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PubMed2002

Consequences of revised estimates of carotenoid bioefficacy for dietary control of vitamin A deficiency in developing countries.

According to existing recommendations of the Food and Agriculture Organization (FAO)/World Health Organization (WHO), the amount of provitamin A in a mixed diet having the same vitamin A activity as 1 microg of retinol is 6 microg of beta-carotene or 12 microg of other provitamin A carotenoids. The efficiency of this conversion is referred to as bioefficacy. Recently, using data from healthy people in developed countries and based on a two-step process, the U.S. Institute of Medicine (IOM) derived new conversion factors. The first step established the bioefficacy of beta-carotene in oil at 2 microg having the same vitamin A activity as 1 microg of retinol; the second step established the bioavailability of beta-carotene in foods relative to that of beta-carotene in oil at 1:6. Thus, 2 microg of beta-carotene in oil or 12 microg of beta-carotene in mixed foods has the same vitamin A activity as 1 microg of retinol. Based on existing FAO food balance sheets and the FAO/WHO conversion rates, all populations should be able to meet their vitamin A requirements from existing dietary sources. However, using the new IOM conversion rates, populations in developing countries could not achieve adequacy. Additionally, field studies suggest that, instead of 12 microg, 21 microg of beta-carotene has the same vitamin A activity as 1 microg of retinol, which implies that effective vitamin A intake is even lower. Therefore, controlling vitamin A deficiency in developing countries requires not only vitamin A supplementation but also food-based approaches, including food fortification, and possibly the introduction of new strains of plants with enhanced vitamin A activity.

Adult↗
PubMed2006

Systems analysis of real-world obstacles to successful cervical cancer prevention in developing countries.

Papanicolaou screening is feasible anywhere that screening for cervical cancer, the leading cause of cancer-related death among women in developing countries, is appropriate. After documenting that the Vietnam War had contributed to the problem of cervical cancer in Vietnam, we participated in a grass roots effort to establish a nationwide cervical cancer prevention program in that country and performed root cause analyses of program deficiencies. We found that real-world obstacles to successful cervical cancer prevention in developing countries involve people far more than technology and that such obstacles can be appropriately managed through a systems approach focused on programmatic quality rather than through ideological commitments to technology. A focus on quality satisfies public health goals, whereas a focus on technology is compatible with market forces.

Developing Countries↗
PubMed2002

Potential carbon mitigation and income in developing countries from changes in use and management of agricultural and forest lands.

The many opportunities for mitigating atmospheric carbon emissions in developing countries include reforesting degraded lands, implementing sustainable agricultural practices on existing lands and slowing tropical deforestation. This analysis shows that over the next 10 years, 48 major tropical and subtropical developing countries have the potential to reduce the atmospheric carbon burden by about 2.3 billion tonnes of carbon. Given a central price of $10 per tonne of carbon and a discount rate of 3%, this mitigation would generate a net present value of about $16.8 billion collectively for these countries. Achieving these potentials would require a significant global effort, covering more than 50 million hectares of land, to implement carbon-friendly practices in agriculture, forest and previously forested lands. These estimates of host-country income potentials do not consider that outside financial investment may or may not be available. Our calculations take no account of the additional benefits of carbon sequestration in forest soils undergoing reforestation, increased use of biomass and reduced use of fossil-fuel inputs and reduced agricultural emissions. In all events, realizing these incomes would necessitate substantially greater policy support and investment in sustainable land uses than is currently the case.

Africa↗
PubMed1993

Environmental and health problems of developing countries.

Environmental variables largely determine the disease pattern in developing countries. Infections and malnutrition predominate, due to the effects of both poverty (a summary of many aspects of material deprivation) and a high ambient temperature. Environmental changes may be intended to improve health--examples include improved domestic water supplies and sanitation--or they may be due to socio-economic developments, which often have favourable or unfavourable health consequences. These are explored for water resource developments, where the health effects are complex, and for deforestation and urbanization. Although environmental impact assessment has been of value in reducing the adverse health impacts of socio-economic development projects, the use of health opportunity assessment is proposed as a more positive approach to optimizing the consequences of development to human health.

Developing Countries↗
PubMed1991

Tuberculosis in developing countries.

Every year, between six and eight million people worldwide develop tuberculosis and 2-3 million die of the disease. The situation is worsening due to the epidemic of human immunodeficiency virus (HIV) infection and reactivation of tuberculosis in patients with 'dual infection'. The World Health Organisation estimated that three million persons had 'dual infection' in 1990; 78% occurring in Africa. Tuberculosis, which affects adults during their most productive years and is a curable and preventable disease, has thus become a priority in the 1990s after a period of neglect. It also has some of the most cost effective health interventions available. The thrust of tuberculosis research in developing countries should be to support national tuberculosis control programmes, both in the development of their infrastructure and in research, to assist and develop tuberculosis control strategies.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Diarrhea in developed and developing countries: magnitude, special settings, and etiologies.

