Pediatric Annals

editorial 

The International Scene: A Pediatric Perspective

Stanford T Shulman, MD

Abstract

Abroad range of international health care topics that pertain to children and pediatricians can be read in this month's Pediatric Annals. Here in the wealthiest country in the world, we often lose sight of the magnitude of the afflictions that affect children in the undeveloped (or developing) areas of the world. Most of these are infections, but the contribution of malnutrition to global childhood morbidity and mortality is highlighted in the review by Dr. Neumann and colleagues. From this article, I learned about the importance of micronutrient deficiencies such as iodine, zinc, iron, and vitamins A and B12.

Children in most of the world are weaned to a high-carbohydrate, lowprotein, and energy-dilute diet that is rich in fiber and phytate. The latter, found in grains and cereals, binds important nutrients (iron, calcium, zinc), rendering them nonabsorbable. It is fascinating that some cultures attempt to override this through processes such as fermentation of starchy foods to reduce their phytate content (Africa), adding powdered dried bovine blood clots to stews (Chile and Kenya), or eating bloodenriched biscuits (Chile).

Childhood tuberculosis (TB) also is pervasive in the developing world, with almost 1 million children diagnosed each year with sputum-smearpositive TB. Because young children with TB rarely are smear positive (and rarely produce sputum!), there may be 20 to 50 times as many actual pediatric TB cases worldwide. It is difficult for us, who see few (if any) real cases of pediatric TB in the United States, to comprehend the scope of this problem worldwide. The articles here by Dr. Adams and from Dr. Marais, who works with children in Cape Town, South Africa, help us to grasp the magnitude and seriousness of this issue for child health worldwide.…

Abroad range of international health care topics that pertain to children and pediatricians can be read in this month's Pediatric Annals. Here in the wealthiest country in the world, we often lose sight of the magnitude of the afflictions that affect children in the undeveloped (or developing) areas of the world. Most of these are infections, but the contribution of malnutrition to global childhood morbidity and mortality is highlighted in the review by Dr. Neumann and colleagues. From this article, I learned about the importance of micronutrient deficiencies such as iodine, zinc, iron, and vitamins A and B12.

Children in most of the world are weaned to a high-carbohydrate, lowprotein, and energy-dilute diet that is rich in fiber and phytate. The latter, found in grains and cereals, binds important nutrients (iron, calcium, zinc), rendering them nonabsorbable. It is fascinating that some cultures attempt to override this through processes such as fermentation of starchy foods to reduce their phytate content (Africa), adding powdered dried bovine blood clots to stews (Chile and Kenya), or eating bloodenriched biscuits (Chile).

Childhood tuberculosis (TB) also is pervasive in the developing world, with almost 1 million children diagnosed each year with sputum-smearpositive TB. Because young children with TB rarely are smear positive (and rarely produce sputum!), there may be 20 to 50 times as many actual pediatric TB cases worldwide. It is difficult for us, who see few (if any) real cases of pediatric TB in the United States, to comprehend the scope of this problem worldwide. The articles here by Dr. Adams and from Dr. Marais, who works with children in Cape Town, South Africa, help us to grasp the magnitude and seriousness of this issue for child health worldwide.

Perhaps most stunning, however, is the article by Dr. Kasper on the United Nations Convention on the Rights of the Child. This 1 990 document outlines a blueprint for describing, assessing, and promoting infant, child, and adolescent health and has been ratified by 191 countries, lacking only Somalia and the US. The fear that execution of minors might be prohibited here if the US were to ratify the Convention speaks volumes about our society. This article is worth reading and pondering carefully.

The orange stamp shown here from Swaziland, one of the poorest African countries, depicts a child with blindness from malnutrition, presumably related to the consequences of vitamin A deficiency and xerophthalmia. The two Bahamian stamps contrast a starving child in a parched desert and the principles of good childhood nutrition.

The multicolored Solomon Islands stamp portrays malaria eradication efforts to eliminate the mosquito vector (anopheles). Finally, the stamp from Monaco depicts Albert C a 1 m e 1 1 e (1863-1933) and Camille Guérin (1872-1961), the Frenchmen who worked from 1906 to 1921 to develop an attenuated strain of bovine tuberculosis after 231 serial subcultures to serve as a vaccine against tuberculosis. The bacillus Calmette-Guérin vaccine was tested in infants in 1 922, and 82 years later still is used widely to prevent tuberculosis.

10.3928/0090-4481-20041001-03

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