Health and nutritional status of boys aged 6 to 12 years in a children observation home.

One hundred and ninety two boys in the age group 6 to 12 years, living in a Children Observation Home in Delhi were studied for their nutritional status and morbidity profile. Body Mass Index (BMI), an age-independent index was used to grade the nutritional status according to which, 36.7% of the boys were found to be malnourished. Signs of specific nutritional deficiencies were observed in 13.5% of the boys. Morbidity in some form or the other was present in 148 (60%) boys. Skin disease was the commonest morbidity (31.7%), followed by diseases of the oral cavity (16.1%), acute respiratory infections (8.6%) and diseases of the ear (9.9%). Need for health promotional activities is stressed to reduce the morbidity and improve the health status of these children.

PIP: The government of India is responsible for caring for India's destitute children. Findings are reported from the July 1992 study of nutritional status and morbidity among 192 boys aged 6-12 years living in a Children Observation Home in North West Delhi. The facility is run by the state's Department of Social Welfare and is comprised of classrooms, a dining room, a kitchen, a medical care unit, and a playground. The children sleep in dormitories and each child is entitled to a balanced diet of cereals, pulses, and vegetables. Welfare officers and attendants are employed to care for the children. In reality, the facilities tend to be inadequate and unhygienic. Using body mass index (BMI) to grade the boys' nutritional status, 36.7% were found to be malnourished, 16.7% severely. Signs of specific nutritional deficiencies were seen in 13.5% and some type of morbidity was observed in 60%. Skin disease was the most common morbidity, with 31.7% afflicted, followed by diseases of the oral cavity (16.1%), acute respiratory infections (8.6%), and diseases of the ear (9.9%). Health promotion activities are needed to improve the health status of this population.

National Iodine Deficiency Disorders Control Programme in India.

Iodine Deficiency Disorders are one of the biggest worldwide public health problem of today. Their effect is hidden and profound affecting the quality of human life. An attempt has been made to describe the various aspects of the National Iodine Deficiency Disorders control Programme (NIDDCP) being implemented in the country. The paper also focuses about the problems associated in implementing this national programme.

PIP: In India, 167 million people are at risk of iodine deficiency disorders (IDDs). 54.4 million people have a goiter. About 8.8 million people have IDD-related mental/motor handicaps. IDD is a problem in every state and union territory. It is a major public health problem in 211 of the 245 districts surveyed. Even though IDDs cannot be cured, they can be easily prevented. Daily consumption of iodized/iodated salt is the most effective and inexpensive way to prevent IDD. In 1962, the government of India implemented the National Goitre Control Programme, now called the National Iodine Deficiency Disorders Control Programme (NIDDCP). In 1982, the government made a policy decision to iodate all edible salt in India by 1992. During 1994-1995, India's private sector produced 34 lakh metric tons of iodated salt per year. The government expects iodated salt production to increase to 50 lakh metric tons in the near future. Iodated salt is transported on the railways under a priority category that is second only to defense. In 19 states and 6 union territories, the sale of noniodated salt has been completely banned. The remaining state governments have been urged to ban the sale of noniodated salt and to include iodated salt under the public distribution system. Each State Health Directorate has been advised to set up an IDD Control Cell. The biochemistry division of the National Institute of Communicable Diseases has a national reference laboratory for monitoring of IDD, and it also trains medical and paramedical personnel. District health officers in all endemic states have test kits to conduct on-the-spot qualitative testing to ensure quality control of iodated salt at the consumption level. NIDDCP provides IDD surveys, health education, and publicity campaigns. Its information, education, and campaign activities include video films, posters, and radio/TV spots.

Dr. B. C. Dasgupta Memorial Oration. Priorities, issues, inter-state variations and challenges.

India spends only 1.5% of GDP on health as against the recommended 5% by W.H.O. for equity and universal coverage. States have a high share (89%) of funding their health care activities as against 9% by centre and 2.8% by U. T.'s. Increasing proportion of health expenditure on salaries (60-90%) and a markedly reduced (29%-5%) proportion on non-salary components is reflected in low-level of utilization of health services. Committed involvement by others in selected crucial areas is lacking. Health financing seems to be directed towards the urban sector with maximum outlays to curative care. There are high inter-state variations in health expenditure and health status. Higher share of SDF on public health does not guarantee a better health status. Health services sector urgently & legitimately needs additional resources. There is need to set up technical committee and research cells to sensitise policy makers, academicians and others and to steer and guide research. Health Financing and Management must be considered together to address issues of equity, efficiency and effectiveness in health care services.

Counselling services for HIV: need of the hour.

