CHILD TO CHILD PROGRAMME

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Title
CHILD TO CHILD PROGRAMME
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The supplement has
been produced for use by
the mass media. The
following pages may be
used as an article with the
support of the illustrations
provided. Further material
may be obtained from the
IYC Secretariat or the
International Labour
Office.
The contents of the
supplement are elaborated
further in a Discussion
Paper - a compilation of
background material of a
technical nature - prepared
for the IYC Secretariat by
the International Labour
Office.

Supplements published in previous issues of Ideas Forum:

N° 1. Photo supplement (I.F. N° 1)
N° 2. Theme N° 1

N° 12. Theme N° 8

Handicapped Children
(I.F. N° 5)

Nutrition (I.F. N° 2)
N° 3. Do-it-yourself exhibits

N° 13. Theme N° 9

(I.F. N° 2)

Children and Books
(I.F. N° 5)

N° 4. Theme N° 2

Development Education
(I.F. N° 3)

N»14. Theme N° 10

Children, Violence and
the Mass Media (I.F. N° 5)

N° 5. Theme N° 3

Refugee Children (I.F. N° 3)

N° 15 CHILD-to-child Programme

N° 6. Theme N° 4

Water and Sanitation
(I.F. N°4)

(I.F. N° 6)
N° 16. Theme N° 11

Children of Migrant Workers
(I.F. N° 6)

N° 7. Theme N° 5

Children and Health
(I.F. N° 4)

N° 17. Theme N« 12

Children and Accidents
(I.F. N° 6)

N" 8. Theme N° 6

Children and Drugs
(I.F. N° 4)
N“ 9. The Child in the World
of Tomorrow (I.F. N° 4)
N° 10. Representing children:

N“ 18. Theme N" 13

Changing Family Patterns
(I.F. N° 6)
N° 19. Theme N” 14

Parent Education (I.F. N° 6)

International Perspectives
(I.F. N° 5)
N“ 11. Theme N° 7

Adoption (I.F. N° 5)

(?)
IYC/IDEAS FORUM SUPPLEMENT/21

The Paper is intended as
a guide to National IYC
Commissions and NonGovernmental Organis­
ations to assist them in
developing appropriate
action plans.
It is not for mass distri­
bution but should serve as
a reference document
available on loan from IYC
Commissions to justified
users.
Opinions expressed in
this supplement are in no
way to be taken as an
official UN statement.

2

Exploited children: a stump
The facts on child labour
throughout the world re­
leased by the International
Labour Office at the begin­
ning of the International
Year of the Child, 1979,
caine as a shock to many.
More than 52 million work­
ing children was too large a
figure to ignore.
And it may turn out to be
too small. A report to be
published this year by the
1LO, summarizing avail­
able information
and
special research carried out
in ten countries of Africa,
Latin America, Asia and
Southern Europe, shows
how easily these figures can
be understated. In many
places, workers under 15 or
who are still attending
school are not included in
the labour force.
In others, it is the occa­
sional and agricultural
workers under age who are
left out. And since child
labour is usually clandes­
tine, all parties are reluc­
tant to reveal its existence.
This is why in a country like
Italy, newspaper calcu­
lations of the number of
children working can be
five or ten times the official
estimates. In other coun­
tries there are no official es­
timates.
It is generally accepted that
the scourge of child labour
is disappearing in the indus­
trially developed countries,
where its full horror was felt
mainly in the mines and
textile mills of the
nineteenth century. In the
less developed countries,
IYC Photo No. 142

especially in Asia, according to the ILO report, it is
still alive and flourishing. A
suney carried out a few
years ago in Portugal
among workers of the en­
gineering industry showed
that over 40 per cent of the
women and over 30 per cent
of the men had started to
work between the ages of 11
and 13. In India, a survey of
15-year-old workers showed
that 24.7 per cent had
started to work between the
ages of 6 and 9.
The Minimum Age Con­
vention adopted by the ILO
in 1973 calls for national
policies aimed at “the
effective abolition of child
labour”. It establishes
different levels for ad­
mission to light work, work
not dangerous to health,
safety or morals, and hazar­
dous occupations, and en­
visages a gradual raising of
minimum age limits. An ac­
companying recommen­
dation advocates a series of
economic
and
social
measures to ensure a level
of family living standards
and income which would
make child labour un­
necessary.
The new' ILO survey,
undertaken as a contri­
bution to the International
Year of the Child, sets out
to give an overview of the
many shapes exploitation
of children still takes
around the world, and to
propose practical ways in
which this can be prevented
and their conditions of
work can be improved.
IYC Photo No. 143

The extraordinary increase in
the population of developing
countries is reflected in addi­
tional pressures put by chil­
dren on the labour market.
By and large, both in develop­
ing and developed countries,
agriculture is where most
child workers are to be found.
To many rural societies it
seems quite natural that a
child, particularly if it docs
not have the alternative of go­
ing to school, should help the
rest of the family earn a living.
This involves a boy or a girl in
all aspects of agricultural
work, although they are usu­
ally (not always) spared its
more strenuous aspects.
They begin by helping
parents—looking after ani­
mals, collecting firewood and
carrying water, weeding.
spreading fertilisers, watch­
ing crops. Later they share in
heavy adult work—plough­
ing, sowing, harvesting. In
many places, coffee-picking is
reserved fqr women and their
children.
And when the father migrates
as a temporary crophand, the
family usually stays home to
do all the work.
But as more and more
peasant families come in to
swell the urban population,
child labour is on the increase
in the towns. City streets offer
a child many chances to sup­
plement the family income:
shoeshining, looking after
parked cars, carrying loads,
loading and unloading trucks
and carts, hawking news­
papers, food, sweets, flowers.
lottery tickets and other
wares, collecting refuse. Some
minors drift into drug traffic
or prostitution; many child
beggars are exploited and
even maimed or disfigured
for begging purposes by their
parents.
Services and small shops also
absorb
a
considerable
amount of child labour. The
little labourers sell, run er­
rands, pack goods, wash cars,
do repair and cleaning work.
They are gasoline station at­
tendants, waiters in bars and
restaurants, bellboys, hair­
dressers. Many girls engage in
paid domestic work.
Children are fewer but no less
active in industry and small
enterprises: They usually
work at packing, sticking and
labelling, but in some industries-bakeries, match factor­
ies, food, textile and leather
industries, manufacturing of
shoes, toys, fireworks-they
also take part in the produc­
tion process, particularly as
home labourers. In Southern
and South Eastern Asia they
are employed in cigarette and

puton to lighter work, such as
cleaning.

/ / In the light of ILO
(/) Q) standards, the Inter­
national Year of the
Child should enable govern­
ments and employers' and
workers’ organisations the
world over to assess the situ­
ation of children at work and
also give the competent nati­
onal bodies and the ILO an op­
portunity and the means to
strengthen their action pro­
grammes for children. For that
purpose the ILO urgently ap­
peals to them to apply its stan­
dards on the minimum age for
admission to employment and
the conditions of employment
of children. A clion should he
based on the following prin­
ciples: (a) a child is not a “ small
adult" but a person entitled to
self-fulfilment through learning
and play so that his adult life is
not jeopardised by his having
had to work at an early age; (b)
governments should, in co­
operation with al! the national
organisations concerned, take
all necessary social and legisla­
tive action for the progressive
elimination of child labour; (c)
pending
the
elimin­
ation of child labour,
_
it must be regulated
\)
and humanised.
S

Schooling
a key factor

glass factories, and in many
countries from Africa to Asia
they are an important source
of labour for traditional
carpet-weaving.
They are also found in the
construction industry, where
they are usually (not always)

Sex bias frequently deter­
mines the kind of work boys
and girls are allowed to do.
Boys are often considered
physically stronger or more *
)
mobile and employed ac­
cordingly. They are also
favoured by the attitude
towards the need for edu­
cation. In rural areas they
make up the majority of
school children because girls
normally stay home to help or
take on seasonal salaried
work.
In some countries, the main
cause for child labour is in­
deed the lack of schools, or,
as a Nigerian researcher
says, “under-achievement in
school”. Work is considered
“the best substitute in case of
inability to acquire formal
education, a character-build- a;.
ing experience”. The problem is most acute in rural
areas, where schools are few
and far between, and where
curricula are not always at­
tuned to the future needs of a
rural worker.
The ideal of universal com­
pulsory education, even at the
primary level, is for many just
a dream. Figures from one
developing country where
compulsory education is writ­
ten into the Constitution
(Mexico) are revealing. Of
more than 16 million school­
age children the country had
in 1978,1.5 million, according

IYC Photo No. 144

IYC Photo No 145

From the “Declaration by the
Director-General of the ILO concerning
the International Year of the Child”,
endorsed by the ILO Governing Body at
its 209th session, February-March 1979.

3

that will never grow
to a researcher, had no access
at all to education. Between
1965 and 1970, 70 per cent of
the children who did have ac­
cess to education were drop­
outs before the sixth grade. Of
those who stayed until sixth
grade, between 20 and 30 per
cent failed their pass exami­
nation. And of those who
passed, only one-half went on
to high school...
The problem of lack of edu­
cational facilities is com­
pounded by mobility of the
family in the case of migrant
agricultural workers, and is
almost insoluble with no­
madic populations.
Beyond the fact that school is
often not free, reasons for
non-attendance and drop­
ping-out (again, affecting
more girls than boys) can also
be traced to the parents’ own
attitude. In many cases the
1LO survey shows, urban chil­
dren between the ages of six
and nine are sent to school
more to keep them away than
to give them an education. Af­
ter that age, being more ma­
ture, stronger and more dis­
ciplined, they can be brought
home to work or sent to earn
their living. In rural areas, the
pull of economic need may be
too strong to keep them at
their schooldesks.
Work is not necessarily a bad
thing for children, depend­
ing on what is understood
by “work”. Contributing
towards the sustenance of the
family, as they do in many so­
cieties, they slowly imbibe the
culture of th.eir community.
This type of work is part of the
process of growing up and
IYC Photo No. 146

maturing, and has positive
value provided children are
treated humanely. Light, in­
teresting and socially useful
tasks can help integrate the
child into the social life of its
group.
But in the mines and factories
of the nineteenth century, a
new type of child labour
evolved where children were
made to work against their
will and for the profit of
others. This scourge has per­
sisted into our times.
Industrial work often places
them in unhealthy^urroundings, in locales which‘are pol­
luted or insufficiently lit and
ventilated. Street work and
agriculture force them to
spend most of the day in the
open, often without adequate
protection, in uncomfortable
positions, in contact with
toxic substances or lifting
heavy weights. They earn less
than adults, and the daily or
weekly duration of work is
frequently excessive for their
age.
Since child labour is usually
associated with poverty.
working children already
start with a nutritional handi­
cap which is made worse by
strenuous effort—a diet of
beans or maize and coffee
may constitute their only fuel
for a long day. Vitamin and
protein deficiencies, anaemia.
bronchitis and TB are fre­
quent resulls-and children
have to go on working while
they are ill.
Their physical development
can thus be slowed down. In
Japan, for instance, women
who had started to work be-

Z" Z Each Member for
A
which this convention
is in force undertakes
to pursue a national policy de­
signed to ensure the effective
abolition of child labour and
to raise progressively the
minimum age for admission
to employment or work to a
level consistent with the fullest
physical and mental
development ofyoung W y
persons.
' '
International Labour Convention 138,
concerning Minimum Age for Admission
to Employment, Article 1

fore 14 were found to be. on
average, 4 centimetres shorter
than girls who were able to
study for a longer spell before
they started to work at 18.
Mental development is also
affeetdd. Children who have
to work like adults have little
time left for playing or for
healthy exercices. They have
no time or energy left for
school. As one Italian resear­
cher says, “they cannot give
free rein to their freedom to
be irresponsible. They cannot
afford to be hesitant or ab­
sent-minded. Any show of
childish behaviour is discou­
raged by employers and adult
workmates. The child soon
identifies with their censure
without understanding its
proper social role, that of op­
timizing profit”. This con­
stant pressure not only can
disrupt family and social life,
but can have a deadly effect
on the nervous system.
Street work imposes fewer
constraints, but exposes chil­
dren to many dangers, includ­
ing (especially girls) physical
assault. They will acquire dis­
taste for regular employment
and tend to drift into the army
of casual workers. Their
physique is undermined by
fatigue, exposure to bad
weather, irregularity of sleep
and meals, smoking, drinking
and diseases. “They may
develop a liking for the petty
excitements of the street and
eventually betemptedintocriminal behaviour,” says a
sociologist. “They will defy
authority without growing
stronger.”

The worst
investment
It is often said that the best
training is work itself, and
that children who have
started working early in their
lives have also had an early
start in acquiring useful skills.
But this is seldom true. Chil­
dren who cannot officially be

admitted to be workers or ap­
Convention No. 138
prentices usually have to slog
away several years at low-pro- j (1973)
ductivity occupations that
Concerning Minimum Age
only “train” them for a mar­
for Admission to Employment
ginal existence.
This is probably the final ar­
gument against child labour
Ratified by the following
“of the second kind”: the vi­
countries
ciousway in which it can stunt
(in alphabetical order)
growth. “If the situation of a
child apprentice who is train­
ing for a real job can be hard j Costa Rica
Cuba
enough”, say 1LO resear­
Finland
chers, “the meagre trainingor
complete lack of training of Germany, Fed. Rep. of
Ireland
children in the informal sec­
Kenya
tor is even worse, because it
Libyan Arab Jamahiriya
leads them to a future as un­
Luxembourg
employed, underemployed
Netherlands
or-in the best of casesNiger
unskilled workers”.
Driven to work prematurely
Poland
by poverty, such children are
Romania
forever lost to the effort of
Spain
building a better world. Child
Uruguay
labour is, in this sense, the I Zambia
worst possible investment a
society can make in its own
future. Obviously many chil­
dren are driven to work by the The way out
sheer weight of physical need;
they would have to go hungry, Children, the ILO stresses,
or hungrier, instead.
are not“adults in miniature”.
But one of the facts clearly I Parents and society must
brought out by the 1LO sur­ realise that strenuous work
vey is that economic need is irremediably impairs their
not the only reason for child health, their physical integrity
labour, and that social factors and their future, and com­
are even more to blame. promises the future of society.
A government survey of the What can be done to stop: it?
reasons for it given by Thai What is the ILO blueprint for
families, for instance, showed preventing work below a
that “poverty” accounted for minimum age-and for pro­
less than 25 per cent. The tecting children who work
parents’ need for manual legally?
help, and their wish to see
their children work, were far o Enforcing ILO Conven­
more determining.
tions and national legislation
against Child Labour. The
ILO’s long-term goal, set out
in several international stan­
dards most recently in Con­
vention No. 138 and Recom­
mendation No. 146 (1973). is
the progressive abolition of
child labour. The attainment
of this goal can be paralyzed
by the weight of poverty and
traditional attitudes. “True
respect of the law.” says the
ILO, “would imply a
thorough protection of chil­
dren against exploitation and.
at the same time, a protection
of the employment and in­
comes of adults.” This means
that vast social policy pro­
grammes would have to be
launched in countries which
decide to raise the age of ad­
mission to employment. Such
policies should include social
assistance to families, exten­
sion of education and the set­
ting of the essential budgetary
priorities. Existing minimum
age legislation should also be
extended progressively to all
sectors of economic activity.

4

• Protection of children at
work. A degree of realism is
necessary. While the law can­
not contradict itself by pro­
hibiting child labour and con­
templating measures to make
it more humane, social policy
can certainly act to present ex­
ploitation. Measures to be
taken will vary according to
traditions and type of work in
each country. They could
consist, for instance, of sub­
sidies or fiscal incentives for
employers to improve the
labour conditions of working
children. They could also in­
clude a form of collective bar­
gaining where the children
themselves and their parents
would take part in discussions
about improvements.
In countries where children
under 14 are legally entitled to
work, special measures to
protect them should be taken,
including reduced working
hours, equal pay for equal
work, a bar on lifting weights,
and vocational training.

work may legally be said not
to exist, there is no organised
force to keep them away from
work. Unions have a very im­
portant part to play in any
campaign to abolish child
labour. They should be made
aware that child labour is not
only intrinsically wrong, but
also undesirable from the
union point of view. Each
child that works takes the
place of an adult and helps to
keep down salaries.

• Promoting public aware­
ness. Information and media
campaigns on the destructive
effects of child labour, and on
its alternatives, should be
organised with the partici­
pation
of governments,
parents, working children,
employers, social workers
and trade unions.

• Social change. The basic
cause of child labour is
poverty, and remedies should
strike at its root. Exploitation
of children is not an isolated
• Encouraging school at­ phenomenon; it takes place
tendance by extending and within a given social context
improving educational facili­ which helps to bring it about.
ties. School should cease be­ The economy, social organis­
ing an unattainable luxury for ation and traditional attitudes
poor or rural boys and girls. all conspire to keep it going.
And they should find in Abolition of child labour is a
schools not only an instru­ long-term objective which
ment of basic general learn­ will not be achieved indepen­
ing but an introduction to the dently of social change. The
ILO has spelled out the prin­
practical needs of adult life.
ciples of such change by de­
• Appealing to trade uni­ claring that the satisfaction of
ons. Since children are not basic human needs should be
unionized, since they have no the aim and the instrument of
bargaining power and their economic growth.

IYC Graphs

be obtained by National Commissions
A printing negative of these graphs can des Nations, CH-1211 Geneva 10.
from the IYC Secretariat (Europe), Palais
Tel. 36 60 11, ext. 4461

Children and work — 1979

Unpaid Family Workers1

Total active
(millions)

(millions)

Percent of
total active

41,2

World

52,0

More developed regions

1,3

Less developed regions

50,7

South Asia

29,0

23,2

9,1

6,4

■l-

0.5

■■0

40,6

'■
East Asia
•

Africa

Latin America

3,1

Europe

0,7

USSR

-

Northern America

0,3

Oceania

0,1

■Illi’6
■Ji ”
Bill 50
w

1 Includes workers on own account. Source: I LO, Bureau of Statistics.

9,2

2,0

0,4

-

-

10

-

0,1
IYC Graph No. 14

Today's children — tomorrow's workers (Projections 1979 and 2000)

IYC Graph No. 1 5

Source; ILO, Bureau of Statistics.

5

IYC

Illustrations

A printing negative of these illustrations can be obtained by National Commissions
from the IYC Secretariat (Europe), Palais des Nations, CH-1211 Geneva 10. Tel.: 34 60 11, ext. 4461

The consequences of children's work
It is increasingly recognised that
work exerts a negative influence on
the child's personality, wellbeing

and development-and this from

many points of view. The following
are some examples:
• The absence of a harmonious
family life, particularly if the child is

employed on some external job, the
due attention and care of parents
being impossible in these cases.

nal work, or jobs accomplished in
the street, the child is exposed to

strength is less than those of the
grown-ups and tires more easily.
This is why it is particularly expos­
ed to occupational diseases (e. g.
tuberculosis in dusty surround­
ings, and in the textile industry) and

social perils and even crime, such
as drugs and prostitution.

to work accidents. What is more,
problems of health may present

• The endangering of health;
while in growth, the child's capacity
of
resistance
and
muscular

themselves, in the short or the

• There is hardly any leisure for
games, sports or cultural activities
required by their age.
• Particularly in the case of exter­

long term, on account of premature
efforts: troubles in growth, defor­

mation of the vertebral colunin, and

cardiac diseases, etc.
• In most cases, means of teach­
ing and training are lacking. which
would ensure fundamental general

and professional knowledge, which
are required for normal mental and

intellectual development, and to
make the child into a skilled worker
and enable him to prosper in the
social and occupational field-W|,en

working it cannot go to school, or is

bound to leave school before time,
or again it is unable to co-ordinate
the two activities, and so the future
of the child is endangered. On the
other hand, and this is quite fre­
quent in the case of apprentices, vo­
cational training is entirely absent.
• Finally, because of the lack of

preparation for occupational life,
many children are condemned to
remain unskilled workers through­
out their lives.

)SS INSTITUTE U.\li <_•>
J SCUPATIONAL HEALTH
Si. John’s Medical Collcg .

IYC Photos
National IYC'Commissions can obtain negatives of photographs and illustrations for the printing of copies,or "^’'“^(^“g^p'hotographer) - distributed6
supplied with each photo negative and the credit line on each print should read: name of agency of origin - photo by (name o> p
y
by IYC. Requests should be addressed to:
T
97 0Q8
International Year of the Child Secretariat (Europe), Palais des Nations, CH-1211 Geneva 10. Tel.: 34 60 11 # 4
e

.

IYC Photo No. 149

IYC Photo No. 151

IYC Photo No. 1 54

._______

________

IYC Photo No 1 50

IYC Photo No. 1 52

IYC Photo No. 1 53

IYC Photo No 155

_______ _

1

GH l©--ci

HOW TO MAKE AN
IL L U MIN AT O R kxx

Koramangala, Bangaloto-SCO 034

DESIGNED BY DON CASTON
DRAWINGS BY JOAN THOMPSON

Appropriate Health Resources and
Technologies Action Group Ltd.,
85 Marylebone High Street,
London W1M3DE, UK

HOW TO MAKE
AN ILLUMINATOR
Two wire coathangers

A piece of
thick
paper.

Four blocks
of wood.
One piece of
wood 12" wide
and 14" long
(300mm x 350mm).

One piece of
wood 1" wide
and 12" long
(20mm x 300mm).
©AHRTAG

1

Fix the piece
of wood to the
base. Drill four
holes in this piece
of wood to hold
the two wire frames.

------ Fix the four
blocks of wood onto
the base with glue
or nails. These
blocks will hold the
thick paper in place.

Bend the thick paper
to fit between the four
blocks of wood.
The paper will reflect
the light.

•Bend the wire
to fit in the holes.
©AHRTAG

3

To illuminate a picture you can use an oil or
candle lamp, battery power, mains electricity or
stand the frame against the window.

If you use an oil or candle
lamp, wrap aluminium foil
around it to increase
the brightness.

Do not use any
material that
might catch
fire.

Oil or candle
lamp

Battery
power

Mains electricity
©AHRTAG

Put a thin piece of
paper in a polythene
bag and put it over
the wire frame.
This will stop you
seeing the light source.
When you are teaching
you can put the picture
for the lesson inside
the polythene bag.
Or you can write or
draw on the polythene
•ags with a soft wax
crayon, a china pencil or a
felt tip pen.

Or you can punch two
holes in overhead
projection sheets and
hook them on
the frame.

©AHRTAG

The Appropriate Health Resources and Technologies
Action Group Ltd.
AHRTAG is concerned with the development of equipment and techniques for
health care at community level. It also provides an information service on
appropriate technology for health.
Special areas of interest include:
• the cold chain
@ dental health
0 disability prevention and rehabilitation
® diarrhoeal diseases

9*1

Since it began in 1977, AHRTAG has been in touch with overseas groups with similar
interests and is part of an informal world network linking people interested in
primary health care. AHRTAG is a WHO Collaborating Centre.

a
111
3

131
a

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Other publications:
O

‘Auxiliaries in primary health care — an annotated bibliography’ edited by
Katherine Elliott, 1979.

O

‘How to look after a refrigerator’ by Jonathan Elford, 1980.

©

‘Playing together’ (1981) — aids for disabled children — a set of 8 ‘pop-up’
illustrations plus instruction sheet.

•

Assisting dental education and dental public health in developing countries:
a symposium, 1981.

•

‘Low cost aids’ (1982) — a book showing a wide range of aids for disabled
children. The text has been kept to a minimum and there are 53 pages of
drawings.

171
181
19j

201

For details of prices and postage write to AHRTAG, 85 Marylebone High Street,
London W1M 3DE, United Kingdom.

211
22j
23j

241

Free publications:
•

Diarrhoea Dialogue — a quarterly newsletter on all aspects of diarrhoeal disease
control. Also available in French and Spanish.

•

‘How to make hand grips’ (1981) — a poster showing ways in which clay, plaster
and epoxy resin putty can be used to make hand grips to allow disabled people to
hold tools, spoons and brushes, etc.

•

The AHRTAG baby length measurer (1982) — a working drawing showing how
to make a baby length measuring device.

251

261

w-

CH ICfc- H

MMfflI
Director. Duncan Guthne GEL MA U.D
Adviser >n Education H..gn Hawes MA MPhil
Adviser in Ch.’d Heahn David C Mcrlev MD FRCP

c/o Institute o‘ Ctyld Health
30 Guiif.'rd Sheet
London WC1N 1CH

Telephone 01 -242 9789

Newsletter 1
*
X
*
X
X
«
J
X

CHILD-to-chiId is an international programme designed to teach nnd
encourage school children to concern themselves with the health of
their younger brothers and sisters.
Simple preventive and
curative activities appropriate to the local situation will be
demonstrated and taught to the children In school, so that they
nay pass ther. on in the family or village envi ronment.
It is hoped
that initiative and encouragement will come from government and
other official sources.

* This Newsletter records some of the CHILO-to-chiId projects under
» discussion, or actually under way in different parts of the world.

• Perhaps YOU would take one of these projects, adapt it to fit your
e own local conditions, and run your own CHILD- to-chi Id scheme...................

CHILDREN AS PART-TIME HEALTH WORKERS
The part-time health worker is now widely accepted.

Many of the preventive and curative

activities of these workers can be undertaken by school children, with enjoyment.

Early warning signs of dangerous illness

Giving the right drink to young children

with diarrhoea

... - one day's fever in
.
babies, and three in
children and adults;
- refusal of food by
small infants;

- inability to see when
it is almost dark night blindness from
lack cf Vitmain A;
- cough and rapid breathing (we can count the
breathing rate against a normal pulse);

- two weeks’ cough;
- fits, and any alteration
in consciousness.

Severe illness and death from diarrhoea
can be prevented in young children if
water with a mixture of salt and sugar
is given to them frequently. For every
stool the child with diarrhoea passes
he requires a glass of water, to which
the right amount.'; of salt and sugar have
been added. A special plastic measure
is available. This .is used to measure
the salt and sugar into an ordinary
teaspoon, so that ir. future the solution
can be made up at home.

; ,-^J]
! /£
*• 4.J

Pneumonia is a common cause of death in small
children. Many of these deaths can be prevented
if cider children and parents recognise the
illness early on.
If a child has taken violent
exercise other children can recognise the signs
~ quick breathing, movement of the soft side of
the nose, and additional movement of the lower
chest.
If a child counts his own (normal) pulse
(60 - 70 per minute) until he reaches a hundred,
he will find that the child out of breath has
breathed more than 50 times.

This programme being developed by Jon Rohde and
others in Indonesia (The Rockefeller foundation,
PO Box 63, Yojyakarta, Indonesia}

THESE ARE ALSO THE
SIGNS OF A CHILD WITH PNEUMONIA
This programme being developed by Karen Olness group.
Children's Health Center, 2525 Chicago Avenue,
Minneapolis, Minnesota 55404, USA.

Thanks for many of the drawings to DAVIT. WERNER,
author of "WHERE THERE IS NO DOCTOR", a book which
will help the villager provide his own health care.
(Available from TALC, B5 Sandpit Lane, St Albans,
AL1 4EY, UY)

Measuring malnutrition

The Shakir strip placed around the middle cf
the upper arm effectively identifies the less
well nourished children Between the ages of
one and five. This technique has already been
used by school children. Ke do net know,
however, how they will pass their findings on
to adults.

In countries where blindness from lack of
Vitamin A occurs, children should be taught
to collect leaves which are normally eaten
green, dip them, in boiling water, dry and
store them for the time when fresh leaves
are not available
.
*

WHO CAN MAKE SUGGESTIONS?

Z sheet on the use of the Shakir strip available from
the CHILD-to-chiId pregrarme. "
Trials being undertaken ly Ransone-Kuti and Ann Bair.asaiye,
Institute of Child Health, Lagos, Nigeria.
Kass production of strips by schools in UK under
invest igation.

Nutrition teaching
Many young children suffer from too little food
containing energy, and not from lack cf protein.
If given extra protein these children will use it
as a source of energy. An amount of the most
commonly used food which provides the energy
requirement - 12C-0 Cals - should be prepared by
the teacher in a form that would be eaten by
local children. Teacher and children will see
at once that the. bulk of this would be too much
for a small child. The teacher would explore
with the children how to obtain the necessary
energy through such foods as oils.
If oil is
not available, suitable oil producing plants
should be grown in the school garden.

Hospital experiences
What happens in hospital should be taught
to the class and to younger children.
for
example, a fractured bone can be represented
by a broken stick and repaired with Plaster
of Paris. The X-rays, if taken, should be
shown to the class.
Being developed hy Hugh Jolly and staff. Charing
Cross Hospitai, London.

Care of the ill child, and first, aid

Using a small child in the class, children
can learn the ways to make a child more
comfortable when it is sick. They should
encourage the child to drink and cat, cocl
down the child with high fever, bathe any
eye which has a discharge, etc.

The school teacher may find seme way of getting
across the need for at least three meals and
snacks each day (a delicate subject). As the
older child often feeds younger children, he can
help the parents give the child more meals and
snacks.

As well as learning how to prevent cuts,
burns, and other injuries to themselves,
they should alsc be taught how to protect
younger children. They should learn first
aid techniques using, where possible,
material from their own home.Being developed by nursing staff at the Hospital
for Sick Children, Great Orcond Street, London.

Dental and general health

~

Neighbourhood
Information on clinic tines can be made
known to far.illes through the children.
They may take younger children to
clinics, and reassure them. They iray
help the work of the clinic in dressing
and undressing younger children, help
with weighing, etc.
Activities in the clinic car. be
reinforced through class teaching in
maths, science and language, and
developed through appropriate graphs,
reading cards ana role play.

----------------

Children should look at each other’s teeth
and those of small children. They should
learr to recognise dental caries and
inflamed gums. They should be shown how
a healthy milk tooth, lost by a younger.
child, is affected by being immersed
ever night in a fizzy drink..

The community's water supplies should be
recorded, and their adequacy discussed. The
need for children co wash their hands before
handling feed for themselves, or particularly
for small children, should be emphasised.
Children would he told of the'Chinese .
programme to rid their country of flics as one
of the pests. The children would learn the
life-cycle cf the fly and clear from around
the school all places where flies could breed.
If simple fly swats could be made, the
children would run compe'itions to see who
could kill the most flics around the school.

BIG BROTHERS AND SISTERS

Older children already spend most of their tine at home caring for their younger brothers
and sisters,

They will have fun providing them with a more stimulating environment, and so

• ,

They will do this through:

.

playing on important part In the younger children's development,

Talking to them

-n.

.

.

.

:

Whatever they are doing, however simple, they.
should put into, words for the younger chil.d to
hear and, in-time, to copy.
p

*01
•2

lEi

Story-telling.
Encourage-"grandparents, .to. tell stories and--pass
them on -to smaller children.

Puppets

'

’OAc'L,-•••

..These cam be. made from’leavespaper, cloth
, or' bits 'of waste'-' material-. ^The J5.ch.pdlj t’-'
child; makes 'these., at^ school,', created ■-a’*
story , and gives’’ a -p.upfcei? sT.^i'tojiydpri'g^r
children' at -Edme '
’
'

od
Puppet shows are

Acting and r'dlc 'playPlays may show the activities of mosquitoes,flies and other health hazardsThese can be
performed for younger children at the clinic
or in a pre-school group.

easy-to "stage"

in the home

As well as being

fen to watch,

Gardening

younger children

The older child helps the small infant-with
a tiny garden, or growing seed in a pot.
Quick growing plants, like the papaya, are
best because they can.be "seen" growing.

can learn from

plays performed
by their older

brothers and

sisters

Playing games with them

As well as knowing their own traditional game:
children should be caught others, particularly
those requiring dexterity and memory.
CHILDREN AS RESEARCH WORKERS
Children olready have a fund of valuable Infornatlon.

They con be encouraged to collect

even more on the health of their family or community.

Census of small children and records of their
health
Almost nowhere do health workers and schools
know the number of small children, information
which is necessary for planning in health and
education. The small children in the
neighbourhood car: be counted,/and information
on‘their:illnesses recorded, particularly
infectious diseases. Where possible a health
worker should come to the school regularly- tc
discuss these findings, and help in the
teaching.
Martin and Liz Schweiger, P.L'FS lalmanirhat, Rar.gpur)
Bangladesh, work with 1OO health workers who visit
schools weekly.

In communities where it is acceptable, a record
of pregnancies and births can be kept. Where

weight charts arc left at.home, information
on immunisation and attendance of : younger.
children at clinics can be collected.
Recognition cards and drawings

•;

• • .>

Common conditions in smal-l children, -such
as skin ’‘diseases,-' eye conditions etc,’may­
be recognised by children from coloured ;
cares’. 'Similarly lameness and other
results of polio can be recognised from ;
drawings. As well as identifying these.
conditions, the cards can suggest simple
treatment at.homef
Charles Beal, 2421 Pulgas Avenue, Palo Alto,
California 94303, USA, is developing cards for
eye conditions.

General information about the International Year of the Child is available from:

IYC Secretariat (US), 666 United Fations Plaza, NEW YORK 10017
IYC Secretariat (Europe), ILD Building Room 929, CH 1211 GENEVA, Switzerland

'Best buy" diets for young children

Child spacing and family planning

If food is sold in markets or shops, its price
and availability can be recorded from season to
season. Teachers and children can then discuss
the best food to buy for small children at
different tires of year, particularly

This is a sensitive subject, and care will
have to be taken not to give offence.
Probably in all countries some information
on how often mothers have babies can be
obtained and studies.
The breast feeding
of children for about two years can be
related to the longer birth interval.
Difficulties for mothers with children
born at close interval can bo discussed,
and the advantages of a birth interval of
three to four years stressed.

HOW TO DEVELOP THE PROGRAMME

EVALUATION

Each country involved in the CHILD-to-child
programme will develop its' own programme. The
following proposals are presented as possible
guidelines for comment

The national CHILD-to-chiId committee will
also develop a system for evaluation. This
may involve simple questions to identify
the knowledge of children before the
activities (perhaps in December 1978), and
again afterwards. This can be repeated in
different schools during the course of the
Year of the Child.

It is hoped that each country will have its
CHILD-to-chiId committee as part of its
national programme for the International Year
of the Child. This committee, probably with
representatives from the Ministries of Health
and Education, will decide on appropriate
activities. Only one or two activities will be
advisable for each school tern, and the
Education Department may suggest a special
CHILD-to-chiId week, or two weeks, in each
school tern. These dates to be sent with
introductory information to all school teachers.
Two or three weeks before the week of each
activity two sides of an illustrated duplicated
sheet to be sent to the school.

Questionnaires might well be compiled by
students from teacher training colleges.
It is important that the education and
health authorities should be able to see
the improvement in the children's knowledge
- and in the health of both school and
pre-school children.

FELLOWSHIPS

(Normally these will be prepared in the local language.
The London office may be able to assist in preparing the
stencils if the translation is sent there.)

offered
for international course

During the CHILD-to-chiId weck(s) the national
Year of the Child committee will encourage mass
media such as radio, newspapers and magazines to
carry similar material.

•

pre-school chlld nutrition"

Many school teachers will wish to involve
organisations such as Scouts, Guides, religious
croups, cr even develop their own Health Brigade
to undertake work in the neighbourhood. Plays
and demonstrations could be arranged, and a
certain amount of ’show
*
encouraged, - eg bands,
marches, songs, badges, and knowledge and skills
rewarded.

STOP

in 1979

"Ecological problems related to

For more information contact:

Prof dr Joseph Hautvast
Director, International Course in
Food Science and Nutrition
c/o Lawickse Allee 11
Wageningcn, Netherlands

PRESS

MESSAGE FROM THE EDITOR
READ AND PASS ON

Please be sure to keep us Informed of your own

CHILD-to-ch!Id programme, and how it develops.

1__________ 2___________
News

about a CHILD-to-chlld project In one place could well

help people in other parts of the world, so please don't
hesitate to write to tell us of your successes and

failures, and the bright Ideas you have had.

3__________ 4___________
We ask you to share this with others

Stencils for local reproduction
of this Newsletter are available
from the CHILD-to-child office.
Please write, quoting ref Hl,
and let us know if a translation
would be useful.

FOUNDATION FOR

TEACHING AIDS AT LOW COST (TALC)

Institute of Child Health, 30 Guilford Street, London WC1N 1 EH

OBJECTIVES OF TALC
TALC provides teaching aids at or below cost price for health
workers.
The objective of this service is to help raise standards
of health care, particularly in developing countries. The Foundation
for Teaching Aids at Low Cost is a self-supporting non-profit
making organization and represents a teaching activity of the Institute
of Child Health of the University of London.

SLIDES FOR TEACHING
Selling slides to assist in learning is the major activity of
TALC. The list of sets available will be found on the centre page,
the order form on page 3, and the various ways in which they may
be supplied and used on pages 1 , 2, 4, 6 and 7.
SELF-MOUNTING SETS

Low Cost Set
90p. (60p.)
*

for 24 slides

including post and packing
See note on VAT charges on
page 3.

This is the most popular method of
supply. So as to reduce the cost
of the sets of slides we ask you to
mount the slides in the cardboard
mounts yourself. This is simple
and quick to do if you follow the
instructions on page 2.
You will receive a strip of film,
self-sealing mounts, and a script
that describes each slide and may
include a series of questions and
answers.

*

Figure in brackets refers to reduced price for those working in
developing countries, or shortly going to those areas.

2.
DIRECTIONS FOR USE OF SELF-SEALING MOUNTS
Cut up the strip of film carefully, using the guide lines. Place
a lamp on the floor and four lines of light will show through the card­
board mount.
Using these lines, centre up the transparency.
Now
fold the mount up and over so that it seals with the blue dot in the
bottom left corner.

To ensure permanent and strong sealing,
slides for a few moments.

sit on the mounted

Each transparency carries not only its number but also letters
identifying the set.
These letters and the number should be copied
onto the cardboard mount.
METHOD OF ORDERING
Fill in the order form on the opposite page with your name and
address (printed) and the code letters of the sets you require. Send
this, together with your cheque or money order made out to TALC,
addressed to:

TALC, Institute of Child Health
30 Guilford Street, London WC1N 1 EH

The price includes postage by surface mail. Additional charges are
made for airmail.
See note on VAT on page 3 for orders delivered
in the U. K.

If you are paying in currencies other than U.K. sterling,
please add the equivalent of 50p. to each order. This is the average
cost to TALC of conversion of cheques from other currencies.

IF YOU DO NOT HAVE ACCESS TO STERLING, EUROPEAN
CURRENCIES, U.S. DOLLARS OR OTHER EASILY
CONVERTIBLE CURRENCIES

TALC may still be able to help. Write an easily legible letter
briefly describing a local charitable organization concerned to help
under-privileged children to whom you are willing to donate a sum in
your local currency equivalent to the cost of the slides you require.
Include this letter with your order and we will attempt to find a
sponsor willing to buy the material for you.
Alternatively, if you are connected with a university or other
recognised teaching organization you can through them purchase a
coupon from UNESCO in your capital city which we can accept in
payment.

3

ORDER FORM
(please complete in block capitals)
Name and
address

If your permanent address is different, please
include this for our mailing list.

MATERIALS REQUIRED:
boxes need be included.

In the case of slides, only the letters in

PLEASE SEND THIS FORM

MADE OUT TO:

TALC

AjRESSED TO:

TALC

WITH CHEQUE OR MONEY ORDER

INSTITUTE OF CHILD HEALTH
30 GUILFORD STREET
LONDON WC1N 1 EH
U.K.
VAT at the standard rate (8%) is to be added to all orders delivered in
the U.K. irrespective of final destination. No VAT need be included for
orders sent out of the U. K.

Please tick if you include an extra payment for:MOUNTING

40p. for 24 slides

AIRMAIL

25p. for 24 slides

(Sets in plastic files and Slide Tape
sets, airmail charged at cost)

4.

SETS

OF

COLOUR

SLIDES

Bf

BREAST FEEDING: A description of normal suckling
and ways of preventing difficulties

BL

BURKITT'S LYMPHOMA:

CcO

CANCRUM ORIS:

CD

CONTRACEPTIVE DEVICES: Methods of Family
Planning, prepared by the IPPF. (Fr)

Ch

THE ROAD TO HEALTH CHART: The use of this chart
in promoting adequate growth and preventing malnutrition
(Fr)

CIG

CLINICAL GENETICS: Clinical genetics described for
senior medical students.

Cm

COMMUNICATION IN HEALTH: Ways in which a health
worker may improve communication.

DhP

DIARRHOEA IN PAPUA NEW GUINEA:
management by auxiliaries.

EAf

EAST AFRICA - CHILDREN'S HEALTH AND WELFARE:
Prepared with UNICEF, this describes UN work. For
general public and school-children.

Fwa
Fwa

1-24
25-48

GR

GROWTH: Diagrams il lustrating normal growth,
only suitable for senior medical students. (Fr)

KwM

MANAGEMENT OF KWASHIORKOR: Common causes
of early death and their prevention. (Sp)

Lp

LEPROSY: A description of the disease with particular
reference to childhood. (Fr)

Its principal clinical features.

Aetiology and management.

Aetiology, and

FOODS OF WEST AFRICA: Foods commonly given
to children, their preparation and nutritional value.
(48 slides, double the cost)

5.

24 slides with script in each set

(except where specified as 48)

Ml

MALNUTRITION: As seen in Indian children but
relevant to other areas.

MnC

MANAGEMENT IN CHILD HEALTH: Principles
of management for health centre workers. (Sp)

MR
MR
---------

1-24
25-48

MENTAL RETARDATION: Common causes
of mental retardation in the U.K. (48 slides,
double the cost)

Suggestions as to how and

MS

SEVERE MEASLES:
why it is severe.

NbC

NEWBORN CARE: A description of important
steps in the management of the newly born.

PcD

PROTEIN CALORIE DEFICIENCY: A description
of the syndromes of kwashiorkor and marasmus.

PEM

PATHOLOGY OF EXPERIMENTAL MALNUTRITION:
Microscopic appearance in animal tissues.

PH

PAEDIATRIC HAEMATOLOGY: Common haematological
conditions found in tropical countries. (Fr)

Sk

COMMON SKIN DISEASES OF CHILDREN IN THE
TROPICS: Common skin conditions in the tropics,
and their management.
(Fr)
SKIN DISEASES IN TEMPERATE ZONES:
conditions in the U.K.

Common

SMALLPOX IN CHILDREN: Cl inical description in
African children and prevention. (Fr)
NATURAL HISTORY OF CHILDHOOD TUBERCULOSIS:
The characteristics of childhood TB.

X-RAYS IN CHILDHOOD:
students to study. (Fr)
(Fr)

script in French available

Some diagnostic X-rays for

(Sp)

script in Spanish available

6.

PRE-MOUNTED SETS

£1 .30 (£1 .00)
*
of 24 slides,

for a set

including

post and packing

For those not wanting to mount
their own slides, these mounted
slides can be supplied at an
increased cost.

SETS MOUNTED IN PLASTIC SHEETS IN FOLDERS
£1.60 (£1.30)
*
of 24 slides,

for a set

including

post and packing

The sets are available mounted
in loose-leaf folders.
The
plastic sheets each hold 24
slides and are interleaved
between the scripts.
Three
sets are normally put in one
file.
This is a satisfactory
way to store the slides.
These plastic slide holders
have been specially designed
for TALC. As well as fitting a
loose-leaf file, they fold to go
in a coat pocket, or with a bar
they can be used to store slides
in a filing cabinet.
Please state if a bar is required instead of a
folder.
As well as being valuable for storing your slides, these
transparent folders, in conjunction with an X-ray viewing box,
are useful in preparing your slides in order as you plan your
I ecture.

* Figures in brackets refer to reduced prices for those teaching
in developing countries, or shortly going to those areas.

7.

Slide Tape Set

£6.00 (£5.00)*

including post and packing
Slide Tape Sets are for use by
individual students. They consist
of a mounted set of slides,
a
compact cassette, already pre­
recorded, the script and a plastic
file as shown. A low cost system
by which a student or small group,
using the Slide Tape Tutor, the
Slide Tape Projector, or any
cassette tape player and slide
projector, can listen to a lecture
recorded anywhere in the world,
with the visual aids that go with it.

The Slide Tape Tutor

£50.00 plus post and packing

The Slide Tape Tutor is
intended for use by individual
students working in a library,
where it can be permanently
locked to a desk.

The Slide Tape Projector
£55.00 plus post and packing

The Slide Tape Projector is
intended for use by 4-6
students at a time. It can be
locked on a table in a sound­
proof cubicle or in a small
room where the tape recorder
will not disturb others.
It
includes a small projector and
a miniature daylight screen.

*Figures in brackets refer to reduced prices for those teaching
in developing countries, or shortly going to those areas.

8.
GROWTH CHARTS

The 'Road to Health Chart1 is
fully described in "Paediatric
Priorities in the Developing
.
**
World"
The objective of this
chart is to overcome malnutrition
by promoting adequate growth.
The chart is also a record of the
child's immunisation state and
can be used to maintain an
adequate birth interval and intro­
duce the mother to family planning
methods.

1 .

A sample of the chart will be sent free on request.
Charts can be sent post and packing free 10 for 50p.
with special rates for large orders. (Also in French)

2.

Charts printed on white card intended for
use by local printers to prepare lithographic
plates. (Also in French)

. 50p.
(US $1 .20)

3.

Flannelgraph with detailed instruction in
its use.

£2.00
(US $4.80)

4.

Overlay transparent sheets. These may be
used in evaluating any change in the weight
of groups of children attending the clinic.

£2.00
(US $4.80)

5.

Large transparency for use with an
overhead projector.

6.

Pre-cut stencil to fit a Gestetner or Roneo
duplicator allowing charts to be printed on
paper for training purposes. (Also in French)

A kit containing all the above can be sent for £5.50

.*
*
*

. 50p. *
(US $1 .20)
£1 .00
(US $2.40)

•

(US $13.20) *

"Paediatric Priorities in the Developing World" by David Morley,
published by Butterworths, London, is available from bookshops.
Through a special fund it can be sent post and packing free from
TALC on receipt of £1 .25 (US$3.20).

All prices quoted include packing and post by surface mail.
Please use order form on page 3 and read instructions on page 2.

COMMUNITY HEALTH CELL
326, V Main. I Block
Koramangala
Bangalore-560034
India

PHOTO - LANGUAGE SERIES
(An Audio-Visual Publication of National Biblical,
Catechetical and Liturgical Centre, Post Bag 577, Bangalore-5)

I-

The National Centre (NBCLC)

The National Biblical, Catechetical and Liturgical Centre
.is an all-India Institution, founded on the 6th February 1967
to plan and implement on a national level under the guidance
of the hierarchy a programme of biblical, catechetical and
liturgical renewal in India, within the overall framework and
movement of Church renewal in India and according to the
spirit and programme of Vatican II and the exigencies of the
post-Vatican period in collaboration with regional and
diocesan agencies. Thus it is to be an agency to promote
and co-ordinate renewal. Each of this triple Centre has
10 departments.

II.

Audio-Visual Projects
One of the departments to promote media of commu­
nication and liturgical arts, to give initiation to
Audio-Visual language, and to organise produc­
tion and distribution of Audio-Visual material, rele­
vant to India.

Besides training thousands of people as leaders of Church
’renewal and promoters of Biblical, Catechetical and Liturgical
Movements and publishing Catechisms for the Primary and
High Schools with Teachers’ Text and Students’ Text, the
Centre has undertaken a few audio-visual projects the most
important of which are :

(1)

Biblical wall-posters : It is a series of 140 large
pictures covering the whole history of salvation
through the Old Testament and the New Testament.
The pictures are painted in Indian art and are

aesthetically of a high quality. The content and
expression are correct and up-to-date from theologi­
cal, scriptural and psychological points of view, as
approved by specialists in these subjects.

The pictures will be printed over a period of
one year. Pre-publication orders may be placed by
an advance of Rs. 140/- for the whole set (packing
and postage is extra).
Pictures will be sent- to
subscribers in instalments as and when they are^
printed and published. A first instalment of 16
pictures is now available for sale. Pictures are sold
only as a complete set, and not individually.

III.

(2)

Life-situation series : It is a series of wall posters
covering major life-situations as milieu and medium
of understanding God’s Word in a relevant way.
This is still at the planning stage.

(3)

Photo-Language :

Photo-language and Life-themes

The Centre is very happy to offer the service of photo­
language publication to the Church in India for making
Catechesis relevant to life and experiential as discovery of
God in our life of which the photos are the expression.

We have selected 11 life-themes as Catechetical themes:
Each theme is developed with the help of photos according
to modern Catechetical pedagogy, namely the existential/
experiential/anthropological approach. For each theme we
have published 10 to 20 photos of 11" x 8|" size with a total
2

of 173 Photos for the 11 themes together.
are:

The 11 themes

1.

God’s wonderful World

2.

Happiness

3.

Friendship and Love

4.

Solidarity and Brotherhood

5.

Freedom

6. Communication

7.

Breaking off

8. Suffering

9.

Trades and Vocations

10.

11.

IV.

Symbols

Symbolic Gestures

Aids for Interpreting Photo-language

The photos of each theme are placed in a cardboard
folder with 3 aids for using and interpreting the photo­
language. ‘

(1)

Photo-language : In order to enable the proper use
and interpretation of photo-language, we offer a
leaflet of short presentation of'“ photo-language ”.
By following these guidelines one will be able to use
this language and to interpret it.

(2)

A brief development of the theme and interpretation of
the Photos'- In a single page we give a two-line
explanation and gospel references for each photo of
the theme. We would have liked very much to
develop fully each of the Catechetical themes and to
show clearly how the photos will be integrated in
this development. However, we realise that the
photos though arranged according to certain themes
can also be used outside the theme in many other
situations. We also presume that these photos will
be used chiefly by those who have undergone a
Catechetical training which includes the use of
photo-language. Hence they will be easily able to
use these photos in various themes indicated in our
COMMUNITY HEALTH CELL
326, V Main, I Block
Koramangala
Bangalore-560034
India

publication. All the same a short reflection is
developed for each theme relating the photos of the
same theme among themselves.
(3)

V.

A complete list of all the photos according to the 11
themes'- We give in two pages the title of all the
173 photos to serve as a quick catalogue of
reference.

Price: Each theme
(with the folder, the photos, the three pamphlets and
sheets of guidelines)
Costs (Subsidised price)
Rs. 15.00
The whole set of 11 themes costs

Rs. 165.00

Themes may be bought either individually or as a com­
plete set.

Copies are available both at :

‘NBCLC’

Asian Trading Corporation

and

P. Bag 577

150, Brigade Road

BANGALORE—560005

BANGALORE—560025

We wish that this photo-language may enable the people
to evoke, discover and appropriate the inexhaustible riches of
the mystery of Incarnation. May it give both the Catechists
and their groups an experience of God through touch, audition
and vision. (I Jn. 1, 1-4) and thereby widen the fellowship
to all and complete the joy of every one.

1st July 1915

4

The 'Must' for
srsery Admission

TN-FORCES
Dept of Social Work,
Loyola College,Chennai - 600 034,
Ph 28175659, Email . tnforces@yahoo com

May 2003

Dr. K. Shanmugavelayutham
Ms M. Bhuvaneswari

Financial Support.
BERNARD VAN LEER
FOUNDATION THE NETHERLANDS

PUBLISHED BY
TN-FORCES,
Dept of Social Work, Loyola College,
Chennai - 600 034.
Ph: 28175659
e-mail: tnforces@yahoo.com

Every year, during the months of January and March
many young parents and concerned citizens are perturbed at
the sight of Nursery Admission Procedures.
The unending “Q’s" of anxious parents to collect the
application forms for either Pre.K.G. or L.K.G. admissions of
their wards regularly draws media attention by way of
photographs, jokes etc.

Denying admission to a, child who is merely two and a
half on the basis of an interview by a panel, labelling a child as
‘Normal’, ‘Clear’ etc. continues to disturb Child Development
Experts and Early Childhood Educationists.
A few elite schools demand that both parents must be
at least graduates; own vehicles etc. All these conditions are
against the child's Fundamental Right to Education.

Commercilisation of Nursery Admissions by way of
donations, voluntary or involuntary with direct or indirect force

adds fuel to fire.
This issue was taken to the attention of the State
Human Rights Commission. This situation was the triggering
point for TN-FORCES to take up the issue of Nursery
Admission Procedures with the vision of, Action for regulation.
Two meetings were conducted with Parents, Teachers,
School Headmasters or Headmistresses, Activists,
Professionals, Consumer activists, Press, Child Development
Experts, Early Childhood Educationists etc.

(1)

The first meeting was held at Chennai on February 16,
2002 and the second meeting was held atTirunelveli on May 13,
2002. The reports were accompanied with the draft copy of the
Nursery Admission Guidelines and sent to all the participants and
invitees.

Written responses were obtained from the following
members of FORCES. They have been incorporated in the TNFORCES’s guidelines for Nursery Admission.

Mrs. Prema Daniel (LA.RE. Chennai).
Dr. R Prema, Professor of Education, Alagappa University.

Ms. S.S. Jayalakshmi, Vidya Vikasani Society, Coimbatore.
Dr. Vrinda Datta, Tata Institute of Social Sciences, Mumbai.

Ms. Lima Shankari Chandreshekhar, Pragati Pre-School, Neyveli.

Apart from this, a model format from the Child
Development Department of Lady Irving College, Delhi, titled,
“An Alternative Approach to Admission to Pre-School" was
consulted to arrive at the present version of the guideline. The
guidelines made in Tamil was circulated among the members of
TN-FORCES who attended the Annual General Body Meeting.

Some of the salient points of the guidelines were submitted
to the high level committee constituted by the State Government
to prepare the Education Manual for Tamil Nadu.

The Nursery Admission Guidelines have been evolving
with the experiences and insights of TN-FORCES, its members
and the participants of our Discussion meets. The guidelines
presented in the booklet is not the final version. TN-FORCES
elicits your opinions and suggestions to further refine and shape
the Nursery Admission Guidelines t6 ensure Child friendly
admission procedures.
By Editor
(2)

Nursery Admission - Issues and
Problems
Early Childhood Education (ECE) is considered a
significant input to compensate for early environmental
deprivations at home by providing a stimulating environment
to the young children. While
on one hand, it is expected
to provide the necessary
maturational and experiential
readiness to the child for
meeting the demands of the
school curriculum, it also
affects
positively
the
enrolment and retention of
girls in primary schools by
providing substitute care
facility for younger siblings.
Envisaged as a holistic input
fostering health, psychological
and nutritional development, the ECCE emphasized the
significance of making it play based while cautioning against
the danger of reducing it to the teaching of three R’s i.e.,
reading, writing, and arithmetic.

Report of National Committees on Pre-school
Education:
❖ National Education Committee (1952-53) has
recommended Nursery Education for Children

(3)

between 3-6 years of age.

❖ The Kothari Committee for Education (1964-1966) has
insisted that the Pre-school education programmes
for children of 3-5 year and 5-6 years must be
implemented within 1966.
❖ The National Education Policy of 1986 on Pre-School
education assumes significance because of its
following three dimensions:

(i) It provides for all-round
development of children
upto 6 years-physically,
emotionally and socially. The
policy refers to preschool as
welfare measures for small
children
(li) It provides for opportunities
and atmosphere for making Basic Education possible
for all and

(iii) Equal opportunity for women.
The Government of Tamil Nadu constituted a
Committee (1992) under the Chairmanship of Prof.
Chittibabu to study the nursery schools in Tamil Nadu
and to examine the feasibility of making Tamil as the 9'

medium of instruction in Nursery Schools.

ECCE Programme:
Early Childhood Care and Education Programmes have
been under implementation on a large scale through the
programme of Integrated Child Development Scheme (ICDS)
and World Bank Integrated Child Development Services - III.
Efforts to integrate Early Childhood Education into activities
4

of these centers and to extend institutionalised educational
facilities for children in the pre-school age group have begun
only during recent years. In the Budget Speech, 2003-2004
it was announced that 5000 Integrated Child Development
Centres would be upgraded as fulfledged Nursery Schools.
Pre-school Education in urban areas, which is fairly wide
spread and is continuously expanding, is largely in the hands
of the private sector without much supervision or support
from the Government.

Different names:
Play School
Fun School

Montessori School
Kindergarten School

4*

Nursery Schdol

4- Creches
+ Balwadis
+ Pre-schools
+ Day Care Centre

Prevalence of different names leads to confussion among the
public. The name Pre-primary School Could be considered

5

the to do away with the ambiguities.

Nursery Schools in Tamil Nadu:
According to the Report of Prof. Chittibabu Committee,
in 1947 there were only 26 schools in Tamil Nadu, which had
not received recognition from the Government. But by 1992
the number of Schools not’ recognized had risen to 5349.
According to Government estimates, there are 20,000 Nursery
Schools in Tamil Nadu, which have not been recognized by^>
the Government. The Nursery and Primary schools are '
governed by the ‘Code of Regulations for Approved Nursery
and Primary schools, 1991. Under this Code about 3216
Approved Nursery schools are functioning in the State.

The code of Regulation for Approved Nursery and
Primary Schools:

The Code of Regulation for
Approved Nursery and Primary
Schools (G.O, Ms. No484,
Education, Date 24-04-1991 as
amended in G.O, Ms 349
Education, stated 31-03-1993) is in
vogue to regulate Nursery Schools.
However the code is applicable
only to recognized schools
functioning under the control of1
Directorate of Primary School
Education. The fact that these rules
are being applied commonly to
both Matriculation and pre-Schools
covering the age group of 3-14
years, generates much
6

confusions; because, many of the common rules are not
applicable to small children. In the Code there is no mention
about how admission should be done.

W

The Code under Chapter III Section 12 deals with
Admission. 'The Headmaster/Headmistress will have the right
of admission and will also be responsible for admission and
to Rules and Instructions issued by the Department from time
to time’. Application for admission shall be made in the form
prescribed by the Code. The form contains Name, Date of
Birth, Nationality and state, Religion, Particulars about SC/ST,
Name of the Parent, Occupation and Address, Mother tongue
etc.

Parents’ Problems:
Overnight queues to collect LKG application forms,
exorbitant fees /donations charged for Nursery Admission,
seem to be the focus issues causing concern. However there
are several other issues
worthy of media attention
and state action. Starting
from
the
parents'
preference for a school up
to the schools' preference
for a child, there are several
unidentified problems. A
private school builds its
image through the media.
Interviews of Toppers in
class X and XII appear in the
print and electronic media.
Innocent parents who want to do the best they can for their
child become victims of such advertisements. A myth that
7

the school producing good number of state-rankers is the
best school in the city is successfully established. Parents
throng towards such
schools. They may
not belong to that
locality at all. Even at
age three or four,
children
travel
impossible distances
for the sake of
belonging
to
'reputed’ schools.
There are a few
schools that prefer children of the neighborhood. Some
parents shift their residence even before applying. Some
parents find easy solutions by giving fake addresses.For Middle
Class parents, getting admission in a Good Nursery School in
India is one of the major missions of their life. Claims of several
urban private schools every year, during admission period are
that their school has highest ranks in Higher Secondary Public
Examinations and they are ’Good’. However, this is not 100 per
cent true since it only depicts their standard of coaching.

Auction:
There are schools, which literally auction a nursery school
seat. They leave a column in the Application Form, which reads ®
something like your contribution to school building fund/ and
the highest bidders will get admission. Following the tradition,
now even nursery schools (play schools) have started
demanding building fund.
Getting Application form itself is a nightmare:

There are schools where getting the application form
itself is a different exercise and a rather difficult job than getting
8

admission. A leading Chennai-based school-issues only 100
forms every year. The remaining applicants will be put on the
waiting list. Thus, there is a huge rush to procure the
application forms. In fact, one can see parents literally sleeping
on the road outside the school on the day prior to the issue
of the forms. Why they should put their children in such a
school, which treats them like street dogs even before
extending admission and runs a school like a factory?
Expensive application form:

With the prevalent uncertain conditions, one parent
buys at least three expensive application forms (minimum).
Schools sell any number of application forms irrespective of
the number of seats available. When it comes to the contents
of the application form a lot of information such as Education,
Occupation and Income of the parents are sought in most
forms. A few schools enquire about the vehicles owned by
the family. Obviously such schools look for the 'haves'. Some
schools deny admissions when one of the parents is not a
graduate and above. Schools mention the need for parental
assistance a-s a reason for preferring qualified parents.
However experienced teachers from such schools opine that
the coaching by the teacher is sufficient for good
performance. Admitting the children from families that measure
up to the schools' socio-economic yard stick amounts to
ridiculing the country’s efforts to Universalise Primary
Education.

Age at admission in Pre-school:
Just two years and the young child is already in the
rat race. Child will be sent to a play school, which will prepare
him for admission to a good school.

A Delhi Pre-school put out an advertisement recently
9

offering Diwali Vijayadasami discount on admissions saying:
"Remember 2 is not 2 early 3 may be 2 late." So, rush. It does
not matter, the advertisement seemed to imply, how old,
rather young, the child was. It's the discount that matters
Book now, a school official says, even if the child was too
young. A Pre-school denied admission to a child recently
calling the child too old. The child was al: of a month older
than two years. In Chennai there is a school where the mother
should register for the Nursery admission for her future child
when she is pregnant.
Anxiety and Stress in Interview

After applying for admission, parents have sleepless
nights in anticipation of the interview. With little idea about
the interview that they have to undergo with their child, they
train or over-tram their child. Tne anxiety and stress of the
parents reflects on the two and a half year old child, who
gets ready to face a panel. In spite of such preparations a
child may be denied admission in a nearby school for factors
unknown to the child or even the parents of the child.
Recomendations in Nursery Admission:

There is unimaginable recommindations from the
influential people like ministers, M.P’s, film stars, and V.I.P's
during Nursery admissions. Many schools are forced to yield
to the pressure for their survival ■ especially when pressure
comes from the Service Departments of the Government.
Agents exploit and there is transaction of money in the form
of donation etc. desperate parents seek all routes to obtain
admission. The irony of the situation is that even those schools
that wish to live their principles are denied an opportunity to
do so given the social demand and pressure

DONATION:

Some schools find simple solutions to the problem of
pressure and enormous demand through donations or heavy
fees. Donations are voluntary while others are indirectly
forced.The State has no control over such practices. Schools
claim to improve the facilities and provide decent salaries to
its teachers. Why should the child or its parents pay for quality
improvement if education is meant to be a service? Is it fair to
deny quality education to a child from a neighborhood merely
because the child's parents cannot afford such donations or
heavy fees?

Admission interviews keep Pre-schools in business. The
following Questions were asked in an interview:
Tell numerals from 1 to 50.
Name a bird, which
lays eggs in flight.
Hume, a bird referred to in
the Rig-Veda.

Name the author of
Vande Mataram.

Say A,B,C,D, till Z.
A child may be asked to
put his hand inside the
bag and without seeing,
pull out its belongings one by one and identifying them.
The bag may contain things like cotton, pencil, pebbles,
piece of wood etc.
What do you see in the sky during daytime and at
night?
11

w

Whom do you love most? "Mummy or papa.”

Rhymes to repeat. ‘Humpty Dumpty’, 'Jack and Jill'
'Twinkle, Twinkle little Star' and Baba Black Sheep down
his throat.

Policy of the Government:
As far as Early Childhood Education is concerned, the
policy of the Government is inadequate. It is failing to provide
the kind of educational service that is appealing to the parents.
There are existing Government schemes to cover the children­
in the below six years’ age group in a holistic manner however
they do not cover young children within the school framework.
The fact is that the L.K.G, U.K.G pattern of Early Childhood
Education is preferred by parents of all economic categories.
Pudhucherry Government has introduced LKG, UKG, in State
schools. This is a welcome measure. Parents are increasingly
aware of the importance of the First Five years (when 80% of
the brain development is complete) in the lives of their
children. There is every reason for the State to show active
interest towards Pre-primary Schooling-/ Early Childhood
Education.

Difficulty in Assessing the
Intelligence:
Psychologists agreed that it is
very difficult to assess the
intelligence of the young child. A
child is comprised of different levels
of behavior. It will smile sometimes,
it will dance sometimes, it will sing
sometimes or it will do nothing
sometimes. And a school calls for an
interview, they tell them it is from
12

9

9.00 a.m. A three year old interviewed at 2.00 p.m. would
have lost all stamina and joy. He/she would like to eat and
sleep for sometime. And at that point if you ask the young
child to display his/her talents what will be the outcome? A
Strike or Non-cooperation movement, even from the most
talented child. Some schools even take written tests.lt is
equally important to note that no child can be branded as
'normal' / 'ready-for-schooling' within a few minutes' interview
or screening by people who are strangers to the child. Speakinga
new language, in a new environment can intimidate anyone leave
alone the child who is so young. Most admissions close six
months before the ensuing academic year. It is unfair to expect
the child to face an interview when it is not even three.
Age and Neighbourhood criteria for admission:

Common specification or conditions for selecting a
child (Age and locality) must be worked out and schools
must adhere to such conditions. There would be no need to
issue the Application form if the conditions are not fulfilled.
Every child who applies for admission has the right to get
admitted. Barring age and locality, there need not be any
condition for choosing the child.
Inclusive Education

Early Childhood Education experts feel that there is
little need to check whether the child is normal because
through the informal, experimential learning through play way
method, every child can learn in its own pace. Even children
with mild disabilities or retardation must be included in the
nursery of their locality.

Parents Right to Information :
It is the duty of the school to inform and orient the
parents about its Rules and Regulations; Policies and
13

procedures etc. The school must be transparent about its
Resources and Facilities as well. The parent must be aware of
the Quality components of a School © The number of trained
teachers available in the school; « the terms and conditions
of service for the teachers and their level of job satisfaction
(crucial to ensure quality of a school). * The teacher student
ratio in the school for L.K.G. & U.K.G. classes; ® The
infrastructural facilities available in the school - » whether there
is a playground, a clean and green environment; « provision
for safe drinking water; clean toilets with adequate water
supply; s the availability of
outdoor and indoor play
materials in accordance with
each
age
groups’
developmental needs; »
scope
for
Play
Way
methodology; room for
teacher-student and parent­
teacher interactions; a
adoption of an
ageappropriate curriculum, ©
co-curncular activities to
ensure all-round development
of the child; a representation of children from all socioeconomic-religious-ethnic backgrounds in each class; a
appreciation for the child’s uniqueness and respect for its
feelings and emotions are some of the components that ensure
quality schooling. The school must respect the parent worthy
of all these information because parents have the right to
Information.

Health Problems:
(Because of the unfriendly Admission Procedures, Parents and
children undergo the following health problems.)
14

Trauma - Pressurising the child to
read and write, and get admission
to a good school.

