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PubMed2002

[A Cochrane review on the umbilical cord care and prevention of infections. Antiseptic solutions are not necessary in developed countries but life-saving in developing countries].

One million newborn infants die every year by bacterial infections, which often have entered the body via the umbilicus. A Cochrane systematic review on "Topical umbilical cord care at birth" by J Zupan and P Garner is reviewed. Zupan and Garner conclude that simply to keep the umbilical cord dry and clean is sufficient for healthy, term neonates in rich countries; disinfectants do not offer any advantage. However, cleaning the umbilical cord with disinfectants may reduce the risk of serious bacterial infections in babies in poor countries or in neonatal wards. Observational studies in poor countries indicate that the life of numerous infants can be saved if pregnant women are vaccinated against tetanus and disinfectants are substituted for harmful cord care traditions. This Cochrane review is credible, but it should be updated and considered tentative since no data on sepsis are included. The search strategy should be better described and observational studies (case control and cohort studies) from poor countries should be included since there are no randomized control trials from these countries.

Anti-Infective Agents, Local↗
PubMed2006

Harnessing information and communication technologies to leverage scarce resources for cancer education, research and practice in developing countries.

In developing countries, low levels of awareness, cost and organizational constraints on access to specialized care contribute to inadequate patient help-seeking behavior. As much as 95% of cancer patients in developing countries are diagnosed at late to end stage disease. Consequently, treatment outcome is dismally poor and a vicious cycle sets in, with public mystification of cancer and the admonishment of cancer medicine as a futile effort, all, to the further detriment of patient help-seeking behavior and treatment engagement. The situation spirals down, when the practice of cancer medicine is not gratifying to the medical practitioner and does not appeal as a medical specialty to those in training. The future of cancer medicine in developing countries thus hinges on the demystification of cancer through positive information, coupled to an effective organization that allows for the optimal use of available resources, facilitates access to specialized care and promotes the flow of knowledge and technology amongst various stakeholders. This paper strives to make a cogent argument and highlight the capital importance of information and communication technologies in organizing and leveraging scarce resources for cancer education, research and practice in developing countries.

Editorial↗
PubMed1999

The introduction of new vaccines into developing countries.

The development and introduction of new vaccines is a costly and time consuming process. Unfortunately, those most in need--individuals in developing countries--are the last to receive these powerful disease preventing products. From the time a vaccine is first licensed in a developed country to the time most of the poor in developing countries have access to the vaccine can be 20-30 years. This delay is unacceptable. There is a great need to reduce this time span. This paper examines five ways of reducing the time span. Each of the five is essential and achieving success on all five will require a heightened level of international effort and coordination.

Developing Countries↗
PubMed2001

Caesarean section in developing countries.

In developing countries, obstetric practice, including the performance of caesarean section, is complicated by problems that are no longer seen in developed countries. The various indications for caesarean section might be the same but the operation is often technically more difficult to perform in developing areas. Developing countries lack resources. This chapter highlights the problems encountered in the developing world. Because cephalopelvic disproportion is one of the main indications for performing caesarean section in our sub-region, the technique of delivery of the impacted fetal head is discussed and alternatives to caesarean section are also suggested. The current view on myomectomy at caesarean section is described; including the technique of bloodless myomectomy at caesarean section. It is hoped that, with the training of postgraduate doctors in anaesthesia and obstetrics, the delivery of obstetric care will be accessible to rural areas in the developing world.

Anesthesia, Obstetrical↗
PubMed1994

Cancer in developing countries.

The developing countries are represented by incidence and mortality datasets from 16 populations. Trends are studied using age specific data from six cancer registries (three in Asia, three in Latin America) and national mortality datasets from Central and South America (three), the Caribbean (two), Asia (two) and Mauritius. In Africa, three cancer registries (in Nigeria, Uganda and Zimbabwe) provide time series of 15 years or more. Systematic examination of time trends is confined to five major sites (stomach, lung, breast, cervix uteri and colon-rectum), with a comment on observed trends in the other important cancers of developing countries (mouth/pharynx, oesophagus and liver). Although uniformity is not to be expected in such diverse material, some overall patterns emerge. Stomach cancer, as in the developed world, appears to be declining in importance. Lung cancer rates are rising, although in males, the increases are most marked in the elderly, with more recent birth cohorts in several populations showing a decline in risk. Breast cancer incidence and mortality rates are rising in most populations, with changes usually more marked in younger women. Conversely, cervix cancer, at present the most common cancer of women in developing countries, shows declines in incidence and mortality in the majority of populations studied, although Africa is clearly an exception. Cancer of the large bowel is becoming more frequent, although there are exceptions (eg Bombay, Mauritius and Trinidad). In the highest risk population (Uruguay), mortality seems to have peaked around 1965 and has since declined.

