WHO publishes new standard for documenting the health of children and youth

24 OCTOBER 2007 | GENEVA/VENICE -- WHO publishes the first internationally agreed upon classification code for assessing the health of children and youth in the context of their stages of development and the environments in which they live.

The International Classification of Functioning, Disability and Health for Children and Youth (ICF–CY) confirms the importance of precise descriptions of children's health status through a methodology that has long been standard for adults. Viewing children and youth within the context of their environment and development continuum, the ICF–CY applies classification codes to hundreds of bodily functions and structures, activities and participation, and various environmental factors that restrict or allow young people to function in an array of every day activities.

The rapid growth and changes that occur in first two decades of life were not sufficiently captured in the International Classification of Functioning, Disability and Health (ICF), the precursor to the ICF–CY. The launch of the ICF–CY addresses this important developmental period with greater detail. Its new standardized coding system will assist clinicians, educators, researchers, administrators, policy makers and parents to document and measure the important growth, health and development characteristics of children and youth.

Children who are chronically hungry, thirsty or insecure, for example, are often not healthy and have trouble learning and developing normally. This classification provides a way to capture the impacts of the physical and social environment so that these can be addressed through social policy, health care and education systems to improve children's well-being.

"The ICF-CY will help us get past simple diagnostic labels. It will ground the picture of children and youth functioning and disability on a continuum within the context of their everyday life and activities. In this way it enables the accurate and constructive description of children’s health and identifies the areas where care, assistance and policy change are most needed," said Ros Madden, Australian Commission on Safety and Quality in Health Care, and, Chair of the Functioning and Disability Reference Group of the WHO Family of International Classifications (WHO-FIC) Network.

The ICF–CY has important implications globally for research, standard setting and mobilizing resources. "For the first time, we now have a tool that enables us to track and compare the health of children and youth between countries and over time," said Nenad Kostanjsek of WHO's Measurement and Health Information team. "The ICF–CY will allow countries and the international community to take informed action to improve children's health, education and rights, by treating their health as a function of the environment that adults provide."

The classification also covers developmental delay. Children who achieve certain milestones later than their peers may be at increased risk of disability. Using this classification, health practitioners, parents and teachers can describe these delays precisely in order to plan for health and educational needs and frame policy debates. The children and youth version of the International Classification of Functioning, Disability and Health (ICF-CY) is launched today in Venice, with international praise:

"The publication of the ICF-CY by the WHO provides, for the first time, a standard language to unify health, education and social services for children," said Dr. Margaret Giannini, Director of the Office of Disability, U.S. Department of Health and Human Services.

"This approach offers a scientific basis for describing each child's functional abilities using a shared language. Further, the ICF-CY has important implications for educational policy, research, and service designs for children and youth with disabilities," said Mary Ruth Coleman Ph.D., President Council for Exceptional Children (2007).

"The ICF-CY is a tool that can be shared by clinical services as well as by schools, community agencies and government entities. Further, with the visibility of an international WHO standard, the ICF-CY can serve to affirm the universal needs and rights of children," said Rune J. Simeonsson, Chair, WHO Work group on ICF-CY Children and Youth; University of North Carolina.

"The approach of focusing on how children and youth function physically, socially and mentally within the context of their development and environment has important implications for special education," said Yutaka Oda, President, National Institute of Special Education, Japan.

For further information, please contact:

Nenad Kostanjsek
Technical Officer
WHO, Geneva
Tel.: +41 22 791 3242
Fax: +41 22 791 4894
E-mail: kostanjsekn@who.int

Lina Reinders
Communications Officer
WHO, Geneva
Tel.: +41 22 791 1828
Fax: +41 22 791 1967
E-mail: reindersl@who.int

Childhood blindness

Main causes of visual impairment Cataract Trachoma Onchocerciasis (river blindness) Childhood blindness Refractive errors and low vision Diabetic retinopathy Glaucoma Age related macular degeneration Corneal opacities Genetic eye disea

Definition

Children in Americas - Download the picture [jpg 314kb]

