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Why children die 'silent deaths' Off the radar screen: While diseases such as AIDS and Ebola get the attention, millions of Third World children die every year of easily preventable or treatable diseases.

GHOSRAWAN, INDIA — GHOSRAWAN, India -- In this village so wretchedly poor that residents sometimes must catch and eat rats, 3-year-old Sonia broke out in fever and began to gasp. After consulting a quack, her parents confined Sonia to their dark shack for five days and nights.

Spotted with rashes, Sonia was finally carried down a monsoon-flooded track to a hospital 10 miles away -- but too late. Two weeks after falling ill, Sonia died. Her mother, Phoolwa Devi, blames the Hindu mother goddess. "It was not in our hands," she said. "It was the wrath of Mata, and we just have to bear it."

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The young child in the state of Bihar, the dirt-poor land south of the Himalayas where the Buddha once preached, died of complications from common measles. Rubeola -- which for American children has come to mean little more than a day or two home from school and a dose of antibiotics -- remains a dreaded mass killer in India and other poor nations.

8 million a year

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In the planet's most impoverished backwaters, from Afghanistan Zaire, rubeola and other pathogens -- cholera, shigella and about 30 diarrhea-causing microbes -- kill more than 4 million children a year, the World Health Organization reports. Pneumonia and other acute lung infections, now childhood's deadliest enemies, claim 4.1 million more.

Such deaths happen with little publicity and kindle only a modicum of outrage, even in countries that are among the worst lTC afflicted. Open a newspaper or listen to a news broadcast in many regions of the globe and you might conclude that the medical emergencies facing humanity are the AIDS pandemic, this year's alarming outbreak of the fatal, incurable Ebola virus, and the mysterious mutations detected in increasingly drug-resistant microbes.

Yet each year, WHO reports, 12.2 million children younger than 5 die, most from preventable causes.

"Theirs are the silent deaths," says A. Mushtaque R. Chowdhury, who holds a doctorate from the London School of Hygiene and Tropical Medicine and is a social activist in Bangladesh, one of the poorest, most densely populated countries.

In India alone, more children die in a single day from diarrhea and its energy-sapping complications such as malnutrition than the nationwide toll from AIDS since it was first detected nine years ago in Bombay. That is at least 1,900 children's deaths a day.

Deaths from diarrhea could be slashed by at least two-thirds with packets of soluble electrolytic salts priced at a few cents each or home remedies that cost next to nothing if parents know how to concoct them, says Dr. Udai Bodhankar, president of the Indian Academy of Pediatrics.

UNICEF, the United Nations Children's Fund, estimates that, because of generalized advances in public health, hygiene and education worldwide, 2.5 million fewer children will die next year than in 1990. But impressive as such progress is, it is uneven, notoriously fragile -- and, some claim, at least in part a mirage.

'At par' -- in 100 years

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"I am sure the day is not far off when we will be at par with the West," predicts Dr. Kamlesh Chopra, chief of pediatrics at the 1,500-bed Lok Nayak Hospital in New Delhi, who is witnessing a dramatic decrease in juvenile diarrhea fatalities. But then, she adds, "it might take us 100 years."

Health officials in Uttar Pradesh, India's most populous state, claim a polio immunization rate of 95 percent in the city of Lucknow and vicinity. But Dr. Varkey Valladiyil Brigeetha of the 45-bed St. Mary's Clinic, grimaces upon hearing the statistics. .. "Everybody knows [our] Health Department statistics carry no value," she says. "In our hospital, 50 percent of the cases we admit have had the polio" shots.

Recently, experts have expressed fears that the world may have reached a turning point -- one where past achievements in equalizing everyone's chance for life and health are threatened.

"Now far less aid is going to developing countries, and even less is going to the poorest," said Dr. Peter Poore, senior health

adviser at Save the Children-U.K. "All evidence suggests that the gains made during the past decade in reducing child mortality are slowing down, and in some cases being reversed."

India is home to more malnourished youngsters than any other country: 75 million children younger than 5, according to a UNICEF survey. But because of budget cuts at the U.S. Agency for International Development, the relief agency CARE says it must scale back its feeding program for mothers and children there: It supplied corn-soya porridge and vegetable oil to 8.5 million women and children two years ago; now it can feed only 6.6. million.

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Inequities in health and access to care appear to be growing. "Who are the people who are now the sickest? It's obviously and clearly the poor," said Dr. Mira Shiva, director of policy for the Voluntary Health Association of India.

UNICEF has calculated that for $25 billion more each year, child malnutrition could be halved, major childhood diseases tamed, deaths for those younger than 5 slashed annually by 4 million, and safe water and sanitation supplied to all communities.

What it would buy

That is a huge sum. Consider, though: It is half of the about $50 billion that Europeans spend each year on cigarettes, $6 billion less than what Americans pay for beer.

But the generosity of outsiders, even if it could be revitalized, cannot do magic. Many developing countries desperately need to do more.

Pakistan, for example, spends 31 percent of its budget on its armed forces -- and 1 percent on health care. (The United States, by comparison, spends 18 percent of its federal budget on defense and 16 percent on two health programs alone, Medicare and Medicaid.)

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In Mozambique, 100 percent of the health budget is provided by foreign donors (and 164 of each 1,000 live newborns don't make it to their first birthday).

In two dozen countries of the Third World, governments that have money to buy Mercedes limousines for their ministers or generals spend less than $5 per inhabitant on health per year. Hundreds of millions in Asia, Africa and Latin America live under leaders whose budgets for health total less than $12 per man, woman and child -- the minimum fixed by the World Bank for essential health services.

"I blame the countries where this occurs as much as the international development community," says Dr. Demissie Habte, an Ethiopian pediatrician who heads the International Center for Diarrheal Disease Research in Bangladesh. "For spending their money on a lot of useless things like arms, I blame Third World countries for creating havoc."



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