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PubMed1997

Epidemiology of needlestick and sharp injuries at a university hospital in a developing country: a 3-year prospective study at the Jordan University Hospital, 1993 through 1995.

OBJECTIVE: To study the epidemiology of needlestick and sharp injuries in a university hospital in a developing country, Jordan. METHODS: A prospective study was undertaken of all needlestick and sharp injuries among workers at the Jordan University Hospital between 1993 and 1995. Health care workers were asked to report in person to the infection-control team to verify the incident and to respond to a questionnaire. Blood was obtained from patients and health care workers immediately and from the health care workers 6 months later for hepatitis B virus, hepatitis C virus, and HIV testing. RESULTS: During the 3-year period, 248 health care workers had needlestick and sharp injuries. Of these, 34.6% were staff nurses, 19%, environmental workers, 15.7%, interns, 11.7%, residents, 8.5%, practical nurses, and 6% were technicians. The incidence density was highest for the interns followed by staff nurses and environmental workers. Of incidents, 22.6% occurred during blood drawing, 11.3% during placing intravenous lines, 8.5% during administration of medication, 11% during recapping the needle, 10.5% during needle disposal, 12.5% during garbage collection, and 5% were caused by a neglected needle. Only 117 patients were identified; 36 of 62 of these had positive results for hepatitis B surface antigen, and 8 of 13 for hepatitis C virus. CONCLUSION: Needlestick and sharp injuries occur frequently in developing countries. Safer disposal facilities and routine hepatitis B vaccine should be adopted.

Developing Countries↗

PubMed1999

Ergonomic strategies for improving working conditions in some developing countries in Asia.

Ergonomic action is growing in Asia in response to increasing local needs. Recent studies in some developing countries in Asia commonly developed and applied widely-applicable measures for assessing local needs in field conditions including small enterprises and agriculture. For this purpose, carefully examining the actual workplace conditions of the local people was essential. Consequently, a number of field studies could contributed to improving the working conditions of the local people in materials handling, workstation design, work organization and work environment by using available local resources. Building on local capacity and practice, action-oriented ergonomics training has also been developing and spreading into many workplaces. Various non-expert human resources including local government units, trade unions, industrial associations and the agricultural sectors have been mobilized to act as participatory trainers in the action-oriented ergonomic training programmes. Training tools such as action checklists, good local examples and group work dynamics have been developed and applied to such training activities. Learning from local achievements and focusing on locally available resources, ergonomists have facilitated these local action processes by developing action-oriented training tools and training local trainers. It was confirmed that a number of ergonomic improvements could be formulated by the self-help initiative of the local people when participatory action tools and training were provided. Developing flexible and dynamic ergonomic research and training methods to meet the diversifying needs of the local people will continuously be important. Ergonomists' efforts to cover the wider population and workplaces need to be strengthened and accelerated.

Asia↗

PubMed2000

Prevention of mother-to-child transmission of HIV in developing countries: recommendations for practice. The Ghent International Working Group on Mother-To-Child Transmission of HIV.

OBJECTIVES: Different approaches to prevent mother-to-child transmission of HIV are being evaluated in developing countries. The first trials using a short regimen of zidovudine have been successful in Thailand, Côte d'Ivoire and Burkina Faso. International and local strategies are now being considered. The Ghent International Working Group on Mother-to-Child Transmission of HIV developed public health policy options to integrate these interventions into basic and maternal and child health (MCH) services. METHODS: The following tasks were undertaken: a critical review of randomized trials; an international pooled analysis of late postnatal transmission of HIV through breastfeeding; a review of the cost-effectiveness and cost-benefit of antiretroviral prophylaxis; a feasibility assessment of preventive strategies, including a postal survey on HIV voluntary counselling and testing (VCT) of pregnant women; the identification of requirements and research priorities for prenatal, obstetric and paediatric care. These projects provided the background for a three-day workshop in Ghent, Belgium, in November 1997. Conclusions were further refined, based on 1998 research findings. RESULTS: A summary of relevant evidence and ten public health recommendations are reported. VCT for pregnant women, a short regimen of zidovudine together with alternatives to breastfeeding currently represent the best option to reduce vertical transmission in most developing countries. The primary goal of the integrated package supporting these interventions is to alleviate overall maternal and infant morbidity and mortality. CONCLUSION: Prevention of mother-to-child transmission of HIV should now be considered for integration into basic health and MCH services of selected countries, with the involvement of governments and donor agencies.

