Swasth hind, Vol. 30, No.5, May 1986.pdf

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extracted text
MAY 1986

* Role of nutrition in the prevention and treatment
of diseases
* Health education based feeding practices
* Health for all by 2000 A.D.
—role of health education

* Campaign against rabies
* Solving the problems of youth

.

*' Water and sanitation — ;
fundamental to life
* Need for effective school health services

In this Issue

swasth
hind

Page No.
Role of nutrition in the prevention and treat­
ment of diseases

39

Arun Paha
&

May 1986

Vaisaka—Jyaistha

XXX

Vol.

Saka 1908

No. 5

K. L. Tiwari

Health Education based feeding Practices

95

Dr S. C. Gupta

READERS WRITE

I am a post-graduate student of Preventive and Socai
Medicine. I am a regular reader of Swasth Hind. It eaner
fails to give insights.

I want to be the subscriber of Swasth Hind, and will lb
proud to have my own copy.
Dr Muley Y. P.
Department of Preventive and
Social Medicine
Govt. Medical College,
Aurangabad-431 001

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

Kotla Marg, New Delhi-110 002

Health for all by 2000 A. D.—role of health
education

98

P. Manohar Reddy

Campaign against rabies
Jean Blanco

101

&
Konrad Bog^.

Animals and man

102

Solving the problems of youth

105

Kum. N. V. Rajeswari
&

M. Hari
Water and sanitation—
fundamental to life

HO
113

EDITOR

Need for effective school health services
—Smt. Mohsina Kidwai

N. G. Srivastava

Conference of State Project Coordinators

115

ASSTT. EDITOR

Books

D. N. Issar

Third
inside
cover

Sr. SUB-EDITOR
Articles on health topics arc invited for publication in this
Journal.

M. S. Dhillon

State Health Directorates are requested to send reports of
their activities for publication.

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The contents of the Journal are freely reproducible. Due
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SWASTH HIND reserves the right to edit the articles sent
for publications.

Mm

ROLE OF NUTRITION IN THE
PREVENTION AND TREATMENT
OF DISEASES
Aruna Palta & K.L. Tiwari
Diet therapy serves in supporting the overall therapeutic programme and it may also be
used as a prophylactic measure in diseases like diabetes, atherosclerosis, liver cirrhosis
and peptic ulcer.
is the prime necessity of health and diet
therapy is the use of food as an agent in effecting
an early recovery from illness. Diet in disease or diet
therapy forms an integral part of medical treatment
whether it is medical, surgical or otherwise. Modified
or therapeutic diet is the food allowance which has
been adjusted to meet the specific requirement's of the
individual.
It may include or exclude certain foods,
may increase or decrease certain nutrients, may res­
trict quantity or may involve a change in consistency
of food.
ood

F

Role of diet in diseases

Modified diets are the principal therapeutic agents
in some diseases such as Diabetes Mellitus and Phenyl
Ketonuria and diet therapy serves in supporting the
overall therapeutic programme. In other instances,
it may be used as a prophylactic measure.
The
improved nutrition may also cut the nations health
bill. For some patients modified diet may be requir­
ed for weeks, months or even for life time, whereas
for others only guidance may be enough for the
improvement cf the normal dLt. Diet plays an im­
portant role as the principal agent or as a prophy­
lactic measure in many diseases like diabetes. Athe­
rosclerosis, fiver cirrhosis and peptic ulcer.
Diabetes

There is no diesase which provokes greater thought
on diet than diabetes. Diabetes (according to Root
& Bailey (1968)) is a disorder of blood sugar regu­
lation.
Diet is the sheet-anchor of treatment in
obese middle aged diabetics and a useful supplement
to insulin therapy in juvenile patients.
A “well
managed” diabetic has a good life expectancy and
hence it is no more a dreaded disease.
Approximately 40% of the new cases of diabetes
can be controlled by diet alone. Rest can be treated
by insulin and diet or oral hypoglycaemic drugs
and diet.
All diabetic diets involve some dietary

May .1986

restrictions, if control is to be satisfactory. By re­
gulating the amount and the time of food intake, the
blood sugar can be maintained throughout twenty
four hours.
Eighty per cent of the diabetics arc
obese. So the most important objective of the die­
tary treat’ment is to control the total caloric intake
in order to attain the desirable body weight. This
can be done by giving a low sugar diet.
Previously high carbohydrates containing
foods
were restricted for diabetics but according to the
Committee on Foods and Nutrition of the American
Diabetes Association (1971) “There no longer ap­
pears to be any need to restrict disproportionately
the intake Of carbohydrates in the diet of most dia­
betic patients. Increase of dietary carbohydrates to
extremes without increase of total calories does not
appear to increase insulin requirement in the insulin
treated diabetic patient'. In the less severe typically
obese diabetics, substitution of
carbohydrates for
fats docs not appear to elevate blood glucose or
worsen glucose tolerance.
The average proportion
of calories consumed from carbohydrates in
U.S.
Population as a whole approximates 45%. This
proportion or even higher appears to be acceptable
for the usual diabetic patient! as Well”. From this.
it is concluded that more attention should be given
to total calories rather than to carbohydrates in the
prescription of therapeutic diets, for diabetes. Atten­
tion has been drawn to the beneficial effects of a
high carbohydrate intake on the blood glucose in
diabetics, (Brunzell et al 1967), a high protein intake
(Estrich et al 1967) and frequent feedings (Wadhura
el al 1973).

Role of exchange list in diabetes.—The diabetic
diet is different for each individual depending upon
the severity of his disease, his activity, the type of
insulin given and on the amount of calories requir­
ed to maintain his desirable body weight. Six food
exchange lists are prepared by the Committee of the
American Diabetes Association. These are: (i) Milk
exchange fist, (ii) Vegetable exchanges, (iii) Fruit

89

exchanges, (iv) Meat exchanges, (v) Bread exchanges,
(vi) Fats exchange list. Any food within an exchange
list may be used in place of another food of the
same list, though the serving sizes vary. Thus by
the use of exchange lists the diabetics can enjoy
all types of foods which were previously omitted in
their menu, in amounts indicated in the exchange
list
Atherosclerosis

An advancement in the knowledge of nutrition,
preventive medicine and control of infectious diseases
by antibiotics has increased the life expectancy but
on the contrary has made the degenerative arterial
diseases more prominent. A person is said to be
“as old as his arteries.” Indeed when the arteries of
the heart, brain and
kidneys show degenerative
changes, the circulation and nutrition of these organs
is affected. Atherosclerosis, which is the thickening
of the arterial walls, due to the deposition of choles­
terol, is generally associated with prosperity. In
under-developed countries where proverty, is still
there, the incidence is low. In prosperous countries
the intake of fat’ is high and a major proportion is
of animal origin, containing large amounts of satu­
rated fatty acids. There is a strong correlation bet­
ween dietary saturated fats and serum cholesterol,
and between serum cholesterol and coronary heart
disease. Masironi (1970) compared death rates from
atherosclerotic heart diseases in 37 countries with
their estimated average dietary consumption and
found that the significant correlation was with satu­
rated fats. Dietary cholesterol has been shown to
have an hypercholesterolemic effect. Keys et al
(1965) suggested that “other things being equal, the
serum cholesterol appears to be a linear function of
the square root of the cholesterol in the daily diet”.
Saturated fats increase the serum cholesterol level
while the polyunsaturated fats are found to lower
the serum cholesterol level. Keys (1957) concluded
that polyunsaturated fatty acids have half the effect
per gram on decreasing serum cholesterol concent­
rations as do saturated fatty acids acting in the oppo­
site direction. The Principal polyunsaturates in the
diet are the linoleic and linolenic acids which are
the most abundant in oils of grains, seeds and nuts.
(Saff Flower-74%, Sunflower-64%; Corn 58%; Soya­
bean dehydrogenated-57%; Cotton seed-51 %; Seasame-40%; Soyabean hydrogenated-37%; Peanut31 %; Palm 9%; Olive-9%; and Coconut 2%).
Increased consumption of sucrose can increase
plasma endogenous triglycerides. In contrast the
starchy foods have a beneficial effect because the
fibres associated with them may have a lipid lower­
ing effect. It was seen that countries where the
intake of starches is high, the rate of coronary heart
diseases is low. Obesity associated with diabetes and
hypertension is an important risk factor in the deve­
lopment of atherosclerosis.
So correction of obe­
sity, if present), should be the chief objective of die­
tary treatment. National Diet-Heart Feasibility
Study 1960-67 shows that cholesterol concentrations
can be effectively lowered by 8-18% through diet

90

and thus may help in the prevention and treatment
of atherosclerosis.
Liver Cirrhosis

Diet therapy is generally accepted as an important,
if not the most important factor in the management
of patients suffering from diseases of the liver. In
certain specific instances alterations of the diet have
a proven relationship to some of the complications
of liver disease, especially to ascites formation and
hepatic coma. Everyone seems to agree that ’mal­
nutrition can and does produce functional, structural
and clinical alterations of the liver in Kwashiorkor
and other types of *‘fatty” liver. A diet' deficient
in proteins and aminoacids, particularly choline and
methionine will produce fatty liver in experimental
animals and if continued long will lead to cirrhosis
in most animals.
Experimentally the liver is found to be more sus­
ceptible to any injury when there is associated mal­
nutrition and therefore adequate nutrition appears
to safeguard the liver against cirrhosis. An injury
to the liver is aggravated when the nutrition is poor
and thus undernut’rition has always been blamed as
a cause of cirrhosis. Necrosis, due to injurious
agents, more readily occurs in cases of malnourished
liver. A low protein diet, a high iron intake alongwith a low protein diet, some toxic substances in
diet and excessive amounts of alcohol, may contri­
bute to the aetiology of liver disease. Provision of
diet rich in proteins, calories, carbohydrates
and
vitamins may be beneficial for the patients of cirr­
hosis. Restriction of dietary sodium to levels about
equal to that' lost by the body from the skin, stool
and urine (200 mg/day) prevents further accumula­
tion of ascitic fluid. A nutritionally well-balanced,
low sodium, adequate protein diet is offered and con­
sumed day after day by the cirrhotic patient. To
replace the taste of salt which is missing in the diet,
patients may use a salt substitute.
Peptic ulcer

In no disease does diet treatment give such dra­
matic symptomatic relief as in peptic ulcer. In the
majority of uncomplicated cases, drugs play a se­
condary role. Success of medical treatment also
depends upon diet control. The overall aim of
dietary control is to provide ‘Physiologic rest’ for
the stomach, reduce mechanical trauma, minimize
the effects of the ingested food on the chemical phase
of gastric secretion and more important to provide
nutrient with maximum neutralizing capacity.
The chief argument to support’ the claim
that
dietary factors might be responsible for gastric ulcer
is the fact that in Great Britain between the two
world wars; Peptic ulcer was 2-5 times as prevalent
in the poorest class as in the upper social classes.
At this time the poorest class was consuming diets
which were below physiological standards both in
^quantity and quality.
—

