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Current approaches to the development of water services such as water supply, sanitation, and hygiene in the Global South are driven by the aim to secure people's rights to access such services. In this literature-based paper, we illustrate how such an interpretation of access limits the ability of development efforts in the sector to (i) address power inequities mediating access to water services, and; (ii) acknowledge and strengthen wellbeing factors implicated with water services beyond basic health. We argue that maintaining the current interpretation of access limits the ability of development initiatives in the water sector to address pressing issues mediating people's ability to benefit from water services. To address these limitations, we propose a reinterpretation of the goal of securing access in international development frameworks grounded in Ribot and Peluso's (2003) theory of access and Amartya Sen’s (1999, 2008, 2013) Capability Approach to human development. Such a reinterpretation strengthens the capacity of global efforts to improve water services to not only foster good health, but also address inequity and other dimensions of human wellbeing such as livelihoods and education. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective To summarize information on Neurogenic Bladder (NB) epidemiology, management and access to patient treatment in developing countries and emerging regions of the world in order to propose future interventions and help governmental as well as non-governmental organizations design their action plans. Methods Different search methods were used to gather the maximum available data. They included strategic searches; reference checks; grey literature searches (reports, working papers, government documents, civil society information); contacting professional societies, registries, and authors; requesting unpublished data from organizations; and browsing related websites and journals. Results The incidence and prevalence rates of NB in developing countries are difficult to establish because epidemiological reports are few and far between. The frequency of bladder dysfunction in neurologically impaired populations can be approximately estimated in some of these countries. Similar information paucity affects diagnostic and therapeutic approaches to NB patients living in less-developed regions of the world. The assessment and management of NB seems to vary markedly between countries, and care of patients from emerging regions of the world is often inadequate. Conclusion Strong concerted efforts are needed on the part of international scientific societies, non-governmental organizations and local governments to work together to change the prognosis for these patients and to improve their quality of life. [ABSTRACT FROM AUTHOR]

Poor infrastructure in developing countries, combined with challenging geographical characteristics, is associated with problems of limited access to resources, poor transportation and environmental health issues. In some developing countries, there are no heating systems during the winter season, which causes problems for both people and livestock. The most common heating source is from open fires using biomass from animal and plant residue, which are also used for cooking. Fireplaces are typically located inside the house, which can lead to respiratory health problems because of limited ventilation. Thus, heating systems with proper ventilation are desirable to mitigate health problems and improve living conditions. Here we describe the application of ‘Ondol’, a traditional Korean heating system that was redesigned for improved efficiency, in remote villages in a mountainous region of Nepal. Total 10 models of Ondol were designed and fabricated, and the temperature profile and uniformity were characterized to select the optimal design. The height and type of the ‘Gorae’ were the most important factors in determining the efficiency. The optimal design was provided to local people, who were trained to replicate and build the Ondol on their own. A post-installation survey was carried out to evaluate the effectiveness of the system. [ABSTRACT FROM AUTHOR]

Background: Developing countries have an estimate of ten times more approved biosimilars than developed countries. This disparity demands the need of an objective regulation that incorporates health policies according to the technological and economical capabilities of each country. One of the challenges lies on the establishment of comparability principles based on a physicochemical and biological characterization that should determine the extent of additional non-clinical and clinical studies. This is particularly relevant for licensed biosimilars in developing countries, which have an extensive clinical experience since their approval as generics, in some cases more than a decade. To exemplify the current status of biosimilars in Mexico, a characterization exercise was conducted on licensed filgrastim biosimilars using pharmacopeial and extended characterization methodologies. Results: Most of the evaluated products complied with the pharmacopeial criteria and showed comparability in their Critical Quality Attributes (CQAs) towards the reference product. These results were expected in accordance with their equivalent performance during their licensing as generics. Accordingly, a rational approval and registration renewal scheme for biosimilars is proposed, that considers the proper identification of CQAs and its thoroughly evaluation using selected techniques. Conclusions: This approach provides support to diminish uncertainty of exhibiting different pharmacological profiles and narrows or even avoids the necessity of comparative clinical studies. Ultimately, this proposal is intended to improve the accessibility to high quality biosimilars in Latin America and other developing countries. [ABSTRACT FROM AUTHOR]