Anti-HIV Agents↗

PubMed2002

[Application of a CO₂ laser for oral soft tissue surgery in children in Sri Lanka--introduction of a laser through activities of aid to a developing country].

The objective of this study was to clarify the effect of CO2 laser irradiation on oral tissue problems in children in Sri Lanka, through the activities of aid to a developing country by the Japan International Cooperation Agency. This study took about six months, during two times periods: from November 2000 to February 2001, and from July 2001 to October 2001, in the paedodontic clinic of the Faculty of Dental Science, University of Peradeniya, in Sri Lanka. A CO2 laser was used on 48 subjects (51 cases), aged between 1 and 15 years, having main indications for labial frenectomy, frenectomy in ankyloglossia, and excision of mucocele. The results indicated that the CO2 laser had the following advantages. 1. Soft tissue cutting was efficient, with no bleeding, giving a clear operative field during operation. 2. There was no need to use sutures. 3. The surgery itself was simple and less time-consuming. Hence, there was no need for general anesthesia for such cases as tongue tie operation in small children. 4. There was no postsurgical infection. As a result, there was no need for analgesics or antibiotics, as post-surgical pain and infection were prevented. 5. Wound contraction and scarring were decreased or eliminated. Considering the above advantages, the use of a CO2 laser proved to be very safe and effective for soft tissue surgery, especially for children in developing countries such as Sri Lanka.

Adolescent↗

PubMed1997

The teaching of evidence-based reproductive health in developing countries.

Evidence-based medicine is gaining increased importance in clinical practice. Unfortunately, prevailing circumstances have prevented this application of the best available evidence to clinical decision-making for reproductive health in developing countries. Poor infrastructure, inadequate personnel, gross underfunding of services for health and education as well as a conservative education system are obstacles in effecting change. By examining these impediments, we suggest strategies for clinical education and research with the aim of improving reproductive health care in developing countries. Evidence-based reproductive health will be promoted through access to appropriate information, interest from government and consumers, curriculum changes, application of research findings and finally, the judicious use of its principles in clinical practice.

Developing Countries↗

PubMed1999

The societal value of vaccination in developing countries.

The vaccination of children against childhood illnesses not only carries the obvious medical and economic benefits, but there exists numerous indirect and often far reaching added societal benefits. In developing countries, vaccination forms the basis of village operated primary health care (PHC) activities leading to a sustained PHC programme. Vaccination programmes provide an opportunity for the provision of other primary care services, as it can be the only recurring activity in primary care, that brings mother and child into contact with health services on a predictable and frequent basis. Vaccination leads to a direct and measurable reduction of child mortality rates and this has been proven to families and communities, resulting in families choosing to have fewer children. Vaccination becomes an opportunity for a higher standard of living as it encourages smaller families and in this way contributes to successes In family planning programmes. The vaccination of children has a great impact on the lives of women in developing countries as they are the principle carers of children. Protecting the lives of children directly through vaccination and through other PHC activities is a major strategy towards improving the lives of women as it liberates their time, energy and resources. The opportunity and provision of vaccination empowers women to protect their own health and that of their children through their own actions, giving an added psychological feeling of control and empowerment in their lives. Therefore, while vaccination services can be delivered alone, they are best delivered along with other services needed by children in their first year of life and by pregnant women: the persons who constitute the priority groups for primary health care services in the developing world. In addition to the monitoring of the growth of the child, the use of oral re-hydration to treat diarrhoea and the promotion of breast-feeding, these services may include malaria treatment and prophylaxis, and counselling with respect to child spacing, nutrition during pregnancy, weaning practices, and clean water and sanitation.

Child↗

PubMed2005

Knowledge of disease and health information needs of the patients with inflammatory bowel disease in a developing country.

