Saturday, April 21, 2007

Andhra Pradesh ranks top in chronic energy deficiency in India

By Syed Akbar
Hyderabad, April 21: Andhra Pradesh, which is prone to frequent dry spells, has the highest percentage of chronic energy deficiency among States in the country both in men and women.
A survey conducted by the city-based National Institute of Nutrition in nine drought-prone States shows that Andhra Pradesh also tops the list with the dubious distinction of 29 per cent of families in drought-hit areas selling away assets to purchase food items.
The survey was conducted in Andhra Pradesh, Chattisgarh, Gujarat, Karnataka, Madhya Pradesh, Maharashtra, Orissa, Rajasthan and Tamil Nadu. The results of the study were published in the latest issue of the NIN's inhouse magazine, Nutrition News.
According to the survey, the overall prevalence of chronic energy deficiency among adult males ranged from a low 26 per cent in Tamil Nadu to a high 50 per cent in Andhra Pradesh. In case of females, it varied from a low 30 per cent in Gujarat to 56 per cent in Andhra Pradesh. The levels of CED among both men and women were relatively higher by about five to 10 per cent than the figures reported in similar surveys conducted earlier in Andhra Pradesh, Karnataka, Maharashtra and Orissa.
The report pointed out that households surveyed adopted a variety of strategies to tackle the food scarcity during drought. A majority of the households in all the States except Maharashtra, availed of assistance from government or NGOs. Some of the strategies adopted were reduction in the frequency/quantity of foods consumed, consumption of low cost foods and use of food stocks/savings.
In Andhra Pradesh, Gujarat, Karnataka and Orissa 20 per cent of the households resorted to migration. About 30 per cent of the households in Andhra Pradesh and 16 per cent in Tamil Nadu sold away household assets to buy foodstuffs during drought. This is as against none in Maharashtra, one per cent in Chattisgarh, two per cent in Gujarat, nine per cent in Orissa and three per cent in Rajasthan.
However, no starvation deaths were reported in any of the villages surveyed in the States.
The problem of severe underweight ranged from a low of 11 per cent in Tamil Nadu to a high of 25 per cent in Madhya Pradesh and in case of severe stunting (a reflection of long duration undernutrition) it was as low as 11 per cent in Tamil Nadu to as high as 39 per cent in Madhya Pradesh.
The prevalence of Kwashiokor, a severe form of protein energy malnutrition, was absent among pre-school children. However marasmus, another form of severe protein energy malnutrition, though of lower magnitude was observed in Andhra Pradesh, Chattisgarh, Maharashtra, Madhya Pradesh and Rajasthan.
Bitot spots, an objective sign of vitamin A deficiency, was more than the WHO suggested cut-off level of 0.5 per cent in all the states except Chattisgarh indicating public health significance of the problem. The rate varied from 2.5 to three in Andhra Pradesh, Gujarat and Karnataka and one to two per cent in Maharashtra, Rajasthan, Madhya Pradesh and Orissa.

Thursday, April 12, 2007

Cotrimoxazole: Basic health workers to institute oral anti-biotic treatment

Syed Akbar
Hyderabad, April 12: Basic health workers have now been empowered to institute oral anti-biotic treatment with cotrimoxazole, a drug known for its side-effects, for treatment of neonatal and childhood infections, particularly sepsis and pneumonia.
The Central government last week issued orders to health secretaries of all States and Union Territories empowering health workers to give cotrimoxazole to infants and children. This in effect means, ordinary health workers with simple training will decide on the medicine and its dosage. Doctors, however, feel that the Central government's order will put the life of neonates and children under five years of age to a greater risk.
The Centre's orders come in the wake of spurt in cases of neonatal sepsis and childhood pneumonia in different parts of the country. Doctors criticise the government saying that it has been pushing the drug since it was easily available, though the side-effects are often severe. The drug institution task has been given to health workers under Integrated Management of Neonatal and Childhood Illnesses.
"We can't risk the health of a neonate by allowing health workers to give cotrimoxazole. It's not a broad spectrum antibiotic," argued Dr J Narsing Rao, assistant professor of paediatrics, Deccan College of Medical Sciences.
He pointed out that neonatal sepsis could be due to various reasons and Cotrimoxazole address only a few of these. "It is not appropriate to administer the medicine without proper study of the individual case. Moreover it should not be given routinely by health workers. It has serious side effects like rashes. Usually we never prescribe this drug for neonates, for whom there are other safer drugs," Dr Narsing Rao observed.
Cotrimoxazole or septrin is a mixture of two drugs, trimethoprim and sulphamethoxazole. It prevents reproduction of harmful bacteria in the body. The drug is excreted through the kidneys and hence doctors should be judicious in prescribing it to those with damage to kidneys. The side-effects include rash, fever, nausea, low white blood cells and liver inflammation.
Child specialist Dr Manorama Prakash said health workers were ill-equipped to administer the drug. "One has to see the condition and nature of the patient before administering the drug. Health workers, how well trained they are, cannot decide on the dosage or course. It will lead to misuse of the drug throwing the lives of children to risk," she added.
But the government wants to push the medicine to curb childhood pneumonia which has higher mortality rate than AIDS. About 19 per cent of deaths in children below five years of age is because of pneumonia.