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PubMed2004

Adapting smoking cessation interventions for developing countries: a model for the Middle East.

OBJECTIVE: To describe the rationale and methods for the development of culturally-sensitive smoking cessation interventions for primary care settings in developing countries. RATIONALE: Smokers in the Middle East have great difficulty quitting. Effective smoking cessation programs are currently lacking in the Middle East, and the development of culturally sensitive programs is hindered by the dearth of standardized information regarding tobacco use and dependence in this region. METHODS: Epidemiological and clinical laboratory methods are needed to determine the prevalence and patterns of tobacco use and nicotine dependence. One strategy is to adapt smoking cessation methods widely used in industrialized countries to the Syrian and Middle Eastern environment. In a recently initiated project, the Syrian Center for Tobacco Studies has been established to address these issues. Initial work is focusing on collecting formative data including key informant interviews, focus groups, and epidemiological surveys to assess smokers' use patterns, needs, and resources. Clinical laboratory techniques are also being applied to assess the physiological, behavioral, and subjective effects of local tobacco use methods, such as narghile (water pipe) smoking. These data will be used to help adapt existing smoking cessation interventions from industrialized countries to be evaluated in a randomized controlled trial. CONCLUSION: There is a great need to develop and disseminate effective cessation interventions in low-income countries. Successful interventions will contribute to a culturally sensitive and sustainable regional tobacco control infrastructure. This paper describes one approach to the development of such an infrastructure that is currently underway in the Middle East.

Developing Countries↗

PubMedDate not supplied

Recent developments in the nutritional management of diarrhoea. 1. Nutritional strategies to prevent diarrhoea among children in developing countries.

This paper discusses various ways in which diarrhoea may be prevented from occurring in children living in developing countries, where it is still a major cause of morbidity and mortality. Possible strategies include promotion of breastfeeding, dietary supplementation with vitamin A, zinc and iron, the prevention of protein-energy malnutrition as far as possible, and improvement in the standard of preparation and hygiene of available weaning foods, involving in particular the wider use of fermented foods.

Breast Feeding↗

PubMed1999

A randomised trial of a Haemophilus influenzae type b conjugate vaccine in a developing country for the prevention of pneumonia--ethical considerations.

In 1993 a placebo-controlled field trial of a Haemophilus influenzae type b (Hib) conjugate vaccine was started in The Gambia. At that time Hib conjugate vaccines had been shown to be efficacious in Europe and North America for the prevention of Hib meningitis. However doubts remained about their value in developing countries, where the epidemiology of Hib disease is quite different and the most important manifestation of Hib disease is pneumonia. The ethical issues facing the investigators before and during the trial are outlined in this paper, along with the views of the different groups involved in the trial. The trial demonstrated the efficacy of the vaccine in this setting and revealed the proportion of childhood pneumonia that is likely due to Hib, which was much higher than had previously been estimated. Since the completion of the trial Hib vaccines are now recommended for use in developing countries by the World Health Organization, largely based on the results of this trial. After a delay of 17 months following the completion of the trial, national Hib vaccination was started in The Gambia in 1997 using vaccine provided by a donation from industry.

Ethics, Medical↗

PubMed1995

The financial components and contribution of occupational health services to the provision of primary health care services in a developing country such as South Africa.

The breakdown of costs and trends for an occupational health service in a developing country such as South Africa could be used to justify and encourage the establishment of health services at workplaces as part of the national primary healthcare policy implementation. It would then be possible to make accessible 6.5 times the current annual budget for primary health care without necessitating generation of further general or specific tax revenue.

Costs and Cost Analysis↗

PubMed2004

Approaches to the control of sexually transmitted infections in developing countries: old problems and modern challenges.

