Challenges of Gastrointestinal Endoscopy in Resource-Poor Countries

Abstract

Over the past 100 years, there has been a dramatic and explosive growth of information about and technology related to the science and practice of gastroenterology. Endoscopy services are the mainstay of diagnosis and treatment in gastroenterology. Endoscopies have undergone significant changes enabled by advances in information technology (IT). The ability to take video pictures onto the computer screen and to print them has enabled more effective image capture, image storage and retrieval as well as quality assessment. The developed countries of the world have taken great advantage of these innovations and developments but the story is totally different for the developing or resource – poor countries. The developing countries are characterized by low measures of development such as income per capita, rate of literacy, life expectancy and other health indices. These countries have not achieved a significant degree of industrialization relative to their populations, and which have in most cases a low standard of living. Strictly speaking, the term developing implies mobility and does not acknowledge that development may be in decline or static in some countries, particularly African countries. It is for this reason that the World Bank classifies countries on the basis of Gross National Income (GNI) per capita (World Bank, 2010). Digestive diseases impose a substantial burden on global health. In the United States, over 40 billion US Dollars was used for gastrointestinal disease in one year (Sandler et al 2002).Comparable information on the digestive health of people living in developing countries may not be available but it is known that diarrheal diseases account for 17.9% of deaths in low-income countries compared to 1.6% in high-income countries (World Health Organization, WHO 2008). Helicobacter pylori is a leading cause of gastrointestinal disease globally. Whereas the prevalence of this infection has declined considerably in the developed world, it is still very high in the developing countries (Torres et al 2000), with the majority of the global burden of infection found here (World Gastroenterology Organization, WGO 2006) because most of the risk factors for its transmission are rife in the developing countries. These include low socio-economic status, crowded living conditions, several children sleeping on one bed, large numbers of siblings and unclean water (Webb et al 1994, Malaty et al 1996, Lindkvist et al 1998, Dominici et al 1999, Nabwera et al 2000).