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PubMed1993

Essential and non-essential drugs marketed by the 20 largest European pharmaceutical companies in developing countries.

This study estimates the proportion of essential drugs out of all drugs offered for sale in six regions of the developing world by the 20 largest European pharmaceutical companies. The total number of drugs offered for sale by the 20 companies is estimated from citations in the most important drug compendia in each region for 1988 and 1989. Essential drugs are defined as drugs listed on the 1988 version of the World Health Organization's (WHO) essential drugs list or equivalent to WHO essential drugs. Only 482, or 16% of a total of 3021 cited drugs were essential drugs or equivalent to an essential drug. The proportion for each company ranged from a low of 5.4% to a maximum of 39.0%. A high proportion, 41.7%, of the 2539 non-essential drugs cited in the compendia contained two or more active ingredients, compared to only 9.5% of the essential drugs. The results indicate that European pharmaceutical companies have yet to focus their drug marketing efforts in developing countries on the essential drugs recommended by the WHO. The ethical responsibility of the pharmaceutical companies is discussed, particularly in respect to their sales on the private market.

Africa↗

PubMed2007

Assessing nutrient flows in septic tanks by eliciting expert judgement: a promising method in the context of developing countries.

Simple models based on the physical and biochemical processes occurring in septic tanks, pit and urine diversion latrines were developed to determine the nutrient flows in these systems. Nitrogen and phosphorus separation in different output materials from these on-site sanitation installations were thus determined. Moreover, nutrient separation in septic tanks was also assessed through literature values and by eliciting expert judgement. Use of formal expert elicitation technique proved to be effective, particularly in the context of developing countries where data is often scarce but expert judgement readily available. In Vietnam, only 5-14% and 11-27% of the nitrogen and phosphorus input, respectively, are removed from septic tanks with the faecal sludge. The remaining fraction leaves the tank via the liquid effluent. Unlike septic tanks, urine diversion latrines allow to immobilize most of the nutrients either in form of stored urine or dehydrated faecal matter. These latrines thus contribute to reducing the nutrient load in the environment and lowering consumption of energy and non-renewable resources for fertiliser production.

Developing Countries↗

PubMed1994

Reforming the health sector in developing countries: the central role of policy analysis.

Policy analysis is an established discipline in the industrialized world, yet its application to developing countries has been limited. The health sector in particular appears to have been neglected. This is surprising because there is a well recognized crisis in health systems, and prescriptions abound of what health policy reforms countries should introduce. However, little attention has been paid to how countries should carry out reforms, much less who is likely to favour or resist such policies. This paper argues that much health policy wrongly focuses attention on the content of reform, and neglects the actors involved in policy reform (at the international, national sub-national levels), the processes contingent on developing and implementing change and the context within which policy is developed. Focus on policy content diverts attention from understanding the processes which explain why desired policy outcomes fail to emerge. The paper is organized in 4 sections. The first sets the scene, demonstrating how the shift from consensus to conflict in health policy established the need for a greater emphasis on policy analysis. The second section explores what is meant by policy analysis. The third investigates what other disciplines have written that help to develop a framework of analysis. And the final section suggests how policy analysis can be used not only to analyze the policy process, but also to plan.

Africa↗

PubMed1988

[Maternal mortality caused by hemorrhage in developing countries. What policy is proposed?].

Maternal mortality in the third world is fifty to two hundred times higher than in developed countries. Haemorrhage following birth or abortion is one of the leading causes of maternal mortality and a specific analysis of this can clarify the problems. The incidence of maternal death by haemorrhage is not clearly documented and fluctuates between 6 and 90 per cent. Patients predicted to be at high risk for haemorrhage in the third trimester should be automatically referred for a higher level of medical care. In fact, many cases of haemorrhage cannot be predicted and death depends on the rate of blood loss and on the pre-existing anaemia. Better nurses' and mid-wives' training, better ante natal care, and the treatment of anaemia should decrease maternal mortality.

Developing Countries↗

PubMed1996

Mortality from tobacco in developed countries: are indirect estimates reliable?

