jueves, 17 de noviembre de 2022

WORLD CHILDRENS DAY - Declaration of the Rights of the Child – The Right to Health and Healthcare – Children with Lymphedema - Pediatric and Primary Lymphedema – Secondary Lymphedema – Lymphatic Filariasis and Podoconiosis

November 20th is an important date, it is to promote the Declaration of the Rights of the Child. World Children's Day promotes and celebrates children's rights, and one of its main objectives is to improve children's health and welfare. ARTICLE 24 (health and healthcare) of the UN Convention on the Rights of the Child states: States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.

Lymphedema is a chronic and progressive disease due to dysfunction of the lymphatic circulatory system. Lymphaedema is a disease that may affect arms, legs, fingers, toes, head, neck, abdomen (belly), genitalia, internal organs, or the whole body, which causes chronic inflammation and swelling in the affected area. Regarding children, it may not only be due to congenital causes (Primary Lymphedema), it can also appear in childhood caused by parasite infections (Lymphatic filariasis).

Lymphatic filariasis (LF) is a neglected disease. It is recognized as a common widespread, seriously handicapping disease of adults, and is generally thought to occur only sporadically in children. New advances in diagnostic tests (antigen detection, pulse-wave Doppler ultrasonography, and lymphoscintigraphy examination) have helped to recognize the subclinical pathology caused by this infection and have revealed that LF is often first acquired during childhood, with as many as one-third of children infected before age 5.

Recent studies indicate that drugs used in mass drug administration programs are capable of reversing sub-clinical lymphatic damage in children and provide benefits other than an interruption of transmission. But when there is permanent irreversible damage to the lymphatic system due to filariasis, it also generally remains subclinical for years or gives rise only to non-specific presentations of adenitis/adenopathy, which will later develop and cause lymphoedema of limbs. Clinical manifestations of the disease appear most frequently during early adulthood or later, and without correct treatment, will then progress to its late severe stage “elephantiasis”, hydrocele, and consequent acute attacks of dermatolymphangioadenitis. Read more about the signs and symptoms of the disease HERE.

Studies have shown that community and family-based intervention has a positive effect on children who already have irreversible damage to their lymphatics, but these measures alone are not enough for edema reduction and control. Correct compression treatment and compression garments are recommended by international scientific societies for the control of long-term clinical manifestations and disease progression. The disease among school children, most of who in developing countries never received proper medical attention, are found to develop anxiety and psychological concerns about the effect of the disease and their fate.

In consequence, very little attention, if any, has been given to the signs and symptoms of lymphatic filariasis in childhood. Lymphedema whatever the cause or setting, all need the same compression treatment and garments to prevent later debulking surgeries or the development of stage elephantiasis. International health organizations must implement correct treatment programs, and emphasize the need for disability-alleviation efforts among children as well as adults. Control of morbidity management with correct compression treatment for established lymphedema should be implemented by national health systems. Read more about what is the best treatment for children with lymphedema HERE.

Scientific studies highlight the importance and implications of compression therapy in controlling the progression of Lymphoedema. Clinical outcomes on interventions to manage lymphedema, show that simple hygiene-based measures are necessary, but these alone are not enough to reduce the limb size and volume. Limb and genital Lymphedema should always be treated in their early stages, and not left undertreated till reaching its severe stage “elephantiasis”.

Recognizing that LF disease starts its development in childhood has immediate practical implications both for the management and to prevent the progression of the disease in individual patients and for the broader public health efforts to overcome all childhood illnesses. For decades, this disease (lymphatic dysfunction) which is treatable and preventable, embodies the failures of health systems, governments, and societies to tackle the structural inequalities and injustices that allow this cruel and ignored condition to thrive. In accordance with children's and human rights, all children suffering from lymphatic dysfunction (lymphedema), whatever its cause or setting, should have access to the correct treatment to manage this chronic and progressive disease.


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