[Ed] The cost of negligence

The failure of successive governments in India, especially those in States that have the highest mortality rates among children younger than five years, to address the critical issue of training health-care providers in rural areas to correctly diagnose and treat children suffering from diarrhoea and pneumonia, has had tragic consequences. These ailments account for the maximum number of under-5 mortality incidence in the country. That the poor management of sick children by health care providers is a major causal factor for under-5 mortality has been brought out by a study carried out in rural Bihar. As other studies have shown, what is true for Bihar will be largely valid for other States as well. That the 340 health-care providers studied seldom practised what little they knew about treating children suffering from the two heath complications is a poignant reminder of the state of the health-care system in rural India. Only 3.5 per cent of the practitioners prescribed the correct treatment using life-saving oral rehydration salts (ORS) alone for children with simple, uncomplicated diarrhoea. Instead, nearly 69 per cent of them prescribed potentially dangerous drugs, including antibiotics, along with ORS; an equal percentage of them prescribed drugs without any ORS. The record was only slightly better in the case of pneumonia. The quality of diagnosis also left much to be desired.

These findings explain why Bihar has the country’s highest infant mortality rate of 55 per 1,000 live births. In 2010, the under-5 mortality in India from diarrhoea and pneumonia was over 600,000, the highest in the world in terms of absolute numbers. In the same year, India was one of the five countries that accounted for nearly 50 per cent of the deaths globally from diarrhoea and pneumonia in this age group. Hence, it is hard to fathom why India did next to nothing to train and equip health-care providers to diagnose and treat children. Bangladesh has not seen any drop in the incidence of acute diarrhoeal disease, but has reduced its under-5 mortality rate by 75 per cent between 1980 and 2011, largely by reducing mortality from the two diseases by means of better case management even in rural areas. In 2006-2007, as much as 76 per cent of children with diarrhoea in rural Bangladesh received ORS, a 2013 paper in The Lancet says. India has indeed done well in reducing under-5 mortality numbers from 2.5 million in 2001 to 1.5 million in 2011. But with only 10 months left to achieve the critical Millennium Development Goal No. 4 of 38 deaths per 1,000 live births among children under five, India can ill-afford to continue with its indifferent attitude to health care in rural areas.