BACKGROUND AND AIMS: This study was performed to have a first-time assessment on the knowledge level of a population of inflammatory bowel disease (IBD) patients in a developing country like Iran and to identify their health information preferences. METHODS: One hundred over 18-year-old IBD patients presenting to an outpatient gastroenterology clinic in Tehran from April to November 2004 were asked to complete Persian-translated version of 24-item Crohn's and Colitis Knowledge (CCKNOW) score questionnaire and an additional questionnaire collecting their favorite disease-related knowledge topics. RESULTS: All of the patients (64 females, 36 males) wished to know more about their disease. The cause of IBD and the medications were the most favorite knowledge topics. The mean and median of CCKNOW score of the patients was 4.65 and 4.0 (out of 24), respectively. Women showed significantly higher scores than men (p=0.006). There was also a weak positive correlation between the level of education and CCKNOW score (Spearman's rho=0.23, p=0.02). No significant correlation was found between age, duration of disease, self-estimated level of suffering from disease, and CCKNOW score. The most severe knowledge deficit was evident in knowledge on IBD complications. CONCLUSION: Despite the overt inclination of Iranian IBD patients to know more about their disease, their knowledge levels were significantly lower than the IBD patients in developed countries. The more profound knowledge deficit in IBD complications may lead to disastrous aftermaths such as late diagnosis of colorectal cancer induced by prolonged IBD. Vigorous patient education programs for the Iranian IBD patient are suggested focusing on areas of knowledge deficit and their favorite topics.

Adult↗

PubMed1994

The spectrum of severe rheumatic mitral valve disease in a developing country. Correlations among clinical presentation, surgical pathologic findings, and hemodynamic sequelae.

OBJECTIVE: To describe the demographic, pathologic, and hemodynamic profiles of patients with severe rheumatic mitral valve disease in a developing country and to assess their relation to uncontrolled rheumatic disease activity. DESIGN: Retrospective, cross-sectional, cohort study. SETTING: Tertiary medical center in Soweto, South Africa. PATIENTS: 714 of 737 consecutive black patients, 4 to 73 years old, with pure mitral regurgitation, pure mitral stenosis, or mixed mitral disease who had mitral valve surgery and in whom preoperative and surgical data were concordant. MEASUREMENTS: Valve lesions were evaluated on the basis of clinical, echocardiographic, hemodynamic, and surgical pathologic data. Active rheumatic carditis was diagnosed according to clinical evidence for concurrent acute rheumatic fever (Jones criteria), macroscopic appearances at surgery, and histologic findings. RESULTS: 219 patients had pure mitral regurgitation, 275 had pure mitral stenosis, and 220 had mixed lesions. Ongoing rheumatic activity was diagnosed in 106 patients with pure regurgitation (47%) and in only 5 patients with pure stenosis (2%). Pure regurgitation was the most common lesion in the first and second decades; the relative prevalence of pure stenosis increased with age. Purely regurgitant valves had pliable, unscarred leaflets (95%), dilated mitral annuli (95%), elongated chordae tendineae (92%), and anterior leaflet prolapse (81%). In contrast, purely stenotic valves had fused leaflet commissures (100%) and rigid leaflets (38%) but no evidence of prolapse. CONCLUSIONS: The spectrum of rheumatic mitral valve disease that is hemodynamically severe in developing countries differs from that currently reported in the United States. Severe, pure rheumatic mitral regurgitation is as prevalent as pure stenosis but has an entirely different time course, surgical anatomy, and relation to disease activity, suggesting a separate pathophysiologic mechanism.

Adolescent↗

PubMed2003

A perspective on nutrition communication in developing countries: from theory to practice.

Though nutrition communities are still far from understanding how to bring science to bear in formulating effective policies and programs, the contributions of nutrition science have provided recommendations leading to ways and means to improve nutrition in developing countries. To transfer these recommendations into successful implementation, effective nutrition communication has played an important role in the development. Nevertheless, its success has been limited due to several factors including the fact that there is likely only a small proportion of professionals who consistently aim to use theory as a tool to guide action. This paper highlights the importance of using theoretical frameworks to guide the design and implementation. Based on Thailand's experience, social cognitive theory and social marketing are suggested for further applications in developing country context. It is proposed that the role of researchers/practitioners should be formed to facilitate nutrition implementation. Issues relating to the creation of supportive structures and environments i.e. quality personnel, capacity building, proper status and reasonable budgets, are also identified.

