Use In Low-income Countries Research Articles

The 'Shape&Roll' Prosthetic Foot: I. Design and Development of Appropriate Technology for Low-Income Countries

The Shape&Roll Prosthetic Foot (patent pending) is an artificial foot designed for use in low-income countries, and may also be useful in industrialised nations. Its design is based on the theory that the roll-over shape of a prosthetic foot should mimic that of the non-disabled physiological foot-ankle complex during walking. This article presents the S&R foot including the unique features incorporated into its design. The results of mechanical tests indicate that the roll-over shape of the foot closely mimics the roll-over shape of the non-disabled ankle-foot complex and an expensive 'high-performance' prosthetic foot. The fatigue testing process for the S&R foot is also described. The foot has been shown to be durable according to the International Organization for Standardization (ISO) standards, with more than five samples tested to date. The Shape&Roll Foot is low in cost, simple to fabricate, light in weight, low in profile, and is highly functional for walking in respect of roll-over characteristics.

Characterisation of prosthetic feet used in low-income countries.

Eleven kinds of prosthetic feet that were designed for use in low-income countries were mechanically characterised in this study. Masses of the different kinds of prosthetic feet varied substantially. Dynamic properties, including damping ratios and resonant frequencies, were obtained from step unloading tests of the feet while interacting with masses comparable to the human body. Data showed that for walking, the feet can be appropriately modeled using their quasistatic properties since natural frequencies were high compared to walking frequencies and since damping ratios were small. Roll-over shapes, the effective rocker (cam) geometries that the feet deform to under walking loads, were determined using a quasistatic loading technique and a spatial transformation of the ground reaction force's centre of pressure. The roll-over shapes for most of the prosthetic feet studied were similar to the roll-over shape of the SACH (solid-ankle cushioned heel) prosthetic foot. All roll-over shapes showed a lack of forefoot support, which may cause a "drop-off" experience at the end of single limb stance and shorter step lengths of the contralateral limb. The roll-over shapes of prosthetic feet appear useful in characterization of foot function.

Improving antibiotic use in low-income countries: an overview of evidence on determinants

The inappropriate use of antibiotics has often been identified as a problem in effective health care delivery. High levels of antibiotics use, often clinically unnecessary, have led to a steady increase in drug resistance. Low-income countries, home to the majority of the world's population, are believed to have an important role in this phenomena. Effective intervention in these practices is often constrained by the paucity of information on determinants of antibiotic use. This review provides information from studies on the factors that influence the use of antibiotics by health providers, dispensers and community members in low-income countries. A proper understanding of these factors should be seen as a precondition for the development of more effective policies and programmes to address inappropriate antibiotic use. The review encompasses physicians’ practices, the role of drug dispensers, and the influences on patterns of drug use across community members. Although a set of papers with useful research data was identified, probably the most important finding of the review was the scarcity of research. If interventions into antibiotic use are to be effective, future research must explore in more depth the socio-cultural rationality of antibiotic usage. The most productive approach would be to combine quantitative studies of the patterns of antibiotic use with the rich variety of qualitative methods like case simulations, focus group discussions, in-depth interviews, informal interviews, or illness diaries to explore determinants. Research programmes alone are unlikely to improve antibiotic use. Priority programme activities would include a carefully designed mix of activities by governments, health delivery systems, health training institutions, professional societies, pharmaceutical companies, consumer organisations, and international organisations. Strategies that lean too heavily on professional education are unlikely to result in large-scale or long-lasting improvement.

Tobacco use, cancer causation and public health impact.

This review describes global patterns of tobacco use and the mechanisms by which tobacco use is involved in carcinogenesis. A second part will discuss the association between tobacco use and risk of specific cancer types. Tobacco use has traditionally been a practice of high-income countries, but it has recently been taken up in low-income countries and it is particularly common in men. A wide variety of tobacco products exist, of which cigarettes are most frequently consumed. Tobacco products contain more than 50 established or identified carcinogens and these may increase risk of cancer by causing mutations that disrupt cell cycle regulation, or through their effect on the immune or endocrine systems. Certain factors such as genes, diet and environmental exposures may alter susceptibility to cancer in tobacco users. Today at least 15% of all cancers are estimated to be attributable to smoking, but this figure is expected to increase because of the uptake of tobacco use in low-income countries.

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.

Impact of land tenure on land use in low-income countries

The role of land tenure in agricultural development has been a subject of intensive research, particularly within the context of land and agrarian reform. The complexity of the world's major land tenure systems is well recognized and no attempt is made here to go beyond an overview as this paper limits itself to the impact of land tenure on land use in low income situations. Present land use is determined by a host of factors, of a physical/biological and socioeconomic nature. In applying land evaluation, the question it is necessary to ask is to what extent, when and where land tenure conditions act as a considerable constraining factor impeding a more optimal use of land resources. Even in what used to be low-population density areas (such as Sub-Saharan Africa) it appears that the frontier phase is becoming exhausted and the intensification of agriculture proceeds; it becomes imperative to examine land tenure in relation to land use implications. It is shown that so far a multi-disciplinary approach has often been lacking in treating land tenure and related issues.