Lelijveld and colleagues suggest that some catch up growth
Lelijveld and colleagues suggest that some catch-up growth occurs after discharge, even outside the expected 1000-day window, in the absence of any specific intervention. The real question now is to establish how this spontaneous partial recovery after treatment for SAM can be improved. During treatment and convalescence, the proportion of dietary intake consisting of nutrients needed for lean tissue growth might also affect body composition. Among the possible factors that could limit lean tissue synthesis, the role of high-quality dietary protein might have been previously underestimated, as suggested by the results of another study, which showed an association between circulating essential amino acids and linear growth. The availability of dietary proteins might be particularly limited for these children. Their requirements might be greater than they are currently estimated to be, resulting from the presence of impaired gastrointestinal function and chronic inflammation. Insufficient zinc intake is also associated with reduced lean tissue deposition and height growth. The possibility to improve the long-term recovery of lean tissue by increasing the intake of high quality proteins, zinc, or both, as well as other micronutrient intake should be explored.
The poorer school performance of children treated for SAM compared with the control groups is also a serious concern, and might also be related to chronic stunting, poor quality diet, or unfavourable social environments before and after the SAM episode. Possible approaches to improve current management should be explored. Results from two clinical trials have suggested that the essential fatty cetrimonium bromide composition of RUTF should be reconsidered, which has implications for cognitive development. Additionally, evidence from previous small-scale studies has suggested that psychosocial stimulation is important for cognitive development during recovery and follow-up. This finding should be confirmed in larger efficacy studies and ways to improve the integration of this component into existing large-scale programmes should be explored during treatment and follow-up.
Surgically treatable conditions represent nearly a third of the global disease burden, claiming 16·9 million lives per year and leading to millions more disabilities and injuries. Although surgery has been labelled a priority for national universal health coverage plans, transpiration remains exceedingly difficult to perform without a system in place to deliver anaesthesia. Safe surgery is impossible without a reliable supply of anaesthesia. In late August, 2016, the quadrennial World Congress of Anaesthesiologists will meet in Hong Kong to showcase the latest research and findings in anaesthesia and intensive care. The Congress will explore leading clinical and technological issues facing anaesthesia providers across all regions of the world. However, because billions of people in low-income and middle-income countries (LMICs) are without access to essential surgical and anaesthesia care, this opportunity should be used to highlight the challenges inhibiting anaesthesia delivery in the world\'s most low-resource surgical settings. Anaesthesia remains an overlooked and under-resourced area of health care in LMICs. In a study of 11 sub-Saharan African countries, all had fewer than one physician-level anaesthetist per 100 000 population, leaving the vast majority of anaesthesia provision to those with a nursing degree or less. In Tanzania, I am one of only 22 physician–anaesthetists in a country of 47 million people. Compounding this human-resource problem is a drastic infrastructure gap: two-thirds of hospitals in sub-Saharan Africa have unreliable electricity, and another third have no access to medical oxygen—both of which are required for the delivery of safe general anaesthesia. Additionally, 40% of facilities in one study had no anaesthesia machine, in part because much of the medical equipment in LMICs is inoperable. That only 3·5% of the world\'s surgical operations are conducted in poor countries—which bear nine in ten trauma, maternal, and paediatric deaths—comes as no surprise.