Global pediatric environmental health.

PubMed

Guidotti, Tee L; Gitterman, Benjamin A

2007-04-01

Children are uniquely vulnerable to environmental health problems. Developed countries report as the most common problems ambient (outdoor) air pollution and lead. Developing countries have a wider range of common problems, including childhood injuries, indoor air pollution, infectious disease, and poor sanitation with unsafe water. Globally, the agencies of the United Nations act to protect children and perform essential reporting and standards-setting functions. Conditions vary greatly among countries and are not always better in developing countries. Protecting the health of children requires strengthening the public health and medical systems in every country, rather than a single global agenda.

How do public health policies tackle alcohol-related harm: a review of 12 developed countries.

PubMed

Crombie, Iain K; Irvine, Linda; Elliott, Lawrence; Wallace, Hilary

2007-01-01

To identify how current public health policies of 12 developed countries assess alcohol-related problems, the goals and targets that are set and the strategic directives proposed. Policy documents on alcohol and on general public heath were obtained through repeated searches of government websites. Documents were reviewed by two independent observers. All the countries studied state that alcohol causes substantial harm to individual health and family well-being, increases crime and social disruption, and results in economic loss through lost productivity. All are concerned about consumption of alcohol by young adults and by heavy and problem drinkers. Few aim to reduce total consumption. Only five of the countries set specific targets for changes in drinking behaviour. Countries vary in their commitment to intervene, particularly on taxation, drink-driving, the drinking environment and for high-risk groups. Australia and New Zealand stand out as having coordinated intervention programmes in most areas. Policies differ markedly in their organization, the goals and targets that are set, the strategic approaches proposed and areas identified for intervention. Most countries could improve their policies by following the recommendations in the World Heath Organization's European Alcohol Action Plan.

KNOW ESSENTIALS: a tool for informed decisions in the absence of formal HTA systems.

PubMed

Mathew, Joseph L

2011-04-01

Most developing countries and resource-limited settings lack robust health technology assessment (HTA) systems. Because the development of locally relevant HTA is not immediately viable, and the extrapolation of external HTA is inappropriate, a new model for evaluating health technologies is required. The aim of this study was to describe the development and application of KNOW ESSENTIALS, a tool facilitating evidence-based decisions on health technologies by stakeholders in settings lacking formal HTA systems. Current HTA methodology was examined through literature search. Additional issues relevant to resource-limited settings, but not adequately addressed in current methodology, were identified through further literature search, appraisal of contextually relevant issues, discussion with healthcare professionals familiar with the local context, and personal experience. A set of thirteen elements important for evidence-based decisions was identified, selected and combined into a tool with the mnemonic KNOW ESSENTIALS. Detailed definitions for each element, coding for the elements, and a system to evaluate a given health technology using the tool were developed. Developing countries and resource-limited settings face several challenges to informed decision making. Models that are relevant and applicable in high-income countries are unlikely in such settings. KNOW ESSENTIALS is an alternative that facilitates evidence-based decision making by stakeholders without formal expertise in HTA. The tool could be particularly useful, as an interim measure, in healthcare systems that are developing HTA capacity. It could also be useful anywhere when rapid evidence-based decisions on health technologies are required.

Gastroenterology in developing countries: Issues and advances

PubMed Central

Mandeville, Kate L; Krabshuis, Justus; Ladep, Nimzing Gwamzhi; Mulder, Chris JJ; Quigley, Eamonn MM; Khan, Shahid A

2009-01-01

Developing countries shoulder a considerable burden of gastroenterological disease. Infectious diseases in particular cause enormous morbidity and mortality. Diseases which afflict both western and developing countries are often seen in more florid forms in poorer countries. Innovative techniques continuously improve and update gastroenterological practice. However, advances in diagnosis and treatment which are commonplace in the West, have yet to reach many developing countries. Clinical guidelines, based on these advances and collated in resource-rich environments, lose their relevance outside these settings. In this two-part review, we first highlight the global burden of gastroenterological disease in three major areas: diarrhoeal diseases, hepatitis B, and Helicobacter pylori. Recent progress in their management is explored, with consideration of future solutions. The second part of the review focuses on the delivery of clinical services in developing countries. Inadequate numbers of healthcare workers hamper efforts to combat gastroenterological disease. Reasons for this shortage are examined, along with possibilities for increased specialist training. Endoscopy services, the mainstay of gastroenterology in the West, are in their infancy in many developing countries. The challenges faced by those setting up a service are illustrated by the example of a Nigerian endoscopy unit. Finally, we highlight the limited scope of many clinical guidelines produced in western countries. Guidelines which take account of resource limitations in the form of “cascades” are advocated in order to make these guidelines truly global. Recognition of the different working conditions facing practitioners worldwide is an important step towards narrowing the gap between gastroenterology in rich and poor countries. PMID:19533805

Recombinase polymerase amplification: Emergence as a critical molecular technology for rapid, low-resource diagnostics.

PubMed

James, Ameh; Macdonald, Joanne

2015-01-01

Isothermal molecular diagnostics are bridging the technology gap between traditional diagnostics and polymerase chain reaction-based methods. These new techniques enable timely and accurate testing, especially in settings where there is a lack of infrastructure to support polymerase chain reaction facilities. Despite this, there is a significant lack of uptake of these technologies in developing countries where they are highly needed. Among these novel isothermal technologies, recombinase polymerase amplification (RPA) holds particular potential for use in developing countries. This rapid nucleic acid amplification approach is fast, highly sensitive and specific, and amenable to countries with a high burden of infectious diseases. Implementation of RPA technology in developing countries is critically required to assess limitations and potentials of the diagnosis of infectious disease, and may help identify impediments that prevent adoption of new molecular technologies in low resource- and low skill settings. This review focuses on approaching diagnosis of infectious disease with RPA.

Is the secure base phenomenon evident here, there, and anywhere? A cross-cultural study of child behavior and experts' definitions.

PubMed

Posada, German; Lu, Ting; Trumbell, Jill; Kaloustian, Garene; Trudel, Marcel; Plata, Sandra J; Peña, Paola P; Perez, Jennifer; Tereno, Susana; Dugravier, Romain; Coppola, Gabrielle; Constantini, Alessandro; Cassibba, Rosalinda; Kondo-Ikemura, Kiyomi; Nóblega, Magaly; Haya, Ines M; Pedraglio, Claudia; Verissimo, Manuela; Santos, Antonio J; Monteiro, Ligia; Lay, Keng-Ling

2013-01-01

The evolutionary rationale offered by Bowlby implies that secure base relationships are common in child-caregiver dyads and thus, child secure behavior observable across diverse social contexts and cultures. This study offers a test of the universality hypothesis. Trained observers in nine countries used the Attachment Q-set to describe the organization of children's behavior in naturalistic settings. Children (N = 547) were 10-72 months old. Child development experts (N = 81) from all countries provided definitions of optimal child secure base use. Findings indicate that children from all countries use their mother as a secure base. Children's organization of secure base behavior was modestly related to each other both within and across countries. Experts' descriptions of the optimally attached child were highly similar across cultures. © 2013 The Authors. Child Development © 2013 Society for Research in Child Development, Inc.

Reinterpreting Responsiveness for Health Systems Research in Low and Middle-Income Countries.

PubMed

Pratt, Bridget; Hyder, Adnan A

2015-07-01

The ethical concept of responsiveness has largely been interpreted in the context of international clinical research. In light of the increasing conduct of externally funded health systems research (HSR) in low- and middle-income countries (LMICs), this article examines how responsiveness might be understood for such research and how it can be applied. It contends that four features (amongst others) set HSR in LMICs apart from international clinical research: a focus on systems; being context-driven; being policy-driven; and being closely linked to development objectives. These features support reinterpreting responsiveness for HSR in LMICs as responsiveness to systems needs, where health system performance assessments can be relied upon to identify systems needs, and/or responsiveness to systems priorities, which entails aligning research with HSR priorities set through country-owned processes involving national and sub-national policymakers from host countries. Both concepts may be difficult to achieve in practice. Country ownership is not an established fact for many countries and alignment to their priorities may be meaningless without it. It is argued that more work is, therefore, needed to identify strategies for how the responsiveness requirement can be ethically fulfilled for HSR in LMICs under non-ideal conditions such as where host countries have not set HSR priorities via country-owned processes. Embeddedness is proposed as one approach that could be the focus of further development. © 2014 John Wiley & Sons Ltd.

The Present State and Future Trends of Blended Learning in Workplace Learning Settings across Five Countries

ERIC Educational Resources Information Center

Kim, Kyong-Jee; Bonk, Curtis; Teng, Ya-Ting

2009-01-01

This article reports survey findings related to the current status and future trends of blended learning in workplace learning settings from diverse cultures. This particular survey was conducted of 674 training and human resource development professionals from five different countries, mostly from the Asia-Pacific region (i.e., China, South…

Implementing Small Scale ICT Projects in Developing Countries--How Challenging Is It?

ERIC Educational Resources Information Center

Karunaratne, Thashmee; Peiris, Colombage; Hansson, Henrik

2018-01-01

This paper summarises experiences of efforts made by twenty individuals when implementing small-scale ICT development projects in their organizations located in seven developing countries. The main focus of these projects was the use of ICT in educational settings. Challenges encountered and the contributing factors for implementation success of…

Eliciting health care priorities in developing countries: experimental evidence from Guatemala.

PubMed

Font, Joan Costa; Forns, Joan Rovira; Sato, Azusa

2016-02-01

Although some methods for eliciting preferences to assist participatory priority setting in health care in developed countries are available, the same is not true for poor communities in developing countries whose preferences are neglected in health policy making. Existing methods grounded on self-interested, monetary valuations that may be inappropriate for developing country settings where community care is provided through 'social allocation' mechanisms. This paper proposes and examines an alternative methodology for eliciting preferences for health care programmes specifically catered for rural and less literate populations but which is still applicable in urban communities. Specifically, the method simulates a realistic collective budget allocation experiment, to be implemented in both rural and urban communities in Guatemala. We report evidence revealing that participatory budget-like experiments are incentive compatible mechanisms suitable for revealing collective preferences, while simultaneously having the advantage of involving communities in health care reform processes. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

The effect of illicit financial flows on time to reach the fourth Millennium Development Goal in Sub-Saharan Africa: a quantitative analysis

PubMed Central

Makuta, Innocent; Bar-Zeev, Naor; Chiwaula, Levison; Cobham, Alex

2014-01-01

Objectives This paper sets out to estimate the cost of illicit financial flows (IFF) in terms of the amount of time it could take to reach the fourth Millennium Development Goal (MDG) in 34 African countries. Design We have calculated the percentage increase in gross domestic product (GDP) if IFFs were curtailed using IFF/GDP ratios. We applied the income (GDP) elasticity of child mortality to the increase in GDP to estimate the reduction in time to reach the fourth MDG in 34 African countries. Participants children aged under five years. Settings 34 countries in SSA. Main outcome measures Reduction in time to reach the first indicator of the fourth MDG, under-five mortality rate in the absence of IFF. Results We found that in the 34 SSA countries, six countries will achieve their fourth MDG target at the current rates of decline. In the absence of IFF, 16 countries would reach their fourth MDG target by 2015 and there would be large reductions for all other countries. Conclusions This drain on development is facilitated by financial secrecy in other jurisdictions. Rich and poor countries alike must stem the haemorrhage of IFF by taking decisive steps towards improving financial transparency. PMID:24334911

Intellectual Capital in Egyptian Software Firms

ERIC Educational Resources Information Center

Seleim, Ahmed; Ashour, Ahmed; Bontis, Nick

2004-01-01

The distribution of knowledge around the world varies significantly with developed countries possessing most of the world's current intellectual capital (IC) compared to developing countries. Most IC research has been conducted in a variety of international settings such as the UK, Scandinavia, Australia, Canada, Austria, Malaysia, the USA, and…

Evidence base for children affected by HIV and AIDS in low prevalence and concentrated epidemic countries: applicability to programming guidance from high prevalence countries.

PubMed

Franco, Lynne Miller; Burkhalter, Bart; de Wagt, Arjan; Jennings, Larissa; Kelley, Allison Gamble; Hammink, Marie-Eve

2009-01-01

As global commitment grows to protect and support children affected by HIV and AIDS, questions remain about how best to meet the needs of these children in low prevalence settings and whether information from high prevalence countries can appropriately guide programming in these settings. A 2007 search for the evidence in low prevalence settings on situational challenges of HIV and AIDS-affected children and interventions to address these challenges identified 413 documents. They were reviewed and judged for quality of documentation and scientific rigor. Information was compiled across eight types of challenges (health and health care, nutrition and food security, education, protection, placement, psychosocial development, socioeconomic status, and stigma/discrimination); and also assessed was strength of evidence for situational and intervention findings. Results were compared to three programming principles drawn from research in high prevalence countries: family-centered preventive efforts, treatment, and care; family-focused support to ensure capacity to care for and protect these children; and sustaining economic livelihood of HIV and AIDS-affected households. Findings show that children affected by HIV and AIDS in low prevalence settings face increased vulnerabilities similar to those in high prevalence settings. These findings support seeking and testing programmatic directions for interventions identified in high prevalence settings. However, low prevalence settings/countries are extremely diverse, and the strength of the evidence base among them was mixed (strong, moderate, and weak in study design and documentation), geographically limited, and had insufficient evidence on interventions to draw conclusions about how best to reduce additional vulnerabilities of affected children. Information on family, economic, sociocultural, and political factors within local contexts will be vital in the development of appropriate strategies to mitigate vulnerabilities.

Self-Rated Health and Mortality: Does the Relationship Extend to a Low Income Setting?

ERIC Educational Resources Information Center

Frankenberg, Elizabeth; Jones, Nathan R.

2004-01-01

Although a relationship between poor self-reported health status and excess mortality risk has been well-established for industrialized countries, almost no research considers developing countries. We use data from Indonesia to show that in a low-income setting, as in more advantaged parts of the world, individuals who perceive their health to be…

How Do Development Assistance Partners Conceptualise and Prioritise Evidence in Priority Setting (PS) for Health Programmes Relevant to Low Income Countries? A Qualitative Study

ERIC Educational Resources Information Center

Kapiriri, Lydia; Sinding, Christina; Arnold, Emmy

2017-01-01

There is limited literature on how donors conceptualise and prioritise evidence in healthcare priority setting (PS) affecting low income countries (LICs). We interviewed 35 donors and reviewed their websites to describe how they conceptualise, prioritise and perceive the role evidence plays in their organisation's healthcare prioritisation…

An Ethnographically Informed Participatory Design of Primary Healthcare Information Technology in a Developing Country Setting.

PubMed

Shidende, Nima Herman; Igira, Faraja Teddy; Mörtberg, Christina Margaret

2017-01-01

Ethnography, with its emphasis on understanding activities where they occur, and its use of qualitative data gathering techniques rich in description, has a long tradition in Participatory Design (PD). Yet there are limited methodological insights in its application in developing countries. This paper proposes an ethnographically informed PD approach, which can be applied when designing Primary Healthcare Information Technology (PHIT). We use findings from a larger multidisciplinary project, Health Information Systems Project (HISP) to elaborate how ethnography can be used to facilitate participation of health practitioners in developing countries settings as well as indicating the importance of ethnographic approach to participatory Health Information Technology (HIT) designers. Furthermore, the paper discusses the pros and cons of using an ethnographic approach in designing HIT.

Integration of Care in Management of CKD in Resource-Limited Settings.

PubMed

Okpechi, Ikechi G; Bello, Aminu K; Ameh, Oluwatoyin I; Swanepoel, Charles R

2017-05-01

The prevalence of noncommunicable diseases, including chronic kidney disease (CKD), continues to increase worldwide, and mortality from noncommunicable diseases is projected to surpass communicable disease-related mortality in developing countries. Although the treatment of CKD is expensive, unaffordable, and unavailable in many developing countries, the current structure of the health care system in such countries is not set up to deliver comprehensive care for patients with chronic conditions, including CKD. The World Health Organization Innovative Care for Chronic Conditions framework could be leveraged to improve the care of CKD patients worldwide, especially in resource-limited countries where high cost, low infrastructure, limited workforce, and a dearth of effective health policies exist. Some developing countries already are using established health systems for communicable disease control to tackle noncommunicable diseases such as hypertension and diabetes, therefore existing systems could be leveraged to integrate CKD care. Decision makers in developing countries must realize that to improve outcomes for patients with CKD, important factors should be considered, including enhancing CKD prevention programs in their communities, managing the political environment through involvement of the political class, involving patients and their families in CKD care delivery, and effective use of health care personnel. Copyright © 2017 Elsevier Inc. All rights reserved.

Sickle Cell Disease: Management Options and Challenges in Developing Countries

PubMed Central

Ansong, Daniel; Akoto, Alex Osei; Ocloo, Delaena; Ohene-Frempong, Kwaku

2013-01-01

Sickle Cell Disease (SCD) is the most common genetic disorder of haemoglobin in sub-Saharan Africa. This commentary focuses on the management options available and the challenges that health care professionals in developing countries face in caring for patients with SCD. In a developing countries like Ghana, new-born screening is now about to be implemented on a national scale. Common and important morbidities associated with SCD are vaso-occlusive episodes, infections, Acute Chest Syndrome (ACS), Stroke and hip necrosis. Approaches to the management of these morbidities are far advanced in the developed countries. The differences in setting and resource limitations in developing countries bring challenges that have a major influence in management options in developing countries. Obviously clinicians in developing countries face challenges in managing SCD patients. However understanding the disease, its progression, and instituting the appropriate preventive methods are paramount in its management. Emphasis should be placed on early counselling, new-born screening, anti-microbial prophylaxis, vaccination against infections, and training of healthcare workers, patients and caregivers. These interventions are affordable in developing countries. PMID:24363877

STATISTICS AND INTELLIGENCE IN DEVELOPING COUNTRIES: A NOTE.

PubMed

Kodila-Tedika, Oasis; Asongu, Simplice A; Azia-Dimbu, Florentin

2017-05-01

The purpose of this study is to assess the relationship between intelligence (or human capital) and the statistical capacity of developing countries. The line of inquiry is motivated essentially by the scarce literature on poor statistics in developing countries and an evolving stream of literature on the knowledge economy. A positive association is established between intelligence quotient (IQ) and statistical capacity. The relationship is robust to alternative specifications with varying conditioning information sets and control for outliers. Policy implications are discussed.

The challenges and opportunities of conducting a clinical trial in a low resource setting: the case of the Cameroon mobile phone SMS (CAMPS) trial, an investigator initiated trial.

PubMed

Mbuagbaw, Lawrence; Thabane, Lehana; Ongolo-Zogo, Pierre; Lang, Trudie

2011-06-09

Conducting clinical trials in developing countries often presents significant ethical, organisational, cultural and infrastructural challenges to researchers, pharmaceutical companies, sponsors and regulatory bodies. Globally, these regions are under-represented in research, yet this population stands to gain more from research in these settings as the burdens on health are greater than those in developed resourceful countries. However, developing countries also offer an attractive setting for clinical trials because they often have larger treatment naive populations with higher incidence rates of disease and more advanced stages. These factors can present a reduction in costs and time required to recruit patients. So, balance needs to be found where research can be encouraged and supported in order to bring maximum public health benefits to these communities. The difficulties with such trials arise from problems with obtaining valid informed consent, ethical compensation mechanisms for extremely poor populations, poor health infrastructure and considerable socio-economic and cultural divides. Ethical concerns with trials in developing countries have received attention, even though many other non-ethical issues may arise. Local investigator initiated trials also face a variety of difficulties that have not been adequately reported in literature. This paper uses the example of the Cameroon Mobile Phone SMS trial to describe in detail, the specific difficulties encountered in an investigator-initiated trial in a developing country. It highlights administrative, ethical, financial and staff related issues, proposes solutions and gives a list of additional documentation to ease the organisational process.

Patterns of public participation.

PubMed

Slutsky, Jean; Tumilty, Emma; Max, Catherine; Lu, Lanting; Tantivess, Sripen; Hauegen, Renata Curi; Whitty, Jennifer A; Weale, Albert; Pearson, Steven D; Tugendhaft, Aviva; Wang, Hufeng; Staniszewska, Sophie; Weerasuriya, Krisantha; Ahn, Jeonghoon; Cubillos, Leonardo

2016-08-15

Purpose - The paper summarizes data from 12 countries, chosen to exhibit wide variation, on the role and place of public participation in the setting of priorities. The purpose of this paper is to exhibit cross-national patterns in respect of public participation, linking those differences to institutional features of the countries concerned. Design/methodology/approach - The approach is an example of case-orientated qualitative assessment of participation practices. It derives its data from the presentation of country case studies by experts on each system. The country cases are located within the historical development of democracy in each country. Findings - Patterns of participation are widely variable. Participation that is effective through routinized institutional processes appears to be inversely related to contestatory participation that uses political mobilization to challenge the legitimacy of the priority setting process. No system has resolved the conceptual ambiguities that are implicit in the idea of public participation. Originality/value - The paper draws on a unique collection of country case studies in participatory practice in prioritization, supplementing existing published sources. In showing that contestatory participation plays an important role in a sub-set of these countries it makes an important contribution to the field because it broadens the debate about public participation in priority setting beyond the use of minipublics and the observation of public representatives on decision-making bodies.

Policy and public health recommendations to promote the initiation and duration of breast-feeding in developed country settings.

PubMed

Dyson, Lisa; Renfrew, Mary J; McFadden, Alison; McCormick, Felicia; Herbert, Gill; Thomas, James

2010-01-01

To develop policy and public health recommendations for implementation at all levels by individuals and organisations working in, or related to, the field of breast-feeding promotion in developed country settings, where breast-feeding rates remain low. Two research phases, comprising (i) an assessment of the formal evidence base in developed country settings and (ii) a consultation with UK-based practitioners, service managers and commissioners, and representatives of service users. The evidence base included three systematic reviews and an Evidence Briefing. One hundred and ten studies evaluating an intervention in developed country settings were assessed for quality and awarded an overall quality rating. Studies with a poor quality rating were excluded. The resulting seventy studies examined twenty-five types of intervention for breast-feeding promotion. These formed the basis of the second consultation phase to develop the evidence-based interventions into recommendations for practice, which comprised (i) pilot consultation, (ii) electronic consultation, (iii) fieldwork meetings and (iv) workshops. Draft findings were synthesised for two rounds of stakeholder review conducted by the National Institute for Health and Clinical Excellence. Twenty-five recommendations emerged within three complementary and necessary categories, i.e. public health policy, mainstream clinical practice and local interventions. The need for national policy directives was clearly identified as a priority to address many of the barriers experienced by practitioners when trying to work across sectors, organisations and professional groups. Routine implementation of the WHO/UNICEF Baby Friendly Initiative across hospital and community services was recommended as core to breast-feeding promotion in the UK. A local mix of complementary interventions is also required.

Genomic Medicine Without Borders: Which Strategies Should Developing Countries Employ to Invest in Precision Medicine? A New "Fast-Second Winner" Strategy.

PubMed

Mitropoulos, Konstantinos; Cooper, David N; Mitropoulou, Christina; Agathos, Spiros; Reichardt, Jürgen K V; Al-Maskari, Fatima; Chantratita, Wasun; Wonkam, Ambroise; Dandara, Collet; Katsila, Theodora; Lopez-Correa, Catalina; Ali, Bassam R; Patrinos, George P

2017-11-01

Genomic medicine has greatly matured in terms of its technical capabilities, but the diffusion of genomic innovations worldwide faces significant barriers beyond mere access to technology. New global development strategies are sorely needed for biotechnologies such as genomics and their applications toward precision medicine without borders. Moreover, diffusion of genomic medicine globally cannot adhere to a "one-size-fits-all-countries" development strategy, in the same way that drug treatments should be customized. This begs a timely, difficult but crucial question: How should developing countries, and the resource-limited regions of developed countries, invest in genomic medicine? Although a full-scale investment in infrastructure from discovery to the translational implementation of genomic science is ideal, this may not always be feasible in all countries at all times. A simple "transplantation of genomics" from developed to developing countries is unlikely to be feasible. Nor should developing countries be seen as simple recipients and beneficiaries of genomic medicine developed elsewhere because important advances in genomic medicine have materialized in developing countries as well. There are several noteworthy examples of genomic medicine success stories involving resource-limited settings that are contextualized and described in this global genomic medicine innovation analysis. In addition, we outline here a new long-term development strategy for global genomic medicine in a way that recognizes the individual country's pressing public health priorities and disease burdens. We term this approach the "Fast-Second Winner" model of innovation that supports innovation commencing not only "upstream" of discovery science but also "mid-stream," building on emerging highly promising biomarker and diagnostic candidates from the global science discovery pipeline, based on the unique needs of each country. A mid-stream entry into innovation can enhance collective learning from other innovators' mistakes upstream in discovery science and boost the probability of success for translation and implementation when resources are limited. This à la carte model of global innovation and development strategy offers multiple entry points into the global genomics innovation ecosystem for developing countries, whether or not extensive and expensive discovery infrastructures are already in place. Ultimately, broadening our thinking beyond the linear model of innovation will help us to enable the vision and practice of genomics without borders in both developed and resource-limited settings.

Use of intraocular lenses in cataract surgery in developing countries: memorandum from a WHO meeting.

PubMed Central

1991-01-01

Visual loss or disability from cataract represents a massive public health and socioeconomic problem in most developing countries. At present, some 13.5 million cases require treatment and this number will increase, as most countries in the Third World are unable to cope with both the backlog and new cases. Cataract extraction with intraocular lens (IOL) implantation is now the established and preferred method in industrialized countries. The introduction of IOLs in developing countries, however, depends on their having adequately trained manpower and facilities (equipment and supplies, including IOLs) for surgery. This will inevitably increase the cost per operated case which, despite the scarce resources for cataract surgery in many developing countries, may be justified by the improved restoration of the patient's vision. Experience has led to the following generic designs for IOLs: the one-piece or three-piece C-loop polymethylmethacrylate (PMMA) posterior chamber lens, which is the current favourite; and, the flexible or rigid one-piece all-PMMA anterior chamber lens, which is a valid alternative in many situations. Further scientific evaluation of the use of these lenses in a wide variety of settings in developing countries is required. Operations research is also needed in order better to define and standardize the various steps and procedures in the surgical and post-operative management of IOL implantation in Third World settings. Meanwhile, the following should be available to ensure safe and good quality cataract surgery using IOLs in developing countries: properly trained surgeons; the needed facilities and equipment with regular supplies; a good quality lens of appropriate design; and the necessary means for careful follow-up of operated patients. PMID:1786616

Prioritizing vaccines for developing world diseases.

PubMed

Saul, Allan; O'Brien, Katherine L

2017-01-20

A major disparity in the burden of health will need to be addressed to achieve the "Grand Convergence" by 2035. In particular people living in low and middle income countries have a much higher burden of infectious diseases. Although vaccines have been very effective in reducing the global burden of infectious disease, there are no registered vaccines to address 60% of the current burden of infectious disease, especially in developing countries. Thus there is a pressing need for new vaccines and for prioritizing vaccine development given that resources for developing new vaccines are strictly limited. As part of the GLOBAL HEALTH 2035: Mission Grand Convergence meeting one working group assessed the SMART vaccine algorithm as a mechanism for prioritizing vaccine development for diseases of priority in the developing world. In particular, the working group considered which criteria in the standard SMART set were considered "key" criteria and whether other criteria should be considered, when prioritizing vaccines for this important set of countries. Copyright © 2016. Published by Elsevier Ltd.

Measuring Socioeconomic Status in Health Research in Developing Countries: Should We Be Focusing on Households, Communities or Both?

ERIC Educational Resources Information Center

Fotso, Jean-Christophe; Kuate-Defo, Barthelemy

2005-01-01

Research on the effects of socioeconomic well-being on health is important for policy makers in developing countries, where limited resources make it crucial to use existing health care resources to the best advantage. This paper develops and tests a set of measures of socioeconomic status indicators for predicting health status in developing…

Nano/microfluidics for diagnosis of infectious diseases in developing countries

PubMed Central

Lee, Won Gu; Kim, Yun-Gon; Chung, Bong Geun; Demirci, Utkan; Khademhosseini, Ali

2010-01-01

Nano/microfluidic technologies are emerging as powerful enabling tools for diagnosis and monitoring of infectious diseases in both developed and developing countries. Miniaturized nano/microfluidic platforms that precisely manipulate small fluid volumes can be used to enable medical diagnosis in a more rapid and accurate manner. In particular, these nano/microfluidic diagnostic technologies are potentially applicable to global health applications, because they are disposable, inexpensive, portable, and easy-to-use for detection of infectious diseases. In this paper, we review recent developments in nano/microfluidic technologies for clinical point-of-care applications at resource-limited settings in developing countries. PMID:19954755

Strategy for Improved Nutrition of Children and Women in Developing Countries. A UNICEF Policy Review.

ERIC Educational Resources Information Center

United Nations Children's Fund, New York, NY.

This United Nations Children's Fund (UNICEF) report proposes a strategy for reducing, and ultimately eliminating, malnutrition in developing countries. It proposes a methodology for the identification of appropriate actions in a given context through situation assessment and analysis, rather than through a predetermined set of technical…

DESIGN AND DEVELOPMENT OF A LOW COST, MULTIFUNCTION, REGIONALLY APPROPRIATE SOLAR OVEN FOR DEVELOPING COUNTRIES IN LATIN AMERICA

EPA Science Inventory

In the average Latin American country, 45% of the population is below the poverty line and 36% live in rural settings (CIA World Factbook). For these sectors, solar ovens might represent their only affordable means of cooking and sterilization. Significant research efforts i...

Outcome of Head and Neck Squamous Cell Cancers in Low-Resource Settings: Challenges and Opportunities.

PubMed

Chaturvedi, Pankaj; Singhavi, Hitesh; Malik, Akshat; Nair, Deepa

2018-06-01

Head and neck squamous cell carcinomas (HNSCCs) are amongst the most common cancers in certain parts of the world. Low-income and low middle- income countries make up 65% of newly diagnosed HNSCC cases annually and account for about 75% of HNSCC global mortality. These countries also suffer from a significant shortage of skilled labor, equipment, and health facilities. This article discusses the burden of HNSCCs in developing countries and the differences in outcomes compared with developed countries. Copyright © 2018 Elsevier Inc. All rights reserved.

National Satellite Forest Monitoring systems for REDD+

NASA Astrophysics Data System (ADS)

Jonckheere, I. G.

2012-12-01

Reducing Emissions from Deforestation and Forest Degradation (REDD) is an effort to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. "REDD+" goes beyond deforestation and forest degradation, and includes the role of conservation, sustainable management of forests and enhancement of forest carbon stocks. In the framework of getting countries ready for REDD+, the UN-REDD Programme assists developing countries to prepare and implement national REDD+ strategies. For the monitoring, reporting and verification, FAO supports the countries to develop national satellite forest monitoring systems that allow for credible measurement, reporting and verification (MRV) of REDD+ activities. These are among the most critical elements for the successful implementation of any REDD+ mechanism. The UN-REDD Programme through a joint effort of FAO and Brazil's National Space Agency, INPE, is supporting countries to develop cost- effective, robust and compatible national monitoring and MRV systems, providing tools, methodologies, training and knowledge sharing that help countries to strengthen their technical and institutional capacity for effective MRV systems. To develop strong nationally-owned forest monitoring systems, technical and institutional capacity building is key. The UN-REDD Programme, through FAO, has taken on intensive training together with INPE, and has provided technical help and assistance for in-country training and implementation for national satellite forest monitoring. The goal of the support to UN-REDD pilot countries in this capacity building effort is the training of technical forest people and IT persons from interested REDD+ countries, and to set- up the national satellite forest monitoring systems. The Brazilian forest monitoring system, TerraAmazon, which is used as a basis for this initiative, allows countries to adapt it to country needs and the training on the TerraAmazon system is a tool to enhance existing capacity on carbon monitoring systems. The support with the National Forest Monitoring System will allow these countries to follow all actions related to the implementation of its national REDD+ policies and measures. The monitoring system will work as a platform to obtain information on their REDD+ results and actions, related directly or indirectly to national REDD+ strategies and may also include actions unrelated to carbon assessment, such as forest law enforcement. With the technical assistance of FAO, INPE and other stakeholders, the countries will set up an autonomous operational forest monitoring system. An initial version and the methodologies of the system for DRC and PNG has been launched in Durban, South Africa during COP 17 and in 2012 Paraguay, Viet Nam and Zambia will be launched in Doha, Qatar at COP 18. The access to high-quality satellite data for these countries is crucial for the set-up.

Setting priorities for safe motherhood programme evaluation: a participatory process in three developing countries.

PubMed

Madi, Banyana Cecilia; Hussein, Julia; Hounton, Sennen; D'Ambruoso, Lucia; Achadi, Endang; Arhinful, Daniel Kojo

2007-09-01

A participatory approach to priority setting in programme evaluation may help improve the allocation and more efficient use of scarce resources especially in low-income countries. Research agendas that are the result of collaboration between researchers, programme managers, policy makers and other stakeholders have the potential to ensure rigorous studies are conducted on matters of local priority, based on local, expert knowledge. This paper describes a process involving key stakeholders to elicit and prioritise evaluation needs for safe motherhood in three developing countries. A series of reiterative consultations with safe motherhood stakeholders from each country was conducted over a period of 36 months. In each country, the consultation process consisted of a series of participatory workshops; firstly, stakeholder's views on evaluation were elicited with parallel descriptive work on the contexts. Secondly, priorities for evaluation were identified from stakeholders; thirdly, the evaluation-priorities were refined; and finally, the evaluation research questions, reflecting the identified priorities, were agreed and finalised. Three evaluation-questions were identified in each country, and one selected, on which a full scale evaluation was undertaken. While there is a great deal written about the importance of transparent and participatory priority setting in evaluation; few examples of how such processes could be implemented exist, particularly for maternal health programmes. Our experience demonstrates that the investment in a participatory priority-setting effort is high but the process undertaken resulted in both globally and contextually-relevant priorities for evaluation. This experience provides useful lessons for public health practitioners committed to bridging the research-policy interface.

Breast cancer screening in developing countries

PubMed Central

da Costa Vieira, René Aloísio; Biller, Gabriele; Uemura, Gilberto; Ruiz, Carlos Alberto; Curado, Maria Paula

2017-01-01

Developing countries have limited healthcare resources and use different strategies to diagnose breast cancer. Most of the population depends on the public healthcare system, which affects the diagnosis of the tumor. Thus, the indicators observed in developed countries cannot be directly compared with those observed in developing countries because the healthcare infrastructures in developing countries are deficient. The aim of this study was to evaluate breast cancer screening strategies and indicators in developing countries. A systematic review and the Population, Intervention, Comparison, Outcomes, Timing, and Setting methodology were performed to identify possible indicators of presentation at diagnosis and the methodologies used in developing countries. We searched PubMed for the terms “Breast Cancer” or “Breast Cancer Screening” and “Developing Country” or “Developing Countries”. In all, 1,149 articles were identified. Of these articles, 45 full articles were selected, which allowed us to identify indicators related to epidemiology, diagnostic intervention (diagnostic strategy, diagnostic infrastructure, percentage of women undergoing mammography), quality of intervention (presentation of symptoms at diagnosis, time to diagnosis, early stage disease), comparisons (trend curves, subpopulations at risk) and survival among different countries. The identification of these indicators will improve the reporting of methodologies used in developing countries and will allow us to evaluate improvements in public health related to breast cancer. PMID:28492725

Qualitative adaptation of child behaviour problem instruments in a developing-country setting.

PubMed

Khan, B; Avan, B I

2014-07-08

A key barrier to epidemiological research on child behaviour problems in developing countries is the lack of culturally relevant, internationally recognized psychometric instruments. This paper proposes a model for the qualitative adaptation of psychometric instruments in developing-country settings and presents a case study of the adaptation of 3 internationally recognized instruments in Pakistan: the Child Behavior Checklist, the Youth Self-Report and the Teacher's Report Form. This model encompassed a systematic procedure with 6 distinct phases to minimize bias and ensure equivalence with the original instruments: selection, deliberation, alteration, feasibility, testing and formal approval. The process was conducted in collaboration with the instruments' developer. A multidisciplinary working group of experts identified equivalence issues and suggested modifications. Focus group discussions with informants highlighted comprehension issues. Subsequently modified instruments were thoroughly tested. Finally, the instruments' developer approval further validated the qualitative adaptation. The study proposes a rigorous and systematic model to effectively achieve cultural adaptation of psychometric instruments.

Anesthesia and the role of short-term service delivery in developing countries.

PubMed

Froese, Alison

2007-11-01

To clarify the ongoing need for involvement of anesthesiologists in short-term surgical projects in developing countries, and provide information to guide the selection of, application for, and preparation for these rewarding experiences. The lack of safe anesthesia services severely limits the performance of needed surgical procedures in developing countries around the world. Even in countries where well-trained anesthesiologists are available in major urban centres, resources are often absent or limited for large numbers of people in rural or remote areas. Anesthesiologists are highly sought members of surgical teams. Internet sites provide extensive project information. Projects occur in Central and South America, Africa, Asia and Eastern Europe. Projects can bring specialized surgical expertise to an otherwise well-serviced urban area, or work in remote areas that have surgical services only when a team comes. Available equipment, drugs, housing, food and transportation vary markedly with project site. Flexibility, adaptability and problem-solving skills are essential. Translators provide language assistance. Anesthesiologists who have experience providing anesthetics in settings with less technological support can assist other anesthesiologists in adapting to less sophisticated settings. Severe shortages of trained health professionals plague developing countries, reflecting complex economic and political problems that will require decades for resolution. Until such time as surgical services are widely available and affordable in remote as well as urban areas of developing countries, anesthesiologists will continue to provide a valuable and personally rewarding contribution through short-term assistance.

DESIGN AND DEVELOPMENT OF A LOW COST, MULTIFUNCTION, REGIONALLY APPROPRIATE SOLAR OVEN FOR MASS PRODUCTION IN DEVELOPING COUNTRIES IN LATIN AMERICA

EPA Science Inventory

In the average Latin American country, 45% of the population is below the poverty line and 36% live in rural settings. For these sectors, solar ovens might represent their only affordable means of cooking and water pasteurization. Significant research efforts in th...

The Economics of Developing Countries Component of GCE "A" Level Economics--A Review of Examination Questions.

ERIC Educational Resources Information Center

Wood, Keith

1984-01-01

A review of the summer examination papers in 'A' level economics set by the eight boards of England and Wales during the period 1979-1983 show that, with two notable exceptions, the boards have not devoted much space to questions relating to the economics of developing countries. (Author/RM)

Teacher Professional Development outside the Lecture Room: Voices of Professionally Unqualified Practicing Teachers in Rural Zimbabwe Secondary Schools

ERIC Educational Resources Information Center

Mukeredzi, Tabitha Grace

2016-01-01

Attempts to address global pressure to achieve Education for All have been hampered by two fundamental challenges in developing countries, namely an acute shortage of teachers and large rural populations in these countries. In addition, qualified, competent teachers shun working in rural settings. While recruitment of professionally unqualified…

Planned, Motivated and Habitual Hygiene Behaviour: An Eleven Country Review

ERIC Educational Resources Information Center

Curtis, Valerie A.; Danquah, Lisa O.; Aunger, Robert V.

2009-01-01

Handwashing with soap (HWWS) may be one of the most cost-effective means of preventing infection in developing countries. However, HWWS is rare in these settings. We reviewed the results of formative research studies from 11 countries so as to understand the planned, motivated and habitual factors involved in HWWS. On average, only 17% of child…

Protecting the ozone layer.

PubMed

Munasinghe, M; King, K

1992-06-01

Stratospheric ozone layer depletion has been recognized as a problem by the Vienna Convention for the Protection of the Ozone Layer and the 1987 Montreal Protocol (MP). The ozone layer shields the earth from harmful ultraviolet radiation (UV-B), which is more pronounced at the poles and around the equator. Industrialized countries have contributed significantly to the problem by releasing chlorofluorocarbons (CFCs) and halons into the atmosphere. The effect of these chemicals, which were known for their inertness, nonflammability, and nontoxicity, was discovered in 1874. Action to deal with the effects of CFCs and halons was initiated in 1985 in a 49-nation UN meeting. 21 nations signed a protocol limiting ozone depleting substances (ODS): CFCs and halons. Schedules were set based on each country's use in 1986; the target phaseout was set for the year 2000. The MP restricts trade in ODSs and weights the impact of substances to reflect the extent of damage; i.e., halons are 10 times more damaging than CFCs. ODS requirements for developing countries were eased to accommodate scarce resources and the small fraction of ODS emissions. An Interim Multilateral Fund under the Montreal Protocol (IMFMP) was established to provide loans to finance the costs to developing countries in meeting global environmental requirements. The IMFMP is administered by the World Bank, the UN Environmental Program, and the UN Development Program. Financing is available to eligible countries who use .3 kg of ODS/person/year. Rapid phaseout in developed countries has occurred due to strong support from industry and a lower than expected cost. Although there are clear advantages to rapid phaseout, there were no incentives included in the MP for rapid phaseout. Some of the difficulties occur because the schedules set minimum targets at the lowest possible cost. Also, costs cannot be minimized by a country-specific and ODS-specific process. The ways to improve implementation in scheduling and incremental costs are indicated.

The scope of cell phones in diabetes management in developing country health care settings.

PubMed

Ajay, Vamadevan S; Prabhakaran, Dorairaj

2011-05-01

Diabetes has emerged as a major public health concern in developing nations. Health systems in most developing countries are yet to integrate effective prevention and control programs for diabetes into routine health care services. Given the inadequate human resources and underfunctioning health systems, we need novel and innovative approaches to combat diabetes in developing-country settings. In this regard, the tremendous advances in telecommunication technology, particularly cell phones, can be harnessed to improve diabetes care. Cell phones could serve as a tool for collecting information on surveillance, service delivery, evidence-based care, management, and supply systems pertaining to diabetes from primary care settings in addition to providing health messages as part of diabetes education. As a screening/diagnostic tool for diabetes, cell phones can aid the health workers in undertaking screening and diagnostic and follow-up care for diabetes in the community. Cell phones are also capable of acting as a vehicle for continuing medical education; a decision support system for evidence-based management; and a tool for patient education, self-management, and compliance. However, for widespread use, we need robust evaluations of cell phone applications in existing practices and appropriate interventions in diabetes. © 2011 Diabetes Technology Society.

The Scope of Cell Phones in Diabetes Management in Developing Country Health Care Settings

PubMed Central

Ajay, Vamadevan S; Prabhakaran, Dorairaj

2011-01-01

Diabetes has emerged as a major public health concern in developing nations. Health systems in most developing countries are yet to integrate effective prevention and control programs for diabetes into routine health care services. Given the inadequate human resources and underfunctioning health systems, we need novel and innovative approaches to combat diabetes in developing-country settings. In this regard, the tremendous advances in telecommunication technology, particularly cell phones, can be harnessed to improve diabetes care. Cell phones could serve as a tool for collecting information on surveillance, service delivery, evidence-based care, management, and supply systems pertaining to diabetes from primary care settings in addition to providing health messages as part of diabetes education. As a screening/diagnostic tool for diabetes, cell phones can aid the health workers in undertaking screening and diagnostic and follow-up care for diabetes in the community. Cell phones are also capable of acting as a vehicle for continuing medical education; a decision support system for evidence-based management; and a tool for patient education, self-management, and compliance. However, for widespread use, we need robust evaluations of cell phone applications in existing practices and appropriate interventions in diabetes. PMID:21722593

Foreign direct investment, institutional development, and environmental externalities: evidence from China.

PubMed

Wang, Danny T; Chen, Wendy Y

2014-03-15

The question of how foreign direct investment (FDI) affects a host country's natural environment has generated much debate but little consensus. Building on an institution-based theory, this article examines how the institutional development of a host setting affects the degree of FDI-related environmental externalities in China (specifically, industrial sulfur dioxide emissions). With a panel data set of 287 Chinese cities, over the period 2002-2009, this study reveals that FDI in general induces negative environmental externalities. Investments from OECD countries increase sulfur dioxide emissions, whereas FDI from Hong Kong, Macau, and Taiwan shows no significant effect. Institutional development reduces the impacts of FDI across the board. By focusing on the moderating role of institutions, this study sheds new light on the long-debated relationships among FDI, institutions, and the environments of the host countries. Copyright © 2014 Elsevier Ltd. All rights reserved.

Issues in the Development and Evaluation of Cross-Cultural Training in a Business Setting.

ERIC Educational Resources Information Center

Broadbooks, Wendy J.

Issues in the development and evaluation of cross-cultural training in a business setting were investigated. Cross-cultural training and cross-cultural evaluation were defined as training and evaluation of training that involve the interaction of participants from two or more different countries. Two evaluations of a management development-type…

Economic evaluations of non-communicable disease interventions in developing countries: a critical review of the evidence base

PubMed Central

Mulligan, Jo-Ann; Walker, Damian; Fox-Rushby, Julia

2006-01-01

Background Demographic projections suggest a major increase in non-communicable disease (NCD) mortality over the next two decades in developing countries. In a climate of scarce resources, policy-makers need to know which interventions represent value for money. The prohibitive cost of performing multiple economic evaluations has generated interest in transferring the results of studies from one setting to another. This paper aims to bridge the gap in the current literature by critically evaluating the available published data on economic evaluations of NCD interventions in developing countries. Methods We identified and reviewed the methodological quality of 32 economic evaluations of NCD interventions in developing countries. Developing countries were defined according to the World Bank classification for low- and lower middle-income countries. We defined NCDs as the 12 categories listed in the 1993 World Bank report Investing in Health. English language literature was searched for the period January 1984 and January 2003 inclusive in Medline, Science Citation Index, HealthStar, NHS Economic Evaluation Database and Embase using medical subheading terms and free text searches. We then assessed the quality of studies according to a set of pre-defined technical criteria. Results We found that the quality of studies was poor and resource allocation decisions made by local and global policy-makers on the basis of this evidence could be misleading. Furthermore we have identified some clear gaps in the literature, particularly around injuries and strategies for tackling the consequences of the emerging tobacco epidemic. Conclusion In the face of poor evidence the role of so-called generalised cost-effectiveness analyses has an important role to play in aiding public health decision-making at the global level. Further research is needed to investigates the causes of variation among cost, effects and cost-effectiveness data within and between settings. Such analyses still need to take a broad view, present data in a transparent manner and take account of local constraints. PMID:16584546

Impact of human development on safety consciousness in construction.

PubMed

Baradan, Selim; Dikmen, Seyyit Umit; Akboga Kale, Ozge

2018-05-03

The International Labour Organization (ILO) reports that the risk of fatal occupational injuries in developing countries is almost twice as high as in developed countries, indicating a potential relationship between the fatality rates and the development level. The human development index (HDI), based on life expectancy, knowledge level and purchasing power parity, endorsed by the United Nations Development Programme, is a widely accepted measure of the development level. This study investigates the relationship between the HDI and the fatality rates reported by the ILO. A 23-country data set is used to demonstrate the general trend of the relationship followed by country-specific analyses for Australia, Spain, Hungary and Turkey. The study conducted is limited to fatal occupational injuries in construction, where the accidents are notoriously high. The results demonstrate a statistically significant inverse relationship between the fatality rates and the HDI.

Indicators of Family Care for Development for Use in Multicountry Surveys

PubMed Central

Kariger, Patricia; Engle, Patrice; Britto, Pia M. Rebello; Sywulka, Sara M.; Menon, Purnima

2012-01-01

Indicators of family care for development are essential for ascertaining whether families are providing their children with an environment that leads to positive developmental outcomes. This project aimed to develop indicators from a set of items, measuring family care practices and resources important for caregiving, for use in epidemiologic surveys in developing countries. A mixed method (quantitative and qualitative) design was used for item selection and evaluation. Qualitative and quantitative analyses were conducted to examine the validity of candidate items in several country samples. Qualitative methods included the use of global expert panels to identify and evaluate the performance of each candidate item as well as in-country focus groups to test the content validity of the items. The quantitative methods included analyses of item-response distributions, using bivariate techniques. The selected items measured two family care practices (support for learning/stimulating environment and limit-setting techniques) and caregiving resources (adequacy of the alternate caregiver when the mother worked). Six play-activity items, indicative of support for learning/stimulating environment, were included in the core module of UNICEF's Multiple Cluster Indictor Survey 3. The other items were included in optional modules. This project provided, for the first time, a globally-relevant set of items for assessing family care practices and resources in epidemiological surveys. These items have multiple uses, including national monitoring and cross-country comparisons of the status of family care for development used globally. The obtained information will reinforce attention to efforts to improve the support for development of children. PMID:23304914

The situation of waste mobile phone management in developed countries and development status in China.

PubMed

Xu, Chengjian; Zhang, Wenxuan; He, Wenzhi; Li, Guangming; Huang, Juwen

2016-12-01

With the rapid development of electronic industry and improvement of living standards, a large number of waste mobile phones were generated. According to statistics, approximately 400million waste mobile phones are generated each year in the world, and 25% of that are contributed by China. Irregular disposal of waste mobile phones will do great harm to environment and human health, while at the same time recycling of them has the potential for high profits. Given the enormous quantity, great harm and resource properties, developed countries have taken necessary measures to manage waste mobile phones. As the largest developing country, China has also set out to pay close attention to waste mobile phones. This paper reviewed the situation ofwaste mobile phone management in the developed countries, focused on the development of waste mobile phone management in China, and analyzed existing problems. In light of the successful experience of the developed countries, some suggestions were proposed to promote the waste mobile phone management in China and worked as a valuable reference for other countries. Copyright © 2016 Elsevier Ltd. All rights reserved.

Developing and implementing mental health policy in Zanzibar, a low income country off the coast of East Africa

PubMed Central

2011-01-01

Background The Zanzibar Ministry of Health and Social Welfare, concerned about mental health in the country, requested technical assistance from WHO in 1997. Aims This article describes the facilitation over many years by a WHO Collaborating Centre, of sustainable mental health developments in Zanzibar, one of the poorest countries in the world, using systematic approaches to policy design and implementation. Methods Based on intensive prior situation appraisal and consultation, a multi-faceted set of interventions combining situation appraisal to inform planning; sustained policy dialogue at Union and state levels; development of policy and legislation, development of strategic action plans, establishment of intersectoral national mental health implementation committee, establishment of national mental health coordination system, integration of mental health into primary care, strengthening of primary-secondary care liaison, rationalisation and strengthening of secondary care system, ensuring adequate supply of medicines, use of good practice guidelines and health information systems, development of services for people with intellectual disability, establishment of formal mechanism for close liaison between the mental health services and other governmental, non-governmental and traditional sectors, mental health promotion, suicide prevention, and research and development. Results The policy and legislation introduced in 1999 have resulted in enhanced mental health activities over the ensuing decade, within a setting of extreme low resource. However, advances ebb and flow and continued efforts are required to maintain progress and continue mental health developments. Lessons learnt have informed the development of mental health policies in neighbouring countries. Conclusions A multi-faceted and comprehensive programme can be effective in achieving considerable strengthening of mental health programmes and services even in extremely low resource settings, but requires sustained input and advocacy if gains are to be maintained and enhanced. PMID:21320308

Ethical concerns in nurse migration.

PubMed

McElmurry, Beverly J; Solheim, Karen; Kishi, Rieko; Coffia, Marcia A; Woith, Wendy; Janepanish, Poolsuk

2006-01-01

International nurse migration is natural and to be expected. Recently, however, those who have fostered nurse migration believe that it will solve nursing shortages in developed countries and offer nurse migrants better working conditions and an improved quality of life. Whether natural or manipulated, migration flow patterns largely occur from developing to developed countries. In this article, nurse migration is examined using primary health care (PHC) as an ethical framework. The unmanaged flow of nurse migrants from developing to developed countries is inconsistent with "health for all" principles. Removing key health personnel from countries experiencing resource shortages is contrary to PHC equity. Often, nurse migrants are placed in vulnerable, inequitable work roles, and employing nurse migrants fails to address basic causes of nurse shortages in developed countries, such as dissatisfaction with work conditions and decreased funding for academic settings. Nurse migration policies and procedures can be developed to satisfy PHC ethics criteria if they (1) leave developing countries enhanced rather than depleted, (2) contribute to country health outcomes consistent with essential care for all people, (3) are based on community participation, (4) address common nursing labor issues, and (5) involve equitable and clear financial arrangements.

Legal Developments and Problems of the Bologna Process within the European Higher Education Area and European Integration

ERIC Educational Resources Information Center

Cippitani, Roberto; Gatt, Suzanne

2009-01-01

2010 sees the end of the process of establishing the European Higher Education Area (EHEA). Although not all countries may have achieved all the objectives, many are those countries and universities who have implemented many of the targets set. Within the Bologna Process, there have been many developments such as: European Credit Transfer and…

Higher Education and Employment: The Changing Relationship. Recent Developments in Continuing Professional Education. Country Study: Japan.

ERIC Educational Resources Information Center

Kaneko, Motohisa

This report, one of a series of country studies on higher education and employment, particularly in continuing professional education, looks at recent developments in Japan. The first of five sections defines the scope of continuing professional education in the context of Japanese economy and society, and sets forth a theoretical framework for…

Infertility in resource-constrained settings: moving towards amelioration.

PubMed

Hammarberg, Karin; Kirkman, Maggie

2013-02-01

It is often presumed that infertility is not a problem in resource-poor areas where fertility rates are high. This is challenged by consistent evidence that the consequences of childlessness are very severe in low-income countries, particularly for women. In these settings, childless women are frequently stigmatized, isolated, ostracized, disinherited and neglected by the family and local community. This may result in physical and psychological abuse, polygamy and even suicide. Attitudes among people in high-income countries towards provision of infertility care in low-income countries have mostly been either dismissive or indifferent as it is argued that scarce healthcare resources should be directed towards reducing fertility and restricting population growth. However, recognition of the plight of infertile couples in low-income settings is growing. One of the United Nation's Millennium Development Goals was for universal access to reproductive health care by 2015, and WHO has recommended that infertility be considered a global health problem and stated the need for adaptation of assisted reproductive technology in low-resource countries. This paper challenges the construct that infertility is not a serious problem in resource-constrained settings and argues that there is a need for infertility care, including affordable assisted reproduction treatment, in these settings. It is often presumed that infertility is not a problem in densely populated, resource-poor areas where fertility rates are high. This presumption is challenged by consistent evidence that the consequences of childlessness are very severe in low-income countries, particularly for women. In these settings, childless women are frequently stigmatized, isolated, ostracized, disinherited and neglected by the family and local community. This may result in physical and psychological abuse, polygamy and even suicide. Because many families in low-income countries depend on children for economic survival, childlessness and having fewer children than the number identified as appropriate are social and public health matters, not only medical problems. Attitudes among people in high-income countries towards provision of infertility care in low-income countries have mostly been either dismissive or indifferent as it is argued that scarce healthcare resources and family planning activities should be directed towards reducing fertility and restricting population growth. However, recognition of the plight of infertile couples in low-income settings is growing. One of the United Nation's Millennium Development Goals was for universal access to reproductive health care by 2015, and WHO has recommended that infertility be considered a global health problem and stated the need for adaptation of assisted reproduction technology in low-resource countries. In this paper, we challenge the construct that infertility is not a serious problem in resource-constrained settings and argue that there is a need for infertility care, including affordable assisted reproduction treatment, in these settings. Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

78 countries: immunization financing in developing and transitional countries.

PubMed

Deroeck, D; Levin, A

1999-01-01

The Special Initiative on Immunization Financing is a project that reviews available information on immunization costs and financing in developing countries in order to inform planned field-based activities to increase sustainability of immunization programs. While routine immunization costs just pennies a dose, newer vaccines such as hepatitis B vaccine cost much more; the full cost of making them routine are not yet known. However, a growing number of governments are paying for these vaccines. Three-quarters of the countries responding to the survey have immunization and vaccination programs in their national budgets. Moreover, international organizations have set up fund and procurement mechanisms to aid countries purchase low-cost, high-quality vaccines.

AFOMP Policy No 5: career progression for clinical medical physicists in AFOMP countries.

PubMed

Round, W H; Stefanoyiannis, A P; Ng, K H; Rodriguez, L V; Thayalan, K; Han, Y; Tang, F; Fukuda, S; Srivastava, R; Krisanachinda, A; Shiau, A C; Deng, X

2015-06-01

This policy statement, which is the fifth of a series of documents being prepared by the Asia-Oceania Federation of Organizations for Medical Physics Professional Development Committee, gives guidance on how clinical medical physicists' careers should progress from their initial training to career end. It is not intended to be prescriptive as in some AFOMP countries career structures are already essentially defined by employment awards and because such matters will vary considerably from country to country depending on local culture, employment practices and legislation. It is intended to be advisory and set out options for member countries and employers of clinical medical physicists to develop suitable career structures.

Planning and evaluating mental health services in low- and middle-income countries using theory of change

PubMed Central

Breuer, Erica; De Silva, Mary J.; Shidaye, Rahul; Petersen, Inge; Nakku, Juliet; Jordans, Mark J. D.; Fekadu, Abebaw; Lund, Crick

2016-01-01

Background There is little practical guidance on how contextually relevant mental healthcare plans (MHCPs) can be developed in low-resource settings. Aims To describe how theory of change (ToC) was used to plan the development and evaluation of MHCPs as part of the PRogramme for Improving Mental health carE (PRIME). Method ToC development occurred in three stages: (a) development of a cross-country ToC by 15 PRIME consortium members; (b) development of country-specific ToCs in 13 workshops with a median of 15 (interquartile range 13–22) stakeholders per workshop; and (c) review and refinement of the cross-country ToC by 18 PRIME consortium members. Results One cross-country and five district ToCs were developed that outlined the steps required to improve outcomes for people with mental disorders in PRIME districts. Conclusions ToC is a valuable participatory method that can be used to develop MHCPs and plan their evaluation. PMID:26447178

Country Profiles. Japan.

ERIC Educational Resources Information Center

Muramatsu, Minoru

This occasional paper on Japan is one of a series setting forth the nature, scope, and accomplishments of population activities in specified countries. Here, an overview is given of population characteristics and growth patterns, the relationship of population growth to socioeconomic development, and the history of population concerns and…

Peru's national greenhouse gas inventory, 1990 : Peru climate change country study

DOT National Transportation Integrated Search

1996-07-01

The aim of this study has been to determine the Inventory and to propose Greenhouse gases mitigation alternatives in order to face the future development of the country in a clean environmental setting, improving in this way the Peruvian standard of ...

Motivation in Cross-Cultural Settings: A Papua New Guinea Psychometric Study

ERIC Educational Resources Information Center

Nelson, Genevieve F.; O'Mara, Alison J.; McInerney, Dennis M.; Dowson, Martin

2006-01-01

There is a paucity of research on motivation and education in developing countries. Although psychological constructs relating to academic engagement and achievement have been identified and researched in a number of cross-cultural settings this body of research has rarely been extended to the developing world. The processes by which students from…

Inventory on the dietary assessment tools available and needed in africa: a prerequisite for setting up a common methodological research infrastructure for nutritional surveillance, research, and prevention of diet-related non-communicable diseases.

PubMed

Pisa, Pedro T; Landais, Edwige; Margetts, Barrie; Vorster, Hester H; Friedenreich, Christine M; Huybrechts, Inge; Martin-Prevel, Yves; Branca, Francesco; Lee, Warren T K; Leclercq, Catherine; Jerling, Johann; Zotor, Francis; Amuna, Paul; Al Jawaldeh, Ayoub; Aderibigbe, Olaide Ruth; Amoussa, Waliou Hounkpatin; Anderson, Cheryl A M; Aounallah-Skhiri, Hajer; Atek, Madjid; Benhura, Chakare; Chifamba, Jephat; Covic, Namukolo; Dary, Omar; Delisle, Hélène; El Ati, Jalila; El Hamdouchi, Asmaa; El Rhazi, Karima; Faber, Mieke; Kalimbira, Alexander; Korkalo, Liisa; Kruger, Annamarie; Ledo, James; Machiweni, Tatenda; Mahachi, Carol; Mathe, Nonsikelelo; Mokori, Alex; Mouquet-Rivier, Claire; Mutie, Catherine; Nashandi, Hilde Liisa; Norris, Shane A; Onabanjo, Oluseye Olusegun; Rambeloson, Zo; Saha, Foudjo Brice U; Ubaoji, Kingsley Ikechukwu; Zaghloul, Sahar; Slimani, Nadia

2018-01-02

To carry out an inventory on the availability, challenges, and needs of dietary assessment (DA) methods in Africa as a pre-requisite to provide evidence, and set directions (strategies) for implementing common dietary methods and support web-research infrastructure across countries. The inventory was performed within the framework of the "Africa's Study on Physical Activity and Dietary Assessment Methods" (AS-PADAM) project. It involves international institutional and African networks. An inventory questionnaire was developed and disseminated through the networks. Eighteen countries responded to the dietary inventory questionnaire. Various DA tools were reported in Africa; 24-Hour Dietary Recall and Food Frequency Questionnaire were the most commonly used tools. Few tools were validated and tested for reliability. Face-to-face interview was the common method of administration. No computerized software or other new (web) technologies were reported. No tools were standardized across countries. The lack of comparable DA methods across represented countries is a major obstacle to implement comprehensive and joint nutrition-related programmes for surveillance, programme evaluation, research, and prevention. There is a need to develop new or adapt existing DA methods across countries by employing related research infrastructure that has been validated and standardized in other settings, with the view to standardizing methods for wider use.

Data sets on pensions and health: Data collection and sharing for policy design

PubMed Central

Lee, Jinkook

2015-01-01

A growing number of countries are developing or reforming pension and health policies in response to population ageing and to enhance the welfare of their citizens. The adoption of different policies by different countries has resulted in several natural experiments. These offer unusual opportunities to examine the effects of varying policies on health and retirement, individual and family behaviour, and well-being. Realizing these opportunities requires harmonized data-collection efforts. An increasing number of countries have agreed to provide data harmonized with the Health and Retirement Study in the United States. This article discusses these data sets, including their key parameters of pension and health status, research designs, samples, and response rates. It also discusses the opportunities they offer for cross-national studies and their implications for policy evaluation and development. PMID:26229178

Providing ethical guidance for collaborative research in developing countries

PubMed Central

Morris, Nina

2015-01-01

Experience has shown that the application of ethical guidelines developed for research in developed countries to research in developing countries can be, and often is, impractical and raises a number of contentious issues. Various attempts have been made to provide guidelines more appropriate to the developing world context; however, to date these efforts have been dominated by the fields of bioscience, medical research and nutrition. There is very little advice available for those seeking to undertake collaborative social science or natural science research in developing countries and what is there tends to be held within disparate sources. Charting the development of a set of ethics documentation for future use by the Ecosystem Services for Poverty Alleviation (ESPA) programme research community, this paper outlines past and present attitudes towards ethics procedures amongst this community and suggests ways in which ethics procedures might be made more relevant and user-friendly to researchers working in this area. PMID:26640509

In search of a common currency: A comparison of seven EQ-5D-5L value sets.

PubMed

Olsen, Jan Abel; Lamu, Admassu N; Cairns, John

2018-01-01

The recently published EQ-5D-5L value sets from Canada, England, Japan, Korea, the Netherlands, Spain, and Uruguay are compared with an aim to identify any similarities in preference pattern. We identify some striking similarities for Canada, England, the Netherlands, and Spain in terms of (a) the relative importance of the 5 dimensions; (b) the relative utility decrements across the 5 levels; and (c) the scale length. On the basis of the observed similarities across these 4 Western countries, we develop an amalgam model, WePP (western preference pattern), and compare it with these 4 value sets. The values generated by this model show a high degree of concordance with those of England, Canada, and Spain. Patient level data were obtained from the Multi-Instrument Comparison project, which includes participants from 6 countries in 7 disease groups (N = 7,933): The WePP values lie within the confidence intervals for the value sets in Canada, England, and Spain across the whole severity distribution. We suggest that the WePP model represents a useful "common currency" for (Western) countries that have not yet developed their own value sets. Further research is needed to disentangle the differences between value sets due to preference heterogeneity from those stemming from methodological differences. Copyright © 2017 John Wiley & Sons, Ltd.

A national EHR strategy preparedness characterisation model and its application in the South-East European region.

PubMed

Orfanidis, Leonidas; Bamidis, Panagiotis; Eaglestone, Barry

2006-01-01

This paper is concerned with modelling national approaches towards electronic health record systems (NEHRS) development. A model framework is stepwise produced, that allows for the characterisation of the preparedness and the readiness of a country to develop an NEHRS. Secondary data of published reports are considered for the creation of the model. Such sources are identified to mostly originate from within a sample of five developed countries. Factors arising from these sources are identified, coded and scaled, so as to allow for a quantitative application of the model. Instantiation of the latter for the case of the five developed countries is contrasted with the set of countries from South East Europe (SEE). The likely importance and validity of this modelling approach is discussed, using the Delphi method.

Emergency medicine clerkship curriculum in a high-income developing country: methods for development and application.

PubMed

Cevik, Arif Alper; Cakal, Elif Dilek; Abu-Zidan, Fikri M

2018-06-07

The published recommendations for international emergency medicine curricula cover the content, but exclude teaching and learning methods, assessment, and evaluation. We aim to provide an overview on available emergency medicine clerkship curricula and report the development and application experience of our own curriculum. Our curriculum is an outcome-based education, enriched by e-learning and various up-to-date pedagogic principles. Teaching and learning methods, assessment, and evaluation are described. The theory behind our practice in the light of recent literature is discussed aiming to help other colleagues from developing countries to have a clear map for developing and tailoring their own curricula depending on their needs. The details of our emergency medicine clerkship will serve as an example for developing and developed countries having immature undergraduate emergency medicine clerkship curricula. However, these recommendations will differ in various settings depending on available resources. The main concept of curriculum development is to create a curriculum having learning outcomes and content relevant to the local context, and then align the teaching and learning activities, assessments, and evaluations to be in harmony. This may assure favorable educational outcome even in resource limited settings.

Developing a framework of, and quality indicators for, general practice management in Europe.

PubMed

Engels, Yvonne; Campbell, Stephen; Dautzenberg, Maaike; van den Hombergh, Pieter; Brinkmann, Henrik; Szécsényi, Joachim; Falcoff, Hector; Seuntjens, Luc; Kuenzi, Beat; Grol, Richard

2005-04-01

To develop a framework for general practice management made up of quality indicators shared by six European countries. Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six national expert panels, each consisting of 10 members, primarily primary care practitioners and experts in the field of quality in primary care participated in the study. The main outcome measures were: (a) a European framework with indicators for the organization of primary care; and (b) ratings of the face validity of the usefulness of the indicators by expert panels in six countries. Agreement was reached about a definition of practice management across five domains (infrastructure, staff, information, finance, and quality and safety), and a common set of indicators for the organization of general practice. The panellist response rate was 95%. Sixty-two indicators (37%) were rated face valid by all six panels. Examples include out of hours service, accessibility, the content of doctors' bags and staff involvement in quality improvement. No indicators were rated invalid by all six panels. It proved to be possible to develop a European set of indicators for assessing the quality of practice management, despite the differences in health care systems and cultures in the six different countries. These indicators will now be used in a quality assessment procedure of practice management in nine European countries. While organizational indicators are part of the new GMS contract in the UK, this research shows that many practice management issues within primary care are also of relevance in other European countries.

Selecting indicators for patient safety at the health system level in OECD countries.

PubMed

McLoughlin, Vivienne; Millar, John; Mattke, Soeren; Franca, Margarida; Jonsson, Pia Maria; Somekh, David; Bates, David

2006-09-01

Concerns about patient safety have arisen with growing documentation of the extent and nature of harm. Yet there are no robust and meaningful data that can be used internationally to assess the extent of the problem and considerable methodological difficulties. This article describes a project undertaken as part of the Organization for Economic Cooperation and Development (OECD) Quality Indicator Project, which aimed at developing an initial set of patient safety indicators. Patient safety indicators from OECD countries were identified and then rated against three principal criteria: importance to patient safety, scientific soundness, and potential feasibility. Although some countries are developing multi-source monitoring systems, these are not yet mature enough for international exchange. This project reviewed routine data collections as a starting point. Of an initial set of 59 candidate indicators identified, 21 were selected which cover known areas of harm to patients. This project is an important initial step towards defining a usable set of patient safety indicators that will allow comparisons to be made internationally and will support mutual learning and quality improvement in health care. Measures of harm should be complemented over time with measures of effective improvement factors.

The Impact of Globalization on a Country's Quality of Life: Toward an Integrated Model

ERIC Educational Resources Information Center

Sirgy, M. Joseph; Lee, Dong-Jin; Miller, Chad; Littlefield, James E.

2004-01-01

The purpose of the paper is to develop a set of theoretical propositions to explain the impact of globalization on a country's quality of life (QOL). In this paper, we describe how globalization impacts the quality of life of residents of a country by first articulating the globalization construct (in terms of inflows and outflows of goods,…

Facebook as a Learning Tool? A Case Study on the Appropriation of Social Network Sites from Mobile Phones in Developing Countries

ERIC Educational Resources Information Center

Pimmer, Christoph; Linxen, Sebastian; Grohbiel, Urs

2012-01-01

This exploratory research investigates how students and professionals use social network sites (SNSs) in the setting of developing and emerging countries. Data collection included focus groups consisting of medical students and faculty as well as the analysis of a Facebook site centred on medical and clinical topics. The findings show how users,…

Design and Multi-Country Validation of Text Messages for an mHealth Intervention for Primary Prevention of Progression to Hypertension in Latin America.

