Article Text

Download PDFPDF

Highlights from this issue
  1. Nick Brown, Editor in Chief1,2,3
  1. 1 Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
  2. 2 Department of Paediatrics, Länssjukhuset Gävle-Sandviken, Gävle, Sweden
  3. 3 Department of Child Health, Aga Khan University, Karachi, Pakistan
  1. Correspondence to Dr Nick Brown, Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden; nickjwbrown{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Literally literacy

Though this issue won’t appear for another 3-4 weeks, given the painful events unravelling in Afghanistan, it would feel banal to the point of negligence to fail to ask ‘where are we going’ in terms of global human rights.

Many years ago, I took a short course on ‘primary health care in low and middle countries’ to equip myself with some knowledge of the public health issues I was likely to encounter first in Sudan and later Afghanistan. Though the teaching was a little too ‘touchy feely’ for my taste, it left an impression based on one talk and one message: female literacy. Once assimilated, I realised that this was central to everything

I was based close to Kabul, during the immediate, relatively upbeat (if not as openly urbane as the 1970s) post-Soviet withdrawal era and have maintained some contact in the form of research collaborations with colleagues in the Afghan Ministry of Health. In parallel, we have seen the tantalising promise of a future of freedom and children’s futures and women’s rights snatched away so abruptly, the purple period from 2001 to 2021 already feeling illusory

So, when the headlines change as they inevitably will (tabloid attention no doubt turning to the off-duty improprieties of a footballer or mid-ranking cabinet member) don’t forget that if classrooms can be kept open, then there is still hope.

Global child health: maternal infection and perinatal outcome

Continuing the neonatal sepsis theme discussed by Carolin Fleischmann and colleagues in the August issue ( Adama Baguiya’s WHO maternal sepsis (GLOSS) group takes another angle, the identification of high risk babies by the mothers’ peripartum condition. Using data from 43 LMICs, neonatal outcomes of mothers with suspected or proven sepsis were compared with those in whom there were no concerns. The direction of effect (predictive) was perhaps not surprising, though the magnitude was. A third of the babies of these women had adverse outcomes: 25% near miss events (outcomes requiring intervention or resuscitation of some sort) and a 10% mortality with an OR of 3.8 (95% CI 2.0 to 7.1) for the most severely unwell mothers. How then can these women be identified earlier before both they and the fetus starts to decompensate? See page 946

Opiates in analgesia

We all have a preferred opiate for analgesia resistant to first and second line alternatives and this particular choice has been, for as long as I can remember, if not divisive then factionalising.

From buprenorphine patches to intranasal fentanyl to oral dextromoramide (the latter admittedly now largely a museum piece) to codeine, each has its (often vocal) proponents, the volume of their arguments not necessarily a correlate of analgesic effect.

In the Drugs and Therapeutics section, Sarah Spenard and colleagues address this chestnut in their systematic review of the literature comparing morphine and hydromorphone, the turn to opioid in the face of the nausea and (histamine agonism-related) pruritus for which morphine itself is renowned. They found high quality evidence from 4 RCTs concluding there was nothing to choose between them in terms of therapeutic or side effects. So, rather than weighing up which opiate, the only question worth asking is ‘is there a reason not to start one now?’ in the face of a child struggling on high dose NSAID treatment. See page 1002

Safety reporting

We are the proud discovers of a new antimicrobial drug, let’s call it ‘viroblast 21’, the performance of which in phase two trials has been (our brochures proclaim) ‘breathtaking’. Agog with excitement, we proceed to the ‘definitive’ randomised controlled trial in children admitted to PICU for respiratory support. The ‘fully adjusted analyses’ (inverted commas, of course intentional) repay the faith we had in the drug, a ‘jaw dropping’ protective HR in time to recovery of 0.2 (95% CI 0.1 to 0.35). The tension is released and celebrations can begin… or can they? The message in Taco Jan Pils’ and colleagues’ systematic review of trials reporting is that, even now, in the era of EQUATOR, CONSORT, siblings and half siblings safety data is often overlooked. Though reporting has improved over the decade since their previous review, it’s baffling that it isn’t 100%. Part of the story is missing. Taking a tangential trajectory, it would be reasonable to argue that the sort of safety reporting leaves a few more loopholes: I want to know whether children can swallow the preparation; whether it tastes good (or at least isn’t emetogenic); and that the cost is not crippling for the health service or patients and parents by which it will ultimately be financed. This too (the economic burden) is also to my mind a side effect: where resources are finite, something else will have to give. Maybe that mouthwatering ‘effect size’ didn’t tell us everything we need to know. See page 1010

Fixing a hole where the rain gets in

The reality is that much of what we do, despite the best public health preventative measures is reactive. The asthmatic child’s parents of ‘who only ever smoke outside’ are advised to stop or get help/gum/patches.

