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Goal 17. Strengthen the means of implementation and revitalize the Global Partnership for Sustainable Development
There are three reasons for the change:
• The MDGs were set to complete in 2015
• Many targets have not been met hence need revision
• There were felt to be omissions so the new goals cover a wider range of determinants
The goals are intended to cover social, economic and environmental priorities and there is intended to be integration between the various goals — see https://sustainable-development.un.org/topics
Whilst there is much to praise in the new goals there are also a number of critical inconsistencies which I will review below.
Child health in the SDGs
Unlike the MDGs there is no single child health target in the SDGs. MDG 4 was clear cut — to reduce under fives mortality by 2/3 by 2015. Whilst there was a big reduction of UFM globally (from 12.7 million in 1990 to 6.3 million in 2013), in many low income countries (notably those in Africa) the target was far from being met. Also the target was limited and said little about nutrition, growth or development.
There are 17 sustainable development goals so room for much more detail.
In contrast the first three SDGs are more comprehensive —
Goal 1 End poverty in all its forms everywhere
Goal 2 End hunger, achieve food security and improved
nutrition, promote sustainable agriculture Goal 3 Ensure healthy lives and promote well-being for all at all ages
Within Goal 3 there are nine targets, the following being those most relevant to children:
3.1 — By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
3.2 — By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births
3.6 — By 2020, halve the number of global deaths and injuries from road traffic accidents
3.7 — By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes
3.8 — Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all
There are also further targets for child health within other goals for example: 16.2 End abuse, exploitation, trafficking and all forms of violence against and torture of children
Violence against girls is covered in Goal 5 — 5.2 Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation
These targets are challenging and we in ISSOP are planning to take up the question of violence against children, which is so pervasive and yet so highly preventable. Perhaps this is something we could collaborate on with EPA?
Inconsistencies in the SDGs
There are however certain inconsistencies and anomalies within the SDGs.
Goal 10 is to reduce inequality within and among countries. These inequalities are severely detrimental to child health. Yet many commentators see the origin of the growing inequalities as being in large part due to the neo-liberal economic policies of Western governments, and the lobbying by big business to promote such policies. See for example http://wer.worldeconomicsassociation.org/files/WEA-WER-4-Woodward.pdf which is a paper by an eminent economist that challenges the way the SDGs approach poverty. Woodward points out in this thoughtful paper (entitled Incrementum ad Absurdum) that if reducing poverty has to rely simply on economic growth, then it will take 100 years to reach the poverty line of $1.25 a day. Only by seriously tackling inequality — meaning measures to curb the growth of wealth — can poverty be genuinely reduced.
The second inconsistency is in relation to climate change. Goal 13 is strong — 'Take urgent action to combat climate change and its impacts'. But this is not compatible with Goal 8: 'Promote sustained, inclusive and sustainable economic growth' — since economic growth (unless defined very clearly as not requiring more scarce resources) will inevitably increase CO2 emissions.
So, let's work with the goals which are clearcut and necessary and question the assumptions underlying those relating to social determinants and growth.
Tony Waterston, International Society for Social Pediatrics and Child Health
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GUT MICROBIOTA FOR HEALTH (GMFH ) — E-BOOK
The Gut Microbiota for Health (GMfH) organisation, which forms part of the European Society of Neurogastro-enterology and Motility (ESNM), is a body which facilitates scientific debate on topics relating to gut microbiota. As well as running an experts exchange programme, the GMfH formed a joint scientific committee alongside the American Gastroenterology (AGA), ESNM, European Society for Paediatric Gastroenterology (ESPGHAN), the European Crohn's and Colitis Organisation (ECCO), and the
European Association for the Study of the Liver (EASL) to run the 4th GMfH World Summit which was held this year in Barcelona (14-15 March).
International speakers and delegates from all fields of gut microbiota research such as doctors, nutritionists, dieticians, pharmacists and biologists joined the summit, where a wide range of research was presented, covering topics such as obesity, breast feeding, bowel disease and liver cancer, amongst others. Many of the topics were of great inte-
rest to the paediatricians in attendance, therefore, we have selected highlights of the summit which are relevant to child health. Professor Massimo Pettoello-Mantovani, Secretary General of the European Paediatric Association (EPA) who attended the summit stated: "The potential impact of gut microbiota within the field of paediatrics is not recognised
enough by general paediatricians due to a lack of transfer between the fields."
We very much hope you find this of interest.
Please click here www.paediatricgutmicrobiota.com to read about the key findings, relevant to paediatricians, from this year's Gut Microbiota for Health Summit.
