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PubMedDate not supplied

Pertussis in developing countries: definition of the problem and prospects for control.

Pertussis is a distinct clinical syndrome caused by Bordetella pertussis. The disease has been well characterized and largely controlled in the industrialized countries. Studies of pertussis in developing countries have been much more limited, in large part because of difficulty in culturing the organisms. Conventional whole-cell vaccine is being widely used in developing countries but without clear epidemiologic measures of efficacy. The introduction of new acellular pertussis vaccines has focused attention on the need to define the impact of pertussis in the developing world and to explore the optimal approach to control of this illness.

Child↗

PubMedDate not supplied

Simple analytic procedures for rapid microcomputer-assisted cluster surveys in developing countries.

Surveys are often deemed necessary in developing countries when routine sources of data are not considered adequate to answer important policy-related questions. Although field work often goes smoothly, many surveys become bogged down in the analysis stage. With the availability of microcomputers and contemporary software, investigators in developing countries can use rapid survey methodology (RSM) to process, analyze, and report survey findings more quickly than ever before. Presented in this paper are three simple analytic procedures for planning and doing two-stage, rapid cluster surveys. All were successfully used in three rapid surveys in rural regions of Burma and Thailand. By use of a spreadsheet and graphics software package, the three procedures (a) derive the first-stage selection of 30 cluster sites with probability proportionate to size, (b) calculate variance estimates and confidence limits for the parameters of interest and graphically present the findings as 90, 95, and 99 percent confidence intervals, and (c) estimate the necessary sample size for planning two-stage, rapid cluster surveys. The procedures can be used both in the field and in teaching workshops or courses on survey methods. Examples are given from three rapid surveys conducted in Hlegu Township, Burma, and Sisaket Province, Thailand. In both countries, local health professionals were first taught the methods in a 1-week workshop before they used the procedure for conducting the rapid computer-assisted surveys.

Analysis of Variance↗

PubMed1990

Supporting cancer care in the developing countries: role of IAEA/WHO.

Cancer management can be expensive and constitutes a major problem in many developing countries where management standards are poor due to many factors, including non-availability of sufficient funds, equipment, and trained personnel. The incidence of cancer is rising worldwide. This is more so in the developing countries, many of whom are less equipped to deal with the problems. Radiation therapy is one of the major treatment modalities for cancer, and it is estimated that about 60% of all cancer patients require this treatment at one time or another during the course of their disease. Unfortunately, radiotherapy facilities are lacking or grossly inadequate in many developing countries. Over the past 8 years the IAEA and WHO have shown more interest in the problem and treatment of cancer in the developing countries. This paper reviews the role of these international organizations, with emphasis on research activities, education (seminars, workshops, training courses), and technical assistance programs. These include establishment or upgrading of radiotherapy facilities, provision of experts, etc. Scientific papers are published with a view to disseminating current information and research findings in the developing countries. The achievements up to date are assessed and discussed.

Africa↗

PubMed1991

Disease control priorities in developing countries: health policy responses to epidemiological change.

Health systems in developing countries are facing major challenges in the 1990s and beyond because of a growing epidemiological diversity as a consequence of rapid economic development and declining fertility. The infectious and parasitic diseases of childhood must remain a priority at the same time the chronic diseases among adults are emerging as a serious problem. Health policymakers must engage in undertaking an epidemiological and economic analysis of the major disease problems, evaluating the cost-effectiveness of alternative intervention strategies; designing health care delivery systems; and, choosing what governments can do through persuasion, taxation, regulation, and provision of services. The World Bank has commissioned studies of over two dozen diseases in developing countries which have confirmed the priority of child survival interventions and revealed that interventions for many neglected and emerging adult health problems have comparable cost-effectiveness. Most developing countries lack information about most major diseases among adults, reflecting lack of national capacities in epidemiological and economic analyses, health technology assessment, and environmental monitoring and control. There is a critical need for national and international investment in capacity building and essential national health research to build the base for health policies.

Acquired Immunodeficiency Syndrome↗

PubMed1991

[Epidemiology of sexually transmissible diseases in developing countries in the era of AIDS].

