CINI's approaches to intervention: an innovative strategy to combat malnutrition in India.

The Child in Need Institute (CINI) has been working toward sustainable health and nutrition development for women and children for the last twenty-six years. During the initial stages, the Institute focused on treatment and prevention of malnutrition in children under five years of age. Over the years, the program strategies have shifted to a more holistic lifecycle approach. This approach targets individuals during crucial periods of their lives--pregnant women, children (0-2 years of age) and adolescents (10-19 years of age)--as well as other vulnerable segments of the population. To reach out to these target groups, the Institute uses a three-pronged strategy that includes case management, behavior change communication, and linkage formation. Programs are either community- or center-based depending upon the need of the populations. CINI's current strategy has shown positive trends in improving the health and nutrition status of women, children, and adolescents in the community. Results include reduction of low birth weight babies, increase in proper antenatal care, reduction of severely malnourished children, decrease in maternal and infant mortality and morbidity rates, and improvement in community involvement in all reproductive and child health programs. CINI is currently monitoring its performance and activities to carry out operations research for providing further evidence for the effectiveness of its interventions.

Promoting wholesome infant-feeding practices in India.

PIP: India's infant nutrition policy is based on the following strategies: 1) promotion of exclusive breastfeeding for the 1st 6 months of life; 2) gradual introduction of supplements such as animal milk and food items from the family's diet (cereals, dahl, and vegetables) after 6 months, while continuing to breastfeed; 3) promotion of improved hygiene in the feeding and handling of infants; 4) education regarding the avoidance of and treatment of infections; and 5) regulation of the use of commercial infant foods. This strategy, in turn, requires attention to many other areas, such as improvement of maternal nutrition through food subsidies to breastfeeding mothers, the provision of workplace facilities for nursing, increased availability of animal milk in rural areas, training of health care personnel in feasible infant nutrition practices in poor communities, improvements in the quality of biscuits in village shops, increases in the outreach of health services, a safer water supply, education regarding the superiority of breast milk over commercial infant formulas, and attention to hospital policies that deter mothers from breastfeeding. It is especially important that the poor, who cannot afford to purchase commercial infant foods, become convinced that less expensive supplements can confer the same benefits if used judiciously.^ieng

National policy on growth monitoring and promotion--Swaziland leads the way.

PIP: Growth faltering is a significant problem in the Royal Kingdom of Swaziland in southern Africa with 33% of all children affected before 5 years of age. The Ministry of Health, Government of Swaziland, in conjunction with UNICEF, developed a strategy to arrest growth faltering. Task forces visited health facilities and recommended that nurses and nursing assistants need to be better trained to counsel on and interpret growth monitoring methods; training materials appropriate for Swaziland need to be developed; and a national stand on growth monitoring and promotion (GMP) needs to be publicized. The Ministry of Health organized a workshop to train health workers in growth monitoring through pre-service and in-service training. The workshop resulted in the development of a GMP manual, posters, and easy-to-understand charts. A national seminar on GMP resulted in a draft of national policy and international experience. UNICEF is currently sharing this experience with East African countries. An appendix delineates the definition, objectives, and implementation of the national GMP policy in Swaziland.^ieng

Growth monitoring in the evolution of clinic based health care through a community based action program.

PIP: In Calcutta, India a voluntary organization was established in 1975 called the Child in Need Institute (CINI) in order to nutritionally rehabilitate the poor. CINI detected malnutrition by utilizing "weight for age" charts and treated malnutrition with food supplements. Women must purchase a growth card to enter the program. Patients are registered, weighed and plotted, given on ort demonstration, educated in health and nutrition, shown supplementary feeding techniques, given a health check up and immunizations, and are given antenatal care. The growth card is referred to at all stages of the care, which causes mothers to realize that it is very important to their health. CINI eventually established mobile clinics run by women's groups. 50% of all children under 3 participate monthly and 30% more participate at 2-3 month intervals. Mothers are more willing to correct the nutrition of their children when they understand the growth charts. The India Institute of Medical Sciences in 1986 assessed the KAP (knowledge, awareness, performance) of 132 village mothers. They found significant appreciation for growth monitoring. Mothers have also become more aware of the importance of sanitation, frequent feeding, and clean water. The growth chart is a tool, but is also viewed as a symbol of the activities of CINI.^ieng

2-Mercapto-ethanol enhancement of agglutination reaction--a possible in vitro serological correlate for assessment of functional immunity in simian malaria.

Conventional indirect haemagglutination test was performed in rhesus monkey sera (collected from Plasmodium knowlesi infected animals) with and without prior treatment of sera with 2-mercapto-ethanol (2-ME). Surprisingly, many sera samples showed significant enhancement of final titre with 2-ME. The 2-ME enhancement effect was more pronounced in the sera of hyperimmune monkeys on further injection of antigen or parasites. It was also noticeable in the sera during primary drug-suppressed P. knowlesi infection and appeared to have a bearing on the immune status of the animals to rechallenge. The use of a soluble antigen prepared from P. knowlesi infected erythrocytes was found to be essential in IHA test to demonstrate the 2-ME enhancement effect. Antigen prepared from freed parasites (commonly used) failed to show a similar effect in IHA. The possible role of certain T-lymphocyte products - antigen binding, non-agglutinating, 2-ME sensitive molecules - in malarial immunology has been proposed.

Antigen-specific non-immunoglobulin "antibody'-like molecules in rhesus monkey serum.

The presence (in sera of rhesus monkeys) of four antigen-specific molecules with different electrophoretic mobilities apart from conventional immunoglobulins has been recognized. Rhesus monkeys have been primed with rabbit erythrocytes (RRBC) and the antigen-specific molecules in the serum have been fished out by absorption onto RRBC. Antisera have been raised in rabbits against such molecules and analysed by immunoelectrophoresis. The antigen-binding property of the four molecules, which do not resemble conventional immunoglobulins has been confirmed by enzyme immunoelectrophoresis. The possibility of these molecules being products of T lymphocytes in the light of observations reported in recent years is discussed.

Alternative approaches to improve child health in India.

PIP: The existing health care system in India has led to high birth and death rates and an alarming incidence of infant mortality. People in the community should be allowed to become involved in their own health state. It is recognized by health experts that self reliance and self help are important in primary health care. Community health services should integrate preventive, curative, promotive, and rehabilitative health measures with community development activities. These health facilities should be simple and effective in terms of cost, technique, and organization. Mature female workers could be trained as nonmedical primary health aides working in their own communities. Nutrition supplemental programs also would contribute to improved infant health. These simple reorganizational measures should improve the health status at the village level.^ieng

Effect of experimental diabetes and glucagon on cAMP-dependent protein kinase in rat liver.

Liver protein kinase was determined in the absence and presence of cAMP4. Experimental alloxan diabetes resulted in a decrease in total protein kinase (+cAMP) and an increase in the activity ratio (-cAMP) divided by (+cAMP) in liver. Insulin treatment of diabetic rats reversed the observed changes in protein kinase in liver. Glucagon administered in vivo to normal rats caused an increase in the activity ratio and a decrease in total protein kinase activity in liver. The changes are similar to those in diabetes. A decrease in the ratio of insulin to glucagon in diabetes may account for the changes in protein kinase observed.