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"Urban trends in developing countries have been studied in broad terms only, which has led to improbable projections for the future. In this paper, a two-equation model has been drawn up and tested by advanced econometric methods to pinpoint the role of explanatory factors and to discover possible trend reversals. Results on both scores have been positive."
Peritoneoscopy in medical cases remains largely unpopular in the USA and the UK. In many developing countries there is often a heavy demand on medical facilities and the rapid diagnosis of intra-abdominal problems is of major importance. We present a series of 193 patients in whom peritoneoscopy was carried out during a 2 1/2-year period. Eighty-six per cent (166) of examinations yielded information of positive diagnostic value. The most common diagnoses were hepatocellular carcinoma, liver cirrhosis, bilharzial fibrosis and peritoneal tuberculosis. The peritoneoscopic appearances in the various lesions are illustrated and discussed. Peritoneoscopy is a safe procedure and its value in a developing country is great, both in terms of economy of man-hours employed and, more particularly, of diagnostic yield.
BACKGROUND: Smoking, alcohol drinking and cannabis use ("risk behaviors") are often initiated at a young age but few epidemiological studies have assessed their joined prevalence in children in developing countries. This study aims at examining the joint prevalence of these behaviors in adolescents in the Seychelles, a rapidly developing country in the Indian Ocean. METHODS: Cross-sectional survey in a representative sample of secondary school students using an anonymous self-administered questionnaire (Global Youth Tobacco Survey). The questionnaire was completed by 1,321 (92%) of 1,442 eligible students aged 11 to 17 years. Main variables of interest included smoking cigarettes on > or =1 day in the past 30 days; drinking any alcohol beverage on > or =1 day in the past 30 days and using cannabis at least once in the past 12 months. RESULTS: In boys and girls, respectively, prevalence (95% CI) was 30% (26-34)/21% (18-25) for smoking, 49% (45-54)/48% (43-52) for drinking, and 17% (15-20)/8% (6-10) for cannabis use. The prevalence of all these behaviors increased with age. Smokers were two times more likely than non-smokers to drink and nine times more likely to use cannabis. Drinkers were three times more likely than non-drinkers to smoke or to use cannabis. Comparison of observed versus expected frequencies of combination categories demonstrated clustering of these risk behaviors in students (P < 0.001). CONCLUSION: Smoking, drinking and cannabis use were common and clustered among adolescents of a rapidly developing country. These findings stress the need for early and integrated prevention programs.
"Increasingly uneven spatial population distribution, especially in developing countries, has brought about a growing need for better statistical information on the extent of the various forms of spatial mobility during the [1980s] and their determinants and consequences....The main issues discussed in this paper are...the problems of defining and measuring spatial mobility in general as well as [reviewing] the types of mobility-related questions in censuses, their strengths and weaknesses, and the possibilities of evaluation of the collected data. Finally, alternative concepts for measuring spatial mobility are discussed which could help to gather information on non-permanent forms of spatial mobility, an issue of growing importance for the developing world." (SUMMARY IN ENG)
BACKGROUND: To assess injection practices and to test interventions aimed at reducing unsafe injections in developing countries, cluster surveys and cluster randomized trials are needed. The design of cluster-based studies requires estimates of intraclass correlation coefficients that have to be obtained from previous studies. This study presents such estimates. METHODS: Data were derived from a cross-sectional study of injection use and health seeking in Pakistan that used 34 clusters to select 1150 study subjects aged > or =3 months. We analysed variance to separate its components. RESULTS: Most of intraclass correlation coefficients were in the range of 0.01-0.05. For proportion of injections received during last 3 months, mean number of injections received and health seeking during the past 3 months the intraclass correlation coefficients were 0.02, 0.04 and 0.02, respectively. CONCLUSION: These estimates can be useful in designing cluster surveys and cluster randomized trials for injection safety in Pakistan and other developing countries.
The limited resources of developing countries are forcing them to search for different options to keep up with the accelerating pace of research into genetic medicine. In Mexico, one such option is the Mexican Network of Molecular Biomedicine (MNMB). With the Internet as a means of communication and a source of information, the MNMB aims to provide a program based on cooperation, high-quality service and patient care.