Swasth Hind

SOURCES OF IMPORTANT NUTRIENTS
(Per 100 gm. edible portion)
Foods

CEREALS
Wheat flour
Rice
Rice flakes (chidwa)
Bajra
Jawar
Ragi
PULSES
Soyabean
Rajmall
Bengal gram dal (channa)
Black gram dal (urad)
Cow pea (lobhia)
Green gram dal (moong)

Lentil
GREEN LEAFY
VEGETABLES
Cauliflower leaves
Turnip leaves
Amaranth (Chulai)
Bengal gram leaves (channa sag)
Beet greens
Corriandcr leaves (dhania)
Fcnu grcck (niclhi)
Mustard leaves (sarson)
Radish leaves
Mint (pudina)
Spinach (palak)
Carrot leaves
Colocasia leaves (arvi leaves)
Drumstick leaves (Saijan pat (a)
Balhua
FRUITS
Orange
Mango
Papaya
Aprico (khurmani)
Loquat
Currants
Phalsa
Bacl
Lemon
Mui burry (shatoot)
Amla
Rcspbcrry
NUTS & DRIED FRUITS
Gingclly seeds (til)
Currants
Cashewnut (kaju)
Raisain (kishmish)
Dales dried (Khajoor)
Almond (badam)
Figs (anjecr)
Walnut (akhroal)
Chilgoza
Groundnut
Coconut (dry)
MILK & MILK PRODUCED
Milk (buffalo)
Milk (cow)
Cheese
Paneer
Khoa

May 1986

Protein

XX
X
X
XX
XX
X

xxxx**
XXX
XXX
XXX
XXX
XXX
XXX

Calcium

Iron

Vitamin A

XX

XXXX**
xxxx
xxxx**

X

XXX

X
X
x

xxxx**
xxxx**
xxxx**
xxxx**
xxxx**
XXX
xxxx**
XXX
XXXX**
xxxx
X
xxxx**
xxxx**
xxxx**
xxxx

XXXX
X
X
X
XX
X
X
X
X
X
X

xxxx**
xxxx**
xxxx
xxxx
■XXX
XXX
xxx
xxx
xxx
XX
X
X

XXXX

XXX
X
XXX
XXzXX
XX
XX
XXX
XX
XXX
XXX
XXXX**
XXXX
XX

XX
XX
X
XX
x

XX
XX
X
X
X
X

XX
XX

XXX

XXX
XX
xx
;XXX
X

xxxx**
XX
X
X
XX
xxxx

XX
X
X
X
X
X

X
XX
X

X

X
xxxx**

xxxx
XX
xxxx**
xxxx**
[XXXX**

X

91

Our fight against debilitating illnesses or diseases depends on the vital const intents of food such as pro­
teins, fats, carbohydrates, vitamins and minerals. Modified diets are also the principal therapeutic agents in
some diseases.
(Reproduced with permission)
Photo Paul Harrison (g)
ANIMAL FOODS
Mutton
Liver (sheep)
Fish (pomphret)
Prawns
Egg
MI SC.
Jaggery
Butter

XXXX**

XX

Protein Legend
X-5-10 gm.
XX-10-20 gm.
XXX-20-30 gm.
XXXX-30-40 gm.

Calcium Legend
X-50-100 mg.
XX-100-150 mg.
XXX-150-200 mg.
XXXX-200-250 mg.

Iron Legend
X-5-10 mg.
XX-10-15 gm.
XXX-15-20 mg.
XXXX-20-25 gm.

Vitamin A Legend
X-500-1000
XX-1000-3000
XXX-3000-6000
XXXX-6000-10,000
mega gram of carotene
♦♦Values higher than the upper limit on the scale.
Nutrition cell of the Directorate General of Health Services,
Ministry of Health & family welfare, New Delhi-110011. —>

92

Swasth Hind

QUALITY CONTROL OF FOOD
ood is essential for growth and
development.
Food habits reflect a variety of patterns accord­
ing to regions of the country. The quality of food
eaten, features the health status of the population in
the country. It is not denying a fact that the strength
of the Nation depends on the health of its population.
This is the prime indicator for the ultimate potentia­
lities a nation may aspire to reach in the sphere of
overall national developmental endeavour.

F

Nutrition on the other hand determines the state of
health. The necessity to maintain health, suggests an
intake of balanced diet, following the principles of
food, hygiene and sanitation. Our strength to fight
against debilitating illnesses or diseases, depends on
the vital constituents of food such as proteins, fats,
carbohydrates, vitamins and minerals. Removal in
part or in whole of any of the nutrients from, food
articles or addition of adulterants adversely affect our
health.
Food adulteration, is, therefore, recognised as an
offence punishable under the Prevention of Food
Adulteration Act, 1954.

Various provisions of the Act will not only ensure
pure and wholesome food to you but also protect you
from being duped by false/exaggerated/misleading
claims. The Act also guides the honest trade about
fair trade practices. Food adulteration helps none—
not even the persons who indulge in it for more econo­
mic gains.

You can prevent adulteration
Mere legislation is not enough. Menace of adulte­
ration can be effectively checked only if you co-ope­
rate with the Government. You can protect yourself
from adulteration by your wise marketing. Buy from
cooperative stores/super bazars or reputed retail
stores. Buy packed commodities carrying I.S.I./
Agmark certification mark.

Whenever you suspect any defect in food articles,
either in taste or appearence, report the matter imme­
diately to the Local (Health) Authority. Some volun­
tary consumer organisations may also assist you in
taking up your complaints with the authorities. In
Delhi, complaints may be addressed to: The Director
(PFA), Department of PFA, Delhi Administration.
5th Floor, I.S.B.T. Building, Kashmere Gate, Delhi.
Complaints against I.S.I. & Agmarked products may
be made to : (1) The Dirtctor General, I.S.I., Manak
Bhawan, New Delhi—110002 (For I.S.I. Marked pro­
ducts); (2). The. Agricultural Marketing Adviser, Gov­
ernment of India, C.G.O. Building, Faridabad-121 001
(Haryana) For Agmark products).
Let' us launch an all out drive for eradicating the
menace of food adulteration so that pure and nutri­
tious food is available to each and every consumer
of our country. This will be our first step in achieving
the goal of ‘Health for All’ by the year 2000 A.D.Q
PFA Division, Directorate General of Health
Services* Ministry of Health & Family
Welfare New Delhi-110011.

To ensure prompt supply of the Journal quote your Subscriber Number and intimate the
change of address.

For all enquiries, please write to :
The Director
Central Health Education Bureau
Kotla Marg, New Delhi-110 002

May 1986

93

Dietary principles:
The following dietary prin­
ciples should be acceptable in all instances relating
»to ulcers.
The diet should be adequate to meet in full the
nutritional needs of the patient with a margin of
‘safety to compensate for various stresses. Obesity
should be corrected if present. High fat containing
foods can be given but not those containing saturat­
ed fatty acids, as the risk of coronary heart diseases
is increased with it. The diet' may consist of small
frequent feedings of chemically, thermally and
mechanically non-irritating foods. It is of utmost im­
portance that ulcer patient does not allow long periods
to elapse without* having something to eat or drink.
/When a patient has severe symptoms, seven small
meals daily should be prescribed. Milk, egg and fruit
juices should be the main ingredients. It is impor­
tant to ensure a good intake of Vitamin C. Previously
only milk and cream feedings were given to ulcer pati­
ents but the current trend is towards a more liberal

diet, similar to the usual soft or light hospital diet,
but involving frequent, small feedings. Meulengracht
presented good evidence that bleeding from the ulcers
may be controlled by feeding the patients with more
sizeable meals composed of high calories, pureed food,
with feedings of milk in between meals. By this nu­
trition is maintained, loss of weight is prevented, con­
valescence is shortened, blood regeneration is favour­
ed and mortality rate is lowered than under the older
starvation method.
Conclusion

Years back Dr Harvey of the U.S. Bureau of Food
and Drugs, made a great prediction, “Food is the
medicine of the future”. Recent researches prove
the truth of his prediction. People do not get adequate
advice and instruction and as a result they may fail
to derive full benefits from their diets.
Thus in the end it may be concluded that diets
have an important role to play as a curative, prophy­
lactic or supporting agent in the treatment of different
diseases.
•
q

AHARA—86: The Central Health Education Bureau, Directorate General of Health Services, had set-up a stall entitled
«Food For Health” in the “AHARA—86—FOOD EXPO” Exhibition held from 25 January to 3 February, 1986, organised
by the Trade Fair Authority in New Delhi. Shri Notwar Singh, State Minister for Fertilizers, inaugurated the Exhibition
on 25 January, 1986.

94

Swasth Hind

HEALTH EDUCATION BASED
FEEDING PRACTICES
Dr S.C. Gupta
The child-feeding practices are associated with the morbidity and mortality patterns
among children. Health education modifies the impact of child feeding practices on
the morbidity and mortality patterns among the children. Socio-cultural factors are
also directly associated with the child-feeding practices. Health education reshapes
the above association also.
hildren between 0 to 2 years

entirely depend
upon their mothers for the socially determined
food which may influence their growth and develop­
ment. Some aspects of the above stated inter-rela­
tionship have already invited the attention of a few
eminent scientists like Jelliffe (1955), Cowan (1982),
Chen (1982), Wyon and Gorden (1971) and Foster et
al (1978), etc. The present study begins with the ques­
tion: As to how far the childfeeding practices are
associated with the morbidity and mortality patterns
among the children; to what extent the above asso­
ciation can be modified through health education?

C

Material and methods

The study deals with a sample of 300 children
within 0-2 years age group. Out of 300 children and
their mothers, a sample of 100 children along with
their mothers was drawn from the children born in
the Christian Medical College, Ludhiana, Punjab, by
using the systematic random sampling method. These
mothers were consistently imparted health education
regarding the maintenance and promotion of child­
feeding practices which are scientifically recommend­
ed. The sample of the remaining 200 children and
their mothers was obtained from the children born
in the homes through stratified random sampling
method. Both the primary and. secondary sources of
data collection were used.
Major findings

The findings reveal that protein-calorie malnutrition
is more common among the children fed on the
vegetarian food than among those who are fed on

May 1986

the non-vegetarian food. Even if the kind of food
given to children is held constant, the occurrence of
protein-calorie malnutrition is significantly higher
among the children born at home than those who are
delivered in the hospital and whose mothers are ex­
posed to health education. The above finding adds to
the observation of Cowan (1982-83): The delay in
the inclusion of the semi-solid food into the diet of
the child is closely associated with a great risk of
malnutrition. Deprivation in the total feeding care
to the children also has an intimate relationship with
the higher incidence of malnutrition. Foster and
Anderson (1978:264) and Chen (1982:3) have also
seen a similar trend. The lack of total feeding care
and the delay in the inclusion of semisolid food into
the diet of a child makes the situation more grave.
Although, the above variables, i.e., total feeding care
and the age at which the semi-solid food is introduced
in the diet of the child have an independent influence
on the incidence of protein-calorie malnutrition, yet
they modify the effect of each other.
If the inclusion of semi-solid food into the diet of
the child is delayed, and he gets an adequate feeding
care in the other pertinent spheres, to a certain extent
the incidence of malnutrition can be controlled. The
above results add to the experiences documented by
Cowan (1982: 3). Even if the total feeding care given
to the child is deficient, a substantial percentage of
children can be saved from protein-calorie malnutrition
by extending health education to the mothers. In a
similar study, W.H.O. (1960:10) also observes that
health education reinforces the desirable health prac­
tices which ultimately result in low sickness rate.