PubMed

Diez-Canseco, Francisco; Zavala-Loayza, J Alfredo; Beratarrechea, Andrea; Kanter, Rebecca; Ramirez-Zea, Manuel; Rubinstein, Adolfo; Martinez, Homero; Miranda, J Jaime

2015-02-18

Mobile health (mHealth) has been posited to contribute to the reduction in health gaps and has shown fast and widespread growth in developing countries. This growth demands understanding of, and preparedness for, local cultural contexts. To describe the design and validation of text messages (short message service, SMS) that will be used for an mHealth behavioral change intervention to prevent hypertension in three Latin American countries: Argentina, Guatemala, and Peru. An initial set of 64 SMS text messages were designed to promote healthy lifestyles among individuals in different stages of behavior change, addressing four key domains: salt and sodium intake, fruit and vegetable intake, consumption of high fat and sugar foods, and physical activity. The 64 SMS text messages were organized into nine subsets for field validation. In each country 36 people were recruited, half of them being male. Of the participants, 4 per country evaluated each subset of SMS text messages, which contained between 6 and 8 SMS text messages regarding different key domains and stages of change. The understanding and appeal of each SMS text message was assessed using a 7-item questionnaire. The understanding and appeal ratings were used to reach a final set of 56 SMS text messages. Overall, each of the 64 SMS text messages received a total of 12 evaluations (4 per country). The majority of evaluations-742 out of a total of 767 (96.7%) valid responses-revealed an adequate understanding of the key idea contained in the SMS text message. On a scale from 1 to 10, the average appeal score was 8.7 points, with a range of 4 to 10 points. Based on their low scores, 8 SMS text messages per country were discarded. Once the final set of 56 SMS text messages was established, and based on feedback obtained in the field, wording and content of some SMS text messages were improved. Of the final set, 9, 8, and 16 of the SMS text messages were improved based on participant evaluations from Argentina, Guatemala, and Peru, respectively. Most SMS text messages selected for the final set (49/56, 88%) were the same in all countries, except for small wording differences. The final set of SMS text messages produced had very high rates of understanding and appeal in three different Latin American countries. This study highlights the importance of developing and validating a package of simple, preventative SMS text messages, grounded in evidence and theory, across three different Latin American countries with active engagement of end users.

Design and Multi-Country Validation of Text Messages for an mHealth Intervention for Primary Prevention of Progression to Hypertension in Latin America

PubMed Central

Diez-Canseco, Francisco; Zavala-Loayza, J Alfredo; Beratarrechea, Andrea; Kanter, Rebecca; Ramirez-Zea, Manuel; Rubinstein, Adolfo; Martinez, Homero

2015-01-01

Background Mobile health (mHealth) has been posited to contribute to the reduction in health gaps and has shown fast and widespread growth in developing countries. This growth demands understanding of, and preparedness for, local cultural contexts. Objective To describe the design and validation of text messages (short message service, SMS) that will be used for an mHealth behavioral change intervention to prevent hypertension in three Latin American countries: Argentina, Guatemala, and Peru. Methods An initial set of 64 SMS text messages were designed to promote healthy lifestyles among individuals in different stages of behavior change, addressing four key domains: salt and sodium intake, fruit and vegetable intake, consumption of high fat and sugar foods, and physical activity. The 64 SMS text messages were organized into nine subsets for field validation. In each country 36 people were recruited, half of them being male. Of the participants, 4 per country evaluated each subset of SMS text messages, which contained between 6 and 8 SMS text messages regarding different key domains and stages of change. The understanding and appeal of each SMS text message was assessed using a 7-item questionnaire. The understanding and appeal ratings were used to reach a final set of 56 SMS text messages. Results Overall, each of the 64 SMS text messages received a total of 12 evaluations (4 per country). The majority of evaluations—742 out of a total of 767 (96.7%) valid responses—revealed an adequate understanding of the key idea contained in the SMS text message. On a scale from 1 to 10, the average appeal score was 8.7 points, with a range of 4 to 10 points. Based on their low scores, 8 SMS text messages per country were discarded. Once the final set of 56 SMS text messages was established, and based on feedback obtained in the field, wording and content of some SMS text messages were improved. Of the final set, 9, 8, and 16 of the SMS text messages were improved based on participant evaluations from Argentina, Guatemala, and Peru, respectively. Most SMS text messages selected for the final set (49/56, 88%) were the same in all countries, except for small wording differences. Conclusions The final set of SMS text messages produced had very high rates of understanding and appeal in three different Latin American countries. This study highlights the importance of developing and validating a package of simple, preventative SMS text messages, grounded in evidence and theory, across three different Latin American countries with active engagement of end users. PMID:25693595

Strengthening laboratory systems in resource-limited settings.

PubMed

Olmsted, Stuart S; Moore, Melinda; Meili, Robin C; Duber, Herbert C; Wasserman, Jeffrey; Sama, Preethi; Mundell, Ben; Hilborne, Lee H

2010-09-01

Considerable resources have been invested in recent years to improve laboratory systems in resource-limited settings. We reviewed published reports, interviewed major donor organizations, and conducted case studies of laboratory systems in 3 countries to assess how countries and donors have worked together to improve laboratory services. While infrastructure and the provision of services have seen improvement, important opportunities remain for further advancement. Implementation of national laboratory plans is inconsistent, human resources are limited, and quality laboratory services rarely extend to lower tier laboratories (eg, health clinics, district hospitals). Coordination within, between, and among governments and donor organizations is also frequently problematic. Laboratory standardization and quality control are improving but remain challenging, making accreditation a difficult goal. Host country governments and their external funding partners should coordinate their efforts effectively around a host country's own national laboratory plan to advance sustainable capacity development throughout a country's laboratory system.

Low back pain in 17 countries, a Rasch analysis of the ICF core set for low back pain.

PubMed

Røe, Cecilie; Bautz-Holter, Erik; Cieza, Alarcos

2013-03-01

Previous studies indicate that a worldwide measurement tool may be developed based on the International Classification of Functioning Disability and Health (ICF) Core Sets for chronic conditions. The aim of the present study was to explore the possibility of constructing a cross-cultural measurement of functioning for patients with low back pain (LBP) on the basis of the Comprehensive ICF Core Set for LBP and to evaluate the properties of the ICF Core Set. The Comprehensive ICF Core Set for LBP was scored by health professionals for 972 patients with LBP from 17 countries. Qualifier levels of the categories, invariance across age, sex and countries, construct validity and the ordering of the categories in the components of body function, body structure, activities and participation were explored by Rasch analysis. The item-trait χ2-statistics showed that the 53 categories in the ICF Core Set for LBP did not fit the Rasch model (P<0.001). The main challenge was the invariance in the responses according to country. Analysis of the four countries with the largest sample sizes indicated that the data from Germany fit the Rasch model, and the data from Norway, Serbia and Kuwait in terms of the components of body functions and activities and participation also fit the model. The component of body functions and activity and participation had a negative mean location, -2.19 (SD 1.19) and -2.98 (SD 1.07), respectively. The negative location indicates that the ICF Core Set reflects patients with a lower level of function than the present patient sample. The present results indicate that it may be possible to construct a clinical measure of function on the basis of the Comprehensive ICF Core Set for LBP by calculating country-specific scores before pooling the data.

Supporting Real Innovation in the 80's--Characteristics of ID Units That Will Make It Happen. A DID/AECT Occasional Paper.

ERIC Educational Resources Information Center

Sachs, Steven G.

Planning the activities for an instructional development unit and evaluating how well it has performed requires a set of standards against which the unit can be compared. This paper proposes a set of standards developed from a variety of references and personal experiences with instructional development units from across the country. Thirty-eight…

Migration from new-accession countries and duration expectancy in the EU-15: 2002–2008

PubMed Central

DeWaard, Jack; Ha, Jasmine Trang; Raymer, James; Wiśniowski, Arkadiusz

2016-01-01

European Union (EU) enlargements in 2004 and 2007 were accompanied by increased migration from new-accession to established-member (EU-15) countries. The impacts of these flows depend, in part, on the amount of time that persons from the former countries live in the latter over the life course. In this paper, we develop period estimates of duration expectancy in EU-15 countries among persons from new-accession countries. Using a newly developed set of harmonised Bayesian estimates of migration flows each year from 2002 to 2008 from the Integrated Modelling of European Migration (IMEM) Project, we exploit period age patterns of country-to-country migration and mortality to summarize the average number of years that persons from new-accession countries could be expected to live in EU-15 countries over the life course. In general, the results show that the amount of time that persons from new-accession countries could be expected to live in the EU-15 nearly doubled after 2004. PMID:28286353

Setting the stage for equity-sensitive monitoring of the maternal and child health Millennium Development Goals.

PubMed Central

Wirth, Meg E.; Balk, Deborah; Delamonica, Enrique; Storeygard, Adam; Sacks, Emma; Minujin, Alberto

2006-01-01

OBJECTIVE: This analysis seeks to set the stage for equity-sensitive monitoring of the health-related Millennium Development Goals (MDGs). METHODS: We use data from international household-level surveys (Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS)) to demonstrate that establishing an equity baseline is necessary and feasible, even in low-income and data-poor countries. We assess data from six countries using 11 health indicators and six social stratifiers. Simple bivariate stratification is complemented by simultaneous stratification to expose the compound effect of multiple forms of vulnerability. FINDINGS: The data reveal that inequities are complex and interactive: inferences cannot be drawn about the nature or extent of inequities in health outcomes from a single stratifier or indicator. CONCLUSION: The MDGs and other development initiatives must become more comprehensive and explicit in their analysis and tracking of inequities. The design of policies to narrow health gaps must take into account country-specific inequities. PMID:16878225

Developing Cultural Competence and Overcoming Ethical Challenges in the Informed Consent Process: An Experience from Egypt

ERIC Educational Resources Information Center

Abdel-Messih, Ibrahim Adib; El-Setouhy, Maged; Crouch, Michael M.; Earhart, Kenneth C.

2008-01-01

Research is conducted in a variety of cultural settings. Ethical standards developed in Europe and the Americas are increasingly applied in these settings, many of which are culturally different from the countries in which these standards originated. To overcome these cultural differences, investigators may be tempted to deviate from ethical…

Poverty, Physical Stature, and Cognitive Skills: Mechanisms Underlying Children's School Enrollment in Zambia

ERIC Educational Resources Information Center

McCoy, Dana Charles; Zuilkowski, Stephanie Simmons; Fink, Günther

2015-01-01

Past research suggests robust positive associations between household socioeconomic status and children's early cognitive development in Western countries. Relatively little is known about these relations in low-income country settings characterized by economic adversity, high prevalence of malnutrition and infectious disease, and relatively lower…

Parental Engagement Strategies in Greek and Nigerian Preschool Settings: Cross-Country Comparison

ERIC Educational Resources Information Center

Rentzou, Konstantina; Ekine, Adefunke

2017-01-01

Acknowledging the fact that parental engagement is more beneficial during early childhood compared to other developmental stages many countries have institutionalised parental engagement. In Nigeria, the government has taken initiatives in order to involve parents in their child's development by encouraging the establishment of School Management…

Patient Blood Management: An International Perspective.

PubMed

Eichbaum, Quentin; Murphy, Michael; Liu, Yu; Kajja, Isaac; Hajjar, Ludhmila Abrahao; Smit Sibinga, Cees Th; Shan, Hua

2016-12-01

This article describes practices in patient blood management (PBM) in 4 countries on different continents that may provide insights for anesthesiologists and other physicians working in global settings. The article has its foundation in the proceedings of a session at the 2014 AABB annual meeting during which international experts from England, Uganda, China, and Brazil presented the programs and implementation strategies in PBM developed in their respective countries. To systematize the review and enhance the comparability between these countries on different continents, authors were requested to respond to the same set of 6 key questions with respect to their country's PBM program(s). Considerable variation exists between these country regions that is driven both by differences in health contexts and by disparities in resources. Comparing PBM strategies from low-, middle-, and high-income countries, as described in this article, allows them to learn bidirectionally from one another and to work toward implementing innovative and preferably evidence-based strategies for improvement. Sharing and distributing knowledge from such programs will ultimately also improve transfusion outcomes and patient safety.

Standard Setting Lessons Learned in the South African Context: Implications for International Implementation

ERIC Educational Resources Information Center

Pitoniak, Mary J.; Yeld, Nan

2013-01-01

Criterion-referenced assessments have become more common around the world, with performance standards being set to differentiate different levels of student performance. However, use of standard setting methods developed in the United States may be complicated by factors related to the political and educational contexts within another country. In…

Community-based interventions to optimize early childhood development in low resource settings.

PubMed

Maulik, P K; Darmstadt, G L

2009-08-01

Interventions targeting the early childhood period (0 to 3 years) help to improve neuro-cognitive functioning throughout life. Some of the more low cost, low resource-intensive community practices for this age-group are play, reading, music and tactile stimulation. This research was conducted to summarize the evidence regarding the effectiveness of such strategies on child development, with particular focus on techniques that may be transferable to developing countries and to children at risk of developing secondary impairments. PubMed, PsycInfo, Embase, ERIC, CINAHL and Cochrane were searched for studies involving the above strategies for early intervention. Reference lists of these studies were scanned and other studies were incorporated based on snow-balling. Overall, 76 articles corresponding to 53 studies, 24 of which were randomized controlled trials, were identified. Sixteen of those studies were from low- and middle-income countries. Play and reading were the two commonest interventions and showed positive impact on intellectual development of the child. Music was evaluated primarily in intensive care settings. Kangaroo Mother Care, and to a lesser extent massage, also showed beneficial effects. Improvement in parent-child interaction was common to all the interventions. Play and reading were effective interventions for early childhood interventions in low- and middle-income countries. More research is needed to judge the effectiveness of music. Kangaroo Mother Care is effective for low birth weight babies in resource poor settings, but further research is needed in community settings. Massage is useful, but needs more rigorous research prior to being advocated for community-level interventions.

Medical devices and diagnostics for cardiovascular diseases in low-resource settings.

PubMed

McGuire, Helen; Weigl, Bernhard H

2014-11-01

Noncommunicable diseases (NCDs), including cardiovascular diseases and diabetes, have emerged as an underappreciated health threat with enormous economic and public health implications for populations in low-resource settings. In order to address these diseases, devices that are to be used in low-resource settings have to conform to requirements that are generally more challenging than those developed for traditional markets. Characteristics and issues that must be considered when working in low- and middle-income countries (LMICs) include challenging environmental conditions, a complex supply chain, sometimes inadequate operator training, and cost. Somewhat counterintuitively, devices for low-resource setting (LRS) markets need to be of at least as high quality and reliability as those for developed countries to be setting-appropriate and achieve impact. Finally, the devices need to be designed and tested for the populations in which they are to be used in order to achieve the performance that is needed. In this review, we focus on technologies for primary and secondary health-care settings and group them according to the continuum of care from prevention to treatment.

A roadmap for development of sustainable E-waste management system in India.

PubMed

Wath, Sushant B; Vaidya, Atul N; Dutt, P S; Chakrabarti, Tapan

2010-12-01

The problem of E-waste has forced Environmental agencies of many countries to innovate, develop and adopt environmentally sound options and strategies for E-waste management, with a view to mitigate and control the ever growing threat of E-waste to the environment and human health. E-waste management is given the top priority in many developed countries, but in rapid developing countries like India, it is difficult to completely adopt or replicate the E-waste management system in developed countries due to many country specific issues viz. socio-economic conditions, lack of infrastructure, absence of appropriate legislations for E-waste, approach and commitments of the concerned, etc. This paper presents a review and assessment of the E-waste management system of developed as well as developing countries with a special emphasis on Switzerland, which is the first country in the world to have established and implemented a formal E-waste management system and has recycled 11kg/capita of WEEE against the target of 4kg/capita set by EU. And based on the discussions of various approaches, laws, legislations, practices of different countries, a road map for the development of sustainable and effective E-waste management system in India for ensuring environment, as well as, occupational safety and health, is proposed. Copyright © 2010 Elsevier B.V. All rights reserved.

Accreditation of undergraduate medical training programs: practices in nine developing countries as compared with the United States.

PubMed

Cueto, Jose; Burch, Vanessa C; Adnan, Nor Azila Mohd; Afolabi, Bosede B; Ismail, Zalina; Jafri, Wasim; Olapade-Olaopa, E Oluwabunmi; Otieno-Nyunya, Boaz; Supe, Avinash; Togoo, Altantsetseg; Vargas, Ana Lia; Wasserman, Elizabeth; Morahan, Page S; Burdick, William; Gary, Nancy

2006-07-01

Undergraduate medical training program accreditation is practiced in many countries, but information from developing countries is sparse. We compared medical training program accreditation systems in nine developing countries, and compared these with accreditation practices in the United States of America (USA). Medical program accreditation practices in nine developing countries were systematically analyzed using all available published documents. Findings were compared to USA accreditation practices. Accreditation systems with explicitly defined criteria, standards and procedures exist in all nine countries studied: Argentina, India, Kenya, Malaysia, Mongolia, Nigeria, Pakistan, Philippines and South Africa. Introduction of accreditation processes is relatively recent, starting in 1957 in India to 2001 in Malaysia. Accrediting agencies were set up in these countries predominantly by their respective governments as a result of legislation and acts of Parliament, involving Ministries of Education and Health. As in the USA, accreditation: (1) serves as a quality assurance mechanism promoting professional and public confidence in the quality of medical education, (2) assists medical schools in attaining desired standards, and (3) ensures that graduates' performance complies with national norms. All nine countries follow similar accreditation procedures. Where mandatory accreditation is practiced, non-compliant institutions may be placed on probation, student enrollment suspended or accreditation withdrawn. Accreditation systems in several developing countries are similar to those in the developed world. Data suggest the trend towards instituting quality assurance mechanisms in medical education is spreading to some developing countries, although generalization to other areas of the world is difficult to ascertain.

Comparison and cost analysis of drinking water quality monitoring requirements versus practice in seven developing countries.

PubMed

Crocker, Jonny; Bartram, Jamie

2014-07-18

Drinking water quality monitoring programs aim to support provision of safe drinking water by informing water quality management. Little evidence or guidance exists on best monitoring practices for low resource settings. Lack of financial, human, and technological resources reduce a country's ability to monitor water supply. Monitoring activities were characterized in Cambodia, Colombia, India (three states), Jordan, Peru, South Africa, and Uganda according to water sector responsibilities, monitoring approaches, and marginal cost. The seven study countries were selected to represent a range of low resource settings. The focus was on monitoring of microbiological parameters, such as E. coli, coliforms, and H2S-producing microorganisms. Data collection involved qualitative and quantitative methods. Across seven study countries, few distinct approaches to monitoring were observed, and in all but one country all monitoring relied on fixed laboratories for sample analysis. Compliance with monitoring requirements was highest for operational monitoring of large water supplies in urban areas. Sample transport and labor for sample collection and analysis together constitute approximately 75% of marginal costs, which exclude capital costs. There is potential for substantive optimization of monitoring programs by considering field-based testing and by fundamentally reconsidering monitoring approaches for non-piped supplies. This is the first study to look quantitatively at water quality monitoring practices in multiple developing countries.

Sustainable development and public health: rating European countries.

PubMed

Seke, Kristina; Petrovic, Natasa; Jeremic, Veljko; Vukmirovic, Jovanka; Kilibarda, Biljana; Martic, Milan

2013-01-28

Sustainable development and public health quite strongly correlate, being connected and conditioned by one another. This paper therein attempts to offer a representation of Europe's current situation of sustainable development in the area of public health. A dataset on sustainable development in the area of public health consisting of 31 European countries (formally proposed by the European Union Commission and EUROSTAT) has been used in this paper in order to evaluate said issue for the countries listed thereof. A statistical method which synthesizes several indicators into one quantitative indicator has also been utilized. Furthermore, the applied method offers the possibility to obtain an optimal set of variables for future studies of the problem, as well as for the possible development of indicators. According to the results obtained, Norway and Iceland are the two foremost European countries regarding sustainable development in the area of public health, whereas Romania, Lithuania, and Latvia, some of the European Union's newest Member States, rank lowest. The results also demonstrate that the most significant variables (more than 80%) in rating countries are found to be "healthy life years at birth, females" (r2 = 0.880), "healthy life years at birth, males" (r2 = 0.864), "death rate due to chronic diseases, males" (r2 = 0.850), and "healthy life years, 65, females" (r2 = 0.844). Based on the results of this paper, public health represents a precondition for sustainable development, which should be continuously invested in and improved.After the assessment of the dataset, proposed by EUROSTAT in order to evaluate progress towards the agreed goals of the EU Sustainable Development Strategy (SDS), this paper offers an improved set of variables, which it is hoped, may initiate further studies concerning this problem.

Bayesian networks modelling in support to cross-cutting analysis of water supply and sanitation in developing countries

NASA Astrophysics Data System (ADS)

Dondeynaz, C.; López Puga, J.; Carmona Moreno, C.

2013-09-01

Despite the efforts made towards the Millennium Development Goals targets during the last decade, improved access to water supply or basic sanitation still remains unavailable for millions of people across the world. This paper proposes a set of models that use 25 key variables and country profiles from the WatSan4Dev data set involving water supply and sanitation (Dondeynaz et al., 2012). This paper suggests the use of Bayesian network modelling methods because they are more easily adapted to deal with non-normal distributions, and integrate a qualitative approach for data analysis. They also offer the advantage of integrating preliminary knowledge into the probabilistic models. The statistical performance of the proposed models ranges between 20 and 5% error rates, which are very satisfactory taking into account the strong heterogeneity of variables. Probabilistic scenarios run from the models allow an assessment of the relationships between human development, external support, governance aspects, economic activities and water supply and sanitation (WSS) access. According to models proposed in this paper, gaining a strong poverty reduction will require the WSS access to reach 75-76% through: (1) the management of ongoing urbanisation processes to avoid slums development; and (2) the improvement of health care, for instance for children. Improving governance, such as institutional efficiency, capacities to make and apply rules, or control of corruption is positively associated with WSS sustainable development. The first condition for an increment of the HDP (human development and poverty) remains of course an improvement of the economic conditions with higher household incomes. Moreover, a significant country commitment to the environment, associated with civil society freedom of expression constitutes a favourable setting for sustainable WSS services delivery. Intensive agriculture using irrigation practises also appears as a mean for sustainable WSS thanks to multi-uses and complementarities. With a WSS sector organised at national level, irrigation practices can support the structuring and efficiency of the agriculture sector. It may then induce rural development in areas where WSS access often is set back compared to urban areas1. External financial support, called Official Development Assistance (ODA CI), plays a role in WSS improvement but comes last in the sensitivity analyses of models. An overall 47% of the Official Development Assistance goes first to poor countries, and is associated to governance aspects: (1) political stability and (2) country commitment to the environment and civil society degree of freedom. These governance aspects constitute a good framework for aid implementation in recipient countries. Modelling is run with the five groups of countries as defined in Dondeynaz et al. (2012). Models for profile 4 (essential external support) and profile 5 (primary material consumption) are specifically detailed and analysed in this paper. For countries in profile 4, fighting against water scarcity and progressing desertification should be the priority. However, for countries in profile 5, efforts should first concentrate on consolidation of political stability while supporting diversification of the economic activities. Nevertheless, for both profiles, reduction of poverty should remain the first priority as previously indicated. 1 JMP statistics, 2004 http://www.wssinfo.org/data-estimates/table/, last access: 22 July 2013.

Can Student Populations in Developing Countries Be Reached by Online Surveys? The Case of the National Service Scheme Survey (N3S) in Ghana

ERIC Educational Resources Information Center

Langer, Arnim; Meuleman, Bart; Oshodi, Abdul-Gafar Tobi; Schroyens, Maarten

2017-01-01

This article tackles the question whether it is a viable strategy to conduct online surveys among university students in developing countries. By documenting the methodology of the National Service Scheme Survey conducted in Ghana, we set out to answer three questions: (1) How can a sample of university students be obtained? (2) How can students…

Examining Social and Economic Impacts of Educational Investment and Participation in Developing Countries: The Educational Impacts Model (EIM) Approach. BRIDGES Research Report Series No. 12.

ERIC Educational Resources Information Center

Crouch, Luis A.; And Others

From 1960 to 1980, school enrollment and educational expenditures in developing countries experienced significant expansion. By the late 1980s, however, this trend had slowed. This report examines the impact of education upon welfare and productivity. A unified global data set is used to address the question from a macroeconomic, gender-specific,…

And young child feeding practices in different country settings.

PubMed

Sanghvi, Tina; Jimerson, Ann; Hajeebhoy, Nemat; Zewale, Medhanit; Nguyen, Giang Huong

2013-09-01

Alive & Thrive aims to increase exclusive breastfeeding and complementary feeding practices in Bangladesh, Ethiopia, and Vietnam. To develop and execute comprehensive communication strategies adapted to each context. We documented how three countries followed an established iterative planning process, with research steps followed by key decisions, to develop a communication strategy in each country. Secondary analysis and formative research identified the priority practices to focus on, and locally specific constraints to proper infant and young child feeding (IYCF). Communication strategies were then developed based on the social, cultural, economic, epidemiological, media use, and programmatic contexts of each country. There were widespread gaps between recommended and actual feeding practices, and these varied by country. Gaps were identified in household, community, and institutional levels of awareness and skills. Strategies were designed that would enable mothers in each specific setting to adopt practices. To improve priority behaviors, messaging and media strategies addressed the most salient behavioral determinants through face-to-face communication, social mobilization, and mass media. Trials of improved practices (TIPs), concept testing, and pretesting of materials proved useful to verify the relevance and likely effectiveness of communication messages and materials tailored for different audiences in each setting. Coordination and collaboration with multiple stakeholders from the start was important to harmonize messages and approaches, expand geographic coverage to national scale, and sustain the interventions. Our experience with designing large-scale communication strategies for behavior change confirms that systematic analysis and local planning cannot be omitted from the critical process of strategic design tailored to each context. Multiple communication channels matched to media habits in each setting can reach a substantial proportion of mothers and others who influence their IYCF practices. Preliminary data suggest that exposure to mass media plays a critical role in rapidly reaching mothers, household members, community influentials, and health workers on a large scale. Combining face-to-face interventions for mothers with social mobilization and mass media was effective in improving IYCF practices.

The Risk Implications of Globalisation: An Exploratory Analysis of 105 Major Industrial Incidents (1971-2010).

PubMed

Beck, Matthias

2016-03-10

This paper revisits work on the socio-political amplification of risk, which predicts that those living in developing countries are exposed to greater risk than residents of developed nations. This prediction contrasts with the neoliberal expectation that market driven improvements in working conditions within industrialising/developing nations will lead to global convergence of hazard exposure levels. It also contradicts the assumption of risk society theorists that there will be an ubiquitous increase in risk exposure across the globe, which will primarily affect technically more advanced countries. Reviewing qualitative evidence on the impact of structural adjustment reforms in industrialising countries, the export of waste and hazardous waste recycling to these countries and new patterns of domestic industrialisation, the paper suggests that workers in industrialising countries continue to face far greater levels of hazard exposure than those of developed countries. This view is confirmed when a data set including 105 major multi-fatality industrial disasters from 1971 to 2000 is examined. The paper concludes that there is empirical support for the predictions of socio-political amplification of risk theory, which finds clear expression in the data in a consistent pattern of significantly greater fatality rates per industrial incident in industrialising/developing countries.

Environmentally Sound Alternatives: Setting the Context.

ERIC Educational Resources Information Center

Chaudhary, Anil K.

1989-01-01

As former colonies struggle with economic development, consumerism competes with environmental awareness and concern. Developing countries should reject the models of the colonial past and create developmental strategies that preserve natural resources. (SK)

Application of ICT in strengthening health information systems in developing countries in the wake of globalisation.

PubMed

Simba, Daudi O; Mwangu, Mughwira

2004-12-01

Information Communication Technology (ICT) revolution brought opportunities and challenges to developing countries in their efforts to strengthen the Health Management Information Systems (HMIS). In the wake of globalisation, developing countries have no choice but to take advantage of the opportunities and face the challenges. The last decades saw developing countries taking action to strengthen and modernise their HMIS using the existing ICT. Due to poor economic and communication infrastructure, the process has been limited to national and provincial/region levels leaving behind majority of health workers living in remote/rural areas. Even those with access do not get maximum benefit from ICT advancements due to inadequacies in data quality and lack of data utilisation. Therefore, developing countries need to make deliberate efforts to address constraints threatening to increase technology gap between urban minority and rural majority by setting up favourable policies and appropriate strategies. Concurrently, strategies to improve data quality and utilisation should be instituted to ensure that HMIS has positive impact on people's health. Potential strength from private sector and opportunities for sharing experiences among developing countries should be utilised. Short of this, advancement in ICT will continue to marginalise health workers in developing countries especially those living in remote areas.

Strengthening expertise for health technology assessment and priority-setting in Africa

PubMed Central

Doherty, Jane E; Wilkinson, Thomas; Edoka, Ijeoma; Hofman, Karen

2017-01-01

ABSTRACT Background: Achieving sustainable universal health coverage depends partly on fair priority-setting processes that ensure countries spend scarce resources wisely. While general health economics capacity-strengthening initiatives exist in Africa, less attention has been paid to developing the capacity of individuals, institutions and networks to apply economic evaluation in support of health technology assessment and effective priority-setting. Objective: On the basis of international  lessons, to identify how research organisations and partnerships could contribute to capacity strengthening for health technology assessment and priority-setting in Africa. Methods: A rapid scan was conducted of international formal and grey literature and lessons extracted from the deliberations of two international and regional workshops relating to capacity-building for health technology assessment. ‘Capacity’ was defined in broad terms, including a conducive political environment, strong public institutional capacity to drive priority-setting, effective networking between experts, strong research organisations and skilled researchers. Results: Effective priority-setting requires more than high quality economic research. Researchers have to engage with an array of stakeholders, network closely other research organisations, build partnerships with different levels of government and train the future generation of researchers and policy-makers. In low- and middle-income countries where there are seldom government units or agencies dedicated to health technology assessment, they also have to support the development of an effective priority-setting process that is sensitive to societal and government needs and priorities. Conclusions: Research organisations have an important role to play in contributing to the development of health technology assessment and priority-setting capacity. In Africa, where there are resource and capacity challenges, effective partnerships between local and international researchers, and with key government stakeholders, can leverage existing skills and knowledge to generate a critical mass of individuals and institutions. These would help to meet the priority-setting needs of African countries and contribute to sustainable universal health coverage. PMID:29035166

Biosecurity measures for backyard poultry in developing countries: a systematic review

PubMed Central

2012-01-01

Background Poultry represents an important sector in animal production, with backyard flocks representing a huge majority, especially in the developing countries. In these countries, villagers raise poultry to meet household food demands and as additional sources of incomes. Backyard production methods imply low biosecurity measures and high risk of infectious diseases, such as Newcastle disease or zoonosis such as Highly Pathogenic Avian Influenza (HPAI). We reviewed literature on biosecurity practices for prevention of infectious diseases, and published recommendations for backyard poultry and assessed evidence of their impact and feasibility, particularly in developing countries. Documents were sourced from the Food and Agriculture Organization (FAO) website, and from Pubmed and Google databases. Results A total of 62 peer-reviewed and non-referred documents were found, most of which were published recently (after 2004) and focused on HPAI/H5N1-related biosecurity measures (64%). Recommendations addressed measures for flock management, feed and water management, poultry trade and stock change, poultry health management and the risk to humans. Only one general guideline was found for backyard poultry-related biosecurity; the other documents were drawn up for specific developing settings and only engaged their authors (e.g. consultants). These national guidelines written by consultants generated recommendations regarding measures derived from the highest standards of commercial poultry production. Although biosecurity principles of isolation and containment are described in most documents, only a few documents were found on the impact of measures in family poultry settings and none gave any evidence of their feasibility and effectiveness for backyard poultry. Conclusions Given the persistent threat posed by HPAI/H5N1 to humans in developing countries, our findings highlight the importance of encouraging applied research toward identifying sustained and adapted biosecurity measures for smallholder poultry flocks in low-income countries. PMID:23216706

A Core Outcome Set for Evaluation of Interventions to Prevent Preterm Birth.

PubMed

van ʼt Hooft, Janneke; Duffy, James M N; Daly, Mandy; Williamson, Paula R; Meher, Shireen; Thom, Elizabeth; Saade, George R; Alfirevic, Zarko; Mol, Ben Willem J; Khan, Khalid S

2016-01-01

To develop a consensus on a set of key clinical outcomes for the evaluation of preventive interventions for preterm birth in asymptomatic pregnant women. A two-stage web-based Delphi survey and a face-to-face meeting of key stakeholders were used to develop a consensus on a set of critical and important outcomes. We approached five stakeholder groups (parents, midwives, obstetricians, neonatologists, and researchers) from middle- and high-income countries. Outcomes subjected to the Delphi survey were identified by systematic literature review and stakeholder input. Survey participants scored each outcome on a 9-point Likert scale anchored between 1 (limited importance) and 9 (critical importance). They had the opportunity to reflect on total and stakeholder subgroup feedback between survey stages. For consensus, defined a priori, outcomes required at least 70% of participants of each stakeholder group to score them as "critical" and less than 15% as "limited." A total of 228 participants from five stakeholder groups from three lower middle-income countries, seven upper middle-income countries, and 17 high-income countries were asked to score 31 outcomes. Of these participants, 195 completed the first survey and 174 the second. Consensus was reached on 13 core outcomes: four were related to pregnant women: maternal mortality, maternal infection or inflammation, prelabor rupture of membranes, and harm to mother from intervention. Nine were related to offspring: gestational age at birth, offspring mortality, birth weight, early neurodevelopmental morbidity, late neurodevelopmental morbidity, gastrointestinal morbidity, infection, respiratory morbidity, and harm to offspring from intervention. This core outcome set for studies that evaluate prevention of preterm birth developed with an international multidisciplinary perspective will ensure that data from trials that assess prevention of preterm birth can be compared and combined. COMET Initiative, http://www.comet-initiative.org/studies/details/603, REGISTRATION NUMBER: 603.

Protecting HIV information in countries scaling up HIV services: a baseline study.

PubMed

Beck, Eduard J; Mandalia, Sundhiya; Harling, Guy; Santas, Xenophon M; Mosure, Debra; Delay, Paul R

2011-02-06

Individual-level data are needed to optimize clinical care and monitor and evaluate HIV services. Confidentiality and security of such data must be safeguarded to avoid stigmatization and discrimination of people living with HIV. We set out to assess the extent that countries scaling up HIV services have developed and implemented guidelines to protect the confidentiality and security of HIV information. Questionnaires were sent to UNAIDS field staff in 98 middle- and lower-income countries, some reportedly with guidelines (G-countries) and others intending to develop them (NG-countries). Responses were scored, aggregated and weighted to produce standard scores for six categories: information governance, country policies, data collection, data storage, data transfer and data access. Responses were analyzed using regression analyses for associations with national HIV prevalence, gross national income per capita, OECD income, receiving US PEPFAR funding, and being a G- or NG-country. Differences between G- and NG-countries were investigated using non-parametric methods. Higher information governance scores were observed for G-countries compared with NG-countries; no differences were observed between country policies or data collection categories. However, for data storage, data transfer and data access, G-countries had lower scores compared with NG-countries. No significant associations were observed between country score and HIV prevalence, per capita gross national income, OECD economic category, and whether countries had received PEPFAR funding. Few countries, including G-countries, had developed comprehensive guidelines on protecting the confidentiality and security of HIV information. Countries must develop their own guidelines, using established frameworks to guide their efforts, and may require assistance in adapting, adopting and implementing them.

Factor Configurations with Governance as Conditions for Low HIV/AIDS Prevalence in HIV/AIDS Recipient Countries: Fuzzy-set Analysis

PubMed Central

Lee, Hwa-Young; Kang, Minah

2015-01-01

This paper aims to investigate whether good governance of a recipient country is a necessary condition and what combinations of factors including governance factor are sufficient for low prevalence of HIV/AIDS in HIV/AIDS aid recipient countries during the period of 2002-2010. For this, Fuzzy-set Qualitative Comparative Analysis (QCA) was used. Nine potential attributes for a causal configuration for low HIV/AIDS prevalence were identified through a review of previous studies. For each factor, full membership, full non-membership, and crossover point were specified using both author's knowledge and statistical information of the variables. Calibration and conversion to a fuzzy-set score were conducted using Fs/QCA 2.0 and probabilistic tests for necessary and sufficiency were performed by STATA 11. The result suggested that governance is the necessary condition for low prevalence of HIV/AIDS in a recipient country. From sufficiency test, two pathways were resulted. The low level of governance can lead to low level of HIV/AIDS prevalence when it is combined with other favorable factors, especially, low economic inequality, high economic development and high health expenditure. However, strengthening governance is a more practical measure to keep low prevalence of HIV/AIDS because it is hard to achieve both economic development and economic quality. This study highlights that a comprehensive policy measure is the key for achieving low prevalence of HIV/AIDS in recipient country. PMID:26617451

Factor Configurations with Governance as Conditions for Low HIV/AIDS Prevalence in HIV/AIDS Recipient Countries: Fuzzy-set Analysis.

PubMed

Lee, Hwa-Young; Yang, Bong-Min; Kang, Minah

2015-11-01

This paper aims to investigate whether good governance of a recipient country is a necessary condition and what combinations of factors including governance factor are sufficient for low prevalence of HIV/AIDS in HIV/AIDS aid recipient countries during the period of 2002-2010. For this, Fuzzy-set Qualitative Comparative Analysis (QCA) was used. Nine potential attributes for a causal configuration for low HIV/AIDS prevalence were identified through a review of previous studies. For each factor, full membership, full non-membership, and crossover point were specified using both author's knowledge and statistical information of the variables. Calibration and conversion to a fuzzy-set score were conducted using Fs/QCA 2.0 and probabilistic tests for necessary and sufficiency were performed by STATA 11. The result suggested that governance is the necessary condition for low prevalence of HIV/AIDS in a recipient country. From sufficiency test, two pathways were resulted. The low level of governance can lead to low level of HIV/AIDS prevalence when it is combined with other favorable factors, especially, low economic inequality, high economic development and high health expenditure. However, strengthening governance is a more practical measure to keep low prevalence of HIV/AIDS because it is hard to achieve both economic development and economic quality. This study highlights that a comprehensive policy measure is the key for achieving low prevalence of HIV/AIDS in recipient country.

International standards for programmes of training in intensive care medicine in Europe.

PubMed

2011-03-01

To develop internationally harmonised standards for programmes of training in intensive care medicine (ICM). Standards were developed by using consensus techniques. A nine-member nominal group of European intensive care experts developed a preliminary set of standards. These were revised and refined through a modified Delphi process involving 28 European national coordinators representing national training organisations using a combination of moderated discussion meetings, email, and a Web-based tool for determining the level of agreement with each proposed standard, and whether the standard could be achieved in the respondent's country. The nominal group developed an initial set of 52 possible standards which underwent four iterations to achieve maximal consensus. All national coordinators approved a final set of 29 standards in four domains: training centres, training programmes, selection of trainees, and trainers' profiles. Only three standards were considered immediately achievable by all countries, demonstrating a willingness to aspire to quality rather than merely setting a minimum level. Nine proposed standards which did not achieve full consensus were identified as potential candidates for future review. This preliminary set of clearly defined and agreed standards provides a transparent framework for assuring the quality of training programmes, and a foundation for international harmonisation and quality improvement of training in ICM.

Ethical and practical challenges surrounding genetic and genomic research in developing countries.

PubMed

Nyika, Aceme

2009-11-01

The nature of some potential benefits and risks associated with genetic research is different from the types of potential benefits and risks associated with other types of health research such as clinical trials and biomedical research involving humans. Whereas most potential risks associated with biomedical research or clinical trials are mainly biological in nature, potential risks associated with genetic research are mainly of socioeconomic nature. Although the peculiarity of some of the aspects of genetic research and the complexity of the science involved are acknowledged, the extent to which these characteristics hinder firstly disclosure of information to participants and their communities and secondly comprehension of the disclosed information is a practical challenge that tends to be exaggerated in some cases. In this article, a brief overview of the various types of genetic research will be given in order to set the scene for some ethical and practical issues surrounding the research in developing countries that will be discussed subsequently. Case studies that illustrate some of the ethical and practical issues flagged will be given, followed by suggestions on possible ways of tackling some of the challenges in developing country settings. Nevertheless, genetic and genomic research could go a long way in providing knowledge that could be useful in the development of drugs and vaccines for many diseases affecting the developing countries.

Lighting up the World The first global application of the open source, spatial electrification toolkit (ONSSET)

NASA Astrophysics Data System (ADS)

Mentis, Dimitrios; Howells, Mark; Rogner, Holger; Korkovelos, Alexandros; Siyal, Shahid; Broad, Oliver; Zepeda, Eduardo; Bazilian, Morgan

2016-04-01

In September 2015, the international community has adopted a new set of targets, following and expanding on the millennium development goals (MDGs), the Sustainable Development Goals (SDGs). Ensuring access to affordable, reliable, sustainable and modern energy for all is one of the 17 set goals that each country should work towards realizing. According to the latest Global Tracking Framework, 15% of the global population live without access to electricity. The majority of those (87%) reside in rural areas. Countries can reach universal access through various electrification options, depending on different levels of energy intensity and local characteristics of the studied areas, such as renewable resources availability, spatially differentiated costs of diesel-fuelled electricity generation, distance from power network and major cities, population density and others, data which are usually inadequate in national databases. This general paucity of reliable energy-related information in developing countries calls for the utilization of geospatial data. This paper presents a Geographic Information Systems (GIS) based electrification analysis for all countries that have not yet reached full access to electricity (Sub-Saharan Africa, Developing Asia, Latin America and Middle East). The cost optimal mix of electrification options ranges from grid extensions to mini-grid and stand-alone applications and is identified for all relevant countries. It is illustrated how this mix is influenced by scrolling through various electrification levels and different oil prices. Such an analysis helps direct donors and investors and inform multinational actions with regards to investments related to energy access.

Recommendations for routine reporting on indications for cesarean delivery in developing countries.

PubMed

Stanton, Cynthia; Ronsmans, Carine

2008-09-01

Cesarean delivery rates are increasing rapidly in many developing countries, particularly among wealthy women. Poor women have lower rates, often so low that they do not reach the minimum rate of 1 percent. Little data are available on clinical indications for cesarean section, information that could assist in understanding why cesarean delivery rates have changed. This paper presents recommendations for routine reporting on indications for cesarean delivery in developing countries. These recommendations resulted from an international consultation of researchers held in February 2006 to promote the collection of comparable data to understand change in, or composition of, the cesarean delivery rate in developing countries. Data are presented from selected countries, categorizing cesareans by three classification systems. A single classification system was recommended for use in both high and low cesarean delivery rate settings, given that underuse and overuse of cesarean section are evident within many populations. The group recommended a hierarchical categorization, prioritizing cesareans performed for absolute maternal indications. Categorization among the remaining nonabsolute indications is based on the primary indication for the procedure and include maternal and fetal indications and psychosocial indications, required for high cesarean delivery rate settings. Data on indications for cesarean sections are available everywhere the procedure is performed. All that is required is compilation and review at facility and at higher levels. Advocacy within ministries of health and medical professional organizations is required to advance these recommendations since researchers have inadequately communicated the health effects of both underuse and overuse of cesarean delivery.

Challenges of Ophthalmic Care in the Developing World

PubMed Central

Sommer, Alfred; Taylor, Hugh R.; Ravilla, Thulasiraj D.; West, Sheila; Lietman, Thomas M.; Keenan, Jeremy D.; Chiang, Michael F.; Robin, Alan L.; Mills, Richard P.

2014-01-01

Global blindness exacts an enormous financial and social cost on developing countries. Reducing the prevalence of blindness globally requires a set of strategies that are different from those typically employed in developed countries. This was the subject of the 2013 Knapp symposium at the American Ophthalmological Society Annual Meeting, and this article summarizes the presentations of epidemiologists, health care planners, and ophthalmologists. It explores a range of successful strategies from the multinational Vision 2020 Initiative to disease-specific schemes in cataract, trachoma control, infectious corneal ulceration, cytomegalovirus retinitis, and retinopathy of prematurity. In each example, the importance of an attitudinal set towards the public health becomes clear. There is reason for optimism in the struggle against global blindness, in large measure because of innovative programs like those described here. PMID:24604415

Building an international network for a primary care research program: reflections on challenges and solutions in the set-up and delivery of a prospective observational study of acute cough in 13 European countries

PubMed Central

2011-01-01

Background Implementing a primary care clinical research study in several countries can make it possible to recruit sufficient patients in a short period of time that allows important clinical questions to be answered. Large multi-country studies in primary care are unusual and are typically associated with challenges requiring innovative solutions. We conducted a multi-country study and through this paper, we share reflections on the challenges we faced and some of the solutions we developed with a special focus on the study set up, structure and development of Primary Care Networks (PCNs). Method GRACE-01 was a multi-European country, investigator-driven prospective observational study implemented by 14 Primary Care Networks (PCNs) within 13 European Countries. General Practitioners (GPs) recruited consecutive patients with an acute cough. GPs completed a case report form (CRF) and the patient completed a daily symptom diary. After study completion, the coordinating team discussed the phases of the study and identified challenges and solutions that they considered might be interesting and helpful to researchers setting up a comparable study. Results The main challenges fell within three domains as follows: i) selecting, setting up and maintaining PCNs; ii) designing local context-appropriate data collection tools and efficient data management systems; and iii) gaining commitment and trust from all involved and maintaining enthusiasm. The main solutions for each domain were: i) appointing key individuals (National Network Facilitator and Coordinator) with clearly defined tasks, involving PCNs early in the development of study materials and procedures. ii) rigorous back translations of all study materials and the use of information systems to closely monitor each PCNs progress; iii) providing strong central leadership with high level commitment to the value of the study, frequent multi-method communication, establishing a coherent ethos, celebrating achievements, incorporating social events and prizes within meetings, and providing a framework for exploitation of local data. Conclusions Many challenges associated with multi-country primary care research can be overcome by engendering strong, effective communication, commitment and involvement of all local researchers. The practical solutions identified and the lessons learned in implementing the GRACE-01 study may assist in establishing other international primary care clinical research platforms. Trial registration ClinicalTrials.gov Identifier: NCT00353951 PMID:21794112

Status of vaccine research and development of vaccines for GBS.

PubMed

Heath, Paul T

2016-06-03

Streptococcus agalactiae (group B streptococcus (GBS)) is the leading cause of neonatal sepsis and meningitis in many countries. Intrapartum antibiotic strategies have reduced the incidence of early-onset neonatal GBS in a number of countries but have had no impact on late onset GBS infection (LOD). In low/middle income settings, the disease burden remains uncertain although in several countries of Southern Africa appears comparable to or higher than that of high-income countries. As disease may be rapidly fulminating cases can be missed before appropriate samples are obtained and this may lead to underestimation of the true burden. Given the rapid onset and progression within hours of birth as well as the deficiencies in IAP strategies and absence of a solution for preventing LOD, it is clear that administration of a suitable vaccine in pregnancy could provide a better solution in all settings; it should also be cost effective. The current leading vaccine candidates are CPS-protein conjugate vaccines but protein-based vaccines are also in development and one has recently commenced clinical trials. Copyright © 2016 World Health Organization. Published by Elsevier Ltd.. All rights reserved.

Telemedicine in neurosurgical emergency: Indian perspective

PubMed Central

Sinha, Virendra Deo; Tiwari, Rahul Nath; Kataria, Rashim

2012-01-01

Telemedicine is rapidly developing telecommunication technology to provide medical information and services. The importance of telemedicine for neurosurgical emergencies was established with the fact that majority of the neurosurgical specialists are practicing in urban settings and in most of the rural areas, neurosurgical care is far off or non-existing. Countries with inadequate health care must incorporate telemedicine in their health care system. Telemedicine offers real benefits in a country as vast as India, where the majority of the population lives in remote areas with no access to even the most basic healthcare. Issues pertaining security, privacy, maintaining standards, and legal aspects are relevant. A recommended set of standards and guidelines for telemedicine needs to be set in place and constantly refined to promote the integrated growth of telemedicine in the country. The paper discusses various issues, shortcomings, and utility of telemedicine in India. PMID:22870155

Determinants of Antibiotic Consumption - Development of a Model using Partial Least Squares Regression based on Data from India.

PubMed

Tamhankar, Ashok J; Karnik, Shreyasee S; Stålsby Lundborg, Cecilia

2018-04-23

Antibiotic resistance, a consequence of antibiotic use, is a threat to health, with severe consequences for resource constrained settings. If determinants for human antibiotic use in India, a lower middle income country, with one of the highest antibiotic consumption in the world could be understood, interventions could be developed, having implications for similar settings. Year wise data for India, for potential determinants and antibiotic consumption, was sourced from publicly available databases for the years 2000-2010. Data was analyzed using Partial Least Squares regression and correlation between determinants and antibiotic consumption was evaluated, formulating 'Predictors' and 'Prediction models'. The 'prediction model' with the statistically most significant predictors (root mean square errors of prediction for train set-377.0 and test set-297.0) formulated from a combination of Health infrastructure + Surface transport infrastructure (HISTI), predicted antibiotic consumption within 95% confidence interval and estimated an antibiotic consumption of 11.6 standard units/person (14.37 billion standard units totally; standard units = number of doses sold in the country; a dose being a pill, capsule, or ampoule) for India for 2014. The HISTI model may become useful in predicting antibiotic consumption for countries/regions having circumstances and data similar to India, but without resources to measure actual data of antibiotic consumption.

Evaluation of vaccines against enteric infections: a clinical and public health research agenda for developing countries

PubMed Central

Clemens, John

2011-01-01

Enteric infections are a major cause of morbidity and mortality in developing countries. To date, vaccines have played a limited role in public health efforts to control enteric infections. Licensed vaccines exist for cholera and typhoid, but these vaccines are used primarily for travellers; and there are two internationally licensed vaccines for rotavirus, but they are mainly used in affluent countries. The reasons that enteric vaccines are little used in developing countries are multiple, and certainly include financial and political constraints. Also important is the need for more cogent evidence on the performance of enteric vaccines in developing country populations. A partial inventory of research questions would include: (i) does the vaccine perform well in the most relevant settings? (ii) does the vaccine perform well in all epidemiologically relevant age groups? (iii) is there adequate evidence of vaccine safety once the vaccines have been deployed in developing countries? (iv) how effective is the vaccine when given in conjunction with non-vaccine cointerventions? (v) what is the level of vaccine protection against all relevant outcomes? and (vi) what is the expected population level of vaccine protection, including both direct and herd vaccine protective effects? Provision of evidence addressing these questions will help expand the use of enteric vaccines in developing countries. PMID:21893543

Development and validation of a socioculturally competent trust in physician scale for a developing country setting.

PubMed

Gopichandran, Vijayaprasad; Wouters, Edwin; Chetlapalli, Satish Kumar

2015-05-03

Trust in physicians is the unwritten covenant between the patient and the physician that the physician will do what is in the best interest of the patient. This forms the undercurrent of all healthcare relationships. Several scales exist for assessment of trust in physicians in developed healthcare settings, but to our knowledge none of these have been developed in a developing country context. To develop and validate a new trust in physician scale for a developing country setting. Dimensions of trust in physicians, which were identified in a previous qualitative study in the same setting, were used to develop a scale. This scale was administered among 616 adults selected from urban and rural areas of Tamil Nadu, south India, using a multistage sampling cross sectional survey method. The individual items were analysed using a classical test approach as well as item response theory. Cronbach's α was calculated and the item to total correlation of each item was assessed. After testing for unidimensionality and absence of local dependence, a 2 parameter logistic Semajima's graded response model was fit and item characteristics assessed. Competence, assurance of treatment, respect for the physician and loyalty to the physician were important dimensions of trust. A total of 31 items were developed using these dimensions. Of these, 22 were selected for final analysis. The Cronbach's α was 0.928. The item to total correlations were acceptable for all the 22 items. The item response analysis revealed good item characteristic curves and item information for all the items. Based on the item parameters and item information, a final 12 item scale was developed. The scale performs optimally in the low to moderate trust range. The final 12 item trust in physician scale has a good construct validity and internal consistency. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Development and validation of a socioculturally competent trust in physician scale for a developing country setting

PubMed Central

Gopichandran, Vijayaprasad; Wouters, Edwin; Chetlapalli, Satish Kumar

2015-01-01

Trust in physicians is the unwritten covenant between the patient and the physician that the physician will do what is in the best interest of the patient. This forms the undercurrent of all healthcare relationships. Several scales exist for assessment of trust in physicians in developed healthcare settings, but to our knowledge none of these have been developed in a developing country context. Objectives To develop and validate a new trust in physician scale for a developing country setting. Methods Dimensions of trust in physicians, which were identified in a previous qualitative study in the same setting, were used to develop a scale. This scale was administered among 616 adults selected from urban and rural areas of Tamil Nadu, south India, using a multistage sampling cross sectional survey method. The individual items were analysed using a classical test approach as well as item response theory. Cronbach's α was calculated and the item to total correlation of each item was assessed. After testing for unidimensionality and absence of local dependence, a 2 parameter logistic Semajima's graded response model was fit and item characteristics assessed. Results Competence, assurance of treatment, respect for the physician and loyalty to the physician were important dimensions of trust. A total of 31 items were developed using these dimensions. Of these, 22 were selected for final analysis. The Cronbach's α was 0.928. The item to total correlations were acceptable for all the 22 items. The item response analysis revealed good item characteristic curves and item information for all the items. Based on the item parameters and item information, a final 12 item scale was developed. The scale performs optimally in the low to moderate trust range. Conclusions The final 12 item trust in physician scale has a good construct validity and internal consistency. PMID:25941182

Trade, TRIPS, and pharmaceuticals.

PubMed

Smith, Richard D; Correa, Carlos; Oh, Cecilia

2009-02-21

The World Trade Organization's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) set global minimum standards for the protection of intellectual property, substantially increasing and expanding intellectual-property rights, and generated clear gains for the pharmaceutical industry and the developed world. The question of whether TRIPS generates gains for developing countries, in the form of increased exports, is addressed in this paper through consideration of the importance of pharmaceuticals in health-care trade, outlining the essential requirements, implications, and issues related to TRIPS, and TRIPS-plus, in which increased restrictions are imposed as part of bilateral free-trade agreements. TRIPS has not generated substantial gains for developing countries, but has further increased pharmaceutical trade in developed countries. The unequal trade between developed and developing countries (ie, exporting and importing high-value patented drugs, respectively) raises the issue of access to medicines, which is exacerbated by TRIPS-plus provisions, although many countries have not even enacted provision for TRIPS flexibilities. Therefore this paper focuses on options that are available to the health community for negotiation to their advantage under TRIPS, and within the presence of TRIPS-plus.

Understanding Democracy and Development Traps Using a Data-Driven Approach.

PubMed

Ranganathan, Shyam; Nicolis, Stamatios C; Spaiser, Viktoria; Sumpter, David J T

2015-03-01

Methods from machine learning and data science are becoming increasingly important in the social sciences, providing powerful new ways of identifying statistical relationships in large data sets. However, these relationships do not necessarily offer an understanding of the processes underlying the data. To address this problem, we have developed a method for fitting nonlinear dynamical systems models to data related to social change. Here, we use this method to investigate how countries become trapped at low levels of socioeconomic development. We identify two types of traps. The first is a democracy trap, where countries with low levels of economic growth and/or citizen education fail to develop democracy. The second trap is in terms of cultural values, where countries with low levels of democracy and/or life expectancy fail to develop emancipative values. We show that many key developing countries, including India and Egypt, lie near the border of these development traps, and we investigate the time taken for these nations to transition toward higher democracy and socioeconomic well-being.

Understanding Democracy and Development Traps Using a Data-Driven Approach

PubMed Central

Ranganathan, Shyam; Nicolis, Stamatios C.; Spaiser, Viktoria; Sumpter, David J.T.

2015-01-01

Abstract Methods from machine learning and data science are becoming increasingly important in the social sciences, providing powerful new ways of identifying statistical relationships in large data sets. However, these relationships do not necessarily offer an understanding of the processes underlying the data. To address this problem, we have developed a method for fitting nonlinear dynamical systems models to data related to social change. Here, we use this method to investigate how countries become trapped at low levels of socioeconomic development. We identify two types of traps. The first is a democracy trap, where countries with low levels of economic growth and/or citizen education fail to develop democracy. The second trap is in terms of cultural values, where countries with low levels of democracy and/or life expectancy fail to develop emancipative values. We show that many key developing countries, including India and Egypt, lie near the border of these development traps, and we investigate the time taken for these nations to transition toward higher democracy and socioeconomic well-being. PMID:26487983

Bridging Community Development and Environmental Education: Rural Water Conservation in Jordan

ERIC Educational Resources Information Center

Hansen, Lexine Tallis

2010-01-01

International community development is a fertile area of research for environmental education scholars and practitioners. Although the community development field is well established, there is relatively little focus on education and learning in community development literature, especially in developing country settings. Particularly,…

The Dynamics of Democracy, Development and Cultural Values

PubMed Central

Spaiser, Viktoria; Ranganathan, Shyam; Mann, Richard P.; Sumpter, David J. T.

2014-01-01

Over the past decades many countries have experienced rapid changes in their economies, their democratic institutions and the values of their citizens. Comprehensive data measuring these changes across very different countries has recently become openly available. Between country similarities suggest common underlying dynamics in how countries develop in terms of economy, democracy and cultural values. We apply a novel Bayesian dynamical systems approach to identify the model which best captures the complex, mainly non-linear dynamics that underlie these changes. We show that the level of Human Development Index (HDI) in a country drives first democracy and then higher emancipation of citizens. This change occurs once the countries pass a certain threshold in HDI. The data also suggests that there is a limit to the growth of wealth, set by higher emancipation. Having reached a high level of democracy and emancipation, societies tend towards equilibrium that does not support further economic growth. Our findings give strong empirical evidence against a popular political science theory, known as the Human Development Sequence. Contrary to this theory, we find that implementation of human-rights and democratisation precede increases in emancipative values. PMID:24905920

The dynamics of democracy, development and cultural values.

PubMed

Spaiser, Viktoria; Ranganathan, Shyam; Mann, Richard P; Sumpter, David J T

2014-01-01

Over the past decades many countries have experienced rapid changes in their economies, their democratic institutions and the values of their citizens. Comprehensive data measuring these changes across very different countries has recently become openly available. Between country similarities suggest common underlying dynamics in how countries develop in terms of economy, democracy and cultural values. We apply a novel Bayesian dynamical systems approach to identify the model which best captures the complex, mainly non-linear dynamics that underlie these changes. We show that the level of Human Development Index (HDI) in a country drives first democracy and then higher emancipation of citizens. This change occurs once the countries pass a certain threshold in HDI. The data also suggests that there is a limit to the growth of wealth, set by higher emancipation. Having reached a high level of democracy and emancipation, societies tend towards equilibrium that does not support further economic growth. Our findings give strong empirical evidence against a popular political science theory, known as the Human Development Sequence. Contrary to this theory, we find that implementation of human-rights and democratisation precede increases in emancipative values.

Infertility and the provision of infertility medical services in developing countries

PubMed Central

Ombelet, Willem; Cooke, Ian; Dyer, Silke; Serour, Gamal; Devroey, Paul

2008-01-01

BACKGROUND Worldwide more than 70 million couples suffer from infertility, the majority being residents of developing countries. Negative consequences of childlessness are experienced to a greater degree in developing countries when compared with Western societies. Bilateral tubal occlusion due to sexually transmitted diseases and pregnancy-related infections is the most common cause of infertility in developing countries, a condition that is potentially treatable with assisted reproductive technologies (ART). New reproductive technologies are either unavailable or very costly in developing countries. This review provides a comprehensive survey of all important papers on the issue of infertility in developing countries. METHODS Medline, PubMed, Excerpta Medica and EMBASE searches identified relevant papers published between 1978 and 2007 and the keywords used were the combinations of ‘affordable, assisted reproduction, ART, developing countries, health services, infertility, IVF, simplified methods, traditional health care'. RESULTS The exact prevalence of infertility in developing countries is unknown due to a lack of registration and well-performed studies. On the other hand, the implementation of appropriate infertility treatment is currently not a main goal for most international non-profit organizations. Keystones in the successful implementation of infertility care in low-resource settings include simplification of diagnostic and ART procedures, minimizing the complication rate of interventions, providing training-courses for health-care workers and incorporating infertility treatment into sexual and reproductive health-care programmes. CONCLUSIONS Although recognizing the importance of education and prevention, we believe that for the reasons of social justice, infertility treatment in developing countries requires greater attention at National and International levels. PMID:18820005

The use of chlorhexidine to reduce maternal and neonatal mortality and morbidity in low-resource settings

PubMed Central

McClure, Elizabeth M; Goldenberg, Robert L; Brandes, Neal; Darmstadt, Gary L; Wright, Linda L

2009-01-01

Of the 4 million neonatal deaths and 500,000 maternal deaths that occur annually worldwide, almost 99% are in developing countries and one-third are associated with infections. Implementation of proven interventions and targeted research on a select number of promising high-impact preventative and curative interventions are essential to achieve Millennium Development Goals for reduction of child and maternal mortality. Feasible, simple, low-cost interventions have the potential to significantly reduce the mortality and severe morbidity associated with infection in these settings. Studies of chlorhexidine in developing countries have focused on three primary uses: 1) intrapartum vaginal and neonatal wiping, 2) neonatal wiping alone, and 3) umbilical cord cleansing. A study of vaginal wiping and neonatal skin cleansing with chlorhexidine, conducted in Malawi in the 1990s suggested that chlorhexidine has potential to reduce neonatal infectious morbidity and mortality. A recent trial of cord cleansing conducted in Nepal also demonstrated benefit. Although studies have shown promise, widespread acceptance and implementation of chlorhexidine use has not yet occurred. This paper is derived in part from data presented at a conference on the use of chlorhexidine in developing countries and reviews the available evidence related to chlorhexidine use to reduce mortality and severe morbidity due to infections in mothers and neonates in low-resource settings. It also summarizes issues related to programmatic implementation. PMID:17399714

Estimates and implications of the costs of compliance with biosafety regulations in developing countries.

PubMed

Falck-Zepeda, Jose; Yorobe, Jose; Husin, Bahagiawati Amir; Manalo, Abraham; Lokollo, Erna; Ramon, Godfrey; Zambrano, Patricia; Sutrisno

2012-01-01

Estimating the cost of compliance with biosafety regulations is important as it helps developers focus their investments in producer development. We provide estimates for the cost of compliance for a set of technologies in Indonesia, the Philippines and other countries. These costs vary from US $100,000 to 1.7 million. These are estimates of regulatory costs and do not include product development or deployment costs. Cost estimates need to be compared with potential gains when the technology is introduced in these countries and the gains in knowledge accumulate during the biosafety assessment process. Although the cost of compliance is important, time delays and uncertainty are even more important and may have an adverse impact on innovations reaching farmers.

Global pharmaceutical regulation: the challenge of integration for developing states.

PubMed

Pezzola, Anthony; Sweet, Cassandra M

2016-12-20

This paper has set out to map the state of pharmaceutical regulation in the developing world through the construction of cross-national indices drawing from World Health Organization data. The last two decades have been characterized by deep changes for the pharmaceutical sector, including the complete transformation of intellectual property systems at the behest of the World Trade Organization and the consolidation of global active ingredient suppliers in China and India. Although the rules for ownership of medicine have been set and globally implemented, we know surprisingly little about how the standards for market entrance and regulation of pharmaceutical products have changed at the national level. How standardized are national pharmaceutical market systems? Do we find homogeneity or variation across the developing world? Are their patterns for understanding why some countries have moved closer to one global norm for pharmaceutical regulation and others have developed hybrid models for oversight of this sector? Access to medicine is a core tool in public health. This paper gauges the levels of standards in public and private generics markets for developing countries building on national-level pharmaceutical market surveys for 78 countries to offer three indicators of market oversight: State Regulatory Infrastructure, Monitoring the Private Market and Public Quality Control. Identifying the different variables that affect a state's institutional capacity and current standard level offers new insights to the state of pharmaceuticals in the developing world. It is notable that there are very few (none at the time of this paper) studies that map out the new global terrain for pharmaceutical regulation in the post-TRIPS context. This paper uses item response theory to develop original indicators of pharmaceutical regulation. We find remarkable resistance to the implementation of global pharmaceutical norms for quality standards in developing states and in regulatory infrastructure. Human capacity across many developing countries remains limited. Most notably, variation among states is stark. Countries that have been leaders in establishing global norms do not appear to have influenced their neighbors in establishing regional patterns. Finally, in contrast to traditional theories of international norms diffusion, global standard-setters such as the United States or European Union appear to have surprisingly little influence on standard setting across our survey. Our research has implications for the framing of technical support on public health initiatives aimed at strengthening local public institutions in medicine and offers a new methodological approach for analyzing drug regulation systems in developing countries.

Developing integrated patient pathways using hybrid simulation

NASA Astrophysics Data System (ADS)

Zulkepli, Jafri; Eldabi, Tillal

2016-10-01

Integrated patient pathways includes several departments, i.e. healthcare which includes emergency care and inpatient ward; intermediate care which patient(s) will stay for a maximum of two weeks and at the same time be assessed by assessment team to find the most suitable care; and social care. The reason behind introducing the intermediate care in western countries was to reduce the rate of patients that stays in the hospital especially for elderly patients. This type of care setting has been considered to be set up in some other countries including Malaysia. Therefore, to assess the advantages of introducing this type of integrated healthcare setting, we suggest develop the model using simulation technique. We argue that single simulation technique is not viable enough to represent this type of patient pathways. Therefore, we suggest develop this model using hybrid techniques, i.e. System Dynamics (SD) and Discrete Event Simulation (DES). Based on hybrid model result, we argued that the result is viable to be as references for decision making process.

Monitoring drinking water, sanitation, and hygiene in non-household settings: Priorities for policy and practice.

PubMed

Cronk, Ryan; Slaymaker, Tom; Bartram, Jamie

2015-11-01

Inadequate drinking water, sanitation, and hygiene (WaSH) in non-household settings, such as schools, health care facilities, and workplaces impacts the health, education, welfare, and productivity of populations, particularly in low and middle-income countries. There is limited knowledge on the status of WaSH in such settings. To address this gap, we reviewed international standards, international and national actors, and monitoring initiatives; developed the first typology of non-household settings; and assessed the viability of monitoring. Based on setting characteristics, non-household settings include six types: schools, health care facilities, workplaces, temporary use settings, mass gatherings, and dislocated populations. To-date national governments and international actors have focused monitoring of non-household settings on schools and health care facilities with comparatively little attention given to other settings such as workplaces and markets. Nationally representative facility surveys and national management information systems are the primary monitoring mechanisms. Data suggest that WaSH coverage is generally poor and often lower than in corresponding household settings. Definitions, indicators, and data sources are underdeveloped and not always comparable between countries. While not all countries monitor non-household settings, examples are available from countries on most continents suggesting that systematic monitoring is achievable. Monitoring WaSH in schools and health care facilities is most viable. Monitoring WaSH in other non-household settings would be viable with: technical support from local and national actors in addition to international organizations such as WHO and UNICEF; national prioritization through policy and financing; and including WaSH indicators into monitoring initiatives to improve cost-effectiveness. International consultations on targets and indicators for global monitoring of WaSH post-2015 identified non-household settings as a priority. National and international monitoring systems will be important to better understand status, trends, to identify priorities and target resources accordingly, and to improve accountability for progressive improvements in WaSH in non-household settings. Copyright © 2015 Elsevier GmbH. All rights reserved.

Breast health in developing countries.

PubMed

Yip, C H; Taib, N A

2014-12-01

Breast cancer is one of the leading cancers world-wide. While the incidence in developing countries is lower than in developed countries, the mortality is much higher. Of the estimated 1 600 000 new cases of breast cancer globally in 2012, 794 000 were in the more developed world compared to 883 000 in the less developed world; however, there were 198 000 deaths in the more developed world compared to 324 000 in the less developed world (data from Globocan 2012, IARC). Survival from breast cancer depends on two main factors--early detection and optimal treatment. In developing countries, women present with late stages of disease. The barriers to early detection are physical, such as geographical isolation, financial as well as psychosocial, including lack of education, belief in traditional medicine and lack of autonomous decision-making in the male-dominated societies that prevail in the developing world. There are virtually no population-based breast cancer screening programs in developing countries. However, before any screening program can be implemented, there must be facilities to treat the cancers that are detected. Inadequate access to optimal treatment of breast cancer remains a problem. Lack of specialist manpower, facilities and anticancer drugs contribute to the suboptimal care that a woman with breast cancer in a low-income country receives. International groups such as the Breast Health Global Initiative were set up to develop economically feasible, clinical practice guidelines for breast cancer management to improve breast health outcomes in countries with limited resources.

Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

PubMed Central

Strother, R. Matthew; Ndiangui, Francis; Chumba, David; Jacobson, William; Dodson, Cecelia; Resnic, Murray B.; Strate, Randall W.; Smith, James W.

2016-01-01

Background Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service. Objectives, methods and outcomes Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to a resource-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme. Conclusion Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment. PMID:28879100

The Social Development Summit and the developing countries.

PubMed

Barnabas, A P; Kulkarni, P D; Nanavatty, M C; Singh, R R

1996-01-01

This article discusses some concerns of the 1996 UN Summit on Social Development. Conference organizers identified the three key conference issues as poverty alleviation, social integration of the marginalized and disadvantaged, and expansion of productive employment. The goal of a "society for all" means dealing with the increasing differences between rich and poor countries, the survival of weaker economies in a competitive market system, wide variations in consumption patterns between countries, attainment of political stability while respecting ethnic identity, the rise in social problems among countries with a high human development index, and increasing joblessness. The Human Development Report for 1994 emphasizes human security. Social development is not the equivalent of human resource development nor a side issue of economic growth. The integration of ethnic groups poses social and political problems. There remains a question about what political system and culture would be best for social integration. Developed countries define poverty as the inability of people and government to provide resources and necessary services for people's productive activity. Poverty in developing countries is blamed on colonialism. Globally, developed countries control 71% of world trade. Sharing resources to meet basic needs throughout the world is not an operational ideal. The highest 20% of income earners receive 83% of the world income. The culture of poverty is the strategy used by the poor to survive. Welfare is not an end in itself but does enable the poor to improve their conditions. Development that focuses on productive employment is uncertain. Developed and developing countries do not share similar perceptions of human rights. There is a question as to who should set the priorities for social development. Sustainable social development is related to preservation of natural resources, control of population growth, and promotion of social security.

