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swasth
hind

HEALTH CARE

May 1985

Vaisakha-Jyaistha
Saka 1907

Vol.

XXIX No. 5

Delivery of health care through cooperatives
Dr A.R. Chaurasia

97

Health care in old age
Dr Hemant Kumar

101

Health of the elderly

103

MALARIA CONTROL
READERS WRITE
We found Swasth Hind very informative and
particularly valuable and relevant to our country.
We decided to have your magazine regularly.
R. C. Gupta
Fracture and Maternity Clinic,
Kala AM, Delhi Road,
Bui and Shahr (U.P.)

Editorial and Business Offices
Central Health Education Bureau

(Directorate General of Health Services)
Kotla Marg, New Delhi-110 002.

National effort towards malaria control
Smt. Mohsina Kidwai

106

Immunization against malaria—the position
in 1984

109

HEALTH STATISTICS
Mortality patterns differ even in third world
Peter Ozorio

CANCER
Cancer cells removed by magnetic beads
Tim Haines

114

Freedom from cancer pain

116

Battle against cancer

118

Cancer diagnosis and treatment
in India
Books

ASSTT. EDITOR

111

121

centres

Third
inside
cover

D. N. Issar
Sr. SUE-EDITOR
M. S. Dhillon

COVER DESIGN
B. S. Nagi

Articles on health topics are invited for publication in this
Journal.
State Health Directorates are requested to send reports of
their activities for publication.

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SWASTH HIND reserves the right to edit the articles sent
for publication.

HEALTH CARE

DELIVERY OF HEALTH CARE
THROUGH COOPERATIVES
Dr A.R. Chaurasia

There is a need of self-propelled working mechanism
wherein the health care delivery agencies including
the government and beneficiaries could plan and
execute health care development programmes in a
coordinated and cost-effective manner.
In this
article, the author suggests the development of
health care delivery system through cooperatives.
The most important feature of such an approach
is that of self-reliance and the increased community
participation, the author feels.

May 1985

HE development of health care
delivery system in our country
has been one of the abiding con­
cern since Independence, Despite
all out efforts during the last thirty
seven years, majority of the popu­
lation, especially in rural areas, is
still devoid of basic health facili­
ties. In an effort to evolve an effi­
cient and effective health care de­
livery system, the strategy of health
care planning has been changed
repeatedly but with limited success.

T

97.

The reasons for this limited success
include:

ficiaries could plan
and execute
health care development program­
mes in a coordinated and cost effe­
1. Lack of proper identification ctive manner. These should in­
of health needs of popula­ clude the identification of primary
tion, especially the rural one. health care needs of the community
2. Lack of involvement of peo­ or area around which all health
ple and their organisations care development activities should
in the decision making pro­ be promoted. Such a programme
cess regarding the delivery calls for the transfer of appropriate
technology in the most effective and
of health care.
acceptable manner, i.e., the deve­
3. Lack of linkage of block lopment of health care delivery sys­
level development plans with tem through cooperatives. The in­
grass root level problems volvement of cooperatives in the
and needs.
development of health care delivery
system is regarded very important
on account of their well known
Community based delivery
organisational structure. Besides
The limitations enunciated above this, cooperatives are instrumental
are well known and widely discuss­ in harnessing local initiatives, pro­
ed. Efforts to tackle these problems viding resources and improving
have also been made. Thus in mass participation. In other words,
order to improve involvement of cooperatives have tremendous po­
the people, the idea of community tentialities as nucleus to health
based health care delivery system care delivery system. Here it will
has been mooted and the posts of be worth mentioning that whenever
village health guides have been cooperatives have acted as nucleus
created, village health committees of development, the impact of
instituted and traditional birth at­ development programme has been
tendants have been trained. Though more abiding.
laudable these efforts are, yet there
is little success in improving the
The approach to the develop­
efficiency of health care delivery ment of health care delivery sys­
system mainly due to the lack of tem through cooperatives is based
involvement of people in the deci­ on both macro as well as micro
sion making process pertaining to considerations. The micro consi­
the delivery of health care.
derations are related to the genera­
tion of community participation and
It is also very much doubted that involvement in the
development
the Government effort alone will process and to develop self-reliance
ever be sufficient to meet the health among beneficiaries while macro
care needs of the population. considerations relate to overall ori­
Therefore, it was only recently that entation of social and cultural set
specific need based and area speci­ up including strengthening of exist­
fic health improvement plans have ing infrastructure. Alternatively,
received attention.
approach to the development of
health care delivery system, taking
cooperatives as nucleus thereof, is
Health care through cooperatives
a multi-pronged, multi-disciplinary
There is a need of self-propelled and multi-directional process.
working mechanism wherein
the
In line with the aforesaid appro­
health care delivery agencies in­
ach,
the strategy for the develop­
cluding the Government and bene­

98

ment of health care delivery sys­
tem through cooperatives is based
on the following principles:
(a) A cooperative society should
be the principal agency in
planning
and
executing
health development plans in
the community. This society
will work in coordination
with other health care deli­
very agencies in the com­
munity.

(b) The required health needs
and. services would be mana­
ged by greater share and in­
volvement of the cooperative
society. It is not possible as
well as desirable that all
health care activities of the
community or area may be
taken up by the cooperative
society only but the society
would take an initiative in
developing a working coor­
dination with other health
care delivery agencies.
(c) The health care development
plans will not only touch the
health care needs but would
encompass in itself social
and cultural aspects of life.
The consideration is that the
social and cultural aspects
may be so oriented that they
act as catalytic agents for
the improvement of health
of the people.

(d) The resources needed for
the development of health
care delivery system would
flow from the cooperative
society itself and also from
other health care delivery
agencies including the gov­
ernment’s budgetary provi­
sions.
(e) The people will actively be
involved in planning and ex­
ecuting the plan for the
development of health care
delivery system. They will

Swasth Hind

Community Jjased health care delivery system needs to be\
vigorously implementedfor securing people's participation.

be enthused to develop a
sense of self-reliance and
involvement in providing
health for all in the com­
munity.

This assembly will function as a
catalytic agent creating an urge in
the people for the development of
health services in their village/
area. This assembly will also help
in motivating the villages for invol­
Organisational setup
vement and participation in the
In order to develop a model of village development plans. All
health care delivery system based families in the village or commu­
on the above principles, the follow­ nity will have representation in
ing organisational framework is the assembly and shall contribute
a fixed amount annually as the
suggested for the rural population.
membership fee of the Assembly.
The model can be modified suita­
This fee may be decided by the
bly for the urban populations also.
assembly itself. Functions of the
1. Formation of a Village Health Village Health Assembly will be:
Assembly. Village Health Assem­
— to identify potentialities of
bly will be the apex body in a
development.
particular village or community.

May 1985

— to bring out factual position
about the state of health in
the village/community.
— to review various ongoing
schemes and health care deve­
lopment plans in the village
including the work of village
health guide and traditional
birth attendants.
— to locate gaps in the existing
infrastructure of health care
delivery system.
— to formulate specific propo­
sals. schemes and program­
mes as per needs.
— to raise funds to meet health
needs of the village/commu­
nity.

99

In order io facilitate the func­
tioning of Village Health Assembly,
it is proposed to divide the Assem­
bly into following five working
groups:

•1. Working
welfare.

group on

VILLAGE HEALTH CARE DELIVERY SYSTEM

(Organisational set up)

family

2. Working group on communi­
cable diseases.
3. Working group on maternal
and child health.
4. Working group on environ­
mental sanitation.

5. Working group
health problems.

on

other

These working groups as well as
the Village Health Assembly, shall,
in the normal course, meet twice
in a year. However, in case of
emergency, the
meetings of the
Assembly as well as the working
groups can be called at short notice.

/
2. Formation of Village Health
Committee*. Village Health Com­
mittee shall be the chief executive
body in the matters of health in the
village/community and shall be
elected from the Village Health As­
sembly. Each working group of the
Assembly shall elect a representa­
tive for the Village Health Com­
mittee. Village Health Guide of the
village or community shall be the
member secretary of the Village
Health Committee. Functions of the
Village Health Committee will be

— collecting membership dues
from the members of Village
Health Assembly.

— keeping liaison with authori­
ties of various health care
delivery agencies including the
government.

— supervising the work of village
health guide and traditional
birth attendants.

Village Health Committee shall
meet every month to review health
situation of the village and shall
submit a report on health status to
Village Health Assembly. The Com­
mittee will also inform the block
health administration about the
working of various paramedical
workers in the area.

3. Establishment of a Village
Health Centre*. The mole calls for
— organising meetings of Village the establishment of a health centre
Health Assembly as well as of in the village/community. This health
centre will be the platform from
working groups.
where all health care activities will
— implementing the decisions of be carried out in the village. This
Village Health Assembly.
health centre will also be the meet­
— maintaining the accounts.

100

ing place of Village Health Assem­
bly and Village Health Committee.
The centre will remain open on fix­
ed hours every day and will be run
by .the Village Health Guide and
Traditional birth Attendant in the
village/community. The cost of run­
ning the health centre will be borne
by both the Village Health Assem­
bly as well as the government or
some other health care delivery
agency.

Role of Block Health Administration
Though the Block Health Admi­
nistration will have no controlling
and supervisory role in the day to
day functioning of Village Health
Centre yet it will work in close
coordination with the Village Health
Assembly and Village Health Com­
mittee. It is clear that the villagehealth care delivery system modell­
ed here cannot meet all health care

(contd. on page J 23)

Swasth Hind

HEALTH CARE IN OLD AGE
Dr Hemant Kumar

Periodic health check-up of elderly
and middle aged people, early detec­
tion and treatment of diseases, scienti­
fic handling of advanced cases, are
important preventive measures against
old age diseases. The author feels
that the importance of periodic check­
up should be brought home to the
public through the active cooperation
of the press, through public lectures
and employment agencies.

May 1985

H

ealthful longevity has always been the cherished

dream of man. This is also evident from a
hymn of Atharva Veda, ‘Jiwem Sardah Satam*, ‘Pasyetn Sardah Satairi denoting a longing for one hund­
red years of life with functioning senses of vision and
hearing.
Life-expectancy is on the increase for the past
many years due to improved standards of medical
care and nutrition. Some of the effects, which are
considered inevitable in old age, may be averted,
e.g., progressive change of muscle into fat, reduced
cardiac output and fall in bone calcium level, etc., if

101

vigorous activities and normal weights arc maintain­
ed. But changes in eyes, ears, kidneys, joints are un­
likely to be modified by any known measure. Some
of the measures which may be taken to attain and
maintain positive health and to lead a better quality
of life are summarised below.
Nutrition
Consumption of suitable diet is the greatest single

factor in preventing senility, increasing life span and
the period of vigorous activity.
It is also felt that good nutrition and composition
of diet, notably its deficiencies and imbalances have
far reaching effects not only later in life, but also at
crucial periods of development. Chebotarev (1973)
also recommends good nutrition and balanced diet to
increase life span.
Firky (1981) feels that a diet of proper quality is
the factor that lengthens the human life span, and
the excessive quantities of diet, whatever is its quality,
will tend to shorten it. This can never be considered
apart from individual’s feelings, economic status, cul­
ture and state of health. The influence of eating prac­
tices are continuous and cumulative.
It is recommended that caloric intake in old age
should be 20-30 per cent less, as compared to young
age. The consumption of proteins should be about
IG per kilogram of body weight, and not more than
25 per cent of the total calories to be provided by
fats. Rest of the calories may be derived from car­
bohydrates which should contribute about 50-60 per
cent of total caloric intake. Vitamins, especially as­
corbic acid and B-complex group of vitamins are
needed more than in adult life, because of reduction
in bacterial flora and absorption capacity of the in­
testine. B-Complex also helps in the maintenance of
muscle tone of gastro-intestinal tract.

Weight and Obesity

Obesity has been observed to be associated with
certain cardiovascular and metabolic disorders, parti­

102

cularly in early old age. A number of factors con­
tribute to the causation of obesity including age, sex,
economic status, physical activities, psychology, eating
habits, genetic factor, endocrine, pregnancy and meta­
bolism.
»

Obese persons are more prone to develop various
cardiovascular, psychological, skin, and metabolic dis­
orders as compared to non-obese persons. Even
their life span tends to be reduced. The statistics of
the metropolitan Life Insurance Co. (USA) have
shown that for a man of 45, an increase of 12 Kg
above standard weight reduces his life expectancy
by 25 per cent.
Exercises
Regular physical exercises have been recommend­
ed for aged persons as it is felt that exercises help
a great deal in the maintenance of good physical
health.
Palmore (1970) observed that aged persons not
doing proper, adequate locomotor activity are two
and half times more prone to develop illness and
they have to be hospitalised for more than 2 weeks
per year because of physical ailments. They have
to visit hospitals one and a half times more than
those who perform adequate exercises.

