Contribution to the Policy and Program in Child Health
The Department of Pediatrics has made an extraordinary contribution to national and global child health policy and programs.
I. DIARRHEAL DISEASE
· Developed an indigenous Rotavirus Vaccine that is currently undergoing field trial by the Government.
o AIIMS neonatal strain G9 P11 specificity
o Sequence analysis demonstrated that VP6, NSP1 and NSP4 genes of AIIMS neonatal strain 116E are of human origin
o Similarity of the VP4 protein of human rotavirus strain 116E to that of bovine B223 strain
o 116E developed as a AGMK cell based vaccine and as a vero cell based vaccine
o This new Indian Rotavirus vaccine is now taken up for trials in infants.
· AIIMS research led to the formulation of global and national guidelines on the management of Persistent Diarrhea
Provided evidence through large randomized controlled trials that nutrition (macro and micro) is the key, and antimicrobials have no role except for systemic infection. Developed and tested an evidence-based stepwise clinical management algorithm which is adopted globally and nationally, and forms a part of standard textbooks and training of physicians.
· In research related to Oral Rehydration Solution (ORS), AIIMS was instrumental in developing the improved low osmolality ORS which is now the global standard.
The research team at AIIMS provided evidencethrough large multi centre randomized
controlled trials that:
o ORS fortified with amino acids (glycine/ alanine/ glutamine) and rice & cereals based ORS were not more beneficial than standard WHO ORS in non cholera diarrhea in children
o Reduced osmolarity ORS (Na+ 75 mmol/l, glucose 75 mmol/l, 245 mosmol/L) was more effective as compared to WHO ORS (311 mosmol/L)
o Based on our studies and global data, WHO, UNICEF & Govt. of India advocated reduced osmolarity ORS (245 mosmol/L) as the universal ORS for all ages & types of diarrhea.
· A series of studies by the Department have led to WHO and national recommendations to include Zinc in the treatment of childhood diarrheal disease
Based on large multi centre randomized controlled trials largely coordinated by the researchers in the Dept of Pediatrics, WHO/UNICEF (2001) & Govt of India (2007) included zinc (20 mg daily for 14 days for children > 6 months and 10 mg for children 2-6 months) in the treatment of childhood diarrhea in Global & National diarrhea guidelines
II. CHILDHOOD TUBERCULOSIS AND HIV
The Department has been instrumental in developing and synthesizing evidence that has led to revised national guidelines in the management of Tuberculosis and HIV in children.
· Conducted a study to show feasibility of category-based treatment of childhood TB; the RNTCP has used this classification.
· Supporting the RNTCP for appropriate dosing of antitubercular medications for children.
· As member of the expert group of the IAP, have contributed to the development of guidelines for diagnosis and management of childhood TB.
· Provided technical support for the roll-out of antiretroviral therapy for children in resource limited settings and in the country.
· Developed simplified dosing guidelines for prescription of anti-retrovirals in children (as FDCs).
· Developed simplified tools to facilitate prescription of antiretrovirals in children.
· Led the expert group for the development of guidelines for ‘second line antiretroviral therapy’ for children (NACO).
III. CHILDHOOD PNEUMONIA AND ASTHMA
The Department has been instrumental in developing and synthesizing evidence that has led to revised new guidelines in the management of pneumonia and asthma in children.
· Conducted studies to evaluate antibiotic regimens for improving the management of pneumonia in children: 3 day amoxicillin; twice daily dosing of amoxicillin.
· Conducted studies to standardize treatment of children with ARI and wheezing.
· Have performed Cochrane reviews for ‘Antibiotic therapy for community acquired pneumonia in children’.
· Participated in development of training module for treatment of acute respiratory infections in children.
· Provided estimates for prevalence of asthma in children in rural areas.
· Studied the socio-economic impact of childhood asthma.
· Developed and tested a simple home-made spacer to reduce the cost of therapy of asthma.
· Contributed to development of a training module for the management of childhood asthma.
The Department led the process of adaptation of the Integrated Management of Neonatal and Childhood Illness strategy for India.
V. RCH II
· Department’s faculty designed the MCH component of RCH II.
VI. IMMUNIZATION POLICY
· Department’s faculty is represented on the NTAGI; and has provided evaluations of the polio program,
VII. NEWBORN HEALTH
The Department is at the forefront of evidence generation and translation for newborn health policy development globally and nationally
· Through the Lancet Newborn Survival series, influenced the global visibility of newborn health as the key to attainment of MDG 4.
· Led the process of developing the draft newborn and child health policy of India (2009-10).
· Developed National Neonatal Perinatal Database research network of 18 institutions in the country; later extended it to 5 countries (Nepal, Sri Lanka, Bangladesh and Indonesia).
· Leading the Indian Council Medical Research initiative on community-based research in home care of newborn infants.
Developing and disseminating newborn health training tools globally and nationally
· Contributed to all the recent WHO tools on newborn health ( Pink Book, the Blue Book, ECPG guide; guidelines on Low birth weight feeding, neonatal resuscitation, childbirth safety checklist, neonatal IMCI), Postnatal Care, Home visiting for newborn care.
· Pioneered the introduction of Kangaroo Mother Care and Neonatal Resuscitation program in India and in South East Asian countries.
· Developed, standardized and disseminated evidence-based Essential Newborn Care training package in India and South East Asian countries.
· Training materials developed by the Department are adopted by the Government, professional bodies and development partners for national scale up (district newborn care, Navjat Shishu Suraksha Karyakram, ASHA training package).
Inventing a New drug
· Developed a low cost indigenous surfactant for treatment of neonatal respiratory distress that would save thousands of lives – due for marketing by a pharmaceutical company.