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PubMed2000

Paediatric infective endocarditis: 19-year experience at a tertiary care hospital in a developing country.

A retrospective study was undertaken to study children who presented with infective endocarditis (IE) to a university teaching hospital in Beirut, Lebanon, between January 1977 and May 1995. Of 41 patients with IE (24F, 17M), 28 (68%) were diagnosed between 1977 and 1985. Patients' ages ranged from 3 to 18 y (mean age 11.3+/-2.8 y), and 13 patients were <10 y of age. Clinical presentations included: fever (in 88%), heart failure (in 39%), neurologic findings (in 20%) and embolic phenomena (in 22%). Nineteen patients (46%) had underlying congenital heart disease (CHD) with tetralogy of Fallot and pulmonary stenosis being the most common. Sixteen patients (39%) had underlying rheumatic heart disease (RHD). A total of 5 children (12%) with normal cardiac anatomy had IE. One had underlying acquired viral myocarditis with mitral insufficiency. Echocardiography showed vegetations in 60%. Blood cultures were positive in 31 patients (76%). IE occurred in three patients following cardiac surgery. In one patient it occurred within 2 mo of surgery and in the other two it occurred within 6 mo. Streptococcus viridans and Staphylococcus aureus were the two most commonly isolated bacteria. Overall mortality rate was 29% (not statistically significant between patients presenting between 1977-1985 and 1986-1995; p = 0.17). There was no statistically significant difference in mortality among the groups (five in the group with CHD, six with RHD and one with structurally normal heart). This study demonstrates that RHD is an important underlying cause of IE in children in our community. This finding is similar to those in other developing countries and different from those in developed countries. Distribution of pathogens and CHD in our study is comparable to some reports in the literature, except for the higher proportion of patients with underlying pulmonary stenosis. Bacterial endocarditis prophylaxis should be emphasized in patients with RHD or pulmonary stenosis.

Adolescent↗

PubMed2003

Micronutrient status during pregnancy and outcomes for newborn infants in developing countries.

More than 9 million neonatal deaths occur each year, 98% of them in developing countries. Neonatal deaths account for two-thirds of deaths in infancy and 40% of deaths before age 5 y. The major direct causes of neonatal death are infections, preterm delivery and asphyxia. Important indirect causes include low birth weight and hypothermia. The present body of work on multiple micronutrient interventions is not sufficient for us to draw conclusions on their effects on neonatal well-being. Because studies have generally concentrated on single micronutrients and a range of outcomes, this paper reviews the findings for individual nutrients and then summarizes the situation. The evidence for the contribution of micronutrient deficiencies to perinatal mortality and duration of gestation is limited, and the evidence base for individual micronutrient effects on neonatal mortality and morbidity is patchy. To translate knowledge into policy, community evaluations of effect and an expanded evidence base that includes affordability, acceptability and scalability are also required. A balance between supply-side and demand-side interventions must be struck, with an emphasis on effect and sustainability. Among the key requirements are randomized, controlled community effectiveness trials of the effect of micronutrient supplementation in pregnancy on perinatal mortality and neurodevelopment, studies on improving adherence and studies on the relation between micronutrient deficiencies and sepsis and neonatal encephalopathy. It would also be helpful to look at mechanisms for bringing the periconceptional period within the ambit of trials.

Developing Countries↗

PubMed2003

A comparison of four screening methods for cervical neoplasia in a developing country.

OBJECTIVE: The purpose of this study was to compare the results of cytologic examination, cervicography, direct acetic acid test, and magnified acetic acid test (speculoscopy) with the results of histologic examination. STUDY DESIGN: The study was a prospective, descriptive, and analytic study that included 1286 women in a primary health facility who were screened by cytologic examination, cervicography, direct acetic acid test, and magnified acetic acid test (speculoscopy). Histologic evidence was obtained on all patients by means of cervical punch biopsies. The biopsy specimens were taken from aceto-white areas or areas suspicious of cancer. In normal individuals, the specimens were taken from the external cervical os at the 12 or 6 o'clock position, whichever was most convenient. Positive cases were treated by colposcopy and large loop excision of the transformation zone. Testing for human immunodeficiency virus infection was not done. RESULTS: Of the 1286 women who were screened, 1093 women (85%) were eligible for analysis. The mean age of the women was 38.6 years. Because histologic evidence was obtained on all women, direct sensitivities and specificities could be calculated for each screening method. The sensitivity, specificity, and positive predictive values for cytologic examination were 53%, 95%, and 47%, respectively; for cervicography were 49%, 88%, and 26%, respectively; for the direct acetic acid test were 79%, 49%, and 12%, respectively; and for speculoscopy were 77%, 45%, and 11%, respectively. Of the 876 patients who were eligible for colposcopy, only 468 women (56%) eventually returned for colposcopy. CONCLUSION: Cytologic examination, cervicography, the direct acetic acid test, and speculoscopy are not suited for screening in developing countries because of the low sensitivity of the cytologic examination and the low specificity of the other tests. Two or more tests combined will increase the sensitivity, but the specificity remains low. Screening methods in developing countries remain an urgent problem.

