CHILDREN'S HEALTH * SANTE ENFANTILE ET ADOLESCENTE

Massive Vancouver conference focuses on tragedy of world's dying children Eleanor LeBourdais

mT

he message delivered at the recent Child Health 2000 .1..World Congress and Exposition was grim. As many as 40 000 children around the world die daily from malnutrition and preventable disease, the audience was told, while 150 million others who are in poor health struggle to survive. It has been estimated that for less money than the world currently spends each day on armaments, the lives of millions of children could be saved every year. When he opened the congress in Vancouver in February, Benoit Bouchard, Canada's minister of health and welfare, spoke of the need to save lives and cited the example provided by the United Nations Children's Fund (UNICEF) immunization program: it has achieved its goal of immunizing 80% of the world's children against six major diseases, and by doing so has saved 3 million lives a year, and 30 million in the last decade. If the world is willing to spend another $20 billion a year on children, Bouchard suggested, UNICEF's year 2000 goals can be achieved, along with many of the 27 objectives agreed on at the 1990 children's health summit at the United Nations. Referring to Canada's leadership role in helping UNICEF reach its 80% immuEleanor LeBourdais is a freelance writer in Port Moody, BC. 1404

CAN MED ASSOC J 1992; 146 (8)

Robert Gallo is disturbed by the complacency he senses in the industrialized world, where HIV infection rates have levelled off. Dr.

nization target, Bouchard added: "We have now set 90% [immunization] as our year 2000 target and Canada has been pleased to contribute $50 million to the next phase of this worthy program." The delegates who flowed into the large plenary assembly room under the watchful eyes of security guards probably thought that attention was being paid to their name tags merely to confirm that all had paid the price of admission. The size of the audience - more than 1000 people also meant that only those close to the front had a good view of the police officers standing near the

podium. They were there to protect Dr. Robert Gallo, the codiscoverer of HIV, their presence a precautionary measure taken in anticipation of a disruption by members of ACT-UP, a militant AIDS activist group that has demonstrated against Gallo before. With no such protesters in evidence in

Vancouver, Gallo was able to discuss work being done in his laboratory at the National Institutes of Health in Bethesda, Maryland, without interruption. While scientists continue to add to the body of knowledge surrounding HIV-related disease, Gallo acknowledged that none of it has made a dent in the AIDS problem. With an estimated 10 million people infected with HIV worldwide, and 1 million people having developed AIDS, the epidemic remains unstable and totally unpredictable. Gallo is disturbed by the complacency he senses in the industrialized world, where infection rates have levelled off. Steeply rising rates in sub-Saharan Africa, South America and southern Asia indicate that any reduction in vigilance would be premature, Gallo argued. He warned that the legacy of today's infection rate will increasingly fall on tomorrow's children. LE 1 5 AVRIL 1992

"People say, 'Lighten up, will you; I don't want to hear this.' And my answer to that is, 'If I learned that my daughter had a progressive terminal illness, I wouldn't say, oh jeeze, doc, lighten up.' " David Suzuki, PhD He described "an abominable sto- ble but nonessential cofactor has ry" in a Vancouver newspaper been discussed for years "but it about young children in many seems out of our grasp to prove parts of the world being increas- the point except by continuing to ingly sought as sex objects by men get stimulating lab data, and we who fear AIDS. "Eight- and need a specific drug." 9-year-olds are being seduced, David Suzuki, PhD, a genetibribed or sold by their parents, so cist, writer and broadcaster, said we will probably see an increased global destruction of the environnumber of children, and not just ment is the biggest threat to the babies, with AIDS in the near health and welfare of children; he future." said it is indisputable that the Gallo said HHV-6, a new planetary biosphere, whose balhuman herpes virus he and col- ance evolved over millions of leagues first reported in 1986, years, is being ripped apart in a might help to shed light on the matter of decades. decline in cytotoxic T-lymAlthough surface gestures are phocytes (CTL) that occurs in made, he suggested no governlate-stage AIDS. While HHV-6 is ment anywhere has shown the poharmless in healthy subjects, it litical will to initiate policies that may replicate more in an im- reflect real commitment to envimunosuppressed host, resulting in ronmental protection: the bottom T-cell damage. line is still industrial expansion "HHV-6 affects CD-8 cells, and economic gain. Thus, the and when it does it turns the gene daily extinction of entire species for CD-4 on. When CD-4 is of plants and animals continues turned on, the cell becomes a unabated, and if current practices target for HIV, and we speculate prevail there will be no wilderness that may be the reason for the left anywhere by the year 2000. decline in CTL during late-stage Suzuki said he is often critiAIDS. This HHV-6 virus could be cized for bearing only bad news. a nonessential cofactor that may "People say, 'Lighten up, will you; I don't want to hear this.' And my speed up progression in AIDS." Gallo said research in this answer to that is, 'If I learned that area has been hampered by the my daughter had a progressive absence of an HHV-6 inhibitor, terminal illness, I wouldn't say, oh and he called on the pharmaceuti- jeeze, doc, lighten up.' I'd want to cal industry to come up with know about every possible thing something specific to HHV-6. that could be done to make her Foscarnet is a potent inhibitor, well again and do it." but it also inhibits HIV replicaThe impact of nutrition and tion and would merely confound eating habits on morbidity and results in clinical trials. Gallo said mortality was addressed by severthe function of HHV-6 as a possi- al speakers. Dr. Alfred Sommer, a APRIL 15, 1992

