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PubMedDate not supplied

Human immunodeficiency virus vaccine development in developing countries: are efficacy trials feasible?

The implementation of human immunodeficiency virus (HIV) vaccine efficacy trials in developing countries represents an unprecedented series of challenges for the medical and scientific communities, health authorities, policy makers, and the populations of diverse countries. Such trials require great attention, dedication, and information at the earliest possible time from many groups in these communities, as well as the clear and full collaboration of all the national and international institutions and agencies involved. This article discusses suggestions and makes recommendations regarding multiple hurdles to trial implementation, including access to appropriate populations, incidence and natural history of HRV type 1 (HIV-1) infection, definition of efficacy endpoints, and logistical, ethical, regulatory, political, and media issues. The conduct of phase I and II trials in developing countries will be a critical step for appropriate vaccine selection and in helping to identify the country- and community-specific issues and the needs for further implementation. Some countries have already established their own national HIV vaccine development plans. Additional operational and action plans with special emphasis on efficacy trial implementation would be strongly recommended after country-specific preparedness workshops and constitution of national or regional task forces.

AIDS Vaccines↗
PubMedDate not supplied

Surgical audit in the developing countries.

Audit assures provision of good quality health service at affordable cost. To be complete therefore, surgical practice in the young developing countries, as elsewhere, must incorporate auditing. Peculiarities of the developing countries and insufficient understanding of auditing may be, however, responsible for its been little practised. This article, therefore, reviews the objectives, the commonly evaluated aspects, and the method of audit, and includes a simple model of audit cycle. It is hoped that it will kindle the idea of regular practice of quality assurance by surgeons working in the young developing nations and engender a sustainable interest.

Developing Countries↗
PubMed1990

The Italian support to prevention of blindness programmes in developing countries.

The authors point out that Italy, as a tradition, has always dedicated special attention to developing countries, due to its geographical position and its cultural background and that in 1971 the Italian Government has created by a law, as part of the Ministry of Foreign Affairs, the Department for Cooperation and Development, the objective of which is to contribute to the enhancement of the living conditions in developing countries. The authors report data on a Trachoma Control Project started in 1973 lasting to 1981, financially supported by the Ministry of Foreign Affairs and technically guided by some of the authors and point out that the major success of this Project is that, since they left the Country in 1981, trachoma control activities are still now carried out by using the same methodologies. Finally, the authors report data on a National Prevention of Blindness Programme, the extension of which will be guided in the near future by the Referral Center for Public Health Ophthalmology of Rome that has just prepared the plan of operation that foresees the reorganization and strengthening of the existing structures and manpower at the head quarter, tertiary, secondary and primary levels.

Blindness↗
PubMed2000

Developing child mental health services in developing countries.

There is an urgent need to pay attention to the mental health of children in developing countries. Professionals confronted with this task face a number of challenges. Services have to be planned in a rational way, keeping in mind the needs of local populations. These needs will often exceed the available resources, and it will be necessary to set priorities. Feasible and cost-effective models of service delivery then have to be developed to meet these needs. This annotation provides a framework within which mental health needs of children can be assessed, priorities established, and services organised. This is illustrated with examples of relevant activities undertaken in low-income developing countries over the last two decades.

Child↗
PubMed1988

Recent trends in migration between core and peripheral regions in developed and advanced developing countries.

"The main finding of this article is that net internal migration to the core regions in the countries of the developed world, which subsided in the 1970s, increased in the 1980s, although not to the level of the 1960s. In some countries of northwest Europe there is a balance now in net flows between core and periphery. In the countries of the periphery of Europe and Japan net internal migration to the core regions increased slightly in the 1980s. Net migration flows to the periphery have completely reversed in Canada, and net flows out of the core regions of the United States have been significantly reduced. In eastern Europe, however, there is still moderate net migration to the core regions without any interruption as seen in western Europe, North America, and Japan. In South Korea and Taiwan rates of net migration to the core regions have been reduced from their high levels of the 1970s, but they are still quite high and show no clear sign of a break from the past."

Asia↗
PubMed1986

Further research on accident rates in developing countries.

Earlier studies have shown that by using cross-sectional data for a group of developing countries, a significant relationship can be established between fatality rates and vehicle ownership levels. This paper updates relationships established in earlier years and identifies whether or not the slope of the regression line has continued to increase (and suggests that for the group of countries as a whole, there is a worsening in the safety situation). Similar relationships are also established for casualty rates. A detailed analysis is made of the relationship between fatality rates and parameters which describe, in part, the social, physical and economic characteristics of the developing countries. These include vehicle ownership, gross national product per capita, road density, vehicle density (per kilometre of road), population per physician and population per hospital bed. Again, comparisons are made with results obtained on earlier studies.

