Dr.Agha Inamullah Khan
Poliomyelitis, often called polio or infantile paralysis, is an infectious disease caused by the Poliovirus. Existing for thousands of years, the disease has been illustrated in ancient art. Polio was first recognized as a distinct condition by Michael Underwood in 1789 and the virus that caused it was first identified in 1908 by Karl Landsteiner. Approximately 90% to 95% of infections cause no symptoms. Another 5 to 10% of people have minor symptoms such as: fever, headache, vomiting, diarrhea, neck stiffness and pains in the arms and legs. The weakness most often involves the legs but may less commonly involve the muscles of the head, neck and diaphragm. Many but not all people fully recover. In those with muscle weakness about 2% to 5% of children and 15% to 30% of adults die. The disease does not occur in any other animals Poliovirus is usually spread from person to person through infected feces entering the mouth. It may also be spread by food or water containing human feces and less commonly from infected saliva. Those who are infected may spread the disease even if no symptoms are present for up to six weeks. The disease may be diagnosed by finding the virus in the feces or detecting antibodies against it in the blood. Polio, as mentioned, primarily spreads through contaminated water supplies, and with warmth and rains of the spring in northern hemisphere.
Polio currently constantly runs in three countries; Pakistan, Afghanistan and Nigeria.
Out of 68 cases detected worldwide in 2012, 59 were from Pakistan and in 2013 the figure reached to 98 and this year it seems rather a record in Global Health Emergencies; 262 confirmed cases so far in Pakistan. And for only the second time in its history, WHO(World Health Organization) declared last year ‘A Public Health Emergency of International Concern (PHEIC). In response it urged vaccination drives to be stepped up, while authorities will ensure that people in 10 countries who want to travel abroad must have gone through Polio vaccination in previous 12 months.
Malnutrition is one cause of contracting the disease, but I thought more people die in India of starvation than in Pakistan, keep aside the recent Thar Desert drought in Sindh Pakistan, that took lives of more than 200 children with malnutrition last year and again this year figure has crossed 100. But we have no case of Polio detected in Thar Desert where malnutrition is the leading cause of death in children.
As of today the 27th of Nov 2014, confirmed polio cases announced by both WHO and Federal Government in Pakistan stand at 262, out of which 163 cases(63%) were detected in FATA, 55(21%) in KPK, 27(10%) in Sindh, 14 cases(5%) in Baluchistan and 03(1%) in Punjab.
Out of 27 cases detected in Sindh, the breakup is as follows:
Dadu 01, Sanghar 01, Badin 01, Shikarpur 01, Gadap Town 10, Orangi Town 02, SITE Town 02, Landhi Town 02, Korangi Town 02, Bin Qasim Town 02, Liaquatabad Town 01, North Karachi 01 and Baldia Town 01.
In addition it is written clearly in the guide lines issued by WHO (World Health Organization) that Oral Polio Vaccine (OPV) should not be given to children with malnutrition because they tend to be immunocompromised already. One big reason could be, yes off course malnutrition, rendering one to be immunocompromised hence the chances to contract any infection increases by many folds, and to add again contaminated drinking water facilities and contaminated sewerage disposal due to living standards below poverty line and overpopulation. So, on what criteria they make selection of individuals to be vaccinated with OPV. Also as per guide lines, there should be at least 40 days’ time period gap between the two successive doses of Oral Polio Vaccine. Strange really we had polio vaccination drive commencing from 10th till 12th of November in Pakistan and again within 12 days of last dose they have started second dose on 24th of November 2014. Can anyone ask them why? And what health hazards will it bring to the individuals?, including possible vaccine induced Polio itself and that could be one reason of the spread.
We had Dengue, Measles and now again alarming figures of Polio. In a report issued on February 28th 2013 post Measles outbreak and deaths; by Federal Ombudsman Secretariat, it was stated that due to incompetent EPI (Extended Program for Immunization), religious and cultural reservations, malnutrition and contaminated drinking water facilities and improper sanitation, people are contracting these communicable diseases. Same reasons are being discussed for outbreak of Polio now that has set new records of epidemics nationwide.
