The changing pattern of population distribution in Japan and its implications for developing countries.
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Asia↗
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Results for “Developing Countries”
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Primary health care led NHS: learning from developing countries.
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Developed Countries↗
Psychiatric training in developing countries.
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Community Psychiatry↗
[THE CAMPAIGN AGAINST INFECTIOUS DISEASES, PARTICULARLY IN ECONOMICALLY UNDER DEVELOPED COUNTRIES].
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Communicable Diseases↗
[Malaria research for developing countries: the PAL+ program].
Despite extensive national and international intervention, little progress has been made in controlling, malaria and other communicable diseases afflicting many developing countries in the world. In response to the need to pursue and enhance investigation, the French Ministry of Research launched the PAL+ program in 1999 with the purpose of promoting concerted "research on malaria and other communicable diseases afflicting developing countries". The program is focused on developing methods of prevention and treatment for countries in Sub-Saharan Africa, Southeast Asia, and Latin America. Advancement of these scientific goals is further by a determined efforts (i) to provide means for national coordination and scientific organization of malaria research in France and (ii) to revive the spirit and mechanisms that characterized previous operations of cooperation between France and countries in the southern hemisphere. This new vision of cooperation is based on two organizational approaches. The first involves integrated programs in which training and transfer of knowledge are essential. The second involves joint projects in which networks maintained by a continuous exchange in operational seminars contribute to establishing a permanent dialogue between the North and South. Priority research areas have been encouraged to respond to specific public health issues with emphasis on establishing a balance between work in the field and development of knowledge. The priority areas include (i) responding to the increasing incidence of drug resistance by identifying of new antimalarial drugs and defining new therapeutic strategies; (ii) understanding the implications of the pathophysiology and physiopathology mechanisms underlying severe malaria manifestations for development of a malaria vaccine; (iii) finding new opportunities for prevention of malaria based on more effective vector control; (iv) using social anthropology to factor population behaviour and habits into the design of effective malaria control measures. The PAL+ program was founded on a commitment to provide participating countries with the means necessary to improve their research capability and to coordinate and structure scientific research by creating enduring partnerships between investigators in France and southern hemisphere countries. For this purpose the PAL+ workshop program involving regular encounters between northern and southern hemisphere researchers has been set up to encourage discussion, interaction, and multidisciplinary projects. The exceptionally instructive impact of these workshops has proven to be an essential element in the overall PAL+ program that has greatly stimulated malaria research. This program has been successful in creating a new spirit of intervention and has provided a rarely equalled vehicle for collaboration. By bringing the whole research community together over the major research programs now under way in the North/South networks, the PAL+ program represents a new and decisive step in achieving the long-sought goal of meaningful scientific cooperation between northern and southern hemisphere countries in the domain of public health.
Antimalarials↗
Speed control in developing countries: issues, challenges and opportunities in reducing road traffic injuries.
Speed has been determined to be one of the most common contributing factors in vehicle crashes. This study explores vehicle speed as a factor in the causation of road traffic crashes, using the example of Ghana. It examines the effectiveness of various speed control measures, based on police-reported traffic crashes in Ghana and published works on speed control measures in both industrialized and developing countries. In Ghana, pedestrians were the main victims of road traffic injuries. The dominant driver error assigned by traffic police was loss of control, with the underlying factor being excessive vehicle speeds. The 'speed factor' alone accounted for more than 50% of all Ghanaian road traffic crashes between 1998 and 2000. While the enforcement of speed limits by traffic police may not be affordable for most developing countries, rumble strips and speed humps were found to be effective on Ghanaian roads. Rumble strips installed on the main Accra-Kumasi highway reduced crashes by about 35% and fatalities by about 55%. Reducing vehicle speeds may be one of the most effective interventions to stem traffic crashes in low-income countries. However, setting lower speed limits is not an effective intervention without the traffic law enforcement resources to ensure that limits are followed. Developing countries must also look to other speed reduction measures such as speed bumps and rumble strips, roads that segregate high- and low-speed users, and technological solutions such as speed governors, as well as greater public awareness of the problem.
Accidents, Traffic↗
HIV-associated tuberculosis in developing countries: clinical features, diagnosis, and treatment.