Background: Cluster randomised trials (CRTs) are a key instrument to evaluate public health interventions, particularly in low- and middle-income countries (LMICs). Fidelity assessment examines study processes to gauge whether an intervention was delivered as initially planned. Evaluation of implementation fidelity (IF) is required to establish whether the measured effects of a trial are due to the intervention itself and may be particularly important for CRTs of complex interventions. Current CRT reporting guidelines offer no guidance on IF assessment. We will systematically review the scientific literature to study current practices concerning the assessment of IF in CRTs of public health interventions in LMICs. Methods: We will include CRTs of public health interventions in LMICs that planned or assessed IF in either the trial protocol or the main trial report (or an associated document). Search strategies use Medical Subject Headings (MESH) and text words related to CRTs, developing countries, and public health interventions. The electronic database search was developed first for MEDLINE and adapted for the following databases: EMBASE, CINAHL, PubMed, and EMB Reviews, to identify CRT reports in English, Spanish, or French published on or after January 1, 2012. To ensure availability of a study protocol, we will include CRTs reporting a registration number in the abstract. For each included study, we will compare planned versus reported assessment of IF, and consider the dimensions of IF studied, and data collection methods used to evaluate each dimension. Data will be synthesised using quantitative and narrative techniques. Risk of bias for individual studies will be assessed using the Cochrane Collaboration Risk of Bias Tool criteria and additional criteria related to CRT methods. We will investigate possible sources of heterogeneity by performing subgroup analysis. This review was not eligible for inclusion in the PROSPERO registry. Discussion: Fidelity assessment may be a key tool for making studies more reliable, internally valid, and externally generalizable. This review will provide a portrait of current practices related to the assessment of intervention fidelity in CRTs and offer suggestions for improvement. Results will be relevant to researchers, those who finance health interventions, and for decision-makers who seek the best evidence on public health interventions. [ABSTRACT FROM AUTHOR]

We analyzed an attempt to develop and clinically test a pneumococcal conjugate vaccine for the developing world, undertaken by public health institutions from the Netherlands, Sweden, Denmark, Norway and Finland: the Dutch Nordic Consortium (DNC), between 1990 and 2000. Our review shows that the premature termination of the project was due less to technological and scientific challenges and more to managerial challenges and institutional policies. Various impeding events, financial and managerial challenges gradually soured the initially enthusiastic collaborative spirit until near the end the consortium struggled to complete the minimum objectives of the project. By the end of 1998, a tetravalent prototype vaccine had been made that proved safe and immunogenic in Phase 1 trials in adults and toddlers in Finland. The planned next step, to test the vaccine in Asia in infants, did not meet approval by the local authorities in Vietnam nor later in the Philippines and the project eventually stopped.The Dutch DNC member, the National Institute of Public Health and the Environment (RIVM) learned important lessons, which subsequently were applied in a following vaccine technology transfer project, resulting in the availability at affordable prices for the developing world of a conjugate vaccine against Haemophilus influenzae type b. We conclude that vaccine development in the public domain with technology transfer as its ultimate aim requires major front-end funding, committed leadership at the highest institutional level sustained for many years and a competent recipient-manufacturer, which needs to be involved at a very early stage of the development.At the national level, RIVM's policy to consolidate its national manufacturing task through securing a key global health position in support of a network of public vaccine manufacturers proved insufficiently supported by the relevant ministries of the Dutch government. Difficulties to keep up with high costs, high-risk innovative vaccine development and production in a public sector setting led to the gradual loss of production tasks and to the 2009 Government decision to privatize the vaccine production tasks of the Institute. [ABSTRACT FROM AUTHOR]

Two rotavirus vaccines have been licensed in >100 countries worldwide since 2006. As of October 2105, these vaccines have been implemented in the national immunization programs of 79 countries, including 36 low-income countries that are eligible for support for vaccine purchase from Gavi, the Vaccine Alliance. Rotavirus vaccines were initially introduced in Australia and countries of the Americas and Europe after completion of successful clinical trials in these regions, and the impact of routine vaccination in reducing the health burden of severe childhood gastroenteritis in these regions has been well documented. Because of concerns around the performance of orally administered rotavirus vaccines in developing countries, vaccine implementation in these settings only began after additional clinical trials were completed and the World Health Organization issued a global recommendation for use of rotavirus vaccines in 2009. This supplementary issue of Clinical Infectious Diseases includes a collection of articles describing the impact and effectiveness of routine rotavirus vaccination in developing countries that were among the early adopters of rotavirus vaccine. The data highlight the benefits of vaccination and should provide valuable evidence to sustain vaccine use in these countries and encourage other countries to adopt routine rotavirus vaccination to reduce the health burden of severe childhood gastroenteritis. [ABSTRACT FROM AUTHOR]

