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PubMed1983

The role of tracheostomy in otolaryngological practice in a developing country.

An analysis of 155 tracheostomies performed over a period of six years in a teaching hospital in a developing country is presented in this paper. It is a follow-up of an earlier analysis of such procedures performed in the same hospital. Tetanus has established itself as the main indication for tracheostomy while other conditions such as laryngotracheobronchitis, which was the leading indication a decade ago, have been treated more successfully as a result of other better and non-invasive management. A continuing analysis of the indication for and mortality attending tracheostomy is considered important as it gives an indication of the quality of health care delivery in developing countries.

Adolescent↗

PubMed2005

Training in pediatric nephrology for developing countries.

During recent years, there has been an increasing demand for specialized care for children with kidney diseases, even in developing countries with limited resources. It is imperative to provide suitable facilities for appropriate and relevant training in pediatric nephrology to promote growth of pediatric nephrology in these areas. The training should give emphasis on preventive aspects, early diagnosis of common diseases and their optimum management with available resources. It should focus on locally prevalent renal diseases. The training programs should take into consideration the socioeconomic and cultural framework of the local community when designing curricula. To overcome the shortage of pediatric nephrology health professionals in the developing countries, the International Pediatric Nephrology Association has taken initiatives to support development of such training programs.

Developing Countries↗

PubMed1986

Menopause, developing countries and the 21st century.

According to the independent projections of the United Nations Population Division and of the World Bank, the global population (presently: 4.7 billion) will continue to grow until the year 2100 or 2150, when it is expected to stabilize at an approximate level of 11 billion. Ninety-five per cent of this future growth will occur in developing countries, with an increasing number and proportion of women aged 45 and over; their number will exceed 700 million before the turn of the century. The past decade, or two, witnessed a dramatic increase in life expectancy at birth, especially in developing country women, but little, if any, information is available about the menopause in those countries. An urgent task of high priority is therefore to establish on a country-to-country basis the age distribution and sociocultural significance of the menopause and of the prevalence of various menopausal disorders, which to a huge extent will determine the health- and social service needs of individual developing countries. Furthermore, a rapid progress must be made in the diagnosis, prevention and treatment of osteoporosis, atherosclerotic cardiovascular disease, musculoskeletal disorders and senility. It is suggested that the establishment of a Special Programme of Research by the World Health Organization on the problems of aging would significantly accelerate progress in this field.

Adolescent↗

PubMed1982

Correlates of life expectancy in less developed countries.

Analyses were performed to investigate several hypotheses concerning the multiple determinants of levels of life expectancy in developing countries in recent decades and some possible explanation for the observed variations in amount of gain in life expectancy from the 1950's to the 1970's. The findings were significant. For level of life expectancy the results of this present work conform by and large to results of other scholars in this area, although the present work is unique in that only developing countries were included. From the 1960's to the 1970's there has been a shift in the relative importance of economic indicators and general social indicators in favor of the social indicators. In the period 1960-65 some 70% of the variation in levels of life expectancy was associated with per capita income and literacy rates in a ratio of about three to two in favor of the economic variable. By 1970-75 the ratio has become six to one in favor of literacy. In addition, the multivariate model showed that the sanitation variables began to appear as significant correlates of levels of life expectancy in the more recent time period, playing a larger role than level of income per capita. Work pursued as part of a separate but concurrent project explored explicitly this three-way interaction between literacy, life expectancy and sanitation.

Developing Countries↗

PubMed1999

Risk of Helicobacter pylori infection among long-term residents in developing countries.

The seroprevalence and incidence of Helicobacter pylori infection were determined among 312 North American missionaries who were serving in developing countries between 1967 and 1984. The majority (81%) resided in sub-Saharan Africa. When initially evaluated, the missionaries had a mean age of 40 years, 65% were female, and all were of white race/ethnicity. An ELISA showed that the initial prevalence of IgG antibody to H. pylori was 17%. After a mean of 7.4 years of service (1917 person-years of exposure), 37 (14%) of 259 initially seronegative subjects seroconverted to anti-H. pylori, giving an annual incidence of 1.9%. These data indicate a relatively higher risk of H. pylori infection among missionaries compared with an annual incidence of seroconversion of 0.3-1.0% in industrialized nations. Long-term residents in developing countries should be evaluated for H. pylori infection when gastrointestinal symptoms develop.

