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Thompson CN, Phan MVT, Hoang NVM, Minh PV, Vinh NT, Thuy CT, Nga TTT, Rabaa MA, Duy PT, Dung TTN, Phat VV, Nga TVT, Tu LTP, Tuyen HT, Yoshihara K, Jenkins C, Duong VT, Phuc HL, Tuyet PTN, Ngoc NM, Vinh H, Chinh NT, Thuong TC, Tuan HM, Hien TT, Campbell JI, Chau NVV, Thwaites G, Baker S. A prospective multi-center observational study of children hospitalized with diarrhea in Ho Chi Minh City, Vietnam. Am J Trop Med Hyg 2015; 92:1045-52. [PMID: 25802437 PMCID: PMC4426562 DOI: 10.4269/ajtmh.14-0655] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 01/28/2015] [Indexed: 12/15/2022] Open
Abstract
We performed a prospective multicenter study to address the lack of data on the etiology, clinical and demographic features of hospitalized pediatric diarrhea in Ho Chi Minh City (HCMC), Vietnam. Over 2,000 (1,419 symptomatic and 609 non-diarrheal control) children were enrolled in three hospitals over a 1-year period in 2009–2010. Aiming to detect a panel of pathogens, we identified a known diarrheal pathogen in stool samples from 1,067/1,419 (75.2%) children with diarrhea and from 81/609 (13.3%) children without diarrhea. Rotavirus predominated in the symptomatic children (664/1,419; 46.8%), followed by norovirus (293/1,419; 20.6%). The bacterial pathogens Salmonella, Campylobacter, and Shigella were cumulatively isolated from 204/1,419 (14.4%) diarrheal children and exhibited extensive antimicrobial resistance, most notably to fluoroquinolones and third-generation cephalosporins. We suggest renewed efforts in generation and implementation of policies to control the sale and prescription of antimicrobials to curb bacterial resistance and advise consideration of a subsidized rotavirus vaccination policy to limit the morbidity due to diarrheal disease in Vietnam.
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Affiliation(s)
- Corinne N Thompson
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - My V T Phan
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Van Minh Hoang
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Pham Van Minh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Thanh Vinh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Cao Thu Thuy
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran Thi Thu Nga
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Maia A Rabaa
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Pham Thanh Duy
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran Thi Ngoc Dung
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Voong Vinh Phat
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran Vu Thieu Nga
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Le Thi Phuong Tu
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ha Thanh Tuyen
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Keisuke Yoshihara
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Claire Jenkins
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Vu Thuy Duong
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Hoang Le Phuc
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Pham Thi Ngoc Tuyet
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Ngoc
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ha Vinh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Tran Chinh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tang Chi Thuong
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ha Manh Tuan
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran Tinh Hien
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - James I Campbell
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Van Vinh Chau
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Guy Thwaites
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Stephen Baker
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom; The London School of Hygiene and Tropical Medicine, London, United Kingdom; The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom; The Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; Gastrointestinal Bacteria Reference Unit, Public Health England, London, United Kingdom; Children's Hospital 1, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam; Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
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Friedlander LR, Puri N, Schoonen MAA, Wali Karzai A. The effect of pyrite on Escherichia coli in water: proof-of-concept for the elimination of waterborne bacteria by reactive minerals. JOURNAL OF WATER AND HEALTH 2015; 13:42-53. [PMID: 25719464 PMCID: PMC5891221 DOI: 10.2166/wh.2014.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present proof-of-concept results for the elimination of waterborne bacteria by reactive minerals. We exposed Escherichia coli MG1655 suspended in water to the reactive mineral pyrite (FeS₂) at room temperature and ambient light. This slurry eliminates 99.9% of bacteria in fewer than 4 hours. We also exposed Escherichia coli to pyrite leachate (supernatant liquid from slurry after 24 hours), which eliminates 99.99% of bacteria over the same time-scale. Unlike SOlar water DISinfection (SODIS), our results do not depend on the presence of ultraviolet (UV) light. We confirmed this by testing proposed SODIS additive and known photo-catalyst anatase (TiO₂) for antibacterial properties and found that, in contrast to pyrite, it does not eliminate E. coli under our experimental conditions. Previous investigations of naturally antibiotic minerals have focused on the medical applications of antibiotic clays, and thus have not been conducted under experimental conditions resembling those found in water purification. In our examination of the relevant literature, we have not found previously reported evidence for the use of reactive minerals in water sanitization. The results from this proof-of-concept experiment may have important implications for future directions in household water purification research.
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Affiliation(s)
- Lonia R Friedlander
- Department of Geosciences, 255 Earth and Space Sciences (ESS) Building, Stony Brook University, Stony Brook, NY 11794-2100, USA E-mail:
| | - Neha Puri
- Department of Biochemistry and Cell Biology and Center for Infectious Diseases, 5120 State University of New York, Stony Brook, NY 11794-5120, USA
| | - Martin A A Schoonen
- Department of Geosciences, 255 Earth and Space Sciences (ESS) Building, Stony Brook University, Stony Brook, NY 11794-2100, USA E-mail:
| | - A Wali Karzai
- Department of Biochemistry and Cell Biology and Center for Infectious Diseases, 5120 State University of New York, Stony Brook, NY 11794-5120, USA
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Aluisio AR, Maroof Z, Chandramohan D, Bruce J, Masher MI, Manaseki-Holland S, Ensink JHJ. Risk factors associated with recurrent diarrheal illnesses among children in Kabul, Afghanistan: a prospective cohort study. PLoS One 2015; 10:e0116342. [PMID: 25679979 PMCID: PMC4332656 DOI: 10.1371/journal.pone.0116342] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 12/08/2014] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Childhood diarrheal illnesses are a major public health problem. In low-income settings data on disease burden and factors associated with diarrheal illnesses are poorly defined, precluding effective prevention programs. This study explores factors associated with recurrent diarrheal illnesses among children in Kabul, Afghanistan. METHODS A cohort of 1-11 month old infants was followed for 18 months from 2007-2009. Data on diarrheal episodes were gathered through active and passive surveillance. Information on child health, socioeconomics, water and sanitation, and hygiene behaviors was collected. Factors associated with recurrent diarrheal illnesses were analyzed using random effects recurrent events regression models. RESULTS 3,045 children were enrolled and 2,511 (82%) completed 18-month follow-up. There were 14,998 episodes of diarrheal disease over 4,200 child-years (3.51 episodes/child-year, 95%CI 3.40-3.62). Risk of diarrheal illness during the winter season was 63% lower than the summer season (HR = 0.37, 95%CI 0.35-0.39, P<0.001). Soap for hand washing was available in 72% of households and 11.9% had toilets with septic/canalization. Half of all mothers reported using soap for hand washing. In multivariate analysis diarrheal illness was lower among children born to mothers with post-primary education (aHR = 0.79, 95%CI 0.69-0.91, p = 0.001), from households where maternal hand washing with soap was reported (aHR = 0.83, 95%CI 0.74-0.92, p<0.001) and with improved sanitation facilities (aHR = 0.76, 95%CI 0.63-0.93, p = 0.006). Malnourished children from impoverished households had significantly increased risks for recurrent disease [(aHR = 1.15, 95%CI 1.03-1.29, p = 0.016) and (aHR = 1.20, 95%CI 1.05-1.37, p = 0.006) respectively]. CONCLUSIONS Maternal hand washing and improved sanitation facilities were protective, and represent important prevention points among public health endeavors. The discrepancy between soap availability and utilization suggests barriers to access and knowledge, and programs simultaneously addressing these aspects would likely be beneficial. Enhanced maternal education and economic status were protective in this population and these findings support multi-sector interventions to combat illness. TRIAL REGISTRATION www.ClinicalTrials.gov NCT00548379 https://www.clinicaltrials.gov/ct2/show/NCT00548379.
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Affiliation(s)
- Adam R. Aluisio
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Emergency Medicine, Division of International Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America
| | - Zabihullah Maroof
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Chandramohan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jane Bruce
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mohammad I. Masher
- Department of Paediatrics, Kabul Medical University, Kabul, Afghanistan Department of Pediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Semira Manaseki-Holland
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jeroen H. J. Ensink
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
Millions of children die every year before they reach the age of 5 years, of conditions largely treatable with existing medicines. The WHO Model List of Essential Medicines was launched in 1977 to make the most necessary drugs available to populations whose basic health needs could not be met by the existing supply system. During the first 30 years of the Model List of Essential Medicines, children's needs were not systematically considered. After adoption of the 'Better medicines for children' resolution by the World Health Assembly, things changed. The first WHO Model List of Essential Medicines for Children was drawn up by a Paediatric Expert Subcommittee and adopted in October 2007. The most recent, 4th Model List of Essential Medicines for Children was adopted in 2013. Data from country surveys show that access to essential medicines for children is still generally poor; much more work is needed.
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Affiliation(s)
- Kalle Hoppu
- Hospital for Children and Adolescents and Department of Clinical Pharmacology, University of Helsinki and Poison Information Centre, Helsinki University Central Hospital, Helsinki, Finland
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le Roux DM, Myer L, Nicol MP, Zar HJ. Incidence and severity of childhood pneumonia in the first year of life in a South African birth cohort: the Drakenstein Child Health Study. LANCET GLOBAL HEALTH 2015; 3:e95-e103. [DOI: 10.1016/s2214-109x(14)70360-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Qazi S, Aboubaker S, MacLean R, Fontaine O, Mantel C, Goodman T, Young M, Henderson P, Cherian T. Ending preventable child deaths from pneumonia and diarrhoea by 2025. Development of the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea. Arch Dis Child 2015; 100 Suppl 1:S23-8. [PMID: 25613963 DOI: 10.1136/archdischild-2013-305429] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite the existence of low-cost and effective interventions for childhood pneumonia and diarrhoea, these conditions remain two of the leading killers of young children. Based on feedback from health professionals in countries with high child mortality, in 2009, WHO and Unicef began conceptualising an integrated approach for pneumonia and diarrhoea control. As part of this initiative, WHO and Unicef, with support from other partners, conducted a series of five workshops to facilitate the inclusion of coordinated actions for pneumonia and diarrhoea into the national health plans of 36 countries with high child mortality. This paper presents the findings from workshop and post-workshop follow-up activities and discusses the contribution of these findings to the development of the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea, which outlines the necessary actions for elimination of preventable child deaths from pneumonia and diarrhoea by 2025. Though this goal is ambitious, it is attainable through concerted efforts. By applying the lessons learned thus far and continuing to build upon them, and by leveraging existing political will and momentum for child survival, national governments and their supporting partners can ensure that preventable child deaths from pneumonia and diarrhoea are eventually eliminated.
