Tremendous strides. Developing countries.
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Acquired Immunodeficiency Syndrome↗
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[An analysis of the fertility transition in developing countries].
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Age Distribution↗
Stat bite: Causes of death in developed and developing countries.
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Cardiovascular Diseases↗
TeleMedMail: free software to facilitate telemedicine in developing countries.
Telemedicine offers the potential to alleviate the severe shortage of medical specialists in developing countries. However lack of equipment and poor network connections usually rule out video-conferencing systems. This paper describes a software application to facilitate store-and-forward telemedicine by email of images from digital cameras. TeleMedMail is written in Java and allows structured text entry, image processing, image and data compression, and data encryption. The design, implementation, and initial evaluation are described.
Computer Communication Networks↗
[Education of foreign physicians from developing countries].
Qualification as specialized consultants in Germany is nearly impossible today for doctors from developing countries. Due to the dense medical job market, foreigners from overseas countries have no chance of being hired for a normal hospital job, which is necessary to get the specialist education. The author, therefore, emphasizes the necessity to create new possibilities of financing such colleagues. The reputation of German medicine might depend to an important extent on such a possibility. It is just this period of professional formation that gives the most important practical professional education for the future work of the candidates. The author asks the German Association of Surgeons for public support of this problem.
Career Choice↗
Prevention of diarrhoea in young children in developing countries.
An updated review of nonvaccine interventions for the prevention of childhood diarrhoea in developing countries is presented. The importance of various key preventive strategies (breast-feeding, water supply and sanitation improvements) is confirmed and certain aspects of others (promotion of personal and domestic hygiene, weaning education/food hygiene) are refined. Evidence is also presented to suggest that, subject to cost-effectiveness examination, two other strategies-vitamin A supplementation and the prevention of low birth weight-should be promoted to the first category of interventions, as classified by Feachem, i.e. those which are considered to have high effectiveness and strong feasibility.
Child↗
Assessing the linkages between low body mass index and morbidity in adults: evidence from four developing countries.
The study explores the relationship between low BMI and illness patterns in four developing countries. Using probit analysis, the study finds small but statistically significant effect of low BMI on proneness to morbidity in Pakistan and Kenya but none in the Philippines and Ghana. The circularity of causation between low BMI and illness was addressed by using the instrumental variable approach. The study also finds that the threshold at which morbidity begins to rise is not consistent with the suggested cut-off of BMI 18.5 kg/m2. The cut-offs were meaningful only in the case of Pakistan, but even here, the sizes of relationships are quite small although statistically significant.
Adolescent↗
Mould deterioration of agricultural commodities during transit: problems faced by developing countries.
Huge quantities of agricultural commodities are being either imported or exported by the developing countries. The commodities have to be transported from the fields of cultivation to the centres of consumption, considerable time being taken for the movement not only because of long distances but also because of various socio-economic, environmental and biological reasons. These commodities are likely to be damaged by mould growth and subsequent aflatoxin accumulation. If the contamination occurs during transit, often no insurance cover for the risk is available. Because of different methods of sampling followed in the exporting and importing countries it is often difficult to define the exact responsibility of the development of aflatoxin as having taken place during transit. The statistics of the export of aflatoxin high-risk commodities like red pepper (chillies), cotton seed and groundnut extractions clearly, for the last decade, demonstrate the extent of loss suffered by the exporting countries because of aflatoxins. The problem of mould damage and mycotoxin contamination can be minimised by improving facilities for storage at ports and transit points as well as on ships.
Aflatoxins↗
Hemophilia treatment in developing countries: products and protocols.
The most important aspect of management of hemophilia is to provide adequate replacement of safe clotting factor concentrates to prevent or treat bleeding episodes. There has been considerable progress in many countries in the developing world with regard to this aspect of care. However, very little data are available in the literature on the types of products being used for factor replacement and the doses being administered for control or treatment of bleeding in different countries. These data are important to document because only then can data from different centers be compared. This article provides data from seven countries: Korea, Malaysia, Thailand, Venezuela, Argentina, Iran, and India. It shows that there is wide variability not only in the types of products used (plasma to recombinant factor concentrates) but also in the doses administered (minimal to very high) for similar indications. Prospective documentation of data on musculoskeletal outcome at these centers and correlation with dose of factor replacement could help identify different models of care. Comparing such data and collating the experience in different countries could be useful for optimizing care and establishing cost-effective models. The combined experience in the developing world in providing hemophilia services should be used to define standards of care that are practical and to set achievable goals.
Developing Countries↗
Pulmonary tuberculosis in children in a developing country.
