Cross-posted from: vern weitzel <vern.weitzel@gmail.com>
Each year we compile a small booklet which summarizes some of the latest research on child health in developing countries: evidence derived from all the randomized trials published over the last year. The aim is to make this information widely available to paediatricians, child health nurses, midwives, researchers, students and administrators in places where up-to-date health information is hard to find. It is hoped that such information will be helpful in reviewing treatment guidelines, clinical practice and public health approaches, and in teaching about paediatrics and evidence-based medicine.
The booklet is available at www.ichrc.org Go to 'reviews' then SCROLL DOWN FOR "Randomised Trials in Developing Countries"
Seven previous editions (2003-2009) are also available. This is part of a project which critically appraises the evidence behind WHO's treatment guidelines.
This year five trials reported significant reductions in child mortality; among these:
- In Ethiopia, the mass administration of a single dose of azithromycin (20mg/kg), to control trachoma, resulted in a halving of mortality among children 1-9 years of age, presumably because of an effect on reducing deaths from other common infections causing deaths. This is probably the most innovative and practice changing trial for the year, and may have wider implications than in trachoma-endemic settings.
- Meta-analysis of RCTs commencing ‘Kangaroo Mother Care’ in the first week of life in Columbia, India and Ethiopia showed a significant reduction in neonatal mortality [relative risk (RR) 0.49, 95% confidence interval (CI) 0.29-0.82] compared with standard care.
- In India, a large study of community-based women’s groups that supported strategies to address maternal and newborn health problems significantly reduced neonatal mortality over a 3 year period. The same effect was not seen in a similar study in Bangladesh
Other important outcomes from studies in 2009-10 include:
- In South Africa short-term multi-micronutrient supplementation significantly reduced the duration of pneumonia or diarrhoea in hospitalized HIV-infected children
- A home stimulation programme taught to caregivers can significantly improve cognitive and motor development in young children infected with HIV, and rehabilitation for children with cerebral malaria can also have a significant benefit on neurocognitive function
- Single dose nevirapine is associated with development of resistance to non-nucleoside reverse transcriptase inhibitor drugs. A short course of AZT plus 3TC, supplementing maternal and infant single-dose nevirapine, reduces resistance mutations in both mothers and infants
- Among HIV-infected women in Tanzania, multivitamins taken in the antenatal period and continued after delivery reduced the risk of low birth weight and infant mortality, but the effect was much stronger for girl babies than boys
- In South Africa and Malawi rotavirus vaccine significantly reduced the incidence of severe rotavirus gastroenteritis during the first year of life
- Insecticide treated bed nets can be coupled with weekly bacterial larvicide distribution in bodies of water to reduce malarial parasitaemia
- Having simple screens on doors and windows reduced rates of anaemia among children in malaria endemic area in Gambia
- In settings where G6PD deficiency is common chlorproguanil-dapsone and its combinations with artesunate, used as intermittent preventative treatment or as treatment for clinical malaria results in a high risk of haemolysis. Three RCTs this year highlighted this complication, and further development of this drug has now ceased
- Delaying BCG vaccination from birth to 10 weeks of age enhances the quantitative and qualitative BCG-specific T cell response, when measured at 1 year of age. In Guinea Bissau mortality was higher among children who received a booster dose of DTP after BCG vaccination
- In India, in the treatment of visceral leishmaniasis a single infusion of liposomal amphotericin B was similar in efficacy and less expensive than 15 infusions of amphotericin B deoxycholate over one month
If you have a laser printer, the document may be printed out as a small booklet form to save trees. After clicking on 'Print' go to 'Properties' and select: 'Print to both sides'; Booklet layout 'Left edge binding'; Pages per sheet 'two pages per sheet'. Printing this way will use only 38 sheets. Then fold the A-4 pages in half to form a booklet.
Please feel free to make as many copies as you like or pass this document on to anyone who may find it useful, it is meant to be shared.
Also see on www.ichrc.org various language versions in PDF of the WHO Pocketbook of Hospital Care for Children, and a new navigable PDF developed by Julian Kelly, which is iphone (and other smart phone) compatible. It increases the usability of the Pocketbook on PC's, laptops, PDA's and phones. To use it with the iphone one needs a PDF reader such as Goodreader to view it. For every other device it opens and runs immediately.
www.ichrc.org
www.rch.org.au/cich
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Trevor Duke
mailto:trevor.duke@rch.org.au