Anxiety disorder - Forcing the
child to 'perform’ and instilling
competitiveness.
Depression disorder - Pressure
arising from comparisons with
peers, and not living up to the
expectations.

Alcoholism and drug addiction at a later age - The child's
ability to adapt is severely compromised, and he- is always
under stress.

Impaired visual motor skills - Children attain 'visual-motor
coordination’ only at the age of seven, but they are forced
to wield a pencil as early as two years.

NCERT Recommendations:
The National Council for Education, Research and
Training (NCERT) has been conducting Annual Seminars for
Principals of leading Schools in Early Childhood Education
(ECE) since 1989. The specific recommendations of these
Seminars have been:
(i) No admission tests for children at pre-primary
stage.
(ii) No formal instruction through reading, writing and
arithmetic at this stage

(lii) The pre-primary school should not admit children
less than 37> years of age.

15

(iv) There should be a system of licensing and
accreditation for pre-primary schools.

Computerisation - Random Selection:
The Directorate of Education, Delhi Administration
abolished its system of admission test for Model Schools in
1991, adopted the system of Computerisation - Random
Selection.
Need Regulation:

There is no Government agency to monitor Nursery
Schools regularly. This provides for exploitation of innocent
parents. But Pre-school is a
"necessary evil". There must be a
certain amount of State regulation
to discipline these institutions.

State
Human
Commission:

Rights

In the previous year a lot of
complaints about Nursery school
admission including donations
charged were taken to the State
Human Rights Commission. The
Commission enquired about the
specificcomplaints and has
provided justice to the people. Nursery school admission is a
human rights problem.

Quality Pre-primary School:
Assuring a teacher student ratio not more than 1:15
during pre-primary class,- * appointing trained teachers, *
providing: good infrastructure, * creative learning experiences,
16

* play way method of teaching, * quality teaching-learning
aids /play materials, * offering standardised age-appropriate
curriculum * arriving at the common age for admission (LKGFour to four and a half years) are some of the recommendation.
* Formal tests and'interviews given to the children / parents
for admission must be done away with. * An opportunity for
the child to visit the nursery.section along with the parents
and informal interaction with the parents should be sufficient.
The Government must take into consideration the above
indicators to ensure quality Pre-Primary Schooling.
Conclusion:

Parents should not force a child to do what they want
them to do; rather they should allow the child’ to do what
the child wants to do and be happy. Schools should, on
the other hand eliminate stressed admission procedures.

17

TN-FORCES'S GUIDELINES FOR
NURSERY ADMISSIONS
Transparency - Giving right information
The admission procedures must be clear-cut and^'
transparent. The schools must publish information leaflet-on
the number seats available, * availability of trained teachers
and their years of experience,- * the curriculum; * the teaching
methodology etc. - respecting the parents' right to
information.

The guiding principles / conditions for admission must
also be printed and such information leaflet must be freely
ava'iliable to the public who are keen to seek admission in
that school for their children. Apart from this, the conditions
must be printed behind the Application Form for admission.
Application Forms

The application form should seek only bear minimum
essential information. There should be no question on whether
both parents are educated and employed, what is their salary,f"
what vehicles they own etc. these are against the Right to
Education and Universal Education.

Preference categories such as neighbourhood
(children from within 1 km radius), contacts with the centre
(whether relatives such as parents, sibilings or others studied
in the institution; whether any relative is currently employedhe
school producing good number of state-rankers is the best
school in the city is successfully established. Parents throng
18

in the institution) must be identified Apart from the
fundamental items essential to reveal the identity of the child,
only item to clarify the preference categories may be included.

The number of seats available and the number of
applications sold must be in the proportion of 1:3. Selling
excess Application Forms mean profit making and amounts
to creating unrealistic expectations in parents.

Cost of Application Form
The cost of Application Form must be minimum, not
exceeding the printing or processing cost.
Age at admission

ECCD and ECE experts are of the opinion that 3 + for
LKG / 4+ for UKG is a generalized term meaning a child of 3
years and ond day and 3 years and 11 months. With children
of vast age difference in the same class learning the same
syllabus the age-specific domains of development are ignored
and the homogeneity of the class may be affected.
Preferable age at admission for Pre-primary Classes
Age

Preprimary Class

Below 3 years as on July 31

Creche’ or Child Care Center

3 years 6 months to 4 years as on July 31 Play Center

4 years to 4 years 6 months as on July 31 LKG
4 years 6 months to 5 years as on July 31 UKG

Preference / Positive discrimination
1)

Children from very poor families and with history of less
education and children with * disability must have positive
discrimination.

It is both difficult and unjust to detect and discriminate
19

a child as normal’at age two or three Early childhood
education itself is meant to be informal, inclusive and
within the natural capacity of any child Therefore the
over emphasis on ’normal’ child at early years could
be reduced so long as there is no significant need for
special training

Procedures - to be avoided
1)

The school should not insist on any unnecessary or
impractical criteria for selecting a child « the child must
know alphabet/numerals; a must speak in English; «must be toilet - trained etc.

2)

While considering siblings, a child should not be
denied seat because it is the third or fourth child. On
any ground, the child who is already born and ready
for schooling cannot be penalized.

3)

There should be-no screening-direct or indirect test
by way of interview, written test etc. for the parents
or the child to select or. reject a child.

+

4)

It should be remembered that any child may
have fear for new environment and cannot be
judged in a few minutes as fit or unfit for class
Interactions with the parents may only be in
the interest of knowing more about them and
the child and not to disqualify them from
admission.

No child could be admitted to the school with
recommendations from the politicians or bureaucrats
or the local rich or the friends and relatives of the
management.

**** If there are valid reasons to deny admission to a child,
the actual reason must be presented in writing to the
child’s parents.
20

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Sunday Express
Chennai, 17 February 2002

Act to check LKG
admissions urged
Express News Service

Chennai, Feb 16: As efforts to
make LKG admission procedu­
res more 'child friendly’.
Forum for Creche and Child
Care Services in TN (.TN-FOR­
CES) and Indian Association
of Pre-school Education (LAPE)
today stressed on the need for
an Act similar to the Mahara­
shtra State Act for regulation
of admission to pre-school cen­
tres.
The resolution was taken at
a discussion convened by TN
FORCES, in which educationi­
sts, parents and NGOs particip­
ated. The participants discus­
sed the existing guidelines for
admission and found practices
such as conduct of entrance
exams, age limit of 2+ in some
schools and absence of a unif­
orm guideline for admissions
as 'detrimental to child develo­
pment’.
4’rema Daniel, LAPE presid.•nt. and Shanmugavclayut
I urn
,
*
convenor of FORCES,
said there was need for more
governmental regulation and
local participation to stop the
mushrnoming of incompetent
and unrecognised "nursery sch­
.
*
ools
■Several such schools had unt­
rained teachers as their facu­
lty who wore not fit lo impart
jn-oper child care :o ihe k)d£.
they (e:r.
Participants
also
spoke

about the collection of huge do­
nations by the schools in the
name of ‘infrastructure develo­
pment’ funds. It was the respo­
nsibility of the school trust or
society to provide basic infras­
tructure and well trained facu­
lty, they felt.
Some schools even mentio­
ned of the amount to be paid as
donations in the application
form itself. Such moves by theschools defeated the very' pur­
pose of the Societies Act,
which demands the societies
and trusts to be non profit mak­
ing ventures.
Drawing up the guidelines
for ideal way' of admissions,
principal of SRF Vidyalaya
RM Krishnan, one of the parti­
cipants, said application forms
for admission to schools sho­
uld be distributed in the 1:3 ra­
tio - if there was one seat, three
applications should be given
away. An age limit of 3-r sho­
uld be followed for admitting
children to pre-KG class. Prefe­
rence should be given to cand­
idates in the neighbourhood of
the school end also to those
whose sibling studied in the
And wbil ' eliminating a stu­
dent. reasons for rejecting the
students should be explained
to the parents. Special child.n
i*
should be given a better
c{ aai>. Medical •uamitiaiion
a.id su. h othei practices shou' 1 h- done away with.

(22)

THE HINDU, Sunday, March 3, 2002

3

Parents oppose formal tests
for kindergarten classes
By Ramya Kannan
CHENNAI, MARCH 2. Even as the

State Human Rights Commis­
sion has taken up the issue of
collection of high fees by
schools, parents and their
wards seem to be concerned
about the drill of admission in­
terviews even for kindergarten
classes
While the cost of the proce­
dure was an issue, parents in
the city seem to be more vexed
with what they feel is an "un­
necessary complicated proce­
dure of tests and interviews-for
entry into the first level of
schooling"
In a recently conducted mini­
study, the convener of TN
Forces, K. Shanmugavelyutham, and a Loyola College social
work student, M. Girish, lis­
tened to parents, full of anxiety,
waiting for results to kindergar­
ten classes.
According to the study, 90 per

cent of die parents interviewed
thought the tests should not be
formal and 60 per cent empha­
sised that they should be easy
and simple. The study observed
that the examinations and
screening tests for kindergarten
children are being conducted
against the Education Commis­
sion's guidelines.
They also believe that the
school admission tests created
an unfavourable psychological
impact on the children, Mr.
Shanmugavelayutham
said.
Most children were stressed
out, afraid and confused, before
and after the tests, though all of
them had completed the PreKG schooling
•The Indian Association for
Pre School Education’s Prema
Daniel is of the opinion that
pre-schools
have
become
coaching classes for LKG admis­
sion tests. It was apparent that
parents were stressed by the in­
terview schedule, as nearly 90

(23)

per cent of the parents admitted
that they had given 'separate
coaching’ for the child.
Enquiries with the target
group, parents between 20 and
40 years seeking admission for
their wards, revealed that ad­
mission expenditure ranged
from Rs. 2,500 to 10,000 and
above. Nearly 60 per cent of the
respondents said they had paid
Rs. 5,000 and above Some of
them had applied in more than
one school.

However, despite this, 80 per
cent of the parents interviewed
were willing to go ahead with
the process, as they believe that
the schools are ‘close’ to their
homes. Only 10 per cent cited
‘good education’ as the reason
for their decision. Though they
were willing to take on the bur­
den, the system was still un­
friendly to children, even as
they hesitate to take their first
steps in the education set-up.

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Feature

V-x/Hi

rJc>2-

CF\-'O-

HEALTHY ENVIRONMENTS SHAPE
THE FUTURE LIFE OF CHILDREN
hild’s world centres around the home, school and the
U local community. These centres should be healthy places
---- where children can thrive and protected from diseases.
But in reality, these places are often so unhealthy that they
underlie the majority of deaths. Afore than 5 million children
front 0 to 14 years die every year world wide from
diseases linked to the environments in which they live,
learn and play - the home, the school, the community.

Generations of children have suffered from certain 'basic'
risks existing in their environments. These are unsafe drinking
water, inadequate sanitation, indoor air pollution, insufficient
food hygiene, poor housing, inadequate waster disposal, and
exposure to chemicals. Degraded environments are the breeding
ground for germs, worms and disease-bearing insects. Half
a billion children worldwide, many of them in South East
Asia Region, are debilitated by diseases such as malaria,
dengue fever and cholera.

Today's 'modern' risks result from the unsafe use of
dangerous chemicals, the inadequate disposal of toxic waste
and other environmental hazards, noise and industrial pollution.
Unsafe chemicals in toys and household products may also
harm children. 'Emerging' potential environmental threats to
health include global climate change, ozone depletion,
contamination by persistent organic pollutants and chemicals
and emerging diseases.

Many environmental threats to children's health are
aggravated by persistent poverty, conflicts, natural and man­
made disasters, and social inequity. The children worst affected
are those in the developing world.
Children have a unique vulncrablity. As they grow and
develop, there are "windows of susceptibility": periods when
their organs and systems may be particularly sensitive to
the effect of certain environmental threats. Children can also
be exposed to harmful environmental hazards before birth,

April 2003

for instance through maternal addiction to tobacco and other
substances. Exposure to environmental risks at early stages
of development can lead to irreversible damage.

Some environmental diseases result in long term
disability; others cause more immediate and short-term effects.
Some may result in conditions such as blindness, crippling
diseases, mental retardation and learning disabilities. These
children who are chronically sick or disabled cannot regularly
attend school and so their social and intellectual development
suffers.
This huge burden of ill-health among children constrains
the social and economic development of their countries. Children
with chronic disease and long-term disability will not grow
up to be healthy and productive people.

The suffering of children because of environmental hazards
is not inevitable. There are solutions. Most of the environmentrelated diseases and deaths can be prevented. Never before
there has been such a range of tools and strategies to protect
children from the dangers lurking in their environments.

Environmental Ilin/tH Io Children?
Children are often exposed not just to one risk factor
at a time but to several risks simultaeously. They live in
unsafe and crowded settlements, or in slums which lack access
to basic services such as water and sanitation, electricity, and
health care. They are more likely to be undernourished,
rendering them to be more vulnerable to environmental threats.
At Home: Many children are born at home, and spend
a major part of their young lives there. But from conception,
their health may be adversely affected by hazards in the home
such as lack of sufficient water, indoor air pollution, inadequate
hygiene, contaminated food and water, chemical exposure from
toxic products and many others.
At School: The school which encompasses the building,
its contents and the site on which it is located, shares many
of the same health risks as the home - as well as others
specific to its environment.

Health Education

7

In the Community: A child's community includes a
number of places - playgrounds, gardens, fields, ponds, rivers
or waste dumps, but their relative importance depends oh
a child's way of life.
The risks to children in their environments are numerous.
There are six groups of environmental health hazards that
must be tackled as priority issues - unsafe drinking water,
lack of hygiene and poor san itation, air pollution, vectorborne diseases, chemical risks, and accidents and
violence. These risks exacerbate the effects of economic
underdevelopment and they cause the bulk of environmentrelated deaths and disease among children.

Unsafe drinking water
Unsafe drinking water encompasses the availability of
safe water in the home for all domestic purposes. Access to
a reliable safe water supply is a human right. If access to
safe water is reliably assured, it contributes greatly to health
- enabling and encouraging personal hygiene through key
actions such as: handwashing, food hygiene, and general
household hygiene. When household water security is
endangered, contaminated water may transmit disease and
lack of water may prevent minimum hygiene behaviour to
protect health.

Impact on the health of children
Many of the diseases that can be prevented through
use of safe water are the same as those that can be transmitted
by contaminated water.
The most important among them is diarrhoea, the.,
second largest child-killer in the world. Diarrhoea is estimated
to cause 1.3 million child deaths per year - about 12% of
the total deaths among children under five in developing
countires. Other infectious diseases with similar patterns of
transmission include hepatitis A and E, dysentery, cholera and
typhoid fever.
Lack of household water security is also associated with
skin and eye infections including trachoma, which may result
from poor personal hygiene.

8

April 2003

Some chemicals that have the potential to harm people's
health can be found in drinking water. For example, an excess
of fluoride in drinking water is associated with crippling
skeletal fluorosis. In countries whore high levels of arsenic
are found in drinking water, the symptoms of arsenicosis are
sometimes seen amongst young children.

Protection of children front risks
front contaminated water:
*

Extending access to improved water sources in rural
and urban areas.

*

Targeting hygiene education at both children and adults.

*

Safe water storage at home : treatment of water when
its quality is in doubt - reduces water contamination
and leads to proven health benefits.
Safe water supply in schools has a direct impact on
health and provides a model intervention serving as an
educational contribution.

*

Protecting water sources from contamination will
contribute to Imnll.h (Hint Is, not only houicoh of drinking

water but also, for example, water used for bathing.
*

Targeting measures in areas affected by hazardous
chemicals in drinking water such as lead, fluoride and
arsenic.

Hygiene and sanitation
The safe disposal of human faeces, including those of
children, is a prerequisite to protecting health. In the absence
of basic sanitation, a number of major diseases are transmitted
through faecal pollution of the household and community
environment. Even if good sanitation facilities are available,
they are not always adequate to improve people's health.
Children and adults must be educated to wash their hands
with soap or ash before meals and after defecating.
In countries of the South-East Asia Region, most people
defecate outdoors, especially in rural areas and urban shuns,
and do not cover or dispose of their excreta. In rural areas
in the Region, people use water for cleansing after defecation,

Health Education

9

then clean their hands by rubbing on the wet ground and
then rinsing. One study found that 61% of the rural population
in India uses water with ash or mud to clean hands, 24%
wash with water only, and only 14% wash with soap and
water.

Impact on the health of children
The most common illness transmitted through faecal
pollution of the household and community environment is
diarrhoea. Others include hepatitis A and E, dysentery, cholera
and typhoid fever.
It is estimated that some 600,000 premature deaths occur
each year in India due to diarrhoea. The number of deaths
due to diarrhoea in the Region as a whole would be higher
and certainly poor hygiene and inadequate sanitation contribute
to this burden of disease.

Lack of clean water and sanitation is also associated
with helminth infection (over 1 billion infections worldwide)
and with Trachoma. Trachoma causes irreversible blindness
with about 6 million people worldwide visually impaired by
this disease.

Improve hygiene and sanitation:
*

Ensure that children have access to safe sanitary facilities
and that children's faeces arc safely disposed of.

*

Adequate and separate latrines for boys and girls in
schools can encourage latrine use and thus reduces
disease transmission as well as school drop out rates
in girls.

*

Proper solid and liquid waste management and relocation
of waste dumps away from human settlements protect
children from exposure to health hazards.

*

Washing hands with soap before meals and after
defecating significantly reduces the risk of diarrhoeal
and other water borne diseases.

10

April 2003

Air pollution
Air pollution is a major environment-related health
threat to children and a risk factor for both acute and chronic
respiratory disease as well as other diseases. Globally, around
2 million children under five die every year from acute
respiratory infections (ARI), many of which are related or
aggravated by environmental hazards.

Indoor air pollution (LAP) is a major factor associated
with acute respiratory infections. A pollutant released indoors
is often more dangerous to a child's health than a pollutant
released outdoors. Limited ventilation increases exposure,
particularly for women and young children in poor households,
as they spend long periods of time indoors.

Cooking and heating with solid fuels such as dung,
fire wood, agricultural residues or coal is the largest source
of IAP. When used in open cooking stoves, the fuels emit
substantial amount of pollutants including particles that are
inhaled without hindrance, like carbon monoxide, nitrogen,
sulphur dioxides and benzene. Nearly 75% of the population
in the SEA Region cook with biomass fuels. An estimated
500,000 women and children die hi India each year due
to IAP-related causes.
Outdoor air pollution from traffic and industrial
processes affects an estimated 25% of the total 1.7 billion
population of the South-East Asia Region, particularly in the
ever-expanding and crowded mega cities of the Region.
Mortality from ambient air pollution in SEAR countries
is significant as it is estimated to cause 124,000 premature
deaths, close to 1% of all deaths in 2000.

Impact on the health of children
Ambient air pollution has been associated with adverse
pregnancy outcomes such as low birth weight and stillbirths.
Studies have shown reasonably consistent and strong
relationships between the indoor use of solid fuels and a
number of diseases. IAP has also been associated with
tuberculosis, asthma and with blindness from cataracts. In
2000, indoor air smoke caused approximately 692,000
premature deaths in SEA, nearly 4.3% of the total
deaths.
Health Education

11

Protection to children from air pollution:
Good ventilation, clean fuels and improved cooking stoves
decrease indoor air pollution and the exacerbation and
development of acute respiratory infections.

Protecting children from smoking and from passive
smoking reduces the risk of respiratory disorders and
other ailments later in life.

*

Use of unleaded gasoline reduces lead exposure in
children and prevents developmental disorders.

Health policies to reduce respiratory illness and
unintentional injuries.

Vector borne diseases
In principle, all vector-borne diseases are a serious
threat to children's health. Some, however, pose a specific
threat to children, because a child's immune system is unable
to cope with the assault by the infectious agent, or because
the way a child behaves may increase vulnerability to disease.
These diseases include: Malaria, Lymphatic filariasis, Japanese
Encephalitis, Dengue Fever and Leishmaniasis.

Impact on the health of children
Although malaria affects people of all ages, children in
general and underprivileged children living in socio-economically
deprived conditions in particular are at a greater risk. Malaria
is one of the major causes of childhood anaemia and spleen
enlargement. It decreases cognitive abilities in children and
is considered an important cause of school absenteeism. Malaria
during pregnancy can lead to low-birth weight babies.
Unprotected children and those going to bed early become
more prone to mosquito bites in the early night hours.
Children who spend considerabe time in schools,
playgrounds and parks located in areas with plenty of surface
water are prone to infective mosquito bites. Day-biting and
split-biting habits of Aedes mosquitoes put the school children
at a greater risk of getting Dengue fever.

Untreated infection with worms of filariasis during
childhood can lead to development of elephantiasis. It can

12

April 2003

become a cause of social stigma affecting people of all ages
including children.

Kala Azar is a major cause of liver and spleen
enlargement in affected children in endemic areas. It can lead
to death if untreated.

Protection to children against
vector borne diseases:
As children usually go to bed earlier than adults, when
mosquitoes become active, the use of insecticide treated
mosquito nets and the screening of windows and doors
provide a very effective means of protecting them against
malaria.

General environmental management, improved water
management in irrigated areas, placing cattle strategically
between breeding places and homesteads, and drainage
or filling of water collections, may help reduce
transmission risks.
Rice production and pig rearing close to housing must
b<> avoided l.o lironli the >Iii|iiiiiom<< EiK'nplinlll.in cyclo,

*

Breeding of mosquitoes in the house can be prevented
by keeping water storage containers fully covered, and
periodically emptying, and drying out containers that
retain water. This will help to reduce Dengue transmission
risks.

Chemical risks
As a result of the increased production and use of
chemicals in every walk of life, children are exposed to a
myriad of chemical risks in homes, schools, playgrounds and
communities. Chemical pollutants are released into the
environment by unregulated industries or are emitted by
motor vehicles or toxic waste sites. Household chemicals such
as pesticides pharmaceuticals and other chemical products
become dangerous if they are kept in inappropriate containers
and in places that are accessible to children. Small children
are "natural explorers": they may ingest dangerous chemical
products and suffer acute poisoning. The result can bo lift)
threatening or disabling.
Health Education

13

Pesticides are the most common toxic compounds found
in the rural areas of the South East Asia Region. Pesticides
unsafely used, stored and disposed of indiscriminately may
harm children and their environment. When applied without
protection and/or excessively, pesticides pose immediate threats
to human health. Children work in agriculture at an early
age. They get exposed directly when they have easy access
to pesticide containers, or while preparing the pesticide
mixtures, or during spraying operations. Pesticides may also
enter the children's body as pesticide residues in contaminated
food and water. Children who work from an early age in
cottage industries - such as bangle industry, beedi rolling or
production of fire crackers - are often exposed to toxic and
hazardous chemicals that are widely and unsafely used.

Chronic exposure to various pollutants in the environment
is linked to damage to the nervous and immune systems. Most
exposures to toxic chemicals and pollutants are preventable.
A number of tools and mechanisms are available to help
identify chemical hazards, create safer environments and prevent
children's exposure. Chemicals of natural origin such as arsenic
or fluoride in water may also represent a special environmental
risk for children.

Impact on the health of chidren
In the South East Asia Region, the single largest
contributor to child poisoning is kerosene. It produces chemical
pneumonitis, secondary infection and eventually, respiratory
failure. The most dangerous household products are - bleaches,
strong detergents and oven cleaners containing sodium
hydroxide, which, if ingested, produce corrosion of the digestive
tract followed by painful, serious sequelae. Repeated surgery
and years of rehabilitation are required for a child who
inadvertently ingests a drain cleaner or crystallised caustic
soda found in the kitchen.

Children are very vulnerable to the neurotoxic effects
of lead in paint, which may reduce their IQ and cause learning
disabilities. They are also vulnerable to the developmental
effects of mercury released into the environment or present
as a food contaminant.

14

April 2003

Protection to children against
chemicals risks:
Ensure safe storage and packaging, and clear labelling
of cleaners, fuels, solvents, pesticides and chemicals used
at home and in schools.
Educate parents and teachers about the potential chemical
hazards. Promote safe toxic-free products and toys.

*

Train health care providers on the recognition, prevention
and management of toxic exposures. Incorporate the
teaching of chemical safety measures into school curricula.

*

Create and enforce legislation to promote the safe use
and disposal of chemicals.
Avoid construction of homes, schools and playgrounds
near polluted areas and hazardous industrial installations.

Accidents and violence
Approximately 20% of all deaths from injuries world­
wide ocur in children under 15years. In 2001, an estimated
685,000 children under 15 wore killed by unintentional injuries.
World-wide, the lending causes of death from unintentional
injuries among children are road traffic injuries (21% in this
age group) and drowning (19%). A safe home, safe roads and
freedom from violence constitute fundamental human rights
for every child.

Impact on the health of children
Water collections and swimming pools are the causes
of drwoning; falls from roof-tops, balconies can result in
serious or fatal injuries. Unprotected and open fires, stoves
and heaters can cause severe burns to children. Toxic agents,
ranging from household chemicals to agricultural pesticides
cause poisoning. Physical, emotional and sexual abuse of
children are a common form of violence. At school, sportsrelated activities and unsafe play areas are the major risk
factors, inaddition to abuse and violence by teachers and
bullying among children.
Motor vehicle accidents by untrained drivers or under

the influence of alcohol, in motorized two-wheelers without
Health Education

15

safe helmet and pedestrian injuries are emerging as major
causes of road traffic injuries in urban and rural areas alike.
Keeping this in mind, WHO will be launching a global
campaign on Safe Hoads during 2004.

Protection to children from accidents
and violence:
Develop national policies on injury prevention.
Improve enforcement of existing laws.

*

Educate the community in first aid.
Organise public awareness campaigns on injury
prevention. Educate school children on road safety
precautions.
Enclose cooking areas and keep matchboxes and lighters
out of reach of children.

Young children should not cross the road alone. They
cannot judge the speed of vehicles and the potential
danger.
*

*

Use child safety seats and safety belts in motor vehicles.

Play safe! Fireworks can injure the eyes and other parts
of the body.
Enforce the law preventing under 18 adolescents to drive
motorized vehicles.

*

Use helmets when riding on motorcycles and scooters.

*

Ensure that play grounds in schools are safe.

•

Use peer counselling to prevent violence.

"

Protect girl children from sexual abuse and molestation
in the school and after school.

WHO -South East Asian Region

For additional information,
refer to websites:
http:llwww.whosea.orgldprlareas.httn
http:llwww.who.intlviolence_injury_p revent ion.

16

April 2003

Studies

CHILD TO CHILD TEACHING
TECHNIQUE IN NUTRITION
EDUCATION
Dr. II. Varalakshrni
*
Dr. R. Jayasree
**
"Let the child look and look again
and understand what and help him
understand what he sees"
• Bill Brohier

Introduction
ducati'n as a dynamic, stimulating experience, would
motivate individuals to develop themselves. This is
especially true in the case of the children who have
a flexible outlook of life during l;ho formative Rtngos. Nutrition
education must bo given to children to unable them l<>

understand that adequate nutrition is essential for good health
that inturn will change their attitude towards food habits
and normal physical and mental development. According to
UNESCO! 1983), nutrition education in schools can help to
alleviate and even prevent the incidence of nutritional
deficiencies among vulnerable children. In this context, a
nutrition teaching objective often discussed should make
gaming more germane to the nutritional related skills learnt
in the classroom to real life situtations.

Such a development pre-supposes a change in direction
on health care and greater community involvement. The
design for the "Child-to-Child programme" was first developed
by the Institute of Education and Child Health of London
University. The International year of child in 1979 brought
Education and Health together to launch the Child-to-Child
concept as a contribution to promote health and education
*

Snmnnya Niahnt

»•

S.P. Mahila

Viavavidyalaynm, Tirupati-517 502.

CMC.

Health Education

17

services. The programme was launched in many countries.
An evaluation of the programme in 1981 recorded nearly
seventy countries involved in Child-to-Child activities. Each
country added its, own particular flavour to this teaching
programme.

In view of the fact that some 350 million children in
the developing countries remain beyond the reach of even
a minimum of essential services in the fields of health,
nutrition and education, child to child approach should be
considered a novel and bold initiative to provide nutritional
education to children. This was welcomed by the WHO and
commended throughout the world. The present study tries
to investigate the child to child approach and its impact on
nutrition knowledge acquired by school children in Tirupati
with the following objectives.

Objectives:
1.

To study the impact of child-to-child teaching technique
on nutrition knowledge of school children.

2.

To observe the difference between the percoive.d
knowledge of student communicators mid their relation
to the efficacy of the child-to-child teaching technique.

3.

To observe the difference between the knowledge gained
bj' the male and female student commnunicators and
the student commnicatees.

Methodology:
From the schools, the list of boys and girls studying
in VIII class were collected and the names of the boys and
girls were arranged in an alphabetical order separately. Among
them 29 boys and 21 girls were selected using tippets random
sampling technique.
The sample was divided into two groups as student
communicators and student communicatees on the basis of
age and sex.

The student child communicators were selected by
observing the children for two days in various activities during
class hours, while at play, during leisure and also with the

18

April 2003

Kelp of the socio-gram technique and by discussing with the
concerned teachers.
The socio-gram technique is concerned primarily with
obtaining choices in interpersonal relations such as - with
whom one would like to work, play, etc., or to whom one
would go for advice on problems. It attempts to describe social
phenomenon in quantitative terms. It may be used in selecting
both professional and lay leaders but a greater use of it is
made in the latter case.

It is necessary that the persons involved in a socio­
metric test know one another. It is also to be emphasized
that the grouping of individuals on the basis of socio-metric
tests is in terms of choices relative to specific situations.
The following questions were formulated under sociogram technique for the study:
1.

Whom would you consult when you have any doubt
with your studies in your class?

2.

With whom would you like to study?

.'J,

With whom would you aharo your problem?

4.

Who among the classmates come to you for help?

Selections of content:
A large number of diet and nutrition surveys have been
carried out among the school children in India. The findings
have shown that majority of school children are malnourished
and consume poor diets. The diets of these children are
deficient in calories, proteins, Vit"A", riboflavin, folic acid, Vit
B12 and iron. The signs and symptoms of anaemia and B
complex dificiencies are widely prevalent among school children.
In the light of these deficiencies among the school children
and also the inadequate emphasis on the efforts to solve the
problem in the educational sphere, we selected "Vit B. Complex"
and Iron as the knowledge content for the current study.

Tools for Data collection:
A structured KAI’ questionnaire was developed and used

for the study. To suit the profile of the sample, the questionnaire
Health Education

19

was developed in Telugu the local language This questionnaire
was administered twice i.e.,

(i)

In the first stage of the study, to collect basic knowledge
of the student communicators and communicatees

(ii)

In the second stage after imparting nutrition education
on B-complex and Iron to find out the impact of the
educational programme and the changes in the knowledge
level.

The questionnarie contained two parts. The first part
of the questionnaire (i.e., part 'A') was used to collect general
information. The second part of the questionnaire, (i.e. partB) was used to collect nutrition knowledge from the students
on B.Complex and Iron.

Checklist was also designed and used as an instrument
to findout the nutritional practices of the children.

Choice of Methods and

Aids:

For imparting nutrition education to children on the
identified areas, teaching technique was used in a formal class
room atmosphere.

Demonstration method was also employed to exhibit the
foods rich in Iron and B.Complex vitamins. The visual aids
used were black board, flannel graph, posters and charts
relevant to the topic. The project was implemented as follows:
A pre-test on nutrition information of B.Complex vitamins
and Iron was administered to assess the knowledge level
of the children. All the children, both the student communicators
and the student communicatees were given the structured
questionnaire to answer.

The student communicators were given nutrition
education relevant to the study, not in the form of lesson
plans but in the form of messages related to:

*
*
*
*

Importance of B.complex vitamins and Iron to our body.
Deficiencies that may occur due to low intakes.
Rich food sources of Iron and B-Complex vitamins.
How to avoid these deficiencies through diet.

20

April 2003

The student communicators were asked to convey these
messages to their fellow classmates, every one of them to
teach atleast four communicatees (i.e; 1:4 ratio). They were
asked to convey the message during their leisure hours at
school or while at play or at their home. The student
communicators were monitored while conveying the messages
to the children and given support and their problems/ doubts,
if any were cleared there itself.

In the same manner all the messages were given to
the student communicators with intervals of fourito five days.
And before giving them the messages of the next topic, the
messages given earlier were reviewed. During the period of
study, continuous monitoring of the student communicators
and the student communicatees were done.
At the end of the study (i.e; after imparting all the
nutrition messages,) the same structured questionnaire which
was used for pretesting their nutritional knowledge level was
used again to post-test the knowledge acquired.

Impact of Study
The mean pro-lost mid poHl-loHl scores of both tho

student communicators and the student communicatees were
compared
Table 1: Mean knowledge pre-test and post-test
scores of student communicators.
SI.
No.

Sample

1.

Student Communicators

Mean
Pre-test Score Post-test Score
7.2

14.9

The above table shows that the final mean knowledge
of the student communicators were higher than their initial
knowledge. This indicates that the nutritional knowledge of
the respondents increased after the nutrition education
intervention programme.

Health Education

21

Table 2: Mean knowledge pre-test and
post-test scores of student communicatees
SI.
No.

Sample

1.

Student Communicatees

Menn
Pre-test Score Post-test Score

7.3

13.6

From the above table, it can be seen that the mean
post-test scores of the student communicatees is higher than
the mean pre-test scores. The increase in knowledge shows
the impact of the nutrition education intervention.
From table 1 and table 2, it is evident that there is
no apparent difference between the calculated mean pre-test
scores of both the student communicators and the student
communicatees. This might be due to the fact that the
students of the selected schools might have been exposed to
a similar kind of stimulus environment both at home and
school with regard to the concepts selected. Since the
background knowledge of both groups of students is similar
(7.2, 7.3) as is evident from the scores of the two groups,
the student groups were comparable with one another.
The effect of the intervention programme could be seen
through the increased knowledge of both the student
communicators and the student communicatees in the post
testing exercises. But the student communicators showed a
higher increase in their knowledge compared to the student
communicatees. This might be due to the extra instruction
provided to the student communicators during the nutrition
education programme. This was done to prepare them for
effective teaching. In fact, they were motivated to learn the
lesson plans more thoroughly by being more attentive compared
to the student communicatees. The findings are in line with
study of Louise and Ellaine (1979) who have asserted that
using student tutors has long been recognised as a beneficial
technique for both the tutor and the tutee.

An observation checklist with ten questions were framed
to know the nutritional practices of both student communicators
and communicatees. The mean scores were 7.3 and 7
respectively, which shows that no significant difference was
there between the two groups because of exposure to similar
kind of atmosphere. Hence the nutritional practices of the
22

April 2003

student coniunicator and the student communicatee are almost
the same.

Findings:
1.

Increase in the final mean scores of the student
communicators indicating the gain in nutrition knowledge.

2.

The mean post-test scores of the student communicatees
is higher than the mean pre-test scores.

3.

Significant increase in the knowledge of the student
communicators were seen.

4.

Significant increase in the knowledge from the pre-test
to post-test of the student communiatees was observed.

5.

There was not much difference between mean pre-test
and post-test scores of male and female student
communicators and also the male and female student
communicatees.

6.

The nutritional practices of the student communicators
and the student communicatees showed no significant
difference indicating similar kind of atmosphere to which
limy wore expound with almllar loe.nllly mid Hurlo tumimiiilii

status group to which they belong.

Conclusions
The study showed that the child-to-child
teaching
method of teaching and learning process is more effective than
the traditional method of teaching. The results indicate that
the higher scores of the student communicatees were a direct
result of child-to-child teaching technique with student
involvement. Student tutors participated very actively, though
in the beginning they were a bit hesitant. A drastic change
took place when the students began teaching. They became
confident and a number of close relationships developed between
the students. By using a progression from teacher to tutor
to tutee, a chain reaction can be set in motion by which
the effects of one nutrition teacher can be felt by many tutees.
Besides, the tutor will be receiving a better nutrition education
than he might have been provided otherwise.

Health Education

23

Reference
1.

Ajit Radhnva & Rajendcr grewal - 1985 Imparling Nutrition education
toRurnl School Children Indian Educational Review, April, Pg. 1&9

2.

Albanese, AA. - 1977 - The Need for Nutrition Education Proceedings
of Nutrition society of India, 21:1

3.

Lnmbo, TA - 1979 - Deputy Director general, world Health organisation,
Child-to-Child published by Max Millan Press on behalf of the Childto-child programme), Pg.5

4.

UNESCO, TA - 1983 - Nutrition - Education : A Case Study
experiences in Schools, UNESCO, Paris.

5.

Louise Mnc Kenzie & Elaine Arbor - 1979 Gross-Age • Teaching
- An Important Concept of Nutrition Education, Vol. 11, No.3, July
- September.

6.

Adivi Reddy A - 1997 - Extension Education Sree Lakshmi Press
Bapatla - 522 101, Guntur District (A.P.)

Dear Members,
Greetings from SEARB.
It is with great pleasure that I wish to communicate
to you that SEARB has been able to get functional
accomodation in the Directorate of Health & Family Welfare
Services complex, effective March 2003. We take this
opportunity to express our sincere appreciation and grateful
thanks to the Health Commissioner and the Director of
Health and Family Welfare Services, Government of
Karnataka for this noble gesture.
We are to equip the SEARB office with the required
infrastructure. A telephone has already been installed,
(Number 080-2352521.) You are requested to send all your
communications to the following address henceforth.
IUHPE - SEARB

Directorate of Health & Family Welfare
Services Complex, Adjacent to the
Office of Joint Director (Leprosy)
Anand Rao Circle, Bangalore 560 009.
Soliciting your active participation and cooperation,
Yours sincerely,
N.R. Vaidyanathan
Regional Director

24

April 2003

6H • ID

The Chief Minister of Maharashtra, Mr. Vilasrao Deshmukh observes in
‘SEARCH’, how a trained VHW takes care of a sick newborn; and in the
emergency situation of sepsis, saves lives by injecting antibiotic.

The IMR in 39 villages was reduced by 45% with Home-based
Neonatal Care.

GHC k-e

i

61

Newsline SPECiALl SEARCHES neo natal care model will be replicated in Maharashtra

State finds SEARCH key to lessen child mortality
1 . yx:. aramnn..

-..n' ’

i. . -J--. -

-.:.w

. .

. .

“This experiment, currently on’
DECEMBER!?'
' in 40 villages, should be multiplied
thousand timesby the government
□ A reportprepared by Gadchi- departments. Since all those who
roli district collector at thefag end of take the decision in the (govern­
1998blew, forthefirst time, thelidoff ment of Maharashtra are present
here and arc con­
the government-sponsored myths
about infant mortality rate (IMR) in vinced about this
tribal Maharashtra.
model. I put my
Cl SEARCH. an NGO working stamp on this deci­
in high IMR rate areas ofGadchiroli sion.’’ Chief Minis­
wrote to the State ChiefMinister re­ ter Viiasrao Deshquesting him to ponder over the sug­ mukh, said last
gestions made by the Gadchiroli col­ Monday. The CM
lector.
was visiting Shodd The Maharashtra Govern­ hgram,
(in
ment in December1999denied that Marathi, it means a
the magnitude ofIMR tn Gadchiroli village of inven­
was everserious.
tions).
the
enerally non-comSEARCH'S head­
mittal over NGO claims quarters in the naxalite-infested
over high IMR in the State. Gadchiroli district. He was accom­
the Maharashtra Government now panied by Health Minister Digvijay
has agreed to replicate Gadchiroli- Khanvilkar and top brass from the
based NGO SEARCH'S home­ health department
based neo-natal care model to
Deshmukh’s gesture has been a
tackle the vexed issues ivolving high . shot in the arm for the voluntary or­
child mortality in health-services ganisations striving to lessen the in­
fant mortality rate in rural Mahastarved rural areas...
MADHAV GOKHALE

G

...

■

- . ,

, "r,- - . ... ..

C

*

rashtraaswellasthenon-abundant health workers to change them into parison villages. This was called
communtiy areas in the urban; effective gynaecologists and ncona-„ “home-based neonatal care,” and
pockets. Anil Shidore, director of • tologists of thd villages since mid- ' was introduced in 39 action vil­
lages to begin with. Village women
Pune-based GreenEarth, consul- 80s.
Lead by Dr Abhay Bang, a- and dais, delivery assistants, were
tants for the SEARCH, told The
Indian Express. Deshmukh had as­ member of US National Academy trained to provide care to mothers
sured SEARCH of Science’s team on child mortal­ and neonates. This approach cov­
ity, SEARCH began with some ered 93 per cent of the neonates in
founder-direc­
tor Dr Abhay global pioneering studies in about
the area and reduced the mortal­
Bang that he a hundred villages in the far eastern
ity rate sizably. The IMR in Gad­
would
visit tribal district of Gadchiroli.
chiroli now was stated to have
In 1998, SEARCH published
come down to 35 per thousand
search project
since he had for the first time, its new model of live births - almost equal to that of
shared a dias village-based newborn care which.
China.
with him at a
SEARCH showed had. reduced
Barefoot doctors have been a
Mumbai-functhe mortality' by about 62 per cent. solution accepted by experts world­
tion, Shidore After it was published in the Lancet wide to ensure effective dissemi­
said.
as a major research paper, the nate of health services. According
The State SEARCH attracted global atten­ to SEARCH’S theory training local
people not only helps in enhancing
would start pilot tion.
projects based on SEARCH model
SEARCH found that nearly 60 the efficacy of medical care, but it
and eventually.-cover the entire per cent cases of child deaths are
also guarantees that the services
State, the CM said.
reported in the first month after the
reach out propcrly.Critical of agen­
Pressing for a social audit of birth. It further noted that in rural cies recording IMR Dr Bang with
child mortality in different parts of areas medical care is hardly sought NGOs working in different tribal
the State, for about two years now, for neonates.
sectors of Maharashtra, has been
SEARCH embarked upon de­
Addressing this problem, closely following instances of child
tailed surveys of the child mortlity SEARCH designed a field trial
mortality in 19 pockets of the
scenario besides training village with 39 action villages and 47 com­ State.

LEAGUE OF RED CROSS SOCIETIES

International Federation of National Red Cross
and Red Crescent Societies

Red Cross/Red Crescent Health Workers

To:

Col leagues,

No matter if you work in a hospital, health centre or in the community you are
one of the most influential persons close to the mother around the time of the
birth of her baby. Knowledge is necessary to promote breastfeeding so tutors
and nurse/midwives should be sure that they have the information which makes
them confident and successful health educators on this subject.
1)

What to you know of the local customs and beliefs associated with pregnancy
and breastfeeding? (This includes a knowledge of the incidence-how many
mothers breastfeed and for how long?)

2)

Do you understand the process of lactation, the composition of breastmilk
and are you able to educate a mother on al 1 of the advantages of breast­
feed! ng?

These areas should be covered

Nutri tional
Economic

Protective (Infectious Diseases)
Contracepti ve
Emotional
3)

Do you really make every effort to promote breastfeeding?
Ante-natal ly

*

Instructing mothers of the advantages of breastfeeding under the
the above headings.

*

At the same time you should be able to discuss the morbidity and
mortality associated with bottle feeding.

*

You should know the total local cost of feeding a child artificially
so the mother makes her decision knowing the future economic commitment.

Delivery

*

Do you use sedatives carefully so the mother and baby are alert enough
to co-operate in breastfeeding immediately after delivery?

*

Do you try to avoid unnecessary episiotomies?

Post-partum

4)

*

Do you encourage demand feeding by keeping the baby close to the mother?

*

Are you sufficiently knowledgeable to advise on various ways to improve
breastmilk supply and to prevent, diagnose and treat any complication
that may arise?

*

Medicines to stop milk should be given only to informed mothers who have
made a firm decision not to breastfeed their baby. Do you offer these
medicines before this decision has been made?

*

Do you discourage complementary artificial feeding of the baby?

*

Are you aware of methods which will re-establish lactation?

*

Have you a system of providing expressed breast milk for those premature
babies or those too weak to suck?

Do you measure your effectiveness as a health teacher by periodically count­
ing the percentage of your mothers who have had a normal puerperium and who
are comfortable breastfeeding their baby?

To attempt to promote breastfeeding without somehow controlling those who
advertise and sell commercial infant formula would be a hard task. We are
fortunate our education efforts are helped by the "Code of Marketing of
Breastmilk Substitutes", drafted by WHO, and supported by the WHO Assembly.
You should have a clear understanding of how the "Code" affects your actions
as a health professional.
The Code does NOT allow YOU

-

To have advertising of Infant Formula in your Institution or working area.

-

To allow representatives of the Infant Formula industry visit the mothers
in your Institutions.

-

To distribute or al low the distribution of free samples of infant formula
or feeding bottles at your health institutions, where these may be an
encouragement to start artificial feeding.

-

To allow industrial "milk" nurses to work from or in your institutions.

-

To accept presents or money from industry to promote the sales and use
of their products.

-

To teach the techniques of artificial feeding in a class.

Do you have changes to make
techniques?
knowledge?

in your practice?
legislation?

How are you going to make these changes?

When are you going to start? ? ? ?

Letter from the League of Red Cross Societies; reprinted by the International Baby Food Action Network (IBFAN), Geneva and
Minneapolis

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Paediatric Priorities in the Developing World
by David Morley

(Butterworths, London 1973)

Of the 500 million children under the age of 5 years, 400 million live in the
developing countries, and it is in this section that 97 per cent of all deaths in
that age group occur.
This book examines the problem facing child health services throughoutthe
developing world : the urgent need to decide which of all the measures that
may be taken to reduce the appalling levels of childhood mortality and
morbidity should have the highest priorities when financial resources are so
severely limited. Paediatricians working in the developed world will also find
the book of interest because it is now becoming clear that no country, however
wealthy, has the financial resources to satisfy all the demands which can
reasonably be made on behalf of the health of its community.
The author is responsible for the innovation of the under-fives' clinic and for
the design of a weight chart to obviate malnutrition. These two measures have
subsequently been adopted by many developing countries.

He gives valuable accounts of the special problems involved with such
priority diseases as 'severe measles', whooping cough and childhood
tuberculosis, and descriptions of their management.
An entirely new approach to family planning is presented, based on knowledge
of the local birth interval and calculation of the 'vulnerable month'. Family
planning advice is seen as an important aspect of the work in the under-fives'
clinics.

tte author's objective is to orientate the medical student or doctor towards the
^Bctical problems he will meet when involved in child care in a rural
community.

Careful emphasis is placed on the social, economic, cultural and ethical
considerations which are ignored by most medical schools.
Not only doctors but also nurses and other health workers, who play such a
vital role in the child health services in developing countries, will benefit from
the provision of this book. Finally, the author's knowledge and discussion of
various topics outside the field of medicine will be of wide interest.

Paediatric Priorities in the Developing World is written for the doctor
dissatisfied with the type of medical training which is based largely on
European systems of health care, much of which may be inapplicable to his
own country. Such young doctors for the most part have very limited
incomes, and the author believes they cannot afford books such as this at
their usual price. Fortunately, he has found sponsors to meet some of the
cost of printing and by waiving his author's rights the cost of the paper back
edition, of over 400 pages and more than 100 diagrams, has been held at
such a low price. A casebound edition is also available.

A Vast Teaching Hospital—OR-Health Centres for the
for the Doctors
Community

Copies available from
Teaching Aids at Low
Cost (TALC)
Institute of Child Health
30 Guilford Street
London WC1N 1 EH
for £1.25 ($3.20)
including cost of
post and packing.

Foundation for Teaching Aids at Low Cost

Institute of Child Health
30 Guilford Street., London UC1N 1EH, U.K.

Where There Is No Doctor
a village heallh care handbook.

David Werner
FOR. COUGHS, COLDS, AND COMMON
DIARRHEA. HERBAL TEAS ARE OFTEN
BETTER, CHEAPER, AND SAFER THAN
MODERN MEDICINES.

WHERE THERE IS NO DOCTOR is much more than a book
on first aid. Using simple words and over 1000
line drawings, the 464 page book explains to the
reader what he or she can do to prevent, recog­
nize, and treat many common sicknesses. The book
helps individuals to realize what they can do for
themselves, as well as which problems need the attention of an experienced
health worker.
David Werner explores a wide range of subjects relevant to the health of the
villager--from diarrhea to tuberculosis, from helpful and harmful home remedies
to the cautious use of modern medicines. Special emphasis is placed on clean­
liness, diet, and vaccinations.
Mothers and midwives will find the information on home birth, care of the mother,
and children's health clear and useful.

WHERE THERE IS NO DOCTOR presents guidelines for the sensible use of both tradi­
tional and modern medicines. It explains which medicines are most useful for
specific illnesses and warns against ones that are dangerous. A special section
at the end of the book gives the uses, dosage, and precautions for each medicine
referred to in the main text.
Included in the book are an index, tear-out sheets for patient reports and
dosage blanks, and special pages on vital signs and the abbreviations, weights,
and measures used in the text. A word list at the end of the book explains
terms that may be unfamiliar to the reader.

WHERE THERE IS NO DOCTOR has a new introductory
section for the village health worker, which dis­
cusses ways to determine needs, share knowledge,
and involve the community in activities that can
better people's health. The health worker is
encouraged to think of health care in terms of
both inmediate and long-term needs of the commu­
nity. He or she is encouraged to work toward a
better balance between prevention and treatment
as well as between people and land.

This introductory section stresses the importance
of using local resources whenever possible, and
of building on the people's local traditions and
ways of healing by adding to (rather than replac­
ing) them with helpful aspects of modern medicine.

G'^§Z

&■

If you want vitamins, buy eggs or other
nutritious foods instead of pills or injections.

YES

loss of feeling
(burns and
scars)

WHERE THERE IS NO DOCTOR is a revised, updated translation of a highly successful
book first written in Spanish—DONDE NO HAY DOCTOR. The Spanish version is now
used in 15 Latin American countries as a training manual for village health workers
and has been widely praised for its simplicity, clarity, and practical value.

"It has no equal in any language as a health education tool."
Newsletter
"DONDE NO HAY DOCTOR...is a breakthrough...."
in the Health Center

Medical Anthropology

Maurice King, author of The Child

'A great paramedical Merck manual for people living far from medical doctors...
outlines the complete home drug store. No book in existence makes diagnoses and
cures so easy to understand and practice. Great chapters on skin and eye diseases
as well as care of mother and child during pregnancy and birth. We need a similar
book in English for Americans--no matter how close to the doctor's office."
Whole Earth Epilog

"It is a most valuable book."

Cesar Chavez

Price List for WHERE THERE IS NO DOCTOR
CLUB FOOT

WITH CAST

We should be pleased to send you a copy of WHERE THERE IS NO DOCTOR by
David Werner.
We can assure you that the book lives up to its
illustrations, a number of which we have shown around this order form
so that you can enjoy them.
Through subsidies it has been possible to produce this book at low
cost.
However, those from the industrialised countries are asked to
pay rather more.

U.K. and other industrialised countries ....£3.60 including postage
and packing
................ £2.40 including postage
and packing

Developing countries

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WHERE THERE IS NO DOCTOR to:

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copies

We are pleased to accept cheques or money orders in any currency
negotiable in the sterling area.
However, please add the equivalent
of 50p to cover the cost of conversion.

EYE WITH IRITIS

pupil small,
often irregular
redness around iris
severe pain

HAVE COMPASSION.
Kindness often helps more
than medicine. Never be
afraid to show you care.

Listen for gurgles in the
intestines. If you hear
nothing after about 2
minutes, this is a danger sign
(See Emergency Problems of
Now try not to push hard. Take
the Gut, p. 93)
many short, fast breaths. This
helps prevent tearing the opening
(see p. 269).
A silent belly is like a silent dog. Beware!

00000000

o
o

TEACHING AIDS AT LOW COST
PO Box 49, St. Albans, Herts. AL1 4AX, U.K. Telephone (0727) 53869

o

A teaching activity of the
Tropica! Child Health Unit, Institute of Child Health, London.

SIMPLE ENGLISH IS
BETTER ENGLISH
Prepared by Dr.Felicity Savage

We use language to communicate.
If we use it more
•imply, we can communicate better. So simplifying
language means improving it. Host often, English
is simplified to improve technical communication
to non-native English speakers. Simplified
English is not only easier to reed, but also it is
much easier to translate. Writing for the non­
native English speaker is important, because so
much technical information is only available in
English. However, the improvements also help
communication between native English speakers!
Simpler languege is espeoielly important when
material is prepared for students with a limited
education. Probably, the same principles can be
applied to other languages besides English.

Hany readers can understand all ths words, or
even all the phrases in this kind of sentence,
but they get lost on the connections and miss the
meaning of the sentence as a whole. There are
seven clauses to connect here.
I have underlined
the connecting words.
This leads on to the next
rule:

Traditionally, "good English" often means the use
of long, complicated sentences, rich in'synonyms

Us must teach mothers of malnourished

while he gets used to the diet that is
taught to the mother.

2.

Use only one or two clauses in each sentence.
Keep each idea in one simple sentence,
perhaps like this -

children to food their children a better

and subordinate claueee, carefully avoiding any
repetition. But that is not an efficient way to
communicate practical information. With practice,'.
simple English need not sound babyish, and need
not offend the sensitivities of the sophisticated
- though that la a minor consideration compared to
the benefits at stake.

diet.

In some areas a special food

supplement is made to help these mothers.

While they are learning about the new
diet, the mothers can give their children

the food supplement.

Here are some of the rules which educationalista
have worked out to help us write more simply and so more clearly and effectively.
Rost of the quotations used were found when
simplifying the English script of a set of slides
distributed through TALC.
1.

Use short sentences - not more then 20 words
(and if possible, less then 16).

To help mothers with malnourished children,

in some areas a special supplement has been
prepared, which they can feed to the child
and which will make good the lack in the
• child’s diet and start him on recovery

1 /7O

The supplement

improves the child’s diet, and he starts

to recover.
These sentences can be broken down even further,
e.g. "Ra.lnourished children need a better diet.
We must teach their mothers to feed them a bettor
diet".
However, the result is longer and it can
become more difficult to connect the ideas again.

3.

Use simple familiar words -"Building" not
"edifice".
"Try"instoad of "endeavour".
"Everywhere" or "found everywhere" not
.
*
"ubiquitous
"Hake? not "construct".
If an
unfamiliar word is essential, define it the first
time it is used, and use it several times, so that
it becomes familiar. "Rosary" (string of beads).
"Bossed" (enlarged). "Pigeon" a bird). General
vocabulary often gives more difficulty then

c)
The word "so" (meaning "alto") it sometimes
used to refer back to something said earlier.
Again, it can be difficult for people to
identify what is referred to.

Us» the same word tach time. Many words have
synonyas.
Choose one, preferably the moot
commonly used, and use it every time.
4.

"Pulse" and "legume" both mean the same thing.
"Deficiency" and "lack", "although" and "in spite
of", "combination" and "interaction" are more or
less the same.

"Mothers become anaemic end SO DO children"
"The cod stores Vitamin D in the liver,
SO CAN the human ...."

5.

("So is" and "if so" are others.)

Inatoad of "got", try to use catch, obtain, become,
fetch, etc.

"So" meaning "also" can be confused with "so"
meaning "therefore". Better say "Mothers and
children both become anaemic", or "Mothers
become anaemic, and children become anaemic".

Use precise words - even if they are a little
loos familiar to a native apoaker - instead of
words with several meeningo, or idiomatic usee:

Uao "expensive" instead of "dear" or "beyond the
teach of" or "beyond the means of".

d)
"Like this" or "in this way" can cause
similar confusion.

"Approximately" may be clearer than "about" or
"something in the region of".
Make positive sentences
You can't completely
avoid negatives, but many are not neceaaary,
and positive sentences are more easily understood.

8.

"Previous" instead of "last".
"Likeness" is better than "fancied resemblance".
"Next" may be clearer than "then",
examine the child’s mouth")

(e.g. "Next,

"After" may be clearer than "when", (e.g. "After
you have examined the child, wash your hands")

Use few pronouns. The subject which "they",
"it", "he" rofars may be unclear.
"Mothers
cannot follow this advico" is better than "They
cannot follow it".
6.

7.

"Do not give skimmed milk to babies under six
months old." (Better say: "Give skimmed milk only
to babies over six months old.")

"Rickets is not uncommon in Indian children."

Why not "Rickets is common in Indian children."?
The subtle implications of "not un" will probably
be lost. If this la not accurate, perhaps it is
best either to give precise figures, or leave out
references to frequency altogether, or parhapa
"Many children in India have rickets".

Repeat words if necessary. Repetition is
forgivable if it makes things clear.

"The child receives no more
than
*
treatment for
diarrhoea." "only
*
would bo bettor, without
changing the meaning.
Again, any subtle innuendo
in the usage "no more than" will be lost anyway.

a)
When referring to a noun in the previous
sentence or before.
If you uea a pronoun,
the reader may not bo able to work out what
"it" or "this" means. In the following
examples, the words in brackets are the nouns
which have been omitted. The nouns did not
appear in the previous sentence, so repetition
was not a serious problem.

In particular, avoid double negatives, especially
a negative conditional: "Unless he eats protein,'
the child will not; recover." This means: "To
recover, the child must eat protein." "Unless"
is often confused with "if", which reverses the
message completely!

Make active sentences - they are clearer than
passive sentences.

"Ttfess last two (paps) are easily taken by
children..... "

9.

"They (ghee, oil and Jaggery) do not contain
•any protein and unless they are eaten ..."

"They need to be eaten ...." - "Eat them ...."

"They (legumes) need to be eaten, if
possible ...."

Instead of "They" etc., start the sentence
"Legumes ...." etc.

b)
Using a new word to refer to something
said before can confuse: "Hyderabad mix
consists of wheat, groundnut, Bengal gram,
skimmed milk and sugar. The first three
ingredients are roasted ....." Not everyone
realises what "the first three ingredients"are.
It is much safer to say: "The wheat, groundnut
and gram are roasted

1/79

"Her attention will soon bo directed towards
another baby" - "She will soon direct her
attention towards another baby".

But perhaps "Another baby will soon take all her
attention" recaptures better what tha passive.
suggested - that the baby is the main subject here!

10.

Use the personal and imperative form This is
especially useful when you give'instructions
on how to do things.

"Advise mothers to give children more food" is
better than "Mothers should be advised". "Yow
can see wasting of his arms" la bettor than
"Wasting can be seen in his arms".
"Treat
pneumonia with penicillin" or "Wo treat pneumonia

2

with penicillin" are battar than "Pneumonia is
treated with penicillin".

woman may run into whose pelvis has been

Thia personal form often helps you to avoid a
passive, without having to use a clumsy subject
form.

result of rickets in childhood." (34 words)

Keep comparatives simple Avoid comparatives
indicating degree.
"The weight curve was
increasing fairly satifactorlly." ("Increasing
well" or perhaps Just "increasing satisfactorily"
or even Just "was increasing".)
11.

"The cod liver oil. must be reasonably fresh"
(just "fresh").

"Somewhat similar" (Just say "similar")
"At least partially" (partly);
"rather younger" (younger)

softened and become contracted aa the

The ideas in this sentence are backwards. We do
not learn about rickets in childhood, which it is
all about, until the last three words.
The order
of ideas really should be :
Child - rickets - pelvis softened - pelvis
contracted - adult woman (pregnant) - obstetric
difficulty - we made a model to show you. However,
we must mention the model early, because we are
looking at a picture of one.

So, how about :
"On the left is a model of a woman's pelvis.
This woman had rickets in childhood.

Wherever possible, say exactly what is meant. For
example, how do you know if cod liver oil is
fresh? Ue need to know the age limit!

Her

pelvis became softened and contracted.

In

adult life, the contracted pelvis caused
severe obstetric difficulties." (32 words)

12.

Put in the connecting word, especially "who"
and "which" and "that".

"This is a form of anaemia found in babies born
to mothers living on a vegetarian diet."
"This is a form of anaemia WHICH IS found in
babies WHO ARE born to mothers WHO ARE living on
a vegetarian diet." is easier to follow.

Sometimes for a native English speaker, it can be
difficult to see where these connections are left
out.

13.

Beware of certain obscure verbal
constructions.

a)

b)

Using the word BY in "by doing" something.
e.g. "Prevent rickets BY GIVING cod liver
oil." Instead, say "To prevent rickets,
give cod liver oil."
"As" is another confusing word. "AS THIS
ia a satisfactory source of calories"
(use BECAUSE).
"As to why this condition
should arise" (? About why?),
"as to
its causation" (ebout the cause).

Surely this is better for all levels of
communication (and not babyish or offensive).
It
is two words shorter.
The only words that might
need defining are "contracted" and "obstetric"
which it is reasonable to teach to health workers.
There are not many difficult words even in the
original sentence (apart from the unnecessary
idiom "may run into"), it is the way the sentence
is strung together that could cause confusion.

USE QUESTIONS AND ANSWERS
You can use these
to pick out and emphasise the main points a
student needs to grasp. They give him a chance to
think for himself, to find out what he already does
(and does not) know, and what the teacher expects
him to retain.
In scripts for slides, questions
can encourage observation.
15.

In the older descriptive prose scripts for slides,
the questions are all put at the end. Many of the
most important points are brought out there.
But
few students read that far!
We now write all
scripts in question form throughout.
Example

a)

You cannot always follow these rules slavishly often a negative is unavoidable, or a simple
passive less clumsy than a difficult active form.
(I have never found how to avoid babies being born.
"Hia mother gave birth to him on 25th December"
makes it sound like HER birthday).

14.

EXPLAIN THINGS IN A CLEAR, LOGICAL ORDER,
ANO IN TIME SEQUENCE

Think about students' problems in ordering
information.

Old form:

descriptive prose format:

"Deficiency of vitamin 0, leading to rickets,
is not uncommon in Indian children. Here we
see a child in hospital in Hyderabad with
severe rickets.
Notice the bossing of the
head, and even in the full length picture, it
is possible, to appreciate the width of the
lower end of the forearm.
On the other side
of the picture this widening of the wrist is
shown next to a normal, rather younger child’s
arm."
This demands no effort from the student, and he
can completely miss what the slide tries to show.
Further, it assumes that he knows already what
rickets is, what bossing ia, and what rickets does
to the forearm. Much of the teaching opportunity
is therefore lost.

"The model of the pelvis on the left suggests
the severe obstetric difficulties that a

1/79

3.

Question fora:
Trying to lead the student to
make observations.
The novics is given all
the information he needs, while the experienced
student's knowledge is tested - and may prove less
sure than he thinks when ha reads a familiar
description.
In the example, the fourth question
is used to test retention of the information given
in Q.1 and Q.2.
This form is longer - but much
mors interesting. Who minds getting the answers
right?

b)

The child on the left was in hospital in
Hyderabad,
Q.
A.

What two abnormal signs does this child show?
His skull is bossed (enlarged).
The lower
end of his forearm is widened.

Q.
A.

What is the name of his condition?
Rickets.

Q.
A.

What causes rickets?
Vitamin 0 deficiency. .The bones are deformed,
because they need Vitamin 0 to calcify
strongly.

Now look at the right hand picture. One hand
is from a healthy child, the other is from a
child with rickets.

Q.
A.

Which arm is from a child with rickets?
The arm on the right, because the lower end
of the forearm is widened.

The sentence about the contracted pelvis (pt.14)
become s:
"Look at the pelvis on the left. Find the
symphysis pubis at the front, and follow
round the pelvic brim to the spine at the
back, first on the right, then on the left.

Q.
A.

What abnormality do you notice?
The two sides of the pelvis are not the same
shape.
They are deformed by rickets.

Q.
A.

Why is a deformed pelvis important?
The pelvic outlet ie smaller than normal. If
a pregnant woman has a small pelvic outlet,
the foetal head cannot go *
through.
So she

has severe obstetric difficulties.

16.

BREAK UP THE TEXT by any means you can think
of.
A solid page of writing is very hard for
people to read. Use pictures, lists of sentences,
numbered points, varied script. Sometimes
algorithms and tables can be used instead of
prose.
Algorithms and tables may help people to
follow new Information, but they may ba harder to
learn than lists of sentences.
Anything, however,
is better than solid prose!

(Based on ’’Let’s make it simple" (Better Child
Care, VHAI), and the ideas of Ken Cripwell,
Patricia Wright, Peter Godwin, and others.)

1/79

4

FL1UNDATION

FOR TEACHING ASOS AT LOW COST

Institute of Chilo Health
30 Guilford Street - London WCIN I EH

NEWSLETTER
Dear Colleague,
This last year has been a full one and we have
much to write to you, some of which we hope will
be of use to everyone.
CHILD-to-child Programme

’78

hand-held models. One of these illustrated here
(Fig.1) is now being made at an economic price
in India. Appropriately concentrated vaccines are
also available from that country. We need more
controlled trials of these machines. They are
recommended to those with a little mechanical
expertise who are willing to dismantle them and
occasionally replace an O-ring or washer.

This is a joint programme being run between the
Institutes of Education and Child Health in the
University of London. The programme was started
in September 1977 and aims to build on what the
older school-age child already does for younger
children in the family. You should already have
received one sheet describing it. This sheet is
now available also in Farsee, Arabic, French,
Portuguese and Spanish. On the blue sheet
accompanying this letter (also available in Arabic,
French and Spanish) you will see a brief descrip­
tion of the activities that have so far been
suggested from all over the world in which school
children can be involved. If you are interested
in developing a programme in your area, please let
us know so that we can put you on the CHILD-tochild mailing list.

l*.Sc.
in Mother and Child Health
—
-------------------------------------------------------

„

1978 will be the last year of the UNICEF/WHO
Course for Senior Teachers of Child Health.
Evaluations and our own experience confirm that
this course has been highly successful in helping
senior paediatricians to appreciate their respon­
sibility for all the children in the community.
We believe the new course, which will be an M.Sc.
in mother and Child Health from London University
and take 15 months, is a natural outcome of the
previous course. The new course will be for
teachers from medical schools and auxiliary
training schools. A blue booklet describing this
m.Sc. course is available.

Shakir Strip

This is now very widely used, both by local groups
and on a national scale in some countries. A new
leaflet about it is available from TALC. These
strips can be used by groups within the community.
We do, however, need more experience in how to
communicate the findings to the community. Perhaps
we should teach our health workers and mothers to
be able to assess a malnourished arm with their
finger and thumb. (Fig.2)

The Tropical Child Health Unit also runs two short
courses each summer in Duly and September.

New sets of slides
Last year was one ot consolidation, and relatively
few new sets have been added. However, in 1977 we
sent out an average of 1,000 sets a month,
totalling a third of a million transparencies!'!
Thanks to assistance from the Nuffield Foundation
we are now able to obtain additional help and
Dr.Felicity King (nee Savage) has already started
to edit and otherwise help in the production of
many new sets.

