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This chapter focuses on the differences between the West and the Third World, such as poverty, age of the population, disease burden, lack of skilled staff and equipment. The Third World has a predominantly young population. Birth rate is higher than in the West, but there is high mortality amongst the under 5 years old, and since the HIV/AIDS epidemic a high mortality in early middle life. Evidence-based medicine starts with a clinical problem, and with the formation of a question regarding optimal care. The mother to child transmission (MTCT) studies for Sub-Saharan Africa can only be done in the Third World situation. The teaching of non-physician anaesthetists, who give the majority of anaesthetics in many countries, is often hampered by the absence of any studies as to what is the best in the conditions in which they are working.
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