Childhood blindness refers to a group of diseases and conditions occurring in childhood or early adolescence, which, if left untreated, result in blindness or severe visual impairment that are likely to be untreatable later in life. The major causes of blindness in children vary widely from region to region, being largely determined by socioeconomic development, and the availability of primary health care and eye care services. In high-income countries, lesions of the optic nerve and higher visual pathways predominate as the cause of blindness, while corneal scarring from measles, vitamin A deficiency, the use of harmful traditional eye remedies, ophthalmia neonatorum, and rubella cataract are the major causes in low-income countries. Retinopathy of prematurity is an important cause in middle-income countries. Other significant causes in all countries are congenital abnormalities, such as cataract, glaucoma, and hereditary retinal dystrophies

Magnitude

According to Gilbert and Foster, the prevalence of blindness in children varies according to socioeconomic development and under-5 mortality rates. In low-income countries with high under-5 mortality rates, the prevalence may be as high as 1.5 per 1000 children, while in high-income countries with low under-5 mortality rates, the prevalence is around 0.3 per 1000 children. Using this correlation to estimate the prevalence of blindness in children, the number of blind children in the world is approximately 1.4 million. Approximately three-quarters of the world’s blind children live in the poorest regions of Africa and Asia.

Prevention and treatment

Prevention and treatment of childhood blindness is disease specific. For Vitamin A deficiency, at a cost of only 5 US cents a dose, vitamin A supplements reduce child mortality by up to 34% in areas where Vitamin A deficiency is a public health problem. As vitamin A deficiency manifests often during an outbreak of measles, properly planned and implemented national vaccination programmes against measles has reduced the prevalence of eye complications. In middle income countries, retinopathy of prematurity (ROP) is among the leading causes of blindness, the incidence of which can be reduced through availability and affordability of screening and curative services. Early treatment of cataract and glaucoma can be beneficial, while low vision devices are helpful in children with residual vision.

VISION 2020 role

On an annual basis VISION 2020 partners have been actively involved in distributing millions of vitamin A capsules to those in need. They have also been involved in the development of pediatric eye care services. The Lions Clubs International Foundation, through their "SightFirst" Initiative is one of the major partners with WHO/VISION 2020 in addressing the causes of childhood blindness. Because of its extensive social and emotional burdens, prevention of childhood blindness is generally high on the agenda when countries develop a national VISION 2020 Action Plan. The causes of childhood blindness, amenable to prevention and treatment, receive attention, not only because there are interventions available to handle these conditions, but also devastating consequences if not addressed.

Shirin Ebadi

Founder and leader of Iranian Children's Right Society:
http://www.iranianchildren.org/index.php

Nobel Peace Prize winner 2003:
Presentation speech

The great Persian poet, Rumi or Mowlavi as Iranians like to call him, lived in the 13th century. Somewhere in his great work "Mathnawi", there is a short poem about a miserable wretch who came under attack by a ferocious dragon. A heroic rescuer rushed in at the last moment, and Rumi's comment is:

"There are such helpers in the world, who rush to save
anyone who cries out. Like Mercy itself,
they run towards the screaming.

And they can't be bought off.
If you were to ask one of those, "Why did you come
so quickly?" he or she would say, "Because I heard
your helplessness."

Another of the great Persian poets, Saadi of Shiraz, who also lived in the 13th century, says in the well-known work "The Rose Garden" – Golistan – that he who is indifferent to the suffering of others is a traitor to that which is truly human.

Dear Shirin Ebadi,

You and the Iranian people represent the tradition of Saadi and Rumi. You are both guide and bridge-builder. You strive to bring people together across cultures, races and religions! That is your hallmark!

The Norwegian poet, Arne Paasche Aasen, wrote in 1939 the lovely poem "Your youth" – about being young in spirit – where he says:

"Now cries the world: We need your heart,
your gifts, your flaming spirit!
And were you to be given youth to have and keep
Then use it – use all your energy and powers"

Dear Shirin Ebadi,

You are young in spirit. You possess great gifts. You have a warm heart. You are brave. We admire your efforts. The world needs you!