95

With an increase in the duration of breastfeeding,
the incidence of diarrhoea progressively declines, which
substantiates the results drawn by W.H.O./UNICEF
(1979 :7). Poor hygiene in the child-feeding practices
is also markedly responsible for the higher frequency
of diarrhoeal sickness. The higher degree of hygiene
in child feeding and adequate breastfeeding reduce
the incidence of diarrhoeal sickness. Even when the
level of child-feeding hygiene is held constant, the
impact of breastfeeding is still visible. Even under
poor hygienic conditions, breast-fed children are less
likely to develop gastrointestinal diseases.
At all the levels of duration of supplementary
feeding, a high frequency of sickness owing to
diarrhoea, is much prevalent among the children born
at home.
The mother’s awareness of the proper
child-feeding practices and the longer duration of
breastfeeding, prevent the incidence of diarrhoea to a
significant level. Health education brings down the
incidence of diarrhoeal sickness and thus promotes
the positive effect of longer duration of breastfeeding.
To some extent the above consideration draws support
from Korostelev (1976:291) and Winikoffe et al
(1981:1). While ascertaining the relationship bet­
ween morbidity and mortality patterns among the
children it is also observed that malnutrition decreases
the resistance of children with the result that they
become more prone to infectious diseases. The
higher the degree of malnutrition, the greater are the
chances of a high death rate from infectious diseases.
As the nutritional status improves, the susceptibility
to high mortality diminishes. The malnourished
children suffer from diarrhoea and respiratory infec­
tions more frequently and more severely. The find­
ings of Chen (1982:1) and Probit (1979:51) accord
with the above observations. It is also substantiated
that health education minimizes the incidence of mor­
bidity among the children fed through faulty child
feeding practices. In the sample of children studied,
the major groups of illnesses are intestinal disorders,
nutritional disorders and respiratory diseases.
The socio-cultural factorcs in morbidity and mortality
patterns

A higher number of the female children suffer from
protein-calorie malnutrition than the male children,
especially among' those whose mothers have a tradi­
tional outlook. The above observation adds to the
facts drawn by Grewal and Cowan (1979:42).

96

The girls are also over-represented among the
children suffering from a higher degree of malnutri­
tion. The above conclusions draw support from
Hendrickse (1966:344). Health education has a great
positive effect in the controlling of protein-calorie
malnutrition. It also reduces the chances of protein­
calorie malnutrition among the children of tradi­
tionally-oriented mothers. The interesting finding
which emerges from this study is that the children
whose mothers possess traditional outlook are not
only susceptible to different degrees of protein-calorie
malnutrition but also suffer from its serious forms
like kwashiorkor and Marasmus.
The study in question also draws one’s attention
to .the fact that the existence of the protein-calorie
malnutrition is significantly lower among the children
born in the nuclear households than among those
who are born in households with complex structure.
These findings draw a certain degree of support from
the experiences of Illingworth (1974:20). The
higher the average number of children in the family,
the greater are the chances of protein-calorie malnu­
trition.

It was also established that malnutrition is a pro­
duct of poverty and it depends most directly on the
quality of life. Low economic level is a major deter­
minant of malnutrition in a society. Gopalan (1980 ;
39) and Chen (1982:1) have also noticed similar
trends. But to some extent among the poor respon­
dents also, if the people avail themselves of health
services, the problem of malnutrition can be dimini­
shed to a great extent. The mother’s exposure to
health education significantly minimizes the adverse
effect of low economic level on the incidence of pro­
tein-calorie malnutrition among the children. In fact,
even when the place of delivery and birth order of
the child are held constant, the impact of economic
level of the family on the occurrence of malnutrition
among the children can be seen. The above findings
are not only in conformity with the findings of
Meegama (1980:124) and Devadas (1972:3) but also
go beyond their respective studies.
In regard to the sex of the child and the mortality
rales among the children, findings show that the death
rate among the female infants is lower than that
among the male infants. During the intrauterine
period also the females had better chances of survival
than males. But while examining the death rate in

Swasth Hind

the age group of 1-5 years, we found that the rate
among the female children is significantly higher.
This higher rate of child mortality among girls is
related to the sex discrimination in child care. The
conclusions drawn by Singh (1972:14) are consistent
with the above observations.
Mortality rates among children born at home are
significantly higher as compared with the children
born in the hospital. The child mortality rates are
markedly higher among children whose mothers have
traditional outlook than those whose mothers have a
modern outlook.
The above analysis establishes that the socio-cul­
tural factors are also closely associated with the mor­
bidity and mortality
pattern among children.
Similarly, our assumption that health education
modifies the impact of the socio-cultural factors on
the mortality and morbidity among children is also

supported by the evidence. But even under poor
social circumstances health education services can
help to improve the feeding practices as is also ex­
perienced by Cowan et al (1981:5) and W.H.O.
(1969:13).
In addition to this, the birth order of the child is
also closely related with the total feeding care given
to the children. Even if the sex of the child and the
place of delivery are controlled the effect of birth order
of the child persists. The findings of Krishnamurthy
(1971:181) and Cowan et al (1982:4) are consistent
to some extent with these observations. Our data in
this context also show that health education strongly
reinforces the positive effect of birth-order of the
child on the total feeding care extended to it. This
demonstrates that health education, as stated by
W.H.O. (1980:2), is the most potential variable for
improving the total feeding care to be given to the
children.
Q

SUGGESTED REFERENCES
1.

Chen, L.C. (1982): Malnutrition and Mortality, Nutri­
tion Foundation of India, Oct. 1982, 1-3.

13.

2.

Cowan, B. et al, (1982): Review and Comments on
Brinkmanship in Nutrition, N.F.l. Bulletin, Oct. 1982,
1-6.

Kroeber, A.L. (1925): (Handbook, of Indians of Cali­
fornia'), Washington, Bureau of American Ethnology
Bulletin, (1978).

14.

Meegama, S.A. (1980): Social Economic Determinants
of Infant and Child Mortality in Sri-Lanka; An Ana­
lysis of Post Experience; Scientific Reporters.

15.

Park, J.E. and K. Park, (1979): Textbook of Preven­
tive and Social Medicine, Jabalpur, Banarsi Dass Bhanot Publishers.

16.

Prohit, C.K. (1979): Common Morbidity Conditions of
Children: An Epidemiological Exercise Under Group
Project Work Training of Undergraduate, Indian Pae­
diatrics, XVI No. 61, No-55.

Rubin Vera (I960): Preface, in V. Rubin (ed) Culture,
Socially and Health, Annals of New York Academy of
Sciences, 84, P-7S3-1086.

3.

Devadas, R. (1972): Nutrition in Tamil-Nadu, Madras,
Sangam Publishers.

4.

Dube, S.C. (1958): India's Changing Villages,
York, Cornell University Press, Ithaca.

5.

Foster, George, M. and Anderson, Barbara G. (1978):
Medical Anthropology, New York, John Willey and
Sons.

6.

Grewal, H.N.S. and Cowan, Betty (1979): Community
Health Department, Annual Report, Ludhiana, Chris­
tian Medical College.

17.

7.

Gopalan, C. (1980): Nutritional Problems in the Deve­
loping Countries H.M. Sinclair and G.R. Rawat (ed.).
World Nutrition and Nutrition Education, New York,
Oxford University Press.

IS. Singh, K. (1972): Indian Social System. Lucknow; Prakashan Kendra.

8.

Hendrickse, R.G. (1966):
Some Observation on the
Social Background to Malnutrition in Tropical Africa,
African affairs, 65: 341-349.

9.

Jelliffe, D.B. (1955): Infant Nutritional in the Sub­
Tropic and Tropics, Genava: World Health Organisa­
tion.

10.

Illing Worth, R.S. (1974): The Development of the
Infant and Young Children, London Churchill Living­
ston.

11.

12.

New

19.

Winikoffe, Bererly, et al (1981): The Obstetrician Op­
portunity: Translating Breast is Best From Theory into
Practice, Infant Feeding Practices-^, New’ Delhi, UNISEF.

20.

Wyon J.B. and Gorden, J.E. (1971):
The
Study, Cambridge, Marvard University Press.

21.

W.H.O. (1960): ‘Teacher Preparation for Health Edu­
cation; Report of a Joint W.H.O.. UNESCO Expert
Committee, Technical Series No. 193, 1-4.

Korostelev, N.B. (1976): Health Education in USSR,
Swasth Hind, Sept. Oct. 1976, 290-292.

22.

W.H.O. (1969): Research in Health Education, Tech­
nical Report Series No. 433, 9-15.

Krishnamurthy, K.A. (1971): Child Health Theme in
Family Planning, Indian! Paedratrics, Vol. 8, No. 2,
PP-181.

23.

WHO/UNICEF (1979):
Background Paper for the
Meeting on Feeding Among Infant and Young Child­
ren, Geneva, 9-12.

May 1986

Khanna

97

HEALTH FOR ALL BY 2000 A.D.
Role of Health Education
P. Manohar Reddy
ndia is a democratic country and the majority of
our people live in rural areas. There are so
many misbeliefs and misconceptions among them and
they follow traditional way of life as well as tradi­
tional food habits. In the rural areas there are no
properly ventilated houses and people live in insani­
tary houses. There is water stagnation in streets and
the surroundings of the houses. This helps in breed­
ing of flies and mosquitoes which transmit many
communicable diseases like cholera, malaria, filaria,
etc. The literacy rate is low when compared to the
developed countries.
Due to illiteracy there are

I

98

many barriers for bringing a rapid change in the
health practices of our people. Therefore, to break
these barriers and to bring a rapid change in the
knowledge, attitude, and behaviour of the people to
adopt healthful habits, health education activity needs
to be intensified extensively on a war footing in the
rural and slum areas in particular and in urban areas
in general. There are only 14 years of time to achieve
the goal of Health for All by 2000 A.D. It is during
this time that M.C.H. services are to be strengthen­
ed, immunization coverage to be improved and mor­
tality rates to be brought down.

