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PubMed2003

Operational indicators for measuring agricultural sustainability in developing countries.

This paper reviews relevant literature on the sustainability indicators theoretically proposed and practically applied by scholars over the past 15 years. Although progress is being made in the development and critical analysis of sustainability indicators, in many cases existing or proposed indicators are not the most sensitive or useful measures in developing countries. Indicator selection needs to meet the following criteria: relative availability of data representing the indicators, sensitivity to stresses on the system, existence of threshold values and guidelines, predictivity, integratability and known response to disturbances, anthropogenic stresses, and changes over time. Based on these criteria, this paper proposes a set of operational indicators for measuring agricultural sustainability in developing countries. These indicators include ecological indicators involving amounts of fertilizers and pesticides used, irrigation water used, soil nutrient content, depth to the groundwater table, water use efficiency, quality of groundwater for irrigation, and nitrate content of both groundwater and crops. Economic indicators include crop productivity, net farm income, benefit-cost ratio of production, and per capita food grain production. Social indicators encompass food self-sufficiency, equality in food and income distribution among farmers, access to resources and support services, and farmers' knowledge and awareness of resource conservation. This article suggests that the selection of indicators representing each aspect of sustainability should be prioritized according to spatial and temporal characteristics under consideration.

Agriculture↗
PubMed1998

Ethics of resource allocation in developing countries: the case of Sri Lanka.

The issues of prioritization of health care services and allocation of resources have recently received increasing attention and discussion. Several reports have been published by governments in different countries and the issues are discussed in many recent books and papers. In this paper the focus is on the problems faced by a developing country when allocation of health care resources is considered. We consider these issues under three headings and exemplify the situation in a developing country by taking Sri Lanka as an example. Firstly the evidence to formulate an ethical basis for the existing health care system in Sri Lanka is discussed, in particular the problem of defining a minimum quality of health care for the population. Secondly, we consider the issues which arise when we want to formulate the ethical basis for health sector reform. In particular, we examine current World Bank proposals. We shall argue that there are a number of important conceptual and ethical issues that have not been properly addressed in the various policy documents. Finally, we introduce our own alternative ethical framework for policy reform.

Developing Countries↗
PubMed2004

Towards an integrated approach to lung health in adolescents in developing countries.

The World Health Organization strategies, Integrated Management of Childhood Illness and Practical Approach to Lung health provide assessment and management guidelines for health workers in developing countries. We reviewed issues important to lung health in adolescents to highlight whether differences in factors such as adolescent behaviour have consequences for the development of case management guidelines, to form a bridge between guidelines for younger children and for adults and to make suggestions for further study. Pneumonia, asthma and tuberculosis are the leading lung health problems in adolescents. As countries industrialise, the importance of asthma mortality and morbidity increases as that of pneumonia and pulmonary tuberculosis decreases. Guidelines for managing pneumonia and asthma in children and adults in developing and developed countries should be adaptable for use in adolescents in developing countries, although more information is needed on predictors of severity such as respiratory rate cut-offs, level of fever, hypotension, malnutrition and level of consciousness. The effectiveness of low-cost treatment for asthma should be explored further. HIV and the global resurgence of tuberculosis pose significant challenges for improving adolescent lung health, and prevention of smoking initiation during adolescence is a priority goal of any integrated approach to improving lung health.

Adolescent↗
PubMed2006

Costs of work-related musculoskeletal disorders (MSDs) in developing countries: Colombia case.

The real burden of occupational diseases, specifically work-related musculoskeletal disorders (MSDs), and its impact on workers' productivity is not known. The situation is critical in developing countries where only cases that cause workers' disability are recorded. In this study, the incidence of MSDs in Colombia was estimated by using the age and gender specific double incidence rate of repetitive strain injuries diseases in Finland for 2002. The results showed that the estimated number of MSDs recorded in Colombia during 2005 was 23,477 cases at the rate of 11.6 cases per 10,000 workers. The estimated total cost of these MSD cases relative to workers' productivity was 171.7 million US Dollars, representing around 0.2% of Colombia's Gross Domestic Product for 2005. The systematic appraisal of the incidence of MSDs and their associated cost on workers' productivity are necessary in developing countries to reduce the costly impact on productivity and to increase workers' well-being.