This article reviews the clinical aspects and diagnosis of HIV-associated tuberculosis in developing countries, and summarizes WHO's recommendations for treatment. According to WHO estimates (early 1992) over 4 million persons worldwide have been infected with HIV and tuberculosis; 95% of them are in the developing countries. Clinical features of HIV-associated pulmonary tuberculosis in adults are frequently atypical, particularly in the late stage of HIV infection, with non-cavitary disease, lower lobe infiltrates, hilar lymphadenopathy and pleural effusion. More typical post-primary tuberculosis with upper lobe infiltrates and cavitations is seen in the earlier stages of HIV infection. Extrapulmonary tuberculosis is reported more frequently, despite the difficulties in diagnosing it. WHO's recent guidelines recommend 6-month short-course chemotherapy with isoniazid, rifampicin, pyrazinamide and ethambutol for patients with HIV-associated tuberculosis. The older 12-month regimen without rifampicin is much less effective. Streptomycin should not be used, because of the risk of transmitting blood-borne pathogens through contaminated needles. Thioacetazone should be abandoned, because of severe adverse reactions observed among HIV-infected patients. The roles of preventive chemotherapy and BCG vaccination for prevention of tuberculosis are also briefly discussed.
Adolescent↗
Quality of primary health care in developing countries: recent experiences and future directions.
Assessing and improving the quality of health care was, until recently, a low priority, both for policy makers in developing countries, and for technical agencies. The authors review the reasons for this long neglect of quality of care, which include: (i) a perceived priority of extending coverage at the expense of quality; (ii) the view that quality is difficult to assess in the absence of reliable documentation and health information systems; and (iii) the perception that improving quality is tantamount to increasing inputs, thus costly and not affordable for many countries. The authors strongly suggest that focusing on improving the process of care through quality assurance (QA) is the most promising avenue to improved quality of care in these countries. They review the current state of the art of QA in developing countries and formulate some policy suggestions: they call for a national commitment and leadership that provides a legal and institutional framework for QA and supports QA teams in the areas of setting professional standards, training, supervision, and information. The authors stress that the focus on process should not lead to a neglect of improving inputs. We conclude by suggesting future research in four broad areas: (i) development, testing and evaluation of new ways to implement QA through operational research; (ii) the links between process as well as inputs and outcomes; (iii) the relationship between quality and other health system variables, such as demand, costs, revenues and equity; and (iv) development of comprehensive quality indicators based on a score of process, input and outcome variables that allow researchers and policy makers to compare quality across time, space and different types of care providers.
Developing Countries↗
Mini incision live donor nephrectomy: an optimal approach for the developing countries.
OBJECTIVE: Laparoscopic donor nephrectomy (LD) is rapidly gaining popularity, however, this may not be affordable by donors in many developing countries because of its high cost. We describe our mini flank incision (MD) donor nephrectomy technique and its outcome. METHODS: A 7-10-cm subcostal rib sparing transverse incision was given 2 cm lateral to the tip of the 12th rib, towards the lateral border of rectus muscle. All dissections were performed with help of long retractors and instruments, vessels were transfixed and cut. In last 45 cases, vessels were clipped with Liga or Weck clips. Donors and recipients outcome was analysed. RESULT: From January 2000 to December 2002 a total of 148 patients underwent donor nephrectomy by mini incision technique. Mean patient age was 44.8 +/- 7.3 yr (range 20-70 yr). Nephrectomies were performed in 115 patients on the left side and in 33 cases on the right side. The mean incision length was 9.1 +/- 1.8 cm (range 7-10 cm). Mean operative time was 105 +/- 10.5 min (70-130 min). Mean analgesic (Tramadol) requirement was 205 +/- 52 mg; postoperative hospital stay was 2.2 +/- 0.5 d. Twelve per cent patients developed fever and 4% had superficial wound infection in postoperative period. Three patients required blood transfusion. Mean convalescence period was 22 +/- 2.8 d. CONCLUSION: Extrapleural, extraperitoneal, subcostal mini incisions live donor nephrectomy is a relatively safe procedure with low morbidity. This technique has a shorter hospital stay, early convalescence and better cosmesis. It is cost-effective and is an ideal substitute for the developing country.
Adult↗
Evaluating effectiveness of complex interventions aimed at reducing maternal mortality in developing countries.
