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Implementation Road Map of Health Technology Assessment in Middle-Income Countries: The Case of Jordan

Almomani E, Alabbadi I, Fasseeh A, Al-Qutob R, Al-Sharu E, Hayek N, et al.

Value Health Reg Issues, 2021 Sep;25:126-134.
PMID: 34015521 DOI: 10.1016/j.vhri.2021.01.003

OBJECTIVES: Health technology assessment (HTA) can increase the appropriateness and transparency of pricing and reimbursement decisions. Jordan is still in the early phase of its HTA implementation, although the country has very limited public resources for the coverage of healthcare technologies. The study objective was to explore and validate priorities in the HTA road map for Jordan and propose to facilitate the preferred HTA status.
METHODS: Health policy experts from the public and private sectors were asked to participate in a survey to explore the current and future status of HTA implementation in Jordan. Semistructured interviews with senior policy makers supported by literature review were conducted to validate survey results and make recommendations for specific actions.
RESULTS: Survey and interview results indicated a need for increased HTA training, including both short courses and academic programs and gradually increasing public funding for technology assessment and appraisal. Multiple HTA bodies with central coordination can be the most feasible format of HTA institutionalization. The weight of cost-effectiveness criterion based on local data with published reports and explicit decision thresholds should be increased in policy decisions of pharmaceutical and nonpharmaceutical technologies.
CONCLUSION: Currently, HTA has limited impact on health policy decisions in Jordan, and when it is used to support pharmaceutical reimbursement decisions, it is mainly based on results from other countries without considering transferability of international evidence. Policy makers should facilitate HTA institutionalization and use in policy decisions by increasing the weight of local evidence in HTA recommendations.

Matched MeSH terms: Developing Countries*
HPV information needs, educational messages and channel of delivery preferences: views from developing country with multiethnic populations

Wong LP

Vaccine, 2009 Feb 25;27(9):1410-5.
PMID: 19150379 DOI: 10.1016/j.vaccine.2008.12.045

This qualitative study used focus group discussions (FGDs) to evaluate information needed in order to make informed human papillomavirus (HPV) vaccination decision, opinion on the most acceptable public education messages, and channel of delivery in a multiethnic, multicultural and multireligion country. A total of 19 FGDs were conducted among mothers of eligible vaccinees, young women eligible for the vaccine, and men. Messages that carry accurate information about HPV-cervical cancer link, the HPV preventive vaccines and at the same time minimize the stigma of a sexually transmitted infection (STI) vaccine were preferred. Educational messages for future HPV educational intervention were developed and methods to effectively convey to the public the need for HPV vaccination were identified. The findings serve as a basis for future intervention to develop research-based communication materials and strategies.

Matched MeSH terms: Developing Countries
Physicians' experiences with HPV vaccine delivery: evidence from developing country with multiethnic populations

Wong LP

Vaccine, 2009 Mar 4;27(10):1622-7.
PMID: 19100803 DOI: 10.1016/j.vaccine.2008.11.107

Physicians' experiences in providing human papillomavirus (HPV) immunization were assessed by mailed questionnaire. Response rate of 41.4% was achieved. Malay Muslim physicians were more likely to agree that cultural sensitivity is an issue when recommending HPV vaccines. Pediatricians and family physicians were more likely to agree that acceptance is better if vaccines were recommended to prevent cervical cancer than to prevent a sexually transmitted disease. Near 70% rated success of HPV vaccines recommendation in their practice as very poor with the majority patients preferred to postpone immunization. Physicians reported cultural disparities in vaccine uptake and perceived high vaccination cost limits its use.

Matched MeSH terms: Developing Countries
Fulltext Cholera in selected countries in Asia

Lopez AL, Dutta S, Qadri F, Sovann L, Pandey BD, Bin Hamzah WM, et al.

