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PubMed1990

Important considerations in the care of diabetic patients in a developing country (Nigeria).

Much attention has been focused on the clinical pattern of diabetes mellitus in developing countries. This has its peculiarities especially with regard to tropical pancreatic diabetes, the aetiopathogenesis of which remains speculative. However, more than the clinical pattern of the disease itself, it is the social, economic, and cultural circumstances within which the disease is managed and coped with that give it its "tropical" distinctiveness. Factors of illiteracy, poverty, lack of adequate shelter or source of safe drinking water, poor environmental sanitation, cultural misconceptions about diseases, scarce health resources, non-availability of drugs or their prohibitive cost, the sale of fake drugs, and of course the ubiquitous traditional and faith healers with their 'miracle cures', all combine to create a milieu which is hostile to the optimal management of a chronic lifelong disease like diabetes mellitus. This review focuses on these oft neglected aspects of diabetes because without due attention to them, the successful management of the diabetic patient in most developing countries will remain elusive.

Community Health Workers↗

PubMedDate not supplied

The problems and promise of vaccine markets in developing countries.

As in the market in North America, major barriers to private investment in the development and production of vaccines exist for markets in developing countries. These include the risks of uncertain funding and demand and the difficulties created by historically low pricing. A number of promising and innovative approaches nonetheless are being explored to increase the incentives and reduce the risks of investing in vaccines for developing countries. These innovations are fueled by the growing recognition of powerful stakeholders that vaccines are a critical technology for ensuring global health.

Developing Countries↗

PubMed2004

The burden of orthopaedic disease in developing countries.

The global burden of musculoskeletal disease in low and middle-income countries is large, growing, and neglected. While there is considerable funding for the control of communicable disease, there has been little attention paid to either the prevention or the treatment of orthopaedic problems in developing countries. "Safe Roads" was the theme for World Health Day 2004, and this paper examines the magnitude of injury in low and middle-income countries, as well as the motors powering its growth, and addresses the balance between the prevention and the treatment of injuries. Finally, it calls upon orthopaedic surgeons in developed countries to build partnerships with their colleagues in less developed countries to improve clinical care, teaching, and research aimed at reducing the global burden of injury.

Developing Countries↗

PubMed1995

Public health crises of cities in developing countries.

During the decade and a half after Alma Ata hundreds of projects were started in developing countries to implement the principles of PHC and start community based health care programs in the rural areas of developing countries. Until the past five years urban health was not seen as a special health problem. Population pressure in the rural areas has created shortages of land, food and employment opportunities. These forces have generated major population movements to the urban centres. The population movements have encouraged unprecedented expansion of urban centres. This sudden concentration of large populations in small geographical areas has resulted in the urban health crises of the developing world. The poor who live in the slum areas have no access to adequate health services, they experience frequent epidemics of communicable diseases like cholera, they live within a heavily polluted environment, and their children have very poor health because they are not immunized and are malnourished. The paper agrees with approaches which have been championed by development agencies to address the urban health crises. These approaches propose the reorientation of urban health systems to include adoption of PHC for urban health programs, intersectoral collaboration and extra budgetary support. The paper argues for further strengthening of the reorientation approach by adjusting the development planning model. It is proposed that the urban plan be integrated into the national development plan so that emerging urban health crises can receive special attention in resource allocation.

Adult↗

PubMed2006

Chapter 28: Studies to assess the long-term efficacy and effectiveness of HPV vaccination in developed and developing countries.

We review studies of the implementation of human papillomavirus (HPV) vaccination programmes in developed and developing countries. The review spans the period from establishment of long-term vaccine efficacy follow-up studies, operational research on issues of vaccine preparedness, and relevant predictive modelling studies during the pre-licensure phase to plans of phase IV effectiveness trials, forms of epidemiological surveillance, and further operational research in the post-licensure phase. Much of the research is already ongoing. Depending on the results of the planned immuno bridging studies among HIV-negative and HIV-positive women, further phase III and/or phase IV trials may be warranted.

Developed Countries↗

PubMed1999

Tuberculosis preventive therapy in HIV-infected persons: feasibility issues in developing countries.