The ICRF and WHO recently published estimates of smoking-attributed deaths in almost 50 developed countries. These estimates are derived without using any available data on the prevalence of smoking or of other risk factors in the countries concerned. This paper describes and discusses the various assumptions on which the derivation depends and shows that they are unlikely to hold in practice. ICRF/WHO attempt to control for confounding by introducing a modification to the standard attributable risk formula which they admit is "crude and arbitrary" but state is "conservative." In fact, this modified formula carries no guarantee of conservatism at all and may overestimate deaths even where there is no confounding. The validity of the ICRF/WHO estimates of smoking-attributed deaths is further undermined by the lack of correlation seen in males between the smoking prevalence rates they estimate indirectly and smoking prevalence rates actually published. The ICRF/WHO estimates of smoking-attributed deaths are shown to have no scientific basis and to be unreliable.

Adult↗

PubMed1996

Doing randomized controlled trials in a developing country: some practical realities.

BACKGROUND: Formal randomized controlled trial results are often reported. The difficulties of doing such trial are not. Developing countries represent a new field in which trials can be undertaken. In this context even less is known about the practicalities involved. METHOD AND RESULTS: A randomized, double-blind, parallel study took significantly longer than expected to complete and subject recruitment and participation fell short of expectations. Different recruitment strategies were used and these performed differently in terms of enrolling trialists. Subjects most frequently left the trial in its early stages. CONCLUSIONS: Possible explanations for these findings include the demography of the country, cultural factors, and the existence of an established doctor-patient relationship.

Antihypertensive Agents↗

PubMedDate not supplied

The burden of acute respiratory infection due to measles in developing countries and the potential impact of measles vaccine.

Measles is a major cause of acute lower respiratory infection (ALRI) in developing countries. Hospital and community-based studies of ALRI have found that measles accounts for 6%-21% of the morbidity and 8%-93% of the mortality due to ALRI. Although live attenuated measles vaccine is one of the most effective vaccines in use today, measles has not been controlled in many parts of the world, primarily because the levels of vaccine coverage required to interrupt measles transmission have not been achieved. In addition, in some areas, a large percentage of cases of measles occur in infants who are younger than the age recommended for vaccination. Recent studies suggest that the Edmonston-Zagreb measles vaccine may be more immunogenic than other vaccine strains in young infants. A substantial proportion of ALRI could be prevented by increasing measles vaccine coverage and by the use of particular vaccine strains in younger children.

Acute Disease↗

PubMed1996

The quantity/quality of children hypothesis in developing countries: testing by considering some demographic experiences in China, India and Africa.

Initially a general regression equation is estimated, making use of cross-country data, relating the level of the total fertility rate to a range of variables, including the level of per capita real income. There is a statistically significant negative relationship between the level of the total fertility rate and real income per capita. Once the theory of the quantity-cum-quality of children hypothesis is set out formally, and in a flexible form, it is clear that this statistical relationship is not inconsistent with this theory. However, this relationship is not a strong, or convincing, test of this hypothesis. To provide more satisfactory tests of this hypothesis, additional relevant information from various developing countries is used. Information on recent demographic changes in China provides a comparatively powerful, direct test of the theory. More indirect tests of the theory are provided by drawing on data for India in the 1960s, and for sub-Saharan African countries in the 1980s and early 1990s. These various tests suggest that the quantity-cum-quality hypothesis, in its flexible form, appears to explain some of the changes in fertility rates observed in various developing countries in recent decades.

Adolescent↗

PubMed1996

Psychosocial and biological aspects of acute brief psychoses in three developing country sites.

This study explored biological as well as psychosocial contributions to the incidence of acute brief psychoses in three developing country sites. The samples were taken from the five year follow-up data of the International Pilot Study of Schizophrenia sites in Ibadan, Nigeria and Agra, India, and from the Determinants of Outcome of Severe Mental Disorders rural Chandigarh site. Baseline narratives of the cases and controls were reviewed and rated for presence or absence of three exposures: fever, departure from or return to parental village (women), and job distress (men). Results showed an association between fever and acute brief psychosis in all three sites. There was an association between acute brief psychosis and departure from or return to the parental village among women in all sites, and among men, an association between job distress and acute brief psychosis was noted in Ibadan and Agra. These findings suggest that psychosocial and biological factors such as these three exposures merit further research to clarify their roles in the etiology of acute brief psychoses.

Acute Disease↗

PubMedDate not supplied

Strategies for poliomyelitis eradication in developing countries.

