MEDICO-SOCIAL PROBLEMS OF TODAY'S YOUTH

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Title
MEDICO-SOCIAL PROBLEMS OF TODAY'S YOUTH
extracted text
swastb hind
* Medico-Social Problems of Todhyk Youth/;^
* The other side ^femack-Addigffi^^®
* Nutrition Education at School Level;
i
* Nutrition and Mental Development^
* Commonsense can avoid Accigen^^

* 'Epilepsy Education and its Evaluation
* Cough and Cough I
* Iatrogenic Corneal
* Popularising Breastfeeding a^amethod df’Cpntraception—A Study
* Plastic Surgery has Special Role -in India, says
Shri Rajiv .Gandhi

I-

In this Issue

May 1987

Vaisakha-Jyaishta

VoL XXXI, No. 5

Saka 1909

/

READERS WRITE

Though I am a man of Mathematics, Swasth Hind
has given me a lot of information regarding healthy lives.
Any lay man who wants to have more information about the
recent inventions in medical science can get plenty of
knowledge from this magazine.
I have liked very much
your issues on Cancer, and Heart disease (July 1985).

I:

Page No.

i
I

Medico-social problems of today's youth
Lt. Col. A. C. Urmil & Col. P. K. Dutta

101

'•

The other side of smack-addiction
Dr M. S. Bhatia & Dr N.K. Dhar

104

Nutrition education at school level
Dr A. C. Moudgil. Dr S. K. Verina

107

i

j
|

Dr Parmjit Kaur, Ms Amita Ummat &
Ms Raman Mehta
Nutrition and mental development
Dr R. D. Shanna

110

Commonsense can avoid accidents

114

!

I

Dr Madhuban Gopal

11

—SRI RATNAKAR PALO, MSc.

Lecturer in Mathematics
Sanjaya Memorial Institute of Technology,
Gollapalli Street,
P. O. Berhampur-760001
Distt. Ganjam (Orissa)

Editorial and Business Offices
Central Health Education Bureau
(Directorate General of Health Services)

Kotla Marg, New Delhi-110 002

Epilepsy education and its evaluation
Prakashi Rajaram & Dr R. Parthasarathy

117

Cough and cough
Dr J. N. Pande

119

Iatrogenic Corneal Ulcers

121

Single Copy
Annual
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122

Dr. G. Gurumurthy
Savitha’s sad story
Dr R. L. Bijlani

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Dr Swatantra Shanna, Dr Prakash Gupta &
Pradeep Kumar Gautam
Popularising breastfeeding as a method of
contraception—a study of Yanadi tribal
women in Andhra Pradesh

Plastic Surgery has special role in India, says
Shri Rajiv Gandhi

125

127

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The contents of this Journal are freely reproducible. Due
acknowledgement is requested.

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The opinions expressed by the contributors are not neces­
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MEDICO-SOCIAL PROBLEMS OF
TODAY’S YOUTH
Lt Col A.C. Urmil & Col P.K. Dutta
It is high time now to pay immediate attention to the medico-social problems of youth,
analyse their aetiology, magnitude and find a solution so that the youth energy can be
properly harnessed and given a twist in the right direction towards social progress.
'Flant'ng youth has become a flaming question. And
youth comes to us wanting to know what we may
purpose to do about a society that hurts so many of
them.'

—Franklin D. Roosevelt.

nd whatever Roosevelt spoke about youth half a

A

Today’s
youth is a confused and bewildered lot.
He has
been finding it more and more difficult to adjust and
adopt himself to the fast pace of social change that
has particularly shaken up the last century or so.
Widening of generation gap, conflict of moral values,
uncertainty about future career and lack of proper
guidance have been the real causes of the youth re­
volution so noticeable all over the world. It has been
rightly said that this reckonable youth force is like
a flood which must be controlled and shown proper
direction, failing which it is likely to sweep away the
gains of social progress so far achieved and leave
the society struggling in turbulent water. The signs
of this have already started appearing in the form of
much of the violence, drug abuse, feeling of frustra­
tion and aimlessness among the youth. It is high
time now to pay immediate attention to the prob­
lems of youth, analyse their aetiology, magnitude
and find a solution so that the ‘youth energy’ can be
properly harnessed and given a twist in the right
direction towards social progress. Rightly, therefore,
the United Nations voiced their concern and drew
public attention by declaring 1985 as the ‘Interna­
tional Year of the Youth’ and the World Health Or­
century ago, still holds good today.

May 1987

ganization adopted ‘Healthy Youth: Our Best Re­
source as the theme for the World Health Day in
1985.
Population explosion

Any problem connected with youth should be im­
mediately taken note of because of their sheer number
alone. It is expected that by the turn of this cen­
tury, the young population in the age group 15 to 24
years will reach some 1,128 million. In India this age
group accounted for 16.6 per cent of our total popu­
lation in 1971 which increased to 18.6 per cent in
1981, an increase of about 12 per cent. The popu­
lation explosion itself has been a major factor lend­
ing immensity to the problems of youth. It is felt
that by solving this problem of ‘population explosion*
alone, the country will be able to mitigate most of
their problems.

Education policy

Correct educational policy in respect of youth is
another major area of our concern. The present
system of education has miserably failed to meet the
psycho-social requirements of the youth in toto. Un­
til now it has only been providing a passoprt to their
future employment. With growing unemployment, the
system has lost this utility and the youth their faith
in the education being provided to them. It is de­
sirable that the education should instill in them a
sense of responsibility towards themselves, their fa­
milies and the society at large. It should also give

101

them a sense of belonging, help them make self sup­
porting and a disciplined lot. The National Educa­
tional Policy should not overlook the specific needs
of the youth.

One of the major causes of frustration among youth
has been a growing uncertainty about employment
opportunities. There is a felt need to have a comp­
rehensive plan to rehabilitate all unemployed youth
and to give priorities to those activities under Five
Year Plans which will create maximum employment
opportunities. The rush for service which is the ambi­
tion of many youths should be stopped and encou­
ragement provided to settle them in business, agri­
culture, handicrafts and small scale industries either
on individual or cooperative basis. For this, neces­
sary guidance, training and financial help should be
made available to them.
Health problems

Youths have fallen victim to cetrain health prob­
lems, multifactorial in origin, with a variety of psy­
cho-social contributory factors. Most of these prob­
lems develop during adolescence which is a very
crucial transitional phase from childhood to adult­
hood. This period is fraught with danger to mental
health and may result in ‘juvenile delinquency’. A
juvenile delinquent is one who has deviated from ac­
cepted normal behaviour in interpersonal relations
and social life and may be labelled as incorrigible, in­
disciplined, disobedient, immoral or anti-social. A
change in socio-cultural pattern resulting into broken
aomes, unhappy home atmosphere and lack of healthy
ecreational facilities has been the basic reason for rise
in juvenile delinquency in India as elsewhere during
the last few decades. The highest incidence is en­
countered in children aged 15 years and above and
the incidence is four to five times more common among
boys than among girls.
Sexually Transmitted Diseases

During recent times a world wide concern has been
voiced about the growing incidence of Sexually
Transmitted Diseases (STD) among teen-agers. Sur­
veys carried out by various workers in our country
have revealed a high proportional case rate in respect
of youth.
The Central Health Education Bureau
(CHEB), in their pilot study in Government hospi­
tals of Delhi in 1981 found that an overwhelming
majority of victims were youths.
Similarly another

102

survey carried out in Lucknow reported that 60 per
cent of the patients surveyed were students. Most of
the patients admitted that they had their first sexual
exposure around 18 years of age. Various surveys
also reveal that premarital sex is increasingly becom­
ing an accepted way of behaviour. The prostitutes
still happen to be the main source of infection in our
country although the ‘good time girl’ has replaced
them ini many other countries. Lack of proper sex edu­
cation, inadequate parental supervision, broken homes,
lack of healthy recreation, easy availability of sex thril­
lers and other pornographic material, easy availabi­
lity of contraceptive devices and permissiveness have
all contributed towards this growing incidence of STD
among youth.
Adolescent girls

Special attention should be paid to the problems
of adolescent girls. In many societies the girls have
not been provided with same opportunities as in the
case of boys in respect of education, health care, em­
ployment, etc. They are in no way inferior to boys
and their education should not be neglected. In 1975,
it was estimated that out of 800 million illiterates in
the world, majority (60%) were females. Besides
general education, the adolescent girls need to be
old about their role as would be mothers and gover­
nesses of the household and be prepared for the same.
Similarly the adolescent boys will also need to be
trained for their future role as fathers and heads of
the families. Education on planned parenthood em­
phasising the evils of population explosion and de­
sirability of small family norm must form an indispensible part of education of adolescents of both the
sexes.
Drug addiction

On the drug front, the picture is getting more dis­
mal. It is no wonder, if today’s frustrated and neg­
lected youth, with misguided curiosity, seeks a so­
lace in addiction to drugs which are so easily avail­
able. Various surveys carried out among college
students in our country reveal that a large propor­
tion of them are addicted to drugs. The proportion
was found to be 33 per cent and 37.4 per cent res­
pectively among students of Delhi and Calcutta Uni­
versities. In U.S.A., it is estimated that 12-20 mil­
lion people smoke marijuna and 30 to 50 per cent
of all high school students have accepted it as an

Swasth Hind

Special attention should be paid to the problems of adolescent girls. They need be pre­
pared for their role as would-be mothers and governesses of the households.

mdispensible part of life. It is feared that by the
year 2000 AD when ‘Health for AH’ is to be attained.
India will be having nearly 15 million drug addicts.
Besides the problem of drug addiction, the youth
needs to be protected from the health hazards asso­
ciated with alcoholism and smoking. Efforts on war
footing are required to impart health education and
guide the students, teachers, parents, social workers,
etc, on various aspects of preventive measures against
drug abuse and their role in implementing these mea­
sures. Steps need be
taken to enact necessary
laws if required to stop the drug proliferation and to
arrange for phychiatric help to addicts, where required.
A newer concept in the form of ‘Youth Guidance
Clinics’ may be given a serious thought on similar
lines as ‘Child Guidance Clinics* for a comparatively
younger lot.
Youth and accidents

The youth should also be cautioned against acci­
dents. Motor vehicle accidents, drowning and bums
happen to be the predominant causes of accidental
deaths among 5-24 years age group in the U.S.A.
In India also accidental deaths are on increase parti­

May 1987

cularly road accidents which account for nearly 33
per cent of all accidental deaths. While extraneous
factors responsible for such accidents must be con­
trolled, the children and youth should be taught pro­
per road discipline, traffic rules and made accident
conscious.

Lastly, the Government through existing schemes
institutions and also various voluntary organisations
should pay special attention to the problems of dis­
advantaged young people (such as those who are
illiterate or could not complete their education; rural
youth who finds himself at a disadvantage vis a vis
his urban counterpart in various competitive fields;
slum dwellers; mentally and physically handicapped
youth; adolescent social deviants, etc) and rehabili­
tate them by instilling in them a ray of hope, by as­
suring them that they are wanted, by guaranteeing
them economic independance and by paying prompt
attention to various other factors adversely affecting
their physical, mental and social development. Any
further neglect of our youth will be suicidal on our
part and attainment of ‘Health for All by 2000 AD*
would be a far fetched dream never to be realised. A

103

THE OTHER SIDE OF
SMACK—ADDICTION
Dr M. S. Bhatia & Dr N. K. Dhar
More research is needed to find out the causes and factors predisposing to drug addiction.
It can also help in finding out better alternatives to the “at risk” individuals at a time when
they are at the verge of becoming drug addicts.
long used psychoactive drugs not only
to enhance pleasure and relieve discomfort, but
also to facilitate the achievement of social, religious,
and ritualistic aims. But during the last decade, many
countries have experienced new trends or problems
related to drug-abuse.
Many people have become
addicted to socialiy-“unacceptable”, “disapproved”,
and “unfamiliar” drugs, which are not only highly
potent but also quite difficult to be got rid off.
an has

M

Problem

The commonly abused drugs are usually classified
according to the effects they have. Therefore, there
are three broad categories most drugs fall into—
depressants (for example—barbiturates, and narco­
tics like Mandrax, Heroin), psychedelics (for ex­
ample—Hashish, Charas, Ganjd) and stimulants (like
Cocaine, and amphetamine).
Out of these, depres­
sants are quite dangerous because they produce a
strong physical and psychological dependence (thus
producing a wide spectrum of withdrwal symptoms
when stopped).