Swasth Hind

Strengthening of School Health Services'. In the
country 50% of the Primary Schools are lacking pro­
per pucca buildings. Most of the schools are not
provided with playgrounds and so there is no oppor­
tunity for the children to play and exercise. The
school should have a clean pot with a lid for storing
safe water daily and only one tumbler should be used
for drawing water from the pot. The health staff who
visit the village should hand over .1 Gram chlorine
tablets to the teacher and ask the teacher to use the
tablets daily for pot chlorination. The teacher is
the best person to identify the sick child and have
good opportunities for parent counselling. Therefore
the teacher should be given special training in health
education who in tum can educate the young children
towards cultivation of healthful habits among children
from the very beginning. The health workers (male
and female) should visit the schools once in a month
and should see that the children get safe water for
drinking. They should also take health education
classes with the help of simple audio-visual aids to
bring about a change towards healthful habits from
the childhood itself. The health workers should
maintain a separate Register with the teacher and
carry out all immunization activities against diph­
theria, tetanus, cholera, and typhoid so that the school
children are prevented from the above diseases. The
Medical Officer of the area should visit the school
quarterly and examine all the children and ensure
treatment. He should also advise the sick children
and their parents on follow-up of treatment and prac­
tising healthful habits. Anaemic children should be
selected, and their parents should be contacted to
hand over a course of Iron and Folic Acid Tablets
preferably to the mother of the child. Education on
nutritious diet should be provided. The teacher
should be asked to ensure good sanitary surround­
ings.

Role of health staff: In some of the States, like
Andhra Pradesh, Health Workers are responsible for
5000 population with a package of preventive, pro­
motive and curative services in the rural area. The
health workers are supplied with a variety of medi­
cines for minor ailments. Hence, the health workers
should be given special training in health education,
so that they can apply health education principles at
every step in the field according to the local situation
and opportunity to bring desired change in the know­
ledge, attitude and behaviour of the people.
Conducting clinic at sub-centre: Parents' hide
their children from immunisation expecting that their
«child will weap and get temperature. As a result of
(this the coverage in the villages is not upto the mark.
IHence, one day in a week should be kept for Antcmatal Clinic and for check up by the Lady Medical
Officer at the sub-centre. Each such centre should be
ssupplied with a refrigerator/ice Box with ice pockets
t<o store and maintain the vaccines under cold chain
sjystem. Each sub-centre should also be supplied with
educational aids like posters, flash cards and flannel
g.;raphs to impart education on mother craft, personal
h ygiene, locally available nutritious diet and on propeer family spacing methods.

May 1986

The health workers can also utilise the opportunity
to communicate the ‘‘small family norm” and mobi­
lise the community for community participation in
the implementation of Health Programmes.

Latrine promotion programme: In the rural areas
most of the people are not aware of the fact that
many faecal borne diseases are transmitted by im­
proper disposal of human excreta. Therefore, the
people should be educated on proper disposal of
excreta by constructing sanitary latrines. Atleast two
village leaders should be selected from each village
and they should be well educated regarding the latrine
promotion programme.
Nutrition demonstration: Most of the people in
rural areas take food to satisfy their hunger and not
for health. They are not aware of the fact that the
locally available cheap foods which are rich in nutri­
tive values are within their easy reach such as green
leaves, leafy vegetables, and local fruit. In order to
educate the people nutrition demonstrations with
community participation should be conducted.
Small family norm: To popularise small family
norm, the health staff should educate the rural people
by involving satisfied acceptors and should also
involve local leaders in Family Welfare Programme.
Community Health Worker should be given reorien­
tation training in health education and they should
be given responsibility to popularise small family
norm in the community through simple visual aids.

Health education: In fact, health education has to
be imparted in all the National Health Programmes
to enlighten the people and to create awareness
among the people for proper utilisation of Govern­
ment services available at the door steps or at Go­
vernment Institutions.
Health education should be carried through various
ways. During family contacts, the health worker is
the best person to bring the desired change in the
lifestyle of the family. Health worker should involve
the head of the family while enquiring the welfare of
the family members.
Group meetings should be conducted at the centre
of the village or in school building, preferably in the
evenings, to educate the group of people by using
film-strip projector. Filmshows should be conducted
for mass communication in all villages of the sub­
centre area in a systematic manner involving local
leaders. This will have a good impact on the com­
munity for bringing positive change.

Every citizen of India should realise that good
health is essential for the welfare of individual, community and the nation. Hence, through intensified
health education, we can bring about desired change
in the health practices of the people towards positive
health by 2000 A.D. Q

99

HEALTH FOR ALL STRATEGIES EVALUATED
he Executive Board of the World Health
Organization (WHO) studied the first evaluation
of the strategy for health for all by the year 2000, pre­
pared by WHO on the basis of data provided by its
Member States. Noting with satisfaction’ that 86%
of Member States submitted reports on the evalua­
tion of their national strategies, the Executive Board
urged all Member States, at the conclusion of its 77th
session in Geneva in January 1986, to work towards
the “reduction of socio-economic and related health
disparities among people, thus fulfilling a fundamental
requisite for the achievement of health for all”.

T

In a resolution on the world health situation, the
Board emphasized that “the achievement of the goal
of health for all by the year 2000 requires continu­
ing political commitment and is intimately linked to
socio-economic development, and to the preservation
of peace”. Member States were also urged “to guide
further itheiri national health
policies and health
development processes towards the achievement of
the goal of health for all and to involve decision­
makers, community leaders, health workers, non-gov­
ernmental organizations and people from all walks
of life in the attainment of national health goals'’.
Recognizing that the ongoing economic crisis facing
much of humanity made it difficult for many coun­
tries to reach the goal of health for all by the year
2000, the resolution requested the Director-General
of WHO “to intensify further support to the least
developed countries, with particular emphasis on ra­
tionalizing and mobilizing additional financial reso­
urces for strengthening their health infrastructure
from national, international, bilateral and nongovern­
mental sources”. The Executive Board of WHO will
review the next evaluation of the global strategy in
January 1989.
Regional Director’s report

Before adopting the resolution, the members of the

100

Board were further briefed on the world health situa­
tion by the Regional Directors’ reports on -the signifi­
cant events which occurred in their .respective regions
since the previous session. The overall conclusion is
that the problems facing developed countries are sur­
facing in developing countries while the health pro­
blems linked to underdevelopment still have to be
solved.

Dr U Ko Ko, Regional Director for South-East Asia
since 1981, was re-elected by the Board for a new
five-year term. He noted in his report that cancer,
cardio-vascular diseases and other diseases of deve­
loped countries were threatening to emerge as major
public health problems in countries that had achieved
higher levels of life expectancy. Malnutrition and
nutritional deficiency disorders and water-, food-, and
vector-borne diseases continued to be major causes of
morbidity and death. However, infant mortality rates
had decreased considerably and life expectancy at birth
was increasing in most countries of the Region.
Focus on immunization

In a resolution on the Expanded Programme on
Immunization, the Executive Board of WHO reaffir­
med that the goal of “reducing morbidity and morta­
lity by providing vaccination for all children of the
world by 1990 remains a global priority and represents
a milestone towards achieving health for all by the
year 2000”. The resolution warned “that the goal will
not be achieved without continuing acceleration of na­
tional programmes”. The resolution “notes with appre­
ciation the increased international support for immu­
nization programmes being provided particularly by
UNICEF and by national development agencies, pri­
vate and voluntary organizations
and individuals,
whose collective efforts are helping to bring the
immunization goal within reach”.
O
—WHO

Swasth Hind

CAMPAIGN AGAINST RABIES
Jean Blancou & Konrad Bogel
countries and territories—mainly in
the developing world—are still suffering from the
spread of rabies among the dog population. Dogs
are a most dangerous reservoir of the disease, accoun­
ting for over 99 per cent of all human cases world­
wide and over 95 per cent of all human post-exposure
treatments.
Without systematic control of the dog
population, the medical services have to give costly
post-exposure treatment. Each year, for every one
million inhabitants in a given country, at least 2,000
receive anti-rabies injections. Even so, a great many
people die in pitiful circumstances for want of this
treatment. The cost to medical services is enormous,
and many countries do not have enough vaccine to
treat all the bitten people who expect help in an
emergency situation.
bout 88

A

The special features of rabies—the fact that it usu­
ally involves known exposure to a deadly infection, its
long incubation period of weeks and months, and the
spread of the disease through dogs over large dis­
tances as a result of international travel—call fo.r
technical cooperation between the affected countries
in combating the disease.
WHO has given new emphasis to the control. of
this disease, particularly in dogs. Frequently aban­
doned by their owners, stray dogs can be seen by the
hundred in towns and villages, feeding on what they
can scavenge. This is why dog ecology studies are
being organized in many countries to learn more about
the dog population and how to control strays or in­
clude them in the vaccination programme.
WHO
Collaborating Centres are trying to develop new vacci­
nes and methods for applying them, for instance
through oral vaccination with suitable baits. Planners
are designing special projects to deal with the trans­
fer of technologies of vaccine production to developing
countries, so that they may become largely indepen­
dent from foreign currency markets.

The work of the veterinarian is intimately linked
with the rapid treatment of exposed persons by the
doctors.
The two professions work closely in the
field of rabies, as in many other major diseases which
are transmitted by animals to man. We can reason­
ably assume that canine rabies can be brought under
control by a joint effort, as has indeed occurred in a
number of countries over the past 30 years, for exam­
ple in Argentina, Chile, Greece, Hong Kong, Italy,
Japan, Portugal and Zimbabwe.

The Ministers of Agriculture of all countries of
the Americas decided to bring the disease under

May 1986

control by 1990, at least in towns and cities. Success­
ful operations in several countries, such as Tunisia,
have shown that this is a realistic goal. Certain coun­
tries in Asia and Africa have also sought WHO’s help
in developing plans, resources and countrywide cam­
paigns. International funding institutions help as far
as possible. Thus the Arab Gulf Programme for UN
Development Organizations and the Swedish Save the
Children Fund support three pilot projects in Ecua­
dor, Tunisia and Sri Lanka. The UN Development
Programme (UNDP) itself is supporting projects in
Asia.

The Rockefeller Foundation is particularly con­
cerned with the transfer of vaccine technology, and the
Order of Malta has created a special World Rabies
Foundation. The World Society for the Protection
of Animals is cooperating closely in view of the res­
ponsibility dog owners have for ensuring the protec­
tion of their animals and man. So high technology,
the management of day-to-day operations, and the
cooperation of the community have all to be inextri­
cably intertwined if they are to be crowned with
success.
WHO Collaborating Centres provide assistance by
testing vaccines, improving diagnostic procedures,
helping national programmes, providing knowhow and
facilitating rapid exchange of epidemioloical infor­
mation. This information network functions in close
cooperation with the International Office of Epizoo­
tics in Paris.

As the worldwide programme proceeds, the watch
and alarm system must be build up. Re-introduction
of the disease in rabies-free areas causes great public
concern and fear, and may result in the loss of human
lives. In any case, it then becomes very expensive to
combat such outbreaks. The most recent outbreaks
have been reported, with all their full impact and con­
sequences, from Spain (1975-1977), Flong Kong, (19801981) and France (1983).

