Coalition launched to accelerate research on the prevention and treatment of COVID-19 in low- and middle-income countriesby The Editorial Team
The manual is part of a series of resources for improving the quality of care forseverely ill children in health facilities. It supports the improved use and availabilityof oxygen therapy in low resource settings. The manual addresses the need forappropriate detection of hypoxaemia and use of pulse oximetry, oxygen deliverysystems and monitoring of patients on oxygen therapy.
Hypoxaemia is a common complication of childhood infections, particularly acute lower respiratory tract infections. In pneumonia—a disease that disproportionately impacts developing countries, and accounts for more than two million deaths of children worldwide—hypoxaemia is a recognised risk factor for death, and correlates with disease severity. Hypoxaemia also occurs in severe sepsis, meningitis, common neonatal problems, and other conditions that impair ventilation and gas exchange or increase oxygen demands. Despite this, hypoxaemia has been overlooked in worldwide strategies for pneumonia control and reducing child mortality. Hypoxaemia is also often overlooked in developing countries, mainly due to the low accuracy of clinical predictors and the limited availability of pulse oximetry for more accurate detection and oxygen for treatment. In this Review of published and unpublished studies of acute lower respiratory tract infection, the median prevalence of hypoxaemia in WHO-defi ned pneumonia requiring hospitalisation (severe and very severe classifi cations) was 13%, but prevalence varied widely. This corresponds to at least 1·5 to 2·7 million annual cases of hypoxaemic pneumonia presenting to health-care facilities. Many more people do not access health care. With mounting evidence of the impact that improved oxygen systems have on mortality due to acute respiratory infection in limited-resource health-care facilities, there is a need for increased awareness of the burden of hypoxaemia in childhood illness.
Many people believe that having access to an adequate and appropriate diet is a basic human right. The provision of nutritional support to the critically ill, therefore, is an issue that is fraught with ethical implications, particularly in patients who have chronic, but stable, illnesses that necessitate intensive care, but in whom recovery is unlikely. Such circumstances, manifest particularly in patients who have severe brain injuries that led to the persistent vegetative state, clearly mitigate against the conduct of placebo-controlled trials of nutritional support. Moreover, it is an irrefutable fact that prolonged starvation will ultimately lead to death. These arguments may have led the critical care community to subject the questions surrounding the provision of feeding to less rigorous scientific evaluation than has been afforded to other interventions, and an assumption that nutritional support must, by definition, be beneficial.
Variable adherence to standardized case definitions, clinical procedures, specimen collection techniques, and laboratory methods has complicated the interpretation of previous multicenter pneumonia etiology studies. To circumvent these problems, a program of clinical standardization was embedded in the Pneumonia Etiology Research for Child Health (PERCH) study. Between March 2011 and August 2013, standardized training on the PERCH case definition, clinical procedures, and collection of laboratory specimens was delivered to 331 clinical staff at 9 study sites in 7 countries (The Gambia, Kenya, Mali, South Africa, Zambia, Thailand, and Bangladesh), through 32 on-site courses and a training website. Staff competency was assessed throughout 24 months of enrollment with multiple-choice question (MCQ) examinations, a video quiz, and checklist evaluations of practical skills.
Despite the existence of low-cost and effective interventions for childhood pneumonia and diarrhoea, these conditions remain two of the leading killers of young children. Based on feedback from health professionals in countries with high child mortality, in 2009, WHO and Unicef began conceptualising an integrated approach for pneumonia and diarrhoea control. As part of this initiative, WHO and Unicef, with support from other partners, conducted a series of five workshops to facilitate the inclusion of coordinated actions for pneumonia and diarrhoea into the national health plans of 36 countries with high child mortality. This paper presents the findings from workshop and post-workshop follow-up activities and discusses the contribution of these findings to the development of the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea, which outlines the necessary actions for elimination of preventable child deaths from pneumonia and diarrhoea by 2025. Though this goal is ambitious, it is attainable through concerted efforts. By applying the lessons learned thus far and continuing to build upon them, and by leveraging existing political will and momentum for child survival, national governments and their supporting partners can ensure that preventable child deaths from pneumonia and diarrhoea are eventually eliminated.
Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age (Review)by Rojas-Reyes MX, et.al
Treatment for lower respiratory tract infections (LRTIs) includes administering complementary oxygen. The effectiveness of oxygen therapy and of different delivery methods remains uncertain. To determine the effectiveness and safety of oxygen therapy and oxygen delivery methods in the treatment of LRTIs and to define the indications for oxygen therapy in children with LRTIs. For this update, we searched CENTRAL, MEDLINE, EMBASE and LILACS from March 2008 to October 2014.
The recent series of reviews conducted within the GlobalAction Plan for Pneumonia and Diarrhoea (GAPPD) addressed epidemiologyof the two deadly diseases at the global and regional level; it alsoestimated the effectiveness of interventions, barriers to achieving highcoverage and the main implications for health policy. The aim of this paperis to provide the estimates of childhood pneumonia at the countrylevel. This should allow national policy–makers and stakeholders to implementproposed policies in the World Health Organization (WHO) andUNICEF member countries.