Books
We would strongly recommend two new books that have
just become available. These are David Werner’s
book ’Where there is no Doctor1, and Maurice King’s
much-researched work ’Primary Child Care*. Both
are well.illustrated, as you will see on the white
sheets describing them.

Immunisation programmes
A number of organisations are showing renewed
concern that more priority should be given to
immunisation, and a handbook on immunisation is
available from WHO Regional Offices, In particular
emphasis is being placed on the cold chain. One
area in which more research and study is required
is with jet injectors, particularly the small

Cut a piece of wood of this circumference or use
the inner cardboard of a toilet roll so that you
know what 12.5 cm. feels like with your fingers
and you can show this to others.

foundation

for teaching aids at low cost
Institute of Child Health

30 Guilford Street • London WON IEH

We

ask you Co share Chis with others

Head and pass on

BOOKS AND PAMPHLETS AVAILABLE FROM TALC.

Teaching Aids at Lou Cost (TALC) is
trying to respond to a need for certain
lou-cost books which are required by
health workers through the post, as these
are often not available locally.

Ue must emphasize, however, that no books
other than those listed below are
available from TALC.

Price
£ p

NUTRITION FOR DEVELOPING
COUNTRIES
King, Morley and Burgess

Written in simple English, with
exercises which can be
undertaken in the community.

3. 00

NUTRITION REHABILITATION
Doan Koppert

The appropriate and cost effective
method of managing malnutrition.

1. 00

THE THERAPY OF THE SEVERELY
MALNOURISHED CHILD
Hay and Whitehead

Up-to-date management in hospital.
Experience of the fl.R.C. unit in
Kampala.

30

THE 'BABY KILLER'
M. Muller

This has highlighted the problems
of bottle feeding. (French, Dutch).

50

REGULATION AND EDUCATION
STRATEGIES FOR SOLVING THE
BOTTLE FEEDING PROBLEM
Ted Greiner

Suggests how international milk
companies may use the medical
profession to propogate bottle
feeding.

85

USING THE METHOD OF PAULO
FREIRE IN NUTRITION
EDUCATION. Theresa Drummond

Excellent account of adult literacy
and nutrition programmes.

85

PAEDIATRIC PRIORITIES IN THE
DEVELOPING WORLD
David Morley

Alternative priorities to those
suggested by traditional paediatrics.
French (3.00)
Spanish (3.00)
Indonesian soon.

3. 00
)(1.50
*

(N)

PRIMARY CHILD CARE
Maurice and Felicity King

Comprehensive child care in simple
language, well illustrated.

1. 95

(N)

OBSTETRICS FAMILY PLANNING
AND PAEDIATRICS
Philpott, Sapire and Axton

Attempts to bring these areas of
health care together.

1. 50

(N)

CHILD-to-Child

Prepared for the International Year
of the Child this describes how elder
children can help younger children's
health and development.

Also free newsletter
available

95

(N)

HEALTH HAS MANY FACES

Water, housing, farming and crafts
essential in development and health.

1. 00

(N)

BREAST FEEDING, THE
BIOLOGICAL OPTION.
0.3. Ebrahim

Up-to-date information on advantages
of breast feeding.

1. 00

Total for this page

£

P

Price

£

P

1.

20

1 .

40

1 .

30

1 .

10

£

P

Brought forward from first page

(N) CHILD CARE IN THE

TROPICS

(N) CARE OF THE NEWBORN IN
DEVELOPING COUNTRIES

(N)

PRACTICAL MOTHER AND CHILD
HEALTH IN DEVELOPING
COUNTRIES

All these are designed for use
in small hospitals and health
centres by G.3. Ebrahim.

(N) A HANDBOOK OF TROPICAL
PAEDIATRICS
BETTER CHILD CARE
V.H.A.I.

Illustrated memory and teaching
aid for talking uith parents.

35

(N) WORLD HEALTH, MAY 1978

Excellent number on primary child
care.

40

Written for European mothers taking
their children to hot climates.

15

THE CARE OF BABIES AND YOUNG
CHILDREN IN THE TROPICS
David Morley

(N) WHERE THERE IS NO DOCTOR
David Werner

Highly practical, many illustrations.
A must for those developing village
programmes.
Also in Spanish (1.75)

(N) KAPOOR'S GUIDE FOR GENERAL
PRACTITIONERS, PARTS I and II

A simple description of general health
health care.
(per set)

SYMPTON TREATMENT MANUAL

Simple statement of common conditions.

40

THE VILLAGE HEALTH WORKER
'Lackey' or 'Liberator'
David Werner

Superbly illustrated, highlights
problems met when integrating the
V.H.W. into existing medical systems.

30

OBSTETRIC EMERGENCIES
3. Everett

For health centres to guide staff
in obstetrical emergencies.

30

HUCKSTER POLIOMYELITIS
R. L. Huckstep

Management of severe deformities
by surgery and appliances.

3., 00

Simply written, well illustrated,
most useful to those uith limited
training in anaesthetics.

1 .

Excellent illustrated small
booklet.

Free

A MANUAL OF ANAESTHESIA
THE SMALL HOSPITAL
F. N. Prior

FOR

THE DIAGNOSIS AND MANAGEMENT
OF EARLY LEPROSY. S.G. Broun

3., 00
(2.,00
)
*

•
2.,

00

00

Good illustrations with a simple
Statement for village health
education.

35

MEMORANDUM ON LEPROSY CONTROL
Oxfam, LEPRA, Leprosy Mission

Small illustrated booklet on the
diagnosis of leprosy.

Free

INSENSITIVE FEET
Leprosy Mission

Management of foot problems in
leprosy.

Free

GUIDELINES FOR HEALTH
PLANNERS
Oscar Gish

The essentials of Health Economies
and planning.

1 .

THE TRAINING OF AUXILIARIES
IN HEALTH CARE
Katherine Elliott

A bibliography of material and
resources for training auxiliaries.
(First edition)

MOBILE HEALTH SERVICES
Oscar Gish and Geoffrey
Walker

Cost benefit study of mobile
services and alternatives.

REPORT OF HEALTH TEAM IN
THE PHILIPPINES

Excellent guide for those setting
up village based programmes.

(N) BETTER CARE IN LEPROSY
V.H.A.I.

Total for this page

00

75

2.

50

5

Price
£

P

Brought forward from second page
CONTACT 44, C. M. C. , Geneva

An integrated health service
programme in rural India.

THE CHINESE SYSTEM OF HEALTH
CARE
H. T. 3. Chabot

Scientific account of health
care in China.

85

PATTERNS OF MORTALITY IN
CHILDHOOD
Puffer

South American study of the
interaction of nutrition and
infection.

F ree

A MODEL HEALTH CENTRE

The building and development of
low cost health facilities.

3.

SIMPLE DENTAL CARE FOR RURAL
HOSPITALS
0. 3. Halestrap

Basic knowledge for a medical
worker caring for dental
conditions. (French)

VISUAL COMMUNICATION HANDBOOK
D. 3. Saunders

For those desiring to become
more effective in communication.

1 . 50

COMMUNICATING WITH
PICTURES

Makes pictures meaningful.
(UNICEF, Nepal)

F ree

apprppriate technology
SOURCEBOOK Darrow and Pam

Solutions to village construction
problems, well illustrated.

1.

IN DEFENCE OF THE NATIONAL
HEALTH SERVICE

A counter to the criticisms of
the U.K.
N.H.S.

50

QUESTIONING DEVELOPMENT
Glyn Roberts

For those with a strong
political stomach.

40

(N) WHO NEEDS THE DRUG COMPANIES?

A critical look at the drug industry.

50

(N) TOMORROW'S EPIDEMIC? TOBACCO
AND THE THIRD WORLD
M. Muller

Describes the way multi nationals
encourage smoking in the Third
World - a disaster for development
even the tobacco farmers.

1.

20

(N) TEACHING VILLAGE HEALTH
WORKERS V.H.A.I.

A kit containing a manual and
visual aids.

2.

75

00

•

F ree

00
40

20

ANAEMIA RECOGNITION CARD

Satisfactory for detecting severe
anaemia by lay workers. (10p each)
(10 for BOp)

SET OF FOUR MEASURING
SPOONS

For use in clinics.
Measure
appropriate quantities of glucose
and salts for a litre of rehydration
fluid.
Four sets for

1.

For use in the home to prevent
dehydration.
Available early 1979
(French, Spanish, Arabic, Swahili etc.)
30 for

1. 00

(N) SUGAR AND SALT MEASURES

to MAKE the dose
add to each cup of water
1 level scoop of sugar (a)
1 level scoop of salt (b)

TAKE the dose
after every diarrhoea
a CHILD must take 1 dose
an ADULT must take 2 doses

£

p

Price?
£

p

£

p

Brought forward from third page
GROWTH CHARTS

Growth charts of this type now widely used.
undergone extensive testing.

Sample of the chart sent free on request.
Large orders £37.50/1000, carriage extra.

The TALC chart has

Ten charts .......................
(French, Spanish,Arabic)

50

Charts printed on white card intended for use by local printers to
prepare lithographic plates. (French, Spanish, Arabic)

50

Flannelgraph with detailed instruction in its use.

2.

Overlay transparent sheets.
For use in evaluating any change
in the weight of groups of children attending clinics.

2. 00

Large transparency for use with an overhead projector.

50

50

Precut stencil for standard duplicator.
Charts can be printed on
paper for training purposes. (French, Spanish, Arabic).

1. 00

A kit containing all the above can be sent for ...................................................

6. 00

Total:
+ 25% postage and packing:

* For those in, or going to developing countries.
(N) New in 1978

Orders over £10 automatically sent by registered cost.
Under £10 additional charge of £1

required for registration.

N.B. If paying by cheque or'money order in currency other than sterling, please add 50p.

Cheques should be made payable to Teaching Aids at Lou Cost or TALC.

Please print your name and address clearly.

Health
workers
need and
love
books

12/78

but
hate
today’s
prices

FOUNDATION

FOR TEACHING AIDS AT LOW COST
Institute of Child Health

30 Guilford Street ■ London WCIN IEH
We ask you to share this with others

BOOKS AND PAMPHLETS AVAILABLE FROM TALC
Teaching Aids at Low Cost (TALC) is
trying to respond to a need for certain
low-cost books which are required by
health workers through the post, as these
are often not available locally.

We must emphasize, however, that no books
other than those listed below are
available from TALC.
£

p

NUTRITION IN DEVELOPING
COUNTRIES
King, Morley and Burgess.

Written in simple English, with
practical exercises which school
children and others can undertake
in the community.

3.

00

(N)

NUTRITION REHABILITATION
Doan Koppert.

The appropriate and cost effective
method of managing malnutrition.

1.

00

(N)

FOOD FIRST
(New Internationalist).

Excellent cartoon strips questioning
assumptions concerning food shortages.

20

THE THERAPY OF THE SEVERELY
MALNOURISHED CHILD
Hay and Whitehead.

Up to date management in hospital.
Experience of the M.R.C. unit in
Kampala.

30

THE 'BABY KILLER1
M. Muller.

The booklet which has highlighted the
problems of bottle feeding.
(Also in French, Dutch and Span ioh-).

50

(N)

REGULATION AND EDUCATION
STRATEGIES FOR SOLVING THE
BOTTLE FEEDING PROBLEM
Ted Greiner.

Suggests how international milk
companies may use the medical
profession to propagate bottle
f eeding.

85

(N)

USING THE METHOD OF PAULO
FREIRE IN NUTRITION
EDUCATION
Therese Drummond.

Excellent account of adult literacy
and nutrition programmes.

85

PAEDIATRIC PRIORITIES IN
THE DEVELOPING WORLD
David Morley.

Sets out alternative priorities to
those suggested by traditional
western paediatrics.
(450 pages).

3. 00

(N)

1.
*
(

50)

French edition.

3. 00

Spanish edition.

2. 50

(Indonesian edition available soon)
(N)

CHILD HEALTH CARE IN RURAL
AREAS

Excellent book for auxiliaries from
the Narangwal study.

2. 25

(N)

CHILD HEALTH FOR HEALTH
EXTENSION OFFICERS AND NURSES
IN PAPUA NEW GUINEA
3. Biddulph.

This book arises from the long
experience of auxiliaries in Papua
Neu Guinea.

2. 75

This book describes background
factors such as water, housing,
farming and crafts, so essential in
development and health.

1. 00

(N) HEALTH HAS MANY FACES

Total for thin page

£

p

Price
£
p

Brought forward from first page
CHILD CARE/fL THE TROPICS
G.3. EbjXnim.

Appropriate forxffealth Centres.

A HANDBOOK OF TROPICAL
PAEDIATRICS
G.3. Ebrahim.

For use in Health Centres
particularly.

55
1. 30

Christian communities in the past have
done much to provide health care.
Changes towards community programmes
are described here.

50

BETTER CHILD CARE
V.H.A.I.

Illustrated memory and teaching
aid for talking with parents.

35

THE CARE OF BABIES AND YOUNG
CHILDREN IN THE TROPICS
David Morley.

Written for European mothers taking
their children to hot climates.

15

(N) COMMUNITY HEALTH ANO
THE CHURCH

(N) WHERE THERE IS NO DOCTOR
David Werner.

Highly practical, many illustrations.
A must for those developing village
programmes.
Also in Spanish.

3.

2.
(*

1.

00

00)
50

(N) THE VILLAGE HEALTH WORKER
’Lackey’ or ’Liberator'.
David Werner.

Superbly illustrated, highlights the
problems met when integrating
village health workers into existing
medical systems.

30

(N) OBSTETRIC EMERGENCIES
3. Everett.

For Health Centres to guide staff in
obstetrical emergencies.

30

Management of severe deformities by
surgery and appliances.

3.

00

(N) A MANUAL OF ANAESTHAESIA FOR
THE SMALL HOSPITAL
F.N. Prior.

Simply written, well illustrated,
most useful to those with limited
training in anaesthetics.

1.

00

MEMORANDUM ON TUBERCULOSIS
IN DEVELOPING COUNTRIES
Oxfam.

Methods of tackling tuberculosis
with limited resources.

HUCKSTER POLIOMYELITIS
R.L. Huckstep.

25

(N) GUIDELINES FOR HEALTH
PLANNERS
Oscar Gish.

The essentials of Health Economics
and planning.

1. 00

(N) MOBILE HEALTH SERVICES
Oscar Gish and Geoffrey
Walker.

Cost benefit study of mobile
services and alternatives.

2. 50

(N) REPORT OF HEALTH TEAM IN THE
PHILIPPINES

Excellent guide for those setting up
village based programmes.

5

PLANNING A COMMUNITY HEALTH
PROGRAMME

A booklet from India.
Useful guide
to developing community health
programme.

15

HEALTH CARE IN CHINA

An introductory study of what China
has achieved in revolutionizing
health care in 25 years.

50

A MODEL HEALTH CENTRE

Instruction in the building and
development of low cost health
f acilities.

3. 00

VISUAL COMMUNICATION
HANDBOOK
0.3. Saunders.

For those desiring to become more
effective in communication.

1. 50

APPROPRIATE TECHNOLOGY
SOURCEBOOK
Darrou and Pam.

Solutions to almost every village
construction problem.
Well
illustrated.

1. 20

Total for this page

2/78

Price
£
P

£

Brought forward from second page

SELF APPRAISAL AND GOAL­
SETTING GUIDE FOR HOSPITAL
DEPARTMENTS
V.H.A.I.

To help those interested in improved
management in health assistance.

QUESTIONING DEVELOPMENT
Glyn Roberts.

Only for those with a strong
political stomach.

30

40

OTHER HATERIAL AVAILABLE FROM TALC

(N) SET OF FOUR MEASURING SPOONS

(N) ANAEMIA RECOGNITION CARD

For use in hospitals and clinics.
Will measure appropriate quantities
of glucose and salts for a litre of
Four sets for
rehydration fluid.

1.

00

Coloured picture of normal and
anaemic tongue.
Proved satisfactory
for recognising severe anaemia.
Price lOp. each (10 for BOp.).
GROWTH CHARTS

Growth charts are fully described in "Paediatric Priorities in the
Developing World".
The objective of this chart is to overcome
malnutrition by promoting adequate growth.
The chart is also a
record of the child's immunisation state and can be used to
maintain an adequate birth interval and introduce the mother to
family planning methods.

1. A sample of the chart will be sent free on request.
Charts can
be sent post and packing free 10 for 50p.
Large orders @ £37.50
per thousand and carriage.
(Also in French and Spanish).
2. Charts printed on white card intended for use by local printers
to prepare lithographic plates.
(Also in French and Spanish).
3. Flannelgraph with detailed instruction in its use.

50

2. 50

4.

Overlay transparent sheets.
These may be used in evaluating
any change in the weight of groups of children attending the
clinic.

5.

Large transparency for use with an overhead projector.

6.

Pre-cut stencil to fit a Gestetner or Roneo duplicator allowing
charts to be printed on paper for training purposes.
(Also in
French and Spanish).

1. 00

A kit containing all the above can be sent for

6. 00

Total
+ 25% postage, packing and administration

*For those in, or going to, developing countries.
(N) Neu in 1977.

2/7 B

2. 00

50

p

ANY

or

THE

FOLLOWING

CAN

6E

SENT

FREE

IF

OTHER

MATERIAL

IS

BEING

ORDERED

(please tick if you require these)

THE DIAGNOSIS AND
MANAGEMENT OF EARLY
LEPROSY
S.G. Brown.

Excellent illustrated small booklet.

PATTERNS OF MORTALITY IN
CHILDHOOD
Puffer.

South American study of the interaction of nutrition
and infection.

PROGRAMME OF STUDIES IN
NON-FORMAL EDUCATION.

From Michigan State University.

CHILD-to-child PROGRAMME

Involvement of school children in the care of small
children.
A programme for the International Year of
the Child (1979).

’Measuring Malnutrition’ - The Shakir strip.
Reading list.
Resources list of addresses for teaching material.
List of free journals.

Please add 25% for administration, packing and postal charges on every order.

Registration fee,

if considered necessary on orders below £10, please add £1.

Orders over £10 will be automatically sent by registered post.
N.B.

If paying by cheque or money order in currency other than sterling, please add 50p.

Cheques should be made payable to Teaching Aids at Low Cost or TALC.
Please print your name and address clearly.

Health
workers
need and
love
books

Foundation for Teaching Aids at Lou Cost,

2/78

but
hate

today’s
prices

Institute of Child Health,
30 Guilford Street, London UC1N 1EH.

FOUNDATION

FDR

TEACHING AIDS AT LOW COST

Institute of Child Health

30 Guilford Street

NEWSLETTER

London WCIN IEH

’80

Dear Colleague,
As we move into the eighties it is a moment to
look back briefly.
In the seventies the Tropical
Child Health Unit was set up in the Institute of
Child Health.
Its major responsibility at that
time was a UHICEF/WHO course for Senior Teachers.
Since the autumn of ’78 this has been replaced by
an PI.Sc. course in Mother and Child Health and the
first nine Fellows to take this course completed
it successfully in December 1979. We were
delighted with how the new concepts in the course
developed and the enthusiasm with which the first
group of Fellows greeted this course. If you are
interested or know someone who is interested,
please write in for the Blue Book. The seventies
also saw TALC become one of the major distributors
of teaching material in the health field. We now
send out a third of a million transparencies a
year as well as much other material.

Lastly, 1979 saw the
Fiacre 1
start of the CHILD-to
child programme
developed jointly
between the Institutes
of Education and Child
Health of London
University. You may
already know about
this programme and
have seen the book
CHILD-to-child. In 1980
this will be available
in Indonesian, Spanish,
French and Portuguese.
The blue sheet accompany­
ing this letter will
bring you up to date with
news on this programme
which was started for the
International Year of the
Child and promises to be
one of the most effective
programmes coming out of
that year. The older
child is an important
’unexploited' agent for
better child health and
development.
Objective of this letter

Through this letter we hope to encourage you in
what you are doing and perhaps to pass on new ideas
and new concepts. In the eighties we are moving
from a situation where health care workers
(largely doctors) took care of others into one
where we are HELPING OTHERS TO TAKE CARE OF
THEMSELVES,
Where there is no Doctor by David Werner is perhaps
the most important book in health to come out in
the last decade and is the source of the drawing
in Figure 2. How available in Portuguese and
Spanish and soon in many other languages.

What sort of health care do people need?

King's ’Micro-Plan'
Maurice King has produced a package of inter­
related material. You are likely already to have
seen his excellent book Primary Child Care (red
cover). This book will particularly help nurses
and medical assistants as they take over most of
the primary care of children.
Do you have Primary
Child Care : The Manager's Guide (green cover)?
With this there are ten sets of slides listed under
PCa-j on the slide list. Lastly, we also have
available a simple method by which the correct
answer to three thousand multiple choice guestions
in the green book can be immediately determined by
the student. As he dabs the correct letter with
washing soda, the phenolphthalein dried onto the
appropriate letter gives a brilliant colour. Try
it out, both you and those you work with will
enjoy it - learning becomes more fun.

See Hou They Grow
Paediatric Priorities in the Developing World has
been widely distributed in English, French,
Indonesian, Portuguese and Spanish. Now a further
book is available which extends these ideas but
concentrates on the Growth Chart and how this is
used in community-based health service. Thanks to
grants, See How They Grow by David Morley and
Margaret Woodland, published by MacMillan, costs
only £1.50 for 265 pages with 152 diagrams (see
TALC list).

Communication of Innovation

How effective are you in spreading new ideas and
concepts in your community? Even more important,
how good are you at getting others to do this?
Does your mail bring you in enough new ideas? If
not, fill in your address in the space on the
yellow sheet, return to TALC and receive some of
the free newsletters that are available.

Spoons for Rghydrat.icn
In parts of the world 40% of deaths in the second
year of life are from dehydration.
If the right
solution containing salts and sugar is fed to
children with diarrhoea, dehydration with much
malnutrition and death can be prevented. Pleasuring
spoons for making up such a solution are now avail­
able from TALC embossed in Arabic, English, French,
Portuguese and Spanish. Has this been tried out
in your area? L'e badly need reports from around
the world on its use. If you can undertake a
trial, write to us for 50 free spoons.

Have you learned to "feel malnutrition"?
Figure 3.

Village health worker feels

Do visit us - we are only 10 minutes from Russell
Square tube station which is now
of an hour’s
run by tube from Heathrow. Try and let us know
you are coming. (’Phone Pat Harman, 01-242-9789)
You can see and order all the TALC material but
slides are no longer available for purchase at
the T.C.H.U.

Tropical Child Health Unit

CHILD-to-Child

William Cutting
Zef Ebrahim
Pat Harman
David Morley
Celia Robinson
Marcia Wickramasinghe

Paula Edwards
Duncan Guthrie
Buliet Gayton
Hugh Hawes
Rhylva Offer
Beverley Young

TALC

Phone:

Christine Bate
Bo Batkin
Buliet Bending
Christine Dayton
Bane Dorling
Sheila Frazer
Gill Gadsden
Lesley Humber

St.Albans (0727) 53869
Leila Lauder
Boan Lund
Diane Merryfield
Marion Newman
Gillian Oliver
Dorothy Stranks
Bean Turner

Teaching health workers
to’ f eel the “size d’f ’p’ieces
of wood representing
malnourished children.

Prepare appropriate pieces of wood or rolled paper
putting these in a bag for your staff to learn
their "feel". Then make sure that when they meet
a child between one and five, they always feel to
assess the arm circumference
Breast Feeding

In Europe there is a return to breast feeding:
over 80% of Swedish babies are breast fed at two
months. At a meeting in Geneva (October 1979)
important recommendations were accepted by
international milk companies. These include "There should be no sales promotion, including
promotional advertising to the public,
Promotion to health personnel should be restricted
to factual and ethical information."
Full report available from W.H.O.

Pew sets of slides (Still only £0.90 in L.O.C.s)
As well as the ten sets already mentioned to go
with King’s book, we have a number of other new
sets. Equally important and strongly recommended
are the sets on CHARTING GROWTH and BREAST FEEDING
which have been completely renewed.

Flannelqraph
On the pink sheet is a description of an excellent
flannelgraph particularly appropriate in Africa.
Visits and courses in 1980
As usual we shall have two orientation courses in
1980. The dates are Duly 7-11 and September 1-12.

PRIMARY CHILD CARE - WHICH OPTION?

FOUNDATION

FOR TEACHING AIDS AT LOW COST
Institute of Child Health

30 Guilford Street - London XA/CIN I EH

TALC sells teaching aids for health workers at or below cost price.
Our purpose is to help raise standards of health care, especially
in the developing countries.
A major activity is producing and
distributing sets of colour slides on various health topics.
With
the sets are scripts describing each slide, and usually including
questions and answers.
This is a teaching activity of the Institute
of Child Health of the University of London.

TALC is a non-profit making organisation; - we keep all prices as
low as possible, and offer reduced rates when we can.
However, we are self-supporting, so we are bound to cover our costs.
HOW TO ORDER: Complete the order form below, and send with cheque or money order to
-----------------------TALC at the above address in London.
MAKE CHEQUES PAYABLE TO: Teaching Aids at Low Cost (TALC).
PAYING FROM OUTSIDE THE U.K. (OR FROM EIRE): If possible arrange for payment in sterling
on a London Clearing Bank.
Or: Pay in your own currency on your own local Bank.
Or: Pay
in U.S. dollars on a U.S. Bank.
Please do not send a sterling cheque drawn on a Bank
outside the U.K.
It is expensive for us to cash these.

If paying in currency other than sterling, please ADD the equivalent of 50p to each
payment.
This is the average cost to us of converting cheques.
Airmail postage: Prices listed cover packing and surface postage only.
For airmail postage
of mounted or unmounted slides, add 40p per set.
For all other items postage is charged at
cost and we will invoice you after despatch.
If you wish, we can invoice you for items and
postage together.
V.A.T.: This is a U.K. tax which must be paid on ALL ITEMS SENT TO AN ADDRESS IN THE U.K.
Please add 15% to your payment. Visitors from overseas must pay V.A.T. if the items are
sent to them at a U.K. address.
You need not pay V.A.T. if the items are sent to an
overseas address.

ORDER FORM

(please write in block capitals)

NAME

ADDRESS you want order sent to:

PERMANENT ADDRESS if different:
(for our mailing list)

.REQUIRED:
To order slides, give CODE LETTERS only and state "Self-mounting"
"Pre-mounted", "Folder" or "Bar", "Slide/tape set".
Total cost of items

V.A.T.

15%

Airmail postage

Currency conversion 50p.

Total in U.K. currency

*..................

Total sent in your
currency

PRICE:

This will depend on the form in which slides are sent.

All prices include packing and world-wide surface postage.
Prices are for sets containing
24 slides.
For sets containing 48 slides, the price is double.

‘Prices in brackets are reduced rates for people working in developing countries, or who
will soon go to such a country.
SELF-MOUNTING SETS:

£1,45' (90p)* for 24 slides and script.

To keep the cost low, we send the slides as a film strip
for you to mount yourself.
Self-sealing mounts and
instructions are included.
These sets are very popular,
and most people have no difficulty mounting the slides.
PRE-MOUNTED SETS: £2.00 (£1.50)
*

for 24 slides and script.

Exactly the same items - but they cost more because the
slides are ready-mounted.

SETS MOUNTED IN PLASTIC FILE/FOLDER OR FILE/BAR:
£3.50 (£3.00)
*

for 24 slides and script.

Each set of slides comes in a special plastic sheet with
24 pockets.
Up to four sheets are put into a card
folder with their scripts.
Or, you can hang the plastic
sheet on a bar to store it in a filing cabinet.
(Please
state "bar" if you would prefer this to a folder.)
You can also use the plastic sheets to prepare slides
for a lecture.
(Hold the whole sheet in front of an
X-ray viewing box or window.)
And you can fold the
sheet up to carry the slides in your pocket.

SLIDE/TAPE SET: £11.00

*
(£8.00)

A mounted set of slides, a cassette with the scripts
recorded on it, and the written script in a plastic file.
Students can listen to a lecture recorded anywhere in
the world and see the slides that go with it!
This may
also help you to understand spoken "medical" English.
Any cassette tape player and projector can be used,
(or one shown below.)

SLIDE/TAPE TUTOR: £60.00, postage not included

For individual students working in a library.
It can be permanently locked to a desk.

SLIDE/TAPE PROJECTOR: £88.00, postage not included

For small groups of students.
You can lock it
on a table in a sound-proof cubicle or small room,
so that the tape recorder does not disturb others.
Includes a small daylight screen.

SETS

OF

SLIDES

COLOUR

* New in 1979

(Sp)

Script in Spanish available

Code

AmP

PROTOZOA:

Related to South America but relevant elsewhere.

AmH

HELMINTHS:

Those of importance in human disease.

*
Bf

BREAST FEEDING: Available in a few months.

BL

BURKITT'S LYMPHOMA:

CcO

CANCRUM ORIS:

Cd

CONTRACEPTIVE DEVICES:

*
ChG

CHARTING GROWTH IN SMALL CHILDREN:
others.

Its principal clinical features.

Aetiology and management.

Methods of Family Planning, prepared by the I.P.P.F.
New ideas on how to teach V.H.W.'s and

In African children.

ChD

CHILDHOOD DEVELOPMENT:

Cig

CLINICAL GENETICS:

Cm

COMMUNICATION IN HEALTH:

DhP

DIARRHOEA:

EAf

EAST AFRICA - CHILDREN'S HEALTH AND WELFARE:
Prepared with UNICEF, this
describes UN work.
For general public and school children.
(No tape recording
available.)

Fbr

FIBRE IN HUMAN DIET:
An excellent and amusing epidemiological account of the
importance of dietary fibre.

Fwa

FOODS OF WEST AFRICA:
Foods commonly given to children, their preparation and
nutritional value.
(48 slides, double the price.)

GR

GROWTH:
Diagrams illustrating normal growth, only suitable for senior medical
students.

JAM

JAMKHED:

KwM

MANAGEMENT OF KWASHIORKOR:
(Sp)

Lp

LEPROSY:

LpCn

THE CLASSIFICATION OF LEPROSY:
improved classification.

MDTD

MICROSCOPIC DIAGNOSIS OF TROPICAL DISEASES:
agents of many tropical diseases.

MI

MALNUTRITION:

MnC

MANAGEMENT IN CHILD HEALTH:
workers (Sp).

MR

MENTAL RETARDATION:
Common causes of mental retardation in the U.K.
(48 slides, double the price.)

MS

SEVERE MEASLES:

*
MUE

MALNUTRITION IN AN URBAN ENVIRONMENT:
setting.

This complex subject well explained.

Ways in which a health worker may improve communication.

Aetiology, and management by auxiliaries.

An innovative agricultural and health programme.

Common causes of early death and their prevention.

A description of the disease with particular reference to childhood.
New understanding that immunology leads to

Microscopic appearance of the

As seen in Indian children but relevant to other areas.
Principles of management for health centre

Suggestions as to how and why it is severe.

Some of the differences in an urban

SETS OF COLOUR SLIDES (continued)

*
NbC

NEWBORN CARE:

NbD

NEWBORN DEVELOPMENT:
newborn.

Differentiating premature and small for dates

NbK

NEWBORN KERNICTERUS:

Prevention through identifying "at risk" children.

NbL

NEWBORN LUNG:

Ntr

NUTRITION REHABILITATION:
areas.

OnC

ONCHOCERCIASIS:
River blindness, a depopulating disease along the rivers
of West Africa and South America.
The disease, how blindness arises and
may be prevented.

*
PCa-j

PRIMARY CHILD CARE:
10 sets of slides for use with King's book, "PRIMARY
CHILD CARE" and his "MANAGER'S GUIDE".
Covers most common childhood
conditions.
(240 slides, ten times the price.)

Ped

PROTEIN CALORIE DEFICIENCY:
marasmus.

PEM

PATHOLOGY OF EXPERIMENTAL MALNUTRITION:
tissues.

PH

PAEDIATRIC HAEMATOLOGY:
tropical countries.

PhW

PHYSIOLOGY OF WOMEN:

Sk

COMMON SKIN DISEASES OF CHILDREN IN THE TROPICS:
in the tropics and their management.

SkT

SKIN DISEASES IN TEMPERATE ZONES:

SpC

SMALLPOX IN CHILDREN:
prevention.

TERL

TECHNIQUES FOR EFFECTIVE READING AND LEARNING:
to improve their learning techniques.

TbP

PATHOLOGY OF TUBERCULOSIS IN CHILDHOOD:

TbNH

NATURAL HISTORY OF CHILDHOOD TUBERCULOSIS:
childhood T.B.

Xma

XEROPHTHALMIA:

XrC

X-RAYS IN CHILDHOOD:

Simple low cost care in the first weeks of life.

Its physiology and pathology.

As developed in India but relevant to other

A description of the syndromes kwashiorkor and

Microscopic appearance in animal

Common haematological conditions found in

Conception and pregnancy in simple diagrams.
Common skin conditions

Common conditions in the U.K.

Clinical description in African children and

For students of all levels

Macroscopic and microscopic.

The characteristics of

Clinical appearance and prevention.

Some diagnostic X-rays for students to study.

WITH EVERY ORDER

WE SEND THIS
TO EXAMINE FINE
DETAIL THE VIEWER
CAN BE USED LIKE
THIS

FREE MULTI-PURPOSE VIEWER

Foundation for Teaching Aids at Lou Cost

Institute of Child Health
30 Guilford Street, London UC1N 1EH, U.K.

€
OBJECTIVES OF TALC

TALC provides teaching aids at or below cost price for health workers.
The objective
of this service is to help raise standards of health care, particularly in developing
countries.
The Foundation for Teaching Aids at Lou Cost is a self-supporting non­
profit making organization and represents a teaching activity of the Institute of Child
Health of the University of London.
SLIDES FOR TEACHING

Selling slides to assist in learning is the major activity of TALC.
available is given on following pages.

The list of slides

To order, complete the form with the code letters of the sets you require and your name
and address and send this, together uith a cheque or money order made payable to:
TEACHING AIDS AT LOU COST (TALC)

addressed to:

TALC,

Institute of Child Health, 30 Guilford Street, London UC1N 1EH, U.K.

Prices include postage by surface mail, airmail charges extra (see note).
V.A.T. at
the standard rate must be added to the cost of all orders delivered in the U.K.,
irrespective of the final destination.

If you are paying in currencies other than sterling, please add the equivalent of 50p.
to each order.
This is the average cost to TALC of conversion of cheques from other
currencies.

■■

SELF-MOUNTING SETS - Lou Cost Set
£1.25 (75p.)
*
for 24 slides, including post
and packing.

This is the most popular method of supply.
So as to reduce the cost of the sets of slides
we ask you to mount the slides in the card­
board mounts yourself.
You will receive a strip of film, self-sealing
mounts, and a script that describes each slide
and may include a series of questions and
answers, together with instructions for mount­
ing .
PRE-MOUNTED SETS
£1.75 (£1.25)
*
for a set of 24 slides,
including post and packing.
For those not wanting to mount their own
slides, these mounted slides can be supplied
at an increased cost.
SETS MOUNTED IN PLASTIC SHEETS IN FOLDERS
£2.25 (£1,75)
*
for a set of 24 slides,
including post and packing.

The sets are available mounted in loose-leaf
folders.
The plastic sheets each hold 24
slides and are interleaved between the scripts.
Three sets are normally put in one file.
This
is a satisfactory way to store the slides.
These plastic slide holders can also fold to go
in a coat pocket, or with a bar they can be
used to store slides in a filing cabinet.
Please state if a bar is reguired instead of a
folder.
As well as being valuable for
storing your slides, these transparent­

folders, in conjunction with an X-ray viewing
box, are useful in preparing your slides in
order as you plan your lecture.

SLIDE TAPE SET
£9.00 (£6.00)
*
including post and packing.
Slide Tape Sets are for use by individual
students.
They consist of a mounted set of
slides, a compact cassette, already pre­
recorded, the script and a plastic file as
shown.
A low cost system by which a student
or small group, using the Slide .Tape Tutor,
the Slide Tape Projector, or any cassette
tape player and slide projector, can listen
to a lecture recorded anywhere in the world,
with the visual aids that go with it.

'■i

E El

EEI

E3 ■

•_ '■'1 •
1

•

--IS--- u’n

Y/':,

•

■R ■E3
k<,l

e

EE

THE SLIDE TAPE TUTOR
£55.□□ plus post and packing.

The Slide Tape Tutor is intended for use by
individual students working in a library,
where it can be permanently locked to a desk.
THE SLIDE TAPE PROSECTOR
£60.00 plus post and packing.

The Slide Tape Projector is intended for use
by 4-6 students at a time.
It can be locked
on a table in a sound-proof cubicle or in a
small room where the tape recorder will not
disturb others.
It includes a small pro­
jector and a miniature daylight screen.

* Figure in brackets refers to reduced price for those working in developino countries
or shortly going to those areas.
y
’

SETS

COLOUR

OF

SLIDES

24 slides with script in each set (except where specified as 48)
A description of normal suckling and ways of preventing

Bf

BREAST FEEDING:
difficulties.

BL

BURKITT'S LYMPHOMA:

CcO

CANCRUM ORIS:

Cd

CONTRACEPTIVE DEVICES:

Ch

THE ROAD TO HEALTH CHART:
The use of this chart in promoting adequate
growth and preventing malnutrition.

*
ChD

CHILDHOOD DEVELOPMENT:

Its principal clinical features.

Aetiology and management.

Methods of Family Planning, prepared by the IPPF.

In African children.

This complex subject well explained.

Cig

CLINICAL GENETICS:

Cm

COMMUNICATION IN HEALTH:
communication.

DhP

DIARRHOEA:

EAf

EAST AFRICA - CHILDREN’S HEALTH AND WELFARE:
Prepared with UNICEF, this
describes UN work.
For general public and school children.
(No tape
recording available).

F ua
Fwa

FOODS OF WEST AFRICA:
Foods commonly given to children, their preparation
and nutritional value.
(48 slides, double the cost).

GR

GROWTH:
Diagrams illustrating normal growth, only suitable for senior
medical students.

*
JAM

3AMKHED:

KuM

MANAGEMENT OF KWASHIORKOR:
prevention. (S p).

Lp

LEPROSY:
hood.

*
LpCn

THE CLASSIFICATION OF LEPROSY:
improved classification.

MI

MALNUTRITION:

MnC

MANAGEMENT IN CHILD HEALTH:
workers. (Sp).

MR
MR

MENTAL RETARDATION:
Common causes of mental retardation in the U.K.
(48 slides, double the cost).

*
MS

SEVERE MEASLES:

NbC

NEWBORN CARE:
newly born.

*
NbD

NEWBORN DEVELOPMENT:

Differentiating premature and small for dates newborn

*
NbK

NEWBORN KERNICTERUS:

Prevention through identifying "at risk" children.

*
NbL

NEWBORN LUNG:

*
NtR

NUTRITION REHABILITATION:
areas.

Ped

PROTEIN CALORIE DEFICIENCY:
and marasmus.

PEM

PATHOLOGY OF EXPERIMENTAL MALNUTRITION:
tissues.

PH

PAEDIATRIC HAEMATOLOGY:
countries.

*
PhU

PHYSIOLOGY OF WOMEN:

Ways in which a health worker may improve

Aetiology, and management by auxiliaries.

An innovative agricultural and health programme.

Common causes of early death and their

A description of the disease with particular reference to child­
New understanding that immunology leads to

As seen in Indian children but relevant to other areas.

Principles of management for health centre

Suggestions as to how and why it is severe.

A description of important steps in the management of the

Its physiology and pathology.

As developed in India but relevant to other

A description of the syndromes of kwashiorkor
Microscopic appearance in animal

Common haematological conditions found in tropical

Conception and pregnancy in simple diagrams.

SETS

OF

COLOUR

SLIDES (continued)

COMMON SKIN DISEASES OF CHILDREN IN THE TROPICS:
in the tropics and their management.

Sk

SkT

SKIN DISEASES IN TEMPERATE ZONES:

SpC

SMALLPOX IN CHILDREN:
prevention.

*
TbP

PATHOLOGY OF TUBERCULOSIS IN CHILDHOOD:

TbNH

NATURAL HISTORY OF CHILDHOOD TUBERCULOSIS:
hood T. B .

*
Xma

XEROPHTHALMIA:

XrC

X-RAYS IN CHILDHOOD:

Common skin conditions

Common conditions in the U.K.

Clinical description in African children and

Macroscopic and microscopic.
The characteristics of child­

Clinical appearance and prevention.

Some diagnostic X-rays for students to study.

* Neu in 1976

(Sp) Script in Spanish available

With every order you will receive a Free multi-purpose vieuer

described below:

DROUTH CHARTS
The 'Road to Health Chart' is fully described
in "Paediatric Priorities in the Developing
.World"
**
The objective of this chart is to
overcome malnutrition by promoting adequate
growth.
The chart is also a record of the
child's immunisation state and can be used to
maintain an adequate birth interval and
introduce the mother to family planning
methods.
1. A sample of the chart will be sent free on request.
Charts can
be sent post and packing free 10 for 50p. uith special rates for
large orders.
(Also in French and Spanish).
2. Charts printed on white card intended for use by local printers
to prepare lithographic plates.
(Also in French and Spanish).

*
50p.

3. Flannelgraph with detailed instruction in its use.

£2.50

4. Overlay transparent sheets.
These may be used in evaluating
any change in the weight of groups of children attending the
clinic.

£2.00

5. Large transparency for use uith an overhead projector.
6. Pre-cut stencil to fit a Gestetner or Roneo duplicator allowing
charts to be printed on paper for training purposes.
(Also in
French and Spanish).

*

*
SOp.

£1.00

*

A kit containing all the above can be sent for £6.00.
** "Paediatric Priorities in the Developing World" by David Morley, published by Butterworths, London, is available from bookshops and direct from TALC (see booklist).
All prices quoted include packing and post by surface mail.

ORDER FORM
(please complete in block capitals)
Name and
address

If your permanent address is different, please include this for
our mailing list.

MAiERIALS REQUIRED:

In the case of slides, only the letters are necessary.

Please tick if you include an extra payment:

AIRMAIL POSTAGE:
V.A.T.

(8%):

Mounted and unmounted sets:
35p. for 24 slides.
For sets in
plastic files, slide -tape sets and growth chart items airmail
postage is charged at cost.
For orders sent to.~addresses- in the U.K. only.

Foundation for Teaching Aids at Lou Cost

Health
workers
need and
love
books

but
hate
today’s
prices

Institute of Child Health
30 Guilford Street, London UC1N 1EH, U.K

BOOKS AND PAMPHLETS AVAILABLE FROM TALC.
Teaching Aids at Lou Cost (TALC) is trying
to respond to a need for certain lou-cost
books uhich are required by health uorkers
through the post, as these are often not
available locally.
Ue must emphasize,
houever, that no books other than those
listed belou are available from TALC.

Price
£
p

HEALTH CARE IN CHINA

An introductory study of uhat China has
achieved in revolutionizing health care
in 25 years.
Ue believe that all
health uorkers in developing countries
should knou something about hou this
has been achieved, and study uhether
similar changes can be brought about
in their oun community.

60

MEDICINE IN CHINA

5 articles by Dr. E.M. Adey and
Dr. A.J. Smith, published in the
British Medical Bournal and reprinted
specially for TALC.
This gives
further information on health care in
China.

40

BOOKS

FOR

AUXILIARIES

NUTRITION IN DEVELOPING
COUNTRIES, by King,
Morley and Burgess.

One of the feu books for health uorkers
uritten in simple English, uith
practical exercises uhich school
children and others can undertake in
the community.

2. 20

PAEDIATRIC OUT-PATIENT
MANUAL, by Pauline Dean,
Paediatrician.

An excellent little book, locally
produced, from St. Luke’s Hospital,
Anua, Nigeria.
It is uell suited for
medical assistants and nurses in out­
patients.

25

SYMPTOM-TREATMENT MANUAL,
from Shanta Bhauan
Hospital, Nepal.

A simple statement of the care of
common conditions.

35

OBSTETRIC EMERGENCIES,
by 3. Everett.

Suitable for Health Centres to guide
staff in obstetrical emergencies.

30

CARE OF THE NEUBORN BABY
IN TANZANIA, by Hamza
and Segall.

A uell-uritten booklet suitable for use
in many countries other than Tanzania.

40

SIMPLE DENTAL CARE FOR
RURAL HOSPITALS,
by D.3. Halestrap.

Gives the basic knouledge required by a
medical uorker uho has to take
responsibility for dental conditions.
Also in French.

40

NUTRITION REHABILITATION
VILLAGE, by 3oan Koppert.

Describes nutrition rehabilitation in
an urban setting.

20

HEALTH CARE OF CHILDREN
UNDER FIVE.

Outcome of a conference on child care
in India.

35

VISUAL COMMUNICATION
HANDBOOK,
by D.3. Saunders.

Uritten for the person uho uishes to
become more effective in communication
at village level.

MEMORANDUM ON TUBERCULOSIS
IN DEVELOPING COUNTRIES,
by Oxfam.

Describes methods of tackling
tuberculosis uith limited resources.

1.

Total for this page

00

15

£

p

Price
£
p

£

1. 25

.

p

Brought Forward from first page

PAEDIATRIC PRIORITIES IN
THE DEVELOPING UORLD,
by David Morley.

A book of 450 pages which sets out
possible alternative priorities to
those suggested by traditional
western paediatrics.

THE 'BABY KILLER'
by M. Muller, produced by
Uar on Want.
(2nd edition)

Highlights the problems produced by
unrestricted advertising of bottle­
feeding in the developing countries.
Also in French, Dutch, Italian and
Spanish.

BOTTLE BABIES,
by 3. Coffingham.

A guide to baby foods.
A follow up on
the 'Baby Killer'.
Also in French and
German.

THE CARE DF BABIES AND
YOUNG CHILDREN IN THE
TROPICS, by David Morley.

A leaflet written for European mothers
taking their children to hot climates
for the first time.

15

THE THERAPY OF THE
SEVERELY MALNOURISHED
CHILD, by R.U. Hay and
R.G. Uhitehead.

Up to date management in hospital.
Experience of the M.R.C. unit in
Kampala.

30

HUCKSTEP POLIOMYELITIS,
by R.L. Huckstep.

Excellent account of management of even
severe deformities.

,

40

1. 50

•

3 . 00

•

•

60

STANDARD TREATMENTS FOR
COMMON ILLNESSES OF
CHILDREN IN PAPUA NEU
GUINEA.
POCKET BOOK OF DRUG
DOSAGES AND PROCEDURES FOR
HEALTH EXTENSION OFFICERS.

These tuc small books have been
produced for health auxiliaries by the
Public Health Department in Papua New
Guinea:
a country well experienced in
the use of such workers.

60

THE TRAINING OF
AUXILIARIES IN HEALTH CARE,
by Katherine Elliott.

A bibliography of useful material and
resources in the training of
auxiliaries.

1.

50

A HANDBOOK OF TROPICAL
PAEDIATRICS, by
G.3. Ebrahim.

For use in Health Centres.

1.

30

A MODEL HEALTH CENTRE.

Building a simple health centre.
This
was produced by a working party set up
by British and Irish Missionary
Societies.

3.

00
•

INTERMEDIATE TECHNIQUES,
by S.U. Eaves and
3.R. Pollock.

Drawings of hospital equipment that can
be made in local workshops.

20

SELF APPRAISAL AND GOAL­
SETTING GUIDE FOR
HOSPITAL DEPARTMENTS.

To help those interested in improved
management.
Produced by the Voluntary
Health Association of India.

30

QUESTIONING DEVELOPMENT,
by Glyn Roberts.

Only for those with a strong political
stomach.

30

OTHER

MATERIAL

AVAILABLE

FROM

.

.

TALC

5 slide viewers

Low-cost hand viewers suitable for use
by individuals to examine slides.

50

.

.

.

10 'Ten Anna' bangles

For screening children aged 1-4 years
for under nutrition.

50

.

.

.

Total

+ 20% postage, packing and administration

ANY

OF

THE

FOLLOWING

CAN

BE

SENT

FREE

IF

OTHER

MATERIAL

IS

BEING

ORDERED

(please tick if you require these)
THE DIAGNOSIS AND
MANAGEMENT OF EARLY
LEPROSY, by S.G. Broun.

Excellent illustrated small booklet.

HEALTH SECTOR POLICY
PAPER, by World Bank.

The World Bank’s new approach to health problems.

PATTERNS OF MORTALITY IN
CHILDHOOD, by Puffer.

A resume of this excellent study on the interaction of
nutrition and infection.

IRAN.
Report of the
Commission on Health
and Medical Problems.

Similar to the Chinese, but in a different political
context.

’Measuring Malnutrition’

The Shakir Strip

’School children evaluating under-fives clinics.’
A method that can be tried where
three-auarters of the children in the village have home-based ueight charts.

Reading list, and a list of sources of teaching material in maternal and child health
for developing countries.

Registration fee, if considered necessary on orders below £10, please add £1.
Orders over £10 will be automatically sent by registered post.

Please add 20% for administration, packing and postal charges on every order.

N.B. If paying by cheque or money order in currency other than sterling, please add 50p.
This is the average cost in converting foreign cheques.
Cheques should be made out to Teaching Aids at Low Cost or TALC.

Please print your name and address clearly

Foundation for Teaching Aids at Low Cost,

Institute of Child Health,
30 Guilford Street, London WC1N 1EH.

BOOKS

z\ND

PAMPHLETS

AVAILABLE

FROM

TALC

Teaching Aids at Low Cost (TALC) is trying to respond to a need for certain low-cost books which are required
by health workers through the post, as these are often not available locally. We must emphasise, however,
that no books other than those listed below are available from TAIXJ.
Up to the present, we have been able to send all books packing and postage free, and also pay our adminis­
trative costs. Due to a precipitous rise in postal charges, we will now unfortunately have to charge a flat
rate of 50p on any order that we supply. Please use this sheet as your order form and send it with your
cheque or money order.
Price

£

p

£

p

HEALTH CARE IN CHINA

An introductory study of what China has achieved in
revolutionising health care in 25 years. We believe
that all health workers in developing countries should
know something about how this has been achieved, and
study whether similar changes can he brought about in
their own community.

60

...

MEDICINE IN CHINA

5 articles by Dr. E.M. Adey and Dr. A.J. Smith,
published in the British Medical Journal and reprinted
specially for TALE. This gives further information on
health care in China.

40

...

IRAN. Report of the
Commission on Health
and Medical Problems

Other countries are producing different plans for health
care, and an example of these is given in this
publication from Iran.

50

BOOKS

FOR

AUXILIARIES

NUTBITION IN DEVELOPING
COUNTRIES, by King,
Morley and Burgess

One of the few books for health workers written in simple
English, with practical exercises which school children
and others can undertake in the community.

1.40

CHILD HEALTH CARE IN
RURAL AREAS — A Manual
for Auxiliary NurseMidwives

This work comes out of the studies undertaken in the
villages around Narangwal in the Punjab, India.

1.00

PAEDIATRIC OUT-PATIENT
MANUAL, by Pauline Dean,
Paediatrician

An excellent little book, locally produced, from
St. Luke’s Hospital, Anna, Nigeria.
It is very well
suited for medical assistants and nurses in out-patients.

25

SYMPTOM-TREATMENT
MANUAL, from Shanta
Bhawan Hospital, Nepal

A simple statement of the care of common conditions.

35

CARE OF THE NEWBORN BABY
IN TANZANIA, by Hamza and
Segall

A well-written booklet suitable for use in many countries
other than Tanzania.

40

SIMPLE DENTAL CARE FOR
RURAL HOSPITALS, by
D.J. Halestrap

Gives the basic knowledge required by a medical worker
who has to take responsibility for dental conditions.

25

NUTRITION REHABILITATION
VILLAGE, by Joan Koppert

Describes nutrition rehabilitation in an urban setting.

20

HEALTH CARE OF CHILDREN
UNDER FIVE

Outcome of a conference on child care in India.

35

VISUAL COMMUNICATION
HANDBOOK, by D.J. Saunders

Written for the person who wishes to become more effective
in communication at village level.

MEMORANDUM ON TUBERCULOSIS
IN DEVELOPING COUNTRIES,
by Oxfam

Describes methods of tackling tuberculosis with limited
resources.

15

MEMORANDUM ON LEPROSY
CONTROL, by Oxfam, Lepra
and the Leprosy Mission

Available in English, French, German and Spanish, this
sets out the basis of management.

15

1.00

Total for this
page

2.

Price
£

p

£

p

Brought forward from first page

OTHER

BOOKS

AVAILABLE

PAEDIATRIC PRIORITIES IN
THE DEVELOPING WORLD, by
D. Morley<
*

A book of 450 pages which sets out possible alternative
priorities to those suggested by traditional western
paediatrics.

THE 'RABY KILLER',’by

Highlights the problems produced by unrestricted
advertising of bottle-feeding in the developing countries.

M. Muller, producedkby
War On Want (2nd edition)

PRACTICAL MOTHER AND CHILD
HEALTH IN DEVELOPING
COUNTRIES, by G.J. Ebrahim

CHILD CARE IN THE TROPICS,
by G.J. Ebrahim

A leaflet written for European mothers taking their
children to hot climates for the first time.

OTHER

5 slide viewers.

40

These three books,
written for health
centres, set out the
requirements for the
basis of maternal and
child health.

THE NEWBORN IN TROPICAL
AFRICA, by G.J. Ebrahim

THE CARE OF RABIES AND
YOUNG CHILDREN IN THE
TROPICS, by D. Morley

1.25

MATERIAL

AVAILABLE

FROM

TALC

Low-cost hand-viewers suitable for use by individuals to examine slides.

10 'Ten Anna' Bangles.

50

For screening children aged 1-4 years for undernutrition.

50

MATERIAL AVAILABLE FOR THE COST OF PACKING AND POSTAGE ONLY (see below
)
*

(Please put a tick in the boxes if you require these)

'Measuring Malnutrition' — The Shakir Strip — The Ten Anna Bangle.

/

’School children evaluating under-fives clinics.' A method that can be tried where
three-quarters of the children in the village have home-based weight charts.

L----- '

Reading list, and a list of sources of teaching material in maternal and child health
for developing countries.

L

PATTERNS OF MORTALITY IN CHILDHOOD, by Puffer.
of infant mortality in the Americas.

------ /
!

This is a summary of the PAHO study

------ -

.----- '

Registration fee if considered necessary, 35p* Administration, packing and postal charges on every order 30p.

N.B.

30

If paying by cheque or money order in currency other than sterling,
please add 50p.

All the books and material listed can be sent by registered mail for £12 or $50.

Make out cheques to Teaching Aids at Low Cost, or TALC. Please do NOT include the words
'Institute of Child Health' on your cheque or money order.
Please PRINT your name and address CLEARLY

Teaching Aids at Low Cost (TALC), Institute of Child Health, 30 Guilford Street, London WC1N 1EH.

TOTAL

From Teaching Aids at Low Cost

(TALC'

srd

March 1 975

The Tropical Child Health Unit
Institute of Chi Id Health
30 Guilford Street, London WC1N 1 EH

Dear Col league,

SLIDES

Teaching Aids at Low Cost (TALC) has grown in
the past year. This letter will be circulated to
over 5,000 addresses throughout the world. It
is sent from the Tropical Child Health Unit, which
is a small group in the Institute of Child Health,
the Medical School of Great Ormond Street Hospital
London. We are dedicated to raising the standards
of child health, particularly in the villages of the
developing world. In this we are greatly helped by
a group of housewives in St. Albans, (TALC), who
in 1974 will have distributed almost 200,000 teach­
ing transparencies round the world.

The number of sets available has increased this
year, and we hope to have many more new sets in
1975. Not yet on the accompanying list is a set
Cd on contraceptive devices, which we believe is
a very considerable advance on the previous set
under th is heading. In 1975 we hope to have all
new supplies of film treated to prevent scratching
or damage from moulds. This will eliminate the
need to use glass mounts.

With this letter is an up-to-date list of these sets
of transparencies, and a list of the books now
-available from TALC. The letter contains ideas
which may help those who are concerned with the
day-to-day health care of less privileged children.

The Slide-Tape Tutor, which is illustrated in the
slide leaflet, has become widely used, and we
know there are several hundred in use. The leaf­
let also illustrates the Slide-Tape Projector,
suitable for a group of 5-10 students working
together in group study. A recent development is
a small low-cost hand-view (Fig. 1), and this can
be used for viewing full frame and half frame film
strips as well as slides. One will be included
free in every order of more than three sets of
slides sent out after the middle of January 1975.
We can also send five of these, packing and
postage free, for 50p. Such a viewer may make it
possible to make more use of transparencies in
teaching. For example, it may be that 5 or 1 0
slides with this viewer could be circulated round
a number of health centres, with a suitable script,
as on-going education for their staff.

CHINA

Two years ago we distributed a paper by Susan
Rifkin, which was then an up-to-date account of
what China has achieved in revolutionising its
health service over the last 25 years. Since then.
more information has become available, and a study
group has produced a paper-back, ’Health Care in
China’ (60p.). TALC has also had reprinted a
series of articles produced in the British Medical
Journal (40p.). We emphasise these two items o-’
the accompanying book list as up till recently heal h
workers have assumed that the developing countries
of the world would slowly produce a health car''
pattern not dissimilar to that which exists in Europe
and North America. However, many now believe
?
all may have much to learn from patterns of care
developed in countries such as China. In Euro>
and America there is much information on how these
new services in China operate. In the develop’, g
world where information on these new patterns of
care is so badly needed books and leaflets are net
so readily available for study and discussion.

EQUIPMENT TO USE WITH SLIDES

THE HEALTH OF “THE'FAMILY

We are most grateful to Dr. Mahler, the new
Director of the World Health Organization, and
the American Public Health Association for allow­
ing us to reproduce the address he delivered in
Washington in the Autumn of 1974.
Fig. 1

BOOKS

Following publicity in last year's letter, 'Paediatric
Priorities in the Developing World’ (£1 .25) has
been widely read
.
*
The demand for this book to be
mailed direct from TALC suggests that there is a
need to make available by direct mailing low-cost
books, particularly those not easily available
through booksellers. We believe those most needed
are books suitable for auxiliaries to use. We now
have several of these available, and a price list is
encl osed.

♦

TALC distributed over 4,000 copies in 1974.
A leaflet describing the book is enclosed.
Please pass this and other material on to friends.

The low-cost Slide Viewer available
from TALC. It is sent flat and the
two ends "click" into position.

CURRENCY DIFFICULTIES
Many of those reading this letter may wish to
purchase slides or books amounting to a few
pounds in value, and yet have difficulty in getting
the necessary currency in sterling, dollars or
other internationally accepted currency. We
would like to draw your attention to our plan on
the bottom of page 2 of the slide leaflet. Help in
obtaining these teaching aids
may also be had
fromSIMAVI, S pruitenboschstraat 6, Haarlem,
Holland, as they have funds allocated to help those
requiring teaching material. Lastly you may be
able to obtain coupons which we can accept from
UNESCO in your capital city.

j ,

2.

THE WEIGHT CHART

SCHOOL FOR PARENTS, MALNUTRITION SCOUTS

We believe that we have now reached a design of
weight chart which is generally acceptable. While
accepting the ideal that every country should have
its own standards, we do not believe this is
feasible at the present time. There is a tremen­
dous task in teaching the use and meaning of the
chart and to achieve this teaching equioment such
as the flannelgraph is required and it is not feasible
for every country to produce this.
We do there­
fore suggest that you consider using the standard
chart with the words translated into your local lang­
uage. This chart and the equipment that goes with
it are listed on the back of the slide list. Included
in this are black-on-white cards which can be used
by a local printer with, we suggest, the words
translated into your local language (Fig. 2). The theory
behind the use of these simple weight charts is des­
cribed in 'Paediatric Priorities in the Developing
World' .

We want to hear about ways in which the community
has been involved in its own health care, and other
ideas which could be widely used. In one area a
group has set up a school which accepts both
parents on one day a month. The child is weighed,
examined, and receives any treatments or immuni­
sations that are required, and the parents attend a
day's schooling on nutrition or other subjects for
which they have shown a preference. In another
area, malnutrition scouts are sent around through a
population of 80,000 with portable hanging scales,
weighing the small children, charting their weights,
and giving helpful but simple advice and treatment
to the mothers. In Hyderabad a local weaning food
is being prepared and packaged by local women and
sold in the market. Leaflets describing these ideas
are avai Iable.

JOURNALS

Kenneth Till (Department of Neurosurgery, The
Hospital for Sick Children, Great Ormond Street,
London WC1N 3JH) collects unwanted journals from
his colleagues and sends them every two or three
months to medical schools or doctors in developing
countries. The journals are mainly 'non-special ist',
e.g. the Lancet, B.M. J. , Proceedings of the Royal
Society of Medicine, the Practitioner. Anyone
interested in taking advantage of this free service
should write to Mr. Till.

RECENT EXPERIENCE WITH
UNDER-FIVES CLINICS

Fig. 2

Diagrammatic representation of the type of
chart that has proved to be internationally
satisfactory.

SHAKIR STRIP AND THE 'TEN ANNA'

BANGLE

For those working in areas where weight charts
have not been introduced and who require a method
to assess the nutritional state of children between
the ages of one and five we recommend the 'TEN
ANNA' BANGLE (Fig. 3) or the SHAKIR STRIP
(Fig. 4) cut from a sheet of X-ray film. More
information on these will be sent on request.
TALC can supply 10 bangles post and packing
free for $1 or 50p.
Fig. 3

The concept that ch ildren need to go to a separate
'Well Baby' or 'Welfare' clinic still persists in
most countries. It is a historical concept no
longer supported by paediatricians or health
planners. Parents who seek care for their infant
through private practitioners expect one doctor
will treat an infection as well as advising on
growth and development and providing immuniV
sations. Parents who use public services go to
a high prest ige curat ive service-- (hospital op------------ -—
clinic) when the child is ill and a 'Well Baby'
clinic for supervision and immunisation. Advocates
of comprehensive care systems such as the Under
Fives Clinics believe that health workers from the
most junior to the senior paediatrician should
always offer a 'package' of preventive and curative
care with whatever resources are available at every

The 'Ten Anna' Bangle. If this
will pass over the mid-upper arm of
children aged 1-5, they are likely
to be malnourished.

Scratches

YELLOW GREEN

12.5

ig. 4
Internal circumference = 12.6 cm

13.5 cm

The Shakir Strip, made from old X-ray
plates, can be used by schoolchildren or
other groups to assess the proportion of
malnourished children in their village.

3.

contact with the child. (Fig. 5 ) Personal pre­
ventive care must be offered by the same workers
who treat the child when he is sick. However,
environmental preventive measures remain only an
indirect responsibility of health workers.

Fig. 5 Which type of chair do you sit in? Are
all preventive and curative resources
available every time the child is in
contact with the health service?

WHAT IS THE HEALTH WORKER'S JOB ?
1. The 'Curative Chair'

2. The 'Preventive Chair'

UNDER-FIVES CLINICS ARE REPRODUCIBLE
In a number of countries care of small children
through under-fives clinics has become a matter
of national concern and political expediency. In
Zambia, Malawi and Sarawak over half the child|ren attend these clinics. In Malawi (Cole-King
If975) 362 clinics were developed within 4 years.
(Fig. 6 ) In all these clinics every child attend­
ing has his weight charted so that malnutrition­
can be avoided by promoting adequate growth
through nutrition education, immunisation, and
treatment when the child is sick.

SUCCESS DEPENDS ON BEHAVIOURAL CHANGE

Joe Wray (1974) has related the success of various
programmes to the amount of behavioural change
required (Fig. 7 ). Little behavioural change is
required of the community for antimalarial cam­
paigns onjn the eradication of smallpox. The
poor response so often met in family’ planning,
improving nutrition, and stopping smoking is
related to our difficulty in changing people’s
behaviour.

Fig. 7 The smallpox eradication and anti-malarial
campaigns which have been successful require
little behavioural change. Campaigns that
require much behavioural change are less
successful.

Smallpox
Malaria

Health programme
success

x. Family planning
x^Improving nutrition
Stopping smoking

o i—-------------------------------- »■

Fia

6

The achievement in Malawi in producing
362 under-fives clinics across the country
within four years.

Behavioural change required
of beneficiary

4.
SUCCESS IN CHANGING BEHAVIOUR DEPENDS
ON INTERPERSONAL RELATIONSHIPS

COMMUNICATION BETWEEN PATIENT AND HEALTH WORKER

He goes on to suggest that there may be an assoc­
iation between the success of the interpersonal
relationships between the health worker and the
members of the community and their ability to
achieve a change in behaviour. (Fig. 8). The
more the health worker can identify with the
people the more chance that worker has of success­
fully changing their behaviour.

Doctor

Doctor
: Paramedical

s, auxiliary
Patient

Behavioural change required
of recipient of care for

MORE APPROPRIATE

■TRADITIONAL’

♦. <
Patient

Part time
health worker

.•1 Us' The Health professionals

prevention or cure

o---- ------------------------Importance of interpersonal
relations between health
worker and recipient of
care
Fig. 8 The success of programmes may relate
closely to the level of communication
between the health worker and the
population he serves.

THE PART-TIME WORKER CAN CREATE
BEHAVIOURAL CHANGE
Part-time health workers are a low-cost resource
we need to develop at a time when other resources
for health care may be in short supply (Morley
1974). They have already established themselves
in their community with skills such as farming,
which they continue to practise, working only
part-time in the health field. They are chosen for
training by a committee of the community, and in
China this 'looks for compassion' in those to be
trained. The training takes place as near as
possible to their home with a minimum of interrup­
tion of family life and farming activities. Parttime health workers are not on any central payroll
and are rewarded by their patients or by the
community in a manner controlled by the local
committee.

The part-time health worker is usually literate,
although successful workers exist who depend on
a literate helper to keep their records. As
suggested in Fig. 9 , the part-time health wo rker
has better interpersonal relationships with the
patient than anyone else in the health team and has
a good chance of achieving a behavioural change.
He does not become one of 'Us' , the health pro­
fessionals, but remains one of 'Them', the
community. He does not suffer from the tempta­
tions to move to the town or city as he is well
established as a farmer and this continues to supply
most of his material rewards, his time spent in
providing he'alth care brings him rewards in terms
of the respect in which he is held by his society.

Cole-King, S. (1975)

Under-fives clinics in
Malawi. (in press)

Morley, D.

Brit. Med. J. (iii), 85.

Wray, J.