In the Spanish outbreak, after eight years without
a sign of the disease, a dog was diagnosed as .rabid
in Malaga, in July 1975. It had. bitten its owner,
who died from the disease two months later. The
authorities took immediate steps to stifle any possible
outbreak. These included keeping the public fully
informed, banning the transport of cats and dogs for
a radius of 10 kilometres around the first case, listing
all such animals in the whole of Malaga province and
putting down all strays, eliminating the fox popula­
tion in the area to avoid any possible spread to the
{contd. on page 104)

101

Disorders in nature are frequently of
man's making; human mismanagement in­
i' creases the risk of many diseases. How; ever, natural conditions are not necessarily
synonymous with peace and harmony. The
[ struggle for survival of animal species and
I individual creatures is permanent and
! projects many risk, factors into human life.
j Infectious diseases in particular are part of
...
this natural system to which we belong.
I Over 150 kinds of human infections and
I intoxications, many of thenrfoodborne. have
j their reservoir irr animals.
Infections are often the cause of catasj trophic population declines among animals
| living in the wild, such as antelope (rinder| pest), jackals (distemper) or rabbits (myx' omatosis). Fortunately, natuie possesses
* mechanisms to heal such severe wounds
inflicted on its ecology.
Infections in nature, including those
transmissible to humans- (which we call
i zoonoses) can result in frightening g
j epidemics when man penetrates into na­
ture and conquers new territories. Biting
• arthropods (ticks and other insects) may
transmit, from ancient reservoirs in wild
animals, some of the most dangerous dis­
eases to man such as relapsing fever,
plague and haemorrhagic fever. Rodents
j contaminate the human environment, and
particularly foodstuffs, with the agents of
leptospirosis and other mortal diseases
such as Lassa fever.
Biting animals transmit rabies. People
who work in forests and agriculture as well
I as tourists are at special risk. In 1967,
! monkeys caught in Africa transmitted to
Europe a highly contagious disease which.
caused several deaths among laboratory
and hospital staff. The natural reservoir of
this newly-detected infection,, now called
Marburg Disease, is still unknown. Birds
and mammals are thought to play a decisive
role in harbouring various close relatives of
the human influenza virus. Worldwide in­
fluenza epidemics in man may well origi­
nate from such reservoirs.
Man-made changes in the landscape or
the ecology may introduce or abruptly in-, i
crease the danger of human infections from |
natural reservoirs. Diseases resulting in ’
much sickness and death have been re­
ported from irrigation projects, artificial
lakes, areas of deforestation, and railway
and road construction sites.
"Natural disorders" become evident and
most hazardous Where such zoonotic dis­
eases establish reservoirs in our domestic
animals which serve as a source of meat.
milk and eggs or are otherwise close to us
as companions. Changes in land use and its
management can cause considerable harm.
Thus, deforestation to create cattle breed­
ing pastures in South America introduced
vampire bats and, through them, rabies
A high density of domestic animals,
both in the countryside and in towns, may
hot only increase the host-parasite burden
of infectious diseases but can also
cause environmental pollution, since
their wastes carry a heavy "burden of
micro-organisms, nitrogens and phosphates Original drawings W Steve-Ewan
into the soil.
.■

Harmony between man and animals in
the context of health means the safe and
effective application of sanitary and veteri­
nary measures in wildlife, domestic animals
and man. These measures are essential to
avoid serious diseases in man and animals
(domestic and wild), to obtain energy, food
and by-products from healthy animals, and
to avoid polluting the environment.
Individual and general measures of hy­
giene are as important as are specific ap­
proaches for preventing, monitoring, con­
trolling and treating diseases that originate
from animal reservoirs and products. And
the safety and effectiveness of what we do
depend on close cooperation between
those national services responsible for ani­
mal and for human health. Steps that have
been jointly planned by these services and
maintained in harmony are today reducing
the burden of many zoonotic diseases, such
as rabies. Rift Valley fever, anthrax, brucel­
losis, leptopsirosis, hydatidosis, tapeworm
infestation and most foodborne infections
and intoxications. In their daily life, people
often help to prevent and control such
diseases through their traditional attitudes
towards animals and food habits; the most
successful national programmes are based
on community cooperation. Meantime
many national and international regulations
regulate the trade in animals and their
products.

A’#* *■
M’A

®i

re

large animal populations, and thus to influ­
ence their growth, density, nutrition, shelter
and health. But it follows that careful obser­
vation of the harmony between ecology and
health measures has become imperative.
particularly in view of the rapidly increasing
demand for foodstuffs and changes in land­
use and farm management.
To-an even greater degree, national pro­
grammes of rural development and urban­
isation take advantage of the intersectoral
functions of veterinary public health in order
to ensure the right ecological balance
through proper prevention, control and
treatment of zoonotic diseases and the
related risk factors. At the international
level, who maintains monitoring systems for
certain diseases, whilst a network of over
50 specialised who collaborating centres
provide their services to prepare and test
vaccines, to help in planning national pro­
grammes, in training specialists and in coor­
dinating research in the field of veterinary
public health. Harmony of action at interna­
tional level supports national efforts. For
example, one country, on its own is unlikely
to get rid of rabies in the dog population.
unless actions are well coordinated bV
neighbouring countries in their own
border areas.
In many countries, national intersectoral
committees (on rabies, salmonellosis or •
zoonoses in general) are being mobilised to
ensure that there is harmony at an opera­
tional level within the country as well as in
international work.
It is only through the harmony of mankind
with the environment and with the animal
kingdom that the lasting health of our future
generations can be safeguarded.
■
— World health. July 1985

undesirable guests
that animals can
transmit to us
1. Parasites-worms,
mites, protozoa and
so forth
2. Bacteria-such as
anthrax, brucellosis,
leptospirosis.
salmonellosis, plague
3. Viruses-includmg
rabies. Rift Valley
fever, certain
encephalitides and
haemorrhagic fevers
4. Fungi-such as
ringworm
Photos WHO

Swasth Hind

May 1986
103

Photo shows injection being given to a boy to protect him from rabies, {Photo WHO}

{Contd, from page 10/)
wild life, and introducing severe penalties for pet
owners who did not conform to regulations.

The measures were successful, and within two years
the disease was considered eradicated from Spain.
In Hong Kong, the outbreak was confined to the
north of the New Territories. Between 1980 and 1981,
there were 16 confirmed cases in dogs, one case in a
cat, and three human cases, all of which proved fatal.

The dog inoculation or destruction campaign was
massive. Within 12 months, 118,217 dogs were inocul­
ated against rabies and 82,816 were destroyed. Police
and other services mounted .roadblocks on roads lead­
ing into and out of the infected area. No further cases
were found, and restrictions on the movement of dogs
were finally lifted in April 1982.

104

In the rabies-free area of France, a cocker spaniel
bitch bit its owne.r and his daughter after behaving
strangely, then escaped and bit 5 other people, 13
dogs and cats, and five sheep before being destroyed.
The bitten humans were safely inoculated, and the ex­
posed animals were put down. Two other cases oc­
curred soon afterwards, but again a mass vaccination
campaign forx all dogs in the neighbourhood and the
death sentence on any unclaimed pets ensured that
the outbreak was contained.
All three examples show that, provided preventive
measures are speedily and forcefully applied, with the
full cooperation of the community, rabies may re­
main a disease to be dreaded but need never be
allowed to get out of hand.
O
—World Health, July 1985

Swasth Hind

{Photo WHO)

SOLVING THE PROBLEMS OF
THE YOUTH
Kum. N.V. Rajeswari & M. Hari
ris Potential of youth, if it is to be properly
tapped, requires understanding and support.
Youth is a very special time with special challenges
and is a period during which the body, personality,
intellect and social attitudes are developing erratically
usually independently of one another and frequently
explosively. It is a time of life that is full of potential
and problems. It is an age characterized by impatience
as well as curiosity and by a strong desire to leave
chi Id-hood behind and play an independent role. It,
therefore, becomes imperative that youth are brought
up in an environment which is stimulating and suffici­
ently challenging for them to be able to explore their
potentialities and build up a satisfying future.

T

Youth, whether student or non-student,
require health education regarding nutrition,
exercise, personal hygiene, disease preven­
tion, family life education and counselling
services. Parents, teachers and social leaders
have to play an important part in these
activities.

May 1986

The adolescents differ physiologically and psycho­
logically from children and adults. As such, youth is
suffering from loss of identity. Thomas Forstenzer
points out that very little has been done in the world
to tjry to understand, let alone do something about,
the problems of youth. It is, therefore, necessary to
go into the needs and problems of our young people

105

with a view to seeking solutions to these problems and
of guiding the youth so that they may make smooth
adjustments to change which they are encountering
within their own growing self as well as in the
environment around them.
Definition

There are many parts of the world where ‘youth*
is almost an unknown concept. Many children are
abruptly and harshly catapulted into adulthood at a
very early age. Youth is a twentieth century pheno­
menon in one sense atleast in the Asian world and
more especially in India. Ideally the youth years are
vital transition from childhood to adulthood. United
Nations identifies the people in the 15—24 age group
as ‘youth’ and it constitutes a substantial and growing
proportion of population.
Situation of youth

In 1975, there
were approximately 738 million
people between 15 and 24. By the year 2000, when
today’s children will have become youth, it is esti­
mated that there will be 1,180 million, an increase
of 60 per cent worldwide. While youth population of
the more developed regions will increase only 5 per­
cent in that period, the same age group in the less
developed regions will increase by 80 per cent. Thus
the challenge is greatest in developing countries. In
1985 there were approximately 170 million, 627 million
and 105 million young people and it will increase to
341 million 679 million and 129 million by the year
2000 A.D. in Africa, Asia and Latin America res­
pectively. The increasing numbers and demands of the
world’s youth pose some very serious problems that
require special attention. Demographically, they are
going to be a very significant) next generation. Because
they are just beginning their sexual and child bear­
ing life, they hold the key to the future demographic
patterns and the resultant quality of life.
Problems

The problems facing this age group are increasing
as fast as its numbers. More than 300 million youths
are unable to find jobs; lack of access to education
and high rates of school drop outs result in wide­
spread illiteracy, particularly among girls. Health
care is inadequate, especially among rural youth. Drug
and alcohol addiction, violence, scarcity, misplace­
ment, anxiety, defensiveness, pragmatism, subsistence,
crime and suicides involve more young people than

106

ever before. In short, the majority of youth in the
world are rural and poor and are already parents,
lacking sufficient food, safe water, proper housing,
health care, basic education and access to employment.
They are growing upon the edge of survival without
any hope for a decent life, and nothing to enable them
to contribute to the development of their community
and country. Hence, the young people have lots of
problems—physical, emotional, social and ethical. This
is a result of unfulfilled need response, complexes and
consequences of copied western style of life, develop­
ment, rural/urban drift, lack of job opportunities
and the world economic situation. All this seems to
indicate that society is often failing to provide youth
with sufficient guidance and opportunity.
Lack of educational facilities

The educational system is one of the many serious
problems concerning youth. If we analyse the types
of youth, we will find mainly two categories—firstly
the student youth, the school goers and the other
non-student youth including school dropouts.
We
have a lack of educational opportunities especially
for the youth in rural areas, because most universities
are located in the cities. The youth, if they are poor,
cannot go to these centres of education. There are
no proper facilities far their education in rural areas
and in slums. Youth services are lacking for all.
Hence they claim that they have no opportunities for
education. The youth are given mainly a general edu­
cation and professional education.
No priority is
given for vocational training either at the high school
level or at the university level. With large numbers
of young people from rural and urban areas clamour­
ing for higher education, there has been a woeful de­
terioration of academic standards. In Western coun­
tries every school and college has counselling bureaus.
In our country, this facility is woefully lacking. The
education provided in schools and colleges is not joboriented. Thus youth are facing problems of lack of
education and training opportunities. Many students
are lost to education after primary years (and only
a small percentage of the secondary school students
enrol in higher education) as there are not enough
schools, or due to their low economic status and to
some extent to irrelevance of education for the kind of
life they live. Teenage pregnancies leads to a large
number of school dropouts or wastage of education
among girls. Our educational system does not provide
social learning in any organized manner.

