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PubMed2004

Occupational allergy as a challenge to developing countries.

A steady increase in the incidence of allergic diseases can be observed since 1950s. For such atopic diseases as bronchial asthma, pollinosis or atopic dermatitis, a significantly increased morbidity rate in the general population has been found. Strikingly enough, the highest prevalence of asthma and allergy was recorded in highly developed countries. It can thus be assumed that the high rate of asthma may be an attribute of the post-industrial societies. The prevalence of occupational allergies is thought to be in direct proportion to the rate with which allergies occur in the general population. In view of the changing environment and lifestyles in the developing countries, their communities are expected to be faced with similar negative epidemiological effects concerning allergies. To counteract the spreading of negative health effects, the following measures need to be undertaken: 1. Limitation of exposure to strong allergens. 2. Modification of the training curriculum for medical personnel and of health service infrastructure, according to new tasks and challenges. 3. Considering a possibility of introducing a system of surveillance over occupational allergies and asthma, like the Surveillance of Work-related and Occupational Respiratory Disease (SWORD) system implemented in UK. This system ensures effective cooperation between specialists in preventive medicine, occupational hygiene services and research workers dealing with occupational health that enables prompt response to emerging hazards.

Asthma↗
PubMed2006

Partnership as an ethical model for medical research in developing countries: the example of the "implementation trial".

The existing model for ethical review of medical research consists primarily of regulations designed to prevent exploitation of participants. This model may fail when reviewing other ethical obligations, particularly the responsibility to provide valuable knowledge to society. Such failure is most apparent in developing countries, in which many stakeholders lack incentives or power to uphold society's interests. An alternative ethical model is that of partnership, which actively involves all partners during ethical review and aims to secure partners' best interests through compromise. Unlike the existing "regulatory" model, the partnership model effectively addresses ethical obligations to provide positive benefits to society. For the partnership model to be effective, power must be shared among partners; thus, the partnership model can be harmonised with the "regulatory" model through explicit consideration of power structures. One opportunity for crafting power balance in developing countries is apparent in "implementation trials"-randomised trials motivated by and integrated into the implementation of long term public health interventions. Given the failings of the existing ethical review model, alternative models-for example, partnership-and means to balance power-for example, implementation trials-must be explored to ensure that medical research provides knowledge of value to societies in the developing world.

Cooperative Behavior↗
PubMed2004

[Mental health care in developing countries: the example of Nigeria].

The availability of mental health resources in most developing countries is poor due to scarcity of resources, competing health problems, and the low priority given to mental health issues. In Nigeria, modern psychiatric care is developing, but as yet most people have no access to it because they cannot afford the treatment. Moreover, treatment facilities are mainly concentrated in large urban centers. The cooperation between the authors of this article is aimed at improving the provision of psychiatric care for people living in Ibadan, Nigeria and rural areas close to the city. We report about the foundation of an association to provide help for mentally ill patients in Africa.

Cross-Sectional Studies↗
PubMed2003

Using burden of disease information for health planning in developing countries: the experience from Uganda.

Given the growing interest in both the use of evidence in planning and in using the burden of disease measure (BOD) and cost-effectiveness analysis, we explored health planners' perception of the usefulness of the BOD in priority setting and planning in developing countries, using Uganda as an example. An exploratory qualitative approach involving in-depth interviews with key policy makers in health at district and national levels was employed. Interviews were supplemented with a review of relevant documents. Analysis involved identification of key concepts from the interviews. Concepts were grouped into categories, namely, the appeal of quantitative data, data limitations, opaque methodology, planning as a political process and opportunity costs. These form the basis of this article. We found that the BOD study results have been used as the basis for the national health policy and in defining the contents of the national essential health care package. The quantification and ranking of disease burden is appreciated by politicians and used for advocacy, resource mobilization and re-allocation. The results have also provided information for priority setting and strategic planning. Limitations to its use included poor understanding of the methodology, poor quality of data in-puts, low involvement of stakeholders, inability of the methodology to capture key non-economic issues, and the costs of carrying out the study. There is commitment, by Ugandan planners to using evidence in priority setting. Since this was an exploratory study, there is a need for more studies in developing countries to document their experiences with the use of evidence, and specifically, the BOD approach in planning and priority setting. Such information would contribute to further synthesis of the approach.