(1974)

(1974)

J. of Trop. Paed. , 20, 1 .

Fig. 9 On the left of the diagram is the situation
in which health care comes only from the
doctor. As the narrow lines suggest,
communication is often poor.
On the right where there are paramedical^^,
or auxiliaries communication is better.
However, the most successful communication
is likely to exist between the part-time health ’
worker and the community which chose him to
serve them.

WE WELCOME VISITORS

At the Tropical Child Health Unit we have been
fortunate in having over 500 visitors this year from
whom we have learnt a great deal . Some have
spent no more than an hour with us; others we
have been happy to have for several weeks, and
they have used our Unit for studying their local
real th probl ems .
Each summer we have two short courses. In 1975
these will be 14-18 July inclusive, and 15-19 Sept­
ember inclusive. The first is primarily for doctors
and the second primarily for nurses. However, we
hope to have a mix in each, as our experience
suggests that we all profit from an interdisciplinary approach. We are also responsible^?
for the UN1CEF/WHO Course for Senior Teachers
of Child Health. This is suitable for those who
are already Lecturers in Departments of Paed­
iatrics. A booklet about this course is available
from the Unit.

Greetings from us all. Please send us any new
ideas that you have evolved.

Tropical Child Health Unit
William Cutting Mette Dogger Zef Ebrahim
Di Hensey David Morley Tom Nchinda
Pramilia Senanayake Margaret Woodland

Teaching Aids at Low Cost

Joan Blissett Barbara Brown Jane Dori ing
Sheila Frazer Pat Hicks Jane Lund
Aileen Morley Dorothy Stranks Phyllida Thewlis

Foundation for Teaching Aids at Lou Cost

OUR

Institute of Child Health
30 Guilford Street, London UC1N 1EH,

U.K.

'77 NEUS LETTER

September,

1976.

Dear Colleague,

This letter brings you greetings from The
Tropical Child Health Unit at the
Institute of Child Health, London and
Teaching Aids at Lou Cost (TALC).
The
number of people visiting our Unit or
making use of the lou cost material from
TALC has groun over the last year and this
•fetter uill be circulated to over 7D00
people on our mailing list.
Let me first
of all mention the various enclosures in
this envelope.

1.

The Slide List.

This last year ue have had a drive for neu
sets of slides and there are 20 neu sets.
Houever, not all these have been completed
in time for this mailing.
The neu sets
that are available have been starred on
the slide list.
It is nou some years
since ue put up the price of our sets of
slides but at last ue have had to increase
the price from 60p. to 75p. for the lou
cost sets.
The price of the other sets
has also had to be increased.
Ue hope to
keep the neu rates steady for as long as
possible.

2.

The Book List.

■till health uorkers in developing countries
®must share uith us the anxiety over the
rapid increase in the price of books and
the difficulties uhich nou arise in
communicating neu ideas.
Ue are aluays
concerned to find lou cost books uhich
have been produced in developing countries
and make these available to other areas
uhere they can be of use.
Ue have a
number of neu books available and ue try
to get these to you at as lou a price as
possible.
Unfortunately uith the rapid
rise of postal charges in the U.K. ue have
found it necessary to ask you to add a
percentage of the bill to cover these
great costs.
Ue keep our administrative
costs to the minimum.

3.

The Polyhedron.

In almost every clinic and office
calendars and posters advertising milk
firms and drug companies are to be found.
Ue are beginning to realize the problems
and dangers that arise from such
advertisement, particularly by the milk
companies.
Houever, a need exists for
material to hang in our offices and
clinics and The Tropical Child Health Unit
and TALC have produced this yellou poly­
hedron.
Ue hope you can find someone uho

has time and interest to carefully cut
this up, then glue it as on the
instructions and hang it in your office o’r
clinic and you can use it for discussions
uith visitors.
4. Leaflet from the International
Development and Research Centre of Canada.

This centre provides a number of useful
small books uhich ue believe uill be of
interest and value to the majority of
health uorkers.
It may be possible to
obtain these free.

5.

Leaflet on ueiqhinq scales.

Over the years ue have had many requests
as to uhich type of scales are most
suitable for under fives' clinics.
Ue
can nou strongly recommend hanging scales.
These are being used in so many countries
and, although the firm sending them out has
despatched uell over 1000, there has been
no one yet uho has found they cause any
trouble.
Some people find the trousers
are not too suitable and, depending upon
the culture, the child may be placed in a
uide variety of receptacles for ueighing.

These letters
stand for
equipment for
charity
hospitals
overseas.
This organization provides equipment and a
limited variety of drugs.
The list
enclosed shous the list of lou cost
generic drugs they have available.
The
lou price has been achieved through bulk
buying of more than 20 million tablets at
a time.
ECHO also provides a list of
surgical equipment' and a list of equipment
for village dispensaries and health
centres, including a lou cost microscope.
Leaflets describing these are available on
request from ECHO.

7. A laboratory manual for rural tropical
hospitals.
'' ”
Although many books have increased in
price ue think this manual is good value
and a leaflet describing it is enclosed.

8.

The postcard for our mailing list.

Please be sure to return this to us by
return of post.
Our mailing list has

grown so large and people move about so
much that it is essential ue keep pur
mailing list up to date every two or three
years.
If you expect to be moving over
the next year, please give us a new
address and, if possible, indicate who
will be taking over from you so that ue
can continue to send the letter to your
Unit.
Failure to send back this card
will automatically mean that your name
comes off our mailing list.

The majority of health interventions
should be undertaken at the most
peripheral practicable level of the health
services by workers most suitably trained
for performing these activities.

GIVE A MAN A FISH
AND YOU FEED HIM FOR A DAY........

.............. TEACH A MAN TO FISH
AND YOU FEED HIM FOR LIFE

The Neu Emphasis on Primary Health Care.
As the objective of the Tropical Child
Health Unit and TALC has always been to
raise the standard of care available for
less privileged children in the villages
and shanty towns of the developing world:
our emphasis has been particularly on
primary health care;
on the use of
auxiliaries;
and more recently on the use
of the part time health worker.
In 1975,
the 28th World Health Assembly of the
World Health Organization took as its
theme the promotion of national health
services.
Some of you may not have seen
this statement.
Ue believe it needs to
be very widely known.
It laid special
emphasis on the provision of primary
health care, which was summarised in the
following general principles:

Tomorrow ho may bo a beggar

Tomorrow if well taught ho will bo teaching others

If you have been involved in an innovated
scheme to provide better primary health
care, do write and tell us about it and
send us any duplicated or other material
which ue keep in country boxes in The
Tropical Child Health Unit.
These are in
constant use by our many visitors.
Visit us or write to us.

Primary health care should be shaped
around the life patterns of the population
it should serve and should meet the needs
of the community.
Primary health care should be an integral
part of the national health system and
other echelons-of services should be
designed in support of the needs of the
peripheral level, especially as this
pertains to technical supply, supervisory
and referral support.

Primary health care activities should be
fully integrated with the activities of the
other sectors involved in community
development (agriculture, education, public
works, housing and communications).
The local population should be actively
involved in the formulation and
implementation of health care activities so
that health care can be brought into line
with
local needs and priorities.
Decisions upon what the community needs,
requiring solution, should be based upon a
continuing dialogue between the people-and
the services.

Health care offered should place a maximum
reliance on available community resources,
especially those which have hitherto
remained untapped, and should remain
within the stringent cost limitations that
are present in each country.
Primary health care should use an
integrated approach of preventive,
promotive, curative and rehabilitative
services for the individual, family and
community.
The balance between these
services should vary according to
community needs and may well change over
time.

We are fortunate at The Tropical Child
Health Unit to welcome more than 500
visitors each year and from them we learn
a great deal.
Some can, unfortunately,
only spend an hour with us, others stay
with us for a few weeks, studying what
others have done when faced with the
enormous problems ue all meet in trying to
provide effective services with limited
resources.

Each summer ue run two short courses.
In
1977 these will be July 11th - 16th and
the first 3 weeks in September.
The first
is primarily for doctors and the second
primarily for nurses.
However, we always
hope for a mix in both and find this more
successful.
Greetings from us all.
Ue are looking
forward to you Visiting us or writing to
us and telling us of new ideas you have
evolved.

Tropical Child Health Unit
William Cutting, Zef Ebrahim, Di Hensey,
David Morley, Marcia Uickramasinghe,
Margaret Woodland.

Teaching Aids at Lou Cost (TALC),
Telephone number St. Albans 53869.

These ladies are all housewives in
St. Albans.
Joan Blissett, Barbara Brown, Jane Dorling,
Sheila Frazer, Chris Gawen, Jessie Harrison,
Joan Lund, Dorothy Stranks, Phyllida Theulis.

MODEL 235PBW INFANT WEIGHING PACK
A pack consists of one scale, five weighing trousers and one

shoulder bag. The scale weighs up to 25KG in jKG steps. These

special markings correspond to those on the ’Road to Health’

charts, as shown below and described in greater detail in the
book ’Paediatric Priorities in the Developing World’# The scale
face and indicator are protected by a 3mm clear plastic cover

which is ventilated to prevent a build - up of moisture. The

trousers are strong and easy to clean, and having five enables
the waiting mothers to put their own child into a pair and onto
the scale. The shoulder bag takes the scale and trousers for

easy carrying. Packs can easily be despatched by parcel post,

but for large numbers we will be pleased to work out the price
to include packing/shipping/insurance etc by air or sea. Write
for full details and a quotation to CMS Weighing Equipment Ltd
*^krailable from TALC,
18 Camden High Street
30 Guilford St, WC1 1EH.

London NW1

OJH

’Hanging scales have several intrinsic advantages,and
being rugged are ideal for regular transportation. There
is usually something from which they can be hung, and if
this is likely to be difficult a special tripod is
available. Mothers soon learn to put their children into
the trousers and onto the scale, so the staff do not
have to handle the child in any way. There seems to be
no difficulty in putting even a small child into the
trousers supplied. With the face designed by Professor
Maurice King the auxilliary worker does not have to make
the complicated calculation of actual weight and
translate it to the weight chart. Instead he puts a dot
on the chart in the same place as the indicator is
relevent to either the half kilo line (dotted) or the
kilo line (solid). This has of course considerable
advantages in areas with populations having low levels
of literacy and where decimal systems may not be easily
understood. In my own experience and that of many other
workers, it has been found that most children in the
developing countries will be quite happy to remain still
in the trousers, and there is very little swing on the
scale needle’.

Dr. David Morley
Scale weighing 25KG in
100g steps on request.

July 75 cost I pack
complete £15.00

Pillar Scale

Sliding Weight Baby Weigher

Supplied as either a
basic Adult weigher or
a Baby, Toddler and
Adult scale.

To the basic
scale the following
extras can be
fitted:
Toddler Rail
Hinged Baby Bowl
Toddler Seat
Height Measure
Handles/Wheels

Accurate machine for Hospital or
Clinic. Weighing from 0 - 13KG
With 10g Accuracy. Capacity of
17KG available on request.

Standard Capacity
0-150KG x 50g

Hospital/Clinic s.

Harpenden Anthropometric Equipment

New Multi-Purpose machine for Mobile
Clinic and Survey work

Full details and shipping costs etc
of any of this equipment available
on request. In addition to those

illustrated we have a range of;
* Hospital and Laboratory Scales

(a)

Infant/Adult Measuring Table

(b)

Wall mounted Stadiometer

(c)

Tanner/Whitehouse Skinfold
Caliper

* Full Range of Harpenden Equipment
* Measuring Tapes

* Special Collapsable Tripod for use
with 235PBW Packs

CMS WEIGHING EQUIPMENT LIMITED
18 CAMDEN HIGH STREET, LONDON, NW1
Telephone: 01-387 2060

OJH, ENGLAND

Cables: Morweigh London NW1

CompHnv Renistered in Fr .ilanri Nn QftQ 037

FOR

FOUNDATION

TEACHING

AIDS

AT

LOU

COST

(TALC)

Institute of Child Health, 30 Guilford Street, London UC1N 1EH.

SOURCES OF TEACHING MATERIAL IN NATERNAL A ND CHILD HEALTH AND NUTRITION FOR OVERSEAS
Teaching Aids at Lou Cost (TALC),
Institute of Child Health, 30 Guilford
Street, London WC1N 1EH.

"24 slide sets", weight charts, aids to
weight chart (flannelgraphs, overlays
etcj.
Free booklist.
Material in
English, some French, a few Spanish.

Courtejoie, Dr. J., Centre pour le
Promotion de la Sante, Kangu Majumbe,
Republic de Zaire.

Excellent simple material for villages.
Material in French, some English and local
languages.

Voluntary Health Association of India,
(CAHP);
C-45, South Extension, Part II,
Neu Deihi 110049, India.

'Flannelgraphs, books, flip charts, etc.
List available.
Material in English,
J local languages and some regional lang.

Christian Medical College and Hospital,
Vellore 4, Madras, India.

Posters, flash cards, flannelgraph.
Material in English and local languages.

F.A.O., Nutrition and Home Economic
Division, Rome, Italy.

Wide variety of material, some useful at
village level.
Material in English,
French and Spanish.

W.H.O., Geneva, Switzerland.

Material in English, French and Spanish.

Health Education Department,
Ethiopia.

Addis Ababa,

Teaching kits.
Material in English and
some local languages.

International Development Research Centre,
(IRDC);
P.O. Box 8500, Ottawa, Canada,
K19 3HG.

Bibliography and booklets on China, the
place of doctors and auxiliaries in health
services.
Sent free to those in develop­
ing countries.

National Food and Nutrition Commission,
P.O. Box 2669, Lusaka, Zambia.

J,Very good posters and other teaching
material on nutrition.
Material in
English and some local languages.

Chief Education Officer, Health Education
Department, Public Health Department,
Ministry of Health, Ibadan, Nigeria.

Posters, may need evaluation.
Material
in English and main Nigerian language
groups.

Material Realise a 1’Atelier de Material
Didactique, Busiga, P.B. 18 Ngozi,
Burundi.

Good flip charts;
a teaching scheme using
well produced flip charts.
Material in
French and local languages.

Medical Recording Service Foundation,
(Royal College of General Practitioners),
P.O. Box 99, Chelmsford CM1 5HL.

Large tape, cassette and slide library.
Material in English.

World Neighbours, 5116 North Portland Ave., IF ilmstrips, manuals,
j Material in English,
Oklahoma City, Oklahoma, 73112, U.S.A.
Shanta Bhawan Community Health Program,
Box 252, Kathmandu, Nepal.

Slides,

D.C.E.A.C., B.P. 288, Yaounde, Cameroun.

Material in French.

N.A.V.I.C., 254 Belsize Road,

flip charts.
French and Spanish.

flip charts.

London NW6.

Information on audio visual equipment.

Professional Health Media Services, The
Health Education Supply Centre, P.O. Box
922, Loma Linda, California 92354, U.S.A.

Books and visual aids (hard and soft).

The Philippine Lutheran Church, P.O. Box
507, Manila, Philippines, D404.

Flip charts.

Saidpur Concern, Teaching Aids Workshop,
c/o CONCERN, P.O. Box 650, Dacca,
Bangladesh.

Flip charts.

I.L.O., Geneva, Switzerland.

Booklets on use of the flannelgraph,
face our future’, etc.

‘Lets

I.T.D.G., Parnell House, Wilton Road,
London SW1.

Booklets on simple technology.
advice on technical problems.

Stichting TOOL, P.O. Box 525, Eindhoven,
The Netherlands.

Booklet on home made soap.
Other
material similar to U.K. I .T.D.G.,
Will
answer questions.

V.I.T.A., 3706 Rhode Island Ave., Mount
Rainier, Maryland 20822’, U.S.A.

Produces village equipment handbook,
similar to U.K.I.T.D.G.

ENI Communication Centre, P.O. Box 2361,
Addis Ababa, Ethiopia.

Wide variety of education packages and
visual aids in child health and nutrition.

African Medical and Research Foundation,
Wilson Airport, P.O. Box 30125, Nairobi,
Kenya.

Booklets for auxiliaries.

Will send

American Foundation for Overseas Blind,
Inc., 22 West 17th Street, New York,
N.Y. 10011, U.S.A.

•• Material from the American Foundation for
Overseas Blind is a "must" if you see
blindness from Vit. A lack.

Alfalit Boliviano, Ounin 6305, Casilla
1466, Cochabamba, Bolivia.

Simple booklets on health in Spanish and
English.

Derechos Reservados, Centro Andino de
Comunicaciones, Casilla 2774, Cochabamba,
Bolivia.

Flip charts in Spanish.

Nutrition Center of the Philippines,
Communications Department, Nichols Inter­
change, South Superhighway, Makati, Rizal,
Philippines.

Produces leaflets and fact sheets in
English.

The Nutrition Section, Public Health
Department, Box 2084, Konedobu, Papua New
Guinea.

Posters and booklets.

If you know of other useful sources please inform Teaching Aids at Low Cost (TALC),
Institute of Child Health, 30 Guilford Street, London WC1N 1EH.

N.B.

8/76

In all cases send a short description of your work and organisation so that
appropriate information can be sent to you.

Foundation for Teaching Aids at Lou Cost

Health
workers
need and
love
books

but
hate
today’s
prices

Institute of Child Health
30 Guilford Street, London UC1 N 1 EH, U.K.

BOOKS AND PAMPHLETS AVAILABLE FROM TALC.
Teaching Aids at Lou Cost (TALC) is trying
to respond to a need for certain lou-cost
books uhich are required by health uorkers
through the post, as these are often not
available locally.
Ue must emphasize,
houever, that no books other than those
listed belou are available from TALC.
Price
£
p

HEALTH CARE IN CHINA

An introductory study of uhat China has
achieved in revolutionizing health care
in 25 years.
Ue believe that all
health uorkers in developing countries
should knou something about hou this
has been achieved, and study uhether
similar changes can be brought about
in their oun community.

60

MEDICINE IN CHINA

5 articles by Dr. E.M. Adey and
Dr. A.J. Smith, published in the
British Medical Journal and reprinted
specially for TALC.
This gives
further information on health care in
China.

40

BOOKS

FOR

AUXILIARIES

NUTRITION IN DEVELOPING
COUNTRIES, by King,
Morley and Burgess.

One of the feu books for health uorkers
uritten in simple E iglish, uith
practical exercises uhich school
children and others can undertake in
the community.

2. 20

PAEDIATRIC OUT-PATIENT
MANUAL, by Pauline Dean,
Paediatrician,

An excellent little book, locally
produced, from St. Luke’s Hospital,
Anua, Nigeria.
It is uell suited for
medical assistants and nurses in out­
patients.

25

SYMPTOM-TREATMENT MANUAL,
from Shanta Bhauan
Hospital, Nepal.

A simple statement of the care of
common conditions.

35

OBSTETRIC EMERGENCIES,
by J. Everett.

Suitable for Health Centres to guide
staff in obstetrical emergencies.

30

CARE OF THE NEUBORN BABY
IN TANZANIA, by Hamza
and Segall.

A uell-uritten booklet suitable for use
in many countries other than Tanzania.

40

SIMPLE DENTAL CARE FOR
RURAL HOSPITALS,
by D.J. Halestrap.

Gives the basic knouledge required by a
medical uorker uho has to take
responsibility for dental conditions.
Also in French.

40

NUTRITION REHABILITATION
VILLAGE, by Joan Koppert.

Describes nutrition rehabilitation in
an urban setting.

20

HEALTH CARE OF CHILDREN
UNDER FIVE.

Outcome of a conference on child care
in India.

35

VISUAL COMMUNICATION
HANDBOOK,
by D.J. Saunders.

Uritten for the person uho uishes to
become more effective in communication
at village level.

1. 00

MEMORANDUM ON TUBERCULOSIS
IN DEVELOPING COUNTRIES,
by Oxfam.

Describes methods of tackling
tuberculosis uith limited resources.

Total for this page

15

£

p

Price
£
p

£

1. 25

.

,

40

.

,

p

Brought Forward From first page

PAEDIATRIC PRIORITIES IN
THE DEVELOPING UORLD,
by David Morley.

A book of 450 pages which sets out
possible alternative priorities to
those suggested by traditional
western paediatrics.

THE 'BABY KILLER'
by PI. Muller, produced by
Uar on Uant.
(2nd edition)

Highlights the problems produced by
unrestricted advertising of bottle­
feeding in the developing countries.
Also in French, Dutch, Italian and
Spanish.

BOTTLE BABIES,
by 3. Coffingham.

A guide to baby foods.
A follow up on
the 'Baby Killer'.
Also in French and
German.

1. 50

THE CARE DE BABIES AND
YOUNG CHILDREN IN THE
TROPICS, by David Morley.

A leaflet written for European mothers
taking their children to hot climates
for the first time.

15

THE THERAPY OF THE
SEVERELY MALNOURISHED
CHILD, by R.U. Hay and
R.G. Uhitehead.

Up to date management in hospital.
Experience of the M.R.C. unit in
Kampala.

30

HUCKSTEP POLIOMYELITIS,
by R.L. Huckstep.

Excellent account of management of even
severe deformities.

STANDARD TREATMENTS FOR
COMMON ILLNESSES OF
CHILDREN IN PAPUA NEU
GUINEA.

•

3 . 00

60

POCKET BOOK OF DRUG
DOSAGES AND PROCEDURES FOR
HEALTH EXTENSION OFFICERS.

These two small books have been
produced for health auxiliaries by the
Public Health Department in Papua New
Guinea:
a country well experienced in
the use of such workers.

60

THE TRAINING OF
AUXILIARIES IN HEALTH CARE,
by Katherine Elliott.

A bibliography of useful material and
resources in the training of
auxiliaries.

1.

A HANDBOOK OF TROPICAL
PAEDIATRICS, by
G.J. Ebrahim.

For use in Health Centres.

1. 30

A MODEL HEALTH CENTRE.

Building a simple health centre.
This
was produ ced by a working party set up
by British and Irish Missionary
Societies.

3.

INTERMEDIATE TECHNIQUES,
by S.U. Eaves and
O.R. Pollock.

Drawings of hospital equipment that can
be made in local workshops.

20

SELF APPRAISAL AND GOAL­
SETTING GUIDE FOR
HOSPITAL DEPARTMENTS.

To help those interested in improved
management.
Produced by the Voluntary
Health Association of India.

30

QUESTIONING DEVELOPMENT,
by Glyn Roberts.

Only for those with a strong political
stomach.

30

OTHER

MATERIAL

AVAILABLE

FROM

50

00

TALC

5 slide viewers

Low-cost hand viewers suitable for use
by individuals to examine slides.

50

10 'Ten Anna' bangles

For screening children aged 1-4 years
for under nutrition.

50

Total

+ 20% postage, packing and administration

...

ANY

OF

THE

FOLLOWING

CAN

BE

SENT

FREE

IF

OTHER

MATERIAL

IS

BEING

ORDERED

(please tick if you require these)

THE DIAGNOSIS AND
MANAGEMENT OF EARLY
LEPROSY, by S.G. Broun.

Excellent illustrated small booklet.

HEALTH SECTOR POLICY
PAPER, by World Bank.

The World Bank’s new approach to health problems.

PATTERNS OF MORTALITY IN
CHILDHOOD, by Puffer.

A resume of this excellent study on the interaction of
nutrition and infection.

IRAN.
Report of the
Commission on Health
and Medical Problems.

Similar to the Chinese, but in a different political
context.

’Measuring Malnutrition' - The Shakir Strip

’School children evaluating under-fives clinics.’
A method that can be tried uherc
three-ouarters of the children in the village have home-based ueight charts.

Reading list, and a list of sources of teaching material in maternal and child health
for developing countries.

Registration fee, if considered necessary on orders belou £10, please add £1.
Orders over £10 uill be automatically sent by registered post.

Please add 20% for administration, packing and postal charges on every order.

N.B. If paying by cheque or money order in currency other than sterling, please add 50p.
This is the average cost in converting foreign cheques.
Cheques should be made out to Teaching Aids at Lou Cost or TALC.

Please print your name and address clearly

Foundation for Teaching Aids at Lou Cost,

Institute of Child Health,
30 Guilford Street, London WC1N 1EH.

FOUNDATION

FOR TEACHING AIDS AT LOW COST
Institute of Child Health

30 Guilford Street ■ London WON I EH
\A/e ask you to share this with others

COMMUNICATION OF INNOVATIONS”
By this we mean no more than passing ideas
around.
The sociologists have studied this
question of how ideas pass around, be it the
management of the child wtih diarrhoea using
salt, sugar and water, or the acceptance of
fertilisers in India or America.
Because you
are reading this you are likely to be what
they would classify as an innovator.
At a meeting, you soon realise that those who
talk most and have the loudest voice do not
always have the most useful things to say.
Unfortunately the same is true of the media,
and as Figure 1 suggests, those who have the
loudest voice and control the media are the
most likely to be heard.

Figure 1 :

How can 'B' get a word in while big 'As' who are
powerful and of high status control the media?
(UNESCO Features No.716, 1977)

If you want to improve your ability as an
innovator perhaps you should:

A.T.H. NEWSLETTER**
1)

encourage ideas to come to you from all
around the world;

2)

discover how you can pass on those inter­
national ideas that appear to be appropriate
to the community you serve, at the same time
encouraging the ideas to be appropriately
modified and new ones to develop;

3)

share your ideas with other people round
the world.
You have the possibility of
having the "International Net" on one side
of you and the "Local Net" on the other
side of you (Figure 2.)
YOU are the link between the "local net"
and the "international net."

THE “INTERNATIONAL NET”

Appropriate Technology for Health Newsletter,
W.H.O., 1211 Geneva 27, Switzerland.
"A new newsletter describing developments in ATH."

BASICS***
Rural Communications, S Petherton, Somerset, U.K.
"Shared information on rural development
CHILDREN IN THE TROPICS**

International Children's Centre, Bois de Boulogne,
Paris, France.
"A journal of mother and child health." (Also French.)

*
CONTACT
**
Christian Medical Commission, 150 Route de Ferney,
1211 Geneva 20, Switzerland.
"Concerned with more appropriate health care."
(Also French, Spanish, Portuguese.)

THE DEFENDER**
You may already receive ideas and innovations from
professional journals sent to you. You can obtain more
ideas by receiving a number of free international news­
letters listed on this sheet. To help you receive these
if you print your name in the space on this sheet, TALC
will pass your address on to the organisation concerned.

Health Educ. Dept., AMRF, POB 30125, Nairobi, Kenya.
"Ideas on effective methods of health education."
DEVELOPMENT COMMUNICATION REPORT*

1414 22nd St.N.W., Washington, D.C. 20037, U.S.A.
"For those interested in communication techniques."

GLIMPSE*

YOUR LOCAL“NET”

International Centre for Diarrheal Disease Research,
G.P.O. Box 128, Dacca 2, Bangladesh.
"New information on diarrhea."

By receiving these free
journals you are accepting
a responsibility to pass
on these ideas. Don't be
like a squirrel who hoards
away his nuts!

HEALTH FOR THE MILLIONS**

Voluntary Health Association of India, C-14, Community
Centre, Nev; Delhi 110 016, India.
"Practical articles on community health."
HEALTH NOTES*

Christian Conference of Asia, 57 Peking Road 4/F, Kowloon,
Hong Kong.
"Articles on community health and health concerns."
I.P.P.F. BULLETIN*

I.P.P.F., 18 Lower Regent Street, London SW1Y 4PW, U.K.
"New ideas and developments in family planning."
THE LEARNER*

Regional Teacher Training Centre, Pahlavi University,
Shiraz, Iran.
"For those concerned with teaching health workers."
LIFE**

League for International Food Education, 1126 16th Street
N.W., Washington, D.C. 20036, U.S.A.
"Current information on nutrition and food technology."

NEWSLETTER FROM THE SIERRA MADRE
*
*

The Hesperian Foundation, Box 1692 Palo Alto, California
94302, U.S.A.
"About a villager-run health care network in Mexico."

Try, whenever you meet fellow workers, to pass
on during conversation one idea they can develop.
Do this not only to those in your profession, but
if possible to others in education, agriculture,
etc. At the same time try to learn from them a
new idea.

One of the ways of feeding in ideas for discussion
and development is by a duplicated newsletter in
the local language. In your area there are probably
many workers in health and other disciplines who
receive little to read. By sending round a news­
letter you will raise their morale and give them
ideas on how they can serve their community better.
Try to include topical local news items and if
possible a few illustrations. Writing and drawil^F
stencils are available on which drawings can be made
quite easily. Drawings can then be taken from books
like David Werner's "Where There Is No Doctor". If
you do not have access to a typewriter, you can
write on these stencils. You do not need even a
duplicator. Stretch a piece of mosquito net
tightly over a wooden frame and fix a stencil to
the undersurface of the net. Squirt ink onto the
net and spread it with a rubber squeegy after placing
paper, one sheet at a time, beneath the stencil.

If you need more information write to Nick Cutler,
41 Highbury Hill, London N5, U.K.

THE N.F.E. EXCHANGE* —~~'

(Non-Formal Education) Information Centre, 513 Erickson
Hall, Michigan State University, E Lansing, MI 48824, U.S.A.
"The spread of learning outside the school."
SALUBRITAS***
APHA, 1015 18th St., N.W., Washington D.C. 20036 U.S.A.
"New ideas in the health field." (Also Spanish.)

Here are some examples of local newsletters available
in English. If you want a copy to see what they are
like, TALC will ask them to send you one.
HEALTH HABITS

*
SOUNDINGS
*

Community Health Dept., Curran Hospital, Box 1048,
Monrovia, Liberia, West Africa.

World Neighbours, 5116 N Portland, Oklahoma City 73112, USA.
"A good source of filmstrips and other teaching aids."

RDRS Health Programme, Lalmanirhat, Bangladesh.

UNESCO FEATURES*

VIBRO

UNESCO, 7 Place de Fontenoy, 75700 Paris, France.
"Articles concerned with justice, peace and the arts."

Yayasan Indonesia Sejahtera, Central Java Rep.,
Jalan Kenanga 163, Solo, Indonesia.

IN TOUCH

HEALTH NEWS AND VIEWS

XEROPTHALMIA CLUB BULLETIN*

P.M.B. 0038, Gaborone, Botswana.

Nuffield Lab of Opthalmology, Oxford, U.K.
"For health workers concerned with blindness and
xeropthalmia."

,***
**
*,

indicates strength of recommendation.

If you want to be linked with the International Net of ideas, print your name in the space below. Then (circle)
the international newsletters that you would like to receive and you think would be useful to you. Please do NOT
circle any you receive already. If you hope to produce a duplicated local newsletter yourself and would like a
sample of these (circle) these as well. Return the slip to TALC.
Please PRINT your name and address
very clearly

A.T.H.

GLIMPSE

BASICS

HEALTH FOR
The Millions

CHILDREN IN
The Tropics
CONTACT

THE DEFENDER
DEVELOPMENT
Comm Report

NEWSLETTER FROM
The Sierra Madre

N.F.E. EXCHANGE

HEALTH NOTES

SALUBRITAS

If you want a sample
copy of newsletters:

I.P.P.F.
Bulletin

SOUNDINGS

HEALTH HABITS

THE LEARNER
LIFE

UNESCO FEATURES
XEROPTHALMIA
Bulletin

IN TOUCH

VIBRO

HEALTH NEWS& VIEWS

August 1979.

FOUNDATION

FOR TEACHING AIDS AT LOW COST
Institute of Child Health

30 Guilford Street • London WCIN I EH

We

ask you to share this with others

BOOKS AND PAMPHLETS
Read and Pass°n

AVAILABLE FROM TALC
Teaching Aids at Low Cost (TALC) is trying to respond
to a need for certain low-cost books which are
required by health workers through the post, as these
are often not available locally. We must emphasise,
however, that no books other than those listed below
are available from TALC.
Free material sent as
available, but only when books are ordered.
Reduced price for those in, or going to, developing countries
(N) Nev; in 1979/80

Price
£ P

NUTRITION FOR DEVELOPING COUNTRIES:
King, Morley and Burgess

Written in simple English,
with exercises which can be
undertaken in the community.

*
1.70

NUTRITION REHABILITATION:
Joan Koppert

The appropriate and cost effective
method of managing malnutrition.

1.00

THE THERAPY OF THE SEVERELY
MALNOURISHED CHILD:
Hay and Whitehead

Up-to-date management in hospital.
Experience of the M.R.C. Unit in
Kampala.

30

FINDING THE CAUSES OF CHILD
MALNUTRITION:
Richard C and Judith E Brown

A concise booklet to help those
tackling malnutrition.

85

HEALTH CARE OF CHILDREN UNDER FIVE:

Outcome of a conference on child
care in India.

35

REGULATION AND EDUCATION STRATEGIES
FOR SOLVING THE BOTTLE FEEDING
PROBLEM: Ted Greiner

Suggests how international milk
companies may use the medical
profession to propagate bottle feeding

85

USING THE METHOD OF PAULO FREIRE IN
NUTRITION EDUCATION: Therese Drummond

Excellent account of adult literacy
and nutrition programmes.

85

PAEDIATRIC PRIORITIES IN THE
DEVELOPING WORLD: David Morley

Alternative priorities to those
3.00
suggested by traditional paediatrics.
ELBS edition 1.95
Indonesian (£3.00)
Portuguese (£3.00)

(N)

(N)

Spanish (£3.00)

SEE HOW THEY GROW: David Morley

A follow-on to PAEDIATRIC PRIORITIES
IN THE DEVELOPING WORLD; the
importance of the growth chart is
emphasised.

1.50

PRIMARY CHILD CARE:
Maurice and Felicity King

Comprehensive child care in simple
language, well illustrated.

3.00

PRIMARY CHILD CARE : A GUIDE FOR THE
COMMUNITY LEADER, MANAGER AND TEACHER
Maurice and Felicity King

An excellent and most useful book;
also contains 3,000 multiple choice
questions.

3.95

OBSTETRICS, FAMILY PLANNING AND
PAEDIATRICS:
Philpott, Sapire and Axton

Attempts to bring these areas of
health care together.

1.50

CHILD-to-child:
(soon in Indonesian, Spanish,
French)
Also free Newsletter available.

Prepared for the International Year
of the Child, this describes how older
children can help younger children's
health and development.

HEALTH HAS MANY FACES

Water, housing, farming and crafts
essential in development and health.

BOOKLET ON THE UNIVERSITY OF LONDON
MASTER OF SCIENCE COURSE IN MOTHER
AND CHILD HEALTH

This describes the course.
The
Free
curriculum it gives may be of help to
others setting up teaching programmes.

VISUAL COMMUNICATION HANDBOOK:
Denys Saunders

For those desiring to become more
effective in communication.

2.75

DON'T FORGET FIBRE IN YOUR DIET:
Denis Burkitt

Those who have listened to Denis
Burkitt or seen his set of slides
will enjoy this book.

1.95

95

1.00

Total for this page:

£ P

Price
E p

Brought forward from first page
Up-to-date information on advantages
of breast feeding.

BREAST FEEDING, THE BIOLOGICAL
OPTION: G J Ebrahim

1.80

CHILD CARE IN THE TROPICS
CARE OF THE NEWBORN IN

I

DEVELOPING COUNTRIES
PRACTICAL MOTHER AND CHILD HEALTH
IN DEVELOPING COUNTRIES
A HANDBOOK OF TROPICAL PAEDIATRICS

(N)

1.50

All these are designed for
use in small hospitals and
health centres.
By G J Ebrahim

1.95

1.95

1.70

j

BETTER CHILD CARE: V.H.A.I.

Illustrated memory and teaching aid
for talking with parents.

35

WORLD HEALTH, MAY 1978

Excellent number on primary child
care.

40

THE CARE OF BABIES AND YOUNG
CHILDREN IN THE TROPICS:
David Morley

Written for European mothers taking
their children to hot climates.

15

WHERE THERE IS NO DOCTOR:
David Werner

Highly practical, many illustrations. 2.95
A must for those developing village
*
1.95
programmes.
Also in Spanish(£2.00) and
Portuguese (£2.00)

KAPOOR'S GUIDE FOR GENERAL
PRACTITIONERS, PARTS I AND II

Excellent simple description of
medical care.
(per set)

THE VILLAGE HEALTH WORKER
’Lackey' of 'Liberator'?:
David Werner

Superbly illustrated, highlights
problems met when integrating the
V.H.W. into existing medical systems.

30

OBSTETRIC EMERGENCIES:
J Everett

For health centres to guide staff
in obstetrical emergencies.

50

HUCKSTEP POLIOMYELITIS:
R L Huckstep

Management of severe deformities
by surgery and appliances.

3.50

A MANUAL OF ANAESTHESIA FOR THE
SMALL HOSPITAL: F N Prior

Simply written, well-illustrated,
most useful to those with limited
training in anaesthetics.

1.00

THE DIAGNOSIS AND MANAGEMENT OF
EARLY’ LEPROSY: S C Brown

Excellent illustrated small booklet.

Free

BETTER CARE IN LEPROSY: V.H.A.I.

Good illustrations with a simple
statement for village health
education.

35

MEMORANDUM ON LEPROSY CONTROL:
Oxfam, LEPRA, Leprosy Mission

Small illustrated booklet on the
diagnosis of leprosy.

Free

INSENSITIVE FEET: Leprosy Mission

Management of foot problems in
leprosy.

Free

LEPROSY CONTROL SERVICES AS AN
INTEGRAL PART OF PRIMARY HEALTH CARE
PROGRAMS IN DEVELOPING COUNTRIES:
German Leprosy Relief Association

Brings together primary health
care and leprosy.

1.25

GUIDELINES FOR HEALTH PLANNERS:
Oscar Gish

The essentials of Health Economies
and planning.

1.00

PRINCIPLES AND PRACTICE OF PRIMARY
HEALTH CARE:
C.M.C., Geneva

Brings together useful copies of
CONTACT on this subject.

1.00

MOBILE HEALTH SERVICES:
Oscar Gish and Geoffrey Walker

Cost benefit study of mobile
services and alternatives.

2.50

Aji integrated health service

Free

CONTACT 44:

C.M.C., Geneva

2.00

programme in rural India.

THE CHINESE SYSTEM OF HEALTH CARE:
H T J Chabot

Scientific account of health care
in China.

85

A MODEL HEALTH CENTRE

The building and development of
low cost health facilities.

4.50

SIMPLE DENTAL CARE FOR RURAL
HOSPITALS: D J Hales trap

Basic knowledge for a medical worker
caring for dental conditions. (French)

50

SELF-APPRAISAL AND GOAL-SETTING
GUIDE FOR HOSPITAL DEPARTMENTS:
V.H.A.I.

To help those interested in
improved management.

30

APPROPRIATE TECHNOLOGY SOURCEBOOK:
Darrow and Pam

Solutions to village construction
problems, well-illustrated.

IN DEFENCE OF THE NATIONAL
HEALTH SERVICE

A counter to the criticisms of
the U.K. N.H.S.

50

QUESTIONING DEVELOPMENT:
G1yn Roberts

For those with a strong political
stomach.

50

1.20

Total for this page:

£ p

Price
E p

E p

Brought forward from second page

(N)

WHO NEEDS THE DRUG COxMPANIES?

A critical look at the drug industry.

50

(N)

TOMORROW'S EPIDEMIC? TOBACCO
AND THE THIRD WORLD: M Muller

Smoking - a disaster for the tobacco
farmer as well as the smoker.

1.20

MENTAL HEALTH: C R Swift

Mental conditions well described
for auxiliaries.

1.00

HEALTH CARE IN THE THIRD WORLD:
A new policy for V.s.O.

A down-to-earth account of medical
problems and the part that
volunteers may play.

Free

INSULT OR INJURY?: Charles Hedawar

Third World marketing of food and
drugs - an indictment.

1.50

HEALTH SECTOR POLICY PAPER:
World Bank

The World Bank's new approach to
health problems.

Free

COMMUNITY HEALTH AND THE CHURCH

An account of a Christian approach
to health care.
Only in French,
Spanish and Portuguese.

SIMPLE ENGLISH IS BETTER ENGLISH:
Felicity Savage

For those concerned with the need to Free
communicate effectively; helps you to
consider the English you use.

(N)

60

TOTAL:
POSTAGE AND PACKING: Second class
Surface mail

(U.K.)
(overseas)

Orders under £4.00, please add £1.00
Orders over £4.00, please add
25% of total cost of order:

r--------------------------------------------------------------- -----------i
[ TERMS
:
CASH WITH ORDER or AGAINST PRO FORMA INVOICE 1
!_ ___________________ i NiB.

-__________________________________-___________

paying by cheque or money order in currency other than sterling drawn on a
British bank, please add 50p.

Cheques should be made payable to TEACHING AIDS AT LOW COST or TALC.
Please print your name and address clearly.

Health
workers
need and
love
books

6/80

FOUNDATION

FOR TEACHING AIDS AT LOW COST

Institute of Chilo Health
30 Guilford Street • London WCIN I EH

NEWSLETTER
Dear Colleague,

This last year has been a full one and we have
much to write to you, some of which we hope will
be of use to everyone.
CHILD-to-child Programme

'78

hand-held models. One of these illustrated here
(Fig.1) is now being made at an economic price
in India. Appropriately concentrated vaccines are
also available from that country. Ide need more
controlled trials of these machines. They are
recommended to those with a little mechanical
expertise who are willing to dismantle them and
occasionally replace an O-ring or washer.

This is a joint programme being run between the
Institutes of Education and Child Health in the
University of London. The programme was started
in September 1977 and aims to build on what the
older school-age child already does for younger
children in the family. You should already have
received one sheet describing it. This sheet is
now available also in Farsee, Arabic, French,
Portuguese and Spanish. On the blue sheet
accompanying this letter (also available in Arabic,
French and Spanish) you will see a brief descrip­
tion of the activities that have so far been
suggested from all over the world in which school
children can be involved. If you are interested
in developing a programme in your area, please let
us know so that we can put you on the CHILD-tochild mailing list.

PI.Sc. in Mother and Child Health
1978 will be the last year of the UNICEF/WHO
Course for Senior Teachers of Child Health.
Evaluations and our own experience confirm that
this course has been highly successful in helping
senior paediatricians to appreciate their respon­
sibility for all the children in the community.
Me believe the new course, which will be an M.Sc.
in Mother and Child Health from London University
and take 15 months, is a natural outcome of the
previous course. The new course will be for
teachers from medical schools and auxiliary
training schools. A blue booklet describing this
M.Sc. course is available.

Shakir Strip

This is now very widely used, both by local groups
and on a national scale in some countries. A new
leaflet about it is available from TALC. These
strips can be used by groups within the community.
Ide do, however, need more experience in how to
communicate the findings to the community. Perhaps
we should teach our health workers and mothers to
be able to assess a malnourished arm with their
finger and thumb. (Fig.2)

The Tropical Child Health Unit also runs two short
courses each summer in Duly and September.

New sets of slides
Last year was one of consolidation, and relatively
few new sets have been added. However, in 1977 we
sent out an average of 1,000 sets a month,
totalling a third of a million transparencies J !
Thanks to assistance from the Nuffield Foundatior
we are now able to obtain additional help and
Dr.Felicity King (nee Savage) has already started
to edit and otherwise help in the production of
many new sets.

Books
We would strongly recommend two new books that have
just become available. These are David Werner's
book 'Where there is no Doctor*, and Maurice King's
much-researched work 'Primary Child Care*. Both
are well.illustrated, as you will see on the white
sheets describing them.

Immunisation programmes

A number of organisations are showing renewed
concern that more priority should be given to
■4mmunisation, and a handbook on immunisation is
available from WHO Regional Offices. In particular
emphasis<is being placed on the cold chain. One
area in whlSh ..more research and study is required
is with jet injectors, particularly the small

Cut a piece of wood of this circumference or use
the inner cardboard of a toilet roll so that you
know what 12.5 cm. feels like with your fingers
and you can show this to others.

Deficient energy intaka due to too much bulk

Rchydration Spoons

Between the ages of 1 and 3 years a child needs
between 1,000 and 1,4000 calories a day.
In the
second year of life, (often a) half of the total
intake of calories fray still come from breast milk.
Host children cannot obtain their full quota of
calories, largely because of the bulkiness of the
diet.
If the child cannot obtain the energy
(calories) he requires, cur efforts to feed him
protein foods will be of no use. He will use this
extra protein to provide calories. We are
concerned that not enough is being written and
said about this aspect of the nutritional problems
of children. Here are figures of the calories
produced by 100 grammes of some common foodstuffs
as purchased.

Very few children will require intravenous therapy
if oral rehydration is started as soon as
diarrhoea occurs.
There is a desperate need to
teach mothers the correct quantity of salt and
sugar to feed. Why not carry a plastic spoon
around in your handbag or pocket, and whenever
you sit down to eat with someone ask them if they
know how to rehydrate a child or an adult. There
is likely to be sugar and salt available on the
table, and you can show them there and then and
get them to taste the fluid. Tell them it should
never be more salty than tears. When diarrhoea
starts, an adult takes two glassfuls for each
stool and a child one.
If you want a supply of
spoons to try, send us £1 and we will send you
some as soon as they are ready.

K cal

K cal.
Maize meal

354

Cassava flour

342

Wheat flour

350

Sweet potato

114

Rice

354

Irish potato

75

Millet flour

365

Yam (fresh)

104

Sorgum flour

353

(1 k cal. = 4.184 k J)

Can you undertake a simple trial which we think
will convince you, your staff and the mothers, of
the importance of the problem of bulk? Weigh an
amount of your local staple food (Rice 338 g.,
Maize meal 338 g., Wheat flour 342 g., Millet
flour 329 g., Sorgum flour 340 g., Cassava flour
351 g.) equivalent to 1200 k cals, or if you do
not have appropriate scales, 2 cupfuls of Maize
meal, Wheat, Millet or Cassava flour, or 1-J cup­
fuls of Rice, and give it to a mother with a young
child to prepare in a manner appropriate for a
child 1-2 years old. When she brings back the
cooked food, you may be surprised to find that it
weighs more than a kilo, more than a child can eat
in a day. Do drop a line to Miss Pat Harman in
the T.C.H.U. giving us your results.

to MAKE the dose
add to each cup of water
1 level scoop of sugar (A)
1 level scoop of salt (B)

TAKE the dose
after every diarrhoea
a CHILD must take
1 dose
an ADULT must take
2 doses

BOTTLE FEO BABIES - Seek advice before use
The above is the wording which will be imprinted
on the spoon. We hope also to have it available
in Arabic, French, Spanish and Swahili and
perhaps other languages later.

Best wishes.

Tropical Child Health Unit
Tropical Child Health Unit

Since the autumn of 1977 the Unit has moved from
the hut to the fourth floor of the Institute of
Child Health. We were very sorry when Margaret
Woodland retired at the end of the year. She
has done so much to develop the resources of the
Unit, and over the last six years she has
welcomed several thousand visitors. Miss Pat
Harman has taken over. As a public health nurse
she worked in Vietnam and Papua New Guinea, and
recently undertook the Diploma Course in Human
Nutrition. Do try and visit us in our new
location ('phone 01-242 9789).

Communication of innovation
Many thanks to those responding to the questionnaire
sene out.
From this we hope to learn how the use
of growth charts and other innovations spread.
The response was excellent.

The Journal of Tropical Paediatrics
and Environmental Child Health
Starting in 1978, this Journal is being published
under the joint auspices of the Tropical Child
Health Unit and the School of Public Health,
University College of Los Angeles. A discount of
10% on the subscription is being offered to those
taking out a 2-year subscription and of 25% for
the first year's subscription to all bona fide
students.
It is the only international Journal
of its kind and ue hope you will be interested.

William Cutting
Zef Ebrahim
□ill Everett
Pat Harman
Di Hensey
Bente Knagenhjelm
David Morley
Marcia Wickramasinghe
TALC

CHILD-to-Child

Joan Blissett
Barbara Brown
Bane Dorling
Sheila Frazer
Gill Gadsden
Pat Haberfield
Leila Lauder
Joan Lund
Margaret Spankie
Dorothy Stranks

Paula Edwards
Duncan Guthrie
Hugh Hawes
Joan Dames

FOUNDATION

FOR TEACH5NG AIDS AT LOW COST

Institute of Child Health
30 Guilford Street • London WON I EH
TALC sells teaching aids for health workers at or below cost
price.
Our purpose is to help raise standards of health care,
especially in the developing countries.
A major activity is
producing and distributing sets of colour slides on various
health topics.
With the sets are scripts describing each slide,
and usually including questions and answers.
This is a teaching
activity of the Institute of Child Health, of the University of
London.
TALC is a non-profit making organisation, - we keep all
prices as low as possible, and offer reduced rates when we can.
However, - we are self supporting, so we are bound to cover our
costs.
HOU TO ORDER:
Complete the order form below,
TALC at the above address in London.

Hake cheques payable to:

and send with cheque or money order to

Teaching Aids at Low Cost (TALC).

Paving from outside the U.K, (or from
sterling on a London Clearing Bank.
Bank.
Or:
Pay in U.S. dollars on a
drawn on a Bank outside the U.K.
It

Eire):
If possible:
arrange for payment in
Or:
Pay in your own currency on your own local
U.S. Bank.
Please do not send a sterling cheque
is expensive for us to cash these.

If paying in currency other than sterling, please ADD the equivalent of 50p.
payment.
This is the average cost to us of converting cheques.

to each

Airmail postage:
Prices listed cover packing and surface postage only.
For airmail
postage of mounted or unmounted slides - add 35p. per set.
For all other items postage is charged at cost and we will invoice you after despatch.
If you wish, we
can invoice you for items and postage altogether.
V.A.T.
This is a U.K. tax which must be paid on ALL ITEMS SENT TO AN ADDRESS IN THE U.K.
Please add 8% to your payment.
Visitors from overseas must pay V.A.T. if the items are
sent to them at a U.K. address.
You need not pay V.A.T. if the items are sent to an
overseas address.

PRICE LIST
All prices include packing and world wide surface postage.
Prices are for sets
containing 24 slides.
for sets containing 48 slides, the price is double.

^Prices in brackets are reduced rates for people working in developing countries, or
who will soon go to such a country.
SELF MOUNTING SETS £1.30 (80p.)
*
slides and script.

for 24

To keep the cost low, we send the slides as a
film strip for you to mount yourself.
Self
sealing mounts and instructions are included.
These sets are very popular, and most people
have no difficulty mounting the slides.
PRE MOUNTED SETS £1.80 (£1.35)
*
slides and script.

for 24

Exactly the same items - but they cost more
because the slides are ready mounted.

SETS MOUNTED IN PLASTIC SHEETS IN FOLDERS
£2.50 (£2.25)
*
for 24 slides and script.
Each set of slides comes in a special plastic
sheet with 24 pockets.
Up to four sheets are
put into a card folder with their scripts.
Or, you can hang the plastic sheet on a bar to
store it in a filing cabinet.
(Please state
"bar" if you would prefer this to a folder).
You can also use the plastic sheets to prepare
slides for a lecture.
(Hold the whole sheet
in front of an X-ray viewing box or window).
And you can fold the sheet up to carry the
slides in your pocket.

SLIDE TAPE SET £10.00 (£7.00)
*

A mounted set of slides, a cassette with the
scripts recorded on it, and the written script
in a plastic file.
Students can listen to a
lecture recorded anywhere in the world and see
the slides that go with it!
This may also
help you to understand spoken "medical" English
Any cassette tape player and projector can be
used, (or one shown below).
SLIDE TAPE TUTOR £55.00,

postage not included.

For individual students working in a library.
It can be permanently locked to a desk.

SLIDE TAPE PROJECTOR £70.00, postage not included.
For small groups of students.
You can lock
on a table in a sound proof cubicle or small
room - so that the tape recorder does not
disturb others.
Includes a small daylight
screen.

SETS
*New ii

COLOUR

OF

SLIDES

(Sp) Script in Spanish available.

1978.

*
AmP

AMERICAN PROTOZOA:
Relates to South America but many of the conditions
are common to other areas.

*
AmH

AMERICAN HELMINTH:
Those of importance in human disease.
relevant to other areas of the world.

*
Bf

BREAST FEEDING:

BL

BURKITT'S LYMPHOMA:

CcO

CANCRUM ORIS:

Cd

CONTRACEPTIVE DEVICES:

*
ChG

CHARTING GROWTH IN SMALL CHILDREN:

ChD

CHILDHOOD DEVELOPMENT:

Cig

CLINICAL GENETICS:

Cm

COMMUNICATION IN HEALTH:
communication.

DhP

DIARRHOEA:

EAf

EAST AFRICA - CHILDREN’S HEALTH AND WELFARE:
Prepared with UNICEF, this
describes UN work.
For general public and school children.
(No tape
recording available).

Fbr

FIBRE IN HUMAN DIET:
An excellent and amusing epidemiological account of
the importance of dietary fibre.

Fwa
Fwa

FOODS OF WEST AFRICA:
Foods commonly given to children,
and nutritional value.
(48 slides, .double the price).

GR

GROWTH:

Many are

Available in a few months.
Its principal clinical features.

Aetiology and management.
Methods of Family Planning, prepared by the IPPF.
Available in a few months.

In African children.

This complex subject well explained.

Aetiology,

Ways in which a health worker may improve

and management by auxiliaries.

Diagrams illustrating normaT' growth,

their preparation

only suitable for senior

medical students.

An innovative agricultural and health programme.

JAM

JAMKHED:

KwM

MANAGEMENT OF KWASHIORKOR:
prevention.
(Sp).

Lp

LEPROSY:
A description of the disease with particular reference to
childhood.

LpCn

THE CLASSIFICATION OF LEPROSY:
improved classification.

MDTD

MICROSCOPIC DIAGNOSIS OF TROPICAL DISEASES:
agents of many tropical diseases.

MI

MALNUTRITION:

MnC

MANAGEMENT IN CHILD HEALTH:
workers.
(Sp).

MR
MR

MENTAL RETARDATION:
Common causes of mental retardation in the U.K.
(48 slides, double the price).

MS

SEVERE MEASLES:

*
NbC

NEWBORN CARE:

NbD

NEWBORN DEVELOPMENT:

Differentiating premature and small for dates newborn.

NbK

NEWBORN KERNICTERUS:

Prevention through identifying "at risk" children.

NbL

NEWBORN LUNG:

Ntr

NUTRITION REHABILITATION:

*
One

ONCHOCERCIASIS:
River blindness, a depopulating disease along the rivers
of W. Africa and S. America.
The disease, how blindness arises and may be
prevented.

Common causes of early death and their

New understanding that immunology leads to

Microscopic appearance of the

As seen in Indian children but relevant to other areas.
Principles of management for health centre

Suggestions as to how and why it is severe.

Available in a few months.

Its physiology and pathology.
As developed in India but relevant to other areas

SETS

OF

COLOUR

SLIDES

(continued)

Ped

PROTEIN CALORIE DEFICIENCY:
kwashiorkor and marasmus.

pen

PATHOLOGY OF EXPERIMENTAL MALNUTRITION:
animal tissues.

PH

PAEDIATRIC HAEMATOLOGY:
tropical countries.

PhU

PHYSIOLOGY OF WOMEN:

Sk

COMMON SKIN DISEASES OF CHILDREN IN THE TROPICS:
conditions in the tropics and their management.

SkT

SKIN DISEASES IN TEMPERATE ZONES:

SpC

SMALLPOX IN CHILDREN:
prevention.

TERL

TECHNIQUES FOR EFFECTIVE READING AND LEARNING:
levels to improve their learning technique.

TbP

PATHOLOGY OF TUBERCULOSIS IN CHILDHOOD:

TbNH

NATURAL HISTORY OF CHILDHOOD TUBERCULOSIS:
childhood T.B.

Xma

XEROPHTHALMIA:

XrC

X-RAYS IN CHILDHOOD:

A description of the

syndromes

Microscopic appearance in

Common haematological conditions found in

Conception and pregnancy in simple diagrams.
Common skin

Common conditions in the U.K.

Clinical description in African children and
For students of all

Macroscopic and microscopic
The characteristics of

Clinical appearance and prevention.

Some diagnostic X-rays for students to study.

With every order we send this free multi-purpose viewer.

OTHER
SET OF FOUR MEASURING SPOONS

MATERIAL

AVAILABLE

FROM

TALC

£1.00 for four sets.

For use in hospitals and clinics.
Will measure appropriate quantities of glucose and
salts for a litre of rehydration fluid.

Coloured picture of normal and anaemic tongue.
severe anaemia.

Proved satisfactory for recognising

ORDER FORM

(Please write in BLOCK CAPITALS)

NAME

ADDRESS you want order sent to:

PERMANENT ADDRESS if different.
(for our mailing list).

U.K.
currency
..........................................................................................................
Total in
sent
in your
currency
..........................................................................................................
Currency conversion 50p.
ITEMS REQUIRED:
To order slides, give CODE LETTERS only and state "Self mounting",
"Pre-mounted", "Folder" or "Bar", "Slide/tape set".

£
...........................................................................................................

Total cost of items

..........................................................................................................
..................................................................................................... .. ..

V.A.T.
Airmail 8%
postage

FOUNDATION

FOR TEACHING AIDS AT LOW COST

Institute of Child Health
30 Guilford Street ■ London WCIN I EH
Tel: 0727 S3869
This leaflet gives details of material available from TALC in
addition to the range of books and slides.
TALC is a non-profit-making organisation ,r a teaching activity of
the Institute of Child Health.
We keep all prices as low as
possible and offer reduced rates where we can.
However, we are
self-supporting, so we are bound to cover our costs.
How to order:

Complete the order form below, and send with cheque or money order to TALC at the above address.

Make cheques payable to:

Teaching Aids at Low Cost (TALC). 1

Paying from outside the U.K, (or from Eire): If possible arrange for payment in sterling on a British bank.
Or: Pay in your own currency on your own local bank. Or: Pay in U.S. dollars on a U.S. bank. Please do not send
a sterling cheque drawn on a bank outside the U.K. It is expensive for us to cash these.
If paying in currency other than sterling, please ADD the equivalent of 50p to each payment.
cost to us of converting cheques.

This is the average

V.A.T. : This is a U.K. tax and must be paid on all items sent to an address in the U.K. with the exception of
ROAD TO HEALTH weight charts. Please add 15% to the total cost of the order including the charge for postage and
packing.

'ROAD TO HEALTH" WEIGHT CHARTS
Growth charts of this type are now widely used. The TALC chart
undergone extensive testing and development over 20 years. We
strongly advise gaining experience with these before developing
your own modifications.

Available in English, Arabic, French, Spanish and Portuguese
£45.00 per thousand, carriage extra. Special rates for orders
over 10,000.
A sample chart will be sent free on request.
10 charts sent for 50p.
NO V.A.T.

Charts printed on white card intended for use by local printers to prepare
lithographic plates.
(French, Spanish, Arabic, Portuguese)

75

Flannelgraph with detailed instruction in its use (for details see below)

25

Overlay transparent sheets. For use in evaluating any change in the weight of
groups of children attending clinics.

2. 50
OO

Large transparency for use with an overhead projector.

Precut stencil for standard duplicator. Charts can be printed on paper for
(French, Spanish, Arabic, Portuguese)
training purposes.

25

8. 00

A kit containing all the above can be sent for
WEIGHING SCALES

TALC do not provide weighing scales. However, we work closely with manufacturers
in developing appropriate models. We recommend that you contact:

C.M.S. Weighing Equipment Ltd, 18 Camden High Street, London NW1 OJH, England.

FLANNELGRAPH OF THE GROWTH CHART

The introduction of growth charts is not easy.
concept involved in completing a growth curve.
understanding and interpreting a growth curve.

3. 25
Many health workers are unused to the
Even more have problems in fully

Exercises in which they are involved using a flannelgraph
can be an important step in the successful use of
growth charts. The flannelgraph consists of a
growth chart printed on cloth 91 cm. x 62 cm.
with two sheets of symbols to cut’out, and
sheets describing the exercises in detail.

NUTRITION AND CHILD HEALTH FLANNELGRAPH
This flannelgraph is appropriate for village teaching in large areas
of Africa. There are seven sheets of cut-outs and detailed
illustrated instructions. These cover the following subjects:

Feed your children often
Learning to eat
Measles
Give your child plenty of soup

Diarrhoea prevention and
home management
Come to the Child
Welfare Clinic

These were well evaluated before being produced, and will be
invaluable to those involved in teaching nutrition, health and
development at village level.

Price:

7. 50

Total for this page:

<
£

p

Brought forward from previous page
KIT FOR MULTIPLE CHOICE QUESTIONS
Multiple choice questions are an effective method of encouraging study.
This is particularly so when the student gets immediate feedback. With
this kit and a duplicator, sheets can easily be prepared on which
phenolphthalein has been dried on to appropriate letters but remains
invisible. The student is supplied with washing soda and dabs a letter.
If correct, the student gets the satisfying response of a bright colour
reaction.

The kit comes complete with a supply of phenolphthalein, washing soda,
pricestencils, perforated plastic overlays and full instructions.
Developing countries:

Satisfactory for detecting severe
anaemia by lay workers.

ANAEMIA RECOGNITION CARD
(lOp each - 10 for 80p)

XEROPTHALMIA RECOGNITION CARD
(lOp each - 10 for 80p)
SET OF FOUR MEASURING SPOONS
(Four sets for £1.00)

SUGAR AND SALT MEASURES
(20 for £1.00)

4. 00
2. 00

Designed to be used to identify
early stage of Vitamin 'A'
deficiency.

Scoops for clinic use. Measure
appropriate quantities of glucose
and salts for a litre of rehydration
fluid.

Spoons for home use, to prevent
dehydration (French, Arabic,
Spanish, Portuguese).

to HAKEeachthecupdoseof i^ater

TAKE
the dose
.
?
..

I teoel scoop of salt (0)

a CHILD must take 1 dose
on ADULT musi-taKe 2 doses

edd

SUGAR. 1 Level scoop of sugar (fl)

BOTTLE fed 0ABIE5-Seek advice before use__

COLE'S SLIDE-RULE CALCULATOR
Tanner-Whitehouse Standards
Height and Weight Attained
0-19 years

Quick method for working out centiles
for height, weight, assessing weight
for height, stunting, wasting, etc.

Price:

2. 20

Total of order:
25% for postage/packing:

15% for V.A.T. (if applicable)
Currency conversion:
Cheque attached for:

CASH
N.B .

WITH

ORDER

If paying by cheque or money order other than sterling drawn on a U.K. bank,
please add 50p.
Cheques should be made payable to TEACHING AIDS AT LOW COST or TALC.

Please print your name and address clearly.

2/80

1

£

p

CH iQLlO

international Year of the Child 1979
DIRECTOR f
* r
Ss< John’s ■ i;
NEWSLETTER 2
BAN<?

c/o Institute of Child Health
3.0'Guilford Street
Londd’n WC1 N 1 EH
.Telephone 01-242 9789

liege & Hospital,
- 560 034.

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CHILD-to-child is an international programme designed to teach and
encourage school children to concern themselves with the health and
general development of their younger brothers and sisters. Simple
preventive and curative activities as well as games, play and
role-playing will be taught to the children in school, so that they
may pass ideas on in the family or community environment. It is
hoped that initiative and encouragement will come from government
and other official sources.

This Newsletter records some of the CHILD-to-child projects being
planned or actually under way in different parts of the world.
Perhaps YOU would take one of these projects and adapt it to fit
your own local conditions, or devise an entirely new project. At
all events, will YOU run a CHILD-to-child scheme......... ?

INTERNATIONAL CONFERENCE
In April a three-week CHILD-to-child
Conference was held in England.
For two weeks
an international group of approximately twenty
met in London, and for a third week twenty more
joined the meeting which moved to a conference
centre at Fittleworth, West Sussex.
The
chairman for the last week was Dr T A Lambo,
Deputy Director-General of the World Health
Organisation, and the participants included
educationalists and medical and paramedical
experts from Bangladesh, Chile, Egypt, India,
Jamaica, Kenya, Malaysia, Mexico, Nigeria,
Philippines, Sri Lanka, Sudan, Uganda and the
United Kingdom.

CONSULTATIVE COMMITTEE

An international consultative committee for
CHILD-to-child has been established, with the
following membership:
SAM ABRAHAM, President of the
Malaysian Paediatric Association

Malaysia

JINAPALA ALLES, Senior Programme
Specialist, UNESCO-UNICEF
Cooperative Programme, Paris

Sri Lanka

TUNDE BAJAH, Senior Research
Fellow, International Centre for
Educational Evaluation, Ibadan

Nigeria

if The two main purposes of the meeting were to
I? build up ‘a prototype framework for a local
i CHTLD'~to-child^programme and to suggest
I activities whicK~a_chTl"d~cduld reasonably be
expected to undertake iri~order to teach his
or her younger brother or sister.

MARIA DANTAS, Professor of Education,
Bahia State

Brazil

HUGH HAWES, Department of Education
in Developing Countries, London
Institute of Education

UK

CHILD-to-child is a world wide programme, and
so it is unlikely that any one programme
would be appropriate to local conditions and
local needs in every country, but the
conference aimed to devise programmes which
could be adapted if not adopted, or which
would encourage groups in many countries_ to
set up their own^ appropriate 'cHlED-£6-cfiTI5
prograjranesT Some of the suggestions put
■forward were discarded but others were
approved and discussed in great detail until
it was felt that they were good enough to
publish.

TOM LAMBO, Deputy Director-General,
World Health Organisation

Nigeria

HOMAI JAL MOOS, Assistant Educational
Adviser, Ministry of Education and
Social Welfare, New Delhi

India

DAVID MORLEY, Tropical Child Health..
Unit, London Institute of Child
Health ’ ""'

UK

DUNCAN GUTHRIE, Secretary

UK

THE NEED FOR ENJOYMENT

Early in the discussion it was realised that
it would be wrong to suggest activities which
would be unattractive to children, or which
would in any way exploit them.
As each
suggestion was put forward delegates asked
) ’Will this be fun?’ and if the answer was in
tTfe^hegative the"proposal was dropped.
*
Emphasis was also laid on making useof games,
role-playing and acting, traditional songs" *
and dances.

I

CHILD-to-child ACTIVITIES

SUGGESTIONS FROM AROUND THE WORLD
Eating well
Children who are well-nourished are physically and mentally healthy, and are less prone
to disease.

Looking after our eyes by eating v/ell

Measuring malnutrition

Vitamin A deficiency is one cause of blindness;
Malnutrition is common in many countries, often severe
older children can:
enough to stunt growth and development. A simple
measure of the degree of malnutrition is the Shakir strip, . r ensure adequate supplies for younger children
which ^faer children can easily be taught to use. This
/gi
by growing vegetables and fruit rich in Vitamin
was described in Newsletter 1.
A, and drying the leaves of certain vegetables
for use out of season.

