The Nicholas Factor

It is Christmas time once again. It is the season of rejoicing; of giving and receiving; of raising our hands in Thanksgiving. My earliest recollections of Christmas festivities are associated with the socks which, we as children (even in Hindu homes), would hang up somewhere (not by the fireside, as there would be none) on Christmas Eve for Father Christmas to fill up. We were always rewarded with sweets or a story book, or something similar, which was sometimes found tucked under our pillows next morning, if it did not fit inside our small socks. But then, we had small desires and these simple gifts made us immensely happy. Read more


It was only much later that I learnt that this custom of hanging up a Christmas stocking originated from the story of Bishop Nicholas on whom the Father Christmas legend is based. The story tells how a local nobleman had lost his fortune and was sadly unable to provide dowries for his three unmarried daughters. St. Nicholas decided to help in secret. He waited until it was night and crept through the chimney. He had three purses of gold coins with him. As he was looking for a place to keep this gift, he noticed the stockings of the three girls that were hung over the mantelpiece for drying, and so put one purse in each stocking. This led to the custom of children hanging stockings or putting out shoes, eagerly awaiting gifts from Santa Claus or Father Christmas.

Another remembrance is of the scene of Nativity, which is still enacted in many missionary schools/churches. That also had a gift component of the three wise men bringing presents of myrrh and incense for the infant Jesus. But it seems that now the humble manger, with the infant Jesus swathed in rags, is almost forgotten. And so are the humble stockings.

We, the modern day parents, sow the seeds of ambition in our children right from infancy. We teach them to think big and act smart in order to become rich and powerful. So their wish list does not fit in a stocking, and really stretches the purse strings of Santa. The more expensive and exclusive the gift, the higher is their happiness quotient. Need has now been overshadowed with greed.  It is not only the children, but even we adults have such skewed up notions about giving and receiving. The other day I was invited to the 1st birthday party of an acquaintance’s grandchild. All of us invitees were trying to outdo the other, carrying loads of gifts for a kid who was literally born with a silver (nay gold) spoon. To my surprise I found that most of the guests, at this supposedly kids’ party, were either business friends or high government officials. Even in such a high profile setting, differential treatment to the guests (depending upon their profit value) was more than obvious. One trio of father, mother and daughter was being particularly pampered by the host. The catering waiters were instructed to take special care of this special guest, who turned out to be some bigwig from the income tax department. Liquor was flowing openly for the men folk (and rather discreetly for the women). The soulful renditions of the hired ghazal singer were drowned in the din of noises. This did not look to me like a children’s party from any angle. It was pathetically amusing that neither the ambience, nor the few kids present there, gave it the feel of someone’s 1st birthday party. But then, perhaps I was being just too stupid and naive. Someone wisely whispered in my ears that such parties are held to enhance the business prospects of the host family—birthdays are just an acceptable excuse. The giving of gifts and partaking of the hosts’ generosity are actually part of the profit generating business strategies, and also an opportunity to show off one’s opulence and social status.

It is a sad commentary on our morality that the noble gesture of giving and receiving is now dictated by social and financial obligations to further our monetary interests. The size and cost of our gift is not dependent upon the needs of the receiver. It depends upon what we hope to gain (other than gratitude) from giving it. The worth of our presents is almost invariably inversely proportional to the economic status of the recipient. Why else do we give cheaper gifts to those who are below our own social/economic status?

If only, our giving could be gentle as silence (as goes one of the hymns I learnt in childhood), and if it keeps in mind the needs of the receiver (and not the greed of the giver), then we will be really blessed. Only if we could inculcate the magnanimous modesty of Saint Nicholas while filling up empty stockings!

The birth of Christ is an event which teaches humanity the lessons of austerity and humility. It teaches us to respect the poorest of the poor and to accept the graces, as well as tribulations of life with equanimity. Let us not forget the real meaning of Christmas, which is of forgiveness and humility. Let us give with humility and receive with grace whatever is offered to us—not only by way of Christmas gifts, but in every sphere of our lives. Let us also not shower money on our children, but teach them to be humble and respectful, and imbibe in them a love for humanity. If we share our bounties with the indigent, our wealth is bound to multiply.

At this time of the Yuletide season let our faith be reaffirmed in the goodness of humankind, so that God is in Her place in heaven and all is right with the world.

May peace and goodwill always prevail on the earth.


Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Diabetes Media Initiative (CNS-DMI).She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP.  Email: shobha@citizen-news.org, website: www.citizen-news.org) 

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Girl students add voice to UP youth policy advocacy campaign

Over 100 girl students of Husain Chutki Bhandar Inter College participated in a poster making and debate competition on the theme 'present condition of youth and their rights.' The competitors from classes 9 to 11, through the medium of brush, colors and words added their voice and support to the urgent need of a youth policy for Uttar Pradesh, which has a large population of youth. The movement for a legal youth policy for the state is being spear-headed through Uttar Pradesh Youth policy advocacy campaign. Read more


"Development of state is impossible without the development of youth," asserted Ms Varsha Verma, winner of the first prize in the poster competition titled.

Sheeba Khatoon who stood second in the same competition urged a re-look into the education system of the state.

