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PubMed1994

Early tangential excision and skin grafting as a routine method of burn wound management: an experience from a developing country.

This study assessed the feasibility of performing early tangential excision and skin grafting for burn wounds 'routinely' in a developing country. An analysis of mortality, morbidity and hospital stay was carried out for 90 burns patients with deep partial skin loss burns out of 202 admissions, who underwent 'early' tangential excision and skin grafting. Overall survival rate was 86.5 per cent. Children below 14 years of age with burns < or = 40 per cent TBSA (total body surface area) had no mortality, 93.5 per cent of adult patients with burns < or = 60 per cent TBSA survived in contrast to those with burns of > 60 TBSA per cent who all died. Morbidity for contractures and hypertrophic scars was nil to minimal. The mean hospital stay for adult patients with major burns was 30 days, with minor burns it was 18.7 days. We conclude that in developing countries, early tangential excision and skin grafting can and should be done routinely for all minor burns and for the major burns who are admitted to a well-equipped burns centre, but not for very 'extensive burns', until biological skin substitutes are more readily available.

Adult↗
PubMedDate not supplied

An estimate of the incidence of hepatitis A in unimmunized Canadian travelers to developing countries.

BACKGROUND: There is a paucity of data describing the risk of acquiring hepatitis A while traveling in the developing world. This paper uses available data to calculate the risk to Canadian travelers. METHODS: Information was gathered from Canadian and international sources on the following: the yearly incidence of hepatitis A among Canadians; the proportion of cases of hepatitis A associated with travel to developing countries; the number of days of such travel by Canadians per year; and the percentage of travelers immunized before departure. Calculations were performed on these figures to arrive at an estimated risk of infection for unimmunized Canadian travelers. RESULTS: The annual incidence of hepatitis A in Canada over the period 1996-2001, adjusted for underreporting, averaged 6.15 cases/100,000 people. During that time, Canadians traveled approximately 36.5 million days/year in developing countries. The literature shows that 4% to 28% (mean 16%) of cases are estimated to have been acquired abroad. It also shows that 14% to 24% (mean 19%) of such travelers are immunized before departure. Based on these figures, the risk of acquiring hepatitis A during 1 month of travel in the developing world is calculated to be approximately 1 case per 3,000 unimmunized travelers. CONCLUSION: Hepatitis A is an important travel-related disease, preventable by immunization. However, our calculations indicate that the risk of acquiring hepatitis A while traveling in the developing world is lower than some previously published estimates. The results represent an average for all types of travel to all such countries. The actual risk will vary considerably, depending on the destination and style of travel.

Canada↗
PubMed1988

Population--a key component of planning education for developing countries.

During the next 20 years, much of the developing world will undergo significant demographic changes, such as population growth and urbanization. The effects of these changes can already be seen in many areas of Latin America, East Asia, and especially Africa. This article suggests how to redesign population studies to provide planners with a framework for understanding the complex interrelationships between demographic factors and development. The commentary which follows provides an example of how the author and her colleagues are implementing such a program at the Department of City and Regional Planning at the University of North Carolina at Chapel Hill.

Americas↗
PubMed1986

Tobacco demarketing campaigns and role model selection in developing countries: the case of Bangladesh.

Tobacco production and consumption is on the increase in developing countries. It is imperative that effective demarketing of tobacco products be initiated. This will call for effective and credible role models. A major study conducted in Dhaka, Bangladesh indicates that doctors are the most credible source of information concerning the dangers of tobacco consumption. Campaigns utilizing elderly male doctors as role models are called for in working to correct to problem of tobacco used in developing countries.

Attitude to Health↗
PubMed1999

The use of alternatives to animal tests in developing countries.

Consideration of alternative methods for animal tests in developing countries is important because good quality laboratory animals and proper animal facilities are not always sufficiently available to perform the currently required quality control tests. In vitro methods have been implemented at the National Institute of Vaccines and Biological Substances (IVAC) in Vietnam. These include serological tests (such as the Toxin Binding Inhibition test and the VERO Cell test) for the estimation of potency of Tetanus and Diphtheria toxoid vaccines and for the evaluation of vaccine field trials. Currently, an inhibition ELISA test to determine anti-rabies activity in equine rabies immunoglobulin preparations is being developed with the long-term goal of its introduction in Vietnam. The results from validation studies are promising and have contributed to decisions made by the National Control Authority to replace imported DPT vaccines in the EPI program with Vietnamese-produced DPT vaccines. This paper summarizes IVAC's experience in introducing alternatives in Vietnam over the last 10 years and reports on the various local validation studies which were performed during this period.