Oral polio vaccine (OPV) delivered only through routine services does not appear to interrupt wild virus transmission in the developing countries. The experience in the Americas, which despite intensive surveillance has not confirmed any cases of paralytic poliomyelitis due to wild poliovirus since 23 August 1991, has shown the necessity of delivery of additional doses of OPV through mass campaigns targeted at all children under five years of age regardless of their previous immunization status and in special mop-up operations targeted at this same age group in areas categorized as at high risk of virus transmission, such as those that harbored the virus in the recent past. High-risk areas were determined by empirical observations, which were subsequently confirmed by molecular epidemiology which indicated the presence of several "reservoirs" that helped maintain transmission over several years. During mop-ups, OPV is delivered house by house. This paper discusses the rationale for the utilization of these strategies and outlines the phases for their preparation and evaluation, with illustrations from recent experiences with the last cases of paralytic poliomyelitis in the Americas.

Adolescent↗

PubMed1994

The relationship between child anthropometry and mortality in developing countries: implications for policy, programs and future research.

The prevention of child mortality is a commonly stated health goal in developing countries and the target of much international assistance in the health sector. Over the past decade the primary strategy for accelerating the reduction in child mortality has been the dissemination of simple, low-cost technologies, such as immunization, oral rehydration therapy and antibiotics, that target specific diseases (Huffmann and Steel 1994). This is done despite the knowledge that malnutrition and disease have a synergistic relationship (Scrimshaw et al. 1968) and that the optimal strategy may involve a combination of health and nutrition interventions. In the 1970s, for instance, it was estimated that malnutrition (notably protein-energy malnutrition--PEM) was the underlying or contributing cause of death for roughly half of all deaths to children aged 1-4 years in several Latin American countries (Puffer and Serrano 1973). Apart from this early study, however, there has been little effort to quantify the contribution of malnutrition to child mortality in other regions of the world in ways which are meaningful to policy. This paper reviews the results of 28 community-based, prospective studies, in 12 Asian and Sub-Saharan African countries, which examined the relationship between anthropometric indicators of malnutrition and child mortality. One purpose is to estimate the contribution of malnutrition to child mortality--distinguishing the effects of severe malnutrition from mild-to-moderate malnutrition--and to examine a number of related issues relevant to policy, programs and research in this area. The accumulated results are consistent in showing that the risk of mortality is inversely related to anthropometric indicators of nutritional status and that there is elevated risk even in the mild-to-moderate range of malnutrition. This latter result contradicts the findings from an earlier, landmark study which suggested that mild-to-moderate malnutrition was not associated with an increased risk of mortality (Chen et al. 1980). The present results indicate that somewhere between 20% and 75% of child deaths are statistically attributable to anthropometric deficits, with most estimates falling in the range 25-50%. When taking account of the relative proportions of severe versus mild-to-moderate malnutrition in the population, the results show further than 16-80% of all nutrition-related deaths are associated with mild-to-moderate malnutrition rather than severe malnutrition. In most studies 46-80% of all nutrition-related deaths are in the mild-to-moderate category.(ABSTRACT TRUNCATED AT 400 WORDS)

Anthropometry↗

PubMed2001

Action-oriented support for occupational safety and health programs in some developing countries in Asia.

Action-oriented support programs have been increasingly playing vital roles in promoting safety and health in developing countries in Asia. This paper studied achievements of 3 action-oriented support programs: the WISE program for small enterprises, the WIND program for farmers, and the POSITIVE program for workers and trade unions. Special attention was paid to how the programs have strengthened local efforts for sustainable actions in safety and health improvements. The results showed that there were significant achievements in action-oriented support programs in the region, including a large number of improvement examples, integration into government policies, and network support through employers' and workers' organizations. Participatory, action-oriented training tools such as action-checklists, local good example photos, and group work methods played key roles in the effective implementation of the programs. It was of note that there were a number of local efforts to extend the coverage of action-oriented support even to hard-to-reach workers such as home-based workers, rural workers, and ethnic minorities. The efforts included the equal participation in the training by female and male farmers, shortened and weekend training programs, photo sheets showing local good examples, and reasonable fee collection for better sustainability. In conclusion, action-oriented support programs provided local people with concrete means to promote safety and health improvements. The successful programs commonly focused on local initiatives and were built on local wisdom and resources.

Asia↗

PubMed1998

Private health care provision in developing countries: a preliminary analysis of levels and composition.

