There are two ways to solve any problem, to work on every step which is responsible for creating the problem or try finding the weakest link in the chain of events leading to the problem and breaking that link.

While working with Dr. Abhay Bang, one of the founders of SEARCH (Society for Education, Action and Research in Community Health, Gadchiroli) I realized that the later way of problem solving has enormous potential in it. It requires comparatively fewer resources and lesser energy to solve the problem than any other way. He has been following the same approach towards solving the major public health problems such as high infant mortality rates and poor maternal and women health at national and international levels. In the case of high prevalence of diarrheal diseases we also selected the way which involves breaking of weakest link. In our case the link of ‘poor hygiene and sanitation.’

During my two-year fellowship tenure at SEARCH, I was supposed to identify a public health problem in the rural community and develop a solution to solve it. While observing many children falling prey to  diarrhea, I understood the role of diarrhea in childhood mortality. Diarrhea is the second leading cause of under five childhood deaths (16%) after pneumonia(17%) in this age group. In nearly 120 million child births in the developing countries, 1.5 million children below the age of five die every year because of diarrheal diseases. In India everyday nearly 1000 children of under five years age group die because of diarrhoeal infections. Poor hygiene and lack of sanitation and impure drinking water are the major causes behind these diarrheal infections.  Viruses like Rotavirus, bacterias like salmonellae, shigellae and some strains of Escherichia coli (E.coli) and parasites like Giardia and Entamoeba histolytica are the common infections responsible for diarrhea. There are no existing estimates for the burden of diarrhea mortality in older Indian children, however, Million Death Study (MDS) in India estimates around 45,000 annual deaths, which is significantly larger than the Global Burden of Disease estimate of approximately 1,000 deaths in children aged 5 to 14 years in all of South Asia.

Why Hand washing ?

After understanding the pathology of diarrhea, we were searching for the solutions to deal with it. Out of all available options for prevention of diarrhea, Hand-washing with water and soap was the most effective and inexpensive way to prevent diarrheal infections. After further literature search I found that habit of hand-washing with water and soap before eating and after using the toilet could prevent diarrhea infection by 47% [1] and acute respiratory infections by one-quarter. Along with preventing many other infections hand-washing prevents Tropical Enteropathy [2], one of the major causes of child undernourishment

Motivated by these shaking statistics about diarrheal diseases and after being convinced by the very simple solution for this important Public Health issues, I started working on prevention of diarrhea in children by promoting habit of hand-washing.

[1] Curtis, Val and Sandy Cairncross (2003). “Effect of washing hands with soap on diarrhoea risk in the community, a systemic review.” The Lancet: Infectious Diseases, Volume 3, May 2003.

[2] The Lancet, Volume 374, Issue 9694, Pages 1032 – 1035, 19 September 2009

One Response to Motivation

  1. Manoj Kumar says:

    Amazing work Dr. Pawankumar.. I am really impressed by your work, dedication and creativity in delivering an excellent solution for Diarrheal diseases..
    Keep it up..


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