[The acceleration of economic growth and improvement of health in insufficiently developed countries].
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Developed Countries↗
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[Our new fragile world doesn't consist of developed and developing countries only].
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Developing Countries↗
An assessment of research on breastfeeding promotion strategies in developing countries.
Breastfeeding and its impact on child survival in developing countries have been well documented. Governments are being urged to encourage breastfeeding through legislation and promotional campaigns. The success of promotional programs depends not only on the interventions themselves but on the acceptance and acquisition of the desired knowledge, skills and behaviors. During the past decade, a variety of strategies have been used in an attempt to promote breastfeeding. These efforts include: (1) modifying hospital policies; (2) using social supports; (3) providing incentives; (4) educating mothers and health workers; and (5) initiating legislation and political action to create policies aimed toward healthier infant feeding practices. Research regarding these promotional activities has been both qualitative and quantitative in nature, designed to provide answers concerning the relative success of different promotional approaches. To varying degrees, findings and conclusions of breastfeeding promotion research can enhance the design, implementation and sustainability of these projects. However, programs and research designs are poorly described in the literature, providing vague conclusions and little guidance for future program planning.
Adult↗
Development and technical basis of simplified guidelines for emergency triage assessment and treatment in developing countries. WHO Integrated Management of Childhood Illness (IMCI) Referral Care Project.
Simplified guidelines for the emergency care of children have been developed to improve the triage and rapid initiation of appropriate emergency treatments for children presenting to hospitals in developing countries. The guidelines are part of the effort to improve referral level paediatric care within the World Health Organisation/Unicef strategy integrated management of childhood illness (IMCI), based on evidence of significant deficiencies in triage and emergency care. Existing emergency guidelines have been modified according to resource limitations and significant differences in the epidemiology of severe paediatric illness and preventable death in developing countries with raised infant and child mortality rates. In these settings, it is important to address the emergency management of diarrhoea with severe dehydration, severe malaria, severe malnutrition, and severe bacterial pneumonia, and to focus attention on sick infants younger than 2 months of age. The triage assessment relies on a few clinical signs, which can be readily taught so that it can be used by health workers with limited clinical background. The assessment has been designed so that it can be carried out quickly if negative, making it functional for triaging children in queues.
Case Management↗
Standardized diagnosis of pneumonia in developing countries.
The World Health Organization recommends the use of raised respiratory rate and chest wall indrawing to enable health workers in developing countries to diagnose pneumonia. We evaluated the current World Health Organization guidelines for management of the child with cough or difficult breathing in Manila, Philippines and Mbabane, Swaziland using an identical protocol in both countries. Raised respiratory rate was defined as greater than or equal to 50/minute for children ages 2 to 12 months and greater than or equal to 40/minute for children 12 months to 5 years. Chest wall indrawing was defined as inward movement of the bony structures of the lower chest wall with inspiration. In the Philippines raised respiratory rate or chest wall indrawing, when applied by a pediatrician, was found to have a sensitivity of 0.81 and specificity of 0.77 for predicting pneumonia as determined by a pediatrician with the aid of a chest roentgenogram. In Swaziland the sensitivity was 0.77 and the specificity was 0.80. When applied by health workers the sensitivity was similar but the specificity was lower. The current World Health Organization ARI case management guidelines predicted pneumonia with similar sensitivity and specificity in two very different developing countries, the Philippines and Swaziland.
Child, Preschool↗
Case management of childhood pneumonia in developing countries: recent relevant research and current initiatives.
Acute respiratory infections (ARI), mostly pneumonia, are one of the leading causes of death in young children in developing countries, accounting for 28% of childhood mortality. This paper provides a summary of the research and technical development efforts made in the last 15 years which contributed to improving the effectiveness of the case management strategy to reduce mortality from pneumonia in children in developing countries. Community intervention studies provided strong evidence that the strategy was feasible and effective in producing a substantial impact on pneumonia mortality. Clinical studies provided the rationale for improving the sensitivity and specificity of key signs of pneumonia, and for enhancing the therapeutic efficacy of standard home treatment. Research also provided data to deal with the problem of the clinical overlap of pneumonia and malaria in children. Technological initiatives succeeded in making appropriate diagnostic and therapeutic devices available. An important body of socio-cultural knowledge about family practices regarding pneumonia and ARI in children was built up and provided orientation on effective communication between health workers and families about home care of children with ARI. Health systems research focused on methods for surveillance of bacterial drug resistance and methodologies for evaluating the control programmes. Despite advances in the development of vaccines against respiratory bacteria and in the prevention of risk factors for pneumonia in children, case management will continue to be a central strategy for preventing mortality. Current international research initiatives are looking into measures that can improve the referral of severe pneumonia and effective management of severe pneumonia at first level hospitals.
Case Management↗
As a bacterial culture medium, citrated sheep blood agar is a practical alternative to citrated human blood agar in laboratories of developing countries.
