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.