Global & Disaster Medicine

Archive for the ‘Kids-Infants’ Category

India’s Supreme Court on Wednesday struck down a decades-old clause in the country’s rape laws permitting a man to have sex with his wife if she is aged 15 to 18 – ruling that it was rape, and therefore a criminal offence.

Thomas Reuters

‘…..”For the longest time, traffickers have been using marriage with minors as an alibi to rape girls in the first instance, to break them, before selling them to pimps and brothel owners,” said Adrian Phillips, an advocate from Justice and Care, which fights trafficking…..Almost 20,000 women and children were victims of human trafficking in India in 2016, a rise of nearly 25 percent from the previous year, according to government data…….’

 


MSF on Malnutrition

MSF

Eight children die every minute because their diet lacks essential nutrients. They will continue to do so unless food aid changes.

MSF admitted 181,600 malnourished children to inpatient or outpatient feeding programs in 2015.

When children suffer from acute malnutrition, their immune systems are so impaired that the risk of death is greatly increased. According to the World Health Organization (WHO), malnutrition is the single greatest threat to the world’s public health.

The critical age for malnutrition is from six months—when mothers generally start supplementing breast milk—to 24 months. However, children under five, adolescents, pregnant or breastfeeding women, the elderly, and the chronically ill are also vulnerable.

People become malnourished if they are unable to take in enough or fully utilize the food they eat, due to illnesses such as diarrhea or other longstanding illnesses, such as measlesHIV, and tuberculosis.

We estimate that only three percent of the 20 million children suffering from severe acute malnutrition receive the lifesaving treatment they need.

What Causes Malnutrition?

Facts

From six months onwards, a child must have a balanced diet to lead a healthy life.
Malnutrition severely weakens a child’s immune system.
Wasting occurs when a malnourished person begins to consume their own body tissue.
RUTFs are the most effective way to treat and prevent malnutrition.

Breast milk is the only food a child needs for its first six months. Beyond this point, breastfeeding alone is not sufficient.

Diets at this stage must provide the right blend of high-quality protein, essential fats and carbohydrates, vitamins, and minerals.

In the Sahel, the Horn of Africa, and parts of South Asia, highly nutritious foods such as milk, meats, and fish are severely lacking.

For a child under the age of two, their diet will have a profound impact on their physical and mental development. Malnourished children under the age of five have severely weakened immune systems and are less resistant to common childhood diseases.

This is why a common cold or a bout of diarrhea can kill a malnourished child. Of the seven million deaths of children under five years of age each year, malnutrition contributes to at least one-third.

 

Symptoms of Malnutrition

Understandably, the most common sign of malnutrition is weight loss. Loss of weight may also be accompanied by a lack of strength and energy and the inability to undertake routine tasks. Those who are malnourished often develop anemia and therefore exhibit a lack of energy and breathlessness.

In children, signs of malnutrition may include an inability to concentrate or increased irritability, and stunted growth. In cases of severe acute malnutrition, swelling of the stomach, face, and legs, and changes in skin pigmentation may also occur.

Diagnosing Malnutrition

Malnutrition is diagnosed by comparing standard weights and heights within a given population, or by the measurement of a child’s mid-upper arm circumference (MUAC).

If dietary deficiencies are persistent, children will stop growing and become ‘stunted’—meaning they have a low height for their age. This is diagnosed as chronic malnutrition.

If they experience weight loss or ‘wasting’—low weight for one’s height—they are diagnosed as suffering from acute malnutrition.

This occurs when a malnourished person begins to consume his or her own body tissues to obtain needed nutrients.

In the severe acute form, children with kwashiorkor—distended stomachs—can be clinically diagnosed with body swelling, irritability, and changes in skin pigmentation.

Treating malnutrition

We believe that ready-to-use therapeutic food (RUTF) is the most effective way to treat malnutrition. RUTFs include all the nutrients a child needs during its development and helps reverse deficiencies and gain weight. RUTFs don’t require water for preparation, which eliminates the risk of contamination with water-borne diseases.

Because of its packaging, RUTFs can be used in all kinds of settings and can be stored for long periods of time. Unless the patient suffers from severe complications, RUTFs also allow patients to be treated at home.

Where malnutrition is likely to become severe, Doctors Without Borders/Médecins Sans Frontières (MSF) takes a preventative approach by distributing supplementary RUTF to at-risk children.

