Nations International Children's Emergency Research Articles

'Auntie UNRRA' at the Crossroads

The United Nations Relief and Rehabilitation Administration only existed for a period of five years. As one of the products of Anglo-American ‘post-conflict planning’, which commenced soon after the outbreak of the Second World War, it formally came into existence in November 1943 to bring aid and relief to peoples and countries devastated by the war. At its founding meeting the 44 participating nations agreed that UNRRA would exist only for a limited period of time. Although it was to provide more than mere ‘soup kitchen’ charity, the longer-term ‘reconstruction’ of the world was beyond its remit; rather, it was to provide materials for immediate ‘relief’ and the means for ‘rehabilitation’. 1 Even in 1943 these broad terms of ‘relief’, ‘rehabilitation’ and ‘reconstruction’ left much room for significant differences in the expectations and commitments of different member countries. The question of the organization's precise lifespan was left open. Although rumours about the imminent closure of UNRRA circulated throughout its existence, and although hardly anyone envisaged UNRRA as a permanent fixture on the international scene, its end came more abruptly than many had anticipated. 2 Faced with the enormity of the relief project on one hand, and a dire shortage of funds to complete this work on the other, delegates already debated at the third meeting of UNRRA's Council in August 1945—only five months after supply operations had begun—whether UNRRA would have to be dissolved by the end of the year. The United States agreed to a further financial contribution at this meeting, but, to reassure a reluctant US Congress, only on the condition that terminal dates for UNRRA's operations were established: all shipments to Europe were to be completed by the end of 1946, and those to the Far East by March 1947. Twelve months later, at the Fifth Council Session in August 1946, Polish, Czech, Yugoslav, and Greek delegates pleaded for the continuation of UNRRA, but to no avail. Will Clayton, American representative and chair of the meeting, saw the solution of future relief needs in bilateral arrangements between countries in need of aid and those willing to provide it. 3 In the end, when UNRRA was not able to complete its already scheduled shipments by December 1946, it was granted a few extra months. But by mid-1947 the organization had all but ceased to operate. By July 1947 all European missions had been terminated, followed by the closure of the Far Eastern offices later that year. During 1948, remaining headquarter staffs were phased out, and the offices eventually closed for good. UNRRA's leftover resources and responsibilities were transferred to a host of new bodies: the Interim Committee of the World Health Organization, the International Refugee Organization, the United Nations International Children's Emergency Fund (UNICEF), the United Nations Economic and Social Organization (UNESCO), and other parts of the newly inaugurated UN apparatus.

The significance of artemisinin in roll back malaria partnership programmes and cancer therapy

The role of the natural product, artemisinin, is discussed, with a view to elucidating its importance as an antimalarial, essential to sustainable global development, especially in the health and welfare industry. An estimated 243 million cases of malaria led to an estimated 863,000 deaths in 2008. The Roll Back Malaria (RBM) Partnership is a global network for co-ordinated action against malaria, launched in 1998 by the World Health Organization (WHO), United Nations International Children Emergency Fund (UNICEF), United Nations Development Programme (UNDP), and World Bank. It promotes consensus among key actors in malaria control, harmonizes action, and mobilizes resources to fight malaria in endemic countries. Large scale use of antimalarial monotherapies such as quinoline compounds (for example, chloroquine) and antifolate drugs (for example, sulfonamides), have culminated in cross-resistance, especially of Plasmodium falciparum, to these conventional antimalarial drugs. Artemisinin, (a sesquiterpene lactone), isolated from the plant Artemisia annua, is a drug used to treat multi-drug resistant strains of falciparum malaria. Saccharomyces cerevisiae microbes can produce the precursor artemisinic acid, by a technique of synthetic biology. The total synthesis of artemisinin can also be performed using the organic reagents, isopulegol. The iron-porphyrin complex-moiety, produced during plasmodium infection of the red blood cells, reacts with artemisinin, a potent inhibitor of hemozoin formation, to produce reactive oxygen radicals which damage the parasite leading to its death. Artemisinin acts on the electron transport chain, by causing the depolarization of the parasite’s mitochondrial membrane, and kills the asexual forms of plasmodium at the erythrocytic stage. Artemisinin selectively inhibits the production of estrogen receptor-alpha gene and thus, arrests the growth of estrogen responsive breast cancer cells. Artemesinin is not used for malaria prophylaxis because of it’s extremely short activity. Artemisinin is fast-acting and poorly bioavailable. The use of semi-synthetic derivatives and analogues of artemisinin, such as artesunate, and artemether, in the production of Artemisinin-based combination therapies (ACTs), for example, lumefantrine-artesunate, increase the therapeutic efficiency of artemisinin to more than 90%, and prevents recrudescence. Key words: Artemisinin, monotherapies, plasmodium, artemisinin-based combination therapies.

