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PubMedDate not supplied

The role of appropriate medical technology procurement and user maintenance instructions in developing countries.

Reports bear witness that a significant proportion of all healthcare equipment in developing countries is not in use. There are many and varied reasons this, including inappropriateness or a lack of basic maintenance. This report addresses these issues, including guidelines for procurement staff and end-users and a bibliography. Examples of the considerations involved are given in the specialties of therapy oxygenation, laboratory tests and solar-powered equipment.

Biomedical Engineering↗
PubMed1997

A philosophy for health informatics education in developing countries: Nigeria as a case study.

The use of computers in the health sector has increased significantly during the last few years in Nigeria. This paper addresses the integration of health and informatics education, or health education and informatics education, or informatics education in health care delivery. It gives an introduction to the status of a health informatics programme in the daily practice of computer use. The essence of a health informatics curriculum, the planning and administration of the programme in medical schools, and what informatics education offers the health sector, even in a developing country, are presented. The problems of administering an informatics programme in a conventional medical training curriculum are highlighted. The article describes the philosophy which should underline the framework for the formulation of appropriate national policies and curricula for health informatics education in developing countries, using Nigeria as a case study.

Curriculum↗
PubMedDate not supplied

Experience with the International League Against Epilepsy classifications of epileptic seizures (1981) and epilepsies and epileptic syndrome (1989) in epileptic children in a developing country.

Four hundred eighty-three epileptic children attending the Pediatric Epilepsy Clinic at Bai Jerbai Wadia Hospital for Children, Bombay, India were classified according to the International League Against Epilepsy (ILAE) classification of epileptic seizures (1981) and epilepsies and epileptic syndromes (1989). The predominant seizures were partial (53.6), generalized (40.3%), and unclassifiable (6%). In epilepsies and epileptic syndromes, 55.3% were partial, 27% were generalized, 13.5% were undetermined, and 4.1% were special syndromes. Although our results were similar in many respects to those of other reported series, some differences were observed in the incidence of partial and generalized seizures, and partial and generalized epileptic syndromes and their subgroups, such as idiopathic, symptomatic, and cryptogenic partial syndromes, idiopathic generalized syndromes, and symptomatic specific syndromes. These differences are probably due to different age limits, methods of case ascertainment and inclusion criteria, different genetic and environmental factors, variable interpretation of clinical and EEG features, and lack of facilities for investigation in developing countries. Despite various limitations, we were able to classify most cases; the ILAE classification can be used in developing countries so that comparison can be made with other studies.

Adolescent↗
PubMed2003

Life span of peripheral intravenous cannula in a neonatal intensive care unit of a developing country.

The use of peripheral intravenous cannulas (IVCs) in the care of sick newborns is a common practice. IVCs, priced five times higher than conventional steel needles, can be more cost effective if insight is available on the variables affecting their life span in situ. The present report summarizes the efforts made to ascertain these factors in a neonatal intensive care unit (NICU) of a developing country. A total of 186 peripheral IVCs (24-gauge teflon) were used in 78 newborns amounting to 7,583 hours of IV therapy (mean, 40.8 hr per cannula; range, 1-136 hr). Of these, 25 cannulas were removed selectively and 84, 50, 17, and 10 were removed for swelling, dislodgement/leakage, blockage, and local erythema, respectively. The median survival time of IVC as expressed by Kaplan-Meir survival analysis was 40 hours (SE, 2.49; 95% confidence interval, 35.12-44.88). Birth weight, gestation, application of splint, fluid and glucose infusion rate, site of cannulation, and administration of ampicillin, gentamicin, amikacin, vancomycin, phenobarbitone, blood products, or calcium gluconate did not influence the median life span of IVCs. Children receiving cefotaxime had a significantly lower median survival time as compared with those not receiving it (36 vs 47 hours, p =.007). Median survival time of IVCs in our set-up was comparable with those in developed countries and was not governed by the cannula or patient variables. Cefotaxime use led to decreased survival of IVCs; though this effect appeared to be related to the mode of administration rather than to the drug per se.

Catheterization, Peripheral↗
PubMed1976

Psychiatric priorities in developing countries.

