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Anaemia is a common public health problem but there is a paucity of studies regarding anaemia in the postpartum period. The objective of this study was to investigate the prevalence of anaemia in the postpartum period and factors associated with it. This prospective community-based study was carried out in a village of Haryana, India. Blood samples were collected for haemoglobin estimation at the end of six weeks postpartum. A total of 211 women were recruited and 168 women were included in the final analysis. It was found that 70% of the study participants were anaemic (Hb < 11 g/dL). Only 37% of the population had consumed ≥90 iron folic acid (IFA) tablets. The mean haemoglobin level of women who had consumed ≥90 IFA tablets in the antepartum period was higher (10.43 g/dL) than those who consumed

This prospective community-based study was conducted in the village of Chhainsa, Haryana, India, in order to discover the incidence and types of postpartum morbidity and the factors associated with the morbidities. The subjects were followed up to 42 days of postpartum with a minimum of three visits; the first visit was within 14 days of delivery and subsequent visits were every 14 days. A first visit was made to 211 women and 174 (82.46%) completed the study. Seventy-four percent reported at least one morbidity and there were 1.75 reported morbidities per woman per postpartum period. Common problems reported were: weakness, lower abdominal pain, perineal pain, abnormal vaginal discharge, high fever, breast problems, excessive vaginal bleeding, etc. There was greater morbidity among women of lower socioeconomic status, parity >4, birth interval >36 months, having a breech or caesarean delivery or a delivery assisted by relatives/neighbours. A significant positive association was found between age and non-maintenance of the ‘five cleans’ during delivery. Seventy-five percent of those who had reported morbidity had taken some action, but only 20% sought help from a qualified doctor and 14% from other health workers.

All births (1211) were recorded in a rural area for 1985 by monthly domiciliary visits and the sociological characteristics were collected from mothers within a month. The analysis of 1201 births is presented: 52.7% were male births, 95.7% were delivered in village itself, 80.4% were delivered by trained dais, 99.5% were live born, 12.9% were born before 37 weeks of gestation, 61.5% were put to breast feed within 6 hours, 35% were of gravida 4 and above, 68.9% did not receive any antenatal care, 67.1% had not received any tetanus toxoid, 70.8% did not receive any folifer tablet, 0.8% had abortion and another 0.8% had still birth in preceding outcome, 1.58% had lost a live born dead in preceding out come, 89.6% stopped breast feeding at conception, 31.7% had birth interval less than 2 years, but 2.2% had less than one year, 2/3rd were born in second half of the year, 17.8% had taken extra food during pregnancy, 21.2% reduced the work after becoming pregnant, 9.5% were born to mothers of less than 20 years age, 98.5% of mothers were housewives and 95.9% mothers were illiterate, 33.5% were born in nuclear family, 22.3% were living in 'Kacha' house, 34.8% had no electricity connection, 37.0% were born to land less, 42.2% had no radio in the house, 7.1% had no conveyance, 52.0% families had piped water supply. These findings have been discussed here.

WHO advocated a standard case management for control of ARI related mortality. India has started an ARI control programme in 15 districts. Conflicting reports appeared regarding the effectiveness of case management strategy. Authors reported earlier that it was not effective. The coverage was only about 57% in pneumonias, and 23% in severe pneumonias. Health agencies & health workers have a low utilizaticn (13.7%), and RMPs were used in large numbers (36.9%). Most of the deaths were in those treated by RMPs (75%). The efficacy of standard case management (88%) is highlighted. The problem of coverage and assumptions behind the strategy were discussed and recommendations for improvement were suggested.

Background: Tobacco and alcohol use are serious health problems. Studies focusing on problems associated with tobacco and alcohol use in the elderly are limited. Aim: To find out the prevalence of tobacco and alcohol use among rural elderly population. Methods: This cross-sectional study was conducted in the intensive field practice area of the Comprehensive Rural Health Services Project in Ballabgarh in Faridabad, Haryana, a rural field practice area of the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. The sample was selected using stratified random cluster sampling. The participants were ?60 years of age at the time of interview. Data on tobacco and alcohol use pattern of 1117 elderly were collected during the interview. Results: The prevalence of smoking was 71.8% in men (n=490) and 41.4% in women (n=497). Among men smokers, 41.5% were light smokers (:-5 beedis/day), 42.9% were moderate smokers (6-20 beedis/day) and 15.6% were heavy smokers (>20 beedis/day). Among women smokers, 71.8% were light smokers, 23.8% were moderate smokers and 4.4% were heavy smokers. Regular alcohol intake was seen in 16.3% of the men compared with 0.8% of the women. Conclusion: The finding of a high prevalence of smoking and alcohol consumption among men in this rural population of India is of serious concern and therefore needs remedial measures.

