THE PROBLEMS OF ORAL HEALTH IN INDIA

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Title
THE PROBLEMS OF ORAL HEALTH IN INDIA
extracted text
■ ISSN, 0586=1179-

JANUARY-MARCH 1996

ilpeh ,

Community participation and

In this issue

swasth hind
Pausa-Chaitra
Saka 1917-18

January-March 1996
Vol. XL Nos. 1—3

OBJECTIVES

Swasth Hind (Healthy India) is a monthly journal
published by the Central Health Education Bureau,
Directorate General of Health Services, Ministry of
Health and Family Welfare, Government of India,
New Delhi. Some of its important objectives and
aims are to:
REPORT and interpret the policies, plans, pro­
grammes and achievements of the Union Minis­

try of Health and Family Welfare.

ACT as a medium of exchange of information on
health activities of the Central and State
Health Organisations.
FOCUS Attention on the major public health
problems in India and to report on the latest
trends in public health.

KEEP in touch with health and welfare workers
and agencies in India and abroad.
REPORT on important seminars,, conferences,
discussions, etc. on health topics.

”

Page

Elimination of Leprosy in India
Dr Shanker Dayal Shanna
The effect of patient and community education
in prevention of disability programme—A study

1

3

T. Ethiraj, P. Antony, Dr P. Krishnamurthy &
Dr N.B.B. Reddy
Mental health care through sub-centres : An
approach
Dr Jugal Kishore & Dr Vinay Kapoor

9

Multi-pronged approach in drug addiction
among youth

12

Paras Nath Garg
Community participation and health for all
Dr Rajkutnar Bansal and Dr Ratan K.

Srivastava
Health communication—Some perspectives
Dr (Mrs) P. K Sharada
Postage stamps : Messengers of health
Dr Y.A. Ketkar & Dr A.C. Urmil

16

18
23

Stroke education and its evaluation

26

Dr Prakashi Rajaram
Risk factors for stroke

28

Marine hygiene
Colonel Jasdeep Singh

30

Robert Koch : The great discoverer
Dr V.K. Tiwari

32

Better co-ordination leads to excellent results—
An Agra experience
Deoki Nandan, GJC Gupta, Manish

34

Subharwal and Neeta Gael
Care of the Ear

36

Dr Vijay Choradia

Editorial and Business Offices
Central Health Education Bureau
(Directorate General of Health Services)
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Articles on health topics are invited for publication in this Journal.

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Due acknowledgement is requested.

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Edited by

M. L. Mehta
M. S. Dhillon

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G. B. L. Srivastava
K. S. Shcmar

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ELIMINATION OF
LEPROSY IN INDIA
DR SHANKER DAYAL SHARMA

PRESIDENT OF INDIA

One fourth of the estimated cases and 60% of the registered cases in the World are in India. In
the last decade, estimated cases have been brought down from about four million to less than a
million. The light at the end of this dark tunnel is finally visible. We, the Government, medi­
cal personnel, voluntary organisations and the public must strive unitedly to achieve Bapu s
dream of the total elimination of leprosy in India.

EPROSY is not a mere medical
problem. Its very mention
evokes an extraordinary dread. It
brings out deep seated prejudices
in the minds of the ignorant.
Because ostracism rather than
medicine was seen'as a solution, it
became as much a social problem
as a medical one.
Inadequate nutrition and sanita­
tion arc among the root causes of
leprosy. It is thus a classic symp­
tom of socio-economic under­
development. It is no accident
that the endemic countries arc the
nations of the South. Eradication
of leprosy, therefore, is an intrinsic
aspect of the progress of such
societies. Its elimination is not
only a humanitarian endeavour.
but one which affirms our ability to
meet the basic wants of our
people.

and should not be taken for a
divine message. Its very curability
removes the stigma attached to the
disease and creates an environ­
ment for the rehabilitation of the
afflicted. In the last decade. Multi
Drug Therapy (MDT) has allowed
leprosy eradication to make con­
siderable headway. You are all
aware that MDT services had been
introduced in 245 districts by
March 1994. Mobile Leprosy
Treatment Units are covering mod­
erate and low endemic districts, I
understand that all districts of the
country have now been sanctioned
MDT. and that from 1995, all lep­
rosy cases will be covered by this
treatment. The result of these
efforts is reflected in a fall of 80% in
the prevalence rate and 70% in the
deformity rate in those districts
where MDT services have been
available for five years.

Medical and social aspects of
leprosy arc inextricably lin­
ked. Effective treatment by mod­
ern medicines should convince
even the most superstitious that
this disease is entirely man-made

Early detection of cases and pro­
mpt treatment with MDT is a
course which has yielded divi­
dends. It has not only improved
motivation among patients and
medical staff, but by demonstrating

L

January—March 1996
1-7/DGHS/ND/96

successful therapy, has increased
voluntary reporting among new
patients. The low relapse rale is
also a matter of encouragement
Yet, this is no time for complacen­
cy. Each sign of progress must
only reinforce in us a determina­
tion to complete the job. The
exercise of monitoring and carry­
ing out special surveys must be
unceasing. Domiciliary
treat­
ment must be expanded. The
organization of health education
must
receive
greater
atten­
tion. Even as MDT services are
consolidated, new treatments must
be
constantly
explored. The
expansion of surgery facilities in
leprosy hospitals is also impor­
tant. As leprosy occurs in the con­
text of poverty, the provision of free
facilities to patients and free supply
of prosthetics and protective equip­
ment should be encouraged. Re­
habilitation programmes must be
rigorously pursued so that the
message is spread that there can be
life after leprosy.
Effective rehabilitation requires
overcoming the prejudices attach-

1

cd to leprosy. Mahatma Gandhi
set a personal example by tending
on Parchure Shastri. Not all of us
have his strengh of conviction or
his selflessness. Yet we can, each
in our own humble way, contri­
bute—by giving time, donating
resources, by creating awareness, or
by providing employment oppor­
tunities. The Government has
programmes to set aside jobs for
the orthopaedically handicap­
ped. But we must look beyond
that in our care for leprosy patients.
The time has come for the private
sector, which should display social
responsibility to step forward. It
should be our joint endeavour to
give economic self-sufficiency to
leprosy patients so that they can
regain confidence and pride in
themselves. We must remember
these words of Bapu—“Why
.should there be a stigma about lep­
rosy any more than about other
infectious diseases ? Real leprosy
is attached to an unclean mind.
To look down upon fellow human

beings, to condemn any com­
munity or class of men, is a sign of
diseased mind far worse than
physical leprosy. Such men are
real lepers of society”.

Voluntary organisations have a
critical role in the fight against lep­
rosy. Their contribution covers
the range of activities involved in
leprosy eradication, from the detec­
tion of cases, to their treatment,
health education, training and
research,
and
rehabilitation.
They have the ability to mobilise
and educate public opinion. The
success of our national programme
rests, to a large measure, on their
efforts. The Hind Kusht Nivaran
Sangh is the oldest of the voluntary
organisations in the country exten­
ding services to leprosy patients.
Its record in health education, com­
munity awareness, and rehabilitaion has been creditworthy. I am
glad to note that the Sangh has
identified priority areas to augment
the activities of the National Pro­

gramme. This includes training
and reorientation of health staff,
orientation courses for health
workers, medical facilities for lep­
rosy patients in Delhi, and reha­
bilitation programmes in different
parts of the country. As the Presi­
dent of the Sangh, I commend
these efforts and urge you to inten­
sify them in the coming years.

One-fourth of the estimated
cases and 60% of the registered
cases of leprosy in the world are in
India. In the last decade, esti­
mated cases have been brought
down from almost four million to
less than a million. The light at
the end of this dark tunnel is finally
visible. We. the Government,
medical
personnel,
voluntary
organisations, and the public must
strive unitedly to achieve Bapu’s
dream of the total elimination of
leprosy in India—From the address
by the President of India at the AGM
of Hind Kusht Nivaran Sangh.

“Why should there be a stigma about leprosy any more than about other infectious dis­
eases ? Real leprosy is attached to an unclean mind. To look down upon fellow
human beings, to condemn any community or class of men, is a sign of diseased mind
far worse than physical leprosy. Such men are real lepers of society.”

—MAHATMA GANDHI

SMOKING SHOULD BE BANNED IN PUBLIC PLACES AND OFFICES

2

Swasth Hind

The Effect of Patient and
Community Education in
Prevention of Disability
Programme—A Study
T. Ethiraj, p. Antony.

Dr p. Krishnamurthy & dr n.b.b. Reddy

UT for the disability that it pro­
duces in a small percentage of
patients, leprosy would be a simple,
innocuous,
infectious
disease.
The potent drugs available in the
form of multidrug therapy (MDT)
have made a definite impact on the
disease in that the case load has
come
down
dramatically
to
manageable levels in most of the
initially
hyperendemic
areas
(Noordccn 1989). But the distur­
bingly visible deformity produced
in a few patients reflects our failure
to come to terms with the disease
completely. Following the spec­
tacular achievement of MDT in
bringing down the case load, dis­
ability prevention is logically gain­
ing significance in the agenda of
leprosy eradication programme
(ILA 1993).

B

The Alma Ata meeting of WHO
has set out the concept of com­
munity based rehabilitation (CBR)
as: “To extent specialized care
using non-specialized providers,
namely the health worker and
ultimately the family and pati­
ents.”

January-March 1996

Th e effect of self care learning by leprosy patients in prevention
of disabilities was studied by adapting two strategies in two sub­
centres of a project in South India, one through patient educa­
tion by trained field staff and the other through community
education involving trained animators and health commit­
tees. One of the subcentres was taken as control where neither
ofthe strategies was employed. In terms ofresults, though both
the strategies were found to be effective in containing occurrence
of new deformities among high risk patients and healing of
trophic ulcers in hands andfeet, strategy I i.e. self care education
of patients by concerned field personnel without prejudice to
their routine work is recommended because of ease in diffusion
of strategy.

Community based rehabilitation
(CBR) is relation to leprosy starts
with prevention of disability (POD)
which forms the primary compo­
nent of CBR (Padmani Mendis
1989). Even a step forward in the
direction of disability prevention
could influence favourably the pre­
vention of stigma, which in most
cases is indisputably due to dis­
figurement.

If a practical strategy of field­
based. community-oriented pre­
vention of disability was made
available, it could have a consider­
able bearing on the outcome of the
eradication programme (Khalfan
1994). An effort in this direction
was made by Demicn Foundation
India Trust (DFIT) to study the
effect of education of patients as
well as community on deformity

3

prevention and disability limit­
ation. The objective of the project
was to study the effect of education
of patients in self-care by field staff
or animator and education of com­
munity about the disease and dis­
ability prevention. The sub ob­
jectives of this project were: (i) To
study the effect of patient education
by field staff or animator in terms
of (a) prevention of disability
among high risk patients, (b) pre­
vention of deterioration of dis­
ability among patients with Grade I
disability and (c) prevention of
deterioration of deformity among
patients with Grade II disability,
and (ii) to study the effect of com­
munity education in terms of (a)
reduction in proportion of new
cases with deformity and (b)
increase in voluntary reporting of
new cases.
Material and Method

The Church of South India
Medical and Leprosy Centre
(CSIMLC), Vandavasi is a Damien
Foundation-sponsored project in
the National Leprosy Eradication
Programme (NLEP) from 1980.
The population covered by the pro­
ject is
1,70,000 (1991
cen­
sus). There were 3,379 known
cases on record at the beginning of
1994. The prevalence rate was
14.4 per thousand in 1980 and it
had come down to 1.9 per 1000 in
January, 1994. There were 476
cases with deformity in this area.

Two strategies were adopted in
two subcentres of Vandavasi to
achieve the objectives as indi­
cated below.
Strategy 1 : In this strategy, the
prevention of disability by sclf-carc
was tried in one subcentre (Vandavasi-II), through education of

Strategy 2: In strategy’ 2. in
another subccntrc (Vandavasi-I).
disability prevention by education
of patients through self-care was
tried with animators selected from
the community health committees
organized in all the villages of the
study area.
One more subcentre (Ponnur)
was taken as control.
The components of self-care
included (Srinivasan 1993):

Skin care: Protective precautions
to prevent injuries to skin of hands
and feet: (a) soaking the affected
limbs in clear water, (b) scraping.
(c) oiling, (d) avoiding heat and
pressure, (e) using footwear and (f)
using cloth to handle hot objects.
Wound
care: Cleaning
the
wound or ulcer or crack, keeping it
covered and allowing it to heal by
resting the part: (a) soaking in
clear water, (b) cleaning surround­
ing skin well, (c) removing foreign
bodies etc. from the wound, (d)
washing with clean water, (e) mop­
ping the wound and drying sur­
rounding skin with a clean cloth, (f)
applying dressing/resting the part
and (g) using footwear.
Joint care: Preventing the occur­
rence of and correcting joint stiff­
ness : (a) massage and exercises
(active as well as passive) and
(b) splinting.

Swelling care: For minor injury
or inflammation and major injury
or infection : (a) splinting the part,
(b) keeping the part raised (hand in
a sling, foot over pillow), (c) resting
the part, (d) referring to doctor if
fever or swelling did not subside
after three days or swelling in­
creased and or pus became
obvious.

patients by the concerned field staff
making the exercise a part of their
routine work.

4

Nerve care: Learning to recog­
nize the onset or worsening of area

of loss of sensation or muscle weak­
ness in hands and feet: (a) nerve
pain—splitting/sling. and (b) loss
of sensation and weakness of
muscle—physiotherapy, exercises.

Eye care : Protecting eyes from
injury and cornea from drying
up: (a) recognising dimness of
vision early, (b) reporting for medi­
cal advice for any eye problem, (c)
think blink for corneal anaesthesia.
(d) frequent washing of eyes with
water, (e) oiling before going to bed
and covering the eyes with cloth, (f)
using glasses or pads and (g)
passive closing of eye lids.

The components for OPD train­
ing were : (a) identification of ner­
ves involved in leprosy and their
examination, (b) functional assess­
ment of nerves, (c) neuritis, (d)
identification of primary and
secondary disabilities, (c) preven­
tion of primary and secondary dis­
abilities; (I) WHO grading of
disability and disability recording.
(g) self-care practices and (h)
records.
The training aimed at improving
the knowledge and skills of the staff
in POD more by practical exercises
than by imparting theoretical
knowledge. Hence hardly any
lime was spent on lectures and
theories.
Methods Adopted

The following methods were
adopted for both strategies :
(i) An action plan was drawn for
12 months from January to Decem­
ber 1994 for the study.

(ii) All the field staff were given
an orientation training in POD for
three days at Vandavasi.
(iii) Screening forms, monitor­
ing records, posters and leaflets
were developed and supplied to the
study area.

Swasth Hind

(iv) The cases with high risk and
deformity were listed and dis­
tributed among the leprosy inspec­
tor. the non * medical supervisor.
social worker and physio techni­
cian in charge. Screening of
known cases was done in Vandavasi I, II and Ponnur to identify
grade 1 and 2 disabilities and high
risk patients who included cases
with facial lesions, cases with skin
lesion near the nerve truck, cases of
broder line types, pregnant and lac­
tating women patients, patients
who had reactions and patients
complaining of paraesthesia.

(v) One day practical demon­
stration of self-care exercises was
conducted for the disabled patients
of both the subcentres at Vandavasi.
(vi) To render the outcome of the
study generally applicable to the
NLEP set up, this study was made
part of the routine work of the field
staff engaged in the project

(vii) Availability of materials at
their homes’ (adapted with the
available ones) for soaking, scrap­
ing and oiling for skin care, ulcer
care and joint care activities was
ensured and physically verified
with each patient with trophic ulcer
or anaesthetic limb. Footwear
supply to all the patients was
ensured.

34 health committees for 23 vil­
lages. Inclusion of women, at
least two of them in each commit­
tee, was ensured.

(ii) One session of informal class
on leprosy was conducted for the
health committee members.
(iii) Thirty-four animators were
chosen from the health committees
and were given one day informal
training in self-care. Each ani­
mator was given a list of patients to
be monitored for self-care in his
village.

(iv) In addition to patient educa­
tion the animators were asked to
involve the people in community
education programmes and assist
field workers in organizing the
same covering the entire village
every month with different pro­
grammes on leprosy eradication
with emphasis on POD. The
health education programmes
included ‘padayatra’ (walks) with
banners, cycle procession, posters
campaign, leaflet campaign, youth
meet, women’s meet, student’s
meet, teacher’s meet, folk songs,
video shows and street play.

(v) Population survey for 1994 in
Vandavasi II subcentre and Ponnur
was suspended in order to study the
effect of health education program­
mes on new case detection.

(viii) Books on self care with
photographic illustrations of exer­
cises in colour were issued to the
patients for reference and con­
sultation.

For grading of disability the
WHO guideline was used in the
study (WHO 1988).

Additional methods adopted for
strategy 2: Health committees were
formed in all the 23 villages coming
under this subcentre. In 11 vil­
lages separate committees were
formed in scheduled caste blocks
where the need for additional ones
was felt. Hence Vandavasi-I had

In strategy 1 each of the four field
staff involved in the patient educa­
tion programme, monitored and
supported the self-care learning of
each patient, under his care at least
once a month. Patient com­
pliance was studied with a check
list and suitably recorded.

January—March 1996

Monitoring & Evaluation

As for strategy 2, monitoring of
self-care was carried out once a
month for each patient by the
animator, and a record of the same
was made. The four field workers
concerned supervised the exercise
of the animators once in a month
and helped the latter solve any pro­
blems in learning by patients.
Once a month the investigators
of the study, consultant physio­
therapist and health educator of
DFIT, visited the project and moni­
tored the activities of the patients.
animators and the staff.

Evaluation of leprosy awareness
was done in Vandavasi I and Pon­
nur with a structured questionnaire
laying emphasis on POD. This
exercise was carried out by 15
trained community health volun­
teers of CSIMLC, for 15 days in
January 1994 for pre-test and 15
days in December 1994 for post-test
in Vandavasi I and Ponnur sub­
centre in order to evaluate the effect
of community education in reform­
ing the attitude of the community
as well as patients in respect of
disability.
In January 1994, 1400 respon­
dents in Vandavasi I and 900 in
Ponnur (control) were interviewed
whereas in December 1994, 1165 of
them in Vandavasi and 749 of them
in Ponnur were available for post­
test evaluation. Hence the results
were based on post-test figures
only.
Appendix A summarizes the
methods described above and the
results obtained.

Results

From January 1994 onwards,
patient education and community
education programmes were con­
ducted as per schedule every month
(ill December 1994, by staff and

5

animators. The results of self-care
learning in the three sub centres are
given in Table I.

New deformity in 1994: Strategy
1 (Vandavasi II): No new defor­
mity developed among the high
risk cases and no new case with
deformity was reported either.

Strategy 2 (Vandavasi I): No
new deformity developed among

high risk patients, but four new PB
cases with anaesthetic hands
(Grade 1 deformity) voluntarily
reported for treatment
Control (Ponnur): Three cases
developed new deformity among
high risk patients, one from
patients under treatment and two
from cases declared RFT; no new
case with deformity was reported.

