Staying safe while waiting for the vaccine: what we need to do.

Societies are organizing themselves to keep the COVID-19 virus at bay for the foreseeable future. The World Health Organization (WHO) has proposed that every country implement a comprehensive set of measures to prevent infection, detect cases, interrupt transmission, control clusters, suppress outbreaks and reduce mortality. Throughout the world, four systems capabilities are emerging that are important for societies to get ahead of the virus and become COVID-19 ready. First: understand the pattern of infection locally and act on it effectively: assess the status of the outbreak; act rapidly and robustly to interrupt transmission. Second: enable people to be active participants in their own responses. Third: focus on the places where people are most at risk of infection. Fourth: assess the performance of responses to COVID-19 infection: detecting cases, interrupting chains of transmission, minimizing adverse consequences, protecting the most vulnerable and ensuring opportunities for sustainable livelihoods and well-being for all, leaving no-one behind. These four capabilities are being woven together within societies: successful weaving can be helped through focusing on three interlinked elements: making information available; assessing and reducing risk; and being able to suppress outbreaks rapidly. This means involving everyone in the response and having strong public health defences. Governments, authorities, public health teams, employers and community organizations make it possible for us to stay safe but, in the end, what happens is up to all of us, individually and collectively. If we are to live well with the threat of COVID-19, solidarity really does matter.

The potential contribution of Iivestock to food and nutrition security: the application of the One Health approach in livestock policy and practice.

Animal products are critical to the nutrition,food security, livelihoods and resilience of hundreds of millions of people throughout the world. Livestock accounts for 40% of worldwide income from agriculture. Demand for animal products is set to continue increasing in the next three decades, as is their market price. If not carefully managed, a worldwide increase in the production of animal-derived products would increase pressure on natural resources (particularly water and land), significantly raising levels of dangerous greenhouse gas emissions and increasing the risk of people contracting zoonotic diseases. These realities are informing governments as they encourage the managed intensification of livestock production. They seek to do this in ways that take account of poorer people's contributions to the growth of rural economies. They look for ways to link together work on agricultural productivity, efficient food systems; infrastructure development; access to energy, water and affordable health care; and the sustenance of environmental services (including the mitigation of any further stimuli for changes in the global climate). Managed intensification of livestock production would also require long-term application of a One Health approach with its focus on mitigating health risks at the interfaces between animals and humans in different ecosystems. It will stimulate the joint working of multiple interests in pursuit of a common goal - ending hunger and malnutrition. The authors would like to see the One Health approach being incorporated within all nations' animal, environmental and public health policies and into the educational agendas of medical and veterinary undergraduate students. It must also be incorporated into preparedness, contingency planning, desk-top exercises and on-site simulations to get ready for the next mega disaster - no matter how improbable it might seem.

Toward a framework and indicators for monitoring Roll Back Malaria.

Roll Back Malaria (RBM) is a new global partnership that aims to halve the malaria burden by the year 2010. A framework and indicators for monitoring the outcomes and impact of RBM have been defined through an extensive consultative process. The framework identifies critical areas for monitoring RBM action relating to 1) the impact on malaria burden, 2) improvements in malaria prevention and treatment, 3) related health sector development, and 4) support for RBM action (including partnerships). A set of RBM indicators has been defined that corresponds to these critical areas but that reflects the major variations in malaria epidemiology and the principal interventions in different parts of the world. Countries would select indicators that are appropriate for their situation. Four global indicators are proposed for use by all countries in which RBM action is under way. Data collection procedures are discussed, and it is indicated how monitoring RBM action can build on existing data-collection mechanisms.

Roll Back Malaria.

Roll Back Malaria is an initiative intended to halve the suffering caused by this disease by 2010. The initiative is being developed as a social movement. Action is directed by national authorities backed by a global partnership which consists of development agencies, banks, private sector groups and researchers. The World Health Organization, the World Bank, UNICEF and UNDP founded the partnership in October 1998. The WHO has established a new Cabinet Project, and a WHO-wide strategy and workplan, to support the partnership. High quality, practical, consistent and relevant technical advice is made available through networks of experts based in research, academic, and disease control institutions, particularly those in endemic countries. The initiative also supports research and development of new products and tools to control malaria. Implementation of Roll Back Malaria began with a series of in-country consultations in 1998, followed by sub-regional consensus building and inception meetings. The current period is one of momentum building at country level during which national authorities are developing their own strategies with the global partners. It is anticipated that, during the year 2000, RBM movements will become active in at least 30 countries.

