being adopted by an increasing number of people, and ingestion of inadequate protein and calories in the diet to arrest the progression of chronic renal failure, may lead to malnutrition. The attendant complications of PEM, malaise, wasting, anemia, and decreased immunity, may predispose these patients to infections. This is commonly seen in both the maintenance hemodialysis and peritoneal dialysis population and may decrease their survival. There is an urgent need for nutritional counseling by a dietitian to contain the damage of malnutrition and to provide important nutritional information to the patient. Consultation with a dietitian should take place at least 3 times yearly and, in malnourished patients, more often, as needed. Dietetic documentation should include reports of food intake, subjective global assessment, anthropometric measurements, estimation of the nPNA, serum albumin, and prealbumin, the serum lipid profile, sodium and potassium intake, calcium and phosphorus status, and any changes in body weight.

Asia↗

PubMed2005

Reliability of data on caesarean sections in developing countries.

OBJECTIVE: To examine the reliability of reported rates of caesarean sections from developing countries and make recommendations on how data collection for surveys and health facility-based studies could be improved. METHODS: Population-based rates for caesarean section obtained from two sources: Demographic and Health Surveys (DHS) and health facility-based records of caesarean sections from the Unmet Obstetric Need Network, together with estimates of the number of live births, were compared for six developing countries. Sensitivity analyses were conducted using several different definitions of the caesarean section rate, and the rates obtained from the two data sources were compared. FINDINGS: The DHS rates for caesarean section were consistently higher than the facility-based rates. However, in three quarters of the cases, the facility-based rates for caesarean sections fell within the 95% confidence intervals for the DHS estimate. CONCLUSION: The importance of the differences between these two series of rates depends on the analyst's perspective. For national and global monitoring, DHS data on caesarean sections would suffice, although the imprecision of the rates would make the monitoring of trends difficult. However, the imprecision of DHS data on caesarean sections precludes their use for the purposes of programme evaluation at the regional level.

Benin↗

PubMed1998

The growing challenge of HIV/AIDS in developing countries.

The burden of HIV infection and disease continues to increase in many developing countries. An emerging theme is of an HIV pandemic composed of mini-epidemics, each with its own characteristics in terms of the trends in HIV prevalence, those affected, and the HIV-related opportunistic diseases observed. A number of explanations for the observed differences in the spread of HIV infection have been proposed but since the factors concerned, such as sexual behaviour and the prevalence of other sexually transmitted diseases, are closely interrelated, it is difficult to tease out which are the most important. Among HIV-related opportunistic diseases, tuberculosis stands out as the most important cause of morbidity and mortality in most developing countries, but the relative prevalence of other diseases shows considerable regional variation. Thus, there is a need for local approaches to the global problem of managing HIV disease. The most pressing public health challenges are to use existing knowledge of strategies to reduce HIV transmission, and to apply them in ways appropriate to the local situation, and to develop, evaluate and implement interventions to prolong healthy life in those already infected.

AIDS-Related Opportunistic Infections↗

PubMed2006

The dangers of rationing dialysis treatment: the dilemma facing a developing country.

The increasing burden of chronic kidney disease places enormous strains on resources of all countries, but especially of those with emerging economies. Few developing countries are able to afford dialysis programs and those that do ration this scarce resource. In South Africa, rationing has been practiced since the introduction of dialysis. Our renal unit carefully screened patients with end-stage kidney disease (ESKD) based on certain medical and socioeconomic criteria. The outcome of these decisions taken by the Assessment Committee is reviewed in this study. Details of the 2442 patients with ESKD assessed between 1988 and 2003 for the renal replacement program were captured. Using univariate and multivariate analysis, the odds of being accepted for treatment based on several variables were determined. The majority (52.7%) of patients with ESKD were not offered renal replacement therapy in the period of study. The number of kidney transplants progressively decreased, as did the number of patients accepted. The patients mostly likely to be accepted for renal replacement therapy were aged 20-40 years, white, employed, married, non-diabetic, and lived in proximity to a dialysis center. Almost 60% of patients were denied renal replacement treatment because of social factors related to poverty. In a developing country, where rationing of treatment is unavoidable, it is difficult to ensure equity of treatment and certain groups are advantaged over others. In our experience, socioeconomic factors influenced decision to accept patients more profoundly than medical ones.

Adult↗

PubMed2002

Dietary assessment tools for developing countries for use in multi-centric, collaborative protocols.