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Affiliation(s)
- Shamim Qazi
- Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Samira Aboubaker
- Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | | | | | - Carsten Mantel
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Tracey Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Mark Young
- Child Health Team, United Nations Children's Fund, Three United Nations Plaza, New York, NY, USA
| | | | - Thomas Cherian
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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257
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Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, Cousens S, Mathers C, Black RE. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015; 385:430-40. [PMID: 25280870 DOI: 10.1016/s0140-6736(14)61698-6] [Citation(s) in RCA: 1970] [Impact Index Per Article: 218.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Trend data for causes of child death are crucial to inform priorities for improving child survival by and beyond 2015. We report child mortality by cause estimates in 2000-13, and cause-specific mortality scenarios to 2030 and 2035. METHODS We estimated the distributions of causes of child mortality separately for neonates and children aged 1-59 months. To generate cause-specific mortality fractions, we included new vital registration and verbal autopsy data. We used vital registration data in countries with adequate registration systems. We applied vital registration-based multicause models for countries with low under-5 mortality but inadequate vital registration, and updated verbal autopsy-based multicause models for high mortality countries. We used updated numbers of child deaths to derive numbers of deaths by causes. We applied two scenarios to derive cause-specific mortality in 2030 and 2035. FINDINGS Of the 6·3 million children who died before age 5 years in 2013, 51·8% (3·257 million) died of infectious causes and 44% (2·761 million) died in the neonatal period. The three leading causes are preterm birth complications (0·965 million [15·4%, uncertainty range (UR) 9·8-24·5]; UR 0·615-1·537 million), pneumonia (0·935 million [14·9%, 13·0-16·8]; 0·817-1·057 million), and intrapartum-related complications (0·662 million [10·5%, 6·7-16·8]; 0·421-1·054 million). Reductions in pneumonia, diarrhoea, and measles collectively were responsible for half of the 3·6 million fewer deaths recorded in 2013 versus 2000. Causes with the slowest progress were congenital, preterm, neonatal sepsis, injury, and other causes. If present trends continue, 4·4 million children younger than 5 years will still die in 2030. Furthermore, sub-Saharan Africa will have 33% of the births and 60% of the deaths in 2030, compared with 25% and 50% in 2013, respectively. INTERPRETATION Our projection results provide concrete examples of how the distribution of child causes of deaths could look in 15-20 years to inform priority setting in the post-2015 era. More evidence is needed about shifts in timing, causes, and places of under-5 deaths to inform child survival agendas by and beyond 2015, to end preventable child deaths in a generation, and to count and account for every newborn and every child. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Li Liu
- The Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shefali Oza
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniel Hogan
- Department of Health Statistics and Informatics, WHO, Geneva, Switzerland
| | - Jamie Perin
- The Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Igor Rudan
- University of Edinburgh Medical School, Edinburgh, UK
| | - Joy E Lawn
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon Cousens
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Colin Mathers
- Department of Health Statistics and Informatics, WHO, Geneva, Switzerland
| | - Robert E Black
- The Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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258
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Requejo JH, Bryce J, Barros AJD, Berman P, Bhutta Z, Chopra M, Daelmans B, de Francisco A, Lawn J, Maliqi B, Mason E, Newby H, Presern C, Starrs A, Victora CG. Countdown to 2015 and beyond: fulfilling the health agenda for women and children. Lancet 2015; 385:466-76. [PMID: 24990815 PMCID: PMC7613194 DOI: 10.1016/s0140-6736(14)60925-9] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The end of 2015 will signal the end of the Millennium Development Goal era, when the world can take stock of what has been achieved. The Countdown to 2015 for Maternal, Newborn, and Child Survival (Countdown) has focused its 2014 report on how much has been achieved in intervention coverage in these groups, and on how best to sustain, focus, and intensify efforts to progress for this and future generations. Our 2014 results show unfinished business in achievement of high, sustained, and equitable coverage of essential interventions. Progress has accelerated in the past decade in most Countdown countries, suggesting that further gains are possible with intensified actions. Some of the greatest coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases. Although inequities are pervasive, country successes in reaching of the poorest populations provide lessons for other countries to follow. As we transition to the next set of global goals, we must remember the centrality of data to accountability, and the importance of support of country capacity to collect and use high-quality data on intervention coverage and inequities for decision making. To fulfill the health agenda for women and children both now and beyond 2015 requires continued monitoring of country and global progress; Countdown is committed to playing its part in this effort.
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Affiliation(s)
- Jennifer Harris Requejo
- Partnership for Maternal, Newborn and Child Health, World Health Organization, 1211 Geneva 27, Switzerland.
| | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Peter Berman
- Harvard School of Public Health, Boston, MA, USA
| | - Zulfiqar Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | | | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Andres de Francisco
- Partnership for Maternal, Newborn and Child Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Joy Lawn
- London School of Hygiene and Tropical Medicine, London, UK
| | - Blerta Maliqi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Elizabeth Mason
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Holly Newby
- United Nations Children's Fund, New York, NY, USA
| | - Carole Presern
- Partnership for Maternal, Newborn and Child Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Ann Starrs
- Family Care International, New York, NY, USA
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259
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Alam MM, Khurshid A, Shaukat S, Sharif S, Suleman RM, Angez M, Nisar N, Aamir UB, Naeem M, Zaidi SSZ. 'Human bocavirus in Pakistani children with gastroenteritis'. J Med Virol 2015; 87:656-63. [PMID: 25611467 DOI: 10.1002/jmv.24090] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2014] [Indexed: 12/20/2022]
Abstract
Human Bocaviruses (HBoV) have been detected in human respiratory and gastrointestinal infections worldwide. Four genotypes of HBoV (HBoV1-4) have been described; HBoV-1 is associated with respiratory tract infections while HBoV-2, -3, and -4 genotypes are considered as entero-pathogenic although the exact role largely remains unclear. The global prevalence of HBoV has been reported, but the epidemiological data from Pakistan is largely unavailable to date. This study was conducted to understand the genetic diversity and disease prevalence of HBoV in hospitalized Pakistani children with acute diarrhea. During 2009, a total of 365 stool samples were collected from children hospitalized with gastrointestinal symptoms (as per WHO case definitions) at Rawalpindi General Hospital, Pakistan. Demographic and clinical data were recorded using a standardized questionnaire. The samples were tested for HBoV and rotavirus using real-time RT-PCR and ELISA, respectively. There were 47 (13%) samples positive for HBoV with 98% (n = 46) showing co-infection with rotavirus. HBoV-1 was the most frequently detected and was found in 94% samples followed by HBoV-2 and HBoV-3 genotypes. The mean age of infected children was 7.57 ± 5.4 months while detection was more frequent in males (n = 32, 68%). All cases recovered after 2.43 ± 1.0 mean days of treatment. On phylogenetic analysis, HBoV strains from Pakistan clustered closely with viruses from neighboring Bangladesh and China. These findings represent the first known epidemiological study in Pakistan to investigate the role of HBoV in acute gastroenteritis. The clinical data demonstrates that HBoV is not significantly associated with gastroenteritis alone and predominantly co-infections with rotavirus are found.
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Affiliation(s)
- Muhammad Masroor Alam
- Department of Virology, National Institute of Health, Islamabad, Pakistan; Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
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260
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Two birds, one stone approach, integrated action plan for pneumonia and diarrhea. Indian Pediatr 2015; 51:957-8. [PMID: 25560150 DOI: 10.1007/s13312-014-0539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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261
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Basnet S, Mathisen M, Strand TA. Oral zinc and common childhood infections--An update. J Trace Elem Med Biol 2015; 31:163-6. [PMID: 24906347 DOI: 10.1016/j.jtemb.2014.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/07/2014] [Accepted: 05/14/2014] [Indexed: 11/27/2022]
Abstract
Zinc is an essential micronutrient important for growth and for normal function of the immune system. Many children in developing countries have inadequate zinc nutrition. Routine zinc supplementation reduces the risk of respiratory infections and diarrhea, the two leading causes of morbidity and mortality in young children worldwide. In childhood diarrhea oral zinc also reduces illness duration and risk of persistent episodes. Oral zinc is therefore recommended for the treatment of acute diarrhea in young children. The results from the studies that have measured the therapeutic effect of zinc on acute respiratory infections, however, are conflicting. Moreover, the results of therapeutic zinc for childhood malaria also are so far not promising.This paper gives a brief outline of the current evidence from clinical trials on therapeutic effect of oral zinc on childhood respiratory infections, pneumonia and malaria and also of new evidence of the effect on serious bacterial illness in young infants.
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Affiliation(s)
- Sudha Basnet
- Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; Centre for International Health, University of Bergen, Bergen, Norway.
| | - Maria Mathisen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromso, Norway
| | - Tor A Strand
- Centre for International Health, University of Bergen, Bergen, Norway; Division of Laboratory Medicine, Sykehuset Innlandet, Lillehammer, Norway
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262
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Picot VS, Bénet T, Messaoudi M, Telles JN, Chou M, Eap T, Wang J, Shen K, Pape JW, Rouzier V, Awasthi S, Pandey N, Bavdekar A, Sanghvi S, Robinson A, Contamin B, Hoffmann J, Sylla M, Diallo S, Nymadawa P, Dash-Yandag B, Russomando G, Basualdo W, Siqueira MM, Barreto P, Komurian-Pradel F, Vernet G, Endtz H, Vanhems P, Paranhos-Baccalà G. Multicenter case-control study protocol of pneumonia etiology in children: Global Approach to Biological Research, Infectious diseases and Epidemics in Low-income countries (GABRIEL network). BMC Infect Dis 2014; 14:635. [PMID: 25927410 PMCID: PMC4272811 DOI: 10.1186/s12879-014-0635-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/17/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Data on the etiologies of pneumonia among children are inadequate, especially in developing countries. The principal objective is to undertake a multicenter incident case-control study of <5-year-old children hospitalized with pneumonia in developing and emerging countries, aiming to identify the causative agents involved in pneumonia while assessing individual and microbial factors associated with the risk of severe pneumonia. METHODS/DESIGN A multicenter case-control study, based on the GABRIEL network, is ongoing. Ten study sites are located in 9 countries over 3 continents: Brazil, Cambodia, China, Haiti, India, Madagascar, Mali, Mongolia, and Paraguay. At least 1,000 incident cases and 1,000 controls will be enrolled and matched for age and date. Cases are hospitalized children <5 years with radiologically confirmed pneumonia, and the controls are children without any features suggestive of pneumonia. Respiratory specimens are collected from all enrolled subjects to identify 19 viruses and 5 bacteria. Whole blood from pneumonia cases is being tested for 3 major bacteria. S. pneumoniae-positive specimens are serotyped. Urine samples from cases only are tested for detection of antimicrobial activity. The association between procalcitonin, C-reactive protein and pathogens is being evaluated. A discovery platform will enable pathogen identification in undiagnosed samples. DISCUSSION This multicenter study will provide descriptive results for better understanding of pathogens responsible for pneumonia among children in developing countries. The identification of determinants related to microorganisms associated with pneumonia and its severity should facilitate treatment and prevention.
