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RF_DIS_15_SUDHA
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Public, Awareness .Campaign on the Cataract Catastrophe in India
Thought for the day
Without getting annoyed or assume an obdurate attitude, people in power, be it in the
Centrnl Government or of State Health departments, have to consider the suffering of die
poor rural people, who are not educated and have no way of even lodging a complaint for
the suffering they have to put up with in life from the damage inflicted on them from
present cataract operations In rural camps.
If these people in power can recognise and provide the right relief, surely God will bless
them and rural people will enjoy their life.
It is a well publicised fact that United Nations, their several agencies such as UNICEF,
whoWorld Bank, several charities involved in Health and Welfare loudly
pronounce and publicise the ‘Human Rights’ and their service to tins end.
Sizc-oUlicTxolilcm
In 1986 Dabu Rajendra Prasad Institute In New Delhi mentioned that cataract patients
waiting for relief were around 3,000,000. As the population-incuses by geometric,
proportions the figure would not be less than the above mentioned figure in 1995.
DesIdes, the older generation getting cataract due to age, the children without Pr0PeJ
nutrition and vitamin ‘A* concentrate develop Night Blindness, which ultimately result m
total blindness This figure Is not estimated. In Rajasthan desert and elsewhere, where the
XX i"at exceeds 4t) to 50 degree, centigrade and storms add to the problem. The
number of people suffering from the eye problems is indeed much more. Add to this>lack
of water to either drink or wash their face and eyes.
If UNICFF Save the Child, Sight Savers, KIDS International and many more which appeal
and collect funds, can give some attention to this simple1 problem andgovernments co
operate, sights of thousands of children can be saved. Will they do it ?
Coming to the cataract problem, civilised methotj, using modem techniques of
IMPLANTING INTRA OCULAR LENS at the time of cataract opera ions, which is
mandatory in USA, UK and other civilised countries, is not available in the oldest
civilisation - namely India.
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•it is available to the rich who can pa/at least Rs. 10.000 each. The present widely practised
method of NBTRA-DAAN or gift of eyesight by voluntary bodies and charities attrac
village victims.
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Most if not all, these operations are done without prc-inspection and total absence of postoperational care and minimum rest needed for healing. Village primary schools or such
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places, In summer vacations,.selected do not ci\joy hygienic conditions. Dust and dirt add
to the problem.
Qualifications of Ophthalmic surgeons is not prescribed
statutory. Anybody can
volunteer to operate. Government hospitals are not properly equipped and in any case can
not take on such a big job to handle 3,000.000 cases.
The recent World Bank loan o/jl 17.8 million and stipulation of number of beds, hospitals,
refraction equipment etc. besides providing team approach, with a qualified surgeon,
nursing staff etc. has not been appreciated and in any case not implemented by many states
to provide relief.
Even assuming tliat this Is done, the damage cannot be minimised. It is a medically
recognised fact that thick glasses, when and where prescribed will not necessarily give the
total relief, as measuring steps to descend or cross the road still pose the difficulty to the
patients.
Second measure which is somewhat popular in the west, namely LASER surgery anA
prescribing contact lenses, has its own problems. The removal of contact lenses, keeping it
in a safe place, clean it and reset it to the eyes pos«4 difficulties. Many infection cases are
reported.
If this Is the case in Western countries, where clean water and some cleaning materials are
available, It is Impossible to adopt it in Indian villages which defriot have posable water
and the patients cannot have a clean bed to sleep on and nowhere to keep the lenses clean.
Though it may sound expensive the cheapest and best remedy is in adopting the Intra
ocular lens implant. Once done, it helps in safe walking, ability to see properly and
prevents the need to keep it away etc.
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Governments should recognise tliat once people get back their sight, the economy of the
country will also improve and it eliminates the expenses on the care of eye problems. Is it
not worth an Investment ?
AWARENESS campaign to educate people and draw the International agencies which
proclaim HUMAN RIGHTS, to treat the village poor also as ‘Human Beings’, entitled to
tlie same equal rights ns the Western industrialised countries, is the need of the hour.
We hope politicians and people In power recognise the suffering of the people going blind
and lead a miserable life till death relieves them and use their good offices to ensure
happiness. Will they open their eyes ?
The awareness campaign should be supported by every honest person, everywhere in the
world.
f
V Lnkshmlpatliy - Programme Assessment and Development Services
4 EltIsley Avenue
Newnhiun
Cambridge CB3 WG
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flnnex. ’07"
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REVISED GUIDELINES FOR PARTICIPATION OF VOLUNTARY ORGANISATIONS
IN CONTROL OF CATARACT BLINDNESS AT DISTRICT LEVEL
1.
