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Breast cancer management in middle-resource countries (MRCs): consensus statement from the Breast Health Global Initiative

Yip CH, Cazap E, Anderson BO, Bright KL, Caleffi M, Cardoso F, et al.

Breast, 2011 Apr;20 Suppl 2:S12-9.
PMID: 21388811 DOI: 10.1016/j.breast.2011.02.015

In middle resource countries (MRCs), cancer control programs are becoming a priority as the pattern of disease shifts from infectious diseases to non-communicable diseases such as breast cancer, the most common cancer among women in MRCs. The Middle Resource Scenarios Working Group of the BHGI 2010 Global Summit met to identify common issues and obstacles to breast cancer detection, diagnosis and treatment in MRCs. They concluded that breast cancer early detection programs continue to be important, should include clinical breast examination (CBE) with or without mammography, and should be coupled with active awareness programs. Mammographic screening is usually opportunistic and early detection programs are often hampered by logistical and financial problems, as well as socio-cultural barriers, despite improved public educational efforts. Although multidisciplinary services for treatment are available, geographical and economic limitations to these services can lead to an inequity in health care access. Without adequate health insurance coverage, limited personal finances can be a significant barrier to care for many patients. Despite the improved availability of services (surgery, pathology, radiology and radiotherapy), quality assurance programs remain a challenge. Better access to anticancer drugs is needed to improve outcomes, as are rehabilitation programs for survivors. Focused and sustained government health care financing in MRCs is needed to improve early detection and treatment of breast cancer.

Matched MeSH terms: Developing Countries*
Childhood pneumonia: a neglected, climate-sensitive disease?

Paynter S, Ware RS, Weinstein P, Williams G, Sly PD

Lancet, 2010 Nov 27;376(9755):1804-5.
PMID: 21111894 DOI: 10.1016/S0140-6736(10)62141-1
Matched MeSH terms: Developing Countries/statistics & numerical data
Fulltext Ethical issues related to epilepsy care in the developing world

Tan CT, Avanzini G

Epilepsia, 2009 May;50(5):975-7.
PMID: 19170738 DOI: 10.1111/j.1528-1167.2008.01934.x

There are three major issues of ethical concern related to epilepsy care in the developing world. First, is it ethical for a developing country to channel its limited resources from direct epilepsy care to research? The main considerations in addressing this question are the particular research questions to be addressed and whether such research will bring direct benefits to the local community. Second, in a country with limited resources, when does ignoring the high treatment gap become an ethical issue? This question is of particular concern when the community has enough resources to afford treatment for its poor, yet is not providing such care because of gross wastage and misallocation of the national resources. Third, do countries with plentiful resources have an ethical responsibility to help relieve the high epilepsy treatment gap of poor countries? Indeed, we believe that reasonable health care is a basic human right, and that human rights transcend national boundaries. Although health care is usually the responsibility of the nation-state, many modern states in the developing world are arbitrary creations of colonization. There is often a long process from the establishment of a political-legal state to a mature functional nation. During the long process of nation building, help from neighboring countries is often required.

Matched MeSH terms: Developing Countries*
Lay perceptions of current and future health, the causes of illness, and the nature of recovery: explaining health and illness in Malaysia

Swami V, Arteche A, Chamorro-Premuzic T, Maakip I, Stanistreet D, Furnham A

Br J Health Psychol, 2009 Sep;14(Pt 3):519-40.
PMID: 18922210 DOI: 10.1348/135910708X370781

This study examined beliefs about the causes and determinants of health, illness, and recovery in an opportunistic sample from Malaysia. In all, 371 women and 350 men completed the Health and Illness Scale, a 124-item scale that examined beliefs about current and future health, and beliefs about the causes of illness and recovery. Each of the four subscales of the Health Illness Scale were factor analysed to reveal the underlying structure. Results showed the emergence of a number of distinct factors in the case of each subscale, of which environmental, life-style, psychological, religious, and fate-related factors were fairly stable across subscales. Results also showed a number of differences in beliefs between religious groups, and that religiosity and sex were the strongest predictors of beliefs across the four subscales. The results are discussed in terms of the available cross-cultural literature on lay beliefs about health.

