While many patients with schizophrenia respond to treatment, the authors found that relatively few developing countries are taking steps to provide care. "It is estimated that in 1990, over 67 percent of all persons with schizophrenia in developing countries [estimated at 17.2 million] were not receiving any treatment, and there is no evidence that the proportion of treated persons is increasing."
The authors recommended that governments and agencies responsible for social and medical policy in developing countries be made aware of "the fact that schizophrenia and other psychotic illnesses are treatable conditions and that significant returns in terms of symptom control, quality of life and reintegration into the community can be achieved if increased funding is provided for local and regional programs that incorporate best-practice procedures and criteria."
Stroke is projected to become the fifth leading condition contributing to the disease burden in developing countries by 2020. Prevention programs are essential to holding this increase in check, but the study found that risk factors are increasing in many developing countries. "The growing adoption of behaviors and lifestyles known to elevate stroke risk, such as tobacco use and high saturated fat intake" will continue to exacerbate the risk of stroke and other vascular diseases. "Current predictions indicate that by 2020, 12 percent of all deaths and nine percent of all DALYs will be attributable to tobacco alone; the vast majority of this increased burden is projected to arise in developing countries."
More money and resources are the solutions to many of the problems involved in treating brain disorders in developing countries. "Where resources are scarce," the authors wrote, "policy makers face difficult choices in allocating limited funds for health care. Such decisions are best made on the basis of rigorous evaluation of the efficacy of proposed interventions and, for those interventions that prove efficacious, their cost effectiveness."
Despite the obstacles, however, the researchers found numerous examples of innovative and cost-effective programs in a handful of developing nations.
In Tanzania, a country that spends only about US$1.33 per capita annually on health care, self-sustaining villages for the care of individuals with chronic psychiatric disorders have been created.
In Malawi, a community education and publicity campaign is moving patients with epilepsy away from traditional healers and into modern hospitals. To overcome distance problems in a country without adequate public transportation, two mobile clinics have been established.
In Iran, a village-based primary care system serves over 60 regions of the country, with the village centers linked to surrounding hospitals and medical schools. The national health program supports training in mental health care for all personnel and the development of a district-level mental health care support system, and it sponsors an annual mental health care week. In addition, the government has established an urban mental health program and created four regional centers for the prevention of mental disorders, with an emphasis on depression and suicide. Officials are also developing a school mental health care program and a child abuse prevention program.