Animal Testing Alternatives↗
PubMed1994

Preterm breech delivery in a developing country.

OBJECTIVES: To determine if cesarean section offers any advantage over vaginal delivery for a preterm breech fetus in a developing country. METHODS: A retrospective analysis from hospital records was done at a tertiary care center in North India. Two hundred and twenty-four preterm breech deliveries (28-36 completed weeks) between January 1988 and December 1991 from a total of 13,149 deliveries at the hospital during this period formed the study group. Fetal death and lethal congenital malformations diagnosed antepartum were excluded. Intrapartum and neonatal morbidity and mortality in vaginal versus cesarean deliveries were the main outcome measures. RESULTS: Although the combined intrapartum and neonatal mortality was significantly higher for vaginal delivery (35.9% vs. 17.7%), there was no significant difference when the data was correlated with birthweight or gestational age. The neonatal morbidity was also similar in both these groups. In women with a poor obstetric history, the neonatal survival was better in the cesarean group (93% vs. 43%; P = 0.0004). CONCLUSION: Even with optimum neonatal care facilities, cesarean section does not offer any advantage over vaginal delivery for a preterm breech fetus in a developing country. The present study does not advocate the routine use of cesarean section for this group of fetuses. However, it is the preferred route of delivery for women with a poor obstetric history.

Adult↗
PubMed2006

Obesity and cardiovascular disease in developing countries: a growing problem and an economic threat.

PURPOSE OF REVIEW: This review examines the rise of risk factors for cardiovascular disease, especially obesity, in developing countries and the implications for both health and economics. RECENT FINDINGS: In the majority of developing countries fertility and infant and child mortality have fallen markedly, and life expectancies have increased. Rapid urbanization, falling food prices, and globalization of economies have contributed to an increase in risk factors for chronic disease. Recent work indicates that the prevalence of these risk factors, including obesity, is rising faster than the historical experience of the West. The transition is affecting women in particular, and increases in risk factors are more marked among lower incomes in growing economies than among the wealthy. Rather than the stereotypical problem of the rich, chronic disease is now a problem for the poor. SUMMARY: Significant research in this area of global health has only been undertaken in the last decade. Additional field research is needed in every dimension of the transition, both to document the problem itself and to determine its economic and societal impact and cost effective responses. Two critical factors are virtually absent from existing work and should be emphasized. First, the impact of rising risk factors for, and mortality from, cardiovascular disease in the work force may imply a growing threat to continued economic progress. Second, because risk factor reduction requires society-wide strategies, broad public-private coalitions will be needed to mobilize sectors beyond healthcare.

Cardiovascular Diseases↗
PubMed2000

Risk factors for neonatal encephalopathy in Kathmandu, Nepal, a developing country: unmatched case-control study.

OBJECTIVE: To determine the risk factors for neonatal encephalopathy among term infants in a developing country. DESIGN: Unmatched case-control study. SETTING: Principal maternity hospital of Kathmandu, Nepal. SUBJECTS: All 131 infants with neonatal encephalopathy from a population of 21 609 infants born over an 18 month period, and 635 unmatched infants systematically recruited over 12 months. MAIN OUTCOME MEASURES: Adjusted odds ratio estimates for antepartum and intrapartum risk factors. RESULTS: The prevalence of neonatal encephalopathy was 6.1 per 1,000 live births of which 63% were infants with moderate or severe encephalopathy. The risk of death from neonatal encephalopathy was 31%. The risk of neonatal encephalopathy increased with increasing maternal age and decreasing maternal height. Antepartum risk factors included primiparity (odds ratio 2.0) and non-attendance for antenatal care (2.1). Multiple births were at greatly increased risk (22). Intrapartum risk factors included non-cephalic presentation (3.4), prolonged rupture of membranes (3.8), and various other complications. Particulate meconium was strongly associated with encephalopathy (18). Induction of labour with oxytocin was associated with encephalopathy in 12 of 41 deliveries (5.7). Overall, 78 affected infants (60%) compared with 36 controls (6%) either had evidence of intrapartum compromise or were born after an intrapartum difficulty likely to result in fetal compromise. A concentration of maternal haemoglobin of less than 8.0 g/dl in the puerperium was significantly associated with encephalopathy (2.5) as was a maternal thyroid stimulating hormone concentration greater than 5 mIU/l (2.1). CONCLUSIONS: Intrapartum risk factors remain important for neonatal encephalopathy in developing countries. There is some evidence of a protective effect from antenatal care. The use of oxytocin in low income countries where intrapartum monitoring is suboptimal presents a major risk to the fetus. More work is required to explore the association between maternal deficiency states and neonatal encephalopathy.

