The Global Context: International Child Health

Approximately 5000 children under 5 years died on 11 September 2001 from diarrhoea, about double the number of persons who were killed when two airplanes crashed into the World Trade Towers in New York. For many years prior to that day, and every day since then, approximately 5000 children under 5 years have died from diarrhoea, by and large preventable by eliminating poverty. In 2003 global expenditure on anti-terrorism measures was quoted to be approximately $US551 billion. The UN Millennium Project has estimated that to cover basic needs in health, education, water, sanitation, food production, roads and other key areas, and achieve the Millennium Development Goals of the poorest countries would cost$US160 billion per year. This can be achieved by the wealthy countries of the world donating 0.7 % of their Gross Domestic Product (GDP). Only 5 of the 13 wealthiest OECD countries currently meet that target. The contribution from the USA (which currently contributes 0.15%) would be approximately $US60 billion – the same as the cost of the Iraq war per year for the first two years, similar to the Bush administration’s tax cuts to those earning more than$US500,000 per annum and approximately what Western Europe spends on alcohol every 6 months. Between 1990 and 2002 child health outcomes, particularly under 5 mortality rates world-wide have been improving except in the Commonwealth of Independent States (former Soviet Republics) and some Sub-Saharan African countries, where under 5 mortality has deteriorated, and rates in Sub-Saharan Africa remain high. However, as overall rates have been falling, inequalities and inequities in child health outcomes within and between nations have been increasing. From 1970-2000 under 5 mortality decreased by 71% in high income countries, but by only 40% in low income countries. The aim of this chapter is to describe broadly the determinants of child health, to question the current approach to improving child health outcomes, particularly in low and middle income countries, and discuss possibilities for improving child health in poor countries and reduce inequalities and inequities, considering strategies at a global, national and local level. ISBN: 978019576495

Cost effectiveness analysis of school based Mantoux screening for TB in Central Sydney, CHERE Discussion Paper No 37

A cost effectiveness analysis of differing school based TB infection screening regimes was conducted for 1996 populations of Year 1 and Year 8 students who attended schools in the areas of Central Sydney Area Health Service and South Western Sydney Area Health Service. The costs of screening would be partially offset by savings in future costs of treating adult cases of TB disease. Screening the high risk group of Year 8 students was found to be the most cost effective screening option. The cost per case prevented and the cost per death prevented were comparable with other health programs which are judged to be ?value for money?. Screening Year 1 students was found to be not as effective nor as cost effective. Universal screening would prevent more cases of adult TB disease than targeted screening but at a relatively high cost per case.TB, cost effectiveness, school based screening

Intention to breastfeed and awareness of health recommendations: findings from first-time mothers in southwest Sydney, Australia

<p>Abstract</p> <p>Background</p> <p>In 2001, the World Health Organisation (WHO) recommended exclusive breastfeeding for the first six months of life. The objectives of this study are to assess awareness of the WHO recommendation among first-time mothers (women at 24 to 34 weeks of pregnancy) and to explore the relationship between this awareness and mothers' intention to exclusively breastfeed for six months.</p> <p>Methods</p> <p>This study was part of the Healthy Beginnings Trial (HBT) conducted in southwest Sydney, Australia. We analysed cross-sectional baseline data of the trial conducted in 2008, including 409 first-time mothers at 24 to 34 weeks of pregnancy. The mothers' awareness of the recommended duration of exclusive breastfeeding and their intention to meet the recommendation were assessed through face-to-face interviews. Socio-demographic data were also collected. Factors associated with awareness of the recommendation, or the intention to meet the recommendation, were determined by logistic regression modeling. Log-binomial regression was used to calculate adjusted risk ratios (ARR).</p> <p>Results</p> <p>Sixty-one per cent of mothers knew the WHO recommendation of exclusive breastfeeding for six months. Only 42% of all mothers intended to meet the recommendation (breastfeed exclusively for six months). Among the mothers who knew the recommendation, 61% intended to meet the recommendation, compared to only 11% among those mothers who were not aware of the recommendation.</p> <p>The only factor associated with awareness of the recommendation was mother's level of education. Mothers who had a tertiary education were 1.5 times more likely to be aware of the recommendation than those who had school certificate or less (ARR adjusted for age 1.45, 95% CI 1.08, 1.94, p = 0.02). Mothers who were aware of the recommendation were 5.6 times more likely to intend to breastfeed exclusively to six months (ARR adjusted for employment status 5.61, 95% CI 3.53, 8.90, p < 0.001).</p> <p>Conclusion</p> <p>Awareness of the recommendation to breastfeed exclusively for six months is independently associated with the intention to meet this recommendation. A substantial number of mothers were not aware of the recommendation, particularly among those with low levels of education, which is of concern in relation to promoting breastfeeding. Improving mothers' awareness of the recommendation could lead to increased maternal intention to exclusively breastfeed for six months. However, whether this intention could be transferred into practice remains to be tested.</p> <p>Trial Registration</p> <p>HBT is registered with the Australian Clinical Trial Registry (ACTRNO12607000168459)</p

