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PubMed1990

Soak-away systems and possible groundwater pollution problems in developing countries.

People in the developing countries do not have adequate sanitation and everyone defaecates somewhere. Those who do not have a toilet or latrine have to resort to indiscriminate defaecation either in the sea shore such as in the Lagos lagoon in Nigeria, or vacant plots and open drains as in Iddo area of Lagos and sides of rural footpaths. Water closets (W.C.s) are the most accepted sanitation system, but the cost of operating and maintaining them is high. As a result sewerage is not appropriate for the majority of people in developing countries whose greater population live in rural areas and small towns. The majority of people in urban areas use septic tanks and very often most of these septic tanks are not properly designed or sometimes located too close to sources of water supply, which then become contaminated. It is generally believed that systems like septic tanks, pit latrines and aqua privies are capable of totally eliminating these pathogens. There are many problems associated with the physical, chemical and biological processes that may result in groundwater pollution from septic tanks. Many experiments have shown that faecal organisms do not travel any significant distance radially as a result of concentration gradient. They are, however, carried with groundwater flow. The task is to prevent pathogens from getting into the aquifer. This paper attempts to highlight the ability of some enteric viruses to survive septic tank wastewater treatment.

Developing Countries↗
PubMed1996

Environmental toxicants in developing countries.

Health effects from environmental toxicants may be a more serious problem in developing countries compared with developed countries because the problem is potentiated by other factors: a) the lack of or failure to enforce regulations, which allows human exposures to genotoxic agents; b) undernourishment of the lower economic and social classes that comprise the most exposed populations from industrial and agricultural activities; and c) parasitic infections that afflict a wide range of populations in both urban and rural areas. Data on the genotoxic effects of different types of exposures, including environmental exposes (natural and industrial), occupational exposures, and infections and medical treatments, are presented and discussed with the point of view that all these factors must be taken into account with respect to regulation and the protection of human health. Occupational exposures in developing countries are higher than in developed countries due to lack of stringent regulations, lack of knowledge of the risks involved, and the negligence of workers. General pollution is another important issue since developed countries have established strict regulations and risky industrial processes are being exported to developing countries, along with banned substances and dangerous industrial wastes. It should be emphasized that stringent regulations in developed countries will not prevent exposures in the long term because toxic substances that are released into the environment will ultimately reach all our future generations.

Animal Population Groups↗
PubMed1994

Options for provision of occupational health services in developing countries.

Different models of occupational health care are available for developing countries to consider in developing their provisions for occupational health services. Even in developed countries there are differences between legal requirements for personnel and services, and voluntary provision of services. The range of activities covered by occupational health services can be extensive. Developing countries often focus on the provision of clinical care and treatment facilities at the workplace with less emphasis on preventive services. This may be related to the perceived value of the clinical skills of the doctor and nurse available at the workplace, plus the lack of other occupational health personnel, and the limited access to occupational hygiene and laboratory facilities. For future occupational health provisions, developing countries have to consider the balance between preventive services versus other clinical and non-clinical services. There will be benefits in reviewing the experience of developed countries in terms of the essential skills and training of occupational health personnel, and the contribution this would make to the health of the workforce in developing countries.

Developing Countries↗
PubMed1991

Chemicals and environmentally caused diseases in developing countries.

This chapter discusses international aspects of diseases resulting from exposure to chemical pollutants in the environment, with an emphasis on developing countries. These countries share many of the same problems of air, water, and pesticide pollution that face the more industrialized countries. In developing countries, however, the problems are compounded by a number of unique situations, viz., economic priorities, high burden of infectious diseases, impoverishment, and absence of a regulatory framework for the disposal of toxic chemicals. This discussion emphasizes the importance of interactions among toxicants, malnutrition, and infectious diseases for both urban and rural populations insofar as these interactions contribute to disease. Toxicants not only produce disease directly but also exacerbate diseases with other causes. Specific examples from developing countries demonstrate how human health effects from exposures to environmental chemicals can be assessed. While they do not strictly fall under the rubric of "developing countries," the public health consequences of inadequate control of environmental pollution in the East European countries should demonstrate the magnitude of the problem, except that in developing countries the public health consequence of environmental chemicals will be aggravated by the widespread malnutrition and high prevalence of infectious diseases. Much needs to be done before we can adequately quantify the contribution of environmental chemicals to morbidity and mortality in developing countries with the level of sophistication now evident in the charting of infectious diseases in these countries.

