Global & Disaster Medicine

Archive for the ‘Kids-Infants’ Category

UN: Child Mortality

Document:  Levels and Trend in Childhood Mortality

Over the last two decades, the world made substantial progress in reducing mortality among children and young adolescents (including children under age 5, children aged 5−9 and young adolescents aged 10−14).

Still, in 2017 alone, an estimated 6.3 million children and young adolescents died, mostly from preventable causes.

Children under age 5 accounted for 5.4 million of these deaths, with 2.5 million deaths occurring in the first month of life, 1.6 million at age 1–11 months, and 1.3 million at age 1−4 years.

An additional 0.9 million deaths occurred among children aged 5−14.

Among children and young adolescents, the risk of dying was highest in the first month of life at an average rate of 18 deaths per 1,000 live births globally in 2017.

In comparison, the probability of dying after the first month and before reaching age 1 was 12 per 1,000, the probability of dying after age 1 and before age 5 was 10 per 1,000, and the probability of dying after age 5 and before age 15 was 7 per 1,000.


9/1/2004: an armed gang of Chechen separatist rebels enters a school in southern Russia and takes more than 1,000 people hostage. Ultimately, about 340 people (1/2 kids) died during the siege.

History

 


India, 2016: Severe Manifestations of Chikungunya Fever in Kids

CHIKV-EID

“……A total of 49 children had chikungunya fever; 36 had nonsevere disease and 13 had severe disease. All patients with severe disease were admitted to the PICU; 11 had illness consistent with the case definition of severe sepsis and septic shock, and 2 had acute liver failure. Of the 36 patients with nonsevere disease, 16 were admitted to the PICU (11 had seizures, 4 had fluid-responsive shock, 1 had peripheral cyanosis and mottling) and 20 were admitted to the pediatric high-dependency unit (3 had bleeding manifestations, 4 had severe abdominal pain, 2 had underlying cyanotic congenital heart disease, 2 had body temperature >40.3°C with irrelevant talking, 7 had dehydration, and 2 had severe rash). The median age was 12 years for patients with severe disease and 6.5 years for patients with nonsevere disease; male sex predominated in both groups (Table). Frequency of fever, body ache, arthralgia, and vomiting were similar for both groups. Peripheral cyanosis, along with mottling of skin and encephalopathy, was significantly higher in the group with severe disease. Serum albumin was significantly lower in the group with severe disease (3 vs. 3.75 g/dL). Of the 11 children with septic shock, 8 were admitted to the hospital within 24 hours of developing fever; 9 had hypotensive shock, and 2 had compensated shock. In this group, 6 children required 1 vasoactive agent, 3 children required 2 vasoactive agents, and 2 children required 3 vasoactive agents. Dopamine was used in 8 patients, dobutamine in 5 patients, epinephrine in 2 patients, and norepinephrine in 2 patients. The median duration of vasoactive support was 56 hours (range 31–114 hours), and the median vasoactive inotropic score in the first 24 hours was 10 (range 5–90; score >15–20 is considered serious). A vasoactive inotropic score >20 was seen in 2 children. Mean pH was 7.26 (reference range 7.35–7.45), mean lactate 5.1 mmol/L (reference range <2 mmol/L), mixed venous saturation 55% (reference range 70%–80%), and mean base excess at admission –7.7 mEq (reference range –2 to 2 mEq). Of the 2 children with acute liver failure with encephalopathy, 1 had dengue virus (positive dengue IgM by enzyme immunoassay) and the other had hepatitis E virus (reactive anti–hepatitis E IgM by enzyme immunoassay) co-infection…..”

Sharma PK, Kumar M, Aggarwal GK, Kumar V, Srivastava R, Sahani A, et al. Severe Manifestations of Chikungunya Fever in Children, India, 2016. Emerg Infect Dis. 2018;24(9):1737-1739. https://dx.doi.org/10.3201/eid2409.180330

 


“UN Secretary-General António Guterres condemned an air strike by pro-Yemini Government coalition forces, which killed scores of children who were on board a bus travelling through a busy market area…..”

UN

9 August 2018

UN Secretary-General António Guterres on Thursday condemned an air strike by pro-Yemini Government coalition forces, which killed scores of children who were on board a bus travelling through a busy market area in the northern province of Saada.

While the exact death toll remains to be confirmed, initial news reports indicate that the number of casualties could be well above 60, with dozens severely injured. Most of the children were reported to be aged between 10 and 13.

