Randomised Trials in Child and Adolescent Health in Developing Countries

Professor Trevor Duke of the University of Melbourne's Department of Paediatrics and The Royal Children's Hospital creates an annual booklet that summarises evidence from randomised or controlled trials in low- and middle-income countries on child and adolescent health from the previous year. The goal is to provide current information to paediatricians, nurses, health workers, and administrators in resource-constrained settings.

This year, there were 540 trial publications identified. These studies were carried out globally. Several trials from 2023-24 are expected to significantly impact child health recommendations, and some have already occurred.

To view the full report, please visit: : Ophthalmology (pngpaediatricsociety.org)

A summary of some of the important results from July 2023 to June 2024:

• In urban Bangladesh, a community based early child development (ECD) social safety-net program using home visitation improved the development of children of young mothers, including improved cognitive and motor skills, reduced experience of violence by mothers, and more engagement by fathers. Similar positive results for community ECD was found in rural India.

• In Rwanda, Bandebereho, a program that worked with parents to build couple relationship and parenting skills and included reflection on gender norms had lasting effects on reduced family violence and physical punishment of children, plus multiple health and relationship outcomes.

• In India, among 27,000 households where water sanitation and hygiene (WASH) training was conducted, households that engaged in a combination of four WASH characteristics: safe source of water for daily use, safe source of drinking water, private or shared flush toilet use, and always handwashing with soap after defecation had a 30% lower risk of cholera than those that did not have these 4 characteristics.

• In Bangladesh, several studies explored the effects of improved water, sanitation on hygiene (WASH) on childhood diarrhoea, including a large cluster RCT involving 360 clusters and 4941 children which showed improved WASH substantially reduces diarrhea risk with largest benefits among children with lowest socio-economic households and during the monsoon season, preventing an estimated 734 (95% CI 385, 1085) cases per 1000 children per month during the seasonal monsoon. A substudy showed improved WASH may improve epigenetics including reduced methylation of cortisol genes, and enhanced adaptive responses of the physiological stress system in early childhood.

• Among 225 Ugandan school children with hookworm, dual-dose albendazole (400mg per day for 2 days) improved the cure rate of hookworm compared to a single-dose of 400mg albendazole (96 vs 84%). And in Gabon, a childhood hookworm vaccine underwent a phase II trial with prosing serological responses.

• In a large cluster RCT in Bangladesh, certain entero-pathogens were more prevalent in the hot rainy season, including Cryptosporidium, E. coli, Shigella, Campylobacter, Aeromonas, and Adenovirus.

• Three trials (in Niger, Mali and Kenya) showed the benefits of involving community health workers and decentralised care in the management of children with acute malnutrition, with equivalent or greater recovery rates, shorter length of hospital stay and reduced costs.

• In a large community based RCT in the Punjab, India involving over 70,000 households and 15,000 births, a maternal and newborn health package, plus training for community- and facility-based health care workers, and community counselling and education sessions improved neonatal mortality rate (39.2/1000 live births vs 52.2/1000 live births in control clusters, improved clean delivery practices, and use of chlorhexidine for cord care.

• In Zambia and Burkina Faso, breast fed infants without HIV, whose mothers had HIV and a viral load >1000 copies per ml, lamivudine prophylaxis in the first 12 months of life in addition to maternal antiretroviral therapy reduced the risk of post-natal mother-to-child HIV transmission.

... view the full summary and report via: : Ophthalmology (pngpaediatricsociety.org)