Air Pollution↗
PubMed1992

Health insurance in developing countries: lessons from experience.

Many developing countries are currently considering the possibility of introducing compulsory health insurance schemes. One reason is to attract more resources to the health sector. If those who, together with their employers, can pay for their health services and are made to do so by insurance, the limited tax funds can be concentrated on providing services for fewer people and thus improve coverage and raise standards. A second reason is dissatisfaction with existing services in which staff motivation is poor, resources are not used to best advantage and patients are not treated with sufficient courtesy and respect. This article describes the historical experience of the developed countries in introducing and steadily expanding the coverage of health insurance, sets out the consensus which has developed about health insurance (at least in Western European countries) and describes the different forms which health insurance can take. The aim is to bring out the advantages and disadvantages of different approaches from this experience, to set out the options for developing countries and to give warnings about the dangers of some approaches.

Contract Services↗
PubMed1995

Planning appropriate hospitals for developing countries.

Since the most prevalent characteristic of developing countries is the lack of human and financial resources, and that social custom and practice play a more important role in developing countries than in others, the paper discusses how those characteristics influence the planning of hospitals, focusing on the issues that differentiate hospitals in developing countries from those in other parts of the world. Against that background the paper proposes an approach to planning hospitals for incremental development and for subsequent growth and change to ensure that they will remain appropriate to evolving patterns of healthcare and changing circumstances in developing countries.

Developing Countries↗
PubMed1994

Managing the health care market in developing countries: prospects and problems.

There is increasing interest in the prospects for managed market reforms in developing countries, stimulated by current reforms and policy debates in developed countries, and by perceptions of widespread public sector inefficiency in many countries. This review examines the prospects for such reforms in a developing country context, primarily by drawing on the arguments and evidence emerging from developed countries, with a specific focus on the provision of hospital services. The paper begins with a discussion of the current policy context of these reforms, and their main features. It argues that while current and proposed reforms vary in detail, most have in common the introduction of competition in the provision of health care, with the retention of a public monopoly of financing, and that this structure emerges from the dual goals of addressing current public sector inefficiencies while retaining the known equity and efficiency advantages of public health systems. The paper then explores the theoretical arguments and empirical evidence for and against these reforms, and examines their relevance for developing countries. Managed markets are argued to enhance both efficiency and equity. These arguments are analysed in terms of three distinct claims made by their proponents: that managed markets will promote increased provider competition, and hence, provider efficiency; that contractual relationships are more efficient than direct management; and that the benefits of managed markets will outweigh their costs. The analysis suggests that on all three issues, the theoretical arguments and empirical evidence remain ambiguous, and that this ambiguity is attributable in part to poor understanding of the behaviour of health sector agents within the market, and to the limited experience with these reforms. In the context of developing countries, the paper argues that most of the conditions required for successful implementation of these reforms are absent in all but a few, richer developing countries, and that the costs of these reforms, particularly in equity terms, are likely to pose substantial problems. Extensive managed market reforms are therefore unlikely to succeed, although limited introduction of particular elements of these reforms may be more successful. Developed country experience is useful in defining the conditions under which such limited reforms may succeed. There is an urgent need to evaluate the existing experience of different forms of contracting in developing countries, as well as to interpret emerging evidence from developed country reforms in the light of conditions in developing countries.

Commerce↗
PubMed1980

[Cardiovascular mortality in industrial and developing countries (author's transl)].

