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News — Evidence-based guidelines for the care of children in emergency situations should be developed and distributed to international relief organizations, according to researchers from the Johns Hopkins Bloomberg School of Public Health and the World Health Organization (WHO). In a review of published literature, the researchers found that the highest mortality rates following armed conflicts, natural disasters, population displacements or famines are often in children younger than five years. The most common causes of death are diarrhea, acute respiratory infections, measles, malaria and malnutrition; these are also the major causes of death in countries with high child mortality rates. The study is published in the January 2006 issue of the Bulletin of the World Health Organization.

"The major causes of child mortality in complex emergencies are well known and we have learned how to manage these conditions in stable situations. However, conflict or disaster often exacerbates the magnitude and severity of these illnesses, requiring rapid assessment and treatment of large numbers of severely ill children. This was seen with the tsunami disaster and the recent earthquake in Pakistan. What we need are simple, easy-to-use guidelines that are brought together in a single package for the different levels of health workers caring for children in complex emergencies," said William J. Moss, MD, MPH, senior author of the study and an assistant professor in the Bloomberg School of Public Health's Department of Epidemiology.

The researchers came to their conclusions after reviewing previously published literature and interviewing representatives from international relief organizations. They found that in emergency situations, most relief organizations use WHO, UNICEF and other ministry of health guidelines that are intended for stable environments. Few studies, however, have assessed how effective these interventions are in reducing child mortality in complex emergencies. Moss and his colleagues note that during emergency situations, care is given by multiple organizations and a broad range of health workers with different levels of training and experience.

The guidelines should be brought together from existing clinical guidelines into an accessible and comprehensive package, according to the study authors. The guidelines should not only address issues such as how to treat patients when referral facilities are not accessible, but also fill some of the gaps in current treatment guidelines. The special needs of unaccompanied children and common mental health problems of all children also should be addressed. The guidelines should be simplified so that community health workers and volunteers can follow them when they act as primary care givers in emergency situations.

"Many of the same diseases that are common to children in non-emergencies are the ones that need to be treated in emergencies. Those treatment protocols already exist, but we need to adapt them for emergency situations," said Moss.

"Child health in complex emergencies" was funded by a grant from the Department of Child and Adolescent Health, World Health Organization to the Center for Refugee and Disaster Response.

Meenakshi Ramakrishnan, Dory Storms, Anne Henderson Siegle and William M. Weiss of the Bloomberg School of Public Health, co-authored the study. Additional co-authors are Ivan Lejnev and Lulu Muhe.