Fatima Bano, who stood third in the competition, stressed the importance of girls’ education. She said education for girls was the surest way of ensuring the progress of any community and state. Stressing that the policy must address the different issues that confront the youth Fatima said that youth participation is important during the drafting of this policy. Through the poster and debate the students addressed the issues of corruption, gender discrimination, technical education, child marriage etc.    

It was pointed out by a student during the debate that in UP only 31.5 per cent girls and 48.6 per cent boys between the ages of 15 to 17 go to school. This and other issues must be addressed in the policy.

According to a recent survey 58,000 girls do not go to school in Lucknow, the state capital.

According to another survey 50 per cent of girls in the state were found anemic. 20.5 per cent women in the state were found suffering from sexually transmitted diseases (STD).

"Issues and concern of the youth of Uttar Pradesh must be addressed through this draft," said Anu, team leader of the advocacy campaign.

She said that through the campaign, sustained efforts have been made to ensure that there is a proper awareness for a policy for youth of Uttar Pradesh in every segment of society.

From November 22 to January 12, in 35 districts of the state an intensive drive has been launched to percolate this campaign to people from all walks of life.
    

Kulsum Mustafa

(The author is a senior journalist and also is the Secretary General of Media Nest)

Media Dialogue With AIDS-Affected Children

To commemorate World AIDS Day, December 1, 2010 some AIDS affected children from Lucknow, Sultanpur, and Bara Banki districts of Uttar Pradesh, had a dialogue with the media at the Uttar Pradesh Press Club. The Uttar Pradesh Welfare For people living with HIV/AIDS (UPNP+) supported by UNICEF and Media Nest, a pan India body of Media professionals, facilitated this one hour long interaction under 'Media for Children'. Read more

The session saw children from different age groups have a direct dialogue with Media persons. They talked about discrimination at school, society and in health services. They rued about how nobody wants to make friends with them, with even their relatives maintaining a safe distance from them for fear of infection. Many had lost their parents and sibling to AIDS and were hurt and humiliated the way they were treated by their relatives and neighbours. The shared it all-- the pain, the trauma and the pathos of being AIDS affected children.

While UNICEF AIDS specialist Dr Khanindra Bhuyan, communication specialist Augustine Veliath, Meena Jadav, UNICEF AIDS (Primary Prevention) consultant and senior members of the UPNP+ were present, there were no formal presentations by the adults in the session.  The floor was left entirely to the children, many of them infected, but all of them ‘affected’ by HIV /AIDS. Many of these children were orphans –HIV/AIDS had claimed one (and in many cases both) of their parents. They had sisters and brothers who had died due to AIDS. All the children talked with great emotion about their traumatic living in a society that has a lot of misconceptions about HIV/ AIDS. They had to cope with not only the loss of their near ones, but also had to deal with the discrimination that they had to face as they were “AIDS affected.” 

The children spoke about their lives, their aspirations. They delved upon stigma at home, in the society, in schools, and at the hands of health providers.
 They spoke about their emotional trauma due to rude behaviour of service providers including teachers, and also the absence of facilities as well as lack of opportunities

While the electronic media persons had not been invited to this session, even the print media photographers had been requested not to click photographs or use the real names of the children. This was an attempt to guard the privacy of these very special children. The media persons were asked to freely interact with the children on a one to one basis or in groups.

“The children had total freedom. They talked reality; they talked about life as they actually lived it. It was bound to touch hearts, it did” said Dr Bhuyan, who was one of the silent observers in this session.

The media and the general public (including educators and health workers) can be partners in this noble task of ensuring social acceptability for these special children, by respecting their dignity and privacy, and by encouraging and reassuring them in all possible ways.

Kulsum Mustafa
(The author is a senior journalist and also serves as Secretary General of Media Nest) 


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Children Affected With HIV/AIDS Attend Training Workshop

Today, 1st of December, is World AIDS Day—a grim reminder of this killer disease, which has devastated millions of families all over the world. In Uttar Pradesh alone, more than 35,000 AIDS patients were registered with the state AIDS Control Office till September, 2010. How many more unregistered people would there be, is anybody’s guess. Amongst the registered ones, there are 1597 male and 777 female HIV positive children. Read more


With a view to lend a helping hand, UNICEF has organized a training workshop for such children at its pavilion at the ongoing Lucknow Mahotsava—a gala, annual event, spread over 10 days.

 The first batch of child reporters and Bal Bandhus (little friends), who arrived in Lucknow on Nov 25 have already completed a very successful training in the media tools. The second batch from Lalitpur district that started their training in the five media tools of communication at UNICEF Pavilion at the Lucknow Mahotsava from Nov 30th.

This second group of children will also be joined at the UNICEF Pavilion by HIV positive affected and infected children who will be coming from six districts of Uttar Pradesh. The children will be brought in by a non-government Lucknow based organisation named  UMEED which works for the rehabilitation and welfare of children living with HIV/AIDS and is part of the workshops from Nov 30-2 Dec 2010 .