The Energy Breakfast

I
I

It is better for a child to eat a good meal early in the
day so Jihut he or she has sufficient energy to cope with
'"TlL lan~ds. Older' OhlTcTren can be taught in
school to regard it as an important dietary factor and
to encourage their younger siblings to eat more.
Best-Buy Diets

By finding out which foods are both nutritious and cheap,
according to season even poor families can afford to eat
better. Older children can find out about these foods as
a school project so that their younger siblings can have
more and better food.
Growing vegetables

Many vegetables are rich in particular
nutritional essentials. Older children
dan learn how to grow vegetables in a
start their own plbt^at home, teaching

- learn how to recognise signs of Vitamin A
deficiency and when treatment by a health
worker is necessary.

/!^ Food preparation by children
Children can learn how to prepare food which is
nutritious and imaginative. This will teach them
about food values and balanced diets.

Food preparation round the world
Children can learn what food
is eaten in different cultures
and how it is prepared. This
will broaden their ideas about
food and form the basis for
projects at school. They
can pass their ideas to
younger children

rjie school garden could be used to
teadh aB'OU'ET the effects _of
fertilisers and seeds on
production.

Children as health workers
Since older children spend so much time with their younger siblings,

prevent them from becoming ill,

they could do much to

treat them when they are, and minimise the effects of illness

rHome management of diarrhoea
Severe diarrhoea is very common and children under
five years frequently die from the resultant
dehydration. Older children can learn how to
prepare and administer the right solution of salt,
sugar and water.

Helping at the clinic
Older children can help, at the clinic by preparing
younger children for weighing, vaccination etc, by
handing but and collecting cards and charts, by
helping to record information and by .playing...with
younger children while they are waiting.
Weighing and measuring children
bolder children at school can survey younger children's
growth and development by weighing and measuring
them at the beginning and end of each term or year,
noting the results and recording them graphically.

A special plastic spoon will be available.

Home nursing

* ACTIVITY SHEETS with suggestions on how to
organise this project are available from:
CHILD-to-child, 30 Guilford Street, London
WClll 1EH

Older children can learn basic nursing techniques
from teachers and health workers and help make
younger children more comfortable when they are ill.

health Scouts

Recognising common illnesses and skin conditions

Teachers, leaders of youth organisations and other
community leaders can help older children to organise
themselves .into groups of Health Scouts. Activities
could include spot maps of the community's immunisation
state, incidence of malnutrition and serious illness,
so as to locate areas of greatest risk.

Much unnecessary suffering and death in younger
children can be prevented if older children can
learn to recognise certain warning signs of common
illnesses and seek help by telling the mother or by
getting help from a health worker. If older
children are taught about the relationship between
skin sepsis, lice, scabies, ringworm and poor
hygiene, and how all these conditions can be
eliminated or reduced by simple personal hygiene,
they can help to protect both themselves and their
younger siblings.

Older children can also draw maps to show where health
services are available and make visits to clinics to
see what services they offer on what date and at what
time.

Recognition cards for illness

Older children can make charts or cards in school
to help them in recognising the visual signs of
illness in younger children.
Seeing and hearing

Older children can test the sight of pre-school
children for signs of visual handicap. They can
make the test charts themselves. Older children
can test the hearing of younger children for
defective hearing by means of a simple game. By
locating pre-school children with sight or hearing
defects, older children can be ready to help them
when they go to school.
*Caring for teeth
Worms and parasites

Older children can teach younger children about
dental hygiene and how to care for their teeth,
either by the proper use of chew-sticks or by
correct brushing.

Older children can protect theu.seIves and their
younger siblings by learning where worms and parasites
breed and how to avoid getting them.

Providing a healthy and safe environment

.

Better community health is built on awareness.

understanding,

communication.

»

.
cooperation and good

By being encouraged to develop these attitudes and translate them Into action

older children can improve the environment for themselves and their younger siblings,

Our neighbourhood and making it better

Children can find out all the factors which help or prevent
children from growinq up healthy; they can devise
community action for improving the environment and pass
on their ideas to younger children.

I Health and the school : Surveys and competitions
It may be easier to teach children the wider application of
health precepts by using the circumscribed area of the
school. With the accent on child initiative and group­
work, personal and environmental health surveys can be
conducted and inter-school competitions organised with a
"health shield" and a prize as awards.
Surveys based on various health priorities:

- Insect-breeding places (e.g flies and snails)
Older children can locate the breeding-places of harmful
insects and either clean them up or eradicate them. They
can also take action to kill flies and water-snails and
teach the younger children about the dangers.
- Animals and pests (e.g. rats)

A similar campaign can be conducted in relation to
animals and pests such as rats. Older children can learn
about the illnesses associated with these and how to
avoid them, and encourage younger children to do the same.

- Water sources and resources
Children can find out where their water comes from and
how plentiful (or scarce) the supply is; whether they
share the water source with animals, how near it is to
waste disposal sites, etc, and take action to improve it.

Action campaigns:

- Waste prevention and disposal
Children can lead a campaign to clear up litter
and find hygienic ways of disposing of waste,
particularly of animal and human excreta, thus
reducing the dangers to health.
- Clean water
Children can undertake a campaign aimed at making
water supplies in the village as free as possible
from pollution and infection.

Play areas
to play :r.

- “

Being involved in organising their own play
areas helps children to develop certain skills and
attitudes. It is hoped that this involvement might
keep them away from playing in dangerous places.
“ Safety in play
Children should learn to manage their own bodies
efficiently and to recognise when they are putting
themselves at risk. Older children can teach
younger children how to play safely.

♦Accidents
Many children are injured in accidents. A lot of these
can be avoided if more care is taken both in the home
and outside. Older children can identify the causes of
common accidents, work out ways of preventing them and
thus protect younger children from harm. They can also
learn how to perform simple first aid.

The number of road vehicles in most countries is
rapidly increasing. So is the danger of children
being run over by them. Therefore it is very
important to teach children how to cross the road
safely, to walk along the road out of the way of
the traffic and to be particularly careful at night.
Older children can both protect and teach younger
children.

Children growing up (understanding children)

......

It is important that older children understand how young children grow up,

They spend so

much time with younger siblings that they are in a position to ploy a major part in their

growth and development,

•Recording children's growth and development.

Developing attitudes

Older children in the school can record the births of
younger children in their own families or in neighbours’
families which do not have an older child at school.
They later record the major milestones in each child's
growth. In this way children who fail to develop will
be detected early and older children can then help.

- Caring

Recording more specific types of information

- Vaccination and immunisation
Older children at school can record vaccinations
given to younger children, and can check that younger
children have been vaccinated at the right time. A
decorative chart made by older children to hang on the
house wall will remind pc»rents when vaccinations are
due.

BlRTHHar Cahd with Immunisation Reminder

It is important for children to recognise their
own feelings toward others and to understand
the feelings of other people. Through discussion,
stories and role playing they may be helped to
develop an attitude of caring towards the people
with whom they live and work.
- Sharing

Older children car. help younger children to
develop attitudes of unselfishness and generosity
by sharing their toys and games, etc, with them,
and encouraging them to share with each other.
- Kindness to others less fortunate
e.g handicapped children

Older children can help younger
children to be helpful to
children less fortunate than
themselves by showing them how
to help; e.g. helping blind
children to walk about by
themselves, and talking about
what they can see so that
blind children can learn about
their environment.

QUOTES WE HAVE PICKED UP ALONG THE WAY..........

"We must learn never to be satisfied
with what we have done ......... "
This Catxf is made by the Children.

"Have the children been consulted?"

"CHILD-to-child is a ‘bag of ideas'"

- illness and accidents in young children
Older children can record the type and severity of
illness or accident younger children experience. This
information will be helpful both in their own health
campaigns and for health workers.

"A programme which starts and ends in
1979 raises false hopes and invites
frustration. The ideal CHILD-to-child
programme is one that is initiated in
1979 and goes on from strength to
strength in years to come."

Stimulating younger children
If children ore to srow up physically and mentally healthy
at the right time.

they need the right kind of stimuli

Since older children spend so much of their time with their younger

siblings they can play a major part

in their growth and development by providing these stimuli.

*Playing with younger children

Acting and role playing

Children can learn at school what a baby or small child
should be doing at a particular age. They can devise
activities to help the small child develop physical,
psycho-motor and intellectual skills.

Acting and role play are natural activities for
children and older children can use both for
conveying health concepts to each other, to
younger children and to the community. They can
perform in their own school or community or go to
other schools or communities, perhaps as part of
a drama festival of health. They can either use
existing material or write their own scripts.

*Toys and games for young children
Young children can learn much through play. Toys and
games help both physical and social skills. Older
children can make toys and games out of locally available
natural and man-made materials for their younger
siblings. They can build, where possible, on local
games and toys and devise new ones for teaching health

Helping the child-minder

Many quite young children are expected to look
after even younger siblings by themselves, and
they may well not be school attenders. Older
school children can try to locate such children,
take toys and games to them and teach them how to
use them. They can also teach them what they
themselves have learnt about child development
and stimulation of young children.
Play and the pre-school child
Young children learn by playing together. Older
children can run play groups for younger children
under adult supervision, either in school
buildings out of school hours cr elsewhere. They
can learn how to run a play group at school and
make toys and games in craft classes.

Stories and story-telling
Stories and story-tellina are means of transmitting the
culture of a community. They also help to develop
socia? and creative skills. Older children can collect
those from their own communities and from other cultures
and teach them tc younger children. They can also make
up some of their own to teach health concepts.

Other ideas
Including the out-of-schcol child

Many children do not go to school. It is important to
include them in the CHILD-to-child programme through
village leaders, teachers, schoolchildren and any other
people who can organise or contribute.
Improving the environment. - tree-planting

Each class could plant one tree per year - preferably
fruit trees - and tend them. This would improve the
environment, teach children tree-cultivation and provide
them with fresh fruit. Older children can help the
younger.
School brothers and sisters

Older children could 'adopt' younger ones for whom they
could be particularly responsible. This can be done in
school or in the community.
h’e are grateful to Shell International Petroleum
Company Limited for supporting the publication of
this newsletter.

j “CHILD to-child”
*
$
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2
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$
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$
$
$
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An illustrated book describing the
programme as it may be applied in different
countries, will be published by the
Macmillan Press in January 1979.
The text
derives from the discussions at the April
Conference, and the illustrations are by
Carol Barker.

"CHILD-to-child" is obtainable through all
booksellers, probable U.K. price £0.95
(paperback), £3.95 (cased), or from
CHILD-to-child, 30 Guilford Street, London
WC1N 1EH, or in cases of difficulty write
to Miss Dawn Hunter-Ellis, Macmillan Press
Marketing Department, 4 Little Essex Street
London WC2R 3LF, quoting International
Standard Book Numbers as follows:

Paperback edition : 0 333 26137 2
Cased edition
: 0 333 26136 4

ST4JP PRt'S5
CH IkD-^-dli). is alre<uh> jpveaSuMi
U)tyjt

5i) ■rfCF Loe.

Feed back
CHILD-to-child activities are reported from:
GUATEMALA/ Where a NAN (NINO a nino) pamphlet
will explain to 400 paramedical health workers
how to teach children from the age of 7 to 12
years old basic health concepts for better
care of their younger brothers and sisters.

IN THE WEST...
Mrs Rosalynn Carter expressed considerable
interest in CHILD-to-child when the
Secretary called on the President’s wife
at the White House recently.
Mrs Carter
followed up the meeting with a letter in
which she said that she was looking forward
to exploring ways that CHILD-to-child might
also be used in the United States.
This is
in line with current thinking within the
CHILD-to-child organisation, and
suggestions for CHILD-to-child activities
appropriate to the industrialised countries
have
from various sources.
The CHILD-to-child administration would be
pleased to hear from any group or
individual with proposals or with reports
of on-going projects.

THE WHITE HOUSE

yard-. 24, 1978

KUWAIT where a CHILD-to-child programme is to
be set up and a study of the primary school
child and the help he gives his younger
brother has been carried out in seven schools.
*

INDIA/ where the Health and Family Welfare

Department of the Government of Gujarat has
set up a CHILD-to-child programme incorporating
Perspna 1 ~hygl ene , immunisarion , .local energy
foods, diarrhoea management.
JORDAN, where the Ministry of Education is

undertaking CHILD-to-child studies of growth,
of pre-school eating habits, feeding and
weaning practices.
BRAZIL, where the Ministry of Education and
Culture is expanding its present programme of
talks broadcast on local radio stations to
include CHILD-to-child.

4
’

BURUNDI, where ACTION IN DISTRESS is planning

to establish CHILD-to-child programmes.

Dear EVncan.

Ihank you icr cor-r.g to discuss the CHim-to-Oiild
Progranire with re.
I siiare yo-.ir conviction that we mist concentrate
greater efforts cn prevention if we are to signifi­
cantly inpro-.t the health of children all over the
world. Ths CHILD-to-Zh: Id Frogranras holds great
prurdse for reproving the health of children evsry-

CHILE, where Dr. Augusto Schuster Cortes,
Professor of Paediatrics in the University of
Chile, has been appointed director of the
national programme ”E1 Nino Ensena al Nifio", and
investigations leading to a continuing programme
were set up in June 1978 and will continue to
the end of the year.

INDIA, where in the city of
children are taught to take
detection of leprosy cases,
that there is nothing to be

Pune, Maharashtra,
part in the
and in explaining
afraid of.

PAPUA NEW GUINEA, Where a programme of hygiene
I look for.vard to hearing rrcre about this progranrre
and tc exploring ways that it rtignt be used here in
the United States.
Sincerely,

and nutrition education has been established
and other programmes are starting.
TRANSKEI, where the Secretary for Health has

suggested to each Area Health Board that a
nominee be made responsible for carrying out
a CHILD-to-child programme and that private
practitioners be involved.
fit .can Guthrie, CbZ. MA, LLJ
Director, CHHO-to-Chi’d Program!
c/c, Institute of Child Health
20 Girlfcrd Street
lender. WCIN LH1
England

A JOINT PROGRAMME

WESTERN SAMOA, Where the IYC Commission has

asked different organisations to prepare
proposals for one or more CHILD-to-child
projects.
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L'ENFANT POUR L'ENFANT :

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A Joint Programme in the International Year
of the Child is a programme which is planned
either tc extend its programme and make it
as effective as possible by enlisting the aid
of other non-governmental organisations, or
to inspire other such organisations to under­
take similar actions in other regions.
CHILD-to-child has both these objectives, and
has accordingly been designated an official
JOINT PROGRAMME. .Already more than 50
organisatior.s have""reported that they are
setting up CHILD-to-child programmes in their
own countries.
~
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Hindi

cpe-ST STetf

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NINO A NINO

I

I

i
CRIANCA A CRIANCA

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*
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*
5
*
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* For translations of CHILD-to-child materials in the
*
* above languages, write to CHILD-to-child, 30 Guilford g
* Street, London WC1N 1EH.
$

Cv\ 10- -'0

30 Guilford Street
London WC1 N 1EH
Telephone 01-242 9789

NEWSLETTER 2
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CHILD-to-child is an international programme designed to teach and
encourage school children to concern themselves with the health and
general development of their younger brothers and sisters. Simple
preventive and curative activities as well as games, play and
role-playing will be taught to the children in school, so that they
may pass ideas on in the family or community environment. It is
hoped that initiative and encouragement will come from government
and other official sources.
This Newsletter records some of the CHILD-to-child projects being
planned or actually under way in different parts of the world.
Perhaps YOU would take one of these projects and adapt it to fit
your own local conditions, or devise an entirely new project. At
all events, will YOU run a CHILD-to-child scheme......... ?

J
J

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INTERNATIONAL CONFERENCE
In April a three-week CHILD-to-child
Conference was held in England.
For two weeks
an international group of approximately twenty
met in London, and for a third week twenty more
joined the meeting which moved to a conference
centre at Fittleworth, West Sussex.
The
chairman for the last week was Dr T A Lambo,
Deputy Director-General of the World Health
Organisation, and the participants included
educationalists and medical and paramedical
experts from Bangladesh, Chile, Egypt, India,
Jamaica, Kenya, Malaysia, Mexico, Nigeria,
Philippines, Sri Lanka, Sudan, Uganda and the
United Kingdom.
The two main purposes of the meeting were to
build up a prototype framework for a local
CHILD-to-child programme and to suggest
activities which a child could reasonably be
expected to undertake in order to teach his
or her younger brother or sister.

CHILD-to-child is a world wide programme, and
so it is unlikely that any one ;programme/.
would be appropriate to local conditions and
local needs in every country, but the
conference aimed to devise programmes which
could be adapted if not adopted, or which
would encourage groups in many countries to
set up their own appropriate CHILD-to-child
programmes.
Some of the suggestions put
forward were discarded but others were
approved and discussed in great detail until
it was felt that they were good enough to
publish.
THE NEED FOR ENJOYMENT

Early in the discussion it was realised that
it would be wrong to suggest activities which
would be unattractive to children, or which
would in any way exploit them-.- -As each
suggestion was put forward delegates asked
'Will this be fun?' and if the answer.was in
the negative the proposal was dropped.
Emphasis was also laid on making use of games,
role-playing and acting, traditional songs
and dances.

CONSULTATIVE COMMITTEE

An international consultative committee for
CHILD-to-child has been established, with the
following membership:

SAM ABRAHAM, President, of the
Malaysian Paediatric Association

Malaysia

JINAPALA ALLES, Senior Programme
Specialist, UNESCO-UNICEF
Cooperative Programme, Paris

Sri Lanka

TUNDE BAJAH, Senior Research
Fellow, International Centre for
Educational Evaluation, Ibadan

Nigeria

MARIA DANTAS, Professor of Education,
Bahia State

Brazil

HUGH HAWES, Department of Education
in Developing Countries,. London
Institute of Education

UK'

TOM LAMBO, Deputy Director-GeneraL,
.World Health Organisation

Nigeria

HOMAI JAL MOOS, Assistant Educational
Adviser, Ministry of Education and
Social Welfare, New Delhi

India

DAVID MORLEY, Tropical Child Health
Unit, London Institute of Child
Health

UK

DUNCAN GUTHRIE, Secretary

UK

-

CHILD-to-child ACTIVITIES

SUGGESTIONS FROM AROUND THE WORLD
Eating well
Children who are well-nourished are physically and mentally healthy, and are less prone
to disease.

♦Measuring malnutrition

Looking after our eyes by eating well

Malnutrition is common in many countries, often severe
enough to stunt growth and development. A simple
measure of the degree of malnutrition is the Shakir strip,
which older children can easily be taught to use. This
was described in Newsletter 1.

Vitamin A deficiency is one cause of blindness;
older children can:

The Energy Breakfast

It is better for a child to eat a good meal early in the
day so that he or she has sufficient energy to cope with
the day’s demands. Older children can be taught in
school to regard it as an important dietary factor and
to encourage their younger siblings to eat more.
Best-Buy Diets
By finding out which foods are both nutritious and cheap,
according to season, ever, poor families can afford to eat
better. Older children can find out about these foods as
a school project so that their younger siblings can have
more and better food.
Growing vegetables

Many vegetables are rich in particular
nutritional essentials. Older children
can learn how to grow vegetables in a
school garden and be encouraged to
start their own plot at home, teaching
younger siblings at the same time.
The school garden could be used to
teach about the effects of
fertilisers and seeds on
production.

- ensure adequate supplies for younger children
by growing vegetables and fruit rich in Vitamin
A, and drying the leaves of certain vegetables
for use out of season.
- learn how to recognise signs of Vitamin A
deficiency and when treatment by a health
worker is necessary.
Food preparation by children
Children can learn how to prepare food which is
nutritious and imaginative. This will teach them
about food values and balanced diets.

Food preparation round the world
Children can learn what food
is eaten in different cultures
and how it is prepared. This
will broaden their ideas about
food and form the basis for
projects at school. They
can pass their ideas to
younger children.

Children as health workers
Since older children spend so much time with their younger siblings,
prevent them from becoming 111,

they could do much to

treat them when they are, and minimise the effects of Illness.

rHome management of diarrhoea
Severe diarrhoea is very common and children under
five years frequently die from the resultant
dehydration. Older children can learn how to
prepare and administer the right solution of salt,
sugar and water.

Helping at the clinic

Older children can help at the clinic by preparing
younger children for weighing, vaccination etc, by
handing out and collecting cards and charts, by
helping to record information and by playing with
younger children while they are waiting.
Weighing and measuring children

A special plastic spoon will be available.

Older children at school can survey younger children's
growth and development by weighing and measuring
them at the beginning and end of each term or year,
noting the results and recording them graphically.

Home nursing
* ACTIVITY SHEETS with suggestions on how to
organise this project are available from:
CHILD-to-child, 30 Guilford Street, London
WC1N 1EH

Older children can learn basic nursing techniques
from teachers and health workers and help make
younger children more comfortable when they are ill.

*Health Scouts

Recognising common illnesses and skin conditions

-eachers, leaders of youth organisations and other
community leaders can help older children to organise
themselves into groups of Health Scouts. Activities
could include spot maps of the community's immunisation
state, incidence of malnutrition and serious illness,
so as to locate areas of greatest risk.

Much unnecessary suffering and death in younger
children can be prevented if older children can
learn to recognise certain warning signs of common
illnesses and seek help by telling the mother or by
getting help from a health worker. If older
children are taught about the relationship between
skin sepsis, lice, scabies, ringworm and poor
hygiene, and how all these conditions can be
eliminated or reduced by simple personal hygiene,
they can help to protect both themselves and their
younger siblings.

Older children can also draw maps to show where health
services are available and make visits to clinics to
see what services they offer on what date and at what
time.

Recognition cards for illness

Older children can make charts or cards in school
to help them in recognising the visual signs of
illness in younger children.
Seeing and hearing

Older children can test the sight of pre-school
children for signs of visual handicap. They can
make the test charts themselves. Older children
can test the hearing of younger children for
defective hearing by means of a simple game. By
locating pre-school children with sight or hearing
defects, older children can be ready to help them
when they go to school.
*Caring for teeth

Worms and parasites

Older children can teach younger children about
dental hygiene and how to care for their teeth,
either by the proper use of chew-sticks or by
correct brushing.

Older children can protect themselves and their
younger siblings by learning where worms and parasites
breed and how to avoid getting them.

Providing a healthy and safe environment
Better community health is built on awareness

communication,

understanding, cooperation and good

By being encouraged to develop these attitudes and translate them into action,

older children can Improve the environment for themselves and their younger siblings,

Our neighbourhood and making it better

Action campaigns;

Children can find out all the factors which help or prevent
children from growing up healthy; they can devise
community action for improving the environment and pass
on their ideas to younger children.

- Waste prevention and disposal

Health and the school : Surveys and competitions

It may be easier to teach children the wider application of
health precepts by using the circumscribed area of the
school. With the accent on child initiative and group­
work, personal and environmental health surveys can be
conducted and inter-school competitions organised with a
"health shield" and a prize as awards.
Surveys based on various health priorities;

- Insect-breeding places (e.g flies and snails)
Older children can locate the breeding-places of harmful
insects and either clean them up or eradicate them. They
can also take action to kill flies and water-snails and
teach the younger children about the dangers.
- Animals and pests (e.g. rats)
A similar campaign can be conducted in relation to
animals and pests such as rats. Older children can learn
about the illnesses associated with these and how to
avoid them, and encourage younger children to do the same.

- Water sources and resources
Children can find out where their water comes from and
how plentiful (or scarce) the supply is; whether they
share the water source with animals, how near it is to
waste disposal sites, etc, and take action to improve it.

Children can lead a campaign to clear up litter
and find hygienic ways of disposing of waste,
particularly of animal and human excreta, thus
reducing the dangers to health.
- Clean water

Children can undertake a campaign aimed at making
water supplies in the village as free as possible
from pollution and infection.

Play areas

- A place to play in
Being involved in organising their own play
areas helps children to develop certain skills and
attitudes. It is hoped that this involvement might
keep them away from playing in dangerous places.

- Safety in play

Children should learn to manage their own bodies
efficiently and to recognise when they are putting
themselves at risk. Older children can teach
younger children how to play safely.
*Accidents
Many children are injured in accidents. A lot of these
can be avoided if more care is taken both in the home
and outside. Older children can identify the causes of
common accidents, work out ways of preventing them and
thus protect younger children from harm. They can also
learn how to perform simple first aid.

The number of road vehicles in most countries is
rapidly increasing. So is the danger of children
being run over by them. Therefore it is very
important to teach children how to cross the road
safely, to walk along the road out of the way of
the traffic and to be particularly careful at night
Older children can both protect and teach younger
children.

Children growing up (understanding children)
It is important that older children understand how young children grow up.

They spend so

much time with younger siblings that they are in a position to play a major part in their

growth and development.

:Recording children's growth and development

Developing attitudes

Older children in the school can record the births of
younger children in their own families or in neighbours
families which do not have an older child at school.
They later record the major-milestones -in-each- child's
growth. In this way children who fail to develop will
be detected early and older children can then help.

- Caring

Recording more specific types of information

It is important for children to recognise their
-own- feelings’ toward others and to understand
the feelings of other people. Through discussion
stories and role playing they may be helped to
develop an attitude of caring towards the people
with whom they live and work.

- Vaccination and immunisation

- Sharing

Older children at school can record vaccinations
given to younger children, and can check that younger
children have been vaccinated at the right time. A
decorative chart made by older children to hang on the
house wall will remind parents when vaccinations are
due.

Birthmt €abk with Immunisation Reminders
‘WeLcome to SBabyAlu

Date (Born:
Your

March 1978

Immuniso.tions

are due:

ABCG

Older children can help younger children to
develop attitudes of unselfishness and generosity
by sharing their toys and games, etc, with them,
and encouraging them to share with each other.
- Kindness to others less fortunate
e.g handicapped children

Older children can help younger
children to be helpful to
children less fortunate than
themselves by showing them how
to help; e.g. helping blind
children to walk about by
themselves, and talking about
what they can see so that
blind children can learn about
their environment.

El D P T date . . . .

@ PO L 1.0 date..

QUOTES WE HAVE PICKED UP ALONG THE WAY..........
"We must learn never to be satisfied
with what we have done .........."

This Card is madefy the Children.

"Have the children been consulted?"
"CHILD-to-child is a 'bag of ideas'"

- illness and accidents in young children

Older children can record the type and severity of
illness or accident younger children experience. This
information will be helpful both in their own health
campaigns and for health workers.

"A programme which starts and ends in
1979 raises false hopes and invites
frustration. The ideal CHILD-to-child
programme is one that is initiated in
1979 and goes on from strength to
strength in years to come."

Stimulating younger children
If children ore to grow up physically and mentally healthy they need the right kind of stimuli

at the right time.

Since older children spend so much of their time with their younger

siblings they can ploy a major part

in their growth and development by providing these stimuli.

*Playing with younger children

Acting and role playing

Children can learn at school what a baby or small child
should be doing at a particular age. They can devise
activities to help the small child develop physical,
psycho-motor and intellectual skills.

Acting and role play are natural activities for
children and older children can use both for
conveying health concepts to each other, to
younger children and to the community. They can
perform in their own school or community or go to
other schools or communities, perhaps as part of
a drama festival of health. They can either use
existing material or write their own scripts.

*Toys and games for young children
Young children can learn much through play. Toys and
games help both physical and social skills. Older
children can make toys and games out of locally available
natural and man-made materials for their younger
siblings. They can build, where possible, on local
games and toys and devise new ones for teaching health

Helping the child-minder
Many quite young children are expected to look
after even younger siblings by themselves, and
they may well not be school attenders. Older
school children can try to locate such children,
take toys and games to them and teach them how to
use them. They can also teach them what they
themselves have learnt about child development
and stimulation of young children.

Play and the pre-school child

Young children learn by playing together. Older
children can run p±ay groups for younger children
under adult supervision, either in school
buildings out of school hours cr elsewhere. They
can learn how to run a play group at school and
make toys and games in craft classes.

Stories and story-telling
Stories and story-telling are means of transmitting the
culture of a community. They also help to develop
social and creative skills. Older children can collect
those from their own communities and from other cultures
and teach them to younger children. They can also make
up some of their own to teach health concepts.

Other ideas
Including the out-of-schcol child

Many children do not go to school. It is important to
include them in the CHILD-to-child programme through
village leaders, teachers, schoolchildren and any other
people who can organise or contribute.

Improving the environment - tree-planting

Each class could plant one tree per year - preferably
fruit trees - and tend them. This would improve the
environment, teach children tree-cultivation and provide
them with fresh fruit. Older children can help the
younger.
School brothers and sisters
Older children could 'adopt' younger ones for whom they
could be particularly responsible. This can be done in
school or in the community.

P,’e are grateful to Shell International Petroleum
Company Limited for supporting the publication of
this Newsletter.

i “CHILD to child
*
*
S
5
’
’
.
«
*
*
5
»
«
J
?
«
I
J
I

*
5
5
*
ft

An illustrated book describing the
programme as it may be applied in different
countries, will be published by the
Macmillan Press in January 1979.
The text
derives from the discussions at the April
Conference, and the illustrations are by
Carol Barker.

"CHILD-to-child" is obtainable through all
booksellers, probable U.K. price £0.95
(paperback), £3.95 (cased), or from
CHILD-to-child, 30 Guilford Street, London
WC1N 1EH, or in cases of difficulty write
to Miss Dawn Hunter-Ellis, Macmillan Press
Marketing Department, 4 Little Essex Street
London WC2R 3LF, quoting International
Standard Book Numbers as follows:
Paperback edition : 0 333 26137 2
Cased edition
: 0 333 26136 4

STOP PRU-55
i L J is

CH I LID -4*0 Uvu LocWtd, T’lew.seJ'tdU u-d J
Af-e douxj so tLcrxie.

2) eSi+ar

Feed back
CHILD-to-child activities are reported from:
GUATEMALA/ Where a NAN (NINO a nino) pamphlet
will explain to 400 paramedical health workers
how to teach children from the age of 7 to 12
years old basic health concepts for better
care of their younger brothers and sisters.

IN THE WEST...
Mrs Rosalynn Carter expressed considerable
interest in CHILD-to-child when the
Secretary called on the President's wife
at the White House recently.
Mrs Carter
followed up the meeting with a letter in
which she said that she was looking forward
to exploring ways that CHILD-to-child might
also be used in the United States.
This is
in line with current thinking within the
CHILD-to-child organisation, and
suggestions for CHILD-to-child activities
appropriate to the industrialised countries
have been invited from various sources.
The CHILD-to-child administration would be
pleased to hear from any group or
individual with proposals or with reports
of on-going projects.

THE WHITE HOUSE

b’arch 24, 1978

KUWAIT where a CHILD-to-child programme is to
be set up and a study of the primary school
child and the help he gives his younger
brother has been carried out in seven schools.
INDIA/ where the Health and Family Welfare
Department of the Government of Gujarat has
set up a CHILD-to-child programme incorporating
personal hygiene, immunisation, local energy
foods, diarrhoea management.
JORDAN/ where the Ministry of Education is

undertaking CHILD-to-child studies of growth,
of pre-school eating habits, feeding and
weaning practices.
BRAZIL/ where the Ministry of Education and
Culture is expanding its present programme of
talks broadcast on local radio stations to
include CHILD-to-child.

BURUNDI/ where ACTION IN DISTRESS is planning

to establish CHILD-to-child programmes.

tear EX-icar.,

Thank ycu for ocning to discuss the CHILD-to-Onld
Prwm? vith .-e.
1 share yorr conviction that we trust concentrate
greater efforts cn prevention if we are to signifi­
cantly --prove the health of children all over the
world, i*?; CHILD
*
to-Chi Id Programro holds great
precise for improving the health of children every­
where.

CHILE/ where Dr Augusto Schuster Cortes,
Professor of Paediatrics in the University of
Chile, has been appointed director of the
national programme ''El Nino Ensena al Niho" , and
investigations leading to a continuing programme
were set up in June 1978 and will continue to
the end of the.year.

INDIA/ where in the city of
children are taught to take
detection of leprosy cases,
that there is nothing to be

Pune, Maharashtra,
part in the
and in explaining
afraid of.

PAPUA NEW GUINEA/ Where a programme of hygiene
I look forward to hearing more about this prograirrre
and to e>.p'_oring ways that it right be used here in
the United States.
Sincerely,

and nutrition education has been established
and other programmes are starting.
TRANSKEI, where the Secretary for Health has

suggested to each Area Health Board that a
nominee be made responsible for carrying out
a CHILD-to-child programme and that private
practitioners be involved.
Duncan Guthrie, C3E, 1-7., LID
Director, OlILD-to-Child Ptcgracne
c/o Institute of Child Health
30 Guilford Street
London WCIN 13H
England

A JOINT PROGRAMME

WESTERN SAMOA/ where the IYC Commission has

asked different organisations to prepare
proposals for one or more CHILD-to-child
projects.
«««««« IHHHHHr fl- *
• »«
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«
*
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LENFANT POUR LENFANT |

i
ft

A Joint Programme in the International Year
of the Child is a programme which is planned
either to extend its programme and make it
as effective as possible by enlisting the aid
of other non-governmental organisations, or
to inspire other such organisations to under­
take similar actions in other regions.
CHILD-to-child has both these objectives, and
has accordingly been designated an official
JOINT PROGRAMME.
Already more than 50
organisations have reported that they are
setting up CHILD-to-child programmes in their
own countries.

»

fl
Hindi

SpOT^

T> fvtV

J
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*

*

np.nict.

:

At‘bic

NINO A NINO
X*

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CRIANCA
A CRIANCA
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3

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* For translations of CHILD-to-child materials in the
*
a above languages, write to CHILD-to-child, 30 Guilford *
* Street, London WC1N 1EH.
*

ch

CONVULSIONS IN THE OLDER INFANT
H B Valman

From the revised edition of "The First Year of Life," published this week

Tonic

• Cry
• Loss of consciousness

• Rigidity
• Apnoea

Clonic
Repetitive limb movements
(rate can be counted}

Sleep

Dangers

o Inhalation of vomit
o Hypoxaemia

In infants between the ages of 1 month and 1 year convulsions are usually
associated with fever. If there is no fever, fits secondary to a structural brain
abnormality, hypoglycaemia, and hypocalcaemia should be considered.
Fits can be divided into generalised or partial seizures. Generalised seizures
include tonic-clonic and myoclonic fits. Partial seizures include focal motor
and temporal lobe fits. During some episodes partial seizures may be
followed by generalised seizures.
Generalised tonic-clonic fits are the most common type. The child may
appear irritable or show other unusual behaviour for a few minutes before
an attack. Sudden loss of consciousness occurs during the tonic phase,
which lasts 20-30 seconds and is accompanied by temporary cessation of
respiratory movements and central cyanosis. The clonic phase follows and
there are jerky movements of the limbs and face. The movements gradually
diminish and the child may sleep for a few minutes before waking confused
and irritable.
Although a typical tonic-clonic attack is easily recognised, other forms of
fits may be difficult to diagnose from the mother’s history. Infantile spasms
may begin with momentary episodes of loss of tone, which can occur in
bouts and be followed by fits in which the head may suddenly drop forward
or the whole infant may move momentarily like a frog. Recurrent episodes
with similar features, whether they are changes in the level of consciousness
or involuntary movements, should raise the possibility of fits. Parents are
very frightened by a fit and may fear that their infant is dying.

Differential diagnosis

Pain or frustration

? Breath holding attack

Convulsions must be differentiated from blue breath holding attacks,
which usually begin at 9 to 18 months. Immediately after a frustrating or
painful experience the infant cries vigorously and suddenly holds his
breath, becomes cyanosed, and in the most severe cases loses consciousness.
Rarely his limbs become rigid, and there may be a few clonic movements
lasting a few seconds. Respiratory movements begin again and the infant
regains consciousness immediately. The attacks diminish with age with no
specific treatment. Mothers may be helped to manage these extremely
frightening episodes by being told that the child will not die and that they
should handle each attack consistently by putting the child on his side.
Rigors may occur in any acute febrile illness, but there is no loss of
consciousness.

Febrile convulsions
The remainder of this paper is concerned with febrile convulsions.
A febrile convulsion occurs in an infant who has a susceptibility to
convulse when he has fever, especially when the temperature is rising
rapidly. It is rare below the age of 6 months and above 5 years and the peak
incidence is from 9 to 20 months. Often fever is recognised only when a
convulsion has already occurred. Febrile convulsions are usually of the
tonic-clonic type. The objective of emergency and prophylactic treatment is
the prevention of a prolonged fit (lasting over 15 minutes) which may be
followed by permanent brain damage, epilepsy, and developmental delay.

86

SELECTIONS FROM BMJ

VOL. 6

MARCH 19W

>• Emergency treatment
If the child has fever all his clothes should be removed and he should be
covered with a sheet only. This applies whether the child is at home or in the
accident and emergency department. If his temperature does not fall within
a few minutes he can be sponged with cool water, a wet sheet can be applied
to his trunk and his head, or he can be placed in a shallow bath of cool, not
cold, water. He should be nursed on his side or prone with his head to one
side because vomiting with aspiration is a constant hazard. It may be
dangerous to take an ill febrile child into his parents’ warm bed.

If convulsions are still occurring or start again rectal diazepam
(0-5 mg/kg) is given and produces an effective blood concentration within
10 minutes. The most convenient preparation resembles a toothpaste tube
(Stesolid). The alternative is to use the standard intravenous preparation
with disposable syringes and short pieces of plastic tubing. The closed end
of the sheath of a disposable needle can be cut off to provide a substitute for
the plastic tubing. If at home the child should then be transferred to
hospital.

Intramuscular paraldehyde can be given instead of rectal diazepam. If
hyaluronidase is added to the paraldehyde it is effective more quickly. A
glass syringe is ideal, but if only a plastic syringe is available the paraldehyde
should be injected within two minutes of filling the syringe. The dose of
paraldehyde is 0-2 ml/kg. One ml of sterile water is added to an ampoule of
hyaluronidase, and 0-1 ml of this solution is aspirated into the syringe
containing the measured amount of paraldehyde and shaken well just before
injection. If the dose of paraldehyde is over 2 ml it should be divided and
given into two sites.
If the convulsions do not stop within 10 minutes of giving rectal diazepam
or paraldehyde the duty anaesthetist should be present while another drug
is given intravenously. Diazepam (0-3 mg/kg) or a short acting barbiturate
must be given slowly over several minutes. Diazepam is an extremely
effective anticonvulsant but the standard preparation cannot be diluted and
it is difficult to measure accurately' the small dose needed in infants. The use
of a 1 ml tuberculin syringe allows small doses to be given slowly. If the dose
is too large or is given too quickly, particularly if the patient has previously
received an anticonvulsant, there is a risk of respiratory arrest. A special
preparation of diazepam for intravenous use (Diazemuls) can be diluted
with glucose solution and can be-measured more accurately. Early transfer
to the intensive care unit should be considered ifa second dose of
anticonvulsant is needed.
All infants who have had a first febrile convulsion should be admitted for
lumbar puncture to exclude meningitis and to educate the parents, as many­
fear that their child is dying during the fit. Physical examination at this stage
usually does not show a cause for the fever but a specimen of urine should be
examined in the laboratory to exclude infection, and a blood culture and
“stix” test should be performed. Most of these children have a generalised
viral infection with viraemia. A febrile convulsion may occur in roseola at
the onset and three days later the rash appears. Occasionally acute otitis
media is present, in which case an antibiotic is indicated, but most children
with febrile convulsions do not need an antibiotic.

Long term management
Leaflet for parents

o Fever control

• Prophylaxis
(a) continuous anticonvulsants
(b) diazepam during fever
• Management of a fit

SELECTIONS FROM BMJ

VOL. 6

march IWO

If they think he has fever parents are advised to cool the infant by taking
off his clothes and giving him paracetamol. A simple leaflet on the
management of convulsions can be given to the parents and they should be
shown how to give rectal diazepam. The use of prophylactic drugs after a
febrile convulsion is controversial but infants less than 1 year of age have
“complex” convulsions by the generally agreed definition and should all
receive cither continuous prophylactic anticonvulsants or, alternatively,
rectal diazepam given 12 hourly while the temperature is above 38-5eC. A
maximum of six doses of prophylactic diazepam is given.
87

Febrile convulsions
Your baby has had a febrile convulsion. This means that he (or she) had a fit
because he had a high temperature. Il is very common for this to happen (one
child in 30 has one between the ages of 9 months and 5 years). The fit was very
frightening for you.
The following is general advice on how to handle him in future.

TEMPERATURE CONTROL
If he starts to develop a temperature:
(1) Take off his clothes.
(2) Give him regular paracetamol in the doses shown:
Less than 1 year
1 x 5 ml spoonful every 6 hours
Over 1 year
2x5 ml spoonfuls every 6 hours
(3) To bring his temperature down it may be necessary' to sponge him with
tepid water for five minutes or place him in a shallow bath of cool, nor cold,
water.

REGULAR MEDICINE
Some infants are more likely to have further fits than others and for them we
recommend regular medicine to prevent this. The medicine has to be given
every day until the child is about 3 */z years, when it can possibly be stopped. ’
Not every' child needs regular medicine and a doctor will advise you if your
child needs it. Each child on regular medicine has a blood test about three
weeks after he starts it to check that the dose is right for him.

Continuous phenobarbitonc at a dosage of
5 mg per kg body weight given only at bedtime is
effective in reducing the incidence of recurrence.
It should be prescribed as tablets which can be
crushed and given in milk or jam. The elixir
contains a high concentration of alcohol and is
unpalatable. Phenobarbiione produces
irritability in some infants and in these cases
sodium valproate can be substituted at a dosage of
20 mg per kg body weight in each 24 hours,
divided into two doses. Sodium valproate is not
the first line drug as it is associated very rarely
with hepatitis or pancreatitis. Phenytoin has no
value in the prevention of febrile convulsions.
Anticonvulsant blood concentrations should
be estimated three weeks after the first dose and
then every six months. Treatment should be
given for a total of two years and then withdrawn
gradually over a few months.

OTHER FITS
If your baby does have another fitx don’t worry! Lie him down where he '
cannot hurt himself, with his head turned to one side so that if he is actually
sick it will not go into his lungs and his tongue will drop forward.
THEN—EITHER
(a) Give rectal diazepam, OR
(6) Take him to your doctor, OR
(c) Call your doctor if he is likely to come quickly, OR
(d) Go to an accident and emergency department (in an emergency you can
call an ambulance).

THE POSITION YOUR CHILD SHOULD BE PLACED IN IF HE HAS
ANOTHER ITT.
Remember io keep all medicines out of the reach of children.

Prognosis for the infant less than 1 year

Risk factors
11) Developmental or neurological
abnormalities before first seizure.
(2) Epilepsy of genetic origin in a parent
or sibling
(3) First febrile seizure longer than
15 minutes.
(4) Focal or followed by transient
neurological sequelae or repeated on
the same day.

Febrile convulsions occur in about 3% of preschool children. In girls less
than 13 months there is more than a 50% risk of a further febrile convulsion
and for boys the risk is 30%. In this age group the risk that a subsequent
attack will be prolonged is 30%. The prognosis for further fits also depends
on the duration of the episode.
In a large American study it was shown that in infants who had no febrile
convulsions the risk of later epilepsy was 0-5%. The occurrence of later
non-febrile seizures was twice as high among those who had recurrent
febrile convulsions compared with those who had one episode. The risk of
later epilepsy increased with the number of risk factors:

No risk factor—later epilepsy 2%.
One risk factor— later epilepsy 3%.
Two or more risk factors -later epilepsy 13%.
Most afebrile seizures develop wit bin a few years of the febrile seizure.
I thank Mr R Lamoni, .mrcog, for .unstruciivv criticism on the article on prenatal diagnosis.

(FROM li.MJ VO!. 1-/7 15 NOV 1989. 13314335;

88

Dr H B Valman, FRCP, is consultant paediau ieian, Northwick Park Hospital, Harrow.

SELECTIONS FROM BMJ

vol.. 6

MARCH 1990

C.K v©--9-

ALIGONDA MISSION LOOTED, HOSTEL CHILDREN BRUTALLY BEATEN.

On 30th August at about 3-30 P.M seven young men from Damacus
village came drunk, armed with lethal weapons and tried to enter into

the Mission compound.

The gate keener objected thorn.

He was beaten

up, and breaking open the gate they entered in Er.Mathew Onatt w'no
saw the scene from his verandah came out, and while he went down to

the school ground he was attacked by one of the assailants with a.

knife. Meanwhile Br.George who was in the field, came to trie scene
and. took away three knives from the assailants. The servants and.
the students came out and chased them out.

Apprehending further disturbance Er. Onatt drafted a petition
to the Mohana Police Station.

As he and. Br. George were about to

start for Mohana they were informed of the blockade created by the
miscreants from Aligonda on the way to Mohana. Finding that the
way to Mohana was dangerous and knowing that a new roard is const­
ructed via damsite they procee-ded through the same.

Being rainy

season the new way was muddy, and the vehicle they were using got

stuck in the loose ground leaving them helpless for over three hours.
Meanwhile a big mob from Aligonda and Datnadua entered the Mission
compound armed with weapons and howling. The hostel children got
scared, got on to the first floor of the school building and shut

themselves in the study room. The mob rushed in there, beat them and
wounded many. The bigger boys managed to jump down through the back

windows and some others were thrown down through the same by the
assailants.

With diabolic fury they wounded the children and left

many of them with bruised hands and legs, broken teeth and swollen

eyes. Most of the furniture in the room were also damaged and the
crowd left at a-bout 7 P.M.
At 10 O'clock in the night the crowd came back and attacked the
prsbytery, they forced their way through the kitchen and broke open

the rooms of Er. Mathew and Br.George,Fr.Cyprian was w away at Pune.
They smashed the tables and iaxi almerahs,looted the valuables and

money and destroyed the rest of the articles.

Meanwhile, as the

Jeep with the confreres was returning to the main road, information
vias given that the house was attacked and looted.

So, instead of

going to the mission they took th^ way'to ’Bhfahmanigam and reached

Berhampur on the following evening at 5 P.M via Daringbadi and Raikia.

Contd..2

----- 2-----information was received at Vijoy B havan at 1.30 A.M on 31st
that the mission of Aligonda was attacked and the children were

deaten,? but nothing about the confreres. Fr.Joseph Das was at the
Bishop's House and was informed. Fr.Mittathany was awakened from
Aquinas and with Fr.Michael they proceeded to Aligonda early in the

morning.

After reaching Mohana a petition was lodged at the Police

-’ta.ti.on at .10 -A..M and with some of the Police personnel they

proceeded to the spot. About two dozen wounded children were there;
the rest and many of the wounded ones also had fika fled to their
home or were carried away by their parents. The police made a quick
enquiry and all returned to Mohana after providing for the needs of
the children and the servants.

That night the mob again attacked the house,broke open the
church and carried away the vestments. They broke open the iron
safe in the house and looted the contents. From the 2nd September
onwards Ploice force is posted there and the investigation is going
cn.
In this connection it may be recalled that an attempt of a

similar nature was made on the 22nd November 1981 by a group of anti­
social elements from Aligonda village entering the school premises
and beating up the school children. Certain cases regarding the
same are pending in the court. It is suspected tlmt the present
incident is linked with the previous one and the attackers intend

to suppress the evidence and take vengance on the school authorities

who had brought them to the book in November last.

Bishop J s House,
DERI JAIPUR (GM) ,

Dt. 7.9.'32.

Fr. Joseph Das.

COMMUNITY HEALTH CELL

CHILD HEALTH

47/1,(First rloor)St. Marks float!
BANGAtO <E GtiOQO!

t’sts are excised. A small cystouietKj^ •* u
xxrn before, during and after ’’the
_j
: tract are uncommon, in female1
c-oertal
' ’ nirls
Commonest are~cyarI0Q
onia of i he ovary, papillary cystE^e^

PAEDIATRIC EDUCATION IN INDIA
.A note by the Union Ministry «.f Health. ('.overnm ■( of India, New Delhi.

r.ulosa ce’l tumour. A pelvic '•iddnp,,
aour.
v- d'

g, or Amoebic Dysentery AND;.AliiraH
-Bahr
and W. J. Muggleton^^rC^I

spends on identification of causative '
..iaige bowel and are thereforejeasfli^S
Authors used a specially des^n’0.xrolium jelly tends to spoil the/pre<-'Vi

eng the suspected area with a
sed fresh and the cells visualiseOfaj,. 7

stage naked eye lesions of amoebic
tsions with undermined edges the; sostage ^^nges are minute ana.sjxm^<

ucosawows crypts of IJeberktmiiAtJ
cut in a mosaic pattern. The'
oebic lesions E. histolytica 'are’-seen i•/:

.necrotic debris. It has a refra’ctflecertain pseudopodia and amoeboid’
cd by warming the stage.
late amoebic from mild bacillary,
xamination and
other
iaborat
..bacillary stage appears
angry,
.istic minute granules,
protein;
arc coarser and more irreguja
-npsy preparation. These intrace!
ulative necrosis of the cryptsii
-cation of leucocytes and rnacr
?erative colitis is that of autoly;
■sm. In mucous colitis the mued
ally, the goblet cells are
is made from other data it
•e of assistance.
The muct
be.^^ appearance and
-lar pattern.

is

.amination is negative and whic
•je diagnosed by means of recti
V. D. Arora*?

•

In India Paediatrics has been recognised as .. speciality only 30
years ago but o, late paediatric education has nei-ii a subject of much
discussion The number of paediatricians who can develop paediatric
education in India is however very small: as a result the present stan­
dard of paediatric teaching in most Medical Colleges is not satisfactory
and this subject has not received the attention it deserves, except in
the last few years.
The period of instruction in paediatrics varies from one month to
six weeks. The facilities for teaching, in few exceptions do not include
well conducted maternal and child health programmes to provide in­
structions in growth and development of children and in preventive
paediatrics. The facilities for instructions in the case of the new-born
are inadequate.

Some of the Medical Colleges provide postgraduate training, name­
ly courses in D.C.H. The Universities of Bombay, Madras, Calcutta
and Patna, recognize the postgraduate training in paediatrics and offer
Diploma in Child Health to students who undergo a year’s course in
Paediatrics. The Medical Colleges in Madras, Bombay. Hyderabad,
Calcutta and Patna offer D.C.H. courses. Courses in M.D. in paediatrics
are offered by Bombay and Patna. Quite a few medical men and
women have taken postgraduate training in paediatrics in England.
lhe D.C.H. (Lond.).
The subject of
headings:

paediatric

education is

being

dealt under

the

Existing facilities for teaching
Recent developments in paediatric education.
Suggestions to promote paediatric care and paediatric education.

Existing facilities for teaching:
(a) Paediatric Beds:

Most of the Medical Colleges have paediatric beds varying Ironi
(>-100 which are used for teaching paediatrics. Some teaching hospitals
have separate paediatric units, others have beds in the Medical Unit
of the teaching hospital. With the exception of Bombay, Madras, and
Vellore, where the Paediatric Units are under the Pi lessors of Pae­
diatrics, in all other Medical Colleges Paediatric Units or Paediatricbeds are under the Professors of Medicine or Lecturers or assistants

in the Medical Unit. The Medical and Nursing staff is inadequate and

INDIAN JOURNAL OF CHILD HEALTH

paediatric care is far short of the standards of care in other,tead^
units. Most of the nursing care is entrusted to the relations. There
no provision for a diet or a formula room.

V»

P

(b) Teaching:

The length of paediatric teachii
varies from 4-8 weeks. Thettlieo;’
retical teaching consists of 1 to 24 lectures. Only a few of the;PaediaS
trie Units have an attached maternity and child welfare centre, namely
Hyderabad, Patna, Bombay, and Nagpur

Instruction in the care of the premature or of the new-borriSisjgW
not satisfactory

(c) Examination:
There is no separate paper in paediatrics but a question
ed in the paper in Medicine. There is also no separate practical' exanii-.
nation in paediatrics

Recent Developments in Paediatric Education:
(a) The Medical Education Conference held in November||M55M
discussed the question of Paediatric education in India and made^jiaMM
following recommendations:
1

(D In view of the vital importance of paediatrics in the. over-SulaaE
■ recent1 ^’deve­ *"
programme of undergraduate education and in view of- the
lopment in the subject, the Conference recommended that special'/dp
partments of Paediatrics should be established in the Medical Colleges
and
'
t

The Government of India have also assisted the Chittar anjaniSCTB
Sadan Hospital, Calcutta & Child Health Institute Trust, CalcuftaJ^

£ ? a & £ S’ g

(c) The Government of India established a special coursefm
Maternal & Child Health at the AU-India Institute of Hygiene.&dPubf
lie Health, Calcutta, in association with the
*
D.P.H. Course to prepare
doctors in health work with special reference to health service&fpi
mothers and children. The department of Maternal & Child Healfhtwas
subsequently expanded in 1950 with WHO/UNICEF assistance aridlffie
scope of training was enlarged. The Institution now provides training
to 30 medical officers and to 30 nurses in public health.
TipH

I

'(b) Since 1947 considerable attention has been paid to improve­
ment of child care programmes in the country and various Statei-Gbyemments have undertaken comprehensive maternal and child health
programmes in the States.

F 8

(2) A period of not less than three months should be devotediji)
its study which deals in the Neo-Natal, Paediatrics, and growthjand
development of child. The Medical Colleges of Madras & VeUore shave
created special paediatric clinics.

CHILD HEALTH

639

PAEDIATRIC EDUCATION IN INDIA

radards of ca-e in other teacHkp
trusted to the relations. There

voluntary organization) which are providing postgraduate courses in
P.C.H. The latter also offers courses in M.D. in paediatrics.
Pevclopmcnt of Paediatric Training under State MCII Projects:

aries irom 4-8 weeks. The theo-ures. Only a few of the Paedia■ nd child welfare centre, namely
zur.

mature or of the new-born is alsb
-?■ 4:^4 ■■

—iatncs but a question is includ-- '■
siso no separate practical exami-.':’ ■
location:

■<
■■■

—ren” held in November. .1955?
-ucation in India -and made the

=ce of paediatrics in the over-aU
_and in view of the recent ,devel.7
•r recommended that special dqcolished in the Medical Colleges :

■411
st months should be devotedff
.J. Paediatrics, and growth?
eeges of Madras & VelloreJiff
■non has been paid to improve-«?/w?
_ountry and various State Govsave maternal and child health
■establNhed a special coursesg
«ia iSPitute of Hygiene &.Pub
_ the- D.P.H. Course to prepan

Terence to health services/foi
3 Maternal & Child Health wai
•5O/UNICEF assistance aridrtht
.stitution now provides training
3 public health.

assisted the Chittaranjan.SeW?

rh Institute Trust, Calcutta®

The States namely, Andhra, Assam, Bihar, Bengal, Bombay, Delhi,
Mysore, Madhya Pradesh, Travancore-Cochin, Uttar Pradesl., Sattrashtra and Hyderabad have undertaken Maternal & Child Health pro­
grammes. Most of these programmes have also included improvement
of paediatric care to provide facilities for paediatric teaching. In the
States of Andhra, Assam, Bihar, Bengal, Bombay, Saurashtra, Delhi,
Mysore, Madhya Pradesh, Travancore-Cochin, Uttar Pradesh and
Hyderabad the State MCH Programmes provided for expansion and
improved facilities for paediatric care and paediatric teaching. These
States have provided approximately 1200 paediatric beds in the various
paediatric units attached to the teaching hospitals. The States have
established Paediatric Units and have appointed paediatricians in
charge of the Units. In some of the Colleges Maternity & Child Wel­
fare Centres have been associated with the paediatric units. In Madhya
Pradesh, Nagpur a Premature Unit has also been established. Inter­
national paediatricians have been provided in 7 States to develop paedia­
tric services and for promoting paediatric education. The UNICEF and
the WHO have assisted in developing paediatric education by providing
international personnel and essential equipment to these projects. The
State Governments have shown great interest in paediatric instruction
and have provided necessary buildings, national personnel and equip­
ment. The improved facilities are utilised for training of medical
students and student nurses as well as for the Health Visitor students

(c) Under the Second Five Year Plan the Government of India
have provided a sum of Rs. 45/- lakhs to assist States to develop paedia­
tric centres attached to Medical Colleges to provide improved facilities
for paediatric teaching of undergraduates. It is proposed to establish
5 paediatric teaching centres in the States and selection will be finaliz­
ed shortly. The scheme is attached.
*
It provides assistance for non­
recurring as well as recurring expenses for developing paediatric teach­
ing for undergraduate medical and nursing students. The services in­
clude establishment of a paediatric unit at the hospital and to develop, 3
Maternity & Child Welfare Centres associated with the Paediatric Unit
for teaching of preventive and social paediatrics. In view of the shor­
tage of senior paediatricians the creation of posts of Professor of Pae­
diatrics has not been insisted upon but adequate medical and nursing
staff has been suggested. The smallest Paediatric Unit for teaching is
to have at least 40 paediatric beds so as to provide two beds for each
student under training.
•

’ Not published in this issue.

<

-—.—t-------

640

INDIAN JOURNAL OF CHILD HEALTH

(.1) There is also provision under the Second Five
assisting two of the existing Paediatric Un. . . to be upgraded touiide
take postgraduate courses in paediatrics and to prepare teachers. such
a Project will shortly be uni ■ rtaken by the Government of Madras t
The WHO and UNICi
are also assisting in this
duration of the Project is five year1. There is also provision for,under4
taking a similar scheme in Bombay at the B J. Hospital for Children
associated with the Grant Medical College.
Suggestions to promote Paediatric Care and Paediatric Education:

The standard of paediatric care is largely dependent on the -stafiSa
dard of paediatric teaching in the Medical Colleges
The paediatncS
care has in the past been the weakest link in the maternal and child W
health service. The services for the sick child and the preventive ■'andi-;.
social paediatrics have not progressed in a coordinated manner/Sin^^BB
a large proportion of the con munity health services are deVoted'i:tch?%l•>:'
children because they are more easily affected by adverse conditional'':’1 ;;
of environment, hygiene and food and as a result of social and ecoh'nwBBB

stress on the community, it is necessary to improve paediatric ■ edi'ica^^^
tion so as to prepare the physician to give necessary care to the tchildfiSt
both in health and disease. The physician should also be able to'pro'^
vide the services for children of all age groups and within the frame: ■* ’
work and resources of the family and the community. He should
knowledge on health education. The Second Five Year Plan providef; P
for establishment of Primary Health Centres in the rural areaSaang^^M
services at the periphery including paediatric care would be in charge:-’of a doctor who will work with the rest of the health team consistih^.'/1--’’.;
of a Health Visitor, midwives and the Sanitary Inspector. The
personnel must have adequate knowledge in obstetrics and paediatricsBK
to function properly in community health services and especiallygih-y-;'''/,
child care programmes. The paediatric education needs to be imfnq&egBHlg

dtayaBrcffl

on the following lines:

■’

(1) The recommendations of the Medical Education
on Paediatric Education should be implemented at an early ■
the Medical Colleges and the Universities concerned.

(2) Each Medical College should have a Paediatric Unit to tp:
vide at least two paediatric beds per student for clinical experienceiljiE,
paediatrics.
(3) There should be well conducted maternity and child W
centres jointly run by the obstetric and the paediatric department
the Medical College as well as the department of preventive and
medicine. The field experience should include both rural and ■'iifS

experience.

(4)

There should be appropriately trained staff to provid

0

PAEDIATRIC EDUCATION IN INDIA

CHILD HEALTH

: the Second Five Year Plan,.
Units to be upgraded to tind
:s and to prepare teachers. Such

by the Government of Madras;'listing in this programme. -The
nere is also provision for,undej.
the B J. Hospital for Children
liege
sy-.,;
<■ and Paediatric Education:

'
.’Jjb
largely dependent on the -stdh-iedical Colleges. The paediafec-' •
link in the maternal and child'
:k child and the preventive:-and;’\
m a coordinated manner. Since. ' '
nealth services are deVotedito-'<
affected by adverse condifMMBIr
s a rn^lt of social and ecohbnii
ry to^Fiprove paediatric edtic
give necessary care to the chi
ran should also be able -to-ipr
ie groups and within the fram'
the community. He should hay
lecond Five Year Plan provid
entres in the rural area&cfn
diatric care would be in charg
■st of the health team consistin'
Sanitary Inspector. The rnedf
ge in obstetrics and paediatr,
alth services and especially
education needs to be imp
Medical Education Comm
demented at an early dati
ies concerned.
-

have^kPaediatric Unit toadcnt^ror clinical experieh
.■d maternity and child w
i the paediatric departmei
rtment of preventive and
include '’oth rural andnir
v

trained staff

to provide;

struction in preventive and social paediatrics. There should be adequate
medical and nursing staff for clinical instruction as well as for instruc­
tion in the field.
(5) The number ol medical and nursing personnel should be
almost double that of the staff in other teaching units of the hospital.

Besides the senior teaching staff and registrar, there should be one
r (house physician) for 10 beds and one nurse for two beds.
doctor
There should be adequate and appropriate equipment for
(6) surgical, and nursing care of children in the Paediatric Units
medical,
as well as in the ..ttached centres.
lions in Neo-Natal Care, clinical experience in
in
(7) The instructions
the treatment of sick children at the out-patient
and in
investigation,
„„
.
and instructions in the care of the well child
as
in the hospital
andwell
in as
preventive
work including child psychology should be a coordinatcd programme.
(8) The instructions may be distributed over the entire period of
(8) teaching,
'
clinical
namely 3rd, 4th, and 5th year, or may be given for
a period of three months during the last year of the clinical teaching.
The same staff should be responsible for theoretical and clinical teach­
ing. The theoretical teaching should be at least 42 lectures spread over
a period of three months and should be supplemented by clinical teach­

ing. The theoretical lectures should include at least 12 lectures on
growth and development of the child and on promotion of health of
children.
(9) There is also need to develop the surgical side of paediatrics

which has so far not received adequate attention.
Postgraduate Training in Paediatrics:
There is also need to develop good postgraduate teaching in Pae­
diatrics. The postgraduate training should only be introduced in those
colleges where the undergraduate training is well established and there
is well experienced staff and facilities to undertake postgraduate train­
ing. The postgraduate courses should be recognised by the University
concerned and the courses should be recognised postgraduate Univer­
sity Degrees such as to offer the candidate opportunities to take up
teaching post in paediatrics (namely M.D. in Paediatrics or its equiva­
lent). The postgraduate training in paediatrics should be such as to
provide experience in preventive and social paediatrics and research
During the postgraduate training a student should have facilities to
carry out independent work in a Unit for at least six months and parti­
cipate in clinical and health teaching of medical students and should
undertake research work in field studies and in clinical studies. Post­
graduate courses in Paediatrics on the above lines are being developed

in Madras and Calcutta.

INDIAN JOURNAL OF CHILD HEALTH

The UNICEF & WHO assistance would be helpful in providingtaESgj

(1) Facilities for postgraduate training in Paediatrics for: MlCffjZ''/
Officers and for training in
iricians.

Public Health of young PaeftffJSSs

(2) Assistance to develop paediatric training at Medical College^, :.
not included
Plan.

■

the M.C.H. Projects or the Second Five Year&'•

(3) Substantial assistance to departments of Paediatrics arid^OliSH
stctrics and department if Preventive and Social Paediatrics-. :
to develop postgraduate teaching in paediatrics and to;deve--.
lop research.

Grant to Combat ’Flu in U.S.A.
The Senate Appropriations Committee has approved a grant of 800,000 dollhrff^g

to the Public Health Service to combat Asian Flu
The Committee added 300,000.'- C
dollars to the 500.000 dollars requested by President Eisenhower for the campaign^| <

VACANCIES
HONORARY ASSISTANT PEDIATRICIAN
BOMBAY MUNICIPAL CORPORATION
Dean. B. Y. L. Nair Hospital and T N. M. College, Dr. A. L, Nair Road;,;.-/.;- ■
Bombay 8, invites applications from the citizens of the Indian Union,, on?^
prescribed forms obtainable from his office on payment of annas eight eadi?§r
inclusive of sales tax for a post of Honorary Assistant Paediatrician (Out~^j
patients Department), B.Y.L. Nair Ch. Hospital. The applications should;.^
reach him on or before 15th October 1957.
■
Qualifications: Candidates must hold a qualification specified in the first£~,:
or second schedule to the Indian Medical Council Act, 1933 as modified tiptop
1942. They should also possess postgraduate qualification of the Bombay;.-'University in the subject or any equivalent qualification of other Statutory^
Universities and/or should have done research work and published it
recognised journal and also possess at least two years teaching experience^
in a post not lower than demonstrator or equivalent posts. The post carries^, y
a period
of six’: ’
an honorarium of Rs. 100/- p.m. The appointment is for
’
....................
months in the first instance and likely to be continued thereafter.

Age limit: Age should not be more than 35 years.
Candidates will have to appear for an interview at their own expense.-

V. B. X. Almeida
for Dean.

REGISTRAR IN PEDIATRICS.
CHRISTIAN

MEDICAL

Wanted Registrar in Pediatrics

COLLEGE

HOSPITAL,

VELLORE.

Salary Rs. 200-10-250

Apply to the Medical Superintendent stating qualifications and experiei

-.--•whff: .JJ-IWJWIJ!

bigg<
The
sess<i
wavt,
vari(
citie
med
duct
miu
Cor]
Visil
ing
the
will

CH \©_. 5

A Summary
The following is a summary of the State of the
World’s Children report for 1990, issued by the
Executive Director of UNICEF, James P. Grant.
For details of the full report, please see back cover.

Great change is in the air as the 1990s begin.
And great change is needed if a century of
unprecedented progress is not to end in a decade
of decline and despair for half the nations of the
world. In many countries poverty, child malnutri­
tion and ill health are advancing again after
decades of steady retreat. And although the
reasons are many and complex, overshadowing
all is the fact that the governments of the
developing world as a whole have now reached
the point of devoting half their total annual
expenditures to the maintenance of the military
and the servicing of debt. These two essentially
unproductive activities are now costing the na­
tions of Africa, Asia and Latin America almost Si
billion every day, or more than S400 a year for
each family in the developing world. The sums
involved are so large that it is difficult to sec them
in any steady perspective. Debt and interest
payments in 1988, the latest year for which figures
are available, totalled SI78 billion - three times as
much as all the aid received from the industrial­
ized countries. Military spending in the develop­
ing nations amounted to Si45 billion - an annual
expenditure which would be enough to end
absolute poverty on this planet within the next ten
years, enabling people everywhere to meet their

own and their children’s needs for food, water,
health care and education.
It is therefore obvious that for much of the
world, some significant reduction in debt servic­
ing and defence spending has become the sine qua
non of a resumption in human progress.

