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  • An urgent need therefore exists for ministries of

    2019-06-29

    An urgent need therefore exists for ministries of health to introduce programmes for the primary and secondary prevention of rheumatic pkd kinase disease through their non-communicable disease programmes. The delivery of penicillin for the treatment of sore throat in children and the prevention of recurrent attacks of rheumatic fever in affected individuals is the central intervention needed to eliminate rheumatic fever and control rheumatic heart disease. PASCAR and WHO-AFRO have issued the Mosi-o-Tunya Call to Action to governments in endemic countries to ensure that the scourge of rheumatic heart disease is eliminated in our lifetimes.
    Immediate and coordinated action is needed to address the epidemic of chronic kidney disease sweeping across Central America. The disorder, known as CKDnT, is not related to traditional causes such as hypertension and diabetes, and mainly affects young male agricultural workers, the highest mortality being in El Salvador and Nicaragua (). However, CKDnT also affects women and non-agricultural workers living in farming communities. Mortality estimates from the Pan American Health Organization () show that chronic kidney disease coded pkd kinase as N18 in WHO\'s International Classification of Diseases revision 10—a proxy for CKDnT—in men younger than 60 years has been responsible for thousands of deaths in the past decade in Central America. CKDnT is characterised by a tubulointerstitial nephropathy with low-grade proteinuria, which has a long subclinical period that tends to progress to end-stage renal disease in a short period of time. The scarcity of coverage and access to health services might contribute to the clinical course and high mortality rates of CKDnT. Health authorities, for example in El Salvador, responded to this poor coverage by increasing access to health services; however, the large number of patients and absence of adequate infrastructure and trained personnel led to overloaded hospitals. Similar epidemiological and clinical patterns of CKDnT have been reported in other countries, such as Sri Lanka. Causes of the CKDnT epidemic are not clear, although a consensus exists among researchers on its multifactorial character and relation to social, environmental, and economic determinants. Most commonly postulated causes include exposure to pesticides, heat stress with recurrent dehydration, and an excessive intake of high-sugar drinks. Exposure to heavy metals, use of non-steroidal anti-inflammatory drugs and alcohol, and infectious diseases have similarly been postulated as causes for the CKDnT epidemic. Research to identify determinants of the epidemic is necessary, but the moral duty to address an epidemic cannot be postponed until its causes are identified. A coordinated response from the public health sector and other related sectors is urgently needed.
    Despite important scientific advances in how violence against children can disrupt healthy early development, the study of these issues has developed in relative isolation. Both areas are increasing in prominence, but so far there has been little call for their integration, despite the important connections between them. Without close integration, scarce resources are at risk of being wasted and potential synergies overlooked. Violence against children is a risk factor for poor early child development and vice versa, with both sharing important risk and protective factors. A systematic review from 2012 suggests thigmotropism child maltreatment is causally related to a broad range of negative outcomes across a lifespan, including major emotional and behavioural problems. A systematic review of exposure to violence in children with disabilities showed that children with a mental or intellectual disability had a more than four times increased risk of any type of violence. Adversities such as poverty, parental psychiatric disorder, and institutionalisation seem to be shared risk factors for poor child development and violence, whereas maternal education is a shared protective factor.