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  • Sunitinib Moving forward we identify several urgent needs an

    2019-05-05

    Moving forward, we identify several urgent needs and challenges. First, the standing of Sunitinib health workers in the health-care systems needs to be legitimised and moved away from largely grant-funded temporary employees or volunteers who might provide educational services towards skilled members of the health-care system who can provide preventive and treatment services. As shown by Balcazar and colleagues, occupational regulation, job training and career development, and guidelines for common measures used in assessment and research can all contribute to more sustainable financing for community health workers. A step in this direction occurred in the USA in 2010 when community health workers were recognised by the US Department of Labor and assigned their own standard occupational classification (number 21-1094). Second, additional clinical models and studies need to show the feasibility and effectiveness of community health workers\' work beyond educational services. The accurate cardiovascular disease screening and referral in Gaziano and colleagues\' study is an example of the type of service that workers can provide accurately and efficiently when trained appropriately. Several other studies have been published that show the ability of community health workers to be part of a team focused on screening and management of non-communicable diseases, and the time is right for expansion of this work. Third, this research will be increasingly effective for policy if it includes a systematic assessment of the value of services provided by workers. In a resource-limited environment, an increased emphasis will be placed on low-cost services for the beneficial health outcomes achieved. This situation presents an opportunity for community health workers to show their value in the health-care system and will be an important step towards creating more sustainable funding streams. Finally, research that can show the system-level requirements of taking the community health worker model to scale will be needed. For example, Singh and Sachs reported that one community health worker per 650 population would result in an estimated cost of only US$6·56 per person per year in sub-Saharan Africa. This type of assessment and vision will play an important part in the scaling up of the community health worker model and to solidify the worker as a legitimate and valuable part of the health-care team aimed at prevention, referral, and management of non-communicable diseases.
    Diarrhoea remains a leading cause of morbidity and mortality in young children around the world, with more than half a million children dying every year from diarrhoeal diseases. In addition to its acute effects, diarrhoea can contribute to malnutrition, growth retardation, and cognitive impairment. A multifaceted approach is needed to combat this Sunitinib public health problem, and a better understanding of specific causative agents of diarrhoea will enable targeted prevention and treatment decisions. In 2013, researchers from the Global Enteric Multicenter Study (GEMS) reported data from seven low-resource countries on the incidence, cause, and adverse outcomes of moderate-to-severe diarrhoea in children from birth to 59 months. The authors of GEMS confirmed the large burden of moderate-to-severe diarrhoea and reported a significant association with linear growth faltering and death in the selected low-resource settings. Rotavirus was, unequivocally, the most common cause of moderate-to-severe diarrhoea in the first 2 years of life, while other pathogens, such as spp and heat-stable toxin-producing enterotoxigenic (ST-ETEC), contributed significantly to mortality. In this issue of , James Platts-Mills and colleagues describe causes of diarrhoeal illness in the Mal-ED study. By contrast with GEMS, which sought to characterise the diarrhoeal episodes most likely to contribute to childhood mortality—that is, moderate-to-severe diarrhoeal disease in children seeking care at health-care facilities—researchers in the Mal-ED study undertook intense community surveillance to record diarrhoea of any severity in the first 2 years of life.