The number of people with diabetic retinopathy (DR) has increased with the increasing prevalence of diabetes mellitus worldwide, especially in developing countries. In recent years, the successful implementation of public health programs in developed countries has been thought to contribute to decreases in blindness from DR. Developing countries, however, have not seen the same improvements, and their public health interventions still face significant challenges. In this review we describe the current state of public health approaches including risk factor control, screening and treatment techniques for DR in developing countries, and suggest recommendations. While the awareness of DR is variable, specific knowledge about DR is low, such that many patients have already experienced vision loss by the time they are screened. Attempts to improve rates of screening, in particular through non-mydriatic cameras and tele-screening, are ongoing and promising, although challenges include collaboration with healthcare systems and technology failures. Laser treatment is the most readily available, with anti-VEGF therapy and vitreo-retinal surgery increasingly sought after and provided. Recommendations include the use of 'targeted mydriasis' for fundus imaging to address high rates of ungradable images, increased communication with diabetes management services to improve patient retention and mobilization of access to DR treatments. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Summary Tuberculosis remains a persistent global health problem and key threat to development in poor countries. While many nations pursue privatization of healthcare, some accounts suggest that private health services are inadequate in addressing the TB burden. We utilize panel regression to empirically investigate data from 99 less-developed nations from 1995 to 2010. The results illustrate private health expenditures do not significantly impact TB rates, while public health expenditures reduce TB rates in developing nations over time. Thus, we caution against international development strategies which promote cuts in public spending and encourage privatization of healthcare as a means to stimulate growth or efficiency. [ABSTRACT FROM AUTHOR]

Background: Many health service delivery models are adapting health services to meet rising demand and evolving health burdens in low- and middle-income countries. While innovative private sector models provide potential benefits to health care delivery, the evidence base on the characteristics and impact of such approaches is limited. We have developed a performance measurement framework that provides credible (relevant aspects of performance), feasible (available data), and comparable (across different organizations) metrics that can be obtained for private health services organizations that operate in resource-constrained settings.Methods: We synthesized existing frameworks to define credible measures. We then examined a purposive sample of 80 health organizations from the Center for Health Market Innovations (CHMI) database (healthmarketinnovations.org) to identify what the organizations reported about their programs (to determine feasibility of measurement) and what elements could be compared across the sample.Results: The resulting measurement framework includes fourteen subgroups within three categories of health status, health access, and operations/delivery.Conclusions: The emphasis on credible, feasible, and comparable measures in the framework can assist funders, program managers, and researchers to support, manage, and evaluate the most promising strategies to improve access to effective health services. Although some of the criteria that the literature views as important - particularly population coverage, pro-poor targeting, and health outcomes - are less frequently reported, the overall comparison provides useful insights. [ABSTRACT FROM AUTHOR]

The article reports on the progress made by developing countries such as the Philippines, India, and Turkey in raising incomes, improving health, and reducing poverty. Topics include dimensions of development progress in these countries including poverty, health, education, and war, and major factors that contributed to this change including global political and economic conditions for development, and globalization and the spread of technologies.

Celiac disease (CD) is an autoimmune disorder, which affects genetically predisposed individuals upon the ingestion of gluten. So, it is the result of both environmental (gluten) and genetic factors (carriers of HLA-DQ2 and DQ8 haplotypes). A duodenal biopsy with positive serology is the gold standard for the diagnosis of CD. Celiac disease world geographical distribution seems to have followed the spread of wheat consumption in addition to the migratory flows of mankind. Following the application of simple serological tests for the diagnosis of CD in the 1980s, it gradually became clear that the prevalence of CD in different countries in the Middle East, North Africa and India is almost the same as that in Western countries. A high index of suspicion for CD should be maintained in all developing countries for patients who present with chronic diarrhea or iron deficiency anemia. The prevalence of CD varies with sex, age, and geographic location. The global prevalence of CD has increased over time from 0.6% in 1991 to 2000 to 0.8% between 2001 and 2016. According to that, there is a need for population-based prevalence studies in many developing countries especially middle east to estimate the burden of CD properly. [ABSTRACT FROM AUTHOR]

Scholarship focusing on how international research can contribute to justice in global health has primarily explored requirements for the conduct of clinical trials. Yet health systems research in low- and middle-income countries (LMICs) has increasingly been identified as vital to the reduction of health disparities between and within countries. This paper expands an existing ethical framework based on the health capability paradigm - research for health justice - to externally-funded health systems research in LMICs. It argues that a specific form of health systems research in LMICs is required if the enterprise is to advance global health equity. 'Research for health justice' requirements for priority setting, research capacity strengthening, and post-study benefits in health systems research are derived in light of the field's distinctive characteristics. Specific obligations are established for external research actors, including governments, funders, sponsors, and investigators. How these framework requirements differ from those for international clinical research is discussed. [ABSTRACT FROM AUTHOR]