Lagos State Governor in Africa, Babatunde Fashola, on last Thursday urged the Federal Government to initiate campaigns against open defecation in the country, saying, “This is one of the ways polio virus is spread.” He further said, “We have seen samples of the virus in water bodies, in soil test and others. This means that our hygiene levels are not still where they should be. The open defecation must stop in Lagos and in Nigeria.
Whenever we talk about development and probe in to our weaknesses; we always compare ourselves and compete with our prospering neighbor India. India is not actually as it appears to be from the Bollywood movies we watch.
According to indiaonlinepages.com, current population of India in 2014 stands at 1,270,272,105(1.27 billion), with total male population figures at 655.8 million, total female population at 614.4 million, with sex ratio of 940 females per 1000 males. Currently 51 child births occur each minute in India. With these figures India stands at second most populous country in the world. And the reasons for this rapid uncontrolled growth being discussed on Indian pages are poverty, illiteracy, and high fertility rate, rapid migration from Bangladesh and Nepal and decreased mortality rate.
The World Bank estimates that India is one of the highest ranking countries in the world for the number of children suffering from malnutrition The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub-Sharan Africa with dire consequences for mobility, mortality, productivity and economic growth.
The 2011 Global Hunger Index (GHI) Report ranked India 15th, amongst leading countries with hunger situation. It also places India amongst the three countries where the GHI between 1996 and 2011 went up from 22.9% to 23.7%, whereas 78 out of the 81 developing countries studied including Pakistan succeeded in improving hunger condition.
One of the major causes for malnutrition in India is gender inequality. Due to the low social status of Indian women, their diet often lacks in both quality and quantity. And also culturally the good food or the food at all, traditionally is served to the house head first; usually men; followed by children and woman lastly eats the left over, despite the fact that she cooks for all. Women who suffer malnutrition are less likely to have healthy babies. In India, mothers generally lack proper knowledge in feeding children. Consequently, new born infants are unable to get adequate amount of nutrition from their mothers.
Subodh Varma, in “The Times of India”, states on the Global Hunger Index, India stands at 67th place of the 80 nations having the worst hunger situation which is worse than nations such as North Korea or Sudan. 25% of all hungry people worldwide live in India. Since 1990 there have been some improvements for children but the proportion of hungry in the population has increased. In India 44% of children under the age of 5 are underweight. 72% of infants and 52% of married women have anemia (low red blood cell count). Research has conclusively shown that malnutrition during pregnancy causes the child to have increased risk of future diseases, physical retardation, and reduced cognitive abilities.
56% of poor Indian household consume cereal to consume protein. But unfortunately, the type of protein that cereal contains does not parallel to the proteins that animal product contain (Gulati, 2012). A report by WHO-UNICEF says that Indians comprised 58 percent of all people who defecate in the open. This is one statistics that will put India in the poor light.
Around 638 million people do not have access to toilets in India followed by Indonesia (58m), China (50m), Ethiopia (49m), Pakistan (48m), Nigeria (33m) and Sudan (17m). And 18 percent of urban India still defecates in open while the percentage of rural India is as high as 69 percent. Another consequence of Toilet shortage in India; is fueling Rape incidents as women are easy prey.
In 2010, the UN estimated based on Indian statistics that 626 million people practice open defecation. In June 2012 Minister of Rural Development Jairam Ramesh stated India is the world’s largest “open air toilet”. He also remarked that Pakistan, Bangladesh and Afghanistan have better sanitation records. Yet India is Polio free country since 2009, considering the cause of its spread which fits otherwise do well for India.
According to Indian norms, access to improved water supply exists if at least 40 liters/capita/day of safe drinking water are provided within a distance of 1.6 km or 100 meter of elevation difference, to be relaxed as per field conditions. There should be at least one pump per 250 persons. But only two Indian cities have continuous water supply and an estimated 69% of Indians still lack access to improved sanitation facilities.