Preamble
Perfonnance of cataract surgery' is the dominant cause of blindness as it
addresses 80% of blind population. The purpose of cataract surgery is to restore
vision of the affected person through provision of package of services that can enable
the person to not only gam sight but also return to his normal working before this
visual disability. The recent review of the programme has however revealed dial the
emphasis by voluntary organisations has been on the surgical services alone thereby
giving focus on quantitative achievements in terms of number of surgeries performed
which though important, does not necessarily mean restoration of quality vision. The
final product of the package of the services is restoration of quality vision and
therefore there is need for a shift from quantitative to qualitative approach.
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In our attempt to achieve targets and increase the quantitative output the VOs
preferred to organise surgical eye camps which are quite attractive to people but do
not provide good operative and post-operative care. The follow-up was found to be
extremely inadequate in camp surgery leading to high failure rate in many instances.
There were some mishaps due to poor sterile condition leading to episodes of mass
blindness following a surgical camp.
It has also been found that involvement of VOs has been restricted to sites
where they are familiar with and have been traditionally working in As a result the
coverage of eye care services has become restricted to urban and peri urban areas and
some pockets of rural areas but the underserved population groups particularly tribal
and geographically inaccessible areas remain without sendees.
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As a result of all the above, prevalence of blindness has remained the same
inspite of quantitative increase in the number of surgeries performed in the last five
years. Therefore, the Govt, of India has modified die schemes for voluntary
goXs11153^0115 t0 impreSS UpOn theireffective involvement in achieving the programme
It was also found that there was an overlap and competetion between various
facilities leading to suboptimal utilisation of resources and disparity widiin and
between districts. As a result the follow-up services were inadequate Therefore in
ofNGOs116 ab°Ve thrCe Chan8eS
be‘n8 SUggeS,ed for slrcamlining the involvement
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(i)
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Type of approaches :
(a)
Reach-in approach by NGOs having eye care facilities or for
recruitment of cases.
(b)
Reach-in approach through camps
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(ii)
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Area of operation :
Restriction of NGOs to serve specific areas of operation in agreement with the
NGOs so as to avoid overlap of jurisdiction between NGOs for every activity.
(iii)
Package of services :
Grant-in-aid would be release to NGOs after the package of service leading
to sight restoration has been provided.
2.
3.
Title of the Scheme:
(I)
Grant-in-aid to NGOs for performance of free cataract operations on
blind persons in NGO base hospitals from assigned geographical area
through reach-in-approach;
(ID
Grant-in-aid to NGOs for assistance in clearing backlog of cataract
blind persons through screening of at risk population, preparation of
blind registers, motivation, transportation, free cataract surgery in
assigned base hospitals (Govt./NGO) and follow up services;
(HI)
Grant-in-aid to NGOs for organising eye camps including free cataract
surgery in identified underserved areas.
Purpose of the Scheme:
The purpose of the Scheme is to reduce the prevalence of blindness,
particularly cataract blindness through involvement of voluntary organisations by
providing package of services including screening of at-risk population preparing
blind registers, motivation, escorts services, cataract surgery, post-operative care and
follow-up services including provision of corrective glasses. This is intended to
restore vision of cataract blind persons with the ultimate objective of clearing the
backlog of cataract blindness in the assigned area.
4.
Eligibility Conditions:
For the purpose of the schemes, a voluntary organisation will mean:
(a)
A society registered under the Indian Societies Registration Act, 1860
(Act XXI of 1860 or any such act resolved by the State) or
(b)
A charitable public trust registered under any law for the time being
in force
(c)
Track record of having experience in providing health services
preferably eye care services over a minimum period of 3 years
(d)
Having available well-trained staff, infrastructure and the required
managerial expertise to organise and carry out various activities under
the scheme
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(e)
Agreeing to abide by die guidelines and the norms of the programme.
5.
Details of the Schemes:
(I)
Grant-in-aid to NGOs for performance offree cataract operations on blind
persons in NGO base hospitals from assigned geographical area through
Reach-in-Approach;
The DECS will need to enter into an agreement with NGOs having facilities
for cataract surgery in their base hospitals as per following details : z
(a)
Identification of base hospitals : The District Blindness Control
Society will identify such base hospitals located in the district which
have infrastructure, requisite equipments and trained manpower to
undertake cataract surgery. This would include identification of
hospitals for IOL surgery on the basis of availability of operating
microscope and other equipments required and trained eye surgeon.
(b)
Allotment of designated area for the scheme : The DECS and the
NGO would then enter into an agreement to perform various activities
in the designated area (or target area) of the district as indicated
below:
(c)
Activities to be performed : The NGO would undertake following
activities in the assigned area of the district:
1
(i)
Screening of population (50+ years) in all the villages/
townships in the assigned area and preparation of village wise
blind registers as per standard format (Annexure - I).
