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This summary highlights the key points and recommendations from the Child Health Track sessions, including insights on improving the use of medicines for children, policy recommendations, research issues, and concerns. It also emphasizes the need to address gaps in knowledge and challenges in scaling up interventions.
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Summary Points and Recommendations from the Child Health Track
Summary: Child Health Track • What have we learned since ICIUM I? • What can we say to Programs and Policy Makers? • What Don’t We Know? • What are our Priority Research Issues and Concerns?
The Crash of New Knowledge: What have we learned since ICIUM I This is where a large graphic or chart can go.
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 pneumococcalresistance does not predict clinical outcomes
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
Improving the Use of Medicines for Children (III) • Micronutrients (especially vitamin A and Zinc) • Extensive data on vitamin A’s 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
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
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
The Ebb of the Waters: What We Do Not Know and What Pulls Us Back This is where a large graphic or chart can go.
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
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?
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
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
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? This is where a large graphic or chart can go.
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