Narcotics or opiates are easily available in the
streets of many cities including Delhi, Bombay, etc.,
under various names as “Horse”, “Morph”, “junk” and
“Chandu”. Out of the opiates, Heroin (which is 200
times more potent than Morphine) is sold under the
various terms as—“Brown Sugar” and “Gardh” in
Bombay, “Smack” and “Powder” in Delhi, “Sakos”
(Sugar), “Skag”, “Peeta” (powder), “Brown Sugar”
and “Cold Turkey” in Goa.
Not only is the number of addicts increasing but
also more and more younger people, coming from all
socio-economic status, are becoming involved. Like
no drug before, it is uniquely equipped to wreck the
greatest amount of damage in the shortest period'. In
Sucheta Kriplani Hospital, during 1982 to 1983, 60
per cent patients who came for de-addiction were al­
cohol addicts while 20 percent were taking canna­

104

bis; 15% other narcotics and 5 per cent were using more
than one drug but none of them was Heroin or
“Smack” addict. But from 1984 to June 1986, the
persons who came for de-addiction included as many
as 80 per cent ‘Smack” addicts. These cases came
more from younger age-group 15-25 years and 20
per cent were having age less than 15 years (many
were school children). Most of them were using this
drug in variable amounts ranging from half to five
grams. The methods employed were snuffing, inha­
lation or injections. .
Why they become addicts

Personal causes—Whether or not a given person
develops dependence on a particular drug will de­
pend on the interaction of three factors :
(a) The personal characteristics and experiences of
the individual taking the drugs : Modem research
in Neuro-Biochemistiy has found out that these per­
sons who become drug addicts lack a chemical subs­
tance called “Endorphins” in their brain, so they seek
artificial sources to fulfil the deficiency of these chemi­
cals necessary for the performance of proper congnitive functions with concentration and interest. Such
persons form a separate special group of drug addicts
who are very difficult to treat and if they are de-addicted, they are again prone to addiction. This is
the explanation why out of every ten who experi­
ment with these drugs, only one becomes an addict
The other special group consists of persons who are
either suffering from minor or major psychiatric
problems (for example—depression, anxiety neuro­
sis, Schizophrenia and various personality disorders)
are more prone to addiction. This constitutes a spe­
cial group because the successful treatment of these
patients primarily consists of treating the underlying
psychiatric illness.
In USA, a study conducted on drug-addicts has
found that! these drug addicts are not simply drug
addicts but as many as 30 to 60 per cent of them

Swasth. Hind

suffer from various underlying psychiatric disorders
ranging from simple anxiety neurosis, depression to
personality disorders (the most dangerous being the
antisocial personality disorder which tend to demons­
trate criminality at times).
(b) The second important factor being the nature
of move immediate socio-cultural millieu : The so­
cio-cultural precursors which facilitate initiation of
drug-use are—problems within the family such as
break-up, divorce, violence, repression and most im­
portant is the lack of communication. The problems
of drug abuse can often be traced back to communi­
cation problems between parents and adescents. If
the parents are very strict, or very permissive, to
the point of being neglectful, their child may turn to
drugs as a way of dealing with the situation. Tolstoy
once said, ''Every unhappy family is unhappy in its
own way”:

Other factors
— 'low self-esteem and little sense of belonging to
the community.
—- frustration, unemployment,- increasing mobility
particularly of youth.
— peer group pressures.
— an abundance of information about the drug effect
and sources.
quest for pleasure.
—. curiosity or defiance of a taboo.
— a response to despair, nervousness, timidity, dep­
ression, boredom or rebellion.

■ (c) The pharmacodynamic characteristics of drug
used, taking into account also the :
— amount used
— frequency of use
— route of administration (ingestion, inhalation or
— injection)
— ready availability of drug and the general pub­
lic acceptance of the use of these “mood modi­
fiers” because one socially acceptable drug abuse
predisposes to other which may not be socially
approved.

The experimental and, or casual use are necessary
precursors to dependence on drugs.
Complications

There are many side-effects of Smack intake rang­
ing from nausea, loss of interest, lethargy, constipa­
tion, impotence, cirrhosis of liver, hepatitis, seda­
tion, abscess, coma and now may be AIDS (ac­
quired through infected syringes or sexual perver­
sions like homosexuality common among drug ad­
dicts). The intake of this kind of drug also suppres­
ses those drives that motivate an individual to feel
hungry, seek sexual gratification and respond to pro­
vocation with anger. In short, they seem to produce
a state of total drive satiation. Some narcotic users

May 1987

say that opiate type drugs give them a pleasant ‘float­
ing’, ‘drifting’ or ‘coasting’ sensation and that every
thing seems to be all right.

The cost of refined Heroin is around Rs. 400 per
gram while that of crude one is between Rs. 20 to
Rs. 40 per gram.
Withdrawal syndrome

Heroin is 200 times stronger than the raw opium
in its physical, psychological and withdrawal effects.
The abstinence (withdrawal) syndrome consists of a
complex of symptoms and signs which include rest­
lessness, body-aches, yawning, lacrimation, running
nose, sweating, flushing, trembling, nausea, diarrhoea,
increased body temperature, and blood pressure, loss
of appetite and body weight. A lay man can judge
a person for Smack intake from the size of pupil (in
eye) (the pupil being pinpoint if the person has taken
the drug).
These withdrawal symptoms are because of adap­
tation of body to the physiological changes resulting
from- drug intake.

The withdrawal symptoms due to psychic depen­
dence are—anxiety, lack of concentration, irritability,
altered behaviour, sleeplessness and even depressed
mood.

The abstinence syndrome appears within, a. few
hours of the last dose, reaches peak intensity in 24
to 48 hours and then subsides gradually within two
weeks time. Thus two weeks time is the crucial time
for patient to suffer these intolerable symptoms.
Management

Inspite of the phenomenal increase in the number
of drug (Smack) addicts, there is limited hospital fa­
cilities and low priority is accorded to drug addicts.
Only few hospitals in Delhi have facility of admission
for drug addicts (eg—G.B. Pant Hospital in New
Delhi has 4 beds but these are only for women.
These hospitals also run De-addiction clinics once a
week).

(a) Treating drug addicts—The basic determinant
of success in treatment of drug addicts is high moti­
vation (higher the motivation, the better is success).

The drug therapy is not the only solution for the
treatment of drug addicts.
There are a great number of people who have a role
to play in dealing with drug use and they are to be
found at different levels of social structure. They
include

— The legislative authorities who make laws and re­
gulations (strict is the law, the better is control,
e.g. as in USA, Germany)
— Public administrators to control the drug avail­
ability

105

— Health (mental and physical) and social service
professionals
— Drug treatment (psychiatric
search centres

services)

and

re­

— School administrators to create awareness
among children because 42 per cent of our popu­
lation consists of individuals less than 15 years
of age
— University services and counselling

— Community services and educators
— The Media helping in advertisement and health
education.

The treatment is more successful if:
— person is taking less dose and addicted to only
one type of drug,
— newly addicted and highly motivated,
— good premorbid-adjustment,

— person has no other obvious stresses or psychia­
tric problems,
and the most important

— good family support.
(b) Relapse—About 80 per cent of the addicts re­
sume their habit within six months.
The main causes of relapse are:

■— presence of overt or latent psychiatric illness,

— poor follow up of patients,

If it is believed that an alteration in legal control
will result in an altered prevalence of a particular
problem, data should be gathered to confirm or re­
fute this expectation.
(ii) Education—Knowledge, in itself is not neces­
sarily protective if the drug is readily available. Re­
ports show that the incidence of dependence on res­
tricted drugs is in many communities higher among
members of the health profession than in the general
population.
It throws doubt upon the preventive
value of knowledge about the dangers of drugs and
emphasises the importance of drug availability as a
factor in the deviant use of drug. So educational pro­
grammes should avoid the danger of promoting an
unnecessary and excessive interest" in dependence pro­
ducing drugs.

(c) At risk approach—Advanced techniques are
needed to influence the groups of the population par­
ticularly “at risk” of becoming drug dependent, that
is, adolescents, individuals in occupational groups
having ready access to drugs, persons with deficiency of
Endorphins in brain, persons suffering from psychia­
tric illnesses like delinquency, sociopathic personalities.
depressives, etc. According to a survey conducted
by NIMHANS, Bangalore, around 35 million people
in India suffer from some minor psychiatric illnesses
like anxiety neurosis and about 15 million from ma­
jor psychiatric illnesses like depression, mania, schizo­
phrenia, etc. So this group is always more prone
to drug addiction because only few patients have
access to psychiatric treatment due to scarcity of psy­
chiatrists.

— easy availability of drug and continuous peer
pressure,

According to Kramer and Cameron (Senior Medi­
cal Officers, WHO), “Unfounded scare or fear tactics
tend only to discredit and, therefore, are not likelv
to be helpful and may be harmful”.

— out door treatment because only few hospitals
have the facility for admission and so the out­
come of treatment is poor.

The school class may be developed as a special
form of the “therapeutic community” to treat the
disturbed child early in his school career.

— poor rehabilitation services,

(c) Prevention:
Methods of prevention can be considered in three
headings:

(i) Legal control restricting the availability—It
may be aimed at the user, curtailing his liberty or
imposing other restraints upon himself if he illegally
possesses or uses the substance.

In general, when a drug is legally and readily avail­
able in a community, variations in the prevalence
of dependence on the drug correspond directly to
the extent of its use.

The excessive use of certain drugs and the related
high prevalence of dependence on them in particular
communities appear to have been associated with
promotion by advertising. Further more the adver­
tising of pharmaceutical preparations in some coun­
tries may have had the result of encouraging the
free and uncritical use of drugs in general.

106

The advertisement without" proper preventive and
rehabilitative treatment is going to create more curio­
sity in “at risk” individuals to experiment these drugs
(for example, statutory warning on cigarette packets
had no effect' on the sale of cigarettes).
It can be
concluded that only the drug treatment of these ad­
dicts is not the end (just like as if the leaves of an
infested tree are sprayed with insecticides without
paying attention to the infected roots), thus, it needs
much more than this.
Research

More research is needed to find out the causes and
factors predisposing to drug addiction.
It can also help in finding out better alternatives to
the “at risk” individuals at a time when they are
at the verge of becoming drag addicts.
O

Swasth Hind

NUTRITION EDUCATION AT
SCHOOL LEVEL
Dr A. C. Moudgil,

Dr S. K. Verma,

Ms Amita Ummat

&

Dr Parmjit Kaur,

Ms Raman Mehta

Nutrition education programme is required in the elementary and secondary schools along
with the comprehensive health education programme. It affects attitudes, knowledge and beha­
viour of children in relation to food. At different school levels, a series of learning experiences
should be developed regarding different aspects of nutrition such as accepting a variety of foods,
realizing that individual differences exit in requirement and use offoods, and realistically evalua­
ting his own nutritional practices. Inservice teacher education should form an important aspect of
the health education policy. The emphasis should be on prevention-through-education approach.
nutrition education programme that
begins in early childhood and continues through
the elementary and secondary schools, can help young
children to acquire a positive attitude toward food.
Also, it can help older children assume responsibility
for their own food selection and prepare them for
adult and parental responsibility for food-selection.
dynamic

A

Comprehensive health education programmes in
elementary and secondary schools offer exceptional op­
portunities to make effective nutrition education avai­
lable to a large number of children. The course of
study has to be heavily based on human ecology,
namely, a study of man in interaction with his environ­
ment.
According to Sinnacore and Harrison (1971),
by environment we do not mean just those elements
provided by nature but also those aspects of the en­
vironment introduced by man, such as pollutants of
air and water, cigarettes, food additives, chemical
fertilizers, insecticides, hybrid varieties and the myriad
of drugs now available in our society.
The nutrition education programme is urgently re­
quired.
Problems such as drug abuse, alcoholism,
lung cancer and malnutrition do not represent medical
failures but educational failures.
The drug addict,
the alcoholic, the lung cancer patient and malnourished
individual may be seriously damaged or reach a point
of beyond help by the time he consults a physician.

May 1987

It is now recognised that prevention through educa­
tional approach conserves not only people but money
as well; rehabilitation is always much more expensive
than prevention.
Food, nutrition and health cut across many areas <
learning, therefore, these subjects lend themselves to
integration into the school programme without requi­
ring large and special allocations of time in the al­
ready crowded school curriculum. Nutrition is re­
quired as a part of health education in the schools.
Other disciplines, for example, home economics, bio­
logy and general science have much to contribute in
nutrition-education as well. Ideally, these disciplines
should play complementary role in providing a rich
and varied experience. But, basic nutrition education
should be made available to every child—college­
bound or not'; boys as well as girls—on a continuing
basis.
Preparation for nutrition-related responsibilities

The curriculum-guides in nutrition are geared to
ward preparing the student for the two types of nutri-1
tion-related responsibilities which individuals have in
our society. These are—

1. To make reasonably adequate choices in selec­
ting his own diet and that of anyone for whom
he selects food.

107

2. To develop and express informed opinions on
issues of public policy which affect nutrition.
Nutrition education is concerned with not only
the student (his attitude, his knowledge and his
behaviour for the next week or the next year)
but also when he becomes a parent and a vot­
ing citizen several years from now.
To affect
attitudes, knowledge and behaviour, we need
programmes which do more than repeat irrele­
vant phrases about how many servings a day,
of which food-groups should be eaten for good
health.
Our goal should be to guide the be­
haviour of children in relation to food, not to
“teach nutrition”.

