Inducements in health campaigns

On May 8, 2007, 68 children from the Indira Nagar slums of Nagpur were admitted to hospital with complaints of nausea, vomiting, headache and abdominal pain. All had received oral doses of vitamin A the day before during a mass nutritional campaign organised by the state government, the Nagpur Municipal Corporation and the Rotary Club of Nagpur. The children were diagnosed with hypervitaminosis A. Some became critically ill but fortunately no one died.

The problem occurred because T-shirts and drawing books were distributed to each child who took a dose of Vitamin A so naturally the children went to different booths and took multiple doses in order to collect the “gifts”. The local ward member knew of children who had collected eight T-shirts (1, 2).

The programme went awry because of total mismanagement, procedural lapses and the casual approach of the organisers. No permission was obtained from higher regulatory authorities for the involvement of the Rotary Club of Nagpur. It was not planned properly; the staff who administered the doses were not trained; and there were no arrangements to tackle medical emergencies. Even children above 14 years of age were administered vitamin A doses. The children being from slums, had higher risk of protein deficiency, and the doses of vitamin A were administered not through the measure provided in the pack, but in caps. No identification mark was put on the children who received the dose and no record was maintained (1, 2). Inducements were offered for taking the dose, resulting repeated doses being administered to the same children.

Fat-soluble vitamins like vitamin A have cumulative toxicity. Those with protein energy malnutrition will experience toxicity with lower doses (3, 4). Long-term toxicity of hypervitaminosis A includes teratogenecity, irreversible damage to liver, desquamation of skin, hyperostosis and bone malformations.

A committee appointed by the government of Maharashtra found that the use of incentives by the Rotary Club of Nagpur, lack of planning and following the procedural requirements had resulted in the incident that affected 68 children, and called for a ban on incentives in such drives (5).

The Rotary has not publicly apologised for its role in the incident, let alone made arrangements for the future follow-up and management of the affected children.

It is unethical to lure children with “free gifts” and then make them suffer with unscientifically conducted health campaigns and nutritional drives.