In his  statement, the UN chief called “on all parties to respect their obligations under international humanitarian law, in particular the fundamental rules of distinction, proportionality and precautions in attack,” emphasising that all parties must take “constant care to spare civilians and civilian objects in the conduct of military operations”.

The Secretary-General called for an “independent and prompt investigation” into this incident and extended his “deepest condolences” to the families of the victims.

The Head of the UN Children’s Fund (UNICEF) also strongly condemned the incident and urged the warring parties and international community “to do what’s right for children and bring an end to this conflict”.

“Attacks on children are absolutely unacceptable,” she said UNICEF Executive Director Henrietta Fore  on Twitter. “I’m horrified by the reported airstrike on innocent children, some with UNICEF backpacks. Enough is enough.”

“How many more children will suffer or die before those who can act, do by putting a stop to this scourge?”  said UNICEF’s chief in a statement.

“Attacking children is the lowest any party of this conflict can go,” UNICEF Yemen Resident Representative Meritxell Relaño told UN News. “There is no justification whatsoever to attacking children.”

According to the UN Children’s Fund, since conflict between pro-Government forces and Houthi rebels escalated in 2015, about 2,400 children have been killed and 3,600 maimed in Yemen.

The head of the UN agency there called all warring parties to “respect international humanitarian law,” and spare children, civilians and civilian infrastructure to prevent Yemen from falling “further into the abyss and the humanitarian catastrophe” it has been facing for over three years.

Yemen’s conflict has its roots in uprisings that date back to 2011, but fighting escalated in March 2015, when an international coalition led by Saudi Arabia intervened militarily at the request of Yemen’s President.

Attacks against civilians have been the scourge of this conflict. According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), “tens of civilians were killed in violence in several governorates” in the past 10 days alone. On 3 August, during a particularly deadly attack, one of the last functioning hospitals, Al Thawra in Al Hudaydah, was struck, reportedly causing the death of dozens of vulnerable, sick and injured civilians.

“It’s hard to believe we live in a world where children should live in fear of such attacks, yet here we are. This doesn’t have to be their reality though. Parties to the conflict and those who have influence over them, including Security Council members, can and should choose to end this catastrophe for the sake of Yemen’s children,” stressed the UNICEF chief.

“We’ve said this before and we are saying it again – parties to the conflict are obliged to do everything possible to protect civilians and civilian infrastructure. This is not a voluntary commitment – it is mandatory on all belligerents,” said Lise Grande, UN Humanitarian Coordinator in Yemen, in the latest OCHA report on the situation there. “So many people have died in Yemen – this conflict has to stop.”


Yemen: Allegedly, an airstrike by the Saudi-led coalition fighting Shiite rebels hit a bus in a market in northern Yemen on Thursday, killing at least 43 people, including children, and wounding as many as 63


2018: A year punctuated by brutal crimes against young girls in India.

NYT

The world’s most dangerous countries for women 2018


Boise, Idaho: 6 children, ages four to 12, were injured in a knife attack, along with 3 adults who rushed to their defense.

CBS

Pacific Northwest sector loop

 


Zika in Kids Living in Puerto Rico

Participants who had confirmed ZIKV infection included 25 infants (7.1%), 69 children (19.7%) aged 1 to 4 years, 95 (27.1%) aged 5 to 9 years, and 162 (46.1%) aged 10 to 17 years. Among these, 260 patients (74.1%) presented for evaluation of ZIKV infection at fewer than 3 days after the onset of symptoms, 340 (96.9%) were discharged to home after evaluation, and 349 (99.4%) had fever, 280 (79.8%) had a rash, 243 (69.2%) had facial or neck erythema, 234 (66.7%) had fatigue, 223 (63.5%) had headache, 212 (60.4%) had chills, 206 (58.7%) had pruritus, and 204 (58.1%) had conjunctival hyperemia.

May 29, 2018
Symptomatic Zika Virus Infection in Infants, Children, and Adolescents Living in Puerto Rico
JAMA Pediatr. Published online May 29, 2018. doi:10.1001/jamapediatrics.2018.0870

Nepal: Orphanage trafficking

Bright

“…..There is a demand for orphans, as institutions need to be filled with children to be profitable for their operators and staff. In absence of enough “real” orphans, many times orphanages turn to traffickers to supply children. They also actively look for poor children in their vicinity and convince the parents that their kids would be better off in the orphanage. …..”

 


May 18, 1927: Bath School Disaster, Bath MI. Andrew Kehoe blows up Bath Consolidated School killing 38 children, 2 teachers.


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