The effect of human activities on water resources has expanded dramatically during the past few decades, leading to the spread of waterborne microbial pathogens. The total global health impact of human infectious diseases associated with pathogenic microorganisms from land-based wastewater pollution was estimated to be approximately three million disability-adjusted life years (DALY), with an estimated economic loss of nearly 12 billion US dollars per year. Although clean water is essential for healthy living, it is not equally granted to all humans. Indeed, people who live in developing countries are challenged every day by an inadequate supply of clean water. Polluted water can lead to health crises that in turn spread waterborne pathogens. Taking measures to assess the water quality can prevent these potential risks. Thus, a pressing need has emerged in developing countries for comprehensive and accurate assessments of water quality. This review presents current and emerging advanced techniques for assessing water quality that can be adopted by authorities in developing countries. [ABSTRACT FROM AUTHOR]

Leishmaniasis is a neglected public health problem caused by the protozoan species belonging to the genus Leishmania affecting mostly the poor populations of developing countries. The causative organism is transmitted by female sandflies. Cutaneous, mucocutaneous, and visceral clinical manifestations are the most frequent forms of leishmaniasis. Chemotherapy still relies on the use of pentavalent antimonials, amphotericin B, paromomycin, miltefosin and liposomal amphotericin B. However, the application of these drugs is limited due to low efficacy, life-threatening side effects, high toxicity, induction of parasite resistance, length of treatment and high cost. Given the fact that antileishmanial vaccines may not become available in the near future, the search for better drugs should be continued. Natural products may offer an unlimited source of chemical diversity to identify new drug modules. New medicines should be less toxic or non-toxic, safe, more efficient, less expensive and readily available antileishmanial agents, especially for low-income populations. In the present review, special focus is on medicinal plants used against leishmanaiasis. The bioactive phytocompounds present in the plant derivatives including the crude extracts, essential oils, and other useful compounds can be a good source for discovering and producing new antileishmanial medicines. [ABSTRACT FROM AUTHOR]

In recent years, non-communicable diseases (NCDs) have globally shown increasing impact on health status in populations with disproportionately higher rates in developing countries. NCDs are the leading cause of mortality worldwide with and a serious public health threat to developing countries. Recognizing the importance and urgency of the issue, a one-day symposium was organized on NCDs in Developing Countries by the CIHLMU Center for International Health, Ludwig-Maximilians-Universität, Munich on 22nd March 2014. The objective of the symposium was to understand the current situation of different NCD public health programs and the current trends in NCD research and policy, promote exchange of ideas, encourage scientific debate and foster networking, partnerships and opportunities among experts from different clinical, research, and policy fields. The symposium was attended by more than seventy participants representing scientists, physicians, academics and students from several institutes in Germany and abroad. Seven key note presentations were made at the symposium by experts from Germany, UK, France, Bangladesh and Vietnam. This paper highlights the presentations and discussions during the symposium on different aspects of NCDs in developing countries. The symposium elucidated the dynamics of NCDs in developing countries and invited the participants to learn about evidence-based practices and policies for prevention and management of major NCDs and to debate the way forward. [ABSTRACT FROM AUTHOR]

The relationship between the public health status and income inequality has been taken into consideration in the last two decades. One of the important questions in this regard is that whether the changes in income inequality will lead to changes in health indicators or not. To answer this question, life expectancy is used as a health indicator and the Gini coefficient is used as an income inequality indicator. In this study, the relationship between income inequality and the public health has been investigated by panel data in Eviews software during 2000-2011 in 65 low-and middle-income countries. By using panel data and considering fixed effects and heterogeneity of sections, the relationship between income inequality and public health status is a significant negative relationship. [ABSTRACT FROM AUTHOR]

Modern society has no shortage of human nutrition science, nor interventions designed to improve the way we eat. Yet nutrition science, and the models, approaches and interventions derived from this, is apparently delivering diminishing returns in terms of population weight gain, unhealthy eating patterns and the obesity ‘epidemic’. We draw on a range of literature(s) to argue that public health nutritionists in affluent societies face an ingenuity gap – a series of complex and inter-connected challenges which are neither fully recognised nor easily amenable to resolution through conventional thinking and practice. Four such challenges are: nutritionism; economism; consumerism and individualism. We use an integrative framework to explain their significance for public health nutrition, where they exert a combined and compounding influence. In addition to these problems, insights from other disciplines show that ‘modern’ society and some of its key characteristics are linked to increasing environmental threats. The latter undermine food security and the sustainability of society itself, and possess global impact. For public health nutrition to be situated in and responsive to this broader context, the discipline will need a better understanding of the relationship between modern society, food choice and environmental sustainability. As ‘healthy eating’ may not be an achievable goal within the present social, economic and cultural system, public health nutrition has a unique and vital role to play in shaping change for the future. [ABSTRACT FROM PUBLISHER]

