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admissions are for bacterial meningitis (unpublished), the common causes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.