The health impact of tourism on local and indigenous populations in resource-poor countries

In the vast Travel Health literature there is still a considerable dearth on tourism's impact on local communities. This review attempts to remedy the situation. Its focus is on potential health impacts on populations living at tourist destinations outside the industrialised world. To facilitate a better understanding of how health is linked to tourism today, a brief overview of the historical and theoretical evolution of tourism is presented. Ecotourism is given special attention as it is perceived as a version of the industry that is more benign on environment and people. After discussing Indigenous Tourism, a variety of potential health implications is outlined. These follow a previously suggested classification of indirect and direct impacts, with the indirect impacts being based on economic, environmental, socio-cultural and, more recently, political impacts, and the direct impacts originating from immediate encounters between tourism and people. Finally, the urgent need for more research is highlighted, and some solutions to minimize health impact are suggested.     

Impact of new developments in antiretroviral treatment on AIDS prevention and care in resource-poor countries

Combination antiretroviral treatment (ARV) including protease inhibitors, decreased the morbidity and mortality due to AIDS in the industrialized world. Many obstacles remain before ARVs can be introduced in resource-poor countries: high treatment costs, lack of laboratories to monitor the treatment, weak healthcare systems, and many other competing healthcare needs. The introduction of ARVs in resource-poor countries should be closely monitored. The first priority for the use of ARVs in resource-poor countries is the prevention of mother-to-child transmission of HIV. News about the success of ARV treatment may lead to an increase in unsafe behaviors including a decreased use of condoms. Therefore, prevention efforts should be strengthened; especially the development of an HIV vaccine needs to become a top priority. Funds for ARV treatment cannot come from the already strained healthcare budgets of resource-poor countries. The pressure on politicians and international donor agencies to provide ARVs to resource-poor countries should be used to increase overall healthcare budgets and to improve healthcare services in general.     

Outcome of childhood acute lymphoblastic leukaemia in resource-poor countries

The causes of treatment failure in childhood acute lymphoblastic leukaemia are thought to differ between resource-rich and resource-poor countries. We assessed the records of 168 patients treated for this disease in Honduras. Abandonment of treatment (n=38), the main cause of failure, was associated with prolonged travel time to the treatment facility (2-5 h: hazard ratio 3.1, 95% CI 1.2-8.1 vs >5 h: 3.7, 1.3-10.9) and age younger than 4.5 years (2.6, 1.1-6.3). 35 patients died of treatment-related effects. Outcome could be substantially improved by interventions that help to prevent abandonment of therapy (such as funding for transport, satellite clinics, and support groups), and by prompt treatment of infection.     

Chronic hepatitis B: management challenges in resource-poor countries

Sylvester Chuks Nwokediuko, Department of Medicine, University of Nigeria Teaching Hospital, Ituku OzallaChronic infection with hepatitis B virus (HBV) is a global public health problem because of its worldwide distribution and its potential to cause sequelae. HBV is most prevalent in China, South East Asia, sub-Saharan Africa, and the Amazon basin of South America where health care resources are most limited. Numerous challenges exist for effective management of chronic HBV infection, particularly in resource-limited regions. These challenges include lack of accurate prevalence data, absence of a surveillance program, and poor political will of governments in resource-poor countries to enforce effective measures to control the disease. There is a lack of understanding regarding HBV infec-tion by both the general public and health care providers. A better understanding of the pathogenesis and treatment of this condition is necessary. The acute shortage of trained medical manpower necessary for accurate diagnosis and treatment of chronic hepati-tis B (CHB) in resource-poor countries is a formidable challenge. The condition is com-plicated by the continuing efflux of medical graduates from low-income economies to richer countries. The most critical problem in the management of CHB is the high cost of laboratory tests and drugs. Drugs are also not readily available. Other challenges in the manage-ment of CHB include stigmatization of patients, co-infection with other viruses, lack of management guidelines, and absence of an effective patient referral system. To address these challenges, governments of resource-poor nations must be committed to budg-etary allocation for the implementation of health programs. It is necessary to provide awareness campaigns, health education, proper screening of blood and blood products for transfusion, active screening, intensification of existing childhood immunization, technical and financial assistance from wealthier nations, and implementation of the recommendations outlined in the Global Hepatitis Policy (2010).     

Implications of a diagnosis of rheumatoid arthritis in resource-poor countries

Rheumatoid arthritis (RA) is a multisystemic autoimmune disease that predominantly affects synovial joints. It causes marked disability, reduces health-related quality of life, and leads to high mortality. The diagnosis of RA is often made by standard criteria, and the management of this condition is usually undertaken according to the established guidelines. In resource-poor settings, the diagnosis and management of RA are hampered by diverse factors such as late presentation, inadequate trained personnel, poor healthcare infrastructure, low socioeconomic status, poor access to both conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics, and a high burden of infectious diseases such as tuberculosis, hepatitis, and human immunodeficiency virus. There is a need to establish registries in these settings to provide adequate information on the pattern, medication, and long-term outcome of RA in resource-poor countries in order to provide a practical and evidence-based management guide for rheumatologists, which is appropriate for these settings.     

Doubts about DOT: antiretroviral therapy for resource-poor countries

INTRODUCTION: Directly observed therapy programs developed for tuberculosis (TB) have been suggested as a model for the provision of HIV medications in resource-poor countries in order to ensure adherence and prevent drug resistance. METHODS: Opinions were formed based on a review of scientific literature regarding the effectiveness of witnessed dosing in directly observed TB therapy programs, adherence to HIV antiretroviral therapy in resource-rich and resource-poor settings, relationship between adherence and HIV antiretroviral drug resistance, HIV viral load and risk of HIV transmission, and stigmatization concerns related to HIV and TB in resource-poor settings. RESULTS/CONCLUSIONS: We suggest that the enthusiasm for HIV directly observed therapy programs is premature based on: equivocal evidence that witnessed dosing is superior to self administered therapy; mistaken assumptions that resource-poor countries are a 'special case' with respect to adherence; possible paradoxical impact of good adherence on HIV drug resistance; unproven efficacy of antiretroviral therapy in preventing HIV transmission; and potential stigmatization of daily antiretroviral dosing.     

Microcomputer applications for primary health care in developing countries

This article explores some ways in which computer technology can be harnessed to strengthen primary health care planning and management, make more efficient use of scare health resources, and maximize the beneficial impact on health of local, district, and national health systems in both developing and developed countries.