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The world celebrates Children's Day on first of October every year. Children are the world's greatest resource. They not only bring happiness and love to the adult world, but also most essentially bring hope along with them. Yet, 11 million children under the age of five die each year from preventable diseases.

Junk food - sources of obeisity

About 70 percent of these deaths are caused by either diarrhoeal diseases, respiratory infections, malaria, measles or malnutrition, according to the World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF). In the year 2000, 1.3 million children under five in developing countries died from diarrhoeal diseases caused by unsafe water supply, inadequate sanitation and poor hygiene. Sixty percent of the 2.2 million deaths a year in children under five caused by acute respiratory infections are associated with indoor air pollution and other unsanitary living conditions.

Following is an interview conducted by Uchita de Zoysa with Prof. Sanath P. Lamabadusuriya, Dean and Senior Professor Paediatrics, Faculty of Medicine at the University of Colombo to mark the World Children's Day.

What is the status of child health in Sri Lanka?

The status of child health care in Sri Lanka is certainly at a higher standard in comparison to rest of the SAARC countries. Our Infant Mortality Rate is the lowest in the region with 16.3 for 1000 live births as recorded in 1997. Similarly our Life Expectancy is high accord to statistics in 2001 the average life expectancy for males is 70.7 years and for females it is 75.4 years. Compared to some African countries where life expectancy is between 40 to 50 years. However other Asian countries such as Singapore, Malaysia, Hong Kong, Japan and Taiwan etc. are far ahead of us.

The reasons for the relatively high standards of health care in Sri Lanka are due to two factors. First reason is free education that has been provided by the state for the last 50 years. It has raised the level of maternal education and awareness in our country.

Health education could therefore be easily imparted. Second reason is free health care provided by the government. Basic immunization and even heart surgery is free for patients in Sri Lanka. The cancer hospital treats patient free of charge as well.

Who is a healthy child?

A child who has grown adequately for his or her age can be considered as a health child, provided the child has a mental capacity to acquire knowledge as well. He also should be free of serious illnesses and be able to participate in outdoor activities with his peers.

In addition to under nutrition, obesity is also becoming a problem amongst some groups of Sri Lankan children. The chief reasons for this are the consumption of fast foods, lack of exercise and more time spent for sedentary activities such as watching TV or accessing the computer. It should be noted that seeds of adult obesity are sown in childhood. This leads to people developing diabetes mellitus, heart disease, high-blood pressure, osteoarthritis etc. in adulthood.

How can a child become unhealthy? What are the kinds of diseases that children need to be protected from?

One main reason that I want to point is the high level of air pollution due to increased vehicular traffic on our roads. The exhaust fumes contribute to the increasing numbers of wheezy children. Children are also affected by respiratory infections. Mainly children who are schooling can easily contact coughs, colds and other diseases from another child.

Parents who are busy tend to send their children to school even if the child is sick. This creates a vicious cycle. Also those children whose mothers are employed as domestics in the Middle East are neglected by their fathers and in-laws and become victims to disease and abuse easily.

What are the life threatening diseases for children? What is the role of vaccination?

First let me assure that we in Sri Lanka have ensured a very sound immunization programme. The government's Expanded Programme of Immunization (EPI) is very good and effective. The government's free immunization programme includes BCG, Triple, Oral Polio, Measles & Rubella vaccinations. From next year Hepatitis B vaccination too will be introduced to the national schedule. Furthermore the government provides vaccination for Japanese encephalitis in the provinces of North Central, North Western, Western, Southern provinces and some districts in the Eastern province, all-free of charge. It can be claimed that over 90% of Sri Lankan children are covered by the government's vaccination programme.

What other important vaccinations are available in the private sector apart from the government administered EPI?

Mainly the Hib Vaccine that is very important and highly recommended. This is to curtail infections due to Haemophilus influenza type B. The diseases that it could prevent are meningitis, pneumonia, acute epiglottitis, septicaemia etc. This vaccine was introduced in the United Kingdom in 1992 and there was a precipitous drop in the incidence of such diseases and deaths. Now in the UK and in many other developed countries where the Hib vaccine is routinely used such diseases are a rarity.

Many of our parents, spend a lot of money on expensive brands of milk food for their children. If one is cost conscious, I would advise them to buy a mid priced milk powder and invest the balance amount in providing the child with the Hib vaccination. This certainly would be a better investment.

Can a General Practitioner prescribe immunization beyond the governments EPI schedule?

Of course! All parents have the right to know best to protect their children from diseases. Therefore it becomes the responsibility of any doctor who deals with children to advise and create awareness about the availability and importance of other essential vaccines for parents who could afford it.

What is the relationship between a mother and a healthy child, and how can a mother assure good health for her child?

The best relationship and care provided by the mother is initiated by exclusively breast-feeding the baby from birth until 4 to 6 months. Even after that breast-feeding could be continued after weaning. However it is also important that nutritious foods are introduced gradually to the child. Locally available vegetables, green leaves, fruits and pulses etc. should be given. Fish and chicken should be introduced after the age of 6 months and eggs after 01 year.

Are there any new developments to ensure good health of our children?

Yes. The government is setting up a Paediatric Cardiac Thoracic Unit at the Lady Ridgeway Children's Hospital. This will be an exclusive unit to conduct surgery for children born with congenital defects.

This decision was taken to give top priority to the health of children. Congenital heart disease accounts for 20 to 35% of deaths in a paediatric medical unit at Lady Ridgeway Children's Hospital. This is because of the large reservoir of such patients requiring surgical treatment and the paucity of such facilities in Sri Lanka. The few existing cardio-thoracic units in other hospitals cater to adults as well as children and invariably adults are given priority. I believe that this is a very important decision because once heart surgery is performed, a child can live a full life span i.e. over 70 years. Coronary by-pass surgery in an adult extends his life span by a few years only. In that sense the nation is making a very valuable investment for its future children.

What kind of preventive action is required to protect our children from communicable diseases?

To ensure that the children, practice good hygiene, consume clean water and food, breathe unpolluted fresh air and receive the appropriate vaccinations. I would also advise that the government should make an effort to include the Hib vaccine in the EPI schedule as soon as possible.

Finally, how should we as a nation celebrate World Children's Day?

Focus on the relevant issues to influence the policy makers to set some goals before the next Children's Day.

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Copyright 2001 The Associated Newspapers of Ceylon Ltd.
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