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Medical technology will contribute to improving the health status of people in developing countries only when it is carefully implemented after proper planning. Providers, users, health ministry employees, and industry all share responsibility for proper planning and careful implementation.
PURPOSE OF REVIEW: Most people affected by glaucoma live in developing countries. Recent trials and reports provide sound evidence for management of glaucoma. This review extrapolates relevant articles to the developing world. RECENT FINDINGS: The predictive value of gonioscopy for progression of primary angle closure suspects (PACS) to primary angle closure (PAC) is only 22% (95% CI: 9.80-34.2). PACS are not uncommon; laser peripheral iridotomy (LPI) is neither indicated nor feasible for all. Twenty-eight and a half percent of PAC progress to primary angle closure glaucoma; the number needed to treat (NNT) for LPI to prevent progression is only 4. Laser peripheral iridoplasty controls acute angle closure glaucoma (AACG) faster than medical therapy alone. Primary lens extraction has also been suggested as treatment for AACG after control of the acute attack. A 5-year NNT for ocular hypertension (OH) of 20 is too high to allow treatment of all OH. High-risk OH and primary open angle glaucoma (POAG) have an NNT of 5 to 6 and merit treatment. Latanoprost and brimonidine are effective in lowering IOP in Asian eyes with POAG, but primary surgical therapy may be a more viable option. For cataract and coexistent glaucoma requiring filtration, trabeculectomy combined with the Blumenthal technique of cataract surgery may be as effective as trabeculectomy combined with phacoemulsification. SUMMARY: The principles of glaucoma management should be the same the world over. Considering the paucity of resources and competing opportunity costs, countries with limited resources have to extrapolate available information in a sensible and cost-effective manner.
One hundred eighteen patients--with 151 osteitis and 33 septic arthritis--were treated in a second category hospital in Sahel (Africa) between 1987 and 1988. A very simple and inexpensive treatment was used; this is of great importance in developing countries, with poor general hygiene and limited reserves of antibiotics. There is no special equipment required, excepted basic instruments for bone surgery. The results were: a) out of a total of 119 patients, 103 cures: 87.3% 7 amputations: 6% 7 failures: 6% 1 death (among the amputees) 1 lost to follow-up b) out of 151 osteitis, 134 cures: 88.7% c) out of 33 arthritis, 21 cures: 63.6%. This series shows that amputation is no longer necessary if the treatment is long enough. Amputation is indicated exceptionally in young patients, even in the poor conditions of the developing countries.
This paper describes a project funded by DFID (Department of International Development of the United Kingdom) for the establishment of breast clinic in an oncological center in a developing country, Sri Lanka. In Sri Lanka the commonest female cancer is breast cancer, with an incidence of 7.7 per 100,000. The project utilized a link with an existing breast clinic at the Royal Marsden UK. The principal methods used for establishing the clinic included, assessment of possible barriers by the exchange of senior staff, the development of guidelines, and regular review of progress by both link partners. As a result of these interactions, the first breast clinic in Sri Lanka was established. In has shown results in an increase in the pick up rate of new patients with breast cancer.
Although gonorrhoea and syphilis are the better known of the sexually transmitted diseases, attention has been drawn to the other sexually transmitted diseases caused by bacteria, viruses, fungi and parasites. Although statistics are not available in most developing countries, herpes genitalis has been suggested as commoner than syphilis as a cause of genital ulceration while non-specific urethritis is commoner than gonorrhoea as a cause of urethritis. The incidence, clinical features and diagnostic procedures of syphilis, herpes genitalis, non-gonococcal urethritis, lymphogranuloma venereum and trichomoniasis have been briefly discussed. The management of these conditions in developing countries have been outlined.
Today, the majority of the world's older persons live in less developed countries, where they represent an increasing proportion of the population. Using interviews conducted with 136 female heads of households in rural Sri Lanka, we considered the importance of age relative to other factors (e.g., marital status, education, employment, diet, and health practices) in accounting for use and evaluation of health services. Marital status figured more importantly than age in the use of services. As unmarried heads of households increase in less developed places, their demands for health care at the village level likely will escalate.
Project Quit Tobacco International is a pioneering attempt to develop culturally appropriate approaches to tobacco cessation within the health sectors of India and Indonesia. An overview of the formative research that contributed to intervention development is presented followed by a discussion of the research design adopted to evaluate the introduction of tobacco cessation in medical schools and clinics chosen for pilot testing. Four stages of research and implementation are described as a means of providing colleagues in developing countries with a prototype for future tobacco cessation research and training efforts.
Haemophilus influenzae type b (Hib) still causes a substantial number of deaths among children in developing countries, despite the availability of effective conjugate vaccines. A major obstacle in developing a Hib vaccine has been limited awareness about the impact of Hib disease. A tool was developed to estimate the national rates of Hib meningitis and pneumonia by assessing retrospective local data over 7 to 10 days. Data from 11 countries in Africa, the Middle East, and Asia were studied and showed rates of Hib meningitis from >50 cases per 100,000 children >5 years in Ghana and Uganda to <15 per 100,000 in Iran, Jordan, and Uzbekistan. Results were affected by the quality of available data. The Hib rapid assessment tool can be useful to countries that desire a timely assessment of Hib disease rates.