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Affiliation(s)
- Valentina Sanchez Picot
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| | - Thomas Bénet
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
- Epidemiology and Public Health Unit, University of Lyon 1, Lyon, France.
| | - Melina Messaoudi
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| | - Jean-Noël Telles
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| | - Monidarin Chou
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia.
| | - Tekchheng Eap
- Department of Pneumology, National Pediatric Hospital, Phnom Penh, Cambodia.
| | - Jianwei Wang
- MOH Key Laboratory of Systems Biology of Pathogens and Dr. Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College), Beijing, China.
| | - Kunling Shen
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Jean-William Pape
- GHESKIO (Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) Centers, Port au Prince, Haiti.
| | - Vanessa Rouzier
- GHESKIO (Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) Centers, Port au Prince, Haiti.
| | | | - Nitin Pandey
- Chatrapati Shahuji Maharaj University, Lucknow, India.
| | | | | | | | - Bénédicte Contamin
- Fondation Mérieux, Centre d'Infectiologie Charles Mérieux (CICM), Antananarivo, Madagascar.
| | - Jonathan Hoffmann
- Fondation Mérieux, Centre d'Infectiologie Charles Mérieux (CICM), Antananarivo, Madagascar.
| | | | | | | | | | | | - Wilma Basualdo
- Hospital Pediátrico "Niños de Acosta Ñu", San Lorenzo, Paraguay.
| | - Marilda M Siqueira
- Respiratory virus Laboratory, Oswaldo Cruz Foundation, Hospital Bonsucesso, Rio de Janeiro, Brazil.
| | - Patricia Barreto
- Respiratory virus Laboratory, Oswaldo Cruz Foundation, Hospital Bonsucesso, Rio de Janeiro, Brazil.
| | - Florence Komurian-Pradel
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| | - Guy Vernet
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| | - Hubert Endtz
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| | - Philippe Vanhems
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
- Epidemiology and Public Health Unit, University of Lyon 1, Lyon, France.
| | - Gláucia Paranhos-Baccalà
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
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263
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Lindstrand A, Bennet R, Galanis I, Blennow M, Ask LS, Dennison SH, Rinder MR, Eriksson M, Henriques-Normark B, Ortqvist A, Alfvén T. Sinusitis and pneumonia hospitalization after introduction of pneumococcal conjugate vaccine. Pediatrics 2014; 134:e1528-36. [PMID: 25384486 DOI: 10.1542/peds.2013-4177] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Streptococcus pneumoniae is a major cause of pneumonia and sinusitis. Pneumonia kills >1 million children annually, and sinusitis is a potentially serious pediatric disease that increases the risk of orbital and intracranial complications. Although pneumococcal conjugate vaccine (PCV) is effective against invasive pneumococcal disease, its effectiveness against pneumonia is less consistent, and its effect on sinusitis is not known. We compared hospitalization rates due to sinusitis, pneumonia, and empyema before and after sequential introduction of PCV7 and PCV13. METHOD All children 0 to <18 years old hospitalized for sinusitis, pneumonia, or empyema in Stockholm County, Sweden, from 2003 to 2012 were included in a population-based study of hospital registry data on hospitalizations due to sinusitis, pneumonia, or empyema. Trend analysis, incidence rates, and rate ratios (RRs) were calculated comparing July 2003 to June 2007 with July 2008 to June 2012, excluding the year of PCV7 introduction. RESULTS Hospitalizations for sinusitis decreased significantly in children aged 0 to <2 years, from 70 to 24 cases per 100 000 population (RR = 0.34, P < .001). Hospitalizations for pneumonia decreased significantly in children aged 0 to <2 years, from 450 to 366 per 100 000 population (RR = 0.81, P < .001) and in those aged 2 to <5 years from 250 to 212 per 100 000 population (RR = 0.85, P = .002). Hospitalization for empyema increased nonsignificantly. Trend analyses showed increasing hospitalization for pneumonia in children 0 to <2 years before intervention and confirmed a decrease in hospitalizations for sinusitis and pneumonia in children aged 0 to <5 years after intervention. CONCLUSIONS PCV7 and PCV13 vaccination led to a 66% lower risk of hospitalization for sinusitis and 19% lower risk of hospitalization for pneumonia in children aged 0 to <2 years, in a comparison of 4 years before and 4 years after vaccine introduction.
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Affiliation(s)
- Ann Lindstrand
- Public Health Agency of Sweden, Solna, Sweden; Departments of Public Health Sciences, Division of Global Health,
| | | | | | - Margareta Blennow
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden; Clinical Sciences and Education, and
| | - Lina Schollin Ask
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | | | - Malin Ryd Rinder
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | | | - Birgitta Henriques-Normark
- Public Health Agency of Sweden, Solna, Sweden; Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Solna, Sweden
| | - Ake Ortqvist
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Sweden; and Department of Medicine, Unit of Infectious Diseases, Karolinska Institutet, Karolinska, Solna, Sweden
| | - Tobias Alfvén
- Departments of Public Health Sciences, Division of Global Health, Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
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264
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MacIntyre J, McTaggart J, Guerrant RL, Goldfarb DM. Early childhood diarrhoeal diseases and cognition: are we missing the rest of the iceberg? Paediatr Int Child Health 2014; 34:295-307. [PMID: 25146836 DOI: 10.1179/2046905514y.0000000141] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Risk factors which interfere with cognitive function are especially important during the first 2 years of life - a period referred to as early child development and a time during which rapid growth and essential development occur. Malnutrition, a condition whose effect on cognitive function is well known, has been shown to be part of a vicious cycle with diarrhoeal diseases, and the two pathologies together continue to be the leading cause of illness and death in young children in developing countries. This paper reviews the burden of early childhood diarrhoeal diseases globally and the emerging evidence of their relationship with global disparities in neurocognitive development. The strength of evidence which indicates that the severe childhood diarrhoeal burden may be implicated in cognitive impairment of children from low- and middle-income counties is discussed. Findings suggest that greater investment in multi-site, longitudinal enteric infection studies that assess long-term repercussions are warranted. Furthermore, economic analyses using the concept of human capital should play a key role in advancing our understanding of the breadth and complexities of the health, social and economic ramifications of early childhood diarrhoeal diseases and enteric infections. This broadened awareness can serve to help advocate for more effective interventions, particularly in developing economies.
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265
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Naimoli JF, Frymus DE, Wuliji T, Franco LM, Newsome MH. A Community Health Worker "logic model": towards a theory of enhanced performance in low- and middle-income countries. HUMAN RESOURCES FOR HEALTH 2014; 12:56. [PMID: 25278012 PMCID: PMC4194417 DOI: 10.1186/1478-4491-12-56] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 09/01/2014] [Indexed: 05/20/2023]
Abstract
BACKGROUND There has been a resurgence of interest in national Community Health Worker (CHW) programs in low- and middle-income countries (LMICs). A lack of strong research evidence persists, however, about the most efficient and effective strategies to ensure optimal, sustained performance of CHWs at scale. To facilitate learning and research to address this knowledge gap, the authors developed a generic CHW logic model that proposes a theoretical causal pathway to improved performance. The logic model draws upon available research and expert knowledge on CHWs in LMICs. METHODS Construction of the model entailed a multi-stage, inductive, two-year process. It began with the planning and implementation of a structured review of the existing research on community and health system support for enhanced CHW performance. It continued with a facilitated discussion of review findings with experts during a two-day consultation. The process culminated with the authors' review of consultation-generated documentation, additional analysis, and production of multiple iterations of the model. RESULTS The generic CHW logic model posits that optimal CHW performance is a function of high quality CHW programming, which is reinforced, sustained, and brought to scale by robust, high-performing health and community systems, both of which mobilize inputs and put in place processes needed to fully achieve performance objectives. Multiple contextual factors can influence CHW programming, system functioning, and CHW performance. CONCLUSIONS The model is a novel contribution to current thinking about CHWs. It places CHW performance at the center of the discussion about CHW programming, recognizes the strengths and limitations of discrete, targeted programs, and is comprehensive, reflecting the current state of both scientific and tacit knowledge about support for improving CHW performance. The model is also a practical tool that offers guidance for continuous learning about what works. Despite the model's limitations and several challenges in translating the potential for learning into tangible learning, the CHW generic logic model provides a solid basis for exploring and testing a causal pathway to improved performance.
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Affiliation(s)
- Joseph F Naimoli
- />United States Agency for International Development, 1300 Pennsylvania Avenue NW, Washington, DC USA
| | - Diana E Frymus
- />United States Agency for International Development, 1300 Pennsylvania Avenue NW, Washington, DC USA
| | - Tana Wuliji
- />University Research Co., LLC, 7200 Wisconsin Avenue, Bethesda, MD USA
| | - Lynne M Franco
- />EnCompass LLC, 11426 Rockville Pike, Rockville, MD USA
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Belizán JM, Salaria N, Valanzasca P, Mbizvo M. How can we improve the use of essential evidence-based interventions? Reprod Health 2014; 11:69. [PMID: 25214358 PMCID: PMC4247776 DOI: 10.1186/1742-4755-11-69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/05/2014] [Indexed: 11/10/2022] Open
Abstract
Between 250,000-280,000 women die worldwide during pregnancy and childbirth each year and children in low- and middle-income countries are 56 times more likely to die before the age of 5 than children in high-income countries. This Editorial discusses the publishing of a supplement within Reproductive Health titled Essential interventions for maternal, newborn and child health which aims to provide a scientific basis to the recommended interventions along with implementation strategies and proposed packages of care.
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Affiliation(s)
- José M Belizán
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
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Lassi ZS, Das JK, Salam RA, Bhutta ZA. Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings. Reprod Health 2014; 11 Suppl 2:S2. [PMID: 25209692 PMCID: PMC4160921 DOI: 10.1186/1742-4755-11-s2-s2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Annually around 40 million mothers give birth at home without any trained health worker. Consequently, most of the maternal and neonatal mortalities occur at the community level due to lack of good quality care during labour and birth. Interventions delivered at the community level have not only been advocated to improve access and coverage of essential interventions but also to reduce the existing disparities and reaching the hard to reach. In this paper, we have reviewed the effectiveness of care delivered through community level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined community level interventions and report findings from 43 systematic reviews. Findings suggest that home visitation significantly improved antenatal care, tetanus immunization coverage, referral and early initiation of breast feeding with reductions in antenatal hospital admission, cesarean-section rates birth, maternal morbidity, neonatal mortality and perinatal mortality. Task shifting to midwives and community health workers has shown to significantly improve immunization uptake and breast feeding initiation with reductions in antenatal hospitalization, episiotomy, instrumental delivery and hospital stay. Training of traditional birth attendants as a part of community based intervention package has significant impact on referrals, early breast feeding, maternal morbidity, neonatal mortality, and perinatal mortality. Formation of community based support groups decreased maternal morbidity, neonatal mortality, perinatal mortality with improved referrals and early breast feeding rates. At community level, home visitation, community mobilization and training of community health workers and traditional birth attendants have the maximum potential to improve a range of maternal and newborn health outcomes. There is lack of data to establish effectiveness of outreach services, mass media campaigns and community education as standalone interventions. Future efforts should be concerted on increasing the availability and training of the community based skilled health workers especially in resource limited settings where the highest burden exists with limited resources to mobilize.
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Affiliation(s)
- Zohra S Lassi
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
- Program for Global Pediatric Research, Hospital For Sick Children, Toronto
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268
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Lassi ZS, Salam RA, Das JK, Bhutta ZA. Essential interventions for maternal, newborn and child health: background and methodology. Reprod Health 2014; 11 Suppl 1:S1. [PMID: 25177879 PMCID: PMC4145855 DOI: 10.1186/1742-4755-11-s1-s1] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Worldwide, 250,000–280,000 women die during pregnancy and childbirth every year and an estimated 6.55 million children die under the age of five. The majority of maternal deaths occur during or immediately after childbirth, while 43% of child death occurs during the first 28 days of life. However, the progress in limiting these has been slow and sporadic. In this supplement of five papers, we aim to systematically assess and summarize essential interventions for reproductive, maternal, newborn and child health from relevant systematic reviews. This paper is an introductory paper detailing the background and methodology used for grading interventions. The following three papers summarize the evidence on essential interventions for pre-pregnancy, pregnancy, childbirth, postnatal (mother and neonatal) and child heath while the last paper describes the essential interventions as per the level of health care delivery and their proposed packages of care.