Adult↗

PubMed2002

Establishing the propensity for dioxin formation using a plume temperature model for medical waste incinerator emissions in developing countries.

Air pollution control devices (APCDs) are not compulsory for medical waste incinerators (MWIs) in developing countries. In South Africa, combustion gases are usually vented directly to the atmosphere at temperatures greater than the formation temperature of dioxin. The possibility of dioxin formation outside the incinerator stack has been hypothesized. A plume model has been developed and tested in the wind tunnel with a scale model of an incinerator stack. The plume temperature and trajectory predictions of the plume model were verified within a +/- 3% experimental accuracy. Using South African data, the plume model predicts that the residence time of gases in the temperature range of 150-450 degrees C in a plume is 1.3 sec on average for 5% of a year (18 days) at meteorological conditions resulting in wind speeds of less than 1 m/sec. Two published dioxin formation models were used to assess the probability of dioxin formation in the plume. The formation models predict that the average polychlorinated dibenzodioxins/furans (PCDD/Fs) formed in the plume will exceed the stack emission regulations in South Africa of 0.2 ng/Nm3 toxic equivalent quotient (TEQ) by between 2 and 40 times. The calculated concentrations do not include additional gaseous PCDD/F compounds that may be formed at high-temperature post-combustion zones through pyrosynthesis mechanisms.

Air Pollution↗

PubMed2000

Criteria for clinical audit of the quality of hospital-based obstetric care in developing countries.

Improving the quality of obstetric care is an urgent priority in developing countries, where maternal mortality remains high. The feasibility of criterion-based clinical audit of the assessment and management of five major obstetric complications is being studied in Ghana and Jamaica. In order to establish case definitions and clinical audit criteria, a systematic review of the literature was followed by three expert panel meetings. A modified nominal group technique was used to develop consensus among experts on a final set of case definitions and criteria. Five main obstetric complications were selected and definitions were agreed. The literature review led to the identification of 67 criteria, and the panel meetings resulted in the modification and approval of 37 of these for the next stage of audit. Criterion-based audit, which has been devised and tested primarily in industrialized countries, can be adapted and applied where resources are poorer. The selection of audit criteria for such settings requires local expert opinion to be considered in addition to research evidence, so as to ensure that the criteria are realistic in relation to conditions in the field. Practical methods for achieving this are described in the present paper.

Developing Countries↗

PubMed2004

Protein/energy ratios of current diets in developed and developing countries compared with a safe protein/energy ratio: implications for recommended protein and amino acid intakes.

Revised estimates of protein and amino acid requirements are under discussion by the Food and Agriculture Organization (FAO)/World Health Organizaion (WHO), and have been proposed in a recent report on Dietary Reference Intakes (DRIs) from the USA. The nature and magnitude of these requirements are not entirely resolved, and no consideration has been given to the potential influence of metabolic adaptation on dietary requirements. We have examined the implications of these new values, and of the conceptual metabolic framework in which they are used, for defining the nutritional adequacy of protein intakes in developed and developing countries. We have expressed proposed values for protein requirements in relation to energy requirements, predicted for physical activity levels of 1.5, 1.75 and 2.0 times basal metabolic rate, in order to generate reference ratios for protein energy/total energy (reference P/E ratio) as a function of age, body weight, gender and physical activity level. Proposed values for amino acid requirements have been used to adjust the available digestible P/E ratio of foods and diets for protein quality. Focusing on the diets of UK omnivores and vegetarians and on diets in India, the risk of protein deficiency is evaluated from a comparison of P/E ratios of metabolic requirements with protein-quality-adjusted P/E ratios of intakes. A qualitative and conservative estimate of risk of deficiency is made by comparing the adjusted P/E ratio of the intake with a reference P/E ratio calculated for age, body weight, gender and physical activity according to FAO/WHO/United Nations University. A semi-quantitative estimate of risk of deficiency has also been made by the cut point approach, calculated as the proportion of the intake distribution below the mean P/E ratio of the requirement. Values for the quality-adjusted P/E ratio of the diet range from 0.126 for the UK omnivore diet to 0.054 for a rice-based diet of adults in West Bengal, which is lysine-limited, falling to 0.050 for 1-year-old children. The reference P/E ratio for men and women increases with age, is higher for females than males, is higher for small compared with large adults at any age and decreases with physical activity. Thus if a particular diet is potentially limiting in protein, protein deficiency is most likely in large, elderly sedentary women followed by the adolescent female and least likely in moderately active young children, the opposite of what has usually been assumed. Within the currently accepted framework, the diets do not meet the protein needs of the entire population of the UK, have a significant risk of deficiency throughout India for all except extremely active small adults, and are grossly inadequate for all population groups, apart from physically active young children in West Bengal, regardless of body weight or level of food intake. The lysine limitation of the cereal-based Indian diets is dependent on the choice of lysine requirement values from the published range. We consider that the value selected is too high, because of uncertainties and inconsistencies in the approaches used. A more appropriate choice from the lower end of the range would remove the lysine limitation of cereal-based diets, and reduce some of the perceived risk of deficiency. However, diets remain limited by the amount of digestible protein for many population groups, especially in West Bengal. In the context of risk management, one option would be to accept the current values and the conceptual metabolic framework within which they have been derived. This would have major implications for the supplies of high-quality protein to the developing countries. An alternative option would be to re-evaluate the currently proposed values for the requirements for protein and amino acids. We conclude that the choice of values for the adult lysine requirement should be re-evaluated and that serious consideration should be given to the extent to which adaptive mechanisms might enable the metabolic requirement for protein to be met from current intakes. This will entail a better understanding of the relationships between dietary protein and health.

