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Should India spend money on Pulse Polio, or improving its water supply?

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  • Anil Kumar
    I read during MBBS training that Polio virus spreads by feco-oral transmission. In such a case, isn t it more profitable to attack the transmission by
    Message 1 of 6 , Jul 5, 2007
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      I read during MBBS training that Polio virus spreads by feco-oral
      transmission. In such a case, isn't it more profitable to attack the
      transmission by improving the water supply, rather then spending
      millions/billions on Pulse Polio vaccination campaigns?

      Improving water quality will also assure protection against other
      feco-oral diseases, isn't it?
    • Dr. Kapil Yadav
      Dear Anil, You have hit the nail on the head, that is improvement of sanitation and water quality may be more cost-effective as compared to targeted disease
      Message 2 of 6 , Jul 5, 2007
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        Dear Anil,
        You have hit the nail on the head, that is improvement
        of sanitation and water quality may be more
        cost-effective as compared to targeted disease
        eradication. But the issue under consideration is
        slightly more complex. Firts of all we have to
        conclusively prove that polio is eradicable..
        eradication in scientific terms and not as described
        by WHO limiting it to "wild virus" only. Secondly, is
        polio eradication a prirority for India or mere
        control is more practical and cost effective. In
        addition to this we have also to consider positive and
        negative effect of IPPI on health system of India.
        Whatever ones styand on polio but everyone i think
        would agree that there is a need to re consider and
        discuss the current situation.
        regards.
        --- Anil Kumar <dr.k.anil@...> wrote:

        > I read during MBBS training that Polio virus spreads
        > by feco-oral
        > transmission. In such a case, isn't it more
        > profitable to attack the
        > transmission by improving the water supply, rather
        > then spending
        > millions/billions on Pulse Polio vaccination
        > campaigns?
        >
        > Improving water quality will also assure protection
        > against other
        > feco-oral diseases, isn't it?
        >
        >


        Dr. Kapil Yadav, M.B.B.S, M.D.(Comm. Med.), AIIMS.



        __________________________________________________________
        Yahoo! India Answers: Share what you know. Learn something new
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      • DR RK SOOD
        Dear friends, I definitely agree that sanitation approach is best to control all waterborne diseases, and had mooted the concept of sanitation approach to
        Message 3 of 6 , Jul 6, 2007
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          Dear friends,

           

          I definitely agree that sanitation approach is best to control all waterborne diseases, and had mooted the concept of sanitation approach to control polio last year on the e-group. The real problem is what has not been done in last 50 years cannot be done overnight. Elimination of open air defecation is the goal of Total Sanitation Mission, but behavior change is a slow process. As a short term measure we have to continue NIDs.

           

          I would like to reiterate that Pulse polio programme has led to definite decline in polio incidence, despite the setback of missing the target. The reasons cited include low vaccine efficacy in UP to poor quality of rounds- rampant corruption and rumors on vaccine. There is no question of stopping polio at this stage, you can take a lesson from history and see the results of stopping the NIDs in Nigeria in 2000. Besides Polio Eradication is an International commitment failing which travelers from the country are likely to face travel restrictions under international health regulations and much more…

           

          The NIDs have led to decline in other health activities in high risk areas of UP, which is matter of grave concern. Strengthening the health system, filling vacancies, ensuring accountability, and weeding out corruption are real challenges. Commitment and funding to basics of primary health care is the real answer to the problem- than finding fault with the globally successful strategy.

           

          YES WE NEED TO INVEST IN WATER SANITATION. An integrated approach consisting of strengthening routine immunization, universal sanitation and drinking water quality monitoring - with extensive social mobilization and enabling environment; and provision of legal measures to enforce the national policies is more likely to work than donor driven NID approach alone.

