SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
We review the problem of limited microbiology resources in developing countries. We then demonstrate the feasibility of a cohort-based approach to integrate microbiology, epidemiology, and clinical medicine to survey emerging infections in these countries.
PURPOSE: To provide recommendations for the implementation of high dose rate (HDR) 192Ir brachytherapy technology in developing countries. METHODS: An Advisory Group Meeting of the International Atomic Energy Agency (IAEA) met to address the implementation of HDR 192Ir brachytherapy technology in developing countries. These recommendations reflect only the personal opinions of the authors and do not necessarily represent the opinion of the IAEA. RESULTS: An HDR treatment system should be purchased as a complete unit that includes the 192Ir radioactive source, source loading unit, applicators, treatment planning system, and control console. Infrastructure support may require additional or improved buildings and procurement of or access to new imaging facilities. A supportive budget is needed for quarterly source replacement and the annual maintenance necessary to keep the system operational. The radiation oncologist, medical physicist, and technologist should be specially trained before HDR can be introduced. Training for the oncologist and medical physicist is an ongoing process as new techniques or sites of treatment are introduced. Procedures for quality assurance (QA) of patient treatment, and the planning system must be introduced. Emergency procedures with adequate training of all associated personnel must be in place. CONCLUSIONS: The decision to select HDR in preference to alternate methods of brachytherapy is influenced by the ability of the machine to treat a wide variety of clinical sites. In departments with personnel and budgetary resources to support this equipment appropriately, economic advantage becomes evident only if large numbers of patients are treated. Intangible benefits of source safety, personnel safety, and easy adaptation to fluctuating demand for treatments also require consideration when evaluating the need to introduce this treatment system.
The main focus of ergonomics is the improvement of working conditions and safety. Studies of workers in industrialized countries (ICs) have focused on subjects like occupational health, work physiology, biomechanics, design, and cognition. However, in industrially developing countries (IDCs), the characteristics and conditions of the worker and his workplace are different. This paper suggests an alternative approach to improve working conditions for ergonomists in industrially developing countries. Together with the ergonomic factors previously stated, this approach also considers the broader social and cultural context within which the worker and his workplace exist. The operator is regarded as a product of his socio-cultural environment. His work place (e.g. its ambience, organization, shopfloor conditions, and the state of technology) and his work practices (e.g. attitudes, behavior, ethics, and problem-solving abilities) are affected by societal conditions (like quality of training and education, technical infrastructure, and technical culture).
Surgical interventions in patients with hemophilia (PWH) in the developing world are difficult in the setting of limited availability of factor concentrates. Although the adequacy of international guidelines for factor concentrate prophylaxis for PWH undergoing surgery has been established, frequently it is not practical in the developing world. These recommendations were not established based on large clinical trials and fail to define the safe lower limit of factor concentrate prophylaxis for surgery. The need to define these lower limits is essential in the developing world so that the limited resources may be used optimally for the cohort of PWH. There are limited data from the developing world with regard to PWH undergoing surgical procedures. In this article, we outline experience from our institution, a tertiary referral center for hemophilia care in India. We trace the basis on which our current factor concentrate prophylaxis regimen (which is lower than that recommended internationally) was established. In our experience our low-dose protocols are effective, reduce factor consumption by one third, and are not associated with a significantly increased risk of delayed hemorrhage. We hope that this experience will form a framework on which guidelines can be established for developing countries.
Measurement of glycated proteins, especially haemoglobins, is now a routine procedure for monitoring previous glycaemic control in diabetic patients in the developed world. Until recently, however, the assays were sophisticated and costly and, therefore, were only rarely used in developing countries. With easier and cheaper tests now available, the measurement of glycaemic control could be also introduced into regional hospitals in developing countries. This paper reviews feasible methods for clinical laboratories with limited resources. Recent experiences from African countries are included.
An example of how follow-up of related cases of diarrhea by epidemiologically-oriented health promoters can result in important public health measures is described. The follow-up of related cases involved a search for an outbreak in which a population with a high attack rate could be defined in order to increase the likelihood of a successful investigation by means of a cross-sectional retrospective study design. Then, through standard epidemiologic techniques, the risk factors to be studied were selected and a questionnaire was designed and executed. The results of this investigation demonstrate that greater meticulousness in pursuing epidemiologic principles is required for success in diarrhea outbreak investigations in developing countries than in developed countries despite the fact that controllable contaminations discoverable by these techniques are much more frequent in the former. In the present investigation it was found that flavored drinks packaged in plastic by a process assuming increasing importance in food distribution were causing diarrhea because of unhygienic manufacturing procedures. A concomitant bacteriologic study helped confirm the epidemiologic findings, and bacteriologic cultures at different points in the manufacturing process suggested a solution to the contamination problem found.