Developing Countries↗

PubMed1996

New antiepileptic drug trials in developing countries: are they necessary?

In recent times, antiepileptic drug (AED) development has expanded with at least seven new AEDs being marketed in a variety of countries. However, in this same period there have been very few trials of new AEDs in the developing world where the majority of people with epilepsy reside. There are many problems with the extrapolation of results from AED trials in developed countries, thus underlining the need for new AED trials in developing countries. This, however, presents a number of ethical and logistical problems, as the majority of people with epilepsy in developing countries are inadequately treated with established drugs. Additionally, there are further problems involving the cost of treatment and the allocation of sparse resources. If trials of new AEDs are to take place in developing countries, strict ethical guidelines must be adhered to, the trials must not be purely marketing exercises, and there must be the continued availability of the new AED to those in the trials who have benefited.

Anticonvulsants↗

PubMed2003

Perinatal mortality and morbidity in developing countries. A global view.

Global perinatal mortality figures show that of the 132 million births per year, there are between 6 and 7 million perinatal deaths. While 90% of these births are in less developed countries, perinatal deaths take 98% of the global share. These statistics show on average the rates as they were in England during the 1930s. The most common recorded medical causes of perinatal deaths are also similar in the less developed countries, and the common denominators are early childbearing, poor maternal health and above all, the lack of appropriate and quality services. Although life-saving practices for most infants have been known for decades, currently a third of mothers still have no access to services during pregnancy, and almost half do not have access to services for childbirth. There are enormous variations both among and within countries. It takes innovation to find the best fit between the needs of women and infants and resources. A health worker with excellent knowledge and skills is the key resource and the best investment. The cost is moderate, and the investment pays a high dividend in improved health of both the mother and her baby, and better health for the next generation at lower cost.

Adult↗

PubMed1993

Biotechnology for developing countries. The case of the Central American isthmus.

Recent developments in the fields of chemistry, molecular biology, computer science, and communications promise to transform the way that many things will be done in the near future in diverse fields of scientific R&D. Fortunately for less developed countries (LDCs) some of the technologies involved are user friendly and safe, avoiding the need for radioactive precursors, large machines, or expensive reagents. For instance, tissue culture, polymerase chain reaction (PCR), dideoxi-sequencing, and recombinant DNA techniques have already invaded clinical laboratories, agricultural field stations, and natural history museums, even in some developing nations. Somatic cell culture for plant biotechnology and immunologic techniques for diagnosis have had wide applications for over a decade in all countries in the Central American Isthmus. More recently, recombinant DNA techniques, including PCR, have been introduced for diagnostic purposes and research at the two largest universities in Costa Rica and at other public institutions and are also used in Guatemala and Panama. Honduras and Nicaragua are only now acquiring these technologies for diagnostic purposes. Biotechnological applications in industry seem to be lagging behind, and presently no good links exist between research laboratories and industry for advanced applications. The application of biotechnologies in environmental problems is slowly underway, with molecular studies of natural wildlife populations and primary forest trees. A major effort is needed to create safe and effective ways of dealing with environmental degradation, wastes, and byproducts of tropical agriculture and industry. The creation of the National Biodiversity Institute (INBio) in Costa Rica to elaborate an inventory of flora and fauna and to prospect for useful substances provides a unique opportunity for biotechnological applications. In addition, government policies to promote biotechnological development are supported by CONICIT (National Research Council), the Ministry of Science and Technology, the newly established Costa Rican Academy of Science, and the national universities. Other countries in the region are beginning to take similar action. At the Cell and Molecular Biology Center (CIBCM) our strategy is to obtain the key components and infrastructure to handle nucleic acids and manage genetic information in databanks. Training has been an important priority during the last decade, with over 20 Central American students receiving graduate degrees in virology, molecular biology, genetics, and immunology, with support from German and Swedish governmental institutions. Diagnosis of viral diseases in cultivated plants and animals was done initially at CIBCM for research and later on a contractual basis for both the public and private agricultural sectors. DNA hybridization and PCR techniques are now replacing or being used concurrently with immunologic techniques.(ABSTRACT TRUNCATED AT 400 WORDS)

Agriculture↗

PubMed2005

The management of sick young infants at primary health centres in a rural developing country.

