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PubMed1998

Changes in the costs of antihypertensive medications in a developing country: a study in Mexico comparing 1990 and 1996.

In developing countries, the cost of antihypertensive medications is one of the principal limiting factors when trying to treat patients with high blood pressure. To determine the changes in cost (in US dollars) of these medications and in the percentage of the minimum wage needed to purchase them, two cost studies (1990 and 1996) done in Mexico were compared. The yearly cost of a treatment with hydrochlorothiazide was US $13.80 in 1990; in 1996 it was US $10.92. Both figures represent 1.1% of the minimum wage that was in effect at the time. Propranolol hydrochloride cost US $50.52 for a year's treatment in 1990, and US $66.12 for the same in 1996. These figures represented, respectively, 4.2% and 6.7% of the minimum wage of 1990 and 1996. The annual cost for nifedipine was US $176.76 in 1990 (14.7% of the minimum wage) and US $242.16 in 1996 (24.8% of the minimum wage). The yearly cost of enalapril was US $233.04 in 1990 and US $433.20 in 1996; these costs represented, respectively, 19.4% and 44.2% of the minimum wage. The comparison of these two cost studies (1990 and 1996) shows why Mexico's population is finding it more difficult to purchase antihypertensive medications. Higher costs and reduced purchasing power seem to be the two principal factors causing this. This is probably affecting the population's health, as it is more difficult to control high blood pressure without proper treatment.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed2004

Can developing countries achieve adequate improvements in child health outcomes without engaging the private sector?

The private sector exerts a significant and critical influence on child health outcomes in developing countries, including the health of poor children. This article reviews the available evidence on private sector utilization and quality of care. It provides a framework for analysing the private sector's influence on child health outcomes. This influence goes beyond service provision by private providers and nongovernmental organizations (NGOs). Pharmacies, drug sellers, private suppliers, and food producers also have an impact on the health of children. Many governments are experimenting with strategies to engage the private sector to improve child health. The article analyses some of the most promising strategies, and suggests that a number of constraints make it hard for policy-makers to emulate these approaches. Few experiences are clearly described, monitored, and evaluated. The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of how to engage the private sector most effectively. The starting point should include the evaluation of the presence and potential of the private sector, including actors such as professional associations, producer organizations, community groups, and patients' organizations.

Child↗

PubMed1997

HIV and AIDS and the eye in developing countries: a review.

An estimated 30 million people worldwide have been infected with the human immunodeficiency virus, the causative agent of the acquired immunodeficiency syndrome. Of these, 90% live in developing countries from where there is relatively little published information about the ocular manifestations of human immunodeficiency virus and acquired immunodeficiency syndrome. We review the information available from Africa, Latin America, and Asia. The prevailing ocular manifestations differ in some developing countries compared with those in the industrialized countries. These differences most likely result from different socioeconomic conditions and basic health care availability and from different patterns of endemic disease present before the human immunodeficiency virus epidemic.

Africa↗

PubMed2006

An economic commentary on the occurrence and control of HIV/AIDS in developing countries: special reference to India.

HIV infection has a complex relationship with poverty, but affects both the rich and poor. HIV/AIDS represents the deadliest emergency and the greatest social, economic and health crisis of modern times. The HIV pandemic affects developed and developing countries differently, with up to 95% of new HIV infections now occurring in developing countries. In India, an estimated 4.58 million people were living with HIV/AIDS. The nation's public health budget could swell by at least 30% and the estimated annual cost of HIV/AIDS appears to be approximately 1% of the gross domestic product. Households affected by an HIV/AIDS-related death can be forced to sell their means of production to cover the high economic burden of treatment and other costs associated with HIV/AIDS. Eventually, the household will dissolve, as parents die and orphaned children are sent to relatives for care and upbringing. Therefore, the poverty will pass onto the next generation. This article looks at the association between poverty and the HIV/AIDS pandemic, and suggests areas in which economics can help to develop solution to them.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Disability in schizophrenia and mood disorders in a developing country.

