Vitamin A deficiency and attributable mortality among under-5-year-olds.

Reported are estimates of the prevalence in developing countries of physiologically significant vitamin A deficiency and the number of attributable deaths. The WHO classification of countries by the severity and extent of xerophthalmia was used to categorize developing countries by likely risk of subclinical vitamin A deficiency. Using vital statistics compiled by UNICEF, we derived population figures and mortality rates for under-5-year-olds. The findings of vitamin A supplementation trials were applied to populations at-risk of endemic vitamin A deficiency to estimate the potential impact of improved vitamin A nutriture in reducing mortality during preschool years. Worldwide, over 124 million children are estimated to be vitamin A deficient. Improved vitamin A nutriture would be expected to prevent approximately 1-2 million deaths annually among children aged 1-4 years. An additional 0.25-0.5 million deaths may be averted if improved vitamin A nutriture can be achieved during the latter half of infancy. Improved vitamin A nutriture alone could prevent 1.3-2.5 million of the nearly 8 million late infancy and preschool-age child deaths that occur each year in the highest-risk developing countries.     

The emerging importance of dietary lipids,quantity and quality,in the global disease burden: the potential of aquatic resources

Achievement of Health-for-All, whereby people everywhere throughout their lives, have the opportunity to reach and maintain the highest attainable level of health is impossible whilst hunger, starvation, and malnutrition remain. Malnutrition covers a broad spectrum of ills, including undernutrition, specific nutrient deficiencies, and overnutrition; and it kills, maims, retards, cripples, blinds, and impairs human development on a truly massive scale worldwide. In the developing world in 1995, of the estimated 10.4 million deaths among children under 5 years of age, protein-energy malnutrition was an associated and causative factor in 5.1 million of these deaths (i.e. 49%). On the other hand, evidence has recently been compiled suggesting that of the more than 10 million cases of cancer that occurred in 1996, an estimated 30-40% (3-4 million every year) are preventable by feasible, appropriate diets, and by physical activity and maintenance of appropriate body weight. Malnutrition affects all age groups across the entire lifespan. From the moment of conception, throughout foetal life, iodine, folate and intrauterine nutrition have a profound influence on development, growth, morbidity, mortality, not only in utero and in early infancy, but on morbidity, physical and mental capacity throughout life. Despite significant improvements in world food supplies, health conditions, and availability of educational and social services, no population escapes malnutrition's grasp. All countries have significant population groups with some form of debilitating malnutrition. Malnutrition worldwide, includes a spectrum of nutrient-related disorders, deficiencies and conditions including the following major public health problems; Intrauterine growth retardation, protein-energy malnutrition, Iodine deficiency disorders, Vitamin A Deficiency, Iron Deficiency Anaemia and Overweight and Obesity (WHO, Website).     

Paediatricians' perspectives on global health priorities for newborn care in a developing country: a national survey

ABSTRACT: BACKGROUND: An understanding of the perception of paediatricians as key stakeholders in child healthcare delivery and the degree of congruence with current investment priorities is crucial in accelerating progress towards the attainment of global targets for child survival and overall health in developing countries. This study therefore elicited the views of paediatricians on current global priorities for newborn health in Nigeria as possible guide for policy makers. METHODS: Paediatric consultants and residents in the country were surveyed nationally between February and March 2011 using a questionnaire requiring the ranking of nine prominent and other neonatal conditions based separately on hospital admissions, mortality, morbidity and disability as well as based on all health indices in order of importance or disease burden. Responses were analysed with Friedman test and differences between subgroups of respondents with MannWhitney U test. RESULTS: Valid responses were received from 152 (65.8%) of 231 eligible physicians. Preterm birth/low birthweight ranked highest by all measures except for birth asphyxia which ranked highest for disability. Neonatal jaundice ranked next to sepsis by all measures except for disability and above tetanus except mortality. Preterm birth/low birthweight, birth asphyxia, sepsis, jaundice and meningitis ranked highest by composite measures while jaundice had comparable rating with sepsis. Birth trauma was most frequently cited under other unspecified conditions. There were no significant differences in ranking between consultants and residents except for birth asphyxia in relation to hospital admissions and morbidity as well as sepsis and tetanus in relation to mortality. CONCLUSIONS: Current global priorities for neonatal survival in Nigeria largely accord with paediatricians' views except for neonatal jaundice which is commonly subsumed under miscellaneous neonatal conditions. While the importance of these priority conditions extends beyond mortality thus suggesting the need for a broader conceptualisation of newborn health, paediatricians should be actively engaged in advancing the attainment of global priorities for child survival and health in this population.     