           

          Dr RK Sood

          Centre for health promotion RTDC Palampur

           


          --- In iapsm_youthmembers@yahoogroups.com, "Dr. Kapil Yadav" <dr_kapilyadav@...> wrote:
          >
          > Dear Anil,
          > You have hit the nail on the head, that is improvement
          > of sanitation and water quality may be more
          > cost-effective as compared to targeted disease
          > eradication. But the issue under consideration is
          > slightly more complex. Firts of all we have to
          > conclusively prove that polio is eradicable..
          > eradication in scientific terms and not as described
          > by WHO limiting it to "wild virus" only. Secondly, is
          > polio eradication a prirority for India or mere
          > control is more practical and cost effective. In
          > addition to this we have also to consider positive and
          > negative effect of IPPI on health system of India.
          > Whatever ones styand on polio but everyone i think
          > would agree that there is a need to re consider and
          > discuss the current situation.
          > regards.
          > --- Anil Kumar dr.k.anil@... wrote:
          >
          > > I read during MBBS training that Polio virus spreads
          > > by feco-oral
          > > transmission. In such a case, isn't it more
          > > profitable to attack the
          > > transmission by improving the water supply, rather
          > > then spending
          > > millions/billions on Pulse Polio vaccination
          > > campaigns?
          > >
          > > Improving water quality will also assure protection
          > > against other
          > > feco-oral diseases, isn't it?
          > >
          > >
          >
          >
          > Dr. Kapil Yadav, M.B.B.S, M.D.(Comm. Med.), AIIMS.
          >
          >
          >
          > __________________________________________________________
          > Yahoo! India Answers: Share what you know. Learn something new
          > http://in.answers.yahoo.com/
          >

        • nick carter
          Hii all, Whatever all have said about Improvemrnt of water and sanitation is absolutely right, i too used to thing the same way, but for last 2 months iam in
          Message 4 of 6 , Jul 9, 2007
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            Hii all,
                       Whatever all have said about Improvemrnt of water and sanitation is absolutely right, i too used to thing the same way, but for last 2 months iam in bihar working with National Polio Surveillance Project of WHO as a S.M.O, and the only way which would be effective in eradication of Polio is Increasing the SNID rounds of Polio immunization and overwhelming the rate of infection with the rate of immunization.Place where iam posted for travelling 62 kilometers which is the distance of my farthest block from the district headquarter, it takes 2 hours one way, because the roads are non existent and the situation get even worse when it rains, the routine immunization coverage if well below 30%,  there is no piped water supply the only means of water supply is ground water, open field defecation is a common sight so i guess that very well explains the scenario.
            regards
            Aikant 

            DR RK SOOD <drrksood@...> wrote:
            Dear friends,
            I definitely agree that sanitation approach is best to control all waterborne diseases, and had mooted the concept of sanitation approach to control polio last year on the e-group. The real problem is what has not been done in last 50 years cannot be done overnight. Elimination of open air defecation is the goal of Total Sanitation Mission, but behavior change is a slow process. As a short term measure we have to continue NIDs.
             
            I would like to reiterate that Pulse polio programme has led to definite decline in polio incidence, despite the setback of missing the target. The reasons cited include low vaccine efficacy in UP to poor quality of rounds- rampant corruption and rumors on vaccine. There is no question of stopping polio at this stage, you can take a lesson from history and see the results of stopping the NIDs in Nigeria in 2000. Besides Polio Eradication is an International commitment failing which travelers from the country are likely to face travel restrictions under international health regulations and much more…
            The NIDs have led to decline in other health activities in high risk areas of UP, which is matter of grave concern. Strengthening the health system, filling vacancies, ensuring accountability, and weeding out corruption are real challenges. Commitment and funding to basics of primary health care is the real answer to the problem- than finding fault with the globally successful strategy.
            YES WE NEED TO INVEST IN WATER SANITATION. An integrated approach consisting of strengthening routine immunization, universal sanitation and drinking water quality monitoring - with extensive social mobilization and enabling environment; and provision of legal measures to enforce the national policies is more likely to work than donor driven NID approach alone.
            Dr RK Sood
            Centre for health promotion RTDC Palampur
             

