Nutritional profiles of adolescents in a rural community of Hooghly district in West Bengal.

This community based study was carried out in Haripal Block of Hooghly district in West Bengal in 2005 to assess the nutritional status of the unmarried adolescents and 204 adolescents were studied. The BMI for age and height for age < 5th percentile were used as criteria for thinness and stunting respectively. The overall prevalence of thinness and stunting were 24.48% and 52.45%, thinness was more common among the boys. The other nutritional deficiency disorders were pallor (12.25%), conjunctival xerosis (9.30%), Vitamin B complex deficiency (1.47%), goitre (0.98%) and dental caries (11.76%). An indication of chronic energy deficiency in the study area was observed.

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.

Action for tackling malnutrition: growth monitoring or surveillance?

Malnutrition is an important Public Health problem globally as well as in India. Mortality is a multi-causal phenomenon in which malnutrition is but one factor directly or indirectly contributing 55% mortality of children under-five years of age. Authors observed higher prevalence of severe degree of Malnutrition in the underserved section of population with specific reference to girl child, under 3 years of age, where there were large number of children in the family, repeated infections and Measles. Growth monitoring Services in the ICDS scheme meant only weight recording and was not at all satisfactory. Even the majority of the Anganwadi workers (AWW) stated that it meant monthly weight recording of children while only few knew it is in addition plotting these on growth charts and advising mothers if growth was not proper. Around 60% of caregivers did not know about growth monitoring. The concept of growth monitoring should be changed to Growth surveillance to emphasize more on the action components of it.

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.

Dental fluorosis in bovine of Nayagarh district of Orissa.

Chronic fluoride toxicity in the form of dental fluorosis was observed in cattle from nine (9) villages under two (2) blocks of Nayagarh district of Orissa. Out of 1117 cattle, 221 (18.09%) showed the signs of dental fluorosis. In all affected villages, the prevalence of dental fluorosis in calves (< 1 year age) was greater than adults. There was significant difference in prevalence in respect to age. The commonly observed signs of dental fluorosis were brown discoloration, mottling, attrition or uneven wearing of teeth with or without pitting. None of the affected animals showed characteristic signs of osteofluorosis. The mean serum and urine fluoride concentration of affected animals were significantly (P < 0.05) higher than those of control animals. Fluoride levels (mean) of ground water and surface water in two blocks were 1.30 +/- 0.16 ppm, 0. 66 +/- 0.08 ppm and 1.12 +/- 0.19 ppm, 0. 48 +/- 0.05 ppm respectively. The fluoride content of grass samples of affected and control (non-endemic) area was comparable. There was a highly positive correlation (r = + 0.664) between prevalence of dental fluorosis and fluoride content of ground water. It was concluded that fluoride intake through the water especially ground water contributed to the development of fluorosis in cattle.

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.

Epidemiology of undernutrition.

OBJECTIVE: The present study was undertaken to find out the magnitude of the problem of under nutrition among the children under 5 years of age and also to identify the important factors influencing the nutritional status of the children. METHODS: 30 cluster sampling technique had been applied in the study. A total of 600 children below five years of age were covered. Twenty under five children from each cluster were chosen for the study which was carried out during January to February '97. As per IAP criteria a total of 60.29% children were undernourished and 3.92% were severely undernourished. According to NCHS standard 46.57% & 6.86% children had weight below-2SD and -3SD respectively. RESULTS: A statistically significant relationship was found between the different age groups and nutritional status of under 5 children. Severe degree of malnutrition had highest prevalence under two years of age. The influence of variables like age, sex, religion, literacy status of parents and morbidity of the children were significantly associated with malnutrition. CONCLUSION: Practice of exclusive breast feeding, introduction of timely complementary feeding, education for maintaining personal hygiene, proper implementation of UIP immunization, periodic deworming, standard case management of diarrhoea and ARI as well as continuation of feeding during illness may reduce malnutrition of under-five children.

Reproductive health needs and care seeking behaviour of pavement dwellers of Calcutta.

An unabated growth of street dwellers in the city of Calcutta is reported to be due to twin reasons like, migration of rural poor people as well as uncontrolled fertility among these poor settlers of the city. A community-based study on reproductive health, fertility and related care seeking behaviour was studied among a sample of women of child bearing age living on streets of Calcutta. Besides, the quite common conditions like leucorrhoea (28.5%), menstrual irregularities (12.3%), infertility (2.5%) and STDs (1.3%) were also reported. But most of these illnesses (three-fourth) were uncared for, and the remaining one-fourth sought treatment from govemment institutions, private agencies or even from untrained practitioners (quacks). The reproductive behaviour of street dwelling women was characterised by early marriage, teenage pregnancies, and scarce use of contraceptives (32%) as well as frequent abortions (2.8%). Very few pregnant women received adequate antenatal care (3.8%). Coverage of tetanus toxoid immunisation (68.5%) and proper iron and folic acid supplementation (16.7%) were also poor. Whereas, antenatal care was received mostly from government health institutions (71%), home delivery (ie, on street) was a common practice and conducted mostly by untrained birth attendants (51.8%).