Congratulations with the 2003 Nobel Peace Prize! The Norwegian Nobel Committee is convinced that the Peace Prize has been awarded to the right person, at the right time and in the right place. When the director of the Nobel Institute telephoned Shirin Ebadi's home in Teheran to tell her the good news, her husband answered that his wife was in Paris and would not be easy to get hold of – she had forgotten her mobile telephone at home. Nevertheless, the news that you had been awarded the Nobel Peace Prize reached you very quickly in Paris, and the entire conference broke out in enthusiastic jubilation. Later, we learned that you were not even aware that you had been nominated for the Nobel Peace Prize.

But then, reactions started pouring in. Not everyone knew your name, but the world understood immediately what the Committee meant: All people are entitled to fundamental rights, and at a time when Islam is being demonized in many quarters of the western world, it was the Norwegian Nobel Committee's wish to underline how important and how valuable it is to foster dialogue between peoples and between civilizations. This is a wish that most people share and that is why the reactions to this year's award have been so positive, even though we understand if you had perhaps hoped for a few more congratulations from the authorities of your own home country and region. And now, of course, you have suddenly become quite a world celebrity!

Today you are here, Shirin Ebadi, in Oslo City Hall to receive the Nobel Peace Prize for 2003. And we rejoice together with you, your closest family and friends, many of whom are present here today.

It is indeed a great pleasure for the Norwegian Nobel Committee to award – for the first time in history – the Nobel Peace Prize to a woman from the Muslim world - a woman that the world can be proud of, as can all other champions of human rights around the world.

It is our sincere hope that the people of Iran will feel joy that a citizen of their country – for the first time in history – receives the Nobel Peace Prize. And we hope that the prize will serve as inspiration for all those who are campaigning for human rights and democracy in your country, in the Muslim world and in all countries in the East and West – everywhere where human rights work needs inspiration and support.

Shirin Ebadi has been awarded the Nobel Peace Prize for her efforts for democracy and human rights and, in particular, for her fight for the rights of women and children. She has been very clear in her opposition to patriarchal cultures that deny equal rights to women, who represent half of the population. But mothers must also be aware of their responsibilities. They are the ones who bring up young boys to be men and who raise daughters to become strong women. Shirin Ebadi is the founder and leader of the Association for Support of Children's Rights in Iran, which has some 5000 members. The centre is located in Teheran and it produces information material for use in schools and operates an emergency hot line for children. The Nobel Committee hopes that the Nobel Peace Prize award to Shirin Ebadi will contribute to an increased focus on the rights of children the world over.

In an interview Shirin Ebadi was asked: "Do you have a message to send to Muslim women?" "Yes", she answered, "Keep on fighting". "Don't believe that you are meant to occupy a lower position in society. Get yourself an education! Do your best and compete in all areas of life. God created us all as equals. By fighting for equal status, we are doing what God wants us to do", argues Shirin Ebadi. In this respect, it is worth noting that some 60 percent of the students at the University of Teheran are, in fact, women. At the same time, we must not forget women's legitimate claim for equality before the law. In law and order, we must all be equal, and women must enjoy exactly the same rights as men. On this issue, Shirin Ebadi stands in the front ranks and we can but admire her for her efforts.

Many are those who have drawn benefit from Shirin Ebadi's commitment and capacity for work. She has pleaded the cause of refugees in a region where they are in such great numbers and so desperately need help. Furthermore, she has called attention to the rights of all citizens – also their right to freedom of expression - irrespective of religion, ethnic origin or political opinion.

As a lawyer, judge, lecturer, author and activist, her voice has sounded clearly and powerfully in her native country Iran, and also far beyond its national borders. She has come forward with professional force and unflagging courage, and she has defied any danger to her own safety. She is truly a woman of the people!

The campaign for fundamental human rights is her most important arena and no society can be called civilized if the rights of women and children fail to be respected. At a time of violence, she has staunchly upheld the principle of non-violence. For her, it is fundamental that the supreme political power of a society is founded on democratic elections. She emphasizes that information and dialogue constitute the best avenue toward a change of attitudes and a settling of conflicts. After years of reflection, she has come to the conclusion that revolution never leads to the changes promised by the revolutionaries. The road forward must move in the direction of non-violence and dialogue, law and order.