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269
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Diouf K, Tabatabai P, Rudolph J, Marx M. Diarrhoea prevalence in children under five years of age in rural Burundi: an assessment of social and behavioural factors at the household level. Glob Health Action 2014; 7:24895. [PMID: 25150028 PMCID: PMC4141944 DOI: 10.3402/gha.v7.24895] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/10/2014] [Accepted: 07/12/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Diarrhoea is the second leading cause of child mortality worldwide. Low- and middle-income countries are particularly burdened with this both preventable and treatable condition. Targeted interventions include the provision of safe water, the use of sanitation facilities and hygiene education, but are implemented with varying local success. OBJECTIVE To determine the prevalence of and factors associated with diarrhoea in children under five years of age in rural Burundi. DESIGN A cross-sectional survey was conducted among 551 rural households in northwestern Burundi. Areas of inquiry included 1) socio-demographic information, 2) diarrhoea period prevalence and treatment, 3) behaviour and knowledge, 4) socio-economic indicators, 5) access to water and water chain as well as 6) sanitation and personal/children's hygiene. RESULTS A total of 903 children were enrolled. The overall diarrhoea prevalence was 32.6%. Forty-six per cent (n=255) of households collected drinking water from improved water sources and only 3% (n=17) had access to improved sanitation. We found a lower prevalence of diarrhoea in children whose primary caretakers received hygiene education (17.9%), boiled water prior to its utilisation (19.4%) and were aged 40 or older (17.9%). Diarrhoea was associated with factors such as the mother's age being less than 25 and the conviction that diarrhoea could not be prevented. No gender differences were detected regarding diarrhoea prevalence or the caretaker's decision to treat. CONCLUSIONS Diarrhoea prevalence can be reduced through hygiene education and point-of use household water treatment such as boiling. In order to maximise the impact on children's health in the given rural setting, future interventions must assure systematic and regular hygiene education at the household and community level.
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Affiliation(s)
- Katharina Diouf
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany;
| | - Patrik Tabatabai
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Department of Gynaecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Jochen Rudolph
- Programme Sectoriel Eau - German Development Cooperation/Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH, Bujumbura, Burundi
| | - Michael Marx
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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270
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Lassi ZS, Mallick D, Das JK, Mal L, Salam RA, Bhutta ZA. Essential interventions for child health. Reprod Health 2014; 11 Suppl 1:S4. [PMID: 25177974 PMCID: PMC4145856 DOI: 10.1186/1742-4755-11-s1-s4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Child health is a growing concern at the global level, as infectious diseases and preventable conditions claim hundreds of lives of children under the age of five in low-income countries. Approximately 7.6 million children under five years of age died in 2011, calculating to about 19 000 children each day and almost 800 every hour. About 80 percent of the world’s under-five deaths in 2011 occurred in only 25 countries, and about half in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China. The implications and burden of such statistics are huge and will have dire consequences if they are not corrected promptly. This paper reviews essential interventions for improving child health, which if implemented properly and according to guidelines have been found to improve child health outcomes, as well as reduce morbidity and mortality rates. It also includes caregivers and delivery strategies for each intervention. Interventions that have been associated with a decrease in mortality and disease rates include exclusive breastfeeding, complementary feeding strategies, routine immunizations and vaccinations for children, preventative zinc supplementation in children, and vitamin A supplementation in vitamin A deficient populations.
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271
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Pantenburg B, Ochoa TJ, Ecker L, Ruiz J. Feeding of young children during diarrhea: caregivers' intended practices and perceptions. Am J Trop Med Hyg 2014; 91:555-62. [PMID: 25092824 DOI: 10.4269/ajtmh.13-0235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Childhood diarrhea is an important cause of malnutrition, which can be worsened when caretakers limit nutritional support. We queried 390 caregivers and their children in a peri-urban community in Lima, Peru regarding general perceptions of feeding and feeding practices during diarrhea. Overall, 22.1% of caregivers perceived feeding during diarrhea to be harmful. At baseline, 71.9% of caregivers would discontinue normal feeding or give less food. Most would withhold milk, eggs, and meats. Approximately 40% of caregivers would withhold vegetables and fruits. A pilot educational intervention was performed to improve feeding during diarrhea. At follow-up survey 3 months later, none of the caregivers would recommend withholding food. Only 23.2% would recommend discontinuing normal feeding and 1.8% perceived food to be damaging. Misperceptions of the role of feeding during diarrhea pose a significant health risk for children, but a simple educational intervention might have a major impact on these perceptions and practices.
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Affiliation(s)
- Birte Pantenburg
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; University of Texas School of Public Health, Houston, Texas; Instituto de Investigación Nutricional, Lima, Peru; Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Theresa J Ochoa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; University of Texas School of Public Health, Houston, Texas; Instituto de Investigación Nutricional, Lima, Peru; Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Lucie Ecker
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; University of Texas School of Public Health, Houston, Texas; Instituto de Investigación Nutricional, Lima, Peru; Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Joaquim Ruiz
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; University of Texas School of Public Health, Houston, Texas; Instituto de Investigación Nutricional, Lima, Peru; Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
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272
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Xu Z, Hu W, Zhang Y, Wang X, Tong S, Zhou M. Spatiotemporal pattern of bacillary dysentery in China from 1990 to 2009: what is the driver behind? PLoS One 2014; 9:e104329. [PMID: 25093593 PMCID: PMC4122401 DOI: 10.1371/journal.pone.0104329] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 07/13/2014] [Indexed: 11/20/2022] Open
Abstract
Background Little is known about the spatiotemporal pattern of bacillary dysentery (BD) in China. This study assessed the geographic distribution and seasonality of BD in China over the past two decades. Methods Data on monthly BD cases in 31 provinces of China from January 1990 to December 2009 obtained from Chinese Center for Disease Control and Prevention, and data on demographic and geographic factors, as well as climatic factors, were compiled. The spatial distributions of BD in the four periods across different provinces were mapped, and heat maps were created to present the seasonality of BD by geography. A cosinor function combined with Poisson regression was used to quantify the seasonal parameters of BD, and a regression analysis was conducted to identify the potential drivers of morbidity and seasonality of BD. Results Although most regions of China have experienced considerable declines in BD morbidity over the past two decades, Beijing and Ningxia still had high BD morbidity in 2009. BD morbidity decreased more slowly in North-west China than other regions. BD in China mainly peaked from July to September, with heterogeneity in peak time between regions. Relative humidity was associated with BD morbidity and peak time, and latitude was the major predictor of BD amplitude. Conclusions The transmission of BD was heterogeneous in China. Improved sanitation and hygiene in North-west China, and better access to clean water and food in the big floating population in some metropolises could be the focus of future preventive interventions against BD. BD control efforts should put more emphasis on those dry areas in summer.
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Affiliation(s)
- Zhiwei Xu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Yewu Zhang
- Chinese Center for Disease Control and Prevention, Beijing, P. R. China
| | - Xiaofeng Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P. R. China
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- * E-mail: (MZ); (ST)
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P. R. China
- * E-mail: (MZ); (ST)
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273
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Mugeni C, Levine AC, Munyaneza RM, Mulindahabi E, Cockrell HC, Glavis-Bloom J, Nutt CT, Wagner CM, Gaju E, Rukundo A, Habimana JP, Karema C, Ngabo F, Binagwaho A. Nationwide implementation of integrated community case management of childhood illness in Rwanda. GLOBAL HEALTH: SCIENCE AND PRACTICE 2014; 2:328-41. [PMID: 25276592 PMCID: PMC4168626 DOI: 10.9745/ghsp-d-14-00080] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/10/2014] [Indexed: 11/15/2022]
Abstract
Between 2008 and 2011, Rwanda introduced iCCM of childhood illness nationwide. One year after iCCM rollout, community-based treatment for diarrhea and pneumonia had increased significantly, and under-5 mortality and overall health facility use had declined significantly. Background: Between 2008 and 2011, Rwanda introduced integrated community case management (iCCM) of childhood illness nationwide. Community health workers in each of Rwanda's nearly 15,000 villages were trained in iCCM and equipped for empirical diagnosis and treatment of pneumonia, diarrhea, and malaria; for malnutrition surveillance; and for comprehensive reporting and referral services. Methods: We used data from the Rwanda health management information system (HMIS) to calculate monthly all-cause under-5 mortality rates, health facility use rates, and community-based treatment rates for childhood illness in each district. We then compared a 3-month baseline period prior to iCCM implementation with a seasonally matched comparison period 1 year after iCCM implementation. Finally, we compared the actual changes in all-cause child mortality and health facility use over this time period with the changes that would have been expected based on baseline trends in Rwanda. Results: The number of children receiving community-based treatment for diarrhea and pneumonia increased significantly in the 1-year period after iCCM implementation, from 0.83 cases/1,000 child-months to 3.80 cases/1,000 child-months (P = .01) and 0.25 cases/1,000 child-months to 5.28 cases/1,000 child-months (P<.001), respectively. On average, total under-5 mortality rates declined significantly by 38% (P<.001), and health facility use declined significantly by 15% (P = .006). These decreases were significantly greater than would have been expected based on baseline trends. Conclusions: This is the first study to demonstrate decreases in both child mortality and health facility use after implementing iCCM of childhood illness at a national level. While our study design does not allow for direct attribution of these changes to implementation of iCCM, these results are in line with those of prior studies conducted at the sub-national level in other low-income countries.