The child entering school is not a blank slate when
it comes to ideas and feelings about food. Some edu­
cators have failed to recognise that although a student
is not acquainted with the teacher’s concepts about
food and nutrition, he does have concepts of his own.
Everybody eats and everybody has a conceptual frame-

the child to develop positive attitude toward food and
eating; accept a variety of foods; recognise differences
in how and what people eat and begin to understand
the relationship of food to health and growth.

At the intermediate level, the curriculum is geared
toward helping the student to understand in some
detail the relationships among food, health and growth;
understand and apply principles for selecting food to
meet nutritional need; develop an appreciation of food
as part of man's physical and socio-cultural environ­
ment.
At the junior high school level, the learning experien­
ces work toward helping the student to apply know­
ledge of nutrition to everyday situation; realize that
individual differences exist in requirement and use of
foods: appreciate the effects of social and environmen­
tal factors on nutritional health; and realistically eva­
luate his own nutritional practices.

The child entering school is not a blank slate when it comes to ideas and feelings about
food.
Some educators have failed to recognise that although a student is not acquainted
with the teacher’s concepts about food and nutrition,
he does have concepts of his
own....Our task is to help the child build nutritionally viable concepts, while'respecting
those viable concepts he already has and are part of his family and cultural background.

work within which he makes decisions about what he
eats. Our task is to help the child build nutritionally
viable concepts, while respecting those viable concepts
he already has and are part of his family and cul­
tural background.
Learning experiences

Nutrition education in schools has in the past been
notoriously dull and in effective, because too often, it
has been seen by both the teacher and the student
only as a set of standards to be learnt.
Within this
conceptual framework, a series of learning experien­
ces should be developed—interaction of the child with
his environment, which o'ould lead to the gradual
evaluton of the concepts, and the achievement of beha­
vioural goals.
At the primary level (kindergarten through third
grade}, the learning experiences work toward helping

108

The senior high school nutrition curriculum seeks to
relate the student’s understanding of nutrition to broad
social concerns and to concerns about his own future.
The student is encouraged to understand that his eat­
ing habits affect his own long-range health and the
health of the next generation; to explore the problems
of malnutrition in his own State, country, and the rest
of the world to become aware of unanswered questions
in the field of nutrition; and of career opportunities
in related fields.
Learning experiences are selected so that a progres­
sion occurs from the simple to the complex, allowing
the student to gradually evolve his own concepts and
ideas.
Many times, the same subject-matter topics
are found at all grade levels, but the experiences sug­
gested should be geared to abilities and needs at each
level to avoid repetition of identical experience and
to provide for increased depth of understanding and
potential for application.

Swasth Hind

Preparation of teachers

PROGRAMME TO CONTROL

In order to launch an educational programme in the
health sciences (including the nutritional sciences), the
low level preparation of teachers in these areas must
be overcome.
The professional preparation of the
average school teacher does not in the majority of
intances include even a single course of study in health
sciences, much less a specific course of study in the
field of nutrition.
Broad-scale inservice teacher-edu­
cation programmes are thus the order of the day. A
major role of the health education coordinator is
teacher-training: he may teach inservice courses him­
self or call upon personnel from the community and/or
school to provide inservice educational opportunities
for teachers.

KUMAR1 SAROJ
KHAPARDE,
Minister of
State for Health and Family Welfare said in Lok
Sabha on 5 March, 1987.
“Six cases of AIDS have
so far been reported from Gujarat (1), J & K (I),
Andhra Pradesh (1), Maharashtra (2), and Delhi (I).

All schools should follow the applied nutrition pro­
gramme recommended by the Government of India
(Halder, 1969). This programme is aimed at up­
grading the nutritional status of all the vulnerable
groups including the school-going population, by help­
ing them produce their own requirement of protective
foods and thereby educating them to realize the need
for consuming those foods. Each school-garden is to
be cultivated and maintained by school children under
the supervision of a trained teacher. Green leafy vege­
tables and fruits grown in these gardens are consumed
by the school children in their school-meal programmes
or anv other feeding programme.
The Masterplan
also provides for the development, in each Block, of
poultries, fisheries and dairies with financial and tech­
nical assistance from the government and the UNICEF.

A good educational system should be sensitive to the
changes in the social environment which it seeks to
serve and constantly adapt’ itself to meet the chang­
ing requirements.
Article 47 of the Constitution of India states, “The
State shall regard the raising of the level of nutrition
and standard of living of its people and improvement
of public health as among its primary duties”
(Chandrasekhar, 1969).

The objectives envisaged in Article 47 can be easily
achieved if nutrition education is made a compulsory
subject in the school syllabus.
(This paper is based
upon a research project funded by Ministry of Health
and Family Welfare, Government of India).

REFERENCES

‘AIDS’

Five persons detected as full blown cases of AIDS
have died.
The surveillance figures have so far
indicated 86 cases of AIDS infection.

The steps being taken by the Government are as
under:
(1) 27 Surveillance centres have been established
in the country to screen high risk group.
In addi­
tion, 4 referral centres where higher level diagnostic
facilities for AIDS are available, have been set up.

(2) Restrictions have been imposed for import of
blood and blood products without AIDS Clearance
Certificate.
(3) All the State Health authorities/Hospitals/STD
clinics have been alerted to look for AIDS cases.
(4) All the blood banks have been
screen the professional blood donors.

instructed to

<5) All the State Health authorities have been
advised to ensure strict sterilization practices in hos­
pitals and clinics or to use pre-sterilized disposable
syringes and needles as far as possible.

(6) Guidelines have been
sent to all the State
health authorities for health care personnel.
(7) All the mass media channels have been in­
volved in educating the people on AIDS, its nature,
transmission and prevention.

(8) Instructions/Guidelines to the State/Union Ter­
ritory health authorities have been issued for medi­
cal examination including that for AIDS for foreign
students being admitted to Indian Universities.
These activities are periodically reviewed and
appropriate remedial and intervention measures are
taken.

There is an allocation of Rs. 50.00 lakhs for the
programme during the year 1987-88.”
She further added that so far, the following expen­
diture had been incurred by the government on AIDS
control programme:

— CHANDRASEKAR, S. (1969)
Comprehensive Health Care
Swasth Hind XIII (6) : 159

1. Purchase of Elisa tests kits,
chemicals and reagent
Rs. 51,25,588 (US $ 394276)

— HALDER, K. (1969). Nutrition for School Children.
Swasth Hind. XIII (6) : 157-8

2. Health education activities.

— SIMCORE, JOHN, S. AND HARRISON, GAIL (1971)
The place of Nutrition in the Health Education
Curriculum. American J. Pub. Heal. 61 (II) : 2282-85.

May 1987

Total

Rs. 40,85,000
Rs. 92,10,588

109

NUTRITION AND MENTAL
DEVELOPMENT
Dr R. D. Sharma
Studies show that undernutrition has been mostly associated with low income groups, and is
more prominent in developing countries. There are large number of children in the world who,
because of undernutrition and other social and economic conditions, will not reach their full
intellectual potential.
T has been felt that undernut­
rition is the most common
health problem in the world, special­
ly in the third world countries, which
affect the physical and psychologi­
cal development of a child.
It is
estimated that about 60 per cent of
the total pre-school population of
the world suffer from some degree
of moderate-to-severe protein-energy
malnutrition.
It is most widely
known from the literature that
undernutrition affects behavioural
development. Dobbing (1971) and
Winick et al (1971) have demonstra­
ted that when undernutrition occurs
either pre-nalally or during the first
two years of life, when brain growth
is at its maximum, the damage to
brain cells will be permanent, thus
leading to mental impairment.

I

tion between the weight for weight
at different stages of pregnancy.
Prentice. Whitehead, Watkinson,
Lamb and Cole (1983) have felt the
need to identify truly at risk groups
for prenatal supplementation pro­
grammes in developing countries.
The various factors interact and are
interdependent.
Cobos and Gue­
vara (1970) have argued that food
intake is dependent upon food avai­
lability, size of family, economic
status, food habits and other factors.
They propose that psychological
damage is associated with under­
nutrition. Grantham, McGregar.
Stewart and Desai (1980) have also
found that malnourished children
had lower mean mental development
quotients than those of the adequa­
tely nourished
children.
They
also had poorer mothers with lower
I.Q. and have lower birth weights.
Therefore, nutritional status is an
important factor directly related to
the mental ability.

ever, there is tendency to consider
many causal elements for intelligent
behaviour.
These currently consi­
dered factors are culture, level of
education of parents, family’s social
condition, opportunities for the
child’s experience, his needs, moti­
vation, aspirations and biological
conditions.
All these variables
undoubtedly are pertinent to the
interpretation of the test’s findings.
However, our problem in the prac­
tical sense is to find reliable ways
of assessing an index of cognitive
functions, and then to try to identi­
fy the reasons for the functioning.

It has been argued, that it is in­
appropriate to compare the child’s
obtained scores to a culturally diffe­
rent reference population.
This
argument is totally valid when one
Many researchers who are work­
considers I.Q. scores as a theoreti­
ing in the area of nutrition have
cal abstraction.
For the purpose
tried to find out the causes of under­
of comparison
within cultural
nutrition.
They have found that
groups, the obtained numbers serve
undernutrition has been mostly asso­ Mental measurement
as reliable indicators relative to
ciated with low income groups, and
Though this article deals in gene­ the groups, but should in no way be
is more prominent in developing
For
countries. Cobos and Guevara ral with the area of undemutrition construed as I.Q. scores.
(1970) proposed an interaction bet­ and mental development, some example, it is nonsense to compare
ween the nutrition status of the indi­ methodological issues of mental a child from Mexico with an Ame­
Of parti­ rican child on an American test.
vidual and his food intake, physical tests will be presented.
health, psychological make up, cular concern is the use of mental One might, on the other hand, con­
individual and his food intake, phy­ tests in a culture different from the sider that after appropriate changes
sical health, psychological male up, one on which they are standardized. are made in the test, there remains
lated to one another and not to the This is critical to quantification of some correlative value within the
One can further
total system in a manner not yet the data. Psychologists have been same population.
trying to identify and measure cog­ argue that the transformed tests are
well understood.
nitive functions in children.
Defi­ capable of assessing and comparing
Miguel, Peter and Bernard (1982) nitions of intelligence were offered the behaviour of children who have
have assessed the significant role of implying various degrees of contri­ suffered nutritional, deprivation with
nutritional status in pregnant wo­ butions from the environment or children who have not experienced
men. They found a good correla­ from inheritance.
Today, how­ such nutritional stress.

no

Swasth Hind

Moderate undernu trition

A study on Head Start children
in United States was conducted by
Sulzer et al (1970) and found that
children suffering
from anaemia,
as defined by low haemoglobin or
low haemotocrit, performed less
well on a vocabulary test than nonanaemic
Head Start
children.
These results suggest that anaemic
children have a slower reaction time
and poorer level of motivation and,
therefore, poorer learning ability.
These data do not, however, allow
us to conclude whether this effect
is chronic or acute.

In Santiago a study on 500 pre­
school children was conducted by
Monckebert
(1970).
He found
strong relationship between nutrition
and intellectual development
He
studied three different groups:
Group A consisted of middle class
children who were not undernouri­
shed, and both of whose parents had
an average secondary education.
Group B and C were of lower-class
children, with parents having an
average of two years of schooling.
Group B had participated for a
period of ten years in a programme
of nutritional supplementation with
milk and free medical care. Group
C did not receive special medical
care.
These children had poor
physical health with the average
height at one year being below the
third percentile of the Io Wa norms.
They reported that in group A. and
B the subnormality rate was three
per cent and five per cent respecti­
vely, while in group C it reached
40 per cent.
Although these re­
sults demonstrate a strong relation­
ship between nutrition and intellect­
ual level, the experiments did not
conclude that the differences were
due only to nutrition.
They feel
that the extra feeding and medical
care programme of group B may
have had an effect on the environ­
ment and cultural and maternal
motivations.
These results, as
well as results of other studies,
demonstrate the difficulties of isola­
ting the effect of undernutrition
on mental capacity.
Severe protein-energy malnutrition

Several recent studies show that
the brain is affected, and to a great
extent, by malnutrition. The degree
to which the brain is affected de­
pends upon the severity of malnu­

May 1987

trition and the age at which malnu­
trition takes place.
The majority
of studies conducted in the area of
malnutrition have examined the
effect of severe protein-energy mal­
nutrition on cognitive development.
Several other factors which have
significant effect on the long-term
consequences of the severe malnu­
trition are; (i) age of onset; (ii) seve­
nty; (iii) duration; (iv) health and
environmental rehabilitation.

