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PubMed1984

A proposed method for the analysis of public health policy in less developed countries.

The study of public health policy in the less developed countries (LDCs) is handicapped by both lack of adequate data and gaps in conceptual apparatus. A new conceptual model is proposed that would be used for future policy analyses to assess what changes in health status of populations in LDCs can be expected as direct functions of increased health service resources, and of improved environmental and econosociocultural conditions. While direct policy analysis is ill-advised at this time due to data inadequacy, the model is illustrated using data presently available for twenty-five relatively homogeneous sub-Sahara African countries. Within the limitations of available data, the findings suggest that reductions in mortality in the region might best be achieved by making appropriate health resources available to the populations. Study findings also suggest that physicians contributed more during the study period to the variance in physical health status than did medical assistants.

Africa↗

PubMed1991

Environmental health in primary schools in a developing country.

In an effort to elucidate the environmental health in developing countries, the environmental and sanitary conditions of Riyadh primary schools were assessed by use of a scoring evaluation sheet for 20 schools representative of primary schools of Riyadh. 20% of schools have been found to be ideally situated and only one fourth of schools with proper building. As regards class rooms, only 25% of them have adequate floor area, window area and are suitably illuminated. Drinking fountains per pupil were inadequate. Overall, environmental rating of 10% excellent, 30% good, and 60% bad were detected in present study. The bad situation of almost two-thirds of primary school buildings in Riyadh is alarming. Remedial suggestion have been forwarded.

Child↗

PubMed1986

Primary hepatitis A virus infection in developing countries: decline of maternal antibodies and time of infection.

In developing countries, HAV seems to be responsible for a widespread, inapparent and protective infection during early childhood. This report emphasizes early infection and its relationship to protection by passive immunity from maternal antibody in a highly endemic area such as Somalia. Our result show that HAV infection in Somalia primarily occurs during the first 4 years of life (4 months to 4 years). Cases are infrequent in the first 3 months due to passive immunity secondary to maternal antibody (cord-blood and colostrum anti-HAV). As the level of protection declines, the rate of acute infection rises as determined by the presence of IgM-specific anti-HAV.

Adolescent↗

PubMed2000

Volunteer activities in developing countries: Haiti, Costa Rica, Uganda, Eritrea, and Guyana.

I have volunteered 16 times in 5 different developing countries. Each of these trips have involved my profession as a CRNA. My students have been health care providers of different types from these countries. Fourteen of these trips have been in conjunction with Health Volunteers Overseas. I have taught clinical and didactic anesthesia and helped develop nurse anesthesia programs in Uganda and Guyana. The purpose of this activity has been to increase the quality of health care in these countries by helping to provide safer anesthesia.

Africa, Eastern↗

PubMed2005

Antimicrobial resistance in developing countries. Part II: strategies for containment.

The growing threat from resistant organisms calls for concerted action to prevent the emergence of new resistant strains and the spread of existing ones. Developing countries have experienced unfavourable trends in resistance-as detailed in part I, published last month--and implementation of many of the containment strategies recommended by WHO is complicated by universal, as well as developing country-specific, factors. The control of selective pressure for resistance could potentially be addressed through educational and other interventions for orthodox and unorthodox prescribers, distributors, and consumers of antimicrobials. At national levels, the implementation of drug use strategies--eg, combination therapy or cycling--may prove useful to lengthen the lifespan of existing and future agents. Programmes such as the Integrated Management of Childhood Illnesses (IMCI) and directly observed short-course therapy (DOTS) for tuberculosis are prescriber-focused and patient-focused, respectively, and have both been shown to positively influence factors that contribute to the selective pressure that affects resistance. The institution of interventions to prevent the transmission of infectious diseases could also lead to beneficial effects on the prevalence of resistance, as has vaccination against Haemophilus influenzae type B and Streptococcus pneumoniae. There has been an upsurge in the number of organisations and programmes that directly address issues of resistance, and collaboration could be one way to stem the dire trend. Additional factors such as unregulated drug availability, inadequate antimicrobial drug quality assurance, inadequate surveillance, and cultures of antimicrobial abuse must be addressed to permit a holistic strategy for resistance control.

