[A decade of child health research in developing countries]

Child mortality continues to be a public health priority world-wide. Even though under-five mortality rates have declined from an estimated 84 per 1000 in 1985-89 to 67 per 1000 in 1999, wide geographical differences persist. During the 1990 World Summit on Children in New York, the world's policy-makers and researchers made improving children's lives by ensuring that each child receives the best care and attention possible their main goal. The strategies identified to achieve this goal have guided and benefited from the progress in child health research throughout the last decade. Indeed, research into the causes of ill-health informs and guides public health programmes to improve the burden of preventable deaths, but it requires sustained and renewed investments for the developing world. In this review paper we have aimed to describe the magnitude of current child morbidity and mortality in the developing world; to review the main advances in child health research since the 1990 World Summit on Children and evaluate the implication of different institutions involved in international child health; to measure the adequacy between priority research setting and public health needs for child health in developing countries; to identify constraints in the application of the research results; and to define key strategies and research challenges that are required in the next decade to respond to child heath needs in developing countries. This assessment is based on a ten-year literature review through Medline and a survey to key international informants in the field of child health in developing countries, using a trilingual open-ended questionnaire. The literature published from January 1990 to June 2001, covering more than 4,700 references, enabled us to review more than 130 articles. We contacted 91 institutions involved in child health, located in 27 countries from five continents, and the response rate to our survey was 49.5%. The current priority health needs of children in developing countries most frequently stated in the literature are the reduction of the burden of malnutrition, diarrhoeal diseases, respiratory diseases, perinatal health, HIV/AIDS, measles and malaria. Based on the survey results, malnutrition (78% of respondents) and perinatal health were the most frequently quoted. Less than 15% of the survey respondents provided an example of a successful application of research in the field of infectious diseases. Political support and conflict of interest are the main constraints mentioned. Malnutrition and non-communicable diseases are considered as main areas of neglect in the field of child health research. Our study shows that the perception of field actors in child health on research priorities does not always correspond to the reality of health needs of children in developing countries. Furthermore, it appears that descriptive epidemiology, evaluation and priority setting strategies are essential tools to guide adequate research activities and further improvement of child health.