Estimating least-developed countries' vulnerability to climate-related extreme events over the next 50 years.

PubMed

Patt, Anthony G; Tadross, Mark; Nussbaumer, Patrick; Asante, Kwabena; Metzger, Marc; Rafael, Jose; Goujon, Anne; Brundrit, Geoff

2010-01-26

When will least developed countries be most vulnerable to climate change, given the influence of projected socio-economic development? The question is important, not least because current levels of international assistance to support adaptation lag more than an order of magnitude below what analysts estimate to be needed, and scaling up support could take many years. In this paper, we examine this question using an empirically derived model of human losses to climate-related extreme events, as an indicator of vulnerability and the need for adaptation assistance. We develop a set of 50-year scenarios for these losses in one country, Mozambique, using high-resolution climate projections, and then extend the results to a sample of 23 least-developed countries. Our approach takes into account both potential changes in countries' exposure to climatic extreme events, and socio-economic development trends that influence countries' own adaptive capacities. Our results suggest that the effects of socio-economic development trends may begin to offset rising climate exposure in the second quarter of the century, and that it is in the period between now and then that vulnerability will rise most quickly. This implies an urgency to the need for international assistance to finance adaptation.

Sustaining the stride of health agenda beyond 2015 in post mdgs scenario: a projected roadmap for the developing countries.

PubMed

Shaikh, Babar Tasneem

2014-01-01

As the world is reaching toward 2015, the echoes of MDGs are becoming louder. Results with regard to achievements of the targets set globally, show mixed results. Very understandably, the developing countries will miss most of the targets by far, and the attributed reasons are obvious. Dearth of resources-financial and human, evidence for decision making, infrastructure, meaningful collaboration with developed countries, and overall governance of the health sector are some of the pitfalls on 2000-2015 screen. Nonetheless, international commitments are sending positive vibes and message that glass is half full. Countries must keep the pace and sustain the stride of MDGs agenda, with an appraised roadmap, of course. Poverty, natural and man-made disasters, and slow socio-economic development, and some incongruous technologies are the challenges en route. A holistic approach is the need of the time, and therefore this paper presents a strategic framework drawn from the WHO's proposed health systems building blocks, which might, help the developing countries and fragile health systems to turn around the state of affairs.

How much incident lung cancer was missed globally in 2012? An ecological country-level study.

PubMed

Sartorius, Benn; Sartorius, Kurt

2016-05-31

Lung cancer incidence is increasing in many low-to-middle-income countries and is significantly under-reported in Africa, which could potentially mislead policy makers when prioritising disease burden. We employed an ecological correlation study design using countrylevel lung cancer incidence data and associated determinant data. Lagged prevalence of smoking and other exposure data were used to account for exposure-disease latency. A multivariable Poisson model was employed to estimate missed lung cancer in countries lacking incidence data. Projections were further refined to remove potential deaths from infectious/external competing causes. Global lung cancer incidence was much lower among females vs males (13.6 vs 34.2 per 100,000). Distinct spatial heterogeneity was observed for incident lung cancer and appeared concentrated in contiguous regions. Our model predicted a revised global lung cancer incidence in 2012 of 23.6 compared to the Globocan 2012 estimate of 23.1, amounting to ~38,101 missed cases (95% confidence interval: 28,489-47,713). The largest relative under-estimation was predicted for Africa, Central America and the Indian Ocean regions (Comoros, Madagascar, Mauritius, Mayotte, Reunion, Seychelles). Our results suggest substantial underreporting of lung cancer incidence, specifically in developing countries (e.g. Africa). The missed cost of treating these cases could amount to >US$ 130 million based on recent developing setting costs for treating earlier stage lung cancer. The full cost is not only under-estimated, but also requires substantial additional social/family inputs as evidenced in more developed settings like the European Union. This represents a major public health problem in developing settings (e.g. Africa) with limited healthcare resources.

Measuring the quality of child health care at first-level facilities.

PubMed

Gouws, Eleanor; Bryce, Jennifer; Pariyo, George; Armstrong Schellenberg, Joanna; Amaral, João; Habicht, Jean-Pierre

2005-08-01

Sound policy and program decisions require timely information based on valid and relevant measures. Recent findings suggest that despite the availability of effective and affordable guidelines for the management of sick children in first-level health facilities in developing countries, the quality and coverage of these services remains low. We report on the development and evaluation of a set of summary indices reflecting the quality of care received by sick children in first-level facilities. The indices were first developed through a consultative process to achieve face validity by involving technical experts and policymakers. The definition of evaluation measures for many public health programs stops at this point. We added a second phase in which standard statistical techniques were used to evaluate the content and construct validity of the indices and their reliability, drawing on data sets from the multi-country evaluation of integrated management of childhood illness (MCE) in Brazil, Tanzania and Uganda. The statistical evaluation identified important conceptual errors in the indices arising from the theory-driven expert review. The experts had combined items into inappropriate indicators resulting in summary indices that were difficult to interpret and had limited validity for program decision making. We propose a revised set of summary indices for the measurement of child health care in developing countries that is supported by both expert and statistical reviews and that led to similar programmatic insights across the three countries. We advocate increased cross-disciplinary research within public health to improve measurement approaches. Child survival policymakers, program planners and implementers can use these tools to improve their monitoring and so increase the health impact of investments in health facility care.

The Risk Implications of Globalisation: An Exploratory Analysis of 105 Major Industrial Incidents (1971–2010)

PubMed Central

Beck, Matthias

2016-01-01

This paper revisits work on the socio-political amplification of risk, which predicts that those living in developing countries are exposed to greater risk than residents of developed nations. This prediction contrasts with the neoliberal expectation that market driven improvements in working conditions within industrialising/developing nations will lead to global convergence of hazard exposure levels. It also contradicts the assumption of risk society theorists that there will be an ubiquitous increase in risk exposure across the globe, which will primarily affect technically more advanced countries. Reviewing qualitative evidence on the impact of structural adjustment reforms in industrialising countries, the export of waste and hazardous waste recycling to these countries and new patterns of domestic industrialisation, the paper suggests that workers in industrialising countries continue to face far greater levels of hazard exposure than those of developed countries. This view is confirmed when a data set including 105 major multi-fatality industrial disasters from 1971 to 2000 is examined. The paper concludes that there is empirical support for the predictions of socio-political amplification of risk theory, which finds clear expression in the data in a consistent pattern of significantly greater fatality rates per industrial incident in industrialising/developing countries. PMID:26978378

Results for Learning Report 2012: Fostering Evidence-Based Dialogue to Monitor Access and Quality in Education

ERIC Educational Resources Information Center

Cortese, Lauren; Crouch, Luis; Pinto, Nancy; Salgado, Vania; Schmidt, Caroline; Soman, Kouassi; Thiam, Mamadou; Chaluda, Ania; Omoeva, Carina

2012-01-01

The Global Partnership for Education (GPE) works with low-income countries around the world to help them provide basic education of good quality to all of their children. Countries develop education sector plans that set clear targets and commitments; their partners including donors, multilateral agencies, civil society and the private sector…

Changing Rules: A Review of Tempus Support to University Governance. A Tempus Study. Issue 01

ERIC Educational Resources Information Center

Reilly, John; Jongsma, Ard

2010-01-01

The Tempus Programme, which funds cooperation in higher education between universities in EU Member States and a defined set of partner countries outside the European Union, is excellently positioned to support explorations into higher education governance in countries that want to draw on the developing EU experience in this field. Governance is…

Comparative Indicators of Education in the United States and Other G-8 Countries: 2002.

ERIC Educational Resources Information Center

Sherman, Joel D.; Honegger, Steven D.; McGivern, Jennifer L.

This report presents a set of education indicators that describes how the United States education system compares with those of the other G-8 countries: Canada, France, Germany, Italy, Japan, the Russian Federation, and the United Kingdom. The data were collected from three main sources: the Organisation for Economic Cooperation and Development's…

Global health and local poverty: rich countries' responses to vulnerable populations.

PubMed

Simms, Chris D; Persaud, D David

2009-01-01

Poverty is an important determinant of ill health, mortality and suffering across the globe. This commentary asks what we can learn about poverty by looking at the way rich countries respond to the needs of vulnerable populations both within their own societies and those of low-income countries. Taking advantage of recent efforts to redefine child poverty in a way that is consistent with the World Health Organization's Commission on Social Determinants of Health, three sets of data are reviewed: levels of child well-being within 23 Organization of Economic Community Development countries; the amount of official development assistance these countries disburse to poor countries; and, government social transfers targeted at families as a percentage of GDP. Analysis shows that countries in Northern Europe tend to have lower levels of child poverty, and are the most generous with social transfers and providing development assistance to poor countries; in contrast, the non-European countries like Australia, Canada, Japan, and the United States, and generally, the G7 countries, are the least generous towards the vulnerable at home and abroad and tend to have the highest levels of child poverty. The findings suggest that nations' responses tend to be ideologically based rather than evidence or needs based and that poverty is neither inevitable nor intractable.

A technology selection framework for supporting delivery of patient-oriented health interventions in developing countries

PubMed Central

Chan, Connie V.; Kaufman, David R.

2009-01-01

Health information technologies (HIT) have great potential to advance health care globally. In particular, HIT can provide innovative approaches and methodologies to overcome the range of access and resource barriers specific to developing countries. However, there is a paucity of models and empirical evidence informing the technology selection process in these settings. We propose a framework for selecting patient-oriented technologies in developing countries. The selection guidance process is structured by a set of filters that impose particular constraints and serve to narrow the space of possible decisions. The framework consists of three levels of factors: 1) situational factors, 2) the technology and its relationship with health interventions and with target patients, and 3) empirical evidence. We demonstrate the utility of the framework in the context of mobile phones for behavioral health interventions to reduce risk factors for cardiovascular disease. This framework can be applied to health interventions across health domains to explore how and whether available technologies can support delivery of the associated types of interventions and with the target populations. PMID:19796709

Utilization and Monetization of Healthcare Data in Developing Countries.

PubMed

Bram, Joshua T; Warwick-Clark, Boyd; Obeysekare, Eric; Mehta, Khanjan

2015-06-01

In developing countries with fledgling healthcare systems, the efficient deployment of scarce resources is paramount. Comprehensive community health data and machine learning techniques can optimize the allocation of resources to areas, epidemics, or populations most in need of medical aid or services. However, reliable data collection in low-resource settings is challenging due to a wide range of contextual, business-related, communication, and technological factors. Community health workers (CHWs) are trusted community members who deliver basic health education and services to their friends and neighbors. While an increasing number of programs leverage CHWs for last mile data collection, a fundamental challenge to such programs is the lack of tangible incentives for the CHWs. This article describes potential applications of health data in developing countries and reviews the challenges to reliable data collection. Four practical CHW-centric business models that provide incentive and accountability structures to facilitate data collection are presented. Creating and strengthening the data collection infrastructure is a prerequisite for big data scientists, machine learning experts, and public health administrators to ultimately elevate and transform healthcare systems in resource-poor settings.

Utilization and Monetization of Healthcare Data in Developing Countries

PubMed Central

Bram, Joshua T.; Warwick-Clark, Boyd; Obeysekare, Eric; Mehta, Khanjan

2015-01-01

Abstract In developing countries with fledgling healthcare systems, the efficient deployment of scarce resources is paramount. Comprehensive community health data and machine learning techniques can optimize the allocation of resources to areas, epidemics, or populations most in need of medical aid or services. However, reliable data collection in low-resource settings is challenging due to a wide range of contextual, business-related, communication, and technological factors. Community health workers (CHWs) are trusted community members who deliver basic health education and services to their friends and neighbors. While an increasing number of programs leverage CHWs for last mile data collection, a fundamental challenge to such programs is the lack of tangible incentives for the CHWs. This article describes potential applications of health data in developing countries and reviews the challenges to reliable data collection. Four practical CHW-centric business models that provide incentive and accountability structures to facilitate data collection are presented. Creating and strengthening the data collection infrastructure is a prerequisite for big data scientists, machine learning experts, and public health administrators to ultimately elevate and transform healthcare systems in resource-poor settings. PMID:26487984

Sources of Free and Open Source Spatial Data for Natural Disasters and Principles for Use in Developing Country Contexts

NASA Astrophysics Data System (ADS)

Taylor, Faith E.; Malamud, Bruce D.; Millington, James D. A.

2016-04-01

Access to reliable spatial and quantitative datasets (e.g., infrastructure maps, historical observations, environmental variables) at regional and site specific scales can be a limiting factor for understanding hazards and risks in developing country settings. Here we present a 'living database' of >75 freely available data sources relevant to hazard and risk in Africa (and more globally). Data sources include national scientific foundations, non-governmental bodies, crowd-sourced efforts, academic projects, special interest groups and others. The database is available at http://tinyurl.com/africa-datasets and is continually being updated, particularly in the context of broader natural hazards research we are doing in the context of Malawi and Kenya. For each data source, we review the spatiotemporal resolution and extent and make our own assessments of reliability and usability of datasets. Although such freely available datasets are sometimes presented as a panacea to improving our understanding of hazards and risk in developing countries, there are both pitfalls and opportunities unique to using this type of freely available data. These include factors such as resolution, homogeneity, uncertainty, access to metadata and training for usage. Based on our experience, use in the field and grey/peer-review literature, we present a suggested set of guidelines for using these free and open source data in developing country contexts.

The effect of illicit financial flows on time to reach the fourth Millennium Development Goal in Sub-Saharan Africa: a quantitative analysis.

PubMed

O'Hare, Bernadette; Makuta, Innocent; Bar-Zeev, Naor; Chiwaula, Levison; Cobham, Alex

2014-04-01

This paper sets out to estimate the cost of illicit financial flows (IFF) in terms of the amount of time it could take to reach the fourth Millennium Development Goal (MDG) in 34 African countries. We have calculated the percentage increase in gross domestic product (GDP) if IFFs were curtailed using IFF/GDP ratios. We applied the income (GDP) elasticity of child mortality to the increase in GDP to estimate the reduction in time to reach the fourth MDG in 34 African countries. children aged under five years. 34 countries in SSA. Reduction in time to reach the first indicator of the fourth MDG, under-five mortality rate in the absence of IFF. We found that in the 34 SSA countries, six countries will achieve their fourth MDG target at the current rates of decline. In the absence of IFF, 16 countries would reach their fourth MDG target by 2015 and there would be large reductions for all other countries. This drain on development is facilitated by financial secrecy in other jurisdictions. Rich and poor countries alike must stem the haemorrhage of IFF by taking decisive steps towards improving financial transparency.

The influence of television on cultural values -- with special reference to Third World countries.

PubMed

Goonasekera, A

1987-01-01

In focusing on the influence of television on cultural values, particularly in third world countries, the discussion covers the impact of the technology of communication on cultural values, the impact of existing, that is traditional, cultural values on television, and the impact of television programs on cultural values. It is not a problem to set up a television transmitting station in any third world country; the hardware is manufactured in developed countries and assembled in a third world country by technicians of the television manufacturing company. The key question is whether the third world country that has acquired this modern piece of technology can put it into operation run it. The operation of a modern television station calls for 3 types of professionals: engineers and technicians, television journalists and producers, and managers and administrators. Consequently, if the host country is to benefit from this transfer of technology it needs to have a community of modern professionals. Also, for a culture to successfully utilize television, it is helpful if the other media of communication are developed. In sum, at the time of the introduction of television in third world countries, such countries should possess an advanced sector of education and mass media which could form the basis for initiating the multiplier effect for which television has the potential. When introducing television to a third world country, one further needs to be aware of the impact that traditional values may have on the utilization of this medium. It can work to entrench traditional inequities in social relationships in the name of cultural uniqueness, and from the perspective of disadvantaged minority groups it could be a form of "cultural imperialism." Thus, when introducing television, the governments of these countries need to consider fostering a set of values and norms that could assist in the modernization of these countries. These should be values that promote human social development, rather than paternalistic traditional values which work to keep the uniqueness of cultural groups. The import and dissemination of television programs from foreign countries emerges as the most visible form of cultural domination. The reason for the overdependence on imported programs are the high cost of local productions, the lack of trained staff, and the lack of will and determination on the part of the management of governments of third world countries. Successful cultural assimilation of television in third world countries depends on the cultural values that it helps to develop and foster in society.

Tropical countries may be willing to pay more to protect their forests

PubMed Central

Vincent, Jeffrey R.; Carson, Richard T.; DeShazo, J. R.; Schwabe, Kurt A.; Ahmad, Ismariah; Chong, Siew Kook; Chang, Yii Tan; Potts, Matthew D.

2014-01-01

Inadequate funding from developed countries has hampered international efforts to conserve biodiversity in tropical forests. We present two complementary research approaches that reveal a significant increase in public demand for conservation within tropical developing countries as those countries reach upper-middle-income (UMI) status. We highlight UMI tropical countries because they contain nearly four-fifths of tropical primary forests, which are rich in biodiversity and stored carbon. The first approach is a set of statistical analyses of various cross-country conservation indicators, which suggests that protective government policies have lagged behind the increase in public demand in these countries. The second approach is a case study from Malaysia, which reveals in a more integrated fashion the linkages from rising household income to increased household willingness to pay for conservation, nongovernmental organization activity, and delayed government action. Our findings suggest that domestic funding in UMI tropical countries can play a larger role in (i) closing the funding gap for tropical forest conservation, and (ii) paying for supplementary conservation actions linked to international payments for reduced greenhouse gas emissions from deforestation and forest degradation in tropical countries. PMID:24982171

International validation of quality indicators for evaluating priority setting in low income countries: process and key lessons.

PubMed

Kapiriri, Lydia

2017-06-19

While there have been efforts to develop frameworks to guide healthcare priority setting; there has been limited focus on evaluation frameworks. Moreover, while the few frameworks identify quality indicators for successful priority setting, they do not provide the users with strategies to verify these indicators. Kapiriri and Martin (Health Care Anal 18:129-147, 2010) developed a framework for evaluating priority setting in low and middle income countries. This framework provides BOTH parameters for successful priority setting and proposes means of their verification. Before its use in real life contexts, this paper presents results from a validation process of the framework. The framework validation involved 53 policy makers and priority setting researchers at the global, national and sub-national levels (in Uganda). They were requested to indicate the relative importance of the proposed parameters as well as the feasibility of obtaining the related information. We also pilot tested the proposed means of verification. Almost all the respondents evaluated all the parameters, including the contextual factors, as 'very important'. However, some respondents at the global level thought 'presence of incentives to comply', 'reduced disagreements', 'increased public understanding,' 'improved institutional accountability' and 'meeting the ministry of health objectives', which could be a reflection of their levels of decision making. All the proposed means of verification were assessed as feasible with the exception of meeting observations which would require an insider. These findings results were consistent with those obtained from the pilot testing. These findings are relevant to policy makers and researchers involved in priority setting in low and middle income countries. To the best of our knowledge, this is one of the few initiatives that has involved potential users of a framework (at the global and in a Low Income Country) in its validation. The favorable validation of all the parameters at the national and sub-national levels implies that the framework has potential usefulness at those levels, as is. The parameters that were disputed at the global level necessitate further discussion when using the framework at that level. The next step is to use the validated framework in evaluating actual priority setting at the different levels.

Local perceptions on factors influencing the introduction of international healthcare accreditation in Pakistan.

PubMed

Sax, Sylvia; Marx, Michael

2014-12-01

One contributor to poor health outcomes in developing countries is weak health systems; key to strengthening them are interventions to improve quality of health services. Though the value of healthcare accreditation is increasingly recognized, there are few case studies exploring its adaptation in developing countries. The aim of our study in Pakistan was to identify perceived factors influencing the adaptation of international healthcare accreditation within a developing country context. We used qualitative methods including semi-structured interviews, a structured group discussion, focus groups and non-participant observation of management meetings. Data analysis used a grounded theory approach and a conceptual framework adapted from implementation science. Using our conceptual framework categories of 'inner' and 'outer' setting, we found six perceived inner health system factors that could influence the introduction of healthcare accreditation and two 'outer' setting factors, perceived as external to the health system but able to influence its introduction. Our research identified that there is no 'one size fits all' approach to introducing healthcare accreditation as a means to improve healthcare quality. Those planning to support healthcare accreditation, such as national and provincial ministries and international development partners, need to understand how the three components of healthcare accreditation fit into the local health system and into the broader political and social environment. In our setting this included moving to supportive and transparent external evaluation mechanisms, with a first step of using locally developed and agreed standards. In addition, sustainable implementation of the three components was seen as a major challenge, especially establishment of a well-managed, transparent accreditation agency able to lead processes such as training and support for peer surveyors. Consideration of local change mechanisms and cultural practices is important in designing a local accreditation approach. The results of our study are important for health systems strengthening in Pakistan and in other developing countries. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Data set for reporting of ovary, fallopian tube and primary peritoneal carcinoma: recommendations from the International Collaboration on Cancer Reporting (ICCR).

PubMed

McCluggage, W Glenn; Judge, Meagan J; Clarke, Blaise A; Davidson, Ben; Gilks, C Blake; Hollema, Harry; Ledermann, Jonathan A; Matias-Guiu, Xavier; Mikami, Yoshiki; Stewart, Colin J R; Vang, Russell; Hirschowitz, Lynn

2015-08-01

A comprehensive pathological report is essential for optimal patient management, cancer staging and prognostication. In many countries, proforma reports are used but these vary in their content. The International Collaboration on Cancer Reporting (ICCR) is an alliance formed by the Royal College of Pathologists of Australasia, the Royal College of Pathologists of the United Kingdom, the College of American Pathologists, the Canadian Partnership Against Cancer and the European Society of Pathology, with the aim of developing an evidence-based reporting data set for each cancer site. This will reduce the global burden of cancer data set development and reduplication of effort by different international institutions that commission, publish and maintain standardised cancer reporting data sets. The resultant standardisation of cancer reporting will benefit not only those countries directly involved in the collaboration but also others not in a position to develop their own data sets. We describe the development of a cancer data set by the ICCR expert panel for the reporting of primary ovarian, fallopian tube and peritoneal carcinoma and present the 'required' and 'recommended' elements to be included in the report with an explanatory commentary. This data set encompasses the recent International Federation of Obstetricians and Gynaecologists staging system for these neoplasms and the updated World Health Organisation Classification of Tumours of the Female Reproductive Organs. The data set also addresses issues about site assignment of the primary tumour in high-grade serous carcinomas and proposes a scoring system for the assessment of tumour response to neoadjuvant chemotherapy. The widespread implementation of this data set will facilitate consistent and accurate data collection, comparison of epidemiological and pathological parameters between different populations, facilitate research and hopefully will result in improved patient management.

Data Set for the Reporting of Carcinomas of the Cervix: Recommendations From the International Collaboration on Cancer Reporting (ICCR).

PubMed

McCluggage, W Glenn; Judge, Meagan J; Alvarado-Cabrero, Isabel; Duggan, Máire A; Horn, Lars-Christian; Hui, Pei; Ordi, Jaume; Otis, Christopher N; Park, Kay J; Plante, Marie; Stewart, Colin J R; Wiredu, Edwin K; Rous, Brian; Hirschowitz, Lynn

2018-05-01

A comprehensive pathologic report is essential for optimal patient management, cancer staging and prognostication. In many countries, proforma reports are used but the content of these is variable. The International Collaboration on Cancer Reporting is an alliance formed by the Royal Colleges of Pathologists of Australasia and the United Kingdom, the College of American Pathologists, the Canadian Partnership Against Cancer and the European Society of Pathology, for the purpose of developing standardized, evidence-based reporting data sets for each cancer site. This will reduce the global burden of cancer data set development and reduplication of effort by different international institutions that commission, publish and maintain standardized cancer-reporting data sets. The resultant standardization of cancer-reporting benefits not only those countries directly involved in the collaboration but also others not in a position to develop their own data sets. We describe the development of an evidence-based cancer data set by the International Collaboration on Cancer Reporting expert panel for the reporting of primary cervical carcinomas and present the "required" and "recommended" elements to be included in the pathology report as well as an explanatory commentary. This data set encompasses the International Federation of Obstetricians and Gynaecologists and Union for International Cancer Control staging systems for cervical neoplasms and the updated World Health Organization classification of gynecologic tumors. The data set also addresses controversial issues such as tumor grading and measurement, including measurement of multifocal carcinomas. The widespread implementation of this data set will facilitate consistent and accurate data collection, comparison of epidemiological and pathologic parameters between different populations, facilitate research, and hopefully result in improved patient management.

Caring for patients with rabies in developing countries - the neglected importance of palliative care.

PubMed

Tarantola, Arnaud; Crabol, Yoann; Mahendra, Bangalore Jayakrishnappa; In, Sotheary; Barennes, Hubert; Bourhy, Hervé; Peng, Yiksing; Ly, Sowath; Buchy, Philippe

2016-04-01

Although limited publications address clinical management of symptomatic patients with rabies in intensive care units, the overwhelming majority of human rabies cases occur in the rural setting of developing countries where healthcare workers are few, lack training and drugs. Based on our experience, we suggest how clinicians in resource-limited settings can make best use of essential drugs to provide assistance to patients with rabies and their families, at no risk to themselves. Comprehensive and compassionate patient management of furious rabies should aim to alleviate thirst, anxiety and epileptic fits using infusions, diazepam or midazolam and antipyretic drugs via intravenous or intrarectal routes. Although the patient is dying, respiratory failure must be avoided especially if the family, after being informed, wish to take the patient home alive for funereal rites to be observed. Healthcare staff should be trained and clinical guidelines should be updated to include palliative care for rabies in endemic countries. © 2016 John Wiley & Sons Ltd.

Tackling NCD in LMIC: Achievements and Lessons Learned From the NHLBI-UnitedHealth Global Health Centers of Excellence Program.

PubMed

Engelgau, Michael M; Sampson, Uchechukwu K; Rabadan-Diehl, Cristina; Smith, Richard; Miranda, Jaime; Bloomfield, Gerald S; Belis, Deshiree; Narayan, K M Venkat

2016-03-01

Effectively tackling the growing noncommunicable disease (NCD) burden in low- and middle-income countries (LMIC) is a major challenge. To address research needs in this setting for NCDs, in 2009, National Heart, Lung, and Blood Institute (NHLBI) and UnitedHealth Group (UHG) engaged in a public-private partnership that supported a network of 11 LMIC-based research centers and created the NHLBI-UnitedHealth Global Health Centers of Excellence (COE) Program. The Program's overall goal was to contribute to reducing the cardiovascular and lung disease burdens by catalyzing in-country research institutions to develop a global network of biomedical research centers. Key elements of the Program included team science and collaborative approaches, developing research and training platforms for future investigators, and creating a data commons. This Program embraced a strategic approach for tackling NCDs in LMICs and will provide capacity for locally driven research efforts that can identify and address priority health issues in specific countries' settings. Published by Elsevier B.V.

How Other Countries Use Deprivation Indices-And Why The United States Desperately Needs One.

PubMed

Phillips, Robert L; Liaw, Winston; Crampton, Peter; Exeter, Daniel J; Bazemore, Andrew; Vickery, Katherine Diaz; Petterson, Stephen; Carrozza, Mark

2016-11-01

Integrating public health and medicine to address social determinants of health is essential to achieving the Triple Aim of lower costs, improved care, and population health. There is intense interest in the United States in using social determinants of health to direct clinical and community health interventions, and to adjust quality measures and payments. The United Kingdom and New Zealand use data representing aspects of material and social deprivation from their censuses or from administrative data sets to construct indices designed to measure socioeconomic variation across communities, assess community needs, inform research, adjust clinical funding, allocate community resources, and determine policy impact. Indices provide these countries with comparable data and serve as a universal language and tool set to define organizing principles for population health. In this article we examine how these countries develop, validate, and operationalize their indices; explore their use in policy; and propose the development of a similar deprivation index for the United States. Project HOPE—The People-to-People Health Foundation, Inc.

Flood damage curves for consistent global risk assessments

NASA Astrophysics Data System (ADS)

de Moel, Hans; Huizinga, Jan; Szewczyk, Wojtek

2016-04-01

Assessing potential damage of flood events is an important component in flood risk management. Determining direct flood damage is commonly done using depth-damage curves, which denote the flood damage that would occur at specific water depths per asset or land-use class. Many countries around the world have developed flood damage models using such curves which are based on analysis of past flood events and/or on expert judgement. However, such damage curves are not available for all regions, which hampers damage assessments in those regions. Moreover, due to different methodologies employed for various damage models in different countries, damage assessments cannot be directly compared with each other, obstructing also supra-national flood damage assessments. To address these problems, a globally consistent dataset of depth-damage curves has been developed. This dataset contains damage curves depicting percent of damage as a function of water depth as well as maximum damage values for a variety of assets and land use classes (i.e. residential, commercial, agriculture). Based on an extensive literature survey concave damage curves have been developed for each continent, while differentiation in flood damage between countries is established by determining maximum damage values at the country scale. These maximum damage values are based on construction cost surveys from multinational construction companies, which provide a coherent set of detailed building cost data across dozens of countries. A consistent set of maximum flood damage values for all countries was computed using statistical regressions with socio-economic World Development Indicators from the World Bank. Further, based on insights from the literature survey, guidance is also given on how the damage curves and maximum damage values can be adjusted for specific local circumstances, such as urban vs. rural locations, use of specific building material, etc. This dataset can be used for consistent supra-national scale flood damage assessments, and guide assessment in countries where no damage model is currently available.

The unfunded priorities: an evaluation of priority setting for noncommunicable disease control in Uganda.

PubMed

Essue, Beverley M; Kapiriri, Lydia

2018-02-20

The double burden of infectious diseases coupled with noncommunicable diseases poses unique challenges for priority setting and for achieving equitable action to address the major causes of disease burden in health systems already impacted by limited resources. Noncommunicable disease control is an important global health and development priority. However, there are challenges for translating this global priority into local priorities and action. The aim of this study was to evaluate the influence of national, sub-national and global factors on priority setting for noncommunicable disease control in Uganda and examine the extent to which priority setting was successful. A mixed methods design that used the Kapiriri & Martin framework for evaluating priority setting in low income countries. The evaluation period was 2005-2015. Data collection included a document review (policy documents (n = 19); meeting minutes (n = 28)), media analysis (n = 114) and stakeholder interviews (n = 9). Data were analysed according to the Kapiriri & Martin (2010) framework. Priority setting for noncommunicable diseases was not entirely fair nor successful. While there were explicit processes that incorporated relevant criteria, evidence and wide stakeholder involvement, these criteria were not used systematically or consistently in the contemplation of noncommunicable diseases. There were insufficient resources for noncommunicable diseases, despite being a priority area. There were weaknesses in the priority setting institutions, and insufficient mechanisms to ensure accountability for decision-making. Priority setting was influenced by the priorities of major stakeholders (i.e. development assistance partners) which were not always aligned with national priorities. There were major delays in the implementation of noncommunicable disease-related priorities and in many cases, a failure to implement. This evaluation revealed the challenges that low income countries are grappling with in prioritizing noncommunicable diseases in the context of a double disease burden with limited resources. Strengthening local capacity for priority setting would help to support the development of sustainable and implementable noncommunicable disease-related priorities. Global support (i.e. aid) to low income countries for noncommunicable diseases must also catch up to align with NCDs as a global health priority.

Can cognitive dissonance methods developed in the West for combatting the 'thin ideal' help slow the rapidly increasing prevalence of eating disorders in non-Western cultures?

PubMed

Witcomb, Gemma L; Arcelus, Jon; Chen, Jue

2013-12-01

Eating disorders are common, life-threatening conditions in Western countries, but until relatively recently they were regarded as uncommon in non-Western cultures. However, the prevalence of eating disorders in many of the more affluent non-Western countries is rising rapidly as community members, particularly young women, internalize the 'thin ideal' that has been widely promoted by the international media. This review discusses the factors involved in the development of eating disorders in non-Western settings with a particular emphasis on the influences of urbanization, modernization, Westernization, and the resulting changes in women's roles. The cognitive dissonance programs developed in Western countries that have proven successful in countering the negative effects of the thin idea are described and their potential application to East Asia and other non-Western countries are discussed.

Can cognitive dissonance methods developed in the West for combatting the ‘thin ideal’ help slow the rapidly increasing prevalence of eating disorders in non-Western cultures?

PubMed Central

Witcomb, Gemma L.; Arcelus, Jon; Chen, Jue

2013-01-01

Summary Eating disorders are common, life-threatening conditions in Western countries, but until relatively recently they were regarded as uncommon in non-Western cultures. However, the prevalence of eating disorders in many of the more affluent non-Western countries is rising rapidly as community members, particularly young women, internalize the ‘thin ideal’ that has been widely promoted by the international media. This review discusses the factors involved in the development of eating disorders in non-Western settings with a particular emphasis on the influences of urbanization, modernization, Westernization, and the resulting changes in women's roles. The cognitive dissonance programs developed in Western countries that have proven successful in countering the negative effects of the thin idea are described and their potential application to East Asia and other non-Western countries are discussed. PMID:24991176

A Comprehensive Review of the Status of Early Childhood Development in the Middle East and North Africa.

ERIC Educational Resources Information Center

Khattab, Mohammad Salih

This report reviews the status of early childhood education (ECE) programs in UNICEF's Middle East and North Africa region. The report compiles information about ECE programs in 18 countries based on a questionnaire sent to UNICEF country offices and other sources. The introduction sets out the economic and social rationales for investing in early…

Sustainable development and public health: rating European countries

PubMed Central

2013-01-01

Background Sustainable development and public health quite strongly correlate, being connected and conditioned by one another. This paper therein attempts to offer a representation of Europe’s current situation of sustainable development in the area of public health. Methods A dataset on sustainable development in the area of public health consisting of 31 European countries (formally proposed by the European Union Commission and EUROSTAT) has been used in this paper in order to evaluate said issue for the countries listed thereof. A statistical method which synthesizes several indicators into one quantitative indicator has also been utilized. Furthermore, the applied method offers the possibility to obtain an optimal set of variables for future studies of the problem, as well as for the possible development of indicators. Results According to the results obtained, Norway and Iceland are the two foremost European countries regarding sustainable development in the area of public health, whereas Romania, Lithuania, and Latvia, some of the European Union’s newest Member States, rank lowest. The results also demonstrate that the most significant variables (more than 80%) in rating countries are found to be “healthy life years at birth, females” (r2 = 0.880), “healthy life years at birth, males” (r2 = 0.864), “death rate due to chronic diseases, males” (r2 = 0.850), and “healthy life years, 65, females” (r2 = 0.844). Conclusions Based on the results of this paper, public health represents a precondition for sustainable development, which should be continuously invested in and improved. After the assessment of the dataset, proposed by EUROSTAT in order to evaluate progress towards the agreed goals of the EU Sustainable Development Strategy (SDS), this paper offers an improved set of variables, which it is hoped, may initiate further studies concerning this problem. PMID:23356822

The Role of Satellite Data for the National Forest Monitoring Systems in the Context of REDD+

NASA Astrophysics Data System (ADS)

Jonckheere, Inge

2012-04-01

Reducing Emissions from Deforestation and Forest Degradation (REDD) is an effort to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. “REDD+” goes beyond deforestation and forest degradation, and includes the role of conservation, sustainable management of forests and enhancement of forest carbon stocks. In the framework of getting countries ready for REDD+, the UN-REDD Programme assists developing countries to prepare and implement national REDD+ strategies. For the monitoring, reporting and verification (MRV), FAO supports the countries to develop national forest monitoring systems (NFMS) based on satellite data that allow for credible MRV of REDD+ activities through time. The UN-REDD Programme through a joint effort of FAO and Brazil's National Space Agency, INPE, is supporting countries to develop cost- effective, robust and compatible national monitoring and MRV systems, providing tools, methodologies, training and knowledge sharing that help countries to strengthen their technical and institutional capacity for effective MRV systems. The Brazilian forest monitoring system, TerraAmazon, which is used as a multi-user basis, allows countries to adapt it to country needs. With the technical assistance of FAO, INPE and other stakeholders, the countries will set up an autonomous operational satellite forest monitoring systems. A beta version and the methodologies of the system for DRC and PNG are launched in Durban (SA) during COP 17, while Paraguay, Zambia and Viet Nam are in development in 2012.

Health Technology Assessment: Global Advocacy and Local Realities Comment on "Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness".

PubMed

Chalkidou, Kalipso; Li, Ryan; Culyer, Anthony J; Glassman, Amanda; Hofman, Karen J; Teerawattananon, Yot

2016-08-29

Cost-effectiveness analysis (CEA) can help countries attain and sustain universal health coverage (UHC), as long as it is context-specific and considered within deliberative processes at the country level. Institutionalising robust deliberative processes requires significant time and resources, however, and countries often begin by demanding evidence (including local CEA evidence as well as evidence about local values), whilst striving to strengthen the governance structures and technical capacities with which to generate, consider and act on such evidence. In low- and middle-income countries (LMICs), such capacities could be developed initially around a small technical unit in the health ministry or health insurer. The role of networks, development partners, and global norm setting organisations is crucial in supporting the necessary capacities. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The international dimensions of neuroethics.

PubMed

Lombera, Sofia; Illes, Judy

2009-08-01

Neuroethics, in its modern form, investigates the impact of brain science in four basic dimensions: the self, social policy, practice and discourse. In this study, we analyzed a set of 461 peer-reviewed articles with neuroethics content, published by authors from 32 countries. We analyzed the data for: (1) trends in the development of international neuroethics over time, and (2) how challenges at the intersection of ethics and neuroscience are viewed in countries that are considered developed by International Monetary Fund (IMF) standards, and in those that are developing. Our results demonstrate a steady increase in global participation in neuroethics from 1989 to 2005, characterized by an increase in numbers of articles published specifically on neuroethics, journals publishing these articles, and countries contributing to the literature. The focus from all countries was on the practice of brain science and the amelioration of neurological disease. Indicators of technology creation and diffusion in developing countries were specifically correlated with increases in publications concerning policy implications of brain science. Neuroethics is an international endeavor and, as such, should be sensitive to the impact that context has on acceptance and use of technological innovation.

THE INTERNATIONAL DIMENSIONS OF NEUROETHICS

PubMed Central

LOMBERA, SOFIA; ILLES, JUDY

2008-01-01

Neuroethics, in its modern form, investigates the impact of brain science in four basic dimensions: the self, social policy, practice and discourse. In this study, we analyzed a set of 461 peer-reviewed articles with neuroethics content, published by authors from 32 countries. We analyzed the data for: (1) trends in the development of international neuroethics over time, and (2) how challenges at the intersection of ethics and neuroscience are viewed in countries that are considered developed by International Monetary Fund (IMF) standards, and in those that are developing. Our results demonstrate a steady increase in global participation in neuroethics from 1989 to 2005, characterized by an increase in numbers of articles published specifically on neuroethics, journals publishing these articles, and countries contributing to the literature. The focus from all countries was on the practice of brain science and the amelioration of neurological disease. Indicators of technology creation and diffusion in developing countries were specifically correlated with increases in publications concerning policy implications of brain science. Neuroethics is an international endeavor and, as such, should be sensitive to the impact that context has on acceptance and use of technological innovation. PMID:18445073

The international migration of nurses in long-term care.

PubMed

Redfoot, Donald L; Houser, Ari N

2008-01-01

This article describes five major factors that are affecting patterns of international migration among nurses who work in long-term care settings: DEMOGRAPHIC DRIVERS: The aging of the populations in developed countries and the low to negative growth in the working-age population will increase the demand for international workers to provide long-term care services. GENDER AND RACE: A dual labor market of long-term care workers, increasingly made up of women of color, is becoming internationalized by the employment of migrating nurses from developing countries. CREDENTIALING: The process of credentialing skilled workers creates barriers to entry for migrating nurses and leads to "decredentialing" where registered nurses work as licensed practical nurses or aides. COLONIAL HISTORY AND GEOGRAPHY: The colonial histories of many European countries and the United States have increased migration from former colonies in developing countries to former colonial powers. WORKER RECRUITMENT: Efforts to limit the recruitment of health care workers from some developing countries have had little effect on migration, in part because much of the recruitment comes through informal channels of family and friends.

The perspectives of researchers on obtaining informed consent in developing countries.

PubMed

Newton, Sam K; Appiah-Poku, John

2007-04-01

The doctrine of informed consent (IC) exists to protect individuals from exploitation or harm. This study into IC was carried out to investigate how different researchers perceived the process whereby researchers obtained consent. It also examined researchers' perspectives on what constituted IC, and how different settings influenced the process. The study recorded in-depth interviews with 12 lecturers and five doctoral students, who had carried out research in developing countries, at a leading school of public health in the United Kingdom. A purposive, snowballing approach was used to identify interviewees. Although the concept and application of the doctrine of IC should have been the same, irrespective of where the research was carried out, the process of obtaining it had to be different. The setting had to be taken into consideration and the autonomy of the subject had to be respected at all times. In areas of high illiteracy, and where understanding of the subject was likely to be a problem, there was an added responsibility placed on the researcher to devise innovative ways of carrying out the study, taking into consideration the peculiarities of the environment. The ethical issues for IC were the same, irrespective of where the research was conducted. However, because the backgrounds, setting, and knowledge of populations differed, there was the need to be similarly sensitive in obtaining consent. The problems of obtaining genuine IC were not limited to developing countries.

Ethical challenges in integrating patient-care with clinical research in a resource-limited setting: perspectives from Papua New Guinea

PubMed Central

2013-01-01

Background In resource-limited settings where healthcare services are limited and poverty is common, it is difficult to ethically conduct clinical research without providing patient-care. Therefore, integration of patient-care with clinical research appears as an attractive way of conducting research while providing patient-care. In this article, we discuss the ethical implications of such approach with perspectives from Papua New Guinea. Discussion Considering the difficulties of providing basic healthcare services in developing countries, it may be argued that integration of clinical research with patient-care is an effective, rational and ethical way of conducting research. However, blending patient-care with clinical research may increase the risk of subordinating patient-care in favour of scientific gains; therapeutic misconception and inappropriate inducement; and the risk of causing health system failures due to limited capacity in developing countries to sustain the level of healthcare services sponsored by the research. Nevertheless, these ethical and administrative implications can be minimised if patient-care takes precedence over research; the input of local ethics committees and institutions are considered; and funding agencies acknowledge their ethical obligation when sponsoring research in resource-limited settings. Summary Although integration of patient-care with clinical research in developing countries appears as an attractive way of conducting research when resources are limited, careful planning and consideration on the ethical implications of such approach must be considered. PMID:23885908

Ethical challenges in integrating patient-care with clinical research in a resource-limited setting: perspectives from Papua New Guinea.

PubMed

Laman, Moses; Pomat, William; Siba, Peter; Betuela, Inoni

2013-07-26

In resource-limited settings where healthcare services are limited and poverty is common, it is difficult to ethically conduct clinical research without providing patient-care. Therefore, integration of patient-care with clinical research appears as an attractive way of conducting research while providing patient-care. In this article, we discuss the ethical implications of such approach with perspectives from Papua New Guinea. Considering the difficulties of providing basic healthcare services in developing countries, it may be argued that integration of clinical research with patient-care is an effective, rational and ethical way of conducting research. However, blending patient-care with clinical research may increase the risk of subordinating patient-care in favour of scientific gains; therapeutic misconception and inappropriate inducement; and the risk of causing health system failures due to limited capacity in developing countries to sustain the level of healthcare services sponsored by the research. Nevertheless, these ethical and administrative implications can be minimised if patient-care takes precedence over research; the input of local ethics committees and institutions are considered; and funding agencies acknowledge their ethical obligation when sponsoring research in resource-limited settings. Although integration of patient-care with clinical research in developing countries appears as an attractive way of conducting research when resources are limited, careful planning and consideration on the ethical implications of such approach must be considered.

Determinants of energy efficiency across countries

NASA Astrophysics Data System (ADS)

Yao, Guolin

With economic development, environmental concerns become more important. Economies cannot be developed without energy consumption, which is the major source of greenhouse gas emissions. Higher energy efficiency is one means of reducing emissions, but what determines energy efficiency? In this research we attempt to find answers to this question by using cross-sectional country data; that is, we examine a wide range of possible determinants of energy efficiency at the country level in an attempt to find the most important causal factors. All countries are divided into three income groups: high-income countries, middle-income countries, and low-income countries. Energy intensity is used as a measurement of energy efficiency. All independent variables belong to two categories: quantitative and qualitative. Quantitative variables are measures of the economic conditions, development indicators and energy usage situations. Qualitative variables mainly measure political, societal and economic strengths of a country. The three income groups have different economic and energy attributes. Each group has different sets of variables to explain energy efficiency. Energy prices and winter temperature are both important in high-income and middle-income countries. No qualitative variables appear in the model of high-income countries. Basic economic factors, such as institutions, political stability, urbanization level, population density, are important in low-income countries. Besides similar variables, such as macroeconomic stability and index of rule of law, the hydroelectricity share in total electric generation is also a driver of energy efficiency in middle-income countries. These variables have different policy implications for each group of countries.

Child development in developing countries: child rights and policy implications.

PubMed

Britto, Pia Rebello; Ulkuer, Nurper

2012-01-01

The Multiple Indicator Cluster Survey was used to provide information on feeding practices, caregiving, discipline and violence, and the home environment for young children across 28 countries. The findings from the series of studies in this Special Section are the first of their kind because they provide information on the most proximal context for development of the youngest children in the majority world using one of the only data sets to study these contexts across countries. Using the framework of the Convention on the Rights of the Child, in particular the Rights to Survival, Development and Protection, findings are explained with implications for international and national-level social policies. Implications are also discussed, with respect to policy makers and the larger international community, who have the obligation to uphold these rights. © 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc.

Assessing variation in tolerance in 23 Muslim-majority and Western countries.

PubMed

Milligan, Scott; Andersen, Robert; Brym, Robert

2014-08-01

Scholars disagree over whether Islam hinders the development of liberal democracy in Muslim-majority countries. We contribute to this debate by assessing the influence of Islam at the individual and national levels on ethnic, racial, and religious tolerance in 23 countries. Our analyses are based on a set of multilevel models fitted to World Values Survey data and national-level contextual information from various sources. Our findings suggest that people living in Muslim-majority countries tend to be less tolerant than are those living in Western countries. Although a significant part of this difference is attributable to variation in level of economic development and income inequality, Muslim countries remain less tolerant even after controlling for these factors. On the other hand, controlling for other individual-level factors, nonpracticing Muslims in Western countries are more tolerant than are all others in both Muslim-majority and Western countries. This finding challenges common claims about the effects of Islam as a religion on tolerance, suggesting that it is Islamic political regimes--not Islam itself--that pose problems for social tolerance.

Development of a point-of-care HIV/AIDS medication dosing support system using the Android mobile platform.

PubMed

Sadasivam, Rajani S; Gathibandhe, Vaibhav; Tanik, Murat M; Willig, James H

2012-06-01

Medication dosing errors can greatly reduce HIV treatment effectiveness as incorrect dosing leads to drug resistance and non-adherence. In order to dose correctly, HIV therapy providers must balance several patient characteristics such as renal functions and weight. In developing countries and other resource-limited settings, dosing errors are more likely because treatment is provided by mid-level providers with only basic training in HIV therapy. These providers also typically lack electronic tools informing medical decisions. Widespread adoption of mobile phones in developing nations offers an opportunity to implement a point-of-care system to help providers reduce dosing errors. We discuss the development of the mHIV-Dr system prototype using the new Android mobile platform. mHIV-Dr is being designed to provide dosing recommendations for front-line providers in developing countries. We also discuss the additional challenges in the implementation of the mHIV-Dr system in a resource limited setting.

Measuring teamwork and taskwork of community-based “teams” delivering life-saving health interventions in rural Zambia: a qualitative study

PubMed Central

2013-01-01

Background The use of teams is a well-known approach in a variety of settings, including health care, in both developed and developing countries. Team performance is comprised of teamwork and task work, and ascertaining whether a team is performing as expected to achieve the desired outcome has rarely been done in health care settings in resource-limited countries. Measuring teamwork requires identifying dimensions of teamwork or processes that comprise the teamwork construct, while taskwork requires identifying specific team functions. Since 2008 a community-based project in rural Zambia has teamed community health workers (CHWs) and traditional birth attendants (TBAs), supported by Neighborhood Health Committees (NHCs), to provide essential newborn and continuous curative care for children 0–59 months. This paper describes the process of developing a measure of teamwork and taskwork for community-based health teams in rural Zambia. Methods Six group discussions and pile-sorting sessions were conducted with three NHCs and three groups of CHW-TBA teams. Each session comprised six individuals. Results We selected 17 factors identified by participants as relevant for measuring teamwork in this rural setting. Participants endorsed seven functions as important to measure taskwork. To explain team performance, we assigned 20 factors into three sub-groups: personal, community-related and service-related. Conclusion Community and culturally relevant processes, functions and factors were used to develop a tool for measuring teamwork and taskwork in this rural community and the tool was quite unique from tools used in developed countries. PMID:23802766

Potential use of NOACs in developing countries: pros and cons.

PubMed

Bista, Durga; Chalmers, Leanne; Bereznicki, Luke; Peterson, Gregory

2014-07-01

Although vitamin K antagonists (VKAs) are effective for long-term thromboprophylaxis in atrial fibrillation (AF), their limitations have led to widespread underutilisation, especially in the developing world. Novel oral anticoagulants (NOACs) have emerged as promising alternatives to VKAs, although there are some particular considerations and challenges to their introduction in developing countries. This review summarises the current state of antithrombotic management of AF in the developing world, explores the early evidence for the NOACs and describes some of the special considerations that must be taken into account when considering the role of the NOACs within developing countries' health care systems. A literature search was conducted via PubMed and Google Scholar to find articles published in English between the years 2000 to 2014. Search terms used were "atrial fibrillation", "oral anticoagulants", "warfarin", "NOACs", "dabigatran", "rivaroxaban", "apixaban", "edoxaban", "time in therapeutic range", "International Normalized Ratio" "cost-effectiveness", "stroke", "adverse-drug reactions" and "drug-drug interactions", together with the individual names of developing countries as listed by the World Bank. We reviewed the results of randomized clinical trials, relevant retrospective and prospective studies, case-studies and review articles. Many developing countries lack or have sporadic data on the quality of AF management, making it difficult to anticipate the potential impact of NOACs in these settings. The utilisation of anticoagulants for AF appears highly variable in developing countries. Given the issues associated with VKA therapy in many developing countries, NOACs offer some potential advantages; however, there is insufficient evidence to advocate the widespread replacement of warfarin at present. VKAs may continue to have a role in selected patients or countries, especially if alternative monitoring strategies can be utilised. The evaluation of the introduction of NOACs should consider safety, budget concerns and the quality of oral anticoagulation care achieved by each country. Prospective registries will be important in developing countries to better elucidate the comparative safety, efficacy and cost-effectiveness of NOACs and VKAs as NOACs are introduced into practice.

A comparative study of interprofessional education in global health care

PubMed Central

Herath, Chulani; Zhou, Yangfeng; Gan, Yong; Nakandawire, Naomie; Gong, Yanghong; Lu, Zuxun

2017-01-01

Abstract Background: The World Health Organization (WHO) and its partners identify interprofessional (IP) collaboration in education and practice as an innovative strategy that plays an important role in mitigating the global health workforce crisis. Evidence on the practice of global health level in interprofessional education (IPE) is scarce and hampered due to the absence of aggregate information. Therefore, this systematic review was conducted to examine the incidences of IPE and summarize the main features about the IPE programs in undergraduate and postgraduate education in developed and developing countries. Methods: The PubMed, Embase, Web of Science, and Google Scholar were searched from their inception to January 31, 2016 for relevant studies regarding the development of IPE worldwide, IPE undergraduate and postgraduate programs, IP interaction in health education, IPE content, clinical placements, and teaching methods. Countries in which a study was conducted were classified as developed and developing countries according to the definition by the United Nations (UN) in 2014. Results: A total of 65 studies from 41 countries met our inclusion criteria, including 45 studies from 25 developed countries and 20 studies from 16 developing countries. Compared with developing countries, developed countries had more IPE initiatives. IPE programs were mostly at the undergraduate level. Overall, the university was the most common academic institution that provided IPE programs. The contents of the curricula were mainly designed to provide IP knowledge, skills, and values that aimed at developing IP competencies. IPE clinical placements were typically based in hospitals, community settings, or both. The didactic and interactive teaching methods varied significantly within and across universities where they conducted IPE programs. Among all health care disciplines, nursing was the discipline that conducted most of the IPE programs. Conclusion: This systematic review illustrated that the IPE programs vary substantially across countries. Many countries, especially the academic institutions are benefiting from the implementation of IPE programs. There is a need to strengthen health education policies at global level aiming at initiating IPE programs in relevant institutions. PMID:28930816

Development and Dematerialization: An International Study

PubMed Central

Steinberger, Julia K.; Krausmann, Fridolin; Getzner, Michael; Schandl, Heinz; West, Jim

2013-01-01

Economic development and growth depend on growing levels of resource use, and result in environmental impacts from large scale resource extraction and emissions of waste. In this study, we examine the resource dependency of economic activities over the past several decades for a set of countries comprising developing, emerging and mature industrialized economies. Rather than a single universal industrial development pathway, we find a diversity of economic dependencies on material use, made evident through cluster analysis. We conduct tests for relative and absolute decoupling of the economy from material use, and compare these with similar tests for decoupling from carbon emissions, both for single countries and country groupings using panel analysis. We show that, over the longer term, emerging and developing countries tend to have significantly larger material-economic coupling than mature industrialized economies (although this effect may be enhanced by trade patterns), but that the contrary is true for short-term coupling. Moreover, we demonstrate that absolute dematerialization limits economic growth rates, while the successful industrialization of developing countries inevitably requires a strong material component. Alternative development priorities are thus urgently needed both for mature and emerging economies: reducing absolute consumption levels for the former, and avoiding the trap of resource-intensive economic and human development for the latter. PMID:24204555

Adding an Expert to the Team: The Expert Flight Plan Critic

ERIC Educational Resources Information Center

Gibbons, Andrew; Waki, Randy; Fairweather, Peter

2008-01-01

This paper reports the development of a practical tool that provides expert feedback to students following an extended simulation exercise in cross-country flight planning. In contrast to development for laboratory settings, the development of an expert instructional product for everyday use posed some interesting challenges, including dealing…

Instructional Development for Early Career Academics: An Overview of Impact

ERIC Educational Resources Information Center

Stes, Ann; Van Petegem, Peter

2011-01-01

Background: Over the past decades, the issue of improving teaching in higher education has been seriously addressed. Centres for instructional development, aimed at enhancing teaching, have been set up in many countries. Instructional development for early career academics is perceived to be of particular importance. Given the considerable…

Informed consent comprehension in African research settings.

PubMed

Afolabi, Muhammed O; Okebe, Joseph U; McGrath, Nuala; Larson, Heidi J; Bojang, Kalifa; Chandramohan, Daniel

2014-06-01

Previous reviews on participants' comprehension of informed consent information have focused on developed countries. Experience has shown that ethical standards developed on Western values may not be appropriate for African settings where research concepts are unfamiliar. We undertook this review to describe how informed consent comprehension is defined and measured in African research settings. We conducted a comprehensive search involving five electronic databases: Medline, Embase, Global Health, EthxWeb and Bioethics Literature Database (BELIT). We also examined African Index Medicus and Google Scholar for relevant publications on informed consent comprehension in clinical studies conducted in sub-Saharan Africa. 29 studies satisfied the inclusion criteria; meta-analysis was possible in 21 studies. We further conducted a direct comparison of participants' comprehension on domains of informed consent in all eligible studies. Comprehension of key concepts of informed consent varies considerably from country to country and depends on the nature and complexity of the study. Meta-analysis showed that 47% of a total of 1633 participants across four studies demonstrated comprehension about randomisation (95% CI 13.9-80.9%). Similarly, 48% of 3946 participants in six studies had understanding about placebo (95% CI 19.0-77.5%), while only 30% of 753 participants in five studies understood the concept of therapeutic misconception (95% CI 4.6-66.7%). Measurement tools for informed consent comprehension were developed with little or no validation. Assessment of comprehension was carried out at variable times after disclosure of study information. No uniform definition of informed consent comprehension exists to form the basis for development of an appropriate tool to measure comprehension in African participants. Comprehension of key concepts of informed consent is poor among study participants across Africa. There is a vital need to develop a uniform definition for informed consent comprehension in low literacy research settings in Africa. This will be an essential step towards developing appropriate tools that can adequately measure informed consent comprehension. This may consequently suggest adequate measures to improve the informed consent procedure. © 2014 John Wiley & Sons Ltd.

Open innovation as a new paradigm for global collaborations in health.

PubMed

Dandonoli, Patricia

2013-08-30

Open innovation, which refers to combining internal and external ideas and internal and external paths to market in order to achieve advances in processes or technologies, is an attractive paradigm for structuring collaborations between developed and developing country entities and people. Such open innovation collaborations can be designed to foster true co-creation among partners in rich and poor settings, thereby breaking down hierarchies and creating greater impact and value for each partner. Using an example from Concern Worldwide's Innovations for Maternal, Newborn &Child Health initiative, this commentary describes an early-stage pilot project built around open innovation in a low resource setting, which puts communities at the center of a process involving a wide range of partners and expertise, and considers how it could be adapted and make more impactful and sustainable by extending the collaboration to include developed country partners.

[Nutrition of newborns in developing areas: a few comments on the present situation and on future necessities].

PubMed

Jelliffe, D B; Jelliffe, E F

1978-01-01

Switching from breast-feeding to bottle-feeding can have negative effects anywhere. In developing areas especially, it can cause marasmus and infectious dyarrhea, resulting in increased infant morbidity and mortality. Breast-feeding practices decreased because of urbanization and changed women's status, but especially because of the very often unethical promotion techniques of infant formulas manufacturers. Some promotional campaigns in developing countries have been so heavy and so successful as to totally change preexisting breast-feeding practices. The major companies producing infant formulas have been repeatedly submitted to criticism, and have recently changed their marketing policies. It is imperative, however, that governments set up legislation to control the still inaccurate and inadequate promotion of infant formulas in many countries. On the other hand, special courses in infant nutrition should be set up at medical schools, to produce sorely needed specialists in pediatric nutrition.

Emerging technologies in point-of-care molecular diagnostics for resource-limited settings.

PubMed

Peeling, Rosanna W; McNerney, Ruth

2014-06-01

Emerging molecular technologies to diagnose infectious diseases at the point at which care is delivered have the potential to save many lives in developing countries where access to laboratories is poor. Molecular tests are needed to improve the specificity of syndromic management, monitor progress towards disease elimination and screen for asymptomatic infections with the goal of interrupting disease transmission and preventing long-term sequelae. In simplifying laboratory-based molecular assays for use at point-of-care, there are inevitable compromises between cost, ease of use and test performance. Despite significant technological advances, many challenges remain for the development of molecular diagnostics for resource-limited settings. There needs to be more advocacy for these technologies to be applied to infectious diseases, increased efforts to lower the barriers to market entry through streamlined and harmonized regulatory approaches, faster policy development for adoption of new technologies and novel financing mechanisms to enable countries to scale up implementation.

Characterization of urban waste management practices in developing Asian countries: A new analytical framework based on waste characteristics and urban dimension.

PubMed

Aleluia, João; Ferrão, Paulo

2016-12-01

This paper characterizes municipal solid waste (MSW) management practices in developing Asia, with a focus on low and middle-income countries. The analysis that is conducted supports a proposed framework that maps out the trends observed in the region in relation to two parameters, waste compositions and urban dimension, which was prepared based on a set of national and urban case studies. The management of MSW in developing Asian countries is driven, first and foremost, by a public health imperative: the collection and disposal of waste in order to avoid the spread of disease vectors from uncollected waste. This comes, however, at a high cost, with local government authorities in these countries spending up to 50% of their budgets in the provision of these services. Little or no value is derived from waste, which is typically seen as a liability and not as a resource that can be harnessed. On the other hand, in many cities in developing Asia there is an informal sector that ekes out a living from the recovery of recyclable materials found in waste. Members of this "informal waste sector" are especially active in areas that are not served by formal waste collection systems, such as slums or squatter areas. A distinctive element shared among many cities in developing Asian countries concerns the composition of the municipal solid waste. MSW in those countries tends to be richer in biodegradable organic matter, which usually accounts for more than 50% of the total waste composition, suggesting that biological methods are more appropriate for treating this organic fraction. Conversely, thermal combustion technologies, which are extensively applied in high-income countries, are technically and economically challenging to deploy in light of the lower calorific value of waste streams which are rich in organics and moisture. Specific approaches and methods are therefore required for designing adequate waste management systems in developing Asian countries. In addition, despite some common characteristics shared among cities in developing Asia, their specific circumstances can significantly vary, even within the same country, calling for the need for context-specific waste management approaches. Set against this background, this paper proposes a guiding framework in the form of a matrix that maps out approaches observed in the management of municipal solid waste in cities of developing Asian countries as a function of the city dimension, share of organics on waste streams, and wealth generated by the city. The cities of Surabaya (Indonesia), Bangalore (India), Quy Nhon (Viet Nam), and Matale (Sri Lanka) are showcased as good practices in the region in the management of solid waste, with their experiences used to illustrate the framework laid out in the matrix. Copyright © 2016 Elsevier Ltd. All rights reserved.

Gender, Socioeconomic Status, and Self-Rated Health in a Transitional Middle-Income Setting: Evidence From Thailand

PubMed Central

Seubsman, Sam-ang; Kelly, Matthew James; Yiengprugsawan, Vasoontara; Sleigh, Adrian C.

2011-01-01

Poor self-rated health (SRH) correlates strongly with mortality. In developed countries, women generally report worse SRH than males. Few studies have reported on SRH in developing countries. The authors report on SRH in Thailand, a middle-income developing country. The data were derived from a large nationwide cohort of 87 134 adult Open University students (54% female, median age 29 years). The authors included questions on socioeconomic and demographic factors that could influence SRH. The Thai cohort in this study mirrors patterns found in developed countries, with females reporting more frequent “poor” or “very poor” SRH (odds ratio = 1.35; 95% confidence interval = 1.26-1.44). Cohort males had better SRH than females, but levels were more sensitive to socioeconomic status. Income and education had little influence on SRH for females. Among educated Thai adults, females rate their health to be worse than males, and unlike males, this perception is relatively unaffected by socioeconomic status. PMID:20460290

Gender, socioeconomic status, and self-rated health in a transitional middle-income setting: evidence from Thailand.

PubMed

Seubsman, Sam-Ang; Kelly, Matthew James; Yiengprugsawan, Vasoontara; Sleigh, Adrian C

2011-09-01

Poor self-rated health (SRH) correlates strongly with mortality. In developed countries, women generally report worse SRH than males. Few studies have reported on SRH in developing countries. The authors report on SRH in Thailand, a middle-income developing country.The data were derived from a large nationwide cohort of 87 134 adult Open University students (54% female, median age 29 years). The authors included questions on socioeconomic and demographic factors that could influence SRH. The Thai cohort in this study mirrors patterns found in developed countries, with females reporting more frequent "poor" or "very poor" SRH (odds ratio = 1.35; 95% confidence interval = 1.26-1.44). Cohort males had better SRH than females, but levels were more sensitive to socioeconomic status. Income and education had little influence on SRH for females. Among educated Thai adults, females rate their health to be worse than males, and unlike males, this perception is relatively unaffected by socioeconomic status.

Multi-Country analysis of palm oil consumption and cardiovascular disease mortality for countries at different stages of economic development: 1980-1997.

PubMed

Chen, Brian K; Seligman, Benjamin; Farquhar, John W; Goldhaber-Fiebert, Jeremy D

2011-12-16

Cardiovascular diseases represent an increasing share of the global disease burden. There is concern that increased consumption of palm oil could exacerbate mortality from ischemic heart disease (IHD) and stroke, particularly in developing countries where it represents a major nutritional source of saturated fat. The study analyzed country-level data from 1980-1997 derived from the World Health Organization's Mortality Database, U.S. Department of Agriculture international estimates, and the World Bank (234 annual observations; 23 countries). Outcomes included mortality from IHD and stroke for adults aged 50 and older. Predictors included per-capita consumption of palm oil and cigarettes and per-capita Gross Domestic Product as well as time trends and an interaction between palm oil consumption and country economic development level. Analyses examined changes in country-level outcomes over time employing linear panel regressions with country-level fixed effects, population weighting, and robust standard errors clustered by country. Sensitivity analyses included further adjustment for other major dietary sources of saturated fat. In developing countries, for every additional kilogram of palm oil consumed per-capita annually, IHD mortality rates increased by 68 deaths per 100,000 (95% CI [21-115]), whereas, in similar settings, stroke mortality rates increased by 19 deaths per 100,000 (95% CI [-12-49]) but were not significant. For historically high-income countries, changes in IHD and stroke mortality rates from palm oil consumption were smaller (IHD: 17 deaths per 100,000 (95% CI [5.3-29]); stroke: 5.1 deaths per 100,000 (95% CI [-1.2-11.0])). Inclusion of other major saturated fat sources including beef, pork, chicken, coconut oil, milk cheese, and butter did not substantially change the differentially higher relationship between palm oil and IHD mortality in developing countries. Increased palm oil consumption is related to higher IHD mortality rates in developing countries. Palm oil consumption represents a saturated fat source relevant for policies aimed at reducing cardiovascular disease burdens.

Effectiveness of medical equipment donations to improve health systems: how much medical equipment is broken in the developing world?

PubMed

Perry, Lora; Malkin, Robert

2011-07-01

It is often said that most of the medical equipment in the developing world is broken with estimates ranging up to 96% out of service. But there is little documented evidence to support these statements. We wanted to quantify the amount of medical equipment that was out of service in resource poor health settings and identify possible causes. Inventory reports were analyzed from 1986 to 2010, from hospitals in sixteen countries across four continents. The UN Human Development Index was used to determine which countries should be considered developing nations. Non-medical hospital equipment was excluded. This study examined 112,040 pieces of equipment. An average of 38.3% (42,925, range across countries: 0.83-47%) in developing countries was out of service. The three main causes were lack of training, health technology management, and infrastructure. We hope that the findings will help biomedical engineers with their efforts toward effective designs for the developing world and NGO's with efforts to design effective healthcare interventions.

Exploring evidence-policy linkages in health research plans: A case study from six countries

PubMed Central

Syed, Shamsuzzoha B; Hyder, Adnan A; Bloom, Gerald; Sundaram, Sandhya; Bhuiya, Abbas; Zhenzhong, Zhang; Kanjilal, Barun; Oladepo, Oladimeji; Pariyo, George; Peters, David H

2008-01-01

The complex evidence-policy interface in low and middle income country settings is receiving increasing attention. Future Health Systems (FHS): Innovations for Equity, is a research consortium conducting health systems explorations in six Asian and African countries: Bangladesh, India, China, Afghanistan, Uganda, and Nigeria. The cross-country research consortium provides a unique opportunity to explore the research-policy interface. Three key activities were undertaken during the initial phase of this five-year project. First, key considerations in strengthening evidence-policy linkages in health system research were developed by FHS researchers through workshops and electronic communications. Four key considerations in strengthening evidence-policy linkages are postulated: development context; research characteristics; decision-making processes; and stakeholder engagement. Second, these four considerations were applied to research proposals in each of the six countries to highlight features in the research plans that potentially strengthen the research-policy interface and opportunities for improvement. Finally, the utility of the approach for setting research priorities in health policy and systems research was reflected upon. These three activities yielded interesting findings. First, developmental consideration with four dimensions – poverty, vulnerabilities, capabilities, and health shocks – provides an entry point in examining research-policy interfaces in the six settings. Second, research plans focused upon on the ground realities in specific countries strengthens the interface. Third, focusing on research prioritized by decision-makers, within a politicized health arena, enhances chances of research influencing action. Lastly, early and continued engagement of multiple stakeholders, from local to national levels, is conducive to enhanced communication at the interface. The approach described has four main utilities: first, systematic analyses of research proposals using key considerations ensure such issues are incorporated into research proposals; second, the exact meaning, significance, and inter-relatedness of these considerations can be explored within the research itself; third, cross-country learning can be enhanced; and finally, translation of evidence into action may be facilitated. Health systems research proposals in low and middle income countries should include reflection on transferring research findings into policy. Such deliberations may be informed by employing the four key considerations suggested in this paper in analyzing research proposals. PMID:18331651

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

PubMed Central

Andela, Valentine B

2006-01-01

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. PMID:16390555

Limited potential of school textbooks to prevent tobacco use among students grade 1–9 across multiple developing countries: a content analysis study

PubMed Central

Saito, Junko; Nonaka, Daisuke; Mizoue, Tetsuya; Kobayashi, Jun; Jayatilleke, Achini C; Shrestha, Sabina; Kikuchi, Kimiyo; Haque, Syed E; Yi, Siyan; Ayi, Irene; Jimba, Masamine

2013-01-01

Objective To evaluate the content of school textbooks as a tool to prevent tobacco use in developing countries. Design Content analysis was used to evaluate if the textbooks incorporated the following five core components recommended by the WHO: (1) consequences of tobacco use; (2) social norms; (3) reasons to use tobacco; (4) social influences and (5) resistance and life skills. Setting Nine developing countries: Bangladesh, Cambodia, Laos, Nepal, Sri Lanka, Benin, Ghana, Niger and Zambia. Textbooks analysed Of 474 textbooks for primary and junior secondary schools in nine developing countries, 41 were selected which contained descriptions about tobacco use prevention. Results Of the 41 textbooks, the consequences of tobacco use component was covered in 30 textbooks (73.2%) and the social norms component was covered in 19 (46.3%). The other three components were described in less than 20% of the textbooks. Conclusions A rather limited number of school textbooks in developing countries contained descriptions of prevention of tobacco use, but they did not fully cover the core components for tobacco use prevention. The chance of tobacco prevention education should be seized by improving the content of school textbooks. PMID:23430601

Small Business Apparel Retailing in Jamaica: An Exploratory Investigation into Product Development Processes and Practices

ERIC Educational Resources Information Center

Johnson-Leslie, Natalie; Gaskill, LuAnn R.

