Developing countries health care

In developing countries, priorities have often been different. Industrialization, water and food supply and sanitation, infrastructure improvements, and basic health care are often the focus of the leaders of a country. In some areas, the availability of a job is much more problematic than some consideration about the quality of the air in the workplace or the home. Many dwellings in developing countries do not have closable windows and doors, so the outdoor and indoor air quality issues are different. In some houses where cooking is done by firewood or charcoal, the air quality outdoors may be considerably better than that inside the smoky residence. 

The proceeding chapters give wimess of an overwhelming scientific development. Antiviral intervention has become a standard, and the worldwide availability of this innovation is perceived as a humanitarian matter of course with a value of its own. However, such an important therapy progress has to be seen in competition with other allocations of scarce funds. Health care resources are Umited - in one country more than in another, but in principle funds invested to antiretroviral intervention will not be available for prevention of HIV/AIDS or for the cure of other diseases. This fundamental scarcity calls for a rational utilization of existing resources and a scientific calculation of the socio-economic impact of antiretroviral intervention. 

Shah and Jenkins (2000) in a review of mental health economic studies from around the world identified 40 cost-of-illness studies, of which five covered all disorders, one neuroses, two panic disorders and one anxiety. All were from developed countries. There were numerous cost-effectiveness studies but none involving the anxiety disorders specifically. One study in the UK examined the cost-benefit analysis of a controlled trial of nurse therapy for neurosis in primary care (Ginsberg et al, 1984). 

National dmg expenditure as a proportion of total health expenditure currently ranges from 7% to 66% worldwide. The proportion is higher in developing countries (24%-66%) than in developed countries (7%-30%). In the former, at the individual and household level, drugs represent a major out-of-pocket health care cost (1). 

Epilepsy is a disorder that afflicts approximately 2 million individuals in the United States, with an age-adjusted prevalence of approximately 4 to 7 cases per 1000 persons.1 The incidence of epilepsy in the United States is estimated at 35 to 75 cases per 100,000 persons per year, which is similar to that of other developed countries.2,3 In developing countries, the incidence is higher at 100 to 190 cases per 100,000 persons per year, possibly related to poor health care and prenatal care, increased risk of neurologic trauma, and increased rates of infections. About 8% of the United States population will experience a seizure during their lifetime. New-onset seizures occur most frequently in infants below 1 year of age and in adults after age 55.4 However, the largest number of patients suffering from epilepsy is between the ages of 15 and 64 years. 

There is no doubt that the eating patterns and physical activity of the adult have a direct effect on the prevalence of nontransmittable chronic illnesses. In recent decades, the prevalence of cardiovascular disease, obesity, cancer, hypertension, and diabetes, among others, has steadily increased, making these diseases the priority for health care systems in many countries, especially in developed countries. 

Contamination of the world s crops by aflatoxin is estimated to cost 10 billion annually, due not only to the direct loss of crops and animals, but also to the maintenance of toxin monitoring services and the indirect cost of human and animal health care (Trail et ah, 1995). Strict legislation will protect the public health in developed countries however, many countries do not have such legislation or testing capacity. Even if such legislation and testing could be implemented, they would reduce the health risk but could not eliminate large-scale economic losses similar to those currently faced by the U.S., the European Union, and other developed countries. 

In many developing countries of the world, there is still a major reliance on crude drug preparation of plants used in traditional medicines for their primary health care. Pharmacognosists employed in the different institutions are aware of the changing trends of herbal medications and a number of useful texts on the analysis, uses, and potential toxicities of herbal remedies have appeared recently, which serves as useful guides in pharmacy practice. The history of medicine includes many ludicrous therapies. Nevertheless, ancient wisdom has been the basis of modem medicine and will remain as one important source of future medicine and therapeutics. The future of natural products drug discovery will be more holistic, personahzed and involve the wise use of ancient and modem therapeutic skills in a complementary manner so that maximum benefits can be accmed to the patients and the community. 

Helicobacter pylori infections are now also accepted as the primary cause of peptic ulcer disease (PUD). In the US, approximately four to five million people suffer from PUD, and the economic consequences of the disease are responsible for as much as 3 to 4 billion in annual health care costs. The situation is even more serious in many developing countries, where HP infections, PUD and gastric cancer are major causes of morbidity. 

In developed countries, the discovery of new medicines and their introduction in the existing health care system during the second part of the last century has dramatically improved health, reducing mortality and morbidity from many common diseases. The society in general have benefited from these advances through the regular access to the needed medicines in their health care system. However, in many developing countries the needed essential medicines are not always available, accessible and affordable to those in need. 

The discovery of new medicines and their introduction into the market will not optimally have positive impacts on health if the needed essential medicines are not available and affordable, if they are not of good quality and if they are not properly utilized by the health care providers and consumers. This chapter will highlight the issues related to commonly occurring problems in the area of medicines in developing countries, and relevant policies and programme to deal with them. In particular, the chapter will highlight the problems of access to... 

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