The health care dilemma in developing countries

The health care dilemma in developing countries

Demasiado o insuficiente: el dilema de la atención de la salud en los países en desarrollo

Studies of overdiagnosis and overuse of tests in low- and middle-income countries (LMICs). Seventy-four studies in 19 of 46 LMICs in sub-Saharan Africa, 45 in 7 of 23 LMICs in East Asia and the Pacific, 28 in 6 of 20 LMICs in Europe and Central Asia, 42 in 8 of 25 LMICs in the Americas Latin America and the Caribbean, 23 in 9 of 13 LMICs in the Middle East and North Africa, and 22 in 6 of 8 LMICs in South Asia. The darker the blue gradient, the more studies originated in the country. White color indicates countries that have no relevant studies that can be identified. Gray color indicates high-income countries. Credit: BMJ Global Health (2022). DOI: 10.1136/bmjgh-2022-008696

Globalization has significantly improved access to quality health care, but some patients in developing countries are getting too much, the researchers say.

A series of scoping reviews of overdiagnosis and overuse of health care reveals that problems of medication overuse, already well established in high-income countries, are now widespread in low-income countries and medium (LMIC).

Dr Loai Albarqouni and Dr Ray Moynihan of Bond University worked with a team of 30 researchers from 15 countries to summarize the evidence.

The first results, published in the BMJ Global Health diary and the Bulletin of the World Health Organizationare based on more than 500 Scientific articles involving nearly eight million participants or health care services in 80 low- and middle-income countries.

Among the findings:

  • An analysis of 5 million patients found high rates of thyroid cancer in some LMICs. However, mortality rates from thyroid cancer had remained low, strongly suggesting that small thyroid tumors are being unnecessarily diagnosed and treated as cancer.
  • A study of more than 3,000 patients from 95 health centers in Sudan found a growing recognition of malaria overdiagnosis and estimated that this wasted US$80 million in the year 2000.
  • In 2014 in Iran, a study found that half of requests for magnetic resonance imaging for low back pain was inappropriate or unnecessary. Another 2021 study in Iran estimated the cost of inappropriate use of brain imaging at just three university hospitals is greater than US$100,000.
  • In Lebanon, a 2020 study found massive overuse of stomach medications called proton pump inhibitors, with two out of three people taking them unnecessarily. Approximately 25 million US dollars were wasted per year.
  • A large global study in 2020 examined antibiotic use among more than 65,000 children under the age of five in Haiti, Kenya, Malawi, Namibia, Nepal, Senegal, Tanzania, and Uganda. Antibiotics were prescribed to more than 80% of children diagnosed with respiratory illnesses, and most of these prescriptions were considered unnecessary.

Dr. Albarqouni, an assistant professor at Bond University’s Institute for Evidence-Based Healthcare, said the studies were the first of their kind.

“They show that solutions are already being tested, although not often enough,” he said.

“One example is a large study in Ghana that found that the introduction of new rapid diagnostic tests could halve unnecessary treatment rates for malaria.”

Dr. Albarqouni said that in low- and middle-income countries there were often too many medicines along with underuse.

A large study encompassing 70 LMICs found a large inequality in caesarean section rates. While the poorer people had inadequate access to emergency C-sections, the richest could get them even when they didn’t need them.

Dr. Moynihan, an assistant professor at the Institute for Evidence-Based Healthcare, said there were plans to build on the results of the reviews and create a world alliance to reduce overdiagnosis and overuse of health care services in LMICs.

“East collaborative effort could better understand the problems and develop and evaluate possible solutions,” he said.

Overdiagnosis and overuse are common in high-income countries. The Organization for Economic Co-operation and Development estimates that about 20 percent of health care spending may be wasted.

Researchers from Bond University’s Institute for Evidence-Based Healthcare helped launch the Preventing Overdiagnosis international scientific conference. The conference has been co-sponsored by the World Health Organization, and the next one will take place in Denmark in 2023.

More information:
Loai Albarqouni et al, Overdiagnosis and overuse of diagnostic and screening tests in low- and middle-income countries: a scoping review, BMJ Global Health (2022). DOI: 10.1136/bmjgh-2022-008696

Bulletin of the World Health Organization paper (doc)

Provided by Bond University

Citation: Too Much or Not Enough: The Health Care Dilemma in Developing Countries (Nov 4, 2022) Retrieved Nov 4, 2022 from .html

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