Neurological, Psychiatric, and Developmental Disorders Meeting the Challenge in the Developing World (2001) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-12
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Health care economists have widely adopted the term burden of disease to express a combination of the frequency and distribution of a disorder or group of disorders, the death and disabil
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Institute of Medicine, was charged to prepare a consensus report that would define the increasing burden caused by neurological, psychiatric, and developmental disorders in developing countries, and to identify opportunities for effectively reducing that burden with cost-effective strategies for prevention, diagnosis, and treatment. The committee was also asked to identify areas for research, development, and capacity strengthening that would contribute most signif~cantly to reducing the overall burden of these disorders in developing countries (Part 1 of the report)
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· identify effective, affordable strategies for their prevention and treatment, and rehabilitation of the afflicted; · identify mechanisms for incorporating care for brain disorders into existing health care systems in developing countries. The data for this study were identified by the committee and other experts from several disciplines through bibliographic references on related topics, and through databases such as Medline, university libraries, and lnternet sites of organizations associated with research and services for neurological and psychiatric disorders.
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Epilepsy affects an estimated 40 million people in developing countries, roughly 85 percent of the total number affected worldwide. The disorder commonly attacks young adults in the most productive years of their lives and fre
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In developing countries this approach may involve a combination of health care, public health awareness, community care, and socioeconomic development. Stroke and its associated disability are increasing in developing countries, where the disorder is projected to become the fifth leading condition contributing to the disease burden by 2020.
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Some developing countries have successfully integrated low-cost prevention, screening, and treatment methods for developmental disabilities, epilepsy, and depression into primary health care programs. Similarly, some have created affordable, community-based rehabilitation programs that help people disabled by brain disorders live as normally as possible.
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Extend and strengthen existing systems of primary care to deliver health services for brain disorders. Secondary and tertiary centers should train and oversee primary care staff, provide referral capacity, and provide ongoing supervision and support for primary care systems in developing countries.
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Where this is not possible because of capacity or resource limitations, however, implementation of component practices is likely to be more cost-effective than inaction. Adapting existing interventions to local levels of resource availability is feasible, and standard approaches for assessing the cost-effectiveness of health care delivery should be used to this end.
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carbamazepine, valproate, or other agents · Adjunctive psychosocial treatments · Control of hypertension with low-dose thiazide, betablockers, and low-cost statins and ACE inhibitors · Sulphonylureas with metformin if needed for diabetes * Supporting evidence for these recommended interventions is derived from research in both developed and developing countries.
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To ensure the sustainability of the program, major donors—such as the World Bank, foundations, and governmental and non-governmental aid organizations must commit initial investments to this effort, and longer-term annual budgets must be established. The integration of brain disorders into primary care, with monitoring and assistance from secondary and tertiary centers in developing countries, will require broad international support and multiple funding sources.
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A sustained, comprehensive, and integrated effort to reduce brain disorders in developing countries will require broad institutional support. This support could be achieved through cooperative links among the full spectrum of organizations associated with brain disorders, spearheaded by the sponsors of this report: the Global Forum for Health Research, the U.S.
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