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Thursday, July 26, 2012

Research that shows child survival progress in developing countries


Press Release

Summary of some of the latest research on child health in developing countries (Uganda): evidence derived from all the randomized trials published over the last year. It is hoped that such information will be helpful in reviewing treatment guidelines, clinical practice and public health approaches, and in teaching about paediatrics and evidence-based medicine.

This year trials reported significant reductions in child mortality: the Uganda studies
  • In Uganda a trial of zinc in the treatment of severe pneumonia showed a significant reduction in deaths in the zinc treated group. This is the first trial of zinc treatment in pneumonia with the power to show a mortality difference. The effect was especially strong in children with HIV. Two other trials this year – from India and Nepal - did not show a significant beneficial effect of zinc on resolution of pneumonia signs. 
  • In 6 African countries initiation of HIV treatment in children who had no prior exposure to nevirapine, ART with zidovudine, lamivudine, and ‘ritonavir-boosted lopinavir’ resulted in lower virological failure than zidovudine, lamivudine and nevirapine. Nevirapine resistance was a common feature of treatment failure. 
  • In 7 African countries in a phase III trial the RTS,S/AS01 malaria vaccine provided protection against both clinical and severe malaria in African children, with vaccine efficacies of 50% for first episode of malaria, and 35% against severe malaria. Another study from 3 African countries in a phase II trial showed similar efficacy (53% and 59%) against the first episode of malaria and all malaria episodes, respectively, when children were followed up at 19 months. A third study of seroresponse in children in Mozambique showed protective anti-circumsporozoite antibodies at 42 months. The RTS,S/AS02 vaccine also induced high levels of anti-hepatitis B surface antigen antibodies. 
  • In a large study in Uganda involving over 100,000 children with suspected malaria, use of rapid diagnostic tests (RDT), compared with presumptive diagnosis, significantly reduced the prescribing of artemether-lumefantrine. However 23% of children with negative RDT were still prescribed antimalarials. Compared with microscopy, RDTs reduced waiting time and were considered more convenient for patients and health workers. 
  • In Lao , China , and Uganda trials of albendazole and mebendazole for the treatment of worm infestation showed that albendazole is more efficacious than mebendazole for hookworm. However single-dose albendazole had low efficacy against hookworm, and treatment daily for 3 days (in Lo and China ), or 2 doses 8 hours apart (in Uganda ) was better. Albendazole had lower efficacy than mebedazole against Trichuris trichiura, where 3 days of treatment (or 2 doses in the one day) was optimal for cure. 
This is the tenth edition of this booklet. It is part of a project supported by WHO, AusAID and many international partners, which critically appraises the evidence behind WHO's treatment guidelines. Previous editions (2003-2011) and further reviews of WHO guidelines are available at www.ichrc.org.au 

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