Experience in the control of tetanus neonatorum (TN) in a rural area is presented. TN was reduced by training of dais, increasing the coverage of tetanus toxoid to pregnant women and distribution of presterilized delivery kits to pregnant ladies for use by birth attendants. The problems of untrained birth attendants, effectiveness of tetanus toxoid coverage and place of delivery are discussed.Researchers analyzed 1972, 1977, 1982, 1987 data on neonatal tetanus death and birth attendants from the Comprehensive Rural Health Services Project in rural Ballabgarh, India which comprised 28 villages. Health workers visited each house in an area monthly. Even though they began vaccinating pregnant women with the tetanus toxoid (TT) in 1970, the TT coverage percentage did not fall substantially until between 1977-1982 (31.6%-70%), by 1983, TT coverage stood at 93%. It was not until TT coverage reached 85% did neonatal tetanus deaths fall significantly. In 1982, they gave every women near the end of pregnancy a sterilized delivery kit complete with gauze, half a razor blade, and thread. The health workers instructed the women to request anyone who delivers the child to use the contents of the kit. Regardless of the year, around 90% of deliveries occurred at home. Except for 1982, untrained individuals attended about 70% of deliveries. 1982 was the year with the highest percentage of trained dais involved in home delivery (27.6%). The percentage of deliveries my primary health care staff did rise from 4.2-12.1% between 1972-1987, however. In this time period, neonatal mortality fell gradually from 42.3-17.9. Moreover neonatal deaths from tetanus fell consistently but dramatically from 14.6-0. The drop in tetanus related deaths between 1972-1977, was not significant, however, because tetanus and septicemia were not differentiated and health staff seldom saw tetanus cases in hospitals. In conclusion, the Comprehensive Rural Health Services Project of India should expand prenatal care including TT to all pregnant women, distribute sterilized delivery kits to these women between 36-40 weeks gestation, and include instructions on how to use the contents of the kit.

This study was conducted in children under the age of four years for a period of one year. By domiciliary visits the diarrheal episodes were recorded, analysed and presented. The findings are based on the diarrheal experience of 4860 children. The attack rate was 2.6/child/year. Family with more than one child had more attacks. Mean duration was 5.76 days and 11.2% had lasted more than 7 days. All the age groups are similarly affected. 75.6% were just plain loose motions and only 4.9% had blood, mucus or fever associated with loose motions. Case fatality was 0.6%. Attack rate was more in June-August and December-February than the other quarters. 42.2% were shown to R.M.P.s. and 33.6% consulted friends or relatives. More than 2/3 gave mainly home made ORS. 69.9% restricted food during attack.

Rural underfives (5335) were followed for a period of one year from January to December 1987 for acute respiratory infections (ARI). Those affected with pneumonias were studied in detail to know the epidemiology. The children reported an attack rate of 0.29/child/year. Severe cases constitute 0.5%. Infants had higher attack rate (0.59/child/year), 47.7% of episodes occurred in infants and 87.7% occurred in children below 3 years. Males had a higher attack rate (0.32 vs 0.27). Mean duration of attack was 5.45 +/- 1.95 days. The attack rate was higher in winter. The case fatality rate was 1.26%. It was highest in neonates (10.7%) Females had higher case fatality rate than males (1.5% Vs 1.1%). Mortality was very high in severe cases. Case fatalities were high in seasons when the climatic change occurred, the highest being in autumn.

All the children between 1-4 year old were followed from January 1985 to December 1987 and all eligible children 9-24 months were given measles vaccine using annual pulse method in November-December 1985 and 86 in the study area. The children in C.R.H.S. Project area were used as controls for comparison. At the end of 2 years and 2 rounds of immunization with measles, significant reductions were observed in 1-4 year old mortality due to diarrhea and malnutrition in the study area in contrast to control area. Using epidemiological data and method of pulse immunization with measles vaccine can bring considerable benefit to this age group.