In recent years, increasing interest in the format of multi-centric studies among different populations in developing nations has evolved in the field of health surveys and epidemiology. Dietary intake data are most often part of these cross-cultural and cross-national collaborative efforts. Various questions have been raised about the appropriate endeavours for dietetics and nutritional sciences in developing societies, the instruments available for application, and the pitfalls and caveats in their use. An important consideration is that studies be hypothesis-driven and not mere 'fishing expeditions' of unfocused data gathering. All known dietary intake measurement tools are within the preview of developing country research, but they often must be adapted individually and differentially to suit a given population. In a multi-centric context, this is complicated. The watchword should be collecting comparable information across sites, not using identical approaches. Choice of dietary intake measurement tools must be honed to the hypotheses and assumptions, on the one hand, and the exigencies and pitfalls of working in the developing country milieu, in which linguistics, seasonality, migration, uncommonness of food systems and ethical considerations present barriers and caveats, on the other. Within the hypotheses, the assumptions regarding the penetration of the measured exposures must be borne in mind. Multi-centre studies in developing countries have relevance and importance in the context of food security, diet and disease, eating behaviour and satiety regulation, and nutritional anthropology.

Adult↗

PubMed1995

The urban environment, poverty and health in developing countries.

The process of urbanization could be described as one of the major global environmental changes directly affecting human health today. Populations particularly affected are in developing countries where rapid urban growth has been accompanied by massive urban poverty. Urban environmental health impacts, particularly the impact on adults of an environment of poverty, are still poorly understood. Definitions of the urban environment tend to be physical, excluding the complex ramifications of a social setting of disadvantage. This paper provides a brief overview of existing knowledge on the links between environment, poverty and health in urban areas of developing countries, with an emphasis on the policy implications implied by research on health differential between groups within cities. The paper argues that urban poverty and inequalities in conditions between groups within cities present a central crisis confronting urban policy in terms of human health and quality of life. The paper suggests that definitions of the urban environment tend to consider only the physical, and not the social complexity of the urban setting. The review concludes that the scale and the complexity of the urban crisis in developing countries demands a real commitment to re-thinking the management of cities to address multiple deprivation. The paper suggests that this challenges urban professionals who continue to act with a bias towards unintegrated single sector solutions despite claims to the contrary.

Developing Countries↗

PubMed2001

Healthy city projects in developing countries: the first evaluation.

The 'healthy city' concept has only recently been adopted in developing countries. From 1995 to 1999, the World Health Organization (WHO), Geneva, supported healthy city projects (HCPs) in Cox's Bazar (Bangladesh), Dar es Salaam (Tanzania), Fayoum (Egypt), Managua (Nicaragua) and Quetta (Pakistan). The authors evaluated four of these projects, representing the first major evaluation of HCPs in developing countries. Methods used were stakeholder analysis, workshops, document analysis and interviews with 102 managers/implementers and 103 intended beneficiaries. Municipal health plan development (one of the main components of the healthy city strategy) in these cities was limited, which is a similar finding to evaluations of HCPs in Europe. The main activities selected by the projects were awareness raising and environmental improvements, particularly solid waste disposal. Two of the cities effectively used the 'settings' approach of the healthy city concept, whereby places such as markets and schools are targeted. The evaluation found that stakeholder involvement varied in relation to: (i) the level of knowledge of the project; (ii) the project office location; (iii) the project management structure; and (iv) type of activities (ranging from low stakeholder involvement in capital-intensive infrastructure projects, to high in some settings-type activities). There was evidence to suggest that understanding of environment-health links was increased across stakeholders. There was limited political commitment to the healthy city projects, perhaps due to the fact that most of the municipalities had not requested the projects. Consequently, the projects had little influence on written/expressed municipal policies. Some of the projects mobilized considerable resources, and most projects achieved effective intersectoral collaboration. WHO support enabled the project coordinators to network at national and international levels, and the capacity of these individuals (although not necessarily their institutions) was increased by the project. The average annual running cost of the projects was approximately 132,000 US dollars per city, which is close to the costs of the only other HCP for which a cost analysis has been undertaken, Bangkok (115,000 US dollars per year) Recommendations for these and other HCPs are provided.

Community Health Planning↗

PubMed1990

[Is the analysis of blindness in developing countries at the occasion of a national census of interest to public health?].

Prevalence of blindness in developing countries is three to ten times higher than in developed countries. Needs for individual medical care are far from being met and this requires the implementation of comprehensive policies of prevention and treatment. Two distinct data sources are available to carry out these policies: direct ophthalmic surveys on representative population samples, and for some countries, a national census in which blindness cases are numbered out. In Togo, both sources are available; we have thus been able to analyse: data from the 1981 national census in which blindness is identified as a social handicap; and the results of 4 W.H.O. surveys conducted from 1982 to 1986, which measure blindness prevalence and analyse its causes. The analysis of both sources shows that: a national census cannot be a substitute for surveys which are the only means for determining blindness causes and implementing action programmes. nonetheless it provides exhaustive information, as well as data on geographical distribution and on age and sex pattern of blindness. It also allows the identification of high prevalence zones--not always spotted through a survey--and thus, the implementation of specific actions in affected zones. It appears, hence, that the question on blindness should be maintained in a national census; providing users bear in mind possible bias in blindness census, the fact that appreciation of blindness is a subjective exercise and also providing they don't yield to the temptation of drawing comparisons between blindness rates which don't cover the same realities.