PROTOCOL: Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street‐connected children and young people

PROTOCOL: Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street‐connected children and young people

Cost Comparison of Baby Friendly and Non–Baby Friendly Hospitals in the United States

The objectives of this study were to provide an economic assessment of the incremental costs associated with obtaining the World Health Organization and United Nations International Children's Emergency Fund designation as a Infant-Friendly hospital. We hypothesized that baby-friendly hospitals will have higher costs than similar non-baby-friendly hospitals. Data from the 2007 American Hospital Association and the 2007 Centers for Medicare and Medicaid Cost Reports were used to compare labor and delivery costs in baby-friendly and non-baby-friendly hospitals. Operational costs per delivery were calculated using a matched-pairs analysis of a sample of baby-friendly and non-baby-friendly hospitals in the United States. Costs associated with labor-and-delivery diagnosis-related codes were analyzed for each baby-friendly hospital and compared with the mean and median costs incurred by non-baby-friendly hospitals. Nursery plus labor-and-delivery costs for the baby-friendly sites were $2205 per delivery, compared with $2170 for the non-baby-friendly matched pair. Baby-friendly facilities have slightly higher costs than non-baby-friendly facilities, ranging from 1.6% to 5%, but these costs were not statistically significant (P > .05). These results suggest that becoming baby-friendly is relatively cost-neutral for a typical acute care hospital. Although the overall expense of providing baby-friendly hospital nursery services is greater than nursery service costs of non-baby-friendly hospitals, the cost difference was not statistically significant. Additional research is needed to compare the economic impact of maternal and infant health benefits from breastfeeding versus the incremental expenses of becoming a baby-friendly hospital.

Appropriate infant feeding practices result in better growth of infants and young children in rural Bangladesh

BackgroundThe World Health Organization and the United Nations International Children's Emergency Fund recommend a global strategy for feeding infants and young children for proper nutrition and health. ObjectiveWe evaluated the effects of following current infant feeding recommendations on the growth of infants and young children in rural Bangladesh. DesignThe prospective cohort study involved 1343 infants with monthly measurements on infant feeding practices (IFPs) and anthropometry at 17 occasions from birth to 24 mo of age to assess the main outcomes of weight, length, anthropometric indexes, and undernutrition. We created infant feeding scales relative to the infant feeding recommendations and modeled growth trajectories with the use of multilevel models for change. ResultsMean (±SD) birth weight was 2697 ± 401 g; 30% weighed < 2500 g. Mean body weight at 12 and 24 mo was 7.9 ± 1.1 kg and 9.7 ± 1.3 kg, respectively. More appropriate IFPs were associated (P < 0.001) with greater gain in weight and length during infancy. Prior IFPs were also positively associated (P < 0.005) with subsequent growth in weight during infancy. Children who were in the 75th percentile of the infant feeding scales had greater (P < 0.05) attained weight and weight-for-age z scores and lower proportions of underweight compared with children who were in the 25th percentile of these scales. ConclusionsOur results provide strong evidence for the positive effects of following the current infant feeding recommendations on growth of infants and young children. Intervention programs should strive to improve conditions for enhancing current infant feeding recommendations, particularly in low-income countries.