Cost of Illness↗
PubMed2006

Release criteria from hospitals of 131I thyrotoxicosis therapy patients in developing countries--case study.

The current release limit, recommended by the International Atomic Energy Agency (IAEA)(1), from hospitals of patients undergoing 131I thyrotoxicosis therapy is approximately 1100 MBq (approximately 30 mCi). Owing to the difference in socio-economic conditions, literacy rate, family system, etc., this release limit may not be applicable in most of the developing countries like Pakistan. Therefore, the prime objective of this case study was to re-evaluate the release criteria for 131I thyrotoxicosis therapy patients by taking into account their lifestyle, economic conditions and other facilities such as availability of private/public transport, etc. In this context, systematic studies were carried out and 50 patients (i.e. 35 outpatients and 15 inpatients) at the Nuclear Medicine Oncology and Radiotherapy Institute (NORI), Islamabad, were studied. Exposure rate at the surface of the body and at a distance of 1 m from the standing patient was measured. Results obtained from this study showed that the dose equivalent delivered by these patients to their family members (particularly children) and general public was higher than annual dose limits recommended by the International Commission for Radiation Protection in their report ICRP Publication 60(2). In the light of this study, it is recommended that the release activity limit of approximately 370 MBq (or dose rate level of approximately 10 microSv h-1 at 1 m from the patient) be adopted instead of approximately 1100 MBq in developing countries like Pakistan.

Developing Countries↗
PubMedDate not supplied

Cyclosporine monotherapy for severe aplastic anemia: a developing country experience.

BACKGROUND: Immunosuppression is the most effective treatment for aplastic anemia after hematopoietic stem cell transplantation. Although the combination of cyclosporine and antithymocyte globulin (ATG) is superior to either agent alone, cyclosporine monotherapy is an easily available, safe and cheap immunosuppressive therapy (IST) option. These advantages are particularly valuable in developing countries where ATG is frequently not available. PATIENTS AND METHODS: In the referral hematology center in Yemen, 20 patients (16 males and 4 females) with severe aplastic anemia (SAA) were prospectively identified and managed with cyclosporine monotherapy during the period between April 2001 and November 2004. RESULTS: Data from 14 patients who received cyclosporine for at least 3 months were analyzed. At 6 months, 2 (14.3%) patients achieved complete remission (CR) and 5 (35.7%) patients achieved partial remission (PR) and at 1 year, 4 (28.6%) patients achieved CR and 3 (21.4%) patients remained in PR. The overall response rate was 50% and the cumulative survival rate at 1 year was 78.6%. The median time to remission was 120 days (range, 46 to 131 days). Side effects were modest and easily monitored. CONCLUSION: Our results support findings that cyclosporine monotherapy is an effective and safe immunosuppressive therapy for SAA, and that it could be a reasonable IST option for patients in developing countries.

Adolescent↗
PubMed1989

Mammography: a critical evaluation of its role in breast cancer screening, especially in developing countries.

Screening for breast cancer using mammography alone, or mammography plus physical examination of the breasts, reduces mortality from breast cancer in women age 50-69. The evidence for effectiveness in older women is less clear. If effective in younger women, benefit is delayed compared to that seen in women age 50 or more. The increasing incidence of breast cancer in developing countries, and the late stage at diagnosis of most disease, supports efforts to introduce screening for breast cancer. However, the requirements of mammography in terms of technology and skilled personnel make it difficult to apply in most developing countries at present. There is a need to evaluate simpler screening tests, such as physical examination of the breasts and breast self-examination, as they can be applied by existing health personnel, and more readily integrated into medical care.

Adult↗
PubMed2000

Integrated institution--community rehabilitation in developed countries: a proposal.

