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PubMed1999

Magnitude of the disease burden from neurocysticercosis in a developing country.

Cysticercosis contributes to higher epilepsy rates in developing countries than in industrialized ones, yet no estimate exists for the associated burden of disease. We used epidemiological data on neurocysticercosis in Peru to calculate the burden of disease and applied our model to the other countries of Latin America where neurocysticercosis is endemic to determine a regional estimate. Analysis of 12 population-based community studies demonstrated that neurocysticercosis was endemic in highland areas and high jungles, with seroprevalences from 6% to 24%. In one community, the adult seizure disorder rate was 9.1% among seropositive persons versus 4. 6% among seronegative persons; we used this difference for estimates. On the basis of average prevalence rates in areas of endemicity of 6%-10%, we estimated that there are 23,512-39,186 symptomatic neurocysticercosis cases in Peru. In Latin America, an estimated 75 million persons live in areas where cysticercosis is endemic, and approximately 400,000 have symptomatic disease. Cysticercosis contributes substantially to neurological disease in Peru and in all of Latin America.

Animals↗
PubMed2001

Service quality perceptions and patient satisfaction: a study of hospitals in a developing country.

Patients'perceptions about health services seem to have been largely ignored by health care providers in developing countries. That such perceptions, especially about service quality, might shape confidence and subsequent behaviors with regard to choice and usage of the available health care facilities is reflected in the fact that many patients avoid the system or avail it only as a measure of last resort. Those who can afford it seek help in other countries, while preventive care or early detection simply falls by the wayside. Patients'voice must begin to play a greater role in the design of health care service delivery processes in the developing countries. This study is, therefore, patient-centered and identifies the service quality factors that are important to patients; it also examines their links to patient satisfaction in the context of Bangladesh. A field survey was conducted. Evaluations were obtained from patients on several dimensions of perceived service quality including responsiveness, assurance, communication, discipline, and baksheesh. Using factor analysis and multiple regression, significant associations were found between the five dimensions and patient satisfaction. Implications and future research issues are discussed.

Bangladesh↗
PubMed1999

Trauma scoring in a developing country.

AIM OF STUDY: The aim of the study was to evaluate the efficacy of trauma scoring systems in a developing country. METHOD: Trauma Score (TS) and Trauma and Injury Severity Score (TRISS) were used to predict the survival of 462 trauma patients during the period January 1996 to July 1996. RESULTS: TS had a sensitivity of 53.9% and a specificity of 98.8% whereas TRISS had a sensitivity of 46% and a specificity of 98.7%. Significant differences in mortality were observed compared with the baseline Major Trauma Outcome Study (MTOS) norms (Z = 4.17, p < 0.001). CONCLUSION: Present injury severity instruments using MTOS coefficients do not accurately predict survival of trauma patients in a developing country, thus highlighting the need for developing new coefficients for trauma scoring in these countries.

Developing Countries↗
PubMed1994

Data utilization and analytical skills among mid-level health programme managers in a developing country.

Mid-level health managers in a developing country were studied to examine the extent to which they are able to use and analyse data they receive from a new health information system. Among 168 managers filling out a self-administered questionnaire, 52% could compute a simple cost-effectiveness ratio and 27% were able to calculate proportions. Only 43% of the managers were able to construct a cumulative graph similar to the one recommended by WHO. Facility with these tasks was not related to levels of training or age. Twelve out of 25 programme managers interviewed in depth did not know how well their particular programme had performed in the previous year. Similarly, only six of these managers knew their best and poorest performing districts. The results of this study suggest; 1) Training managers in data analysis and use is critical if health information systems are to actually improve health care delivery. 2) Data intended for the use of programme managers need to be presented in simple ways. 3) Further social research is required to understand how managers perceive and use data. 4) Efforts to ensure the use of data should not be seen as something to be 'added on' after information systems are in place.

Data Interpretation, Statistical↗
PubMed1998

Rural psychiatry in developing countries.

During the last two decades several initiatives have been taken to improve psychiatric services in low-income rural areas in developing countries. They have included the formulation of national mental health programs and establishment of pilot programs for integration of mental health care with primary health care in India, Iran, and other countries in Asia, Africa, and South America. The psychiatrist has multiple roles to play in meeting the many challenges of providing mental health care in rural areas in developing countries.

Developing Countries↗
PubMed2001

Can improvements in breast-feeding practices reduce neonatal mortality in developing countries?