FROM THE INTERNATIONAL LITERATURE
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THE ROLE OF PROBIOTICS IN THE ANTIBIOTIC ASSOCIATED DIARROHEA IN CHILDREN
The use and effectiveness of probiotics in children has been a long lasting important debate during the past years, which continues to raise the attention of pediatricans. In particular, several articles in the recent past have discussed the role of probiotics for the prevention of Antibiotic-Associated Diarrhea in children, focusing on advantages and disadvantages. A paper published by the ESPGHAN Working Group for Probiotics Prebiotics in the Journal of Pediatric Gastroenterology and Nutrition in December 2015 (http://www.ncbi. nlm.nih.gov/pubmed/26756877) provides recommendations, developed by the Working Group (WG) on Probiotics of ESPGHAN, for the use of probiotics for the prevention of antibiotic-associated diarrhea (AAD) in children. The recommendations were based on a systematic review of previously completed systematic reviews and of randomized controlled trials (RCTs) published subsequently to these reviews. The recommendations were formulated only if at least 2 RCTs that used a given probiotic (with strain specification) were available. The quality of evidence (QoE) was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. The use of probiotics for preventing AAD was considered in particular in the presence of risk factors such as class of antibiotic (s), duration of antibiotic treatment, age, need for hospitalization, comorbidities, or previous episodes of AAD diarrhea.
Szajewska H, Canani RB, Guarino A, Hojsak I, Indrio F, Kolacek S, Orel R, Shamir R, Vandenplas Y, van Goudoever JB, Weizman Z. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Children. J Pediatr Gastroenterol Nutr. Dec. 2015, Epub ahead of print (http://www.ncbi.nlm.nih.gov/pubmed/26756877) A further recent report from a working group of gastroen-terologists and nutritionists from the Great Ormond Street Hospital (UK), the Guy's and St Thomas NHS Foundation Trust (UK), the University St Joan de Resus (Sp), and the University of Nottingham UK, discusses the role of antibiotic resistance, and the background and prevalence of Antibiotic Associated Diarrhoea (AAD). The working group emphasizes that following an increasing amount of interest in therapies that may influence changes to gut microbiota, an approach that has been adopted by many healthcare professionals for the management of AAD is the use of probioticis. The report discusses the evidences reported in several studies, that the use of specific probiotics effectively reduces the incidence of AAD in children, also reduce associated healthcare costs and aid antibiotic compliance.
Castillejo De Villasante G, Koglmaier J, Lindley K, Hallowes S and Avery A. Antibiotic Associated Diarrhoea
and the use of probiotics in children. REPORT 2015 (http://paediatricgutmicrobiota.com/aadeng/)
GENETIC ANALYSIS OF CHILDREN WITH CONGENITAL TUFTING ENTEROPATHY (CTE). A CLINICAL CONDITION CARACHTERIZED BY DIARRHEA
• Congenital tufting enteropathy (CTE), an inherited autosomal recessive rare disease, is a severe diarrhea of infancy which is clinically characterized by absence of inflammation and presence of intestinal villous atrophy. The importance of genetic analysis in the diagnosis of genetic diseases is a well consolidated notion. However, genetic analysis covering all the wide range of genetic diseases if is not always available in all hospital centers. In fact, since histological analysis is still not decisive in predicting the outcome of CTE patients, the identification of new mutations contributes to the genotype-phenotype correlation and provides further information about the assessment of the clinical outcome of the patients. A recent article published by D'Apolito et al in the World Journal of Pediatrics (D'Apolito et al. Genetic analysis of Italian patients with congenital tufting enteropathy, World J Pediatr. 2015 Dec 18. Epub ahead of print) emphasizes the importance of genetic analysis, in particular in the Congenital Tufting Enteropathy (CTE). The study underlines the important role of performing the molecular screening of both the typical EpCAM and SPINT2 genes in the diagnosis of various congenital diarrheal disorders. The identification of a novel EpCAM mutation increasing the mutational spectrum of allelic variants associated with this gene further contributes to better understanding the pathogenesis of disorders. LINK: http://www.ncbi.nlm.nih.gov/pubmed/26684320
Collaboration for genetic analysis offered to the community of Pediatrics:
The first author, Dr. Maria D'Apolito, responsible of the Pediatric Research Laboratory at UNIFG, reports that the Institute of Pediatrics of the University of Foggia (Italy) offers the pro bono scientific support of the Research Center of the University of Foggia, providing the molecular screening of both EpCAM and SPINT2 genes to those centers needing genetic analysis to perform final diagnosis in children with suspected Congenital Tufting Enteropathy and other genetic disorders.
EPA/UNEPSA thanks Dr. D'Apolito for her kind and generous offer.
For those that may be interested, Dr. D'Apolito can be contacted directly using the following information:
Dr. Maria D'Apolito. Institute of Pediatrics University of Foggia, Italy
Centro di Ricerche Biomediche «E. Altomare» Via Napoli, 20/71122 Foggia, Italy Email: maria.dapolito@unifg.it Tel: 0039.0881.588091
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