Swasth Hind

Unemployment and under-employment

Youth unemployment, that
most crippling road
block on the bridge from childhood to adulthood has
reached unprecedented proportions in many industrial
and developing countries particularly in urban areas.
And it has struck without discrimination at the educa­
ted, and the uneducated alike. Another important
problem is the economic situation increasingly demands
a high level of education attainment for participation
in the labour force. An adolescent who lacks the
basic educational qualifications, greatly disadvantages
himself for participation in the labour foirce. This
can be evident from the finding that the unemployed
in many parts of the world include a very high percen­
tage of young people—many of them illiterate, most
of them unskilled and inexperienced. The dice are
already heavily loaded against them. Under-employ­
ment is very high in developing countries.
Health problems

The youth everywhere and in developing countries
like ours in particular are facing manifold problems
in relation to health care opportunities. The health
problems of youth consist of, in addition to purely
medical problems, problems of medico-social nature
like emotional problems, psychosexual problems, delin­
quent behaviour, addictions, etc. The following medi­
cal problems may be considered peculiar to this age
group: (i) disorders related to reproductive functions
particularly in girls, (ii) communicable diseases espe­
cially sexually transmitted diseases, (iii) accidents and
certain psychological disorders.

The age period 15—24 years is a period of sexual
maturation and transition from childhood to adult­
hood and youth are further under great emotional,
academic and vocational pressures. Hence, maladjust­
ment resulting in psychological disorders, drug addic­
tion, smoking and alcoholism are common in youth.
Drug and alcohol consumption among youths leads to
vandalism and disrespect for elders and authority.
Drug addictions

During the last decade we have seen a marked in­
crease in the use of psychoactive or mind altering
drugs in our society. Drug abuse and dependence may
occur at any age but seem to be most common during
adolescence and young adulthood. Drug use by youth
may serve a number of special motivations. There
may be simple urge to rebel against adult constraints
by using disapproved drugs, or simple curiosity, due

May 1986

to lack of love and attention of parents or emotional
disturbances of varying degrees of severity and an
inability to cope with the demands of living or to find
a meaningful personal identity.
Smoking

Unwise lifestyles pose the biggest threats to young
people’s health. Innovative judgements, a tendency
to show off, or the desire to keep up with their
fellows—all these incline them towards risk taking be­
haviour. In many cases, the cigarette is the very first
contact young people have with the lifestyles of adul­
thood. The percentage of teenage boys and girls
smoking is 16 and 19 per cent in United States, 26
and 13 per cent in Papua New Guinea; 14 and 10 per
cent in Nigeria; 9 and 6 per cent in India respectively
and 46 per cent both for boys and girls in Uruguay.
Drinking (alcoholism)

Drinking in general has increased during the last
20 years and this increase has been somewhat steeper
among young people. In the urban areas it is usually
the high school college and university students who
take to drink because it is fashionable. Road acci­
dents, many of which are related to alcohol, are one
of the major killers and producers of disability in
young people. The young also may become violent
due to alcoholism.
Juvenile -delinquency

Juvenile delinquency is one aspects of the malad­
justment problems, chiefly due to lack of proper
family support and educational and recreational faci­
lities, youth turn to gang behaviour and juvenile crime
particularly in urban areas. In other words broken
homes, parental rejection and faulty discipline and
unusual stresses, are mainly responsible for juvenile
delinquency.
Crisis of identity

The major task facing youth today is a search for
meaningful identity. The search for identity by an
adolescent causes a great deal of stress on parents.
The problem is further complicated by the constant
testing of limits by the adolescents.
Attitude of the adults towards the youth

Most behaviour problems in adolescents are mani­
festations of an on-going conflict between adolescent
and family. Parental rejection is the major problem
facing the youth today. Parental criticism of appea­

107

rance, habits, dress and manners, parental strictness
on spending habits and eating habits, parental teasing
about friendships, parental comparison with sisters or
brothers and with other children are some of the points
that bother adolescents most about their parents. What
is lacking most is the constant dialogue between the
old and the young. In nuclear families, often working
parents have little time so spend with their growing
children. The youth is compelled to turn to outside
groups for understanding and advice. Radio, TV,
movies, cheap literature and other media of communi­
cation retard his moral growth.
Poor housing facilities

Many youths live in houses which are both over­
crowded and hazardous to their health. About 54
per cent, 43 per cent and 63 per cent of the youth
live in housing with 3 or more persons per room in
Pakistan, Guatemala and El Salvador respectively.
Many youth live in housing without access to safe
water. The percentage of this in rural and urban
areas respectively is 23 per cent and 69 per cent in
India, 28 per cent and 80 per cent in Pakistan, 11 per
cent and 79 per cent in Guatemala, 31 per cent and
90 per cent in Bolivia, 4 per cent and 87 per eent in
Uruguay and 28 per cent and 67 per cent in Khana.
More responsibility at an early age

For many youths, particularly females, the respon­
sibilities of adulthood come early. The early age of
marriage is a serious problem for girls leading young
girls into adult responsibility without preparation.
Added to this, dowry system is affecting young girls
especially in India.
Sexuality and fertility

In many societies there are reports of increased
premarital sexual activities among ever-younger people,
declining ages of first coitus, greater numbers of ado­
lescent pregnancies, induced abortion, and sexually
transmitted diseases and an increasing incidence of
child birth among teenage mothers. In Jamaica, the
problem of adolescent pregnancy is more acute, one
in three births being to teenage mothers.
The solution

The major challenges of adolescence are complet­
ing the transition from childhood to adulthood, at­
taining mature attitudes in regard to sex, choosing
a vocation and planning further education, search­

108

ing for the meaning and purpose of life,
one's self.

and finding

We have not provided our youth with the services
which they should have. We need to understand our
young people. Youth students have more amenities,
more choices and greater opportunities but there is
more competition, more tensions and more emotional
problems. We have to have new insights about the
needs of the young persons, better understanding of
the dynamic nature of his personality and the pro­
blems of adjustments he faces in order to help him
in his growth in self-realisation, in civic responsibility
and in vocational and economic efficiency. Youth
cannot be seen in isolation, many of the problems
facing them are closely linked to their childhood. We
cannot address the problems that confront today’s
youth, appraise their situation, promote policies and
define actions relating to them without taking a look
at the all-embracing nature of their development,
their care and upbringing before and through adole­
scence.

Despite increasing attention to youth research and
programme development the record is far from con­
sistent. So, we have to do more for them than they
have and make a special effort to understand their
problems. We have to tackle some of the common
problems of youth such as youth unemployment,
under-employment, issues of regional and inter­
national peace and security, issues of education and
training, issues of family and community life, pro­
blems of equality for young women, health, housing
and environment issues; crimes and problems result­
ing from migration.
The primary focus should be on activities at the
national and local levels to “address and deal with
specific needs and aspirations of youth”.
A new education policy

At present a new system of education is needed.
There should be strong educational reforms. For this
we need a proper guidance system in our schools and
colleges. High priority should be given to the educa­
tion and to technical and vocational training. By
extending the availability of education for all and
compulsory education for children, we can improve
ithc educational status of youth. Counselling and
guidance services should find high priority in our
educational planning. Special programmes for re­
moval of illiteracy among non-student youth are to
be taken up urgently.

Swas th Hind

Other do’s an don’ts

It is important to take into account the less fortu­
nate youths who are out of school. They could be
reached in youth gatherings or homes and helped to
gain back their confidence through, for
example,
adult literacy programmes or vocational training.

The employment opportunities should be increased
and there should not be job discrimination against
young workers. It is important that our young peo­
ple are given guidance in choice of profession. The
young people, and particularly the girls, need to be
given an opportunity to contribute to the manpower
and economic resources that are so vital to national
development, and should not be buidened down with
sexual and parental responsibilities before their ap­
pointed time.
Youth whether student or non-student require
health education regarding nutrition, exercise, perso­
nal hygiene, disease prevention, etc., family life
education and counselling services. Parents, teachers
and social leaders have to play important part in
these activities.

Promotion of sports and recreational services for
youth in general are to be taken up. 7he co-operative
effort of government and voluntary agencies is re­
quired for this purpose.
There should be more strict legislation reducing
the availability of alcohol, especially for young peo­
ple below certain ages, and it should be implemented
more effectively. If age is characterized by caution,
youth is characterized by a love of risk taking. Such
impulses can be guided to take positive forms—sports,
outdoor adventure, social experiments rather than
towards the negative habits of cigarette smoking,
abuse of alcohol or dependence on other drugs.

The youthful energy and drive can easily be mis­
directed into resentment or revolt, if parents and
adults, in general do not find ways and means of
communicating with teenagers and building up a
constructive partnership. Well planned camps and
youth services bring youth and adults close in a
natural wholesome way.
Through these are built
bridges of understanding over which not only youth

May 1986

guidance can move along with ease, but friendships
develop between the young and older adults.
There is a mounting need for imparting home and
family life education to our young adults. Youth
services should include sex and health education. The
young people need accurate scientific information,
professional counselling and social services, as well as
medical and health programmes specially designed to
deal with their need for sexual expression. There is
a need for better trained, adolescent-oriented service
personnel who can relate to their young client’s
perceptions, fears, attitudes, and aspirations.

Marriage counselling is another neglected area of
youth education. Education at college level should
include an elective course on “The Home, Family
and Responsible Parenthood” to help youth in this
most important area of life.

Youth needs guidance for leisure time. Our youth
have the utmost leisure and they have the most waste­
ful of time. Parents and educators should recognise
this as an important guidance service that we need to
provide for our youth to save them from wasting their
time and talent.
Conclusion

With our awareness now of the multiple problems
that the adolescent faces, we are in real danger of
being pessimistic about them.
Adolescents are
going to struggle through their adolescence and a
large percentage of them are going to reach maturity
and as a result of that they will .make the world better
than the one they entered. Youth can only motivate
the youth. The Nation’s prosperity thus depends to a
considerable extent upon how the youth are organi­
sed, mobilised, trained and guided.
The present
adolescents are not only questioning and protesting
and challenging but are potential agents of social
change.
There are no clear-cut answers and solutions that
would be applicable to all situations; each country
and community must decide and act for itself. But
act it must, for any further delay would only hurt our
adolescents in the long run.
O
Courtesy:

Vojana,-September 1—15,1985

109

commitment to the decade is definite and
unhesitating as is clear from the fact that the
Plan allocation (Rs. 49 crores in 1951—56) for water
and sanitation rose to Rs. 3,908 crores which later
was raised to 4,177.51 crores in the Sixth Plan.

