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PubMed1985

Pre-exposure rabies immunization with human diploid cell vaccine: decreased antibody responses in persons immunized in developing countries.

In November 1982, a U.S. Peace Corps volunteer in Kenya completed pre-exposure rabies prophylaxis with a standard 3 dose intradermal (ID) series of human diploid cell rabies vaccine (HDCV). In May 1983, she was bitten by a dog and died of rabies 3 months later. An initial investigation revealed that the patient, as well as 9 of 11 others immunized at the same time, had no rabies antibody titers (less than 1:5). We therefore instituted investigations into the immunogenicity of pre-exposure HDCV both in the United States and in developing countries. A serosurvey revealed unexpectedly low rabies titers in both Peace Corps volunteers and others immunized in developing countries. Antibody titers measured 2-3 weeks after ID immunization were compared in 9 groups totaling 271 persons in the United States and Kenya. There was no statistically significant difference in antibody titers in the 6 U.S. groups immunized from 1980-1984 (P greater than 0.15); however, groups immunized in the United States had significantly higher titers than a group of Kenyan nationals (P less than or equal to 0.0001), and the Kenyans had significantly higher titers than 2 Peace Corps groups immunized in Kenya (P less than or equal to 0.0001). No single hypothesis proposed (laboratory error, vaccine potency, vaccination technique, or specific immune suppression) accounted for the observed differences. Although we cannot fully explain the poor response to HDCV, it is probably due to multiple factors. We conclude that persons immunized with ID pre-exposure HDCV in developing countries should have rabies antibody titers determined to ensure their seroconversion; for persons immunized in the United States, such titers need not be routinely determined.

Adult↗

PubMed2002

The management of burns in a developing country: an experience from the republic of Yemen.

BACKGROUND: Burns management and mortality rates have improved in even developing countries including some Arab states. This paper describes an experience with burn victims in the Yemen to draw attention to the victims' plight, the challenge posed to bodies, such as the International Society of Burn Injury (ISBI), and, the basic required corrective measures. PATIENTS AND METHODS: Between 1996 and 1999, sponsored surgical teams paid four visits to four Yemen cities. The patients presented here are a consecutive series of the plastic surgery operations that the teams performed. No literature on burn care in the Yemen could be traced. RESULTS: The cities visited were Mokalla, Sayown, Taiz and Aden. Of 406 plastic procedures, 139 were for post-burn contracture release and are the focus of this paper. The victims were mostly children and the hand (49; 35%) was the most common site. Types of operation performed were release and split skin grafi, excision and full thickness skin grafi, release and local flap, and, multiple Z-plasty. CONCLUSIONS: This experience confirms the believe that, given initiative and efficient organization of available resources, developing countries such as the Yemen can also achieve better burn management. Solutions suggested are determining local health needs; onsite conferences, symposia and training programs; local personnel to visit burn centers overseas; burn research and prevention activities; and epidemiologic studies.

Adolescent↗

PubMed1999

Tuberculosis among immigrants from developing countries in the province of Milan, 1993-1996.

SETTING: The Province of Milan, which has high rates of immigration from developing countries, and the Villa Marelli Institute (VMI), Reference Centre for Tuberculosis Control of Lombardy. OBJECTIVE: To describe epidemiology and clinical patterns of tuberculosis among immigrants from developing countries (IDCs) in the Province from 1993 to 1996. DESIGN: Retrospective analysis of the registries of the Regional Bureau for Public Health and of the VMI concerning immigrant patients with active TB living in the Province. Restriction fragment length polymorphism (RFLP) analysis of the available strains to detect recent transmission among immigrants. RESULTS: IDCs represented 22.8% of all TB cases. The standardised incidence rate was eight times higher in IDCs compared to Italians. Of 596 cases notified in IDCs, 524 (87.9%) had been referred at least once to the VMI. Of these, 77.2% were diagnosed within 5 years of arrival, and 86.6% were brought to medical attention because of symptoms. RFLP fingerprinting demonstrated that the mean period of stay in Italy was significantly higher in clustered than in non clustered patients (61.5 versus 37.3 months). Spread to the native population was episodic. CONCLUSIONS: The incidence of TB is higher among more recent immigrants (i.e., Peruvians). TB cases are largely due to reactivation of infection occurring in the country of origin. Preventive measures for early diagnosis of disease or chemoprophylaxis of dormant infection are not regularly performed, but should be implemented for those immigrants at high risk.

Adult↗

PubMed2002

Nuclear and isotopic techniques for addressing nutritional problems, with special reference to current applications in developing countries.

