Apoyando el desarrollo en la primera infancia : de la ciencia a la aplicación a gran escala

Mensajes clave de la serie: Las consecuencias de salud y económicas de no actuar son elevadas. Un alarmante 43% de los niños menores de cinco años que viven en países de ingresos bajos y medianos (en total, unos 250 millones de niños) están en riesgo de tener un desarrollo inadecuado a causa de la pobreza y el retraso del crecimiento.1,4 En realidad, este porcentaje es más elevado porque hay otros factores que representan riesgos para la salud y el bienestar. Un mal comienzo en la vida puede afectar negativamente la salud, la nutrición y el aprendizaje. Estos efectos negativos se extienden a la edad adulta, resultando en bajos ingresos económicos y generando tensiones sociales. Además, estas consecuencias negativas repercuten no solo en la generación actual, sino también en las futuras. Se calcula que los individuos afectados por un mal comienzo en la vida sufren una pérdida de aproximadamente una cuarta parte del promedio anual de ingresos en la edad adulta, mientras que los países pueden perder hasta el doble de su gasto actual del PIB en salud y educación; Los niños pequeños necesitan recibir, desde el principio, un cuidado cariñoso y sensible a sus necesidades. El desarrollo empieza en el momento de la concepción. Los estudios demuestran que la primera infancia no es solamente el período de mayor vulnerabilidad a los factores de riesgo, sino también una etapa crítica en la que los efectos positivos de las intervenciones tempranas son más marcados y en la que se pueden reducir los efectos de los factores que afectan negativamente al desarrollo. La experiencia que influye más en el desarrollo de los niños pequeños es el cuidado cariñoso y sensible que le procuran sus padres, otros familiares, sus cuidadores y los servicios comunitarios. El cuidado cariñoso y sensible a las necesidades del niño se caracteriza por la existencia de un ambiente estable que facilita la buena salud y la nutrición de los niños, que protege al niño de posibles peligros y le ofrece la posibilidad de empezar su aprendizaje a una edad temprana, a través de relaciones e interacciones cariñosas. Los beneficios del cuidado cariñoso y sensible se extienden a toda la vida y se expresan en una mejor salud, mayor bienestar y mayor capacidad de aprender y de ganarse la vida. Las familias necesitan apoyo para proveer el cuidado cariñoso y sensible, incluyendo recursos materiales y económicos, políticas nacionales, como licencias de paternidad remuneradas, y prestación de diversos servicios, incluyendo servicios de salud, nutrición, educación y la protección infantil y social; Debemos de entregar intervenciones multisectoriales comenzando con el sector salud como punto de partida para llegar a los niños más pequeños. El objetivo de estas intervenciones, entre ellas el apoyo a las familias para que puedan proporcionar un cuidado cariñoso y sensible y hagan frente a los problemas que se puedan presentar, es proteger al niño de diversos riesgos que pueden afectar a su desarrollo. Para ello, se pueden integrar las intervenciones en los servicios de salud materno-infantil existentes. Estos servicios deben satisfacer las necesidades tanto del niño como de su cuidador principal. Por tanto, deben apoyar el desarrollo del niño y la salud y el bienestar de la madre y la familia. Este enfoque viable es un punto de partida esencial para establecer colaboraciones multisectoriales de ayuda a las familias que permitan llegar a los niños más pequeños. Estas intervenciones deben satisfacer necesidades básicas como la nutrición, el apoyo al crecimiento y la salud; la protección de los niños; la prevención de la violencia doméstica, la protección social que asegure la estabilidad económica de la familia y la capacidad para acceder a servicios; y la educación que brinde acceso a oportunidades de aprendizaje de calidad a una edad temprana; Debemos reforzar la capacidad de las autoridades gubernamentales para ampliar los servicios que funcionan. Cuatro estudios de casos realizados en países de distintas regiones del mundo demuestran que se pueden llevar a gran escala programas nacionales que son efectivos y sostenibles. Sin embargo, para que esto suceda es un requisito indispensable el contar con liderazgo de las autoridades y dar prioridad a las políticas adecuadas. Los gobiernos disponen de distintas opciones para alcanzar las metas y los objetivos fijados en relación con el desarrollo en la primera infancia, desde iniciativas que promuevan cambios y abarquen a diversos sectores gubernamentales hasta la ampliación progresiva de servicios existentes. Los servicios y las intervenciones en favor del desarrollo de los niños pequeños son fundamentales para que todos ellos alcancen el máximo de su potencial en el transcurso de su vida y para extender estos efectos a la siguiente generación. Este propósito es un elemento central de los Objetivos de Desarrollo Sostenible

