Lymphoedema management: an international intersect between developed and developing countries. Similarities, differences and challenges

Lymphoedema is a chronic swelling condition that contributes to disability, dysfunction and lost quality of life. Significant disparities exist worldwide regarding the availability of resources necessary to identify, treat and manage lymphoedema. This disparity transcends socio-economic status and is a common problem in both developed and developing countries. The overall impact of lymphoedema as a public health problem, however, is underestimated, principally due to the lack of epidemiologic data. These problems pose barriers to optimal identification and management of this disabling, lifelong condition. In 1997, the World Health Organization (50.29) resolved that lymphatic filariasis should be eliminated as a public health problem. A component of this strategy focuses on disability management for those suffering from lymphatic filariasis-related morbidity. This initiative has enhanced lymphoedema awareness in developing countries. However, significant deficits persist in health care providers' knowledge, educational initiatives and basic disease identification and treatment. In developed countries, lymphoedema continues to be an underrecognised condition and assumed to be only cancer-related. Health care resources allocated to treat and manage the disease are insufficient for basic and ongoing care, resulting in disease progression and disability. The International Lymphoedema Framework project, established in 2002, seeks to establish a consensus for best practices in the management of lymphoedema worldwide to reduce this disability burden. A basic global construct for lymphoedema management is needed to decrease morbidity and promote optimal disease management across all cultural and socio-economic boundaries. Many countries are unaware of the importance of lymphoedema management and have not defined a national strategy with respect to this problem. The objective of this article is to define similarities and differences in strategies for lymphoedema management between developed and developing countries and advocate for a cohesive and concerted approach to disease management.     

Public health requirements for rapid progress in global health

Abstract

Effective public health interventions can save hundreds of millions of lives in developing countries, as well as create broad social and economic benefits. Unfortunately, public health approaches and solutions applied in developed countries are often assumed to be inappropriate or unattainable in developing countries. This has sometimes forestalled effective interventions in parts of the world where they are most needed, despite conditions that now facilitate lasting solutions to both long-standing and emerging global public health problems. Core public health functions are similar regardless of a country's income level. Although some resource-intensive approaches from industrialised nations are inappropriate in less developed countries, many basic public health measures achieved decades ago in developed countries are urgently needed, highly appropriate, extremely cost-effective and eminently attainable in developing countries today. About half of the disease burden in low and middle-income countries is now from non-communicable diseases, but non-communicable disease epidemics that will otherwise increase rapidly in the developing world can be avoided or reversed. Progress of public health in developing countries is possible, but will require sufficient funding and human resources; improved physical plant and information systems; effective programme implementation and regulatory capacity; and, most importantly, political will at the highest levels of government.     

Strategies and tools for the control/elimination of lymphatic filariasis.

Lymphatic filariasis infects 120 million people in 73 countries worldwide and continues to be a worsening problem, especially in Africa and the Indian subcontinent. Elephantiasis, lymphoedema, and genital pathology afflict 44 million men, women and children; another 76 million have parasites in their blood and hidden internal damage to their lymphatic and renal systems. In the past, tools and strategies for the control of the condition were inadequate, but over the last 10 years dramatic research advances have led to new understanding about the severity and impact of the disease, new diagnostic and monitoring tools, and, most importantly, new treatment tools and control strategies. The new strategy aims both at transmission control through community-wide (mass) treatment programmes and at disease control through individual patient management. Annual single-dose co-administration of two drugs (ivermectin + diethylcarbamazine (DEC) or albendazole) reduces blood microfilariae by 99% for a full year; even a single dose of one drug (ivermectin or DEC) administered annually can result in 90% reductions; field studies confirm that such reduction of microfilarial loads and prevalence can interrupt transmission. New approaches to disease control, based on preventing bacterial superinfection, can now halt or even reverse the lymphoedema and elephantiasis sequelae of filarial infection. Recognizing these remarkable technical advances, the successes of recent control programmes, and the biological factors favouring elimination of this infection, the Fiftieth World Health Assembly recently called on WHO and its Member States to establish as a priority the global elimination of lymphatic filariasis as a public health problem.     

Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers

There is a growing literature on health seeking behaviours and the determinants of health services utilization especially in the context of developing countries. However, very few focused studies have been seen in Pakistan in this regard. This paper presents an extensive literature review of the situation in developing countries and relates the similar factors responsible for shaping up of a health seeking behaviour and health service utilization in Pakistan. The factors determining the health behaviours may be seen in various contexts: physical, socio-economic, cultural and political. Therefore, the utilization of a health care system, public or private, formal or non-formal, may depend on socio-demographic factors, social structures, level of education, cultural beliefs and practices, gender discrimination, status of women, economic and political systems environmental conditions, and the disease pattern and health care system itself. Policy makers need to understand the drivers of health seeking behaviour of the population in an increasingly pluralistic health care system. Also a more concerted effort is required for designing behavioural health promotion campaigns through inter-sectoral collaboration focusing more on disadvantaged segments of the population.     

A systematic review of factors influencing the psychological health of conflict-affected populations in low- and middle-income countries

Abstract

Background. Elevated levels of poor mental health have been recorded amongst populations affected by armed conflict. The aim of this study was to systematically review existing evidence on the factors influencing general psychological health of conflict-affected populations in low- and middle-income countries.

Methods. Quantitative studies that described statistically significant associations with general psychological health of adult conflict-affected persons in low- and middle-income countries were included. Bibliographic databases and humanitarian agency websites were searched, and a screening, selection and review process was applied. The findings are described using commonly recurring categories of demographic characteristics, socio-economic factors and exposure to traumatic events.

Results. Fifteen studies met the inclusion criteria. Factors with an association with worse general psychological health were demographic factors of gender (women), older age and not being married; socio-economic factors, such as low education level, low income and assets, not working, residential status, living conditions and insecurity; and a number of violent and traumatic events including forced displacement – particularly internal displacement.

Conclusions. The evidence base was weak and methodological limitations were noted. Further research is required to better understand the factors influencing general psychological health amongst conflict-affected populations in low- and middle-income countries.     

Understanding the Interconnections Between Ethnicity,Gender, Social Class and Health

Abstract

This paper presents the findings of a qualitative study about the impact of ethnicity, gender, and socio-economic status upon health, and use and access to appropriate service provision. A total of 54 interviews were carried out with women who identified themselves as Muslim and Bangladeshi. Health and social care professionals were also interviewed. However, the focus of this paper is upon the ways in which women conceptualised their health and social care needs and concerns. Our findings indicate that individual characteristics serve to mediate the influence of gender and ethnicity on health, but for the women in our study, socio-economic status represents the most potent factor in adversely affecting their health status and access to health care.     

Determinants of accessibility and affordability of health care in post-socialist Tajikistan: Evidence and policy options

Abstract

There is increasing evidence of rising levels of inequality in health care utilisation in the post-socialist countries of Central Asia and the Caucasus. Against this backdrop, we investigate the determinants of accessibility and affordability of health care utilisation in Tajikistan. A modified version of the Andersen Behavioural Model is used to conceptualise the determinants of health care utilisation in Tajikistan. Poisson and Ordered Logit regression models are performed to estimate the determinants of health care utilisation. Empirical results demonstrate that poverty, chronic illness and disability are the most important determinants of health care utilisation and affordability in Tajikistan. Other significant determinants include gender, the level of education of the household head, and the availability of medical personnel at a given population point. These findings suggest an urgent need for health care reform in order to ensure equality in accessibility and affordability for the entire population.     

The Conceptual and Empirical Link Between Health Behaviors,Self Reported Health,and the Use of Home Health Care in Later Life

ABSTRACT

The primary qualification for Medicare's home health care benefit is being homebound, typically by a chronic disability. Disability and functional ability in late-life are heavily influenced by the long-term practice of health behaviors. One of the goals of Healthy People 2000 is to increase the years of healthy life which are measured, in part, by self reported health status. This compression of morbidity would, in effect, reduce the need for long term care. This paper examines three conceptual models linking health behaviors to self reported health in a unique sample of older adults who have chosen to participate in a corporate sponsored wellness program. It is hoped that these findings will encourage further research on formulating empirical pathways from health behaviors to reduced need for home health care.     

