Summary Points and Recommendations from the Child Health Track

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Summary Points and Recommendations from the Child
Health Track
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Summary Child Health Track

• What have we learned since ICIUM I?
• What can we say to Programs and Policy Makers?
• What Dont We Know?
• What are our Priority Research Issues and
  Concerns?

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The Crash of New Knowledge What have we
learned since ICIUM I
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Improving the Use of Medicines for Children (I)

• ARI and Pneumonia
• We can reduce unnecessary/inappropriate use
• Short course antibiotic therapies
• Efficacious, Cost effective Improve adherence
  Reduce side effects and Reduce pressure on AMR
  emergence
• Oral antibiotic therapy can be used to treat
  Severe Pneumonia in hospitalized children
• Expanded use of Bronchodilators will reduce the
  inappropriate use of antibiotics for wheezing
  children
• In vitro data on pneumococcal resistance does not
  predict clinical outcomes

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Improving the Use of Medicines for Children (II)

• Malaria
• Artemisinin combination therapy (ACT) is
  efficacious in management of malaria (though
  global data on children is limited)
• Rectal artesunate suppositories are potentially
  life-saving in stabilizing children with severe
  malaria prior to presentation at an inpatient
  facility
• ACT drugs may appear to be expensive but may be
  cost-effective given extensive use of ineffective
  therapies

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Improving the Use of Medicines for Children (III)

• Micronutrients (especially vitamin A and Zinc)
• Extensive data on vitamin As efficacy on
  improving MCH
• Zinc is an effective therapeutic adjuvant for
  improving diarrhea case management
• Encouraging (though not-yet definitive data) on
  zinc as a therapeutic adjuvant for pneumonia

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Improving the Use of Medicines for Children (IV)

• Behavioral Intervention Research
• Numerous small-scale education-based
  interventions showed an ability to change
  knowledge and short-term behaviors in
• Health Professionals
• Health Para-professionals
• Mothers and Caregivers
• Students
• Drug Sellers (both licensed and unlicensed)
• Peer-to-peer interventions are effective in
  changing professional practices

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The Calm Waters of Policy Advice and Program
Guidance
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Policy Recommendations and Programme Guidance

• Policy and Programmes
• WHO-defined non-severe pneumonia should be
  treated with three-day therapy
• Acute diarrhea should be managed with low
  osmolarity ORS and Zinc
• Joint WHO-UNICEF statement on extending
  antibiotic use to CHWs for the management of
  pneumonia to reduce mortality
• Global recommendations need to be locally adapted
  as appropriate

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The Ebb of the Waters What We Do Not Know and
What Pulls Us Back
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Major Gaps in Knowledge

• Lack of impact data for knowledge-based
  interventions
• Too little attention to economic issues
• Little clarity on approaches to modify the
  economic incentives driving commercial drug
  seller activities
• Trade-offs between expanding access to
  antibiotics and impact on resistance
• Sustainability of ACT for malaria

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Research Issues and Concerns (I)

• How to take our known technologies and
  interventions to public health programme scale?
• How to increase both coverage and quality?
• How to use Mass Media effectively to improve drug
  use practices?
• What interventions are feasible at the health
  system level to improve the use of medicines?

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Research Issues and Concerns (II)

• ARI case management in HIV endemic areas
• How to strengthen referral systems to allow for
  appropriate case management for inpatient
  conditions?
• How to expand use of STGs and DTCs to improve
  inpatient care of childhood illness?
• Social science research on household behavior on
  access, utilization, and adherence
• Research on micronutrient drug interactions

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Methodologic Issues

• Drug intervention trials (both clinical and
  behavioral) need to consider
• Clinical outcomes
• Pharmacoeconomics
• Impact on resistance (microbiological issues)
• Patient adherence
• Clinical trials need to have better (and
  standardized) definitions of clinical failures
• Need better tools to improve specificity of
  pneumonia diagnosis
• Need expanded use of costing guidelines/ tools

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Are we sitting too peacefully on the beaches of
small-scale knowledge-based interventions while
the Tidal Waves of commercial interests
supporting inappropriate use and antimicrobial
resistance prepares to crash over us?
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Thanks

• Participants in the Child Health Track Sessions
• Major Funding Agencies for Child Health Track
• WHO Child and Adolescent Health
• WHO Essential Drugs and Medicines
• USAID Office of Health

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Thanks to our Thai colleagues