Again and again, this year's Laureate has stressed that she is an Iranian. "I am proud to be an Iranian. I shall live in Iran for as long as I possibly can," she says. For Shirin Ebadi, this has meant a life in fear, but she has learned to live with her fear and she is optimistic about the future. People insist on ruling themselves. The time when ruling powers could threaten their way to dominion is gone forever. Rulers "will realize that the time for governing through fear is drawing to a close the world over. Why should Iran be an exception?" she says.

The 110 persons and organizations that have been awarded the Nobel Peace Prize over the years are extremely diverse. But the majority of them have one thing in common – they are optimists, unshakable optimists. It is their optimism that gives them the inspiration they need in their struggles. Furthermore, many of the laureates are filled with a courage that we can scarcely understand. Even under the most challenging of circumstances, they keep going – day after day, year after year.

Shirin Ebadi has run great risks. As a lawyer, she brings cases to court that few others would venture to get involved in. Her ideas are spreading in ever-widening circles, and, to quote the Norwegian poet Paasche Aasen: You must be true to your own youth, "so that the field you plough can grow when your work is done."

There are several long lines running through the 102 years of Nobel Peace Prize history. In the last few decades, the most distinct of these has perhaps been the increasing emphasis that the Norwegian Nobel Committee has placed on democracy and human rights. Who was the first to receive the Peace Prize according to this tradition is open for debate. Was it the prize awarded to Woodrow Wilson in 1919 or to Carl von Ossietzky in 1935, or even the 1951 prize to the French union leader, Léon Jouhaux? Although human rights represent one dimension of all these three awards, there were also other dimensions involved. Hence, the first indisputable human rights prize was perhaps, after all, the one awarded to Albert Lutuli of South Africa in 1960.

In the more than four decades since, many such prizes have followed. Some names shine brighter than others: Martin Luther King (1964), Andrei Sakharov (1975), Amnesty International (1977), Lech Walesa (1983), Desmond Tutu (1984), Aung San Suu Kyi (1991) – and she is especially in our thoughts today – Rigoberta Menchú (1992) and Nelson Mandela (1993) and then this year, Shirin Ebadi. It is against this backdrop that we can more easily understand what this year's Laureate has achieved and what the consequences of such a prize can be, when it works at its best.

The idea of human rights and democracy is gaining ground - albeit slowly. Practising human rights is always a challenge; high demands will always be placed on those who wish to live up to their ideals. It is with great satisfaction that we see that the idea of people's right to govern themselves through free elections is gradually prevailing in many parts of the world. By comparison to only 10-15 years ago, all of eastern Europe, Russia and several other countries of the former Soviet Union, many states in eastern Asia and not least in Latin America, as well as a few in Africa have now adopted democratic forms of government. Perhaps the Norwegian Nobel Committee is able to stimulate a development that still has mainly local roots and explanations. Every nation must fight its own battle. But we who stand on the outside looking in can express our sympathy and make our contribution.

Shirin Ebadi is a conscious Muslim. She sees no conflict between Islam and fundamental human rights. Islam is a diverse religion. How the message of justice is to be realized in practice and how human integrity is to be preserved is an essential issue for Muslims of today. We shall listen to all positive, novel interpretations, all proposals of reform. Here too, women have an important role to play; no longer is it for elderly men to interpret the message, argue many Muslim women. "Those who kill in the name of Islam, they violate Islam", says Shirin Ebadi. We know that human rights are being violated not only in Muslim countries. It happens whether regimes our religious or secular, nationalistic or Marxist.

For Shirin Ebadi, therefore, it is not religion that is the deepest root cause of the problem. But, no matter what, state and religion should be separate, is her view, since the political arena should be open to so many diverse interests and views. Shirin Ebadi underlines that the dialogue between different cultures in the world must be founded on the values they have in common. There need be no fundamental conflict between Islam and Christianity. That is why she was pleased that the Pope was among the first to congratulate her on the Peace Prize.