Apart from learning the five media tools from the 18 master trainers from Maharajganj who are conducting the workshop, the HIV positive children will also be celebrating the World AIDS Day today in Lucknow at the Mahotsava.

Let all of us contribute in some way or the other to keep  the spirit of these young fighters high.

Anjali Singh - CNS
(The author is a UNICEF consultant and a senior journalist. She is also the Director of Saaksham Foundation) 

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From Fit To Fat

World Diabetes Day is on 14th November
Diabetes, one the four priority non-communicable diseases (NCDs) identified by the World Health Organization (WHO), remains a misunderstood and neglected epidemic with numbers increasing alarmingly in every region of the world. According to the International Diabetes Federation (IDF), there are over 300 million people with diabetes worldwide with low- and middle- income countries account for 4 out of 5 cases of diabetes. There are 50.8 million people with diabetes in India and 92.4 million in China. To add fuel to fire, India seems to be at a threshold of an 'outbreak' of obesity, more so in urban Indian cities. Read more

Obese children and adolescents are at an increased risk for the development of early-onset type-2 diabetes mellitus (T2DM) and coronary heart disease (CHD). This phenomenon is accelerated by nutritional westernization and sedentary lifestyle. There is a near global consensus amongst doctors and scientists that healthy dietary and lifestyle practices should be inculcated in children to prevent future development of T2DM and CHD.

Unless preventive measures are taken, obese and insulin resistant children will get affected with T2DM and CHD in young adulthood.

According to Prof (Dr) G Choudhuri, Professor and Head, Department of Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, "The age of onset of diabetes is decreasing, and it is occurring at a younger age these days. Diabetes has a strong genetic component but gets unmasked with disorganized lifestyle and eating habits. The 2 important lifestyle issues of concern are increased body weight and lack of exercise. Indians, especially urban ones, are particularly predisposed to exercise deficient lifestyle. These changes are being increasingly observed now in urban children, and nearly 20% or more school kids are overweight or obese, and are potentially at risk of developing diabetes."

Prof Barry M Popkin, a professor of nutrition at the University of North Carolina rues that, "some children, including very young children, snack almost throughout the day. Such findings raise concerns that more children in the world are moving toward a dysfunctional eating pattern-one that can lead to unhealthy weight gain and obesity."

According to Prof (Dr) Anoop Misra, former Professor, Department of Medicine, All India Institute of Medical Sciences (AIIMS) and Director and Head, Department of Diabetes and Metabolic Diseases, Fortis Hospitals (New Delhi and Noida), who is also the Director, Diabetes Foundation (India): "Trans fatty acids are one of the strongest poisons affecting human metabolism today." Trans Fats are found in fast food products made with hydrogenated oil in an unregulated market, a time bomb waiting to explode, even as the Indian Union Health Ministry is contemplating for processed food manufacturers to list the Trans-fat content on nutrition basis.

Diabetes Foundation (India), with help from other global agencies, is striving to create awareness about lifestyle related diseases in children and adolescents through three major community centric health initiatives involving the education of schoolchildren, teachers and parents regarding diabetes and obesity. These are:-


Project MARG (Medical education for Children / Adolescents for Realistic Prevention of Obesity and Diabetes and for a Healthy Aging), which focuses on primary prevention of not only obesity and diabetes, but also of non-communicable diseases in general, by targeting school children in several cities of India.

Project CHETNA (Children's Health Education Through Nutrition and Health Awareness), which aims at prevention of obesity, diabetes, and heart disease, in order to inculcate healthy lifestyle and nutrition habits in school children.

Project TEACHER (Trends in childhood nutrition and lifestyle factors in India) which covers 4 major cities of India to obtain in- depth understanding of nutrition and lifestyle behaviours that affect the health and well being of urban Indians , particularly children, through detailed knowledge attitude and practice survey questionnaires, group discussions and anthropometric measurements of children and their mothers.

Project HOPE (Health Oriented Programmes and Education) with Prof (Dr) G Choudhuri as its founder member - has been concentrating on lifestyle as one of its thrust areas and targeting diabetes prevention as one of its goals. Its mission is to promote health awareness in schools throughout the city of Lucknow. It recognizes that healthy children learn better and that school based programmes can help to influence the health of students.

More such initiatives are needed to encourage our children/adolescents to eat a nutritious diet and increase physical activity. Schools can be targeted to become harbingers of this change by increasing sports activities in their premises and by monitoring the food/snacks preferences of the students. Some schools have indeed changed the school canteen menu to a tasty health menu and have stopped the sale of cola drinks on the campus. It is worth mentioning here that a single serving of soda or other sweetened soft drink contains between 120 and 200 calories of sugar, equivalent to a man's recommended intake for a full day and exceeding the recommended daily intake for a woman.

According to a study conducted by researchers from the University of California, the booming popularity of sugary soft drinks has led to 6,000 more deaths, 14,000 more cases of heart disease and 130,000 new cases of diabetes in the past 10 years. "We can demonstrate an association between daily consumption of sugared beverages and diabetes risk," researcher Litsa Lambrakos said. "We can then translate this information into estimates of the current diabetes and cardiovascular disease that can be attributed to the rise in consumption of these drinks."