Early intervention of multiple home visits to prevent childhood obesity in a disadvantaged population: a home-based randomised controlled trial (Healthy Beginnings Trial)

<p>Abstract</p> <p>Background</p> <p>Studies have shown that a proportion of children as young as two years are already overweight. This indicates that obesity prevention programs that commence as early as possible and are family-focused are needed. This Healthy Beginnings Trial aims to determine the efficacy of a community-based randomized controlled trial (RCT) of a home visiting intervention in preventing the early onset of childhood overweight and obesity. The intervention will be conducted over the first two years of life to increase healthy feeding behaviours and physical activity, decrease physical inactivity, enhance parent-child interaction, and hence reduce overweight and obesity among children at 2 and 5 years of age in the most socially and economically disadvantaged areas of Sydney, Australia.</p> <p>Methods/design</p> <p>This RCT will be conducted with a consecutive sample of 782 first time mothers with their newborn children. Pregnant women who are expecting their first child, and who are between weeks 24 and 34 of their pregnancy, will be invited to participate in the trial at the antenatal clinic. Informed consent will be obtained and participants will then be randomly allocated to the intervention or the control group. The allocation will be concealed by sequentially numbered, sealed opaque envelopes containing a computer generated random number. The intervention comprises eight home visits from a specially trained community nurse over two years and pro-active telephone support between the visits. Main outcomes include a) duration of breastfeeding measured at 6 and 12 months, b) introduction of solids measured at 4 and 6 months, c) nutrition, physical activity and television viewing measured at 24 months, and d) overweight/obesity status at age 2 and 5 years.</p> <p>Discussion</p> <p>The results of this trial will ascertain whether the home based early intervention is effective in preventing the early onset of childhood overweight and obesity. If proved to be effective, it will result in a series of recommendations for policy and practical methods for promoting healthy feeding and physical activity of children in the first two years of life with particular application to families who are socially and economically disadvantaged.</p

Development of a child and youth report card for Central Sydney, 2000

This article describes how the first Child and Youth Report Card for the Central Sydney Area Health Service (CSAHS) was developed. The purpose of the Report Card is to contribute to the improvement of child and youth health outcomes through supporting service planning by providing regular information on the status of child and youth health in CSAHS to managers, planners, health professionals and other relevant stakeholders in child and youth health

Commentary on ‘Household interventions for prevention of domestic lead exposure in children’, with a response from the review authors

This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Yeoh B, Woolfenden S, Wheeler DM, Alperstein G, Lanphear B. Household interventions for prevention of domestic lead exposure in children. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006047. DOI: 10.1002/14651858.CD006047.pub2. Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary articl

Access to primary health care for Australian adolescents: How congruent are the perspectives of health service providers and young people, and does it matter?

Abstract Objective: To explore the extent of congruence between the views of service providers and young people (on adolescents' health concerns, barriers to accessing health services and ideal service model) in order to improve and increase the appropriateness, quality and usage of primary health care services. Methods: A qualitative data collection technique was used. During 2001/02, focus groups were conducted in urban and rural locations with adolescents (in and out of mainstream education), general practitioners, community health staff and youth health workers. Results: Service providers and young people identified a similar range of health concerns for young people, with young people adding additional issues of great importance to them that service providers felt were not in their ‘domain of treatment’. There was reasonable congruence in regard to ‘ideal service model’ with some differences relating to methods of information delivery. However, for ‘barriers to accessing services’ there were major discrepancies. Conclusions: While there is some common understanding between young people and service providers on certain aspects of health services, there are clearly areas where perceptions differ. This discrepancy matters because it may adversely affect the quality of provider‐adolescent interaction and the willingness of adolescents to access services. Implications: To deliver optimal health services to young people, the differences in understanding regarding services need to be addressed. Strategies could include promotion to, and encouragement of, young people to seek help, continuing professional education of providers and changes in remuneration policies