Biotechnology to improve health in developing countries -- a review

The growing health disparities between the developing and the developed world call for urgent action from the scientific community. Science and technology have in the past played a vital role in improving public health. Today, with the tremendous potential of genomics and other advances in the life sciences, the contribution of science to improve public health and reduce global health disparities is more pertinent than ever before. Yet the benefits of modern medicine still have not reached millions of people in developing countries. It is crucial to recognize that science and technology can be used very effectively in partnership with public health practices in developing countries and can enhance their efficacy. The fight to improve global health needs, in addition to effective public health measures, requires rapid and efficient diagnostic tools; new vaccines and drugs, efficient delivery methods and novel approaches to therapeutics; and low-cost restoration of water, soil and other natural resources. In 2002, the University of Toronto published a report on the "Top 10 Biotechnologies for Improving Health in Developing Countries". Here we review these new and emerging biotechnologies and explore how they can be used to support the goals of developing countries in improving health.     

Functional consequences of adult malnutrition in developing countries: a review

Credible concepts of malnutrition depend critically on evidence that functional impairment differentiates variation in size from unacceptable abnormality. This paper reviews functional studies on capacity for work, mortality, reproductive outcomes, competitive success, and cultural preferences. Future research priorities should include the comparative significance of simple physical dimensions in distinct ethnic groups for long-term biological and socioeconomic outcomes, and the relationships between the biological and cultural significance of variation in physique.     

A model of a code of ethics for tissue banks operating in developing countries

Ethical practice in the field of tissue banking requires the setting of principles, the identification of possible deviations and the establishment of mechanisms that will detect and hinder abuses that may occur during the procurement, processing and distribution of tissues for transplantation. This model of a Code of Ethics has been prepared with the purpose of being used for the elaboration of a Code of Ethics for tissue banks operating in the Latin American and the Caribbean, Asia and the Pacific and the African regions in order to guide the day-to-day operation of these banks. The purpose of this model of Code of Ethics is to assist interested tissue banks in the preparation of their own Code of Ethics towards ensuring that the tissue bank staff support with their actions the mission and values associated with tissue banking.     

Hypoxia in childhood pneumonia: better detection and more oxygen needed in developing countries.

Even though hypoxia is a major risk factor for death in children with acute respiratory infection in developing countries, oxygen is not part of first line treatment. Because oxygen is not readily available in developing countries it tends to be given to the most seriously ill children, whose outcome is poor. Oxygen might be useful if given earlier in the course of the disease. Clinical signs are not clear cut, however, though the presence of cyanosis and grunting together with a raised respiratory rate can significantly increase the detection of hypoxaemia. A simple oximeter would make detection easier, and oxygen concentrators are more cost effective than bottled oxygen. Ideally oxygen should be given to children in the early stages of clinical pneumonia to prevent deterioration.     

Genetically modified and organic crops in developing countries: A review of options for food security

Since two decades ago, when the first GM crops were introduced, there have increasingly been hot debates on the applications of gene manipulation. Currently, the development of GM crop varieties has raised a wide range of new legal, ethical and economic questions in agriculture. There is a growing body of literature reflecting the socio-economic and environmental impacts of GM crops which aims to criticize their value for farming systems. While organic crops are promoted as environmentally-friendly products in developed countries, they have provoked great controversy in developing countries facing food security and a low agricultural productivity. Discussion has been especially vigorous when organic farming was introduced as an alternative method. There are in fact, a few tradeoffs in developing countries. On the one hand, farmers are encouraged to accept and implement GM crops because of their higher productivity, while on the other hand, organic farming is encouraged because of socio-economic and environmental considerations. A crucial question facing such countries is therefore, whether GM crops can co-exist with organic farming. This paper aims to review the main considerations and tradeoffs.     

Under-reporting of road traffic mortality in developing countries: application of a capture-recapture statistical model to refine mortality estimates

Road traffic injuries are a major cause of preventable death in sub-Saharan Africa. Accurate epidemiologic data are scarce and under-reporting from primary data sources is common. Our objectives were to estimate the incidence of road traffic deaths in Malawi using capture-recapture statistical analysis and determine what future efforts will best improve upon this estimate. Our capture-recapture model combined primary data from both police and hospital-based registries over a one year period (July 2008 to June 2009). The mortality incidences from the primary data sources were 0.075 and 0.051 deaths/1000 person-years, respectively. Using capture-recapture analysis, the combined incidence of road traffic deaths ranged 0.192-0.209 deaths/1000 person-years. Additionally, police data were more likely to include victims who were male, drivers or pedestrians, and victims from incidents with greater than one vehicle involved. We concluded that capture-recapture analysis is a good tool to estimate the incidence of road traffic deaths, and that capture-recapture analysis overcomes limitations of incomplete data sources. The World Health Organization estimated incidence of road traffic deaths for Malawi utilizing a binomial regression model and survey data and found a similar estimate despite strikingly different methods, suggesting both approaches are valid. Further research should seek to improve capture-recapture data through utilization of more than two data sources and improving accuracy of matches by minimizing missing data, application of geographic information systems, and use of names and civil registration numbers if available.     

