Child Health Research: Project Achievements
Acute Respiratory Infection (ARI)
- A 7-valent pneumococcal conjugate vaccine demonstrated an estimated efficacy of 77 percent among all children who received at least one dose of the vaccine prior to 24 months.
- Showed that improved nutrition in developing countries (including breastfeeding and reduction of low-birth weight) would greatly reduce pneumonia mortality.
- After the introduction of Haemophilus influenzae type b (Hib) conjugate vaccine into The Gambia, the annual incidence of Hib meningitis has fallen from more than 200 per 100,000 before vaccination to 21 per 100,000 in less than one year.
- Showed that ARI could be prevented in the developing world through improved nutrition and increased breastfeeding.
- A 45 percent reduction in pneumonia incidence with zinc supplementation in India.
- Determined that cotrimoxazole is effective for non-severe pneumonia, but amoxycillin is better for severe cases.
- 95 percent efficacy of Haemophilus influenzae type-b (Hib) conjugate vaccine in The Gambia.
- Improved case management of ARI and reduced antibiotic use by 26 percent and case fatality rate by 27 percent in Pakistan.
- Showed that maternal immunization against Streptococcus pneumoniae elevated infant serum antibody levels two-to-three fold higher than control infants.
Diarrheal Diseases
- Developed a standardized approach for
oral rehydration therapy
treatment of children with severe malnutrition and diarrhea that resulted in fewer episodes of hypoglycemia, less need for intravenous fluids, and a 47 percent reduction in mortality. These findings were incorporated into new WHO guidelines.
- Determined that El Nino increased hospital admissions due to diarrhea over 200 percent during the last season.
- Showed that approximately 40 percent of all hospitalized diarrhea cases are due to rotavirus in urban and rural Bangladesh. In addition, reanalysis of the efficacy of the past rotavirus vaccine trials in Peru and Brazil has demonstrated that a safe vaccine would have a significant public health impact.
- Characterized newly emergent pathogen Vibrio cholerae O139 and designed rapid diagnostic tests.
- Characterized a new toxigenic clone of Vibrio cholerae O1 El Tor.
- Designed a surveillance system to detect Vibrio cholerae O1 by sampling potable water and sewage in Peru.
- Designed an algorithm, using locally-available foods, that is up to 89 percent effective in treating persistent diarrhea (1996), and is now incorporated into the Integrated Management of Childhood Illness (IMCI) guidelines in over 79 countries around the world.
Infant and Neonatal Health
- Field research has found that zinc supplements reduce mortality by 66 percent in low birth weight (SGA) infants.
- A large multi-center study in The Gambia, Papua New Guinea, The Philippines and Ethiopia documented that S. pneumoniae and S. aureus are the most common causes of severe infections (together comprising more than 40 percent of infections) in neonates and young children. This emphasizes the necessity to maintain adequate stocks of drug formularies to combat these common neonatal pathogens, and establish an urgent need to deliver conjugate pneumococcal vaccines to the developing world.
- Low birth weight (LBW), not premature birth, was found to be the most important determinant for subsequent poor growth in infants and children. Because most study infants experienced chronic intrauterine undernourishment, catch-up growth was highly restricted and weight, at 12 months, was highly correlated with birth weight. Improvement of LBW is likely to lead to increases in one-year weight and overall infant nutrition
- In the process of developing a new diagnostic tool and treatment approach for Group B Streptococcus and bacterial vaginosis, which are major causes of perinatal/neonatal deaths.
- Validated the verbal autopsy method for determining infant death in a nationwide study in Bangladesh.
Infectious Diseases and Antimicrobial Resistance (AMR)
- Demonstrated that steroid therapy did not improve outcome in bacterial meningitis allowing WHO to make a clear recommendation against the use of steroids in this disease.
- Developed emergency response system for a dengue outbreak at the request of the Bangladesh government and mission. This approach has been adopted by WHO for use globally.
- Developed an innovative and field-appropriate education process involving immediate feedback and small group discussions, followed by self-assessment meetings. These efforts have reduced the number of children inappropriately treated with antibiotics for simple ARI from 70 percent to 23 percent.