            --- In iapsm_youthmembers@ yahoogroups. com, "Dr. Kapil Yadav" <dr_kapilyadav@ ...> wrote:
            >
            > Dear Anil,
            > You have hit the nail on the head, that is improvement
            > of sanitation and water quality may be more
            > cost-effective as compared to targeted disease
            > eradication. But the issue under consideration is
            > slightly more complex. Firts of all we have to
            > conclusively prove that polio is eradicable..
            > eradication in scientific terms and not as described
            > by WHO limiting it to "wild virus" only. Secondly, is
            > polio eradication a prirority for India or mere
            > control is more practical and cost effective. In
            > addition to this we have also to consider positive and
            > negative effect of IPPI on health system of India.
            > Whatever ones styand on polio but everyone i think
            > would agree that there is a need to re consider and
            > discuss the current situation.
            > regards.
            > --- Anil Kumar dr.k.anil@.. . wrote:
            >
            > > I read during MBBS training that Polio virus spreads
            > > by feco-oral
            > > transmission. In such a case, isn't it more
            > > profitable to attack the
            > > transmission by improving the water supply, rather
            > > then spending
            > > millions/billions on Pulse Polio vaccination
            > > campaigns?
            > >
            > > Improving water quality will also assure protection
            > > against other
            > > feco-oral diseases, isn't it?
            > >
            > >
            >
            >
            > Dr. Kapil Yadav, M.B.B.S, M.D.(Comm. Med.), AIIMS.
            >
            >
            >
            > ____________ _________ _________ _________ _________ _________ _
            > Yahoo! India Answers: Share what you know. Learn something new
            > http://in.answers. yahoo.com/
            >


            Be a better Globetrotter. Get better travel answers from someone who knows.
            Yahoo! Answers - Check it out.

          • Rajesh Sood
            Dear friend, I too have worked with NPSP in Bihar in the same situation, and more than your firsthand impressions. A block took 2 hrs and I found stage IV VVM
            Message 5 of 6 , Jul 23, 2007
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              Dear friend,
               
              I too have worked with NPSP in Bihar in the same situation, and more than your firsthand impressions.
              A block took 2 hrs and I found stage IV VVM there,
              electrical power supply was for 2-6 hrs a day and generators were not operated to save on fuel costs.
               
              But the ultimate malady was lack of funds for routine immunisation- they were not able to transport
              the vaccines to blocks even though ANM were willing to conduct RI camps.
              We have entirely forgotten the basics.
               
              Sanitation needs a lot more to be done in /bihar than in other sates- but that does not
              knockout the best approach to polio eradication. If millions and billions can be raised for NIDs,
              why not for sanitation, routine immunisation? Easy way out is not always the best approach.
               
              polio eradication is an international committment, we need to rethink our strategies.
               
              Dr RK Sood

               
              On 7/9/07, nick carter <Dr_3917@...> wrote:

              Hii all,
                         Whatever all have said about Improvemrnt of water and sanitation is absolutely right, i too used to thing the same way, but for last 2 months iam in bihar working with National Polio Surveillance Project of WHO as a S.M.O, and the only way which would be effective in eradication of Polio is Increasing the SNID rounds of Polio immunization and overwhelming the rate of infection with the rate of immunization.Place where iam posted for travelling 62 kilometers which is the distance of my farthest block from the district headquarter, it takes 2 hours one way, because the roads are non existent and the situation get even worse when it rains, the routine immunization coverage if well below 30%,  there is no piped water supply the only means of water supply is ground water, open field defecation is a common sight so i guess that very well explains the scenario.
              regards
              Aikant 


              DR RK SOOD <drrksood@...> wrote:
              Dear friends,
              I definitely agree that sanitation approach is best to control all waterborne diseases, and had mooted the concept of sanitation approach to control polio last year on the e-group. The real problem is what has not been done in last 50 years cannot be done overnight. Elimination of open air defecation is the goal of Total Sanitation Mission, but behavior change is a slow process. As a short term measure we have to continue NIDs.
               