Table I

Straiegy 1
Jan W

Control

Strategy 2

Dec ’94

Jan -94

Dec ’94

Jan ’94

Dec ’94

54
123

393
87
74

86
76

Total known cases
High risk cases
Cases with deformity

618
91
93

91
93

486
54
119

Grade 1

12

12

20

24

8

7

3
5
2
2

3
5
2
2

6
8
2
4

7
•11
2
4
—

1
3
2
2
—

1
2
2
2

81

81

99

99

66

69
15
18
12
19
3
2

Hand
Foot

Eye

—* Left
— Right
— Left
— Right
— Left
— Right

Grade 2

— Left
— Right
— Left
— Right
— Left
— Right

20
28
12
14
3
4

20
28
12
14
3
4

41
47
16
17
7
4

41
47
16
17
7
4

14
16
12
19
3
2

Trophic ulcers
— Left
Hand
■ — Right
— Left
Foot
— Right

32

7
_—
1
2
4

34

11
—
1
4
6

31

27

2
3
11
15

2
3
8
14

—
—
—
—

—
—
—
—
—

Hand

Foot
Eye

New deformity - Grade 1
— Left
Hand
— Right
— Left
Fool
— Right
— Left
Eye
— Right
New deformity - Grade 2

Hand

Foot
Eye

— Left.
,— Right
— Left’
— Right
— Left. •
— Right

’ r
4
11
16

—

—

2
4
13
15

—

4
2
2 ,
—
—»
—

—
—

—

——

3
1
2
—

Trophic ulcers in 1994: Table II
shows the results regarding tro­
phic ulcers.
Worsening of disability: Strategy 1
& 2: No worsening of disability
occurred in both the sub centres in
the sense that no patient in the high
risk group developed Grade 1
deformity, nor patients with Grade
1 progressed to Grade 2, nor
patients with Grade 2 deterio­
rated further:

Control area: Three cases deve­
loped Grade 2 deformity: two from
RFT patients and one from
patients under treatment. All the
three were cases of borderline
tuberculoid type.
Level of leprosy awareness in the
comm unity regarding POD: As part
of community-based approach in
Strategy 2, this aspect was studied
in Vandavasi I and Ponnur subcen­
tre with a structured questionnaire
consisting of 12 questions: seven on
leprosy and five on deformities (sec
below). For this purpose 1165 peo­
ple from Vandavasi I and 749 from
Ponnur were interviewed in
January 1994 for pre-test assess­
ment and December 1994 for post­
test assessment. Here focus is
made (Table III) only on the infor­
mation elicited on POD aspect
from the answers for the questions
given below. Correct answers arc
given within brackets.
(1) What will happen if leprosy
is not treated in early
stage? (deformity)
(2) Can medicine prevent defor­
mity? (yes)
(3) Is leprosy curable after
occurrence of deformity?
(yes)
(4) Are ulcers and absorption
due to leprosy? (No, by
carelessness)
(5) Would you like to freely
move with a cured disabled
patient? (yes)
SWASTH HIND

6

Tabic FI— Trophic ulcers
Strategy 1
(Vandavasi II)

Strategy 2
(Vandavasi I)

Control
(Ponnur)

Trophic ulcer in
January 1994

32

34

81

Trophic ulcer
in December 1994

7

11

27

Tabic in

Vandavasi I
% of right answers

Q. 1
Q. 2
Q. 3
Q. 4
Q. 5

Ponnur
% of right answers

Pre-test
Jan. ’94

Post-test
Dec. '94

Pre-test
Jan. '94

Post-test
Dec. '94

7.6
37.3
20.1
18
32.8

34.8 (+27.2)
64.1 (+26.8)
47.6 (+27.5)
8.7 (+6.9)
35.7 (+2.9)

10.9
37.1
212
0.8
142

11.8 (+0.9)
39.9 (+2.8)
26.7 (+5 5)
0.8 (NIL.)
14.4 (+0.2)

In Vandavasi the increase of
post-test percen tage of right
answers over that of the pre-test can
easily be claimed as improvement
brought about by health education
programmes conducted during the
study period. However, the mechanism to retain the gains even in the
absence of such programmes is yet
lo be evolved.

ing of cases increased by 13% (from
27% in ’93 to 40% in ’94) whereas the
increase for the same in Ponnur
was 0.4% (from 20.6% in ’93 to 21%
in ’94).

Discussion

New deformity: As regards new
cases with deformity, no such cases
were reported in Vandavasi II and
Ponnur, in Vandavasi I, new case
reportings in the early stage of disability (Grade 1) could be~duc to

Voluntary reporting (Table IV): As
a by-product of community educalion in Strategy 2, voluntary reportTable IV

New cases registered

Vfear

Vandavasi II

Vandavasi I

Ponnur

1992
1993
1994

78
75
53

74
72
40

21
19
19

Voluntary cases a mong new ones

Year

Vandavasi II

Vandavasi I

Ponnur

1992
1993
1994

12 (15.3%)
16 (21.3%)
14
(26%)

12 (162%)
17 (23.6%)
16
(40%)

4 (19.0%)
6 (20.6%)
4
(21%)

January—March 1996

the intensive health education
under Strategy 2, since the patients.
on questioning at admission, men­
tioned the source of information as
street play conducted in their
villages.

Development of new deformities
among high risk patients in Ponnur
and the non-occurrence of new
deformity among high risk patients
in the study area could be
explained only in terms of regular
monitoring of the patients by the
field worker or animator during thc
study period.
Trophic ulcers in 1994: The sharp
decline in the number of trophic
ulcers in the study area at the end of
the study period (December ’94) is
quite interesting when compared to
the figures of Ponnur. It was
found that while in January 1994
there were 27. 28 and 26 cases with
Grade 2 problems in the feet in
Vandavasi II, Vandavasi I and Pon­
nur (control) areas respectively,
comparable figures for December
1994 were 7. 11 and T1 respectively
(Table I).

This progress in ulcer care in the
study areas could be reasonably
attributed to the successful adop­
tion of self-care practices of the
patients.
Worsening in disability status in
1994: Though in the study areas as
well as in the control area no case
was recorded as having worsened
in his or her existing disability
status, development of new defor­
mity among three high risk
patients in Ponnur was a definite
set-back in the health condition of
the patients. This phenomenon
could be explained by the non­
availability of patient education
in Ponnur.

Limitations: Certain limitations
were brought to light in this study.
particularly in Strategy 2 in which
animators were used. It was

7

found from the records of the
animators that some of them had
failed to make regular visits to the
patients allotted to them for mon­
itoring. Some animators paid fre­
quent visits to the patients of their
choice, visiting others only occa­
sionally. These flaws in the quality
of the animators arc understand­
able since these individuals had
varied social, cultural and edu­
cational backgrounds. No incen­
tive or remuneration was paid to
them, because the concept of this
study was not in favour of it.
As for recurrence of ulcer, that
problem could not be studied in a
one year project.

Post-study examination: In order
to assess the sustainability of the
impact of patient education. 15
patients taken at random in
villages of Vandavasi II were
examined for trophic ulcers and
self-care practices by two officers of
DFIT in April 1995. Only two
patients were seen with ulcers, one
on the hand, and another one on
the foot persisting from 1994.
Almost all the patients were able to
explain how to carry out selfcare exercises.

The same assessment was done
in two villages of Ponnur (control)
sub-centre with five patients. Four
of them were having trophic ulcers
leading us to infer that self-care was
not practised or sustained when
there was no active patient
education.
Conclusion

Of the two strategics tested.
though both of them produced
more or less similar results in res­
pect of POD. Strategy 1 which was
patient education by leprosy field
staff is worth recommending for
field application, because the
transfer of the skill and knowledge
of POD to the actual beneficiary.
the patient, was made in Strategy 1
directly by the field technical staff
and was facilitated by their inti­
mate relationship with the patients

8

and the technical know-how
gained from the training. In
Strategy 2, the same process was
made through an agent, the
animator, a third party in between
the technical personnel and the
patient. This passive education to
patients when compared to that of
Strategy 1, is a detour to reach the
destination, the patient
Though there is positive side of
community education in POD, in
involving the community members
as animators and health commit­
tees who hail from the same place
of the patients, the indirect form of
education in this strategy needs
monitoring by the technical per­
sonnel which means visits by
health personnel are inevitable.
This inevitability made the exercise
ultimately staff-based. In such a
context, direct participation of the
field staff in self-care education, in
place of indirect one will certainly
be more productive and yield better
results as shown in this study.

The ultimate aim would be the
sustenance of self-care practices, in

the absence of inputs by the field
staff, through involvement of
trained family members and local
health volunteers.
References

1.

ILA 1993. Workshop 9. Tnt .1 Lepr
61 : 744-747.

2.

Khalfan KH 1994. Disability and
literacy. CBR News No. 16.

3.

Noordecn SK 1989. Address at the
Asian Meeting on Rehabilitation in Lep­
rosy at Kuala
Lumpur.. Kusht
Vinashak, Vol 12. No. 9 & 10 :3-4.

4.

Padmani Mendis 1989 - Paper pre­
sented at the Asian Meeting of
Rehabilitation on CBR and Training in
Rehabilitation. Kusht Vinashak Vol 12
No. 9 & 10: 5—10.

5.

Srinivasan H 1993. Prevention of dis­
abilities in patients with leprosy—A
practical guide. World Health Orga­
nisation. Geneva.

6.

WHO 1988. Expert committee on
leprosy—Sixth Report, WHO Tech Rep
Ser 768, p 35.

Courtesy: Indian Journal
of Leprosy,—Oa-Dec. 1995.

SWASTH HIND

Mental Health Care Through
Sub-Centres : An Approach
DR JUGAL KlSHORE

&

Dr vinay Kapoor

According to WHO. one

per cent of the population.
suffers from severe incapa­
citating mental disorders
and 10 per cent from mild

mental

disorders.

This

situation places a heavy
burden on primary health

centres (PHCs) and in the
community for its impact

on economic, social and

psychophysiological deve­

lopment.

There is a need

of integrated mental health

policy for the needy people
who come to PHCs and

sub-centres for help.
January—March 1996
2-7/DGHS/ND/96

ccording to WHO, in many
countries including India, 1%
of the population suffers from
severe incapacitating mental disor­
ders and 10% from mild mental dis­
orders, ’"3- A heavy burden of
psychiatric morbidity at primary
health centre (PHC) and in the
community raised alarm for its
impact on economic, social and
psychophysiological
develop­
ment. This attracted the attention
for the very important priority area
to provide health services. Cer­
tainly, there is a need of integrated
mental health policy for the needy
people, those who take pain to
come to the PHC and Subcentre for
some help,

A

Psychiatric morbidity at primary
health care units

Developed countries: The pre­
valence rates of psychiatric mor­
bidity vary from 10%-43% at
primary health care units.5"5The prevalence rates of depression
in general medical setting, has
been reported to range from 10%
to 40%.7-8-

India : Most of the studies, con­
ducted either in teaching hospital
or in peripheral district hospital,

reported l8%-54% of psychiatric
morbidity. At
rural
primary
health units the psychiatric mor­
bidity is reported to be 10.4%17.7%.9-10- In a survey conducted
at a rural PHC of Haryana, we
found 41.7% of the adult OPD
patients were suffering from psy­
chiatric illnesses. Among them.
21.5% of patients were having pure
psychiatric illness even without
physical illness. 4

Classification of Psychiatric Dis­
orders
Standardized classification is
essential for data collection, inter­
national and national comparison
and for psychopathological re­
search. We have Diagnostic and
Statistical Manual of Mental Dis­
orders (DSM) 11 and International
Classification of Diseases (ICD)
systems. ”• It has been clearly
documented that the presentation
of
psychiatric
illnesses
are
markedly distinct in community
care settings. Moreover the pri­
mary care personnel would re­
quire a classification that is simple
and easy to use, describing the
common disorders they see in their
work settings. At present the

9

WHO has formulated ICD-10 suit­
able for use in all level of health
care setting. Broadly, we can
classify Mental Disorders as:
A

Organic Mental Disorders

B

Substance use Disorders

C

Schizophrenia
sions

D

Mood (Affective) Disorders

E

1.
2.
3.
4.

F

Sexual Dysfunctions

G

Personality Disorders

H

Mental Retardation

and

Delu­

Anxiety Disorders
Adjustment Disorders
Conversion Disorders
Somatoform Disorders

mon drugs
setting, i, is.

SCREENING FOR PSYCHIAT­
RIC DISORDERS AT SUB­
CENTRE

For Nonpsychotic Patients: The
multipurpose worker can use. Self
Rating Questionnaire (SRQ) for
screening purpose. This is very
simple and easy to administer on
lay population and having high
sensitivity and specificity at 6
positive responses out of 20
questions.4, ®.
Self-Reporting Questionnaire

1.

Mood disorders and soma to fo mi
disorders are the most common
psychiatric entities among psy­
chiatric illnesses. These disorders
are more common among females
within the age group of 30-45
yrs. Anxiety disorders (Genera­
lized anxiety disorder, panic and
phobias) are also common among
OPD patients. Small number of
patients do suffer from personality.
schizophrenia, mental retardation
and sexual disorders. Around
0.5%-l% of the patients arc having
addiction and substance use disor­
ders. Majority of patients with
mood, anxiety, conversion, adjust­
ment and somatoform disorders
are presented with somatic symp­
toms at primary health set­
ting. Correct diagnosis and good
management will increase the
efficiency of the primary health
care delivery system. Most of the
minor and common psychiatric
disorders can be effectively mana­
ged at PHC and Subcentre level.
The available experience shows
that 60%-80% of chronicity and dis­
ability of psychiatric illnesses
could be prevented and completely
recovered with the help of modern
techniques and safe use of com­

10

at primary health

2.
3.
4.
5.
6.
7.
8.

9.
10.

11.

12.
13.
14.
15.
16.

17.

18.
19.
20.

Do you often have head­
ache?
Is your appetite poor?
Do you sleep badly?
Arc you easily frightened?
Do your hands shake?
Do you feel nervous/tensc/
worried?
Is your digestion poor?
Do you have trouble think­
ing clearly?
Do you feel unhappy?
Do you find difficulty to make
decision?
Do you cry more than un­
usual?
Do you find difficult to enjoy
your daily activities?
Is your daily work suffer­
ing?
Are you unable to play a use­
ful part in life?
Have you lost interest in
things?
Do you feel that you are a
worthless person?
Has the thought of ending
your life being in your
mind?
Do you feel tired all the
time?
Do you have uncomfortable
feeling in your stomach?
Arc you easily tired?

SRQ positive patients should be
evaluated in detail for correct psy­
chopathology. Mostly
these
patients, after initial consultation
with PHC’s doctor or psychiatrist,
can be managed at subcentre by
MPW. Il has been observed that
these MPW’s could be trained to
identify and manage the case of
common psychiatric disorder inde­
pendently. The National Institute
of Mental Health & NeurosciencesBangalore. is conducting many
training courses for MPW’s.14
There is a need to lake initiative by
all medical colleges to conduct
such courses for MPW’s.
For Psychotic Patients: Few obser­
vations by MPW’s arc sufficient to
identify psychotic patients in the
community
or
al
subccntre. These are as follows :

1.

Who talk nonsense and act in
a strange manner that is con­
sidered abnormal?

2.

Who has become very quiet
and docs not talk or mix
with people?

3.

Who claim to hear voices or
see things others cannot hear
or sec?

4.

Who arc very suspicious and
claim that some people are
trying to harm them?

5.

Who have become unusually
cheerful, crack jokes and say
that they arc very wealthy.
arid superior to others or he is
a king or prime minister when
it is not really so?

6.

Who suffer from fits or loss of
consciousness
and
fall
down?

7.

Who lake drugs like alcohol.
opium, ganja regularly or
excessively?

These patients should be convin­
ced for their treatment and referred

Swasth Hind

to PHC or hospital. Everytime
(hey should be reminded for going
to PHC. These patients should
get consultation at subcentres
wherever they arc run by doctors
once in a week.

Management of Psychiatric Patients
at Subcentre

I. Psychophannacological manage­
ment . Tricyclic antidepressant and
anlianxicty can safely be given by
MPW’s after the initial prescription
made by doctors or psychia­
trists. Appropriate doses, dura­
tion. and side-effects of drugs need
to be understood. In their Held
visit they should visit these patients
and their families and must inquire
about the compliance of the drug.
any side-effect and well-being.

2. Psychosocial
management:
MPW’s arc more close to the
patients and their families. They
arc better equipped with the back­
ground information and good rap­
port. MPW’s should be trained in
providing mental health education
to family members of the patient.
They can provide better psy­
chotherapy, counselling, gene­
ral support, environmental mani­
pulation and family sessions: all
arc very effective in reducing the
suffering and mortality due to psy­
chiatric disorders.

Multipurpose workers can be
useful agents to modify the be­
haviours injurious to health in the
community. Tobacco
depen­
dence, violence, experimentation
with drugs and alchohol. sexual
activities in adolescents, and somatisation of illness can effectively be
dealt with through anganwadi
workers, MPW’s and social welfare
officers if they arc trained effec­
tively in mental health care.
Handbooks and manuals for MPW
must be available at each subcenIrcs. For each task an approach
difficulty/severity level must be
specified, beyond which the pro­
blem should be referred to the next
health care. With such an appro­
ach to deal with mental health pro­
blems we hope that the country
would succeed in achieving the
goal of health for all by 2000.

Haryana. Thesis (MD)
AIIMS. New Delhi.
5.

Shephard M. Cooper. B Psychiatric ill­
ness in general practice (cd.) 1966. Ox­
ford University Press. London.

6.

Goldberg. D.P. Blackwell. B. Psychiat­
ric illness in general practice: A detailed
study using a new method of case iden­
tification. BMJ. 1970. 2 : 439-443.

7.

Wright, JH, et al. Depression in family
practice patients. South Medical Jour­
nal, 1980, 73 : 1031-1034.

8.

Barnes, G.E. et al. Depression in Cana­
dian general practice attendees. Cana­
dian J. Psychiatry. 1984. 29:2-11.

9.

Harding. TW el al. Mental disorders in
primary health care: A. study of their
frequency and diagnosis in four
developing countries. Psychological
Medicine. 1980, 10:231-241.

10.

SriRam. TG et al : Minor psychiatric dis­
turbances in primary health care : A study
on their prevalence and characteristic
using a simple case detection techni­
que. Ind. J. Psychiat. 1987. 23 : 213226.

11.

APA. Diagnosis and statistical manual
of mental disorders (cd. 3rd., revised).
Washington. DC: APA.

12.

WHO. International classification of
disease-10 Revision. 1990. Geneva.

13.

Chandershekhar. MR el al. Village
leaders—Agents of Mental Health Edu­
cation. Swasth Hind. 1990. Feb.
Vol. XXXIV No. 2

14.

Murthy. RS et al. Manual for mental
health care for Multipurpose worker.

References

I.

2.

WHO. Introduction of a mental health
component into primary health care.
(1990), Geneva, Switzerland.
Seshadri. S. Community Mental Health
News. Issue No..2. 1986.

3.

ICMR. Severe mental morbidity. In­
dian Council of Medical Research
Bulletin 1988. Dec. 18. 12.

4.

Jugal Kishore. Recognition and dia­
gnosis ofmental disorders among patients
attending a primary health centre of

1993 June.

NIMHANS. Bangalore. 1988.

DO YOU KNOW?
Age is no safeguard. People of any age can have high blood pressure, but if you are
over 25 you are doubly at risk. For most, 3 simple ways to reduce high b.p.
are—
* a balanced diet,

* salt reduction, and

* weight reduction.

January—March 1996

11

Multi-Pronged Approach
in Drug Addiction among Youth
Paras Nath Garg
The problems of drug addiction among youth are multi-faceted and closely associated with
the socio-economic changes in the society. A restrained decline can only be achieved by a
multi-pronged and prolonged approach jointly by various sectors like health, education,
social welfare, media, political structure, custom, law, home, excise, university and voluntary
agencies through inter-disciplinary and integrated line of action.
stimates suggest that approxi­
mately 30% of the World’s
population is currently between the
ages of 10 and 24 years. Between
I960 and 1980, the world popula­
tion of 15-24 years old, increased by
66%, while the total population of
the world increased by 46%. Of all
15-24 years old, the percentage liv­
ing in developing countries was
77.6% in 1980 and it is predicted to
be 83.5% by the year 2000 AD.
(WHO 1986). The youth in our
country, is the most precious asset
for human resource develop­
ment. Never in the history of the
world, have there been so many
young people.