Herman (1971) also emphasised on physical exer­
cises for elderly persons. He divides the elderly
persons into two group: (i) those who have led an
active physical life, (ii) those who have led a seden­
tary life. For the persons belonging to the former
group, he suggests to continue active physical exer­
cises as before. For the persons belonging to the
latter group, he recommends mild physical exercises
to begin with, e.g.. hiking, cycling, etc., to re-educate
their muscles, heart and nervous system without

causing any strain.
Smoking
It has been established that mortality among ciga­
rette smokers, from all causes, is twice as high as
among non-smokers and corresponds to a difference
(conid. on page 104)

Swasth Hind

HEALTH OF THE ELDERLY
consultative meeting for national plan formula­
tion for the Health of the Elderly was held in the
WHO South East Asia Regional Office, New Delhi, from
28 to 30 November 1984. Participants from Bangladesh,
India, Nepal, Sri Lanka and Thailand attended the
meeting which had the following objectives: —

A

(ii) Such pilot projects should be organized for pro­
viding knowledge and skills for developing appropriate
patterns of similar community-based services towards
promotivc, preventive, curative and rehabilitative as­
pects of the elderly in the country.

(1) To review the Global Plan on Ageing in the con­
text of the regional and national situation.

(iii) Budgetary requirements should be identified and
adequate resources mobilized for implementation of
these pilot projects.

(2) To prepare guidelines for the formulation of the
national plan through the suitable adoption/adaptation
of the global plan of action with the focus on India.

3. National policy and plan

(3) To identify the role of governmental, non-govern­
mental and other agencies in programmes for the health
of the elderly at the national level.

The consultative meeting recommended the following
guidelines for the formulation of the National Policy and
Plan for the Health of the Elderly:
1. Situational analysis

(a) The Existing National Health Policy should be
reviewed and adequate provision made for the health
of the elderly to guarantee the promotivc, preventive,
curative and rehabilitative needs of this group.

(b) Priority attention should be directed towards the
preservation of traditional values with appropriate action
to ensure socio-economic security for the elderly and
an acceptable quality of life.

(a) The existing health status of the elderly popula­
tion should be assessed in terms of quantity and quality.
The qualitative status should include details such as
spiritual, social, economic, physical and mental well­
being and other humanitarian and development aspects
of ageing.

(c) The national plan and strategy for the health
of the elderly should promote the integrated and com­
munity-involved development of health activities in
accordance with the objectives of Health for All by the
Year 2000 through the primary health care approach.

(b) The demographic characteristics should be ana­
lysed with special reference to the age groups 60-70,
70 and above.

4. Resources

(c) The needs of the elderly and the current resour­
ces available to meet these needs should be identified.

(d) A suitable proforma should be designed for
obtaining essential information through a sample sur­
vey and appropriate parameters identified for develop­
ing an effective programme with an in-built monitoring
and evaluation system for the health of the elderly.
2. Preliminary action
(a) Mechanism for planning and management
An identified national focal point or nodal ministry
will constitute a National Committee with representa•tives from different sectors/disciplines to guide and
promote a preliminary community-based action plan.

(b) Pilot projects
(i) Pilot projects should be launched and suitably
located to represent geographical, cultural and socio­
economic variations in the country.

May 1985

Resources for organizing and implementing the inte­
grated community-based action plan for the health of
the elderly should be mobilized from the communities,
voluntary organizations, industrial sectors, national bud­
get and international agencies including non-govern­
mental agencies.

5. Time frame
(a) The situational
within one year.

analysis

should be completed

(b) The results based on preliminary action through
pilot projects should be available by the end of the
third year.

(c) The review of any existing national plan and its
reformulation or the formulation of national
plans,
with a policy declaration should be finalized within a
period of five years.
— H.F.A. 2000, November-December 1984

103

(contd. from page 102)
in life expectancy. Stopping smoking would be ex­
pected not only to increase the average life span,
but also to promote better health by eliminating
diseases such as emphysema.
Percentage of smokers among aged population
seems to be fairly high in our country. Garg et al.
(1982) in his study reported that 23.2 per ceht of
aged persons smoked bidis and 8.7 per cent were
cigarette smokers.

Smoking also reduces total life span. In a study
of aged subjects it was observed that two-third of
heavy or moderate smokers died sooner than expect­
ed, and underwent more operations, paid more visits
to doctors, and suffered more from ill health of various
nature.
Franklin (1977) comments, ‘stop smoking and
reduce the incidence of Myocardial Infarction two
fold*. He also feels that avoidance of smoking is an
important measure in the prevention of death and
disability. Maldhure et al. (1982) observed in a
study of 108 workers in a cotton mill, that chronic
bronchitis was nine times more common in smokers
as compared to non-smokers.

The 1971 report of the Royal College of Physicians
of London on the effects of smoking on health pro­
vides useful summary of information on the diseases
now known to be associated with smoking-cancer of
the lung, chronic bronchitis and emphysema, coro­
nary artery occlusion, angina pectoris, cancers of
mouth, pharynx, larynx, and oesophagus, cancer of
the bladder and pulmonary tuberculosis. Among
patients with peptic ulcer, those who smoke have
a higher death rate than those who do not, and a
mother smoking during pregnancy may retard the
growth of the foetus.

Stresses and Strains
It has been proved beyond doubt that excessive
physical or mental stresses and strains may preci­
pitate or accentuate diseases like angina, bronchial
asthma, hypertension, peptic ulcer, hyperthyroidism,
various forms of dermatitis, migraine and ulcerative
colitis.
It is, therefore, advocated that aged persons should
try to minimise the strains and stresses to which they

104

may be exposed to avoid precipitation or accentua­
tion of related diseases, which sometimes may even
involve the risk of life, e.g., ischaemic heart diseases,
bronchial asthma, etc. Joint family system is ideal
for elderly in the present setup, as it helps in reducing
physical and mental strains of life to which they are
exposed.

Ssenkoloto (1982) also feels ‘family support’ as
probably the best media of . support for elderly and
would add life to years.
Chebolarev (1982) feels ‘what is most important is
that in extreme old age, people should not lose in­
terest in the joys of life. It is equally vital that
they should still do intellectual and physical work
within their capacity and society should continue to
benefit from their experience’.

Regular Check-up

It is suggested that in order to prevent death and
disability, aged must seek early diagnosis and prompt
treatment of his ailments and maintain normal serum
tryglyceride and cholesterol levels by appropriate
dietary changes as needed.
Periodic health check-up of elderly and middle
aged people, early detection and treatment of diseases,
scientific handling of advanced cases, are important
preventive measures against old age diseases. It
may also be emphasised that importance of periodic
check-up should be
brought home to the public
through the active cooperation of the press, through
public lectures and employment agencies.

To minimise physical and psychological deteriora­
tion in old age, preventive medical measures should
be taken earlier in life. Chemotherapy can certainly
help to improve the quality of later life by prolong­
ing the healthy years. As there is no cure for old
age, early prevention of degenerative changes holds
the key to sustained physical and mental well-being
in later life.

Dr Mahler, Director General of WHO believes that
the elderly need prompt clinical care when they are
ill and here the thrust of primary health care can
bring about important change by acting as an early
warning and first intervention system. However, the
entire range of medical rehabilitative services should
be ready to be called into play when required.

Swasth Hind

Preservation of traditional values with appropriate action to ensure
socio-economic security for the elderly needs priority attention

REFERENCES

Chebotarev, D.(l982). The Biology of ageing. World Health, May
issue.

Herman. A.P.(1971). Exercise after Sixty. Herald of Health, Vol
48.No.U,pp. 16-17, 19.

Davidson, S. and Macleod, J.(1973). The principles and practice
of Medicine, 10th Edition.

Kern, A. Richard(1971). Emotional problems in relation to ageing
and old age. Geriatrics, Vol- 26, pp.83-93.

Forbesc, W.F. and Thompson, M.E.(1980). The Economics of
Tobacco. World Health, Feb. Mar. Issue,
pp. 10-13.

Palmore, E.(1970). Health practices and Illness among the aged.
The Gerontologist, Vol-10, pp. 313-316.

Firky, M.E.(1981). Nutrition and the Elderly. World Health,
April issue, pp.13-15.

Gorg, S.K., Mishra, V.N.Gupta, S.C.,Bhatnagar, M. and Singh,
R.B. (1982). Health Profile of a Rural
Population in Meerut District. I. J. Com­
munity Medicine., Vol.VII, No.2.

May 1985

Sen PC(1973). Food for the Ageing Person, Your Health, Vol. 22.
pp.363-364.
Ssenkoloto, G.M.(1982). Family support for the Elderly. World
Health, May issue.

Vakil, R.J. and Gujar, K.T.(1968). Cliniko-pathological aspects
of old age. Maharashtra Med. J., Vol. 15,
No.I, pp.51-60.
A

105

MALARIA CONTROL

NATIONAL EFFORT TOWARDS
MALARIA CONTROL
—Smt. Mohsina Kidwai

The States should take urgent steps to ensure that insecticides and
anti-malarial drugs in required quantity are made available in the
field and whenever bottlenecks develop, these are sorted out most
expeditiously.

hose who are working in the National Malaria
Eradication Programme are well aware that control
or eradication of malaria is not an easy task. Over
last two decades, we have learnt that whenever efforts
have slackened, the malaria has come back in a big
way.
We may recall that dedicated work by the
malaria workers in the late fifties and mid sixties
brought down the incidence of malaria from 75
million cases to one lakh per year. It was an achieve­
ment which was lauded throughout the World.
However, as the areas went into advanced stage of
malaria eradication, i.e., maintenance phase and were
handed over to General Public Health agencies to
keep the malaria free status, in 50 per cent area of
the country, because of lack of infrastructure and
complacency of general field staff, the focal out­
breaks started occurring in the country.
As a result
of this, between 1965 and 1976, there was 64 fold in­
crease in malaria incidence in the country.
The
Ictal malaria positive cases recorded during 1976
were 6.4 million.

T

The reason for the same was indifferent case detec­
tion and delayed institution of remedial measures
to contain the focal outbreaks.
To some extent, the
delays in supplies of insecticides resulted in poor and
untimely spray coverage and were also responsible for
this resurgence.

106

Strategy to control malaria

Government took notice of this rising trend in
malaria as early as 1968 and resorted to realistic re­
phasing.
They also constituted a team of national
and international experts to go in-depth in the pro­
blems of malaria and the control strategy. As a result
of the recommendations of the In-Depth Evaluation
Team and the Consultative Committee of Experts, it
emerged that it was not possible to eradicate malaria
with the present technology in difficult areas inhabited
by approximately 90 million people.
The goal of
eradication was deferred and a strategy to control
malaria and to maintain the gains achieved was evolved
and implemented under the Modified Plan of Opera­
tions.
It is heartening to know that since implementa­
tion of the Modified Plan of Operation in 1977, there
has been a steady decline in the incidence of malaria
in the country.
However, whereas from 1977 to
1979, the rate of decline was satisfactory, thereafter
the rate of decline has slowed down.
In 1979-80, the malaria eradication programme
was made 50:50 centrally sponsored scheme. Under
this scheme, the State Governments were expected
to provide matching grant for malaria control. Those

Swasth Hind

States, which were using BHC and Malathion were
expected to purchase these insecticides out of their
share and also meet the operational cost of spray
operations, etc., initially, to be shared later, on 50
per cent basis with the Centre.
However, some of
1he States did not provide matching grants for the
programme in spite of the funds made available by
the Planning Commission and the Centre.
This
resulted in inadequate procurement of insecticide by
the States.
Further the required funds for engaging
spray staff were not sanctioned by the State Govern­
ments leading to poor insecticidal spray coverage
both in time and space.
Occurrence of new cases of malaria cannot be con­
trolled by any other means except by good spray
coverage and that has been the reason for slow pro­
gress of the programme in many of the States over
the past few years and particularly, during 1983-84.
As per reports received so far, at the Directorate of
NMEP for the year 1984, it has been observed that
the total incidence of malaria in the country has gone
up by 12 per cent to which 21 States and Union Ter­
ritories have contributed.

P. falciparum infection, if not treated in time, is
capable of producing mortality. It is necessary that
in areas where this parasite is predominant, special
measures should be taken up.
The Government of
India with the help of SI DA and WHO launched a
special programme of P. falciparum Containment in
1977 covering north-eastern States and some areas in
the States of Orissa, Bihar, West Bengal, Gujarat,
Maharashtra and Rajasthan. Under this programme,
special inputs have been provided to strengthen the
supervision of field operations.
It is satisfying to
note that in these areas, incidence of malaria includ­
ing P. falciparum has declined over the years.
However, it is a matter of , great concern that the
areas of Uttar Pradesh, Bihar, Haryana, Delhi, Rajas­
than, Punjab, which had traditionally low P. falciparum
incidence in recent past, are now recording high in­
cidence of P. falciparum In these areas, it is necessary
to strengthen the operations to prevent deaths due to
P. falciparum. These States should take timely spray
operations in areas with high incidence of malaria and
strengthen the surveillance operations, so that a per­
son suffering from malaria can immediately get clini­
cal relief and also the deaths can be prevented by
proper treatment.