Human studies relating to the
effect of undernutrition on mental
development present major pro­
blems which are not easily over­
come.
Warren (1973) presents a
critical review of the pioneering stu­
dies and examines the methodologi­
cal problems inolved. He cites the
studies of Caback and Nojdanvic
(1965), Stoch and Smythe (1963
1967) and several others, where the
age of onset of undernutrilion, seve­
rity, duration and rehabilitation were
unknown. Furthermore, most of
these studies employed a crude mat­
ching control group, and when sib­
lings were used only a few were
tested. Another weakness of these
studies is that undernourished child­
ren were selected on the basis of
their height, weight and head cir­
cumference and very little was
known about their health back­
ground.

During the assessment of beha­
vioural and psychological develop­
ment in malnourished infants, cer­
tain methodological considerations
should be kept in mind.
It is
essential to-distinguish between im­
mediate, short term and long term
effects of undemutrition and to
trace the patterns of behaviour re­
covery.
Thus, it is important to
assess the undernourished infant’s
behaviour during nutritional treat­
ment and recovery, and to assess
the longitudinal effects through
early puberty.
In addition, it is
essential to establish well defined
control groups. A matched control
reference group should be drawn
from well-nourished infants from
other families of the same socio­
economic status.
Healthy siblings
in fact may constitute better cont­
rol group, whose genetic and envi­
ronmental backrounds are more
similar.
However, it should be
noted that such controls come from
the same home that lead to under­
nutrition in one child.

Other possible factors contribut­
ing to the effects of undernutrition
could be the age of onset and dura­
tion of undernutrition.
Craviote
and Rebels (1965) suggested that
the younger the child at the time
of hospitalization for severe under­
nutrition the less complete his be­
haviour recovery. This is in line
with the views of Dobbing (1971)
and Winick (1971) who stress the
greatest risk to the structure of
nervous system is in th? young
undernourished organism.
Chase
and Martin (1970) reported that
children who became severely under­
nourished before the age of four
months showed less mental impair­
ment when tested about 2| years
later, than those who suffered undernutrition after four months.
Heit­
zig et al (1972) found no association
with the age of onset, nor did Evans
et al (1971), Yatkin et al (1971) re­
ported an inverse relationship bet­
ween age on admission and l.Q. op
discharge from the Rehabilitation
unit The differences between their
three age groups (birth—6 months;
6 months—12 months; 12 months—
18 months) were significant at 0.01
level.
In a follow up study con­
ducted by Mclaren, Yatkin, Kanawati, Sabhagh and Kadi (1973) re­
ported no association with age of
admission and subsequent l.Q.
They suggested that this lack of
relationship may stem from two
major factors.
Firstly, older child­
ren would tend to have undernouri­
shed for a longer period of time,
with a more adverse effect on later
intellectual level.
Secondly, the
effects of undernutrition on mental
performance are likely to be more
severe during an earlier rather than
a later period of post-natal life.
These two main factors operate
with mutually antagonistic effects.
Therefore, the duration of as well as
the age of onset of undernutrition
is a contributing and interacting
factor affecting mental growth.
Many researchers have observed
that the general stimulus type milieu
of the institution during medical
rehabilitation contributes to the
overall progress of the subjects. In
order to study and control for the
stimulation factor, half of the in­
fants of the unstimulated group
(US), were roomed in the usual cli­
nical enironment.
The other half,
that stimulated group(s\ received

111

extra perceptual and emotional sti­
mulation consisting of a colourful
room decorated with pictures, red
curtains and bright coloured lino­
leum on the floor.
During their stay in hospital the
children were assessed every 2 weeks
for 8 testing sessions on the 1955
revision of the Griffiths Mental
Development Scale.
This scale
gives a general development quo­
tient (DQ) and measures of five
mental functions:
locomotor, per­
sonal, social, learning and speech,
eye and hand-co-ordination, and
performance.
The control group
was tested in a similar fashion: 8
times, every 2 weeks.
During hospitalization, both ex­
perimental groups (S and US) im­
proved consistently and significantly
regardless of the environmental sti­
mulus conditions.
The differences
between all the eight test sessions
were significant at the P < .001
level.
The greatest improvement
occurred during the first three test
sessions, i.e., during the first month
that the children spent in the hospi­
tal. Moreover, the stimulated group
improved significantly more than
unstimulated group. The difference
became significant (p
0.05) at
the fourth session.
From the fifth
session onward, or 8 weeks after
admission, the difference was high­
ly significant (P n .001).
How­
ever, despite the fact that both
groups kept on improving steadily
throughout the four months, they
never attained the level of the nor­
mal group. The control group kept
more or less to the same rate of
mental development during the six
sessions. It is of interest to note
that, in the experimental groups, of
the five mental function studies,
the greatest' improvement occurred
in the personal social function. The
scores for hearing and speech seem­
ed the most retarded over the en­
tire period of recovery.

Mclaren et al (1973) conducted a
follow up study of 30 of the severely
malnourished children and 15 of their
controls. The results were compar­
ed to their three respective control
groups: data were collected on three
additional groups for the purpose of
comparison with the follow up data.
Measurements were taken with 30
young siblings of the original maras­
mic group. An additional 15 child­
ren with ‘failure to thrive’ who had

112

Studies show that psychological damage is associated with undernutrition

never received nutritional treatment,
and 15 of their healthy siblings were
examined.
Of the 30 previously
marasmic children, 15 were of the sti­
mulated group and 15 were of the
unstimulated.
All children were
assessed on the adopted Lebaneseversion of the Stanford-Binet Intelli­
gence Scale. The results show that
all the previously marasmic child­
ren obtained poorer scores than the
other two groups on general intelli­
gence, memory, visual motor, rea­
soning and social-intelligence tasks.
The best scores were obtained by
the healthy children. These results
are remarkably similar to two recent
follow up studies of severely under­
nourished children who were fully
rehabilitated
(Hertzig,
Birch,

Richardson and Tizard, 1972) and
Birch, Pineiro, Alcade, Toca and
Cravioto-study
was a significant
correlation between the present I.Q.
of previously marasmic infants and
their present physical growth (r=0.
56, p * 0.01).

Schofield (1980) studied the effect
of long term psychological stimula­
tion on mental development of seve­
rely malnourished children.
The
effect of adding psychological sti­
mulation to the treatment of seve­
rely malnourished children was stu­
died by comparing the development
level (DQ) of children with those
of an adequately nourished group
with diseases other than malnutri­
tion and a second
mulnourished
group who received standard care

Swasth Hind

F.E. Proceedings of
only.
The intervention children populations living under nutritional IL MONCKEBERG,
the conference on the Assessment of
underwent structured play sessions stress to be normal even if the stress
Tests of Behaviour from studies of
daily in the hospital and weekly is extreme and 25 per cent of the
nutrition in the Western Hemisphere
(NIH) 73-242, P. 107, (1970).
for six months after discharge; population manifests moderate to
The
mothers were also shown how to severe neurological deficits.
play with them.
The non-inter­ remaining individuals in such popu­ 'y PRENTICE, A.M., WHITEHEAD. R.G.
WATKINSON. M. LAMB, W. a,
vention malnourished group show­ lations have either avoided or sur­
COLE, I. J. Prenatal dietary supple­
ed a lower D.Q. than the adequa­ vived these stresses.
mentation of African women and birth­
tely nourished
group throughout
weight, Lancet, 1, (8323). 489-492,
(1983).
the study. The intervention group
made significant improvements in
13. SCHOFIELD, D.N. Effect of long­
D.Q. in hospital and continued to
term psychological stimulation on men­
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15. STOCK, M.B. AND P. M. SMYTHE.
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18

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7. EVANS, D.E., A.D. MOODIE AND
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AND M. NELSON. The effect of un­
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STEWART, M. E. DESAI, P.. The?.
WILLIAM,
R. BEARDSLEO, PETER
their full intellectual potential.
relationship between hospitalization,
H. WOLFF, IRWING MURTURTY,
social-background,
severe
protein-ener
­
Some believe that investments in
BINDU PARIKH and HARRY SHgy malnutrition and mental develop­
education are to certain degree
WACHAMAN. The effect of infantile
ment in young Jamaican children, Eco­
malnutrition on behavioural develop­
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can Journal of Clinical Nutrition, Vol.
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RICHARDSON AND J. TIZARD. 22. YATKIN, U. S. AND D. S. MCLA­
education will bring permanent im­
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(1972).
(1970).

1 hope it is quite clear to the
reader that despite our emphasis on
people with behavioural deficit and
retarded mental growth, we expect
the large majority of individuals in

May 1987

1. LEVITSKY, D.A. AND R.H. BARNES. 23 YATKIN, U.S. D.S. MCLAREN, A.A.
KANAWATI AND S. SABHAGH,
Proceedings of the conference on the
Effect of undernutrition in early b’fe
Assessment of Tests of Behaviour
on subsequent behavioural
develop­
from Studies on Nutrition in the Wes­
ment Proc. XIII, Intera. Congr Pedia,
tern Hemiphere, (NIH), 73-242, p. 3,
2, 71, (1971).
(1970).

113

COMMONSENSE CAN AVOID
ACCIDENTS
Dr Madhuban Gopal
Most accidents are caused by unsafe conditions, and unsafe acts, or both. In the event of an
accident some simple commonsense rule has either been ignored, forgotten or misunderstood.

lower production rates and lessen the
quality of products. Accidents, by increasing
production costs, raise the prices of commodities pur­
chased by the people. The injured worker, how­
ever, pays most through the loss of an arm, legs, eye
or perhaps the loss of his job or even his life.
ccidents

A

Most accidents are caused by unsafe conditions,
and unsafe acts, or both. Some simple commonsense
rule has either been ignored, forgotten or misunder­
stood.

Major cause of injuries is the mishandling
of materials.
Stooping with the back arched and
with the load out at the end of the arms causes the
back injury while lifting. The worker, therefore,
should plant his feet firmly, well apart. He should
then squat with his knees bent and get a good grip on
the object. He should keep his back as straight as
he can and lift slowly, without jerking, but pushing
up with his legs. The strong leg muscles should do
the work rather than the back muscles. The body
should never be twisted with the load.
Filled cylinders should be kept chained. Cylinder
dollies should be used to move compressed gas cylin­
ders.
Long objects should be carried over the
shoulder with the end held as high as possible to pre­
vent striking other employees or damaging property.

Falls from an elevated place as a result of stumb­
ling, slipping, or loss of balance are usually caused
by plain carelessness.
For example, objects left in
the middle of the aisle or on stairs, spilled oil, grease,
or water, waxed floor may cause falls.
Stairs should be walked up and down slowly with
feet firmly planted on each step and the handrail used.
Jumping from trucks or rushing has caused serious
injuries.
Falls from ladders have disabled many.
Ladders should be long enough so that it is not neces­
sary to stand on the top rungs. The ladder should be
set one foot away for every four feet up to the point
of support.
Since the rungs are usually one foot
apart, it is easy to figure the distance.
Ladders

114

should be checked for crack or loose rungs and one
should never overreach from a ladder.
Work injuries due to falling, moving or flying ob­
jects have occurred when the injured worker has failed
to wear protective equipment needed.
Safety glasses
or shields will protect the eyes from small particles
that can cause permanent blindness.
Protective
equipments are of no value unless worn. Similarly,
safety hats should be worn while overhead work is
going on and where there might be falling objects.
Safety shoes and steel toe box saves from a crushed
root or an injured toe.
In addition to wearing required protective equip­
ment, the worker must stay away from, under cranes,
suspended loads, or overhead works.
One should
stand clear when bells or horns warn him of passing
vehicles or overhead equipment.
One should stay
clear from danger zone or barricaded areas.

Misuse of machines, disregard of guards, failure to
dress properly when operating machines (loose jewel­
lery or clothing), not locking or lagging main power
switches during repairs, or letting machines run un­
attended also cause work related injuries.
Accidents
have resulted due to non-maintenance of safety devi­
ces installed to neutralize a toxicant from going to
the atmosphere.

These are a few commonsense precautions all
workers should take because, in addition to prevent­
ing injuries, they are the best way to do the job.
Occupational health and safety programmes with
emphasis on prevention have been able to reduce
mechanical) and health hazards. Safety team-work
needs everyone’s cooperation.
Hazards of pesticides

Precautions are advisable in special jobs.
In this
article, information on hazards of pesticides is being
disseminated.

Swasth Hind

Major cause of accidents is the mishandling of materials.
Photo shows a scene of a mismanaged kitchen.

Many agricultural chemicals are now used in farm­
ing operations to kill insects, weeds, disease agents,
or rodents and to improve the fertility of the soil. The
pesticides used in fight against harvest depressing fac­
tor is compared to a weapon which can become dan­
gerous.
Even when using it for a good cause, the
operator must be fully aware of dangers involved and
of safety measures.
Besides direct contact with the pesticide at the time
of manufacture, storage or operation, people are ex­
posed indirectly to the residues (the remnant of pes­
ticide or its toxic metabolite after application) on vege­
table, fruits or soil. Although these residues are pre­
sent in ppm to ng level, they need to be monitored
and should not be consumed before the recommended
waiting period.
Such exposure may lead to chronic
toxicity.