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Affiliation(s)
| | - Adam C Levine
- The Warren Alpert Medical School of Brown University , Providence, RI , USA ; Co-first authors
| | | | | | - Hannah C Cockrell
- Brown University, Watson Institute for International Studies, Development Studies Program , Providence, RI , USA
| | | | - Cameron T Nutt
- Dartmouth Center for Health Care Delivery Science , Hanover, NH , USA
| | | | - Erick Gaju
- Rwanda Ministry of Health , Kigali , Rwanda
| | - Alphonse Rukundo
- Malaria and other Parasitic Diseases Division, Rwanda Biomedical Center , Kigali , Rwanda
| | - Jean Pierre Habimana
- Malaria and other Parasitic Diseases Division, Rwanda Biomedical Center , Kigali , Rwanda
| | - Corine Karema
- Malaria and other Parasitic Diseases Division, Rwanda Biomedical Center , Kigali , Rwanda
| | | | - Agnes Binagwaho
- Rwanda Ministry of Health , Kigali , Rwanda ; Harvard Medical School, Department of Global Health and Social Medicine , Boston, MA , USA ; Dartmouth College, Geisel School of Medicine , Hanover, NH , USA
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274
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VijayRaghavan K. New paradigms for indigenous vaccines. Vaccine 2014; 32 Suppl 1:A3-4. [DOI: 10.1016/j.vaccine.2014.04.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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275
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Salam RA, Maredia H, Das JK, Lassi ZS, Bhutta ZA. Community-based interventions for the prevention and control of helmintic neglected tropical diseases. Infect Dis Poverty 2014; 3:23. [PMID: 25114793 PMCID: PMC4128617 DOI: 10.1186/2049-9957-3-23] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 07/03/2014] [Indexed: 11/10/2022] Open
Abstract
In this paper, we aim to systematically analyze the effectiveness of community-based interventions (CBIs) for the prevention and control of helminthiasis including soil-transmitted helminthiasis (STH) (ascariasis, hookworms, and trichuriasis), lymphatic filariasis, onchocerciasis, dracunculiasis, and schistosomiasis. We systematically reviewed literature published before May 2013 and included 32 studies in this review. Findings from the meta-analysis suggest that CBIs are effective in reducing the prevalence of STH (RR: 0.45, 95% CI: 0.38, 0.54), schistosomiasis (RR: 0.40, 95% CI: 0.33, 0.50), and STH intensity (SMD: -3.16, 95 CI: -4.28, -2.04). They are also effective in improving mean hemoglobin (SMD: 0.34, 95% CI: 0.20, 0.47) and reducing anemia prevalence (RR: 0.90, 95% CI: 0.85, 0.96). However, it did not have any impact on ferritin, height, weight, low birth weight (LBW), or stillbirths. School-based delivery significantly reduced STH (RR: 0.49, 95% CI: 0.39, 0.63) and schistosomiasis prevalence (RR: 0.50, 95% CI: 0.33, 0.75), STH intensity (SMD: -0.22, 95% CI: -0.26, -0.17), and anemia prevalence (RR: 0.87, 95% CI: 0.81, 0.94). It also improved mean hemoglobin (SMD: 0.24, 95% CI: 0.16, 0.32). We did not find any conclusive evidence from the quantitative synthesis on the relative effectiveness of integrated and non-integrated delivery strategies due to the limited data available for each subgroup. However, the qualitative synthesis from the included studies supports community-based delivery strategies and suggests that integrated prevention and control measures are more effective in achieving greater coverage compared to the routine vertical delivery, albeit it requires an existing strong healthcare infrastructure. Current evidence suggests that effective community-based strategies exist and deliver a range of preventive, promotive, and therapeutic interventions to combat helminthic neglected tropical diseases (NTDs). However, there is a need to implement and evaluate efficient integrated programs with the existing disease control programs on a larger scale throughout resource-limited regions especially to reach the unreachable.
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Affiliation(s)
- Rehana A Salam
- Division of Women and Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | | | - Jai K Das
- Division of Women and Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | - Zohra S Lassi
- Division of Women and Child Health, The Aga Khan University, Karachi 74800, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan
- Center for Global Child Health Hospital for Sick Children, Toronto, Canada
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276
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Lassi ZS, Salam RA, Das JK, Bhutta ZA. The conceptual framework and assessment methodology for the systematic reviews of community-based interventions for the prevention and control of infectious diseases of poverty. Infect Dis Poverty 2014; 3:22. [PMID: 25105014 PMCID: PMC4124965 DOI: 10.1186/2049-9957-3-22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 07/18/2014] [Indexed: 11/18/2022] Open
Abstract
This paper describes the conceptual framework and the methodology used to guide the systematic reviews of community-based interventions (CBIs) for the prevention and control of infectious diseases of poverty (IDoP). We adapted the conceptual framework from the 3ie work on the 'Community-Based Intervention Packages for Preventing Maternal Morbidity and Mortality and Improving Neonatal Outcomes' to aid in the analyzing of the existing CBIs for IDoP. The conceptual framework revolves around objectives, inputs, processes, outputs, outcomes, and impacts showing the theoretical linkages between the delivery of the interventions targeting these diseases through various community delivery platforms and the consequent health impacts. We also describe the methodology undertaken to conduct the systematic reviews and the meta-analyses.
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Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan
- Center for Global Child Health Hospital for Sick Children, Toronto, Canada
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277
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Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, Sankar MJ, Blencowe H, Rizvi A, Chou VB, Walker N. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 2014; 384:347-70. [PMID: 24853604 DOI: 10.1016/s0140-6736(14)60792-3] [Citation(s) in RCA: 866] [Impact Index Per Article: 86.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Progress in newborn survival has been slow, and even more so for reductions in stillbirths. To meet Every Newborn targets of ten or fewer neonatal deaths and ten or fewer stillbirths per 1000 births in every country by 2035 will necessitate accelerated scale-up of the most effective care targeting major causes of newborn deaths. We have systematically reviewed interventions across the continuum of care and various delivery platforms, and then modelled the effect and cost of scale-up in the 75 high-burden Countdown countries. Closure of the quality gap through the provision of effective care for all women and newborn babies delivering in facilities could prevent an estimated 113,000 maternal deaths, 531,000 stillbirths, and 1·325 million neonatal deaths annually by 2020 at an estimated running cost of US$4·5 billion per year (US$0·9 per person). Increased coverage and quality of preconception, antenatal, intrapartum, and postnatal interventions by 2025 could avert 71% of neonatal deaths (1·9 million [range 1·6-2·1 million]), 33% of stillbirths (0·82 million [0·60-0·93 million]), and 54% of maternal deaths (0·16 million [0·14-0·17 million]) per year. These reductions can be achieved at an annual incremental running cost of US$5·65 billion (US$1·15 per person), which amounts to US$1928 for each life saved, including stillbirths, neonatal, and maternal deaths. Most (82%) of this effect is attributable to facility-based care which, although more expensive than community-based strategies, improves the likelihood of survival. Most of the running costs are also for facility-based care (US$3·66 billion or 64%), even without the cost of new hospitals and country-specific capital inputs being factored in. The maximum effect on neonatal deaths is through interventions delivered during labour and birth, including for obstetric complications (41%), followed by care of small and ill newborn babies (30%). To meet the unmet need for family planning with modern contraceptives would be synergistic, and would contribute to around a halving of births and therefore deaths. Our analysis also indicates that available interventions can reduce the three most common cause of neonatal mortality--preterm, intrapartum, and infection-related deaths--by 58%, 79%, and 84%, respectively.
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Affiliation(s)
- Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Jai K Das
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rajiv Bahl
- World Health Organization, Geneva, Switzerland
| | - Joy E Lawn
- Maternal, Adolescent Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA; Research and Evidence Division, UK AID, London, UK
| | - Rehana A Salam
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Vinod K Paul
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Hannah Blencowe
- Maternal, Adolescent Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Arjumand Rizvi
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Victoria B Chou
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Neff Walker
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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278
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The geographical co-distribution and socio-ecological drivers of childhood pneumonia and diarrhoea in Queensland, Australia. Epidemiol Infect 2014; 143:1096-104. [PMID: 25018008 DOI: 10.1017/s095026881400171x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
SUMMARY This study aimed to explore the spatio-temporal patterns, geographical co-distribution, and socio-ecological drivers of childhood pneumonia and diarrhoea in Queensland. A Bayesian conditional autoregressive model was used to quantify the impacts of socio-ecological factors on both childhood pneumonia and diarrhoea at a postal area level. A distinct seasonality of childhood pneumonia and diarrhoea was found. Childhood pneumonia and diarrhoea were mainly distributed in the northwest of Queensland. Mount Isa city was the high-risk cluster where childhood pneumonia and diarrhoea co-distributed. Emergency department visits (EDVs) for pneumonia increased by 3% per 10-mm increase in monthly average rainfall in wet seasons. By comparison, a 10-mm increase in monthly average rainfall may cause an increase of 4% in EDVs for diarrhoea. Monthly average temperature was negatively associated with EDVs for childhood diarrhoea in wet seasons. Low socioeconomic index for areas (SEIFA) was associated with high EDVs for childhood pneumonia. Future pneumonia and diarrhoea prevention and control measures in Queensland should focus more on Mount Isa.
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279
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Bulled N, Singer M, Dillingham R. The syndemics of childhood diarrhoea: a biosocial perspective on efforts to combat global inequities in diarrhoea-related morbidity and mortality. Glob Public Health 2014; 9:841-53. [PMID: 25005132 DOI: 10.1080/17441692.2014.924022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Diarrhoea remains the second leading cause of death in children under 5 years. Moreover, morbidity as a result of diarrhoea is high particularly in marginalised communities. Frequent bouts of diarrhoea have deleterious and irreversible effects on physical and cognitive development. Children are especially vulnerable given their inability to mount an active immune response to pathogen exposure. Biological limitations are exacerbated by the long-term effects of poverty, including reduced nutrition, poor hygiene and deprived home environments. Drawing from available literature, this paper uses syndemic theory to explore the role of adverse biosocial interactions in increasing the total disease burden of enteric infections in low-resources populations and assesses the limitations of recent global calls to action. The syndemic perspective describes situations in which adverse social conditions, including inequality, poverty and other forms of political and economic oppression, play a critical role in facilitating disease-disease interactions. Given the complex micro- and macro-nature of childhood diarrhoea, including interactions between pathogens, disease conditions and social environments, the syndemic perspective offers a way forward. While rarely the focus of health interventions, technologically advanced biomedical strategies are likely to be more effective if coupled with interventions that address the social conditions of disparity.
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Affiliation(s)
- Nicola Bulled
- a The Center for Global Health , University of Virginia , Charlottesville , VA , USA
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280
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Lassi ZS, Das JK, Haider SW, Salam RA, Qazi SA, Bhutta ZA. Systematic review on antibiotic therapy for pneumonia in children between 2 and 59 months of age. Arch Dis Child 2014; 99:687-93. [PMID: 24431417 DOI: 10.1136/archdischild-2013-304023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Community-acquired pneumonia (CAP) remains a force to reckon with, as it accounts for 1.1 million of all deaths in children less than 5 years of age globally, with disproportionately higher mortality occurring in the low and middle income-countries (LMICs) of Southeast Asia and Africa. Existing strategies to curb pneumonia-related morbidity and mortality have not effectively translated into meaningful control of pneumonia-related burden. In the present systematic review, we conducted a meta-analysis of trials conducted in LMICs to determine the most suitable antibiotic therapy for treating pneumonia (very severe, severe and non-severe). While previous reviews, including the most recent review by Lodha et al, have focused either on single modality of antibiotic therapy (such as choice of antibiotic) or children under the age of 16 years, the current review updates evidence on the choice of drug, duration, route and combination of antibiotics in children specifically between 2 and 59 months of age. We included randomised controlled trials (RCTs) and quasi-RCTs that assessed the route, dose, combination and duration of antibiotics in the management of WHO-defined very severe/severe/non-severe CAP. Study participants included children between 2 and 59 months of age with CAP. All available titles and abstracts were screened for inclusion by two review authors independently. All data was entered and analysed using Review Manager 5 software. The review identified 8122 studies on initial search, of which 22 studies which enrolled 20,593 children were included in meta-analyses. Evidence from these trials showed a combination of penicillin/ampicillin and gentamicin to be effective for managing very severe pneumonia in children between 2 and 59 months of age, and oral amoxicillin to be equally efficacious, as other parenteral antibiotics for managing severe pneumonia in children of this particular age group. Oral amoxicillin was also found to be effective in non-severe pneumonia as well. The review further found a short 3 day course of antibiotics to be equally beneficial as 5 day course for managing non-severe pneumonia in children between 2 and 59 months of age. This review updates evidence on the general spectrum of antibiotic recommendation for CAP in children between 2 and 59 months of age, which is an age group that warrants special focus owing to its high disease and mortality burden. Evidence derived from the review found oral amoxicillin to be equally effective as parenteral antibiotics for severe pneumonia in the 2-59 month age group, which holds important implications for LMICs where parenteral drug administration is an issue. Also, the review's finding that 3 day course of antibiotic is equally effective as 5 day course for non-severe pneumonia for 2-59 months of age is again beneficial for LMICs, as a shorter therapy will be associated with a lower cost. The review addresses some research gaps in antibiotic treatment for CAP as well, and this crucial information is presented with the aim of providing a targeted cure for the middle and low income setting.