It is possible that the Peace Prize may, in the short-term, have led to more hostilities than peace in the homeland of some Peace Prize laureates. But the Nobel Committee's acknowledgement of democracy and human rights rests on the belief that repression cannot persist in the long run. In the last few decades in particular, we have seen how large parts of the world have abruptly thrown off the yoke of dictatorship. Repression leads to conflict. Most people will simply not put up with the "peace of the graveyard", and one of the most certain findings of modern political science is precisely that democracies do not go to war against each other.

I appeal to all individuals, all peoples and to all nations of the world:

Let us work together for a better world.
Let build peace and prevent war.
Let us make the world a better place to live in for young and for old.
Let us focus on human integrity and human rights.
Let us fight against poverty and disease in the world.
Let justice, respect and cooperation prevail among peoples and nations of the world.
Let us TOGETHER realize the dream of world peace.

As the university man that I am, I challenge all universities the world over to be even more distinct in underscoring the world's need for peace, democracy and social and economic justice.

Dear Peace Prize Laureate Shirin Ebadi,

We admire your efforts for human rights in general and your struggle for the rights of women and children in particular.
We admire your work for peace without resorting to violence.
We admire your work for dialogue between religions of the world.

We hope that the Nobel Peace Prize may contribute to the realization of your dream.

Allow me finally to revert to the great poet Rumi who wanted to expose everything that prevents us from seeing the world as it is – and who also tells us that the vision or dream leads to clear-sightedness. In a poem, whose Norwegian title is "Draumen som må tolkast" - The dream that must be interpreted, Rumi says:

"and although we seem to sleep, there is an inner vigilant voice that steers the dream, that will finally awake us to the truth about who we are."

The great Norwegian poet Olav H. Hauge also had a dream. He has written the beautiful poem "It's the Dream", that I would like to conclude with:

"It's the dream we carry in secret
that something miraculous will happen
that must happen
that time will open
that the heart will open
that doors will open
that mountains will open
that springs will gush –
that the dream will open
that one morning we will glide into
some harbour we didn't know was there."

Anal-retentive?

This morning i saw a girl with dyskeratosis congenita-she told me in the world, 1 in a million has this. She was 15 and very dark-skinned-her background i later found out was Phillipino. She had aplastic anemia at 2 and had a bone marrow transplant at 6. Her symptoms of tiredness, dyspnea and orthopnea only became worse in the last 3 weeks although dyspnea was tolerated for the past 2 years. She was admitted on multiple occassions to the ED before for dyspnea in which one of such episodes led to the diagnosis of dyskeratosis congenita.
Emedicine:
Dyskeratosis congenita (DKC), also known as Zinsser-Engman-Cole syndrome, is a rare, progressive bone marrow failure syndrome characterized by the triad of reticulated skin hyperpigmentation, nail dystrophy, and oral leukoplakia. Evidence exists for telomerase dysfunction, ribosome deficiency, and protein synthesis dysfunction in this disorder. Early mortality is often associated with bone marrow failure, infections, fatal pulmonary complications, or malignancy.

She told me her current status involves fibrosis of her lungs..her liver and spleen are also both affected. When i saw her, both her arms were wrapped in bandages and she mentioned she had "increased dry and flaky skin" over the past few weeks....I went to get her file and can't help feeling sick myself as I tried to imagine what it would be like to have gone through such encounter at that age myself. She spoke over her cell phone and when i came back to examine her-i noticed she was at the brink of tears-i couldn't carry out the PE further and thought best to leave her to herself. Her descriptions and words were clear and it seemed that she was calm enough to relate her story to me throughout yet a large part of me didn't know how to react. A medical student is supposed to take this scientifically and understand what exactly it is-there is no need to be affected emotionally since to put it rationally, this is one case among probably many many cases in the children's hospital worth crying over. Yet, I couldn't help but ask myself truly, what is the best way to respond to such patient if he or she is under your care? If i were her doctor, i want to save her life. Belonging to this part of the world, she's eligible for a lung transplant. Yet, is liver transplant or spleen transplant available to her if they fail too? I wonder how much we owe the progress of medicine throughout history to give people like her hope to live on.

