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An innovation in child health: Globally reaching out to child health professionals

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      Abstract

      Worldwide deaths of children younger than 5 years reduced from 12.7 million in 1990 to 6.3 million in 2013. Much of this decline is attributed to an increase in the knowledge, skills, and abilities of child health professionals. In turn this increase in knowledge, skills, and abilities has been brought about by increased child-health-focused education available to child health professionals. Therefore child-health-focused education must be part of the strategy to eliminate the remaining 6.3 million deaths and to achieve the United Nations Millennium Development Goals. This article describes a child-health-focused program that was established in 1992 and operates in 20 countries: Australia, Bangladesh, Botswana, Cambodia, China, Ethiopia, Hong Kong, India, Kenya, Malawi, Mongolia, Myanmar, Sierra Leone, the Seychelles, the Solomon Islands, Tanzania, Tonga, Vanuatu, Vietnam, and Zimbabwe. The Diploma in Child Health/International Postgraduate Paediatric Certificate (DCH/IPPC) course provides a comprehensive overview of evidence-based current best practice in pediatrics. This includes all subspecialty areas from infectious diseases and emergency medicine through to endocrinology, respiratory medicine, neurology, nutrition, and dietetics. Content is developed and presented by international medical experts in response to global child health needs. Content is provided to students via a combination of learning outcomes, webcasts, lecture notes, personalized study, tutorials, case studies, and clinical practice. One hundred eleven webcasts are provided, and these are updated annually. This article includes a brief discussion of the value and focus of medical education programs; a description of the DCH/IPPC course content, approaches to teaching and learning, course structure and the funding model; the most recent evaluation of the DCH/IPPC course; and recommendations for overcoming the challenges for implementing a multinational child-health-focused program.

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      Most cited references 29

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      Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000.

      Information about the distribution of causes of and time trends for child mortality should be periodically updated. We report the latest estimates of causes of child mortality in 2010 with time trends since 2000. Updated total numbers of deaths in children aged 0-27 days and 1-59 months were applied to the corresponding country-specific distribution of deaths by cause. We did the following to derive the number of deaths in children aged 1-59 months: we used vital registration data for countries with an adequate vital registration system; we applied a multinomial logistic regression model to vital registration data for low-mortality countries without adequate vital registration; we used a similar multinomial logistic regression with verbal autopsy data for high-mortality countries; for India and China, we developed national models. We aggregated country results to generate regional and global estimates. Of 7·6 million deaths in children younger than 5 years in 2010, 64·0% (4·879 million) were attributable to infectious causes and 40·3% (3·072 million) occurred in neonates. Preterm birth complications (14·1%; 1·078 million, uncertainty range [UR] 0·916-1·325), intrapartum-related complications (9·4%; 0·717 million, 0·610-0·876), and sepsis or meningitis (5·2%; 0·393 million, 0·252-0·552) were the leading causes of neonatal death. In older children, pneumonia (14·1%; 1·071 million, 0·977-1·176), diarrhoea (9·9%; 0·751 million, 0·538-1·031), and malaria (7·4%; 0·564 million, 0·432-0·709) claimed the most lives. Despite tremendous efforts to identify relevant data, the causes of only 2·7% (0·205 million) of deaths in children younger than 5 years were medically certified in 2010. Between 2000 and 2010, the global burden of deaths in children younger than 5 years decreased by 2 million, of which pneumonia, measles, and diarrhoea contributed the most to the overall reduction (0·451 million [0·339-0·547], 0·363 million [0·283-0·419], and 0·359 million [0·215-0·476], respectively). However, only tetanus, measles, AIDS, and malaria (in Africa) decreased at an annual rate sufficient to attain the Millennium Development Goal 4. Child survival strategies should direct resources toward the leading causes of child mortality, with attention focusing on infectious and neonatal causes. More rapid decreases from 2010-15 will need accelerated reduction for the most common causes of death, notably pneumonia and preterm birth complications. Continued efforts to gather high-quality data and enhance estimation methods are essential for the improvement of future estimates. The Bill & Melinda Gates Foundation. Copyright © 2012 Elsevier Ltd. All rights reserved.
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        How many child deaths can we prevent this year?

