Citizen News Service (CNS)

"Choose life, not tobacco": appeals Shobha Shukla to VIT students

2012-01-19T10:31:00.002+05:30

Since majority of tobacco addiction takes root in young age, children and youth need to be informed of tobacco-related diseases, disabilities and deaths to make a wise choice and say NO to tobacco, said Shobha Shukla, Managing Editor, CNS, who was speaking at Vellore Institute of Technology (VIT) in Tamil Nadu on 18th January 2012. Shobha Shukla is a former senior faculty at Loreto Convent College and a noted social activist with Indian Society Against Smoking, Asha Parivar and National Alliance of People's Movements (NAPM).

"Tobacco use is one of the main risk factors for a number of chronic diseases, including cancer, lung diseases, and cardiovascular diseases Tobacco use is one of the biggest PREVENTABLE public health threats India has ever faced" said Shobha Shukla, who has co-authored a three language book series on "Voices from the field on Childhood Pneumonia" (Hindi, Urdu and English, 2011).

"It kills more than ten lakh people in India every year. Up to half of current users will eventually die of a tobacco-related disease. Tobacco users who die prematurely deprive their families of income, raise the cost of health care and hinder economic development" said Shobha Shukla.

She added: "Tobacco is the major cause of oral cancer. Stopping all kind of tobacco consumption will certainly reduce the risk of cancer but reducing the consumption of tobacco does not reduce your risk of cancer. So stop using tobacco to prevent cancer. Those who have pre-cancerous lesions, should stop using tobacco and get checked by a dentist, to reduce the chance of getting oral cancer."

"Tobacco users need help to quit. Studies show that few people understand the specific health risks of tobacco use. For example, a 2009 survey revealed that only 37% of smokers knew that smoking causes coronary heart disease and only 17% knew that it causes stroke. Among smokers who are aware of the dangers of tobacco, most want to quit. Counselling and medication can more than double the chance that a smoker who tries to quit will succeed" said Shukla.

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Finance minister's pre-budget consultation: Civil society inputs into budget making and governance

2012-01-19T09:41:00.001+05:30

[हिंदी] Pranab Mukherjee, Finance Minister of India, convened a pre-budget consultation with a diverse group of people on 17th January 2012 in New Delhi. One of the representatives from social sector was Dr Sandeep Pandey, Magsaysay Awardee and noted social activist, who made the following suggestions on budget making and governance.

Agriculture should be given highest priority with preferably a separate budget. The difference between crop and non-crop agricultural loan should be abolished. The loan should be interest free. In no case the interest should be more than 4% and it should be simple interest. Compound interest should not be applied in the case of farmers. The approval of wife should be necessary if a man is applying for loan. In fact wife should be treated as head of the family, as is being proposed in the Food Security Act, for all schemes where family is the beneficiary. Minimum support price should be replaced by profitable price which should be more than the investment by the farmer. The prices of fertilisers, seeds and diesel should be under control or subsidised. Farmers should be encouraged to shift to organic farming so that their dependence on market reduces. Adequate storage capacity in the form of godowns, preferably in every Gram Sabha, should be created so that food garins are not wasted and the farmer can sell it when she feels appropriate. Agriculture based cottage industry should be encouraged to strengthen rural economy.

NREGS wages should be increased to Rs. 250 per day with scope for increase with every price rise and every hike in salaries of government employees. All agricultural wages should be paid through NREGS. The guarantee of wages should be to individuals and not to the entire family and should extend to all round the year.

BPL norm of expenditure of Rs. 32 and Rs. 26, for urban and rural areas, respectively, should be withdrawn. The BPL lists should be prepared by the Gram Sabhas or the poor should self select themselves to avail of the benefits from various governmental welfare and development schemes.

Community kitchens, on the line of 'langars' in Gurudwaras, should be encouraged especially from religious and public places to take care of problem of malnutrition as a supplement to the government's Food Security Act.

Vulgar display of wealth at marriage, social and political functions should be curtailed in the same manner as expenditure on elections has been checked by strict rules.

80% of electricity and all other resources should be meant for the rural areas.

There should be a ban on liquor.

Schools and Health Care centres must have adequate number and variety of teachers and doctors, respectively. It is ironical that on one hand we have a huge unemployment problem and on the other shortage of teachers, doctors and other employees like the Village Development Officers, BDOs, etc., so crucial for development.

The income gap between the lowest and highest paid members of society should not be more than 1:10. There should be a ceiling on expenditure. Instead of poverty line, prosperity line should be determined and only the rich should be taxed.

To check corruption cases of assests disproportionate to known sources of income should be investigated on a routine basis and stringent action taken if found guilty. All undervalued property should be acquired by the government and Urabn Land Ceiling Act should be re-enacted so that black money cannot be invested in land and property. Proposed ceiling is one 300-500 sq. metres plot or one 3500-4000 sq. feet flat per family. Currency notes of higher denomination should be withdrawn from the economy to curb black money.

Corruption is not just in terms of money transactions. A discrepancy in decision making should also be brought under the definition of corruption. For example, police files a fake case against an innocent person. He is arrested. The police constructs evidence in support of its charges and files a chargesheet. The matter drags on in court and after a prolonged hearing the person is acquitted. But by this time he has already spent a significant part of his lifetime in jail. The people responsible for putting innocent person in jail on the basis of cooked up evidence must also be tried under anti-corruption law. Similarly, filing inaccurate reports, delaying decision making, hiding information to prevent appropriate timely action must also be considered part of corruption.

The notion of VIP or worse VVIP must be done away with. It is an idea antithetical to democracy. If equality is guaranteed under Constitution how could some people be more important. Politicians and bureaucrats must learn to live and work like ordinary citizens. It is abominable that ordinarily in Secretariats, Vidhan Sabha's or the Parliament one cannot meet these so called VIPs in their offices until they instruct the gatekeepers to issue a ‘pass’ to the visitor. This implies that any ordinary citizen not acquianted with these ruling elites directly or indirectly can never hope to meet them in their office. Meeting the bureaucrats at their residence is simply unimaginable. The people’s representatives and public servants have created unreachable echelon for themselves. Can this be allowed in a democracy? They enjoy all privileges at the cost of public exchequer but are not willing to meet the people. Most of the privileges should be withdrawn from them. They should either get a high salary and manage everything, including housing, transporation, etc., on their own or if they want to keep the privileges then they should accept a reduced salary. They expect a family working under MGNREGS to survive on roughly Rs. 33 a day (income in stipulated 100 days spread over entire year) or a beneficiary family under any of the pension schemes on Rs. 400 per month but do not want to cap their salaries and perks. In any case the red/blue becon light from the vehicles must be removed except for ambulances. All security and most Class IV employees in personal service of higher level officers should be removed. The idea of a human being guarding another adult human being or providing personal service is feudal and anti-democractic.

The MP and MLA Local Area Development (LAD) funds should be scrapped.

Different classes in railways, airlines, etc. must be abolished. General class in railways in which people have to travel like animals should be abolished. Seats should be filled up on first come first serve basis rather than paying capacity. There should be an emergency quota for medical cases or candidates appearing for some examination/interview, etc. Different standards of schools and hospitals must be abolished. Inspite of a Right to Education Act in place the ideas of common school system and neighbourhood school have not been implemented. The doctors must be asked to prescribe generic medicines rather than brand names and medical shops like Fair Price Shops should be within the reach of people so that medicines may be accessible, both in physical sense as well as monetary. Same quality of service must be available to all citizens. The idea that you can avail better service by paying more money is anti-democractic. In fact, this is legalizing corruption. After all, corruption is trying to seek special treatment by paying money.

The requirement of getting a document attested by gazatted officer could be easily done away with. This will mean tremendous saving of time and energy. Attestation was required when photocopies were not available. A hand written copy of a document had to be checked for veracity. But in the case of a photocopy self-attestation should do just like now to seek admission in a primary school the date of birth certified by parents is accepted.

Construction workers move out from the construction site once a building is complete. They then look out for fresh work. A construction worker who has worked at a site to complete a building must get the option of permanent accommodation at that site as a mark of respect for her contribution to that building. Similarly, other artisans and workers must be respectfully compensated for their labour. Domestic help should also have a stake in the house(s) in which they are employed. Similarly, landless agricultural labourer must have a permanent stake in the field in which she cultivates. Social security schemes must be designed for all rather than only the government employees or service sector employees. Every citizen must be entitled for a pension so that they can spend their old age respectably.

The Foreign Direct Investment (FDI) in retail sector should not be allowed.

No government conferences or meetings should be held in hotels when the government has such a huge infrastructure. There should be an attempt to check misuse of public money in government functions. The tradition of display of weaponry on Republic Day parade or the agressive ceremony at Wagha border daily should be done away with. Instead they should be replaced by friendly celebrations.

Buildings with huge open spaces, like the modern airports, must be opened up for homeless as night shelters.

Multilevel working of employees/officers, e.g., junior clerk, senior clerk, office superintendent, level of many officers, seems not conducive for a responsive governance, as it takes a long time and that too without fixing responsibility explicitly for anyone.so every government servant should be allotted a work with full responsibility to get it completed in a stipulated time, of-course the task may be entrusted with one's ability. Similarly, upliftment of poors should not be left merely on launching a scheme, rather an officer must be made fully responsible and on completion of the task only that they must earn their salary. If the government employees want salaries comparable to private sector they should also be held accountable so far as their performance is concerned. The responsibility for poverty, hunger, malnutrition, farmer suicides, child and mother mortality, poor health services and low levels of literacy has to be ultimately fixed.

(Submitted by Dr Sandeep Pandey for pre-budget consultation with social sector of finance minister on 17th January, 2012.)

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Biggest threat to citizens lurks within our borders

2012-01-16T09:40:00.001+05:30

Newspapers in India today feature a news prominently where the Army Chief has said that nuclear weapons are not for war-fighting (because it will finish the world) but have a deterrent value. Also the news highlights that Pakistan has slightly more nuclear warheads than India - further fueling the ongoing arms race in the Indian sub-continent. Firstly, we believe that the nuclear weapons have zero deterrent value. If nuclear weapons had a deterrent value then nuclear powers would not have been attacked by countries that have no nuclear weapon, and nuclear powers would not have to lose a war. Secondly, where should India invest a significant portion of its budget - in strengthening military/ army or systems that help fight the 'enemies' that are real threat to its citizens on daily basis?

Which is the biggest killer of our citizens in India? And what is the biggest threat to us Indians? Is it the enemy across the border or is it the conditions in which our people live on day-to-day basis that puts them at risk of premature death? Should not this decide where the public money is invested in so that our citizens are healthy, safe and secure? Non-communicable diseases (NCDs) account for about two-third of deaths, and lead conditions include heart diseases, stroke, diabetes, cancer, among others.

According to a news published in The Times of India, 21% of India's population is undernourished, nearly 44% under-5 children are underweight and 7% of them are dying before they reach five years. India is firmly established among the world's most hunger-ridden countries (Source: International Food Policy Research Institute - IFPRI which combines the above three indicators to give us a Global Hunger Index (GHI) according to which India is 67th among the worst 80 countries in terms of malnourishment.)

In India, diarrhoea continues to be a significant cause of mortality. Childhood pneumonia is the biggest cause of death for under-five children. How can one justify when our people are dying of preventable, and even worse, curable, causes such as pneumonia, diarrhoea, tuberculosis, or hunger?

The above-mentioned news further adds: the proportion of hungry in the population has actually gone up. Today India has 213 million hungry and malnourished people by GHI estimates although the UN agency Food and Agriculture Organization (FAO) puts the figure at around 230 million. The National Family and Health Survey (NFHS), last carried out in 2004-05, had shown that 23% of married men, 52% of married women and a chilling 72% of infants were anemic - a sure sign that a shockingly large number of families were caught in a downward spiral of slow starvation (Source: TOI news).

Where is the biggest threat to majority of our citizens - across the borders or within our country? Should we invest huge amounts of money in weapons and military or should we strengthen our health systems?

Citizens have to seriously ponder of the utility (or futility) of investing significant amounts of limited public money India has in nuclear weapons and other arms and ammunition. Where should our money (public money) be invested? In bombs or in providing basic human amenities to every citizen? Should not governments provide social security to every citizen instead of so-called false sense of security that comes from nuclear weapons and other forms of weapons?

Time for citizens to think rationally and make a choice.

Bobby Ramakant - CNS

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Recommendations to conduct elections in a more democratic and fair manner

2012-01-13T09:46:00.001+05:30

[हिंदी] Some very clear suggestions were submitted yesterday to the Chief Election Commission of Uttar Pradesh state to conduct forthcoming Vidhan Sabha elections in February 2012 in a more democratic and fair manner. Dr Sandeep Pandey, Magsaysay Awardee and Vice President, Socialist Party and member, National Presidium, Lok Rajniti Manch, has submitted a list of five strategic recommendations to increase accountability and transparency in the electoral process.

We are reproducing the letter Dr Sandeep Pandey wrote to Mr Umesh Sinha, Chief Election Commissioner, Uttar Pradesh below:

To: Shri Umesh Sinha
Chief Election Commissioner
Uttar Pradesh
Dated: 12 January 2012

Subject: Some suggestions for conducting elections in a more democratic and fair manner

Dear Umesh ji,
In continuance with our discussion earlier today in your office I would like to submit to you the following suggestions:

(1) Kindly make the 'shadow register' as well as the expenses reported by the candidate public on a regular basis - so that people and voters can monitor if your 750 microobservers and other officials are documenting all expenses and report if any is missing, subject to due verification of course. This will increase transparency in the election process and also up the accountability of candidates and monitor how honestly they are reporting their own electoral expenses.

(2) The common expenses incurred by a Party, for example in hiring helicopters and chartered airplanes, should be divided equally among all candidates or at least among candidates of that party for whom this serivce is used. Otherwise, it'll not be a level playing field for candidates belonging to smaller parties and independent candidates.

(3) The expenses incurred in covering the statues of Ms. Mayawati and those of elephants should be borne by BSP. Even though these were built at government expense but because of the very fact that they are required to be covered as they are associated with a particular party, this party should bear the expenses. More so, as they were built only during the term of last government. The public is being burdedned twice, first for the construction of these statues and then to cover them.

(4) There should be ban on established parties to use their symbol for campaigning before the symbols are alloted to independent candidates. Essentially, all candidates should get the same period for campaigning with their symbols in order to ensure fairness of the contest.

(5) An officer of the Election Commission must sit outside the Secretariat building, where a 'pass' is required for entry, so that she is accessible to any ordinary voter or representatives of smaller parties and independent candidates who may not always succeed in convincing the staff of Commission to issue them a 'pass.'

Regards,

Sandeep Pandey
Lok Rajniti Manch and Socialist Party
A-893, Indira Nagar, Lucknow-226016: Phone: 0522 2347365, 9415022772 (Arundhati Dhuru)

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2012 Elections: Lok Rajniti Manch releases code of conduct

2012-01-10T10:13:00.001+05:30

[हिंदी] Lok Rajniti Manch had organized a political meeting on 7th January 2012 which was attended by members of Lok Rajniti Manch, Samajwadi Jan Parishad, Socialist Party, Loktantrik Samajwadi Party, Jan Sangharsh Morcha, Sajha Sanskriti Manch, Varanasi and some individuals. Prominent among those who attended were Dr. B.D. Sharma, Pannalal Surana, S.R. Darapuri, Dr Sandeep Pandey, Lal Bahadur Singh, Ajit Jha, J.P. Singh, Onkar Singh, Girish Pandey, Anup Gupta, Uma Shankar Mishra, R.K. Agarwal and K.K. Sharma. Code of conduct for candidates supported by the Lok Rajniti Manch in forthcoming elections was agreed upon.

CODE OF CONDUCT FOR ELECTIONS - issued by Lok Rajniti Manch -

1. The candidate should have a background of social activism. After winning or losing elections she or he should continue to work on issues related to common people just as before. This implies that election will be fought based upon the socially relevant work done by the candidate.

2. The candidate will spend as less money as possible in fighting the election. She or he will not be flamboyant or extravagant. Election will be fought by taking donations from the people. Complete transparency will be observed in accounts.

3. There will be no significant change in the lifestyle of the candidate if she or he wins the election. The candidate should remain easily accessible and be available for the people just like before.

4. Election canvassing will be done more through people to people contact instead of resorting to expensive ways of campaigning.

5. Only the vehicles used by the members of the social organization will be used for election campaigning.

6. Votes will not be sought by giving any incentive or any kind of threat.

7. The candidate will not keep any weapon for her or his protection and even after winning will not arrange weapons for her or his protection.

8. The candidate will not use any professional people or ways for election campaigning. For example, paying to get the news published in the newspaper is one such activity.

9. People should engage in election campaigning for a candidate with the feeling of support instead of getting paid for it.

10. The election will be contested on common people’s issues and not based on religion, caste or any such factor.

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Adieu Dr Govil!

2012-01-09T17:06:00.002+05:30

The hands, which healed, bringing back thousands of kids to life from near death, are no more. The voice that inspired hope in the hopeless is silenced. We lost Professor (Dr) Yogesh C Govil, Professor of Paediatrics, Chhatrapati Shahuji Maharaj Medical University, (erstwhile King George’s Medical College), Lucknow, to the cruel hands of fate. He, who was like God to many of his patients, was snatched away by God in a fatal car accident on Sunday, the 8^th of January, 2012. An excellent and sensitive doctor, who touched many lives with his humility and gentleness, Dr Govil will be fondly and tearfully remembered by his colleagues and numerous patients who virtually idolized him. We at CNS are proud of our long association with Dr Govil. Despite his very busy schedule, he always found time to enlighten us about various childhood diseases.

Reproduced below are some of his golden words, as told to CNS, on a range of topics related to paediatric health:--

On the importance of mother’s milk---"Bottle feeds and formula milk certainly cannot be a replacement for breast milk, because no human endeavour can put those factors which the Almighty has done. They may be sufficient in terms of nutritive value to some extent, but there are many other benefits of mother’s milk which the formula food cannot meet. Maternal and infant bonding cannot be provided by these foods. A lot of research has ultimately proved that breast milk is the best milk. A child should be exclusively breastfed during the first 6 months, and then weaned away gradually by starting complementary food like cereals, mashed papaya, banana etc. As the child grows, all types of household diets must be added with some butter and ghee also, so that dense calories can be provided."

On good nutrition--- “One cannot define nutrition in variant degrees-- if it is not good it will certainly be bad. Bad nutrition is such that either it leads the child to become overweight or underweight. Bad nutrition is one extreme for affluent families, where kids are fond of junk food, which overfill them with calories; and at the other extreme are families with poor socio-economic status who are forced to dilute milk and other food, which deprives them of the nutrient values."

On public awareness of childhood diseases---“The biggest intervention that can be done is education. No measure is better than awareness, and for that people need to be educated about the havoc which tobacco and fuel smoke can wreak on innocent infants and children, exposing them to several diseases, like pneumonia, and related complications (which may even be fatal) for no fault of theirs.”

On the misuse of antibiotics---“Development of antibiotic resistance among common pathogens is a global concern. Unfortunately, nowadays a lot of antibiotic misuse is happening in our country and the reason is that many a times patients are been treated by unqualified practitioners of medicine, especially in rural areas. I think more than 20%-30% of patients initially go to unqualified practitioners, who are in the habit of advising lots of broad spectrum antibiotics in the beginning. Even in viral infections, where antibiotics are not usually indicated, antibiotics are prescribed. This is prevalent in the urban setup as well. Very often patients try to self medicate also, as antibiotics are easily available over the counter. This develops a resistance against normal (narrow spectrum) antibiotics, thus making them ineffective. Before the first wonder drug penicillin was discovered in the 1930s, men used to die like flies, and if this trend (overuse of antibiotics) continues that era would return.”

We at CNS join thousands others in paying homage to this departed soul. May we continue his legacy of dedication and selfless service to one and all, irrespective of social status, caste and creed.

Shobha Shukla - CNS

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[CNS Video] Paths that were never trodden...

2012-01-04T13:59:00.000+05:30

[CNS Video] Voices of the voiceless...

2012-01-04T13:54:00.000+05:30

What’s Cooking In The Kitchen: Peace or Conflict?

2011-12-31T19:15:00.004+05:30

I recently read about an innovative takeout restaurant in Pittsburgh, called Conflict Kitchen, which only serves cuisine from countries that the United States of America is in conflict with. This landmark eatery was begun by three Pittsburgh artists - Jon Rubin, Jon Pena and Dawn Weleski - who aptly call it a "public artwork experiment", with the objective "to see how we can get past the conflict that is going on between governments and introduce people to the everyday life and culture of these countries." Till now, it has featured dishes from Iran, Afghanistan and Venezuela, and future iterations hope to focus on North Korea, Cuba and other countries. This unique synthesis of food, art and sociology, is indeed a novel attempt in forging friendships between people of the so called enemy territories, by creating a platform for discussions of international conflict, culture, and politics over a meal.

Unfortunately in India, we see more of a kitchen conflict fuelling family discords. Instead of acting as a unifying factor, food in India whets the appetite for skirmishes amongst the deadly trio of mother-son-daughter in law, as well as between communities. Many a battles have been lost and won (depending on which side of the family you represent) on the hot beds of the kitchen turf. I have yet to come across a married Indian woman, who, at one time or the other, has not been the recipient of this clichéd statement: ‘You cannot cook like my mother’. There is nary an Indian woman who could come anywhere near to the culinary expertise of her ma- in- law. And yet an Indian man comes of age (for marriage) when he starts working in a place away from his parents, and yearns for home cooked food. It is a better bargain for him to look for a bride rather than hire a cook.

Thus steps the new woman in his life to make her way to his heart through his stomach. But, India is a land of colourful culinary diversity. Each community and caste, nay family, boasts of its own unique recipes and cooking style which, in their eyes, is the world’s gold standard benchmark. So, one family’s food becomes another family’s poison. Woe betide the newly wedded daughter-in-law who cannot cook the lowly potato or the bottle gourd in the manner in which her newly acquired relatives are used to!

