Food Security and Anthropometric Failure Among Tribal Children in Bankura, West Bengal.

We conducted a cross-sectional study among 188 tribal children aged 6-59 months using two-stage sampling in Bankura-I Block of Bankura district, West Bengal, India, to assess their nutritional status and its relation with household food security. Weight and height/length were measured and analyzed as per new WHO Growth Standards. Mothers of the study children were interviewed to obtain relevant information. Prevalence of Composite Index of Anthropometric Failure was 69.1% and multiple anthropometric failures were more likely among tribal children aged 24-59 months with irregular utilization of supplementary nutrition and from households with severe grades of food security.

Elimination of iodine deficiency disorders--current status in Purba Medinipur district of West Bengal, India.

BACKGROUND AND OBJECTIVES: Towards sustainable elimination of iodine deficiency disorders (IDD), the existing programme needs to be monitored through recommended methods and indicators. Thus, we conducted the study to assess the current status of IDD in Purba Medinipur district, West Bengal. METHODS: It was a community based cross-sectional study; undertaken from October 2006-April 2007. 2400 school children, aged 8-10 years were selected by '30 cluster' sampling technique. Indicators recommended by the WHO/UNICEF/ICCIDD were used. Subjects were clinically examined by standard palpation technique for goitre, urinary iodine excretion was estimated by wet digestion method and salt samples were tested by spot iodine testing kit. RESULTS: The total goitre rate (TGR) was 19.7% (95% CI = 18.1-21.3 %) with grade I and grade II (visible goitre) being 16.7% and 3% respectively. Goitre prevalence did not differ by age but significant difference was observed in respect of sex. Median urinary iodine excretion level was 11.5 mcg/dL and none had value less than 5 mcg/dL. Only 50.4% of the salt samples tested were adequately iodised (> or = 15 ppm). CONCLUSION: The district is in a phase of transition from iodine deficiency to iodine sufficiency as evident from the high goitre prevalence (19.7%) and median urinary iodine excretion (11.5 mcg/dL) within optimum limit. But, salt iodisation level far below the recommended goal highlights the need for intensified efforts towards successful transition.

Iodine deficiency disorders among school children of Dakshin Dinajpur District, West Bengal.

Iodine deficiency disorders (IDD) are major public health problems in India, including West Bengal. Existing programme to control IDD needs to be continuously monitored through recommended methods and indicators. Thus we undertook the study to assess the prevalence of goiter, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level in Dakshin Dinajpur district, West Bengal. We conducted a community-based, cross-sectional study in 2004; among 2250 school children, aged 8-10 years. The '30 cluster' sampling methodology and indicators for assessment of IDD, as recommended by the joint WHO/UNICEF/ICCIDD consultation, were used for the study. Goitre was assessed by standard palpation technique, UIE was analyzed by wet digestion method and salt samples were tested by spot iodine testing kit. Of the 2250 children, 419 (18.6%) had goitre (95% CI = 17.0 - 20.2%). Total goitre rate (TGR) was not significantly different in respect of gender, age and religion. Visible goitre rate was 2.5%. Median urinary iodine excretion level was 16 mcg/dL (normal: > or = 10 mcg/dl.) and 16.5% children had value less than 5 mcg/dL. Only 67.4% of the salt samples tested had adequate iodine content of > or = 15 ppm, with significant difference between Hindus and Muslims (chi2 = 12.68, d.f. = 1, p < 0.01). TGR of 18.6% indicate the district is still endemic for IDD, but median urinary iodine within normal range reflects no current iodine deficiency. The district is in the transition phase from iodine-deficient to iodine-sufficient. Measures are to be sustained for successful transition towards elimination.

Status of maternal and new born care at first referral units in the state of West Bengal.

