THE CHILD AND V.D.

by Major M. P. Vora

Ref: The Economic Times, September 26, 1982 Pages 4 & 5

The United Nations has declared 1979 as the International Year for the child, to focus public attention on the child’s plight and to improve its quality. The International Year for the child (ICY) has come and gone, but the maintenance of good health is a continuous process. It was the most appropriate time, to take stock and review measures to achieve the objectives.

India has adopted a national policy for her children, and declared them as “a supremely important asset, whose nurture and solicitude are her responsibility.” There is a National Children’s Board and National Commission of IYC. However, these statements seem like the pious platitudes only, as the reality of inaction continues unfailingly. It is imperative, that we change our attitudes, cast aside prejudices and inactivity, towards the large number of hapless and miserable children in the country.

Much publicity was given over various media, to many aspects of childhood disabilities such as mental retardation, paralysis, blindness, deafness, and nutritional deficiencies etc, the number of children involved in each category and the measures taken or to be taken for their correction. However in none of these talks or articles, was any reference made, even by way of narration, to the vast number of children involved in venereal disease hazard for the children. Will the Indian Council for Child Welfare pay due attention to this problem at the earliest?

The significance of high incidence of V.D. in children, has been deliberately ignored. Unluckily, it is considered unworthy of attention. This conspiracy of silence, regarding V.D., is a familiar experience of most venereologists. The age-old assumption that venereal diseases are associated with promiscuous sex relations continues to weigh on the public mind, implying immoral sex behaviour, in which children are not usually involved, hence its incidence in children is not generally appreciated by the public.

Our failure to recognize V.D. in children to a great extent is due to a totally false conception. By the definition, a child is an unborn or new born human offspring from its conception up to 14 to 15 years. It may be unborn, newly born, infant, toddler, juvenile or adolescent. For our purpose, it is enough to consider a child up to 15 years of age, irrespective of when the puberty begins or ends.

I would like to emphasize, that these diseases do attain significant proportions in children, and contribute greatly to their illness, disabilities, and deaths. A large number of children experience health hazards of different magnitude, apart from sizable loss of child population. An authentic assessment of all data in both qualitative and quantitative terms are very necessary but are often not available, overlooked or ignored by health authorities.

The number of children, who become victims of V.D., cannot be stated precisely, for want of accurate statistics, and particularly, when we have a strong tendency to push under the carpet everything, that concerns to V.D. However, some indication of the extent of V.D. in children can be inferred or deducted fairly accurately, from the circumstantial evidence, and otherwise sketchy information, that are available in the country. The term V.D. may appear misleading, irrelevant and inappropriate, when one speaks of congenital syphilis acquired in the uterus or ex-utero, at the time of delivery. But there is no substance in this. Person-to-person transmission of V.D by direct (sexual or asexual) or indirect contact is common. The IYC was the best time, to awaken and alert the public, to make them aware of their menace, gravity and magnitude.

V.D can incidiously cripple or destroy fellow-beings, irrespective of age, sex, colour, cast, economic or social status. They have serious impact not only on the individual human victim, but also on the other members of the family and the whole community. Of all the social ills of man, the least manifest and least likely ever to be static, are venereal diseases. However, they relegated, notwithstanding the alarming rise, to a position of no importance, because of the social stigma. They are rarely spotlighted like malaria, typhoid, cancer, or tuberculosis. The micro-organisms that cause V.D are not inhibited or restrained, by any barriers like age, sex, climate, season or place. They attack humans at all times and places.

Treponema pallidum of syphilis can affect a fetus in the uterus, at the time of its birth or there-after, threatening its very existence or inflicting permanent disabilities. But this is conveniently ignored. The virtual unawareness, lack of appreciation and absence concern, impair or destroy the well-being, health and happiness of childhood. Does not this amount to flagrant violation or denial of United Nations aim and solemn declaration?

It is said, that the child population constitutes nearly 40 to 42 percent of the total population of the country. If the total population of India is assumed to be 700 million, the child population comes to 280 to 290 million. How many children of this child population suffer from V.D.? Nearly 125 to 130 infants out of 1000 born yearly, die soon after their birth. How many deaths of these are due to syphilis and the virus transmitted? What is the role of syphilis and gonorrhoea, in the causation of disabilities like blindness, deafness, paralysis, and mental retardation among children?

V.D may cause abortion, miscarriage, still-birth, or neonatal death. Authentic data regarding prematurity, newborn mortality, infant mortality, child mortality and the rates of various disabilities in the children are of prime importance to the health planners and venereologists. These questions, therefore, require adequate answers from our health authorities, to determine precisely the effects of V.D. on the national child health. Will the health authorities in the country give due attention to these problems, collect necessary data, and compile statistical studies, to throw light on this vital topic?

While searching for information, I struck on the report of Bombay city for the year 1920. Though it is outdated it is sure to give an indication of the havoc V.D can cause. “The J.J Hospital recorded that 18.7 percent of its indoor patients and 23.3 percent of its outdoor patients had an evidence of V.D. At the Motalibai and Cama Hospitals for women 10 to 15 percent patients were sero-positive for syphilis. Among 2000 yearly still-births in the city 18.5 percent (370) were due to syphilis. Out of the 9000 children that died annually, 3000 died of congenital syphilis. Of the blind 30 percent of the deaf 25 percent and the mentally deficient 50 percent children were due to the result of V.D.” But this report could not act as an eye-opener.

The Executive Health Officer, Municipal Corporation of Greater Bombay has kindly supplied figures for 1978: total population 81 lakhs, total child population 24 lakhs, total births 2041120, total infant mortality 14743.64, still-births 6570.

