Disease In Low-income Countries Research Articles

Schizophrenia Prognosis: Debate Rages On

Schizophrenia Prognosis: Debate Rages On

A cross-sectional study of vascular risk factors in a rural South African population: data from the Southern African Stroke Prevention Initiative (SASPI).

BackgroundRural sub-Saharan Africa is at an early stage of economic and health transition. It is predicted that the 21st century will see a serious added economic burden from non-communicable disease including vascular disease in low-income countries as they progress through the transition. The stage of vascular disease in a population is thought to result from the prevalence of vascular risk factors. Already hypertension and stroke are common in adults in sub-Saharan Africa. Using a multidisciplinary approach we aimed to assess the prevalence of several vascular risk factors in Agincourt, a rural demographic surveillance site in South Africa.MethodsWe performed a cross sectional random sample survey of adults aged over 35 in Agincourt (population ≈ 70 000). Participants were visited at home by a trained nurse who administered a questionnaire, carried out clinical measurements and took a blood sample. From this we assessed participants' history of vascular risk, blood pressure using an OMRON 705 CP monitor, waist circumference, body mass index (BMI), ankle brachial index (ABI), and total and HDL cholesterol.Results402 people (24% men) participated. There was a high prevalence of smoking in men, but the number of cigarettes smoked was small. There was a striking difference in mean BMI between men and women (22.8 kg/m2 versus 27.2 kg/m2), but levels of blood pressure were very similar. 43% of participants had a blood pressure greater than 140/90 or were on anti-hypertensive treatment and 37% of participants identified with measured high blood pressure were on pharmacological treatment. 12% of participants had an ABI of < 0.9, sugesting the presence of sub-clinical atheroma. 25.6% of participants had a total cholesterol level > 5 mmol/l.ConclusionWe found a high prevalence of hypertension, obesity in women, and a suggestion of subclinical atheroma despite relatively favourable cholesterol levels in a rural South African population. South Africa is facing the challenge of an emerging epidemic of vascular disease. Research to establish the social determinates of these risk factors and interventions to reduce both individual and population risk are required.

Treatment for children with severe aplastic anemia and sickle cell disease in low income countries in Latin America: A report on the recent meetings of the Monza International School of Pediatric Hematology/Oncology (MISPHO): Part III

Treatment of hematologic disorders in low-income countries (LIC) is difficult. This report summarizes treatment of sickle cell disease and aplastic anemia by pediatric hematologists from 15 LIC who participate in the Monza International School of Pediatric Hematology/Oncology (MISPHO). Patients with severe sickle cell disease were treated with low dose hydroxyurea, which safely reduced vaso-occlusive crises. Patients with severe aplastic anemia fared poorly due to lack of availability and high cost of anti-thymocyte globulin and cyclosporine and lack of access to stem cell transplantation. Appropriate therapy was most likely to occur in MISPHO centers with an active twinning program with a center in a high-income country.

Aid and the Supply Side: Public Investment, Export Performance, and Dutch Disease in Low-Income Countries

Contemporary policy debates on the macroeconomics of aid often concentrate on short-run Dutch disease effects, ignoring the possible supply-side impact of aid financed public expenditure. In the simple model of aid and public expenditure presented here, public infrastructure generates an inter-temporal productivity spillover, which may exhibit a sector-specific bias. The model also provides for a learning-by-doing externality, through which total factor productivity in the tradable sector is an increasing function of past export volumes. An extended computable version of this model is used to simulate the effect of a step increase in net aid flows. The simulations show that beyond the short run, when conventional demand-side Dutch disease effects are present, the relationship between enhanced aid flows and real exchange rates, output growth, and welfare is less straightforward than simple models of aid suggest. Public infrastructure investment that generates a productivity bias in favor of non-tradable production delivers the largest aggregate return to aid, but at the cost of deterioration in the income distribution. Income gains accrue predominantly to skilled and unskilled urban households, leaving the rural poor relatively worse off. Under plausible parameterizations of the model, the rural poor may also be worse off in absolute terms.

COMMENTARY: The silent burden of gynaecological disease in low income countries

In 2000 the UN published eight millennium development goals (MDGs) to be achieved by 2015. These eight goals were chosen to give an overview of progress on the larger development agenda and focus the minds of the international community. Two of the MDGs directly address women’s reproductive health: to reduce maternal mortality by 75% and to halt and begin to reverse the spread of HIV/AIDS. While admirable these goals ignore the prevalence of many treatable conditions causing disability and distress in women’s lives. The estimation of disease burden via Disability Adjusted Life Years (DALYs) as advocated by the World Health Organization is an attempt to move away from mortality-based indicators. This approach allows a formal evaluation of the cost-effectiveness of interventions in order to assist with priority setting. The DALY is a single comparable measure of a health outcome designed to quantify both premature mortality and disability. Having calculated DALYs lost through a disease or group of diseases cost effectiveness is then measured in terms of cost of intervention ‘per DALY saved’. However the DALY approach has been criticised because of the nature of the disability weights used and the quality of epidemiological estimates of incidence and duration. Disability weights are derived from assessments of the degree of disability resulting from a particular condition made by medical experts. (excerpt)