Matched MeSH terms: Developing Countries*
Constraint analysis to improve integrated dairy production systems in developing countries: the importance of participatory rural appraisal

Devendra C

Trop Anim Health Prod, 2007 Dec;39(8):549-56.
PMID: 18265864

The paper describes the rationale and importance of the approaches and methodologies of Participatory Rural Appraisal (PRA) to enable constraint analysis, to understand the complexities of farming systems and to improve integrated dairy productivity. Implicit in this objective is Farming Systems Research (FSR), which focused on cropping systems in the 1970's, with the subsequent addition of animal components. The methodology for FSR involves the following sequential components: site selection, site description and characterization (diagnosis), planning of on-farm research, on-farm testing and validation of alternatives, diffusion of results, and impact assessment. PRA is the development of FSR, which involves the active participation of farmers to identify constraints and plan appropriate solutions. In the Coordinated Research Project (CRP), the approach was adapted to 10 different country situations and led to Economic Opportunity Surveys (EOS) and Diagnostic Surveillance Studies (DSS), allowing the planning and implantation of integrated interventions to improve dairy productivity.

Matched MeSH terms: Developing Countries*
Outcome of patients with head and neck cancers: 10-year experience of a otorhinolaryngology--head and neck unit in a tertiary hospital of a developing country

Shashinder S, Choo PK, Gopala KG

Eur J Cancer Care (Engl), 2008 Jan;17(1):93-7.
PMID: 18181897 DOI: 10.1111/j.1365-2354.2007.00814.x

Being a rapidly developing country, a study was needed to see how we faired in treating head and neck cancer patients compared with international standards. Although being a retrospective study, this research shows that there is still a lot to be done in our developing nation in educating the general public about head and neck cancers as most of them presented in the later stages to us. There also needs to be a proper review about the treatment modality offered to patient as our survival results are far behind in certain categories of cancers compared with the developed nations.

Matched MeSH terms: Developing Countries*
The Breast Health Global Initiative: clinical practice guidelines for management of breast cancer in low- and middle-income countries

Yip CH, Anderson BO

Expert Rev Anticancer Ther, 2007 Aug;7(8):1095-104.
PMID: 18028018

Breast cancer is an increasingly urgent problem in low- and mid-level resource countries of the world. Despite knowing the optimal management strategy based on guidelines developed in wealthy countries, clinicians are forced to provide less-than-optimal care to patients when diagnostic and/or treatment resources are lacking. For this reason, it is important to identify which resources commonly applied in resource-abundant countries most effectively fill the healthcare needs in limited-resource regions, where patients commonly present with more advanced disease at diagnosis, and to provide guidance on how new resource allocations should be made in order to maximize improvement in outcome. Established in 2002, the Breast Health Global Initiative (BHGI) created an international health alliance to develop evidence-based guidelines for countries with limited resources (low- and middle-income countries) to improve breast health outcomes. The BHGI serves as a program for international guideline development and as a hub for linkage among clinicians, governmental health agencies and advocacy groups to translate guidelines into policy and practice. The BHGI collaborated with 12 national and international health organizations, cancer societies and nongovernmental organizations to host two BHGI international summits. The evidence-based BHGI Guidelines, developed at the 2002 Global Summit, were published in 2003 as a theoretical treatise on international breast healthcare. These guidelines were then updated and expanded at the 2005 Global Summit into a fully comprehensive and flexible framework to permit incremental improvements in healthcare delivery, based upon outcomes, cost, cost-effectiveness and use of healthcare services.

Matched MeSH terms: Developing Countries*
Fulltext Evidence-based prescribing of statins: a developing world perspective

Ong HT

PLoS Med, 2006 Mar;3(3):e50.
PMID: 16478294
Matched MeSH terms: Developing Countries*
An audit of fresh frozen plasma usage in a tertiary referral centre in a developing country