I

ndia’s

At the beginning of the decade (1981) only 77.7
per cent of the towns and cities and 31 per cent
rural people had adequate supply of drinking water.
Only about 0.5 per cent of rural people had some
sanitary facility for disposal of human waste. Al­
most the entire rural population, some 52 crores of
them defecated in the open.

WATER AND
SANITATION
Fundamental to life

Water and sanitation are fundamental to life.
They are pre-requisites for a healthy life.
This is a field where Governmental and
Voluntary Agencies have to work with the
people to make it a success. As it is for
the people, it has to become a people’s
programme if its aims are to be realised.

In a random survey in urban areas it was found
that 27 per cent had flush latrines, about 67 per
cent have either dry latrines or one bucket a day and
some 33 per cent have no latrines at all.
Such
statistics may be cold and nauseating, but without
them the country cannot work out solutions to this
problem.
After various studies and their evalua­
tion, the Government of India is determined to go
ahead with the programmes to reach drinking water
to all citizens by March 1991.
For waste disposal
the target set is to cover 80 per cent for urban areas
and 25 per cent for rural areas. The estimated ex­
penditure is Rs. 14,700 crores; which will cover 95
per cent of the people.
Five per cent, who could
not be covered will be covered in Eighth Plan.
In the Code of Basic Requirements of Water Sup­
ply, Drainage and Sanitation, as well as the National
Building Code a minimum of 135 litre per consumer
day (Ipcd) has been provided with all residences pro­
vided with full flushing system for e^reta removal.
The earlier manual had recommended certain require­
ments for domestic, non-domestic, fire demand and
industrial needs. The present committee has revie­
wed these figures and the following recommendations
have been made.

Urban requirements depend upon the size of the
community.
For communities with the strength of
upto 10,000, upto 100 Ipcd should be supplied, upto
50,000 about 125 litres and communities above that
200 litres.
Each case will have to be studied indi­
vidually.

In rural communities where house service con­
nections are not contemplated and where water is
given through hand pumps, the supply will not be
less than 40 Ipcd.

110

Swasth Hind

«

IMMUNIZE &
PROTECT YOUR CHILD
Immunization can protect your child from such dreadful diseases
as neonatal tetanus, poliomyelitis, diphtheria, whooping cough,
tetanus, tuberculosis and measles. Bring your child at the right
age for the full course ofthe vaccines to the nearest primary health
centre, dispensary or hospital where free vaccination facilities are
available.
Immunization Schedule
Vaccine

Age
• Pregnant Women
16-36 weeks

■ Infants
3-9 months

•
»• • r. ■-

9-12 months
18-24 ”

*

Na of doses

Disease

TT (Protects
both mother
and child)

2*

Tetanus

DPT

9

Polio
BCG
Measles
DPT
Polio

3
1
1
1 (booster)
1 (booster)

Diphtheria,whooping
cough,Tetanus
Poliomyelitis
Tuberculosis
Measles

*Give one dose,if vaccinated previously.
The interval between 2 doses should not be less than one month. Minor coughs^ colds, mild
fever and diarrhoea are not considered contra indications to vaccination.

davp 85/429

Universal Immunization Programme has been launched on
19th November 1985— the birth day of Smt. Indira Gandhi.
The successful Implementation of this Programme would be
the most appropriate living memorial to her.

May 1986

111

Institutional demands also have to be taken into
consideration.
Hospitals with less than 100 beds
will have to be given 455 Ipcd per bed while those
with more than 100 should get 340 Ipcd. Hotels.
nurses, hostels, boarding schools, restaurants, air and
sea ports, railway junctions offices, factories, cinemas,
concert halls, theatres have all to be supplied with
water, both for drinking and for sanitation.
A machinery has been set up to make the realisa­
tion of this aim a reality. An Apex Committee with
the Secretary, Ministry , of Works and Housing to co­
ordinate programme planning and operations has
been formed.
It has constituted three Working
Groups on “Financial Resources”, “Materials and
Equipments” and “Programme Manpower”. Reports
of the Working Groups have been approved by the
Working Committee and endorsed by the Conference
of State Ministers, Secretaries. Chief Engineers, and
Heads of Implementation Agencies in charges of
water supply and sanitation.

In 1981, Government tried to define its target by
describing a Problem Village as one which does not
have a safe drinking water source within 1.6 kms.
With an annual drainage of 1360 millions acre feet, it
was not beyond us. The Lok Sabha Estimates Com­
mittee later wanted to define a problem village as
one having no such source within 500 Hectometres
(0.5 km).
Moreover, the depletion of ground water
itself led to the increase in the number of villages
which do not have water within 1.6 kms.
All this
had led to a substantial increase in the money to be
invested and the efforts to be made to achieve the
target in a given time frame.

Novel Programmes

India took up this challenge by adding water sup­
ply to novel programmes such as Minimum Needs
Programme (MNP) and Accelerated Rural Water
Supply Programme.
A sum Rs. 2140 crores was
made available to these programmes.
According to
latest available figures. 1.31.964 villages were covered
by December 1983.

For human waste disposal 14,000 pour-flush, low
cost latrines were supplied to 210 towns in 11 States
and 3 Union Territories, till the end of 1983, under
the aegis of the UNDP. They were well received.
By 1984 December, 37,738 new pour-flushers were
installed in the same 210 towns.
These latrines cost only about Rs. 200 per unit
and need just 1.5 to 2 litres of water for flushing.
For a latrine with sewerage connections the running
minimum cost is Rs. 1,500. The new latrines are
simple in design and the village masons can repro­
duce them on a mass scale.
All the 170 munici­
palities of Rajasthan have accepted this technology.
Many States have started training personnel, and the
State Governments are making provisions for this in
their Plan estimates.

As an integral part of Applied Nutrition Pro­
gramme, water supply is provided to primary schools
and rural health centres. About 20 States are utili­
sing rigs to dig borewells in rural areas. A sturdy,
reliable, deep-well handpump, the India
Mark-II,
developed by UNICEF is in extensive use in the
countryside.
—PIB Q

THE CHILD SURVIVAL AND DEVELOPMENT REVOLUTION
Growth monitoring charts, packets of oral rehydration salts, and vaccines, are low-costs
life-saving growth-protecting technologies which can enable parents to protect their children
against the worst effects of poverty. Similarly, a matrix of up-to-date and down to earth
information about pregnancy, breast-feeding, weaning, feeding during and immediately after
illness, child spacing, and how to make and use home-made oral rehydration solutions, could
also empower parents to protect the lives and the health of their children.
But how can these technologies and this information be put at the disposal of million of
families in the low-income world? For at least the next quarter of a century, significant
improvement in the health of the poor World’s children will depend on how well that Question
can be answered.
.
•
n
The initial task of the Child Survival and Development Revolution is the communication of
what is now possible.
From: Grant, J. P. Marketing child survival. Assignment children, 65/68: 3 (1984).

112

Swasth Hind

NEED FOR
EFFECTIVE
SCHOOL HEALTH
SERVICES
—Smt. Mohsina Kidwai
ealth status of the children of a nation is a
highly reliable index of the health of her popu­
lation.
Our Government is earnestly taking mea­
sures to improve the health indices, and has achieved
tangible success in this direction. It is, however, a
reality that the health and nutrition status of our
children especially young children is far from satis­
factory.
The infant mortality rate of 105 is consi­
derably high, when compared to the rates obtained in
the developed world.
Protein calorie deficiency is
major nutritional disorder among children. Vitamin
4A’ deficiency leading to blindness affects children
below 6 years of age and around 25,000 children
become blind every year due to this cause. Large
number of school children suffer from anaemia.
Poor nutritional status of school children is responsi­
ble for adverse effects on school progress. Many
young school-going children are infact chance survi­
vors of chronic episodes of malnutrition in their early
life. Their dietary situation continues to be unsatis­
factory.
In view of their poor resistance and phy­
sical stamina, they end up as substandard adults with
low functional capacity and. endurance.
During the
school stage the overcrowding in classroom, poor
sanitary environment coupled with
inadequate
arrangements for drinking water and toilet facility,
all contribute to lowering of general health standards.
Children who are mal-nourished and are unhealthy
have difficulty in mastering school material, and their
learning is slow and there are high chances of drop­
ping out early from school, ft is estimated that more
than fifty per cent of students drop out of schools
before reaching class V.

H

Surveys carried out in India indicate that the major
health problems faced by our school children are:
malnutrition, infectious diseases, dental caries, tra­
choma, refractive errors, ear, nose and throat
diseases.
Our country is committed to achieve an appropriate
level of Health for All by the Year 2000 A.D. The
needs of children and our duties towards them are
enshrined in our Constitution.
Our late
Prime
Minister Smt. Indira Gandhi had stated, “There is
hardly any constructive activity which does not con-

May 1986

Smt. Mohsina Kidwai, Minister or
,
J Health ana
Family Welfare, delivering the Inaugural Address at
the Conference of the State Project Coordinators of the
National School Health Services Scheme at CHEB, New
Delhs.

113

cern itself with welfare of children." The National
Policy for Children adopted in 1974 by our Govern­
ment laid emphasis on areas iike child health, child
nutrition and welfare of handicapped children. The
policy also emphasised that health services for school
children should be an integral part of school activi­
ties and should include supplementary nutrition,
health check up, immunization and referral services.
Schools should have safe drinking water, sanitary
latrines, adequate light and air, and clean surround­
ings.
Our Government provides health care to the child­
ren as a part of the comprehensive health care to the
community through the health infrastructure which
is being constantly expanded in rural and urban
area of the country. However, there arc some ex­
clusive schemes for child health care like prophyla­
xis against nutritional anaemia, against blindness due
to Vitamin ‘A’ deficiency and immunization against
imectious diseases.
The Integrated Child Develop­
ment Service Scheme of the Ministry of Human Re­
source Development, provides a package of services
.to mothers and children below six years of age com­
prising supplementary nutrition, immunization, health
check-up, health and nutrition education and referral
services, etc. The number of 1CDS Projects is being
gradually increased.