Diarrheal diseases are major causes of morbidity, with attack rates ranging from two to 12 or more illnesses per person per year in developed and developing countries. In addition, diarrheal illnesses account for an estimated 12,600 deaths each day in children in Asia, Africa, and Latin America. The causes of diarrhea include a wide array of viruses, bacteria, and parasites, many of which have been recognized only in the last decade or two. While enterotoxigenic Escherichia coli and rotaviruses predominate in developing areas, Norwalk-like viruses, Campylobacter jejuni, and cytotoxigenic Clostridium difficile are seen with increasing frequency in developed areas; and Shigella, Salmonella, Cryptosporidium species, and Giardia lamblia are found throughout the world. The rational management of infectious diarrhea requires the highly selective use of laboratory tests for these varied etiologic agents, depending on the clinical and epidemiologic setting. The purpose of this review is to provide an overview of the magnitude, special settings, and etiologies of diarrhea endemic to developed and developing countries. This information permits a practical approach to the diagnosis and management of common diarrheal illnesses in different settings.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Cervical cancer control in developing countries: memorandum from a WHO meeting.

This memorandum summarizes the report of a WHO Consultation on the Control of Cervical Cancer in Developing Countries, held on 6-7 November 1994, in New Delhi, India. Evaluated was the current situation with regard to cervical cancer and the relevance of current practices in screening. New pragmatic approaches to cervical cancer were proposed that are relevant for developing countries; this includes empowerment of women to come forward, and visual inspection-"downstaging".

Developing Countries↗
PubMed1995

Consensual partnering in the more developed countries.

"An especially spectacular demographic trend in the more developed countries since the mid 1960s has been the increasing frequency with which couples have cohabited without being formally married. This paper summarizes evidence that exists for the emergence of this phenomenon in different countries, and reviews the substantial literature it has generated.... The view is expressed that research to date often has avoided confronting the diversity of meanings consensual unions have for those who live in them."

Behavior↗
PubMed1994

Developing-country travel and endemic diseases.

Australians increasingly travel to developing countries for holiday and business and encounter new health risks that arise from changes in lifestyle, climate, geography or cultures, and exposure to infectious agents. Rare exotic tropical infections are possible but uncommon.

Australia↗
PubMed2004

Arsenic drinking water regulations in developing countries with extensive exposure.

The United States Public Health Service set an interim standard of 50 microg/l in 1942, but as early as 1962 the US Public Health Service had identified 10 microg/l as a goal which later became the World Health Organization Guideline for drinking water in 1992. Epidemiological studies have shown that about one in 10 people drinking water containing 500 microg/l of arsenic over many years may die from internal cancers attributable to arsenic, with lung cancer being the surprising main contributor. A prudent public health response is to reduce the permissible drinking water arsenic concentrations. However, the appropriate regulatory response in those developing countries with large populations with much higher concentrations of arsenic in drinking water, often exceeding 100 microg/l, is more complex. Malnutrition may increase risks from arsenic. There is mounting evidence that smoking and arsenic act synergistically in causing lung cancer, and smoking raises issues of public health priorities in developing countries that face massive mortality from this product. Also, setting stringent drinking water standards will impede short term solutions such as shallow dugwells. Developing countries with large populations exposed to arsenic in water might reasonably be advised to keep their arsenic drinking water standards at 50 microg/l.

Animals↗
PubMed2006

Cesarean section on request in a developing country.

OBJECTIVE: To assess the prevalence of cesarean sections (CSs) and women's reasons for requesting the procedure in a developing country. METHOD: Pregnant women scheduled for elective CS were interviewed to determine whether the procedure was requested by them or suggested by a physician. The women who personally requested a CS filled out questionnaires before surgery and at the postnatal visit 6 weeks later, and their answers were analyzed. RESULTS: The prevalence of CS on request was 4.4%. Previous infertility and advanced maternal age at first pregnancy were the most common reasons for requesting a CS, but most women said they would prefer a vaginal delivery in subsequent pregnancies. CONCLUSION: The women who requested a CS in this study did so for reasons different from those put forth by women in developed countries. The view that a CS is the surest way toward a live birth was the critical factor underlying their choice.

Adult↗
PubMed1992

Women and AIDS in developing countries.