(ii)
Identification of cases fit for cataract surgery, motivation
thereof and transportation (including one attendant if require to
and fro) to the base hospital.
(iii)
Pre-operative examination and investigation as required.
(iv)
Performance of cataract surgery by 1CCE or ECCE/IOL as per
target indicated.
(v)
Post-operative care including management of complications if
any and post-operative education and counselling regarding do’s
and dont’s, importance for using glasses etc.
(vi)
Follow-up sendees including refraction and provision of
aphakic glasses providing best possible correction (not standard
+ 10 D glasses).
(vii)
Submission of village-wise monthly reports.
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(viii)
Maintenance of individual surgical cards as per prescribed
format (Annexure - II).
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Grant-in-aid :
(d)
X
The Grant-in-aid would be provided to the NGO for all free cataract
surgeries performed on patients from the assigned area on the basis of table
given below. If any of these activities are not perfonned by the NGO e.g.
provision of spectacles in IOL surgery, the corresponding amounts would not
be reimbursed. The DBCS is expected to provide sutures and Intra Ocular
Lenses supplied by Govt, of India. If due to any reasons, such items are not
provided in kind, the NGO would be reimbursed tlie cost of sutures and IOLs
at Rs.50 and Rs.200 respectively.
Items
Drugs & consumables
Cash (Rupees)
Kind
150
Provided by DBCS
Sutures
Spectacles
75
Organisational overheads
50
Transport/POL *
75
Provided by DBCS
Intra Ocular Lens for IOL
surgery only
*
This includes providing transport facility to the patient and one attendant to
and fro for pre-operative examination, surgery, discharge after post-operative care
and follow-up service. Thus minimum of 4 trips will be required.
(e)
Terms of Payment :
Reimbursement will be subject to following conditions :
(ID
(a)
Only persons from the target area operated by tlie designated Base
Hospital will be eligible for payment
(b)
Reimbursement of Rs.350 to Rs.600 as the case may be only on
submission of the individual surgical records.
Grant-in-aid to NGOs for assistance in clearing backlog of cataract blind
persons through screening of at risk population, preparation of blind
registers, motivation, transportation, free cataract surgery in assigned base
hospitals (Govt. /NGO) and follow up senices;
The DBCS is permitted to involve NGOs having experience in implementing
in poverty alleviation and welfare programmes for the poor, women etc. for helping
to clear backlog of cataract blind.
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(a)
Identification of NGOs : The District Blindness Control Society
would identify NGOS located in the district having a good track record
of participation in health care services and credibility in the community
to be served.
(b)
Allotment of geographical jurisdiction/ area and base hospital: The
DECS and the NGO enter into an undertaking to perform various
activities as per para (c) below in the designated area of the district.
The DECS and the NGO (or private hospital if willing to colloborate
with govt.) would also mutually agree for the base hospital (Govt, or
non-Govt.) which would provide surgical services to the identified
patients.
(c)
Activities to be performed : The NGO would undertake following
activities in the assigned area of the district:
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(i)
Screening of population (50+ years) in all the villages/
tow’nships in the assigned area and preparation of village wise
blind registers as per standard format.
(ii)
Motivation and transportation of patients (including one
attendant if required) to the base hospital.
(iii)
Provide escort services and counselling during pre and post
operative period regarding do’s and dont’s, importance for
using glasses etc.
(iv)
Organise follow-up services including refraction and provision
of aphakic glasses providing best possible correction (not
standard +10 D glasses).
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Grant-in-aid : Grant-in-aid would be provided to the NGO for all free
cataract surgeries performed on patients from the assigned area on the
basis of the table given below. If any of these activities are not
performed by the NGO, the corresponding amounts would not be
reimbursed.
(d)
Items
Cash (Rupees)
Organisation and counselling
50
Transport/POL
75
It is expected that base hospital in the above scheme would be in most
instances a Govt, hospital such as Medical College Hospital/ District Hospital.
Therefore the NGO would not need to arrange for any drugs and consumables as
these would be arranged by the DECS either by procurement or by receiving
commodity assistance by govt, of India (sutures and lOLs). Likewise, the DECS wil
provide for the spectacles and supply the surgical records to the NGOs :
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(e)
Terms of Payment :
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Reimbursement will be subject to following conditions :
(HI)
(a)
Only persons from the target area operated by the designated Base
Hospital will be eligible for payment
(b)
Reimbursement of Rs.50 to Rs. 125 as the case may be only on
submission of the individual surgical records.
Organising eye camps including free cataract surgery in identified
underserved areas.