The winds of change

But as we enter the 1990s, the winds of political
change are again beginning to stir the human
condition. And the most important of the changes
they are bringing is the thaw in the cold war.
More rapidly than could have been imagined,
the result has been a defusing of regional tensions
and the beginning of what may become a
fundamental re-examination of present levels of
military expenditure.
Armed conflicts still scar the surface of the
planet. But fewer wars are being fought in the
world at this moment than at any time in the last
half-century. And in some developing countries,
including China, India and Pakistan, which
together account for half the population of the
third world, levels of military spending have
begun to fall for the first time in fifty years.
It is therefore not impossible to think in terms
of an outbreak of peace - with far-reaching conse­
quences for every other aspect of the human

THE STATE OF THE WORLD’S CHILDREN 1990

endeavour. At present, total military expendi­
tures, in both industrialized and developing
worlds, easily exceed the combined annual incomes
of the poorest half of humanity. The diversion of
even 5% or 10% of this vast sum would be enough
to reaccelerate progress towards a world in which
the basic human needs of all were met.

The environmental challenge

There would of course be no shortage of new
challenges in a world struggling free of its
preoccupation with war. But alongside the great
social and environmental issues, and inseparably
linked to them, there remains the quieter but
even more fundamental claim of the 1 billion
people, a fifth of mankind, who still lack adequate

food, clean water, elementary education, and
basic health care.
In particular, it is the concern of UNICEF to
argue that the needs of children, and particularly
of those millions of children who are still living
and dying in malnutrition and ill health as the
twentieth century draws to a close, should have
first claim on our concerns and capacities, and on
the even greater resources which may gradually
be released if the world were indeed to move
away from its long and wasteful preoccupation
with war.
The largest generation

The moral dimension of this argument is o'
course familiar. It is the greatest condemnation o."

Causes of child deaths
Almost two thirds of the 14 million child deaths each
year are accounted for by just four specific causes diarrhoea, respiratory infections, measles, and

neo-natal tetanus. The great majority of these
deaths could now be prevented at very low cost.

Annual deaths of children under five by main causes’

’ For the purposes of this chart, one cause has been allocated
for each child death. In practice, children often die of multiple
causes and malnutrition is a contributory cause in approximately
one third of all child deaths. Measles deaths are sometimes
Source WHO ana UNICEF eslr-noles

ascribed to acute respiratory infection as a severe case
of measles renders a child highly susceptible to other infections
and pneumonia is often the ultimate reason for a death for which
measles is primarily responsible.

our times that more than a quarter of a million
small children should still be dying every week of
easily preventable illness and malnutrition. Every
day measles, whooping cough and tetanus, all of
which can be prevented by an inexpensive course
of vaccines, kill almost 8,000 children. Every day
diarrhoeal dehydration, which can be prevented at
almost no cost, still kills almost 7,000 children.
Every day pneumonia, which can be treated by
low-cost antibiotics, kills more than 6,000 children.
Every single one of those deaths is the death of
a child who had a personality and a potential, a
family and a future. And for every child who dies,
several more live on with malnutrition and ill
health and are thereby unable to fulfil the mental
and physical potential with which they were born.
Death and suffering on this scale is simply no
longer necessary’; it is therefore no longer accept­
able. Morality' must march with capacity.
But as is often the case, the moral argument is
ultimately inseparable from the practical. The
long-term consequences of poverty will affect us
all increasingly as we move towards a new
millennium. Malnutrition means poor physical
and mental growth, poor performance at school
and at work; high child death rates mean high
birth rates and rapid population growth; lack of
education precludes people from contributing
fully to, or benefiting fully from, the development
of their communities; hopelessness and the denial
of opportunity erodes self-respect and sows the
seeds of almost insoluble social problems; en­
trenched injustices and the parading of unattaina­
ble wealth before the eyes of poverty' provoke an
instability and violence which often take on a life
of their own; and, finally, it is becoming increas­
ingly obvious that the extremes of deprivation
preclude environmental sensitivity, forcing mil­
lions to over-exploit their surroundings in the
name of survival.
A major renewal of effort to protect the lives
and the development of children, and to end the
worst aspects of poverty, would therefore be the
greatest long-term investment that the human
race could make in its future economic prosperity,
political stability’ and environmental integrity.
The time to make that investment is now. One
and a half billion children will be born in the

decade of the 1990s. Towards the end of that
decade, a historic turning-point will be reached as
the number of children being born into the world
finally reaches its peak and begins to decline. It is
UNICEF’s most fundamental belief, as the world
struggles to free itself from the old preoccupation
with war, that there could be no more important
new preoccupation than protecting the lives and
the development of the largest generation of
children ever to be entrusted to mankind.

The rights or the child

In the closing years of the 1930s, several new
developments and some practical achievements
have suggested that this new priority' for children
may be beginning to emerge.
In both industrialized and developing worlds
there is clearly a growing recognition that the
physical, mental and emotional needs of the
young are a legitimate matter of concern for a
nation’s political leaders. The President of the
United States, for example, has expressed the
belief that “owr national character can be measured
by how we care for our children”. And in making
the same point about the world’s responsibility
for its children, President Mikhail Gorbachev has
stated simply that “mankind can no longer put up
with the fact that millions of children die every year
at the close of the twentieth century”.

The growing importance of this issue may soon
find expression in the first-ever World Summit for
Children which was suggested in this report last
year and which has since been endorsed by over
100 governments. Projected for the second half of
1990, the Summit would bring together Presi­
dents and Prime Ministers from all regions of the
world to discuss and draw world attention to the
need for a new preoccupation with children. On
the agenda would be the glaring opportunities
now available for saving the lives of up to 50
million young children and protecting the normal
growth of many millions more in the decade
ahead. Chapter II of the full text of the 1990
State of the World's Children report is devoted
to a discussion of the six most obvious and
universal of those opportunities and is intended as
3

the STATE OF THE WORLD’S CHILDREN 1990

a specific input to the preparations for the
Summit.
A Summit for Children would also consider
another major development in the emergence of
this priority.

After ten years of detailed negotiations, the
Convention on the Rights of the Child has finally
tA brought before the General Assembly of the
tinted Nations. Setting minimum standards of
protection for children’s survival, health and
education, as well as providing explicit protection
against exploitation at work, against physical or
sexual abuse, and against the degradations of war,
the Convention is the first agreement among the
nations of the world on the legally defined rights
of the child. Like many such documents in
history, it is the statement of an ideal which few if
any nations have so far achieved. But as more and
more nations ratify its text and begin to enact its
provisions into national law, and as the press and
public become more concerned to ensure its
observance, it may gradually become the standard
below which any civilized nation, rich or poor,
will be ashamed to fall.

The principle of first call

^anscending its detailed provisions, the Con­
vention on the Rights of the Child embodies a
fundamental principle which UNICEF believes
should affect the course of political, social and
economic progress in all nations over the next
decade and beyond. That principle is that the
lives and the normal development of children
should have first call on society’s concerns and
capacities and that children should be able to
depend upon that commitment in good times and
in bad. In other words, protection for the lives
and the growth of children should not have to
depend on the vagaries of adult society, on
whether a country is at war or at peace, on
whether a particular party is in power, on whether
the economy has been well managed or bungled,
on whether debts have been paid or rescheduled,
on whether commodity prices have fallen or risen,
or on anv other trough or crest in the endless and
inevitable undulations of political and economic
life in the modern nation state.
4

If the trench of such a principle could be dug
across the battlegrounds of political and economic
change in the decade ahead, then civilization itself
would have made a significant advance. Failure to
protect the physical, mental and emotional devel­
opment of children is the principal means by
which humanity’s difficulties are compounded
and its problems perpetuated. And special mea­
sures to protect children from the inadequacies
and mistakes of the adult world is a principal
means by which many of mankind’s most funda­
mental problems might ultimately be confronted.

Children paying debts

Nothing could demonstrate the need for this
principle more clearly than the impact of the debt
crisis on children. For if the principle of first call
had already been entrenched in the conscience of
nation states and of the international community,
then the story of these years for many millions of
the world’s children would have been very
different. As it is, the lack of specific protection
afforded to children during the process of eco­
nomic adjustment has meant that the heaviest
burden of the debt crisis has undoubtedly fallen
on the growing minds and bodies of the rising
generation.
First of all, the poorest and most vulnerable
children have paid the third world’s debt with the
sacrifice of their normal growth.

Over the course of the 1980s, average incomes
have fallen by 10% in most of Latin America and
by over 20% in sub-Saharan Africa. For the very
poorest, those who are forced to spend three
quarters of their incomes on food, cuts in income
on this scale cannot mean anything else but the
malnourishment of their children.
Second, the poorest and most vulnerable
children have paid the third world’s debt with
their health.
Over the last few years, a decline in health
spending per person has been documented in
more than three quarters of the nations of Africa
and Latin America. Hundreds of health clinics
have been closed down, and many which remain

open are understaffed and lacking essential sup­
plies.
Fragmentary evidence of the tragic and inevita­
ble results is gradual!}' becoming available. Infant
mortality, for example, is known to have risen in
parts of Latin America and Africa south of the
Sahara.

Third, the poorest and most vulnerable chil­
dren have also paid the third world’s debt with the
loss of their only opportunity to be educated.
In the 37 poorest countries, spending per head
on schools has declined by approximately 25% in
the last decade. In one out of five developing
countries, primary student numbers have actually
started declining. In two out of every three
developing countries spending per student has
declined in real terms since 1980.
Ways and means of reversing the trend will be
the dominant item on the agenda of the first
World Conference on Education for All to be held
in Thailand in March 1990.

Adjustment with a human face

It is for all of these reasons that, throughout the
1980s, UNICEF has advocated a strategy of
‘adjustment with a human face’. No economic
theory or political ideology can justify even a
temporary sacrifice of children’s growing minds
and bodies. And it makes both economic sense
and human sense to protect the poor and the
vulnerable - and especially the children - when
economies have to be adjusted to new and more
difficult external circumstances.
In many countries, the sheer scale of the debt
crisis means that specific action to protect chil­
dren is unlikely to be sufficient without some
significant progress against the problem of debt
itself.
Unfortunately, the debt crisis has now become
the debt trap. The way out is through a return to
healthy economic growth, but the hard-won
surpluses which should be available to invest in
that growth are instead being sluiced away into
the servicing of the debt itself.

The debt crisis therefore casts its shadow across
the next decade as well as the last.
There are some small signs of hope. In the last
two years, the total debt of the developing world
has fallen for the first time since the debt crisis
began in the early 1980s. And although debt
service ratios have not yet begun to decline, there
is at least a growing recognition that more drastic
and decisive action on debt - including the writ­
ing-off of most of the remaining debts owed by
Africa to the governments of the Western indus­
trialized nations, and further reductions in the
commercial debts of many Latin American coun­
tries - is in the interests of both industrialized and
developing worlds.
But in the process of struggling to release this
second of the two great brakes on human
progress, it is also essential that the international
community make a major new commitment to the
spirit of the Convention on the Rights of the Child
and to the fundamentally more civilized principle
that the protection of children’s lives and develop­
ment should be the last and not the first
obligation to be sacrificed when times are hard.
Without such a commitment, it is inevitable
that the lives, the health, the growth, and the
education of millions of children in the 1990s will
again be sacrificed on the altar of debt repay­
ments and adjustment programmes.
Asia’s challenge

The impact of the debt crisis on children is one
illustration of the need for a new ethic to protect
children in times of turbulence and transition. But
it would be a mistake to assume that this new
ethic is needed only in the poorest countries or
only in the most extreme cases of economic
hardship or civil turmoil.
In both the United States and the United
Kingdom, for example, ten years of steady
economic growth has been accompanied by a
doubling of the number of homeless families. And
while the safety nets of social services have slowly
frayed, the number of children living in poverty­
in the United States has risen by more than 3
million (from 11% of the child population in 1979
5

THE STATE OF THE WORLD’S CHILDREN 1990

to over 15% today). Such figures - and they are
not confined to the United States - represent just
as great a violation of the new ethic embodied in
the Convention as anything which has happened
in the debt-affected countries of the developing
world over the last decade.

This same principle also applies to those
reloping countries which have avoided the debt
trap and maintained steady, and in some cases
spectacular, rates of economic progress over the
last decade. Much of Asia falls into this category.
The dynamic exporting nations of East Asia are
well-known examples, but the giant economies of
China and India and the populous nations of
Bangladesh, Pakistan and Thailand have also
experienced ten years of rising per capita incomes
and slow falls in the proportions of their popula­
tions living below the poverty’ line.

•

Some of those nations have consciously put
economic growth to work for the well-being of
their children. But many countries have seen
steady economic gains without the equivalent
social advance, showing that a conscious and
specific commitment is necessary' to translate the
one into the other.
The problem of absolute poverty' in the world
A has its centre of gravity in South Asia.

.^proximately 40% of all the young children who
die in the world each year, 45% of the children
who are malnourished, 35% of those who are not
in school, and over 50% of those who live in
absolute poverty', are to be found in just three
countries - India, Pakistan, and Bangladesh.
The principle of first call is therefore as
relevant to Asia, as it moves into what may be
another decade of significant economic progress,
as it is in the most debt-burdened countries of
Africa or Latin America.

In sum, the Convention on the Rights of the
Child and its fundamental principle of first call for
children on society’s capacities and concerns is
universally applicable. And as the world-wide
adjustment of economies towards a greater role
for market economics in almost all societies gets
under way, that principle will become even more
necessary to protect children from the turbulence
that will be caused and the mistakes that will
6

inevitably be made. As the problems facing the
children of today’s free market economies clearly
show, the market-place can be a brutal place for
those who lack the purchasing power to make it
serve their needs. ‘Adjustment with a human
face’, which UNICEF has advocated in relation to
the developing world’s debt crisis throughout the
last decade, is therefore also relevant to the
industrialized world, including the Soviet Union
and the countries of Eastern Europe as they move
towards the restructuring of their economic
systems, and to the United States as it undergoes
the adjustment of its own economy to the reality
of its huge budget and trade deficits. Whatever
the direction or cause of political and economic
change in the adult world, children should be
specially protected, as far as is humanly possible,
from its worst effects.

The achievements of the 80s

The second half of the 1980s has also seen
major practical breakthroughs towards this new
ethic for children.
From very’ low levels at the beginning of the
1980s, immunization has now reached approxi­
mately two thirds of the developing world’s
children. From being almost unknown outside
scientific circles a decade ago, oral rehydration
therapy (ORT) is now being used by one family
in every three. And from only 15% or 20% in the
1960s, effective methods of planning births are
now being used by approximately 50% of all
couples in tffeir childbearing years.
The result is that the first two of these
technologies alone are now estimated to be saving
over 3 million young lives each year.
Immunization, in particular, has been the
public health success story of the last decade. The
target of 80% immunization coverage by the end
of 1990 has been reached or brought within reach
by most nations - and there is still one more year
to go. The result is the saving of approximately 2
million children each year from death by measles,
whooping cough or tetanus. In addition, there are
an estimated one and a half million children
growing up normally in the developing world

Today who would be crippled by polio were it not
for the immunization efforts of the last decade.
It is practical achievements of this kind which
make it realistic to think of an emerging new ethic
for children and a new priority' for tackling the
problems of malnutrition, preventable illness and
early death, in the decade ahead.

Vaccines prevent two million deaths
a year
Over two million child deaths a year are now being
prevented by vaccines, but almost three million
children are still dying, annually, from vaccine
preventable disease. Tetanus toxoid immunization
(to protect the mother-to-be and her new-born child)
lags disastrously behind.

Millions of children

Vaccine preventable diseases: deaths,
and cases of polio, prevented and still
occurring, 1988

Present, knowledge about such issues as immu­
nization, dehydration, breast-feeding, child
growth, respiratory infections, birth spacing, safe
motherhood, malaria and the prevention of
illness, make it possible, at an affordable cost, to
build a wall of protection around the growing
minds and bodies of the children of the 1990s.
But fulfilling that potential, a potential to save the
lives of well over 50 million children during the
next decade and to protect the nutritional health
and normal growth of many millions more,
depends above all on the political commitment to
give those children first call on our concerns and
capacities.
Moving towards new national c mmitments to
undertake that task, and new in .rnational com­
mitments to support it, is the practical purpose of
the proposed World Summit for "hildren.
The specific opportunities

On present trends, more than 100 million
children will die from illness and malnutrition in
the 1990s.
The causes of those deaths can be listed on the
fingers of one hand. Most will die of dehydration
caused by diarrhoea, or of pneumonia, or tetanus,
or measles, or whooping cough. These five
common illnesses, all relatively easy and inexpen­
sive to prevent or treat, will acc junt for over half
of all child deaths and over half of all child
malnutrition in the decade which lies ahead.
Low-cost vaccines, oral rehydration therapy,
and antibiotics, could between them prevent most
of this quiet carnage. And the time is overdue for
these basic scientific advances to be put at the
disposal of the whole human family rather than
being restricted to the minority' in the industrial­
ized nations. The vaccines cost less than Si.50
per fully immunized child. Sachets of oral rehy­
dration salts (ORS) cost approximately 10 cents
each. A course of antibiotics costs approximately
SI.

‘ The large increases in the number of polio cases
prevented, ovc' the last year, is caused mainly by the
surge in polio in munization in China, where coverage
has reached almost 95% in 1989.
Source WHO and UNICEF: UC1 Reports

It is not only a question of money and
technology. It is also a question of the delivery'
systems and the infrastructure, the management
skills and the training, and the use of all possible
channels to inform and support parents in
7

THE STATE OF THE WORLD’S CHILDREN 1990

applying today’s knowledge. But to put the
problem into an overall perspective, the addi­
tional costs, including delivery, of a programme to
prevent the great majority’ of child deaths and
child malnutrition in the decade ahead might
reach approximately S2.5 billion per vear by the
£ 1990s.

Two and a half billion dollars is a substantial
sum. It is 2% of the poor world’s own arms
spending. It is as much as the Soviet Union has
been spending on vodka each month. It is as
much as U.S. companies have been spending each
year to advertise cigarettes. It is 10% of the
European Economic Community’s annual sub­
sidy to its farmers. It is as much as the world as a
whole spends on the military every day.
Whatever other reasons may be given, and
however difficult the economic climate of the
decade ahead may be, it is impossible to accept
for one moment the notion that the world cannot
afford to prevent the deaths and the malnutrition
of so many millions of its young children.

Nor can it be accepted that the children at risk
are too difficult to reach. Over the last 20 years,
the developing world has revolutionized its capato communicate with the vast majority of its
<mizens: Newspapers, radio or television now
reach into almost every home; education and
health services now have some presence in almost
every community; employers, trade unions and
co-operatives are now in regular communication
with their work-forces and memberships; retail
industries, public services and advertising agen­
cies regularly speak to a huge public; the voices of
religion, of the non-governmental organizations,
of the women’s movements, of the arts and
entertainment industries, now reach unpreceden­
ted audiences.
The deficit is therefore not primarily in the
technology', nor in the finances, nor in the
outreach capacity. It is in the awareness that the
job can be done and in the determination to
mobilize all possible resources to do it.
For the proposed World Summit for Children,
and for all those who become involved in
responding to this great challenge, what follows is
a brief summary of the six major opportunities to

r

protect the lives and the normal growth of
children in virtually every developing country' in
the decade ahead.

1. Universal child immunization

Despite the rapid progress of the 1980s,
immunization remains one of the greatest of all of
those opportunities. Approximately 3 million
children are still dying each year because they
have not been immunized and because disease,
malnutrition and death are more common among
those children w’ho have not yet been reached. It
is therefore essential to maintain the momentum
and reach 80% immunization coverage by the end
of 1990 and over 90% coverage as soon as
possible thereafter.
It is a matter of particular concern that the two
biggest killers among the vaccine-preventable
diseases - measles and neonatal tetanus - are the
two for which immunization lags furthest behind.
Measles still claims 1.5 million young lives each
year, and other illnesses and malnutrition are now
known to be up to ten times more common in the
months and years following a measles outbreak.
Measles is therefore one of the single most deadly
threats to the children of the 1990s and universal
measles immunization must remain one of the
decade’s greatest goals.
Immunization against tetanus also trails behind.
Coverage of pregnant women in the developing
world still stands at less than 30%, and the number
of recorded tetanus cases among women and new­
born babies has therefore fallen very little in the
1980s. It is a matter of national and international
shame that something so easily and inexpensively
preventable should still be killing more than three
quarters of a million infants and many thousands of
young women each year.
The problems are many. But the 1980s have
shown that high coverage can be achieved even in
the poorest nations and even in the most difficult
of economic times. In China, for example, still
among the poorest twenty countries in the world,
immunization coverage has already reached over
95% nation-wide for polio, DPT, measles, and
BCG vaccines.

2. Oral rehydration therapy

To protect children from life-threatening and
nutritionally damaging bouts of diarrhoeal dis­
ease, all families need to be informed that most
diarrhoeal disease can be prevented by breast­
feeding, by having children fully immunized, by
using latrines, by keeping food and water clean,
and by washing hands before touching food.
In the absence of basic services such as water
supply and safe sanitation, not all families will be
able to act on that information. But that does not
mean that they do not have the right to know why
it is that their children are so often ill or what it is
that they themselves can do about it.
When illness does strike, parents should know
that food and liquid are essential. It is not diarrhoea
itself but the accompanying dehydration which
kills two and a half million children each year".
And it is not anti-diarrhoeal drugs but oral
rehydration salts (ORS), breast-milk, gruels, soup,
rice water, fruit juices, tea, coconut water and
clean water itself which can prevent that dehydra­
tion in almost all cases.

When diarrhoea is more serious than usual,
help is needed. The technology required is a 10
cent sachet of oral rehydration salts which all
health workers can keep in stock and which all
parents can be taught how to use.
Some countries have made progress in training
health workers to use the therapy. Even more
widely, many nations have begun to put today’s
knowledge about preventing diarrhoeal dehydra­
tion at the disposal of parents. After a decade of
such efforts, one third of the developing world’s
families know about the breakthrough and are
attempting to put it into practice.
The result is that an estimated 1 million lives are
now being saved each year.

The saving of 1 million lives each year is an
impressive achievement. But more than 2 million
children are still dying each year from diarrhoeal

* Of the estimated 4 million child deaths per year from diarrhoeal
disease, approximately 60% are now caused by dehydration and
are therefore susceptible to ORT.

dehydration when an effective low-cost therapy
has been available for nearly twenty years.
The question which would face a World Summit
for Children is therefore whether or not the
obvious thing will be done - will ORT be made as
available and as well known as Coke and Pepsi or
will we watch twenty-five million more children
die of dehydration in the decade ahead?

3.

Acute respiratory infections

Acute respiratory infections rank alongside
diarrhoeal diseases as the major killers of the
world’s children. And again, parents need to
know that many such infections can be prevented
by breast-feeding, immunization and safe wean­
ing. And as with dehydration, any parent of a
child with a cough or cold needs to know the one
symptom which means that the child’s life is in
danger. Scientists are now agreed on that one
symptom. If a child is having difficulty in
breathing or is breathing much more rapidly than
normal, then it is essential to get the child to a
clinic immediately. In most cases, the technology
required to save life is a course of antibiotics,
taken orally, and usually costing less than SI.
The question of whether antibiotics are to be
made more widely available through primary
level health workers is a question which must be
resolved before the 1990s are more than a year or
two old.
There is still debate about this issue. But WHO
and UNICEF believe that enough evidence has
now been accumulated to show that hundreds of
thousands of children’s lives could be saved each
year if community health workers were trained in
and entrusted with the use of simple, basic firstline antimicrobials such as cotrimoxazole which
are inexpensive, easy to store, and likely to be
effective in the majority of cases.
The studies will continue. But the time has now
come to act on what we already know.
Oral antibiotics and oral rehydration therapy
are two of mankind’s most powerful instruments
for the protection of its children. It is therefore
essential that all health workers are empowered to
9

THE STATE OF THE WORLD’S CHILDREN 1990

use them. Yet most communin’ health workers
today are forbidden to prescribe antibiotics and
most have not been trained to use oral rehydra­
tion therapy. The training of all health workers in
the use of these two technologies is therefore
i^haps the greatest public health priority of the
^P>0s. It is the path by which almost every single
developing country could reduce child illness and
child deaths on a significant scale in the decade
ahead.
Applying these solutions on the same scale as
the problems would therefore be one of the most
important and obvious agenda items for a Summit
far Children. For it is clear that high-level political
intervention is now necessary to overcome the
obstacles and mobilize the resources to apply’
these known low-cost solutions to these known
high-cost problems.
When a hundred of a country’s citizens are
killed in a plane crash or a rail accident, the event
can be sure to demand the attention of press,
public and politicians. When 4 million children a
year are killed because two known and inexpen­
sive solutions have not been made available, then
this too ought to be worthy of the attention of
^fctions and the intervention of political leaders.
4.

Breast-feeding

Breast-feeding appears to be on the decline in
many developing nations as commercial pres­
sures, the use of milk powder and feeding bottles
in hospitals, and the increased participation of
women in the labour force all conspire to make
bottle feeding seem the attractive option.
The continuation of this trend would be
disastrous.
It has been consistently demonstrated, over
many years and in many nations, that bottle-fed
infants contract far more illnesses and are as
much as 25 times more likely to die in childhood
than infants who are exclusively breast-fed for the
first six months of life.
That risk increases with poverty. In deprived
and often illiterate communities, expensive pow­
dered milks are often overdiluted with unsafe
water and fed to infants from unsterilized feeding

bottles. Malnutrition and infection result. Breast­
feeding, by contrast, is nutritionally perfect,
always hygienic, promotes healthy growth, ‘im­
munizes’ infants against common infections,
helps prevent dehydration and reduces the sever­
ity’ of respiratory’ infections.
A minority of nations have acted on these facts
by launching public information programmes and
by enacting into law the WHO/UNICEF Interna­
tional Code of Marketing of Breastmilk Substitutes
which is designed to promote the advantages of
breast-feeding and to prevent the irresponsible
promotion of feeding bottles and powdered
baby milk for babies. It is a low-cost option for
reducing both child deaths and child malnutrition
in the decade ahead, and it is an option open to
the political leadership of all nations.
5.

Birth spacing

The majority of infant and ‘maternal’ deaths
happen when births are more than four in total, or
are closer together than two years, or are to
women who are younger than 18 or older than
35. The timing of births is therefore also one of
the most crucial of all factors affecting the health
of mothers and children.
Empowering people with knowledge about the
importance of timing births, and enabling them to
act on that knowledge by providing culturally
acceptable methods of family planning, therefore
commands a place among today’s outstanding
opportunities for protecting the lives and the
health of many millions of women and children.
Family planning is a controversial issue which
generates passions and principles on all sides. But
it touches and is touched by so many other facets
of human progress that it cannot be ignored.
There are today 300 million couples in the
developing world who do not want any more
children but who are not using any effective
means of limiting family size. A strong demand
for planning births therefore already exists. If that
demand were to be met, then a number of major
gains could be made:
First, there would be a steep reduction in the
more than 100,000 illegal abortions which are

now performed every day of the year and in the
500 deaths of young women which are the daily
result.
Second, there would be a significant improve­
ment in the health of many millions of women
who would be relieved of the enormous physical
and mental burdens of having too many children
too close together or at too early or too late an
age. An estimated half a million women die every
year of causes related to childbirth and a majority
of those deaths could now be prevented by the
well-informed spacing and timing of births.

Third, the lives of the children who are born
would be immeasurably improved. Not only
would child death rates fall, perhaps by as much
as a third, but the quality of child care, of health,
nutrition, and education, would inevitably rise as
parents were able to invest more of their time,
energy' and money in a smaller number of
children.
Fourth, population growth would be slowed.
Evidence from the World Fertility Survey suggests
that if women who do not want to become
pregnant were empowered to exercise that choice

The spread of oral rehydration therapy
Low cost oral rehydration therapy (ORT) can be
used to prevent or treat the dehydration, caused by
diarrhoea, which is the single most common cause
of death among children under-five.

Almost unknown at the beginning of this decade,
ORT is now being used by one in three of the
developing world's families and is preventing an
estimated one million child deaths every year.

Percentage ORT use rate

Percentage of children under five with diarrhoea being treated with ORT,
annual deaths prevented and still occurring, developing countries', 1984-88

1980

81

82

83

84
Year

85

86

87

88

Estimated child deaths prevented
and still occurring, 1988

For the purposes of this chart. ORT includes the use of both
sachets of oral rehydration salts (known as ORS),
recommended mainly for the treatment of dehydration, and

also home-made solutions of salt and sugar or other fluids
which are recommended for the prevention of dehydration.

Source- WHO , CDDj and UNICEF estimates

* Excluding China.

11

THE STATE OF THE WORLD’S CHILDREN 1990

then the rate of population growth in the
developing world would fall bv approximately
30%.

With so many substantial advantages to be had
the meeting of an existing demand at an
ajjordable cost, the promotion of the knowledge
and the means of timing births also lays claim to
consideration as one of the first priorities of the
1990s.
6.

The attack or. malnutrition

For many parents, feeding children properly is
made virtually impossible by famine, war, or
absolute poverty. But one of the important
advances in knowledge over the last decade has
been the gradual realization that much of today’s
malnutrition, possible even the majority, resides
in homes where adequate food is available, and
that the culprit is just as likely to be frequent
illness, poor health care and the lack of knowl­
edge.
Common childhood illnesses - especially diardwea, measles, whooping cough and other respifjjry infections - take away a child’s appetite
and lower food intake. Each illness also inhibits
the absorption of food, burns up calories, and
drains away nutrients in diarrhoea and vomiting.
In poor communities without either clean water
or safe sanitation, it is not uncommon for children
to have between six and twelve such illnesses a
year. Malnutrition is the almost inevitable result.
For this reason, many of the priority actions
already discussed in this report - and especially
measles immunization, breast-feeding, and the
prevention and proper treatment of diarrhoeal
disease - would also reduce child malnutrition.
Practical steps towards ending child malnutri­
tion could therefore be taken in the early 1990s
by implementing low-cost methods of preventing
and treating child illness and by mounting nation­
wide efforts to put today’s nutritional knowledge
at the disposal of all parents.
That knowledge itself is not complicated.
Every parent should know:
O That breast-milk alone is the best possible
12

food for the first four to six months of a child’s
life.
O That by the age of four to six months, the
child needs other foods in addition to breast-milk.
Introducing solid foods earlier increases the risk
of infection; leaving it much later leads to
malnutrition.
O That a child under three years of age needs
feeding twice as often as an adult with smaller
amounts of more energy-rich food.
O That food and drink should not be withheld
when a child is ill or has diarrhoea.
O That after an illness, a child needs extra
meals to catch up on the growth lost.
O That leaving at least two years between
births, and making sure the mother-to-be has
enough food and rest, is essential for the good
health of the mother and for the nutritional well­
being of the child.
All channels of communication can support the
effort to put this information at the disposal of all,
but, as with many other advances in health
knowledge, it is the community health worker
who can do most to inform and support parents in
putting nutritional knowledge into practice.
Ideally, a community health worker should
assist all mothers in the monthly weighing of all
children under the age of three. In any child,
growth is the most important single indicator of
health. If a child is regularly putting on weight
every month, then there is unlikely to be anything
fundamentally wrong. If the child is not gaining
weight, something is very definitely wrong and
action has to be taken.
With only a few months’ training, a health
worker can perform this and many other vital
services, putting at the disposal of parents not
abstract nutritional education but timely, practical
tips about the health and growth of their own
children.

Doing the obvious

This overview shows that effective solutions to
the most important causes of illness, malnutrition,

and death among the children of the 1990s are
available and affordable today.
UNICEF believes that they add up to a case for
making the 1990s into a Decade for Doing the
Obvious. And it is in search of a commitment to
do the obvious on a sufficient scale that UNICEF
has proposed a Summit for Children. For it is only
the commitment of a nation’s leaders, the aware­
ness of a nation’s people, and the mobilization of
a nation’s organized resources, which can put
today’s solutions into effect on the scale required.
But it is equally obvious that the available
solutions to major child health problems cannot
be applied in a total vacuum. Permanent systems
of communication, access to services, and practi­
cal support are necessary’ if today’s health knowl­
edge is to be truly put at the disposal of the
majority. And this in turn depends to a significant
degree on the training of health workers, the
development of primary health care systems, the
availability of water and sanitation services, and
the level of literacy and education among the
population at large.
These are the dimensions of development
which are most threatened by the process of
adjustment to debt and recession and which the
Summit for Children must also address.

Development with a human face

Children cannot wait until our economic mis­
takes and omissions have been rectificd.lt is now
that their minds and bodies are being formed and
it is now that they need adequate food, health
care and education. What is required is a new
commitment to a style of development which
gives priority to the poor and particularly to the
health, nutrition and education of their children in
good economic times and in bad.
In particular, policy commitments to universal
health care and universal education, the two great
goals of social development, are of fundamental
importance to today’s children - and tomorrow’s
world.
This larger task of moving towards ‘develop­
ment with a human face’ would of course require

significant additional resources. Assuming that
real progress is made in reducing the outflow of
debt and interest payments and increasing the
inflow of investments to the developing world,
then it can be estimated that an additional S50
billion a year would be required, throughout the
1990s, to move forward towards the great human
goals of adequate food, water, health care and
education for every man, woman and child on
earth. The approximate price tag for moving
convincingly in this direction is therefore less
than one half of one percent of the world’s gross
international product or about 5% of present
military spending.
Half of this sum might come from the develop­
ing countries themselves if priorities were re­
examined and the balanced tipped more in favour
of the poor. The other half, or approximately S25
billion a year, might be expected to come in
increased aid from the industrialized nations. To
put such a sum into perspective, it would mean
increasing today’s aid levels by approximately
50% so that, for example, the Western industrial­
ized nations would be giving an average of 0.5%
of their GNPs instead of today’s 0.35%. The aid
target agreed in the 1960s was 0.7%.
Now is therefore the time for the developing
nations to analyse what restructuring in favour of
the poor is possible within their own resources
and to draw up well thought through plans for
maintaining and expanding primary education,
for primary health care systems, for national
nutrition programmes, and for environmental
protection.
Such plans could form the basis for an in­
creased and newly directed aid and investment
effort in the decade ahead.
If such thinking were to become the consensus
of the 1990s, then it would be possible to think in
terms of compacts between groups of donor
nations and individual developing countries for
the specific purpose of making measurable pro­
gress towards agreed goals which might include
universal primary education, low cost water and
sanitation services, a halving of child malnutri­
tion, the reduction of measles and neonatal
tetanus, and a number of other major advances
which are now possible.
13

1

THE STATE OF THE WORLD’S CHILDREN 1990

In many countries, significantly increased aid
for such programmes would be needed to make
them politically feasible. And enhancing the
political feasibility of long-term action in favour of
the poor, and of the environment, is the most
important role which aid can play in the 1990s.

For twenty years, aid has remained at approxi­
mately one third of one percent of the industrial­
ized world’s GNP. It is pitifully small. The
Awncial resources available to the developing
"rid must be increased - through debt reduc­
tion, trade reform, and improvements in both the
quantity and quality of aid - if progress is to be
made. But these resources need to be enlarged as
part of a long-term and consciously planned effort
to protect the poor from the immediate effects of
adjustment programmes and to invest in the most
reliable of all engines for future growth - a
healthy, well-nourished and well-educated people.

Government and children

It is the particular responsibility' of govern­
ment, in both industrialized and developing
worlds, to set the parameters for a new deal for
children in the 1990s.

In the lessening of regional and ideological
^Micts, in the beginning of progress towards
cRarmament, and in the birth of a new global
awareness of environmental issues, it is possible
that, as Soviet Foreign Minister Eduard Shevard­
nadze has put it, “/I new political intellect is
prevailing over the dark legacy of the past".
If the twenty-first century is to be a better one
for mankind than the twentieth has been, then it
is essential that the principle of first call for
children become a part of that new political
intellect.

It is within our power to end child deaths, child
abuse, child illness and child malnutrition on the
scale which defaces our _iv;lization today. And it
is within our power to ensure that every child has
a school to go to, a health worker to refer to, and a
diet which allows normal mental and physical
growth.
14

But as the 1990s begin, it is important to begin
the journey towards those great goals by taking
the most obvious first steps. Several of the
greatest health advances in human history now
fall within the range of the practical and the
affordable.
Achieving such progress is no longer a ques­
tion of physical or financial possibility. It is a
question of political priority.
In the developing world, from the traumatic
events of the 1980s must be born a new
commitment to styles of development which give
priority to meeting the minimum needs and
enhancing the productive skills of the poor
majority during the 1990s.
In the industrialized world, a new commitment
to the international development effort is also
demanded of political leaders, press and public.
The first step towards this commitment, in
both developing and industrialized worlds, would
be a decision to realise the major specific
opportunities outlined above. The cost of doing
so, an additional S2 billion to S3 billion a year,
might be shared equally between the developing
and industrialized nations.
From the broader perspective of our common
future, ensuring the healthy physical and mental
development of children is the most important
investment that can be made in the healthy social
and economic development of our societies.
Doing what can now be done to achieve that goal
is therefore an issue worthy of its place on the
agenda of the world’s political leaders, the world’s
press and the world’s public, as we enter the last
decade of the twentieth century.

The full text of the 1990 State of the World’s
Children report is available from all
UNICEF offices or by writing to the Divi­
sion of Information, UNICEF House, 3 UN
Plaza, New York, NY 10017, USA. The
report is also published by Oxford Univer­
sity Press.

CH '©- If-

PRELIMINARY REPORT OF A WORKSHOP SERIES AND SURVEY
ON

ANITA

GANESH

SAMVADA
3/2, 1st Cross Annipura,
Off Double Road, Sudhamnagar,
Bangalore 560027
( Tel 2234475)

OONi

""ENTS

I-

Abstract

II.

Childhood Sexual Abuse : An Introduction

III.

The Planning and Scope of the Survey

IV.

Methodology

V.

Findings

*
.«

ACKNOWLEDGMENTS

I he idea of doing this study came from friends and s'.'dents while we shared our own experiences of
childhood sexual abuse. This idea was greatly encouraged by my colleagues at SAMVADA and 1
slowly began some preparatory reading. Discussions with Dr. Shekar Seshadri, Child Psychiatrist from
N1MHANS helped give the study a concrete shape. He also took part in the investigations and has
helped immensely in reflecting on the findings.

g

Our colleague Lucy translated the questionnaire into Kannada and conducted the workshops in the
Kannada speaking colleges despite pressure of time. Ar- n Kotenkar has spent hours together in the
coding ci' data and working with the whole statistics! p; < of vie study, constantly encouraging and
guiding the whole team in his quiet way.
^Valli, a student of SAMVADA worked tirelessly in the data coding and data entry. Mallesh was as
^usual indispensable xeroxing, typing tabulating and doing all the invisible work. Bachi cheered us right
through it got depressing with his wit, discussions and hot tea!

This study would not have been possible if the girl students we interacted with in the workshops did not
trust us and share the most difficult and distressing of experiences with us. We are truly grateful to the
college lecturers and principals who allowed us to conduct the workshops despite the exams looming
ahead.

1

1. ABSTRACT

This is an account of die insights we have gained into childhood sexual abuse (C.S.A.) in our society.
I he basis of these insights is not a "survey" in the conventional sense. We chose instead to conduct a
series of workshops gathering information and simultaneously discussing the issue of C.S.A with 348
girl students, from various schools and colleges in and around Bangalore.

An overview of existing literature on C.S.A. ( mostly from the west) suggests that this was once con­
sidered as confined to a handful of paedophiles, but is now recognized as endemic to society. The
world over, research into C.S.A. began very recently in 1978 | U.S. National Centre on Child Abuse
and Neglect | and therefore only for the past two decades has it been acknowledged as a problem of
unimaginable proportions.

However research into C.S.A in India is in its infancy. This is largely because of the secrecy and
stigma attached to it and the lack of a language for enquiry. There is an urgent need to understand
C.S.A. in the Indian context thoroughly, before we can get down to taking any kind of preventive or
therapeutic action.
This study has focussed on enquiring into :
* 1'he incidence of childhood sexual abuse among females in our society and the age at which
abuse occurs.
,z~
* The perception of those abused in terms of who they blamed and whether they felt in control or
not.
* The extent, nature and type of disclosure •. ?out their own abuse
* Who the abusers are.
* How the abused perceive die impact of the abuse experiences on themsei.es and what their
concerns are.

It does not explore why C.S.A. exists nor does it examine die socio- ecological factors, social relations
or 'be personal and / or familial predispositions that could precipitate abuse.

The workshops addressed the essential blamelessness of the victims and helped them see childhood
sexual abuse both as a personal and collective (and therefore political) issue. For many, it was the first
time this topic was addressed in a group or in a classroom and for some it was the very first time they
disclosed their own abuse. So it was a kind of "taking the lid off" in a sense.
Purpose of the study

Through the study it is proposed to identify the most vulnerable age- groups so as to formula): preven­
tive tools ( personal safety workshops and educational material) for children approaching the "high
z
risk" age.
The information pro-tided by our respondents regarding how they have perceived the impact of the
abuse on them, .‘'ill help greatly in formulating messages to be incorporated ; t educational and thera­
peutic material I interventions.
1 he study could also Ke^a starting point for a dialogue with those who feel concerned.about the issuer­
women’s groups, educationists, parents, lawyers, doctors, counsellors and therapists. We hope that to­
gether we could work towards preventing abuse through educating children, evolving sensible laws, in­
fluencing the law enforcing machinery for a greater sensitivity to the children’s’ trauma and raising
general public awareness through campaigns. In this direction, we hope to be ab e to train a group of
interested persons to work as lay counsellors.

We envi: ige that the findings from this study would throw up ,reas for further research and study.
There is .< lot that we have to comprehend about C.S.A. and we hope this effort will encourage you to
take up more inept enquiries into the various facets of abuse.
Similar studies and workshops;GOuld als< : taken up in other cities, towns and rural areas to gd .
glimpse into the larger picturel'The section on methodology has therefore been done in some detail to
help those who wish to carry out such an enquiry in other places.

1

II. CHILDHOOD SliXUAI. M3USI- : AN INTRODUCTION

WhaLis Child Sexual Abuse?

One oi the most common misconceptions people have about sexual abuse is that "rape" is sexual abuse.
I he media also carries stories on "Child rape" based on police reports, which tell us very little about
what really goes on. The entire gamut of types, forms and degrees of abuse has been pushed under the
carpet so effectively that it is almost easy to believe it doesn’t exist. Yet, if only we would look a
little, ask a little and listen, we would hear a lot. Listen to this:

"Eve teasing has become an almost daily experience and I have learnt to forget about it no sooner than
it happens, but the physical abuse which 1 have gone through five times ( not actual rape) was done by
bastards called my relatives. These happened at night when 1 slept along with these wretched people
thinking it was not wrong, some times because of a lack of space.... and sometimeffwhen meeting
cousins and relatives after a long time, we would ieep in the same room to have a'long chat. Taking
advantage of the darkness, these persons, (my uncle once, my cousins thrice and my grandfather once )
abused me at different times. I The first incident was when I was 8 years old I. The next day they all
seemed to talk to me as if nothing had happened. probably they thought that 1 had been sleeping be­
cause that is what I pretended, though I was awak •, 1 was dumbstruck and spellbound...

It took me a long time to forget this and somehow I put it out of my mind. Still I was able to talk about
this only when I became a young adult oj twenty one years. I told dll this to my sister who is a year
older than me. I was shocked to hear that she too has been abused by four of the same people who had
abused me. A fter consoling each other we have decided not to let any of the young girls whom we know
to sleep along with these so called Blood relatives or anything called man. And I have decided that one
day 1 will teach these wretched men a lesson..." (The girl’s identity is not known, tills is what she
wrote on the questionnaire in response to our question on how childhood sexual abuse experiences have
affected you).
Her sense of pain, helplessness and anger at the betrayal of trust is what abuse is all about and many of
us can identify with this kind of experience. Yet, some simple definitions will help in clarifying what
the term child sexual abuse means.
t) What do we mean by abuse’? Abuse is verbal or physical behaviour by one person, ( perpetrator)
awards another person,(victim) which is considered in their culture to be significantly upsetting, de­
meaning, harmful and I or traumatic. Abuse can be verbal abuse, psychological or physical.

Liz Kelly, a British researcher defines abuse: "Violence or abuse is the deliberate use of humiliation/
threat/ coercion/ force to enhance one s personal status/power at some one else’s expense, and/or con­
strain the behaviour of others, and/or get ones' needs and wants met at others cost." (Kelly, 1991 p. 1.3).

it) What is sexual abuse? Is sexual abuse only rape?
Sexual abuse is abusive behaviour having a significantly sexual aspect. Sexual abuse can be through
language, body exposure, body contact and can occur with or without other forms of abuse.

Hi) What is childhood sexual abuse?

Sexual abuse of a child, where the perpetrator is generally an adult or a significantly older child; the
child is not considered to be tally capable of informed choice or informed consent. A forced choice
thus occurs with perpetrators generally forcing or persuading the child, directly or indirectly, and this
unfair abuse of power in the relationship means that a child is not a equal partner. The key issue then is
the exploitation of the child for the sexual gratification of the adult.
A more comprehensive definition has been provided by Driver & Droisen (1989 ,p.5) which says child
sexual abuse is " any sexual behaviour directed at a person under 16 without that persons informed con-

3

sent. Sexual behaviour may involve touching parts of the child or requesting the child touch oneself, it­
self or others; ogling the child in a sexual manner, taking pornographic photographs, or requiring the
child to look at parts of the body, sexual acts or other material in a way which is arousing to oneself;
and verbal comments or suggestions to the child which are intended to threaten the child sexually or
otherwise to provide sexual gratification for oneself. It must be defined by every circumstance in which
it occurs : in families, in state run and private institutions, on the street, in classrooms in pornography,
advertising and films ".
iv) Incidence of C.S.A

Studies in North America indicate that one in four girls and one in six boys are sexually abused before
the age of eighteen. Official figures reveal that 3,00,000 to 4,00,00 cases of sexual abuse of children
are reported annually in former West Germany. The World Health Organisation states that one in every
10 children is sexually abused. Statistics have varied depending on the type of samples chosen and the
definitions of sexual abuse, but the now widely accepted view is that, by far the most abuse is against
girls with one in four girls having been abused as children.
v) Who are the abusers!
What is even more heart wrenching is that most of the abuse is by family members. With girls, the
abusers are usually uncles, fathers, brothers, cousins and close relatives, whereas for boys the abusers
are often outside the home - teachers, coaches, older friends etc.
For both however, it is . known and trusted adult to the child who abuses that trust. What it also means
that the abuser is often a person the child cares about and wants the persons approval and affection.
This makes the cr-ild vulnerable to repeated abuse sometimes stretched over years together.

vi) At what age are children sexually abused!
There is no specific age group of children who are safe from abuse. Children even 11 months old have
been sexually assaulted. A survey doze in the U.S. by the Federal Government in 1992 showed that
30% of rape victims had not yet reached their tenth birthday. In Delhi 54% of the rape victims (from
police records 1992) were found to be below 15 and in 80 % of these cases the rapist was known to the
child.
■ii) Effects of abuse on the child
I’he trauma of a sexually abused person is hard to describe. Some studies have been done into the short
term and long term effects of C.S.A. which manifest themselves differently. However the findings are
still rather scam an uncertain. In the short run, sexually abused children have been found to be prone io
a variety of psychological and behavioural disturbances caused by the trauma of abuse. These could
include bedwetting, nightmares, sleep disorders, depression, anxiety, running away from home, multi­
ple personality disorders, precocious sexual behaviour or its inverse, extreme inhibition and low self
esteem caused by a sense of guilt and shame.

The extent of long term effects are dependent on several variables like the age at onset of abuse, rela­
tionship to the offender, duration and frequency of abuse, the use of force, penetration or invasiveness
of the abuse and family functioning. However the main variable is the individual persons response
which depends on whether she blames herself for the abuse, her general demeanor and outlook to life,
socialisation and her level of awareness about what has happened.
A seventeen year old engineering student was brought to a psychiatric hospital for refusal to go to
college, and feeling extremely fearful and anxious.

The clinical diagnosis was anxiery neurosis with panic. During therapy, it was revealed that she had
been raped by her uncle when she was eleven years old. She had also been threatened with dire
consequences if she let anybody know. The uncle continued to be a frequent visitor to the household.
She began ond-ering whether all meq would do the same to her 'the Opportunity aros'e and became

reserved in her interactions with men. even her father and brother. These feelings became markedly ex­
aggerated when she left her al! girls school tofttn college where she had to interact with the opposite
sex. She would become extremely fearful, develop panic, attacks and had a pervasive sense of anger
towards her male classmates. Eventually she dropped out of college altogether. ' Sanjecv Jain, Mccna
V, Valsa E and Janardhan Reddy in I J.P. 1993|.
In comparison with women not having a history of CSA, women who have reported CSA show evi­
dence of ; adult sexual disturbance or dysfunction, anxiety and fear, depression, revictimization experi­
ences and someti nes suicidal behavior. Some have also reported homosexual experiences in adoles­
cence or adulthood.

However it is pertinent to point out here that most of those abused grow up to be normal functi mal
adults where scars heal over time with love and emotional security.

Reversely, data indicates that a third of adults with marital or emotional disorders, had been victims of
sexual abuse during their childhood. Sixty seven percent of female criminals had been sexually abused
as children. ( Nirmala Niketan, Bombay)

Disclosure
Abuse is often accompanied by threats of dire consequences "...if you tell any one what ’ die " or by
cajoling - " ...this is a special secret between you am' me only, lets not tell anyone about it" by the
abuser. Culture and socialization itself have a deterring effect and discourage victims Iron, disclosing as
it attaches a stigma to the person who has been abused, making him or her feel sullied. With smaller
children, who do not know what has been done to them, it may not occur to them to tell anyone about
it. It is often the physical hurt which she / he runs to "show mummy" who then asks how it happened.
The main dilemmas in disclosure are : Whom to tell?., someone in the family or outside? Why to tell ?
When ? How to tell- totally, partially or modified ? What to tell?

At the same lune there could also be a tremendous urge to tell someope,
to be believed, to be reassured that it is not one’s fault, ( there is often a fear of being reprimanded)
and a need to be protected from further abuse.
The Indian Context

Is childhooo sexual abuse prevalent in Indian society or are .,e
simply aping the west in this regard and assuming that because it exists there, it is prevalent here as
well ?
There is a need for concrete data about the incidence of C.S.A. here. Both structured and ui. .tructurcd
explorations into the issue would be necessary. Data from the west would be inappropriate for any
preventive.efforts in India in the light of our familj structures,
social and cultural environment, value systems, sexu«. mores and levels of knowledge about sex and
sexuality.

In a culture which places too much importance on fen'iale virginity and equates it with purity, virtue,
"izzat" and honour, the sorrow, bewilderment, anger and trauma of an abused person is aggravated by
a sense of shame and self contempt. This could even lead to attempts at suicide and self destruction.
Hear of being maligned forces victims to keep quiet and the secret pain and shame is a tremendous
burden for a young mind.

Support systems like counselling facilities, legal action, sex education, public campaigns for ;• .areness,
sensitive law making and enforcing bodies need to be built up taking into account the context of abuse
and the stigma attached to the victim in bur society.

r

At the same time, the very values on which this culture is based, need to be questioned and young boys
and girls have to be educated to analyse social structures which have pervaded the common psyche.

Summary
There is sufficient evidence to indicate that C.S;A cuts across families from all sections of society irre­
spective of class, caste, ethnicity and religion. The question then is, is sexual abuse purely sexual? Or
is it an aggression associated with power and with contempt?
Given the magnitude of the problem it can no longer be dismissed as confined to pathological families /
or individuals. Surely there is something basically wrong in the power relations between men and
women, between adults and children. The sanctity of the family as a nurturing haven, as the bosom of
love and security can no longer be taken for granted. The innocence of children can no longer be ro­
man: ised or eulogized as cuteness. And we can no longer say that what goes on in the family whether wife battering, marital rape or child sexual abuse- is none of society’s business.

The uaditional diagnosis and response to C.S.A. appears restricted to treatment I protection of individ­
ual victims and treatment or rehabilitation I punishment of abusers because of the contextual variability.
There is therefore a need to contextualise the issue and have a multi pronged approached to sexual
abuse.

Ill,

THE SCOPE AND PLANNING OE THE SURVEY

I) Our main focus is to establish whether or not sexual abuse c: female children is taki g place
in Indian society. The study is an open ended enquiry (rather than a testing of a hypodiesis), into the
extent uf sexual abuse among female children, age at which it occurs, perception of blame and control,
extent and nature of disclosure, who the abusers are and the effects of abuse experiences on the victims.

The class bacufcround of die respondents is roughly related i. d e type of college or school
Urban English speaking - - upper middle class
Urban Kannada speaking - ~ middle and lower middle class
Ruial Kannada speaking - - middle and lower middle class

Though we are aware that sexual abuse of girl children exists in poorer sections of society, we did not
include them partly because of lack of access. Secondly, some categories like rag-picking girls, daughBbrs of commercial se;- workers, children in remand homes ard correctional .nstitutionj, rural dalith
girls could show much higher r-te.s cf abuse. vary?',-;. patten •; of abuse and possibly more extra familial
abuse.
In these categories literacy rates would be near zero and so a written questionnaire where anonymity of
the respondent is maintained, would not have been possible. Asking questions orally face io face would
have been most threatening for them as the inic viewer would be a complete stranger. Inc’.iding them
along with girl students wouic then lead to misleading findings - not representing either the "normal"
risk categories or the "high" risk categories of girls. These sections have to be ..tudied separately, in
depth, in the context of their socio economic situation.

Thereivre it is not really a sample representative of our society at la.ge, but rather a sample represent­
ing certain cross sections of society whdre the chances of C.S.A would Ise neither abnormally high or
abnormally low.

This study is limited to C.S.A. among girls because the incidence of abuse is higher among female
children. Thj^.iJoes not in any way imply that we are unconcerned about sexual abuse of male children it exists and we do care, but it needs to be studied separately'.'It would have been impossible to include
male students in most of the workshops along v. nh the girl students as it could have made the girls
Imore reticent and withdrawn.

We have chosen to collect information from girls in the age group of 15 to 21 who have passed puberty
and the age where C.S.A. could have occurred. Choosing a younger age gioup could have led to
missing out on abuse experiences m the late teens.. Also, we have limited expertise in dealing with
ongoing abuse within the home and lia_ we come across such cases, we would have been handicapped
by our inability to help.'
' 1
.

2)

-

S

1 11

rl

S'' . ’

'>

. (i .

,

I'

.

Deciding what to ask and what we cannot / should not I need not ask
and the rationale behind our decisions

i) We decided to ask
a) Whc .ier eve te.. ed heard'of or witnessed eve leaking
b) whether molested
c) whether sexually abused by using force, coercion, aggression
d) age at ab"se
e) self-blame or not
f) felt in control over the situation or nd'
g) disclosed dr' not
h) whom discloseo to and when
i) nature *o ’ disclosure

.

jr

7

j) relationship to abuse
k) frequency of hard spectrum abuse
1) number of hard spectrum abusers
m) how abuse experiences affected them and what their conc-ms are.
Defining . '.e range of abuse :
There is a range of sexual abuse, and the first thing we had to clarify was our definitions of sexual
abuse from the point of view of the scope of this study. Broadly speaking, there are soft spectrum
forms of abuse and hard spectrum forms. Seen on a continuum, our definition of soft spectrum abuse
would include eve teasing in its various forms. However for the purpose of the study we have limited it
to mean physical forms of eve teasing like pinching of breasts and bottoms and it does not include
whistles, winks and verbal comments.

"Eve teasing" v. Id therefore refer to acts of touching of breasts and bottoms rather fleetingly where
the abuser is taking advantage of a crowded or public place and the anonymity it offers. By calling it
soft spectrum abuse, w;
i> ■'5 way i-cp.f ag thnt the person eve teased takes it ligh’iy or that it is
not traumatic.
Under hard spectrum child sexual abuse we include overtures I unequivocal sexual invitations / physical
touches of a sexual nature, which are ou
*. of place in the context of the relationship which exists, wtae
the abuser is misusing the power of age, kinship and / or the opportunity to transgress physical bouiW
aries. Molestation would therefore form a predominant part of this spectrum of abuse and would
include sexual touching of the abused or the abuser forcing the victim to sexually fondle the abuser.
i ne hardest spectrum of sexual abuse of children would be acts involving aggression and force i.e rape,
attempted rape, oral sex, penetration using objects, using the victim to masturbate etc.

We deemed to differentiate between these three levels of abuse and seek information about all three.
We also decided to study these three levels on the dimensions of perceived control, self blame, disclo­
sure arid'relationship to abuser.

ii) We decided I.OT to ask
a) Name, family details like income level, religion, joint family or nuclear family, number of family
members and sibling position. /■'. first we were rather keen on getting information about the families to
see whether we could draw any correlations between family profile and the extent / nature of abuse.

Later we realised that our sample size is much too small to draw conclusions about specific communi­
ties or family types. Secondly we questioned whether such information would help in planning pre^tive steps. Thirdly, seeking information about their families might have made the respondents unsuw
about the anonypiity of the om /ey and r.<ay have frightened them from le'ling the truth about their
abuse experiences.

There are also some disadvantages in not having this information. For example, when we ask about
whom they have disclosed to, if a respondent does not mention mother or sister, we have no way of
knowing whether she has a mother and sister or not!

0) Immediate reaction to abuse and levels of distress / disability
Hov. jo you ask someone about their reaction to a painful and traumatic incident (s)? A "yes/no" ques­
tion about whether you were distressed or riot, wouiu be gipssly inadequate. Therefore it was decided
to
away with this question in a structured form. In the open ended question about how abuse has
affected them, they could write, if they wished, about their reactions and levels of distress as well.

c) Identity of abuser: The purpose of the entire exercise was not to study the abuser and his or her pro­
file. Nor was the intention to take any punitive or therapeutic action on the abuser. What we wish to
know is merely the relationship of the abuser to the victim in the case of hard spectrum abuse.

d) Explicit details of form of abuse: The questions on hard spectrum abuse read as follows :
Have you ever experienced forms of overture or physical touch of an insistenitpr "sexual" Natif-'l
nr..

Have you ever experienced serious forms of sexual abuse involving coercion, aggression and/or physi­
cal hurt ?

These querf?.^ «re explained in the workshop to help them understand what is meant in each question,
but we have no way 01 knowing what exactly took place. Did he make a pass? Was it fondling and
kissing ? Did the abuser exhibit his< mitals? Did he force her to touch or fondle his private parts. ? Did
he force oral sex ? Did he attempt "penetration" ? Did he "rape", seduce, beat or gag ? Did he make
any threats, if yes. what were they?

Seeking seen information through a questionnaire could be too threatening. On the other hand, how
will it help if v.e knc.-» : Would we have sufficient cases of serious abuse to make any conclusions about
the forms it takes? Such information may be disclosed in a therapeutic setting but may not be disclosed
through a questionnaire.
T

* 3) The accent of the study is on qualitative rather than quantitative data because
* The sample is small (348) .
* It is retrospective .
* Respondents might be afraid to gi.c information, especially about i.ilrafamily rape.
* Memory’ of incident may be repressed.
* The ef fects of abuse on the victims cannot be quantified, as it is a one time statement of currently
perceived effects Some of the effects in terms of their sexuality and adult relationship have
probably not yet been discovered and / or articulated.

(How we worked at maximizing accuracy within these parameters is outlined in the section on
Methodology)

*1

IV,

METHODOLOGY

1. Deciding Who to ask: To get a fair representation of the problem, we decided not to work with a
pre-screened sample, but rather a random sample of girl students in the 15 to 21 age group from
selected colleges and schools catering to Urban English speaking, Urban Kannada speaking and rural
kannada speaking girls.
Within the school or college, the group we addressed was randomly chosen from the point of conve­
nience. In some colleges it was the final year from a particular discipline chosen randomly, in some a
cross section of girls from all classes and in some colleges it was the pre university students. The size
of the groups addressed ranged from 16 to 68.
A total of 14 colleges I schools were approached, two refused and in one college, the dates suggested
by us did not suit the students. Approaching the college authorities and seeking permission to conduct
the session entailed some explanations about the issue and we found it very much easier to get permis­
sion when the person in authority was female. Our experiences at Colleges where men were approached
for permission turned out to be problematic as they were not convinced about C.S.A.. or attributed it to
misbehavior on the part of the girls!!
In contrast, where women were approached, they were very helpful and wanted the workshop con­
ducted. The staff even answered the questionnaire in a few cases.- This was largely because the female
teachers I principals could identify with the issue of childhood sexual abuse and spoke about abuse Aj
cases they knew of or about their own experiences.

Twelve colleges/schools gave permission, and in eleven we conducted the workshops.

2. Formulating the questionnaire: We made most of the questions easy to an: ver with a "YES
/NO" response, providing separate space to write about their experiences. The i^estions were fitted
into a single sheet to give an impression of simplicity and brevity, beginning from simple and least
"resistance invoking" questions to the more sensitive.
The language for enquiry : Choosing the right words was very difficult, especially wht a we had to
translate the questions into Kannada. We found that the words we’a either considered ouscene or had
other negative connotations.
We were not happy to use the term "Eve le .sing" for its inherent sexist bias, but still decided to use it *"
because it is easily understood by gii t •; of ui:s age group.
Words like r?me and molestation were not used, as they have very !imited-and painful connotations.
Question 4, as ‘ated in the questionnaire and ;s explained in the workshop';'wou'd cover a range from
overture to physical touch. The question is phrased in this way so that the various forms of this
A
spectrum of abuse ar included.

Similarly in phrasing queslit n five, and in explaining what all such abuse implic
form of penetration , attempted penetration was to be included.

it was clear that any

3. Designing the interactive workshop:- Options considered, dilemmas faced end final design
selected :
Right from the outse\ we were aware that it is neither possible or desirable io walk tn and out of
schools and colleges administering questionnaires on such a sensitive issue. We metefore contemplated
various ways in which we could get to elicit and provide information about C.S A. t the same time.

i) Options C msidered
Option (A): introductory inputs and d:‘cussions about C.S.A. with a group followed t.y distribution of
questionnaire to be tilled and returned io us through the post / volunteers
Option (B): Introductory inputs and discussion with a group followed by administration of questionnaire

Option (C): Introductory 'inputs and •discussion simultaneous with the administration of th<- ques?
tionnairc, requiring about 1.5 hours. This could be preceded by a preparatory session for students in
the 15 to 17 age group, introducing them to adolescence, sexuality etc and clarifying myths they have'
abou, related issues.
Since Option (C) seemed'the most promising in terms of the quality and accuracy ol i-i format ion we
would receive, we decided to adopt this method, which would essentially be a rather lengthy interactive
dialogue session.
r

ii) Dilemmas and Anxieties Faced
*

Will we trigger off successfully repressed memories of a traumatic event? Do we have a right to do
this?-lf it happens, in what way can we reach out to the person concerned?

* -What If someone starts crying / having a breakdown during the workshop? How do we react and
reach out? Will the college authorities throw us out?
*

What if the abuse was never perceived as abuse? It could have even been perceived as a pleasurable
and privilege experience. How do we help them discern abuse from non abuse?

*

How do we differentiate between date rape and situations where thergirl is a wilib.g party ;o
fondling and caressing, not willing to go "all the way" but gives in to sex under pressure.from the
l-oyfnend feeling a sense of loss of control and later feeling used I abused?

*

How co we differentiate between children’s’ sexual explorations of each others bodies and -muse?

*

How do we clarify that sex with informed consent with boy or girl friend for mutual pleasure is not
abuse’

In our attends to resolve these dilemmas we decided to do three things.
a) Make a concrete offer of help to those who wish to talk.
b) Clearly Explain the "gray" areas listed out above .
c) Clearly explain to the college and students the purpose of the workshop and study.

4. Conducting the workshops :
The workshop design envisaged the following stages:
I) Setting the tone and mood-:

* Preparatory sessions for younger "students in the 15 to 17 age group were conducted in three colleges.
“ Assurance of anonymity,
* Stressing on our collective experiences as women and our collective responsibility to share so that
appropriate steps can be taken,
* Reiterating th;: if any one has been abused it is not her fault and there is no need to feel guilty or
ashamed,
* Affirming the positive nature of our sexuality,
* Cautioning that all men are not bad.
* Before asking the last question, stating that the "loss" of virginity doesn’t mean its the end, most of
those molested and raped in childhood grow to be healthy and functional adults leading fulfilling
and happy lives.

2) Our own disclosures and sharing our concerns was to be an integral pan of the workshop to help in
personalising the issue and giving it a face. Also, the fact that we have survived abuse experiences,
coped and are now able to talk about it, would itself have some therapeutic value and encourage them
to disclose.

II

3) I'he gradual build up: The questionnaire is distributed and we start from soft spectrum abuse expe­
riences like "eve teasing" ( which most people can relate to and talk about) slowly moving to hard
spectrum abuse involving molestation and rape.

(See Appendix 1 for the outline of the contents of the workshop and its structure. |

We often look their attention off the questionnaire and related anecdotes in between so that they
wouldn’t feel they like objects of a uncaring and impersonal survey.

a

4) Making an offer of help to those who feel they need to talk or feel they need counselling, Giving in­
formation about where professionals involved are available, leaving addresses and phone numbers.

11

V.

BINDINGS

Soil spectrum Abuse

I) i he incidence of "Eve Teasing"

This section was included in the survey section and in the workshops as a relatively non threatenir.;
area to star, with. The findings are thnt 82% of the respondents have had personal experiences of "eve
teasing". The striking feature was that 70% of the respondents have directly witnessed -acd episode(s).
These indicate that the phenomenon is both widespread and visible i.e, there are vas: susriers ofeve
teasers and they are unafraid of being watched.
=:.

Many of the girls have written (in the narratives) that eve leasing is "... almost a daily affair" an<‘. have
resigned themselves to this commonplace phenomenon.
.• here is a sm .11 variation in our statistical findings about eve teasing in different classes of society. - r?

0

EVE TEASING

Urban Eng ish
Urban Kannada
Rural Kannada

YES Freq.

YES %

NO Frea.

NO %

137
95
52

93 %
75 %
75 %

10
32
17

7
25
25

The percentage of urban English speaking girls who have been eve teased is significantly higher than
the Kannada speaking girls. This could be because of several factors. The Kannada speaking girls were
still feeling shy, diffident and. inhibited as this was asked in the early pan of the workshop.
1 am sure this finding could tempt some people to say that it is because of the way the elite girls cress.
We have no data on what they were’ wearing when eve teased, but most girls wear salwar kameez to
college irrespective of class background. What is true however is that the urban English speaking girls
are much more mobile and move arc-ind on their own therefore making them more vulnerable..--.

