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Neurological, Psychiatric, and Developmental Disorders: Meeting the Challenge in the Developing World
interest of all governments to make a commitment to addressing brain disorders, building on the investments in health care they have already made.
ESTABLISHING NATIONAL AND LOCAL PRIORITIES FOR ADDRESSING BRAIN DISORDERS
In developing countries, the design and implementation of programs must be tailored to each country's needs and resources. The specific health needs of at-risk groups, resource constraints, the cultural context, and the local capacity to implement and sustain an intervention must all be taken into account. Building on evidence derived from programs in a variety of settings, this report highlights the need for rigorous operational research in conjunction with the provision of care. Several strategies for reducing the burden of brain disorders in the developing world emerged as this report was being prepared. Each requires further research for effective implementation based on consideration of the local resources and the community's health priorities.
THE POTENTIAL FOR PREVENTION
Prevention is critical in reducing the impact of brain disorders and in many instances is more cost-effective than treatment. Once established, impairment caused by these disorders is often irreversible. However, many potentially disabling disorders are now preventable. Examples include iodine supplementation to prevent mental retardation due to iodine deficiency; immunization against polio; folic acid supplementation and food fortification to reduce the number of children born with neural tube defects; and control of cysticercosis to prevent epilepsy. Appropriate, affordable treatment for other disorders, such as providing antidepressants or anticonvulsants, can prevent a lifetime of disability.
It is therefore essential to overcome existing barriers in developing countries to recognition of the public health importance of brain disorders and the development of strategies and programs for their prevention and treatment. Multifaceted research is needed to address these gaps, develop new prevention strategies, and assess the cost-effectiveness and sustainability of preventive strategies in specific settings. Multidisciplinary research involving collaboration between the health and social sciences and aiming to understand and remove these barriers should be targeted for increased funding.
INCREASING THE CLINICAL AND RESEARCH PROFESSIONAL CAPACITY IN DEVELOPINGCOUNTRIES
For a variety of historical, social, and economic reasons, many developing countries have a severe shortage of trained professionals with expertise in the