O. P. Aggarwal

Breast feeding patterns in an urban resettlement colony of Delhi

Studies on duration and patterns of breast feeding based on recall may lead to a bias about the exact feeding status. The present study was designed to overcome the bias using the ‘current status analysis method’. Mothers of 650 infants from 0 to 12 months of age attending a Health Centre were interviewed about the current feeding patterns of the infants and other socioeconomic variables. Month-wise prevalence of feeding patterns was determined. It was observed that breast feeding was maintained at a high level (more than 90%) throughout infancy while exclusive breast feeding showed a rapid decline. At 1 month, 74% and at 4 months, 46% of infants were exclusively breast-fed. The median duration of exclusive breast feeding was 3.83 months. Mothers with lesser education and lower family income were more likely to exclusively breast feed (p < 0.05). The time interval between birth and first breast feed was 24–48 hours in most (48.9%) of the infants. Majority (76.9%) of the infants received pre-lacteal feeds. Hospital-born infants received their first feed earlier and were less likely to receive pre-lacteal feeds as compared to those bom at home (p < 0.001 ). Thus, the practice of exclusive breast feeding has to be promoted amongst pregnant and lactating mothers by health personnel. Also knowledge regarding infant feeding has to be imparted in schools and colleges.

Long-term nutritional effects of ICDS.

Nutritional status of 1243 children (636 boys and 607 girls) in the age group of 7–13 years was assessed in relation to utilisation of Integrated Child Development Services (ICDS) during their childhood. All the houses in every 10th Anganwadi selected by systematic random sampling were surveyed in the ICDS project, Nand Nagri in East Delhi. Information regarding utilisation of ICDS facilities, sociodemographic details, general awareness etc. was collected by interview technique and anthropometric and clinical examination of every child was done and Anganwadi attendance score was calculated for each child. It was found that most of the children were nonbeneficiaries (59.1%). On univariate analysis Anganwadi attendance score, age, sex of the child and education status of the father showed statistically significant association (p<0.005) with malnutrition. On Multiple logistic regression analysis higher age (OR 1.4155 for grade 1 malnutrition and 1.6913 for grade 4 malnutrition) and being female (OR 1.5214 for Grade 4 malnutrition) remained significant risk factors for development of malnutrition for all grades. Anganwadi attendance score did not show any statistically significant association for decreasing the risk of getting malnourished for any grades of malnutrition in 7–13 years age group. There is special need to take special care for girls as well as to continue the special nutrition care even at an higher age. More in depth studies are needed so as to formulate effective nutritional policies for children.

Perceptions of teachers regarding sex education in National Capital Territory of Delhi.

A cross sectional study was conducted to find out the knowledge and attitudes of school teachers regarding sex education. Information was collected from 476 senior secondary school teachers belonging both to the government and public schools, selected randomly in National Capital Territory of Delhi using pre-tested close ended questionnaires. A majority of school teachers (73%) were in favour of imparting sex education to school children. Regarding contents of sex education, 90% agreed to the inclusion of reproductive anatomy, physiology including menstruation and birth control measures like condoms and oral pills. However, a majority of school teachers did not want sex education to include topics like abortion, premarital sex and masturbation etc. Fourteen years of age was considered to be the most appropriate for imparting sex education by 28.6% of school teachers. School teachers and doctors were considered by 69.4% and 63.6% of the respondents respectively to be the most appropriate persons for providing sex education.

Assessment of availability and working components of school health services in Delhi

A total of 204 schools of different types and geographical zones were surveyed. Principals of the selected schools were interviewed to generate data regarding availability and working components of school health during last one year. School health services were non existent in 56 (27.45%) of the total schools and in another 27%, the visits made by school health team were only three or less during last one year. The situation was much better in NDMC and MCD schools but in Govt. of Delhi group, 40 of the 82 schools did not have any school health services. In most of the schools having some form of school health sevices (govt. or private), all the essential areas of health appraisal viz. anthropometry, general health check-up, vision testing, ENT check-up and dental examination were covered. In 21.62% of such schools no health education activity was done by the school health team. Even in the schools having some form of school health services, referral-follow up system did not seem to be working well. In this situation health check-ups merely satisfy administrative requirements and end up with some data for storage. School health services in Delhi, like other health services, are administered through multiple agencies with somewhat overlapping areas and responsibilities. This has more disadvantages than benefits. An integration of various school health schemes in Delhi with uniform system and standards should be attempted.