One hundred and six mothers in a rural area were interviewed to determine as to how they recognise pneumonia in children, what therapies they practice with mild acute respiratory illnesses and pneumonias and the feeding practices they adopt. Most mothers recognised pneumonia by noticing fast respiratory rate and difficulty in breathing. More severe cases were recognised by these signs among a higher percentage of mothers. As regards management of mild ARI episodes, more than half the mothers preferred not to give any treatment or use only home remedies. In pneumonias, a majority of them preferred to consult a qualified doctor. Nearly a third of them were of the opinion that they would take the child to hospital if the disease was severe. Regarding feeding practices, most of them stated that they would continue feeding, fluids and breast feeds. Only 10% desired to stop and another 15% would decrease the amounts.106 mothers in a rural area were interviewed to determine how they would recognize pneumonia in children, what therapies they would practice with mild acute respiratory illnesses (ARI) and pneumonia, and the feeding practices they have adopted. Most mothers recognized pneumonia by observing the quick respiratory rate and difficulty in breathing. More severe cases were recognized by these among a higher % of mothers. With regard to management of mild ARI episodes, more that 1/2 of the mothers preferred not to give any treatment or to use only home remedies. In pneumonias, a majority preferred to consult a qualified doctor. Nearly 1/3 of them were of the opinion that they would take the child to a hospital if the disease was severe. Insofar as feeding is concerned, most of them stated that they would continue feeding, fluids, and breastfeeds. Only 10% said they would stop and 15% said they would decrease the amounts.

A nutrition survey was conducted among 543 mothers of 547 3-year old children living in Sector 1 of Dr. Ambedkar Nagar, a resettlement community, in South Delhi, India to examine weaning practices and the supplementation pattern among these poor urban women. 33.3% of the 3-month old infants had already received animal milk. In fact, 22.9% of these infants 1st received animal milk within the 1st month. 44.6% of 3-6 month infants received animal milk and other supplements. This figure was 74.2% for 6-9 month olds and 88.7% for 9-12 month olds. When mothers 1st began giving animal milk, most (80%) added plain water to the animal milk at a ratio of 3:1. Those giving their infants infant formula also diluted it. Of the children using bottles, 92.2% and 88.6% had only 1 bottle and 1 nipple, respectively. Only 1.2% of the mothers sterilized the bottle properly. 84.5% gave their infants supplementary feeds because they believed they no longer had enough breast milk. They also tended to start supplementary feeds themselves (80.5%). Mothers had a tendency to delay supplementation as evidenced by the average age for introduction of semisolid foods which was 10.3 months. Weaning foods were dal, khichri, rice, chapati, and biscuits. 34.2% of the children were not weaned until after they reached their 1st birthday. These results indicated a high risk of infection due to the early introduction of fluids other than breast milk to young infants. The children were also at risk of malnutrition because of the tendency to introduced semisolid foods later than the recommended age of 4-6 months. Health workers must educate mothers about proper child feeding practices whenever possible since most made the decision to supplement breast milk on their own.

A prospective intervention study was conducted in Ballabgarh block of Haryana. The study area has a population of about 30,000 under a state run P.H.C. area. The control area has a population of about 60,000 under Comprehensive Rural Health Services Project of All India Institute of Medical Sciences. ARI control strategies as advocated by WHO was instituted in the study area. Measles and DPT immunization was strengthened. The ARI cases detected or reported to Health Workers were managed as per the standard case management procedure. The underfives mortality, infant and 1–4 years mortality rates were initially higher in study area and differences were statistically significant. After 2 years, the reductions in study area were substantial and differences were not statistically significant. The ARI mortality in underfives, and 1–4 years were higher in study area at the beginning compared to control area. Though they were less than in control area after 2 years of intervention the observed differences were not statistically significant in both periods. The reduction of 37% in underfives mortality and 26% due ARI mortality is substantial. More benefit was attained with measles immunization than with standard case management. ARI control programme is advocated for application on national level vigourously covering with measles immunization and to include the village based private practitioners in the strategy for effective case management.

