I am a retired Professor of pediatric surgery and started my medical training at Chittagong Medical School in Bangladesh in 1963. Soon afterwards, I went to the United Kingdom to pursue higher post-graduate training. It was there that I developed an interest in pediatric surgery. I spent time at the Great Ormond Street Hospital learning pediatric surgery and also trained in general surgery in the UK. After completion of my training, I was a locum consultant at the George Elliot Hospital in Nuneaton. I returned to Bangladesh in 1982 and joined government service. I eventually became a Professor of pediatric surgery at Bangabandhu Sheikh Mujib Medical University followed by Dhaka Medical College Hospital.
Pediatrics is a branch of medicine that deals with the care of children, from being a new born to the ages of 16-18. Pediatricians look at specific health issues and diseases related to different stages of growth and development. It is a diverse and stimulating specialty and is hugely rewarding for doctors.
Globally, child mortality rate – the rate of death among infants and children between the ages of 1 month and 5 years, has been a concerning issue, particularly in Africa and South Asia. A 2015 UNICEF analysis shows that child mortality rate has dropped by 53% from 1990. Under-five deaths have reduced globally from 12.7 million in 1990 to 5.9 million in 2015. However, 16,000 children under 5 still die every day. 45% of these deaths occur in the neonatal period i.e. the first 28 days of life.
In 1990, Bangladesh had an under-five mortality rate of 144 per 1,000 children. That number dropped to 38 per 1,000 children in 2015, exemplifying the huge strides the country has taken to achieve this feat.
The main causes of death in Bangladeshi children include prematurity, pneumonia, complications during labor and delivery, diarrhea, sepsis, and malaria. Nearly half of all under-five deaths are associated with undernutrition. Most of these deaths are preventable with simple interventions.
Broadly, pediatricians work in the following areas:
- General pediatric units
- Community based settings
- Specialized units such as neonatology
Treating a child is different from treating an adult. There are differences in anatomy, physiology, and pathology. As a child grows, anatomical and physiological parameters change. Congenital defects, genetic variance, and developmental issues are of great concern to pediatricians. Another major difference between adults and children is the issue of consent. Children are generally not able to make decisions for themselves and parents or guardians are responsible for these decision. A pediatrician often has to treat the parents as well, rather than just treating the child.
In the developing world, malnutrition and infectious diseases are the predominant problems that pediatricians are faced with. There are also several social issues that need to be overcome including poverty, chronic illness in the family, child labor and others. Malnutrition leads to poor growth and development, making the child susceptible to a range of other consequential secondary diseases. Infectious and diarrheal diseases are extremely common, while HIV and hepatitis are endemic. A lack of accessible medical care makes these diseases potentially fatal.
Overall, pediatrics is an incredibly important specialty. Children are our future and we need to ensure that we are taking the best possible care of them. With the financial constraints faced by the healthcare system in a developing country such as Bangladesh, it becomes more of a challenge to provide this service. Currently, this service is provided by a combination of government funding, non-government organizations, and the private sector. With the continued development and growth of the country there will be an increased expenditure on pediatric healthcare, which should help in improving the health and wellbeing of children in Bangladesh.
At Praava Health, we will prioritize healthcare for children. We will provide a comprehensive immunization program with monitoring of growth and development as per international guidelines. We will ensure children get the most up to date, evidence-based treatment.