Prevention of Healthcare Associated Infections in Developing Countries

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Introduction:

Developing countries are normally defined as those lacking the level of nationwide industrialization, infrastructure and technological advances normally found in Western Europe and North America. The vast majority of countries in Africa, Asia, Central & South America, Oceania and the Middle East fall in this developing category and often face addition challenges in terms of lower levels of literacy and standards of living. Nevertheless, within this broad group, there are various sub-categories, each having different characteristics as well as economic strengths. Indeed some are relatively wealthy oil exporting nations or newly industrializing world economies; a considerable number are middle income countries. At the end of the development scale lie around fifty very poor nations with predominantly agricultural economies, which tend to be heavily dependent on external aid.

From a medical perspective, many developing countries are often characterised by significant health and hygiene issues. Indeed it has been estimated that more than 1 billion inhabitants in these countries do not have access to safe water and even less to basic sanitation (1). Around 1.5 million children in the developing world die per year; diarrhoea is responsible for more than 80% of these deaths (2). One of the reasons for this state of affairs is the low expenditure and budgetary allocation within the poorer countries of the world towards health. Indeed the proportion of annual expenditure for health related initiatives in many developing countries is often less than 5% of Gross Domestic Product (GDP), sometimes less than 0.1% (3).

Healthcare associated infections in developing countries

Unlike more affluent countries, infectious diseases continue to pose a heavy burden of morbidity as well as mortality in developing nations (4). Amongst the more important disease entities are a wide range of respiratory diseases including tuberculosis, various gastrointestinal infections, AIDS and HIV plus a spate of parasitic infestations of which malaria is the most significant. However this situation is not limited to ambulatory settings and is equally relevant within healthcare institutions. Deficient infrastructures, rudimentary equipment and a poor quality of care contribute towards incidences of nosocomial infections which have been estimated to be between 2-6 times higher than those in developed nations (5). In many instances, such figures are often guesstimates because surveillance systems are often either non existent or else unreliable. However, the limited studies on prevalence of healthcare associated infections in some developing countries in the world suggest that up to 40% of these are probably preventable (5). This situation appears to particularly severe within intensive care settings where up to 60 to 90 infections per 1000 care-days have been reported; excess mortality rates in more severe infections such as blood stream and lower respiratory infections approaches 25% in adults and more than 50% in neonates (6).

The challenges of infection in healthcare facilities within developing nations is also of a wider spectrum than that normally found in equivalent hospitals in the western world. Numerous publications have highlighted the frequency by which normally community infections, such as cholera, measles and enteric pathogens, spread nosocomially within such institutions (7, 8). In many instances outbreaks are traceable to an index case who would have been inappropriately managed in a background of overcrowding and limited hospital hygiene. Similar cases of transmission have also been reported in the case of respiratory infections including measles (9). Tuberculosis transmission in healthcare facilities is a major occurrence in many African countries as well as parts of Asia and Latin America (10). In many instances this disease is strongly related to the rise of HIV within these same geographical regions and is not...
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