The information concerning V.D. in children, stillbirths, infant and child mortality due to V.D and seropositive rate in pregnant women, though specially asked for, could not be obtained unfortunately. Non-availability of this information hardly speaks well for the city health authorities. It would have certainly shown the extent of V.D. component responsible for health havoc in childhood.

In 1960, the Union deputy minister for health stated, “Nearly 20 million people are infected with V.D. every year and 13 percent among them are teenagers.” (It means that 2.6 million children had got venereal infection in that year).

Dr.T.Guthe, the former C.M.O for the Communicable Diseases to the WHO, stated in 1965, that “The incidence of V.D. is very high in India, and Bombay ranks among the ten most highly infected cities in the world.” V.D. is not static and their incidence increases like the compound interest. The actual situation today must be worse. It is estimated that there are annually more than 70 million new cases and a yearly rise of 10 to 12 percent in the incidence. The estimable figure for child involvement may easily surpass the 10 million mark a year. This is an alarming situation, indeed: but no one seems to be least concerned or upset.

At the Institute of Venereology, Madras, 894 children out of 41,020 total patients were treated in 1978. At the V.D. centre, the Safdarjung Hospital, Delhi, 2,067 children out of 2,02,803 patents and 1,131 children out of 75,483 patients were treated for V.D. in 1974 and 1975, respectively.

Three autopsy studies on stillborn births in Tamil Nadu, revealed germs of syphilis as the cause of their deaths in (1) 3 percent out of 164, (2) 9 percent out of 35 and (3) 5 percent out of 22 dead born infants. This gives an overall average rate of 5.6 percent for the stillborn births, attributable to syphilis. This clearly proves that a significant proportion of foetal or infantile deaths were due to active syphilis acquired from their mothers.

Table I shows the sero-positivity rate for syphilis in pregnant women.

This gives an overall average rate of 10.15 percent. It means that one out of ten pregnant women is affected with syphilis.

If these findings and figures have real meaning, it becomes crystal clear that there is an urgent need to enforce the serologic test for syphilis, and screening for gonorrhoea, by the smear and culture examinations routinely, as part of antenatal care, in pregnant women and to give prompt and appropriate therapy for the positive women to save their children from deaths, and to reduce the rates of morbidity and disabilities among them. It is not always easy to diagnose V.D. precisely on a simple clinical examination. The reliable and prompt laboratory help is imperative. The general public and the medical profession must be fully aware of the supreme benefits of the antenatal care, which must include tests above mentioned.

The importance of the doctor’s role in the preventive medicine and the public co-operation in this task can be scarcely exaggerated. To achieve this objective, the most essential prerequisites are the establishment of free, reliable and quick laboratory services as well as competent medical services all over the country- both in the cities and rural areas. However, these facilities are overlooked in many medical institutions; recently established primary health centre are conspicuously devoid of these facilities. This show how faulty is our health planning as far as venereology is concerned. Our health planners and administrators have to recognize and appreciate this problem in total. This is sheer negligence of the welfare of the children. It would be tragic to allow children to die, suffer physical defects or endure unnecessarily.

It is worth knowing that Treponema pallidum is transmitted transplacentally to the fetus, as early as 10 to 12 weeks after the gestation, and can be recovered from the infant, whether it is alive or dead. An untreated congenital syphilitic infant may show variety of manifestations, or may remain latent i.e. without signs or symptoms, up to the age of 15 years, to be recognized only in the late childhood. During the early maternal syphilis, the risk of infection of the fetus is 95 percent, and the fetal loss is about 60 percent. Serologic surveys have confirmed that in apparent or unrecognized syphilitic infection is common without obvious illness, and that it is the most common cause of the spread of the disease.

Many innocent children get infected with syphilis, gonorrhoea or both by a sexual contacts with infectious persons or as the result of sexual assaults on them by unscrupulous persons, who’s falsely believe there-by to get they cured of their disease. Besides, causal or forced sexual relationships of various kinds are not uncommon. Children, who work in hotels and restaurants, are frequent and easy targets of sexual assaults. But such examples do not come to light for the fear of shame, stigma or ignorance. Moreover there are persons with V.D. who have received an inadequate or inefficient treatment and are not tested for ‘cure’- a very common phenomenon in the country; they are likely to deliver dead, living with manifestations or perfectly healthy looking babies to outwit a doctor. Children’s homes, uses correction for children and juvenile jails have cases of this type. Gonococcal infection in the pregnant women can cause blindness or systemic infection in her infants.

We are fortunate today to have an adequate knowledge, sophisticated techniques to determine the exact etiology of these diseases excellent methods of prevention and treatment. These can be used in time to save children.

V.D, in children has become the pressing problem. This must be widely appreciated, and attempt made to ward them off. They are highly preventable and easily curable in the early stages. Their gravity, extent and magnitude have been shown by examples. It is urged by concrete steps for their prevention, early detection and efficient treatment must be taken, to save a vast number of children. Routine testing for V.D. in pregnant women must be compulsory at all health care centre and antenatal clinics; widespread reliable and prompt laboratory and treatment facilities must be made freely available all over the country. This is sure to pay excellent dividends.

The incidence of congenital syphilis, child deaths and disabilities can be markedly reduced, nay, completely eliminated, if proper steps are taken in time. It is pity that we have not been using what we have wisely and intelligently. Neglect of V.D. is distressing and unpardonable today. The compelling need is for urgent steps to correct the deficiencies in our medical education and services and to plan wisely to secure good health for all in the country.