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In 2011, 16.55 lakh children under 5 died in India, six times more than China’s 2.49 lakh. One reason for the staggering numbers is that 27 million babies — the highest in the world — are born in India. The others are malnutrition and under-vaccination, writes Sanchita Sharma.

columns Updated: Feb 03, 2013 01:44 IST
Sanchita Sharma

Madhuri Bansal, 13, gets a little red tablet each Monday along with the rest of Classes 6-12 students at Sarvodaya Kenya Vidyalaya in Shalimar Bagh in north Delhi.

She’s been told that the tablet will keep her healthy and active. What she hasn’t been told is that it will also help her children, if and when she chooses to have them, live and stay healthy.

Anaemia -- a deficiency of oxygen-carrying haemoglobin in the blood -- kills 10% newborns and 4% under-five children in India.

The little red tablet given to Bansal and friends after her mid-day meal is part of the Centre’s Weekly Iron and Folic Acid Supplementation Programme for 10-19 year olds across India.

The grand plan is to prevent anaemia in young people, particularly in adolescent girls, through distribution of iron and folic acid tablets at school and through anganwadi workers for adolescents out of school.

Nutritional anaemia affects one in five people worldwide, but is particularly high in India among people with a largely vegetarian diet and those prone to infections.

More than 5 crore adolescents are anaemic (haemoglobin <12 gm% in girls and <13gm% in boys), shows data from the the National Nutrition Monitoring Bureau Survey, anaemia being as high as 55.8% in girls and 30.2% in boys aged 15-19 years.

“By April this year, 13 crore adolescents -- 6 crore enrolled in classes 6-12 in government, government-aided and municipal schools, and 7 crore out-of-school girls -- will get their weekly dose. In the short-term, it improves their nutritional status and making adolescents function optimally, both physically and mentally.

"The long-term benefit is to break the inter-generational cycle of anaemia, which is a major cause of mother and child illness and death,” said Aradhana Gupta, mission director, National Rural Health Mission, who will present this data at Summit for Child Survival and Development in Chennai next week.

Iron supplementation is being coupled with biannual de-worming (Albendazole 400mg), six months apart, for control of intestinal worms that cause nutritional deficiencies, diarrhoea, abdominal pain, dehydration and weakness, which affect learning and cause physical stunting.

“Growth spurt leading to increased nutritional demand in the body, poor diets, worm infestation and, in girls, increased loss of iron due to menstruation, is a major cause of anaemia in adolescents.

"If not corrected, iron-deficiency anaemia stays throughout life,” says Dr Anoop Misra, director of the Centre of Internal Medicine, Fortis Hospital.

The other thrust area to keep India's 27 million babies born each year healthy is improving routine vaccination.

Though child and newborn deaths have almost halved — fallen by 45% — since 1990, India is among the top four countries (India, Nigeria, Congo, Pakistan and China) that account for half of the world’s under-five deaths.

A major reason is that 39% children are not fully vaccinated, which puts them at risk of infections such as pneumonia, tuberculosis, meningitis, diphtheria, tetanus and whooping cough, shows UNICEF’s Coverage Evaluation Survey 2009 data presented by Health Minister Ghulam Nabi Azad in Parliament in December 2012.

Vaccines are the most cost-effective way to prevent childhood infections, with innovations making it possible to combine several in one to make delivery more efficient and cost-effective.

Take the vaccines for diphtheria, tetanus, and pertussis (whooping cough), which were combined into a single vaccine way back in 1924. The price of all three doses is less than Rs.20.

It has reduced tetanus deaths by 88% and pertussis deaths by 70% in developing countries. Almost all deaths from the three diseases will stop if vaccine coverage improves to 95%.

Riding on the success of the polio campaign that ensured India had no polio in two years, the Centre has declared 2012-13 as the “year of intensified Routine Immunisation” with plans to plug gaps in delivery that include providing vaccines at a convenient time and place, and increasing monitoring and tracking of children who miss vaccinations.

How successful they are will show sooner than later, for losing children to disease is not a forgettable statistic.