'To put or not to put' becomes the biggest dilemma of her life, be it onions, tomatoes, green chillies, spices—the list is endless. So differently developed are our taste buds and culinary preferences that no two families cook any one vegetable the same way. An interstate or inter religion marriage further stokes the fires of derision and rebuke. Now, one may have a fish eating bride left to rummage in the kitchen sink of a plant eating household which cannot even tolerate the smell of onions/garlic; or a coy vegetarian newlywed battling her tears from the aroma of a freshly made omelette. This kitchen conflict also finds space in most of our soap operas on the idiot box, which revel in depicting designer kitchens of filthy rich families where daughters-in-law, dressed in all their fineries, spend their days stoking the kitchen fires, and chopping, cutting, and brewing intrigues against each other.

All this may seem ridiculous, even inane, to the Pittsburghers who are making a valiant attempt to reduce international conflict, through their novel experiment for a synthesis of food, art and sociology. We need to learn a lot from the concept of Conflict Kitchen where recipes from enemy countries are being used to replace the feelings of hatred with those of tolerant understanding. The Iranian kubideh (minced meat kabab served in freshly baked barbari bread with onion, mint, and basil), Afghani Bolani Pazi (homemade afghan turnover filled with pumpkin, spinach, lentils, or potatoes and leeks), and Venezuelan Arepas (homemade grilled corn cakes served with a variety of fresh fillings), are some of the past takeouts from this kitchen which have been well received in their custom designed wrappers, that include interviews with Iranians, Afghans, and Venezuelans on subjects ranging from the food and culture of their respective countries to the current geopolitical turmoil.

India makes a good study in contrast, where there are still many households who would not partake of a meal touched or cooked by members of certain communities and religions. To be a meat eater or a vegetarian maybe a personal choice, but to ridicule/despise food on the basis of who cooks it and in what style, only shows ones intolerance and prejudice. Eating is a divine fine art wherein each morsel of food should be savoured and thanked for, and not a bit of it wasted. It should not be of much consequence if the colour of the gravy is a little too red/white/yellow; if each grain of rice clings or separates from the other; if the spinach leaves have been finely or coarsely chopped; if the cooking style is different from ours. Family recipes may be no less than heirlooms for us. But we have no right to denigrate those of others.

Food should not upset our appetite for tolerance and love, but break the mental barriers that alienate us from other diverse cultures and communities. Before crossing international borders we need to break our regional/community/caste food prejudices in order to enjoy with equal relish the innumerable varieties of delectable cuisines, irrespective of the social, religious and economic status of the kitchen in which they are cooked.

This coming New Year let our food preferences not create obstacles, but get past human conflict and remove cultural ignorance. Let us resolve not to chop relationships, brew intolerance, simmer hatred, or bake corruption. Instead enjoy the Kashmiri kahwa (spiced green tea), the Bengali mishti doi (sweet curd), the Lakhnawi kebab and roomali roti (handkerchief thin bread), and the South Indian dosa, along with myriad other cuisines, with equal relish. A teaspoon of love, a pinch of sincerity, and a dash of sensitivity will make all food a delightful eating experience, in which we share across the table our passions, hopes and fears, irrespective of caste, creed, religion and nationality.

Wishing all of us a very peaceful, tolerant, honest and healthy 2012!

Shobha Shukla - CNS

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If it is not A or B it must be C: A Stealthy Killer on the Prowl

2011-12-29T11:49:00.003+05:30

Till the early 70s, nothing much was known about hepatitis C and it was called NANB (not A not B). Its genome could be cloned only in 1989. The Hepatitis C virus (HCV) has 6 different variants - genotypes 1, 2, 3, 4, 5, and 6. Within each genotype are further divisions called subtypes and mutations of the hepatitis C virus called quasi species. This variability of the virus has made it difficult to treat it and to develop a vaccine that will protect against all strains of HCV.

The World Health Organization lists HCV as a major cause of acute hepatitis and chronic liver disease. Globally, 3 to 4 million persons are newly infected each year. Various blood bank studies indicate that an estimated 1% of the Indian population is affected with this virus. So in a 1,210 million population about 12 million would be infected with Hep C Virus (genotype 3 and 1), which is a huge number.

HCV is mostly transmitted by infected body fluids that get into the body through infected needles/syringes, unsafe blood transfusion, sexual contact, and mother to child transmission (5% risk). According to Professor (Dr) Gourdas Choudhuri, Head of the Gastroenterelogy Department of Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, “In India, hospitals too are a source of infection. Although most modern hospitals now use disposable syringes/needles, reusable accessories are used for some invasive procedures, (like cardiac angiography, or some procedures involving gastrointestinal tract), in order to reduce costs, and this poses a bit of risk for Hep C. So sterilisation process for these accessories should be done meticulously and monitored closely. Also, despite good testing, the blood used in transfusion may contain the HCV. There is something called the window period, and there are instances where despite a very good test performed on the blood we come across post transfusion Hep C. The recent vogue of tattooing is another proven risk factor for HCV.”

Hepatitis C is indeed a difficult disease by way of diagnosis and treatment. The virus can remain in the body without manifesting itself for a long period. In its early stages, there are virtually no symptoms, making timely diagnosis very difficult. By the time symptoms appear, the liver is already shrunken, cirrhosis has set in, and the person is beyond the stage of treatment. So it is important to test high risk individuals even if they do not have any symptoms. As both HCV and HIV get into the body through the same routes of transmission, they are very likely to co infect the same people. Hence people living with HIV are a high risk group, and so are the injecting drug users. People who have been transfused inadequately tested blood are also at risk.

In an exclusive interview given to CNS, Dr Franco Buonaguro, Director, Unit of Molecular Biology and Viral Oncology, Napoli, Italy, informed that, “The risk is completely different in men and women. In women the disease may not manifest at all, but in men it may become a major problem within 20 years. A young woman would probably live for over 40 years without any symptoms. My mother has HCV which she got through an infected syringe in the 60s, when we did not have disposable syringes in Europe. But, as she is a woman, does not drink, and does not have other cofactors, her RNA levels do not move up. But for a young man with alcohol addiction, it is less than 10 years.”

He further said that, “Hep C can be treated with a combination of pegylated interferon and ribavirin. The treatment response is 46% in patients with Genotype 1 and 76% in patients with genotypes 2 and 3. But in case of people living with HIV and co-infected with HCV, the response reduces drastically to 20% for genotype 1 and 62 % for type 2 and 3.”

In a country like India, the high cost of diagnosis and treatment of HCV poses a big challenge. For people who do not clear the virus spontaneously from their body and develop chronic forms of the disease, treatment is currently unavailable in the public healthcare system and unaffordable in the private sector.

According to Prof (Dr) Choudhuri, “The first diagnostic test, called anti HCV, costs Rs 500. So, at times doctors are reluctant to ask for the test in the beginning, even in people who might be at high risk. If this test is positive then one has to undergo two more tests—HCV RNA and HCV genotyping, which together cost around Rs 12000. Thereafter if the person is a candidate for therapy, it is usually a 6 to 12 months long treatment costing around Rs 2.5 lakhs. Besides, the treatment is too long and fraught with many adverse effects—fever, haemoglobin drop, anaemia, WBC count fall, depression—not a pleasant experience.”

So what is the way out? Dr Choudhuri feels that, ‘We need to create a lot of awareness about the disease as most people are unaware of it. High risk individuals must go for diagnosis much before symptoms appear. Secondly there should be good hospital practices, more stringent testing for HCV in blood banks, use of disposable syringes/needles which are not reused, and very good management/control of intravenous drug use.”

“In fact, there is some good news on the cost front. Till now only two companies (Roche and Schering-Plough) in the world were making pegylated interferon which was quite expensive. Now two Indian companies (Ranbaxy and Cadilla) have launched it in India, bringing down the treatment cost for genotype 3 to about Rs 1 lakh which is a little more affordable. Manufacture of low cost generic medicines can also help. But the only issue is that while generics are well established for chemical compounds, where efficacy can be tested, HCV drugs have to be tested in terms of bio efficacy too, and not just by way of chemical structures. So there will need to be a little more reassurance from companies launching generic interferons about their effectiveness.”

Of late the demand for providing free treatment for HCV in India is gaining ground, especially by people living with HIV (PLHIV) who are co infected with HCV. Although HCV treatment is free in many developed countries, Dr Buonaguro strongly believes that, “It depends upon society and economy of the country if HCV treatment is to be part of government health program. The priorities may be different if there are other diseases killing people in a very short time—cholera, malaria, etc. I would suggest that, as genotypes 2 and 3 are very responsive to treatment, government can help in their treatment. But if the patient has to pay, I would advise the patient to opt for treatment if it is genotype 2 or 3, as there is high chance of success. But if it is number one, one must seriously think if it is really worthwhile to begin treatment.”

Shobha Shukla - CNS

(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" published in November 2011 and a report on Hepatitis C and HIV treatment access issues in December 2011. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

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People should court arrest in support of Anna's movement: Dr Sandeep Pandey

2011-12-26T11:26:00.001+05:30

Photo credit: Jittima J - CNS

[हिंदी] Growing number of citizens are organizing themselves to support Anna Hazare, when he begins his fast tomorrow in Mumbai to strengthen his campaign against corruption. "We appeal to the citizens that when Anna Hazare sits on the fast in Mumbai then they should also organize a demonstration or a public fast in their local area and then court arrest at the district headquarters or nearest police station" said Dr Sandeep Pandey, Magsaysay Awardee and noted social activist with National Alliance of People's Movements (NAPM), Asha Parivar and Lok Rajniti Manch.

"I will be sitting on a fast at Asha Ashram, Village Lalpur, Post (and Police Station) Atrauli, (Hardoi district) during 27-29 December 2011, and then cort arrest on 30th December at Atrauli Police Station with other supporters" said Dr Pandey.

Regarding the forthcoming Vidhan Sabha elections, Dr Sandeep Pandey appealed to the citizens that they should not vote for any corrupt political party or its candidates and consider voting for an honest candidate, even if that candidate is standing in elections as an independent or has bleak chance of winning the elections. Those who vote for corrupt political party or candidate will be contributing to fuelling corruption, said Dr Pandey.

CNS

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ASICON video: Getting to Zero: Long road ahead for India's AIDS response [Part II]

2011-12-23T18:04:00.002+05:30

ASICON video: Getting to Zero: Long road ahead for India's AIDS response [Part I]

2011-12-23T18:02:00.001+05:30

Woman Empowerment Is Crucial In The War Against HIV/AIDS

2011-12-23T10:59:00.004+05:30

It is being increasingly felt that women should be the focal point of all programmes targeted at achieving the goal of ‘getting to zero new infections, zero new deaths and zero discrimination in HIV/AIDS.’ Whether they are monogamous housewives, or sex workers or the partners of injecting drug users, they continue to remain the most at risk population. So their needs have to be addressed, and their capabilities harnessed, to prevent the spread of the disease. They will have to be considered as an integral part of the solution to the problem which is besetting not only millions of them but others too. India needs to focus more on women and prioritize their interests as human beings, in order to reach the Millennium Development Goal of ‘getting to zero’.

In 2009, we had 2.39 million people living with HIV in India, of which 39% were females and 4.4% were children. In the opinion of Dr Hoosen Coovadia, Scientific Director of Doris Duke Research Institute Durban, unless women are liberated from poverty, malnutrition, gender inequality and male dominance, it would be difficult to reduce HIV transmissions in India and elsewhere. According to him it is not enough to boast about the number of women parliamentarians, women CEOs and women scientists a country has. Unless the common woman at the grass roots level has freedom from oppression/discrimination in her home, her community and her work place, we will not be able to have the freedom from the epidemic of HIV.

Dr I S Gilada, Secretary of AIDS Society of India, also agrees that even the so called low risk population of women is very vulnerable to the disease in a country like India, where women do not have a control over their own sexuality and reproductive health and are unequal partners in conjugal relationships. The unsuspecting housewife can get infected by her husband, as she is not in a position to insist upon the use of male controlled prevention methods, like the condom, for safe sex. Once she gets infected, there are high chances that the virus is transmitted to her child (in utero, during delivery, or during breastfeeding). Parent to child transmissions account for 5.4% HIV infections in India, and in 2009, 18,000 children were infected with HIV through this vertical route. Although there are strategies and drugs to prevent parent to child transmissions (PPTCT), but in resource poor settings like India, PPTCT services are often unavailable or inaccessible to most women. In our country, 75% women are not covered for PPTCT, and 43% of those who are eligible do not receive Anti Retroviral Treatment.

The problems get compounded if the woman happens to be a sex worker. Dr Gilada, who is also the Secretary of People’s Health Organisation of India, the first NGO in India that started AIDS awareness and intervention programme amongst Mumbai sex workers, has worked relentlessly for several years to mitigate the problems of this neglected and despised section of society. According to him, “When I started working with sex workers in Mumbai, people said it was an impossible task as most of them were illiterate. But I believed that although they had not gone to school, they were human beings with brains. We convinced them that the use of condoms was in the interest of their own well being, and not in the interest of their clients. Initially there was resistance, but their unified stand on ‘no condoms no sex’ eventually increased the rate of condom usage to 95% in the areas where we were working.”

Dr RR Gangakhedkar, Deputy Director of National AIDS Research Institute (NARI), insists upon the need to reach individual sex workers, and have community led interventions which will have minimum number of gatekeepers, so that sex workers themselves manage to reach the invisible ones in their community. He finds it worrisome that the typology of sex workers is changing; as they are moving from brothels to venue based sex work, and are even becoming mobile, thus making outreach still more difficult. This mobility would also result in the spread of HIV to small towns. In Maharashtra alone, two thirds of the sex workers had at least one large move during last 12 months.

Dr Jana, who has worked in the field of HIV/AIDS for over 30 years, feels that, “We cannot treat a sex worker simply as a focussed target of HIV. She is also a human being like any of us—whether it is for accessing credit, or getting her child educated, or protecting herself from structural and domestic violence. Unless the program encompasses all categories of people irrespective of their social and economic status and occupation, we will not be able to reach zero. If a change in social attitudes and practices can happen in our society it would be good for all of us.”

Social, economic and political empowerment of women is crucial which alone will allow them to overcome the barriers in their personal life to insist upon safe sex practices, demand better prevention options and access the treatment facilities available. If a woman has to depend upon a man for condom use, then her chances of protection are reduced tremendously, spiralling more new infections. About 87 % of the HIV infections in India are due to unprotected sex. If we want to achieve zero new infections then HIV prevention strategies cannot remain male dominated. We need to develop and popularise more women controlled protection devices like the female condom, microbicides etc. which will go a long way in eliminating new HIV infections and deaths.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" published in November 2011 and a report on Hepatitis C and HIV treatment access issues in December 2011. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

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Geting to ZERO: Long Road Ahead for India's AIDS programme

2011-12-21T11:28:00.001+05:30

[हिंदी] [Photo] The CNS documentary film-maker and FM Radio Programme Producer from Chiang Mai, Thailand, Ms Jittima Jantanamalaka, interacted with Lucknow citizens after screening of her documentary film-series on non-communicable diseases (NCDs) and chronic health conditions in Lucknow. Jittima serves as the Managing Director of the JICL Media and Communication Services Company, which also hosts the Citizen News Service (CNS).

One of her documentary films screened in Lucknow was made in Lucknow in Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS) during ASICON 2011, titled “GETTING TO ZERO: LONG ROAD AHEAD FOR INDIA’S AIDS PROGRAMME” (28:30 minutes, English). It makes a poignant statement bringing forth ground realities of AIDS responses in India matched against aspirational targets of “getting to zero new HIV infections, new HIV deaths and HIV-related discrimination” by 2015 of the government and UN agencies.

Unless we address tuberculosis (TB) and HIV co-infection, people living with HIV (PLHIV) will continue to die with TB. TB is the biggest cause of mortality for PLHIV. If we stigmatize, discriminate against or criminalize HIV high risk groups such as injecting drug users, men who have sex with men (MSM) or sex workers, then we will continue to drive the populations that are at an elevated risk of HIV underground and make existing health services inaccessible for them. It is impossible to reach ZERO new HIV infections, ZERO new HIV deaths and ZERO discrimination unless health systems are strengthened enough that no one dies of preventable causes of deaths such as pneumonia, diarrhoea, TB, hepatitis B or C virus, malnutrition, among others.

One of the most shameful failures of National AIDS Control Organization (NACO) has been on preventing HIV transmission from parent to the child. When medicines exist to achieve ZERO new HIV infection in children born to either HIV sero-discordant parents or both PLHIV parents, then why are there more than 18,000 children (2009 data) getting infected with HIV during delivery or postnatal? This is totally unacceptable. Also India continues to provide single dose nevirapine which is an outdated and less effective way to prevent transmission of HIV from parent to child.

Earlier this year, in June 2011, Jittima Jantanamalaka’s film, “Protect public health and social justice in Thailand,” was screened in Sao Paulo, Brazil.

CNS

Will A Global Funding Slowdown Push Back Health Programmes?

2011-12-20T17:51:00.002+05:30

The global financial crisis has led to a slowdown in growth of funding to improve health in many developing countries. According to new research findings from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, “Stagnating funding from the United States and shortfalls at the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) indicate troubled future for development assistance for health, raising the possibility that developing countries will have an even harder time meeting the Millennium Development Goal deadline looming in 2015.”

Health funding through United Nations agencies stopped increasing in 2011, and the GFATM announced recently that it would make no new grants until 2014 due to funding shortfalls. Preliminary estimates indicate that health assistance channelled through the Global Fund declined by $529 million, or 16%, between 2010 and 2011.

Key findings from the report ‘Financing Global Health 2011: Continued Growth as MDG Deadline Approaches’, which was released recently by IHME, indicate that:

(i) The US has greatly slowed the pace of growth to 2% between 2010 and 2011, after a decade of rapid increases in development assistance.

(ii) Development assistance to non-governmental organizations increased by 8% from 2010 to 2011, after two years of drops in funding.

(iii) Growth in development assistance for HIV/AIDS, tuberculosis, and health sector support slowed between 2008 and 2009, whereas development assistance for malaria, non communicable diseases (NCDs), and maternal, newborn, and child health accelerated over the same period. However development assistance for NCDs was just 1% of total DAH in 2009, although NCDs represent 45% of the overall disease burden in developing regions.

(iv) Spending by country governments on health accelerated between 2008 and 2009, increasing from $368.46 billion to $410.50 billion, 16 times the total amount spent for development assistance for health (DAH).

(v) For every $1 of development assistance for health that governments receive, they redirect $0.56 on average from the health sector to other spending priorities.

(vi) Generally countries with the most significant disease burdens receive the most development assistance for health (with the exception of 12 high disease burden countries)

India received most of its aid (29%) in the form of loans and grants from development banks, primarily the World Bank, and was one of the top DAH recipients of Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). UK was India’s second largest funder of DAH from 2004 to 2009, representing 23% ($873.62 million) of total health assistance received by India. In 2011, the UK decided it would only commit to sending aid to India until 2015, and pressure is mounting on its government to totally cut off aid to India.

According to Dr Michael Hanlon from the Institute for Health Metrics and Evaluation, “Ultimately, whether health outcomes improve within a country will be determined by how that country sets priorities. Aggregating across the set of countries we track, domestic government spending on health increased from $192 billion in 1999 to $410 billion in 2009. The pace of that increase was very fast, equal to 11% annually between 2007 and 2009. However, development assistance for health continued to increase through 2011, at a much slower rate of 4%. So we are observing a global trend that more money is devoted to health, but the growth of those funds is slowing. For example, India has been receiving less aid in recent years. In 2011, development assistance for health to India dropped by nearly 10% from $771 million to $700 million. As a result of this global slowdown, in many countries policy makers will need to be more purposeful in setting priorities and allocating available resources than they have in the past.”

With funding shrinking globally, well planned and properly managed investments in health programmes in low/ middle income countries are a must. For example, the Avahan program, an India AIDS Initiative, which was funded by the Bill & Melinda Gates Foundation, is estimated to have prevented over 100,000 new HIV infections over a period of 5 years. The program targeted key at-risk groups but ultimately had a benefit for the broader population. IHME had also reported recently that something as simple as making sure that a home has at least one insecticide-treated bed net can lead to a 23% reduction in malaria-related child mortality; and that most of the world’s countries are reducing child mortality and maternal mortality more quickly than a decade ago.

In the opinion of Dr Hanlon “If governments modify their behaviour and reduce the trend of redirecting $0.56 on average from the health sector to other spending priorities, then more money would be devoted to health, which would result in measurably better health outcomes. Governments are spending more of their own money on health every year. When they receive significant sums of aid, they tend to shift a portion of their own money to other areas. The net effect, though, is still an increase in overall spending. For example, if a government spends $100 of its own money on health and receives $10 in health assistance, it ultimately spends a $104.40 on health instead of the full $110.”

“If policymakers are able to find new ways to better allocate resources, it would be a welcome response to the economic crisis. It is crucial for countries to set priorities to maximize the impact of all available funds. One area which needs improvement is transparency. Nongovernmental organizations, for example, receive millions in public and private funding, but they generally don’t make their country-level expenditure data publicly available. That makes it very difficult for researchers, policymakers and the public to make the kind of cost-effectiveness comparisons that are needed, especially in tough economic times.”

So efficient planning, innovative programmes and honest accountability could go a long way in tiding over tight pockets, and turning the dream of a healthy life into reality for the poorest of the poor .

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" published in November 2011 and a report on Hepatitis C and HIV treatment access issues in December 2011. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

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Luther L Terry Award to Dr Mira B Aghi

2011-12-19T01:30:00.001+05:30

One of the most respected and senior tobacco control advocates Dr Mira B Aghi has been rightly chosen to be conferred upon the 2012 Luther L Terry Award, for her outstanding community service. Dr Aghi has been on the forefront of the fight against the big tobacco. She has led the tobacco control movement in India and also been involved with tobacco control Internationally.

