To reduce the burden of diarrhoea in India, we will need to deliver a comprehensive package of proven interventions, says dipika sur


A NEW global study published recently in The Lancet has confirmed rotavirus as a leading cause of diarrhoeal disease in children in India and across the world. With more than 100,000 children dying of rotavirus every year in India, this research must catalyse all stakeholders into action to protect their health and wellbeing.
India has experienced impressive improvements in economic status and population health over the past few decades but the country still lags behind in child survival. The mortality rate for children aged five and younger currently stands at 61 per 1,000 live births and this is higher than many countries of similar per capita gross domestic product.
Diarrhoeal diseases are significant contributors to this high child mortality rate. Despite being largely preventable and treatable, diarrhoeal diseases are the second leading cause of death among children under five years of age globally, followed by pneumonia. In 2010, experts estimated that almost 1,7 million children of under five years of age died in India and it has been shown that 18 per cent of these deaths occurred because of diarrhoeal diseases.
The illness is caused by many different bacteria, viruses and other pathogens. The challenge — without clear data on which pathogens account for the most severe illness and death — has been how to prioritise resources and research to reduce the burden of these diseases. The release of new findings from the Global Enteric Multicentre Study reveals critical information that can help us target our approach and finally reduce this burden. Gems is the largest and most in-depth study on diarrhoeal diseases to date — conducted in four sites in sub-Saharan Africa and three in South Asia, including Kolkata, India – and provides new insight on the causes and impact of these diseases.
The study found that the incidence of moderate to severe diarrhoea in India was the highest of the seven countries studied. It estimated that there were roughly 90 episodes of moderate to severe diarrhoea among every 100 infants aged 0-11 each year. Rotavirus was the leading cause of illness in children under the age of two in the slums of Kolkata and, on its own, caused an episode of Musculoskeletal disorders in approximately one of every four infants each year.
To reduce the burden of diarrhoea in India, we will need to deliver a comprehensive package of proven interventions. This includes access to oral rehydration therapy, zinc supplementation, encouraging exclusive breastfeeding for the first six months of a child&’s life and improvements in hygiene, sanitation and drinking water. Previously published Gems data found that less than 30 per cent of children with diarrhoeal disease who stayed at home received Oral Rehydration Salts– an affordable and effective treatment. To supplement these interventions, rotavirus vaccines offer a significant, targeted hope for protecting children from this terrible disease.
This is where India has an advantage. Its strong scientific community can innovate new technologies very quickly and our vaccine manufacturers are capable of producing quality medication for the world. We have already developed an indigenous rotavirus vaccine — designated 116E – which has been shown to be safe and immunogenic in Indian infants. Bharat Biotech, based in Hyderabad, with the Department of Biotechnology, developed this vaccine in a uniquely designed private-public partnership model and the results are evident.
India is at a critical juncture. It has been more than two years since our last case of polio, which highlights the success we can have if strong partnerships are formed between multiple stakeholders.  However, with diarrhoeal diseases still a major child killer, this is no time to rest. The true legacy of polio eradication in India could fade if the government does not invest in innovations and new vaccines to fight diseases that cause the maximum number of child deaths. Not only would it provide tremendous social and economic returns, we would be making great strides towards a more equitable country where all children achieve their right to survival, good health and holistic development.

The writer is principal investigator, Global Enteric Multicentre Study, and deputy director and senior head, National Institute of Cholera and Enteric Disease Epidemiology