The neonatal period: A missed opportunity for the prevention of iron deficiency and its associated neurological consequences?

Iron deficiency is the most common micronutrient deficiency worldwide. Iron is essential for the development of multiple organ systems, most especially the developing brain. Iron deficiency, particularly during sensitive periods of brain development, such as in early childhood, is associated with long‐lasting adverse consequences for cognition, motor function and behaviour. Little consideration has been given to iron deficiency in newborn infants and its potential health consequences. Fetal iron accretion is compromised by pregnancy complications such as pre‐term birth and gestational diabetes mellitus, and our work has identified an increased risk of low iron stores at birth from maternal lifestyle factors such as smoking and obesity. Early‐life events, including Caesarean section delivery, further add to the cumulative risk of neonatal iron deficiency, which can persist throughout infancy into early childhood. While investigations into the long‐term neurological consequences of neonatal iron deficiency are limited, there is evidence of poorer memory, motor function and language ability in children born iron deficient. Recently, we also identified significant behavioural consequences of neonatal deficiency persisting from 2 to 5 years of age, with effects particularly apparent in ‘high‐risk’ children born to obese or smoking mothers or delivered by Caesarean section. Interventions targeting the fetal/neonatal period could therefore represent a key opportunity for the prevention of iron deficiency and its associated long‐term health consequences. A dual approach is required, comprising public health strategies targeting prevention, to improve health in women of reproductive age, and the development of screening strategies for the early detection of iron deficiency in newborn infants.     

四川省50个县新生儿死亡及有关因素分析

我省卫Ⅵ项目县1992年平均新生儿死亡率为49.77％。,新生儿7天内死亡占73.1％,1天内死亡占43.1％。新生儿死亡的主要原因为新生儿窒息、肺炎、早产和新生儿破伤风。新生儿死前保健服务状况、人口出生率、年人均收入、文化水平、新法接生率、住院分娩率、产前检查率、产后访视率等都是新生儿死亡率的影响因素。要想从总体上改善儿童出生后的生存条件,必须采取综合措施,进一步落实计划生育基本国策,特别是增加妇幼卫生投入,将工作重点放在降低早期新生儿死亡率,做好孕产妇系统管理,提高新法接生率和住院分娩率。针对新生儿主要死因开展适宜技术培训,提高各级妇幼卫生人员的服务能力,加强孕期、产期、新生儿期有关医疗保健知识的宣传,提高人群的自我保健意识。     

Can maternal depression increase infant risk of illness and growth impairment in developing countries?

Despite relative improvement in living conditions and availability of modern healthcare, infant mortality rates continue to be very high in many developing countries. High rates of depression have also been reported in women in these countries. The continuous care and attention of children is a demanding task, and poor physical or mental health in mothers might be expected to have adverse consequences on their children's health, nutrition and psychological well-being. Review of published literature reveals very little research in developing countries on the association between poor mental health in mothers and the subsequent physical well-being of their children. We hypothesize that the level of care provided by mothers with depression may put their infants at higher risk of infection and impaired growth, compared with infants of mothers without depression. We outline approaches to test such a hypothesis in a developing country, and discuss its implications.     