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.

A rapid assessment of anaemia in pregnancy in West Bengal with special reference to care seeking behaviour of mothers.

A cross-sectional study was conducted among the pregnant women in three administrative divisions of West Bengal to undertake a rapid assessment about the magnitude of the problem of anaemia in pregnancy and also to study care seeking behaviour for the same. The findings revealed that the occurrence of anaemia in these three divisions were very high to the extent of 86.39% and popularly known as 'Raktasunyata" or 'Raktalpata' to the common people. As per WHO guidelines (< 40% prevalence) it could be considered as public health problem of very high magnitude. Caregivers prescribed iron supplementation only in 70% of registered pregnant women when 100% coverage of pregnant women with IFA tablet is our national goal. Amongst this group 72.2% were partially consuming these tablets. Main reason for irregular or partial consumption was inability to purchase iron tablets (52.63%). Around 16% mothers were taking rest for 2 hours at daytime during pregnancy. Most important reasons for not consuming iron tablets were that iron was prescribed on the day of study (43.18%) and iron was not prescribed even though mothers were registered (36.23%). Focus group discussion highlighted some factors regarding improvement of the situation.

Nutritional status of pavement dweller children of Calcutta City.

Pavement dwelling is likely to aggravate malnutrition among its residents due to extreme poverty, lack of dwelling and access to food and their exposure to polluted environment. Paucity of information about nutritional status of street children compared to that among urban slum dwellers, squatters or rural/tribal population is quite evident. The present study revealed the magnitude of Protein Energy Malnutrition (PEM) and few associated factors among a sample of 435 underfives belonging to pavement dweller families and selected randomly from clusters of such families, from each of the five geographical sectors of Calcutta city. Overall prevalence of PEM was found almost similar (about 70%) to that among other 'urban poor' children viz. slum dwellers etc., but about 16% of them were found severely undernourished (Grade III & V of IAP classification of PEM). About 35% and 70% of street dweller children had wasting and stunting respectively. Severe PEM (Grade III & IV) was more prevalent among 12-23 months old, girl child, those belonged to illiterate parents and housewife mothers rather than wage earners. It also did increase with increase of birth rate of decrease of birth interval.

Sentinel surveillance on poliomyelitis and neonatal tetanus: a report.

A 5 year sentinel surveillance (1989-93) of paralytic poliomyelitis and neonatal tetanus was undertaken at a rural Medical College Hospital at Burdwan, West Bengal. Poliomyelitis incidence showed an overall declining trend, which corroborated with the increased OPV coverage over the years. Incidence was more in males than females. Male:female ratio varied between 2.31:1 to 1.2:1. From 1989 to 1992, age-shift in poliomyelitis was observed when more cases were occurring above 1 year subjects. Cases were reported to be high during the months June to September every year. Incidence of neonatal tetanus (NNT) also showed a declining trend during the 5 year study period. A male preponderance was observed. NNT cases were more prevalent during the months between August and November. In an attempt for eradication of paralytic poliomyelitis and elimination of NNT, containment and other public health measures were undertaken a part of surveillance activities. The obstacles encountered in the surveillance system, as well as lacunae identified in undertaking appropriate health measures was discussed.

A report of diphtheria surveillance from a rural medical college hospital.

A 5-year sentinel surveillance of diphtheria from 1989 to 1993 was undertaken at a rural medical college hospital. No significant change in the number of diphtheria cases was observed in spite of sustained high level of diphtheria, pertussis, tetanus vaccine-3 doses (DPT3) coverage. Most of the diphtheria cases occurred during July to November. Age distribution of diphtheria cases showed that more than 75% occurred above 2 years age (except in 1989) and around 65% cases above 3 years age. The age shift in diphtheria signified success of primary diphtheria immunisation, as well as indicated the lack of coverage with booster doses at appropriate ages. Because of high coverage with primary diphtheria immunisation there was decrease in circulating toxigenic C diphtheriae resulting in less natural boosting of antibody titre. Thus, in absence of booster immunisation, the older children and adults were more vulnerable to diphtheria. The findings of the study justified the need of emphasising importance of booster diphtheria immunisation at appropriate ages for effective control of diphtheria.