E

Today’s young people arc the
healthiest age-group and are better
educated than ever before (FI.
Mahler-1985). The vast majority
of young people succeed rather
than fail, despite the difficulties
they now face; their energy, idea­
lism and creativity can be used to
great advantage, they are eager for
responsibility, they want challen­
ges and arc prepared to take risk for
what they believe in. The young
people are a great resource for
health. (WHO 1985)

Throughout the history of man­
kind, there is hardly any country or
culture which has not encountered

12

problems with the use and abuse
of drugs.
Since the earliest recorded times.
drugs have been employed for dif­
ferent reasons—mainly religious.
recreational and medicinal. For
example, alcohol and opium were
both well known in ancient Egyption culture and cannabis was com­
monly used in Hindu ceremonial
rites as well as in Indian and
Chinese medicine. Drug-related
problems, therefore arc not new.
Often they affect a nation as a
whole. Good models of prevent­
ing drug problems can also be
traced in history. Fourteen’ cen­
turies ago, alcoholism was one of
the challenging problems among
the Pegan Arabian tribes and was
successfully dealt with by sys­
tematic Islamic teaching, persua­
sion, religious conviction, collec­
tive action and good leader­
ship. (Taha Baasher 1985)
Magnitude of Drug Addiction

Drug addiction among youth
presents as destructive a threat to
the present and the future of our
generation as the PLAGUES which
swept many parts of the world in
the earlier centuries. Unless con­
trolled, its effects could be even
more 4 insidious
and
devas­
tating. (World Health 1986). It is

a burning problem-at the national
and international scene and is a
man-made disaster of earth-shak­
ing proportion produced by the
society for having lost its hold on
the individual because of not res­
pecting the value system practised
from times immemorial.

According to the World Health
Organization, in every 10 seconds.
One person dies of a tobaccorelated disease somewhere in the
world. Tobacco is responsible for
99% of all lung cancc;. 75% of
all chronic bronchitis and emphy­
sema and 25% of all Ischaemic
disease. (William U. Chandler1986)
In another survey report 9% of
the teenaged boys and 6% of the
teenaged girls in India arc smokers
(K. Balan-1986). Indian Council
of Medical Research (I.C.M.R.) has
reported in a study conducted in
different major cities of India that
46% of male students and 18% of
the female students of Delhi
University
were
drug
users.
(Mohammad Najmi-1983)
According to WHO’s estimates
approximately two and a half
million people die every year
throughout the world from the dis­
eases caused by tobacco. (Valery
Abramou-1988) One quarter of

' Swasth Hind

smokers die prematurely from the
habit. A study in UK reveals that
among any 1000 young youth, who
smoke, one will be murdered, six
will be killed on the road and about
250 will be killed by conditions
stemming from tobacco. (Nedd
willard-1986)

Despite the known -health ha­
zards. the production of alcoholic
drinks is increasing all over the
world and the consumption of
alcohol per person is soaring on a
global scale.
More a Social than
problem

a Medical

It is clear from the study so far
that drug abuse and addiction is
not confined to any class or creed.
rich or poor, young or old. All arc
affected. The majority of drug­
abusers arc not aware of its physi­
cal. psychological or economic
consequences. Il is realized that
drug-addiction is more a social
than a medical problem with
dimensions that require a multi­
disciplinary approaches.
Personal responsibility
free lifestyle

in

Drug-

Unwise lifestyles pose the biggest
threat to young people’s health.
Innovative judgements, a tendency
to show off, or the desire to keep up
with their fellows—all these incline
them towards risk-taking beha­
viour. This may include experi­
menting with dangerous substan­
ces like alcohol or drugs.
There is a growing trend which
shifts the emphasis from hospital­
based care to those every day
actions that promote health.
Among the major elements of
healthy lifestyles, personal respon­
sibility covers a wide area. In­
dividuals must be encouraged to
lake steps to preserve their own

January—March 1996

health and to avoid behaviour that
is detrimental. This refers directly
to the use of tobacco under any
form and the abuse of alcohol and
other drugs. (Malhcr H-1986)

A drug-free society would obvi­
ously rely on the optimum mobili­
zation and utilization of commu­
nity resources. Any programme
to be successful and effective.
requires the total support and
involvement of the community by
and large. Combating drug abuse
requires the support of every seg­
ment of society including govern­
mental and non-governmental
organizations, much more than
any other programme does. Build­
ing up a positive public opinion
against drug-abuse is of crucial
importance and hence the support
of the parents, teachers, community
opinion leaders and general public
al large is essential both for con­
trolling supply and demand for
drugs.
Multi-pronged approach in DrugAddiction

No one approach will bring
about a major change in behaviour.
but taken together such different
strategies arc beginning to have an
effect, not least in taking away the
social acccplibility of drug-addic­
tion.

A judicious combination of
health promotion, health advocacy,
health education. legislation and
youth-targeted motivation cam­
paigns will help to bring the
“issues” into the open and inspire
communities and individuals to do
something about “drug-addiction”.
(Nedd Willard 1986).
Drug problems arc among the
most damaging menaces of mod­
ern life. Their effective preventive
strategy calls for the development
of all-out efforts, involving all the
social sectors concerned and with
active community participation.

The development of activities at
the community level, mobilising the
will of the people to lake action to
counter the threat of the drug
abuse, will greatly strengthen a
national programme of preven­
tion. Community involvement is
based on knowledge of the com­
munity and its problems, indi­
viduals need to be identified within
the community who will work
closely with the health sec­
tor. Thus a programme of health
promotion (cducation/p revention/
protection) should therefore in­
volve the active participation of
community leaders in its design.
delivery and evaluation (MarcusGrant 86).

Obstacle in prevention of drug­
addiction and Health Promotion
Norman Sartorius (1986) des­
cribed the three giant obstacles in
the prevention of drug-addiction.
namely low value to health, phar­
macological native of the substan­
ces and the native of the envi­
ronment in which most people
live today.

To overcome the above obstacles,
health promotion activities namely
raising the value of health, healthy
lifestyle (drug-free life) and suitable
action on controlling production.
marketing, retailing and distribu­
tion of the narcotic drugs are
required. Joint health promotion
activities by workers in many social
sectors—education, social welfare.
medicine, industry and by the opi­
nion formers can be undertaken.
The social values play a signifi­
cant role in drug-addiction. The
social values which make drug­
taking an acceptable norm among
peer group of youngsters, who need
to be reconsidered and reoriented
towards raising the values of
healthy lifeso 1'«

13

Special anti-smoking campaigns
and
diagnostic-cum-trcatment
camps are also found to be success­
ful efforts to decrease the addiction
problems among youth in Canada,
Sweden and United States. 80%
succcsssful achievement against
opium and opiates-Dc-addiction
have been reported through camp
approach in the Opium-Dc-addiction treatment training and re­
search trust, Jodhpur (Rajasthan).
(P. N. Singh Manaklao-1984)
Joint action on drug-addiction
A princple “the whole is greater
than parts” is applied with the
treatment and prevention for drug­
addiction. Any one health or
social sector can accomplish a cer­
tain amount, but the network of
health and social sectors can
accomplish much more together,
than they can accomplish indivi­

Research experience shows that
drug addiction among youth re­
quires a multi-disciplinary, multi­
pronged and prolonged attack
from various sectors in a platform
to combat the ill-effects and eradi­
cation of the problems. Action to
reduce health problems arising
from narcotic and psychotropic
drug misuse still has to face power­
ful political and economic interest
that are opposed to effective pro­
gramme.
Key role in drug-addiction among
youth

dually. (WHO 1986).

Youth peers, school teachers,
medical practitioners, community
health workers, parents and opi­
nion leaders have a key role to play
in the early identification, aware­
ness, counselling, management
and rehabilitation of the drug­
addicts.

The informal group of youth
peers, sport associations, youth
councils, boy and girls scouts have
a piotal role. The skills of these
informal groups can be and in
some cases are already being
utilized for the promotion of
healthy life style among youth and
to provide education, information
and counselling. The need of
parents-child relationship is wellknown. specially during the habit
formation age. The vital role of
family in self-reliant health promo­
tion. disease prevention and treat­
ment has been further enhanced
with the introduction of primary
hcalh care approach.

Medical practitioners, school
teachers and community health
workers and village health guides
can play a crucial role in early
detection, management and pre­
vention of cases of drug or alcohol

Operational Ilcalih Promotion activities of various Sectors in drug-addiction among youth

Sector

ACTIVITIES

Health

Research

Case
detection

Treat­
ment

Preven­
tion

Couns­
elling

Educa­
tion

Camp
approach

University

Research

Service

—

Project
sponsorship

Educa­
tion

—

—-

Education

Research

Early
detection

—

Healthy
life-style

Couns­
elling

Education

Follow Up

Social
Welfare

Awareness

Coordina­
tion

Couns­
elling

Education

—

—

Rehabilitation

Media

Awareness

Motiva­
tion

Education

Social
Mobilization

—

—

Fear arousal
Communication

Political
Leaders

Community
participation

Support

Commitment
to drug free
lifestyle

Healthy
leadership

Motivation

—

Will to Combat
drug abuse

Industry

Incentive
scheme

Facilities for
detection

Coordination

—

Reduction
in demand

—

Awareness &
Counselling

Home
Excise &
Custom

Law
enforcement

Problem
solving
approach

—

—

—

—

Prevention of
illicit Trafficking

Voluntary
organization

Participate
observation

Coordination

Follow Up

Motivation

Education

—

Counselling
& Rehabilitation

14

SWASTH HIND

misuse in the community. Being
part of the community they should
be aware of the drugs that are com­
monly misused and alert to new
substances entering the area or new
forms of drug use. They are in a
position to encourage the forma­
tion of community action group
(self-help group) and foster com­
munity
awareness. Changing
social networks and encouraging
community involvement are pro­
ven methods of helping people suf­
fering from drug or alcohol related
problems. Strategy
may
be
developed with workers in other
sectors such as social welfare, adult
education, media, voluntary agen­
cies etc. so that a whole network of
groups can be involved in reducing
and preventing alcohol and drugrelated problems at both the per­
sonal and the community level.
Principles in drug-addiction among
youth

(a)

(b)

(c)

(d)

Policies, goals, priorities and
lines of action for the preven­
tion of drug-addiction have to
be met in harmony with local
condition and relevant to the
social setting.
Regardless of the circumstan­
ces. the addict on discovery
should be treated primarily as
il [person and not as a
criminal.

leaders, peers and teachers on
drug-addiction is a must, to
enable them to provide
necessary support to the
youth.
India is a signatory to achieve the
goal of health for all. The idea
and targets of a Drug Addiction
Free Society by the year 2000.
would be indispensable for achiev­
ing the goal of Health For All by
2000 AD.

The problems of drug addiction
among youth are multifactoral and
multi-faced and closely associated
with the socio-economic changes
in the society. An effective sus­
tained decline can only be achieved
by a multi-pronged and prolonged
approach, with the joint action
(efforts) of the various sectors such
as health, education, social welfare.
media, political structure, custom.
law, home, excise, university and
voluntary associations through an
inter-disciplinary, integrated and
coordinated line of action.

References

I

Abramov Valery (1988)—Run for your
life World Health—Nov. 1988.

*

Balan. K. (1986)—A Smoke free society
by the year 2000. Swasth Hind—Sept.
1986.

j

Baasher Taha (1985)—Preventing drug
problems—World Health—Aug/Sept.
1985—Page 8.
Chandler-William. U. (1986)—Smoking habit kills one out of every four
smokers—World Health—June 86

-

Grant-Marcus (1986)—Meeting the
threat of drug abuse—World Health—
June 1986—Page 20-21.

z

Mahler, H. (1985)—Healthy youth-our
best resource—World Health—Jan/Feb.
1985.

7

Manaklao—P. N. Singh (1989)—Treat­
ment of Drug Addiction—A camp
Approach — Swasth Hind— 1989 Page
232-233.

Najmi-Mohammad (1983)— DrugAddiction—A
Social evil—Swasth
Hind—Sept. 1983.

q

Sartorius-Norman(1986)—Putting
a
higher Value on Health—World Health
—June 1986, Page 2-3.

.0

Willard Nedd (1986)—Tobacco the last
gasp—World Health—JanJFcb. 86,
Page 20.

Suggestions

1. Integration of health promo­
tion on drug addiction in school/
college and adult education.

Parents must be made to
understand that a poor
quality of parent-child rela­
tionship is responsible for
many forms of social mal­
adjustment.

2. Orientation and counselling
of youth community leaders and
village level workers.

Orientation and motivation to
the
parents.
community

4. Parliamentary and Assembly
constituency-wise research data on

January-March 1996

drug addiction must be analysed
and given to the politicians to get
their participation, commitment
and line of action on the magnitude
of the problem.

3. Behavioural research on drug­
addiction problems.

lL W.H.O. (1986)—T.R.S. 731—Young
people’s health—a challenge for society.
WHO—Geneva.

p

WHO (1985)—World Health Statistics
.Quarterly vol. 38—No. 3. WHO
—Geneva, 1985.

Ij

WHO (1986)—Drug-dependence and
alcohol related problems—A manual for
community Health Workers—WHO
—Geneva (1986).

15

COMMUNITY
PARTICIPATION AND
HEALTH FOR ALL

Gujarat’. Table 2 shows si
data for Vivekananda Gi
Kalyana Kendra situated i
Hills,' Mysore ”. Further ;
ber of such experiments ha
documented in Anubhav se
other publications 7. notat
the Jamkhed project, KEb
Health for one millioT
etc.

Dr Rajkumar Bansal
and
DR Ratan K. Srivastava

t

N the past dec.ade, especially

since the adoption of the
Ideclaration
of Alma-Ata on

primary health care, community
participation has become in­
creasingly recognised as a key ele­
ment in improving health, parti­
cularly among the poor and under­
served populations in deve­
loping countries. It is concerned
not with advanced medical
technology but rather with apply­
ing tried and tested health care pro­
cedures to the health problems of
the poor and underprivileged’.
Many definitions of community
participation have been sug­
gested,
however a comprehen­
sive definition can be “Community
participation is a way of living
which needs to be inculcated in all
the citizens of the world so as to
enable and embolden them to
actively, collectively and volun­
tarily diagnose their problems and
felt needs; find and implement
socioculturally, economically and
scientifically acceptable solutions
with community logistics, either
with or without external support so
as to eliminate or minimise their
problems; fulfil their felt needs;
and plan for their future develop­
ment so as to benefit and enable
them to lead a socially, eco­
nomically and healthy productive
life”. The aim should be to attain
positive health and wellbeing.
Historically since Independence,
the various government program­
mes show a shift from cooperation

16

Developing countries are facing severe resource paucity for
health care provision including safe water supply, sanitation
and housing. It is high time that the pivotal significance of com­
munity participation is recognised, legalised and optimised to
bring about a radical change in the health development plan­
ning. This will help in bringing about health care services
within the reach of common citizens and help them to
utilise the same.

to participation with the eventual
aim being to move towards the
stage of involvement’.

ture is harmonious and supportive
to the needs of the people.

This trend has been due to two
factors mainly:

There are many successful exam­
ples of participatory health
approaches
throughout
the
world 7
In India the need for
community participation is reflec­
ted in almost all the plan
documents, more so from the sixth
plan document (1978-83) onwards.
Panchayat Raj and cooperatives
were instruments aimed to ensure
community
participation. The
Health Guide Scheme, Trained
Dais Scheme and ICDS were
especially tailored by the govern­
ment for greater community
involvement in
health care
activities. However participatory
methods have
largely been
encouraged by non-governmental
agencies, some of whom have suc­
cessfully implemented their pro­
grammes with extensive com­
munity supports and scant govern­
ment supports. Table 1 shows the
programme indicators of SEWA—
Rural situated
at Jhagadia,

(i)

Inappropriateness of the
‘Western’ medical system
in our context and under­
utilization of these ser­
vices, and

(ii)

Realisation of the fact that
public health policy is not
only concerned with cur­
ing, disease but forms an
integral part of a country’s
general
development
policies’*’.

Advantages
The main advantages of com­
munity participation are : optimal
coverage, greater efficiency, more
equitable distribution, self reliance
of the community and enhanced
effectiveness of a program­
me*. Community participation
ensures that the health infrastruc­

Swasth Hind

In concluding it has
that the developing c<
facing severe resource
health care provisic
safe water supply, st
housing. It is high
pivotal significance
participation is re>
lized and optimi'
bring about a radic
health developnv
vital part of the
ment planning.
tate to bring he
within the ar
citizens and ;
utilisation
o
resources.
References

I.

Rifkin S’
maternal
ning j

Health
2.

Trakrc
in het
mcs.
of
198c

3.

Oa
het
th
F

4.

1

Table 1

nlar

SEWA (Society for Education Welfare & Action)—Rural

uana

PROGRAMME INDICATORS
num, been
esand
i. being,

project,
project
r

Impact Data (Per 1000)

Infant mortality rate
Child mortality rate
Crude death rate
Crude birth rate

.

_

1980-81/82
164
13
12

1985-86
61
43
8

24

24

NA
50
25

95
60
85

33
9
7
0

83
60
50
48

15

10

37
NA

71
47

.

_ , .

Service Data (per cent)

" I. Maternal Health Care
be stated
mines are
iiaucity tor
including,
station and
mic that the
C community
pulsed, legaft. This will

Antenatal registration
Antenatal care
Delivery by trained personnel

Child Care

11.

i change in the
U planning, a
weraW developChis 'will faciliAh care services
nit of common
i.o help optimal
the available

Immunization
B.C.G.
DPT/DT
Polio
Measles
Nutritional Status
Grade III & TV malnutrition
TO. Others
Couple protection rate
T.B. case holding as percent of cases registered

Table 2
Vivekananda Girijana Kalyana Kendra
PROGRAMME INDICATORS: 1990

Community participation in
md child hcalth/Jamily planggrammes. Geneva : World
organization; 1990.
IPL. Community participation
i. and/amily welfare programBev; Delhi; National Institute
ttalth and Family Welfare;

Infant Mortality Rate
Child Mortality Rate
Crude Death Rate
Crude Birth Rate
Maternal Mortality Rate

1980-81
145
_
14
38
|

1990
28.0
24.0
35
*20.4
1.0

Karnataka Stale
1987-90
75.0
61.0
8.7
28.9
5.0

SERVICE DATA:
Mother and Child care:

r.y, P. Community involvement in
Im development: an examination of
critical issues.
Geneva; World
tilth Organization; 1989.

.tiled Nations Department of
oonomic and Social Affairs. Popular
nrticipation in development—Emerg­
ing trends in community development.
•Jkw York; "United Nations; 1911.
Werhagen K. How to promote people’s

Antenatal coverage
Deliveries by trained dais
Immunisation: DPT & Polio

20%
5%
5%

90%
60%
95%

Normal

40%

90%

III degree Malnutrition
Literacy

20%
3%

4%
4%

61.1
34.8
68%

NUTRITIONAL STATUS:
—
—
—

participation in rural development
through local organizations. Review

of International Cooperation 1980.
13(D:I, 2%.
World Health Organization. Com­
munity involvement in health deve­
lopment—challenging health services.
Geneva ; W.H.O.; 1991.
Newell KW. Health by the people.
Geneva ; World Health Organiza­
tion; 1915.

January—March 1996
3-1 /DGHS/HD/96

World Health Organization.
I7ie
training a d utilization of auxiliary per­
sonnel for rural health teams in develop­
ing countries. Geneva : W.H.O.;
1971.

8.

9.

Sohoni NR. Society for education,
welfare and action—rural—Anubhav

Scries. New Delhi: Ford Foundation;

1988.
10.

Mohan De A. Vivekananda Girijana
Kalyana Kendra—Anubhav Series
New Delhi:
Voluntary Healt
Association of India; 1991.

