- Email: [email protected]
Providing paediatric palliative care in Kenya
Correspondence
includes estimates of their related population-attributable fractions. Bailey and Godfrey-Faussett rightly point to the importance of these links for policy development and implementation. As discussed in our paper, the links between tuberculosis and non-communicable diseases have major potential policy implications. To improve early diagnosis of all people with tuberculosis, intensified case detection is necessary in specific high-risk groups. This could include, for example, regular tuberculosis screening of people with diabetes in settings where tuberculosis prevalence is high. To further improve health outcomes in tuberculosis patients, comorbidities need to be optimally managed. Such management requires early diagnosis and good management of diabetes and undernutrition, as well as efforts to minimise the harmful use of alcohol and tobacco in people diagnosed with tuberculosis. Such efforts would also help to strengthen general care for non-communicable diseases. To prevent tuberculosis more effectively, the prevalence of noncommunicable diseases and their risk factors need to be reduced at population level. This requires broad public health efforts, including regulatory approaches and actions to address social and economic determinants of ill health. WHO and the International Union Against Tuberculosis and Lung Disease have already developed a framework for tuberculosis and tobacco,3 and are in the process of developing a similar framework for tuberculosis and diabetes.4,5 We are also pursuing work to improve the evidence base on tuberculosis and nutrition, alcohol misuse, and mental health. We declare that we have no conflicts of interest.
*Knut Lönnroth, Mario C Raviglione [email protected] Stop TB Department, WHO, 1211 Geneva, Switzerland 1
1988
Bailey SL, Godfrey-Faussett P. Where is diabetes in The Lancet‘s tuberculosis Series? Lancet 2010; 376: 683.
2
3
4
5
Lönnroth K, Castro K, Chakaya JM, et al. Tuberculosis control and elimination 2010–50: cure, care, and social development. Lancet 2010; 375: 1814–29. WHO, International Union against Tuberculosis and Lung Disease. A WHO/the Union monograph on TB and tobacco control. WHO/ TB/2007.390. Geneva, Switzerland: World Health Organization, 2008. Ottmani SE, Murray MB, Jeon CY, et al. Consultation meeting on tuberculosis and diabetes mellitus: meeting summary and recommendations. Int J Tuberc Lung Dis 2010; 14: 1513–17. Harries AD, Murray MB, Jeon CY, et al. Defining the research agenda to reduce the joint burden of disease from diabetes mellitus and tuberculosis. Trop Med Int Health 2010; 15: 659–63.
global guidelines for the treatment of acute and chronic pain in adults are also urgently needed. The international community can hardly expect countries to improve if it is not willing to support the normative work which is essential for national programmes. We declare that we have no conflicts of interest.
*Willem K Scholten, Barbara Milani [email protected] Access to Controlled Medicines, Department of Essential Medicines and Pharmaceutical Policies, World Health Organization, 1211 Geneva, Switzerland 1
Providing paediatric palliative care in Kenya Your Sept 11 Editorial (p 846)1 discusses the excellent Human Rights Watch report, Needless Pain: Government Failure to Provide Palliative Care for Children in Kenya,2 which provides one example of how poor access to pain management affects children around the world. The report correctly informs on WHO’s work and we welcome its recommendation to complete the ongoing treatment guidelines on chronic pain for children. However, your Editorial labels these WHO guidelines as “long overdue”,1 which is not entirely fair. WHO established thorough procedures for guideline development, consistent with best practices, including appropriate use of evidence. We finalised a scoping document in October, 2008, and donors enabled us to work on guidelines from early 2009. In 2 years, we went through the intensive steps of retrieval and appraisal of evidence and formulation of recommendations. Those draft recommendations are currently subject to a final expert review. After clearance and editing, they will be published in the coming months. The Editorial highlights the fact that Human Rights Watch criticises health donors for overlooking pain treatment and palliative care. We agree with this assertion. Updated evidence-based
2
The Lancet. Providing paediatric palliative care in Kenya. Lancet 2010; 376: 846. Human Rights Watch. Needless pain: government failure to provide palliative care for children in Kenya. New York, USA: Human Rights Watch, 2010.
Department of Error Swedberg K, Komajda M, Böhm M, et al, on behalf of the SHIFT Investigators. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet 2010; 376: 875–85—In this Article (Sept 11), the names of three of the trial investigators listed at the end of the paper were misspelt. “M Lajnscak” should have read “M Lainscak”, “I Roldan Rabanedo“ should have read “I Roldan Rabadán“, and “M Leva“ should have read “M Ieva”. These corrections have been made to the online version as of Dec 10, 2010. Almeida C, Braveman P, Gold MR, et al. Methodological concerns and recommendations on policy consequences of the World Health Report 2000. Lancet 2001; 357: 1692–97—In this World Health Report 2000 publication (May 26, 2001), the 13th author’s surname was mis-spelled. The correct spelling is “Claudia Travassos”.