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During the 1990s, bioethicists raised questions about certain clinical trials conducted in developing countries. These inquiries led to revisions in the Declaration of Helsinki and recommendations from the US National Bioethics Advisory Commission. This article raises doubts about the original questions and subsequent recommendations. It is possible that impractical solutions have been proposed for nonexistent ethical problems.
This article explores conceptual issues in the development and use of environmental health indicators for basic problems related to water and sanitation in developing countries. In this context, faecal contamination is the most important environmental health problem, responsible for the death of approximately 3 million children a year, and the infection of hundreds of millions. Good indicators would be invaluable in assessing the magnitude and source of such problems in different settings.
The Toxicology Service at the Medical University of Southern Africa (MEDUNSA) deals with a predominantly developing Black patient population. To determine priorities, a retrospective comparative epidemiological study for the period 1970-1976 was made of Black and White patients admitted to the teaching hospitals of the University of the Orange Free State. The study revealed that among Whites the pattern of poisoning was very similar to that reported from developed countries. Drug poisonings predominated, there were more deliberate than accidental poisonings, and the majority of patients were females. Among the developing Black community, the picture differed markedly. Drug overdoses were responsible for very few poisonings, most poisonings were accidental, and males predominated. In addition, the vast majority of poisonings occurred in childhood. Accordingly, the toxicology service at MEDUNSA regards drug identification and psychiatric help for attempted suicides as low priorities and is geared toward establishing epidemiological trends and dealing with problems such as the treatment and prevention of organophosphate poisoning, paraffin poisoning, carbon monoxide poisoning, and poisoning with traditional African medicines.
A survey of Essential National Health Research (ENHR) was conducted between December 1997 and November 1998 in nine developing countries. A total of 27 respondents from seven South East Asian and two Caribbean countries completed questionnaires. Respondents included 14 men and 13 women with a median age of 48 years (range 25-69 years); 15 were researchers, seven were health providers, three policy makers and one a community representative (one no response). ENHR was formally adopted in five countries mainly through public policy statements. Seven countries had a mechanism in place for promotion of ENHR and national meetings were held in five countries in the year prior to the survey. A special activity was conducted in order to define health research priorities in eight countries and a list of these priorities was available in seven countries. The level of ENHR activity was ranked as low or moderate in most countries except India and Malaysia which were rated as moderate to high. Three countries reported that the process resulted in new or additional funds being made available for research, while India reported available funds being reallocated to meet the priorities defined. The respondents of six countries said that ENHR networking had led to tangible results, including improved collaboration among researchers and research institutions and the sharing of resources among different organizations (five countries). The ENHR process had resulted in research findings being used to formulate or change health policy in five countries. Most countries had not produced any new research protocols through the ENHR process. However, there were 250 new research protocols in India and 68 in Pakistan, of which 20 and between 25 and 35, respectively, were funded and 15 peer reviewed articles had been published from India. This survey does suggest that the ENHR process may be promoting health research on priority health problems and the use of results to formulate policy in selected countries. However, it is too early to assess the contribution of ENHR to health and development and a variety of different studies would be needed to conduct this assessment.
Obesity is one of the main public health problems in developed countries. It is considered to be a risk factor associated with the genesis or development of the major chronic diseases. The classification of a population by weight and the awareness of its determining factors are essential elements in order to undertake health planning programmes and health promotion projects. In Europe, the prevalence of obesity (BMI 30) is greater in northern countries (7% in men and 9% in women in the Netherlands; 5.3% and 9.1% respectively in Sweden) than in southern countries (Spain: 11.5% in men and 15.2% for women) or further east (Germany: 10.6% in men and 11.6% among women). In the United States, obesity is taking on alarming proportions, with an increase of 8 percentage points between 1976 and 1994, placing the problem at a level of 22.5% of the population classified as obese. The prevalence of obesity in Spain is 13.4%, higher after the age of 45 years, among women and in individuals with a lower educational level. The pattern of geographical distribution evidences a greater prevalence towards the south and south-east, with statistical significance among males. It is necessary to analyze in further depth the factors involved in the genesis of obesity and to institutionalize community health programmes for its prevention, monitoring and treatment.
In 1990, world political leaders decided to make an effort to reduce childhood mortality in developing countries. One of several formulated goals was to reduce childhood mortality by one third compared with the figures for 1990. The child health programmes, which include vaccination, diarrhoeal and respiratory infection programmes, have already managed to reduce the mortality from common childhood diseases significantly. WHO is primarily an organization with technical cooperative aspirations, but still needs all possible available professional and economic support, in order to reduce childhood mortality even further.