COMMUNITY
PARTICIPATION AND
HEALTH FOR ALL
Dr Rajkumar Bansal
and
DR Ratan K. Srivastava
N the past decide, especially
since the adoption of the
declaration of Alma-Ata on
primary health care, community
participation has become in­
creasingly recognised as a key ele­
ment in improving health, parti­
cularly among the poor and under­
served populations in deve­
loping countries. It is concerned
not with
advanced medical
technology but rather with apply­
ing tried and tested health care pro­
cedures to the health problems of
the poor and underprivileged1.
Many definitions of community
participation have been sug­
gested, 1’s, however a comprehen­
sive definition can be “Community
participation is a way of living
which needs to be inculcated in all
the citizens of the world so as to
enable and embolden them to
actively, collectively and volun­
tarily diagnose their problems and
felt needs; find and implement
socioculturally, economically and
scientifically acceptable solutions
with community logistics, either
with or without external support so
as to eliminate or minimise their
problems; fulfil their felt needs;
and plan for their future develop­
ment so as to benefit and enable
them to lead a socially, eco­
nomically and healthy productive
life”. The aim should be to attain
positive health and wellbeing.

I

Historically since Independence,
the various government program­
mes show a shift from cooperation

16

Developing countries are facing severe resource paucity for
health care provision including safe water supply, sanitation
and housing. It is high time that the pivotal significance of com­
munity participation is recognised, legalised and optimised to
bring about a radical change in the health development plan­
ning. This will help in bringing about health care services
within the reach of common citizens and help them to
utilise the same.

to participation with the eventual
aim being to move towards the
stage of involvement2.

ture is harmonious and supportive
to the needs of the people.

This trend has been due to two
factors mainly:

There are many successful exam­
ples of participatory health
approaches
throughout
the
world 7
In India the need for
community participation is reflec­
ted in almost all the plan
documents, more so from the sixth
plan document (1978-83) onwards.
Panchayat Raj and cooperatives
were instruments aimed to ensure
community
participation. The
Health Guide Scheme, Trained
Dais Scheme and ICDS were
especially tailored by the govern­
ment for greater community
involvement in
health
care
activities. However participatory
methods
have
largely been
encouraged by non-governmental
agencies, some of whom have suc­
cessfully implemented their pro­
grammes with extensive com­
munity supports and scant govern­
ment supports. Table 1 shows the
programme indicators of SEWA—
Rural
situated
at Jhagadia,

(i)

Inappropriateness of the
‘Western’ medical system
in our context and under­
utilization of these ser­
vices, and

(ii)

Realisation of the fact that
public health policy is not
only concerned with cur­
ing, disease but forms an
integral part of a country’s
general
development
policies1’2.

Advantages

The main advantages of com­
munity participation are: optimal
coverage, greater efficiency, more
equitable distribution, self reliance
of the community and enhanced
effectiveness
of a
program­
me5. Community participation
ensures that the health infrastruc­

SWASTH HIND

Table 1

Gujarat9. Table 2 shows similar
data for Vivekananda Girijana
Kalyana Kendra situated at B.R.
Hills,' Mysore 10. Further a num­
ber of such experiments have been
documented in Anubhav series and
other publications 7, notable being
the Jamkhed project, KEM project,
Health for one million project
etc.

SEWA (Society for Education Welfare & Action)—Rural

PROGRAMME INDICATORS

In concluding it has to be stated
that the developing countries are
facing severe resource paucity for
health care provision including
safe water supply, sanitation and
housing. It is high time that the
pivotal significance of community
participation is recognised, lega­
lized and optimised. This will
bring about a radical change in the
health development planning, a
vital part of the overall develop­
ment planning. This will facili­
tate to bring health care services
within the ambit of common
citizens and also help optimal
utilisation
of
the
available
resources.

1985-86
61
4.3
8
24

Impact Data (Per 1000)
Infant mortality rate
Child mortality rate
Crude death rate
Crude birth rate
Service Data (per cent)
I. Maternal Health Care

1980-81/82
164
13
12
24

Antenatal registration
Antenatal care
Delivery by trained personnel
11. Child Care
Immunization
B.C.G.
DPT/DT
Polio
Measles
Nutritional Status
Grade III & IV malnutrition
III. Others
Couple protection rate
T.B. case holding as percent of cases registered

NA
50
25

95
60
85

3-3
9
7
0

83
60
50
48

15

10

37
NA

71
47

Table 2
Vivekananda Girijana Kalyana Kendra

PROGRAMME INDICATORS: 1990
References
1.
Rifkin SB. Community participation in
maternal and child hcalth/family plan­
ning programmes. Geneva: World
Health Organization; 1990.

2.

3.

4.

6.

World Health Organization. Com­
munity involvement in health deve­
lopment—‘challenging health services.
Geneva : W.H.O.; 1991.

7.

Newell KW. Health by the people.
Geneva : World Health Organiza­
tion; 1975.

January—March 1996
3-7/DGHS/ND/96

90%
60%
95%

61.1
34.8
68%

Normal

40%

90%

—

III degree Malnutrition
Literacy

20%
3%

4%
4%

Antenatal coverage
Deliveries by trained dais
Immunisation: DPT & Polio

United Nations Department of
Economic and Social Affairs. Popular
participation in development—Emerg­
ing trends in community development.
New York: United Nations; 1971.

Vcrhagen K. How to promote people’s
participation in rural development
through local organizations. Review
of International Cooperation 1980;
73(1): 1, 28.

20%
5%
5%

SERVICE DATA:
Mother and Child care:

Oakley, P. Community involvement in
health development: an examination of
the critical issues.
Geneva; World
Health Organization; 1989.

5.

1990
28.0
24.0
35
»20.4
1.0

Infant Mortality Rate
Child Mortality Rate
Crude Death Rate
Crude Birth Rate
Maternal Mortality Rate

Trakroo PL. Community participation
in health and family welfare program­
mes. New Delhi: National Institute
of Health and Family Welfare;
1989.

Karnataka State
1987-90
75.0
61.0
8.7
28.9
5.0

1980-81
145
—
14
38
5

NUTRITIONAL STATUS:

8.

9.

World Health Organization.
The
training a d utilization of auxiliary per­
sonnelfor rural health teams in develop­
ing countries. Geneva
W.H.O.;
1977.
Sohoni NK. Society for education.
welfare and action—rural—Anubhav

Scries. New Delhi: Ford Foundation;
1988.

10.

Mohan De A. Vivekananda Girijana
Kalyana Kendra—Anubhav Series.
New Delhi: Voluntary Health
Association of India; 1991.

17

HEALTH COMMUNICATION
—Some Perspectives
Dr (Mrs) P. V. SHARADA
ommunication research is
gaining momentum simulta­
neously with the developments in
mass-media. As generally known,
communication
is
contex­
tual. But research in development
communication,
particularly
health communication, is not
much significant. While some of
the
general
communication
theories seem to be applied in
spreading messages, the specific
models of health communication
need to be used widely in designing
campaigns. There is still a need to
probe and experiment as to what
works and what does not and if it
works how ? etc.

C

Television. Radio, print, films
and inter-personal media are being
extensively used in the area of
health communication. The res­
ponses to health messages in terms
of awareness, acceptance and
adoption are well identified and the
suitable communication strategics
have been formulated. Studies
have confirmed the effectiveness of
media. A thematic survey of 64
Family Planning films in India
(1983) by Akhila Iyer (1) has
emphasized the effectiveness of the
film medium for publicity in the
interior rural areas. However, she
felt the need for the peope to get
used to the film medium to respond
fully to the message it con­
veys. The analysis also points out
io the need for special films to be
produced for rural audience in easy
language with a story pattern
reflecting local milieu to the extent

18

Significant research in health conununication is still to be done.
While some of the general communication theories seem to be
applied in spreading health messages, specific models of health
communication need to be used widely in designing health
campaigns.

possible. A collaborative study by
NIHFW (1985) on “Evaluation of
Media reach and effectiveness” (2)
confirmed that “Communication is
an important component in the
programme and has a close posi­
tive relationship with awareness.
knowledge and practice of Family
Planning
methods”. A
mul­
timedia communication campaign
was conducted between 1988 and
1989 to promote family planning
among men in Zimbabwe (3) The
campaign consisted of a 52—
episode semiweekly radio soap
opera, about 60 motivational talks,
and two pamphlets about con­
traceptive methods. Changes over
lime were measured by comparing
a subset of a follow-up survey con­
ducted from October to December
1989 to a baseline survey conducted
from April to June 1988. Men
exposed to the campaign were also
compared to men who were not
exposed. The follow-up survey
revealed that the men exposed to
the campaign were significantly
more likely than other men to make
the decision to use family planning
and to say that both spouses should
decide how many children to
have.

Behavioural Information

But still experts feel the need to
understand the behavioural pat­
terns of the target audience and
strengthen the evaluation techni­
ques, expecially by applying com­
munication research methods and
different models of health com­
munication. It may be pertinent
to quote Carriere (4) Who said ‘
require behavioural infotmaGc.;
that is hard, empirical, scien­
tifically gathered and generali­
zable”. Stressing the need for
professional approach to com­
munication and ^creative message
design and a skilful use of the many
mass media and person-to-person
channels now at our disposal he
further says “Unless an enlightened
public health leadership invites
and mobilizes the market and
audience researchers, the message
designers and the media planners,
our approaches at behaviour
change will remain fragmentary,
ineffective and amateurish. The
real need is to demystify health
knowledge in communication”.
This calls for the attention of the
health professional to understand

Swasti-i Hind

the nature and scope of health
communication as an area of
specialization, bridge the gap bet­
ween research and field activity,
interact regularly with the pro­
fessional
communicators
to
develop right perspectives in
material production, etc. The pre­
sent paper is an attempt to provide
some information on the first need,
i.e, understanding the nature and
scope of health communication
and the discussion has mainly con­
centrated on exploring the underly­
ing principles/theories of mass
communication that are widely
accepted and used in the field of
Health and Family Welfare and
some models of health com­
munication
and
their
suit­
ability to the present day
programmes, etc., The informa­
tion may be of some benefit and
interest to people involved in
designing Media messages in the
area of Health and Family
Welfare.
Major Theories

Three major theories are con­
sidered important by communi­
cation researchers—(1) Magic—
Bullet Theory (2) Two step—Flow
theory and (3) Agenda setting
theory.
(1)

Magic—Bullet Theory

This is the oldest theory which
attached greater importance to
mass-media. According to the
earlier thinkers Mass-media like a
bullet, can penetrate into the heads
of the citizens. It has the power of
injecting messages directly and
influence people in the desired
manner. For example:
Poster on
Health (5)

Maternal

and

Child

Mother bathing her baby; cap­
tion says, “If a baby’s future is to be
bright the mother has to be
healthy. For health care for both
mother and child, come to Primary
Health Centre”.

January—March 1996

OUR NEW DIRECTOR
Dr (Mrs) K. Kehar took over as the
Director, Centra! Health Education
Bureau (CHEB), New Delhi with
effect from 25th January. 1996. She
is the ex-officio Dy. Director General
of Health Services.
Born on 19th September. 1938 at
Jabalpur in Madhya Pradesh. Dr
Kehar has had her schooling at Bar­
nes High School, Devlali (Maha­
rashtra) and obtained her MBBS
Degree from Christian Medical
College CMC. Ludhiana, Punjab in
the year 1960.

Dr. (Mrs.) K. Kehar

Dr Kehar started her career as
Assistant Surgeon under the Central
Government Health Scheme (CGHS)
in June<1963.

She worked in the Employees State Insurance Corporation (ESIC) for
over eight years from July. 1968 to July, 1976 serving in its various dispen­
saries. Dr Kehar joined Delhi Administration in 1976 and served there in
different capacities for nearly nine years. As family and State Immuniza­
tion Officer, Delhi, she supervised the Family Welfare and Immunization
activities in the capital.
Dr Kehar served as Medical Officer (RH).and then as Chief Medical
Officer (RH) in the Rural Health Division of the Directorate General of
Health Services. Ministry of Health and Family Welfare from July. 1985 to
March, 1991. Here she coordinated and monitored the Scheme of Train­
ing and Employment of Multi-purpose Workers (Male): Training of Com­
munity Health Workers, and also coordinated the Meetings of Central
Councils of Health and Family Welfare.

As Asstt. Commissioner (SS), and Dy. Commissioner (T.O.) in the
Department of Family Welfare. Ministry of Health and Family Welfare from
March, 1991 to January, 1996, Dr Kehar was instrumental in Planning &
Formulations of various programmes and activities, technical guidance in
the family welfare programmes, monitoring and coordination of reproduc­
tive research being organised by various organisations as well as clinical
training in Family Welfare, i.e., sterilisation. IUD insertion. MTP and Oral Pill
administration.
Dr Kehar has participated in various National and International
meetings on contraceptive use and reproductive health. It was from Dy.
Commissioner (T.O.), that Dr Kehar joined C.H.E.B. in January. 1996 to
provide leadership in the provision of preventive and promotive health
care through various media and methods.

19

Radio-spot on Medical Termination
of Pregnancy (6)
Woman announcer introuduccs
an eminent lady doctor saying that
she will talk to the audience on
medical termination of pregnancy.
Lady doctor’s voice follows—“Do
you know? If your health is
endangered due to pregnancy or
child-bearing or if contraceptives
have failed’and an unwanted con­
ception occurs there are hospitals
all over the State where abortion
facilities arc provided free of
cost”.

In these two examples, it is
assumed that the audience exposed
to the above media will receive
information
and
act accor­
dingly. The power of the media is
being perceived to be direct and
powerful. However, the present
health communicators are aware of
the limitations of the magic-bullet
theory and are using such messages
initially to create awareness.
(2)

Two step—flow theory

When mere transmission of
information could not achieve the
desired behavioural change, the
thinkers shifted their attention to
observe the other influences such
as inter-personal etc. Two step­
flow theory gives more importance
to inter-personal communication
as far as the influence is concerned
and treats mass-media as source of
information. According to this
school of thought, information
flows in two steps, i.e., from mass
media to opinion leaders and
therefrom to people. Here the
influence of mass-media is in­
direct Opinions were also ex­
pressed during this period that
people receive information from
one medium but seek other sources
(Media) to confirm their know­
ledge. Hence proponents of this
theory argued; media helps to rein­
force the messages but cannot

20

directly influence the audien­
ce. Two step-flow theory was
accepted to be valid for quite a long
time and its effect can be seen in
commercial advertisements in
which the suggestions of neigh­
bours, friends and relatives are
given more importance, especially
in publicizing the products. Two
step-flow theory is more effectively
used in commercial advertising (at
present also) than in Develop­
ment Communication.
Example: Radio spot (30 seconds) on
Maternal and Child Health
(7)
Two women: one woman en­
quires about the health of the
other’s children. “What health”?
says the other “Here I am, unwell
myself: how can I keep my
children fit? Something or the
other is always wrong”__ ._____
The first voice urges; “Why don’t
you go to the Primary Health Cen­
tre then”? Commentator con­
cludes: For correct advice about the
health of mother and child, visit the
Primary Health Centre”.
Same example can be further
extended (60 seconds spot) where
the second woman narrates her
positive experiences with PHC in
mother and child care.

. In the above example, the infor­
mation is positioned in the form of
friends’ suggestion giving more
weightage to interpersonal com­
munication. However,
people
who refute Two step-flow theory
claim that whether there is direct or
indirect influence of Mass-Media
the power of the media is indisput­
able since it is the main source
of information.
(3)

Agenda setting theory

While the Two step-flow theory
dominated the scene for long time.

invasion of Television has opened
the doors for new thinking giving
more importance to Mass-Media
again. Supporting the Magic­
bullet theorists, the present thin­
kers feel that the research tech­
niques in the past were not ade­
quate to prove the effects of
media. The main focus of the pre­
sent research is how media influen­
ces the opinions of the people?
While some felt the information
transmitted through media appeals
to the cognitions, for some it
influences the attitudes. To know
this, in-depth studies were carried
out with special emphasis on “con­
tent analysis of the programmes”
and “persuasion methods”. From
those has emerged “Agenda setting
theory”. According to this theory
both in selecting the contents and
the methods of Communication
media assumes greater role and sets
an agenda as “What people should
know” and “how it should be
given” etc.

Examples: 1. Media propaganda
on AIDS.
2. Phone-in Program­
mes over Radio on
health issues like
Mother and Child
care, etc.
As said by Backer et al (8) the
agenda setting process is a social
phenomenon through which an
issue begins to receive sharply
increased mass-media coverage, in
turn creating more widespread
public opinion about the issue and
eventually leading to responses
by policy makers. Rogers and
Dearing (9) identified three
main components in the agenda
setting process, i.e., the “Media
agenda”, “Public agenda” and
“Policy agenda” and explains as
below. The figure also shows cer­
tain aspects which may influence
these agendas.

Swasth Hind

learn by observing individual mod­
els who perform particular be­
haviour. The models may be in
everyday life or they may be depic­
ted in the Mass-Media. The social
modelling may be unplanned
and spontaneous”.

imitation in agenda setting
sobserved byresearchers is
ficculty in assessing the
jf an agenda set by a parnncdium. This problem
isypecially when different
amsmit information on the
issue, overlapping one
where it becomes difficult
>mre the contributions of
odium to the agenda and its
•e. For instance at a par­
lime if Radio, T.V., print,
*sonal
and
Traditional
simultaneously makes proa on “AIDS”, it is difficult
s the impact created by each
above media. However,
s have been developed to
ac this limitation.

