//Death for lack of Rs 1.25

Death for lack of Rs 1.25

Lakhs of children die of diarrhoea every year in India, but the Union health ministry refuses to launch a national campaign to stop the killer epidemic

Vijay Sanghvi Delhi, Hard News Media , Dec 2006

Life has little value when death becomes cheaper. It could not be cheaper than the price of Rs. 1.25 only. That is the price of one packet of Oral Rehydration Salts (ORS) that can cure a child of acute diarrhoea. But lakhs of children do not get it and are condemned to die. Not one, not two, but more than six-and-a-half lakh children below the age of three die each year in India of diarrhoea.

According to reports from the World Health Organisation (WHO) and other agencies, two thirds of deaths occur within the first week of birth. Out of every thousand births in the country, about 35 babies die within one month, 30 before one year, and 26 between age one and five.

Another study on ‘sex in infant mortality’ by Dr R Khanna, A Kumar and JF Vaghela reveals that diarrhoea is responsible for 22 per cent of infant deaths. But twice as many girls die as boys, though there is no significant difference between male and female children in other cases of infant deaths. In 10 per cent of deaths, there is no preceding illness and no other satisfactory cause has been found. Three out of every four such deaths are of girls. The conclusion is that the excess number of unexplained deaths occur because girls are treated less favourably than boys. It is possible that some people have hit upon a dubious, no-cost method of getting rid of girl children since the government has banned prenatal sex tests.

The Union health ministry appears to be unaware of these estimates of infant deaths. There was no mention of this mass killer in the annual report tabled by the ministry in Parliament, though the report devoted considerable space to the spread of AIDS and government schemes to control the disease.

Lack of sanitation, improper disposal of human excreta, absence of safe drinking water and use of contaminated water are some of the chief reasons for the spread of diarrhoeal disease. According to one estimate, 2.6 billion people— 42 per cent of the world population—live in unhygienic conditions, without proper facilities of sanitation. Of these, 772 million live in India alone, which means, one fourth of the total number of people in our country live in unhealthy conditions.

Oral rehydration therapy is the best and cheapest cure for children and adults suffering from acute diarrhoea. Three packets of ORS are enough to rescue a patient from the jaws of death. The cure rate is more than 90 per cent and ORS packets are easily available, but they do not reach the intended beneficiaries.

Incidentally, ORS is an invention of India. The connection between diarrhoea and loss of fluids was first established in 1830 by a surgeon working for the British East India Company in Calcutta. The southern Ganges basin region (in Bangladesh, earlier in India) was afflicted with outbreaks of diarrhoea each year. However, serious interest in treating diarrhoea with oral rehydration did not pick up till the outbreak of cholera in the middle of the last century.

Treatment with ORT (Oral Rehydration Therapy) was propelled by Dr Dilip Mahalnobis, who was the health officer at the border of Bengal when the influx of refugees from East Pakistan began in March 1971. He had participated in experiments on ORS at Johns Hopkins International Centre for Medical Research and Training in Calcutta earlier. When he ran out of intravenous saline bottles in the first two weeks after the trickle of refugees began, he decided, in desperation, to use ORS. He blended salt and sugar in the proportions he had used during experiments, put the solution in plastic bags, and sealed them with hot iron to hand over to every family that came in from East Pakistan. Nine million refugees were housed in Dandakaranya refugee camps and not a single death from diarrhoea happened in those nine months.

It is ironic, then, that more than 35 years later in India, lakhs of children continue to die because of the low level of awareness about ORS treatment. The awareness level is a mere 30 per cent in rural areas and slightly more than 60 per cent in urban areas. Dr MK Bhan and Dr Shinjini Bhatnagar reveal in another study that the rate of prescription for ORS is not much higher among paediatricians; more than 50 per cent medics prescribe antimicrobial drugs for treatment of diarrhoea even though ORS solution has contributed substantially more to the reduction in mortality from diarrhoeal disease.

The Union health ministry has prepared campaign material for 14 diseases excluding diarrhoea, which has also not been given the status of a national campaign in the manner the polio campaign has been undertaken. Although the ministry releases advertisements to newspapers almost every alternate day with healthy pictures of the Union health minister, it has not released a single advertisement on diarrhoea and ORS in the last two years. The one television advertisement that it has released focuses on a wealthy home, not a poor family.

The ministry has stopped distribution of ORS sachets to states since this year, as health is now considered a state subject. Hence, it is the responsibility of states now to procure ORS packets for distribution. But there is no mechanism to monitor the annual expenditure sanctioned for diarrhoea in all the states (roughly Rs 55 crore) or find out if the ORS packets are actually distributed. Or else, do they continue to rot in storage rooms?

A hospital in Sonepat, in Haryana, gave an ORS sachet in May 2003 with an expired date (July 1, 2001) to Arpan Jain for his daughter who was suffering from diarrhoea. When he raised a din about it, he was given another packet, which, too,  had an expiry date of July 2001. This shows that even hospitals are not very careful when distributing ORS packets. Not many people raise hue and cry, as the disease affects mostly children of poor families.

Have the Union and state health ministries given some thought to distribution networks for ORS packets that may be different from their routine ritualism and rhetoric? After all, any number of branded mint packets are available at every paan shop across the remotest parts of the country (as are soft drinks). Since localities where the poor reside have larger numbers of paan and tea shops, these ‘networks’ can be used as an avenue for easy accessibility and distribution of ORS packets (and, indeed, even quinine to fight malaria or dengue, which, too, are mass killers and epidemics). Tobacco products manufacturers can also be approached to market ORS packets through their networks.  Surely, if soft drinks and mint and gutkas can reach the most distant interiors of India, why can’t ORS packets or cheap drugs like quinine or Disprin?

Unless out-of-the-box thinking goes into evolving strategies for fighting the scourge of diarrhoea, the same number of children will continue to die at a young age. But who cares? These are, after all, the children of the poor in the next global superpower that is India…