What better way to celebrate India's Children's Day this year on 14th November (which coincides with the World Diabetes Day, 14th November), than us parents, teachers, school authorities and youngsters to join hands in this noble endeavour of going from fat to fit, by saying no to colas/ junk food and yes to healthy snacks, and hop/skip /jump/ swim/ cycle/ dance to a diabetes free world.

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email: shobha@citizen-news.org, website: www.citizen-news.org)

Comic book explains TB vaccine clinical trial

[To read the full comic book, click here]

TALLINN, ESTONIA: Finding participants for clinical trials is one of the challenges in the development of new vaccines against tuberculosis (TB). The South African Tuberculosis Vaccine Initiative (SATVI) recently launched a new means to reach out to communities where trials take place: a comic book. Read more

The 12-page comic book, printed in Afrikaans, Xhosa and English, aims to communicate information on TB vaccine clinical research in an entertaining and understandable way. Under the title ‘Carina’s Choice’ it tells the story of a young woman’s decision to enroll her baby daughter into a clinical trial for new TB vaccines. “Why did you do that?” a friend asks her on the cover, inside the answer follows.

The comic gives information on TB vaccine clinical trials and deals with common questions and misunderstandings on those trials in communities. Consultative focus group sessions with community stakeholders were held in the development of the comic, which helped shape among others the characterisation, setting, facts and community concerns that needed to be communicated, and language used.

“Many people in the community are not familiar with research,” explains SATVI co-director Hassan Mahomed, adding that levels of education and literacy are often low. “Regarding clinical trials, there is some superstition, many myths exist about e.g. taking blood, as well as ideas that people are used as guinea pigs, bad things will happen, or other negative attitudes. The comic deals with these thoughts, it explains what happens in trials. This way, we hope to increase knowledge and understanding.”

SATVI is conducting clinical trials in South-Africa for multiple novel TB vaccines. According to Mahomed, tuberculosis is widely known among communities, but not everybody is equally familiar with the need for new vaccines. The limitations of Bacille Calmette Guérin (BCG), the currently only available vaccine, are referred to in the comic book as well. Around 10,000 books have been printed, Stop TB Partnership funded the design. “The comics will be handed out through clinics, NGOs and at home visits,” Mahomed said at the sidelines of the Second Global Forum on TB Vaccines in Tallinn (September 21-24), Estonia.

The comic is a new tool for SATVI, which already works with e.g. posters, leaflets and DVDs explaining what clinical trials are all about. “Also through local media, radio, newspapers and NGOs we inform people about trials,” Mahomed adds. SATVI staff go out to communities, workplaces, schools, clinics and homes of newborns to contact and recruit people.

SATVI further works with a community advisory board (CAB) made of individuals from the community to represent the community’s interests in clinical trials. “They give advice to the researchers and input from the community. In every way it is very important to engage with communities”

SATVI staff and CAB members are also present in the comic book. It ends with a bill of rights for research participants. “It is all about informed consent,” Mahomed says. “At all times, even when people are participating already, they need to be constantly reminded of their rights and informed about the process of the trial.”

“We don’t know yet what impact the comic books will have,” he continues. “The comics will be handed out to groups of community members in different settings. After reading the comics, they will be engaged in focus group discussions to check understanding of the issues raised and also attitudes towards the comics themselves. Of course we hope the comic will have effect and improve understanding.”

The Worcester Senior Secondary, a local high school, has converted the comic book into a theatre play. This play was the centerpiece of the official launch of the book on October 9.

Babs Verblackt-CNS
(The author is a freelance journalist, a Fellow of CNS Writers' Bureau and Associate Communications atTuBerculosis Vaccine Initiative – TBVI)  


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ICPS aims at building a protective environment for children

"Child protection is a way of ensuring that children, under-privileged children in particular, are brought under a safety net umbrella. It is a system under which the most unwanted child is ensured the warmth of security, and full enjoyment of the basic rights," said Ratna Saxena, Integrated Child Protection Scheme (ICPS) consultant, UNICEF. Read more


Ms Saxena, was addressing media persons at the bi-monthly media sensitization programme on children's issue at "Media for children" jointly hosted at UP Press Club by "Media Nest" and UNICEF.

Explaining Integrated Child Protection Scheme (ICPS) in detail she informed that it is a centrally sponsored scheme of the Government of India which aims at building a protective environment for children and guarantees against child abuse, exploitation, violence and deprivation of primary care. While the programme is running in 15 states, Uttar Pradesh (UP), where in live the largest number of the country's children is yet to sign the memorandum of understanding (MoU). ICPS which came into force in 2009 capsules a number of government schemes on child protection.

"From ensuring total and lasting child protection the government and civil society must join hands," said Ms Saxena, adding that of course things will start rolling once the first and most vital step of the state government signing the MoU is completed.

The second step will be to ensure that other mandatory structures like-setting up committees, database, building capacity of families, communities and NGOs who will help carry forward the scheme.

She emphasized that media role is very important in the successful implementation of ICPS.

She played video clips of the beautiful song where India's top singers lend their voice to focusing attention on child rights. The song which called for ensuring that the children get all the rights to live said that we must not forget that these children are the future of our country.

