Impact of Cryptosporidium spp. interaction with co-occurring microorganisms on moderate-to-severe diarrhea in the developing world

Diarrheal illness is responsible for over a quarter of all deaths in children under 5 years of age in sub-Saharan Africa and South Asia. Recent findings have identified the parasite Cryptosporidium as a contributor to enteric disease. We examined 9,348 cases and 13,128 controls from the Global Enteric Multicenter Study to assess whether Cryptosporidium interacted with co-occurring pathogens based on adjusted odds of moderate-to-severe diarrhea (MSD). Cryptosporidium was found to interact negatively with Shigella spp., with multiplicative interaction score of 0.16 (95% CI: 0.07 to 0.37, p-value=0.000), and an additive interaction score of -9.81 (95% CI: -13.61 to -6.01, p-value=0.000). Cryptosporidium also interacted negatively with Aeromonas spp., Adenovirus, Norovirus, and Astrovirus with marginal significance. Odds of MSD for Cryptosporidium co-infection with Shigella spp., Aeromonas spp., Adenovirus, Norovirus, or Astrovirus are lower than odds of MSD with either organism alone. This may reduce the efficacy of intervention strategies targeted at Cryptosporidium.

Developing countries' anti-cyclical policies in a globalized world

Includes bibliography

Developing countries' anti-cyclical policies in a globalized world

Includes bibliography

The improvement of care for paediatric and congenital cardiac disease across the World: a challenge for the World Society for Pediatric and Congenital Heart Surgery

The diagnosis and treatment for paediatric and congenital cardiac disease has undergone remarkable progress over the last 60 years. Unfortunately, this progress has been largely limited to the developed world. Yet every year approximately 90% of the more than 1,000,000 children who are born with congenital cardiac disease across the world receive either suboptimal care or are totally denied care. While in the developed world the focus has changed from an effort to decrease post-operative mortality to now improving quality of life and decreasing morbidity, which the focus of this Supplement, the rest of the world still needs to develop basic access to congenital cardiac care. The World Society for Pediatric and Congenital Heart Surgery [http://www.wspchs.org/] was established in 2006. The Vision of the World Society is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The Mission of the World Society is to promote the highest quality comprehensive care to all patients with pediatric and/or congenital heart disease, from the fetus to the adult, regardless of the patient`s economic means, with emphasis on excellence in education, research and community service. We present in this article an overview of the epidemiology of congenital cardiac disease, the current and future challenges to improve care in the developed and developing world, the impact of the globalization of cardiac surgery, and the role that the World Society should play. The World Society for Pediatric and Congenital Heart Surgery is in a unique position to influence and truly improve the global care of children and adults with congenital cardiac disease throughout the world [http://www.wspchs.org/].

Telemedicine and developing countries - successful implementation will require a shared approach

Telemedicine is often proposed as a solution to certain health-care problems in the developing world. There seems to be little published experience on which to make judgements. A literature search revealed 39 articles, of which only two related to any kind of direct clinical work; most of them were review articles or editorials. The majority of the work reported was educational in nature, and there has been little clinical experience. It seems probable that telemedicine can help with the education of health-care workers and patients; it seems likely that it could bring major benefits to the organization of health-care. Without proper trials, it will be impossible to determine the place of health-care in the developing world. Trials are the only way in which rational decisions can ultimately be reached regarding whether scarce resources should be devoted to telemedicine in developing countries, or whether they should be employed in more conventional health-care measures whose outcomes are known to be cost-effective.

