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correspondence

Indian Pediatr 2012;49: 249

Childhood Deaths in India – The Invisible Disasters

Adhisivam B

Assistant Professor, Department of Pediatrics, Jawaharlal Institute of Post graduate Medical Education and Research (JIPMER), Pondicherry 605 006, India.
Email: [email protected]
 


When a natural disaster like tsunami or earthquake strikes, the whole world turns its attention and quick relief measures are undertaken. However, if the same deaths occur in a smaller proportion on a daily basis, they go unnoticed. It is a sad fact that the pediatric population, especially in a tropical country like India is the worst affected by these invisible micro disasters. India alone accounts for 22% of deaths worldwide among children younger than 5 years due to diarrhea attributable to rotavirus infection [1]. It is indeed a paradox that a country which can invest billions in Formula One Grand Prix and IPL cricket matches cannot prevent children silently dying from dehydration due to diarrhea.

More than 400 people, mainly children, have died in an ongoing outbreak of viral encephalitis in northern India. It is distressing that children die due to Japanese encephalitis despite the availability of an effective vaccine. Nearly 6,000 children have died of encephalitis in BRD Medical College hospital, Gorakhpur since the first case was detected in 1978. Until 2005, the majority of deaths were caused by Japanese encephalitis. But in the past six years, children have been dying of other forms of viral encephalitis, the exact cause of which is unclear [2]. Though there is a thrust towards non communicable diseases worldwide, India still has a mammoth task related to infectious disease burden.

About 2·35 million children died in India in 2005 contributing to more than 20% of all deaths in children younger than 5 years worldwide. More than three-fifths of these deaths were from five causes: pneumonia, prematurity and low birthweight, diarrheal diseases, neonatal infections, and birth asphyxia and birth trauma. Each of the major causes of neonatal deaths can be prevented or treated with known, highly effective and widely practicable interventions such as skilled attendance during delivery, emergency obstetric care, and simple immediate care for newborn babies [3].

Apart from the above well documented causes, children dying due to rural emergencies like envenomation due to snakebite and scorpion sting are under-reported. The increasing road traffic accidents often include overcrowded school vehicles. Selective abortion of girls, especially for pregnancies after a firstborn girl, has increased substantially in India. Most of India’s population now lives in states where selective abortion of girls is common [4]. These invisible disasters need to be addressed to ensure India’s progress towards Millennium Development Goal (MDG) 4. Spending on health care in India also remains low (only 4.2 % of GDP), in comparison to many countries, which will also have a direct impact on child mortality [5]. 

A concerted programmatical input is urgently needed for a multi-pronged response to these disease problems. Health workers alone lack the wherewithal to handle this unrecognized epidemic.

References

1. Tate JE, Burton AH, Boschi-Pinto C, Steele AD, Duque J, Parashar UD. The WHO-coordinated Global Rotavirus  Surveillance Network. 2008 estimate of world-wide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirusvaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis. 2011 Oct 24. [Epub ahead of print]

2. Biswas S. India encephalitis outbreak kills 400, mainly children (cited 2011Oct 12). Available from: http://www.bbc.co.uk/news/world-south-asia-15269441. Accessed on 12 October, 2011.

3. Million Death Study Collaborators. Causes of neonatal and child mortality in India: a nationally representative mortality survey. Lancet. 2010;376:1853-60.

4. Jha P, Kesler MA, Kumar R, Ram F, Ram U, Aleksandrowicz L, et al. Trends in selective abortions of girls in India: analysis of nationally representative birth histories from 1990 to 2005 and census data from 1991 to 2011. Lancet. 2011;377:1921-8.

5. World health organization. India statistics 2009. Available from:  http://www.who.int/countries/ind/en/. Accessed on 12 October, 2011.

 

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