Nuclear and isotopic techniques are valuable tools in human nutritional research studies. Isotopes, both radioactive and nonradioactive, enable detailed evaluations of nutrient intake, body composition, energy expenditure, status of micronutrients, and nutrient bioavailability. In recent times, isotopic methods have been widely used in a number of coordinated research projects and technical cooperation projects of the International Atomic Energy Agency's Nutrition Programme. The doubly labeled water technique combines the use of the stable isotopes oxygen-18 and hydrogen-2 (deuterium) to measure total energy expenditure in free-living human subjects, and to investigate the magnitude and causes of both undernutrition and the emergence of obesity in developing countries. The deuterium dilution technique is a reliable tool to measure breastmilk intake and thereby infant growth and development. In collaboration with the World Health Organization's Growth Monitoring Program, this technique is being used to generate new data on growth standards for children in developing countries. This technique is also used in the measurement of body composition by the estimation of lean body mass and fat mass in individuals. Stable isotopes of iron and zinc have been successfully used to assess the nutritional impact of several nationwide food supplementation-programs conducted on pregnant and lactating women and children in both industrialized and developing countries. Isotopic techniques are especially suitable for monitoring changes in body composition, energy metabolism, and mineral status (with particular reference to osteoporosis) in the elderly. Nuclear methods have also served to develop models for a physiological reference man in Asia in support of radiological health and safety issues, for establishing elemental composition of foods, and for measurement of pollutants in the environment.

Adolescent↗

PubMedDate not supplied

[Ethical constraints of clinical trials in developing countries: experience of the French National Agency for AIDS Research (ANRS)].

The ethical principles of clinical research in the developing countries have recently been revised in most international guidelines. Their implementation leads to practical difficulties in the field. As an institutional sponsor, the French National Agency for AIDS Research (ANRS), responsible for research on AIDS and hepatitis in France and in the developing countries, released an Ethical Charter. It represents a commitment for the ANRS partners from the North and the South. The most important principles of the Charter are as follows: an early integration of research in the national programmes of public health; a strong partnership between North and South at any step of the research; a clear definition of rules concerning evaluation and ethical follow-up of the research; enrolment of the subjects; healthcare; care for the patients; and management of the post-study.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Quality of life in newly diagnosed patients with lung cancer in a developing country: is it important?

There are no data regarding quality of life (QoL) assessments in lung cancer in developing countries like India. Quality of life was evaluated in 76 newly diagnosed lung cancer patients by using the World Health Organization Quality of Life questionnaire in Hindi (WHOQoL-Bref) (men 87%). The mean age was 55 years (SD = 10). Cough, dyspnoea, chest pain and haemoptysis were present in 83%, 72%, 66% and 43% of patients respectively. The median duration of symptoms was 5.9 months (range 1-13). Eighty-nine per cent had non-small cell lung cancer. The median pack-years smoked was 23 (range 0.5-88). Most patients (53%) had a Karnofsky's Performance Status (KPS) of 70 and 83% had stage III or IV disease. Quality of life did not correlate with age, gender, presence or duration of symptoms, histological type, stage of disease or degree of smoking. The physical and psychological domains of QoL correlated significantly with the KPS (P = 0.001 and P = 0.01 respectively). Patients with a KPS of 80 had better physical (P < 0.001), psychological (P < 0.01) and social (P < 0.05) QoL than those with a KPS of 70. In conclusion, patients with lung cancer in a developing country like India have an unsatisfactory QoL. The Karnofsky's Performance Scale is a simple and reliable surrogate marker for assessing QoL in these patients. Larger multi-centric studies may help in providing a more comprehensive evaluation of the effect of various demographic and clinical variables on QoL in this setting.

Carcinoma, Non-Small-Cell Lung↗

PubMedDate not supplied

Training program in Japan for health caretakers from developing countries.

In 1979, the International Center for Medical Research was organized in Kobe University School of Medicine and promoted the scientific cooperation through invitation of foreign scientists from developing countries as the Core University of Medical Science of Japan Society for the Promotion of Science (JSPS). Perinatal medicine is one of the main subjects in this program and we have accepted more than thirty neonatologists from Indonesia, Philippines, Thailand and other developing countries.

Developing Countries↗

PubMed1998

A comparison of international learning experiences for baccalaureate nursing students: developed and developing countries.

As faculty seek creative learning opportunities for students in a changing social, political, and health care environment, knowledge about international learning experiences can provide critical information for decision making. This study sought the answer to two questions: What are the learning outcomes of an international experience for baccalaureate nursing students and what are the similarities and differences in what students learn in developed and developing countries? Using grounded theory methodology, 14 students who had participated in international learning experiences were interviewed. Three major categories emerged from the data analysis: personal and professional growth, empirical knowledge, and the learning experience. More similarities than differences were identified among the students who had traveled to developing versus developed countries. The findings suggest that international experiences need to include the opportunity to provide direct nursing care. A proposed model for such experiences is presented.

Adult↗

PubMedDate not supplied

Urbanization in a developing country: city size and population composition.