Anti-Bacterial Agents↗

PubMed1985

[Alcohol consumption in developing countries. Review of available data for 3 African countries].

The increasing alcohol consumption throughout the world appears to constitute an enduring public health problem. In developing countries, the consequences of such consumption should be considered as questions of both classical alcohol-linked pathology and of food balance. Available data for 3 countries in Africa (Burkina Faso, Congo, Cameroons) show an important growth in the industrial production of alcoholic beverages (mostly beer) over the last 20 years, while variation in traditional home production remains unknown. However, the lack of data on consumption does not permit a good appreciation of this problem.

Alcohol Drinking↗

PubMed1992

The role of international non-governmental organisations in dealing with cataract blindness in developing countries.

The international non-governmental organisations (INGOs) dealing with the prevention and cure of blindness in developing countries are closely networked with each other and are an integral part of the International Agency for the Prevention of Blindness (IAPE) and the World Health Organization (WHO) Global Programme for the Prevention of Blindness. As operable cataract accounts for more than half of world blindness. As operable cataract accounts for more than half of world blindness the INGOs have a particular interest in this blinding condition which took on major proportions with the eye camp movement in South Asia from the end of the 1960s. Despite this initiative, and the use of paramedic cataract surgeons in many African countries, the volume of cataract surgery is being outstripped by increased incidence arising from greater longevity as a product of improved general health. Among the options facing the INGOs in the 1991s are the increased utilisation of eye beds through year round surgery in South Asia and shorter post-operative hospital occupancy and the possibility of putting lens implantation surgery within the economic reach of INGOs and partner NGOs and governments.

Africa↗

PubMed1976

Nutritional surveillance of young children in developing countries.

This paper discusses simple but effective methods of surveillance of growth and nutrition of children in developing countries where resources are scarce and food shortages most likely to occur. In the youngest age group, the simplest weight-for-age chart, already used, is undoubtedly the best method. Where the age of children is not known, arm circumference provides an acceptable alternative. In older children, arm circumference alone may not be reliable and can be improved by measuring height as well and combining the two results.

Africa, Western↗

PubMed2003

[Breastfeeding in developing countries: update and current recommendations].

Data from numerous surveys conducted by UNICEF using standardized methods in most developing countries over the last 10 years now enable evaluation of the status of breastfeeding in the world. The purpose of this report is to present findings concerning the duration of exclusive breastfeeding, appropriate complementary feeding, and continued breastfeeding after 6 months. Analysis of these data indicates that progress is being made but that various problems remain. In an effort to improve the situation, the WHO/UNICEF has undertaken a number of initiatives and issued several recommendations.

Adult↗

PubMed1976

Subclinical intestinal malabsorption in developing countries.

Asymptomatic small intestinal disease characterized by abnormalities of structure and function has been reported from many developing countries. Abnormalities of structure include changes in villus architecture and in appearance under both the light and the electron microscope. Changes in function include abnormalities in the absorption of xylose, fat, vitamin B(12), amino acids, and dipeptides and excessive faecal losses of nitrogen and energy. The etiology of the condition is unknown but appears to be closely related to exposure to the environment. The nutritional consequences of this condition have not been fully explored but for people living on marginally sufficient dietary intakes they may be extremely important.

Anemia, Hypochromic↗

PubMed1988

A preliminary investigation of antibiotic resistance in Enterobacteriaceae isolated from children with diarrhoea from four developing countries.