Atrial fibrillation (AF) is the most common arrhythmia and is a major cardiovascular challenge due to its close association with increased morbidity and mortality. Although the incidence and prevalence of AF is slightly lower in developing countries than in developed countries, the AF-associated risk of stroke is similar. Treatment of AF is far from satisfactory in developing countries, which may be due to limited health-care resources and social and racial characteristics that differ from Western populations. Chronic rate control is still the main treatment strategy of persistent AF because anti-arrhythmic drugs have only a modest long-term effect on maintenance of sinus rhythm, and no superior impact in terms of cardiovascular outcomes. With the development of ablation techniques and strategies, more AF patients received catheter ablation, although the benefit, complications, and high recurrence rate associated with AF ablation remain under investigation. Improvement in antithrombotic therapy of AF has been observed, although still fewer patients receive oral anticoagulants in developing countries than in Western countries. Novel treatment for the prevention of thromboembolism, such as new oral anticoagulants with different mechanisms of action or the percutaneous transcatheter closure of the left atrial appendage, has recently been introduced in developing countries as an alternative option for the prevention of AF-associated strokes. More data are needed regarding upstream therapy. [ABSTRACT FROM AUTHOR]

Qualitative research methodology enables researchers to explore social and behavioural issues related to public health that are not achievable with quantitative methods. Several complex public health issues can be better understood by exploration using qualitative methodologies. However, these methodologies are underutilized in public health research particularly in developing countries. This paper aims to introduce qualitative research to students and researchers in public health in developing countries and to encourage its use in research by presenting an overview of how to undertake a qualitative research study. Key aspects of this methodology include choosing and working within a theoretical framework, recruitment of participants, following the right process of data analysis, and presentation of findings for publication. [ABSTRACT FROM AUTHOR]

There has been rapid progress in the understanding of the pathophysiology of the hemolytic uremic syndrome (HUS) disease spectrum; thus, complex diagnostic and therapeutic requirements have emerged in parallel. Current recommendations for diagnosis and therapy were rapidly adapted from the prior skilled scientific groundwork. However, such recommendations can be realized only when highly specialized laboratories and sufficient financial resources are available. Thus, many recommendations are not feasible for patients living and working in developing countries. More than one-third of the world's population has no access to essential drugs and more than half of this group lives in the poorest regions of Africa and Asia. From this perspective, distinct initial diagnostic and therapeutic recommendations, as well as international cooperations are needed to complete proper diagnostic work-ups in a stringent and cost-efficient manner and to enable patients to be adequately treated with available resources. However, while costs for complement-targeted drugs remain tremendously high, state-of-the-art treatment options remain unavailable for the vast majority of patients in developing areas. [ABSTRACT FROM AUTHOR]

The relative income–health hypothesis postulates that income distribution is an important determinant of population health, but the age and sex patterns of this association are not well known. We tested the relative income–health hypothesis using panel data collected for 21 developed countries over 30 years. Net of trends in gross domestic product per head and unobserved period and country factors, income inequality measured by the Gini index is positively associated with the mortality of males and females at ages 1–14 and 15–49, and with the mortality of females at ages 65–89 albeit less strongly than for the younger age groups. These findings suggest that policies to decrease income inequality may improve health, especially that of children and young-to-middle-aged men and women. The mechanisms behind the income inequality–mortality association remain unknown and should be the focus of future research. [ABSTRACT FROM PUBLISHER]

There is no substantial difference in conducting research that is both ethical and responsive to the health needs in developing and developed nations. Differences are in financial constraints, technological expertise in identification and addressing needs, and in the perception of equal partnership of all stakeholders. There will be differences in emphasis of research but this is slowly blurred due to globalisation. Public health emergencies in developing countries need timely and effective global collaborative research to implement control strategies. Research needs should be based on predictive models with learning from past emergencies, technological advances, strategic critical appraisal of local and global health information, and dialogue with all stakeholders. Adequate funding will be challenging and resources from national, international and aid foundations will be needed. Issues associated with such funding include deployment of international rapid response teams, collaborating researchers, transfer of technology, and intellectual property ownership. While all types of research ranging from basic, applied, clinical studies, meta-analysis, and translational research are relevant, the relative importance and specific allocation of resources to these may differ. Is the choice related to responsiveness or based on researchers' perception of their contributions to evidence-based practice and research? Ethical issues relating to vulnerable groups, risk distribution, quality issues, research integrity and oversight are just as important. Internationally funded research including clinical trials must be sensitive to such issues to avoid allegations of exploitation. Thus the potential of utilisation and buy-in of research findings and recommendations must be considered. [ABSTRACT FROM AUTHOR]

