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Effect of exclusive breastfeeding on selected adverse health and nutritional outcomes: a nationally representative study.
BMC Public Health. 2017 Nov 21; 17(1):889.BACKGROUND: Despite growing evidence in support of exclusive breastfeeding (EBF) among infants in the first 6 months of birth, the debate over the optimal duration of EBF continues. This study examines the effect of termination of EBF during the first 2, 4 and 6 months of birth on a set of adverse health and nutritional outcomes of infants. METHODS: Three waves of Bangladesh Demographic and Health Survey data were analysed using multivariate regression. The adverse health outcomes were: an episode of diarrhea, fever or acute respiratory infection (ARI) during the 2 weeks prior to the survey. Nutritional outcomes were assessed by stunting (height-for-age), wasting (weight-for-height) and underweight (weight-for-age). Population attributable fraction was calculated to estimate percentages of these six outcomes that could have been prevented by supplying EBF. RESULTS: Fifty-six percent of infants were exclusively breastfed during the first 6 months. Lack of EBF increased the odds of diarrhea, fever and ARI. Among the babies aged 6 months or less 27.37% of diarrhea, 13.24% of fever and 8.94% of ARI could have been prevented if EBF was not discontinued. If EBF was terminated during 0-2 months, 2-4 months the odds of becoming underweight were 2.16 and 2.01 times higher, respectively, than babies for whom EBF was not terminated. CONCLUSION: Children who are not offered EBF up to 6 months of their birth may suffer from a range of infectious diseases and under-nutrition. Health promotion and other public health interventions should be enhanced to encourage EBF at least up to six-month of birth. TRAIL REGISTRATION: Data of this study were collected following the guidelines of ICF International and Bangladesh Medical Research Council. The registration number of data collection is 132,989.0.000 and the data-request was registered on September 11, 2016.
Pakistan Journal of Medical Sciences. 2007 Oct-Dec; 23(6):932-935.The objectives were to compare the prevailing prescribing practices of paediatricians with minor and major diploma for common paediatric problems. It was a Cross sectional study in which 10 % of children visiting the outpatient department of paediatrics, Hamdard university hospital with gastroenteritis and Acute respiratory infections, diagnosed according to UNICEF/ WHO protocol were enrolled, their prescriptions checked and results were entered in specially designed Performa. Five hundred prescriptions were reviewed of which 308 were due to Gastro enteritis, 192 were due to respiratory tract infections1). Average numbers of drugs/ prescription were 3.33 +or- 1.2. Paediatricians with minor diploma prescribed 3.5 +or- 1.2 drugs/ prescription. Paediatricians with major diploma prescribed 2.8 +or-1.2 drugs/ prescription (p-valve 0.32) Antibiotic in diarrhoea and respiratory tract infections (upper and lower respiratory tract infections were written in 81.7% cases by paediatricians with lower diploma and 77.7 % cases by paediatricians with major diploma (p-valve 0.27). In respiratory tract infections antihistamines were prescribed in 79.7% of cases by paediatricians with minor diploma and 69.5 % cases by paediatricians with major diploma (p-valve0.11). Anti emetic in Gastroenteritis were written in 69.1% cases by paediatricians with minor diploma and 56.2% cases by Paediatricians with major diploma (p-valve 0.021). More drugs and more antibiotic were given by doctors, with major diploma. Antibiotics were totally different than recommended by the National ARI programme, which the Paediatricians teach in Medical Colleges. The antibiotics prescribed for common Paediatric Problems were totally different than recommended by the National ARI programme which the Paediatricians teach in Medical College. Active intervention is needed to improve the quality of medical education of physicians who treat children, while in depth measures are required for the training of paediatricians. (author's)
American Journal of Tropical Medicine and Hygiene. 2007 Nov; 77(5):793-794.The World Health Organization (WHO) estimates that Streptococcus pneumoniae is responsible for up to one million deaths annually among children less than five years of age. Pneumococcus is a leading cause of bacterial pneumonia, meningitis, and sepsis. However, due to diagnostic challenges, the burden of pneumococcal disease is largely invisible. In this issue of the journal, Abdullah Brooks and others uncover the substantial disease burden affecting children living in an impoverished urban community in Dhaka, Bangladesh. This is the most rigorous study of the pneumococcal disease burden in an Asian setting. The overall incidence of invasive pneumococcal disease among children less than five 5 years of age was 447 episodes per 100,000 child years, which is comparable to incidence rates found among children coming to hospitals in rural African settings and more than five times higher than rates seen prior to widespread vaccination in the United States, a setting in which blood cultures are frequently performed on febrile children. Before this study, direct evidence for the high pneumococcal disease burden in Asia lagged behind that for Africa, despite the importance of pneumonia as a leading cause of childhood mortality in both regions. (excerpt)
Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2005 Jan 10.  p.Acute Respiratory Infections (ARIs) are a major cause of mortality and morbidity in emergencies. About 20% of all deaths in children under 5 years are due to Acute Lower Respiratory Infections (ALRIs - pneumonia, bronchiolitis and bronchitis); 90% of these deaths are due to pneumonia. Early recognition and prompt treatment of pneumonia is life saving. Causative organisms may be bacterial (most commonly Streptococcus pneumoniae and Haemophilus influenzae) or viral. However, it is not possible to differentiate between bacterial and viral ARIs based on clinical signs or radiology. Low birth weight, malnourished and non-breastfed children and those living in overcrowded conditions are at higher risk of getting pneumonia. These children are also at a higher risk of death from pneumonia. (excerpt)
Lancet. 2004 Nov 27; 364:1974-1983.Communicable diseases, alone or in combination with malnutrition, account for most deaths in complex emergencies. Factors promoting disease transmission interact synergistically leading to high incidence rates of diarrhoea, respiratory infection, malaria, and measles. This excess morbidity and mortality is avoidable as effective interventions are available. Adequate shelter, water, food, and sanitation linked to effective case management, immunisation, health education, and disease surveillance are crucial. However, delivery mechanisms are often compromised by loss of health staff, damage to infrastructure, insecurity, and poor co-ordination. Although progress has been made in the control of specific communicable diseases in camp settings, complex emergencies affecting large geographical areas or entire countries pose a greater challenge. Available interventions need to be implemented more systematically in complex emergencies with higher levels of coordination between governments, UN agencies, and non-governmental organisations. In addition, further research is needed to adapt and simplify interventions, and to explore novel diagnostics, vaccines, and therapies. (author's)
The evolution of diarrhoeal and acute respiratory disease control at WHO. Achievements 1980–1995 in research, development, and implementation.
Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 1999.  p. (WHO/CHS/CAH/99.12)For 15 years, WHO’s efforts to combat diarrhoeal disease and acute respiratory infections—two childhood killers—focused on translating relevant research into the practical tools and action needed by countries, then on working with countries to introduce, monitor, and evaluate their use. In 1990, the WHO Division of Diarrhoeal and Acute Respiratory Disease Control (CDR) was formed and brought together the work of the WHO Programme for the Control of Diarrhoeal Diseases (CDD), established in 1980, and the WHO Programme on Acute Respiratory Infections (ARI), established in 1984. The experience of the CDD and ARI Programmes provided valuable insight into the process of programme development and, in particular, the cycle of research, development, implementation and evaluation. The work of these Programmes illustrated a natural and logical thread connecting research to the development and evaluation of priority interventions that can have the most impact in countries burdened by these diseases. The Programmes recognized the need for lessons learned in the field to be incorporated into improved interventions, tools and guidelines, and to guide priority setting for future research. This document describes how the cycle of research, development, implementation and evaluation has kept work focused on the changing challenges to the prevention and treatment of diarrhoeal disease and acute respiratory infections. As part of this cycle, the Programmes’ research agenda underwent a significant evolution between 1980 and 1995. Research activities shifted from a focus on etiology and epidemiology to one that emphasized addressing practical operational problems in order to improve programme implementation and effectiveness, particularly in developing countries. (excerpt)
Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2001.  p. (WHO/FCH/CAH/01.02)This document reviews the efficacy and safety of cough and cold medicines in young children (under 5 years of age) with an acute respiratory infection. A systematic literature review was carried out to identify appropriate randomized controlled trials (RCTs). The results of the relatively few RCTs which have been carried out in children are especially important. Results from trials carried out on adults cannot be reliably extrapolated to include children owing to important differences in their anatomy and immune responses and in the etiology of the common cold. The pharmacokinetics and toxicity of drugs in children are often different from those in adults. Plasma drug concentrations may differ substantially because of immature liver and kidney functions and differences in gastrointestinal absorption, plasma binding, and relative volumes of fat and water. As a general rule, the differences are more pronounced in infants and young children and in malnourished children. (excerpt)
Technical bases for the WHO recommendations on the management of pneumonia in children at first-level health facilities.