There is now strong evidence from several randomized controlled trials for the efficacy of preventive therapy in the prevention of tuberculosis in tuberculin skin test positive persons infected with the human immunodeficiency virus (HIV). The World Health Organization and the International Union Against Tuberculosis and Lung Disease recommend preventive therapy for tuberculin skin test positive, HIV-infected persons who do not have active tuberculosis. While implementation of preventive therapy is manageable in industrialised countries because it is affordable and the infrastructure is in place to screen, treat and monitor patients on a regular basis, its implementation in developing countries presents several problems. Feasibility issues such as identification of large numbers of HIV-infected persons, exclusion of active tuberculosis, identification of those most likely to benefit, supervision of preventive therapy and monitoring of adverse drug reactions need to be resolved before tuberculosis preventive therapy can be introduced on a larger scale in developing countries. Possible sites for implementation of a tuberculosis preventive therapy service include voluntary counselling and testing centres for HIV and occupational health clinics for military personnel, hospital or company workers. Feasibility studies need to be carried out to address these issues in developing countries.

Antitubercular Agents↗

PubMed2002

Capacity-building for health research in developing countries: a manager's approach.

Research may be viewed as rigorous inquiry to advance knowledge and improve practices. An international commission has argued that strengthening research capacity is one of the most powerful, cost-effective, and sustainable means of advancing health and development. However, the global effort to promote research in developing countries has been mostly policy driven, and largely at the initiative of donor agencies based in developed countries. This policy approach, although essential, both contrasts with and is complementary to that of research managers, who must build capacity "from the ground up" in a variety of health service settings within countries and with differing mandates, resources, and constraints. In health organizations the concept of research is broad, and practices vary widely. However, building research capacity is not altogether different from building other kinds of organizational capacity, and it involves two major dimensions: strategic and operational. In organizations in the health field, if reference to research is not in the mission statement, then developing a relevant research capacity is made vastly more difficult. Research capacities that take years to develop can be easily damaged through inadequate support, poor management, or other negative influences associated with both internal and external environments. This paper draws from key international research policy documents and observations on the behavior of research and donor agencies in relation to developing countries. It examines capacity-building primarily as a challenge for research managers, realities underlying operational effectiveness and efficiency, approaches to resource mobilization, and the need for marketing the research enterprise. Selected examples from South Asia and Latin America and the Caribbean are presented.

Developing Countries↗

PubMed2006

Eye health promotion and the prevention of blindness in developing countries: critical issues.

This review explores the role of health promotion in the prevention of avoidable blindness in developing countries. Using examples from eye health and other health topics from developing countries, the review demonstrates that effective eye health promotion involves a combination of three components: health education directed at behaviour change to increase adoption of prevention behaviours and uptake of services; improvements in health services such as the strengthening of patient education and increased accessibility and acceptability; and advocacy for improved political support for blindness prevention policies. Current eye health promotion activities can benefit by drawing on experiences gained by health promotion activities in other health topics especially on the use of social research and behavioural models to understand factors determining health decision making and the appropriate choice of methods and settings. The challenge ahead is to put into practice what we know does work. An expansion of advocacy-the third and most undeveloped component of health promotion-is essential to convince governments to channel increased resources to eye health promotion and the goals of Vision 2020.

Blindness↗

PubMed1995

Non-specific beneficial effect of measles immunisation: analysis of mortality studies from developing countries.

OBJECTIVE: To examine whether the reduction in mortality after standard titre measles immunisation in developing countries can be explained simply by the prevention of acute measles and its long term consequences. DESIGN: An analysis of all studies comparing mortality of unimmunised children and children immunised with standard titre measles vaccine in developing countries. STUDIES: 10 cohort and two case-control studies from Bangladesh, Benin, Burundi, Guinea-Bissau, Haiti, Senegal, and Zaire. MAIN OUTCOME MEASURES: Protective efficacy of standard titre measles immunisation against all cause mortality. Extent to which difference in mortality between immunised and unimmunised children could be explained by prevention of measles disease. RESULTS: Protective efficacy against death after measles immunisation ranged from 30% to 86%. Efficacy was highest in the studies with short follow up and when children were immunised in infancy (range 44-100%). Vaccine efficacy against death was much greater than the proportion of deaths attributed to acute measles disease. In four studies from Guinea-Bissau, Senegal, and Burundi vaccine efficacy against death remained almost unchanged when cases of measles were excluded from the analysis. Diphtheria-tetanus-pertussis and polio vaccinations were not associated with reduction in mortality. CONCLUSION: These observations suggest that standard titre measles vaccine may confer a beneficial effect which is unrelated to the specific protection against measles disease.

Bangladesh↗

PubMed2001

Behavioral problems in school-going children: implications for medical teachers in developing countries.

