Supplementary Material for: Insights from the WHO and National Lists of Essential Medicines: Focus on Pediatric Diabetes Care in Africa

<b><i>Background:</i></b> Access to essential medicines in pediatric endocrinology and diabetes is limited in resource-limited countries. The World Health Organization (WHO) maintains two non-binding lists of essential medicines (EMLs) which are often used as a template for developing national EMLs. <b><i>Methods:</i></b> We compared a previously published master list of medicines for pediatric endocrinology and diabetes with the WHO EMLs and national EMLs for countries within the WHO African region. To better understand actual access to medicines by patients, we focused on diabetes and surveyed pediatric endocrinologists from 5 countries and assessed availability and true cost for insulin and glucagon. <b><i>Results:</i></b> Most medicines that are essential in pediatric endocrinology and diabetes were included in the national EMLs. However, essential medicines, such as fludrocortisone, were present in less than 30% of the national EMLs despite being recommended by the WHO. Pediatric endocrinologists from the 5 focus countries reported significant variation in terms of availability and public access to insulin, as well as differences between urban and rural areas. Except for Botswana, glucagon was rarely available. There was no significant relationship between Gross National Income and the number of medicines included in the national EMLs. <b><i>Conclusions:</i></b> Governments in resource-limited countries could take further steps to improve EMLs and access to medicines such as improved collaboration between health authorities, the pharmaceutical industry, patient groups, health professionals, and capacity-building programs such as Paediatric Endocrinology Training Centres for Africa

Global Emergencies in Child Health: Challenges and Solutions—Viewpoint and Recommendations from the European Paediatric Association and the International Pediatric Association

Global emergencies, including natural disasters, epidemics, drought, armed conflicts, and the SARS-CoV-2 pandemic, have affected populations on five continents, causing devastating socioeconomic effects.Children are a most vulnerable and defenseless group. In tense situations, they feel overwhelmed and insecure and are often left to their own devices. Their rights to protection and integrity are threatened.3 The European Paediatric Association, Union of the National European Paediatrics Societies and Associations and the International Pediatric Association, representing the national pediatric societies from 149 countries, held a joint conference on October 9, 2021, in Zagreb, Croatia, to discuss the issue of global emergencies in pediatrics and their significant economic and social impact. Delegates discussed the challenges posed by a wide variety of emergencies in the context of increasing global complexities, while also exploring possible solutions. This article, prepared by the European Paediatric Association, Union of the National European Paediatrics societies and Associations–International Pediatric Association working group, includes the viewpoint and recommendations from the conference he group strongly recommends that countries develop, reorganize, and strengthen their health systems to address the social and environmental issues caused by global emergencies to enable more efficient and effective allocation and use of available resources for disaster preparedness and emergency response resources in communities. The statement emphasizes the importance of active involvement of all stakeholders, including governments and healthcare professionals. Their joint effort should focus on developing strategic partnerships with key international constituencies, such as the diplomatic, nongovernmental, legal, and academic communities, and the media with the aim of providing adequate support to infants, children, and adolescents affected by adversities.6 Pediatricians and their professional societies across the world must collaborate and share their experiences with new and emerging challenges in child health and together mitigate against inequalities within and between countries and between continents and together strongly and courageously advocate for the health and well-being of children

An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence

This paper represents an international collaboration of paediatric endocrine and other societies (listed in the Appendix) under the International Consortium of Paediatric Endocrinology (ICPE) aiming to improve worldwide care of adolescent girls with polycystic ovary syndrome (PCOS)(1). The manuscript examines pathophysiology and guidelines for the diagnosis and management of PCOS during adolescence. The complex pathophysiology of PCOS involves the interaction of genetic and epigenetic changes, primary ovarian abnormalities, neuroendocrine alterations, and endocrine and metabolic modifiers such as anti-Mullerian hormone, hyper-insulinemia, insulin resistance, adiposity, and adiponectin levels. Appropriate diagnosis of adolescent PCOS should include adequate and careful evaluation of symptoms, such as hirsutism, severe acne, and menstrual irregularities 2 years beyond menarche, and elevated androgen levels. Polycystic ovarian morphology on ultrasound without hyperandrogenism or menstrual irregularities should not be used to diagnose adolescent PCOS. Hyperinsulinemia, insulin resistance, and obesity may be present in adolescents with PCOS, but are not considered to be diagnostic criteria. Treatment of adolescent PCOS should include lifestyle intervention, local therapies, and medications. Insulin sensitizers like metformin and oral contraceptive pills provide short-term benefits on PCOS symptoms. There are limited data on anti-androgens and combined therapies showing additive/synergistic actions for adolescents. Reproductive aspects and transition should be taken into account when managing adolescents. (C) 2017 S. Karger AG, Basel.WoSScopu