Saving our children

Among countries with comparable development indicators, India has the potential to address many of its challenges with unique homegrown resources. The information technology sector, for example, has transformed the country’s economy and is currently helping expand access to a wide range of quality services for some of the poorest in India. India’s space and atomic energy programmes are outstanding examples of indigenous technical ingenuity.

As economic growth continues to decelerate, the government, which has committed to doubling the country’s R&D spending by 2017, may consider deferring or delaying planned expansion of scientific capacity. It is critical that we do not forget the important role of indigenous scientific innovation, in particular, to improve livelihoods and promote wellbeing. To reiterate Jawaharlal Nehru’s words, “It is science alone that can solve the problems of hunger and poverty, of insanitation and illiteracy.”

Child health is one area where investments in innovation can result in tremendous social and economic returns. India nearly halved child mortality rates between 1990 and 2010. Improved healthcare services and access to simple health interventions, such as oral rehydration therapy to address severe cases of diarrhoea, have contributed to this encouraging reduction of child deaths.

However, in 2010, experts estimate that almost 17 lakh children less than five years of age died in India. This is still far too many children. Pneumonia and diarrhoea, together, account for a significant proportion of these deaths. There are even more hospitalisations and out patient visits from these two diseases.  Because of the tremendous emotional and financial toll that diarrhoea takes on Indian families, we need to take these threats to our children seriously.

Far too many parents in India have to deal with the pain of having lost a child from diarrhoea. It is even sadder considering that tools are available to treat diarrhoea and even more importantly, to protect children from some of the most common causes of diarrhoea. It is unacceptable that children die of a preventable and treatable illness. All families in India deserve equal access to health innovations that could help children and protect children.

Diarrhoea is caused by several different organisms and is most often spread through contaminated food or water and person-to-person contact. Certain types of diarrhoea are more serious than others. Acute watery diarrhoea is associated with rapid dehydration that can last for hours or even days. If fluids and electrolytes are not replenished, diarrhoea can be life threatening. Children who suffer from malnutrition are more vulnerable to the causes of diarrhoea. In an unfortunate twist, diarrhoea also in turn perpetuates malnutrition and leaves children prone to infections.

Large-scale investment

To address an issue such as diarrhoea, safe water and sanitation do matter, but require large-scale investment in infrastructure and in maintenance by the government. For individual and community level understanding and management of diarrhoea, you need to bring the lab to the field to understand what causes disease.Some of the first studies in India aimed to determine the cause of severe diarrhoea in India – the kind that causes life-threatening dehydration.

Researchers found that a viral pathogen called rotavirus was the most common cause. Rotavirus is of particular concern because it is so ubiquitous, leaving nearly all children – rich and poor – at risk. However, outcomes vary greatly depending on the family’s circumstances. For a child of high socioeconomic status with consistent access to care, the virus will likely cause only minor illness. For less fortunate children, it could be a death sentence if appropriate care is not provided or is provided late in illness.

To reduce the burden of diarrhoea in India, we must try to reach all children with a comprehensive package of proven interventions. This includes access to oral rehydration therapy, zinc supplementation, exclusive breastfeeding for the first six months of a child’s life, and improvements in hygiene, sanitation, and drinking water. However, because rotavirus is so contagious and resilient, these approaches alone will not adequately prevent diarrhoea. Vaccination against rotavirus offers significant hope for protecting children from this disease.

We know already that countries that have introduced rotavirus vaccines have experienced major reductions in severe diarrhoea. Several academic and research institutions in India, including mine, have  been involved in the development of indigenous rotavirus vaccines that could, if all goes well, reduce the number of illnesses and hospitalisations due to diarrhoea. If rotavirus vaccines were introduced at current immunisation levels, we could save tens of thousands of lives, and even more hospitalisations and outpatient visits. This could save India more than Rs100 crore in annual medical costs. The savings to families would also be significant. A survey at many hospitals in India found that the average cost of hospitalization for diarrhoea caused by rotavirus was nearly Rs 3,000, which is 7.6 per cent of the average family’s total household budget.

Having contributed significant funding, the government has been a terrific supporter of developing new rotavirus vaccines in India.To fully embrace the potential of science toward improved livelihoods and truly inclusive growth, we need to do more research and development that addresses the needs of India’s people, with a focus on the most vulnerable.

 As with the rotavirus vaccine development efforts, we have the resources and the capacity in India to address our most pressing health needs, if we use a strategic approach that prioritises problems and then makes a concerted effort to address them. However, development of a product such as a vaccine is not sufficient, we must also work together to develop and implement policies that ensure that everyone has access to the fruits of our scientific endeavors. 

(The writer is a professor in the department of gastrointestinal sciences at the Christian Medical College, Vellore)