CHAIN REACTION ON GOOD HEALTH- SETH BERKLEY.HINDUSTAN TIMES 6 FEB 2016

ISSUES RAISED IN THE ARTICLE

Though India is one of the fastest growing economy in the world and the present dispensation is boosting business and entrepreneurship through good governance initiatives and government reforms but the economic growth also depend upon the health of children and future workforce.

  • Death of 1.4 million children under the age of 5 every year
  • Critical gap between the haves and haves not-poor children with inadequate vaccine supply chain; cold chain equipments; which raises the issue of equity.
  • The problem to reach every last child for immunization: logistic challenges ,inadequate vaccine supply chains.

WAY OUT:

As the government latest programme Make in India emphasis on innovation- the same entrepreneurship zeal should be channelized to encourage innovations to improve access to vaccines by modernising supply chains and equipments- helping in transport and keep vaccines safe. By unleashing the innovative zeal of entrepreneurs in this field under Make In India programme, India can become the innovative leader in immunization technologies which in turn will improve its own immunization coverage and equity domestically.

ADDITIONS

More children under the age of 5 die in India than in any other country in the world and from five main causes – that are avoidable

Pneumonia: Pneumonia is an infection in one or both lung. It can be caused by fungi, bacteria, or viruses. Pneumonia causes inflammation in your lung’s air sacs, or alveoli. The alveoli fill with fluid or pus, making it difficult to breathe. Worldwide, pneumonia is the leading cause of death for children under the age of five. India accounts for almost 25% of the world’s pneumonia child deaths. World Pneumonia day observed on November 12, every year.

Premature and low birth weight: The prevalence of low birth weight (LBW) is higher in Asia than elsewhere, predominantly because of undernutrition of the mother prior to and during pregnancy. There are qualitative differences in dietary requirements during early and late pregnancy – micronutrients and proteins required in early pregnancy, and calories and other nutrients later. Micronutrient deficiencies during pregnancy have been shown to have serious implications on the developing foetus. Nearly half the pregnant women still suffer from varying degree of anaemia, with the highest prevalence in India, which also has the highest number of maternal deaths in the Asian region. Optimal weight gain during pregnancy and a desirable foetal outcome may be a result of synergisitic effects of improved food intake, food supplementation, improved micronutrient intake, education and the environment of the pregnant woman and her family.

Diarrhoeal diseases: Diarrhoeal disease is the second leading cause of death in children under five years old. It is both preventable and treatable.A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene.Diarrhoea is a leading cause of malnutrition in children under five years old. Diarrhoea can last several days, and can leave the body without the water and salts that are necessary for survival. Most people who die from diarrhoea actually die from severe dehydration and fluid loss. In developing countries, children under three years old experience on average three episodes of diarrhoea every year. Each episode deprives the child of the nutrition necessary for growth. As a result, diarrhoea is a major cause of malnutrition, and malnourished children are more likely to fall ill from diarrhoea.

Neo-natal infections: The vast majority of newborns enter the world healthy. But sometimes, infants develop conditions that require medical tests and treatment. Newborns are particularly susceptible to certain diseases, much more so than older children and adults. Their new immune systems aren’t adequately developed to fight the bacteria, viruses, and parasites that cause these infections.

 Birth asphyxia, and birth trauma — Asphyxia—insufficient oxygen supply—can lead to severe hypoxic ischaemic organ damage in newborns followed by a fatal outcome or severe life-long pathologies.

Improvements in pre-natal care, expanded neo-natal and obstetric care, proper management of diarrhoea and pneumonia, and adding new vaccines to immunisation programmes could substantially reduce child deaths in the country. The fourth Millennium Development Goal (MDG-4) aimed to reduce mortality — between 1990 and 2015 — among children under five by two-thirds.

TERMS USED

PRENATAL: Occurring or existing before birth.

POSTNATAL  Relates to the newborn in the period immediately after birth. A suitable subdivision is: early postnatal—within 48 hours of birth; delayed postnatal—2 to 7 days; late postnatal—1 to 4 weeks

Called micronutrients because they are needed only in minuscule amounts, these substances are the “magic wands” that enable the body to produce enzymes, hormones and other substances essential for proper growth and development. As tiny as the amounts are, however, the consequences of their absence are severe. Iodine, vitamin A and iron are most important in global public health terms; their lack represents a major threat to the health and development of populations the world over, particularly children and pregnant women in low-income countries.