Putting the spotlight on the impact of tobacco use upon young girls and women was one of the passions for Dr Mira B Aghi. Young girls and women were particularly targetted by the tobacco industry in a mosaic of deceptive ways and Dr Aghi had persistently raised an alarm to save them from tobacco use.

She is also one of the first group of people in India that had come together to forge a national alliance which today is known as the Advocacy Forum for Tobacco Control (AFTC). She serves as a senior Adviser to AFTC - a pan India civil society coalition on tobacco control.

Dr Mira B Aghi will receive this prestigious award at a ceremony during the 15th World Conference on Tobacco or Health in Singapore (March 2012).

This is what Dr Aghi said in her CNS article (July 2011): "The risk from tobacco smoking is even bigger than previously thought. Smoking causes 10% of 10 million deaths per year from all causes in India. It may soon account for 20% of all male deaths and 5 % of all female deaths between the ages of 30 and 69.Men who smoke bidis shorten their lives by six years and those who smoke cigarettes lose about ten years of life. It is not just death but the diseases, the disability and the dilapidation that smoking causes that is truly worrisome and worrying." (Read complete article here)

Dr Aghi is a noted Behavioural Scientist and Communication Expert. Dr Aghi's work has focused on intervention research and advocacy in India and internationally, including South Asia, Southeast Asia, the Middle East, and Eastern and Southern Africa. She was the first woman from Asia to be awarded the WHO Gold Medal on Tobacco Control in 1989 and is a tireless advocate for tobacco control across various sectors including Parliamentarians.

Bobby Ramakant - CNS

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Oh To be Born Free - Without the Human Immunodeficiency Virus

2011-12-17T08:07:00.004+05:30

Every child has the right to be born HIV negative, even though one or both of the parents may be living with HIV. According to the UNAIDS 2011 report, there has been a 50% decline in the number of new HIV infections in India which fell from 2.4% to around 1.21% in 2009. Yet we are far from achieving the UNAIDS goal of zero new infections, zero deaths and zero discrimination by 2015. These goals were also at the centre of scientific deliberations at the ongoing 4th National Conference of AIDS Society of India (ASICON), which is being held at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, from 16th to 18th December.

New HIV infections can be controlled to a large extent by preventing parent to child transmission (PPTCT) of the HIV virus during pregnancy, delivery or breastfeeding. Nearly 5% of infections in India are attributable to the vertical route (parent to child transmission). It is estimated that in 2009, less than 25% of the number of pregnant women living with HIV in India received anti-retroviral treatment to prevent parent-to-child transmission. National AIDS Control Organisation (NACO) confirms that 18,000 children were infected with HIV from vertical route (parent to child transmission) in 2009, although strategies to prevent them are very much available.

According to Dr Ishwar S Gilada, Secretary-General of AIDS Society of India (ASI), "It is a shame for us that we cannot protect the rights and lives of our children. Zero new infections can become possible by preventing parent to child transmission, where one can have 100% prevention in the child. Each of these survivals would amount to saving 68 years of normal life, whereas by saving one adult we save only 10 to 15 years."

Dr Hoosen Coovadia, Scientific Director of Doris Duke Research Institute, Durban, also feels that the elimination of parent to child transmission of HIV is a realisable goal in developing countries. According to him, "The effectiveness of PPTCT interventions against HIV-1 is one of the greatest successes in the basket of prevention strategies used to control the HIV epidemic. The benefits of intervention programmes directed at all three routes (in utero, during delivery, and postnatal during breastfeeding) of transmission of HIV-1 are evident in industrialized countries where transmission rates have fallen from about 25% to under 2% and survival of infants has increased. However in resource poor settings PPTCT services are often unavailable or inaccessible. The use of artificial milk formulas instead of breast milk to prevent postnatal HIV transmission, especially during the first 6 months of life is associated with growth failure, high morbidity, malnutrition and even death."

In an exclusive interview to Citizen News Service (CNS), Dr Coovadia emphasized that, "It is not enough just to reduce parent to child HIV transmission rates, but it is equally important to increase survival rate of infants. Children are not just dying of HIV but also due to malnutrition, diarrhoea and pneumonia. Exclusive breastfeeding for the first six months (followed by non-exclusive breastfeed till 18 months) is critical to the issue of survival and health of the infants. One of the major advances made in recent years is in reducing HIV transmission through mother’s milk to very low levels of just 1% to 2%."

Dr Coovadia recommended a combination of two drug therapy for preventing HIV transmission and improving survival - the drug Zidovudine (AZT) during pregnancy and Nevirapine during delivery and for about 10 days after. To reduce breastfeed transmissions either the mother can be given HAART (highly active antiretroviral), or Nevirapine can be given to the baby for about 6 months. He prefers the second option as it is better and more cost effective.

Dr RR Gangakhedkar, Deputy Director of National AIDS Research Institute (NARI), an Indian Council of Medical Research (ICMR) institute in Pune, and Dr Gilada also plead for a multidrug regimen instead of the outdated single dose nevirapine which is currently used in the Indian government’s PPTCT programme. Dr Gilada laments that PPTCT programmes are not very powerful in our country, and unless they shift to the two drug regimen, it would be very difficult to achieve zero new infections. According to him a much better option is Lopanivar plus Ritonavir given in the last trimester for 6 to 8 weeks offers 99% protection.

Let us hope that the National AIDS Cotnrol Organization (NACO) would bring about a qualitative as well as quantitative change in its intervention programmes targeted at reducing transmission of infections to newborns. Of course, there is no single magic bullet to curb the epidemic at large. So a cocktail approach will be needed, depending upon the targeted populations which could be as varied as male/female sex workers, innocent housewives, migrant labour, injecting drug users, men who have sex with men. But above all, we will have to bring about a social, economic and political improvement in the lives of women, so that they are able to exercise greater control over their sexual and reproductive health rights, and demand an end to the needless spread of this chronic infection.

Shobha Shukla - CNS

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National AIDS Conference opens in SGPGI Lucknow

2011-12-16T21:24:00.000+05:30

[हिंदी] The 4th National Conference of AIDS Society of India (ASICON) was inaugurated by Dr RK Sharma, Director, Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS) and Dr Hoosen Coovadia, South Africa and Dr Mark Wainberg, former President, International AIDS Society (IAS) today at the SGPGIMS Convention Centre. Dr Ishwar S Gilada, Chair of ASICON and Secretary General of AIDS Society of India (ASI), Dr JK Maniar, President, ASI and Dr Tapan Dhole, Professor and Head, Department of Microbiology and Co-Chair of ASICON also graced the inauguration.

The 4th ASICON has brought together 15 international medical experts and 70 national medical experts who will be speaking on issues related to HIV prevention, treatment, care and support. More than 150 doctors including those from rural parts of the country have received scholarship support to attend this academic congress on clinical management of HIV and other 500 healthcare providers attending this congress.

According to the National AIDS Control Organization (NACO), co-sponsor of ASICON, India has 23.95 lakh people living with HIV (PLHIV), with 0.25% HIV incidence in women and 0.36% HIV incidence in men. “Because of reduction in new HIV infections and positive consequence of increased antiretroviral therapy (ART), AIDS-associated mortality has declined” said Dr DCS Reddy, former Professor, Community Medicine Department, Banares Hindu University (BHU). Compared to 2005 data, HIV infection rates among injecting drug users (IDUs) and HIV transmission through contaminated blood and blood products have gone up by 2010. In 2005, 1.1% of HIV infection was reported among IDUs, however by 2010, the HIV rate jumped to 5%.

Out of the total estimated PLHIV of 23.95 lakhs, 5% are living in Uttar Pradesh (UP) state compared to 21% in Andhra Pradesh and 17% in Maharashtra states.

The NACO programmes have seen a remarkable scale-up over the past years. In 2007, only 773 targetted interventions were there in India covering 30% of high risk groups (HRGs) such as men who have sex with men (MSM), IDUs and sex workers. By 2011, there are 1473 targetted interventions in India covering 75% of HRG populations, said Dr DCS Reddy.

The rates of sexually transmitted infections (STIs) have gone up too from 2.1% in 2007 to 10.1% in 2011. “Even treatable STIs are seen in alarming numbers in certain pockets” said Dr RR Gangakhedkar, senior Scientist, National AIDS Research Institute (NARI), Indian Council of Medical Research (ICMR).

Currently there are 426,000 PLHIV on ART in 2011 compared to 16000 in 2004.

Bobby Ramakant - CNS

Coordinated and locally supported AIDS response is warranted in India

2011-12-15T22:23:00.000+05:30

AIDS conference to open in SGPGI Lucknow: 16-18 Dec

[हिंदी] The 4th National Conference of AIDS Society of India (ASICON) will take place in Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS) Convention Centre during 16-18 December 2011. Dr Ishwar S Gilada, Chair of the 4th ASICON said that this congress will bring together 15 international medical experts and 70 national medical experts who will be speaking on issues related to HIV prevention, treatment, care and support. More than 150 doctors including those from rural parts of the country have received scholarship support to attend this academic congress on clinical management of HIV.

Dr Tapan Dhole, Co-Chair of 4th ASICON said that India’s noted HIV experts and international faculty will deliberate on a range of issues around HIV such as HIV prevention, HIV diagnostics, antiretroviral therapy (ART), co-infections associated with HIV like tuberculosis (TB), Hepatitis C virus (HCV) or Hepatitis B virus (HBV), HIV-associated cancers, drug resistance to medicines used in ART, genetic factors in susceptibility and HIV disease progression, Isoniazid (INH) preventive therapy and TB prevention among people living with HIV (PLHIV), HIV and Herpes, challenges in integrating sexual and reproductive health services for PLHIV in healthcare, gender issues, neurological involvement, eye complications associated with HIV, among others. Meet the experts, speed-learning, skills-building and tele-medicine will feature in this conference. No Alcohol and No Smoking if Official Conference policy, first such thing in any of medical conferences.

The global AIDS epidemic has completed 30 years of its devastating presence. India’s first AIDS awareness campaign has completed 26 years and crossed 25 years of diagnosing the first AIDS case in 1986.

Though India ranks high in HIV numbers, but because of its affordable ART drugs it plays a saviour globally by supplying over 80% of ART drugs to the world, thereby preventing deaths and ameliorating the sufferings of millions of PLHIV. Ironically we save millions globally but loose thousands to HIV nationally.Admittedly,the National AIDS Control Organisation (NACO) said India recorded 18,000 children getting HIV from 65,000 HIV+ve mothers in 2009, where as there are strategies to prevent them. HIV+ve women received a single-dose nevirapine, an outdated strategy meant for Africa. However, ASI will prevail upon NACO to rethink on this through ASICON.

A ghastly-devastating disease of early 1990s has become a chronic manageable disorder now. Treatment for only richer countries and the rich in poorer countries has become affordable to most countries. India is at crossroads vis-à-vis HIV that it makes imperative to look back in the recent past, take stock of what has been achieved and what has been amiss in order to decide future plan for a better tomorrow. The UNAIDS has termed India as the third worst HIV-affected country after South Africa (5.5 million) and Nigeria (2.9 million). How can one compare India to a nation less than the size of one of her states but with 30 times more HIV prevalence?

What has saved the larger Indian population from HIV is the Indian culture, the responsiveness of its youth, efforts of NGOs and medical caregivers and yeomen contribution of our pharma.

Treasure India’s Asset: India’s clinically oriented, conservative, comprehensive and holistic care has earned accolades. Its wait-n-watch approach in starting ART is indeed a blessing in disguise for HIV patients (as against ‘Hit-Early, Hit-Hard’ approach of the West). It improves quality of life, increases survival, reduces cost and spares them of impending drug-resistance. Indian culture of joint families and lasting marriages with integrity in women folks have been an asset in providing psycho-social support and reduced transmission. The age of the first sexual experience is higher in India.

“One Tablet a Day: Keeps HIV at Bay!” treatment invented in India made ART cheaper, safer and easier. Ironically, the MNCs made hue and cry, calling Indian Generics copy-cats! When the ‘West copies the East’ in making ‘combo’ medicines, why apply different yardsticks? Indian pharma took a lead, risking litigations, circumvented patents by producing generic copies using reverse engineering and brought down the prices to 1%, with 100% bio-equivalence (quality). The yearly cost of cheapest combo has come down from US$ 11452/- per patient to $69. Indian Pharma must be lauded for saving millions.

What is amiss? Less than 10% of the pregnant HIV+ve women received PPTCT and that too only single-dose nevirapine; only 56% of sex workers are reached with HIV prevention program and 38% of them identify correct ways of prevention methods. Only 20% of the infections are recorded at NACO, due to inherent flaws in the reporting system. More than half of the infected people do not know their HIV status. Our efforts to make the risk-takers understand their vulnerability have been inadequate. Only 30% adults with advanced HIV infection are receiving ART (up from 6% in 2005); while 20% patients at free roll out are dead, 12.5% have lost to follow-up or stopped ART in 2 years. We are facing an extremely challenging situation with Multi-drug resistant and extremely drug resistant (MDR/XDR) TB and HIV, Immune Reconstitution Inflammatory Syndrome (IRIS) – a serious disease situation caused by regaining the lost immunity following successful ART, HIV+ alliances, jobs for recovered people and mediclaim for HIV patients. Vaccine and Microbicide is a distant dream.

More such in-depth reviews and dialogue on issues around HIV response in India will be hosted during the ASICON. ICMR, Medical Council of India, Dept. of Bio-Technology, Govt. of India, SGPGI, NACO and Peoples Health Organisation are co-sponsors, where as it is Co-Funded by the prestigious National Institutes of Health (NIH), USA through Office of AIDS Research. There will be a large Pharma Exhibition at the conference about 55 poster will be displayed from all over India.

Bobby Ramakant - CNS

New pictorial warnings MISSING on tobacco packets

2011-12-15T11:19:00.001+05:30

[हिंदी] Although since 1st December 2011, all tobacco packs sold in India must be carrying stronger and more effective pictorial health warnings as per the new notification issued by the Ministry of Health and Family Welfare, Government of India, vide Gazette of India notification (dated 27 May 2011), as per the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA 2003), many tobacco packets sold in Lucknow are NOT carrying these new powerful warnings, rather have the old warning labels.

The government notification came out on 27 May 2011, and tobacco industry had more than SIX MONTHS to implement the same – serious action should be taken against the tobacco industry and stocks flouting pictorial warning ruling should be confiscated by the authorities, said Bobby Ramakant, WHO Director-General's WNTD Awardee 2008.

In the past, our government has held the dubious distinction of deferring and/or diluting these warnings, not once but several times under immense lobbying/pressure from the tobacco industry. The Health Ministry said to the Central Information Commission in November 2008 that it is tobacco industry pressure that is not letting it implement tobacco control health policies effectively" said Shobha Shukla, tobacco control advocate who is leading the Indian Society Against Smoking.

"We must remember that India became a signatory to the World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC) in February 2004, and is required to comply with pictorial warnings’ protocols as per the global tobacco treaty. According to the WHO, large, graphic health warning labels on tobacco packages are an essential component of a national strategy to reduce tobacco use" added Shukla.

"Under COTPA 2003, statutory warnings were introduced by our government on all tobacco products in 2005. But it was evident that this measure alone was not sufficient to reduce the use of tobacco. Consequently, the government notified rules on pictorial warnings first on July 5, 2006. However, the actual implementation of these rules was postponed repeatedly, apparently because of pressure exerted by the tobacco companies. The first and existing pictorial warnings had come into being on 31 May 2009 and were ridiculously mild and ineffective. So it will be after close to two and a half years that they will hopefully be replaced by more effective pictures of cancerous mouths/cheeks (on smokeless/chewing form of tobacco packs), and diseased lungs (on cigarette packs). As per the COTPA 2003, 40% of the front face of tobacco packets should have new pictorial health warnings every year" said Ramakant.

"When a large proportion of the population is illiterate, written warnings may be ignored, but not strong pictorial warnings. It is a good public health strategy which costs the government and the public nothing because the cost of the colourful package warning will be met by the tobacco companies. Also FOREIGN-MADE CIGARETTE BRANDS (such as Indonesia-made Gudang Garam) being sold in Lucknow MUST carry these pictorial warnings" said Rahul Kumar Dwivedi, who is the youth leader coordinating the Citizens for Healthy Lucknow (CHL) Campaign.

CNS

Peace and democracy issues to be in spotlight when people from Pakistan and India meet in Allahabad

2011-12-12T10:46:00.002+05:30

[हिंदी] 8th joint convention of India and Pakistan chapters of PIPFPD in Allahabad
The 8th joint convention of India and Pakistan chapters of Pak-India People’s Forum for Peace and Democracy (PIPFPD) is scheduled to be held during 29-31 December 2011 in Allahabad, UP, India, said Mr Irfan Ahmad, senior Vice President of PIPFPD (UP State chapter) in a press conference at UP Press Club.

This forthcoming joint convention of PIPFPD in Allahabad will bring together hundreds of peace activists from both the nations. The joint convention of PIPFPD will further endorse the following steps to be taken both by civil society and the governments of South Asia:

1. Improve and strengthen a relationship of friendship and cooperation among the countries of South Asia. To achieve this, these countries should become Visa Free so that the people of the region enjoy full freedom to meet each other, and thus the common socio-cultural and historical heritage of the region is taken forward, and trade is enhanced.

2. Democratic and humanistic values be strengthened in these countries, and adequate social and legal protection be afforded to the oppressed and marginalized sections of society, particularly to women, dalits, and ethnic and religious minorities; active steps be taken for repealing laws, and ending social practices, that are discriminatory towards these sections.

3. India and Pakistan take the lead in putting an end to their nuclear weapons and begin working towards making the entire South Asian region a Nuclear-free Zone in a time-bound manner. This may be done in a phased manner, beginning with the freezing of nuclear weaponry, followed by disarmament, and culminating in total disarmament.

4. Recent nuclear emergency in Japan leaves no doubt that this world needs to renounce nuclear power for military and civil/ energy purposes, as soon as possible, to put an end to any further catastrophe in the name of 'energy', 'security' or 'technology'. Nuclear power is clearly the most dangerous options for civil or military use.

5. Democratic values and systems of governance must become the prevailing norm for the entire South Asian region.

6. Immediate steps be taken by all the governments of the region to halt militarization and to gradually reduce military expenditure in a publicly stated, transparent and pro-active manner; the resources thus saved be allocated for such common concerns as health and education.

7. Given the common socio-cultural and historical heritage of the region, active initiatives for peace and harmony be taken by progressive forces to counter the sectarian and communal forces destabilizing the region.

8. Steps be taken for the restoration of rights to natural resources like water, land and forests, to their rightful ownership by the common people of the region; the illegitimate and destructive appropriation of these rights by the forces of globalization, which we believe are anti-people, be halted.

Bobby Ramakant- CNS

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FDI in Retail without Enhanced Social Security will be Suicidal

2011-12-08T14:00:00.002+05:30

A lot of well off and educated sections of our society are rooting for FDI in retail. There seems to be a disappointment among the middle/upper middle class consumers and the corporate world that the Government of India has put this policy on hold. There was an article published in The Telegraph on 5th December 2011 titled “How Bengal gains from FDI: Experiment that protected 6500 farmers from a curse.”

The article describes how in some districts of Bengal, Pepsico company has brought economic gain and security to several farmers, including the small ones, who have agreed to grow and sell a special grade of 'pepsi potatoes' to the company. It reports that Pepsi buys potatoes through the vendors at a fixed price that is much higher than the wholesale price or prevailing local market price. These vendors are typically big traders, dealers or even big farmers. The article makes a point that the small farmers who sell 'pepsi potatoes' to these vendors are better off than the former situation in which they were dependent on and exploited by the local "Mahajan". Through this example the article makes the concluding point that FDI in retail will bring in more such economic benefit to many more such small farmers. The article, in a way, presents the best possible argument about how FDI in retail will benefit small farmers.

The article is of course written with half facts selected to suit its tenor. What it describes is not representative of what Pepsi or similar firms normally do. Pepsi (Frito Lay, in this case) does not deal directly with small farmers. As the article itself mentions, it deals with intermediaries or with large farmers to cut down its transaction costs. If at all some small farmers are at one end of this chain, they have to interface with bigger intermediaries, and get low price because of their poor bargaining position. Frito Lay does indulge in long term forward and fixed price procurement with big agricultural traders and agents. In the process Frito Lay reduces its long term risk and expected cost by weighing quantity and price fluctuations in the market. The big traders and agents in turn make margin by cutting into margins of those from whom they procure.

It is sometimes possible that the price a small farmer gets by selling his/her produce to pepsi’s vendors (intermediary agents) is higher than the locally prevailing price. However, this situation seems to be temporary or an exception. On the supply side, small farmers – dependent on chemical fertilizers, pesticides and pumped irrigation, without having the scale of land to absorb those costs – are almost always less economical than large landowning farmers. On the demand side, companies like pepsi are under perpetual competitive pressures to cut cost and standardize quality. FDI in retail will increase this pressure from the demand side. Such pressures from both demand and supply sides eventually force steady concentration of land in fewer hands, as this movement achieves economy of scale and standardization and can still yield positive margins for the large landowners. This is what has happened to many of high income countries. However this movement also eventually throws off many small farmers from their lands. Most of high income countries responded to this social challenge by providing new employment and skill upgrade opportunities and enhancing social security net.

There may also be a few cases where small farmers get better price because they have organised themselves into some kind of a cooperative. By forming cooperative they increase their bargaining power and gain access to scale related economies, for example, storage in godowns, bulk transport, and direct transaction with wholesalers or bulk sellers. “Cooperatives” is certainly a good way to reduce economic vulnerability of small players. However existence of cooperatives is not in the interest of big intermediary traders and agents as it cuts into the latter’s exploitative economic power.

If FDI in retail comes in then the Government must bear additional responsibility to protect interests of small farmers and small retailers (small shopkeepers and vendors). One way is to support them with (i) formation of cooperatives so that their bargaining position in the marketplace increases, and (ii) training in new skills and technologies so that they can increase operational efficiency and cut down their own transaction cost while simultaneously reaching out to larger sections of markets.

