Talking Drums

The West African News Magazine

A Generation Born to Die?

....UNICEF calls for action on child death.

by Poku Adaa

In a flurry of advance media publicity, the United Nations Children's Fund UNICEF, in a report published last week, has drawn the attention of the World to the high rate of infant deaths especially in poor countries of the World. POKU ADAA, our Tropical Sciences Correspondent looks at the relevant aspects of the report and the measures which have been recommended to deal with it and deplores the attitude of some institutions and business homes in the developed countries to economically exploit the poor out of their misery and penury.
This is the statement of the 1959 United Nations Declaration of the Rights of the Child. The practical realisation of this declaration is shouldered by UNICEF, the UN Agency which has the mandate to 'emphasise programmes of long range benefit to children in developing countries through working a partnership with governments to reach the most disadvantaged children and their mothers."

The UNICEF report, "The State of the World's Children 1984", which was published recently, is part of the campaign to draw the attention of the world to the plight of children who, ravaged by disease and deprivation, always face certain death in the first year of their life. According to the report, 15 million children die every year from diseases like whooping cough, measles, tetanus, polio, diarrhoea, diphtheria and tuberculosis. Speaking on British early morning television on Friday, 9th December 1983, Ueffa Konnin, UNICEF a director said: "The scale of child deaths is equivalent to the consequences of exploding two atomic bombs on the developing world". The UNICEF report recommends four measures which can halve the number of children who die every year, viz, oral rehydration therapy for diarrhoea sufferers, growth charts to monitor the weight and well-being of children as they grow, community education on breastfeeding and extended immunisation programmes.

Diarrhoea in children especially in newly-born infants kills by 'dehydration', i.e., the inability of the body to absorb what is taken in resulting in a systematic drying up of the body due to continuous watery stools and persistent vomiting. The condition often starts when babies are forcibly removed from wholly liquid feed by the breasts and introduced to bottle feeding and semi solid foods. They become easily susceptible to infection on exposed to improperly sterilised feedware, contaminated food, unsafe water and less hygienic conditions.

Diarrhoea can be exacerbated by malnutrition and can lead to quick deaths. UNICEF, in its report, has recommended oral rehydration, i.e. gradual restoration of the body salts and fluids and one way of achieving this is by giving the child a simple mixture of glucose and common salt in water at periodic intervals for up to twenty-four hours while the child is taken off his normal diet. The medical journal, LANCET calls it 'the medical breakthrough of the century', while some newspaper reports call it 'a revolution in infant care'.

The true fact is that the practice of oral rehydration therapy has been known for over two decades now, having been extensively documented by the Pan American Health Organisation and the World Health Organisation. That glucose and salty water can enhance the absorption of sodium salts through the walls of the intestines was first reported in 1949. To make the world believe that it is a new miracle just thrown from the heavens down to earth is clearly an over-dramatisation of a serious and sensitive issue.

There is no doubt, however, that the method is the best known effective way to check the devastation that the disease can cause, as unlike intra venous infusion, it can be administered easily by all mothers and the efforts by UNICEF to draw the word's attention to a known, though less used, therapy is timely and must be commended in that vein.

The World Health Organisation has already developed a packet containing the correct amounts of glucose and salts to be dissolved in a stated amount of clean boiled-and-cooled water for drinking by victims of the disease. In the U.K. a similar sachet is marketed as 'Dioralyte' by Armour Pharmaceutical Company Limited of Eastbourne, Sussex. Their sachets,which are obtainable only prescription, contains, for every 200 millilitres of water, 0.2 grammes of sodium chloride, 0.3 grammes of sodium bicarbonate, 0.3 grammes of potassium chloride and 8.0 grammes of glucose, and flavoured with cherry syrup.

The UNICEF report recommends that in rural communities where such ready-made packages are unavailable, parents should be taught by health authorities to mix the correct amounts of these ingredients: sugar, salt and water. It is a pity though that in many developing countries, sugar is an essential commodity which only the privileged can find and afford. Certainly in West Africa, such a situation exists. Perhaps, UNICEF should have recommended sugar substitutes such as honey, or sweet berries.

Traditionally, child diarrhoea has always been dealt with, albeit crudely by a mixture of the salty liquid extracts of half-boiled rice and drops of fresh honey and children are not allowed to eat meat while they are taking this mixture, apparently because the body cannot absorb proteins in meat in a diarrhoeal condition. Thus oral rehydration therapy has its roots even in so-called poor countries.

The sad and certainly very distasteful aspects of the genuine UNICEF campaigns is the heavy commercialisation that is clouding its intentions:- According to a British Independent Television 'World in Action' programme on 8th December 1983, a factory in the U.K. has suddenly got big business to manufacture plastic double-cupped spoons for shipment to developing countries to dish out the salts for treating diarrhoea.

No doubt, it will provide a few jobs here but who says people in the developing countries have no means of taking fluids into their mouths? What UNICEF should stress is the hygienic way in which these salts should be administered for surely there must be a more cost-effective way of ensuring proper measurement of these salts.

There ought not to be any need for health authorities in developing countries to import special spoons in order to contain infant diarrhoea. One hopes that UNICEF will not encourage such economic spin-offs out of the misery and poverty of humanity. Moreover, already 34 countries are manufacturing the drug sachets, with imported inputs of course. Nevertheless, the therapy for child diseases should be made as 'appropriate' as can be possible without overburdening the communities who need it with excessive costs.

One cannot underestimate the beneficial effect of breast-feeding in infant care, as it is the only source of sterilised, hygienic feed for a growing body. However, as the UNICEF report rightly observed, there are signs that breastfeeding is gradually being deliberately outmoded and being replaced by powdered milk and other substitutes. Infants are being weaned off at too early an age and there may be some reasons for this: young mothers harbour a fear, a dangerously foolish fear that they tend to lose the firmness of their breasts and that flagging breasts are an easy way to premature ageing, unattractive to male partners. Bottle-feeding is thus becoming fashionable, though the near cogent reason is that it is handy for working mothers who have to leave their infants to go and work.

Secondly, multinational food com- panies are partly to blame for prolifer- ating poor countries with so-called 'infant formulae' and breast-milk substitutes with heavy-funded promo- tion campaigns. This is a formidable challenge to UNICEF and Womens' institutions and organisations to investigate the socio-economic roots of such a trend and seek ways to reverse the practice before it gets out of hand. Immunisation, says the report, to combat the six killer diseases of measles, polio, whooping cough, diphtheria, tetanus and tuberculosis must be expanded and efficiently administered so that all children can have access to them soon after they're born.

The UNICEF report recommends a means of continual monitoring of a child's health progress through what it calls 'Growth Charts'. This implies drawing daily or periodic graphs to see how weight varies with the age of the child. There should be a continuous rise but should it fall at some point, it is a sure sign that something has gone wrong. In theory it sounds a perfect indicator, but putting this idea into practice is bound to be difficult indeed.

Take a West African country, for example, where pens, paper, transport, weighing balances, etc., are non-existent, just unavailable. Now how growth charts can be done even once every two months is an uphill task. This particular recommendation may suit certain urban hospitals only. But as a universal recommendation for rural communities, it is a non-starter.

All in all, the UNICEF Campaign is commendable as it is a way out to 'Save the Little Ones' and protect a generation who otherwise will have been born to die.



talking drums 1984-01-03 two years of Ghana's revolution nigeria and ivory coast reschedule debts