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Pesticide use in developing countries.

Chemical pesticides have been a boon to equatorial, developing nations in their efforts to eradicate insect-borne, endemic diseases, to produce adequate food and to protect forests, plantations and fibre (wood, cotton, clothing, etc.). Controversy exists over the global dependence on such agents, given their excessive use/misuse, their volatility, long-distance transport and eventual environmental contamination in colder climates. Many developing countries are in transitional phases with migration of the agricultural workforce to urban centres in search of better-paying jobs, leaving fewer people responsible for raising traditional foods for themselves and for the new, industrialized workforce. Capable of growing two or three crops per year, these same countries are becoming "breadbaskets" for the world, exporting nontraditional agricultural produce to regions having colder climates and shorter growing seasons, thereby earning much needed international trade credits. To attain these goals, there has been increased reliance on chemical pesticides. Many older, nonpatented, more toxic, environmentally persistent and inexpensive chemicals are used extensively in developing nations, creating serious acute health problems and local and global environmental contamination. There is growing public concern in these countries that no one is aware of the extent of pesticide residue contamination on local, fresh produce purchased daily or of potential, long-term, adverse health effects on consumers. Few developing nations have a clearly expressed "philosophy" concerning pesticides. There is a lack of rigorous legislation and regulations to control pesticides as well as training programs for personnel to inspect and monitor use and to initiate training programs for pesticide consumers.

Agriculture↗

Pediatric injuries presenting to an emergency department in a developing country.

PURPOSE: To describe the causes and outcomes of pediatric injuries using the emergency departments (ED) as a surveillance site. METHOD: Prospective, 14-day surveys of all injuries were conducted in the EDs of the two national trauma referral hospitals of Trinidad and Tobago. Data on patient demographics, type, cause, and outcome of injuries were collected. The chi 2 test for significance was used for categorical variables. RESULTS: Pediatric patients (< 20 years) accounted for 41.5% (714/1722) of injury visits. Of these, 62.6% were male and 17.4% were < four years old, 26.2% four to nine years, 31.1% 10 to 14 years, and 25.4% were 15 to 19 years old. Three patients (0.4%) died, 68.6% were discharged, and 31.0% admitted. Intentional injuries accounted for 13.9% of injuries. Of the intentional injuries, the assailant was significantly more likely to be known than not (P < 0.01). The most common causes of all injuries were: falls, 44.4%; blunt objects, 12.3%; sharp objects, 11.8%; motor vehicle (including pedestrians), 7.4%; poison, 3.6%; and burns, 1.7%. Injuries occurring in the home accounted for 46.2%; in school, 25.5%; sports/recreation, 11.1%; and at work, 4.5%. The most common injuries were: lacerations, 30.8%, contusions/abrasions, 26.7%, fractures, 18.8%; and sprains/dislocations, 9.4%. CONCLUSION: Pediatric injuries are a significant cause of morbidity and mortality in this country, accounting for almost one third of injured patients. Because of the low frequency of pediatric injury deaths, ED surveillance may be a more effective means of identifying high risk groups and activities for injuries. Data from EDs may be useful in other developing countries to develop injury prevention programs.

Adolescent↗

Maternal survival in developing countries: what has been done, what can be achieved in the next decade.

Every year, approximately 600000 women die of pregnancy-related causes - 98% of these deaths occur in developing countries. For every woman who dies, at least 30 suffer injuries and often, permanent disability. The challenge today is to re-orient programmes on priority interventions, and to mobilize sufficient resources for their implementation. More resources have been put into antenatal care than into delivery care and the management of complications of births and unsafe abortions. This article describes the effective strategies for reducing maternal death, their policy requirements and programmatic implications, and provides examples of successful developing country programmes. Priority interventions include: (1) improving availability and use of essential obstetric care for the management of complications; (2) strengthening family planning services; (3) ensuring skilled attendance at birth; (4) promoting women-friendly health services; (5) increasing district-level planning with community participation; and (6) monitoring process with process indicators. Finally, the promotion of safe motherhood as a right is of crucial importance. Needed now is political commitment as well as coordinated action for the implementation of large-scale programmes in low-income countries.