Adolescent↗
PubMedDate not supplied

Health and safety in clinical laboratories in developing countries: safety considerations.

BACKGROUND: Clinical laboratories are potentially hazardous work areas. Health and safety in clinical laboratories is becoming an increasingly important subject as a result of the emergence of highly infectious diseases such as hepatitis and HIV. This is even more so in developing countries where health and safety have traditionally been regarded as low priority issues, considering the more important health problems confronting the health authorities in these countries. METHODS: We conducted a literature search using the medical subheadings titles on the INTERNET over a period of twenty years and summarized our findings. RESULTS: This article identifies hazards in the laboratories and highlights measures to make the laboratory a safer work place. It also emphasizes the mandatory obligations of employers and employees towards the attainment of acceptable safety standards in clinical laboratories in Third World countries in the face of the current HIV/AIDS epidemic in many of these developing countries especially in the sub-Saharan Africa while accommodating the increasing work load in these laboratories. CONCLUSION: Both the employer and the employee have major roles to play in the maintenance of a safe working environment. This can be achieved if measures discussed are incorporated into everyday laboratory practice.

Clinical Medicine↗
PubMed2005

Effect of closed unit policy and appointing an intensivist in a developing country.

OBJECTIVE: We hypothesized that a dual strategy--instituting a closed intensive care unit (ICU) policy and simultaneously appointing an intensivist--would improve patient outcome in a university hospital of a developing country and that the benefit would increase over time. DESIGN: Data were prospectively collected over 5 months before the policy change (open policy) and over an initial 6 mos (early closed policy) and subsequent 12 mos (late closed policy) after the policy change. SETTING: The study was conducted at a medical ICU of a university hospital in Turkey. PATIENTS: Two hundred patients were recruited during open policy, 149 during early closed policy, and 210 during late closed policy. MEASUREMENTS AND RESULTS: Instituting a closed policy and simultaneously appointing a critical care specialist was associated with the admission of sicker patients and more frequent use of invasive procedures. Compared with open policy, patients were approximately 4.5 times more likely to survive their hospital stay during early closed policy (p < .001) and approximately five times more likely during late closed policy (p < .0001). Among patients receiving mechanical ventilation, hospital mortality was lower during the early (57%) and late closed periods (59%) than during open period (91%; p < .01). In multivariate analysis, open policy, mechanical ventilation, central venous catheterization, sepsis, and higher Acute Physiology and Chronic Health Evaluation II score each independently predicted mortality. The change in policy resulted in the admission of progressively sicker patients over time and increased the use of mechanical ventilation and central venous catheters. CONCLUSION: A dual strategy of closed policy and simultaneously appointing an intensivist fostered admission of sicker patients and improved the survival of patients requiring admission to an ICU of a developing country.

APACHE↗
PubMed1989

Management of carcinoma breast with conservative surgery and radiation therapy-experience in a developing country.

Between 1980 and 1987, 14 patients with breast cancer who refused mastectomy were treated at the V.N. Cancer Centre, Coimbatore, with excision of the lump, followed by radiation therapy and adjuvant chemotherapy/hormonal therapy. No attempt was made to boost the tumour bed with interstitial implants or electron beam for want of these facilities. No patient developed local or loco-regional disease or distant metastases during the period of follow-up which ranged between 10 and 76 months. Ten of the 14 patients have been followed up for more than two years. Most published data on breast-conserving treatment for cancer breast are from the U.S., UK and Europe. There are not many papers published from the developing countries. This paper gives an insight into this subject in the developing countries.