Vaccine, 2020 02 29;38 Suppl 1:A18-A24.
PMID: 31326255 DOI: 10.1016/j.vaccine.2019.07.035

INTRODUCTION: Although the current pandemic of cholera originated in Asia, reports of cholera cases and outbreaks in the region are sparse. To provide a sub-regional assessment of cholera in South and Southeast Asia, we collated published and unpublished data from existing surveillance systems from Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam.
METHODS: Data from existing country surveillance systems on diarrhea, acute watery diarrhea, suspected cholera and/or confirmed cholera in nine selected Asian countries (Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam) from 2011 to 2015 (or 2016, when available) were collated. We reviewed annual cholera reports from WHO and searched PubMed and/or ProMED to complement data, where information is not completely available.
RESULTS: From 2011 to 2016, confirmed cholera cases were identified in at least one year of the 5- or 6-year period in the countries included. Surveillance for cholera exists in most countries, but cases are not always reported. India reported the most number of confirmed cases with a mean of 5964 cases annually. The mean number of cases per year in the Philippines, Pakistan, Bangladesh, Malaysia, Nepal and Thailand were 760, 592, 285, 264, 148 and 88, respectively. Cambodia and Vietnam reported 51 and 3 confirmed cholera cases in 2011, with no subsequent reported cases.
DISCUSSION AND CONCLUSION: We present consolidated results of available surveillance in nine Asian countries and supplemented these with publication searches. There is paucity of readily accessible data on cholera in these countries. We highlight the continuing existence of the disease even in areas with improved sanitation and access to safe drinking water. Continued vigilance and improved surveillance in countries should be strongly encouraged.

Matched MeSH terms: Developing Countries
Landscaping analysis of immunization progress and program structures in selected middle income Southeast Asian countries

Basa JE, Clemens R, Clemens SAC, Nicholson M

Vaccine, 2024 Apr 02;42(9):2326-2336.
PMID: 38448324 DOI: 10.1016/j.vaccine.2024.02.047

This study examined the performance and structures of national immunization program in five middle-income Southeast Asian countries - Malaysia, Thailand, Philippines, Viet Nam, and Myanmar, and analyzed how the different structures relate to the difference in program performance to identify effective strategies in the study countries that facilitated good immunization performance. Data were derived from published literature, and WHO/UNICEF/Gavi databases, with 2010 as the baseline year. UMICs Malaysia and Thailand maintained ≥90 % coverage from 2010 to 2020 and even during the COVID-19 pandemic in 2021. LMICs Viet Nam and donor-supported Myanmar also achieved 80-90 % coverage for most routine vaccines in 2020. The Philippines have not reached ≥90 % coverage since 2010, with the maximum only 72 % (MCV1 and Polio3) in 2020. All study countries prioritize immunization and increased government financing since 2010 by minimum 91 % in Malaysia and 1897 % in Myanmar. However, Myanmar still largely depended on donor support with government financing only 32 % of immunization costs in 2021. The Philippines funds 100 % of immunization costs and ensures sustainable financing for the NIP through earmarked "sin tax" revenues from alcohol and tobacco. Donor support influenced new vaccine introductions among the study countries, with Gavi countries Myanmar and Viet Nam introducing more new vaccines, compared to Gavi-ineligible Malaysia and Thailand. The Philippines reported vaccine stock-outs every year amounting to 28 stock-outs events from 2010 to 2019, compared to only 1-4 stockouts in the other study countries. Donor support, innovative financing, and domestic vaccine manufacturing all play an important role in the efficient delivery of immunization services as demonstrated by the several new vaccine introductions and high immunization rates in Myanmar though Gavi and UNICEF support, additional annual $1.2 billion budget for health and immunization from "sin taxes" in the Philippines, and lack of stockouts for vaccines sourced at affordable prices from domestic manufacturers in Viet Nam.