Recent developments in the epidemiology of sexual transmitted diseases (STD) in developing countries are reviewed. STD are very frequent in the tropics, particularly in large urban areas. They put a heavy burden on public health because they affect the economically most important age groups and because their sequellae may be fatal. Pelvic inflammatory disease and its consequences, and morbidity during pregnancy and the neonatal period are among the most important causes of mother and child morbidity. STD favour sexual transmission of HIV and may therefore explain the explosive AIDS epidemics in many developing countries. Antimicrobial resistance has made treatment of gonorrhoea and chancroid more difficult and more expensive. STD and HIV infection may be responsible for up to 17% of productive years lost to disease in certain regions. Strategies to control STD should be developed and linked with the AIDS programs. Both should be integrated in the primary health care system.

Developing Countries↗

PubMed1978

Patterns of fertility decline in developing countries, 1950-75.

Since 1965 there have been substantial declines in the crude birth rates of many countries in the developing world, particularly the largest countries. This auspicious trend is shown clearly in an analysis of population figures for the last 25 years, despite the fact that there are deficiencies in the data. In 1950 the average crude birth rate for developing countries was 42 per thousand per year. Over the next 15 years, declines in the crude birth rate were limited to a relatively few, and for the most part small, countries. After 1965, however, for the 13 developing countries with a population numbering 35 million and over, there have been declines in the crude birth rate averaging 13 percent, with declines of over 12 percent in 9 of them. The effects of a number of sociodemographic factors on crude birth rates are examined, and the analysis shows that increases in the age at marriage and decreases in marital fertility were the principal factors affecting declines since 1965.

Adolescent↗

PubMed1978

Physician importation--a solution to developing countries' rural health care problems?

Developing countries almost universally suffer from severe health service shortages, particularly in rural areas. Manpower problems are the most critical aspect of the shortages. Iran has recently begun a massive program to increase physician supply in its rural areas by importation of physicians from India, Pakistan, and the Philippines. The present study investigated two questions: What are physicians' reasons for accepting a post in a rural area of another country, and what are the attitudes of residents in such rural areas toward foreign physicians? Results of a questionnaire survey of foreign physicians indicate that the most common reasons for physician acceptance of the posts were higher salaries and the desire to go eventually to a Western country. Results of an interview survey of Iranian consumers indicate that residents of rural areas were far more likely to prefer Iranian auxiliaries than non-Iranian physicians.

Consumer Behavior↗

PubMed1991

Nutritional problems of developing countries.

The nutritional problems of developing countries are conditioned by poverty, near exclusive reliance on plant sources of nutrients, and high rates of infections. Common deficiency diseases include protein-energy malnutrition, nutritional anemias, vitamin A deficiency, iodine deficiency, and possibly others. Population subgroups at particularly high risk are the children and women of poor families. Control of these nutritional diseases requires systematic diagnosis of the existing situation and appropriate intervention strategies such as targeted food and specific micronutrient supplementation, food fortification, nutrition education, and reductions in infections as well as general improvements in economic conditions and social equity.

Child↗

PubMed1987

Rehabilitation of chronic schizophrenics in a developing country.

Mental health services in Pakistan, as in most developing countries, have not advanced beyond elementary level. Considering the population size, there are few beds in psychiatric wards or hospitals for those in need, and little, if any, opportunity for mentally ill individuals to receive aid and assistance in the community. One model which provides a comprehensive array of services for chronic mental patients in the community is known as the 'Clubhouse'. Since 1971, Fountain House has provided social, vocational, and residential services to chronic schizophrenics in Lahore, based on the concept of mental patients as members of a club receiving self-help through mutual cooperation. Equally basic to the model is the concept of family structure. Based on 14 years of experience, it has been found that the Clubhouse model can be initiated, grow, and thrive in a developing country. Essential to this process has been full involvement of the community. The model can be fully incorporated with adaptations reflecting local conditions and circumstances in other developing countries.