319 episodes of infections in 174 cancer patients over a period of 3 years are reported in a developing country. 178 episodes were seen in leukaemias, 83 in lymphomas and 58 in other cancers. 146 episodes appeared in 89 neutropenic patients and 173 in non-neutropenic patients. In 163 (51%) episodes positive cultures were obtained with a total of 212 organisms. 192 (90.6%) of the isolates were bacteria; of these 107 (55.7%) were gram positive and 85 (44.3%) were gram negative. The findings are consistent with those reported in developed countries. Most commonly isolated bacteria were: staphylococcus, Escherichia coli, streptococcus, enterobacter, pseudomonas, diphtheroids and salmonella. 15 isolates (7%) were of candida. Most common sites of infection were respiratory tract, kidney and urinary tract and skin. There were a total of 64 deaths: 36 were directly related to infections. 11 of these patients died of hospital acquired infections; most commonly isolated organisms in these infections were staphylococcus, E. coli, pseudomonas and streptococcus.
When we were invited to prepare this background paper on the health problems of the developing countries for the Commission on Health Research for Development, our first thought was to compile and organize available data on the causes of morbidity and mortality affecting different age groups in various populations. It soon became clear that this would not be especially useful. There are major gaps in the available data, particularly from the poorer countries and for people above 5 years of age. The data that are available are often of poor or uncertain quality, collected from unrepresentative or undefined subpopulations, and not strictly comparable due to different definitions and data-collection methods. Additionally, in the absence of agreed definitions and analytical frameworks, it is not clear what could or should be done with the data on health problems so amassed. More fundamentally, we have come to doubt whether the current array of epidemiological concepts and tools is sufficient for the task. We therefore decided that, while giving an overview of current knowledge on levels and trends of morbidity and mortality, the emphasis of this paper should be more towards concepts, methods, and data deficiencies. In Section 1, we set out definitions and frameworks for considering health problems and health research; we review recent conceptual models for the analysis of the determinants of child survival; and we outline a framework, focusing on modifiable determinants of health and life-cycle health effects, which is used in subsequent sections. In Section 2, relationships between national and societal level determinants and health are reviewed and then set aside. In Section 3, we review available data on world patterns and trends of morbidity and mortality, highlighting the data deficiencies and lacunae. In Section 4, we follow the life of a woman in a developing country and examine the health problems, and their determinants, which she and her children face. In Section 5, we draw these strands together and, having reviewed current approaches to prioritizing health problems and suggested some ways in which they could be improved, in Section 6 identify several research priorities, emphasizing the need for methodological research. This paper was commissioned in March 1987; prepared in draft and presented to a meeting at Chateau de Bossey, Geneva, Switzerland during 15-17 July; and revised and completed in September 1987. It is in no sense definitive or final.(ABSTRACT TRUNCATED AT 400 WORDS)
This article reflects on the process that leads to perceptions of teenage childbearing as a social problem and examines whether that process will occur in developing countries as it has in the United States. In postindustrial Western economies, family and adult control over young peoples' sexual behavior has loosened, while marriage rates have declined. In the United States, nonmarital births to adolescents, particularly among poor minorities who have few opportunities and reasons to delay childbearing, have become a cause for public concern. However, the economic, educational, and nuptial changes that have occurred in other postindustrial countries have not necessarily led to fertility problems among teenagers, because of a greater willingness to acknowledge their sexual activity and to provide the resources to prevent their childbearing. Although developing nations may undergo changes that result in more schooling and greater autonomy for adolescents, whether nonmarital births will come to constitute a problem will depend on many different factors; the United States provides an example of the conditions they may wish to avoid.