It is estimated that 8-10 million people worldwide are infected with HIV, the virus causing AIDS; a large proportion live in developing countries. A review of the recent literature reveals that the impact of HIV/AIDS is particularly great on women in developing countries for four reasons. (1) Stereotypes related to HIV/AIDS have meant that women are either blamed for their spread or not recognized as potential patients with the disease. The consequences can be: delayed diagnosis and treatment, stigmatization, loss of income and violations of human rights. (2) Women are at increased risk of exposure to HIV infection for reasons related indirectly and directly to their gender. (3) The psychological and social burdens are greater for women than men in a similar situation. These include: problems related to pregnancy and motherhood; rejection as marital partners, loss of security and income (if they or their partners are seropositive); and greater demands to cope with the effects of the epidemic, both as lay persons and professionals. (4) Women's frequently low socioeconomic status and lack of power make it difficult for them to undertake prevention measures. Prevention programs targeting sex workers have begun and need to be continued. However, more programs are needed for women in general, including older women, men, traditional health practitioners and opinion leaders, incorporating seropositive women wherever possible. In addition, HIV/AIDS-related research regarding women must be increased as well as their access to adequate health services and income-earning opportunities.

Developing Countries↗
PubMed1996

Prevention of HIV infection in developing countries.

The HIV/AIDS epidemic continues to spread rapidly in developing countries. Heterosexual transmission accounts for almost three-quarters of infections. Current strategies have been effective in the prevention of HIV spread within certain groups but they have had limited impact on the general spread of the epidemic. There is a need to complement these strategies with approaches that will influence the social and environmental determinants of risk to enable those vulnerable to infection to protect themselves.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Acute viral bronchiolitis and its sequelae in developing countries.

Acute viral bronchiolitis (AVB) is a common disease found throughout the world. Various aspects of it are being studied: its epidemiology, diagnosis, prognosis and treatment. Most of these studies are being conducted in developed countries, with only a few taking place in developing countries. Risk factors such as poor nutrition, an adverse environment and early weaning should be studied where these features are common. Treatment aspects such as cost-effectiveness in low income settings need further study. Use of ribavirin and respiratory syncytial virus (RSV)-immunoglobulin are good examples. Post-bronchiolitic sequelae also need to be studied in low income countries. There is evidence that bronchiolitis obliterans is unusually frequent in some Latin-American countries such as Argentina and Brazil. It will be helpful to undertake combined studies in countries with the same socio-economics, investigating the preventive and management aspects of AVB and its sequelae to reduce the morbidity and mortality.

Acute Disease↗
PubMed1992

Promoting maternal health in developing countries.

Most maternal deaths are preventable, yet more than 500,000 women die annually worldwide. However, the risk of maternal mortality is unevenly distributed; 99 percent of all maternal deaths occur in developing countries. This article examines the causes of this disparity and suggests several recommendations for social workers to promote maternal health in developing countries.

Developing Countries↗
PubMed2006

Does the evidence support the use of concurrent chemoradiotherapy as a standard in the management of locally advanced cancer of the cervix, especially in developing countries?

Locally advanced cancer of the cervix (FIGO stages III and IVA) is one of the most common malignancies in developing countries. Conventional treatment has been a judicious combination of external radiotherapy and intracavitary brachytherapy. However, prompted by the results of five randomised-controlled trials (RCTs) published in close succession, The National Cancer Institute (NCI) alert in 1999, and two meta-analyses, the management of cancer of the cervix has gradually changed. Concurrent chemoradiotherapy with cisplatin alone, or in combination, is gradually being favoured for the treatment of cancer of the cervix. This overview examines whether the published evidence is sufficiently adequate to justify the use of chemoradiotherapy using cisplatin as standard care in the management of cancer of the cervix, especially in developing countries, where most women present with locally advanced cancer of the cervix. A critical review of the various phase III randomised trials and meta-analyses indicates that, although chemoradiotherapy could be a standard form of treatment for early cancer of the cervix, its role in advanced stages needs further exploration before this could be incorporated into routine clinical care.

Combined Modality Therapy↗
PubMed2000

Transfusion safety in developing countries and the Indian scenario.

The AIDS pandemic has brought into focus the importance of safe blood transfusion. The management of an effective transfusion service is an expensive endeavour even in the most developed countries, and is therefore a monumental challenge for developing countries with limited budgets and other priorities. HIV prevalence in the Indian population has shown a steady rise from 0.5% in 1990 to 1.2% in 1997 with the highest prevalence in cities. When the HIV infection was discovered in India in 1986, the health authorities set up the National AIDS Control Organisation (NACO) with a primary focus on ensuring a safe blood supply. NACO was funded by the World Bank and technically supported by WHO. The supreme Court of India has also taken up the issue of blood safety by banning paid donations by the end of 1997 and established the autonomous National Blood Transfusion Council and the State Transfusion Councils. The Drugs Controller of India and State F.D.A. have issued licences to all blood banks to streamline them after all requirements are met. However, there are a number of blood banks which are operating without licences. While India collects three million units of blood, barely 10% is available as blood components, and only a percentage of the blood is being screened for infectious markers. Nevertheless, there is a general recognition that an improved transfusion service is required in India.

Blood Transfusion↗