Prathiba R, Jayaranee S, Ramesh JC, Lopez CG, Vasanthi N

Malays J Pathol, 2001 Jun;23(1):41-6.
PMID: 16329547

This paper evaluates the practice of fresh frozen plasma (FFP) transfusion at the University Hospital, Kuala Lumpur, and analyses its usage by the various clinical departments. The aim of this study is to identify where it is inappropriately used and the clinical indications in which such misuse is common. A retrospective analysis of the blood bank request forms and work sheets during a 6-month period between January 1998 and June 1998 formed the basis of this study. Overall, 40% of 2665 units transfused were considered appropriate. However, out of the 931 episodes of FFP transfusions only 31% were for appropriate indications. The average FFP requirement when used for appropriate indication was about 4 units per episode, whereas for inappropriate indication it was 2.5 units per episode. Inappropriate use in terms of the number of units was highest by the surgical services (68%) and Orthopaedics (64%), while the Department of Paediatrics had the lowest incidence of inappropriate use (40%). When Paediatrics was used as the benchmark, the incidence of inappropriate use by other departments was significantly higher (p < 0.01). As for FFP usage in common clinical indications, there was a high incidence of inappropriate use in burns (82%), perioperative period (73%), cardiac surgery (68%), massive bleeding (62%) and trauma (60%). The findings in this study, specifically the use of FFP for volume support in trauma, massive bleeding and burns, routine requests without identified indication in cardiac bypass surgery, and prophylactic use in the perioperative period can be the basis for recommendations to minimize the inappropriate use of FFP in the future.

Matched MeSH terms: Developing Countries*
Safe-water shortages, gender perspectives, and related challenges in developing countries: the case of Uganda

Baguma D, Hashim JH, Aljunid SM, Loiskandl W

Sci Total Environ, 2013 Jan 1;442:96-102.
PMID: 23178827 DOI: 10.1016/j.scitotenv.2012.10.004

The need for water continues to become more acute with the changing requirements of an expanding world population. Using a logistical analysis of data from 301 respondents from households that harvest rainwater in Uganda, the relationship between dependent variables, such as water management performed as female-dominated practices, and independent variables, such as years of water harvesting, family size, tank operation and maintenance, and the presence of local associations, was investigated. The number of years of water harvesting, family size, tank operation and maintenance, and presence of local associations were statistically significantly related to adequate efficient water management. The number of years of water harvesting was linked to women's participation in household chores more than to the participation of men, the way of livelihoods lived for many years. Large families were concurrent with a reduction in water shortages, partially because of the availability of active labour. The findings also reveal important information regarding water-related operations and maintenance at the household level and the presence of local associations that could contribute some of the information necessary to minimise water-related health risks. Overall, this investigation revealed important observations about the water management carried out by women with respect to underlying safe-water shortages, gender perspectives, and related challenges in Uganda that can be of great importance to developing countries.

Matched MeSH terms: Developing Countries*
Diagnostic cerebral angiography in spontaneous intracranial haemorrhage: a guide for developing countries

Abu Bakar I, Shuaib IL, Mohd Ariff AR, Naing NN, Abdullah JM

Asian J Surg, 2005 Jan;28(1):1-6.
PMID: 15691788

OBJECTIVE: Spontaneous intracranial haemorrhage constitutes 18-40% of all stroke cases. Indications for cerebral angiography to find underlying potentially treatable vascular abnormalities are not clear. This study determined which intracranial haemorrhage patients need cerebral angiography by correlating computed tomography (CT) findings, age and hypertension history with cerebral angiography findings.
METHODS: A total of 54 patients (8-79 years) with intracranial haemorrhage who underwent both CT examination and six-vessel cerebral angiography were studied over a 2-year period. Cerebral angiography was repeated within 6 weeks if the first angiogram was negative.
RESULTS: Angiography detected vascular lesions in 50% of cases (aneurysm 38.9% and arteriovenous malformation, AVM, 11.1%). In the aneurysm group, angiographic yield was 34.3% whereas in the AVM group, it was 37.9%. Subarachnoid haemorrhage (SAH) combined with other types of haemorrhage (such as intracerebral haemorrhage, ICH) was not significantly correlated with the likelihood of finding a vascular lesion, both aneurysm and AVM (p = 0.157). Age less than 50 years had significant correlation (p = 0.021) in the AVM group as well as in the aneurysm group (p < 0.001). A history of hypertension was associated with both aneurysm (p = 0.039) and AVM (p = 0.008). No patients with deep intracerebral haematoma had vascular lesions. The presence of an intravascular haemorrhage (IVH) had significant correlation with aneurysm (p = 0.008) but not AVM. There was no significant difference in mean age between patients with and without a vascular lesion (p = 0.134).
CONCLUSION: Cerebral angiography is justified in patients with ICH accompanied by pure SAH (p = 0.001). Other factors associated with finding a vascular lesion were a history of hypertension and the presence of IVH. Diagnostic cerebral angiography is indicated for patients with ICH and SAH and IVH with a history of hypertension, regardless of age.