Many psychiatrists assert that an expansion of mental health services in the developing countries is overdue. This will only take place if: (i) the tasks of mental health care are undertaken by a wide range of non-specialist health workers, including those responsible for primary health care; and (ii) services are directed initially at a very limited range of priority conditions. The method of priority selection is discussed, and the process required for translation of priority decisions into health action is exemplified by two illustrations.

Chronic Disease↗
PubMed1988

Measles in developing countries. Part II. The predicted impact of mass vaccination.

A mathematical model is developed to mimic the transmission dynamics of the measles virus in communities in the developing world with high population growth rates and high case fatality rates. The model is used to compare the impacts of different mass vaccination programmes upon morbidity and mortality arising from infection by measles virus. Analyses identify three conclusions of practical significance to the design of optimal vaccination programmes. First, there is no single optimum age at which to vaccinate children for all urban and rural communities in developing countries. For a given community the best age at which to vaccinate depends critically on the age distribution of cases of infection prior to the introduction of control measures. Second, numerical studies predict that the introduction of mass vaccination will induce a temporary phase of very low incidence of infection before the system settles to a new pattern of recurrent epidemics. Mass vaccination acts to lengthen the inter-epidemic period in the post-vaccination period when compared with that prevailing prior to control. Third, numerical simulations suggest that two-phase and two-stage vaccination programmes are of less benefit than one-stage programmes (achieving comparable coverage) aimed at young children. The paper ends with a discussion of the needs for: improved programmes of data collection; monitoring of the impact of current vaccination programmes; and the development of models that take account of viral transmission dynamics, host demography and economic factors.

Adolescent↗
PubMed2003

Dementia diagnosis in developing countries: a cross-cultural validation study.

BACKGROUND: Research into dementia is needed in developing countries. Assessment of variations in disease frequency between regions might enhance our understanding of the disease, but methodological difficulties need to be addressed. We aimed to develop and test a culturally and educationally unbiased diagnostic instrument for dementia. METHODS: In a multicentre study, the 10/66 Dementia Research Group interviewed 2885 people aged 60 years and older in 25 centres, most in Universities, in India, China and southeast Asia, Latin America and the Caribbean, and Africa. 729 had dementia and three groups were free of dementia: 702 had depression, 694 had high education (as defined by each centre), and 760 had low education (as defined by each centre). Local clinicians diagnosed dementia and depression. An interviewer, masked to dementia diagnosis, administered the geriatric mental state, the community screening instrument for dementia, and the modified Consortium to Establish a Registry of Alzheimer's Disease (CERAD) ten-word list-learning task. FINDINGS: Each measure independently predicted a diagnosis of dementia. In an analysis of half the sample, an algorithm derived from all three measures gave better results than any individual measure. Applied to the other half of the sample, this algorithm identified 94% of dementia cases with false-positive rates of 15%, 3%, and 6% in the depression, high education, and low education groups, respectively. INTERPRETATION: Our algorithm is a sound basis for culturally and educationally sensitive dementia diagnosis in clinical and population-based research, supported by translations of its constituent measures into most languages used in the developing world.

Algorithms↗
PubMed1988

[[Mortality estimation using proportional mortality indicators for developing countries]].

The author extends a technique for the indirect estimation of mortality originally developed by Courbage and Fargues. The technique is applied to national data from 35 developing countries for the year 1975. "Nine families of model life tables constructed by Coale and Demeny and the United Nations were applied to each of the object populations, and the level of mortality corresponding to the value of PMI (proportional mortality indicator: percentage of deaths at the ages 50 years and over) obtained from death registration data, was determined for each family." The author notes that the technique does not require assumptions regarding features of the population in question and is applicable to a non-stable population or an open population without any adjustment. (SUMMARY IN ENG)

Demography↗
PubMed2005

Detection of cervical abnormalities in a developing country using measurement of Brn-3a in cervical smears.