Health care technology as a policy issue

Health care technology has become an increasingly visible issue in many countries, primarily because of the rising costs of health care. In addition, many questions concerning quality of care are being raised. Health care technology assessment has been seen as an aid in addressing questions concerning technology, including benefits and costs. A number of industrialized countries have developed active programs of health care technology assessment during the past two decades. Eight countries at similar levels of socio-economic and health development--Australia, Canada, France, Germany, the Netherlands, Sweden, the United Kingdom and the United States--have been examined to gain insights into how they manage health care technology and what place technology assessment has in such management. In addition to seeking general information, specific cases--treatment for coronary artery disease, medical imaging, laparoscopic surgery, treatment of end-stage renal disease, neonatal intensive care, and breast cancer screening--were examined in each country.     

Promoting emergency medical care systems in the developing world: Weighing the costs

Abstract

Despite the global health community's historical focus on providing basic, cost-effective primary health care delivered at the community level, recent trends in the developing world show increasing demand for the implementation of emergency care infrastructures, such as prehospital care systems and emergency departments, as well as specialised training programmes. However, the question remains whether, in a setting of limited global health care resources, it is logical to divert these already-sparse resources into the development of emergency care frameworks.

The existing literature overwhelmingly supports the idea that emergency care systems, both community-based and within medical institutions, improve important outcomes, including significant morbidity and mortality. Crucial to the success of any public health or policy intervention, emergency care systems also seem to be strongly desired at the community and governmental levels. Integrating emergency care into existing health care systems will ideally rely on modest, low-cost steps to augment current models of primary health care delivery, focusing on adapting the lessons learned in the developed world to the unique needs and local variability of the rest of the globe.     

Physicians' management of filarial lymphoedema and hydrocele in Pondicherry, India

Many countries have implemented mass drug administration programmes to eliminate lymphatic filariasis, but few have also implemented morbidity management programmes to help patients with chronic lymphoedema or hydrocele due to the infection. A study was carried out to assess current morbidity management by physicians in Pondicherry, India. Fifty-two physicians were interviewed, using a semi-structured questionnaire. For the management of hydrocele, all physicians referred hydrocele patients for surgery and 83% prescribed diethylcarbamazine (DEC). For the management of chronic lymphoedema patients, most doctors (75%) prescribed DEC and 56% mentioned the possibility of surgery. Only 10% of the physicians gave advice about limb hygiene, although recent research has shown the importance of hygiene measures to prevent further progression of lymphoedema. For the management of lymphoedema patients presenting with acute attacks, all physicians prescribed DEC and antibiotics and only 15% gave advice about limb hygiene. We conclude that limb hygiene instruction for home care should be more strongly emphasised to optimize management of lymphoedema patients in Pondicherry.     

Chronic disease and disability among Iraqi populations displaced in Jordan and Syria

The Iraq conflict resulted in the largest displacement in the Middle East since the Palestinian crisis, and provision of health services to the displaced population presents a critical challenge. The study aimed to provide information on chronic medical conditions and disability to inform humanitarian assistance planning. Nationally representative cross‐sectional surveys of Iraqi populations displaced in Jordan and Syria were conducted in late 2008 and early 2009. Clusters of 10 household were randomly selected using probability‐based sampling; a total of 1200 and 813 Iraqi households in Jordan and Syria, respectively, were interviewed. The majority of respondents in both countries perceived healthcare as unaffordable but accessible; cost was an important barrier to care. In Jordan, most routine health expenditures were for medications where in Syria, expenses were divided between medical consultations and medication. Chronic disease prevalence among adults was 51.5% (confidence interval (CI): 49.4–53.5) in Syria and 41.0% (CI: 39.4–42.7) in Jordan, most common were hypertension and musculoskeletal problems. Overall disability rates were 7.1% (CI: 6.3–8.0) in Syria and 3.4% (CI: 3.0–3.9) in Jordan. In both countries, the majority of disability was attributed to conflict, prevalence was higher in men than women, and depression was the leading cause of mental health disability. Chronic illnesses, disabilities and psychological health are key challenges for the Iraqi population and the health systems in Jordan and Syria. Continued attention to the development of systems to manage conditions that require secondary and tertiary care is essential, particularly given reported difficulties in accessing care and the anticipated prolonged displacement. Copyright © 2012 John Wiley & Sons, Ltd.     

