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The article discusses the successful implementation of family planning services in Ethiopia and the lessons that it provided. Topics discussed include the expansion of family planning services in developing countries by the Bill & Melinda Gates Foundation and the Department for International Development in Great Britain and the importance of family planning in achieving public health outcomes and other development objectives of a country.

The article explores the feasibility of comprehensive cancer control which merits a worldwide effort to expand cancer prevention in middle- and low-income countries. It offers information on the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. It discusses the important role played by a combination of increased access to primary care and well designed disease-control programmes in enhancing cancer care and control. An overview of the cancer control and treatment programmes of several countries is also presented.

This article discusses the role of primary care strategies in maternal, newborn, and child health (MNCH). The authors outline a strategy that links community based NMCH interventions in underserved populations to increased access to referral facilities that can provide more medically complicated treatments such as Caesarian sections. Health indicators from Uganda and Pakistan are analysed to develop recommendations for the integration of primary and specialised medical care in the treatment of NMCH issues. INSETS: Panel 1: Effect of primary health-care interventions on...;Panel 2: Effect of primary health-care interventions on....

This article discusses efforts to integrate primary medical care for mothers and children in the public health systems of developing countries and impoverished regions. Research indicating the importance of combining capacity building efforts with the development of community based health interventions to ensure the effectiveness of care is addressed. The long term health effects and financial benefits of integrating medical care for the women and infant children is framed in terms of the need for intergovernmental cooperation and sensitivity to the needs of health care providers and local communities. The conflict between donor desire for statistically measurable results and the inherently long term nature of building health infrastructure and intergovernmental relationships is noted. INSETS: Key messages;Panel 1: Barriers to effective implementation of integrated...;Panel 3: Strengthening health systems in poor settings;Panel 4: Integration of maternal, newborn, and child health...

This article discusses research into health outcomes in countries that have focussed on primary care since the 1978 Alma-Ata, Kazakhstan conference established universal health care as an international goal. The countries assessed have made the most dramatic changes in their child mortality rates since 1978. These countries are then analysed in terms of the relationship between their health outcomes and their per capita gross national income. Successful countries improved their life expectancy statistics faster than their GNI grew. Issues of governance, violence and political stability are cited as explanations for the different performances of different countries. INSETS: Panel 1: Thailand's progress in primary health care and...;Panel 2: Composite lessons learned from countries that are....

This article discusses the role of community participation in medical care for mothers and their newborn children. The role of community participation in public health administration is framed as a goal established by the 1978 Alma-Ata, Kazakhstan Declaration on primary care in public health. Controversy regarding the relative importance of targeted interventions and community based health services in international aid to medical care is described. Community based efforts to develop public health interventions are framed in terms of their small scale compared to commodity based approaches that provide products such as mosquito netting and oral rehydration formula to treat diarrhoea. INSETS: Panel 1: Projects in rural India and Kenya which influenced...;Panel 2: Building community empowerment;Panel 3: Case study of how women's groups are addressing first....

This article discusses public health interventions designed to cope with the chronic disease burdens faced by developing countries and impoverished regions. The ageing of populations in these countries and the proliferation of chronic diseases such as AIDS are assessed as challenges facing public health administration. efforts to improve health risk assessment, diagnostic, and early intervention strategies for the treatment of chronic illness are described. The authors encourage the integration of this treatment method within existing primary medical care systems directed toward high risk populations. INSETS: Key messages;Panel 1: Chronic diseases and global mental health;Panel 2: Scaling-up of HIV treatment;Panel 3: Mexico's Veracruz initiative for diabetes awareness...

This article assesses the implementation of health care reforms proposed by the Alma-Ata, Kazakhstan Declaration on health services accessibility in 1978. These principles included equal access to treatment, social justice, and health care for all. Changes in the provision of primary care are analysed in terms of the changing contexts in which public health services are administered. Issues arising from the development of integrated health systems and an increasing focus on evidence-based approaches to medicine are considered. The increasing importance of community participation in medical care is noted. The importance of increased access to medical technology in the developing world is encouraged. INSETS: Panel 1: Declaration of Alma-Ata International Conference on...;Panel 3: Summary of the main programmes and tasks within the....

