KARACHI, Feb 19 Healthcare experts believe that administration of intramuscular (IM) injections to children under the age of five years is one of the factors behind the emergence of paralytic polio cases in Sindh and other parts of the country.

They stressed the need for ascertaining diagnostic reports before prescribing any IM injection for children with symptoms like febrile fever or muscular weaknesses. Otherwise, they warned, the children exposed to the polio virus could be at the risk of paralysis.

According to a source privy to polio eradication management efforts in Sindh, the first confirmed polio case in Sindh this year was detected last Saturday in Gadap Town of Karachi where the victim child, 16-month-old son of Mohammad Usman, received IM in both his lower limbs. This was followed by paralysis of both lower limbs, adding an avoidable precipitating factor converting non-paralytic polio into paralytic type.

Some reports compiled by the surveillance team of the polio eradication programme also suggested that the high percentage (62 %) of confirmed polio cases in Pakistan last year had received IM injections prior to development of paralysis in injected limb with an increasing trend during period from 2003 (28%).

About 72 per cent of the 18 children falling prey to the polio virus and developing paralysis in 2008 had the history of IM injections preceding paralysis.

There is also a view that IM injection must be avoided, particularly during summer months (May to September), which are considered as peak polio virus transmission months. If required in serious cases, the drugs should be given by intravenous route.

Drugs administered by IM route included antibiotics, antipyretics, steroids, DPT vaccines, vitamins, chloroquine, aqueous solution of human placenta, extract and others.

Prof Iqbal Memon, chairman of the provincial experts committee on polio, endorsed the views and said that physicians should ensure less frequent use of IM injections to children up to five years as the injections could accelerate the paralytic development.

Doctors, paediatricians and healthcare providers should avoid use of injection therapy to children without ascertaining the diagnosis, he said, adding that health practitioners' organisations should also help spread the message.

Discussing the epidemiological characteristics of polio cases, the surveillance reports say that over 56 per cent of the confirmed polio cases in Pakistan last year had their first contact with medical doctors, while over 42 per cent contacted informal healthcare providers.

The situation in Sindh is not very much different as nine (50 per cent) of the total cases reported last year first contacted qualified doctors and the remaining patients first contacted informal health care providers.

Socio-economic status of parents is also a factor affecting child health. It is reported that 85 per cent polio cases detected last year in Pakistan (94 per cent of them in Sindh alone) came from the poor class. A maximum of 66 per cent of the polio cases reported in the country last year lived in rural towns or villages comprising 10 or more houses.

In Sindh, the maximum cases of polio (about 39 per cent) lived in urban slums or katchi abadis, followed by about 28 per cent in rural town and villages.