              I would like to reiterate that Pulse polio programme has led to definite decline in polio incidence, despite the setback of missing the target. The reasons cited include low vaccine efficacy in UP to poor quality of rounds- rampant corruption and rumors on vaccine. There is no question of stopping polio at this stage, you can take a lesson from history and see the results of stopping the NIDs in Nigeria in 2000. Besides Polio Eradication is an International commitment failing which travelers from the country are likely to face travel restrictions under international health regulations and much more…
              The NIDs have led to decline in other health activities in high risk areas of UP, which is matter of grave concern. Strengthening the health system, filling vacancies, ensuring accountability, and weeding out corruption are real challenges. Commitment and funding to basics of primary health care is the real answer to the problem- than finding fault with the globally successful strategy.
              YES WE NEED TO INVEST IN WATER SANITATION. An integrated approach consisting of strengthening routine immunization, universal sanitation and drinking water quality monitoring - with extensive social mobilization and enabling environment; and provision of legal measures to enforce the national policies is more likely to work than donor driven NID approach alone.
              Dr RK Sood
              Centre for health promotion RTDC Palampur
               

              --- In iapsm_youthmembers@yahoogroups.com, "Dr. Kapil Yadav" <dr_kapilyadav@...> wrote:
              >
              > Dear Anil,
              > You have hit the nail on the head, that is improvement
              > of sanitation and water quality may be more
              > cost-effective as compared to targeted disease
              > eradication. But the issue under consideration is
              > slightly more complex. Firts of all we have to
              > conclusively prove that polio is eradicable..
              > eradication in scientific terms and not as described
              > by WHO limiting it to "wild virus" only. Secondly, is
              > polio eradication a prirority for India or mere
              > control is more practical and cost effective. In
              > addition to this we have also to consider positive and
              > negative effect of IPPI on health system of India.
              > Whatever ones styand on polio but everyone i think
              > would agree that there is a need to re consider and
              > discuss the current situation.
              > regards.
              > --- Anil Kumar dr.k.anil@... wrote:
              >
              > > I read during MBBS training that Polio virus spreads
              > > by feco-oral
              > > transmission. In such a case, isn't it more
              > > profitable to attack the
              > > transmission by improving the water supply, rather
              > > then spending
              > > millions/billions on Pulse Polio vaccination
              > > campaigns?
              > >
              > > Improving water quality will also assure protection
              > > against other
              > > feco-oral diseases, isn't it?
              > >
              > >
              >
              >
              > Dr. Kapil Yadav, M.B.B.S, M.D.(Comm. Med.), AIIMS.
              >
              >
              >
              > __________________________________________________________
              > Yahoo! India Answers: Share what you know. Learn something new
              > http://in.answers. yahoo.com/
              >
               


              Be a better Globetrotter. Get better travel answers from someone who knows.
              Yahoo! Answers - Check it out.


            • nick carter
              well nice too know that u too have worked in NPSP but things are changing in Bihar, may be u saw the worst time of the project. And as far as basics is
              Message 6 of 6 , Jul 23, 2007
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                well nice too know that u too have worked in NPSP but things are changing in Bihar, may be u saw  the worst time of the project. And as far as basics is concerned one thing is sure that the Water & Sanitation infrastructure that will be created even at lightening speed will be very minuscule in front of the Children immunized . so i still believe that for the time being what is being done is the best available option
                regards
                Aikant

                Rajesh Sood <drrksood@...> wrote:
                Dear friend,
                 
                I too have worked with NPSP in Bihar in the same situation, and more than your firsthand impressions.
                A block took 2 hrs and I found stage IV VVM there,
                electrical power supply was for 2-6 hrs a day and generators were not operated to save on fuel costs.
                 
                But the ultimate malady was lack of funds for routine immunisation- they were not able to transport
                the vaccines to blocks even though ANM were willing to conduct RI camps.
                We have entirely forgotten the basics.
                 
                Sanitation needs a lot more to be done in /bihar than in other sates- but that does not
                knockout the best approach to polio eradication. If millions and billions can be raised for NIDs,
                why not for sanitation, routine immunisation? Easy way out is not always the best approach.
                 
                polio eradication is an international committment, we need to rethink our strategies.
                 