Over the past decade there has been an increasing concern about the impact of chronic, noncommunicable diseases on the health of developing world populations. Traditionally, major causes of illness and death in developing countries have been linked to infectious diseases and undernutrition, and these are still major public health problems in several regions of the world. But recent projections indicate that in 20 y noncommunicable diseases will account for over 60% of the disease burden and mortality in the developing world. Obesity is recognized as an underlying risk factor for many of these chronic conditions. As in developed societies, the risk for obesity in developing countries is also strongly influenced by diet and lifestyle, which are changing dramatically as a result of the economic and nutrition transition. This symposium discusses key aspects of the phenomenon of obesity in the developing world and provides some specific examples from countries facing increasing prevalence of that condition.
The practicalities when applying the ICH GCPs (International Conference on Harmonization 1996 Good Clinical Practices [EU, MHLW, FDA. International Conference on Harmonization Guideline for Good Clinical Practice; 1997] in less developed countries (ldcs) are seldom discussed and we found no guidelines as how to "adapt" them. Below we illustrate how ICH GCP principles can be implemented in different settings. We have recently conducted in Asia (Hechi, China; Karachi, Pakistan; Hue, Vietnam; North Jakarta, Indonesia and Kolkata, India) large-scale cluster-randomized effectiveness evaluations of the Vi polysaccharide typhoid fever vaccine (Vi PS project) among approximately 200,000 individuals(1)[Acosta CJ, Galindo CM, Ali M, Abu-Elyazeed R, Ochiai RL Danovaro-Holliday MC et al. A multi-country cluster randomized controlled effectiveness evaluation to accelerate the introduction of Vi polysaccharide typhoid vaccine in developing countries in Asia: rationale and design. TMIH 2005;10(12):1219-1228]. There is no doubt on the importance of ICH GCP in its contribution to ethical and scientifically sound clinical research. However, when the ICH GCP is implemented in ldcs some considerations must be made in order to adequately tailor them. Vaccine trials in ldcs are a frequent setting for such challenges because of the increased global interest conducting health research in such countries. The ICH GCP principles are discussed below within the framework of this recent typhoid fever vaccine study experience.
An important factor that all cochlear implant teams have to deal with one way or another is the coast of the prostheses. This problem takes on very special characteristics in developing countries. This paper is based on the authors' experience in establishing the cochlear implant program of the "Hospital General Manuel Gea Gonzalez", a public hospital in Mexico City, and tries to determine which should be the optimal characteristics of an implant to be used in developing countries.
Enteric pathogens constitute a major pediatric threat in the developing world through their impact on morbidity and mortality, physical and cognitive development and cause and effect relationship with malnutrition. Although many bacterial pathogens can cause diarrheal diseases, a group of less than 10 including Shigella spp., enterotoxigenic Escherichia coli (ETEC), Vibrio cholerae, and possibly, Campylobacter jejuni account for a significant percentage of these diseases in developing countries. Rotavirus is also a major cause of diarrheal diseases. Vaccines against these agents offer a potentially effective control measure against these diseases, but safe, practical, and effective vaccines for many of these agents have yet to be realized. Many vaccine development approaches are under investigation, but the one that is currently most advanced and that has been most widely applied to enteric pathogens is the use of orally administered live or killed whole pathogen preparations. If inactivated, these vaccines will probably be administered as multiple doses with approximately 10(10) to 10(11) total particles per dose, but they are relatively safe for oral administration. Further, they may not require a buffer for delivery and can be stored in liquid formulations. Fewer doses may be required for some live attenuated pathogen vaccines, but a buffer will most likely be required for oral delivery and the product must be stored in a dried formulation. Also, safety becomes more of a concern with live pathogens depending on the degree of attenuation, host immunocompetence, and the total number and kinds of attenuated pathogens which may be present in a combined agent vaccine. Both live and killed whole pathogen vaccines can be immunogenic and have the possibility to serve as vectors for other antigens. Although many organisms and serotypes are clinically important, by exploiting antigenic cross reactivity and using some pathogen components as vectors for cloned antigens of other pathogens, it could be possible to induce immunity against major enteric pathogens/serotypes with <10 whole pathogen components in a multi-agent vaccine. Safe and effective mucosal adjuvants may in the future be useful in whole pathogen vaccines, but they do not seem to be essential for immunization. Further, dietary supplements such as zinc, mixed routes of delivery and new regimens are under study which may in the future enhance further the effectiveness of the whole pathogen vaccines which now seem realizable in the near term. For this to happen, however, a coordinated and committed effort is necessary now to address the immunologic, regulatory, manufacturing, testing and implementation issues which will be involved in the realization of this important product to benefit children's health worldwide.
