How are the healthcare needs of children changing in the developing world? How can poor countries most effectively use limited resources to improve child health? What should their priorities be? To design effective strategies for improving health, it is important to know the most significant problems and select appropriate cost-effective approaches.

Research co-ordinated by the World Health Organisation (WHO) reviewed childhood disease patterns in the developing world. Public health programmes do not currently cover some significant components of the childhood disease burden. Injuries and non-communicable diseases (NCDs) are becoming increasingly important.

Child healthcare programmes in developing regions prioritise diseases linked to poverty - infections, malnutrition, and complications of childbirth. Although these continue to be the major health problems affecting children in poorer countries, other threats are emerging.

Socio-economic changes can transform disease patterns. Improved life expectancy, falling birth rates and urbanisation mean that an increasing proportion of child health problems arises from injuries and NCDs.

Researchers determined Disability Adjusted Life Years (DALYs - a measure of years lost through disability or premature death) attributable to various causes. They focused on injuries, asthma, dental decay, epilepsy, diabetes and rheumatic heart disease as conditions in childhood for which large-scale public health interventions may be feasible in developing countries.

The study revealed that:

• 28 percent of the childhood disease burden in developing countries is attributable to injuries and NCDs. This is expected to rise to 45 percent in 2020.
• Falls, drowning and road traffic accidents are the main causes of unintentional childhood injury. Injuries also result from war, domestic violence and accidents in the home.
• 90 percent of asthma cases occur in developing regions, costing 2.5 DALYs per 1000 population.
• Dental decay is also a significant source of lost DALYs for children in developing countries (1.3 per 1000 population).
• Treatment for epilepsy is often absent or incorrect due to lack of training, poor compliance with or unavailability of drug treatment, and social prejudice.
• Death rates for children within four to six years of diagnosis with diabetes range from 30 to 100 percent in many countries.

Recommendations for policy-makers addressing these health problems include:

• adapting cost-effective interventions to the local context of health patterns and resources
• investigating the cost and effectiveness of interventions to prevent injuries and NCDs among children
• formulating strategies to combat child abuse by raising public awareness, providing counselling and support, and training healthcare workers and police officers to identify and refer cases of abuse
• applying lessons about surveillance, integration and community participation from existing healthcare programmes to the control of injuries and NCDs
• integrating these strategies into existing frameworks such as child survival or school health programmes
• expanding the role of community health workers to include family education on injury prevention and NCDs.

Source(s):
'Injuries and non-communicable diseases: emerging health problems of children in developing countries' by J. Deen, T. Vos, S. Huttley and J. Tulloch, Bulletin of the World Health Organisation 77 (1999)

Funded by: World Health Organisation

id21 Research Highlight: 1 June 2001

Further Information:
Sharon Huttly
Maternal and Child Epidemiology Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0)207 299 4674
Fax: +44 (0)20 7299 4625
Contact the contributor: sharon.huttly@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Other related links:
UNICEF's State of the World's Children report is now on-line.

There is another issue of the WHO Bulletin on child mortality.

The WHO is a good starting point for information on non-communicable diseases.

The Health of Populations in Transition site has details of this NCD research programme.