Delivery of Health Care↗

Physicians and surgeons volunteering in developing countries: a personal perspective.

After a physician volunteers in the developing world, his or her eyes open to vast problems. There are many opportunities for physicians to volunteer in developing countries. Medical personnel should know the major agencies that send volunteers and understand how their actions help in disaster relief, direct patient care, or teaching. Volunteers should work with major established organizations to ensure they are not more of a burden than a help. Individuals assisting in training, development, or human rights investigations can change the world by their efforts.

Developing Countries↗

Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes.

This paper synthesizes the rates, barriers, and outcomes of HIV serostatus disclosure among women in developing countries. We identified 17 studies from peer-reviewed journals and international conference abstracts--15 from sub-Saharan Africa and 2 from south-east Asia--that included information on either the rates, barriers or outcomes of HIV serostatus disclosure among women in developing countries. The rates of disclosure reported in these studies ranged from 16.7% to 86%, with women attending free-standing voluntary HIV testing and counselling clinics more likely to disclose their HIV status to their sexual partners than women who were tested in the context of their antenatal care. Barriers to disclosure identified by the women included fear of accusations of infidelity, abandonment, discrimination and violence. Between 3.5% and 14.6% of women reported experiencing a violent reaction from a partner following disclosure. The low rates of HIV serostatus disclosure reported among women in antenatal settings have several implications for prevention of mother-to-child transmission of HIV (pMTCT) programmes as the optimal uptake and adherence to such programmes is difficult for women whose partners are either unaware or not supportive of their participation. This article discusses these implications and offers some strategies for safely increasing the rates of HIV status disclosure among women.

Attitude to Health↗

Diarrhoeal disease: current concepts and future challenges. Epidemiology of diarrhoeal diseases in developed countries.

Diarrhoeal diseases are a common problem in industrialized countries, resulting in appreciable morbidity and mortality. While the total burden of these illnesses is much less than that in developing countries, the same basic disease risk factors influence transmission. This article reviews selected environmental, host and pathogen-specific factors which shape the epidemiology of infectious diarrhoea in developed countries. The effective adaptation of techniques from molecular biology, such as plasmid analysis, deoxyribonucleic acid hybridization, and the polymerase chain reaction, to studies of diarrhoeal disease epidemiology is also discussed.

Aged↗

Water and wastewater in developing countries: present reality and strategy for the future.

This paper summarises the paper presentation sessions at the Conference, as well giving insights on the issues related to developing countries. It also discusses the present status of practice and research on water and wastewater management, and projected future scenario based not only on the papers presented in the Conference, but also on other sources. The strategy is presented to overcome many problems in developing countries such as rapid urbanization, industrialization, population growth, financial and institutional problems and, depleting water resources. The strategy consists of Integrated Urban Water Management (IUWM), cleaner industrial production, waste minimisation and financial arrangements.

Cities↗

Can context justify an ethical double standard for clinical research in developing countries?

BACKGROUND: The design of clinical research deserves special caution so as to safeguard the rights of participating individuals. While the international community has agreed on ethical standards for the design of research, these frameworks still remain open to interpretation, revision and debate. Recently a breach in the consensus of how to apply these ethical standards to research in developing countries has occurred, notably beginning with the 1994 placebo-controlled trials to reduce maternal to child transmission of HIV-1 in Africa, Asia and the Caribbean. The design of these trials sparked intense debate with the inclusion of a placebo-control group despite the existence of a 'gold standard' and trial supporters grounded their justifications of the trial design on the context of scarcity in resource-poor settings. DISCUSSION: These 'contextual' apologetics are arguably an ethical loophole inherent in current bioethical methodology. However, this convenient appropriation of 'contextual' analysis simply fails to acknowledge the underpinnings of feminist ethical analysis upon which it must stand. A more rigorous analysis of the political, social, and economic structures pertaining to the global context of developing countries reveals that the bioethical principles of beneficence and justice fail to be met in this trial design. CONCLUSION: Within this broader, and theoretically necessary, understanding of context, it becomes impossible to justify an ethical double standard for research in developing countries.