Sexually transmitted infections (STIs) constitute a huge health and economic burden for developing countries: 75-85% of the estimated 340 million annual new cases of curable STIs occur in these countries, and STIs account for 17% economic losses because of ill health. The importance of STIs has been more widely recognised since the advent of the HIV/AIDS epidemic, and there is good evidence that the control of STIs can reduce HIV transmission. The main interventions which could reduce the incidence and prevalence of STIs include primary prevention (information, education and communication campaigns, condom promotion, use of safe microbicides, and vaccines), screening and case finding among vulnerable groups (for example, pregnant women), STI case management using the syndromic approach, targeted interventions for populations at high risk (for example, sex workers), and in some circumstances (targeted) periodic mass treatment. The challenge is not just to develop new interventions, but to identify barriers to the implementation of existing tools, and to devise strategies for ensuring that effective STI control programmes are implemented in the future.

Adolescent↗

PubMed1999

Prevention of diarrhoea in young children: abundant experience in developing countries.

(1) The prevention of diarrhoea in young children has been the subject of many intervention studies in developing countries, and their combined results identify the most effective measures. (2) While it lasts, maternal breast-feeding reduces the overall mortality and mortality linked to diarrhoea. (3) In vitamin A-deficient children, supplementation reduces overall mortality and deaths specifically due to diarrhoea. (4) Maternal education on weaning can improve children's nutritional status and may thereby reduce mortality related to diarrhoea. (5) The promotion of personal and domestic hygiene reduces morbidity due to diarrhoea. (6) Facilitating access to drinking water and sanitation is a very effective way of reducing overall childhood mortality.

Breast Feeding↗

PubMed2007

Predictors of mortality in elderly patients with acute renal failure in a developing country.

This prospective study was undertaken to systematically analyze the predictors of mortality in the elderly in a developing country. All elderly patients with ARF hospitalized at this tertiary care centre over 1 year were studied. Various predictors analyzed were hospital-acquired ARF, causative factors of ARF, preexisting hypertension and diabetes mellitus, severity of renal failure (initial and peak serum creatinine, need for dialysis), and complications of ARF: infection during the course of illness; serum albumin levels and critical illness defined as presence of two or more organ system failures excluding renal failure. Of 33,301 patients admitted, 4,255 (12.7%) were elderly. Of these 69 (1.6%) had ARF. On analysis of the whole group, both young and elderly, age >60 years had an independent predictor of mortality (odds ratio 5.6, P = 0.001). Forty-two of the 69 (60.9%) elderly ARF patients died. The mortality was significantly increased in those elderly with hospital-acquired ARF (79.2%, P = 0.027), those with sepsis as a cause of ARF (71.2%, P = 0.004), those who required dialysis (72.5%, P = 0.022), those developing an infection during the course of ARF (87.9%, P = 0.000) and in those with a critical illness (90.0%, P = 0.00). On logistic regression analysis of those variables that were significant on univariate analysis, only critical illness (odds ratio 9.97) and infection during course (odds ratio 9.72) were the independent predictors of mortality. To conclude, ARF complicates only 1.6% of hospitalized elderly patients but is associated with a high mortality rate of 61%. Infection during the course of illness and critical illness were the independent predictors of mortality.

Acute Kidney Injury↗

PubMed1979

Comparison of methods for estimating the frequency of paralytic poliomyelitis in developing countries.

Standard reporting systems have proved to be unreliable in estimating the frequency of paralytic poliomyelitis in many developing countries. The effectiveness of three survey methods for estimating the prevalence of lameness attributable to poliomyelitis were compared in the Danfa Health Project district of rural Ghana. Lameness was studied because it is easily identified by inexpensive survey techniques. A postal survey of school headteachers was the least costly and most accurate method, giving a prevalence of lameness attributable to poliomyelitis of 7.2 per 1000 schoolchildren. This method is recommended for countries with an extensive network of primary schools. Medical examinations in a village health survey yielded a prevalence of 4.6 per 1000 children aged 6-15 years. This method was relatively expensive but could be justified if the survey was multipurpose. A question added to the annual district census showed a prevalence of 2.2 per 1000 children, a rate still many times higher than estimates from national statistics. The inclusion of such a question in a census or other national survey entails little additional cost and with more careful questioning results should improve. Repeated surveys can be used to assess the success of poliomyelitis vaccination programmes.