Adolescent↗

PubMed2003

The economics of TB control in developing countries.

Tuberculosis is one of the world's biggest killers and the burden is skewed towards developing countries, where the relative share of this disease is largest. This has much to do with poor living conditions and less developed public health systems. Nevertheless, even with these factors taken into account, the mortality from this disease is still unjustifiably high given the fact that it is treatable in the vast majority of cases with relatively inexpensive drugs. There are three main reasons for this situation: a low propensity to seek healthcare when sick; poor diagnosis upon seeking care; and high levels of non-compliance with treatment when diagnosed. Taken in combination, this means that of those who seek care, some get appropriate diagnosis at their first contact, while many do not. Unfortunately, not all of those who are diagnosed actually begin treatment and of those who do, a smaller percentage actually complete it. This article will look at each of these issues, and in particular their costs, in turn, and suggest areas in which economics can help to develop solutions to them.

Antitubercular Agents↗

PubMed1999

Contribution of nutrition to the health transition in developing countries: a framework for research and intervention.

The major focus of public health programs in developing populations is alleviating undernutrition. In South Africa, however, as in many other developing countries, the African population is experiencing rapid urbanization characterized by a double burden of disease in which noncommunicable diseases (NCD) become more prevalent and infectious diseases remain undefeated. The possible mechanisms through which nutrition contributes to the additional vulnerability to NCD experienced by developing populations are explored and research priorities in this area are identified.

Developing Countries↗

PubMed2006

Cotrimoxazole prophylaxis for HIV-positive TB patients in developing countries.

Despite provisional recommendations from the World Health Organization and UNAIDS that cotrimoxazole (CTX) prophylaxis be offered to all individuals living with AIDS, including HIV-positive patients with TB, its routine use in developing countries particularly Africa has been minimal. Concerns were expressed regarding its effectiveness in areas of high bacterial resistance, that its widespread use might substantially increase bacterial cross-resistance in the community and that this intervention might promote resistance of malaria parasites to sulphadoxine-pyrimethamine. We review the current evidence on the above concerns and highlight the main operational considerations related to implementing CTX prophylaxis as a basic component of care for HIV-positive TB patients in developing countries.

AIDS-Related Opportunistic Infections↗

PubMed2004

[A survey of school teachers' knowledge and behaviour about epilepsy, in a developing country such as Senegal].