The DECS may involve NGOs having experience for organising eye camps
including organising cataract surgery in camp situations as per guidelines given
below:
(a)
Identification of NGOs : The District Blindness Control Society
would identify such NGOs located in the district which have
experience and good track record in organising eye camps including
cataract surgery.
(b)
Allotment of underserved area : The DECS and the NGO would
agree to organise eye camps in identified underserved areas as per
following criteria :
(C)
a
There is no Govt, or non Govt, or private facility for free
cataract surgery’ within a distance of 40 k.m. by motorable road
or
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There is no Govt, or non Govt, facility for free cataract
surgery within a distance of 10 k.m. having no road and
motorable transport.
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The area is predominantly tribal or is geographically difficult
terrain (e.g. hilly area, desen. forest and frequently flooded
area) and therefore inaccessible for most part of the year.
Activities to be performe-d : The NGO would undertake following
activities in the assigned area of the district:
(i)
Screening of population (504- years) in all the villages/
townships in the assigned area and preparation of village wise
blind registers as per standard formal.
(ii)
Identification of cases fit for cataract surgery, -motivation
thereof and transportation (including one attendant if require)
to the camp site.
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(iii)
Pre-operative examination and investigation as required.
(iv)
Performance of cataract surgery by ICCE. All technical
guidelines issued by Govt, of India with regard to surgery in
camps should be strictly adhered to. The sutures provided as
commodity assistance should be used as per guidelines i.e. one
suture per surgery.
(v)
Post-operative care including management of complications if
any and post-operative education and counselling regarding do’s
and dont’s, importance for using glasses etc.
(vi)
Follow-up services including refraction and provision of
aphakic glasses providing best possible correction (not standard
+ 10 D glasses).
(vii)
The camps should be organised on a fixed day approach (e.g.
first Monday of every month) so as to encourage follow-up
services and provision of glasses. A camp cycle and protocol
norms for necessary visits are at Annexure - III.
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(d)
Grant-in-aid :
The Grant-in-aid would be provided to the NGO for all free cataract surgeries
performed on patients from the assigned area on the basis of table given
below. If any of these activities are not performed by the NGO e.g. provision
of spects, the corresponding amounts would not be reimbursed. The DECS
is expected to provide sutures supplied by Govt, of India. If due to any
reasons, such items are not provided in kind, the NGO would be reimburse
the cost of sutures at Rs.50 per surgery respectively.
Cash
(Rupees)
Items
150
Drugs & consumables
Provided by DECS
Sutures
*
Kind
Spectacles
75
Organisation and counselling
50
Transport/POL *
75
This includes providing transport facility to the patient and one
attendant to and fro for pre-operative examination, surgery, discharge
after post-operative care and follow-up sendee. Thus minimum of 4
trips will be required.
In case of sheduled tribal areas as certified by the DECS, Rs.50 per
case additional amount will be provided.
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(e)
Terms of Payment:
c
Reimbursement will be subject to following conditions :
(a)
Only persons from the target area operated in the eye camp
will be eligible for payment
(b)
Reimbursement upto Rs.400 as the case may be, only on
submission of the individual surgical records.
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MATERNAL AND CHILD HEALTH
SCHEME FOR PROPHYLAXIS AGAINST BLINDNESS
IN CHILDREN CAUSED BY VITAMIN ‘A’
DEFICIENCY
FAMILY PLANNING PROGRAMME
FOURTH FIVE YEAR PLAN
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Technical Information : MCH No. 2
1.
MATERNAL AND CHILD HEALTH—
THE CONCERN OF FAMILY’PLANNING PROGRAMME
The family planning programme is vitally concerned with promoting the health of
mothers and children. While it advises the couples to limit the size of their family to 2 or 3
children it also takes measures to promote the health of those few children. With this end in
view, family planning programme has provided funds for schemes for prevention of diseases
and promotion of health among mothers and children. One of them is the scheme for
controlling blindness among children caused by vitamin ’A’ deficiency.
2. VITAMIN ‘A’ DEFICIENCY AMONG CHILDREN—A PROBLEM
Vitamin A’ deficiency is widely prevalent in the country, specially amongst the pre
school-age children. Surveys carried in the southern and eastern parts of the country have
revealed that at least 30 to 50 per cent of all childrenin the pre-school age-group have eye
manifestation as a result of vitamin ’A’ deficiency. The most severe form of vitamin ’A’ defici
ency - keratomalacia - causes softening and necrosis of the cornea of the eye leading to comp
lete blindness. It has been estimated that not less than 12,000 to 14,000 children go blind in
the country every year as a result of keratomalacia. The economics of such malnutrition is
of great significance in view of the large amount of money which has to be invested in the
rehabilitation of these handicapped children in later life.