2006-01-01

While the process and practices of retail product development in developed countries have been documented, a void exists in descriptive analysis regarding retail product development in an international setting. The primary purpose of this study was to explore small business apparel retailing, and specifically the retail product development process…

Technical analysis on energy conservation and emission reduction of new energy electric vehicle in China

NASA Astrophysics Data System (ADS)

Zheng, Chaocheng

2017-10-01

With the global environmental problems and energy crisis continuously emerging, all countries are taking active measures to achieve the benign development of domestic economy and society. Vehicle, as a large oil consumption and emissions of carbon dioxide, nend to be a revolutionary change. Therefore, the development of new energy electric vehicle has become the consensus of the world. On this background, this paper has sorted out the current state and the related development planning of new energy electric vehicles in different countries to predict the car ownership of the new energy electric vehicles using elastic coefficient method and setting different path of development, conclude that under the consideration of energy conservation and emissions reduction factors, our country should mainly promote the BEV to realize the maximum energy conservation and emissions reduction.

Valuation of preference-based measures: can existing preference data be used to generate better estimates?

PubMed

Kharroubi, Samer A

2018-06-05

Experimental studies to develop valuations of health state descriptive systems like EQ-5D or SF-6D need to be conducted in different countries, because social and cultural differences are likely to lead to systematically different valuations. There is a scope utilize the evidence in one country to help with the design and the analysis of a study in another, for this to enable the generation of utility estimates of the second country much more precisely than would have been possible when collecting and analyzing the country's data alone. We analyze SF-6D valuation data elicited from representative samples corresponding to the Hong Kong (HK) and United Kingdom (UK) general adult populations through the use of the standard gamble technique to value 197 and 249 health states respectively. We apply a nonparametric Bayesian model to estimate a HK value set using the UK dataset as informative prior to improve its estimation. Estimates are compared to a HK value set estimated using HK values alone using mean predictions and root mean square error. The novel method of modelling utility functions permitted the UK valuations to contribute significant prior information to the Hong Kong analysis. The results suggest that using HK data alongside the existing UK data produces HK utility estimates better than using the HK study data by itself. The promising results suggest that existing preference data could be combined with valuation study in a new country to generate preference weights, making own country value sets more achievable for low and middle income countries. Further research is encouraged.

Better Measurement for Performance Improvement in Low- and Middle-Income Countries: The Primary Health Care Performance Initiative (PHCPI) Experience of Conceptual Framework Development and Indicator Selection.

PubMed

Veillard, Jeremy; Cowling, Krycia; Bitton, Asaf; Ratcliffe, Hannah; Kimball, Meredith; Barkley, Shannon; Mercereau, Laure; Wong, Ethan; Taylor, Chelsea; Hirschhorn, Lisa R; Wang, Hong

2017-12-01

Policy Points: Strengthening accountability through better measurement and reporting is vital to ensure progress in improving quality primary health care (PHC) systems and achieving universal health coverage (UHC). The Primary Health Care Performance Initiative (PHCPI) provides national decision makers and global stakeholders with opportunities to benchmark and accelerate performance improvement through better performance measurement. Results from the initial PHC performance assessments in low- and middle-income countries (LMICs) are helping guide PHC reforms and investments and improve the PHCPI's instruments and indicators. Findings from future assessment activities will further amplify cross-country comparisons and peer learning to improve PHC. New indicators and sources of data are needed to better understand PHC system performance in LMICs. The Primary Health Care Performance Initiative (PHCPI), a collaboration between the Bill and Melinda Gates Foundation, The World Bank, and the World Health Organization, in partnership with Ariadne Labs and Results for Development, was launched in 2015 with the aim of catalyzing improvements in primary health care (PHC) systems in 135 low- and middle-income countries (LMICs), in order to accelerate progress toward universal health coverage. Through more comprehensive and actionable measurement of quality PHC, the PHCPI stimulates peer learning among LMICs and informs decision makers to guide PHC investments and reforms. Instruments for performance assessment and improvement are in development; to date, a conceptual framework and 2 sets of performance indicators have been released. The PHCPI team developed the conceptual framework through literature reviews and consultations with an advisory committee of international experts. We generated 2 sets of performance indicators selected from a literature review of relevant indicators, cross-referenced against indicators available from international sources, and evaluated through 2 separate modified Delphi processes, consisting of online surveys and in-person facilitated discussions with experts. The PHCPI conceptual framework builds on the current understanding of PHC system performance through an expanded emphasis on the role of service delivery. The first set of performance indicators, 36 Vital Signs, facilitates comparisons across countries and over time. The second set, 56 Diagnostic Indicators, elucidates underlying drivers of performance. Key challenges include a lack of available data for several indicators and a lack of validated indicators for important dimensions of quality PHC. The availability of data is critical to assessing PHC performance, particularly patient experience and quality of care. The PHCPI will continue to develop and test additional performance assessment instruments, including composite indices and national performance dashboards. Through country engagement, the PHCPI will further refine its instruments and engage with governments to better design and finance primary health care reforms. © 2017 Milbank Memorial Fund.

Teaching clinical skills in developing countries: are clinical skills centres the answer?

PubMed

Stark, Patsy; Fortune, F

2003-11-01

There is growing international interest in teaching clinical skills in a variety of contexts, one of which is Clinical Skills Centres. The drivers for change making Skills Centres an important adjunct to ward and ambulatory teaching come both from within and outside medical education. Educationally, self-directed learning is becoming the accepted norm, encouraging students to seek and maximize learning opportunities. There are global changes in health care practice, increased consumerism and increasing student numbers. In some countries, professional recommendations influence what is taught. Increasingly, core skills curricula and outcome objectives are being defined. This explicit definition encourages assessment of the core skills. In turn, all students require equal opportunities to learn how to practise the skills safely and competently. The moves towards interprofessional education make joint learning in a"neutral" setting, like a Clinical Skills Centre, appear particularly attractive. To discuss the potential role of Clinical Skills Centres in skills training in developing countries and to consider alternative options. Many developing countries seek to establish Clinical Skills Centres to ensure effective and reliable skills teaching. However, the model may not be appropriate,because fully equipped Clinical Skills Centres are expensive to set up, staff; and run. They are not the only way to achieve high quality clinical teaching. Suggested options are based on the philosophy and teaching methods successfully developed in Clinical Skills Centres that may fulfil the local needs to achieve low cost and high quality clinical teaching which is reflective of the local health needs and cultural expectations.

Pharmaceutical policies in European countries.

PubMed

Barros, Pedro Pita

2010-01-01

Pharmaceutical expenditures have an important role in Europe. The attempts to control expenditure have used a wide range of policy measures. We reviewed the main measures adopted by the European Union countries, especially in countries where governments are the largest third-party payers. To complement a literature review on the topic, data was gathered from national reviews of health systems and direct inquiries to several government bodies. Almost all countries regulate prices of pharmaceutical products. Popular policy measures include international referencing to set prices (using as benchmark countries that have set lower prices), internal reference pricing systems to promote price competition in domestic markets, and positive lists for reimbursement to promote consumption of generics (including in some cases substitution by pharmacists of drugs prescribed by physicians). Despite the wide range of policy measures, it is not possible to identify a "silver bullet" to control pharmaceutical expenditures. We also identified two main policy challenges: policy coordination among countries within the European Union to maintain incentives for R&D at the global level, and the development of new relationships with the pharmaceutical industry; namely, the so-called risk-sharing agreements between the pharmaceutical industry and governments/regulators (or large third-party payers).

Harmonisation of standards for permissible radionuclide activity concentrations in foodstuffs in the long term after the Chernobyl accident.

PubMed

Balonov, M; Kashparov, V; Nikolaenko, A; Berkovskyy, V; Fesenko, S

2018-06-01

The article critically examines the practice of post-Chernobyl standardisation of radionuclide concentrations (mainly 137 Cs and 90 Sr) in food products (FPs) in the USSR and the successor countries of Belarus, Russia and Ukraine. Recommendations are given on potential harmonisation of these standards of radionuclide concentrations in FPs among the three countries, taking into account substantial international experience. We propose to reduce the number of product groups for standardisation purposes from the current amount of several dozens to three to five groups to optimise radiation control and increase the transparency of the process. We recommend five product groups for the standardisation of 137 Cs and three groups for 90 Sr in food in radiocontaminated areas. The values of standards for individual product groups are recommended to be set proportionally to the measured specific activity in each of these groups, which will reduce unreasonable food rejection. The standards might be set for the entire country, and could be also used to control imports from other countries as well as exports to other countries. The developed recommendations were transferred in 2015-2016 to the regulatory authorities of the three countries.

Service Quality: A Main Determinant Factor for Health Information System Success in Low-resource Settings.

PubMed

Tilahun, Binyam; Fritz, Fleur

2015-01-01

With the increasing implementation of different health information systems in developing countries, there is a growing need to measure the main determinants of their success. The results of this evaluation study on the determinants of HIS success in five low resource setting hospitals show that service quality is the main determinant factor for information system success in those kind of settings.

Development and Implementation of a Pediatric Palliative Care Program in a Developing Country.

PubMed

Doherty, Megan; Thabet, Chloé

2018-01-01

Palliative care is recognized as an important component of care for children with cancer and other life-limiting conditions. In resource limited settings, palliative care is a key component of care for children with cancer and other life-limiting conditions. Globally, 98% of children who need palliative care live in low- or middle-income countries, where there are very few palliative care services available. There is limited evidence describing the practical considerations for the development and implementation of sustainable and cost-effective palliative care services in developing countries. Our aim is to describe the key considerations and initiatives that were successful in planning and implementing a hospital-based pediatric palliative care service specifically designed for a resource-limited setting. Bangabandu Sheikh Mujib Medical University (BSMMU) is a tertiary referral hospital in Bangladesh. Local palliative care services are very limited and focused on adult patients. In partnership with World Child Cancer, a project establishing a pediatric palliative care service was developed for children with cancer at BSMMU. We describe four key elements which were crucial for the success of this program: (1) raising awareness and sensitizing hospital administrators and clinical staff about pediatric palliative care; (2) providing education and training on pediatric palliative care for clinical staff; (3) forming a pediatric palliative care team; and (4) collecting data to characterize the need for pediatric palliative care. This model of a hospital-based pediatric palliative care service can be replicated in other resource-limited settings and can be expanded to include children with other life-limiting conditions. The development of pilot programs can generate interest among local physicians to become trained in pediatric palliative care and can be used to advocate for the palliative care needs of children.

Comparison and Cost Analysis of Drinking Water Quality Monitoring Requirements versus Practice in Seven Developing Countries

PubMed Central

Crocker, Jonny; Bartram, Jamie

2014-01-01

Drinking water quality monitoring programs aim to support provision of safe drinking water by informing water quality management. Little evidence or guidance exists on best monitoring practices for low resource settings. Lack of financial, human, and technological resources reduce a country’s ability to monitor water supply. Monitoring activities were characterized in Cambodia, Colombia, India (three states), Jordan, Peru, South Africa, and Uganda according to water sector responsibilities, monitoring approaches, and marginal cost. The seven study countries were selected to represent a range of low resource settings. The focus was on monitoring of microbiological parameters, such as E. coli, coliforms, and H2S-producing microorganisms. Data collection involved qualitative and quantitative methods. Across seven study countries, few distinct approaches to monitoring were observed, and in all but one country all monitoring relied on fixed laboratories for sample analysis. Compliance with monitoring requirements was highest for operational monitoring of large water supplies in urban areas. Sample transport and labor for sample collection and analysis together constitute approximately 75% of marginal costs, which exclude capital costs. There is potential for substantive optimization of monitoring programs by considering field-based testing and by fundamentally reconsidering monitoring approaches for non-piped supplies. This is the first study to look quantitatively at water quality monitoring practices in multiple developing countries. PMID:25046632

Decomposing cross-country differences in quality adjusted life expectancy: the impact of value sets.

PubMed

Heijink, Richard; van Baal, Pieter; Oppe, Mark; Koolman, Xander; Westert, Gert

2011-06-23

The validity, reliability and cross-country comparability of summary measures of population health (SMPH) have been persistently debated. In this debate, the measurement and valuation of nonfatal health outcomes have been defined as key issues. Our goal was to quantify and decompose international differences in health expectancy based on health-related quality of life (HRQoL). We focused on the impact of value set choice on cross-country variation. We calculated Quality Adjusted Life Expectancy (QALE) at age 20 for 15 countries in which EQ-5D population surveys had been conducted. We applied the Sullivan approach to combine the EQ-5D based HRQoL data with life tables from the Human Mortality Database. Mean HRQoL by country-gender-age was estimated using a parametric model. We used nonparametric bootstrap techniques to compute confidence intervals. QALE was then compared across the six country-specific time trade-off value sets that were available. Finally, three counterfactual estimates were generated in order to assess the contribution of mortality, health states and health-state values to cross-country differences in QALE. QALE at age 20 ranged from 33 years in Armenia to almost 61 years in Japan, using the UK value set. The value sets of the other five countries generated different estimates, up to seven years higher. The relative impact of choosing a different value set differed across country-gender strata between 2% and 20%. In 50% of the country-gender strata the ranking changed by two or more positions across value sets. The decomposition demonstrated a varying impact of health states, health-state values, and mortality on QALE differences across countries. The choice of the value set in SMPH may seriously affect cross-country comparisons of health expectancy, even across populations of similar levels of wealth and education. In our opinion, it is essential to get more insight into the drivers of differences in health-state values across populations. This will enhance the usefulness of health-expectancy measures.

Pilot testing of dipsticks as point-of-care assays for rapid diagnosis of poor-quality artemisinin drugs in endemic settings.

PubMed

Guo, Suqin; He, Lishan; Tisch, Daniel J; Kazura, James; Mharakurwa, Sungano; Mahanta, Jagadish; Herrera, Sócrates; Wang, Baomin; Cui, Liwang

2016-01-01

Good-quality artemisinin drugs are essential for malaria treatment, but increasing prevalence of poor-quality artemisinin drugs in many endemic countries hinders effective management of malaria cases. To develop a point-of-care assay for rapid identification of counterfeit and substandard artemisinin drugs for resource-limited areas, we used specific monoclonal antibodies against artesunate and artemether, and developed prototypes of lateral flow dipstick assays. In this pilot test, we evaluated the feasibility of these dipsticks under different endemic settings and their performance in the hands of untrained personnel. The results showed that the dipstick tests can be successfully performed by different investigators with the included instruction sheet. None of the artemether and artesunate drugs collected from public pharmacies in different endemic countries failed the test. It is possible that the simple dipstick assays, with future optimization of test conditions and sensitivity, can be used as a qualitative and semi-quantitative assay for rapid screening of counterfeit artemisinin drugs in endemic settings.

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

PubMed

Chitnis, V; Chitnis, S; Patil, S; Chitnis, D

2003-10-18

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.

Criteria for clinical audit of the quality of hospital-based obstetric care in developing countries.

PubMed Central

Graham, W.; Wagaarachchi, P.; Penney, G.; McCaw-Binns, A.; Antwi, K. Y.; Hall, M. H.

2000-01-01

Improving the quality of obstetric care is an urgent priority in developing countries, where maternal mortality remains high. The feasibility of criterion-based clinical audit of the assessment and management of five major obstetric complications is being studied in Ghana and Jamaica. In order to establish case definitions and clinical audit criteria, a systematic review of the literature was followed by three expert panel meetings. A modified nominal group technique was used to develop consensus among experts on a final set of case definitions and criteria. Five main obstetric complications were selected and definitions were agreed. The literature review led to the identification of 67 criteria, and the panel meetings resulted in the modification and approval of 37 of these for the next stage of audit. Criterion-based audit, which has been devised and tested primarily in industrialized countries, can be adapted and applied where resources are poorer. The selection of audit criteria for such settings requires local expert opinion to be considered in addition to research evidence, so as to ensure that the criteria are realistic in relation to conditions in the field. Practical methods for achieving this are described in the present paper. PMID:10859855

Vaccine safety monitoring systems in developing countries: an example of the Vietnam model.

PubMed

Ali, Mohammad; Rath, Barbara; Thiem, Vu Dinh

2015-01-01

Only few health intervention programs have been as successful as vaccination programs with respect to preventing morbidity and mortality in developing countries. However, the success of a vaccination program is threatened by rumors and misunderstanding about the risks of vaccines. It is short-sighted to plan the introduction of vaccines into developing countries unless effective vaccine safety monitoring systems are in place. Such systems that track adverse events following immunization (AEFI) is currently lacking in most developing countries. Therefore, any rumor may affect the entire vaccination program. Public health authorities should implement the safety monitoring system of vaccines, and disseminate safety issues in a proactive mode. Effective safety surveillance systems should allow for the conduct of both traditional and alternative epidemiologic studies through the use of prospective data sets. The vaccine safety data link implemented in Vietnam in mid-2002 indicates that it is feasible to establish a vaccine safety monitoring system for the communication of vaccine safety in developing countries. The data link provided the investigators an opportunity to evaluate AEFI related to measles vaccine. Implementing such vaccine safety monitoring system is useful in all developing countries. The system should be able to make objective and clear communication regarding safety issues of vaccines, and the data should be reported to the public on a regular basis for maintaining their confidence in vaccination programs.

Systems Science for Caribbean Health: the development and piloting of a model for guiding policy on diabetes in the Caribbean.

PubMed

Guariguata, L; Guell, C; Samuels, T A; Rouwette, E A J A; Woodcock, J; Hambleton, I R; Unwin, N

2016-10-26

Diabetes is highly prevalent in the Caribbean, associated with a high morbidity and mortality and is a recognised threat to economic and social development. Heads of Government in the Caribbean Community came together in 2007 and declared their commitment to reducing the burden of non-communicable diseases (NCDs), including diabetes, by calling for a multi-sectoral, systemic response. To facilitate the development of effective policies, policymakers are being engaged in the development and use of a system dynamics (SD) model of diabetes for Caribbean countries. Previous work on a diabetes SD model from the United States of America (USA) is being adapted to a local context for three countries in the region using input from stakeholders, a review of existing qualitative and quantitative data, and collection of new qualitative data. Three country models will be developed using one-on-one stakeholder engagement and iterative revision. An inter-country model will also be developed following a model-building workshop. Models will be compared to each other and to the USA model. The inter-country model will be used to simulate policies identified as priorities by stakeholders and to develop targets for prevention and control. The model and model-building process will be evaluated by stakeholders and a manual developed for use in other high-burden developing regions. SD has been applied with success for health policy development in high-income country settings. The utility of SD in developing countries as an aid to policy decision-making related to NCDs has not been tested. This study represents the first of its kind.

A systematic assessment of the current capacity to act in nutrition in West Africa: cross-country similarities and differences.

PubMed

Sodjinou, Roger; Bosu, William K; Fanou, Nadia; Déart, Lucie; Kupka, Roland; Tchibindat, Félicité; Baker, Shawn

2014-01-01

Although it is widely accepted that lack of capacity is one of the barriers to scaling up nutrition in West Africa, there is a paucity of information about what capacities exist and the capacities that need to be developed to accelerate progress toward improved nutrition outcomes in the region. To systematically assess the current capacity to act in nutrition in the West Africa region and explore cross-country similarities and differences. Data were collected from 13 West African countries through interviews with government officials, key development partners, tertiary-level training institutions, and health professional schools. The assessment was based on a conceptual framework of four interdependent levels (tools; skills; staff and infrastructure; and structures, systems and roles). In each of the surveyed countries, we assessed capacity assets and gaps at individual, organizational, and systemic levels. Important similarities and differences in capacity assets and gaps emerged across all the surveyed countries. There was strong momentum to improve nutrition in nearly all the surveyed countries. Most of the countries had a set of policies on nutrition in place and had set up multisectoral, multi-stakeholder platforms to coordinate nutrition activities, although much remained to be done to improve the effectiveness of these platforms. Many initiatives aimed to reduce undernutrition were ongoing in the region, but there did not seem to be clear coordination between them. Insufficient financial resources to implement nutrition activities were a major problem in all countries. The bulk of financial allocations for nutrition was provided by development partners, even though some countries, such as Niger, Nigeria, and Senegal, had a national budget line for nutrition. Sporadic stock-outs of nutrition supplies were reported in most of the countries as a result of a weak logistic and supply chain system. They also had a critical shortage of skilled nutrition professionals. There was limited supervision of nutrition activities, especially at lower levels. Nigeria and Ghana emerged as the countries with the greatest capacities to support the expansion of a nutrition workforce, although a significant proportion of their trained nutritionists were not employed in the nutrition sector. None of the countries had in place a unified nutrition information system that could guide decision-making processes across the different sectors. There is an urgent need for a shift toward wider reforms for nutrition capacity development in the West Africa region. Addressing these unmet needs is a critical first step toward improved capacity for action in nutrition in the region.

Supervised toothbrushing programs in primary schools and early childhood settings: A scoping review.

PubMed

Dickson-Swift, V; Kenny, A; Gussy, M; de Silva, A M; Farmer, J; Bracksley-O'Grady, S

2017-12-01

In this article we report the findings of a scoping review that aimed to identify and summarise the range of programs and guidelines available for toothbrushing programs in schools and early childhood settings. Dental caries is one of the most common preventable diseases affecting children worldwide. Untreated caries can impact on child health and wellbeing, development, socialisation and school attendance. Supervised toothbrushing programs in schools and other early childhood settings can be effective in improving the oral health of young children. There is limited understanding of the salient issues to consider when developing such programs or how they are best implemented in real world settings. A scoping review methodology was utilised to provide a summary of the guidelines and programs available. Key search terms were developed, mapped and utilised to identify guidelines and programs across 6 databases and key search engines. We located 26 programs and guidelines that met the inclusion and exclusion criteria for the review. These were collated and summarised across key countries and critical aspects of program development and implementation were identified. Toothbrush type and storage, toothpaste strength and method of dispensing, toothbrush storage, staff training and parental consent are key considerations that varied widely. Guidelines for supervised toothbrushing programs vary within and across countries due to differences in water fluoridation and availability of low fluoride toothpastes. The results of this review provide critical information to be considered when establishing and implementing toothbrushing programs in these settings. Copyright© 2017 Dennis Barber Ltd.

Development of a core set of quality indicators for paediatric primary care practices in Europe, COSI-PPC-EU.

PubMed

Ewald, Dominik A; Huss, Gottfried; Auras, Silke; Caceres, Juan Ruiz-Canela; Hadjipanayis, Adamos; Geraedts, Max

2018-06-01

Paediatric ambulatory healthcare systems in Europe are, because of historical reasons, diverse and show strikingly different outcomes. All across Europe, the benchmarking of structures, processes and outcomes could reveal opportunities for improving Paediatric Primary Care (PPC). The aim of this study was to develop a set of Quality Indicators (QIs) to assess and monitor PPC in Europe. In a three-step process, we used the available external evidence and European expert consensus in a modified RAND/UCLA Appropriateness Method (RAM) to develop an indicator set. (1) A broad literature and online research of published QI and guidelines yielded an inventory of 1516 QI. (2) A collaborative panel of paediatric senior experts from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) from 15 European countries participated in a first consensus process to reduce the initial indicator inventory by eliminating not PPC-focused indicators and duplicates. (3) In a second consensus process, the panel rated the QI regarding validity and feasibility. The final QI set "COSI-PPC-EU" consists of 42 indicators in five categories of PPC: (A) health promotion/prevention/screening (13 QI), (B) acute care (9 QI), (C) chronic care (8 QI), (D) practice management (3 QI) and (E) patient safety (9 QI). COSI-PPC-EU represents a consented set of a limited number of valid quality indicators for the application in paediatric primary care in different healthcare systems throughout Europe. What is Known: • Paediatric ambulatory healthcare systems in Europe are diverse and show strikingly different outcomes. • There are known gaps in quality performance measures of paediatric primary care in Europe. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. What is New: • A set of 42 quality indicators for primary paediatric care in Europe was developed in a multi-country collaborative effort. The method combined a systematic literature review and a consensus process among European paediatric experts. • The quality indicator set can facilitate quality improvement of PPC. After studying the feasibility, providers can use COSI-PPC-EU to monitor, compare and improve performance of practices, regions and countries.

Postmarketing surveillance in developing countries.

PubMed

Meirik, O

1988-01-01

Authorities in developing countries need to monitor the possible adverse consequences of the increasing use of drugs in their countries. Definite differences exist in the risk-benefit ratios for developed and developing countries, particularly with fertility-regulating drugs. Some physicians believe that the increased risk of thrombosis associated with oral contraceptives (OCs) should not be considered as important in developing countries due to the fact that the background level of venous thrombosis is so low in developing countries that even a 50- or 100-fold increase in relative risk would neither be detectable nor important compared to the risk of unwanted pregnancy. In addition, evidence exists of geographically linked factors in the etiology of some adverse drug reactions (ADRs). Authorities in Brazil, India, Indonesia, Pakistan, the Philippines, Thailand, and Venezuela have established voluntary ADR reporting systems. Several developing countries also actively follow the World Health Organization's International Drug Monitoring Program and have access to its data base. A number of other methodological approaches to postmarketing surveillance are in use in addition to voluntary ADR reporting systems. These include cross-sectional surveys, studies of temporal and geographic correlations of diseases and drug use, and case-control and cohort studies. Each of these approaches offers specific advantages. Postmarketing surveillance should begin at the time new drugs, including contraceptive methods are introduced. Surveillance needs to be an integral part of plans for the introduction of new contraceptive methods in settings where the infrastructure to carry out such surveillance is in place. 3 major public sector agencies, Family Health International, the Population Council, and the World Health Organization, developed a plan to obtain funding for the postmarketing surveillance of a contraceptive implant, Norplant-R. A controlled cohort study will be conducted in 6-10 developing countries. The pilot phase of the surveillance began in 1987. The project objective is to detect possible adverse effects of Norplant-R as well as any health benefits of the method. It also will assess the feasibility of the cohort methodology for postmarketing surveillance in developing countries.

The changing relationship between family size and educational attainment over the course of socioeconomic development: evidence from Indonesia.

PubMed

Maralani, Vida

2008-08-01

Many studies from developed countries show a negative correlation between family size and children's schooling, while results from developing countries show this association ranging from positive to neutral to negative, depending on the context. The body of evidence suggests that this relationship changes as a society develops, but this theory has been difficult to assess because the existing evidence requires comparisons across countries with different social structures and at different levels of development. The world's fourth most populous nation in 2007, Indonesia has developed rapidly in recent decades. This context provides the opportunity to study these relationships within the same rapidly developing setting to see if and how these associations change. Results show that in urban areas, the association between family size and children's schooling was positive for older cohorts but negative for more recent cohorts. Models using instrumental variables to address the potential endogeneity of fertility confirm these results. In contrast, rural areas show no significant association between family size and children's schooling for any cohort. These findings show how the relationship between family size and children's schooling can differ within the same country and change over time as contextual factors evolve with socioeconomic development.

Developing quality indicators for general practice care for vulnerable elders; transfer from US to The Netherlands.

PubMed

van der Ploeg, E; Depla, M F I A; Shekelle, P; Rigter, H; Mackenbach, J P

2008-08-01

Measurement of the quality of healthcare is a first step for quality improvement. To measure quality of healthcare, a set of quality indicators is needed. We describe the adaptation of a set of systematically developed US quality indicators for healthcare for vulnerable elders in The Netherlands. We also compare the US and the Dutch set to see if quality indicators can be transferred between countries, as has been done in two studies in the UK, with mixed results. 108 US quality indicators on GP care for vulnerable elders, covering eight conditions, were assessed by a panel of nine clinical experts in The Netherlands. A modified version of the RAND/UCLA appropriateness method was used. The panel members received US literature reviews, extended with more recent and Dutch literature, summarising the evidence for each quality indicator. 72 indicators (67% of US set) were (nearly) identical in the Dutch and US sets. For some conditions, this percentage was much lower. For undernutrition, only half of the US indicators were included in the Dutch set. For depression, many indicators were discarded or changed in a significant way, with the result that only five of the original 17 indicators (29%) are the same in the Dutch and the US set. Quality indicators can be transferred between countries, but with caution, because in two of the three studies on transferring indicators between the US and Europe, 33-44% of the indicators were discarded. For some conditions in the current study, this percentage is much higher. For undernutrition, there is hardly any evidence, and differences between the indicator sets can be attributed to differences in expert opinion between the countries. For depression, it seems that different evidence is considered important in the US and in The Netherlands, of which the Dutch body of knowledge is not known in the US.

Overcoming the Problems of Inconsistent International Migration data: A New Method Applied to Flows in Europe.

PubMed

de Beer, Joop; Raymer, James; van der Erf, Rob; van Wissen, Leo

2010-11-01

Due to differences in definitions and measurement methods, cross-country comparisons of international migration patterns are difficult and confusing. Emigration numbers reported by sending countries tend to differ from the corresponding immigration numbers reported by receiving countries. In this paper, a methodology is presented to achieve harmonised estimates of migration flows benchmarked to a specific definition of duration. This methodology accounts for both differences in definitions and the effects of measurement error due to, for example, under reporting and sampling fluctuations. More specifically, the differences between the two sets of reported data are overcome by estimating a set of adjustment factors for each country's immigration and emigration data. The adjusted data take into account any special cases where the origin-destination patterns do not match the overall patterns. The new method for harmonising migration flows that we present is based on earlier efforts by Poulain (European Journal of Population, 9(4): 353-381 1993, Working Paper 12, joint ECE-Eurostat Work Session on Migration Statistics, Geneva, Switzerland 1999) and is illustrated for movements between 19 European countries from 2002 to 2007. The results represent a reliable and consistent set of international migration flows that can be used for understanding recent changes in migration patterns, as inputs into population projections and for developing evidence-based migration policies.

Lessons learned from the casualties of war: battlefield medicine and its implication for global trauma care

PubMed Central

Boyle, Peter; Autier, Philippe; van Wees, Sibylle Herzig; Sullivan, Richard

2015-01-01

Summary According to the Global Burden of Disease, trauma is now responsible for five million deaths each year. High-income countries have made great strides in reducing trauma-related mortality figures but low–middle-income countries have been left behind with high trauma-related fatality rates, primarily in the younger population. Much of the progress high-income countries have made in managing trauma rests on advances developed in their armed forces. This analysis looks at the recent advances in high-income military trauma systems and the potential transferability of those developments to the civilian health systems particularly in low–middle-income countries. It also evaluates some potential lifesaving trauma management techniques, proven effective in the military, and the barriers preventing these from being implemented in civilian settings. PMID:25792616

Helping public sector health systems innovate: the strategic approach to strengthening reproductive health policies and programs.

PubMed

Fajans, Peter; Simmons, Ruth; Ghiron, Laura

2006-03-01

Public sector health systems that provide services to poor and marginalized populations in developing countries face great challenges. Change associated with health sector reform and structural adjustment often leaves these already-strained institutions with fewer resources and insufficient capacity to relieve health burdens. The Strategic Approach to Strengthening Reproductive Health Policies and Programs is a methodological innovation developed by the World Health Organization and its partners to help countries identify and prioritize their reproductive health service needs, test appropriate interventions, and scale up successful innovations to a subnational or national level. The participatory, interdisciplinary, and country-owned process can set in motion much-needed change. We describe key features of this approach, provide illustrations from country experiences, and use insights from the diffusion of innovation literature to explain the approach's dissemination and sustainability.

Building Futures Scenarios for Universities and Higher Education: An International Approach

ERIC Educational Resources Information Center

Vincent-Lancrin, Stephan

2004-01-01

The article presents a set of scenarios for universities and higher education in the Organisation for Economic Cooperation and Development (OECD) area. The first section gives a brief overview of the main forces currently at play in higher education in OECD countries, setting the context in which speculation about the future takes place. The…

Could Australia Have Its Own Teacher Professional Standards for Teaching Relationships and Sexuality Education?

ERIC Educational Resources Information Center

Collier-Harris, Christine A.; Goldman, Juliette D. G.

2017-01-01

In many countries, there are no professional standards determining attributes, praxis, effectiveness and evaluation for teachers of relationships and sexuality education in schools. However, in the USA, a new set of pre-service teacher preparation standards has been developed for sexuality education and health. Australia has a set of generic…

Testing of English in India: A Developing Concept

ERIC Educational Resources Information Center

Ramanathan, Hema

2008-01-01

English is the associate official language in India and serves as a unifying force in this multilingual country. The teaching of English in K-12 settings focuses on the skills of reading and writing. Listening and speaking skills are not awarded much time, if any, in most classrooms or test settings; only two Boards of Examinations mandate their…

Population education in Africa South of Sahara.

PubMed

1985-01-01

This book discusses the strategy of the systematic introduction of population and family life education programs into the education systems of developing countries. The objectives of this type of education are not only to create awareness among learners of the linkages between population factors and peoples's standards of living, but also to encourage national decision-making and actions in ways that are personally meaningful and socially desirable. This issue presents a number of ideas from practitioners in the population and family life education field concerning suitable approaches for developing population education programs to make them respond positively to the needs of developing countries, particularly in Africa. It also presents country, regional, and agency-level field experiences to show the dimensions of the field as well as the strengths and weaknesses of the technics adopted in implementing the programs. The articles are presented in 3 parts: 1) planning, development, and pedagogy; 2) experiences at the country, regional, and agency levels; and 3) 3 sets of recommendations in recent years that have a direct relevance to the development of population eudcation programs in sub-Saharan Africa.

Developmental Inventories Using Illiterate Parents as Informants: Communicative Development Inventory (CDI) Adaptation for Two Kenyan Languages

ERIC Educational Resources Information Center

Alcock, K. J.; Rimba, K.; Holding, P.; Kitsao-Wekulo, P.; Abubakar, A.; Newton, C. R. J. C.

2015-01-01

Communicative Development Inventories (CDIs, parent-completed language development checklists) are a helpful tool to assess language in children who are unused to interaction with unfamiliar adults. Generally, CDIs are completed in written form, but in developing country settings parents may have insufficient literacy to complete them alone. We…

Dying from cancer in developed and developing countries: lessons from two qualitative interview studies of patients and their carers

PubMed Central

Murray, Scott A; Grant, Elizabeth; Grant, Angus; Kendall, Marilyn

2003-01-01

Objective To describe the experiences of illness and needs and use of services in two groups of patients with incurable cancer, one in a developed country and the other in a developing country. Design Scotland: longitudinal study with qualitative interviews. Kenya: cross sectional study with qualitative interviews. Settings Lothian region, Scotland, and Meru District, Kenya. Participants Scotland: 20 patients with inoperable lung cancer and their carers. Kenya: 24 patients with common advanced cancers and their main informal carers. Main outcome measures Descriptions of experiences, needs, and available services. Results 67 interviews were conducted in Scotland and 46 in Kenya. The emotional pain of facing death was the prime concern of Scottish patients and their carers, while physical pain and financial worries dominated the lives of Kenyan patients and their carers. In Scotland, free health and social services (including financial assistance) were available, but sometimes underused. In Kenya, analgesia, essential equipment, suitable food, and assistance in care were often inaccessible and unaffordable, resulting in considerable unmet physical needs. Kenyan patients thought that their psychological, social, and spiritual needs were met by their families, local community, and religious groups. Some Scottish patients thought that such non-physical needs went unmet. Conclusions In patients living in developed and developing countries there are differences not only in resources available for patients dying from cancer but also in their lived experience of illness. The expression of needs and how they are met in different cultural contexts can inform local assessment of needs and provide insights for initiatives in holistic cancer care. What is already known on this topic?Cancer treatment is a priority and is well developed in the United KingdomThere is an increasing burden on inadequately funded health services in developing countriesWhat this study addsThe experience of dying from cancer in Scotland contrasts starkly with that experienced in KenyaInequalities in provision of palliative care persist between developed and developing countriesDespite the availability of resources in the United Kingdom, people still have major areas of unmet needsConsideration of patients' experiences and provision of care in contrasting cultural settings can highlight gaps in frameworks of cancer care PMID:12586671

How countries cope with competing demands and expectations: perspectives of different stakeholders on priority setting and resource allocation for health in the era of HIV and AIDS

PubMed Central

2012-01-01

Background Health systems have experienced unprecedented stress in recent years, and as yet no consensus has emerged as to how to deal with the multiple burden of disease in the context of HIV and AIDS and other competing health priorities. Priority setting is essential, yet this is a complex, multifaceted process. Drawing on a study conducted in five African countries, this paper explores different stakeholders′ perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and Health and how different stakeholders perceive this. Methods A sub-analysis was conducted of selected data from a wider qualitative study that explored the interactions between health systems and HIV and AIDS responses in five sub-Saharan countries (Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi). Key background documents were analysed and semi-structured interviews (n = 258) and focus group discussions (n = 45) were held with representatives of communities, health personnel, decision makers, civil society representatives and development partners at both national and district level. Results Health priorities were expressed either in terms of specific health problems and diseases or gaps in service delivery requiring a strengthening of the overall health system. In all five countries study respondents (with the exception of community members in Ghana) identified malaria and HIV as the two top health priorities. Community representatives were more likely to report concerns about accessibility of services and quality of care. National level respondents often referred to wider systemic challenges in relation to achieving the Millennium Development Goals (MDGs). Indeed, actual priority setting was heavily influenced by international agendas (e.g. MDGs) and by the ways in which development partners were supporting national strategic planning processes. At the same time, multi-stakeholder processes were increasingly used to identify priorities and inform sector-wide planning, whereby health service statistics were used to rank the burden of disease. However, many respondents remarked that health system challenges are not captured by such statistics. In all countries funding for health was reported to fall short of requirements and a need for further priority setting to match actual resource availability was identified. Pooled health sector funds have been established to some extent, but development partners′ lack of flexibility in the allocation of funds according to country-generated priorities was identified as a major constraint. Conclusions Although we found consensus on health priorities across all levels in the study countries, current funding falls short of addressing these identified areas. The nature of external funding, as well as programme-specific investment, was found to distort priority setting. There are signs that existing interventions have had limited effects beyond meeting the needs of disease-specific programmes. A need for more comprehensive health system strengthening (HSS) was identified, which requires a strong vision as to what the term means, coupled with a clear strategy and commitment from national and international decision makers in order to achieve stated goals. Prospective studies and action research, accompanied by pilot programmes, are recommended as deliberate strategies for HSS. PMID:23231820

How countries cope with competing demands and expectations: perspectives of different stakeholders on priority setting and resource allocation for health in the era of HIV and AIDS.

PubMed

Jenniskens, Françoise; Tiendrebeogo, Georges; Coolen, Anne; Blok, Lucie; Kouanda, Seni; Sataru, Fuseini; Ralisimalala, Andriamampianina; Mwapasa, Victor; Kiyombo, Mbela; Plummer, David

2012-12-11

Health systems have experienced unprecedented stress in recent years, and as yet no consensus has emerged as to how to deal with the multiple burden of disease in the context of HIV and AIDS and other competing health priorities. Priority setting is essential, yet this is a complex, multifaceted process. Drawing on a study conducted in five African countries, this paper explores different stakeholders' perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and Health and how different stakeholders perceive this. A sub-analysis was conducted of selected data from a wider qualitative study that explored the interactions between health systems and HIV and AIDS responses in five sub-Saharan countries (Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi). Key background documents were analysed and semi-structured interviews (n = 258) and focus group discussions (n = 45) were held with representatives of communities, health personnel, decision makers, civil society representatives and development partners at both national and district level. Health priorities were expressed either in terms of specific health problems and diseases or gaps in service delivery requiring a strengthening of the overall health system. In all five countries study respondents (with the exception of community members in Ghana) identified malaria and HIV as the two top health priorities. Community representatives were more likely to report concerns about accessibility of services and quality of care. National level respondents often referred to wider systemic challenges in relation to achieving the Millennium Development Goals (MDGs). Indeed, actual priority setting was heavily influenced by international agendas (e.g. MDGs) and by the ways in which development partners were supporting national strategic planning processes. At the same time, multi-stakeholder processes were increasingly used to identify priorities and inform sector-wide planning, whereby health service statistics were used to rank the burden of disease. However, many respondents remarked that health system challenges are not captured by such statistics.In all countries funding for health was reported to fall short of requirements and a need for further priority setting to match actual resource availability was identified. Pooled health sector funds have been established to some extent, but development partners' lack of flexibility in the allocation of funds according to country-generated priorities was identified as a major constraint. Although we found consensus on health priorities across all levels in the study countries, current funding falls short of addressing these identified areas. The nature of external funding, as well as programme-specific investment, was found to distort priority setting. There are signs that existing interventions have had limited effects beyond meeting the needs of disease-specific programmes. A need for more comprehensive health system strengthening (HSS) was identified, which requires a strong vision as to what the term means, coupled with a clear strategy and commitment from national and international decision makers in order to achieve stated goals. Prospective studies and action research, accompanied by pilot programmes, are recommended as deliberate strategies for HSS.

The global cancer burden and human development: A review.

PubMed

Fidler, Miranda M; Bray, Freddie; Soerjomataram, Isabelle

2018-02-01

This review examines the links between human development and cancer overall and for specific types of cancer, as well as cancer-related risk-factors and outcomes, such as disability and life expectancy. To assess human development, the Human Development Index was utilized continuously and according to four levels (low, medium, high, very high), where the low and very high categories include the least and most developed countries, respectively. All studies that assessed aspects of the global cancer burden using this measure were reviewed. Although the present cancer incidence burden is greater in higher Human Development Index countries, a greater proportion of the global mortality burden is observed in less developed countries, with a higher mean fatality rate in the latter countries. Further, the future cancer burden is expected to disproportionally affect less developed regions; in particular, it has been estimated that low and medium Human Development Index countries will experience a 100% and 81% increase in cancer incidence from 2008 to 2030, respectively. Disparities were also observed in risk factors and average health outcomes, such as a greater number of years of life lost prematurely and fewer cancer-related gains in life expectancy observed in lower versus higher Human Development Index settings. From a global perspective, there remain clear disparities in the cancer burden according to national Human Development Index scores. International efforts are needed to aid countries in social and economic transition in order to efficiently plan, implement and evaluate cancer control initiatives as a means to reduce the widening gap in cancer occurrence and survival worldwide.

An Energy Overview of the Kingdom of Thailand

DOE Office of Scientific and Technical Information (OSTI.GOV)

anon.

The DOE Office of Fossil Energy is maintaining a web site that is meant to provide useful business- and energy-related information about countries and regions of the world for exporters, project developers, and researchers. The site consists of more than 130 country pages (organized into seven different world regions), with each country page having its own set of links to information sources about that country. There are also more than 30 Country Energy Overviews at the web site -- each of these is a comprehensive review of a specific country's entire energy situation, including sections on Energy Policy, Oil, Naturalmore » Gas, Coal, Hydroelectric/Renewables, Nuclear Power, Energy Transmission Infrastructure, Electricity, Electric Industry Overview, Environmental Activities, Privatization, Trade, and Economic Situation. The specific country highlighted in this Country Energy Overview is Thailand. The site is designed to be dynamic. Updates to the overviews will be made as need and resource s permit.« less

An Energy Overview of the Republic of Egypt

DOE Office of Scientific and Technical Information (OSTI.GOV)

anon.

2003-10-17

The DOE Office of Fossil Energy is maintaining a web site that is meant to provide useful business- and energy-related information about countries and regions of the world for exporters, project developers, and researchers. The site consists of more than 130 country pages (organized into seven different world regions), with each country page having its own set of links to information sources about that country. There are also more than 30 Country Energy Overviews at the web site -- each of these is a comprehensive review of a specific country's entire energy situation, including sections on Energy Policy, Oil, Naturalmore » Gas, Coal, Hydroelectric/Renewables, Nuclear Power, Energy Transmission Infrastructure, Electricity, Electric Industry Overview, Environmental Activities, Privatization, Trade, and Economic Situation. The specific country highlighted in this Country Energy Overview is Egypt. The site is designed to be dynamic. Updates to the overviews will be made as need and resources permit.« less

An Energy Overview of Romania

DOE Office of Scientific and Technical Information (OSTI.GOV)

anon.

2003-10-20

The DOE Office of Fossil Energy is maintaining a web site that is meant to provide useful business- and energy-related information about countries and regions of the world for exporters, project developers, and researchers. The site consists of more than 130 country pages (organized into seven different world regions), with each country page having its own set of links to information sources about that country. There are also more than 30 Country Energy Overviews at the web site -- each of these is a comprehensive review of a specific country's entire energy situation, including sections on Energy Policy, Oil, Naturalmore » Gas, Coal, Hydroelectric/Renewables, Nuclear Power, Energy Transmission Infrastructure, Electricity, Electric Industry Overview, Environmental Activities, Privatization, Trade, and Economic Situation. The specific country highlighted in this Country Energy Overview is Romania. The site is designed to be dynamic. Updates to the overviews will be made as need and resources permit.« less

An Energy Overview of Venezuela

DOE Office of Scientific and Technical Information (OSTI.GOV)

anon.

2003-10-20

The DOE Office of Fossil Energy is maintaining a web site that is meant to provide useful business- and energy-related information about countries and regions of the world for exporters, project developers, and researchers. The site consists of more than 130 country pages (organized into seven different world regions), with each country page having its own set of links to information sources about that country. There are also more than 30 Country Energy Overviews at the web site -- each of these is a comprehensive review of a specific country's entire energy situation, including sections on Energy Policy, Oil, Naturalmore » Gas, Coal, Hydroelectric/Renewables, Nuclear Power, Energy Transmission Infrastructure, Electricity, Electric Industry Overview, Environmental Activities, Privatization, Trade, and Economic Situation. The specific country highlighted in this Country Energy Overview is Venezuela. The site is designed to be dynamic. Updates to the overviews will be made as need and resources permit.« less

An Energy Overview of the Czech Republic

DOE Office of Scientific and Technical Information (OSTI.GOV)

anon.

2003-10-17

The DOE Office of Fossil Energy is maintaining a web site that is meant to provide useful business- and energy-related information about countries and regions of the world for exporters, project developers, and researchers. The site consists of more than 130 country pages (organized into seven different world regions), with each country page having its own set of links to information sources about that country. There are also more than 30 Country Energy Overviews at the web site -- each of these is a comprehensive review of a specific country's entire energy situation, including sections on Energy Policy, Oil, Naturalmore » Gas, Coal, Hydroelectric/Renewables, Nuclear Power, Energy Transmission Infrastructure, Electricity, Electric Industry Overview, Environmental Activities, Privatization, Trade, and Economic Situation. The specific country highlighted in this Country Energy Overview is the Czech Republic. The site is designed to be dynamic. Updates to the overviews will be made as need an d resources permit.« less

An Energy Overview of Argentina

DOE Office of Scientific and Technical Information (OSTI.GOV)

anon.

2003-10-20

The DOE Office of Fossil Energy is maintaining a web site that is meant to provide useful business- and energy-related information about countries and regions of the world for exporters, project developers, and researchers. The site consists of more than 130 country pages (organized into seven different world regions), with each country page having its own set of links to information sources about that country. There are also more than 30 Country Energy Overviews at the web site -- each of these is a comprehensive review of a specific country's entire energy situation, including sections on Energy Policy, Oil, Naturalmore » Gas, Coal, Hydroelectric/Renewables, Nuclear Power, Energy Transmission Infrastructure, Electricity, Electric Industry Overview, Environmental Activities, Privatization, Trade, and Economic Situation. The specific country highlighted in this Country Energy Overview is Argentina. The site is designed to be dynamic. Updates to the overviews will be made as need and resources permit.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

anon.

The DOE Office of Fossil Energy is maintaining a web site that is meant to provide useful business- and energy-related information about countries and regions of the world for exporters, project developers, and researchers. The site consists of more than 130 country pages (organized into seven different world regions), with each country page having its own set of links to information sources about that country. There are also more than 30 Country Energy Overviews at the web site--each of these is a comprehensive review of a specific country's entire energy situation, including sections on Energy Policy, Oil, Natural Gas, Coal,more » Hydroelectric/Renewables, Nuclear Power, Energy Transmission Infrastructure, Electricity, Electric Industry Overview, Environmental Activities, Privatization, Trade, and Economic Situation. The specific country highlighted in this Country Energy Overview is Colombia. The site is designed to be dynamic. Updates to the overviews will be made as need and resources permit.« less

An Energy Overview of the Republic of Poland

DOE Office of Scientific and Technical Information (OSTI.GOV)

anon.

The DOE Office of Fossil Energy is maintaining a web site that is meant to provide useful business- and energy-related information about countries and regions of the world for exporters, project developers, and researchers. The site consists of more than 130 country pages (organized into seven different world regions), with each country page having its own set of links to information sources about that country. There are also more than 30 Country Energy Overviews at the web site -- each of these is a comprehensive review of a specific country's entire energy situation, including sections on Energy Policy, Oil, Naturalmore » Gas, Coal, Hydroelectric/Renewables, Nuclear Power, Energy Transmission Infrastructure, Electricity, Electric Industry Overview, Environmental Activities, Privatization, Trade, and Economic Situation. The specific country highlighted in this Country Energy Overview is Poland. The site is designed to be dynamic. Updates to the overviews will be made as need and resources permit.« less

Research during medical school: is it particularly difficult in developing countries compared to developed countries?

PubMed Central

Siddaiah-Subramanya, Manjunath; Singh, Harveen; Tiang, Kor Woi

2017-01-01

Objectives Medical student involvement in research has been declining over the years. We reviewed the factors that hinder participation in research with a focus on developing countries. Methods Literature search was performed using PubMed, MEDLINE and Cochrane Library. Peer-reviewed articles published between 1995 and 2017 were screened for relevance to identify key factors affecting medical student involvement in research with a particular focus on developing world. Analytical review is presented here in this article in relation to commonly reported aspects related to research during medical school. Results This search revealed varied contributing factors that hinder students’ growth and interest in research. It commonly highlighted few aspects in relation to research during medical school, and they were “variability in research uptake among students and issues related to them, their knowledge and attitude toward research and organizational input and its influence on students”. Conclusion While early introduction to research by inculcating a mindset aimed at research has been proposed, it has not been seen in practice during either the medical school or beyond to an extent that was expected. It appears that developing countries, while they share some of the reasons with developed countries, have their own set of difficulties, which are influenced by culture, beliefs and priorities. PMID:29180910

Social capital and health in the least developed countries: A critical review of the literature and implications for a future research agenda

PubMed Central

Story, William T.

2015-01-01

Research on the linkage between social capital and health has grown in recent years; however, there is a dearth of evidence from resource-poor countries. This review examines the association between social capital and physical health (including health behaviours) in the least developed countries (LDCs). Citations were searched using three databases from 1990 to 2011 using the keyword ‘social capital’ combined with the name of each of the 48 LDCs. Of the 14 studies reviewed, 12 took place in Africa and two in South Asia. All used cross-sectional study designs, including five qualitative and nine quantitative studies. The literature reviewed suggests that social capital is an important factor for improving health in resource-poor settings; however, more research is needed in order to determine the best measures for social capital and elucidate the mechanisms through which social capital affects health in the developing world. Future research on social capital and health in the developing world should focus on applying appropriate theoretical conceptualizations of social capital to the developing country context, adapting and validating instruments for measuring social capital, and examining multilevel models of social capital and health in developing countries. PMID:24172027

Group Occupational Health Service in a Developing Country

PubMed Central

de Glanville, H.

1970-01-01

In 1967 an experimental group occupational health service was set up in Dar es Salaam to provide direct service to industrial firms. Larger companies were visited by a doctor, smaller firms in rotation by auxiliaries. After three years 65 companies had joined with over 15,000 employees, and workers were attending the group dispensaries at a rate of over 250,000 visits a year. Such an approach through direct service to the working community appears to be more appropriate to a developing country than a purely advisory central occupational health unit. PMID:5483327

Staphylococcus aureus disease and drug resistance in resource-limited countries in south and east Asia.

PubMed

Nickerson, Emma K; West, T Eoin; Day, Nicholas P; Peacock, Sharon J

2009-02-01

By contrast with high-income countries, Staphylococcus aureus disease ranks low on the public-health agenda in low-income countries. We undertook a literature review of S aureus disease in resource-limited countries in south and east Asia, and found that its neglected status as a developing world pathogen does not equate with low rates of disease. The incidence of the disease seems to be highest in neonates, its range of clinical manifestations is as broad as that seen in other settings, and the mortality rate associated with serious S aureus infection, such as bacteraemia, is as high as 50%. The prevalence of meticillin-resistant S aureus (MRSA) infection across much of resource-limited Asia is largely unknown. Antibiotic drugs are readily and widely available from pharmacists in most parts of Asia, where ease of purchase and frequent self-medication are likely to be major drivers in the emergence of drug resistance. In our global culture, the epidemiology of important drug-resistant pathogens in resource-limited countries is inextricably linked with the health of both developing and developed communities. An initiative is needed to raise the profile of S aureus disease in developing countries, and to define a programme of research to find practical solutions to the health-care challenges posed by this important global pathogen.

A case study of polypharmacy management in nine European countries: Implications for change management and implementation.

PubMed

McIntosh, Jennifer; Alonso, Albert; MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt

2018-01-01

Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.

Multi-criteria decision analysis of breast cancer control in low- and middle- income countries: development of a rating tool for policy makers.

PubMed

Venhorst, Kristie; Zelle, Sten G; Tromp, Noor; Lauer, Jeremy A

2014-01-01

The objective of this study was to develop a rating tool for policy makers to prioritize breast cancer interventions in low- and middle- income countries (LMICs), based on a simple multi-criteria decision analysis (MCDA) approach. The definition and identification of criteria play a key role in MCDA, and our rating tool could be used as part of a broader priority setting exercise in a local setting. This tool may contribute to a more transparent priority-setting process and fairer decision-making in future breast cancer policy development. First, an expert panel (n = 5) discussed key considerations for tool development. A literature review followed to inventory all relevant criteria and construct an initial set of criteria. A Delphi study was then performed and questionnaires used to discuss a final list of criteria with clear definitions and potential scoring scales. For this Delphi study, multiple breast cancer policy and priority-setting experts from different LMICs were selected and invited by the World Health Organization. Fifteen international experts participated in all three Delphi rounds to assess and evaluate each criterion. This study resulted in a preliminary rating tool for assessing breast cancer interventions in LMICs. The tool consists of 10 carefully crafted criteria (effectiveness, quality of the evidence, magnitude of individual health impact, acceptability, cost-effectiveness, technical complexity, affordability, safety, geographical coverage, and accessibility), with clear definitions and potential scoring scales. This study describes the development of a rating tool to assess breast cancer interventions in LMICs. Our tool can offer supporting knowledge for the use or development of rating tools as part of a broader (MCDA based) priority setting exercise in local settings. Further steps for improving the tool are proposed and should lead to its useful adoption in LMICs.

National treatment systems in global perspective.

PubMed

Klingemann, H

1999-09-01

Drug policy development is mostly viewed as emerging within the nation state. Processes of diffusion of innovative policies have been neglected to a large extent. The comparative study of public policy has demonstrated, however, that diffusion is an important predictor of early policy adaptation. Thus, the analysis asks the general question of the relative importance of endogenous and exogenous effects on the development of drug policies in various countries. Specifically it describes the Swiss debate leading to the popular initiative on 'Youth Without Drugs' as well as the international reactions regarding its liberal outcome. Results of an expert survey show two broad types of reactions. There is one set of countries where chances for the introduction of limited heroin-prescription trials during the next 5 years are considered probable and a second set of countries which seems to be strictly status quo oriented. In the concluding section a model is suggested which systematically considers endogenous as well as exogenous predictors of 'soft' or 'hard' drug policy adoption. Results of a first tentative test of the model are encouraging for future empirical research on diffusion processes of drug policies.

Criteria for implementing interventions to reduce health inequalities in primary care settings in European regions.

PubMed

Daponte, Antonio; Bernal, Mariola; Bolívar, Julia; Mateo, Inmaculada; Salmi, Louis-Rachid; Barsanti, Sara; Berghmans, Luc; Piznal, Ewelina; Bourgueil, Yann; Marquez, Soledad; González, Ingrid; Carriazo, Ana; Maros-Szabo, Zsuzsanna; Ménival, Solange

2014-12-01

The current social and political context is generating socio-economic inequalities between and within countries, causing and widening health inequalities. The development and implementation of interventions in primary health care (PHC) settings seem unavoidable. Attempts have been made to draw up adequate criteria to guide and evaluate interventions but none for the specific case of PHC. This methodological article aims to contribute to this field by developing and testing a set of criteria for guiding and evaluating real-life interventions to reduce health inequalities in PHC settings in European regions. A literature review, nominal group technique, survey and evaluation template were used to design and test a set of criteria. The questionnaire was answered by professionals in charge of 46 interventions carried out in 12 European countries, and collected detailed information about each intervention. Third-party experts scored the interventions using the set of evaluation criteria proposed. Nine criteria to guide and evaluate interventions were proposed: relevance, appropriateness, applicability, innovation, quality assurance, adequacy of resources, effectiveness in the process, effectiveness in results and mainstreaming. A working definition was drawn up for each one. These criteria were then used to evaluate the interventions identified. The set of criteria drawn up to guide the design, implementation and evaluation of interventions to reduce health inequalities in PHC will be a useful instrument to be applied to interventions under development for culturally, politically and socio-economically diverse PHC contexts throughout Europe. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Predictors of Desire to Institutionalization in Dementia Caregivers From a Developing Country.

PubMed

Sinha, Preeti; Yohannan, Sherin; Thirumoorthy, A; Sivakumar, Palanimuthu Thangaraju

2017-08-01

Older adults with dementia have higher rates of institutionalization than those without dementia. Desire to institutionalization (DTI) is an important factor influencing the actual institutionalization but is less well studied. This cross-sectional study examines the DTI with the scale of same name developed by Morycz, in 1985, in a sample of 50 caregivers of patients with dementia in a tertiary clinical care setting in a developing country. Caregiver burden associated with personal strain (by factor analyzed Zarit Burden Interview scale), and stress perceived out of caregiving (by Perceived Stress Scale) predicted higher DTI. Besides, those who were married had lower DTI scores. The factors which didn't affect DTI were total caregiver burden, family and social support, age of patient and caregiver, education of caregiver, severity and duration of dementia, and treatment duration. These results were different from those of developed country-based DTI studies and may indicate sociocultural differences.

Exclusionary policies in urban development: Under-servicing migrant households in Brazilian cities

PubMed Central

Feler, Leo; Henderson, J. Vernon

2012-01-01

Localities in developed countries often enact regulations to deter low-income households from moving in. In developing countries, such restrictions lead to the emergence of informal housing sectors. To deter low-income migrants, localities in developing countries withhold public services to the informal housing sector. Using a large sample of Brazilian localities, we examine migration and exclusion, focusing on the public provision of water to small houses where low-income migrants are likely to live. Withholding water connections reduces the locality growth rate, particularly of low-education households. In terms of service provision, during dictatorship in Brazil, we find evidence of strategic exclusion, where localities appear to withhold services to deter in-migration. We also find evidence of strategic interactions among localities within metro areas in their setting of service levels: if one locality provides more services to migrant households, other localities respond by withholding service. PMID:22707807

[An overview of telehealth initiatives in Latin America].

PubMed

dos Santos, Alaneir de Fátima; D'Agostino, Marcelo; Bouskela, Maurício Simon; Fernandéz, Andrés; Messina, Luiz Ary; Alves, Humberto José

2014-01-01

This article aimed to systematize the views on telehealth in Latin America and to present the experience of building an instrument for monitoring the development of telehealth initiatives based on the reality of this region. A group was structured to coordinate telehealth efforts in Latin America, with members appointed by the ministries of health of 16 countries. Five thematic groups were also set up. Based on international experiences and focusing on the reality of telehealth in the continent, an instrument was created to monitor the development of telehealth in Latin America. Several countries have national telehealth projects: Brazil, Colombia, Ecuador, Mexico, Panama. Others are in the process of development and early deployment: Bolivia, Costa Rica, Cuba, El Salvador, Guatemala, Peru, Venezuela. The instrument described in the article, which is still being tested, proposes a characterization of countries according to their telehealth development stage: nonexistent, nascent, intermediate, advanced, and exemplary. Currently, important telehealth initiatives are already underway in Latin America.

Reflections on the development of health economics in low- and middle-income countries

PubMed Central

Mills, Anne

2014-01-01

Health economics is a relatively new discipline, though its antecedents can be traced back to William Petty FRS (1623–1687). In high-income countries, the academic discipline and scientific literature have grown rapidly since the 1960s. In low- and middle-income countries, the growth of health economics has been strongly influenced by trends in health policy, especially among the international and bilateral agencies involved in supporting health sector development. Valuable and influential research has been done in areas such as cost–benefit and cost-effectiveness analysis, financing of healthcare, healthcare provision, and health systems analysis, but there has been insufficient questioning of the relevance of theories and policy recommendations in the rich world literature to the circumstances of poorer countries. Characteristics such as a country's economic structure, strength of political and social institutions, management capacity, and dependence on external agencies, mean that theories and models cannot necessarily be transferred between settings. Recent innovations in the health economics literature on low- and middle-income countries indicate how health economics can be shaped to provide more relevant advice for policy. For this to be taken further, it is critical that such countries develop stronger capacity for health economics within their universities and research institutes, with greater local commitment of funding. PMID:25009059

Large-scale road safety programmes in low- and middle-income countries: an opportunity to generate evidence.

PubMed

Hyder, Adnan A; Allen, Katharine A; Peters, David H; Chandran, Aruna; Bishai, David

2013-01-01

The growing burden of road traffic injuries, which kill over 1.2 million people yearly, falls mostly on low- and middle-income countries (LMICs). Despite this, evidence generation on the effectiveness of road safety interventions in LMIC settings remains scarce. This paper explores a scientific approach for evaluating road safety programmes in LMICs and introduces such a road safety multi-country initiative, the Road Safety in 10 Countries Project (RS-10). By building on existing evaluation frameworks, we develop a scientific approach for evaluating large-scale road safety programmes in LMIC settings. This also draws on '13 lessons' of large-scale programme evaluation: defining the evaluation scope; selecting study sites; maintaining objectivity; developing an impact model; utilising multiple data sources; using multiple analytic techniques; maximising external validity; ensuring an appropriate time frame; the importance of flexibility and a stepwise approach; continuous monitoring; providing feedback to implementers, policy-makers; promoting the uptake of evaluation results; and understanding evaluation costs. The use of relatively new approaches for evaluation of real-world programmes allows for the production of relevant knowledge. The RS-10 project affords an important opportunity to scientifically test these approaches for a real-world, large-scale road safety evaluation and generate new knowledge for the field of road safety.

Influence of birth rates and transmission rates on the global seasonality of rotavirus incidence.

PubMed

Pitzer, Virginia E; Viboud, Cécile; Lopman, Ben A; Patel, Manish M; Parashar, Umesh D; Grenfell, Bryan T

2011-11-07

Rotavirus is a major cause of mortality in developing countries, and yet the dynamics of rotavirus in such settings are poorly understood. Rotavirus is typically less seasonal in the tropics, although recent observational studies have challenged the universality of this pattern. While numerous studies have examined the association between environmental factors and rotavirus incidence, here we explore the role of intrinsic factors. By fitting a mathematical model of rotavirus transmission dynamics to published age distributions of cases from 15 countries, we obtain estimates of local transmission rates. Model-predicted patterns of seasonal incidence based solely on differences in birth rates and transmission rates are significantly correlated with those observed (Spearman's ρ = 0.65, p < 0.05). We then examine seasonal patterns of rotavirus predicted across a range of different birth rates and transmission rates and explore how vaccination may impact these patterns. Our results suggest that the relative lack of rotavirus seasonality observed in many tropical countries may be due to the high birth rates and transmission rates typical of developing countries rather than being driven primarily by environmental conditions. While vaccination is expected to decrease the overall burden of disease, it may increase the degree of seasonal variation in the incidence of rotavirus in some settings.

Diffusion of counterfeit drugs in developing countries and stability of galenics stored for months under different conditions of temperature and relative humidity.

PubMed

Baratta, Francesca; Germano, Antonio; Brusa, Paola

2012-04-01

To investigate the diffusion of counterfeit medicines in developing countries and to verify the stability of galenic dosage forms to determine the stability of galenics prepared and stored in developing countries. We purchased 221 pharmaceutical samples belonging to different therapeutic classes both in authorized and illegal pharmacies and subjected them to European Pharmacopoeia, 7th ed. quality tests. An UV-visible spectrophotometric assay was used to determine the galenics stability under different conditions of temperature (T) and relative humidity (RH). A substantial percentage of samples was substandard (52%) and thus had to be considered as counterfeit. Stability tests for galenics showed that the tested dosage forms were stable for 24 months under "standard" (t=25±2°C, RH=50±5%) conditions. Under "accelerated" (t=40±2°C, RH=50±5%) conditions, samples were stable for 3 months provided that they were stored in glass containers. Stability results of samples stored in "accelerated" conditions were similar to those obtained by on site in tropical countries and could so supply precious information on the expected stability of galenics in tropical countries. This study gives useful information about the presence of counterfeit medicinal products in the pharmacies of many developing countries. This should serve as an alarm bell and an input for the production of galenics. We recommend setting up of galenic laboratories in developing countries around the globe.

Social, economic, and political factors in progress towards improving child survival in developing nations.

PubMed

Lykens, Kristine; Singh, Karan P; Ndukwe, Elewichi; Bae, Sejong

2009-01-01

Child mortality is a persistent health problem faced by developing nations. In 2000 the United Nations (UN) established a set of high priority goals to address global problems of poverty and health, the Millennium Development Goals, which address extreme poverty, hunger, primary education, child mortality, maternal health, infectious diseases, environmental sustainability, and partnerships for development. Goal 4 aims to reduce by two thirds, between 2000 and 2015, the under-five mortality rate in developing countries. In sub-Saharan Africa from 2000 to 2006 these rates have only been reduced from 167 per 1,000 live births to 157, and 27 nations in this region have made no progress towards the goal. A country-specific database was developed from the UN Millennium Development Goal tracking project and other international sources which include age distribution, under-nutrition, per capita income, government expenditures on health, external resources for health, civil liberties, and political rights. A multiple regression analysis examined the extent to which these factors explain the variance in child mortality rates in developing countries. Nutrition, external resources, and per capita income were shown to be significant factors in child survivability. Policy options include developed countries' renewed commitment of resources, and developing nations' commitments towards governance, development, equity, and transparency.

Disease management index of potential years of life lost as a tool for setting priorities in national disease control using OECD health data.

PubMed

Jang, Sung-In; Nam, Jung-Mo; Choi, Jongwon; Park, Eun-Cheol

2014-03-01

Limited healthcare resources make it necessary to maximize efficiency in disease management at the country level by priority-setting according to disease burden. To make the best priority settings, it is necessary to measure health status and have standards for its judgment, as well as consider disease management trends among nations. We used 17 International Classification of Diseases (ICD) categories of potential years of life lost (YPLL) from Organization for Economic Co-operation and Development (OECD) health data for 2012, 37 disease diagnoses YPLL from OECD health data for 2009 across 22 countries and disability-adjusted life years (DALY) from the World Health Organization (WHO). We set a range of 1-1 for each YPLL per disease in a nation (position value for relative comparison, PARC). Changes over 5 years were also accounted for in this disease management index (disease management index, DMI). In terms of ICD categories, the DMI indicated specific areas for priority setting for different countries with regard to managing disease treatment and diagnosis. Our study suggests that DMI is a realistic index that reflects trend changes over the past 5 years to the present state, and PARC is an easy index for identifying relative status. Moreover, unlike existing indices, DMI and PARC make it easy to conduct multiple comparisons among countries and diseases. DMI and PARC are therefore useful tools for policy implications and for future studies incorporating them and other existing indexes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Macroergonomic aspects in the design of development programs in IDCs.

PubMed

Coelho, Denis A; Ferrara, Patricia R; Couvinhas, Ana F; Lima, Tânia M; Walter, Jake K

2012-01-01

This paper revisits three reports on ergonomic aspects of development initiatives taking place in Industrially Developing Countries (IDCs). These include a macro-ergonomics intervention in a habitation community in Cape Verde (aimed at designing solutions contributing to sustainable development), the evolution of poultry growers' control strategies as an integrative broiler operation is introduced in Mozambique, and a set of macro-ergonomic considerations related to the Agro Forestry Village Project in Mozambique. The paper seeks to set the reviewed development endeavors against the backdrop of the goals of ergonomics interventions. This reflection may inform development agents in future processes of design and implementation of integrated community and work systems transformation.

