Diagnostic dilemma in developing countries

Effective healthcare practice is often hindered, and in some instances compromised in developing countries due to wide ranging diagnostic incapabilities. Developing countries are faced with harsher economic climates, and frail political/ government systems, all critical to effective healthcare delivery. To compound these already gigantic problems, misplaced priorities often leave these countries with infantile health systems, which results in the practice and delivery of sub-optimal patient care, with attendant public health consequences. The result? Many illnesses in these countries either go undiagnosed, or are poorly characterized; resulting in poor health indices and indicators, which unfortunately may have no end in sight in the near future.

The Cambridge English dictionary defines a developing country as a country with little industrial and economic activity, and where people generally have low incomes. The United Nations and International Monetary Fund, have standard measures by which they classify a country as developing, or developed. The characterization of a country as developing quickly indicates that it is performing below some set standards, when compared with countries characterized as developed. And in keeping with this assumption is the reality that many countries characterized as developing, often have poorer health indices and outcomes when compared with their counterparts in developed countries.

It is no surprise then that developing countries frequently have weaker health systems compared with the rest of the globe, designated as ‘developed’. A key factor for this divergent result is the display of misplaced priorities. The health budgets in developing countries are frequently a tiny fraction, compared to other aspects of the government’s budget. More funds are frequently allocated to running government parastatals, than supporting the healthcare system. Like the saying, “put your money where your mouth is”, these government infrastructures in developing countries clearly have their priorities set on other sectors, that may have minimal bearing with improving the health of its people.

Predisposing factors to diagnostic dilemma

It is important to note that developing countries are frequently limited in their capabilities to arrive at far reaching diagnoses, which may frequently impact its people. For example, many children in developing countries presenting with seizures are quickly diagnosed with cerebral malaria, meningitis, tetanus or other infectious causes. This is because there is a limited capability to go beyond the boundaries of these ‘comfortable’ diagnoses, due to a lack of more sophisticated diagnostic techniques. Whereas children in more developed countries presenting similarly, are exposed to a wide range of diagnoses, which are either ruled out or in after an extensive medical work-up. What are the reasons for these dissimilar results? What are the root causes of these phenomena in developing countries? Below are some probable explanations:

  • Lack of basic infrastructure: Many developing countries still struggle with providing basic essential services to its constituents including electricity and water, thereby limiting the potential to make well informed diagnostic decisions. How can health professionals effectively diagnose a health condition whose diagnostic reliability is dependent on the availability of constant electricity? For example, even if some international donors were to provide sophisticated diagnostic equipments to hospitals or other health facilities in developing countries such as CT scan or MRI, what difference would it make without a constant source of electricity to power these machines? Therefore, if a child presented with a questionable diagnostic dilemma that requires more advanced techniques to make a concrete diagnosis, physicians would rather seek the easiest way out, and make a diagnosis of cerebral malaria or meningitis.

annie-spratt-427337.jpgPhoto by Annie Spratt on https://unsplash.com

  • Government policy: Surprisingly, several government policies in developing countries do not give the level of importance needed by the healthcare sector to it. This is evident by taking a look at, and studying the budgets of governments in developing countries. The health sector is still given a little portion of the budgets, putting to light the interests of these government entities. The saying “putting your money where your mouth is” cannot be over-emphasized in developing countries. Some of these country’s’ budgets are devoted more to other sectors including the maintenance of ministerial parastatals, that healthcare spending unfortunately takes a back seat at the policy administration levels.
  • Medical education training: Medical education training in developing countries is region specific. For example, for countries in the tropics, medical education is often referred to as “Tropical Medicine”. Therefore, the curriculum for medical education and training is geared towards cases that are familiar within a region, while cases that are considered exotic are often not prioritized. Therefore, physicians trained in these regions learn to diagnose what is referred to as “common cases”, assuming that all diseases are region specific. How can a physician ever make a diagnosis of tuberous sclerosis in a young child presenting with persistent unremitting seizures, if they have never been taught about its presenting features? And even if a physician were to make a provisional diagnosis of this condition, how could this ever be confirmed with no access to functional MRI techniques? Thus, diagnostic possibilities are often limited in developing countries because physicians have been trained to make only “comfortable” diagnoses, limiting the capability to go beyond a certain comfort region.
  • Dearth of medical research: Many governments in developing countries do not place the same emphasis on carrying out clinical/medical research compared to their counterparts in developed countries. Therefore, knowledge is often limited on the presentation and management of uncommon clinical cases. As a result of this, many patients have fallen victims to misdiagnoses because their healthcare providers may have lacked the resources to make far reaching diagnostic possibilities. Medical research is often carried out to impact more knowledge about the presentation, course and management of different diseases. And it is important to note that due to genetic and environmental variations; disease characteristics may become impacted based on these factors. Also directly stemming from this point is the lack of standardization of regulatory authorities in developing countries, which jeopardizes the reliability of research experiments in this region. Therefore, with a dearth of clinical research in developing countries, the knowledge required to expand diagnostic options is often limited.
  • Misappropriation of Basic emergency funds: Even though governments in developing countries may have funds designated as ‘emergency funds’, these may be frequently misappropriated due to several systemic or bureaucratic practices. The result is that whenever there is a disease outbreak requiring immediate needs assessments and funds disbursements, government entities may be unprepared to mitigate the effects of those outbreaks. The result of this scenario is the scaling up of outbreaks to epidemic proportions, with the attendant consequences of misdiagnosis, late diagnosis or at the worst end of the spectrum missed diagnosis. An example is the recent Ebola disease outbreak in some developing countries including Liberia and Sierra Leone.

Many developing countries are still caught in the web of diagnostic dilemmas of several diseases. There is still a huge gap between the diagnostic capabilities in developed countries and developing countries. The result of this gap is that citizens in developing countries end up suffering from the effects of misdiagnosis, late diagnosis or no diagnosis at all. This is a huge public health problem in an area of the world already plunged by poverty and deprivation. Unfortunately, the solution to majority of these problems lies with these governments. A good place to start will be a reprioritization of government policies to elevate the healthcare sector to the pedestal it deserves, in order to better serve its citizens.

To your continued success. Cheers!!!

Evi Abada

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