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PubMed1990

The role of preventive medicine in developing countries.

In trying to demonstrate the importance of preventive medicine in health care promotion, previous studies involving prevention and control of diseases have been discussed. Preventive medicine is also urged as the best method to help promoting health especially in the developing countries. Developed countries are urged to support developing countries, materially and financially in promoting their health. In terms of cost analysis prevention is an investment in health that produce a reduced probability of mortality and/or morbidity, therefore, we, investors in the developing countries, have to sacrifice something today in order to gain a benefit at a later point in time.

Communicable Disease Control↗
PubMed1993

Diarrhoeal disease: current concepts and future challenges. Molecular biological approaches to the epidemiology of diarrhoeal diseases in developing countries.

Diarrhoea in developing countries is caused by an increasingly long list of bacterial, viral, and parasitic pathogens with rotavirus, enterotoxigenic Escherichia coli, Campylobacter, Shigella, and Salmonella heading the list. Using methods to detect most of the known enteropathogens, one or more enteropathogen(s) is isolated in two-thirds of diarrhoeal illnesses in the developing world. Many of these enteropathogens are also frequently isolated from children without diarrhoea. An aetiologic agent is more frequently isolated from cases of invasive diarrhoea than from those with secretory diarrhoea. Deoxyribonucleic acid probes have proved very useful in detecting pathogens such as enterotoxigenic (ETEC), enteroinvasive (EIEC), and enteropathogenic E. coli (EPEC), but have not yet proved to be particularly rapid or less expensive. Molecular biology has proved useful in epidemiological studies as a means of strain identification. Plasmids were initially used as convenient markers and proved useful in identifying epidemic strains of bacteria. Other molecular markers, such as ribotyping, are accurate enough to be used as taxonomic tools.

Bacterial Infections↗
PubMed1992

Women's access to health care in developing countries.

Women in developing countries are frequently confronted with a myriad of socio-cultural factors which negatively impinge upon physical well-being and accessibility to appropriate health care services. Institutional, economic, and educational barriers effect and lowers their standard of living when compared to their male counterparts. Women must become agents of change to improve their situation. Factors such as access to income, legal rights, social status, and education may prove far more important in determining women's access to health care than technology distribution and governmental strategies.

Cross-Cultural Comparison↗
PubMed1978

The need for quality control in the developing countries.

In the developing countries there is a need for greater activity in the quality control of vaccines used in immunization programmes. The establishment of a quality control facility can give assistance not only in the checking of vaccines at the time of release, but also in monitoring the efficacy of the cold chain. Furthermore, the antibody responses of the local child population to the vaccines can be measured. Quality control should be established before vaccine manufacturer, therefore, and the economics of importing vaccine in the bulk concentrated form with dilution, blending and filling locally is worthy of consideration.

Antibodies↗
PubMed1981

Chest trauma in a developing country.

In a developing country with inadequate clinical facilities a conservative method of management of a major clinical problem is often the only rational approach. This policy was adopted in the management of 145 patients with chest trauma in a teaching hospital in Nigeria. Automobile accidents were the cause of the thoracic injuries in 73.1% of the patients; 71.7% of the patients were managed as in-patients. The management of the patients was essentially aimed at correction of hypovolaemia, tube drainage of pleural collections, and relief of pain by intercostal nerve block. Major operative procedures were adopted in 11 cases (7.6%) for persistent haemothorax or for pyothorax, ruptured diaphragm, ruptured abdominal viscus, and subdural haematona. No operative reduction of rib fractures was performed and only 1 of the 12 patients with flail chest was mechanically ventilated. The hospital mortality was 9.7% and, despite a high rate of default at follow-up attendances, no late death or serious complication was recorded. Th aspects peculiar to chest trauma in Nigeria are discussed.

Accidents, Traffic↗
PubMed1977

The role of drug information centres for improving patient care in Pakistan and other developing countries.

Relevant and uptodate information about drugs in common use is either unavailable or scarce, in Pakistan and other developing countries. Developed countries inspite of all the facilities available for learning have recognised the limitation of human memory. Drug information centres have therefore been established for repeated reminder and continued education for the practicing doctors in prescribing drugs and early recognition of adverse reactions to them. The proposal for establishing such drug information centres in Pakistan and other developing countries for further improving the patient care and early reporting of adverse reaction to drugs in this paper is based on the encouraging response to and beneficial experience by such centres in the western world. There is every reason that it will succeed in improving the health of the people of Pakistan.

Developing Countries↗
PubMed1991

Paediatric oncology in developing countries.

Paediatric oncology in developing countries is a specialty in its own right that has so far been largely neglected by the western medical profession. It has specific features of genetic cancer predisposition and of external factors influencing phenotypic cancer manifestations. We point out here some of the specific features of cancer presentation in children of developing countries.