The start-up phase of the national satellite forest monitoring systems for DRC and PNG: a joint venture between FAO and INPE

NASA Astrophysics Data System (ADS)

Jonckheere, I. G.; FAO UN-REDD Team Forestry Department

2011-12-01

Reducing Emissions from Deforestation and Forest Degradation (REDD) is an effort to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. "REDD+" goes beyond deforestation and forest degradation, and includes the role of conservation, sustainable management of forests and enhancement of forest carbon stocks. In the framework of getting countries ready for REDD+, the UN-REDD Programme, a partnership between UNEP, FAO and UNDP, assists developing countries to prepare and implement national REDD+ strategies. Designed collaboratively by a broad range of stakeholders, national UN-REDD Programmes are informed by the technical expertise of FAO, UNDP and UNEP. For the monitoring, reporting and verification, FAO supports the countries to develop satellite forest monitoring systems that allow for credible measurement, reporting and verification (MRV)of REDD+ activities. These are among the most critical elements for the successful implementation of any REDD+ mechanism, also following the COP 16 decisions in Cancun last year. The UN-REDD Programme through a joint effort of FAO and Brazil's National Space Agency, INPE, is supporting countries to develop cost-effective, robust and compatible national monitoring and MRV systems, providing tools, methodologies, training and knowledge sharing that help countries to strengthen their technical and institutional capacity for effective MRV systems. To develop strong nationally-owned forest monitoring systems, technical and institutional capacity building is key. The UN-REDD Programme, through FAO, has taken on intensive training together with INPE, and has provided technical help and assistance for in-country training and implementation for national satellite forest monitoring. The goal of the start-up phase for DRC and Papua New Guinea (PNG) in this capacity building effort is the training of technical forest people and IT persons from these two interested REDD+ countries, and to set-up the national satellite forest monitoring systems. The Brazilian forest monitoring system, TerraAmazon, which is used as a basis for this initiative, allows countries to adapt it to country needs and the training on the TerraAmazon system is a tool to enhance existing capacity on carbon monitoring systems. The start-up phase of the National Forest Monitoring System for DRC and PNG will allow these countries to follow all actions related to the implementation of its national REDD+ policies and measures. The monitoring system will work as a platform to obtain information on their REDD+ results and actions, related directly or indirectly to national REDD+ strategies and may also include actions unrelated to carbon assessment, such as forest law enforcement. With the technical assistance of FAO, INPE and other stakeholders, the countries will set up an autonomous operational forest monitoring system. An initial version and the methodologies of these syste,s will be launched in Durban, South Africa during COP 17 and is presented here.

Distance learning--an educational tool for developing countries.

PubMed

Dobson, M B

2000-01-01

Many anaesthetists in small hospitals and developing countries have poor access to educational materials. The use of electronic means of publication and distribution, combined with the concepts of distance learning, can lead to better levels of knowledge and clinical practice. A project based on these principles has been set up in Zimbabwe, and is proving helpful to both trainers and trainees. All District Hospitals have been visited, and trainees in them identified. A survey has been completed to identify the subject areas in which training is most necessary. Trainees have been provided with reference materials on CD-ROM which they can access by computer (each hospital has a computer). Specialist anaesthesiologists in the country are producing interactive tutorials which can be sent out by e-mail to every hospital, and these are backed up by a programme of regular visits, seminars and clinical teaching. The programme is proving helpful to both trainees and tutors, and has the potential to be used in the future in other developing countries.

Mapping agricultural landscapes and characterizing adaptive capacity in Central America

NASA Astrophysics Data System (ADS)

Holland, M. B.; Imbach, P. A.; Bouroncle, C.; Donatti, C.; Leguia, E.; Martinez, M.; Medellin, C.; Saborio-Rodriguez, M.; Shamer, S.; Zamora, J.

2013-12-01

One of the key challenges in developing adaptation strategies for smallholder farmers in developing countries is that of a data-poor environment, where spatially-explicit information about where the most vulnerable smallholder communities are located is lacking. Developing countries tend to lack consistent and reliable maps on agricultural land use, and have limited information available on smallholder adaptive capacity. We developed a novel participatory and expert mapping process to overcome these barriers and develop detailed national-scale maps that allow for a characterization of unique agricultural landscapes based on profiles of adaptive capacity for smallholder agriculture in each area. This research focuses specifically on the Central American nations of Costa Rica, Guatemala, and Honduras, where our focus is on coffee and basic grains as the two main cropping systems. Here we present the methodology and results of a series of in-depth interviews and participatory mapping sessions with experts working within the broader agricultural sector in each country. We held individual interviews and mapping sessions with approximately thirty experts from each country, and used a detailed survey instrument for each mapping session to both spatially identify distinct agricultural landscapes, and to further characterize each area based on specific farm practices and social context. The survey also included a series of questions to help us assess the relative adaptive capacity of smallholder agriculture within each landscape. After all expert mapping sessions were completed in each country we convened an expert group to assist in both validating and refining the set of landscapes already defined. We developed a characterization of adaptive capacity by aggregating indicators into main assets-based criteria (e.g. land tenure, access to credit, access to technical assistance, sustainable farm practices) derived from further expert weighting of indicators through an online platform. Our final steps in this process have been to compare the series of expert-derived agricultural landscapes with a set of probability maps for smallholder farming developed from available country-level secondary datasets in order to fill area gaps. We see this analysis and participatory process as closely related to previous work by Eakin et al. (2011) in the region. It provides an example of how expert input and participatory mapping can help meet the pressing need for a deeper contextual understanding of the vulnerability of smallholder farmers to climate change in a data-poor environment. The methods and results of our research also offer an applied example how to approach analysis of adaptive capacity and vulnerability within agricultural systems, and we have purposefully focused on a set of methods that can easily transfer to other countries within regions such as the Tropics. Reference: Eakin, H., L.A. Bojórquez-Tapia, R. Monterde Diaz, E. Castellanos, J. Haggar. 2011. Adaptive Capacity and Social-Environmental Change: Theoretical and Operational Modeling of Smallholder Coffee Systems Response in Mesoamerican Pacific Rim. Environmental Management 47:352-367.

[Neonatal and pediatirc intensive care in developing countries. Myth or reality? Luxury or necessity? From theory to practice].

PubMed

Alaoui, I

2003-01-01

Neonatal and pediatric intensive care poses a major challenge in developing countries where the socio-economic level is low and health care resources are limited. Given the large size of the pediatric population as well as of great socio-cultural and symbolic importance of the child, there is a natural, compelling need for management of serious diseases in newborns and infants. The lack of timely disease prevention and treatment accounts in part for the frequency and severity of cases. Thus the status of intensive care units can exist in this setting is a pertinent question. The purpose of this study was to attempt to answer this question by surveying neonatal and pediatric care in developing countries based on experience in Morocco over the last 25 years.

The Role of Policy and Institutions on Health Spending.

PubMed

de la Maisonneuve, Christine; Moreno-Serra, Rodrigo; Murtin, Fabrice; Oliveira Martins, Joaquim

2017-07-01

This paper investigates the impact of policies and institutions on health expenditures for a large panel of Organisation for Economic Co-operation and Development countries for the period of 2000-2010. A set of 20 policy and institutional indicators developed by the Organisation for Economic Co-operation and Development are integrated into a theoretically motivated econometric framework, alongside control variables related to demographic (dependency ratio) and non-demographic (income, prices and technology) drivers of health expenditures per capita. Although a large share of cross-country differences in public health expenditures can be explained by demographic and economic factors (around 71%), cross-country variations in policies and institutions also have a significant influence, explaining most of the remaining difference in public health spending (23%). Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Resident Participation in Seattle's Jobs-Plus Program

ERIC Educational Resources Information Center

Liebow, Edward B.; Reid, Carolina Katz; O'Malley, Gabrielle E.; Marsh, Scott; Blank, Susan

2004-01-01

The Jobs-Plus Community Revitalization Initiative for Public Housing Families ("Jobs-Plus") began operating in seven public housing developments around the country in 1998, but its implementation in Seattle?s Rainier Vista development differs significantly from its implementation in other sites. Two factors set Seattle Jobs-Plus apart: First, a…

Union Type and Depressive Symptoms among Mexican Adults

ERIC Educational Resources Information Center

Schmeer, Kammi K.; Kroeger, Rhiannon A.

2011-01-01

Diversity in union type is increasing around the world as cohabitation and higher order unions become more prevalent in developing and developed countries. This necessitates a more nuanced understanding of how different union types relate to individual well-being across social settings. In this study, the authors analyze nationally-representative…

Entrepreneurship Perceptions and Career Intentions of International Students

ERIC Educational Resources Information Center

Davey, Todd; Plewa, Carolin; Struwig, Miemie

2011-01-01

Purpose: This paper aims to identify the differences between African and European students with regard to their entrepreneurial intentions, attitudes towards entrepreneurship, role models and entrepreneurial experience. It also aims to set the scene for future comparative research between developing and developed countries in the area of graduate…

Challenges associated with tracking resources allocation for reproductive health in sub-Saharan African countries: the UNFPA/NIDI resource flows project experience.

PubMed

Sidze, Estelle M; Beekink, Erik; Maina, Beatrice W

2015-05-05

Universal access to reproductive health services entails strengthening health systems, but requires significant resource commitments as well as efficient and effective use of those resources. A number of international organizations and governments in developing countries are putting efforts into tracking the flow of health resources in order to inform resource mobilization and allocation, strategic planning, priority setting, advocacy and general policy making. The UNFPA/NIDI-led Resource Flows Project ("The UNFPA/NIDI RF Project") has conducted annual surveys since 1997 to monitor progress achieved by developing countries in implementing reproductive health financial targets. This commentary summarizes the Project experiences and challenges in gathering data on allocation of resources for reproductive health at the domestic level in sub-Saharan African countries. One key lesson learnt from the Project experience is the need for strengthening tracking mechanisms in sub-Saharan African countries and making information on reproductive health resources and expenditures available, in particular the private sector resources.

Low Back Pain in 17 Countries, a Rasch Analysis of the ICF Core Set for Low Back Pain

ERIC Educational Resources Information Center

Roe, Cecilie; Bautz-Holter, Erik; Cieza, Alarcos

2013-01-01

Previous studies indicate that a worldwide measurement tool may be developed based on the International Classification of Functioning Disability and Health (ICF) Core Sets for chronic conditions. The aim of the present study was to explore the possibility of constructing a cross-cultural measurement of functioning for patients with low back pain…

Mapping a Global Agenda for Adolescent Health

PubMed Central

Patton, George C.; Viner, Russell M.; Linh, Le Cu; Ameratunga, Shanthi; Fatusi, Adesegun O.; Ferguson, B. Jane; Patel, Vikram

2016-01-01

Major changes in health are underway in many low- and middle-income countries that are likely to bring greater focus on adolescents. This commentary, based on a 2009 London meeting, considers the need for strategic information for future global initiatives in adolescent health. Current coverage of adolescent health in global data collections is patchy. There is both the need and scope to extend existing collections into the adolescent years as well as achieve greater harmonization of measures between surveys. The development of a core set of global adolescent health indicators would aid this process. Other important tasks include adapting and testing interventions in low- and middle-income countries, growing research capacity in those settings, better communication of research from those countries, and building structures to implement future global initiatives. A global agenda needs more than good data, but sound information about adolescent health and its social and environmental determinants, will be important in both advocacy and practice. PMID:20970076

Contextual Factors that Foster or Inhibit Para-Teacher Professional Development: The Case of an Indian, Non-Governmental Organization

ERIC Educational Resources Information Center

Raval, Harini; McKenney, Susan; Pieters, Jules

2012-01-01

The appointment of para-professionals to overcome skill shortages and/or make efficient use of expensive resources is well established in both developing and developed countries. The present research concerns para-teachers in India. The literature on para-teachers is dominated by training for special needs settings, largely in developed societies.…

Recent Trends in Burn Epidemiology Worldwide: A Systematic Review

PubMed Central

Smolle, Christian; Cambiaso-Daniel, Janos; Forbes, Abigail A.; Wurzer, Paul; Hundeshagen, Gabriel; Branski, Ludwik K.; Huss, Fredrik; Kamolz, Lars-Peter

2017-01-01

Burn injuries have been more prevalent among low socioeconomic populations and in less developed regions. Incredible advances in burn care and social development over the recent decades, however, should have placed the incidence and severity of burns in a downwards trend. The aim of this review was to give an overview on current trends in burn epidemiology across the world. Also the socioeconomic development in countries that have published epidemiological data used in this study has been taken into account when comparing the results. There was a worldwide downwards trend of burn incidence, burn severity, length of hospital stay, and mortality rate. These findings were particularly pronounced in very highly developed countries. Data from highly and medium developed countries were more heterogeneous. No studies could be obtained from low developed countries. Comparisons between the different studies were compromised by the fact that studies emerged from specialized facilities on one hand and general hospitals on the other. Analyzed studies were also frequently focusing on limited patient populations such as “children” or “elderly”. Our findings indicate the need for an international burn database with a minimal data-set in order to obtain objective and comparable results in respect of burn epidemiology. PMID:27600982

Better Country: A Strategy for Rural Development in the 1980's.

ERIC Educational Resources Information Center

Department of Agriculture, Washington, DC.

The report of the 25-member National Advisory Council on Rural Development, appointed by the Secretary of Agriculture, defines rural needs and sets forth strategies for rural development in the 1980's. A review of the decade between 1970 and 1980 discusses rapid economic growth of rural areas, social progress, and changes in public service, and…

Using Impact Bonds to Achieve Early Childhood Development Outcomes in Low- and Middle-Income Countries

ERIC Educational Resources Information Center

Gustafsson-Wright, Emily; Gardiner, Sophie

2016-01-01

The Sustainable Development Goals (SDGs, or Global Goals) and their associated targets set out by the United Nations in 2015 explicitly seek to address some of the largest challenges facing children around the world. Early Childhood Development (ECD) interventions have been found to improve adult health and education levels, reduce crime, and…

Gender Equality in Education in the Context of the Millennium Development Goals: Challenges and Opportunities for Women

ERIC Educational Resources Information Center

Moletsane, Relebohile

2005-01-01

This article addresses the question: In the context of poverty, gender-based violence (GBV) and HIV/AIDS currently ravaging under-resourced countries, dare we set our hopes for gender- equitable development in general, and gender equality in education in particular, on the Millenium Development Goals MDGs? The article analyses the…

Evaluation of Follow-Up Effects of the International Child Development Programme on Caregivers in Mozambique

ERIC Educational Resources Information Center

Skar, Ane-Marthe Solheim; Sherr, Lorraine; Clucas, Claudine; von Tetzchner, Stephen

2014-01-01

Parenting programs have been used to good effect in many settings, yet few are systematically introduced and evaluated in developing countries. This study explores the relative long-term effect of participation in the International Child Development Programme (ICDP) in a group of caregivers in Mozambique. A quasi-experimental design was used to…

Benchmarking health IT among OECD countries: better data for better policy

PubMed Central

Adler-Milstein, Julia; Ronchi, Elettra; Cohen, Genna R; Winn, Laura A Pannella; Jha, Ashish K

2014-01-01

Objective To develop benchmark measures of health information and communication technology (ICT) use to facilitate cross-country comparisons and learning. Materials and methods The effort is led by the Organisation for Economic Co-operation and Development (OECD). Approaches to definition and measurement within four ICT domains were compared across seven OECD countries in order to identify functionalities in each domain. These informed a set of functionality-based benchmark measures, which were refined in collaboration with representatives from more than 20 OECD and non-OECD countries. We report on progress to date and remaining work to enable countries to begin to collect benchmark data. Results The four benchmarking domains include provider-centric electronic record, patient-centric electronic record, health information exchange, and tele-health. There was broad agreement on functionalities in the provider-centric electronic record domain (eg, entry of core patient data, decision support), and less agreement in the other three domains in which country representatives worked to select benchmark functionalities. Discussion Many countries are working to implement ICTs to improve healthcare system performance. Although many countries are looking to others as potential models, the lack of consistent terminology and approach has made cross-national comparisons and learning difficult. Conclusions As countries develop and implement strategies to increase the use of ICTs to promote health goals, there is a historic opportunity to enable cross-country learning. To facilitate this learning and reduce the chances that individual countries flounder, a common understanding of health ICT adoption and use is needed. The OECD-led benchmarking process is a crucial step towards achieving this. PMID:23721983

Benchmarking health IT among OECD countries: better data for better policy.

PubMed

Adler-Milstein, Julia; Ronchi, Elettra; Cohen, Genna R; Winn, Laura A Pannella; Jha, Ashish K

2014-01-01

To develop benchmark measures of health information and communication technology (ICT) use to facilitate cross-country comparisons and learning. The effort is led by the Organisation for Economic Co-operation and Development (OECD). Approaches to definition and measurement within four ICT domains were compared across seven OECD countries in order to identify functionalities in each domain. These informed a set of functionality-based benchmark measures, which were refined in collaboration with representatives from more than 20 OECD and non-OECD countries. We report on progress to date and remaining work to enable countries to begin to collect benchmark data. The four benchmarking domains include provider-centric electronic record, patient-centric electronic record, health information exchange, and tele-health. There was broad agreement on functionalities in the provider-centric electronic record domain (eg, entry of core patient data, decision support), and less agreement in the other three domains in which country representatives worked to select benchmark functionalities. Many countries are working to implement ICTs to improve healthcare system performance. Although many countries are looking to others as potential models, the lack of consistent terminology and approach has made cross-national comparisons and learning difficult. As countries develop and implement strategies to increase the use of ICTs to promote health goals, there is a historic opportunity to enable cross-country learning. To facilitate this learning and reduce the chances that individual countries flounder, a common understanding of health ICT adoption and use is needed. The OECD-led benchmarking process is a crucial step towards achieving this.

The development and pilot-testing of a training curriculum in adolescent medicine and health.

PubMed

Michaud, Pierre-André; Stronski, Susanne; Fonseca, Helena; Macfarlane, Aidan

2004-07-01

To select and propose a set of knowledge, attitudes, and skills essential for the care of adolescents; to encourage the development of adolescent health multidisciplinary networks; and to set up training programs in as many European countries as possible. The curriculum was developed by 16 physicians from 11 European countries with various professional specializations. In line with modern guidelines in medical education, it is a modular, flexible instrument which covers the main teaching areas in the field, such as basic skills (i.e. setting, rights and confidentiality, gender and cultural issues) as well as specific themes (i.e. sexual and reproductive health, eating disorders, chronic conditions). It consists of 17 thematic modules, each containing detailed objectives, learning approaches, examples, and evaluation methods. Two international one-week summer schools were used to assess the feasibility and appropriateness of the curriculum. The overall evaluation was good, with most of the items surpassing three on a four-point Likert scale. However, it pointed to several aspects (process and content) which will need to be refined in the future, such as an increase in interactive sessions (role playing), and a better mix of clinical and public health issues.

Gavi's Transition Policy: Moving From Development Assistance To Domestic Financing Of Immunization Programs.

PubMed

Kallenberg, Judith; Mok, Wilson; Newman, Robert; Nguyen, Aurélia; Ryckman, Theresa; Saxenian, Helen; Wilson, Paul

2016-02-01

Gavi, the Vaccine Alliance, was created in 2000 to accelerate the introduction of new and underused vaccines in lower-income countries. The period 2000-15 was marked by the rapid uptake of new vaccines in more than seventy countries eligible for Gavi support. To stay focused on the poorest countries, Gavi's support phases out after countries' gross national income per capita surpasses a set threshold, which requires governments to assume responsibility for the continued financing of vaccines introduced with Gavi support. Gavi's funding will end in the period 2016-20 for nineteen countries that have exceeded the eligibility threshold. To avoid disrupting lifesaving immunization programs and to ensure the long-term sustainable impact of Gavi's investments, it is vital that governments succeed in transitioning from development assistance to domestic financing of immunization programs. This article discusses some of the challenges facing countries currently transitioning out of Gavi support, how Gavi's policies have evolved to help manage the risks involved in this process, and the lessons learned from this experience. Project HOPE—The People-to-People Health Foundation, Inc.

Building technological capability within satellite programs in developing countries

NASA Astrophysics Data System (ADS)

Wood, Danielle; Weigel, Annalisa

2011-12-01

This paper explores the process of building technological capability in government-led satellite programs within developing countries. The key message is that these satellite programs can learn useful lessons from literature in the international development community. These lessons are relevant to emerging satellite programs that leverage international partnerships in order to establish local capability to design, build and operate satellites. Countries with such programs include Algeria, Nigeria, Turkey, Malaysia and the United Arab Emirates. The paper first provides background knowledge about space activity in developing countries, and then explores the nuances of the lessons coming from the international development literature. Developing countries are concerned with satellite technology because satellites provide useful services in the areas of earth observation, communication, navigation and science. Most developing countries access satellite services through indirect means such as sharing data with foreign organizations. More countries, however, are seeking opportunities to develop satellite technology locally. There are objective, technically driven motivations for developing countries to invest in satellite technology, despite rich debate on this topic. The paper provides a framework to understand technical motivations for investment in satellite services, hardware, expertise and infrastructure in both short and long term. If a country decides to pursue such investments they face a common set of strategic decisions at the levels of their satellite program, their national context and their international relationships. Analysis of past projects shows that countries have chosen diverse strategies to address these strategic decisions and grow in technological capability. What is similar about the historical examples is that many countries choose to leverage international partnerships as part of their growth process. There are also historical examples from outside the space arena in which organizations have pursued technological capability. Scholars have analyzed these examples and developed insightful frameworks. The paper draws key concepts from this literature about the nature of development, technology, knowledge and organizational learning. These concepts are relevant to learning in new satellite programs, but the ideas must be applied cautiously because of the nature of satellite technology. The paper draws three major lessons from the international development literature regarding absorptive capacity, tacit knowledge and organizational learning; it synthesizes these lessons into a cohesive, original framework. The closing section proposes future work on a detailed study of technological learning in specific government satellite programs.

Impact of multisectoral health determinants on child mortality 1980-2010: An analysis by country baseline mortality.

PubMed

Cohen, Robert L; Murray, John; Jack, Susan; Arscott-Mills, Sharon; Verardi, Vincenzo

2017-01-01

Some health determinants require relatively stronger health system capacity and socioeconomic development than others to impact child mortality. Few quantitative analyses have analyzed how the impact of health determinants varies by mortality level. 149 low- and middle-income countries were stratified into high, moderate, low, and very low baseline levels of child mortality in 1990. Data for 52 health determinants were collected for these countries for 1980-2010. To quantify how changes in health determinants were associated with mortality decline, univariable and multivariable regression models were constructed. An advanced statistical technique that is new for child mortality analyses-MM-estimation with first differences and country clustering-controlled for outliers, fixed effects, and variation across decades. Some health determinants (immunizations, education) were consistently associated with child mortality reduction across all mortality levels. Others (staff availability, skilled birth attendance, fertility, water and sanitation) were associated with child mortality reduction mainly in low or very low mortality settings. The findings indicate that the impact of some health determinants on child mortality was only apparent with stronger health systems, public infrastructure and levels of socioeconomic development, whereas the impact of other determinants was apparent at all stages of development. Multisectoral progress was essential to mortality reduction at all baseline mortality levels. Policy-makers can use such analyses to direct investments in health and non-health sectors and to set five-year child mortality targets appropriate for their baseline mortality levels and local context.

Setting priorities for teaching and learning: an innovative needs assessment for a new family medicine program in Lao PDR.

PubMed

Kanashiro, Jeanie; Hollaar, Gwen; Wright, Bruce; Nammavongmixay, Khamphong; Roff, Sue

2007-03-01

Lao People's Democratic Republic (Lao PDR) is a small, tropical, landlocked country in southeast Asia. It is one of the least developed countries in the region, and its socioeconomic indicators are among the lowest 25% in the world. The World Health Organization has long called for increased equity in primary health care access around the world. To meet this need in Lao PDR, the Family Medicine Specialist Program was developed, a Lao-generated postgraduate training program designed to produce community-oriented primary care practitioners to serve the rural, remote areas of Lao PDR, where 80% of the population lives. An innovative method of needs assessment was required to determine the health care priorities to be met by this new program. Through the use of a modified Delphi technique, local key leaders in medical education, clinical specialists, and teachers were consulted to develop prioritized objectives for the hospital-based curriculum of the program. By setting priorities for teaching and learning in the unique and needy circumstances of Lao PDR, a novel approach to curriculum planning in a low-income country was explored and ultimately formed the foundation of the new curriculum. This process served to direct the allocation of scarce resources during implementation of this groundbreaking program. More importantly, this model of needs assessment could potentially be used to customize medical curricula in other low-income countries facing challenges similar to those in Lao PDR.

Role of salt intake in prevention of cardiovascular disease: controversies and challenges.

PubMed

He, Feng J; MacGregor, Graham A

2018-06-01

Strong evidence indicates that reduction of salt intake lowers blood pressure and reduces the risk of cardiovascular disease (CVD). The WHO has set a global target of reducing the population salt intake from the current level of approximately 10 g daily to <5 g daily. This recommendation has been challenged by several studies, including cohort studies, which have suggested a J-shaped relationship between salt intake and CVD risk. However, these studies had severe methodological problems, such as reverse causality and measurement error due to assessment of salt intake by spot urine. Consequently, findings from such studies should not be used to derail vital public health policy. Gradual, stepwise salt reduction as recommended by the WHO remains an achievable, affordable, effective, and important strategy to prevent CVD worldwide. The question now is how to reduce population salt intake. In most developed countries, salt reduction can be achieved by a gradual and sustained reduction in the amount of salt added to food by the food industry. The UK has pioneered a successful salt-reduction programme by setting incremental targets for >85 categories of food; many other developed countries are following the UK's lead. In developing countries where most of the salt is added by consumers, public health campaigns have a major role. Every country should adopt a coherent, workable strategy. Even a modest reduction in salt intake across the whole population can lead to a major improvement in public health and cost savings.

Militant extremist mind-set: Proviolence, Vile World, and Divine Power.

PubMed

Stankov, Lazar; Saucier, Gerard; Knežević, Goran

2010-03-01

In the present article, the authors report on the development of a scale for the measurement of the militant extremist mind-set. A previous pilot study identified 56 statements selected from writings of various terrorist groups as well as from psychological, historical, and political texts on terrorism. These statements, together with measures of personality, social attitudes, values, and social cynicism, were administered to participants from 9 countries (N = 2,424). A series of exploratory factor analyses of 56 statements produced 3 factors: Proviolence, Vile World, and Divine Power. Correlations of these factors with external variables indicate that Divine Power is a traditional religiosity scale, whereas Proviolence and Vile World scales cannot be accounted for by the existing psychological constructs. The distribution of scores on the Proviolence scale is skewed, indicating that the majority of participants disapprove of this attitude. The authors also present means for the countries included in the analysis. Participants from Malaysia endorse Vile World and Divine Power statements stronger than participants from other countries. The 3 Asian countries (China, Korea, and Malaysia) endorse Proviolence more strongly than countries from other parts of the world. PsycINFO Database Record (c) 2010 APA, all rights reserved.

Comparison of national health research priority-setting methods and characteristics in Latin America and the Caribbean, 2002-2012.

PubMed

Reveiz, Ludovic; Elias, Vanessa; Terry, Robert F; Alger, Jackeline; Becerra-Posada, Francisco

2013-07-01

To compare health research priority-setting methods and characteristics among countries in Latin America and the Caribbean during 2002 - 2012. This was a systematic review that identified national health research policies and priority agendas through a search of ministry and government databases related to health care institutions. PubMed, LILACS, the Health Research Web, and others were searched for the period from January 2002 - February 2012. The study excluded research organized by governmental institutions and specific national strategies on particular disease areas. Priority-setting methods were compared to the "nine common themes for good practice in health research priorities." National health research priorities were compared to those of the World Health Organization's Millennium Development Goals (MDG). Of the 18 Latin American countries assessed, 13 had documents that established national health research priorities; plus the Caribbean Health Research Council had a research agenda for its 19 constituents. These 14 total reports varied widely in terms of objectives, content, dissemination, and implementation; most provided a list of strategic areas, suggestions, and/or sub-priorities for each country; however, few proposed specific research topics and questions. Future reports could be improved by including more details on the comprehensive approach employed to identify priorities, on the information gathering process, and on practices to be undertaken after priorities are set. There is a need for improving the quality of the methodologies utilized and coordinating Regional efforts as countries strive to meet the MDG.

Provision of inpatient rehabilitation and challenges experienced with participation post discharge: quantitative and qualitative inquiry of African stroke patients.

PubMed

Rhoda, Anthea; Cunningham, Natalie; Azaria, Simon; Urimubenshi, Gerard

2015-09-28

The provision of rehabilitation differs between developed and developing countries, this could impact on the outcomes of post stroke rehabilitation. The aim of this paper is to present provision of in-patient stroke rehabilitation. In addition the challenges experienced by the individuals with participation post discharge are also presented. Qualitative and quantitative research methods were used to collect data. The quantitative data was collected using a retrospective survey of stroke patients admitted to hospitals over a three- to five-year period. Quantitative data was captured on a validated data capture sheet and analysed descriptively. The qualitative data was collected using interviews from a purposively and conveniently selected sample, audio-taped and analysed thematically. The qualitative data was presented within the participation model. A total of 168 medical folders were reviewed for a South African sample, 139 for a Rwandan sample and 145 for a Tanzanian sample. The mean age ranged from 62.6 (13.78) years in the South African sample to 56.0 (17.4) in the Rwandan sample. While a total of 98 % of South African stroke patients received physiotherapy, only 39.4 % of Rwandan patients received physiotherapy. From the qualitative interviews, it became clear that the stroke patients had participation restrictions. When conceptualised within the Participation Model participation restrictions experienced by the stroke patients were a lack of accomplishment, inability to engage in previous roles and a perception of having health problems. With the exception of Rwanda, stroke patients in the countries studied are admitted to settings early post stroke allowing for implementation of effective acute interventions. The participants were experiencing challenges which included a lack of transport and the physical geographic surroundings in the rural settings not being conducive to wheelchair use. Stroke patients admitted to hospitals in certain African countries could receive limited in-patient therapeutic interventions. With the exception of barriers in the physical environment, stroke patients in developing countries where resources are limited experience the same participation restrictions as their counterparts in developed countries where resources are more freely available. Rehabilitation interventions in these developing countries should therefore be community-based focussing on intervening in the physical environment.

Applying commodity chain analysis to changing modes of alcohol supply in a developing country.

PubMed

Jernigan, D H

2000-12-01

Development sociology has used global commodity chains as one way of analyzing the dynamics of power and profit-taking in globalized production networks made up of multiple firms and occurring in multiple national settings. A substantial portion of the alcohol supply in developing countries is now produced through such production networks. Particularly in the beer and spirits trade, a small number of transnational firms control networks of local producers, importers, advertisers and distributors. These networks serve to embed transnational or transnationally backed brands in the local culture, using the tools of market research, product design and marketing to influence local drinking practices. Case materials from Malaysia's beer industry help to illustrate how the transnational firms dominate in those links of the commodity chain in which monopoly or oligopoly control is most likely to be found: the design/recipe and marketing/advertising nodes. Their control of the commodity chains and extraction of monopoly or oligopoly profits from them places substantial resources and influence over drinking settings and practices in foreign hands. The impact of this influence on state efficacy and autonomy in setting alcohol policy is an important subject for future research on the creation and implementation of effective alcohol policies in developing societies.

Asthma prevalence and severity in low-resource communities.

PubMed

Cruz, Álvaro A; Stelmach, Rafael; Ponte, Eduardo V

2017-06-01

The prevalence of asthma was thought to be low in most low-income countries, but several reports have indicated this is not always true. This is a narrative review of recent publications on the burden of asthma in low and middle-income countries (LMIC) and underprivileged communities from developed countries. Several studies have reported a low prevalence of asthma is LMIC, but indicate it is increasing. In the last few years, however, many surveys demonstrated this may not always be true. An analysis of the International Study for Asthma and Allergy in Childhood phase III database indicated although the prevalence of asthma among children and adolescents is higher in the developed countries, symptoms of asthma are often more severe in less affluent nations. The rate of uncontrolled asthma is also higher among underprivileged communities of developed countries. Secondary analysis of data generated by the WHO's world health survey performed among adults of 70 countries indicate symptoms of asthma are less frequent in middle-income countries and more frequent in the extremes, low income and high income. This sort of U shaped distribution suggests the disease (or syndrome) comprise more than one major phenotype related to diverse underlying mechanisms. In fact, recent reports show symptoms of asthma among the poor are associated with unhygienic living conditions, which may reduce the risk of atopy but increase the risk of nonatopic wheezing. Urbanization and exposure to air pollution also seem to contribute to an increasing prevalence severity of asthma in LMIC. Access to proper diagnosis and treatment with controller medications for asthma, specially with inhaled corticosteroids is feasible and cost-effective, reduce symptoms, health resource utilization, improves quality of life, and reduce mortality in low-resource settings. Prevalence of asthma was thought to be low in low-income countries, but several reports have indicated this is not always true. Under diagnosis, under treatment, exposure to air pollution, and unhygienic living conditions may contribute to a higher frequency and severity of symptoms of asthma among the poor. Proper diagnosis and treatment with controller medications for asthma is feasible and cost-effective in low-resource settings.

Argentina soybean yield model

NASA Technical Reports Server (NTRS)

Callis, S. L.; Sakamoto, C.

1984-01-01

A model based on multiple regression was developed to estimate soybean yields for the country of Argentina. A meteorological data set was obtained for the country by averaging data for stations within the soybean growing area. Predictor variables for the model were derived from monthly total precipitation and monthly average temperature. A trend variable was included for the years 1969 to 1978 since an increasing trend in yields due to technology was observed between these years.

Assessing Global Marine Biodiversity Status within a Coupled Socio-Ecological Perspective

PubMed Central

Selig, Elizabeth R.; Longo, Catherine; Halpern, Benjamin S.; Best, Benjamin D.; Hardy, Darren; Elfes, Cristiane T.; Scarborough, Courtney; Kleisner, Kristin M.; Katona, Steven K.

2013-01-01

People value the existence of a variety of marine species and habitats, many of which are negatively impacted by human activities. The Convention on Biological Diversity and other international and national policy agreements have set broad goals for reducing the rate of biodiversity loss. However, efforts to conserve biodiversity cannot be effective without comprehensive metrics both to assess progress towards meeting conservation goals and to account for measures that reduce pressures so that positive actions are encouraged. We developed an index based on a global assessment of the condition of marine biodiversity using publically available data to estimate the condition of species and habitats within 151 coastal countries. Our assessment also included data on social and ecological pressures on biodiversity as well as variables that indicate whether good governance is in place to reduce them. Thus, our index is a social as well as ecological measure of the current and likely future status of biodiversity. As part of our analyses, we set explicit reference points or targets that provide benchmarks for success and allow for comparative assessment of current conditions. Overall country-level scores ranged from 43 to 95 on a scale of 1 to 100, but countries that scored high for species did not necessarily score high for habitats. Although most current status scores were relatively high, likely future status scores for biodiversity were much lower in most countries due to negative trends for both species and habitats. We also found a strong positive relationship between the Human Development Index and resilience measures that could promote greater sustainability by reducing pressures. This relationship suggests that many developing countries lack effective governance, further jeopardizing their ability to maintain species and habitats in the future. PMID:23593188

Development of a survey instrument to investigate the primary care factors related to differences in cancer diagnosis between international jurisdictions

PubMed Central

2014-01-01

Background Survival rates following a diagnosis of cancer vary between countries. The International Cancer Benchmarking Partnership (ICBP), a collaboration between six countries with primary care led health services, was set up in 2009 to investigate the causes of these differences. Module 3 of this collaboration hypothesised that an association exists between the readiness of primary care physicians (PCP) to investigate for cancer – the ‘threshold’ risk level at which they investigate or refer to a specialist for consideration of possible cancer – and survival for that cancer (lung, colorectal and ovarian). We describe the development of an international survey instrument to test this hypothesis. Methods The work was led by an academic steering group in England. They agreed that an online survey was the most pragmatic way of identifying differences between the jurisdictions. Research questions were identified through clinical experience and expert knowledge of the relevant literature. A survey comprising a set of direct questions and five clinical scenarios was developed to investigate the hypothesis. The survey content was discussed and refined concurrently and repeatedly with international partners. The survey was validated using an iterative process in England. Following validation the survey was adapted to be relevant to the health systems operating in other jurisdictions and translated into Danish, Norwegian and Swedish, and into Canadian and Australian English. Results This work has produced a survey with face, content and cross cultural validity that will be circulated in all six countries. It could also form a benchmark for similar surveys in countries with similar health care systems. Conclusions The vignettes could also be used as educational resources. This study is likely to impact on healthcare policy and practice in participating countries. PMID:24938306

International variations and trends in renal cell carcinoma incidence and mortality.

PubMed

Znaor, Ariana; Lortet-Tieulent, Joannie; Laversanne, Mathieu; Jemal, Ahmedin; Bray, Freddie

2015-03-01

Renal cell carcinoma (RCC) incidence rates are higher in developed countries, where up to half of the cases are discovered incidentally. Declining mortality trends have been reported in highly developed countries since the 1990s. To compare and interpret geographic variations and trends in the incidence and mortality of RCC worldwide in the context of controlling the future disease burden. We used data from GLOBOCAN, the Cancer Incidence in Five Continents series, and the World Health Organisation mortality database to compare incidence and mortality rates in more than 40 countries worldwide. We analysed incidence and mortality trends in the last 10 yr using joinpoint analyses of the age-standardised rates (ASRs). RCC incidence in men varied in ASRs (World standard population) from approximately 1/100,000 in African countries to >15/100,000 in several Northern and Eastern European countries and among US blacks. Similar patterns were observed for women, although incidence rates were commonly half of those for men. Incidence rates are increasing in most countries, most prominently in Latin America. Although recent mortality trends are stable in many countries, significant declines were observed in Western and Northern Europe, the USA, and Australia. Southern European men appear to have the least favourable RCC mortality trends. Although RCC incidence is still increasing in most countries, stabilisation of mortality trends has been achieved in many highly developed countries. There are marked absolute differences and opposing RCC mortality trends in countries categorised as areas of higher versus lower human development, and these gaps appear to be widening. Renal cell cancer is becoming more commonly diagnosed worldwide in both men and women. Mortality is decreasing in the most developed settings, but not in low- and middle-income countries, where access to and the availability of optimal therapies are likely to be limited. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Round table discussion " Development of qualification framework in meteorology (TEMPUS QUALIMET)"

NASA Astrophysics Data System (ADS)

Bashmakova, I.; Belotserkovsky, A.; Karlin, L.; Petrosyan, A.; Serditova, N.; Zilitinkevich, S.

2010-09-01

The international consortium has started implementing a project aimed at the development of unified framework of qualifications in meteorology (QualiMet), setting a system of recognition and award of qualifications up to Doctoral level based on standards of knowledge, skill and competence acquired by learners is underway. The QualiMet has the following specific objectives: 1. To develop standards of knowledge, skills and competence for all qualifications up to Doctoral level needed in all possible occupations meteorology learner can undertake, by July 2011 2. To develop reciprocally recognized rubrics, criteria, methods and tools for assessing the compliance with the developed standards (quality assurance), by July 2012 3. To set the network of Centers of Excellence as the primary designer of sample education programs and learning experiences, both in brick-and-mortar and distant setting of delivery, leading to achievement of the developed standards, by December 2012 4. To set a system of mutual international recognition and award of qualifications in meteorology based on the developed procedures and establishment of self-regulatory public organization, by December 2012 The main beneficiaries of the project are: 1. Meteorology learners from the consortium countries. They will be able to make informed decisions about available qualification choices and progression options and provided an opportunity for students and graduates to participate in the system of international continuous education. 2. Meteorology employers from the consortium countries, They will be able to specify the level of knowledge, skill and competence required for occupational roles, evaluate qualifications presented, connect training and development with business needs. 3. Students and academic staff of all the consortium members, who will gain the increased mobility and exchange the fluxes of culturally and institutionally diversified lecturers and qualified specialists

Current micronutrient recommendations in Europe: towards understanding their differences and similarities.

PubMed

Doets, Esmée L; de Wit, Liesbeth S; Dhonukshe-Rutten, Rosalie A M; Cavelaars, Adriënne E J M; Raats, Monique M; Timotijevic, Lada; Brzozowska, Anna; Wijnhoven, Trudy M A; Pavlovic, Mirjana; Totland, Torunn Holm; Andersen, Lene F; Ruprich, Jiri; Pijls, Loek T J; Ashwell, Margaret; Lambert, Janet P; van 't Veer, Pieter; de Groot, Lisette C P G M

2008-04-01

Nowadays most countries in Europe have established their own nutrient recommendations to assess the adequacy of dietary intakes and to plan desirable dietary intakes. As yet there is no standard approach for deriving nutrient recommendations, they may vary from country to country. This results in different national recommendations causing confusion for policy-makers, health professionals, industry, and consumers within Europe. EURRECA (EURopean micronutrient RECommendations Aligned) is a network of excellence funded by the European Commission (EC), and established to identify and address the problem of differences between countries in micronutrient recommendations. The objective of this paper is to give an overview of the available micronutrient recommendations in Europe, and to provide information on their origin, concepts and definitions. Furthermore this paper aims to illustrate the diversity in European recommendations on vitamin A and vitamin D, and to explore differences and commonalities in approaches that could possibly explain variations observed. A questionnaire was developed to get information on the process of establishing micronutrient recommendations. These questionnaires were sent to key informants in the field of micronutrient recommendations to cover all European countries/regions. Also the latest reports on nutrient recommendations in Europe were collected. Standardisation procedures were defined to enable comparison of the recommendations. Recommendations for vitamin A and vitamin D were compared per sex at the ages 3, 9 months and 5, 10, 15, 25, 50 and 70 years. Information extracted from the questionnaires and reports was compared focusing on: (1) The concept of recommendation (recommended daily allowance (RDA), adequate intake (AI) or acceptable range), (2) The year of publication of the report (proxy for available evidence), (3) Population groups defined, (4) Other methodological issues such as selected criteria of adequacy, the type of evidence used, and assumptions made. Twenty-two countries, the World Health Organization (WHO)/the Food and Agriculture Organization of the United Nations (FAO) and the EC have their own reports on nutrient recommendations. Thirteen countries based their micronutrient recommendations on those from other countries or organisations. Five countries, WHO/FAO and the EC defined their own recommendations. The DACH-countries (Germany, Austria and Switzerland) as well as the Nordic countries (Norway, Sweden, Finland, Denmark and Iceland) cooperated in setting recommendations. Greece and Portugal use the EC and the WHO/FAO recommendations, respectively and Slovenia adopted the recommendations from the DACH-countries. Rather than by concepts, definitions, and defined population groups, variability appears to emerge from differences in criteria for adequacy, assumptions made and type of evidence used to establish micronutrient recommendations. The large variation in current micronutrient recommendations for population groups as illustrated for vitamin A and vitamin D strengthens the need for guidance on setting evidence based, up-to-date European recommendations. Differences in endpoints, type of evidence used to set recommendations, experts' opinions and assumptions are all likely to contribute to the identified variation. So far, background information was not sufficient transparent to disentangle the relative contribution of these different aspects. EURRECA has an excellent opportunity to develop tools to improve transparency on the approaches used in setting micronutrient recommendations, including the selection of criteria for adequacy, weighing of evidence, and interpretation of data.

[The European countries confronting cancer: a set of indicators assessing public health status].

PubMed

Borella, Laurent

2008-11-01

We now know that efficient public policies for cancer control need to be global and take into account each and all the factors involved: economics and level of development, style of life and risk factors, access to screening, effectiveness of the care-providing system. A very simple scorecard is proposed, based on publicized public health indicators, which allows a comparison between European countries. We extracted 49 indicators from public databases and literature concerning 22 European countries. We made correlation calculations in order to identify relevant indicators from which a global score was extracted. Using a hierarchical clustering method we were then able to identify subsets of homogeneous countries. A 7 indicator scorecard was drawn up: national gross product, scientific production, smoking rate, breast screening participating rate, all cancer mortality rate (male population), 5 years relative survival for colorectal cancer and life expectancy at birth. A global score shows: 1) the better positioned countries: Switzerland, Sweden, Finland and France; 2) the countries where cancer control is less effective: Estonia, Hungary, Poland and Slovakia. Three subsets of countries with a fairly similar profile were identified: a high level of means and results group; a high level of means but a medium level of results group; and a low level of means and results group. This work emphasizes dramatically heterogeneous situations between countries. A follow-up, using a reduced but regularly updated set of public health indicators, would help induce an active European policy for cancer control.

Genetic education and the challenge of genomic medicine: development of core competences to support preparation of health professionals in Europe

PubMed Central

Skirton, Heather; Lewis, Celine; Kent, Alastair; Coviello, Domenico A

2010-01-01

The use of genetics and genomics within a wide range of health-care settings requires health professionals to develop expertise to practise appropriately. There is a need for a common minimum standard of competence in genetics for health professionals in Europe but because of differences in professional education and regulation between European countries, setting curricula may not be practical. Core competences are used as a basis for health professional education in many fields and settings. An Expert Group working under the auspices of the EuroGentest project and European Society of Human Genetics Education Committee agreed that a pragmatic solution to the need to establish common standards for education and practice in genetic health care was to agree to a set of core competences that could apply across Europe. These were agreed through an exhaustive process of consultation with relevant health professionals and patient groups. Sets of competences for practitioners working in primary, secondary and tertiary care have been agreed and were approved by the European Society of Human Genetics. The competences provide an appropriate framework for genetics education of health professionals across national boundaries, and the suggested learning outcomes are available to guide development of curricula that are appropriate to the national context, educational system and health-care setting of the professional involved. Collaboration between individuals from many European countries and professions has resulted in an adaptable framework for both pre-registration and continuing professional education. This competence framework has the potential to improve the quality of genetic health care for patients globally. PMID:20442748

Genetic education and the challenge of genomic medicine: development of core competences to support preparation of health professionals in Europe.

PubMed

Skirton, Heather; Lewis, Celine; Kent, Alastair; Coviello, Domenico A

2010-09-01

The use of genetics and genomics within a wide range of health-care settings requires health professionals to develop expertise to practise appropriately. There is a need for a common minimum standard of competence in genetics for health professionals in Europe but because of differences in professional education and regulation between European countries, setting curricula may not be practical. Core competences are used as a basis for health professional education in many fields and settings. An Expert Group working under the auspices of the EuroGentest project and European Society of Human Genetics Education Committee agreed that a pragmatic solution to the need to establish common standards for education and practice in genetic health care was to agree to a set of core competences that could apply across Europe. These were agreed through an exhaustive process of consultation with relevant health professionals and patient groups. Sets of competences for practitioners working in primary, secondary and tertiary care have been agreed and were approved by the European Society of Human Genetics. The competences provide an appropriate framework for genetics education of health professionals across national boundaries, and the suggested learning outcomes are available to guide development of curricula that are appropriate to the national context, educational system and health-care setting of the professional involved. Collaboration between individuals from many European countries and professions has resulted in an adaptable framework for both pre-registration and continuing professional education. This competence framework has the potential to improve the quality of genetic health care for patients globally.

The Changing Relationship Between Family Size and Educational Attainment Over the Course of Socioeconomic Development: Evidence From Indonesia

PubMed Central

MARALANI, VIDA

2008-01-01

Many studies from developed countries show a negative correlation between family size and children’s schooling, while results from developing countries show this association ranging from positive to neutral to negative, depending on the context. The body of evidence suggests that this relationship changes as a society develops, but this theory has been difficult to assess because the existing evidence requires comparisons across countries with different social structures and at different levels of development. The world’s fourth most populous nation in 2007, Indonesia has developed rapidly in recent decades. This context provides the opportunity to study these relationships within the same rapidly developing setting to see if and how these associations change. Results show that in urban areas, the association between family size and children’s schooling was positive for older cohorts but negative for more recent cohorts. Models using instrumental variables to address the potential endogeneity of fertility confirm these results. In contrast, rural areas show no significant association between family size and children’s schooling for any cohort. These findings show how the relationship between family size and children’s schooling can differ within the same country and change over time as contextual factors evolve with socioeconomic development. PMID:18939668

SCREENING INFORMATION DATA SETS (SIDS)

EPA Science Inventory

The Organization for Economic Cooperation and Development (OECD) is jointly investigating international high production volume (HPV) chemicals. These HPV chemicals are defined as chemicals produced in one OECD Member country in quantities above10,000 metric tons (22 million lbs) ...

Building Sustainable Capacity for Cardiovascular Care at a Public Hospital in Western Kenya

PubMed Central

Binanay, Cynthia A.; Akwanalo, Constantine O.; Aruasa, Wilson; Barasa, Felix A.; Corey, G. Ralph; Crowe, Susie; Esamai, Fabian; Einterz, Robert; Foster, Michael C.; Gardner, Adrian; Kibosia, John; Kimaiyo, Sylvester; Koech, Myra; Korir, Belinda; Lawrence, John E.; Lukas, Stephanie; Manji, Imran; Maritim, Peris; Ogaro, Francis; Park, Peter; Pastakia, Sonak; Sugut, Wilson; Vedanthan, Rajesh; Yanoh, Reuben; Velazquez, Eric J.; Bloomfield, Gerald S.

2015-01-01

Cardiovascular disease deaths are increasing in low- and middle-income countries and are exacerbated by health care systems that are ill-equipped to manage chronic diseases. Global health partnerships, which have stemmed the tide of infectious diseases in low- and middle-income countries, can be similarly applied to address cardiovascular diseases. In this review, we present the experiences of an academic partnership between North American and Kenyan medical centers to improve cardiovascular health in a national public referral hospital. We highlight our stepwise approach to developing sustainable cardiovascular services using the health system strengthening World Health Organization Framework for Action. The building blocks of this framework (leadership and governance, health workforce, health service delivery, health financing, access to essential medicines, and health information system) guided our comprehensive and sustainable approach to delivering subspecialty care in a resource limited setting. Our experiences may guide the development of similar collaborations in other settings. PMID:26653630

Critical role of developing national strategic plans as a guide to strengthen laboratory health systems in resource-poor settings.

PubMed

Nkengasong, John N; Mesele, Tsehaynesh; Orloff, Sherry; Kebede, Yenew; Fonjungo, Peter N; Timperi, Ralph; Birx, Deborah

2009-06-01

Medical laboratory services are an essential, yet often neglected, component of health systems in developing countries. Their central role in public health, disease control and surveillance, and patient management is often poorly recognized by governments and donors. However, medical laboratory services in developing countries can be strengthened by leveraging funding from other sources of HIV/AIDS prevention, care, surveillance, and treatment programs. Strengthening these services will require coordinated efforts by national governments and partners and can be achieved by establishing and implementing national laboratory strategic plans and policies that integrate laboratory systems to combat major infectious diseases. These plans should take into account policy, legal, and regulatory frameworks; the administrative and technical management structure of the laboratories; human resources and retention strategies; laboratory quality management systems; monitoring and evaluation systems; procurement and maintenance of equipment; and laboratory infrastructure enhancement. Several countries have developed or are in the process of developing their laboratory plans, and others, such as Ethiopia, have implemented and evaluated their plan.

Head and neck surgical subspecialty training in Africa: Sustainable models to improve cancer care in developing countries.

PubMed

Fagan, Johannes J; Zafereo, Mark; Aswani, Joyce; Netterville, James L; Koch, Wayne

2017-03-01

Cancer poses a health crisis in the developing world where surgery is the mainstay of treatment for head and neck cancers. However, a shortage of surgeons with appropriate skills exists. How do we train head and neck surgeons in developing countries and avoid a brain drain? The ideal model provides appropriate affordable training leading to establishment of head and neck cancer centers that teach and train others. Different head and neck surgery training models are presented based on the personal experiences of the authors. Surgical exposure of head and neck fellows in Cape Town and (potentially) in Nairobi is benchmarked against programs in the United States. Surgical exposure in Cape Town is equivalent to that in the United States, but more appropriate to a developing world setting. Training can be achieved in a number of ways, which may be complimentary. Fellowship training is possible in developing countries. © 2016 Wiley Periodicals, Inc. Head Neck 39: 605-611, 2017. © 2016 Wiley Periodicals, Inc.

Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries

PubMed Central

Kobayashi, Miwako; Vekemans, Johan; Baker, Carol J.; Ratner, Adam J.; Le Doare, Kirsty; Schrag, Stephanie J.

2016-01-01

Globally, group B Streptococcus (GBS) remains the leading cause of sepsis and meningitis in young infants, with its greatest burden in the first 90 days of life. Intrapartum antibiotic prophylaxis (IAP) for women at risk of transmitting GBS to their newborns has been effective in reducing, but not eliminating, the young infant GBS disease burden in many high income countries. However, identification of women at risk and administration of IAP is very difficult in many low and middle income country (LMIC) settings, and is not possible for home deliveries. Immunization of pregnant women with a GBS vaccine represents an alternate pathway to protecting newborns from GBS disease, through the transplacental antibody transfer to the fetus in utero. This approach to prevent GBS disease in young infants is currently under development, and is approaching late stage clinical evaluation. This manuscript includes a review of the natural history of the disease, global disease burden estimates, diagnosis and existing control options in different settings, the biological rationale for a vaccine including previous supportive studies, analysis of current candidates in development, possible correlates of protection and current status of immunogenicity assays. Future potential vaccine development pathways to licensure and use in LMICs, trial design and implementation options are discussed, with the objective to provide a basis for reflection, rather than recommendations. PMID:27803803

Global access to infertility care in developing countries: a case of human rights, equity and social justice.

PubMed

Ombelet, W

2011-01-01

According to WHO data more than 180 million couples in developing countries suffer from primary or secondary infertility. The social stigma of childlessness still leads to isolation and abandonment in many developing countries. Differences between the developed and developing world are emerging because of the different availability in infertility care and different socio-cultural value surrounding procreation and childlessness. Although reproductive health education and prevention of infertility are number one priorities, the need for accessible diagnostic procedures and new reproductive technologies (ART) is very high. The success and sustainability of ART in resource-poor settings will depend to a large extend on our ability to optimise these techniques in terms of availability, affordability and effectiveness. Accessible infertility treatment can only be successfully introduced in developing countries if socio-cultural and economic prerequisites are fulfilled and governments can be persuaded to support their introduction. We have to liaise with the relevant authorities to discuss the strengthening of infertility services, at the core of which lies the integration of infertility, contraceptive and maternal health services within public health care structures. After a fascinating period of more than 30 years of IVF, only a small part of the world population benefits from these new technologies. Time has come to give equitable access to effective and safe infertility care in resource-poor countries as well.

Labor migration and risk aversion in less developed countries.

PubMed

Katz, E; Stark, O

1986-01-01

"In this paper we question the pioneering work of Todaro, which states that rural-to-urban labor migration in less developed countries (LDCs) is an individual response to a higher urban expected income. We demonstrate that rural-to-urban labor migration is perfectly rational even if urban expected income is lower than rural income. We achieve this under a set of fairly stringent conditions: an individual decision-making entity, a one-period planning horizon, and global risk aversion. We obtain the result that a small chance of reaping a high reward is sufficient to trigger rural-to-urban labor migration." excerpt

Population education in the school curriculum: a comparative analysis of the American and Asian models.

PubMed

Okobiah, O S

1981-02-01

The content, strategies, and objectives of population education curriculum materials developed for use in school systems in a developed country (US) and in a developing country (Thailand) were compared. It was assumed that the objectives and strategies of population education developed in a specific country would reflect the way in which population matters were viewed by that country's policy makers and planners. In developed countries, population education is primarily an outgrowth of environmental concerns. In less developed countries population education is pursued mainly because of concerns about rapid population growth. The specific curriculum materials which were analyzed were the Population, Environmental-Ecological Education Project developed by the Missouri State Department of Education and the Population and Family Education Project developed in Bangkok. A conceptual framework for analyzing the content of the materials was developed. The framework included 5 major parameters. These parameters were 1) a description of the human population, 2) basic population concepts and processes, 3) population dynamics, 4) the causes and consequences of population change, and 5) population issues. Content analysis of the materials revealed that the content focus was similar for both of the curriculum materials. 74% of the Asian curricula and 73% of the US curricula focused on population issues and on the causes and consequences of population growth; however, the US materials emphasized environmental consequences and policies while the Asian materials emphasized family planning policies and the effects of population growth on family, community, sociocultural, and personal factors. Marked differences were revealed when the instructional strategies and course objectives of the materials were judged in reference to established educational standards of objectivity. All of the sampled instructional strategies in the US materials were judged as suitable for use in the formal school setting in that they encouraged students to analyze information and to develop their own generalizations. Most of the sampled strategies in the Asian materials were judged to be inappropriate for use in the formal school setting as they sought to indoctrinate students with specific attitudes and norms, e.g., the small family norm. The materials instructed the Asian teachers to manipulate, limit, and mold discussion sessions while the US materials encouraged teachers to develop the analytic skills of their students. The approach adopted in the Asian materials will ultimately defeat the goal of population education which is to prepare students to make informed and rational population related decisions when they reach adulthood.

Tracking progress towards global drinking water and sanitation targets: A within and among country analysis.

PubMed

Fuller, James A; Goldstick, Jason; Bartram, Jamie; Eisenberg, Joseph N S

2016-01-15

Global access to safe drinking water and sanitation has improved dramatically during the Millennium Development Goal (MDG) period. However, there is substantial heterogeneity in progress between countries and inequality within countries. We assessed countries' temporal patterns in access to drinking water and sanitation using publicly available data. We then classified countries using non-linear modeling techniques as having one of the following trajectories: 100% coverage, linear growth, linear decline, no change, saturation, acceleration, deceleration, negative acceleration, or negative deceleration. We further assessed the degree to which temporal profiles follow a sigmoidal pattern and how these patterns might vary within a given country between rural and urban settings. Among countries with more than 10 data points, between 15% and 38% showed a non-linear trajectory, depending on the indicator. Overall, countries' progress followed a sigmoidal trend, but some countries are making better progress and some worse progress than would be expected. We highlight several countries that are not on track to meet the MDG for water or sanitation, but whose access is accelerating, suggesting better performance during the coming years. Conversely, we also highlight several countries that have made sufficient progress to meet the MDG target, but in which access is decelerating. Patterns were heterogeneous and non-linearity was common. Characterization of these heterogeneous patterns will help policy makers allocate resources more effectively. For example, policy makers can identify countries that could make use of additional resources or might be in need of additional institutional capacity development to properly manage resources; this will be essential to meet the forthcoming Sustainable Development Goals. Copyright © 2015 Elsevier B.V. All rights reserved.

Universal Factors of Student Achievement in High-Performing Eastern and Western Countries

ERIC Educational Resources Information Center

Lee, Jihyun

2014-01-01

This study investigates whether a common set of student attitudes and behavioral tendencies can account for academic achievement across different, especially high-performing, countries via analysis of the PISA 2009 international data set. The 13 countries examined are 5 of the top-performing Eastern countries/systems, namely Shanghai China, South…

Evaluation of community pharmacy-based services for type-2 diabetes in an Indonesian setting: pharmacist survey.

PubMed

Wibowo, Yosi; Parsons, Richard; Sunderland, Bruce; Hughes, Jeffery

2015-10-01

Diabetes is an emerging chronic disease in developing countries. Currently the management of diabetes in developing countries is mainly hospital or clinic based. With burgeoning numbers of patients with diabetes, other models need to be evaluated for service delivery in developing countries. Community pharmacists are an important option for provision of diabetes care. Currently, data regarding practices of community pharmacists in diabetes care have been limited to developed countries. To evaluate current community pharmacy-based services and perceived roles of pharmacists in type 2 diabetes care, and characteristics (pharmacist and pharmacy) associated with current practice. Community pharmacies in a developing country setting (Surabaya, Indonesia). A questionnaire was administered to pharmacists managing a random sample of 400 community pharmacies in Surabaya, Indonesia. Current practice and pharmacists' perceived roles were rated using Likert scales, whilst an open-ended question was used to identify priority roles. Logistic regression models determined characteristics associated with current practice. A response rate of 60% was achieved. Dispensing (100%) and education on how to use medications (72.6%) were common current pharmacy practices. More than 50% of pharmacists were supportive towards providing additional services beyond dispensing. The highest priorities for services beyond dispensing were education on medications [i.e. directions for use (58.6%) and common/important adverse effects (25.7%)], education on exercise (36.5%), education on diet (47.7%), and monitoring medication compliance (27.9%). Facilitators identified were: being perceived as part of a pharmacist's role (for all priority services), pharmacies with more than 50 diabetes customers per month (for diet education), and pharmacists' involvement in diabetes training (for compliance monitoring). The key barrier identified was lower pharmacist availability (for diet education as well as compliance monitoring). Most community pharmacies in Surabaya, Indonesia have only provided a basic service of dispensing for type 2 diabetes patients. Many pharmacists believed that they should extend their roles particularly regarding patient education and monitoring. The development of pharmacist professional roles would assist in managing the burgeoning burden of diabetes. The identified facilitators/barriers provide baseline data to support the development of community pharmacy-based diabetes services.

Problems associated with substandard and counterfeit drugs in developing countries: a review article on global implications of counterfeit drugs in the era of antiretroviral (ARVs) drugs in a free market economy.

PubMed

Nsimba, Stephen E D

2008-12-01

To review the global implications associated with the use of substandard and or counterfeit drugs in developing and may be developed countries. The focus of this review is particularly on antiretroviral (ARVs), antimalarials and other drugs. Review of various literatures through Pub-Med, Medline, Google and Internet search to retrieve and download published materials was done by the author of this review paper. When patients receive a counterfeit medicines, they are subjected to multiple risks. They often suffer more than just an inconvenience; as they become victims of fraud medicines and are all put at risk of adverse effects from unprescribed medicines or substandard ingredients. Additionally, patients may lose confidence in health care professionals including their physician and pharmacist, and potentially modern medicine or the pharmaceutical industry in general. Counterfeit or substandard (poor quality) drugs pose threats to society; not only to the individual in terms of the health side effects experienced, but also to the public in terms of trade relations, economic implications, and the effects on global pandemics. It is vital for suppliers, providers, and patients to be aware of current trends in counterfeiting in order to best prepare for encounters with suspicious products. Furthermore, this is an issue that needs to be continually dealt with on national and international policy levels. Developing countries should try their level best to establish good laboratories for monitoring and checking quality of all pharmaceuticals manufactured locally and those imported or donated to these countries. The Ministries of Health and all stakeholders involved in this issue must ensure that all drugs meet the set or established international standards and national standards. Failure to do so will be to misuse the hard earned forex that is normally borrowed from banks for the procurement and distribution of drugs to its people. Indeed sub-standard medications do more harm than good to people's health and it is unethical to give such drugs to people. Of course, in any market, some corruption and fraud always exist, but there are few commercial markets where fraud can have such drastic impact on global health and welfare. It is essential, therefore, that a multi-faceted approach be used to control this problem which affects the international community and continuously threatens the health of millions of people especially in developing countries. Developing countries should try their best at all costs establish good laboratories for monitoring or checking for quality control for all pharmaceuticals locally manufactured and those imported (entering) or donated to countries to make sure that they meet the set or established international or national standards. Short of that countries will be wasting a lot of money using forex which has been borrowed in a form a loans procuring and distributing to its people sub-standard medications which will do more harm than good to its indigenous people and this is unethical per se to give people drugs not meeting required set international standards.

Health promotion in Kenya: a volunteer nurse's experience.

PubMed

Kater, Vered; Liebergall, Michal

2010-01-01

This article presents a case study describing how nurses can improve the health behaviors of people living in developing countries. Difficulties and potential solutions are presented. Health promotion allows people to exert control over their health to improve it. A primary difficulty of health promotion in developing countries is communication between care providers and patients. One solution is the utilization of an interpreter; however, in the present study, no professional interpreters were available, thereby complicating the comprehension of new health-related concepts. Another challenge is to understand the patients' perspectives as related to healthcare values. Additionally, as a result of a dearth of evidence-based research in developing countries, difficulties arise in implementing, assessing, and evaluating health promotion programs. Despite these obstacles, nurses continue to travel to developing countries to promote health. Recommendations include respect for a community's health values and incorporation of these values into healthcare planning. To be accepted as a teacher by the local population, the nurse must be able to set aside his/her personal beliefs relating to healthcare, well-being, and disease. Health promotion initiatives should include the means for implementation, thereby enabling the local population to develop skills that will allow them to carry out health promotion projects.

EURRECA: development of tools to improve the alignment of micronutrient recommendations.

PubMed

Matthys, C; Bucchini, L; Busstra, M C; Cavelaars, A E J M; Eleftheriou, P; Garcia-Alvarez, A; Fairweather-Tait, S; Gurinović, M; van Ommen, B; Contor, L

2010-11-01

Approaches through which reference values for micronutrients are derived, as well as the reference values themselves, vary considerably across countries. Harmonisation is needed to improve nutrition policy and public health strategies. The EURRECA (EURopean micronutrient RECommendations Aligned, http://www.eurreca.org) Network of Excellence is developing generic tools for systematically establishing and updating micronutrient reference values or recommendations. Different types of instruments (including best practice guidelines, interlinked web pages, online databases and decision trees) have been identified. The first set of instruments is for training purposes and includes mainly interactive digital learning materials. The second set of instruments comprises collection and interlinkage of diverse information sources that have widely varying contents and purposes. In general, these sources are collections of existing information. The purpose of the majority of these information sources is to provide guidance on best practice for use in a wider scientific community or for users and stakeholders of reference values. The third set of instruments includes decision trees and frameworks. The purpose of these tools is to guide non-scientists in decision making based on scientific evidence. This platform of instruments will, in particular in Central and Eastern European countries, contribute to future capacity-building development in nutrition. The use of these tools by the scientific community, the European Food Safety Authority, bodies responsible for setting national nutrient requirements and others should ultimately help to align nutrient-based recommendations across Europe. Therefore, EURRECA can contribute towards nutrition policy development and public health strategies.

Diffusion of counterfeit drugs in developing countries and stability of galenics stored for months under different conditions of temperature and relative humidity

PubMed Central

Baratta, Francesca; Germano, Antonio; Brusa, Paola

2012-01-01

Aim To investigate the diffusion of counterfeit medicines in developing countries and to verify the stability of galenic dosage forms to determine the stability of galenics prepared and stored in developing countries. Methods We purchased 221 pharmaceutical samples belonging to different therapeutic classes both in authorized and illegal pharmacies and subjected them to European Pharmacopoeia, 7th ed. quality tests. An UV-visible spectrophotometric assay was used to determine the galenics stability under different conditions of temperature (T) and relative humidity (RH). Results A substantial percentage of samples was substandard (52%) and thus had to be considered as counterfeit. Stability tests for galenics showed that the tested dosage forms were stable for 24 months under “standard” (t = 25 ± 2°C, RH = 50 ± 5%) conditions. Under “accelerated” (t = 40 ± 2°C, RH = 50 ± 5%) conditions, samples were stable for 3 months provided that they were stored in glass containers. Stability results of samples stored in “accelerated” conditions were similar to those obtained by on site in tropical countries and could so supply precious information on the expected stability of galenics in tropical countries. Conclusion This study gives useful information about the presence of counterfeit medicinal products in the pharmacies of many developing countries. This should serve as an alarm bell and an input for the production of galenics. We recommend setting up of galenic laboratories in developing countries around the globe. PMID:22522996

Development of an international scale of socio-economic position based on household assets.

PubMed

Townend, John; Minelli, Cosetta; Harrabi, Imed; Obaseki, Daniel O; El-Rhazi, Karima; Patel, Jaymini; Burney, Peter

2015-01-01

The importance of studying associations between socio-economic position and health has often been highlighted. Previous studies have linked the prevalence and severity of lung disease with national wealth and with socio-economic position within some countries but there has been no systematic evaluation of the association between lung function and poverty at the individual level on a global scale. The BOLD study has collected data on lung function for individuals in a wide range of countries, however a barrier to relating this to personal socio-economic position is the need for a suitable measure to compare individuals within and between countries. In this paper we test a method for assessing socio-economic position based on the scalability of a set of durable assets (Mokken scaling), and compare its usefulness across countries of varying gross national income per capita. Ten out of 15 candidate asset questions included in the questionnaire were found to form a Mokken type scale closely associated with GNI per capita (Spearman's rank rs = 0.91, p = 0.002). The same set of assets conformed to a scale in 7 out of the 8 countries, the remaining country being Saudi Arabia where most respondents owned most of the assets. There was good consistency in the rank ordering of ownership of the assets in the different countries (Cronbach's alpha = 0.96). Scores on the Mokken scale were highly correlated with scores developed using principal component analysis (rs = 0.977). Mokken scaling is a potentially valuable tool for uncovering links between disease and socio-economic position within and between countries. It provides an alternative to currently used methods such as principal component analysis for combining personal asset data to give an indication of individuals' relative wealth. Relative strengths of the Mokken scale method were considered to be ease of interpretation, adaptability for comparison with other datasets, and reliability of imputation for even quite large proportions of missing values.

Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future.

PubMed

Schultz, Marcus J; Dunser, Martin W; Dondorp, Arjen M; Adhikari, Neill K J; Iyer, Shivakumar; Kwizera, Arthur; Lubell, Yoel; Papali, Alfred; Pisani, Luigi; Riviello, Beth D; Angus, Derek C; Azevedo, Luciano C; Baker, Tim; Diaz, Janet V; Festic, Emir; Haniffa, Rashan; Jawa, Randeep; Jacob, Shevin T; Kissoon, Niranjan; Lodha, Rakesh; Martin-Loeches, Ignacio; Lundeg, Ganbold; Misango, David; Mer, Mervyn; Mohanty, Sanjib; Murthy, Srinivas; Musa, Ndidiamaka; Nakibuuka, Jane; Serpa Neto, Ary; Nguyen Thi Hoang, Mai; Nguyen Thien, Binh; Pattnaik, Rajyabardhan; Phua, Jason; Preller, Jacobus; Povoa, Pedro; Ranjit, Suchitra; Talmor, Daniel; Thevanayagam, Jonarthan; Thwaites, C Louise

2017-05-01

Sepsis is a major reason for intensive care unit (ICU) admission, also in resource-poor settings. ICUs in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome. To describe differences between resource-poor and resource-rich settings regarding the epidemiology, pathophysiology, economics and research aspects of sepsis. We restricted this manuscript to the ICU setting even knowing that many sepsis patients in LMICs are treated outside an ICU. Although many bacterial pathogens causing sepsis in LMICs are similar to those in high-income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can sometimes be more important than the response of the host. There are substantial and persisting differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs, but with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and the important differences in resources. Addressing both disease-specific and setting-specific factors is important to improve performance of ICUs in LMICs. Although critical care for severe sepsis is likely cost-effective in LMIC setting, more detailed evaluation at both at a macro- and micro-economy level is necessary. Sepsis management in resource-limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.

The Challenges of Leading an International Branch Campus: The "Lived Experience" of In-Country Senior Managers

ERIC Educational Resources Information Center

Healey, Nigel M.