Of course social security like what is common in European countries and Japan is needed too. Experience of rich countries tells us that the more markets are opened up the more social security nets are required. So FDI policy must be introduced together with new and enhanced social security policy. The two policies need to go hand in hand. The former without the latter will spell socio-economic disaster for the large masses.

Dr Rahul Pandey

(The author is an entrepreneur who specializes in operations research model development, supply chain management, and energy and climate change policy. Formerly he has been a faculty member at Indian Institute of Technology (IIT) Bombay and Indian Institute of Management (IIM) Lucknow. Currently he teaches supply chain management and operations strategy courses as a visiting professor at IIM Lucknow. He can be reached at rahulanjula@gmail.com )

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A Healthy Childhood Means A Tobacco Free Childhood

2011-12-05T16:58:00.001+05:30

Life seems to have come full circle for Aamir Khan, the much acclaimed Bollywood star, who after being named the brand ambassador in July 2011, of the Women and Child Development Ministry, for spreading the message of curbing malnutrition among children and mothers, was recently appointed, in November 2011, as the national brand ambassador of UNICEF, to promote Child Nutrition and Child Rights. This has raised a few eyebrows in view of the fact that the same Aamir Khan had earlier endorsed a soft drink brand, despite several studies pointing to the health hazards of cola drinks for children. This is what he had to say in his defence, “I don’t have a tainted past. I haven’t done any work till date that would hurt anyone… at least not deliberately. But, if anyone still got hurt then I’d just say sorry to them from the bottom of my heart. I did that ad long time ago. I don’t even endorse the brand anymore.”

Noble sentiments indeed, especially when they come from one of the highest-paid actors on the endorsement circuit, after he reportedly pocketed Rs 8-10 crore annually for endorsing a nutritionally dubious product for 10 long years. Aamir Khan had been the face of Coke's most popular campaigns over the years, including 'thanda matlab Coca-Cola' which was an instant hit with the Indian masses, young and old.

It is something like having your cake and eating it too, along with the icing. Of course there is no doubt about his business acumen in being a part of meaningful as well as entertaining cinema as a versatile actor (Lagaan,Rang De Basanti, Three Idiots), wonderful director (Taare Zameen Par) and a great producer (Jaane tu yaa Jaane naa, Lagaan, Peepli Live). However, one needs to practice what one preaches, and set up personal examples while treading the grounds of social responsibility. He also joined some other prominent members of the film industry in rubbishing The Ministry of Health and Family Welfare's recent directive to ban smoking on screen, and termed it as an attack on creative freedom and expression. According to him, "I have never advocated smoking, which is why I have stayed away from doing tobacco advertisements. However, my answer to the Government's directive on banning smoking on screen or showing it with justifications in a film is: If you show other illegal activities on screen, then don't attack only smoking; Don't attack my creative freedom; Don't take away the audience's right to enjoy cinema by imposing views/restrictions on them, especially when they could be watching a crucial scene. How can you do that?"

Is Aamir Khan really so naive as to be oblivious of the dangerous impacts of smoking scenes in films, particularly on young minds. According to a recent study (the largest to date involving over 16,000 teens from across 6 European countries) on Smoking in movies and adolescent smoking, published in Thorax, an international journal of respiratory medicine: The link between smoking in movies and adolescent smoking is robust and transcends different cultural contexts. Youth who were highly exposed to onscreen smoking were about twice as likely to smoke as lightly exposed youth. Limiting young people's exposure to movie smoking could have important public health implications.

Another study conducted by the NGO Hriday Shan on 4000 teenage students across 12 schools of Delhi, and published in July, 2011 in the British Medical Journal also confirmed that: ‘Watching tobacco use in Bollywood movies and receptivity to tobacco promotional activities were both independently associated with ever tobacco use among adolescents in India. Onscreen smoking is not just encouraging children twice as much to smoke - but worse – it is affecting the youngest of the lot. Today an average 6th standard student is using more tobacco products than an 8th standard student.” This should come as a shocking revelation to unsuspecting parents, and a danger sign that shows how vulnerable children are to tobacco advertising.

Popular film stars of the likes of Amir Khan are virtually venerated and emulated by youngsters in India. So Aamir Khan would do well to take up his new role, as brand ambassador for children, seriously by setting up an example himself. He cannot delink his personal habits and leanings (freedom of expressions notwithstanding) from a public cause. It is hoped that he would take this assignment seriously, and his new avatar, of promoting good nutrition in children, would give him the moral strength to quit smoking, once for all, and also encourage him not to endorse smoking in films/ and or unhealthy food products, so that he is able to convince children/youth on the need of a ‘tobacco and smoke free society’, which is essential for a nutritionally balanced growth of the child.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" published in November 2011. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

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Sing for those who are voiceless

2011-12-02T12:25:00.003+05:30

On World AIDS day, 1st December 2011, a program 'Sing For Those Who Are Voiceless' was organized by Maan AIDS Foundation, to celebrate their achievements of the past one year in bringing vulnerable and voiceless communities together to fight AIDS. The foundation shared its one year's progress report of the work it has done under the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund)'s Regional Project programme. This project has helped in strengthening community based organizations in the country with a view to integrate the most at risk populations of lesbians, gays, bisexuals and transgenders (LGBTs) with the existing HIV/AIDS control and treatment programmes of the government.

Ten years back, there were very few Community Based Organizations (CBOs) in the country, and even they were doing voluntary work without any funds and with very little strategic direction. Under this project, Maan AIDS Foundation has to develop about 30 such community based units, under the Pehchan (identity) Programme. In one year it has not only put in place 11 new CBOs, but also helped and facilitated the existing ones, putting 7 of them on board, and thus bringing 18 new programmes under its ambit within one year. All these programmes would go a long way in strengthening the national programme by reaching out to districts where there is hardly any HIV/AIDS intervention going on, and thus help the government in achieving its goals of Zero HIV infections by increasing community involvement and ownership. The ultimate goal is ‘no more new infections, no stigma and no discrimination’ in the field of HIV/AIDS for all affected populations.

Maan AIDS Foundation also announced the rolling of another programme DIVA, which would begin as soon as final approval from the Government of India's National AIDS Control Organization (NACO) is received - which is one of Maan AIDS Foundation’s Global Fund regional programmes addressing diversity in action for supporting communities and reducing vulnerabilities. This will be rolled out in 18 states, including UP, and strengthen the capacities of roughly 60 CBOs. Yet another European Union funded programme will cover another 16 states to strengthen the capacities of CBOs, and support the existing ones to scale up their services.

AWARENESS BOOTHS
Maan AIDS Foundation also organized 5 awareness booths on World AIDS Day, 2011, in collaboration with their local CBO Bharosa, at Badshahnagar, GPO, Chowk, Begum Hazrat Mahal Park and Charbagh, to create awareness amongst the general public about the problems of persons having different sexual orientations.

The sole aim of all these efforts is to reach out to populations for interventions that have been hitherto unreached, and also address the mental health issues of LGBTs. Most of the existing programs look at the visible population only. But the main aim of all these new programmes is to reach the unreached and to target those segments of populations for interventions which have remained hidden due to social ostracism and stigma. They may think differently from the rest of us, but they are also an integral part of society and children of the same God who loves all of us.

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Celebrating life in a positive way

2011-12-01T20:53:00.003+05:30

As we once again commemorated World AIDS Day on 1st December 2011, it is time to share the joys and sorrows of people living with HIV (PLHIV) with a positive attitude. It is also high time that instead of targeting the affected population, we sensitize the so called unaffected populations (those who are not living with the disease and do not belong to high risk groups), so that they become more aware of this once dreaded disease and stop treating those living with it as untouchables. Of course a lot of water has flown since the first case of HIV was detected in India in 1986, and the tag of ‘killer’ attached to the disease has been replaced by ‘chronic’. We now talk of people living with HIV and not people suffering from HIV.

In the darkness of ignorance that still engulfs the horizon of HIV/AIDS, there are some shining stars which rekindle our belief in the indomitable human spirit. Asha Ramaiah is one such woman, who was diagnosed of her positive status in 1995. I first met her in August 2011, and was immediately attracted by her pearly white smile, little realizing the ocean of tears it must have waded before settling on her face. Hers is a story that is an inspiration, not just for PLHIV, but more for those who are not positive (in their attitude, and/or in their HIV status).

In her own words, as told to CNS:

"I was an introvert as a child, and never dared to protest against anybody or anything that I did not want to do. I obeyed my parents without asking any questions, who did not even take my consent when they married me off as soon as I turned 18. And I am sure even if they would have asked me I would not have voiced my opinion. I realized the need to stand up and voice my opinion much later. Within six months of my marriage, my husband took very ill and was diagnosed with AIDS. When the doctors wanted me to undergo a blood test, I did not understand why. Even when they told me that I was HIV positive, I hardly understood what it really meant. My father-in-law started beating me and blaming me for his son’s illness. Soon after, my husband expired and my parents brought me back. But they too started isolating me as they were afraid that my two younger sisters would not get married if someone knew about my HIV status. At 19, I was too young to understand the challenges that awaited me. I enrolled myself for social work training and then came to know about how HIV infection affects the immune system. I was scared for the first time. But, after the initial shock, I stood up to face life once again, thanks to the strength of my womanhood. In 1998 my doctor directed me to Samraksha, an NGO doing pioneering work in the HIV and AIDS sector.

While working with Samraksha I was exposed to a world which I had never ever imagined. Samraksha facilitated a capacity building process for me by giving an exposure through various conferences and training programmes on HIV/ AIDS, and gave me the opportunity to complete my diploma in Counselling from Christian Counselling Centre, Vellore. I could now organize support group meetings and worked with other PLHIVs as a counsellor. I not only listened to their anxieties and concerns, but also explored with them how to progress towards living positively in a satisfactory manner. I also met Elango and entered into matrimony once again in the year 2000 - this time with my own choice and with my eyes wide open to the reality that he was also a person living with HIV. I also became one of the founder members of KNP+, a network of people living with HIV in Karnataka. These two events changed my life, both at the personal and professional level. There was no looking back now. I was extremely happy when my son Yatish Darshan was born in November 2001, but the happiest day came 18 months later when the doctors declared him HIV negative.

Today, when I look back, I feel, I have come a long way. I am here because of my own strong will to survive and overcome, and also because of the support and encouragement of my organization, my parents, friends and other PLHIVs. Without their support, the road was dark and thorny. And it is this great sense of togetherness and hope which I enjoy with my husband and my son by my side. This hope is my way of celebrating my life. As person living with HIV for the last 16 years, I am not taken antiretroviral (ART) drugs, but simply following the doctor’s advice and taking proper treatment for opportunistic infections. A word of advice for all women—A good education and financial stability are very important along with guarding our reproductive health."

This is what our former President Dr APJ Abdul Kalam had to say about Asha in 2006: "Friends, the message we get from the experience of Smt Asha is that as human beings we may get into a problem. But we should not get defeated. We should find out ways of converting this very problem to our advantage and succeed. The courage we see how the lady defeated the disease and most importantly she withstood the onslaught of alienation from her parents, husband and the society. This I call as indomitable spirit of a HIV affected person. Many Asha Ramaiahs are needed to make the people suffering from HIV AIDS, leprosy, polio, cancer and TB feel comfortable and lead a normal productive life in our society."

Asha is not alone in her journey. There are others also who have faced similar predicaments. Manoj, of Gorakhpur, and a member of UP Network of people living with HIV (UPNP+), too faced a lot of stigma and ostracism from his family members and even from healthcare providers when he was first diagnosed with the disease. His elder brother’s family treated him as a social outcast. But a simple yet meaningful intervention of his family doctor changed everything. When Manoj bared his heart to him, the doctor made it a point to visit his house daily after lunch and lie down on Manoj’s bed, and eat the eatables taken from his hands. In this way he convinced the family that AIDS did not spread through touch or eating out of the same plate. The family took Manoj back in their fold, who has since married a widow living with HIV. He feels that apart from proper medical treatment, it is the love and support of the near ones which acts as an elixir of life to PLHIV. He is very grateful to his mentor Mr Naresh Yadav, chair of International Treatment Preparedness Coalition (ITPC) India who, according to him, is doing yeoman’s service by reaching out to the unreached PLHIV and encouraging them to lead a normal life.

The coming days may be hard for the PLHIV community with financial grants drying up, threatening the free availability of anti retroviral drugs. While donors need to relook into this matter and production of generic drugs needs to be safeguarded in all free trade agreements, the least we can do is to lend a helping hand here and a soothing word there to bring about social inclusiveness and mitigate the woes of those living with HIV/AIDS. God forbid, it could be anyone of us tomorrow who might contract it through no fault of theirs. Let us do unto others as we would want them to do to us.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" published in November 2011 and a report on Hepatitis C and HIV co-infection and treatment access issues in December 2011. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

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World AIDS day 2011: Want to get to zero? Deal with TB!

2011-12-01T19:46:00.002+05:30

A giant condom will be 'wrapped' around the Dutch Munt Tower in Amsterdam this week. It’s probably one of the more striking activities that will mark World AIDS Day. Meetings, film-viewings, theatre plays, articles, brochures and many other happenings will call upon people to join the fight against AIDS. To effectively fight AIDS though, we need to also fight tuberculosis. 'Getting to zero' is this year’s theme for World AIDS Day.

Getting to zero, backed by a United Nations campaign that will run until 2015, means zero new infections, zero discrimination and zero AIDS-related deaths; a bold and important aspiration. However, to get to zero AIDS-related deaths, we need to realise that one out of every four people living with HIV will die of tuberculosis. Worldwide, TB is the third most important killer of women, the second deadliest infectious disease and the leading cause of death among people with HIV-infection.

HIV and TB are so deeply connected that they are often described as a ‘dual epidemic’. Each disease speeds up the progress of the other; HIV infection is the strongest risk factor for turning latent tuberculosis into active disease, while TB-bacteria accelerate the progress of HIV infection in the patient. Getting to zero AIDS-related death means having to deal with tuberculosis too.

People living with HIV need to be often and properly screened for tuberculosis. They need to receive preventative treatment where necessary and they need to be treated fast and effectively in case of active disease. According to a global plan called ‘Time to act’, published by WHO, UNAIDS and the Stop TB Partnership, a million lives can be saved between now and 2015 by more effectively dealing with TB/HIV co-infection.

Still, scientific modelling shows that tuberculosis will not be eliminated without new, more effective vaccines. Vaccines that are safe for HIV-infected children and that provide better protection against pulmonary TB. Over the past years, scientists have made tremendous progress in the development of these vaccines. We now need to call upon politicians, decision makers, industries and donors to provide them with all the support they need to deliver these vaccines and eliminate tuberculosis.

Jojanneke Nieuwenhuis
(The author is an Associate Communications and Advocacy Relations, TuBerculosis Vaccine Initiative - TBVI)

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Costly medicines mean DEBT or DEATH for people with chronic hepatitis C

2011-11-29T13:48:00.002+05:30

[To download or read the report online, click here]
A new report to be released on World AIDS Day, by International Treatment Preparedness Coalition (ITPC) India (download here), has questioned the silence maintained by the Indian Ministry of Health and Family Welfare on its response to the Hepatitis C virus (HCV), which is emerging as a growing public health threat. According to the World Health Organization, hepatitis C virus (HCV) is a major cause of acute hepatitis and chronic liver disease. Globally, 3 to 4 million persons are newly infected each year. The burden of the disease in India will continue to rise in the absence of prevention and harm reduction measures with vulnerable communities.

"HIV and hepatitis viruses are transmitted in similar ways and it makes public health sense to link HCV prevention efforts to HIV programme" said Naresh Yadav, Chair of ITPC India. "In addition to HCV screening in blood banks, prevention and harm reduction efforts for HIV and HCV with vulnerable communities should go hand in hand. Unless this is done, HCV infections will rise in India even though HIV transmission rates reduce, particularly among injecting drug users (IDU), the most vulnerable community," said Naresh Yadav.

According to this report, there are two main obstacles to an effective HCV response in the country. First is the absence of prevention efforts; second is the lack of political will to treat HCV-among policymakers in the Health Ministry.

Currently, HCV treatment is a combination of two drugs, pegylated interferon and ribavirin. For people who do not clear the virus spontaneously from their body and go on to develop chronic forms of the disease that affects the liver, treatment is currently unavailable in the public healthcare system and unaffordable in the private sector.

The high cost of HCV treatment in India is attributed to the absence of generic competition due to patent barriers. India, as part of its obligations under World Trade Organization's (WTO) international trade rules, had to introduce product patents on medicines in 2005.

Pegylated interferon alpha 2a and alpha 2b, used in the treatment of Hepatitis C, were among the first set of drugs to come under patent monopoly in India. The patents granted by the Indian Patent Office to two pharmaceutical companies - Roche and Schering-Plough, block the development of more affordable generic versions of the drug. As a result both these companies charge exorbitant prices from patients, ranging from Rs. 14,000 to 18,000 per dose.

"People living with HIV are increasingly being diagnosed with HCV co-infection. Hepatitis C, is the "silent killer," threatening to undermine HIV treatment efforts", said Naresh Yadav. "We need not only AIDS medicines but also access to HCV medicines from the government. People are now dying because the price of the HCV drug that can save them is too high. Prohibitive pricing of lifesaving medicines by pharma companies is unethical and unacceptable” said Naresh Yadav.

According to this report, the government has been moving far too slowly on addressing the problems of patients who need HCV treatment. When drugs are patented, and pharmaceutical companies fail to fulfil their obligation to make patented medicines available and affordable to patients, the only way to bring prices down is through examining the validity of the patent granted or compulsory licensing which allows generic production of more affordable versions. Instead of addressing the problem, it's like the government is pretending the death and the sickness that HCV causes are not happening.

The ITPC India members had also met officials and Chairperson of Health Committee of Planning Commission of the Government of India earlier in October 2011 and provided them with meeting documents for consideration to be fed into the next five year plan (12th FYP: 2012-2017).

The ITPC India report makes the following key recommendations:
1. Include Hep-C in surveillance system
2. Initiate Hep-C testing through current ICTCs with proper pre- and post- test counselling
3. Provide free Hep-C treatment to people where medically it is indicated
4. Government must integrate a comprehensive and well-coordinated Hep-C programme within the National AIDS Control programme at NACO as both HIV and HCV interventions are going hand in hand and will maximise AIDS programme performance as well as save lives from Hep C
5. Phase out toxic Stavudine (d4T) from India’s ART programme
6. Expand second-line ART coverage and initiate third-line ART in current ART programme and guideline
7. Remove SACEP criteria from countries ART programme

Bobby Ramakant - CNS

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Scare Them To Quit: Use Repulsive Pictorial Health Warnings On Tobacco Packs

2011-11-29T11:05:00.002+05:30

[Hindi] Come December 1, 2011, and all chewing and smoking tobacco packs sold in India will hopefully carry stronger and more effective pictorial health warnings, as per the new notification issued by the Ministry of Health and Family Welfare, Government of India, vide Gazette of India notification dated 27 May 2011, to implement pictorial warning sections of the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA 2003).

However there are serious concerns that the tobacco industry may try to continue the sale of tobacco products with old warnings even after 1st December 2011, in the garb of exhausting past stocks. Fears and doubts about postponement/weakening of the new rule are also rife (and rightly so) in the minds of anti tobacco activists. In the past, our government has held the dubious distinction of deferring and/or diluting these warnings, not once but several times under immense lobbying/pressure from the tobacco industry.

We must remember that India became a signatory to the World Health Organization's Framework Convention on Tobacco Control (WHO FCTC) in February 2005, and is required to comply with pictorial warnings' protocols as per the global tobacco treaty. The use of pictorial warnings on tobacco product packets is one of the six "M POWER" effective tobacco control strategies - clubbed as 'MPOWER' –declared by WHO in 2008 to help its member countries to control tobacco use. In this acronym, W stands for 'warn' about the dangers of tobacco use. According to the WHO, putting large and strong graphic health warning labels on tobacco packages is a good public health strategy which costs the government and the public nothing because the cost of the colourful package warnings is borne by the tobacco companies.

Under its Cigarette and Other Tobacco Products Act (COTPA) 2003, statutory warnings were introduced by the Indian government on all tobacco products in 2005. But evidently, this measure alone was not sufficient to reduce the use of tobacco. Consequently, the first government rules on mandatory pictorial warnings were notified on July 5, 2006. However, the actual implementation of these rules was postponed repeatedly, apparently because of pressure exerted by the tobacco companies. The first pictorial health warnings, consisting of pictures of scorpion and cancer infected lungs, eventually came into being on May 31, 2009, and were ridiculously mild and ineffective. So it will be after more than two and a half years that these will hopefully be replaced by more grotesque pictures of cancer stricken mouths (on chewing tobacco packs), and diseased lungs (on cigarette/bidi packs). As per the COTPA 2003, tobacco packets should have new pictorial health warnings every year. Many activists, including the medical fraternity, seriously doubt the efficacy of even the new pictures—especially those of the diseased lungs on a man’s chest, as it is difficult for smokers to visualise the gory nature of tobacco-related diseases and fatalities from them. Those to be used on chewing tobacco packs look more effective, and are likely to scare the user.

It is said that a picture can speak a thousand words. Various studies outside India, especially in countries where large and strong graphic warnings pictorial warnings on packages of tobacco products have been implemented, have revealed that such warnings play a significant role in informing consumers about the health risks of tobacco use, motivating smokers to quit and discouraging non-smokers, including children, from taking to this habit. Graphic warnings have a greater impact than written ones, and can be recognized by illiterate audiences and children-two vulnerable population groups. As of now, 40 countries across the globe are using this tool to curb the menace of tobacco with Uruguay in the lead, having the toughest pictorial warnings covering 80% of the surface area of cigarette packs.

