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Review
. 2009 Jun 21;15(23):2839-54.
doi: 10.3748/wjg.15.2839.

Gastroenterology in developing countries: issues and advances

Kate L Mandeville  1 , Justus Krabshuis, Nimzing Gwamzhi Ladep, Chris J J Mulder, Eamonn M M Quigley, Shahid A Khan
Affiliations
Review

Gastroenterology in developing countries: issues and advances

Kate L Mandeville et al. World J Gastroenterol. .

Abstract

Developing countries shoulder a considerable burden of gastroenterological disease. Infectious diseases in particular cause enormous morbidity and mortality. Diseases which afflict both western and developing countries are often seen in more florid forms in poorer countries. Innovative techniques continuously improve and update gastroenterological practice. However, advances in diagnosis and treatment which are commonplace in the West, have yet to reach many developing countries. Clinical guidelines, based on these advances and collated in resource-rich environments, lose their relevance outside these settings. In this two-part review, we first highlight the global burden of gastroenterological disease in three major areas: diarrhoeal diseases, hepatitis B, and Helicobacter pylori. Recent progress in their management is explored, with consideration of future solutions. The second part of the review focuses on the delivery of clinical services in developing countries. Inadequate numbers of healthcare workers hamper efforts to combat gastroenterological disease. Reasons for this shortage are examined, along with possibilities for increased specialist training. Endoscopy services, the mainstay of gastroenterology in the West, are in their infancy in many developing countries. The challenges faced by those setting up a service are illustrated by the example of a Nigerian endoscopy unit. Finally, we highlight the limited scope of many clinical guidelines produced in western countries. Guidelines which take account of resource limitations in the form of "cascades" are advocated in order to make these guidelines truly global. Recognition of the different working conditions facing practitioners worldwide is an important step towards narrowing the gap between gastroenterology in rich and poor countries.

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Figures

Figure 1
Figure 1
Distribution of countries as per International Monetary Fund (IMF) definitions of economic development (IMF statistical database[3]: reproduced with kind permission of IMF).
Figure 2
Figure 2
Association between coverage of oral rehydration therapy (ORT) use and mortality rates from diarrhoea in selected countries (from Podewils et al[23], 2004. Reproduced with kind permission of Elsevier).
Figure 3
Figure 3
Geographical distribution of the prevalence of chronic hepatitis B virus infection, 2002 (from Mast et al[67], 2004. Reproduced with kind permission of Elsevier).
Figure 4
Figure 4
Graph showing number of countries who have introduced hepatitis B vaccination programme and global infant three dose vaccine coverage (“HepB3”) (reproduced with kind permission of World Health Organisation).
Figure 5
Figure 5
Geographical distribution of countries with a critical shortage of health service providers (doctors, nurses and midwives) (reproduced with kind permission of World Health Organisation).
Figure 6
Figure 6
Map showing location of World Gastroenterology Training Centres worldwide (reproduced with kind permission of World Gastroenterology Organisation).
Figure 7
Figure 7
Cut Foley urethral catheter reloaded unto the Opti-vu cap for variceal band ligation at the Endoscopy Unit of Jos University Teaching Hospital, Nigeria.
Figure 8
Figure 8
A more complicated cascade for management of dyspepsia in a region with a high prevalence of H pylori infection but limited access to endoscopy (reproduced with kind permission of WGO). IBS: Irritable bowel syndrome; Rx: Retreatment; Success: Symptoms resolve; Failure: Symptoms persist.
See this image and copyright information in PMC

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References

    1. Ferreira FH, Ravallion M. Global Poverty and Inequality: A review of the evidence. Policy research working paper for the World Bank. Washington: World Bank; 2008.
    1. World Health Organization. World Health Organization Statistical Information System (WHOSIS). Accessed August 4, 2008. Available from: URL: http://www.who.int/whosis/en/
    1. International Monetary Fund Statistical Database. Accessed August 5, 2008. Available from: URL: http://www.imfstatistics.org/imf/
    1. World Health Organization (WHO) World Health Report 2000 - Health systems: improving performance. Geneva: WHO; 2000. Available from: URL: http://www.who.int/whr/2000/en/
    1. Snyder JD, Merson MH. The magnitude of the global problem of acute diarrhoeal disease: a review of active surveillance data. Bull World Health Organ. 1982;60:605–613. - PMC - PubMed

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