2016-01-01

In recent years, an increasing number of major universities have set up international branch campuses (IBCs). There are now more than 200 IBCs, with more under development. Little is known about the unique challenges that face IBC managers, who are normally seconded from the home university to set up and operate the satellite campus in a new and…

Misalignment between perceptions and actual global burden of disease: evidence from the US population.

PubMed

Siegel, Karen R; Feigl, Andrea B; Kishore, Sandeep P; Stuckler, David

2011-05-09

Significant funding of health programs in low-income countries comes from external sources, mainly private donors and national development agencies of high-income countries. How these external funds are allocated remains a subject of ongoing debate, as studies have revealed that external funding may misalign with the underlying disease burden. One determinant of the priorities set by both private donors and development agencies is the perceptions of populations living in high-income countries about which diseases are legitimate for global health intervention. While research has been conducted on the priorities expressed by recipient communities, relatively less has been done to assess those of the donating country. To investigate people's beliefs about the disease burden in high-income countries, we compared publicly available data from U.S. surveys of people's perceptions of the leading causes of death in developing countries against measures of the actual disease burden from the World Health Organization. We found little correlation between the U.S. public's perception and the actual disease burden, measured as either mortality or disability-adjusted life years. While there is potential for reverse causality, so that donor programs drive public perceptions, these findings suggest that increasing the general population's awareness of the true global disease burden could help better align global health funding with population health needs.

Resource availability for the management of maternal sepsis in Malawi, other low-income countries, and lower-middle-income countries.

PubMed

Abdu, Mohammed; Wilson, Amie; Mhango, Chisale; Taki, Fatima; Coomarasamy, Arri; Lissauer, David

2018-02-01

To assess the availability of key resources for the management of maternal sepsis and evaluate the feasibility of implementing the Surviving Sepsis Campaign (SSC) recommendations in Malawi and other low-resource settings. A cross-sectional study was conducted at health facilities in Malawi, other low-income countries, and lower-middle-income countries during January-March 2016. English-speaking healthcare professionals (e.g. doctors, nurses, midwives, and administrators) completed a questionnaire/online survey to assess the availability of resources for the management of maternal sepsis. Healthcare centers (n=23) and hospitals (n=13) in Malawi showed shortages in the resources for basic monitoring (always available in 5 [21.7%] and 10 [76.9%] facilities, respectively) and basic infrastructure (2 [8.7%] and 7 [53.8%], respectively). The availability of antibiotics varied between Malawian healthcare centers (9 [39.1%]), Malawian hospitals (8 [61.5%]), hospitals in other low-income countries (10/17 [58.8%]), and hospitals in lower-middle-income countries (39/41 [95.1%]). The percentage of SSC recommendations that could be implemented was 33.3% at hospitals in Malawi, 30.3% at hospitals in other low-income countries, and 68.2% at hospitals in lower-middle-income countries. The implementation of existing SSC recommendations is unrealistic in low-income countries because of resource limitations. New maternal sepsis care bundles must be developed that are applicable to low-resource settings. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

Modeling Social Dimensions of Oral Health among Older Adults in Urban Environments

ERIC Educational Resources Information Center

Metcalf, Sara S.; Northridge, Mary E.; Widener, Michael J.; Chakraborty, Bibhas; Marshall, Stephen E.; Lamster, Ira B.

2013-01-01

In both developed and developing countries, population aging has attained unprecedented levels. Public health strategies to deliver services in community-based settings are key to enhancing the utilization of preventive care and reducing costs for this segment of the population. Motivated by concerns of inadequate access to oral health care by…

Non-Formal Education for Rural Development: Strengthening Learning Opportunities for Children and Youth. Interim Report.

ERIC Educational Resources Information Center

United Nations Economic and Social Council, New York, NY.

This interim report, commissioned by UNICEF, emphasizes the value of nonformal educational programs to educationally deprived rural children and youth in developing countries. The first set of basic findings and recommendations arising from this extensive international research study is presented. Organized into five chapters, the text includes…

Entrepreneurship Education at School in Europe. Eurydice Report

ERIC Educational Resources Information Center

Bourgeois, Ania; Balcon, Marie-Pascale; Riiheläinen, Jari Matti

2016-01-01

Entrepreneurship education is essential not only to shape the mind-sets of young people but also to provide the skills, knowledge and attitudes that are central to developing an entrepreneurial culture. This report captures all the latest developments in this regard in European countries, following earlier Eurydice reports (2006, 2012). It covers…

The health transition: the cultural inflation of morbidity during the decline of mortality.

PubMed

Johansson, S R

1991-04-01

It has become commonplace to observe that as mortality falls, morbidity levels rise. The question is why? The explanation offered here stresses the multidimensional nature of morbidity, and the important role that diverse cultural forces have on the patterns of behaviour which underlie reporting behaviour during modernization. These forces involve rising health expectations on the part of ordinary people, including their ability to perceive illness and their willingness to seek professional help, and institutional pressures on medical professionals which reward them for discovering and treating an ever-growing set of non-fatal diseases. Since non-Western developing countries are training physicians to practice scientific medicine, are educating their citizens to think about disease along modern lines, and measure morbidity as developed countries do, there is every reason to suppose that as mortality falls in these countries, morbidity will rise, just as it has done in the developed world.

Generic medicines policies in the Asia Pacific region: ways forward.

PubMed

Nguyen, Tuan A; Hassali, Mohamed A A; McLachlan, Andrew

2013-01-01

Generic medicines are a key strategy used by governments and third-party payers to contain medicines costs and improve the access to essential medicines. This strategy represents an important opportunity provided by the global intellectual property regimes to discover and develop copies of original products marketed by innovator companies once the patent protection term is over. While there is an extensive experience regarding generic medicines policies in developed countries, this evidence may not translate to developing countries. The generic medicines policies workshop at the Asia Pacific Conference on National Medicines Policies 2012 provided an important opportunity to discuss and document country-specific initiatives for improving access to and the rational of use of generic medicines in the Asia Pacific region. Based on the identified barriers and enablers to implementation of generic medicines policies in the region, a set of future action plans and recommendations has been made.

"Talkin' about a revolution": How electronic health records can facilitate the scale-up of HIV care and treatment and catalyze primary care in resource-constrained settings.

PubMed

Braitstein, Paula; Einterz, Robert M; Sidle, John E; Kimaiyo, Sylvester; Tierney, William

2009-11-01

Health care for patients with HIV infection in developing countries has increased substantially in response to major international funding. Scaling up treatment programs requires timely data on the type, quantity, and quality of care being provided. Increasingly, such programs are turning to electronic health records (EHRs) to provide these data. We describe how a medical school in the United States and another in Kenya collaborated to develop and implement an EHR in a large HIV/AIDS care program in western Kenya. These data were used to manage patients, providers, and the program itself as it grew to encompass 18 sites serving more than 90,000 patients. Lessons learned have been applicable beyond HIV/AIDS to include primary care, chronic disease management, and community-based health screening and disease prevention programs. EHRs will be key to providing the highest possible quality of care for the funds developing countries can commit to health care. Public, private, and academic partnerships can facilitate the development and implementation of EHRs in resource-constrained settings.

Generation of common coefficients to estimate global solar radiation over different locations of India

NASA Astrophysics Data System (ADS)

Samanta, Suman; Patra, Pulak Kumar; Banerjee, Saon; Narsimhaiah, Lakshmi; Sarath Chandran, M. A.; Vijaya Kumar, P.; Bandyopadhyay, Sanjib

2018-06-01

In developing countries like India, global solar radiation (GSR) is measured at very few locations due to non-availability of radiation measuring instruments. To overcome the inadequacy of GSR measurements, scientists developed many empirical models to estimate location-wise GSR. In the present study, three simple forms of Angstrom equation [Angstrom-Prescott (A-P), Ogelman, and Bahel] were used to estimate GSR at six geographically and climatologically different locations across India with an objective to find out a set of common constants usable for whole country. Results showed that GSR values varied from 9.86 to 24.85 MJ m-2 day-1 for different stations. It was also observed that A-P model showed smaller errors than Ogelman and Bahel models. All the models well estimated GSR, as the 1:1 line between measured and estimated values showed Nash-Sutcliffe efficiency (NSE) values ≥ 0.81 for all locations. Measured data of GSR pooled over six selected locations was analyzed to obtain a new set of constants for A-P equation which can be applicable throughout the country. The set of constants (a = 0.29 and b = 0.40) was named as "One India One Constant (OIOC)," and the model was named as "MOIOC." Furthermore, the developed constants are validated statistically for another six locations of India and produce close estimation. High R 2 values (≥ 76%) along with low mean bias error (MBE) ranging from - 0.64 to 0.05 MJ m-2 day-1 revealed that the new constants are able to predict GSR with lesser percentage of error.

Costs of Addressing Heroin Addiction in Malaysia and 32 Comparable Countries Worldwide

PubMed Central

Ruger, Jennifer Prah; Chawarski, Marek; Mazlan, Mahmud; Luekens, Craig; Ng, Nora; Schottenfeld, Richard

2012-01-01

Objective Develop and apply new costing methodologies to estimate costs of opioid dependence treatment in countries worldwide. Data Sources/Study Setting Micro-costing methodology developed and data collected during randomized controlled trial (RCT) involving 126 patients (July 2003–May 2005) in Malaysia. Gross-costing methodology developed to estimate costs of treatment replication in 32 countries with data collected from publicly available sources. Study Design Fixed, variable, and societal cost components of Malaysian RCT micro-costed and analytical framework created and employed for gross-costing in 32 countries selected by three criteria relative to Malaysia: major heroin problem, geographic proximity, and comparable gross domestic product (GDP) per capita. Principal Findings Medication, and urine and blood testing accounted for the greatest percentage of total costs for both naltrexone (29–53 percent) and buprenorphine (33–72 percent) interventions. In 13 countries, buprenorphine treatment could be provided for under $2,000 per patient. For all countries except United Kingdom and Singapore, incremental costs per person were below $1,000 when comparing buprenorphine to naltrexone. An estimated 100 percent of opiate users in Cambodia and Lao People's Democratic Republic could be treated for $8 and $30 million, respectively. Conclusions Buprenorphine treatment can be provided at low cost in countries across the world. This study's new costing methodologies provide tools for health systems worldwide to determine the feasibility and cost of similar interventions. PMID:22091732

Reflections on the development of health economics in low- and middle-income countries.

PubMed

Mills, Anne

2014-08-22

Health economics is a relatively new discipline, though its antecedents can be traced back to William Petty FRS (1623-1687). In high-income countries, the academic discipline and scientific literature have grown rapidly since the 1960s. In low- and middle-income countries, the growth of health economics has been strongly influenced by trends in health policy, especially among the international and bilateral agencies involved in supporting health sector development. Valuable and influential research has been done in areas such as cost-benefit and cost-effectiveness analysis, financing of healthcare, healthcare provision, and health systems analysis, but there has been insufficient questioning of the relevance of theories and policy recommendations in the rich world literature to the circumstances of poorer countries. Characteristics such as a country's economic structure, strength of political and social institutions, management capacity, and dependence on external agencies, mean that theories and models cannot necessarily be transferred between settings. Recent innovations in the health economics literature on low- and middle-income countries indicate how health economics can be shaped to provide more relevant advice for policy. For this to be taken further, it is critical that such countries develop stronger capacity for health economics within their universities and research institutes, with greater local commitment of funding. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Design for All in Scandinavia - a strong concept.

PubMed

Bendixen, Karin; Benktzon, Maria

2015-01-01

Design for All is more than an appealing point of view. It is a concept that offers a set of challenges capable of generating innovation and giving design added value and weight. In the Scandinavian tradition, the concept has developed from a purely social dimension to a design topic that is discussed both in terms of its business potential and in relation to Corporate Social Responsibility, CSR. This article gives a State of the Art of the development of Design for All in the Scandinavian countries: Denmark, Norway, Sweden and Finland during the past 15 years, beginning with a common review and joint Scandinavian projects, followed by an overall review country by country which include selected case studies over the past 15 years. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Tracking development assistance and government health expenditures for 35 malaria-eliminating countries: 1990-2017.

PubMed

Shretta, Rima; Zelman, Brittany; Birger, Maxwell L; Haakenstad, Annie; Singh, Lavanya; Liu, Yingying; Dieleman, Joseph

2017-07-14

Donor financing for malaria has declined since 2010 and this trend is projected to continue for the foreseeable future. These reductions have a significant impact on lower burden countries actively pursuing elimination, which are usually a lesser priority for donors. While domestic spending on malaria has been growing, it varies substantially in speed and magnitude across countries. A clear understanding of spending patterns and trends in donor and domestic financing is needed to uncover critical investment gaps and opportunities. Building on the Institute for Health Metrics and Evaluation's annual Financing Global Health research, data were collected from organizations that channel development assistance for health to the 35 countries actively pursuing malaria elimination. Where possible, development assistance for health (DAH) was categorized by spend on malaria intervention. A diverse set of data points were used to estimate government health budgets expenditure on malaria, including World Malaria Reports and government reports when available. Projections were done using regression analyses taking recipient country averages and earmarked funding into account. Since 2010, DAH for malaria has been declining for the 35 countries actively pursuing malaria elimination (from $176 million in 2010 to $62 million in 2013). The Global Fund is the largest external financier for malaria, providing 96% of the total external funding for malaria in 2013, with vector control interventions being the highest cost driver in all regions. Government expenditure on malaria, while increasing, has not kept pace with diminishing DAH or rising national GDP rates, leading to a potential gap in service delivery needed to attain elimination. Despite past gains, total financing available for malaria in elimination settings is declining. Health financing trends suggest that substantive policy interventions will be needed to ensure that malaria elimination is adequately financed and that available financing is effectively targeted to interventions that provide the best value for money.

Issues to consider in the derivation of water quality benchmarks for the protection of aquatic life.

PubMed

Schneider, Uwe

2014-01-01

While water quality benchmarks for the protection of aquatic life have been in use in some jurisdictions for several decades (USA, Canada, several European countries), more and more countries are now setting up their own national water quality benchmark development programs. In doing so, they either adopt an existing method from another jurisdiction, update on an existing approach, or develop their own new derivation method. Each approach has its own advantages and disadvantages, and many issues have to be addressed when setting up a water quality benchmark development program or when deriving a water quality benchmark. Each of these tasks requires a special expertise. They may seem simple, but are complex in their details. The intention of this paper was to provide some guidance for this process of water quality benchmark development on the program level, for the derivation methodology development, and in the actual benchmark derivation step, as well as to point out some issues (notably the inclusion of adapted populations and cryptic species and points to consider in the use of the species sensitivity distribution approach) and future opportunities (an international data repository and international collaboration in water quality benchmark development).

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies

PubMed Central

Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

2017-01-01

Abstract Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. PMID:28369396

Combining Google Earth and GIS mapping technologies in a dengue surveillance system for developing countries

PubMed Central

Chang, Aileen Y; Parrales, Maria E; Jimenez, Javier; Sobieszczyk, Magdalena E; Hammer, Scott M; Copenhaver, David J; Kulkarni, Rajan P

2009-01-01

Background Dengue fever is a mosquito-borne illness that places significant burden on tropical developing countries with unplanned urbanization. A surveillance system using Google Earth and GIS mapping technologies was developed in Nicaragua as a management tool. Methods and Results Satellite imagery of the town of Bluefields, Nicaragua captured from Google Earth was used to create a base-map in ArcGIS 9. Indices of larval infestation, locations of tire dumps, cemeteries, large areas of standing water, etc. that may act as larval development sites, and locations of the homes of dengue cases collected during routine epidemiologic surveying were overlaid onto this map. Visual imagery of the location of dengue cases, larval infestation, and locations of potential larval development sites were used by dengue control specialists to prioritize specific neighborhoods for targeted control interventions. Conclusion This dengue surveillance program allows public health workers in resource-limited settings to accurately identify areas with high indices of mosquito infestation and interpret the spatial relationship of these areas with potential larval development sites such as garbage piles and large pools of standing water. As a result, it is possible to prioritize control strategies and to target interventions to highest risk areas in order to eliminate the likely origin of the mosquito vector. This program is well-suited for resource-limited settings since it utilizes readily available technologies that do not rely on Internet access for daily use and can easily be implemented in many developing countries for very little cost. PMID:19627614

The global economic burden of dengue: a systematic analysis.

PubMed

Shepard, Donald S; Undurraga, Eduardo A; Halasa, Yara A; Stanaway, Jeffrey D

2016-08-01

Dengue is a serious global burden. Unreported and unrecognised apparent dengue virus infections make it difficult to estimate the true extent of dengue and current estimates of the incidence and costs of dengue have substantial uncertainty. Objective, systematic, comparable measures of dengue burden are needed to track health progress, assess the application and financing of emerging preventive and control strategies, and inform health policy. We estimated the global economic burden of dengue by country and super-region (groups of epidemiologically similar countries). We used the latest dengue incidence estimates from the Institute for Health Metrics and Evaluation's Global Burden of Disease Study 2013 and several other data sources to assess the economic burden of symptomatic dengue cases in the 141 countries and territories with active dengue transmission. From the scientific literature and regressions, we estimated cases and costs by setting, including the non-medical setting, for all countries and territories. Our global estimates suggest that in 2013 there were a total of 58·40 million symptomatic dengue virus infections (95% uncertainty interval [95% UI] 24 million-122 million), including 13 586 fatal cases (95% UI 4200-34 700), and that the total annual global cost of dengue illness was US$8·9 billion (95% UI 3·7 billion-19·7 billion). The global distribution of dengue cases is 18% admitted to hospital, 48% ambulatory, and 34% non-medical. The global cost of dengue is substantial and, if control strategies could reduce dengue appreciably, billions of dollars could be saved globally. In estimating dengue costs by country and setting, this study contributes to the needs of policy makers, donors, developers, and researchers for economic assessments of dengue interventions, particularly with the licensure of the first dengue vaccine and promising developments in other technologies. Sanofi Pasteur. Copyright © 2016 Elsevier Ltd. All rights reserved.

A change roadmap towards research paradigm in low-resource countries: retinoblastoma model in Egypt.

PubMed

Alfaar, Ahmad Samir; Nour, Radwa; Bakry, Mohamed Sabry; Kamal, Mohamed; Hassanain, Omneya; Labib, Rania M; Rashed, Wafaa M; Elzomor, Hossam; Alieldin, Adel; Taha, Hala; Zaghloul, Mohamed Saad; Ezzat, Sameera; AboElnaga, Sherif

2017-02-01

Research on childhood diseases represents a great global challenge. This challenge is maximized in both childhood cancer disciplines and developing world. In this paper, we aim at describing our institution experience in starting a structured childhood cancer research program in one of the developing countries in a short time based on philanthropic efforts. We used retinoblastoma as an example for what was conducted in this program. Starting in 2008, this program included improving clinical practice and its related supporting services besides developing new research services that both complement the clinical activities and pave the way towards creating a research foundation in the country. Results included developing hospital standard treatment protocols, developing national clinical trials, joining international consortia for childhood cancers clinical trials, developing data collection tools and real-time analytics, establishing a biobanking facility, and developing highly qualified team for conducting clinical, epidemiologic, and translational research studies. Moreover, this effort resulted in improving both clinical practice and patients' awareness nationally. This model can be used for other startup facilities that aim at finding answers for their national health problems in low-resource setting.

Argentina corn yield model

NASA Technical Reports Server (NTRS)

Callis, S. L.; Sakamoto, C.

1984-01-01

A model based on multiple regression was developed to estimate corn yields for the country of Argentina. A meteorological data set was obtained for the country by averaging data for stations within the corn-growing area. Predictor variables for the model were derived from monthly total precipitation, average monthly mean temperature, and average monthly maximum temperature. A trend variable was included for the years 1965 to 1980 since an increasing trend in yields due to technology was observed between these years.

What criteria do decision makers in Thailand use to set priorities for vaccine introduction?

PubMed

Pooripussarakul, Siriporn; Riewpaiboon, Arthorn; Bishai, David; Muangchana, Charung; Tantivess, Sripen

2016-08-02

There is a need to identify rational criteria and set priorities for vaccines. In Thailand, many licensed vaccines are being considering for introduction into the Expanded Program on Immunization; thus, the government has to make decisions about which vaccines should be adopted. This study aimed to set priorities for new vaccines and to facilitate decision analysis. We used a best-worst scaling study for rank-ordering of vaccines. The candidate vaccines were determined by a set of criteria, including burden of disease, target age group, budget impact, side effect, effectiveness, severity of disease, and cost of vaccine. The criteria were identified from a literature review and by in-depth, open-ended interviews with experts. The priority-setting model was conducted among three groups of stakeholders, including policy makers, healthcare professionals and healthcare administrators. The vaccine data were mapped and then calculated for the probability of selection. From the candidate vaccines, the probability of hepatitis B vaccine being selected by all respondents (96.67 %) was ranked first. This was followed, respectively, by pneumococcal conjugate vaccine-13 (95.09 %) and Haemophilus influenzae type b vaccine (90.87 %). The three groups of stakeholders (policy makers, healthcare professionals and healthcare administrators) showed the same ranking trends. Most severe disease, high fever rate and high disease burden showed the highest coefficients for criterion levels being selected by all respondents. This result can be implied that a vaccine which can prevent most severe disease with high disease burden and has low safety has a greater chance of being selected by respondents in this study. The priority setting of vaccines through a multiple-criteria approach could contribute to transparency and accountability in the decision-making process. This is a step forward in the development of an evidence-based approach that meets the need of developing country. The methodology is generalizable but its application to another country would require the criteria as relevant to that country.

The European Glaucoma Society Glaucocard project: improved digital documentation of medical data for glaucoma patients based on standardized structured international datasets.

PubMed

Schargus, Marc; Grehn, Franz; Glaucocard Workgroup

2008-12-01

To evaluate existing international IT-based ophthalmological medical data projects, and to define a glaucoma data set based on existing international standards of medical and ophthalmological documentation. To develop the technical environment for easy data mining and data exchange in different countries in Europe. Existing clinical and IT-based projects for documentation of medical data in general medicine and ophthalmology were analyzed to create new data sets for medical documentation in glaucoma patients. Different types of data transfer methods were evaluated to find the best method of data exchange between ophthalmologists in different European countries. Data sets from existing IT projects showed a wide variability in specifications, use of codes, terms and graphical data (perimetry, optic nerve analysis etc.) in glaucoma patients. New standardized digital datasets for glaucoma patients were defined, based on existing standards, which can be used by general ophthalmologists for follow-up examinations and for glaucoma specialists to perform teleconsultation, also across country borders. Datasets are available in different languages. Different types of data exchange methods using secure medical data transfer by internet, USB stick and smartcard were tested for different countries with regard to legal acceptance, practicability and technical realization (e.g. compatibility with EMR systems). By creating new standardized glaucoma specific cross-national datasets, it is now possible to develop an electronic glaucoma patient record system for data storage and transfer based on internet, smartcard or USB stick. The digital data can be used for referrals and for teleconsultation of glaucoma specialists in order to optimize glaucoma treatment. This should lead to an increase of quality in glaucoma care, and prevent expenses in health care costs by unnecessary repeated examinations.

Leapfrog diagnostics: Demonstration of a broad spectrum pathogen identification platform in a resource-limited setting

PubMed Central

2012-01-01

Background Resource-limited tropical countries are home to numerous infectious pathogens of both human and zoonotic origin. A capability for early detection to allow rapid outbreak containment and prevent spread to non-endemic regions is severely impaired by inadequate diagnostic laboratory capacity, the absence of a “cold chain” and the lack of highly trained personnel. Building up detection capacity in these countries by direct replication of the systems existing in developed countries is not a feasible approach and instead requires “leapfrogging” to the deployment of the newest diagnostic systems that do not have the infrastructure requirements of systems used in developed countries. Methods A laboratory for molecular diagnostics of infectious agents was established in Bo, Sierra Leone with a hybrid solar/diesel/battery system to ensure stable power supply and a satellite modem to enable efficient communication. An array of room temperature stabilization and refrigeration technologies for reliable transport and storage of reagents and biological samples were also tested to ensure sustainable laboratory supplies for diagnostic assays. Results The laboratory demonstrated its operational proficiency by conducting an investigation of a suspected avian influenza outbreak at a commercial poultry farm at Bo using broad range resequencing microarrays and real time RT-PCR. The results of the investigation excluded influenza viruses as a possible cause of the outbreak and indicated a link between the outbreak and the presence of Klebsiella pneumoniae. Conclusions This study demonstrated that by application of a carefully selected set of technologies and sufficient personnel training, it is feasible to deploy and effectively use a broad-range infectious pathogen detection technology in a severely resource-limited setting. PMID:22759725

The terrain of health policy analysis in low and middle income countries: a review of published literature 1994–2007

PubMed Central

Gilson, Lucy; Raphaely, Nika

2008-01-01

This article provides the first ever review of literature analysing the health policy processes of low and middle income countries (LMICs). Based on a systematic search of published literature using two leading international databases, the article maps the terrain of work published between 1994 and 2007, in terms of policy topics, lines of inquiry and geographical base, as well as critically evaluating its strengths and weaknesses. The overall objective of the review is to provide a platform for the further development of this field of work. From an initial set of several thousand articles, only 391 were identified as relevant to the focus of inquiry. Of these, 164 were selected for detailed review because they present empirical analyses of health policy change processes within LMIC settings. Examination of these articles clearly shows that LMIC health policy analysis is still in its infancy. There are only small numbers of such analyses, whilst the diversity of policy areas, topics and analytical issues that have been addressed across a large number of country settings results in a limited depth of coverage within this body of work. In addition, the majority of articles are largely descriptive in nature, limiting understanding of policy change processes within or across countries. Nonetheless, the broad features of experience that can be identified from these articles clearly confirm the importance of integrating concern for politics, process and power into the study of health policy. By generating understanding of the factors influencing the experience and results of policy change, such analysis can inform action to strengthen future policy development and implementation. This article, finally, outlines five key actions needed to strengthen the field of health policy analysis within LMICs, including capacity development and efforts to generate systematic and coherent bodies of work underpinned by both the intent to undertake rigorous analytical work and concern to support policy change. PMID:18650209

Value congruence in health care priority setting: social values, institutions and decisions in three countries.

PubMed

Landwehr, Claudia; Klinnert, Dorothea

2015-04-01

Most developed democracies have faced the challenge of priority setting in health care by setting up specialized agencies to take decisions on which medical services to include in public health baskets. Under the influence of Daniels and Sabin's seminal work on the topic, agencies increasingly aim to fulfil criteria of procedural justice, such as accountability and transparency. We assume, however, that the institutional design of agencies also and necessarily reflects substantial value judgments on the respective weight of distributive principles such as efficiency, need and equality. The public acceptance of prioritization decisions, and eventually of the health care system at large, will ultimately depend not only on considerations of procedural fairness, but also on the congruence between a society's values and its institutions. We study social values, institutions and decisions in three countries (France, Germany and the United Kingdom) in order to assess such congruence and formulate expectations on its effects.

Indonesia. Adolescent reproductive health forms part of 5th country programme cycle.

PubMed

1995-01-01

Indonesia is now entering the Fifth Country Program Cycle of Population. The reproductive health and family well-being of the youth forms part of the country program. In order to translate this component into concrete action program, a project document in its first draft was developed for UNFPA (UN Population Fund) funding by the government and with the assistance of UNFPA CST, Bangkok and UNFPA Field Office in Jakarta. The project aims to raise the level of commitment and degree of participation of families, particularly parents, for developing among their pre-adolescent and adolescent children a better understanding of the concepts/process of adolescent reproductive health and desirable attitudes and values dealing with family well-being. This is to be achieved through family-centered learning approaches that will contribute to the adoption of the small, happy, and prosperous family norm. To achieve this goal, the project will develop national capacity by creating management teams, developing sets of training and counseling materials, delivering key messages through the media, upgrading skills in adolescent counseling and developing better understanding of adolescent reproductive health and family well-being issues among the facilitators. The strategy to be used is to set up small groups of 20-30 families which will regularly meet to discuss adolescent problems and issues with the help of cadres. They will be supported by provincial reproductive health and family well-being counseling centers which will also be set up to handle serious cases difficult for parents to handle. These centers, to be run by NGOs, will provide counseling services to parents and youth, evolve innovative and culturally acceptable counseling techniques, and at the same time serve as material and information collection, development and dissemination centers. The project will be launched in collaboration with seven NGOs in seven selected provinces. It is currently under review by UNFPA and the Government. full text

A comparative analysis of biomedical research ethics regulation systems in Europe and Latin America with regard to the protection of human subjects.

PubMed

Lamas, Eugenia; Ferrer, Marcela; Molina, Alberto; Salinas, Rodrigo; Hevia, Adriana; Bota, Alexandre; Feinholz, Dafna; Fuchs, Michael; Schramm, Roland; Tealdi, Juan-Carlos; Zorrilla, Sergio

2010-12-01

The European project European and Latin American Systems of Ethics Regulation of Biomedical Research Project (EULABOR) has carried out the first comparative analysis of ethics regulation systems for biomedical research in seven countries in Europe and Latin America, evaluating their roles in the protection of human subjects. We developed a conceptual and methodological framework defining 'ethics regulation system for biomedical research' as a set of actors, institutions, codes and laws involved in overseeing the ethics of biomedical research on humans. This framework allowed us to develop comprehensive national reports by conducting semi-structured interviews to key informants. These reports were summarised and analysed in a comparative analysis. The study showed that the regulatory framework for clinical research in these countries differ in scope. It showed that despite the different political contexts, actors involved and motivations for creating the regulation, in most of the studied countries it was the government who took the lead in setting up the system. The study also showed that Europe and Latin America are similar regarding national bodies and research ethics committees, but the Brazilian system has strong and noteworthy specificities.

Insights into the management of chronic myeloid leukemia in resource-poor settings: a Mexican perspective.

PubMed

Gomez-de-León, Andrés; Gómez-Almaguer, David; Ruiz-Delgado, Guillermo J; Ruiz-Arguelles, Guillermo J

2017-09-01

The arrival of targeted therapy for chronic myeloid leukemia (CML) was revolutionary. However, due to the high cost of tyrosine kinase inhibitors, access to this highly effective therapy with strict monitoring strategies is limited in low to middle-income countries. In this context, following standard recommendations proposed by experts in developed countries is difficult. Areas covered: This review aims to provide an insight into the management of patients with CML living in a resource-limited setting. It addresses several issues: diagnosis, initial treatment, disease monitoring, and additional treatment alternatives including allogeneic hematopoietic stem cell transplantation. Expert commentary: Imatinib is probably the most cost-effective TKI for initial treatment in developing and underdeveloped countries. Generic imatinib preparations should be evaluated before considering their widespread use. Adherence to treatment should be emphasized. Adequate monitoring can be performed through several methods successfully and is important for predicting outcomes, particularly early in the first year, and if treatment suspension is being considered. Access to further therapeutic alternatives should define our actions after failure or intolerance to imatinib, preferring additional TKIs if possible. Allogeneic transplantation in chronic phase is a viable option in this context.

The influence of cost-per-DALY information in health prioritisation and desirable features for a registry: a survey of health policy experts in Vietnam, India and Bangladesh.

PubMed

Teerawattananon, Yot; Tantivess, Sripen; Yamabhai, Inthira; Tritasavit, Nattha; Walker, Damian G; Cohen, Joshua T; Neumann, Peter J

2016-12-03

Economic evaluation has been implemented to inform policy in many areas, including coverage decisions, technology pricing, and the development of clinical practice guidelines. However, there are barriers to evidence-based policy in low- and middle-income countries (LMICs) that include limited stakeholder awareness, resources and data availability, as well as the lack of capacity to conduct country-specific economic evaluations. This study aims to survey health policy experts' opinions on barriers to use of cost-effectiveness data in these settings and to obtain their advice on how to make a new cost-per-DALY database being developed by Tufts Medical Center more relevant to LMICs. It also identifies the factors influencing transferability. In-depth interviews were conducted with 32 participants, including policymakers, technical advisors, and researchers in Health Ministries, universities and non-governmental organisations in Bangladesh, India (New Delhi, Tamil Nadu and Karnataka) and Vietnam. The survey revealed that, in all settings, the use of cost-effectiveness information in policy development is lacking, owing to limited knowledge among policymakers and inadequate human resources with health economics expertise in the government sector. Furthermore, researchers in universities do not have close connections with health authorities. In India and Vietnam, the demand for evidence to inform coverage decisions tends to increase as the countries are moving towards universal health coverage. The informants in all countries argue that cost-effectiveness data are useful for decision-makers; however, most of them do not perform data searches by themselves but rely on the information provided by the technical advisor counterparts. Most interviewees were familiar with using evidence from other countries and were also aware of the influences of contextual elements as a limitation of transferability. Finally, strategies to promote the newly developed database include training on basic economic evaluation for policymakers and researchers, and effective communication programs, with support from reputable global agencies. Although cost-effectiveness information is recognised as essential in resource allocation, there are several impediments in the generation and use of such evidence to inform priority setting in LMICs. As such, the Cost-per-DALY database should be well-designed and introduced with appropriate promotion strategies so that it will be helpful in real-world policymaking.

A framework for evaluation of flood management strategies.

PubMed

Hansson, K; Danielson, M; Ekenberg, L

2008-02-01

The resulting impact of disasters on society depends on the affected country's economic strength prior to the disaster. The larger the disaster and the smaller the economy, the more significant is the impact. This is clearest seen in developing countries, where weak economies become even weaker afterwards. Deliberate strategies for the sharing of losses from hazardous events may aid a country or a community in efficiently using scarce prevention and mitigation resources, thus being better prepared for the effects of a disaster. Nevertheless, many governments lack an adequate institutional system for applying cost effective and reliable technologies for disaster prevention, early warnings, and mitigation. Modelling by event analyses and strategy models is one way of planning ahead, but these models have so far not been linked together. An approach to this problem was taken during a large study in Hungary, the Tisza case study, where a number of policy strategies for spreading of flood loss were formulated. In these strategies, a set of parameters of particular interest were extracted from interviews with stakeholders in the region. However, the study was focused on emerging economies, and, in particular, on insurance strategies. The scope is now extended to become a functional framework also for developing countries. In general, they have a higher degree of vulnerability. The paper takes northern Vietnam as an example of a developing region. We identify important parameters and discuss their importance for flood strategy formulations. Based on the policy strategies in the Tisza case, we extract data from the strategies and propose a framework for loss spread in developing and emerging economies. The parameter set can straightforwardly be included in a simulation and decision model for policy formulation and evaluation, taking multiple stakeholders into account.

Air pollution and population health: a global challenge.

PubMed

Chen, Bingheng; Kan, Haidong

2008-03-01

"Air pollution and population health" is one of the most important environmental and public health issues. Economic development, urbanization, energy consumption, transportation/motorization, and rapid population growth are major driving forces of air pollution in large cities, especially in megacities. Air pollution levels in developed countries have been decreasing dramatically in recent decades. However, in developing countries and in countries in transition, air pollution levels are still at relatively high levels, though the levels have been gradually decreasing or have remained stable during rapid economic development. In recent years, several hundred epidemiological studies have emerged showing adverse health effects associated with short-term and long-term exposure to air pollutants. Time-series studies conducted in Asian cities also showed similar health effects on mortality associated with exposure to particulate matter (PM), sulfur dioxide (SO(2)), nitrogen dioxide (NO(2)) and ozone (O(3)) to those explored in Europe and North America. The World Health Organization (WHO) published the "WHO Air Quality Guidelines (AQGs), Global Update" in 2006. These updated AQGs provide much stricter guidelines for PM, NO(2), SO(2) and O(3). Considering that current air pollution levels are much higher than the WHO-recommended AQGs, interim targets for these four air pollutants are also recommended for member states, especially for developing countries in setting their country-specific air quality standards. In conclusion, ambient air pollution is a health hazard. It is more important in Asian developing countries within the context of pollution level and population density. Improving air quality has substantial, measurable and important public health benefits.

Antimicrobial resistance in South East Asia: time to ask the right questions.

PubMed

Kakkar, Manish; Chatterjee, Pranab; Chauhan, Abhimanyu Singh; Grace, Delia; Lindahl, Johanna; Beeche, Arlyne; Jing, Fang; Chotinan, Suwit

2018-01-01

Antimicrobial resistance (AMR) has emerged as a major public health concern, around which the international leadership has come together to form strategic partnerships and action plans. The main driving force behind the emergence of AMR is selection pressure created due to consumption of antibiotics. Consumption of antibiotics in human as well as animal sectors are driven by a complex interplay of determinants, many of which are typical to the local settings. Several sensitive and essential realities are tied with antibiotic consumption - food security, livelihoods, poverty alleviation, healthcare access and national economies, to name a few. That makes one-size-fits-all policies, framed with the developed country context in mind, inappropriate for developing countries. Many countries in the South East Asian Region have some policy structures in place to deal with AMR, but most of them lack detailed implementation plans or monitoring structures. In this current debates piece, the authors argue that the principles driving the AMR agenda in the South East Asian countries need to be dealt with using locally relevant policy structures. Strategies, which have successfully reduced the burden of AMR in the developed countries, should be evaluated in the developing country contexts instead of ad hoc implementation. The Global Action Plan on AMR encourages member states to develop locally relevant National Action Plans on AMR. This policy position should be leveraged to develop and deploy locally relevant strategies, which are based on a situation analysis of the local systems, and are likely to meet the needs of the individual member states.

Road safety risk evaluation and target setting using data envelopment analysis and its extensions.

PubMed

Shen, Yongjun; Hermans, Elke; Brijs, Tom; Wets, Geert; Vanhoof, Koen

2012-09-01

Currently, comparison between countries in terms of their road safety performance is widely conducted in order to better understand one's own safety situation and to learn from those best-performing countries by indicating practical targets and formulating action programmes. In this respect, crash data such as the number of road fatalities and casualties are mostly investigated. However, the absolute numbers are not directly comparable between countries. Therefore, the concept of risk, which is defined as the ratio of road safety outcomes and some measure of exposure (e.g., the population size, the number of registered vehicles, or distance travelled), is often used in the context of benchmarking. Nevertheless, these risk indicators are not consistent in most cases. In other words, countries may have different evaluation results or ranking positions using different exposure information. In this study, data envelopment analysis (DEA) as a performance measurement technique is investigated to provide an overall perspective on a country's road safety situation, and further assess whether the road safety outcomes registered in a country correspond to the numbers that can be expected based on the level of exposure. In doing so, three model extensions are considered, which are the DEA based road safety model (DEA-RS), the cross-efficiency method, and the categorical DEA model. Using the measures of exposure to risk as the model's input and the number of road fatalities as output, an overall road safety efficiency score is computed for the 27 European Union (EU) countries based on the DEA-RS model, and the ranking of countries in accordance with their cross-efficiency scores is evaluated. Furthermore, after applying clustering analysis to group countries with inherent similarity in their practices, the categorical DEA-RS model is adopted to identify best-performing and underperforming countries in each cluster, as well as the reference sets or benchmarks for those underperforming ones. More importantly, the extent to which each reference set could be learned from is specified, and practical yet challenging targets are given for each underperforming country, which enables policymakers to recognize the gap with those best-performing countries and further develop their own road safety policy. Copyright © 2012 Elsevier Ltd. All rights reserved.

Overcoming the Problems of Inconsistent International Migration data: A New Method Applied to Flows in Europe

PubMed Central

Raymer, James; van der Erf, Rob; van Wissen, Leo

2010-01-01

Due to differences in definitions and measurement methods, cross-country comparisons of international migration patterns are difficult and confusing. Emigration numbers reported by sending countries tend to differ from the corresponding immigration numbers reported by receiving countries. In this paper, a methodology is presented to achieve harmonised estimates of migration flows benchmarked to a specific definition of duration. This methodology accounts for both differences in definitions and the effects of measurement error due to, for example, under reporting and sampling fluctuations. More specifically, the differences between the two sets of reported data are overcome by estimating a set of adjustment factors for each country’s immigration and emigration data. The adjusted data take into account any special cases where the origin–destination patterns do not match the overall patterns. The new method for harmonising migration flows that we present is based on earlier efforts by Poulain (European Journal of Population, 9(4): 353–381 1993, Working Paper 12, joint ECE-Eurostat Work Session on Migration Statistics, Geneva, Switzerland 1999) and is illustrated for movements between 19 European countries from 2002 to 2007. The results represent a reliable and consistent set of international migration flows that can be used for understanding recent changes in migration patterns, as inputs into population projections and for developing evidence-based migration policies. PMID:21124647

The Tip of the Iceberg: The Quest for Innovation at the Base of the Pyramid

NASA Astrophysics Data System (ADS)

Gordon, M. D.; Awad, N. F.

Much of the world in Asia, Latin America, and Africa is at an early stage of economic development similar to what the United States and other developed countries experienced many decades ago. Yet, much as their needs for hard and soft infrastructure, effective business practices, and an educated workforce parallel similar needs that underlay earlier development in the West, replicating Western development would overlook the hallmarks of the current century: widely available information and communications technology; a set of electronic linkages among the world; and a global business environment, to name just a few. Consequently, it should be possible to allow developing countries to use "leapfrog" technologies that were inconceivable decades ago to support their development. One means of identifying these opportunities is by matching traditional development needs with novel support by connecting previously unrelated literatures.

Educational inequalities in obesity and gross domestic product: evidence from 70 countries.

PubMed

Kinge, Jonas Minet; Strand, Bjørn Heine; Vollset, Stein Emil; Skirbekk, Vegard

2015-12-01

We test the reversal hypothesis, which suggests that the relationship between obesity and education depends on the economic development in the country; in poor countries, obesity is more prevalent in the higher educated groups, while in rich countries the association is reversed-higher prevalence in the lower educated. We assembled a data set on obesity and education including 412,921 individuals from 70 countries in the period 2002-2013. Gross domestic product (GDP) per capita was used as a measure of economic development. We assessed the association between obesity and GDP by education using a two-stage mixed effects model. Country-specific educational inequalities in obesity were investigated using regression-based inequality indices. The reversal hypothesis was supported by our results in men and women. Obesity was positively associated with country GDP only among individuals with lower levels of education, while this association was absent or reduced in those with higher levels of education. This pattern was more pronounced in women than in men. Furthermore, educational inequalities in obesity were reversed with GDP; in low-income countries, obesity was more prevalent in individuals with higher education, in medium-income and high-income countries, obesity shifts to be more prevalent among those with lower levels of education. Obesity and economic development were positively associated. Our findings suggest that education might mitigate this effect. Global and national action aimed at the obesity epidemic should take this into account. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Water security for productive economies: Applying an assessment framework in southern Africa

NASA Astrophysics Data System (ADS)

Holmatov, Bunyod; Lautze, Jonathan; Manthrithilake, Herath; Makin, Ian

2017-08-01

Achieving water security has emerged as a major objective in Africa, yet an analytical or diagnostic framework for assessing water security in African countries is not known to exist. This paper applies one key dimension of the 2016 Asian Development Bank's (ADB) Asian Water Development Outlook (AWDO) to assess levels of water security for productive economies in countries of the Southern African Development Community (SADC). Economic aspects of water security cover four areas: economic activities in the broad sense, agriculture, electricity, and industry. Water security in each area is measured through application of a set of indicators; results of indicator application are then aggregated to determine economic water security at a country-level. Results show that economic water security in SADC is greatest in the Seychelles and South Africa, and lowest in Madagascar and Malawi. Opportunities for strengthening economic water security in the majority of SADC countries exist through improving agricultural water productivity, strengthening resilience, and expanding sustainable electricity generation. More profoundly, this paper suggests that there is clear potential and utility in applying approaches used elsewhere to assess economic water security in southern Africa.

Pan-European stochastic flood event set

NASA Astrophysics Data System (ADS)

Kadlec, Martin; Pinto, Joaquim G.; He, Yi; Punčochář, Petr; Kelemen, Fanni D.; Manful, Desmond; Palán, Ladislav

2017-04-01

Impact Forecasting (IF), the model development center of Aon Benfield, has been developing a large suite of catastrophe flood models on probabilistic bases for individual countries in Europe. Such natural catastrophes do not follow national boundaries: for example, the major flood in 2016 was responsible for the Europe's largest insured loss of USD3.4bn and affected Germany, France, Belgium, Austria and parts of several other countries. Reflecting such needs, IF initiated a pan-European flood event set development which combines cross-country exposures with country based loss distributions to provide more insightful data to re/insurers. Because the observed discharge data are not available across the whole Europe in sufficient quantity and quality to permit a detailed loss evaluation purposes, a top-down approach was chosen. This approach is based on simulating precipitation from a GCM/RCM model chain followed by a calculation of discharges using rainfall-runoff modelling. IF set up this project in a close collaboration with Karlsruhe Institute of Technology (KIT) regarding the precipitation estimates and with University of East Anglia (UEA) in terms of the rainfall-runoff modelling. KIT's main objective is to provide high resolution daily historical and stochastic time series of key meteorological variables. A purely dynamical downscaling approach with the regional climate model COSMO-CLM (CCLM) is used to generate the historical time series, using re-analysis data as boundary conditions. The resulting time series are validated against the gridded observational dataset E-OBS, and different bias-correction methods are employed. The generation of the stochastic time series requires transfer functions between large-scale atmospheric variables and regional temperature and precipitation fields. These transfer functions are developed for the historical time series using reanalysis data as predictors and bias-corrected CCLM simulated precipitation and temperature as predictands. Finally, the transfer functions are applied to a large ensemble of GCM simulations with forcing corresponding to present day climate conditions to generate highly resolved stochastic time series of precipitation and temperature for several thousand years. These time series form the input for the rainfall-runoff model developed by the UEA team. It is a spatially distributed model adapted from the HBV model and will be calibrated for individual basins using historical discharge data. The calibrated model will be driven by the precipitation time series generated by the KIT team to simulate discharges at a daily time step. The uncertainties in the simulated discharges will be analysed using multiple model parameter sets. A number of statistical methods will be used to assess return periods, changes in the magnitudes, changes in the characteristics of floods such as time base and time to peak, and spatial correlations of large flood events. The Pan-European flood stochastic event set will permit a better view of flood risk for market applications.

TOWARDS A CORE DATA SET FOR LANDSCAPE ASSESSMENTS

EPA Science Inventory

One of the primary goals of the NATO Committee on Challenges to Modern Society (CCMS) Landscape Pilot Study is to further develop, apply, and share landscape assessment technologies and spatial databases among participating countries, with the ultimate aim of sustaining environme...

Research priority setting for integrated early child development and violence prevention (ECD+) in low and middle income countries: An expert opinion exercise.

PubMed

Tomlinson, Mark; Jordans, Mark; MacMillan, Harriet; Betancourt, Theresa; Hunt, Xanthe; Mikton, Christopher

2017-10-01

Child development in low and middle income countries (LMIC) is compromised by multiple risk factors. Reducing children's exposure to harmful events is essential for early childhood development (ECD). In particular, preventing violence against children - a highly prevalent risk factor that negatively affects optimal child development - should be an intervention priority. We used the Child Health and Nutrition Initiative (CHNRI) method for the setting of research priorities in integrated Early Childhood Development and violence prevention programs (ECD+). An expert group was identified and invited to systematically list and score research questions. A total of 186 stakeholders were asked to contribute five research questions each, and contributions were received from 81 respondents. These were subsequently evaluated using a set of five criteria: answerability; effectiveness; feasibility and/or affordability; applicability and impact; and equity. Of the 400 questions generated, a composite group of 50 were scored by 55 respondents. The highest scoring research questions related to the training of Community Health Workers (CHW's) to deliver ECD+ interventions effectively and whether ECD+ interventions could be integrated within existing delivery platforms such as HIV, nutrition or mental health platforms. The priority research questions can direct new research initiatives, mainly in focusing on the effectiveness of an ECD+ approach, as well as on service delivery questions. To the best of our knowledge, this is the first systematic exercise of its kind in the field of ECD+. The findings from this research priority setting exercise can help guide donors and other development actors towards funding priorities for important future research related to ECD and violence prevention. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Employment Patterns in OECD Countries: Reassessing the Role of Policies and Institutions. OECD Economics Department Working Papers No. 486

ERIC Educational Resources Information Center

Bassanini, Andrea; Duval, Romain

2006-01-01

This paper explores the impact of policies and institutions on employment and unemployment of OECD countries in the past decades. Reduced-form unemployment equations, consistent with standard wage setting/price-setting models, are estimated using cross-country/time-series data from 21 OECD countries over the period 1982-2003. In the…

National policy development for cotrimoxazole prophylaxis in Malawi, Uganda and Zambia: the relationship between Context, Evidence and Links

PubMed Central

2011-01-01

Background Several frameworks have been constructed to analyse the factors which influence and shape the uptake of evidence into policy processes in resource poor settings, yet empirical analyses of health policy making in these settings are relatively rare. National policy making for cotrimoxazole (trimethoprim-sulfamethoxazole) preventive therapy in developing countries offers a pertinent case for the application of a policy analysis lens. The provision of cotrimoxazole as a prophylaxis is an inexpensive and highly efficacious preventative intervention in HIV infected individuals, reducing both morbidity and mortality among adults and children with HIV/AIDS, yet evidence suggests that it has not been quickly or evenly scaled-up in resource poor settings. Methods Comparative analysis was conducted in Malawi, Uganda and Zambia, using the case study approach. We applied the ‘RAPID’ framework developed by the Overseas Development Institute (ODI), and conducted a total of 47 in-depth interviews across the three countries to examine the influence of context (including the influence of donor agencies), evidence (both local and international), and the links between researcher, policy makers and those seeking to influence the policy process. Results Each area of analysis was found to have an influence on the creation of national policy on cotrimoxazole preventive therapy (CPT) in all three countries. In relation to context, the following were found to be influential: government structures and their focus, donor interest and involvement, healthcare infrastructure and other uses of cotrimoxazole and related drugs in the country. In terms of the nature of the evidence, we found that how policy makers perceived the strength of evidence behind international recommendations was crucial (if evidence was considered weak then the recommendations were rejected). Further, local operational research results seem to have been taken up more quickly, while randomised controlled trials (the gold standard of clinical research) was not necessarily translated into policy so swiftly. Finally the links between different research and policy actors were of critical importance, with overlaps between researcher and policy maker networks crucial to facilitate knowledge transfer. Within these networks, in each country the policy development process relied on a powerful policy entrepreneur who helped get cotrimoxazole preventive therapy onto the policy agenda. Conclusions This analysis underscores the importance of considering national level variables in the explanation of the uptake of evidence into national policy settings, and recognising how local policy makers interpret international evidence. Local priorities, the ways in which evidence was interpreted, and the nature of the links between policy makers and researchers could either drive or stall the policy process. Developing the understanding of these processes enables the explanation of the use (or non-use) of evidence in policy making, and potentially may help to shape future strategies to bridge the research-policy gaps and ultimately improve the uptake of evidence in decision making. PMID:21679387

Validation of quality indicators for the organization of palliative care: a modified RAND Delphi study in seven European countries (the Europall project).

PubMed

Woitha, Kathrin; Van Beek, Karen; Ahmed, Nisar; Jaspers, Birgit; Mollard, Jean M; Ahmedzai, Sam H; Hasselaar, Jeroen; Menten, Johan; Vissers, Kris; Engels, Yvonne

2014-02-01

Validated quality indicators can help health-care professionals to evaluate their medical practices in a comparative manner to deliver optimal clinical care. No international set of quality indicators to measure the organizational aspects of palliative care settings exists. To develop and validate a set of structure and process indicators for palliative care settings in Europe. A two-round modified RAND Delphi process was conducted to rate clarity and usefulness of a previously developed set of 110 quality indicators. In total, 20 multi-professional palliative care teams of centers of excellence from seven European countries. In total, 56 quality indicators were rated as useful. These valid quality indicators concerned the following domains: the definition of a palliative care service (2 quality indicators), accessibility to palliative care (16 quality indicators), specific infrastructure to deliver palliative care (8 quality indicators), symptom assessment tools (1 quality indicator), specific personnel in palliative care services (9 quality indicators), documentation methodology of clinical data (14 quality indicators), evaluation of quality and safety procedures (1 quality indicator), reporting of clinical activities (1 quality indicator), and education in palliative care (4 quality indicator). The modified RAND Delphi process resulted in 56 international face-validated quality indicators to measure and compare organizational aspects of palliative care. These quality indicators, aimed to assess and improve the organization of palliative care, will be pilot tested in palliative care settings all over Europe and be used in the EU FP7 funded IMPACT project.

The way ahead--the new technology in an old society.

PubMed

Sharma, Manju; Swarup, Renu

2003-01-01

Biotechnology is one of the most important scientific and technological revolutions of the last century and has greatly benefited various aspects of human life. The potentials are enormous and many breakthroughs have already been achieved in the area of healthcare, food, agricultural products and environmental production. The developments in this important area provide immediate benefits to mankind and offer environmentally friendly technologies for sustainable development. The Department of Biotechnology, Government of India, set up in 1986, has played an important catalytic role in promoting this revolutionary field. Research and development, technology validation and demonstration, technology transfer, human resource development, setting up of Centers of Excellence and promoting industry-academia interactions have been some of the major achievements during the last 15 years. A unique feature of this Department is the strong interaction with scientists and institutes across the country to promote biotechnology research and development efforts for commercialization and also to benefit the rural population for socio-economic development. A large number of research institutes/universities and organizations across the country have been supported in the areas of agriculture, healthcare, environment and industry. In addition, basic research has also been an important thrust area. In order to ensure that the benefits of biotechnology reach the masses at large, a very stringent biosafety mechanism has been adopted. India is a country rich in biodiversity with two hot spots and has a strong base of expertise available in nearly all fields--thus biotechnology could flourish leading to a Bioindustrial Revolution. We are today poised to be the leaders in this field in the 21st Century.

Three models of community mental health services In low-income countries

PubMed Central

2011-01-01

Objective To compare and contrast three models of community mental health services in low-income settings. Data Sources/Study Setting Primary and secondary data collected before, during, and after site visits to mental health programs in Nigeria, the Philippines, and India. Study Design Qualitative case study methodology. Data Collection Data were collected through interviews and observations during site visits to the programs, as well as from reviews of documentary evidence. Principal Findings A set of narrative topics and program indicators were used to compare and contrast three community mental health programs in low-income countries. This allowed us to identify a diversity of service delivery models, common challenges, and the strengths and weaknesses of each program. More definitive evaluations will require the establishment of data collection methods and information systems that provide data about the clinical and social outcomes of clients, as well as their use of services. Conclusions Community mental health programs in low-income countries face a number of challenges. Using a case study methodology developed for this purpose, it is possible to compare programs and begin to assess the effectiveness of diverse service delivery models. PMID:21266051

The National Institutes of Health Affordable Cancer Technologies Program: Improving Access to Resource-Appropriate Technologies for Cancer Detection, Diagnosis, Monitoring, and Treatment in Low- and Middle-Income Countries

PubMed Central

Divi, Rao; Gwede, Michael; Tandon, Pushpa; Sorg, Brian S.; Ossandon, Miguel R.; Agrawal, Lokesh; Pai, Vinay; Baker, Houston; Lash, Tiffani Bailey

2016-01-01

Point-of-care (POC) technologies have proved valuable in cancer detection, diagnosis, monitoring, and treatment in the developed world, and have shown promise in low-and-middle-income countries (LMIC) as well. Despite this promise, the unique design constraints presented in low-resource settings, coupled with the variety of country-specific regulatory and institutional dynamics, have made it difficult for investigators to translate successful POC cancer interventions to the LMIC markets. In response to this need, the National Cancer Institute has partnered with the National Institute of Biomedical Imaging and Bioengineering to create the National Institutes of Health Affordable Cancer Technologies (ACTs) program. This program seeks to simplify the pathway to market by funding multidisciplinary investigative teams to adapt and validate the existing technologies for cancer detection, diagnosis, and treatment in LMIC settings. The various projects under ACTs range from microfluidic cancer diagnostic tools to novel treatment devices, each geared for successful clinical adaptation to LMIC settings. Via progression through this program, each POC innovation will be uniquely leveraged for successful clinical translation to LMICs in a way not before seen in this arena. PMID:27730015

[The status of human cloning in the international setting].

PubMed

Rey del Castillo, Javier

2006-01-01

The General Assembly of the United Nations submitted a Declaration on Human Cloning in March 2005. The text of such Declaration was the result of a difficult and long process, taking more than three years. Being a Declaration instead of a Resolution, it has not legal capability in inforcing United Nations members to act according to its recommendations. This article begins with an explanation of several terms referred to cloning. Different countries' legislation on cloning is analyzed. Positions of the same countries at the Convention of the United Nations are as well analyzed. Comparing both countries' views shows that national legislation on cloning is independent and orientated by some countries' particular interests and biological and ethical views on these issues. Future developments on human cloning and its applications will be shared among all countries, both the ones currently allowing and supporting "therapeutic" cloning and the ones now banning it. In such case, it would be important to reach agreements on these issues at an international level. The article discusses possible legislative developments and offers some proposals to reach such agreements.

Power law for the duration of recession and prosperity in Latin American countries

NASA Astrophysics Data System (ADS)

Redelico, Francisco O.; Proto, Araceli N.; Ausloos, Marcel

2008-11-01

Ormerod and Mounfield [P. Ormerod, C. Mounfield, Power law distribution of duration and magnitude of recessions in capitalist economies: Breakdown of scaling, Physica A 293 (2001) 573] and Ausloos et al. [M. Ausloos, J. Mikiewicz, M. Sanglier, The durations of recession and prosperity: Does their distribution follow a power or an exponential law? Physica A 339 (2004) 548] have independently analyzed the duration of recessions for developed countries through the evolution of the GDP in different time windows. It was found that there is a power law governing the duration distribution. We have analyzed data collected from 19 Latin American countries in order to observe whether such results are valid or not for developing countries. The case of prosperity years is also discussed. We observe that the power law of recession time intervals, see Ref. [1], is valid for Latin American countries as well. Thus an interesting point is discovered: the same scaling time is found in the case of recessions for the three data sets (ca. 1 year), and this could represent a universal feature. Other time scale parameters differ significantly from each other.

Gynecological cancers in developing countries: the challenge of chemotherapy in low-resources setting.

PubMed

Basile, S; Angioli, R; Manci, N; Palaia, I; Plotti, F; Benedetti Panici, P

2006-01-01

The epidemiologic pattern of cancers in developing countries differs in many aspects from that of industrialized nations. Cancer natural history, microbiologic environment, patient's immune system, and drug availability may differ as well. Four of five new cases of cervical cancer and most of cervical cancer deaths occur in developing countries. Where chemoradiation and supportive care facilities are unavailable, it would be logical to consider an inexpensive effective drug. In locally advanced cases, neoadjuvant chemotherapy followed by surgery should be considered the treatment of choice. For ovarian cancer, it may be reasonable to maintain a secure supply of platinum and/or taxanes. For endometrial cancer, platinum compounds are proved active chemotherapic single agents. Oral medroxyprogesterone acetate (MPA) may represent a good chance for treating an advanced or recurrent disease. For vulvar/vaginal cancer, the role of chemotherapy alone is currently considered limited, and it is mostly used as palliative treatment in advanced or recurrent cases. Whenever possible, standard western chemotherapic regimens should be applied in developing countries as well. When standard therapies are unavailable, drugs of choice should be easily accessible, inexpensive, and effective. The most commonly used drugs are cisplatin, cyclophosphamide, and MPA.

Accelerating health equity: the key role of universal health coverage in the Sustainable Development Goals.

PubMed

Tangcharoensathien, Viroj; Mills, Anne; Palu, Toomas

2015-04-29

The Sustainable Development Goals (SDGs), to be committed to by Heads of State at the upcoming 2015 United Nations General Assembly, have set much higher and more ambitious health-related goals and targets than did the Millennium Development Goals (MDGs). The main challenge among MDG off-track countries is the failure to provide and sustain financial access to quality services by communities, especially the poor. Universal health coverage (UHC), one of the SDG health targets indispensable to achieving an improved level and distribution of health, requires a significant increase in government investment in strengthening primary healthcare - the close-to-client service which can result in equitable access. Given the trend of increased fiscal capacity in most developing countries, aiming at long-term progress toward UHC is feasible, if there is political commitment and if focused, effective policies are in place. Trends in high income countries, including an aging population which increases demand for health workers, continue to trigger international migration of health personnel from low and middle income countries. The inspirational SDGs must be matched with redoubled government efforts to strengthen health delivery systems, produce and retain more and relevant health workers, and progressively realize UHC.

Population dynamics and environmental degradation in Nepal: an interpretation.

PubMed

Karki, Y B

1993-01-01

This paper examines the special problems that are faced by developing countries, specifically Nepal, which have to sustain increasing populations from a depleting natural resource base. Nepal is an example of a developing country where fertility is high and mortality is decreasing fast, resulting in a high rate of population growth. Nepal's rapid population growth has had a significant impact on natural resource depletion and consequently, environmental degradation. The case of Nepal demonstrates the difficulties confronting developing countries, which attempt practical implementation of the population policy guidelines set out in Agenda 21. Past and current population programs in this country have failed to address the population problem as multidimensional, and have failed to encourage grassroots participation. Economic stagnation and poverty encourage a large family size, and are delaying declines in fertility which subsequently leads to high land encroachment and fast depletion of natural resources like forests and water. The government needs to implement an integrated, multidimensional approach, which emphasizes literacy, education, lowering infant mortality, and providing contraceptives along with follow-ups. Finally, the greatest action must consist of fostering a higher rate of planned economic and social development that must be shown to have meaning for, and impact on the population in general.

Access to infertility care in the developing world: the family promotion gap.

PubMed

Asemota, Obehi A; Klatsky, Peter

2015-01-01

Infertility in resource-poor settings is an overlooked global health problem. Although scarce health care resources must be deployed thoughtfully, prioritization of resources may be different for recipient and donor countries, the latter of whom focus on maternal health care, prevention, and family planning. For women and couples with involuntary childlessness, the negative psychosocial, sociocultural, and economic consequences in low-income countries are severe, possibly more so than in most Western societies. Despite the local importance of infertility, few resources are committed to help advance infertility care in regions like sub-Saharan Africa. The worldwide prevalence of infertility is remarkably similar across low-, middle-, and high-income countries. The World Health Organization (WHO) recognizes infertility as a global health problem and established universal access to reproductive health care as one of the United Nation's Millennium Developmental Goals for 2015. Currently, access to infertility care is varied and is usually only attainable by the very wealthy in low-income countries. We provide an overview on the current state of access to infertility care in low-income countries such as in sub-Saharan Africa and a rationale for providing comprehensive reproductive care and possible solutions for providing cost-effective infertility services in these settings. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Concept of Competence in the Development of Vocational Education and Training in Selected EU Member States

ERIC Educational Resources Information Center

Weigel, Tanja; Mulder, Martin; Collins, Kate

2007-01-01

This contribution reviews how four European countries--England, Germany, France and the Netherlands--use the concept of competence in the process of developing vocational education and training. Competence in England is set in the context of the National Vocational Qualifications; in Germany within action competence and the approach to learning…

Gender Violence in Schools in the Developing World

ERIC Educational Resources Information Center

Dunne, Mairead; Humphreys, Sara; Leach, Fiona

2006-01-01

This paper explores gender violence in schools in what is commonly known as the "developing world" through a review of recent research written in English. Violence in the school setting has only recently emerged as a widespread and serious phenomenon in these countries, with the consequence that our knowledge and understanding of it is embryonic;…

Designing primary health care teams for developing countries.

PubMed Central

Reisman, A; Duran, L

1983-01-01

A time-honored industrial engineering technique, job evaluation, which was developed to set rates for manual labor, was used in the design of new teams for delivering primary health care in Latin America. The technique was used both in writing job descriptions for new allied health personnel and in designing the curriculums needed to train the personnel. PMID:6856744

Motivating Teachers in the Developing World: Insights from Research with English Language Teachers in Oman

ERIC Educational Resources Information Center

Wyatt, Mark

2013-01-01

According to some commentators, targets set by the international community for bringing education to all children in developing countries are threatened by a teacher motivation crisis. For this crisis to be addressed, challenges to the motivation of teachers in such contexts need to be understood from perspectives both theoretical and comparative.…

The Development of the International Baccalaureate in Spanish Speaking Countries: A Global Comparative Approach

ERIC Educational Resources Information Center

Resnik, Julia

2016-01-01

This paper compares the development of International Baccalaureate (IB) schools in four different settings: Argentine, Chile, Spain and Ecuador. The global comparative approach used in this study, based on actor-network theory (ANT), allows us to analyse the connections and interactions between global actors and the plurality of national,…

Global Health Equity: Cancer Care Outcome Disparities in High-, Middle-, and Low-Income Countries

PubMed Central

de Souza, Jonas A.; Hunt, Bijou; Asirwa, Fredrick Chite; Adebamowo, Clement

2016-01-01

Breakthroughs in our global fight against cancer have been achieved. However, this progress has been unequal. In low- and middle-income countries and for specific populations in high-income settings, many of these advancements are but an aspiration and hope for the future. This review will focus on health disparities in cancer within and across countries, drawing from examples in Kenya, Brazil, and the United States. Placed in context with these examples, the authors also draw basic recommendations from several initiatives and groups that are working on the issue of global cancer disparities, including the US Institute of Medicine, the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, and the Union for International Cancer Control. From increasing initiatives in basic resources in low-income countries to rapid learning systems in high-income countries, the authors argue that beyond ethics and equity issues, it makes economic sense to invest in global cancer control, especially in low- and middle-income countries. PMID:26578608

Post-2015 Education Recommendations of the High-Level Panel: Joint Comments of the Basic Education Coalition and the Global Campaign for Education-US

ERIC Educational Resources Information Center

Revaz, Cris; Gragert, Edwin H.

2013-01-01

As part of the ongoing planning and debate around the next set of global development goals to replace the expiring Millennium Development Goals, in July 2012 the UN Secretary General commissioned "a high level panel of eminent persons" from 27 countries to make recommendations on the development agenda beyond 2015. After conducting…

A case study of polypharmacy management in nine European countries: Implications for change management and implementation

PubMed Central

MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F.; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt

2018-01-01

Background Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Methods Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Results Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Conclusion Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives. PMID:29668763

Resource requirements for cancer registration in areas with limited resources: Analysis of cost data from four low- and middle-income countries.

PubMed

Tangka, Florence K L; Subramanian, Sujha; Edwards, Patrick; Cole-Beebe, Maggie; Parkin, D Maxwell; Bray, Freddie; Joseph, Rachael; Mery, Les; Saraiya, Mona

2016-12-01

The key aims of this study were to identify sources of support for cancer registry activities, to quantify resource use and estimate costs to operate registries in low- and middle-income countries (LMIC) at different stages of development across three continents. Using the Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool), cost and resource use data were collected from eight population-based cancer registries, including one in a low-income country (Uganda [Kampala)]), two in lower to middle-income countries (Kenya [Nairobi] and India [Mumbai]), and five in an upper to middle-income country (Colombia [Pasto, Barranquilla, Bucaramanga, Manizales and Cali cancer registries]). Host institution contributions accounted for 30%-70% of total investment in cancer registry activities. Cancer registration involves substantial fixed cost and labor. Labor accounts for more than 50% of all expenditures across all registries. The cost per cancer case registered in low-income and lower-middle-income countries ranged from US $3.77 to US $15.62 (United States dollars). In Colombia, an upper to middle-income country, the cost per case registered ranged from US $41.28 to US $113.39. Registries serving large populations (over 15 million inhabitants) had a lower cost per inhabitant (less than US $0.01 in Mumbai, India) than registries serving small populations (under 500,000 inhabitants) [US $0.22] in Pasto, Colombia. This study estimates the total cost and resources used for cancer registration across several countries in the limited-resource setting, and provides cancer registration stakeholders and registries with opportunities to identify cost savings and efficiency improvements. Our results suggest that cancer registration involve substantial fixed costs and labor, and that partnership with other institutions is critical for the operation and sustainability of cancer registries in limited resource settings. Although we included registries from a variety of limited-resource areas, information from eight registries in four countries may not be large enough to capture all the potential differences among the registries in limited-resource settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

Backward Planning a Craniomaxillofacial Trauma Curriculum for the Surgical Workforce in Low-Resource Settings.

PubMed

Shaye, David A; Tollefson, Travis; Shah, Irfan; Krishnan, Gopal; Matic, Damir; Figari, Marcelo; Lim, Thiam Chye; Aniruth, Sunil; Schubert, Warren

2018-06-06

Trauma is a significant contributor to global disease, and low-income countries disproportionately shoulder this burden. Education and training are critical components in the effort to address the surgical workforce shortage. Educators can tailor training to a diverse background of health professionals in low-resource settings using competency-based curricula. We present a process for the development of a competency-based curriculum for low-resource settings in the context of craniomaxillofacial (CMF) trauma education. CMF trauma surgeons representing 7 low-, middle-, and high-income countries conducted a standardized educational curriculum development program. Patient problems related to facial injuries were identified and ranked from highest to lowest morbidity. Higher morbidity problems were categorized into 4 modules with agreed upon competencies. Methods of delivery (lectures, case discussions, and practical exercises) were selected to optimize learning of each competency. A facial injuries educational curriculum (1.5 days event) was tailored to health professionals with diverse training backgrounds who care for CMF trauma patients in low-resource settings. A backward planned, competency-based curriculum was organized into four modules titled: acute (emergent), eye (periorbital injuries and sight preserving measures), mouth (dental injuries and fracture care), and soft tissue injury treatments. Four courses have been completed with pre- and post-course assessments completed. Surgeons and educators from a diverse geographic background found the backward planning curriculum development method effective in creating a competency-based facial injuries (trauma) course for health professionals in low-resource settings, where contextual aspects of shortages of surgical capacity, equipment, and emergency transportation must be considered.

Combining evidence and values in priority setting: testing the balance sheet method in a low-income country.

