The pooled prevalence of clinical rheumatic

The pooled prevalence of clinical rheumatic heart disease (ie, presence of pathological murmur) seemed to be comparable whether it was measured by auscultation only (2·9 per 1000 people, 95% CI 1·7–5·0) or by echocardiography and auscultation (2·7 per 1000 people, 1·6–4·4), which is remarkable. Consensus is emerging that this group of people with asymptomatic but clinically evident rheumatic heart disease should be considered for secondary antibiotic prophylaxis with penicillin to prevent progression to symptomatic disease, although there is no randomised evidence to support this recommendation. However, the challenge is how to manage treatment in children and adolescents with clinically silent rheumatic heart disease, whose prevalence was substantially higher than the cases of clinically manifest rheumatic heart disease in this systematic review. There is limited information on the natural history and virtually no evidence upon which to Monastrol manufacturer the management of children and adolescents with asymptomatic subclinical rheumatic heart disease that is detected on active surveillance. The time has come to launch large-scale prospective studies of the natural history of latent rheumatic heart disease and trials to assess the efficacy of penicillin prophylaxis to prevent progression of disease. The most important message of this systematic review and meta-analysis is that rheumatic heart disease remains a major public health problem in developing countries. The disease causes the highest number of disability-adjusted life-years of all listed cardiovascular diseases among 10–14-year-olds (516·6 per 100 000 people, 95% CI 425·3–647·0) and the second highest number among children aged 5–9 years (362·0 per 100 000 people, 294·6–462·0). WHO has set a target of reducing premature mortality from rheumatic heart disease and other non-communicable disease by 25% by the year 2025. This target can be achieved and exceeded through the establishment of national rheumatic heart disease programmes that implement a comprehensive strategy for primary and secondary prevention of the disease, such as the Stop Rheumatic Heart Disease A.S.A.P. Programme, which has been launched in Africa.
Pneumonia is the leading killer of children younger than 5 years, and the greatest risk of mortality from pneumonia in childhood is in the neonatal period. Substantial reductions in childhood pneumonia deaths have been hindered by a lack of progress in addressing neonatal mortality. Deaths in the neonatal period constitute 41·6% of the 6·3 million children who die annually before their fifth birthday. In 2010, there were an estimated 1·7 million cases of neonatal sepsis and 510 000 cases of neonatal pneumonia. On Nov 12, World Pneumonia Day, we focus on prevention of pneumonia in these youngest and most susceptible victims.
The past decade has seen increasing global policy attention to nutrition. Concrete steps have been taken to construct a global governance architecture for nutrition and also to mobilise resources for action. Efficacious, low-cost interventions exist, and there is greater consensus around technical issues, including the role of nutrition-specific and nutrition-sensitive interventions in addressing malnutrition in different settings. The economic argument to invest in nutrition is well developed, supported by cost-benefit analyses and studies that quantify the cost to scale up interventions. Additionally, the normative argument to protect and promote the right to food and health supports a moral obligation to act. However, as stakeholders gather at the Second International Conference on Nutrition (ICN2) and commit to the Rome Declaration on Nutrition this month, significant challenges remain in implementing the global nutrition agenda and in translating policy momentum into tangible results. Historically, implementation of nutrition policy has confronted persistent obstacles. This is not surprising since progress requires success at each step in the policy reform cycle: building political commitment for nutrition, designing and revising relevant policies, getting new policies accepted and adopted, and implementing the policies in ways that advance nutrition goals. Many obstacles arise from political economy sources, suggesting that better understanding of these factors could help mitigate impediments and advance nutrition goals. There is growing agreement, both in the academic literature and from development agencies, that development cannot be understood, analysed, or managed without explicit recognition of the roles of politics, economics, and institutions in shaping what happens. In practice, application of a political economy perspective broadens the operational lens to look beyond technical solutions, sensitising practitioners to the roles of power, incentives, institutions, and ideas that shape policy processes in reality. Expansion of conceptual horizons is particularly relevant for nutrition: our review of the literature on the political economy of food and nutrition security showed how these factors create a powerful web of obstacles to achieving nutrition security. Although the nutrition community is constantly engaged in political economy in practice, the capacity for systematic analysis is limited. Thus, more systematic application of political economy analysis for food and nutrition security, along with serious capacity development in this field, could help implement nutrition reforms.