Adult↗

PubMed1990

Dental caries in developing countries in relation to the appropriate use of fluoride.

Although it is widely believed that caries prevalence in developing countries is increasing rapidly, a review of studies from Africa and China provides equivocal evidence. Data from child and adult populations indicate that the disease is almost ubiquitous but with a slow rate of progression. Theoretically, administration of fluoride in such populations should result in reducing caries progression rates, but too little is known about the magnitude of the effect, and therefore about the cost-effectiveness of different methods of fluoride administration. The lack of a developed infrastructure and of trained personnel in many developing countries limits the applicability of many strategies. Methods of fluoride administration that minimize systemic exposure are to be recommended where affordable or practical. In the light of economic constraints and slow caries lesion progression rates, however, improvements in oral hygiene practices may be the most important method of controlling the disease whether or not fluoride is available or accessible.

DMF Index↗

PubMed1989

Environmental protection and its trends in developing countries.

On instances of some worldwide problems of environmental protection, the authors refer to the fact, that a target of industrial countries is to help to the developing countries. Mainly it means an aim in such sense, that the dangerous failures and faults which happened in the past, should not be repeated as a consequence of temporaneous economical problems in the Third World. In the long run it is a common interest of all and certainly a sufficient motivation of a commonly coordinated effort in this field. It is at most desirable, that all developing projects, from a simple water supply to the integrated developing concepts, for example eco-agriculture projects, correspond with the national interests as well as with the specific requirements of environmental control.

Developing Countries↗

PubMed2000

Fat and energy needs of children in developing countries.

The fat requirements of children can be judged according to 4 criteria: 1) the possible obligate needs of fat as a metabolic fuel, 2) the provision of a sufficiently energy-dense diet to meet energy needs, 3) the adequate supply of essential fatty acids, and 4) the supply of sufficient fat to allow adequate absorption of fat-soluble vitamins. In these respects the fat requirements of children in developing countries are probably similar to those of children in affluent nations except for the additional needs imposed by environmental stresses, particularly recurrent infections. In many developing countries, the low energy density of weaning foods appears to be a major contributor to growth faltering and ultimate malnutrition. Evidence from doubly labeled water studies suggests that these diets are adequate when children are healthy but fail to support rapid catch-up growth after diarrhea and other infections. The issues in determining and meeting the fat needs of children in developing countries are illustrated with use of detailed comparative dietary data from a rural community in The Gambia and from Cambridge, United Kingdom. The outstanding feature of the Gambian data is the great importance of breast milk as a source of fat and essential fatty acids up until the end of the second year of life. Weaning foods and adult foods contain low amounts of fat, which causes a sharp transition from adequate fat intakes to probable inadequate fat intakes when children are weaned from the breast. The effects of such low fat intakes, particularly in terms of immune function, require investigation.

Adolescent↗

PubMed1999

Home monitoring of blood glucose (HMBG) in Type-2 diabetes mellitus in a developing country.

The cost-effectiveness of home monitoring of blood glucose (HMBG) in Type-2 diabetes in a developing country was evaluated. A total of 64 uncomplicated Type-2 diabetic individuals of higher middle class to rich socio-economic status were studied. Thirty-two were allocated to conventional monthly hospital visits group-I (Gr-I) and 32 to HMBG with hospital visits at 3 monthly intervals group-II (Gr-II). In Gr-I, compared to baseline, HbA1c values decreased by 0.76% (95% CI 0.11-1.42) after 9 months and by 0.95% (95% CI 0.12-1.77) after 15 months but lost significance after 18 months follow-up. On the other hand, in Gr-II patients, HbA1c decreased significantly from baseline from 3 months and remained so at 18 months when it was decreased by 1.37% (95% CI 0.25-2.49). Hypoglycaemic episodes per patient year follow-up were significantly lower among Gr-II patients (0.172 vs. 0.354, P = 0.03). Considering the cost for conveyance, wage loss, investigation, institutional cost, glucometer and test strips, the total cost per patient was quite similar in both groups. The present study suggests that HMBG with proper diabetes education may be cost-effective at least in selected groups of individuals with Type-2 diabetes, even in a developing country such as Bangladesh.

