As with the development of the rotavirus vaccines to combat diarrhoea, India has the capacity and resources to address the country’s most pressing health issues
Among countries with comparable development indicators, India has the potential to address many of its challenges with unique home-grown resources. The information technology sector, for example, has transformed the country’s economy and is currently helping expand access to a wide range of quality services for some of the poorest in India. India’s space and atomic energy programmes are outstanding examples of indigenous technical ingenuity.
As economic growth continues to decelerate, it is critical that we do not forget the important role of indigenous scientific innovation, in particular, to improve livelihoods and promote well-being. To reiterate what Jawaharlal Nehru said: “It is science alone that can solve the problems of hunger and poverty, of insanitation and illiteracy.”
Child health is one area where investments in innovation can result in tremendous social and economic returns. India nearly halved child mortality rates between 1990 and 2010. Improved health-care services and access to simple health interventions, such as oral rehydration therapy (ORT) to address severe cases of diarrhoea, have contributed to this encouraging reduction of child deaths.
Link with malnutrition
However, in 2010, experts estimate that almost 17 lakh children less than five years of age died in India. This is still far too many. Pneumonia and diarrhoea, together, account for a significant proportion of these deaths. There are even more hospitalisations and outpatient visits from these two diseases. They each take a tremendous emotional and financial toll on Indian families and we need to take these threats seriously. It is unacceptable that children die of preventable and treatable illnesses. All families in India deserve equal access to health innovations that could help children and protect children.
Diarrhoea is caused by several different organisms and is most often spread through contaminated food or water and person-to-person contact. Certain types of diarrhoea are more serious than others. Acute watery diarrhoea is associated with rapid dehydration that can last for hours or even days. If fluids and electrolytes are not replenished, diarrhoea can be life threatening. Children who suffer from malnutrition are more vulnerable to the causes of diarrhoea. In an unfortunate twist, diarrhoea also in turn perpetuates malnutrition and leaves children prone to infections.
To address an issue such as diarrhoea, safe water and sanitation do matter, but require large-scale investment in infrastructure and in maintenance by the government. For individual and community level management of diarrhoea, you need to bring the lab to the field to understand what causes the disease. Some of the first studies here aimed to determine the cause of severe diarrhoea in India — the kind that causes life-threatening dehydration. Researchers found that a viral pathogen called rotavirus was the most common cause. Rotavirus is of particular concern because it is so ubiquitous, leaving nearly all children — rich and poor — at risk. However, outcomes vary greatly depending on the family’s circumstances. For a child of high socioeconomic status with consistent access to care, the virus will likely cause only minor illness. For less fortunate children, it could be a death sentence if appropriate care is not provided or is provided late in illness.
Use this package
To reduce the burden of diarrhoea in India, we must try to reach all children with a comprehensive package of proven interventions. This includes access to ORT, zinc supplementation, exclusive breastfeeding for the first six months of a child’s life, and improvements in hygiene, sanitation and drinking water. However, because rotavirus is so contagious and resilient, these approaches alone will not adequately prevent diarrhoea. Vaccination against rotavirus offers significant hope for protecting children from this disease.
We know already that countries that have introduced rotavirus vaccines have experienced major reductions in severe diarrhoea. Several academic and research institutions in India, including mine, have been involved in the development of indigenous rotavirus vaccines that could, if all goes well, reduce the number of illnesses and hospitalisation due to diarrhoea.
If rotavirus vaccines were introduced at current immunisation levels, we could save tens of thousands of lives, and even more hospitalisation and outpatient visits. This could save India more than Rs.100 crore in annual medical costs. The savings to families would also be significant.
Having contributed significant funding, the government has been a terrific supporter of developing new rotavirus vaccines in India. As with the rotavirus vaccine development efforts, we have the resources and the capacity in India to address our most pressing health needs, if we use a strategic approach that prioritises problems and then makes a concerted effort to address them. However, development of a product such as a vaccine is not sufficient. We must also work together to develop and implement policies that ensure that everyone has access to the fruits of our scientific endeavours.
(Dr. Gagandeep Kang is a professor in the Department of Gastrointestinal Sciences at Christian Medical College, Vellore.)
Keywords: India's health issues, malnutrition, Indian medical services, child deaths, oral rehydration therapy, health-care services
We have long known that India has far more people than are given a
chance to lead decent lives,
that this inability to meet the obiligations of society to its
individuals begins at childhood remains shaming of our politics, our
economics and most sadly, of our culture.
As Bill Gates in his Annual letter for the year 2013 says, measurement is the key factor that contributes to innovation. So, getting a quantitative analysis of the various parameters of child death will help to tackle this challenge to a greater extent.
Creativity and improvisation must be the key elements of Primary health Care system. Optimul utilization of the available resources and ensuring accessibility and availability of appropriate technology which is acceptable to the common poor people with involvement of the community always reamin the basic priciples of the primary health care system.OR powder supplied by the government is of poor quality is not acceptable by the community.
Vaccination is indeed the best intervention with visisble impact, but however, the government should ensure availability of pentavalent or 6 in 1 vaccine so that the acceptability of the vaccines is enhanced and improved coverage is ensured.Governments should be more people centric than policy centric.
This comment on health policy from one of the leaders in rotavirus research is welcome. As
she suggests, we need to prioritise affordable and feasible outcomes and pursue them
vigorously. This article coincides with another in the New York Times suggesting that the
closer you move health care to the beneficiaries the more sustainable it would be. If you
combine these two ideas, it is clear that the primacy in health care in India should move from
tertiary care to primary/secondary level care.
This is an excellent article providing ways to use scientific findings
to curb gastrointestinal infections and diseases that take a toll on
children. There are other measures that need to be addressed. These
are water and food borne diseases. Protected water-supply in the towns
and villages is a simple preventive measure. With the introduction of
mid-day meals to school children in many states, daily inclusion of
probiotics in the form of "dahi" will be another way to alleviate
these infections. Dahi will not only provide good nutrition, but also
act as a prophylactic against enteropathogens. The addition of
selected probiotic bacteria to "dahi" will enhance the prophylactic
effect. The cost for this will be much lower than treating these
chronic infections. And there are no dietary taboos to including
"dahi" as a supplement to the normal food served in the mid-day meals.
These measures will complement the medical treatments proposed in the
article.
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