Background: In southern Africa, a substantial health transition is underway, with the heavy burden of chronic infectious illness (HIV/AIDS and tuberculosis) paralleled by the growing threat of non-communicable diseases. We investigated the extent and nature of this health transition and considered the implications for primary health care.Methods: Health and sociodemographic surveillance started in the Agincourt subdistrict, rural South Africa, in 1992. In a population of 70 000, deaths (n=6153) were rigorously monitored with a validated verbal autopsy instrument to establish probable cause. We used age-standardised analyses to investigate the dynamics of the mortality transition by comparing the period 2002-05 with 1992-94.Findings: Mortality from chronic non-communicable disease ranked highest in adults aged 50 years and older in 1992-94 (41% of deaths [123/298]), whereas acute diarrhoea and malnutrition accounted for 37% of deaths (59/158) in children younger than 5 years. Since then, all-cause mortality increased substantially (risk ratio 1.87 [95% CI 1.73-2.03]; p<0.0001) because of a six-fold rise in deaths from infectious disease affecting most age and sex groups (5.98 [4.85-7.38]; p<0.0001), and a modest increase in deaths from non-communicable disease (1.15 [0.99-1.33]; p=0.066). The change in female risk of death from HIV and tuberculosis (15.06 [8.88-27.76]; p<0.0001) was almost double that of the change in male risk (8.13 [5.55-12.36]; p<0.0001). The burden of disorders requiring chronic care increased disproportionately compared with that requiring acute care (2.63 [2.30-3.01]; p<0.0001 vs 1.31 [1.12-1.55]; p=0.0003).Interpretation: Mortality from non-communicable disease remains prominent despite the sustained increase in deaths from chronic infectious disease. The implications for primary health-care systems are substantial, with integrated chronic care based on scaled-up delivery of antiretroviral therapy needed to address this expanding burden. INSET: Panel: Management of chronic non-communicable disease in Agincour. [ABSTRACT FROM AUTHOR]

Background: The treatment of perinatal depression is a public-health priority because of its high prevalence and association with disability and poor infant development. We integrated a cognitive behaviour therapy-based intervention into the routine work of community-based primary health workers in rural Pakistan and assessed the effect of this intervention on maternal depression and infant outcomes.Methods: We randomly assigned 40 Union Council clusters in rural Rawalpindi, Pakistan, in equal numbers to intervention or control. Married women (aged 16-45 years) in their third trimester of pregnancy with perinatal depression were eligible to participate. In the intervention group, primary health workers were trained to deliver the psychological intervention, whereas in the control group untrained health workers made an equal number of visits to the depressed mothers. The primary outcomes were infant weight and height at 6 months and 12 months, and secondary outcome was maternal depression. The interviewers were unaware of what group the participants were assigned to. Analysis was by intention to treat. The study is registered as ISRCTN65316374.Findings: The number of clusters per group was 20, with 463 mothers in the intervention group and 440 in the control group. At 6 months, 97 (23%) of 418 and 211 (53%) of 400 mothers in the intervention and control groups, respectively, met the criteria for major depression (adjusted odds ratio (OR) 0.22, 95% CI 0.14 to 0.36, p<0.0001). These effects were sustained at 12 months (111/412 [27%] vs 226/386 [59%], adjusted OR 0.23, 95% CI 0.15 to 0.36, p<0.0001). The differences in weight-for-age and height-for-age Z scores for infants in the two groups were not significant at 6 months (-0.83 vs -0.86, p=0.7 and -2.03 vs -2.16, p=0.3, respectively) or 12 months (-0.64 vs -0.8, p=0.3 and -1.10 vs -1.36, p=0.07, respectively).Interpretation: This psychological intervention delivered by community-based primary health workers has the potential to be integrated into health systems in resource-poor settings. [ABSTRACT FROM AUTHOR]

This article discusses research into the role of health care training in the prevention of child mortality in developing countries. The levels of health care provided by personnel trained in Integrated management is childhood illness (IMCI) are assessed in terms of the amount of training that they possess. Personnel from Bangladesh, Tanzania, Uganda, and Brazil are compared. The use of IMCI interventions is judged to be equal regardless of the level of training possessed by practitioners implementing the protocol. The possibility that this could allow for reductions in training requirements for health care providers in underserved areas is explored.

This article presents a systematic review of research into the administration and financing of public health interventions in developing countries and impoverished regions. The development of financing programs for primary care systems is assessed in terms of the implementation of user fees and the use of financial incentives to encourage health outcomes. The importance of task shifting, and emphasis on the devolution of primary care from professional doctors and nurses onto allied health personnel is emphasised. The importance of small scale interventions in the development of public health resources for the administration INSETS: Key messages;Panel 1: Taxonomy of governance, financial, and delivery...;Panel 2: Assessing the applicability to low-income and...;Panel 3: Key messages from systematic reviews of implementation..

This article discusses research into the efficacy of the World Health Organisation guidelines on the integrated management of childhood illness (IMCI) in the treatment of pediatric pneumonia in Bangladesh. Low levels of Patient compliance with hospitalisation orders in cases of childhood pneumonia are noted, leading researchers to recommend a shift to treatment in first-level care facilities. This research was conducted in Matlab, a rural section of Bangladesh. The modification of IMCI guidelines in this region is presented as an example of the potential benefits of adapting treatments to cross cultural and financial barriers.

This article discusses efforts to reduce the incidence of child mortality by two-thirds by 2015 under the auspices of the United Nations Millennium Project. The significance of improved maternal health care and obstetrics in achieving this goal is noted. The promising results presented by a study, published elsewhere in this issue, of the efficacy of community-based newborn care programs in rural India are noted. The administrative limitations of overstretched and undercompensated community health care workers in developing countries is noted. Challenges faced by people interested in adapting this process for application in urban areas and in Africa are noted.

The authors comment on the emergence of non-communicable diseases (NCDs) as the leading cause of death and disability in low-income and middle-income countries. Topics cited include limited efforts in international aid response with regard to NCDs, the important conclusions indicated in the report entitled "The Emerging Global Health Crisis: Noncommunicable Disease in Low- and Middle-income Countries" released on December 5, 2014, and the international efforts for addressing NCDs.

