PARALYTIC POLIOMYELITIS IN A RURAL AREA OF NORTH-INDIA

Background. Paralysis due to poliomyelitis is common in rural areas. T he extent of paralysis, type and place of treatment and effect of loca l treatment on children with poliomyelitis was assessed in a house-to- house survey conducted between 1990 and 1991 in a rural area of north India. Methods. Trained field workers conducted a house-to-house surve y in 9 villages of Haryana with a total population of 22 883. All case s of deformity and muscular weakness suspected to be due to poliomyeli tis were examined and details regarding immunization, diagnosis, treat ment and follow up were recorded. The late consequences of neglect as well as inappropriate medical advice were also assessed by physical ex amination and direct questioning of the parents. Results. Thirty-seven cases of paralytic poliomyelitis were identified indicating a prevale nce rate of 1.6 per 1000 population. Of these, 97% were paralysed befo re they were 2 years old and 60% had a history of intramuscular inject ions preceding paralysis. Only 14% of them had received either partial or complete immunization. The majority of families preferred to take treatment from traditional healers or in city hospitals but not from p rimary health centres. Conclusion. Despite the national immunization p rogramme, paralytic poliomyelitis continues to be a significant proble m in the villages surveyed. Primary health centres are an unreliable s ource of epidemiological data for paralytic poliomyelitis as villagers do not prefer to visit them for treatment of the disease. Injections given for treatment of fevers in rural areas may play a role in precip itating paralytic poliomyelitis. These findings highlight the urgency of a broad-based primary health care approach at primary health centre s. Traditional healers and private practitioners should be trained to provide physiotherapy to children with polio and educated about the im portance of not giving injections to children with minor fevers.