- Email: [email protected]
UNICEF: suggestions for change
Correspondence
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Horton R. UNICEF leadership 2005–2015: a call for strategic change. Lancet 2004; 364: 2071–74. Setty-Venugopal V, Upadhyay UD. Birth spacing: three to five saves lives. Population reports, series L, no 13. Baltimore: Johns Hopkins Bloomberg School of Public Health, Population Information Program, 2002. Knodel J. Fertility decline and children’s education in Thailand: some macro and micro effects. New York: Population Council, 1992. Adamson P. A failure of imagination. In: The progress of nations. New York: UNICEF, 1996.
Richard Horton1 has brought the issue of the next Chief Executive of UNICEF into the public forum for debate. In Ecuador, UNICEF works mainly as a watchdog, promoting greater government spending on education; very little is proposed or done in other areas, including health. Another troubling reality is UNICEF’s obsession with eliminating child labour, with no regard for children’s right to survive. I declare that I have no conflict of interest.
Corticosteroids and acute asthma: see also Department of Error
Richard Horton1 has hit the mark. So many have struggled with the idea of rights for children while trying to emphasise the centrality of survival to the realisation of any such rights. The simple interventions for survival emphasised by James Grant, Executive Director of UNICEF from 1980 to 1995, are still not realised by more than half the world’s children today. The Lancet series in 20032 shows clearly what can and should be done, with predictable and measurable results. UNICEF should concentrate on its mandate for the children of the world with more than pious rhetoric and return to the doable tasks so consistently articulated by Grant: safe delivery, breast feeding, early proper treatment of diarrhoea and pneumonia, immunisation, protection from malaria, and attention to nutrition in all its aspects. The lives of millions can be saved, and the quality of life for poor families immeasurably improved. The next leader of UNICEF should be committed to making these do-ables happen, rather than hobnobbing about in prestigious meetings talking about rights that never materialise.
Ivan Grijalva [email protected] Center for Research on Health and Nutrition, Ecuador 1
Corticosteroids and acute asthma Throughout their Comment, Francine Ducharme and Brian Rowe (Dec 4, p 2000)1 refer to the effect of dexamethasone in treatment of acute severe asthma. The study they reviewed2 was a randomised trial of intramuscular versus oral methylprednisolone in the treatment of asthma exacerbations. Readers of the Comment could be misled into thinking patients with severe asthma should be given intramuscular dexamethasone 160 mg. This dose is about five times more potent than methylprednisolone and could produce severe side-effects such as myopathy.
Jon Rohde
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Horton R. UNICEF leadership 2005–2015: a call for strategic change. Lancet 2004; 364: 2071–74. Venis S. Child survival. Lancet 2003; 361: 2172.
Jarvis JN, Centola M. Gene-expression profiling: time for clinical application? Lancet 2005; 365: 199–200—In this Comment (Jan 15), most of the reference numbers were omitted from the text. A corrected pdf version appears on our website. http://image.thelancet.com/extras/ 05doe2web.pdf
[email protected] Department of Medicine, Queen Mary’s Hospital, Sidcup, Kent DA14 6LT, UK
1
Travis P, Bennett S, Haines A, et al. Overcoming health-systems constraints to achieve the Millennium Development Goals. Lancet 2004; 364: 900–06—In this Public Health article (Sept 4), on page 904, the third sentence of the first paragraph under the heading Advancing the learning agenda should be: “An analysis by the Alliance for Health Policy and Systems Research reported that health-system research may attract only 0·018% of total health expenditure in developing countries.” The author and title of the associated reference (32) should be: Alliance for Health Policy and Systems Research. Strengthening health systems research in developing countries: the role and promise of research on policy and systems: draft for submission to the WHO Bulletin, 2004.
Charles Shee
I declare that I have no conflict of interest.
3 Moray Place, Orangezicht, Cape Town 8001, South Africa
Ducharme FM, Rowe BH. Intramuscular versus oral methylprednisolone in asthma. Lancet 2004; 364: 2000–01—In this Comment (Dec 4) all four mentions of dexamethasone in the text should read methylprednisolone.
I declare that I have no conflict of interest.
[email protected]
294
Horton R. UNICEF leadership 2005–2015: a call for strategic change. Lancet 2004; 364: 2071–74.