The burden of child maltreatment in the East Asia and Pacific region

This study estimated the health and economic burden of child maltreatment in the East Asia and Pacific region, addressing a significant gap in the current evidence base. Systematic reviews and meta-analyses were conducted to estimate the prevalence of child physical abuse, sexual abuse, emotional abuse, neglect, and witnessing parental violence. Population Attributable Fractions were calculated and Disability-Adjusted Life Years (DALYs) lost from physical and mental health outcomes and health risk behaviors attributable to child maltreatment were estimated using the most recent comparable Global Burden of Disease data. DALY losses were converted into monetary value by assuming that one DALY is equal to the sub-region’s per capita GDP. The estimated economic value of DALYs lost to violence against children as a percentage of GDP ranged from 1.24% to 3.46% across sub-regions defined by the World Health Organization. The estimated economic value of DALYs (in constant 2000 US$) lost to child maltreatment in the EAP region totaled US$151 billion, accounting for 1.88% of the region’s GDP. Updated to 2012 dollars, the estimated economic burden totaled US $194 billion. In sensitivity analysis, the aggregate costs as a percentage of GDP range from 1.36% to 2.52%. The economic burden of child maltreatment in the East Asia and Pacific region is substantial, indicating the importance of preventing and responding to child maltreatment in this region. More comprehensive research into the impact of multiple types of childhood adversity on a wider range of putative health outcomes is needed to guide policy and programs for child protection in the region, and globally

Prevalence and factors associated with non-utilization of healthcare facility for childbirth in rural and urban Nigeria: Analysis of a national population-based survey

Aim: The aim of this study was to assess the rural–urban differences in the prevalence and factors associated with non-utilization of healthcare facility for childbirth (home delivery) in Nigeria. Methods: Dataset from the Nigeria demographic and health survey, 2013, disaggregated by rural–urban residence were analyzed with appropriate adjustment for the cluster sampling design of the survey. Factors associated with home delivery were identified using multivariable logistic regression analysis. Results: In rural and urban residence, the prevalence of home delivery were 78.3% and 38.1%, respectively (p < 0.001). The lowest prevalence of home delivery occurred in the South-East region for rural residence (18.6%) and the South-West region for urban residence (17.9%). The North-West region had the highest prevalence of home delivery, 93.6% and 70.5% in rural and urban residence, respectively. Low maternal as well as paternal education, low antenatal attendance, being less wealthy, the practice of Islam, and living in the North-East, North-West and the South-South regions increased the likelihood of home delivery in both rural and urban residences. Whether in rural or urban residence, birth order of one decreased the likelihood of home delivery. In rural residence only, living in the North-Central region increased the chances of home delivery. In urban residence only, maternal age ⩾ 36 years decreased the likelihood of home delivery, while ‘Traditionalist/other’ religion and maternal age < 20 years increased it. Conclusion: The prevalence of home delivery was much higher in rural than urban Nigeria and the associated factors differ to varying degrees in the two residences. Future intervention efforts would need to prioritize findings in this study

Neonatal tetanus in Turkey; what has changed in the last decade?

dikici, bunyamin/0000-0001-7572-6525WOS: 000259222800001PubMed: 18713452Background: Neonatal tetanus (NT) is still considered as one of the major causes of neonatal death in many developing countries. The aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may contribute (or may have contributed) to the elimination of the disease in Diyarbakir. Methods: The data of sixty-seven infants whose epidemiological and clinical findings were compatible with neonatal tetanus were reviewed. Patients were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Factors having a contribution to the higher rate of tetanus among newborn infants were discussed. Results: A total of 55 cases of NT had been hospitalized between 1991 and 1996 whereas only 12 patients admitted in the last decade. All of the infants had been delivered at home by untrained traditional birth attendants (TBA), and none of the mothers had been immunized with tetanus toxoid during her pregnancy. Twenty-eight (41.8%) of the infants died during their follow-up. Lower birth weight, younger age at onset of symptoms and at the time admission, the presence of opisthotonus, risus sardonicus and were associated with a higher mortality rate. Conclusion: Although the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the last decade efforts including appropriate health education of the masses, ensurement of access to antenatal sevices and increasing the rate of tetanus immunization among mothers still should be made in our region to achieve the goal of neonatal tetanus elimination

Equity in health and healthcare in Malawi: analysis of trends

<p>Abstract</p> <p>Background</p> <p>Growing scientific evidence points to the pervasiveness of inequities in health and health care and the persistence of the <it>inverse care law</it>, that is the availability of good quality healthcare seems to be inversely related to the need for it in developing countries. Achievement of the Millennium Development Goals is likely to be compromised if inequities in health/healthcare are not properly addressed.</p> <p>Objective</p> <p>This study attempts to assess trends in inequities in selected indicators of health status and health service utilization in Malawi using data from the Demographic and Health Surveys of 1992, 2000 and 2004.</p> <p>Methods</p> <p>Data from Demographic and Health Surveys of 1992, 2000 and 2004 are analysed for inequities in health/healthcare using quintile ratios and concentration curves/indices.</p> <p>Results</p> <p>Overall, the findings indicate that in most of the selected indicators there are pro-rich inequities and that they have been widening during the period under consideration. Furthermore, vertical inequities are observed in the use of interventions (treatment of diarrhoea, ARI among under-five children), in that the non-poor who experience less burden from these diseases receive more of the treatment/interventions, whereas the poor who have a greater proportion of the disease burden use less of the interventions. It is also observed that the publicly provided services for some of the selected interventions (e.g. child delivery) benefit the non-poor more than the poor.</p> <p>Conclusion</p> <p>The widening trend in inequities, in particular healthcare utilization for proven cost-effective interventions is likely to jeopardize the achievement of the Millennium Development Goals and other national and regional targets. To counteract the inequities it is recommended that coverage in poor communities be increased through appropriate targeting mechanisms and effective service delivery strategies. There is also a need for studies to identify which service delivery mechanisms are effective in the Malawian context.</p

