India is once again in the news for all the wrong reasons. Along with four other countries India in 2010 accounted for half the estimated number of global deaths from eight main causes in children younger than five years. A recent study in The Lancet has revealed that half the number of global deaths caused by infections again took place in these five countries. In all, there were nearly 1.7 million estimated deaths in India that year. With nearly 400,000 deaths, pneumonia turned out to be the top killer disease, followed by diarrhoea causing more than 210,000 deaths. In fact, India is one of the five countries where most have died from two preventable infectious diseases — pneumonia and diarrhoea. Apparently, in India, pneumonia felled the most in both age groups — about 143,000 deaths in neonates (less than 28 days old) and nearly 254,000 in those aged 1-59 months. The corresponding mortality figures for diarrhoea were nearly 19,000 in neonates and 193,000 children aged 1-59 months. That no significant improvements took place during the period 2005-2010 became clear in a November 2010 The Lancet study that looked at the estimated deaths in 2005 at ages 1-59 months. Half the 1.5 million deaths in 2005 were from pneumonia and diarrhoea.
These findings should come as no surprise as the main causative factors have yet to be addressed. A majority of people, especially in rural areas, do not have access to safe drinking water, and sanitation and hygiene levels are terrible. A recent UNICEF report says 638 million people, or nearly 54 per cent of the population, defecate in the open. The corresponding figure in Bangladesh and Brazil is just seven per cent. The report adds that only six per cent of rural children below five years used toilets. While Jairam Ramesh, Union Minister for Drinking Water and Sanitation, is determined to rid the country of open defecation by 2017, what needs to be undertaken immediately is to spread a simple yet cost-effective public health message — the importance of handwashing with soap after defecation. Unfortunately, only about half of all Indians regularly wash their hands with soap after contact with excreta. Washing hands can cut diarrhoea by over 40 per cent, and about 30 per cent of respiratory infections, including pneumonia, can be avoided. The gain is more if this practice is adopted before eating. Global Handwashing Day, endorsed by many countries, including India, was initiated in 2008 to drive home this important message. But awareness building should be a continuous process and cannot be restricted to just one day.