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281
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Rongsen-Chandola T, Winje BA, Goyal N, Rathore SS, Mahesh M, Ranjan R, Arya A, Rafiqi FA, Bhandari N, Strand TA. Compliance of mothers following recommendations to breastfeed or withhold breast milk during rotavirus vaccination in North India: a randomized clinical trial. Trials 2014; 15:256. [PMID: 24976452 PMCID: PMC4082496 DOI: 10.1186/1745-6215-15-256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 06/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neutralizing antibodies in breast milk may adversely influence the immune response to live oral vaccines. Withholding breastfeeding around the time of vaccine administration has been suggested for improving vaccine performance. However, we do not know whether mothers find withholding breastfeeding around the time of vaccination acceptable and how they perceive this recommendation. METHODS In a clinical study designed to examine predictors of poor immune response to rotavirus vaccine in infants in India, Rotarix® was administered to infants at 6 and 10 weeks with other childhood vaccines. For the study, 400 mother-infant pairs were randomized into two groups in a 1:1 ratio. Mothers were either recommended to withhold breastfeeding or were encouraged to breastfeed half an hour before and after administration of Rotarix®. The mother-infant pairs were observed and the breastfeeding intervals were recorded during this period. Mothers were administered a questionnaire about their perception of the intervention after the infants received the second dose of Rotarix®. RESULTS Almost 98% (391/400) of the infants received both doses of Rotarix®. Adherence to the recommendations was high in both groups. All mothers in the group who were asked to withhold breastfeeding did so, except one who breastfed her infant before the recommended time after the first dose of Rotarix®. Of the mothers, 4% (7/195) reported that the recommendation to withhold breastfeeding was difficult to follow. All mothers in this group reported that they would withhold breastfeeding at the time of vaccination if they were asked to by a health-care provider. Only one mother responded that withholding breastfeeding would be a reason for not giving rotavirus vaccine to her infant. CONCLUSIONS Withholding breastfeeding half an hour before and after vaccination appears to be acceptable to mothers in this setting. If withholding breastfeeding produces an improvement in the performance of the vaccine, it could be used to increase the public health impact of rotavirus immunization. TRIAL REGISTRATION Clinical Trial Registry, India (CTRI/2012/10/003057), Clinicaltrials.gov (NCT01700127).Date of Registration: Clinical Trial Registry, India: 28 September 2012, Clinicaltrials.gov: 3 October 2012.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tor A Strand
- Innlandet Hospital Trust, Lillehammer, Norway and Centre for International Health, University of Bergen, Bergen, Norway.
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282
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Goyet S, Barennes H, Libourel T, van Griensven J, Frutos R, Tarantola A. Knowledge translation: a case study on pneumonia research and clinical guidelines in a low- income country. Implement Sci 2014; 9:82. [PMID: 24969242 PMCID: PMC4094455 DOI: 10.1186/1748-5908-9-82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 06/23/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The process and effectiveness of knowledge translation (KT) interventions targeting policymakers are rarely reported. In Cambodia, a low-income country (LIC), an intervention aiming to provide evidence-based knowledge on pneumonia to health authorities was developed to help update pediatric and adult national clinical guidelines. Through a case study, we assessed the effectiveness of this KT intervention, with the goal of identifying the barriers to KT and suggest strategies to facilitate KT in similar settings. METHODS An extensive search for all relevant sources of data documenting the processes of updating adult and pediatric pneumonia guidelines was done. Documents included among others, reports, meeting minutes, and email correspondences. The study was conducted in successive phases: an appraisal of the content of both adult and pediatric pneumonia guidelines; an appraisal of the quality of guidelines by independent experts, using the AGREE-II instrument; a description and modeling of the KT process within the guidelines updating system, using the Unified Modeling Language (UML) tools 2.2; and the listing of the barriers and facilitators to KT we identified during the study. RESULTS The first appraisal showed that the integration of the KT key messages in pediatric and adult guidelines varied with a better efficiency in the pediatric guidelines. The overall AGREE-II quality assessments scored 37% and 44% for adult and pediatric guidelines, respectively. Scores were lowest for the domains of 'rigor of development' and 'editorial independence.' The UML analysis highlighted that time frames and constraints of the involved stakeholders greatly differed and that there were several missed opportunities to translate on evidence into the adult pneumonia guideline. Seventeen facilitating factors and 18 potential barriers to KT were identified. Main barriers were related to the absence of a clear mandate from the Ministry of Health for the researchers and to a lack of synchronization between knowledge production and policy-making. CONCLUSIONS Study findings suggest that stakeholders, both researchers and policy makers planning to update clinical guidelines in LIC may need methodological support to overcome the expected barriers.
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Affiliation(s)
- Sophie Goyet
- Epidemiology and Public Health Unit, Institut Pasteur, Phnom Penh, Cambodia
| | - Hubert Barennes
- Agence Nationale de recherche sur le SIDA et les hépatites, Paris, France
- ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Université de Bordeaux, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
| | - Therese Libourel
- Université Montpellier 2, UMR Espace Dev, IRD-UM2-UAG-ULR, Montpellier, France
| | - Johan van Griensven
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Roger Frutos
- Université Montpellier 2, CPBS, UMR 5236 CNRS-UM1-UM2, Montpellier, France
- Intertryp, UMR 17, IRD-Cirad, Campus international de Baillarguet, 34398 Montpellier, Cedex 5, France
| | - Arnaud Tarantola
- Epidemiology and Public Health Unit, Institut Pasteur, Phnom Penh, Cambodia
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283
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Rahman AE, Moinuddin M, Molla M, Worku A, Hurt L, Kirkwood B, Mohan SB, Mazumder S, Bhutta Z, Raza F, Mrema S, Masanja H, Kadobera D, Waiswa P, Bahl R, Zangenberg M, Muhe L. Childhood diarrhoeal deaths in seven low- and middle-income countries. Bull World Health Organ 2014; 92:664-71. [PMID: 25378757 PMCID: PMC4208570 DOI: 10.2471/blt.13.134809] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 05/04/2014] [Accepted: 05/13/2014] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the clinical characteristics of children who died from diarrhoea in low- and middle-income countries, such as the duration of diarrhoea, comorbid conditions, care-seeking behaviour and oral rehydration therapy use. METHODS The study included verbal autopsy data on children who died from diarrhoea between 2000 and 2012 at seven sites in Bangladesh, Ethiopia, Ghana, India, Pakistan, Uganda and the United Republic of Tanzania, respectively. Data came from demographic surveillance sites, randomized trials and an extended Demographic and Health Survey. The type of diarrhoea was classified as acute watery, acute bloody or persistent and risk factors were identified. Deaths in children aged 1 to 11 months and 1 to 4 years were analysed separately. FINDINGS The proportion of childhood deaths due to diarrhoea varied considerably across the seven sites from less than 3% to 30%. Among children aged 1-4 years, acute watery diarrhoea accounted for 31-69% of diarrhoeal deaths, acute bloody diarrhoea for 12-28%, and persistent diarrhoea for 12-56%. Among infants aged 1-11 months, persistent diarrhoea accounted for over 30% of diarrhoeal deaths in Ethiopia, India, Pakistan, Uganda and the United Republic of Tanzania. At most sites, more than 40% of children who died from persistent diarrhoea were malnourished. CONCLUSION Persistent diarrhoea remains an important cause of diarrhoeal death in young children in low- and middle-income countries. Research is needed on the public health burden of persistent diarrhoea and current treatment practices to understand why children are still dying from the condition.
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Affiliation(s)
| | - Md Moinuddin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mitike Molla
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lisa Hurt
- London School of Hygiene and Tropical Medicine, London, England
| | - Betty Kirkwood
- London School of Hygiene and Tropical Medicine, London, England
| | - Sanjana Brahmawar Mohan
- Centre for Health Research and Development of the Society for Applied Studies, New Delhi, India
| | - Sarmila Mazumder
- Centre for Health Research and Development of the Society for Applied Studies, New Delhi, India
| | | | | | - Sigilbert Mrema
- Ifakara Health Institute, Ifakara and Rufiji, United Republic of Tanzania
| | - Honorati Masanja
- Ifakara Health Institute, Ifakara and Rufiji, United Republic of Tanzania
| | - Daniel Kadobera
- Makerere University, Iganga/Mayuge Health and Demographic Surveillance Site, Iganga, Uganda
| | - Peter Waiswa
- Makerere University, Iganga/Mayuge Health and Demographic Surveillance Site, Iganga, Uganda
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Mike Zangenberg
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Lulu Muhe
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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284
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Lassi ZS, Kumar R, Das JK, Salam RA, Bhutta ZA. Antibiotic therapy versus no antibiotic therapy for children aged two to 59 months with WHO-defined non-severe pneumonia and wheeze. Cochrane Database Syst Rev 2014:CD009576. [PMID: 24859388 DOI: 10.1002/14651858.cd009576.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Worldwide, pneumonia is the leading cause of death among children under five years of age and accounts for approximately two million deaths annually. The World Health Organization (WHO) has developed case management guidelines based on simple clinical signs to help clinicians decide on the appropriate pneumonia treatment. Children and infants who exhibit fast breathing (50 breaths per minute or more in infants two months to 12 months of age and 40 or more in children 12 months to five years of age) and cough are presumed to have non-severe pneumonia and the WHO recommends antibiotics. Implementation of these guidelines to identify and manage pneumonia at the community level has been shown to reduce acute respiratory infection (ARI)-related mortality by 36%, although apprehension exists regarding these results due to the questionable quality of evidence. As WHO guidelines do not make a distinction between viral and bacterial pneumonia, these children continue to receive antibiotics because of the concern that it may not be safe to do otherwise. Therefore, it is essential to explore the role of antibiotics in children with WHO-defined non-severe pneumonia and wheeze and to develop effective guidelines for initial antibiotic treatment. OBJECTIVES To evaluate the efficacy of antibiotic therapy versus no antibiotic therapy for children aged two to 59 months with WHO-defined non-severe pneumonia and wheeze. SEARCH METHODS We searched CENTRAL (2014, Issue 1), MEDLINE (1946 to March week 3, 2014), EMBASE (January 2010 to March 2014), CINAHL (1981 to March 2014), LILACS (1982 to March 2014), Networked Digital Library of Theses and Dissertations (23 July 2013) and Web of Science (1985 to March 2014). SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating the efficacy of antibiotic therapy versus no antibiotic therapy for children aged two to 59 months with non-severe pneumonia and wheeze. We considered studies that defined non-severe pneumonia as cough or difficulty in breathing with a respiratory rate above the WHO-defined age-specific values (respiratory rate of 50 breaths per minute or more for children aged two to 12 months, or a respiratory rate of 40 breaths per minute or more for children aged 12 to 59 months) and wheeze for inclusion. We have excluded non-RCTs (quasi-RCTs). DATA COLLECTION AND ANALYSIS Two review authors independently assessed the search results and extracted data. MAIN RESULTS We did not identify any study that completely fulfilled our inclusion criteria. AUTHORS' CONCLUSIONS There is a clear need for RCTs to address this question in representative populations. We do not currently have evidence to support or challenge the continued use of antibiotics for the treatment of non-severe pneumonia, as suggested by WHO guidelines.
