Correspondence
prenatal treatment for toxoplasma 4 Liesenfeld O, Press G, Montoya JC, et al. False-
infection,2 there has never been a
definitive consensus. Nevertheless,
mass screening for toxoplasmosis
is mandatory in some European
countries, including Italy, with a
consequent “cost” to both the public
and patients. In theory, screening can
only be done if there is a reliable and
valid test to detect the disease in its
preclinical stage and if advantages of
interventions are clear.3 But there is
evidence that serological screening in
pregnancy is not reliable.4,5
Between 1995 and 2006,
542 mother-child pairs were counselled
in our department for suspected
toxoplasmosis. Repetition of serology
and reinterpretation of the serological
profile (of all previous results) revealed
a false-positive rate of 90% obtained in
previous IgM tests and a seroconversion
rate of 12% (63/542).
The rationale behind the decision
to continue screening was that
benefits to the fetus outweigh the
consequences of a false-positive
result (anxiety, invasive prenatal
diagnosis, treatment of uninfected
women). However, given the
uncertainty about the benefits of
prenatal treatment, is it ethically
correct to carry on?
We declare that we have no conflict of interest.
*Pasquale Martinelli, Annalisa Agangi,
Giuseppe M Maruotti
martinel@unina.it
Department of Gynecology and Obstetrics, Centre
for STD and HIV/AIDS in Obstetrics and
Gynaecology, University of Naples Federico II, via
Pansini 5, Naples, Italy
1 The SYROCOT (Systematic Review on
Congenital Toxoplasmosis) study group.
Effectiveness of prenatal treatment for
congenital toxoplasmosis: a meta-analysis of
individual patients’ data. Lancet 2007; 13:
115–22.
2 Gilbert RE, Gras L, Wallon M, Peyron F,
Ades AE, Dunn DT. Effect of prenatal
treatment on mother to child transmission
of Toxoplasma condii: retrospective cohort
study of 554 mother-child pairs in Lyon,
France. Int J Epidemiol 2001; 30: 1303–08.
3 Chervenak JL, Chervenak FA, McCullough LB.
Ethical and legal dimensions of medicine of
the pregnant woman and fetus. In: Reece EA,
Hobbins J, eds. Medicine of the fetus and the
mother, 2nd edn. Philadelphia: Lippincott
Raven, 1999.
824
Conference Center to develop
positive results in immunoglobulin M (IgM)
Toxoplasma antibody tests and importance of
confirmatory testing: the Platelia Toxo IgM
test. J Clin Microbiol 1997; 35: 174–78.
5 Roberts A, Hedman K, Luyasu V, et al.
Multicenter evaluation of strategies for
serodiagnosis of primary infection with
Toxoplasma gondii. Eur J Clin Microbiol Infect Dis
2001; 20: 467–74.
Early child development
in developing countries
“Finally I have data to convince
my Minister of Finance to invest
in early child development” repor-
ted the Minister of Women and
Child Development, Malawi, at a
meeting held at the Institute of
Child Health, London, UK, to
mark The Lancet’s series on child
development in developing countries
(Jan 6–Jan 20).1–3
At the meeting, hosted by the
Centre for International Health and
Development, presenters explained
that more than 200 million children
younger than 5 years are not
developing to their potential owing
to poverty, poor health, and nutrition.
Although effective interventions
are available, coverage is low. Repre-
sentatives from WHO, UNICEF, and
the World Bank expressed a strong
commitment to strengthening pro-
grammes and research to move the
Lancet recommendations forward.
Other agencies including UNESCO,
the Bernard van Leer and Aga Khan
Foundations, and many non-gov-
ernmental organisations explained
how they are putting the recom-
mendations into practice.
The Lancet steering group will
become the International Child
Development Committee. This
year, we plan to advocate for early
child development programmes
through presentations at meetings
in Turkey, India, Spain, Venezuela,
and Bangladesh and at the Society
for Research in Child Development
and the Pediatric Academic Societies.
We will meet at the Rockefeller
Foundation’s Bellagio Study and
implementation strategies and
establish priorities in collaboration
with the Child Health and Nutrition
Research Initiative. We will provide
guidance in assessment of existing
programmes, development of new
models for delivering services, and
integration of child development
activities into health and nutrition
services. In 2 years, we will report
on global progress in early child
development programmes.
The International Child Development Committee
comprises S Grantham-McGregor, P Engle, M Black,
M Cabral de Mello, J Meeks Gardner, B Lozoff,
N Ulkuer, T Wachs, S Walker, and M Young. I declare
that I have no conflict of interest.
Sally Grantham-McGregor, on behalf
of the International Child Development
Committee
sally@mcgregor22.freeserve.co.uk
Centre for International Health Development,
Institute of Child Health, University College, London
WC1N 1EH, UK
1 Grantham-McGregor S, Cheung YB, Cueto S,
Glewwe P, Richter L, Strupp B, the
International Child Development Steering
Group. Developmental potential in the first
5 years for children in developing countries.
Lancet 2007; 369: 60–70.
2 Walker SP, Wachs TD, Meeks Gardner J, et al,
the International Child Development Steering
Group. Child development: risk factors for
adverse outcomes in developing countries.
Lancet 2007; 369: 145–57.
3 Engle PL, Black MM, Behrman JR, et al, the
International Child Development Steering
Group. Strategies to avoid the loss of
developmental potential in more than
200 million children in the developing world.
Lancet 2007; 369: 229–42.
Risk factors for adverse
outcomes in developing
countries
In their child development series
article, Susan Walker and colleagues
(Jan 13, p 145)1 cite two of our recent
publications:2,3 “Two small Brazilian
studies suggest an association
between incidence of diarrhoea in
the first 2 years of life and impaired
cognitive performance in later
childhood.89,90 However, a larger
cohort study in Peru with control for
www.thelancet.com Vol 369 March 10, 2007