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PubMed2001

Strategies for risk assessment and control in welding: challenges for developing countries.

Metal arc welding ranges from primitive (manual) to increasingly complex automated welding processes. Welding occupies 1% of the labour force in some industrialised countries and increasing knowledge of health risks, necessitating improved assessment strategies and controls have been identified by the International Institute of Welding (IIW), ILO, WHO and other authoritative bodies. Challenges for developing countries need to be addressed. For small scale production and repair work, predominantly by manual metal arc on mild steel, the focus in developing economies has correctly been on control of obvious physical and acute health affects. Development introduces more sophisticated processes and hazards. Work pieces of stainless steel and consumables with chromium, nickel and manganese constituents are used with increasingly complex semi-manual or automated systems involving variety of fluxes or gasses. Uncritical adoption of new welding technologies by developing countries potentiates future health problems. Control should be integral at the design stage, otherwise substantive detriments and later costs can ensue. Developing countries need particular guidance on selection of the optimised welding consumables and processes to minimise such detriments. The role of the IIW and the MFRU are described. Applications of occupational hygiene principals of prevention and control of welding fume at source by process modification are presented.

Air Pollutants, Occupational↗

PubMed1995

A review of dietary and environmental correlates of obesity with emphasis on developing countries.

The relationships between dietary and environmental factors and obesity are reviewed. Findings from selected population studies of diet and body weight are presented. In general, the results from population studies of diet and obesity have been inconsistent and marked with methodological weaknesses, especially the use of cross-sectional study design. Apart from the diet, several social and economic factors appear to be important correlates of obesity in the population. However, most studies have focused on the socioeconomic status as a broad, composite measure. The relationships between income, education, occupation, place of residence, and obesity are reviewed here, with emphasis on the developing countries. In many developing countries, the changing dietary pattern, along with rising life expectancy and changing socioeconomic environment, has contributed to the increasing problems of obesity and other diet-related chronic diseases that will have an enormous impact on the health and health care resource of these countries in the near future.

Body Weight↗

PubMed1996

Successfully establishing laparoscopic surgery programs in developing countries. Clinical results and lessons learned.

BACKGROUND: Laparoscopic surgery has not been widely established in developing countries due to the lack of access to training and lack of money. We describe our experience using on-site training programs to efficiently teach and propagate laparoscopic surgery in Leon, Nicaragua; La Paz, Bolivia; and Santa Cruz, Bolivia. METHODS: A group of well-trained and motivated local surgeons was identified in each country as the initial target for teaching. Participants were taught basic and advanced laparoscopic surgery during on-site didactics, animal laboratories, and proctoring sessions. Follow-up courses were held until the target group of surgeons was capable of independently teaching and supervising laparoscopic surgery among other surgeons in each country. RESULTS: Multiple technical and logistic difficulties were encountered. In Leon, Nicaragua, and La Paz, Bolivia, a total of eight surgeons were fully trained and proctored in laparoscopic cholecystectomy. In La Paz and Santa Cruz, Bolivia, a total of seven surgeons were instructed in advanced laparoscopic procedures. To date, over 180 patients have undergone laparoscopic cholecystectomy or advanced procedures with a morbidity similar to that reported in literature series in the United States. CONCLUSIONS: Our experience demonstrates that in spite of numerous limitations, basic and laparoscopic surgery can be efficiently and safely taught in developing countries. Many lessons were learned in how to safely and efficiently use laparoscopic equipment and instruments within strict financial constraints.

Clinical Competence↗

PubMed1995

Work in a developing country.

Some health professionals seek the exciting challenge of working for a time in a developing country. Uncertainties about taking this step, however, may have to be addressed. It is important to understand your reasons for wanting to work overseas-it is ill advised, for example, to go abroad just to escape job dissatisfaction in Britain. Skills needed for international aid work nowadays centre on low tech community based programmes, and enabling, facilitating, and managing skills are more important than clinical skills. Further training may be necessary. Careful planning both for the work abroad and for a return to work in Britain is advisable; full health insurance cover, for example, is important. Although working in a developing country is largely unrecognised as an asset to a professional career in Britain, attitudes are slowly changing. A spell overseas can be very relevant to a career plan and the NHS.

Developing Countries↗

PubMed1993

The ontogeny of the gut mucosal immune system and the susceptibility to infections in infants of developing countries.

In this review we summarize data on the human gut mucosa associated lymphatic tissues as part of the common mucosal immune system. Its embryonal-fetal and post-natal ontogeny becomes severely distorted and compromised by mal-/undernutrition which is so prevalent in developing countries. Pathogenetic interdependencies exist between maternal-fetal undernutrition, the ontogeny of the immune system, constant antigenic stimulation of the mucosal immune system post-natally, and the 14 million deaths annually from infections in children below the age of 5 years in developing countries. A detailed knowledge of these interdependencies is required for effective prevention and treatment in an attempt to reduce the high morbidity and mortality rates of children in developing countries.