May 1987

Basic rules

Simple basic rules are given.
Read the label and follow the directions on the
label. Rule 19 of the Insecticides Act calls for the
following information:

Name of insecticide and manufacturer, registration
number of the insecticide, names of ingredients, type of
formulation, net contents of the pack, quality control
batch number, date of manufacture, expiry date, anti­
dote statement and warning symbols.

Besides, each unit pack has one leaflet to accommo­
date a detailed information about the pesticide like
names of insects, weeds which are controlled, optimum
dosage, symptoms of poisoning and safety measures
required, container disposal and method of storage.

115

If the label is not clear, one should call the chemi­
cal dealer, health department or someone who can ex­
plain it.
One must know what is in the container,
what it is for, how to use it safely, what equipment
may be needed, how to store it, how to dispose of
unused portions and the container, and what to do if
toxic chemicals get on or in the body.

One should use as directed, using only the amount
recommended on the label.
Companies spend much money and effort testing
chemicals to determine the amount, time, and method
of application for maximum effectiveness, safety and
economy.
Don’t believe that a little more chemical
must be better. It is not true. If the chemical fails,
consult an expert rather than trying out heavier appli­
cations or mixtures with other chemicals.

Some chemicals can be safely handled with a few
precautions; while others may require special handling

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

and protective devices.
Avoid contact or inhalation.
After their use, wash your hands before eating s or
smoking and change clothing on return to your home

Chemicals should be stored in the original or ap­
proved container, labels intact, in a suitable storage
area.
Chemicals should be locked up or stored
beyond the access and ingenuity of children, animals.
and unauthorised persons.
Never put chemicals in
unmarked containers.
Many children are poisoned
because people keep chemicals in ordinary bottles
meant for foodstuff.

Dispose of unused chemicals and empty containers.
Burial is best, especially for toxic materials. Unless
the label says so, chemicals and containers should not
be burned because they might give off harmful
fumes, leave poisonous ashes, cause intense fire, or
even explode.
Toxic chemicals should never be
poured on the ground or into a stream.
O

,

Process begins on World Narcotics Pact

W

hen someone at an international meeting on nar­

cotics suggested that the kat plant be added to the
list of banned drugs, representatives of the Arab
states strongly objected. The expert from Yemen,
where mildly narcotic kat is chewed like gum but
alcohol is prohibited, suggested in rebuttal that liquor
be added to that list. The angry exchange reflects
the difficult work ahead for the UN Commission cn
Narcotic Drugs, which ended a week-long meeting in
Vienna on 11 February.

The 28 nations attending the meeting passed a
resolution creating a panel of experts to draft a con­
vention for world-wide co-operation in fighting illicit
drug traffic. But speedy adoption of a convention
faces obstacles when such basic tasks as defining a
list of illegal narcotics drugs prove to be difficult.
Use of marijuana, for example, gets tacit approval
in some countries where people do not consider it
harmful. And scientists have yet to agree on a stan­
dard international definition of marijuana. The socalled ‘designer drugs’ pose a different problem. Al­
though just as potent and dangerous as closely relat­
ed narcotics, designer drugs differ from them chemi­
cally, thus preventing police and the courts from
acting. If a nation goes through the cumbersome
process of making one such variation illegal, the
manufacturer can produce a new drug by marginally
changing the formula again.

Other issues become sticky. The UN Commission
passed another resolution urging the rich ‘consumer’

116

countries to give more money to help poorer Third
World countries battle the powerful drug barons.

The delegates to this conference are already pre­
paring for the next one, to be held from 17 to 26
June, the first ever with delegates.
Ms. Tamar Oppenheimer, Director of the Confer­
ence secretariat, said the goal of the June meeting is
to “combat the drug problem in all its forms at the
national, regional and international levels and adopt a
comprehensive multidisciplinary outline on future
activities.”

She said the delegates would “produce a final do­
cument, which is a manual which can be used by
everyone, from governments to individuals.” Al­
though they may debate the terms of the proposed
convention, they won’t be able to adopt one yet; that
will take longer.
Non-governmental organisations
will be meeting simultaneously with the ministers in
June, Ms. Oppenheimer said.
“What we are aiming for is a change of emphasis,”
she told a press conference on 11 February. “Upto
now we have been attacking the supply. Now we
want to attack demand—and for that we need the
co-operation of non-govemmental organisations.”
With a slogan “Yes to life, no to drugs”, she said,
the June conference will consider such issues as drug
education and the treatment and rehabilitation of
drug addicts.—U.N. Newsletter, 21 Feb. 1987.
O

Swasth Hind

EPILEPSY EDUCATION AND
ITS EVALUATION
Prakashi Rajaram and Dr R. Parthasarathy
In order to evaluate the impact of ‘epilepsy education’, a small experiment was
conducted at the Neurology unit of the National Institute of Mental Health & Neuro-Sciences,
Bangalore. Authors feel that after educational campaign a significant improvement was noticed
in awareness about causation, hereditary influences, nature of epilepsy and social aspects
of fits.
eople have many misconceptions, negative atti1 tudes and unhealthy behaviour towards issues
pertaining to health in general and epilepsy in parti­
cular. Planned efforts by health professionals are
needed to make apositive impact! on the exitsing con­
ditions. In the absence of systematic attempts at
people’s education, it is difficult to induce any kind
of change in the minds of common men.

Studies indicate that attitudes towards health pro­
blems remain negative at different levels in various
sections of the community. Such findings alone may
not be sufficient. Of late, it isJ emphasised that atten­
tion needs to be focussed on the methods of change
of attitudes and not the attitudes per se.
Rarely do we come across studies evaluating me­
thods of education regarding illnesses. Epilepsy
being one of the commonest illnesses affecting at
least one per cent of population at any given point
of time, it is important to focus on this problem from
an educational perspective. Moreover, considering
the inexplicable anxieties it creates in the individual
and infinite ‘relationship difficulties’ arising out of
epilepsy and also the stigma attached with this ill­
ness, it is essential to assess the impact of education
about epilepsy.
In organizing educational programmes in the hos­
pitals and community, the professional social workers
play a vital role. Professional skills for working with

May 1987

individuals, groups and communities are
able for effective health education.

indispens­

Simple experiment in epilepsy education

In order to evaluate the impact of “epilepsy edu­
cation”, a small experiment was conducted by psy­
chiatric social worker attached to the Neurology Unit
of the National Institute of Mental Health and Neuro
Sciences, Bangalore. For this purpose, an informa­
tive lecture followed by discussion was organised by
neurologist, for a group of 25 educated members of
a women’s voluntary agency involved in various so­
cial service activities. At the end of the discussion
they were given a booklet on “Social and Medical
aspects of Epilepsy”, published by the Indian Epilepsy
Association, Bangalore Chapter.

FIRST PHASE
Misconceptions of the Members

An assessment prior to epilepsy education: To
know their attitude and knowledge, the members
were asked to fill in a structured questionnaire on
epilepsy. More than 65% of the members believed
that epilepsy was caused by evil spirits and black
magic. Another belief that most of them (more than
50%) entertained was that, worms in the stomach
caused epilepsy. More than 70% of the members
believed that fits were contagious. Yet another mis­
conception prevailing among at least 30% of the
members was that placing a key in the hands of the

117

patient during fits would alone be sufficient to cure
him of fits. Besides, many other wrong notions per­
taining to personal and social life of epileptics, about
65% of the respondents expressed their ignorance
about its various important social aspects.
SECOND PHASE
Contents and method of epilepsy education

In one of the weekly meetings of the Women’s As­
sociation, a neurology expert was asked to deliver a
simple lecture on “Social and Medical Aspects of
Epilepsy”. This lecture highlighted the causes, nature
and common types of fits, nature of medical treat­
ment and its principles, first-aid during major fits and
febrile convulsions among children. Besides the
social components of the illness, i.e.t Do’s and Don’ts
for the patients, epilepsy in relation to schooling,
work, marriage, sex, children’s sports, driving, emo­
tions and alcohol were given much emphasis in this
lecture.

The lecture, given in local language, avoided tech­
nical terms and difficult terminologies and used the
question-and-answer method. Following the lecture,
ample time was given for clarification and discussion.
This session lasted for about three hours. The group
members showed keen interest and actively participa­
ted in the discussions. A booklet on social and me­
dical aspects of epilepsy was also given to all the
members to supplement their knowledge about it.

NATIONAL DRUG AUTHORITY
Replying to a question in Rajya Sabha on 3
March, 1987, Shri R. K. Jaichandra Singh, Minister
for Chemicals & Petrochemicals said, “The National
Drugs & Pharmaceuticals Authority, an Apex Body,
is proposed to be established with a permanent Secre­
tariat to coordinate matters relating to the develop­
ment of the Pharmaceutical Industry in the country.”

He further said, “ Fifteen drugs have been reserved
for public sector.
They are Streptomycin, Tetra­
cycline, Oxytetracycline, Gentamycin, Sulphaquanidine, Sulphadimidine,
Sulpha methoxy-pyridazine,
Sulphadimcthoxine, Vitamin Bf, Vitamin B2, Folic
Acid, Quinine, Analgin, Phenobarbitone and
Mor­
phine.”
Replying to another question, the Minister said
that the existing Drugs (Prices Control) Order, 1979
would continue to operate till a new Drugs (Price
Control) Order was issued incorporating the new
measures announced by the Government.
The Minister said that a seven member Committee
would identify the essential drugs to be included
in the proposed Category II which was headed by
Dr Vijay Kelkar, Chairman, Bureau of Industrial
Costs and Prices.
O

THIRD PHASE
Preliminary assessment of gains in
changes in attitude

knowledge and

To know the impact of the ‘Epilepsy Education
Components’, the same questionnaire was readmini­
stered to the members of the women’s association
after four weeks. It was interesting to find, that the
responses like ‘I don’t know’ had almost become nil.
Only a negligible small number (less than 4%) did
not know about seven items in the questionnaire. A
significant improvement was noticed in awareness
about causation, hereditary influences, nature of epi­
lepsy and social aspects of fits. This, in turn proves
that education given about epilepsy had an impact on
the members of the voluntary association. However,
it is worth noting that 100% change could not be
achieved in all the items. Unless we take these issues
continuously and consistently with the members, im­
provement to the highest degree may not be possible.

118

Implications of evaluation for health education

Systematic efforts at monitoring the progress are es­
sential in health care, specially health education. In
health education, this component is not given due
consideration by the health professionals. The evalu­
ation not only reveals what positive changes result­
ed because of the education but also what positive
results failed to occur despite the education. Illnesses
carrying ‘stigma* require evaluation-oriented educa­
tion to develop new methods of education and to
improvise methodologies and change the contents.
These attempts when replicated in different centres,
would help developing definite modules of health
education specific to our socio-cultural settings. No
doubt, such collective efforts by the health profes­
sionals will make the “Health for all by 2,000 A.D.”
a reality.
Q

Swasth Hind

COUGH AND COUGH
Dr J.N. Pande
Most of the respiratory disorders result from tobacco smoking, environmental pollution, lack
of immunization and poor nutrition. These conditions are preventable to a great extent. The
author in this article suggests simple guidelines to promote respiratory health.
Cough is an extremely common symptom of respiratory disease. There is hardly
any one amongst us who has not had cough. Quite frequently cough is a manifesta­
tion of minor respiratory infections such as common cold or flu, but it may also be
an important symptom of underlying serious disorders such as tuberculosis or lung
cancer.
/k normal adult inhales something like 15,000 litres
iioi air every day. This air is frequently conta­
minated by various pollutants, namely, dust particles,
tobacco smoke, smoke from the factories, emissions
from automobiles, and smoke from domestic fuel. In
spite of the fact that the nose and upper respiratory
passages have an excellent mechanism for filtration
of air and removal or particulate material above 10
microns, some of the pollutants do reach the lower
respiratory tract. They are then trapped in a protec­
tive mucus blanket covering the lower respiratory
tract, and either coughed out or removed by ciliary
movement to the throat from where they are swallow­
ed.

Like sneezing, cough is also a protective reflex for
the respiratory tract. It helps in eliminating foreign
bodies, inhaled irritants or excessive secretions from
the respiratory passages. During the act of coughing,
these materials are ejected very much like the bullet
from an air gun.
Respiratory infections

Respiratory infections are the commonest cause of
cough. These infections, which may be caused by
bacteria or viruses, results from inhalation of air
contaminated by micro-organisms. When a diseased
person coughs or sneezes, he may eject up to a million
tiny particles containing micro-organisms. Many of
these remain suspended in the air as droplet nuclei,
and cause infection in other subjects in the vicinity.