In developing countries when causes of death are registered cardiovascular mortality levels revealed themselves surprising. For instance, they appear to be more important in Tebessa (Algeria) during 1974-1975, Mauritius (1973-1976) or Egypt (1971-1973) than in france, United States or Sweden before the age of 45 and very near after this age. These results are consistent with the mortality patterns by causes of death proposed by Preston according to life expectancy at birth. Before the age of 45, rheumatic heart diseases can explain this overmortality. After this age the recent observations in the Third-World, especially in Africa, show that cardiomyopathy, cardiomegaly and principally hypertension are widely spread to-day. On the other hand, ischemic heart diseases are still rare. For many authors, cardiovascular diseases are increasing in Africa because ways of life in developing and developed countries are becoming identical. In fact, this trend could be a little artificial. Formerly indeed, disparity in population age structures and mortality differences for all other causes were not enough taken into account.

Adolescent↗
PubMed1972

Concept of a paediatric emergency ward for the cities of a developing country.

Children's hospitals in developing countries carry an enormous patient load. Available facilities must be organized to provide essential care for all. At the Red Cross Children's Hospital in Cape Town this has been achieved by the development of an emergency ward attached to the outpatient department. It is suggested that this concept should be applied in large hospitals of other developing countries.

Bronchiolitis, Viral↗
PubMed1990

Reproductive epidemiologic research in developing countries.

This paper discusses the scientific rationale for carrying out reproductive epidemiologic research in developing countries, and the generalizability of results of research done in developed countries to developing countries. Practical problems encountered in doing research in developing countries include limited resources, overcommitted researchers, cost, and study monitoring. Cultural differences that affect the design and conduct of research activities in developing countries are also discussed.

Anemia, Sickle Cell↗
PubMed1990

A study of financial resources devoted to research on health problems of developing countries.

The Commission on Health Research for Development is an independent, international commission composed of 12 leaders from the fields of health research, social science research and development policy. Chaired by John Evans, the other Commissioners are Gelia Castillo, vice-chair, F. H. Abed, Sune Bergstrom, Doris Calloway, Esmat Ezzat, Demissie Habte, Walter Kamba, Adetokumbo Lucas, Adolfo Martinez-Palomo, Saburo Okita and V. Ramalingaswami. The Commission began its work in November 1987, charged with analysing the strengths, weaknesses and gaps in current research on health problems of developing countries, and making proposals and promoting action for improvement. The Commission is sponsored by a variety of foundations, bilateral donor agencies, and international organizations. The Commission's report was published in the spring of 1990. As part of the work of the Commission Secretariat, we have undertaken a study of financial resources devoted to research on the health problems of developing countries. The study which began in May 1988 has three objectives: (i) To describe the current pattern of funding for research on the health problems of developing countries. (ii) To provide a baseline against which future trends and/or new programmes can be measured. (iii) To explore the possibility of an ongoing information system on research on health problems of developing countries.

Developing Countries↗
PubMed1985

Socioeconomic and health effects on mortality declines in developing countries.

It has been argued that mortality declines in developing countries have not been associated with social and economic factors because of the diffusion from the developed countries to the developing countries of health and medical techniques. This paper examines the relationship between socioeconomic development and health and mortality declines in developing countries which are in two different stages of the demographic transition. A path model linking socioeconomic and health variables and mortality is developed and tested for early and late transition nations. The empirical findings indicated that the network of socioeconomic variables and their effects on mortality were much more significant in late transition countries than in early transition countries. While the impact of health services on crude death rates is large in the early transition nations, its impact declines considerably as countries reach a more transitionally 'mature' stage.

Cross-Cultural Comparison↗
PubMed1996

Prospects, problems, and prerequisites for national health examination surveys in developing countries.

Design options for the development of health information systems are evaluated. The health examination survey is found to be an appropriate method for meeting data needs for health planning, program design, and evaluation activities in developing countries. The model proposed is a national cross-sectional prevalence survey employing both interviews and physical examinations to produce a health status profile of a countries population. Examination data are objective, internationally comparable, and not dependent upon reports of clinical encounters in the population. Limitations inherent to health examination surveys are reviewed in reference to their potential in developing countries. Not all countries may be able to conduct health examination surveys; criteria are presented to assist in evaluation of the feasibility of application in specific countries.

