Global & Disaster Medicine

Archive for the ‘Kids-Infants’ Category

In celebration of World Breastfeeding Week

USAID

“……The benefits of breastfeeding don’t just extend to babies; studies found it can even protect women from breast and ovarian cancer later in life, reduce the risk of type 2 diabetes and contribute to healthy timing and spacing of pregnancies. In fact, scaling up breastfeeding could prevent over 800,000 child deaths and 20,000 deaths among women each year...…”


World Breastfeeding Week 2019

USAID

The cognitive, health and economic benefits of breastfeeding are well established and recognized, yet only 37 percent of children under 6-months-old in low- and middle-income countries are exclusively breastfed and about 50 percent of newborns initiate breastfeeding within one hour of birth.

Breastfeeding has one of the highest returns on investment of any development activity: every dollar invested in breastfeeding interventions yields an estimated $35 in economic gains. Breastfeeding duration is also associated with higher IQ and income as well as greater educational attainment. Inversely, suboptimal breastfeeding is associated with economic losses of about $302 billion each year, or 0.49 percent of world gross national income. With support to scale up global breastfeeding practices, the deaths of 823,000 children under 5-years-old and 20,000 women could be prevented, annually.


Causes of severe pneumonia requiring hospital admission in children around the world

Lancet

“…….Between Aug 15, 2011, and Jan 30, 2014, we enrolled 4232 cases and 5119 community controls. The primary analysis group was comprised of 1769 (41·8% of 4232) cases without HIV infection and with positive chest x-rays and 5102 (99·7% of 5119) community controls without HIV infection.

Wheezing was present in 555 (31·7%) of 1752 cases (range by site 10·6–97·3%).

30-day case-fatality ratio was 6·4% (114 of 1769 cases).

Blood cultures were positive in 56 (3·2%) of 1749 cases, and Streptococcus pneumoniae was the most common bacteria isolated (19 [33·9%] of 56). Almost all cases (98·9%) and controls (98·0%) had at least one pathogen detected by PCR in the NP-OP specimen. The detection of respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus, influenza virus, S pneumoniae, Haemophilus influenzae type b (Hib), H influenzae non-type b, and Pneumocystis jirovecii in NP-OP specimens was associated with case status.

The aetiology analysis estimated that viruses accounted for 61·4% (95% credible interval [CrI] 57·3–65·6) of causes, whereas bacteria accounted for 27·3% (23·3–31·6) and Mycobacterium tuberculosis for 5·9% (3·9–8·3).

Viruses were less common (54·5%, 95% CrI 47·4–61·5 vs 68·0%, 62·7–72·7) and bacteria more common (33·7%, 27·2–40·8 vs 22·8%, 18·3–27·6) in very severe pneumonia cases than in severe cases.

RSV had the greatest aetiological fraction (31·1%, 95% CrI 28·4–34·2) of all pathogens. Human rhinovirus, human metapneumovirus A or B, human parainfluenza virus, S pneumoniae, M tuberculosis, and H influenzae each accounted for 5% or more of the aetiological distribution. We observed differences in aetiological fraction by age for Bordetella pertussis, parainfluenza types 1 and 3, parechovirus–enterovirus, P jirovecii, RSV, rhinovirus, Staphylococcus aureus, and S pneumoniae, and differences by severity for RSV, S aureus, S pneumoniae, and parainfluenza type 3. The leading ten pathogens of each site accounted for 79% or more of the site’s aetiological fraction…..”


WHO: All about polio

WHO

Key facts

  • Polio (poliomyelitis) mainly affects children under 5 years of age.
  • 1 in 200 infections leads to irreversible paralysis. Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.
  • Cases due to wild poliovirus have decreased by over 99% since 1988, from an estimated 350 000 cases then, to 33 (1) reported cases in 2018.
  • As long as a single child remains infected, children in all countries are at risk of contracting polio. Failure to eradicate polio from these last remaining strongholds could result in as many as 200 000 new cases every year, within 10 years, all over the world.
  • In most countries, the global effort has expanded capacities to tackle other infectious diseases by building effective surveillance and immunization systems.

