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PubMed2004

Challenges to developing countries after joining WTO: risk assessment of chemicals in food.

FAO/WHO encourages member countries to develop national food control measures based on risk assessment in order to assure proper protection level to consumers and facilitate fair trade. This is particularly important for developing countries as WTO members because it is clearly stated in the Sanitary and Phytosanitary Measures (SPS) Agreement that: (a) SPS measures should be based on risk assessment techniques developed by relevant international organizations; and (b) Codex standards which is based on risk assessment are regarded as the international norm in trade dispute settlement. When conducting risk assessment on food chemicals (including additives and contaminants) in developing countries, in most cases it is not necessary to conduct their own hazard characterization because the ADIs or PTWIs of food chemicals developed by international expert groups (e.g. JECFA) are universally applicable and also developing countries do not have the resources to repeat those expensive toxicological studies. On the other hand, it is necessary to conduct exposure assessment in developing countries because exposure to food chemicals varies from country to country. This is not only crucial in setting national standards, but also very important for developing countries to participate in the process of developing Codex standards. In addition to food standard development, risk assessment is also useful in setting up priorities in imported food inspection and evaluating the success of various food safety control measures.

Animals↗
PubMed1991

Anaesthetic equipment for a developing country.

A development aid project to Malawi is described. This involved the development of a suitable anaesthetic machine for use in under-developed countries and the selection of a suitable oxygen concentrator to provide it with air and oxygen. All government hospitals were provided with anaesthetic equipment and personnel were trained to keep it regularly serviced. Follow up testing of reliability was undertaken. The cost benefit to the country amounted to 234,084 pounds (sterling) per year. This is the first instance of widespread use of standardized anaesthetic equipment which includes oxygen concentrators.

Anesthesiology↗
PubMed1989

Technology and women's health in developing countries.

In developing countries is medical technology transfer reaching women? Do women control new technologies or are they only passive recipients? What is the impact of these new technologies on women's health and welfare? To answer these questions this article explores concepts of health, technologies, and women, then gives findings from an extensive literature search on contraception, childbirth, immunization, essential drugs, oral rehydration therapy, water, sanitation, and breast-feeding. The article concludes with recommendations on pre-project planning studies, monitoring, and evaluation.

Developing Countries↗
PubMed2006

Immunization strategies for the control of serogroup C meningococcal disease in developed countries.

In developed countries, the epidemiology of serogroup C meningococcal disease is characterized by unpredictable outbreaks and a bimodal distribution of cases, with the highest incidence rate among those below 1 year of age and a second peak in teenagers. Serogroup C meningococcal conjugate vaccines elicit a thymus-dependent immunological response that is already present in young infants and is characterized by the production of protective antibodies and the development of memory. Results from immunogenicity and effectiveness studies indicate that waning of immunity occurs over time, and the protection conferred by vaccination before 1 year of age seems to be shortlived. Very different control strategies have been implemented throughout the world and existing vaccination schedules may not be optimal. A schedule consisting of a first dose around 1 year of age and a second dose around 12 years of age seems to be a very cost-effective option in most epidemiological scenarios.

Developed Countries↗
PubMedDate not supplied

Standardised assessment in developing countries.

In developing countries, the standardised psychiatric assessment raises special problems: lack of trained manpower, lack of research facilities, transcultural aspects of concepts and wording originally elaborated by Western psychiatrists. The author gives a few examples, mainly from the PSE.

Africa↗
PubMed1993

Special problems experienced with pesticide use in developing countries.

The developing countries comprise more than 75% of the total world population covering most of Africa, Asia, Latin America, and South Europe. Their warm climate favors cultivation of many strategic crops including cotton, rubber, rice, corn, spices, tea, coffee, cocoa beans, sugarcane, tobacco, legumes, tropical and subtropical fruits, and vegetables. They are bound to the industrialized countries for exporting their cash crops and importing all production equipment and materials including pesticides and fertilizers. They suffer from illiteracy, overpopulation, and low standards of living. Their deficient economy and infrastructure hinder their ability to regulate efficiently registration of pesticides. Their inhabitants are at high risk due to the acute and chronic adverse health effects induced by pesticide exposure under both occupational and epidemiological conditions. Their legislations, regulations, technical capabilities, and medical care need to be upgraded to a reliable standard. This is essential for the global welfare because any hazardous pesticides dumped or released in the environment in these countries will not be dissipated but can reappear as residues in imported raw foods or by destroying terrestrial and aquatic life, through their transportation within the atmosphere, or in liquid discharges to soil and water bodies. International assistance and support are badly needed by United Nations Agencies, mainly WHO, UNEP, FAO, ILO, IPCS, IRPTC, and other relevant international organizations.