In a country like India with its multilingual and multicultural communities, a pictorial warning can break cultural, regional and language barriers. Moreover, when a large proportion of the population is illiterate, written warnings may be ignored, but not strong pictorial warnings which, if implemented properly, can go a long way in reducing the number of tobacco users and tobacco related deaths, and help India reduce its ever increasing number of tobacco users. WHO’s latest report on the "global tobacco epidemic", released this year, says that while 33% adult Indian males and 18.4% adult Indian females use smokeless tobacco, the corresponding figure for those taking a puff stands at 24.3% males and 2.9% females. Among the youth, 19% males and 8.3% females use some form of tobacco.

It is hoped that this time our government will not succumb to any pressures from any quarter, to weaken and/or stall implementation of effective pictorial warning labels on tobacco/cigarette packs, which should be strong enough to repel the users, thus showing them the option to lead a healthy life. It must also be ensured that these pictorial warnings are also depicted on packs of foreign brands of cigarettes, which are sold in the country.

Shobha Shukla - CNS

Call for Equality and Empowerment to mark World AIDS Day

2011-11-29T10:54:00.002+05:30

This year, as the Indian response to HIV/AIDS marks a quarter century, the spotlight is on marginalised groups most impacted by the epidemic. On the eve of World AIDS Day, the Pehchān programme will call for continued and expanded efforts to protect and support men who have sex with men (MSM), transgenders and hijras in India. In a major event at the New Delhi YMCA, Pehchān will mark the progress that has been made in addressing HIV in these populations and highlight the need for sustained investment and support.

More than 200 people including television personalities, activists, policy makers, and people living with HIV will participate, sharing their experiences and showing their support for the cause.

The theme for World AIDS Day 2011 is Getting to Zero: Zero New HIV Infections, Zero Discrimination and Zero AIDS-related Deaths. Reflecting this global goal, the event will present speeches, cultural performances by community members and the launch of a new set of Pehchān advocacy posters. The evening will also include the staging of a short dramatic piece that describes a mother’s discovery of her son’s homosexuality.

Initiated in 2010, Pehchān is implemented by India HIV/AIDS Alliance and a consortium of partners including Humsafar Trust, Maan AIDS Foundation, SAATHII, Sangama, and SIAAP. Working through robust partnerships with the National AIDS Control Organisation (NACO) and the State AIDS Control Societies (SACS), the programme is building the capacity of 200 community-based organisations to provide HIV prevention programming for more than 4,50,000 MSM, transgenders and hijras in 17 Indian states. Funded by the Global Fund, Pehchān is their largest single-country grant to date focused on the HIV response for vulnerable and underserved sexual minorities.

James Robertson, India HIV/AIDS Alliance Country Director, said, "Pehchān’s World AIDS Day event is an opportunity for us to unite and renew our commitment to stopping new HIV infections. MSM, transgender and hijra communities are disproportionately affected by the epidemic and yet are still often neglected. While India has put high-risk groups at the heart of its national HIV prevention strategy, the Pehchān programme is ensuring that communities have the capacity to take up this charge."

The prominent gay rights activist Ashok Row Kavi continued, "NACO has supported the development of Pehchān to strengthen government efforts to prevent HIV and protect health in MSM, transgender and hijra communities. We hope that this shared and collective effort that will spread to other government sectors and to society at large in India and beyond."

Sonal Mehta, Director of Policy and Programmes at India HIV/AIDS Alliance, concluded, "In spite of the reading down of Section 377 in 2009, MSM, transgenders or hijras remain stigmatized and outside the mainstream. Even as Pehchān empowers these groups, intolerance and discrimination against them continues and must end. While headway has been made, the journey to equality is not over."

CNS

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Demanding justice for Soni Sori of Dantewada

2011-11-29T01:00:00.000+05:30

32 organizations and 55 individuals from across India have sent this letter to Raman Singh, Chief Minister, Chhattisgarh protesting the custodial torture of Soni Sori and demanding the punishment of the perpetrators of violence against her.
Shri Raman Singh
Chief Minister, Chhattisgarh
Room No. 303, Mantralaya, D.K.S. Bhavan,
Raipur (C.G.) 492001
Fax # 0771 2221306, 2331001 Date: 28 November 2011

Subject: Justice needs to be served to soni sori: demand for action against officials responsible for custodial torture and deception in court.

Sir,

We have already written to you in protest against the custodial torture of Soni Sori of Dantewara district (letter attached). Further, at a meeting with your Principal Secretary, N. Baijendra Kumar in Delhi on 14th October 2011, he assured us that she was ‘safe in jail and that her wounds were not serious. He also said that the Health Secretary had confirmed the fact’ and so there was no need for concern about her safety.

However, as all the facts reveal, this was far from the truth.

The video that emerged showing Soni writhing in pain in the Dantewada District Hospital on 11 October was indeed, was evidence of custodial torture. On 15th October, the District Hospital, Dantewada medical report confirmed that she had contusion in her head and spine and that black marks were visible on her finger tips – further confirming this fact.

In her recent letter to the Supreme Court, Soni Sori clearly states that she had been pulled out of her cell at the Jagdalpur Police Station at ‘midnight of 8th/9th October on the orders of SP Ankit Garg, stripped and given electric shocks’. She woke up the next morning with acute pain all over her body, head and spine. That she could not even get down from the vehicle and walk to the court and be presented in front of the Magistrate is further proof of the extreme pain that she was undergoing because of the injuries inflicted upon her the previous night.

At this point itself we had ample reason to fear that Soni had also been subjected to sexual abuse and torture. This apprehension has also been proven true with the revelations of the medical report of the NRS Medical College Hospital in Kolkata which has stated clearly that two stones had been inserted in her vagina and one in her rectum, and that she has annular tears in her spine. Such conduct by police officials is absolutely outrageous and cannot go unpunished!

It is shocking that she has been subjected to all this after she was taken from the Saket Court in Delhi on assurances that there would be no physical or mental torture, and that all investigations would be conducted as per the law.

In the strongest words, we demand that the state government of Chattisgarh:

Immediately initiate punitive action against all concerned officials who authorised her to be flown to Raipur from Delhi and created the circumstances where she could be tortured in police custody before being produced in the Dantewada District Court.

Initiate punitive action against SP Ankit Garg and all other police officials involved in her custodial torture, as well as medical officials who falsified her medical records claiming she was fine.

Stop contesting Soni’s demand to face trial outside Chhattisgarh because clearly she is absolutely unsafe in the state!

If the Government of Chattisgarh fails to take proper action to safeguard the legal rights and dignity of an undertrial, it is clear that it has no moral authority to continue in office.

Pushpa Achanta

Addressing gender inequality is an absolute must to stem HIV

2011-11-27T09:19:00.002+05:30

[हिंदी][Images] Two films, "Diamonds" and "In Women's Hands" were screened by CNS in Lucknow on Saturday, 26th November, 2011, in the lead up to World AIDS Day, 1st December 2011, and to mark 16 Days of Activism against Gender Violence, which is an international event seeking gender equality in society, and lasts through November 25 (International Day against Violence against Women) to December 10 (International Human Rights Day) every year, to emphasize that gender-based violence is not merely a women’s issue but it is a fundamental issue of violation of human dignity and human rights.

Both films address the issue of domestic violence and gender inequality which continues to put millions of women and young girls at an increased risk of infections such as HIV among other undesired outcomes. They also document the inherent strength and resilience in women who are positively alive with HIV and convey a strong message of hope.

'DIAMONDS' is a documentary based on the personal narratives of four women living with HIV, which forms part of a book by the same name (authored by an HIV activist Susan Paxton) about ten women and one girl who are HIV-positive. Like diamonds, formed under tremendous pressure to become the strongest and most brilliant natural substance on earth, these women have overcome incredible challenges to become leaders in their communities. In this documentary, Neri (from Philippines), Kiren (from Malaysia), Huyen (from Vietnam) and Pharozin (from Cambodia) talk of their life’s struggles, and challenges, the fear of being shunned by society, of eventually accepting themselves as positive women, and ultimately emerging as winners and advocates for people living with HIV and as powerful voices in the global dialogue on AIDS. Their lives carry a powerful message of hope and empowerment.

The documentary film 'IN WOMEN'S HANDS' captures the dilemmas of women living in a world of AIDS - women who face the growing risk of HIV with limited options to protect themselves. All around the world, unprotected sex with a long term partner is the number one risk factor for HIV infection in women. They are more likely to contract HIV from a single unprotected sex act than men, yet are unable to protect themselves from HIV without the cooperation of their male partners. Women need prevention methods that are under their direct control. Men-who-have-sex-with-men (MSM) and transgender populations also struggle to negotiate condom use with their insertive partners while having rectal or anal sex, thereby putting themselves at a heightened risk of contracting HIV among other STIs. Insisting on using condom use can also risk putting women or MSM or transgender populations at risk of violence. Prevention options for STIs including HIV need to be developed sensitive to the needs of populations who are least likely to use or negotiate the use of existing prevention methods. Existing HIV prevention methods such as male or female condoms provide bidirectional protection to both partners engaged in the sexual act.

The film "In Women's Hands" captures the need for the research and development of microbicides. According to the World Health Organization (WHO), microbicides are compounds that can be topically applied in the form of a cream/gel inside the vagina or rectum to protect against sexually transmitted infections (STIs) including HIV. They are not yet available and currently under research and development.

The development of microbicides is seen as a key to empowering women to protect themselves from HIV. Women are biologically more vulnerable to the transmission of STIs and many cultural and economic factors compound this vulnerability. Millions of women live in societies that permit them no role in sexual decision-making, that condone male infidelity and assign the burden of shame and stigma associated with infectious diseases to women. Existing preventive strategies have largely failed to address this vulnerability, focusing on abstinence, mutual monogamy and male condom use, none of which are easily controlled by women.

Vaginal or rectal microbicides are also likely to fail until both partners who engage in sexual act understand and respect the need to protect themselves against HIV and other STIs. Not only do women or MSM or transgender populations need preventive options that they can choose to use freely to protect themselves, but the gender inequalities that make it harder for them to insist on safer sex must be addressed too. In this way they will be able to protect not only themselves, but also their partners from avoidable infections.

Both the films highlight the link between gender-based discrimination and HIV/AIDS. Globally, HIV/AIDS disproportionately affects women, and the incidence of HIV/AIDS among women is rising. In 1997, 41 per cent of HIV infected adults were women. In 2009, out of the 33.3 million people around the world living with HIV/AIDS, 50% (16.6 million) were women. This feminization of HIV/AIDS is a worrying trend.

The HIV epidemic in India, first recognised in 1986, is now just under 25 years old and is counted among the most serious public health problems in the country. India carries the largest burden of HIV after South Africa (5.5 million) and Nigeria (2.9 million). It is estimated that around 2.3 million people in India are living with HIV. Of these, an estimated 39% are female and 3.5% are children. As HIV transmission in India is largely through heterosexual contact, the infection rate for women is increasing, and the low economic and social status of women continues to be a barrier to preventing new infections.

However, a new report by the Joint United Nations Programme on HIV/AIDS (UNAIDS), released on 21st November, 2011 shows that India has witnessed a decline in new infections by a significant 56% between 2006-10, which is a welcome sign indeed. India has 4.48 lakh HIV positive patients on the lifesaving anti-retroviral therapy (ART) at present, against the target of 3.4 lakh. Yet, as of now, only 20%-40% of the eligible HIV population was actually receiving ART - one of the lowest HIV treatment coverage in the world. Also, less than 40% of pregnant women had access to ART to prevent new HIV infections among children. Latest researches have proved that in the case of HIV/AIDS, treatment is prevention, and that those on ART are not only able to keep their own disease under control, their chances of transmitting the virus and infecting others is drastically reduced. So it is essential that all those who are in need of it, are brought under ART, and those receiving it continue to do so. The governments will have to ensure that drug stock outs do not occur for want of finances or faulty supply systems, or for any other reason, so that treatment adherence is not compromised.

The discussions that followed the screening of the two films, acknowledged that along with women empowerment, men need to be de-conditioned from their age old and traditional patriarchal role in society and become more sensitive towards the mental and physical needs of their female partners. It was strongly felt by the audience (which was an interesting mix of journalists, educationists, social activists, people working with high risk groups such as MSM, FSWs, IDUs, homeless children, women who have faced violence, young entrepreneurs among others) that there should be more commitment on the part of government to implement its public health programmes, and more community participation to ensure availability of, and adherence to quality treatment.

According to the UNAIDS estimates, there are now 33.3 million people living with HIV, including 2.5 million children. During 2009 some 2.6 million people became newly infected with the virus and an estimated 1.8 million people died from AIDS. It is therefore imperative for the global community to work together to achieve universal access to HIV prevention, treatment and care in order to have "Zero new HIV infections, Zero discrimination, and Zero AIDS-related deaths."

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" published in November 2011. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

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Breastfeeding: A Child's First Immunization

2011-11-25T20:45:00.000+05:30

Mother’s milk is the ideal nutritionally perfect food for newborns and infants. It is like nectar for the infant and is aptly called the first vaccine that can be given to the child. Apart from the unique ability to nourish the baby, it is also packed with several antibodies (immune globulins) that provide protection against common childhood illnesses, including pneumonia, a prime cause of child mortality which kills more than 4,300 children everyday worldwide. It is safe, easy to digest, is readily available and very affordable.

Breastfeeding is the cheapest and most effective way to ensure a child’s health and survival. A lack of exclusive breastfeeding during the first six months of life contributes to over a million avoidable child deaths each year. Beyond the immediate benefits for children, breastfeeding contributes to a lifetime of physical and mental health and well being. It is no wonder then that the World Health Organization actively promotes exclusive breastfeeding for the first six months of the child’s birth.

According to Dr. Neelam Singh, Consultant Obstetrician and Gynaecologist and Chief Functionary of Vatsalya Resource Centre on Health, “Exclusive breastfeeding implies that the child should be only, and only, be on mother’s milk for six months, and not given anything else like water, gripe water or honey. Breast milk contains a number of immune globulins which increase the child’s resistance to a wide range of diseases especially pneumonia and diarrhoea. Apart from increased immunity, breast fed infants also have better mental development. There is evidence that the intelligence quotient (IQ) of these children is higher by 8 to 10 points as compared to children who are not breastfed. Breastfeeding also reduces the risk of allergic conditions like skin diseases, asthma and even coronary heart disease in later years of life.”

Dr. S.N. Rastogi, a renowned Paediatrician who runs a private clinic in Lucknow says, “Exclusive breast feed is the best feed that can be given to a child.”

Dr. S. K. Sehta, Consultant Paediatrician and Neonatologist, Lucknow, feels that breastfeeding builds an emotional bonding between the mother and the child which plays a crucial role in mother-child relationship. Also, breast milk has certain hormones (which are lacking in formula, cow/ buffalo milk) which increase the child’s resistance to a host of diseases including pneumonia.

Despite the medical fraternity vouching for the efficacy of mother’s milk, less than 40% of infants below six months of age are exclusively breastfed. In fact only 15% to 20% of the mothers coming to Dr Neelam Singh were following this regimen strictly. Support for mothers is essential as many mothers may face initial hiccups to exclusive breastfeeding, like nipple pain; fear that there is not enough milk to sustain the baby; lack of information; and socio cultural barriers.

According to Dr. Neelam Singh, “Not only the doctor, but everyone who converses with a new mother-- the nurse, attendant and her family members--has a distinct role to play. The doctor’s responsibility is to assure the mother that she can give her child complete nutrition by exclusive breastfeeding and to ensure that breastfeeding is started early. The paramedical staff should educate her about the benefits of breastfeeding and help her continue with it. The family’s role is to support her and take good care of her food and nourishment. For working mothers the workplace environment and working conditions should be baby friendly -- flexible working hours that allow mother to breastfeed her baby; separate feeding rooms where the infant can be brought at the time of feeding; and/ or maternity leave for six months. Many nations are working in this direction but in our country a lot needs to be done.”

Dr. S. N. Rastogi feels that, “Some women are figure conscious and think that breast feeding will spoil their figure. But this is a myth. In other cases mothers themselves are under fed and so they are not able to produce enough milk.”

Dr. S. K. Sehta, says, “In India a large number of mothers are undernourished and there is the fear of insufficient lactation, so they switch over to top feed which is absolutely a wrong practice. If the child is being exclusively breastfed for the first six months, the chances of a large number of infectious diseases is drastically reduced. Only in extremely rare (around 1%) cases where we find that sufficient breast milk is not being produced, or if the mother is suffering from some serious ailment, that the doctor allows top feed in the form of the infant formula milk available in the market, if the parents can afford it. But a number of drawbacks are associated with formula milk and bottle feeding. The level of hygiene demanded by bottle-feeding is very hard to meet here. This predisposes the child to infection. They also tend to dilute the milk which leads to undernourishment of the child.”

Dr. Neelam Singh too agrees that, “Infant formula milk may perhaps meet the nutrient requirements but it does not have immune globulins. Also, bottle feeding demands greater hygiene and cleanliness which is not possible in our country. India is a tropical country with high temperature that favours spread of communicable diseases, and formula milk cannot increase a child’s resistance to fight diseases, whereas mother’s milk has.”

In the chaos of ignorance about the benefits of breastfeed, there are some sane voices of mothers like Mrs. Alpana Singh, which are worth emulating. Alpana, a new mother who delivered her second child recently at a private nursing home (City Hospital) in Lucknow, says, “I exclusively breastfed my first child during the first six months, starting from day one, after my caesarean delivery and did not give him even water or top feed. Since I had to join my workplace only after three months of maternity leave, I made use of the breast pump to store my breast milk for 3-4 hours. This way I tried my best to breastfeed my baby for at least one year.”

Health facilities that support breastfeeding - by making trained breastfeeding counsellors available to new mothers - encourage higher rates of the practice. To provide this support and improve care for mothers and newborns, there are now more than 20 000 "baby-friendly" facilities in 152 countries, thanks to a WHO-UNICEF initiative. Public health workers working with the masses have a distinct role to play in dispelling the misconceptions and socio-cultural dogmas associated with breastfeeding. We need to mobilize not only the mothers but also their families about the importance of exclusive breastfeeding. It needs a combined effort from the entire society so that breastfeeding is encouraged.

Somya Arora, CNS
(The author is doing her post-graduation in microbiology from Lucknow University and writes on social justice issues for CNS: www.citizen-news.org)

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Off-Track, Off-Target - Sanitation in South Asia: Women Economists Urge Governments to Act

2011-11-21T10:25:00.001+05:30

The observance of World Toilet Day was initiated by the World Toilet Organization on 19th November 2001, to raise global awareness of the emotional and psychological consequences the poor endure as a result of inadequate sanitation. Yet it is a disgrace that this completely preventable crisis continues to blight the lives of 2.6 billion people across the globe that do not have access to proper, clean sanitation. A group of about 35 women economists from different countries of Europe, UK, US, Australia and India, have written an open letter to the Prime Ministers and Presidents of South Asian nations, including India, which are facing acute sanitation crisis. From India Jayati Ghosh, Professor, Centre for Economic Studies and Planning, Jawaharlal Nehru University, Bina Agarwal, Director, Institute of Economic Growth, Delhi University and Isher Judge Ahluwalia, Chairperson Board of Governors, Indian Council for Research on International Economic Relations have signed the letter.

The letter states: “On the day you are reading this letter 4,000 more children below five will die from diseases caused due to unsafe water and poor sanitation. The mortality is much higher than what is caused by diseases like AIDS, Malaria and Measles combined.”

The letter was released on the eve of World Toilet Day, 2011, along with the latest report ‘Off-track, Off-target’ on water and sanitation situation in India, published by the international charity WaterAid. According to the report, there are more people in the world today lacking adequate sanitation services than in 1990. The report also claims that unless immediate action is taken, India would fail to meet the Millennium Development Goal (MDG) of reducing the number of people living without sanitation facilities to half by 2015. India’s MDG target is to ensure that 86% of the population gets safe drinking water by 2015 and 59% of the population is covered with adequate sanitation by that time.

The WaterAid report also points out that many of the neighbouring nations too are heading towards failure in meeting the Millennium Development Goals. As per the present progress rates, Pakistan will achieve the MDG goals in 2028, Bangladesh in 2029 and Nepal will meet the target not before 2030.

“To get the sanitation and water MDGs back on track, South Asian countries, which are off track, need to spend at least 1% of their gross domestic product (GDP) on improving sanitation services,” suggests the report. It also calls on countries, which are providing funds to developing nations, to prioritise and double their financial assistance in the water, sanitation and hygiene sector by allocating an annual additional grant of USD10 billion.

A glance at the sanitation and water status in India would reveal that: Almost 50% of households even in big cities like Bangalore and Hyderabad do not have sewerage connection; Only 21% of waste water is treated, as compared to 57% in South Africa; In about 80% of the rural households, the average water supply is less than 5 hours a day and over 70% of the household do not have access to toilets or sewerage system; Out of 600,000 villages only 250,000 are free from open defecation.

India accounts for 58% of the world’s population of open defecators. Though the government records claim that 88% of the Indian population has access to safe drinking water, only 31% are covered by proper sanitation facilities. According to statistics, the nation has achieved MDG target in water sector, but with the current rate of progress the nation is feared to miss the sanitation target by 32 years. The Indian Minister for Rural Development and Drinking Water Supply and Sanitation Jairam Ramesh too says, “Sanitation is the biggest blot on the human development portfolio in India, as the sanitation situation is disastrous.”

Given this dismal scenario, it seems ironical that the states have been unable to utilize even the available funds. For example, in the last fiscal year, under Total Sanitation Campaign for Rural Areas, 27 billion rupees remained unutilised whereas 19 billion rupees were not used in the Rural Water Programme. Consequently, the nation is paying the cost for not spending on drinking water and sanitation in the form of loss of working days, expenditure on healthcare, school drop outs, malnutrition, anaemia, and infant/child mortality.

“Every year thousands of children die in India due to a lack of adequate sanitation and clean water. While some progress has been made, we continue to bear the true cost from the failure to ensure basic water and sanitation services. The Government must increase the level of spending on water and sanitation, and donor governments should increase the share of aid they spend on water and sanitation, so that all stake holders can work together to turn around the situation,” says Indira Khurana, WaterAid’s India’s Director, Policy and Programmes.