BACKGROUND: Reducing the worldwide mortality ratio by 75 per cent between 1990 and 2015 is a key Millennium Development Goal. Randomized controlled trials (RCTs) are the accepted 'gold standard' to assess the effectiveness of interventions but they are not always appropriate for practical, ethical or economic reasons in developing countries. This study examines the use of cluster randomized trials and quasi-experimental (nonrandomized) study designs to evaluate complex interventions implemented to reduce maternal mortality. METHODS: We systematically searched electronic databases including MEDLINE, EMBASE, CINAHL, BNI, ASSIA, IBSS, CSA and COCHRANE. English language publications between 1990 and 2003 were included. Studies that assessed the effects of complex interventions aimed at reducing maternal mortality in developing countries were included. RESULTS: Four cluster randomized trials and eleven quasi-experimental studies were identified. Two cluster randomized trials examined reduction in prenatal visits with no adverse effects on maternal mortality. Two trials assessed the effects of vitamin A supplementation. Both trials found a significant reduction in maternal mortality ratios after vitamin A supplementation. A decline in maternal deaths was reported in eight of the nonrandomized studies. Measuring maternal mortality was a frequent problem because of insufficient sample sizes and/or poor recording methods. Other limitations include lack of suitable comparison groups and difficulties assessing the effects of confounding factors in the quasi-experimental studies. CONCLUSIONS: RCTs may not be appropriate to evaluate complex interventions in maternal mortality and cluster RCTs and quasi-experimental designs may be more suitable. However, further work is required to improve the robustness of such alternative study designs.
Developing Countries↗
Tuberculosis incidence in developing countries with high prevalence of HIV infection.
OBJECTIVE: To study the impact of the HIV epidemic on tuberculosis (TB) incidence in developing countries. DESIGN: A simple mathematical model is constructed using figures from published reports to estimate the rise of TB incidence as the HIV epidemic expands. METHOD: Two groups with different risk of developing TB are identified: individuals with dual infection of HIV and Mycobacterium tuberculosis and the rest of the population. The model is based on a combination of the incidence and the percentage of TB in these two groups. The expected rise in TB incidence and the percentage of TB cases that will be HIV-positive are plotted against the prevalence of HIV. CONCLUSIONS: Unless appropriate action is taken, TB incidence in developing countries will double as the prevalence of HIV infection reaches 13 per hundred adults.
Cohort Studies↗
Computer model for municipal solid waste treatment in developing countries.
Many integrated solid waste management (ISWM) models are available but are of little use to developing countries such as India since they do not take into account typical developing countries municipal solid waste characteristics such as high organic content, poor performance of formal sector control and support, high activity of scavengers and waste pickers, etc. The goal of this study is to create a computer program to determine the least cost treatment and disposal system for a given solid waste management problem. To demonstrate its applicability, the model was applied to the Indian city Amritsar. A typical Indian city like Amritsar generates about 500 ton of MSW/d with 45% moisture content, 30% volatile matter, and calorific value of 1500 kcal/kg. The computer model was run for various technologies. Results showthatfor Amritsar city incineration an expenditure of U.S. dollars (USD) 6.62 is incurred, whereas landfilling, composting, and biomethanation digester give an income of USD 0.13, USD 0.20, and USD 0.23 per ton of MSW, respectively. This empirical exercise not only reveals the model's strengths such as highlighting important interdependencies in the waste management sector but also its requirement for quality data.
Bacteria, Anaerobic↗
Ethical issues in screening for hearing impairment in newborns in developing countries.
Screening of newborns for permanent congenital or early-onset hearing impairment has emerged as an essential component of neonatal care in developed countries, following favourable outcomes from early intervention in the critical period for optimal speech and language development. Progress towards a similar programme in developing countries, where most of the world's children with hearing impairment reside, may be impeded by reservations about the available level of support services and the possible effect of the prevailing healthcare challenges. Ethical justification for the systematic introduction of screening programmes for hearing in newborns based on the limitations in current primary prevention strategies, lack of credible alternative early-detection strategies and the incentives for capacity-building for the requisite support services is examined.
Cost-Benefit Analysis↗
Microcomputer applications in health population surveys: experience and potential in developing countries.
Regrettably, because the content and technology are evolving so rapidly the literature on the application of microcomputer technology to health and development is either out of date, or hard to find (e.g. unpublished reports from consultants working with development agencies or universities). The time needed to review and publish an article or a book dictates that by the time it is published, any statements about current hardware will be obsolete. For example, a recent volume by Ingle et al., quite sound from the theoretical and practical point of view is already out of date with respect to hardware details. For that reason no hardware suggestions are made in this article. On the other hand, detailed reports of experience with first-generation microcomputers are very useful to the individual planning a developing country application. From the literature and our own field experience with respect to microcomputer applications in health/population surveys in developing countries, the following are useful summary points for projects currently going into the field. Careful planning is absolutely necessary if microcomputer technology is to be applied successfully to field data collection problems. Search out organizations with similar experiences. Collaboration among staff at all levels is essential for a system to be installed and utilized effectively. The particular technology combination selected must be adapted to the field situation. Remember survey complexity and size. Training is essential, and should be on-the-job and oriented towards specific tasks. If time consuming and repetitive tasks are given over to the microcomputer the technology will be readily accepted and fully utilized. To the extent that a community of users can be formed, the entire adoption process will be stimulated and results improved. Most maintenance and some repairs should be carried out in the field by local project personnel. For most survey and data acquisition problems some custom programming will be needed; this requires a good working knowledge of a powerful programming language (although this is likely to change in the near future). For descriptive statistics and small data management problems off-the-shelf software is appropriate but can be expensive. Compare options. Standardization and compatibility must be considered in all applications. This is important!(ABSTRACT TRUNCATED AT 400 WORDS)
Computers↗
Obesity among schoolchildren in developing countries.