The aim of this study was to investigate how the prevalence and severity of psychiatric disabilities in patients with chronic schizophrenia compares with that in patients with chronic mood disorders. A total of 128 patients, 80 with chronic schizophrenia and 48 with chronic mood disorders as confirmed by DSM-III-R, were examined using the World Health Organization Psychiatric Disability Assessment Schedule (WHO/ DAS). There were no significant differences in the prevalence and severity of disabilities between the two disorders. Two-thirds of the patients with chronic schizophrenia and over half the patients with chronic mood disorders had dysfunctional behaviour and experienced significant disabilities. The prevalence of disabilities among these Malaysian patients was not markedly different from that seen in developed countries, suggesting that the prognosis in developing countries may not be as favourable as previously thought.

Adult↗

PubMed2003

The burden of disease from indoor air pollution in developing countries: comparison of estimates.

Four different methods have been applied to estimate the burden of disease due to indoor air pollution from household solid fuel use in developing countries (LDCs). The largest number of estimates involves applying exposure-response information from urban ambient air pollution studies to estimate indoor exposure concentrations of particulate air pollution. Another approach is to construct child survival curves using the results of large-scale household surveys, as has been done for India. A third approach involves cross-national analyses of child survival and household fuel use. The fourth method, referred to as the 'fuel-based' approach, which is explored in more depth here, involves applying relative risk estimates from epidemiological studies that use exposure surrogates, such as fuel type, to estimates of household solid fuel use to determine population attributable fractions by disease and age group. With this method and conservative assumptions about relative risks, 4-5 percent of the global LDC totals for both deaths and DALYs (disability adjusted life years) from acute respiratory infections, chronic obstructive pulmonary disease, tuberculosis, asthma, lung cancer, ischaemic heart disease, and blindness can be attributed to solid fuel use in developing countries. Acute respiratory infections in children under five years of age are the largest single category of deaths (64%) and DALYs (81%) from indoor air pollution, apparently being responsible globally for about 1.2 million premature deaths annually in the early 1990s.

Air Pollutants↗

PubMed1999

Cancer prevention education in developing countries: toward a model for nurse educators.

The National Cancer Institute, United States of America, funded a series of continuing education courses in cancer prevention between 1986 and 1994 for nurses from developing countries. The purpose of this program was to stimulate interest and facilitate an increase in the participants' knowledge of primary and secondary cancer prevention. The long-term objectives were to increase the number of nurses, internationally, prepared to engage in the prevention and the early detection of cancer in their countries, to expand the international cancer nursing network, and to have these nurses ultimately play a role in reducing the incidence of cancer in developing countries. More than 50 nations were represented. Participants were chosen for their demonstrated ability to influence nursing education and practice in their country. They completed a demographic data sheet, an attitude inventory, a program evaluation and pre- and postconference activities surveys. Before and after attending the conference, participants were asked to identify anticipated problems and obstacles to their goal achievement. These problems included a lack of screening facilities and a lack of primary prevention services. Although numerous differences existed in their education, experience, and personal attributes, the participants voiced common problems with cancer prevention programs. Results from the postconference survey showed a substantial increase in cancer-related activities conducted by the participants. Activities included an increase in cancer content in nursing education programs, an increase in public and professional presentations on cancer prevention, and improvement in the delivery of cancer care.

Adult↗

PubMed1991

Recommendations for establishing a drug and toxicology information center in a developing country.

The purpose of this work was to formulate guidelines to help health professionals in establishing or strengthening the capabilities of drug and toxicology information centers and related facilities in developing countries. These guidelines are based on the experience of an established drug and toxicology information service in Zimbabwe which has been operating for more than ten years and on information obtained from other centers in developed countries. The guidelines provide advice rather than a unique model and should therefore be adapted rather than adopted. We conclude that national drug policies should include provision for establishing drug information centers. The World Health Organization and similar organizations should assist in establishing these centers. We believe that a drug and toxicology information center is more beneficial to the community when it is part of the teaching curriculum and continuing education for health professionals. Therefore, the center should be located in a medical teaching institution.

Developing Countries↗

PubMed2001

[Research training in the programs of neurosurgery residency. Analysis of the situation in other developed countries and proposals to implementing the current program in Spain].

