Paediatricians should uphold professional ethics, merit and desist from Group Politics-Prof. A. G. Billoo

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 21st Biennial Pediatric Conference

Paediatricians should uphold professional
ethics, merit and desist from Group
Politics-Prof. A. G. Billoo

Speakers highlight the importance of improving immunization
coverage in EPI to reduce morbidity and mortality

KARACHI: Prof. A. Ghaffar Billoo an eminent paediatrician of the country has advised the Pakistan Pediatric Association (PPA) members to uphold professional ethics, desist from group politics and disregard for merit. He was speaking during the inaugural session of the 21st Biennial Pediatric Conference held at Karachi from November 2-4, 2012. It was very well attended by pediatricians from all over the country besides some foreign delegates. Mr. Nisar Khouro Speaker Sindh Assembly was the chief guest at the occasion.
Talking about history of PPA, Prof, Billoo said that it was born in 1965 at PMA House Karachi with the name of Association of Pediatricians of Pakistan and Brig. Sirajul Haque was named as the first President and Dr. Hamid Ali Khan as Vice President. Name was changed in 1974 as Pakistan Pediatric Association during PPA conference in Lahore and Prof. Shaukat Raza Khan was elected as President. PPA, Prof. Billoo said, is highly respected among all professional organizations of Pakistan. Prof.Z.A. Bhutta stands out tall among all as he has created a name Pakistan. We are facing brain drain of Specialists due to non-conducive working environments. We also lagg behind in our subspecialty training and manpower. We are still struggling with disease like pneumococcal disease, diarrhea, typhoid, which kill thousands of our children every year. We are still facing ignominy of being one of the last four countries in the World harboring polio. WHO conference in 1978 has demanded 5% of GDP spending on health but after 30 years we are still spending about 1% on health, he added.

Prof. Iqbal Memon along with Dr. Hasinna Chagani and
Dr. Sami Ahmed addressing a press conference to highlight
the salient features of the 21st Biennial Pediatric
conference held at Karachi recently.

Mr. Nisar Khouro addressing the participants said that we are a developing country and have a long way to go. Our child mortality is high because we do not have proper health infrastructure and many people living in far flung areas still do not have access to health care. In some cases the doctors are reluctant to go and serve in rural areas with the result that many of these healthcare facilities are not functioning. Our women education is not good and majority does not go to hospital for delivery and deprive First Aid to newborns. Nine vaccines are now available but we are not getting benefit of that and Polio drops are also being refused by people in some areas, he added. He hoped that presence of experienced pediatricians would provide a unique opportunity to the participants for mutual exchange of experience and discussions on the latest developments in the field of pediatrics. 
Earlier Prof. Iqbal Memon, President PPA in his welcome address pointed out that 4.5 million babies are born every year and 27 million are under five years of age. Four hundred thirty five thousand children die every year. Malnutrition, diarrhea and pneumonia are the major culprits. We have to give priority to our children and increase health allocations. Health is now provincial subject and provincial Government has to fulfill its duty. He demanded proper service structure for pediatricians and felt that Neonatal health was our major issue. We must work for Safe delivery in family planning, better healthcare facilities for children. Now Pneumococcal vaccine is being introduced in our EPI programme for which our Government must be appreciated. Prof. Iqbal Memon lauded the efforts of the senior pediatricians who had played an important role for the better health of our young generation.

Prof. A.G Billoo, Mr. Nisar Khouro, Prof. Iqbal Memon, Dr Ameer Muhammad Khan Jogezai,
Dr. Zareen Fasih and Dr. Sami Ahmed speaking during the inaugural session of the
21st Biennial Pediatric conference held at Karachi from November 2-4, 2012.

Dr. Ameer Muhammad Khan Jogezai, outgoing President of PPA speaking at the occasion said that health of children is very important and we are still unable to solve the problems of child healthcare. We have failed to eradicate polio. We must look towards positive aspects and work together for the betterment of our young generation. Dr. Zareen Fasih presented the Secretary General’s annual report and highlighted various projects initiated for child health care which includes preventive strategies with Typhoid Vaccines, incitation of water purification plant in Sindh Province. Pneumococcal vaccine is being provided against pneumonias. Disaster management cell has been established besides campaign for eradication of polio and Dengue workshops. 