The Global Fund to Fight AIDS, Tuberculosis and Malaria: funding for unpopular public-health programmes

The Global Fund to Fight AIDS Tuberculosis and Malaria was established to provide resources for the prevention treatment and care of these diseases in low-income countries. Among the guiding principles of the Global Fund is the notion of national ownership. In practice applications for funding need to be endorsed by a group of people collectively known as a Country Coordinating Mechanism (CCM) which must include a representative from the relevant national government. Such partnerships can help to facilitate local coordination but can also create barriers to access to the available funding which is why the Global Fund has produced criteria for non-CCM applications. Specifically such applications can be considered when from a country that has no legitimate government is in conflict or facing a natural disaster or has suppressed or never established partnerships with civil society and nongovernmental organisations (NGOs). Limitations associated with the Global Fund’s CCM criteria do however remain and are amplified when those affected by a relevant disease such as HIV are marginalised within their own country or when proposed public-health interventions are incongruent with government policies. These limitations were identified during the third-round review of the Global Fund when the Thai Drug Users Network and the Raks Thai Foundation submitted a proposal to implement an HIV focused intervention for injection drug users. (excerpt)

Aid and the Dutch Disease in Low-Income Countries: Informed Diagnoses for Prudent Prognoses

This paper demonstrates that the Dutch disease need not materialize in low-income countries that can draw on their idle productive capacity to satisfy the aid-induced increased demand. Diagnoses on, and prognoses for, the Dutch disease should take into account country-specific circumstances to avoid ill-advised policies. The paper emphasizes that using public resources inefficiently can be more painful than real exchange rate appreciations, which may not necessarily embody the Dutch disease.

Aid and the Dutch Disease in Low-Income Countries: Informed Diagnoses for Prudent Prognoses

This paper demonstrates that the Dutch disease need not materialize in low-income countries that can draw on their idle productive capacity to satisfy the aid-induced increased demand. Diagnoses on, and prognoses for, the Dutch disease should take into account country-specific circumstances to avoid ill-advised policies. The paper emphasizes that using public resources inefficiently can be more painful than real exchange rate appreciations, which may not necessarily embody the Dutch disease.

The Syndromic Approach to Treatment of Sexually Transmitted Diseases in Low-Income Countries: Issues, Challenges, and Future Directions

Background: Sexually transmitted diseases (STDs) are a major cause of adult morbidity worldwide. In 1991, the World Health Organization (WHO) introduced the concept of the “syndromic approach” to managing sexually transmitted diseases in low-income countries, however, there has been some controversy regarding the ongoing use of this approach.Objectives: (I) To understand the use of the syndromic approach to managing sexually transmitted diseases in low-income countries, and to determine if evidence supports its continued use. (2) To help Canadian doctors understand the past STD management of immigrant patients from low-income countries, and evaluate the direct effect (if any) of such medical practices to the patient’s health and perception of health in Canada.Methods: Medline was searched under the key words “sexually transmitted diseases,” “developing nations,” and “syndrome,” as well as “algorithms,” “prevention and control”, and “WHO.” Research articles and data were also accessed from the Web sites of WHO, UNAIDS, Reproductive Health Online (JHSPH), and the Centers for Disease Control and Prevention (USA). Data were selected based on the relevance to the topic, and research articles assessed from a methodological perspective. Most research articles were of Level II-2 evidence or lower as described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam.Results: In resource-poor countries, the use of the syndromic approach is appropriate for high-risk groups and for symptomatic individuals. However, it is still a poor screening approach when applied to asymptomatic cases, particularly in women. Risk scoring and simple laboratory tests help to increase the algorithmic sensitivity of the syndromic approach.Conclusion: Syndromic management involves making clinical decisions based on a patient’s symptoms and signs. Until inexpensive, simple, and accurate STD diagnostics are developed and made available for use in low-income countries, a modified syndromic approach is the most feasible method of STD management in these countries. It is useful for Canadian physicians to be aware of this approach especially when caring for women from these countries.

Maternal behavioural risk factors for severe childhood diarrhoeal disease in Kinshasa, Zaire.

This study examines the relationship between severe diarrhoeal disease and maternal knowledge and behaviours related to hygiene and sanitation. Some 107 paediatric cases admitted to two hospitals in Kinshasa, Zaire in 1988 were matched on age and nearest-neighbour status to 107 controls. Personal interviews and observational methods were used to assess knowledge and behaviours related to hygiene and sanitation. Cases and controls had equivalent socioeconomic status, demographic profiles and access to water and sanitation facilities. However, cases generally exhibited lower levels of knowledge and less sanguine sanitary practices than did controls. Of particular interest was the finding that very specific behavioural items distinguished cases from controls. The disposal of the child faeces and household garbage and mother's knowledge that poor caretaker cleanliness was a cause of diarrhoea in children showed the strongest associations with risk of diarrhoea. There was an exponential relationship between the number of these items a mother answered incorrectly and the odds of diarrhoeal disease. The risk attributable to these three variables was as high as 70%. These findings provide further support for the view that focused educational interventions may have a substantial impact on the occurrence of severe diarrhoeal disease in low-income countries.