Child wellbeing and income inequality in rich societies: ecological cross sectional study

. Pickett K.E. &amp; Wilkinson R.G. ( 2007 ) , 335 , 1080 – 1085 . DOI: 10.1136/bmj.39377.580162.55. Objectives To examine associations between child well‐being and material living standards (average income), the scale of differentiation in social status (income inequality), and social exclusion (children in relative poverty) in rich developed societies.Design Ecological, cross‐sectional studies.Setting Cross‐national comparisons of 23 rich countries; cross‐state comparisons within the USA.Population Children and young people.Main outcome measures The United Nations International Children's Emergency Fund index of child well‐being and its components for rich countries; eight comparable measures for the US states and District of Columbia (teenage births, juvenile homicides, infant mortality, low birth weight, educational performance, dropping out of high school, overweight, mental health problems).Results The overall index of child well‐being was negatively correlated with income inequality (r = −0.64, P = 0.001) and percentage of children in relative poverty (r = −0.67, P = 0.001) but not with average income (r = 0.15, P = 0.50). Many more indicators of child well‐being were associated with income inequality or children in relative poverty, or both, than with average incomes. Among the US states and District of Columbia all indicators were significantly worse in more unequal states. Only teenage birth rates and the proportion of children dropping out of high school were lower in richer states.Conclusions Improvements in child well‐being in rich societies may depend more on reductions in inequality than on further economic growth.

Feeding practices in 105 counties of rural China

China has the largest population in the world with more than 70% of the people living in rural areas. Over 34% of children under the age of 5 years are responded to show moderate or severe growth stunting, so United Nations International Children's Emergency Fund and Chinese Ministry of Health conducted this large-scale survey in China. This study aimed to learn the feeding practice, to find the problems in child-feeding practice and to provide evidence for the government to develop an approach to child malnutrition in rural China. A structured questionnaire was used to survey 21,036 mothers of children with age of 0-24 months. Of the 20,915 children, 98.22% were breastfeeding and 24.36% were exclusively breastfeeding. The proportion of children with weekly protein intake was 78.47%. Among the infants under 4 months, the risk of pneumonia in the group of exclusive breastfeeding was 1.69%, while in the group of non-exclusive breastfeeding was 3.63%, showing a statistically significant difference between the two groups. The risk of diarrhoea in the group of exclusive breastfeeding and in the group of non-exclusive breastfeeding among the infants under 4 months was 24.37% and 40.86%, respectively, also showing a statistically significant difference between the two groups. For children with age 4-6 months, the complementary feeding contributed to a higher prevalence of diarrhoea, but not pneumonia. The breastfeeding was very common, but the exclusive breastfeeding was quite low and the exclusive breastfeeding for children under the age of 4 months decreased the risks of pneumonia and diarrhoea. For children with age 4-6 months, the exclusive breastfeeding could decrease the risk of diarrhoea, too. Protein intake was insufficient for children in rural China. The rural people lacked health knowledge and were greatly influenced by traditional feeding practices.

Children’s Rights in the Context of HIV/AIDS in Southern Africa

Children in Southern Africa are living under extreme, difficult circumstances because of the spread of HIV/AIDS. Protecting and enhancing the rights of children can be regarded as an investment in the future. The principles identified in the World Fit for Children document from the United Nations International Children's Emergency Fund, within the context of HIV/AIDS, were used as a theoretical framework for a study conducted in one of the provinces of South Africa. A survey was conducted as a collaborative research project to map out critical trends regarding the fulfillment of children's rights, patterns, and structures of services available and the identification of capacity gaps. Right holders and duty bearers were interviewed, area surveys were conducted, and field observations were performed to determine data. Recommendations were made to raise the awareness of children's rights and to mobilize the community into action. To realize children's rights, emphasis must be placed on physical survival, development, and protection. Duty bearers should recognize and accept their responsibilities to establish, facilitate, manage, and/or control plans of action to address the devastating consequences of HIV/AIDS. Children should be empowered with knowledge, skills, and awareness to engage in and claim their rights.

Globalizing What: Education as a Human Right or as a Traded Service?