The state of One Health research across disciplines and sectors:a bibliometric analysis

There is a growing interest in One Health, reflected by the rising number of publications relating to One Health literature, but also through zoonotic disease outbreaks becoming more frequent, such as Ebola, Zika virus and COVID-19. This paper uses bibliometric analysis to explore the state of One Health in academic literature, to visualise the characteristics and trends within the field through a network analysis of citation patterns and bibliographic links. The analysis focuses on publication trends, co-citation network of scientific journals, co-citation network of authors, and co-occurrence of keywords. The bibliometric analysis showed an increasing interest for One Health in academic research. However, it revealed some thematic and disciplinary shortcomings, in particular with respect to the inclusion of environmental themes and social science insights pertaining to the implementation of One Health policies. The analysis indicated that there is a need for more applicable approaches to strengthen intersectoral collaboration and knowledge sharing. Silos between the disciplines of human medicine, veterinary medicine and environment still persist. Engaging researchers with different expertise and disciplinary backgrounds will facilitate a more comprehensive perspective where the human-animal-environment interface is not researched as separate entities but as a coherent whole. Further, journals dedicated to One Health or interdisciplinary research provide scholars the possibility to publish multifaceted research. These journals are uniquely positioned to bridge between fields, strengthen interdisciplinary research and create room for social science approaches alongside of medical and natural sciences. OHEJP PhD project: SUSTAI

Clean birth kits to improve birth practices: development and testing of a country level decision support tool

Background: Clean birth practices can prevent sepsis, one of the leading causes of both maternal and newborn mortality. Evidence suggests that clean birth kits (CBKs), as part of package that includes education, are associated with a reduction in newborn mortality, omphalitis, and puerperal sepsis. However, questions remain about how best to approach the introduction of CBKs in country. We set out to develop a practical decision support tool for programme managers of public health systems who are considering the potential role of CBKs in their strategy for care at birth. Methods: Development and testing of the decision support tool was a three-stage process involving an international expert group and country level testing. Stage 1, the development of the tool was undertaken by the Birth Kit Working Group and involved a review of the evidence, a consensus meeting, drafting of the proposed tool and expert review. In Stage 2 the tool was tested with users through interviews (9) and a focus group, with federal and provincial level decision makers in Pakistan. In Stage 3 the findings from the country level testing were reviewed by the expert group. Results: The decision support tool comprised three separate algorithms to guide the policy maker or programme manager through the specific steps required in making the country level decision about whether to use CBKs. The algorithms were supported by a series of questions (that could be administered by interview, focus group or questionnaire) to help the decision maker identify the information needed. The country level testing revealed that the decision support tool was easy to follow and helpful in making decisions about the potential role of CBKs. Minor modifications were made and the final algorithms are presented. Conclusion: Testing of the tool with users in Pakistan suggests that the tool facilitates discussion and aids decision making. However, testing in other countries is needed to determine whether these results can be replicated and to identify how the tool can be adapted to meet country specific needs

Profiles and behavioral consequences of child abuse among adolescent girls and boys from Barbados and Grenada

The current study used latent class analysis to uncover groups of youths with specific abuse (physical, emotional, and sexual) profiles in and outside the family, and identify how membership in each abuse group is associated with behavioral outcomes. Data were collected among a sample of male (n = 662; M age = 13.02 years) and female (n = 689; M age = 12.95 years) children and adolescents (9 – 17 years old) from Barbados and Grenada. Selfreport surveys were completed by participants in school settings. Three latent classes of child abuse were distinguished among boys, including ‘low abuse’ (39.2% of the sample), ‘physical and emotional abuse high outside/medium in the family’ (43.2%), and ‘high overall abuse’ (17.6%). Among girls, four unique classes were recovered: ‘low abuse’ (40.7%), ‘high physical and emotional abuse outside the family’ (7.6%), ‘high emotional and moderate physical abuse’ (33.9%), and ‘high overall abuse’ (17.8%). Compared with members of low abuse groups, youths who reported having experienced high/moderate levels of various forms of violence, including those who were abused in multiple ways and across the two settings (‘high overall abuse’), were significantly more likely to engage in violent and hostile behavior. Abused and non-abused youths did not differ on non-violent conflict resolution skills. The significance of present findings for future research and practice is discussed