Reasons for the high correlation between city size and educational attainment in developing countries are explored. "Two explanations are examined. First, the types of goods produced in larger cities require relatively high skill labor inputs. Second, public and perhaps private services demanded by higher skill people are only offered in larger cities. The paper econometrically tests these hypotheses for Brazil, estimating the elasticities of substitution (or typically complementarity) between high and low skill labor and the 'bright lights' effect for high versus low skill labor."

Americas↗

PubMed1997

Iron deficiency in developed countries: prevalence, influence of lifestyle factors and hazards of prevention.

OBJECTIVE: To review the prevalence of iron deficiency in developed countries, the influence of lifestyle factors that may contribute to its occurrence, and dangers of population directed prevention. DESIGN: Relevant literature was selected to identify populations at risk for iron deficiency and iron overload. RESULTS: Although iron deficiency anaemia is not a major health problem in developed countries, specific groups of the population remain endangered. These groups are young children, adolescents, pregnant women, the elderly, blood donors, vegetarians, endurance athletes and migrants. On the other hand, about 10% of Caucasians carry the mutation for hereditary haemochromatosis and are at risk for iron overload. CONCLUSION: Measures to prevent iron deficiency should be specifically aimed at population groups at risk. Actions to increase iron intake and bioavailability in the general population can be harmful for subjects with homozygous and heterozygous forms of iron overload diseases.

Adolescent↗

PubMed2004

Effective subsidies in developing countries.

During the last decades, significant subsidies have been allocated to government-owned water and sewerage enterprises in developing countries. However, water and sewerage coverage is still far from desirable and the poor are particularly affected by the shortage of these services. The truth is that a considerable part of these subsidies have been used up to build huge infrastructure works that would make some construction firms happy, while often decreasing the service costs for the richer. The costs associated of delivering water and sanitation services to the poor are significantly higher, as they often live in slums or irregular urban developments without urban infrastructure. It is possible, and desirable, to improve government's effectiveness through the use of appropriate economic incentives. The Brazilian River Basin Pollution Abatement Program, based on the "output-based aid" concept, is a good example of how this can be achieved. The Program is a success story that shows that the quality of expenditures on sanitation can be considerably improved if governments of developing countries refrain from contracting sanitation infrastructure works and start paying for results, not for promises.

Brazil↗

PubMed1999

Nurse practitioners in developing countries: some ethical considerations.

One of the principles of health care ethics is the principle of justice. An important expression of justice is equity. The provision of basic primary health care services to all people is the key to eliminating the gross inequities in health status existing in many countries. For many years nurses in developing countries have 'led the way' in bringing these essential services to poor rural communities, including the diagnosis and treatment of illnesses, and the prescribing and dispensing of medications. Nurses are the most appropriate health workers for this role, but most have not been prepared adequately for it. This is unsafe for patients and puts nurses at legal risk. Justice requires that patients should obtain access to safe health care and that nurses should receive appropriate education. Nurse practitioner programmes are being established to prepare nurses for this advanced practice role, but here again ethical considerations apply. Justice will be served only if nurse practitioner programmes are accessible to the nurses who are most likely to work in medically underserved communities where the need is greatest.

Clinical Competence↗

PubMed1994

District hospitals and strengthening referral systems in developing countries.

An important strategy to make a better use of the scarce resources available to the health sector in developing countries should focus on strengthening the referral system. Hospitals overcrowded with patients who could be more cheaply treated in smaller facilities is a common feature of poorly functioning referral systems. After defining what is meant by referral system, the paper discusses the main problems affecting its implementation within a primary health care strategy in developing countries. The essential prerequisites for an effective referral system are then discussed, emphasizing the need for a clear division of tasks between the different levels of the health delivery system. The paper concludes that efficiency gains and improvement of access are the most likely outcomes of a well-functioning referral system.

Continuity of Patient Care↗

PubMed2006

Cow's milk and linear growth in industrialized and developing countries.

The strongest evidence that cow's milk stimulates linear growth comes from observational and intervention studies in developing countries that show considerable effects. Additionally, many observational studies from well-nourished populations also show an association between milk intake and growth. These results suggest that milk has a growth-stimulating effect even in situations where the nutrient intake is adequate. This effect is supported by studies that show milk intake stimulates circulating insulin-like growth factor (IGF)-I, which suggests that at least part of the growth-stimulating effects of milk occur through the stimulation of IGFs. Given that the biological purpose of milk is to support the newborn during a period of high growth velocity, such an effect seems plausible. Adding cow's milk to the diet of stunted children is likely to improve linear growth and thereby reduce morbidity. In well-nourished children, the long-term consequences of an increased consumption of cow's milk, which may lead to higher levels of IGF-I in circulation or an increase in the velocity of linear growth, are likely to be both positive and negative. Based on emerging data that suggest both growth and diet during early life program the IGF axis, the association between milk intake and later health is likely to be complex.