3. TRADITIONAL MEASURES FOR CONTROL OF VITAMIN ‘A’ DEFICIENCY
In the past, the control of vitamin ‘A’ deficiency has been linked with the general
improvement of the nutritional status of the population. Nutrition education of mothers
to persuade them to include foods rich in vitamin ‘A’ like green leafy vegetables in the diet of
young children has been of some benefit. However, the recent findings that protein malnutri
tion accentuates vitamin‘A’deficiency and that these two deficiencies exist handin hand is
another complicated problem. Both protein-caloric malnutrition and keratomalacia are found
to be common in the southern and eastern parts of India.
Another measure implemented through the health agencies is the distribution of
vitamin ‘A’ and ‘D‘ capsules and codliver oil through the Child Welfare Clinics of medical and
health institutions. For such supplementation to show results the child should be given at least
one capsule of vitamin ‘A' and kD: twice a week. Our past experience has shown that it is
difficult in the rural areas to ensure that the mothers administer these capsules regularly to
their children to prevent the development of deficiency of the vitamin. As a result of these
lacunae, no significant impact has been produced on the incidence of keratomalacia in the
co untry.
4. A NEW APPROACH
Recent studies have shown that oral administration of a large dose of 2 lakh I. U. of
vitamin ‘A- in oil every six months can protect children from developing keratomalacia. The
studies have shown that vitamin ‘A' given by mouth is readily absorbed and stored in the liver
from where it is gradually released for utilisation in the tissues. Unlike many of the vitamins,
vitamin *A‘ is not excreted in the urine and this is an advantage. No toxic manifestations
have been observed in connection with the use of vitamin ‘A’ in the dosage mentioned above.
In the shape of implementation this measure can be equated with prophylactic inoculations.
5. PLAN Ob OPERATION
Rupees forty lakhs have been provided for the scheme in the Fourth Five Year Plan
budget in the Central sector. Supplies of vitamin ‘A’ are procured by the Department of
Family Planning and distributed to the State Health Departments, the cost of the drug being
adjusted as a grant. The State Family Planning Officers who are responsible for the adminis
tration of the programme have to place indents on the Government Medical Stores Depot,
Bombay, for obtaining their supplies. The Medical Stores Depot would send the supplies to
the District Officers concerned.
6. SI LECTION Ob AREAS
The Slate Nutrition Officers would select the areas of maximum prevalence of
keratomalacia based on the nutritional status surveys conducted by them. Tn view of the
limited financial resources the programme for the present would be confined to such areas
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identified for this purpose. As far as possible all the childrenin the age group 1-3 years
should be covered during the first year of the programme. These children should get the
benefit of the programme till they reach five years of age.
7.
AGENCY FOR ADMINISTRATION
The existing maternal and child health and family planning organisations would be
responsible for administration of the programme. In the urban areas the programme should
be administered through the child welfare clinic of the urban family planning centres, general
hospitals, maternity homes, etc. It has to be ensured that there should be no risk of
repeated administration of the drug. Therefore, in such institutions the vitamin ‘A’
should be administered only through the child health clinic and not through the general
out-door department of the institutions.
In the rural areas the programme would be implemented through the primary health
centres and its sub-centres under the supervision of the medical officer. The auxiliary-nurscmidwife and the family planning health assistant working in the primary health centre would
have the immediate responsibility for administering the drug to the children. The drug has
to be put into the mouths of the children by the workers themselves.
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As coverage of the entire agc-group and avoidance of repeated administration of the
drug are of great importance, it is desirable to fix a specified period for administering the
programme. For example, the primary health centre/ urban MCH centre may decide to
cover all the eligible children during the month of September 1970 and complete the adminis
tration of the drug during the period of one month; the administration of the next dose to
these children as well as new children to be included, would then have to be done in the
month of March 1971 only. Adoption of such a strategy would go towards effective
implementation of the programme and lessen the load on the ANM/FP health assistant who
are multipurpose workers with various other responsibilities. The children could be collected
at the sub-centres or in other suitable places or contacted in the homes according to
convenience.
8.
DOSAGE AND MODE OF ADMINISTRATION
1 ml.
The vitamin ‘A’ preparation supplied has a strength of 1 lakh I.U, of vitamin ‘A’ per
The recommended dose is 2 lakhs I.U. of vitamin ‘A’ or 2 ml. of this preparation to
3
be given by mouth. The administration should be repeated every six months till the child
is five years of age.
Vitamin‘A’preparation has a relatively short-shelf life of about 15 months. Proper
precaution should be taken about the storage and use of the drug before the date of expiry
indicated on the lable.