Adolescent↗
PubMed2005

Animal welfare and developing countries: opportunities for trade in high-welfare products from developing countries.

Discussion on the potential for developing countries to develop trade in niche markets such as higher welfare standards has been highlighted with moves by the World Organisation for Animal Health (OIE) to set internationally agreed standards for animal welfare. This paper examines the existing and potential trade in value-added higher welfare products using case studies in the beef and poultry sectors from three countries in Africa, Asia and Latin America. It shows that at present there is only a small trade in these products but that this can have a major effect at a national level. In the beef export trade from Namibia, the existence of the only assurance scheme in Africa setting standards in hygiene, veterinary care and animal welfare has created a trusted, safe and healthy product and ensured that Namibia has grown into Africa's largest exporter of beef to the European Union. In Thailand, the broiler industry, which has enjoyed annual growth in the past 15 years, is developing value-added products to develop markets to counter competition from other countries. The development and implementation of standards for organic products in both Thailand and Argentina over the past decade have also resulted in growth in the export markets of these products. The paper concludes that there is growth potential for the sectors in all three markets which can be assisted by the development of OIE baseline standards.

Animal Welfare↗
PubMed2004

Proceedings of the workshop on food-consumption surveys in developing countries: methodologic considerations in descriptive food-consumption surveys in developing countries.

This paper reviews some methodologic issues relative to food-consumption studies in developing countries, including sampling considerations; capturing temporal variation in food consumption; choice of dietary instruments and protocols; and food-composition databases and needs for adequate software interfaces. Increasingly, issues of cross-country and regional comparability in food-consumption data are now coming into the decision mix. Comparability of data across countries requires comparability of several fundamental systems. Specific countries and cultural contexts must tackle problems of how to estimate individual intakes when one-dish serving is the norm; how to keep up with rapidly changing food supplies; how to capture ingredients added at the table that may be concentrated sources of nutrients or other components of interest; and how to document out-of-home eating. Assumptions about error, bias, and intra-individual variation in food intake need to be thoroughly tested in developing-country contexts. There is an urgent need for improvement in the availability of appropriate food-composition databases and software interfaces for developing-country use.

Data Collection↗
PubMed2004

Reducing maternal mortality: can we derive policy guidance from developing country experiences?

Developing countries are floundering in their efforts to meet the Millennium Development Goal of reducing maternal mortality by 75% by 2015. Two issues are being debated. Is it doable within this time frame? And is it affordable? Malaysia and Sri Lanka have in the past 50 years repeatedly halved their maternal mortality ratio (MMR) every 7-10 years to reduce MMR from over 500 to below 50. Experience from four other developing countries--Bolivia, Yunan in China, Egypt, and Jamaica-confirms that each was able to halve MMR in less than 10 years beginning from levels of 200-300. Malaysia and Sri Lanka, invested modestly (but wisely)--less than 0.4% of GDP--on maternal health throughout the period of decline, although the large majority of women depended on publicly funded maternal health care. Analysis of their experience suggests that provision of access to and removal of barriers for the use of skilled birth attendance has been the key. This included professionalization of midwifery and phasing out of traditional birth attendants; monitoring births and maternal deaths and use of such information for high profile advocacy on the importance of reducing maternal death; and addressing critical gaps in the health system; and reducing disparities between different groups through special attention to the poor and disadvantaged populations.

Developing Countries↗
PubMed2003

Pathways to evidence-based reproductive healthcare in developing countries.

OBJECTIVE: Developing country clinicians are aware of the discourse of evidence-based medicine but heavily constrained in their ability to access and apply new knowledge. This study aimed to obtain primary descriptive data about access to and application of reproductive health-related medical knowledge in developing countries. DESIGN: Qualitative study using semi-structured interviews. SETTING: India and Yemen. SAMPLE: Forty-one doctors working in obstetrics, gynaecology, general practice and family planning services. METHODS: Interviews were tape recorded and transcribed verbatim. A theory-driven approach was conducted to carry out thematic analysis. MAIN OUTCOME MEASURES: Descriptions of experiences, attitudes and needs. RESULTS: Doctors felt the need to update their knowledge but this was not always achieved due to time and financial constraints. Alternative knowledge sources were described including the Internet, scientific meetings, medical family networks and speciality medical societies but access to these was limited by the expense of equipment, unfamiliarity with the technology and restricted advertisement of scientific meetings and conferences. Institutional hierarchy and conflict of generations were identified as barriers to change. Demoralisation was a common obstacle. On the positive side, involvement in medical education was a powerful driver for seeking new knowledge and applying research evidence to clinical practice. CONCLUSIONS: Priorities are to identify needs specific to different countries and medical settings in the developing world, access for all to full text journals and educational activities that fully engage practitioners in the early stages of their careers. Clinical teachers are the nodal group with the strongest incentive to obtain and use new knowledge.