: popular theories and modhealth communication are
marketing theory, Social
ig theory, theory of diffund Health belief model
tree of them are discussed

sial marketing theory: This
highlights the need to
and consumer behaviour
lying marketing principles
earch. Proponents of this
believe that marketing apnceds to be introduced in
nnent communication also.
absence the possibility of
ng a new idea or message is
ARY—MARCH 1996

very low. Positioning of a pro­
duce, strategy formulation, pricing,
audience segmentation and market
research etc., which are very impor­
tant in making people buy a pro­
duct, should be exactly applied in
spreading health messages also,
they opine. The unsatisfactory
performance in popularizing the
oral rc-hydration solution (ORS)
inspite of its relative effectiveness
compared to the other alternatives
available in the market has been
attributed to lack of marketing
approach at different levels i.e.
positioning probing, publicity, sup­
ply and market research etc.
However many feel, marketing
approach in making people accept
new ideas especially in social issues
like health and education etc.
where the results are long term and
difficult to perceive is not as easy as
it is suggested. An analysis of
fourteen indepth interviews with
social marketing programme per­
sonnel involved in carrying out
such programmes conducted by
Neil McKee (10) has revealed that
social marketing language does
appear to be a barrier to the wide
acceptance of the field managers
and staff of non-profit develop­
ment organizations.
(2) Social Learning Theory : The
basic idea of social learning ac­
cording to Bandura (11) Who first
proposed it is that “individuals

One can see the effect of social
learning theory in almost all pre­
sent
day
health
communi­
cation. Especially portrayal of
characters in Television serials.
Radio dramas, and magazine
stories etc. (models who adopt good
health practices and lead happy life
and models who suffer due to bad
health
practices
etc.). Social
learning theoty is practised in
interpersonal
and
traditional
media also in role plays and other
folk
forms. Supporting
this
theory Me. Allister et al (12) also
observed that social models in­
fluence changes in attitudes and
beliefs, decision-making and the
acquisition of new patterns of
behaviour.
(3) Diffusion
of
Innovations:
How to make people adopt new
ideas or innovations? The theory
of diffusion of innovations ex­
plains this process. Many studies
were carried out in the United
States on this concept. “Diffu­
sion” is a process and “inno­
vations” are new ideas. Backer et
al (13) observe two types of
innovations of specific concern
to health communication cam­
paigns—“incremental” and “pre­
ventive”. Individuals decide to
adopt the new idea now, at “tl” (see
figure) in order to gain an incre­
ment in a desired outcome at “t2”,
in the near term future.
Preventive innovations are more
difficult to diffuse rapidly. An
individual must take an action
(that is adopt a life-style change)
now at ‘tl* in order to lower the pro­
bability of occurrence of an expec­
ted unwanted future event (such
heart disease, cancer, AIDS or

21

j-spot on Medical Termination
'nancy (6)

oman announcer introuduccs
.•minent lady doctor saying that
e will talk to the audience on
.edical termination of pregnancy;
„ady doctor’s voice follows—“Do
you know? If your health is
endangered due to pregnancy or
child-bearing or if contraceptives
have failed and an unwanted con­
ception occurs there arc hospitals
all over the State where abortion
facilities arc provided free of
cost”.
In these two examples, it is
assumed that the audience exposed
to the above media will receive
information and
act accor­
dingly. The power of the media is
being perceived to be direct and
powerful. However, the present
health communicators are aware of
the limitations of the magic-bullet
theory and are using such messages
initially to create awareness.
(2) Two step—flow theory

When mere transmission of
information could not achieve the
desired behavioural change, the
thinkers shifted their attention to
observe the other influences such
as inter-personal etc. Two step­
flow theory gives more importance
to inter-personal communication
as far as the influence is concerned
and treats mass-media as source of
information. According to this
school of thought, information
flows in two steps, i.e.. from mass
media to opinion leaders and
therefrom to people. Here the
influence of mass-media is in­
direct. Opinions were also ex­
pressed during this period that
people receive information from
'ic medium but seek other sources
confirm their know^’■'onents of this
' *o rcin-

dircctly influence the audien­
ce. Two step-flow theory was
accepted to be valid for quite a long
time and its effect can be seen in
commercial advertisements in
which the suggestions of neigh­
bours, friends and relatives are
given more importance, especially
in publicizing the products. Two
step-flow theory is more effectively
used in commercial advertising (at
present also) than in Develop­
ment Communication.
Example: Radio spot (30 seconds) on
Maternal and Child Health
(7)

Two women: one woman en­
quires about the health of the
other’s children. “What health”?
says the other “Here I am. unwell
myself: how can I keep my
children fit? Something or the
other is always wrong”...............
The first voice urges; “Why don’t
you go to the Primary Health Cen­
tre then”? Commentator con­
cludes; For correct advice about the
health of mother and child, visit the
Primary Health Centre”.
Same example can be further
extended (60 seconds spot) where
the second woman narrates her
positive experiences with PHC in
mother and child care.

In the above example, the infor­
mation is positioned in the form of
friends’ suggestion giving more
weightage to interpersonal com­
munication. However,
people
who refute Two step-flow theory
claim that whether there is direct or
indirect influence of Mass-Media
the power of the media is indisput­
able since it is the main source
of information.
(3)

Agenda setting theory

While the Two step-flow theory
dominated the scene for long time.

invasion of Television has opened
the doors for new thinking giving
more importance to Mass-Media
again. Supporting the Magic­
bullet theorists, the present thin­
kers feel that the research tech­
niques in the past were not ade­
quate to prove the effects of
media. The main focus of the pre­
sent research is how media influen­
ces the opinions of the people?
While some felt the information
transmitted through media appeals
to the cognitions, for some it
influences the attitudes. To know
this, in-depth studies were carried
out with special emphasis on “con­
tent analysis of the programmes”
and “persuasion methods”. From
those has emerged “Agenda setting
theory”. According to this theory
both in selecting the contents and
the methods of Communication
media assumes greater role and sets
an agenda as “What people should
know” and “how it should be
given” etc.

Examples: 1. Media propaganda
on AIDS.
2. Phone-in Program­
mes over Radio on
health issues like
Mother and Child
care, etc.
As said by Backer et al (8) the
agenda setting process is a social
phenomenon through which an
issue begins to receive sharply
increased mass-media coverage, in
turn creating more widespread
public opinion about the issue and
eventually leading to responses
by policy makers. Rogers and
Dearing (9) identified three
main components in the agenda
setting process, i.e., the “Media
agenda”, “Public agenda” and
“Policy agenda” and explains as
below. The figure also shows cer­
tain aspects which may influence
these agendas.
SWASTH HIND

One limitation
theory as observ
the difficulty
impact of an :
ticular medi
arises espcc
media trans'
same issv
another wt
to measu
each met'
influenc
ticular
Interpr
media
paga»
to as
of
me
o^

(’experience and interpersonal
L among elites and other individuals

Real World indicators of the
importance of an agenda issue or event

learn
els who pertu..
haviour. The models u...
everyday life or they may be depic
ted in the Mass-Media. The social
modelling may be unplanned
and spontaneous”.

One can see the effect of social
learning theory in almost all pre­
sent
day
health
communi­
cation. Especially portrayal of
characters in Television serials.
Radio dramas, and magazine
stories etc. (models who adopt good
health practices and lead happy life
and models who suffer due to bad
health
practices
etc.). Social
learning theory is practised in
interpersonal
and
traditional
media also in role plays and other
folk
forms. Supporting
this
theory Me. Allister et al (12) also
observed that social models in­
fluence changes in attitudes and
beliefs, decision-making and the
acquisition of new patterns of
behaviour.

very low. Positioning of a pro­
duce, strategy formulation, pricing,
audience segmentation and market
research etc., which are very impor­
tant in making people buy a pro­
duct, should be exactly applied in
spreading health messages also,
they opine. The unsatisfactory
performance in popularizing the
oral rc-hydration solution (ORS)
inspite of its relative effectiveness
compared to the other alternatives
available in the market has been
(3) Diffusion
of
Innovations:
attributed to lack of marketing
How to make people adopt new
approach at different levels i.e.
ideas or innovations? The theory
positioning probing, publicity, sup­
of diffusion of innovations ex­
ply and market research etc.
plains this process. Many studies
However many feel, marketing
were carried out in the United
approach in making people accept
States on this concept. “Diffu­
new ideas especially in social issues
sion” is a process and “inno­
like health and education etc.
vations” are new ideas. Backer et
Some popular theories and modwhere the results are long term and
al (13) observe two types of
>s in health communication are
difficult to perceive is not as easy as
innovations of specific concern
Social marketing theory, Social
it is suggested. An analysis of
to health communication cam­
M.carning theory, theory of diffu­
fourteen indepth interviews with
paigns—“incremental” and “pre­
sion and Health belief model
social marketing programme per­
ventive”. Individuals decide to
etc. Three of them are discussed
sonnel involved in carrying out
adopt the new idea now. at “tl” (see
here.
such programmes conducted by
figure) in order to gain an incre­
Neil McKee (10) has revealed that
ment in a desired outcome at “t2”,
(1) Social marketing theory: This
social marketing language docs
in the near term future.
theory highlights the need to
appear to be a barrier to the wide
Preventive innovations are mon
understand consumer behaviour
acceptance of the field managers
difficult to diffuse rapidly. A
by applying marketing principles
and staff of non-profit develop­
individual must take an actv
and research. Proponents of this
ment organizations.
(that is adopt a life-style chan
thocry believe that marketing ap­
now at ‘tl’ in order to lower the '
(2) Social Learning Theory: The
proach needs to be introduced in
bability of occurrence of an e?
basic idea of social learning ac­
development communication also.
ted unwanted future event
cording to Bandura (11) Who first
In its absence the possibility of
proposed it is that “individuals
heart disease, cancer. Alf
accepting a new idea or message is
m agenda setting
1 by researchers is
m assessing the
,enda set by a par.m. This problem
lily when different
ilt information on the
,
overlapping one
.we it becomes difficult
, the contributions of
Jim to the agenda and its
For instance at a parone if Radio, T.V., print,
>«onal
and
Traditional
simultaneously makes proi.'a on “AIDS”, it is difficult
sss the impact created by each
i»e above media. However,
oods have been developed to
.■'come this limitation.

January—March 1996

Radio-spot on Medical Termination
of Pregnancy (6)
Woman announcer introuduccs
an eminent lady doctor saying that
she will talk to the audience on
medical termination of pregnancy;
Lady doctor’s voice follows—“Do
you know? If your health is
endangered due to pregnancy or
child-bearing or if contraceptives
have failed and an unwanted con­
ception occurs there are hospitals
all over the State where abortion
facilities are provided free of
cost”.

In these two examples, it is
assumed that the audience exposed
to the above media will receive
information and act accor­
dingly. The power of the media is
being perceived to be direct and
powerful. However, the present
health communicators are aware of
the limitations of the magic-bullet
theory and are using such messages
initially to create awareness.
(2) Two step—flow theory

When mere transmission of
information could not achieve the
desired behavioural change, the
thinkers shifted their attention to
observe the other influences such
as inter-personal etc. Two step­
flow theory gives more importance
to inter-personal communication
as far as the influence is concerned
and treats mass-media as source of
information. According to this
school of thought, information
flows in two steps, i.e., from mass
media to opinion leaders and
1 herefrom to people. Here the
influence of mass-media is in­
direct. Opinions were also ex­
pressed during this period that
people receive information from
one medium but seek other sources
(Media) to confirm their know­
ledge. Hence proponents of this
theory argued; media helps to rein­
force the messages but cannot

20

directly influence the audien­
ce. Two step-flow theory was
accepted to be valid for quite a long
time and its effect can be seen in
commercial advertisements in
which the suggestions of neigh­
bours, friends and relatives are
given more importance, especially
in publicizing the products. Two
step-flow theory is more effectively
used in commercial advertising (at
present also) than in Develop­
ment Communication.

Example: Radio spot (30 seconds) on
Maternal and Child Health
(7)

Two women: one woman en­
quires about the health of the
other’s children. “What health”?
says the other “Here I am, unwell
myself: how can I keep my
children fit? Something or the
other is always wrong”...............
The first voice urges; “Why don’t
you go to the Primary Health Cen­
tre then”? Commentator con­
cludes: For correct advice about the
health of mother and child, visit the
Primary Health Centre”
Same example can be further
extended (60 seconds spot) where
the second woman narrates her
positive experiences with PHC in
mother and child care.

In the above example, the infor­
mation is positioned in the form of
friends’ suggestion giving more
weightage to interpersonal com­
munication. However,
people
who refute Two step-flow theory
claim that whether there is direct or
indirect influence of Mass-Media
the power of the media is indisput­
able since it is the main source
of information.
(3)

Agenda setting theory

While the Two step-flow theory
dominated the scene for long time.

invasion of Television has opened
the doors for new thinking giving
more importance to Mass-Media
again. Supporting the Magic­
bullet theorists, the present thin­
kers feel that the research tech­
niques in the past were not ade­
quate to prove the effects of
media. The main focus of the pre­
sent research is how media influen­
ces the opinions of the people?
While some felt the information
transmitted through media appeals
to the cognitions, for some it
influences the attitudes. To know
this, in-depth studies were carried
out with special emphasis on “con­
tent analysis of the programmes”
and “persuasion methods”. From
those has emerged “Agenda setting
theory”. According to this theory
both in selecting the contents and
the methods of Communication
media assumes greater role and sets
an agenda as “What people should
know” and “how it should be
given” etc.

Examples: 1. Media propaganda
on AIDS.
2. Phone-in Program­
mes over Radio on
health issues like
Mother and Child
care, etc.
As said by Backer et al (8) the
agenda setting process is a social
phenomenon through which an
issue begins to receive sharply
increased mass-media coverage, in
turn creating more widespread
public opinion about the issue and
eventually leading to responses
by policy makers. Rogers and
Dearing (9) identified three
main components in the agenda
setting process, i.e., the “Media
agenda”, “Public agenda” and
“Policy agenda” and explains as
below. The figure also shows cer­
tain aspects which may influence
these agendas.
SWASTH HIND

learn by observing individual mod­
els who perform particular be­
haviour. The models may be in
everyday life or they may be depic­
ted in the Mass-Media. The social
modelling may be unplanned
and spontaneous”.

One limitation in agenda setting
theory as observed by researchers is
the difficulty in assessing the
impact of an agenda set by a par­
ticular medium. This problem
arises especially when different
media transmit information on the
same issue, overlapping one
another where it becomes difficult
to measure the contributions of
each medium to the agenda and its
influence. For instance at a par­
ticular time if Radio. T.V., print,
Interpersonal and Traditional
media simultaneously makes pro­
paganda on “AIDS”, it is difficult
to assess the impact created by each
of the above media. However,
methods have been developed to
overcome this limitation.
Some popular theories an<^mod­
els in health communication are
Social marketing theory, Social
Learning theory, theory of diffu­
sion and Health belief model
etc. Three of them are discussed
here.

(1) Social marketing theory: This
theory highlights the need to
understand consumer behaviour
by applying marketing principles
and research. Proponents of this
thocry believe that marketing ap­
proach needs to be introduced in
development communication also.
In its absence the possibility of
accepting a new idea or message is

January-March 1996

very low. Positioning of a pro­
duce, strategy formulation, pricing.
audience segmentation and market
research etc., which are very impor­
tant in making people buy a pro­
duct, should be exactly applied in
spreading health messages also.
they opine. The unsatisfactory
performance in popularizing the
oral re-hydralion solution (ORS)
inspite of its relative effectiveness
compared to the other alternatives
available in the market has been
attributed to lack of marketing
approach at different levels i.e.
positioning probing, publicity, sup­
ply and market research etc.
However many feel, marketing
approach in making people accept
new ideas especially in social issues
like health and education etc.
where the results are long term and
difficult to perceive is not as easy as
it is suggested. An analysis of
fourteen indepth interviews with
social marketing programme per­
sonnel involved in carrying out
such programmes conducted by
Neil McKee (10) has revealed that
social marketing language docs
appear to be a barrier to the wide
acceptance of the field managers
and staff of non-profit develop­
ment organizations.
(2) Social Learning Theory: The
basic idea of social learning ac­
cording to Bandura (11) Who first
proposed it is that “individuals

One can see the effect of social
learning theory in almost all pre­
sent day
health
communi­
cation. Especially portrayal of
characters in Television serials.
Radio dramas, and magazine
stories etc. (models who adopt good
health practices and lead happy life
and models who suffer due to bad
health
practices
etc.). Social
learning theory is practised in
interpersonal
and
traditional
media also in role plays and other
folk
forms. Supporting
this
theory Me. Allister et al (12) also
observed that social models in­
fluence changes in attitudes and
beliefs, decision-making and the
acquisition of new patterns of
behaviour.
(3) Diffusion
of Innovations:
How to make people adopt new
ideas or innovations? The theory
of diffusion of innovations ex­
plains this process. Many studies
were carried out in the United
Slates on this concept “Diffu­
sion” is a process and “inno­
vations” are new ideas. Backer et
al (13) observe two types of
innovations of specific concern
to health communication cam­
paigns—“incremental” and “pre­
ventive”. Individuals decide to
adopt the new idea now, at “tl” (see
figure) in order to gain an incre­
ment in a desired outcome at “t2”,
in the near term future.
Preventive innovations are more
difficult to diffuse rapidly. An
individual must take an action
(lhai is adopt a life-style change)
now at ‘tl* in order to lower the pro­
bability of occurrence of an expec­
ted unwanted future event (such
heart disease, cancer, AIDS or

21

unwanted pregnancy) at t2. The
sought after reward is distant in
time, and may not happen even if
the preventive action is taken.
Under these conditions, it is
understandable why individuals do
not adopt preventive innovations
easily or rapidly.
(1)

flow theory ofcourse, was found to
be useful for all the messages and is
still
in practice. Continuous
application of the models in com­
munication material production
and evaluation, not only can prove
the effectiveness of the models but
also bring out new ideas which can

Short time
lapse

Beneficial
consequenses

:---------------------------------------- :------------------>
li
t2
(2) Preventive Innovation
Adopt the
innovation

longtime
lapse

ti

To explain the theory of “diffu­
sion of innovation” in simple
words the rate of adoption of a new
idea will be initially low. But
when a few members of the com­
munity accept the innovation the
programme “takes off’ and pro­
ceeds rapidly. This stage is.called
“critical mass”. Thereafter, the
innovation will continue to diffuse
in a self-sustaining process. The
health professional has to make
extensive campaigning till the rate
of adoption reaches this stage and
can step out of the programme
later.
Do these theories and models fit
into
the
existing
program­
mes?. Do they truly reflect the
health seeking behaviour of the
target audience? or. Do we need
altogether new models? While
generalizations are not possible
there is a need to see the effective­
ness of these models in all impor­
tant key messages. For example,
social marketing model may suit in
promoting condoms and ORS
Agenda setting theory for AIDS &
Sanitation and social learning
theory for educating people on the
age of the marriage etc. Two step­

22

MULTI-CENTRE trials are about
to start on a new type of contracep­
tive for women that has already
achieved 100 per cent success on

100 volunteers.

Incremental innovation

Adopt the
innovation

New lease of life
for the IUD

Beneficial
consequences
:------------------ >
t2
be used for designing messages for
specific audiences like, Women,
Youth & Tribals etc. For example
in women and child health the
existing.media programmes are :—
Women groups in interpersonal
communication, specific audience
programme like womens’ program­
mes over Radio and T.V. and spe­
cial columns for women in news­
papers, etc. While this is widely
accepted some thinkers arc critical
about discussing the issues of
wotpens’ health in isolation.
However the concepts like inter-’
spouse communication, male res­
ponsibility etc. have not drawn
much attention of the health com­
municators and the conventional
approach is still being followed.
Such views call for the need to
develop specific models of media
messages for women and child
health also. This is an area open
for health communication re­
searches to explore.

The device, known as the Butter­
fly intrauterine device (IUD)
because of its looped shape, is the
first of its type not to require
threads for retrieval. Instead it is
retrieved with a thin hook.
Project leader Mr Jason Gardosi
explained : “There has not been
considerable evidence that the con­
tinued presence of IUD thread is
associated with pelvic infection
and resultant infertility. The str­
ing or thread may also cause dis­
comfort to the partner during
intercourse.

Of the 100 volunteers that have
used the Butterfly coil, he said:
“There have so far been no pre­
gnancies and no infections, suspec­
ted or proven.
“We believe that IUDs arc a
generally good, but under-used
form of contraception. The new
Butterfly IUD will give this method
of family planning a new lease
of life.”

Akhila Iyer—Report:—Project in
“Family Hanning communication for
Rural young married couples in
Suharanpur district oj UJP. ” F roin i he

For more information, contact: Mr
Jason Gardosi, University of Not­
tingham. Nottingham; England NG7
2RD. Tel: 115951 5798. Fax: 115
951 5733.

(Contd. on Page No. 25)

—Courtesy: SPECTRUM

References

1.

A clinical study has been under
way since January 1993, with the
new copper coil contraceptive for
the womb, which has been deve­
loped in the Queen’s Medical Cen­
tre. based at Nottingham Uni­
versity in the English Midlands.

swasth Hind

POSTAGE STAMPS :
Messengers of Health
DR Y. A. KETKAR and DR A. C. URMIL

Postal stamps and other postal stationery have been playing a significant role as messengers
of health the world over. This method of promotion of health awareness/education has not
only proved easy but also cost-effective.
ESIDES mass media, postage
stamps have also been utilized
to convey various philanthropic/
health messages to the people at
large. They are now being utilized
increasingly in the Held of health
education for creating public
awareness about major public
health problems and motivate
them to make others (family mem­
bers, friends, co-workers etc) also
aware of these problems. Such
awareness and motivation of others
is a natural outcome of the visual
appeal which these stamps have, if
they are properly brought out.
Some of them, in fact, also prove to
be master pieces of art and printing
which philatelists would like to pre­
serve. Besides this, for conveying
the health message and creating
public awareness, nationwide, they
have a wider and closer contact
with the people as compared to
posters—another medium being
used for the same purpose for a lon­
ger time. As compared to posters..
the postage stamps, being less
expensive, also prove to be more
cost-effective in the long run.
Mass media like radio, T.V. and
newspapers arc being increasingly
used for promoting information,
education and communication

B

January—March 1996

about of health. But, unfor­
tunately, in India due to poverty
and illiteracy and rising cost of
paper and printing, these media
have their own limitations.
Stamps As Messengers of Health :
Their Growing Importance

The unique role of postage
stamps in spreading various mes­
sages has been fully appreciated.
And at present, these are being
increasingly utilized for this pur­
pose by all the nations as well as
the United Nations Organization
(UNO), because these postal
stamps reach every nook and cor­
ner of the globe. Besides postage
stamps, the postal services all over
the world periodically bring out
First Day Covers, envelopes, cards
and inland letters on which various
mcssages/slogans also are printed,
including those on health.