OBJECTIVE: to review the literature on the relationship between breast-feeding practices in the first month of life and neonatal mortality. METHODS: Medline and Cochrane databases were searched using the keywords breastfeeding, and neonatal mortality, supplemented with additional searches using the keywords developing countries, colostrum, infant feeding and infant mortality, hypoglaecemia, hypothermia, breastfeeding practices, and suckling. FINDINGS: breast feeding helps prevent hypothermia and hypoglycaemia in newborn babies, which are contributory causes of early neonatal deaths especially among low birth weight and premature babies. During the late neonatal period, most deaths in developing countries are due to infections such as sepsis, acute respiratory tract infection, meningitis, omphalitis and diarrhoea. Feeding colostrum and breast feeding, especially exclusive breast feeding, protects against such deaths. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: in most developing countries, nearly all women breast feed in the first month of life, but often breast feeding is delayed beyond the first hour after birth, and exclusive breast feeding is not usually practised. Policies and training of staff of maternity centres and hospitals can encourage early initiation of breast feeding and exclusive breast feeding. Midwives can support community-based efforts to support exclusive breast feeding. Breast feeding plays an important role in reducing neonatal mortality and should be strongly emphasised by programmes attempting to reduce neonatal mortality.

Age Factors↗
PubMed2000

Public health measures to control hepatitis B virus infection in the developing countries of the Asia-Pacific region.

Hepatitis B virus (HBV) infection is prevalent in the Asia-Pacific region and the disease burden caused by chronic HBV infection has been enormous. Although vaccination programmes have been implemented in the past decade, and there are extremely successful countries in the region, many countries still cannot afford a control program. These countries are often populous and highly endemic for HBV infection. To overcome this, aid from developed countries or private foundations should be actively sought. In the developing countries of this region, HBV infection in early childhood is the main cause of chronic HBV status, and thus universal vaccination of all infants is the best way to control HBV infection. Because of the expense and extra costs of screening pregnant women, the use of hepatitis B immune globulin may not be essential. To achieve the goal of universal infant vaccination, public education should be done in parallel with education of health professionals and control measures. The Asia Pacific region has more people with chronic hepatitis B than any other part of the world, and control of HBV infection in this region will no doubt be the most important and challenging task to be taken in the beginning of the new millennium.

Asia↗
PubMed2003

Soil erosion in developing countries: a socio-economic appraisal.

Soil erosion is the single most important environmental degradation problem in the developing world. Despite the plethora of literature that exists on the incidence, causes and impacts of soil erosion, a concrete understanding of this complex problem is lacking. This paper examines the soil erosion problem in developing countries in order to understand the complex inter-relationships between population pressure, poverty and environmental-institutional dynamics. Two recent theoretical developments, namely Boserup's theory on population pressure, poverty and soil erosion and Lopez's theory on environmental and institutional dynamics have been reviewed. The analysis reveals that negative impacts of technical change, inappropriate government policies and poor institutions are largely responsible for the continued soil erosion in developing countries. On the other hand, potential for market-based approaches to mitigate the problem is also low due to the negative externalities involved. A deeper appreciation of institutional and environmental dynamics and policy reforms to strengthen weak institutions may help mitigate the problem.

Commerce↗
PubMed2002

Anesthetic care in developing countries: equipment and techniques.

Various organizations have been formed to provide short-term surgical services in developing countries. In these countries, the ability to provide effective anesthetic care requires the team to transport most of the equipment necessary to provide perioperative care for various surgical procedures. We review the basic supplies necessary to provide such care and discuss some of the issues related to the anesthesia machines, techniques, and monitoring in developing countries. Suggestions and options for preoperative assessment, intraoperative anesthetic care, and postoperative care, including pain management, are provided.

Anesthesia↗
PubMed1981

Training in epidemiology for medical assistants in developing countries.

The role of the Medical Assistant (MA) in developing countries in reviewed, with special reference to East Africa, in particular Tanzania. The development of training objectives in epidemiology for the MA is then described. A project is reported which has attempted to develop, field-test and evaluate a set of training materials in epidemiology for MA students in East Africa, based upon these training objectives. In general, these materials appear acceptable and appropriate both to students and teachers. The need is stressed for long-term evaluation of this approach.

Community Health Centers↗
PubMed1997

Use of ciprofloxacin in developing countries.

