Growth of civil society in developing countries: implications for health

Owing to changes in political systems, the number of non-governmental organisations worldwide has increased substantially since 1980. The influence of civil society on health and health care depends on the recognition of its role as a partner in primary health care, on its success in the scaling up of activities, on its cooperation with the State and business sector, and on networking. In the event of health-sector reforms, civil society should focus on equity and justice, and advocate health as a public responsibility. The impact on health would increase if medical personnel joined forces with civil society and if medical schools added public speaking, networking, and lobbying to their agenda. The trend is that an increasing number of agents are getting involved in the promotion of health.     

Measuring health and economic status of older adults in developing countries

Aging and health care are the emerging policy issues in the Third World. However, we currently do not have the data to address these issues because economic status and health have not been integrated into a single survey design. This article discusses the rationale for the principal features of an emerging new international survey design which includes integration of younger and older families; reliance on retrospective data; intensive measurement of economic status, health outcomes and utilization and intergenerational transfers; and the combination of a household and community survey.     

Trials in developing countries

Good clinical trials can be carried out in the developing countries but ethical issues concerning the trials are frequently brought up for international debate. The concern has its own merit but can be amended if investigators (local and international) pay serious attention to these criticisms and work out the way that will most benefit the trial participants. Although scientific progress is important, it must come after the rights, the safety and the benefit of the patients. Frequently, the ethical standard is delicately balanced, depending on who looks at it and from what angles they look. Critics, investigators, volunteers, sponsors and regulatory agencies have their own mandates, expectations and limitations, and thus they need to keep an open line of communication in order to benefit all parties involved.     

Perinatal infections--problems in developing countries

The transmission of infections from the biologic mother to her offspring is popularly known as perinatal infection (PI). It is not synonymous to infections during the perinatal or neonatal period. Physicians should avoid focusing attention only on the TORCH agents in the evaluation of suspected PI. Perinatal period begins from 28 weeks of gestation. Would one consider in utero infections in the first or second trimester of pregnancy as PIs? Developing countries have difficulty in collecting reliable and accurate data of PIs. These data are useful to define the magnitude of the problems, to monitor the trends, to recognise the mode of spread, and to find a solution of PIs. Most PIs are asymptomatic and diagnosis is extremely difficult. Developing countries need rapid, easy-to-operate, simple, and cheap diagnostic tools urgently. Access to health care in the remote city is limited. Newer drugs are too expensive and very few patients can benefit from these. Each developing country should prioritize its PI problems and tackle those that have serious public health problems and socio-economic impact. Most developing countries should focus on HIV (human immunodeficiency virus) and HBV (hepatitis B virus) infections. Other countries where ophthalmia, malaria or tuberculosis are prevalent or endemic, should focus on these. Developing countries are more willing to allocate the budget for prevention of diseases than for treatment. There may be problem of promulgating the information on prevention of diseases because of illiteracy, multi-lingual community. Vaccines where available, should be affordable. Other effective prevention guidelines should be workable in poorer nations. The government should play an important role in enforcing immunisation program by intensive promotion program or by legislation.     

Rural psychiatry in developing countries

During the last two decades several initiatives have been taken to improve psychiatric services in low-income rural areas in developing countries. They have included the formulation of national mental health programs and establishment of pilot programs for integration of mental health care with primary health care in India, Iran, and other countries in Asia, Africa, and South America. The psychiatrist has multiple roles to play in meeting the many challenges of providing mental health care in rural areas in developing countries.     

Use of ciprofloxacin in developing countries

BACKGROUND: The demographic and subsequent economic pressures in developing nations have contributed to the increasing levels of antibiotic resistance among both commensal flora and pathogenic bacteria. As empirical options are diminishing daily, the role of ciprofloxacin in pediatric infections is becoming increasingly significant. OBJECTIVE: The levels of resistance among various enteric pathogens are described, and the efficacy and safety of ciprofloxacin in treating infections such as shigellosis, cholera and Escherichia coli gastroenteritis are discussed. The findings of a large study of invasive salmonellosis in children in rural Africa are briefly presented, including the role of ciprofloxacin in multiresistant invasive disease. In addition the role of ciprofloxacin as a chemoprophylactic agent in the control of meningococcal disease is discussed. RESULTS: The efficacy and safety of ciprofloxacin in children were found to be similar to those observed in adults for gastrointestinal infectious diseases. Overall the data presented confirm that ciprofloxacin is a safe and efficacious agent for use in children in the developing world. CONCLUSION: Ciprofloxacin has been shown to be safe and efficacious in children in developing countries. Subsequently a priority for both the pharmaceutical industry and regulatory authorities in developing nations is to prevent fluoroquinolone misuse and development of antibiotic resistance.     

Undercover careseekers: simulated clients in the study of health provider behavior in developing countries

The simulated client method (SCM) has been used for over 20 years to study health care provider behavior in a first-hand way while minimizing observation bias. In developing countries, it has proven useful in the study of physicians, drug retailers, and family planning services. In SCM, research assistants with fictitious case scenarios (or with stable conditions or a genuine interest in the services) visit providers and request their assistance. Providers are not aware that these clients are involved in research. Simulated clients later report on the events of their visit and these data are analyzed. This paper reviews 23 developing country studies of physician, drug retail, and family planning services in order to draw conclusions about (1) the advantages and limitations of the methods; (2) considerations for design and implementation of a simulated client study; (3) validity and reliability; and (4) ethical concerns. Examples are also drawn from industrialized countries, related methodologies, and non-health fields to illustrate the issues surrounding SCM. Based on this review, we conclude that the information gathered through the use of simulated clients is unique and valuable for managers, intervention planners and evaluators, social scientist, regulators, and others. Areas that need to be explored in future work with this method include: ways to ensure data validity and reliability; research on additional types of providers and health care needs; and adaptation of the technique for routine use.     

VD education in developing countries. A comparison with developed countries

The amount of natural anti-DNP-cap, anti-NIP-cap or anti-ABA-TYR in human IgM was measured by using immunoabsorbents and hapten elution. We found that 1.0% of pooled human IgM is specific for DNP-cap, 0.2% for NIP-cap and 0.02% for ABA-TYR. Haptens NIP and DNP were found to be cross-reactive when tested with natural antibodies even though they were not cross-reactive when tested with immune antibodies.