Even the National Sample Survey Office (NSSO), Government of India data of 2008-09 indicates that the poor sections of society, especially in the rural areas, are four times less likely to have access to improved sanitation facilities i.e. having a toilet at home, in comparison to the rich population. According to the WHO/UNICEF Joint Monitoring Programme, India has provided sanitation cover to over 200 million people between 1995 and 2008. However, the progress has been rated as highly inequitable as it displays exclusion of certain caste and communities. A research by WaterAid illustrates that the Scheduled Castes in particular are denied access to water facilities. Even the children from scheduled caste communities are not allowed to drink water from common water sources in schools.

To draw the attention of the government towards this crisis, WaterAid has joined hands with End Water Poverty Campaign (a campaign involving 190 organisations all across the globe to end the water and sanitation crisis). Together they are organising 50 ‘Crisis Talk Events’ in 20 nations on World Toilet Day today. These talks are to focus on various dynamics of the issue. During these events the local groups are to meet the politicians to discuss the water and sanitation crisis in their respective areas.

Alka Pande
(The author is a senior journalist based in Lucknow, India)

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Children of India Unite: Let Your Voices Become An Uproar For Justice

2011-11-19T17:34:00.001+05:30

India is shining, and we all love our young India whose 40% population is below 18 years of age. Our country boasts of having 57 billionaires, out of which 7 are amongst the top 100 richest people of the world. So what if: every 15 seconds a child dies of pneumonia/diarrhoea/simple neonatal diseases; if 48% of India’s children below 5 years of age are malnourished—the highest in the world; if it boasts of a world first with 17 million child labourers ; if 1 out of every 4 commercial sex workers are below 18 years of age; if it ranks first in having maximum number of 61 million stunted children in the world and if only 2 out of every 5 children below 14 years of age go to school....the list is endless.

Food, health and education are the basic rights of every child. Yet our government allocates only 3.23% and 1.06% of its GDP to education and health respectively. (Even Malaysia allocates 8% to education and Bangladesh 2.3% to health). So it is high time that the government fulfils its promise of increasing this at least to 6% for education and 3% for health (a total of 9% of its GDP) by the year 2014. This is exactly what the ‘Nine is Mine’ campaign about. Spearheaded by Brother Steve Rocha of the Christian Brothers, it is a participatory advocacy initiative of the children across India, to stir up public support to press the government to fulfil its promise of allocating 9% of the GDP for education and health. The campaign seeks to create a committed consensus and political will within the entire nation to put quality education and basic healthcare on priority, with a view to end poverty, social exclusion and discrimination.

Loreto Convent Intermediate College, Lucknow, recently played host to the members of the Nau Kadam Yatra, comprising 18 children (nine of whom are visually/hearing/physically challenged) who are traversing through nine different states of India, garnering support for their just demand that 9% of the country’s GDP be allocated for education and health. This yatra is a part of the ‘Nine is Mine’ campaign, and is being led by Wada Na Todo Abhiyan (Do Not Break The Promise). It aims at giving children an experience of advocacy, lobbying and participation in governance and accountability.

The focus of this event in Lucknow (held on 16th November, 2011) was on the urban poor child, where three ‘out of school children’ spoke on their life experiences as part of the ‘children’s hearings’ programme of the yatra. The school provided a platform to hear the voices of the unheard, and reverberated with the testimonies of Neelam, Sitara and Shivam-- children of rag pickers and beggars—who echoed the voices of millions of underprivileged children across India, demanding a more equitable and just social order. Their pleadings were joined by the voices of the school children, underprivileged children, teachers, politicians and media present in the audience.

The delegates of the Nau Kadam Yatra also presented a soul stirring mime show, wherein without uttering a single word, they focussed on various problems faced by the children in our country-- like child labour, commercial sex, malnourishment, lack of education, discrimination of the girl child—compelling the audience to take up their call for action, and raise voices with them (and not just for them).

This Yatra or journey started from Shillong on 8th November and would culminate in Delhi on 20th November on Child Rights Day passing through nine states. At each halt they are holding ‘children’s hearings’ on stories of various focus groups like tribal/adivasi/dalit children, children living in conflict, vulnerable urban/rural children, the girl child, children with disabilities, thus exploring different facets of Child Rights issues. In Delhi they would be joined by two other yatras traversing through other parts of India. Together they hope to have an audience with the Honourable President of India, and would collectively present a memorandum to the policy makers for allocating 9% of the GDP for education and health with a view to achieve the UN Millennium Development Goals of ending chronic poverty and hunger by the year 2015.

In an interview given to CNS, Brother Steve Rocha confided that, “The seeds of this movement were sown by the Loreto Sisters of Ireland, who introduced me to the Millennium Development Goals, in an event organized in Loreto Bowbazar, Kolkata, in 2006. I went back and shared these goals with my students, at St Columbus School in Delhi, and one of them remarked: ‘Thank you very much, Brother. But what are we going to do about it?’ This stumped me. Here was a child asking me to do something, rather than just talk. So we started by painting our school walls with the 8 millennium goals. Then we felt that this was not enough, and thus began this advocacy campaign for social justice, to pressurise the government to fulfil its promise of allocating 9% of its GDP for education and health towards the achievement of the UN Millennium Development Goals of ending chronic poverty and hunger by the year 2015.”

“We are living in an age where children need to be heard, not just seen. The Convention on Child Rights acknowledges that they have the right to be heard and the right to have their opinion taken seriously. Every child has the right to quality education and basic health facilities. It is not only about budget allocations, but also about how the programmes are delivered. We need to look at the various flagships of the government and keep the government accountable to keep its promises and deliver them well. Children should be involved in the process of policy making, as well as its implementation. We need to interact with our elected members, convey to them what our hopes and desires are and we need them to speak out on behalf of millions of vulnerable children.”

Archbishop Desmond Tutu, one of the forces behind the anti apartheid movement of South Africa had rightly remarked—if everyone who wishes to see the end of poverty and human suffering, speaks out, the noise will be deafening. Politicians and everyone will have to listen.

Children may not have votes but they have voices. They have the right to quality education and to good health. They have the right to live. It is high time we joined their voices and held their hands. We have no right to kill the dreams of children. In fact, they will have to keep us elders alive with their aspirations, and keep us reminded as to what ideals are, what the real human spirit is all about. We have to take this movement forward and keep shouting, till deaf ears hear us. Only then nine will be ours.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught Physics at India's prestigious Loreto Convent for over three decades. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

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New times, new tactics: broadening the argument for TB vaccine development

2011-11-19T09:48:00.002+05:30

What if no extra funding for tuberculosis vaccine research comes in? To Joris Vandeputte, Vice-President of the Tuberculosis Vaccine Initiative (TBVI), this is an unimaginable scenario. “That would delay the delivery of new vaccines with ten to fifteen years. Or more likely, the most advanced candidates would disappear completely and we would be back at square one.” Dr Vandeputte hosted a seminar about arguments for investment in the development of new TB vaccines at the recently concluded 42nd Union World Conference on Lung Health in France. During the seminar tuberculosis advocates discussed how to broaden the range of arguments that can be used to convince politicians and decision makers to invest in the fight against tuberculosis.

Nearly one and a half million people die from TB every year, leaving millions and millions of children orphaned. Annually, nearly nine million people fall ill with this devastating disease. In people living with HIV, tuberculosis is one of the main causes of death. Still these arguments don’t seem to be cause to provide the needed resources to eliminate the disease.

“TBVI knocked on every door asking for grant money to develop new vaccines. We met friendly and less friendly faces without tangible success. Eventually people told us to create a business case, to show why it is economically responsible to invest in these research projects.” So that is what TBVI did: costs and benefits were calculated, a financial model was designed. Currently, the organisation is working with European decision makers to try and get the investment plans approved.

“The benefits of investing in TB vaccines are numerous,” explains Mr Vandeputte. “Tuberculosis costs 0.52 percent of the world’s GNI. That may not seem much, but it comes down to a couple of hundred billion dollars. In the WHO European region the cost of TB is over 2 billion euros and in the EU-27 region we calculate the costs to be at least 750 million euros per year. With more new, effective vaccines we can significantly reduce this financial burden and make elimination of tuberculosis by 2050 a reality for the world. As a bonus, developing new vaccines means great innovation and it can boost economies and create jobs.”

TBVI’s funding model, of which Dr Vandeputte was one of the architects, asks European governments to support it so the organisation can leverage money from European institutions such as the European Investment Bank. An amount of 560 million euros, spread over ten years, should be enough to bring one or two vaccines, perhaps more, out of TBVI’s portfolio to a point where private sector can take over. The invested money will be paid back through royalties and exit fees on successful vaccine candidates.

“It’s a huge challenge,” admits Joris Vandeputte. “But we have to get this done. TB is a real threat and a serious financial burden. Without investment in new tools, we will not be able to eliminate the disease. We now have a strong portfolio with a variety of promising vaccine candidates. TBVI is ready to take the next step. We ask advocates to cry out that new tools to eliminate tuberculosis can become a reality by the end of this decade, if we invest now.”

Jojanneke Nieuwenhuis
(The author is an Associate Communications and Advocacy Relations, TuBerculosis Vaccine Initiative - TBVI)

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Where does the buck stop????

2011-11-17T17:50:00.001+05:30

Each year 14th of November is celebrated as Childrens' Day in India, and this year (2011), as part of this celebration, a workshop was organized by Global Health Advocates (GHA) India, titled ‘Towards Eliminating Pediatric TB’. The gathering had interesting and informative presentations from Dr. Ashok Kumar Deputy Director General, Health Services, who also heads the RNTCP, Dr. Sachdeva from Central TB Division, Dr. Sangeeta Sharma, Pediatrician from LRS Institute, Dr. Amdhekar, a private practitioner and former president of the Indian Academy of Pediatrics, and a Civil Society representative.

The highlight of the meeting was the sharing by the parents of 2 boys, Akshay and Pankaj aged 13years and 6years who were diagnosed with Extensively Drug resistant (XDR) TB about a year ago at LRS Institute, New Delhi. The family hails from Punjab, a neighbouring state, and when the children started getting sick, they ran from pillar to post before finally being referred to LRS Institute in Delhi. The pediatrician at LRS diagnosed them as having XDR, admitted them and asked them to purchase the medicines for treatment. The father is the only earning member in the family and works as a vegetable vendor. Their monthly income cannot be more than INR 3000 which is about 60 USD. The family was told that since they were not residents of Delhi, they had to purchase the medicines themselves. This hospital catered to Delhi patients only.

The family had to go back to their native place and, with no other means to pay for the expensive medication, mortgaged their home for 200,000 INR, (about 4000 USD) and bought the medicines for their children. This put them at risk of losing their home, made them poorer and made them victims of stigma due to the sons’ illness. The boys have been removed from school by the principal. The hapless mother wondered tearfully if they would ever get suitable husbands for their two daughters, what with the stigma associated with the disease, the loss of their home and the ensuing forced extreme poverty.

TB treatment is free in India. That is what the government claims, and holds out its Revised National Tuberculosis Control Programme (RNTCP) as one to be emulated. Then why were these children refused free drugs? Is it because those suffering from MDR and XDR TB are not the state's responsibility because it costs at least 200 times more for treatment of MDR and XDR TB compared to a 6 months treatment of drug sensitive TB?

Who is responsible for making the already poor family poorer? Who will take responsibility for the complete violation of the rights of these two children? Who is going to pay??? The buck needs to stop somewhere. Dr. Ashok Kumar, in answer to the questions regarding such incidents where patients were being sent away with prescriptions from many hospitals, agreed to look into the matter and as head of the RNTCP, took the blame upon himself for this serious mistake.

I think we have all failed these (and many other) children and are guilty. The National TB programme coordinators, the pediatricians, civil society members and activists-- none of us can turn a blind eye as children die of TB-- one every 5minutes-- whether it be due to poor/mis diagnosis, unavailability of cheap but quality treatment, and/or misconceptions prevalent in the society about the disease.

Blessina Kumar
(The author is a senior TB activist and serves as a Vice Chair of the Stop TB Partnership)

Atharva: Tell-tale of a pneumonia crusader

2011-11-17T17:34:00.002+05:30

15 OCTOBER 2011: Atharva, is a 2 years and 10 months old child who is battling for life at the Paediatric Intensive Care Unit (ICU), Chhatrapati Shahuji Maharaj Medical University. Hospitalized for over 3 months the child gets terrified even at the sight of equipments. He tried to hide in his mother’s lap seeing the CNS reporter’s camera and other gadgets. Atharva’s father is a PAC jawan. His mother Mrs. Renu Bala Sharma had a long painful story to tell. “He got fever on the 21st July. We consulted a private doctor in Sujanpura, Alambagh regularly for 3 days that is 22nd, 23rd and 24th July 2011. On the 25th July, he told us that our child has pneumonia.”

When enquired about whether she had heard about the disease earlier she says, “We had heard that pneumonia is a common disease of children and children do get infected with it often but we had never thought it would get so serious.”

Atharva’s parents are well-educated and showed no negligence towards their child’s illness. They consulted medical help as soon as Atharva got fever and chest congestion. His mother adds, “He had no disease before. The first day he got fever we brought him to the doctor. We can’t be careless with our child. We had sought medical attention immediately.”

From here began a series of hospitalizations. Mrs. Sharma says, “So we took him to another private children’s hospital in L.D.A. Colony and got him admitted there. He was treated there till 29th July. On the 29th July they told us that the bag of pneumonia has burst inside. There is a bag inside. Suddenly it appeared that he is not being able to breathe. We felt it is his last hour and it seemed very difficult that we would be able to reach a super-speciality mother and child Hospital in Alambagh (popular for IVF) in time. They said that if we can spend money then we can refer him to this hospital. We said that that money is not important we want our child. So he was brought to this hospital on 29th July and got him admitted around 4pm.”

Private hospitals mostly operate with the aid of on-call doctors who are called when a patient of their specialization is admitted. There is no 24 hour supervision of experts. In a serious illness as pneumonia where the patient’s condition deteriorates quickly, such an arrangement can put several lives at risk and it did in Atharva’s case as well.

At this super-speciality mother and child hospital, Alambagh, Atharva’s condition worsened until he was put on ventilator and taking probably his last breaths as the doctors there had declared so.

Atharva’s mother laments,“There they saw two X-rays which were of the initial stages. When they examined him they said that it has got filled with air. The pneumonia has burst, I’m expressing in my language from my understanding. They inserted I.C.D. after which he was relieved a little. It appeared that now he is able to breathe. Then they asked us to bring blood bottles for transfusion. We came to the medical college to get blood. The blood was given in three stages. They kept on giving their treatment. They did not tell us anything and carried on with their treatment. We felt very helpless. All we could do was shell out money and watch the doctors with hope. The condition of my child kept on deteriorating. They had inserted a single tube and following that another thick tube, which caused his body to swell tremendously. My two year old son appeared to be ten years old. His cheeks had swollen. It felt as if his eyes would fall off. It seemed as if air had filled up in his entire body. He would lie down and they would make incisions, then force out the fluids by applying pressure. His genital region had also swollen up. The doctors would do nothing despite our request. They would say we can take the child anywhere we wanted to. In the end they put him on ventilator.

They told my husband that now he has only two hours of life left. Your child will survive for hardly 2 hours.” For a middle-class family private hospital treatment can mean a life time’s saving, but Atharva was lucky to find help of some relatives. Mrs. Sharma narrates, “At that time all my family members, my sister, sister’s husband, brother, brother’s wife everybody had gathered there. They all were trying to find a way to save my child’s life. We have spent about INR 150,000 in his treatment already. I only want my child healthy and sound now.”

Private hospitals play very safe when admitting cases. A complicated case with meagre hope of survival is rejected to save the private hospital’s brand name. Athatva’s parents even tried to approach the city’s biggest multi-speciality hospitals for help. Mrs. Sharma says, “We tried to approach Lucknow’s new and biggest multi-speciality hospital in Gomti Nagar but they denied accepting such a severe case.”

Finally Atharva was brought to the government-run tertiary care centre and medical college, Chhatrapati Shahuji Maharaj Medical University (CSMMU) – erstwhile King George’s Medical College - on 5th August 2011. His mother takes a sigh of relief saying, “They did not leave any treatment. It was his destiny and our good luck that he survived. At one point we were at dead end. I felt my child won’t come back to me. Professor (Dr) YC Govil is like a God for me.”

Futher narrating the apathies of private hospitals she adds, “We feel that his condition got so complicated only because of negligence on the part of doctors. They did not get any tests done. They did not know what treatment to give. They were treating him on guesswork. They were even giving treatment for TUBERCULOSIS, the tablet which is given empty stomach in the morning.”

Atharva was a healthy child but wasn’t exclusively breastfed for the first six months, probably due to lack of awareness about its importance in preventing pneumonia and other childhood illnesses. His mother says, “I have breastfed my child. Even now he wants me to feed him but because we are in a hospital I don’t want to feed him. During the first five months I used to give apple juice and water along with my milk but I started giving him cereals only after his ‘Annaprashan’ at the start of his sixth month. He used to eat everything. Gradually he had started taking everything.”

The pneumonia vaccination because of its high cost has not yet been included in the Government of India’s vaccination programme. There is also little awareness among the masses about the existence of these vaccines and about the fatal nature of the disease. Atharva’s parents are no different. His mother laments, “We got him vaccinated against every disease. At the one and a half month then at two and a half months. There is a immunization card. We went by the card. We don’t know whether it had pneumonia vaccine also in it. We have spent lakhs of rupees already on his treatment. Had we known about the vaccine we would have definitely got him immunized.”

Development of antibiotic resistance among common pathogens is a global concern. Professor (Dr) YC Govil, Department of Paediatrics, CSMMU, remarks “There is a lot of disparity in between the treatment at private and government hospitals. Lot of antibiotic misuse is happening in our country and the reason is many a times patients are been treated by unqualified practitioners of medicine in rural areas. I think almost 20-30% of patients would initially go to an unqualified practitioner. So here they are in habit of advising lots of broad spectrum antibiotics in the beginning. Even in viral infection where antibiotics are not usually indicated. This is also prevalent in the urban setup as well. Before the first wonder drug penicillin was discovered men used to die like flies and if this trend continues that era would return.”

The senior resident doctor incharge of Atharva told the CNS reporter that Atharva was on ventilator when brought. Further he adds, “His sputum showed positive result for multiple pathogens like Streptococcus pneumonia and Eshcherichia coli. He did not respond to any of the traditional antibiotics. Finally was given tigecycline, a newly released and most advanced chemotherapeutic agent. The patient responded to it and was removed from ventilator. The patient is stable now. But under observation.”

Somya Arora - CNS
(The author is doing her post-graduation in microbiology from Lucknow University and writes on social justice issues for CNS: www.citizen-news.org)

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Act On Diabetes Now: Exercise Well, And Eat Healthy

2011-11-13T12:52:00.003+05:30

The year 2011 marks the 21st anniversary of the World Diabetes Day, the primary global awareness campaign of the diabetes community, which was launched in 1991 on 14th November by the International Diabetes Federation (IDF) and World Health Organization (WHO) to draw attention to the already high number of people living with diabetes at that time (over a 100 million). But the situation seems to have worsened with every passing year.

Recent figures released by IDF paint a scary picture of the diabetes epidemic showing no signs of abatement. 366 million people worldwide are now living with the disease and many more are at risk; diabetes is responsible for 4.6 million deaths a year; it is among the top ten causes of disability resulting in devastating complications such as blindness and lower limb amputations; all nations- rich and poor- are suffering its impact, and the disease is hitting the poorest hardest. It is an increasing burden on global health system with an estimated $500 billion spent a year on it.

Keeping in mind this dismal scenario, the IDF and WHO are calling upon thousands of people from over 170 countries to join together to Act On Diabetes Now –the theme of this year’s World Diabetes Day—with a view to put diabetes firmly in the public spot light and take corrective action. The reasons for this almost four times rise in the incidence in diabetes over a period of 21 years could be manifold. According to Mr Lorenzo Piemonte, Communications Coordinator at IDF, “Diabetes is strongly linked to urbanization, which is the case in many developing countries where 80% of the new diabetes cases are happening. As people have access to more wealth they adopt more western lifestyles, which results in an increased risk to developing type 2 diabetes, the most common form of the disease. It is often still considered the rich man’s disease, but the numbers show that it hits the poor man the hardest even in developed countries, and is increasing in every country of the world with a disproportionate impact on the developing countries.”

Dr Gourdas Choudhuri, Professor and Head, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), also agrees that Type2 diabetes (commonly called adult onset diabetes), is spiralling mainly because of unhealthy lifestyles. According to him, “Type2 diabetes has a very strong genetic component and the genes of this have been passed down for over generations in us Indians. Yet it was not as common in our forefathers as it is in us now. The reason for this is the changing environment and life style. If we have the genes, it definitely makes us more prone to diabetes, but it does not mean that we will necessarily develop the disease. But a very high consumption of high sugar and fat—much more than what the body needs – makes our bodies fertile ground for diabetes. A high Bone Mass Index (above 25) means that there are excess fat cells in the body, and fat cells are natural antagonism reaction of insulin. Therefore their presence contributes to insulin deficiency, which is the underlying cause of diabetes. Another reason is lack of exercise and sedentary life habits both in adults and children.”

So what is the best step forward, to counteract the onslaught of diabetes? Dr Choudhuri firmly believes that, “We need to exercise well, and eat healthy. Exercise not only brings the body weight down, it also improves glucose metabolism. It is also absolutely necessary to have healthy food options available in the market. It is a good sign that multinational fast food chains, which used to sell only calorie loaded dishes like burgers and pizzas, are slowly succumbing to the demands of health conscious people, and have started selling salads too, especially in the west. In India, as of now, that level of awareness is not there. But it is just a question of mindset. Once we perceive it is as a necessity, we are bound to consume healthier and low calorie foods. A positive start in this direction is the availability of sugar free ice creams and sweets, which are safer options for people living with diabetes. Again, ‘Subway’ outlets in India are selling a variety of healthy food options of brown bread, greens and salads.”

