Physicians should be alive to the social context of an epidemicJanuary 5, 2021
Poverty is a determinant of malnutrition. It manifests itself through inadequate dietary intake, lack of medical care, and lack of access to sanitation, health and hygiene. Malnutrition among children is associated with poverty and has many adverse consequences. Poor health, cognitive impairment and childhood mortality are short-term consequences, while the likelihood of developing non-communicable diseases is a long-term consequence.
Besides medical interventions, what we need are nutrition-oriented interventions for children, as can be seen in the poverty reduction programmes of many developing countries.
A case in point is the recent outbreak of shigellosis in Kerala. The serogroup of the pathogen identified here was Shigella sonnei, even though Shigella flexneri is the most common serogroup in India. The transformation of Shigella flexneri to Shigella sonnei has earlier been reported from Sri Lanka, Vietnam and other countries which are under a constant state of social transformation, and now, it seems to have arrived in India too.
There can be many reasons for it.
Food security is particularly vulnerable to changes in the economic status of a population and to inequities in the distribution of wealth within it. Migration from rural to urban settings often forces the migrants to live in unhygienic situations.
Our government was able to increase food production on par with increasing population, but it was achieved mostly through increased production of cereals, rather than that of millets and pulses. Even non-food crops are promoted, but they can’t directly address the issue of nutrition security. This can double the burden of malnutrition.
So, as doctors, we should learn to view such diseases in their socio-medical contexts and educate our patients on the role of proper nutrition and hygiene in keeping them at bay.
Professor and HOD, Department of Paediatrics,T D Medical College,Hospital, Alappuzha