To maintain the continuum from pre-school to school
stage,- health care services are provided through the
School Health Service Programme. The broad objec­
tive of the services under the scheme are promotion
of positive health concepts, awakening health cons­
ciousness among children, medical check up, early
diagnosis, treatment, referral to specialist centres, fol­
low up and diseases prevention.
The. development of School Health Services in India
has been sporadic and uneven. Various Slates have
launched school health schemes in one form or the
other, with varying priorities. Lack of financial re­
sources with the State Governments have, however,
restricted the scope and reach of the services. Con­
sidering the fact that the School Health Programme
was not implemented uniforma I ly in all the States
and adequate funds were not allotted by States for
this programme, Government of India constituted a
Task Force on School Health Services in 1981 to
assess the status of die programme and suggest mea­
sures as future guidelines for launching a comprehen­
sive School Health Service Programme in the country.
On the recommendations of the Task Force an In­
tensive Pilot Project on School Health Services was
started in 1982 in 25 selected blocks located in 17
States and 3 Union Territories.
The broad objectives of this Intensive Pilot Project
include study of: (i) extent of prevailing morbidity
including nutrition status of children in the project
areas, (ii) volume and type of acute and chronic
morbid conditions requiring referral facilities, (iii) To
detcrime feasibility of entrusting primary school tea­
chers with responsibility related to health status of the

114

school children, (iv) strengthening health education in
order to have belter results from the schemes. Besides,
there are specific objectives relating to feedback about
adequacy of existing resources to provide one medical
check up to all students of primary classes during a
year and suitability of mechanism for ensuring referrals,
follow up, health education and monitoring, etc.
In the year 1984-85, the project was extended to
additional 75 Primary Health Centres, thus totalling
100 PHCs in 21 States and 3 Union Territories. The
scheme is now 100% Centrally Sponsored and covers
1.0 lakh primary school children of rural, tribal and
backward areas. The primary purpose of the Project is
to draw experiences and develop feasible and workable
module so as to extend the scheme to other areas in
a phased manner. Though the project had been in
operation for more than three years in 25 PHCs and
approximately 20 months in other 75 PHCs, this too
has been found to suffer from limitations. 1 am sure
that the State Programme Officers would use this
forum to make a thorough assessment of bottlenecks
and suggest practical measures so that the programme
may be implemented effectively.

Concomitant to effective school health services are
availability of minimum healthful living conditions in­
cluding safe drinking water, proper drainage, safe dis­
posal of waste and adequate nutrition for children.
All these call for increased coordination of activities
by various Government departments and voluntary
bodies. A systematic planning, implementation and
programme evaluation would help in getting better
yields from the inputs. Our objective through these
programmes is to enable children to develop as healthy
and duty conscious citizens, imbibe desirable habits
to protect themselves from preventable diseases and
adopt a lifestyle which may keep them away from
most of the non-communicable diseases. Our objec­
tives also include making them rational citizens, fight
superstitions, misconceptions, beliefs and fads which
are likely to adversely affect their health, and make
maximum use of available health care facilities. This
requires proper coordination of activities of various
Ministries involved in developmental activities for
children. 1 may mention here dial the Ministry of
Human Resources Development is actively consider­
ing a comprehensive scheme, pooling the resources of
Health, Social Welfare, Education and Rural Develop­
ment Departments for the overall development of the
personality of the child.
Our Prime Minister, Slid Rajiv Gandhi declared
while launching the Universal Immunization Pro­
gramme on 19 November, 1985, that “All children
do not come with the same natural endowments, but
every Government should be able to give to every
child the best opportunity to develop its potential, to
the fullest”. The school health service scheme of
the Government is one such measure and the Govern­
ment is keen to make it a success.
•
(Text of the Inaugural Address delivered by the
Minister of Health and Family Welfare, at the
conference of the State Project Coordinators of the
National School Health Services Scheme held on
24th January, 1986, in New Delhi.')

Swasth Hind

NATIONAL SCHOOL HEALTH SERVICES SCHEME

CONFERENCE OF STATE PROJECT COORDINATORS
Conference of the
State Project Coordinators of the National School
Health Services Scheme was held on 24 January,
1986, at the Central Health Education Bureau, New
Delhi. Smt. Mohsina Kidwai, Minister of Health and
Family Welfare inaugurated the Conference. She re­
viewed the health problems and prevailing health con­
ditions in the schools. She emphasised the need for
strengthening of basic facilities in the schools like
safe drinking water, sanitary latrines, drainage and
clean surroundings for developing healthful living
practices. She also stressed the role of health educa­
tion for prevention of health problems and health
promotion with a view to achieve Health for All by
the Year, 2000 A.D. She further highlighted the im­
he Orientation-cum-Review

T

portance of health services for the school-going chil­
dren including immunizations.
Shri P. K. Umashankar, Additional Secretary Health.
addressing the State Project Coordinators, reviewed
the development of School Health Services in the
country and requested the participants to suggest alter­
native approaches for successful and meaningful im­
plementation of the programmes vis-a-vis the large
student population to be covered under the constraints
of limited resources. He further emphasised the im­
portance of coordination between home, school and
community, including health education departments,
and voluntary agencies. He suggested that the parti­
cipants may consider involvement of medical colleges

Smt. Mohsina .Kidwai viewing the exhibition organised during the State Project Coordinators Conference at
the Central Health Education Bureau. Seen in the photo are (from right) .
Dr H. C. Agarwal, Director
CHEB\ Dr Mahendra Dutta, Deputy Director General (Planning) and Shri J. S. ManjuL Deputy. Director
(School Health Education), CHEB.

May 1986

115

and private medical practitioners to ensure maximum
coverage through this scheme.

actual funds are remitted to the State Governments,
before any action is taken.

The Conference was attended by the officers of the
Directorate General of Health Services, Central Health
Education Bureau and the Health Directorates of the
States. Dr H. S. Hassan, Regional Director, Health
Education, SEARO, WHO and Mrs. Anna Kari Bill,
SIDA, representative and Dr U. C. Gupta, Director,
Dr A. V. Baliga Memorial, Trust, also attended the
Conference, as special invitees.

The State Project Coordinators informed that all
the States and U.Ts. are implementing the scheme.
The National School Health Services Scheme is an
additional charge given, usually, to an officer who has
several other responsibilities and as such required at­
tention is not paid. Difficulties of not having exclu­
sive vehicle and having inadequate number of medical
officers at the PHCs, were brought forth as major
impediments in the way of effective implementation
of the scheme.

Shri P. K. Mehrotra, Joint Secretary (M) and Dr
Mahendra Dutta, Deputy Director General (Planning)
chaired the sessions in which Statewise progress under
the Scheme was discussed. DDG(P) clarified the pro­
cedure regarding expenditure under the centrally spon­
sored schemes. He made it very clear that once the
Administrative Sanction is issued by the respective
State Government, the expenditure can be incurred as
per approved pattern of the scheme and is reimbursed
by the Central Government. It is not necessary that

Joint Secretary (M) emphasised that the State Pro­
ject Coordinators should expeditiously follow-up issue
of administrative sanctions with their respective Gov­
ernments where these have not been issued so far.
He further stressed frequent visits to the PHCs im­
plementing the scheme and ensure periodic meetings
of the Project Coordination Committees at the State
and district levels.
Q

The Universal Immunization Programme was launched in Andhra Pradesh on 19 November, 1985.
Dr M.S.S. Koteswara Rao,
Minister for Medical and Health, delivered the Presidential Address at a function in Hyderabad. To his right are Shri G. Narayan
Rao, Speaker, Andhra Pradesh Legislative Assembly; Shri Kala Venkat Rao, Minister for Municipal Administration; Shri Arjun Rao,
Special Officer, Municipal Corporation of Hyderabad and Dr D. Sunder Rao, Director of Health and Family Welfare.

116

Swasth Hind

BOOKS

AUTHORS OF THE MONTH
Smt. Aruna Palta

Alcohol policies, edited by Marcus Grant. Copen­
hagen. WHO Regional Office for Europe, 1985, 153
pages (WHO Regional Publications, European Series,
No. 18). ISBN 92 980 1109 2.

If we are serious about the goal of health for all by
the year 2000, then we cannot afford to ignore alcoholrelated problems. Throughout the WHO European
Region, and in many other parts of the world, rates
of alcohol consumption and of alcohol-related pro­
blems are now so high that they give rise to conside­
rable concern. Piecemeal attempts to deal with these
problems seem to have had inadequate results. In
an effort to find a more lasting solution, WHO has
begun to pay special attention to the development of
national alcohol policies.

What is presented here is an integrated approach to
the whole question of policy formulation. Past ex­
periences are analysed and research priorities arc
assessed. A real attempt is made to suggest the
logical sequence of stages in national policy develop­
ment. The contribution made by economists is parti­
cularly important, since one of the many conclusions
of this book is that a reasonable balance needs to be
struck between economic and public health interests.

But alcohol-related problems must not be viewed in
isolation. They need to be seen as a consequence of
particular life-styles and of choices made both by indi­
viduals and by societies. What this book achieves is
a sharpening of the focus on preventing alcohol-related
problems without any loss of the wider view of health.
It is concerned not only with promoting alcohol poli­
cies in a general sense, but with demonstrating that
they are indeed practical, necessary and comprehen­
sive. It is to be hoped that the suggestions it con­
tains will be studied and adapted by all those, through­
out the world, who are interested in improving health.
This book is, in a real sense, a plan for action and
its success will be measured by the extent to which
it is actually used in developing and implementing
alcohol policies.

Asstt. Professor,
Department of Home Science,
Govt. Girls P. G. College.
Raipur-492 001.
Shri K. L. Tiwari
Asstt. Professor,
Department of Botany,
Govt. Science College,
Raipur-492 001.
Dr S. C. Gupta,
Reader in Health Education.
Department of Community Medicine,

Christian Medical College,
Ludhiana (Punjab)
Shri P. Manohar Reddy
Health Educator.
Subsidiary Health Centre,
Pathikonda, Palamaner Taluk,
Chiltoor District (A.P.)

Kum. N. V. Rajeswari

and
Shri M. Hari

Senior Research Fellows,
Department of Population Studies,
S. V. University,
Tirupati.

FIRST HUMAN TRIAL OF BIRTH
CONTROL VACCINE IN AUSTRALIA
Thirty women have volunteered for the world’s
first human trial of a synthetic birth-control vaccine,
which began in February, 1986 in Adelaide, Australia,
at Flinders Medical Centre, a Collaborating Centre
of the World Health Organization (WHO).

The trial, part of WHO’s Special Programme of
Research, Development and Research Training in
Human Reproduction, is scheduled to last for nine
months, and aims to determine the safety and side­
effects of the vaccine in already sterilized women.
Following successful completion of this phase, the
vaccine will then be tested on fertile women to deter­
mine its efficacy as a birth control method. Also to
be determined is the duration of the vaccine’s effect,
which is foreseen to be between one and two years.
WHO estimates that if all the trials proceed satisfac­
torily. the vaccine could be available by the mid1990s.
The vaccine was developed by Ohio State Univer­
sity (USA), in collaboration with other academic insti­
tutions, the pharmaceutical industry and WHO over
the past decade. It has already been shown to be
safe in several animal species, and to prevent pre­
gnancy in baboons.
Q
—WHO

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SPECIAL NUMBERS 1985
January

The International Youth Year (Theme: Parti­
cipation, Development and Peace)

February

Nutrition

March-April World Health Day,
(Theme: Healthy Youth; Our Best Resource)

June

Environment and Health

July

Heart Disease

August

Health Progress

October

Behavioural Research and Health

November

Universal Children’s Day
(Theme: Community Participation)

December

Women, Health and Development

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