May 1985

Urban Malaria

Due to intensified spray operations in the rural areas,
the incidence of malaria in rural areas went down dras­
tically. However, in the urban areas the incidence of
malaria went up because of lack of interest by local
bodies in carrying out antilarval operations. Realising
the financial difficulties and constraints of States and
local bodies, Government of India took up an Urban
Malaria Scheme under NMEP. Under this Scheme,
131 towns were sanctioned. Some of the States have
not yet implemented the scheme in full in many of the
towns sanctioned by the Central Government. The Ur­
ban Malaria operations except in few towns are not
being implemented properly, and it has been observed
that in some of the towns, the incidence is going up
year after year. To specifically mention Madras and
Calcutta; these metropolitan cities have got adequate
resources and man power, but due to poor implemen­
tation of field activities, not much has been achieved.
Resistance to insecticides
It has been often brought out by the States that one
of the reasons for increasing incidence of malaria is
the resistance of vector to DDT and BHC. The ex­
periments carried out by the Malaria Research Cen­
tre of the Indian Council of Medical Research and
NMEP have revealed that even in those areas, where
vector resistance is found by laboratory tests, improv­
ed spray operations with adequate doses and total
coverage with DDT can bring down the incidence
and there is no immediate need to change the insecti­
cide. However, in the past, on the recommendations
of the experts, in some areas alternate insecticide
Malathion was introduced, and considering the financial
constraint of the States, it was made 100 per cent
Centrally Sponsored. The States were allocated ade­
quate funds for purchase of Malathion. It is observ­
ed that some of the States did not purchase Malathi­
on in time and the targetted areas could not be cover­
ed.
Recently, some of the States have approached the
Central Government for change of insecticide, i.e.,
from DDT/BHC to Malathion in some more areas.
Unless the operations are geared up in the existing
areas and it is finally evaluated on technical grounds,
further whatever
Malathion has been provided is
used satisfactorily with good results, it will not be
possible for the Central Government to increase the

107

areas under Malathion coverage.
Another problem
of resistance in malaria parasite to chloroquine
appeared a few years back. We have set up a machi­
nery under the Central Government to monitor the
foci of P. falciparum resistance to chloroquine
all over the country and on the basis of the results so
obtained, alternate drug strategy is decided in consul­
tation with the experts.
However, to prevent exten­
sion of these foci, it is necessary that this strain of
malaria parasite should not be transmitted or allowed
to extend to other areas; this can only be done by
adequate intensive and timely spray operations, detec­
tion of cases and treatment.
The Directorate of
NMEP has been informing the State Governments
regarding location of such foci.. It is for the State
Governments to see that the spray operations in
these areas are appropriately conducted with streng­
thened supervision.

Lack of supervision
Last year, while reviewing the programme, it was
found that one of the reasons for poor spray coverage
was lack of supervision and inappropriate approach
to the community.
On this subject, the existing
advice of the Central Government was not being
implemented.
A detailed letter was sent to all State
Health authorities at various levels outlining the
methods in regard to planning of spray operations and

health education, so as to obtain full public co-opera­
tion. It is important to know, how far this has been
implemented.
Nearly 40 per cent of the resources allocated to
Health Sector are being earmarked for malaria pro­
gramme every year. Such a large chunk of resource
of the country have to be utilised in a gainful manner
for malaria control.
Even if only one State fails to
allocate appropriate funds, out of their share, for
malaria control the resultant breakdown
of field
operations leads not only in rise of malaria incidence
in that particular State, but also affects the neigh­
bouring States due to transmigration of population for
various developmental activities.
It is, therefore.
essential that all States should implement the pro­
gramme as planned by providing adequate resources
and manpower and keep pace with the national effort
towards malaria control.
A special drive will have
to be initiated and the system of monitoring will have
to be improved. The States should take urgent steps
to ensure that insecticide and antimalarial drugs in
required quantity are made available in the field and
whenever bottlenecks develop, these are sorted out
most expeditiously.
(Based on the inaugural speech by the Union Minister of Health
and Family Welfare, at the All India Conference of Malaria and
Filaria Workers held in Delhi from 29-31 January 1985.)

CHANGE OF ADDRESS
Please don't forget to intimate the change of address. To ensure prompt supply of Swasth Hind, please quote your
Subscriber Number;'

For all enquiries, please write to’.
The Director
Central Health Education Bureau
(Directorate General of Health Services)
Kotla Marg, New Delhi-110 002.

108

Swasth Hind

Immunization Against Malaria
— The position in 1984
he historic success in eradicating
smallpox by vaccination has pro­
voked a demand by the public, led
by their representatives and the
news media, for similar achievements
in other diseases notably malaria. It
is obvious, particularly in most coun­
tries of South-East Asia, that the
goal of HFA 2000 will not be attain­
ed if malaria persists to any great
extent; and so it is natural to as­
pire towards a single weapon that
may in one stroke, or a series of
swift strokers, defeat malaria.

T

Unfortunately, the world is still
many years away from a method of
immunization against malaria that
will, in terms of effectiveness and
duration of protective action, be
comparable to that 200-year-old
veteran, smallpox vaccination. The
production of such a vaccine is, ne­
vertheless, a priority target in the
world-wide programme of malaria
research, and as much time is be­
ing devoted to it as to the produc­
tion of new antimalarial drugs and
insecticides; this demanding work
involves the collaboration of a great
variety of medical research institu­
tions, ranging from the most aca­
demic scientific laboratories to teams
undertaking practical tests in the
field.

It was found experimentally 45 years ago, at the Malaria

Institute of India, that a brief immunity could be induced
in chicken.
cd a duration of protection of one
year might be acceptable as a mini­
mum.

At each step in its development
in the animal or mosquito host the
parasite is theoretically open to
attack, and indeed antimalarial drugs
owe their efficacy largely to their
ability to bring parasite metabolism
to a halt by blocking its use of
one or another essential chemical.
Likewise there are innumerable steps
in the parasite's life-cycle where its
structure, functions or even its im­
mediate environment, on which it is
dependent, might be altered by im­
munological actions bringing its
development to a halt and either kill­
ing it directly or rendering it attrac­
tive to killer body cells. At the pre­
sent time most of these avenues for
immunization remain theoretical.
Malaria vaccines in practice

In these early days of the science
of malaria immunology, very few
of the potential avenues for immu­
Malaria vaccines in theory
nization have been explored and
Successful immunization against shown to offer promises. The three
a parasitic disease like malaria or a that are being most actively deve­
viral disease like smallpox depends loped involve destruction of three
on stimulation of the host’s inter­ key stages of the parasite, (a) the
nal defence mechanisms, chemical stage that is injected into the human
and cellular, to neutralize or destroy host, and thus initiates the entire in­
the invader. The stimulant is a fection—the sporozoite, (b) the stage
protein substance, an antigen, coat­ that enters the human red blood cells
ing the invading organism and pro­ thus initiating the clinical symptoms
voking the victim’s defence mechani­ —the merozoite, and (c) the stage
sms to produce a counteracting anti­ emerging in the mosquito’s stomach
body. Unlike protection obtained by to continue the parasite’s life cycle
administration, usually at weekly in­ in nature, having been sucked from
tervals, of antimalarial drugs, pro­ the patient’s blood by the feeding
tection through immunization should mosquito—the gamete. All of these
not require repeated intervention; developmental stages of the parasite
for operational convenience, where may be coated by antibody produc­
an entire population must be reach- ed by the host following specific sti­

May 1985

mulation, and are thus inactivated
and delivered up to killer cells.

It was found experimentally 45
years ago, at the Malaria Institute
of India, that a brief immunity could
be induced in chickens by inoculat­
ing into them large numbers of spo­
rozoites of the appropriate species
of malaria parasite.
The sporo­
zoite when irradiated prior to ino­
culation lost its ability to initiate
the infection but had an enhanced
capability of evoking an immune res­
ponse in the host chicken. The find­
ing was developed in the 1960s in
rodent and monkey malaria models,
and by 1973 successful tests had been
undertaken, under rigorous ethical
and safety precautions, using the
most important human malaria para­
site Plasmodium falciparum in seve­
ral volunteers.

Another approach to malaria im­
munization was also being develop­
ed in the 1960s, involving use of the
blood stages of the malaria parasite.
Injection into test animals includ­
ing monkeys of these stages, princi­
pally the merozoites, immunized the
animals for up to a year but again
the immunity was stage-specific be­
ing protective against fresh merozoite inoculation but not against the
sporozoites to be accompanied by
an adjuvant which enhances the
effect; only recently have adjuvants
been developed that are not toxic
to man.
The third stage of the parasite that
is immunogenic is the gametocyte.
Production of antibodies is stimulat­
ed by inoculation into the animal of
concentrated gametocytes, the sexual
stage that circulates without sym­
ptoms in the animal and waits to
be sucked with a drop of blood into

109

(he biting mosquito in order to ini­
tiate the parasite cycle in the insect.
These antibodies, produced in the
animal, are carried in the drop of
blood into the mosquito, where they
proceed to destroy the gameto­
cytes which upon release from their
ted blood cell shelter are preparing
lo mate. This mechanism, therefore,
does not act to prevent the malaria
attack in the animal, but interfere
with transmission of the disease in
nature.
These three kinds of immuniza­
tion have certain features in com­
mon. They are stage-specific: spo­
rozoites induce production of antibo­
dies protective against sporozoites,
not merozoites. and vice-versa. They
are species-specific: the few sporo­
zoite trials in man indicated that the
two principal types of parasites,
those responsible for falciparum
malaria and those responsible for
vivax malaria, do not cross-protect.
And they are relatively short-lasting,
although there is evidence that small
booster doses may prolong protection
once it has been established.

Availability of malaria vaccines

Problems in producing a vaccine
abound. Only live sporozoites.
which are fragile and cannot readily
be preserved, are immunogenic: it
is impractical to maintain elaborate
colonies of mosquitoes to transmit
them at vaccination centres. Enor­
mous numbers of merozoites are
needed to manufacture a nierozoite
vaccine, and the latter must contain
an adjuvant. The duration of pro­
tection is brief, being measured in
months rather than (as with small­
pox) years.
Nevertheless, the day that a mero­
zoite vaccine becomes available for
human trials has been brought much
closer by two recent developments, a
cultivation method for the mass pro­
duction of merozoites (already func­
tioning in laboratories in several
South-East Asian countries), and the
identification of chemicals that may
prove to be safe adjuvants, it is
even possible that the barrier against
production of a practical sporozoite
vaccine may be circumvented: a
technique is being developed, where­
by the antibody that destroys incom­
ing sporozoites is produced in the
animal in response not to the initial
injections of irradiated live sporozoi­

110

tes but to less complex and fragile
substances that elicit the same res­
ponse.
Furthermore, genetic engineering
is being invoked. Gene splicing (in­
volving implantation in simpler and
more manageable microbes such as
vaccinia virus of the gene responsi­
ble for production of malaria anti­

gen) and hybridoma production (hy­
bridization of a rapidly-reproducing
mouse cancer cell with a mouse ly­
mphocyte cell charged to produce
antibody against human malaria) are
among the methods now being deve­
loped to provide us, in a few years’
time practicable malaria vaccines.
— HFA 200

A STEP CLOSER TO THE MALARIA VACCINE
“Remarkable scientific progress” was made last year in the quest for vaccines
against, malaria, and a vaccine will probably be tested in man within the next
two years.
Reporting this to the Seventy-fifth session of the Executive Board
of the World Health Organization, which was held in Geneva in January 1985. Dr.
Adetokunbo O. Lucas warned that much technical work remained to be done
in the laboratory and in the field before a vaccine would be ready for mass im­
munization campaigns.
Dr Lucas—Director of the Special Programme for Research and Training
in Tropical Diseases (TDR)—said that he knew of some important initiatives
which were being postponed for financial reasons. There was a danger that the
speed of development might be hampered, at least in part, by financial cons­
traints.
The TDR Programme is co-sponsored by the United Nations Development
Programme, the World Bank, and WHO (the executing agency). Dr Lucas re­
ported that a number of important antigens have been identified and their struc­
tures are being definedBiologically active fragments are being synthesized.
Candidate antigens are being produced through genetic engineering, synthesis of
polypeptides and splicing certain malaria parasite genes into the vaccinia virus.

As to when a vaccine will be available, Dr Lucas said: “One realistic esti­
mate is that within the next two years a vaccine will probably be tested in
man”. But he added that testing of candidate vaccines in man and deployment
of vaccines were two separate tilings.
“There has been an important stride
forward, but a lot of technical work needs io be done in the laboratory and in
the field before a vaccine will be ready for use-” There is clear evidence of
industrial interest, he told the Executive BoardSeveral pharmaceutical com­
panies have become involved in the development of the malaria vaccine and
this should accelerate the process.
Malaria is a very widespread debilitating
disease which particularly affects the rural areas of tropical countries and is a
common cause of death, especially among children.
It is caused by a para­
site in the bloodstream which is normally transmitted from person to person by
the bite of a mosquito. In the 1960s there were high hopes that the disease
could be eradicated altogether. But since then, both the malaria parasite and
the mosquito have repeatedly developed resistance to every chemical compound
used against them.

