Group No : 5

Mariam Waseem 2019-ag-8518

Hareem Gul 2019-ag-8464

HND 3rd Semester Evening

Topic :

Diseases In the Developing World

In the developing world, the leading infectious causes of death are

respiratory tract infections, diarrheal diseases, tuberculosis, malaria, and
AIDS, which together represent >90% of deaths . The remaining 10% are
due to tropical diseases and various other infections.In industrialized
countries, respiratory tract infections, bloodstream infections, urinary tract
infections, and infections of the digestive system represent 90% of
infection-related deaths; other diseases such as tuberculosis, hepatitis B
and C, diarrheal diseases, and AIDS represent nearly all of the remaining
10% . As already stated by Kalache in 1996, many infectious diseases “no
longer kill but neither do they die”. This aphorism is also a reminder that the
impact of infectious diseases should not only be measured by mortality
rate, but also by morbidity and quality of life, particularly in the aging
population.

Infectious diseases have been a major human enemy in the course of

history. Advent of vaccines, antibiotics, antimicrobial agents and improved
sanitary and hygienic conditions has contributed in the human fight against
microbes which produce contagious disease processes. Nonetheless, this
great human battle seems far from winning. Western countries have
already been successful in reducing the morbidity and mortality rates of the
infectious disease in their countries due to several strong physical, social,
public health and political sectors that work hand in hand to timely report
and combat spread of contagious diseases. However, there could not be a
state of complete control despite massive capital investment, human will
and determination as well as dedicated research and innovation.

The situation is worse in the developing countries that are already suffering
from poverty, hunger, lack of resources, infrastructure, political stability and
will. One may witness several such infectious diseases in these parts of the
world that hardly exist in today’s industrialized countries. In recent decades,
trend of greatest burden of infectious diseases is observed in remote
regions of developing countries. However, most of the research and
innovation on the public health issue of infectious disease and control
measures are being carried out at the institutes situated overseas.

Developing countries offer great potential for infectious disease research

for exploring epidemiology, biology, cure and prevention. For example,
molecular epidemiologists may be interested in source tracking and genetic
finger printing of infectious agents, whereas vaccinologists in study of
vaccine efficacy in this area of the world. One may also consider studying
the underlying mechanism of antibiotic resistance in bacteria or emergence
of highly virulent strains of certain bacterial, viral or fungal species.
Understandably, it is not feasible for most of the developing economies to
invest much in sectors such as drug discovery and vaccine development.
Nevertheless, huge opportunities still exist in this area for dedicated
scientists and young researchers.

Infectious disease research equally faces almost the same challenges in all
countries of the developing world. Lack of financial resources required for
sophisticated equipment and reagents, expertise and training centers are
challenges that every scientist faces while doing their work. It is worth
mentioning that social, cultural and political constraints are equally
important factors. Lack of political will and corruption has a major obstacle
in fostering research activities here.
We are of the mind that young researchers may bring about changes by
exploiting the rapid global changes offering huge opportunities of
communication in today’s globalizations age. Collaboration between
laboratories has been conventional in the developed world. One may
benefit largely by networking nationally and internationally for joint research
projects. Societal and cultural constraints may be overcome by the young
scientists who are more open, tolerant, exposed and willing to explore.
Above all, key responsibility is on the shoulders of the local governments to
equip their scientists with technology, expertise, working environment and
required resources for innovative research. International organizations and
funding bodies have been generous in their financial and technical support,
but the real weakness lies at our own end.

Scientists of the developing world often find it difficult to get a place for their
research work in the quality research journals. One of the many reasons
behind it is poor study design, writing and presentation skills and ethical
issues. One may improve these all with little training without the need of
massive investment.

FACTORS:
Poverty, poor education, low health knowledge, poor infrastructure,
geographic factors, life style, and environmental factors (i.e., limited access
to resources such as clean water) have been identified as primary factors
contributing to the high incidence of infectious diseases among women in
developing countries. Also, such women tend to have limited or no access
to health care, be vitamin deficient, and have lower status in their
communities.

Often, infectious diseases may run a substantially longer course for women
in developing countries because of stigma, family needs, and shame.
Another important barrier to combating infectious diseases among women
in developing countries is the lack of use and the misuse of prescription
medication.