Structural and organizational features of school health schemes in Delhi

The magnitude of work and existence of multiple agencies makes the task of providing school health services to ail pupils of the State of Delhi with uniform standards, a very complex job. The present article looks at the matter from the provider’s end, illustrates the structural and organizational features of various school health schemes in Delhi and tries to come out with some suggestions for improvement. This study was based on qualitative research methods.Besides the three major agencies involved i.e. Govt. of Delhi, MCD and NDMC, a host of private and other agencies were also contributing significantly in covering a total of approx. 3700 schools with around 19 lakh children. Organizational and other features of school health services varied widely according to the providing agency.There is a need for integration between various school health schemes in Delhi. Since MCD school health scheme appeared to be better organized, its features can be adopted while developing uniform standards.About the components of services, promotive inputs and follow-up of health appraisals are the areas that need to be strengthened. Proper maintenance of cumulative health records, central documentation and timely dissemination of reports are also equally important and need strengthening.

Process evaluation of pulse polio immunisation in Delhi

The aim of the study was to assess the functional aspects and the staffing at Pulse Polio immunisations posts. Interns and medical students conducted the survey in eighty seven pulse polio immunisation posts scattered all over National Capital Territory of Delhi on 18th January 1997. A lire-tested structured format containing information pertaining to dose utilisation and staffing was filled. Number of children given pulse polio was on an average 459.2 per immunisation post (474.7 rural, 516.35 slums and 435.0 urban). Average number of neonates (below one month) per immunisation post given polio drops was 5.1 (1.1%). The break-up for rural area, slums and urban area was 3.0 (0.63%), 6.7 (1.30%) and 4.9 (1.13%) respectively. By 12 pm, 67.8% and by 2 pm 88.7% of the doses had been administered. Staffing at most of the immunisation posts was adequate for all categories of staff except doctors (0.48 per booth).

Knowledge of fresh medical graduates about immunization: Impact of posting in community medicine

Immunization being the most cost effective health intervention rightly forms an integral part of MCH health activities spectrum. Of late medical colleges in the country are directly involved from the planning to evaluation stages in the immunization programmes in their respective catchment areas.Immunization knowledge of 91 interns during their course of involvement in community work, was tested on the first day and last day of their three months posting in the Community Medicine Department. The study showed positive impact of training in the Department of Community Medicine on the performance levels of interns. This was found mainly attributable to effective interaction of interns with the community in the field and taking independent decisions as per the case requirements.

Study of Old Age Health Problems in a Rural Area of Delhi

The life expectancy of Indian population has increased from 32 years to more than 52 years (Government of India 1982). This has been largely achieved by improved health services for the people, specially for the mothers and children and by control of major communicable diseases. This has brought to the fore-front the social, medical and psychological problems of the aged people. In India, 5.97% of the population is 60 years and above (Census 1971). Not many studies have been done highlighting the health and social problems of this group of population.

Weight pattern of pre-school children in a rural area of Delhi

In a cross-sectional study weights of 542 boys and 547 girls of rural area recorded at different times during 0–4 yr of their age was analysed. The mean birth weight was found to be 2.84 kg. It doubled at the age of 4 months, tripled around 1 1/2 yrand quandrupled around 3 1/2 yr. The average weight gain per month during first two months was nearly 800 gm for next two months about 500 gm per month and about 220 gm per month thereafter till the age of one year. The mean weights up to the age of 5 months were on the curve of 80 percent of 50th percentile of Harvard standard (usually considered as the lower limit of normal) but substantially lower after that age. Individually, 61.38 percent of the weights for age were less than this lower limits of normal. On the other hand, 4.72 percent weights for age were higher than even the upper limits of normal measured by the 50th percentile of Harvard standard. After the age of 2 months, male children weighed more than female children by a small but constant margin of about 250 gm on an average. However, at the age of 314 yr females overtook males. A possible hypothesis explaining this phenomenon is discussed