In 1982, a total of 6-5 million confirmed malaria cases were reported.
However this figure did not include tropical Africa, where laboratory confirma­
tion of clinical cases is very limited and reporting is, therefore, deficient. In
fact, the vast majority of cases go unreported, and it has been estimated that
the total of clinical malaria cases in the world in 1982 was in the neighbourhood
of 90 million. The early 1980s have continued to show the general deteriora­
tion in the epidemiological situation throughout the world that has been the pre­
dominant trend over the last decade.
To realize a reduction in the mortality
and morbidity caused by malaria will require not only intensive national efforts,
reinforced by carefully considered WHO regional and global action, but also
major breakthroughs in scientific research.
—■WHO Release

Swasth Hind

HEALTH STATISTICS

MORTALITY PATTERNS
DIFFER EVEN IN THIRD WORLD
Peter Ozorio

The majority of deaths from all causes occurred among the under 15 age group
in developing countries, and in the over 65 age group in industrialized countries.
Infant mortality rates are lowest in Japan, the Netherlands and the Nordic
countries. Life expectancy is highest in Japan for both males and females. Onehundred and thirty seven countries reported some two million cases of measles.
a major childhood disease, during 1982. These are among highlights of the
World Health Organization’s World Health Statistics Annual, 1984. World
Health Organization, Geneva, just published.
q ixteen developing countries of the Western Pacific

O Region of WHO reported altogether more deaths
in 1980 from diseases that normally afflict affluent
nations than from infectious and parasitic diseases.

An estimated 32 per cent—or 2.9 million—of the
deaths in these countries were caused by diseases of
the circulatory system, and other degenerative dis­
eases. such as diabetes, stomach ulcers, and cirrhosis
of the liver, which are among the main problems of
the industrialized world. Infectious and parasitic dis­
eases, the number one killers in the Third World are
estimated to account for 25 per cent—or 2.6 million—
of all deaths reported by the 16 countries, the lowest
proportion of all developing regions. This is attri­
buted mainly to reduced mortality from such diseases
in the largest developing country of the Western Paci­
fic region—-China.
These figures are contained in the World Health
Statistics Annual, 1984 of the World Health Organi­
zation (WHO) which gives mortality for 150 causes
of death, plus estimated infant mortality rates as well
as life expectancy rates for Africa, the Americas, the
Eastern Mediterranean. Europe, South-East Asia and
the Western Pacific, the six geographical regions of
WHO.

Just published, the 400-page Annual also gives
morbidity (the number of cases) for the world’s lea­

May 1985

ding childhood diseases—diphtheria, measles, pertus­
sis, poliomyelities, tetanus, neonatal tetanus, and
tuberculosis.
“The dissemination of this information will hope­
fully encourage countries to use these data to identify
health needs and to improve the management of their
health systems” the report says.

The following are estimates of mortality for infec­
tious and parasitic diseases for other developing
regions •

' — 50 per cent—or 3.5 million—of all deaths in
the African region;
- 45 per cent in the Eastern Mediterranean and
South-East Asian regions—or 1.8 and 6.7
million deaths respectively;

— 31 per cent—or I million—in Latin America
and the Carribean.

“The dissemination of this information will hopeagainst uncritically viewing the health problems of
all developing regions together, and should stress the
need for a more careful scrutiny of regional health
problems?’
AH causes of death
A total of 50 million deaths from all causes were
estimated to have occurred throughout the world, dur­
ing 1980. The rcgion-by-region breakdown:

111

South-East Asia, 15.5 million deaths; the Western
Pacific, 10.5 million; Europe, 8.5 million; Africa, 7.2
million; the Americas. 5.2 million; and the Eastern
Mediterranean, 3.9 million. The mortality pattern by
age structure is as follows :

— In developing countries, the majority of deaths
occurred in the under 15 age group, namely 60 per
cent in the African and Eastern Mediterranean re­
gions; over 50 per cent in South-East Asia; and 40
per cent in Latin America and the Caribbean.
For the 16 developing countries in the Western
Pacific, the figure is under 20 per cent again largely
attributable to China’s progress in reducing mortality
from the infectious and parasitic diseases which tend
to claim mostly young lives.

— In developed countries the majority of deaths—
from 65 to 70 per cent—occurred among people aged
over 65, as compared to 25 to 40 per cent for Third
World countries.
infant mortality

The infant mortality rate (deaths under the age of
one year) ranged from 6 to 8 deaths per 1,000 live
births for Japan, the Netherlands, and the Nordic
countries to over 100 for most African and many
Asian nations. Nonetheless, the rate in most African
countries showed a decline by more than 20 per 1,000
over the last decade. Among the five lowest rates
worldwise over the period 1980-85:

— In Africa: Mauritius and Reunion with 42
deaths per 1,000 live births; Cape Verde, 77; Zim­
babwe, 83; and Botswana, 87.
— In Latin America and the Carribean: Puerto
Rico with 17 deaths per 1,000 live births; Costa Rica,
Cuba plus Martinique, 20 each; and Barbados plus
Guadeloupe, 23 each.

— In South-East Asia: Democratic People’s Re­
public of Korea with 32 deaths per 1,000 live births;
Sri Lanka, 38; Mongolia, 50; Thailand, 51; and Indo­
nesia, 87.
— In the Western Pacific: Singapore, with 11
deaths per 1,000 live births; Hong Kong, 12; Fiji, 28;
Malayasia and the Republic of Korea, 29; and China,
38.

— In developed nations: Finland, Sweden, plus
Iceland with 7 deaths per 1,000 live births each; and
Denmark, Norway, the Netherlands and Japan, with
8 each.
— Among other infant mortality rates: England
and Wales with 11 deaths per 1,000 live births; France
10; Canada 11; the United States 12.
Life expectancy

Japan leads in life expectancy for both males and
females, the WHO Annual shows. For the former, it
is 74.5 years, and for the latter, 80.2.

112

Greece is second in male life expectancy, at 73.6
years, followed by Hong Kong, 73.5; Sweden, 73.5;
and the Netherlands, 72.8.

Hong Kong is second in female life expectancy at
79.9 years, followed by Norway, 79.8; the Netherlands,
79.7, and Sweden, 79.6 Hong Kong is the only Third
World area ranking among the top five with a life
expectancy for men and women equal to that of in­
dustrialized nations. Over the last decade, Viet Nam
showed the largest increase in life expectancy, 8.5
years; followed by China, 8.3 years; Jordan, 7.6
years; and Syria, 7.3.
Specific causes of death

While general mortality figures are shown for deve­
loping and developed countries alike, the Annual
gives specific causes of death, adjusted for age, for
30 countries, mainly industrialized. Highlights in­
clude :
— Ischamic heart disease: The death rate from
heart attack for both men and women ranged from a
peak of 300 per 100,000 population adjusted for age,
as in Scotland, to a minimum of 49, in Japan. Second
among the top five rates are those of Ireland and
Finland, each reporting around 280 deaths per
100,000: followed by Czechoslovakia, 270; and New
Zealand, 267.
Other rates include: Sweden with 264 deaths per
100,000; the United States, with 250; England and
Wales, with 244; plus, among the lower rates, the
Federal Republic of Germany’s 166; Itlay’s 129; and
France’s 75.

— Cancers, All forms: The death rates from can­
cers for both men and women ranged from a maxi­
mum of 256 per 100,000 population, age-adjusted, as
in Luxembourg, to a minimum of 118, in Puerto
Rico.

Second among the top five rates are those of Hun­
gary, reporting 244 deaths per 100,000, followed by
Scotland, 238; Belgium and Czechoslovakia about 230
each.
Among other rates are the following: England and
Wales with 215 deaths per 100,000 population; France
205; Canada with 202; the United States 192. Among
the lower rates: Japan, 163; Kuwait, 150; Bulgaria,
149; and Mauritius, 124.
— Lung cancer: The death rate from lung cancer
along ranged from a peak of 70 per 100,000 popu­
lation, age-adjusted, as in Scotland, to a minimum of
22, in Sweden.

Second among the top five rates are those of
England and Wales, as well as the Netherlands re­
porting between 56 and 57 deaths per 100,000 popu­
lation each, closely followed by Belgium 53.7. Canada

Swasth Hind

end the United States, along with Denmark, Czechos­
lovakia, Hungary and Luxembourg, each showed a
death rate of roughly 50 per 100,000.
Among the lower rates, are those of Norway with
24; and of Japan, with 23.

Figures for Canadian women alone show a steadily
increasing death rate from lung cancer, from 18.1 in
1979, to 22 per 100,000 in 1982, representing a 20
per cent increase in deaths in four years, doubling
that of Canadian men.
— Alcoholism'. The death rates from cirrhosis, of
the liver for both sexes ranged from a peak of 33 per
100,000 population, age-adjusted, in Italy, to a mini­
mum of four, that of England and Wales.

Second among the top five rates are those of Hun­
gary. reporting 31.7 per 100,000 population, followed
by France, 28.2; Austria, 27.2; and Yugoslavia, 24.4.
Among other rates are the following: Federal Re­
public of Germany, 22.8 deaths per 100,000; Czechos­
lovakia, 20.3; Japan 15.6; the United States, 15.5;
Canada 11.9, plus among lower rates, that of Nor­
way, 4.4; Ireland. 4.7; and the Netherlands, 5.9.
— Accidents: The death rates from road accidents
for both sexes ranged from 23.4 per 100,000 popu­
lation, age-adjusted, as in Yugoslavia, to a minimum
of 8.8. in Sweden.

Second among the top five rates are those of Aus­
tria, reporting 23.1 per 100,000, followed by the Uni­
ted States, 21.4; Australia, 21.3; and New Zealand,
20.6.
Among other rates are the following: Belgium with
21.2 deaths per 100,000 population; France, 19.7; the
Federal Republic of Germany, 16.2; Canada, 15.5,
plus, among the lower rates, that of Sweden 8.8; Eng­
land and Wales. 9.7; and Japan, 10.7.

Childhood diseases
The incidence by region of childhood diseases re­
ported to WHO during 1982 is as follows:

— Measles: Some 2 millions cases reported by 137
countries. The breakdown: 660,000 reported in the
Western Pacific; 630,000 in Africa; 230,000 in SouthEast Asia; 200,000 in the Eastern Mediterranean;
190,000 in Europe; and 130,000 in Americas.
— Tuberculosis: Some 1.6 million reported by 114
countries. The breakdown: 750,000—nearly one half
of the total—in the South-East Asia; 420,000 in the
Eastern Mediterranean; 205,000 in Africa; 175,000
in the Western Pacific; 30,000 in the Americas; and
15,000 in Europe.

May 1985

— Pertussis {whooping cough): Some 1.1 million
cases reported by 135 countries. The breakdown:
335,000 in the Western Pacific; 305,000 in South-East
Asia; 180,000 in Africa; 120,000 in the Eastern Medi­
terranean; 85,000 in the Americas; and 60,000 in
Europe.

— Tetanus: Some 75,000 cases reported by 127
countries. The breakdown: 50,000 in South-East Asia;
9,000 in Africa; 7,000 in the Western Pacific; 4,000
in the Eastern Mediterranean; 3,700 in the Americas;
and 300 in Europe.

— Diphtheria: Some 53,000 cases reported by 120
countries. The breakdown: 20,000 in South-East Asia;
18,000 in the Western Pacific; 10,000 in the Eastern
Mediterranean; 3,800 in the Americas; 1,500 in
Africa; and 140 in Europe.
— Poliomyelitis: Some 37,000 cases reported by
124 countries. The breakdown: 16,000 in South-East
Asia; 9,000 in the Western Pacific; 7,000 in the Eas­
tern Mediterranean; 3,000 in Africa; 800 in the
Americas; and 250 in Europe.
— Neonatal tetanus: Some 6,000 cases reported
by 51 countries. The breakdown: 2,000 in South-East
Asia; 1,500 in Africa; 1,400 in the Eastern Mediter­
ranean; 800 in the Americas; and 50 in the Western
Pacific. No cases of neonatal tetanus were reported
in Europe in 1982.

Although the number of countries reporting these
diseases has increased, the total number of cases re­
ported “for most diseases is known to be low,” the
Annual says. For instance, while more countries are
reporting neonatal
tetanus—caused by unhygienic
ways of cutting the umbilical cord—experts estimate
that figures represent only between two and five per
cent of all cases.