I’m digressing but only slightly as, what I’m getting at are the upstream (preventative) vs downstream (symptomatic) approaches. Until recently, all treatment in cystic fibrosis was, by necessity, reactive/downstream: the advent of the CF transmembrane modulator family, correctors and potentiators has changed all this. Iolo Doull’s compelling review from the discovery of the molecule to the consistent improvements in all objective measures of lung and overall health by its augmentation testifies to this. This is exciting for other reasons too: in the same way that anti-retroviral treatment in HIV became bolder and gathered pace, there is impetus for novel orphan drug development with implications beyond CF alone. See page 941

Linked Articles

  • Review
    Claire Edmondson Christopher William Course Iolo Doull
  • Drug therapy
    Taco Jan Prins Corine Rollema Eric van Roon Tjalling de Vries
  • Global child health
    Adama Baguiya Mercedes Bonet José Guilherme Cecatti Vanessa Brizuela Ala Curteanu Meile Minkauskiene Kapila Jayaratne Carolina Carvalho Ribeiro-do-Valle Mihaela-Alexandra Budianu João Paulo Souza Séni Kouanda the GLOSS research group Mohammad Iqbal Aman Bashir Noormal Virginia Díaz Marisa Espinoza Julia Pasquale Charlotte Leroy Kristien Roelens Griet Vandenberghe M Christian Agossou Sourou Goufodji Keke Christiane Tshabu Aguemon Patricia Soledad Peralta Víctor Conde Altamirano Rosalinda Hernández Muñoz Vincent Batiene Kadari Cisse Henri Gautier Ouedraogo Cheang Kannitha Lam Phirun Tung Rathavy Elie Simo Pierre-Marie Tebeu Emah Irene Yakana Javier Carvajal María Fernanda Escobar Paula Fernández Lotte Berdiin Colmorn Jens Langhoff-Roos Wilson Mereci Paola Vélez Yasser Salah Eldin Alaa Sultan Abdulfetah Abdulkadir Abdosh Alula M Teklu Dawit Worku Kassa Richard Adanu Philip Govule Charles Noora Lwanga William Enrique Romero María Guadalupe Aceituno Carolina Bustillo Rigoberto Castro Bredy Lara Vijay Kumar Vanita Suri Sonia Trikha Irene Cetin Serena Donati Carlo Personeni Guldana Baimussanova Saule Kabylova Balgyn Sagyndykova George Gwako Alfred Osoti Zahida Qureshi Raisa Asylbasheva Aigul Boobekova Damira Seksenbaeva Faysal El Kak Saad Eddine Itani Sabina Abou Malham Diana Ramašauskaitė Owen Chikhwaza Luis Gadama Eddie Malunga Haoua Dembele Hamadoun Sangho Fanta Eliane Zerbo Filiberto Dávila Serapio Nazarea Herrera Maldonado Juan Ismael Castañeda Tatiana Caraus Victor Petrov Yadamsuren Buyanjargal Seded Khishgee Bat-Erdene Lkhagvasuren Bouchra Assarag Amina Essolbi Rachid Moulki Nafissa Bique Osman Zara Jaze Arlete Mariano Hla Mya Einda Thae Maung Maung Khaing Nwe Tin Tara Gurung Amir Babu Shrestha Sangeeta Shrestha Kitty Bloemenkamp Marcus J Rijken Thomas Van Akker María Esther Estrada Néstor Pavón Gómez Olubukola Adesina Chris Aimakhu Bukola Fawole Rizwana Chaudhri Saima Hamid M Adnan Khan María del Huatuco Hernández Nelly Zavaleta Pimentel Maria Lu Andal Carolina Paula Martin Zenaida Dy Recidoro Lucian Pușcașiu Léopold Diouf Dembo Guirassy Philippe Marc Moreira Miroslav Borovsky Ladislav Kovac Alexandra Kristufkova Sylvia Cebekhulu Laura Cornelissen Priya Soma-Pillay Vicenç Cararach Marta López María José Benedé Hemali Jayakody Dhammica Rowel Mohamed Elsheikh Wisal Nabag Sara Omer Victoria Tsoy Urunbish Uzakova Dilrabo Yunusova Thitiporn Siriwachirachai Thumwadee Tangsiriwatthana Catherine Dunlop Marian Knight David Lissauer Aquilino M Pérez Jhon Roman Gerardo Vitureira Dinh Anh Tuan Luong Ngoc Truong Nghiem Thi Hanh Mugove Madziyire Thulani Magwali Stephen Munjanja Edgardo Abalos Mónica Chamillard Bukola Fawole Pisake Lumbiganon Ashraf Nabhan Ruta Nadisauskiene Linda Bartlett Fernando Bellissimo-Rodrigues Shevin T Jacob Sadia Shakoor Khalid Yunis Liana Campodónico Cristina Cuesta Hugo Gamerro Daniel Giordano Fernando Althabe Mercedes Bonet Vanessa Brizuela A Metin Gülmezoglu João Paulo Souza
  • Drug therapy
    Sarah Spénard Charles Gélinas Evelyne D. Trottier Fannie Tremblay-Racine Niina Kleiber