Key trials in developing countries – 2015-2016

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Here is a recently published booklet which summarises much of the latest research on child health in developing countries. It consists of evidence derived from all the randomised trials published over the last year.

Professor Trevor Duke, Intensivist at the Royal Children’s Hospital in Melbourne has put together this excellent summary of some of the key findings, and has kindly allowed us to share it with our DFTB readers.

This year there were 187 publications from randomised or controlled trials. We have high-lighted just a few of the trials.  It is well worth perusing the booklet, if only to realise how lucky those of us are that practice in the developed world when it comes to resources.

Pneumonia

Pneumonia is a leading cause of mortality in children under 5 years old worldwide.

In a trial of over 1000 Indian children with clinical signs of pneumonia with tachypneoa, and chest indrawing out-patient treatment with oral amoxicillin was similar, in regard to treatment failure, as in-hospital treatment, at 7 days.

In a trial of hospitalized children with community acquired pneumonia in Thailand, switching to oral antibiotics within 24 hours of cessation of fever and symptom improvement, was as effective as conventional intravenous therapy.

Use of bubble-CPAP in children with severe pneumonia in Bangladesh was associated with lower risk of death than standard oxygen therapy.

Inotropes

In the setting of fluid refractory shock, in Brazil, early peripheral adrenaline was associated with decreased mortality when compared with dobutamine.

Diarrhoeal illness

A single dose of oral ondansetron reduced the risk of treatment failure with oral rehydration solution and reduced the need for IV therapy in India.

Whilst medical interventions do work, cultural interventions are more useful.

In a large meta-analysis of over 14,000 cases in low and middle income countries hand-washing promotion reduced community diarrhoea rates by about 30%.

Improving water quality in communities in Ghana by drilling bores reduced diarrhoea prevalence in children by 11%. This is in contrast to efforts in rural India to improve sanitation and reduce open defecation which were only partially successful in reducing faecal bacterial loads and cases of diarrhoea.

Neonates

When treating hyperbilirubinemia in term and late-preterm neonates in Nigeria, filtered sunlight was effective in controlling bilirubin levels on 93% of days, and conventional phototherapy was effective in 90% of days. It appeared safe with temperatures higher than 38.0°C occurringin 5% of infants receiving filtered sunlight and in 1% of those receiving conventional phototherapy.

Like most studies in low and middle income countries sample sizes are small and so it is hard to generalize but among preterm Indian neonates with a patent ductus arteriosus, enteral paracetamol was as effective as intravenous indomethacin in closing the PDA: 100% (36/36) versus 94.6% (35/37) respectively.

This is the 14th edition of this booklet.  Previous editions, which summarise 2182 trial publications from 2002-2015 are available at www.ichrc.org.

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An Emergency Physician with a special interest in education and lifelong learning. When not drinking coffee and reading Batman comics he is playing with his children.

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