OBJECTIVE: We evaluated the clinical and epidemiologic characteristics of Peruvian children presenting with pulmonary tuberculosis (PTB) to determine whether features predictive of confirmed PTB could be identified. STUDY DESIGN: This was a cross-sectional study of 135 children (mean age: 6.8 years) presenting to the Hospital del Niño in Lima, Peru, with presumptive diagnosis of PTB. Clinical, epidemiologic, and laboratory findings were compared between 3 groups of pediatric patients with a presumptive diagnosis of PTB: those with positive Mycobacterium tuberculosis (MTB) cultures, those likely to have PTB based on clinical criteria but with negative cultures, and those who did not meet clinical diagnostic criteria or have positive cultures. RESULTS: A total of 50 (37%) patients were diagnosed with definitive PTB based on positive sputum culture. Another 55 (47%) patients were classified as having probable PTB based on meeting at least 2 of the following criteria: cough lasting for at least 2 weeks, typical chest radiograph changes, purified protein derivative (PPD) >/=10 mm, or history of tuberculosis family contact. Patients with definitive or probable PTB were significantly older than patients without clinical PTB, and those with symptomatic disease were significantly older than those with asymptomatic disease. Patients with PTB diagnosed by culture were significantly more likely than those diagnosed using clinical criteria to have cough lasting >/=2 weeks, fever, and a PPD >/=10 mm. CONCLUSIONS: The typical presentation of PTB in Peruvian children includes symptoms of active pulmonary disease similar to those seen in adults. This presentation differs significantly from that reported in developed countries, where many children have minimal or no symptoms at the time of presentation. The diagnostic criteria for pediatric PTB must be modified in hyperendemic developing country environments where features may differ from those described in the United States. The triad of cough lasting >/=2 weeks, fever, and a PPD >/=10 mm was highly predictive for culture-positive PTB among children in this low-income Peruvian population.
Age Factors↗
[The role of a specialised risk analysis group in the Veterinary Services of a developing country].
Since the World Trade Organization (WTO) Agreement on the Application of Sanitary and Phytosanitary Measures was established, risk analysis in trade, and ultimately in Veterinary and Animal Health Services, has become strategically important. Irrespective of their concept (discipline, approach, method, process), all types of risk analysis in trade involve four periods or phases:--risk identification-- risk assessment--risk management--risk information or communication. All veterinarians involved in a risk analysis unit must have in-depth knowledge of statistics and the epidemiology of transmissible diseases, as well as a basic knowledge of veterinary science, economics, mathematics, data processing and social communication, to enable them to work with professionals in these disciplines. Many developing countries do not have enough well-qualified professionnals in these areas to support a risk analysis unit. This will need to be rectified by seeking strategic alliances with other public or private sectors that will provide the required support to run the unit properly. Due to the special nature of its risk analysis functions, its role in supporting decision-making, and the criteria of independence and transparency that are so crucial to its operations, the hierarchical position of the risk analysis unit should be close to the top management of the Veterinary Service. Due to the shortage of personnel in developing countries with the required training and scientific and technical qualifications, countries with organisations responsible for both animal and plant health protection would be advised to set up integrated plant and animal risk analysis units. In addition, these units could take charge of all activities relating to WTO agreements and regional agreements on animal and plant health management.
Animals↗
The age structures and marital status differences of married and not married male suicide rates: 12 developed countries.
Male suicide rates, circa 1960, specific to age and marital status for 12 developed countries show married men with lower suicide rates than not married men. This results in differences in the age structures of married and not married suicide rates. We test three explanations of lower married than not married suicide rates: 1) Gibbs and Martin's (1964) marital status integration hypothesis; 2) marital status differences in norms regarding the acceptability of suicide; and 3) Durkheim's societal integration theory. All three explanations are supported by multivariate regressions. The strongest support is for societal integration. The models explain over 80% of the variance in both married and not married male age-specific suicide rates. These regression equations generate predicted suicide rates and these predicted rates are then used to see if they account for the observed age structures of married and not married men. They do in 19 of 24 tests.
Adolescent↗
Partnered care in the Bahamas: A model of advanced healthcare delivery for developing countries.
OBJECTIVE: To assess the delivery of advanced specialized medical care using The Partnered Care Model as a means of providing affordable access to all, irrespective of ability to pay. DESIGN AND METHODS: A retrospective analysis of all persons presenting to a specialized, private, cardiac unit, The Bahamas Interventional Cardiology Center (BICC), over an 8.5-year period from March 1996 to September 2004 was conducted. The Bahamas Heart Center's Discounted Service System had been applied since inception to all patients in three groups including insured patients billed at 100% of the fee schedule of The Medical Association of the Bahamas for the procedures performed, private self-pay and government patients billed at 75% and 50% respectively. Their respective distribution and contributions to total revenue was analyzed. A series of financial models were constructed taking into consideration variables that could influence the percentages of revenues collected from each sector and the number of individuals served RESULTS: One thousand five-hundred and forty-two patients received services in BICC over the 8.5 year period (56% males and 44% females age range: 0.25 - 96 years, with mean age of 55.7 years). One thousand eight-hundred and eighty-eight patient-procedures were performed, with 51% insured generating 69% total revenue, 18% Private producing 16% Revenue, and 31% Government patients generating 15%. Financial models were created to predict revenue behaviour in various scenarios. CONCLUSION: Partnered Care is a viable alternative for Governments (Ministries of Health) of developing countries to provide costly specialized healthcare to their populations at minimal expense and capital outlay. Partnered Care reduces the otherwise overwhelming burden of healthcare cost to governments, particularly in developing countries, by sharing the burden of care between the private, user and government sectors.