Matched MeSH terms: Developing Countries
A comparison of urban migration in Sarawak and the Philippines

Sutlive V

Urban anthropol, 1977;6(4):355-69.
PMID: 12310786
Matched MeSH terms: Developing Countries
Agriculture: access to technology limited

UN Chron, 1997;34(4):58.
PMID: 12293737

From country to country and even regionally, the roles of women in agriculture vary, but most of their labor is in unpaid subsistence production and their contributions tend to be underestimated, according to the results of the [UN] Secretary-General's report. Depending on circumstances, they have complementary roles with men, sharing or dividing tasks in the production of crops, care of animals, and forestry management. In sub-Saharan Africa, for example, women contribute 60-80% of labor in food production for both household consumption and sale, while in Malaysia the women account for only 35% of the agricultural labor force, and in Ireland the participation rate is only 10.4%. Although women make this important amount of labor contributions to agricultural production, "development policies tend to favor export crops to earn foreign exchange and the agricultural research tends to address the improvement of production and technologies for commercial production". This results in limited access for women to technical knowledge and innovations, including irrigation, machinery, farming techniques and extension services. This is strengthened by the fact that most of the extension services target farmers who own land and can obtain credit to invest in input and technology.

Matched MeSH terms: Developing Countries*
Larger than life: billboard communication in Southeast Asia

Barnard B

UFSI Rep, 1983.
PMID: 12339664
Matched MeSH terms: Developing Countries
Fulltext Revisiting the global problem of cryptosporidiosis and recommendations

Shrivastava AK, Kumar S, Smith WA, Sahu PS

Trop Parasitol, 2017 Jan-Jun;7(1):8-17.
PMID: 28459010 DOI: 10.4103/2229-5070.202290

Cryptosporidiosis is a gastrointestinal illness caused by the protozoan parasite Cryptosporidium species, which is a leading cause of diarrhea in a variety of vertebrate hosts. The primary mode of transmission is through oral routes; infections spread with the ingestion of oocysts by susceptible animals or humans. In humans, Cryptosporidium infections are commonly found in children and immunocompromised individuals. The small intestine is the most common primary site of infection in humans while extraintestinal cryptosporidiosis occurs in immunocompromised individuals affecting the biliary tract, lungs, or pancreas. Both innate and adaptive immune responses play a critical role in parasite clearance as evident from studies with experimental infection in mice. However, the cellular immune responses induced during human infections are poorly understood. In this article, we review the currently available information with regard to epidemiology, diagnosis, therapeutic interventions, and strategies being used to control cryptosporidiosis infection. Since cryptosporidiosis may spread through zoonotic mode, we emphasis on more epidemiological surveillance-based studies in developing countries with poor sanitation and hygiene. These epidemiological surveys must incorporate fecal source tracking measures to identify animal and human populations contributing significantly to the fecal burden in the community, as mitigation measures differ by host type.

Matched MeSH terms: Developing Countries
Poverty and mortality among the elderly: measurement of performance in 33 countries 1960-92

