Reproductive technologies in developing countries

Are there any ethical concerns about reproductive technologies that are specific or unique to developing countries? Three ethical concerns often mentioned specifically in regard to developing countries are (1), the "overpopulation argument"; (2) the limited resources argument; and (3) the ethical problem of poorly trained practitioners offering their services to unsuspecting and uninformed infertile individuals or couples. Each argument is explored in some detail, with the conclusion that ethical problems do, in fact, exist but are not unique to developing countries. Nevertheless, the difficulties relating to reproductive technologies are likely to be greater in developing countries than in developed ones because of limited resources and a larger number of poor people residing there.     

Intergenerational healthcare inequities in developing countries

Concern about the rapid ageing of all societies reaches alarming proportions as healthcare inequities are steeply rising, prompting the elderly to live longer but subject to insufficient social protection and healthcare in the wake of dwindling public resources. The aged population of developing nations are facing additional hardships due to the growing gap between needs and the financial reductions of public institutions, retirement funds, and the trend towards privatization of essential services turned into commodities. Current approaches to allocation of insufficient resources without ageist discrimination are briefly discussed: individual self‐care aimed at successful, active and healthy ageing based on resourcefulness of the privileged elderly; utilitarian approaches founded on QALY and fair innings, and human rights focused on the plights of the elderly. These approaches cannot apply to resources poor nations, who need to engage in context‐bound bioethics dealing with the realities of their exposed ageing population. A developing world bioethics is needed to face the plights of the elderly in countries with low and middle‐income and insufficient social capital. Suggested are: 1) a phenomenological approach based on the interaction of bioethics and ethnology, furthering grass‐roots input from the elderly; 2) Create small communities –campus‐like boroughs– to simplify accessibility to social services and healthcare facilities, as an alternative to the high‐cost WHO proposal of age‐friendly large cities.     

Affordable assisted reproductive technologies in developing countries: pros and cons

¹ Correspondence address. E-mail: akandewole{at}yahoo.com Infertility in developing countries is pervasive and a seriousconcern. In addition to the personal grief and suffering itcauses, the inability to have children especially in poor communitiescan create broader problems, particularly for the woman. Infertilityservices in developing countries span the spectrum from preventionto treatment. From a societal and public health standpoint,prevention is cost–effective and is considered by manygovernments and public health care providers to be a priorityfor service delivery. While prevention remains paramount, takenalone it ignores the plight of infertile couples, includingthose with non-infectious causes of infertility. Two key argumentsare frequently used to challenge the development of new reproductivetechnologies in developing countries: overpopulation and limitedresources. Evidence supports the conclusion that there is acompelling need for infertility treatment beyond prevention.In many instances, assisted reproductive technologies (ART)are the last hope or the only means to achieve a child for couples.In an effort to make much needed ART to developing countriesaccessible and affordable, developing countries should lookto public–private partnerships. Governments have a responsibilityto ensure safe and effective services including the controlof standards for clinical procedures and the regulation of professionalpractice.     

Joint venture capital investment for clean technologies and their problems in developing countries

All technological developments are aimed at improving the quality of life of a community of people. Biotechnology is a technology which allows the exploitation of microorganisms, plants and animal cells to take place within an economic framework. Developing countries are looking for programmes achieving sustainable, economical growth conducive to a higher per capita income of the community. Any joint venture which promises social advances and economic benefits will have to be rural-based. This presentation discusses the need for a change in fermentation industry attitudes to allow joint venture capital investment in clean technologies together with the problems developing countries face for the implementation of such technologies.The author is with MIRCEN-Biotechnology Brisbane and the Pacific Regional Network, Department of Microbiology, University of Queensland, St. Lucia 4072, Australia     

Evaluation of existing sustainable infrastructure rating systems for their application in developing countries

Several sustainable building rating systems were created worldwide during the last decades due to economic growth and the significance of environmental impact associated with the building industry. Similar infrastructure rating tools have started to be developed and implemented, being highly necessary to promote its development. Even though the existing sustainable infrastructure rating systems are focused on advanced economies, growing environmental concerns are increasing the need for new systems in the Developing World. This research analyses some of the mainstream infrastructure rating frameworks such as Envision (USA), Civil Engineering Environmental Quality (CEEQUAL) assessment (UK) and Infrastructure Sustainability (IS) Rating Tool (Australia) from the perspective of the Triple Bottom Line (economy, environment and society), in order to determine the effectiveness of their application in the context of the least developed countries. The analysis revealed that the three tools are biased towards the environmental dimension and are mainly oriented to developed countries. Consequently, the foundations on which these systems are based need to be further developed and enhanced to be of real relevance in poorer nations by balancing the weight of sustainable pillars, incorporating effective management guidelines and development goals set by United Nations declarations, and considering impacts beyond the single project framework.     