About sixty scientific papers were presented during the conference besides eight memorial lectures and four pre conference workshops. About two thousand five hundred delegates from all over Pakistan besides USA, UK, Canada, China, India, Philippines, Saudi Arabia, Malaysia, Nepal, Bangladesh and the Middle East countries attended the conference. In the inaugural session services of Senior members who are known as pioneers of Paediatrics in Pakistan was appreciated and presented with shields. Those who were honoured included Prof. Nizamul Hassan, Prof. A. H Haqqani, Prof. Aftab Qureshi,. Dr. Abdul Malik Kasi, Prof. Ashfaq Ahmed, Prof. Mushtaq Khan, Prof. Tariq Iqbal Bhutta, Dr. Abbas Ghani, Dr. Muhammad Rafique and Prof. A.G. Billoo. Majority of them were present at the occasion.
One of the morning interactive sessions was devoted to vaccination and it was chaired by Prof. Sajid Maqbool, Anita Zaidi and Prof. Lu Lu. Responding to questions it was stated that one should not bother about the booster dose of Hepatitis B Vaccine. It was emphasized to optimize schedule dosing and administration of vaccines. The recommended schedule for these vaccines is six, ten and fourteen weeks followed by a booster dose at six months. One of the recommendations suggest zero, one and six. WHO has come up with its guidelines for Vaccination for GAVI supported countries. It was also argued why despite multiple booster doses, we have not been able to eliminate polio? Responding to this the chairpersons remarked that we should not forget the fact that we fail to cover the entire paediatric population during these campaigns. We need to improve our coverage during these vaccination campaigns. India has eliminated polio and now only three countries are left with polio which includes Pakistan, Nigeria and Afghanistan. Main reasons our Pakistan’s failure to eliminate polio and increased prevalence of vaccine preventable diseases was that we have not been able to reach every child every time. According to one of the reports 15% children were missed in both the latest vaccination campaigns in Karachi. It was also suggested that the paediatricians should start giving vaccines in case they do not trust the quality of vaccines provided by the government. Paediatricians should identify areas where immunization services needs to be improved. GAVI has been extremely helpful and now Pneumococcal vaccine has also been provided which has been added in the EPI programme.
Prof. Sajid Maqbool along with Dr. Nadeem Khawar chaired one of the sessions wherein Prof. Lu Lu was the first speaker. Talking about the global burden of pneumonia and pneumococcal disease, she said that there are one hundred fifty million events every year of which 12-15% are severe which require hospitalization. Pneumonia accounts for 1.5 million deaths every year of this thirty thousand deaths are due to pneumonia. It has high prevalence in countries like India, China, Nigeria, and Pakistan. Presence of fever, acute respiratory symptoms, evidence of chest wall in drawings and mixed bacterial viral etiologies is under estimated. Penicillin resistance is very high in Asia Pacific though it is low in India and Philippines. One million deaths can be prevented through prevention and over six hundred thousand deaths can be saved by appropriate treatment. Main barriers include health seeking behaviors and access to healthcare. It is time that these barriers are removed. Singapore, she said had erratic facility for PCV till 2005 and in pre 1990s period, the mortality figures were 29.5% which drastically reduced after proper supply of PCV.
Dr. Nadeem, Khawar from Peshawar spoke about high cost of hospital treatment and reducing the toll by managing pneumonia. He pointed out that the number of death due to pneumonia was quite high in developing countries. Some of the reasons are adverse community practices, malnourished host, inappropriate washing and bathing of the child, weak health system and lack of proper referral system. Viral infections are quite high and we can reduce it by proper immunization. He was of the view that coverage was much more important than the introduction of the vaccines. Talking about the diagnosis of pneumonia he said that the presenting symptoms include cough, difficulty in breathing, high respiratory rate. If the child is unable to eat and drink it is a danger sign and these patients must be hospitalized immediately. Amoxicillin recommended for CAP is not very effective is a misconception. We need to promote appropriate use of anti viral agents in OPD. In case one is suspicious of complications only then one should ask for chest X-ray. Children with respiratory distress will need hospitalization. As regards treatment, we need to improve family and community practice. Children with fast breathing rate will need antibiotics but we should also remember that fast breathing is not pneumonia all the time. Severe pneumonia can be successfully treated by oral medications with close monitoring and close follow up, he added.

Post conference Press conference

On the conclusion of the conference, Prof. Iqbal Memon President PPA along with Dr. Hasinna Chagani and Dr. Sami Ahmed addressed a press conference and highlighted the recommendation of the conference. Pakistan Pediatric Association Prof. Memon stated has asked all the Provincial Governments to establish an exclusive and full-fledged emergency medical care centre for children at all teaching hospitals. PPA has also demanded establishment of liver transplantation centers for children across the country. PPA has also urged the government to put in place a proper service structure for the pediatricians in the public health sector and also called upon the Pakistan Medical and Dental Council to give more importance to pediatric healthcare education and review its decision to reduce examination marks for child health subjects. Mother and child healthcare should be given priority and PPA should also be given representation in Drug Regulatory Authority. Association has proposed to the Government to make it mandatory for parents to produce vaccination cards at the time of seeking admission of their children to schools or applying to NADRA for identity cards or registration which will help improve target of immunization. PPA had decided to observe 2013-14 as the year to promote and increase the awareness regarding vaccination.
Replying to a question Prof, Iqbal Memon said that desired results could not be achieved in reducing child and maternal mortality rate in the country. Vaccination Centers under the EPI programme need improvement. Although these centers did not match number of children who required preventive vaccines against diseases, still many of them had become non-functional because of lack of required facilities. New expensive pneumococcal vaccine for children under one year of age is being introduced shortly across the country, it was highly important to ensure that the vaccines reached all children equally in urban and rural areas. Participants of the conference also discussed status of malnutrition of children and crucial anemic condition of mothers-to-be and experts stressed the need for reorganizing the maternal health services in the country, he added.

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