Attitude of Health Personnel↗
PubMed1986

The Drug Formulary Committee in a developing country.

Most developing countries suffer badly from misguided drug selection and purchases, erratic supplies and distribution, and wasteful or inappropriate drug use. Barbados is one of the few developing countries with an active Drug Formulary Committee. This committee develops a formulary that is revised and updated annually, providing guidance on rational prescribing. The Barbados Drug Formulary Committee has operated for 5 years on principles similar to those of a P & T Committee, but with a more restricted list and a flexible approach geared to specific local problems. The Drug Formulary and ongoing educational activities, which have been effective agents in promoting rational prescribing, are described.

Barbados↗
PubMed1988

An avidin-biotin amplified ELISA for thyrotropin in human serum. Its implication for routine determination of thyrotropin in developing countries.

In developing countries the acquisition and use of radioisotopes with their short shelf lives poses enormous problems. The objective of this study was to develop a simple, sensitive, non-isotopic method for the measurement of TSH in human serum. A conventional sandwich enzyme-linked immunosorbent assay (ELISA) technique was modified to incorporate the avidin-biotin complex (ABC) in order to enhance the sensitivity of a solid-phase micro-ELISA for TSH. The lower limit of TSH detectability was 0.2 mIU/l. TSH levels ranged from 0.3 to 5.1 mIU/l in euthyroid subjects, 11.5-98.0 mIU/l in hypothyroid subjects and less than 0.2-2.1 mIU/l in hyperthyroid subjects. Sera from euthyroid post-menopausal or pregnant women yielded TSH levels within the normal range. The correlation between the TSH values obtained in the ELISA-ABC and a sensitive commercial immunoradiometric method was high (n = 59, r = 0.980, P less than 0.01). The simplicity and relatively high sensitivity of the procedure should make it a method of choice for TSH determination in small hospitals and those in developing countries.

Aged↗
PubMed2003

Some problems and pitfalls in developing countries.

In developed countries with well-structured health care and reimbursement systems, epilepsy care is evidence based. By contrast, in developing countries, patients with epilepsy encounter several significant barriers to adequate treatment and are more often managed according to local ethnic, racial, religious, economic, educational, and cultural diversities. Cost is one issue that clearly determines antiepileptic drug (AED) selection, and it is reasonable to recommend one of the traditional, and cheaper, AEDs as first-line therapy. However, the appropriate choice of drug in an individual patient is a balance of efficacy, tolerability, and cost and should be tailored to individual affordability.

Anticonvulsants↗
PubMed1999

An evaluation of the 'voice test' as a method for assessing hearing in children with particular reference to the situation in developing countries.

In developing countries with limited no or access to standard audiometric methods a 'voice test' is a potential non-technological alternative method of assessing hearing. A three level 'voice test' was developed, refined and standardised-accurate response to a whispered voice equating with normal hearing, to a conversational voice with mild hearing loss and to a loud voice to moderate/severe hearing loss. In a hospital based study 177 children were voice tested in sound treated rooms and then tested using standard audiometric procedures to determine precise hearing thresholds. In this situation the voice test had a specificity of 95.9% and a sensitivity of 80%. When the test was evaluated on 201 children aged 3-8 years, first voice tested and then tested with standard audiometry in the classrooms of their pre-primary schools it was found to have a specificity of 97.8% and a sensitivity of 83.3%. With this degree of accuracy in detecting hearing impairment and given the simplicity required to administer the test, it is felt that such a test could be recommended for use by primary health care workers in developing countries where access to standard audiometric methods for assessing hearing are not available.

Audiometry↗
PubMed2003

Solar disinfection of infectious biomedical waste: a new approach for developing countries.