PIP: HIV infection and AIDS have only begun to hit India. While prevention is paramount in the fight against HIV infection, counseling services must also be made available to individuals who are already infected with HIV. Counseling affords direct interpersonal contact and the opportunity to pose questions of health personnel. This process helps infected and/or sick individuals to better absorb information and cope with all the aspects of HIV infection. Data suggest that STD infection rates have declined in some African countries where counseling programs have been put into place. Given these merits of counseling, the government of India should develop and implement appropriate policy guidelines, while providing the necessary facilities and manpower to meet patient needs.^ieng

Logistics management in Universal Immunisation Programme.

PIP: The review of the National Immunization Programme of India in 1989 focused attention to the issue of storage and distribution of vaccines. Cold-chain equipment such as walk-in-coolers (WICs), deep freezers, ice-lined refrigerators (ILRs), and vaccine carriers proliferated after the introduction of the universal immunization program (UIP) but the available units fell short of the official targets in 1988, especially ILRs (7500 proposed and 2876 available) and vaccine carriers (250,000 proposed and 35,500 available). Some states had over 6 months of supplies of vaccines whose management posed problems of losing potency: oral polio virus (OPV) potency was acceptable in 63% of stock in 1988. Syringes, needles, stoves, pressure-cooker sterilizers, dial thermometers, and refrigerator repair kits were in short supply especially at the primary health care (PHC) level. Only 1/3 of subcenters had sterilizers and 58% had vaccines carriers. Logistics management on the state level required provision of vaccines based on previous use and eligible population with even distribution throughout the year. On the district level WICs were needed for every district with 1.5 million inhabitants. Recording of vaccine requirement, utilization, and storage would aid target allocations and avoid wastage. On the institutional and PHC level an ILR and a transporting vehicle was needed. The number of women and children eligible for immunization had to be calculated based on real population figures. Cold-chain capacity of 30,000-40,000 vials was required for a district as well as about 500 reusable syringes and needles a year along with vaccination cards exceeding the number of women and children by 10% for recordkeeping at the PHC center.^ieng

Use of reported immunisation performance data in monitoring UIP.

Health information system is not well developed in most parts of the country. We propose to use locally available data on immunization performance so as to make them more informative and useful for implementing and supervisory personnel. Reclassification of data according to estimated number of eligibles, monthly performance and age of children immunized can given impressions about coverage, sustainability of services and their quality. Similarly, area and institution-wise data can be used to identify places needing more attention. Active use of available data will help in improvement of vaccine coverage and control of target diseases.

PIP: Immunization performance data (1985-89) from a district health office in a state of India were analyzed to demonstrate various means to make the data more useful in monitoring the universal immunization program (UIP). The proposed system was community based. Ideally it should be computerized. Considerable differences in immunization coverage existed between the eligible population and actual number immunized. It was proposed that sustainability of immunization performance by evaluated by having district authorities review reports monthly and quarterly. In this district, immunization activities increased in the December-March period for al vaccines. It is pointed out that the best results would be obtained when sustained quality activities are provided year round. The UIP should redesign forms to report vaccines given to infants only. Narrow class intervals (e.g., 6 months for BCG, DPT3, and OPV3) would be most helpful. In the district, 82.1-99.7% of immunized infants received a vaccine in the 1st year. UIP monitoring should separate data by area to see where improvements are needed. Immunization coverage was greater in urban areas of the district than at rural primary health centers (PHC) and subcenters. It is also suggested that data from each PHC be separated out to determine the quality of coverage/vaccine. For example, a plus sign equaled 80% coverage. Using data to constantly monitor immunization activities will improve vaccine coverage and control target diseases.

Absenteeism in leprosy patients in a rural area in Tamil Nadu.

Of the 3382 leprosy patients taking treatment in Hemerijckx Rural Centre Area, 150 randomly selected patients, who were irregular for treatment, were matched with 150 patients who were regular for treatment, by age, sex and type of disease. The characteristics and the reasons for regularity/irregularity in treatment of these 300 patients were studied. There were more Lepromatous patients (20%) among regulars. A greater proportion of irregulars belonged to backward (54%) and scheduled castes (35%). The proportion of irregulars were more (32%) in the initial phase of the disease. There were more irregular patients among the illiterate group (61%). The knowledge of the irregular patients about early sign, causation, spread, curability and duration of treatment were found to be lacking. The clinic timing was unsuitable for 33% of irregular patients. 23% of irregulars experienced some intolerance to DDS. When 94% of regulars attended clinic in order that they may be 'cured', 63% of irregulars stayed away because of 'work'.