Furthermore, even though some one million deaths
are estimated to occur in the world from the disease,
the WHO Annual says, “until recently tetanus immu­
nization of women has not been considered a priority
in most immunization programmes and reporting of
tetanus separately from all tetanus is only being done
by a few countries.” Though still low, reporting is
better for measles, “estimated to be about three per
cent” and even polio, “between one and 26 per cent.”
“Documentation of success is required to sustain
the political and financial support being provided to
the immunization programme”, the WHO Annual
notes, “and documentation of failure is required, to
guide remedial actions.”
«

—WHO Feature

113

CANCER

CANCER CELLS REMOVED BY
MAGNETIC BEADS
Tim Haines
n the summer of 1983 a little girl’s life was saved

I

by some minute polystyrene beads, a magnet and
a special cocktail of chemicals from a mouse.
This extraordinary treatment was the result of five
years’ work by Dr John Kemshead and his team at
the Imperial Cancer Research Fund (ICRF) in Lon­
don. The team is now at the centre of an interna­
tional programme to treat children suffering from the
same disease that threatened the girl’s life—a rare
but lethal form of cancer called neuroblastoma.

The technique used is a revolutionary way of clean­
ing tumour cells out of bone marrow and, if it proves
successful in the long term, it has implications in
many other forms of cancer.
All aggressive tumours, such as neuroblastoma,
have an unpleasant habit of metastisising where bits
of cancerous tissue break away from the original
growth and settle elsewhere in the body to form se­
condary cancers. It is, therefore, vital when treating
these patients to dose the whole body. Unfortunately,
bone marrow is very sensitive to the strong chemi­
cals and radiation used by doctors to kill the malig­
nant cells in a cancer patient’s body.

Cleansing bone marrow

First he went to the Jet Propulsion Laboratories in
Pasadena, United States of America, and borrowed
some minute beads designed there by two polymer
chemists. Each sphere was made of polystyrene with
a magnetite core and measured only 3 /xm across-in
other words, tens of thousands could fit on the head
of a pin. These beads could make the tumour cells
magnetic but a way had still to be found of attaching
them to the cell surface.

To do this, Dr Kemshead used special molecules
called monoclonal antibodies. These naturally adher­
ed to the surface of the beads and then, when mixed
with the marrow sample, hunted out the cancer cells,
rather like heat-seeking missiles, and attached them­
selves and the beads to them.

Producing antibodies

However, making the monoclonal antibodies was
not easy. First the research team had to inject neuro­
blastoma cells into a mouse and then wait two or
three months while the animal’s natural defence cells
made antibodies (molecules specifically designed by the
immune system to identify foreign particles in the
body) against the neuroblastoma. The mouse’s spleen
was then removed with the immune cells it contained
made immortal by fusion with a myeloma cell line
which just kept cloning off exact replicas. This took
a further two -months.

So, before treatment begins, some marrow is re­
moved and kept safely while high doses of drugs are
used. When the marrow is returned, it has the capa­
city to grow and regenerate. But the whole treatment
will have been wasted if in the sample returned to the
patient there are cancer cells ready and waiting to
start growing again.

The resulting monoclonal antibodies had to be ri­
gorously tested to make sure they only homed in on
neuroblastoma cells and did not also stick to normal
marrow cells. At all stages during this process there
was the danger of infection—something that could
wipe out the whole batch of antibodies.

What Dr Kemshead has managed to do is to find an
efficient method of cleaning the sample before it is
returned to the treated patient. His idea was simple
—make the tumour cells magnetic and then draw
them out with a magnet leaving a pure marrow sam­
ple behind.

Dr Kemshead estimates that it takes about a year
to develop a monoclonal antibody and in order to
catch all the neuroblastoma cells he used a mixture
of six. Now his laboratories at the ICRF’s Institute
of Child Health in London have become a centre for
monoclonal production. Marrow samples, chilled for

114

Swasth Hind

transportation, are sent from all over the world to be
cleansed by the new magnetic technique. So far, 21
children have been treated in this way, some from
Lyons, France, and others from Boston, United States;
Milan, Italy; and Dublin, Republic of Ireland. All
but one are still alive and many have returned to
normal lives.

Limited number
The longest survivor is a little French girl called
Claire. She had already been treated for neuroblas­
toma with a complete course of radiation and anti­
cancer drugs. But her bone marrow still contained
2% cancer cells.
So in July 1983 about 10% of her marrow was
removed and flown to London. There it was raced
by car to the ICRF laboratories and cleaned by Dr
Kemshead. Twenty-six days after the marrow had
been returned to Claire she was out of hospital and
some nine months later there had been no sign of the
cancer returning.

However, this treatment is still on trial. Dr Kemshead’s facilities are available only to the small group
of doctors and their patients involved in the present
study.
In the near future the ICRF team will continue to
treat only these small numbers of patients until follow­
up investigations have confirmed the efficacy of the
work.

Quick contact
Meanwhile, the team continues to work on differ­
ent monoclonal antibodies. The main thrust of the
research has been on finding some for leukaemias or
blood cancers.
It is also possible to link very potent poisons to
(monoclonal antibodies. These can then be injected
into the bone marrow and the antibody homes in on
the cancer cell bringing the toxin with it, destroying
the malignant cells. It guides the poison away from
the patient’s normal tissue. Blood cancers are the
most rewarding area to work in because, after injec­
tion, the monoclonal antibodies are quickly brought
into contact with the disease. Most of the work is on
childhood illnesses but the team hopes soon to have
monoclonal antibodies for a blood cancer called com­
mon acute lymphoblastic leukaemia that affects both
children and adults.

May 1985

Dr John Kemshead of the Imperial Cancer Research
Fund (ICRF), London whose team is experimenting
cancer cell removal by magnetic beads

Overcoming rejection
Another area where Dr Kemshead’s team is work­
ing on “cleaning up” bone marrow for transplanta­
tion. With some diseases, all the patient’s bone mar­
row is destroyed and doctors often try to replace it
with donor material.
However, unless this is a perfect match the host
rejects the new tissue. This adverse reaction is encou­
raged by the presence of immune cells, called Tlymphocytes, in the donor marrow. If these can be
identified and removed before the graft is put into
the host, it will reduce the amount of rejection.

Working with groups at University College Hospi­
tal, London, and at the University of Cambridge, the
ICRF researchers soon hope to have the right cock­
tail of antibodies to do this. For the present, the
magnetic solution to one type of cancer is the only
practical treatment to result from their work but, with
this proving to be 99.9% successful, there is a pro­
mise of further successful treatments.
A

115

Leading experts in the treatment of cancer pain from 22 countries met in Geneva
from 11-14 December, 1984. According to recent estimates, each year more than
ten million cancer patients suffer pain. In 30 per cent of cases the pain is severe
or even unbearable.

FREEDOM FROM CANCER PAIN
in pain therapy from 22 countries have
recommended wide-ranging measures to counter
the general neglect of the problem of cancer pain,
while simultaneously calling for education and infor­
mation programmes to promote the concept of “Free­
dom from Cancer Pain” as a right for cancer patients.
xperts

E

The recommendations, made to the World Health
Organization (WHO) following a four-day meeting on
cancer pain held in Geneva from 11-14 December
1984 to recommend a global programme of cancer pain
management, take into account virtually all aspects
—psychological, technical, legal and educational—of
the treatment of cancer pain.

“Drugs are the mainstay of cancer pain manage­
ment”, the experts state. “If used correctly—the right
drug in the right dose at the right time inervals—
they are effective in a high percentage of patients.”
And they add: “The scientific foundation for the suc­
cessful treatment for cancer pain now exists.”
In major recommendations, the experts:
—Urge governments to ensure that legislation con­
trolling the use of opioids (narcotic drugs) do not
‘‘prevent cancer patients with pain from getting the
pain-relieving opioids that they need.”
—Call for more education in pain management at
both the graduate and undergraduate levels.

—Advocate information through mass media so
that patients, and particularly their families, are made
aware that pain is not inevitable, and almost always
controllable.

—Advocate also as the basis for the management
of pain WHO’s “Guidelines for Relief of Cancer
Pain”, a part of which is a three-stage “pain-control
ladder” that sets out (he drugs required—aspirin, co­
deine and morphine—for relieving pain.
—Ask that a global network be established to help
disseminate knowledge about pain and what can be
done about it. Thus far 32 countries are part of the
network.

116

. —Set as goal the treatment of cancer pain, not only
in specialized cancer centres, which is the case now,but in hospitals and homes.

In the case of cancers far advanced, the experts’
view is that patients receive care in their home should
they wish.
Furthermore, the experts state “family members be
given training in the home care of cancer patients,
and receive financial support”, for instance paid leave
from work.

Worldwide one out of ten deaths are due to can­
cer. According to the experts each day close to four
million people are suffering from cancer pain, or are
being treated for it.
The meeting was chaired by Dr Kathleen Foley,
Memorial Sloan-Kettering Cancer Center, New York.
The vice-chairmen were Dr Luzito de Souza, Tata
Memorial Hospital, Bombay and Dr D. C. Jayasuriya, Colombo, Sri Lanka. Dr Robert Twycross, Chur­
chill Hospital. Oxford, was rapporteur.

Problem of cancer Pain

According to recent estimates, each year more
than ten million cancer patients suffer pain. In 30
per cent of cases the pain is severe or even unbear­
able.
Although there is the knowledge of how to re­
lieve pain, WHO experts say, very little is being
done not only in developing countries, which lack
the medications needed as well as the expertise, but
also in industrialized countries where analgesics—
pain-killers—are available.
He quotes as an example the US National Cancer
Institute, which spent nearly $ 5.5 billion on can­
cer programmes from 1971 to 1976. Of that total,
only $ 560,000 went for research on cancer pain.
Figures published earlier this year show that there
are numerically more cases of cancer in the Third
World than in developed countries. Of an estimated

Swasth Hind

5.9 million new cases worldwide, 3 million occur in
developing countries. Most are incurable at the time
of diagnosis.
In addition, the figures show that there are more
deaths from cancer yearly in the developing world,
2.3 million, than in the developed world, 2 million.
Such facts have lead WHO to launch a conscious*
ness-raising campaign under the theme “Cancer is
a Third World Problem Too.” Its aim is to prevent
a third of all cancers, to cure a third, if cases arc
detected early enough—and to relieve pain.

A major problem in pain relief is Lear of addiction,
which leads physicians to undcr-prescribe drugs, and
nurses to under*dose patients. In addition, many pa­
tients are unaware that pain can be relieved and con­
sequently accept suffering needlessly.

Another problem is the insufficiency of professional
education in cancer pain therapy. A study of text­
books on clinical management of cancer commonly
used in US schools of medicine show less than a
quarter of one per cent of pages devoted to pain.
Yet another problem is that of reconciling the needs
of the patient for pain relieving drugs on the one
hand, to legislation controlling drugs on the other.
WHO’s three-step treatment
Eighty-seven per cent of cancer patients who were
part of a Japanese test of guidelines for pain therapy
f—or a total of 136 out of 156 patients—received
“complete relief” when put under a three-step treat­
ment for the management of pain developed by the
World Health Organization (WHO).
The tests were carried out in 1983-84 by Dr Fumikazu Takeda at the Saitama Cancer Center, north of
Tokyo, according to a report presented at the open­
ing of a four-day WHO meeting on pain management.

Central to the guidelines for pain therapy is the
administration of analgesics—pain-killers—regularly
at fixed intervals, rather than only “as required” at
times of pain, which is generally the practice.
The drugs increase in strength, from non-narcotic
to mild and then to strong narcotic pain-killers until
the patient is pain-free—hence the concept of the
treatment as an “analgesic ladder.” If a drug proves
ineffective, a stronger, rather than a different, drug is
prescribed.

Additional drugs, technically called “adjuvants,”
are also used under special conditions. Psychotropic

May 1985

drugs are prescribed, for instance, to calm fears and
«anxieties.
As part of a new initiative, WHO is attempting to
raise consciousness to a largely neglected problem
in cancer care, the management of pain. The guidelines
have been developed essentially to teach non-pain
specialists how to control most cancer pain by the use
of a few potent drugs well.
The ages of the patients treated at the Saitama
centre ranged from 8 to 83. Most of them sufferred
from gastrointestinal cancer, but lung, head and neck,
and breast cancer were among prevalent forms. In 80
per cent of patients cancer had spread.

Before cancer therapy commenced, pain was severe
ifor about two-thirds of patients. “Most patients suffer­
ed from their pains throughout the day, and had an­
xiety and fear, and some were deeply depressed,” Dr
Takeda said.

Aspirin or paracetamol was given by mouth every
four to six hours to patients with mild or moderate—
and at times even severe—pain. Where these non-narcotics were ineffective, codeine, a mild narcotic, was
added, administered, again, at regular intervals.
Where pain was not relieved by non-narcotics or
mild narcotics, and when pain was severe and chronic,
morphine was given every four hours, in some cases
with adjuvant drugs.

“Psychological dependence was not reported at
all,” says Dr Takeda. But, “in the strong narcotic
group, nausea was the most frequent side effect.” It
was observed in 21 patients.