Mr Rajib Ghoshal, Child Protection Specialist, UNICEF, said that creating protection homes for children should be the last priority of the government. The emphasis should be to foster care for poor, unwanted children. He said in order that for society and community may take on this additional responsibility willingly both social as well as economic incentive must be made the pre-requisite.

He quoted the scheme is running well through Palanhaar of Rajasthan.

As per the 2001 census, the population of children (below 18 years) was 42.2 crores (422 million) out of which around 17 crores (170 million), i.e. 40% of the children, are vulnerable or experiencing difficult circumstances.

The protective environment also focuses on children deprived of primary caregivers, particularly in the context of a) children who are in formal care institutions; b) children deprived of their liberty; c) separated children; d) abandoned children; e) children living in the streets; and f) orphaned and vulnerable children (OVC).

Earlier Mr Augustine Veliath, Communication Specialist, UNICEF, in his opening remarks asked a very vital question. He said many a time children are left behind alone with no fault of theirs like children of locked-up parents, sex workers, orphans. "Where do we take children who have nobody?"

He said that while the Integrated Child Protection Scheme (ICPS) aims at the development of the child, it also ensures the total protection to a child left alone to face the world.

"For the success of the scheme that ensures every child its right through society and government it is important that media asks the right question on a ICPS," said Mr Augustine.

Kulsum Mustafa - CNS

(The author is a senior journalist and also serves as the Secretary-General of Media Nest)

WDF addressing diabetes among children of developing nations

[Listen to audio podcast of CNS exclusive interview with WDF President Dr Anil Kapur, click here]
Recognizing the compelling need to improve prevention, treatment, care and support services for children with diabetes, the World Diabetes Foundation (WDF) has scaled up initiatives to address both types of diabetes among children: type-I and type-II, said Dr Anil Kapur, President of WDF, who spoke to CNS after receiving the IDRF Lifetime Achievement Award. Read more

"For type-I diabetes WDF is supporting initiatives in several low-income and least developed countries where we are working along with other organizations, and providing funding for training of doctors to be able to provide appropriate care for children with type-I diabetes" said Dr Anil Kapur. 

"This type-I diabetes is a special form of diabetes and needs special kind of attention. In addition to this, we are funding initiatives that will produce materials which would be useful for both: these children and their parents, for self-care" added Dr Kapur.

"WDF supports camps where children with type-I diabetes can meet other children with type-I diabetes and learn from each other and take courage from each other on how they are managing their diabetes. We do that in 5-6 countries in Africa" said Dr Kapur.

"Coming to the initiatives on how do we work on obesity and reducing the risk of type-II diabetes in children, we are funding several programmes, in several countries around the world, where basically these programmes are addressing school health. Teachers are being trained on how to communicate with children about physical activities and health food. Children are screened in a non-invasive way to find if they are obese or overweight or if there is a very strong risk of diabetes then they are also screened for diabetes" said Dr Kapur.

"Predominantly what this school health programme does is that it provides an environment where children actively participate. There are healthy lunch-box competition, debates and discussions on healthy living, on what is good and what is bad for health, and demonstrations on how they can practice yoga, or how physical activity is important for them, writing competitions, essays, slogan writing. These programmes also serve issues like canteen food, and food that is served around the school location, because you might change food at the school canteen but there are shops around the schools which offer junk food and aerated soft drinks which can be harmful" said Dr Kapur. 

There is a big programme in north India with Dr Anoop Mishra of Diabetes Foundation (India), and similarly there is another programme in south Indian state of Kerala with Dr G Vijaya Kumar in Pathanamthitta district, where entire district schools are covered with school health initiatives and state education department is taking interest in it, and local education department officials are involved as well as the gram panchayat is also getting involved, informed Dr Kapur.

Apart from India WDF is also funding similar initiatives in other countries.

"There is also a very interesting programme we did in Andhra Pradesh where school children were taught about healthy living, diabetes, obesity and how to avoid it, and as part of the school project they were encouraged to go and screen people in their close community for urine sugar, and they were taught how to do the urine sugar and go and check adults and report back" said Dr Anil Kapur. "Of course urine sugar is not the most appropriate test but for children it was a good exercise where they combined practical demonstration of how testing is done along with the learning about issues around diabetes" added Dr Kapur.

Let us hope that governments are listening and will integrate healthy living initiatives in existing programmes targetting children, particularly those at high risk of diabetes in an effective manner. 

Bobby Ramakant - CNS 

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Not caring for children with diabetes is a human rights violation

[Listen to audio podcast of CNS exclusive interview with WDF President Dr Anil Kapur, click here]
Predominantly type-I diabetes affects children. "In case of these children with type-I diabetes, when they don't get insulin it is deciding whether they will survive or they will die" said Dr Anil Kapur, President of the World Diabetes Foundation (WDF) who was conferred upon the IDRF Lifetime Achievement Award last week. "So it is a basic human rights to live issue here. It needs to be stressed that governments in every country in the world should make sure that these children get access to proper  care - in terms of supply of insulin, diagnostics and for monitoring and also they  should receive information on how they should remain healthy day-to-day" said Dr Anil Kapur. Read more

"In many developing countries these children do not have access to even proper care and treatment, they do not get insulin, they don't have facility to monitor themselves, and many times people who are treating them - physicians, general practitioners - are often not aware that children also get type-I diabetes and sometimes these children would die even before a diagnosis is made in many of the developing countries" added Dr Anil Kapur.