The Expanded Programme on Immunization in 1988

Only 40-50% of the world's children are correctly vaccinated, and each year about 3.5 million children die or become invalids following illnesses preventable by vaccination. It is hoped that new strategies and simplification of vaccination schedules will permit a rapid increase in vaccination coverage so that the UNICEF goal of vaccination of all the world's children by 1990 will be met. As of June 1987, it was estimated that 45% of children in developing countries excluding China had been vaccinated against tuberculosis, 21% against neonatal tetanus, 30% against measles, 45% against whooping cough, and 44% against polio. Most of the illnesses covered by the Expanded Program of Immunization (EPI) can occur very early in life in developing countries. The World Health Organization recommends that children under 1 year old be considered a target group for vaccination. BCG and an extra polio dose should be administered at birth. The DPT injections and oral polio doses should be administered at 6, 10, and 14 weeks. The measles and, where necessary, yellow fever vaccines should be administered at 9 months. The oral polio dose at birth does not always cause antibody synthesis and is intended to provide temporary protection only. The minimum interval between DPT and polio doses is 4 weeks. There is no maximum interval and no need to restart an interrupted series. Vaccination of mothers against tetanus protects the newborn against neonatal tetanus. Pregnant women should be vaccinated twice at intervals of at least 1 month and with the 2nd dose at least 30 days before delivery. The WHO recommends that the target group for tetanus vaccination be enlarged to include all fertile aged women. In the EPI, all vaccines may be administered simultaneously, with DPT, polio, and BCG before 9 months for children seen for the 1st time. Malnourished children should receive priority in vaccination. Premature infants should be given BCG and a preliminary dose of oral polio vaccine before leaving the maternity hospital. Contraindications to vaccination are exceptional and include high fever, acute disorders, and serious reactions to the 1st DPT dose. BCG may be contraindicated for children with clinical signs of AIDS. Vaccination should be integrated into the daily routine of health facilities and the vaccination status of mothers and children should be determined at each contact with the health center. Mass vaccination campaigns can dramatically increase coverage but are costly and require detailed planning and intersectorial coordination.     

Population ageing: a looming public health challenge

The World Health Organization (WHO) launched the "International Year of Older Persons" on October 1, 1998, and announced that the theme of 1999 World Health Day in April would be "Active Aging." Both initiatives seek to draw attention to the necessity of creating policies dealing with aging in light of the demographic aging found throughout the world. Physically, aging slows the body's capacity for self-regulation and self-healing. Socially, old age may be a period of increasing isolation as children migrate and companions die. Currently 355/580 million people aged 60 years and older live in developing countries. This increase has been fueled by declining mortality rates and increases in average life expectancy from 41 years in the early 1950s to 62 years in 1990. By 2020, the number of elderly people is projected to reach more than 1000 million, with 70% living in developing countries, especially in China, India, Indonesia, Brazil, and Pakistan. More than 20 developing countries currently have a life expectancy at birth of 72 years or more. It is expected that by 2020, 75% of mortality will be age-related. Also, the number of people with mental health disorders, such as senile dementia, will increase as will the incidence of visual impairment and general morbidity. Issues that require attention are policies to deal with treatment choices that merely prolong life robbed of its quality, the creation of a reliable database, ways to improve quality of life in old age, and provision of care for the elderly.     

2014年苏州市出生窒息发生情况及其影响因素分析

目的：了解苏州市新生儿出生窒息发生情况及其相关危险因素,通过加强围生期保健管理,进一步预防苏州市新生儿出生窒息发生,提高出生人口素质。方法登陆苏州市妇幼卫生信息平台,调取2014年苏州市妇幼保健院新生儿分娩登记信息,包括 Apgar 评分、孕妇年龄、户籍、分娩孕周、胎儿性别、出生体质量、胎数、胎位、胎次、产次、产检次数和分娩方式等,选择胎龄≥28周活产儿进行出生窒息单因素卡方分析和多因素 Logistic 回归模型评估相关性。结果2014年苏州市妇幼保健院新生儿出生窒息发生率为1.05%。外地户籍、分娩孕周<37周、出生体质量<2500 g 或≥4000 g、产次≥3次、助产和剖宫产均为新生儿出生窒息发生的危险因素(P <0.05),而胎数≥2为新生儿出生窒息的保护因素(P <0.01)。结论出生窒息严重危害新生儿健康,产前及产时多因素均为其影响因素,需加强围生期管理,强化新生儿复苏技能培训,从而降低出生窒息发生概率和危害性。     