Background: There is increasing interest in provision of essential surgical care as part of public health policy in low- and middle-income countries (LMIC). Relatively simple interventions have been shown to prevent death and disability. We reviewed the published literature to examine the cost-effectiveness of simple surgical interventions which could be made available at any district hospital, and compared these to standard public health interventions. Methods: PubMed and EMBASE were searched using single and combinations of the search terms 'disability adjusted life year' (DALY), 'quality adjusted life year,' 'cost-effectiveness,' and 'surgery.' Articles were included if they detailed the cost-effectiveness of a surgical intervention of relevance to a LMIC, which could be made available at any district hospital. Suitable articles with both cost and effectiveness data were identified and, where possible, data were extrapolated to enable comparison across studies. Results: Twenty-seven articles met our inclusion criteria, representing 64 LMIC over 16 years of study. Interventions that were found to be cost-effective included cataract surgery (cost/DALY averted range US$5.06-$106.00), elective inguinal hernia repair (cost/DALY averted range US$12.88-$78.18), male circumcision (cost/DALY averted range US$7.38-$319.29), emergency cesarean section (cost/DALY averted range US$18-$3,462.00), and cleft lip and palate repair (cost/DALY averted range US$15.44-$96.04). A small district hospital with basic surgical services was also found to be highly cost-effective (cost/DALY averted 1 US$0.93), as were larger hospitals offering emergency and trauma surgery (cost/DALY averted US$32.78-$223.00). This compares favorably with other standard public health interventions, such as oral rehydration therapy (US$1,062.00), vitamin A supplementation (US$6.00-$12.00), breast feeding promotion (US$930.00), and highly active anti-retroviral therapy for HIV (US$922.00). Conclusions: Simple surgical interventions that are life-saving and disability-preventing should be considered as part of public health policy in LMIC. We recommend an investment in surgical care and its integration with other public health measures at the district hospital level, rather than investment in single disease strategies. [ABSTRACT FROM AUTHOR]

The World Bank is an important external funder of health aid to developing countries. However, many accounts of health sector change and reform do not account for the role that international financial institutions may play in these policy changes. In this paper, I review the World Bank's health policies since 1975, discussing its changing role and policies for developing countries' health policies. I then summarize the existing empirical evidence for the effect of the World Bank in developing countries' health sectors, focusing on Latin American countries. [ABSTRACT FROM AUTHOR]

Studies on developed countries demonstrate that an increase in women legislators leads to a prioritization in health, an increase in social policy spending, and a decrease in poverty. Women representatives could therefore improve development trajectories in developing countries; yet, currently, no cross-national and longitudinal studies explore this possibility. Using random effects panel regression, we examine the influence of women's representation on child health (one development indicator) across 102 developing countries from 1980 to 2005. Compared to countries with no women in parliament, countries meeting a 20-percent threshold experience increased rates of measles immunizations (10 percentage points), DPT immunizations (12 percentage points), infant survival (0.7 percentage points) and child survival (1 percentage point). Incremental increases in women's representation show that child health improves most in socially and economically disadvantaged countries, and in countries less integrated in the world polity. Our findings reveal the importance of increased women's representation, particularly in less developed and less globally embedded countries. [ABSTRACT FROM PUBLISHER]

The article explores the cross-cultural and international inequalities in life expectancy rates, noting the increasing divide between life expectancy in wealthy nations and those of people in developing countries. It addresses the impact of factors including warfare, poverty, and disease and the intersectionality of these factors as contributing to low life expectancy rates. It comments on the significant impact of HIV/AIDS on global health and life expectancy, as well as explores the effects of hunger and modernization.

The purpose of this work is to analyze the parasitological risks of treated wastewater reuse from a stabilization pond in the city of Piracicaba, in the State of SãO Paulo (Brazil), and the level of treatment required to protect public health. Samples were taken from raw and treated wastewater in stabilization ponds and submitted to a parasitological, microbiological and physicochemical analysis. The study revealed on treated wastewater the presence of Ascaris sp. and Entamoeba coli with an average density of 1 cysts L-1 and 6 eggs L-1, respectively. For Ascaris, the annual risks of infection due to the accidental ingestion of wastewater irrigation were 7.5 × 10-2 in 208 days and 8.7 × 10-2 in 240 days. For Total Coliforms and Escherichia coli in treated wastewater, the average density was 1.0 × 105 MPN/100 ml and 2.7 × 104 MPN/100 ml respectively, representing 99% and 94% removal efficiency, respectively. For BOD, COD, TS and TSS removal efficiency was 69, 80, 50 and 71%, respectively. The removal efficiency for nitrogen; ammonia nitrogen and total phosphate was 24, 19 and 68%, respectively. The average density of helminths eggs in treated wastewater is higher compared to the density of the limit value of ≤1 egg L-1 and tolerable risk is above the level recommended by the World Health Organization. Multiple barriers are necessary for the reduction of organic matter, chemical contaminants and parasites from treated wastewater. Standards for the sanitary control of treated wastewater to be reused in agricultural irrigation areas should be compiled for developing countries in order to minimize public health risks. [ABSTRACT FROM AUTHOR]