Geneva, Switzerland, WHO, Programme for the Control of Acute Respiratory Infections, 1991.  p. (WHO/ARI/91.20)About 13 million children under 5 years of age die every year in the world, 95% of them in developing countries. Pneumonia is one of the leading causes, accounting for about 4 million of these deaths. Despite this fact, for a combination of technical and operational reasons, pneumonia has been a neglected problem until very recently. Clinicians and epidemiologists thought that the control of respiratory infections did not deserve high priority because of the difficulties involved in preventing and managing these infections; it was said that antibiotics might not be an effective treatment against pneumonia because patients are often weakened by conditions such as chronic malnutrition and parasitic infections, and that a wide variety of viruses and bacteria are associated with pulmonary infections making it impossible to identify the specific etiological agent in each patient (1.) On the other hand, some public health experts felt that a programme aimed at preventing mortality from pneumonia could not succeed because it would be difficult to deliver the available technology (antibiotics) through peripheral health units and community-based health workers. At most, one quarter of the pneumonia cases in children can be prevented by the measles and pertussis vaccines included in the immunization schedule of the Expanded Programme on Immunization. There is a clear need for research to develop and test vaccines against the most frequent agents of pneumonia in children. Such research has been pursued by WHO, notably within the Programe for the Control of Acute Respiratory Infections (ARI) and the Vaccine Development Programme; however, WHO has simultaneously been utilizing current clinical knowledge to formulate a case management strategy to reduce the high mortality from pneumonia in children. The present document is not intended to provide detailed case management guidelines. These are to be found in the manual "Acute respiratory infections in children: Case management in small hospitals in developing countries. A manual for doctors and other senior health workers", document WHO/ARI/90.5 (1990). (excerpt)
Acute respiratory infections in children: case management in small hospitals in developing countries. A manual for doctors and other senior health workers.
Geneva, Switzerland, WHO, Programme for the Control of Acute Respiratory Infections, 1990.  p. (WHO/ARI/90.5)Acute respiratory infections (ARI) are one of the commonest causes of death in children in developing countries. They are responsible for four of the estimated 15 million deaths that occur in children under 5 years of age each year; two-thirds of these deaths are in infants (especially young infants). Lung puncture studies in developing countries indicate that most cases of severe pneumonia in children are caused by bacteria, usually Streptococcus pneumoniae or Haemophilus influenzae. This contrasts with the situation in developed countries, where the great majority are due to viruses. (excerpt)
American Journal of Clinical Nutrition. 2003 Aug; 78(2):291-295.Background: Opinions and recommendations about the optimal duration of exclusive breastfeeding have been strongly divided, but few published studies have provided direct evidence on the relative risks and benefits of different breastfeeding durations in recipient infants. Objective: We examined the effects on infant growth and health of 3 compared with 6 mo of exclusive breastfeeding. Design: We conducted an observational cohort study nested within a large randomized trial in Belarus by comparing 2862 infants exclusively breastfed for 3 mo (with continued mixed breastfeeding through = 6 mo) with 621 infants who were exclusively breastfed for = 6 mo. Regression to the mean, within-cluster correlation, and cluster- and individual-level confounding variables were accounted for by using multilevel regression analyses. Results: From 3 to 6 mo, weight gain was slightly greater in the 3-mo group [difference: 29 g/mo (95% CI: 13, 45 g/mo)], as was length gain [difference: 1.1 mm (0.5, 1.6 mm)], but the 6-mo group had a faster length gain from 9 to 12 mo [difference: 0.9 mm/mo (0.3, 1.5 mm/mo)] and a larger head circumference at 12 mo [difference: 0.19 cm (0.07, 0.31 cm)]. A significant reduction in the incidence density of gastrointestinal infection was observed during the period from 3 to 6 mo in the 6-mo group [adjusted incidence density ratio: 0.35 (0.13, 0.96)], but no significant differences in risk of respiratory infectious outcomes or atopic eczema were apparent. Conclusions: Exclusive breastfeeding for 6 mo is associated with a lower risk of gastrointestinal infection and no demonstrable adverse health effects in the first year of life. (author's)
