A review of the literature informing affordable, available wound management choices for rural areas of tropical developing countries.
Health professionals are often absent in rural areas of tropical developing countries. Current wound management in this environment is costly and largely ineffective. Achieving effective wound management in this setting will require educating the lay health providers who manage wounds in villages. Two extensive literature searches were conducted using CINAHL and Medline with no date, geographic, or language restrictions. The question, "What is the evidence base for topical wound treatments and dressings that are affordable and available in developing countries?" was addressed by critically evaluating all 18 identified clinical studies and reviews. The results suggest that a moist wound environment can be maintained using improvised dressings such as banana leaves, saline-soaked furniture foam, and food wrap, and that these choices are superior to many commercial dressings. Some varieties of honey, papaya pulp, EUSOL, and lubricating jelly are effective, affordable substances for treating and debriding wounds. Papaya pulp can be unsafe if not very closely monitored. No studies addressing the second question, "What are the topical wound management interventions currently being used in rural areas of tropical developing countries?" were found. However, 13 articles that could guide the design of research studies in this field were identified and are reviewed here. This literature describes a wide variety of wound prevention and management methods, some known to be deleterious for healing. These two literature reviews reveal the large gaps in the evidence base on available and affordable wound treatment options for rural patients in developing countries. Future research should address these gaps.