I was interested to read the editorial by Reddy and van den Hombergh,
"Synthesizing evidence for improving child health in India" in the March
issue of Indian Pediatrics [1].They mention that high neonatal mortality,
diarrheal disorders and pneumonia still remain the chief causes of
morbidity and mortality in children, especially those below the age of 5
years, and also that community based newborn care, oral rehydration
therapy and early detection and adequate management of acute respiratory
infections are not widely used. They emphasize the difficulty of bridging
the gap between evidence and policy and that policymakers would "benefit
from information that is relevant to decisions highlighted for them and
having evidence contextualized to their settings". Whereas it is important
to generate, synthesize and communicate relevant evidence, we must
understand that the chief constraints in improving child health and
welfare include adverse socioeconomic conditions, illiteracy and
ignorance, poor sanitation and hygiene, lack of safe water, and vector
control.
In most parts of India, rural communities are
illiterate and poorly informed about basic health care. If parents
understood the benefits of vaccinations and several other measures to
prevent common diseases and obtain appropriate treatment for illness, they
would make use of available facilities and demand better services. In
recent years the Government has launched a number of initiatives, which if
properly implemented would have prompt and far reaching benefits. The
National Rural Health Mission (NRHM) includes several important components
to tackle the existing problems. The appointment of accredited social
health activist (ASHA) in villages for health facilitation, and
participation of village panchayats in various healthcare activities,
improvement of sanitation and several other programs undertaken by the
Ministries of Rural development and Panchayati Raj are crucial measures.
However, education and empowerment of the underprivileged communities
(rural as well as urban), and their participation is of utmost importance
without which no program is likely to succeed.
There are wide variations in indices of health status
in different States of the country, and between affluent segments and
underprivileged urban and rural communities. Morbidity and mortality
patterns among the latter are highest and need to be investigated and
analyzed separately and addressed appropriately. Generating new, relevant
information on child health is clearly necessary, but enough information
is already available for application of effective control measures.
I have also noted that efforts at bridging the gap
between evidence and policy for child health programs in India and the
series of systematic reviews are a result of partnership between Public
Health Foundation of India and UNICEF. The Indian Academy of Pediatrics (IAP)
has vast experience over several decades in various fields of child health
and child welfare. Their expertise would be very useful in making
recommendations for intervention and action in these areas.