OBJECTIVE: We have previously shown that Brn-3a is elevated in biopsies from women in the United Kingdom with high grade cervical neoplasia, and that it specifically trans-activates the HPV URR in vitro and in vivo. The aim of this study is to establish the relationship of Brn-3a, HPV E6 and pathological diagnosis in cervical smear from women in a developing country with a high prevalence of cervical disease. This is a follow-up of our previous work in which for the first time Brn-3a and E6 levels in cervical smears from women in United Kingdom were shown to correlate with the histological diagnosis of cervical neoplasia and were even better in predicting underlying pre-malignant disease than conventional procedures. METHOD: Cervical smears from 295 women with cervical abnormalities attending gynecological clinics in Brazil were used to make RNA. The mRNA levels of Brn-3a and HPV E6 were measured and the data obtained were used to establish the relationship between Brn-3a and the histological diagnosis. RESULTS: The cellular transcription factor Brn-3a was readily measured in cervical smears from the Brazilian population. Its presence was shown to be frequently associated with the expression of HPV E6. The measured level of Brn-3a parallels the severity of the cervical ailment and predicts the pathological categories. CONCLUSIONS: The ability of Brn-3a to predict for cervical ailments is independent to the geographical characteristics of the population, and hence it could be used routinely as an adjunct to colposcopy and pathological diagnosis in developing and developed countries.

Adolescent↗
PubMed1993

Problem-based learning for training primary health care managers in developing countries.

The 'International Course for Primary Health Care Managers at District Level In Developing Countries' (ICHM) came into being in 1988. Its creation was the direct result of an Italian Government initiative to improve the managerial skills of health care personnel at intermediate level. Problem-based learning (PBL) was selected as the most promising educational approach and the method became associated with primary health care (PHC) management. At the end of three experimental years (1988-1990) a basic course structure that would be open to continual improvement was defined. This paper describes how PBL was implemented practically in 1991, the main problems identified with the method and the corrective action taken for the year 1992.

Administrative Personnel↗
PubMed1996

Vaccine stability in the context of vaccine delivery in a developing country: India.

Infant immunisation coverages of 80-85% have become sustainable throughout the developing world. The vaccine market is enormous in developing countries; in 1992, the total consumption of vaccine doses amounted to 2207 millions. There were only 127 million births, and the actual doses given to infants would have been fewer than 1000 million. This indicates huge wastage, which could be saved if vaccines were more stable at high temperatures and did not become contaminated. The vaccine delivery problems are compounded by the rural residence of the majority of the population and by the reliance on village health workers who are not the optimum health care providers. Under these circumstances, post-marketing epidemiological surveillance of vaccine-preventable diseases is absolutely necessary to monitor vaccine performance which is a function of the efficacy of the products and their potency when delivered.

Child↗
PubMedDate not supplied

Trauma in developing countries, a personal experience in Papua New Guinea.

Trauma is a serious threat in developing countries. Prevention efforts, which have been so effective in other countries in controlling the incidence of injuries, are almost nonexistent. The lifestyles make the population prone to injury and tribal cultures may practice rituals that create personal injury. Developing nations lack adequate health care services for a large section of the population. A trauma nurse who visited Papua New Guinea describes her experience with living and working in various health care settings.

Delivery of Health Care↗
PubMed2006

Cystogastrostomy: a valid option for treating pancreatic pseudocysts of children in developing countries.

Twelve children with pancreatic pseudocysts were managed for over 10 years at our institute that is a tertiary referral center of our country. A majority of them had posttraumatic pancreatic pseudocysts. Six of them were early referrals and presented within 1-2 weeks of pancreatic injury while the remaining six were referred later than 6 weeks with thick cyst walls. An initial conservative management and observation (with serial ultrasounds) led to a resolution of the pseudocysts in three patients (25% resolution rate). All the remaining subjects were treated using surgical modality (cystogastrostomy). In all the subjects where cystogastrostomy was done, the pseudocysts resolved completely, except in one child, who required the procedure to be repeated. The authors encountered no complications of the pancreatic pseudocyst disease in children i.e. infection, rupture, etc, that have been frequently described for adults. The authors conclude that pancreatic pseudocyst is a comparatively benign entity in children with a better outcome than in adults. Though various sophisticated treatment modalities are in vogue in the developed countries for managing pancreatic pseudocysts in children, cystogastrostomy is still a valid option for this purpose in the developing countries with suboptimal infrastructure and gives good results.

Adolescent↗
PubMed2002

Affordable access to essential medication in developing countries: conflicts between ethical and economic imperatives.

