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correspondence

Indian Pediatr 2010;47: 541-542

Homicide by Neglect? Uncontrolled Pediatric Infectious Diseases


T Jacob John

439, Civil supplies Godown Lane, Kamalakshipuram, Vellore, TN, 632002.

Email: [email protected] 
 


Aiding or abetting someone’s death is criminal act in jurisprudence. If diagnosis or treatment is faulty for a child with serious illness, the medical attendant is guilty of negligence – attracting punitive consequences and payment of compensation to the afflicted. Is not the agency supplying water contaminated with Vibrio cholerae or Salmonella typhi guilty of criminal negligence?

The choice of the named pathogens is with reason. Both are notoriously water-borne. The April issue of Indian Pediatrics has two papers on therapy of cholera and diagnosis of typhoid fever, both bacteriologically proven(1,2). One counted 180 children with cholera in one hospital in Delhi, during March 2006 to February 2007(1). The other counted 41 children with typhoid fever in one hospital in Mysore(2). The nation-wide magnitude of cholera and typhoid fever are unimaginably enormous. Yet India has no systematic control plan against water-borne infectious diseases (IDs).

Another paper reported overall prevalence of 3.5% clinical tuberculosis (TB) among children attending one hospital in Agra(3). The reason for continued high burden of pediatric TB in spite of routine BCG vaccination remains uninvestigated by the National TB Control Programme. Falciparum malaria is widely prevalent in most States, malaria control programme notwithstanding. I recently found that 2-5% of pediatric admissions are for bacterial meningitis (unpublished), the common causes of which are Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae. For bacterial meningitis, there is no control program.

The national average coverage of children with the cheapest of vaccines (against diphtheria, whooping cough, tetanus, measles and polio) is <50%(4). Since in some States it is >80%, in others it must be dismally low - and vaccine-preventable ‘killers’, except polio, are obviously prevalent. India does not practice public health surveillance and no reliable data exist on burdens or spectrum of IDs. This is like closing eyes to miss the obvious.

Why does India’s health system neglect to prevent IDs? Lack of intervention tools cannot be blamed. Is lack of systematic intervention by national policy(5)? If lack of public demand is an excuse not to spend funds on public health, Indian Academy of Pediatrics ought to make that explicit demand. Whatever the reasons, the Government is not justified in passively promoting morbidity, mortality and family-level poverty by not controlling IDs.

The manifesto of Indian National Congress (INC) for 2009 parliamentary elections promised ‘health security for all’(6). After winning the elections INC remains silent on it. The Party President and Prime Minister are accountable to people on the promise. Health security subsumes ID-control, for which responsibility with accountability should be assigned to the Minister and Secretary, Department of Health and to Directors of Health Services and National Centre for Disease Prevention and Control.

References

1. Kaushik JS, Gupta P, Faridi MMA, Das S. Single dose azithromycin versus ciprofloxacin for cholera in children: A randomized controlled trial. Indian Pediatr 2010; 47: 309-315.

2. Narayanappa D, Sripathi R, Kumar KJ, Rajani HS. Comparative study of dot-enzyme immunoassay (Typhidot-M) and Widal test in the diagnosis of typhoid fever. Indian Pediatr 2010; 47: 331-333.

3. Garg P. Prevalence of tuberculosis at secondary hospitals in Uttar Pradesh. Indian Pediatr 2010; 47: 365-366.

4. National Family Health Survey – 3. Available at: http://www.nfhsindia.org/anfhs3.html. Accessed on 23 April, 2020.

5. Government of India Ministry of Health and Family Welfare. National Health Policy. http://www.mohfw.nic.in/NRHM/Documents/National_Health_Policy_2002.pdf. Accessed on 23 April 2010.

6. Manifesto of Indian National Congress, Lok Sabha Election 2009. http://aicc.org.in/new/manifesto09-eng.pdf. Accessed on 23 April 2010.

Declaration. I declare no conflict of interests. The opinions are personal and do not necessarily reflect those of any organization/committee of which I am a member.
 

 

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