Bahamas↗
Single-dose versus multi-dose vaccine vials for immunization programmes in developing countries.
Excessive vaccine wastage and safety concerns have prompted the international health community to develop and supply vaccines in formats other than the standard multi-dose vial. This article presents a programmatic and economic comparison of the major differences between the multi-dose vials and single-dose formats used for immunization services in developing countries. Multi-dose vials, in general, sell at a lower per-dose price and occupy less cold-chain capacity than single-dose formats. However, higher wastage rates may offset these benefits, especially for more expensive vaccines. Single-dose formats offer several important programmatic benefits, such as increased vaccination opportunities and improved vaccine safety. One single-dose format, the prefilled auto-disable (AD) device, provides additional injection safety and convenience features because it physically combines the vaccine and AD syringe. Selecting the appropriate vaccine presentation will depend on many factors. However, multi-dose vials are likely to be most appropriate for cheaper vaccines and in settings where cold-chain storage capacity is restricted. Single-dose formats will be most appropriate for more expensive vaccines and where there are problems with unsafe injection practices. Prefilled AD injection devices will be particularly useful in expanding outreach services while eliminating the possibility of needle reuse.
Developing Countries↗
Potential interventions for the prevention of childhood pneumonia in developing countries: improving nutrition.
Acute respiratory infections are the leading cause of childhood death in developing countries. Current efforts at mortality control focus on case management and immunization, but other preventive strategies may have a broader and more sustainable effect. This review, commissioned by the World Health Organization, examines the relations between pneumonia and nutritional factors and estimates the potential effect of nutritional interventions. Low birth weight, malnutrition (as assessed through anthropometry), and lack of breast-feeding appear to be important risk factors for childhood pneumonia, and nutritional interventions may have a sizeable effect in reducing deaths from pneumonia. For all regions except Latin America, interventions to prevent malnutrition and low birth weight look more promising than does breast-feeding promotion. In Latin America, breast-feeding promotion would have an effect similar to that of improving birth weights, whereas interventions to prevent malnutrition are likely to have less of an effect. These findings emphasize the need for tailoring interventions to specific national and even local conditions.
Breast Feeding↗
What technologies for health care in developing countries?
In order to decide whether a health technology is suitable for introduction into a developing country it is first necessary to assess both it and the infrastructural conditions in which it would have to function. The present article examines the rationale for establishing national health technology assessment programmes and outlines how they might be conducted.
Delivery of Health Care↗
Factors affecting the contraceptive choice in a developing country.
OBJECTIVES: To evaluate the factors affecting the contraceptive choice of women in a developing country. METHODS: Demographic characteristics, education and income level, previous and current contraceptive choices of the women from a maternity and a university hospital were retrospectively reviewed for 2 years. The data obtained from the two hospitals were analyzed by Student's t- and chi2-tests. RESULTS: Family planning services were offered to 651 and 7427 women in the university and the maternity hospital, respectively. Although the mean ages and income levels of the women in two centers were similar, the women in the university hospital had lower mean gravidity and mean number of living child, while they had higher education level and previous modern contraceptive use (P < 0.05-0.001). The women in the university hospital more frequently preferred combined oral contraceptive and surgical sterilization, while those in the maternity hospital chose condom and intrauterine device (P < 0.01-0.001). CONCLUSIONS: Women with higher education level had a lower number of pregnancies and living children due to more frequent use of previous effective contraception and they chose combined oral contraceptives and irreversible methods more frequently.
Adolescent↗
Ablation of posterior urethral valves in the newborn using Fogarty balloon catheter: A simple method for developing countries.
PURPOSE: The aim of this study was to review the efficacy and safety of using a Fogarty balloon catheter to ablate posterior urethral valves (PUV) in the newborn in a developing country. METHODS: Five newborn babies weighing 1.4 to 3.9 kg (mean, 2.08 kg; with 4 weighing less than 2.0 kg) who had severe obstructive uropathy caused by PUV were subjected to valve ablation using a size 6F Fogarty balloon catheter in the radiology department without anesthesia. The ages ranged from 10 to 61 days (mean, 26.4 days) at the time of valve ablation. RESULTS: Successful ablation of PUV was achieved in 4 of 5 (80%) patients after one attempt at ablation. There was failure to ablate the PUV in 1 patient despite 2 attempts to do so. All 4 patients with successful ablation of PUV had grade IV vesicoureteric reflux (VUR) before valve ablation. Postablation micturating cystourethrogram (MCU) showed complete disappearance of VUR in one child. In 2, VUR improved to grade III and II immediately after valve ablation, and further improved to grade I and 0, respectively, at MCU repeated 3 months later. In one child, grade IV VUR persisted during the postablation VUR and remained at that grade 3 months later. CONCLUSIONS: Fogarty balloon catheter ablation of PUV is an effective, economic, and simple alternative to endoscopic valve fulguration in very sick and small neonates. It is particularly suitable for use in developing countries in which expensive endoscopes may not be readily available.
Catheter Ablation↗