Journal Article↗

Practical screening priorities for hearing impairment among children in developing countries.

Routine screening for hearing impairment in childhood is now widespread in industrial countries, although there is considerable controversy over the most efficient techniques and procedures. In most developing countries, however, routine screening programmes for hearing impairment do not currently exist. The problems involved in implementing screening programmes in developing and industrial countries are very different, and in selecting screening procedures for a particular population the following factors have to be taken into consideration: the environmental test conditions; the availability of resources for equipment and the training of testers; the local attitudes towards disability; the level of hearing impairment that may cause handicaps; and the major types of pathology causing hearing impairment. We suggest that in developing countries children should be screened at school entry using a simple field audiometer and that the external ear be inspected for the presence of a discharge. There is an urgent need to develop reliable and simple screening procedures for infants and young children; where possible, all children should be screened for severe or significant hearing impairment before the age of 2 years. No screening should, however, be implemented until appropriate follow-up services are available.

Acoustic Impedance Tests↗

Mortality and long-term course in schizophrenia with a poor 2-year course: a study in a developing country.

BACKGROUND: The short-term course of schizophrenia is reported to be better in some developing country settings. The long-term course in such settings, however, has rarely been studied. AIMS: To examine the long-term course and mortality of schizophrenia in patients with a poor 2-year course. METHOD: The report is based on two incidence cohorts of first-contact patients in urban and rural Chandigarh, India, originally recruited for the World Health Organization Determinants of Outcome of Severe Mental Disorders study. Patients were assessed using standardised instruments at 2- and 15-year follow-ups. RESULTS: Ninety-two per cent of the patients with a poor 2-year course had a poor long-term course and 47% died - a nine times higher mortality rate than among patients with other 2-year course types. CONCLUSIONS: In this developing country setting, a poor 2-year course was strongly predictive of poor prognosis and high mortality, raising questions about the adequacy of care for such patients.

Adult↗

Research priorities for tobacco control in developing countries: a regional approach to a global consultative process.

OBJECTIVE: To develop regional tobacco control research agendas for developing countries through a consultative process. METHODS: Research for International Tobacco Control, located at the International Development Research Centre in Ottawa, Canada, convened three regional meetings for Latin America and the Caribbean, South and Southeast Asia, and Eastern, Central and Southern Africa. Participation by researchers, policymakers, and advocates from a wide range of disciplines ensured an accurate representation of regional issues. RESULTS: The four main recurring themes within each regional agenda were: (1) the lack of standardised and comparable data; (2) the absence of a network for communication of information, data, and best practices; (3) a lack of adequate capacity for tobacco control research, especially in non-health related areas such as economics and policy analysis; and (4) a need for concerted mobilisation of human and financial resources in order to implement a comprehensive research agenda, build partnerships, and stimulate comparative research and analysis. Specific research issues included the need for descriptive data with respect to the supply side of the tobacco equation, and analytical data related to tobacco use, production and marketing, and taxation. CONCLUSIONS: There was a uniform perception of tobacco as a multidisciplinary issue. All regional agendas included a balance of health, economic, agricultural, environmental, sociocultural, and international trade concerns. Research data are urgently required to provide a sound basis for the development of tobacco control policies and programmes. As tobacco control takes its rightful place on the global health agenda, it is vital that funding for tobacco control research be increased.

Developing Countries↗

Obesity among schoolchildren of different socioeconomic levels in a developing country.

Obesity, as malnutrition, is associated with an increased tendency to morbidity and mortality. Its prevalence has been reported to be increasing. Studies carried out in developed countries have shown obesity to be directly correlated with low socioeconomic level. The objective of the present study was to determine the prevalence of obesity among 300 children aged 84 to 143 months who were attending three schools of different socioeconomic levels in the town of Ribeirão Preto, State of São Paulo, Brazil. Weight, height, arm circumference and tricepital skinfold were measured. The prevalence of obesity in the sample was 16.7 per cent, distributed as follows: 38 per cent for high socioeconomic level, 12 per cent for middle socioeconomic level, and 4 per cent for low socioeconomic level. The prevalence of malnutrition was 8.3 per cent. The overall frequency of obesity reported here is as high as that found in developed countries, but, in contrast, obesity was directly correlated with socioeconomic level.