Overall, through the application of the “ladder”
principle for cancer pain relief, 87 per cent of pa­
tients received “complete relief,” 9 per cent “accep­
table relief,” and the remaining 4 per cent “partial
relief.”
In addition to Japan, tests are also being carried
out in India, Italy and the United States.
One out of ten individuals world-wide dies of
cancer. According to WHO, over a half of all can­
cer patients suffer needleesly from pain because pain­
killers are not adequately used, and too little train­
ing is provided to cancer specialists in how to treat
pain.

What is needed now, WHO experts say, is to ap­
ply what is already known to bring help to millions
of sufferers throughout the world.
/\

117

BATTLE AGAINST CANCER
Deep-Tumour Treatment On Trial
Doctors hope that trials, soon to start in Britain
with the world’s most advanced neutron therapy
machine, will lead to the successful control of deepseated tumours for which there is at present no
effective treatment.

The 60 million electron-volts cyclotron machine,
which has the most penetrating and accurate beam
of neutron radiation available in any hospital, has
been completed at Clattcrbridgc Hospital near Liver­
pool (North-West England) at a cost of £3 million.
It will start treating patients al the end of this year.
Neutron therapy was developed as a result of cli­
nical research on a cyclotron at London’s Ham­
mersmith Hospital, which was the first machine of
its type to be used exclusively for medical research.
It has now been used to treat over 2,000 people
suffering from tumours that were inoperable or re­
sistant to radiotherapy. At least a dozen high-energy
machines arc now involved in cancer treatment in
the United States, Federal Germany, Belgium and
Japan, and a number use dose and treatment tech­
niques developed al the Hammersmith Hospital.
The treatment involves the use of neutrons, the
particles that exist in atomic nuclei. When produ­
ced in a high-energy beam by the cyclotron, fast neu­
trons interact with body matter to successfully com­
bat tumour cells resistant to X-rays and gamma
rays.

The Clattcrbridgc cyclotron machine will be able
to tackle deep-seated tumours in the stomach, pan­
creas and prostate—areas where surgery and X-ray
treatment have a less than 30 per cent success rate.
The new machine also has a special device that al­
lows the neutron beam to be steered with precision
onto the tumour. Because of its accuracy there will
be less damage to healthy tissue next to the tumour.
The trials planned for the Clatterbridgc machine
will involve some 500 patients and should produce
for the first time a definitive assessment of the value
of neutrons in cancer treatment.
—B.I.S.

Early detection saves lives
Well-known Soviet
surgeon Nikolai Malinovski,
recently announced in a press conference that the
growth of the number of lethal cancer cases in the
USSR has been stopped due to the accomplishments of
national medicine. In recent years, the cancer mor­
tality rate among men has remained unchanged,
while women show a downward trend.

The Academician said that the slogan of the
World Health Organisation that cancer is curable in
principle and that its early detection saves life was
well justified and has been confirmed by practice.
The development of new drugs as well as laser and
isotope therapy improve the chances of convales­
cence. Surgeons are now
successfully performing

118

.operations which they would not dare perform ear­
lier. This does not mean, however, that a radical
cure for cancer has been found, Malinovski said.
—Soviet Features, Nov. 1984
Primary
health workers can detect
mouth lesions

prccanccrous

Mouth cancer is the commonest form of cancer
in South-East Asia. More than 100 000 cases are
estimated to occur yearly, some 90% of them cau­
sed by iocal forms of betel nut and tobacco quid
chewing and smoking.
Fortunately, up to 15 years may elapse before the
precursor lesions become malignant. If these mouth
lesions are detected in time, the disease is curable
through radiotherapy and
surgery. Unfortunately,
however, most sufferers seek help only when they are
in pain, which is an advanced symptom. By then, it
is too late. A study of hospital patients in Sri Lanka
showed that only a minority of all mouth cancer cases
were detected early enough for cure.

A pilot project carried out jointly by Sri Lanka
and WHO has demonstrated the possibility of early
detection with simple technology applied by primary
health workers, mainly midwives- In one year 35
such workers examined 29,000 villagers in the course
of routine house visits near the ancient capital city
of Kandy. They had learned in a two-day training
course to check 10 sites in the mouth for red or white
patches, ulcers, nodules, or tumours.
“They took the adults outside in the sunlight, sat
them on a chair, and examined their mouths with
two long-handled dental mirrors”, explained the pro­
ject leader, Dr Saman Warnakulasuriya, who is Di­
rector of the Department of Oral Medicine al Peradeniya University. “It took about three minutes.” The
midwives found suspicious signs in 1200 people—
about 4% of those screened—and referred them for
further examnation. Although only about half of the
people referred showed up for re-examination by me­
dical staff al the dental school, 90% of these were
confirmed to require medical care or close observa­
tion.

So capable have primary health workers proved
that the project has now been extended to Jaffna and
Galle, at opposite ends of the island.
—WHO Chronicle
Cervical Cancer: If treated early, cure is 100 per cent

Throughout Latin America and the Caribbean, can­
cer of the cervix is the most common cancer and the
leading cause of cancer deaths among women“Approximately one in every thousand women bet­
ween 30 and 35 years of age ... will develop cervical

Swasth Hind

cancer every year,”. WHO’s regional
Americas, in Washington, D. C. reports.

office for the

It takes about five years for localised cancer to de­
velop and another ten years for “invasive”, or advan­
ced, cancer to set in. Tf a patient is treated at an
early stage, the cure rate is virtually 100 per cent. Tf
she is treated later, when the disease has begun to
spread, it is 45 per cent.
Says Dr Jorge Litvak. Programme Coordinator for
Adult Diseases: “Tf we detect it at the early stage, a
cure is possible with minimal treatment. And that is
important for developing countries- Cervical cancer
responds well to radiotherapy with standard—not so­
phisticated—equipment adequate for treatment. Tn
the event that surgery is required, a person with gy­
naecological skills can carry out the operation.” Ac­
cording to recommendations, where the prevalence of
cervical cancer is high, women who are sexually
active should take a Pap smear yearly. Where the
prevalence is low, they should take the test two years
in a row and then every three years.
—HFA 2000

“We estimate (hat 80 and 90 per cent of chronic lung
disease in the country is directly attributed to cigarette
smoking, and thus over 50,000 of these deaths could
have been prevented.” Dr C. Everett Koop, the Surgeon
General says. He has called for a smoke-free society
by the Year 2000.
In addition, his report cites “very-solid” evidence
that “passive smoking” poses a health problem to
non-smokers, and especially to children. Those from
smoking households have been shown to be more susce­
ptible to respiratory diseases than those whose parents
are non-smokers, the report says, leading the Surgeon
General to suggest that “a parent interested in the
best health of his children should stop.”
Legislation making the language of warnings more
precise has already passed the U.S. House of Repre­
sent lives and is now being considered by the U.S.
Senate.
•
—World Health, October 1984

SITUATION TN INDIA

The Chronology of U.S. Warning Against Cigarettes

National scheme for control of cancer

Warnings on cigarettes packages and advertising.
required under U.S. law. grew sterner in tone in just
five years, from 1965 to 1970—From the cautious,
“Cigarette Smoking May Be Hazardous to Your
Health” to the assertive, “It is Dangerous to Your
Health” as the link between cigarettes and ill health
became irrefutably established.

Il was estimated that 3.00,000 people died of cancer
every year, based on data collected by the Population
Based Cancer Registries at Bangalore, Bombay and
Madras under the National Cancer Registry Project of
the Indian Council of Medical Research. This infor­
mation was given in the Lok Sabha on 2 August, 1984.

Now. along with the 1983 Surgeon General’s report
showing 62,000 deaths from chronic lung disease, such
as emphysema, the U.S. Congress is readying even’
stronger alerts. Proposed are four labels to be rotated
on packages and advertising. (See box below for chro­
nology of warnings.)

Information on trends of cancer incidence on a
national basis was not available. However, such in­
formation was available for the Bombay Metropolitan
area only through Bombay Cancer Registry since 1964,
according to which there had been a slight increase in
cancer incidence. The age standardised incidence rates
per 1,00.000 males were 137.7 (1964-72) and 140.2
(1975-78) and per 1.00.000 females were 122.7 (196472) and 129.0 (1975-78).

Adopted 1965
Caution: Cigarette Smoking May be Hazardous to
Your Health.
Adopted 1970
Warning: The Surgeon General Has Determined
That Cigarette Smoking is Dangerous to Your Health.
Proposed 1983
Surgeon General's Warning:
Smoking by Pregnant Women May Result in Fetal
Injury. Premature and Low Birth Weight.

Surgeon General’s Warning:
Cigarette Smoke Contains Carbon Monoxide.
Surgeon General’s Warning:
Smoking Causes Lung Cancer. Heart Disease, Emphy­
sema and May Complicate Pregnancy.
Surgeon General’s Warning:
Quitting Smoking Now Greatly Reduces Serious Risks
to Your Health.

May 1985

The Government had launched a cancer Research
and Treatment Programme in 1.975 during the 5th
Five Year Plan. Under this Programme, 10 existing
Cancer Institutions had been identified as Regional
Centres for Cancer Research
and Treatment; 24
Early Cancer Detection Centres and 25 Post Partum
Pap Smear Testing Units had been set up. Under
this Programme. Central assistance of Rs. 12.00 lakhs
and Rs. 50.000 was also afforded to State Government
insti'utions/voluntary organisations for installation of
Cobalt Therapy Units and setting up of Early Cancer
Detection Centres respectively. Apart from this, three
Population Based Cancer Registries at Bangalore.
Bombay and Madras and
three Hospital Tumour
Registries at Chandigarh. Trivandrum and Dibrugarh
had been set up.

Rise in Incidence of Lung Cancer
Accurate information on the trends of lung cancer
incidence on a national basis is not available. How­
ever. according to information from
the Bombay

119

Cancer Registry since 1964. there has been a slight in­
crease in the age adjusted incidence rate of lung
cancer in males.

There is a considerable evidence from different parts
of the world implicating cigarette smoking as the main
cause of lung cancer.
The World Health Organisation has warned that
lung cancer may acquire serious proportions in deve­
loping countries if concerted action against tobacco
smoking is not initiated at the present time.
The Indian Council of Medical Research consti­
tuted a Task Force on primary and secondary preven­
tion of oral precancerous and cancerous lesions in
1982 whose recommendations pertain to a large extent
to the control of tobacco use and health education to
the people against dangers of smoking. The Govern­
ment of India had already enacted legislation titled
’Cigarette (Regulation of Production, Supply and Dis­
tribution) Act. 1975. The main objective of the Act
is to provide restriction in relation to trade and com­
merce and production, supply and distribution of ciga­
rette and for matters connected therewith or inciden­
tal thereto. A number of other measures including
health education have also been* undertaken.
This information was given in Lok Sabha in reply
to a question in August 1984.

Integrated approach to fight cancer

Experts participating
in the first
international
workshop on “head and neck cancer”, warned that
incidence of cancer in India was likely to increase
because of industrialisation and other health hazards.
They pleaded for an integrated approach on a na­
tional level to control and cure the disease in the
early stages. Facilities for detection and treatment
should be made available at the district level to pre­
vent the disease from assuming alarming proportions.
Participants in the international workshops held on
2 January. 1985. at New Delhi for the first time, dis­
cussed various aspects of the disease, the treatment
available in the country and advances made to com­
bat the malady.
They said that prevention was better than cure. Pre­
vention was easier in the case of head and neck
cancer by reducing the intake of tobacco and main­
taining a better standard of oral hygiene.

Inaugurating the workshop, attended by over 200
Indian and foreign experts, the Union Minister for
Parliamentary Affairs, Shri H. K. L. Bhagat, called
upon doctors to educate the people about cancer. He
said the head and neck cancer affected 1,50.000 people

120

in the country every year. The patients mostly be­
longed to the weaker sections. Efforts should be made
for early diagnosis and optimal treatment to patients
in medical colleges and district hospitals.
Shri Bhagat urged the doctors to develop simple and
cheap diagnostic tools for cancer so that they could
be used by those in distant areas of the country.

Prof. B. N. Sinha of the Association of Surgeons of
India, said the younger generation should be involved
in the cancer eradication programme.
Dr Prom Kakar, head of the ENT department of
Maulana Azad Medical College and joint programme
chairman of the workshop, said the workshop would
formulate a programme to fight the disease with a
target to eradicate it by 2000 A.D.

He said most of the 500.000 cancer cases reported
every year were beyond-cure because of the advance
stage of the disease. The head and neck cancer ac­
counted for 40 per cent, to the total incidence of
cancer. The percentage of the middle age people was
highest among the head and neck cancer patients.
Prof. K. Shanmugaratnam. Professor of Pathology.
National University of Singapore, and Director, Singa­
pore Cancer Register, in his keynote address on “epidemology of head and neck cancer”, said the incidence
of this cancer was 5 to 28 per cent, of the total cancer
burden in various countries. Tn India the percentage
was higher. Mouth cancer could be prevented by
slopping or cutting down intake of betels as well as
cigarettes.