The essay comments on the the issues of biopolitics in developing countries, paying particular attention to the differences between humanitarianism and development. The author believes that philanthropic health initiatives underscore the 21st century shift towards a humanitarian aid market sponsored by public-private business partnerships. Other topics discussed include the biopolitical imaginary, health infrastructures in developing nations, and the moral norm of valuing human life.

Abstract: A substantial portion of the world’s population does not have ready access to safe water. Moreover, obtaining water may involve great expense of time and energy for those who have no water sources in or near home. From an historical perspective, with the invention of piped water, fetching water has only recently become largely irrelevant in many locales. In addition, in most instances, wells and clean surface water were so close by that fetching was not considered a problem. However, population growth, weather fluctuations and social upheavals have made the daily chore of carrying water highly problematic and a public health problem of great magnitude for many, especially women, in the poor regions and classes of the world. In this paper, we consider gender differences in water carrying and summarize data about water access and carrying from 44 countries that participated in the Multiple Indicator Cluster Survey (MICS) program. Women and children are the most common water carriers, and they spend considerable time (many trips take more than an hour) supplying water to their households. Time is but one measure of the cost of fetching water; caloric expenditures, particularly during droughts, and other measures that affect health and quality of life must be considered. The full costs of fetching water must be considered when measuring progress toward two Millennium Development Goals – increasing access to safe drinking water and seeking an end to poverty. [Copyright &y& Elsevier]

The imperative for improving health in the world's poorest regions lies in research, yet there is no question that low participation, a lack of trained staff, and limited opportunities for data sharing in developing countries impede advances in medical practice and public health knowledge. Extensive studies are essential to develop new treatments and to identify better ways to manage healthcare issues. Recent rapid advances in availability and uptake of digital technologies, especially of mobile networks, have the potential to overcome several barriers to collaborative research in remote places with limited access to resources. Many research groups are already taking advantage of these technologies for data sharing and capture, and these initiatives indicate that increasing acceptance and use of digital technology could promote rapid improvements in global medical science. [ABSTRACT FROM AUTHOR]

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.

"Health promotion" is one of the main paradigms of communication for development, which has been constant over time and has had a notorious influence in various regions of the world, probably because it has been promoted and funded by USAID, the US cooperation agency. Although there is no one model of health promotion, the name designates strategies and actions organised from the State, with support from external agents, to reach the least favoured population, allegedly with the purpose of enabling people to actively participate in the decision making process around health policies and programmes that affect their lives. Based on reports from concrete country experiences, documents from international forums and above all from direct observation by the author, this article aims to demonstrate that there has always been a great gap between the institutional and scientific discourse on health promotion, and its real relevance in Third World countries. [ABSTRACT FROM AUTHOR]

The article explores the effectiveness of the 1959 World Health Organization (WHO) Smallpox Eradication Program (SEP), initiated through the efforts of Deputy Minister of Health of the Soviet Union Viktor M. Zhdanov at the 1958 meeting of the World Health Assembly (WHA), the governing body of WHO. It became a fully funded program in 1967 and in 1977 global eradication of smallpox occurred. SEP was funded by the U.S., the Soviet Union supplied the vaccine, and the program was predominantly carried out in the developing countries of Latin America, Africa, and Asia simultaneously. The author explores the American-Soviet collaboration to improve global public health during the Cold War and considers how nongovernmental organizations impact the foreign policies of world powers.

