CNS: November 2011

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

[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.

[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).

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.

Demanding justice for Soni Sori of Dantewada

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.

[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.

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.

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.

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.

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.

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.

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.”

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.

[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.

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.

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).

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.

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.

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.

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.

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.

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%.

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.

Pneumonia is a severe form of acute lower respiratory infection that specifically affects the lungs. It is the prime cause of child mortality under 5 accounting for 20% post-neonatal deaths worldwide. The best way to reduce pneumonia related mortality is to provide timely and effective treatment. When children suffering from pneumonia are promptly treated with antibiotics, popularly known as “wonder drugs” chances of mortality are considerably lowered. Estimates suggest that if antibiotic treatment were universally delivered to children with pneumonia, around 600,000 lives could be saved each year. This number could more than double to 1.3 million if both prevention and treatment interventions to reduce pneumonia deaths were universally delivered.

Good Nutrition implies an adequate and well balanced diet combined with regular physical activity. It is the cornerstone of good health and the key to improving a child’s natural defenses, and hence one of the most effective measures in preventing pneumonia. Besides, it also helps to reduce the length of the illness if a child does become ill. Good health and hygiene are the two facets of nutrition which help in building early immunity of the child by boosting the immune system. Nutrition relies on 'which' food and 'how much' food is required by the child.

Pneumonia, the leading global killer of children under five, is a disease that occurs most commonly when a child’s still-developing defence system is weakened by malnutrition, air pollution, co-infections with HIV/AIDS and measles, and low birth weight. Appropriate therapies will cure most cases of paediatric bacterial pneumonia. But many children go untreated, and as a result as many as 20% of them die, sometimes within 3 days of onset. It is no wonder then, that pneumonia is responsible for almost 1.6 million deaths per year, which is about one-fifth of all paediatric deaths around the world. Apart from breastfeeding and improved living conditions, access to vaccines and antibiotics, and timely treatment can dramatically reduce deaths from childhood pneumonia in developing countries.

Each year, millions of children succumb to diseases like pneumonia which are preventable with readily available vaccines. Pneumonia is the leading killer of children under 5 claiming 1.5 million young lives every year. Despite being the cause of almost 20% of all under 5 deaths, the disease attracts less than 5% of the global health funding. Vaccines against two of the main causes of life-threatening pneumonia— pneumococcal (Streptococcus pneumoniae) and Hib (Haemophilus influenzae Type b) have been developed and are currently being used in the developed countries. But coverage in third world countries like India (which accounts for almost 40% of the worldwide childhood pneumonia cases) is low, particularly of pneumococcal vaccines. If developing countries had these vaccines, the lives of almost 1 million children under age 5 could be saved every year.

Exclusive breast feeding implies the concept of feeding the child only with mother's milk from first hour of birth up to a minimum of six months, without any other supplement like water, honey or any top feed. During the initial post natal phase, breast milk is in the form of colostrums which has antibiotic like properties and lactoferins, which give the child an integral immunity against various diseases, including pneumonia. Breast milk is also rich in proteins, has enzymatic activity that prevents the growth of bacteria and viruses, and fulfils all the nutritional requirements of the new born for the first six months.

The best way to prevent serious respiratory infections such as pneumonia is to practice good hygiene. Infection control is highly dependent on the principles of personal hygiene, and by keeping ourselves and our surroundings clean, illnesses like pneumonia can be contained or even prevented. Most cases of pneumonia, whether acquired in the community or in the hospital, are caused by bacteria, and some by viral or fungal infections. These pathogens travel as airborne particles, ready to cause infection once they are inhaled and able to attack the lungs, filling the lung sacs with pus and fluid, limiting oxygen intake and making it hard to breathe. To prevent the recurrences of acute pneumonia, maintenance of community hygiene is as important as personal hygiene.

Malnutrition or bad nourishment is a major health problem, especially in developing countries. Along with inadequate sanitation and poor hygiene, it plays a vital role in predisposing children to pneumonia and other diseases. Pneumonia is the leading killer of children under 5, claiming 1.5 million young lives every year. An estimated 98% of the children who die of pneumonia live in developing countries. We can reduce these deaths by two-thirds, just by feeding our children with the right foods in right amounts and at the right time, in clean surroundings.

Mother’s milk plays a key role in preventing childhood pneumonia, which is a very serious problem, globally killing one child (below 5 years of age) every 20 seconds. It is responsible for almost 1.6 million child deaths per year, which is nearly 20% of all paediatric deaths around the world. Most of these children (about 98%) who die of pneumonia are from the developing countries. In India, more than 40,000 children under 5 years of age succumb to pneumonia every year.

Every 20 seconds, somewhere a child dies from pneumonia. Pneumonia accounts for 20% under 5 child mortality, killing 1.5 million children per year. This loss of life is even more painful because these deaths are preventable with sufficient interventions. The World Health Organization (WHO) lists several environmental factors that increase a child's susceptibility to pneumonia. These are (i) indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung); (ii) living in crowded homes; and (iii) parental smoking. It also suggests that addressing environmental factors such as indoor air pollution, by providing affordable clean indoor stoves and encouraging good hygiene in crowded homes, can reduce the number of children who fall ill with pneumonia.

Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. Hence improvements in the living environment to reduce the spread of germs play an important role in pneumonia control.

One Swallow Cannot Make A Summer But Together We Shall Overcome
The theme of the recently concluded 42nd Union World Conference on Lung Health was ‘Partnerships for Scaling Up and Care’. The large number of delegates who attended this 5 day yearly event came from diverse fields - doctors, donors, governments, civil society, NGOs, advocates, affected communities and a host of other stakeholders. According to the dictionary ‘partnership is an arrangement where parties agree to cooperate to advance their mutual interests. Partnership means a formal agreement between two or more parties that have agreed to work together in the pursuit of common goals.’ But what did partnerships really mean to them in the context of the global health issues of lung health, especially tuberculosis. Here is a kaleidoscopic glimpse of the expectations and dreams of the participants:

More than a billion people do not have access to toilets in South Asia. Over 700 million of these people defecate in the open and get exposed to severe health risks, violence besides adding to environmental pollution. On top of this, majority of schools without toilets and hand washing facilities, which restrict the behaviour change in the next generation, are only making the situation worse. The above situation has brought the South Asian at a crossroad where though they are performing better economically but at the same time facing daunting health challenges.

Although vaccination against certain kind of pneumonia is widely available and recommended by the World Health Organization (WHO) yet it remains out of reach of millions of children who might have benefitted by it and not developed pneumonia had they received the shot in time. The cost of the pneumonia vaccine is prohibitive and a clear barrier to access. But the low levels of awareness about pneumonia vaccination also keep the potentially life-saving shots out of reach of most at risk children. No wonder that the pneumonia vaccination is not a part of the free vaccines provided to children by the government in public healthcare centres in India.

Although pneumonia continues to be the biggest cause of under 5 years of age mortality for children yet its vaccination is not included under the public health programme of the Government of India. Most people who get their children vaccinated have to buy it from the private sector. Most alarming human rights issue is that the children who are likely to need it most or those children who are most at risk of pneumonia, are the ones least likely to be able to afford a pneumonia vaccine.

Various doctors of Uttar Pradesh opine that mother’s milk is very important during the first six months of a baby’s life. It protects the child not only from pneumonia but also from various other infectious diseases like diarrhoea, malnutrition among others. It is also the most effective way to keep the child healthy. Infants should not be given any top feed, supplement or bottle milk during the first six months. According to a study, children who are not breastfed during the first six months have five times higher risk of mortality due to pneumonia than those who are exclusively breastfed during the first six months.

[Based on an exclusive interview of Dr Anne Detjen with CNS, at the recently concluded 42^nd Union World Conference on Lung Health, Lille, France]

Mikkel Vestergaard Frandsen, the CEO and owner of Vestergaard Frandsen (a company focused on achieving the United Nation's Millennium Development Goals of eradicating extreme poverty, combating infectious disease and reducing global warming) opened his Inaugural Lecture at the just concluded 42nd World Conference on Lung Health, by showing a video clip of a 14 years old poor African girl who contracted TB in a poor and indoor pollution ridden home and died of it a few months ago. The clip was a telling commentary on the status of childhood TB in poor household settings. TB in children is still highly under diagnosed, under reported and under estimated.

Hygiene and cleanliness should be maintained within the households and children should not be exposed to tobacco smoke or smoke coming out of cook stoves. Passive tobacco smoke is not only harmful for health but also puts children at high risk of contracting pneumonia. "Cleanliness and hygiene is very important for controlling pneumonia especially in children. In our country there is a tradition to put kohl (kajala) in the eyes of the children, give them oil massages, etc. We need to be very cautious regarding hygiene when it comes to children as their immunity is still developing" said Dr KN Dwivedi, noted Paediatrician from Gorakhpur.

Good nutrition can save a child from malnutrition and pneumonia both. "Nutritious diet is the fuel of life, just what petrol is to a car. The best nutrition for a newly born child for at least first six months is mother's milk. Only after first six months, other food items are introduced very gradually and mother's milk is recommended for two years. By one year of age, a child can nearly eat whatever an adult person can eat too. Point to remember is that good nutrition is fundamental to a child's healthy tomorrow" said Dr KN Dwivedi, noted Paediatrician from Gorakhpur.

Pneumonia is the leading single cause of childhood mortality. Childhood pneumonia accounts for 19 per cent deaths in children less than 5 years. Pneumonia kills more children than any other illness, more than measles, malaria and AIDS combined. According to the World Health Organization (WHO) globally 156 million new pneumonia cases are reported every year in the developing world. As many as 8.7 per cent of these cases are severe enough to be life-threatening and require hospitalization. India accounts for the maximum 43 million new cases followed by China (21 million cases) and Pakistan (10 million cases). Pneumonia is estimated to kill 410,000 children in India every year.