Recent economic and political advances in developing countries on the African continent and South East Asia are threatened by the rising death and morbidity rates of HIV/AIDS. In the first part of this paper we explain the reasons for the absence of affordable access to essential AIDS medication. In the second part we take a closer look at some of the pivotal frameworks relevant for this situation and undertake an ethical analysis of these frameworks. In the third part we discuss a few of the proposed solutions to the problem and conclude with an argument in support of our preferred course of action. In this article we argue for compulsory licensing of essential AIDS medications in the current conditions of public health emergency. We argue on broadly consequentialist grounds that compulsory licensing is preferable both morally and pragmatically to the alternatives, notably the currently offered price cuts and drug donation schemes.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Hydrocarbon emissions and health risks from cookstoves in developing countries.

The nonmethane hydrocarbon emissions from several types of cookstoves commonly used in developing countries were measured in a pilot study conducted in Manila, the Philippines. Four types of fuel, i.e., wood, charcoal, kerosene, and liquefied petroleum gas (LPG), were tested. Because kerosene was burned in three different types of stoves, there were six fuel/stove combinations tested. Fifty-nine nonmethane hydrocarbons were identified frequently in emissions of these cookstoves, with emission ratios to CO2 up to 5.3 x 10(-3). The emissions were quantitated with emission factors on both a mass basis (emissions/kg fuel) and a task basis (emissions/cooking task). On a task basis, combustion of biomass fuels (wood and charcoal) generally produced higher emission factors than combustion of fossil fuels (kerosene and LPG). One type of kerosene stove (wick stove), however, still generated the greatest emissions of some individual and classes of hydrocarbons, indicating that emissions were dependent on not only fuel types but also combustion devices. Some hydrocarbons, e.g., benzene, 1,3-butadiene, styrene, and xylenes, were of concern because of their carcinogenic properties. The lifetime risk from exposures to these compounds emitted from cookstoves was tentatively estimated by using a simple exposure model and published cancer potencies.

Air Pollutants↗
PubMed2005

Outcomes of high volume cataract surgeries in a developing country.

AIM: To analyse the outcome of high volume cataract surgery in a developing country, community based, high volume eye hospital. METHODS: In a non-comparative interventional case series, the authors reviewed the surgical outcomes of 593 patients with cataract operated upon by three high volume surgeons on six randomly selected days. There were 318 female (54%) and 275 male (46%) patients. Their mean age was 59.57 (SD 10.13) years. The majority of the patients underwent manual small incision cataract surgery (manual SICS). Extracapsular cataract extraction with posterior chamber intraocular lens (ECCE-PCIOL) and intracapsular cataract extraction (ICCE) were also done on a few patients as clinically indicated. RESULTS: Best corrected visual acuity of >or=6/18 was achieved in 94% of the 520 patients who could be followed up on the 40th postoperative day (88% follow up rate). Intraoperative and immediate postoperative complications as defined by OCTET occurred in 11 (1.9%) and 75 (12.6%) patients, respectively. Average surgical time of 3.75 minutes per case (16-18 cases per hour) was achieved. Statistically significant risk factors for outcomes were found to be age >60, sex, and surgeon. CONCLUSION: High volume surgery using appropriate techniques and standardised protocols does not compromise quality of outcomes.

Age Factors↗
PubMed2004

Classification of childhood hearing impairment: implications for rehabilitation in developing countries.

AIM: To ascertain the rehabilitation needs of hearing impaired school entrants in developing countries based on current criteria for evaluating classification of childhood hearing impairment. METHODS: The profile of hearing impairment was examined in 50 children from eight randomly selected mainstream schools, based on findings from medical history, physical examination, otoscopy, pure-tone audiometry and tympanometry. The hearing thresholds across frequencies 0.25 - 8.0 kHz were analysed. The results were compared with conventional pure-tone averages (0.5 - 4.0 kHz) and WHO's criteria/threshold for disabling hearing impairment. RESULTS: Seventeen (94.4%) of the 18 children with conductive hearing loss based on conventional audiometry had high-frequency hearing loss. Similarly, 10 children (83.3%) of the 12 children with sensorineural hearing loss and 19 children (95%) of the 20 children with mixed hearing loss had high-frequency hearing loss. Forty-six hearing impaired children (92%): comprising those with permanent unilateral hearing loss > 30 dBHL, permanent hearing loss would have been missed by WHO criteria. CONCLUSIONS: Conventional school audiometry and WHO criteria for disabling hearing impairment are unlikely to detect the full spectrum of hearing disability in relation to activity limitation and participation restriction. The rehabilitation needs of the affected children cannot therefore be appropriately addressed by these approaches.

Acoustic Impedance Tests↗