One important issue is to create the awareness about the type-I diabetes in children and making sure that there is access to appropriate care and treatment. "In World Diabetes Foundation (WDF) we have been advocating that this should be seen as a human rights issue unlike other conditions, where making treatment available is about surviving and about finding a better quality of life" said Dr Anil Kapur.

"Increasingly with rising obesity around the world the first people who are getting affected in a big way are the children. And increasingly we are finding that more and more children are overweight or obese in the developing countries. These are often the children that are born small in weight, and they often have high levels of fat, and increasingly the doctors that are treating children are finding that these children get a different form of diabetes (type-II diabetes) in late teens" said Dr Anil Kapur.

"This is a sorry state of affairs because they would live a long part of their life with type-II diabetes which increases the risk for various other complications that are associated with diabetes and this form of diabetes is eminently preventable, and we need to create public awareness about prevention of obesity, about ensuring that school children have the ability to play sports, they have access to playgrounds and access to physical activity, and in the curriculum it is important that physical activity is not taken out, and instead of putting in more academic subjects, and loading children with lot of homework, I think we have become too obsessed with performance and high test grades, and both parents and children are under pressure that children must perform well academically" said Dr Kapur.

When children come back from school they have lot of homework and no time to play. The other issue is that even if they have time to play outside school, the outside urban environment is often not safe. "So these are some of the issues about urbanization, about providing safe areas for children to play, and do outdoor physical activity. It could be done in school, it could be done at home, or in community parks, this is something that we need to do for the future generation. Failing to do that I think we will be faced with a massive problem of not only diabetes but consequences of diabetes in terms of cardiovascular diseases, stroke, kidney failures, blindness, amputation among others. It is very important to focus attention on this aspect too" emphasized Dr Anil Kapur.

Bobby Ramakant - CNS 


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Rural child health initiative reaches out to UP's poor

Photo credit: Kulsum Mustafa

Wednesday and Saturdays are Routine Immunization days in Uttar Pradesh. From morning one witness rural women with infants in arms making a beeline for primary health centres. But June and December are more special months for little children in India's most populous state with very poor development indicators. It is in these two months when health call beacons all the under five in remotest corners of the state. Read more




"Bal Swasthya Poshan Mah" (BSPM) is a bi-annual government health programme that addresses the grave issue of malnutrition from which a major number of the state children suffer. During BSPM children are given the vital vitamin A dose the deficiency of which can result in preventable blindness.  The children also get the routine immunization (RI). During BSPM counseling of young mothers, pregnant and lactating women is also done regarding the right nutrition for their children which includes breastfeeding, complimentary feeding, supplementary feeding, usage of iodine salt, and proper sanitation.

While this health initiative is for all the 72 districts of Uttar Pradesh, special focus is being given on 15 districts which have been identified as 'high risk (HR).'

Farrukhabad, situated some 250 km from the state capital Lucknow is one such HR districts. The UP government has taken the help of UNICEF for this.

"The high risk district generally have a high density of Muslims and lower castes, the idea is to reach out to them and ensure that they are not left out in this health campaign," explained UNICEF medical representative Dr Deepak Sinha in the district.

"Kamaalganj, one of the six blocks in Farukkabad district has 50 per cent Muslim population. Thus efforts have been made to reach out to them through the leading Muslim persons in the area," he explained. Dr Tausif Baig, district coordinator, Farukkahabad, Social Mobilizing network, UNICEF said that they are going from door-to-door with a team to explain to the population the advantages of availing of the facilities during the BSPM.

He informed that their initiative of getting the publicity material printed in Urdu has got a lot of good response.

The team is also ensuring that reach out to the minority community during the weekly Friday congregations.

One can only hope that concentrated and sustained efforts will bear fruit and the community comes forward to avail of the health facilities being offered free of cost to them like to people of other community.

Kulsum Mustafa
(The author is a senior journalist and also the Secretary of Media Nest) 


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A childhood free from tuberculosis (TB)

Tuberculosis (TB) is a major killer of children in poor countries. Over 250,000 children develop TB and every one minute two children die of TB worldwide. It has been estimated that as many as one third of the world's population is infected with TB, and an estimated 20-50% of children who live in households where an adult has active tuberculosis, become infected. "Also the power to resist TB infection is normally poor in the first 5 years of life, as the immune system is less developed. The resistance can be further reduced by malnutrition, HIV, other childhood infections and worm infestations – all too common in poor countries" said Professor (Dr) Surya Kant, from Pulmonary Medicine department at CSM Medical University (erstwhile King George's Medical College - KGMC). Good words of caution before the XVIII International AIDS Conference (IAC) opens in Vienna, Austria next week. Read more

So the risk to contract TB becomes particularly high in the developing world where family size is large, houses are crowded and more than half the population are children. Moreover, diagnosis is difficult in children, and often fatally delayed. TB can have devastating long term effects on children who can be left deaf, blind and/or totally paralysed from TB meningitis, even after it is cured.