While the importance of the private sector in providing health services in developing countries is now widely acknowledged, the paucity of data on numbers and types of providers has prevented systematic cross-country comparisons. Using available published and unpublished sources, we have assembled data on the number of public and private health care providers for approximately 40 countries. This paper presents some results of the analysis of this database, looking particularly at the determinants of the size and structure of the private health sector. We consider two different types of dependent variable: the absolute number of private providers (measured here as physicians and hospital beds), and the public-private composition of provision. We examine the relationship between these variables and income and other socioeconomic characteristics, at the national level. We find that while income level is related to the absolute size of the private sector, the public-private mix does not seem to be related to income. After controlling for income, certain socioeconomic characteristics, such as education, population density, and health status are associated with the size of the private sector, though no causal relationship is posited. Further analysis will require more complete data about the size of the private sector, including the extent of dual practice by government-employed physicians. A richer story of the determinants of private sector growth would incorporate more information about the institutional structure of health systems, including provider payment mechanisms, the level and quality of public services, the regulatory structure, and labour and capital market characteristics. Finally, a normative analysis of the size and growth of the private sector will require a better understanding of its impact on key social welfare outcomes.

Delivery of Health Care↗

PubMed2004

[When and how is medical teleconsultation to doctors practising in remote areas of developing countries convenient and reliable? About eight clinical cases].

A poorly equipped internal medicine doctor (IMD), practising in remote areas of developing countries, can be assisted with expertise teleconsultations by using the common analogical telephone lines. By that way, the clinical cases he challenges became multidisciplinary and the success of the treatment enhanced. Eight cases are reported as examples. The expertise is made up by eight remote-access experts on different medical fields. The effectiveness of the support of the consultants is compared one to the other. In laboratory, dermatology and, partly, cyto-pathology fields the teleconsultations are reliable and not time-consuming, for the key tool is the digital picture sent by e-mailing. In cardiology (heart ultrasound scan) and radiology fields both effectiveness and benefit-cost ratio are disputable. Heart ultrasound scan is a dynamic test and filming is needed to provide the consultant with good records. In radiology field, the upper digestive tract X-ray scan is usually carried out with few shots, due to the unsustainable charges on the patient. That matter impairs the consultant's effectiveness to support. Although the black-outs of the transmission were common throughout IMD-consultant videoconferences, the physical examination of the patient, performed by the IMC under consultant's direct supervision, is highly supportive both in neurology and paediatric fields. The physiotherapist's show of physical rehabilitation exercises by videoconference is highly supportive as well.

Adolescent↗

PubMed2005

Maternal mental health and child nutritional status in four developing countries.

OBJECTIVE: To test the hypothesis that maternal common mental disorders (CMD) are associated with poorer child nutritional status in four developing countries (Ethiopia, India, Vietnam, and Peru). DESIGN: Community based cross sectional survey in 20 sites in each of the four countries. Maternal CMD measured by the self reporting questionnaire 20 items (SRQ20). Potential confounding factors include: household poverty, household composition, maternal characteristics such as age and education, child characteristics such as birth weight, age, and sex. Possible mediating factors included the child's physical health and breast feeding status. SETTING: Urban and rural, poor and middle income areas in each country. PARTICIPANTS: 2000 mothers and their children aged 6-18 months in each country. MAIN OUTCOME MEASURES: Child stunting and underweight measured using standard anthropometric techniques. RESULTS: Levels of maternal CMD and child malnutrition are high in each study setting. After adjusting for confounding factors, the odds ratios (OR) for the association of maternal CMD with child stunting are: India 1.4 (95%CI 1.2 to 1.6), Peru 1.1 (0.9 to 1.4), Vietnam 1.3 (0.9 to 1.7), and Ethiopia 0.9 (0.7 to 1.2). For child underweight, the confounder adjusted ORs are: India 1.1 (0.9 to 1.4), Peru 0.9 (0.6 to 1.2), Vietnam 1.4 (1.1 to 1.8), and Ethiopia 1.1 (0.9 to 1.4). No clear evidence for effect modification by the child's age or sex was found. Possible mediating factors for the effect of maternal CMD on child malnutrition did not provide strong suggestions for potential mechanisms. CONCLUSIONS: There was a relation between high maternal CMD and poor child nutritional status in India and Vietnam. However, the findings from Peru and Ethiopia do not provide clear evidence for a similar association being present in non-Asian countries. Regardless of the direction of the relation, child nutrition programmes in Asia should consider incorporating promotion of maternal mental health.