MALARIA :
Malaria is a major cause of morbidity and mortality in developing countries.
Higher parasite loads and a higher proportion of severe forms (e.g.,
cerebral complications, more-frequent fatal outcome) have been reported
to be associated with malaria among elderly individuals without immunity,
as compared with the younger adult population. The situation in areas of
endemicity is more complex. Because of the development of immunity, the
incidence of fatal disease decreases with age it occurs most commonly in
children <5 years old, is less frequent among adolescent individuals, and is
relatively rare among adults. However, epidemiological reports now
suggest an increase in fatal disease in elderly individuals. From an
immunological point of view, this makes sense, because immune protection
from severe malaria needs continuous reactivation, suggesting that it might
not withstand age-associated loss of immune function; moreover, a
heightened Th1 response is thought to be protective against malaria , and
immunosenescence is characterized by a shift from a Th1 response to a
predominantly Th2 response.

We are aware of only a single study that addresses symptoms of malaria in

elderly individuals with immunity. This study analyzed elderly patients who
were hospitalized for malaria in the infectious diseases department of the
Dakar University hospitals in Senegal. All cases were due to Plasmodium
falciparum infection. In these patients, asthenia, myalgia, and coma were
the 3 most common symptoms, found in 95%, 95%, and 75% of the cases,
respectively. Note that fever was observed in only 58% of the elderly
patients. This contrasts with results typically found in middle aged patients,
among whom the most commonly observed symptoms are fever (80%–
95%), asthenia (20%–30%), and myalgia (20%). Coinfection (e.g., urinary
tract infection and pneumonia) is common in elderly patients and was
observed in 40%, compared with 20%–30% of middle-aged patients.
Overall mortality in these elderly patients from Dakar was 32% , which is
higher than the mortality rate associated with severe malaria in the middle-
aged patient population (10%–25%) . Of interest, elderly patients who did
not fulfill established criteria of malaria severity also had a very high
mortality rate.

LEISHMANIASIS :
Similar to other parasitic infections, visceral leishmaniasis (also known as
kala-azar) is a re-emerging disease. The annual estimates for the
worldwide incidence and prevalence of this disease are 0.5 million and 2.5
million, respectively. Kala-azar is clustered in eastern Africa, northeastern
India, and South America , where it accounts for ∼1 of every 1000 deaths
due to infectious disease . These relative numbers are the same for both
young and old adults . Thus, at present, kala-azar is not a problem that is
particularly prevalent in the elderly population. However, this situation might
change. Indeed, it is now clearly established that latent infection with
Leishmania exists, as illustrated by the reactivation of Leishmania in
patients with HIV infection and transplant recipients. In a manner similar to
that of latent Mycobacterium tuberculosis infection, survival of Leishmania
amastigotes occurs within macrophages . The rate of positive Leishmania
skin test results among the elderly population in affected countries is high:
30%, 60%, and 70% in India, Brazil, and The Sudan, respectively. Thus,
even if only 1% of elderly individuals eventually experience a reactivation of
leishmaniasis, this infection might become a relevant geriatric problem in
affected countries.
HELMINTHIASIS:
In recent years, numerous re-emerging helminth zoonosis have been
described ,but, thus far, few of them have been associated with the aging
population. One example that has been associated with this population is
chronic infection with the hookworm Nectar Americanos in China.
Symptoms of chronic disease depend on the worm burden and have been
described as anemia and hyperproteinemia . The prevalence of infection
increases with age: from ∼20% in adolescent individuals, to ∼50% in
middle aged individuals, and to >80% in very old individuals (age, >80
years) . In addition, the egg count in the stool of infected persons increases
with age and is >100-fold higher in very old individuals than in
adolescents . Given the correlation between egg count and chronic
symptoms, it is likely that the high parasite density observed in elderly
individuals aggravates typical age-associated problems such as anemia
and hyperproteinemia.

Infected people excrete helminth eggs in their faeces, which then

contaminate the soil in areas with inadequate sanitation. Other people can
then be infected by ingesting eggs or larvae in contaminated food, or
through penetration of the skin by infective larvae in the soil (hookworms).
Infestation can cause morbidity, and sometimes death, by compromising
nutritional status, affecting cognitive processes, inducing tissue reactions,
such as granuloma, and provoking intestinal obstruction or rectal prolapse.
Control of helminthiasis is based on drug treatment, improved sanitation
and health education.