2)

Age at first experience of eve teasing :

Jf the near universality of the personal and contemporaneous experience o. "eve teasing" is disturbing,
^ie age at first experience is shocking. Pre pubescent girls also experience eve teasing as indicated
below. The implications of this are discussed later.
ACE XT 1ST EVE TEXSING

Frequency

Age up to 10
33
Age 11 to 14
74
Age over 15
146
36
Missing cases
Not Applicable(not eve teased) 59

Valid %
13
29
58
—
—

348

3)

Self blame :

On the whole 78% of the respondents who were eve teased felt that they themselves were NOT to
blame for what happened. This is further elaborated in the narratives where they express indignation
and anger rather than self blame.

13

Percentage

Frequency

SELF BLAME

YES
NO
Missing
Not eve teased

22
78

60
211
18
59
348

Here again there are significant differences in the extent of self blame depending on the type of colleges
as indicated below:
Yes________
Yes______
Percentage
Frequency

SELF BLAME: Eve teasing

Urban English
Urban Kannada
Rural Kannada

13
19
54

16
18
26

With .54% of the rural girls blaming themselves for being eve teased, it is clear that their socialisation^
different from the urban girls.
w
Needless to say, when you blame yourself, the trauma is compounded.
•-?.

4)

Disclosure:

■

Disclosure is considered to be a sigmficant communication oehaviour and we wanted to explore
whether a disclosive network exists about eve teasing.
Si % of those who have been eve teased have disclosed their experiences to at least one person. There is
a parity here in different categories of colleges where the percentage of disclosure is between 81 to 82
%. The variation comes in the timing of disclosure highlighted below.
75% of the respondents have heard first person account of eve teasing from friends and peers -md
72% made a disclosure about this ce-closure.

fhe overall findings indicate that th , disclosure network about eve teasing experiences is extensive
though not total. 19% of the respondents have never disclosed their eve teasd g and the survey
m
was their first disclosure.

5,

Time of Disclosure

The time taken to disclose reflects how.comfortablc peo ; feel about talking about such issues.: A.
person who feels that she will be believed, not judged ar . not. looked down upon will disclose sooner
'•han others. It is also a reflection of the kind of support system that exists and the opportunities it pro­
vides oirls with to talk about their troubled experiences.

time ce disclosure

Disclosed immediately
Disclosed later
Disclosed much later
Mot appli-.. Pie (not e,c teased)
Missing cases

Frequency
95
95
31
59
68

Percentage
43
43
:4
—

IT

I here is a significant variation in the times of disclosure of respondents depending on their class back­
ground.
TIME OF DISCLOSURE

Urban English
Urban Kannada
Rural Kannada

% disclosed
immediately

% disclosed
later

% disclosed
much later

57

33
49
61

10
14
25

14

This low incidence of immediate disclosure and higher incidence of "much later" disckc ure among
rural girls is again a reflection of their self blame, level of comfort in talking about abuse and the fear
of stigma. The urban Kannida girls fall in between the urban English and the rural Kannada.

Tvoe of disclosure.' eve teasing

Frequency

Total
Partial
Modified
Missing
Not applicable

155
57
15
62
59

68
25
7

With a majority (68%) of ’■espondents having disclosed the entire episode of how they .were eve teased,
it is heartening to note that they could talk about the experience in totality. The critical question here is
why haOe 32% of the respondents felt a need to censor or motjjfy what happened to them': What were
they afraid of and why?

7) ToW hW PlSCl-OShD ’.

—■

A total of 250 disclosures have been made by 202 respondents.
Twenty respondents have made two disclosures and 14 have made three disclosures. The distribution of
to whom the disclosures have been made is as follows:
. ,.
To whom eve teasinq disclosed:

Family Members
Female Friend
Non Family members

Frequency

Percentage ..

98
140
12

39
56
5

250

100

Within the family disclosures include 52 (20 %) to mothers, 28 (11 %) to sisters and 28 (11 %) to other
family members including brothers, fathers and other relatives.

The fact that female friends have been the m in source of comfort and solace is significant with regard
to eve teasing experiences.

IS"

Hard s|>ectrum Abuse
Insistent/ sexual overtures or touches

The general visibility of eve teasing has been referred to earlier. This visibility often gives rise to an
acceptance of the behaviour as "normal".

In this context, the finding that 47% of the respondents have experienced insistent or sexual overtures
and / or physical touch assumes importance. A figure of 47% indicates that abuse experiences are in
near parity with non abusive experiences. This raises important questions of what is normal and what is
abnormal ? If one in two girls has had such an experience of abuse, one can hardly discern between
what is the rule what is the exception.

Incidence of overture / sexual touch shows a variation depending on college type as illustrated below :
OVERTURE/SEXUAL TOUCH

:

Urban English
Urban Kannada
Rural Kannada

YES Freq.
87
45
28

YES %

NO Fred.

NO %

56
82
43

39
65
61

61
35
39

1, At which age
There is no significant difference in the ages at which such abuse occurs in comparison.to ages at which
girls are eve teased. However the trauma of pre pubescent and pubescent girls experiencing sexual
overture and touch, as against eve teasing would be much more e . ecially because the abuser here is
most often a family member as compared to an unknown eve teaser.

The distribution is as follows :
qe at first overture /touch

Freci'iencv

Age up to 10
Age .1 to 14
Age over 15
Not applicable (not abused)
Miss

21
43
79
181
24

Valid

■

15
30
55

348

i;or I df these respondents, !t : abuse has occurred on mo-e than one .occasion and for a .third, the expe-_
rience '.as octim ed in the hands of more than one perpetrator. Tbejii plications of this are tremendous
in the context v- the long term effects of repeated abuse / multiple.:-' serson the child’s psyche and
behasi.'ur,

2. Se'-f blame

As compared tc cvc leasing where 22 % felt they themselves wer?.to blame, a larger percentage, i.e.
37 7< ;f those who experienced overture / touch felt self blame, tjiis is ironic because in reality victims
of am, type of abuse are never at fault, but have been conditioned.to th :k that they must have con­
tributed in some way to their victimisation.
. 10m these figures it indicates that more serious the abuse the higher is the sense of seif blame.

16

Selt Blame ____________________

Frequency______ Percentage

Feel selt blame
Do not tee1, selt blame
Missing
Not applicable (not abused)

37
63

52
87
28
181

3-'; 8

Here again the variations within college type are signi/.cant:
63% of the rural girls abused feel self blame as compared to only 22% of the urban English girls who
feel self blame in the context of overtures and sexual touches. The level of self blame is also signifi­
cantly high in the urban Kannada group with 55% blaming self.
FEEL SELF BLAME

:

Urban English
Urban Kannada
Rural Kannada

YES Freq

YES %

17
23
12

22
54
63

yt
«

NO Freq.
t6o
20
7

NO %

-6
37

Disclosure of overture / touch

67% oi the respondents who have experienced overture / sexual toucii made a disclosure about their
experiences. This is less than the extent of disclosure: made about experiences of eve teasing ( dis­
closed by 81 %4 and is to be-expected given the social context and the secre.y shrouding such abuse.
There is no signiticant variation in the extent of discle.irc among students from different types of col­
leges.

4. Time of Disclosure
% disclosed
immediately

Urban English
Urban Kannada
Rura; Kannada

% disclosed
later

32
25
17

% disclosed
much later

34
34

d he data indicates that a third of students from all types of colleges wait till much later to make their
disclosure.
Imoking at the extent of immediate disclosures, the highest incidence is with the urban English speaking
(32%) and reduces gradually as we go down the social ladder as they opt for disclosing later.

5.

Type of disclosure

As abuse becomes more serious it becomes more difficult to make total disclosures, hampered by a lack
of an appropriate language to describe
what was done and what body parts were touched.
TYPE Of DISCLOSURE____________________________

Frequency_________

Total
Partial
Modified
Not Applicable(not abused)
Not disclosed
Missing

57
30
13
181
49
18

- Percentage
57
30
13

IT-

The variations in type of disclosure according to college type is as follows :
TYPE OF DISCLOSURE

£

total

Urban English
Urban Kannada
Rural Kannada

%

58
50
69

Partial

% modified

34
27
23

8
23
8

The group with the highest percentage of modified disclosures is the urban Kannada speaking group.
Our data indicates that 69% of the rural respondents made total disclosures and consequently here the
incidence of partial or modified disclosures is the lowest.

6, Who is the abuser?
Often when we talk about molestation and sexual invitations we envisage that the abusers are outsiders,
but the data reveals the opposite with the majority of abusers being family members.
TOUCH /

Percentage

Frequency

OVERTURE ABUSER

Family Members (Male)
Female Friend
Non Family Members (Male)
Tota± number of abuse events

55
•1

44
170

In the non family members there are those who are known to the respondents and others who are
strangers. The number of strangers who have abused is 32, comprising half the non family abusers.
This also means that 33 of the non family abusers were known to the girls and were neighbours,
friends, teachers etc. On the whole 75% of the abusers have been known to the girls abused by them.
' he betrayal of trust by a known person, sometimes a Icved one is bewildering for an adolescent girl
and this has caused many of their io become extremely distrustful and suspicious of men. This is
further elaborated in the narratives section.

SrnoujH>KMsw«uy:; coercion,

aggression, rape etc

L Incidence of serious forms of abuse

By serious forms of abuse we ha-e meant attemi. s at penetrauon, forced oral sex, rape ano
victim to masturbate.
FERI Ol'S FORMS OF ABUSE

Yes
No

Frequency

Percentage

49
279
20

15
85

ting the

On the average wc have found that 15 % of respondents have experienced serious forms of sexual
abuse. The implications of one in every six girls being seriously abused are tremendous. In the context
of rhe. .n. — term and long term e. jets of serious abuse, this is a very disturbing finding because the
victims nave almost no support system except family and friends. When one in every six girls has been
seriou y abused we have act and act fast as the repercussion are several and worrying.

1 he variations in terms of college type are as follows :
SERIOUS FORMS OF ABUSE

Abuse Frequency

Abuse Percentage

Urban English
20
Urban Kannada
11
Rural Kannada
18
Not applicable ( no serious abuse) 279
Missing
20

14
9
30

2. Repeated abuse

38 % of those who experienced serious forms of sexual abuse had repeated experience of abuse and
62% had such an experience once. The. highest percentage of repeated abuse was in the urban Kannada
category with 50 % of those seriously abused reporting that they had been abused many times. This has
to be seen in conjunction with the prevalence of abuse among the urban Kannada group (9%) which is
lower but more repetitive than the urban English and rural college respondents. ( see table above)
3.

Age at serious forms of abuse

Frequency

AGE AT TIME OF SERIOUS ABUSE
Age upto 10
Age 11 to 14
Age over 15
Not: applicable (no serious a'busej
Missing
■

11
5
19
279
34

Percentage
32
.14
54

As compared to age at eve teasing and sexual touch / overture where 13 % of the victims are less than
10 »ears of age.
see here that 32% cr the victims of serious abuse are less than ten years old. Dels
this mean that the lesser the age of the go is, the abusers feel more powerful and abuse is therefore
more serious? Or is it a matter of physiology ? As eveteasing and molestation are essentially target .d
towards breasts is-it possible that the under ten age group is not victimised as much as the other ag
groups as breasts and hips have not yet started developing? Rape and attempts at penetration do not rebreasts and are focussed on the vagina which even little girls have. Does this fact coupled with;
(Wfact the small girls are ‘tily coerced and more likely to be ignorant about sex, encourage serious
abusers
to look out. for youucer children?
.
•
g
. A
*
4.

Self blame

SELF BLAKE:

SEEZ-^ ■31-5:

Frequency

Feel self blame.
Do NOT feel self
Not applicable ( no serious abuse)
Missing

20
20
279
29

Percentage
50
50

50% of those v, j hr.- '~x=z: .-.eriousiy abused hold themselves responsible to some extent and feel seif
blame. This is significantly higher that the feeling of self blame cmong eve teasing victims (22%) and
victims of overture / sexual touch ( ?1%). Therefore as the seriousness of the abuse increases, the
extent blame goes up.

Variations with regard to college type :
FEEL SELF EL

Frequency

E

8
5

Urban English
Urban Kannada
Rural Kannada

7

Percentage

42
50
64

V. ilh 64% of rural girls feeling self blame having gone hrough serious forms of sexual abuse, it is sig­
nificantly higher than the percentage of girls feeling se.. blame front, urban English (42%) and urban V
Kannada (50%) speaking colleges.

5.

Disclosure

61 % of respondent' who have experienced serious forms
.muse have made a disclosure. This not
significantly less than the percentage of those who disclor“‘t their overture / sexual touch experiences
(67%)
hut is much low. r than the disclosures arout eve teasing (,81 %).
There is no significant difference in the’extent ot disclosure among the respondents from differeofcrpes
of colleges as illustrated below :
Frequency

DISCLOSURE

Urban English
Urban Kannada
Rural Kannada

12
6
10

Percentaqe
... 63
60
59

59% of rural respondents, 60% of urban kannada and 63 % of urban Eng.ish who have been seriously
abused have disclosed their experiences.
6. Time of disclosure
DISCLOSURE TIME:

SERIOUS rll'SE

Immediate disclosure
Later disclosure
Much later disclosure
Not disclosed
Not applicable ( no serious abuse)
Missing

Frequency

Percentage

10
5
11
18
279
25

39
19
42

There is no significant difference when comparing the time of disclosure of eve teasing, overture /
touch and serious forms of sexual abuse. The percentage making disclosures mu, h later is low (14%)
as far as eve teasing is concerned in comparison to those experiencing sexual touch and serious abuse.
7.

Nature of disclosure

A majority ( 64 %) of the seriously abused respondents have been able to make total disclosures. 20 %
of them have made partial disclosures and 16% have made modified disclosures.

The nature of disclosure varies widely among respondents from different backgrounds. Among the
urban Kannada respondents who were seriously abused, no one has made a partial disclosure, 80% havi
made total disclosures and 20% made modified disclosures.

Nature
■i ■

disclosure

% made total
% made partial
disclosure__________ d i sclosurc

Urban English’’'-bar Kannada

8.

73
80

% made modiliod
disci osurc

18
-

9
20

To Whom serious abuse disclosed

;ny of the family being the point of abuse and also the source of support in serious abuse, is sig.<m nt. While the girls have turned more to friends to disclose their eve teasing experiences, they
rarderrsJed on family members to talk to in cases of rapes and other serious abuse.
Serious abuse:
'
I.o. ot
Percentage Ox
■d i sclosures______________ disclosures________________ _____ disclosures

a mi i y members
Female Friends

14
9

61
39

?

23
9. Who are the abusers?

Thirty eight abusers were identified by the tespondents who were seriously abused. The details are as
ioiiows.
. ABUSERS: SERIOUS SEXUAL ABUSE
Male Family members
Male Non Family mergers

No. of abusers .

Percentage

21
17

55
45

38

This is almost identical to the profile of abusers in sexual touch I overture.

21

PERSONAL NARRATIVES

Telling stories about past events in our lives is a universal human activity. The content of narratives
and their form ( Why we tell the story "this’ way), what we emphasize and omit, our stance as pro­
tagonists or victims,... all these tell what shape we can claim of our lives and the way in which we are
fashioning our identities and making a point.
In order to explore how the respondents perceive their abuse experiences, abuse of friends and C.S.A.
in general, we decided to ask an open ended question, to which they could respond in a narrative form.
The question asked was " How have these experiences affected you and what are your concerns in this
regard?
Speaking about traumatic experiences can be extremely difficult as disordered experiences have to be
given a reality, unity and coherence.
The purpose of seeking narratives and then analysing them was to see how they have imposed order on
the flow of experience, how they have created plots from chaos creating events and how they have tried
to make sense of he abuse events in their lives.

The response to this question ranged from blank sheets, to terse one I two sentence(s) and sometime^
more prolifically ... an entire page of outpouring of experiences, emotions, questions, pleas and intro­
spective reflections.
Ou reading the narratives carefully, we found that the main focus was on :

(a) relating abuse events and disclosures in some detail
(b) immediate emotional reactions to an abuse experience
(c) long term effects of abuse on themselves
(d) attitudes to men
(e) expectations from the organisers of the workshops
What we coded for analysis (see Appendix) was divided into four parts comprising (b), (c),(d) and (e)
listed above. A detailed analysis of these is in Section I below. All quotes are reproduced exactly as
written by the respondents.
■»
The pan (a) of descriptions of abuse events were not very numerous, but provided us some insights into
the tellings of abuse and little about what was actually done to them. These were not coded for analysis
as the number of respondents who wrote about this was too small. Some of these narratives are repro­
duced in Section 2 verbatim to provide a glimpse into these events.
A

it is peninent to point out here specific uestions about the areas were not asked and therefore all 3e£
respondents have not touched upon eat of these areas. Their responses have been tree flowing per­
sonal narratives, touching on various fa .ets of abuse from the point of view of their subjective realities.
We nave gleaned some trends which respondents have touched upon for the purpose of an analysis..

Section I,

Reactions to abuse, long term effects, attitudes to men & expectations
1) Emotional Reactions

Enr onal reactions to abuse have included .sadness, feat. ngertf guilt, shock, helplessness, disgust,
humiliation, frustration, worry and confusion. A total of 375 emotional react, .is have been recorded
which are distributed as follows:

EHCIIOHIL

______ Frequency

Sadness
"ear
n vC i iT '
Shock
Helplessness
Di sgust
Humiliate
Frustrar_™
Contusion
Worry
Number ot expressed re? itior.s:

Percentage

31

119
8

31

18
9
51
27
13
2-1
8,
6

19
5
2
14
7
3
7
.. 2
2

375

1.00

<2

The predominant feelings are sadness, anger and helplessness:- These frequencies tell us very
little about the intensity of emotions involved. More articulate respondents have been able to spell out
clearly what they have felt, whereas ma'fiy others have not been able to say more than " I feel very b.
about this exirerience" and ‘bad’ could mean sad, ashamed, guilty and many other emotions.
Anger:- Some ot ,ieir expressions are very vehement and relate to how they . sh they could retaliate
to the abuse :

One of the girls who has been seriously abused writes: " Feel like chopping off a man’s prideT^
Another girl who has been eve teased and molested writes ”1 feel bad and feel 11nC kicking those'who
did this".
A respondent who has been physically abused at the age of seventeen writes " .. 1 have been emotion­
ally affected- adversely... at least while it lasted and for a few hours alter the incident ( sometimes for
a couple of days), anger,’heated anger has been a very important component. }n fact looking back,
anger is what 1 probably felt the most, coupled with disgust."
Frustration and helplessness
One fails to react to such situations ( eve teasing) after some time
though the helplessness and distress does not reduce. Speaking about it at home becomes very difficult
and overtures at home are hard to be reacted to" writes a student who was abused by her cousin. An­
other respondent puts it this way " many times 1 think of revenge in vain"

Fear:- ” Initially I was scared of my brother, I am still scared of him. I hardly ever talk to him.. I even
get dreams of my childhood & they really do haunt me..." A girl who was raped once and molested
many times by her brother between the ages of 8 and 9.
Shame :-"... the first feeling is anger and shame,... you feel ashamed of the situation and feel stupid,
you only feel worse. Since 1 am not close to my mother or anybody it was very difficult"

Humiliation :- ' Feel like a piece of shit" and " I felt and still feel that I have been insulted by the
males of our society".

Disgust : -" It is so disgusting that somebody can touch you and feel you as if you are a public
property..." or " Sickening that people can do things as crazy as this.."
Confusion:- " I didn’t know then what had happened and later found out from my mother what it

meant." Another girl who was eve teased when 6 and abused when 13 says " I never could understand
what touching the private parts meant and I was confused initially"
Shock :-" 1 was shocked initially...though I had heard other girls’ experiences... 1 didn’t imagine that 1

would be a victim some day...."

23

2) Long-term effects

Long term effects as perceived by them at the moment have been articulated by some respondents.
The frequency is as follows (For those seriously abused):
Frequency

LONG TERH FFFECT

Percentage

Hurt
Depression
Suicide attempt
Problems in physical intimacy
No long term effect telt
Learnt to handle situations

77
30
4
9
12
27

48
18
2
6
8
17

Total No. ot effects stated

159

100

Hurt and depressed:- A girl who was abused by her "neighbour uncle" when she was six and raped al
the age of eight describes how it has affected her : "... Earlier on I had these periods of extreme de­
gression and after I disclosed it to my friend, we visited a psychiatrist a few times....its much better
now, though there are still times when 1 blame myself for what happened
"
Nor disclosing who abused her when she was seventeen, a respondent writes " I feel very disgusted and
tormented"

Problems in physical intimacy:- The problems in this regard have been narrated form the point of
view of avoiding any kind of touching to specific problems in intimate relationships :" 1 avoid hugging
as a symbolism of farewells" and "... My abuse was mild, but occasionally, in my relationship with my
boyfriend, I experience revulsion when there is caressing of my body"
3)

Altitudes to men : Hatred, distrust, fear,

The basic attitudes to men which have been expressed by tue respondents refer to a sense of distrust .
hatred and fear. The details are as follows:
Frequency

ATTITUDE

Percentage

Hateed
Distrust
Fear
Need to be alert

19
54
16
47

14
40
12
34

■-

136

100 i-.

-

Attitudes stated

Distrust and the need i.o be alert: Distrust is the predominant attitude. Implicit in.the need to
is also a assumption tha< till men cannot be trusted.

alert

Distrust of al) men, especially older strange men” is how c ie respondent has described her reaction ?.
her abuse by her friends brother. Expressions of hatred are mixed with an urge to avenge the wrong
■lone to them: "1 think women should become stronger and lust bash them up... nothing succeeds like
brute force"

Regarding distrust of men, the narratives seem io touch on .: sense of sorrow about their suspicions.
"These experiences have made me behave in a very odd way with gu -...I don’t even trust my dad ar.u
my brother" or "... I avoid crowds, I’m constantly on guard and cannot communicate in a relaxed
manner.." A respondent who has had
persona! experience of abuse, but has been told b i friend
about her abuse writes " ...all men arc tot good and 1 hate men"

4)

Expectations

Martyns! f narratives contained expectations of what they felt s .’Id b<-.-done about Childhood Sexual
AbustfoiR; . . taints’ centered around the need to prevent abuse
taking place, need to punish
abusers and the need to be able to talk more openly about sexual issues
! he details of their expectations are as toll ws:
Frcuucncv

Percentage

Help to Abuser
Punishment to abuser
-z^ation needed
talk about sex
Women should fight
Shoulo be Prevented
Help to abused
Girls learn martial
ts

3
45
39
53
42
98
26
9

1
14
J"
17
13
31
8
3

Exp ctations' stated:

315

100

Expcurarior

"here is ar; overwhelming feeling that something should he done to prevent such abuse from taking
place. Sor ot the respondents havdilso given their ' Jeas of ho this can be done and would ii
some organisations to step forward in this direction.
Need to lalk-x •ov' ,':..ch issues openly
" These experiences haw .-ug me that there »s no need to
hide and be secretive about such things. One feels muC: better if we confide in someone. M helps to
take the burden off your head and mind.. we can make others aware of what could happen so that they
equip themselves."

Prevention and Punishment to abuser One of the most interesting observations on this is that sev­
eral girls have mentioned a need for law-to be enforced and a need to punish abusers as an act of dete-rence. However, not a single Law student has talked about the need to punish abusers. Is this because
the former were reacting from an emotional need to punish, while the Law students were responding
from a realistic understanding >i the limitations of the Law and the'trauma of the -.dm a prosecu­
tion, especially when the abuser is someone you love ?
Help to those abused
" I feel very desolate anc bad...my main concern is to try and forget this...to
krase it out of my mind. Can you help?" While some of the narratives contained such open pleas tor
"elp, other.- wanted help to be extended to others whom they know are abused.

Section 2,
Abuse experiences :

" These experiences affected me mentally... I don’t talk about them to my
family members excepting my mom and sister. I generally feel ashamed to speak out to my daddy and
brother. I don’t narrate such things to my triends also.” This respondent has not disclosed her eve
teasing experience to anyone, but told her sister about a sexual touch attempt much after it happened.
See form 30.3,327,320
Difficulty in disclosure

About self blame : "...putting the blame on yourself all the time is an act of cowardice and guilt and

will not help anyone. Instead it will encourage these people tn feel right about themselves and indulge
further in such heinous acts. So, help yourself and help others!

iS

Conclusion
This is a preli . try repou
1 w have n. inletilt'. ..T making an, tine! conclusions at this juncture.
We have a lol or midi nt.itmi -..td data which r an be lurlher scrutinised, examined and analysed in the
light of the discu >ions.\hi li we hope this import will generate.
1 would like to end on this note with the above quote from a respondent’s narrative about self blame.
While we should work together to loo! at ways of preventing abuse, we also have to help in healing
wounds caused by sexual abuse. The fust ..iep in mis direction is really to stop blaming ourselves and
others who have been • used.

Here we only recap briefly the main findings :

S3 % o! respondents have experienced physical eve teasing, 13% oi them when they were less than
10 y cars old
*

T'k ol'respondents have been i mlesled / experm.med sexual overture and 15% of them were less
than it) years old.

1; ot t, e respondents have experienced serious forms of sexual abuse including rape and 31
them were less than It) years old.

*

W

Disclosures have been made by 86 % of those eve teased, 67% of those molested and ol % of those
seriously abw.eu.

As the seriousness of abuse increases tl.v tendency to self blame also increases. 22% ol those eve
leased, 37% of those molested and 50% of those seriously abused feel self blame.
*

fhe tendency to blame self increases as we go down the social ladder and move iroin urban to rural
representation.

The preponderant i i fuels are sadness, depiession, anger, helplessness and distiust of men.

it

<TH |0-i-

League of Red Cross and
Red Crescent Societies
CHILD ALIVE Programme

Project Proposal for
India and Bangladesh

Dr. N. D. Sutherland
Senior Technical Advisor
December 1986

TABLE OF CONTENTS

Introduction ..................................................

page

1

page

5

page

6

page

9

Bangladesh Red Cross Society - CHILD ALIVE Programme for 1987-88

I.

Review of CHILD ALIVE Demonstration Project in
Char Chandia............................................

Plan for 1987

II.

........................................

Indian Red Cross CHILD ALIVE Project

9
I.

Demonstration Project Component

.....................

II. Information and Training Project Component

page 11

Annexes
1.

Char Chandia Programme Proposal, February 1986

2.

Proposed Plan of Activity for Char Chandia, 1987

3.

Comparative Statement of Child Survey, Char Chandia

4.

"Basic Messages" for use in CHILD ALIVE training

5-

Budget for 1987/88, Bangladesh Red Cross Society CHILD ALIVE Programme

6.

Original CHILD ALIVE proposal of the Indian Red Cross Society

7-

CHILD ALIVE Basic Survey Tabulation (Modules 1 & 2)

8.

Budget for 1987/88, Indian Red Cross Society CHILD ALIVE Programme

9.

Financial Reporting Requirements

10.

"CHILD ALIVE Facts and Activity Report"

11.

Training Session Evaluation

12.

Pre- and Post Workshop Evaluation

13.

Position Description:

14.

"Learn more about diarrhoea"

15.

Basic First Aid — How to cope with diarrhoea

Technical Liaison Officer

CHILD ALIVE PROJECT PROPOSAL FOR INDIA AND BANGLADESH: I987-I988

The Red Cross Societies of India and Bangladesh and the
League of Red Cross and Red Crescent Societies
Introduction
The major causes of childhood disease, disability and death in India
and Bangladesh are to a large extent preventable or treatable with
simple technologies. While Governments and intergovernmental agencies
in both countries have been addressing these issues with increasing
commitment,
including financial and personnel resources, only limited
progress
has
been
made.
Deaths
from
diarrhoea
and
the
vaccine-preventable diseases,
for example, remain unacceptably high.
Public knowledge and action towards the home management of diarrhoea
and the prevention of its spread,
especially in children,
are
inadequate. Similarly,
although in some areas vaccines are not yet
readily available, even where provision is adequate acceptance has
often been very poor. The resultant low immunization coverage has
allowed these diseases to continue to take their toll of life, produce
disabilities and cause recurrent periods of unnecessary illness, which
in turn contributes to a precarious nutritional status and increased
susceptibility to disease.

It is clear that all relevant organizations and the public will need
to be informed and mobilized to assist in the control of the major
causes
or
morbidity
and
mortality in India and Bangladesh.
Non-government organizations will have an important role to play in
the process of assisting governments achieve even the most basic
improvements in the health status of the people.
The League of Red Cross and Red Cross Societies has developed a
programme called CHILD ALIVE which aims to support national Red Cross
and Red Crescent Societies develop their existing health programmes
with a particular emphasis on improving the health of children.

India and Bangladesh Red Cross Societies' CHILD ALIVE Project:
The overall objective of the CHILD ALIVE project for India and
Bangladesh is to decrease the avoidable disabilities and deaths caused
by diarrhoea and the vaccine-preventable diseases by stimulating and
supporting the Red Cross Societies'
activities which focus on the
control of these diseases. Through these activities, the project
would also aim to strengthen the Red Cross Societies by increasing
their capacity to plan, implement, monitor and evaluate their health
programmes.
The Red Cross Societies in these two countries have been carrying out
CHILD
ALIVE demonstration projects to examine the problems of
diarrhoea and the vaccine-preventable diseases in some depth, and to
develop appropriate Red Cross actions which will change awareness and
activity at the community level. These demonstration projects were
started in 1985 by the National Societies themselves with some
funding,
technical and planning support from CHILD ALIVE. The
demonstration projects have provided excellent opportunities for
orientating and training National Society personnel and for evaluating
different strategies. Activities in these areas will be continued and
expanded,
which will facilitate the continued testing of training
materials and methods,
and provide a defined population for closer
monitoring.
Such expansion will also ensure a constantly improved
cost/beneficiary ratio.

- 2 -

The CHILD ALIVE projects in India and Bangladesh have focussed on
diarrhoea and the vaccine-preventable diseases because of a number of
inter-related factors:

* They are still major health problems in these two countries;
* The interventions are known to be effective;

* The strategies for the control of these diseases include many of
the key issues in primary health care;
* Governments in both countries are mounting major efforts just at
this time directed at controlling these health problems;

* There
are specific activities in the fields of public
information and mobilization, which are essential to the control
of these health problems, towards which the Red Cross Societies in
India and Bangladesh can make an important contribution through
existing training programmes and networks of volunteers.
Since many of the reasons for the persistence of these health problems
in India and Bangladesh are similar, the major elements proposed for
the CHILD ALIVE programmes in these two countries are the same.

In studies carried out by the Indian and Bangladesh Red Cross
Societies in preparation for the next phase of their CHILD ALIVE
programmes, it was found that:
*

Diarrhoea is
a major health problem and the
substantial proportion of deaths in small children;

*

Home management of diarrhoea and the referral of diarrhoea
cases is often inadequate and appropriate skills are not known;

*

Strategies for the prevention
or are not carried out;

*

Parents and often health workers do not know that six important
childhood diseases are preventable by timely immunization;

of

cause

of

a

diarrhoea are either not known

* Immunization coverage rates remain extremely low despite the
_____ availability of vaccines at district or local health facilities.

Preliminary results in these and other CHILD ALIVE projects indicate
that teaching parents about good home management of their children's
diarrhoea and informing them about simple preventive strategies can
achieve changes in behavior and a decrease in mortality.
In addition,
informing parents of the benefits of immunization and mobilizing
communities to achieve this end has resulted in increased immunization
levels.
These activities have been carried out by trained Red Cross volunteers
and directly support Ministry of Health programmes.
It is clear that
without
such
cooperation
with Government Health services and
personnel,
in terms of providing referral services for dehydrated
diarrhoea cases and in providing the supply side of the immunization
programmes, much less would have been achieved.
The CHILD ALIVE
Programme is designed to utilize the traditional Red Cross strength of
volunteers working at the community level who can assist governments
to increase their impact on these health problems.

- 3 -

The CHILD ALIVE Programmes in both countries are characterized by:

* A demonstration project area where the strategies are being worked
out in detail and where monitoring is more intense;
* A much larger programme of training the Red Cross Youths, First
Aiders and Volunteers in the proven strategies, with the specific
aim of training large numbers of parents at the home level;
* A commitment to monitor and evaluate the programme so that
adjustments can be made and impact on the home treatment of
diarrhoea and immunization levels can be determined;
* Close cooperation with existing Ministry of Health programmes,
especially those for the control of diarrhoeal diseases and
immunization; with existing and planned UNICEF initiatives;
and
with other agencies working in this field such as ICDDRB(Dhaka)
and NICED(Calcutta).

The CHILD ALIVE Programme in Geneva is in full support of the
individual project proposals and has assisted in their development. A
Technical Liaison Officer will be assigned to the overall project to
strengthen and support the technical aspects of training, monitoring,
and evaluation as well as financial reporting. A position description
of the Liaison Officer and a budget are attached as Annex 13.

Reporting

Project reporting will be in the form of a midyear progress report and
a detailed annual report. The responsibility for this reporting will
be with the National Societies, with assistance from the Liaison
Officer.
Financial reporting will be in line with standard procedures for all
CHILD ALIVE
programmes
carried
out by National Societies in
cooperation with the League of Red Cross and Red Crescent Societies
(see Annex 9)•
Evaluation

Ongoing evaluations will be carried out within each programme.
Demonstration projects have annual household surveys and more frequent
child surveys to assess the impact of the programme. Training
projects will be evaluated through skills-testing of trainees and
activity reports.
Surveys
similar to those developed for the
demonstration projects will be carried out on a sample of the
households (see Annexes 11,12,14 and 15 for examples of the proposed
evaluation methods and training materials).

- 4 -

Budget:

1987-88

The overall budget for the two years, 1987 and 1988, is summarised by
both year and component. The total funding requirements for the
project over the two year period is USD 997.600.

Separate breakdowns of the budgets for the Bangladesh and Indian Red
Cros Societies'
CHILD ALIVE projects and the Liaison Officer are
provided in Annexes 5. 8, and 13.
Summary by Year (in U.S. Dollars)

1987

Bangladesh
India
Liaison Officer
Senior Technical Adviser

151,800
122,500
79,000
11,700

TOTAL 1987

365,000

1988
Bangladesh
India
Liaison Officer
Senior Technical Adviser

193,300
343,300
83,000
13,000

TOTAL 1988

632,600

GRAND TOTAL

997,600

Summary by Component (in U.S. Dollars)

Bangladesh

1987
1988
TOTAL

151,800
193,300

1987
1988
TOTAL

122,500
343.300

345,100

India

465,800

Liaison Officer
1987
1988
TOTAL

79,000
83,000

Senior Technical Adviser
1987
1988
TOTAL

11,700
13,000

GRAND TOTAL

162,000

24,700
997,600

- 5 -

BANGLADESH RED CROSS SOCIETY
CHILD ALIVE PROGRAMME FOR 1987-88

Introduction:

The previous submission entitled "Programme proposal, part 1, Char
Chandia" should be used as a reference document, and is attached as
Annex 1. The specific plan of action for the demonstration area in
Char Chandia and for the greatly expanded training targets is attached
as Annex 2.
I.

REVIEW OF CHILD ALIVE DEMONSTRATION PROJECT IN CHAR CHANDIA:

(A)

Chronology of activities 1986:

January: Annual Survey completed on the population of 1800
people. Compilation completed, draft plan of action and targets
outlined.
February: Project visited by League team, Sutherland and Smyke,
and agreement signed with the Bangladesh Red Cross Society.

March:

Child survey carried out after volunteer training.

April:

Survey analysis completed and training of mothers planned.

May: Participation with Sutherland in joint government/WHO Review
of National Control of Diarrhoeal Diseases Programme.
June - September: Training of Field Supervisor and training of
volunteers to train mothers in basic information on diarrhoeal
disease
and
the
benefits of immunization. The Government
vaccinator was encouraged to visit the project and the community
was mobilized by volunteers for immunization of mothers and
children.
October: Review of Child Survey completed.

(B)

Results of CHILD ALIVE surveys (see Annex 3):

Six active volunteers were recruited, trained and used in training
mothers,
community mobilization and survey work. The volunteers
worked 15 days per month and were supervised by the CHILD ALIVE
Field Coordinator.

1.
Impact on mothers' knowledge:
i) preparation of sugar/salt solution increased from 13% to 7^%ii) ability to identify 3 or more signs of dehydration increased
from 0% to 23%.
Impact on home management of diarrhoea cases:
home management with sugar/salt solution increased
from 3% to 26%.
ii) number of diarrhoea cases not treated in the home decreased
from 48% to 26%.

2.
i)

- 6 -

3- Percentage of target population in the community immunized
(only BCG, tetanus toxoid, and DPT vaccines available):
Children:
BCG from 0.4%
to
37%
DPT from 0.4%
to
32% (2nd dose)
Mothers:
Tetanus toxoid from 0.0%

to

28%

These findings indicate that community awareness and action has
changed in regard to immunization and diarrhoea as a result of the
education of mothers by the trained volunteers. The second annual
survey will be carried out as per schedule in January 1987 and
will give further data on changes, including mortality.

(C)

Financial reporting:

Activities outlined in an agreement between the Bangladesh Red
Cross Society and the League have been carried out and a financial
statement of expenditures has been produced.
As implementation of the project was somewhat delayed, the advance
of Taka 255.000 from the League will be sufficient to cover all
costs for 1986. The balance as at November 15,
1986 is Taka
51,551 and will cover the planned activities and salaries until
the end of December 1986.
II. PLAN FOR 1987

(A)

General Principles:

The Bangladesh Red Cross Society CHILD ALIVE Programme aims to
improve immunization coverage and the management of diarrhoeal
disease in support of the Government of Bangladesh programmes by:

i) Training as many Red Cross members and volunteers as possible
in the basic messages;
ii) Asking those trained to disseminate their knowledge to others
and to work with Ministry personnel when called upon.

The Bangladesh Red Cross Society will monitor the impact of the
CHILD ALIVE Programme by evaluating its work both intensively in
the demonstration project area and selectively in the larger
training area.
Liaison with Government, WHO,
and UNICEF will be increased in
order to ensure that Red Cross training and mobilization by
volunteers to increase acceptance of immunization will begin in
areas where there is improved supply.
Red Cross personnel available for training are members of schools,
colleges and communities who have volunteered during relief
operations or people who wish to learn more about the Red Cross.
They may be expected to be community leaders of the future, open
to new ideas and with some commitment to community service.
While the Bangladesh Red Cross Society (BDRCS) has traditionally
been involved with disaster relief and fixed health facilities
with service given by paid medical staff, some new trends are

- 7 developing.
Increased attention to Youth in all 64 districts of
the country is being focussed through paid Red Cross unit
officers. Their function is to plan and carry out training and to
plan activities for these youth members who are estimated to
number 150,000.
Cyclone preparedness volunteers in the coastal
region numbering more than 20,000 receive training from the Red
Cross in a joint programme with Government. Also, new cadres of
village health workers
(VHWs) are being trained by the BDRCS to
increase the outreach of the Mother and Child Health Centres.

The CHILD ALIVE Programme for 1987 plans to supplement existing
Red Cross training programmes with an additional three days for
trainers and one day for all trainees.
During the "Child Alive"
training,
simplified
messages
on the home management and
prevention of diarrhoeal disease, and the six vaccine-preventable
diseases and the immunizations needed for their control will be
taught to the volunteers.
In addition, training materials will be
distributed and specific activities planned. Activities to be
encouraged include:
taking the messages into a number of homes,
assisting
the
vaccinators on immunization days, and other
activities as suggested by the volunteers or their trainers.
Food and other support will be given to the trainees on the days
of training,
but subsequent activities will be carried out on a
volunteer basis.
This can be encouraged by awarding a BDRCS CHILD
ALIVE "badge" to those completing the defined activities.

The target number of trainees in 1987 is 30,000, as outlined
below.
If
each trainee in turn trains an additional ten
households, it would be possible to reach 300,000 households with
the messages. The content of the training is seen in the draft
training framework, attached as Annex 4. This document summarizes
the basic messages for Red Cross and Red Crescent personnel on
diarrhoeal disease and immunization.

(B)

Specific Training Planned:

1.

Cyclone Preparedness Volunteers (CPP)

The BDRCS plans to train 65OO volunteers in 8 coastal locations
with 8 teams of trainers. Child Alive will provide three-days of
training to trainers and a one-day of training to the volunteers.
2.

Red Cross Youth

(a) A youth camp with leaders,
teachers and youths from the whole
country will be held in Dhaka in January for one week. One day
will be devoted to CHILD ALIVE training, using 12-15 instructors
with trainee groups of 50-60. A group of 700-800 is expected and
will be available to assist in further training at the district
level throughout the year.
(b) Youth Training Programmes at the district level: The Red Cross
has unit officers hired to look after one or two districts and to
carry out youth training throughout the year on the topics of Red
Cross principles, first aid, etc. Throughout 1987 in schools,
colleges and in youth camps, a target group of 20,000 is expected
to be reached in existing programmes. The CHILD ALIVE Programme
will consist of one day of training in these courses and will plan
out activities which
can
later be carried out under the
supervision of unit officers and teachers attached to Red Cross.

- 8 Detailed plans for these training sessions are now being drawn up.
A three-day training course for the Unit Officers will be done in
preparation for this.
Para-medical staff

3-

-

4.

The 150 BDRCS paramedical staff will attend a routine refresher
course in 1987CHILD ALIVE will offer two days training during
these refresher courses.

Char Chandia Demonstration Project

The target population in the first area was 1800 people. The plan
for 1987 is to use the same volunteers (with perhaps some 2-3 new
trainees) to begin training in the adjacent area which has a
population of 5000. The plan, as indicated in Annex 2, is to do a
baseline survey and follow up surveys in the whole area. Training
will be less intense and follow much more closely the content used
in the other CHILD ALIVE training activities in the country.
Training will be domiciliary and less intensively supervised, the
purpose being to determine whether an increase in immunization
coverage and improved knowledge and practice in diarrhoea control
can be achieved with less intensive training.
In addition, regular training will be gradually withdrawn from the
original project site.
However, monitoring through surveys will
continue in order to see how improvements persist after the
training is stopped. It is hoped therefore that the demonstration
project will better reflect the impact we could expect from the
less supervised activities of the trained volunteers within the
broader programme throughout the country.

(C)

Personnel:

BDRCS CHILD ALIVE training cell:

This group will be responsible for planning and carrying out
training in cooperation with other BDRCS personnel and will be
responsible for developing the materials for the instructor and
trainee sessions. This information will be produced in adequate
supply so that the material can be given to each trainee. The
material will be consistent with National Government policy on
immunization and diarrhoea.
The training cell will be responsible to the Director of Health
Services who will be responsible for project reporting and liaison
with other BDRCS departments, such as Finance and Youth.

The training cell will consist of the National CHILD ALIVE
Coordinator, Dr.
Mohiuddin, who will be the leader; a training
officer and a training manager who are to be recruited. The field
coordinator Mr. Talukder will be responsible to Dr. Mohiuddin for
the demonstration project. He will also from time to time assist
with other training programmes. The training cell will have their
own offices with administrative support supplied by the BDRCS.
(D) Budget 1987/88: The total budget for the Bangladesh Red Cross
Society's CHILD ALIVE project is US$151,800 for 1987 and US$193,300
for I988.
See Annex 5 for details.

- 9 -

INDIAN RED CROSS SOCIETY CHILD ALIVE PROJECT
PLAN & BUDGET FOR I987
OUTLOOK FOR 1988

Introduction:
The Indian Red Cross Society developed some proposals in 1986 for a
"CHILD ALIVE" Programme, and submitted these in October 1986 (Annex
6). However,
this proposal was felt to be over ambitious, with the
intention to mobilize and train large numbers of Red Cross personnel
throughout the country,
and was not specific enough in providing a
detailed plan of action on how they wished to proceed. A revised
outline and budget was developed after a recent visit to the Indian
Red Cross by the CHILD ALIVE Senior Technical Adviser and should
provide a practical and attainable plan for the immediate future. This
plan is outlined below.
I.

DEMONSTRATION PROJECT COMPONENT

Overview:

The Indian Red Cross initiated at their expense a pilot study in Salt
Lake near Calcutta to determine baseline characteristics of the
community, its environment,
and the health status of its children.
Not surprisingly,
diarrhoea and dysentery were major causes of
morbidity and mortality and the skills for home management were very
limited. Immunization coverage, even for available vaccines, was
virtually zero.
Although the original objectives of the project (page 8 of Annex 6)
included providing "health care services", the plan is now simplified
to provide,
through trained Red Cross volunteers, basic training on
diarrhoeal disease
(to include home management, correct referral upon
recognizing dehydration and other danger signals,
and prevention
strategies).
In addition, these volunteers will be trained to provide
information and motivation for complete immunization of women and
children and to assist the government vaccinators to achieve their
targets. The impact of this training will be evaluated through
regular monitoring of all mothers and children (see Annex 7).

The work in the demonstration area has stopped since the survey due to
a lack of funds, which also meant that no Child Alive coordinator was
hired to guide the project. When funds are available, the work in
Salt Lake will resume with the training programme and surveys as
outlined below.

Objectives:
General:
- to reduce the mortality and morbidity due to diarrhoeal disease
and vaccine-preventable diseases.

Specific:
- to improve home management, referral and preventive strategies
for diarrhoeal disease.
- to raise immunization coverage for children and women.
Method:

10 - Training through Red Cross volunteers
messages" in all homes in the community.

who

teach

the

"basic

- Coordinator and volunteers to encourage the community to receive
maximum benefit from the government vaccination programme.
- Coordinator and volunteers to assist local government vaccinators
. in their campaign objectives for the communities.

Action plan proposed:

1
J

F

M

A

M

9

J

8
J

7

A

0

S

N

D

recruit & train
field coordinator
train volunteers
volunteers train
parents in home
planning session &
biannual report
preparation
survey

--

------------

module 1 & 2

__
------------

module 2

Monitoring, evaluation and reporting:
The responsibility for monitoring and reporting on this demonstration
project is with the National CHILD ALIVE Coordinator with assistance
from the Liaison Officer. Quarterly activity reports should be made
and detailed reports of activities, survey results and plans are to be
prepared
every
six months and submitted to Indian Red Cross
Headquarters and to relevant departments in the League Secretariat.
Evaluation of the impact of the training and community mobilization
will be through surveys and by supervisors' observations and reports.

11

II.

INFORMATION AND TRAINING PROJECT COMPONENT

Introduction:
As outlined in the previously-mentioned document(Annex 6), it is
planned to train large numbers of Red Cross Youths in the basic CHILD
ALIVE messages. These young men and women who have come forward to
the Red Cross to volunteer for training will then be asked to take
these messages to their families, neighbours, and to the community.
These trained workers will also be available to assist the Government
in their immunization and diarrhoea control strategies. The Red Cross
infrastructure can thus be made available for spreading health care
messages. Clearly it would be best to begin in the demonstration area
with this training as soon as a National Child Alive coordinator can
be recruited and trained.

During the first six
months
of
1987 the two or three key
people at the national level will develop a detailed training plan for
the first state level training. Haryana or West Bengal have been
suggested as the first states for starting the CHILD ALIVE training
activities because there are strong Red Cross structures, there are
already large numbers of youths undergoing training in 1986, and there
are logistical advantages to starting either near the National
Headquarters in New Delhi or near the demonstration project site in
West Bengal.
It is proposed that the training programme will develop in the
following way (although the details on how this will be accomplished
will have to be developed during the feasibility study phase):
i) Trainers will be recruited
staff, First Aid Trainers,
schools.

from existing Red Cross health care
and Junior Red Cross counsellors in

ii) Materials very similar to the "basic messages" for Child Alive
are available in India through UNICEF and the Government of India.
These will be utilized as far as possible for all trainers. The
CHILD ALIVE Project would also make use of existing Government,
UNICEF, WHO/CDD or EPI courses and materials in preparing the
senior staff.
iii)

Through the
utilization
of
the
existing
Red
Cross
infrastructure and training programmes, activities, etc., the
trainers will then inform the youths and prepare them for
activities to maximize the outreach.

Objectives:

General:

To develop the potential of the Indian
reduce the morbidity and mortality due
vaccine-preventable diseases.

Red Cross personnel to
to diarrhoea and the

Specific:

To increase knowledge in the home about the vaccine-preventable
diseases and the management and prevention of diarrhoeal disease
through the CHILD ALIVE basic messages.

12
Activities:

A feasibility study in the first six months of 1987 will be carried
out by the National Training Cell and the Technical Liaison Officer in
consultation with the Indian Red Cross Joint Secretary and the
League's CHILD ALIVE Senior Technical Advisor. The aim of this study
will be to prepare a detailed plan of action for the first State-level
training and to review the activities in the demonstration area.
The plan should cover a six-month period for training the trainers in
a 3-day course for 200 participants and a one-day course for 20,000
youths.
It is planned that each of the trained youths will carry out
specific activities (see annex 10) to increase the contact to at least
10 homes, thereby giving the potential impact of the messages to
200,000 homes.

Action plan:

__________________________________________ 1 9 8 7__________________
JFMAMJJASOND
recruit & train:
--------1) liaison officer_______________ __ _________________________________
2) national
coordinator-------- --------- ---------------------------- ---- ---3) 2nd member of
national cell------------------ ----------------------------------4) State training
cell member-------------------- ------------ ----------------------feasibility study
------------------------training prog,
1st State________
training plan
for 1988_________
report submission

Monitoring and Reporting:

State-level training staff
are
responsible for monitoring and
reporting on all training carried out. They report in turn to the
national coordinator and Liaison Officer. Reports on all training and
the activities carried out by the trainees will be summarized every
six months.

- 13 -

Evaluation:

Evaluation of the training will be carried out by selective pre-and
post-training tests, especially during the trainers' training, and
standard methodologies are being prepared (See Annex 11 & 12).
Evaluation of the changes in knowledge and skills of trainees will be
done on a selective basis by supervisors, and the evaluation of the
activities to be carried out by the trainees will be done by
collecting a record from each trainee before he or she is awarded
their "CHILD ALIVE Badge".
Budget:

The
total
budget for both the Demonstration Project and the
Information and Training Component of the Indian Red Cross Society's
CHILD ALIVE project is US$122,5OO for 1987 and US$343,300 for 1988.
See Annex 8 for details.

For further information about this proposal, please contact:
W. Donald Sutherland, M. D.
Senior Technical Adviser
CHILD ALIVE Programme
League of Red Cross and Red Crescent Societies
p. 0. 372
CH-1211 Geneva 19
Switzerland

PROJECT PROPOSAL ANNEX 4

CHILD ALIVE BASIC MESSAGES FOB BED CBOSS AND
BED CBESCENT PEBSONNEL ON:

-diarrhoeal disease:
home treatment and prevention

- immunization against measles,
polio, tetanus, whooping cough,
tuberculosis and diphtheria

THIS IS A FRAMEWORK PREPARED BY CRIED ALIVE FOR ALL RED CROSS
& RED CRESCENT CHILD ALIVE "TRAINING" PROGRAMMES WHICH FOCUS
ON DIARRHOEA AND THE VACCINE-PREVENTABLE DISEASES.
THESE
BASIC MESSAGES SHOULD BE INCLUDED IN ALL CHILD ALIVE PROJECT
PROPOSALS,
WITH APPROPRIATE ADAPTATIONS AND ADDITIONS TO
TAKE NATIONAL EPI & CDD POLICIES INTO CONSIDERATION

HOKE NANAGEHENT OF
ACUTE DIARRHOEA

5 BASIC MESSAGES
1.

FLUIDS

2.

BREAST

3.

FOOD- CONTINUE SOFT FOODS OR RESUME WITHIN 24 HOURS

4.

WATCH

FOR

DEHYDRATION

5.

WATCH

FOR

DANGER

INCREASE AMOUNT OF ANY AVAILABLE FLUID
(and/or sugar and salt solution)
(and/or oral rehydration solution)
GIVE TO THE CHILD FROM THE START OF DIARRHOEA
GIVE 1/2 to 1 CUP AFTER EACH WATERY STOOL

FEEDING

CONTINUE DURING DIARRHOEA

SIGNS

5 SI G B 8

OF

1.

SUNKEN

EYES

2.

SKIN

PINCH

DEHYDRATION (DBVBESS)

OR

FONTANELLE

STAYS

UP

(MORE THAN 2 SECONDS)

3.

WEAKNESS

4.

DRY

MOUTH

5.

LACK

OF

AND

URINE

THIRST

AND

TEARS

5 DANGER SIGNS

IN A CHILD WITH DIARRHOEA

1.

DEHYDRATION

2.

SEVERE

DIARRHOEA

- MORE THAN 10 STOOLS PER DAY
- DIARRHOEA LASTING MORE THAN 2 DAYS

3.

SEVERE

4.

FEVER

5.

BLOODY

VONITTING

STOOLS

SKILL
TO

TO

MIX

AND

USE

SUGAR

&

SALT

SOLUTION

i)

1 LEVEL TSP SALT

ii)

8 LEVEL TSP SUGAR

tit)

1 LITER CLEAN MATER

tv)

GIVE 1/2 - 1 CUP TO CHILD AFTER EACH NATERY STOOL

v)

MIX FRESH SOLUTION EACH MORNING

MIX

&

USE

ORAL

REHYDRATION

SOLUTION

i)

AMOUNT OF CLEAN MATER INDICATED ON THE PACKAGE

ii)

1 PACKAGE OF ORAL REHYDRATION SALTS

Hi)

GIVE 1/2 - 1 CUP TO CHILD AFTER EACH MATERY STOOL

iv)

MIX FRESH SOLUTION EACH MORNING

1.

2.

5

IMPORTANT

TO

PREVENT

BREAST

DIARRHOEA

CHILDREN

ALL

FEED

ACTIONS

*

BREAST MILK ONLY FOR 4 MONTHS

*

BREAST FEED AT LEAST TO AGE 1 YEAR

PAY

ATTENTION

TO

MEANING

FOODS

* PREPARE CLEANLY
* USE IMMEDIATELY
* DO NOT START UNTIL AGE 4 MONTHS

3.

MASH

HANDS

ESPECIALLY * AFTER PASSING STOOLS

* BEFORE PREPARING FOOD
* BEFORE EATING

4.

DISPOSE

STOOLS

SAFELY

* ESPECIALLY CHILDREN'S

5.

USE

CLEAN

AND

FOOD

MATER

FOR

PREPARATION

DRINKING

SIX DISEASES

PREVENTED

M IMMUNIZATION

THESE ABE SERIOUS DISEASES THAT KILL AND DISABLE CHILDBEN

DISEASE

1

2

MEASLES

|

i
i

i
i
i
i
i
i
ii
i
ii
i
|ii
\ ii

WHOOPING
COUGH
(also known |
as pertussis)\
i
i
i
i
i

3

4

TETANUS of
NEWBORN

POLIO

\
j
i
i
i
i
i
i

'
i
i
i
i
i
i
i
ii

5

DIPHTHERIA

|
i
i
ii
i
ii
i
i
i

6 TUBERCULOSIS |

____________________ i

i
i
i
i
i

LOCAL NAME

\| DESCRIPTION — CHILD HAS:

i
i

ii
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
i
ii
i
ii
ii
i
i
ii
ii
ii
ii
ii
ii
ii
ii
i
i
i\
[
i
i
i
i

Fever, red runny eyes,
cough, rash

Typical cough often leading
to vomiting

Baby stops sucking the breast
& develops rigid muscle spasms
in 2nd & 3rd week after birth

Lameness & paralysis

Choking membrane in the throat

Fever and wasting

FULL

IMMUNIZATION

1. ALL CHILDSEN MUST RECEIVE ONE DOSE
THEIR FIRST BIRTHDAY.

2.

OF

HANS:

BCG (FOR TUBERCULOSIS) BY

ALL CHILDREN MUST RECEIVE
THREE
INJECTIONS
OF DPT (FOR
DIPHTHERIA, WHOOPING COUGH AND TETANUS) BY THEIR FIRST BIRTHDAY.

3. ALL CHILDREN MUST RECEIVE THREE DOSES OF POLIO VACCINE, BY MOUTH,
BY THEIR FIRST BIRTHDAY.

4. ALL CHILDREN MUST RECEIVE ONE
THEIR FIRST BIRTHDAY.

INJECTION

OF

MEASLES

VACCINE BY

5.

ALL WOMEN MUST RECEIVE, TWO INJECTIONS OF TETANUS TOXOID BEFORE
OR DURING PREGNANCY(to protect their babies from getting tetanus)

6.

ALL IMMUNIZED CHILDREN AND WOMEN SHOULD HAVE AN IMMUNIZATION

RECORD CARD.

ABOUT
PARENTS

UHMZATI08
SEED

TO

K S 0»:

1.

IT IS UP TO PARENTS TO ASK FOR IMMUNIZATION.

2.

IT IS UP TO PARENTS TO TAKE THEIR CHILDREN TO BE IMMUNIZED
ON TIME.

3.

MALNOURISHED CHILDREN SHOULD BE IMMUNIZED.

4.

SICK CHILDREN CAN BE IMMUNIZED.

5.

MILD FEVER, LOCAL SNELLING, AND PAIN OFTEN OCCUR FOR 1 OR 2 DAYS

AFTER IMMUNIZATION.

THIS IS NORMAL AND IS ALNAYS LESS SERIOUS

THAN THE DISEASE.

6.

CHILDREN NITH OTHER REACTIONS SHOULD BE TAKEN TO THE CLINIC.

SPECIFIC
ABOUT

fflFOBMTIOS

fflMIZAffl

IS

FOB

people

THEIR

COfflUNIW

This information should be obtained for each community by the
Red Cross trainee and given to all parents

1.

FIRST CONTACT
AT WHAT AGE SHOULD THE CHILD RECEIVE ITS FIRST IMMUNIZATION?

2.

MEASLES IMMUNIZATION
AT WHAT AGE SHOULD A CHILD RECEIVE MEASLES IMMUNIZATION?

3.

TETANUS TOXOID
WHEN SHOULD A WOMAN RECEIVE HER FIRST TETANUS IMMUNIZATION?

4.

WHERE IS THE NEAREST PLACE WHERE PEOPLE CAN GET IMMUNIZATION?

5.

WHICH DAY(S) AND AT WHAT TIME IS IMMUNIZATION

6.

WHERE SHOULD PARENTS GO IF THEY ARE WORRIED ABOUT AN

AN IMMUNIZATION REACTION?

AVAILABLE?

PROJECT PROPOSAL

ANNEX 10

CHILD ALIVE FACTS AND ACTIVITY REPORT

It is very important that people trained in the CHILD ALIVE
training programmes go out in the homes and spread their new
knowledge. They should not just sit back and wait for an accident to
happen. They must both teach parents how to take care of children
with diarrhoea and what to do in the home to prevent diarrhoea from
happening. They must also actively encourage parents to take children
for immunization.

This facts and activity report has been designed in order to help
assess knowledge and activities of the students.
It is a model and
should be changed to suit the local situation and the training
programme
that
the students have gone through.
It should be
translated into the language that is used at the course.
The answers of the questions provides the student with a
checklist of facts for the home visits. The activity record serves as
part of an evaluation of the training course.
People who have gone through training, answered the questions and
carried out the activities should be rewarded a CHILD ALIVE BADGE.

2

CHILD ALIVE FACTS AND ACTIVITY REPORT

Date:
Branch:

Name:
National Society:

When you have answered the following questions correctly and done
the activities you are entitled to receive the CHILD ALIVE Badge.

QUESTIONS
1. What can you do at home when a
child has diarrhoea?

1

sugar and salt

I take ... teaspoon of ....
and ... teaspoon of
and mix with
(amount) of

3. What are the DANGER SIGNS for
diarrhoea (when children need to
be taken to a health worker)?

1
2
3..........................
4
5

4. Name
the 6 common childhood
diseases that can be prevented
by immunization:

1
2
3
4
5
6

2. How do you
solution?

mix

5.

At what age should a child have
the first immunization?

6.

By what age should
fully immunized?

7.

At what
age should a child
receive measles immunization?

8.

When should women be immunized
against tetanus?

9.

Where
is
the
immunization clinic?

10.

When is it open?

a child be

closest

- 3 -

TASKS

1. I visited the following parents and told them how to take care of a
child with diarrhoea, and showed them how to mix sugar and salt
solution/
I also told them when and where they can have their children
immunized and explained about reactions after immunization.

1.
2.
3.

4.
56.

2. I checked the immunization cards of the following children and
encouraged parents to take children, who were not fully immunized to
the clinic.

4.
56.

1.
2.
33.

I told the following women that they need to be immunized against
tetanus before or during pregnancy in order to protect their newborn
children.

1.
2.
4.

34.

I visited my local clinic and offered to help with the organisation
of immunization days, keeping immunization records and talking to
mothers of children with diarrhoea.
Name of the nurse I talked with

5- I went to the school and talked with teachers about diarrhoea and
immunization. We also talked about activities that school children
can do to spread the word about how to take care of a child with
diarrhoea and to promote immunization.

Name of the teacher I talked with

By my signature I affirm that I have completed the questions and
activities for the CHILD ALIVE Badge.
Signature:

Date:

CH 1'0.-?-

a healthy child, a sure future

WORLD HEALTH DAY, 7 APRIL 1979 • INTERNATIONAL YEAR OF

CONTENTS

1.

MESSAGE from Dr H. Mahler, Director-General of the'-^oridi'Uealth
Organization

2

ABOUT WORLD HEALTH DAY

3

HEALTH OF THE WORLD'S CHILDREN: NEEDS AND PROBLEMS
by Division of Family Health, WHO

4

HEALTH CARE:

5

NUTRITION AND CHILD HEALTH

FOCUS ON THE CHILD AND MOTHER

by Dr Moises Behar, Chief, Nutrition Unit
Division of Family Health, WHO

6.

Goal of EPI: PROTECTION FOR EVERY CHILD FROM PREVENTABLE DISEASES
by Dr R. H. Henderson, Programme Manager
on Immunization, WHO

7

KILLER DIARRHOEA NEED NOT KILL

by Peter Ozorio, Information Officer, WHO

8

Expanded Programme

Geneva

CHILD CARE HAS CHANGED IN KASAI MOHALLA
by Jitendra Tuli, Information Officer, WHO Regional Office
for South-East Asia

9.

MOTHER AND CHILD HEALTH:

A FACT SHEET

Distributed by the Public Information Unit of the WHO Regional Office
for South-East Asia, Indraprastha Estate, Ring Road, New Delhi-110002.

a healthy child, a sure future
WORLD HEALTH DAY, 7 APRIL 1979 ■ INTERNATIONAL YEAR OF THE CHILD 1979

Message from Dr H. Mahler

Director-General of the World Health Organization

for
WORLD HEALTH DAY, 1979
A HEALTHY CHILD, A SURE FUTURE

The first years are crucial in laying the foundation of good health and
improving the quality of life.

Yet, of the 125 million children bom in 1978, 12 million - mostly in
developing countries - are not likely to live to see their first birthday.
And this tragic loss of human life is only the tip of the iceberg:
even
greater is the tragedy of the large number of the survivors who, because of
adverse environmental conditions, will not enjoy the fruits of good health or
develop to their full human potential.
Of an estimated 1500 million children in the world today, 1220 million or
81 per cent, live in developing countries, a majority of them in an environment
characterized by malnutrition, infection, poor housing, lack of safe water and
sanitation, and inadequate health care.

Starting with such a serious disadvantage, most of these children have
little chance of realizing their full economic and social potential.
They
will in turn give birth to another unhealthy generation, thus helping to
perpetuate a vicious cycle.
*
The roots of this continuing tragedy reach far beyond the area of
influence of health services.
Indeed, experience of the past several decades
has clearly shown that health action in order to be effective must be planned
and executed not as an independent exercise but as part of the total
development effort and in harmony with the other interacting forces

contributing to socioeconomic progress.

WHD.79/1

.......... 2

2
World Health Day this year is an occasion to rouse the social conscience
to the plight of millions of the world's children.
The nations of the world
at the Thirtieth World Health Assembly, and more recently at the International
Conference on Primary Health Care, held in Alma-Ata, have committed themselves
to the goal of health for all by the year 2000.
Children born between 1979
and 2000 will constitute more than one-third of the world's population at the
turn of the century.
This calls for immediate action by all concerned to
ensure the best possible health care to the children being born today.

The success of that action will be ensured by the primary health care
approach focusing on the needs of the most disadvantaged sections of the
community and the most vulnerable population group - mothers and children and emphasizing the:role of the individual, the family and the community for
their own health and well-being.
There is need to understand that while the task of safeguarding the health
of today's children is urgent, it cannot be accomplished through conventional
means.
What is required is a radical new approach emphasizing the just
distribution of health resources; mobilization of national and international
resources ;
imaginative use of traditional medicine and its practitioners;
research and development of appropriate health technologies relevant to local
needs;
and close cooperation among the nations of the world.

In some affluent societies of the developed world, there are problems of
a different kind.
Not only are there pockets of want in the midst of plenty,
but also problems created by the effects of a poor psychosocial environment,
which can lead to neglect and ill treatment of children, drug dependence, vice
and crime.
This has to be seen against the background of changes in the
supportive role of the family in child rearing.
In developed countries the
traditional way of child care has been replaced by practices that make the
families over-dependent on professional and semi-professional groups or
persons.
The right balance should be struck between the respective roles of
the society and the family, and no effort should be spared to promote selfreliance of the family in regard to the health of its members, particularly in
child rearing.

While changes in traditional family life styles are inevitable, every
community must make an effort to see that valuable practices - such as breast­
feeding - are not allowed to disappear.
There is sound sense in creating the
new by grafting on to what was best in the past.
The United Nations declared 1979 as the International Year of the Child
(IYC) in recognition of the "fundamental importance" of programmes benefiting
children - "not only for the well-being of the children, but also as part of
broader efforts to accelerate economic and social progress".
Activities
generated by IYC and World Health Day, it is hoped, will create a socio­
political climate of urgency in regard to the needs and problems of today’s
children, and lay the groundwork for continuing and systematic action focusing
on the health and well-being of the child.

■HD. 79/1

a healthy child, a sure future
WORLD HEALTH DAY, 7 APRIL 1979 ■ INTERNATIONAL YEAR OF .jrf M.P 19$ + '

O~

ABOUT WORLD HEALTH DAY1'

World Health Day is observed every seventh of April-.to mafikfl”t^g^oming into

force of WHO’s Constitution 31 years ago.
A theme for the dayi's chosen each
year to focus attention on a specific aspect of public health.
This year - the International Year of the Child - the theme is the well­
being of the child, and the slogan is:
"A healthy child, a sure future".

