"Life can only be understood backwards; but it
must be lived forward"
-Soren Kierkegaard
As Indian Academy of Pediatrics (IAP) completes its
glorious golden era of service to the health of Indian children, the
time cannot be more apt to introspect on its interesting past journey to
plan ahead for a better future. Over the years, IAP has become a force
to reckon with and is increasingly recognized by the policy makers as an
important Civil Society Organization (CSO) to partner with to bring in
the desired positive changes in the child health indices of the country.
But this hard earned respect comes with a package of increased
responsibilities towards the 20000 plus pediatrician members serving
over 150 million children of the country.
Integration of Health Services: A Focus on
Public-Private Partnership
Despite the advances in medical field, India
continues to contribute nearly 20% of under-five mortality. There is
inequity in health care related to geography, gender and socioeconomic
status across the country [1]. The strengthening of existing
primary-care services and targeted programs, for children in most need,
is undoubtedly the need of the hour. The efforts can be compounded by
the integration of different skills and resources of both private and
government entities for joint investment in the provision of public
services.
Tackling Resistance From Antibiotics
Emerging and increasing resistance to antibiotics has
become a threat to public health globally. Around 30-70% prevalence of
methicillin-resistant Staphylococcus aureus (MRSA) has been
reported from various parts of the country [2]. Resistance to
sulfa-pyrimethamine needs to be closely monitored to protect the
antimalarial efficacy of artesunate combination therapy [3]. Most
pediatric and neonatal intensive care units are facing the problem of
nosocomial infections with resistant gram-negative bacteria. Strategies
to reduce the emergence and spread of drug resistance to other major
infections like enteric fever and tuberculosis need to be proactive. To
face this herculean challenge, the academy has proposed the launch of a
rational antimicrobial module from 2014 which will aim at training
pediatricians all over the country on choosing and using the most
optimal antibiotic regimens, and reducing antibiotic misuse. The module
will also create opportunities to interact with the experts and discuss
the practical issues faced by the practioners.
TB or Not TB? – Solving the Riddle
Though there have been intense efforts for novel
diagnostic, therapeutic and preventative interventions for tuberculosis
(TB) in adults, childhood TB has been relatively neglected [4]. The
diagnostic and therapeutic challenges in children with tuberculosis are
far more complex than adults. Pediatric cases contribute to 20-40% of
overall TB burden in India. Revised National TB control Program (RNTCP)
and IAP have published management guidelines in 2012. However,
challenges remain to address policy-practice and knowledge gaps,
especially in sphere of diagnosis of disease, including latent and
drug-resistant TB. A training course will be launched in 2014 to train
the pediatricians in basic microbiology, clinical aspects, diagnostic
issues and programmatic challenges related to TB.
Advocacy in Immunzation
The role played by the academy in drafting updated
recommendations on immunization cannot be undermined. IAP’s
recommendation on sequential use of OPV-IPV-OPV is the right step paving
the way for introduction of injectable polio vaccine (IPV) in the
National Immunization Program. ‘Immunization and Adverse Events
Following Immunization’ along with disease surveillance initiated by the
IAP under the IAP infectious diseases surveillance program, ‘idsurv’
has been lauded by the ‘National Center for Disease Control’ and
‘Integrated Disease Surveillance Project’. The collaboration aims to
build epidemiologic data that would help the policy makers of the
country to plan interventions. We need to now consolidate further by
moving beyond mere sensitization of the members.
IAP ‘Mission Uday’ project, in its 2nd year,
needs to focus on the select districts and generate some useful data.
Major under-five killers, diarrhea and pneumonia need to be tackled with
more realistic measures. Advocacy needs to be translated into action at
field level and it will happen only when the IAP members move out of
their chambers and join hands with the fractured public health network
in making the health care and health education reach the unreached rural
India.
IAP Web-Revolution 2014
Web-revolution in the form of relay of live
conferences and CMEs to nodal centers and individual links is in cards
from 2014 onwards. The latest technology will be used to provide
convenience of learning and interaction, especially for the postgraduate
medical students, who otherwise have to compromise time and energy in
travelling to these venues.
As we embark on the journey of the second half of IAP
century, we now stand at a turning point where we hope to capitalize on
the lessons from the past with an inspiration to face old and new
challenges to deliver the best professional services.
References
1. Balarajan Y, Selvaraj S, Subramanian SV. Health
care and equity in India. Lancet. 2011;377:505-15.
2. Dharmapalan D, Yewale V. MRSA – Prevalence and
Challenges. In: Parthasarathy A, editor. Textbook of Pediatric
Infectious Diseases. 1st ed. New Delhi: Jaypee Brothers Medical
Publishers; 2013.
3. Shah NK, Dhillon GP, Dash AP, Arora U, Meshnick
SR, Valecha N. Antimalarial drug resistance of Plasmodium falciparum in
India: changes over time and space. Lancet Infect Dis. 2011;11:57-64.
4. Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B.
Paediatric tuberculosis. Lancet Infect Dis. 2008;8:498-510.