May 1987

Cough is a common symptom of upper respiratory
viral infections or colds. It is estimated that an
average healthy person suffers from 2-3 episodes of
viral respiratory infections every year. The disease
is mostly self-limiting, and requires no specific treat­
ment. In most of these instances, the person recovers
within a week of onset of symptoms with a ‘cold­
like* illness. However, any cough which lasts more
than a fortnight must be taken seriously. Moreover,
if the cough is accompanied by pus or blood mixed
sputum it calls for immediate attention, by a physi­
cian. Other signs of underlying serious disease
include weight loss, prolonged fever, chest pain,
breathlessness, night sweats, palpitations, wheezing,
hoarseness of voice, etc.
Smokers frequently suffer from chronic cough,
which is often dismissed as ‘smokers cough’ and of no
importance. This, however, is a wrong notion. To­
bacco smoking is the most important cause of serious
respiratory disorders such as chronic bronchitis, em­
physema and lung cancer. Early symptoms of these
disorders are likely to be treated lightly as ‘smokers
cough* with disastrous consequences.
Tuberculosis of lungs

Tuberculosis of the lungs continues to be a very
serious health problem in India. Persistent and un­
explained cough calls for thorough medical check-up
as well as an X-ray of the chest, and sputum exa­
mination. It may be emphasized that physical exa­
mination of the patient by stethoscope alone may not

119

By and large, most of the respiratory disorders result from tobacco
smoking, environmental pollution, lack of immunization and poor
nutrition. These conditions therefore, can be preventable to a great extent.

be enough to rule out the possibility of tuberculosis,
and in the presence of suggestive symptoms, an X-ray
of the chest must always be taken. An enlightened
individual has the right to demand this investigation,
if overlooked by the treating physician.
Lung cancer

Lung cancer is a smoking related cancer, and there­
fore largely preventable. Cough and spitting of
blood are important symptoms of this disease, but
unfortunately, the diagnosis is rarely established at
early stages, and the disease usually has a fatal out­
come. Hence greater emphasis should be on preven­
tion of lung cancer by avoiding or stopping smoking
rather than its early diagnosis and treatment.
Prevention of respiratory diseases

There are several measures which can be extreme­
ly useful in the prevention of various respiratory
diseases. They must be practised by all of us, and
are an important part of health education. Some of
the important measures are enumerated below:
(1) Proper observation of immunization schedule
recommended in India. B.C.G. vaccination
given at three months of age ds helpful in
reducing the incidence of tuberculosis. Vac­
cination against diphtheria, whooping cough
and measles is also important in preventing
these disorders and their sequelae.

minately in the house, on the roadside or in
public places.
Sputum should preferably be
collected in a closed container and disposed of
in a proper fashion.

(5) Tobacco smoking should be discouraged. It
should be banned at all public places. Every
smoker must remember that he is endangering
not only his own health, but also of his spouse
and children, as well as his close associates.
(6) Regulations regarding industrial hygiene must
be strictly enforced in order to provide clean
air not only to the industrial workers, but also
to the persons residing in the vicinity of in­
dustrial areas. Adequate ventilation must be
provided for the workers working in dusty en­
vironments. Smoke-emitting vehicles should
be banned from plying on the road.
(7) Use of smoky domestic fuel should be avoid­
ed if possible. If at all it is used, the kitchen
should be well ventilated to let out the smoke.
Smoke-emitting fuel should not be used in the
bedrooms.

(8) Any person having cough for more than a
fortnight should consult a physician. It should
be done earlier if other symptoms such as
chest pain or blood spitting are present. If
the physician is unable to make a diagnosis by
physical examination alone, he should order a
chest X-ray and sputum examination.

(2) Large family size, overcrowding, poor socio­
economic status and malnutrition are signifi­
cantly related to the incidence of respiratory
infections in children. These are basic issues
and the Government is tackling the problem
by promoting family planning and literacy
amongst the affected communities.

(9) Full and complete treatment for respiratory
infections, particularly tuberculosis, is manda­
tory in order to avoid complications and
chronioity. Physicians advice regarding treat­
ment should be strictly adhered to.

(3) Prompt and adequate treatment of childhood
respiratory infections is necessary to prevent
the development of complications and sequelae
causing life-long respiratory disability.

(10) Regular physical exercise tones up the respira­
tory system. Daily physical exercise resulting
in a feeling of mild breathlessness is desirable.
Certain breathing exercises are also beneficial
in improving the efficiency of the respiratory
muscles.

(4) Certain measures may be useful in preventing
the spread of respiratory infections from one
person to another. A person having cough
should* always put a cloth or kerchief over his
mouth, and nose while coughing or sneezing.
Close physical contact with a diseased person
by his friends and relatives should be avoid•• ed. Diseased person should not spit indiscri­

120

By and large, most of the respiratory disorders re­
sult from tobacco smoking, environmental pollution,
lack of immunization and poor nutrition. These con­
ditions therefore can be preventable to a great extent.
We should all endeavour to promote respiratory
health by observation of the simple guidelines sug­
gested above—From AllMS Public Lecture.
Q

Sw^sth

IATROGENIC CORNEAL ULCERS
Dr Swatantra Sharma,

Dr Prakash Gupta & Shri Pradeep Kumar Gautam

Iatrogenic corneal ulcers in eyes are the commonest, and are caused by quacks to whom the
patient goes for one or the other type of eye trouble. Quacks in turn pretend to have removed
some foreign body by mopping with cotton or sewing needle or pin causing corneal ulcers and
permanent opacities in patients.
and purulent inflammation of cornea
is called comeal ulcer. Comeal Ulcers often
lead to permanent opacities leading to lower visual
acuity while complications may lead to loss of the
eye.

Interesting cases

uperficial

S

Case No. 1: A 60 year old female had aphakia
right eye for the last five years. She got foreign body
removed 50 times which she attributes to “KHOT”
(evil spirit). Clinically she had superficial keratitis
with iritis and trachoma, for which she was treated and
responded.

Infection, malnutrition and injuries arc the impor­
tant causes of corneal ulcers, out of which trauma is
the commonest and frequent cause of comeal ulcers.
While the Government! is focussing greater at­
tention on Blindness Control, we noticed at District
Hospital, Hamirpur in Himachal Pradesh, that Iatro­
genic Corneal Ulcers in eyes are the commonest, and
are caused by quacks to whom the patient goes for
one or the other type of eye trouble. Quacks in-tum
pretend to have removed some foreign body by mop­
ping with cotton or sewing needle or pin causing
corneal ulcers and permanent opacities in patients.

Case No. 2: A 50 year old female got foreign body
removed 30 times. Clinically she had superficial kera­
titis with grade IV trachoma in both eyes which res­
ponded to treatment.
Case No. 3: A 70 year old female got foreign body
removed when she got white patch on the cornea.
Clinically she had hypopion comeal ulcer in her right
eye with mucocoele and she was operated upon for
mucocoele, after which she responded to treatment for
comeal ulcer.

Case studies

Case No. 4: A 45 year old female developed severe
headache and watering eyes for which she got foreign
body removed twice. Clinically she had acute conges­
tive glaucoma in both eyes with PL & PR present in
both eyes. After a course of medical treatment she
was operated upon and improved.

Of the 100 patients examined* in the Eye Out-Pa­
tient Department during a period of three months at
the District Hospital, Hamirpur, only 21 came direct­
ly without any previous treatment. The rest (79
cases) had come after getting foreign body removed
ranging from one to 50 times. Out of the total 79
cases, 60 were females, 4 males and 15 children.

Discussion

Disease pattern

1.
2.
3.
4.
5.

Viral conjunctivitis with Corneal
Iridocyclitis
Acute Congestive Glaucoma
Sub-conjunctival Haemorrhage
Acid Bum (Accidental)

Ulcer

95
2
1

1
1

Quackcty pattern

As many as six persons have been identified in this
District who practise eye quackery, five of whom being
old women. All of them were from poor families and
charged nothing but some grains in return. Warning
to these quacks proved successful and efforts are on
to put an end to such type of iatrogenic blindness in
this area.

May 1987

Of the many causes of comeal ulcer described in
books and reported in the literature, Iatrogenic corneal
ulcers are poorly highlighted. It is hopeless on the
part of the profession as well as our country when the
Control of Blindness is covered under the National
Health Programmes, that such practices still continue.
Blindness due to comeal cause is by and large cured
by comeal grafting. Corneas are rarely available and
India has to import donated eyes mostly from SriLanka which are very costly and a laborious technique
of surgery is involved which is not practised in many
parts of the country including Himachal Pradesh.
Hence, the purpose of this article is to create awareness
about iatrogenic corneal ulcer that it can be, and is
better, prevented. Health authorities and health wor­
kers should on their part take suitable measures
against such quacks and educate people on such pro­
blems.
O

121

POPULARISING BREASTFEEDING
AS A METHOD OF CONTRACEPTION
A Study of Yanadi Tribal Women in
Andhra Pradesh
Dr G. Gurumurthy
Breastfeeding has a strong fertility inhibiting effect, i.e. the prolonged breastfeeding reduces
fertility as a natural biological phenomenon, claims the author. Hence, it may be treated as
one of the types of contraception for postponing and limiting the birth.
reastfeeding is an important cultural variable
which influences fertility through post-partum
amenorrhoea (PPA) and birth interval (Bongaarts,
1980). It is one of the proximate variables which
inhibit fertility as a result of prolonging the duration of
postpartum amenorrhoea. Breastfeeding influences volation by means of physiological mechanism and is
also a principal determinant of amenorrhoea. They are
interrelated and one affects the other resulting in posi­
tive correlation. Normally, without breastfeeding the
average emenorrhoea interval is only 1.5 to 2.0 months.
Secondly, amenorrhoea is affected not only by the
duration of breastfeeding, but also by the type and
intensity of breastfeeding. It has been noted that
women who give only breast milk to their infants are
much less likely to resume menstruation than are those
who supplement the diets of their infants with fluids
by bottle or with solid food.

B

It is found from the Khanna study (Wyon and
Gordon, 1971) that all wives believed that lactation
protected against conception, particularly until the re­
turn of menstruation after child birth.
Many main­
tained that lactation resulted in natural spacing of
pregnancies with no need of any contraceptive for
birth control for a year or more after a child is bom,
as breastfeeding was virtually universal in this region.
It was also observed that breastfeeding evidently sup­
pressed menstruation for a median period of ten
months more than the time otherwise expected. Bonga­
arts (1982) suggested that the longer duration of
breastfeeding might be the cause of the longer pregn­
ancy interval. Biologically it is well known that
through hormonal action initiated by lactation the
birth interval can be prolonged; this can act as mea­
sure of birth control and also reduce the natural fer­
tility. Therefore, breastfeeding has a strong fertility

122

inhibiting effect, i.e., the prolonged breastfeeding re­
duces fertility as a natural biological phenomenon.
Hence, it may be treated as one of the types of con­
traception for postponing and limiting the births.

Breastfeeding period varies from society to society
or country to country, depending upon the culture and
development. It ranges from 3 to 48 months, the
period is usually lower in urban women as compared
to rural women (Venkatarangan, 1974). Moreover, in
some of the studies carried out in India, it is indicated
that the period of breastfeeding is more among the
mothers aged 30 and above, as compared to those in
the age group below 29 years. Also it is obseived
that age of the women and breastfeeding have a posi­
tive correlation (Krishnamurthy, 1967). In India
women breastfeed their babies for 16.5 months in
Bombay region (Malini Karkal, 1969) and 21 months
in Punjab area (Wyon and Gordon, 1971). In the case
of Andhra Pradesh it was 18 months for Muslims, 20
months for caste Hindus and 24 months for Harijans
(Mahadevan et al., 1981). The mean lactation period
was 16.1 months in Taiwan, 23.0 months for Korea,
24 months in Nepal and 26.5 months in Indonesia
(Bongaarts, 1982). Where as in western populations
it is generally short, and many women do not lactate
at all; in traditional societies of Africa, Latin America
and Asia, breastfeeding is usually long and often lasts
until next pregnancy occurs (Bongaarts, 1978). Hence,
it was decided to study the effect of breastfeeding on
fertility among Yanadi Tribal women in Andhra Pra­
desh.

Discussion
In the present study of Yanadic, it was found that
97.8 per cent of the mothers practised breastfeeding
and the remaining 2.2 per cent stated that they had no

Swasth Hind

milk at the time of child birth to feed their babies.
This shows that breastfeeding is universal in this tribal
community. They also supplement the diet of their
babies with goat or cow’s milk and with fluids as well
as solid foods from the fifth month onwards. It is the
general practice in this community that tney breastfeed
their babies till the next pregnancy occurs. Even dur­
ing night time whenever the child cries, the baby is
given the breast to suck. They do not provide any
type of bottle feeding. The mean number of time, mo­
thers breast feed the babies per day is found to be
7.5. Besides, it is noticed that on an average the
first breastfeeding commences at 5 A.M. and the last
breastfeeding is at 8 P.M.

Further, an attempt was made to study the period of
breastfeeding by Yanadi women; the last but one
child was considered for the study, as in the case of
last child, some of the babies may still be continuing
to be breast feed and hence the duration of breast­
feeding may not be completed. The mean period of
breastfeeding is found to be 24 months.

