Health of
children in India in the last decade
In the past
The scourge of
malnutrition and
anemia has always been there for Indian children. Dharani in Maharashtra, is well known for its malnourished young. Smallpox in children has been eradicated and has paved the way for AIDS. If detected early during pregnancy, the fetus can be treated. Doctors Abhay and Rani Bang of SEARCH (Society for Education, Action and Research in Community Health), a grassroots
Health organization that has succeeded in cutting infant mortality rates in Gadchiroli by up to 75%, were honored recently by Time Magazine. Set up by Abhay and Rani Bang in 1986, SEARCH operates in 42 villages. The results of their work are dramatic -- there has been a 75% decline in pneumonia mortality among children, and a 56% reduction in neonatal deaths, deaths in children who were less than one month of age.
Present day health scene
Dr Nitin Shah, President of the Indian Academy of Pediatrics (IAP) says that public health system facilities are very good and up to the mark at least in the Indian cities. As they are over crowded, people think they are not good, but it is not so and they provide really good care. He can never forget that he has learnt medicine from such a public health facility! Again it is not necessary that all private health facilities are necessarily of good quality!
The present scenario of child health care in India is bleak when one goes by the data available. Dr Shah in his address during the National Conference of Indian Academy of Pediatrics held in New Delhi in January 2006 said that ‘India still annually contributes 2.5 million of the global 10.8 million under 5 deaths and this is not acceptable. We know that most of these children die of ARI, acute diarrhea, neonatal causes, measles, malaria and HIV. We also know that 65% of these deaths are preventable if we could somehow manage to deliver some of the 17 low cost, time tested interventions to those who need them the most; interventions like breast feeding, zinc and iron supplementation, immunization, Oral Rehydrating Supplements, antibiotics for ARI, neonatal services, etc. The entire IAP 2006 Plan of action revolves around this issue and IAP proposes one program each to look after these important child health issues‘.
Data in Indian Pediatrics, a medical journal, says that acute diarrhea contributes 22% of the under-5 deaths. Malnutrition and anemia form major public health problems among the school age children, particularly in developing countries like India. The children of tribal communities, due to their low socio-economic status and social isolation, become highly vulnerable in this regard. It is disheartening to note that ORS is used in less than 20% of diarrhea episodes while antibiotics are misused in most of them. Dr Shah says that we know that malnutrition is seen in almost 65% of our children and anemia in 90% of them.
The major stumbling block in further reduction of Infant Mortality Rate, IMR, now is Neonatal death which contributes to 50% of the under-5 deaths and 75% of the infant deaths.
The future is bright!
The Future of children’s health in India is expected to be bright, say
pediatricians in India. At the least, plans on paper indeed look good. According to the World Health Organization (WHO) Guidelines, children suffering from Severe acute malnutrition (SAMN) require management in hospital. It is expected that 2.6 million under-five children are suffering from SAMN. In India, there are only 0.9 million total hospital beds. Admission of all children with SAMN is thus not possible, and hence home-based management is an unavoidable alternative for most of these subjects. Preliminary evidence suggests that this alternative may be acceptable, cost-effective, and reduce morbidity and mortality.
To check the infant mortality rate and shortage of specialized staff in the
rural areas, the government has expanded the Unicef-supported ‘Integrated Management of Neo-natal and Childhood Illness’ (IMNCI) programme to six districts in India which have been identified as ‘low performing’ in terms of health care. At present, the IMNCI programme is being implemented only in Raichur in Karnataka. The other low-performing districts are Bidar, Gulbarga, Bagalkot, Koppal and Bijapur. Over the last six months as many as 100 health workers have been trained for the programme in Raichur. According to UNICEF’s Programme Officer (Health) India, Dr K Suresh, IMNCI takes care of the fact that the pediatrician cannot reach every child born in the country. It de-mystifies the image of the doctor and imparts skill training to the front-level health worker, he said. He noted that in Raichur there was only one pediatrician at the District Government Hospital, when ideally there should have been at least three. Medical officers, Lady Health Visitors (LHVs), Auxiliary Nurses and Midwives (AN-Ms) and Anganawadi workers are among those trained. IMNCI is designed so that the front-level health worker visits the new born and its mother at least thrice after 10 days of delivery; the first of these visits being within 24 hours. The IMNCI trainee or health worker looks out for post-natal issues like congenital anomalies requiring immediate attention, problems in breast feeding and infection of the umbilical cord. Dr Suresh noted that in Guna and Shivpuri in Madhya Pradesh, the Unicef has even succeeded in training illiterate village women for the programme.
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