Adolescent↗

PubMed2003

Changes in child survival are strongly associated with changes in malnutrition in developing countries.

Considerable evidence suggests that malnutrition affects human performance, health and survival, including physical growth, morbidity, mortality, cognitive development, reproduction, physical work capacity and risks for several adult-onset chronic diseases. In recent decades, development agencies and governments have emphasized selective interventions to improve health and nutritional status, such as immunizations, oral rehydration, antibiotics and micronutrients, with child survival as a major motivation and justification. Although the efficacy of these approaches for improving child survival has been amenable to study, providing some of the rationale for using these approaches, it has not been possible to test directly the effects of improvements in general malnutrition. The present study quantified the effects of changes in general malnutrition, as measured by child weight-for-age (WA), on changes in child survival in 59 developing countries, using aggregate, longitudinal data at national and subnational levels from 1966 to 1996. Mixed model analysis (in SAS) was used, to take advantage of the multilevel and longitudinal nature of these data sets. Changes in WA have a statistically significant effect on changes in child mortality, independent of socioeconomic and policy changes represented by the secular trend. The secular trend in mortality began earlier and leveled off at higher mortality rates in populations with a higher prevalence of malnutrition. Gaps in coverage of selective interventions are more likely and more serious in the more malnourished populations. Continued reduction in mortality will require improved targeting of selective interventions and general nutritional improvement to the most marginal populations.

Child, Preschool↗

PubMed1992

Building applied health research capacity in less-developed countries: problems encountered by the ADDR Project.

As governments and other donors renew their support for research scientists in less developed countries, it becomes important to consider new questions about the process of funding scientific research and scientific researchers. This paper argues that research capacity building is a development goal subject to structural constraints and cultural impediments among both donors and recipients. Using data from one specific research capacity building program, the Applied Diarrheal Disease Research Project (ADDR), we describe a set of constraints among donors, recipient institutions, and individual recipients of research grants. We then describe how ADDR supports its investigators, how it has responded to the identified constraints, and what obstacles it still faces. Research capacity building programs in health would be well-served by focusing more attention on research problem identification, and dissemination and application of research findings.

Anthropology, Cultural↗

PubMed1998

Blood transfusion in developing countries: problems, priorities and practicalities.

The acute medical services could not exist without blood transfusions--life-savers in many situations. But transfusions can also be a quick and easy route for the transmission of infectious agents such as HIV, HBV, HCV and malaria. Infection through blood supply is a major issue in all countries but particularly in those with economic constraints which limit safety. This study was carried out in India (March-May 1997) and involved centres in Delhi, Calcutta and Vellore. It examined many aspects of blood transfusion including donor screening, use of professional donors, blood testing and criteria for blood use. The many problems in Indian blood transfusion services are mirrored in other countries. Here we examine the problems, priorities and practicalities of blood transfusion particularly in developing countries.

Blood Banks↗

PubMed1986

[Child mortality in Nepal: an analysis of its socioeconomic determinants and a comparison with other developing countries].

The author studies child mortality in Nepal in this section of a large comparative project involving 15 developing countries. "Employing a method suggested by Trussell and Preston (1982) a child mortality index is computed for every woman by relating actual number of child deaths to the expected number of child deaths implied by marital duration, fertility, and the national mortality level. Based on the Nepal Fertility Survey of 1976 bi-, tri-, and multivariate analysis showed significant child mortality differentials according to mothers' and fathers' education, religion, and ecological region. The population of Nepal is still extremely homogeneous in that 96% of all ever-married women aged 15-49 can neither read or write, 95% live in rural areas, and 90% are Hindus. For women deviating from this pattern child mortality is in most cases substantially lower." (SUMMARY IN ENG)

Asia↗

PubMed1990

Research on AIDS interventions in developing countries: state of the art.