Diabetes research for developing countries

EAGLES investigations into the specific needs for diabetes research in developing countries, and Europe's potential to support that research [European Union and Diabetes http://ec.europa.eu/health/ph_information/dissemination/diseases/diabetes_en.htm, EU Research on Diabetes http://ec.europa.eu/research/leaflets/diabetes/index_en.html] reach nine major conclusions. In each case, they involve tuning European research to have the greatest impact in the shortest possible time, by understanding and respecting developing countries' conditions of health, politics and economics. Major recommendations arise from the lack of national population-based epidemiology to enable planning and convince political powers of the need for action; from countries' low healthcare budgets, entailing needs for the cheapest possible interventions; from the need to investigate interventions specifically tuned to national circumstances; and finally from the needs for specific local biomedical research, such as studies into the several unique African phenotypes of the disease. The details of our nine recommendations can be seen at the end of the report.     

Rabies diagnosis for developing countries

Background

Canine rabies is a neglected disease causing 55,000 human deaths worldwide per year, and 99% of all cases are transmitted by dog bites. In N''Djaména, the capital of Chad, rabies is endemic with an incidence of 1.71/1,000 dogs (95% C.I. 1.45–1.98). The gold standard of rabies diagnosis is the direct immunofluorescent antibody (DFA) test, requiring a fluorescent microscope. The Centers for Disease Control and Prevention (CDC, Atlanta, United States of America) developed a histochemical test using low-cost light microscopy, the direct rapid immunohistochemical test (dRIT).

Methodology/Principal Findings

We evaluated the dRIT in the Chadian National Veterinary Laboratory in N''Djaména by testing 35 fresh samples parallel with both the DFA and dRIT. Additional retests (n = 68 in Chad, n = 74 at CDC) by DFA and dRIT of stored samples enhanced the power of the evaluation. All samples were from dogs, cats, and in one case from a bat. The dRIT performed very well compared to DFA. We found a 100% agreement of the dRIT and DFA in fresh samples (n = 35). Results of retesting at CDC and in Chad depended on the condition of samples. When the sample was in good condition (fresh brain tissue), we found simple Cohen''s kappa coefficient related to the DFA diagnostic results in fresh tissue of 0.87 (95% C.I. 0.63–1) up to 1. For poor quality samples, the kappa values were between 0.13 (95% C.I. −0.15–0.40) and 0.48 (95% C.I. 0.14–0.82). For samples stored in glycerol, dRIT results were more likely to agree with DFA testing in fresh samples than the DFA retesting.

Conclusion/Significance

The dRIT is as reliable a diagnostic method as the gold standard (DFA) for fresh samples. It has an advantage of requiring only light microscopy, which is 10 times less expensive than a fluorescence microscope. Reduced cost suggests high potential for making rabies diagnosis available in other cities and rural areas of Africa for large populations for which a capacity for diagnosis will contribute to rabies control.     

Biomedical training for developing countries

A conference on this topic sponsored by the International Union of Biochemistry and Molecular Biology (IUBMB) was held in Oxford on 11 and 12 April 1995 under the auspices of the Oxford International Biomedical Centre (OIBC)     

Hemovigilance in developing countries

Hemovigilance like quality systems and audits has become an integral part of the Blood Transfusion Service (BTS) in the developed world and has contributed greatly to the development of the blood service. However developing countries are still grappling with donor recruitment and efforts towards sufficiency and safety of the blood supply. In these countries the BTS is generally fragmented and a national hemovigilance program would be difficult to implement. However a few developing countries have an effective and sustainable blood program that can deliver equitable, safe and sufficient blood supply to the nation. Different models of hemovigilance program have been introduced with variable success. There are deficiencies but the data collected provided important information that can be presented to the health authorities for effective interventions.Hemovigilance program modeled from developed countries require expertise and resources that are not available in many developing countries. Whatever resources that are available should be utilized to correct deficiencies that are already apparent and obvious. Besides there are other tools that can be used to monitor the blood program in the developing countries depending on the need and the resources available. More importantly the data collected should be accurate and are used and taken into consideration in formulating guidelines, standards and policies and to affect appropriate interventions. Any surveillance program should be introduced in a stepwise manner as the blood transfusion service develops.