We asked public health professionals from around the globe to offer up their most pressing public health issues. Many responded with incredible depth and insight on a variety of issues. This segment addresses children as a population that needs more attention in research and treatment.
Public health expert Dr. Tamar Lasky is working on a range of public health and clinical research issues, comparative effectiveness research, patient reported outcomes (mostly in the area of pharmacoepidemiology), and the discipline focusing on optimum use of medications in populations. “This last one is a rapidly growing area and draws on skills regarding communication and education of patients, decision support, patient engagement, and the quantitative skills of statistical analysis, use of large databases, and data mining,” explains Lasky. “Within the broad arena of pharmacoepidemiology, questions about the use of medications in children are understudied. Children use fewer medications than adults, but the amount of use is growing, and information about efficacy and safety of medications used by children is lacking. It is not always possible to use information from adult studies to infer dosage, efficacy and safety in children, and for this reason, studies assessing pediatric questions are necessary. It is also a fascinating area, cutting across all areas of medicine and affecting children and parents across all socio-economic and geographic groupings. Children are exposed to psychotropic, asthma, dermatologic and other medications, most of which have not been studied or labeled for pediatric use.”
Abdulrahman Saban Hammond, a public health expert working in Ghana, is focusing on tuberculosis (TB) and tuberculosis-associated diseases. “TB continues to increase worldwide because of new levels of difficulty to diagnosis, as well as to treat and prevent the disease. For instance, recent outbreaks of extreme drug-resistant TB (XDR-TB) in Kwazulu Natal, and reports of misdiagnosis due to failure to recognize non-mycobacteria tuberculosis in adults in Mali, have shed more light on the threat posed by the different forms of the disease. These events emphasize the need to look at control efforts to reduce transmission of the disease. Although clinical and basic research has explored novel ways of diagnosing and managing TB disease, there still remains a lot to be done with respect to harnessing the innovation of new tools for the control of the disease,” says Hammond.
Until recently, Hammond explains that control of TB was traditionally focused on adult forms of the disease rather than in infants and younger children. The excuse for this trend has been that children do not contribute much to the burden of TB. “Data emerging from the year 2000, however, showed that, at least 11 percent of all global cases of TB occurred in children. In addition, it is known that many children die from TB in the endemic regions of the world. Sadly, exposure of infants and young children to adults with infectious forms of TB provides them a higher risk environment in which they can develop the disease. And for most children below 15 years of age such exposure often becomes complicated because of vaccination with M. bovis BCG (the only available vaccine for TB, whose type of immune protection is not fully understood) and exposure to environmental mycobacteria,” says Hammond. Additionally, the risks for developing TB for those children with HIV may increase several fold given that they have less developed immune system.
“Although media coverage and the work being done in adults to prevent and control all forms of tuberculosis is necessary, coverage of prevention, control and treatment of TB in children must be seen as a complementary effort that is necessary for understanding primary transmission of TB, and to unravel the complexities associated with therapeutic management of the disease,” says Hammond. “I’m strongly inclined to believe that a balanced coverage of childhood TB will also facilitate better allocation of resources to supplement efforts at diagnosis, prevention and management of all forms of TB and its associated diseases.”
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