It was noted that two-fifths of the women (42%)
breastfeed their babies from 13 to 24 months while,
over one-third of them (34%,) continued breastfeed­
ing for 25 to 36 months. About 14 per cent of wo­
men continued breastfeeding for 37 months or more.
The remaining one-tenth of them (11%) practiced
breastfeeding only upto 12 months. In general it
may be noted that an overwhelming majority of
Yanadi women (76%) practised breastfeeding from
one to three years (13 to 36 months). The fertility
behaviour of Yanadis in relation to breastfeeding is
shown in the Table below:

Table:

Mean number of live births in relation to
the period of breastfeeding and duration of
marriage.

Period of
Breastfeeding
(in months)
Upto 12

13 — 24
25 — 36
37 +

Total

Duration of marriage (in years)
upt-j 10

11 to 20

2.5
(12)
2.4
(108)
2-3
(66)
2.2
(15)

4.5
(24)
4-3
(84)
3.6
(102)
24
(38)

2.4
(201)

21 +

Total

6.1
(27)
5.7
(60.)
5.0
(33)
4.8
(31)

4.8
(63)
3.8
(252)
3.4
(201)
34
(84)

3.8
5.4
3.7
(600)
(151)
(248)
—
Figures in brackets indicate the number of women.

May 1987

The period of breastfeeding has a negative
association with fertility
behaviour of individuals.

The period of breastfeeding has a negative associa­
tion with fertility behaviour of individuals which is
found even in Yanadi tribal community. The women
with 12 months duration of breastfeeding have the
fertility of 4.8 live births and those who practised
breastfeeding for 37 months and above have a signi­
ficantly lower fertility of 3.4 mean live births. Hence,
the fertility has declined as the period of breast­
feeding progressively increased. When the duration
of married life is controlled, a similar consistent rela­
tionship is noticed even under different age cohorts
of women. Nevertheless, the decline of fertility is
more conspicuous among the women of middle and
older age groups as compared to youngsters. There­
fore, the hypothesis that longer the duration of
breastfeeding lower will be the fertility is proved
which shows that breastfeeding acts as a method of
contraception. In this context an effective mass edu­
cation campaign about the advantages of breast­
feeding through cinemas and television may encourage

123

the people to go for a longer
period of breast
feeding instead of bottle feeding. This may supple­
ment the normal efforts being made to promote breast­
feeding through population and health education pro­
grammes by the change agents who work in tribal
areas also.

REFERENCES

1.

JOHN BONGAARTS, 1978: A Frame work for analysthc proximate determinants of Fertility,
Population
and Development Review, Vol. 4(1), March, pp. 105120.

2-

JOHN BONGAARTS, 1980 : The Fertility inhibiting
effects of the Intermediate fertility variables. The po­
pulation Council Working paper No. 57, N-Y. May,
pp. 1-29.

3.

JOHN BONGAARTS, 1982 : The proximate determi­
nants of
Natural martial fertilityThe Population
Council Working paper No- 89, N. Y. September, pp.
1-34.

4.

JOHN B. WFON AND JOHN E. GORDON, 1971 :
The Khanna study—Population Problems in the rural
Punjab, Harvard University Press, Cambridge, Massa­
chusetts, 1971, pp. 134-171.

5.

KRISHNAMURTHY, S- 1967 : Amenorrhoea in rela­
tion to age, parity and rate of conception in women,
Journal of Family Welfare, Bombay, Vol. XIV, Sept.
1967. p. 45.

6.

MAHADEVAN, K- e‘ al., 1981 : Culture, Nutrition
and Infant and childhood mortality: A Study in South
Central India, S.V. University, Tirupati (Mimeographed).

7.

MALINI KARKAL,
1969 : Post-partum Amenorrhoea
in greater Bombay, UPS, Bombay, April p. 1-14 (Mi­
meographed).

8.

VENKATARANGAN, L-B., 1974 : Breastfeeding and
its impact on post-partum Amenorrhoea—A study in
Chidambaram, Tamil Nadu, (Mimeographed).

UNICEF Chief for primary health care
A need to broaden and accelerate all aspects of
primary health care—the goal of Alma-Ata-was ex­
pressed by Mr. James Grant, Executive Director of
the United Nations Children’s Fund (UNICEF) in an
address to the 79th Session of the World Health Or­
ganization’s Executive Board meeting in Geneva.

Mr. Grant emphasized the complementarity between
UNICEF, which “addresses the needs of the whole
child” and the World Health Organization (WHO)

124

INFLUENZA VACCINES FOR 1987-1988
-Modified composition recommendedRepresentatives of the World Health Organiza­
tion (WHO) Collaborating Centres for Reference and
Research on Influenza have completed their yearly
meeting to formulate their recommendations concern­
ing the influenza . vaccines to be manufactured for
the 1987-1988 season.
Having studied the preva­
lence and antigenic character of the various viruses
isolated during the current season, they recommended
that the vaccine for use in the 1987-1988 season be
tri valent and contain the following antigens:
— an A/Singapore .'6/86 (H1N1)—like antigen ‘
— a B/Ann Arbor/1/86-like antigen, and
— an A (H3N2) antigen, to be recommended
During the 1986-1987 season, influenza A (H1N1)
viruses have predominated and in
most countries
have been the only type of influenza virus to be iso­
lated.
Almost all of them were similar to the
A/Singapore/6/86-!ike strains isolated in Asia from
April to July 1986, which has been recommended in
August 1986 in addition to the three components
chosen in February 1986. There were few influenza
B viruses isolated and all were similar to the type
used in the previous vaccine.

As for the A (H3N2) type, the viruses isolated
during the past season were very heterogenous and
a change in this component appears necessary.
Work is in progress to define an appropriate A
(H3N2) antigen and further information will be issued
at the end of March 1987.
Details of the influenza epidemiology, antigenic and
vaccine studies leading to the recommendations for
the influenza vaccine appear in the WHO Weekly
Epidemiological Record, No. 9, issued in Geneva
on 27 February 1987.
—W.H.O. Release

which “provides not only the technical expertise for
policy, but addresses the health needs of all
the
world’s population, extending many realms beyond
UNICEF’s area of concern.”
“The challenge that we face in improving the well­
being of the world’s poor amidst the current economic
climate will require solutions built on the foundation
of all that we know and that we are capable of pro­
ducing. We know that we stand together in confron­
ting that challenge”, said Mr. Grant.

Swasth Hind

SAVITA’S SAD STORY
Dr R. L. Bijlani
Every one has nearly forgotten it and forgiven her but she has neither forgotten it nor for­
given herself. The entire episode is still very fresh in her mind including its minutest details.
She hasn’t missed a single vaccination at school since then, and 1 don’t think she will.
avita and Savita were good friends.

They were
neighbours, and they went to the same school.
They were generally seen together.
One day their
teacher announced that the next day all children
would be given TAB vaccination. It was an injection
to prevent typhoid, she told them.
She added that
in case some chi id did not want it, he or she should
bring a letter from the parents explaining why the in­
jection should not be given.
The last sentence
brought a sense -of relief to all the children. So there
was, after all. a way to escape the torture, they
thought.
Most children went home and pestered
their parents for a letter. So did Kavita and Savita.

K

Kavita’s father said, “Before I give you the letter, let
me tell you an old story from my life. When I was
twelve, I had fever, whfich started like any ordinary
fever. But instead of coming down in a few days, it
kept mounting up, slowly and steadily, day after day.
Your grandpa changed a couple of doctors, and every.
doctor tried several medicines, but nothing seemed to
work. Finally, we all knew it was typhoid. By then, I
had grown very weak. In addition to fever, I also
started, getting loose motions. I was given only very
watery curd and some rice to eat. After the third week.
I was half awake and half asleep most of the time.
I didn’t really know what was happening. I was told
that I used to say all sorts of funny and meaningless
things.
When the fever came down after five weeks.
I had been reduced to a skeleton. I was scared of
seeing my own face in the mirror.
For another
month, I could not walk, I will never forget that
experience”.
Troublesome illness

At this point, Kavita’s mother said, ‘The other day
Kusum the doctor auntie, was telling me that these
days good drugs are available for typhoid. But still,
generally it takes about a week of fever before* doctors
start suspecting typhoid and diagnose it, and another

May 1987

week for the cure to be complete. Although it is
much better than before, tyhoid is still very trouble­
some illness”.
Her father continued, “Summer has already set in.
Soon it will be vacations, and we will go out some­
where. We may have to eat at all sorts of places.
We will not be sure how clean the cooks are, and we
will not know how old the food is. Besides, you would
like to have plenty of ice-cream, sugarcane juice and
many old things during summers. It will be quite a
wonder if somehow or the other some typhoid germs do
not get into your body.
And if you want to know
what typhoid can be like perhaps no body can tell you
better than I have just done. Now, will you get me
some paper and a pen. I shall give you the letter you
wanted”.

Kavita laughed and said, “Papa, don’t be funny.
Do you really think I am so stupid as to choose typhoid
instead of a prick”.

Like most of the other childern, Savita also wanted
to take the letter to school. As soon as she reached
home, she talked about it to her mother. Her mother
said, “Let us wait till Papa comes back home. Then
he can give you the letter”. That day her father came
back home very late. Savita had already gone to bed.
The next morning was like all other mornings. There
was such a mad rush about getting ready. Naturally,
Savita forgot all about the injection and the letter.
On her way to school, Kavita reminded her about it
Savita felt so bad. She felt like running back home
to get the letter. Kavita told her in brief the story
her father had told her, and said, “See, 1 am hot
carrying any letter although I remembered. Come
on Savita, both of us will take the injection”. But
Savita said, “I am no goody goody kid to be taken
in by stories like that. I will find a way to avoid the
injection”. And she did find a way. She thought

125

that if she told the teacher the way things had
really happened, the teacher would force her lo take
the injection. Instead, if she told the teacher that
she had already got the injection, the teacher might
exempt her easily for fear of any harm resulting
from the second injection.
Escapes injection

At school, when the teacher told the children to
queue up for the injection, Savita made a very inno­
cent, almost pathetic, face and said io the teacher,
“Ma’am, my father had taken me to the dispensary
and got me the TAB injection only two weeks ago.
He came back very late yesterday night. In the
morning, when we got up, he said he would give
me the letter. But after that he forgot all about it.
and so did I”, she said looking rather sheepish, and
added, “I’m sorry, Ma’am”. Savita was normally a
well-behaved and honest girl. Therefore, the teacher
believed her. and exempted her from the injection.
On their way back from school, Kavita was
cross with Savita for telling a lie. Savita said, “My
father never says no to anything I ask. He had noi
said no even to the letter. It is just that I forgot to
ask him for it. So you can’t say that I lied”. Kavita
said, “Then what about the injection at the dispen­
sary?” “Oh”, Savita said, “that was a harmless
little lie so that the teacher would agree to leave me
out”. Kavita said, with
obvious sarcasm in her
voice, “Of course, it’s harmless for everyone except
you”. Although Savita put up a brave front while
facing Kavita, she did have a sense of guilt when she
reached home. She was relieved that her parents
did not broach the subject. In a few days, she also
forgot the episode.
Develops Fever
Soon it was the summer vacation. Savita and
her brother, Arun, were very excited because they
were planning to go for a holiday to Kashmir in
June.
They started dreaming about the beautiful
mountains, the clear Dal lake, and the pretty
shikaras, which they had seen only in pictures so
far. There were many sessions of arguments on whe­
ther they would stay in a hotel or in a house boat,
and on what all they would bring from Kashmir. All
this excitement did not last very long, however. It
was cut short on 25th May when Savita developed
fever.
Her parents as well as their doctor, Kusum
Khanna, assured Savita and Arun that it looked like
a viral fever, and would be all right within a few
days. However, when instead of going down, the

126

fever started going up, everybody’s heart started sink
ing. On 30th May, finally, the doctor took a sample
of Savita’s blood in a large special-looking bottle.
and said she would test it to see whether it was
typhoid.
On 31st May. after some deliberation, it
was finally decided to cancel the trip to Kashmir.
They would go next year, the parents said, to con­
sole the weeping children. The next day was the day
they had been waiting for for several months. First
June was the day for going to Kashmir. Instead it
turned out to be the day on which Dr
Kusum
Khanna announced that Savita did have typhoid ■
Learns from experience

As might be expected, Savita had been suffering
for the past one week not only physically, but also
mentally. The way she escaped the TAB injection.
and the conversation she had with the teacher and
later Kavita, kept coming back to her repeatedly
How she wished, she had been honest! “After all.
what is there in a prick,” she thought, “So many
children had tolerated it smilingly, why could’t I.
oh, why couldn’t I!” In her imagination, she relived
the day of the injection with a difference umpteen;
number of times. She would imagine herself in the
queue, take the injection with a smile, and tell every­
one how brave she was. But suddenly, she would come
back to reality with a thud.
She was in bed, lying
with fever. None could change the past, she realised
from personal experience.
When Kusum aunty
announced that she had typhoid, she couldn’t keep
it to herself any more. She broke down and told
everything.
Her parents felt like scolding her, but
seeing how sorry she was, and how much she had
suffered, they didn’t.
But Arun couldn’t control
himself.
He gave full vent to his anger without
mincing words.
He told her that she had ruined
the holidays, she was a lier, she was a cheat, typhoid
served her right, God had punished her, he would
never forgive her, and a lot more.
The next summer came sooner than expected. TAB
was given in the school, and need it be said that
Savita was at the head of the queue tb take the injec­
tion.
They went to Kashmir in the vacation, and
had a gala time.
Everyone has nearly forgotten
Savita’s illness and forgiven her, but she has neither
forgotten it nor forgiven herself.
The entire episode
is still very fresh in her mind including its minutest
details.
She hasn’t missed a single vaccination at
school since then, and I don’t think she will. Do you?