BMJ. British Medical Journal. 2003 Apr 12; 326(7393):782.WHO believes that as much as a third of the world’s total burden of disease is caused by environmental factors. Children under 5, who comprise only 10% of the world population, currently bear 40% of the global disease burden. (excerpt)
Lancet. 2003 Mar 22; 361(9362):1017.WHO issued a global health alert on March 13 after several outbreaks of severe acute respiratory syndrome (SARS) were reported across the world. The SARS outbreaks began in Asia and since then 167 suspected cases have been reported in Canada, Hong Kong, Indonesia, Singapore, Thailand, Vietnam and most recently Germany. Suspected cases in the USA, UK, Israel, Australia, and France have not been confirmed and two cases in Geneva, initially thought to be SARS have now been discounted. (excerpt)
[Unpublished] 1993. ii, 49 p. (WHO/ARI/93.28)The World Health Organization's (WHO) Programme for the Control of Acute Respiratory Infections (ARIs) reviewed the literature to provide this background paper on oxygen therapy for ARIs in young children in developing countries. The paper begins with a review of the use of oxygen therapy and examines its role in reducing pneumonia-related mortality and indications for its use. The review discusses the strength of the evidence for a relationship between individual clinical signs and hypoxemia or mortality associated with severe pneumonia. The clinical signs discussed include central cyanosis, inability to drink, severe chest indrawing, breath rate of more than 70 breaths per minute in children aged 2 months to 5 years, grunting in infants aged less than 2 months, and restlessness. The second major section of the paper is devoted to the oxygen delivery system. Oxygen cylinders and oxygen concentrators are sources of oxygen. Methods of oxygen administration covered include nasopharyngeal catheter, nasal prongs (cannula), headbox, facemask, and humidification. The third major section provides guidelines for oxygen administration. More specifically, it covers indications for oxygen use when oxygen is scarce and when it is abundant and for when to stop oxygen therapy, warnings on the use of oxygen, using oxygen concentrators and oxygen cylinders (especially installation, equipment for the administrator of oxygen, and initial procedures), giving oxygen to more than one patient from a concentrator and from a cylinder, and administration of oxygen through various methods.
Bronchodilators and other medications for the treatment of wheeze-associated illnesses in young children.
[Unpublished] 1993. , [iv], 37 p. (WHO/ARI/93.29)The World Health Organization's (WHO) Programme for the Control of Acute Respiratory Infections (ARIs) reviewed the literature to provide this background paper on available drugs for the treatment of wheeze, the common causes of wheeze, and the pathogenesis and pathophysiology of asthma and bronchiolitis. It focuses on children in countries with a high infant mortality rate and where bacterial pneumonia is a major public health problem. When health providers manage wheeze in children, they must consider the fact that bacterial pneumonia is the leading cause of respiratory death in young children in developing countries. Even health providers in developed countries should consider bacterial pneumonia as the cause of wheeze. These providers tend to associate viral infections with wheeze. Many children with an ARI have combined viral and bacterial infections. About 50% of outpatient cases with confirmed Haemophilus influenzae and Streptococcus pneumoniae bacteremic pneumonia have wheeze. The first bronchodilator physicians should use to manage acute episodes of wheeze is a beta-2 adrenergic agent, e.g., salbutamol. Financial limitations will restrain the likelihood of long-term preventive therapy of acute episodes of wheeze caused by asthma. The best prophylactic options for asthma-related recurrent wheeze are sodium cromoglycate and inhaled corticosteroids. The leading therapeutic drugs for treating acute asthma include an inhaled beta-2 adrenergic agent with oral corticosteroids if needed. This treatment will achieve bronchodilatation and reversal of the airway narrowing caused by mucosal edema, by mucus hypersecretion, and by smooth muscle spasm. Long-term beta agonist therapy alone will not reduce airway inflammation. Allergen avoidance can also protect against recurrent wheeze in some cases. The annexes include tables on the presentation and dosage of bronchodilators and other drugs for the treatment of wheeze in children aged 0-5 and on bronchodilators and other drugs for the treatment of wheeze in the WHO list of essential drugs.
