Children belonging to the Sahariya tribe, the indigenous Munda-speaking adivasis in Baraipura village in the Shivpuri district in the Madhya Pradesh, rarely go to school. They also don’t get vaccinated.
The handful born in government hospitals and clinics received BCG vaccination against tuberculosis and oral polio vaccine. A few others got a single dose against the recommended five doses of the DTP vaccine that protects against diphtheria, tetanus and pertussis (whooping cough).
Almost no one has received more than two vaccines.
Giving each child three dose of DTP is the World Health Organisation’s accepted global indicator for routine immunisation performance. In India, DPT3 coverage is 72% against a global target of 90%. The block medical officer (BMO) in Shivpuri’s Pohri block confidently says routine immunisation in his predominantly tribal block is an astounding 90%, which is higher than India’s national average of 72%! He later admits he doesn’t know as he took charge the BMO a month ago.
Most women in Baraipura village have three to five children, and most have lost as many children in the first five years of their birth to malnutrition and infections. None of them know what killed their child.
Pneumonia kills one child every three minutes in India, with more than 180,000 children dying of the infection each year. It’s the leading cause of death of children under-5 years, taking more lives than HIV, malaria, tuberculosis, Zika and Ebola, combined.
Pneumonia is not the only child killer, diarrhoea kills another 120,000 children. Between them, the two infections are responsible for one in four under-5 deaths in India, killing close to 300,000 children before their fifth birthday.
With an under-5 population of more than 121 million, India accounts for the highest number of the global 1.5 million childhood pneumonia and diarrhoea deaths, followed by Nigeria and Pakistan. Seventy-two percent of pneumonia and diarrhoea child deaths occur in just 15 countries that are home to 55% of the world’s under-5 population, said 2016 Pneumonia & Diarrhea Progress Report released last week.
Both disease can be prevented and treated. Vaccines exist against both diseases, and happily, India is introducing both in a phased manner. If it reaches all the children it is meant to reach, the can swiftly halve under-5 deaths.
India’s on track. Union Health Minister JD Nadda announced last week that the pneumococcal conjugate vaccine (PCV-13) will be introduced in phases from 2017 in Himachal Pradesh, Bihar, Uttar Pradesh, Rajasthan and Madhya Pradesh to protect against pneumococcal diseases such as pneumonia, ear infections, sinus infections and meningitis in a phased manner by 2017-18. Pneumococcal pneumonia is the most common form of bacterial pneumonia, with symptoms including high fever, chills and a productive cough with breathing difficulty and pain in the lungs, which can lead to septicaemia (blood poisoning) and death.
PCV-13 protects against 13 of the 90 types of pneumococcal bacteria, which is caused by infection with Streptococcus pneumoniae bacteria that spreads from person to person through close contact. These 13 strains cause most severe infections in children and about half of infections in high-risk adults over 65 who have diabetes, chronic lung conditions, liver disease, kidney disease or heart disease, among others.
The deactivated vaccine contains no live pneumococcal bacteria and cannot cause disease. Vaccine shots can safely be given at the same time as other vaccines in the schedule, which will help demonstrate how the combined effect will bring down hospitalisations and death in children who are also being given rotavirus vaccine, which was introduced earlier this year to combat diarrhoea in the four states -- Andhra Pradesh, Haryana, Himachal Pradesh and Odisha.
No one intervention is enough. Apart from preventive vaccination, exclusive breastfeeding in the first six months of life, safe water and adequate nutrition are a must o build child immunity. Worldwide, six months exclusive breastfeeding rates vary widely, from 65% in India to 0% in Chad and 5% in Somalia.
Treatment for pneumococcal disease includes appropriate use of antibiotics and oxygen, while diarrhoea is treated using oral rehydration salts (ORS) and zinc supplement to restore water and electrolytes lost with watery stools. Just giving children ORS can save more than 90% of the 120,000 lives lost to diarrhoea each year.
In India, close to 30% children miss out on life-saving vaccines each year. Many thousands would be alive if they had been vaccinated. Just telling people to get their child vaccinated is not enough. Health-workers also need to explain why they must do it.
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