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  • July is a time to join together


    July 28 is —a time to “join together to make the elimination of viral hepatitis our next greatest achievement”. Hepatitis is, belatedly, beginning to nudge its way into the global awareness. Having been neglected entirely in the Millennium Development Goals, it gets a name-check alongside AIDS, tuberculosis, and malaria within Sustainable Development Goal target 3.3, and—at the World Health Assembly in May this year—the first was endorsed. This much-anticipated strategy has a goal of eliminating viral hepatitis as a major public health threat by 2030, and particularly focuses on hepatitis B and C viruses, which cause the greatest burden worldwide.
    In 2015, Cuba became the first country to be validated by WHO for having achieved the elimination of mother-to-child transmission of HIV and syphilis. In June, 2016, Thailand, Armenia, Belarus, and Moldova were also validated. This is amazing news, which demonstrates that, given the political will, a policy for effective prenatal screening and treatment, and a commitment to implement that policy at every level of the health-care system, countries with limited resources can now have an HIV and syphilis free generation. The paper by Saman Wijesooriya and colleagues in reports on progress towards the elimination of congenital syphilis between 2008 and 2012. The good news from this report is that maternal syphilis infections are estimated to have decreased by 38% and adverse pregnancy outcomes by 39% during this time. The reduction was greatest in Asia, with India alone accounting for 66% of the reduction in maternal infections and 64% of the reduction in adverse outcomes. The proportion of pregnant women not tested for syphilis in antenatal care declined in all regions except Africa (49·0%) and the Eastern Mediterranean region (18·6%).
    With the recognition that early child development lays the foundation for subsequent academic and social performance, economic productivity, and societal contributions, support for early child development programmes and policies has increased worldwide. Longitudinal studies and neuroscientific evidence have shown that, during the formative periods of children\'s development, bosentan architecture and functioning are responsive to environmental conditions (both adversities and nurturance), which continue throughout life and into the subsequent generation. In response to the role of early child development in building human capacity, the Sustainable Development Goals (SDGs) include two targets for children younger than 5 years: meet developmental milestones (indicator 4.2.1) and participate in organised learning before primary school (indicator 4.2.1). The SDGs hold countries accountable for measuring and reporting on these targets. Attention to early child development programmes and policies is desperately needed because millions of young children in low-income and middle-income countries (LMICs) are not meeting SDG targets. Estimates based on population-level indicators of nutrition (stunting) and extreme poverty show that 39% of children younger than 5 years in LMICs are at risk of not reaching their developmental potential, and initial estimates from UNICEF\'s Early Childhood Development Index (ECDI) based on reports from nearly 100 000 caregivers show that 36·8% of children aged 3 and 4 years in LMICs do not achieve basic cognitive and socioemotional skills. ECDI scores are positively associated with caregiver–child joint activities such as reading, playing, listening to stories, counting, singing, or travelling outside of home, illustrating the centrality of the caregiving environment to child development. Caregiver–child activities are at the heart of many early child development programmes. One review concluded that health-care workers in LMICs can implement effective strategies for caregiver behaviour change related to early child development. To be effective, strategies should address various aspects of caregiving (eg, feeding, communication, and play activities), include frequent contact with health-care workers (eg, twice per month), start early before the onset of dysfunctional caregiver–child interactions, and be of sufficient duration to enable caregivers to practise and normalise the behaviours (eg, 12 months). In a Jamaican study with more than 20 years of follow-up, in adults (aged 25 years) who were stunted early in life, individuals who received caregiver–child enriched activities for 2 years through home visits had higher cognitive functioning; less anxiety, depression, and violence; and greater earnings than individuals who had been randomly assigned to the control group.