Baltimore ophthalmologist affiliated with the Johns Hopkins School of Medicine, cited vitamin A deficiency as the primary reason 3 million Third World children die every year, even though adequate food sources of the vitamin are readily available in most of those countries. Studies have clearly indicated that vitamin A deficiency is the most important cause of child blindness, resulting in more than 250 000 new cases each year. Sommer pointed out that vitamin A status appears to be a critical factor in the incidence of other life-threatening illnesses as well. "Children who are better nourished but have vitamin A deficiency are at higher risk of respiratory disease and diarrhea than are children who are wasted or severely malnourished but do not have vitamin A deficiency. This means vitamin A status has a greater impact on mortality rates than overall levels of malnutrition." In Africa, measles was long thought to be the major cause of blindness in children because 80% of blind children were found to have had measles within a month of losing their sight. However, Sommer said Tanzanian studies subsequently revealed that more than half of the children who developed corneal ulceration during or within a month of having measles did so because the measles interfered with their vitamin A status. Motivating people to eat CAN MED ASSOC J 1992; 146 (8)

1405

properly is often the best, and also the most difficult, solution to a vitamin-deficiency problem. "We found in Indonesia the most significant risk factor for vitamin A deficiency during the first year of life was whether a child was breast-fed," Sommer said. During the weaning period and through to the second and third year, vitamin status often depended on whether the child started to eat papaya and mango, which are good and readily available sources of vitamin A. Because much vitamin A deficiency occurs in countries where carotene-rich foods are plentiful, Sommer said the greatest challenge may lie in finding ways to educate families about the importance of proper nutrition, as well as ways of motivating children to "eat their spinach." In First World North America, a preoccupation with thinness is causing malnutrition of a different sort - even babies are now being subjected to the low-fat obsessions of their parents, and there may be potentially destructive results. Dr. Fima Lifshitz, a professor of pediatrics at Cornell University, suggested that a generation of short children may be the legacy of the dietary ban on fats. The reduction or elimination of food sources like red meat also reduces the supply of zinc and iron, which are vital to physiologic growth and development. If these elements are not received through some other dietary source, the result can be "nutritional dwarfing" and an irreversible loss of about 2 inches of height by adulthood. Lifshitz pointed out that children who have been on such diets do not look malnourished or exhibit disturbed psychologic functioning or behaviour. "The only evidence of a problem may be decreased growth rates, because anyone who does not eat appropriate nutrient for growth will slow down as a way of adaption. APRIL 15, 1992

By ingesting one-third less, they adjust basal metabolic rates by decreasing growth and saving energy expenditure that allows them to maintain homeostasis without any evidence of disease except poor growth." While it is obviously possible to substitute food items so that the needed balance of nutrients is maintained, Lifshitz said many people simply do not do it. And although no one has recommended low-fat diets for babies, low-fat and skim milk formula feeding in the first few months of life is now causing instances of failure to thrive. At a symposium on adolescent health, Dr. Roger Tonkin, an associate professor of pediatrics at the University of British Colum-

bia, discussed anorexia nervosa and bulimia nervosa. He described anorexic patients as being more concerned with thinness than weight, whereas bulimic ones fear getting fat but lack the anorexic patient's drive to be thin. To identify the kind of eating disorder an adolescent may be experiencing, it is helpful to consider various possible contributing factors and situations. Tonkin said adolescents sometimes may appear to have a classic eating disorder but in fact do not: eating disturbances may be found in those involved in sports, weight training, gymnastics or ballet dancing, and in patients with chronic diseases such as diabetes or cystic fibrosis. These factors can influence eating, but are gen-