AIDS :
The number of elderly patients with HIV infection is increasing throughout
the world . In industrialized countries, HIV-infected individuals aged ⩾50
years account for 10%–15% of HIV-infected individuals but seroprevalence
in this age group remains relatively low (∼0.1%; M. Gebhard [Federal
Public Health Office, Bern, Switzerland] and M. Rickenbach [University
Hospital, Lausanne, Switzerland], personal communication). In developing
countries, elderly individuals represent a smaller fraction of HIV-infected
individuals (4.5%, 5.6%, and 7.6% in Asia, Africa, and Latin America,
respectively) but HIV type 1 seroprevalence is often much higher: for
example, 2.5% of the elderly population in rural villages of CaCamerooand
15% of the elderly population in Dar es Salaam (the capital of Tanzania)
have been reported to be HIV positive. In some developing countries, HIV
infection is now one of the main causes of hospitalization for people >55
years of age. The main route of HIV infection in the elderly population is
heterosexual transmission; transmission by men who have sex with men
and injection drug users plays only a minor role. Nosocomial HIV
transmission also plays a role in developing countries but, to the best of our
knowledge, no data are available for the elderly population.

The main presenting features of HIV infection in elderly Africans at

hospitalization are wasting (40%–50%), fever (39%–89%), weight loss
(40%–100%), and diarrhea (30%–60%). One study reported a 10.5-month
delay between the onset of symptoms and hospital admission. HIV-positive
elderly individuals in developing countries have a shorter survival than does
the younger population. Data from Malawi, however, suggest that this
increased mortality is, at least in part, attributable to the age-related
increase in overall mortality. Coinfections (including tuberculosis, malaria,
leishmaniasis, pneumonia, and diarrheal syndrome) might have an
important impact on mortality in elderly patients, but no data concerning
this question are available.

HIV infection is caused by the human immunodeficiency virus. You can get
HIV from contact with infected blood, semen, or vaginal fluids. Most people
get the virus by having unprotected sex with someone who has HIV.
Another common way of getting it is by sharing drug needles with someone
who is infected with HIV.
Tuberculosis :
In developing countries (in particular, those located in sub-Saharan Africa
and Asia), tuberculosis is much more common than in industrialized
countries. Although, in industrialized countries, annual incidence rates of
tuberculosis show a slight decrease both in younger adults (age, 25–64
years) and in elderly individuals (age, >65 years) ,in developing countries,
the incidence of tuberculosis is still increasing ,and—at least in some
countries—this increase affects the elderly population preferentially
(increases are 30%–300% greater than in the younger population).

As in industrialized countries , the presentation of tuberculosis in the elderly

population of developing countries is atypical, with more disseminated
disease and more-frequent lower lobe involvement in the case of
pulmonary tuberculosis. The time periods from the onset of symptoms to
the establishment of diagnosis are longer and outcomes are worse than
they are in the younger population.

In general, antituberculous treatment in elderly populations is efficient and

safe, but drug-induced hepatitis and interactions with other drugs may be
relevant problems. In most developing countries, antituberculous drugs,
which are relatively cheap, can be obtained. Instrumental to the distribution
of drugs (but also instrumental to increasing compliance and avoiding
resistance) is Directly Observed Therapy Strategy (commonly known as
DOTS) .However, the difficulties faced by the elderly population in
obtaining access to health care (e.g., limited financial sources, functional
disabilities, and remote living areas) may lead to an exclusion from
treatment, a situation that has already been documented in India . In
Taiwan, rates of drug resistances have been found in the elderly population
that are higher than those in the general population.
Influenza:
Because of the lack of efficient surveillance programs in developing
countries, it is difficult to assess the real impact of influenza in elderly
patients. However, studies of several outbreaks in Taiwan and South Africa
show that influenza is associated with greater morbidity and mortality in
elderly patients than in the general population and studies from Argentina,
Brazil, and China demonstrate the efficacy of vaccination in the elderly
population with respect to the prevention of both influenza-like illness and
pneumonia.