PURPOSE: To propose a system for the provision of comprehensive, coordinated rehabilitation services that would meet all the needs of persons with disability in a timely and cost-effective manner. METHODS: Study of the literature pertaining to features of settings available for the delivery of medical rehabilitation in developed countries; presentation of the evolution of a tertiary rehabilitation centre into an institution practicing community-oriented rehabilitation. Review of various issues and implications of integrating institutional-based and community-based rehabilitation. RESULTS: Rehabilitation settings differ in skills and resources and consequently, in the treatment, care and concern they are able to offer. It is essential to find the balance between medical, nursing and social needs of persons with disability and their requirements for skills and resources at a given time, and to provide rehabilitation, support and guidance in the setting most appropriate to these requirements and needs at the lowest cost possible. CONCLUSION: The integration of the rehabilitation institution of a region with secondary and primary care of the region, into one functional entity for the purposes of providing the needed services, would enable finding the most appropriate setting, and facilitate addressing all needs, as well as increase the availability and accessibility of comprehensive rehabilitation at an affordable cost. This could be a viable way of providing rehabilitation in developed countries of Europe, where the need for it is expected to rise in excess of the population increase.

Community Health Services↗
PubMed2006

Navigating laparoscopic surgery into the next decade in developing countries - a personal perspective.

INTRODUCTION: Over 500 years ago, Vasco de Gama navigated from west to east, from Lisbon in Portugal to Calicut in India, in an epic voyage that lasted over 1 year (Fig. 1). This voyage was perhaps the greatest historic and, certainly, the greatest navigational achievement of the last millennium. For better or for worse, it catalysed a series of events that forever changed not only the history, but also the geography of the world. DISCUSSION: In our plans to navigate endoscopic surgery into the next decade in developing countries, we too should endeavour to change both the history and the geography of surgery. This talk traces a journey over 34 years of effort to spread laparoscopic surgery into developing countries.

Cholecystectomy, Laparoscopic↗
PubMed2004

Cost-effective solutions for sewage treatment in developing countries--the case of Brazil.

Cost-effective solutions are a must in developing countries, not only regarding investment costs, but also in respect to technology and operating practices. With these two goals in mind, in Brazil a particular effort has been directed for the development and application of the Chemical Enhanced Primary Treatment (CEPT) process and of the Upflow Anaerobic Sludge Blanket (UASB) process, both followed by complementary secondary treatment. Both technologies are under current expansion in Brazil. Large CEPT plants have been designed and built, up to 3.7 m3/s average design flow, as well as large UASB reactors, up to 3.0 m3/s average design flow. The applied technologies are cost-effective: they present low investment and efficiencies of BOD removal of up to 50% to 70%. They allow the plant construction in steps, an initial phase with efficiency over the usual primary treatment, and in order to achieve best effluent quality and meet legal water quality standards, a logic upgrade post-treatment can later on be implemented. The higher initial reduction of BOD and TSS also permits savings in construction and operational costs of secondary treatment, due to lower organic load and lower energy consumption. Sludge represents a particular point of attention: in the cases when the CEPT was used, Chemical Stabilisation of the Sludge (CSS) has also been practiced, eliminating the high construction costs of the digesters, all the plant staying chemically operated. In the cases when the UASB is used preceding secondary treatment, sludge can easily return to the anaerobic vessel, the costly sludge digestion unit being avoided. UASB reactors have practically no equipment in the anaerobic vessel, no energy consumption, low sludge production, and when applied in hot climates as in Brazil, heating devices are not required. The Brazilian experience, some particular cases, special comments on design and different secondary treatment processes are presented in this paper, as a contribution to the discussion of cost and benefits, a prime point to be considered.

Bacteria, Anaerobic↗
PubMed1991

Seroepidemiology of Helicobacter pylori infection in India. Comparison of developing and developed countries.