Wang J, Jamison DT, Bos E, Vu MT

Trop Med Int Health, 1997 Oct;2(10):1001-10.
PMID: 9357491

This paper analyses the effect of income and education on life expectancy and mortality rates among the elderly in 33 countries for the period 1960-92 and assesses how that relationship has changed over time as a result of technical progress. Our outcome variables are life expectancy at age 60 and the probability of dying between age 60 and age 80 for both males and females. The data are from vital-registration based life tables published by national statistical offices for several years during this period. We estimate regressions with determinants that include GDP per capita (adjusted for purchasing power), education and time (as a proxy for technical progress). As the available measure of education failed to account for variation in life expectancy or mortality at age 60, our reported analyses focus on a simplified model with only income and time as predictors. The results indicate that, controlling for income, mortality rates among the elderly have declined considerably over the past three decades. We also find that poverty (as measured by low average income levels) explains some of the variation in both life expectancy at age 60 and mortality rates among the elderly across the countries in the sample. The explained amount of variation is more substantial for females than for males. While poverty does adversely affect mortality rates among the elderly (and the strength of this effect is estimated to be increasing over time), technical progress appears far more important in the period following 1960. Predicted female life expectancy (at age 60) in 1960 at the mean income level in 1960 was, for example 18.8 years; income growth to 1992 increased this by an estimated 0.7 years, whereas technical progress increased it by 2.0 years. We then use the estimated regression results to compare country performance on life expectancy of the elderly, controlling for levels of poverty (or income), and to assess how performance has varied over time. High performing countries, on female life expectancy at age 60, for the period around 1990, included Chile (1.0 years longer life expectancy), China (1.7 years longer), France (2.0 years longer), Japan (1.9 years longer), and Switzerland (1.3 years longer). Poorly performing countries included Denmark (1.1 years shorter life expectancy than predicted from income), Hungary (1.4 years shorter), Iceland (1.2 years shorter), Malaysia (1.6 years shorter), and Trinidad and Tobago (3.9 years shorter). Chile and Switzerland registered major improvements in relative performance over this period; Norway, Taiwan and the USA, in contrast showed major declines in performance between 1980 and the early 1990s.

Matched MeSH terms: Developing Countries/statistics & numerical data*
Fulltext Toxicity of Chlorophyllin against Lymnaea acuminata at Different Wavelengths of Visible Light

Chaturvedi D, Singh VK

Trop Life Sci Res, 2016 Aug;27(2):25-36.
PMID: 27688849 DOI: 10.21315/tlsr2016.27.2.3

Fasciolosis is a water and food-borne disease caused by the liver fluke Fasciola hepatica and Fasciola gigantica. This disease is widespread in different parts of the world. Lymnaeidae and Planorbidae snails are the intermediate hosts of these flukes. Snail population management is a good tool to control fasciolosis because gastropods represent the weakest link in the life-cycle of trematodes. Chlorophyll can be extracted from any green plant. Chlorophyllin was prepared from spinach in 100% ethanol by using different types of chemicals. The chlorophyll obtained from spinach was transformed into water-soluble chlorophyllin. In the present paper, toxicity of chlorophyllin against the snail Lymnaea acuminata was time and concentration dependent. The toxicity of extracted and pure chlorophyllin at continuous 4 h exposure of sunlight was highest with lethal concentration (LC50) of 331.01 mg/L and 2.60 mg/L, respectively, than discontinuous exposure of sunlight up to 8 h with LC50 of 357.04 mg/L and 4.94 mg/L, respectively. Toxicity of extracted chlorophyllin was noted in the presence of different monochromatic visible lights. The highest toxicity was noted in yellow light (96 h, LC50 392.77 mg/L) and the lowest in green light (96 h, LC50 833.02 mg/L). Chlorophyllin in combination with solar radiation or different wavelength of monochromatic visible lights may become a latent remedy against the snail L. acuminata. It was demonstrated that chlorophyllin was more toxic in sunlight. Chlorophyllin is ecologically safe and more economical than synthetic molluscicides which have the potential to control the incidence of fasciolosis in developing countries.

Matched MeSH terms: Developing Countries
Excision biopsy of lymph node--needle fixing technique

Arumainathan U, Kumar M, Raman R

Trop Doct, 2003 Jan;33(1):31.
PMID: 12568517
Matched MeSH terms: Developing Countries
The partograph in community obstetrics

Lennox CE, Kwast BE

Trop Doct, 1995 Apr;25(2):56-63.
PMID: 7778195
Matched MeSH terms: Developing Countries*
Fulltext Important zoonotic intestinal protozoan parasites in Asia