As of 2010, only two cities in India — Thiruvananthapuram and Kota—get continuous water supply.
As of 2003, it was estimated that only 27% of India’s wastewater was being treated, with the remainder flowing into rivers, canals, groundwater or the sea. For example, the sacred Ganges (Ganga Nadi) river is infested with diseases and in some places “the Ganges becomes black and septic. Corpses, of semi-cremated adults or enshrouded aborted babies, drift slowly by.” Newsweek describes Delhi’s sacred Yamuna (Jamna) as “a putrid ribbon of black sludge” where the concentration of fecal bacteria is 10,000 times the recommended safe maximum despite a 15-year program to address the problem. Cholera epidemics are not unknown. But never Polio, why!!!!!
In 2005 none of the 35 Indian cities with a population of more than one million distributed water for more than a few hours per day, despite generally sufficient infrastructure. Owing to inadequate pressure people struggle to collect water even when it is available. According to the World Bank, none have performance indicators that compare with average international standards.
According to the Pakistan Social And Living Standards Measurement Survey of 2010-11, the main source of drinking water was as follows: 32% tap water, 28% hand pump, 27% motor pump, 4% dug well and 9% others. Assuming that other sources are identical to unimproved water sources, access to an improved water source was 91%, almost identical to the 2010 figure estimated by the JMP. For sanitation, the survey estimates that 66% had a flush toilet, 15% a non-flush toilet and 18% had no toilet at all. If all toilets were considered to be a form of improved sanitation, access according to this estimate would be 81%, much higher than the JMP estimate of 48%. Now compare the two countries, yet we are suffering from alarming figures of Polio, Why!!!!
Kashmor is one of the districts that suffered massive destruction during 2010 and 2011 floods. Open defecation, poor hygiene practices and use of contaminated water lead to incidence of diseases like Diarrhea, Cholera and Polio causing deaths or disability of people, majority of which are women and children. Whereas the above mentioned figures of open defecation in India or access to clean safe drinking water, or malnutrition does not cause Polio there. Funny isn’t it?
In Pakistan, according to the Joint Monitoring Program for Water Supply and Sanitation of the World Health Organization WHO, and UNICEF, access in Pakistan to an improved water source increased from 85% in 1990 to 92% in 2010. At the same time improved sanitation coverage increased from 27% to 48%. Yet we have Polio, why!!!
In an official notification issued, the Indian High Commission to Pakistan stated,’ Travelers from Pakistan to India after January 30, 2014, are required to carry their vaccination record as evidence of Polio vaccination’ and will only be allowed to enter the country thereafter. It stated that record for administrating OPV (oral polio vaccine) may be obtained from an authorized medical Centre in the format laid out in the World Health Organization’s International Health Regulations 2005 International Certificate of Vaccination. Once administered, the OPV remains effective for one year, after which the vaccination should be taken again.
Pakistan has recorded an increase of 40% in the number of fresh Polio cases as compared to last year and the count still goes on. However India has been Polio free since 2009; therefore, in a bid to maintain its status, India issued the new travel restrictions for Pakistani adults and children. This was published in The Express Tribune, December 12th, 2013.
USAID demanded that to achieve certain target and a failure to achieve one, all EPI managers at Provincial and Federal level and District Health Officers should be made accountable.
It was feared that in Sindh alone, despite now increasing the immunization targets from 60% up to 90%, with political will even, the chances of wide spread disease epidemics cannot be ruled out. Why? Presumably we are corrupt nation hence we do not achieve our targets set for vaccination may be, lack of will to work ,and irresponsible attitudes may be, but the parameters to be reason for a Polio outbreak and of that large scale as it is happening in Pakistan are much lower in Pakistan than India. Strange! Isn’t it? What is the ultimate reason? Keep pondering. So WHO, is polluting Pakistan with Polio????????????????????????????????????????????