Community Mental Health Centers↗

PubMed1992

Mortality from tobacco in developed countries: indirect estimation from national vital statistics.

Prolonged cigarette smoking causes even more deaths from other diseases than from lung cancer. In developed countries, the absolute age-sex-specific lung cancer rates can be used to indicate the approximate proportions due to tobacco of deaths not only from lung cancer itself but also, indirectly, from vascular disease and from various other categories of disease. Even in the absence of direct information on smoking histories, therefore, national mortality from tobacco can be estimated approximately just from the disease mortality statistics that are available from all major developed countries for about 1985 (and for 1975 and so, by extrapolation, for 1995). The relation between the absolute excess of lung cancer and the proportional excess of other diseases can only be approximate, and so as not to overestimate the effects of tobacco it has been taken to be only half that suggested by a recent large prospective study of smoking and death among one million Americans. Application of such methods indicates that, in developed countries alone, annual deaths from smoking number about 0.9 million in 1965, 1.3 million in 1975, 1.7 million in 1985, and 2.1 million in 1995 (and hence about 21 million in the decade 1990-99: 5-6 million European Community, 5-6 million USA, 5 million former USSR, 3 million Eastern and other Europe, and 2 million elsewhere, [ie, Australia, Canada, Japan, and New Zealand]). More than half these deaths will be at 35-69 years of age: during the 1990s tobacco will in developed countries cause about 30% of all deaths at 35-69 (making it the largest single cause of premature death) plus about 14% of all at older ages. Those killed at older ages are on average already almost 80 years old, however, and might have died soon anyway, but those killed by tobacco at 35-69 lose an average of about 23 years of life. At present just under 20% of all deaths in developed countries are attributed to tobacco, but this percentage is still rising, suggesting that on current smoking patterns just over 20% of those now living in developed countries will eventually be killed by tobacco (ie, about a quarter of a billion, out of a current total population of just under one and a quarter billion).

Adult↗

PubMed1992

The magnitude of mortality from acute respiratory infections in children under 5 years in developing countries.

This article reviews the available evidence of mortality from acute respiratory infections (ARI) among children aged under 5 years in contemporary developing countries and compares the findings with European populations before 1965. In European populations before 1965, the level of mortality was found to be a determinant of the proportion of deaths due to ARI. There were marked differences according to regional patterns of mortality. Deaths from ARI played a smaller role after 1950, when the use of antibiotics became generalized. In developing countries, the role of ARI mortality seems to be similar to the European experience. The age pattern is very marked. In absolute values, ARI mortality is highest in the neonatal period and decreases with age. In relative values, ARI mortality is highest in the postneonatal period. ARI, mainly pneumonia, accounts for about 18% of underlying causes of death in developing countries. Pneumonia and other ARI are frequent complications of measles and pertussis; ARI is also commonly found after other infections and in association with severe malnutrition. Virtually no data are available in developing countries to provide final estimates of the role of ARI in mortality of children aged under 5 years. However, the WHO figure of 1 out of 3 deaths due to--or associated with--ARI may be close to the real range of the ARI-proportional mortality in children of developing countries. Results are discussed in light of the definitions of ARI used in various studies, the difficulties in ascertaining and coding multiple causes of death and the quality of data from some sources.

Acute Disease↗

PubMed1991

Oral health manpower projection methods and their implications for developing countries: the case of Zimbabwe.

Manpower projections for oral health are generally held to be more accurate than those for other health sectors since the diseases involved and their treatment times can be predicted more precisely. Nevertheless most oral health manpower projections are either overestimates or are not in line with the resources of individual countries, especially in developing countries. Zimbabwe was taken as the study case, and oral health manpower projections were made using two of the most commonly employed methods and one new approach. The projections obtained using the three methods were all different, and even the lowest projection is beyond the resources of the country. It is recommended that in making oral health manpower projections, the facilities available to accommodate these personnel should also be taken into account.

Dental Hygienists↗

PubMed1987

The management of congenital talipes equinovarus in developing countries.

