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PubMed2005

Country development does not presuppose the loss of forest resources for traditional medicine use.

There are challenges in using ethnobotany as a research technique. Foremost, there is a generational loss of traditional medicine knowledge and a loss of plant resources as raw material for medicinal use. These losses are frequently attributed to the development and modernization of cultures. However, recent work has reported that the loss of languages, a classic marker of traditional knowledge, does not correlate with the relative development status of a country. By analyzing datasets regarding the relative development status of countries and land use patterns, I show that the loss of natural resources for traditional medicine use does not correlate with the relative development status of a country. This work implies that with proper governance, it is possible for countries to develop while preserving the natural resources utilized in traditional medicine.

Conservation of Natural Resources↗

PubMed1992

HIV-associated tuberculosis in developing countries: epidemiology and strategies for prevention.

The association between tuberculosis and HIV presents an immediate and grave public health and socioeconomic threat, particularly in the developing world. In early 1992 WHO estimated that approximately 4 million people had been infected with both Mycobacterium tuberculosis and HIV since the beginning of the pandemic; 95% of them were in developing countries. The association between tuberculosis and HIV is evident from the high incidence of tuberculosis, estimated at 5-8% per year, among HIV-infected persons, the high HIV seroprevalence among patients with tuberculosis, the high occurrence of tuberculosis among AIDS patients, and the coincidence of increased tuberculosis notifications with the spreading of the HIV epidemic in several African countries. The impact of the two epidemics on resource-poor countries has ominous social and medical implications, and the already overstretched health services now have to face a tremendously increasing tuberculosis problem. HIV infection worsens the tuberculosis situation by increasing reactivation of latent tuberculosis infection in dually infected persons as well as by favouring rapid progression of new infections in the HIV-infected. This also results in an increase of the risk of infection and a subsequent increase of cases in the general population. In order to respond to this urgent problem, the highest priority must be given to strengthening tuberculosis control programmes in the countries where they are poorly developed and where the prevalence of HIV and tuberculosis infections is high. Besides improving the cure rate by early diagnosis and prompt treatment of patients with tuberculosis, two major strategies that need consideration include BCG vaccination and preventive chemotherapy among HIV-infected individuals. The latter strategy is considered as the most critical intervention that would help to limit the expected increase in clinical tuberculosis from the pool of HIV and tuberculosis coinfected individuals. However, a number of issues need to be addressed urgently and before such an intervention can be implemented in the developing countries.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

Interventions to prevent HIV/AIDS among adolescents in less developed countries: are they effective?

The objective of this study was to summarize and critically assess the effects of interventions to prevent HIV/AIDS among adolescents in less developed countries. Reports of studies that evaluated interventions for preventing HIV/AIDS/STDs among persons aged 11-25 years were obtained from online computer databases, by searching conference proceedings and relevant journals, and by following up references cited in published reports. Studies were included if they investigated any educational, behavioral, psychosocial or other intervention that aimed to prevent or reduce HIV/AIDS/STD among persons aged 11-25 years in a less developed country. Only studies that included a control group, and which involved pre- and post-intervention assessments were included. Outcome measures included: (i) changes in safe sex practices (abstinence, condom use, limitation of sexual partners, avoidance of casual sex), (ii) knowledge about HIV/AIDS transmission and prevention methods, (iii) perception of HIV/AIDS/STD risks, (iv) self-efficacy with regard to condom negotiation and refusal of sex, (v) uptake of voluntary counseling and testing (VCT), and (vi) reduction in incidence of HIV/AIDS/STDs. Studies were assessed in terms of intervention format (e.g., education, role-play, video), duration, and setting (school or community). Reported improvements in outcome measures in intervention versus control groups were assessed. Sixteen studies met the inclusion criteria. Thirteen of these were conducted in Africa and three in Latin America. Twelve of the sixteen studies were school-based, and four were community-based. The interventions reviewed were not resoundingly successful in achieving their goals of increasing knowledge of HIV/AIDS, altering attitudes, improving negotiation and communication skills, or in influencing positive behavior evidenced through consistent condom use, abstinence, or reducing the number of partners. Considering the importance of HIV/AIDS prevention among adolescents, design of evaluation studies of programs in less developed countries need to be improved. The use of randomized controlled trials or other rigorous approaches for evaluating population-based behavioral interventions (e.g., Solomon Four design) is recommended.

Acquired Immunodeficiency Syndrome↗

PubMed2002

Reflections and recommendations on research ethics in developing countries.