Animals↗

PubMedDate not supplied

Haemophilus influenzae disease and immunization in developing countries.

Haemophilus influenzae is one of the leading causes of severe bacterial infection in children of developing regions, causing 30% of the cases of culture-positive pneumonia and 20%-60% of the cases of bacterial meningitis. In infants and children, the majority of isolates from cerebrospinal fluid and blood and 16%-38% of pulmonary isolates are H. influenzae type b. The availability of several new polysaccharide-protein conjugate vaccines for the prevention of invasive disease due to H. influenzae type b prompts this review of the epidemiology of H. influenzae disease in the developing world and of the characteristics of current H. influenzae type b vaccines. To develop a strategy for use of H. influenzae type b vaccines in developing countries, the following data are needed: the age-specific attack rates of H. influenzae type b disease and the immunogenicity and efficacy of these vaccines in young infants in developing countries. Should H. influenzae type b vaccines prove to be inadequate for the prevention of H. influenzae pneumonia, the use of non-type b H. influenzae vaccines may be necessary.

Bacterial Capsules↗

PubMed1996

Evaluating new vaccines for developing countries. Efficacy or effectiveness?

Despite the profusion of promising new vaccines against illnesses prevalent in developing countries, uncertainties about the balance between costs and benefits of new vaccines have retarded their use in public health practice. Conventional prelicensure trials of vaccine protection exacerbate these uncertainties by focusing on measurement of vaccine efficacy--the performance of a vaccine under idealized conditions. Vaccine effectiveness trials provide a more pragmatic perspective by addressing the performance of a vaccine under the ordinary conditions of a public health program, by capturing direct as well as indirect effects of vaccination, and by comprehensively addressing outcomes of public health concern. The use of effectiveness trials should enable more rational triaging of new vaccines for developing countries and may accelerate the introduction of new vaccines into public health practice by resolving speculative debates about practical costs and benefits.

Case-Control Studies↗

PubMed2005

Carrier detection and prenatal diagnosis of hemophilia in developing countries.

Hemophilia A and B, inherited as X-linked recessive traits, are the most common hereditary hemorrhagic disorders caused by a deficiency or dysfunction of coagulation factor VIII (FVIII) or FIX, respectively. Hemophilia is prevalent worldwide, without ethnic or geographic limitations, and remains a life-threatening and often disabling condition. Advances in molecular medicine in this century have markedly improved hemophilia treatment. However, management is still largely inadequate in developing countries. Therefore, carrier detection and prenatal diagnosis remain the key steps for the prevention of the birth of children with hemophilia in developing countries where patients with this coagulation disorder rarely live beyond childhood. Carrier detection and prenatal diagnosis are possible by direct or indirect genetic analysis of the F8 or F9 genes. In countries with more advanced molecular facilities and higher budget resources, the most appropriate choice in general is a direct strategy for mutation detection by prescreening techniques or direct mutation detection. However, in countries with limited facilities and low budget resources, carrier detection and prenatal diagnosis are usually performed by linkage analysis with genetic markers. This article suggests the possibilities of genetic diagnosis and a feasible strategy for carrier detection and prenatal diagnosis in families with hemophilia A and B in developing countries.

Developing Countries↗

PubMed1991

Lot quality assurance sampling techniques in health surveys in developing countries: advantages and current constraints.

Traditional survey methods, which are generally costly and time-consuming, usually provide information at the regional or national level only. The utilization of lot quality assurance sampling (LQAS) methodology, developed in industry for quality control, makes it possible to use small sample sizes when conducting surveys in small geographical or population-based areas (lots). This article describes the practical use of LQAS for conducting health surveys to monitor health programmes in developing countries. Following a brief description of the method, the article explains how to build a sample frame and conduct the sampling to apply LQAS under field conditions. A detailed description of the procedure for selecting a sampling unit to monitor the health programme and a sample size is given. The sampling schemes utilizing LQAS applicable to health surveys, such as simple- and double-sampling schemes, are discussed. The interpretation of the survey results and the planning of subsequent rounds of LQAS surveys are also discussed. When describing the applicability of LQAS in health surveys in developing countries, the article considers current limitations for its use by health planners in charge of health programmes, and suggests ways to overcome these limitations through future research. It is hoped that with increasing attention being given to industrial sampling plans in general, and LQAS in particular, their utilization to monitor health programmes will provide health planners in developing countries with powerful techniques to help them achieve their health programme targets.