JAMA. 1993 Feb 17; 269(7):846, 850.From February 1991 through July 1992, 67,000 Bhutanese of Nepalese ethnic origin entered southeastern Nepal because of ethnic persecution in Bhutan, and were established in 6 refugee camps. In July 1992, the Office of the UN High Commissioner for Refugees, the Save the Children Fund, and CDC established a surveillance system to monitor morbidity and mortality of these refugees. Mortality surveillance was established for diarrhea, acute respiratory infections (ARI), measles, malaria, injuries, maternal deaths, and other/unknown. Data were collected from March through July 1992 by a single designated health worker at each camp by interviewing the families. From March 25 through June 30, daily mortality rates for children under 5 years, of age (<5MR) averaged over each week were 2.3-8.8 deaths/10,000 persons/day, a rate 2-8 times greater than in Nepal. Daily crude mortality rates (CMRs) for the entire camp population were 1.5 deaths/10,000/day. Based on verbal autopsies of 89 deaths during July 3-19, 49 (55%) deaths were caused by ARI and 25 (28%) by diarrhea. The ARI-specific <5MR (1.6 deaths/10,000/day) was more than 5 times greater than the ARI-specific mortality rate for persons aged =or> 5 years (0.3 deaths/10,000/day). From March 1 through April 30, 549 cases of measles were recorded at camp health centers. Following this outbreak, <5MRs increased to 4.4-8.8 deaths/10,000/day during April 1-May 16. Nearly 12% of patients with diarrhea during July 3-19 had bloody diarrhea. Shigella flexneri types 1, 2, and 3 were cultured from 5 of 13 (38%) patients. All isolates were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole but sensitive to nalidixic acid. From June 15 through July 19, in one camp 38 (3.4%) of 1129 refugees with suspected malaria had blood smears slide-positive for Plasmodium falciparum and 37 (3.3%) had blood smears positive for P. vivax.
[Unpublished] . , 101 p.This study was conducted by a working group of religious leaders from Al Azhar formed by request of UNICEF. The point of the study is to establish religious support of practical health care for children. The idea was endorsed by the religious leaders and a working groups was created to research the Koran in an effort to make the strongest possible theological case for child health care. 6 specific issues were to be supported: (1) immunization of children for diphtheria, pertussis, tetanus, measles, polio, and tuberculosis; (2) treatment of diarrheal dehydration with oral rehydration therapy; (3) promoting improved health practices; (4) support for breastfeeding; (5) encouragement of early treatment of respiratory infections; (6) immunizing pregnant mothers for tetanus. A number of TV events were shown during the religious program (Fi Rihab El Iman) which concentrated on child protection and sound upbringing as well as how to effectively meet the child's needs before and after birth. The working groups produced 6 research papers that drew heavily from the Koran, hadiths and famous quotations. UNICEF supports issuing these papers together as a reference book for people in related fields. This booklet is a synthesis of the research papers and has been widely disseminated attention was paid to use very simple language so as to maximize its appeal and effect.