Dr Choudhuri further stresses: “I cannot overemphasize the importance of schools in inculcating good eating habits and healthy life styles in students. Several things need to change at the school level. Firstly, school timings are getting shorter, and the whole emphasis is on academics and scholastic achievements. A comprehensive development of the child is taking a back seat. Secondly, the extent of games and sports activities has come down sharply, probably because of lack of available time in school. This needs to be dealt with on a serious footing. We need a more inclusive approach to physical activities, and regular use of the games field should be made compulsory for all, and not just for those who are good at sport/athletics. The other issue is that schools need to play an active part in deciding what is sold in the school canteen, as is already happening in many developed countries. One of the good things that have started in the US and other countries is the ban on sale of cola drinks in and around the schools (not just in the canteen). Sugared soft drinks with empty calories are one of the major causes of obesity. We need to do that in India too. The canteen food in Indian schools is not healthy. It is generally deep fried stuff like samosas, bread pakoras and chhola bhaturas. School authorities have to be more sensitive to these issues, and ensure that healthy (and not junk) food is sold in the canteens. Also there should be no fast food shops located in the vicinity of schools. Healthy food does not mean boring and unpalatable food. In my own hospital here we coaxed our cafeteria guy to sell at least 5 food items which were very healthy and yet tasty. One is puffed rice with baked peas, which is a legume and has fibre and protein. Another option was to make a roll of roti instead of paratha stuffed with boiled vegetables which were tastily flavoured with different types of sauces. This became a huge success with the hospital staff. Such options should be made available in schools too.”

In September this year, the UN High Level Summit on Non Communicable Diseases, held in New York, brought diabetes to the attention of world leaders and put it on the global health agenda. Mr Piemonte rightly feels that, “14th November, this year, presents the perfect opportunity to build on the momentum generated by the Summit and produce a powerful and united voice calling on governments and decision makers to deliver on their commitments, which they made in September, to tackle the epidemic.”

If nothing is done to prevent a further rise, we would be looking at over half a billion people living with diabetes within a generation. So let us all join hands to help make a difference and achieve a healthy future. On the eve of this world diabetes day, the famous Taj Mahal of India will, for the first time, bathe in blue light, joining scores of other monuments worldwide, to show solidarity in the fight against diabetes.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught Physics at India's prestigious Loreto Convent for over three decades. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

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Voices from the field on childhood pneumonia: Book released

2011-11-12T15:27:00.002+05:30

[Download the book "Voices from the field on childhood pneumonia" in हिंदी, English, Urdu ]
Pneumonia despite being preventable and curable, is the world's (and India’s) leading killer of children under five, claiming one young life every 20 seconds. That’s 4,300 young lives lost every day. That's more than AIDS, malaria and measles combined. Pneumonia is one of public health’s most solvable problems, said Dr Ajay Mishra, Managing Director, Nelson Hospital for Paediatric and Neonatal Medicine, Aliganj, Lucknow. “We have safe, effective and affordable tools to help children. Children should have access to effective and affordable treatment using antibiotics, which typically cost less than one dollar per dose. Tragically, only an estimated 1 of every 5 children with pneumonia receives antibiotics” said Dr Ajay Mishra.

A book titled “Voices from the field on childhood pneumonia” was released electronically and in hard copy in three languages – English, Hindi and Urdu, which is a compilation of articles authored by a group of ten citizen journalists who write for online portal CNS: www.citizen-news.org

The group of authors include: Shobha Shukla, Somya Arora, Shikha Srivastava, Rahul Kumar Dwivedi, Ritesh Arya, Neeraj Mainali, Nadeem Salmani, Jitendra Dwivedi, Jittima Jantanamalaka and Bobby Ramakant.

These articles have been written as part of a CNS series in lead up to the World Pneumonia Day, 12 November 2011.

These authors conducted interviews with paediatricians, gynaecologists and obstetricians, parents and guardians of children who had pneumonia and other public health experts in Lucknow, Bahraich and Gorakhpur, during October-November 2011. They focussed on the following five themes:

Theme 1: Importance of exclusive breastfeeding during the 1st six months of life in protecting children from pneumonia and many other diseases
Theme 2: Importance of good nutrition and hygiene (including hand-washing) in preventing pneumonia and other diseases
Theme 3: Importance of indoor air pollution (cook stove, tobacco smoke) in preventing pneumonia and other diseases
Theme 4: Access to affordable vaccines in our communities to prevent childhood pneumonia
Theme 5: Access to standard quality treatment to save lives from pneumonia

The publication is online at: www.citizen-news.org and readers are welcome to download or distribute it for public cause.

CNS

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Wake up call after years of neglect on childhood pneumonia

2011-11-12T12:41:00.003+05:30

Pneumonia is the world's leading killer of children under five, claiming one young life every 20 seconds. That's more than AIDS, malaria and measles combined. Pneumonia is one of global health’s most solvable problems. We have safe, effective and affordable tools to help children. Children should have access to effective and affordable treatment using antibiotics, which typically cost less than one dollar per dose. Tragically, only an estimated 1 of every 5 children with pneumonia receives antibiotics.

Effective “case management” strategies can help to ensure that children receive the right treatment for pneumonia quickly, even in the poorest communities. “Pneumonia project in Malawi was based on our TB model which was delivering standard case management to children most at risk. The ‘know how’ is there but getting the ‘know how’ to the children is the problem. We know that the standard case management works but in most countries the problem is the weak health systems. One of the International Union Against Tuberculosis and Lung Disease (The Union)’s strengths is technical assistance in trying to build up and give capacity building to the health systems. And we showed this that if we do this for children with lung disease then we can have a huge impact. And it doesn’t cost a fortune. Another challenge is delivering oxygen to children with very severe pneumonia. So this needs to be addressed as well” said Dr Penny Enarson, Head, Child Lung Health Division, The Union.

DRUG STOCK-OUTS ARE MAJOR STUMBLING BLOCKS
Antibiotics used for treating pneumonia are still the first line antibiotics (and not the expensive ones) such as Benzopenicillin, gentamycin, amoxicillin among others. “These are quite inexpensive, easily managed but again usually it is the problem of logistics. Very often the governments either don’t get the supply or don’t maintain the supply of these antibiotics. So it is a major stumbling block for any strategy that is based on the standard case management because it relies on uninterrupted supply of antibiotics. These antibiotics are not expensive especially in India, because India is manufacturing a lot of these drugs. Countries in South Asia, South East Asia and Africa import these drugs from India. So it is a matter of commitment and ministries of health being logistically capable of keeping a stock of drugs always at the district and health centre levels for they are not expensive. There are two new vaccines for pneumonia, the HiB vaccine and pneumococcal vaccine. But both of them are expensive and not many countries have added them to their vaccine regiment because of the cost perhaps. These are major vaccines that really help in reducing deaths from pneumonia”, said Dr Penny Enarson.

IRRATIONAL USE OF DRUGS IS ANOTHER CHALLENGE
A problem when we can buy drugs over the counter is the over use or irrational use of drugs. “We follow rational use of drugs in standard case management and lot of it is about educating the mother on rational use of drugs. For example, children with common cold don’t need antibiotics, although it is so much easier for the physician to give it and mother is happy indeed. Children with common cold need some extra food and care etc, else this is where probably drug resistance can occur” said Dr Penny Enarson.

"To do a drug-resistance study is quite expensive, and that is why lot of countries don’t know their drug-resistance history. But by actually doing the treatment we do get to know that it works. In lot of countries there is no resistance to first line antibiotics but recently there has been some shift away from benzopenicillin and gentamycin for very severe pneumonia. Usually for less severe pneumonia we were earlier using cotrimoxazole but nearly every other country is resistant to that. More countries are now switching to amoxicillin which is a little more expensive. These are based upon the recommendations of the WHO and lot of these studies were done in Pakistan", said Dr Penny Enarson.

"It has shown in many studies that if we exclusively breastfeed an infant for the first six month,s then the child is less likely to get infections and it also helps the immune system, which is extremely important. However, in countries where there is no family planning, it is likely that there are more infants than one the mother has to nourish. So it can be quite difficult. The other issue is that should mothers who are living with HIV continue breastfeeding? But with antiretrovirals this issue has been addressed and studies show that exclusive breastfeeding cuts down on infections in the infant."

Dr Enarson thinks that, "Most of the deaths of pneumonia occur in under one year of age, so that is why there is real push for mothers to exclusively breastfeed and reduce the risk of the child dying. It has been shown that the children who are exclusively breastfed don’t die of pneumonia as often as the ones who aren’t.”

Dr Enarson agrees that, "Malnutrition is a huge problem and more so in Asia than anywhere else. 50% deaths in children are precipitated by malnutrition. Simple handwashing can cut down a huge amount of early infections especially during mother and child interaction. Malnutrition has to be addressed in conjunction with other disease programmes such as diarrhoea, pneumonia, measles, malaria, etc as they all are compounded by malnutrition. Indoor air pollution is also known to increase the risk of pneumonia. Especially for mothers who have infants on their backs or are holding the child while cooking and smoke from cook stoves can up the risk. Secondhand smoke is a risk for developing pneumonia."

RARELY A CHILD COMES TO CLINIC WITH ONE ILLNESS
“I can speak from my experience in Malawi that rarely will we see a child with one illness. So if the child has pneumonia, she/he may have diarrhoea, measles, malaria, malnutrition, or co-infection with HIV in areas or populations where HIV incidence is high. It is difficult to tell the child who presents with pneumonia and malaria. Very often one or the other is missed. Meningitis is also another co-morbidity. People need to be aware that children don’t come with just one problem” said Dr Penny Enarson.

Pneumonia is still the number one killer of children. It is dreadful that these children should not be dying because it is quite easy to diagnose and fairly cheap to treat. The governments and others working on health systems strengthening need to understand that if they really want to reach the Millennium Development Goal No. 4 then they have to address pneumonia in children, else they will not reach it.

We can win the fight against pneumonia. More than one million young lives can be saved annually with vaccines and antibiotics, by reducing indoor air pollution and through breastfeeding for the first six months of life.

Bobby Ramakant – CNS

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Gift your child low pneumonia risk by quitting tobacco

2011-11-12T12:30:00.001+05:30

One of the major risk factors for childhood pneumonia is exposure of the child to tobacco smoke. Another risk factor is biomass smoke (smoke coming out of cook stoves). “Indoor air pollution includes both – tobacco smoke and biomass smoke and both of them are related to lung diseases. However, the tobacco smoke is related to a larger variety of lung diseases than the biomass smoke is. Certainly tobacco smoke is clearly associated with tuberculosis (TB)-- both latent TB infection and active TB disease -- and of course with chronic lung diseases like Chronic Obstructive Pulmonary Disease (COPD) and lung cancer. Association of biomass smoke with tuberculosis is not that clear, but it is clearer with childhood pneumonia, and very clearly associated with COPD and lung cancer in women” said Professor (Dr) Donald A Enarson. Director (Scientific Activities), the International Union Against Tuberculosis and Lung Disease (The Union).

Agrees Professor (Dr) Rama Kant, the World Health Organization (WHO) Director-General’s Awardee for tobacco control (2005) and National President-elect of Association of Surgeons of India: “The problem of indoor tobacco smoke pollution is more pronounced in the case of children living in hutments and slums. They are more exposed to secondhand tobacco smoke which contains over 4000 chemicals, many of which are not only carcinogenic, but also reduce the child’s immunity. These children are already very likely to be malnourished, deprived of proper ventilation and sunlight. On top of this, right from the time they are inside the mother’s womb, they are at a very high risk of being exposed to the hazards of secondhand tobacco smoke, even when they have not seen the light of life, as smoking is more common in poor people.”

There is an already established link between smoking and poverty. “So according to me one important and worthwhile intervention is that facilities for tobacco cessation should be made available to people who are ready to quit. People are, by and large, more aware about the health risks of tobacco consumption and smoking, thanks to efforts made by NGOs and government and other agencies. But they do not know where to go to quit tobacco successfully. I can say this with confidence that facilities for tobacco cessation are very meagre in our country, and this is a sad part. Unless we have facilities that can help people quit, and unless they are available constantly, many of the efforst to control tobacco will go waste. The WHO had started around 20 such clinics, but gradually they are closing down due to paucity of funds and government efforts are not of that level which can manage these clinics” said Prof (Dr) Rama Kant.

Prof (Dr) Enarson is in agreement: “Difficulty with tobacco smoke is persuading people not to smoke or to stop smoking and persuading people to change their behaviour is not so easy. One of the things we focussed on was trying to catch people’s attention based upon some of the personal experiences that they had. With biomass smoke we have tried to catch people’s attention by identifying champions in the community who have suffered some adverse effects themselves and they can champion the issue with their neighbours. We did this for biomass smoke, but the same is true for tobacco smoke. In most societies the most challenging problem people face is to have a child who is hospitalized for a serious illness.”

“So we focussed on requesting the families to bring in their children for serious pneumonia and trying to talk to them about tobacco smoking and biomass smoke exposure. And in this way trying to persuade them that this is an important issue, educate them and encourage them to be champions of health in their own communities. If someone from outside the community comes in and begins to preach to people that is not a very successful way to change their behaviour” added Prof (Dr) Enarson.

Suggests Prof (Dr) Rama Kant: “So I want to emphasize two things - people need to be aware that smoking should be controlled and never done inside homes, and secondly cessation facilities will go a long way in preventing children from suffering from pneumonia and its complications (including deaths). We have a jumbo system of public healthcare consisting of a large number of doctors, paramedics and other staff. But their services are not being utilised to the fullest, especially in the rural areas. So, cessation facilities can be integrated with the existing healthcare system, and piggy back on the existing health services.”

Clearly pneumonia is the most important killer of small children in the world. “Unfortunately we haven’t paid that much attention to pneumonia as we have for other lung diseases, and I feel that this should be a priority. Even among people living with HIV (PLHIV) pneumonia is probably more common than tuberculosi,s although tuberculosis co-infection is very important in PLHIV. We need to find a way to highlight the issue of pneumonia," said Prof (Dr) Enarson.

Shobha Shukla and Bobby Ramakant – CNS

Irony: Preventable pneumonia is biggest killer of children under 5

2011-11-12T12:19:00.002+05:30

Pneumonia can be prevented. It can be treated using first-line cheap and easily available antibiotics. Despite being preventable and curable, it continues to be the lead cause of morbidity and mortality for children below the age of five years. “Pneumonia is a serious disorder affecting children even in their very early stages of life. The tragedy is that it is preventable. So, the top priority is to prevent it and, if it develops, then to provide timely treatment,” said Professor (Dr) Gourdas Choudhuri, Head, Department of Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS), Lucknow. Prof Gourdas Choudhuri is a noted public health expert too.

HEALTH AND TREATMENT LITERACY
“Pneumonia occurs due to overcrowding in small homes with poor ventilation. The problem is further aggravated if one or both of the parents smoke. Passive smoking makes children more prone to chest and pulmonary infections. The other important aspect in preventing pneumonia is about hygiene - cleanliness and hand washing will prevent the germs from spreading. So, a general sense of hygiene should be there at all times. The other issue is of pollution - the fumes and dust in the air which children breathe. These particles will aggravate the bacteria and the virus if they are around. There is a need for a lot of awareness in mothers about their child picking up pneumonia at an early stage. Chest infections in children are bound to happen. But if a child has high or persistent coughing, a doctor should be sought so that antibiotics can be given timely. Timely access to medical care is crucial. In the early stages of the disease oral antibiotics work. But once the child becomes very sick, much more intensive care is required - like hospitalisation, stronger and more expensive injectible antibiotics among others. So, proper awareness of the disease is an important issue in increasing the survival rate of children” said Prof Choudhuri.

“Pneumonia is a serious infection of the lungs and can be caused by several germs. The role of vaccines in preventing the disease cannot be overlooked. However, a vaccine may work well against some of these but not all. So it is difficult to have a complete vaccine for full protection.Some vaccines, like the Hib vaccine, are good and a must, which can be given routinely. The pneumococcal vaccine is another good vaccine. But the issue is whether the strains causing the disease, which are present in the community, are the same as those present in the vaccine, otherwise the vaccine will not work, and the money spent will not get the protection one is expecting. Pneumococcus, one of the germs that cause pneumonia in children, has many strains. The vaccine, which is currently available, has strains that are found chiefly in the western world, and its profile does not match with the strains found in our country. So a routine immunization with one vaccine may not work”, explained Prof Choudhuri.

“There is co-infection and co morbidity in pneumonia. Children suffering from some respiratory problem like asthma/chronic bronchitis; children whose spleens have been removed; children with a depressed immune system; malnourished children; and children more prone to pneumococcal infections - are more vulnerable to pneumonia.”

OBESE CHILDREN ARE ALSO MALNOURISHED
“Lifestyle disorders play a crucial role in upping the risk to pneumonia. Obese children are also malnourished and so have a compromised immune system. So it is important to ensure that children keep an ideal body weight and use the sports field and/or do plenty of exercise to keep their lungs healthy. One of the most preventable factors is passive smoking. It does not directly cause pneumonia, but makes the child more vulnerable to it. Smoking does nobody any good, and fathers especially need to be made aware to be more responsible towards their children’s health”, said Prof Choudhuri.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: http://www.citizen-news.org/)

Early recognition and management of childhood pneumonia

2011-11-12T12:09:00.001+05:30

Pneumonia is the leading cause of death among children under 5 years of age worldwide. One child dies from pneumonia every 20 seconds. That means 4,300 young lives are lost every day. “Pneumonia is a common respiratory infection in children and an important cause of morbidity and mortality, even in new born infants. 98% of children who die of pneumonia live in developing countries” said Professor (Dr) PK Misra, luminary paediatrician, who is the former Principal of India’s prestigious King George’s Medical College (KGMC, now known as Chhatrapati Shahuji Maharaj Medical University) and also the former Head of the Paediatrics Department at KGMC.

Added Prof (Dr) PK Misra: “Pneumonia is an infection of the lungs, filling them with fluid. It causes cough and fever and can make breathing difficult. Severe pneumonia can be deadly. In developing countries, children under 5 years of age are at risk, especially in the poorest communities. Tobacco smoke and other indoor air pollution increase susceptibility to pneumonia. Some children and adults are at greater risk because they have other infections, such as HIV. Children who are poorly nourished can also have weakened immune systems, putting them at higher risk of contracting pneumonia.”

Prof (Dr) PK Misra further explains that "globally, bacteria such as Hib and pneumococcus are estimated to cause more than 50% of pneumonia deaths in children under 5 years of age. Viruses and fungi can also cause pneumonia infections. In resource-poor settings, pneumonia can be diagnosed by the symptoms it causes, including cough, fever and difficulty or fast breathing. Chest X-rays and laboratory tests can also diagnose pneumonia, but these tools are often unavailable in developing countries, especially in remote rural communities, making it more difficult to diagnose and treat pneumonia."
“Some pneumonia can often be prevented with vaccines against Hib and pneumococcus. Measles and pertussis (whooping cough) infections can result in pneumonia complications, so vaccinating against these childhood diseases can prevent some pneumonia cases. Inexpensive antibiotics can effectively treat pneumonia at the community level. Early recognition and early management are very important. If pneumonia cannot be managed at the health centre, then early referral to a better health centre can become life saving at times. But all cases don’t need highest level of medical care. Pneumonia can be effectively managed (depending upon the condition) by providing home-based care. Early recognition of signs by family members, or by those who look after the child, that a child needs medical attention without delay at an appropriate health centre, are crucial. Aseptic and clean environment should be maintained to raise the child and those who are caring for the child should wash their hands properly, wash clothes properly, and keep the umbilicus clean and not put anything there which can infect the child through umbilicus” said Prof (Dr) PK Misra.

Shobha Shukla and Bobby Ramakant – CNS

Antibiotic Therapy: The Pneumonia Panacea

2011-11-10T13:21:00.001+05:30

Pneumonia is the single largest cause of death in children worldwide. It kills an estimated 1.6 million children every year – more than AIDS, malaria and tuberculosis combined. Almost four children die from pneumonia every single minute. Research has shown that prevention and proper treatment of pneumonia could avert one million deaths in children every year. With proper treatment alone, 600 000 deaths could be avoided. The World Health Organization (WHO) and UNICEF launched Integrated Management of Neonatal and Childhood Illness (IMNCI) and which aims to protect, prevent, and treat pneumonia in children. There have been few studies of the clinical efficacy for identifying and treating pneumonia in children in developing countries with low-cost, low-tech medication and care.

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which are filled with air. When an individual has pneumonia, the alveoli get filled with pus and fluid, which makes breathing painful and limits oxygen intake. The common symptoms of pneumonia are rapid or difficult breathing, cough, fever, chills, loss of appetite and wheezing in case of very severe pneumonia. When it becomes critical, children may experience in-drawing of chest, hypothermia and convulsions.

Pneumonia can be treated with antibiotics, but less than 20% of children with pneumonia receive the antibiotics they need. Although the WHO guidelines advise health workers to provide oral antibiotics for cases of non-severe pneumonia and to refer severe cases to hospitals for treatment with antibiotics by injection, many children with severe pneumonia either die before they reach a hospital, or are so sick by the time they arrive that nothing more can be done to save them. Hence, WHO, and UNICEF have initiated a Global Action Plan for Prevention and Control of Pneumonia (GAPP) in the context of child survival strategy which identifies priority activities that need to be conducted to reduce pneumonia mortality.

About 60% of pneumonia cases in the developing world are caused mainly by bacteria. Antibiotics to a large extend can control pneumonia if provided well on time. Dr.Y.C.Govil (Professor of Pediatrics in Chatrapati Sahuji Maharaj Medical University) says," Penicillin was discovered in the 1930s, and before that there were no antibiotics and people use to die like flies. Similar thing will happen if pneumonia is not checked. It is unfortunate, but now a days, a lot of antibiotic misuse is happening in our country and the reason is that many a times patients are been treated by unqualified practitioners of medicine in rural areas. I think almost 20%-30% or even more of patients would initially go to an unqualified practitioner. So here they are in the habit of advising lots of broad spectrum antibiotics in the beginning. Even in viral infection, where antibiotics are not usually indicated, antibiotics are prescribed. This is also prevalent in the urban setup as well. Very often patients try to self medicate also, as antibiotics are easily available over the counter. This develops a resistance against normal (narrow spectrum) antibiotics, thus making them ineffective."