There is a strong epidemiological association between poor nutritional status and low-birthweight (LBW) newborns. According to the World Health Organization (WHO), 95% of total LBW in the world are born in developing countries. Nevertheless, the nutritional etiology of intra uterine growth retardation (IUGR) is still controversial and not yet established largely because of contradictory nutritional studies in pregnancy. In 1981 Menon et al described an animal model of IUGR due to mild deficiency in essential fatty acids (EFA, linoleic and alpha linolenic acids), with a strong correlation between EFA intake during pregnancy and fetal growth. According to the WHO reports in the last decade, there was a dramatic deficiency of lipid intakes (less than 10% of total caloric amounts) in the majority of developing countries while the EFA requirements alone of normal nourished women are evaluated at 6% of total caloric amounts during pregnancy. A mild deficiency in dietary EFA may be a limiting factor in fetal growth processes in humans as it has been shown in animals. Such a mechanism could be easily verified. Research proposals are made in an attempt to test this hypothesis in developing countries with possible applications in further nutritional interventions in pregnancy.
Epilepsy is the most common serious neurological disorder and is one of the world's most prevalent noncommunicable diseases. As the understanding of its physical and social burden has increased it has moved higher up the world health agenda. Over four-fifths of the 50 million people with epilepsy are thought to be in developing countries; much of this condition results from preventable causes. Around 90% of people with epilepsy in developing countries are not receiving appropriate treatment. Consequently, people with epilepsy continue to be stigmatized and have a lower quality of life than people with other chronic illnesses. However, bridging the treatment gap and reducing the burden of epilepsy is not straightforward and faces many constraints. Cultural attitudes, a lack of prioritization, poor health system infrastructure, and inadequate supplies of antiepileptic drugs all conspire to hinder appropriate treatment. Nevertheless, there have been successful attempts to provide treatment, which have shown the importance of community-based approaches and also indicate that provision for sustained intervention over the long term is necessary in any treatment programme. Approaches being adopted in the demonstration projects of the Global Campaign Against Epilepsy--implemented by the International League Against Epilepsy, the International Bureau for Epilepsy, and the World Health Organization--may provide further advances. Much remains to be done but it is hoped that current efforts will lead to better treatment of people with epilepsy in developing countries.
Public perceptions and political debates regarding the risks and benefits of agricultural biotechnology are well documented in industrialized countries. Yet, hardly any surveys have been conducted in developing countries. The following study aims to contribute to a better understanding of stakeholder attitudes toward agricultural biotechnology in developing countries. For this purpose, stakeholder representatives in the public debates in Mexico and the Philippines were asked to complete two nearly identical questionnaires on the risks and benefits of agricultural biotechnology. A comparison of stakeholder attitudes in the Philippines and Mexico is interesting because it shows how the different political systems, cultural and ecological backgrounds, and the regional context of food and agriculture influence perceptions. In general, the results of the surveys indicate that the participants in both countries consider genetic engineering to be an important tool to address agricultural, nutritional, and environmental problems, and they do not regard transgenic foods as risky for consumers. However, they are concerned about the potential impact of such transgenic crops on their countries' rich biological diversity and do not believe that national biosafety guidelines will be implemented properly. Although the surveys show that stakeholder attitudes in the Philippines and Mexico are quite similar, they also highlight significant differences in perception often related to cultural and political aspects.
