Overcoming challenges of cancer treatment programmes in developing countries: a sustainable breast cancer initiative in Ethiopia.

The incidence of breast cancer is rising in many developing countries. Here we describe a programme to improve the support infrastructure for the management of patients with breast cancer in Addis Ababa, Ethiopia. Tamoxifen, a cheap, oral, yet effective, anti-cancer agent was made available freely to encourage staff and patients to follow well-defined, but achievable, protocols of care. Mammography, improved histopathological review, tissue hormone receptor assays, agreed treatment algorithms with a cycle of continuous audit of over 250 patients and cross-departmental patient management groups led to a considerable improvement in the management of breast cancer patients in a single institution. Aspects of this programme are now being extended to other regional hospitals in Ethiopia. Fairly limited investments in programmes for cancer can stimulate considerable improvements in the overall approach to malignant disease by encouraging a positive approach, even in very low resource environments.

Anthropological perspectives on injections: a review.

Qualitative studies from developing countries have pointed to the widespread popularity of injections. In addition to their use by formal and informal providers and traditional healers, there is now increasing evidence of the use of injections and injection equipment by lay people. Epidemiological research links the large number of unsafe injections to serious bloodborne infections such as viral hepatitis B and C and acquired immunodeficiency syndrome (AIDS). The present article examines the reasons behind the demand for injections by consumers and the administration of unnecessary or unsafe injections by different types of provider. Interventions aimed at reducing the risk of unsafe injections are discussed in relation to cultural and social factors as well as those factors associated with health systems. Suggestions are made for approaches to the design of such interventions.

PIP: This paper reviews the anthropological perspectives on injections. Qualitative studies from developing countries have pointed out the widespread popularity of injections, which varies according to the culture concerned. Injections are seen as an outstanding symbol of biomedicine and have often been portrayed as such in health and vaccination campaigns. There is now increasing evidence of the use of injections and injection equipment by lay people. Epidemiological research links a large number of unsafe injections to serious bloodborne infections such as viral hepatitis B and C and AIDS. This article examines the reasons for the increasing demand of injections by consumers and the administration of unnecessary or unsafe injections by different types of provider. Furthermore, interventions to reduce the number of unnecessary injections are discussed in relation to cultural and social factors, as well as those associated with health systems. Suggested approaches useful in the design of such interventions are outlined.

Injections: a fatal attraction?

The abuse of injections in the developing world has reached alarming proportions in recent years. Formal as well as informal health providers administer far too many injections to clients who perceive this form of treatment as superior to all other forms of medicine administration. Often sterilization procedures are less than adequate or non-existent, thereby increasing the risk of spreading HIV and infectious diseases to all segments of the population. Very little is at present known about why injections are so popular or the extent to which they are administered in the various health care sectors in developing countries. This article gives an overview of the present state of knowledge and highlights the need for further information in order to address the problem appropriately. It is suggested that the quest for injections may be seen as part of some general trends of change in the developing world. The article also indicates some of the important areas for further research.