DEHYDRATION: water and electrolytes (sodium, chloride, potassium and bicarbonate) are lost through liquid stools, vomit, sweat, urine and breathing. Dehydration occurs when these losses are not replaced.

Electrolytes are minerals in your blood and other body fluids that carry an electric charge.

Electrolytes affect the amount of water in your body, the acidity of your blood (pH), your muscle function, and other important processes. You lose electrolytes when you sweat. You must replace them by drinking fluids that contain electrolytes. Water does not contain electrolytes. Common electrolytes include: Calcium Chloride, Magnesium, Phosphorous, Potassium, Sodium.

Malnutrition: When a person is not getting enough food or not getting the right sort of food, malnutrition is just around the corner. Even if people get enough to eat, they will become malnourished if the food they eat does not provide the proper amounts of micronutrients – vitamins and minerals – to meet daily nutritional requirements. Malnutrition at an early age leads to reduced physical and mental development during childhood. Stunting, for example, affects more than 147 million pre-schoolers in developing countries, according to SCN’s World Nutrition Situation 5th report. Iodine deficiency, the same report shows, is the world’s greatest single cause of mental retardation and brain damage

Undernutrition is usually thought of as a deficiency primarily of calories (that is, overall food consumption) or of protein. Deficiencies of vitamins and minerals are usually considered separate disorders (see Vitamins and seeMinerals). However, when calories are deficient, vitamins and minerals are likely to be also. Undernutrition, which is often used interchangeably with malnutrition, is actually a type of malnutrition. Malnutrition is an imbalance between the nutrients the body needs and the nutrients it gets. Thus, malnutrition also includes overnutrition (consumption of too many calories or too much of any specific nutrient—protein, fat, vitamin, mineral, or other dietary supplement), as well as undernutrition.

Mission Indradhanush was launched by Ministry of Health and Family Welfare (MOHFW) Government of India on 25th December, 2014. The objective of this mission is to ensure that all children under the age of two years as well as pregnant women are fully immunized with seven vaccine preventable diseases. Full immunization coverage to be expanded from 65% to atleast 90% children of the country. The Mission Indradhanush, depicting seven colours of the rainbow, targets to immunize all children against seven vaccine preventable diseases, namely:

Diphtheria; Pertussis (Whooping Cough); Tetanus; Tuberculosis; Polio; Hepatitis B and Measles.

In addition to this, vaccines for Japanese Encephalitis (JE) and Haemophilus influenzae type B (HIB) are also being provided in selected states.

For the first phase, 201 high focus districts across 28 states in the country that have the peak number of partially immunized and unimmunized children were identified by the Government.

The aim of second phase is to achieve full immunization in 352 districts which includes 279 mid priority districts, 33 districts from the North East states and 40 districts from phase one  where huge number of missed out children were detected.

                  India’s Universal Immunisation Programme (U.I.P.) is one of the largest in the world in terms of quantities of vaccine used, the number of beneficiaries, the number of Immunisation session organised, the geographical spread and diversity of areas covered.

The national policy of Immunisation of all children during the first year of life with DPT, OPV, BCG to complete the series of primary vaccination before reaching the age of one year was adopted in 1978 with the lunching of EPI to increase the Immunisation coverage in infancy to 80%. Universal Immunisation programme UIP was launched in 1985 in a phased manner. The measles vaccine was added in 1985 and in 1990 Vit A supplementation was added to the program. All vaccines are available free of cost under the Universal Immunization Programme in India.

.The Vaccination Schedule under the UIP is:

BCG (Bacillus Calmette Guerin) 1 dose at Birth (upto 1 year if not given earlier)

DPT (Diphtheria, Pertussis and Tetanus Toxoid) 5 doses; Three primary doses at 6,10,14 weeks and two booster doses at 16-24 months and 5 Years of age

OPV (Oral Polio Vaccine) 5 doses; 0 dose at birth, three primary doses at 6,10 and 14 weeks and one booster dose at 16-24 months of age

Hepatitis B vaccine 4 doses; 0 dose within 24 hours of birth and three doses at 6, 10 and 14 weeks of age.

Measles 2 doses; first dose at 9-12 months and second dose at 16-24months of age

TT (Tetanus Toxoid) 2 doses at 10 years and 16 years of age

TT – for pregnant woman two doses or one dose if previously vaccinated within 3 Year

In addition, Japanese Encephalitis (JE vaccine) vaccine was introduced in 112 endemic districts in campaign mode in phased manner from 2006-10 and has now been incorporated under the Routine Immunisation Programme.

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