Cross-Sectional Studies↗
PubMedDate not supplied

[Organ transplantation as a health priority in developing countries].

The epidemiology profile of developing countries is in transition. While the prevalence of infectious and preventable diseases, malnutrition, and in general the health problems traditionally associated to the poor, is still high, the characteristic health profile of industrialized countries (i.e. chronic and degenerative diseases, accidents, violence, social pathology) is beginning to surface. This paper focuses on the need to consider organ transplantation as a health priority in developing countries, as an important element in the global strategy to cover both aspects of the health care demand.

Developing Countries↗
PubMedDate not supplied

[Artificial crystalline lens in developing countries (author's transl)].

In developing countries, cataract affects many young but also poor patients. They have difficulties to get operated and generally cannot afford to buy spectacles. Implanting artificial crystalline lens is, then, theorically the best solution. This skillfull technique, nevertheless, requires a high level sanitary environment. Recent advances in the surgical treatment of cataract and postoperative correction of aphakia minimized its risks. Improvements in plastics technology give new possibilities. A study of the various techniques available and of the changes required in the sanitary environment of developing countries give some hope for a possibility of using artificial crystalline lens in these countries.

Cataract↗
PubMed1991

Public and private donor financing for health in developing countries.

Among the many variables that influence the outcome of national health status in both developed and developing countries, the availability and efficiency of financing is critical. For 148 developing countries, annual public and private expenditures from domestic sources (1983) were estimated to be approximately $100 billion. For the United States alone, annual public and private costs for medical care are almost five times larger ($478 billion, 1988). In contrast to domestic expenditures, the total flow of donor assistance for health in 1986 was estimated to be $4 billion, approximately 5% of total current domestic expenditures by developing countries. Direct donor assistance for development purposes by the United States Government approximates 0.5% of the US federal budget (1988). Approximately 10% of all United States development assistance is allocated for health, nutrition, and population planning purposes. While the total health sector contribution is on the order of $500 million annually, the US contribution represents about 13% of health contributions by all external donors. In sub-Saharan Africa, all donor health allocations only reach 3.4% of total development assistance. While available data suggest that private and voluntary organizations contribute approximately 20% of total global health assistance, data reporting methods from private agencies are not sufficiently specific to provide accurate global estimates. Clearly, developing countries as a whole are dependent on the efficient use of their own resources because external financing remains a small fraction of total domestic financing. Nevertheless, improvement in health sector performance often depends on the sharing of western experience and technology, services available through external donor cooperation. In this effort, the available supply of donor financing for health is not restricted entirely by donor policy, but also by the official demand for external financing as submitted by developing countries. In perspective, the supply of financing for health greatly exceeds the receipt of well-articulated and officially approved proposals from developing countries. The major constraints that produce this imbalance are unfamiliarity of ministries of health with potential donor sources; passive approaches to external financing; unfamiliarity with proposal preparation; increasing competition within developing countries by competing sectors, such as industry and agriculture; limited numbers of trained personnel; and absence of an international system which is able to support developing countries in mobilizing external financing. Tested solutions to these issues have been applied in one geographic region.(ABSTRACT TRUNCATED AT 400 WORDS)

Delivery of Health Care↗
PubMed1994

Reversibility of stunting: epidemiological findings in children from developing countries.

The growth literature from developing countries is reviewed to assess the extent to which stunting, a phenomenon of early childhood, can be reversed in later childhood and adolescence. The potential for catch-up growth increases as maturation is delayed and the growth period is prolonged. However, maturational delays in developing countries are usually less than two years, only enough to compensate for a small fraction of the growth retardation of early childhood. Follow-up studies find that subjects who remain in the setting in which they became stunted experience little or no catch-up in growth later in life. Improvements in living conditions, as through food supplementation or through adoption, trigger catch-up growth but do so more effectively in the very young. One study cautions that in older adopted subjects, accelerated growth may accelerate maturation, shorten the growth period and lead to short adult stature.

Adolescent↗