Child↗
PubMed1977

Specialist training and medical research in developing countries of tropical Africa: a case for the establishment of postgraduate medical schools.

Developing countries like developed ones need highly skilled medical personnel, referred to as 'specialists'. In the case of developing countries, the training of these specialists abroad is expensive to the sponsoring governments, imposes a lot of hardship on the doctors and, above all, the course-content of such training takes little or no cognizance of the environment in which these doctors would later practise. The developing countries also cannot afford the loss of years in valuable services which the training abroad entails. Attempts are now being made to train specialists wholly or partly at home, in some developing countries. The approach is still not much divorced from what obtains in Britain and North America, that is, one of being trained on the job, with the onus for self-education being placed on the prospective students. Such students in most developing countries of tropical Africa have little or no facilities for further education outside their places of work. It is proposed that purpose-designed postgraduate medical schools may provide a temporary solution to specialist training in developing countries of tropical Africa. Such schools would in addition provide highly skilled medical service as well as obviate the need and the expense for the setting up of government sponsored medical research and training institutes.

Africa, Western↗
PubMed1995

Early detection of breast cancer in industrially developing countries.

Although the incidence of breast cancer is lower in industrially developing countries than in developed ones, half the global toll of breast cancer is in developing countries. As in the West, the incidence of breast cancer is rising in developing countries, and strategies for controlling breast cancer need to be defined taking into account the prevailing socio-economic realities. Mammography is unlikely to be a cost-effective approach to early detection. Because most breast cancers in developing countries occur in women below the age of 50, mammography is also likely to be less effective. The success of breast self-examination (BSE) requires strong motivation and the recognition that breast cancer is a potential hazard. Both these requirements are unlikely to be met in developing countries and, consequently, compliance will be low and BSE will not be performed properly. Nevertheless, the teaching of BSE may be used as a medium for increasing awareness about breast cancer. Physical examination (PE) of the breast conducted by female health workers is likely to be the most appropriate approach to early detection in developing countries. To be cost-effective, PE should be integrated into already existing health care programmes which reach women in their homes. The effectiveness of PE in the early detection of breast cancer has been underestimated, and evidence is reviewed which suggests that it may be a simple and inexpensive alternative to mammography screening even in developing countries.

Adult↗
PubMed1988

Vaginal delivery after caesarean section: is it safe in a developing country?

Many studies from developed countries have shown that a trial of vaginal delivery after a Caesarean section can be a safe alternative to repeated Caesarean section when certain criteria are fulfilled. However, few data are available from developing countries where, in most cases, there is no electronic fetal heart rate monitoring, no information about the prior section and no X-ray pelvimetry. At Gweru Hospital, 401 patients with a scarred uterus have been managed according to a standard protocol and 288 were allowed to have a trial of scar. The results show that the trial was successful in 235 mothers (82%) and there were only 2 uterine ruptures (0.7%). Postpartum morbidity was higher after Caesarean section than after vaginal delivery.

Adult↗
PubMed1989

Implementing change in medical education in developing countries.

Medical schools in developing countries are constantly faced with the problem of adapting an inherited style of education to suit local needs and constraints. Often these needs have changed considerably since the curriculum was first established. Yet the difficulty of bringing about curricular changes, especially in conventional medical schools, is well known. This paper attempts to guide innovators in developing countries, but many of the suggestions are appropriate to all innovators. The issue of international standards is closely scrutinised, and their hypothetical nature revealed. The detrimental effect of national licensing examinations on curricular innovation is discussed. The futility of ad hoc changes and the need for a carefully thought out philosophy of change which leads logically to new ways of educating future professionals are stressed. Guidelines for maintaining an innovation and for evaluating its short- and long-term outcomes are developed.

Communication Barriers↗
PubMed1990

Soak-away systems and possible groundwater pollution problems in developing countries.

People in the developing countries do not have adequate sanitation and everyone defaecates somewhere. Those who do not have a toilet or latrine have to resort to indiscriminate defaecation either in the sea shore such as in the Lagos lagoon in Nigeria, or vacant plots and open drains as in Iddo area of Lagos and sides of rural footpaths. Water closets (W.C.s) are the most accepted sanitation system, but the cost of operating and maintaining them is high. As a result sewerage is not appropriate for the majority of people in developing countries whose greater population live in rural areas and small towns. The majority of people in urban areas use septic tanks and very often most of these septic tanks are not properly designed or sometimes located too close to sources of water supply, which then become contaminated. It is generally believed that systems like septic tanks, pit latrines and aqua privies are capable of totally eliminating these pathogens. There are many problems associated with the physical, chemical and biological processes that may result in groundwater pollution from septic tanks. Many experiments have shown that faecal organisms do not travel any significant distance radially as a result of concentration gradient. They are, however, carried with groundwater flow. The task is to prevent pathogens from getting into the aquifer. This paper attempts to highlight the ability of some enteric viruses to survive septic tank wastewater treatment.