WHO's mission for vision

The number of blind and visually impaired is expected to double by the year 2020; 90% of blind people live in developing countries. It is estimated that 80% of the world's blindness is preventable or curable. The World Health Organization (WHO) and a consortium of nongovernmental organizations (NGOs) have launched the Global Initiative for the Elimination of Avoidable Blindness. According to Dr. Bjorn Thylefors, Director of WHO's Programme for the Prevention of Blindness and Deafness, the global initiative will focus on disease control, human resource development, infrastructure, and technology. Priority will be given to the following: 1) cataracts, with a backlog of 16-20 million cases; 2) trachoma, the most common cause of preventable blindness with some 5.6 million blind and 146 million active cases in need of treatment; 3) childhood blindness caused by vitamin A deficiency, measles, conjunctivitis in the newborn, or retinopathy of prematurity; 4) river blindness (onchocerciasis); and 5) refractive errors and low vision. Treatment for trachoma will follow the surgery, antibiotics, facial cleanliness, and environmental hygiene strategy. Dr. Thylefors believes trachoma can be eliminated globally by 2020.     

随州市曾都区2008--2012年5岁以下儿童死亡情况分析

目的了解随州市曾都区5岁以下儿童死亡变化趋势及主要死亡原因,为制定降低5岁以下儿童死亡率的干预措施提供依据。方法对2008--2012年随州市曾都区29个乡镇（办事处、农场）623例5岁以下儿童死亡监测资料进行回顾性分析,总结5岁以下儿童死亡率的变化趋势、死亡年龄的结构特点和死亡原因。结果5年间,随着住院分娩率的上升,5岁以下儿童死亡率呈逐年下降趋势;儿童死亡主要发生在婴儿期;儿童死亡的原因主要为早产或低出生体重儿、出生窒息、肺炎、意外窒息、先天性心脏病、溺水以及其他先天异常,以先天性心脏病及其他先天异常死亡率增多,其他出生窒息、早产或低出生体重儿和肺炎死亡率仍居高不下。结论要降低5岁以下儿童死亡率,需采取积极的干预措施,首先加强孕产期保健管理,优生优育,降低出生缺陷,提高产科、新生儿科服务质量,积极推广产科、新生儿科适宜技术,降低婴儿特剐是新生儿死亡率,是降低5岁以下儿童死亡率的关键。     

THE HEALTH EFFECTS OF THE INTERNATIONAL TRANSFER OF MEDICAL TECHNOLOGY

The rapid international transfer of medical technologies to the developing countries is in progress, promoting a “high technology” model of medicine mat is reflected in the structure of hospitals and university faculties, and medical education and practice. The resulting growth of specialties and sub-specialties in hospitals may inhibit the development of appropriate, village-based primary care services. Postgraduate medical education programs donated by the United States, Australia or Europe may disregard the vital issues of provision of universal primary care and local control of health services, and train doctors to devote resources to high technology urban models of care. Medical graduates emigrate to industrial countries because they find no “market” for their services in villages, where needs are the greatest. Bilateral foreign aid programs, WHO sponsored projects, multinational corporate transactions and medical missions and education have been important sources of technology transfer. While a national pharmacopoeia requires only 200 drugs, with 17 basic drugs in village clinics, most patients are denied suitable drug therapy because of inadequate primary care and the inappropriate transfer and promotion of over 4000 drugs that are expensive, incompletely tested in local conditions, or toxic. The deficiency in basic health services means only about 4 million of the 80 million children born each year in Africa, most of Latin America and South East Asia are effectively immunised with available vaccines. There are some apparently successful examples of appropriate health systems, based on the principles of universal access to primary care by health workers, and a national referral system to secondary and tertiary care. Effective monitoring of technology transfer and the development of appropriate health services involves important roles for the WHO and greater international co-operation among community health workers.     

