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[Washington, D.C.], MCSP, 2017 Jun. 5 p. (USAID Cooperative Agreement No. AID-OAA-A-14-00028)This brief complements the 2012 WHO Guidelines on Basic Newborn Resuscitation, and highlights key changes and best practices for newborn resuscitation in resource-limited settings. Successful implementation of these recommendations at the time of birth is intended to improve the quality of care for newborns, and contribute to better health outcomes and reduce preventable newborn deaths and disabilities due to birth asphyxia.
[Unpublished] 1993.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[Unpublished] 1993.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.
BMJ. British Medical Journal. 1999 Jan 2; 318(7175):8.A 5-year plan to cut childhood deaths from asthma by half has been announced by WHO in association with other international respiratory organizations. The initiative aims to cut the estimated 25,000 avoidable asthma related deaths that occur in children each year. Other targets include cutting the number of childhood hospitalizations due to asthma by at least a quarter and the number of school days lost by half. Moreover, the project is focusing on children because of the strong evidence that the incidence of asthma is increasing rapidly in this age group throughout the world. The immediate strategies proposed to meet the targets set by the initiatives include encouraging health service providers to make provision for sufficient numbers of well educated health professionals to allow access to specialist care. Furthermore, particular emphasis is also being placed on preventive treatment.
The management of fever in young children with acute respiratory infections in developing countries.
[Unpublished] 1993. ii, 17 p. (WHO/ARI/93.30)The World Health Organization's (WHO) Programme for the Control of Acute Respiratory Infections (ARIs) has prepared guidelines on the management of fever in young children with ARIs in developing countries. A child with an ARI who has a fever does not necessarily have pneumonia. Fever alone is not an indication for antibiotics. However, fever in an infant aged less than 2 months may indicate a serious bacterial infection or malaria and should be referred to a hospital. A modest increase in body temperature may improve the immune system's ability to fight infection. Adverse effects of fever alone rarely occur and tend to occur in very ill and immunocompromised children (e.g., very severe pneumonia) or in children with a fever greater than 42 degrees Celsius. High fevers or rapid increase in temperature in young children often cause convulsions, which tend to resolve spontaneously and to cause no long-term neurological complications. Antipyretic treatment does not seem to prevent febrile convulsions. Lethargy and reduced appetite often accompany high fevers in children. A 10-15 mg/kg dose of paracetamol every 6 hours is the safest and most effective way to treat fever in children aged 2 months to 5 years. A fever of less than 39 degrees Celsius (rectal) is not an indication for antipyretic treatment among these children. In fact, such treatment would waste health services and family resources. It may be indicated in children experiencing fever-related discomfort, however. Additional fluids, appropriate clothing, and appropriate environmental conditions should be provided for young children with high fever. Tepid sponging does not help febrile children and should not be done. Health workers should tell parents what causes fever and reasons for treatment. They should try to ease parents' fears about their child's fever.
AMERICAN REVIEW OF RESPIRATORY DISEASE. 1992 Oct; 146(4):818-22.In May 1990 in Boston, Massachusetts, in the US, American Thoracic Society, the American Lung Association, and the International Union Against Tuberculosis and Lung Disease hosted the World Conference on Lung Health. At the end of the conference, participants adopted several resolutions calling on WHO and governmental and nongovernmental organizations to take specific actions to prevent and control lung diseases. The Conference adopted 7 resolutions pertaining to tuberculosis (TB) and AIDS, such as governments must ensure high quality care for TB and AIDS patients and strengthen TB and AIDS prevention programs. Since acute respiratory infections (ATIs), the leading cause of death in children, cause considerable suffering and death in children, the Conference asked WHO and government and nongovernment organizations to increase funding for provision, cold storage, and distribution of vaccines in developing countries, and for training care workers, and for programs to help parents recognize the signs and symptoms requiring medical attention. Other ARI-related resolutions included education about the risk and prevention of indoor air pollution and increased funding for research to develop heat-stable vaccines. Resolutions related to air pollution and health embraced tighter controls of emission of air pollutants, development of policies to protect indoor air, and more research into the hazards of indoor and outdoor air pollution. More research and gathering of accurate data on deaths and illness due to asthma were among resolutions related to asthma. Resolutions on smoking included a call for the end of all governmental support for the tobacco industry, including the import and export of tobacco products, and of all advertisements and promotions of tobacco products; for nonsmoking policies in all public places, especially health care facilities and schools; and for health workers to be societal role models by not smoking.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1991; 69(6):779-89.5-15% of all 3-15 year old children in the world are mentally impaired. In fact, 0.4-1.5% (10-30 million) are severely mentally retarded and an additional 60-80 million children are mildly or moderately mentally retarded. Birth asphyxia and birth trauma account for most cases of mental retardation in developing countries. >1.2 million newborns survive with severe brain damage and an equal number die from moderate or severe birth asphyxia. Other causes of mental retardation can also be prevented or treated such as meningitis or encephalitis associated with measles and pertussis; grave malnutrition during the 1st months of life, especially for infants of low birth weight; hyperbilirubinemia in neonates which occurs frequently in Africa and countries in the Pacific; and iodine deficiency. In addition, iron deficiency may even slow development in infants and young children. Current socioeconomic and demographic changes and a rise in the number of employed mothers may withhold the necessary stimulation for normal development from infants and young children. Primary health care (PHC) interventions can prevent many mental handicaps. For example, PHC involves families and communities who take control of their own care. Besides traditional birth attendants, community health workers, nurse midwives, physicians, and other parents must also participate in prevention efforts. For example, they should be trained in appropriate technologies including the risk approach, home risk card, partograph, mouth to mask or bag and mask resuscitation of the newborn, kick count, and ictometer. WHO has field tested all these techniques. These techniques not only prevent mental handicaps but can also be applied at home, health centers, and day-care centers.