A large number of children suffer from behavioral problems during their development. Many of these problems are transient and may not even be noticed. At times, however, the extent of these problems and their overall effects on a child's development can be serious (Morita et al., 1993). Further, children may exhibit these behaviors in one setting and not in others (e.g. at home or in school, but not both). In developed countries, parents tend to seek advice for even minor problems, such as persistent thumb sucking, while in developing countries, major problems, even childhood schizophrenia, may go unattended. An awareness of the prevalence of these problems is important so that appropriate mental health services can be planned and provided for affected children, to improve their prospects for leading healthy, productive lives. Such awareness can help enhance the teaching of graduate doctors, equipping them to deal with these problems effectively.

Journal Article↗

PubMed1971

Rheumatic heart disease in children in developing countries.

The features of rheumatic heart disease in 31 Nigerian children aged 5-11 years are presented. The majority of these children sought medical attention when they were in advanced cardiac failure. In approximately 23% of the children a past history of acute rheumatic fever was obtained. It is suggested that in developing countries, skin ulcers may be as important a focus of beta-haemolytic streptococcal infection as the throat is in developed countries in the aetiology of acute rheumatic fever. Rheumatic heart disease in developing countries present two main problems, namely, diagnosis and management including prophylaxis. The differential diagnosis of rheumatic heart disease in some tropical countries and the factors which affect the management of the disease are discussed.

Cardiomyopathies↗

PubMed2003

Low-cost anti-HIV compounds: potential application for AIDS therapy in developing countries.

A considerable progress has been made in recent years in the field of drug development against HIV. However, the current cost of AIDS drugs is the main obstacle that prevents their use in developing countries, where 95% of HIV-infected patients reside. The average yearly price of AIDS therapy and related health care of affected patients in the USA runs as high as $22,000 - an amount that corresponds to the combined income of as many as one hundred individuals in developing countries. Even in the USA, patients without medical insurance cannot afford the costly therapy. From the beginning it was clear that the most feasible and economic means of finding a solution is to identify anti-HIV drugs among already available and preferably over-the-counter pharmaceuticals, which have historically been used for unrelated clinical purposes. This review summarizes the development and discovery of affordable and potentially promising AIDS drugs. The anti-HIV activity of drugs and immunomodulating substances such as warfarin, cimetidine, levamisole, acetaminophen, gramicidin, and V-1 immunitor are described and discussed in relation to their clinical application. These compounds may be used in a cocktail drug combination.

AIDS Vaccines↗

PubMed2002

Comprehension during informed consent in a less-developed country.

Few practical guidelines exist on how to ensure that research participants in less-developed countries understand the consent form before enrollment. In a study of HIV-1 transmission in Haiti, participants were required to pass an oral examination on the contents of the consent form with a passing score of 12/15 (80%) before enrollment. 15 individuals were given information during a single meeting with a physician, and three (20%) passed. 30 subsequent volunteers were given information by a counsellor during three meetings, and 24 (80%) passed. Formal assessment of research participants' comprehension of the consent form should be considered as a routine step in the informed consent process in less-developed countries.

Adult↗

PubMed2004

Reframing the HIV/AIDS debate in developing countries IV: does ethics have anything to offer?

Dealing with HIV/AIDS is one of the major ethical challenges facing the world today. It is suggested that an expanded discourse on ethics, divided into three levels, can help give a fuller understanding of all aspects of the HIV/AIDS pandemic. The levels are: (1) micro level (doctor-patient relationship); (2) meso level (civic and public health ethics); and (3) macro level (ethics of international relationships). At the micro level, the four principles of respect for autonomy, beneficence, non-maleficence and justice apply to HIV patients, as to any other. However, the overwhelming demand for medical care, and the lack of doctor availability in developing countries seriously limits their application. At the meso level, the Tavistock principles give a framework for health systems. The principles are: rights to health and health care; balancing resources among competing needs; comprehensiveness; cooperation among patients, clinicians and managers; focus on improvement, safety and openness. In this context, rights are respected by not discriminating on the basis of sex, geography, tribe or race. A balance has to be struck between treatment and prevention. Comprehensiveness means not ignoring palliative care and health improvement strategies. Cooperation requires 'the reciprocity and interdependence that characterise community'. The remaining principles are self-explanatory, but frequently ignored in health planning. At a macro level, there is a need for ethical discourse about issues like increasing inequality between rich and poor countries; the use of economic levers by developed countries to the disadvantage of developing countries; the international debt crisis; the tiny health care spend (US5-10 dollars per capita per annum) in Africa; and other problems like refugee and migrant labour movements. These factors fuel global instability and the HIV/AIDS pandemic, as well as contributing to the threat of terrorism and environmental degradation. We need to look at how the values of Western democracy can be revised to address these problems. For example, scientific knowledge should be made available to all who can benefit from it; individualism should be put into the context of the common good; and free market forces need to be modified to reflect the fact that we live in a world that is increasingly interdependent.