Developing Countries↗

PubMed1996

Serotyping of Streptococcus pneumoniae by agglutination assays: a cost-effective technique for developing countries.

There is a need for additional data on the distribution of pneumococcal serotypes in developing countries. We report the use of a coagglutination (COA) and a latex agglutination (LA) test for serotyping Streptococcus pneumoniae which were evaluated using 114 clinical isolates in Vellore, India. In tests to serotype 30 fresh isolates of pneumococci from meningitis (8 isolates), bacteraemia/septicaemia (21 isolates) and peritonitis (1 isolate) cases, there was complete concordance among the three methods. An additional 20 isolates (11 from cerebrospinal fluid and 9 from blood cultures) were serotyped using both LA and COA, with full agreement between the results. With a further 30 isolates, there was 93% concordance for the COA types with serotypes assigned by a WHO reference laboratory. The COA and LA serotyping results were equivalent in accuracy to those obtained using quellung serotyping. Both these agglutination tests are rapid, valid, and relatively cheap, and with appropriate validation by reference laboratories they could be more widely used in developing countries to obtain local and regional data on pneumococcal serotype distribution.

Agglutination Tests↗

PubMed2004

Upper limits in developing countries: warning against too much in lands of too little.

Recent trends in dietary patterns have provided a confusing and sometimes contradictory statement about the state of nutrition throughout the world. On the one hand, undernutrition caused by caloric and micronutrient deficiencies are still prevalent in developing countries. On the other hand, obesity caused by excess caloric intake is increasing at alarming rates in most developed and some developing countries. At the center of this confusion is the desire by health ministries to provide sound nutritional advice to prevent chronic diseases. One approach is to provide upper limits for nutrients that may be harmful if consumed in large quantities. This policy may be effective and sound for those nations with a low prevalence of food insecurity, but for many countries, especially those with trouble ensuring an adequate intake of protein and micronutrient-rich foods, the use of upper limits may result in unknown and potentially harmful effects and lead to delayed improvement in overall nutritional status. To explore this idea, a recent study looking at the relationship between early undernutrition and risk for obesity in children living in the shantytowns of Sao Paulo, Brazil is reviewed. The focus of this study was to better understand how the long-term effects of undernutrition on health and later risk for chronic diseases. This study illustrates the precarious state of health in developing countries and provides the backdrop for a discussion on food security and the potential effects of establishing policies on food intake in unstable settings.

Brazil↗

PubMed1993

Ureteroscopic treatment of lower ureteral calculi in the era of extracorporeal shock wave lithotripsy: from a developing country point of view.

In a series of 229 lower ureteral calculi manipulated with either extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy the stone clearance rate 7 days after treatment was 40.6% and 90%, respectively. Only 17 of 32 patients (53.1%) treated with ESWL were rendered stone-free at 4-week followup. In addition to concern about stone clearance, other medical and social factors, and the availability of health insurance coverage must be considered. Since the differences of living standards between highly developed and developing countries are great, the selection of ESWL or ureteroscopy as primary treatment of lower ureteral calculi must be based on the socioeconomical status of a specific country. Because ESWL devices are not readily available in most developing countries and ureteroscopy is cost-effective, highly efficacious (greater than 92%) and involves minimal morbidity (less than 10%) for calculi removal in experienced hands, we recommend ureteroscopy as the treatment of choice for lower ureteral stones, with ESWL as the alternative, in developing countries.

Adult↗

PubMed2002

Risk of mortality for dementia in a developing country: the Yoruba in Nigeria.

BACKGROUND: Limited data exist on the impact of dementia in developing nations, including its association with mortality. OBJECTIVE: The purpose of this paper is to assess the relationship between dementia and five-year mortality on a community dwelling elderly Yoruba population in the developing country of Nigeria and to compare those results with those from an elderly African-American community in Indianapolis. METHODS: A two-phase design was used to ascertain dementia status in two sites. In the first phase, the Community Screening Instrument for Dementia (CSI-D) was administered. In the second phase, subjects were sampled for the clinical assessment according to their CSI-D performance category. Proportional hazards regression was used to assess the relationship between mortality and cognitive status at both sites after adjusting for demographics and chronic disease conditions. RESULTS: For the entire screened population, poor and intermediate performance on the CSI-D is associated with increased mortality at both sites; however the effect of CSI-D performance did not significantly differ between the two sites. For the clinically assessed sample, dementia was significantly associated with increased mortality at both sites (Ibadan RR = 2.83, Indianapolis RR = 2.05), but the effect was not significantly different across the two sites. CONCLUSION: Dementia resulted in an increased risk of mortality for Yoruba of a magnitude similar to African-Americans suggesting that the impact of dementia on mortality risk may be similar for developing and developed countries.