Body Height↗

The management of unreduced traumatic dislocation of the hip in developing countries.

Traumatic dislocation of the hip often remains untreated in developing countries. This paper reports the outcome of twenty nine patients with neglected dislocations (3 anterior and 26 posterior). We have outlined the indications for five different methods of treatment. An attempt has been made to explain the causes of poor results.

Adolescent↗

Cooperation between developing countries and the pharmaceutical industry in the control of parasitic diseases: a proposal for a practical approach.

In this paper a pragmatic approach to the cooperation between developing countries and the pharmaceutical industry is proposed. This approach is based upon a division of tasks between the partners involved, thus maximizing the output through optimal use of each partner's capabilities. In the model proposed here, the pharmaceutical industry remains responsible for continued therapeutic research and development. These efforts are rewarded by the industry's transfers of active ingredients to pharmaceutical production plants. Pharmaceutical production and packaging plants can be decentralized and located in developing countries. Local organized integrated health care programs are the clients of the regional pharmaceutical plants. These programs can be coordinated and sponsored by national and international agencies and organizations. It is suggested that the transactions, possibly with the exception of the delivery of the products to the patients, be concluded along principles of the market economy. Dirigism and bureaucracy must be avoided.

Delivery of Health Care↗

High rates of appendicectomy in a developing country: an attempt to contribute to a more rational use of surgical resources.

OBJECTIVE: In view of the high appendicectomy rate in a university teaching hospital in a developing country, we investigated the regional epidemiology of appendicitis. DESIGN: Prospective clinical and pathological study. SETTING: Teaching hospital, Madagascar. SUBJECTS: 165 patients who underwent appendicectomy during a two month period. INTERVENTIONS: Clinical investigation and histopathological examination of removed appendixes. MAIN OUTCOME MEASURES: Appendicitis score, local incidence of appendicectomy, appendicitis, perforation, and negative appendicectomy. RESULTS: There was a high incidence of primary appendicectomy (51.1/10,000 population/year) in relation to the incidence of histologically confirmed appendicitis (7.7/10,000), resulting in a negative appendicectomy rate of 85% (43/10,000). There were considerable sex related differences in the incidence of primary appendicectomy (81/10,000 women/year; 22/10,000 men), appendicectomy for appendicitis (12/10,000 women/year; 4/10,000 men) and non-perforating appendicitis (8/10,000 women/year; 2/10,000 men), but much less in that of perforating appendicitis (4/10,000 women/year; 2/10,000 men). CONCLUSION: There is potential for more economic use of medical resources by reducing the rate of negative appendicectomy. The incidence of non-perforating appendicitis depends on the number of appendicectomies done, which may explain the differences observed in the incidence of appendicitis between industrialised and developing countries.

Appendectomy↗

The ethics of research related to health care in developing countries.

The Ethics of Research Related to Health Care in Developing Countries by the Nuffield Council on Bioethics makes a number of innovative recommendations that depart from codes such as the Declaration of Helsinki. It recommends that standards of care might be relativised to the standard of that nation. It recommends that very good reasons need to be given for not giving post-trial access to medications but recognises that there may be justifiable instances of this. It is the view of the authors that these and other recommendations of the report are sensible pieces of advice given the complexities of the developing world.

Clinical Trials as Topic↗

Socioeconomic factors and dental caries in developing countries: a cross-national study.

The purpose of the present study was to analyze statistically correlations between socioeconomic factors and the prevalence of dental caries in developing countries. The DMFT index, which evaluates the incidence of dental caries, showed a positive correlation (P < 0.01) with several socioeconomic factors, such as life expectancy, adult literacy rate, school attendance rate, population employed in the service sector, population aged 15-64 years, and urban population. According to multiple regression analysis, population aged 15-64 years, population employed in the service sector, and urban population were the most influential independent socioeconomic variables, in descending order, with a regression coefficient of 0.635 and a coefficient of determination of 0.404 (P < 0.001). This finding suggests that the prevalence of dental caries in developing countries increases with the degree of urbanization.

Adolescent↗