Reduced infant mortality: a societal indicator, an emotional imperative, or a health objective?

PIP: We prefer to use the term infant mortality rate (IMR) than infant mortality. IMR is less emotional, causes less anxiety, and implies poverty and hardship while infant mortality signifies dead children. Not all societies consider prevention of infant deaths as their 1st priority albeit still a social and emotional priority. IMR has been used for a century as a health subindex. Further many people consider the IMR as an indicator of adverse economic, nutritional, environmental, and social conditions. The IMR should be used in a more restrictive manner since children can be saved from death yet they continue to experience morbidity and live in poverty. Further those factors which cause infant deaths also affect survivors and their consequences are hard to gauge. To improve on overall health and not just reduction of infant mortality, a local and appropriate health service which the population accepts must have clear objectives and provide continuous prevention and treatment programs for all cohorts of children. Yet many developing countries which would clearly benefit from continuous child health programs do not operate such a health system. Similarly international, bilateral, and other external organizations who support child survival programs must also plan on continuous self sustaining services that are directed to the living as well as the dead. Moreover their priorities should be compatible with national priorities. In conclusion, a global or even national recession that raises absolute or relative poverty or reduces the transfer of resources which are now going to temporary vertical infant death prevention programs will most likely increase IMR and decrease infant health.^ieng

[Nutritional problems in developing countries: priorities for the pediatrician]. / Ernährungsprobleme in Entwicklungsländern: Prioritäten für den Kinderarzt.

Problems of nutrition in Third World countries must be approached on several levels with different emphases (a) the child (thoroughly tested and economical treatment); (b) mother and child (information about food given to children at home); (c) household (provision of supplies concentrated on households in which growth retardation is observed in children); (d) national (government health programs aimed at improvement of resources available to needy families mus be intensified); (e) international (with a great many specific socioeconomic problems to be tackled). The priorities in our attempts to solve the problems of adequate nutrition for children must be: analysis of the background to existing malnutrition; the development of standardized approaches; special training for medical and paramedical workers involved; evaluation of results; communication of procedures and results to others.

Growth monitoring--inappropriate promotion of an appropriate technology.

Growth monitoring has been identified as an important component of the 'Child Survival and Development Revolution'--an initiative advocated by UNICEF and supported by several other development agencies. In this initiative, improvements in the survival of children are attained through the widespread promotion, distribution and utilisation of selected health maintaining technologies by family members. Health workers, community institutions and welfare services help the family by providing encouragement, support and assistance. Growth monitoring has been identified as one of the key technologies--not only because it helps to promote the satisfactory nutrition of children, but also because it provides an opportunity for uniting other low-cost child health interventions. This paper re-examines the importance of widespread growth monitoring as a part of child care in developing countries. In the early sections, reasons for monitoring the growth of children are examined and the role of growth monitoring in primary health care is considered. The rationale for including growth monitoring in the child survival revolution is explored and the potential benefits of growth monitoring are reviewed. The authors then examine the results that have been achieved, to date, in a variety of programmes where child growth is being monitored. They conclude with a re-assessment of the importance of growth monitoring in child care. If the widespread promotion of growth monitoring is being considered as a means to improve the health of a community's children, three key questions must be answered. What are the risks associated with growth faltering or weight loss? To what extent can different health, educational or welfare interventions reduce these risks?(ABSTRACT TRUNCATED AT 250 WORDS)

Feeding, illness and nutritional status of young children in rural Gujarat.

Eighty children, aged 0-18 months, were studied over a period of 6 months. Information was obtained from monthly interviews with mothers, when the children were also weighed. Feeding practices, incidence of illness and weight gain were described. The children who were nutritionally most at risk were identified. The average weight of the children was 1 kg less than the NCHS international reference by 3 months, 1.7 kg by 9 months. The majority of mothers did not introduce foods other than breast milk before 9 months. The children from labourers' households gained less weight between 3 and 6 months, had a higher prevalence of malnutrition and more reports of illness than children from non-labourers' households. The implications of these results for workers in child health and nutrition programmes are discussed.