This article discusses the need to develop and provide access to diagnostic technologies that enable the development of primary care in developing countries. The difficulties of adapting technology developments to meet the funding priorities of organizations such as the United Nations Millennium Development Goals. The problem of organizations that prioritise technology development over the adaptation of existing technologies for under served communities is also described. The authors encourage support for the local development of medical technologies in developing regions of Africa so that they can be marketed competitively. The potential for technology transfer to improve medical care in Africa is assessed.

This article reviews the public health goals and interventions developed following the Alma-Ata, Kazakhstan declaration on primary health care in 1978. The difficulties faced by public health administrators in developing health care infrastructure in line with this declaration are addressed. The challenges posed by changing economic circumstances and chronic diseases such as AIDS and tuberculosis to the development of primary health care programs are presented. The 2008 World Health Organisation report on primary health care is presented as a guiding document for continuing efforts to implement the Alma-Ata goals.

This article discusses the political tensions that limit the treatment of multidrug resistant tuberculosis. The risks posed by violence among patients receiving treatment for the disease to medical practitioners is assessed, and investments in physical restraints to enforce isolation are considered. The persistence of the public health risk posed by tuberculosis because of limitations in the diagnostic capabilities and treatment facilities for the disease is outlined. The alternative practice of community centered treatment for tuberculosis, which is practiced in Kenya, is described.

This article discusses the safety issues surrounding bacille Calmette-Guérin (BCG) vaccination in asymptomatic patients with the HIV virus. This vaccination, which prevents a vascular infection similar to tuberculosis, is no longer recommended by the World Health Organization for HIV positive newborns because of their susceptibility to BCG disease. In order to administer BCG vaccines properly in countries where the burden of tuberculosis and HIV is elevated, the improvement of HIV diagnostic capabilities is recommended.

This article discusses research by Enayet Chowdhury, presented elsewhere in this article, into the treatment of childhood pneumonia in the developing world. The development of health interventions that can improve health services accessibility for children with pneumonia is explored. The study focused on implementation research and the use of this data to improve the World Health Organisation Integrated Management of Childhood Illness (IMCI) guidelines. In developing countries such as Bangladesh compliance with hospitalisation recommendations is low, so Chowdhury recommends developing treatment strategies that rely on local health care providers.

This article discusses public health issues facing southern Sudan in the context of political instability that has persisted in that region since the civil war ended in 2006. Statistics relating to maternal mortality and death from preventable diseases such as tuberculosis and diarrhoea are noted. Limitations to the deployment of health care personnel because of the shortage of facilities and a lack of public safety are described. The South Sudan Internal Affairs Minister Paul Mayon and the police spokesman Machar Akau both comment on the security situation. Challenges faced by immunisation programs are presented.

This editorial discusses the Toyako Framework for Action on Global Health developed for the leaders of the Group of Eight (G8) nations by the G8 Health Experts Group. The focus of this framework on the development of programs to combat infectious diseases is discussed. The authors present reservations regarding the recruitment of doctors from developing countries by the G8 nations and the lack of concrete plans regarding sanitation infrastructure.

The author reflects on the health hazards posed by electronic waste (e-waste) recycling in developing countries. He cites as example the town of Agbogbloshie near Accra, Ghana, where discarded electronic equipment like computers and mobile phones are processed to extract valuable components like copper and gold. He claims that e-waste recycling is also practiced as a trade in countries like India, China and Malaysia.

This editorial discusses a report by the United Nations Office on Drugs and Crime on the increasing popularity of amfetamines, metamfetamines, and ecstasy in developing countries. The increased prominence of metamfetamine use in developing countries is framed in terms of the health risks associated with the drugs including psychosis, and complications relating to adulterated versions of the substance. Harm reduction strategies are recommended for dealing with these narcotics.

This editorial discusses the priorities laid out by the United Nations World Health Organisation report on Social Determinants of health. The journal notes its support of the project and also ties its success to the implementation of the Millennium Development Goals. The relationship between improvements in medical care and economic improvements to the everyday life of people in the developing world is explored.

This article discusses the UNICEF publication "Sustainable Elimination of Iodine Deficiency." This publication charted the progress of the international community in treating iodine deficiency since the World Summit for Children in 1990. The iodisation of salt in the developing world in order to mitigate this deficienct is described.

The article presents information on the efforts of the GAVI Alliance to provide vaccination programs in underdeveloped countries around the world. The organization's efforts are said to have prevented millions of cases of infant mortality. GAVI's ongoing strategy, announced in June of 2008, includes plans to provide vaccines against non-childhood diseases as well, such as rabies, typhoid and cervical cancer.

The author discusses plans to publish a theme issue of "The Lancet" on November 8, 2008 focusing on the social determinants of health. The issue will be produced in tandem with the "Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health" conference to be held on November 6-7, 2008. A report by the Save the Children organization titled "The Road Less Travelled: Barriers to Poor Children's Healthcare Utilisation in Developing and Transitional Countries," is discussed.