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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

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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