Promoting family integrated early child development (during first 1000 days) in urban slums of India (fine child 3-3-1000): Study protocol.

AIMS: This project tests a novel, targeted home visitation programme for child development targeted behaviour change during the first 1,000 days for families in Delhi urban slums. BACKGROUND: The first 1,000 days have highest brain development potential and is dependent on the available nutrition, health, social and cognitive stimulus. Over 1.3 million children are born annually in the slums of India and are at risk of limited development potential. The children in urban slums at multiplicity of adversities at family, society and environmental levels. No tools are available for the community health functionaries to support the families to promote child development. DESIGN: This cohort study targets provision of behaviour change interventions targeted at three groups (pregnant women, infants and children in year 2) to document the impact on child development. METHODS: This implementation project delivers nutrition, health and child stimulation integrated services for the families through existing government community health workers and nurses. These workers shall train the families using audio-visual messages in tablets and demonstration kits for practice through quarterly home visits. Data on health, nutrition and child development shall be collected at baseline, midterm and after one year. The data from these participants shall be compared with data from recently delivered women, children aged 13 months and 25 months without intervention to document the impact. DISCUSSION: The successful implementation of the project has potential for future integration of the child development components into the existing programme at scale. The learning from this project shall be useful for India and other developing countries. IMPACT: The first 1,000 days are critical period in human brain development and cognitive function acquisition potential, which is dependent on the available nutrition, health, social and cognitive stimulus. The development potential in children born and living in the slums, who are exposed to various adversities, can be mitigated through appropriate family-level practices with support from the community health workers and Nurses. This study is documenting the feasibility and impact of home visit linked coaching of families for improving child development status during the first 1,000 days in three sums of Delhi, India.

Introduction of New Vaccines in State Immunization Schedule - Delhi's Experience.

Immunization is an established, cost-effective, preventive intervention to improve child survival. To provide protection against vaccine preventable diseases, all countries in the world have an immunization program that offers selected vaccines to the eligible beneficiaries. In India, Expanded Program of Immunization was started in 1978, and then Universal Immunization Program was launched in 1985 with six antigens. This article describes the experience with institutionalization of four state-specific vaccines by Delhi in its immunization schedule to enlarge the ambit of immunization services. It attempts to highlight the state's perspective in terms of the implementation policy, operational strategy adopted and evolution of immunization program in the state over 16 years.

Measles Outbreak in High Risk Areas of Delhi: Epidemiological Investigation and Laboratory Confirmation.

OBJECTIVE: To describe epidemiological and laboratory characteristics of the measles outbreaks recorded in the urban slums of Delhi (designated as high risk areas under the Polio program), from February through July 2014. METHODS: As a part of surveillance and containment measures, an extensive field investigation for measles case search (WHO definition) through 'house to house survey' was conducted by district health teams and field volunteers of National Polio Surveillance Project (NPSP), WHO, Delhi from February through July, 2014. The data generated by the health teams was collected and analyzed. RESULTS: About 1.1 million households in the high risk areas of Delhi were surveyed for epidemiological investigations. A total of 1337 suspected measles cases were reported. The case fatality rate (CFR) was 1.2 %. Statistical analysis showed significant relation between age of the child (measles case) and immunization status. Higher numbers of reported cases were above 5 y and less than 9 mo of age. Measles IgM was detected in 132 cases and D8 strain was isolated on genotyping. CONCLUSIONS: The outbreak was predominantly localized to the high risk areas (urban slums) of the city. Low CFR was reported during the outbreaks. The outbreaks highlight the need to extend the reach of immunization services to urban slums and strengthen measles surveillance including laboratory based surveillance.