A study was conducted in 12 First Referral Units (FRUs), selected through multistage sampling, from 6 districts of West Bengal. Infrastructure facilities, record keeping, referral system and MCH indicators related to newborn care were documented. Data was collected by review of records, interview and observation using a pre-designed proforma. Inadequate infrastructure facilities (e.g. no sanctioned posts of specialists, no blood bank at rural hospitals declared as First Referral Units etc.); poor utilization of equipment like neonatal resuscitation sets, radiant warmer etc, lack of training of the service providers were evident. Records/registers were available but incomplete. Referral system was found to be almost nonexistent. Most of the deliveries (86.1%) were normal delivery. Deliveries (87.71%) and immediate neonatal resuscitation (94.9%) were done mostly by nursing personnel. Institution based maternal, perinatal and early neonatal mortality rates were found to be 5.6, 62.4 and 25.2 per 1000 live births respectively. Eclampsia (48.9%), hemorrhage (17.7%), puerperal sepsis (7.1%) were reported to be major causes of maternal mortality. Common causes of early neonatal mortality were birth asphyxia (54.3%), sepsis (14.6%) and prematurity/LBW (12.4%).

Evaluation of vitamin A status during pregnancy.

Adequate maternal vitamin A nutrition is essential for successful pregnancy outcome and estimation of serum retinol among pregnant women enables a precise and objective assessment of vitamin A status, during pregnancy, even in subclinical state. In order to evaluate vitamin A status during pregnancy, and its relationship with personal and pregnancy related variables of the mother, 300 antenatal clinic attenders were interviewed at RG Kar Medical College and Hospital, Calcutta and tested for serum retinol, using Carr-Price test. Serum retinol values less than 30 microg/dl and 20 microg/dl, in this study, were considered as poor and severe vitamin A deficiency respectively. According to this 14.7% and 4% pregnant women were found to be suffering from poor and severe vitamin A deficiency respectively. Clinical signs of vitamin A deficiency (eg, nightblindness) were reported only among 60% cases of the deficient population. The problems of vitamin A deficiency were associated with low literacy and poor nutritional status of the mother, advanced gestational age of current pregnancy,increased number of pregnancies, shorter interval between births and poor dietary intake of vitamin A rich foods during pregnancy. The study thus raises the question of supplementation of vitamin A, during pregnancy, in Indian context where habitual diets are either inadequate or deficient in vitamin A.

A study of dietary pattern, household food security and nutritional profile of under-five children of a community of West Bengal.

A cross-sectional study was carried out in a tribal community of West Bengal to study the dietary pattern, household food security, utilisation of services and nutrition profile of under-five children. It was observed that average calorie consumption was 2,236 with 48% food insecured families. Cereals, starchy food and green leafy vegetables consumption was higher than the recommended daily allowance while pulses (scarcely supplied in fair price shops), milk, oil and sugar were less than recommended daily allowance. Nearly 11% kcal were coming from alcohol consumption. Public distribution system should supply all essential items with an improved quality on a regular basis and supply during lean season should be ensured. Prevalence of malnutrition in the children under-five years of age was 80.90% and 9.26% were suffering from severe grades. More severely malnourished children were observed in the age group of 12-23 months, amongst female children, in the families where mothers were working and also in the families where numbers of sibling were 2 or more. Services available under Integrated Child Development Services Scheme were utilised by 47.3% children.

Missed opportunities for immunisation in children.

All opportunities for immunisation in children should be utilised properly, as sustaining high levels of full immunisation coverage is essential to meet the goal of eradication of poliomyelitis as well as control the other vaccine-preventable diseases; yet many opportunities for immunisation are missed in all types of health facilities, even in teaching hospitals. Reducing such missed opportunities is the cheapest way to increase immunisation coverage. The present study discusses the problem of missed opportunities for immunisation in children in Paediatric Outpatient Department and Immunisation Clinic of R.G. Kar Medical and Hospital, Calcutta and the underlying factors of the problem. Prevalence of missed opportunities in Paediatric OPD and Immunisation clinic was 37.8% and 1.4% respectively. Most of the missed opportunities were attributed to health care providers and delivery system of health care of the studied hospital.

Perception and practice regarding pulse polio immunisation in an urban community of Calcutta.