Mak JW

Trop Biomed, 2004 Dec;21(2):39-50.
PMID: 16493397

Intestinal protozoa are increasingly being studied because of their association with acute and chronic diarrhoea in immunocompromised as well as immunocompetent patients. Various community outbreaks due to contamination of water or food with these protozoa have further highlighted their importance in public health. Among these important pathogens are Giardia duodenalis, Entamoeba histolytica, Cryptosporidium parvum, Cyclospora cayetanensis, Isospora belli, and microsporidia. Except for the cyst-forming G. duodenalis and E. histolytica, the others are intracellular and form spores which are passed out with the faeces. These organisms are also found in various animals and birds and zoonotic transmission is thought to occur. These infections are distributed worldwide, with a higher prevalence in developing compared to developed countries. However, the relative importance of zoonotic infections especially in developing countries has not been studied in detail. The prevalence rates are generally higher in immunodeficient compared to immunocompetent patients. Higher prevalence rates are also seen in rural compared to urban communities. Most studies on prevalence have been carried out in developed countries where the laboratory and other health infrastructure are more accessible than those in developing countries. This relative inadequacy of laboratory diagnosis can affect accurate estimates of the prevalence of these infections in developing countries. However, reports of these infections in travellers and workers returning from developing countries can provide some indication of the extent of these problems. Most studies on prevalence of amoebiasis in developing countries were based on morphological identification of the parasite in faecal smears. As the pathogenic E. histolytica is morphologically indistinguishable from that of non-pathogenic E. dispar, estimates of amoebiasis may not be accurate. The epidemiology of human microsporidia infections is not completely understood. Two species, Enterocytozoon bieneusi and Encephalitozoon intestinalis, are associated with gastrointestinal disease in humans and it is believed that human to human as well as animal to human infections occur. However, the importance of zoonotic infections has not been fully characterised. G. duodenalis cysts, microsporidia and Cryptosporidium oocysts have been detected in various ground water resources, but their role in community outbreaks and maintenance of the infection has not been fully characterised. The taxonomic classification and pathogenic potential of B. hominis are still controversial. While considered by many as yeast, fungi or protozoon, recent sequence analysis of the complete SSUrRNA gene has placed it within an informal group, the stramenopiles. This review covers recent published data on these zoonotic infections and examines their public health importance in Asian countries.

Matched MeSH terms: Developing Countries
Diagnostics of intestinal parasites by light microscopy among the population of children between the ages of 4-12 in eastern Turkey

Babat SO, Sirekbasan S, Macin S, Kariptas E, Polat E

Trop Biomed, 2018 Dec 01;35(4):1087-1091.
PMID: 33601855

Intestinal parasitic infections are among important health problems in developing countries. In societies living in low socioeconomic conditions, it has been neglected and mostly affects children. It is important to determine the prevalence and type of intestinal parasites in order to determine the intervention strategies for these infections. Therefore, the aim of this study is to evaluate intestinal parasite prevalence and IgE levels and the factors associated with the region in which the children population live, in Sirnak province, in the eastern of Turkey. A total of 357 symptomatic children aged 4 to 12 years, who were admitted to the Paediatric Polyclinic of Sirnak State Hospital, were examined prospectively. The collected stool samples were examined with direct wet-mount and concentration method under light microscope. In addition, total serum IgE levels were compared among 223 children with parasitic disease and 134 children without parasitic disease. One or more intestinal parasites were detected in 223 out of the 357 children participating in the study. The ratio of single, double, and triple parasitic infections in children was 32.5 %, 22.4 % and 7.6 %, respectively. The most common parasites determined in the study were Taenia spp. (39.9%), Enterobius vermicularis (38.6%) and Giardia intestinalis. (30 %). The difference between IgE levels determined in both groups was not regarded to be statistically significant. This study indicated that that intestinal polyparism is very common in children living in the province of Sirnak, which is located in the east of Turkey, neighbouring Iraq and Syria in the South. For this reason, sustainable control measures are urgently needed to improve personal hygiene and sanitation, to provide a healthy infrastructure and to improve the quality of existing water resources.