Department of Error
2
Ducharme FM, Rowe, BH. Intramuscular versus oral methylprednisolone in asthma. Lancet 2004; 364: 2000–01. Lahn M, Bijur P, Gallagher EJ. Randomized clinical trial of intramuscular vs oral methylprednisolone in the treatment of asthma exacerbations following discharge from an emergency department. Chest 2004; 126: 362–68.
www.thelancet.com Vol 365 January 22, 2005
1
2
3
4
Horton R. UNICEF leadership 2005–2015: a call for strategic change. Lancet 2004; 364: 2071–74. Setty-Venugopal V, Upadhyay UD. Birth spacing: three to five saves lives. Population reports, series L, no 13. Baltimore: Johns Hopkins Bloomberg School of Public Health, Population Information Program, 2002. Knodel J. Fertility decline and children’s education in Thailand: some macro and micro effects. New York: Population Council, 1992. Adamson P. A failure of imagination. In: The progress of nations. New York: UNICEF, 1996.
Richard Horton1 has brought the issue of the next Chief Executive of UNICEF into the public forum for debate. In Ecuador, UNICEF works mainly as a watchdog, promoting greater government spending on education; very little is proposed or done in other areas, including health. Another troubling reality is UNICEF’s obsession with eliminating child labour, with no regard for children’s right to survive. I declare that I have no conflict of interest.
Corticosteroids and acute asthma: see also Department of Error
Richard Horton1 has hit the mark. So many have struggled with the idea of rights for children while trying to emphasise the centrality of survival to the realisation of any such rights. The simple interventions for survival emphasised by James Grant, Executive Director of UNICEF from 1980 to 1995, are still not realised by more than half the world’s children today. The Lancet series in 20032 shows clearly what can and should be done, with predictable and measurable results. UNICEF should concentrate on its mandate for the children of the world with more than pious rhetoric and return to the doable tasks so consistently articulated by Grant: safe delivery, breast feeding, early proper treatment of diarrhoea and pneumonia, immunisation, protection from malaria, and attention to nutrition in all its aspects. The lives of millions can be saved, and the quality of life for poor families immeasurably improved. The next leader of UNICEF should be committed to making these do-ables happen, rather than hobnobbing about in prestigious meetings talking about rights that never materialise.
Ivan Grijalva [email protected] Center for Research on Health and Nutrition, Ecuador 1
Corticosteroids and acute asthma Throughout their Comment, Francine Ducharme and Brian Rowe (Dec 4, p 2000)1 refer to the effect of dexamethasone in treatment of acute severe asthma. The study they reviewed2 was a randomised trial of intramuscular versus oral methylprednisolone in the treatment of asthma exacerbations. Readers of the Comment could be misled into thinking patients with severe asthma should be given intramuscular dexamethasone 160 mg. This dose is about five times more potent than methylprednisolone and could produce severe side-effects such as myopathy.
Jon Rohde
1
2
Horton R. UNICEF leadership 2005–2015: a call for strategic change. Lancet 2004; 364: 2071–74. Venis S. Child survival. Lancet 2003; 361: 2172.
Jarvis JN, Centola M. Gene-expression profiling: time for clinical application? Lancet 2005; 365: 199–200—In this Comment (Jan 15), most of the reference numbers were omitted from the text. A corrected pdf version appears on our website. http://image.thelancet.com/extras/ 05doe2web.pdf
[email protected] Department of Medicine, Queen Mary’s Hospital, Sidcup, Kent DA14 6LT, UK
1
Travis P, Bennett S, Haines A, et al. Overcoming health-systems constraints to achieve the Millennium Development Goals. Lancet 2004; 364: 900–06—In this Public Health article (Sept 4), on page 904, the third sentence of the first paragraph under the heading Advancing the learning agenda should be: “An analysis by the Alliance for Health Policy and Systems Research reported that health-system research may attract only 0·018% of total health expenditure in developing countries.” The author and title of the associated reference (32) should be: Alliance for Health Policy and Systems Research. Strengthening health systems research in developing countries: the role and promise of research on policy and systems: draft for submission to the WHO Bulletin, 2004.
Charles Shee
I declare that I have no conflict of interest.
3 Moray Place, Orangezicht, Cape Town 8001, South Africa
Ducharme FM, Rowe BH. Intramuscular versus oral methylprednisolone in asthma. Lancet 2004; 364: 2000–01—In this Comment (Dec 4) all four mentions of dexamethasone in the text should read methylprednisolone.
I declare that I have no conflict of interest.
[email protected]
294
Horton R. UNICEF leadership 2005–2015: a call for strategic change. Lancet 2004; 364: 2071–74.
Department of Error
2
Ducharme FM, Rowe, BH. Intramuscular versus oral methylprednisolone in asthma. Lancet 2004; 364: 2000–01. Lahn M, Bijur P, Gallagher EJ. Randomized clinical trial of intramuscular vs oral methylprednisolone in the treatment of asthma exacerbations following discharge from an emergency department. Chest 2004; 126: 362–68.
www.thelancet.com Vol 365 January 22, 2005