Human blood agar (HuBA) is widely used in developing countries for the isolation of bacteria from clinical specimens. This study compared citrated sheep blood agar (CSBA) and HuBA with defibrinated horse blood agar and defibrinated sheep blood agar (DSBA) for the isolation and antibiotic susceptibility testing of reference and clinical strains of Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus. Reference and clinical strains of all organisms were diluted in brain heart infusion and a clinical specimen of cerebrospinal fluid and cultured on all agars. Viable counts, colony morphology, and colony size were recorded. Susceptibility testing for S. pneumoniae and S. pyogenes was performed on defibrinated sheep blood Mueller-Hinton agar, citrated sheep blood Mueller-Hinton agar (CSB MHA), and human blood Mueller-Hinton agar plates. For all organisms, the colony numbers were similar on all agars. Substantially smaller colony sizes and absent or minimal hemolysis were noted on HuBA for all organisms. Antibiotic susceptibility results for S. pneumoniae were similar for the two sheep blood agars; however, larger zone sizes were displayed on HuBA, and quality control for the reference strain failed on HuBA. For S. pyogenes, larger zone sizes were demonstrated on HuBA and CSBA than on DSBA. Poor hemolysis made interpretation of the zone sizes difficult on HuBA. CSBA is an acceptable alternative for the isolation of these organisms. The characteristic morphology is not evident, and hemolysis is poor on HuBA; and so HuBA is not recommended for use for the isolation or the susceptibility testing of any of these organisms. CSB MHA may be suitable for use for the susceptibility testing of S. pneumoniae.
Agar↗
[Drugs in developing countries. Current status, problems and possible solutions].
Based mainly on economic, administrative and drug logistics indicators, the article critically reviews the use of drugs in less developed countries in the context of the global drug scene. The lack of balance in less developed countries (LDCs) between indicators of need and determinants of political, economic, professional, educational and sociocultural nature, including product marketing efforts is highlighted. Special emphasis is given to the global WHO Action Programme on Essential Drugs, its background, strategies, implementation and tentative impacts. Country case examples from Sri Lanka, Bangladesh, Kenya, Zimbabwe and the Gambia are used for illustration. Varying progress is made in about half the 110 LDCs which have formally adopted the WHO concepts. Delayed implementation, setbacks and failures are prevalent. These reflect financial and other resource constraints, political ambiguity, qualitative and quantitative deficiencies related to manpower and insufficient back-up measures of an educational and informative character. An orientation towards operational research based on competence-building according to needs and strategies is highly desirable. Accordingly a plea is made for multidisciplinary collaboration in North-South networks at university level.
Developing Countries↗
Improvement of radiotherapy facilities in developing countries: a three-tier system with a teleradiotherapy network.
Incidence of cancer has been projected to rise worldwide by around 50% in the next 20 years, most of which will be in developing countries. To face this unprecedented global health problem, it is essential to plan effective health-care strategies. Radiotherapy-a main component of the multidisciplinary therapeutic approach for cancer-involves a huge capital investment that can pose difficulties for developing countries. Limited resources should therefore be used effectively to meet the projected requirements and to find ways to offer quality-assured radiotherapy to patients. Taking advantage of the global explosion of telecommunication technology, we present a proposal for creation of an integrated three-tier radiotherapy service, which consists of primary, secondary, and tertiary radiotherapy centres in developing countries-coordinated through a teleradiotherapy network. Such a network could be cost effective, help to bridge the gap, and give all patients access to the state-of-the-art technology in radiotherapy.
Cancer Care Facilities↗
Pharmaceutical companies pledge vaccines for developing countries.
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Developing Countries↗
Older women in developing countries.
Women's issues are markedly underrepresented in international policy and research discussions. This paper addresses these deficits by delineating the particular conditions of aging women in developing countries. While these women experience many of the age-related problems as their counterparts in developed countries, cultural and economic influences place them at a greater disadvantage.
Aged↗
Health organization in developing countries: innovations in the Peoples Republic of China.
The medical care delivery systems of most low-income countries are largely patterned on those of industrialized societies and are ill suited to the needs of developing countries. The present alternative model of health care in China has evolved after prolonged and often bitter debate extending over twenty years. The system that has been developed is one that appears uniquely suited to the needs of a large rural developing country; but it has been achieved in large part not through the medical profession but by evolving a system based upon participation by the people themselves and the development of new health-worker roles.
China↗
Lethal toxic encephalopathy due to childhood shigellosis in a developed country.
Shigellosis results in considerable morbidity in endemic areas, but mortality is rare in developed countries. All pediatric deaths (n = 15) in Israel following shigellosis in the past 10 years were reviewed. The patients' ages ranged from 5 months to 11 years; there were eight boys and seven girls. Three were institutionalized mentally retarded patients, 11 were healthy children. Twelve had definite clinical signs of brain death within 48 hours of onset of disease. Cause of death in all patients was consistent with toxic encephalopathy. No other systemic complication was implicated as the cause of death except for one case consistent with a "Reye-like" syndrome. Shigella species were as follows: 8 flexneri, 4 sonnei, 1 dysenteriae, and 2 were not identified. Case-control study of these patients vs surviving, hospitalized patients with shigellosis showed similar severity of fever, diarrhea, vomiting, and dehydration and similar incidence of convulsions. Headache was a prominent feature of patients who died; 5 of 7 verbal patients complained of this symptom as opposed to 2 of 20 in the control group (P less than .01). There were no significant differences in the hematological and biochemical profile (except for an increased incidence of hyponatremia in the study group), pattern of shigella species, or antibiotic sensitivity. These findings indicate that mortality from shigellosis in a developed country is due primarily to the toxic encephalopathy syndrome.