Urbanization and mental health in developing countries

It is expected that the urban population in developing countries will double in the next 30 years. While urbanization is accompanied by health problems, population density can lower public health costs. Common mental disorders, such as anxiety, depression, insomnia, fatigue, irritability, and poor memory, account for 90% of all mental disorders, cause behavioral problems in offspring, and impede recovery from physical ailments. Those who suffer most from common mental disorders include women, those between 15 and 49 years old, and low-income populations. Strong links have been established between socioenvironmental factors and common mental disorders, and an urban environment has been associated with many possible risk factors for such disorders. Only a small percentage of people with mental disorders seek primary health care and even less receive secondary- or tertiary-level care. Common mental disorders place a large burden on primary health care services, however, but most of the patients suffering from mental disorders seek care for physical disorders that mask proper diagnosis and treatment. Thus, the World Health Organization advocates the introduction of mental health components in primary health care services in developing countries. In order to reach those who remain outside of the health care system, community-based interventions such as self-help groups or efforts to promote wider social changes or address poverty should be undertaken. Mental health in developing countries is gaining attention as the attendant loss in economic productivity of human capital has become apparent.     

A methodological approach and framework for sustainability assessment in NGO-implemented primary health care programs

An estimated 10.8 million children under 5 continue to die each year in developing countries from causes easily treatable or preventable. Non governmental organizations (NGOs) are frontline implementers of low-cost and effective child health interventions, but their progress toward sustainable child health gains is a challenge to evaluate. This paper presents the Child Survival Sustainability Assessment (CSSA) methodology--a framework and process--to map progress towards sustainable child health from the community level and upward. The CSSA was developed with NGOs through a participatory process of research and dialogue. Commitment to sustainability requires a systematic and systemic consideration of human, social and organizational processes beyond a purely biomedical perspective. The CSSA is organized around three interrelated dimensions of evaluation: (1) health and health services; (2) capacity and viability of local organizations; (3) capacity of the community in its social ecological context. The CSSA uses a participatory, action-planning process, engaging a 'local system' of stakeholders in the contextual definition of objectives and indicators. Improved conditions measured in the three dimensions correspond to progress toward a sustainable health situation for the population. This framework opens new opportunities for evaluation and research design and places sustainability at the center of primary health care programming.     

如皋市1990～1999年新生儿死亡监测资料分析

如皋市 1990～ 1999年 10年间新生儿死亡 130 0例 ,死亡率为 0 918% ,男女比为 1 5 3∶1,其中早期死亡占 75 % ;其死因顺位为早产、出生窒息、新生儿肺炎、先天畸形、意外窒息 ,死于医院的新生儿占死亡总数的 75 6 2 %。提出新生儿保健工作的重点 ,并进行探讨 ,采取综合措施是降低新生儿死亡率的关键。     

Practical screening priorities for hearing impairment among children in developing countries.

Routine screening for hearing impairment in childhood is now widespread in industrial countries, although there is considerable controversy over the most efficient techniques and procedures. In most developing countries, however, routine screening programmes for hearing impairment do not currently exist. The problems involved in implementing screening programmes in developing and industrial countries are very different, and in selecting screening procedures for a particular population the following factors have to be taken into consideration: the environmental test conditions; the availability of resources for equipment and the training of testers; the local attitudes towards disability; the level of hearing impairment that may cause handicaps; and the major types of pathology causing hearing impairment. We suggest that in developing countries children should be screened at school entry using a simple field audiometer and that the external ear be inspected for the presence of a discharge. There is an urgent need to develop reliable and simple screening procedures for infants and young children; where possible, all children should be screened for severe or significant hearing impairment before the age of 2 years. No screening should, however, be implemented until appropriate follow-up services are available.     