POPLINE. 2001 Mar-Apr; 23:3.Nearly 1 in 3 children born in Sierra Leone's diamond-rich Kenema district died last year before turning 1 year old, according to a recently released report. Issued by Sierra Leone's Health and Sanitation Ministry and the International Rescue Committee (IRC), the report came on the heels of a mortality survey in the West Central African country. The UN International Children's Emergency Fund (UNICEF) previously reported that Sierra Leone's infant mortality level of 157 newborn deaths per 1000 births is the world's highest. The new study, however, demonstrates that the rate in Kenema is almost twice that level. Robin Nandy of IRC called the findings “a public health catastrophe”. Additionally, the survey revealed an overall death rate for Kenema that was 3 times the normal level for sub-Saharan Africa--44 deaths a year per 1000 people. UNICEF estimated in 1999 that the overall mortality rate in Sierra Leone was much lower--24 deaths per 1000 people--though even that number is considered among the world's highest mortality rates. Most of the deaths were attributed to common illnesses that are easily treatable, with ailments involving fever proving to be the most fatal. Malaria was the leading cause of death, followed by diarrheal disease and respiratory infections. Nandy called the findings worse than anticipated since Kenema was fairly peaceful last year, compared to considerable fighting the year before. She said that IRC assumes death rates are even higher in areas where conflict continues. With a fertility rate of 6.3 children per woman, Sierra Leone is on course to double its population of 5.2 million in only 26 years and triple its human numbers in 50 years. (full text)
IMPACT ON HIV. 2000 Jun; 2(1): p..In sub-Saharan Africa, the WHO and the Joint UN Programme on HIV/AIDS (UNAIDS) are recommending that HIV-infected people take daily doses of cotrimoxazole, an inexpensive antibiotic, to prevent some of the opportunistic infections that can kill people with weakened immune systems. Studies in three African countries suggest that prophylactic use of the drug could add years to the lives of HIV-positive people. Once considered questionable for use in Africa, cotrimoxazole is effective in preventing other HIV-related infections that are common in the region, including certain bacterial pneumonia and diarrheal diseases. It may also protect against toxoplasmosis, a parasitic brain disease, and isosporiasis, a parasitic infection of the intestines. In Cote d'Ivoire, preventive use of cotrimoxazole yielded a 50% reduction in death rate in one study and a 50% decrease in dangerous complications, such as pneumonia and diarrhea, in another. The publication of implementation guidelines of prophylaxis programs in sub-Saharan Africa is being planned by the WHO and UNAIDS.
[Mortality due to acute respiratory infections in Latin America and prospects for control] Mortalidad por infeccion respiratoria aguda en America Latina y perspectivas de control.
In: Memorias de Cocoyoc. Primer Seminario. Situacion y Perspectivas de la Mortalidad en Menores de Cinco Anos en America Latina, Cocoyoc, Morelos, Mexico, 23/26 Octubre 1988, compiled by Pan American Health Organization [PAHO], Mexico. Secretaria de Salud, UNICEF. Washington, D.C., PAHO, . 597-611.Acute respiratory infection (ARI) is the principal cause of health service consultations and hospital admissions in children under 5. In developing countries, a high proportion of pneumonias have a bacterial etiology. ARIs are a significant cause of death because of limited access to antibiotic therapy and increased frequency of malnutrition and other risk factors. The main life-threatening respiratory syndromes of children after pneumonia are bronchitis and acute laryngitis or croup. Fewer than 2% of small children with pneumonia die in developed countries, but an estimated 10-20% die in developing countries, and the decline in pneumonia mortality has been slow. Operational studies indicate that children die because health care is not sought or is sought too late. The World Health Assembly recommends a global effort to control respiratory diseases to reduce mortality in children under 5. The recommended strategies are based on results of clinical-etiological, operational, and feasibility studies. They include education of health workers and the community in prevention and management of ARIs and simple therapeutic regimes applicable at all levels of complexity and adequate for different countries. The etiological studies confirm the importance of bacterial agents. The basic intervention for reducing mortality is timely and adequate treatment of moderate forms at the primary level and hospital referral for serious cases. A very simple classification suitable for use by physicians or auxiliary personnel is required. The first line therapy selected by most Latin American countries is benzatinic penicillin combined with cotrimoxazol for cases showing no improvement within 48 or 72 hours.