OBJECTIVE: To evaluate the effectiveness of active management of labor in the setting of a developing country. METHODS: This historical cohort study compared the labor characteristics and outcome of all anti-HIV positive nulliparous pregnant women (n=96), who delivered between January 1991 and March 1999, treated with traditional labor management to all anti-HIV negative nulliparous pregnant women (n=1856), who delivered in 1998, treated with active management of labor in the tertiary center of a developing country. The year 1998 was chosen by using the total cesarean section rate of nulliparous patients from 1991 to 1998 to find the mean, then selected the year with cesarean section rate nearest to the mean as a control. Data were analyzed by the chi-square and t-tests. RESULTS: The length of labor was significantly shortened in the active management group (6.3+/-3.3 h vs. 8.9+/-6 h, P<0.001). A significantly greater proportion of the traditional management group had prolonged labor (29.3% vs. 4.9%, P<0.001). However, the cesarean section rate was not different between the two groups (active vs. traditional=17% vs. 14.6%, P=0.7) with dystocia as a major indication in both groups. Maternal and fetal complications were not different. CONCLUSION: The active management of labor shortened the duration of labor and reduced prolonged labor; however, it did not decrease the cesarean section rate.
BACKGROUND: Improving the quality of care for sick children referred to hospitals in less-developed countries may lead to better outcomes, including reduced mortality. Data are lacking, however, on the quality of priority screening (triage), emergency care, diagnosis, and inpatient treatment in these hospitals, and on aspects of these potential targets that would benefit most from interventions leading to improved health outcomes. METHODS: We did a qualitative study in 13 district hospitals and eight teaching hospitals in seven less-developed countries. Experienced paediatricians used a structured survey instrument to assess initial triage, emergency and inpatient care, staff knowledge and practices, and hospital support services. FINDINGS: Overall quality of care differed between countries and among hospitals and was generally better in teaching hospitals. 14 of 21 hospitals lacked an adequate system for triage. Initial patient assessment was often inadequate and treatment delayed. Most emergency treatment areas were poorly organised and lacked essential supplies; families were routinely required to buy emergency drugs before they could be given. Adverse factors in case management, including inadequate assessment, inappropriate treatment, and inadequate monitoring occurred in 76% of inpatient children. Most doctors in district hospitals, and nurses and medical assistants in teaching and district hospitals, had inadequate knowledge and reported practice for managing important childhood illnesses. INTERPRETATION: Strengthening care for sick children referred to hospital should focus on achievable objectives with the greatest potential benefit for health outcome. Possible targets for improvement include initial triage, emergency care, assessment, inpatient treatment, and monitoring. Priority targets for individual hospitals may be determined by assessing each hospital.
Acute lower respiratory infection in children is a major cause of morbidity and mortality in developing countries. Viral and bacterial agents incite characteristic host responses at the level of the bronchi, bronchioles, alveolar walls, and air spaces that correlate with the clinical course. A systematic review of histopathologic features will enhance the understanding of the pathogenetic mechanisms and cofactors that influence the disease process, particularly how tissue injury may be influenced by nutritional status and access to antibiotics. Research priorities include immunologic assessment, micronutrient assays, and standardized autopsies in developing countries. DNA probes for organisms and immunocytochemical identification of cell markers in tissue promise a new era in microscopic visualization of pathogen-host interactions. International collaborative research between ministries of public health and medical universities must be encouraged as a means of providing technical assistance and of advancing new knowledge. Systematic standardized autopsy studies from multiple geographic areas may help define pathologic mechanisms, monitor the natural history of disease, and evaluate interventions in diverse populations.
Parkinsonism is the commonest extrapyramidal disorder. The condition arises when the striatonigral dopamine content falls below a critical value. The principle of treatment is dopamine replacement or counteracting the effects of acetycholine, the neurotransmitter which is in abundance. The choice of drug is determined by availability, cost, and side effects. The most commonly prescribed drugs in developing countries are the anticholinergics, which are the least expensive. The dopamine-replacement agents are second-line drugs and it appears as if low doses are effective in improving rigidity, gait abnormality, and postural instability. The use of dopa-agonist drugs is more limited, because of cost and side effects. Surgical management of cases is still in its infancy in developing countries. This review also highlights the more recent modes of management practised mainly in developed countries.