The prevalence of resistance to commonly used antibiotics was investigated in groups of children from four developing countries, Peru, Belize, Zaire and Sudan. Enterobacteriaceae spp. isolated from faeces of children with diarrhoea were tested for sensitivity to ampicillin, tetracycline, sulphonamide, trimethoprim, streptomycin and chloramphenicol. Overall, the highest prevalence of resistance was to sulphonamide (56% of children) and the lowest was to chloramphenicol (19% of children). For individual locations, isolates from Sudan had the highest prevalence of antibiotic resistance, 65% of the isolates being resistant to ampicillin, tetracycline, trimethoprim and streptomycin. Transfer of resistance was studied for some isolates using Escherichia coli Hb101 as recipient.

Belize↗

PubMed1992

[Management of beta-thalassemias in a developing country. Experience of a pediatric service in Oran (Algeria)].

The management of beta-thalassemia in a developing country faces a host of organizational, logistic, and funding problems. Experience acquired against this background of multiple deficiencies is reported here. Only 60% of children with documented beta-thalassemia were monitored more or less regularly. The remaining 40% died or were lost to follow-up. Clinical results were acceptable in terms of growth but transfusion goals (pretransfusion Hb greater than or equal to 10 g/dl) were achieved in only 7% of cases and adverse effects to transfusions proved difficult to prevent. Lastly, funding remained grossly inadequate since only 5.4% of actual costs in drugs and small equipment were covered. This lack of funds has a major impact on decision-making concerning the care of this type of patient.

Adolescent↗

PubMed2003

[The resurgence of pertussis in developed countries: a problem for Brazil as well?].

Pertussis is currently considered an important public health problem in developed countries. In most of these countries, mass immunization for pertussis was initiated in the 1950s and was followed by a marked decrease in disease incidence. In the 1970s, pertussis was apparently under control in countries were vaccine coverage was maintained high. However, in the last two decades of the 20th century, the number of reported cases increased in all age groups, including adolescents and adults, indicating resurgence of the disease. This brief note aims to present the possible reasons for resurgence of this disease and to discuss the prospects of its future dynamics in Brazil. There has been no evidence to date for the resurgence of pertussis in Brazil. However, since mass immunization in Brazil began only in the 1980s, one cannot rule out the possibility that pertussis will resurge in the near future. Therefore, it is important that public health services closely monitor the epidemiological situation of pertussis in order, if necessary, to rapidly update the current immunization strategy.

Adolescent↗

PubMed2002

An overview of small-scale food fermentation technologies in developing countries with special reference to Thailand: scope for their improvement.

Small-scale food fermentation technologies in developing countries have evolved through years of experience rather than through scientific breakthroughs. Many small-scale manufacturers are, therefore, reluctant to accept change and modify fermentation processes. Upgrading the quality and safety of fermented foods, while reducing their production cost and maintaining their authenticity and uniqueness, is of utmost importance. One strategic approach, which has been successfully implemented for the improvement of small-scale soy sauce fermentation in Thailand, is the consortium approach. This approach has allowed industry to work closely in sharing knowledge and common problems, which in turn has provided scientists with the research direction that would best benefit the industry. This consortium approach has brought about changes in the methodologies used in the production of soy sauce, by shortening processing times, introducing fiberglass tanks as bioreactors instead of the traditionally used small earthenware containers and introducing cost-effective waste management systems. One barrier to the application of starter cultures in the small-scale fermentation industry is the loss of uniqueness of fermented products. However, the advent of molecular biology techniques has allowed science to tailor starter cultures to the specific requirements of the manufacturer. Using the techniques of molecular biology, it has been shown that microflora of a specific product vary according to origin and sensory quality. A cell bank is being developed to serve as a resource base for Thai fermented pork sausage in order to facilitate the application of starter cultures in the manufacture of that product.

Developing Countries↗

PubMed1991

A simplified general method for cluster-sample surveys of health in developing countries.

