Friday, 30 December 2016

The Rising Incidence of Diarrhea in India

Diarrhea is the second leading cause of child mortality, worldwide. As estimated by Health Ministry, over 1.2 lakh children aged less than five years, succumb to diarrhea every year. The mortality rate is of 5 per 1000 live births in the country, as stated in an annual report released by International Vaccine Access Center.  

The primary factors which contribute to Diarrheal attacks among children are:
  •          contaminated water and food
  •          malnutrition
  •          inadequate sanitation and
  •          lack of immunization
The diarrheal disease further compromises the health of the child by hindering development, cognitive impairment and poor immune response.

According to a new research published in The Lancet, the number of cases of children dying from Diarrhea was twice as high as estimated previously. The attributable pathogens – Viruses, parasites, bacteria and other infections has been substantially underestimated. The research consisted of analysis of over 1000 samples from Bangladesh, India, Pakistan, the Gambia, Kenya, Mali and Mozambique. Its findings included that shigella and rotavirus were the most common infections among children below the age of 5. The other infections were followed by adenovirus, enterotoxin-producing E coli (ETEC), Cryptosporidium, and Campylobacter. The study concluded that while there is an oral vaccine that exists for rotavirus, a need was highlighted for shigella and ETEC vaccines which should to be prioritized. Diarrhea can also be managed through supportive care with rehydration and zinc supplementation. The use of antibiotics is not usually recommended unless there are signs of dysentery or if cholera is suspected.

Progress in immunization coverage is now being made in India with the introduction of rotavirus vaccine in Haryana, Andhra Pradesh, Himachal Pradesh and Odisha in 2016. There is a further expansion plan in March 2017 where the vaccine will be introduced in in the state of Rajasthan.17.25 lakh children will benefit from this introduction. Along with Rajasthan Tripura, Assam, Madhya Pradesh and Tamil Nadu in second phase. There are also simple proven interventions that can prevent death, including vaccines, antibiotics, exclusive breastfeeding, and access to treatment and care.

"It may not be possible to stop incidence of diarrhea by intervention but prevent deaths from it," says CK Mishra, additional secretary to the Health Ministry.

In India, only 54.4% children suffering from diarrhea receive ORS, whereas 30% of children are malnourished and are therefore, at an increased risk of getting the infection. We urgently need to find approaches to escalate the deployment of solutions to ensure that there is continued positive progress in reducing preventable child deaths.

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Thursday, 15 December 2016

Blog: Evolution of Universal Immunization Programme (UIP)

Vaccines have been a proven tool for controlling and eliminating life-threatening infectious diseases. Vaccines empower the body’s own immune system to protect the person against subsequent diseases. As per World Health Organization(WHO), vaccinations have averted 2-3 million deaths annually. Till date, number of initiatives have been undertaken around the world to improve the immunization coverage and protect children and adults against infectious diseases.

First Immunization Programme in India called the ‘Expanded Programme of Immunization (EPI)’ was launched in 1978 with an objective to increase the Immunization coverage up to 80 per cent in infants. The vaccines included in the programme were DPT, OPV, BCG and typhoid vaccines. Unfortunately, the programme couldn’t cover the targeted population as planned and was only able to cover a part of the urban population. At such a point in time, the country needed a significant programme for immunization which could reduce mortality and morbidity of various infectious diseases.

Later in 1985, the Government of India renamed Expanded Programme of Immunization (EPI) to Universal Immunization Programme (UIP). The main objective of Universal Immunization Programme was to reduce mortality and morbidity.

It aimed to enhance indigenous vaccine production capacity in India and establish cold chains. It focused on phased implementation of vaccines with a goal to cover all districts by 1990. Implementation of monitoring and evaluation system was also included in the programme. As time progressed, following were the key improvements introduced in the Universal Immunization Programme: 

With several improvements and successful implementations, Universal Immunization Programme is amongst the largest public health intervention measures undertaken in India. It is also amongst the largest Immunization programmes in the world in terms of- quantity of vaccine used, number of beneficiaries reached out to, number of immunization sessions organized and the geographical spread and diversity of areas covered. It has changed how cold chain system used to work, helped establish a network of outreach immunization sites, identified alternative delivery model for the vaccines and also enhanced capacity building of health functionaries and medical officers.

Keeping in the mind the progression of vaccines and their massive reach in the world, the Universal Immunization Programme(UIP) has remained focused and has prioritized number of initiatives both at the national as well as the state levels. The government of India along with multiple development partners have initiated various measures to escalate and improve the functioning and service delivery of various vaccination programmes in the country.
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