A survey was conducted at an Integrated Child Development Services (ICDS) Scheme project in North Calcutta among 656 mothers having children less than 3 years of age to assess their perception and practice regarding pulse polio immunisation (PPI). It was revealed that 91.8% of under 3-year children received PPI on 9-12-1995 and 94.4% on 20-1-1996. Major reasons for not accepting the services on those two days included 'mothers unaware' (22%), 'child too small' (30.5%), etc. Major source of first information was television (TV)/radio (57.2%) followed by anganwadi workers (AWWs) (33.8%). However, majority of the mothers were finally motivated for PPI by AWWs (58.8%) followed by the role of TV/radio (34.1%). Although 70.7% mothers knew the name of the vaccine correctly, only 3.5% mothers could tell the exact purpose of its administration. Most mothers (73%) opined that 2 drops of oral polio vaccine (OPV) was administered to their children and only 14.6% hoped that such programmes will be conducted by the Government in future. The average waiting time of mothers at immunisation centres was found to be 7.2 minutes.

An assessment of AIDS awareness program--for I.C.D.S. functionaries.

An assessment of the "One Day AIDS Awareness Program" for I.C.D.S. functionaries was done. The pre-training knowledge level scores were 55.3%, 39.3% and 60.4% of the total score, in 24-Parganas (S), Burdwan and Calcutta districts respectively. However, the post-training assessment scores were observed to be 91.9%, 84.9% and 94.8% in 24-Parganas (S), Burdwan and Calcutta districts respectively. The percentage increase in mean scores was found to be 66.5%, 115.8% and 57.1% in 24-Parganas (S), Burdwan and Calcutta districts respectively.

(Dr. P. C. Sen Award on rural health practice). Infant and early childhood mortality in some rural ICDS blocks of west Bengal.

This one year prospective study was carried out to determine the CBR, CDR and different underfive mortality rates in some selected rural ICDS blocks of West Bengal and also to find out the common causes of infant and childhood mortality in these areas. It was revealed that most of the above mentioned indicators in ICDS blocks were considerably lower than that of National figures, but more or less similar to those of rural Bengal as recorded in routine Govt. reports. Compared to the picture of rural West Bengal, both still birth & perinatal mortality rates were found higher in all ICDS blocks. The causes of mortality trends among under fives' were found similar to that of rural India pattern i.e. prematurity, acute respiratory infections and diarrhoea being the leaders. Neonates, who contributed the largest share of infant mortality died mainly due to prematurity. So, observations like high perinatal mortality & still birth rates, huge proportion of neonatal death during infancy, same IMR but low 5MR, and death of neonates due to prematurity etc. claim the necessity of improving maternal component of ICDS services, their nutritional care in particular.

Infant feeding practices in a rural community of west Bengal.

A study on breast feeding and weaning practices was carried out in a sample of 57 lactating mothers of rural community. Although early start and prolonged breast feeding was an universal practise, but timely weaning was neglected and offered to 54.5% of infants only. On the contrary, introduction of artificial milk to young infants was a culturally accepted baby feeding.

A study of the impact of health education inparted to school children on their knowledge, attitude and practice in regard to personal hygiene.

Education concerning prevailing health problems and the method of preventing and controlling them was considered to be one of the first eight essential activities in primary health care. Hence this study was attempted to assess the impact of health education on the knowledge, attitude and practices of school children aged 10-14 years in two secondary schools situated in Burdwan District of West Bengal. For this purpose health education was imparted by a team consisting of Medical Officer and Paramedical staff. Education was given on personnel hygiene. The entire education programme was arranged in such a way that the course could be completed in six months time. The knowledge, attitude and practice status of the students was assessed before imparting training, twice during the training period at an interval of three months and finally after 9 months from the start of training. The evaluation was done with the help of scoring. The results indicated that the health knowledge of the student significantly improved after education. Attitude of the students towards personal hygiene also improved significantly after education. The practice of personal hygiene improved significantly as well. The present study also revealed that the improvement in health practice was not commensurating with the improvement of knowledge and attitude after education.

Global review on ORT (oral rehydration therapy) programme with special reference to Indian scene.

This communication is an attempt to review the status and implementation of the Oral Rehydration Therapy in the programme for Control for Diarrhoeal Diseases. The Global and the Indian situations are separately discussed, with more emphasis on the latter. Use of Home Available Fluids (HAF), Salt Sugar Solution (SSS). Commercial packets of ORS and the Government supplied packets of ORS are also assessed.