Matched MeSH terms: Developing Countries*
The value of life and accident costing: a willingness-to-pay study amongst motorcyclists in Malaysia

Mohd Fauzi MY, Nor Ghani MN, Radin Umar RS, Ahmad Hariza H

Appl Health Econ Health Policy, 2004;3(1):5-8.
PMID: 15702934

Motorcyclists constitute a large proportion of total road casualties in Asian countries Unfortunately, studies conducted for the purpose of evaluating the cost of traffic crashes, and cost-benefit analyses of safety interventions, are almost nonexistent in these countries. The loss-of-output approach to valuing life has been used for many years, yet this method has also long been criticised as it results in significant resource misallocation. This study attempts to overcome this problem by estimating the value of a statistical life among motorcyclists using the willingness-to-pay method that is commonly used in developed countries. The study recommends adopting a value of MYR1.1 million (almost five times the previous estimate) per statistical life for public policy analysis involving motorcycle safety.

Matched MeSH terms: Developing Countries/economics
The evidence for emergency obstetric care

Paxton A, Maine D, Freedman L, Fry D, Lobis S

Int J Gynaecol Obstet, 2005 Feb;88(2):181-93.
PMID: 15694106

We searched for evidence for the effectiveness of emergency obstetric care (EmOC) interventions in reducing maternal mortality primarily in developing countries.

Matched MeSH terms: Developing Countries*
Anthropometric data reduction using confirmatory factor analysis

Ademola James, Rohani JM, Olusegun AG, Rani MR

Work, 2014;47(2):173-81.
PMID: 23324693 DOI: 10.3233/WOR-121530

OBJECTIVE: The unavailability of anthropometric data especially in developing countries has remained a limiting factor towards the design of learning facilities with sufficient ergonomic consideration. Attempts to use anthropometric data from developed countries have led to provision of school facilities unfit for the users. The purpose of this paper is to use factor analysis to investigate the suitability of the collected anthropometric data as a database for school design in Nigerian tertiary institutions.
PARTICIPANTS: Anthropometric data were collected from 288 male students in a Federal Polytechnic in North-West of Nigeria. Their age is between 18-25 years.
METHODS: Nine vertical anthropometric dimensions related to heights were collected using the conventional traditional equipment. Exploratory factor analysis was used to categorize the variables into a model consisting of two factors. Thereafter, confirmatory factor analysis was used to investigate the fit of the data to the proposed model.
RESULTS: A just identified model, made of two factors, each with three variables was developed. The variables within the model accounted for 81% of the total variation of the entire data. The model was found to demonstrate adequate validity and reliability. Various measuring indices were used to verify that the model fits the data properly. The final model reveals that stature height and eye height sitting were the most stable variables for designs that have to do with standing and sitting construct.
CONCLUSION: The study has shown the application of factor analysis in anthropometric data analysis. The study highlighted the relevance of these statistical tools to investigate variability among anthropometric data involving diverse population, which has not been widely used for analyzing previous anthropometric data. The collected data is therefore suitable for use while designing for Nigerian students.
KEYWORDS: Exploratory factor analysis; measurement model; school ergonomics

Matched MeSH terms: Developing Countries*
Development and validation of a multilateral index to determine economic status in developing countries: the Patient Financial Eligibility Tool (PFET)

Saba J, Audureau E, Bizé M, Koloshuk B, Ladner J

Popul Health Manag, 2013 Apr;16(2):82-9.
PMID: 23276290 DOI: 10.1089/pop.2012.0049

The objective was to develop and validate a multilateral index to determine patient ability to pay for medication in low- and middle-income countries. Primary data were collected in 2009 from 117 cancer patients in China, India, Thailand, and Malaysia. The initial tool included income, expenditures, and assets-based items using ad hoc determined brackets. Principal components analysis was performed to determine final weights. Agreement (Kappa) was measured between results from the final tool and from an Impact Survey (IS) conducted after beginning drug therapy to quantify a patient's actual ability to pay in terms of number of drug cycles per year. The authors present the step-by-step methodology employed to develop the tool on a country-by-country basis. Overall Cronbach value was 0.84. Agreement between the Patient Financial Eligibility Tool (PFET) and IS was perfect (equal number of drug cycles) for 58.1% of patients, fair (1 cycle difference) for 29.1%, and poor (>1 cycle) for 12.8%. Overall Kappa was 0.76 (P<0.0001). The PFET is an effective tool for determining an individual's ability to pay for medication. Combined with tiered models for patient participation in the cost of medication, it could help to increase access to high-priced products in developing countries.