Epilepsy is one of the most common disorders encountered in children of developing countries. In Senegal, as in many other African countries, the disease is enrobed in superstition, discrimination, and stigma. There is a clear-cut lack of information programs in the developing world about seizures and epilepsy. Academic achievement of children with epilepsy is hampered by social barriers in addition to the burden of the disease and its treatment. The aim of this study was to evaluate teachers'knowledge, awareness, and current attitudes about epilepsy in order to obtain baseline data for the development of a school health education program on epilepsy. The study was carried out in Dakar. It was conducted by sending self-administered and anonymous questionnaires to 400 elementary school teachers; the data were randomly mapped, stratified, and chosen to produce a statistically representative sample of the teacher population of Dakar. The questionnaires contained 22 items related to knowledge of epilepsy, the attitude of teachers towards epilepsy, and their ability to provide first aid in case of seizures. A total of 373 teachers (93p.cent) completed the questionnaires. For 69p.cent, epilepsy arises in the brain, for 28.7p.cent it is a subnatural affliction. Epilepsy was considered to be contagious for 24p.cent and could be cured for 73p.cent. Although 66p.cent would help an epileptic pupil during a seizure, 53p.cent mentioned harmful measures. Eighty-four percent noticed that an epileptic child could go to a normal classroom, while 62.5p.cent would prefer a special school. Eighty-four percent said their knowledge on epilepsy was not sufficient and the majority (99p.cent) desired training on epilepsy. For 25.7p.cent, better collaboration between parents, doctors, and teachers would b helpful to achieve better management of epileptic children. This study demonstrated encouraging knowledge of teachers about epilepsy. However, some of their wrong attitudes may be attributed to superstitions and could be improved by informative actions and better training about epilepsy. Such education might be provided by local health professionals with the collaboration of parents, teachers, and non-governmental organizations.

Adult↗

PubMed2000

Potential of using existing injury information for injury surveillance at the local level in developing countries: experiences from Bangladesh.

Although injury is a major public health problem in Bangladesh, as in other low income countries in the world, it has gained very little attention from policy makers, or even health professionals, mainly due to the lack of valid injury information in these countries. To address the injury problem, there is an urgent need to develop injury surveillance activities, based on existing sources of potential interest for obtaining injury information. This study is an evaluation of existing injury data sources in terms of prevention orientation representativeness, and sustainability with respect to the use of these sources in injury surveillance at the local level in Bangladesh. The regular injury information sources that have been used in this study include hospital records, post-mortem reports, newspaper reports, and police reports. In addition, 60 health practitioners in the area, representing various categories, were interviewed according to questionnaire, and ten others were interviewed in-depth about their opinions regarding their participation in the injury surveillance system. The information sources were then assessed for their potential to be included in the surveillance system. The validity was estimated by means of comparisons of the different sources. All the existing sources of injury information suffer from certain deficiencies such as, lack of representativeness, low prevention orientation and poor sustainability. Post-mortem reports and police reports have been found to be potential sources of mortality data but not morbidity data. Hospital records can be seen as potential sustainable sources of injury morbidity data but suffer from low prevention orientation and representativeness. The injury information was not consistent from source to source and failed to depict the true picture of injury in the area. To develop an injury surveillance system, a combination of data obtained from several different sources is necessary to compensate for inadequacies in the individual sources and to improve the overall usefulness of the system. Updated with E-codes, hospital discharge records could be used for injury morbidity surveillance, and updated police and post-mortem data can be used for mortality data in injury surveillance systems at the local level in developing countries.

Bangladesh↗

PubMed1993

Methodology of OTA's report on drug labeling in developing countries.

This article discusses the methodology of the OTA Project on Drug Labeling in Developing Countries. This report describes (a) the process of the project; (b) observations from a field visit to Thailand; (c) the development of the multinational pharmaceutical industry; and (d) influences on multinational pharmaceutical companies from their home countries, host countries, international organizations, self-regulation, and public interest groups. The results of the assessment will appear in the final report to Congress.

Consumer Advocacy↗

PubMed1999

Spinal tuberculosis in adults. A study of 103 cases in a developed country, 1980-1994.

Spinal tuberculosis (TB) accounts for about 2% of all cases of TB. New methods of diagnosis such as magnetic resonance imaging (MRI) or percutaneous needle biopsy have emerged. Two distinct patterns of spinal TB can be identified, the classic form, called spondylodiscitis (SPD) in this article, and an increasingly common atypical form characterized by spondylitis without disk involvement (SPwD). We conducted a retrospective study of patients with spinal TB managed in the area of Paris, France, between 1980 and 1994 with the goal of defining the characteristics of spinal TB and comparing SPD to SPwD. The 103 consecutive patients included in our study had TB confirmed by bacteriologic and/or histologic studies of specimens from spinal or paraspinal lesions (93 patients) or from extraspinal skeletal lesions (10 patients). Sixty-eight percent of patients were foreign-born subjects from developing countries. None of our patients was HIV-positive. SPD accounted for 48% of cases and SPwD for 52%. Patients with SPwD were younger and more likely to be foreign-born and to have multiple skeletal TB lesions. Neurologic manifestations were observed in 50% of patients, with no differences between the SPD and SPwD groups. Of the 44 patients investigated by MRI, 6 had normal plain radiographs; MRI was consistently positive and demonstrated epidural involvement in 77% of cases. Bacteriologic and histologic yields were similar for surgical biopsy (n = 16) and for percutaneous needle aspiration and/or biopsy (n = 77). Cultures for Mycobacterium tuberculosis were positive in 83% of patients, and no strains were resistant to rifampin. Median duration of antituberculous chemotherapy was 14 months. Surgical treatment was performed in 24% of patients. There were 2 TB-related deaths. Our data suggest that SPwD may now be the most common pattern of spinal TB in foreign-born subjects in industrialized countries. The reasons for this remain to be elucidated.

