S.T.D. AND THE CHILD
Major. M. P. Vora,
Maharashtra Medical Journal
Vol. XXIX, No.3 of June 1982; Pages: 81-84
THE UNITED NATIONS HAD DECLARED 1979 AS THE INTERNATINAL YEAR FOR THE CHILD to focus public attention on the child’s plight and to improve its quality. The International Year (I.Y.C) for the child 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 object longed for.
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 the National Children’s Board, the Indian Council for the Child Welfare. However, these statements seem like the pious platitudes only, as the reality of apathy, aversion and inaction continues unfailingly. It is imperative that prevailing attitudes are changed, prejudices are cast aside and inactivity towards the large number of hapless and miserable children in the country is discarded.
Much publicity was given over various media to many aspects of childhood disabilities such as mental retardation, paralysis, blindness, deafness, nutritional deficiencies etc., the number of children involved in each category and measures taken or to be taken for their correction. However, in none of these talks or articles was any reference, even by way of narration, to the vast number of children involved in venereal diseases, a serious hazard for children! The I.Y.C. was the best time to awaken and alert the public and to make them aware of their menace, gravity and magnitude.
Our failure to recognise V.D. in children to a great extent is due to the false conception. The significance of high incidence of V.D. in children has been, unfortunately considered unworthy of attention and ignored. This conspiracy of silence regarding V.D. is a familiar experience especially of venereologists. The age-old assumption that venereal diseases are associated with promiscuous sex relations or immoral sex behaviour continues to weigh on the public mind, children are usually not involved in such acts; hence its incidence in children is generally not anticipated sand appreciated.
Who can be labeled as a child? By the definition, a child is an unborn or new born human offspring from the conception upto 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 upto 15 years of age, irrespective of when the puberty begins or ends.
The writer would 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 the sizable loss of child population. An authentic assessment of all data in both qualitative and quantitative terms is very necessary but is 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 there is a strong tendency to push under the carpet everything that concerns V.D. However, some requisites are the establishment of free, reliable and quick laboratory services as well as the competent medical services, all over the country - both in cities and rural areas. However these facilities are overlooked in many medical institutions; the recently established Primary Health Centres are conspicuously devoid of these facilities. How obsolete and faulty is our health care and planning as far as venereology is considered, becomes obvious. The health planners and administrators in the country have failed to recognise and appreciate this problem in toto. Is not this sheer negligence of the welfare of the children? It would indeed, be tragic to allow unnecessarily our children to die, suffer physical defects and endure.
It is worth knowing that Treponema pallidum is transmitted transplacentally to the foetus as early as 10to 12 weeks after gestation and can be recovered from the infant, whether it is born alive or dead. An untreated congenital syphilitic infant may show variety of manifestations or may remain latent i.e. without signs and symptoms upto the age of 15, to be recognised only in the late childhood. During the early maternal syphilis, the risk of infection of the foetus is 95 percent and the foetal loss is about 60 percent. Serologic serveys have confirmed that inapparent or unrecognised syphilitic infection is common without obvious illness and that it is the most common cause of spread of the disease. Many innocent children get infected with syphilis, gonorrhoea or both by asexual contacts with infectious persons or as the result of asexual assaults on them by unscrupulous persons, who falsely believe thereby, to get themselves cured of heir disease. Besides, casual sexual relationships (oral and anal) are not uncommon. Children who work in hotels and restaurants are frequent and easy targets for sexual contacts. But such examples do not come to light for fear of shame, stigma or ignorance.
Moreover, there are persons with V.D., who have received an inadequate or inefficient treatment and rarely 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 out-wit a doctor. Children’s homes, houses of correction for children and juvenile jails have cases of V.D. Gonococcal infection in the pregnant women can cause blindness or systemic infection in their infants. Female children are highly susceptible to gonococci.
We are fortunate today, to have an adequate knowledge, sophisticated techniques to determine the exact etiology of these diseases and excellent methods of prevention and treatment. These can be used effectively to save children in the country.
V.D. in children has become the pressing problem. This must be widely appreciated and attempts made to ward them off. They are highly preventable and easily curable, especially in the early stages. Their gravity extends and magnitudes have already been discussed. It is urged that concrete steps must be taken, without delay, for their prevention, early detection and efficient treatment, to save a vast number of children. Routine screening of V.D. in pregnant women must be made compulsory, at all health care centres and antenatal clinics, widespread reliable and prompt laboratory and treatment facilities must be made free available all over the country. This is a matter of prudence and 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 a 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 deficiencies in our medical services and to plan wisely to secure good health for all in the country.