Bijnor witnesses high mortality of kids as killer disease ignored

Success story: Salim who battled pneumonia and survied.  

Manisha Jha

At least 50 per cent of pneumonia deaths are caused by Haemophilus influenzae type b and pneumococcus: WHO

BIJNOR: Travelling about 250 kilometres away from the Capital into the dusty rural heartland of Bijnor in Uttar Pradesh one comes face-to-face with the grim reality of rural health infrastructure and of its missed opportunities in checking diseases that are quietly wiping out a sizeable population of children under five years. One such disease is pneumonia which, according to estimates, annually accounts for the death of over four lakh children.

According to WHO, in India, at least 50 per cent of pneumonia deaths of children under five years of age are caused by two bacteria, Haemophilus influenzae type b (Hib) and pneumococcus.

Bijnor paediatrician Dr Vipin M. Vashishtha said: “These deaths are entirely preventable if the Government is serious about ensuring widespread use of pneumococcal and Hib vaccine, risk reduction and improved treatment. But the Government's priority is directed towards polio eradication neglecting other silent killer diseases such as pneumonia. Seriousness to draft a well-defined policy on pneumonia is lacking and has to come from the very top level for it to percolate down to the State and village level. Even a basic surveillance system to monitor pneumonia spread and provide authentic data on it is presently absent.”

“Apart from introducing pneumonia vaccines immediately in the National Immunisation Programme and ensuring availability of effective anti-biotic for pneumonia treatment, the Government's awareness drive for promoting breastfeeding, importance of balanced diet and prevention of malnutrition and indoor air pollution could help check the disease spread to a large extent,” he added.

In Bijnor, according to Dr. Vashishtha, people's tendency to provide over-diluted cow, buffalo and powdered milk to their children due to poverty and practice of solid fuel cooking in at least one out of four households is a major cause behind making children susceptible to pneumonia.

Preventive measures

According to him, while preventive measures such as pneumococcal vaccine is available to a minority of affluent people who can afford the costly vaccine, it remains out of touch for about 90 per cent of Bijnor residents who comprise mostly daily wage labourers and whose children are already “more vulnerable” to pneumonia.

“I fail to understand why the Government is holding back introduction of this vaccine in government hospitals and health centres. It is only allowing its distribution in the private sector where it is not needed as the affluent section already enjoys enough protection and immunity,” he added.

The Pneumonia Task Force (Bijnor) chairman Dr. A. K. Aggarwal said: “No drastic measures are needed to prevent pneumonia as even merely improving immunization coverage of the existing Universal Immunisation Programme vaccines would go a long way in ensuring that children get protection against diseases. At present the coverage of routine immunisation is only 30 per cent in U.P., leaving about 70 per cent area uncovered.”

Parents of three-year-old Salim, who resides in a village off Bakshi Wala Road, Bijnor, and battled with pneumonia recently still have no clue as to why their son fell sick. His cousin sister wasn't so lucky. Salim's 26-year-old mother Afrozi said: “Salim stopped eating and drinking anything for about 22 days and contracted measles and typhoid. He could not even stand up. However, in our village the old ladies forbid women from taking their young children to the doctor in case of measles so I didn't go. Suddenly one day I noticed that he was turning breathless so I panicked and took him to the hospital but the doctor was out of town and I had to wait for four more days.''

“On finally seeing Salim the doctor immediately admitted him for 10 days. He was given drips and eight injections daily for the next eight days. Meanwhile, my husband who works as a scrap dealer had to leave his job and take turns to be with him at the hospital. We have borne the entire cost of Salim's treatment that came to about Rs.13,000 by pawning off my jewellery and borrowing from relatives. My husband only earns Rs.100 per day and will pay off the money slowly,” she added.

According to Afrozi, pneumonia is a common occurrence in her village and she has never heard of any vaccine and only recalls taking her sons for polio vaccination.

“A year ago my elder son Shokeen also contracted the disease when it was really cold but he survived unlike my uncle's daughter who died,” she added. Though apart from auxiliary mid-wives and angadwadi workers, Bijnor has 2,200 community health workers called Accredited Social Health Activist (ASHA) under the National Rural Health Mission who are presently being trained in phases to check Bijnor's Infant Mortality Rate (IMR), they lack awareness on pneumonia.

State Trainer, Comprehensive Child Survival Programme, Bijnor, Dr Ram Kumar Singh said: “The ASHA's primary work is visiting villages to spread awareness about maternal health and refer serious cases to hospitals. They are given basic training in social behaviour and clinical recognition of diseases to check the IMR but no specific training is given to them on pneumonia.”

Inadequate infrastructure

Chief Medical Officer, Bijnor, Dr. A. Kumar said: “Though facilities are available for treatment of pneumonia, we are still lacking adequate rural health infrastructure and manpower. We have X-Ray facility for pneumonia diagnosis in only one district government hospital and six zila parishad hospitals in Bijnor.

Moreover, our strength of doctors at the Bijnor district hospital needs to be doubled from the present 90. Due to poor facilities, over work and low pay for doctors in rural postings, there is reluctance among specialist doctors to stick to their jobs.”