Adolescent↗

PubMedDate not supplied

Tuberculosis in developing countries and methods for its control.

Tuberculosis is a major cause of morbidity and mortality in developing countries. It is estimated that one-fifth of the world population is infected, 12-16 million people have the disease, every year 6-8 million develop tuberculosis and 2-3 million die from it. Four methods for the prevention of tuberculosis are available: improvement of socio-economic conditions, case-finding and treatment, chemoprophylaxis, and vaccination. Each of these methods is examined in relation to a model of the chain of transmission and development of disease. Improvement of socio-economic conditions, responsible for the decline of tuberculosis in the developed world, must be seen as a long-term solution. Case-finding and treatment is the only method expected to have an important short-term impact on transmission. A summary of the results of 35 studies shows the estimated efficacy of bacillus Calmette-Guérin (BCG) vaccination ranging from 96% to none. Follow-up results from 10 controlled trials are consistent with waning of BCG protective efficacy with time since vaccination. Chemoprophylaxis and vaccination are expected to protect the individual but not to have a significant short-term impact on transmission.

Antitubercular Agents↗

PubMedDate not supplied

Respiratory health effects associated with exposure to indoor wood burning in developing countries: a Papua New Guinea perspective.

Some of the highest exposures to air pollutants in developing countries occur inside homes where solid biofuel, particularly wood fuel, is used for daily cooking. A relatively high proportion of the world population living in these countries is exposed to increased levels of indoor air pollutants produced by inefficiently burning stoves. Inhalation of these pollutants may have serious consequences, which are highlighted in this paper, for the respiratory health of the people who have been exposed.

Air Pollution, Indoor↗

PubMed2000

Overweight and obesity in preschool children from developing countries.

OBJECTIVES: To estimate levels and trends in overweight and obesity in preschool children from developing countries; to study how overweight varies by the educational level of the mother, by urban or rural residence, and by gender; to investigate how these relationships are related to the gross national product (GNP). DESIGN: 71 national nutrition surveys since 1986 from 50 countries were used. SUBJECTS: 150,482 children 12 to 60 months from the most recent survey from each country were the primary sample. MEASUREMENTS: Overweight and obesity were defined as weight-for-height (>1 or >2 s.d., respectively) of the WHO/NCHS reference curves. Stunting was <-2 s.d. of the same reference. Urban was as defined in each of the surveys and higher education was defined as at least one year of secondary schooling or higher. RESULTS: 32 of 50 countries had a prevalence of obesity below 2.3%, the value in the reference population. The prevalences of overweight and obesity were lowest in Asia and in Sub-Saharan Africa. In 17 countries with serial data, no consistent regional trends could be detected. Overweight was more common in urban areas, in children of mothers with higher education, and in girls; these relationships did not differ by GNP but GNP was related negatively to stunting and positively to overweight. CONCLUSIONS: Obesity does not appear to be a public health problem among preschool children in Asia and Sub-Saharan Africa. In a number of countries in Latin America and the Caribbean, the Middle East and North Africa, and the region of Central Eastern Europe/Commonwealth of Independent States, levels are as high as in the United States.

Child Welfare↗

PubMed1987

Benefits and risks of childhood immunisations in developing countries.

The ratio of benefit to harm from an imaginary, modest immunisation programme in a developing country and the numbers of lives likely to be saved and severe handicaps prevented have been estimated. Immunisation is much more likely to benefit children than to harm them, and health workers can be confidently encouraged not to withhold the benefits of immunisation from most children.

Child↗

PubMed1987

Demographic aspects of population aging in developed countries.

There has been a dramatic growth of the elderly (aged 60+) population in the developed countries since 1950. By the year 2000, roughly 20% of the population in these countries will belong to the aged. Women far outnumber men among the elderly due to differential mortality trends between the sexes. Male life expectancy at age 60 varies from 19.1 years in Japan to 14.6 years in Hungary. Among females, the range is from 23.2 years (Canada) to 18.4 years (Romania). Mortality rates have declined dramatically in several countries since 1970 due primarily to declines in death rates from ischaemic heart disease and stroke.

Aged↗