Dr Jatin Shah, an expert from a prestigious cancer
institute in the U.S., said it was possible to cure a
person. As a result of these advances, he said it was
now possible to save three out of four persons and
prolong their lifespan as compared to the earlier survi­
val ratio of one out of every three.
He pointed out that it was possible to prevent
cancer by using vitamin analogues which are compound
pre-cursors of vitamins. They were known to prevent
or retard cancer in animals. These compounds, known
as Retinoids, were now being tested on human beings.
Every person who has the habit of smoking of chew­
ing betels should have a thorough check-up every year.
Dr Ashok Mehta of the Tata Memorial Hospital,
Bombay, said mouth cancer was eight times more pre­
valent among ‘pan’
chewers.
Smokers developed
throat cancer or laryngeal cancer. According to him,
most of the 75 per cent, neck and throat cancer cases
were reported al a very late stage when no line of
treatment was possible.
x
A

Swasth Hind

CANCER DIAGNOSIS AND TREATMENT
CENTRES IN INDIA
nder Cancer Research and Treatment Programme

U

have been established in the country. These are :

10 Regional Cancer Centres

1. Chiltaranjan National Cancer Research Centre, Calcutta.
2. Cancer Institute, Madras.
3. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences,
New Delhi.
4. Gujarat Cancer & Research Institute, Ahmedabad.
5. Kidwai Memorial Institute of Oncology, Bangalore.
6. Cancer Hospital and Research Institute, Gwalior.
7. Regional Centre for Cancer Research and Treatment, Cuttack.
8. Dr. B.B. Cancer Institute, Gauhati.
9. Cancer Wing of the Medical College, Trivandrum.
10. Tata Memorial Cancer Centre, Bombay.
Besides, the Indian Council of Medical Research have one permanent institute
(Cytology Research Centre) located at the Maulana Azad Medical College, New
Delhi where one of the thrust areas of work is on early diagnosis of cancers of the
uterine cervix (which is the most common cancer in Indian women) and on studying
the natural history of precancerous lesions of the uterine cervix using a multi­
disciplinary approach.
While the first 9 cancer centres are supported financially by the Ministry of
Health and Family Welfare the 10th at Bomoay is under the administrative control
of the Department of Atomic Energy who also support it financially.

Apart from the above there are about 142 hospitals in the country where
treatment facilities for cancer are available :
ANDHRA PRADESH
1. Mehdi Nawaj Jung
Cancer Hospital,
HYDERABAD, Andhra Pradesh.
2. M.G.M. Hospital,
Warangal, Andhra Pradesh.
3. Govt. General Hospital
Kakinada, Andhra Pradesh.
4. Govt. General Hospital
GUNTUR, Andhra Pradesh.
5. Govt. General Hospital
KURNOOL, Andhra Pradesh.
6. S.V.R.R. Hospital,
TIRUPATl, Andhra Pradesh.
7. King George Hospital,
VISHAKHAPATNAM, A. P.
S. Gandhi Hospital,
SECUNDERABAD, A.P.

May 1985

ASSAM
Assam Medical College
and Hospital,
D1BRUGARH, Assam.
10. Gauhati Medical College
and Hospital, GAUHATI
11. Dr. B. Bruch Cancer
Institute, GAUHATI.

9.

BIHAR
Medical College &
Hospital, PATNA.
13. Medical College &
Hospital, DARBHANGA.
14. Mehcrbai Tata Memorial
Hospital, JAMSHEDPUR.

12.

GUJARAT

M. P. Shah Cancer Research
Institute, AHMEDABAD.
16. Civil Hospital,
AHMEDABAD (H&P).
17. Seth Vadilal Savabhai
General Hospital,
AHMEDABAD.

15.

IS. Irwin Group of Hospital,
JAMNAGAR.
19. Shri Sayaji General Hospital,
BARODA.
20. Sir T. Hospital,
BHAVNAGAR.
21. Govt. Hospital.
RAJKOT.
22. Nathalal Parekh Cancer
Hospital, RAJKOT.

121

Cancer Registry since 1964. there has been a slight in­
crease in the age adjusted incidence rale of lung
cancer in males.

There is a considerable evidence from different parts
of the world implicating cigarette smoking as the main
cause of lung cancer.
The World Health Organisation has warned that
lung cancer may acquire serious proportions in deve­
loping countries if concerted action against tobacco
smoking is not initiated at the present time.
The Indian Council of Medical Research consti­
tuted a Task Force on primary and secondary preven­
tion of oral precancerous and cancerous lesions in
1982 whose recommendations pertain to a large extent
to the control of tobacco use and health education to
the people against dangers of smoking. The Govern­
ment of India had already enacted legislation tilled
‘Cigarette (Regulation of Production, Supply and Dis­
tribution) Act. 1975. The main objective of the Act
is to provide restriction in relation to trade and com­
merce and production, supply and distribution of ciga­
rette and for matters connected therewith or incidential thereto. A number of other measures including
health education have also been' undertaken.
This information was given in Lok Sabha in reply
to a question in August 1984.

Integrated approach to fight cancer
Experts participating
in the first
international
workshop on “head and neck cancer”, warned that
incidence of cancer in India was likely to increase
because of industrialisation and other health hazards.

They pleaded for an integrated approach on a na­
tional level to control and cure the disease in the
early stages. Facilities for detection and treatment
should be made available at the district lever to pre­
vent the disease from assuming alarming proportions.
Participants in the international workshops held on
2 January, 1985. at New Delhi for the first time, dis­
cussed various aspects of the disease, the treatment
available in the country and advances made to com­
bat the malady.
They said that prevention was better than cure. Pre­
vention was easier in the case of head and neck
cancer by reducing the intake of tobacco and main­
taining a better standard of oral hygiene.

Inaugurating the workshop, attended by over 200
Indian and foreign experts, the Union Minister for
Parliamentary Affairs, Shri H. K. L. Bhagat, called
upon doctors to educate the people about cancer. He
said the head and neck cancer affected 1,50.000 people

120

in the country every year. The patients mostly be­
longed to the weaker sections. Efforts should be made
for early diagnosis and optimal treatment to patients
in medical colleges and district hospitals.

Shri Bhagat urged the doctors to develop simple and
cheap diagnostic tools for cancer so that they could
be used by those in distant areas of the country.
Prof. B. N. Sinha of the Association of Surgeons of
India, said the younger generation should be involved
in the cancer eradication programme.
Dr Prem Kakar, head of the ENT department of
Maulana Azad Medical College and joint programme
chairman of the workshop, said the workshop would
formulate a programme to fight the disease with a
target to eradicate it by 2000 A.D.

He said most of the 500.000 cancer cases reported
every year were beyond-cure because of the advance
stage of the disease. The head and neck cancer ac­
counted for 40 per cent, to the total incidence of
cancer. The percentage of the middle age people was
highest among The head and neck cancer patients.
Prof. K. Shanmugaratnam. Professor of Pathology,
National University of Singapore, and Director, Singa­
pore Cancer Register, in his keynote address on “epidemology of head and neck cancer”, said the incidence
of this cancer was 5 to 28 per cent, of the total cancer
burden in various countries. Tn India the percentage
was higher. Mouth cancer could be prevented by
stopping or cutting down intake of betels as well as
cigarettes.
Dr Jatin Shah, an expert from a prestigious cancer
institute in the U.S., said it was possible to cure a
person. As a result of these advances, he said it was
now possible to save three out of four persons and
prolong their lifespan as compared to the earlier survi­
val ratio of one out of every three.

He pointed out that it was possible to prevent
cancer by using vitamin analogues which are compound
pre-cursors of vitamins. They were known to prevent
or retard cancer in animals. These compounds, known
as Retinoids, were now being tested on human beings.
Every person who has the habit of smoking of chew­
ing betels should have a thorough check-up every year.
Dr Ashok Mehta of the Tata Memorial Hospital,
Bombay, said mouth cancer was eight times more pre­
valent among ‘pan’
chewers.
Smokers developed
throat cancer or laryngeal cancer. According to him,
most of the 75 per cent, neck and throat cancer cases
were reported at a very late stage when no line of
treatment was possible.
A

Swasth Hind

CANCER DIAGNOSIS AND TREATMENT
CENTRES IN INDIA
nder Cancer Research and Treatment Programme

U

have been established in the country. These are :

10 Regional Cancer Centres

1. Chittaranjan National Cancer Research Centre, Calcutta.
2. Cancer Institute, Madras.
3. Institute Rotary Cancer Hospital, A.11 India Institute of Medical Sciences,
New Delhi.
4. Gujarat Cancer & Research Institute, Ahmedabad.
5. Kidwai Memorial Institute of Oncology, Bangalore.
6. Cancer Hospital and Research Institute, Gwalior.
7. Regional Centre for Cancer Research and Treatment, Cuttack.
8. Dr. B.B. Cancer Institute, Gauhati.
9. Cancer Wing of the Medical College, Trivandrum.
10. Tata Memorial Cancer Centre, Bomoay.
Besides, the Indian Council of Medical Research have one permanent institute
(Cytology Research Centre) located at the Maulana Azad Medical College, New
Delhi where one of the thrust areas of work is on early diagnosis of cancers of the
uterine cervix (which is the most common cancer in Indian women) and on studying
the natural history of precancerous lesions of the uterine cervix using a multi­
di sc ipl i nary approach.

While the first 9 cancer centres are supported financially by the Ministry of
Health and Family Welfare the 10th at Bomoay is under the administrative control
of the Department of Atomic Energy who also support it financially.
Apart from the above there are about 142 hospitals in the country where
treatment facilities for cancer are available :
ANDHRA PRADESH
Mehdi Nawai Jung
Cancer Hospital,
HYDERABAD. Andhra Pradesh.
2. M.G.M. Hospital,
Warangal, Andhra Pradesh.
3. Govt. General Hospital
Kakinada, Andhra Pradesh.
4. Govt. General Hospital
GUNTUR, Andhra Pradesh.
5. Govt. General Hospital
KURNOOL, Andhra Pradesh.
6. S.V.R.R. Hospital,
TIRUPATI, Andhra Pradesh.
7. King George Hospital,
VISHAKHAPATNAM, A. P.
8. Gandhi Hospital,
SECUNDERABAD, A.P.

1.

May 1985

ASSAM
Assam Medical College
and Hospital,
D1BRUGARH, Assam.
10. Gauhati Medical College
and Hospital, GAUHATI
11. Dr. B. Bruch Cancer
Institute, GAUHATI.
9.

BIHAR
Medical College &
Hospital, PATNA.
13. Medical College &
Hospital, DARBHANGA.
14. Mcherbai Tata Memorial
Hospital, JAMSHEDPUR.
12.

GUJARAT
Ml. P. Shah Cancer Research
Institute, AHMEDABAD.
16. Civil Hospital,
AHMEDABAD (H&P).
17. Seth Vadilal Savabhai
General Hospital.
AHMEDABAD.

15.

IS. Irwin Group of Hospital,
JAMNAGAR.
19. Shri Sayaji General Hospital,
BARODA.
20. Sir T. Hospital,
BHAVNAGAR.
21. Govt. Hospital,
RAJKOT.
22. Nathalal Parekh Cancer
Hospital, RAJKOT.

121

Lions Cancer Detection Centre
(Trust) SURAT.
24. Civil Hospital,
JUNAGADH.

23.

HARYANA
25. Medical College & Hospital,
ROHTAK.

J & K
26. S.M.H.S. Hospital,
SRINAGAR.
27. S.M.G.S. Hospital,
JAMMU.

HIMACHAL PRADESH
28. H. P. Hospital,
Snowdon, SIMLA.
KARNATAKA
29. Victoria Hospital,
BANGALORE.
30. Dowring & Lady Curzon
Hospital, BANGALORE.
31. Kidwai Memorial Cancer Relief
Research and Training
Institute, BANGALORE.
32. J. L. N. Medical College &
Civil Hospital, BELGAUM.
33. Medical College & Hospital,
BELLARY, Karnataka.
34. K. Medical College &
Hospital HUBL1,
KARNATAKA.
Govt. Wcnlock Hospital,
MANGALORE, Karnataka.
36. Karnataka Cancer Theraputic
Research Institute, HUBL1.
37. Kasturba Med. College &
Hospital, MAN1PAL,
Karnataka.
38. Krishncrajcndra Hospital,
MYSORE.

35.

KERALA
39. Medical College Hospital,
TRIVENDRUM.
40. Medical College Hospital,
KOZHIKODE.
41. Medical College Hospital.
KOTTAYAM.
42. General Hospital,
ERNAKULAM.
MADHYA PRADESH
43. Hamidia Hospital
BHOPAL, M.P.
44. Shasklya Gyara Panch
Trust Cancer Hospital.
INDORE.
45. Cancer Hospital & Med.
College, JABALPUR.

122

J. A. Group of Hospital,
GWALIOR.
47. Cancer Hospital &
Research Institute,
GWALIOR.
48. Gandhi Memorial Cancer
Hospital, REVA.
49. D. K. Hospital,
RAIPUR.
50. Cancer Hospital,
RAIPUR.
51. Ratten Massihi Chikitsalaya,
46.