The potential for constructed wetlands for wastewater treatment and reuse in developing countries: a review

Constructed wetlands are among the recently proven efficient technologies for wastewater treatment. Compared to conventional treatment systems, constructed wetlands are low cost, are easily operated and maintained, and have a strong potential for application in developing countries, particularly by small rural communities. However, these systems have not found widespread use, due to lack of awareness, and local expertise in developing the technology on a local basis. This paper summarizes information on current methods used for wastewater treatment in developing countries, and briefly gives basic information on wetlands. The paper further examines the potential of constructed wetlands for wastewater treatment and reuse in developing countries by looking at the results of current research initiatives towards implementation of the technology in these countries. Future considerations in choosing constructed wetlands as wastewater treating systems in developing countries are highlighted.     

A discrete-time model with vaccination for a measles epidemic.

A discrete-time, age-independent SIR-type epidemic model is formulated and analyzed. The effects of vaccination are also included in the model. Three mathematically important properties are verified for the model: solutions are nonnegative, the population size is time-invariant, and the epidemic concludes with all individuals either remaining susceptible or becoming immune (a property typical of SIR models). The model is applied to a measles epidemic on a university campus. The simulated results are in good agreement with the actual data if it is assumed that the population mixes nonhomogeneously. The results of the simulations indicate that a rate of immunity greater than 98% may be required to prevent an epidemic in a university population. The model has applications to other contagious diseases of SIR type. Furthermore, the simulated results of the model can easily be compared to data, and the effects of a vaccination program can be examined.     

A data assimilation technique applied to a predator-prey model

A new approach for data assimilation, which is based on the adjoint method, but allows the computer code for the adjoint to be constructed directly from the model computer code, is described. This technique is straightforward and reduces the chance of introducing errors in the construction of the adjoint code. Implementation of the technique is illustrated by applying it to a simple predator-prey model in a model fitting mode. A series of identical twin numerical experiments are used to show that this data assimilation approach can successfully recover model parameters as well as initial conditions. However, the ease with which these values are recovered is dependent on the form of the model equations as well as on the type and amount of data that are available. Additional numerical experiments show that sufficient coefficient and parameter recoveries are possible even when the assimilated data contain significant random noise. Thus, for biological systems that can be described by ecosystem models, the adjoint method represents a powerful approach for estimating values for little-known biological parameters, such as initial conditions, growth rates, and mortality rates.     

Effect of dengue vector control interventions on entomological parameters in developing countries: a systematic review and meta-analysis

The aim of this review was to compare the effects of different dengue vector control interventions (i.e. biological control, chemical control, environmental management and integrated vector management) with respect to the following entomological parameters: Breteau index (BI), container index (CI), and house index (HI). We systematically searched PubMed, ISI Web of Science, Science Direct, the Dengue Bulletin of the World Health Organization and reference lists of retrieved articles on dengue vector control interventions in developing countries. We extracted data on the effectiveness of different dengue vector control interventions (defined as the relative reduction of an entomological measure caused by the intervention compared with the control or pre-intervention phase) and calculated a measure of combined relative effectiveness, with 95% confidence intervals (95% c.i.). We identified 56 publications covering 61 dengue vector control interventions. Integrated vector management was found to be the most effective method to reduce the CI, HI and BI, resulting in random combined relative effectiveness values of 0.12 (95% c.i. 0.02-0.62), 0.17 (95% c.i. 0.02-1.28) and 0.33 (95% c.i. 0.22-0.48), respectively. Environmental management showed a relatively low effectiveness of 0.71 (95% c.i. 0.55-0.90) for the BI, 0.49 (95% c.i. 0.30-0.79) for the CI and 0.43 (95% c.i. 0.31-0.59) for the HI. Biological control (relative effectiveness for the CI: 0.18) usually targeted a small number of people (median population size: 200; range 20-2500), whereas integrated vector management focused on larger populations (median: 12 450; range: 210-9 600 000). In conclusion, dengue vector control is effective in reducing vector populations, particularly when interventions use a community-based, integrated approach, which is tailored to local eco-epidemiological and sociocultural settings and combined with educational programmes to increase knowledge and understanding of best practice. New research should assess the density-dependent effectiveness of each control measure in order to estimate whether reducing vector numbers has an impact on dengue transmission when populations are at a critical threshold.