Considerable advances have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, the mechanisms underlying these benefits, and in the clinical management of breastfeeding. This policy statement on breastfeeding replaces the 1997 policy statement of the American Academy of Pediatrics and reflects this newer knowledge and the supporting publications. The benefits of breastfeeding for the infant, the mother, and the community are summarized, and recommendations to guide the pediatrician and other health care professionals in assisting mothers in the initiation and maintenance of breastfeeding for healthy term infants and high-risk infants are presented. The policy statement delineates various ways in which pediatricians can promote, protect, and support breastfeeding not only in their individual practices but also in the hospital, medical school, community, and nation.

/pdf/breastfeeding-and-the-use-of-human-milk-2m74a0njro.pdf

Breastfeeding and the Use of Human Milk

Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups.

https://www.jhsph.edu/sebin/k/a/2005_MQ_Starfield.pdf

Contribution of Primary Care to Health Systems and Health

https://www.who.int/immunization/diseases/tetanus/lancet-2012-global-child-mortality.pdf

Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000

Developmental potential in the first 5 years for children in developing countries

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)60549-1.pdf

Global, regional, and national causes of child mortality in 2008: a systematic analysis

How many child deaths can we prevent this year

WHO and the United Nations Children's Fund (UNICEF) annually review data on immunization coverage to estimate national coverage with routine service delivery of the following vaccines: bacille Calmette-Guerin; diphtheria-tetanus-pertussis, first and third doses; either oral polio vaccine or inactivated polio vaccine, third dose of either; hepatitis B, third dose; Haemophilus influenzae type b, third dose; and a measles virus-containing vaccine, either for measles alone or in the form of a combination vaccine, one dose. The estimates are based on government reports submitted to WHO and UNICEF and are supplemented by survey results from the published and grey literature. Local experts, primarily national immunization system managers and WHO/UNICEF regional and national staff, are consulted for additional information on the performance of specific immunization systems. Estimates are derived through a country-by-country review of available data informed and constrained by a set of heuristics; no statistical or mathematical models are used. Draft estimates are made, sent to national authorities for review and comment and modified in light of their feedback. While the final estimates may not differ from reported data, they constitute an independent technical assessment by WHO and UNICEF of the performance of national immunization systems. These country-specific estimates, available from 1980 onward, are updated annually.

/pdf/who-and-unicef-estimates-of-national-infant-immunization-47uoa4r3fk.pdf

WHO and UNICEF estimates of national infant immunization coverage: methods and processes

Levels and trends in under-5 mortality, 1990–2008

Data from two parallel household surveys conducted in Iraq by UNICEF in 1999 show that under-5 mortality declined steadily from 1974 to 1990, reaching about 63 per 1,000 live births in the period 1986-90. It then rose dramatically to 118 per 1,000 in 1991, the year of the Gulf War. The number of 'excess' under-5 deaths (i.e., the number in excess of the number predicted from past trends) in Iraq between 1991 and 1998 was calculated assuming that, instead of the rates measured by the 1999 survey for this period, either (a) average mortality rates for the period 1986-90 had been maintained, or (b) mortality had continued to decline at the rate observed between 1974 and 1990. According to these calculations, the estimated number of excess deaths resulting from the Gulf War and its aftermath up to 1998 was between 400,000 (assumption a) and 500,000 (assumption b).

/pdf/annual-mortality-rates-and-excess-deaths-of-children-under-1mhflbx4w0.pdf

Annual mortality rates and excess deaths of children under five in Iraq, 1991-98.

About 2.1 million Indian children under 5 years of age die each year. In spite of reductions in child mortality rate over the past two decades, the rate remains high at 87 per 1000 live births. The main causes are diarrhoea, pneumonia, and for deaths among the neonates asphyxia, pre-term delivery, sepsis and tetanus. The major underlying cause of death is undernutrition. Child survival interventions of proven impact, feasible for use at high coverage in India were identified, and their effect on child mortality was calculated if high coverage were to be achieved. Exclusive breastfeeding, oral rehydration therapy, and adequate complementary feeding were among the most effective interventions. If these interventions would be applied universally 57% of mortality among pre-schoolers could be prevented. No cause specific mortality data were available from individual Indian states. Nevertheless, the range of child mortality, as well as the proportion of neo-natal deaths, occurring across the states, suggests that at state level 50-70% of deaths can be prevented. The results show that the targets set in the millennium development goals as well as in the Tenth Five Year plan can be reached.

Gareth Jones

Papers

How many child deaths can we prevent this year

WHO and UNICEF estimates of national infant immunization coverage: methods and processes

Levels and trends in under-5 mortality, 1990–2008

Annual mortality rates and excess deaths of children under five in Iraq, 1991-98.

Child survival in India