PubMed

Makundi, Emmanuel; Kapiriri, Lydia; Norheim, Ole Frithjof

2007-09-24

Procedures for priority setting need to incorporate both scientific evidence and public values. The aim of this study was to test out a model for priority setting which incorporates both scientific evidence and public values, and to explore use of evidence by a selection of stakeholders and to study reasons for the relative ranking of health care interventions in a setting of extreme resource scarcity. Systematic search for and assessment of relevant evidence for priority setting in a low-income country. Development of a balance sheet according to Eddy's explicit method. Eight group interviews (n-85), using a modified nominal group technique for eliciting individual and group rankings of a given set of health interventions. The study procedure made it possible to compare the groups' ranking before and after all the evidence was provided to participants. A rank deviation is significant if the rank order of the same intervention differed by two or more points on the ordinal scale. A comparison between the initial rank and the final rank (before deliberation) showed a rank deviation of 67%. The difference between the initial rank and the final rank after discussion and voting gave a rank deviation of 78%. Evidence-based and deliberative decision-making does change priorities significantly in an experimental setting. Our use of the balance sheet method was meant as a demonstration project, but could if properly developed be feasible for health planners, experts and health workers, although more work is needed before it can be used for laypersons.

Reverse gastric tube oesophageal substitution for staged repair of oesophageal atresia and tracheo-oesophageal fistula.

PubMed

Bode, Christopher Olusanjo; Ademuyiwa, Adesoji Oludotun

2014-01-01

The management of oesophageal atresia and tracheo-oesophageal atresia (OATOF) is very challenging. While in developed countries survival of patients with this condition has improved, the outcome in many developing countries has been poor. Primary repair through a thoracotomy (or video-assisted thoracoscopic surgery where available) is the gold standard treatment of OATOF. However, in our setting where patients typically present late and with minimum support resources such as Neonatal Intensive Care Unit and total parenteral nutrition; staged repair may be the only hope of survival of these patients and this communication highlights the essential steps of this mode of treatment.

eGTTP - bridging distances with online training

NASA Astrophysics Data System (ADS)

Doran, Rosa

2015-08-01

The Galileo Teacher Training Program vision is to empower teachers on the use of modern tools and resources for astronomy education. Bringing modern astronomy to the hands of students all over the world represents much more than providing pieces of knowledge. It represents the construction of the building blocks of awareness about our place in the cosmos and our role as specie. In the era of fast track for information exchange, there are still some severe limitations on the provision of equal opportunities to all. Overcoming these limits is the goal of the eGTTP for Portuguese speaking countries. The aim of the project is to provide online training to teachers in the Portuguese speaking countries. With support from the Office of Astronomy for Development we are building experience on how to provide effective support to educators in several countries with different settings, experiences, barriers and needs. In this presentation we hope to share our success stories and set the road for a sustainable continuation of this effort.

Maximizing protection from use of oral cholera vaccines in developing country settings

PubMed Central

Desai, Sachin N; Cravioto, Alejandro; Sur, Dipika; Kanungo, Suman

2014-01-01

When oral vaccines are administered to children in lower- and middle-income countries, they do not induce the same immune responses as they do in developed countries. Although not completely understood, reasons for this finding include maternal antibody interference, mucosal pathology secondary to infection, malnutrition, enteropathy, and previous exposure to the organism (or related organisms). Young children experience a high burden of cholera infection, which can lead to severe acute dehydrating diarrhea and substantial mortality and morbidity. Oral cholera vaccines show variations in their duration of protection and efficacy between children and adults. Evaluating innate and memory immune response is necessary to understand V. cholerae immunity and to improve current cholera vaccine candidates, especially in young children. Further research on the benefits of supplementary interventions and delivery schedules may also improve immunization strategies. PMID:24861554

Generating political priority for newborn survival in three low-income countries.

PubMed

Smith, Stephanie L; Shiffman, Jeremy; Kazembe, Abigail

2014-01-01

Deaths to babies in their first 28 days of life now account for more than 40% of global under-5 child mortality. High neonatal mortality poses a significant barrier to achieving the child survival Millennium Development Goal. Surmounting the problem requires national-level political commitment, yet only a few nation-states have prioritised this issue. We compare Bolivia, Malawi and Nepal, three low-income countries with high neonatal mortality, with a view to understanding why countries prioritise or neglect the issue. The three have had markedly different trajectories since 2000: attention grew steadily in Nepal, stagnated then grew in Malawi and grew then stagnated in Bolivia. The comparison suggests three implications for proponents seeking to advance attention to neglected health issues in low-income countries: the value of (1) advancing solutions with demonstrated efficacy in low-resource settings, (2) building on existing and emerging national priorities and (3) developing a strong network of domestic and international allies. Such actions help policy communities to weather political storms and take advantage of policy windows.

Clostridium difficile infection in low- and middle-human development index countries: a systematic review.

PubMed

Forrester, Joseph D; Cai, Lawrence Z; Mbanje, Chenesa; Rinderknecht, Tanya N; Wren, Sherry M

2017-10-01

To describe the impact and epidemiology of Clostridium difficile infection (CDI) in low- and middle-human development index (LMHDI) countries. Prospectively registered, systematic literature review of existing literature in the PubMed, Ovid and Web of Science databases describing the epidemiology and management of C. difficile in LMHDI countries. Risk factors were compared between studies when available. Of the 218 abstracts identified after applying search criteria, 25 studies were reviewed in detail. The weighted pooled infection rate among symptomatic non-immunosuppressed inpatients was 15.8% (95% CI 12.1-19.5%) and was 10.1% (95% CI 3.0-17.2%) among symptomatic outpatients. Subgroup analysis of immunosuppressed patient populations revealed pooled infection rates similar to non-immunosuppressed patient populations. Risk factor analysis was infrequently performed. While the percentages of patients with CDI in LMHDI countries among the reviewed studies are lower than expected, there remains a paucity of epidemiologic data evaluating burden of C. difficile infection in these settings. © 2017 John Wiley & Sons Ltd.

Leadership development and HIV/AIDS

PubMed Central

Szekeres, Greg; Coates, Thomas J.; Ehrhardt, Anke A.

2010-01-01

Leadership development among all sectors addressing HIV/AIDS has come to be recognized as a critically important endeavor as the HIV pandemic moves into its fourth decade. Globally, there is a tremendous need for well-trained leaders in healthcare, research, policy, programme management, activism and advocacy, especially in countries and settings with high HIV prevalence and limited human resource capacity. This article examines the growing need for HIV/AIDS leadership development, and describes and assesses a number of current initiatives that focus on leadership development in a variety of populations and settings. A series of recommendations are provided to expand the scope and impact of leadership development activities; recommendations are primarily targeted towards foundations and other funders and leadership development programme managers. PMID:18641465

Motivating teachers in the developing world: Insights from research with English language teachers in Oman

NASA Astrophysics Data System (ADS)

Wyatt, Mark

2013-07-01

According to some commentators, targets set by the international community for bringing education to all children in developing countries are threatened by a teacher motivation crisis. For this crisis to be addressed, challenges to the motivation of teachers in such contexts need to be understood from perspectives both theoretical and comparative. Thus an analysis is required of the changes that have taken place particularly in countries whose education systems have developed rapidly in recent decades. Case studies of motivated teacher behaviour in such national contexts might be of relevance to educational reformers. Drawing upon the tenets of self-determination theory (SDT), this article begins by discussing the nature of the reported teacher motivation crisis in the developing world more generally. It then focuses on the Sultanate of Oman, highlighting recent historical developments there. Having thus set the scene, the author considers the extent to which negative environmental influences on teacher motivation in Oman have been addressed and then looks for evidence of intrinsic motivation in case studies of Omani English teachers. Returning to the developing world more generally, conclusions focus on how teachers' psychological needs for competence, autonomy and relatedness can be met through educational policies that reduce negative influences on teacher motivation and provide both inspiring professional development opportunities and work environments characterised by respect.

A Systematic Study of Sustainable Development Goal (SDG) Interactions

NASA Astrophysics Data System (ADS)

Pradhan, Prajal; Costa, Luís.; Rybski, Diego; Lucht, Wolfgang; Kropp, Jürgen P.

2017-11-01

Sustainable development goals (SDGs) have set the 2030 agenda to transform our world by tackling multiple challenges humankind is facing to ensure well-being, economic prosperity, and environmental protection. In contrast to conventional development agendas focusing on a restricted set of dimensions, the SDGs provide a holistic and multidimensional view on development. Hence, interactions among the SDGs may cause diverging results. To analyze the SDG interactions we systematize the identification of synergies and trade-offs using official SDG indicator data for 227 countries. A significant positive correlation between a pair of SDG indicators is classified as a synergy while a significant negative correlation is classified as a trade-off. We rank synergies and trade-offs between SDGs pairs on global and country scales in order to identify the most frequent SDG interactions. For a given SDG, positive correlations between indicator pairs were found to outweigh the negative ones in most countries. Among SDGs the positive and negative correlations between indicator pairs allowed for the identification of particular global patterns. SDG 1 (No poverty) has synergetic relationship with most of the other goals, whereas SDG 12 (Responsible consumption and production) is the goal most commonly associated with trade-offs. The attainment of the SDG agenda will greatly depend on whether the identified synergies among the goals can be leveraged. In addition, the highlighted trade-offs, which constitute obstacles in achieving the SDGs, need to be negotiated and made structurally nonobstructive by deeper changes in the current strategies.

Maternal mortality as a Millennium Development Goal of the United Nations: a systematic assessment and analysis of available data in threshold countries using Indonesia as example

PubMed Central

Reinke, Evelyn; Supriyatiningsih; Haier, Jörg

2017-01-01

Background In 2015 the proposed period ended for achieving the Millennium Development Goals (MDG) of the United Nations targeting to lower maternal mortality worldwide by ~ 75%. 99% of these cases appear in developing and threshold countries; but reports mostly rely on incomplete or unrepresentative data. Using Indonesia as example, currently available data sets for maternal mortality were systematically reviewed. Methods Besides analysis of international and national data resources, a systematic review was carried out according to Cochrane methodology to identify all data and assessments regarding maternal mortality. Results Overall, primary data on maternal mortality differed significantly and were hardly comparable. For 1990 results varied between 253/100 000 and 446/100 000. In 2013 data appeared more conclusive (140–199/100 000). An annual reduction rate (ARR) of –2.8% can be calculated. Conclusion Reported data quality of maternal mortality in Indonesia is very limited regarding comprehensive availability and methodology. This limitation appears to be of general importance for the targeted countries of the MDG. Primary data are rare, not uniformly obtained and not evaluated by comparable methods resulting in very limited comparability. Continuous small data set registration should have high priority for analysis of maternal health activities. PMID:28400953

Influence of oral polio vaccines on performance of the monovalent and pentavalent rotavirus vaccines.

PubMed

Patel, Manish; Steele, A Duncan; Parashar, Umesh D

2012-04-27

In recent years, two live, oral rotavirus vaccines have been successfully tested in developing and industrialized countries, and both vaccines are now recommended by the World Health Organization for all children worldwide. Both immunogenicity and efficacy of these rotavirus vaccines has been lower in developing compared to industrialized settings. We reviewed the data on the effect of trivalent OPV on the immunogenicity and efficacy of two rotavirus vaccines currently recommended by the WHO. While rotavirus vaccines have not affected immune responses to OPV, in general, the immune responses (i.e., antibody levels) to rotavirus vaccination were lower when rotavirus vaccines were co-administered with OPV. Limited data suggests that the interference is greater after the first dose of OPV, presumably because the first dose is associated with greatest intestinal replication of vaccine polio virus strains, and this interference is largely overcome with subsequent rotavirus vaccine doses. Despite the lower immunogenicity, one large efficacy study in middle income Latin American countries showed no decrease in protective efficacy of rotavirus vaccine in infants receiving concurrent OPV. While these data are encouraging and support simultaneous administration of rotavirus vaccines and OPV, additional evidence should be gathered as rotavirus vaccines are used more widely in developing country settings, where OPV is routinely used, rather than inactivated polio vaccine. Published by Elsevier Ltd.

Special Session 4: Astronomy Education between Past and Future

NASA Astrophysics Data System (ADS)

de Greve, Jean-Pierre

2010-11-01

The special session aims at discussing an integrated approach of the different efforts to increase and promote the teaching and learning of astronomy in the world, with emphasis on developing countries. To this end, attention will be given to research on education, specifically in the field of physics, to best practices of the use of astronomy in educational systems (specifically in developing countries), and to innovative learning initiatives other than formal education. The Special Session aims also at creating a universal perspective wherein modern (post-Copernican) astronomy will presented as an intellectual cumulus. The objective of the session is to disseminate best practices in teaching and learning activities of astronomy and to give an opportunity to learn about initiatives in different cultural and socio-economic settings. The special session also wants to give food-for-thought and proposals for reflection for an integrative approach, and for optimization processes, to enhance the interest in astronomy and its role as a trigger towards science education in the educational systems, with emphasis on the developing countries. The outcome should be a sensitization of teachers and students alike to the concept of a universal history of astronomy and creation of some reliable source material which can be used as a teaching aid in a culture-specific context. The outcome could be a set of recommendations for future integrated actions, and eventually recommendations on new initiatives, framed into the new decadal policy plan.

Principles of adoption of the successful environmental practices used in developed countries into mining industry in developing countries.

NASA Astrophysics Data System (ADS)

Masaitis, Alexandra

2013-04-01

The successful implementation of the environmental practices in the mining industry is of a paramount importance, as it not only prevents both local and trans-border pollution but also guarantees clean and healthy environment for the people regardless of their place of habitation. It is especially important to encourage the progress of the environmental practices implementation in developing countries because such countries have resource-oriented economy based on exploitation of nonrenewable resources. Poor environmental practices in developing countries will lead to local environmental crises that could eventually spill into surrounding countries including the most economically advanced. This abstract is a summary of a two-year research project attempted (1) to determine deficiencies of the mining sector ecological practices in developing countries and (2) to suggest substitute practices from developed countries that could be adapted to the developing countries reality. The following research methods were used: 1. The method of the system analysis, where the system is an interaction of the sets of environmental practices with the global mining sector; 2. The comparative method of inquiry, where the comparison was made between environmental protection practices as implemented in the US (developed country) and the developing countries such as RF, Mongolia mining sectors; 3. Quantitative date analysis, where date was collected from "The collection of statistic data", Russian Geographic Society Annual reports, the US EPA open reports, and the USGS Reports; The following results were obtained: Identified the systemic crisis of the ecological environmental policies and practices in the mining sector in developing countries based on the exploitation of nonrenewable resources, absence of the ecological interest by the mining companies that lack mechanisms of environmental and public health protection, the lack of insurance policy, the lack of risk assistance, and in the presence of the audit and monitoring that do not address the local conditions of the mining operations. Based on the above the following concepts were thought of to improve the environmental conditions in mining sector: 1. Was developed the Regional Environmental Management principle based on the local conditions such as physiographic region, local population, and socioeconomic conditions of the area; 2. Devised were criteria for the risk assessment for developing countries. Where the fundamental principals were public health, both near and far from the operation, environmental and biodiversity impact, waste management, long- and short- term rehabilitation plans, compliance with international standards and norms. 3. Developed was the mechanism of the economic motivation to make mining operations "environmentally friendly" that includes defrayal of expenses from both direct and indirect damages. 4. Identified were spheres of possible cooperation between mining companies, government organizations, and the NGOs. These include development of international standards for Good Neighbor Agreement, exchange of environmental information, exchange of successful environmental, health, and safety practices between mining operations from developed and developing countries. The study showed the dire necessity for the mining industry that operates in developing countries to adopt the successful environmental practices used in developed countries. To achieve this goal the Regional Environmental Management principle, the risk assessment criteria, the mechanism of the economic motivation and the principles for international cooperation can play an extremely important role.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marara, Madeleine; Okello, Nick; Kuhanwa, Zainab

This paper reviews and compares the condition of the environmental impact assessment (EIA) system in three countries in the East Africa region: Kenya, Rwanda and Tanzania. The criteria used for the evaluation and the comparison of each system are based on the elements of the legal, administrative and procedural frameworks, as well as the context in which they operate. These criteria are adapted from the evaluation and quality control criteria derived from a number of literature sources. The study reveals that the EIA systems of Kenya and Tanzania are at a similar stage in their development. The two countries, themore » first to introduce the EIA concept into their jurisdiction in this part of Africa, therefore have more experience than Rwanda in the practice of environmental impact assessment, where the legislation and process requires more time to mature both from the governmental and societal perspective. The analysis of the administrative and procedural frameworks highlights the weakness in the autonomy of the competent authority, in all three countries. Finally a major finding of this study is that the contextual set up i.e. the socio-economic and political situation plays an important role in the performance of an EIA system. The context in developing countries is very different from developed countries where the EIA concept originates. Interpreting EIA conditions in countries like Kenya, Rwanda and Tanzania requires that the analysis for determining the effectiveness of their systems should be undertaken within a relevant framework, taking into account the specific requirements of those countries.« less

A Classroom Tariff-Setting Game

ERIC Educational Resources Information Center

Winchester, Niven

2006-01-01

The author outlines a classroom tariff-setting game that allows students to explore the consequences of import tariffs imposed by large countries (countries able to influence world prices). Groups of students represent countries, which are organized into trading pairs. Each group's objective is to maximize welfare by choosing an appropriate ad…

Testing the relationship between personality characteristics, contextual factors and entrepreneurial intentions in a developing country.

PubMed

Karimi, Saeid; Biemans, Harm J A; Naderi Mahdei, Karim; Lans, Thomas; Chizari, Mohammad; Mulder, Martin

2017-06-01

Drawing upon the theory of planned behaviour (TPB), we developed and tested a conceptual model which integrates both internal personality factors and external contextual factors to determine their associations with motivational factors and entrepreneurial intentions (EIs). We then investigated if the model of EI applies in a developing country, namely Iran. We also set out to identify the most relevant factors for EI within this developing country context. Do distal predictors of EI including personality factors (i.e. need for achievement, risk taking and locus of control) and contextual factors (i.e. perceived barriers and support) significantly relate to EI via proximal predictors including motivational factors (i.e. attitudes towards entrepreneurship and perceived behavioural control [PBC])? Data were collected on 331 students from 7 public universities. The findings support the TPB for EI in Iran. All three motivational factors related to EI, but PBC showed the strongest association, which is different than in developed country contexts. Possible explanations for these differences are discussed. All three personality characteristics indirectly related to EI via the proximal attitudes towards entrepreneurship and PBC. Perceived contextual support and barriers indirectly related to EI via proximal PBC while perceived barriers also directly related to EI. © 2015 International Union of Psychological Science.

Recent trends in burn epidemiology worldwide: A systematic review.

PubMed

Smolle, Christian; Cambiaso-Daniel, Janos; Forbes, Abigail A; Wurzer, Paul; Hundeshagen, Gabriel; Branski, Ludwik K; Huss, Fredrik; Kamolz, Lars-Peter

2017-03-01

Burns have been more prevalent among low socioeconomic populations and in less developed regions. Incredible advances in burn care and social development over the recent decades, however, should have placed the incidence and severity of burns in a downwards trend. The aim of this review was to give an overview on current trends in burn epidemiology across the world. Also the socioeconomic development in countries that have published epidemiological data used in this study has been taken into account when comparing the results. There was a worldwide downwards trend of burn incidence, burn severity, length of hospital stay, and mortality rate. These findings were particularly pronounced in very highly developed countries. Data from highly and medium developed countries were more heterogeneous. No studies could be obtained from low and middle income countries. Comparisons between the different studies were compromised by the fact that studies emerged from specialized facilities on one hand and general hospitals on the other. Analyzed studies were also frequently focusing on limited patient populations such as "children" or "elderly". Our findings indicate the need for an international burn database with a minimal data-set in order to obtain objective and comparable results in respect of burn epidemiology. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

How have systematic priority setting approaches influenced policy making? A synthesis of the current literature.

PubMed

Kapiriri, Lydia; Razavi, Donya

2017-09-01

There is a growing body of literature on systematic approaches to healthcare priority setting from various countries and different levels of decision making. This paper synthesizes the current literature in order to assess the extent to which program budgeting and marginal analysis (PBMA), burden of disease & cost-effectiveness analysis (BOD/CEA), multi-criteria decision analysis (MCDA), and accountability for reasonableness (A4R), are reported to have been institutionalized and influenced policy making and practice. We searched for English language publications on health care priority setting approaches (2000-2017). Our sources of literature included PubMed and Ovid databases (including Embase, Global Health, Medline, PsycINFO, EconLit). Of the four approaches PBMA and A4R were commonly applied in high income countries while BOD/CEA was exclusively applied in low income countries. PBMA and BOD/CEA were most commonly reported to have influenced policy making. The explanations for limited adoption of an approach were related to its complexity, poor policy maker understanding and resource requirements. While systematic approaches have the potential to improve healthcare priority setting; most have not been adopted in routine policy making. The identified barriers call for sustained knowledge exchange between researchers and policy-makers and development of practical guidelines to ensure that these frameworks are more accessible, applicable and sustainable in informing policy making. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of urbanisation on asthma, allergy and airways inflammation in a developing country setting.

PubMed

Robinson, Colin L; Baumann, Lauren M; Romero, Karina; Combe, Juan M; Gomez, Alfonso; Gilman, Robert H; Cabrera, Lilia; Gonzalvez, Guillermo; Hansel, Nadia N; Wise, Robert A; Barnes, Kathleen C; Breysse, Patrick N; Checkley, William

2011-12-01

Asthma is a growing public health problem in developing countries. However, few studies have studied the role of urbanisation in this phenomenon. It was hypothesised that children living in a peri-urban setting in Peru have higher rates of asthma and allergy than rural counterparts. 1441 adolescents aged 13-15 years were enrolled from two settings: a peri-urban shanty town in Lima (n = 725) and 23 rural villages in Tumbes (n = 716). Participants filled in questionnaires on asthma and allergy symptoms, environmental exposures and sociodemographics, and underwent spirometry, and exhaled nitric oxide (eNO) and allergy skin testing. Indoor particulate matter (PM) concentrations were measured in 170 households. Lima adolescents had higher rates of lifetime wheezing (22% vs 10%), current asthma symptoms (12% vs 3%) and physician-diagnosed asthma (13% vs 2%; all p <0.001). Current rhinitis (23% vs 12%), eczema (12% vs 0.4%), atopy (56% vs 38%), personal history of cigarette smoking (7.4% vs 1.3%) and mean indoor PM (31 vs 13 μg/m(3)) were also higher in Lima (all p < 0.001). The peri-urban environment of Lima was associated with a 2.6-fold greater odds (95% CI 1.3 to 5.3) of asthma in multivariable regression. Forced expiratory volumes were higher and FEV(1)/FVC (forced expiratory volume in 1 s/forced vital capacity) ratios were lower in Lima (all p < 0.001). Higher eNO values in Lima (p < 0.001) were attributable to higher rates of asthma and atopy. Peri-urban adolescents had more asthma, atopy and airways inflammation and were exposed to more indoor pollution. The findings provide evidence of the risks posed to lung health by peri-urban environments in developing countries.

Effect of urbanisation on asthma, allergy and airways inflammation in a developing country setting

PubMed Central

Robinson, Colin L; Baumann, Lauren M; Romero, Karina; Combe, Juan M; Gomez, Alfonso; Gilman, Robert H; Cabrera, Lilia; Gonzalvez, Guillermo; Hansel, Nadia N; Wise, Robert A; Barnes, Kathleen C; Breysse, Patrick N; Checkley, William

2017-01-01

Background Asthma is a growing public health problem in developing countries. However, few studies have studied the role of urbanisation in this phenomenon. It was hypothesised that children living in a peri-urban setting in Peru have higher rates of asthma and allergy than rural counterparts. Methods 1441 adolescents aged 13–15 years were enrolled from two settings: a peri-urban shanty town in Lima (n=725) and 23 rural villages in Tumbes (n=716). Participants filled in questionnaires on asthma and allergy symptoms, environmental exposures and sociodemographics, and underwent spirometry, and exhaled nitric oxide (eNO) and allergy skin testing. Indoor particulate matter (PM) concentrations were measured in 170 households. Results Lima adolescents had higher rates of lifetime wheezing (22% vs 10%), current asthma symptoms (12% vs 3%) and physician-diagnosed asthma (13% vs 2%; all p <0.001). Current rhinitis (23% vs 12%), eczema (12% vs 0.4%), atopy (56% vs 38%), personal history of cigarette smoking (7.4% vs 1.3%) and mean indoor PM (31 vs 13 μg/m3) were also higher in Lima (all p <0.001). The peri-urban environment of Lima was associated with a 2.6-fold greater odds (95% CI 1.3 to 5.3) of asthma in multivariable regression. Forced expiratory volumes were higher and FEV1/FVC (forced expiratory volume in 1 s/forced vital capacity) ratios were lower in Lima (all p <0.001). Higher eNO values in Lima (p <0.001) were attributable to higher rates of asthma and atopy. Conclusions Peri-urban adolescents had more asthma, atopy and airways inflammation and were exposed to more indoor pollution. The findings provide evidence of the risks posed to lung health by peri-urban environments in developing countries. PMID:21730351

Zone 1 retinopathy of prematurity in a transitional economy: a cautionary note.

PubMed

Carden, Susan M; Lan, Luu Ngoc; Huynh, Tess

2006-06-01

To describe three low risk infants in whom severe retinopathy of prematurity developed. A prospective, observational case series. setting: National Hospital of Pediatrics, Hanoi, Vietnam. study population: Premature infants in the neonatal ward. observation procedure: Eye examinations. Severe retinopathy of prematurity occurred in three infants. All had zone 1 disease and other unusually severe findings, such as neovascularization of the disk. These infants would not be at risk for the development of such severe retinopathy of prematurity in countries with a developed economy. Unusual characteristics of retinopathy of prematurity may be occurring in countries with transitional economies. Screening programs should be implemented and should take into consideration the possibility that retinopathy of prematurity may occur in infants who fall outside the screening guidelines that are used in the developed world.

Rheumatic heart disease across the Western Pacific: not just a Pacific Island problem.

PubMed

Abouzeid, Marian; Katzenellenbogen, Judith; Wyber, Rosemary; Watkins, David; Johnson, Timothy David; Carapetis, Jonathan

2017-01-01

Some of the highest recorded rheumatic heart disease (RHD) prevalence and mortality rates are from the World Health Organization's Western Pacific Region (WPR). RHD burden has been well documented in much of the WPR subregion of Oceania, but less is known about RHD outside the Pacific Islands and Australasia. We aimed to review RHD burden in WPR outside Oceania to identify countries with high RHD burden and those with contemporary data gaps. We searched the peer-reviewed literature for English-language primary studies published between 1980 and April 2017 that reported RHD prevalence or mortality in the 13 WPR countries/areas outside Oceania, and Taiwan. We also searched for official government reports and health indicator documents. Results were synthesised narratively and reported stratified by 2015 Human Development Index (HDI) level. 30 peer-reviewed publications fulfilling inclusion criteria were identified, representing nine countries/areas. RHD prevalence and mortality have fallen in association with economic development, particularly in very high HDI countries. In several countries that have undergone recent economic development, RHD persists particularly among older populations. In poorer WPR countries there is a persistent RHD burden, including in young populations. Some countries had no available data. Although RHD burden has declined in many high-resource settings across the WPR, in several poorer countries, the impact of RHD appears to continue. Elsewhere, insufficient contemporary data make it difficult to gauge the current status of RHD burden and control. Concerted efforts are needed to fill information gaps and implement action to address this avoidable disease.

Psychological wellbeing, physical impairments and rural aging in a developing country setting.

PubMed

Abas, Melanie A; Punpuing, Sureeporn; Jirapramupitak, Tawanchai; Tangchonlatip, Kanchana; Leese, Morven

2009-07-16

There has been very little research on wellbeing, physical impairments and disability in older people in developing countries. A community survey of 1147 older parents, one per household, aged sixty and over in rural Thailand. We used the Burvill scale of physical impairment, the Thai Psychological Wellbeing Scale and the brief WHO Disability Assessment Schedule. We rated received and perceived social support separately from children and from others and rated support to children. We used weighted analyses to take account of the sampling design. Impairments due to arthritis, pain, paralysis, vision, stomach problems or breathing were all associated with lower wellbeing. After adjusting for disability, only impairment due to paralysis was independently associated with lowered wellbeing. The effect of having two or more impairments compared to none was associated with lowered wellbeing after adjusting for demographic factors and social support (adjusted difference -2.37 on the well-being scale with SD = 7.9, p < 0.001) but after adjusting for disability the coefficient fell and was non-significant. The parsimonious model for wellbeing included age, wealth, social support, disability and impairment due to paralysis (the effect of paralysis was -2.97, p = 0.001). In this Thai setting, received support from children and from others and perceived good support from and to children were all independently associated with greater wellbeing whereas actual support to children was associated with lower wellbeing. Low received support from children interacted with paralysis in being especially associated with low wellbeing. In this Thai setting, as found in western settings, most of the association between physical impairments and lower wellbeing is explained by disability. Disability is potentially mediating the association between impairment and low wellbeing. Received support may buffer the impact of some impairments on wellbeing in this setting. Giving actual support to children is associated with less wellbeing unless the support being given to children is perceived as good, perhaps reflecting parental obligation to support adult children in need. Improving community disability services for older people and optimizing received social support will be vital in rural areas in developing countries.

Challenges in reducing group B Streptococcus disease in African settings.

PubMed

Nishihara, Yo; Dangor, Ziyaad; French, Neil; Madhi, Shabir; Heyderman, Robert

2017-01-01

Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and meningitis in high-income settings and is associated with high rates of neonatal mortality and morbidity. There is now increasing evidence to suggest that there is a high GBS disease burden in resource-limited countries, and it is therefore critically important to identify suitable and practical preventive strategies. In Europe and North America, intrapartum antibiotic prophylaxis (IAP) has led to a dramatic reduction of early-onset GBS disease. However, the methods for identifying pregnant women who should receive IAP and how to reduce late-onset GBS disease are not without controversy and are challenging for most sub-Saharan African countries. GBS vaccines are approaching phase III trials but are still under development. This review aims to explore the current evidence related to strategies for reducing invasive GBS disease in an African setting, the development of a GBS vaccine and whether preventative measures against GBS disease can be practically implemented. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Saving maternal lives in resource-poor settings: facing reality.

PubMed

Prata, Ndola; Sreenivas, Amita; Vahidnia, Farnaz; Potts, Malcolm

2009-02-01

Evaluate safe-motherhood interventions suitable for resource-poor settings that can be implemented with current resources. Literature review to identify interventions that require minimal treatment/infrastructure and are not dependent on skilled providers. Simulations were run to assess the potential number of maternal lives that could be saved through intervention implementation according to potential program impact. Regional and country level estimates are provided as examples of settings that would most benefit from proposed interventions. Three interventions were identified: (i) improve access to contraception; (ii) increase efforts to reduce deaths from unsafe abortion; and (iii) increase access to misoprostol to control postpartum hemorrhage (including for home births). The combined effect of postpartum hemorrhage and unsafe abortion prevention would result in the greatest gains in maternal deaths averted. Bold new initiatives are needed to achieve the Millennium Development Goal of reducing maternal mortality by three-quarters. Ninety-nine percent of maternal deaths occur in developing countries and the majority of these women deliver alone, or with a traditional birth attendant. It is time for maternal health program planners to reprioritize interventions in the face of human and financial resource constraints. The three proposed interventions address the largest part of the maternal health burden.

Developing countries use music videos to promote teen sexual restraint.

PubMed

Pemberton, M

1991-12-15

The Center for Communications Programs of the Johns Hopkins University has successfully produced and aired songs and music videos promoting teenage sexual restraint in developing countries. Entertaining music videos convey accurate messages to target audiences more effectively than teachers and doctors are able. In addition to successes in the Philippines and Nigeria, overwhelming success has been met with Wait, a video with Latin American pop start Tatiana and Johnny. A hit in 11 Latin American countries reaching 1 in Mexico, the video received 1 million hour s free air time. Passionate, powerful, and persuasive, these videos have prompted increased contraceptive use in countries where they have been aired. The Center's videos and songs have proved popular and profitable in a competitive market of ideas, earning 3-4 times their production costs. Accordingly, health experts from Johns Hopkins University recognize the potential role of these productions in preventing AIDS and unwanted pregnancies in other settings. Where Baltimore leads the U.S. in teen pregnancies, the Center would like to air soap opera on sexual responsibility. Production costs in the U.S. are, however, 10 times higher than in developing countries. With the collaboration of media executives, significant financial and social rewards could result from such a production.

Preconception health assessment in China, Lebanon and the Philippines: applicability to other countries.

PubMed

Reeve, Mary-Elizabeth; Charafeddine, Lama; Zhong, Nanbert; Padilla, Carmencita D; Yunis, Khalid; El Rafei, Reem; Alamiddine, Kawthar; Zhao, Xinliang; Jiang, Xiaoqing; Howson, Christopher P

2014-07-01

To test the utility of a preconception checklist tool in identifying preconception health needs of women in three countries; China, Lebanon and the Philippines. An academic medical center within each country participated in the development and testing of a preconception checklist tool, which was administered over a 6 month period to selected target groups in each country. The checklist provided valuable data on the preconception health of 6,530 women. Aggregated data identified common preconception health needs across all countries, including provision of modern contraceptives and adequate immunization coverage; HIV and STI screening; treatment for anemia; and counseling for maintenance of a healthy weight. A preconception checklist tool was found to be useful in distinct cultural settings. The study was a pilot. Future steps include validation and standardization of the checklist, data from which could be used to help shape preconception care policies and implementation strategies.

A Review of Pediatric Critical Care in Resource-Limited Settings: A Look at Past, Present, and Future Directions

PubMed Central

Turner, Erin L.; Nielsen, Katie R.; Jamal, Shelina M.; von Saint André-von Arnim, Amelie; Musa, Ndidiamaka L.

2016-01-01

Fifteen years ago, United Nations world leaders defined millenium development goal 4 (MDG 4): to reduce under-5-year mortality rates by two-thirds by the year 2015. Unfortunately, only 27 of 138 developing countries are expected to achieve MDG 4. The majority of childhood deaths in these settings result from reversible causes, and developing effective pediatric emergency and critical care services could substantially reduce this mortality. The Ebola outbreak highlighted the fragility of health care systems in resource-limited settings and emphasized the urgent need for a paradigm shift in the global approach to healthcare delivery related to critical illness. This review provides an overview of pediatric critical care in resource-limited settings and outlines strategies to address challenges specific to these areas. Implementation of these tools has the potential to move us toward delivery of an adequate standard of critical care for all children globally, and ultimately decrease global child mortality in resource-limited settings. PMID:26925393

The legacy of the Child Health and Nutrition Research Initiative (CHNRI).

PubMed

Black, Robert E

2016-06-01

Under the Global Forum for Health Research, the Child Health and Nutrition Research Initiative (CHNRI) began its operations in 1999 and became a Swiss foundation in 2006. The vision of CHNRI was to improve child health and nutrition of all children in low- and middle-income countries (LMIC) through research that informs health policy and practice. Specific objectives included expanding global knowledge on childhood disease burden and cost-effectiveness of interventions, promoting priority setting in research, ensuring inclusion of institutions and scientists in LMIC in setting priorities, promoting capacity development in LMIC and stimulating donors and countries to increase resources for research. CHNRI created a knowledge network, funded research through multiple rounds of a global competitive process and published research papers and policy briefs. A signature effort was to develop a systematic methodology for prioritizing health and nutrition research investments. The "CHNRI method" has been extensively applied to global health problems and is now the most commonly used method for prioritizing health research questions.

Safety and efficacy of misoprostol for induction of labour in a semi-urban hospital setting.

PubMed

Loto, O M; Fadahunsi, A A; Kolade, C O

2004-09-01

Most studies on the use of misoprostol for induction of labour have been carried out in well-endowed hospitals in developed countries with state-of-the-art monitoring equipment. There is need for more studies to be conducted in facilities with limited resources, if more patients are to benefit from the low cost and effectiveness of the drug. Following Ethical Committee approval, 152 women had labour induced in our maternity unit using intravaginal misoprostol. The patients were monitored clinically using the WHO model partograph with digital palpation of uterine contractions and intermittent auscultation of fetal heart with a pinard stethoscope. One hundred and thirty-five (88.8%) of the women had a vaginal delivery, while nine (5.9%) had a caesarean section for various obstetric indications. Eight cases of uterine hyperstimulation were noted but none of uterine rupture. We conclude that misoprostol can be used safely for induction of labour in less endowed hospital settings such as in developing countries, using basic clinical tools for monitoring.

The Control of Rotavirus Gastroenteritis in The United States

PubMed Central

Glass, Roger I.; Parashar, Umesh; Patel, Manish; Tate, Jacqueline; Jiang, Baoming; Gentsch, Jon

2012-01-01

Since 2006, two new vaccines have been licensed to prevent rotavirus, the cause of 20% to 50% of severe acute gastroenteritis in young children worldwide. These vaccines have been implemented in national immunization programs in about 30 high- and middle-income countries, including the United States, and vaccine use has led to substantial decreases in diarrhea-related health care visits. In addition to reductions in diarrhea burden in vaccinated children, decreases have been observed in older, unvaccinated age groups in many settings, suggesting indirect benefits (i.e., herd immunity) from vaccination. Although the efficacy of these oral rotavirus vaccines is expectedly lower in developing countries in Asia and Africa, the public health benefits of vaccination in these settings, where more than 90% of the estimated 453,000 annual deaths from rotavirus occur, are likely to be substantial. Efforts continue to develop alternative rotavirus vaccines that could have a better efficacy and safety profile and may be less expensive. PMID:23303967

Building Sustainable Capacity for Cardiovascular Care at a Public Hospital in Western Kenya.

PubMed

Binanay, Cynthia A; Akwanalo, Constantine O; Aruasa, Wilson; Barasa, Felix A; Corey, G Ralph; Crowe, Susie; Esamai, Fabian; Einterz, Robert; Foster, Michael C; Gardner, Adrian; Kibosia, John; Kimaiyo, Sylvester; Koech, Myra; Korir, Belinda; Lawrence, John E; Lukas, Stephanie; Manji, Imran; Maritim, Peris; Ogaro, Francis; Park, Peter; Pastakia, Sonak D; Sugut, Wilson; Vedanthan, Rajesh; Yanoh, Reuben; Velazquez, Eric J; Bloomfield, Gerald S

2015-12-08

Cardiovascular disease deaths are increasing in low- and middle-income countries and are exacerbated by health care systems that are ill-equipped to manage chronic diseases. Global health partnerships, which have stemmed the tide of infectious diseases in low- and middle-income countries, can be similarly applied to address cardiovascular diseases. In this review, we present the experiences of an academic partnership between North American and Kenyan medical centers to improve cardiovascular health in a national public referral hospital. We highlight our stepwise approach to developing sustainable cardiovascular services using the health system strengthening World Health Organization Framework for Action. The building blocks of this framework (leadership and governance, health workforce, health service delivery, health financing, access to essential medicines, and health information system) guided our comprehensive and sustainable approach to delivering subspecialty care in a resource-limited setting. Our experiences may guide the development of similar collaborations in other settings. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Should oral misoprostol be used to prevent postpartum haemorrhage in home-birth settings in low-resource countries? A systematic review of the evidence.

PubMed

Hundley, V A; Avan, B I; Sullivan, C J; Graham, W J

2013-02-01

Using misoprostol to prevent postpartum haemorrhage (PPH) in home-birth settings remains controversial. To review the safety and effectiveness of oral misoprostol in preventing PPH in home-birth settings. The Cochrane Library, PubMed, and POPLINE were searched for articles published until 31 March 2012. Studies, conducted in low-resource countries, comparing oral misoprostol with a placebo or no treatment in a home-birth setting. Studies of misoprostol administered by other routes were excluded. Data were extracted by two reviewers and independently checked for accuracy by a third. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data were sythesised and meta-analysis was performed where appropriate. Ten papers describing two randomised and four non randomised trials. Administration of misoprostol was associated with a significant reduction in the incidence of PPH (RR 0.58, 95% CI 0.38-0.87), additional uterotonics (RR 0.34, 95% CI 0.16-0.73), and referral for PPH (RR 0.49, 95% CI 0.37-0.66). None of the studies was large enough to detect a difference in maternal mortality, and none reported neonatal mortality. Shivering and pyrexia were the most common side effects. The finding that the distribution of oral misoprostol through frontline health workers is effective in reducing the incidence of PPH could be a significant step forwards in reducing maternal deaths in low-resource countries. However, given the limited number of high-quality studies in this review, further randomised controlled trials are required to confirm the association, particularly in different implementation settings. Adverse effects have not been systematically captured, and there has been limited consideration of the potential for inappropriate or inadvertent use of misoprostol. Further evidence is needed to inform the development of implementation and safety guidelines on the routine availability of misoprostol. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Human rotavirus vaccine (Rotarix): focus on effectiveness and impact 6 years after first introduction in Africa.

PubMed

O'Ryan, Miguel; Giaquinto, Carlo; Benninghoff, Bernd

2015-01-01

A decade after licensure of the human rotavirus vaccine (HRV), a wealth of evidence supports a reduction of rotavirus (RV) gastroenteritis-associated mortality and hospitalizations following HRV inclusion in national immunization programs. Nevertheless, the majority of real-world data has been generated in high- or middle-income settings. Clinical efficacy trials previously indicated RV vaccine performance may be lower in less-developed countries compared with wealthier counterparts. Using recently published data from Africa, we examine the effectiveness and impact of HRV in resource-deprived areas, exploring whether vaccine performance differs by socioeconomic setting and the potential underlying factors. HRV vaccine effectiveness in early adopting African countries has proven to be similar or even superior to the efficacy results observed in pre-licensure studies.

Less Developed Countries (LDCs) Facing Higher Education Curricula Reform Challenges in a "New World (Dis)Order"

ERIC Educational Resources Information Center

Gilder, Eric

2011-01-01

In a previous article for "EJHE," I detailed Curricula Reform (CR) efforts in Higher Education (HE) in four (relatively) well developed regional and national settings (The EU, the USA, Hong Kong SAR China, and Singapore). I detailed the backdrop motivating the moves by policymakers to reform the curricula in such "world class"…

Vulnerability of Internally Displaced Children in Disaster Relief Camps of Pakistan: Issues, Challenges, and Way Forward

ERIC Educational Resources Information Center

Hirani, Shela Akbar Ali

2014-01-01

Pakistan is a developing country with the second highest infant and child mortality rates in South Asia. During the past years this region has undergone several humanitarian emergencies that have negatively affected all the aspects of health and development of young children. During these emergencies relief camps are set up by governmental and…

Multiple Perspectives on Integrated Education for Children with Disabilities in the Context of Early Childhood Centres in Hong Kong

ERIC Educational Resources Information Center

Lai, Yuk Ching; Gill, Judith

2014-01-01

The integration of children with disabilities in mainstream early childhood settings is a common practice in many developed and developing countries world-wide. A number of key points have been raised concerning such integration, including the increased attention to civil education about the rights of persons with disabilities, training for…

Point-of-Care Diagnostics in Low Resource Settings: Present Status and Future Role of Microfluidics

PubMed Central

Sharma, Shikha; Zapatero-Rodríguez, Julia; Estrela, Pedro; O’Kennedy, Richard

2015-01-01

The inability to diagnose numerous diseases rapidly is a significant cause of the disparity of deaths resulting from both communicable and non-communicable diseases in the developing world in comparison to the developed world. Existing diagnostic instrumentation usually requires sophisticated infrastructure, stable electrical power, expensive reagents, long assay times, and highly trained personnel which is not often available in limited resource settings. This review will critically survey and analyse the current lateral flow-based point-of-care (POC) technologies, which have made a major impact on diagnostic testing in developing countries over the last 50 years. The future of POC technologies including the applications of microfluidics, which allows miniaturisation and integration of complex functions that facilitate their usage in limited resource settings, is discussed The advantages offered by such systems, including low cost, ruggedness and the capacity to generate accurate and reliable results rapidly, are well suited to the clinical and social settings of the developing world. PMID:26287254

Roads to Health in Developing Countries: Understanding the Intersection of Culture and Healing.

PubMed

Ibeneme, S; Eni, G; Ezuma, A; Fortwengel, G

2017-01-01

The most important attribute to which all human beings aspire is good health because it enables us to undertake different forms of activities of daily living. The emergence of scientific knowledge in Western societies has enabled scientists to explore and define several parameters of health by drawing boundaries around factors that are known to influence the attainment of good health. For example, the World Health Organization defined health by taking physical and psychological factors into consideration. Their definition of health also included a caveat that says, "not merely the absence of sickness." This definition has guided scientists and health care providers in the Western world in the development of health care programs in non-Western societies. However, ethnomedical beliefs about the cause(s) of illness have given rise to alternative theories of health, sickness, and treatment approaches in the developing world. Thus, there is another side to the story. Much of the population in developing countries lives in rural settings where the knowledge of health, sickness, and care has evolved over centuries of practice and experience. The definition of health in these settings tends to orient toward cultural beliefs, traditional practices, and social relationships. Invariably, whereas biomedicine is the dominant medical system in Western societies, traditional medicine-or ethnomedicine-is often the first port of call for patients in developing countries. The 2 medical systems represent, and are influenced by, the cultural environment in which they exist. On one hand, biomedicine is very effective in the treatment of objective, measurable disease conditions. On the other hand, ethnomedicine is effective in the management of illness conditions or the experience of disease states. Nevertheless, an attempt to supplant 1 system of care with another from a different cultural environment could pose enormous challenges in non-Western societies. In general, we, as human beings, are guided in our health care decisions by past experiences, family and friends, social networks, cultural beliefs, customs, tradition, professional knowledge, and intuition. No medical system has been shown to address all of these elements; hence, the need for collaboration, acceptance, and partnership between all systems of care in cultural communities. In developing countries, the roads to health are incomplete without an examination of the intersection of culture and healing. Perhaps mutual exclusiveness rather inclusiveness of these 2 dominant health systems is the greatest obstacle to health in developing countries.

The case for an international patient-reported outcomes measurement information system (PROMIS®) initiative

PubMed Central

2013-01-01

Patient-reported outcomes (PROs) play an increasingly important role in clinical practice and research. Modern psychometric methods such as item response theory (IRT) enable the creation of item banks that support fixed-length forms as well as computerized adaptive testing (CAT), often resulting in improved measurement precision and responsiveness. Here we describe and discuss the case for developing an international core set of PROs building from the US PROMIS® network. PROMIS is a U.S.-based cooperative group of research sites and centers of excellence convened to develop and standardize PRO measures across studies and settings. If extended to a global collaboration, PROMIS has the potential to transform PRO measurement by creating a shared, unifying terminology and metric for reporting of common symptoms and functional life domains. Extending a common set of standardized PRO measures to the international community offers great potential for improving patient-centered research, clinical trials reporting, population monitoring, and health care worldwide. Benefits of such standardization include the possibility of: international syntheses (such as meta-analyses) of research findings; international population monitoring and policy development; health services administrators and planners access to relevant information on the populations they serve; better assessment and monitoring of patients by providers; and improved shared decision making. The goal of the current PROMIS International initiative is to ensure that item banks are translated and culturally adapted for use in adults and children in as many countries as possible. The process includes 3 key steps: translation/cultural adaptation, calibration, and validation. A universal translation, an approach focusing on commonalities, rather than differences across versions developed in regions or countries speaking the same language, is proposed to ensure conceptual equivalence for all items. International item calibration using nationally representative samples of adults and children within countries is essential to demonstrate that all items possess expected strong measurement properties. Finally, it is important to demonstrate that the PROMIS measures are valid, reliable and responsive to change when used in an international context. IRT item banking will allow for tailoring within countries and facilitate growth and evolution of PROs through contributions from the international measurement community. A number of opportunities and challenges of international development of PROs item banks are discussed. PMID:24359143

The case for an international patient-reported outcomes measurement information system (PROMIS®) initiative.

PubMed

Alonso, Jordi; Bartlett, Susan J; Rose, Matthias; Aaronson, Neil K; Chaplin, John E; Efficace, Fabio; Leplège, Alain; Lu, Aiping; Tulsky, David S; Raat, Hein; Ravens-Sieberer, Ulrike; Revicki, Dennis; Terwee, Caroline B; Valderas, Jose M; Cella, David; Forrest, Christopher B

2013-12-20

Patient-reported outcomes (PROs) play an increasingly important role in clinical practice and research. Modern psychometric methods such as item response theory (IRT) enable the creation of item banks that support fixed-length forms as well as computerized adaptive testing (CAT), often resulting in improved measurement precision and responsiveness. Here we describe and discuss the case for developing an international core set of PROs building from the US PROMIS® network.PROMIS is a U.S.-based cooperative group of research sites and centers of excellence convened to develop and standardize PRO measures across studies and settings. If extended to a global collaboration, PROMIS has the potential to transform PRO measurement by creating a shared, unifying terminology and metric for reporting of common symptoms and functional life domains. Extending a common set of standardized PRO measures to the international community offers great potential for improving patient-centered research, clinical trials reporting, population monitoring, and health care worldwide. Benefits of such standardization include the possibility of: international syntheses (such as meta-analyses) of research findings; international population monitoring and policy development; health services administrators and planners access to relevant information on the populations they serve; better assessment and monitoring of patients by providers; and improved shared decision making.The goal of the current PROMIS International initiative is to ensure that item banks are translated and culturally adapted for use in adults and children in as many countries as possible. The process includes 3 key steps: translation/cultural adaptation, calibration, and validation. A universal translation, an approach focusing on commonalities, rather than differences across versions developed in regions or countries speaking the same language, is proposed to ensure conceptual equivalence for all items. International item calibration using nationally representative samples of adults and children within countries is essential to demonstrate that all items possess expected strong measurement properties. Finally, it is important to demonstrate that the PROMIS measures are valid, reliable and responsive to change when used in an international context.IRT item banking will allow for tailoring within countries and facilitate growth and evolution of PROs through contributions from the international measurement community. A number of opportunities and challenges of international development of PROs item banks are discussed.

Preventing preterm births: trends and potential reductions with current interventionsin 39 very high human development index countries

PubMed Central

Chang, Hannah H.; Larson, Jim; Blencowe, Hannah; Spong, Catherine Y.; Howson, Christopher P.; Cairns-Smith, Sarah; Lackritz, Eve M.; Lee, Shoo K.; Mason, Elizabeth; Serazin, Andrew C.; Walani, Salimah; Simpson, Joe Leigh; Lawn, Joy E.

2013-01-01

Summary Background Each year,1.1 million babies die from prematurity, andmany survivors are disabled. Worldwide, 15 million babies are preterm(<37 weeks’ gestation),withtwo decades of increasing ratesinalmost all countries with reliable data. Improved care of babies has reduced mortality in high-income countries, although effective interventions have yet to be scaled-up in most low-income countries. A 50% reduction goal for preterm-specific mortality by 2025 has been set in the “Born Too Soon” report. However, for preterm birth prevention,understanding of drivers and potential impact of preventive interventions is limited. We examine trends and estimate the potential reduction in preterm birthsforvery high human development index (VHHDI) countries if current evidence-based interventions were widely implemented. This analysis is to inform a “Born Too Soon” rate reduction target. Methods Countries were assessed for inclusion based on availability and quality ofpreterm prevalence data (2000-2010), and trend analyses with projections undertaken. We analysed drivers of rate increases in the USA, 1998-2004. For 39 VHHDI countrieswith >10,000 births, country-by-country analyses were performed based on target population, incremental coverage increase,and intervention efficacy. Cost savings were estimated based on reported costs for preterm care in the USAadjusted usingWorld Bank purchasing power parity. Findings From 2010, even if all VHHDI countries achieved annual preterm birth rate reductions of the best performers, (Sweden and Netherlands), 2000-2010 or 2005-2010(Lithuania, Estonia)), rates would experience a relative reduction of<5% by 2015 on average across the 39 countries.Our analysis of preterm birth rise 1998-2004 in USA suggests half the change is unexplained, but important drivers includeinductions/cesareandelivery and ART.For all 39 VHHDI countries, five interventionsmodeling at high coveragepredicted 5%preterm birth rate relative reduction from 9.59 to 9.07% of live births:smoking cessation (0.01 rate reduction), decreasing multiple embryo transfers during assisted reproductive technologies (0.06), cervical cerclage (0.15), progesterone supplementation (0.01), and reduction of non-medically indicated labour induction or caesarean delivery (0.29).These translate to 58,000 preterm births averted and total annual economic cost savings of ~US$ 3 billion. Interpretation Even with optimal coverage of current interventions, many being complex to implement, the estimated potential reduction in preterm birth is tiny. Hence we recommenda conservative target of 5% preterm birth rate relative reductionby 2015. Our findings highlight the urgent need for discovery research into underlying mechanisms of preterm birth, and developmentof innovative interventions. Furthermore, the highest preterm birth rates occur in low-income settings where the causes of prematurity may differand have simpler solutions, such as birth spacing and treatment of infections in pregnancy. Urgent focus on these settings also is critical to reduce preterm births worldwide. PMID:23158883

Perceptions and impact of plain packaging of tobacco products in low and middle income countries, middle to upper income countries and low-income settings in high-income countries: a systematic review of the literature

PubMed Central

Hughes, Nicole; Arora, Monika; Grills, Nathan

2016-01-01

Objective To review the current literature around the potential impact, effectiveness and perceptions of plain packaging in low income settings. Method A systematic review of the literature. Data sources 9 databases (PubMed, Global Health, Social Policy and Practice, Applied Social Sciences Index and Abstracts (ASSIA), CINAHL, PsycINFO, British Library for Development Studies (BLDS), Global Health Library and Scopus) were searched. The terms used for searching combined terms for smoking and tobacco use with terms for plain packaging. Study selection Studies investigating the impact of plain packaging on the determinants of tobacco use, such as smoking behaviour, appeal, prominence, effectiveness of health warnings, response to plain packs, attitudes towards quitting or likelihood of smoking in low-income settings, were identified. Studies must have been published in English and be original research of any level of rigour. Data extraction Two independent reviewers assessed studies for inclusion and extracted data. Data synthesis The results were synthesised qualitatively, with themes grouped under four key headings: appeal and attractiveness; salience of health warnings and perceptions of harm; enjoyment and perceived taste ratings; and perceptions of the impact on tobacco usage behaviour. Results This review has identified four articles that met the inclusion criteria. Studies identified that tobacco products in plain packaging had less appeal than in branded packaging in low-income settings. Conclusions This review indicates that plain packaging appears to be successful in reducing appeal of smoking and packets, and supports the call for plain packaging to be widely implemented in conjunction with other tobacco control policies. However, there are considerable gaps in the amount of research conducted outside high-income countries. PMID:27000787

Mental health system development profiles and indicators of scientific and technology innovation.

PubMed

Vilela Chaves, Catari; Moro, Sueli

2009-06-01

In this paper, mental health is discussed in the context of the system of innovation in health care. A set of mental illnesses is investigated in order to broaden our understanding of how they can be connected to the health innovation system. Two country typologies are investigated. The first typology uses the Grade of Membership approach to group 112 countries with similar policies, programs, legislation, treatment and mental health funding methods for 2001. The second is the hierarchical cluster approach, which uses scientific papers and patents from 118 countries as proxies for science and technology in 2001. The results indicate the presence of some countries in two extreme groups. On the one hand, countries with the best performance in the field of mental health have the best mental health infrastructure and are also ranked first in science and technology in this area. On the other hand, countries with the worst performance in the field of mental health also have the worst mental health infrastructure and are in the worst position in science and technology. By analyzing the international data on scientific publications and mental health systems, we find that as countries become more advanced, they significantly increase their scientific production as well as their focus on the health sector. These two movements make it possible for countries to build their own catching-up processes, focused on the health system. Accordingly, it is expected that mental health care can benefit from that strengthening in the health care sector. IMPLICATION FOR HEALTH CARE PROVISION AND USE: This paper identifies which countries need to improve their mental health and science and technology infrastructures. IMPLICATION FOR HEALTH POLICIES: The main policy recommendation refers to the strengthening of the health innovation system. This policy was chosen because, statistically speaking, according to the crisp sets and the fuzzy sets theories, this evaluation, made with data from general and especially mental health care, indicates that competence in the mental health care area requires a strong presence in terms and an emphasis on overall health. A main research issue should be the comparison of the results of this work with those from the new database published by the World Health Organization (WHO). In this way, it will be possible to observe whether or not countries have improved their infrastructure in mental health care.

Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index.

PubMed

Chang, Hannah H; Larson, Jim; Blencowe, Hannah; Spong, Catherine Y; Howson, Christopher P; Cairns-Smith, Sarah; Lackritz, Eve M; Lee, Shoo K; Mason, Elizabeth; Serazin, Andrew C; Walani, Salimah; Simpson, Joe Leigh; Lawn, Joy E

2013-01-19

Every year, 1·1 million babies die from prematurity, and many survivors are disabled. Worldwide, 15 million babies are born preterm (<37 weeks' gestation), with two decades of increasing rates in almost all countries with reliable data. The understanding of drivers and potential benefit of preventive interventions for preterm births is poor. We examined trends and estimate the potential reduction in preterm births for countries with very high human development index (VHHDI) if present evidence-based interventions were widely implemented. This analysis is to inform a rate reduction target for Born Too Soon. Countries were assessed for inclusion based on availability and quality of preterm prevalence data (2000-10), and trend analyses with projections undertaken. We analysed drivers of rate increases in the USA, 1989-2004. For 39 countries with VHHDI with more than 10,000 births, we did country-by-country analyses based on target population, incremental coverage increase, and intervention efficacy. We estimated cost savings on the basis of reported costs for preterm care in the USA adjusted using World Bank purchasing power parity. From 2010, even if all countries with VHHDI achieved annual preterm birth rate reductions of the best performers for 1990-2010 (Estonia and Croatia), 2000-10 (Sweden and Netherlands), or 2005-10 (Lithuania, Estonia), rates would experience a relative reduction of less than 5% by 2015 on average across the 39 countries. Our analysis of preterm birth rise 1989-2004 in USA suggests half the change is unexplained, but important drivers include non-medically indicated labour induction and caesarean delivery and assisted reproductive technologies. For all 39 countries with VHHDI, five interventions modelling at high coverage predicted a 5% relative reduction of preterm birth rate from 9·59% to 9·07% of livebirths: smoking cessation (0·01 rate reduction), decreasing multiple embryo transfers during assisted reproductive technologies (0·06), cervical cerclage (0·15), progesterone supplementation (0·01), and reduction of non-medically indicated labour induction or caesarean delivery (0·29). These findings translate to roughly 58,000 preterm births averted and total annual economic cost savings of about US$3 billion. We recommend a conservative target of a relative reduction in preterm birth rates of 5% by 2015. Our findings highlight the urgent need for research into underlying mechanisms of preterm births, and development of innovative interventions. Furthermore, the highest preterm birth rates occur in low-income settings where the causes of prematurity might differ and have simpler solutions such as birth spacing and treatment of infections in pregnancy than in high-income countries. Urgent focus on these settings is also crucial to reduce preterm births worldwide. March of Dimes, USA, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Institutes of Health, USA. Copyright © 2013 Elsevier Ltd. All rights reserved.

Designing a global monitoring system for pilot introduction of a new contraceptive technology, subcutaneous DMPA (DMPA-SC).

PubMed

Stout, Anna; Wood, Siri; Namagembe, Allen; Kaboré, Alain; Siddo, Daouda; Ndione, Ida

2018-06-01

In collaboration with ministries of health, PATH and key partners launched the first pilot introductions of subcutaneous depot medroxyprogesterone acetate (DMPA-SC, brand name Sayana ® Press) in Burkina Faso, Niger, Senegal, and Uganda from July 2014 through June 2016. While each country implemented a unique introduction strategy, all agreed to track a set of uniform indicators to chart the effect of introducing this new method across settings. Existing national health information systems (HIS) were unable to track new methods or delivery channels introduced for a pilot, thus were not a feasible source for project data. We successfully monitored the four-country pilot introductions by implementing a four-phase approach: 1) developing and defining global indicators, 2) integrating indicators into existing country data collection tools, 3) facilitating consistent reporting and data management, and 4) analyzing and interpreting data and sharing results. Project partners leveraged existing family planning registers to the extent possible, and introduced new or modified data collection and reporting tools to generate project-specific data where necessary. We routinely shared monitoring results with global and national stakeholders, informing decisions about future investments in the product and scale up of DMPA-SC nationwide. Our process and lessons learned may provide insights for countries planning to introduce DMPA-SC or other new contraceptive methods in settings where stakeholder expectations for measureable results for decision-making are high. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Resource requirements for cancer registration in areas with limited resources: Analysis of cost data from four low- and middle-income countries☆

PubMed Central

Tangka, Florence K.L.; Subramanian, Sujha; Edwards, Patrick; Cole-Beebe, Maggie; Parkin, D. Maxwell; Bray, Freddie; Joseph, Rachael; Mery, Les; Saraiya, Mona

2018-01-01

Background The key aims of this study were to identify sources of support for cancer registry activities, to quantify resource use and estimate costs to operate registries in low- and middle-income countries (LMIC) at different stages of development across three continents. Methods Using the Centers for Disease Control and Prevention’s (CDC’s) International Registry Costing Tool (IntRegCosting Tool), cost and resource use data were collected from eight population-based cancer registries, including one in a low-income country (Uganda [Kampala)]), two in lower to middle-income countries (Kenya [Nairobi] and India [Mumbai]), and five in an upper to middle-income country (Colombia [Pasto, Barranquilla, Bucaramanga, Manizales and Cali cancer registries]). Results Host institution contributions accounted for 30%–70% of total investment in cancer registry activities. Cancer registration involves substantial fixed cost and labor. Labor accounts for more than 50% of all expenditures across all registries. The cost per cancer case registered in low-income and lower-middle-income countries ranged from US $3.77 to US $15.62 (United States dollars). In Colombia, an upper to middle-income country, the cost per case registered ranged from US $41.28 to US $113.39. Registries serving large populations (over 15 million inhabitants) had a lower cost per inhabitant (less than US $0.01 in Mumbai, India) than registries serving small populations (under 500,000 inhabitants) [US $0.22] in Pasto, Colombia. Conclusion This study estimates the total cost and resources used for cancer registration across several countries in the limited-resource setting, and provides cancer registration stakeholders and registries-with opportunities to identify cost savings and efficiency improvements. Our results suggest that cancer registration involve substantial fixed costs and labor, and that partnership with other institutions is critical for the operation and sustainability of cancer registries in limited resource settings. Although we included registries from a variety of limited-resource areas, information from eight registries in four countries may not be large enough to capture all the potential differences among the registries in limited-resource settings. PMID:27793574

Discrimination in the workplace, reported by people with major depressive disorder: a cross-sectional study in 35 countries

PubMed Central

Brouwers, E P M; Mathijssen, J; Van Bortel, T; Knifton, L; Wahlbeck, K; Van Audenhove, C; Kadri, N; Chang, Ch; Goud, B R; Ballester, D; Tófoli, LF; Bello, R; Jorge-Monteiro, M F; Zäske, H; Milaćić, I; Uçok, A; Bonetto, C; Lasalvia, A; Thornicroft, G; Van Weeghel, J

2016-01-01

Objective Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers’ attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not). Method Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data. Results Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment. Conclusions Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD. PMID:26908523

Discrimination in the workplace, reported by people with major depressive disorder: a cross-sectional study in 35 countries.

PubMed

Brouwers, E P M; Mathijssen, J; Van Bortel, T; Knifton, L; Wahlbeck, K; Van Audenhove, C; Kadri, N; Chang, Ch; Goud, B R; Ballester, D; Tófoli, L F; Bello, R; Jorge-Monteiro, M F; Zäske, H; Milaćić, I; Uçok, A; Bonetto, C; Lasalvia, A; Thornicroft, G; Van Weeghel, J

2016-02-23

Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers' attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not). Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data. Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment. Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

National quality indicators and policies from 15 countries leading in adult end-of-life care: a systematic environmental scan.

PubMed

Virdun, Claudia; Luckett, Tim; Lorenz, Karl A; Phillips, Jane

2018-06-01

The importance of measuring the quality of end-of-life care provision is undisputed, but determining how best to achieve this is yet to be confirmed. This study sought to identify and describe national end-of-life care quality indicators and supporting policies used by countries leading in their end-of-life care provision. A systematic environmental scan that included a web search to identify relevant national policies and indicators; hand searching for additional materials; information from experts listed for the top 10 (n=15) countries ranked in the 'quality of care' category of the 2015 Quality of Death Index study; and snowballing from Index experts. Ten countries (66%) have national policy support for end-of-life care measurement, five have national indicator sets, with two indicator sets suitable for all service providers. No countries mandate indicator use, and there is limited evidence of consumer engagement in development of indicators. Two thirds of the 128 identified indicators are outcomes measures (62%), and 38% are process measures. Most indicators pertain to symptom management (38%), social care (32%) or care delivery (27%). Measurement of end-of-life care quality varies globally and rarely covers all care domains or service providers. There is a need to reduce duplication of indicator development, involve consumers, consider all care providers and ensure measurable and relevant indicators to improve end-of-life care experiences for patients and families. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Analysis of Six Reviews on the Quality of Instruments for the Evaluation of Interprofessional Education in German-Speaking Countries.

PubMed

Ehlers, Jan P; Kaap-Fröhlich, Sylvia; Mahler, Cornelia; Scherer, Theresa; Huber, Marion

2017-01-01

Background: More and more institutions worldwide and in German-speaking countries are developing and establishing interprofessional seminars in undergraduate education of health professions. In order to evaluate the different didactic approaches and different outcomes regarding the anticipated interprofessional competencies, it is necessary to apply appropriate instruments. Cross-cultural instruments are particularly helpful for international comparability. The Interprofessional Education working group of the German Medical Association (GMA) aims at identifying existing instruments for the evaluation of interprofessional education in order to make recommendations for German-speaking countries. Methods: Systematic literature research was performed on the websites of international interprofessional organisations (CAIPE, EIPEN, AIPEN), as well as in the PubMed and Cinahl databases. Reviews focusing on quantitative instruments to evaluate competencies according to the modified Kirkpatrick competency levels were searched for. Psychometrics, language/country and setting, in which the instrument was applied, were recorded. Results: Six reviews out of 73 literature research hits were included. A large number of instruments were identified; however, their psychometrics and the applied setting were very heterogeneous. The instruments can mainly be assigned to Kirkpatrick levels 1, 2a & 2b. Most instruments have been developed in English but their psychometrics were not always reported rigorously. Only very few instruments are available in German. Conclusion: It is difficult to find appropriate instruments in German. Internationally, there are different approaches and objectives in the measurement and evaluation of interprofessional competencies. The question arises whether it makes sense to translate existing instruments or to go through the lengthy process of developing new ones. The evaluation of interprofessional seminars with quantitative instruments remains mainly on Kirkpatrick levels 1 and 2. Levels 3 and 4 can probably only be assessed with qualitative or mixed methods. German language instruments are necessary.

Analysis of Six Reviews on the Quality of Instruments for the Evaluation of Interprofessional Education in German-Speaking Countries

PubMed Central

Ehlers, Jan P.; Kaap-Fröhlich, Sylvia; Mahler, Cornelia; Scherer, Theresa; Huber, Marion

2017-01-01

Background: More and more institutions worldwide and in German-speaking countries are developing and establishing interprofessional seminars in undergraduate education of health professions. In order to evaluate the different didactic approaches and different outcomes regarding the anticipated interprofessional competencies, it is necessary to apply appropriate instruments. Cross-cultural instruments are particularly helpful for international comparability. The Interprofessional Education working group of the German Medical Association (GMA) aims at identifying existing instruments for the evaluation of interprofessional education in order to make recommendations for German-speaking countries. Methods: Systematic literature research was performed on the websites of international interprofessional organisations (CAIPE, EIPEN, AIPEN), as well as in the PubMed and Cinahl databases. Reviews focusing on quantitative instruments to evaluate competencies according to the modified Kirkpatrick competency levels were searched for. Psychometrics, language/country and setting, in which the instrument was applied, were recorded. Results: Six reviews out of 73 literature research hits were included. A large number of instruments were identified; however, their psychometrics and the applied setting were very heterogeneous. The instruments can mainly be assigned to Kirkpatrick levels 1, 2a & 2b. Most instruments have been developed in English but their psychometrics were not always reported rigorously. Only very few instruments are available in German. Conclusion: It is difficult to find appropriate instruments in German. Internationally, there are different approaches and objectives in the measurement and evaluation of interprofessional competencies. The question arises whether it makes sense to translate existing instruments or to go through the lengthy process of developing new ones. The evaluation of interprofessional seminars with quantitative instruments remains mainly on Kirkpatrick levels 1 and 2. Levels 3 and 4 can probably only be assessed with qualitative or mixed methods. German language instruments are necessary. PMID:28890927

Gender differences in public and private drinking contexts: a multi-level GENACIS analysis.

PubMed

Bond, Jason C; Roberts, Sarah C M; Greenfield, Thomas K; Korcha, Rachael; Ye, Yu; Nayak, Madhabika B

2010-05-01

This multi-national study hypothesized that higher levels of country-level gender equality would predict smaller differences in the frequency of women's compared to men's drinking in public (like bars and restaurants) settings and possibly private (home or party) settings. GENACIS project survey data with drinking contexts included 22 countries in Europe (8); the Americas (7); Asia (3); Australasia (2), and Africa (2), analyzed using hierarchical linear models (individuals nested within country). Age, gender and marital status were individual predictors; country-level gender equality as well as equality in economic participation, education, and political participation, and reproductive autonomy and context of violence against women measures were country-level variables. In separate models, more reproductive autonomy, economic participation, and educational attainment and less violence against women predicted smaller differences in drinking in public settings. Once controlling for country-level economic status, only equality in economic participation predicted the size of the gender difference. Most country-level variables did not explain the gender difference in frequency of drinking in private settings. Where gender equality predicted this difference, the direction of the findings was opposite from the direction in public settings, with more equality predicting a larger gender difference, although this relationship was no longer significant after controlling for country-level economic status. Findings suggest that country-level gender equality may influence gender differences in drinking. However, the effects of gender equality on drinking may depend on the specific alcohol measure, in this case drinking context, as well as on the aspect of gender equality considered. Similar studies that use only global measures of gender equality may miss key relationships. We consider potential implications for alcohol related consequences, policy and public health.