In: Disease and mortality in Sub-Saharan Africa, edited by Richard G. Feachem, Dean T. Jamison. Oxford, England, Oxford University Press, 1991. 119-21.This article is an overview of comprehensive up-to-date accounts of the current literature on infective and parasitic diseases and malnutrition found in part II of the 1991 World Bank publication entitled Disease and Mortality in Sub-Saharan Africa. It also points out that the region has a problem with insufficient health information systems and lack of surveillance. Malaria is still a major cause of morbidity and mortality in Sub-Saharan Africa. Further the mosquito vectors become resistant to insecticides and the parasite becomes resistant to drugs. It poses many challenges to epdiemiologists, malariologist, pharmacologists, and immunologists. Yet there are not enough of African malaria scientists to address these problems. Diarrhea remains a leading cause of morbidity and mortality in small children in Sub-Saharan Africa. It includes the dysenteries, typhoid, other salmonella infections, cholera, and intestinal parasitic infections such as hookworm and ascaris. Countries in Sub-Saharan Africa need to emphasize good hygiene, safe excreta disposal, and safe water supply to prevent these conditions. Another major cause of disease and mortality in children is acute respiratory infections (ARIs) such as pneumonia. Antibiotics can treat some of these ARIs. WHO's Expanded Programme on Immunization (EPI) operates in many Sub-Saharan African countries and coverage is often high. For example, the Gambia has reached 80% coverage in children <2 years old with measles, DPT-3, BCG, polio-3, and yellow fever. Yet the 6 disease of EPI continue to afflict children. The AIDS epidemic exacerbates the burden of Sub-Saharan Africa which is already fraught with disease. Children in Sub-Saharan Africa also bear a nutritional burden (40% prevalence of stunting and 9% of wasting). Further many children also suffer from micronutrient deficiencies such as vitamin A. Other health problems in Sub-Saharan Africa include leprosy, meningococcal meningitis, and physical handicaps.
Dhaka, Bangladesh, UNICEF, 1988. 36 p.In 1988, floods occurred in Bangladesh like in 1987, but they were worse in 1988. They affected nearly everyone in the inundated areas, especially 4.63 million infants and children. The social response was greater in 1988 than 1987, with individuals leading the effort. Health conditions were generally poor, but the floods worsened these conditions, especially impacting on diarrhea and acute respiratory infections (ARIs). The diarrhea case fatality rate during the 4 months following the 1987 floods doubled indicating that the rate in 1988 would probably result in >80% excess morality among children <5 years old. Since about 1 million homes were lost and 2 million damages, many families and children stayed in crude shelters and were exposed to cold nights in November-February. They therefore were at high risk of ARIs. This and malnutrition would threaten the lives of many children. Normally malnutrition increased during the postmonsoon period due to already existing poverty, disease, and inadequate food intake, but the 1988 floods would increase malnutrition, especially among the children of the poorest of the poor. At the peak of the 1988 floods, about 200,000 hand pumps in the affected area were flooded thereby making it possible for people to draw potable water. They then drew water from the polluted flood waters which had inundated most of the few latrines. Despite efforts to operate refugee centers in a sanitary manner, they most likely had an inadequate water supply and means of feces disposal. Further, due to crowded conditions, refugees used unhygienic practices. Such conditions continued in slums, but government and volunteer workers were able to reach them easier than the rural refugee centers. The floods hindered efforts to repair the primary schools damaged in 1987. In 1988, >50% of schools were damaged in 16 districts. All schools were damaged in 3 UNICEF responded to the 1988 floods by generating US$5 million for special assistance with most money going to food and nutrition.