Body Height↗
PubMed1996

Retail pharmacies in developing countries: a behavior and intervention framework.

Retail pharmacies in developing countries are one of the most important sources of advice on pharmaceuticals. Among the reasons the clients give are ease of access; availability of medicines; quality of service (no waiting and convenient hours of operation); and cheaper products, availability of credit, or the option to buy drugs in small amounts. However, the appropriateness of prescribing by retail pharmacy staff has been found to be far from acceptable. In childhood diarrhea, for example, oral rehydration salts (ORS), the appropriate diarrhea treatment, are recommended much less than pharmaceuticals of limited value, such as antimotility agents, adsorbents, etc. Little information is available for reasons underlying such behaviors. In this paper, we present a conceptual framework in which to analyze factors that may affect retail pharmacy prescribing, and we suggest strategies for behavior change. We developed this framework after examining relevant literature on retail pharmacy prescribing. We propose that pharmacy factors, client factors, physician practice and regulatory factors are the four sets of important factors for understanding pharmacy prescribing behavior. For intervention, we present four types of interventions which could be used for changing the behavior of pharmacy staff: information alone, persuasion, incentives and coercion. The behavior and intervention frameworks presented in this paper should also help in guiding further research in this area. For example, new information on the effects of ownership type, availability vs actual role of professional staff and authority structure on pharmacy treatment behaviors would be useful areas for future research. Similarly, additional research is needed on the comparative effects of coercive, persuasive and incentive strategies on pharmacy treatment behaviors.

Adult↗
PubMed2004

Hand-carried cardiac ultrasound enhances healthcare delivery in developing countries.

The availability of cardiac ultrasound is limited in developing countries. We evaluated the feasibility and diagnostic capability of a hand-carried cardiac ultrasound device in 126 patients (age 44 +/- 24 years) referred for consultation to a cardiology clinic in rural Mexico. The hand-carried cardiac ultrasound device identified 86 cardiac findings and obviated the need for further comprehensive echocardiographic evaluation in 90% of patients (113 of 126).

Adult↗
PubMed2000

The ethics of placebo-controlled trials in developing countries to prevent mother-to-child transmission of HIV.

Placebo-trials on HIV-infected pregnant women in developing countries like Thailand and Uganda have provoked recent controversy. Such experiments aim to find a treatment that will cut the rate of vertical transmission more efficiently than existing treatments like zidovudine. This scenario is first stated as generally as possible, before three ethical principles found in the Belmont Report, itself a sharpening of the Helsinki Declaration, are stated. These three principles are the Principle of Utility, the Principle of Autonomy and the Principle of Justice. These are taken as voices of moral imperative. But although each has intuitive appeal, it can be shown that there are possible scenarios in which they give conflicting prescriptions. To achieve consistency, one must be subordinate to the others. The voice of utility is taken as subordinate to those of justice and autonomy and it is shown that given plausible assumptions about the level of poverty and education in the developing country targeted, the experiment is ruled morally wrong in the name of both justice and autonomy. Moreover, it is argued that no justification can be found for the inclusion of a placebo group, when strictly defined. By contrast, a 'no-treatment' control arm might be justified, but only when the demands of autonomy are satisfied, demands that are more stringent than they might appear. A utilitarian defence of the experiment is examined, namely that the would-be participants are in a no-loss situation, and it is shown that this defence is seriously flawed. Finally, it is concluded that there is no justification for amending the Declaration of Helsinki.

Adult↗
PubMed1984

Prevention of oral diseases in developing countries.

Low caries prevalence, high rates of periodontal disease and widespread oral mucosal disease constitute the major oral health problems in the developing countries. Dental caries is mainly occlusal in distribution and is on the increase. Periodontal disease in the major cause of tooth loss in adults. Its rate of progression is more rapid in developing countries. In the Asian countries, specifically, oral cancer is the most common of all cancers. These problems should be viewed against a background in which there is a shortage of dental manpower; a considerable amount of unmet dental need; escalating costs of curative dental services; and the low priority oral health occupies, due to the prevalence of a multitude of other health problems. A strategy in keeping with the primary health care approach would be an integrated oral health care delivery system with prevention and health education as priorities. Based on the philosophy of self-reliance such programmes would have to be field-based and implemented with maximum community participation. Sri Lanka has developed an oral health programme founded on these principles. School-based health education and preventive programmes are implemented by the dental personnel with the active cooperation of the teachers and parents. The teachers, after basic training in dental health, organize and conduct dental health educational programmes in schools. Fluoride mouth rinses are used for specially selected children. Senior students are given leadership roles in the programmes. They supervise and guide oral health promotional activities in the schools. The public health staff under the leadership of the Medical Officer of Health are actively involved. Village health volunteers, family health workers, traditional medical practitioners and religious leaders all play active roles in the health educational programmes.