Research performed by neurosurgeons has been always linked to the progress of our specialty, and research training is included in the Neurosurgery Residency Programs in developed countries. Since the methodology of research related to the basic knowledge of the nervous system function is becoming increasingly complex, it could be proposed that neurosurgeons can not longer contribute to productive research in neurosciences, and this idea might be easily accepted in certain countries such as Spain, where research training is not contemplated in the Residency Program of Neurosurgery. However, all neurosurgeons academic or not, should exhibit a critical and inquiring mentality which enables them to evaluate scientific information and communicate their own clinical experience to the neurosurgical community. Such a critical capacity can not be acquired by a resident trained only in the art of clinical diagnosis and the surgical technique. The new medical practice is based on both basic and clinical-epidemiological research, and the new residents must be immersed into a motivating and inquisitive environment in which the scientific method is continuously applied to the clinical practice. In this paper I consider research training in Neurosurgery in developed countries with the aim of identifying a strategy for introducing a period devoted to research in the Spanish Residency Program. Thus, the methodologies, objectives, contents, duration and the moment for receiving research training in other countries are analysed and some alternatives for solving the problem in our country are pointed out.

Developed Countries↗

PubMed1989

Recent work with microcomputers for census processing in developing countries.

The use of microcomputers to process census data in developing countries is discussed. Specifically, the authors describe the Integrated Microcomputer Processing System (IMPS) developed by the U.S. Bureau of the Census and focus "on the recent experience of Burkina Faso and Senegal in using microcomputers. A summary is given of the use of IMPS by an increasing number of countries. Additionally, this paper describes the latest enhancements and future plans for IMPS. It concludes with some thoughts on the use of microcomputers in the areas of data collection and processing, as well as in the use and dissemination of census data."

Africa↗

PubMed2001

Quantifying the effects of exposure to indoor air pollution from biomass combustion on acute respiratory infections in developing countries.

Acute respiratory infections (ARI) are the leading cause of burden of disease worldwide and have been causally linked with exposure to pollutants from domestic biomass fuels in developing countries. We used longitudinal health data coupled with detailed monitoring and estimation of personal exposure from more than 2 years of field measurements in rural Kenya to estimate the exposure-response relationship for particulates < 10 microm diameter (PM(10)) generated from biomass combustion. Acute respiratory infections and acute lower respiratory infections are concave, increasing functions of average daily exposure to PM(10), with the rate of increase declining for exposures above approximately 1,000-2,000 microg/m(3). This first estimation of the exposure-response relationship for the high-exposure levels characteristic of developing countries has immediate and important consequences for international public health policies, energy and combustion research, and technology transfer efforts that affect more than 2 billion people worldwide.

Acute Disease↗

PubMed1998

On the need to assess cancer risk in populations environmentally and occupationally exposed to virus and chemical agents in developing countries.

Evidence exists that exposure to poultry oncogenic viruses may produce elevated cancer mortality in human populations, particularly excesses of cancer of lung and excesses of cancer of lymphopoietic tissues. To date, this potential risk is unknown in populations from the developing countries. This paper suggests the need to assess cancer risk in populations of developing countries with reported environmental exposure to chicken meat products and eggs; the need to assess risk of cancer in populations inoculated with vaccines from infected chicken embryos; and the need to assess risk of cancer in occupational populations highly exposed to poultry oncogenic viruses, and with potential concurrent exposure to chemical agents known or suspected to be carcinogens.

Agricultural Workers' Diseases↗

PubMed1983

Osteoarthritis in some developing countries.

Only a few studies on osteoarthritis (OA) have been performed in developing countries. They all concern African populations. OA occurs less frequently in developing populations. Whether this is due to genetic or environmental factors or to selective forces like an excessive mortality at younger ages, is difficult to decide. Development of criteria for clinical degenerative joint disease is recommended. Furthermore studies are proposed on the geographical distribution of specific joint OA, the concept of generalized OA, the pattern of joint involvement, the natural history of degenerative joint disease, and the role of occupation, sports, and environmental factors.

Adult↗

PubMed1994

The 'kangaroo-method' for treating low birth weight babies in a developing country.