9. HEALTH EDUCATIOiN
The community should be prepared both through individual and group approach on
the problem of vitamin ‘A’ deficiency and the advantages of the prophylactic programme
envisaged.
10.
EVALUATION
The base line survey at the commencement of the programme and repeated surveys
at periodical intervals would be necessary. A small representative sub-sample from each
State would have to be chosen for these surveys. The assistance of the National Institute
of Nutrition, Hyderabad, could be taken in conducting these surveys.
11.
RECORDS
Child health records as prescribed by the State Health Department should be main
tained in respect of the children covered under the programme and the dates of administra
tion of vitamin ‘A’ noted thereon. In addition, a register showing the particulars of the
children covered and the receipt and issue of vitamin ‘A’ supplied should be maintained in
the proforma at Appendix-I.
12.
REPORTS
Monthly reports on the number of children covered and the position regarding the
receipt and issue of the drugs should be furnished by the individual institutions to their
supervising authority. Consolidated monthly reports should be sent by the State Family
Planning Officers so as to reach the Department of Family Planning by the 15th of next
month in the proforma at Appendix-II.
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APPENDIX I
(A)
SI.
No.
(1)
REGISTER OF BENEFICIARIES UNDER THE VITAMIN ‘A’
DEFICIENCY PROPHYLAXIS PROGRAMME
Date of Child
Registra Card
No.
tion
(3)
(2)
Initials
Remarks of the
Worker
(8)
(6) 1|2 | 3 | 4 , 5 | 6 | 7 , 8 | 9 I 10
(9)
(7)
Name Address bo
(4)
(5)
Date of Administration
(B) STOCK REGISTER OF RECEIPTS AND ISSUES OF VITAMIN ‘A’ LIQUID
Date
Receipt
Issue
Balance
Remarks
Initials
(1)
(2)
(3)
(4)
(5)
(6)
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APPENDIX-II
PROPHYLAXIS AGAINST BLINDNESS IN CHILDREN CAUSED
BY VITAMIN A DEFICIENCY
Report for the month ending
197
for the State of
(A) STATEMENT OF BENEFICIARIES
.
Category
Age of children
(year)
No, covered
during the
mont h
Progressive
total for
the year
Remark s
1- 2
2- 3
3- 4
4- 5
1) Children given
1st dose
(Total 1-5 years)
2) Children given
2nd dose
1- 2
2- 3
3- 4
4- 5
(Total 1-5 years)
(B)
POSITION REGARDING THE RECEIPT AND ISSUE OF THE DRUG
Opening
balance on the
1st day of the
month in
millilitres
Receipt during
the month in
millilitres
Issued during
the month in
millilitres
On hand on the
last day of the
month in
millilitres
(1)
(2)
(3)
(4)
Remarks
(5)
Age break-up of children may be given.
1-5 years age group should be given,
If the break-up is not available then the total children in
Place.......... ............ Date
Signature,
Designation
m.H2E> l-S -'t S’-
DIET .AM? CHILD BLINDNESS
The number of children who become blind each year in
Asia as a result of malnutrition is now though to be 250,000.
This new estimate recently announced by the Helen Keller
International Organisation (HKI) is more than double previous
estimates for the world as a whole.
Nutritional blindness, or xerophthalmia-a progressive eye
disease brought on by lack of vitamin A-is the leading cause
of blindness in young children, striking from birth to 60 months
of age. A further 8-10 million Asia children are also thought
to become partially blind each year as a result of generally poor
nutrition.
According to Dr. Alfred Sommer, HKI project scientist,
the mortality rate among young xerophthalmia victims is as high
as 50 to 80 per cent.
The irony is that the symptoms of xerophthalmia are
easily reversed in the early stages of the disease and blindness
can be prevented by the simple means of giving high potency
vitamin A capsules every four to six months. In addition, some
of the deficiency symptoms, such as night blindness, extreme
sensitivity of eyes to light, and the wrinkling and drying of the
eye membranes can easily be taught to health auxiliaries. Because
of this, .HKI is optimistic that it programme in a number of
developing countries, funded in part by US AID, UNICEF and WHO,
can eradicate this disease by the year 2000.
In Haiti, where more than half the children are clinically
malnourished and 70 per cent of those in city slums consume less
than half the minimum daily Calories inecessary for healthy development, a publicity campaign promoting the programme has used a simple
slogan "Vitamin A for beautiful eyes", This is repeated on radio
broadcasts, in folk songs ard by clinic staff. A special effort
is made to give massive dose capsules of vitamin A
to the most
vulnerable group of ill and malnourished children,
through
hospital clinics, health and nutrition centres which
-i link nutrition
and child care to other matters such
as maternal health and family
planning.