RATLAM.

52.

Chritjan Hospital
Mungcli, B1LASPUR, M.P.

MAHARASHTRA
B. Y. L. Charitable Hospital,
BOMBAY-400008.
54. Tata Memorial Hospital,
PAREL, BOMBAY-400012.
55. Mahatma Gandhi Memorial Hosp.
PAREL, BOMBAY-400012.
56. K.E.M. Hospital,
PAREL, BOMBAY-400012.
57. Bombay Hospital,
BOMBAY-400020.
58. L.T.M.G. Hospital, Med.
College SION, BOMBAY-400022.
59. Jaslok Hospital & Research
Centre, Peddar Road,
BOMBAY-400026.
60. Dr. BALABHAI Nanawati Hospt.
Vile-Parle (West)
BOMBAY-400056.

53.

Gokuldas Tezpal Hospital,
BOMBAY.
62. St. George Hospital
BOMBAY
63. Central Railway Hospital,
BOMBAY.
64. Medical College Hospital,
NAGPUR.
65. Doga Memorial Hospital,
NAGPUR.
66. Maya General Hospital,
NAGPUR.
67. Sant Tukodiji Hospital,
NAGPUR.
-68. Sahakari Rugnalaya,
NAGPUR.
69. Sasoon General Hospital
B. J. Medical College,
PUNE.
70. Command Hospital, Southern
Command, PUNE.
71. Miraj Medical College &
Hospital, Miraj,
(MAHARASHTRA)-416410.
72. Wonless Hospital, M.M.C.
MIRAJ.
73. District Hospital,
AMR AVATI.

61.

Salvation Army Hospital,
AHMEDNAGAR.
75. Medical College &
Hospital, Aurangabad.
76. S.R.T.R. Medical College,
Ambajugai, Distt. BHIR.
77. Distt. Hospital,
JALGAON.
78. General Hospital,
SANGLI.
79. Dr. V. M. Medical College
SHOLAPUR.
80. Danraj Giriji Hospital,
SOLAPUR.
81. Distt. Govt. General
Hospital SHOLAPUR
82. Shri Sidheshwcr Cancer
Hospital & Research
Centre, Hotji Road,
SOLAPUR-4J3003.
83. Distt. Hospital,
WARDHA.
84. Mahatma Gandhi Institute of
Medical Sciences, Sewagram,
WARDHA.
74.

MEGHALAYA
85. Khasi Hills Wellsh Mission
Hospital, SHILlONG, Meghalaya.
ORISSA
86. Cancer Institute,
S.C.B. Medical College &
Hospital CUTTACK, Orissa.
87. V.S.S. Medical College
Hospital, Burla, SAMBALPUR.
88. M.K.G.G. Medical College &
Hospital, BERHAMPUR, Orissa.

PUNJAB
89. Shri Guru Teg Bahadur
Hospital, AMRITSAR.
90. Rajendra Hospital
PAT1LALA.
91. Christian Medical College,
B. M. Hospital,
LUDHIANA.
92. Daya Nand Medical College
& Hospital, LUDHIANA.
93. Civil Hospital,
GURDASPUR.
94. Civil Hospital.
BATALA, Punjab

RAJASTHAN
95. J. L. N. Hospital.
AJMER-305001.
96. P. B. Men’s Hospital,
BIKANER-334001.
97. S. M. S. Hospital,
JAIPUR-302001.
98. M. G. Hospital,
JODHPUR-342001.

Swasth Hind

99. Umaid Hospital,
JODHPUR-342001.
100. General Hospital.
UDAIPUR-313001.
101. Associated Group of
Hospitals, UDAIPUR-313001.

1.15. Thanjavur Medical College &
Hospital, THANJAVUR.
116. Tirunelveli Medical College &
Hospital, TIRUNELVELI.
117. Christian Medical College &
Hospital, VELLORE, Tamil Nadu.

TAMIL NADU

UTTAR PRADESH
102. Cancer Institute (W.I.A.)
118. G. B. Hospital, AGARTALA,
Adyar, MADRAS-600020.
Tripura.
103. International Cancer Centre,
119.
Sarojini Naidu Hospital,
Neyyoor, KANYAKUMARI-629802.
AGRA
104. Institute of Child Health &
120. Kamla Nehru Memorial
Hospital for children.
Hospital. ALLAHABAD, U.P.
Egmore, MADRAS.
121. Gandhi Memorial & Associated
105. Govt. Hospital for Women &
Hospital LUCKNOW, U.P.
Children, MADRAS.
122. J. K. Institute of Radiology &
106. B.S.R.M. Lying Hospital,
Cancer, KANPUR, U.P.
MADRAS.
123. Sir Sunderpal Hospital,
107. Govt. General Hospital
Institute of Medical
(Barnard Institute of Radiology)
Sciences, VARANASI.
MADRAS.
124. Lovatti Hospital
108. Govt Royapettah Hospital, Madras.
RAMNAGAR, VARANASI.
109. Govt. Stanley Hospital, Madras.
WEST BENGAL
110. Kilpauk Med. College & Hospital,
MADRAS.
125. Medical College &
Hospital, CALCUTTA,
111. Govt. Brakime Hospital, MADURAI.
West Bengal.
112. Kuppu Swami Naidu Memorial
126. R. G. Kar Medical College &
Hospital COIMBATORE.
Hospital CALCUTTA, West Bengal.
113. Cbingleput Medical College &
127. Nilratan Sirkar Medical
Hospital, CHINGLEPUT.
College & Hospital, CALCUTTA.
114. Arignar Anna Cancer Institute,
128. Chitranjan Cancer Hospital
RAILWAY ROAD,
CALCUTTA, West Bengal.
KANCHIPURAM.

(contd. from page 100)
needs of the community. Therefore,
Block Health Administration will
help the Village Health Assembly
suggesting solutions to health pro­
blems and providing inputs when­
ever necessary. Specifically, the
role of Block Health Administration
shall include:

— providing preventive services
such as immunisation.
— evaluating performance of
village health care delivery
system.
— developing a referral system
from village health care deli­
very system to primary health
centre and onwards.

— providing incentives to the villarge health care delivery sys­

May 1985

tem for the improvements in the
health status of the village/
community.
The approach outlined above is a
simple one to increase community
participation. The most important
feature of the approach is that of
self-reliance. Since each family of
the village shall contribute some­
thing towards health of the commu­
nity it is no more dependent on the
government efforts and money. Be­
cause of this feature, the system is
flexible also. It can be extended
according to the needs of the village/
community provided funds are avai­
lable or the Village Health Assem­
bly is in a position to raise the funds.
Similarly the system can be deve­
loped according to the needs of the
village/community which vary from

129. Seth Sukhlal Karnani Memorial
Hospital, CALCUTTA.
130. Institute of Post Graduate Medical
Education & Research
CHANDIGARH.
131. Medical College & Hospital,
PANAJI, Goa, Daman & Diu.
132. Gosalia Memorial Hospital &
Research Institute, Dona Paula,
PANAJI.
133. Asile Hospital, Mapusa, PANAJI,
GOA.
134. Jawaharlal Nehru Post
Graduate Medical Education &
Research Institute.
PONDICHERRY.
135. All India: Instt. of Medical
Sciences, New Delhi.
136. Safdarjung Hospital, New Delhi.
137. Dr. Ram Manohar Lohia
Hospital, NEW DELHI.
138. Smt. S. K. Medical College &
Hospital, NEW DELHI.
139. L.N.J.P. Narayan Hospital,
NEW DELHI.
140. G B. Pant Hospital,
NEW DELHI..
141. Holy Family Hospital, NEW
DELHI.
142. N. R. Central Hospital.
NEW DELHI. A
This information is based on a State­
ment placed in Parliament in reply to
a question in August 1984).

community to community. But all
such decisions regarding extension,
etc., are to be formulated and appro­
ved by the Village Health Assembly.

It may be pointed out at this
stage that all the requirements of
village health care delivery system
proposed here already exist in one
form or the other. The need is to
reorganise them in such a way so as
to give an increased role in the ope­
rational responsibility to the villag­
ers. To start with the ad-hoc Village
Health Committees already establish­
ed may be given responsibility of
the formation of Village Health As­
sembly. Then the Village Health
Committee may be got elected from
the Village Health Assembly and
the cart may be put on wheels. A

123

> ' Keep a gap of ' * §
three years
between two children ?

Choose any method
IMirodh

124

Copper T

Oral Pill

i

Swasth Hind

BOOKS

Authors of the month
Dr. A.R* Chaurasia
Statistical Laboratory
Department of Community Medicine
G-R. Medical College
Gwalior-474 009

Drugs, driving, and traffic safety, edited by R.E. Wil­
lette & J.M. Walsh. Geneva, 1983, 57 pages (WHO Off­
set Publication No. 78). ISBN 92 4 170078 5.

Dr. Hemant Kumar
Rural Health Training Centre (RHTC)
P.O. Jawan
Distt. Aligarh (UP)

The drinking driver has been long recognised as one
of the most serious traffic safety problems, and consider­
able attention and correctve efforts are currently direct­
ed at reducing the number of drivers whose driving is
unsafe because of the effects of alcohol. But what of
other drugs? The risk of accidents associated with the
taking of drugs (particularly psychoactive drugs), whe­
ther obtained on prescription, over the counter, or illi­
citly, is widely recognized but difficult to assess in
terms of its magnitude and impact on societies and pu­
blic health.

Smt. Mohsina Kidwai
Union Minister of Health and Family Welfare,
Nirman Bhawan
New Delhi-110 011
Peter Ozorio
Information Officer
World Health Organisation
Geneva
Tim Haines
London Press Service
c/o British High Commission
New Delhi-110 021

The purpose of the new publication is to consider
the problem associated with evaluating the effects of
drugs on driving and traffic safety and to suggest stan­
dardized approaches to further work in this field.

STUDY OF WOMEN IN
RURAL COMMUNITIES IN INDIA

Problems of analytical toxicology and epidemiolo­
gical research are discussed, as are behavioural tests
that can indicate impaired driving performance. Re­
commendations for systematic test procedures are
put forward. There are-, brief sections on the role of pub­
lic health authorities and on international collabora­
tion.

Britain's Overseas
Development
Administration
has
awarded a grant of £10,000 to Professor John Durnin of
the Department of Physiology, Glasgow University, towards
a continuing study of women in situations of regular margi­
nal nutrition in rural communities in India. The study,
which is being carried out in collaboration with the National
Institute of Nutrition in Hyderabad, is also backed by the
European Community.

One annex outlines analytical methods for detect­
ing and identifying drugs in blood, urine and saliva
samples, giving sensitivity limits for certain classes
of drug. Another provides a theoritical model for the
analysis of correlations between drug- concentration
and drug effect. As an example of a notable effort
to educate the public and to reduce accidents, the
last annex gives the Nordic Council’s recommendations
for labelling seven main classes of drug and the text
of a leaflet that is given to patients when these drugs
are dispensed.

Prof. Durnin explained that the study is into the con­
dition of women who are not malnourished in the recog­
nised sense but are subjected routinely to levels of food
intake which may be barely adequate and which at certain
times of the year fall to totally inadequate levelsOver
an 18-month period, the study will try to establish how the
women adapt to these circumstances while they keep house,
as well as carrying out heavy work in the fieldsMeasure­
ments will be taken of their body weight, body fat, meta­
bolic rates, and their ability to undertake the work at diffe­
rent times of the year.
Their food intake will also be
monitored.

“It is intended to discover whether, while they have to
work in the fields, social arrangements are such that the
women are freed from domestic chors,” said Prof. Durnin.
“We shall also be looking at what cultural effects there
are on the communities in question when food is scarce.
We hope that the results of this project, which is due to be
completed in the summer of 1986, will indicate how such
marginally nourished populations adapt to their circums­
tances, both physiologically and culturally.*’
— BIS

Public health officials and legislators concerned with
traffic safety and with the effects and interactions of
drugs will find much to interest them in this book,
which will also be valuable to accident-prevention
offices, automobile associations, and the like.
—WHO CHRONICLE

No. 5,

1984

ISSUED BY THE CENTRAL HEALTH EDUCATION BUREAU
NSW

dblht-110 002

and

printed

by

the

(DIRECTORATE GENERAL OF HEALTH SERVICES), KOTLA MARG,

manager,

government of India

press,

coimbatore-641019.

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

Read

AROGYA SANDESH

hind

(A Hindi illustrated monthly)

SPECIAL NUMBERS 1984

Community Participation and
Health

January

For

March-April World Health Day
Theme : Children’s Health :
Tomorrow’s Wealth

*Healthful living

August

Health Progress

*Information on health programmes

November

Children’s Day
Theme : Childrens and Youth
Together looking Forward to
a New Era

*New developments in the field of health

*Health news from India and abroad

Each Issue of
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Gives you a perspective on
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