Persistently excessive morbidity and mortality rates in less developed countries (LDCs) served by primary health care systems suggest that the quality of services is inadequate. The PRICOR project, sponsored by the United States Agency for International Development, has designed and implemented methods for quality assessment and problem solving in LDC health systems. After developing comprehensive lists of essential activities and tasks, similar to practice parameters, for seven child survival interventions, PRICOR supported comprehensive quality assessment studies in twelve LDC countries. The studies, yielding over 6000 observations of health worker-client encounters, indicated highly prevalent, serious program deficiencies in areas including diagnosis, treatment, patient education and supervision. To facilitate corrective action, PRICOR assisted managers in conducting operations research to resolve priority problems revealed by the assessments. The recently initiated Quality Assurance Project is building on PRICOR techniques in designing and implementing sustainable continuous quality improvement programs for LDC health systems.
In the last years a new approach to cooperation programmes with developing countries has been followed. It critically considers cooperation as donation and makes a big contribution to cooperation for the development of developing countries. For such reasons some topics such as 'education' and the 'management of the health services and technologies' have become more important than in the past. The authors report, first on some general aspects of the cooperation programmes in this field and, secondly, on some experiences relating to a cooperation programme for the management of medical technologies in Ethiopia.
BACKGROUND: Non-cystic-fibrosis (non-CF) bronchiectasis in childhood is still one of the most common causes of childhood morbidity in developing countries. The management of these patients remains problematic, and there are few studies of long-term outcome. OBJECTIVE: The aim of this retrospective study was to define the general characteristics, underlying causative factors and long-term follow-up results of non-CF bronchiectasis patients. METHODS: One hundred and eleven consecutive children, diagnosed with non-CF bronchiectasis were included in the study. General characteristics and underlying causes were recorded from the medical records. Clinical outcomes were evaluated in terms of lung function tests, annual exacerbation rates and patient/parent perception of health status. RESULTS: Mean age of the patients was 7.4 +/- 3.7 years at presentation, and patients had been followed 4.7 +/- 2.7 years on average. In 62.2% of the patients, an underlying etiology was identified, whereas postinfectious bronchiectasis was the most common (29.7%). In spite of intensive medical treatment, 23.4% of the patients required surgery. The annual lower respiratory infection rate has decreased from a mean of 6.6 +/- 4.0 to 2.9 +/- 2.9 during follow-up (p < 0.0001). Lung function tests were also found to be improved (mean FEV1% 63.3 +/- 21.0 vs. 73.9 +/- 27.9; p = 0.01; mean FVC% 68.1 +/- 22.2 vs. 74.0 +/- 24.8; p = 0.04). There was clinical improvement in both the surgical (73%) and medical (70.1%) groups (p > 0.05). CONCLUSION: In conclusion, bronchiectasis remains a disease of concern to pediatricians, particularly in developing countries. Infections are still important causes of bronchiectasis, and clinical improvement can be achieved by appropriate treatment. Although medical treatment is the mainstay of management, surgery should be considered in selected patients.
Prevention is a core value of any health system. Nonetheless, many health problems will continue to occur despite preventive services. A significant burden of diseases in developing countries is caused by time-sensitive illnesses and injuries, such as severe infections, hypoxia caused by respiratory infections, dehydration caused by diarrhoea, intentional and unintentional injuries, postpartum bleeding, and acute myocardial infarction. The provision of timely treatment during life-threatening emergencies is not a priority for many health systems in developing countries. This paper reviews evidence indicating the need to develop and/or strengthen emergency medical care systems in these countries. An argument is made for the role of emergency medical care in improving the health of populations and meeting expectations for access to emergency care. We consider emergency medical care in the community, during transportation, and at first-contact and regional referral facilities. Obstacles to developing effective emergency medical care include a lack of structural models, inappropriate training foci, concerns about cost, and sustainability in the face of a high demand for services. A basic but effective level of emergency medical care responds to perceived and actual community needs and improves the health of populations.
The majority of hearing impaired children live in the developing countries. Limited resources are available for screening, prevention, diagnosis and intervention. These problems were the topic for discussion in a special session in the Congress.