Adult↗

PubMed2000

Indoor air pollution in developing countries and acute lower respiratory infections in children.

BACKGROUND: A critical review was conducted of the quantitative literature linking indoor air pollution from household use of biomass fuels with acute respiratory infections in young children, which is focused on, but not confined to, acute lower respiratory infection and pneumonia in children under two years in less developed countries. Biomass in the form of wood, crop residues, and animal dung is used in more than two fifths of the world's households as the principal fuel. METHODS: Medline and other electronic databases were used, but it was also necessary to secure literature from colleagues in less developed countries where not all publications are yet internationally indexed. RESULTS: The studies of indoor air pollution from household biomass fuels are reasonably consistent and, as a group, show a strong significant increase in risk for exposed young children compared with those living in households using cleaner fuels or being otherwise less exposed. Not all studies were able to adjust for confounders, but most of those that did so found that strong and significant risks remained. CONCLUSIONS: It seems that the relative risks are likely to be significant for the exposures considered here. Since acute lower respiratory infection is the chief cause of death in children in less developed countries, and exacts a larger burden of disease than any other disease category for the world population, even small additional risks due to such a ubiquitous exposure as air pollution have important public health implications. In the case of indoor air pollution in households using biomass fuels, the risks also seem to be fairly strong, presumably because of the high daily concentrations of pollutants found in such settings and the large amount of time young children spend with their mothers doing household cooking. Given the large vulnerable populations at risk, there is an urgent need to conduct randomised trials to increase confidence in the cause-effect relationship, to quantify the risk more precisely, to determine the degree of reduction in exposure required to significantly improve health, and to establish the effectiveness of interventions.

Acute Disease↗

PubMed1997

Implementing family planning programs in developing countries: lessons and reflections from four decades of Population Council experience.

Over the last three decades, contraceptive prevalence has risen from about 10% to nearly 60% in developing countries, but still about 1 in 4 births in developing countries (outside China) is unwanted. More than 120 million women in these countries who do not want to become pregnant do not use contraceptives. Nearly 600,000 women die each year from pregnancy-related causes, between 67,000 and 204,000 of them from unsafe abortions. At the 1994 International Conference on Population and Development in Cairo, delegates endorsed the view long advocated by the Population Council: the primary purpose of family planning programs should be to help women avoid unwanted pregnancy and achieve their fertility goals safely. That means, at the very least, that programs should address those reproductive health issues that are directly related to fertility regulation. To meet the Cairo challenge, progress is needed simultaneously on several levels. We need more and better contraceptive technologies that meet the needs of different groups; higher-quality family planning services; more outreach to underserved groups (such as men and adolescents); programs tailored to local cultures; and measures to address all the factors that prevent women who do not want to become pregnant from using contraceptives. The call for a client-centered, reproductive health approach to family planning constitutes a critique of programs driven by demographic goals. The new family planning paradigm puts a premium on 'quality of care'. Unfortunately, many family planning programs still fall substantially short of offering clients reproductive choice and supporting their reproductive health. The Population Council takes the view that contraceptive research and development is an essential component of a multilevel strategy to reduce unwanted fertility safely. New products, used ethically and provided with quality, would be of tremendous benefit to women and men throughout the world. The Population Council has developed, registered, and licensed seven products, including some of the most widely used contraceptives in the world. The Council is also one of the world centers for research on male reproductive physiology and male contraception. New contraceptive methods are only as good as the context in which they are offered. To accelerate the pace of overall fertility decline, governments must adopt policies that reduce the economic and social risks associated with having smaller families, and policies that promote later and planned childbearing.