In 2015, MSF admitted 181,600 malnourished children into feeding programs.

 


World Vision: More than 800,000 children risk death by starvation in East Africa and aid agencies have just weeks – months at most – to save them

Thomson Reuters

  • World Vision – the world’s largest international children’s charity
  • “We’re seeing emaciated children, nearly skeletons, lying in pain in hospital beds … We’re seeing mothers unable to breastfeed because they are malnourished themselves.”
  • “The hunger crisis is wreaking havoc on 24 million people (in East Africa) – more than the population of Berlin, London, Chicago and Bangkok combined.”

 


At Cox’s Bazar: Some 150,000 Rohingya children will be immunized over 7 days for measles, rubella and polio.

Washington Post

“…..Refugee camps were already beyond capacity and new arrivals were staying in schools or huddling in makeshift settlements with no toilets along roadsides and in open fields. Police were checking vehicles to prevent the Rohingya from spreading to nearby towns in an attempt to control the situation…..many children are suffering from flu and risk pneumonia……. Many are suffering from diarrhea, dehydration, skin diseases or worse……..”


UNICEF’s six-point agenda for action to keep refugee and migrant children safe.

UNICEF

This joint report from UNICEF and the International Organization for Migration (IOM) explores in detail survey data from the Central and Eastern Mediterranean Sea routes to Europe, focusing on adolescents and youth on the move from Africa and Asia. The analysis reveals staggering rates of trafficking and exploitation, and also points to the xenophobia and racism that make young refugees and migrants − especially those from sub-Saharan Africa − vulnerable

“We risked our lives to come here,” says 17-year-old Mohammad, who travelled through Libya to seek asylum in Italy. “We crossed a sea. We knew it is not safe, so we sacrificed. We do it, or we die.”

Some of the world’s most dangerous migration routes cross the Mediterranean Sea – a major pathway to Europe for migrants and refugees from Africa, the Middle East and Asia.

Up to three-quarters of children and youth face abuse, exploitation and trafficking on these migration routes. Some are more vulnerable than others: those travelling alone, those with low levels of education and those undertaking longer journeys.

Most vulnerable of all are those who, like Mohammad, come from sub-Saharan Africa.

These findings come from a new UNICEF and International Organization for Migration report Harrowing Journeys: Children and youth on the move across the Mediterranean Sea, at risk of trafficking and exploitation.

As the world continues to grapple with the reality of migration and displacement, the report’s findings underscore the urgent need for action to protect the most vulnerable among those on the move.

Uprooted adolescents and youth facts


Across the islands of Indonesia, more than 267,000 children are estimated to use tobacco products every day.

CNN


The effects of ORT in this sequence of photos of a dehydrated Egyptian child

Beginning of ORT sequence. Image courtesy of Norbert Hirschhorn

Second step in ORT sequence. Image courtesy of Norbert Hirschhorn

Third step in ORT sequence. Image courtesy of Norbert Hirschhorn

Fourth step in ORT sequence. Image courtesy of Norbert Hirschhorn

Final step in ORT sequence

“……You can see the effects of ORT in this sequence of photos below of a dehydrated Egyptian child treated entirely with ORT. These pictures, taken by me, were made into large posters for use by NGOs in Goma.”

Sincerely,

Norbert Hirschhorn, MD
London

 

 

NIH

Oral Rehydration Therapy: A Top Medical Advance of the 20th Century

History of Oral Rehydration Therapy (ORT)

A man being treated for cholera.

Credit: CDC
A man being treated for cholera.

Without treatment, the diarrhea caused by cholera infection can quickly lead to severe dehydration and death. The fluid loss is so rapid that half of those who will die of the disease succumb within 12 hours of developing symptoms. In the 1800s, many physicians believed that cholera destroyed the intestine and that medical intervention was futile. At the time, physicians had little knowledge of microbiology and human physiology, and since the disease was so aggressive, early efforts to rehydrate patients were not successful. There was some experimentation with intravenous (IV) methods to treat the most severely ill patients, but the chemical solutions that were administered tended to be non-sterile and dangerously unbalanced. Oral rehydration treatment was also confounded by immediate reflexive vomiting.