Swasth Hind

Plastic Surgery has Special Role in India
—Says Shri Rajiv Gandhi
“
India has an old tradition of science. We
had developed a vibrant scientific temper many
thousands years ago. Unfortunately, with time much
of it has got a bit lost and we are trying to now revive
that.
Now as part of task of nation-building we
once again try to rebuild that scientific temper, that
openness of mind.
We look to the past for inspira­
tion, we look abroad to other countries for inter­
action and cross fertilization; but essentially it is our
•wn effort
in your particular field (plastic
surgery) we have an old tradition.
An old doctor
about 2500 years ago, called Shushruta had developed
a technique for plastic surgery on noses.
Appa­
rently there was a great need for it at that time.
because of punishment' for adultery (one) was to have
(one’s) nose cut off and, then it needed its repairs, things
were to set back into place again.
These traditions
from ancient sciences from different parts of the
world have been adopted into modem science. Vac­
cinations from Turkey, many other Indian cures are
how part of modem medicines.
We in India, are
looking to use in these old methods with new science
and developing them to their fullest today. We have
somehow got absorbed in looking outside for every
development and we have ignored our own pioneer­
ing fields.
This time we look for a model that is
suitable for India, a model that is suitable for every
developing country.

For a country like India, Plastic surgery is very
important: but perhaps in a different way to how it
is used in the Western world.
We are more worried
about the problems that arise from our poverty,
from the types of diseases that exist in India and the
specific problems of the industry still in its infancy.
an industry in which correct discipline has still not
been absorbed.
We have problems stemming from
diseases such as leprosy, elephantiasis,
problems in
the home because of the types of technology that are
in use, bums from stoves, the clothes women wear,
Mvlon-inflammable materials, industrial accidents from
threshers, from sugar presses, other industries, mili­
tary accidents, diseases such as cancer.
All these
problems have to be faced in our environment.
It
is very easy to try and set the best, the most sophis­
ticated equipment but then when you try to take it
into the more remote areas, the rural areas, it does
not work.
The support systems
are not there,
adequate training is not .there and many problems
arise. We have to develop our own environment,
©ur own methodologies, equipment suited to our own
country and our own needs.
This translation of
developed sciences in other countries to out own
needs, the innovation that is required is, what is
challenging us today.
We have to go to the fron­

May 1987

tiers of science to benefit our people, yet that must be
translated into what is socially meaningful, what is
socially relevant, what can reach out to the
millions of our people.
The transition from labo­
ratory to hospital must take into account the social.
economic and cultural realities of our country. Our
medical scientists are to some extent conscious of
these larger realities.
While global asset is very
relevant for us, it is more relevant to absorb and
synthesise and adapt these developments to the real
challenge that is facing us in India, in our rural
areas, in our more backward areas
There is an
essential role for plastic surgery in India
From the inaugural address to the IX International
Congress of Plastic Surgery held on 1 March, 1987
in New Delhi.
o

Environmentalists adopt proposals on
desert control
Environmentalists from 15 nations at a five-day
meeting, adopted a set of recommendations designed
to help save Asia and the Pacific from becoming a
desert-plagued region.
Among the recommendations, contained in the con­
cluding report of an intergovernmental meeting, are
the establishment of a regional consultative group and
the development of an atlas depicting the region’s
current and future desert situations.

According to the report, the group would provide
policy guidance for a regional network of research
and training centres for desertification control.

Establishing a regional consultative group “is a
sound one”, said VJ. Ram, Officer-in-Charge of the
United Nations Economic and Social Commission, for
Asia and the Pacific (ESCAP), in a closing statement.
Through such body, “the already existing co-opera­
tion among the concerned agencies may be further
strengthened,” added Mr. Ram, who is also Chief,
ESCAPUNIDO Division of Industry, Human Settle­
ments and Technology.
—U.N. Weekly Newsletter.

127

Health Minister calls for Eradicating Malaria
hri P. V. Narasimha Rao, Union

S

Minister for Health and Fa­
mily Welfare, recently called for an
intensification of efforts to eradicate
malaria. Speaking to members of
the Parliamentary Consultative Com­
mittee of his Ministry at New Delhi,
he said incidence of p. falciparum
malaria must be brought down.
The Minister said that a meeting of
State Health Ministers and Secret­
aries and members of this Com­
mittee would be convened shortly
to discuss this problem.

Two slide shows presented by the
Ministry on the National Malaria
Eradication Programme sparked off

Satellite may help

Eradicate Malaria
AMERICAN scientist’s have laun­
ched an experimental project that
will use earth-orbiting satellites with
electronic sensors to combat the
global resurgence of malaria.

a lively discussion among the mem­
bers. A study by ICMR on an
experiment conducted in Kheda
district of Gujarat showed that
malaria can be eradicated without
the use of spray. The study reveal­
ed that one way to eradicate
malaria is by feeding the inputs of
health education, biological and
ecological control and chemotherapy
into the community. The study
noted that the Kheda experiment
was a success. The community had
sustained economic gains as a result
of this experiment.

The Minister said that other prio­
rity areas were leprosy, tuberculosis

each year in the tropical countries,
killing one million people annually
in tropical Africa alone.
The Ames project will use elec­
tronic remote-sensing equipment
carried abroad orbiting satellites
and high-flying aircraft to monitor
environmental
conditions,
like
rainfall and surface water, that
trigger the breeding of malaria­
carrying mosquitoes.

Researchers at the National
Aeronautics and Space Administra­
tions Ames Research Centre in
Mountain-view, California, expect
the pilot-project to lead to a major
advance in Malaria control by the
early 1990s. If effective in the war
against malaria, the technique will
be applied to many kinds of insectborne diseases.

This will allow malaria control
measures like water drainage and
the use of pesticides, to be focused
at times and in areas of highest risk.
These scientists hope ultimately to
monitor large equatorial regions
weekly and deliver data to develop­
ing countries with 24 to 48 hours.

Malaria, although not very com­
mon in developed countries, occurs
in hundreds of x millions of people

Remote—sensing satellites, like
lands at, are able to “see” in both
the visible and near-infrared wave­

128

and blindness. He agreed with the
members on the urgent need to
combat the menace of Japanese en­
cephalitis. Areas of high incidence
must be sprayed, he said. He also
urged State Governments to imple­
ment the bye-laws to control breed­
ing of mosquito larvae.
The meeting was attended by the
Minister of State for Health and
Family Welfare, Kumari Saroj
Khaparde. Among the members
present were Dr. (Smt.) Kalpana
Devi, Dr. V. Venkatesh, Smt.
Prabhawati Gupta (Lok Sabha) and
Shri Durga Prasad Jamuda, Shri
Sat Paul Mittal (Rajya Sabha). O

lengths, and the recorded data are
converted into computer images, en­
abling the study of various environ­
mental features.

“It is our goal to develop a
system that any nation can use”.
says project chief, Mr Paul Sebasta
“All they would need is a personal
computer and a rooftop antenna
(small satellite dish) to collect data
that would help them in predicting
where malaria outbreaks might
occur so they can take intervention
measures. We feel the programme
has a very good chance of success”,
he says.
After successful demonstration of
the technique they hope to turn the
operations over to an international
health organisation or interested
governments.
Centre Calling, Feb, 1987.
O

Swasth Hind

Public
Health: Myth, mysticism and rerjity,
by Dr U Ko "Koi SEA ‘RHP No.- 14, pp 61, Price Ind.
Rs. 60.- or Sw. Fr. 12.

Health is
indivisible, and the
topic of public
health has universal appeal, since it is of relevance
to everyone everywhere.

In this slim publication, the author, Dr U Ko Ko,
WHO Regional Director for South-East Asia, traces
the history of. public health, which can be said to
have had its origins during the Industrial Revolu­
tion in England in the eighteenth century.
The
most marked feature of that period was the largescale migration of people from the rural areas to the
industrial towns and cities which, however, could not
grow fast enough to accommodate the influx.
The
new health problems resulting from such overcrowd­
ing led to the gradual evolution of organizations res­
ponsible for the
nation's health.
Public
health
acts were also promulgated, stimulated by the cut­
break of two epidemics—of cholera in 1845 and of
influenza in 1847.

Thus, the realization of the intimate relationship
between insanitary conditions and epidemics led to
the recognition of the importance of- workers’ health
and the establishment of hospitals.
The frontiers
of public health were expanding, especially in the
direction of bacteriology, with the evolution of new
theories about disease and infection in Europe and
America, which were closely watching the public
health movement in England. At the same time, how­
ever, curative medicine was beginning to acquire a
separate identity, with surgery and medicine becom­
ing distinct) specialities together with a variety of sub*
specialities.
Much progress has thus been made over the past
two centuries.
However, primary health care is a
radical departure from the conventional health care
systems of the past.
It is an integrated approach
integrating promotive, preventive, curative and rehaibilitative medicine—and is also an integral part of a
country’s socio-economic development leading, in
turn, to an improved quality of life. This book,
therefore, makes a strong plea for perceiving medi­
cine as a whole so as to derive the maximum benefit
from technological advancements and make medi­
cine a potent instrument to achieve health for all.

The narrative makes fascinating
readings,
not
only for health workers but all those interested in
health—and that includes everyone.
Q

AUTHORS OF THE MONTH
Lt. Col. A.C. Urmil
Reader
and

Col. P.K. Dutta
j
. j;' *!^. • ;*.
Associate Professor
Department of Preventive and Social Medicine
Armed Forces Medical College
Pune-40
Maharashtra
Dr A.C- Moudgil
Dr S.K. Verma
, Dr Pamijit Kaur
Ms. Amita Ummat

and

Ms. Raman Mehta* *' '
Postgraduate Institute of Medical Education
and Research.
Chandigarh

Prakashi Rajaram
Psychiatric Social Worker
and
Dr R. Parfhasar’fhy
Lecturer in Psychiatric Social Work
Department of Psychiatric Social Work
National Institute of Mental Health and
Neurosciences,
Bangalore-560 029
Dr J.N. Pande
Associate Professor of Medicine
All-India Institute of Medical Sciences
Ansari Nagar
New Delhi-110 029

Dr Swatantra Sharma
D.O.MS.
Dr Prakash Gupta
M.H.A.M.S. (Family Medicine)
and
Pradeep Kumar Gautam
Hamirpur
Himachal Pradesh

Dr R.D. Sharma
Project Officer
Department of Adult and Continuing Education
Garhwal University, Srinagar,
Garhwal, Uttar Pradesh

Dr G. Gurumurthy
Lecturer in Population Studies
Sri Venkateswara University
Tirupati-517502
Andhra Pradesh

Dr Madhuban Gopal
Scientist
Division of Agricultural Chemicals
Indian Agricultural Research Institute
New Delhi-110 012

Dr R.L. Bijlani
Associate Professor
Department, of Physiology,
All-India Institute of Medical Sciences
Ansari Nagar
New Delhi-110 029

ISSUED BY THE CENTRAL HEALTH EDUCATION BUREAU (DIRECTORATE GENERAL OF HEALTH SERVICES). KOTLA MARG,

NEW

DELHI—110 002

AND

PRINTED BY THE MANAGER, GOVERNMENT OF

INDIA

PRESS, COIMBATORE—641 019.

Regd. No. D-<C) 359
Regd. No. R. N. 4504/57

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swasth hind

AROGYA SANDESH

(A Hindi illustrated monthly)

SPECIAL NUMBERS 1986
March—April

World Heaih Day
(Theme: Healthy Living:
Everyone a Winner)

June

Environment, Water and
Sanitation

July

Food, Nutrition and Health

August

Health Progress in India

November

Children’s Day

December

Family Welfare

For
♦Healthful living
♦Information on health programmes
♦New developments in the field of health

♦Health news from India and abroad

Each issue is a herald of health

SWASTH HIND
Gives you a perspective on
India’s Plans and Programmes
in the field of Public Health
Send your order alongwith the cost by M.O./Postal Order to:
The Director
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Swasth hind, Vol. 31, No.5, May 1987.pdf

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