Globalizing What:Education as a Human Right or as a Traded Service? Katarina Tomasevski Introduction Globalization tends to be described as an extralegal phenomenon.1 This image does not apply to education for which there is international law, albeit composed of two parallel and disconnected legal regimes. International human rights law defines education as a human right; international trade law defines it as a service. 2 International human rights law is older than the law on trade in services, and domestic educational laws tend to be even older.3 Most of these define education [End Page 1] as compulsory and also as a right.4 Accordingly, they specify the corresponding governmental obligations. Large budgetary allocations for education reflect the legally defined extensive role of the state in education,5 and teachers are often the largest segments of the civil service.6 Against that role of the state in providing and/or financing education, globalization (defined as interaction across national borders unmediated by the state) fosters disengagement from education. The key facet of globalization, liberalization, is predicated on increasing the privatization of education,7 which demands decreased involvement of the state. In the 1990s, [End Page 2] this facet was built into the international law on trade in services, resulting in two conflicting legal regimes for education. International human rights law mandates state intervention, requiring it to ensure, at least, free and compulsory education for all children. International law on trade in services legitimates the sale and purchase of education, excluding those who are unable to purchase it, thereby jeopardizing the key human rights requirements that at least primary education should be free and compulsory. This article examines the practice of states in accommodating this legal duality of education. It focuses on the developing regions and countries in transition8 because the poverty of families, communities, and countries precludes access to education for many, if not most, unless education is free, namely provided or financed by the state. Its point of departure is international human rights law, which defines human rights—including the right to education—as universal. Its translation into reality would entail a minimum entitlement to education throughout the world, to be secured through international cooperation. Thereby governments would collectively comply with their human rights obligations. Consequently, globalization of education would be guided by a universal human rights obligation to ensure that education is free and compulsory for all school-age children in the world. However, the creation of international human rights law during the Cold War divided human rights into civil and political on the one hand, and economic, social, and cultural, on the other hand. Although education belongs in both categories, it also has been categorized as an economic, social, and cultural right. Its civil and political dimensions require respect of freedom; its social and economic dimensions mandate state provision and/or financing of education, while education as a cultural right often necessitates its affirmation as a collective right.9 [End Page 3] For the majority of countries in the world that recognize economic, social, and cultural rights,10 the corresponding human rights obligations presuppose governments' willingness and ability to raise revenue and devote the maximum available resources to human rights. An important aim is to ensure that education is free at the point of use, at least for compulsory education. Therein originates the conflict of laws. While international human rights law recognizes every child's entitlement to free education, international trade law makes access to education dependent on the ability to pay.11 Free trade does not have safeguards for the rights of the poor, least of all, for poor children. Hence, state intervention to safeguard free education for the millions of poor children necessitates corrective steps for the free market in education, facilitated by international cooperation. However, global development finance policies work in the opposite direction, as does trade in educational services.12 These counterpoised pressures, especially upon the governments of poor, impoverished, or indebted countries, result in an increasing incidence of for-fee rather than free education. [End Page 4] The phenomenon is not new; it was marked memorably by the United Nations International Children's Emergency Fund's (UNICEF) "Adjustment with a Human...

World report on violence and health: What it means for children and pediatricians

World report on violence and health: What it means for children and pediatricians

Vitamin A Deficiency and Golden Rice—A Literature Review

Purpose: To present one possible framework by which to appraise the potential for golden rice to prevent vitamin A deficiency (VAD)/xerophthalmia.Design: Literature review.Method: Twenty‐nine articles were read and the term ‘issue’ was used for factors that the authors of the articles or secondary sources identified as being either causative or protective of VAD/xerophthalmia. The term ‘issue’ was not used exclusively to indicate that the factor caused VAD/xerophthalmia.Setting: VAD and xerophthalmia in developing countries.Main Outcome Measure: The number of issues identified and the frequency with which they occurred.Results: Twenty issues were identified with varying degrees of frequency. Socio‐economic/environmental, parasitic infestation and dark green leafy vegetables were the issues mentioned most frequently. Each issue was addressed in relation to golden rice. It is difficult to ascertain whether the frequency with which an issue was raised is relative to how important it is in relation to the other issues. It is interesting to note that socio‐economic/environmental factors are regarded as the fundamental causes of VAD/xerophthalmia and in this review it was one of the most frequently occurring issues in the 29 articles.Conclusions: It appears that the elimination of VAD/xerophthalmia in developing countries is not likely in the foreseeable future, even with the introduction of golden rice. This genetically modified rice does little more than add another supplement to the market. The World Health Organization and the United Nations International Children's Emergency Fund have failed to eliminate VAD/xerophthalmia through the use of supplements, fortification and dietary modification. So of interest is the rationale behind spending public money to develop rice which has been genetically modified with pro‐vitamin A when other supplements have failed. It is the socio‐economic/environmental issues which impact on whether a population has VAD/xerophthalmia and these are not being addressed.

Training peer counselors to promote and support exclusive breastfeeding in Bangladesh.

