Despite dramatic improvements in survival, nutrition, and education over recent decades, today's children face an uncertain future. Climate change, ecological degradation, migrating populations, conflict, pervasive inequalities, and predatory commercial practices threaten the health and future of children in every country. In 2015, the world's countries agreed on the Sustainable Development Goals (SDGs), yet nearly 5 years later, few countries have recorded much progress towards achieving them. This Commission presents the case for placing children, aged 0-18 years, at the centre of the SDGs: at the heart of the concept of sustainability and our shared human endeavour. Governments must harness coalitions across sectors to overcome ecological and commercial pressures to ensure children receive their rights and entitlements now and a liveable planet in the years to come.

Abstractbackground Progress towards MDG4 for child survival in South Africa requires effective prevention of mother-to-child transmission (PMTCT) of HIV including increasing exclusive breastfeeding, as well as a new focus on reducing neonatal deaths. This necessitates increased focus on the pregnancy and early post-natal periods, developing and scaling up appropriate models of community-based care, especially to reach the peri-urban poor.methods We used a randomised controlled trial with 30 clusters (15 in each arm) to evaluate an integrated, scalable package providing two pregnancy visits and five post-natal home visits delivered by community health workers in Umlazi, Durban, South Africa. Primary outcomes were exclusive and appropriate infant feeding at 12 weeks post-natally and HIV-free infant survival.results At 12 weeks of infant age, the intervention was effective in almost doubling the rate of exclusive breastfeeding (risk ratio 1.92; 95% CI: 1.59-2.33) and increasing infant weight and length-for-age z-scores (weight difference 0.09; 95% CI: 0.00-0.18, length difference 0.11; 95%

No abstract

In this analysis, one of the following signs severe enough to require medical treatment within 48 hours of delivery served as diagnostic factors for establishing AFE: hypotension, respiratory distress, disseminated intravascular coagulation, coma, or seizures; and absence of any other medical explanations for the clinical course. A retrospective study of AFE cases was performed. A total of 20 fatal and nonfatal cases between 1993 and 2006 were reported. A fatality rate of 11% [95% confidence interval (CI), 3%-45%] was found in the LEMMoN study. The increased rate of AFE fatalities caused a rise in the maternal mortality ratio to 0.63 per 100,000 live births (odds ratio, 5.8; 95% CI, 1.3-25.3). The most common reported symptom of AFE was hemorrhage (14/20 cases; 70%), followed by dyspnea and disseminated intravascular coagulation (both 13/20 cases; 65%), and fetal bradycardia and hypotension (11/20 cases; 55%). Disseminated intravascular coagulation and hemorrhage were the most common combination of symptoms (11/20 cases; 55%). The onset of AFE symptoms was either intrapartum (13/20 cases; 65%) or postpartum (5/20 cases; 25%). Maternal age differed by 4.6 years (mean 35.2 vs. 30.6; P < 0.001) from the general pregnant population, and no cases of AFE occurred in patients younger than the age of 30. Most cases occurred in women of 35-39 years (12/20 cases; 60%). AFE was dominant in the third trimester (mean gestational age 36.9 wk; 95% CI, 34.3-39.6); 2 women (10%) developed AFE before 30 weeks. Multiparas were more likely to develop AFE compared to nulliparous women (16/20 cases were multiparous; 80%; P = 0.06). A higher risk of perinatal mortality was found in AFE cases (8/20 cases; 38.1%, P < 0.001) with 28.6% fetal mortality and 9.5% neonatal mortality).Given that AFE is a diagnosis made by exclusion and its current diagnostic criteria, AFE is being underreported. Higher maternal age and multiparity are the most important risk factors for developing AFE.Topics: Neonatal Morbidity and Mortality, Obstetric Complications P reterm birth is the second most common cause of death in children less than 5 years old worldwide. In most highincome and middle-income countries, preterm birth is the leading cause of child deaths. Preterm birth is subdivided based on gestational age: extremely preterm, less than 28 weeks; very preterm, 28 to less than 32 weeks; and moderate or late preterm, 32 to less than 37 weeks. Decreasing gestational age is associated with increasing mortality, disability, intensity of neonatal care needed, and increasing costs. However, data on preterm births are not collected by the United Nations and, therefore, country estimates and time trend analyses are limited. Using various data sources, this study now reports worldwide, regional, and national estimates of preterm birth rates in 2010 and for the period from 1990 to 2010, if sufficient data were available.All reports from 1990 or later of >50 births that reported a preterm birth rate or included data allowing the rate to be calculated were analyzed...

BackgroundThe World Health Organization recommends that antiretroviral therapy be started as soon as possible, irrespective of stage of HIV infection. This ‘test and treat’ approach highlights the need to ensure that men are involved in prevention of mother-to-child HIV transmission (PMTCT). This article presents findings from a rapid appraisal of strategies to increase male partner involvement in PMTCT services in Uganda, Democratic Republic of Congo, Malawi, and Côte d'Ivoire in the context of scale-up of Option B+ protocol.DesignData were collected through qualitative rapid appraisal using focus groups and individual interviews during field visits to the four countries. Interviews were conducted in the capital city with Ministry of Health staff and implementing partners (IPs) and at district level with district management teams, facility-based health workers and community health cadres in each country.ResultsCommon strategies were adopted across the countries to effect social change and engender greater participation of men in maternal, child and women's health, and PMTCT services. Community-based strategies included engagement of community leaders through dialogue and social mobilization, involving community health workers and the creation and strengthening of male peer cadres. Facility-based strategies included provision of incentives such as shorter waiting time, facilitating access for men by altering clinic hours, and creation of family support groups.ConclusionsThe approaches implemented at both community and facility levels were tailored to the local context, taking into account cultural norms and geographic regional variations. Although intentions behind such strategies aim to have positive impacts on families, unintended negative consequences do occur, and these need to be addressed and strategies adapted.A consistent definition of ‘male involvement’ in PMTCT services and a framework of indicators would be helpful to capture the impact of strategies on cultural and behavioral shifts. National policies around male involvement would be beneficial to streamline approaches across IPs and ensure wide-scale implementation, to achieve significant improvements in family health outcomes.