BACKGROUND: The demographic and subsequent economic pressures in developing nations have contributed to the increasing levels of antibiotic resistance among both commensal flora and pathogenic bacteria. As empirical options are diminishing daily, the role of ciprofloxacin in pediatric infections is becoming increasingly significant. OBJECTIVE: The levels of resistance among various enteric pathogens are described, and the efficacy and safety of ciprofloxacin in treating infections such as shigellosis, cholera and Escherichia coli gastroenteritis are discussed. The findings of a large study of invasive salmonellosis in children in rural Africa are briefly presented, including the role of ciprofloxacin in multiresistant invasive disease. In addition the role of ciprofloxacin as a chemoprophylactic agent in the control of meningococcal disease is discussed. RESULTS: The efficacy and safety of ciprofloxacin in children were found to be similar to those observed in adults for gastrointestinal infectious diseases. Overall the data presented confirm that ciprofloxacin is a safe and efficacious agent for use in children in the developing world. CONCLUSION: Ciprofloxacin has been shown to be safe and efficacious in children in developing countries. Subsequently a priority for both the pharmaceutical industry and regulatory authorities in developing nations is to prevent fluoroquinolone misuse and development of antibiotic resistance.

Anti-Infective Agents↗
PubMed2002

Consanguinity and hearing impairment in developing countries: a custom to be discouraged.

Consanguineous marriage is a tradition which is commonly practised among Asian, African, and Latin American communities whether they are living in their own countries or settled in Europe or the USA. These communities, in addition to their custom of interrelated marriage, have large families and are a rapidly growing population. The siblings of consanguineous marriages have a significantly higher incidence of autosomal recessive diseases including hearing impairment. Two epidemiological surveys were carried out 10 years apart. There were 6,421 subjects from Riyadh City and 9,540 from all other parts of the Kingdom of Saudi Arabia. A random sample was examined otologically and a questionnaire was filled in that included age, sex, family relation, number of siblings, etc. ENT examination and audiological assessment were performed. Consanguinity was found among 22 per cent as first cousins and 23 per cent as second cousins in the first survey. In the second survey 19 per cent were first cousins and 28 per cent second cousins. The rate of consanguinity was 45 per cent in the first survey and 47 per cent in the second. The prevalence of hereditary sensorineural hearing loss (SNHL) was 66.07 per cent and 36.6 per cent in the first and second survey respectively. The incidence of hereditary hearing impairment is very high in developing countries compared to developed countries. Prevention is essential to reduce the incidence of genetic hearing loss. Consanguinity should be discouraged through health education of the public about the adverse effect of interrelated marriage. Genetic counselling, premarital and antenatal screening are to be applied whenever possible, at least for those at risk of developing genetic diseases including hearing impairment.

Child↗
PubMed2005

Community-based supplementary feeding for promoting the growth of young children in developing countries.

BACKGROUND: Supplementary feeding is defined as the provision of extra food to poor children or families beyond the normal ration of their home diets. The impact of food supplementation on child growth merits careful evaluation in view of the reliance of many states and NGOs on this intervention to improve child health in developing countries. OBJECTIVES: To evaluate the effectiveness of community-based supplementary feeding for promoting the physical growth of pre-school children in developing countries. SEARCH STRATEGY: Searches of CENTRAL 2005 (Issue 2), MEDLINE 1966 to 2005, EMBASE 1980 to 2005, CINAHL 1982 to 2005, LILACS 1982 to 2005, Social Science Citation Index 1956 to 2005, and Dissertation Abstracts International (late 1960s to 2005) were conducted. SELECTION CRITERIA: Randomised controlled trials evaluating supplementary feeding in children aged 0-5 years old in developing countries. DATA COLLECTION AND ANALYSIS: Data were extracted and analysed independently by two authors. MAIN RESULTS: Four trials met the inclusion criteria for this review. No meta-analysis is currently appropriate due to the clinical heterogeneity among the included studies. We group these trials into two categories: a) studies without formally assessment of malnourishment at baseline and, b) studies involving children formally assessed as malnourished.a) A cluster RCT conducted in Indonesia in 1991(20 Day Care Centres, n = 113 children), found no benefit in weight-for-age and height-for-age z-scores of the intervention group compared to the control group after three months of intervention. A study in Guatemala included four villages as unit of analysis (exact sample sizes were not provided). The length of 3-yr-old children was based on a 'before-after comparison' by village size and type of supplement. According to this analysis, the difference in net change in the large villages was 2.55 cm and in the small villages was 2.35 cm. The mean of these differences is 2.45 +- 0.10 cm (mean +- SD).b) A study conducted in Jamaica (n = 65 children) reported a positive effect on length (cm) in the supplemented group compared to controls [WMD 1.3 (0.03 to 2.57)] after 12 months of intervention. A trial from Indonesia (n = 75 children) found no benefit in growth after 12 months of supplementation. AUTHORS' CONCLUSIONS: Based on the small number of available trials, no firm conclusions of the effectiveness of supplementary feeding to the growth of pre-school children could be drawn. Issues of research design such as blinding and sample size calculation need to be addressed in future studies.