Accidents, Traffic↗
PubMed2005

The health workforce: managing the crisis ethical international recruitment of health professionals: will codes of practice protect developing country health systems?

Many countries are using the strategy of international recruitment to make up for shortages of health professionals to the detriment of health systems in the poorest parts of the world. This study reviewed the potential impact of eight national level and international codes of practice or similar instruments that are being introduced to encourage ethical recruitment in order to protect these countries. Whilst effective dissemination of the instruments is generally in place, support systems, incentives and sanctions and monitoring systems necessary for effective implementation and sustainability are currently weak or have not been planned. If such codes or instruments are to be used to protect developing country health systems, lessons should be learnt from the early adopters; the focus of protecting developing country health systems needs to be emphasised in instruments with multiple objectives; the process of implementing the instruments strengthened; and internal and external pressure needs to be increased to ensure the codes and instruments lead to ethical recruitment and help to protect developing country health systems.

Codes of Ethics↗
PubMed2000

[Treatment of status epilepticus in a developing country].

Status epilepticus (SE) is a condition requiring emergency care, which is often poorly managed in developing countries due to the lack of personnel, drugs, and insufficient technical and medical means. This study aims at determining the epidemiologic and etiologic characteristics and the difficulty in treating SE under the existing medical practice conditions in a developing country such as Senegal. A retrospective study was therefore carried out based on SE medical files at the University Hospital of Dakar over the period January 1988 to December 1998, and included several hospital departments, i.e., paediatrics, infectious diseases and neurology. Over an 11-year period 697 cases were recorded; of these, 48.2% of patients were under 5 years of age. The seizures were generalized in 58.2% of cases, partial in 21.2%, partial secondarily generalized, or with an association of both clinical presentations in 20.6% of cases. The etiology was as follows: mainly infectious (67%), followed by resistant and/or unbalanced epilepsy (9.9%), epilepsy of vascular origin (8%), and various other causes. The overall mortality rate was 24.8%. A long period between the onset of clinical symptoms and hospital treatment was noted, with an average time lapse of 16.6 h before treatment. The drugs utilized were diazepam and phenobarbitol, administered by injection. The overall outcome could be improved by better management, i.e., better prevention and an efficient treatment of infectious diseases, a reduction in the time before treatment, and improved means of intensive care.

Adolescent↗
PubMed2006

Early hearing detection at immunization clinics in developing countries.

Early hearing detection has become a standard of neonatal care in most parts of the developed world. A growing number of developing countries are also currently exploring practical and culturally appropriate options for early hearing detection. Recent findings from on-going infant hearing screening programs in Nigeria and South Africa suggest that hearing screening programs are feasible if integrated into early childhood immunization programs in developing countries, especially where a significant number of births occur outside regular hospitals. A major challenge for a multi-stage screening protocol is how to minimize default rates for follow-up till diagnosis. However, this could be systematically addressed through improved parental education and appropriate support at various stages of the program.

Ambulatory Care Facilities↗
PubMed1998

Are you overlooking oral rehydration therapy in childhood diarrhea? It's not just for use in developing countries.

In 1978, Lancet declared that development of effective oral rehydration solutions might prove to be the most important medical advance of the century. Since then, according to estimates of the World Health Organization, use of the solutions has saved a million children a year worldwide. Why, then, has this method of treating diarrhea-induced dehydration been so overlooked in the United States, where several hundred children still die annually of effects of diarrhea? One reason, the authors believe, is that physicians in developed countries have only limited exposure to serious dehydration and so are poorly informed on the principles of intervention. The authors provide practical advice on assessing dehydration in children, providing initial and maintenance rehydration, and reinstituting feeding.

Antidiarrheals↗
PubMed2004

Reframing the HIV/AIDS debate in developing countries III: an effective, equitable response.