Geneva, Switzerland, World Health Organization [WHO], 1999. 68 p. (WHO/CDS/99.1; Building a Foundation for Health Development)This paper focuses on the prevention and control of infectious diseases. The WHO reported that infectious diseases caused about 25% of child and young adult mortality as of 1998. In low-income countries, infectious diseases account for 45% of deaths, and are also responsible for 63% of child mortality and 48% premature death. The 6 infectious diseases that caused 90% of the mortality cases include acute respiratory infections (pneumonia and influenza), HIV/AIDS, diarrhea, tuberculosis (TB), malaria, and measles. The obstacles that these diseases pose on health and the economy can be removed through disease prevention and control with cost-effective strategies, such as childhood vaccinations, bednets for malaria, directly observed treatment short-course for TB, integrated management of childhood diseases, antibiotics, and HIV prevention. Due to increased travel, the emergence of diseases and unexpected outbreaks, resistance to antibiotics, and economic development, infectious diseases have become a serious problem both in the developing and industrialized countries.
Outcome for children under 5 years hospitalized with severe acute lower respiratory tract infections in Yemen: a 5 year experience.
JOURNAL OF TROPICAL PEDIATRICS. 1998 Dec; 44(6):343-6.In developing countries, more than 4 million children under 5 years old die annually of acute respiratory infections (ARI), especially pneumonia. ARI is a leading cause of morbidity and mortality among children under age 5 years in Yemen. During 1991-95, 2554 children under age 5 years hospitalized with severe acute lower respiratory tract infection in Al-Sabeen Hospital, Sana'a, Yemen, were studied to document their case fatality rates (CFRs) and the effects upon outcome of introducing the WHO-ARI standard case management protocol for inpatients with severe/very severe pneumonia. 47.7% (1218) of the children were under age 6 months, while 74.1% were under 1 year old. 64% were male. 221 of the 2554 cases died, for an overall CFR of 8.7%. 118 of the deaths (53.4%) were among children under age 6 months and 188 (85%) were under 1 year old. Although the WHO standard case management guidelines were implemented in 1995, there was no significant reduction in case fatality rates in 1995 relative to 1991, 1992, 1993, and 1994. Late hospital admission with cyanosis, malnutrition, and rickets increased resistance of the common causative organisms such as pneumococci and H. influenzae to WHO-recommended antibiotics. Measures to reduce lower respiratory tract infection-related mortality could include improving maternal nutrition, health education, promoting breast-feeding, preventing rickets and nutritional anemia among vulnerable age groups, and vaccination against pneumococci and H. influenzae type b.
WHO meeting on maternal and neonatal pneumococcal immunization. Reunion de l'OMS sur la vaccination antipneumococcique de la mere et du nouveau-ne.
WEEKLY EPIDEMIOLOGICAL RECORD. 1998 Jun 19; 73(25):187-8.In developing countries, pneumococcus is an important cause of serious infections during the first 3 months of life and the most important cause of meningitis in that age group. A meeting of experts was held January 26-27, 1998, at World Health Organization headquarters to review strategies for the prevention of pneumococcal disease in early infancy. Polysaccharide-protein conjugate vaccines designed for use in young infants have been developed and are currently being evaluated for use at the time of routine DTP immunization. Early pneumococcal infections, however, which may be responsible for up to 30% of infant pneumococcal deaths, may not be preventable by the infant immunization strategies currently under investigation. Additional approaches to preventing pneumococcal disease in early infancy include the immunization of pregnant women. The experts supported efforts to move toward large-scale studies of the safety and efficacy of vaccinating pregnant women with pneumococcal polysaccharide vaccine or one of the pneumococcal polysaccharide-protein conjugate vaccines currently being developed. An alternative approach to controlling pneumococcal disease during the first 3 months of life would be neonatal immunization with pneumococcal conjugate vaccines.
