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Thu Dec 9 03:57:02 EST 2010


most likely to die during humanitarian crises caused by famine, war, and =
natural disasters. Relief agencies are keenly aware of this and do their =
utmost to save as many young lives as possible as well as maintain the =
standard of health care children enjoyed before disaster hit. A 2006 =
report by the National Research Council, Child Health in Complex Emergencie=
s, suggests, however, that these agencies' efficiency in terms of =
safeguarding child health might be increased if a set of common, comprehens=
ive, evidence-based clinical guidelines were available for use by all. The =
report defines a complex emergency as a situation of armed conflict, =
population displacement, food insecurity (which could be caused by =
extended drought, some other natural disaster, or other circumstances), or =
some combination of these situations with an associated increase in =
mortality and malnutrition. In addition, during the acute phase, the =
mortality rate will be at least double that of baseline. Currently, the =
report shows, some agencies have their own guidelines for addressing =
certain areas of child health during emergencies, but lack them for =
others. Many, however, use guidelines produced by authorities such as the =
WHO and UNICEF-guidelines that were produced for stable, noncrisis =
situations, and that might therefore be less applicable in emergency =
settings. Still others have a distinct lack of clinical guidelines. In =
addition, many of those guidelines that do exist have either never been =
assessed for effectiveness or are aimed at physicians, when it is actually =
personnel with less medical training-including field-instructed volunteers =
not formally trained in the care of children-who often take on the bulk of =
child health care provision. Further, these guidelines may not be in a =
language local health workers understand.=20
The report throws down a daunting challenge: to produce a single set of =
locally adaptable clinical guidelines covering all child health problems =
likely to be encountered in emergency situations, then tailor them to the =
different expertise levels necessary and translate them into several =
different languages. This gargantuan task begs the question of whether =
this is feasible from the viewpoint of human and financial resources. Do =
relief agencies have the time, money, and personnel to devote to such a =
project? What would be the forum for such a venture? Who would provide =
leadership? Would the fear of surrendering independence hinder the =
adoption of common clinical guidelines by some agencies? In short-can this =
be done?=20
Why Child Health?
Children under the age of 5 regularly bear the brunt of the death toll =
associated with complex emergencies. The medical literature eloquently =
shows the need for special attention to child health in such situations. =
According to a 4 August 1993 JAMA report, of all those who died in the =
1991 Kurdish refugee crisis, two-thirds were under 5 years of age. In the =
10 April 1993 issue of The Lancet, another team reported that during the =
1992 Somali famine, 74% of all children under age 5 in displaced persons =
camps died. Four years later, in the 5 April 1997 issue of The Lancet, yet =
another team reported that in 1996, 54% of all the deaths among refugees =
from Rwanda and Burundi who fled to eastern Zaire were under the age of 5.
 Read this important editorial free of charge at  http://www.ehponline.org/=
docs/2006/114-10/focus-abs.html=20



Colen CG et al. Maternal Upward Socioeconomic Mobility and Black-White =
Disparities in Infant Birthweight American Public Health Association 2006 =
96: 2032-2039
The authors set out to estimate the extent to which upward socioeconomic =
mobility limits the probability that Black and White women who spent their =
childhoods in or near poverty will give birth to a low-birthweight baby. =
They analyzed data from the National Longitudinal Survey of Youth 1979 and =
the 1970 US Census to complete a series of logistic regression models.=20
The authors found that for=20
v	White women, the probability of giving birth to a low-birthweight =
baby decreases by 48% for every 1 unit increase in the natural logarithm =
of adult family income, once the effects of all other covariates are taken =
into account.=20
v	Black women, the relation between adult family income and the =
probability of low birthweight is also negative; however, this association =
fails to reach statistical significance.=20
The authors conclude that upward socioeconomic mobility contributes to =
improved birth outcomes among infants born to White women who were poor as =
children, but the same does not hold true for their Black counterparts.=20


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The National Fetal and Infant Mortality Review Program is a partnership =
between ACOG and federal MCHB.



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