Helicobacter pylori (previously Campylobacter pylori) is now accepted as the major cause of type B gastritis and thus what is known about the epidemiology of type B gastritis can reasonably be transferred to H. pylori. We used a specific ELISA for anti-H. pylori IgG to study the prevalence of H. pylori infection in a population of lower socioeconomic class from Hyderabad, India. The results from India were compared to studies from other parts of the world. Two hundred thirty-eight individuals ages 3 to 70 participated. The frequency of H. pylori infection increased with age (P less than 0.01) and was greater than 80% by age 20. H. pylori infection was present in 79% of the population studied; there was no gender-related difference in prevalence of H. pylori infection. IgG antibody against hepatitis A (HAV) was rapidly acquired in Hyderabad; in a subset of 58 children between the ages of 3 and 21 tested, the frequency of anti-HAV was 98.2%. The prevalence of H. pylori infection increases with age in both developed and developing countries. The high age-specific prevalence of H. pylori infection in developing countries is probably a reflection of the lower socioeconomic level of those areas.

Developing Countries↗
PubMed2005

Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality.

OBJECTIVES: To investigate the relationship between accumulated health-related problems (deficits), which define a frailty index in older adults, and mortality in population-based and clinical/institutional-based samples. DESIGN: Cross-sectional and cohort studies. SETTING: Seven population-based and four clinical/institutional surveys in four developed countries. PARTICIPANTS: Thirty-six thousand four hundred twenty-four people (58.5% women) aged 65 and older. MEASUREMENTS: A frailty index was constructed as a proportion of all potential deficits (symptoms, signs, laboratory abnormalities, disabilities) expressed in a given individual. Relative frailty is defined as a proportion of deficits greater than average for age. Measures of deficits differed across the countries but included common elements. RESULTS: In each country, community-dwelling elderly people accumulated deficits at about 3% per year. By contrast, people from clinical/institutional samples showed no relationship between frailty and age. Relative fitness/frailty in both sexes was highly correlated (correlation coefficient >0.95, P<.001) with mortality, although women, at any given age, were frailer and had lower mortality. On average, each unit increase in deficits increased by 4% the hazard rate for mortality (95% confidence interval=0.02-0.06). CONCLUSION: Relative fitness and frailty can be defined in relation to deficit accumulation. In population studies from developed countries, deficit accumulation is robustly associated with mortality and with age. In samples (e.g., clinical/institutional) in which most people are frail, there is no relationship with age, suggesting that there are maximal values of deficit accumulation beyond which survival is unlikely.

Age Distribution↗
PubMed2003

Economic constraints on production and consumption of animal source foods for nutrition in developing countries.

Livestock ownership currently supports and sustains the livelihoods of an estimated 675 million rural poor, who depend partially or fully on livestock for their income and/or subsistence. Human population growth, increasing urbanization and rising incomes are predicted to double the demand for, and production of, livestock and livestock products in the developing countries over the next 20 y. Land availability limits the expansion of livestock numbers in extensive production systems in most regions, and the bulk of the increase in livestock production will come from increased productivity through intensification and a wider adoption of existing and new production and marketing technologies. The significant changes in the global consumption and demand for animal source foods, along with increasing pressures on resources, are having some important implications for the principal production systems. Production at the smallholder level is constrained by a number of barriers, lack of competitiveness and risk factors. The future holds both opportunities as well as serious pitfalls for animal production in developing countries. There is a danger that livestock production and processing will become dominated by integrated large-scale commercial operations, displacing small-scale livestock farmers and thus exacerbating rural poverty and malnutrition. Conversely, correctly managed, a dynamic livestock sector could prove to be a catalyst for stimulating rural economies. However, the livestock sector will not take on this role on its own, but requires proactive policies on behalf of the private and public sectors.

Animal Feed↗
PubMed1972

The application of ergonomics to developing countries.

Ergonomics is a science that can be applied throughout the technological continuum. Although the ergonomist has usually been involved in identifying and solving problems introduced by technological advances in industrial societies, a vast field for his specialist skills also exists in developing countries. Current literature on ergonomics and its application to developing countries is reviewed, areas where help can be given are identified, and means by which this can be brought about are proposed.

Journal Article↗