                Dr RK Sood

                 
                On 7/9/07, nick carter <Dr_3917@yahoo. com> wrote:
                Hii all,
                           Whatever all have said about Improvemrnt of water and sanitation is absolutely right, i too used to thing the same way, but for last 2 months iam in bihar working with National Polio Surveillance Project of WHO as a S.M.O, and the only way which would be effective in eradication of Polio is Increasing the SNID rounds of Polio immunization and overwhelming the rate of infection with the rate of immunization. Place where iam posted for travelling 62 kilometers which is the distance of my farthest block from the district headquarter, it takes 2 hours one way, because the roads are non existent and the situation get even worse when it rains, the routine immunization coverage if well below 30%,  there is no piped water supply the only means of water supply is ground water, open field defecation is a common sight so i guess that very well explains the scenario.
                regards
                Aikant 


                DR RK SOOD <drrksood@gmail. com> wrote:
                Dear friends,
                I definitely agree that sanitation approach is best to control all waterborne diseases, and had mooted the concept of sanitation approach to control polio last year on the e-group. The real problem is what has not been done in last 50 years cannot be done overnight. Elimination of open air defecation is the goal of Total Sanitation Mission, but behavior change is a slow process. As a short term measure we have to continue NIDs.
                 
                I would like to reiterate that Pulse polio programme has led to definite decline in polio incidence, despite the setback of missing the target. The reasons cited include low vaccine efficacy in UP to poor quality of rounds- rampant corruption and rumors on vaccine. There is no question of stopping polio at this stage, you can take a lesson from history and see the results of stopping the NIDs in Nigeria in 2000. Besides Polio Eradication is an International commitment failing which travelers from the country are likely to face travel restrictions under international health regulations and much more…
                The NIDs have led to decline in other health activities in high risk areas of UP, which is matter of grave concern. Strengthening the health system, filling vacancies, ensuring accountability, and weeding out corruption are real challenges. Commitment and funding to basics of primary health care is the real answer to the problem- than finding fault with the globally successful strategy.
                YES WE NEED TO INVEST IN WATER SANITATION. An integrated approach consisting of strengthening routine immunization, universal sanitation and drinking water quality monitoring - with extensive social mobilization and enabling environment; and provision of legal measures to enforce the national policies is more likely to work than donor driven NID approach alone.
                Dr RK Sood
                Centre for health promotion RTDC Palampur
                 

                --- In iapsm_youthmembers@ yahoogroups. com, "Dr. Kapil Yadav" <dr_kapilyadav@ ...> wrote:
                >
                > Dear Anil,
                > You have hit the nail on the head, that is improvement
                > of sanitation and water quality may be more
                > cost-effective as compared to targeted disease
                > eradication. But the issue under consideration is
                > slightly more complex. Firts of all we have to
                > conclusively prove that polio is eradicable..
                > eradication in scientific terms and not as described
                > by WHO limiting it to "wild virus" only. Secondly, is
                > polio eradication a prirority for India or mere
                > control is more practical and cost effective. In
                > addition to this we have also to consider positive and
                > negative effect of IPPI on health system of India.
                > Whatever ones styand on polio but everyone i think
                > would agree that there is a need to re consider and
                > discuss the current situation.
                > regards.
                > --- Anil Kumar dr.k.anil@.. . wrote:
                >
                > > I read during MBBS training that Polio virus spreads
                > > by feco-oral
                > > transmission. In such a case, isn't it more
                > > profitable to attack the
                > > transmission by improving the water supply, rather
                > > then spending
                > > millions/billions on Pulse Polio vaccination
                > > campaigns?
                > >
                > > Improving water quality will also assure protection
                > > against other
                > > feco-oral diseases, isn't it?
                > >
                > >
                >
                >
                > Dr. Kapil Yadav, M.B.B.S, M.D.(Comm. Med.), AIIMS.
                >
                >
                >
                > ____________ _________ _________ _________ _________ _________ _
                > Yahoo! India Answers: Share what you know. Learn something new
                > http://in.answers. yahoo.com/
                >
                 


                Be a better Globetrotter. Get better travel answers from someone who knows.
                Yahoo! Answers - Check it out.



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