Aged↗

PubMed1988

The choice of prosthetic and orthotic technique for less developed countries: analysis and perspectives in Colombia.

In their efforts to set up orthopaedic technical services, less developed countries such as Colombia have often relied on so called "turn key" technology transfers depending on the know-how and the infrastructures in industrial countries. The sophisticated industrial product stands thus in sharp contrast to the "single item" product which relies on traditional crafts and local materials. Both extreme forms of technology are currently employed in most less developed countries including Colombia. While the high-technology product is costly and requires a specialized base to produce and to service it, the "single item" product lacks generally the minimum requirements in terms of uniform quality, biomechanical function and cosmetic acceptability. Although the remarkably high standard of industrial products explain their worldwide demand and distribution, it should not be concluded that countries such as Colombia have no other choice than to adopt these technologies. In search of an intermediate alternative, the potential of a yet undervalued, appropriate technology is explored and an accurate account of its advantages is given.

Colombia↗

PubMed1993

Field tests for rational drug use in twelve developing countries.

Increasing efforts are being made to improve drug-use practices and prescribing behaviour in developing countries. An essential tool for such work is an objective and standard method of assessment. We present here a set of drug-use indicators produced and tested in twelve developing countries. We describe practical applications, which include the use of indicators to increase awareness among prescribers in Malawi and Bangladesh, to identify priorities for action (eg, polypharmacy in Indonesia and Nigeria, overuse of injections in Uganda, Sudan, and Nigeria, and low percentage of patients who understood the dosage schedule in Malawi), and to quantify the impact of interventions in Yemen, Uganda, Sudan, and Zimbabwe.

Developing Countries↗

PubMed1996

Global variations in cancer survival. Study Group on Cancer Survival in Developing Countries.

Population-based cancer registries from Algeria, China, Costa Rica, Cuba, India, the Philippines, and Thailand are collaborating with the International Agency for Research on Cancer in a study of cancer survival in developing countries. Comparisons with the SEER program results of the National Cancer Institute in the United States, and the EUROCARE study of survival in European countries revealed considerable differences in the survival of patients with certain tumors associated with intensive chemotherapeutic treatment regimes (Hodgkin's disease and testicular tumors), more modest differences in the survival of patients with tumors for which early diagnosis and treatment confer an improved prognosis (carcinomas of the large bowel, breast, and cervix), and only slight differences for tumors associated with poor prognosis (carcinomas of the stomach, pancreas, and lung). With limited resources to meet the challenge of the increasing incidence of cancer expected in the next few decades, health authorities in developing countries should be aware of the importance of investing in a range of cancer control activities, including primary prevention and early detection programs as well as treatment.

Developed Countries↗

PubMed2001

Nutrition and aging in developing countries.

The number of individuals aged 60 y or older is projected to double as a proportion of the world's population and to more than triple in number over the next 50 y. These changes will be most dramatic in the less developed countries, where the transition from a young to old age structure will be more compressed in time than it has been for developed countries. At the same time, there is evidence of a characteristic sequence of changes in diet and declines in physical activity associated with social and economic change. Diets are becoming higher in fats, animal products, and refined foods and lower in fiber, contributing to rapidly increasing prevalences of obesity and type 2 diabetes. The number of people with diabetes in developing countries is projected to almost triple by the year 2025. Hypertension and vascular disease are also rapidly becoming more prevalent. Evidence that lower birth weights are associated with greater likelihood of adult obesity and chronic disease underscores the magnitude of risk in these countries. Few programs or institutions currently exist to address the problems of the growing elderly population. The social changes that accompany urbanization will likely increase nutritional risk for this group. Despite lower energy intakes with age, elderly have higher requirements for several micronutrients, making them vulnerable to deficiencies that further aggravate chronic conditions. To reduce the impending burden of disease and disability worldwide, urgent action is needed to understand and to address the nutritional needs of the aging population.

Aging↗

PubMed2006

Chapter 8: Screening for cervical cancer in developing countries.

Organised and quality assured cytology-based screening programmes have substantially reduced cervical cancer incidence in many developed countries. However, there are considerable barriers to setting up cytology-based screening programs, particularly in developing countries. This has stimulated the search for novel and alternative approaches to cytology for cervical cancer prevention. These approaches generally perform as well as cytology, and sometimes better, although many of them have a lower specificity, resulting in higher false-positive rates. The possibility of linking screening to treatment in a one- or two-visit strategy appears to be safe, feasible and effective. Barriers to establishing screening programs and the pitfalls encountered differ from one country to the next. Country-specific solutions need to be found, while being cognizant of the criteria that have enabled successful screening programmes.

Developing Countries↗