Exclusive breastfeeding is rare in Bangladesh. About 90% of women have home deliveries, so the Baby-Friendly Hospital Initiative has no mechanism to reach them. Mother support groups do not exist, and community health workers do not have time to promote and support exclusive breastfeeding. To provide this kind of support at the community level, an area in Dhaka was selected for a peer-counseling intervention program. Using certain selection criteria, 1 woman from each community was trained as a peer counselor. The training was based on the World Health Organization/United Nations International Children's Emergency Fund 40-hour breastfeeding counseling course and related books. Counseling skills were taught using demonstrations and role play, followed by practical training in the project area. The intervention was very successful, as 70% of the mothers in the project area breastfed their infants exclusively for 5 months compared to only 6% in the control area. The authors describe the peer counseling training, strategies used for peer counseling visits, and lessons learned.

Striving for global drug availability

Chifumbe Chintu (photo) is professor of paediatrics and child health, and director of HIV/AIDS and TB research and training. Peter Mwaba is a consultant physician at the University Teaching Hospital and the Ministry of Health, Zambia. The lack of resources with which to pay for treatment of patients with infectious and non-infectious diseases in resource-poor nations, despite the proven efficacy of available drugs, raises several major ethical issues. The right of all human beings to enjoy living standards conducive to good health is enshrined in Article 25 of the United Nations Universal Declaration of Human Rights, established just over 50 years ago. This declaration states that “everyone has the right to a standard of living adequate for the health and well-being of themselves and of their family—including food, clothing, housing, and medical care and necessary social services—and the right to security in the event of unemployment, sickness, disability, widowhood, old age, or their lack of livelihood in circumstances beyond their control”. WHO and UNICEF (the United Nations International Children's Emergency Fund) reaffirmed this statement in 1978 in a joint Alma-Ata declaration. In part, this declaration states that the gross inequality in the health of people, particularly that between more-developed and less-developed countries, is politically, socially, and economically unacceptable. WHO and UNICEF called for a new economic order to address this inequality. WHO then set the goal of achieving health for all by the year 2000. Perhaps not surprisingly, this objective has not been met. Some of the major hurdles associated with essential medicines being unavailable in resource-poor nations include: general poverty; poor prescribing habits, including polypharmacy, as a result of limited diagnostic facilities; lack of national drug policies in some less-developed countries; and limited research aimed at establishing the most appropriate drugs and therapeutics in most less- developed countries. In 1996, the United Nations, in partnership with the World Bank and the International Monetary Fund, embarked on a special initiative of debt relief for Africa. The Jubilee 2000 initiative, in which cancellation of debts owed by the poorer nations to the wealthier ones is called for, is generating wide support. However, critics of this initiative argue that the funds freed by such debt cancellation might not reach those in greatest need. The overwhelming tragedy is that the poor people of the world are unable to help themselves. Governments in the less-developed world are limited in their ability to provide basic health care, in part as a result of their huge debts and the requirement to pay interest on loans provided by wealthy nations. The net result is the deterioration of health-care delivery. While African governments battle with the repayment of multi-billion-dollar debts, there are signs of continued deterioration in the delivery of health care. The above factors, taken together with the exorbitant cost of many drugs and therapeutic agents, make them beyond the reach of many poor nations. Even if finances for the purchase of essential drugs were available, these drugs would not necessarily be used correctly. Some of the erratic drug supplies seen in most resource-poor countries could be attributed to poor prescribing habits. Inaccurate prescription of drugs is commonly a result of limited or absent diagnostic facilities. If the supply of essential drugs and therapeutics is to be improved, the capacity for doctors and health-care workers in these countries to diagnose common ailments should be strengthened, and training and retraining should be tied in with programmes aimed at an increase in the drug supply. The tendency, in light of limited diagnostic facilities, is to prescribe many drug combinations so that a wide range of potential diagnoses is covered. To improve the quality and quantity of existing stocks of drugs, national bodies should be formed to supervise the procurement, quality control, stock management, and distribution of essential drugs. These bodies should work hand in hand with established institutions within WHO and UNICEF. In turn, WHO and UNICEF could provide technical and logistical support. Such bodies should, from time to time, review national policies on essential drugs on the basis of available evidence. Such bodies could also help in the reduction of costs. Major pharmaceutical companies in the western world are reluctant to invest in research on new drugs in less-developed countries because of a general lack of protection for innovations in most resource-poor nations. The World Trade Organisation should address the rules governing the trade-related aspect of intellectual property rights so that drugs to treat diseases of public-health importance—eg, respiratory infections, malaria, tuberculosis, and HIV and AIDS—could be made accessible to resource-poor countries.