Symptoms

Polio is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus is transmitted by person-to-person spread mainly through the faecal-oral route or, less frequently, by a common vehicle (for example, contaminated water or food) and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness of the neck and pain in the limbs. 1 in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.

People most at risk

Polio mainly affects children under 5 years of age.

Prevention

There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.

Global caseload

Wild poliovirus cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then, to 33 (1) reported cases in 2018.

Of the 3 strains of wild poliovirus (type 1, type 2, and type 3), wild poliovirus type 2 was eradicated in 1999 and no case of wild poliovirus type 3 has been found since the last reported case in Nigeria in November 2012.

WHO Response

Launch of the Global Polio Eradication Initiative

In 1988, the Forty-first World Health Assembly adopted a resolution for the worldwide eradication of polio. It marked the launch of the Global Polio Eradication Initiative (GPEI), spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, and supported by key partners including the Bill & Melinda Gates Foundation. This followed the certification of the eradication of smallpox in 1980, progress during the 1980s towards elimination of the poliovirus in the Americas, and Rotary International’s commitment to raise funds to protect all children from the disease.

Progress

Overall, since the GPEI was launched, the number of cases has fallen by over 99%.

In 1994, the WHO Region of the Americas was certified polio-free, followed by the WHO Western Pacific Region in 2000 and the WHO European Region in June 2002. On 27 March 2014, the WHO South-East Asia Region was certified polio-free, meaning that transmission of wild poliovirus has been interrupted in this bloc of 11 countries stretching from Indonesia to India. This achievement marks a significant leap forward in global eradication, with 80% of the world’s population now living in certified polio-free regions.

More than 16 million people are able to walk today, who would otherwise have been paralysed. An estimated 1.5 million childhood deaths have been prevented, through the systematic administration of vitamin A during polio immunization activities.

Opportunity and risks: an emergency approach

The strategies for polio eradication work when they are fully implemented. This is clearly demonstrated by India’s success in stopping polio in January 2011, in arguably the most technically-challenging place, and polio-free certification of the entire South-East Asia Region of WHO occurred in March 2014.

Failure to implement strategic approaches, however, leads to ongoing transmission of the virus. Endemic transmission is continuing in Afghanistan, Nigeria and Pakistan. Failure to stop polio in these last remaining areas could result in as many as 200 000 new cases every year, within 10 years, all over the world.

Recognizing both the epidemiological opportunity and the significant risks of potential failure, the “Polio Eradication and Endgame Strategic Plan” was developed, in consultation with polio-affected countries, stakeholders, donors, partners and national and international advisory bodies. The new Plan was presented at a Global Vaccine Summit in Abu Dhabi, United Arab Emirates, at the end of April 2013. It is the first plan to eradicate all types of polio disease simultaneously – both due to wild poliovirus and due to vaccine-derived polioviruses.

Future benefits of polio eradication

Once polio is eradicated, the world can celebrate the delivery of a major global public good that will benefit all people equally, no matter where they live. Economic modelling has found that the eradication of polio would save at least US$ 40–50 billion, mostly in low-income countries. Most importantly, success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.


Mass distribution of azithromycin could be a strategy for reducing childhood mortality in parts of sub-Saharan Africa.

NEJM

“…..it remains unclear how azithromycin might be preventing childhood deaths. “Thus far our general sense is that azithromycin may work better in places with the highest childhood mortality, and these places have a very high burden of infectious illnesses, so we think azithromycin very likely is treating a multitude of infections that might ultimately have caused a death,” he [study co-author and University of California-San Francisco ophthalmology professor Jeremy Keenan, MD, MPH] said.

Other theories include a benefit to childhood growth, a change in gut microbiota, or an anti-inflammatory effect…..”


Sandy Hook Elementary School: The unintended consequences of well-intended generosity.