www.thelancet.com Vol 376 December 11, 2010
includes estimates of their related population-attributable fractions. Bailey and Godfrey-Faussett rightly point to the importance of these links for policy development and implementation. As discussed in our paper, the links between tuberculosis and non-communicable diseases have major potential policy implications. To improve early diagnosis of all people with tuberculosis, intensified case detection is necessary in specific high-risk groups. This could include, for example, regular tuberculosis screening of people with diabetes in settings where tuberculosis prevalence is high. To further improve health outcomes in tuberculosis patients, comorbidities need to be optimally managed. Such management requires early diagnosis and good management of diabetes and undernutrition, as well as efforts to minimise the harmful use of alcohol and tobacco in people diagnosed with tuberculosis. Such efforts would also help to strengthen general care for non-communicable diseases. To prevent tuberculosis more effectively, the prevalence of noncommunicable diseases and their risk factors need to be reduced at population level. This requires broad public health efforts, including regulatory approaches and actions to address social and economic determinants of ill health. WHO and the International Union Against Tuberculosis and Lung Disease have already developed a framework for tuberculosis and tobacco,3 and are in the process of developing a similar framework for tuberculosis and diabetes.4,5 We are also pursuing work to improve the evidence base on tuberculosis and nutrition, alcohol misuse, and mental health. We declare that we have no conflicts of interest.
*Knut Lönnroth, Mario C Raviglione [email protected] Stop TB Department, WHO, 1211 Geneva, Switzerland 1
1988
Bailey SL, Godfrey-Faussett P. Where is diabetes in The Lancet‘s tuberculosis Series? Lancet 2010; 376: 683.
2
3
4
5
Lönnroth K, Castro K, Chakaya JM, et al. Tuberculosis control and elimination 2010–50: cure, care, and social development. Lancet 2010; 375: 1814–29. WHO, International Union against Tuberculosis and Lung Disease. A WHO/the Union monograph on TB and tobacco control. WHO/ TB/2007.390. Geneva, Switzerland: World Health Organization, 2008. Ottmani SE, Murray MB, Jeon CY, et al. Consultation meeting on tuberculosis and diabetes mellitus: meeting summary and recommendations. Int J Tuberc Lung Dis 2010; 14: 1513–17. Harries AD, Murray MB, Jeon CY, et al. Defining the research agenda to reduce the joint burden of disease from diabetes mellitus and tuberculosis. Trop Med Int Health 2010; 15: 659–63.
global guidelines for the treatment of acute and chronic pain in adults are also urgently needed. The international community can hardly expect countries to improve if it is not willing to support the normative work which is essential for national programmes. We declare that we have no conflicts of interest.
*Willem K Scholten, Barbara Milani [email protected] Access to Controlled Medicines, Department of Essential Medicines and Pharmaceutical Policies, World Health Organization, 1211 Geneva, Switzerland 1
Providing paediatric palliative care in Kenya Your Sept 11 Editorial (p 846)1 discusses the excellent Human Rights Watch report, Needless Pain: Government Failure to Provide Palliative Care for Children in Kenya,2 which provides one example of how poor access to pain management affects children around the world. The report correctly informs on WHO’s work and we welcome its recommendation to complete the ongoing treatment guidelines on chronic pain for children. However, your Editorial labels these WHO guidelines as “long overdue”,1 which is not entirely fair. WHO established thorough procedures for guideline development, consistent with best practices, including appropriate use of evidence. We finalised a scoping document in October, 2008, and donors enabled us to work on guidelines from early 2009. In 2 years, we went through the intensive steps of retrieval and appraisal of evidence and formulation of recommendations. Those draft recommendations are currently subject to a final expert review. After clearance and editing, they will be published in the coming months. The Editorial highlights the fact that Human Rights Watch criticises health donors for overlooking pain treatment and palliative care. We agree with this assertion. Updated evidence-based
2
The Lancet. Providing paediatric palliative care in Kenya. Lancet 2010; 376: 846. Human Rights Watch. Needless pain: government failure to provide palliative care for children in Kenya. New York, USA: Human Rights Watch, 2010.
Department of Error Swedberg K, Komajda M, Böhm M, et al, on behalf of the SHIFT Investigators. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet 2010; 376: 875–85—In this Article (Sept 11), the names of three of the trial investigators listed at the end of the paper were misspelt. “M Lajnscak” should have read “M Lainscak”, “I Roldan Rabanedo“ should have read “I Roldan Rabadán“, and “M Leva“ should have read “M Ieva”. These corrections have been made to the online version as of Dec 10, 2010. Almeida C, Braveman P, Gold MR, et al. Methodological concerns and recommendations on policy consequences of the World Health Report 2000. Lancet 2001; 357: 1692–97—In this World Health Report 2000 publication (May 26, 2001), the 13th author’s surname was mis-spelled. The correct spelling is “Claudia Travassos”.
www.thelancet.com Vol 376 December 11, 2010