Blindness↗

PubMed2004

Association between some educational indicators and dental caries experience of 12-year-old children in developing countries: an ecological approach.

OBJECTIVE: The aim of this study was to investigate the association between some educational indicators and dental caries experience of 12-year-old children in developing countries. BASIC RESEARCH DESIGN: The ecological association between DMFT levels amongst 12 year olds (DMFT-12 index) with six educational indicators (adult literacy rate, mean years of schooling, pupil-teacher ratio for primary level, educational expenditure as a percentage of gross national product, primary enrollment ratio and percent completing primary level) has been studied using developing countries as the unit of analysis. Pearson's correlation analysis and stepwise linear multiple regression technique were used to identify the significantly associated educational indicators with the DMFT-12 index. RESULTS: A negative association between DMFT-12 index and percent completing primary education level has been observed (r = -0.509; p < 0.01). Also, stepwise regression analysis results have shown that only percent completing primary level education is significantly associated with DMFT-12 index scores (partial regression coefficient = -0.042; 95% confidence intervals: -0.064, -0.021). CONCLUSION: Dental caries experience of 12-year-old children appears to be highest in countries with low percent of primary level completion. Percent completing primary level education may be considered a good predictor of DMFT-12 index in developing countries.

Child↗

PubMed2004

Migration of health-care workers from developing countries: strategic approaches to its management.

Of the 175 million people (2.9% of the world's population) living outside their country of birth in 2000, 65 million were economically active. The rise in the number of people migrating is significant for many developing countries because they are losing their better-educated nationals to richer countries. Medical practitioners and nurses represent a small proportion of the highly skilled workers who migrate, but the loss for developing countries of human resources in the health sector may mean that the capacity of the health system to deliver health care equitably is significantly compromised. It is unlikely that migration will stop given the advances in global communications and the development of global labour markets in some fields, which now include nursing. The aim of this paper is to examine some key issues related to the international migration of health workers and to discuss strategic approaches to managing migration.

Africa↗

PubMed2006

Strategies for the prevention and control of osteoporosis in developing countries.

The frequency of osteoporosis and fragility fractures has been studied to a very limited extent in few developing countries. The aim of this paper is to review briefly the burden of osteoporosis and fragility fractures in these countries and to propose some strategies for the prevention and control of those conditions, considering barriers and facilitators for their implementation. The evolution of the demographic composition in most regions with developing countries shows a considerable increase in life expectancy and therefore, a significant growth in elderly population can be expected. Reports on the incidence of fragility fractures show figures in many of those countries that are comparable to those found in developed nations. Health resources (for acute treatment of fractures, their rehabilitation and chronic management, for diagnostic centers and drug therapy for osteoporosis) are limited in most of those regions and are allocated to other health priorities. Internationally accepted guidelines can be adapted to the realities of developing nations and may be promoted by organizations of health professionals and patients, but require endorsement and support by health authorities. The steps should include: (a) campaigns to increase awareness, both among the population at risk and relevant health workers; (b) the promotion of a preventive lifestyle in the general population; (c) the development of national or regional, evidence-based guidelines for the diagnosis and treatment of osteoporosis; (d) development and implementation of guidelines for the treatment of fragility fractures, their rehabilitation and prevention of falls; (e) collection of economic data on fractures and osteoporosis; and (f) development of country-specific fracture databases. These steps may help in reducing the increasing burden of osteoporotic fractures. Their implementation will require solid scientific basis and commitment from policy makers, health professionals, patient organizations, and ultimately the general population.

Developing Countries↗

PubMed1977

The challenge of obstetrics in a developing country.

For the 13 months between 1 May 1975 and 31 May 1976 a prospective study was made in a maternity wing of a hospital in a developing country. Out of 2196 mothers who gave birth, 278 were classified as requiring special care. The rate of caesarean section showed a steep fall, from 30,76% in 1967 to 2,98% in 1976. The rate for the present series was just over 3%. The series has highlighted the challenges the obstetrician has to meet in a developing country. Patients with pre-eclampsia rank high in the admissions, as do patients with a bad obstetric history, Venereal disease is commonly encountered and requires adequate treatment. Lack of adequate medical services is among the important factors responsible for the obstetric difficulties encountered. Lack of communication and transport facilities aggravates the problems of midwives and obstetricians in developing countries. This study shows how a simple plan and hard work by all concerned can achieve commendable results in spite of the overwhelming inadequacies.

Adolescent↗