In view of artistic, colourful pos­
tage stamps with their profound
visual impact being inroduced fre­
quently. the hobby of stamp collec­
tion (philately) is also gaining
popularity. It has a special appcal/attraction for the children. It
helps them in improving their

general knowledge regarding a
country, its language, monetary
unit, type of government, etc. If
they try to find out in detail about a
stamp, they learn a lot more.
‘Catch Them Young’ is one of the
principles of teaching and philately
very well fits in this approach.
Messages on health can motivate
them towards primordial preven­
tion, i.e. avoidance of risk factors
(smoking, obesity, drug abuse, etc.)
predisposing
towards
various
health problems of later life.
Two Categories

Philatelists
usually
divide
stamps into two major categories,
i.e.. definitive and thematic. The
latter includes those dealing with
particular subjects such as birds,
maps, paintings, flowers, sports
etc. Compared to other subjects.
the number of stamps dealing with
health-related subjects is con­
sidered as inadequate, needing
more thrust in their production.
both numberwise and variety­
wise.
Health Related Events on Stamps

Many countries have issued
stamps with theme on health-

23

related matters. India has also
brought out stamps on such sub­
jects. viz. Malaria. Red Cross. Nut­
rition. Family Welfare etc. Every
year on 14 November (Jawaharlal
Nehru’s Birthday) observed as
Children’s Day. a special stamp is
issued. This large and multi­
coloured stamp is unique in one
more respect—it is based on selec­
ted drawing or painting done by a
child. During the International
Year of the Child (1979), a stamp
was released bearing the slogan
‘Happy Child—Nation's Pride’.
Similarly, a commemorative stamp
was issued during 1974 reminding
the people about the ‘World Pop­
ulation Year’ being observed dur­
ing that year.
Yugoslavia had issued several
stamps on Red Cross Organi­
sation. These attractive stamps
depict various activities of Red
Cross, viz. humanitarian and peace
activities, emergency services, first
aid, nursing, blood donation etc.
Many countries issued stamps on
Red Cross at the time of celebration
of centenary year of Red Cross
(1863-1963). Our country also
issued a stamp bearing a photo­
graph of Henry Dunant, the foun­
der of Red Cross. Spain had
issued several stamps dealing with
anti-tuberculosis programme. In
1966. the World Health Organisa­
tion (WHO) launched the global
programme for eradication of
Smallpox. The disease was de­
clared eradicated on 8th May
1980. During the period 1966-80.
several nations brought out stamps
in support of this campaign. For
example, some of these stamps
echoed the 1965 World Health Day
theme ‘Smallpox—Constant Alert’.
The largest number of stamps on
smallpox were, however, issued
during 1978, the year after the
world’s last case of smallpox.
This is because the Universal Pos­
tal Union (UPU) had made a fer-

24

i. Madagascar. 1977. World Health Day— "Immunize
ond protect your child".
2 Switzerland. 1958—WHOs 10th anniversary.

vent appeal to all its member
nations that smallpox eradication
should be adopted as the principal
philatelic theme during 1978. Bet­
ween 1968-1972 when smallpox
eradication and measles control
programmes were on. several coun­
tries of the Central and Western
Africa issued stamps featuring
‘Jet Injector.

Since AIDS has become a
scourge of global concern, the UN
Postal Administration has brought
out a set of stamps on AIDS.
These stamps are valid for postage
purpose only at UN post-offices at
Geneva, New York and Vien­
na. These are however available
to philatelists from UN Offices
around the world. These stamps
bear the slogan ‘Fight AIDS
Worldwide’. WHO has also ap­
pealed to all its member countries
(about 166) to bring out their own
stamps on this theme, either as a

3. Afghanistan. 1972. World Hoolth Day— Your
beart .5 your Iwullh
4. Thailand. 1962 —Malaria.

part of World AIDS Day which is
observed on 1 December every year
or on an appropriate National
Day.
The UN Postal Administration
has also issued 6 stamps which
highlight the efforts made by WHO
and UNICEF to save children from
vaccine preventable diseases, the
major killer diseases of children
such as measles, tuberculosis.
diphtheria, whooping cough and
tetanus.
Stamps on Pioneers in Health/
Medical Field

Many well-known personalities
in medical fields have been
honoured by bringing out stamps
on
them. For example,
to
commemorate the memory of
Dr. Haffkine, who discovered
cholera vaccine, India brought out
a stamp in 1964. Many physicians

Swasth Hind

and scientists with their major con­
tribution in medical field, have also
been honoured by many nations,
viz., Florence Nightingale, Robert
Koch, Ronald Ross, Louis Pasteur
etc. It is worthwhile to mention
that Kyle, R.A. and Shampo, M.A.
have edited a book titled ’Medicine
and Stamps’ which contains infor­
mation on 157 stamps. Each
stamp is described in detail with a
short life-sketch df the pioneer/
scientist. The stamps are printed
in black and white. The jacket of
the book and the centre-spread.
however, contain coloured photo­
graphs of the stamps.
Indeed, postal stamps (and other
postal stationery, too) have been
playing a significant role as
messengers of health all over the
globe. For this purpose, this
method of promotion of health
awarcncss/education has not only
proved easy but also cost-ef­
fective. It, should, therefore be
employed for this purpose frequen­
tly and extensively.
□□

(Contd. from Page No. 22)
Family Planning Foundation Centre
for Development of instructional
technology New Delhi.
2.

3.

Evaluation of media reach and
effectiveness—A collaborative study
(1985) pp. 122.
National Institute of Health and
Family Welfare New Delhi.
Population Centre—Bangalore.
Population
research
Centre
Lucknow.
Institute of Rural Health and Family
Welfare Trust.
Research Centre—Patna.
Phyllis T. Piotrow, D. Lawrence Kin­
caid, Michelle J. Hindin, Cheryl L.
Lctlcnmaicr, Innocent Kuscka, Terry
Silbcmian, Alex Zinanga, Florence
'Chikara, Donald J. Adamchak.
Michael T. Mbizvo, Wilma Lynn
Opia Mensah Kumah, and Young-Mi
Kim—Changing Men’s Attitudes and
Behavior: The Zimbabwe Male
Motivation Project—Studies in Family
planning—volume 23 number 6/part
I November/December 1992 Bi­
monthly published by the population

January—March 1996

council, I Dag Hammarskjold plaza.
New York 1992.
4.

5.

Carrier Rolf. C : Who died when and
from what and why isn’t more being
done about that?—Opportunities for
meeting the challenges of child and
maternal health in India in the
1990s.
Health
Action—Special
issue
on Mother and Child Care—A
National monthly magazine of
HAFA-Sccunderabad (A.P.) 1990.
Kakar V.N.:
Communication in
Family planning—India’s experien­
ce. National Institute of Health and
Family Welfare New Delhi-1987
pp. 175.

6.

Ibid

7.

Ibid

8

Backer Thomas E., Rogers Everett
M. and Pradeep Sopory: Desig­
ning Health Communication cam­
paigns :
What Works?—SAGE
Publications Ltd UK. 1992 pp. 22.

9.

Roger, E.M.. and Dearing, J.W.
(1988). Agenda-setting
research;
Where has it been, where is it going? In
JA Anderson (Ed), Communication
year book 11 (pp. 555, 594). New­
bury park CASAGE.

10.

Me Kee Neill—A community based
learning approach; Beyond social
Marketing—
Shirley A White. K. Sadanandan
Nair & Joseph Ascroft (Ed) Par­
ticipatory Communication working for
change and development—SAGE
Publications—New Delhi 1994.

11.

Bandura. A (1986) Socialfoundations
of thought and action. Engelwood
Clifts, NJ Prentice—Hall.

12.

Me Aister Afreet Aurelie G*.
Ramirez, Galavotti Christine and
Kipling J. Gallion. Anti smoking
campaigns : Progress in the applica­
tion of social learning theory, in
Ronald E. Rice Charles K. Akin
(Ed) Public communication Cam­
paigns—SAGE
Publications
England, pp. 299. 300 & 301.

13.

Baker et al: Opcit pp. 5 & 6

O.

25

Stroke Education and its Evaluation
Dr Prakashi Rajaram

HE word “Stroke” as defined in
the dictionary means many
things, “the act or movement of
striking”: “one of a scries of recur­
ring movements”: “Any ill effect”:
etc. But when used in its medical
sense it suggests an attack usually
in an elderly person, that occurs
suddenly and is inevitably accom­
panied by severe and life threaten­
ing paralysis of one-half of the
body.

T

Stroke is the most common cause
of neurological disability in the
adult population. Of the patients
who suffer a stroke, a third would
survive but with severe disability, a
third would make a good recovery
with functional independence and
the remaining would succumb to
it. The onset is usually sudden
with maximum defect at the onset,
so the shock to patients and
relatives is extreme.
Strokes are divided into two
main types : Cerebral infarction
and cerebral haemorrhage.

Cerebral infarction means that a
part of the brain is damaged due to
lack of blood because the vessel
feeding the area is blocked. If the
blood supplied is not restored quic­
kly, the affected area of the btain
tissue dies (becomes “Infarcted”).
Cerebral haemorrhage means
bleeding into the brain and is due
to the rupture of either a blood

26

vessel or an aneurysm, which is a
localized dilation of the blood
vessel. At least half the patients,
have also elevated blood pressure.
Risk factors in Stroke

Certain factors increase the risk
of having a stroke. Some can be
avoided
while
others
can­
not Awarness of these risk fac­
tors particularly the avoidable
ones, is important not only to the
patient but also to the family as
well. It is essential that the patient
and the family attempt to avoid
high-risk situations to prevent the
first or the subsequent strokes.
These factors are as follows
hypertensions, Diabetes, Mellitus,
high cholesterol and blood fats,
heart disease, oral contraceptives
without
medical consultation.
smoking and obsity etc.

Stroke is no respecter of age, race
or sex. Thus any one can be affec­
ted. Men appear to have a higher
incidence of stroke in the earlier
years than women. Some experts
believe that it may be due to the
added protection given to women
by female hormones. This hypo­
thesis is further substantiated by
the observation of the incidence of
stroke in women after menopause
being equal to that in men of the
same age.
The extent to which inherited
factors contribute to stroke is not

known. However, a correlation
does appear to exist It is possible,
however, that increased stress and
poor dietary patterns contribute to
making a person more susceptible
to stroke.
The epidemiological studies con­
ducted in India have indicated that
45 to 57 persons in a population of
one lakh are affected by different
types of stroke.

Depending on the conditions of
the patients a regular medical treat­
ment for underlying diseases is
given to them. In addition, ap­
propriate Nursing Care, Physio­
therapy, Occupational Therapy,
Speech Therapy are also extended
to patients affected with stroke. In
some of the sophisticated hospitals,
the services of clinical social
worker and psychologist are made
available to the patients to handle
psychological,
vocational and
interpersonal difficulties.
Common Problems

Once a stroke has occurred, the
patient and his/her family are
usually confronted with drastic
changes . in their life-style. The
patient may be unable to speak,
move or see as he once did. His
bladder and bowel function are
sometimes affected. Memory dys­
function in the patient and
emotional changes in both patient
and family are also familier proSWASTH HIND

blcins. In addition to these physi­
cal, mental and behavioural
changes, alteration in work as­
signments and finances are fre­
quently seen. Thus, stroke brings
in many adjustment problems and
warrants many sacrifices from the
family and patient.

Many misconceptions prevail
among the people regarding this
illness. Many people believe that
stroke is caused by evil spirits or by
the sins of previous birth. Karma or
due to God’s curse. It is common
to see special preparations like
piegeon blood and other related
items being used to cure the
illness. Patients arc taken to dif­
ferent types of healers. Unless the
family members are educated
about the scientific facts of
illness, the patient and the family

members continue to suffer in
silence.
In our attempt to assess the effec­
tiveness of stroke education, a
study was undertaken at National
Institute of Mental Health and
Neuro Sciences (NIMHANS),
Bangalore.

Thirty-relatives of stroke patients
were given * systematic stroke
education—basic facts about brain,
nature of stroke, early recognition
of stroke, risk factors, types of
stroke, investigation, treatment and
rehabilitation.
For the purpose of comparison
another group of thirty relatives of
stroke patients was taken up. This
group did not get systematic
stroke education.

As a result of systematic stroke
education the family members tend
to appreciate the role of brain.
They also come to know about the
causes or risk factors contributing
to stroke. The stroke education
also helped the family members to
be regular in follow-up and after
care. Family members extended
the cooperation and support for
faster recovery in patients. The
study proved that the systematic
stroke education brought forth
positive changes in relatives—
knowledge, attitude and behaviour
towards stroke over a period of
time. Our experience in woking
with stroke patients and their
relatives has substantiated the
research findings that stroke
education should become an essen­
tial component of any comprehen­
sive care programme for stroke
patients both in the hospital and in
the community settings.

Bid to improve cervical screening
AN extra test for women taking part
in a cervical cancer screening pro­
gramme may ultimately save up to
1,000 additional lives a year in
Britain.

Researchers from the London­
based Imperial Cancer. Research
Fund (ICRF) are planning a major
trial to discover the effect of adding
a test for human papillomaviruses
(HPV) to the Pap smear.

Dr Jack Cuzick. head of ICRF’s
mathematics, statistics and epi­
demiology department, says his

January—March 1996

team found that an HPV test pic­
ked up high grade abnormalities
not found by the smear test. He
continued: “Adding the HPV test
may be important in preventing the
invasive cancers we are now seeing
in women with apparently ade­
quate screening histories.

“It may be that many of the
abnormalities we found only
through HPV testing would have
spontaneously returned to normal
or been detected by subsequent
smear tests before they progressed
to cancer. That is the main reason
wc need a large trial, involving
several hundreds of thousands of
women.”

Dr Cuzick says an HPV test on a
large scale might not only reduce
the incidence of cervical cancer
and save lives, but might actually
reduce the cost of screening in three
ways—by immediate referral of
women who have abnormalities
destined to persist; by safely allow­
ing five-year intervals between
smears and by stopping screening
at an earlier age for women who are
truly negative on both tests.”

For more information, con­
tact : Imperial Cancer Research
Fund, Lincoln’s Inn Fields. London
WC2A 3PX. Tel: 171 242 0200.
Fax: 171 269 3262.
—SPECTRUM

27

Risk Factors for Stroke
I low can a stroke be prevented?

When stroke occurs, there can be
severe losses in mental and bodily
functions—or even death. That is
why preventing stroke is so
important.

The best way to prevent a stroke
from occurring is to reduce the risk
factors for stroke.
What are the risk factors for
stroke?
Some factors that increase the
risk of stroke are hereditary. Others
arc a function of natural processes.

Still others result from a person’s
lifestyle. Factors resulting from
heredity or natural processes can­
not be changed, but environmental
factors can be modified with a doc­
tors help.
Risk factors that can be treated

Five partly controllable risk fac­
tors arc : (1) high blood pressure, (2)
heart disease, (3) cigarette smoking,
(4) high red blood cell count and
(5) transient ischemic attacks.
High Blood Pressure—Hyper­
tension is the most important risk
factor for stroke. In fact, stroke risk
varies directly with blood pressure.
What makes high blood pressure
even more significant is that it
afflicts about one in every three or
four American adults. And women
do not tolerate high blood pressure
any better than men. The effect of
hypertension does not ease as a
person gets older either. That is
why everyone should have their

28

blood pressure checked regularly.
Controlling high blood pressure
reduces the risk of stroke signi­
ficantly; often blood pressure can
be controlled simply by eating a
healthier diet and maintaining pro­
per weight. Drugs to control blood
pressure are also available. Many
people think the reason the death
rate from stroke has declined over
the past decade is due to better con­
trol of high blood pressure.

Heart Disease—A diseased heart
increases the risk of stroke. Inde­
pendent of blood pressure, people
with heart problems have more
than twice the risk of stroke than
people with normally functioning
hearts. The four major controllable
risk factors for heart attacks are
cigarette/tobacco smoke,
high
blood cholesterol, high blood pre­
ssure and physical inactivity. Con­
trolling these factors reduces the
risk of heart disease and thus the
risk of stroke. Rheumatic (valvular)
heart disease is another cause in
developing countries.
Cigarette Smoking— I n recen t
years studies have shown cigarettes
smoking to be an important risk
factor for stroke. Inhaling cigarette
smoke produces a number of
effects that damage the cardiovas­
cular system. Nicotine in tobocco
smoke increases a person’s blood
pressure. Carbon monoxide also
gels in the blood, reducing the
amount of Oxygen the blood can
supply to the body. Cigarette smoke
also causes the platelets in the

blood to become sticky and cluster,
shortens platelet survival, dec­
reases clotting time and increases
blood thickness.

High Red Blood Cell Count—A
marked, or even moderate increase
in the red blood cell count is a risk
factor for stroke. The reason is that
increased red blood cells thicken
the blood and make clots more
likely. This problem is treatable by
removing blood or administering
"blood thinners”.
Transient Ischemic Attacks (TIAs)—
Only about 10 percent of strokes
arc preceded by TLAs. Neverthe­
less, TIAs are extremely important:
they are strong predictors of stroke.
TIAs are usually treated with drugs
that inhibit clots from forming.
Risk factors that cannot be
changed
Seven risk factors for stroke can­
not be changed. These are: (1) age,

(2) sex, (3) race. (4) diabetes
mcllitus, (5) prior stroke, (6) here­
dity and (7) asymptomatic caro­
tid bruit.

Age—Incidence of stroke is
strongly related to age. Older peo­
ple have a much greater stroke risk
than younger people. The risk of
stroke in people aged 65 to 74 is
about 1 percent a year. If they have
had a TIA. it increases 5 to 8 per­
cent a year.
Ser—The incidence of stroke is
about 30 percent higher for men
than women. For people over age

Swasth Hind

65, the difference
greater still.

is

slightly

Race—African-Americans have
more than 60 percent greater risk of
death and disability from stroke
(han whites. This may be because
African-Americans have a greater
incidence of high blood pressure.

Other, less well-documented risk
factors includes: (1) geographic area,
(2) season and climate, (3) socio­
economic factors, (4) excessive
alcohol intake and (5) certain kinds
of drug abuse.

Geographic Area. Strokes are
more common in the South­
eastern United States (the socalled “Stroke Belt”) than in
other areas. Stroke is also
more common in Japan.
China & Taiwan where it is
believed to be related to high
blood pressure.

Diabetes Mellitus—Although dia­
betes is treatable, the fact that a per­
son has it still makes it much more
likely that he or she will suffer a
stroke. This is even more true for
women than for men. Many times
Diabetics also have hypertension,
increasing their risk of stroke
even more.

Season and Climate. Stroke
deaths occur more often dur­
ing periods of extreme
temperatures.

Prior Stroke—The risk of stroke
for someone who’s already had one
is many times that of someone who
has not.