Saving newborn lives in Asia and Africa: cost and impact of phased scale-up of interventions within the continuum of care

BACKGROUND: Policy makers and programme managers require more detailed information on the cost and impact of packages of evidenced-based interventions to save newborn lives, particularly in South Asia and sub-Saharan Africa, where most of the world's 4 million newborn deaths occur. METHODS: We estimated the newborn deaths that could be averted by scaling up 16 interventions in 60 countries. We bundled the interventions in a variety of existing maternal and child health packages according to time period of delivery and service delivery mode, and calculated the additional running costs of implementing these interventions at scale (90% coverage) in sub-Saharan Africa and South Asia. The phased introduction and expansion of interventions was modelled to represent incremental strategies for scaling up neonatal care in developing country health systems. RESULTS: Increasing coverage of 16 interventions to 90% could save 0.59-1.08 million lives in South Asia annually at an additional cost of US dollars 0.90-1.76 billion. In sub-Saharan Africa, 0.45-0.80 million lives saved would cost US dollars 0.68-1.32 billion. Additional costs for increased antenatal interventions are low, but given relatively high baseline coverage and lower impact, fewer additional newborn lives can be saved through this package (5-10%). Intrapartum care has higher impact (19-34% of deaths averted) but is costly (US dollars 1.66-3.25 billion). Postnatal family-community care, with potential for high impact at low cost (10-27%, US dollars 0.38-0.75 billion), has been neglected. A first phase of scaling up care in 36 high (NMR 30-45) and 15 very high (NMR >45) mortality countries would cost approximately US dollars 0.56-1.10 and US dolars 0.09-0.17 billion annually, respectively, and would avert 15-32% and 13-29% of neonatal deaths, respectively, in these countries. Full coverage with all interventions in the 51 high and very high mortality countries would cost US dollars 2.23-4.37 billion, and avert 38-68% of neonatal deaths (1.13-2.05 million), at an extra cost per death averted of US dollars 1100-3900. CONCLUSIONS: Low-cost, effective newborn health interventions can save millions of lives, primarily in South Asia and sub-Saharan Africa. Modelling costs and impact of intervention packages scaled up incrementally as health systems capacity increases can assist programme planning and help policy makers and donors identify stepwise targets for investments in newborn health.     

新生儿窒息病因与远期预后的关系

目的:探讨新生儿窒息病因与远期预后的关系,为早期防治提供依据。方法:对241例新生儿窒息采用临床病例分析和定期随访,满4岁后用Wechsler学前及初小儿童智能量表(WPPSI)和儿童智能量表修正版(WISC-R)进行智能测定。结果:新生儿窒息前5位病因由高到低依次为脐带因素、羊水异常、胎位不正、早产儿、胎儿窘迫。重度窒息和出生孕周<37周中智力低下、癫痫、脑瘫患病率明显高于轻度窒息和孕37~42周者。结论:加强围产期保健,加强孕期自我监护及胎儿监护,避免宫内缺氧及早产,及时处理高危妊娠,可减少新生儿窒息发生率。     

儿童维生素A全球干预进展

维生素A是人体内重要的微量营养素之一,维生素A缺乏症是导致儿童可预防性失明的主要原因,并增加了严重感染导致疾病和死亡的风险。在大多数发展中国家,维生素A缺乏仍然是重要的公共卫生问题。虽然维生素A的来源多样,补充方式也有多种,但就国家及国际层面而言,缺乏较新的政策指导维生素A的干预。故而在分析全球最新维生素A缺乏症流行趋势及大量干预研究的基础上做出以下综述。