Nutrition education also encourages diet rich in vitamin
A foods, such as mangoes and green leafy vegetables and extensive
training programmes have been run to make doctors and health
workers sensitive to the relationship between diet and the eye.
2
2
RECIPES FCF INFANTS AN? TODFLERS
The nutrition research workers have evolved recipes
suitable for feeding infants and toddlers in India with
articles of food in common use in households. These were
cooked and fed to children and found to be nutritious and
acceptable. Apart from the usual recipes in common use like
rice and chapaties a few others that can be used are given below:
RICE UPPUMA
Ingredients :
Rice Uppuma
Parboiled rice
Green gram dhal
Onion (big)
Drumstick leaves
Green chillies
Mustard
Groundnut oil
Salt
Water
25 g.
25 g.
25 g.
13 g.
10 g.
1 9i g.
16 g.
a pinch
2 (cups )
Method :
Rice and dhal are roasted and broken into granules.
Roasted §reen gramdhal is cooked with 3/4th cup of water and
mashed • The oil is heated and seasoned with mustard, chopped
onion and chillies. About 3/4th cup of water is added to the
seasoned ingredients. Salt is added and mixed. The roasted
rice granules are sprinked with water and continuously stirred.
It is cooked for 10 minutes.
RAGI AFAI-rSWEET
Ingredients
Ragi flour
Roaster Bengal gram
dhal flour
Jaggery
Coconut scrapings
Oil(groundnut)
Water (teaspoonfulls)
30 g.
12 g.
17 g.
5 g.
8 g.
3 g.
Method :
Jaggery is dissolved in water. Ragi flour and roasted
Bengal gramdhal flour are mixed together with the jaggery water.
Coconut scrapings are added and mixed. A thick dough is prepared,
and the adai is prepared on a greased iron pan (Tawa).
Source: SWASTH HIND - November 1979.
-J
ST JOHN'S MEDICAL COLLEGE BANGALORE 34
(Dept of Community Medicine)
C 0 N J U N. q T I V IT I S
Conjunctivitis is a highly infectious eye disease. It is caused by
bacteria, fungus or virus. It is the inflammation of the thin
transparent sheet that covers the white of the eye (sclera) and
innerside of the lids. Though the disease is normally not dangerous
delay in proper treatment may affect ihe eye-sight.
Conjunctivitis starts quite suddenly and may become severe within four
to six hours sincethe onset of its early symptoms.
All age group is equally affected ty Conjunctivitis,
SYMPTOMS : The disease begins with irritation in one or both the eyes.
The eyes look ted and more painful and the eye-lids are swollen. There
is watery or thin mucus discharge from the eye's in the beginning^
followed by thick white or yellowish-white discharge that may collect
in the eye.
^There is inability to open the eye and the patient shuns bright light.
If untreated, it can lead on to ulceration of the cornea and permanent
corneal c;ccity (Safedi, Madha, Phoola) and permanent impairment of
vision.
HOW IT SPREADS : The disease spreads through the contaminated fingers,
clothings such as towels, handkerchief, etc., and other articles of the
patient suffering from this disease. Flies and other eye-gnats also
spread the disease from a sick person to others. It also occurs due
to dust, dirt, smoke, use of dirty water for bathing, or using the common
Surma Salai from the patient of this diseascor by use of the same finger
for application of Kajal to more than one person.
If treated properly the disease can be cured within four to seven days.
Patients do not require hosoitalisatioh.
the
PREVENTION : - Personal cleanliness, hygienic care and keeping
surroundings clean arc the best prevention against the disease. Towels,
handkerchiefs and other clothes of daily use of the patients should not
be mixed with the clothes of others until they are washed. Over-crowding
should be avoided.
Wash the clothes including the towels and handkerchiefs of the patient
preferably in hot water, before use again.
Children suffering from the disease should not go to the school till
they arc cured.
Use sun-glasses to protect the eyes from too much light or protect
the eyes from the flare by use of umbrella or by covering the head with
a clean piece of cloth which also protects the eyes. Sun-glasses of a
patient should not be used by others.
2
Avoid bathing in ponds or swimming pools when there arc large number of
cases.
Wash the eyes
with clean luke warm water three to four ti’.'ies a day.
Take rest for three to four days in the house. Consult the doctor immediately
This will help in speedy recovery on the one hand and reduce the chances
of spreading the diseasein the community cn the otlicr hand
Do not use common Surma Salai (applicator) mee... t for all mjmbcrs of the
family.
Avoid use of Kajal.
PWMBKR :
Conjunctivitis is a highly infectious eye diseaseThe disease is not dangerous except whore the treatment is delayed.