Child↗
PubMedDate not supplied

Levels of maternal mortality in developing countries.

This paper is aimed at improving our ability to assess the magnitude of maternal mortality in developing countries, where reliable data on maternal deaths are scarce. First, the upper and lower limits of maternal mortality in a population are determined based on the general levels of mortality and fertility in a population. The relative importance of maternal deaths as a proportion of death among women of reproductive ages may, therefore, vary from less than 1 percent in low-mortality countries to about 25-30 percent in high-mortality countries. Second, the analysis and interpretation of maternal mortality data from health facilities and vital registration systems can be improved if a variety of other data sources are used, such as coverage of deliveries in hospitals and at home, and all causes of death among women of reproductive age. It is estimated that approximately 515,000 women died annually due to pregnancy-related causes in developing countries between 1980 and 1985. Ninety percent of these deaths took place in Africa and South Asia, where births are frequent and maternal mortality levels are high.

Abortion, Induced↗
PubMed1989

The influence of different sexual-contact patterns between age classes on the predicted demographic impact of AIDS in developing countries.

A model is developed to describe the spread of HIV within heterosexual communities and the demographic impact of AIDS. The model combines epidemiologic and demographic processes and is designed to mirror the impact of AIDS in sub-Saharan Africa. Refinements on past work in this area include unequal probabilities for transmission from females to males and from males to females, the inclusion of an age- and sex-dependent sexual-partner choice function and distributed incubation plus infectious periods. Numerical studies suggest that unequal transmission probabilities (weighted to a greater probability from males to females than vice versa), and the tendency of males to choose sexual partners of the opposite sex younger than themselves, both act to increase the demographic impact of AIDS over that predicted with equal transmission between the sexes and partner choice restricted within given age classes. Analyses support the conclusions of past work that the epidemic will only have a small detrimental impact on the dependency ratio of a population (the ratio of dependents to working adults) even when a weighting is added to take account of the extra burden imposed by the care of adult AIDS patients. However, a small increase in the ratio can imply a significant rise in the number of dependents within the population. Stimulation studies of the impact of changes in behavior to reduce transmission highlight to the need to induce such changes as early as possible in the course of the epidemic in order to minimize its impact. Directions for future research are discussed emphasizing the need to acquire quantitative data on sexual habits and to construct models to represent heterogeneity in sexual behavior.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Do we need to use nitric oxide in preterm babies in developing countries?

Neonatal care in developing nations is advancing rapidly. There is an increasing tendency to include nitric oxide in the therapeutic armamentarium. But the opinion regarding its use remains divided among neonatologists even in the western world. Nitric oxide has an established role in the management of persistent pulmonary hypertension in term neonates. However, the use of nitric oxide in preterm neonates has been controversial and the Cochrane review updated in 2001 did not give conclusive answers. There have been adequately powered multi-centre trials recently on the issue, planned to resolve the controversy. The present communication highlights the salient features and conclusions drawn from these trials.

Developing Countries↗
PubMed2002

Educational attainment and HIV-1 infection in developing countries: a systematic review.

OBJECTIVES: To assess whether educational status is associated with HIV-1 infection in developing countries by conducting a systematic review of published literature. METHODS: Articles were identified through electronic databases and hand searching key journals. Studies containing appropriately analysed individual level data on the association between educational attainment and HIV-1 status in general population groups were included. RESULTS: Twenty-seven articles with appropriately analysed results from general population groups in developing countries were identified, providing information on only six countries. Large studies in four areas in Africa showed an increased risk of HIV-1 infection among the more educated, whilst among 21-year-old Thai army conscripts, longer duration of schooling was strongly protective against HIV infection. The association between education and schooling in Africa was stronger in rural areas and in older cohorts, but was similar in men and women. Serial prevalence studies showed little change in the association between schooling and HIV over time in Tanzania, but greater decreases in HIV prevalence among the more educated in Uganda, Zambia and Thailand. CONCLUSIONS: In Africa, higher educational attainment is often associated with a greater risk of HIV infection. However, the pattern of new HIV infections may be changing towards a greater burden among less educated groups. In Thailand those with more schooling remain at lower risk of HIV infection.

Adult↗