Lancet：腹泻计划每年可挽救200万儿童

　　根据世界卫生组织(WHO)和联合国儿童基金会(UNICEF)的计划，如果在全球肺炎和腹泻死亡率最高的75个国家实施已在发达国家成功保护儿童免受这两种疾病伤害的策略，将有可能每年挽救200万儿童的生命。《柳叶刀》杂志4月12日围绕这一话题在线发表了4篇文章。

　　“预防与控制肺炎与腹泻综合全球行动计划”以经过实践检验的策略为基础，例如良好营养、安全饮水、头6个月内完全母乳喂养，在正确时间获得正确药物用于预防和治疗这2种疾病，以及在最高危儿童中普及可挽救生命的干预手段。

　　UNICEF卫生项目全球主管Mickey Chopra博士在WHO新闻发布会上指出：“我们知道该做什么。假如在死亡率最高的这75个国家能达到在最富裕的20个国家实施这些策略时所达到的覆盖率，我们最早在2015年就能预防200万儿童死亡。2015年是‘千年发展目标’的截止期限。”

　　WHO妇女、新生儿、儿童与青少年健康部门主任Elizabeth Mason博士在新闻发布会上指出，孟加拉、柬埔寨、埃塞俄比亚、马拉维、巴基斯坦和坦桑尼亚等国的经验表明，将针对这2种致命性疾病的预防措施密切整合，更能有效增进健康。这项全球行动计划旨在促进这种整合，在减少无用功的同时获得协同效应。它的目标是使90%的儿童能够获得针对肺炎的抗生素和针对腹泻的口服补液盐，目前能获得这2种治疗资源的儿童分别仅占31%和35%。

　　该计划还试图使年龄＜5岁的儿童的严重肺炎和严重腹泻发病率比2010年降低75%。最终目标是在2025年之前，将5岁以下儿童的肺炎死亡率降至3例/1,000活产以下，腹泻死亡率降至1例/1,000活产以下。为了遏制这些疾病的扩散，该计划还将致力于使医疗机构和家庭能够获得基本饮水、环境卫生，以及洗手所需的水和肥皂。

　　“上述解决方案并不需要什么高新技术。我们已经掌握了被证明有效的干预手段。很多儿童死亡的原因是医疗卫生服务过于零散，而且最高危的儿童未能获得这些服务。”

　　全球儿童死亡中有28.5%归咎于肺炎和腹泻，2011年约有200万儿童死于这2种疾病。疾病负担最重的是撒哈拉以南非洲和南亚，死于肺炎、腹泻的儿童有近90%来自这2个地区。英国爱丁堡大学的Harry Campbell博士和Igor Rudan博士指出，只要花费60亿~70亿美元，在2025年之前就能避免95%的腹泻死亡和67%的肺炎死亡，而这笔费用仅占2012年伦敦奥运会支出的1/4。

　　“我们完全有能力实施减少儿童肺炎和腹泻死亡的计划。结果将取决于我们对儿童生存率的重视程度和投资力度。”

与腹泻相关的拓展阅读：

• CGH：胆汁酸合成与肠易激综合征腹泻有关
• PLOS ONE：含抗菌溶菌酶山羊奶可加快腹泻康复速度
• FDA批准首个用于HIV/AIDS患者抗腹泻药
• 联合国儿基会：洗手是预防腹泻病最简宜方法
• 临床实践——慢性腹泻的治疗 更多信息请点击：有关腹泻更多资讯

Pneumonia, Diarrhea Plan May Save 2 Million Children Yearly
By applying strategies that successfully protect children in the world's richest countries from pneumonia and diarrhea to the 75 countries around the globe with the highest death rates for both ailments, 2 million children's lives could be saved each year, according to an ambitious plan outlined by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).
The group's Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea relies on such tried and true strategies as good nutrition, safe drinking water, exclusive breast-feeding for the first 6 months of life, and access to the right medicines at the right time to prevent and treat the 2 diseases, slash mortality rates, and extend life-saving interventions to the world's most vulnerable children. The evidence base for the global action plan is expanded on in a series of 4 papers published online April 12 by the Lancet.
"We know what to do. If, in the 75 countries with the highest death rates, we apply to the entire population the same coverage of essential interventions enjoyed by the richest 20 per cent of households, we can prevent the deaths of 2 million children even as soon as 2015, the deadline for the Millennium Development Goals," Mickey Chopra, PhD, global head of UNICEF's health programs, said in a WHO news release.
Already, countries such as Bangladesh, Cambodia, Ethiopia, Malawi, Pakistan, and Tanzania have demonstrated that closely integrating prevention strategies for both lethal ailments, rather than operating them on parallel tracks, can improve health, Elizabeth Mason, MD, the WHO's director of maternal, newborn, child and adolescent health, said in the WHO news release.
The global action plan seeks to expand such integration efforts, reduce inefficiencies, and capture synergies. It aims to give 90% of all children access to antibiotics for pneumonia and oral rehydration salts for diarrhea, which is a major improvement from the current rates of 31% and 35%, respectively.
The plan also seeks to reduce the incidence of severe pneumonia and severe diarrhea for children younger than 5 years by 75% compared with 2010 levels. The ultimate goal is to lower mortality in children younger than 5 years from pneumonia to fewer than 3 per 1000 live births and from diarrhea to less than 1 per 1000 live births, by the year 2025.
To tamp down on the overall spread of these diseases, the plan aims to work toward universal access to basic drinking water, adequate sanitation, and water and soap for hand washing in healthcare facilities and homes, among other strategies.
"The solutions to tackling pneumonia and diarrhoea do not require major advances in technology," the action plan states. "Proven interventions exist. Children are dying because services are provided piecemeal and those most at risk are not being reached. Many of the causes and solutions for childhood pneumonia and diarrhoea are inter-related, and thus, this plan proposes an innovative approach for integrating the planning, delivery and monitoring of health interventions for these two diseases."
Around the world, pneumonia and diarrhea are responsible for 28.5% of all deaths among children, which resulted in roughly 2 million childhood deaths in 2011. The highest burden is in sub-Saharan Africa and South Asia, where nearly 90% of pneumonia and diarrhea deaths among children occur. About 95% of deaths from diarrhea could be averted and 67% of deaths from pneumonia could be prevented by 2025 for $6 to $7 billion, less than one quarter of what was spent to hold the 2012 Olympics, note the coauthors of a Lancet paper, Professor Harry Campbell, MD, and Professor Igor Rudan, PhD, DSc, MD, both from the University of Edinburgh, United Kingdom, in the news release.
"The solutions to reducing childhood pneumonia and diarrhoea deaths are well within our capacity," state the authors of the third Lancet series article from Boston University School of Public Health, WHO, UNICEF, and the Clinton Health Access Initiative, in the news release. The pathway "depends on how we prioritise child survival and the investments we choose to make," they continue.