Adolescent↗
PubMed2002

A proposal for cervical screening information systems in developing countries.

The effective and efficient delivery of cervical screening programs requires information for planning, management, delivery and evaluation. Specially designed systems are generally required to meet these needs. In many developing countries, lack of information systems constitutes an important barrier to development of comprehensive screening programs and the effective control of cervical cancer. Our report outlines a framework for creating such systems in developing countries and describes a conceptual model for a cervical screening information system. The proposed system is modular, recognizing that there will be considerable between-region heterogeneity in current status and priorities. The proposed system is centered on modules that would allow for the assembly and computerization of data on Pap tests, since these represent the main screening modality at the present time. Additional modules would process data and create and maintain a screening database (e.g., standardize, edit, link and update modules) and allow for the integration of other types of data, such as cervical histopathology results. An open systems development model is proposed, since it is most compatible with the goals of local stakeholder involvement and capacity-building.

Databases as Topic↗
PubMed1987

[Internal migration in developing countries: rationality of rural-urban migration].

"In many developing countries there is a positive and nondecreasing rural-urban net migration. As a rule, making migration decisions jointly is advantageous for individual potential migrants and their families. Rationality of migration decisions depends on the specific character of the constituents of the basic decision model. In most cases, individual or family rationality of migration does not coincide with collective rationality. Trying to bring the two together requires trying to improve the coordinative function of main economic variables and trying to improve the decision makers' information." (SUMMARY IN ENG)

Behavior↗
PubMed2003

[Neonatal and pediatirc intensive care in developing countries. Myth or reality? Luxury or necessity? From theory to practice].

Neonatal and pediatric intensive care poses a major challenge in developing countries where the socio-economic level is low and health care resources are limited. Given the large size of the pediatric population as well as of great socio-cultural and symbolic importance of the child, there is a natural, compelling need for management of serious diseases in newborns and infants. The lack of timely disease prevention and treatment accounts in part for the frequency and severity of cases. Thus the status of intensive care units can exist in this setting is a pertinent question. The purpose of this study was to attempt to answer this question by surveying neonatal and pediatric care in developing countries based on experience in Morocco over the last 25 years.

Child↗
PubMed2003

An extended field test of the WHO severe malnutrition guidelines in hospitals in developing countries: preliminary observations.

The WHO has published guidelines for the inpatient management of severe malnutrition. A qualitative study in hospitals in developing countries is being conducted to document the re-organisation of the clinical ward and support services required to implement these guidelines and to gain an impression of the feasibility and sustainability of such a re-organisation. Following a postal survey of experts in the management of malnutrition in children in developing countries, hospitals were contacted and asked if they were interested to participate in the study. If so, they were requested to submit background information about admission patterns, the frequency of malnutrition, and current practice. Based on this information, hospitals are selected for a preliminary visit. Following this, and the final selection, a paediatrician conducts three visits to the study hospital over a one-year period to appraise the current practice, assist the health staff in recognising the strengths and shortcomings of their current management, help them find locally appropriate solutions, support the implementation process through a participatory approach and assess the outcome. A structured survey instrument is used to guide the assessment and identification of problems. Results of the first visit, which documents the existing situation, and changes identified by staff and implemented during the second visit are presented.

Attitude of Health Personnel↗
PubMed1992

Routine radio-imaging in filarial chyluria--is it necessary in developing countries?

Chyluria is a common presentation of filariasis in developing countries and mostly affects economically poor classes. The judicious use of investigations is mandatory to keep the cost of treatment acceptable. A modified plan is suggested for managing such patients without using retrograde pyelography or lymphangiography. A total of 54 patients were studied at 2 separate institutions, with retrograde pyelography being carried out at one institution but not at the other. All patients were treated primarily by the instillation of 1% silver nitrate, with an initial success rate of 70%. Eight patients who failed to respond underwent pyelolymphatic disconnection, the success rate being 88%. The omission of retrograde pyelography and lymphangiography had no effect on either treatment or outcome. The value of these radio-imaging techniques is discussed.

Adult↗