The threat of worldwide obesity in children is a reality and has become pandemic. Previously a concern of only developed countries, rapid, escalating rates of overweight children now dominate the public health concerns of middle-and low-income nations as well. There are, of course, many influences that have literally shaped the global population, but there is also a recent observable pattern that is shared by those developing countries with increasingly obese children: a grand structural shift in diet and activity levels on every continent and in every region has occurred in the last quarter century, accompanied by rising rates of obesity. Two central public health concerns drive the need for effective interventions: the immediate health of children and the imminently crushing blow that is coming to health care systems and developing economies due to high rates of chronic disease. In developed nations, the role of gatekeeper has shifted to childcare providers, media, and schools, but in the developing world the traditional role of the mother as home manager has remained intact. Accepting the mother as the primary care provider within the child's nuclear environment places the mother as the guardian of the family's resources, which may be a viable alternative to the types of health-promotion efforts found in past ineffective models.
Adolescent↗
Statistical considerations for the interpretation of commonly utilized road traffic accident indicators: implications for developing countries.
The problem of increasing road traffic accidents and their consequences of death, injury and disability poses a growing concern, especially in developing countries. The objectives and nature of various indicators that countries with scarce economic resources can obtain are examined. The statistical and epidemiological considerations discussed should enable health care planners in developing countries to decide on the appropriate indicators required to properly assess the extent of the problem and aid in the amelioration and prevention of this "disease." Various indicators are discussed and a pragmatic guide examining their advantages and disadvantages is provided.
Accidents, Traffic↗
The impact of consuming iron from non-food sources on iron status in developing countries.
OBJECTIVE: : To determine the impact of contaminant iron and geophagy on iron intake and status of persons living in developing countries. DESIGN: : Literature for review was identified by searching Medline and Agricola, from appropriate other texts and from three reports from the Opportunities for Micronutrient Interventions (OMNI) Project of USAID. SETTING: : The dietary intake of iron by people living in developing countries is generally high but iron deficiency remains prevalent. This apparent paradox is because the iron being consumed is predominantly in the non-haem form, which is poorly absorbed. Some of this non-haem iron is from contamination of food with iron from soil, dust and water; iron leaching into food during storage and cooking; contamination during food processing such as milling; and the practice of geophagy. RESULTS: : Although the contribution of contaminant iron to overall iron intake is well documented, its absorption and thus its impact on iron status is not. To be available for absorption, contaminant iron must join the common non-haem pool, i.e. be exchangeable. The absorption of exchangeable contaminant iron is subject to the same interactions with other constituents in the diet as the non-haem iron that is intrinsic to food. The limited available evidence suggests wide variation in exchangeability. In situations where a significant fraction of the contaminating iron joins the pool, the impact on iron status could be substantial. Without a simple method for predicting exchangeability, the impact of contaminant iron on iron status in any particular situation is uncertain. CONCLUSIONS: : Interventions known to increase the absorption of iron intrinsic to foods will also increase absorption of any contaminant iron that has joined the common pool. Any positive effect of geophagy resulting from an increased intake of iron is highly unlikely, due to inhibiting constituents contained in soils and clays. The efficacy of approaches designed to increase the intake of contaminant iron remains encouraging but uncertain. An approach using multiple interventions will continue to be essential to reduce iron deficiency anaemia.
Biological Availability↗
Recent trends in fertility in less developed countries.
The rate of increase of population in less developed countries accelerated rapidly from 1850 to 1960 because of a rapid decline in mortality while fertility remained high. In the 1960's, the birth rate as a whole began to decline more rapidly than the death rate--very rapidly in some populations, most notably that of China, more gradually in others, and not at all in some of the poorest populations. The momentum of growth implies continued increase in populations for several decades even in countries where fertility has fallen the most, and very large additional increases where there has been no decline in the rate of childbearing.
Age Factors↗