Evidence-based guidelines for the care of children in
emergency situations should be developed and distributed to
international relief organizations, according to
researchers from the Johns
Hopkins Bloomberg School of Public Health and the World
Health Organization.
In a review of published literature, the researchers
found that the highest mortality rates following armed
conflicts, natural disasters, population displacements or
famines are often in children younger than 5. The most
common causes of death are diarrhea, acute respiratory
infections, measles, malaria and malnutrition; these are
also the major causes of death in countries with high child
mortality rates. The study is published in the January
issue of the Bulletin of the World Health
Organization.
William J. Moss, senior author of the study and an
assistant professor in the Bloomberg School's Department of
Epidemiology, said, "The major causes of child mortality in
complex emergencies are well-known, and we have learned how
to manage these conditions in stable situations. However,
conflict or disaster often exacerbates the magnitude and
severity of these illnesses, requiring rapid assessment and
treatment of large numbers of severely ill children. This
was seen with the tsunami disaster and the recent
earthquake in Pakistan," he said. "What we need are simple,
easy-to-use guidelines that are brought together in a
single package for the different levels of health workers
caring for children in complex emergencies."
The researchers came to their conclusions after
reviewing previously published literature and interviewing
representatives from international relief organizations.
They found that in emergency situations, most relief
organizations use WHO, UNICEF and other ministry of health
guidelines that are intended for stable environments. Few
studies, however, have assessed how effective these
interventions are in reducing child mortality in complex
emergencies, when care is given by multiple organizations
and a broad range of health workers with different levels
of training and experience.
The guidelines, Moss and his colleagues said, should
be brought together from existing clinical guidelines into
an accessible and comprehensive package. They not only
should address issues such as how to treat patients when
referral facilities are not accessible but also should fill
some of the gaps in current treatment guidelines. The
special needs of unaccompanied children and common mental
health problems of all children also should be addressed.
The guidelines, they said, should be simplified so that
community health workers and volunteers can follow them
when they act as primary care givers in emergency
situations.
"Many of the same diseases that are common to children
in nonemergencies are the ones that need to be treated in
emergencies. Those treatment protocols already exist, but
we need to adapt them for emergency situations," Moss
said.
The study was funded by a grant to the Johns Hopkins
Center for Refugee and Disaster Response from the
Department of Child and Adolescent Health, World Health
Organization. Meenakshi Ramakrishnan, Dory Storms, Anne
Henderson Siegle and William M. Weiss, all of the Bloomberg
School, co-authored the study. Additional co-authors are
Ivan Lejnev and Lulu Muhe.
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