Brain Diseases↗
A plea for an initiative to strengthen family medicine in public health care services of developing countries.
An analysis of standards for the best practice of family medicine in Northern European countries provides a framework for identifying the difficulties and deficiencies in the health services of developing countries, and offers strategies and criteria for improving primary health care practice. Besides well-documented socioeconomic and political problems, poor quality of care is an important factor in the weaknesses of health services. In particular, a patient-centered perspective in primary care practice is barely reflected in the medical curriculum of developing countries. Instead, public sector general practitioners are required to concentrate on preventive programs that tackle a few well-defined diseases and that tend to be dominated by quantitative objectives, at the expense of individually tailored prevention and treatment. Reasons for this include training oriented to hospital medicine and aspects of GPs' social status and health care organization that have undermined motivation and restricted change. A range of strategies is urgently required, including training to improve both clinical skills and aspects of the doctor-patient interaction. More effective government health policies are also needed. Co-operation agencies can contribute by granting political protection to public health centers and working to orient the care delivered at this level toward patient-centered medicine.
Benchmarking↗
[Contribution of bronchial fibroscopy in pneumonology services in developing countries].
Bronchial fibroscopy is a recent investigation method that requires equipment and facilities difficult to implement in respiratory diseases units in developing countries. In Burkina Faso, this technique was introduced for the first time in February 1997. The purpose of this study was to determine the contribution of bronchial fibroscopy for the diagnosis of respiratory disease in countries with limited resources. This study was conducted between February 1997 and October 1998 at the respiratory diseases unit of the Yalgado Ouedraogo National Hospital Center in Ouagadougou, Burkina Faso. Thirty-five cases of tuberculosis were diagnosed, including 29 cases with bronchial node involvement, where bronchial fibroscopy is an essential diagnostic examination, and 6 cases of bacteriologically proven pulmonary tuberculosis. Ten cases of lung cancer were diagnosed (40% squamous cell carcinoma). Malignant disease is a reality in developing countries despite low rates of diagnosis due to insufficient diagnostic facilities. For tuberculosis, the importance of specific treatment is certainly well established and should always be initiated, even if fibroscopy cannot be performed. This contrasts with the situation for malignant disease, where the high prevalence of lung cancer (9.9% of the bronchial fibroscopies performed) is associated with total lack of treatment due to the absence of a thoracic surgery unit or a radiotherapy unit, and the impossibility of providing satisfactory surveillance of anti-cancer chemotherapy.
Bronchoscopy↗
The associations between feeding modes and diarrhoea among urban children in a newly developed country.
The protective effect of breastfeeding against infantile diarrhoea may be less pronounced in areas with modern water supply and sanitation facilities. This finding raises the question whether protection by breastfeeding against infantile diarrhoea in developing countries will decline with improvement in water supply and sanitation. To address this question a historical cohort study of the associations between feeding modes and diarrhoea incidence and severity in children aged 0-14 months at baseline was done in Al Ain city, United Arab Emirates. In this city in a newly developed country, modern water supply and sanitation facilities have become available to everyone during the last two decades. During three months of follow-up of 249 children, the nonbreastfed had more diarrhoea than did the partly breastfed, who in turn had more diarrhoea than did the fully breastfed. After multivariate adjustment, this dose-response effect was consistent for three measures of diarrhoeal morbidity in each child: occurrence or non-occurrence of incidence episodes, number of episodes, and total severity score. However, significant differences were seen only between the nonbreastfed and fully breastfed subgroups. These results indicate that in Al Ain, despite the universal access to modern water supply and sanitation facilities, breastfeeding plays an important role in reducing the incidence and severity of infantile diarrhoea. This observation is particularly important given the growing concern that, as an unwanted effect of 'modernisation', breastfeeding is on the decline in Al Ain and comparable populations elsewhere.
Breast Feeding↗
Nutrition and aging: potentials and problems for research in developing countries.
The demographic explosion of persons over 60 years of age is a reality in developed and developing countries alike. There is evidence that research on aging and nutrition in Third World countries is growing and developing. Specific research programs, and the linking of these programs in timely multicenter efforts, promise both valuable descriptive research for the benefit of national populations and comparative insights that will help us to learn more, collectively, about the intrinsic nature of the aging process itself.
Aged↗
Barriers to uptake and use of modern methods of contraception in developing countries.
As the next millennium approaches, the current world population of 5.9 billion will continue to increase by 81 million per year -- 93% of which will come from the developing countries. Poor uptake and utilisation of various modern methods of contraception in the developing countries is mainly responsible. In this article, we identify various barriers responsible for the low prevalence of contraceptive uptake in these countries and suggest how these barriers may be eliminated. We conclude that by increasing contraceptive availability and utilisation, population explosion can be significantly controlled.
Contraception↗