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Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Hospital, Stadium Road, PO Box 3500, Karachi, Pakistan, 74800
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285
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Zar HJ, Ferkol TW. The global burden of respiratory disease-impact on child health. Pediatr Pulmonol 2014; 49:430-4. [PMID: 24610581 DOI: 10.1002/ppul.23030] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 01/27/2014] [Indexed: 11/09/2022]
Abstract
Respiratory disease is the major cause of mortality and morbidity worldwide, with infants and young children especially susceptible. The spectrum of disease ranges from acute infections to chronic non-communicable diseases. Five respiratory conditions dominate-acute respiratory infections, chronic obstructive pulmonary disease, asthma, tuberculosis (TB), and lung cancer. Pneumonia remains the predominant cause of childhood mortality, causing nearly 1.3 million deaths each year, most of which are preventable. Asthma is the commonest non-communicable disease in children. Pediatric TB constitutes up to 20% of the TB caseload in high incidence countries. Environmental exposures such as tobacco smoke, indoor air pollution, and poor nutrition are common risk factors for acute and chronic respiratory diseases. Pediatric and adult respiratory disease is closely linked. Early childhood respiratory infection or environmental exposures may lead to chronic disease in adulthood. Childhood immunization can effectively reduce the incidence and severity of childhood pneumonia; childhood immunization is also effective for reducing pneumonia in the elderly. The Forum of International Respiratory Societies (FIRS), representing the major respiratory societies worldwide, has produced a global roadmap of respiratory diseases, Respiratory Disease in the World: Realities of Today-Opportunities for Tomorrow. This highlights the burden of respiratory diseases globally and contains specific recommendations for effective strategies. Greater availability and upscaled implementation of effective strategies for prevention and management of respiratory diseases is needed worldwide to improve global health and diminish the current inequities in health care worldwide.
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Affiliation(s)
- Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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286
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Fischer Walker CL, Walker N. The Lives Saved Tool (LiST) as a model for diarrhea mortality reduction. BMC Med 2014; 12:70. [PMID: 24779400 PMCID: PMC4234397 DOI: 10.1186/1741-7015-12-70] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diarrhea is a leading cause of morbidity and mortality among children under five years of age. The Lives Saved Tool (LiST) is a model used to calculate deaths averted or lives saved by past interventions and for the purposes of program planning when costly and time consuming impact studies are not possible. DISCUSSION LiST models the relationship between coverage of interventions and outputs, such as stunting, diarrhea incidence and diarrhea mortality. Each intervention directly prevents a proportion of diarrhea deaths such that the effect size of the intervention is multiplied by coverage to calculate lives saved. That is, the maximum effect size could be achieved at 100% coverage, but at 50% coverage only 50% of possible deaths are prevented. Diarrhea mortality is one of the most complex causes of death to be modeled. The complexity is driven by the combination of direct prevention and treatment interventions as well as interventions that operate indirectly via the reduction in risk factors, such as stunting and wasting. Published evidence is used to quantify the effect sizes for each direct and indirect relationship. Several studies have compared measured changes in mortality to LiST estimates of mortality change looking at different sets of interventions in different countries. While comparison work has generally found good agreement between the LiST estimates and measured mortality reduction, where data availability is weak, the model is less likely to produce accurate results. LiST can be used as a component of program evaluation, but should be coupled with more complete information on inputs, processes and outputs, not just outcomes and impact. SUMMARY LiST is an effective tool for modeling diarrhea mortality and can be a useful alternative to large and expensive mortality impact studies. Predicting the impact of interventions or comparing the impact of more than one intervention without having to wait for the results of large and expensive mortality studies is critical to keep programs focused and results oriented for continued reductions in diarrhea and all-cause mortality among children under five years of age.
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Affiliation(s)
- Christa L Fischer Walker
- Department of International Health Johns Hopkins Bloomberg School of Public Health, Institute for International Programs, Baltimore, MD, USA
| | - Neff Walker
- Department of International Health Johns Hopkins Bloomberg School of Public Health, Institute for International Programs, Baltimore, MD, USA
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287
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Tran NT, Portela A, de Bernis L, Beek K. Developing capacities of community health workers in sexual and reproductive, maternal, newborn, child, and adolescent health: a mapping and review of training resources. PLoS One 2014; 9:e94948. [PMID: 24736623 PMCID: PMC3988080 DOI: 10.1371/journal.pone.0094948] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/20/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Given country demands for support in the training of community health workers (CHWs) to accelerate progress towards reaching the Millennium Development Goals in sexual and reproductive health and maternal, newborn, child, and adolescent health (SR/MNCAH), the United Nations Health Agencies conducted a synthesis of existing training resource packages for CHWs in different components of SR/MNCAH to identify gaps and opportunities and inform efforts to harmonize approaches to developing the capacity of CHWs. METHODS A mapping of training resource packages for CHWs was undertaken with documents retrieved online and from key informants. Materials were classified by health themes and analysed using agreed parameters. Ways forward were informed by a subsequent expert consultation. RESULTS We identified 31 relevant packages. They covered different components of the SR/MNCAH continuum in varying breadth (integrated packages) and depth (focused packages), including family planning, antenatal and childbirth care (mainly postpartum haemorrhage), newborn care, and childhood care, and HIV. There is no or limited coverage of interventions related to safe abortion, adolescent health, and gender-based violence. There is no training package addressing the range of evidence-based interventions that can be delivered by CHWs as per World Health Organization guidance. Gaps include weakness in the assessment of competencies of trainees, in supportive supervision, and in impact assessment of packages. Many packages represent individual programme efforts rather than national programme materials, which could reflect weak integration into national health systems. CONCLUSIONS There is a wealth of training packages on SR/MNCAH for CHWs which reflects interest in strengthening the capacity of CHWs. This offers an opportunity for governments and partners to mount a synergistic response to address the gaps and ensure an evidence-based comprehensive package of interventions to be delivered by CHWs. Packages with defined competencies and methods for assessing competencies and supervision are considered best practices but remain a gap.
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Affiliation(s)
- Nguyen Toan Tran
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Geneva, Switzerland
| | - Luc de Bernis
- United Nations Population Fund (UNFPA), Geneva Office, Geneva, Switzerland
| | - Kristen Beek
- Faculty of Health, University of Technology, Sydney, Australia
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288
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Stenberg K, Axelson H, Sheehan P, Anderson I, Gülmezoglu AM, Temmerman M, Mason E, Friedman HS, Bhutta ZA, Lawn JE, Sweeny K, Tulloch J, Hansen P, Chopra M, Gupta A, Vogel JP, Ostergren M, Rasmussen B, Levin C, Boyle C, Kuruvilla S, Koblinsky M, Walker N, de Francisco A, Novcic N, Presern C, Jamison D, Bustreo F. Advancing social and economic development by investing in women's and children's health: a new Global Investment Framework. Lancet 2014; 383:1333-1354. [PMID: 24263249 DOI: 10.1016/s0140-6736(13)62231-x] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A new Global Investment Framework for Women's and Children's Health demonstrates how investment in women's and children's health will secure high health, social, and economic returns. We costed health systems strengthening and six investment packages for: maternal and newborn health, child health, immunisation, family planning, HIV/AIDS, and malaria. Nutrition is a cross-cutting theme. We then used simulation modelling to estimate the health and socioeconomic returns of these investments. Increasing health expenditure by just $5 per person per year up to 2035 in 74 high-burden countries could yield up to nine times that value in economic and social benefits. These returns include greater gross domestic product (GDP) growth through improved productivity, and prevention of the needless deaths of 147 million children, 32 million stillbirths, and 5 million women by 2035. These gains could be achieved by an additional investment of $30 billion per year, equivalent to a 2% increase above current spending.
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Affiliation(s)
- Karin Stenberg
- Department of Health Systems Financing, World Health Organization, Geneva, Switzerland.
| | | | | | - Ian Anderson
- Independent Consultant, Canberra, ACT, Australia
| | - A Metin Gülmezoglu
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Marleen Temmerman
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Elizabeth Mason
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | | | - Zulfiqar A Bhutta
- SickKids Center for Global Child Health, Toronto, ON, Canada; Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan
| | - Joy E Lawn
- London School of Hygiene and Tropical Medicine, London, UK
| | - Kim Sweeny
- Victoria University, Melbourne, VIC, Australia
| | | | | | | | - Anuradha Gupta
- The Ministry of Health and Family Welfare, Government of India, India
| | - Joshua P Vogel
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mikael Ostergren
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | | | | | - Colin Boyle
- University of California, San Francisco, CA, USA
| | - Shyama Kuruvilla
- The Partnership for Maternal, Newborn & Child Health, hosted by the World Health Organization, Canada
| | | | - Neff Walker
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Andres de Francisco
- The Partnership for Maternal, Newborn & Child Health, hosted by the World Health Organization, Canada
| | - Nebojsa Novcic
- The Partnership for Maternal, Newborn & Child Health, hosted by the World Health Organization, Canada
| | - Carole Presern
- The Partnership for Maternal, Newborn & Child Health, hosted by the World Health Organization, Canada
| | | | - Flavia Bustreo
- Family, Women's and Children's Health, World Health Organization, Geneva, Switzerland
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Geldsetzer P, Williams TC, Kirolos A, Mitchell S, Ratcliffe LA, Kohli-Lynch MK, Bischoff EJL, Cameron S, Campbell H. The recognition of and care seeking behaviour for childhood illness in developing countries: a systematic review. PLoS One 2014; 9:e93427. [PMID: 24718483 PMCID: PMC3981715 DOI: 10.1371/journal.pone.0093427] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 03/06/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pneumonia, diarrhoea, and malaria are among the leading causes of death in children. These deaths are largely preventable if appropriate care is sought early. This review aimed to determine the percentage of caregivers in low- and middle-income countries (LMICs) with a child less than 5 years who were able to recognise illness in their child and subsequently sought care from different types of healthcare providers. METHODS AND FINDINGS We conducted a systematic literature review of studies that reported recognition of, and/or care seeking for episodes of diarrhoea, pneumonia or malaria in LMICs. The review is registered with PROSPERO (registration number: CRD42011001654). Ninety-one studies met the inclusion criteria. Eighteen studies reported data on caregiver recognition of disease and seventy-seven studies on care seeking. The median sensitivity of recognition of diarrhoea, malaria and pneumonia was low (36.0%, 37.4%, and 45.8%, respectively). A median of 73.0% of caregivers sought care outside the home. Care seeking from community health workers (median: 5.4% for diarrhoea, 4.2% for pneumonia, and 1.3% for malaria) and the use of oral rehydration therapy (median: 34%) was low. CONCLUSIONS Given the importance of this topic to child survival programmes there are few published studies. Recognition of diarrhoea, malaria and pneumonia by caregivers is generally poor and represents a key factor to address in attempts to improve health care utilisation. In addition, considering that oral rehydration therapy has been widely recommended for over forty years, its use remains disappointingly low. Similarly, the reported levels of care seeking from community health workers in the included studies are low even though global action plans to address these illnesses promote community case management. Giving greater priority to research on care seeking could provide crucial evidence to inform child mortality programmes.
