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Indian Journal of Community Medicine

Letter to Editor: Changing Scenario of Child Health due to Pulse Polio Immunisation Campaigns

Author(s): Prof. Umesh Kapil

Vol. 30, No. 3 (2005-07 - 2005-09)

I read the article entitled .A Retrospective Study of Diphtheria Cases, Rajkot, Gujrat.. pulished in October-December Issue of IJCM. The article was very informative and useful. The authors have documented decreasing trend in number of admissions of Diphtheria patients during 1985 (77) to 1995 (02) in a District Hospital, Rajkot, Gujarat State (1).

In India, the pulse polio immunization of eradication of polio disease was started in 1995. Under the PPI, 4-6 rounds of polio immunization round are being undertaken in each state. Concerns have been raised in past that emphasis on PPI rounds is leading to low emphasis on routine immunizations and other components of Child Health Services which are delivered by the peripheral health workers (2). The Rajkot study has also substantiated the same concern. The Rajkot study documented that from 1996, a gradual increase in the number of cases of Diphtheria admitted to the district hospitals from 05 in 1996 to 43 in 2002.

The re-emergence of diphtheria has also been earlier reported from a tertiary care hospital in Delhi (3,4). The hard data on incidence of diphtheria, measles, neonatal tetanus is not available from large scale systematic research studies but the single centre research studies like conducted in Rajkot do substantiate that the diseases which had become rare or gradually are re-emerging in the country (1).

The national scenario of decline in infant mortality rate (IMR) also reflect that the PPI rounds have adversely affected the child health services. Prior to 1995 there was a reduction of infant mortality rate by 3.3% per year. However, after 1995 the decline in IMR was only 1.8% per year (5). IMR is an important health indicator which reflects the health care services provided to the population.

For the past several years, the focus on the polio programme has been so intense that all other programmes have come to a virtual standstill. In several states, even schools are closed as government teachers are asked to assist with pulse polio. As a result, in states with already poor development indicators, total immunization coverage for all other diseases is at an all time low. For example, immunizaitoin coverage in Bihar is only 13%, followed by Rajasthan with 19.7% and UP at 26.7% (6). The performance of these states reflects in the soft data collected by the Central Bureau of Health Intelligence. Measles showed a rapid decline for several years. Over 1.6 lakh cases in 1980 declined rapidly by the '90s, despite the increase in population. In 1995, 31,397 measles cases were reported. However, in 2001, the number of cases reported by Central Bureau of Health Intelligence, Government of India, New Delhi, showed a clear increase of nearly 20,000 over 1995. Similarly, diphtheria cases, which were declining sharply, now show an upward trend (7). We have to continue with PPI rounds but a conscious efforts should be made to avoid monthly campaigns for other vertical interventions like Vitamin A supplementation to young children, tetanus toxoid to pregnant mothers etc. to cause minimum disruption in the routine child health care services delivered by peripheral health care functionaries.

References

  1. Patel UV, Patel BH, Bhavsar BS, Dabhi HM, Doshi SK. A Retrospective Study of Diphtheria Cases Rajkot, Gujarat. Indian Journal of Community Medicine Vol. 2004, 29, 4:161
  2. Gupta AP. Polio Eradication in India. Indian Pediatrics 2003; 40:1099-1100.
  3. Singhal T, Lodha R, Kapil A, Jain Y, Kabra SK. Diphtheria- down but not out. Indian Pediatr. 2000; 37:728-38.
  4. Lodha R, Dash NR, Kapil A, Kabra SK. Diphtheria in urban slums in north India. Lancet. 2000:15;355:204.
  5. Diphtheria, measles on a killing spree. The Times of India, New Delhi, November 8, 204; pp 12.
  6. Srivastava RN, Polio Eradication : Future Strategies, Indian Pediatrics 2003; 40: 1101-1102.
  7. Ministry of Health and Family Welfare, Health Information of India (2001); Central Bureau of Health Intelligence, Government of India Press, New Delhi pp 22-76.

Prof. Umesh Kapil
Department of Human Nutrition,
All India Institute of Medical Sciences
Ansari Nagar, New Delhi-110 029
e-mail: [email protected]

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