AIMS: To investigate the epidemiology of illness among young infants at remote health clinics in a rural developing country, and to determine risk factors for mortality that might be used as triggers for emergency treatment or referral. METHODS: Multi-site 12 month observational study of consecutive presentations of infants less than 2 months, and an investigation of neonates who died in one district without accessing health care. RESULTS: Forty per cent of 511 young infant presentations occurred in the first week of life and most of these in the first 24 hours. Twenty five deaths were recorded: 18 in the health facilities and seven in villages. In addition there were eight stillbirths. Clinical signs predicting death were: not able to feed, fast respiratory rate, apnoea, cyanosis, "too small", "skin-cold", and severe abdominal distension. Signs indicating severe respiratory compromise were present in 25% of young infants; failure to give oxygen therapy was a modifiable factor in 27% of deaths within health facilities. A high proportion of seriously ill young infants were discharged from health facilities early without adequate follow up. A common reason for not seeking care for fatally ill neonates was the perception by parents that health staff would respond negatively to their social circumstances. CONCLUSIONS: Clinical signs with moderate positive predictive value for death may be useful triggers for emergency treatment and longer observation or urgent referral. The results of this study may be useful in planning strategies to address high neonatal mortality rates in developing countries.

Anti-Infective Agents↗

PubMed1996

Do not resuscitate orders and pediatric patients: the role of a clinical ethics committee in a developing country.

No published information is currently available about formal "do not resuscitate" (DNR) orders for pediatric patients in developing countries, even though there has been extensive discussion of how to determine who should be involved. This article reports the experience of a clinical ethics committee that recommended DNR orders at a pediatric public hospital in Chile. The committee consisted of four permanent physician members and temporary members including clergymen, nurses, the head of the patient's hospital unit, and the attending physician. Attending physicians submitted cases to the committee on a voluntary basis, and the committee's recommendations were not binding. During the 1990-1993 study period the committee recommended issuing DNR orders for 16 of the 34 patients it evaluated. The hospital records of these 16 patients were retrospectively reviewed for information about the patient's age and diagnosis, the committee's specific recommendations, and the outcome of the case. It was found that the committee typically recommended specific measures to help the child's parents and attending staff in addition to the DNR order. The average patient age was 2 years and 2 months. Nearly all of the patients had chronic and multiple pathologies. In all cases the committee recommendations (taken by consensus) were followed by the attending physician with the consent of the patient's parents. Eleven of the 16 patients for whom DNR orders were issued died during the study period. The five others remained alive despite respiratory insufficiency, severe neurologic damage, or hepatic failure. In general the committee's recommendations appeared useful, providing stronger arguments for DNR decisions and suggesting further support measures for patients, their families, and the attending professionals. This finding supports the idea that clinical ethics committees can provide both valuable support and an opportunity to arrive at better decisions in the public hospitals of developing countries.

Child↗

PubMed2002

Appropriate starter culture technologies for small-scale fermentation in developing countries.

Modern food biotechnology has moved a long way since ancient times of empirical food fermentations. Preservation and safeguarding of food are, however, still major objectives of fermentation. In addition, other aspects, such as wholesomeness, acceptability and overall quality, have become increasingly important and valued features to consumers even in developing countries where old traditions and cultural particularities in food fermentations are generally well maintained. Due to limitations in infrastructure and existing low technologies, rural areas in most developing countries have not been able to keep abreast of global developments toward industrialisation. At the same time, fermented foods play a major role in the diet of numerous regions in Africa and Asia. In many traditional approaches, the advantages of some form of inoculation of a new batch, e.g. by back-slopping or the repeated use of the same container (e.g. a calabash) is appreciated and generally practised. Still, the benefits of small-scale starter culture application as a means of improved hygiene, safety and quality control, in support of HACCP approaches, are not yet realised in small-scale fermentation operations. Approaches and considerations for the selection of pure cultures for small-scale, low-tech applications may differ in some respects from the large-scale industrial approaches practised since 100 years. Selection criteria should take account of the substrate, technical properties of the strain, food safety requirements and quality expectations. Lack of experience in the application of starter cultures in small-scale operations and under rural conditions presents a major obstacle but also an exciting challenge to food microbiologist and technologist. Culture preservation, maintenance and distribution demand special logistic and economic considerations. Quality, safety and acceptability of traditional fermented foods may be significantly improved through the use of starter cultures selected on the basis of multifunctional considerations, also taking into account the probiotic concept and possibilities offered for improved health benefits.