General guidelines are presented for the use of cluster-sample surveys for health surveys in developing countries. The emphasis is on methods which can be used by practitioners with little statistical expertise and no background in sampling. A simple self-weighting design is used, based on that used by the World Health Organization's Expanded Programme on Immunization (EPI). Topics covered include sample design, methods of random selection of areas and households, sample-size calculation and the estimation of proportions, ratios and means with standard errors appropriate to the design. Extensions are discussed, including stratification and multiple stages of selection. Particular attention is paid to allowing for the structure of the survey in estimating sample size, using the design effect and the rate of homogeneity. Guidance is given on possible values for these parameters. A spreadsheet is included for the calculation of standard errors.

Child↗

PubMed2001

An integrated proposal to explain the epidemic of cardiovascular disease in a developing country. From socioeconomic factors to free radicals.

An increase of coronary artery disease has been observed in developing countries during the last years. Various factors may explain this accelerated increase. We propose that inappropriate diet and inadequate sanitary infrastructure may act as triggers to create an imbalance between nitric oxide (NO) and superoxide (O2-). An increase in the concentrations of oxidized LDL produces both decreased NO and increased O2- endothelial synthesis, by accumulation of asymmetrical NG-NG-dimethyl-L-arginine, the endogenous inhibitor of NO, and by activation of NAD(P)H oxidase. On the other hand, high rates of chronic infection-inflammation, due to inappropriate sanitary environment stimulate higher circulating levels of proinflammatory cytokines. These cytokines also contribute to reduced NO and increased O2- endothelial production through the same mechanisms of oxidized LDL. The net result of this imbalance is an increased generation of peroxynitrate that injures the endothelium in a proatherogenic, prothrombotic and vasoconstrictive manner.

Arginine↗

PubMed1992

The untold story: how the health care systems in developing countries contribute to maternal mortality.

This article attempts to put together evidence from maternal mortality studies in developing countries of how an inadequate health care system characterized by misplaced priorities contributes to high maternal mortality rates. Inaccessibility of essential health information to the women most affected, and the physical as well as economic and sociocultural distance separating health services from the vast majority of women, are only part of the problem. Even when the woman reaches a health facility, there are a number of obstacles to her receiving adequate and appropriate care. These are a result of failures in the health services delivery system: the lack of minimal life-saving equipment at the first referral level; the lack of equipment, personnel, and know-how even in referral hospitals; and worst of all, faulty patient management. Prevention of maternal deaths requires fundamental changes not only in resource allocation, but in the very structures of health services delivery. These will have to be fought for as part of a wider struggle for equity and social justice.

Abortion, Legal↗

PubMed1994

Developing countries' health expenditure information: what exists and what is needed?

In the past decade, the scarcity of financial resources for the health sector has increasingly led countries to take stock of national health resources used, review allocation patterns, assess the efficiency of existing resource use, and study health financing options. The primary difficulties in undertaking these analyses have been 1) the lack of information on health expenditures and 2) not using existing information to improve the planning and management of health sector resources. The principle sources of available health expenditure information are reported by organizations such as the World Bank, WHO, UNICEF and OECD. Special studies and non-routine information are a second major source of information. This existing data has a number of difficulties, including being sporadic, inconsistency, inclusion of only national level public expenditure, high opportunity and maintenance costs, quantitative and qualitative differences across countries, and validity and interpretability problems. Reliable health expenditure data would be useful not only for in-country, national purposes, but also for cross-national comparisons and for development agencies. Country uses of health expenditure data include policy formulation and planning and management, while international uses would facilitate examination of cross-national comparisons, reviews of existing programmes and identification of funding priorities. Collaborative efforts between countries and international development agencies, as well as between agencies, are needed to establish guidelines for health expenditure data sets. This development must ensure that the resulting information is of direct benefit to countries, as well as to agencies. Results of such collaborative efforts may include a set of standardized methodologies and tools; standardized national health accounts for developing countries; and training to enhance national capabilities to actively use the information. The opportunities for such collaboration are unique with the issuance of the World Development Report 1993, to build on this work in clearly identifying what is needed and proposing a standardized data set and the tools necessary to regularly and economically gather such data.

Data Collection↗