This paper reviews achievements of past and current research on AIDS interventions in developing countries, and identifies three major issues. (1) Several areas of research have been severely neglected, namely transmission from mother to infant, the impact of treating curable STD and transmission in health care settings. (2) AIDS intervention research is mainly concerned with behavioral changes in a very intimate part of human lives, namely sexual relationships. This makes it difficult to design studies that are at the same time ethically acceptable and scientifically sound. A more creative mix of methodologies is needed, that goes hand in hand with a close collaboration between researchers from the social sciences and health sciences field. (3) Counseling is a major aspect of any targeted AIDS intervention program. However, there is no evidence yet for the effectiveness of specific messages and particular forms of counseling. Investigation in this area is urgently needed.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Diagnosis of causes of childhood deaths in developing countries by verbal autopsy: suggested criteria. The SEARCH Team.

In the absence of medical certification of deaths in developing countries, lay reporting and verbal autopsy have emerged as useful alternative methods for collecting data on causes of death. Of these, verbal autopsy offers advantages and is widely used in field studies and child survival programmes. However, because uniform and valid criteria for the diagnosis of common causes of death are lacking, comparison of the results of different studies becomes meaningless. This article proposes such a set of criteria for the cause of death among neonates and for those aged 1-59 months. The criteria are based on the findings of earlier validation studies, a Delphi survey and the experience gained from performing 1000 verbal autopsies in Gadchiroli, India. The emergence of such standardized criteria of causes of death should be of immense value for health planning, monitoring and evaluation purposes and for interregional comparisons.

Autopsy↗

PubMed2006

Estimating the cost of cervical cancer screening in five developing countries.

BACKGROUND: Cost-effectiveness analyses (CEAs) can provide useful information to policymakers concerned with the broad allocation of resources as well as to local decision makers choosing between different options for reducing the burden from a single disease. For the latter, it is important to use country-specific data when possible and to represent cost differences between countries that might make one strategy more or less attractive than another strategy locally. As part of a CEA of cervical cancer screening in five developing countries, we supplemented limited primary cost data by developing other estimation techniques for direct medical and non-medical costs associated with alternative screening approaches using one of three initial screening tests: simple visual screening, HPV DNA testing, and cervical cytology. Here, we report estimation methods and results for three cost areas in which data were lacking. METHODS: To supplement direct medical costs, including staff, supplies, and equipment depreciation using country-specific data, we used alternative techniques to quantify cervical cytology and HPV DNA laboratory sample processing costs. We used a detailed quantity and price approach whose face validity was compared to an adaptation of a US laboratory estimation methodology. This methodology was also used to project annual sample processing capacities for each laboratory type. The cost of sample transport from the clinic to the laboratory was estimated using spatial models. A plausible range of the cost of patient time spent seeking and receiving screening was estimated using only formal sector employment and wages as well as using both formal and informal sector participation and country-specific minimum wages. Data sources included primary data from country-specific studies, international databases, international prices, and expert opinion. Costs were standardized to year 2000 international dollars using inflation adjustment and purchasing power parity. RESULTS: Cervical cytology laboratory processing costs were I$1.57-3.37 using the quantity and price method compared to I$1.58-3.02 from the face validation method. HPV DNA processing costs were I$6.07-6.59. Rural laboratory transport costs for cytology were I$0.12-0.64 and I$0.14-0.74 for HPV DNA laboratories. Under assumptions of lower resource efficiency, these estimates increased to I$0.42-0.83 and I$0.54-1.06. Estimates of the value of an hour of patient time using only formal sector participation were I$0.07-4.16, increasing to I$0.30-4.80 when informal and unpaid labor was also included. The value of patient time for traveling, waiting, and attending a screening visit was I$0.68-17.74. With the total cost of screening for cytology and HPV DNA testing ranging from I$4.85-40.54 and I$11.30-48.77 respectively, the cost of the laboratory transport, processing, and patient time accounted for 26-66% and 33-65% of the total costs. From a payer perspective, laboratory transport and processing accounted for 18-48% and 25-60% of total direct medical costs of I$4.11-19.96 and I$10.57-28.18 respectively. CONCLUSION: Cost estimates of laboratory processing, sample transport, and patient time account for a significant proportion of total cervical cancer screening costs in five developing countries and provide important inputs for CEAs of alternative screening modalities.