- An ongoing effort to strengthen tuberculosis control and establish effective Directly Observed Treatment, Short Course (DOTS) campaigns in rural areas of Rio de Janeiro, Brazil. This work has demonstrated that 82 percent completion of all doses is achievable and that patient cure rates in a country with a 40 percent default rate of DOTS interventions can be improved. The program has already moved treatment success rates from 60 percent to 84 percent in its first year of existence.
- Trained key officials in Russia's Kemerovo region in the control of multi-drug resistant tuberculosis (MDR-TB) and assisted in the development of an action plan.
- Field testing of an innovative, rapid, and inexpensive technique for diagnosing TB in an urban slum of Lima, Peru that has some of the world's highest prevalence of TB and morbidity and mortality for HIV/MDR-TB.
- In Cambodia, the CHR project has developed and implemented a cross-training effort for the country's HIV and TB care programs. This has been accomplished by adding a TB component to an existing HIV-care program that provides home care to about 700 symptomatic patients in the greater Phnom Penh area.
- Implementation of a DOTS program in Indonesian hospitals and then linking them to the national TB program.
- A large multi-center study in India to document the etiology and antimicrobial resistance (AMR) of S. pneumoniae and H. influenzae invasive infections. This study has found up to 85 percent resistance to routinely used antimicrobial drugs. Higher levels of drug resistance were found in urban areas (78 percent cotrimoxazole resistance) vs. 39 percent in rural areas, and identified pneumococcal serotypes that should optimally be included in vaccine formulation for India.
- Developed Invasive Bacterial Infection Surveillance (IBIS) to monitor Streptococcus pneumoniae and Hemophilus influenzae - b prevalence and antibiotic resistance in India. IBIS found: Significant levels of resistance (up to 85 percent) to antimicrobial drugs; higher levels of drug resistance in urban areas (78 percent resistance to cotrimoxazole in New Delhi) than in rural areas (39 percent), and determined pneumococcal serotypes that must be included in vaccine formulation for India.
- Demonstrated that greater improvements in prescribing practices resulted when problem oriented, small-group educational approaches were used in addition to ongoing discussions among clinical peers that were reinforced by routine supervision and monitoring.
- Determined that physician prescribing practices were influenced by factors other than knowledge of the correct therapeutic choice. Factors, such as duration of practice, and caregivers' expectations have an important influence on physician prescribing practices of antimicrobials.
- Showed that compliance in administering cotrimoxazole preparations was strongly correlated with caregivers' difficulty in administering the medication.
Integrated Management of Childhood Illness (IMCI)
- Developed a tool to measure the effectiveness of counseling caregivers in treatment compliance that has been adopted by the Ugandan Ministry of Health as part of nationwide monitoring of worker performance.
- Developed simple guidelines for emergency triage assessment and treatment of patients in the developing world.
- Validated the basic IMCI outpatient guidelines for treatment of pneumonia, diarrhea, malnutrition and need for referral in six countries - these guidelines are the cornerstone of IMCI which are now widely implemented around the world.
- Validated IMCI guidelines were developed for need of referral in young infants and children with pneumonia in Bangladesh.
- Refined the malaria diagnosis guidelines for highly endemic areas.
- Developed an IMCI Course for Health Workers.
Nutrition and Micronutrients
- Daily zinc supplementation in small for gestational age babies documented a 66 percent reduction in mortality.
- Demonstrated that oral zinc supplementation in children under 5 reported a 24 percent reduced probability of continuing diarrhea and a 42 percent reduced probability of treatment failure or death in children with persistent-diarrhea.
- The use of zinc to prevent infectious diseases showed that zinc had a significant preventive effect on incidence and prevalence of diarrhea and pneumonia.
- Established the safety of vitamin A when administered with childhood immunizations.
- Established that a single, large postpartum dose of vitamin A raised breastmilk retinol levels in women, and reduced duration of ARI and febrile illness in their infants.
- Among young mothers with infants hospitalized for diarrhea, exclusive breastfeeding levels were increased significantly to 75 percent through the use of community lactation counselors.
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