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Primary health care is the cornerstone of universal health coverage and guarantor of quality comprehensive health care for all, including children [1]. Views on what comprehensive primary health care entails and what health services can and should deliver at the primary health care level for children and adolescents differ. Different health systems offer a range of curative and preventive interventions for children and adolescents. Some of those interventions are evidence-based with proven benefits. Others are common practices based on tradition, expert opinion, or common sense and there is no felt need for justifying their effectiveness or benefit. Some interventions however may not only be without benefit for the child but harmful [2, 3].
Against this backdrop, the WHO Pocket Book on Primary Health Care for Children and Adolescents (see Fig. 1 below) defines evidence-based standards of health care for a child or adolescent according to which every child attending primary health care services across the European Region should be cared for. During the development process of the Pocket Book, it became apparent that recommendations and practices for preventive interventions for infants and children are particularly controversial and the book’s editorial group and members of the European Confederation for Primary Care Paediatricians (ECPCP) realised the need for collating existing evidence for recommendations and practices for disease prevention for infants, children and adolescents.
Fig. 1
The draft WHO Pocket Book of Primary Health Care for Children and Adolescents, expected publication date end 2021
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This supplement summarises and reviews the available evidence for selected preventive interventions to inform key chapters of the Pocket Book and thereby helps to close the practice gap for prevention. In a series of articles, Sophie Jullien and colleagues first provide the background, describe the methods in detail, and present the supplement’s main findings [4]. The author then critically reviews and summarises the strengths of the recommendations and quality of evidence for ten preventive interventions based on major documents of international paediatric societies and institutions, mostly from Europe [5‐14].
The Pocket Book aims to help deliver on the promise of primary health care: its focus on evidence-based practices and prevention should counteract inappropriate medicalisation of health services (i.e. preferring invasive or active treatment over conservative or watchful management, intravenous treatment over oral rehydration therapy and multiple drugs over just one) and prevent unnecessary treatment and hospitalisation. Its success, however, will also require a critical review of health-system financing.
As of today, health spending overwhelmingly goes towards curative care, not prevention: Europe’s governments spend only 3% of the total health expenditure (THE) on health promotion and disease prevention [15]. Funding needs to be made available to enable the provision of evidence-based treatment and prevention services for children and adolescents. These services need to be included in state-guaranteed benefits packages or covered under health insurance schemes to be made available for children and adolescents without cost to them at the point of care.
Attaining the sustainable development goals (SDGs) requires a substantial shift in thinking about child and adolescent health, according to the global review of the implementation of the UNICEF/WHO Strategy of the Integrated Management of Childhood Illness (IMCI) to reduce childhood mortality and improve quality of care for children [16]. The focus moves from the survival of children under 5 years old to a holistic view of child and adolescent health and attention shifts to health promotion, disease prevention, early risk factor management and monitoring of chronic conditions [17]. The summaries of evidence for preventive interventions for children published in this supplement are an important step in this direction and providing comprehensive evidence-based primary health care for children and adolescents.
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About the supplement
This article has been published as part of BMC Pediatrics Volume 21, Supplement 1 2021: Defined preventive interventions for children under five years of age: evidence summaries for primary health care in the WHO European region. The full contents of the supplement are available at https://bmcpediatrics.biomedcentral.com/articles/supplements/volume-21-supplement-1.
Authors‘contributions
Both authors developed the idea for the manuscript. SC wrote the draft manuscript. MW provided critical appraisal of the manuscript. SCmade subsequent revisions and both authors read and approved the final manuscript. The authors gratefully acknowledge support of the editorial group of the WHO Pocket Book of Primary Health Care for Children and Adolescents in Europe, particularly Julia Mutevelli. The author(s) read and approved the final manuscript.
Declarations
Ethics approval and consent to participate
Ethics approval was not required.
Availability of data and materials
Not applicable
Competing interests
The authors declare that they have no competing interests. MW is a staff member of the World Health Organization. The authors alone are responsible for the opinions expressed in this publication and they do not necessarily reflect the policies and positions of the World Health Organization. Funding for the editorial: Not applicable The development of the Pocket Book and related activities were partially funded by the Federal Ministry of Health of Germany and through a grant of the Russian Government.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
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Wer ihn je erlebt hat, wird ihn nicht vergessen: den Schmerz, den die beim Öffnen oder Schließen des Reißverschlusses am Hosenschlitz eingeklemmte Haut am Penis oder Skrotum verursacht. Eine neue Methode für rasche Abhilfe hat ein US-Team getestet.
Zwar scheint es laut einer Studie aus den USA und Kanada bei der Reanimation von Kindern außerhalb einer Klinik keinen Unterschied für das Überleben zu machen, ob die Wiederbelebungsmaßnahmen während des Transports in die Klinik stattfinden oder vor Ort ausgeführt werden. Jedoch gibt es dabei einige Einschränkungen und eine wichtige Ausnahme.
Welchen Einfluss das Alter ihrer Mutter auf das Risiko hat, dass Kinder mit nicht chromosomal bedingter Malformation zur Welt kommen, hat eine ungarische Studie untersucht. Sie zeigt: Nicht nur fortgeschrittenes Alter ist riskant.
Ob ungeborene Kinder, die kleiner als die meisten Gleichaltrigen sind, schneller wachsen, wenn die Mutter sich mehr ausruht, wird diskutiert. Die Ergebnisse einer US-Studie sprechen dafür.
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