As in the past, WHO’s principal role is to provide resource materials for
the organizers of the observance.
It is the governments and nongovernmental
organizations who plan and organize observances at the community, district and
national levels, drawing the attention of the public to specific local health
problems.
The mass media also play a major part in this effort to raise health
consciousness .

NGOs wishing to take part in the Day’s observance should coordinate their
efforts with those of the official health services, World Health Day Committees
or National IYC Commissions.

It is hoped that World Health Day this year will be an occasion to raise
public consciousness in regard to the social wellbeing of children and families,
to strengthen ongoing programmes of direct benefit to children, and to initiate
others that will continue over the years.
National IYC Commissions could be an
important vehicle for the development and implementation of these programmes ,
In the promotion of health care for mothers and children, emphasis should
be placed on the primary health care approach with full participation of
families and communities to highlight such activities as:
Promotion of breastfeeding;
nutrition education based on local foods;
promotion of oral rehydration to prevent deaths from diarrhoea;
small-scale
water supply and waste disposal schemes;
and immunization against the six
major diseases of children included in WHO’s Expanded Programme on Immunization.
The enclosed materials, it is hoped, will be of some use to media represen­
tatives, school teachers, health educators, public speakers and other com­
municators as background information to prepare items of greater relevance to
the local health situation.
The articles in this kit may be summarized, trans­
lated or adapted in any manner at the discretion of the users,

Photographs: Black-and-white photographs relating to the theme "A Healthy Child,
A Sure Furute" are available for reproduction only. Editors may request them from
the Public Information Unit, WHO, Indraprastha Estate, Ring Road, New Delhi-110002.

Embargo:

WHD.79/2

Please do not publish this material before 31 March 1979.

a healthy child, a sure future

WORLD HEALTH DAY. 7 APRIL 1979 ■ INTERNATIONAL YEAR OF THE CHILD 1979

HEALTH OF THE WORLD'S CHILDREN:

NEEDS AND PROBLEMS

by

Division of Family Health, WHO

The total wastage of life represented by the deaths of young
children is enormous.
In most of Africa, for instance, nearly twothirds of all deaths are those of children under five years.
In more
prosperous parts of the developing world, the proportion falls to about
one-quarter;
but this is still very much higher than the proportion in
developed countries - 5 per cent or less.

Health cannot be achieved where poverty and misery abound, where food and
safe water are scarce, where housing is inadequate, and where public and community
services are lacking or rudimentary.
In such conditions, faced by two-thirds of
the world's people, ill-health and premature death are the rule of the day.
Most
severely affected by such environmental risk factors are the childbearing women
and the children themselves.
Because of their special vulnerability they pay a
heavy price in terms of death, morbidity, retarded growth and disability.
The tragic situation of the mothers and children in the developing world
poses the greatest challenge to the achievement of WHO's goal of "health for all
by the year 2000".
Yet it is ironical and paradoxical that so few reliable data
can be found to measure the health problems of these top priority target groups
for health care and social development.
The International Year of the Child, it
is hoped, will trigger efforts to improve the information base on the health and
health-related problems of the poorest and underprivileged population groups.
This information can be the basis for effective strategies of health and social
development, focused where the need is greatest.

Nevertheless, it is possible to obtain a statistical overview of the world s
child population, as well as of the births and infant deaths, from existing data
(Tables 1-3).
For simplicity, the data have been grouped by the 20 major regions
of the world, and these have been ranked in order of increasing life-expectancy at
birth.
Such grouping inevitably conceals many local variations, since poor and
underprivileged population groups are found in almost all countries, in rural
areas and on the fringes of large towns.
On the other hand, the presentation
does highlight the vast differences between various parts of the world, and in
particular between those areas (Africa and South Asia) where the life-expectancy
WHD.79/3

.......... 2

is below 60 years, and the rest of the world.
Although these areas contain only
about 41% of the world's population, they account for 50% of the world's 1500
million children, 57% of the 122 million births each year, 77% of all 12 million
infant deaths, and probably about 90% of all deaths occurring in the period of
childhood.
Thus, while the risk of dying before the end of adolescence is about
1 in 40 in the developed countries, it is as high as 1 in 2 - a 5O/5O chance - in

some African countries.

As can be seen from Table 1, the total wastage of life represented by the
deaths of young children is enormous.
In most of Africa nearly two-thirds of all
deaths are those of children under five years.
In the more prosperous parts of
the developing world, the proportion falls to about one-quarter;
but this is
still very much higher than the proportions in developed countries - 5% or less
(Fig. 1).
Environment and early death

For infants and young children, the risk of dying is very closely related to
the environment in which they live.
Inadequate food, exposure to infections and
lack of elementary hygiene and care pose obstacles which the young child is ill
equipped to deal with, yet which it cannot escape.
This is why the infant mortal­
ity rate (IMR) is universally recognized not only as a most important indicator of
the health status of the children, but also of the level of social development.
The data in Table 2 and Fig. 2 illustrate the great differences that exist between
countries and regions in the levels of infant mortality and early childhood mortal'
ity.
They do not, however, tell the full story of the wastage of young lives
from risk factors associated with poverty and ignorance.
The risks begin to appear even before birth, through the condition of the
mother.
If she is malnourished, if she is too young or too old, if her last child
was born less than 24 months ago, if she already has four or more children, and if
she is deprived of basic pregnancy care, the risk of an abortion, a stillbirth or
an early infant death is greatly enhanced.
The perinatal mortality (i.e. from
28th week of gestation to one week of life) varies by a factor of five between the
lowest and the highest levels observed.
Although the perinatal period occupies
less than 0.54 of the average life-span, in many developing countries there are
more deaths within this period than during the next 30 years of life.
Many of the risk factors which determine perinatal mortality also endanger
the life of the mother, causing a high maternal mortality with consequent
additional risks for her orphaned children.
Unsafe obstetric practices, includ­
ing clandestine abortions, also contribute to the level of maternal mortality,
which ranges from less than 5 per 100 000 births in most privileged communities to
about 1000 per 100 000 in some developing countries.

After the first week of a child's life, the environmental factors play a very
important role as determinants of infant and childhood mortality.
Tetanus infec­
tion of the newborn may take a heavy toll in the first few weeks of life.
In some
areas where preventive services and tetanus immunization are lacking, up to 10%
of liveborn infants succumb to this disease.
Diarrhoea and pneumonia of "unknown
etiology", or simply caused by microflora which is not otherwise pathogenic, are
extremely common in children exposed to an unsanitary and hostile environment.
The case fatality rate of what would normally be trivial episodes of disease can
increase dramatically when elementary care is not given, due to lack of means, to
ignorance or to a combination of these.
For many of these children, malnutrition
appears as an additional factor, reinforcing the adverse effects of the infections.

WHD.79/3

.............3

- 3 Breastfeeding is widely practised in most populations in the developing
countries, and thus ensures adequate nutrition of most children for the first six
or nine months.
However, when the child becomes old enough to need supplementary
food, the scarcity of suitable foods, lack of purchasing power of the family, as

well as traditional beliefs and taboos about what a baby should eat, often lead
to an insufficient and unbalanced diet. The resulting malnutrition, or outright
starvation, further increases vulnerability to infection and reduces the child's
chances of survival.

A childhood mortality study in the Americas showed that no less than 57% of
the children who died before the age of five years were found to have malnutri­
tion as underlying or associated cause of death, the peak of this mortality being
in the post-neonatal period (i.e. from one to 12 months of age).
The impact
of adverse external factors on the mortality in this crucial period of life can
be surmised from the fact that the post-neonatal mortality is 20 times higher
in countries with the highest levels than in those with the lowest.
As can be seen from Table 2, in the ages 1-4 years, the mortality can still
be substantial, but is of a much lower level than infant mortality.
This is true
in all populations.
Where the post-neonatal mortality is high, the same under­
lying causes as discussed above may continue to be important during the second or
even the third year of life.
In some countries in Africa, and in places where
prolonged breastfeeding has protected the infant from early malnutrition and some
infections, the mortality in the second year of life might be of the same order
of magnitude as the infant mortality.
Infectious diseases of childhood, such as
measles, whooping cough and diphtheria affect mostly this age-group, and can lead
to high case fatality rates in malnourished children.
For example, during the
famine conditions in the sub-Sahel, the case fatality rate of measles was estima­
ted as 50%.
This contrasts with the 7-10% commonly found in tropical Africa,
which is already much higher than the case fatality of measles in most other
populations.
Because the 1-4 years mortality in the most developed countries
has been reduced to very low levels, the differentials observed between countries
with the lowest and the highest levels are extremely great, corresponding to a
factor of fifty or above.
Leading causes of death

From the above discussion it is already clear that the differences in infant
and childhood mortality between developing and developed countries are not just
in the levels of mortality but also in the leading causes of death.
This point
is emphasized in Table 3, which gives the leading causes of death among four age
groups of children, as synthesized from available information about various
developed and developing countries.
The overwhelming importance of diarrhoeal
disease and respiratory infections as a cause of death throughout childhood in
the developing countries, is obvious, closely followed by communicable - and
preventable - diseases such as whooping cough and measles.
After the age of
five years, accidents of all kinds, including household and traffic accidents,
also become important.
In the developed countries, deaths from infections are
quite rare, especially after the first few years of life, while accidents become
the leading cause of death from the age of one year.
The remaining causes list­
ed as important represent conditions which are not easy to prevent or to cure
such as congenital anomalies, neoplasms and heart disease.
Naturally, these
conditions also affect children in developing countries, but their relative
importance is overshadowed by the infections.

WHD.79/3

4

In the most developed countries, the infant and perinatal mortality rate
has continued to decline during the past decades, due to improved obstetric and
perinatal technologies and, especially, to a more widespread availability of
these technologies.
There are, however, still considerable differentials in
infant and perinatal mortality according to socioeconomic status in many
developed countries.

Growth and development of the child
Deaths of infants and of their mothers may be the most dramatic
consequence of ill health, but there are other serious consequences which affect
the child and, indeed, may follow it throughout adult life.
The damage done by
infections and associated malnutrition to a young child in its formative years
is manifested in retarded physical growth and mental development, which it may
never be able to catch up on, thus impairing the potential for a full and active
adult life.
Poverty, ignorance and ill health thus create a vicious cycle
spanning from one generation to the next, and from which the individual has
little chance of escape.

A striking expression of this generation link is the frequency pf "low birth
weight" (LBW) babies, i.e. babies weighing less than 2500 grams at birth.
It
is now known that this frequency is closely determined by the same adverse
maternal and environmental factors which determine the level of perinatal
mortality, in particular the nutritional status of the mother.
It has also
been observed in developed countries that the frequency is higher among
mothers who smoke during pregnancy.
About 21 million LBW (small for date)
babies are born each year, the greatest majority of them in developing countries.
The observed incidence rate ranges from about 4% in the most developed countries
to over 30% in some poor rural populations.
This is illustrated in Fig. 3 which
also shows that a high proportion of LBW is accompanied by a lowering of all
birth weights.
It is also known that LBW is the single most important factor
determining the survival chances of the child.
The infant mortality rate is
about 20 times greater for all LBW babies than for other babies, but the lower
the birth weight the lower is the survival chance.
For these reasons, it is increasingly realized that the simple measures of
birth weight and - during childhood - of height and weight provide very
sensitive and reliable indicators of the health status of the child population.
Not only are the data easier to collect than data on infant mortality, but the
very process of collecting them, i.e. the regular weighing of all children,
provides warning signals, leading to timely preventive action for the individual
child and for the community.
:tions for better child health

From the above statements about the health problems of the world's children
it is evident that no specific health programme and no single set of actions can
remedy these problems.
The real "iceberg" of which excessive infant mortality
is but one visible tip consists of poverty, hunger, ignorance and other socio­

WHD.79/3

economic ills and can be successfully tackled only through a broad development
programme directed at the roots of these ills.

As stated by -Dr H. Mahler, Director-General of the World Health Organization
the essential elements for the attainment of health for all include adequate food
and housing, with protection of houses against insects and rodents; water
adequate to permit cleanliness and safe drinking;
suitable waste disposal;
services for the provision of antenatal, natal and postnatal care, including
family planning;
infant and childhood care, including nutritional support;
immunization against the major infectious diseases of childhood; prevention and
control of locally endemic diseases;
elementary care of all age-groups for
injury and diseases;
and easy access to sound and useful information on prevail­
ing health problems and the methods of preventing and controlling them.
This list of broad elements could be elaborated with special reference to
the health of children to include:
health education of parents (and youth) with
regard to all aspects of reproductive health;
nutritional support to pregnant
women;
promotion of appropriate, simple technologies for managing deliveries
and minor complications;
promotion of breastfeeding and appropriate weaning
foods;
monitoring of the growth of infants and children.

Within the overall goal of "health for all by the year 2000", one indicator
of achievement would be an infant mortality rate of less than 50 per 1000 live­
births and a life expectancy at birth of more than 60 years for all countries.

WHD.79/3

WHD.7 9 /3
TABLE

DEMOGRAPHIC ESTIMATES BY GEOGRAPHIC REGIONS,

1.

1978

(in millions unless otherwise stated)

Annual

Population

Life expectancy

Children aged:

at birth

Region

(years)

of children
aged:

births

Total

0-4 years

5-14 years

number of deaths

Annual

number of

1

under

under 5 years
as

1-4

year

years

(thousands)

(th ouaands)

(6)

(7)

(8)

564

55

381

215

(2)

(3)

(4)

42

128

24

34

6.3

Middle Africa

42

50

9

13

2.2

East Africa

45

124

23

33

5.8

845

1

Mid South Asia

49

879

145

232

32.5

4 423

Southern Africa

52

31

5

7

1.2

150

South East

1

percentage

of all deaths

010

(I)
West Africa

(5)

Deaths of children

1

61

629

60

609

46

65

44

41

Asia

52

341

58

91

12. 6

463

352

Northern Africa

52

103

18

28

4.4

580

399

68

South West Asia

55

92

16

24

3.9

423

128

48
49

Tropical

Sub-total

49

748

298

462

69.0

9 274

3 961

South America

61

188

31

50

7.0

689

163

50

63

87

16

24

3.6j

256

79

48

0.8

53

8

27

Middle America

1

28

4

7

122

131

236

24.7

1 431

631

23

40

4

8

0.9

66

9

21

13

2

8

132

12

6

Caribbean

64

East Asia

66

Temperate South America

66

Oceania

68

22

3

4

0.5

USSR

69

261

22

45

4. 7

Eastern Europe

70

108

9

16

1.9

49

8

1

5

Southern Europe

71

137

11

24

2.3

56

9

5

Western Europe

72

153

11

25

1.8

28

6

4

Northern Europe

72

82

6

13

1.1

14

3

2

73

North America
World

Sources

Notes:

4

60

242

19

43

3.6

219

565

957

121.8

Population Reference Bureau

(1),

(2).

Cols

(3),

(4)

- Population Reference Bureau and

Cols

(6),

(7)

- Table 2.

Col.

(8)

Cols

(5)

-

- Cola

(6) and (7) and

Inc

,

54

12

4

115

10

3

901

25

1978 Estimates.

UN Selected World Demographic

Indicators

1975.

Population Reference Bureau.

Totals were calculated before rounding, rounded figures may not add to totals.
Col. (8) - Figure for North Africa is greatly influenced by the estimated fall

in the overall

death rate

(UN Estimate).

TABLE 2.

EARLY CHILDHOOD MORTALITY

Death rates

Region

0-1 year
(per 1000 live births)

1-4 years
(per 1000)

West Africa
Middle Africa
East Africa
Mid-South Asia
Southern Africa
South-East Asia
Northern Africa
South-West Asia

161
173
145
136
118
116
131
115

30
30
35
14
30
8
28
10

Subtotal

134

17

99
70
65
58
72
28
28
25
24
15
13
15

7
6
3
2
3
1
1
1
1
1
1
1

83

8

Tropical South America
Middle America
Caribbean
East Asia
Temperate South America
Oceania
USSR
Eastern Europe
Southern Europe
Western Europe
Northern Europe
North America
World

Source:

WHD.79/3

WHO/FHE estimates based on a variety of sources.

8 -

TABLE—3.

LEADING CAUSES OF CHILD DEATHS
*

(summarized from WHO Technical Report Series No. 600)

Developed country

Developing country

Infants

Birth injuries
Congenital anomalies
Influenza, pneumonia
Enteritis, diarrhoeal diseases

Enteritis, diarrhoeal diseases
Influenza, pneumonia
Bronchitis, etc.
Whooping cough

1-4 years

Accidents
Congenital anomalies
Malignant neoplasms
Influenza, pneumonia

Enteritis, diarrhoeal diseases
Influenza, pneumonia
Bronchitis, etc.
Measles

5-9 years

Accidents
Malignant neoplasms
Congenital anomalies
Heart diseases

Enteritis, diarrhoeal diseases
Influenza, pneumonia
Accidents
Measles

10-14 years

Accidents
Malignant neoplasms
Congenital anomalies
Heart diseases

Influenza, pneumonia
Accidents
Enteritis, diarrhoeal diseases
Measles

A
Malnutrition as an underlying or associated cause of death due to
infections is not singled out in this table.

WHD.79/3

9

FIG. 1
DEATHS OF CHILDREN AGED UNDER 5 YEARS AS A
PERCENTAGE OF DEATHS AT ALL AGES

WHD. 79/3

10

FIG. 2
PROPORTION OF INFANTS AND CHILDREN
DYING BEFORE THE AGE OF 5 YEARS

WHD. 79/3

-11

FIG. 3
DISTRIBUTION OF BIRTH WEIGHTS OF INFANTS
IN TWO CONTRASTING COMMUNITIES

Low birth weight (LBW)

WHD. 79/3

WHD.79

FIG. 4

CAUSES OF DEATH OF INFANTS AGED UNDER 1 YEAR, & CHILDREN AGED 1 TO 4 YEARS, IN THREE COUNTRIES
CUBA

COSTA RICA

UNITED KINGDOM

Infant
mortality

Deaths
1 —4 years

HHO 78856

Infectious diseases (incl.
diarrhoeal & respiratory)

Congenital anomalies

Nutritional diseases

a healthy child, a sure future

WORLD HEALTH DAY, 7 APRIL 1979 ■ INTERNATIONAL YEAR OF THE CHILD 1979

HEALTH CARE:

FOCUS ON THE CHILD AND MOTHER

It is no longer socially acceptable that high cost technology
is available to a small minority, while the majority of the rural
population and the urban fringes have no care apart from whatever
traditional care might be available.
Although accurate data are
wanting, it can safely be said that in 1978 the vast majority of
mothers and children in the world were not receiving any organized
health care.

Ours is perhaps the first generation in the history of mankind that has the
knowledge and resources to achieve health improvement on a world scale.
Yet
many children die early in life from diseases that could have been prevented, and
hundreds of millions of lives are thwarted by ill-health, malnutrition and
infection.

In the past few decades, science and technology have taken giant strides in
the field of health, but the benefits are largely enjoyed only by privileged
communities of the world.
Vast rural and peri-urban populations of the
developing world have remained untouched by these advances.
Offical health
care systems in many areas are not reaching the people most in need.
Disparities
in health care are seen not only between countries but also within countries
where, often, a disproportionately high amount of the limited health resources
is spent on services for the urban elite at the cost of the other sectors of the
population.
The worst sufferers under these conditions are the two most
vulnerable groups:
mothers and children.
The problem calls for a new approach to the development of health care.
This was recognized by the International Conference on Primary Health Care held
in Alma-Ata in September 1978, when it adopted a Declaration pleading for social
justice in health and an equitable distribution of health resources.
The Conference proclaimed a main social target for governments and the
world community:
"the attainment by all peoples of the world by the year 2000
of a level of health that will permit them to lead a socially and economically
productive life".
The key to attain this target, the Conference declared, was

the primary health care approach.

The primary health care concept seeks to bring about the overall promotion
of health by supporting the individual, the family and the community in assuming
responsibility for their own health.
It involves organizing other levels of
the national health system in support of primary health care which responds to
the priority essential health needs of the masses of people.
The active
participation of the community is sought to define its needs and find ways to
meet them.
Full use is made of the available community and national resources.
Other sectors, such as education, agriculture, housing, public works, information
and communications, and industry are mobilized along with health.

WHD.79/4

2

2

Although no single model is applicable everywhere, primary health care
should include the following essential elements:
education about common health

problems and ways to prevent and control them;
promotion of proper nutrition;
an adequate supply of safe water;
basic sanitation; maternal and child health,
including family planning;
treatment for common diseases and injuries;
immuni­
zation against major infectious diseases;
and prevention and control of locally
endemic diseases.
MCH and primary health care

Many of these elements have a direct bearing on maternal and child health.
The reason is obvious:
about two-thirds of most populations consist of women
of childbearing age and children under the age of 15, and they constitute a
particularly vulnerable group.
This vulnerability stems from and is inherent
in the rapid process of growth and development during pregnancy and early child­
hood.
There are special biological and psycho-social needs that form part of
this process and necessitate a continuity of care, especially when environmental
conditions are adverse.

The health of all people is closely related to the level of their socio­
economic development, but mothers and children suffer most severely from the
consequences of poor socioeconomic conditions.
Thus, unless radical measures
are taken now, the majority of today's children will have little chance to grow
into the healthy adults required for tomorrow's development tasks, and the cycle
of poverty and disease will continue unbroken.
The importance of investment in its broadest sense - in the children of today for a better tomorrow cannot be
overemphasized.
Maternal and child care must therefore be an indispensable priority
element of primary health care in every community.
It includes the promotive,
preventive, curative and rehabilitative health care for mothers and children,
and the sub-areas of maternal health, family planning, child health, school
health, handicapped children, adolescence, and the health aspects of care of
children in special settings such as day care.

Content of maternal and child care

The strategies and technologies for health care in most developing countries
have been largely based on imported models.
These are often irrelevant to
their priority problems, and make little use of the community resources,
including the family's potential for self care.

It is now generally accepted that the content of MCH care should always be
flexible and based on, and adapted to, local needs, resources and specific social
and ocher environmental characteristics.
Rather than the standard set of
routine activities, MCH care is now conceived of as all activities which promote
health and prevent or solve health problems of mothers and children, irrespective
of whether they are curative, diagnostic, preventive or rehabilitative, and
whether they are carried out in health centres or in the home by primary health
care workers, traditional birth attendants, or highly trained specialists.

WHD.79/4

- 3 -

The major causes of illness and death of mothers and children in developing
countries are malnutrition, infection and the consequences of unregulated
fertility, usually in combination.
The components of care which have the
greatest effect on these three conditions include:
care during pregnancy, child­
birth and postnatal period, especially nutrition care;
prevention, diagnosis
and management of prevalent diseases affecting mothers and children;
promotion
of infant and child nutrition, including the promotion of breast-feeding and use
of appropriate weaning foods;
supervision of growth and development in child­
hood;
prevention of infections in childhood, through immunization, environmental
sanitation, education;
family planning care, including prevention and treatment
of infertility;
and family life education, including the promotion of healthy
childrearing and sex education.
These are actions requiring a continuity of care throughout the crucial
phases of development:
pregnancy, childbirth, infancy, weaning, early childhood
and adolescence.
Because of this, and the scarcity of resources, it is not
feasible to extend the whole range of MCH care to all mothers and children.
Priorities have to be decided upon according to the local situation and the local
levels of morbidity and mortality, and as perceived by the community.

The content of mother and child health care also will be influenced by the
changing social and economic patterns.
In more and more areas of the world,
such factors as urbanization, rural migration, political upheavals, changing
patterns of women's work and status have far-reaching effects on the health needs
and problems of families and on the way they function, especially concerning
childbearing and childrearing.
Health care, social legislation and other social
support measures have to adapt to these changing needs and problems.

Integration of care
Some existing MCH services are fragmented into structures and functions,
such as separate "clinics" for antenatal "old", antenatal "new", "under-one
clinics", toddler clinics and well-baby clinics.
This approach has changed
over the years, as the concepts of integrated, comprehensive health care, and
the principle of equity in health care were increasingly accepted.
It has led
to a rethinking and departure from the conventional "MCH services":
every
contact of mothers and/or children with the health care system offers an

opportunity to deal with the preventive, curative and rehabilitative aspects of
problems of all the family members, and to see each individual's problems and
needs in the context of the family and community.
But it has to be admitted
that, in spite of increasing evidence of the efficiency and effectiveness of
such an integrated approach, it is still not operating in many countries.
Full coverage

The call for equity and social justice implies a major redistribution of
resources, leading to full coverage of health care.
It is no longer socially
acceptable that high cost technology is available to a small minority, while the
majority of the rural population and the urban fringes have no care apart from
whatever traditional care might be available.
Although accurate data are not
available, it can safely be said that in 1978 the vast majority of mothers and
children in the world were not receiving any organized health care.

WHD.79/4

4

- 4 -

Since it has to be recognized that resources are scarce, alternative ways
of organizing maternal and child health care must be applied with careful
organization of all available resources to solve the priority health problems
and to promote health.
One of the promising approaches for better use of
resources is based on the early detection of risk groups and individuals with
subsequent redistribution of resources to ensure essential care for all mothers
and children, but more skilled care for those at higher risk.

People as the focus
Health for all is not something which can be imposed nor is it something
which can be given to or provided to people.
It can only be achieved by the
active participation of informed and motivated people.

It is now time to recognize that without appropriate health knowledge without easy access to sound and useful information on prevailing health problems
and the methods of preventing and controlling them - people will continue to be
"recipients" of health care by "health workers" with a top-down approach, rather
than being truly involved and demanding about their responsibility for their own
health.
Children themselves, especially those in schools - both urban and rural can actively share in the community participation for health.
As part of a
dynamic learning process, they can learn about their own situation concerning
health and about the ways and means to influence that situation for themselves,
their families and their community.
People's health greatly depends on environment and lifestyle, both of which
can be controlled to a large extent by the individual, the family and the
community.
Smoking, pollution of every kind, irrational eating habits, are
examples of threats to health related to lifestyle.
Since lifestyle is set
early in life, the family setting is crucial for the development of healthy
living patterns.
Health and health-related workers in MCH care have important
roles in influencing these patterns through information and support.

Workers in MCH:

a more relevant approach

As MCH care tends to move away from conventional patterns, and shifts to a
family and community-centred system of health care, the traditional roles of
health personnel in MCH care must also change.
It is proposed that a wider
range of workers should be involved in MCH:
they may be community development
workers, traditional healers, primary health workers, health auxiliaries, health
professionals and specialists at many levels.
The specific roles and categories
of health and health-related manpower working in MCH will depend on the local
situation, on the availability of manpower, including community resources such
as the traditional birth attendant and community volunteers;
on the nature of
community participation;
on the content and levels of care;
and on the
supporting health care system, including regional and national centres of
referral and supervision.

WHD.79/4

5

5

These new approaches must be reflected in the training of workers in MCH.
Training programmes for MCH care must ensure that national self-reliance is
achieved and that sufficient numbers of health and health-related workers at all
levels are trained for total coverage of MCH care.
The training has to be
specifically oriented to the tasks to be performed, with field training in
realistic settings and relevant to the local health care priorities.
The
training will also have to instil a positive attitude towards working as a team,
particularly as workers from different disciplines and areas are involved.
MCH as part of intersectoral development

The wellbeing and health status of mothers and children depend not only on
basic health care, but also on adequate housing, good sanitation and safe water
supplies, adequate income (in cash or produce) to meet daily needs, availability
of sufficient nutritious food, and access to education, transport and other
public services.
Obviously the health care system alone cannot meet all these
needs.
Most of them, in fact, are the responsibility of other sectors;
but

there is a need to coordinate and focus the efforts of many sectors to promote
health.
This is more easily said than done.
While many examples exist of
truly effective coordination of efforts for the benefit of mothers and children,
in too many other instances there is a total lack of coordination both within
and between sectors.
The most important role of MCH in multisectoral coordination may be to make
a continuous effort to communicate with those working in other sectors and help
them to become aware of the health requirements and needs of mothers and children
to identify clearly activities that affect mothers' and children's health,
and to encourage and assist the personnel of these sectors to carry out these
activities.
The promotion of adequate maternity legislation and day-care
facilities are examples.
Also, new approaches to school health education could
be promoted in which all parts of educational programmes contain forceful and
appropriate elements of "learning how to live healthy lives" rather than having
a few and separate "courses" on health.

One hundred and thirty-four countries made a commitment at Alma-Ata to
achieve health for all by the year 2000.
Children born now, during the
International Year of the Child, will judge whether the promise has been kept.

WHD.79/4

a healthy child, a sure future

WORLD HEALTH DAY, 7 APRIL 1979 ■ INTERNATIONAL YEAR OF THE CHILD 1979

NUTRITION AND CHILD HEALTH

by
Dr Moises Behar
Chief, Nutrition Unit
Division of Family Health
World Health Organization

Children who develop severe malnutrition die, unless proper treat­
ment is available in time - which is seldom.
Many others, not recognized
as malnourished, easily die of measles, diarrhoea, respiratory infections
and other common diseases of childhood which are not serious in wellnourished children.
Others who survive are often retarded in their
growth and development, physical and mental, and become the small
chronically malnourished and uneducated parents of another generation
with the same fate.

During the past several years, newspapers and television have often carried
dramatic pictures of miserable, emaciated children in the third world suffering
from starvation.
These are examples of a situation that is intolerable in
the face of today's sophisticated technology and advances in medical science,
and in an age when the main nutritional problem of young children in affluent
societies is obesity.
It must be realized, however, that with all their
tragic drama, these starving children represent only the tip of the iceberg;
they are acute exacerbations of a hideous, much larger and not sufficiently
recognized problem of hidden hunger which affects the majority of the children
of the third world.
For instance, it has been observed for a long time that babies at birth are
much smaller in the developing countries than in the industrialized ones.
The
difference was once thought to be an ethnic characteristic.
But we now have
evidence that this is in fact a manifestation of malnutrition, starting in the
very critical period of intrauterine life.
In some parts of the developing
world, up to half the children are born weighing less than 2500 grams.
In
industrialized countries low birth weight is observed only in babies born
prematurely.
However, premature birth is not the main factor in the case of
babies born underweight in developing countries;
the majority of them are
born at term, from small, chronically undernourished mothers.
They start life
with a great handicap.
Many of them will die during their first week or
months of life, and those who survive will be retarded in their physical and
mental development.

WHD.79/5

2

2
Importance of breastfeeding
In most parts of the developing countries infants after birth are still
breastfed.
This practice has great health significance and contributes much
to the survival of these children in the very poor conditions in which they
live.
For at least their first three to four months of life, they receive
from mother's milk the best possible nourishment and, in addition, protection
against the common infectious diseases, particularly from the deadly diarrhoeal
diseases to which they are heavily exposed.
In general, in spite of the usually
poor nutritional status of their mothers, most do well during this period.
Unfortunately, the practice of breastfeeding is rapidly declining, particularly
in the poor urban areas, but also in rural populations.
This is a result of
changes in the structure of societies and of the influence of the culture and
values of the industrialized world.
The consequences are disastrous.
Under any circumstances breastfeeding is the ideal type of feeding for
children during their first months of life.
In industrialized societies it has
been possible, in the past few decades, to replace mother's milk with artificial
formulae for feeding young children.
This has proved to be relatively safe
when the family can afford it, is sufficiently educated, has the necessary
facilities and lives in a clean environment.
It is now known, however, that
even under these conditions formulae-fed children are subject to health risks
during their infancy and later life which could be avoided by breastfeeding.
But for populations which are not economically and culturally prepared, who
do not have at home the necessary facilities and resources and who live in an
unsanitary environment, bottle-feeding of children with milk formulae is
extremely dangerous, exposing them to severe malnutrition and deadly infections
at a very early age
Weaning:

a critical period

After the age of four to six months, breast milk is not sufficient to
satisfy the nutritional requirements of the child, and other foods must be
added.
The period of weaning is critical in the child's life.
For economic,
cultural and other reasons, children are very often deprived of the additional
foods they need.
The result is that their growth starts to slow down, they
become apathetic, react less to social and psychological stimuli, and are more
susceptible to infectious diseases - all manifestations of chronic malnutrition.
Even though the amount of breast milk may not be sufficient to satisfy all the
child's needs after this period, it is still of great value, and breastfeeding
must continue along with the weaning foods.
If the child is completely
weaned before it is prepared to share the family diet, the consequences can
be disastrous.
The weaning period - from the age of four to six months until about two to
three years - coincides with a time in the baby's life when the immunity to
common infections inherited from the mother and complemented by the antiinfectious properties of breast milk, diminishes and finally disappears.
As
a result of the introduction of other foods and the children's greater mobility
they become much more exposed to the environment, usually heavily contaminated.
Thus frequent infections are compounded with chronic malnutrition.
Some of
the children will develop severe malnutrition and die if not properly treated
in time.
Many more, although not recognized as malnourished, will easily die
of measles, diarrhoea, respiratory infections and other common diseases of
childhood which are not serious in well-nourished children.
Those who survive
will be retarded in their growth and development, physical and mental, and will
eventually become the small, chronically malnourished and uneducated parents
of another generation with the same fate.
This is how malnutrition contributes
to the perpetuation of poverty and misery.

3

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3
Handicaps of donated food

Efforts to correct this tragic situation have often proved ineffective,
either because they were not given the requisite priority, or because the
measures taken were of a palliative nature or, in many cases, misconceived.
Supplementary feeding programmes relying on donated foods provide a case in
point.
For logistic reasons, mainly related to easier distribution, it is
children over three years and those at school who receive these foods.
The
children do perhaps benefit from this extra food, but the population at greater
risk is missed, since it is now recognized that the need of supplementary feeding
is greater for younger children and for pregnant and lactating mothers.
In
some programmes that include these mothers among recipients of supplementary
food, it has been noticed that instead of consuming it themselves, they share
ic with the whole family.
This may seem natural, but the supplementary value
is almost completely lost.

When the food is donated from foreign sources and not locally available,
a supplementary food programme cannot possibly serve to improve dietary habits
of the people.
In fact, it may produce unfavourable results by making the
families and countries dependent on foreign foods.
More importantly, despite
the good intentions, such programmes tend co use up the manpower and other
resources that the country could otherwise devote to more fundamental
effective nutrition-oriented activities, and create the false impression that
the problem is being solved while in fact it is being perpetuated.
Nutrition education is another measure commonly taken against malnutrition.
Frequently, however, even when an adequate methodology is used, the messages
are based on principles which are not applicable under the specific circumstances
in which the people live.
For instance, foods are recommended which are not
only impracticable for economic, cultural or other reasons, but sometimes not
even strictly necessary.
It is no wonder that most of these efforts have been
unsuccessful in improving dietary practices, and sometimes have even helped in
making them worse.
The problem of malnutrition is indeed complex, with many more social than
strictly medical aspects.
In the long run, only a rational socioeconomic
development will correct it - one that will eliminate the basic causes of
malnutrition:
poverty, ignorance and poor environmental conditions in which
large sectors of the populations in the developing countries now live.

It is important to emphasize that chronic malnutrition as commonly seen
in most countries will not be solved merely by producing more food or increasing
resources at the national level, unless a more rational and equitable distri­
bution is introduced and the resources are used primarily to improve the living
conditions of all the people.
This must be kept in mind in initiating any
efforts for socioeconomic development.
Much can be done now
However, young children cannot wait for long-term plans.
They are affected
now.
The continued suffering of children contributes to the perpetuation of
unacceptable standards of living.
Furthermore, it is known now that lack of
money is not always the main hurdle in improving the diet of young children.
Very significant improvements can be made with a better utilization of locally
available and acceptable foods chat are commonly eaten by the family, but not

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- 4 -

given to young children at the right time or in adequate amounts and proportions.
Efforts to promote the maintenance of breastfeeding and counteract the factors
responsible for its decline, and to improve weaning practices in the local
context while respecting traditional values can go a long way towards providing
a better diet for young children - even under the circumstances that now prevail
in most developing countries.
But improved diet must go together with basic
sanitation and health care of mothers and children.
This will only be possible
within the primary health care approach, with active participation of the
communities themselves.

In the words of Dr Halfdan Mahler, WHO Director-General, "poor malnourished
parents produce malnourished children who in turn will become poor and mal­
nourished parents".
This "vicious spiral" must be broken by improving child
health and nutrition levels.
This is a challenge to the governments of the
world and the international community in the International Year of the Child
and in the years to come.
The wellbeing of the majority of the world's
population is at stake.

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Goal of EPI
PROTECTION FOR EVERY CHILD FROM PREVENTABLE DISEASES

by
Dr R. H. Henderson
Programme Manager
Expanded Programme on Immunization
World Health Organization

Six diseases of children, virtually banished from the developed
countries but commonplace in the developing part of the world, take a
toll of some five million lives every year.
And for every child that
dies, another lives who is crippled, blind, mentally retarded or other­
wise disabled for life.
These are diseases that can be prevented by
immunization, but despite the low cost and ease of delivery, less than
10% of the 80 million children born each year in developing countries
are now receiving immunization services.

This year, as in many years past, millions of children in the developing
world will die or be crippled by diseases that effective immunization services
have virtually banished from the developed countries.
To end this gross
inequality, WHO and its Member nations have committed themselves to providing
immunization services for every child in the world by 1990.
These services
have been recognized as a basic component of primary health care, a revolutionary
new strategy to achieve WHO's proclaimed goal of "health for all by the year
2000".
Six diseases of childhood are now included in what is known as the
Expanded Programme on Immunization (EPI):
diphtheria, pertussis (whoopingcough), tetanus, measles, poliomyelitis and tuberculosis.
While these six
diseases are under attack, basic systems are being developed that will permit
countries to deliver any vaccine of merit.
These delivery systems will play
an increasingly important role in preventing death and disability as advances
in research make new vaccines available.

WHO.79/6

2

■Five million deaths
The six diseases provide a good starting point.
They kill some five
million children each year, and for each dead child, another lives who is
crippled, blind, mentally retarded or otherwise disabled for life.
These
numbers are so large that their significance is not easily grasped by those
in developed countries.
In the developing countries, the diseases are so common­
place that parents, and sad to say, health workers and political leaders are still
for the most part numbed into accepting this continuing tragedy.
Thus less than
10% of the 80 million children born each year in developing countries are now

receiving immunization services, despite their low cost and ease of delivery.

Of the six diseases, the leading killers are measles, pertussis, and tetanus
of the newborn.
The first two diseases have case fatality rates ranging between
1% and 10%, the higher rates more commonly observed among younger and/or less wellnourished children.
Tetanus of the newborn probably affects less than 2% of
children in developing countries born to unimmunized mothers, but 70% to 90% of
those infected die.
The leading crippier is poliomyelitis.
Virtually every unimmunized
child is infected with one or more of the polioviruses.
This infection
results in paralysis in about 1% of children under the age of three years,
and in a higher proportion of children infected at older ages.
An ominous
trend of increasing numbers of reported paralytic poliomyelitis cases has been
observed in developing areas during the past few years.
Perhaps this reflects
improved reporting, but it may be an indication also of improved standards of
living and sanitation, which, by delaying the average age of first exposure
to polioviruses, may be contributing to higher paralytic attack rates.
Deaths
may occur in 15% of paralytic cases.

Although infection with the bacilli which cause tuberculosis is not
infrequent in childhood, and can spread to many sites within the body or
result in meningitis, a child's first infection is likely to cause no symptoms,
and may emerge only years later as an active disease, producing disability and
death.
Tuberculosis remains a major public health problem, with some threeand-a-half million new cases and half a million deaths occurring each year.
It can be prevented by BCG vaccination but because the disease remains dormant
for a long period in many individuals, the impact of BCG often takes many years,
unlike most other vaccines whose results can be observed much more quickly.
The morbidity and mortality resulting from diphtheria is less well defined
than for other diseases, although over 100 000 deaths are believed to be
occurring annually among children of less than five years of age.
National commitment

What can be done to rectify the situation?
Developing countries seeking
to ensure immunization services for all children, irrespective of social strata,
face a difficult challenge.
The challenge, however, is to provide simple
and inexpensive services for all, and does not require an investment in new

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3

or complex medical technology.
It can be met through personal and national
commitment to achieve the programme goal.
The basic commitment to provide immunization services for all of their
children by the target date of 1990, should be reflected in funds allocated
by the countries in their national budgets.
A programme manager and

supporting staff for each national programme should be identified.
The next
step is the development of detailed plans of operations describing exactly
what the country intends to do to make the programme a success.
These plans
are necessary not only for the sound management of the programmes, but also
for international agencies and donor countries who wish to ensure that the
resources they might be willing to invest in expanding immunization programmes
will be well utilized.
Because immunization services must continue to be delivered to successive
generations of susceptible children, an immunization programme cannot be planned
as an intensive short-term effort, or delivered through mass campaigns that
cannot be sustained over a several-year period.
For this reason, emphasis
in the planning stage is given to the integration of immunization services
within the primary health care network of each country, using immiin i zatinn
to strengthen this level of care rather than promoting it as a competitive service.
This is particularly true for maternal and child health care, which is incomplete
without immunization.
WHO's catalytic role

WHO's role, at the global, regional and country levels, is that of a
catalyst.
It responds to the expressed needs and desires of Member States
while promoting attitude changes conducive to the achievement of the programme
goals.
WHO activities in support of national programmes are concentrated in
four areas.
Programme operations:
Technical cooperation in the implementation of national
programmes is provided through fellowships, short- and long-term consultant
and written materials.
Stress is placed on improving epidemiological information
systems, development and implementation of appropriate operational strategies,
integration of immunization activities into ongoing or planned primary health care
activities, especially MCH, and on developing evaluation systems to monitor
progress and suggest shifts in strategy or changes in emphasis.

Basic and applied research:
WHO is taking an active part in promoting both
basic and applied research relevant to the objectives of EPI.
Continued studies
on the nature and mode of spread of the target diseases are needed to refine
information concerning age of attack, extent of complications, patterns of
transmission, and barriers to protection with various vaccines.
Applied
research will focus on ways of improving operational strategies and on improving
the quality and appropriateness of supplies and equipment.
One of the main hurdles immunization programmes face in tropical climates
is the problem of keeping the vaccines from becoming impotent during storage or

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4

transportation.
An important research undertaking during the coming five years,
therefore, is the testing and development of suitable cold chain equipment, such
as refrigerators, cold boxes, vaccine carriers and cold packs that could be
manufactured in the countries or regions where they are to be used.
Studies on
syringes and jet injectors are being pursued to identify the most efficient,
inexpensive and hygienic means of giving injections to large groups of people.
With UNDP support and technical supervision by WHO's biologicals unit, work
is being carried out to develop more stable, more potent and less reactogenic
vaccines, concentrating particularly on pertussis, polio and measles.
Training:
EPI training activities are at present laying emphasis on the
preparation of national programme managers.
The training is based on a selfinstructional curriculum and methodology specifically designed for EPI.
In
coming years, emphasis will shift to the training of middle level supervisory
personnel.
The curricula being developed for them will cover the major
operational activities of EPI, but will have the flexibility to permit the training
and re-training of field staff according to national programme needs.
In all
courses, students will be equipped to become the teachers ol future courses
which they themselves can
give.
To strengthen national and regional vaccine
quality control and production capacities, training programmes for selected
laboratory supervisors are being initiated.
In addition, manuals have been
distributed describing WHO-recommended techniques for the production and
quality control of the components of DPT vaccine (a combined vaccine against
diphtheria, pertussis and tetanus), and which provide information on the construction-of vaccine production and quality control facilities.

Exchange of information:
Through training courses, meetings and distribution of
written materials, WHO provides opportunities for the exchange of experience,
ideas and methodologies among countries involved in the programme.
Published
materials relevant to the programme are reviewed and selected items transmitted
to key persons.
An EPI Global Advisory Group has been established which
includes national representatives from at least one country in each of WHO's six
regions.
This Group meets annually to review and assess the programme's
progress and to advise on overall strategies and policies.

Regional resources

During the coming decade, the cost of fully immunizing a child against
the six target diseases is likely to average approximately US$ 3.00.
In most
countries, half of this amount will come from national resources (particularly
covering items such as personnel facilities and operating expenses), and half
from oufside contributions (particularly covering vaccines, cold chain
equipment and transport).
Towards the end of the decade, as the goal of
immunizing every child in the world is approached, the costs - to be met by
donor agencies and governments - will increase to some US$ 150 million per
year.

WHD.79/6

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Uncomfortable challenge
The Expanded Programme on Immunization presents the world with an
uncomfortable challenge.
Smallpox eradication has in all probability been
achieved, and the uplifting success of this worldwide collaborative effort has
raised expectations of what ought to be achievable in the field of health.
The Expanded Programme on Immunization is the logical follow-up to the smallpox
programme, applying the lessons learned to many diseases instead of one, and
focusing on the establishment of permanent systems for disease prevention rather
than on a time-limited effort.
It presents an uncomfortable challenge because
its prospects for success are so bright, and the consequences of its failures are
so grim - not only in human terms, but as an admission of inability to fulfil
the promises of the primary health care approach.
However, success can be
achieved with the sustained commitment of recipient countries and the long-term
support, of donor governments and agencies.
With such commitment and support
world attitudes can be changed during the next decade so that the existence of
a single child without access to immunization services becomes just as
unacceptable as a single case of smallpox today.

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a healthy child, a sure future

WORLD HEALTH DAY, 7 APRIL 1979 • INTERNATIONAL YEAR OF THE CHILD 1979

KILLER DIARRHOEA NEED NOT KILL
by
Peter Ozorio
Information Officer
World Health Organization, Geneva

(7-JW

Cholera broke out of its south-east Asian stronghold in 1961, island­
hopping eastwards and westwards from breeding grounds in the Celebes, Indonesia.
Just about a decade later, while standing virtually on the doorsteps of the
western world, cholera took a new path - leaping clear across the African
continent, and appearing in 1970 in West Africa for the first time in over half
a century.
In the 17 years since the resurgence of that diarrhoeal disease, in what
is now referred to as the seventh cholera pandemic - the sixth ended in 1923 cholera has been reported by 80 countries in all.
The number of cases soared
from some 11 000 at the beginning of the disease's odyssey to 65 734 in 1976,
the latest full year for which figures are available.

Such a rapid spread has, naturally, put cholera in the news, catching

attention and causing consternation, largely because of its link to tourism
and trade.
All of that, of course, ignores the central fact that cholera,
headlines notwithstanding, makes up but a small proportion of diarrhoeal cases
the world over.
Not seeing the forest for the trees
According to Dr Db-iman Barua, medical officer, who is focal point of the
World Health Organization's diarrhoeal diseases programme, cholera cases
"constitute less than five to ten per cent, of the total number of acute
diarrhoea cases" reported worldwide.
Thus, while public alarm is justified,
it is a situation of not seeing the forest for the trees.
That point is perhaps more convincingly made statistically.
In the
developing countries, diarrhoeal diseases rank among the first three leading
causes of children's deaths, taking an estimated five to 18 million lives and some experts put the figure as high as 20 million - a year.
Most
frequently deaths among children under three are caused by diarrhoeal diseases.

Another indication of the problem's enormity is the estimate that during
1975, children under age five alone suffered some 500 million attacks of
diarrhoea.
The deadly nature of the disease is well documented also by

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2

the Inter-American Investigation of Childhood Mortality.

The 12-city study

of some 35 000 children's deaths published in 1972 attributes 28.6 per cent.
of the mortality to childhood diarrhoeas.

What makes the death toll so high is that affected children are generally
malnourished, a condition that renders them prone to diarrhoea in the first
place, and which, in turn is aggravated by diarrhoea.
"Malnutrition and

diarrhoea is a vicious and self-perpetuating circle", says Dr Barua.
Children between six months and two years are most susceptible to diarrhoea.

Already losing body fluids as a result of illness, they are, in far too many
cases, further weakened by the reluctance of well-intentioned mothers to feed
them - acting in the mistaken belief that it is to the good to deny food to the
child - and thus, in effect, compounding the malnutrition.
"There is no physiological basis to the common belief that the bowel should
be 'rested' during acute diarrhoea", says Dr N. F. Pierce, Johns Hopkins
University, Baltimore.

Developing oral rehydration
Recent studies on the annual incidence of childhood diarrhoea carried out
in Bangladesh, Guatemala, India and Indonesia put mortality rates at between
20 to 55 per 1000 children yearly - a rate prevalent at the turn of the
century in industrial countries.

Therefore, the reasoning is that, as in the developed world, the conquest
of diarrhoeal diseases will depend eventually on a multitude of social and
environmental factors - among them, improved nutrition and food hygiene, but
particularly the provision of adequate water supplies and sewage disposal
sys terns.
At the end of 1975, according to figures for developing countries, only
77 per cent, of urban and 22 per cent, of rural populations were served with
piped water.
And the percentages were even less for sewage disposal services
75 per cent, for urban and 15 per cent, for rural populations.

The meaning of those figures is clear:
that the foregoing as solutions
to the diarrhoeal problem are long-term ones at best, aimed at saving the lives
of future young generations.
The question of stemming the drain on life
the immediate question - however, is not being deferred thanks to the recent
development of a new method of rehydration.

Mortality from diarrhoea is due to dehydration.
If dehydration is
prevented, most deaths can be averted.
Death comes when the body loses lifesustaining fluids and salts.
In cholera, for instance, fluid losses can
reduce weight by 10 per cent. in from five to six hours.
Lives are saved
through rehydration fluids, administered intravenously by trained~health"”

workers stationed in clinics or hospitals where - indeed the onl
the fluid is stocked and can be administered.

laces

All is changing now, mainly because of the work of scientists at
Calcutta Infectious Hospital, India, and the Dacca Research Cholera
the

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... .3

oratories, Bangladesh.
Working with visiting colleagues, in particular
hose .ron Johns Hopkins, and the United States Center for Disease Control,
-Atlanta, the scientists developed a rehydration fluid based on some salts
and sugar.
In addition to being inexpensive to produce, its chief advantage
is that the fluid is not administered intravenously but by mouth, thus making
possible treatment at home.

The fxuid comprises these four components:
3.5 g of sodium chloride
(cable salt), 2.5 g of bicarbonate (baking soda) and 1.5 g of potassium
chloride.
The basic ingredients are mixed in with 20 g of glucose, to
facilitate absorption by the intestine, and dissolved in a litre (about
four measuring cups) of drinking water.
The cup over the drip

In an early test of effectiveness, under "worst possible conditions", says
Dr Barua, oral rehydration quelled an outbreak of cholera and other acute
diarrhoeal diseases among Bangladesh refugees streaming across India's eastern
border in 1971.
In one refugee camp, with some 4000 suffering from diarrhoeal
diseases, including 1600 children under age five, only three per cent, died a low rate in comparison to the 30 per cent, mortality estimated for the
entire refugee influx.
Furthermore, of the three per cent, deaths, a half
occurred before treatment began.
What made the vital difference was the decision of the camp's health
officials to treat with the rehydration cup rather than with the intravenous
drip.

Trials in the Philippines for seven months, and in Turkey for 16, monitoring
the recovery rate of two groups of children, those on and those not on a regime
of oral rehydration therapy, point up another impressive advantage in the use
of fluids against diarrhoea - monthly weight gains.
In both countries, children who were fed the fluids outgained others who
were not.
As put by Dr L. J. Mata, University of Costa Rica, San Jose:
"The
mean weight gain of non-treated children was significantly below that of-the
growth average curve".

The trials that have been carried out have all but surpassed expectation,
leading to a UNICEF decision to promote production in developing countries, but
also to distribute it themselves packaged simply as ORS (oral rehydration salts).
While such steps are long overdue, required and welcome, much more needs
to be done and, according to a recent meeting of the WHO advisory group of
experts on diarrhoeal diseases, done without delay.

Naturally enough, it is the mother who is vital in any campaign to prevent
childhood diarrhoeal deaths, but mothers, taking into account household chores,
need all the help - practical and educational - they can get.
Ideally, the
formula should be made available to them pre-packaged.
If this is not possible,
then dehydration can be prevented by giving a child, on the onset of diarrhoea,

a simpler, home-made preparation.

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4

That was well understood in Indonesia.
A four-cent plastic scoop was
developed to make easier the mother's task of measuring ingredients.
The scoop
was designed double-headed to hold 5 g of sugar at one end and 1 g of salt at the
other - the recommended amount of the two basic components in case four are not
available.
The ingredients are dissolved in 200 cc (one cup) of potable water.

Furthermore, says Jon E. Rohde, of the Rockefeller Foundation's mission in
Indonesia, efforts were made to persuade mothers that a "sick intestine needs
food to recover", and to continue to breastfeed, or to supplement diets of
sick children, in Java, for instance, with egg and honey.
Man versus machine

Whether simple or sophisticated methods are used in packaging, depends on
both the extent of the problem and of the budget.
But calculations by Norbert
'Hirshhorn, Management Sciences for Health, Cambridge, Massachusetts, showed that:

"One person can manually measure out salts and sugar by spoon measures
to make up to 100 to 300 packets per day.
A $ 5,000 to $ 10,000 mixing
machine can dispense thousands of packets per day automatically."
However produced there is no question but that oral rehydration fluids
make good economic sense.
Use of the more costly intravenous fluids now can
be reduced by about 75 per cent, and confined to treatment of severe cases,
where the patient, after losing in fluids the equivalent of ten per cent, in
body weight, is in shock.

In addition, the use of oral therapy will ease the pressure on hospital
beds.
Up to an estimated one-third of all beds in children's wards are now
filled by victims of diarrhoea.
In short, oral therapy is already proven effective.
Experts hail the
rehydration fluids as "the single most effective therapeutic tool in the
treatment of acute diarrhoeal disease."
It is inexpensive to produce.
All
that remains is to put the fluids into the hands of families.
When that is done, "very few should die if treatment can start early and,
preferably, at home", Dr Barua says simply.

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a healthy child, a sure future

WORLD HEALTH DAY, 7 APRIL 1979 • INTERNATIONAL YEAR OF THE CHILD 1979

CHILD CARE HAS CHANGED IN KASAI MOHALLA

by
Jitendra Tuli
Information Officer
WHO Regional Office for South-East Asia

There was a time, says Basanti, the village midwife, when
anything sharp that came in handy was good enough to cut the umbilical
cord, and any old piece of cloth to bind it up.
All that is changed
now with spreading awareness about health among the people, and the
opening of health centres, one of the main functions of which is
providing mother and child care.

The neighbourhood of Kasai Mohalla in Najafgarh, a town about 25 km from
New Delhi, is typical of other low-income residential areas the world over.
What makes it special is that where its two-room tenements have now mushroomed,
corn grew but a couple of decades ago.
The Kasai Mohalla - which is Hindi for a neighbourhood of butchers - is a
lively place made boisterous with children trying to coax all manner of live­
stock into some semblance of orderly living.
The locality, according to its
residents, enjoys a distinction of another kind - it is booming with babies.'
That certainly was the impression one got during a recent visit when, within
four hours, two babies were delivered by the same midwife.
There were other
points of similarity; both mothers were below 25, both had had more than one
pregnancy and each had lost a child at birth.
Also, the mothers, Preniwati and
Laddo, had both received care from their local health centre which has come to
occupy a special place in the life of the community.
It is located in the
practice field for the Rural Health Training Centre which imparts inservice
training to public health nurses, lady health visitors, medical interns from
New Delhi colleges, district-level medical officers and other paramedical health
workers.

A few hours after she delivered her fourth child, a boy, Prenswati was resting
in one of the two rooms she shares with her family and her in-laws.
Her
condition would provide her the privilege of seclusion and bed rest for at least
10 days.
During this period, the midwife and the public health nurse, who had
been looking after her ever since she registered at the health centre, would
visit her daily to help her bathe the baby and generally to look after both mother
and child.

2
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2

Their visits to Premwati's house usually develop into sessions on health
education.
As curious neighbourhood women and children gather in the courtyard
they are given tips on personal hygiene, told of the special nutritional
requirements of mother and child and advised on how these can be obtained from
locally available foods and vegetables.
The mothers are also encouraged to
continue breastfeeding.
The small courtyard usually overflows with eager
listeners.
More conscious of health

According to the centre's midwife, who has been serving in the area for the
past 26 years, the people of Najafgarh are definitely more conscious now of
better health practices.
This is confirmed by Basanti, one of Najafgarh's
most popular dais (traditional midwives), who long ago lost track of the number
of babies delivered by her, and who has added to her experience a six-month
training course at the health centre.
Recalling her earlier days, Basanti says there was a time when anything
handy that was sharp enough could be used to cut the umbilical cord.
And to
tie it up, a tassel from the corner of a sari or a length of thread pulled out
from a woven sheet or quilt would do.
She claims that she has never lost a
mother or child as a result of post-delivery infection, but after some gentle
prodding of her memory she describes infants dying from a disease whose symptoms
suggest tetanus.
However, all that is in the past.
Now, all pregnant women
registered with the centre are protected against tetanus.
This explains the
absence of neo-natal tetanus cases in the records of the centre.

"Oh, things are so different now", affirms Basanti.
She points to the
large pan of water boiling in the adjoining room.
For the next 10 days,
Premwati and her baby will use only boiled water for drinking and bathing.
Visiting health workers will also show her how to carefully wash the baby's
clothes and dry them out in the sun.
Premwati does not lack guidance and the wisdom of experience, though.
Her mother-in-law, Imrati, who lives in the same tenement, gave birth to 11
children, seven of whom survived the critical childhood years.
Her father-inlaw, who works in the local municipal office, explains how much help the
midwives, and other health staff from the centre have given the people in his
community.
Because of the health centre, he says, everybody in Kasai Mohalla,
or for that matter, in Najafgarh itself, has easy access to health services.
"This is so different from the days when I was a child.
We had to travel for
miles to get to the nearest dispensary.
And if you had a minor ailment, you
just waited until it took care of itself.
I remember we used to lose so many
young children due to some disease or the other".
On an average, the health centre receives over 500 outpatients every day.
These include farmers with minor injuries sustained in the field, children
with diarrhoea, anaemic mothers and malnourished children, to name a few.
Laddo's baby

The centre's involvement in the community, and vice versa, is more than
confirmed in the case of Laddo, the other mother who does not have the benefit
of advice from her mother-in-law.
Her husband, at 27, is the family elder,
and mostly away at work as a mason.
Her single-room, thatched-roof dwelling
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is shared by her husband's younger brother and sister and her own six-year-old
son, Rajesh.
In deference to tradition, a length of steel chain and a steel
knife had been kept under the bed where Laddo and her infant daughter rested.
The chain and knife are supposed to ward off the evil spirits that startle and
frighten the child.

Unlike Premwati, who registered at the health centre when she was more
than four months pregnant, Laddo came to the centre's notice during the public
health nurse's routine visit to the locality.
The public health nurse says
that two questions that the health workers make it a point to ask on their
rounds are;
if any woman is "with child", and if anyone is ill.
"That's how
we came to know that Laddo was pregnant", she says, "we immediately made out a
card for her, and since she was anaemic, we began the necessary treatment.
From then on, till her delivery, her progress was carefully followed".

Now that the baby has arrived, Laddo gets the necessary care and advice
during regular visits by the health workers.
Among other things, they will
see to it that the baby gets the necessary immunizations in time.
They also
maintain a link with the municipal health authorities to whom they report all
births and deaths.

In acknowledging the help she gets from the health workers, Laddo shyly
adds that if she had come to know of them some years ago, she, perhaps, would
not have lost her first child who was stillborn.
Looking at her daughter
lying snugly by her side, she adds that the baby, who was born prematurely,
would never have survived but for the facilities of the health centre.
Pointing
to Rajesh, she recalls that recently the boy was badly hurt while playing.
The
health visitor took him to the centre where his wound was stitched up and he was
provided with timely medical aid.
In many villages not very far from Najafgarh,
Laddo says, such aid is not yet available.

To promote health in communities such as Kasai Mohalla, a great deal remains
to be done.
But the fact is undeniable that something is being done.
A
beginning has been made, and the fact that Laddo's tiny daughter lives is an
eloquent testimony to the effectiveness of primary health care at work.

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a healthy child, a sure future

WORLD HEALTH DAY, 7 APRIL 1979 ■ INTERNATIONAL YEAR OF THE CHILD 1979

MOTHER AND CHILD HEALTH:

A FACT SHEET

Infant
mortality
- The average world-wide infant mortality rate is estimated at 83 deaths p.er
1OOO live births.
Or, stated another way, one baby out of 12 dies during
the first year.”

«->

- In developing countries, the infant mortality rate is generally from 10 to
20 times higher than that of developed countries.
At the turn of the
century, the rates for developed countries were similar to those for
developing countries today.
- Infant mortality rates reach a high of 200 per 1000 live births in some
developing countries.
Among developed countries, Sweden recorded the
lowest rate of 8.3 deaths per 1000 in 1976.
- A goal set for the year 2000 is the achievement by all countries of a rate
of less than 50 deaths per 1000 live births.

- In 1978, of an estimated 122 million children born, between 10 and 12 million
died before reaching their first birthday.
About 77%. of these deaths
occurred in Africa and South Asia.
- The Inter-American Investigation of Childhood Mortality, a 12-city study of
35 000 deaths of children under five years, published in 1972, showed 79% or 27 000 deaths - as occurring in infants not yet a year old.
- The study showed nutritional deficiencies, coupled with low birth weight,
as the underlying or associated cause of death in 57% of the cases
investigated.

Rates are calculated on the basis of statistics compiled for different
periods of life.
The following are the terms used:
Perinatal period:

The period from the twenty-eighth week of pregnancy
to the seventh day of life.

Neonatal period, early:

The first seven days of life.

Neonatal period, late:

Up to the twenty-eighth day of life.

Post neonatal period:

From the twenty-eighth day of life to the end of
a year.

Infant mortality:

Deaths during the first twelve months of life.

Childhood mortality:

Deaths occurring from age one to four.

The last two are most commonly used as an indication of the health of
children and as a gauge of social development.
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Age:
1-4 years

- Overall, childhood'mortality rates are falling but the decline varies from
country to country.

- Accidents and congenital malformations are the two leading causes of death
for the age group one to four in developed countries, and enteritis and

diarrhoeal diseases along with influenza, and pneumonia in developing
countries.
In some developing countries, childhood mortality accounts for 33% of all
deaths, while in most developed countries it accounts for less than 1%.
Age:
1-11 months
- In developing countries, an estimated 60 to 807. of childhood deaths occur
between the ages of one month and one year.
These deaths are attributable
mainly to socio-environmental causes such as infectious diseases and
nutritional deficiencies.
Among the former, diarrhoeal disease is the
first and pneumonia the second cause of death.

11/
'

1/
'

- Of the 35 000 deaths studied in the Inter-American Investigation of
Mortality, 427. - or 14 800 deaths - occurred during the post neonatal
period.
Nutritional deficiencies took their highest toll during the third
and fourth months after birth.
- The more serious the malnutrition in mothers, the more uncertain is the
future of the children;
and the greater the number of offspring, the more
serious the risk to mother and child.
- Studies show that post neonatal mortality increases steadily with birth
order, and that infants born into already large families run a higher risk
of death from infectious diseases.

- In developed countries, almost all neonatal deaths, that is up to the
twenty-eighth day of life, occur during the first week after birth, with
the first 24 hours the time of greatest risk.
Before and
after birth

- Intrauterine asphyxia, malformations, injuries, and infections are among
the main causes of death during the perinatal period, that is shortly before
and after birth.
- Of 3.1 million babies born in the United States yearly, nearly 31 000 do not
survive the first week.
Another 34 000 die in the uterus during late
pregnancy.
- Figures for 1975 in WHO's data bank show perinatal mortality rates ranging
from 11.1 per 1000 live births to 60.2.

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Weight
at birth

Birth weight is an indicator of health.
In virtually all countries, the
weight of a child born to affluent families is higher than that of a child
born to underprivileged families.
The Inter-American study showed that the less the baby weighs at birth,
the greater the chances of death.
Close to 707. of the 8732 infants born
in hospital who died in the neonatal period weighed less than 2500 g (about
5 lbs) at birth.
- Among factors influencing birth weight are:
the health, size and nutritional
status of the mother; her obstetrical history;
smoking during pregnancy;
the order of birth of the child; and the interval between births.
- In the developed world, the rate of low-birth-weight babies ranges from
2 to 3% in some countries, and from 7 to 107. in most other countries.
In
developing countries, from 25 to 45% of all babies born are under weight.
- In the developed world, under-weight babies are generally born prematurely.
In developing countries they are born full-term to undernourished mothers.
- More than 23 million low-weight babies are born yearly - 22 million of
these in the developing world, where intrauterine growth retardation is a
major problem.

*

»"
-

- Studies of twins, followed through the ages of seven and eleven, show that
a few hundred grams difference in weight at birth results in significantly
different school performances.

- Studies by the Institute of Nutrition of Central America and Panama,
Guatemala, show that the average birth weight can be increased by more than
100 g (just under 4 oz) through supplementary feeding of undernourished
mothers.
- In southern India, the treatment of anaemic mothers led to an increase in.
birth weight of offspring.

Height, an
indicator
- Height, as well as weight, is a reliable health indicator.
Shortness in
any child population is less likely related to genetic factors, than to
malnutrition and infection.

- With the exception of a few ethnic groups, there is evidence showing that
all children have a similar growth potential.
- A study of pre-school nutrition in Colombia shows more growth retardation
in families with five and more children than in four-children families.

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The breast-fed
are healthy
- Studies confirm that mortality and morbidity rates are substantially lower
in infants exclusively breast-fed than in others partially or fully bottle­
fed.
- A study in Chile shows breast-fed children three to five times less
susceptible to diarrhoea than bottle-fed children.
An Indonesian survey
found 9O7» of feeding bottles contaminated with faecal microorganisms.
- There is no better food for babies than breast milk, according to a WHO
expert committee on maternal and child health.
However, breast-feeding
is on the decline in most parts of the world.

AC

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VI'

- Even during the weaning period, breast-feeding should continue.
- In addition to protecting the child from infection and improving infant
nutrition, full breast-feeding may also suppress or retard the start of
ovulation and thus result in reducing fertility on the whole.
Deaths of
mothers

- In the developed world, some countries report maternal mortality rates of
less than 6 per 100 000 live births.
In the developing world, maternal
mortality ranks among the main causes of death in women between ages 15 and
45.
- Figures in WHO's data bank show rates of maternal mortality ranging
from 3.2 to 349.9 per 100 000 live births.

- In the developing world, maternal mortality is generally high in the first
pregnancy, and lower in the second and third.
The risk rises with the
fourth pregnancy, and reaches high levels after the fifth.
Yet 40% of all
deliveries fall in high risk categories.
- A world-wide survey of maternity care, carried out in 1966, showed more than
half of all pregnant women as receiving neither trained antenatal super­
vision nor skilled help during labour.
With a few exceptions, the
situation remains unchanged today.

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