Experience with a low-cost telemedicine system in three developing countries

The Swinfen Charitable Trust was established in 1998 with the aim of helping the poor, sick and disabled in the developing world. It does this by setting up simple telemedicine links based on email to support doctors in isolated hospitals. The first telemedicine link was established to support the lone orthopaedic surgeon at the Centre for the Rehabilitation of the Paralysed (CRP) in Savar, near Dhaka in Bangladesh, in July 1999. An evaluation of the 27 referrals made during the first year of operation showed that the telemedical advice had been useful and cost-effective. Based on the success of the Bangladesh project, the Swinfen Charitable Trust supplied: digital cameras and tripods to more hospitals in other developing countries. These are Patan Hospital in Nepal (March 2000), Gizo Hospital in the Solomon Islands (March 2000), Helena Goldie Hospital: on New Georgia in the Solomon Islands (September 2000) and LAMB Hospital in Bangladesh (September 2000).

Introduction to politics of climate change: discourses of policy and practice in developing countries

This Themed Section aims to increase understanding of how the idea of climate change, and the policies and actions that spring from it, travel beyond their origins in natural sciences to meet different political arenas in the developing world. It takes a discursive approach whereby climate change is not just a set of physical processes but also a series of messages, narratives and policy prescriptions. The articles are mostly case study-based and focus on sub-Saharan Africa and Small Island Developing States (SIDS). They are organised around three interlinked themes. The first theme concerns the processes of rapid technicalisation and professionalisation of the climate change ‘industry’, which have sustantially narrowed the boundaries of what can be viewed as a legitimate social response to the problem of global warming. The second theme deals with the ideological effects of the climate change industry, which is ‘depoliticisation’, in this case the deflection of attention away from underlying political conditions of vulnerability and exploitation towards the nature of the physical hazard itself. The third theme concerns the institutional effects of an insufficiently socialised idea of climate change, which is the maintenance of existing relations of power or their reconfiguration in favour of the already powerful. Overall, the articles suggest that greater scrutiny of the discursive and political dimensions of mitigation and adaptation activities is required. In particular, greater attention should be directed towards the policy consequences that governments and donors construct as a result of their framing and rendition of climate change issues.

Simple telemedicine for developing regions: Camera phones and paper-based microfluidic devices for real-time, off-site diagnosis

This article describes a prototype system for quantifying bioassays and for exchanging the results of the assays digitally with physicians located off-site. The system uses paper-based microfluidic devices for running multiple assays simultaneously, camera phones or portable scanners for digitizing the intensity of color associated with each colorimetric assay, and established communications infrastructure for transferring the digital information from the assay site to an off-site laboratory for analysis by a trained medical professional; the diagnosis then can be returned directly to the healthcare provider in the field. The microfluidic devices were fabricated in paper using photolithography and were functionalized with reagents for colorimetric assays. The results of the assays were quantified by comparing the intensities of the color developed in each assay with those of calibration curves. An example of this system quantified clinically relevant concentrations of glucose and protein in artificial urine. The combination of patterned paper, a portable method for obtaining digital images, and a method for exchanging results of the assays with off-site diagnosticians offers new opportunities for inexpensive monitoring of health, especially in situations that require physicians to travel to patients (e.g., in the developing world, in emergency management, and during field operations by the military) to obtain diagnostic information that might be obtained more effectively by less valuable personnel.

The promised LAN: the transformative power of information and communications technology in developing countries

Este tese analise as implicações dos investimentos em tecnologia de informação e comunicação (ICT) em países ainda em desenvolvimento, especialmente em termos de educação, para estimular a implementação de uma infra-estrutura mais moderna em vez da continuação do uso de métodos tradicionais. Hoje, como o interesse e os investimentos em ICT estão crescendo rapidamente, os módulos e as idéias que existem para medir o estado de ICT são velhos e inexatos, e não podem ser aplicados às culturas de países em desenvolvimento. Políticos e investidores têm que considerar estes problemas quando estão pensando em investimentos ou socorros para programas em ICT no futuro, e investigadores e professores precisam entender os fatores importantes no desenvolvimento para os ICTs e a educação antes de começar estudos nestes países. Este tese conclue que investimentos em tecnologias móbeis e sem fios ajudarem organizações e governos ultrapassar a infra-estrutura tradicional, estreitando a divisão digital e dando o resulto de educação melhor, alfabetização maior, e soluções sustentáveis pelo desenvolvimento nas comunidades pobres no mundo de países em desenvolvimento.

