Clinical Review Recent advances


BMJ 2001; 322 doi: (Published 16 June 2001) Cite this as: BMJ 2001;322:1469
  1. Anjali Jain, instructor in paediatrics (,
  2. Matthew M Davis, lecturer in paediatrics and internal medicineb
  1. a Department of Pediatrics, Section of General Pediatrics; University of Chicago Children's Hospital, 5841 South Maryland Avenue, MC 6082, Chicago, Illinois 60637, USA
  2. b Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan 48109-0456, USA
  1. Correspondence to: A Jain

    During the past century, advances in hygiene, antibiotic development, and immunisations have resulted in cures for most childhood infections. Because access to medical care is not universally available, however, infectious diseases continue to be the main source of childhood mortality and morbidity. Increasingly, disparities in the health of children are linked to differences in socioeconomic status between industrialised and developing countries and between lower and higher income families within those countries. For example, diseases that are preventable by vaccination, such as polio, continue to flourish in parts of the world, and children are still becoming infected with HIV because identifying infected mothers and delivering effective drugs to them are formidable tasks.

    In this review, we examine four prominent health issues influenced by social or economic conditions: vertical transmission of HIV, vaccines, obesity, and teenage smoking. The advances made in these areas are relevant to both industrialised and developing countries.


    We searched Medline for relevant articles published since 1 January 1999 and reviewed recent government documents where relevant. We also identified additional educational resources related to each of the four topics that may be of interest to doctors and families.

    Mother to child transmission of HIV

    At the end of 1999, 1.3 million children worldwide were living with HIV and 3.8 million children had died since the beginning of the epidemic.1 Currently, more than 95% of children with HIV live in developing countries. Almost all children with HIV under 15 years old acquired the infection through vertical transmission, at birth or postnatally. Although studies have shown that vertical transmission can be virtually eliminated with antiretroviral drugs, major questions and obstacles must be addressed before HIV in children can be successfully prevented and treated.

    Recent advances

    Simplified antiretroviral regimens can prevent the vertical transmission of HIV in developing countries

    Public-private partnerships are helping to overcome the problems of low …

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