Yet Paediatric TB does not have a high priority in many developing countries as fewer children than adults have the disease and children are not usually infectious, and often, limited resources mean that infectious cases have priority.

Although the TB vaccine, BCG, does limit some of the severe forms of tuberculosis, but by no means does it prevent them all. Thousands of such "immunised" children in the developing world still suffer from tuberculosis meningitis and other forms of disease. A vast number of children infected remain undiagnosed – creating a reservoir of future adult disease.

Hence there is need to prioritize diagnosis, prevention and treatment of TB as well as TB-HIV co-infection in children.

"Childhood TB is difficult to detect. The infected child usually has no external symptoms and remains quite well. There would be no reason for the parents to see their medical doctor. The 'disease' is self-limiting" said Dr Muherman Harun from Jakarta, Indonesia, in an online consultation hosted by the CNS Stop-TB Initiative, and the global Stop-TB eForum that was established by the Health & Development Networks (HDN) in early 2001.

Dr Muherman continues: "TB in children has become uncommon in high TB prevalence countries when routine BCG vaccination is routinely given to all new-born babies. BCG vaccination does prevent many deaths from miliary and/or meningitis TB, and also reduces the incidence of extra pulmonary TB. But BCG also appears to mask the manifestation of primary or childhood TB on chest X-ray so that no childhood TB can be found. Children, who fail to thrive, who often cough and from time to time have sub febrile temperature, have less appetite, transpiration at night and show no response to antibiotics, are often falsely treated as childhood TB. The unfortunate children are treated with anti-TB drugs for 6 to 12 months, or even more, as the chest X-ray result from radiologists show that lungs are not yet entirely 'normal.' (On retrospection, all of the chest x-rays from the start of treatment, were in my opinion, just normal)."

"So, in countries where BCG vaccination is given at a national scale we have to be aware of the numerous (false-) diagnoses of pulmonary childhood TB" said Dr Harun.

Dr K Suresh of India is committed to the cause of eradicating the scourge of TB. He feels that India can definitely be proud of reducing severe forms of childhood TB like TB meningitis and fulminating miliary TB, a common occurrence during the 1960s. Similarly spinal TB in children has also become relatively rare.

But, at the same time, the challenge for diagnosing TB in children continues —an area where hardly any progress has been made during the last 50 years. The situation is worse in remote rural and tribal population.

Dr Suresh made some pertinent observations about the situation in India under the Revised National TB Control Programme (RNTCP), keeping in mind the International Standards for TB Care (ISTC).

According to him, "Most children under 5 years do not produce sputum, so they get excluded for diagnosis. Children between 6-14 years may be subjected for sputum examination if having cough of two weeks are more. Even for them examining sputum twice is very uncommon, leave apart collecting early morning specimen. For children with extra pulmonary TB (likely to be more than Pulmonary TB), collecting appropriate sample for microscopy as advised is hardly visible explicitly except in a few tertiary facilities in the country. As per the International Standards for Tuberculosis (TB) Care (ISTC) norms, radiographic suspects should meet criteria of 3 negative smears, and cases showing lack of response to appropriate antibiotics, and radiographic findings consistent with TB should be put on DOTS. This seems to be rarely done in India. The RNTCP reports of 2009 and 2010 do not mention anything about cases diagnosed using this criterion."

Dr Suresh further adds: "The National AIDS Control Programme (NACP)/ RNTCP coordination mechanism (TB/HIV package) has been started in India only in 2008 and covers only about 18 states. In persons with HIV infection, diagnosis should be expedited. But not many ARTs in the countries are equipped with this facility, nor do the district TB centres refer sputum positive cases for HIV testing adequately. Though it is reported that 10.6 % of referrals (HIV positives) suspected to have TB have been confirmed to be tubercular and 12% of TB patients were confirmed as HIV positive in 2009. In 2009 the proportion of TB patients with known HIV status has increased from 34% to 62%. Unfortunately the RNTCP does not look into desegregated status for children in this category too."

Dr Suresh rued that desegregated data for children with TB, association of TB and HIV/AIDS is hardly reviewed with serious concern. He appealed to agencies whose mandate is Children (UNICEF, Save the Children etc) to wake up and add activities for childhood TB along with HIV/AIDS in all their projects, and join hands in all government efforts to ameliorate the Childhood TB status and co-existence of TB-HIV co-infection in children.

He hopes that 'Stop TB' campaign does not get limited to sputum positive adult TB-HIV co-infection alone. Children are our future. They cannot speak for themselves. Somebody needs to speak for them. An important step in this direction would be for countries to collect and share desegregated actual data (and not mere estimates) for children on TB, HIV/AIDS and their co-infections.