Journal Article↗

PubMed1993

[Epidemiology of traveler's diarrhea in Spanish tourists travelling in developing countries].

BACKGROUND: Travellers' diarrhea (TD) is the most frequent problem in travellers going to the developing countries. This paper analyses the prevalence of the syndrome by geographical areas as well as the risk factors in 2209 Spanish travellers to 3 continents. METHODS: Epidemiological data were gathered through a personnel interview filled by the travellers during their return trip. Those were introduce in a DbaseIII plus computer program and were evaluated through the Epi Info program. RESULTS: The overall prevalence of TD found was 41%. The Indian subcontinent, the Middle East and Moghreb countries showed a higher prevalence of TD. Trekkers and people on boat cruises (Nile and Amazon) had the highest prevalence of TD. The consumption of non-carbonic drinks and ice creams was significantly associated to TD. Travellers with previous gastrointestinal illnesses suffered more TD than others. CONCLUSIONS: Despite the fact that Spain in considered an area of intermediate risk for TD we found no significant differences in the prevalence of TD in Spanish travellers when compared with other published series from developed countries.

Adolescent↗

PubMed2002

Using process indicators to monitor and evaluate obstetric services in developing countries.

Measuring progress toward safe motherhood goals is an increasingly important priority for developing countries and their development partners. A defined set of process indicators is increasingly being used to monitor and evaluate the availability, use, and quality of emergency obstetric services as a practical alternative to maternal mortality (MM) measures. Measuring MM requires either efficient vital registration systems or large expensive surveys. Some of the data for process indicators are available from the existing recording systems at health facilities, and others are increasingly being incorporated into routine health information systems. The use of process indicators has demonstrated how poorly health services meet the basic needs of pregnant women and has already influenced major policy shifts in a number of countries. As more countries adopt the 6 basic indicators developed by the United Nations, work continues to identify and implement additional indicators, particularly those that will improve measurements of quality of care.

Developing Countries↗

PubMed2004

Quality of age data in patients from developing countries.

BACKGROUND: Age misreporting is common in demographic studies but the prevalence and magnitude of age misreporting in clinical cohorts is unknown. We analysed single-year age distribution and terminal digit preference in cancer patients from developing countries. METHOD: Age distribution was analysed by plotting a single-year age of 3874 cancer patients from 72 different countries, mainly from the Indian subcontinent and the Middle East, who resided in the UAE at the time of cancer diagnosis. Preference for age ending with digits '0' and '5' was evaluated using Whipple's index (WI), which has value 100 in cohorts without preference. Preference for all 10 terminal digits was expressed as the difference between the found and expected frequencies using Myers blended method and was graphed. RESULTS: Age data quality was low in cancer patients from the Indian subcontinent (WI = 177) and Middle Eastern countries (WI = 113-204). Females of all nationalities supplied better quality of age data (lower WI) than males. Preference for age ending with digits '0' and '5' was found in all populations except the UAE male citizens who did not show preference for terminal digit '0'. CONCLUSION: Age data quality in this cohort of patients from developing countries was low. Preference for age ending with numbers '0' and '5' is common. In studies conducted in developing countries, age data quality should be analysed as it may bias results and weaken the power of the study.

Age Distribution↗

PubMed1996

Prevalence of Helicobacter pylori infection and chronic dyspeptic symptoms among immigrants from developing countries and people born in industrialized countries.

The relationship between Helicobacter pylori infection and chronic dyspepsia is controversial. To determine the effect of H. pylori infection on dyspeptic symptoms, we compared the prevalence of H. pylori infection in immigrants from developing countries and people born in industrialized countries. Upper abdominal symptoms were assessed by a questionnaire and H. pylori infection was determined with a 13C-urea breath test and serology. H. pylori infection was found in 63% of subjects from developing countries and 11% of subjects from industrialized countries. There was no difference in the prevalence of dyspeptic symptoms between the 2 groups. The lack of difference in chronic dyspeptic symptoms between the groups, despite a major difference in the H. pylori prevalence, suggests that H. pylori infection is not a major contributor to chronic dyspepsia.

Adolescent↗