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    • The findings of Trotter and colleagues

    2019-04-29

    The findings of Trotter and colleagues provide further insight into transmission dynamics of within households in the meningitis belt. However, the low sensitivity rate of oropharyngeal swabbing (estimated as 57·8% [95% CI 53·5–62·0] in this study) is a limitation. Nevertheless, results of this evaluation along with surveillance data suggest that targeting school-age children and adolescents for vaccination with conjugate vaccines could provide maximum benefit in terms of direct protection and generation of herd immunity. Further household carriage evaluations specifically carried out during epidemics are needed to assess the relative importance of household transmission in the setting of widespread community transmission. Antibiotic chemoprophylaxis of household members of meningococcal disease cases is recommended in the meningitis belt outside of outbreaks, although is rarely practiced due to resource and logistical constraints. Even though no known cases of meningococcal disease were reported in households participating in the study from Trotter and colleagues, the increased rate of subsequent carriage in index households supports this recommendation and efforts to improve its uptake. Additional evaluation of carriage among household contacts of a meningococcal case in both outbreak and non-outbreak settings would provide additional data to inform antibiotic chemoprophylaxis recommendations in the meningitis belt.
    Between 1990 and 2015, the under-5 mortality rate declined by 53%, resulting in approximately 48 million more children reaching their fifth birthday than would have occurred had 1990 mortality rates continued. Many of these children, however, continue to live in conditions of adversity—marked by extreme poverty, undernutrition, conflict, and insecurity—and are not afforded the level of care required to ensure that they meet their developmental potential. Neuroscience research in the past two decades is unequivocal that the period from conception through early childhood (ie, at least the first 3 years) is foundational in terms of NU 7441 cost development. There is increasing evidence (mostly from high-income countries) that delivering quality interventions in the early years is cost-effective, reduces health inequities, improves learning and academic attainment, lowers crime and violence, and can substantially improve adult health and economic productivity. For the first time, the foremost global development framework—the new Sustainable Development Goals (SDGs)—includes child development, under target 4.2. This is also reflected in the new Global Strategy for Women\'s, Children\'s and Adolescents\' Health (2016–2030), within which one of the core objectives is to ensure that all women, children, and adolescents have an equal chance to thrive (and not simply survive). Thus, any research agenda that aims to give young children the chance to both survive and thrive must ensure that early child development (ECD) is prioritised in order to inform policy and programmatic implementation and achieve the SDG target. Although the scientific evidence is clear, donor and policy neglect of ECD has been striking. Recently however, high-level support for ECD has been emerging, including in the recent series. To optimise the impact of this new momentum, ECD research prioritisation is required. Between February and November, 2015, we conducted a priority-setting exercise to set research priorities for ECD to 2025. This is part of WHO\'s larger initiative to set priorities for maternal, newborn, child, and adolescent health. We used the Child Health and Nutrition Research Initiative (CHNRI) methodology for setting priorities in health research investments because: (a) radioactive decay is a carefully developed and documented conceptual framework available in the public domain; (b) it has demonstrated usefulness in several previous exercises; and (c) it is increasingly being used by policy makers, large donors, and international organisations. We adapted a set of five criteria from the CHNRI methodology—answerability, effectiveness, feasibility, impact, and effect on equity—against which an expert group scored research investment priorities. Library searches and snowball sampling were used to identify 348 experts (both researchers and programme experts) who were then approached by email to provide their three to five top research questions. 74 participants responded, generating 406 research questions, which we then collated into a composite set of questions by eliminating redundancies and overlaps, excluding irrelevant questions, and identifying thematic areas. This process yielded 54 questions that were then scored by 69 of the original experts against the five criteria outlined above. Composite scores ranging from 0 to 100% were calculated for each research question. The experts who completed scoring were geographically diverse, with 7% from WHO African Region, 34% from the Americas, 5% from Eastern Mediterranean Region, 18% from European Region, 11% from South-East Asian Region, and 8% from Western Pacific Region; 18% considered themselves international (WHO or UNICEF or international non-governmental organisations or agencies).