Effect of topical emollient treatment of preterm neonates in Bangladesh on invasion of pathogens into the bloodstream.

Topical emollient therapy may reduce the incidence of serious infections and mortality of preterm infants in developing countries. We tested whether emollient therapy reduced the burden of pathogens on skin and/or prevented bacterial translocation. Neonates <33 wk gestational age were randomized to treatment with sunflower seed oil (SSO) or Aquaphor or the untreated control group. Skin condition score and skin cultures were obtained at enrollment and on d 3, 7, and weekly thereafter, and blood cultures were obtained for episodes of suspected nosocomial sepsis. For analysis, blood cultures were paired with skin cultures obtained 0-3 d before the blood culture. Skin condition scores at 3 d were better in patients treated with either emollient compared with untreated controls; however, skin flora was similar across the groups. The SSO group showed a 72% elevated odds of having a false-positive (FP) skin culture associated with a negative blood culture (i.e. skin flora blocked from entry into blood) compared with the control group. Topical therapy with SSO reduced the passage of pathogens from the skin surface into the bloodstream of preterm infants.

Skilled care at birth in the developing world: progress to date and strategies for expanding coverage.

Skilled attendance at delivery is one of the key indicators to reflect progress toward the Millennium Development Goal of improving maternal health. This paper assesses global progress in the use of skilled attendants at delivery and identifies factors that could assist in achieving Millennium Development Goals for maternal health. National data covering a substantial proportion of all developing country births were used for the estimation of trends and key differentials in skilled assistance at delivery. Between 1990 and 2000, the percentage of births with a skilled attendant increased from 45% to 54% in developing countries, primarily as a result of an increasing use of doctors. A substantial proportion of antenatal care users do not deliver with a skilled attendant. Delivery care use among antenatal care users is highly correlated with wealth. Women aged 35 and above, who are at greatest risk of maternal death, are the least likely to receive professional delivery care. Births in mid-level facilities appear to be a strategy that has been overlooked. More effective strategies are needed to promote skilled attendance at birth during antenatal care, particularly among poor women. Specific interventions are also needed to encourage older and high parity mothers to seek professional care at delivery.

Socioeconomic differentials in supplementation of vitamin A: evidence from the Philippines.

The efficacy of supplementation of vitamin A in child survival has been well-demonstrated. However, the effectiveness of a programme of vitamin A supplementation at the population level has been rarely examined. Understanding how programmes reach disadvantaged children can help improve the design of initiatives of vitamin A supplementation. The differentials in receipt of vitamin A by socioeconomic status were assessed using data from the Philippines. Factors associated with receipt of vitamin A during the last six months were examined using the Philippines Demographic and Health Surveys conducted in 1993 and 1998. In total, 6,970 and 6,118 children aged 12-59 months were included in 1993 and 1998 respectively. Logistic regression was used for identifying associations between the outcome and the household socioeconomic variables. The coverage of national-level vitamin A supplementation increased from 27% in 1993 to 79% in 1998. However, children whose mothers did not complete primary education and children living in poor households were less likely to receive supplementation. This disparity increased between the surveys: the adjusted odds of vitamin A intake by poor households compared to middle-class households declined from 0.73 [95% confidence interval (CI) 0.61-0.87) in 1993 to 0.52 (95% CI 0.42-0.63)] in 1998, resulting in an increased health inequity. The vitamin A programme in the Philippines was not uniformly successful in reaching the most vulnerable children. Approaches targeting vulnerable households or approaches not requiring mothers to travel to distribution centres may be more promising.