Mycoses associated with AIDS in the Third World

Despite advances in diagnosis and treatment, the epidemiological status of the human immunodeficiency virus (HIV) infection is far from under control in most of the developing world. Sub-Saharan Africa, Southeast Asia and India show increased rates of new infections. In Latin America and the Caribbean there were 1.6 million estimated cases of HIV-infected patients at the end of 1997. Fungal diseases have been one of the most relevant diagnoses in relation to the acquired immunodeficiency syndrome (AIDS), Infections due to Candida species and Cryptococcus neoformans var, neoformans are common worldwide. Histoplasma capsulatum, Coccidioides immitis and Penicillium marneffei are important causes of disease in endemic areas. Infection due to Sporothrix schenckii, Blastomyces dermatitidis and Paracoccidioides brasiliensis are uncommon even where they are endemic. Phaeohyphomycetes, hyalohyphomycetes and zygomycetes are still rare as a cause of disease among AIDS patients, However, agents pertaining to these groups, such as Aspergillus spp., have an increasing incidence. Superficial mycoses due to dermatophytes have special features from epidemiological, clinical and therapeutic points of view.

Care arrangements for people with dementia in developing countries

Background: Rapid demographic ageing will soon lead to large increases in the numbers of persons with dementia in developing countries. This study is the first comprehensive assessment of care arrangements for people with dementia in those regions. Methods: A descriptive and comparative study of dementia care; caregiver characteristics, the nature of care provided, and the practical, psychological (Zarit Burden Interview, General Health Questionnaire) and economic impact upon the caregiver in 24 centres in India, China and South East Asia, Latin America and the Caribbean and Africa. Results: We interviewed 706 persons with dementia, and their caregivers. Most caregivers were women, living with the person with dementia in extended family households. One-quarter to one-half of households included a child. Larger households were associated with lower caregiver strain, where the caregiver was co-resident. However, despite the traditional apparatus of family care, levels of caregiver strain were at least as high as in the developed world. Many had cutback on work to care and faced the additional expense of paid carers and health services. Families from the poorest countries were particularly likely to have used expensive private medical services, and to be spending more than 10% of the per capita GNP on health care. Conclusions: Older people in developing countries are indivisible from their younger family members. The high levels of family strain identified in this study feed into the cycle of disadvantage and should thus be a concern for policymakers in the developing world. Copyright © 2004 John Wiley & Sons, Ltd.

Globalizing talent and human capital: implications for developing countries

Includes bibliography

Twelve factors influencing sustainable recycling of municipal solid waste in developing countries