Optimally combined regional geoid models for the realization of height systems in developing countries - ORG4heights

NASA Astrophysics Data System (ADS)

Lieb, Verena; Schmidt, Michael; Willberg, Martin; Pail, Roland

2017-04-01

Precise height systems require high-resolution and high-quality gravity data. However, such data sets are sparse especially in developing or newly industrializing countries. Thus, we initiated the DFG-project "ORG4heights" for the formulation of a general scientific concept how to (1) optimally combine all available data sets and (2) estimate realistic errors. The resulting regional gravity field models then deliver the fundamental basis for (3) establishing physical national height systems. The innovative key aspects of the project incorporate the development of a method which links (low- up to mid-resolution) gravity satellite mission data and (high- down to low-quality) terrestrial data. Hereby, an optimal combination of the data utilizing their highest measure of information including uncertainty quantification and analyzing systematic omission errors is pursued. Regional gravity field modeling via Multi-Resolution Representation (MRR) and Least Squares Collocation (LSC) are studied in detail and compared based on their theoretical fundamentals. From the findings, MRR shall be further developed towards implementing a pyramid algorithm. Within the project, we investigate comprehensive case studies in Saudi Arabia and South America, i. e. regions with varying topography, by means of simulated data with heterogeneous distribution, resolution, quality and altitude. GPS and tide gauge records serve as complementary input or validation data. The resulting products include error propagation, internal and external validation. A generalized concept then is derived in order to establish physical height systems in developing countries. The recommendations may serve as guidelines for sciences and administration. We present the ideas and strategies of the project, which combines methodical development and practical applications with high socio-economic impact.

Common software and interface for different helmet-mounted display (HMD) aircraft symbology sets

NASA Astrophysics Data System (ADS)

Mulholland, Fred F.

2000-06-01

Different aircraft in different services and countries have their own set of symbology they want displayed on their HMD. Even as flight symbolgy is standardized, there will still be some differences for types of aircraft, different weapons, different sensors, and different countries. As an HMD supplier, we want to provide a system that can be used across all these applications with no changes in the system, including no changes in the software. This HMD system must also provide the flexibility to accommodate new symbology as it is developed over the years, again, with no change in the HMD software. VSI has developed their HMD software to accommodate F-15, F- 16, F-18, and F-22 symbology sets for the Joint Helmet Mounted Cueing System. It also has the flexibility to accommodate the aircraft types and services of the Joint Strike Fighter: Conventional Takeoff and Landing variant for the USAF, Carrier-based Variant for the USN, and the Short Takeoff and Vertical Landing variant for the USMC and U.K. Royal Navy and Air Force. The key to this flexibility is the interface definition. The interface parameters are established at power-on with the download of an interface definition data set. This data set is used to interpret symbology commands from the aircraft OFP during operation and provide graphic commands to the HMD software. This presentation will define the graphics commands, provide an example of how the interface definition data set is defined, and then show how symbology commands produce a display.

Sobriety checkpoints in Thailand: a review of effectiveness and developments over time.

PubMed

Ditsuwan, Vallop; Veerman, J Lennert; Bertram, Melanie; Vos, Theo

2015-03-01

This review describes the legal basis for and implementation of sobriety checkpoints in Thailand and identifies factors that influenced their historical development and effectiveness. The first alcohol and traffic injury control law in Thailand was implemented in 1934. The 0.05 g/100 mL blood alcohol concentration limit was set in 1994. Currently, 3 types of sobriety checkpoints are used: general police checkpoints, selective breath testing, and special event sobriety checkpoints. The authors found few reports on the strategies, frequencies, and outcomes for any of these types of checkpoints, despite Thailand having devoted many resources to their implementation. In Thailand and other low-middle income countries, it is necessary to address the country-specific barriers to successful enforcement (including political and logistical issues, lack of equipment, and absence of other supportive alcohol harm reduction measures) before sobriety checkpoints can be expected to be as effective as reported in high-income countries. © 2011 APJPH.

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies.

PubMed

Petersen, Inge; Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

2017-06-01

Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Differentiating Language Arts in Belize

ERIC Educational Resources Information Center

Cook, Pamela R.

2009-01-01

Purpose: There is limited amount of research that constitutes non-traditional curricula implemented within an institutionalized context of developing countries. An attempt is made in this project to gain a clearer understanding of a non-traditional early learning program within an orphanage campus setting of Ladyville, Belize, Central America.…

Health checkup and telemedical intervention program for preventive medicine in developing countries: verification study.

PubMed

Nohara, Yasunobu; Kai, Eiko; Ghosh, Partha Pratim; Islam, Rafiqul; Ahmed, Ashir; Kuroda, Masahiro; Inoue, Sozo; Hiramatsu, Tatsuo; Kimura, Michio; Shimizu, Shuji; Kobayashi, Kunihisa; Baba, Yukino; Kashima, Hisashi; Tsuda, Koji; Sugiyama, Masashi; Blondel, Mathieu; Ueda, Naonori; Kitsuregawa, Masaru; Nakashima, Naoki

2015-01-28

The prevalence of non-communicable diseases is increasing throughout the world, including developing countries. The intent was to conduct a study of a preventive medical service in a developing country, combining eHealth checkups and teleconsultation as well as assess stratification rules and the short-term effects of intervention. We developed an eHealth system that comprises a set of sensor devices in an attaché case, a data transmission system linked to a mobile network, and a data management application. We provided eHealth checkups for the populations of five villages and the employees of five factories/offices in Bangladesh. Individual health condition was automatically categorized into four grades based on international diagnostic standards: green (healthy), yellow (caution), orange (affected), and red (emergent). We provided teleconsultation for orange- and red-grade subjects and we provided teleprescription for these subjects as required. The first checkup was provided to 16,741 subjects. After one year, 2361 subjects participated in the second checkup and the systolic blood pressure of these subjects was significantly decreased from an average of 121 mmHg to an average of 116 mmHg (P<.001). Based on these results, we propose a cost-effective method using a machine learning technique (random forest method) using the medical interview, subject profiles, and checkup results as predictor to avoid costly measurements of blood sugar, to ensure sustainability of the program in developing countries. The results of this study demonstrate the benefits of an eHealth checkup and teleconsultation program as an effective health care system in developing countries.

Turning the tide: national policy approaches to increasing physical activity in seven European countries.

PubMed

Bull, Fiona; Milton, Karen; Kahlmeier, Sonja; Arlotti, Alberto; Juričan, Andrea Backović; Belander, Olov; Martin, Brian; Martin-Diener, Eva; Marques, Ana; Mota, Jorge; Vasankari, Tommi; Vlasveld, Anita

2015-06-01

Physical inactivity is one of the four leading behavioural risk factors for non-communicable disease (NCD). Like tobacco control, increasing levels of health-enhancing physical activity (HEPA) will require a national policy framework providing direction and a clear set of actions. Despite frequent calls, there has been insufficient progress on policy development in the majority of countries around the world. This study sought and summarised national HEPA policy in seven European countries (Finland, Italy, the Netherlands, Norway, Portugal, Slovenia and Switzerland). Data collection used a policy audit tool (PAT), a 27-item instrument structured into four sections. All countries reported some legislation or policy across the sectors of education, sport and health. Only some countries reported supportive policy in the transport and environment sectors. Five countries reported a stand-alone HEPA policy and six countries reported national recommendations. HEPA prevalence targets varied in magnitude and specificity and the presence of other relevant goals from different sectors highlighted the opportunity for joint action. Evaluation and the use of scientific evidence were endorsed but described as weak in practice. Only two countries reported a national multisector coordinating committee and most countries reported challenges with partnerships on different levels of policy implementation. Bringing together the key components for success within a national HEPA policy framework is not simple. This in-depth policy audit and country comparison highlighted similarities and differences and revealed new opportunities for consideration by other countries. These examples can inform countries within and beyond Europe and guide the development of national HEPA policy within the NCD prevention agenda. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Energy from waste in Europe: an analysis and comparison of the EU 27.

PubMed

Sommer, Manuel; Ragossnig, Arne

2011-10-01

This article focuses on analysing the development of waste-generated energy in the countries of the European Union (EU 27). Besides elaborating the relevant legal and political framework in the waste and energy sector as well as climate protection, the results from correlation analyses based on the databases of the energy statistics from Eurostat are discussed. The share of energy from waste is correlated with macro-economic, waste- and energy-sector-related data, which have been defined as potentially relevant for energy recovery from waste in the countries of the European Union. The results show that a single factor influencing the extent of waste-generated energy could not be isolated as it is being influenced not only by the state of economic development and the state of development of waste management systems in the respective countries but also by energy-sector-related factors and the individual priority settings in those countries. Nevertheless the main driving force for an increase in the utilization of waste for energy generation can be seen in the legal and political framework of the European Union leading to the consequence that market conditions influence the realization of waste management infrastructure for waste-generated energy.

Learning experiences in population education: proposed guidelines and core messages.

PubMed

1984-01-01

As a result of the 1984 Regional Workshop for the Development of Packages of Adequate Learning Requirements in Population Education, the participants tackled the problem of non-institutionalization of population education into the formal and non-formal educational curricula in their countries. Based on their deliberations, several sets of guidelines and core messages were formulated to provide countries with a more definite direction that will hopefully ensure the functional and effective integration of population education in their respective national school and out-of-school curriculum system. Useful packages of learning materials in population education should help realize the country's population policy and goals within the broader framework of socioeconomic development, and the content of the package should comprehensively cover the core messages of the country's Population Information, Education and Communication (IEC) Program. The population knowledge base of the package should be accurate and relevant; the package should provide for graphic and visual presentation and for assessment of effects on the target groups. Proposed core messages in population education discuss the advantages of small family size and delayed marriage, and aspects of responsible parenthood. Other messages discuss population resource development and population-related beliefs and values.

Designing climate change mitigation plans that add up.

PubMed

Bajželj, Bojana; Allwood, Julian M; Cullen, Jonathan M

2013-07-16

Mitigation plans to combat climate change depend on the combined implementation of many abatement options, but the options interact. Published anthropogenic emissions inventories are disaggregated by gas, sector, country, or final energy form. This allows the assessment of novel energy supply options, but is insufficient for understanding how options for efficiency and demand reduction interact. A consistent framework for understanding the drivers of emissions is therefore developed, with a set of seven complete inventories reflecting all technical options for mitigation connected through lossless allocation matrices. The required data set is compiled and calculated from a wide range of industry, government, and academic reports. The framework is used to create a global Sankey diagram to relate human demand for services to anthropogenic emissions. The application of this framework is demonstrated through a prediction of per-capita emissions based on service demand in different countries, and through an example showing how the "technical potentials" of a set of separate mitigation options should be combined.

Twenty cultural and learning principles to guide the development of pharmacy curriculum in Pacific Island countries.

PubMed

Brown, Andrew N; McCormack, Coralie

2014-01-01

A lack of education capacity to support the development of medical supply management competency is a major issue affecting Pacific Islands countries (PICs). Limited human resources and underdeveloped medicines supply management competency are two significant impediments to reaching the health-related Millennium Development Goals in many countries in this rural and remote region. Two recent review publications have provided relevant background documenting factors affecting learning and teaching. These articles have presented available information regarding competency and training requirements for health personnel involved in essential medicine supply management in the region. This background research has provided a platform from which tangible principles can be developed to aid educators and professionals in PICs in the development and delivery of appropriate pharmacy curriculum. Specifically the aim of the present article is to identify culturally meaningful learning and teaching principles to guide the development and delivery of pharmaceutical curriculum in PICs. Subsequently, this information will be applied to develop and trial new pedagogical approaches to the training of health personnel involved in essential medicines supply management, to improve medicine availability for patients in their own environment. This article forms part of a wider research project involving the United Nations Population Fund Suva subregional office, the University of Canberra, Ministry of Health officials and health personnel within identified PICs. Two previous reviews, investigating Pacific culture, learning approaches, and training requirements affecting pharmaceutical personnel, were synthesised into a set of principles that could be applied to the development of pharmaceutical curriculum. These principles were validated through focus groups of health personnel using action research methods. An initial set of 16 principles was developed from the synthesis of the two reviews. These principles were reviewed by two focus groups held in Fiji and the Solomon Islands to produce a set of 20 validated principles. These validated principles can be grouped under the headings of learning theory, structure and design, and learning and teaching methods. The 20 principles outlined in this article will be used to develop and trial culturally relevant training approaches for the development of medicine management competencies for various cadres of health personnel in PICs. These principles provide a practical framework for educators and health professionals to apply to health-based education and training in the Pacific, with potential application to other rural and remote environments.

Cognitive screening tools for identification of dementia in illiterate and low-educated older adults, a systematic review and meta-analysis.

PubMed

Paddick, Stella-Maria; Gray, William K; McGuire, Jackie; Richardson, Jenny; Dotchin, Catherine; Walker, Richard W

2017-06-01

The majority of older adults with dementia live in low- and middle-income countries (LMICs). Illiteracy and low educational background are common in older LMIC populations, particularly in rural areas, and cognitive screening tools developed for this setting must reflect this. This study aimed to review published validation studies of cognitive screening tools for dementia in low-literacy settings in order to determine the most appropriate tools for use. A systematic search of major databases was conducted according to PRISMA guidelines. Validation studies of brief cognitive screening tests including illiterate participants or those with elementary education were eligible. Studies were quality assessed using the QUADAS-2 tool. Good or fair quality studies were included in a bivariate random-effects meta-analysis and a hierarchical summary receiver operating characteristic (HSROC) curve constructed. Forty-five eligible studies were quality assessed. A significant proportion utilized a case-control design, resulting in spectrum bias. The area under the ROC (AUROC) curve was 0.937 for community/low prevalence studies, 0.881 for clinic based/higher prevalence studies, and 0.869 for illiterate populations. For the Mini-Mental State Examination (MMSE) (and adaptations), the AUROC curve was 0.853. Numerous tools for assessment of cognitive impairment in low-literacy settings have been developed, and tools developed for use in high-income countries have also been validated in low-literacy settings. Most tools have been inadequately validated, with only MMSE, cognitive abilities screening instrument (CASI), Eurotest, and Fototest having more than one published good or fair quality study in an illiterate or low-literate setting. At present no screening test can be recommended.

An Entangled Model for Sustainability Indicators

PubMed Central

Cedano, Karla G.; Martínez, Manuel; Jensen, Henrik J.

2015-01-01

Nowadays the challenge for humanity is to find pathways towards sustainable development. Decision makers require a set of sustainability indicators to know if the sustainability strategies are following those pathways. There are more than one hundred sustainability indicators but they differ on their relative importance according to the size of the locality and change on time. The resources needed to follow these sustainability indicators are scarce and in some instances finite, especially in smaller regions. Therefore strategies to select set of these indicators are useful for decision makers responsible for monitoring sustainability. In this paper we propose a model for the identification and selection of a set of sustainability indicators that adequately represents human systems. In developing this model, we applied evolutionary dynamics in a space where sustainability indicators are fundamental entities interconnected by an interaction matrix. we used a fixed interaction that simulates the current context for the city of Cuernavaca, México as an example. We were able to identify and define relevant sets indicators for the system by using the Pareto principle. In this case we identified a set of sixteen sustainability indicators with more than 80% of the total strength. This set presents resilience to perturbations. For the Tangled Nature framework we provided a manner of treating different contexts (i.e., cities, counties, states, regions, countries, continents or the whole planet), dealing with small dimensions. This model provides decision makers with a valuable tool to select sustainability indicators set for towns, cities, regions, countries, continents or the entire planet according to a coevolutionary framework. The social legitimacy can arise from the fact that each individual indicator must be selected from those that are most important for the subject community. PMID:26295948

An Entangled Model for Sustainability Indicators.

PubMed

Vázquez, Pável; Del Río, Jesús A; Cedano, Karla G; Martínez, Manuel; Jensen, Henrik J

2015-01-01

Nowadays the challenge for humanity is to find pathways towards sustainable development. Decision makers require a set of sustainability indicators to know if the sustainability strategies are following those pathways. There are more than one hundred sustainability indicators but they differ on their relative importance according to the size of the locality and change on time. The resources needed to follow these sustainability indicators are scarce and in some instances finite, especially in smaller regions. Therefore strategies to select set of these indicators are useful for decision makers responsible for monitoring sustainability. In this paper we propose a model for the identification and selection of a set of sustainability indicators that adequately represents human systems. In developing this model, we applied evolutionary dynamics in a space where sustainability indicators are fundamental entities interconnected by an interaction matrix. we used a fixed interaction that simulates the current context for the city of Cuernavaca, México as an example. We were able to identify and define relevant sets indicators for the system by using the Pareto principle. In this case we identified a set of sixteen sustainability indicators with more than 80% of the total strength. This set presents resilience to perturbations. For the Tangled Nature framework we provided a manner of treating different contexts (i.e., cities, counties, states, regions, countries, continents or the whole planet), dealing with small dimensions. This model provides decision makers with a valuable tool to select sustainability indicators set for towns, cities, regions, countries, continents or the entire planet according to a coevolutionary framework. The social legitimacy can arise from the fact that each individual indicator must be selected from those that are most important for the subject community.

Priority setting and implementation in a centralized health system: a case study of Kerman province in Iran.

PubMed

Khayatzadeh-Mahani, Akram; Fotaki, Marianna; Harvey, Gillian

2013-08-01

The question of how priority setting processes work remains topical, contentious and political in every health system across the globe. It is particularly acute in the context of developing countries because of the mismatch between needs and resources, which is often compounded by an underdeveloped capacity for decision making and weak institutional infrastructures. Yet there is limited research into how the process of setting and implementing health priorities works in developing countries. This study aims to address this gap by examining how a national priority setting programme works in the centralized health system of Iran and what factors influence its implementation at the meso and micro levels. We used a qualitative case study approach, incorporating mixed methods: in-depth interviews at three levels and a textual analysis of policy documents. The data analysis showed that the process of priority setting is non-systematic, there is little transparency as to how specific priorities are decided, and the decisions made are separated from their implementation. This is due to the highly centralized system, whereby health priorities are set at the macro level without involving meso or micro local levels or any representative of the public. Furthermore, the two main benefit packages are decided by different bodies (Ministry of Health and Medical Education and Ministry of Welfare and Social Security) and there is no co-ordination between them. The process is also heavily influenced by political pressure exerted by various groups, mostly medical professionals who attempt to control priority setting in accordance with their interests. Finally, there are many weaknesses in the implementation of priorities, resulting in a growing gap between rural and urban areas in terms of access to health services.

Psychological interventions for post-traumatic stress disorder in people living with HIV in Resource poor settings: a systematic review.

PubMed

Verhey, Ruth; Chibanda, Dixon; Brakarsh, Jonathan; Seedat, Soraya

2016-10-01

Post-traumatic stress disorder is pervasive in low- and middle-income countries. There is evidence to suggest that post-traumatic stress disorder is more common among people living with HIV than non-infected matched controls. We carried out a systematic review of interventions for adult post-traumatic stress disorder from resource poor settings with a focus on people living with HIV. We included all studies that investigated interventions for adult post-traumatic stress disorder from resource poor settings with a focus on interventions that were either randomised controlled trials or observational cohort studies carried out from 1980 to May 2015. Of the 25 articles that were identified for full review, two independent reviewers identified seven studies that met our study inclusion criteria. All randomised controlled trials (RCT) (n = 6) used cognitive behavioural therapy-based interventions and focused on people living with HIV in resource poor settings. There was only one study focusing on the use of lay counsellors to address post-traumatic stress disorder but core competencies were not described. There were no intervention studies from Africa, only an observational cohort study from Rwanda. Rigorously evaluated interventions for adult post-traumatic stress disorder in people living with HIV are rare. Most were undertaken in resource poor settings located in high-income countries. There is a need for research on the development and implementation of appropriate interventions for post-traumatic stress disorder in people living with HIV in low- and middle-income countries. © 2016 John Wiley & Sons Ltd.

Developing open source, self-contained disease surveillance software applications for use in resource-limited settings

PubMed Central

2012-01-01

Background Emerging public health threats often originate in resource-limited countries. In recognition of this fact, the World Health Organization issued revised International Health Regulations in 2005, which call for significantly increased reporting and response capabilities for all signatory nations. Electronic biosurveillance systems can improve the timeliness of public health data collection, aid in the early detection of and response to disease outbreaks, and enhance situational awareness. Methods As components of its Suite for Automated Global bioSurveillance (SAGES) program, The Johns Hopkins University Applied Physics Laboratory developed two open-source, electronic biosurveillance systems for use in resource-limited settings. OpenESSENCE provides web-based data entry, analysis, and reporting. ESSENCE Desktop Edition provides similar capabilities for settings without internet access. Both systems may be configured to collect data using locally available cell phone technologies. Results ESSENCE Desktop Edition has been deployed for two years in the Republic of the Philippines. Local health clinics have rapidly adopted the new technology to provide daily reporting, thus eliminating the two-to-three week data lag of the previous paper-based system. Conclusions OpenESSENCE and ESSENCE Desktop Edition are two open-source software products with the capability of significantly improving disease surveillance in a wide range of resource-limited settings. These products, and other emerging surveillance technologies, can assist resource-limited countries compliance with the revised International Health Regulations. PMID:22950686

A guide for establishing restoration goals for contaminated ecosystems

USGS Publications Warehouse

Wagner, Anne M.; Larson, Diane L.; DalSoglio, Julie A.; Harris, James A.; Labus, Paul; Rosi-Marshall, Emma J.; Skarbis, Krisin E.

2016-01-01

As natural resources become increasingly limited, the value of restoring contaminated sites, both terrestrial and aquatic, becomes increasingly apparent. Traditionally, goals for remediation have been set before any consideration of goals for ecological restoration. The goals for remediation have focused on removing or limiting contamination whereas restoration goals have targeted the ultimate end use. Here, we present a framework for developing a comprehensive set of achievable goals for ecological restoration of contaminated sites to be used in concert with determining goals for remediation. This framework was developed during a Society of Environmental Toxicology and Chemistry (SETAC) and Society of Ecological Restoration (SER) cosponsored workshop that brought together experts from multiple countries. Although most members were from North America, this framework is designed for use internationally. We discuss the integration of establishing goals for both contaminant remediation and overall restoration, and the need to include both the restoration of ecological and socio-cultural-economic value in the context of contaminated sites. Although recognizing that in some countries there may be regulatory issues associated with contaminants and clean up, landscape setting and social drivers can inform the restoration goals. We provide a decision tree support tool to guide the establishment of restoration goals for contaminated ecosystems. The overall intent of this decision tree is to provide a framework for goal setting and to identify outcomes achievable given the contamination present at a site.

Institutions and national development in Latin America: a comparative study

PubMed Central

Portes, Alejandro; Smith, Lori D.

2013-01-01

We review the theoretical and empirical literatures on the role of institutions on national development as a prelude to present a more rigorous and measurable definition of the concept and a methodology to study this relationship at the national and subnational levels. The existing research literature features conflicting definitions of the concept of “institutions” and empirical tests based mostly on reputational indices, with countries as units of analysis. The present study’s methodology is based on a set of five strategic organizations studied comparatively in five Latin American countries. These include key federal agencies, public administrative organizations, and stock exchanges. Systematic analysis of results show a pattern of differences between economically-oriented institutions and those entrusted with providing basic services to the general population. Consistent differences in institutional quality also emerge across countries, despite similar levels of economic development. Using the algebraic methods developed by Ragin, we test six hypotheses about factors determining the developmental character of particular institutions. Implications of results for theory and for methodological practices of future studies in this field are discussed. PMID:26543407

New frontiers for health information systems using Epi Info in developing countries: structured application framework for Epi Info (SAFE).

PubMed

Ma, J; Otten, M; Kamadjeu, R; Mir, R; Rosencrans, L; McLaughlin, S; Yoon, S

2008-04-01

For more than two decades, Epi Info software has been used to meet the data management, analysis, and mapping needs of public health professionals in more than 181 countries and 13 languages. Until now, most Epi Info systems have been relatively simple, mainly because of a lack of detailed and structured guidance for developing complex systems. We created the structured application framework for Epi Info (SAFE), which is a set of guidelines that allows developers to create both simple and complex information systems using accepted good programming practices. This has resulted in application code blocks that are re-useable and easy to maintain, modify, and enhance. The flexibility of SAFE allows various aggregate and case-based application modules to be rapidly created, combined, and updated to create health information systems or sub-systems enabling continuous, incremental enhancement as national and local capacity increases. SAFE and Epi Info are both cost-free and have low system requirements--characteristics that render this framework and software beneficial for developing countries.

Assessing health system performance in developing countries: a review of the literature.

PubMed

Kruk, Margaret Elizabeth; Freedman, Lynn P

2008-03-01

With the setting of ambitious international health goals and an influx of additional development assistance for health, there is growing interest in assessing the performance of health systems in developing countries. This paper proposes a framework for the assessment of health system performance and reviews the literature on indicators currently in use to measure performance using online medical and public health databases. This was complemented by a review of relevant books and reports in the grey literature. The indicators were organized into three categories: effectiveness, equity, and efficiency. Measures of health system effectiveness were improvement in health status, access to and quality of care and, increasingly, patient satisfaction. Measures of equity included access and quality of care for disadvantaged groups together with fair financing, risk protection and accountability. Measures of efficiency were appropriate levels of funding, the cost-effectiveness of interventions, and effective administration. This framework and review of indicators may be helpful to health policy makers interested in assessing the effects of different policies, expenditures, and organizational structures on health outputs and outcomes in developing countries.

Issues in International Energy Consumption Analysis: Electricity Usage in India’s Housing Sector

EIA Publications

2014-01-01

India offers a unique set of features for studying electricity use in the context of a developing country. First, it has a rapidly developing economy with high yearly growth rates in gross domestic product (GDP). Second, it has the second -largest population in the world and is likely to have the largest population in the future. Third, its electric system is maturing—with known difficulties (outages, shortages, issues with reliability and quality) that are characteristic of a developing country. This article focuses on electricity use in the residential sector of India and discusses key trends and provides an overview of available usage estimates from various sources. Indian households are an interesting environment where many of India’s unique features interact. The recent economic gains correlate with rising incomes and possible changes in living standards, which could affect electricity or other energy use within households. Additionally, the maturing electric system and large population in India both offer opportunities to study a range of interactions between electrification and electricity usage in a developing country.

Urbanisation and child health in resource poor settings with special reference to under-five mortality in Africa.

PubMed

Garenne, Michel

2010-06-01

The health of children improved dramatically worldwide during the 20th century, although with major contrasts between developed and developing countries, and urban and rural areas. The quantitative evidence on urban child health from a broad historical and comparative perspective is briefly reviewed here. Before the sanitary revolution, urban mortality tended to be higher than rural mortality. However, after World War I, improvements in water, sanitation, hygiene, nutrition and child care resulted in lower urban child mortality in Europe. Despite a similar mortality decline, urban mortality in developing countries since World War II has been generally lower than rural mortality, probably because of better medical care, higher socio-economic status and better nutrition in urban areas. However, higher urban mortality has recently been seen in the slums of large cities in developing countries as a result of extreme poverty, family disintegration, lack of hygiene, sanitation and medical care, low nutritional status, emerging diseases (HIV/AIDS and tuberculosis) and other health hazards (environmental hazards, accidents, violence). These emerging threats need to be addressed by appropriate policies and programmes.

Developing a National-Level Concept Dictionary for EHR Implementations in Kenya.

PubMed

Keny, Aggrey; Wanyee, Steven; Kwaro, Daniel; Mulwa, Edwin; Were, Martin C

2015-01-01

The increasing adoption of Electronic Health Records (EHR) by developing countries comes with the need to develop common terminology standards to assure semantic interoperability. In Kenya, where the Ministry of Health has rolled out an EHR at 646 sites, several challenges have emerged including variable dictionaries across implementations, inability to easily share data across systems, lack of expertise in dictionary management, lack of central coordination and custody of a terminology service, inadequately defined policies and processes, insufficient infrastructure, among others. A Concept Working Group was constituted to address these challenges. The country settled on a common Kenya data dictionary, initially derived as a subset of the Columbia International eHealth Laboratory (CIEL)/Millennium Villages Project (MVP) dictionary. The initial dictionary scope largely focuses on clinical needs. Processes and policies around dictionary management are being guided by the framework developed by Bakhshi-Raiez et al. Technical and infrastructure-based approaches are also underway to streamline workflow for dictionary management and distribution across implementations. Kenya's approach on comprehensive common dictionary can serve as a model for other countries in similar settings.

Comparing internal migration across the countries of Latin America: A multidimensional approach

PubMed Central

Bernard, Aude; Rowe, Francisco; Bell, Martin; Ueffing, Philipp; Charles-Edwards, Elin

2017-01-01

While considerable progress has been made in understanding the way particular aspects of internal migration, such as its intensity, age profile and spatial impact, vary between countries around the world, little attention to date has been given to establishing how these dimensions of migration interact in different national settings. We use recently developed measures of internal migration that are scale-independent to compare the overall intensity, age composition, spatial impact, and distance profile of internal migration in 19 Latin American countries. Comparisons reveal substantial cross-national variation but cluster analysis suggests the different dimensions of migration evolve systematically to form a broad sequence characterised by low intensities, young ages at migration, unbalanced flows and high friction of distance at lower levels of development, trending to high intensities, an older age profile of migration, more closely balanced flows and lower friction of distance at later stages of development. However, the transition is not linear and local contingencies, such as international migration and political control, often distort the migration-development nexus, leading to unique migration patterns in individual national contexts. PMID:28328932

The impact of mobile health interventions on chronic disease outcomes in developing countries: a systematic review.

PubMed

Beratarrechea, Andrea; Lee, Allison G; Willner, Jonathan M; Jahangir, Eiman; Ciapponi, Agustín; Rubinstein, Adolfo

2014-01-01

Rates of chronic diseases will continue to rise in developing countries unless effective and cost-effective interventions are implemented. This review aims to discuss the impact of mobile health (m-health) on chronic disease outcomes in low- and middle-income countries (LMIC). Systematic literature searches were performed using CENTRAL, MEDLINE, EMBASE, and LILACS databases and gray literature. Scientific literature was searched to identify controlled studies evaluating cell phone voice and text message interventions to address chronic diseases in adults in low- or middle-income countries. Outcomes measured included morbidity, mortality, hospitalization rates, behavioral or lifestyle changes, process of care improvements, clinical outcomes, costs, patient-provider satisfaction, compliance, and health-related quality of life (HRQoL). From the 1,709 abstracts retrieved, 163 articles were selected for full text review, including 9 randomized controlled trials with 4,604 participants. Most of the studies addressed more than one outcome. Of the articles selected, six studied clinical outcomes, six studied processes of care, three examined healthcare costs, and two examined HRQoL. M-health positively impacted on chronic disease outcomes, improving attendance rates, clinical outcomes, and HRQoL, and was cost-effective. M-health is emerging as a promising tool to address access, coverage, and equity gaps in developing countries and low-resource settings. The results for m-health interventions showed a positive impact on chronic diseases in LMIC. However, a limiting factor of this review was the relatively small number of studies and patients enrolled, highlighting the need for more rigorous research in this area in developing countries.

Towards a sustainable framework for computer based health information systems (CHIS) for least developed countries (LDCs).

PubMed

Gordon, Abekah Nkrumah; Hinson, Robert Ebo

2007-01-01

The purpose of this paper is to argue for a theoretical framework by which development of computer based health information systems (CHIS) can be made sustainable. Health Management and promotion thrive on well-articulated CHIS. There are high levels of risk associated with the development of CHIS in the context of least developed countries (LDC), thereby making them unsustainable. This paper is based largely on literature survey on health promotion and information systems. The main factors accounting for the sustainability problem in less developed countries include poor infrastructure, inappropriate donor policies and strategies, poor infrastructure and inadequate human resource capacity. To counter these challenges and to ensure that CHIS deployment in LDCs is sustainable, it is proposed that the activities involved in the implementation of these systems be incorporated into organizational routines. This will ensure and secure the needed resources as well as the relevant support from all stakeholders of the system; on a continuous basis. This paper sets out to look at the issue of CHIS sustainability in LDCs, theoretically explains the factors that account for the sustainability problem and develops a conceptual model based on theoretical literature and existing empirical findings.

Gene co-ops and the biotrade: translating genetic resource rights into sustainable development.

PubMed

Reid, W V

1996-04-01

The 1992 Convention on Biological Diversity marks a basic change in the international status of genetic resources. Prior to the Convention, these resources were considered to be the "heritage of mankind.' Although the intent of this open access regime was to ensure the widespread availability of genetic resources for agriculture and industry, commercial use of the resources provided no additional economic incentive for conservation by source countries. The Biodiversity Convention corrects this policy failure by establishing that states have sovereign rights over their genetic resources, thereby enabling market incentives to complement various multilateral mechanisms that might directly fund biodiversity conservation. A number of obstacles face countries that are translating this broad right to regulate access into specific policies, laws, and regulations designed to meet conservation and development objectives. A review of these obstacles and of trends in technological development suggest that nations and developing country institutions should take a set of actions to develop access legislation and Material Transfer Agreements, establish biodiversity "cooperatives' and intermediary institutions to facilitate information exchange, develop minimum standards for access legislation, and require that prior informed consent of local communities be obtained by all biodiversity collectors.

Partnering with migrant friendly organizations: a case example from a Canadian school of nursing.

PubMed

Hickey, Jason; Gagnon, Anita J; Merry, Lisa

2010-01-01

Worldwide immigration to many high-income countries suggests that these countries' health care systems must become responsive to a more diverse population. Experiences working with newly arrived populations can provide healthcare students, professionals, and teachers, with valuable insight into the health and social conditions these newcomers face in both source and receiving countries. One way to gain this experience may be by developing partnerships between schools of nursing in receiving countries and international health organizations working in areas that are major migrant source regions for these countries. In this paper, we use a case example to describe, the process of identifying international, migrant-focused organizations, and the steps involved in developing partnerships with these organizations, for the implementation of a migrant health component in health professional curricula. After creating a set of criteria to evaluate partnership potential, we identified a list of international health organizations with whom we thought a partnership might be possible. Following application of our criteria, future work is being pursued with two organizations. Potential implications of this partnership include benefits to all parties involved that may help us move towards increased population and public health capacity.

Primary Health Care as a Foundation for Strengthening Health Systems in Low- and Middle-Income Countries.

PubMed

Bitton, Asaf; Ratcliffe, Hannah L; Veillard, Jeremy H; Kress, Daniel H; Barkley, Shannon; Kimball, Meredith; Secci, Federica; Wong, Ethan; Basu, Lopa; Taylor, Chelsea; Bayona, Jaime; Wang, Hong; Lagomarsino, Gina; Hirschhorn, Lisa R

2017-05-01

Primary health care (PHC) has been recognized as a core component of effective health systems since the early part of the twentieth century. However, despite notable progress, there remains a large gap between what individuals and communities need, and the quality and effectiveness of care delivered. The Primary Health Care Performance Initiative (PHCPI) was established by an international consortium to catalyze improvements in PHC delivery and outcomes in low- and middle-income countries through better measurement and sharing of effective models and practices. PHCPI has developed a framework to illustrate the relationship between key financing, workforce, and supply inputs, and core primary health care functions of first-contact accessibility, comprehensiveness, coordination, continuity, and person-centeredness. The framework provides guidance for more effective assessment of current strengths and gaps in PHC delivery through a core set of 25 key indicators ("Vital Signs"). Emerging best practices that foster high-performing PHC system development are being codified and shared around low- and high-income countries. These measurement and improvement approaches provide countries and implementers with tools to assess the current state of their PHC delivery system and to identify where cross-country learning can accelerate improvements in PHC quality and effectiveness.

Breast cancer in South Asia: a Bangladeshi perspective.

PubMed

Hossain, Mohammad Sorowar; Ferdous, Shameema; Karim-Kos, Henrike E

2014-10-01

South Asian countries are facing a hidden breast cancer epidemic. A significant proportion of the breast cancer cases occur in premenopausal women. Knowledge of the various aspects of breast cancer in different geographical regions is limited in South Asia. In this article, we review the Bangladeshi perspective of the epidemiology, risk factors, pathology, diagnosis and treatment of breast cancer. As in other developing countries, because of the lack of breast cancer awareness in Bangladeshi population and inadequate access to health care, most patients are diagnosed at an advanced stage of the disease. Early detection has a crucial impact on overall treatment outcomes. To battle against breast cancer in resource-limited countries like Bangladesh, it is not feasible to set up a parallel health service system solely dedicated to cancer. Therefore, a cost-effective public health strategy is needed which could reach a large number of women in the country. Considering all these issues, we propose an innovative female-based primary healthcare approach focused on awareness, screening and early detection of breast cancer in Bangladesh. This preventive strategy could be a model for other resource-limited developing countries. Copyright © 2014 Elsevier Ltd. All rights reserved.

A survey of tobacco dependence treatment guidelines in 121 countries

PubMed Central

Piné-Abata, Hembadoon; McNeill, Ann; Raw, Martin; Bitton, Asaf; Rigotti, Nancy; Murray, Rachael

2013-01-01

Aims To report progress among Parties to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in developing national tobacco treatment guidelines in accordance with FCTC Article 14 guideline recommendations. Design Cross-sectional study. Setting Electronic survey from December 2011 to August 2012; participants were asked to complete either an online or attached Microsoft Word questionnaire. Participants One hundred and sixty-three of the 173 Parties to the FCTC at the time of our survey. Measurements The 51-item questionnaire contained 30 items specifically on guidelines. Questions covered the areas of guidelines writing process, content, key recommendations and other characteristics. Findings One hundred and twenty-one countries (73%) responded. Fifty-three countries (44%) had guidelines, ranging from 75% among high-income countries to 11% among low-income countries. Nearly all guidelines recommended brief advice (93%), intensive specialist support (93%) and medications (96%), while 66% recommended quitlines. Fifty-seven percent had a dissemination strategy, 76% stated funding source and 68% had professional endorsement. Conclusion Fewer than half of the Parties to the WHO FCTC have developed national tobacco treatment guidelines, but, where guidelines exist, they broadly follow FCTC Article 14 guideline recommendations. PMID:23437892

National health inequality monitoring: current challenges and opportunities.

PubMed

Hosseinpoor, Ahmad Reza; Bergen, Nicole; Schlotheuber, Anne; Boerma, Ties

National health inequality monitoring needs considerably more investment to realize equity-oriented health improvements in countries, including advancement towards the Sustainable Development Goals. Following an overview of national health inequality monitoring and the associated resource requirements, we highlight challenges that countries may encounter when setting up, expanding or strengthening national health inequality monitoring systems, and discuss opportunities and key initiatives that aim to address these challenges. We provide specific proposals on what is needed to ensure that national health inequality monitoring systems are harnessed to guide the reduction of health inequalities.

Poison control centers in developing countries and Asia's need for toxicology education

DOE Office of Scientific and Technical Information (OSTI.GOV)

Makalinao, Irma R.; Awang, Rahmat

2005-09-01

Poison control centers (PCCs) in developing countries have been set up in response to the challenge of decreasing mortality and morbidity from poisoning. The services range from poison information to actual clinical treatment mostly of acute cases. Lately, PCCs have expanded from their traditional role to one that actively engages in community health studies, toxicovigilance along with treatment of chronic poisoning. Recognizing that types of poisoning and specific needs may vary from country to country, toxicology education that addresses these unique regional issues has become more necessary. Toxicology education, both formal and informal, exists in various stages of development inmore » Asia. Clearly, there are gaps that need to be addressed especially in areas where there are no poison centers or where strengthening is necessary. Collaboration between PCCs in developing countries can help augment available resources including human, analytical and technical expertise. The critical mass of trained toxicologists will fill in the demand for clinical and regulatory specialists and educators as well. This paper highlights the experiences and resources available to the Philippine and Malaysian poison centers and the strengths generated by networking and collaboration. The role of Asia Pacific Association of Medical Toxicology (APAMT) as the Science NGO representative to the Intergovernmental Forum on Chemical Safety (IFCS) forum standing committee in promoting chemical safety at the regional level will be discussed. The 'Clearinghouse on the Sound Management of Chemicals', a platform for engaging multi-stakeholder and interdisciplinary partnerships, will be described as a possible model for capacity building to advance chemical safety through education and training not only in developing countries in Asia but globally as well.« less

Harm reduction and viral hepatitis C in European prisons: a cross-sectional survey of 25 countries.

PubMed

Bielen, Rob; Stumo, Samya R; Halford, Rachel; Werling, Klára; Reic, Tatjana; Stöver, Heino; Robaeys, Geert; Lazarus, Jeffrey V

2018-05-11

Current estimates suggest that 15% of all prisoners worldwide are chronically infected with the hepatitis C virus (HCV), and this number is even higher in regions with high rates of injecting drug use. Although harm reduction services such as opioid substitution therapy (OST) and needle and syringe programs (NSPs) are effective in preventing the further spread of HCV and HIV, the extent to which these are available in prisons varies significantly across countries. The Hep-CORE study surveyed liver patient groups from 25 European countries in 2016 and mid-2017 on national policies related to harm reduction, testing/screening, and treatment for HCV in prison settings. Results from the cross-sectional survey were compared to the data from available reports and the peer-reviewed literature to determine the overall degree to which European countries implement evidence-based HCV recommendations in prison settings. Patient groups in nine countries (36%) identified prisoners as a high-risk population target for HCV testing/screening. Twenty-one countries (84%) provide HCV treatment in prisons. However, the extent of coverage of these treatment programs varies widely. Two countries (8%) have NSPs officially available in prisons in all parts of the country. Eleven countries (44%) provide OST in prisons in all parts of the country without additional requirements. Despite the existence of evidence-based recommendations, infectious disease prevention measures such as harm reduction programs are inadequate in European prison settings. Harm reduction, HCV testing/screening, and treatment should be scaled up in prison settings in order to progress towards eliminating HCV as a public health threat.

Guidelines on Diabetic Eye Care: The International Council of Ophthalmology Recommendations for Screening, Follow-up, Referral, and Treatment Based on Resource Settings.

PubMed

Wong, Tien Y; Sun, Jennifer; Kawasaki, Ryo; Ruamviboonsuk, Paisan; Gupta, Neeru; Lansingh, Van Charles; Maia, Mauricio; Mathenge, Wanjiku; Moreker, Sunil; Muqit, Mahi M K; Resnikoff, Serge; Verdaguer, Juan; Zhao, Peiquan; Ferris, Frederick; Aiello, Lloyd P; Taylor, Hugh R

2018-05-24

Diabetes mellitus (DM) is a global epidemic and affects populations in both developing and developed countries, with differing health care and resource levels. Diabetic retinopathy (DR) is a major complication of DM and a leading cause of vision loss in working middle-aged adults. Vision loss from DR can be prevented with broad-level public health strategies, but these need to be tailored to a country's and population's resource setting. Designing DR screening programs, with appropriate and timely referral to facilities with trained eye care professionals, and using cost-effective treatment for vision-threatening levels of DR can prevent vision loss. The International Council of Ophthalmology Guidelines for Diabetic Eye Care 2017 summarize and offer a comprehensive guide for DR screening, referral and follow-up schedules for DR, and appropriate management of vision-threatening DR, including diabetic macular edema (DME) and proliferative DR, for countries with high- and low- or intermediate-resource settings. The guidelines include updated evidence on screening and referral criteria, the minimum requirements for a screening vision and retinal examination, follow-up care, and management of DR and DME, including laser photocoagulation and appropriate use of intravitreal anti-vascular endothelial growth factor inhibitors and, in specific situations, intravitreal corticosteroids. Recommendations for management of DR in patients during pregnancy and with concomitant cataract also are included. The guidelines offer suggestions for monitoring outcomes and indicators of success at a population level. Copyright © 2018 American Academy of Ophthalmology. All rights reserved.

Consensus and contention in the priority setting process: examining the health sector in Uganda.

PubMed

Colenbrander, Sarah; Birungi, Charles; Mbonye, Anthony K

2015-06-01

Health priority setting is a critical and contentious issue in low-income countries because of the high burden of disease relative to the limited resource envelope. Many sophisticated quantitative tools and policy frameworks have been developed to promote transparent priority setting processes and allocative efficiency. However, low-income countries frequently lack effective governance systems or implementation capacity, so high-level priorities are not determined through evidence-based decision-making processes. This study uses qualitative research methods to explore how key actors' priorities differ in low-income countries, using Uganda as a case study. Human resources for health, disease prevention and family planning emerge as the common priorities among actors in the health sector (although the last of these is particularly emphasized by international agencies) because of their contribution to the long-term sustainability of health-care provision. Financing health-care services is the most disputed issue. Participants from the Ugandan Ministry of Health preferentially sought to increase net health expenditure and government ownership of the health sector, while non-state actors prioritized improving the efficiency of resource use. Ultimately it is apparent that the power to influence national health outcomes lies with only a handful of decision-makers within key institutions in the health sector, such as the Ministries of Health, the largest bilateral donors and the multilateral development agencies. These power relations reinforce the need for ongoing research into the paradigms and strategic interests of these actors. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Unexpected flood loss correlations across Europe

NASA Astrophysics Data System (ADS)

Booth, Naomi; Boyd, Jessica

2017-04-01

Floods don't observe country borders, as highlighted by major events across Europe that resulted in heavy economic and insured losses in 1999, 2002, 2009 and 2013. Flood loss correlations between some countries occur along multi-country river systems or between neighbouring nations affected by the same weather systems. However, correlations are not so obvious and whilst flooding in multiple locations across Europe may appear independent, for a re/insurer providing cover across the continent, these unexpected correlations can lead to high loss accumulations. A consistent, continental-scale method that allows quantification and comparison of losses, and identifies correlations in loss between European countries is therefore essential. A probabilistic model for European river flooding was developed that allows estimation of potential losses to pan-European property portfolios. By combining flood hazard and exposure information in a catastrophe modelling platform, we can consider correlations between river basins across Europe rather than being restricted to country boundaries. A key feature of the model is its statistical event set based on extreme value theory. Using historical river flow data, the event set captures spatial and temporal patterns of flooding across Europe and simulates thousands of events representing a full range of possible scenarios. Some known correlations were identified, such as between neighbouring Belgium and Luxembourg where 28% of events that affect either country produce a loss in both. However, our model identified some unexpected correlations including between Austria and Poland, and Poland and France, which are geographically distant. These correlations in flood loss may be missed by traditional methods and are key for re/insurers with risks in multiple countries. The model also identified that 46% of European river flood events affect more than one country. For more extreme events with a return period higher than 200 years, all events impact more than one country. These tail events also demonstrate that it is unlikely for the market to experience an extreme event which does not affect at least five European countries.

Development of healthcare quality indicators for rheumatoid arthritis in Europe: the eumusc.net project.

PubMed

Petersson, Ingemar F; Strömbeck, Britta; Andersen, Lene; Cimmino, Marco; Greiff, Rolf; Loza, Estibaliz; Sciré, Carlo; Stamm, Tanja; Stoffer, Michaela; Uhlig, Till; Woolf, Anthony D; Vliet Vlieland, Theodora P M

2014-05-01

Eumusc.net (http://www.eumusc.net) is a European project supported by the EU and European League Against Rheumatism to improve musculoskeletal care in Europe. To develop patient-centred healthcare quality indicators (HCQIs) for healthcare provision for rheumatoid arthritis (RA) patients. Based on a systematic literature search, existing HCQIs for RA were identified and their contents analysed and categorised referring to a list of 16 standards of care developed within the eumusc.net. An international expert panel comprising 14 healthcare providers and two patient representatives added topics and during repeated Delphi processes by email ranked the topics and rephrased suggested HCQIs with the preliminary set being established during a second expert group meeting. After an audit process by rheumatology units (including academic centres) in six countries (The Netherlands, Norway, Romania, Italy, Austria and Sweden), a final version of the HCQIs was established. 56 possible topics for HCQIs were processed resulting in a final set of HCQIs for RA (n=14) including two for structure (patient information and calculation of composite scores), 11 for process (eg, access to care, assessments, and pharmacological and non-pharmacological treatments) and one for outcome (effect of treatment on disease activity). They included definitions to be used in clinical practice and also by patients. Further, the numerators and the denominators for each HCQI were defined. A set of 14 patient-centred HCQIs for RA was developed to be used in quality improvement and bench marking in countries across Europe.

Raising more domestic money for health: prospects for low- and middle-income countries.

PubMed

Elovainio, Riku; Evans, David B

2017-04-01

Since the 2007/2008 financial crisis, the rhetoric in the development assistance dialogue has shifted away from raising more international funding for health, to requesting countries to move toward self-sufficiency. This paper examines the potential of 46 countries identified by an international panel in 2009 as being of high need to raise additional funding for health from domestic sources. Economic growth alone would allow 12 of them to reach a level of health spending where their populations could have access to a very basic set of health services. All of them have the potential to raise additional domestic funds through a range of measures that have been tried successfully in other low- and middle-income countries, but they would all remain well below the eventual objective of universal health coverage without increased and predictable external financial support.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Spickett, Jeffery, E-mail: J.Spickett@curtin.edu.au; Faculty of Health Sciences, School of Public Health, Curtin University, Perth, Western Australia; Katscherian, Dianne

The approaches used for setting or reviewing air quality standards vary from country to country. The purpose of this research was to consider the potential to improve decision-making through integration of HIA into the processes to review and set air quality standards used in Australia. To assess the value of HIA in this policy process, its strengths and weaknesses were evaluated aligned with review of international processes for setting air quality standards. Air quality standard setting programmes elsewhere have either used HIA or have amalgamated and incorporated factors normally found within HIA frameworks. They clearly demonstrate the value of amore » formalised HIA process for setting air quality standards in Australia. The following elements should be taken into consideration when using HIA in standard setting. (a) The adequacy of a mainly technical approach in current standard setting procedures to consider social determinants of health. (b) The importance of risk assessment criteria and information within the HIA process. The assessment of risk should consider equity, the distribution of variations in air quality in different locations and the potential impacts on health. (c) The uncertainties in extrapolating evidence from one population to another or to subpopulations, especially the more vulnerable, due to differing environmental factors and population variables. (d) The significance of communication with all potential stakeholders on issues associated with the management of air quality. In Australia there is also an opportunity for HIA to be used in conjunction with the NEPM to develop local air quality standard measures. The outcomes of this research indicated that the use of HIA for air quality standard setting at the national and local levels would prove advantageous. -- Highlights: • Health Impact Assessment framework has been applied to a policy development process. • HIA process was evaluated for application in air quality standard setting. • Advantages of HIA in the air quality standard setting process are demonstrated.« less

Advances in Developing HIV-1 Viral Load Assays for Resource-Limited Settings

PubMed Central

Wang, ShuQi; Xu, Feng; Demirci, Utkan

2010-01-01

Commercial HIV-1 RNA viral load assays have been routinely used in developed countries to monitor antiretroviral treatment (ART). However, these assays require expensive equipment and reagents, well-trained operators, and established laboratory infrastructure. These requirements restrict their use in resource-limited settings where people are most afflicted with the HIV-1 epidemic. Inexpensive alternatives such as the Ultrasensitive p24 assay, the Reverse Transcriptase (RT) assay and in-house reverse transcription quantitative polymerase chain reaction (RT-qPCR) have been developed. However, they are still time-consuming, technologically complex and inappropriate for decentralized laboratories as point-of-care (POC) tests. Recent advances in microfluidics and nanotechnology offer new strategies to develop low-cost, rapid, robust and simple HIV-1 viral load monitoring systems. We review state-of-the-art technologies used for HIV-1 viral load monitoring in both developed and developing settings. Emerging approaches based on microfluidics and nanotechnology, which have potential to be integrated into POC HIV-1 viral load assays, are also discussed. PMID:20600784

Epidemiology of international terrorism involving fatal outcomes in developed countries (1994-2003).

PubMed

Wilson, Nick; Thomson, George

2005-01-01

We aimed to describe the public health burden and epidemiology of international terrorism (i.e. involving foreign nationals) with fatal outcomes in developed countries. Data was abstracted from a United States Department of State database for 21 'established market economy' countries and 18 'former socialist economies of Europe' for 1994-2003. To put the findings in a wider context, comparisons were made with WHO data on all homicides for each country. A total of 32 international terrorist attacks causing fatalities were identified over the 10-year period. These resulted in 3299 deaths, giving a crude annual mortality rate of 0.3 per million population. The mortality burden attributable to international terrorism in these countries was 208 times less than that attributable to other homicide. Even for the country with the highest mortality burden from international terrorism (the United States), this ratio was 60. There was no statistically significant trend in the number of attacks over time, but the attack severity (in terms of deaths per attack) was higher in the latter part of the 10-year period. A number of limitations with this data set were identified. If a more rigorous definition of 'international terrorism' was used, then this would substantially reduce the total number of such attacks defined in this way. In conclusion, there is a need for better quality data and improved classification systems for describing international terrorism. Nevertheless, the available data indicates that the mortality burden from international terrorism in developed countries is small compared to that from other homicide.

FAO UN-REDD- INPE Joint Programme on Forest Monitoring Systems based on RS and GIS techniques

NASA Astrophysics Data System (ADS)

Jonckheere, I. G.; FAO UN-REDD MRV Team

2010-12-01

Capacity Development and Training for National Forest Monitoring Systems for Reducing Emissions from Deforestation and Forest Degradation in Developing Countries (REDD+) REDD+, which stands for ’Reducing Emissions from Deforestation and Forest Degradation in Developing Countries’ - is an effort to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. The UN-REDD Programme, a collaborative partnership between FAO, UNDP and UNEP launched in September 2008, supports countries to develop capacity to REDD+ and to implement a future REDD+ mechanism in a post-2012 climate regime. The programme works at both the national and global scale, through support mechanisms for country-driven REDD strategies and international consensus-building on REDD+ processes. The UN-REDD Programme gathers technical teams from around the world to develop common approaches, analyses and guidelines on issues such as measurement, reporting and verification (MRV) of carbon emissions and flows, remote sensing, and greenhouse gas inventories. Within the partnership, FAO supports countries on technical issues related to forestry and the development of cost effective and credible MRV processes for emission reductions. While at the international level, it fosters improved guidance on MRV approaches, including consensus on principles and guidelines for MRV and training programmes. It provides guidance on how best to design and implement REDD+, to ensure that forests continue to provide multiple benefits for livelihoods and biodiversity to societies while storing carbon at the same time. Other areas of work include national forest assessments and monitoring of in-country policy and institutional change. FAO and INPE (Brazilian Space Agency) have joint forces through a MoU signed last year in Copenhagen. A major joint programme has been agreed upon to set up national forest satellite monitoring systems in the developing countries and to train them in order to get them ready for REDD+. The outcomes about the role of satellite remote sensing technologies as a tool for monitoring, assessment, reporting and verification of carbon credits and co-benefits under the REDD+ mechanism are here presented.

Driving a decade of change: HIV/AIDS, patents and access to medicines for all

PubMed Central

2011-01-01

Since 2000, access to antiretroviral drugs to treat HIV infection has dramatically increased to reach more than five million people in developing countries. Essential to this achievement was the dramatic reduction in antiretroviral prices, a result of global political mobilization that cleared the way for competitive production of generic versions of widely patented medicines. Global trade rules agreed upon in 1994 required many developing countries to begin offering patents on medicines for the first time. Government and civil society reaction to expected increases in drug prices precipitated a series of events challenging these rules, culminating in the 2001 World Trade Organization's Doha Declaration on the Agreement on Trade-Related Aspects of Intellectual Property Rights and Public Health. The Declaration affirmed that patent rules should be interpreted and implemented to protect public health and to promote access to medicines for all. Since Doha, more than 60 low- and middle-income countries have procured generic versions of patented medicines on a large scale. Despite these changes, however, a "treatment timebomb" awaits. First, increasing numbers of people need access to newer antiretrovirals, but treatment costs are rising since new ARVs are likely to be more widely patented in developing countries. Second, policy space to produce or import generic versions of patented medicines is shrinking in some developing countries. Third, funding for medicines is falling far short of needs. Expanded use of the existing flexibilities in patent law and new models to address the second wave of the access to medicines crisis are required. One promising new mechanism is the UNITAID-supported Medicines Patent Pool, which seeks to facilitate access to patents to enable competitive generic medicines production and the development of improved products. Such innovative approaches are possible today due to the previous decade of AIDS activism. However, the Pool is just one of a broad set of policies needed to ensure access to medicines for all; other key measures include sufficient and reliable financing, research and development of new products targeted for use in resource-poor settings, and use of patent law flexibilities. Governments must live up to their obligations to protect access to medicines as a fundamental component of the human right to health. PMID:21439089

40 CFR 97.510 - State NOX Ozone Season trading budgets, new unit set-asides, Indian country new unit set-aside...

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 22 2012-07-01 2012-07-01 false State NOX Ozone Season trading budgets... BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS TR NOX Ozone Season Trading Program § 97.510 State NOX Ozone Season trading budgets, new unit set-asides, Indian country new unit set-aside, and...

40 CFR 97.510 - State NOX Ozone Season trading budgets, new unit set-asides, Indian country new unit set-aside...

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 22 2013-07-01 2013-07-01 false State NOX Ozone Season trading budgets... BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS TR NOX Ozone Season Trading Program § 97.510 State NOX Ozone Season trading budgets, new unit set-asides, Indian country new unit set-aside, and...

40 CFR 97.510 - State NOX Ozone Season trading budgets, new unit set-asides, Indian country new unit set-aside...

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 21 2014-07-01 2014-07-01 false State NOX Ozone Season trading budgets... BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS TR NOX Ozone Season Trading Program § 97.510 State NOX Ozone Season trading budgets, new unit set-asides, Indian country new unit set-aside, and...

Specific features of medicines safety and pharmacovigilance in Africa

PubMed Central

Pal, Shanthi N.; Olsson, Sten; Dodoo, Alexander; Bencheikh, Rachida Soulayami

2012-01-01

The thalidomide tragedy in the late 1950s and early 1960s served as a wakeup call and raised questions about the safety of medicinal products. The developed countries rose to the challenge putting in place systems to ensure the safety of medicines. However, this was not the case for low-resource settings because of prevailing factors inherent in them. This paper reviews some of these features and the current status of pharmacovigilance in Africa. The health systems in most of the 54 countries of Africa are essentially weak, lacking in basic infrastructure, personnel, equipment and facilities. The recent mass deployment of medicines to address diseases of public health significance in Africa poses additional challenges to the health system with notable safety concerns. Other safety issues of note include substandard and counterfeit medicines, medication errors and quality of medicinal products. The first national pharmacovigilance centres established in Africa with membership of the World Health Organization (WHO) international drug monitoring programme were in Morocco and South Africa in 1992. Of the 104 full member countries in the programme, there are now 24 African countries with a further nine countries as associate members. The pharmacovigilance systems operational in African countries are based essentially on spontaneous reporting facilitated by the introduction of the new tool Vigiflow. The individual case safety reports committed to the WHO global database (Vigibase) attest to the growth of pharmacovigilance in Africa with the number of reports rising from 2695 in 2000 to over 25,000 in 2010. There is need to engage the various identified challenges of the weak pharmacovigilance systems in the African setting and to focus efforts on how to provide resources, infrastructure and expertise. Raising the level of awareness among healthcare providers, developing training curricula for healthcare professionals, provisions for paediatric and geriatric pharmacovigilance, engaging the pharmaceutical industries as well as those for herbal remedies are of primary concern. PMID:25083223

A Needs Assessment to Identify the Reality of Two Rural School Cases in South Africa: Potential for ICT4D or Not?

ERIC Educational Resources Information Center

Pade-Khene, C.

2012-01-01

Understanding the potential or need for ICT support in education within developing countries, requires an in-depth needs assessment to comprehend, elaborate and set the desired priorities of rural schools. A Needs Assessment was conducted as part of an on-going comprehensive evaluation process of an ICT for development project, the Siyakhula…

Southeast Asia Report. No. 1296

DTIC Science & Technology

1983-06-07

proposals. Agrarian Reform Minister Coftrado F. Estrella , head of the seven-man delegation, said the Philippine posi- tions on integrated...rural development, human set- tlements, social develop- ment, and other topics were incorporated in the commission’s report. Estrella said the...alleviation of poverty." Estrella said that the ESCAP sought to "analy* ze agricultural policies and Strategie« of member- countries and examine ways of

The Virtual Research and Extension Communication Network (VRECN): An Interactive Learning and Communication Network for Research and Extension Personnel. Concept Paper for the Food & Agriculture Organisation of the United Nations (FAO).

ERIC Educational Resources Information Center

Richardson, Don

A Virtual Research and Extension Communication Network (VRECN) is a set of networked electronic tools facilitating improvement in communication processes and information sharing among stakeholders involved in agricultural development. In developing countries, research and extension personnel within a ministry of agriculture, in consultation and…

Developing Programmes to Promote Participation in Sport among Adolescents with Disabilities: Perceptions Expressed by a Group of South African Adolescents with Cerebral Palsy

ERIC Educational Resources Information Center

Bantjes, Jason; Swartz, Leslie; Conchar, Lauren; Derman, Wayne

2015-01-01

Adolescents with disabilities in developing countries frequently have limited access to sporting opportunities and comparatively little is known of their lived experiences and preferences. We set out to understand what a group of adolescents with cerebral palsy (CP) living in South Africa perceive to be important components of programmes developed…

The Subject and the Setting: Re-Imagining Opportunities for Primary Teachers' Subject Knowledge Development on School-Based Teacher Education Courses

ERIC Educational Resources Information Center

Knight, Rupert

2017-01-01

The landscape of teacher education is undergoing significant change in many countries and this is often associated with a move towards greater school involvement in the preparation of teachers. One aspect of teaching expertise that is particularly challenging for primary student-teachers is the development of subject knowledge across a wide range…

Mammographic image quality in relation to positioning of the breast: A multicentre international evaluation of the assessment systems currently used, to provide an evidence base for establishing a standardised method of assessment.

PubMed

Taylor, K; Parashar, D; Bouverat, G; Poulos, A; Gullien, R; Stewart, E; Aarre, R; Crystal, P; Wallis, M

2017-11-01

Optimum mammography positioning technique is necessary to maximise cancer detection. Current criteria for mammography appraisal lack reliability and validity with a need to develop a more objective system. We aimed to establish current international practice in assessing image quality (IQ), of screening mammograms then develop and validate a reproducible assessment tool. A questionnaire sent to centres in countries undertaking population screening identified practice, participants for an expert panel (EP) of radiologists/radiographers and a testing panel (TP) of radiographers. The EP developed category criteria and descriptors using a modified Delphi process to agree definitions. The EP scored 12 screening mammograms to test agreement then a main set of 178 cases. Weighted scores were derived for each descriptor enabling calculation of numerical parameters for each new category. The TP then scored the main set. Statistical analysis included ANOVA, t-tests and Kendall's coefficient. 11 centres in 8 countries responded forming an EP of 7 members and TP of 44 members. The EP showed moderate agreement when the scoring the mini test set W = 0.50 p < 0.001 and the main set W = 0.55 p < 0.001, 'posterior nipple line' being the most difficult descriptor. The weighted total scores differentiated the 4 new categories Perfect, Good, Adequate and Inadequate (p < 0.001). We have developed an assessment tool by Delphi consensus and weighted consensus criteria. We have successfully tabulated a range of numerical scores for each new category providing the first validated and reproducible mammography IQ scoring system. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Monitoring Water Targets in the Post-2015 Development Goals

NASA Astrophysics Data System (ADS)

Lawford, R. G.

2015-12-01

The Water Sustainable Development Goal (SDG) provides a comprehensive approach to developing water services in a way that ensures social equity, health, well-being and sustainability for all. In particular, the water goal includes targets related to sanitation, wastewater, water quality, water efficiency, integrated water management and ecosystems (details to be finalized in September 2015). As part of its implementation, methods to monitor target indicators must be developed. National governments will be responsible for reporting on progress toward these targets using national data sets and possibly information from global data sets that applies to their countries. Oversight of this process through the use of global data sets is desirable for encouraging the use of standardized information for comparison purposes. Disparities in monitoring due to very sparse data networks in some countries can be addressed by using geospatially consistent data products from space-based remote sensing. However, to fully exploit these data, capabilities will be needed to downscale information, to interpolate and assimilate data both in time and space, and to integrate these data with socio-economic data sets, model outputs and survey data in a geographical information system framework. Citizen data and other non-standard data types may also supplement national data systems. A comprehensive and integrated analysis and dissemination system is needed to enable the important contributions that satellites could make to achieving Water SDG targets. This presentation will outline the progress made in assessing the needs for information to track progress on the Water SDG, options for meeting these needs using existing data infrastructure, and pathways for expanding the role of Earth observations in SDG monitoring. It will also discuss the potential roles of Future Earth's Sustainable Water Futures Programme (SWFP) and the Group on Earth Observations (GEO) in coordinating these efforts.

Global Seasonality of Rotavirus Disease

PubMed Central

Patel, Manish M.; Pitzer, Virginia; Alonso, Wladimir J.; Vera, David; Lopman, Ben; Tate, Jacqueline; Viboud, Cecile; Parashar, Umesh D.

2012-01-01

Background A substantial number of surveillance studies have documented rotavirus prevalence among children admitted for dehydrating diarrhea. We sought to establish global seasonal patterns of rotavirus disease before widespread vaccine introduction. Methods We reviewed studies of rotavirus detection in children with diarrhea published since 1995. We assessed potential relationships between seasonal prevalence and locality by plotting the average monthly proportion of diarrhea cases positive for rotavirus according to geography, country development, and latitude. We used linear regression to identify variables that were potentially associated with the seasonal intensity of rotavirus. Results Among a total of 99 studies representing all six geographical regions of the world, patterns of year-round disease were more evident in low- and low-middle income countries compared with upper-middle and high income countries where disease was more likely to be seasonal. The level of country development was a stronger predictor of strength of seasonality (P=0.001) than geographical location or climate. However, the observation of distinctly different seasonal patterns of rotavirus disease in some countries with similar geographical location, climate and level of development indicate that a single unifying explanation for variation in seasonality of rotavirus disease is unlikely. Conclusion While no unifying explanation emerged for varying rotavirus seasonality globally, the country income level was somewhat more predictive of the likelihood of having seasonal disease than other factors. Future evaluation of the effect of rotavirus vaccination on seasonal patterns of disease in different settings may help understand factors that drive the global seasonality of rotavirus disease. PMID:23190782

Cardiac rehabilitation delivery model for low-resource settings

PubMed Central

Grace, Sherry L; Turk-Adawi, Karam I; Contractor, Aashish; Atrey, Alison; Campbell, Norm; Derman, Wayne; Melo Ghisi, Gabriela L; Oldridge, Neil; Sarkar, Bidyut K; Yeo, Tee Joo; Lopez-Jimenez, Francisco; Mendis, Shanthi; Oh, Paul; Hu, Dayi; Sarrafzadegan, Nizal

2016-01-01

Objective Cardiovascular disease is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be cost-effective and efficacious in high-income countries. CR could represent an important approach to mitigate the epidemic of cardiovascular disease in lower-resource settings. The purpose of this consensus statement was to review low-cost approaches to delivering the core components of CR, to propose a testable model of CR which could feasibly be delivered in middle-income countries. Methods A literature review regarding delivery of each core CR component, namely: (1) lifestyle risk factor management (ie, physical activity, diet, tobacco and mental health), (2) medical risk factor management (eg, lipid control, blood pressure control), (3) education for self-management and (4) return to work, in low-resource settings was undertaken. Recommendations were developed based on identified articles, using a modified GRADE approach where evidence in a low-resource setting was available, or consensus where evidence was not. Results Available data on cost of CR delivery in low-resource settings suggests it is not feasible to deliver CR in low-resource settings as is delivered in high-resource ones. Strategies which can be implemented to deliver all of the core CR components in low-resource settings were summarised in practice recommendations, and approaches to patient assessment proffered. It is suggested that CR be adapted by delivery by non-physician healthcare workers, in non-clinical settings. Conclusions Advocacy to achieve political commitment for broad delivery of adapted CR services in low-resource settings is needed. PMID:27181874

Socio-Cultural Environments and Suggestopedia.

ERIC Educational Resources Information Center

Bayuk, Milla

The suggestopedic model of accelerated learning as developed by Lozanov is referred to by him as a set of attitudes inherent to sociocultural behavior common to the Soviet Bloc countries. The theoretical base accounts for a built-in obedience reflex, acceptance of authority, lack of competitiveness, promotion of collective growth, and a…

Re-Thinking Intelligence: Schools That Build the Mind

ERIC Educational Resources Information Center

Resnick, Lauren B.; Schantz, Faith

2015-01-01

We now understand that human intelligence, once thought to be determined almost solely by heredity, is malleable. In developed countries, average intelligence test scores have increased substantially since the tests began to be administered 100 years ago. In school settings, however, intelligence is often still treated as a fixed attribute that…

INFO RELEASE. National Information Network for Recreation, Leisure and Sport.

ERIC Educational Resources Information Center

Sharma, Vidya S.

A study by the Northern Territories Department of Community Development systematically and specifically identified information needs and categories of clients through a set of intellectual concepts in the fields of sport, recreation, and leisure. A survey of Australia's serials holdings was conducted to assess the country's existing information…

Health and Schooling: Evidence and Policy Implications for Developing Countries.

ERIC Educational Resources Information Center

Gomes-Neto, Joao Batista; And Others

1997-01-01

Exploits a unique data set (EDRURAL) from three northeastern states of Brazil to investigate the complementarities of health with school attainment and cognitive achievement. The promotion models and value-added achievement models demonstrate the value of students' visual acuity. Achievement models highlight the role of good nutrition. Eye…