Do not forget children in evidence-informed healthcare

Dr Meenu Singh, co-chair
22nd Cochrane Colloquium
Shobha Shukla, CNS Columnist
Very often the plea for simple and effective healthcare for children gets drowned in the din of voices of vested interests (including those of pharmaceutical companies) that clamour to draw attention to long lasting adult diseases like cardiac, neurological, and diabetes problems, just to name a few. Producing/selling drugs for them is far more profitable than for childhood diseases like diarrohea and pneumonia, which have a short span, and so are nobody’s baby. It is high time we stood up for the cause of evidence based healthcare for children.

Dr Meenu Singh, a co-chair of the 22nd Cochrane Colloquium and Head of Pediatric Pulmonology, Asthma and Allergy Clinics, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, while speaking to Citizen News Service (CNS) stressed upon the need for an evidence-informed child health policy and practice. She said that, “We know a lot of things that do work for saving lives of children. Simple interventions, like vaccination, coupled with the WASH initiative (that promotes basic water sanitation and hygiene in the communities), can help bring down incidence of diarrhea and save lives. Another intervention is Rotavac--India's first indigenous preventive vaccine against rotavirus-- the major cause of diarrhea deaths among children. This vaccine, developed by Dr MK Bhan, costs less than $1, which is 1/40th of the cost of imported vaccines currently available in India. Rotavac vaccine will be soon available in the public health programme.”

It must be remembered that India accounts for 22% of the estimated global deaths from diarrhea caused by rotavirus which kills around 1,00,000 children every year in the country.

“So even in the vertical programmes if we have public health system strengthening, all interventions augment each other and work better like booster doses,” she said.

Dr Singh also advocated the concept of homebased care for children. A study done by Drs Abhay and Rani Bang in Gadchiroli district of Maharashtra has shown that Home-Based Newborn Care package, delivered at a low cost by trained female community health workers at the village level really works. This has received global recognition and changed newborn care policy in many developing countries.

Pneumonia is another common life threatening disease in children. Dr Singh agreed that, “There is a high possibility that a lot illness that is being labelled as pneumonia in children is not actually pneumonia. Pneumonia can be bacterial or viral and should not be treated symptomatically, as this can lead to misdiagnosis and mistreatment. We must have clinical as well as lab-based tools (like multiplex PCRs) that can differentiate between the two types. It is important to make correct antibiotic choices based on clinical indicators supplemented with lab data, rather than just being prescriptive.”

Not many studies have been done in India to look at the different serotypes in pneumonia. According to one study done by Dr Nishant Jaiswal, Senior Research Officer in ICMR Advanced Centre for Evidence Based Child Health at PGIMER, the currently used pneumococcal conjugate vaccine (PCV-13) is not only prohibitively expensive (one dose costing INR 4000), but also not good enough for the whole population as it covers only about 60% of the strains of pneumonia found in India.

If a vaccine prevents a certain group of serotypes only, the other serotypes tend to overwhelm. So, according to Dr Singh, “We need to focus more on basic research to develop our own local vaccines that focus on strains prevalent in India. We need to be more pragmatic in our approach and try to introduce therapeutic measures that are based upon evidence and are also cost effective by doing more research.”

Dr Singh cautioned against overuse of antibiotics in children: “Even some bacterial illnesses do not require antibiotics as the body self heals. Our body’s microbiome (collection of trillions of microbes in the human body, that play a role in many basic life processes) get altered due to irrational use of antibiotics.”

ICMR has established an Advanced Centre for Evidence Based Child Health, at PGIMER, Chandigarh, which is the first of its kind in India dealing in evidence based child healthcare. Among other things, it is enabling doctors to develop critical thinking, try to get evidence and practice only those strategies that are evidence based. Keeping in mind the need to involve policy makers in systematic reviews, this centre works in close collaboration with the government through linkages with the Ministry of Health.

Then again parents are very important stakeholders for evidence informed interventions in child healthcare. It is important for scientists and policy makers to remain informed on the feedback about the social aspect of evidence based care-- whether the interventions are population friendly or not—which is as important as the medical aspect.

Shobha Shukla, Citizen News Service (CNS)
27 September 2014
(The author is the Managing Editor of Citizen News Service - CNS. She is a J2J Fellow of National Press Foundation (NPF) USA and received her editing training in Singapore. She has earlier worked with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored and edited publications on gender justice, SRHR, childhood TB, childhood pneumonia, Hepatitis C Virus and HIV, and MDR-TB. Email: shobha@citizen-news.org, website: www.citizen-news.org) 

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