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Motivation and retention of health workers in developing countries: a systematic review

Mischa Willis-Shattuck, Posy Bidwell, Steve Thomas*, Laura Wyness, Duane Blaauw and Prudence Ditlopo

BMC Health Services Research 2008, 8:247  doi:10.1186/1472-6963-8-247

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The potential benefits of aspirin in developing countries

Gareth Morgan   (2009-01-23 18:32)  Welsh Assembly Government email

The systematic review of motivation and retention of health professionals in developing countries has important policy implications (1). In particular, improving the morale of health professionals appears to be achievable by adequate resources along with a service delivery infrastructure that is appropriate to the country and the specific health challenges it faces. <br><br>There are a number of factors that are of relevance to this agenda, including future disease projections which suggest that vascular disease will be the leading cause of death in developing countries in 2030 (2). Underpinning this, at least in part, is the rising prevalence of type 2 diabetes mellitus and obesity in developing countries (3). Furthermore, evidence suggests that in developing countries, some treatments may not be affordable and ways to increase availability, reduce prices and improve affordability of medicines is required (4).<br>Low-dose aspirin prophylaxis is inexpensive and reduces the risk of vascular disease so perhaps increased use of the medicine in developing countries could have far reaching benefits. Since the risk of vascular disease increases with age, low-dose aspirin prophylaxis might be beneficial once an individual becomes 50 years old (5). Furthermore, aspirin is also showing promise in cancer control (6) although the potential increased use of aspirin in the population does raise ethical issues, including risk of undesirable effects (7).<br>However, the appropriate use of low-dose aspirin could help save many lives in the increasingly ageing populations of developing countries (8). Furthermore, the potential reduction of the vascular disease burden in developing countries could help release valuable financial and human resources. Such resources could help develop service delivery infrastructures which would in turn improve the motivation and retention of health professionals. (December 15th 2008)<br>Gareth Morgan FRSPH, National Service Framework for Older People Project Manager, Welsh Assembly Government. Wales, UK. Email : Gareth.morgan3@wales.gsi.gov.uk<br>Dr Iskandar Idris DM FRCP (Lon) FRCP (Edin), Consultant Physician, <br>Sherwood Forest Hospital Foundation Trust, Nottinghamshire, England, UK.<br><br>Hon Senior Lecturer, University of Sheffield<br>Academic Unit of Diabetes, Endocrinology and Metabolism. Email:<br>IIdris@aol.com<br>References:<br>1. Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. Improving motivation and retention of health professionals in developing countries : a systematic review. BMC Health Serv. Res. 2008;8(1):247.<br>2. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3(11):e512.<br>3. Idris I, Deepa R, Fernando DJ, Mohan V. Relation between age and coronary heart disease (CHD) risk in Asian Indian patients with diabetes: A cross-sectional and prospective cohort study. Diabetes Res Clin Pract. 2008 Aug;81(2):243-9. Epub 2008 May 20. <br>4. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2008 Nov 28. [Epub ahead of print]<br>5. Bulugahapitiya U, Siyambalapitiya S, Sithole J, Fernando DJ, Idris I. Age threshold for vascular prophylaxis by aspirin in patients without diabetes. Heart. 2008 Nov;94(11):1429-32.<br>6. Morgan G.P. The potential contribution of aspirin to cancer control programmes. http://www.ecancermedicalscience.com/ accessed on November 18th 2008. <br>7. Morgan G. ethical considerations in relation to aspirin prophylaxis. Quality in Primary Care 2008;16(6):433-440<br>8. Hennekens CH. Aspirin in the treatment and prevention of cardiovascular disease : current perspectives and future directions. Curr. Atheroscler. Rep. 2007;9(5):409-416.<br>

Competing interests

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