Gen­der, in­come, ge­og­ra­phy bias re­main in health de­liv­ery

Hindustan Times ST (Mumbai) - - HTNATION - SANCHITA SHARMA


More chil­dren in In­dia are get­ting im­mu­nised against vac­cine-pre­ventable ill­nesses than ever be­fore, but progress re­mains mixed and a lot more needs to be done to pre­vent ill­nesses among poor and marginalised chil­dren in both ur­ban and ru­ral ar­eas, ac­cord­ing to a new re­port.

The Pneu­mo­nia and Diar­rhoea Progress Re­port 2018, which tracks ef­forts to be­ing down deaths from the two pre­ventable dis­eases that killed 1.36 mil­lion un­der-5 chil­dren – one in four un­der-5 child deaths glob­ally – said 70% of the global deaths con­tinue to oc­cur in 15 coun­tries, in­clud­ing In­dia.

With 26 mil­lion births every year, it was not sur­pris­ing that In­dia had the most pneu­mo­nia and diar­rhoea deaths with 260,990 chil­dren dy­ing in 2016, fol­lowed by Nige­ria and Pak­istan. What was wor­ry­ing was that In­dia tied with Pak­istan for the sev­enth place among 15 coun­tries in the In­te­grated Global Ac­tion Plan for the Preven­tion and Con­trol of Pneu­mo­nia and Diar­rhoea (GAPPD) score, which ranked coun­tries on de­liv­er­ing key life-sav­ing in­ter­ven­tions such as breast­feed­ing, vac­ci­na­tion, ac­cess to care, use of an­tibi­otics, ORS, and zinc sup­ple­men­ta­tion. Tanzania fol­lowed by Bangladesh topped the rank­ing.

De­spite In­dia show­ing im­prove­ment in child health, in­di­cated by fall­ing un­der-5 mor­tal­ity rate (U5-MR), from 43 in 2015 to 39 per 1,000 births in 2016, a deeper dive into data re­veals that ac­cess to vac­ci­na­tion and in­ter­ven­tions varies sub­stan­tially by ge­og­ra­phy, gen­der, mother’s ed­u­ca­tion and in­come. The gen­der gap in rou­tine im­mu­ni­sa­tion coverage re­mains across In­dia, which is re­flected in the U5-MR data. De­spite an im­pres­sive 9% an­nual drop in un­der-5 deaths, U5-MR is 37 for boys and 41 for girls, which in­di­cates more girls con­tinue to die of pre­ventable causes be­fore their fifth birth­day. Even in low-in­come ar­eas and ur­ban slums in Delhi, 78 girls were fully im­mu­nised for every 100 boys.

In­dia’s scores for exclusive breast­feed­ing de­clined, as did coverage of oral re­hy­dra­tion so­lu­tion used to treat di­ar­rhoeal dis­ease, which is given only to barely 20% sick chil­dren, found the re­port. Along with pro­mot­ing breast­feed­ing, in­creas­ing Hae­mophilus in­fluen­zae type b (Hib) vac­ci­na­tion, scal­ing up the ro­tavirus vac­cine that was first in­tro­duced in mid-2016 against diar­rhoea, and ex­pand­ing the pneu­mo­coc­cal con­ju­gate vac­cine (PCV) beyond six states can lead to fur­ther fall in child deaths. The re­port rec­om­mends the use of high-quality data to en­sure chil­dren are not missed and the coun­try meets the UN’S Sustainable De­vel­op­ment Goal tar­get of re­duc­ing U5-MR to less than 25 per 1,000 live births by 2030.

Recog­nis­ing that vac­cines are the most ef­fec­tive way to stop pre­ventable deaths from in­fec­tions and dis­ease, In­dia ex­panded its vac­cine arsenal un­der univer­sal im­mu­ni­sa­tion pro­gramme and vac­ci­nated at least 106.144 lakh chil­dren un­der In­ten­si­fied Mis­sion In­drad­hanush in 2017-18.

Apart from the seven vac­cines that gave the pro­gramme its name -- tu­ber­cu­lo­sis, po­liomyeli­tis, hep­ati­tis B, diph­the­ria, per­tus­sis, tetanus and measles – new vac­cines against measles rubella, ro­tavirus, Hib, PCV and po­lio have been added, along with Ja­pa­nese En­cephali­tis vac­cine for chil­dren un­der 15 in 112 en­demic districts.

The tar­get is to reach the un­vac­ci­nated and par­tially vac­ci­nated to reach at least 90% chil­dren by December 2018.

The ben­e­fits of vac­ci­na­tion go beyond the im­mu­nised child. Vac­ci­nat­ing a crit­i­cal mass of peo­ple in a com­mu­nity cre­ates a “herd im­mu­nity” that pro­tects even those who haven’t been vac­ci­nated. In cases where a vac­cine of­fers par­tial pro­tec­tion, such as flu vac­cines, peo­ple who have been vac­ci­nated have milder symp­toms, lower chances of hos­pi­tal­i­sa­tion and com­pli­ca­tions, less use of po­tent an­tibi­otics and anti-vi­rals, and lower risk of death.

Apart from the direct sav­ings on cost of treat­ment, the in­di­rect gains in­clude stay­ing healthy, not miss­ing school, in­creased pro­duc­tiv­ity, bet­ter ed­u­ca­tional at­tain­ment and im­proved job po­ten­tial, all of which lead to an im­proved quality of life.

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