Vancouver conference aimed to harness "peace dividend" for world's children The Child Health 2000 World Congress and Exposition that was held in Vancouver in February was perceived as a natural follow-up to the 27 objectives agreed on at the September 1990 World Summit for Children that was held at the United Nations in New York. Dr. Wah Jun Tze, the congress chairman, wanted to harness the "peace dividend," believing that funds can be channelled toward lowering the death toll now that the Cold War is over and the two superpowers are no longer likely to engage in mass destruction. With a budget of nearly $1.5 million provided by more than 40 sponsors and the federal and provincial governments, Tze, head of the University of British Columbia's division of pediatric endocrinology, created a 9-member planning committee and a 20-member international advisory council to or-

ganize the congress. The planners had three primary goals: to introduce systems for the application of modern medical technology in the Third World, to develop programs and review preventive health care methods on an international scale, and to look at resources that can be directed at attempting to reduce the mortality rate of children around the world. The final result was a program comprising four plenary sessions, 10 subspecialty conferences, 24 symposia and 18 workshops that featured more than 300 world-renowned experts in the field of child health; the speakers were drawn from Canada, the US and 14 other countries. Eighteen months in planning, the congress marked the first time that such a distinguished group of health care professionals and scientists had come together to address the needs of children. CAN MED ASSOC J 1992; 146 (8)

1409

"We found in Indonesia the most significant risk factor for vitamin A deficiency during the first year of life was whether a child was breast-fed." - Dr. Alfred Sommer

erally unrelated to concerns about weight. Because eating disorders arrest adolescent development, Tonkin said the route to improvement is to get development moving again. "It's important to recognize that they have not finished pubital growth," he said, "and need to have normal weight in order to finish that process." Normalization of weight should be a primary objective of treatment, along with awareness that a return to normal weight does not mean the eating disorder has been cured. Counselling is a cornerstone of therapy, and is centred on the adolescent's concepts of body image. "You have to talk about the metabolic needs of growth spurt in adolescence, and the potential for arrest and stunting of growth with chronic undernutrition." Tonkin pointed to an increasing number of reports suggesting a strong likelihood of sexual abuse in cases involving an eating disorder, particularly in the case of bulimic patients. "The other thing we have found is that the difficult kids to manage are the ones who have been sexually abused." Tonkin added that bulimia can turn up in some surprising places. "If you go to your local race track and into the jockeys' room, it will smell of vomit. Jockeys have to make weight and they like to eat, and that's the way they handle it." Dr. Brian Strom, a pharmaco1410

CAN MED ASSOC J 1992; 146 (8)

epidemiologist at the University of Pennsylvania in Philadelphia, blamed poor research and public over-reaction for the withdrawal of many potentially useful drugs during the last 20 years. Bendectin, an antiemetic used during pregnancy, was taken off the market in 1983 not because of documented problems "but because of fear of such problems and the costs of litigation, which made it uneconomical to keep on the US market." Even drugs that have been in use for decades may face these problems, Strom said. Halcion (triazolam), the world's top-selling benzodiazepine, was recently withdrawn from distribution in the United Kingdom because of mounting criticism. Strom said many of the drug disasters of the last 20 years resulted in the removal of drugs for inappropriate reasons. "These were new drugs that may not even have caused adverse effects, or if they did, caused them uncommonly. They still had useful situations when they could be used, but out of fear and lack of information, they were removed. "The really important question may not be whether it causes an adverse reaction, but how often it does," Strom concluded. A rare reaction or side effect need not affect all feasible applications as long as "you steer it away from those subgroups and save the drug's availability for people who will be able to use it, while avoid-

ing these adverse reactions." At a session on pediatric leukemia, Dr. Anna Meadows, a professor of pediatrics and oncology at the Children's Hospital of Philadelphia, expressed doubt about the significance of electromagnetic fields and power lines in the incidence of leukemia. "If you look at the electromagnetic spectrum, vis-a-vis ionizing and nonionizing rays, we don't really have any evidence that these low-frequency rays have anything to do with the biologic changes that occur in leukemia." While there has been some evidence of possible changes in the nuclei of cells exposed to electrical fields, Meadows said further study is needed before conclusions are reached. "The real question is, how can we explain what's happening in a stem cell when it gets exposed to an electric or magnetic field to cause it to develop either a mutation or a proliferative advantage?" Meadows suggested it is ironic that children in underdeveloped countries are less likely to develop all kinds of leukemia than their peers in the industrialized world. "You have to have a certain number of lymphoid cells to be able to have those cells change or mutate to become leukemia, and stress and malnutrition and disease tend to eliminate a lot of this tissue in these children. I think that is why acute lymphocytic leukemia does not occur to the same extent in these countries as in the US.". For prescribing information

see

page 1485

-

Massive Vancouver conference focuses on tragedy of world's dying children.

CHILDREN'S HEALTH * SANTE ENFANTILE ET ADOLESCENTE Massive Vancouver conference focuses on tragedy of world's dying children Eleanor LeBourdais mT...
712KB Sizes 0 Downloads 0 Views