Adult↗
PubMed1997

Undercover careseekers: simulated clients in the study of health provider behavior in developing countries.

The simulated client method (SCM) has been used for over 20 years to study health care provider behavior in a first-hand way while minimizing observation bias. In developing countries, it has proven useful in the study of physicians, drug retailers, and family planning services. In SCM, research assistants with fictitious case scenarios (or with stable conditions or a genuine interest in the services) visit providers and request their assistance. Providers are not aware that these clients are involved in research. Simulated clients later report on the events of their visit and these data are analyzed. This paper reviews 23 developing country studies of physician, drug retail, and family planning services in order to draw conclusions about (1) the advantages and limitations of the methods; (2) considerations for design and implementation of a simulated client study; (3) validity and reliability; and (4) ethical concerns. Examples are also drawn from industrialized countries, related methodologies, and non-health fields to illustrate the issues surrounding SCM. Based on this review, we conclude that the information gathered through the use of simulated clients is unique and valuable for managers, intervention planners and evaluators, social scientist, regulators, and others. Areas that need to be explored in future work with this method include: ways to ensure data validity and reliability; research on additional types of providers and health care needs; and adaptation of the technique for routine use.

Attitude of Health Personnel↗
PubMed2002

Growth performance of affluent Indian children is similar to that in developed countries.

OBJECTIVE: A cross-sectional survey was conducted in order to determine whether an affluent population in south Delhi had a growth performance similar to that in developed countries and to identify socioeconomic factors that militated against optimal growth in this group. METHODS: The weights and lengths of 395 children aged 12-23 months and the heights of 331 mothers and 153 grandmothers were measured and information was obtained on family socioeconomic status and child-feeding practices. Children born prematurely, i.e. before 37 weeks of gestation, and those with illness adversely affecting growth, were excluded from the analysis, as with the NCHS/WHO reference population. RESULTS: In 341 children included in the analysis, the mean Z-scores for weight-for-age, length-for-age and weight-for-length were -0.45, -0.28 and -0.32 respectively. About 6% of the children were underweight (weight-for-age Z-score < or =-2), 3% were stunted (length-for-age Z-score < or =-2), and 4% were wasted (weight-for-length Z-score < or =-2). The factors that were significantly associated with higher length-for-age were one or both parents having 17 years or more of education (mean length-for-age Z-score -0.17) and non-vegetarian diet (mean length-for-age Z-score - 0.18). No socioeconomic factors were associated with mean weight-for-length. CONCLUSION: The children in this affluent population were close to the NCHS/WHO reference population with regard to anthropometric indicators. The subpopulation with higher parental education had even better growth. It is intended to include this subpopulation in the WHO Multicentre Growth Reference Study.

Adult↗
PubMed2005

Conducting research in developing countries: experiences of the informed consent process from community studies in Peru.

This article discusses the process for obtaining genuine informed consent for the participation of human subjects in research in developing countries. We discuss the consent process in the light of recently published guidelines, the experience of nutrition and health research projects, and the ethics review process of the Instituto de Investigacion Nutricional with peri-urban and rural populations in Peru. We discuss the cultural context in relation to (i) who should be involved in the decision for participation, especially for research in children and in community settings; (ii) when to use written or verbal consent; (iii) the format and presentation of the consent form to ensure understanding by the target population; and (iv) the process of how and by whom information is given and consent is obtained. Common concerns of participants with regard to their involvement in research studies are presented, as well as aspects that participants find difficult to understand. Some specific concerns of conducting research with Indigenous Peoples are discussed. We recommend future research to further understand and implement informed consent processes to assure genuine and voluntary consent in different developing country contexts.

Biomedical Research↗
PubMed1981

[Documentation in developing countries and related technological issues].

