Nutritional surveillance of young children in developing countries.

This paper discusses simple but effective methods of surveillance of growth and nutrition of children in developing countries where resources are scarce and food shortages most likely to occur. In the youngest age group, the simplest weight-for-age chart, already used, is undoubtedly the best method. Where the age of children is not known, arm circumference provides an acceptable alternative. In older children, arm circumference alone may not be reliable and can be improved by measuring height as well and combining the two results.     

Prevention of diarrhoea in young children in developing countries.

An updated review of nonvaccine interventions for the prevention of childhood diarrhoea in developing countries is presented. The importance of various key preventive strategies (breast-feeding, water supply and sanitation improvements) is confirmed and certain aspects of others (promotion of personal and domestic hygiene, weaning education/food hygiene) are refined. Evidence is also presented to suggest that, subject to cost-effectiveness examination, two other strategies-vitamin A supplementation and the prevention of low birth weight-should be promoted to the first category of interventions, as classified by Feachem, i.e. those which are considered to have high effectiveness and strong feasibility.     

Prevalence and trends of overweight among preschool children in developing countries

BACKGROUND: Obesity during childhood is a matter of growing concern. Several reports show increasing rates of obesity in developed countries, whereas the extent of the problem in developing countries remains unknown. OBJECTIVE: The aim of this study was to fill this gap by quantifying the prevalence and trends of overweight among preschool children in developing countries. DESIGN: One hundred sixty nationally representative cross-sectional surveys from 94 countries were analyzed in a standardized way to allow comparisons across countries and over time. Overweight was defined as a weight-for-height >2 SDs from the National Center for Health Statistics/World Health Organization international reference median. Prevalences of wasted children (< -2 SDs) are also presented to enable comparisons between both ends of the distribution. RESULTS: The global prevalence of overweight was 3.3%. Some countries and regions, however, had considerably higher rates, and overweight was shown to increase in 16 of 38 countries with trend data. Countries with the highest prevalences of overweight are located mainly in the Middle East, North Africa, and Latin America. Rates of wasting were generally higher than those of overweight; Africa and Asia had wasting rates 2.5-3.5 times higher than overweight rates. Countries with high wasting rates tended to have low overweight rates and vice versa. CONCLUSIONS: These estimates show that attention should be paid to monitoring levels and trends of overweight in children. This, however, should not be done at the expense of decreasing international commitments to alleviating undernutrition. The data presented confirm that undernutrition remains a major public health problem worldwide.     

HIV infection in children in developing countries

Disease progression in children acquiring HIV infection vertically from their mothers is more rapid in developing countries compared with developed countries. The probability of death by 12 months in sub-Saharan Africa ranges from 0.23 to 0.35, and by 5 years is 0.57-0.68. Data from Europe in the era before highly active anti-retroviral therapy (HAART) yielded probabilities of 0.1 and 0.2, respectively. Confirming the diagnosis can be difficult in resource-limited settings. Existing clinical case definitions are useful epidemiologically, but of low positive-predictive value in individual children. Priorities for research into management issues include nutrition (infant feeding, vitamin A and micronutrient supplementation), prophylaxis against Pneumocystis carinii pneumonia (PCP), and bacterial infections, case management of persistent diarrhoea, diagnosis/prevention/management of tuberculosis in children and prevention of sexual transmission in adolescents.     

Surgical services for children in developing countries

There is growing evidence that childhood surgical conditions, especially injuries, are common in developing countries and that poor care results in significant numbers of deaths and cases of disability. Unfortunately, however, surgical care is not considered an essential component of most child health programmes. Strategies for improving paediatric surgical care should be evidence-based and cost-effective and should aim to benefit the largest possible number of children. The most likely way of achieving policy change is to demonstrate that childhood surgical conditions are a significant public health problem. For paediatric purposes, special attention should also be given to defining a cost-effective package of surgical services, improving surgical care at the community level, and strengthening surgical education. Surgical care should be an essential component of child health programmes in developing countries.     

Long-term trends in fetal mortality: implications for developing countries

This paper discusses the problems of defining and measuring late-fetal mortality (stillbirths). It uses evidence from 11 developed countries to trace long-term trends in fetal mortality. Issues associated with varying definitions and registration practices are identified, as well as the range of possible rates, key turning points and recent convergence. The implications for developing countries are spelled out. They emphasize the possible limitations of WHO estimation methods and survey-based data by examining the cross-sectional associations among 187 countries in the year 2000. The important role of skilled birth attendants is emphasized in both data sets, but the different effects on maternal mortality and late-fetal mortality are also noted.     