It was uneasy for me and i went to the community centre to continue with my data entry and research write-up. It was a logical, straightforward, systematic task which one does without emotions and legitimately so by all standards of humanity i believe. Then i went to attend the CPC conference in SCH. The case was about a premature, breech delivered baby from RPA who was withdrawn ventilatory support after struggling with multiple brain and multi-organ failure problems perinatally. An autopsy was performed and the pathologist presented the slides pointing out the features technically and concluded her speculated cause for baby's conditions post-birth. Throughout, i can't help but ask myself-is this truly necessary? why are we doing this? to me at that time, everything which happened during the CPC seemed "anal retentive" or rather "extraneous". The only benefit which i thought may be important is that such cases or such traditions will contribute to future scientific progress-although in medicine, i wonder how highly i would put scientific progress given that my idea of life is not about extension but quality and personal transcendence in this world. Why not talk about prevention rather than cure? I just can't see myself being part of the "anal retentive" groups of consultants who are essentially invaluable for their competencies but surely, any person with humility will realise that they themselves don't "save lives" as such without first acknowledging the existence of system and colleagues who are part and parcel of their professional work. I don't know if i truly believe that it's worth dedicating one's life to a level of competency which essentially leads one to the narrow scientific discourse which may or may not be relevant in the long run. In addition, i still don't know if it's possible to retain one's humanity whilst performing activities which eventually require one to feel less and be more efficient or specialised. My intuition tells me that i probably wouldn't even if i could. I think to give myself better perspective, i should probably read more surrounding this: Kuhn's scientific revolutions....though my gut feeling tells me that biology as such and my concern is weakly linked to that...
I guess perhaps it's a niche issue and in understanding myself-i supposed one tries at best to cope with what is unnecessary whilst preserving the best and enthusiasm in oneself to embrace and look forward to what is most meaningful for one's life and humanity itself.

Control of Neglected Tropical Diseases (NTD)

At least 1 billion people — one sixth of the world’s population, or 1 person in 6 — suffer from one or more neglected tropical diseases (NTDs), such as Buruli ulcer, cholera, cysticercosis, dracunculiasis (guinea-worm disease), foodborne trematode infections (such as fascioliasis), hydatidosis, leishmaniasis, lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiasis, trachoma and trypanosomiasis, although there are other estimates that suggest the number could be much higher. Several of these diseases, and others such as dengue, are vector-borne. Often, those populations most affected are also the poorest and most vulnerable and are found mainly in tropical and subtropical areas of the world. Some diseases affect individuals throughout their lives, causing a high degree of morbidity and physical disability and, in certain cases, gross disfigurement. Others are acute infections, with transient, severe and sometimes fatal outcomes. Patients can face social stigmatization and abuse, which only adds to the already heavy health burden.

For a large group of these diseases – mainly helminthic infections – effective, inexpensive or donated drugs are available for their prevention and control. These tools, when used on a large scale, are able to wipe out the burden caused by these ancient scourges of humanity. For leprosy, treatment with effective antibiotics is leading to the elimination of such ancient disabling disease. There is also a cost-effective approach to treating yaws that could lead to elimination and final eradication of this debilitating disease that may cause gross deformation. In the case of blinding trachoma, the use of the recommended strategy (SAFE) of an effective antibiotic is enhancing the progress towards final elimination. Large-scale, regular treatment plays a central role in the control of many NTDs such as filariasis, onchocerciasis, schistosomiasis and soil-transmitted nematode infections. For example, regular chemotherapy against intestinal worms reduces mortality and morbidity in preschool children, improves the nutritional status and academic performance of schoolchildren, and improves the health and well-being of pregnant women and their babies.

There is second group of NTDs for which the only clinical option currently available is systematic case-finding and management at an early stage. These diseases include Buruli ulcer, Chagas disease, cholera and other diarrhoeal diseases, human African trypanosomiasis, and leishmaniasis. Simple diagnostic tools and safe and effective treatment regimens need to be developed urgently for some of these diseases. However, even for these infections, systematic use of the present, imperfect tools at an early stage can dramatically reduce mortality and morbidity. For others, vector control tools are available and present the main method of transmission control, as in the case of Chagas disease.