Sustainable management of solid waste is a global concern, as exemplified by the United Nations Millennium Development Goals (MDG) that 191 member states support. The seventh MDG indirectly advocates for municipal solid waste management (MSWM) by aiming to ensure environmental sustainability into countries’ policies and programs and reverse negative environmental impact. Proper MSWM will likely result in relieving poverty, reducing child mortality, improving maternal health, and preventing disease, which are MDG goals one, four, five, and six, respectively (UNMDG, 2005). Solid waste production is increasing worldwide as the global society strives to obtain a decent quality of life. Several means exist in which the amount of solid waste going to a landfill can be reduced, such as incineration with energy production, composting of organic wastes, and material recovery through recycling, which are all considered sustainable methods by which to manage MSW. In the developing world, composting is already a widely-accepted method to reduce waste fated for the landfill, and incineration for energy recovery can be a costly capital investment for most communities. Therefore, this research focuses on recycling as a solution to the municipal solid waste production problem while considering the three dimensions of sustainability environment, society, and economy. First, twenty-three developing country case studies were quantitatively and qualitatively examined for aspects of municipal solid waste management. The municipal solid waste (MSW) generation and recovery rates, as well as the composition were compiled and assessed. The average MSW generation rate was 0.77 kg/person/day, with recovery rates varying from 5 – 40%. The waste streams of nineteen of these case studies consisted of 0 – 70% recyclable material and 17 – 80% organic material. All twenty-three case studies were analyzed qualitatively by identifying any barriers or incentives to recycling, which justified the creation of twelve factors influencing sustainable municipal solid waste management (MSWM) in developing countries. The presence of regulations, enforcement of laws, and use of incentive schemes constitutes the first factor, Government Policy. Cost of MSWM operations, the budget allocated to MSWM by local to national governments, as well as the stability and reliability of funds comprise the Government Finances factor influencing recycling in the third world. Many case studies indicated that understanding features of a waste stream such as the generation and recovery rates and composition is the first measure in determining proper management solutions, which forms the third factor Waste Characterization. The presence and efficiency of waste collection and segregation by scavengers, municipalities, or private contractors was commonly addressed by the case studies, which justified Waste Collection and Segregation as the fourth factor. Having knowledge of MSWM and an understanding of the linkages between human behavior, waste handling, and health/sanitation/environment comprise the Household Education factor. Individuals’ income influencing waste handling behavior (e.g., reuse, recycling, and illegal dumping), presence of waste collection/disposal fees, and willingness to pay by residents were seen as one of the biggest incentives to recycling, which justified them being combined into the Household Economics factor. The MSWM Administration factor was formed following several references to the presence and effectiveness of private and/or public management of waste through collection, recovery, and disposal influencing recycling activity. Although the MSWM Personnel Education factor was only recognized by six of the twenty-two case studies, the lack of trained laborers and skilled professionals in MSWM positions was a barrier to sustainable MSWM in every case but one. The presence and effectiveness of a comprehensive, integrative, long-term MSWM strategy was highly encouraged by every case study that addressed the tenth factor, MSWM Plan. Although seemingly a subset of private MSWM administration, the existence and profitability of market systems relying on recycled-material throughput, involvement of small businesses, middlemen, and large industries/exporters is deserving of the factor Local Recycled-Material Market. Availability and effective use of technology and/or human workforce and the safety considerations of each were recurrent barriers and incentives to recycling to warrant the Technological and Human Resources factor. The Land Availability factor takes into consideration land attributes such as terrain, ownership, and development which can often times dictate MSWM. Understanding the relationships among the twelve factors influencing recycling in developing countries, made apparent the collaborative nature required of sustainable MSWM. Factors requiring the greatest collaborative inputs include waste collection and segregation, MSWM plan, and local recycled-material market. Aligning each factor to the societal, environmental, and economic dimensions of sustainability revealed the motives behind the institutions contributing to each factor. A correlation between stakeholder involvement and sustainability existed, as supported by the fact that the only three factors driven by all three dimensions of sustainability were the same three that required the greatest collaboration with other factors. With increasing urbanization, advocating for improved health for all through the MDG, and changing consumption patterns resulting in increasing and more complex waste streams, the utilization of the collaboration web offered by this research is ever needed in the developing world. Through its use, the institutions associated with each of the twelve factors can achieve a better understanding of the collaboration necessary and beneficial for more sustainable MSWM.

Can the World Trade Organization Ensure that International Food Aid is Genuine?

The Doha Round negotiation mandate proposes to minimise trade distortions and commercial displacement under the cover of international food aid, without preventing genuine food aid from reaching people in need. This paper presents problematic aspects of food aid for trade and competition, an overview of the international governance of food aid, and the present rules on food aid embodied in Article 10.4 of the WTO Agreement on Agriculture. The latest available Draft Modalities for Agriculture (December 2008) are seen as an only halfway successful implementation of the Doha mandate. A new text with better targeted disciplines and a political food aid commitment as part of the Doha Round Final Act are proposed in the conclusions.