Finding the Right IV Formulation

Progress was slow, but after many years of fine-tuning IV formulations for cholera patients, this method began to reduce mortality. By 1965, improved understanding of physiology and the administration of sterile, well-balanced IV fluids prevented death in almost every case.

However, there were a number of practical limitations to IV administration in cholera-endemic areas such as Bangladesh and India. During seasonal epidemics, for example, hospitals had to admit hundreds of patients each day. The logistical challenges left many patients untreated at home or by the roadside on their way to treatment facilities. With each patient requiring up to 40 liters of sterile IV fluid, supplies quickly ran out.

Exploring Oral Fluid Administration

In the 1960s, a number of physicians began to explore oral fluid administration as a supplemental treatment for cholera patients once IV fluid rehydration had blunted the reflexive vomiting. Pioneering the field was retired Navy Captain Dr. Robert A. Phillips, the third director of the NIAID-funded Cholera Research Laboratory that later became the International Centre for Diarrhoeal Disease Research, Bangladesh (link is external) (ICDDR,B). Dr. Phillips, a pathophysiologist with many years’ experience in cholera research and treatment, had helped to refine IV rehydration methods, but like many physicians, was attracted to the theoretical simplicity and ease of oral rehydration—if it could be accomplished.

The main challenge with oral rehydration was that fluids were not absorbed, and any ingested liquids simply added to the volume of diarrhea. But Dr. Phillips had an idea. Guessing that the strength of the oral fluids was inadequate, he tried adding glucose to the fluids. He immediately noticed that patients drinking glucose-supplemented electrolytes passed less diarrhea, indicating that fluid was being absorbed. Dr. Phillips cautiously reported the phenomenon, and in so doing opened the door to one of the 20th century’s most important medical advances.

Soon afterward, research teams in what are now Dhaka, Bangladesh, and Kolkata, India, conducted careful clinical trials and established that oral rehydration fluids with balanced salts and glucose did indeed result in decreased diarrhea, rapid rehydration and surprisingly quick recovery.

The first clinical trials of what would become known as Oral Rehydration Therapy (ORT) took place in 1968. Patients who were given an oral solution containing glucose and electrolytes were found to need 79 percent less IV rehydration for full recovery than those who did not receive the oral solution. A follow-up study found that patients with mild and moderate cholera cases could be treated with ORT alone. Not only did most patients recover quickly, but the treatment was inexpensive and could be administered by family members in the home, and by other untrained individuals, increasing its effectiveness in emergency and low-resource situations.

Separate studies supported by NIAID showed that administration of the antibiotic tetracycline reduced the need for rehydration fluids by 60 percent. Pathophysiological studies revealed that in contrast to the understanding of earlier years, the cholera pathogen did not destroy the intestine, but used a toxin to alter the transport of solutes across the intestinal membrane. Oral rehydration with the correct fluids sped up recovery by compensating for the activity of the toxin.

ORT Saves Lives Today

ORT remains the current treatment of choice due to its safety, effectiveness, low cost, simple preparation, and easy administration. According to the World Health Organization, up to 80 percent of cholera patients can be successfully treated by ORT alone, the remaining severe cases requiring preliminary IV rehydration before transitioning to ORT. ORT is estimated to save over one million lives per year, and was described in the British Medical Journal’s “Medical Milestones” series as one of the most significant medical advances of the 20th century.

NIAID Research and Future Challenges

Emerging cholera pathogens present a challenge to the power of rehydration therapy and antimicrobials. For example, antimicrobial resistance can affect the ability of the cheap and widely available antibiotic tetracycline to reduce the duration and intensity of disease. In addition, novel cholera pathogens are emerging that possess a particularly active version of the cholera toxin. These strains result in a higher proportion of severe cases that must be immediately rescued with aggressive IV rehydration before receiving ORT. Finally, modern cholera strains are powerfully competitive in the environment, replacing endemic strains and occupying the natural waters upon which hundreds of millions of people depend.

Recent research has shown that these aggressive cholera strains have spread across Asia and Africa, and have recently appeared in Haiti. Cholera remains a fierce pathogen that ruthlessly exploits poverty, inequity, natural and man-made disaster, and poor access to health care. NIAID sponsors a robust research program to understand cholera evolution, develop new therapeutics and vaccines, and collaborate with international partners to continue the fight against this ancient and modern disease.