While bibliographical referencing and indexing services have risen to a high level of efficiency-thanks to computers and other technical innovations-the same cannot be said for documentation in the form of texts and charts. However early an order is placed, it can take weeks for the final stage of the process to be completed. If even in developed countries the process can be slow and costly, in developing countries it is affected by the same socioeconomic conditions that impede the provision of health services. In the latter countries wide variations are apparent in the numbers of libraries, collections and lending library systems, and in the accessibility of books and journals on health. For physicians and nurses at some remote locations the only source of information on discoveries and new ideas may be the advertising supplied to them by traveling medical salesmen. There are grounds for optimism, however. In these countries more and more important books and journals are being published in the health field. In Latin America a number of areas of national interaction have come into view which promise to grow into a true network of biomedical and health information.

Abstracting and Indexing↗
PubMed2003

Uses of population census data for monitoring geographical imbalance in the health workforce: snapshots from three developing countries.

BACKGROUND: Imbalance in the distribution of human resources for health (HRH), eventually leading to inequities in health services delivery and population health outcomes, is an issue of social and political concern in many countries. However, the empirical evidence to support decision-making is often fragmented, and many standard data sources that can potentially produce statistics relevant to the issue remain underused, especially in developing countries. This study investigated the uses of demographic census data for monitoring geographical imbalance in the health workforce for three developing countries, as a basis for formulation of evidence-based health policy options. METHODS: Population-based indicators of geographical variations among HRH were extracted from census microdata samples for Kenya, Mexico and Viet Nam. Health workforce statistics were matched against international standards of occupational classification to control for cross-national comparability. Summary measures of inequality were calculated to monitor the distribution of health workers across spatial units and by occupational group. RESULTS: Strong inequalities were found in the geographical distribution of the health workforce in all three countries, with the highest densities of HRH tending to be found in the capital areas. Cross-national differences were found in the magnitude of distributional inequality according to occupational group, with health professionals most susceptible to inequitable distribution in Kenya and Viet Nam but less so in Mexico compared to their associate professional counterparts. Some discrepancies were suggested between mappings of occupational information from the raw data with the international system, especially for nursing and midwifery specializations. CONCLUSIONS: The problem of geographical imbalance among HRH across countries in the developing world holds important implications at the local, national and international levels, in terms of constraints for the effective deployment, management and retention of HRH, and ultimately for the equitable delivery of health services. A number of advantages were revealed of using census data in health research, notably the potential for producing detailed statistics on health workforce characteristics at the sub-national level. However, lack of consistency in the compilation and processing of occupational information over time and across countries continues to hamper comparative analyses for HRH policy monitoring and evaluation.

Journal Article↗
PubMedDate not supplied

Differences in teenage pregnancy rates among five developed countries: the roles of sexual activity and contraceptive use.

CONTEXT: Adolescent pregnancy, birth, abortion and sexually transmitted disease (STD) rates are much higher in the United States than in most other developed countries. METHODS: Government statistics or nationally representative survey data were supplemented with data collected by private organizations or for regional or local populations to conduct studies of adolescent births, abortions, sexual activity and contraceptive use in Canada, the United States, Sweden, France and Great Britain. RESULTS: Adolescent childbearing is more common in the United States (22% of women reported having had a child before age 20) than in Great Britain (15%), Canada (11%), France (6%) and Sweden (4%); differences are even greater for births to younger teenagers. A lower proportion of teenage pregnancies are resolved through abortion in the United States than in the other countries; however, because of their high pregnancy rate, U.S. teenagers have the highest abortion rate. The age of sexual debut varies little across countries, yet American teenagers are the most likely to have multiple partners. A greater proportion of U.S. women reported no contraceptive use at either first or recent intercourse (25% and 20%, respectively) than reported nonuse in France (11% and 12%, respectively), Great Britain (21% and 4%, respectively) and Sweden (22% and 7%, respectively). CONCLUSIONS: Data on contraceptive use are more important than data on sexual activity in explaining variation in levels of adolescent pregnancy and childbearing among the five developed countries; however, the higher level of multiple sexual partnership among American teenagers may help explain their higher STD rates.

Abortion, Induced↗