Socioeconomic Factors. There
is some evidence that strokes
are more likely to occur
among poor people than
among
more
affluent
people.

Heredity—Stroke risk is greater
for people who have a family his­
tory of stroke.

Asymptomatic Carotid Bruit—A
bruit is an abnormal sound heard
when a stethoscope is placed over
an artery (in this case, the carotid
artery, which is in the neck). Carotid
bruit clearly indicates increased
stroke risk. However, a bruit mainly
indicates atherosclerosis; it does not
necessarily mean the carotid aitery
will become clogged and a stroke
will result.

Excessive Alcohol intake. More
than two drinks per day raises
blood pressure. Binge drink­
ing can lead to stroke.

*

Certain Kinds of Drug Abuse.
Intravenous drug abuse car­
ries a high risk of stroke from
cerebral embolisms. Cocaine
use has been closely related to
strokes, heart attacks and a

“First of all our young men must be strong.

strong my young friends, that is my advice to you.

football than through the study of Gita.

variety of other cardiovas­
cular complications. Some of
them have been fatal even in
the first-time cocaine users.
Other risk factors Besides the risk factors listed,
other (controllable) factors indirec­
tly increase stroke risk. These
include : (1) elevated blood choles­
terol and lipids, (2) physical inac­
tivity and (3) obesity. These are
secondary risk factors, because
they affect the risk of stroke

indirectly by increasing the risk of
heart disease (which is a primary
risk factor for stroke).

Finally, it is worth noting that
some rather low-level risk factors
when combined with certain other
risk factors—become extremely
significant. Taking oral contracep­
tives and smoking cigarettes, for
example, increases the risk of
stroke considerably. More to the
point 10 percent of the population
in whom, one-third of all strokes
occur have a set of five risk factors.
These are : (1) abnormal glucosetolcrance, high blood pressure.
elevated blood cholesterol levels,
cigarette smoking and left ven­
tricular hypertrophy (the over­
development of the left side of the
heart). People who have all these
factors should have close medical
supervision.
—Source: American Heart
Association

Religion will come afterwards.

Be

You will be nearer to heaven through

You will understand the Gita better with your

biceps, your muscles a little stronger”.

—Swami Vivekanand

January—March 1996

29

MARINE HYGIENE
Colonel Jasdeep Singh

ITH increasing population,
requirement of food has
increased to such an extent
that the techniques to increase food
production by the methods like fer­
tilizers, insecticides, better seeds,
mechanical tools and other advan­
cements in the field of agriculture
alone may not be sufficient We
have to explore sea resources to a
much greater extent and advance
our techniques in such a way that
sea-food reaches the consumer in
hygienic and more acceptable
form. As fish and shell fish are
becoming an important source of
protein, we have to ensure that
these valuable products reach the
consumer without posing any
public health problem in the form
of microbial infections or intox­
ications. Perishable nature of the
fish adds to these hazards. We also
have to safeguard marine products
from aquatic pollution and im­
proper handling.

W

Fish is one of the cheapest source
of animal protein that provides us
as much as 15 to 23% of pro­
tein. Fish is a good source of
vitamin A, D and also of somo B
group vitamins. It provides us
good amount of iron. It is also a
good source of calcium, provided it
is consumed along with bones.
Sea fish is a very rich source of
iodine. Among marine creatures
shell fish is assuming more impor­
tance and has become a delicacy in
certain parts of the world.
Shellfish includes certain molluscs
like oysters,clams and scallops and
crustaceans like crabs, crayfish,
lobserts and shrimps.
Health Hazards

Except for certain biotoxins, no
other major disease is known, to be
transmissible directly to man as a

30

To meet the ever-increasing protein requirement of human popula­
tion various agricultural resources despite technology advancements
may not suffice. Rich sea resources are required to be explored to a
much greater extent so that the nutritious sea-food is made available
to a large number of consumers in hygienic acceptable forms.
result of fish or shellfish. All the
diseases where man is affected are
manmade. Aquatic pollution in
the catchment area resulting from
sewage or industrial wastes is res­
ponsible for a large number of
hazards.
Improper handling
techniques and perishable nature
of these marine products add to the
problem further.

Sewage pollution in the catch­
ment area results in various intes­
tinal diseases or food poisoning.
Among the various bacterial infec­
tions
vibrio
parahaemolyticus,
cholera,
salmonellosis,
botulism are transmitted to man
through marine food.
Vibrio
parahaemolyticus food poisoning
is most common and is responsible
for as many as 50% of all the cases
of food-bome disease but botulims
is more important from the public
health point of view. Botulism is
responsible for a large number of
mortality and morbidity as the
organism.

Clostridium botulinum can grow
and produce toxins without impart­
ing any noticeable change in the
taste and odour of food.
In areas where people consume
raw or insufficiently cooked
marine food, incidence of certain
helminthic parasitic diseases like
Diphyllobothrium latum is high.
Recently 3 new nematode diseases
have been recognized. Anisakis
larvae causes severe allergic reac­
tions during its migration in the

human beings. Angiostrongyhis
cantonensis infection is acquired
when insufficiently cooked food
like prawns and crabs are con­
sumed. its larval stage in man
causes eosinophilic meningitis.
Capillaria phillipinensis is another
nematode infection which is
acquired when improperly cooked
fresh water fish containing eggs of
the parasite is consumed, it causes
atrophic changes in the intestines
resulting in intractable diarrhoea
and malabsorption syndrome.

Similarly incidence of certain
viral diseases like infectious
hepatitis is high where bivalve
fishes like oysters or clams are
taken from sea water which is
grossly contaminated with sewage.
In addition to sewage, various
industries are also discharging
numerous known and unknown
chemicals into the catchment area.
Thfte chemical toxins are bound to
endanger the health in one way or
the other. Minamata disease is one
such example which resulted from
organic mercury compounds. The
disease developed in the form of
paralysis or death in all those who
consumed fish caught from Mina­
mata Bay to which an industry was
discharging its wastes. This indus­
try was using mercuric chloride for
manufacturing of vinyl chloride
and was discharging its untreated
wastes into Minamata Bay. This is
one of the situations which could
have been averted and a large num­
ber of human beings saved from
sufferings.

S WASTE HIND

Even when due care is exercised
in avoiding the aquatic pollution of
catchment area or fish is caught
from approved area, still the health
can be endangered through impro­
per handling during transportation
and storage of these marine
products.
Some biotoxins of shellfish are
responsible in causing paralytic
shellfish poisoning (PSP) and are
of great epidemiological impor­
tance. Certain edible filter feeding
molluscs like mussels, clams, oys­
ters etc are the main source of the
toxin for man in whom the build up
of toxin can occur in a few days
after taking certain toxic plankton
but its natural elimination takes
several weeks. In small doses this
neurotoxin causes tingling sensa­
tion of the mouth and lips, larger
doses may cause collapse, paralysis
and death. There is no known
antidote for it
Fish toxins which present differ­
ing behaviour are grouped into
three important classes.

(a) Ciguatera poisoning: It is a
peculiar type of fish toxin which
appear in many tropical species
including snapper and grouper.
The precise cause is unknown. Fish
may suddenly become toxic and
remain so for years. The toxin is
heat stable which produces
symptoms of mild paralysis and
gastro-intestinal disturbances, in
extreme cases death may occur.

(b) Tetraodon (puffer fish poison­
ing) : Puffer fish is present in tropi­
cal region including Indian Ocean.
The toxin is heat stable and is
localised to gonads and liver of the
fish. The amount of the toxin
varies according to the season and
is responsible for a serious disease
with a high mortality. Control of
this poisoning is easy through
public health measures and fish is
rendered edible after removing the
gonads and liver.
(c) Scromboid poisoning: Tuna,
bonito, mackerel and related fish

January—March 1996

become toxic following bacterial
decomposition due to improper
preservation. The toxin again is
heat stable and causes symptoms
resembling those produced by his­
tamine. Hygienic handling tech­
niques can reduce the risk of
such poisoning.

Control measures
Control of marine hazards is a
joint effort by public health and
fishery department. Basically, it
involves the measures such as con­
trol of area or season of catch and
evisceration of toxic organs of
the fish.

Control over catchment area
Catchment area should be
absolutely free from sewage or
industrial pollution. Water stan­
dard should be as near as that of
drinking water. Coliform group of
organisms are the best indicator of
sewage pollution and has been
used by WHO in the classification
of the catchment area.
1.

(a) Approved: If coliform count,
most probable number (MPN), is
less than 70/100 ml of water and
sanitary survey of the area is
satisfactory.

(b) Conditionally approved: If
MPN is less than 70/100 ml of
water but sanitary survey is not
satisfactory.
(c) Restricted: If MPN is more
than 70/100 ml but less than 70/
100 ml of water. Here marketing is
allowed after relaying of the
product

(d) Prohibited: When MPN is
more than 70/100 ml of water,
catchment area is declared as pro­
hibited. This standard should be
strictly adhered to by our fishery
industry.
2. Control over catching, handling
and storage
To avoid bacterial pollution on
the skin surface of the fish drift nets

or floating gill nets should be used.
Trawling with a net on the sea bot­
tom may increase the number of
bacteria on the skin surface of the
fish 100 times. When net is hauled
out of water and placed on board
the ship, some fish are subjected to
pressure and their intestinal con­
tents may be pressed out on to the
skin of surrounding fish, fish
should be separated and disposed
of immediately.

To avoid microbial spoilage and
to remove active digestive enzymes,
visceral organs of the fish should
be removed (Evisceration). If the
fish arc brought up from deep
water, sudden expansion of the
bladder also produces the same
effects, so evisceration should be
done at the earliest In certain com­
mercial methods fish is killed in
water; such fish should be taken
out immediately from the warm sea
water.
This is very important
especially under our climatic
conditions.
Fishing boats should have ref­
rigeration facilities, so that after
catching the fish is chilled
immediately and the temperature is
maintained between —1°C and
+2°C. Port procedures such as
weighing and sorting should be
carried out without much delay
and fish should be moved to con­
sumers as quickly as possible.

3. Monitoring of new species
When a new species of the fish is
introduced, it should be properly
investigated for its safety before
allowing it to be marketed.
To achieve the maximum bene­
fits of the available knowledge it is
very much essential to educate and
train the people engaged in the pro­
fession and also to disseminate the
knowledge to general public so that
this valuable food is consumed
with utmost safety.

31

SPECIAL ON WORLD TB DAY—25th MARCH

ROBERT KOCH :
The Great Discoverer
(Who discovered Tubercle bacillus in March 1882)
DR V. K. TIWARI

Robert Koch, the celebrated German Doctor, the great discoverer, is well-known and
remembered for his famous discovery in the field of medicine. These important dis­
coveries have established him a medical giant and a internationally famous scientist in the
history of medicine.
Life History. Assignments and Work
ROBERT KOCH was bom on
11th December. 1843 in Clausthal
village in Horz mountains in the
state of Honnovcr in Germany.
His father was a local councillor
and a mining engineer by pro­
fession. He completed medical
studies at Gottingen University and
qualified maxima cum laundc with
an MD thesis in succinic acid.
Prof. G. J. Henle (1803-1885). a
great histologist was his teacher at
medical school.

Robert Koch started general
practice for a time but in 1870.
when Franco-Prussian war broke
out. he volunteered for the army
and worked in military hospital al
Lorraine and Orleans in Fran­
ce. On his discharge from army.
he obtained a diploma in Public
Health and took up the post of
Distt Physician in Wollheim.
There his wife Emily Fraatz pre­
sented him a microscope on his
birthday and he set up a primitive
laboratory and commenced his
study of infectious diseases. He
made breathtaking discoveries in
his primitive laboratory.
In 1876. Koch demonstrated the
life-cycle of Anthrax bacillus. He

32

was then invited to Breslau to con­
tinue his bacteriological researches
and the next three years (1877-80)
proved to be exciting and fruit­
ful. During this period, he laid
the foundation of modern bac­
teriological techniques introducing
glass slides and coverslips, exami­
nation by hanging drop, fixing and
staining of bacteria, culture on
solid media by poured plate
method, microphotography, disin­
fection by steam sterilization and
common causes of wound infec­
tions.

In 1880, Koch was appointed an
extraordinary member of Imperial
Health Office in Berlin on the pro­
posal of Julius Cohn in recognition
of his work. In 1881. in the Inter­
national Medical Congress in Lon­
don, his demonstration of bacterio­
logical techniques created a sen­
sation. Even Pasteur exclaimed,
“This is a great step for­
ward”. This was the most impor­
tant single contribution in the
science of Bacteriology by Koch.
He worked very hard with utmost
dedication for 6-7 months and by
March 1882, he had succeeded in
finding the causative organism of
tuberculosis.

Cholera Vibrio Isolated

Robert Koch, in the year 1883
headed German Cholera Commis­
sion in Egypt and India, where he
isolated cholera vibrio, as the cause
of cholera. By 1885. he was elec­
ted Professor of Hygiene and Bac­
teriology in Berlin and Koch
Institute was built for him in
1891. He was busy travelling to
great extent, studying tropical, dis­
eases of Africa and Asia. During
the year 1897, he came to India and
visited many important institutions
including Mukteshwar in U. P.
Hills.

Koch visited Italy, Indonesia.
New-Guinea. USA. Japan. India
and Africa. In Japan he was
greatly honoured by his old student
and associate Kitasato at his own
Institute of Bacteriology and a
shinlo shrine was erected there in
his honour and even now, the
annual tribute is being paid to
him. Even after his retirement
from the Institute of Infectious Dis­
eases. he continued to be univer­
sally honoured and was elected
member of German Academy of
Sciences and was later elevated to
the title of Excellency.

Swasth Hind

first Tuberculin Residue.
Koch’s Lymph) for diagnostic
use and therapeutic remedy.
It was followed with con­
troversy but paved the way for
subsequent
research
on
allergy and immunity.

Discovery of Tubercle Bacillus

It was on 24lh March 1882 that
Koch announced the discovery of
tubercle bacillus, the causative
organism of the dreaded disease
tuberculosis in the evening mon­
thly meeting of Berlin Physiologi­
cal society, chaired by Prof. D.
Raymond. The
distinguished
scientists present at that moment
were Helm Holtz. Loeffler. Paul
Ehrlich and Vircho.

7.

Nobel Prize

In 1905. the greatest honour was
bestowed by awarding him Nobel
Prize for medicine for his work on
tuberculosis. Koch
married
Emily Fraatz in 1867. a childhood
friend. They were blessed with
one daughter, Gertrude, in 1868.
Later, this marriage broke up after
26 years. In March 1910, he
developed cardiac failure and died
on 27th May 1910 at the age of
67.
Robert Koch’s
Medicine

1.

2.

Contributions

Cultured Tubercle Bacilli
using cattle blood scrum solid
medium.

4.

Developed
slide
culture
technique for growing tuber­
cle bacilli.
Carried out experiments on
living attenuated strains for
immunization of cattle and
named ‘Tauruman*. It was
later abandoned.

Introduced Tuberculin (old
Tuberculin. New Tuberculin.

January—March 1996

In E. Africa, uncovered the
cause of mysterical fever in
Usumbura mountain, as due
to malaria.

13.

Showed that trypnosomes, the
causative organisms of sleep­
ing sickness undergoes a
cyclical phase in Tsetse
flics.

14.

For the first time he showed
that certain disinfectants are
bactericidal rather than bac­
teriostatic and also main­
tained that the different
organisms differ in their sus­
ceptibility to various dis­
infectants.

15.

Carried out basic studies
into disease resulting from
wounds.

slides

* Examination by hanging
drop.

A Medical Giant

* Fixing and
bacteria.

staining of

* Culture on solid media by
pourcd-platc methods.

Discovered Tubercle bacillus
on 24th March 1882.

Developed stain for staining
tubercle bacilli.

6.

* Introducing glass
apd cover slips.

the

12.

Laid the foundation of mod­
ern bacteriological technique
by:

to

3.

5.

8.

Isolated Cholera Vibrio as a
cause of cholera in Egypt
He successfully showed by
histopathological studies that
the lession was confined to
intestinal
mucus
mem­
brane. He also discovered
that the bacilli were respons­
ible for Egyptian phthalmia.

posals for preventing
transmission of disease.

* Microphotography of the
micro organisms.

9.

Invented
disinfection
steam sterilization.

10.

Using bacteriological techni­
ques. he demonstrated strep­
tococci and staphylococci in
the wound infection.

11.

by

Investigated prevalent disease
among sheep called Anthrax.
Koch successfully isolated the
bacillus, studied its life-cycle
from the spores, proved the
actio-pathogenesis,
cul­
tured the germs, determined
the conditions under which
its spores develop and spread
and pul forward effective pro­

It can be very well concluded that
any single discovery of Robert
Koch-thc discovery of tubercle
bacillus being outstanding, would
have ensured him a place in medi­
cal history. But when one con­
siders
his
total
outstanding
achievements, he stands out as one
of the medical giants of all time.
Medicine and humanity at large
remain for ever indebted to him.
References
1.

Webb. G. B.—Robert Koch 1843-1910.
Annals of Medical History. New series.
1932. 4. 509.

2.

Young. R. A.—The influence ofthe dis­
covery ofthe tubercle bacillus by Robert
Koch on medicine. Hospital social ser­
vice. 1933. 27. 451.

3.

Editorial—Recent researches on bac­
teria. 11. Koch s investigations an tuber­
culosis. British Med. Journal. ISS2.
I 706.

(Contd. on Page No. 35)

National Pulse Polio Immunization (PPI) Programme 1995-96

Better Coordination Leads to
Excellent Results—An Agra Experience
DEOKI NANDAN

G. K. Gupta

Manish Subharwal
and
Neeta Goel
OLIO is one of the most dreaded
diseases of infancy and early
childhood. Once attacked, its
impact is suffered life-long. The
only positive aspect of this disease
is that it is vaccine preven­
table. Based on the efforts of
international community, we arc
now foreseeing the day when there
will be no polio in this world.

P

The year 1995 will be written in
golden words in the history of man­
kind and medicine. This year has
given a major boost to the efforts
which will certainly lead to polio
eradication, one day. It was star­
ted by the WHO on the World
Health Day on 7th April 1995. by
giving a slogan ‘A World Without
Polio-Target 2000'.
An important strategy in eradi­
cating a vaccine preventable dis­
ease is ‘Mop Up Round'. Under
(his strategy, the vaccine is ad­
ministered to the mass population.
on one single day. Such Mop Up
Round was planned for Oral Polio
Vaccine in India and it was decided
to administer the vaccine to all little
Indian citizens on December 9.
1995 and January 20. 1996. The
Government decided to observe
National Holiday on these dates.
It was the responsibility of the Dis­

34

trict Administration and the Dis­
trict Health Administration of all
the districts of India to ensure that
each child below the age of 3 years
was given oral polio vaccine on
these dates. They were free to
adopt their own strategies for this
(ask (but adhering to the general
guidelines issued by the Minis­
try). Agra district adopted a uni?
que strategy and made this festival
a grand success in the district

Once the centre of activities was
shifted to the department of SPM.
SN Medical College, Agra, a con­
trol room was established in the
department and a co-ordination
committee at the level of college
was formulated under the chairper­
sonship of the Principal and
various faculty members of the
institution as members. Medical
students, residents, research staff
and other staff who volunteered
were assigned the responsibility of
administering the vaccine.

Methodology

The District Magistrate. Agra
formulated a District Coordination
Committee which included Offi­
cers of district administration.
district health
administration.
Principal and Heads of the Depart­
ment of SPM and Paediatrics. SN
Medical College. NGOs active in
the city, renowned private prac­
titioners and media personnel. It
was then decided to divide the dis­
trict into two divisions wz. Rural
and Urban. The rural division
was coordinated by Dy. CMO
(MCI1) and the activities in the
urban area were coordinated by
Head. Dcplt. of SPM. SN Medical
College. Agra, under the leadership
of Principal SN Medical College.
Agra.