Health and Safety in the Lesotho Highlands Dam and Tunnel Construction Program

Abstract

To review health and safety practice s and to determine the occupational health status of dam workers in the Lesotho Highlands, a health and safety audit and a health study of 258 workers was undertaken. The workers were administered respiratory health questionnaires and underwent chest x-rays and lung function and audiometric testing. The audit revealed a low level of aware ness of health and safety issues at all levels of management and a lack of occupational medicine an d industrial hygiene systems. Noise-induced hearing loss occurred among 92% of the study subjects. Among the 158 dam construction workers, 5.4% had pneumoconiosis. With poorly developed laws and regulatory bodies, unsophisticated trade unions, and little client supervision, health and safety had a low priority in this construction project. Recommendations are made that are pertinent to health and safety management where international companies are operating in developing countries.     

Health care utilization,cost burden and coping strategies by disability status: an analysis of the Viet Nam National Health Survey

There is a need for nationally representative information on the affordability of health care by disability status to assist in the design of equitable health systems in developing countries. Using the Viet Nam National Health Survey (2001–2002), this paper analyses health care utilization, cost burden and coping strategies for people with disabilities versus the population at large. The results clearly show that the disabled population are more prone to hospitalization, and spend more on inpatient stays and pharmaceuticals. Households with disabled members are at greater risk of catastrophic health expenditures and debt financing, posing a serious threat to economic welfare. Copyright © 2010 John Wiley & Sons, Ltd.     

Mobile-Health Approach: A Critical Look on Its Capacity to Augment Health System of Developing Countries

Background:

The mobile-health approach is currently knocking the doors of public health to make use of this rapidly advancing technology in developing countries; therefore, it needs a critical look on its capacity in improving health system of developing countries.

Materials and Methods:

A systematic review of studies in literature published till 31^st October 2013 of last 10 years on key search word: Capacity of mobile-health in improving health system of developing countries was done from medical search engines abstracting databases such as Pub-med, WHO, Cochrane database, Google scholar, and Bio-med Central. Both types of studies elucidating utility and no benefit of mobile-health in developing countries were included as main criteria for deciding the capacity of mobile-health approach in health system of developing countries. M-health studies on areas of impact, effectiveness, and evaluation and previous reviews, conferences data, and exploratory studies were the main study designs incorporated. Studies on m-health in developed world, Indian studies as well data from thesis or dissertation were excluded in this review.

Discussion:

Multi-faceted mobile-health applications, strategies, and approaches currently lack proper regulation and standardization from health care authorities, and currently their results also vary from good to no beneficial effects as found in this review.

Conclusion:

Umbrella of mobile-health approaches must be used intelligently, keeping in mind the fact that, it can provide a greater access and quality health care to larger segments of a rural population and its potential to improve the capacity of health system in developing countries.     

A delicate web: Household changes in health behaviour enabled by microcredit in Burkina Faso

Abstract

Providing microcredit to women in developing countries has long been highlighted as a simple and effective strategy for poverty reduction and health improvement. However, little is known about how microcredit enables changes in health behaviour. This knowledge is critical to further strengthen microcredit initiatives. This qualitative study, conducted in Burkina Faso, shows how microcredit can not only facilitate savings and investment strategies, but also lead to changes in household decision-making, enabling women to initiate health prevention, seek health treatment and manage health emergencies. Some changes led to increased household burdens for women that impeded health gains, such as administrative loan delays by the microcredit institution and reduced household contributions by the husband. Furthermore, the study highlighted the fragile nature of health gains, which may be eroded due to economic shocks on a household, such as crop failure, drought or illness.     

Agriculture for Life: A Guide for Health Promotion and Participation for Farmers with Health Challenges

Abstract

Agriculture for Life is an online product of health promotion content for farmers, ranchers, and their family members who are impacted by issues of disability, chronic health conditions, and aging. The process of developing the content is described. The author team began by using an action research method developed for creating consumer health information and the process was initiated by gathering of data to identify the information needs of Oklahoma farmers and ranchers with health concerns or disability status. After the needs assessment, selected searches of the research literature were conducted to ascertain the best levels of evidence for online programing, including finding examples of online programs with outcome data and use of adult learning theory. The prefacing work of content creation was initiated by reviewing key documents related to web accessibility, design conventions, and online ethics. The article describes the systematic process of creating the online product.