发展中国家婴幼儿辅食添加营养干预效果的Meta分析

目的 评价添加辅食对发展中国家婴幼儿健康水平的影响。方法 收集Cochrane Central Register of Controlled Trials 、MEDLINE、Web of Science、PubMed、中国知网、万方数据库自建库到2017年 12月底发表的关于婴幼儿辅食添加干预随机对照实验研究,按照纳入、排除标准筛选文献,使用RevMan5.3软件对文献进行Meta分析。结果 共纳入13篇文献,6 496例样本,来自11个国家。分析结果显示:辅食添加干预可提高婴幼儿血红蛋白水平(MD = 3.29,95% CI 2.26～4.32,P＜0.001),降低其贫血患病率(RR = 0.73,95%CI 0.69～0.77,P＜0.01),Z评分合并效应无差异HAZ(MD = 0.07,95%CI -0.05～0.20,P = 0.25)、WAZ(MD = -0.02,95%CI -0.15～0.12,P = 0.79)、WHZ(MD = -0.02,95%CI -0.27～0.24,P = 0.90)。结论 辅食添加对发展中国家婴幼儿血红蛋白水平的提高和降低贫血患病率有效果。     

Livestock production systems in developing countries: status, drivers, trends

This paper describes and assesses the current status of livestock production systems, the drivers of global livestock production, and the major trends in such production. The analysis covers the six major livestock species: cattle and buffaloes, goats and sheep, pigs and chickens. Global drivers of the livestock sector include economic growth and income, demographic and land use changes, dietary adjustments and technological change. The rate of change and direction of livestock development vary greatly among world regions, with Asia showing the most rapid growth and structural change. The paper also examines system dynamics, by analysing the ways livestock production has adjusted to external forces. A brief discussion of how these trends link to food safety concludes the paper.     

Main trends in the physical development of young children

The physical development ofjunior schoolchildren living in Ufa, a large industrial town, was studied. The findings were compared with the data of the 1946-1947, 1972, and 1998 studies of physical development. Analysis of the materials indicated that the accelerating processes among young children continued till the end of the previous century, the maximum change in anthropometric indices being observed in the period of 1947 to 1972. In the past years, there has been a gradual decrease in the average values of length in junior schoolchildren and there has been a tendency for body weight and chest circumference to decrease.     

Mortality trends in Fiji

Objectives: Mortality level and cause of death trends are evaluated to chart the epidemiological transition in Fiji. Implications for current health policy are discussed. Methods: Published data for infant mortality rate (IMR), life expectancy (LE) and causes of death for 1940–2008 were assessed for quality, and compared with mortality indices generated from recent Ministry of Health death recording. Trends in credible mortality estimates are compared with trends in proportional mortality for cause of death. Results: IMR declined from 60 deaths (per 1,000) in 1945 to below 20 by 2000. IMR for 2006–08 is estimated at 18–20 deaths per 1,000 live births. Excessive LE estimates arise by imputing from the IMR using inappropriate models. LE increased, but has been stable at 64 years for males and 69 years for females since the late 1980s and early 1990s respectively. Proportional mortality from diseases of the circulatory system has increased from around 20% in the 1960s to more than 45%. Extensive variation in published mortality estimates was indentified, including clearly incompatible ranges of IMR and LE. Conclusions: Mortality decline has stagnated. Relatively low IMR and proportional mortality trends suggest this is largely due to chronic diseases (especially cardiovascular) in adults. Implications: Reconciliation of mortality data in Fiji to reduce uncertainty is urgently needed. Fiji's health services and donor partners should place continued and increased emphasis on effective control strategies for cardiovascular disease.     

发展中国家儿童营养政策的经验和教训

在我国进行儿童营养干预和制定儿童营养政策的时候要充分借鉴其他国家的经验。在对一些发展中国家儿童营养政策回顾的基础上,通过经验和教训两方面的案例探索成功实施儿童营养政策的共同点。在儿童营养政策的领导和组织方面,要有坚定的政治承诺,并与其他公共政策紧密结合;在制度和机制设计方面,要保证可持续筹资、社区充分参与,并有针对母亲和儿童的食品补贴政策;在政策实施上,要保证其有效执行和发挥母亲在政策中的关键作用。     

Routes to better health for children in four developing countries

Despite the availability of effective, affordable interventions for the most common causes of death, more than ten million children in developing countries die each year. This article describes the circumstances of four countries whose reductions in child mortality exceeded what might be expected from their poor economic circumstances, and it asks whether they followed common routes to improved health for children. The findings suggest that contextual factors, such as the degree of economic development, good governance, and strong health care systems, matter less than do targeted health intervention, foreign aid, and technical assistance. In general, these findings contradict prevailing U.S. foreign policy regarding the circumstances in which progress toward health goals can be made.     

Protein and energy requirements of young children living in the developing countries to allow for catch-up growth after infections.

Children who have lost weight because of infection or other causes of ill-health need to produce catch-up growth after the illness is over. This catch-up growth can be rapid and requires a higher minimum protein intake relative to energy intake than does normal growth. Suitable protein-energy ratios for catch-up growth have been calculated.     

Antibiotic therapy for bacterial meningitis in children in developing countries.

We carried out a study to investigate the effectiveness of chloramphenicol alone as a treatment for bacterial meningitis. A total of 70 consecutive children aged > 3 months with bacterial meningitis, who had been admitted to the paediatric hospital of the All India Institute of Medical Sciences, were randomized to receive chloramphenicol alone or chloramphenicol + penicillin. The two groups were matched with each other. Treatment failure occurred with three (9%) patients in the chloramphenicol-alone group and with four (12.1%) patients in the combination therapy group (P > 0.05). The mean duration of intravenous therapy, the number of intravenous cannulae used per patient, and the incidence of thrombophlebitis were significantly higher for the group that received the combination therapy. Also, the cost of using chloramphenicol + penicillin was four times higher than that of chloramphenicol alone. Hence, chloramphenicol alone was as effective as chloramphenicol + penicillin and much cheaper and more convenient to use.