There are examples of great successes in the fight against both of these groups of NTDs. Since 1985, 14.5 million patients have been cured of leprosy through multidrug therapy; today, less than a million people are affected by the disease. Before the start of the Guinea-worm Eradication Programme in the early 1980s, an estimated 3.5 million people in 20 endemic countries were infected with the disease. In 2005, only about 10 000 cases were reported in 9 endemic countries, and the programme is moving towards eradication. Onchocerciasis has freed more than 25 million hectares of previously onchocerciasis-infected land available for resettlement and agricultural cultivation, thereby considerably improving development prospects in Africa and Latin America.

Increased awareness and advocacy are needed to draw attention to the realistic prospect of reducing the negative impact of NTDs on the health and social and economic well-being of affected communities. The WHO Department of Control of Neglected Tropical Diseases is committed to supporting Member States and partners to achieve this goal.

UNITAID celebrates major achievements in first year of existence

20 SEPTEMBER 2007 | GENEVA -- In the year since it was established, the international drug purchase facility UNITAID has managed to reduce the price of HIV treatments for children by almost 40%, and those for second-line antiretroviral (ARV) drugs by between 25% and 50%. In collaboration with the Clinton Foundation, UNITAID has also delivered more than 33 000 paediatric treatments against HIV/AIDS and is on course to meet the needs of 100 000 children by the end of 2007.

Moreover, UNITAID has committed a total of US$ 45 million for second-line antiretroviral drugs to fund the treatment of 65 000 patients by 2008. Four countries (Botswana, Cameroon, Uganda and Zambia) have already received a first supply of second-line ARV drugs through UNITAID and a further 13 countries are currently awaiting delivery. UNITAID was launched in September 2006 during the United Nations General Assembly.

In partnership with the World Health Organization (WHO) and UNICEF, UNITAID has purchased and distributed 1.3 million Artemisinin-based Combination Therapies (ACT) in Burundi and Liberia. In addition, UNITAID is supporting ACT procurement and delivery to eight countries through collaboration with the Global Fund to Fight AIDS, Tuberculosis and Malaria, and UNICEF. Delivery of the ACTs will begin in October 2007.

UNITAID is also contributing to the fight against tuberculosis together with the Global Drug Facility and the Stop TB Partnership. By the end of the year, UNITAID will have provided TB treatments to 150 000 children in 19 countries and will be supporting the provision of drugs for Multidrug - resistant TB in 17 low-income countries.

Background on UNITAID

The mandate of UNITAID is to contribute to the scaling up of access to treatments for HIV/AIDS, malaria and tuberculosis in developing countries by leveraging quality drugs and diagnostics price reductions and accelerating the pace at which these are made available. For each programme, UNITAID sets up an ad hoc partnership with existing organizations: WHO, UNICEF, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Clinton Foundation (CHAI), Global Drug Facility/Green Light Committee and the Stop TB Partnership.

UNITAID offers beneficiary countries long-term support through sustainable and predictable funding, mobilized by innovative financing mechanisms, such as a solidarity contribution on air tickets, together with multi-year predictable budgetary contributions.

Based in Geneva, its Trust Fund and lean Secretariat are hosted by WHO. At present, 27 countries of which 19 are in Africa are members and hence contribute to UNITAID. At least 85% of UNITAID funds are spent in low income countries (LICs). The budget of UNITAID for 2007 is over US$ 300 million and 90% has already been committed to programmes in more than 80 countries.

For further information, please contact:

Audrey Quehen
UNITAID communications officer
Tel.: +41 22 791 14 37
Mobile: +33 6 86 70 97 60
E-mail: quehena@who.int

WHO stresses need to ensure the safety of children's medicines

21 SEPTEMBER 2007 | GENEVA -- The lack of thorough and reliable clinical data on the way medicines affect children requires strengthened safety monitoring and vigilance of medicinal products. This is the fundamental message of Promoting safety of medicines for children, released today by the World Health Organization (WHO).

The publication gives an overview of the problem and offers solutions on how best to address side effects from medicines in children; namely, through improved reporting systems and collaboration between governments, regulatory authorities, research institutions and the pharmaceutical industry. The publication is part of a broad effort WHO is initiating to expand children's access to quality-assured, safe and effective medicines.