Very severe pneumonia in children under five requires treatment with injectible antibiotics in a hospital. The case management strategy for very severe pneumonia, which includes treatment with injectible chloramphenicol followed by oral chloramphenicol, has successfully decreased child deaths from pneumonia. WHO recommends the treatment at the level of primary health workers, and for them the guidelines are just to recognize it by increased respiratory rate and administer some basic antibiotics and if required then refer the child to a hospital.

Dr. Vijaya Mohan (Consultant Pediatrician, Vivekananda Polyclinic and Institute of Medical Sciences) says," We can diagnose pneumonia by physical and clinical findings and also by examining blood or X-ray. Even if the facilities are not available then by simply examining the child one can detect pneumonia. Antibiotics administered in the treatment of pneumonia, actually depend on the organism which is causing pneumonia. Penicillins, cephalosporins are usually suggested. But in the field WHO recommends Cotrimoxazole, Chloramphenicol."

Shikha Srivastava - CNS

Vaccine Shots Can Combat The Death Shot Of Pneumonia

2011-11-10T12:21:00.004+05:30

It is unfortunate that pneumonia is the world's leading killer of young children despite the fact that possible medications and immunizations for the disease are available. Then why are our children being held hostage by pneumonia? The possible reasons could be unavailability/unaffordability of medication and/or lack of information.

Realizing that reducing child deaths from pneumonia is the need of the hour, the Global Action Plan for the Prevention and Control of Pneumonia (GAPP) has come up with recommendations on specific goals and targets to reduce mortality from pneumonia. It also aims that every child is protected against pneumonia through a healthy environment, and has access to preventive and treatment measures. I am reminded of the words of Dr Margaret Chan, Director-General of World Health Organization (WHO), which I read recently: "This action plan provides the strategy to prevent and control pneumonia, which today kills more children than any other illness."

The GAPP’s simple three-pronged vision of "protect, prevent and treat" has the potential to save more than a million children who die of pneumonia each year.
(i) Protecting every child by providing an environment where they are at low risk
(ii) Preventing children from becoming ill with pneumonia (with vaccination against its causes: measles, pertussis, Streptococcus pneumoniae and Haemophilus influenzae b)
(iii) Treating children who become ill with pneumonia with the right care.
This strategy is hoped to lead to a reduction in child pneumonia deaths by 65% and cut the number of severe pneumonia cases in children by 25%.

The GAPP's vision-Pneumococcal vaccine uptake will be gradual and in some countries it will only be introduced in 2014, thus 90% coverage by 2015 will not apply to it.), Easy4, Hibirix, tetrad Hib (4% reduction in all child deaths with Hib.

In the context of child survival strategies, countries should address pneumonia control by way of vaccinations and health care programmes. As pneumonia is caused by various organisms like- Pneumococcus, Sreptococcus, Haemophilus influenzae or Mycoplasma etc, the vaccine is guided by the type of organisms causing pneumonia. So there are a number of vaccines available, like Pneumococal Vaccine and the Haemophilus influenzae or Hib Vaccine. Others include the BCG vaccine for tuberculosis, DPT vaccine for diphtheria and pertusis which are the infections of the upper respiratory tract, and measles vaccine which indirectly prevents pneumonia, because a child with measles becomes very weak and is more prone to the super added infection of pneumonia. Three doses of Hib vaccine along with DPT are effective against Haemophilus influenza (which is a very virulent bacterium and responsible for a highly fatal pneumonia in children) and reduce incidence of mortality among children by 22%–34%. WHO has urged that countries with high rates of mortality in children aged under 5 years, and countries with a high prevalence of HIV, should consider introducing pneumococcal conjugate vaccines into the national immunization program and Hib vaccine for infant immunization in all countries. But as of now, this is only implemented in the developed countries while the developing countries are still striving for it. GAPP's vision is that the Pneumococcal Vaccine uptake will be gradual and in some countries it may only be introduced in 2014.

Negligence and lack of education play another important role in boosting pneumonia. The WHO, Global data bank on infant and child pneumonia reveals that only 82% of children receive their first routine dose of a vaccine against measles. Not all countries have introduced Hib vaccination, although there has been recent progress in this area. Few countries have yet not included the pneumococcal conjugate vaccine in their national immunization programmes, though there is strong interest in many countdown countries to do so. Low coverage prevails for other interventions also, and it is usually the children at greatest risk of pneumonia, who are not covered.

These life saving vaccines come with a high price tag and are not pocket friendly. Hence it becomes difficult for the common masses to afford them. It is for this reason that they are not included in the Government health care programmes in India. According to Dr. Vijaya Mohan (Consultant Pediatrician, Vivekananda Polyclinic and Institute of Medical Sciences) "The affluent class can afford the vaccine but the problem of common masses is that it is costly."

Another important hurdle in preventing pneumonia is the lack of information. The general public is mostly not aware of these vaccines, as they are not mentioned in the government health care programme. The mother of a three years old child Atharva, who was admitted in Chhatrapati Shahuji Maharaj Medical University with acute pneumonia, said," If I ever knew that there is a vaccine available against pneumonia, I would have made all efforts to get my child vaccinated to prevent him from such dreadful conditions as he is facing now."
The achievement of the global objectives for pneumonia prevention and control will require coordination among the concerned individual programmes at country and regional levels and expanded support from development agencies.

Shikha Srivastava - CNS

Weakest link in war against TB: Community participation

2011-11-09T10:25:00.000+05:30

Around one third of the world population is estimated to be infected with the TB bacterium and is at risk of developing the disease. There were 8.8 million new cases of TB in 2010 and the disease killed a staggering 1.4 million people. Many more struggle with the disease which, apart from causing human suffering, slows down economic growth. The situation is said to be serious in Europe, alarming in Africa and worrisome in parts of Asia. And yet, the current TB drug treatment regimen is just too old, grossly inadequate, and unable to control the epidemic. There is just one vaccine available, which was discovered almost 100 years ago, and which provides limited protection.

Not only is there a dearth of effective and patient friendly medicines, there are discriminatory policies too in many countries, either by law or by society, which reduce access to healthcare services for the affected populations due to fear and mistrust. From the public health point of view, the consequences are catastrophic - lower case detection, increased infection rate, and more of drug resistant TB. The vulnerable tuberculosis population consists of women and girls (who account for more than 50% of our planet’s population and are still discriminated), injecting drug users in congregated settings, migrants/ immigrants, poor or malnourished people particularly children, among others. We all know that it is unethical to discriminate against TB patients or for that matter those suffering from any disease. This prevents access to healthcare and helps in spreading the disease rather than curbing it.

Dr Gilles Cesari, Regional Director at the International Union Against Tuberculosis and Lung Disease (The Union)'s office in Singapore, spoke to CNS at the recently concluded 42nd Union World Conference on Lung Health, Lille, France. Dr Cesari informs that "Transgenders, female sex workers and people living with HIV are refused access to care in some TB DOTS Centers in Bangladesh; 63 countries have some form of HIV (or TB) specific restriction to entry, stay and residence of immigrants; and 28 countries deport people once HIV+/TB status is known."

Dr Cesari feels that at the grassroots level, a lot has to be done to enable vulnerable populations to access proper TB treatment. He cites the example of "Singapore, which I thought was an ideal place to live in. But then I saw the sorry state of its discriminatory laws in public health. It heavily discriminates against migrants (who are legally staying in the country) as far as TB is concerned. As soon as they are diagnosed with TB, which they contracted in Singapore, they are immediately deported to their home country. This is not only sad from human rights point of view; it is catastrophic from a public health perspective too. These people obviously are afraid to go the healthcare centres for fear of reprisal. So they knowingly do not access treatment spreading the disease in their community. All this could be prevented only if they had a fearless access to standard treatment and care. Deportment does not solve the problem. In fact it increases it manifold. They end up infecting many more people before succumbing to the disease themselves. There is no way we can stop a disease by deporting patients."

What could be the reason for this sorry state of affairs? Well one important factor could be lack of active community participation. It was only a strong community involvement that forced governments, stakeholders, researchers to change the scenario in the field of HIV/AIDS during the last 25 years. There have been new drugs, new tools, and new guidelines/protocols to combat this once dreaded disease—all because of intense lobbying by the community. This is somehow missing in the field of TB. We do have the Patients' Charter for Tuberculosis Care (a rights and responsibilities framework for people with TB). But it is rarely shared with patients, and even many doctors may not be aware of it.

According to Dr Cesari, "One reason for this could be that that as HIV is a chronic disease for life, there is more group participation of people living with HIV to fight for their rights. Also HIV earlier (in the early 80s) affected more of men who have sex with men (MSMs), who were at that time already fighting for their sexual rights. So that helped a lot. But TB gets cured. So once people get cured they tend to forget about it. But in HIV you can never forget, for it is never the past. So it is important for ex-TB patients to become activists and help in overcoming stigma at the community and government level. We also need better diagnostic tools for TB. Now HIV can be diagnosed in just 5 minutes with the latest tools we have. Why not in TB? Yes I agree that during the last decade, lot more research has happened, including operational research in the field of TB. There are many good people having many good ideas to combat TB. We only need to prioritise these efforts and the community has to demand it as they did in HIV."

Dr Nils Billo, Executive Director, The Union, feels that "Community Participation is not very good in TB as it affects mainly the poor people and poor people do not always have a voice. HIV/AIDS affected many people in the industrialized countries which have a lot of influence. And they have pushed very hard and have been able to build up a very big community movement. Unfortunately, we have not been able to do that in TB, and this has reflected in the fact that less attention is being given to TB by governments and donors."

In an interview given exclusively to CNS, Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership, emphasizes upon the need to understand, raise and address the issue of stigma in TB associated with vulnerable populations, especially women and children. According to her, "It is important to make women part of the solution and involve and empower them. Even when we design programs to address and reduce stigma we have to make sure that our partners who are contributing to it are women. We have to create an international movement addressing women and children which will give the chance for countries to raise the issue at their level. You have to give a bit of the power globally to them, and then it can be raised at country level. I come from the Balkans and there TB stigma is a big issue. In my country in Romania, my parents even if they hear me coughing, ask me to go inside the house because they are scared that as people know I am working in TB, so they may think I have TB. So in most parts of the world, there is huge stigma for women, and this prevents them from going to a doctor and to seek treatment. So women need to have a voice in the National TB Programs."

Dr Ditiu concedes that "Community participation in TB is less because traditionally, worldwide TB was dealt by public health sectors and not by NGOs. Unlike people living with HIV/AIDS, TB patients are sick when they are sick, and then they go out. Because of the stigma attached with this infectious disease, a lot of people say - Okay I had it, I got cured and now I don’t even want to remember about it anymore. So it is difficult to have a patient beyond the 6 months of treatment to get engaged. Also, National TB Programs are pretty vertical and are not too keen in linking and in reaching out to the affected populations. That is why a lot of TB care is done in a very medical way, without involving outside partners; and the civil society, particularly the private sector remain non traditional partners. But we should remember that TB is not about individual patients. It is a global health problem and has to be dealt with accordingly."

Rights are rarely handed over to the lawful recipients on a platter. The same is true of tuberculosis. So unless TB patients and communities raise a storm of voices to demand their rights, access to proper and timely treatment/care may remain a far dream for many of them. One of the ways can be to implement the Patients' Charter for TB Care in letter and spirit at all levels of TB programmes so that people with TB can be empowered and use their Charter for TB Care to demand and access International Standards for TB Care, both of which are integral components of the Global Stop TB Strategy.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She is currently writing from the 42nd Union World Conference on Lung Health, Lille, France. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)

Environmental Burden Can Weigh Down Your Child's Health

2011-11-08T16:17:00.001+05:30

Environmental burden is a threat to children and a risk factor for both acute and chronic respiratory diseases. While second-hand tobacco smoke and certain other pollutants are known risk factors for acute respiratory infections indoor air pollution from biomass fuel is also one of the major contributors to the global killer of children i.e. pneumonia. In fact, in developing countries, indoor pollution increases the risk of pneumonia by about 38%.

According to World Health Organization (WHO), nearly half of the deaths among children under five years old from acute lower respiratory infections (ALRI) are due to particulate matter inhaled from indoor air pollution from household solid fuels. Among these deaths, 44% are due to pneumonia.

Around 3 billion people still cook and heat their homes using solid fuels in open fires and leaky stoves. About 2.7 billion burn biomass (wood, animal dung, crop waste) and a further 0.4 billion use coal. Most are poor, and live in developing countries. Such cooking and heating produces high levels of indoor air pollution with a range of health-damaging pollutants. In poorly ventilated dwellings, indoor smoke can be 100 times higher than acceptable levels for small particles. More than 1 million people die every year from chronic obstructive respiratory diseases (COPD) that develop due to exposure to such indoor air pollution. It is particularly high among women and young children, who spend a lot of time near the domestic hearth.

Dr. Vijaya Mohan, Senior Pediatrician, Vivekananda Polyclinic and Institute of Medical Sciences, said that "In the villages cooking may lead to indoor pollution as they cook on 'chulha' and this leads to carbon dioxide emission. And in the cities lifestyle things like carpets and inadequate ventilation may predispose the child to respiratory infections."

Urban indoor pollution may also occur due to limited spacing plan, use of synthetic materials for building and furnishing, use of chemical products, and presence of mites and cockroaches in the house. Dampness, overcrowding, and small particulate matter/pollutants present in indoor smoke inflame the airways and lungs, impairing the immune response and reducing the oxygen-carrying capacity of the blood. They are the most common reasons for causing pneumonia and associated mortality in young children. About 20% of all deaths in children under 5 years are due to Acute Lower Respiratory Infections, 90% of which are due to pneumonia.

Passive smoking is another reason for the increased incidence of ARI in children. There is no safe level of exposure to secondhand smoke and children are exposed to it more than adults. Not only is a child's body still developing physically, but her breathing rate is also faster than that of adults. The immature immune systems and narrow airways of infants and young children make them more susceptible. Every year, an estimated 150,000 to 300,000 children under 18 months of age get pneumonia or bronchitis from breathing secondhand tobacco smoke. Research has shown that children, who grow up in a smoky household, where one or both parents smoke, are likely to have twice the amount of respiratory and lung disorders as compared to children in non smoky households. Also, mothers who smoke may contribute to inadequate breast milk production.

According to Dr.Jyotsna Mehta, Senior Gynecologist and Obstetrician at Sahani and City Hospital: “In urban societies that we are dealing with, smoking has become rampant. We promote patients to quit smoking. It should be strictly avoided during the pregnancy. It must be ensured that the child does not ever become a passive smoker, whether in the womb or outside it."

Unfortunately, finding an affordable solution for controlling indoor air pollution by reducing smoke exposure, reducing fuel costs, and attaining sustainability is a complex and evolving process. The WHO is preparing new indoor air quality guidelines for household fuel combustion. Introducing cleaner fuel, better ventilation by enlarging windows, and adding smoke hoods over the cooking area are interventions that can reduce pneumonia risk. Changing to full-scale cleaner household fuel could lower pneumonia incidence by 50%. The WHO has also launched a Framework Convention on Tobacco Control (WHO-FCTC) for further driving the need for clearer guidance on protection from second hand smoke. Children should be especially kept away from smoke. Smoke may not directly cause pneumonia, but it certainly leads to some ciliary dysfunction which may actually cause predisposition to the colonization of bacteria and viruses and make children more susceptible to pneumonia. The major interventions can be a switch at the household level to cleaner gaseous or liquid fuels; better combustion ventilation through high-quality biomass stoves; and strict self control on indoor smoking—all in the interest of our children’s health.

In the words of Dr YC Govil, Professor of Paediatrics in Chhatrapati Shahuji Maharaj Medical University (erstwhile King George’s Medical College Lucknow): “The biggest intervention that can be done is education. No measure is better than awareness and for that people need to be educated about the havoc which tobacco and fuel smoke can wreak on innocent infants and children, exposing them to pneumonia related complications, (which may even be fatal) for no fault of theirs.”

Shikha Srivastava - CNS

Breathe In Clean Air To avoid Childhood Pneumonia

2011-11-08T16:04:00.001+05:30

Pneumonia is a serious disorder affecting children even in their very early stages of life. Like other acute respiratory infections, pneumonia targets the world’s most vulnerable children as it occurs when a child’s still-developing defence system is weakened. Malnutrition, crowded housing, smoking, and polluted air have all been linked to higher incidences of pneumonia, the leading global killer of children under five. The Acute Respiratory Infections (ARI) Atlas confirms that indoor air pollution significantly increases the incidence of pneumonia. The risk depends on how toxic the pollutants are, how long and at what concentration the exposure occurs and the adequacy of ventilation.

Children are particularly vulnerable because (i) their lungs, respiratory defences and immune systems are not fully developed (ii) they breathe more in proportion to their body size and (iii) they are likely to spend more time in polluted home environments. Out of the total annual child mortality of 1.96 million from pneumonia, an estimated 871,500 deaths are caused by indoor air pollution associated with cooking/heating with wood, animal dung, charcoal and other biomass fuels, which are used by half the world’s population for cooking—most of them belonging to the developing countries, like India where wood/coal burning stoves are used by 826 million people. Death toll from Acute Respiratory Infections (ARI) among Indians is also very high--higher than all deaths from HIV/AIDS, malaria and TB combined. In 2008, 371605 children under 5 succumbed to pneumonia in India.

According to Dr Ajay Misra, Managing Director of Nelson Hospital of Paediatrics and Neonatal Medicine Lucknow, the chief sources of indoor air pollution in Indian homes are cooking fuel, insects, and tobacco smoke. The smoke emanating from the chulha (cook stove) in village homes permeates the air in and near the house, and affects the lungs. Even living in posh houses behind closed doors and windows, with no proper ventilation and flow of clean air, poses a danger.

Tobacco is another significant source of indoor pollution and nearly 50% of the world’s children being exposed to tobacco smoke in their daily lives. Tobacco use releases particulates and chemical toxins in the air and smoking indoors endangers the smoker as well as those present at home. Smoking impairs the lung functions of a child. So the risk of respiratory tract infections linked to second hand smoke is heightened in children. A child is twice as likely to be hospitalised with an ARI if a parent smokes. Tobacco use by 241 million Indians also contributes to ARI mortality.

Dr Gourdas Choudhuri, Professor and Head, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, is very emphatic in saying that, “One of the most preventable factors (of childhood pneumonia) is passive smoking. Pneumonia occurs due to overcrowding in small homes with poor ventilation. The problem is further aggravated if one or both of the parents smoke. Passive smoking makes children more prone to chest and pulmonary infections. Smoking does nobody any good, and fathers especially need to be made aware to be more responsible towards their children’s health. The other issue is of pollution—the fumes and dust in the air which children breathe. These particles will aggravate pneumonia causing bacteria and virus if they are around. Overcrowding allows pathogens to spread rapidly, especially when ventilation is inadequate and sanitation is poor. There is a need of a lot of awareness in mothers about picking up pneumonia at an early stage.”

Professor (Dr) Rama Kant, an eminent surgeon and former Head of the Department of Surgery at Chhatrapati Shahuji Maharaj Medical University (erstwhile King George’s Medical College), Lucknow is passionately involved with social and public health issues. He is a recipient of the World Health Organization (WHO) Director-General’s Award for his contribution in tobacco control (2005) and is the President-elect of Association of Surgeons of India (ASI). He firmly believes that tobacco consumption is playing havoc with the lives of children as well as adults. According to him, “There is an already established link between smoking and poverty. So children living in hutments and slums are more affected by the pollution of tobacco smoke which contains over 4000 chemicals, many of which are not only carcinogenic, but also reduce the child’s immunity. These children are already malnourished, and deprived of proper ventilation and sunlight. On top of this, right from the time they are inside the mother’s womb, they are exposed to the hazards of tobacco smoke, thus making them easy targets for pneumonia.”

In the opinion of Prof (Dr) Rama Kant, “An important and worthwhile intervention is that facilities for tobacco cessation should be made available to people who are ready to quit smoking. Thanks to the efforts made by the government and NGOs, people are now more aware about the health hazards of tobacco. But they do not know where to go as facilities for tobacco cessation are very meagre in our country. Unless we have continuously available cessation facilities that can help people quit, many of the tobacco control efforts will go waste. The WHO did start such clinics, but gradually they are closing down due to paucity of funds and government indifference to manage them. So I want to emphasize two things—people need to be aware that smoking should be controlled and never done inside homes, and secondly, cessation facilities will go a long way in preventing children from suffering from pneumonia related deaths. We have a jumbo system of public health system consisting of a large number of doctors, paramedics and other staff. But their services are underutilised, especially in the rural areas. So cessation facilities can be integrated with and piggy back on the existing public healthcare services.”

Dr Ajay Misra also agrees that “Tobacco smoke is a major cause of respiratory diseases in India and is associated with pneumonia in adults. Second hand smoke does affect the children’s lungs, and reduces their immunity, making them more vulnerable to pneumonia. In order to reduce mortality from pneumonia, it is important to educate the public about prevention strategies—good diet, proper cleanliness and a good environment.”

Improvements in health care, nutrition and the environment are interventions that can significantly reduce the incidence of childhood pneumonia. Access to cleaner fuels for cooking and heating can drastically improve the situation. In India, the ‘national biomass cook stoves initiative’ launched in 2009, targets to distribute low emission stoves in rural areas, and make them accessible to 87% of Indian households over the next 10 years, resulting in 240,000 fewer deaths from ARIs in children. Improving ventilation in houses and enforcing tobacco control policies, so that there is no second hand smoke in the house, will go a long way in preventing childhood pneumonia.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: http://www.citizen-news.org/)