The problems with management of haemophilia in developing countries are poor awareness, inadequate diagnostic facilities and scarce factor concentrates for therapy. The priorities in establishing services for haemophilia include training care providers, setting up care centres, initiating a registry, educating affected people and their families about the condition, providing low-cost factor concentrates, improving social awareness and developing a comprehensive care team. A coagulation laboratory capable of reliably performing clotting times with correction studies using normal pooled, FVIII and FIX deficient patient plasma and factor assay is most essential for diagnosis. More advanced centralized laboratories are also needed. Molecular biology techniques for mutation detection and gene tracking should be established in each country for accurate carrier detection and antenatal diagnosis. Different models of haemophilia care exists. In India, there is no support from the government. Services, including import of factor concentrates, are organized by the Haemophilia Federation of India, with support from other institutions. Haemophilia is managed with minimal replacement therapy (about 2000 i.u./PWH/year). In Malaysia, where the system is fully supported by the government, facilities are available at all public hospitals and moderate levels of factor concentrates are available 'on-demand' (about 11,000 i.u./PWH/year) at the hospitals. Haemophilia care in South Africa is provided through major public hospitals. Intermediate purity factor concentrates are locally produced (about 12,000 i.u./PWH/year) at low cost. The combined experience in the developing world in providing haemophilia services should be used to define standards for care and set achievable goals.
This article examines two strands of discourse on wild capture fisheries; one that focuses on resource sustainability and environmental impacts, another related to food and nutrition security and human well-being. Available data and research show that, for countries most dependent on fish to meet the nutritional requirements of their population, wild capture fisheries remain the dominant supplier. Although, contrary to popular narratives, the sustainability of these fisheries is not always and everywhere in crisis, securing their sustainability is essential and requires considerable effort across a broad spectrum of fishery systems. An impediment to achieving this is that the current research and policy discourses on environmental sustainability of fisheries and food security remain only loosely and superficially linked. Overcoming this requires adoption of a broader sustainability science paradigm to help harness synergies and negotiate tradeoffs between food security, resource conservation, and macroeconomic development goals. The way society chooses to govern fisheries is, however, an ethical choice, not just a technical one, and we recommend adding an ethical dimension to sustainability science as applied to fisheries.
The author spent 6 months as director of a major university hospital accident and emergency department in Kuala Lumpur, Malaysia. A brief summary of this experience is provided, followed by a series of recommendations based on the experience that may provide some guidance in future efforts to establish emergency medicine in developing areas of the world.
BACKGROUND: The rising burden of cancer in the developing world calls for a re-evaluation of the treatment strategies employed to improve patient management, early detection and understanding of the disease. There is thus an increasing demand for interdisciplinary research that integrates two or more disciplines of what may seemed to be highly unrelated and yet very much needed as strategies for success in research. This paper presents the processes and barriers faced in building partnerships in oral cancer research in a developing country.
METHODS: A case study was undertaken in a developing country (Malaysia) to assess the strengths and weaknesses of the situation leading to the formation of a multidisciplinary research partnership in oral cancer. Following the formalization of the partnership, further evaluation was undertaken to identify measures that can assist in sustaining the partnership.
RESULTS: The group identifies its strength as the existence of academia, research-intensive NGOs and good networking of clinicians via the existence of the government's network of healthcare provider system who are the policy makers. The major weaknesses identified are the competing interest between academia and NGOs to justify their existence due to the lack of funding sources and well trained human resources.
CONCLUSIONS: With the growing partnership, the collaborative group recognizes the need to develop standard operating procedures (SOPs) and guidelines for the sharing and usage of resources in order to safeguard the interest of the original partners while also attending to the needs of the new partners.
Radiology is a relatively high-cost and high-maintenance aspect of medicine. Expertise is constantly required, from acquisition to its use and quality assurance programmes. However, it is an integral part of healthcare practice, from disease diagnosis, surveillance and prevention to treatment monitoring. It is alarming that two thirds of the world is deficient in or lacks even basic diagnostic imaging. Developing and underdeveloped countries need help in improving medical imaging. Help is coming from various organisations, which are extending hands-on teaching and imparting knowledge, as well as training trainers to increase the pool of skilled practitioners in the use of imaging equipment and other aspects of radiology services. The scene for social radiology is changing and set to positively impact the world in the (near) future.
The paper examines the impacts of financial development on sectoral carbon emissions (CO2) for environmental quality in Malaysia. Since the financial sector is considered as one of the sectors that will contribute to Malaysian economy to become a developed country by 2020, we utilize a cointegration method to investigate how financial development affects sectoral CO2 emissions. The long-run results reveal that financial development increases CO2 emissions from the transportation and oil and gas sector and reduces CO2 emissions from manufacturing and construction sectors. However, the elasticity of financial development is not significant in explaining CO2 emissions from the agricultural sector. The results for short-run elasticities were also consistent with the long-run results. We conclude that generally, financial development increases CO2 emissions and reduces environmental quality in Malaysia.
Health Informatics (HI) has become a world wide issue since 2005 when the WHO Health Metrics Network (HMN) was formed to encourage all of the developing countries (151) to get started in eHealth. Prior to this HMN initiative the only countries with HI in place were the developed countries (40) and a few developing countries (Jamaica, Malaysia, etc.) that were just getting started in HI with a very limited number of applications compared to the developed countries. This paper suggests that much of the experience in HI gained in the developed countries can be shared with the developing countries as 'lessons learnt' - as long as the issue of economics is kept front and foremost in the planning.
Effective population-level solutions to the obesity pandemic have proved elusive. In low- and middle-income countries the problem may be further challenged by the perceived internal tension between economic development and sustainable solutions which create the optimal conditions for human health and well-being. This paper discusses some of the ecological obstacles to addressing the growing problem of obesity in 'aspiring' economies, using Malaysia as a case study. The authors conclude that current measures to stimulate economic growth in Malaysia may actually be exacerbating the problem of obesity in that country. Public health solutions which address the wider context in which obesity exists are needed to change the course of this burgeoning problem.