A total of 397 booths were iden­
tified by the district health ad­
ministration and it was decided to
transport vaccine to these booths
by the district health adminis­
tration. In all 417 volunteers were
registered which included students,
interns, residents, research staff
and other office staff. A series of
orientation, motivation and train­
ing sessions were organised for
these registered volunteers.

A team consisting of residents,
interns and other staff was for­
mulated and this team visited
various schools and colleges of
Agra giving the message of PPI
to children.

SWASTH HIND

The total urban area of the dis­
trict was divided into 20 sectors,
majority of which were the D-type
health centres of Agra. Among
other sectors were the Depth of
Obst. and Gynac. and Dcptt. of
SPM. SN Medical College. Agra.
Lady Loyal Hospital and a sector
comprising of miscellaneous posts
at hospitals of armed forces.
railway and bus stations etc. The
Medical Officers were the sector incharges and were to coordinate
activities in their respective sectors
and other health staff posted in
these sectors were instructed to
assist in all possible aspects. The
posting of Medical College volun­
teers was then accomplished. The
simple strategy was two under­
graduate students or one resident/
inlcm/staff at one post. In
addition volunteers from other
degree colleges and local NGO
were also requested to partici­
pate.

Though the vaccine was avail­
able at the booths, three bulk
depots were established, viz., one
each at Deptt. of SPM, SN Medical
College and CMO Office and one
mobile unit.
Monitoring and Evaluation

A mobile monitoring team was
formulated comprising of various
faculty members of Medical

College with the coordination of
the Department of SPM, SN Medi­
cal College, Agra. The team was
readily available to visit various
posts during the immunization ses­
sion to observe the performance,
rectify any problems/confusions at
the spot and fill an assessment pro­
forma for process evaluation.

Inferences

It was the result of the combined
effort at various levels which
generated a lot of enthusiasm and
awareness among the general com­
munity. Following
were
the
coverage during the two phases :
Age

An evaluation team comprising
of statisticians, research staff and
residents of Deptt. of SPM, SN
Medical College, Agra was for­
mulated. At the end of the
immunization session, each sector
in-charge was to bring the report to
the Control Room, where it was
immediately screened and com­
piled to give the final results in the
form of children immunized and
vaccine consumed.

After the first phase of PPI on
December' 9, 1995 a series of
meetings of various committees
were organised by the Deptt. of
SPM, SN Medical College, Agra in
order to make the second phase
even more effective and minimize
the problems faced during the first
phase. The
recommendations
made by these committees were
duly incorporated. One of the
major recommendations was to
increase the number of booths and
make sub-depots of vaccine at the
sector level.

December
9. 1995

January
20. 1996

0—3 year
children

1.15,498

1.56.283

3—5 year
children

21.124

25,897

Total

136.622

1.82.180

Recommendation

It was a general impression that
this herculean task would not have
been possible without the coopera­
tion of each and every individual
who participated in its own capa­
city in this programme. It can.
therefore, be concluded that dedi­
cated efforts of the community can
make any national programme a
grand success. In future, to make
other national programmes, a suc­
cess, community participation
should be viewed as a key compo­
nent. and it is quite possible, which
is evident by our
AGRA
EXPERIENCE.

(Contd. from Page No. 33)
4.

5.

Sakula. A—Robert Koch (1843-1910).
founder of the science of bacteriology
and discoverer of the tubercle bacillus.
British J of Dis. of the chest. 1979.
73, 389.
Grange. J. M. and Bishop. P. J. —
'UBER TUBERCULOSE'. A tribute to
Robert Koch's discovery’ of tubercle
bacillus. 1882. Bull, of Int. Union Ag.
Tub. 1982. vol. 57. no. 42. p. 116121.

January—March 1996

6.

Editorial—Ind. J. Tub.. 1982. vol. 29.
No. 2.

7.

Sakula. A—Robert Koch, centenary of
the discovery of the tubercle bacillus.
1882. Bull, of Int. Un. Ag. Tub.. 1982.
Vol. 57, No. 42.

8.

Koch Robert—The Aetiology of Tuber­
culosis: The paper read before the
physiological society in Berlin March

24. 1882 and from the Berliner
Klinische Wochcnschrift. 1982. 19.
221.
9.

Stcinbnick. P—Robert Koch. World
Health. Jan. 1982. p. 4—7.

10.

Allen. B. W. and Hinkes. W. F.—
Koch's stain for tubercle bacilli. Bull, of
Int. Un. Ag. Tub.. 1982. vol. 57 No. 3—
4. p. 190—192.

35

National Pulse Polio Immunization (PPI) Programme 1995-96

Better Coordination Leads to
Excellent Results—An Agra Experience
DEOKI NANDAN

G. K. Gupta
Manish Subharwal
and
NEETA Goel
OLIO is one of the most dreaded
diseases of infancy and early
childhood. Once attacked, its
impact is suffered life-long. The
only positive aspect of this disease
is that it is vaccine preven­
table. Based on the efforts of
international community, we arc
now foreseeing the day when there
will be no polio in this world.

P

The year 1995 will be written in
golden words in the history of man­
kind and medicine. This year has
given a major boost to the efforts
which will certainly lead to polio
eradication, one day. It was star­
ted by the WHO on the World
Health Day on 7th April 1995. by
giving a slogan ‘A World Without
Polio-Target 2000'.
An important strategy in eradi­
cating a vaccine preventable dis­
ease is ‘Mop Up Round’. Under
this strategy, the vaccine is ad­
ministered to the mass population.
on one single day. Such Mop Up
Round was planned for Oral Polio
Vaccine in India and it was decided
to administer the vaccine to all little
Indian citizens on December 9.
1995 and January 20. 1996. The
Government decided to observe
National Holiday on these dates.
It was the responsibility of the Dis­

34

trict Administration and the Dis­
trict Health Administration of all
the districts of India to ensure that
each child below the age of 3 years
was given oral polio vaccine on
these dates. They were free to
adopt their own strategies for this
task (but adhering to the general
guidelines issued by the Minis­
try)- Agra district adopted a uni?
que strategy and made this festival
a grand success in the district

Once the centre of activities was
shifted to the department of SPM.
SN Medical College, Agra, a con­
trol room was established in the
department and a co-ordination
committee at the level of college
was formulated under the chairper­
sonship of the Principal and
various faculty members of the
institution as members. Medical
students, residents, research staff
and other staff who volunteered
were assigned the responsibility of
administering the vaccine.

Methodology

The District Magistrate. Agra
formulated a District Coordination
Committee which included Offi­
cers of district administration.
district health administration.
Principal and Heads of the Depart­
ment of SPM and Paediatrics. SN
Medical College. NGOs active in
the city, renowned private prac­
titioners and media personnel. It
was then decided to divide the dis­
trict into two divisions viz. Rural
and Urban. The rural division
was coordinated by Dy. CMO
(MCII) and the activities in the
urban area were coordinated by
Head. Dcptt. of SPM. SN Medical
College. Agra, under the leadership
of Principal SN Medical College.
Agra.

A total of 397 booths were iden­
tified by the district health ad­
ministration and it was decided to
transport vaccine to these booths
by the district health adminis­
tration. In all 417 volunteers were
registered which included students,
interns, residents, research staff
and other office staff. A series of
orientation, motivation and train­
ing sessions were organised for
these registered volunteers.

A team consisting of residents,
interns and other staff was for­
mulated and this team visited
various schools and colleges of
Agra giving the message of PPI
to children.

Swasth Hind

The total urban area of the dis­
trict was divided into 20 sectors,
majority of which were the D-type
health centres of Agra. Among
other sectors were the Depth of
Obst. and Gynac. and Depth of
SPM. SN Medical College. Agra.
Lady Loyal Hospital and a sector
comprising of miscellaneous posts
at hospitals of armed forces.
railway and bus stations etc. The
Medical Officers were the sector incharges and were to coordinate
activities in their respective sectors
and other health staff posted in
these sectors were instructed to
assist in all possible aspects. The
posting of Medical College volun­
teers was then accomplished. The
simple strategy was two under­
graduate students or one resident/
intem/staff at one post. In
addition volunteers from other
degree colleges and local NGO
were also requested to participate.
Though the vaccine was avail­
able at the booths, three bulk
depots were established, viz., one
each at Deptt. of SPM, SN Medical
College and CMO Office and one
mobile unit.
Monitoring and Evaluation

A mobile monitoring team was
formulated comprising of various
faculty members of Medical

College with the coordination of
the Department of SPM, SN Medi­
cal College, Agra. The team was
readily available to visit various
posts during the immunization ses­
sion to observe the performance,
rectify any problems/confusions at
the spot and fill an assessment pro­
forma for process evaluation.

Inferences

It was the result of the combined
effort at various levels which
generated a lot of enthusiasm and
awareness among the general com­
munity. Following
were
the
coverage during the two phases :
Age

An evaluation team comprising
of statisticians, research staff and
residents of Deptt. of SPM, SN
Medical College, Agra was for­
mulated. At the end of the
immunization session, each sector
in-charge was to bring the report to
the Control Room, where it was
immediately screened and com­
piled to give the final results in the
form of children immunized and
vaccine consumed.

After the first phase of PPI on
December'9, 1995 a series of
meetings of various committees
were organised by the Deptt. of
SPM, SN Medical College, Agra in
order to make the second phase
even more effective and minimize
the problems faced during the first
phase. The
recommendations
made by these committees were
duly incorporated. One of the
major recommendations was to
increase the number of booths and
make sub-depots of vaccine at the
sector level.

December
9, 1995

January
20. 1996

0—3 year
children

1.15,498

1.56,283

3—5 year
children

21.124

25,897

Total

136.622

1.82.180

Recommendation

It was a general impression that
this herculean task would not have
been possible without the coopera­
tion of each and every individual
who participated in its own capa­
city in this programme. It can.
therefore, be concluded that dedi­
cated efforts of the community can
make any national programme a
grand success. In future, to make
other national programmes, a suc­
cess, community participation
should be viewed as a key compo­
nent. and it is quite possible, which
is evident by
our
AGRA
EXPERIENCE.

(Contd. from Page No. 33)
4.

5.

Sakula, A—Robert Koch (1843-1910).
founder of the science of bacteriology
and discoverer of the tubercle bacillus.
British J of Dis. of the chest. 1979.
73, 389.
Grange. J. M. and Bishop. P. J. —
‘UBER TUBERCULOSES A tribute to
Robert Koch’s discovery of tubercle
bacillus. 1882. Bull, of I nt. Union AgTub. 1982, vol. 57. no. 42. p. 116121.

January—March 1996

6.

Editorial—Ind. J. Tub.. 1982. vol. 29,
No. 2.

7.

Sakula. A—Robert Koch, centenary of
the discovery of the tubercle bacillus.
1882. Bull, of Int. Un. Ag. Tub.. 1982.
Vol. 57, No. 42.

8.

Koch Robert—The Aetiology of Tuber­
culosis: The paper read before the
physiological society in Berlin March

24. 1882 and from the Berliner
Klinische Wochcnschrift. 1982. 19.
221.

9.

Steinbruck- P—Robert Koch. World
Health. Jan. 1982. p. 4—7.

10-

.Allen. B. W. and Htnkes. W. F —
Koch’s stain for tubercle bacilli. Bull, of
Int. Un. Ag. Tub.. 1982, vol. 57 No. 3—
4. p. 190—10

35

CARE OF THE EAR
Dr Vijay Choradia
ar is a delicate and com­
plicated structure, a special
sense organ for hearing and
balance. Let us care for the ear.

E

1. Guardians, Teachers and
Policemen etc. be watchful. Don’t
slap ears—Drum might perforate
and there could be deafness.
2. Don’t scratch ears with
match-sticks or Pen or Hair pins
etc. Repeated or frequent scratch­
ing might lead to fungal or bac­
terial infection. Of course, clean
discharging ear with clean “Bud”
(sterile cotton over a stick) but do
not let it go too much inside.

3. Never allow anyone to put
Hydrogen paroxidc into your
cars.

4. In children many times.
stone, seed, pearl etc. may get
lodged into the ears which might
damage ear drum. Be careful
about it.
5. Protect ears of children frpm
cold breeze. Do not neglect cough
and cold. Severe- upper respira­
tory infections might go to middle
car and neglected nose, sinus and
throat problems could affect car.
If children pull their ear or
excessively cry or complain of
scratching or car ache, consult your
ENT surgeon.

6. Mothers—let’s do a proper
breast feeding (head up while feed­
ing and regular burping). Do not
feed children in lying down posi­
tion. Feeds might enter the ears
via eustachian tube (as they arc
straight and weak).

36

7. Treat under or malnutrition
(risk of frequent URI) and en­
courage breast feeding.
8. Do not blow your nose dur­
ing cold and avoid flying during
cold. If essential to fly—take
decongestant tablets and nasal
drops before hand. Always chew
decongestant tablets or chocolate,
both during take off and landing.
9. Acute infections of ear or
fluid in car should be treated at the
earliest possible and effectively
(which might include minor sur­
gery like incision of drum and/or
grommet). Conductive ear deaf­
ness due to chronic ear discharge.
etc., could be prevented.

10. Do not put dirty oil or
liquid. Do not get your ear
cleaned by road-side quacks.
Normally wax comes of its own and
require only minimal cleaning by
towel or buds. But if there is
wax—only pure oils like olive or
ground-nut, first made hot and
then cooled, can be put: but the best
thing is that consult your ENT
specialist. Ear ache could be due
to nose, throat or teeth problem
and there is no need of putting oils
for such problems.

11. Do not swim in dirty rivers
or pools of water. Person with
drum hole or ear discharge should
not swim. Also don't swim during
a cold attack.
12. Those patients with car dis­
charge should put vaseline or ncosporin smeared cotton plug while
taking a bath or shower and should
remove them after drying hair.

After this clean ears with clean
towel.
13. Towels and pillows of per­
son with ear discharge should not
be used by others.
14. Do not use ear drops for
long. Also, as far as possible.
avoid use of ototoxic drugs like
Streptomycin. Quinine etc. Use
them with great caution in child­
ren. pregnant women or aged peo­
ple and those with renal or liver
problem. Be watchful during their
use.

15. Avoid regular exposure to
loud music or high frequency musi­
cal instruments, cracker blasts and
keep yourself away from such
sites.
16. Those working in factories
with noise producing machines
should be taken care of. Periodic
check-up, use of ear muffs or plugs
and acoustic treatment be provided
at working place. Change the
excess noise producing or spoilt
machine. Take all measures of car
protection (to noise pollution).
17. Understand the reasons for
inner ear deafness and try to pre­
vent them.

(i)

Chromosomal or heredi­
tary sensory-neural loss
needs genetic counselling.

(ii) Proper care of pregnant
women
and
delivery
should be conducted pro­
perly and timely. If there
is some viral infections
known to damage ear and

Swasth Hind

there is no vaccine avail­
able against such infec­
tions pregnancy might
have to be terminated.
(iii) Vaccination
measles.

against

(iv) Effective
treatment of
meningitis and other pro­
blems known to cause
deafness in children.

(v)

STATEMENT ABOUT OWNERSHIP AND PARTICULARS ABOUT
NEWSPAPER SWASTII HIND TO BE PUBLISHED IN THE FIRST ISSUE
EVERY YEAR AFTER LAST DAY OF FEBRUARY

Early diagnosis and treat­
ment of diabetes, high
blood pressure, blood dis­
orders like anaemia, etc.,
and heart problems.

(vi) Avoid ototoxic drugs or use
them with great caution
when they are essentially
required (examples of
these drugs—Streptomy­
cin,
Quinine,
Aspirin
etc.).
18. Take the proper care of deaf
children. They need special affec­
tion by some one and proper train­
ing (like lip reading, sign language,
propcruse and care of hearing aids,
etc.).
19. Excessive smoking and al­
cohol are harmful to ears also.
Say ‘No’ to both.

FORM IV
(See Rule 8)

1.
2.
3.

Place of publication
Periodicity of its publication
Printer’s Name
Nationality
Address

4.

Publisher’s Name
Nationality
Address

5.

Editor’s Name
Nationality
Address

6.

Name and address of Individuals
who own the newspaper and
partners or shareholders holding
more than one per cent of the
total capital

New Delhi
Monthly
Manager
Indian
Government of India Press
Coimbatore (T. N.)
Dr (Mrs) K Kehar
Indian
Director,
Central Health Education Bureau.
Directorate General of Health Services.
Kolla Road. New Delhi-110002.
M. L. Mehta. Sr. Sub-Editor
Indian
Central Health Education Bureau.
Directorate General of Health Services.
Kotla Road. New Delhi-110002.
Nil

I. Dr (Mrs) K. Kehar. declare that the particulars given above are true to the best
of my knowledge and belief.

NEW DELHI,
20 June, 1996.

Sd/(DR (MRS) K. KEHAR)
DIRECTOR

Authors of the month
Mr T. Ethiraj
Mr P. Antony
Dr P. Krishnamurthy
Dr N. B. B. Reddy
Damien Foundation India Trust
27 Vcnugopal Avenue
Spurtank Road
Madras-600 031

Deptt. of Community Medicine
Pramukhswami Medical College
KARAMSAD, KHEDA-388 325 (Gujarat)

Dr Jugal Kishorc and
Dr Vinay Kapoor
Centre for Community Medicine
All India Instt. of Medical Sciences
Ansari Nagar
New Delhi-110029

Dr Y. A. Kctkar
Prof. & Head and
Dr A. C. Urmil
Deptt. of Preventive & Social Medicine
Krishna Institute of Medical Sciences
KARAD-415 110 (Maharashtra)

Sliri Paras Nath Garg
Lecturer in Health Education
Deptt. of Community Medicine
S. S. Medical College
REWA-486 001 (M. P.)
Dr Rajkumar Bansal and
Dr Ratan K. Srivastava

Dr (Mrs) P. V. Sharada
H. No. 6-1-149/1
Padmarao Nagar
SECUNDERABAD-500 025 (A P.)

Dr Prakashi Rajaram
Deptt. of Psychiatric Social Work
National Institute of Mental Health &
Neuro Science
Post Bag No. 2900
BANGALORE-560 029

Colonel Jasdecp Singh
Commanding Officer &
Senior Medical Officer
323 Fd Arab
c/o 99 AP.O.

Dr V. K. Tiwari
c/o Shri R. C. Sharma
7 Brij Lok Colony
Pilibhit Road
BAREILLY (U. P.)
Dcoki Nandan
G. K. Gupta
Manish Subharwal
■ a
Necla Gocl
* IS*
Deptt. of S.P AL
S. N. Medical College
AGRA-282 002 (U. P.)

KHO

v

Dr Vyay Choradia
11 Anoop Nagar
INDORE-452 008

ISSUED BY THE CENTRAL HEALTH EDUCATION BUREAU (DIRECTORATE GENERAL OF HEALTH SERVICES). KOTLAMARG
NEW DELHI-110 002 AND PRINTED BY THE MANAGER. GOVERNMENT OF INDIA PRESS. COIMBATORr^j Q ’

W

A. <f

WASTH HIND

■B

r \?

7
PHILATELIC BUREAU
KARACHI

5. Pakistan; [977—^World Rheumatism Year.
6. Iran, 1 960i World Health Day— "Malaria
eradication *—a world challenge’’.
7. Switzerland, 1978 — WHO's 30th anniversary.

26

8.
9.
10.
11.

Switzerland. 1948 — First stamp used by WHO.
Switzerland. 1962 — Malaria.
Czechoslovakia. 1981—Smoking.
United Kingdom. 1981 — International Y®ar ol the
Disabled.

Wo<’d Hje.Mth Fo/ufrn

Vo1- 9

1988

POSTAGE STAMPS AS HEALTH MESSENGE
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