Child healthcare in the 21 st century and beyond: the Role of Preventive Interventions, clinical evidence and research

Abstract

In this inaugural lecture I will dwell on the current state of child healthcare in Kenya and other developing countries, the current thinking on the way well and sick children should be cared for and future trends in child healthcare in the latter part of this century and beyond. This lecture will address principles and concepts on child healthcare with regard to policy concerns and minimal details on the content of the areas included in the lecture. I will reiterate theInaugual Lecture: Child Healthcare in the 21 st century and beyond:... need to put emphasis on the role of prudent guidelines and policies on child healthcare and the involvement of the individuals and communities in the care of their own health. I will also reiterate the need to increase the number and scope of peripheral health units and the role of research in improving child health care. I will highlight some of the work I have done over the years that influence policy on child healthcare in selected areas such as malaria; allergies; asthma and immunisation. The young are often the most vulnerable and disadvantaged in society and their needs require special attention. Therefore the decisions made on their healthcare need to be more accurate and should be based on carefully and exhaustively investigated processes rather than the use of anecdotal and dogmatic evidence. The use of evidence in Paediatric healthcare does de-emphasise the use of intuition and unsystematic clinical experience by healthcare workers while managing childhood illnesses. Evidence-based medicine utilizes patho-physiologic rationale as sufficient grounds for clinical decision making and stresses the examination of the evidence from clinical research. Evidence-based medicine requires new skills of the paediatrician, including efficient literature search and application of formal rules of evidence in evaluating the clinical literature. It is no longer enough to take the word of a consultant Paediatrician or sub-specialist as the way things are done just because he or she is an authority in a given field of Paediatrics as this has been found to be inconsistent with findings from clinical audit. The use of evidence based medicine will assist patients and their guardians understand easily and to get accurate information on illnesses affecting them. This makes it easier for paediatricians to explain the final diagnosis to patients and their guardians. Any diagnosis needs to be supported by clinical and laboratory evidence based on best practices. The application of clinical epidemiology in clinical medicine assists in the use of the clinical and laboratory evidence in arriving at the most likely possible diagnosis using sensitivity and specificity calculations including the positive predictive value. This evidence should include autopsy and histo-pathological findings in cases of death