Matched MeSH terms: Developing Countries
Poverty related diseases amongst Malaysia's low-income community: a review

Abu Bakar N, Sahimin N, Lim YAL, Ibrahim K, Mohd Zain SN

Trop Biomed, 2023 Mar 01;40(1):65-75.
PMID: 37356005 DOI: 10.47665/tb.40.1.013

Poverty, as proven by several studies, is a driving force behind poor health and hygiene practices. This review attempts to outline common communicable and non-communicable diseases that disproportionately affect Malaysia's 2.91 million low-income households. The current study also looks into the government's housing and healthcare programmes for this demographic to improve their health and well-being. The initial examination yielded incredibly little research on this marginalised community, with event reporting typically generalised to the Malaysian community as a whole rather than analysing disease incidences based on household income, which would better reflect povertydriven diseases. As a result, there is an acute need for more accurate information on the epidemiology of diseases among the poor in order to address this public health issue and provide conclusions that can drive policy designs.

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*
A coordinated research programme to develop methodologies for an integrated approach to improve small scale market oriented dairy systems in developing countries

Perera BM

Trop Anim Health Prod, 2007 Dec;39(8):543-8.
PMID: 18265863

A five-year Coordinated Research Project (CRP) entitled 'Integrated approach for improving small scale market oriented dairy systems' is currently being implemented by the Food and Agriculture Organization and the International Atomic Energy Agency, through their Joint Programme on 'Nuclear Techniques in Food and Agriculture'. The objectives are to (a) identify and prioritize the constraints and opportunities in the selected dairy farms; (b) determine the most important limiting factors; (c) develop intervention strategies; (c) assess the economic impact of the interventions; (d) develop methodologies for recording and demonstrating the economic impact; and (e) promote the adoption and dissemination of proven strategies and methodologies. Fifteen institutes in developing as well as developed countries are participating in the project, through ten research contracts (Bangladesh, Cameroon, Pakistan, Paraguay, Peru, South Africa, Sri Lanka, Tanzania, Tunisia and Venezuela), one technical contract (Peru) and four research agreements (Malaysia, U.K., U.S.A. and Uruguay). The initial phase of the project, which focused on the conduct of Participatory Rural Appraisals and Economic Opportunity Surveys in the countries of the research contract holders, has now been completed. This paper describes the background to the CRP approach and the procedures used for developing, initiating and implementing this project.

Matched MeSH terms: Developing Countries
Health problems of agricultural workers in Malaysia

Lim HH

Trop Geogr Med, 1983 Mar;35(1):83-9.
PMID: 6612777

The present paper reviews the health problems of rural agricultural workers in Malaysia. As is common with most developing countries, the agricultural sector forms the pillar of the national economy in Malaysia, the major products being rubber, palm oil, rice and timber. Most of the agricultural workers, who form the largest occupational group in the country, live in the rural areas under poor socioeconomic and environmental conditions. Their general health problems include large families, substandard housing, overcrowding, lack of piped water supply and sanitary excreta disposal, malnutrition and prevalent diseases such as cholera, typhoid, dysentery and parasitic infections. The specific occupational health problems include infectious diseases, agricultural accidents, pesticide poisonings, physical hazards, keratitis nummularis and snake-bites. The organization of agricultural health services in developing countries is also discussed.

Matched MeSH terms: Developing Countries
Pneumonia and diarrhoeas: killers of toddlers in developing countries

Chen ST

Trop Geogr Med, 1975 Mar;27(1):103-8.
PMID: 806152

Pneumonia and diarrhoeas are an important cause of toddler mortality and morbidity in developing countries. Of the 147 children admitted to the University Hospital at Kuala Lumpur in 1971 for pneumonia and diarrhoeas 50 (34%) were found to be suffering from protein-calorie malnutrition of varying degrees of severity. The malnourished children tended to come from poorer homes, and to have a larger number of siblings born in rapid succession when compared with normal weight children. Anemia was more common among the malnourished children. The interaction of infection and malnutrition and the social implications of these diseases are important. It is vital that hospitals in developing countries promote health in addition to their traditional curative role.

Matched MeSH terms: Developing Countries

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