The health care dilemma in developing countries

BMJ Global Health (2022). DOI: 10.1136/bmjgh-2022-008696″ width=”800″ height=”378″/>

Studies on overdiagnosis and overuse of tests in low- and middle-income countries (LMIC). 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- those LMICs in Latin America and the Caribbean, 23 in 9 of the 13 LMICs in the Middle East and North Africa, and 22 in 6 of the 8 LMICs in South Asia. The darker the blue gradient, the more studies originate from the country. White color indicates countries that do not have 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 greatly improved access to quality health care, but some patients in developing countries are getting too much of it, researchers say.

A series of reviews of the extent of overdiagnosis and overuse of health services reveal that the problems of too many drugs – already well established in high-income countries – are now widespread in low- and middle-income countries (LMICs).

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

The first results published in BMJ Global Health diary and Bulletin of the World Health Organizationare based on more than 500 research articles involving almost eight million participants or health services in 80 LMICs.

Among the findings:

  • Analysis of 5 million patients found high rates of thyroid cancer in some LMICs. However, the death rate from thyroid cancer remains low, strongly suggesting that small thyroid tumors are being unnecessarily misdiagnosed and treated as cancer.
  • A study of more than 3,000 patients from 95 health centers in Sudan found increasing recognition of the overdiagnosis of malaria and estimated that it lost US$80 million in 2000.
  • In 2014, a study in Iran found that half of MRI requests for low back pain were inappropriate or unnecessary. Another 2021 study in Iran estimated the cost of brain imaging misuse in just three teaching hospitals to be over US$100,000.
  • In Lebanon, a 2020 study found massive overuse of stomach drugs called proton pump inhibitors, with two out of three people taking them unnecessarily. An estimated US$25 million is wasted annually.
  • A major global study in 2020 examined antibiotic use among more than 65,000 children under five in Haiti, Kenya, Malawi, Namibia, Nepal, Senegal, Tanzania and Uganda. Antibiotics were prescribed to more than 80% of children diagnosed with respiratory illness, and most of these prescriptions were deemed unnecessary.

Dr Albarquni, assistant professor at Bond University’s Institute for Evidence-Based Health, 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 the rate of unnecessary malaria treatment.”

Dr Albarquni said too many drugs often coexisted with underuse in LMICs.

A large study covering 70 LMICs found a huge disparity in caesarean section rates. While the poorest people did not have adequate access to emergency C-sections, the richest could obtain them even when they were not needed.

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

“These joint efforts could further understand the problems and develop and evaluate potential 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 Health have helped launch the Preventing Overdiagnosis international scientific conference. The conference is co-sponsored by the World Health Organization and the next one will be held in Denmark in 2023.

More info:
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)

Courtesy of Bond University

Quote: Too Much or Not Enough: The Health Dilemma in Developing Countries (2022, November 4) Retrieved November 4, 2022, from

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