Developing countries need to balance resources for treatment and prevention. In Southern Africa, only 100,000 out of 4.1 million people who need HIV/AIDS anti-retroviral therapy (ART) are able to access it. The drop in the price of ART has led to opportunities to increase the numbers receiving treatment, but problems remain. Increasing health service focus on HIV might poach staff and resource from other important programs like TB, malaria or child health. It depends on good organisation and laboratory support. It may medicalise the epidemic and distract attention from the need for education and prevention. There is now good evidence that preventive strategies, including STD treatment, improved practices of blood transfusion and needle use, use of drugs to prevent mother child transmission, voluntary counselling and testing, increased condom availability and behaviour change are very effective in reducing spread. It is obvious that both treatment and prevention strategies are necessary. International aid is still inadequate. The European Union spends 50 billion dollars on agricultural subsidies, but donates only 140 million dollars for HIV in Africa. As funding increases, it is vital that it is well used and reaches the people who need it most.

Journal Article↗
PubMed1994

Hypoxia in childhood pneumonia: better detection and more oxygen needed in developing countries.

Even though hypoxia is a major risk factor for death in children with acute respiratory infection in developing countries, oxygen is not part of first line treatment. Because oxygen is not readily available in developing countries it tends to be given to the most seriously ill children, whose outcome is poor. Oxygen might be useful if given earlier in the course of the disease. Clinical signs are not clear cut, however, though the presence of cyanosis and grunting together with a raised respiratory rate can significantly increase the detection of hypoxaemia. A simple oximeter would make detection easier, and oxygen concentrators are more cost effective than bottled oxygen. Ideally oxygen should be given to children in the early stages of clinical pneumonia to prevent deterioration.

Child↗
PubMed1996

Clinical audit in a developing country.

The advantages of health care audits in developing countries with severe resource constraints are discussed, citing examples from Malawi. Measuring quality in health care raises the standard of care through decreased uncertainty in health care provision, rationalized choice, appropriate direction of limited resources, increased job satisfaction and improved ethical standards.

Adult↗
PubMed1993

Health priorities in developing countries.

In essence then, the health sector in developing countries is weak and fragile; it is vulnerable to external financial pressures and the vagaries of national budget priorities. Throughout the world, leaders in health must seek more effective ways of impressing upon others who make national policy the long term consequences of crises which disrupt health services. Above all, the impact of disinvestment in health in creating underdevelopment and the value of investment in health in creating development must be demonstrably established. Health must be seen as an engine of national development.

Acquired Immunodeficiency Syndrome↗
PubMed1992

A call to the international nursing community: put AIDS in developing countries on the agenda.

In some African countries 10%-15% of the middle class may due during the 1990s and at the present time the human infrastructure is being eroded by HIV. Over 90% of home and community care is being supervised by nursing and midwifery personnel in some developing countries. What will happen if these carers become ill or die? Peter Kerr provided a micro view of HIV disease in developing countries in 'Health care crisis in Africa', August ANJ. In this article he discusses the macro implications for developing countries as they encounter the consequences of what is likely to be the most devastating epidemic of this century.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Inguinal hernia repair in a developing country.

Hernia surgery is typically same-day surgery and can be safely conducted in a developing country. We describe a collaborative effort of the American Hernia Society, the Institute of Latin American Concerns, medical industries, the United States Peace Corps, physicians, surgical residents and nurses from many institutions. During three 5-day periods, we operated on 236 patients and repaired 252 hernias (73% inguinal). In addition, an education day for local physicians was conducted on three occasions and included televised live surgical demonstrations and interactive lectures with question and answer sessions. We suggest this to be a viable public health initiative and demonstrate the role of surgeons in advancing and providing state-of-the-art inguinal hernia surgery to a developing country and its underserved population.

Developing Countries↗
PubMed2005

Never-treated patients with schizophrenia in the developing country of Bali.

BACKGROUND: A considerable number of individuals with schizophrenia go undiagnosed and untreated in developing countries. In the current study, we investigated the prevalence of schizophrenia, the treatment status of individuals with schizophrenia, and factors associated with never-treated status in a Balinese rural community. METHOD: A door-to-door survey was conducted on 8546 people from the general population to detect individuals with schizophrenia using standardized screening instruments in Bali. RESULTS: Thirty-nine individuals with schizophrenia were identified, giving a point prevalence of 4.2 per 1000 population. Never-treated group subjects (n = 20: 51.3%) had a significantly higher total score on the Positive and Negative Syndrome Scale (p < 0.05) and were less likely to have a history of violent behavior (p < 0.01) than Treated group subjects (n = 19: 48.7%). All 9 subjects who had never shown violent behavior remained untreated. CONCLUSION: The clinical condition of the never-treated individuals with schizophrenia was poor. Individuals with schizophrenia without violent behavior had no opportunity to undergo medical treatment in this developing country setting.

Adult↗