Shobha Shukla
(The author is the CNS Editor, has worked earlier with State Planning Institute, UP, and teaches Physics at India's prestigious Loreto Convent. Email: shobha@citizen-news.org, website: www.citizen-news.org)

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Red Ribbon Express: On track to good health

It's called the express of hope. After completing a successful run through 100 districts in the state of Tamil Nadu educating and sensitizing over 75000 people about HIV/AIDS and health, The Red Ribbon Express is now Uttar Pradesh bound. As the World's largest AIDS Conference opens in Vienna, Austria next week (XVIII International AIDS Conference - IAC), the largest multimedia, multi-sectoral mass mobilization campaign launched so far - the Red Ribbon Express, is all set to chug through 17 districts of Uttar Pradesh (UP) and dispel myths and fears about the disease, and also spread awareness on treatment, care and support for people living with HIV (PLHIV). Read more




The Red Ribbon Express is an initiative of the National AIDS Control Organisation (NACO) in collaboration with National Rural Health Mission (NRHM), the Ministry of Railways, UNICEF, Hindustan Latex Family Planning Promotion Trust (HLFPPT) and the Rajiv Gandhi Foundation.

Sporting a positive motto which says "Embarking on the journey of life" the Red Ribbon Express has managed to reach several thousands of people through innovative outreach programmes and informative displays which it carries in its eight coaches about AIDS. A sensitization task considered impossible until now.

Explains Dr Mridula Sharma, Joint Director, Uttar Pradesh State AIDS Control Society (UPSACS), "the idea behind this unique concept is to combat the fast spreading menace of AIDS. This journey of the Red Ribbon Express through 17 districts of UP is the second phase of the campaign by NACO. The first phase was launched in 2007-2008 and the train covered over 9000 kms in UP, but this time the focus in more on eastern UP and semi-urban, urban areas and even blocks have been included in some places to ensure maximum reach of the message the express has to give. While the highest turnout of people so far out of the 22 states and 152 districts the express has visited, has been in Tamil Nadu, with 75000 people being sensitized, in UP we hope to beat that record when the train will start it's journey from Chopan in Sonebhadra on 17 July 2010 after it will be flagged of by the Health Minister himself. The Red Ribbon Express will cover 25000 kms and pass through a number of stations returning to New Delhi on Nov 29, 2010."

A mammoth exercise indeed as the express which will leave Chopan on July 19, 2010  for Chattisgarh and Jharkhan and will re-enter UP on August 29, 2010 to  travel through Allahabad, Varanasi, Zafrabad, Akbarpur, Ballia, Mau, Bhatni, Nautanwa, Ayodhya, Amethi, Rae Bareli, Lucknow, Barabanki, Hardoi, Bareily and Saharanpur, to halt in Lucknow till October 10, 2010.

Informs Ayan Chakraverti, Regional Communication Officer, BBC World Trust, a collaborating agency as well for the event, "The branding of the Red Ribbon Express has been done by JWT and the target group in the general population  that we will hope to reach includes youth and women groups, adolescent students from schools and colleges, MLAs, corporators , Pradhans, Panchayati Raj institution members, youth in uniformed services like the defence forces personnel, out of school youth in the community and Aaganwadi workers, ASHA, SHG members etc. The express has eight well designed coaches each dedicated to exhibitions of educational material on HIV/AIDS complete with interactive touch screens and 3-D models. In the second phase of the express' run a coach has been totally devoted to display of information on general health, hygiene and communicable diseases like swine flu, tuberculosis (TB) and reproductive and child health (RCH) services. In addition to that counseling cum medical services will also be available with two consulting doctors sitting in for treatment and advice on sexually transmitted infections (STIs) and reproductive tract infections (RTIs)."

And if that was not enough the Red Ribbon Express will also conduct on platform activities at each stations it visits which will have cultural performances of plays and skits by Yayawar Rangmandal theatre group based on the theme of HIV/AIDS.

Informs Augustine Veliath, Communication Specialist, UNICEF Lucknow, "The two most important inclusions in this second phase of the campaign is the focus on stigma related to HIV. This will be effectively dealt with through a play which is being prepared by National School Of Drama and Bhartendu Natya Akademi and is fully directed by people who have tested positive to HIV. But the play will not be ready for the flag off from Chopan on July 17, 2010 so UP's own theatre group Yayawar Rangmandal will present a play initially. Secondly the voice of children will also be heard in the journey of the Red Ribbon Express through a World Comics Exhibition by children affected and infected HIV/AIDS. At every station panels displaying the comics will be put up for people to see and understand the dreams and aspirations of these children."

With so much planned for the next three months on the itinerary of the Red Ribbon Express seems like the fight against HIV/AIDS is all set to gain momentum in the state.

And to ensure that maximum people benefit from it All India Radio, Doordarshan, DAVP, Information Department and the Press Information Bureau all have joined hands to flash information on the locations the train will visit from time to time.

Advertisement spots and social messages both on TV and Radio about the Red Ribbon Express with be aired into homes 24x7! And even if you wanted to you cannot miss it. Or so that is what officials are planning.

And why not as they want to be sure people will be there when the Red Ribbon Express rolls into their station as it surely promises you a journey full of happy and healthy life!

Anjali Singh - CNS
(The author is a senior journalist, writes for Citizen News Service (CNS) and also is the Director of Saaksham Foundation)

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