Screening for congenital hypothyroidism used as an indicator of the degree of iodine deficiency and of its control.

Neonatal thyroid screening using serum thyrotropin (TSH) as the primary screening test detects not only permanent sporadic congenital hypothyroidism, whose incidence is about 1 per 4000 births, but also compensated or transient primary hypothyroidism, whose incidence can be as high as 1 in 10 neonates and whose main cause is iodine deficiency. Elevated serum TSH in the neonate indicates insufficient supply of thyroid hormones to the developing brain, and therefore, constitutes the only indicator that allows prediction of possible impairment of mental development at a population level, which is the main consequence of iodine deficiency. Therefore, the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), and the International Council for Control of Iodine Deficiency Disorders (ICCIDD) included neonatal TSH as one of the indicators for assessing iodine deficiency disorders (IDD) and their control. In the absence of iodine deficiency, the frequency of neonatal TSH above 5 mU/L whole blood (or 10 mU/L serum) is less than 3%. A frequency of 3%-19.9% indicates mild IDD. Frequencies of 20%-39.9% and above 40% indicate moderate and severe IDD, respectively. Neonates exhibit elevated serum TSH more frequently than adults for a similar degree of iodine deficiency. Consequently, they appear hypersensitive to the effects of iodine deficiency. This characteristic is explained by a particularly low iodine content of the thyroid of neonates and, consequently, by an accelerated turnover rate of their intrathyroidal iodine reserves. This turnover rate is 1% in adults. It is 17% in the neonate in conditions of iodine repletion, but is as high as 62% and 125% in conditions of moderate and severe iodine deficiency, respectively. Such an accelerated turnover rate requires thyroid hyperstimulation by TSH that is morphologically evidenced even in moderately iodine deficient neonates. Neonatal screening using primary TSH is implemented in most countries with mild IDD where it detects the cases of sporadic, permanent congenital hypothyroidism and where it is also used as a monitoring tool for IDD evaluation and control. However, the implementation of such programs in countries affected by moderate or severe IDD is still insufficient because of lack of resources of the countries. This should be considered in the framework of the external support often provided to these countries for the implementation of programs of universal salt iodization. Monitoring of these programs in order to achieve the goal of sustainable elimination of IDD now constitutes an absolute priority.

The pediatrician's role in the twenty-first century.

The world's children comprise: (i) those in wealthy, industrialized countries; (ii) those from rapidly industrializing countries; (iii) minority groups including recently arrived immigrants in otherwise affluent and healthy societies; (iv) previously traditional people in rapid transition to urbanized, Western lifestyles; and (v) many millions living in grinding poverty in overcrowded, unhygienic conditions where child mortality is high and often due to malnutrition and infections. Industrialization, affluence, better housing, hygiene and nutrition, better clinical care and disease prevention have helped enhance child health in many countries over the past century. However, this is being offset by obesity, smoking, alcohol and drug abuse and social disruption, mental disease and high rates of violence including homicide and suicide. These 'new morbidities' are worse among minorities and in populations undergoing rapid social change. Social pressures including unemployment, depression and family dysfunction are important. Pediatricians must become active in decisions about the use of public resources in disease prevention, health education and more rational and equitable use of high technology. They should also be active advocates for children and their rights and advise governments about all issues that affect child health, protection and well-being. This is particularly so in the poorest and developing countries. There is a need for better international collaboration, training and exchange programs involving the International Pediatric Association, United Nations International Children's Emergency Fund, World Health Organization and other local, national and regional organizations to help overcome these problems as the next century draws near.

Vitamin A and Respiratory Syncytial Virus Infection-Reply

With concern about vitamin A toxic side effects, Dr Donnelly wonders if the children with respiratory syncytial virus infection in our study 1 would have benefited more if we had given them β-carotene, a vitamin A precursor, rather than vitamin A solution. We found that a onetime oral administration of 100 000IU of vitamin A for 21 inpatient children infected with respiratory syncytial virus did not provide any measurable clinical benefit or cause vitamin A toxic effects. The dose of vitamin A in our study was based on the World Health Organization–United Nations International Children's Emergency Fund recommendations for the use of vitamin A for measles. 2 Evidence from African studies 3-5 have shown that vitamin A, not β-carotene, benefits patients with measles. The mean serum retinol levels in children with acute measles infection in those studies were approximately half of that in the US children with respiratory syncytial virus

The International Tuberculosis Campaign: a pioneering venture in mass vaccination and research.