Bacteria↗

PubMed2001

Serum antigliadin antibody levels as a screening criterion before jejunal biopsy indication for celiac disease in a developing country.

The objective of the present study was to determine the efficacy of detection of antigliadin immunoglobulins G and A (IgG and IgA) for the diagnosis of celiac disease in a developing country, since other enteropathies might alter the levels of these antibodies. Three groups were studied: 22 patients with celiac disease (mean age: 30.6 months), 61 patients with other enteropathies (mean age: 43.3 months), and 46 patients without enteropathies (mean age: 96.9 months). Antigliadin IgG and IgA ELISA showed sensitivity of 90.9 and 95.5%, respectively. With the hypothetical values of prevalence ranging from 1:500 to 1:2000 liveborns, the positive predictive value varied from 8.5 to 2.3% for IgG and from 4.8 to 1.1% for IgA. Considering the patients without enteropathies, specificity was 97.8 and 95.7% for IgG and IgA, respectively. In patients with other enteropathies, specificity was 82.0 and 84.1%, respectively. When patients with and without other enteropathies were considered as a whole, specificity was 88.8 and 91.6%, respectively. The specificity of positive IgG or IgA was 93.5% in children without enteropathies and 78.7% in the presence of other enteropathies. The negative predictive value for hypothetical prevalences varying from 1:500 to 1:2000 liveborns was 99.9%. Thus, even in developing countries where the prevalence of non-celiac enteropathies is high, the determination of serum antigliadin antibody levels is a useful screening test prior to the jejunal biopsy in the investigation of intestinal malabsorption.

Analysis of Variance↗

PubMed1993

International Foundation for Dermatology. A challenge to meet the dermatologic needs of developing countries.

The primary goal of the IFD, which serves under the aegis of the International Committee of Dermatology (the governing body of the International League of Dermatological Societies), is to improve dermatology and dermatologic care in rural areas and developing countries. The principal mission of the IFD is to create regional dermatology training centers in geographic areas of greatest need. The first such center, serving the 12 countries of the African Regional Health Community, is located in Moshi, Tanzania. After successfully completing a 2-year course, the emerging dermatology officers will return to their countries of origin to promulgate the information they have learned by teaching others. The second RDTC is located in Chimaltenango, Guatemala to serve 10 countries in the Caribbean basin by training auxiliary nurses to man health posts in rural areas in this region. All dermatologists in the developed world should view their responsibility to their profession and to those suffering from dermatologic diseases in developing countries as a challenge that can be met if we all labor together to ensure a better world for those who currently have minimal or no dermatologic care. Remember: Give a man a fish and you feed him for one day; teach a man to fish and you feed him for life!

Academic Medical Centers↗

PubMed2005

The role of physical therapy and rehabilitation in the management of hemophilia in developing countries.

Without replacement therapy, patients with severe hemophilia (PWH) will have five damaged joints by the age of 20, which lead to limitation of activities and prevent normal participation in society. Of all PWH, 80% live in developing countries, where access to factor replacement is limited. Physiotherapy and rehabilitation help to prevent disabilities, stimulate activities and participation, and help to preserve autonomy. Rehabilitation should be organized by creating awareness that physiotherapy and rehabilitation (next to availability of safe clotting factor) are very important in developing countries. Locally available medical and social systems and materials should be used for both education and aids and adaptations. Trainers must be trained to develop local treatment protocols. PWH and their families need to be educated and trained to do exercises. Important treatment modalities are management of pain, active muscle strengthening exercises, combined measures and exercises to regain range of motion, training proprioception and coordination, functional training, and orthotics and shoe adaptations.

Developing Countries↗