Adolescent↗

PubMed2002

Management of chronic osteomyelitis in a developing country using ceftriaxone-PMMA beads: an initial study.

Chronic osteomyelitis is a debilitating disease that is fairly common in developing countries. Various operative techniques have been adopted in the management of this disease but there have been few reports of their use in Africa. In this report, we present our experience of the use of a modified two-staged Belfast operation in patients with chronic osteomyelitis in Ibadan, Nigeria. An important modification of the procedure was the substitution of gentamicin beads (Septopal) with ceftriaxone-polymethylmethacrylate (PMMA) beads at the saucerised segment of bone at the first stage. Thirty-four patients with chronic osteomyelitis had the two-stage Belfast operation in 35 long bones; of these, 32 patients had ceftriaxone-PMMA antibiotic beads inserted at the saucerised segment of bone at the first stage, while the other two patients had gentamicin beads inserted. One of the two patients who had gentamicin beads had a residual collection of pus at second stage surgery but, following a repeat debridement, the cavity was rid of infection. There was recurrence of infection in three patients (8.6%) who had a suction drain inserted at the first stage and in six patients (17.1%) who had no suction drain at the first stage. The locally produced ceftriaxone-PMMA beads were found to be as efficient as the commercially available gentamicin beads in eluting antibiotics locally, thereby eliminating the residual infection in the bone cavities after the first stage. Another important outcome was a fourfold saving in cost in choosing to use ceftriaxone-PMMA beads rather than gentamicin beads.

Adolescent↗

PubMed1999

Repair of total anomalous pulmonary venous connection in infancy: experience from a developing country.

BACKGROUND: Corrective surgery for total anomalous pulmonary venous connection in infancy still carries high morbidity and mortality rates in developing countries. The present study evaluates the factors responsible for it. METHODS: Seventy-three infants were operated on for total anomalous pulmonary venous connection from January 1987 through October 1997. Age ranged from 5 days to 12 months (mean, 3.9+/-0.24 months), with 10 (13.7%) patients younger than 1 month old. Patient weight varied from 2.0 to 5.2 kg (mean, 3.7+/-0.27 kg). Most (90.5%) patients were small for their ages (< 50th percentile). Anomalous connection was supracardiac in 42 (57.5%), cardiac in 18 (24.7%), infracardiac in 4 (5.5%), and mixed in 9 (12.3%) patients. Thirty-five patients had obstructed drainage. Preoperatively, 30 patients received antibiotic therapy for respiratory tract infection, 3 patients had balloon atrial septostomy, and 4 patients required mechanical ventilation. Fifteen patients (20.5%) were operated on as an emergency procedure. For supracardiac and infracardiac connections, a posterior approach was used for anastomosis. In cardiac type, coronary sinus was unroofed and the resultant defect along with atrial septal defect was closed with a single patch. RESULTS: The operative mortality rate was 23.3% (17 of 73). Pulmonary hypertensive crisis was the cause of death in 10 patients. Emergency operation and weight less than the 25th percentile were the important risk factors for operative mortality. Young age (< 1 month) and type of drainage did not affect the mortality. Follow-up ranged from 1 to 108 months (mean, 56.4+/-26.0 months). There were two late deaths. The actuarial survival (Kaplan Meier) at 9 years was 72.87%+/-5.39%. CONCLUSION: Failure of early recognition, and thus delayed referral, accounted for onset of cardiac cachexia, respiratory tract infection, and severe pulmonary hypertension, which had a major effect on unfavorable outcome.

Body Weight↗

PubMed1991

Pharmaceuticals and developing countries: problems and prospects.

For many decades there was little consensus on the nature and type of pharmaceutical policies best suited for developing countries. In the aftermath of the Nairobi Conference on the Rational Use of Drugs and the formulation of criteria by expert groups convened by the World Health Organization a consensus has emerged on many aspects. Infrastructure development and the deployment of trained manpower are now perceived as two of the essential requisites for the implementation of national pharmaceutical policies. The article reviews selected problem areas in the pharmaceuticals sector and proposes strategies to overcome them.

Developing Countries↗