NYT

“……In the six and a half years since the deadliest elementary school shooting in American history, more than $100 million in federal, state, corporate and private money flowed into this community of about 28,000 in southwestern Connecticut……so much money engulfed the vulnerable, wounded Newtown that it inevitably sowed division. The town became a case study of how Americans’ material expressions of grief can become more an obstacle than an aid to recovery……..”

  • 60,000 teddy bears

“……..Lesson 1” from Sandy Hook is for the authorities — the mayor, the city council or the governor — to swiftly establish a single nonprofit benefiting victims and their families, so money intended for them is not atomized, or given to charities that lack the experience or ability to distribute it to them.

https://www.youtube.com/watch?v=Y7uv3zqSq9o

 


Kashmir’s Children in the Labor Market

IPS

“…..According to government figures, there are over 175,000 children actively involved in child labour in the state, which has a population of 12 million.

Mir says the actual number of child working could be much higher as government figures only reveal the reported cases and a majority of the child labour cases go unreported due to the fear of punishment.

An independent report titled “Socio Economic and Ethical dimensions of Child Labour in Kashmir” conducted in 2005 by Professor Fayaz Ahmad claimed that at the time there were more than 250,000 children in the state working in auto repair shops, brick klins, as domestic labourers, and as carpet weavers and sozni embroiderers.

One of the prime reasons for child labour was poverty……

A 2009 study conducted by the Department of Sociology, University of Kashmir, reveals that about 66 percent of child labourers have only studied until the eighth grade. It further states that 9.2 percent of child labourers are between five and 10 years old, while 90 percent of them are between 11 and 14 years old.

The study also points out that once children start earning money, 80 percent of them stop attending school…..”


Egypt: One in five children are stunted or too short for their age

IPS News

WASTING                                                    STUNTING                                                     UNDERWEIGHT

Low weight for height                               Low height for age                                                 Low weight for age

 

In Egypt, despite the investment in the health sector, and a notable decline in child mortality, malnutrition rates remain high.


For young children under five years of age:
• Stunting remains a significant public health concern in Egypt, affecting 1 in 5 children

• Wasting has increased significantly since 2000, and the trend is significantly higher among girls

• Wasting and underweight stand at 8 and 6 percent, respectively

• The incidence of anemia is high, standing at 27 percent

Stunting is a measure of chronic malnutrition; it reflects inadequate nutrition over a long period, or effects of recurrent or chronic illnesses. The stunting rate of children under five is the percentage whose height-for-age is below minus 2 standard deviations (moderate and severe stunting) from the median heightfor-age.

Underweight reflects both acute and chronic malnutrition. The underweight rate for children under-five is the percentage of whose weight-for-age is below minus 2 standard deviations (moderate) and minus 3 standard deviations (underweight) from the median weightfor-age.

Wasting is a measure of current acute malnutrition, which may reflect acute food shortage or recent episodes of illness. The wasting rate is the percentage of children under-five whose weightfor-height is below minus 2 standard deviations (moderate) and minus 3 standard deviations (severe) from the median weight-for-height.

Overweight is defined as excessive fat accumulation that may impair health. The overweight rate among children under five is the percentage whose weight-forheight is above plus 2 standard deviations from the median weight-for-age. Among adolescents and adults, it is the percentage of individuals with a Body Mass Index equal or higher than 25.


4/20/1999: At approximately 11:19 a.m., Dylan Klebold, 18, and Eric Harris, 17, dressed in trench coats, began shooting students outside the school before moving inside to continue their rampage. By 11:35 a.m., Klebold and Harris had killed 12 fellow students and a teacher and wounded another 23 people.

HxC


A bus full of school children was set on fire by its driver (an Italian of Sengalese origin) in the outskirts of Milan on Wednesday in an apparent protest against migrant drownings in the Mediterranean

Reuters

“…..All the children managed to escape unhurt before the bus was engulfed in flames…..”


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