Matched MeSH terms: Developing Countries*
Improving access to essential drugs for people living with HIV/AIDS

Balasubramaniam K

Issues Med Ethics, 2000 Jan-Mar;8(1):26-7.
PMID: 16323335
Matched MeSH terms: Developing Countries*
An international comparison of women's occupational health issues in the Philippines, Thailand, Malaysia, Canada, Hong Kong and Singapore: the CIDA-SEAGEP study

Choi BC

Occup Med (Lond), 2005 Oct;55(7):515-22.
PMID: 16174662

An international comparison study of women's occupational health issues was carried out in 2000 for the Philippines, Thailand, Malaysia, Canada, Hong Kong and Singapore. The study was funded by the Canadian International Development Agency's Southeast Asia Gender Equity Program.

Matched MeSH terms: Developing Countries*
Controlling water pollution in developing and transition countries--lessons from three successful cases

Kathuria V

J Environ Manage, 2006 Mar;78(4):405-26.
PMID: 16171929

The policy prescription for solving environmental problems of developing countries and countries-in-transition (CIT) is slowly getting polarized into two viewpoints. One group of researchers and policy advocates including multilateral organizations upholds extensive use of market based instruments (MBIs) in these countries. The other group argues that institutions need to be built first or the policy makers should select the incremental or tiered approach taking into account the existing capabilities. The group also insists that the financial, institutional and political constraints make environmental regulation in these countries more problematic than in industrialized countries. In the short-run, the immediate needs of the developing countries can be addressed effectively by learning lessons from the difficulties encountered by a few successful cases and accordingly evolving an appropriate policy instrument. In this paper an attempt has been made to highlight three such cases from three different parts of the world--Malaysia (Asia-pacific), Poland (Eastern Europe) and Colombia (Latin America). The paper looks into what policy instruments led to a fall in water pollution levels in these countries and what role did MBIs play in this pollution mitigation? The case studies suggest that it is a combination of instruments--license fee, standards, charge and subsidies--reinforced by active enforcement that led to an overall improvement in environment compliance.

Matched MeSH terms: Developing Countries*
Diagnosis and management of Duchenne muscular dystrophy in a developing country over a 10-year period

Thong MK, Bazlin RI, Wong KT

Dev Med Child Neurol, 2005 Jul;47(7):474-7.
PMID: 15991868

Clinical data on Duchenne muscular dystrophy (DMD) are lacking in developing countries. The objective of this study was to delineate the demographic characteristics, investigations, and outcome of 21 Malaysian males diagnosed with DMD over a period of 10 years. Mean age presentation was 3 years 8 months (SD 23mo; range 10 to 84mo), mean duration from first presentation to diagnosis was 3y 7mo (SD 26mo; range 5 to 84) and the mean age for loss of ambulation was 11 years (SD 25mo; range 102 to 168). There was family history of DMD in five of the 21 patients. Muscle biopsy showed confirmatory findings of DMD in the 16 patients tested. Molecular genetic analysis showed dystrophin gene deletions in 11 of these 16 patients. Four and seven of the students stopped schooling and had learning difficulties, respectively; only nine had satisfactory school performances. Eight out of 14 patients evaluated were classified as having severe to total dependency levels on the modified Barthel Index for activities of daily living assessment. DMD is associated with significant medical and social needs for a developing country such as Malaysia. Earlier referral, genetic counselling, and provision of support and rehabilitative services are the main priorities.

Matched MeSH terms: Developing Countries*
Fulltext Mobile health-care information for all: a global challenge

Royston G, Hagar C, Long LA, McMahon D, Pakenham-Walsh N, Wadhwani N, et al.

Lancet Glob Health, 2015 Jul;3(7):e356-7.
PMID: 26087979 DOI: 10.1016/S2214-109X(15)00054-6
Matched MeSH terms: Developing Countries*

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