Tobacco control in schools of India: review from India Global School Personnel Survey 2006.

School personnel are role models for students, teachers of tobacco use prevention curricula, and key influencers for tobacco control policies in schools. With their daily interactions and strong influence on their students they represent an influential group for tobacco control. Data collected through the Global School Personnel Survey during 2006 in 180 school; of 6 regions of India have shown that a large proportion (29%) of school personnel used tobacco. The scarcity of tobacco free school policies and relevant teaching materials (non existent in 62% of schools surveyed) and lack of training among school personnel (84%) reported in this study indicate the extent of undermining the scope of prevention efforts in schools to reduce adolescent tobacco use prevalence in India. Majority of school personnel in India strongly agreed that they should receive specific training to help students avoid or stop using tobacco. Training of school personnel along with introduction of comprehensive school policies and its vigorous enforcement will help adolescent students and school personnel to adopt and maintain a tobacco free lifestyle.

A pilot survey on hand washing among some communities of West Bengal.

A cross-sectional observational study was carried out between April to May 2006 by interview method and observation technique with the objective to know the knowledge regarding hand washing in the community and it was done in the slum and nonslum urban areas and also one rural area. The result shows that in urban slum area 98% washed their hands with soap after defecation; Only 36%, 16% and 2% washed their hands with soap before meal, before serving food and before cooking respectively. However, it was observed that 69% used soap and water for hand washing after cleaning the child's faeces. In rural area 71% used soap and water after defecation while 26% used mud or ash. Only 13%, 1%, 1% and 5% used soap and water before meal, before serving food, before cooking and after cleaning the child's faeces. 82.35% of respondents in non slum area and 89% of respondents in rural area considered that diarrhoea and dysentery could be prevented by hand washing while they did not give importance to hand washing in prevention of diarrhoea over other methods like cleanliness, boiling and purification of water. ARI was much higher (25.72%) in rural area followed by slum area (13.77%) and non-slum area (3.87%). Out of 30 observations among 302 interview made on hand-washing only first step i.e. palm washing (transient rubbing the palm with soap) was followed by all the participants observed. Time taken for such hand-washing was only around five seconds (ideal 15-30 seconds) in urban slum and rural areas while in non slum area it varied between 7-10 seconds on an average. No one followed any other steps of hand-washing, recommended by IFH.

Positive deviance--the West Bengal experience.

There are 11.1 million children in the age group 0-6 years in West Bengal. Of these, every second child under 3 years of age is underweight, more than four out of ten are stunted, and one out of eight are wasted. The Integrated Child Development Services (ICDS) programme in West Bengal has 355 operational projects covering 53,064 operational anganwadi centers reaching out to more than four million beneficiaries--approximately half of whom are children in the age group 0-3 years. The Department of Women and Child Development (DWCD) is trying to identify and replicate innovative, community-based, sustainable approaches. One such innovative initiative has been the "Keno Parbo Na" project based on the Positive Deviance (PD) approach which aims to reduce and prevent malnutrition among children under 3 years of age by focusing on local solutions and resources, local behaviors and practices. Behavior change is emphasized through participatory learning and community mobilization. The pilot phase of the project has been completed in two districts [Four blocks (2 in each District) and 32 villages/AWCs (8 in each block)] of West Bengal (Murshidabad and South 24 Parganas). The analysis of the project activities so far reveals that the issue of malnutrition and its prevention is now visible in the villages covered. Acceptance of desirable behavioral practices is observed within the community. A steady reduction in the moderate and severe level of malnutrition was noted across four districts. A general preponderance of girl children was noted at the entry stage indicating higher levels of severe and moderate malnutrition among girl children to begin with but also suggesting PD as an important strategy in reducing the gender gap in malnutrition. The boys gain in terms of nutritional status faster than the girls so in the intermediate phase malnourished girls are more in number. However, by the sixth / ninth round, as the malnutrition levels decline substantially, the gender gap tends to close.

An evaluation of routine immunization coverage in some districts of West Bengal and Assam.