The debate on the ethics of international clinical research involving collaboration with developing countries has achieved a high profile in recent years. Informed consent and universal standards have been most intensively debated. Exploitation and lack of adequate attention to justice in the distribution of risks/harm and benefits to individuals and communities have to a lesser extent been addressed. The global context in which these debates are taking place, and some of the less obvious implications for research ethics and for health are discussed here to broaden understanding of the complexity of the debate. A wider role is proposed for research ethics committees, one that includes an educational component and some responsibility for audit. It is proposed that new ways of thinking are needed about the role of research ethics in promoting moral progress in the research endeavour and improving global health.

Anecdotes as Topic↗

PubMed2000

Association of Burkitt's lymphoma with the Epstein-Barr virus in two developing countries.

The clinical presentation of Burkitt's lymphoma (BL) and it's association with the Epstein-Barr virus (EBV) varies in different geographic areas, BL in developing countries being "intermediate" between the sporadic and endemic types, both in it's clinical presentation and it's association with EBV, which varies from 25-80%. In this study we have analysed the clinical features, EBV association, subtype and prevalence of the deleted variant of the Latent Membrane Protein-1 (LMP-1) of EBV in forty-two cases from two developing countries- India (n = 25) and Argentina (n = 17). In both countries the abdomen was the site most commonly involved while jaw involvement was rare. EBV was detected by in-situ hybridization using the EBER-1 RNA probe. 47% of cases from Argentina and 80% of cases from India were EBER positive. EBV typing using EBNA-3C primers showed a predominance of Type A in both countries (India-13/16 and Argentina-(7/8)). The 30bp deletion of the LMP-1 gene was detected in all evaluated cases from Argentina while the wild type of the gene was seen in all the evaluable Indian cases. Our study highlights the similarities and differences in the clinical presentation and EBV association of BL in two developing countries and also indicates that the subtype of EBV and prevalence of the LMP-1 deletion may reflect the predominant subtype in a particular population.

Adolescent↗

PubMed1998

The use of restriction fragment length polymorphism (RFLP) analysis for epidemiological studies of tuberculosis in developing countries.

DNA fingerprinting, of which restriction fragment length polymorphism (RFLP) typing is the most common method used, has permitted novel investigations of the epidemiology and pathogenesis of tuberculosis. The use of IS6110, an insertion sequence which is present in Mycobacterium tuberculosis, is generally considered to be the standard RFLP method, but other molecular typing techniques may be used as adjuncts in selected circumstances. A number of epidemiologic studies using RFLP typing have been done in both industrialized and developing countries. The major findings include the confirmation or identification of chains of transmission (of both drug-sensitive and drug-resistant strains of tuberculosis), distribution of strain clusters within populations, differentiation of relapse from exogenous reinfection, better understanding of the pathogenesis of tuberculosis, identification of laboratory cross-contamination, and insight into the molecular evolution of the species. For developing countries, where the burden of tuberculosis is greatest, three major areas of investigation for the use of RFLP analysis in epidemiologic studies of tuberculosis have been identified: 1) community transmission, 2) nosocomial transmission, and 3) human immunodeficiency virus (HIV)-related tuberculosis. Elements of protocols are suggested which can be used by investigators to perform well-designed epidemiologic studies which will be relevant to developing countries and which are likely to have an impact on control programmes in these settings.

AIDS-Related Opportunistic Infections↗

PubMed1992

Spectrum of hospital-acquired acute renal failure in the developing countries--Chandigarh study.

The spectrum of hospital-acquired acute renal failure in the developing countries has not been documented. We undertook a prospective study to define the causes and outcome of hospital acquired acute renal failure as seen at a referral center in North India. Over a one year period, all patients who developed acute elevation in serum creatinine during the hospital stay were studied. One hundred and ninety of 29,503 admitted patients (0.64 per cent) satisfied the criteria for entering into the study. Nephrotoxic drugs (29 per cent), decreased renal perfusion (21 per cent), major surgery (18 per cent) and septicaemia (17 per cent) were the most frequent causes. Acute renal failure was non-oliguric in 52 per cent of patients. Non-oliguric patients had significantly fewer episodes of hyperkalaemia, neurological abnormalities, metabolic acidosis and gastrointestinal bleeding. They required fewer episodes of dialysis (p < 0.001) and had a significantly lower mortality (p < 0.001) compared to the oliguric patients. Other poor prognostic factors included severity of renal insufficiency, high baseline serum creatinine and presence of multiorgan failure. The present study shows that the spectrum of hospital-acquired acute renal failure in the developing countries is quite similar to that of technologically advanced countries, although the pattern of community acquired acute renal failure is vastly different.