        This is the second of five papers in the child survival series. The first focused on continuing high rates of child mortality (over 10 million each year) from preventable causes: diarrhoea, pneumonia, measles, malaria, HIV/AIDS, the underlying cause of undernutrition, and a small group of causes leading to neonatal deaths. We review child survival interventions feasible for delivery at high coverage in low-income settings, and classify these as level 1 (sufficient evidence of effect), level 2 (limited evidence), or level 3 (inadequate evidence). Our results show that at least one level-1 intervention is available for preventing or treating each main cause of death among children younger than 5 years, apart from birth asphyxia, for which a level-2 intervention is available. There is also limited evidence for several other interventions. However, global coverage for most interventions is below 50%. If level 1 or 2 interventions were universally available, 63% of child deaths could be prevented. These findings show that the interventions needed to achieve the millennium development goal of reducing child mortality by two-thirds by 2015 are available, but that they are not being delivered to the mothers and children who need them.
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          What works? Interventions for maternal and child undernutrition and survival.

          We reviewed interventions that affect maternal and child undernutrition and nutrition-related outcomes. These interventions included promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition; and reduction of disease burden (promotion of handwashing and strategies to reduce the burden of malaria in pregnancy). We showed that although strategies for breastfeeding promotion have a large effect on survival, their effect on stunting is small. In populations with sufficient food, education about complementary feeding increased height-for-age Z score by 0.25 (95% CI 0.01-0.49), whereas provision of food supplements (with or without education) in populations with insufficient food increased the height-for-age Z score by 0.41 (0.05-0.76). Management of severe acute malnutrition according to WHO guidelines reduced the case-fatality rate by 55% (risk ratio 0.45, 0.32-0.62), and recent studies suggest that newer commodities, such as ready-to-use therapeutic foods, can be used to manage severe acute malnutrition in community settings. Effective micronutrient interventions for pregnant women included supplementation with iron folate (which increased haemoglobin at term by 12 g/L, 2.93-21.07) and micronutrients (which reduced the risk of low birthweight at term by 16% (relative risk 0.84, 0.74-0.95). Recommended micronutrient interventions for children included strategies for supplementation of vitamin A (in the neonatal period and late infancy), preventive zinc supplements, iron supplements for children in areas where malaria is not endemic, and universal promotion of iodised salt. We used a cohort model to assess the potential effect of these interventions on mothers and children in the 36 countries that have 90% of children with stunted linear growth. The model showed that existing interventions that were designed to improve nutrition and prevent related disease could reduce stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%. To eliminate stunting in the longer term, these interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women's empowerment.
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            Author and article information

            Affiliations
            1School of Medical and Health Sciences, Edith Cowan University, WA, Australia
            2Discipline of Paediatrics and Child Health, University of Sydney, The Children’s Hospital at Westmead, Westmead, NSW, Australia
            3Hong Kong College of Family Physicians, Aberdeen, Hong Kong, China
            4Department of Genetics, Immunology, Biochemistry and Nutrition, Maharashtra University of Health Sciences, Aundh Civil Hospital, Sanghavi Phata, Aundh Pune, India
            Author notes
            CORRESPONDING AUTHOR: Russell Jones, PhD, Professor of Clinical Education, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia and Chair DCH/IPPC Education Advisory Group, Tel.: +61-447-997858, E-mail: russell.jones@123456ecu.edu.au
            Journal
            FMCH
            Family Medicine and Community Health
            FMCH
            Compuscript (Ireland)
            2009-8774
            2305-6983
            July 2016
            August 2016
            : 4
            : 3
            : 35-44
            Copyright © 2016 Family Medicine and Community Health

            This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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