Journal Article↗

PubMed2004

High infectious burden, low cancer incidence, and early malignancy in developing countries: a molecular hypothesis in term of the role of nitric oxide.

Nitric oxide (NO) is a neurotransmitter which plays a powerful role in the immune system: it kills bacteria, and, it also destroys the tumor cells. Specifically, immune system stimuli gamma interferon and lipopolysaccharide transmit signals to a macrophage nucleus causing the production of nitric oxide synthase, the enzyme that converts arginine to NO. The NO thus produced not only destroys bacteria but also attacks the tumor cells by inhibiting the energy-producing Krebs cycle, electron transport activity and DNA synthesis. People in developing countries who survive repeated childhood infections must be inferred to have robust microphage/NO systems and thus, also, a strong immunity against cancer--thence the low incidence of cancers in these countries. However, those unfortunate few in these countries who do develop cancer, despite a robust microphage/NO system, must be presumed to have a markedly virulent tumor development micro-environment (e.g., activation of tumor promotion genes, inactivation of tumor suppression genes, multiple mutations, etc.) that escapes even the particularly alert immune surveillance--thence the earlier (by about a decade) death by cancer in those countries. Thus the NO hypothesis put forward here simultaneously provides a mechanistic causation for (i) low cancer incidence in countries subjected to heavy infectious burdens, and (ii) the earlier occurrence (by about a decade) of major cancers in those countries when the immune surveillance, despite its robustness, fails to destroy the incipient formation of cancer cells.

Communicable Diseases↗

PubMed1997

Tears while cooking: an indicator of indoor air pollution and related health effects in developing countries.

Indicators for cooking fuel pollution are needed to determine the extent of fuel-related problems in developing countries and to assess the success of measures undertaken to reduce such problems. It is proposed that eye irritation in the form of tears or smarting eyes during cooking time [tears while cooking (TWC)] is a useful determinant of indoor air pollution from cooking-related sources. An analysis of data from three cities (Lusaka, Maputo, and Hanoi) showed that TWC is more prevalent in conditions of higher particulate pollution. Persons experiencing TWC were also found to have more respiratory symptoms. The prevalence of TWC provides a good indicator of groups that are at greater risk of health impairment due to indoor air pollution. Surveying for this condition is simple and nonintrusive, which makes it a useful screening indicator, though it cannot replace more thorough investigations in epidemiological studies. It can, however, be used in guiding interventions to the most needy groups. It can also be used to assess the success of measures introduced to reduce pollution hazards relating to the cooking environment, such as improved stoves, chimneys, and kitchen improvement.

Air Pollution, Indoor↗

PubMed2004

Serious bacterial infections in newborn infants in developing countries.

PURPOSE OF REVIEW: The overwhelming majority of the world's annual 4 million neonatal deaths occur in developing countries. This review therefore briefly addresses the burden, aetiology, prevention and management of serious neonatal bacterial infections in low-income settings. RECENT FINDINGS: Bacterial infection is the biggest cause of neonatal admissions to hospitals, and probably the biggest cause of morbidity in the community, but its burden is unclear. The commonest serious infections involve bacteraemia, meningitis and respiratory infection, and case fatality rates may be as high as 45%. Key pathogens are Escherichia coli, Klebsiella species, Staphylococcus aureus and Streptococcus pyogenes. The incidence of neonatal infections with group B streptococcus is highly variable, as is the spectrum of antimicrobial resistance. SUMMARY: Current areas of research include the rectification of micronutrient deficiencies, neonatal skin care, appropriate breastfeeding recommendations, cleansing of the birth canal, and simplified methods of diagnosis of infection. Operational activities include the control of neonatal tetanus, the diagnosis and treatment of sexually transmitted infections, integrated strategies for improving pregnancy, childbirth and neonatal survival, community-based management of acute respiratory infections, and community-based management of neonatal sepsis.

Bacterial Infections↗