Irritation, watering of eyes, selling of eye-lids,, redress, of cyd?' and
discharge from the eyes, are the symptoms of the disease,.
The disease spreads through contaminated fingers, clothing an: o.tr.er
articles of the patient.
Systematic treatment will cure the disease within four to sov.?. days.
Personal cleanliness and hygienic care will help preven'; Lie
Keep your surroundings clean to avoid flies.
•
is ^se-
YOU TAKE CARE CF EYES - THEY TAKE :CW O? YOU
. , Ad
. :
!•
I
Nutrition Education Pamphlets 2
We can save a child's eyes in another way.
We can give him massive doses of vitamin A by
mouth. The National Institute of Nutrition in
Hyderabad has studied this method carefully. They
found that if you give a child 200,000 I.U.
(60,000 micro gms) of vitamin A by mouth every
6 months, he will be fully protected from vitamin
A deficiency. This is especially important for
children between the ages of 1 and 3 years.
How can a pregnant mother protect her un
born child from becoming vitamin A defi
cient ?
A pregnant mother should eat plenty of foods
which contain vitamin A. Then her body can give
vitamin A to the baby inside her womb. If the
pregnant mother gets plenty of. vitamin A, her
unborn baby also gets plenty of vitamin A. This
protects the baby from blindness due to vitamin
200000 I.U.
OF
I Ik l
’
A
■
BLINDNESS
IN CHILDREN
vitamin
A
deficiency
*
hV’
A xV -
-X■
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T
I
A pregnant woman needs more vitamin A than usual
If we give a child massive doses of vitamin A
we can easiiv and safely prevent blindness. The
Government of India has started a national pro
gramme for prevention of vitamin A deficiency.
’ - .They use this method.
Children who are &Und because of
vitamin A deficiency
Formerly "Vitamin A Deficiency and Blindness”, Folders on
Nutrition—2, produced by NIN, Hyderabad.
Produced by UNICEF, New Delhi, for National
Institute of Nutrition. Hyderabad. Designed by
•Stet—The Media People, New belhi
'i 5"
NATIONAL INSTITUTE OF NUTRITION
INDIAN COUNCIL OF MEDICAL RESEARCH
Vitamin A deficiency and blindness
Children who do not get enough vitamin A in
their food may become blind. They have vitamin A
deficiency. Several thousand young children in
India are blind because they do not get enough
vitamin A in their food.
Who becomes blind from vitamin A defici
ency?
Children between the ages of 1 and 5 years
are most likely to become blind from vitamin A
deficiency. In some areas in India people mostly
eat rice. Children in these areas often do not get
enough vitamin A in their food. They have vitamin
A deficiency. These areas are Andhra Pradesh,
Bihar, Karnataka, Kerala, Orissa, Tamil Nadu and
West Bengal.
How can you tell if a child has vitamin A
deficiency blindness ?
If a child has vitamin A deficiency, he does not
become blind suddenly. He becomes blind slowly.
If you notice that a child has some early signs
of vitamin A deficiency, you can cure him. You can
save his eyes completely.
If a child has one of these signs, you must
treat him quickly. If you do not treat him quickly,
the child may become completely blind. In severe
cases of vitamin A deficiency, the black part of the
child's eye becomes damaged. Then the child be
comes totally blind. We call thfs kind of blindness.
Keratomalacia.
Many inexpensive foods also contain vitamin A.
Palak, amaranth, methi, carrots, papaya and mango
are all inexpensive foods. They all contain plenty
of vitamin A.
I
I
o
.it
dI
c
fM ■
ii I
Iwl
*
■
Some inexpensive foods which contain^
vitamin A
Look for these signs:
—If a child cannot see well in dim light, he has
night blindness. Night blindness is the first sign
of vitamin A deficiency.
—If the white part of a child's eye is dull and dry
he has an early sign of vitamin A deficiency.
—If a child has greyish foamy patches shaped like
triangles on the white part of his eye, he has
Bitot's spots. Bitot's spots are another early sign
of vitamin A deficiency.
Sometimes people do not eat these foods.
They think these foods are harmful. Perhaps they
are ignorant, or superstitious. Perhaps they have a
false belief about these foods But we know that
these foods are good. We must encourage children
to,eat them.
ir
o
Keratomalacia
UM"
How can we treat vitamin A deficiency ?
We can treat vitamin A deficiency with food.
Some foods contain a lot of vitamin A. If we give
a child these foods, he will not get vitamin A
deficiency blindness.
Vitamin A is present in milk, eggs, ghee and
fish liver oils. But these foods are expensive, and
some parents cannot afford them.
■
I
Give your child foods which contain plenty of
vitamin A
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