Poor developing countries cannot afford expensive technologies such as incineration for management of infectious biomedical waste. We assessed solar heating as an alternative technology. We immersed simulated infectious waste with added challenge bacteria in water in a box-type solar cooker, which was left in the sun for 6 h. In 24 sets of observations, the amount of viable bacteria was reduced by about 7 log. We also tested infectious medical waste with a heavy load of bacteria (10(8)-10(9)/g) from our hospital's burn unit for solar heat disinfection in 20 experiments. Our results showed a similar 7 log reduction in the amount of viable bacteria. Solar heating thus seems to be a cheap method to disinfect infectious medical waste in less economically developed countries.

Developing Countries↗
PubMed1991

Swedish Agency for Research Cooperation with Developing Countries. Prospects for public health benefits in developing countries from new vaccines against enteric infections.

The symposium participants concluded that vaccines with even moderate efficacy can be highly useful to prevent large numbers of severe illness episodes and deaths and that the decision of whether to initiate a vaccine program should be based on measures or estimates of public health effectiveness rather than only on protective efficacy. Studies of protective efficacy are of course critical to establish the vaccine's biologic activity, but additional aspects of public health effectiveness are also crucial in making these decisions. First-generation vaccines are available against typhoid, cholera, and soon rotavirus diarrhea, and vaccines against enterotoxigenic E. coli diarrhea and shigellosis are under development. The problems related to enteric diseases are enormous; the vaccines may soon be produced at low cost and promise to be relatively more easy to distribute than most previous vaccines. The number of illnesses and deaths averted from vaccine programs are potentially great. Pilot programs using the new vaccines should urgently be considered in areas where the disease burden is high, and steps should be taken to monitor effectiveness of the intervention in these programs. Such studies of vaccine effectiveness and costs in a "real world" situation are an essential step of the research process and should be used to guide the organization of larger-scale programs. Finally, many of the necessary research and development activities relevant to public health vaccinology must address country-specific problems. Developing countries should consider the role of vaccine-related research among the priorities for their essential national health research and build the necessary capabilities in applied and basic medical sciences and in the social sciences.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗
PubMed1988

Problems in assessing rationality of drug utilization in less developed countries.

Less developed countries are facing various difficulties in assessing rationality of drug utilization. The problems are essentially related to four major areas; (a) Policies, administration and management, (b) Practice and services, (c) Education and training, (d) Monitoring and research. Drug policies have often failed to recognise the importance of identifying the levels of rationality of the various components of drug utilization. Consequently, neither the need nor the mechanisms to assess rationality were considered. Drug utilization data and records have been poorly developed and maintained, e.g. mal-managed, inaccurate, and without continuity with regard to collection, monitoring and evaluation. Provision and supply of drugs were handled by an unnecessary multiplicity of departments and state offices, none of which keeping complete records and/or information in relation to needs of drugs nor other health care requirements. Deficiencies and shortcomings associated with medical/pharmaceutical practice, services, education and training have as well contributed significantly to the failure of the less developed countries to assess and promote rationality of drug utilization.

Developing Countries↗
PubMed2002

Overview of human health and chemical mixtures: problems facing developing countries.

In developing countries, chemical mixtures within the vicinity of small-scale enterprises, smelters, mines, agricultural areas, toxic waste disposal sites, etc., often present a health hazard to the populations within those vicinities. Therefore, in these countries, there is a need to study the toxicological effects of mixtures of metals, pesticides, and organic compounds. However, the study of mixtures containing substances such as DDT (dichlorodiphenyltrichloroethane, an insecticide banned in developed nations), and mixtures containing contaminants such as fluoride (of concern only in developing countries) merit special attention. Although the studies may have to take into account simultaneous exposures to metals and organic compounds, there is also a need to consider the interaction between chemicals and other specific factors such as nutritional conditions, alcoholism, smoking, infectious diseases, and ethnicity.

Agriculture↗
PubMed2003

Treatment of haemophilia in the developing countries.

In developing countries, most of the patients with haemophilia are in the paediatric age group as they seldom reach adulthood because of inadequate treatment. Haemophilia is not given the priority it deserves as there are high numbers of other serious health problem. Haemophilia care should be integrated into the existing healthcare system of a primary care centre, a treatment centre, a comprehensive care centre and a reference centre. It is considered important to educate the personnel through the curriculum of medical students and all healthcare personnel. Diagnosis should be started at the antenatal stage and subsequently confirmed by laboratory testings. Qualified therapeutic products should be produced locally in combination with imported affordable factor concentrate. In-house preparation of fibrin glue is helpful for dental procedures without the need for any blood component. Home care treatment is essential and can be adopted even by parents with low literacy. Lastly, research for laboratory diagnosis, treatment and prevention should be continuously conducted to serve people with haemophilia specifically in developing countries.

Blood Component Transfusion↗