Contraception↗

PubMedDate not supplied

Strengthening care for injured persons in less developed countries: a case study of Ghana and Mexico.

In all countries, the priority for reducing road traffic injuries should be prevention. Nonetheless, there are low-cost ways to strengthen the care of injured persons, that will help to lower the toll from road traffic. The purpose of this review was to elucidate ways to accomplish this goal in the context of less developed countries. Studies selected for this review were obtained by Medline review, selecting on key words such as trauma, injury, trauma care, essential health services, and developing country. Articles pertaining to any country and all available years were considered. In addition, the authors utilized articles from the gray literature and journals from Mexico and Ghana that are not Medline referenced. Studies surveyed point to road safety and other forms of injury prevention, as well as prehospital care, as likely priorities for developing countries. Nonetheless, hospital-based improvements can contribute to decreases in mortality and, especially, decreases in disability. For both prehospital and hospital based care, studies revealed several critical weak points to address in: (1) human resources (staffing and training); (2) physical resources (equipment, supplies, and infrastructure); and (3) administration and organization. The 'essential services' approach, which has contributed to progress in a variety of fields of international health, needs to be developed for the care of the injured. This would define the trauma treatment services that could realistically be made available to virtually every injured person. It would then address the inputs of human resources, physical resources, and administration necessary to assure these services optimally in the different geographic and socioeconomic environments worldwide. Finally, it would identify and target deficiencies in these inputs that need to be strengthened.

Accidents, Traffic↗

PubMed2005

Transfusion-transmitted infection in hemophilia in developing countries.

Treatment of patients with bleeding disorders (especially those with hemophilia) with blood products has been associated with infections with blood-borne viruses. Of these, hepatitis B and C viruses (HBV and HCV, respectively) and the human immunodeficiency virus (HIV) have created major health problems. Although virus-inactivation procedures have virtually eliminated these viruses from newer factor concentrates since 1985, the risk remains in developing countries where there is no ready access to these concentrates. Although a few of these countries have established their own fractionation facilities and in others the respective governments make concentrates available, the large majority of countries still face the problems of blood-borne infections. HCV will invariably lead to liver damage and many hemophiliacs who were exposed to the HCV virus will succumb to cirrhosis. Only approximately 10% of hemophilic patients infected with HCV will clear the infection naturally. Coinfection with HIV shortens the life expectancy. The HIV epidemic in hemophiliacs began in the mid-1980s. Patients in developed countries were especially affected because they were predominantly treated with factor concentrates that were manufactured from thousands of blood donors. Hemophiliacs in developing countries have considerably less HIV infection, although it does exist and depends largely on the source of the plasma fractions. Progress has been made not only in the purification of factor concentrates, but also in the understanding of the HIV virus and in the development of antiretroviral treatment modalities. However, there are still several challenges in delivering antiretroviral treatment that must be addressed before the full impact of these transmitted infections is known.

Blood Coagulation Factors↗

PubMed2006

Quality of life in patients with glaucoma who live in a developing country.

PURPOSE: To assess the functional status and well-being in glaucoma patients who live in a developing country. METHODS: Cross-sectional case control study, comprising 102 glaucoma patients and 58 controls. All subjects were administered the Medical Outcomes Study 36-item short-form survey (SF-36). SF-36 scores for study and control groups were compared. Statistical analysis included Student's t-test for score data and Student's t- and chi-square tests for demographic data. RESULTS: Patients with glaucoma had significantly lower scores than healthy control subjects (p < 0.05) in five domains of the SF-36 survey (physical functioning, role-emotional, bodily pain, social functioning and mental health). Bodily pain was the domain with the lowest score. CONCLUSIONS: Patients with glaucoma who live in a developing country have less functional status than non-glaucomatous patients.

Aged↗

PubMed2004

Diffusion of innovations: family planning in developing countries.