Acute Kidney Injury↗

PubMed2004

Alzheimer Disease International's 10/66 Dementia Research Group - one model for action research in developing countries.

BACKGROUND: The 10/66 Dementia Research Group (10/66) founded in 1998, is a network of over 100 researchers from mainly developing countries. 10/66 is committed to encourage more good quality research in those regions, where an estimated two-thirds of all those with dementia live. It represents a collaboration of academics, clinicians, and an international non-governmental organization, Alzheimer's Disease International (ADI). METHOD: 10/66 pilot studies in 26 centres in Latin America, India, Africa and China and SE Asia suggest that education and culture-fair diagnosis is an attainable aim. Despite extended family care networks, these studies also identified high levels of practical, psychological and economic strain upon caregivers. Population-based studies in six centres will now estimate prevalence, describe impact and seek to identify genetic and environmental risk factors in novel settings. At a practical level, 10/66 has studied ways to circumvent the lack of help-seeking in developing countries, and has developed a low-level intervention to educate and train caregivers. CONCLUSION: The links with ADI and its international networks, and the volunteerism of ADIs members have fostered the rapid growth of 10/66. The partnership facilitates both the raising of awareness and influence upon policy, as 10/66 research evidence can be used by ADI and national Alzheimer's Associations to direct and support advocacy.

Aged↗

PubMed2003

Efficacy of polysaccharide pneumococcal vaccine in adults in more developed countries: the state of the evidence.

We review studies on the efficacy against disease caused by Streptococcus pneumoniae of the 23-valent polysaccharide pneumococcal vaccine in adult populations in the more developed countries. Meta-analyses of primary vaccine trials have attempted to reduce uncertainty from lack of power. Vaccine efficacy calculated from studies in South African gold-miners and in Papua New Guinea, with high attack rates and differing serotype patterns, cannot automatically be applied to more developed countries. Meta-analyses will overestimate a protective effect if this clinical heterogeneity is ignored. Meta-analyses limited to trials in the more developed setting show no protective effect against pneumococcal pneumonia and a non-significant protective effect against bacteraemia. Lack of a specific diagnosis limits the ability to detect a protective effect against pneumococcal pneumonia. Most, but not all, observational studies confirm a protective effect against bacteraemia. An effect on mortality in more developed countries has yet to be documented.

Adult↗

PubMed2002

Defining nutritional status of women in developing countries.

OBJECTIVE: To define a de facto reference body mass index (BMI) for women in developing countries and compare its performance with the Quetelet BMI. DESIGN: A logarithmic equation for elite wt/ht references was developed using the weight (wt) and height (ht) of 10,524 non-pregnant elite mothers. Functional outcomes were compared using both BMIs. SETTING: Forty-six national surveys from 36 developing countries. SUBJECTS: Mothers 15-49 years old. RESULTS: The defacto reference standard deviation showed 2.2% of elite women were undernourished and 6.3% overnourished; lower and upper limits for 'ideal' wt/ht were 73% and 137%, respectively. Compared with the age-based and medium frame standards of the First and Second National Health and Nutrition Examination Surveys (NHANES I & II), the defacto reference defined fewer women as undernourished (5.3% vs. 10.5% and 14.4%, respectively), but more as overnourished (20.4% vs. 13.7% and 15.9%, respectively). In the de facto reference, BMI = wt/ht(1.6). Using the age-based and medium-frame-based Quetelet BMI (wt/ht2), 28.5% and 31.7% had a low and 13.0% and 14.7% a high BMI, respectively. For the defacto reference, 18.4% of the elite mothers had a low BMI and 19.3% a high BMI. Applying the de facto reference to all women showed that the distribution of BMI was similar irrespective of the reference used. Functional outcomes were similar for both BMIs. CONCLUSIONS: The NHANES I & II growth curves define more women as overnourished than the de facto curve, but the opposite for defining the undernourished. Functional outcomes were similar for both BMIs, suggesting there is no great advantage to using a defacto BMI based on national-level data from these 46 national surveys.

Adolescent↗

PubMed1986

Rural development and primary health care in less developed countries.