References

Carpenter CCJ, Sack RB, Mitra PP, Mondal A. Tetracycline therapy in cholera (link is external)Journal of the Indian Medical Association. 43:309-312 (1964).

Chatterjee HN. Reduction of cholera mortality by the control of bowel symptoms and other complications. (link is external) Postgraduate Medical Journal. 33(380):278-284 (1957).

Chin CS, Sorenson J, Harris JB, Robins WP, Charles RC, Jean-Charles RR, Bullard J, Webster DR, Kasarskis A, Peluso P, Paxinos EE, Yamaichi Y, Calderwood SB, Mekalanos JJ, Schadt E, Waldor MK. The origin of the Haitian cholera outbreak strain (link is external)New England Journal of Medicine. 364(1):33-42 (2011).

Fontaine O, Garner P, Bhan MK. Oral rehydration therapy: The simple solution for saving lives. (link is external) British Medical Journal. 334(supp1):s14 (2007).

Nalin DR, Cash RA, Islam R, Molla M, Phillips RA. Oral maintenance therapy for cholera in adults. (link is external) Lancet. 2(7564):370-373 (1968).

Nalin DR, Cash RA, Rahman M. Oral (or nasogastric) maintenance therapy for cholera patients in all age-groups. (link is external) Bulletin of the World Health Organization. 43(3):361-363 (1970).

Phillips RA. Water and electrolyte losses in cholera (link is external)Federation Proceedings. 23:705-712 (1964).

Savarino SJ. A legacy in 20th century medicine: Robert Allan Phillips and the taming of cholera (link is external)Clinical Infectious Diseases. 35(6):713-720 (2002).

Ruxin JN. Magic bullet: The history of oral rehydration therapy. (link is external) Medical History. 38(4):363-397 (1994).

World Health Organization. Fact Sheet No. 107: Cholera (link is external) (2010).


An explosion at the gates of a Chinese kindergarten that killed 8 and injured more than 60 was caused by a 22-year-old suicide bomber

BBC


7 people were killed and 59 injured Thursday in an explosion at the front gate of a kindergarten in eastern China

CBS News

 


Circulating vaccine-derived poliovirus type 2 – Democratic Republic of the Congo

WHO

Disease outbreak news
13 June 2017

In the Democratic Republic of the Congo (DRC), two separate circulating vaccine-derived poliovirus type 2s (cVDPV2s) have been confirmed. The first cVDPV2 strain has been isolated from two acute flaccid paralysis (AFP) cases from two districts in Haut-Lomami province, with onset of paralysis on 20 February and 8 March 2017. The second cVDPV2 strain has been isolated from Maniema province, from two AFP cases (with onset of paralysis on 18 April and 8 May 2017) and a healthy contact in the community.

Public health response

The Ministry of Health, supported by WHO and partners of the Global Polio Eradication Initiative (GPEI), has completed a risk assessment, including evaluating population immunity and the risk of further spread.

Outbreak response plans are currently being finalized, consisting of strengthening surveillance, including active case searching for additional cases of AFP, and supplementary immunization activities (SIAs) with monovalent oral polio vaccine type 2 (mOPV2), in line with internationally-agreed outbreak response protocols.

Surveillance and immunization activities are being strengthened in neighbouring countries.

WHO risk assessment

WHO assesses the risk of further national spread of these strains to be high, and the risk of international spread to be medium.

The detection of cVDPV2s underscores the importance of maintaining high routine vaccination coverage everywhere, to minimize the risk and consequences of any poliovirus circulation. These events also underscore the risk posed by any low-level transmission of the virus. A robust outbreak response as initiated is needed to rapidly stop circulation and ensure sufficient vaccination coverage in the affected areas to prevent similar outbreaks in the future. WHO will continue to evaluate the epidemiological situation and outbreak response measures being implemented.

WHO advice

It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.

WHO’s International Travel and Health recommends that all travellers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than four weeks) from infected areas should receive an additional dose of OPV or inactivated polio vaccine (IPV) within four weeks to 12 months of travel. As per the advice of the Emergency Committee convened under the International Health Regulations (2005), efforts to limit the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC). Countries affected by poliovirus transmission are subject to Temporary Recommendations. To comply with the Temporary Recommendations issued under the PHEIC, any country infected by poliovirus should declare the outbreak as a national public health emergency and consider vaccination of all international travellers.


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