If an American pediatrician's conversation with Dr. Johannes Holm, a Danish pathisiologist and future director of the International Tuberculosis Campaign, had not been interrupted, the campaign would probably not have become a monumental precedent for world health activities. The International Tuberculosis Campaign was conducted under the auspices of the United Nations International Children's Emergency Fund and three Scandinavian voluntary organizations. In a program that started in the war-torn areas of Europe, nearly 30 million persons underwent tuberculin testing, and almost 14 million were given BCG (bacille Calmette-Guérin) vaccine. In addition, a postgraduate school for physicians was initiated, new laboratories were established and old ones were improved, hundreds of young doctors and nurses were introduced to international public health, and, perhaps most important, research and service were successfully integrated. The success of the campaign led to its becoming the first major disease control and research activity of the World Health Organization.

The pioneers of rural Pakistan: the Lady Health Visitors.

Since 1978, when the World Health Organization and the United Nations International Children's Emergency Fund called for urgent action by all governments to provide appropriate health care for the underprivileged, the world community has attempted to implement primary health care strategies. Pakistan, with a population of 118 million people, is one of those countries where the rural population and the underprivileged groups in the katchi-abadis (squatter settlements) of the urban areas lack appropriate and accessible health services. This article highlights the community experiences of a remarkable group of young Muslim women, the Lady Health Visitors (LHVs) of the Aga Khan Health Services, who deliver primary health care services to disadvantaged women and children in the northern mountainous areas and rural villages of Pakistan. The LHVs are the first contact with the health care system that these underprivileged women experience. The LHVs cure, care, teach, and train traditional birth attendants. In addition, they perform health promotion and document their findings. To provide their maternal and child health services, the LHVs travel by foot through miles of rough terrain to settlements and villages. Prenatal and postnatal care, anemia, diarrhea, and malnutrition are among the major health care problems of these rural women and their children under 5 years of age.

Vitamin A Treatment of Measles

In spite of the availability of effective vaccines, measles continues to be a public health problem throughout the world. In 1990, the Centers for Disease Control received more than 27 672 reports of measles in the United States. Complications were reported in one third of infected children younger than 5 years of age.1 Of the 89 measles-related deaths in 1990, 55% occurred in children younger than 5 years old. Several recent investigations have indicated that vitamin A treatment of children with measles in developing countries has been associated with reductions in morbidity and mortality. The World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF) issued a joint statement recommending that vitamin A be administered to all children diagnosed with measles in communities where vitamin A deficiency (serum vitamin A &amp;lt;10 µg/dL) is a recognized problem and where mortality related to measles is ≥1%. The recommended regimen is 100 000 IU by mouth at the time of diagnosis for infants younger than 12 months of age, and 200 000 IU for older children. In the presence of ophthalmologic signs of vitamin A deficiency, such as night blindness, Bitot's spots (grayish white deposits on the bulbar conjunctiva adjacent to the cornea) or xerophthalmia, the WHO recommends the dose be repeated in 24 hours and again 4 weeks later.2 Vitamin A is available in low-cost liquid formulations and is supplemented in infant formulas (2000 µ/L). RATIONALE FOR VITAMIN A Vitamin A is a necessary substrate for preserving epithelial cell integrity and in addition plays a role in immune modulation.1-3

Community participation and involvement: theoretical and empirical issues.

In 1978, the World Health Organization (WHO) and the United Nations International Children's Emergency Fund (UNICEF), in their Alma Ata Declaration, declared a war against ill health and lack of access to and use of health services by advocating a joint effort among countries to bring health for all for the year 2000. Although such wars have been waged many times before, this time the declaration had a slightly different message, one paying respect to the people who are the target of that declaration. The message was to help people achieve their health potential within their abilities, values, and technologies by helping them help themselves. Other significant parts to this message included dealing with the use of local technology, the involvement of intersectorial cooperation, and the view of health as integral to development (WHO, 1978).