One of the best examples of the validity of the theory of "diffusion of innovations" is the case of family planning in developing countries. The desire of health, development and environment advocates in rich countries to make modern contraceptive use and lower fertility a norm in developing countries was translated into organized efforts to reach top-level leaders in these countries. Once on board, these high-level leaders cooperated with bilateral and international funding agencies as well as private foundations to develop mass media and community education campaigns, while simultaneously setting up clinic infrastructure; training doctors, nurses and outreach workers; and developing a new and varied "cafeteria" of modern methods. Over the intervening decades, this innovation was indeed diffused and became a norm, but not without its controversies and missed opportunities.

Developing Countries↗

PubMed2005

Maternal views on infant hearing loss in a developing country.

BACKGROUND: Parental support for infant hearing loss is essential for a successful infant screening programme. However, in developing countries where unfavourable customs and beliefs towards childhood disabilities have been reported, parental support towards infant screening is uncertain and there is presently no published evidence on the subject. OBJECTIVE: To elicit the views of mothers and would-be mothers in order to ascertain their knowledge on infant hearing loss and their attitudes towards infant hearing screening. METHODS: A structured questionnaire consisting of 15 questions was administered to 101 mothers (mean age 31.6+/-7.3 years, range: 21-55 years) attending two community hospitals in Lagos, Nigeria. The responses were evaluated by descriptive statistics, factor analysis of the principal components and multiple regression analysis. The reliability of the two main domains (knowledge and attitude) was tested for internal consistency by Cronbach's alpha coefficient. RESULTS: Maternal knowledge was highest for measles (73%; mean score 2.54) and ear discharge (73%; mean score 2.51) but low for birth asphyxia (37%; mean score 1.90), traditional medicine (42%; mean score 2.03) and jaundice (47%; mean score 2.09) as causes of hearing loss. Attitude towards neonatal screening was positive in majority of mothers (92%; mean score 2.84) and there was a high acceptance of hearing aids as an early intervention option (84%; mean score 2.70). Five factors (eigenvalue>1) were extracted after principal component analysis with the attitude variables loading highly and exclusively on one factor. Age was the only demographic variable that was associated with a domain (knowledge) after multiple regression analysis. The component scales for the two domains were highly internally consistent (alpha coefficients of 0.84 and 0.83). CONCLUSIONS: Contrary to the concerns often expressed about parental support for infant hearing screening programmes in developing countries, this study suggests that current parental knowledge and attitude favour early detection and intervention of childhood hearing impairment.

Adult↗

PubMed1992

An intelligent computer-assisted instruction system designed for rural health workers in developing countries.

This paper describes an intelligent computer-assisted instruction system that was designed for rural health workers in developing countries. This system, called Consult-EAO, includes an expert module and a coaching module. The expert module, which is derived from the knowledge-based decision support system Tropicaid, covers most of medical practice in developing countries. It allows for the creation of outpatient simulations without the help of a teacher. The student may practice his knowledge by solving problems with these simulations. The system gives some initial facts and controls the simulation during the session by guiding the student toward the most efficient decisions. All student answers are analyzed and, if necessary, criticized. The messages are adapted to the situation due to the pedagogical rules of the coaching module. This system runs on PC-compatible computer.

Computer Simulation↗

PubMed1995

The duration of breastfeeding by HIV-1-infected mothers in developing countries: balancing benefits and risks.

How best to advise mothers infected with human immunodeficiency virus type 1 (HIV-1) in developing countries regarding breastfeeding is an important issue that has generated considerable debate. Previous studies have addressed this problem by means of mathematical models, but without considering the issue of the duration of breastfeeding. A mathematical model was developed to compare the age-specific risks of mother-to-child HIV transmission versus the excess mortality due to not breastfeeding. In this model it is assumed that both the risk of mother-to-child transmission of HIV through breast milk and the relative risk of not breastfeeding do not vary with age. The model indicates that, in HIV-1-seropositive mothers, the decrease in child mortality afforded by breastfeeding may exceed the risk of mother-to-child HIV-1 transmission only during the first 3-7 months of life. Thereafter the risk of HIV-1 transmission probably exceeds the mortality benefit of breastfeeding. Experimental studies of counselling HIV-1-infected mothers to limit their duration of breastfeeding should be considered in the setting of developing countries.

Breast Feeding↗