Adolescent↗

PubMed2004

[The PAL+ program, an incentive concerted action about malaria and associated infectious diseases, for developing countries].

The French Ministry in charge of Research has launched a multi-institutional incentive concerted action to assist Southern countries on malaria: the PAL+ program. PAL+ aims at bringing out: 1) conditions to promote novel preventive and therapeutic tools adapted to existing situations in the countries concerned; 2) a contribution to help research teams in Southern countries become competitive. PAL+ plans to strengthen cooperative relationships with developing countries (subsaharian Africa, South East Asia and South American countries). Research programs were oriented towards public health needs in malaria-endemic countries and thus mainly focused on: i) development of new antimalarial drugs and new therapeutical strategies: new targets and new leads for drugs, clinical assays for recognition of malaria and optimization of effective treatment or prophylactic drug dosage; ii) pathophysiology of severe malaria: mechanisms of immunity, biology and genome of host and parasite and research leading to vaccine trials; iii) basic and field research on mosquito genetics and biology which may lead to new prevention and control opportunities; iv) social studies on behaviours and habits around prevention and medication of malaria. The objective is to help Southern countries increase their capacity in clinical research, epidemiology, therapeutics, public health and social science (e.g. behaviours and habits accompanying medicine-taking). This means a true partnership and training adapted to specific needs and based on sound science. Research was therefore largely pursued in the laboratories of Southern countries and PAL+ supported the initiative in different ways by: i) providing easier opportunities for scientists from the North to collaborate with scientists from the South; ii) supporting networks of scientist collaborations. This was achieved by setting up a new type of relationships between scientists, based on a continuous dialogue and on bringing them together in small meetings on thematic discussions, the so-called Ateliers de PAL+. The Ateliers should play a major role in increasing the scientific capacity in developing countries. PAL+ program is a commitment to speed up better understanding of the disease by helping endemic countries contribute to research for their own benefit.

Africa South of the Sahara↗

PubMedDate not supplied

Improving the health of women in developing countries: the time is now.

The health problems of women in developing countries remain far too low on the international community's list of priorities. Progress can be made toward decreasing maternal mortality in resource-poor countries without sizable new research efforts. Strategies include improving access to emergency obstetric care and family-planning services. Reducing maternal mortality rates by 75% is one of the key Millenium Development Goals. Making women's health a priority will improve the outlook for women in the developing world.

Developing Countries↗

PubMedDate not supplied

Early detection of hearing impairment in a developing country: what options?

The concept of early detection is often predicated on a specified time-interval for optimal neural development in early childhood. This has been facilitated by advances in objective screening methods such as auditory brainstem response (ABR) and otoacoustic emissions (OAE). However, the prospects for this trend in developing countries remain doubtful, because of adverse socio-economic conditions. Consequently, the relative effectiveness of available tests was evaluated to determine the most viable option for mass screening based on findings from a broader study among 359 school entrants (mean age 6.7 years) in Lagos. The specificity of the questionnaire for detecting hearing loss was 94.0 per cent as against 62.4 per cent for otoscopy and 84.0 per cent for tympanometry. The sensitivities for the three methods were 10.0 per cent, 56.0 per cent and 52.0 per cent, while the positive predictive values were 21.7 per cent, 19.4 per cent and 34.6 per cent respectively. Notwithstanding its limitations, the administration of a well-structured questionnaire at school entry, complemented with parental education, may constitute the inevitable and immediate option for an early detection program in a developing country.

Acoustic Impedance Tests↗

PubMed2000

Neurocysticercosis and epilepsy in developing countries.

Neurocysticercosis is a disease of poverty and underdevelopment. Little is known about the natural history of the infection in humans, but some of the mechanisms whereby the parasite remains silent and evades the host immune response are understood. Symptomatic neurocysticercosis usually results from host inflammatory response after parasite death, and the clinical manifestations can be diverse. There is no evidence that cysticidal treatment does more good than harm in addition to conventional antiepileptic treatment. Population control measures involving immunisation or mass treatment have not shown long term effectiveness.Epilepsy, similarly to neurocysticercosis, is a largely unrecognised but increasing burden on the welfare and economies of developing countries. The technology of drug treatment and psychosocial rehabilitation is well known but requires widespread and effective dissemination at low cost. There is little epidemiological data on risk factors for epilepsy in developing countries on which to base prevention strategies. The public health prioritisation of chronic disorders such as epilepsy remains a challenge for policy and practice in developing countries. For both neurocysticercosis and epilepsy, there is a dilemma about whether limited public resources would better be spent on general economic development, which would be expected to have a broad impact on the health and welfare of communities, or on specific programmes to help individual affected people with neurocysticercosis and epilepsy. Either approach requires detailed economic evaluation.

Cost of Illness↗