Agriculture↗
PubMed1997

Assessing medical technology in less-developed countries.

Less developed countries (LDCs) are limited in medical resources. Medical technology and the management talent required to handle it play a particularly major role in their national health care and has significant economic, political, and ethical ramifications. This study of the assessment process of medical technology in the LDCs proposes a limited framework for the analysis of the major parameters involved, i.e., stakeholders, boundaries and constraints, goals and objectives, criteria to be met, performance measures, and measurement of performance. The importance of the intangible factors is elucidated.

Decision Making, Organizational↗
PubMed1995

Urban nutrition in developing countries.

In developing countries, the past decades have seen a marked demographic shift from rural to urban. By the year 2000, 40% of the population of the Third World will live in urban areas. We have limited specific knowledge of the similarities and differences in diet, nutrition status, and health effects of diet and lifestyle between the traditional rural populations and the emerging urban poor. Such information will be useful for basic descriptive information as well as for assistance in the design and execution of health and nutrition projects for the urban poor.

Child↗
PubMed1990

National training of radiotherapists in Sri Lanka and Zimbabwe: priorities and strategies for cancer control in developing countries.

The development of therapy resources should not be done in isolation of other cancer control activities. The right priorities and strategies must be determined in a systematic way, preferably through well-conceived national cancer control programs. If this is not done, it is unlikely that the therapy efforts will have any impact on cancer in the developing countries, as most cancers are incurable when seen for therapy. Therapy efforts must be linked with the search for earlier referral and diagnosis of cancer patients. However even limited resources may have an effect on controlling cancer, provided that the right priorities and strategies are followed. National and regional training facilities with a suitably adapted syllabus in radiotherapy and oncology must be a part of these priorities and strategies. The World Health Organization (WHO) has initiated, in close collaboration with the National Governments, national and regional training courses in radiotherapy and oncology in Sri Lanka and Zimbabwe.

Developing Countries↗
PubMed1985

Influenza surveillance: alternative laboratory techniques for a developing country.

In developing countries it is often impractical to use conventional methods to isolate and identify influenza viruses. The use of trypsin-treated LLC-MK2 cells for the isolation of myxoviruses, in conjunction with the indirect fluorescent antibody technique for identification of isolates and for direct detection of viral antigens in specimens, was an effective combination of techniques which enabled our laboratory in Papua New Guinea to participate in an influenza surveillance programme. The application of these techniques in routine respiratory virus surveillance and in the investigation of an outbreak of influenza-like illness is described.

Child↗
PubMed1994

Maternal health in the age of AIDS: implications for health services in developing countries.

In developing countries, the HIV/AIDS epidemic will have a major impact on all phases of women's reproductive lives, and will alter many standard approaches to the management of MCH (maternal and child health) services related to fertility regulation, pregnancy, delivery and the postpartum period. AIDS-related increased caseloads, occupational risk to health workers and reduced resources will further compromise MCH services. MCH programme managers and service providers need to better understand the nature of both technical and service-related issues intersecting both the MCH and AIDS fields to mitigate this impact.

AIDS-Related Opportunistic Infections↗
PubMed1992

Diabetes in the elderly in a developing country.

In developing countries diabetes in the elderly is thought to be uncommon and is consequently ignored by health planners. We assessed the prevalence of complications of diabetes mellitus and frequency of hospital admissions in patients aged 60 and over in a hospital diabetic clinic in Sri Lanka. Elderly diabetic patients, though comprising only 23% of clinic patients, accounted for 46% of admissions. The prevalence of coronary artery disease, peripheral vascular disease, cerebrovascular disease, hypertension and visual handicap was increased in the diabetic patients when compared to age and gender matched controls. We conclude that diabetes in the elderly is a significant cause of morbidity in Sri Lanka.

Aged↗
PubMed2004

A systematic review of the health outcomes related to household water quality in developing countries.

In developing countries, the microbial contamination of household drinking water is implicated in the prevalence of various diseases. This systematic review is concerned with two health outcomes, general diarrhoea and cholera, and their relationship with water quality at point-of-use. Observational studies investigating this relationship are reviewed, as well as studies of home water treatment and storage interventions. For cholera, a clear relationship was found with contaminated water. Home water treatment and storage interventions were also found to reduce cholera. For general diarrhoea, no clear relationship was found with point-of-use water quality, although interventions did significantly reduce diarrhoeal incidence. Reasons for these apparently contradictory results concerning general diarrhoea are discussed and suggestions for further research offered. The policy implications of the findings are also discussed.

Cholera↗
PubMed2006

Commercial living non-related organ transplantation: a viewpoint from a developed country.