A coverage evaluation survey was carried out in the five districts of West Bengal and Goalpara district of Assam during the period from November 2002 to April 2003 through 40 clusters sampling technique. Results revealed that highest coverage with routine immunization was in Paschim Medinipur (82.5%) followed by Kolkata (71.6%), Malda (65.3%), 24 Parganas South (61.9%) districts of West Bengal. Murshidabad district of West Bengal had only 41.3% coverage while poorest coverage was observed in Goalpara district (27.2%) of Assam. "Not aware of the need for routine immunization" was the main reason for not being vaccinated with all the UIP vaccines. Vaccination was given mainly through government hospitals in Kolkata while it was administered mainly through subcentres in the other rural districts.

Evaluation of pulse polio immunization in some districts of West Bengal & Assam.

A cross-sectional non-interventional survey was carried out in 5 districts of West Bengal and one district of Assam to find out the extent of coverage during IPPI. It was observed that in the recent rounds of IPPI, more than 95% coverage was observed in all the surveyed districts excepting in 24 Parganas South where coverage was around 92%. Situation at the Goalpara district further needed attention, as the coverage during February 03 as well as in the past two rounds were 90.13%, 88.13%, and 91.04% respectively. In all these districts booths were the main sites for IPPI dose though 1/3rd to 1/4th of the beneficiaries received immunization at home also. It was also observed that around 10% of the beneficiaries were not administered any PPI dose in the either of the rounds, in 24 Parganas (south) & Murshidabad districts, from where maximum number of Poliomyelitis cases were reported. At Goalpara it was 19%. Main reason for not being covered with PPI doses in either of the rounds in all the districts excepting Kolkata was "Not aware of the need for additional doses". In Kolkata "child sick" was the main reason. Health workers were main source of information of PPI in South 24 Parganas (67.13%), Malda (58.25%) & West Midnapur (54%). At Murshidabad "announcement through mike" (61.25%) was the main source of information while in Kolkata, TV was the main source (67.13%). Miking (56.38%) was the main source of information for PPI at Goalpara district of Assam. It was observed that involvement of multiple methods & media of communication was helpful in disseminating dates & other information of PPI.

Future challenges in communication for promoting ORT--an overview.

Oral rehydration therapy (ORT) is a cheap and simple intervention aimed to prevent mortality and morbidity associated with dehydration due to diarrhoea. ORT promotion strategies through programme communication, social mobilisation and social marketing, and advocacy efforts have yielded substantial improvement in the scenario. However, it has also taught us lessons and suggested changes in communication strategies to make the promotion efforts more effective in future.

An overview of multicentric training workshops for public health professionals on reproductive and child health programme in India.

The major emphasis of Reproductive and Child Health (RCH) programme in India is delivery of client-oriented, demand driven and broader ranges of high quality, safe and effective services for children, adolescents, mothers and reproductive age group population at large. Increased client satisfaction is considered as main determinant for improved acceptance of the services. Thus, well trained and motivated health personnel are necessary to deal with highly sensitive, personal health issues of the clients, like contraception, abortion, infertility services etc. The Indian Public Health Association organized total 10 workshops in several places of India (A total 322 members, composed of Medical Administrators (54.7%), Faculty members of Medical Colleges (24.5%), Sociologist and Nutritionists (13.9%) and also public health personnel (6.9%) participated in the workshop). Learning objectives and lesson plans etc. were formulated. Accordingly the contents were incorporated in a module, validated and pretested. The training sessions were conducted by briefing, discussion, group exercise and VIPP method and were evaluated by semi structured. The pre/post assessment schedule and scored scale of feedback from participantsAE were used for evaluation. The pre-post assessment scores revealed wide variations of mean score among the participants of several places. Significant post workshop improvement of knowledge was quite evident, with few exceptions. The group variants of pre and post score of results was considered to be due to heterogeneous groups of participants. Review of objectivity and quality of the questionnaire were felt as necessary.

Utilization of maternal services in west Bengal.

A study was conducted in selected blocks of West Bengal to assess the utilization of available maternal health services specially immunization, antenatal care and other services. Coverage with two doses of tetanus toxoid levels varied between 58.6 to 86.7% but it fell far short of Universal Immunization Programme target of 100%. Drop out rates were slightly higher in the rural areas. It was observed that in 5 out of 7 blocks more than 55% of the deliveries were conducted either at hospital or Primary Health Centre by health personnel. However, untrained dais predominated over the trained dais in conducting deliveries in most of the areas. This indicates the poor availability or utilization of the latter.