Global strategies for improving child health under scrutiny

This week's issue of THE LANCET is largely devoted to research and comment on health-systems development for developing countries, ahead of a global summit being held in Mexico City next month. The lead editorial (p 1555) highlights the main challenges ahead: 'research for health must no longer be confined to the components--the drugs, the devices, the vaccines. The Mexico Ministerial Summit must boldly and publicly assert that the traditional biomedical model of health research is wholly inadequate to tackle disease alleviation in the less-developed world. A new health-systems research specialty must be founded, one that is supported technically and financially by the affluent nations and integrated within the policy and health systems of less-developed countries. This research specialty must focus on narrowing the gap between what is known and what is done, and should lead to a culture where policy and practice derives from evidence. The specialty should also draw on what useful research has already been done in other disciplines, such as the social, behavioural, and organisational sciences.'

Two studies in this week's issue give an insight into the effectiveness of a global strategy for improving child health in developing countries: the Integrated Management of Childhood Illness (IMCI) introduced by WHO in the mid 1990s.

More than ten million children worldwide die every year; 95% of these deaths occur in 42 less developed countries. Neonatal disorders, diarrhoea, pneumonia, and malaria are the main causes of child death, although HIV/AIDS accounts for at least 10% of deaths in some African countries. Undernutrition is a major underlying cause and has been estimated to contribute to more than half of all childhood deaths.

The main components of the IMCI strategy (the integrated management of childhood illness) are: the adoption of an integrated approach to child health and development in countries' national health policies; adaptation of

Contact: Joe Santangelo

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