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Affiliation(s)
- Pascal Geldsetzer
- Department of Global Health & Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Thomas Christie Williams
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Amir Kirolos
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Sarah Mitchell
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Louise Alison Ratcliffe
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Maya Kate Kohli-Lynch
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Esther Jill Laura Bischoff
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Sophie Cameron
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Harry Campbell
- Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
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290
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Micronutrients for the Prevention and Treatment of Diarrhea in Children in Low- and Middle-Income Countries. CURRENT TROPICAL MEDICINE REPORTS 2014. [DOI: 10.1007/s40475-014-0014-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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291
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The Role of Maternal Breast Milk in Preventing Infantile Diarrhea in the Developing World. CURRENT TROPICAL MEDICINE REPORTS 2014; 1:97-105. [PMID: 24883263 DOI: 10.1007/s40475-014-0015-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Multiple interventions have been designed to decrease mortality and disability in children. Among these, breastfeeding is the most cost effective intervention for protecting children against diarrhea and all causes of mortality. Human milk is uniquely suited to the human infant, both in its nutritional composition and in the nonnutritive bioactive factors that promote survival and healthy development. Suboptimal breastfeeding has been linked with numerous adverse child health outcomes including increased incidence of diarrhea and pneumonia. This review provides an update regarding recent studies on the effect of breastfeeding on diarrhea morbidity and mortality in children in developing countries, describes major human milk components responsible for this protective effect (oligosaccharides, secretory immunoglobulins, lactoferrin, bacterial microbiota, etc.), and highlights areas for future research in this topic. Breastfeeding promotion remains an intervention of enormous public health potential to decrease global mortality and promote better growth and neurodevelopment in children.
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292
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Unger CC, Salam SS, Sarker MSA, Black R, Cravioto A, El Arifeen S. Treating diarrhoeal disease in children under five: the global picture. Arch Dis Child 2014; 99:273-8. [PMID: 24197873 DOI: 10.1136/archdischild-2013-304765] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Rates of childhood mortality due to diarrhoea remain unacceptably high and call for renewed global focus and commitment. Affordable, simple and effective diarrhoeal treatments have already been available for many years, yet a shift in international health priorities has seen coverage of recommended treatments slow to a near-standstill since 1995. This article reviews coverage of recommended childhood diarrhoeal treatments (low-osmolarity oral rehydration solution (ORS) and zinc), globally and regionally, and provides an overview of the major barriers to wide-scale coverage. It is argued that to ensure smooth supply and equitable distribution of ORS and zinc, adequate financing, relevant policy changes, strong public, private and non-government organisation (NGO) collaboration, local manufacturing of pharmaceuticals, mass media awareness and campaigning, in conjunction with strong government support, are necessary for successful treatment scale-up.
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Affiliation(s)
- Carla Chan Unger
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), , Dhaka, Bangladesh
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293
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Lindenmayer GW, Stoltzfus RJ, Prendergast AJ. Interactions between zinc deficiency and environmental enteropathy in developing countries. Adv Nutr 2014; 5:1-6. [PMID: 24425714 PMCID: PMC3884090 DOI: 10.3945/an.113.004838] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Zinc deficiency affects one-fifth of the world's population and leads to substantial morbidity and mortality. Environmental enteropathy (EE), a subclinical pathology of altered intestinal morphology and function, is almost universal among people living in developing countries and affects long-term growth and health. This review explores the overlapping nature of these 2 conditions and presents evidence for their interaction. EE leads to impaired zinc homeostasis, predominantly due to reduced absorptive capacity arising from disturbed intestinal architecture, and zinc deficiency exacerbates several of the proposed pathways that underlie EE, including intestinal permeability, enteric infection, and chronic inflammation. Ongoing zinc deficiency likely perpetuates the adverse outcomes of EE by worsening malabsorption, reducing intestinal mucosal immune responses, and exacerbating systemic inflammation. Although the etiology of EE is predominantly environmental, zinc deficiency may also have a role in its pathogenesis. Given the impact of both EE and zinc deficiency on morbidity and mortality in developing countries, better understanding the relation between these 2 conditions may be critical for developing combined interventions to improve child health.
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Affiliation(s)
| | | | - Andrew J. Prendergast
- Zvitambo Institute for Maternal Child Health Research, Harare, Zimbabwe,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and,Centre for Paediatrics, Queen Mary University of London, UK,To whom correspondence should be addressed. E-mail:
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294
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Vélez LF, Sanitato M, Barry D, Alilio M, Apfel F, Coe G, Garcia A, Kaufman M, Klein J, Kutlesic V, Meadowcroft L, Nilsen W, O'Sullivan G, Peterson S, Raiten D, Vorkoper S. The role of health systems and policy in producing behavior and social change to enhance child survival and development in low- and middle-income countries: an examination of the evidence. JOURNAL OF HEALTH COMMUNICATION 2014; 19 Suppl 1:89-121. [PMID: 25207449 PMCID: PMC4205911 DOI: 10.1080/10810730.2014.939313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, economic incentives (for both caregiver and provider), health systems strengthening/policy/legislation, and others. Recommendations for policy, practice, and research are given based on fairly strong data across the areas of health service delivery, health workforce, health financing, governance and leadership, and research.
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Affiliation(s)
| | - Mary Sanitato
- Bureau for Global Health, U.S. Agency for International Development
,
Washington
,
District of Columbia
,
USA
| | - Donna Barry
- Center for American Progress
,
Washington
,
District of Columbia
,
USA
| | - Martin Alilio
- U.S. Agency for International Development
,
Washington
,
District of Columbia
,
USA
| | - Franklin Apfel
- World Health Communication Associates
,
Somerset
,
United Kingdom
| | - Gloria Coe
- U.S. Agency for International Development
,
Washington
,
District of Columbia
,
USA
| | - Amparo Garcia
- U.S. Forest Service
,
Washington
,
District of Columbia
,
USA
| | - Michelle Kaufman
- Center for Communication Programs
, Johns Hopkins Bloomberg School of Public Health
,
Baltimore
,
Maryland
,
USA
| | - Jonathan Klein
- American Academy of Pediatrics
,
Elk Grove Village
,
Illinois
,
USA
| | - Vesna Kutlesic
- National Institutes of Health
,
Bethesda
,
Maryland
,
USA
| | | | - Wendy Nilsen
- Office of Behavioral and Social Sciences Research
, National Institutes of Health
,
Bethesda
,
Maryland
,
USA
| | | | | | - Daniel Raiten
- National Institutes of Health
,
Bethesda
,
Maryland
,
USA
| | - Susan Vorkoper
- National Institutes of Health
,
Bethesda
,
Maryland
,
USA
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295
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Abstract
Although the number of child deaths has declined globally over the past 20 years, many countries still lag behind their millennium development goal targets, and inequity in child health remains a pernicious problem both between and within countries. Breastfeeding is a key intervention to reduce child mortality, and in an article published in BMC Medicine, Roberts and colleagues have shown that breastfeeding interventions can have a significant role in reducing inequity in child health. With the proper attention paid to overcoming the barriers to scaling up breastfeeding interventions, deployment of effective interventions in health facilities and the community, and improvements in support for breastfeeding interventions across society, many countries that are struggling to meet their millennium development goals could make significant gains in child survival and inequity.
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Affiliation(s)
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 113-0033, Japan.
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296
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Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, Bustreo F, Evans D, Feachem RGA, Frenk J, Ghosh G, Goldie SJ, Guo Y, Gupta S, Horton R, Kruk ME, Mahmoud A, Mohohlo LK, Ncube M, Pablos-Mendez A, Reddy KS, Saxenian H, Soucat A, Ulltveit-Moe KH, Yamey G. Global health 2035: a world converging within a generation. Lancet 2013; 382:1898-955. [PMID: 24309475 DOI: 10.1016/s0140-6736(13)62105-4] [Citation(s) in RCA: 678] [Impact Index Per Article: 61.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Dean T Jamison
- Department of Global Health, University of Washington, Seattle, WA, USA
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297
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Affiliation(s)
- Zulfiqar A Bhutta
- From the Centre for Global Child Health, Hospital for Sick Children (SickKids), Toronto (Z.A.B.); the Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan (Z.A.B.); and the Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (R.E.B.)
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298
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Dreibelbis R, Freeman MC, Greene LE, Saboori S, Rheingans R. The impact of school water, sanitation, and hygiene interventions on the health of younger siblings of pupils: a cluster-randomized trial in Kenya. Am J Public Health 2013; 104:e91-7. [PMID: 24228683 DOI: 10.2105/ajph.2013.301412] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the impact of school water, sanitation, and hygiene (WASH) interventions on diarrhea-related outcomes among younger siblings of school-going children. METHODS We conducted a cluster-randomized trial among 185 schools in Kenya from 2007 to 2009. We assigned schools to 1 of 2 study groups according to water availability. Multilevel logistic regression models, adjusted for baseline measures, assessed differences between intervention and control arms in 1-week period prevalence of diarrhea and 2-week period prevalence of clinic visits among children younger than 5 years with at least 1 sibling attending a program school. RESULTS Among water-scarce schools, comprehensive WASH improvements were associated with decreased odds of diarrhea (odds ratio [OR] = 0.44; 95% confidence interval [CI] = 0.27, 0.73) and visiting a clinic (OR = 0.36; 95% CI = 0.19, 0.68), relative to control schools. In our separate study group of schools with greater water availability, school hygiene promotion and water treatment interventions and school sanitation improvements were not associated with differences in diarrhea prevalence between intervention and control schools. CONCLUSIONS In water-scarce areas, school WASH interventions that include robust water supply improvements can reduce diarrheal diseases among young children.
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Affiliation(s)
- Robert Dreibelbis
- Robert Dreibelbis is with the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. Robert Dreibelbis is also with the Hubert Department of Global Health, and Matthew C. Freeman, Leslie E. Greene, and Shadi Saboori are with the Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA. Richard Rheingans is with the Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville
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299
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Abstract
10 years ago, The Lancet published a Series about child survival. In this Review, we examine progress in the past decade in child survival, with a focus on epidemiology, interventions and intervention coverage, strategies of health programmes, equity, evidence, accountability, and global leadership. Knowledge of child health epidemiology has greatly increased, and although more and better interventions are available, they still do not reach large numbers of mothers and children. Child survival should remain at the heart of global goals in the post-2015 era. Many countries are now making good progress and need the time and support required to finish the task. The global health community should show its steadfast commitment to child survival by amassing knowledge and experience as a basis for ever more effective programmes. Leadership and accountability for child survival should be strengthened and shared among the UN system; governments in high-income, middle-income, and low-income countries; and non-governmental organisations.
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Affiliation(s)
- Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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300
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Abstract
This paper provides an overview of the historical development and current status of the Lives Saved Tool (LiST). The paper provides a general explanation of the modeling approach used in the model with links to web sites and other articles with more details. It also details the development process in developing both the model structure as well as the assumptions used in the model. The paper provides information about how LiST has been and is currently being used by various organizations and within national health programs. We also provide a review of the work that has been done to try to validate the outputs of the model.
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Affiliation(s)
- Neff Walker
- Institute for International Programs and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Yvonne Tam
- Institute for International Programs and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ingrid K Friberg
- Institute for International Programs and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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