Conspiracy or Coincident?
Large-scale Vitamin A supplementation began in Bangladesh in 1973 as part of the Nutritional Blindness Prevention of Children aged 12-59 months and with National Immunisation Drive (NID) in 1995. Children aged between one and five years are given Vitamin A capsules while de-worming tablets are given to those between two and five. Vitamin A contributes helps to build the immune system, helping children to better cope with common diseases such as measles, diarrhoea and respiratory infections. Studies show that Vitamin-A supplementation also helps children to grow faster, to be less anaemic, and it reduces mortality rates. It is estimated that every year, Vitamin-A capsules save the lives of over 30,000 children in Bangladesh and reduce illness amongst thousands of others On the other hand, worm infestation causes weight loss, poor growth and anaemia, educational leading to poor achievement.
Bangladesh is the first country in South Asia to integrate Vitamin-A supplementation of children between 12-59 months with the NIDs in 1995, and is also one of the first countries in the world to develop the new strategy - National Vitamin-A Plus campaign - that is used to deliver multiple interventions to children. The deworming and vitamin A supplementation programme has significantly improved the healthcare of infants in Bangladesh. For such initiatives Bangladesh ranks one of the most successful countries of the above 40 countries in the world where millions of children are receiving at least one Vitamin A supplement yearly.
As part of the regular programme an estimated 20 million children were administered Vitamin-A Plus capsules and 19 million children were given de-worming tablets under a joint programme of the National Institute of Nutrition and UNICEF on June 6.
However, this is for the first time in the history of such a successful programme that a mess has happened. After the nationwide Vitamin A and deworming campaign different newspaper reports published that as many as 400 children had become sick in different districts, including Faridpur, Dinajpur, Nilphamari, Jhenidah, Bandarban, Munshiganj and Patuakhali, as a result of what the parents claimed taking vitamin A capsules and deworming tablets. The babies were being treated for diarrhoea, stomachache and nausea at hospitals. Two of them died allegedly of diarrhoea.
Reassuring the people, however, the Health Minister AFM Ruhal Haque in the parliament reiterated that no child died as a result of taking the Vitamin A capsule and deworming tablet. The health minister in parliament said sometimes people could have symptoms like nausea or headache as side effects of the de-worming tablets.
The minister also claimed that some vested quarters might have hatched a conspiracy against the programme, which had been operating in the country successfully for the last three decades. According to the minister a few of the children got diarrhoea and were admitted to hospitals, as some parents gave their children tamarind or lemon juice following instruction given through loudspeakers in their locality.
Even at the cabinet meeting on June 08 the Prime Minister, Sheikh Hasina, smelt a rat saying that a quarter might have a hand in sensationalising the incidents by using various means, said a minister who attended the meeting.
To find out why the children became sick, however, a five-member probe committee, led by ABM Jahangir Alam, director of Public Health Care (PHC) and Children Health Department, was formed. For further investigation, samples of the tablets were earlier sent for tests at the laboratory of Institute of Epidemiology Disease Control and Research and in another USA laboratory named CDC Atlanta.
On the other hand, expressing confidence on the actions taken by the government to investigate the cases of children allegedly becoming sick after taking Vitamin A capsules and de-worming tablets, the World Health Organisation (WHO) and Unicef offices of Bangladesh in a joint statement also reassured parents that Vitamin A capsules and de-worming tablets are safe. In a joint statement, the WHO and Unicef offices said Vitamin A supplementation and de-worming tablets are effective interventions that contribute to strengthening the health of young children.
However, the government probe submitted the report on June 11 to the Health Secretary, that the incident of children falling ill around the country did not find any link between it and the Vitamin A Plus campaign running nationwide. The probe found some other causes behind the illness of the children who had been admitted to the hospitals.
The report said Habib, 11, who died at Daulatdia, had been suffering from encephalitis. He had also not taken any Vitamin A or de-worming pills.
After getting the probe report the Health Minister briefed the press that those who were admitted to hospital with diarrhoea had already been suffering from the condition for a few days and this had no connection to the intake of Vitamin A capsules. The health minister also disclosed that the laboratory test report at Institute of Epidemiology Disease Control and Research stated that the Vitamin A capsule and Albendazol (deworming tablet) being administered to children were safe.
Meanwhile some health experts began to criticise the government organising seminars and giving statements in newspapers. At a seminar at the IDB auditorium some health experts criticised the government for not including members of civil organisations in the probe committee as that would have been more neutral. They also questioned how officials of Unicef and World Health Organisation made comments on the quality of the Vitamin A and de-worming tablets before they were tested in any laboratory.
Even a few health experts in interviews with some newspapers gave some confusing statements that taking the medicines immediately after having a full meal or in empty stomach might have been the reason. Refuting such statements child expert Professor M Abid Hossain Mollah says , "There is no link between intake of Vitamin A capsules and de-worming tablets with meal and temperature. Medical science has never endorsed the idea that temperature and empty stomach has any impact with regard to the intake of Vitamin A capsules and de-worming tablets."
Now the government is waiting for the report from CDC Atlanta, USA, where more samples have been sent for tests. It is expected that the government will make all the facts behind the incidents public for the sake of keeping such a popular and much-needed programme.
(R) thedailystar.net 2009