In developed countries, the use of living unrelated donors is restricted to purely altruistic donors who have a close and emotional relationship with the recipients. By law, commercial transplantation is illegal. Increasing shortness of donors, the excellent results of kidney transplants from spousal and living unrelated donors as well as the very low risk for the donor has been used as an argument for paid organ donation. Arguments in favour are the relief of donor-organ shortage, short waiting times for renal transplantation, economic benefits for the donor as well as the economic benefits for society by reducing the costs of dialysis by more transplants. Major arguments against are exploitation of the donor, coercion, and a growing black market. Despite the fact that different societies have different norms or reproaches that we are failing our patients and accept the death of thousands, kidney trade has created an environment of corruption and commercialisation, which brings even the cadaver transplant program into disrepute. However, denying the existence of paid organ donation does not contribute to solve the problem. A public discussion about consequences of changing ethics and human rights, rather than pragmatic solutions, is needed.

Adolescent↗
PubMed1998

Preoperative work up: are the requirements different in a developing country?

In developing countries there is a tendency to advocate routine testing in asymptomatic healthy patients to identify undocumented significant medical conditions. A retrospective review of pre- operative laboratory investigations undertaken in patients attending the General Surgical department was performed. Three hundred and twenty patients case notes were reviewed, patients were selected on the basis of common general surgical procedures. Two hundred and sixteen patients (67.5%) did not have any associated medical illness on history and physical examination. Analysis of laboratory results showed that 42/216 (19.4%) had low hemoglobin. An abnormal chest X-ray was the next common abnormality 11/103 (10.6%). Mild hypokalemia (> 3 mEq/L) was seen in 6/123 (4.8%) and a raised blood sugar level was seen in 1/113 (0.88%) patients. Only one patient with hemoglobin of 4.8 gm/dL needed preoperative intervention, the rest of the abnormalities did not effect the treatment plan or outcome. The results were in general agreement with other studies except for the high proportion of low hemoglobin seen in the female population. It is suggested that a thorough history and physical examination is a reliable and inexpensive preoperative screening tool. Guidelines for pre-operative investigations in American Society of Anesthesiologists Grade I (ASA I) patients are suggested.

Adolescent↗
PubMed1994

Health and human rights: the challenge for developing countries.

What are the priorities when it comes to health and human rights? This article is subtended by the following principle, i.e. issues of health and human rights must be considered from different angles in industrial countries and developing countries. Indeed, the subjects that preoccupy the countries of 'the North,' such as the ethics of mandatory screening, assisted insemination, and euthanasia, to name a few, are of only marginal importance in the 'South.' The exception is the very specific case of health services' involvement in the organization of torture, which is common to North and South. Geographical, economic and cultural barriers have been lowered or removed in most industrialized countries and using effective, good-quality services has become a right for the overwhelming majority of their citizens. Priority in the developing countries continues to be given above all to improving the quality and effectiveness of health services and making them accessible to the greatest number of people. This article starts with a brief historical overview of the development of the 'health and human rights' concept. The body of the paper will then be devoted to an analysis of constraints and identification of the solutions that will allow health to become a real 'human right' for the people of developing countries. Health as a human right is the challenge for developing countries.

Developing Countries↗
PubMedDate not supplied

What can developing economies learn from health system reforms of developed countries?

This paper outlines some general lessons developing nations can draw from the health system reform experiences of developed nations. Using the experiences of developed countries, developing countries should be better able to anticipate socio-economic changes and choose an optimal path for their health systems development to accompany those changes. Most developed countries have adopted rather common objectives and principles in their health systems because of market failure in health care; developing countries may start adopting those principles because they do not have market conditions in the first place. It is suggested that developing countries strengthen what is probably the most fundamental initial systemic asset they have: public finance. They should do so by attracting democratically, possibly through earmarked taxes, resources otherwise channelled through the private sector, competing with public finance for limited real resources. This effort can be promoted by giving consumers, mainly of high income groups and in urban areas, more say (through institutions performing the OMCC function) in the nature of care these groups have access to under auspices of public finance. Where feasible, private insurance as a major source of finance should be seen as a transitional phenomenon, giving way to the emergence of OMCC institutions which require similar financial and managerial market infrastructure. Private and competitive provision of care may be unrealistic in many developing areas because of both scarcity of real resources, mainly manpower, and health needs. The challenge of government is, as resources grow, to divest itself from the provision of care and stay involved in activities and facilities that are of 'public nature'--under specific circumstances--that foster private competitive provision. In general, the government should play an enabling role also by investing in health promotions and management skills for health systems.

Developed Countries↗