The traditional approach has been to regard health activities as a small component of rural development programmes. Under the Primary Health Care approach health is seen as the lever for rural development. But there are tendencies in the implementation of Primary Health Care in less developed countries towards limiting the range of activities to preventive and curative personal health services and of denuding it of its community development orientation. This paper highlights some of the issues that seem to militate against the establishment of Primary Health Care with its full complement of rural development activities. These activities together with the preventive and curative personal health services undertaken in the framework of community development promise to lead to the achievement of the hitherto elusive goal of improving the socioeconomic and health status of the rural population of less developed countries.

Allied Health Personnel↗

PubMed2004

Biocultural diversity in the sustainability of developing-country food systems.

The policy implications of a model of contemporary food systems for developing countries that integrates nutrition, reduction of disease risk, culture, income generation, and biodiversity are reviewed within a theoretical and empirical examination of the relevance of nutrition to the priorities put forward at the World Summit on Sustainable Development in Johannesburg, South Africa, 2002. Agricultural, health, economic, and social policies with local reach are necessary responses to the increase in noncommunicable disease associated with the globalization of food systems. Nutrition offers a nexus for the changes in individual behavior and motivation essential for fundamental shifts in production and consumption patterns. Mutual consideration of biocultural diversity and nutrition can guide policy, research, promotion, and applied action in developing countries. Benefits from enhanced use of biodiversity must legitimately flow to the undernourished poor, while potential negative consequences must be minimized and mitigated. Quality and quantity of food need not be mutually exclusive. Functions related to energy density, glycemic control, oxidative stress, and immunostimulation define important research priorities. Tests of the hypothesis that biodiversity equates with dietary diversity and health might combine quantitative indicators of dietary and biological diversity with nutrition and health outcomes. Biodiversity, where it is part of traditional agricultural and food systems, can be best conserved and enhanced through rational use within a broad-based developmental focus on small-scale and low-input production. The fact that traditional systems, once lost, are hard to recreate underlines the imperative for timely documentation, compilation, and dissemination of eroding knowledge of biodiversity and the use of food culture for promoting positive behaviors.

Biodiversity↗

PubMed2004

The European and developing countries clinical trails partnership.

The European and Developing Countries Clinical Trials Partnership (EDCTP) is a new venture between 14 states of the European Union (EU) and Norway to support the conduct of clinical trials of drugs and vaccines (and microbicides) against HIV/AIDS, malaria and tuberculosis in Africa, to develop the capacity to conduct such trials in African institutions, and to promote a more integrated approach to health research amongst European countries. It is funded for 5 years with a contribution of euros 200 million from the European Commission, matched by an equivalent sum that is spent directly by national research programmes of EU member states and Norway on activities that fall under the EDCTP remit. EDCTP seeks to be synergistic with other funding bodies supporting research on these diseases and will promote collaborative research, involving support from multiple funding agencies and harnessing and networking expertise across different African and European countries.

Africa South of the Sahara↗

PubMed1975

Pneumonia and diarrhoeas: killers of toddlers in developing countries.

Pneumonia and diarrhoeas are an important cause of toddler mortality and morbidity in developing countries. Of the 147 children admitted to the University Hospital at Kuala Lumpur in 1971 for pneumonia and diarrhoeas 50 (34%) were found to be suffering from protein-calorie malnutrition of varying degrees of severity. The malnourished children tended to come from poorer homes, and to have a larger number of siblings born in rapid succession when compared with normal weight children. Anemia was more common among the malnourished children. The interaction of infection and malnutrition and the social implications of these diseases are important. It is vital that hospitals in developing countries promote health in addition to their traditional curative role.

Anemia↗

PubMed2005

Getting evidence into practice: what works in developing countries?

PURPOSE: We summarize and comment on the available literature on the effectiveness of interventions designed to change professional behaviour in order to bring evidence into practice in developing countries. DATA SOURCES: We used a strategy adapted from the Effective Practice & Organization Care (EPOC) Cochrane group. STUDY SELECTION: Forty-four studies met pre-defined selection criteria. Controlled and uncontrolled trials of interventions were included. Studies measured either professional compliance with agreed standards or patients' clinical outcomes. Data extraction. Data were extracted using a pre-defined extraction tool and studies were appraised accordingly. RESULTS OF DATA SYNTHESIS: Data were synthesized and categorized according to different types of intervention. Audit and feedback was found to be effective, at least in the short term, when combined with other approaches. Similarly, educational interventions were more effective when designed to address local educational needs and organizational barriers. We found insufficient evidence to assess the effectiveness of educational outreach, local opinion leaders, use of mass media, and reminders. Educational materials alone are unlikely to influence change. However, the majority of studies had weak designs and failed to exclude possible biases. CONCLUSION: Current evidence for the effectiveness of interventions to change health professionals' behaviour in developing countries is either scanty or flawed due to poorly designed research. Given the recent drive to improve quality of care, this should be a priority area for researchers and international agencies supporting health systems development in developing countries. This review provides an insight into some of the methodological issues that interested researchers may face.