Developing Countries↗
PubMed1996

Environmental toxicants in developing countries.

Health effects from environmental toxicants may be a more serious problem in developing countries compared with developed countries because the problem is potentiated by other factors: a) the lack of or failure to enforce regulations, which allows human exposures to genotoxic agents; b) undernourishment of the lower economic and social classes that comprise the most exposed populations from industrial and agricultural activities; and c) parasitic infections that afflict a wide range of populations in both urban and rural areas. Data on the genotoxic effects of different types of exposures, including environmental exposes (natural and industrial), occupational exposures, and infections and medical treatments, are presented and discussed with the point of view that all these factors must be taken into account with respect to regulation and the protection of human health. Occupational exposures in developing countries are higher than in developed countries due to lack of stringent regulations, lack of knowledge of the risks involved, and the negligence of workers. General pollution is another important issue since developed countries have established strict regulations and risky industrial processes are being exported to developing countries, along with banned substances and dangerous industrial wastes. It should be emphasized that stringent regulations in developed countries will not prevent exposures in the long term because toxic substances that are released into the environment will ultimately reach all our future generations.

Animal Population Groups↗
PubMed1994

Options for provision of occupational health services in developing countries.

Different models of occupational health care are available for developing countries to consider in developing their provisions for occupational health services. Even in developed countries there are differences between legal requirements for personnel and services, and voluntary provision of services. The range of activities covered by occupational health services can be extensive. Developing countries often focus on the provision of clinical care and treatment facilities at the workplace with less emphasis on preventive services. This may be related to the perceived value of the clinical skills of the doctor and nurse available at the workplace, plus the lack of other occupational health personnel, and the limited access to occupational hygiene and laboratory facilities. For future occupational health provisions, developing countries have to consider the balance between preventive services versus other clinical and non-clinical services. There will be benefits in reviewing the experience of developed countries in terms of the essential skills and training of occupational health personnel, and the contribution this would make to the health of the workforce in developing countries.

Developing Countries↗
PubMed1991

Chemicals and environmentally caused diseases in developing countries.

This chapter discusses international aspects of diseases resulting from exposure to chemical pollutants in the environment, with an emphasis on developing countries. These countries share many of the same problems of air, water, and pesticide pollution that face the more industrialized countries. In developing countries, however, the problems are compounded by a number of unique situations, viz., economic priorities, high burden of infectious diseases, impoverishment, and absence of a regulatory framework for the disposal of toxic chemicals. This discussion emphasizes the importance of interactions among toxicants, malnutrition, and infectious diseases for both urban and rural populations insofar as these interactions contribute to disease. Toxicants not only produce disease directly but also exacerbate diseases with other causes. Specific examples from developing countries demonstrate how human health effects from exposures to environmental chemicals can be assessed. While they do not strictly fall under the rubric of "developing countries," the public health consequences of inadequate control of environmental pollution in the East European countries should demonstrate the magnitude of the problem, except that in developing countries the public health consequence of environmental chemicals will be aggravated by the widespread malnutrition and high prevalence of infectious diseases. Much needs to be done before we can adequately quantify the contribution of environmental chemicals to morbidity and mortality in developing countries with the level of sophistication now evident in the charting of infectious diseases in these countries.

Air Pollution↗
PubMed1980

[Cardiovascular mortality in industrial and developing countries (author's transl)].

In developing countries when causes of death are registered cardiovascular mortality levels revealed themselves surprising. For instance, they appear to be more important in Tebessa (Algeria) during 1974-1975, Mauritius (1973-1976) or Egypt (1971-1973) than in france, United States or Sweden before the age of 45 and very near after this age. These results are consistent with the mortality patterns by causes of death proposed by Preston according to life expectancy at birth. Before the age of 45, rheumatic heart diseases can explain this overmortality. After this age the recent observations in the Third-World, especially in Africa, show that cardiomyopathy, cardiomegaly and principally hypertension are widely spread to-day. On the other hand, ischemic heart diseases are still rare. For many authors, cardiovascular diseases are increasing in Africa because ways of life in developing and developed countries are becoming identical. In fact, this trend could be a little artificial. Formerly indeed, disparity in population age structures and mortality differences for all other causes were not enough taken into account.

Adolescent↗
PubMed1972

Concept of a paediatric emergency ward for the cities of a developing country.

Children's hospitals in developing countries carry an enormous patient load. Available facilities must be organized to provide essential care for all. At the Red Cross Children's Hospital in Cape Town this has been achieved by the development of an emergency ward attached to the outpatient department. It is suggested that this concept should be applied in large hospitals of other developing countries.

Bronchiolitis, Viral↗