The results of introducing the 'kangaroo method' (constant nursing of the baby skin to skin on the mother's chest), as the exclusive means of treating low birth weight (LBW) babies is reported, in the context of a mission hospital in a developing country without incubators and standard equipment for care of LBW neonates. Details of the method developed are described. The survival of babies born under 1500 g improved from 10% to 50%, whereas that of babies 1500-1999 g improved from 70% to 90%. The method is well accepted by the community, and easily grasped by all hospital staff. Staff expectations concerning survival have dramatically improved, and a considerable saving in workload is experienced. The kangaroo method as described is strongly recommended to all units in developing countries treating LBW babies without modern equipment.

Breast Feeding↗

PubMed2001

Alternative study designs for research on women's gynaecological morbidity in developing countries.

Although community-based studies are considered to be the 'gold standard' for research on gynaecological morbidity among women, there is growing appreciation of the significant challenges to successfully undertaking such studies in developing countries. In this review, the constraints to undertaking community-based studies are discussed and alternative study designs are evaluated. Our review suggests that these alternative designs have both limitations as well as strengths compared to community-based designs. An important limitation concerns possible selection bias in the populations studied and the extent to which findings can be generalized to the broader population. Important advantages include higher feasibility, lower respondent refusal rates especially for medical procedures, lower costs, and potentially a more direct link between research and utilization. We conclude that the alternative study designs considered provide researchers with an expanded array of tools for investigating the issue of women's gynaecological morbidity in developing countries.

Adolescent↗

PubMed2004

The cost effectiveness of pharmacological smoking cessation therapies in developing countries: a case study in the Seychelles.

OBJECTIVE: To examine the incremental cost effectiveness of the five first line pharmacological smoking cessation therapies in the Seychelles and other developing countries. DESIGN: A Markov chain cohort simulation. SUBJECTS: Two simulated cohorts of smokers: (1) a reference cohort given physician counselling only; (2) a treatment cohort given counselling plus cessation therapy. INTERVENTION: Addition of each of the five pharmacological cessation therapies to physician provided smoking cessation counselling. MAIN OUTCOME MEASURES: Cost per life-year saved (LYS) associated with the five pharmacotherapies. Effectiveness expressed as odds ratios for quitting associated with pharmacotherapies. Costs based on the additional physician time required and retail prices of the medications. RESULTS: Based on prices for currently available generic medications on the global market, the incremental cost per LYS for a 45 year old in the Seychelles was 599 US dollars for gum and 227 dollars for bupropion. Assuming US treatment prices as a conservative estimate, the incremental cost per LYS was significantly higher, though still favourable in comparison to other common medical interventions: 3712 dollars for nicotine gum, 1982 dollars for nicotine patch, 4597 dollars for nicotine spray, 4291 dollars for nicotine inhaler, and 1324 dollars for bupropion. Cost per LYS increased significantly upon application of higher discount rates, which may be used to reflect relatively high opportunity costs for health expenditures in developing countries with highly constrained resources and high overall mortality. CONCLUSION: Pharmacological cessation therapy can be highly cost effective as compared to other common medical interventions in low mortality, middle income countries, particularly if medications can be procured at low prices.

Adult↗

PubMedDate not supplied

[Generic drugs in developing countries].

Drugs are generally considered as consumer goods which serve to protect, maintain and restore health. In recent years, the proportion of national expenditure devoted to health has increased in all developing countries. The use of generic drugs can reduce health costs, if part of a national drug action plan, and their quality is confirmed (quality control, distribution system, correct utilization). Nevertheless, a large proportion of the population in developing countries has no access to these drugs. This situation requires establishing financing schemes for drug supplies, with community involvement and participation of the population. However, such schemes can result in limited access and inequity.

Africa South of the Sahara↗

PubMed1994

Priorities for pharmaceutical policies in developing countries: results of a Delphi survey.

The use of the Delphi method as a systematic and logical approach to establishing consensus among international experts on the priorities for interventions in national drug policies in developing countries is described. The Delphi survey showed a high degree of reliability, as evidenced by the high response rate, the quality of respondents, and the high standard for consensus. In addition to creating consensus on key issues and key components for priority intervention, the study identified six components that could constitute a basic framework for designing drug policy in developing countries. The study's conclusions have important implications for decision-makers within international development agencies and national governments.

Delphi Technique↗