Developing countries face steady growth in the prevalence of chronic diseases, along with a continued burden from communicable diseases. "Mobile" health, or m-health-the use of mobile technologies such as cellular phones to support public health and clinical care-offers promise in responding to both types of disease burdens. Mobile technologies are widely available and can play an important role in health care at the regional, community, and individual levels. We examine various m-health applications and define the risks and benefits of each. We find positive examples but little solid evaluation of clinical or economic performance, which highlights the need for such evaluation. [ABSTRACT FROM AUTHOR]

The links between rapid population growth and concerns regarding climate change have received little attention. Some commentators have argued that slowing population growth is necessary to reduce further rises in carbon emissions. Others have objected that this would give rise to dehumanizing "population control" programmes in developing countries. Yet the perspective of the developing countries that will be worst affected by climate change has been almost completely ignored by the scientific literature. This deficit is addressed by this paper, which analyses the first 40 National Adaptation Programmes of Action reports submitted by governments of least-developed countries to the Global Environment Facility for funding. Of these documents, 93% identified at least one of three ways in which demographic trends interact with the effects of climate change: (i) faster degradation of the sources of natural resources; (ii) increased demand for scarce resources; and (iii) heightened human vulnerability to extreme weather events. These findings suggest that voluntary access to family planning services should be made more available to poor communities in least-developed countries. We stress the distinction between this approach, which prioritizes the welfare of poor communities affected by climate change, and the argument that population growth should be slowed to limit increases in global carbon emissions. The paper concludes by calling for increased support for rights-based family planning services, including those integrated with HIV/AIDS services, as an important complementary measure to climate change adaptation programmes in developing countries. [ABSTRACT FROM AUTHOR]

India provided one of the most challenging chapters of the world-wide smallpox eradication program. The campaign was converted from a project in which a handful of officials tried to impose their ideas on a complex health bureaucracy to one in which its components were constantly adapted to the requirements of a variety of social, political, and economic contexts. This change, achieved mainly through the active participation of workers drawn from local communities in the 1970s, proved to be a momentous policy adaptation that contributed to certification of smallpox eradication in 1980. However, this lesson appears to have been largely forgotten by those currently managing the Global Polio Eradication Initiative. We hope to show ways in which contemporary efforts to eliminate polio woridwide might profitably draw on historical information, which can indicate meaningful ways in which institutional adaptability is likely to help counter the political and social challenges being encountered in India. (Am J Public Health. 2009; 99:1176-1184. doi:10.2105/AJPH.2008.135624.) [ABSTRACT FROM AUTHOR]

The article discusses rotavirus prevalence in developing countries, the introduction of live, oral attenuated rotavirus vaccines, and a study in Nicaragua to assess the connection between RotaTeq, a pentavalent rotavirus vaccine (RV5), and severe diarrhea requiring intravenous (IV) fluid replacement or hospital admission. The children studied had a diagnosis of rotavirus diarrhea and were eligible for RV5 vaccine. A control group was selected by matching the birth date of each case of diarrhea in the study. The study found that children vaccinated with RV5 had a lower risk of severe diarrhea from rotavirus.

Objective To evaluate the effect of neonatal vitamin A supplementation on infant mortality, morbidity and early adverse effects. [Design Systematic review, meta-analysis, and meta-regression of randomised controlled trials. Data sources Electronic databases and hand search of reviews; abstracts and proceedings of conferences. Review methods Randomised or quasi-randomised or cluster randomised, placebo controlled trials evaluating the effect of prophylactic, neonatal (<1 month) supplementation with synthetic vitamin A on mortality or morbidity within infancy (<1 year), and early adverse effects (S7.days). Results The six included trials were from developing countries. There was no convincing evidence of a reduced risk of mortality during infancy (relative risk 0.92, 95% confidence interVal 0.75 to 1.12, P=0.393 random effect; I2=54.1%) or of an increase in early adverse effects including bulging fontanelle (1.16,0.81 to 1.65, P=0.418; I2=65.3%). No variable emerged as a significant predictor of mortality, but data for important risk groups (high maternal night blindness prevalence and low birth weights) were restricted. Limited data (from one to four trials) did not indicate a reduced risk of mortality during the neonatal period (0.90,0.75 to 1.08, P=0.270; I2=O%), cause specific mortality, common morbidities (diarrhoea and others), and admission to hospital. There was, however, evidence of an increased risk of acute respiratory infection and a reduced risk of clinic visits. ß Conclusions There is no convincing evidence of a reduced risk of mortality and possibly morbidity or of increased early adverse effects after neonatal supplementation with vitamin A. There is thus no justification for initiating such supplementation as a public health intervention in developing countries for reducing infant mortality and morbidity. [ABSTRACT FROM AUTHOR]

The article discusses the effects of the selectivity of health system strengthening (HSS) strategies on the goal high-quality health systems in developing countries. It is stated that global health actors (GHAs) in the domain of HSS often use the terms global health initiative and global health partnership, which are ill defined. It notes that GHAs claim to support health systems but focus on disease-specific interventions. It also mentions the importance of an effective approach to HHS.

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...

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]