Congenital Talipes Equinovarus often remains untreated in developing countries. At our Institute in Calcutta, where we have modern facilities, a programme was undertaken using simple techniques in selected cases. Since 1964, 5,312 cases of congenital talipes equinovarus were treated by percutaneous elongation of the Achilles tendon, plantar fasciotomy and corrective plasters. In 4,502 cases the results are good enough to recommend this technique, even in developed countries.

Achilles Tendon↗

PubMed1985

Using surveys for management and measurement of health in developing countries.

National household surveys have been a basic statistical feature for many decades in the industrialized countries and more recently in the developing world. This paper deals with the potential of national household surveys for obtaining health information in developing countries. In this regard the United Nations National Household Survey Capability Programme (NHSCP) aims at collaborating with developing countries to establish a continuing flow of integrated statistics.

Data Collection↗

PubMed1991

The WHO Collaborative Study of Neoplasia and Steroid Contraceptives: the influence of combined oral contraceptives on risk of neoplasms in developing and developed countries.

A hospital-based case-control study was conducted in eight developing and three developed countries to determine whether use of combined oral contraceptives alters risks of various cancers. An observed trend of increasing risk of invasive cervical cancer with duration of use may not represent a causal relationship and is the subject of further study. Decreased risks of ovarian and endometrial carcinomas in users likely indicate a protective effect of oral contraceptives, the degree of which was similar in developing and developed countries. A small increase in risk of breast cancer in recent and current users was found to be somewhat greater in developing than developed countries. Both causal and non-causal interpretations of this finding have been offered. No associations were found between oral contraceptives and in situ cervical, hepatocellular, cholangio, or gallbladder carcinomas, or uterine sarcomas; but the power of this study to detect alterations in risks of these neoplasms in long-term users was low.

Breast Neoplasms↗

PubMed1991

Tuberculosis and HIV-infection in developing countries.

Tuberculosis is a major public health problem in developing countries. In recent years, a (cost-)effective intervention has been developed in the national programmes of Tanzania and other developing countries. HIV transmission in populations with a high background prevalence of tuberculosis infection will increase the incidence of tuberculosis disease substantially. World Health Organization and World Bank are currently formulating new strategies to revitalise the global efforts against tuberculosis.

Adolescent↗

PubMed1991

The needs of developing countries and the resources required.

Nosocomial infections in developing countries represent a major public health problem that is not universally recognized. In Latin America rates for nosocomial infections range from 10 to 26% with a severe impact on morbidity and mortality and a consequent economic burden. The fundamental needs are: (1) to recognize the importance of this problem; (2) to modify the attitude of government authorities in the sense that hospital care could be improved; (3) to teach medical personnel the importance of infection control at the beginning of their training; and (4) to increase the awareness of the population of its right to better health care. From an international point of view we should establish the following guidelines: (1) the World Health Organisation should establish a worldwide programme on nosocomial infections; (2) medical and nursing schools should include regular courses on infection control; (3) international organizations should support training and research programmes in developing countries, focusing on the regional needs for infection control.

Cross Infection↗

PubMed1991

[Vaccines and developing countries].

Infectious diseases are the main cause of mortality and morbidity in developing countries. The Expanded Programme on Immunization, initiated by WHO in 1974, now reaches 60 mill. a year at a cost of less than 2 US $ per immunized child, and saves 2.2 mill. lives annually. The present vaccines, however, have significant shortcomings. Measles vaccine is given too late to prevent the large number of deaths occurring in the first year of life. Attenuated polio vaccine has to be given three times and inherits the risk of "vaccine palsy" and revertion to virulence. Tetanus vaccine given to children does not prevent neonatal tetanus, the main cause of tetanus casualties. BCG does not control spread of tuberculosis. Vaccines given parenterally involve some risk of spread of HIV, and some potentially useful vaccines are too expensive for developing countries. By only modest investments modern gene technology could give improved and new vaccines which would potentially save 20 mill. lives a year. Particularly promising is the recent development of multi-vaccine-vectors. However, poor prospects for profit in developing countries and patent "swapping" by commercial producers severely hamper development in the vaccine field.

Developing Countries↗