Tuberculosis causes more deaths worldwide than any other single infectious disease. Most new cases occur in developing countries, where the emergence of HIV/AIDS-associated multidrug-resistant Mycobacterium tuberculosis could disrupt the effective delivery of chemotherapy. Diagnosis, one of the cornerstones of the modern national tuberculosis control programs in developing countries, is based on sputum smear microscopy, which can be delivered effectively only through a national laboratory network. Tuberculosis diagnostic services can be delivered in lock step with the expanding laboratory network in an incremental manner, beginning with the simplest procedure and ending with the most sophisticated ones.
An exact assessment of the animal health situation in a country is an essential element in formulating eradication and control programmes, and in regulating international trade in animals and animal products from that country. Due to a lack of human and technical resources, Veterinary Services in developing countries often lack precise knowledge on disease occurrence. Since the collection and transmission of reliable information on animal diseases in developing countries are major concerns of the Office International des Epizooties (OIE), a project aimed at improving this situation was implemented with international financial support. This project involved the development by the Centre for the Application of Methodology for the Diagnosis of Animal Diseases (CAMDA) of field kits for the diagnosis of the main diseases present in tropical Africa: rinderpest, peste des petits ruminants (PPR), contagious bovine pleuropneumonia (CBPP) and contagious caprine pleuropneumonia (CCPP). Several tests already exist, such as complement deoxyribonucleic acid (cDNA)-specific probes and polymerase chain reaction (PCR) for rinderpest and PPR, DNA probes and PCR for CBPP, capture enzyme-linked immunosorbent assay, the agglutination test and the immunobinding peroxidase test for CCPP, etc. With specific reference to these examples, the various problems faced by the OIE and CAMDA are reviewed.
A cohort of 337 Spanish travellers to developing countries is presented. They all consulted us for traveller's diarrhea (TD). Bacteriological, parasitological and virological examinations were performed. A bacterial cause was found in 61.65% of travellers. Toxigenic and classical pathogenic Escherichia coli strains were the main bacterial agents. In comparison with other studies, Spanish travellers harboured Y. enterocolitica and EPEC organisms as a cause of TD. G. lamblia and E. histolytica were the most frequently isolated protozoa. Helminths were found in only 9 patients. No rotavirus infections were diagnosed. Previous antibiotic treatment had been taken by 161 patients. The percentage of isolated enteropathogens was similar in travellers who had previously taken antibiotic treatment and those who had not.
Travelers to developing countries are at risk of contracting tropical infectious diseases that they or their physicians may be unfamiliar with. Proper pre-travel counsel should be given concerning general health risks that may be encountered abroad, immunizations, malaria prophylaxis and prevention and treatment of traveler's diarrhea. In Rhode Island, expert advice may be obtained at the Traveler's Clinics at the Miriam Hospital in Providence (401-274-3700 or 331-8500, ext. 4075) and the Memorial Hospital in Pawtucket (401-722-6000, ext. 2545). The Miriam Traveler's Clinic is open Wednesday (9-1) and all day Friday while the Memorial Traveler's Clinic is open Tuesday afternoon. These Traveler's Clinics are headed by Drs G.R. Olds and S.M. Opal, respectively.
Clinical data on Duchenne muscular dystrophy (DMD) are lacking in developing countries. The objective of this study was to delineate the demographic characteristics, investigations, and outcome of 21 Malaysian males diagnosed with DMD over a period of 10 years. Mean age presentation was 3 years 8 months (SD 23mo; range 10 to 84mo), mean duration from first presentation to diagnosis was 3y 7mo (SD 26mo; range 5 to 84) and the mean age for loss of ambulation was 11 years (SD 25mo; range 102 to 168). There was family history of DMD in five of the 21 patients. Muscle biopsy showed confirmatory findings of DMD in the 16 patients tested. Molecular genetic analysis showed dystrophin gene deletions in 11 of these 16 patients. Four and seven of the students stopped schooling and had learning difficulties, respectively; only nine had satisfactory school performances. Eight out of 14 patients evaluated were classified as having severe to total dependency levels on the modified Barthel Index for activities of daily living assessment. DMD is associated with significant medical and social needs for a developing country such as Malaysia. Earlier referral, genetic counselling, and provision of support and rehabilitative services are the main priorities.