V. P. Reddaiah

Acute respiratory infections in rural underfives

A prospective study was conducted in rural areas of Ballabgarh Block, Haryana by following 5,078 children for a period of 1 year in 1986. The morbidity due to ARI was 3.67 attacks/child/year with lowest attack rates in summer (2.1 in June), and highest in winter (4.78 in January). The moderate and severe cases constituted 14.7% of all cases. Proportional mortality rate due to ARI was 22.6% in these children. 66.5% of deaths were in infants. But the case fatality was 1.31% and the ARI related mortality was 6.3/1000 children and underfives mortality was 26.0/1000 children.

Control of tetanus neonatorum in a rural area

Experience in the control of tetanus neonatorum (TN) in a rural area is presented. TN was reduced by training of dais, increasing the coverage of tetanus toxoid to pregnant women and distribution of presterilized delivery kits to pregnant ladies for use by birth attendants. The problems of untrained birth attendants, effectiveness of tetanus toxoid coverage and place of delivery are discussed.

Supplementary iron dose in pregnancy anemia prophylaxis

This study was conducted to determine the optimum dose of supplemental iron for prophylaxis against pregnancy anemia. One hundred and ten pregnant women were randomly allocated to three groups: Group A receiving equivalent of 60mg, group B 120 mg and Group C 240 mg, elemental iron as ferrous sulphate daily; the content of folic acid was constant in all the three groups (0·5 mg). These women had at least consumed 90 tablets in 100±10 days. Blood was drawn at the beginning and at the end of the treatment. Fifty percent were anemic (<11g/100 ml). The hemoglobin levels rose similarly in all groups and the differences were statistically not significant. Fifty-six percent had depleted iron stores (serum ferritin value <12 μg/1) at the beginning of the study. Following therapy a statistically significant increase in iron stores was observed in group B and C as compared to group A. The difference between group B and C was not significant. The side effects increased with increasing doses of iron; 32·4%, 40·3% and 72% in group A, B and C respectively. Based on these findings, the authors advocate that optimum dose of iron should be 120 mg instead of 60 mg as is currently being used in the National Nutritional Anemia Prophylaxis Programme. *** DIRECT SUPPORT *** A08BC044 00008

Breast feeding practices in a resettlement colony and it's implications for promotional activities

The mothers of 547 children less than three years of age were interviewed for breastfeeding practices using WHO suggested methodology in a resettlement colony of South Delhi. Only 1.8% of children were never breastfed. Prelacteal feeds were given in 90.9% of infants. More than half received their first breastfeed on 3rd day or later. Among children under three months of age, one third were already receiving top milk. 68.4% of mothers felt that the child should be breastfed for as long as possible. Demand feeding was practised by 95% of the mothers. Most of the mothers did not seek privacy to breastfeed their children. The need to identify desirable and. undesirable infant feeding practices prevalent in an area has been stressed so that appropriate promotional activities can be carried out more effectively.

Knowledge, attitude and practices regarding acute respiratory infections

One hundred and six mothers in a rural area were interviewed to determine as to how they recognise pneumonia in children, what therapies they practice with mild acute respiratory illnesses and pneumonias and the feeding practices they adopt. Most mothers recognised pneumonia by noticing fast respiratory rate and difficulty in breathing. More severe cases were recognised by these signs among a higher percentage of mothers. As regards management of mild ARI episodes, more than half the mothers preferred not to give any treatment or use only home remedies. In pneumonias, a majority of them preferred to consult a qualified doctor. Nearly a third of them were of the opinion that they would take the child to hospital if the disease was severe. Regarding feeding practices, most of them stated that they would continue feeding, fluids and breast feeds. Only 10% desired to stop and another 15% would decrease the amounts.

Factors influencing prevalence of breastfeeding in a resettlement colony of New Delhi

Influence of some family and maternal characteristics on prevalence of breastfeeding was studied in a cross sectional study using WHO suggested methodology. 547 mothers with children less than three years of age were interviewed with the help of a schedule. Age and parity of the mother, sex of the child, length of urban stay, mother’s going for work did not influence the prevalence of breastfeeding. Prevalence was higher among illiterate mothers and mothers belonging to lower socio-economic status. The mothers from higher socio-economic status initiated breastfeeding earlier. More mothers from higher socio-economic status and those with better education thought that supplementation was needed before the child was 4 months old and felt that breastfeeding was needed for less than two years.

Comprehensive rural health services project Ballabgarh : trends in underfive mortality

Mortality data of underfives during 1972–1974 and 1982–1984 in rural area were analysed. Underfives’ deaths were reduced by 35.9%, though the reduction was less in infants (27.2%), than in post infancy underfives (46.9%). The underfives’ death rate came down by 44.1% (from 38.3) to21.4 per 1000 underfives during the decade. The infant deaths show a uniform reduction in different age periods. The female underfives’ deaths are more than male deaths indicating a relative neglect of female children. The only diseases showing reduction in mortality in a substantial manner are tetanus and typhoid. Otherwise there is a general reduction in all causes. Prematurity, acute respiratory infections, diarrhoeal diseases, malnutrition and septicemia constituted 84.7% of deaths in infancy in 1982–84 and acute respiratory infections, malnutrition and diarrheal diseases constituted 69.7% in the 1–4 age group. This study shows how a strong referral service built into medical care with preventive and promotive methods can reduce the underfives mortality.

Antenatal care and perinatal mortality

There were 1092 deliveries in 1982 at CRHS project, Ballabgarh. Of these 643 had antenatal care (study group) and 439 did not receive minimum antenatal care (study group) and 439 did not receive minimum antenatal care (control group). The mean birth weights in study and control groups were 2·84 and 2·71 kg respectively and the difference was statistically not significant. The percentage of births with less than 2500 gm was 19·9 and 28·7 per cent respectively in study and control groups. This difference was highly significant. The still birth rate, first week mortality rate and perinatal mortality rate were 16·8, 12·46 and 29·0 in study group and 63·8, 48·66 and 109·3 in control group giving evidence regarding the benefit of antenatal care in reducing perinatal mortality.

Effectiveness of measles immunization on diarrhea and malnutrition related mortality in 1–4 year olds

All the children between 1–4 year old were followed from January 1985 to December 1987 and all eligible children 9–24 months were given measles vaccine using annual pulse method in November–December 1985 and 86 in the study area. The children in C.R.H.S. Project area were used as controls for comparison. At the end of 2 years and 2 rounds of immunization with measles, significant reductions were observed in 1–4 year old mortality due to diarrhea and malnutrition in the study area in contrast to control area. Using epidemiological data and method of pulse immunization with measles vaccine can bring considerable benefit to this age group.

Epidemiology of measles in a rural community

In a rural population 15,680 children below 10 years of age were kept under surveillance by the multi purpose workers for one year (1984). Measles developed in 436. The maximum incidence occurred between 1 and 4 years of age, but infants 6 months and above were also affected. The first half of the year (January to June) saw the most number of cases. Complications developed in 88 children. The most frequent was diarrhea followed by bronchopneumonia. There were seven deaths.