WORLD HEALTH FORUM. 1998; 19(2):174-81.Until the late 1960s, health professionals most often recommended that people with diarrheal disease take antidiarrheal drugs and refrain from eating for at least 24 hours. At the same time, work was underway on the development of oral rehydration therapy (ORT), which was subsequently adopted in 1971 to complement the limited supply of intravenous treatment for thousands of patients in West Bengal. The success of ORT in treating diarrheal disease led to the establishment of the World Health Organization's (WHO) Program for the Control of Diarrheal Diseases in 1980, and the subsequent broader access to packets of oral rehydration salts in health facilities. WHO was also involved in efforts to control acute respiratory infections, establishing the Acute Respiratory Infections Program to validate the use of clinical signs for diagnosis and evaluate the impact of the approach. Since WHO's maintenance of these two parallel single-disease programs resulted in some duplication of effort, they were merged in 1990 to form the Division of Diarrheal and Acute Respiratory Disease Control. The division's mandate was later modified and expanded in 1996 in the creation of the Division of Child Health and Development responsible for the control of diarrheal diseases, acute respiratory infections, and other childhood killers like measles, malaria, and malnutrition.
[Children in poor countries also have a right to good health care. A new health care program will reduce child mortality] Aven barn v fattiga lander har ratt till god vard. Nytt omvardnadsprogram skall minska barnadodligheten.
LAKARTIDNINGEN. 1997 Oct 8; 94(41):3637-41.This article discusses the integrated management of childhood illness (IMCI) approach, developed by WHO and UNICEF based on international experience, which allows the care and treatment of sick children in countries with limited resources. It is estimated that every year 12 million children die in low-income countries before age 5. 70% of these deaths are related to common diseases: respiratory infections, diarrhea, measles, malaria, and malnutrition. The guidelines were developed for local health workers. Two flowcharts were designed for presenting the guidelines: one for children aged 1 week to 2 months and one for children aged 2 months to 5 years. For infants, the treatment of bacterial infections, diarrhea and feeding, and low weight are paramount. Fever and breathing difficulty may be the expression of severe general infection. The care of children aged 2 months to 5 years should consider four general warning symptoms: cramps, loss of consciousness, inability to drink or suckle, and constant vomiting. The presence of one of these symptoms indicates serious illness and the need for immediate care. Coughing and breathing difficulties are signs of severe pneumonia or serious respiratory illness, which requires transfer to a hospital after administering a dose of antibiotics. The use of trimethoprim-cotrimoxazole is recommended for treatment of pneumonia, while trimethoprim-sulfamethoxazole is indicated for malaria. The diagnosis, classification, and treatment of diarrhea is performed according to earlier WHO guidelines. General erythema and either coughing, a cold, or red eyes are the signs of measles.
SYNOPSIS. 1998 Jan; (2):1-8.The World Health Organization (WHO)/UN Children's Fund (UNICEF) Integrated Management of Childhood Illness (IMCI) guidelines were designed to maximize detection and appropriate treatment of illnesses due to the most common causes of child mortality and morbidity in developing countries: pneumonia, diarrhea, malaria, measles, bacterial infections in young infants, malnutrition, anemia, and ear problems. The health worker first examines the child and checks immunization status, then classifies the child's illness and identifies the appropriate treatment based on a color-coded triage system. By May 1997, 17 countries had introduced IMCI and 16 others were in the process of introduction. This issue reports on field tests of the guidelines conducted in Kenya, the Gambia, Uganda, Bangladesh, and Tanzania. Health workers who used the guidelines performed well when compared to physicians who had access to laboratory and radiographic findings as well as health workers trained in full case management. Of concern, however, are research findings suggesting the potential for overdiagnosis in some disease classifications. Current IMCI research priorities include the following: 1) determining health workers' ability to learn to detect lower chest wall indrawing; 2) identifying clinical signs to increase the specificity of referral for severe pneumonia; 3) identifying other clinical signs to increase the specificity of hospital referrals, thereby reducing unnecessary referrals; 4) investigating how clinical care for severely ill children could be expanded in areas where referral is not feasible; 5) finding ways to increase the specificity of the diagnosis of malaria; and 6) recognizing clinical signs to increase the specificity of the diagnosis of severe anemia and the specificity of the diagnosis of moderate or mild anemia, with the possible goal of regional adaptation of the anemia guidelines.