Statement of Minimal Acceptable Care in Paediatric Endocrinology Global Inequalities in Pediatric Endocrine Care Martin O Savage, London, United Kingdom Fernando Cassorla, Santiago, Chile ESPE/LWPES Lyon September, 2005

Statement of Minimal Acceptable Care in Paediatric Endocrinology Public health measures Prevention of disease Diagnosis Treatment

Statement of Minimal Acceptable Care in Paediatric Endocrinology 1.A standard of education should be reached which results in an increase in the interval between menarche and pregnancy and modification of maternal workload. 2.Improvement in paediatric and adolescent nutritional status achieving BMI between -2 and +2 SD. 3.Education programs providing awareness of benefits of breast feeding, balanced nutrition and regular exercise. 4.Effective primary health care programs to identify children failing to thrive and grow. Public Health measures

Prevention of disease 1.Establishment of public health programs to optimise maternal nutrition and prevent fetal growth failure. 2.Organisation of measures to prevent deficiencies of essential nutrients such as iodine and vitamin D. 3.Establishment of national growth curves to detect deviations from normal height and weight. Links to academic departments in developed countries may be necessary to achieve this. 4.Establishment of national screening programs for congenital hypothyroidism. Statement of Minimal Acceptable Care in Paediatric Endocrinology

Diagnosis 1.Access to paediatricians, ideally trained in endocrinology, to care for children with endocrine disorders. 2.Availability of central laboratories with standardised, quality controlled assays for measurement of basic peptide and steroid hormones. 3. Access to radiological equipment and trained radiologists with ability to diagnose endocrine disorders, particularly those that are life- threatening.

Statement of Minimal Acceptable Care in Paediatric Endocrinology Treatment 1.Identification of financial resources to guarantee availability of sufficient supplies of internationally approved synthetic hormones for treatment of basic endocrine deficiencies. 2.Availability of medications for control of states of hormonal excess such as precocious puberty and hyperthyroidism. 3. Establishment of standards of international accreditation for centres and physicians involved in the management of endocrine disorders in children.

Global Inequalities in Paediatric Endocrine Care Specific Recommendations for the Paediatric Endocrinology Community

1.Develop professional clinical training through short fellowship programs based on the active links established through our sister societies. 2.Develop laboratory training programs to set up essential assays for the diagnosis of endocrine disorders in the developing world. The endocrine community should;

1.Establish a reagent bank to help set up, in the developing world, the required assays for diagnosis and treatment of endocrine disorders. 2.Establish an international bank of medications to provide treatment, such as insulin and GH, at a reduced cost for life-threatening and chronic endocrine disorders in the developing world.