"We need to learn more about the way children's bodies react to medicines so we can improve global child health. That's why it's extremely important to keep track of potential side effects in child populations. Ultimately, this will save lives and build up a knowledge base for the future," said Dr Howard Zucker, WHO Assistant Director-General for Health Technology and Pharmaceuticals.

A large proportion of side effects or adverse reactions to medicines in the adult population are due to irrational use or human error and are therefore preventable. In the case of children, even more factors come into play. The main challenge is the lack of clinical data. This results in fewer medicines being developed, produced and marketed specifically for children. Often, children are given medicines that have only been tested in adults and are not officially approved for use in child populations (this is known as "off-label use").

Non-availability of appropriate paediatric formulations forces health care providers to resort to administering portions of crushed or dissolved tablets or the powder contained inside a capsule without any specific indication of the required dosage. For that reason, according to the report, potentially harmful medication errors may be three times more common in children than in adults.

An appropriate format or structure for a child's medicine is also important. Small children sometimes choke or asphyxiate while trying to swallow big tablets. For instance, earlier this year four children under 36 months died from choking on albendazole tablets (used to combat worms) during a de-worming campaign in Ethiopia.

New and innovative medicines on the market provide indications for children but still lack evidence of long-term benefit and risk. Side effects associated with antiretroviral medicines, for example, have been reported to occur in up to 30% of HIV-infected children on antiretroviral therapy. Most of those side effects could be reversed by modifying the dosage or changing to an alternative medicine.

The report estimates that less than 10% of all serious adverse reactions to medicines are reported globally. In part, this is due to the fact that many developing countries have not yet established medicine safety monitoring and reporting systems; and when they have these are usually under-resourced. Because children - particularly very young ones - are less articulate in describing symptoms and their non-verbal communication is often misunderstood or ignored, even serious adverse reactions in children often go unreported to health practitioners or authorities.

Intended for policy-makers, manufacturers, medicines control bodies and researchers, Promoting safety of medicines for children provides a series of recommendations to address medicine safety for children.

For instance, all countries should establish national and regional monitoring systems for the detection of serious adverse medicine reactions and medical errors in children. When such reporting systems exist, it is crucial that manufacturers follow up on adverse reactions to their products once they are on the market.

In addition, regulatory authorities need to make an effort to refine the science of clinical trials in children, create an active post-marketing surveillance programme and develop public databases of up to date information about efficacy and safety in paediatric medicines.

To assist countries, WHO will:

• publish an official WHO List of Essential Medicines for Children;
• continue to create awareness in countries and in the research community on the urgent need to monitor the use of medicines in children;
• identify research gaps in children's medicines; and
• create protocols on monitoring adverse effects for child-specific medicines.

Note for editors/reporters

To ensure that a medicine works and that its adverse effects are limited, pharmaceutical companies are required by law in most countries to have tested their medicines in healthy volunteers and patients before making them widely available. The trials need to be approved by ethics committees and competent regulatory authorities. Volunteers must be made aware of the risks involved in the trials and must give their informed consent. However, ethical and regulatory approvals are much stricter for children and there is also the problem of obtaining informed consent from children and/or their carers. This results in fewer clinical trials conducted on children than on adults.

Clinical trials generally do tell a good deal about how well a medicine works for a defined disease and what potential harm it may cause. But they provide no information for populations with different characteristics from the trial group, such as age, gender, state of health, co-treatment with other medicines and ethnic origin.

Therefore, for many medicines, and particularly new, complex products, safety monitoring does not stop after launching the product; it must be followed by careful patient monitoring and by further scientific data collection.

WHO promotes medicine safety through its International Drug Monitoring Programme, which began to operate in 1968. Initially a pilot project in 10 countries with established national reporting systems for adverse reactions to medicines, the network has expanded significantly as more countries worldwide develop national pharmacovigilance centres. Currently, over 100 countries participate in the programme.

For further information, please contact:

Daniela Bagozzi
Tel.: +41 22 791 45 44
Mobile: +41 79 475 54 90
bagozzid@who.int