Developing Countries↗

PubMed1993

[Characteristics of tuberculosis in Japan compared with those in other developed countries].

To clarify the characteristics of the tuberculosis situation in Japan, it was analysed in comparison with those in other developed countries. The results are summarized as follows: 1. The tuberculosis epidemic peaked at the end of 1910s in Eastern Japan, and in the 1940s in Western Japan. It is estimated that the annual risk of tuberculosis infection was 4% or more until the end of the World War II. Tuberculosis has spread much later and was much more prevalent up through the 1940s in Japan than in other developed countries. 2. A modern tuberculosis control programme including active case-finding, isolation of infectious cases, charge free medication and BCG vaccination was launched in 1951, and in 1961 an effective case-holding system was established. Tuberculosis incidence decreased rapidly thereafter. As the rate of decrease was almost the same as that of the Inuit (Eskimo) (Fig. 1), one might say that Japan is one of the countries where tuberculosis incidence decreased most rapidly. 3. Incidence of tuberculosis in children is 2.1 per 100,000 in 1991 which is lower than that of the U.S.A. (3.1 per 100,000). 4. Incidence of tuberculosis among the aged is much higher than that of other developed countries as shown in Fig. 3. Of course, this is mainly caused by the fact that a higher percentage of Japanese aged 55 years or more was infected with tubercle bacilli in the past.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2002

Experiences and challenges in developing countries.

Compared with the industrialized nations, the challenges of combating iron (Fe) deficiency in developing countries include the far greater magnitude of the problem, the more limited resources and the more complex nature of the setting. The two groups most affected by Fe deficiency are young children and women of reproductive age. Infant diets in developing countries are low in iron, due to less use of industry prepared foods and much lower consumption of food from animal sources. Successful experiences in countries such as Chile and the United States have shown that it is feasible to reduce anemia levels in young children through the use of fortified infant food products and low cost weaning foods. In settings in which people are already using processed foods, the cost of improving the nutritional value of these foods is marginal compared with the significant benefits. However, costs and accessibility by the poorest are important concerns, and other options such as supplementation and efforts to improve complementary feeding also require attention. The high prevalence of iron and other micronutrient deficiencies due to poor diets and/or infections among women before and during pregnancy calls for strategies such as fortification and periodic supplementation. Experience to date suggests that fortification of staples (e.g., wheat flour) is a cost-effective and feasible strategy, but regulatory monitoring is required to demonstrate effectiveness and ensure quality. Supplementation is still required for all pregnant women, however, and challenges remain in finding ways to improve coverage and compliance. In summary, effectively combining and balancing the needs of program implementation, research and community involvement will help combat Fe deficiency.

Anemia, Iron-Deficiency↗

PubMed2006

Management of APL in developing countries: epidemiology, challenges and opportunities for international collaboration.

Acute promyelocytic leukemia (APL), a relatively rare hematologic malignancy, is highly curable with current treatment strategies. However, these strategies may be unavailable in countries with limited resources. A review of records in several Latin American countries revealed that approximately 30% of deaths among children and adults with APL were caused by early complications associated with the disease or its treatment. Further, APL accounts for 20% to 25% of cases of AML in these countries, consistent with the previous observation of increased incidence of APL in Latin Americans. The lack of population-based registries in developing countries has made it difficult to determine the real incidence of APL. Moreover, APL appears to have other unique epidemiologic characteristics, including association of primary APL with an increased body mass index at diagnosis and association of secondary APL with breast cancer. To facilitate the development of local capacity and implement effective treatment of APL in developing countries, the International Committee of the American Society of Hematology has assembled a working group to formulate treatment guidelines based on evidence from clinical trials results in the developed world but adapted to local resources. It is hoped that uniform treatment, careful documentation of specific outcome data, and ongoing monitoring of treatment efficacy and toxicity will improve the cure rate and provide biologic and epidemiologic information about APL in developing countries. This initial demonstration project may be joined by other countries, providing a framework for additional clinical investigation in this highly curable form of leukemia.

Developing Countries↗