Community based study was conducted in rural area of comprehensive rural health services Project, Ballabgarh of All India Institute of Medical Sciences to measure the incidence of risk factors (mainly based on interrogation and simple clinical examination) in pregnant women, their distribution and magnitude, the risk of bad outcome and utility of this approach in the field. The incidence of risk factors was 9·6 per cent. Severe anemia in current pregnancy, neonatal death in last pregnancy or more than one neonatal death in previous pregnancies, still birth in last pregnancy or more than one still-birth in previous pregnancies, three or more sucessive abortions, more than ten pregancies accounted for 84·8 per cent of those with single risk factor. The relative risk of bad outcome in pregnancies with risk factor is 4·69 times more than in those without risk factor. Pregnant women with severe anemia in current pregnancy or neonatal death in last pregnancy or more than one neonatal death in previous pregnancies had a relative risk of 4·27 and 7·89 respectively. If the still-births group and abortion group are combined with neonatal death group still the relative risk is high i.e. 6·35. These individual risk factors are easily identifiable by trained paramedicals or health volunteers. But the sensitivity (29·6%) and predictability (17·8%) of this approach are very low.

Influence of some family and maternal characteristics on prevalence of breastfeeding was studied in a cross sectional study using WHO suggested methodology. 547 mothers with children less than three years of age were interviewed with the help of a schedule. Age and parity of the mother, sex of the child, length of urban stay, mother's going for work did not influence the prevalence of breastfeeding. Prevalence was higher among illiterate mothers and mothers belonging to lower socio-economic status. The mothers from higher socio-economic status initiated breastfeeding earlier. More mothers from higher socio-economic status and those with better education thought that supplementation was needed before the child was 4 months old and felt that breastfeeding was needed for less than two years.

In a rural population 15,680 children below 10 years of age were kept under surveillance by the multi purpose workers for one year (1984). Measles developed in 436. The maximum incidence occurred between 1 and 4 years of age, but infants 6 months and above were also affected. The first half of the year (January to June) saw the most number of cases. Complications developed in 88 children. The most frequent was diarrhea followed by bronchopneumonia. There were seven deaths.

Etude faite sur une periode de 4 ans qui permet de voir les besoins necessaires a un centre rural de sante de l'enfant

The mothers of 547 children less than three years of age were interviewed for breastfeeding practices using WHO suggested methodology in a resettlement colony of South Delhi. Only 1.8% of children were never breastfed. Prelacteal feeds were given in 90.9% of infants. More than half received their first breastfeed on 3rd day or later. Among children under three months of age, one third were already receiving top milk. 68.4% of mothers felt that the child should be breastfed for as long as possible. Demand feeding was practised by 95% of the mothers. Most of the mothers did not seek privacy to breastfeed their children. The need to identify desirable and. undesirable infant feeding practices prevalent in an area has been stressed so that appropriate promotional activities can be carried out more effectively.

543 mothers of children under 3 years of age, from an urban resettlement neighborhood of New Delhi were interviewed concerning length of lactation, amenorrhea, subsequent pregnancy and contraceptive use. The interview was based on a pretested, structured, semi-open tool. By 18 months after birth, 96.3% of lactating, and 97.9% of non-lactating mothers were menstruating. In the overall group, 52.9% of lactating, and 93.2% of nonlactating mothers were menstruating. 14% had conceived; 5.3% during amenorrhea. The birth interval between the index and penultimate child was 2 years or less in 20% and 2-3 years in 40%. 17.8% were using contraception, and 33% had been sterilized. Since about 5% conceived during lactation, lactation is about as effective as oral contraception when used in developing countries. Lactation alone, however, is not adequate for contraception, and must be supplemented by artificial contraception. WHO recommends that the 25th to 50th percentile of time of resumption of menstruation in a given population be used as the time to suggest contraception. This would be between 6.5 and 10.5 months for these lactating subjects, or 2.5 months if not breastfeeding. Condoms or injectables are recommended for use during breastfeeding.

Mortality data of underfives during 1972–1974 and 1982–1984 in rural area were analysed. Underfives’ deaths were reduced by 35.9%, though the reduction was less in infants (27.2%), than in post infancy underfives (46.9%). The underfives’ death rate came down by 44.1% (from 38.3) to21.4 per 1000 underfives during the decade. The infant deaths show a uniform reduction in different age periods. The female underfives’ deaths are more than male deaths indicating a relative neglect of female children. The only diseases showing reduction in mortality in a substantial manner are tetanus and typhoid. Otherwise there is a general reduction in all causes. Prematurity, acute respiratory infections, diarrhoeal diseases, malnutrition and septicemia constituted 84.7% of deaths in infancy in 1982–84 and acute respiratory infections, malnutrition and diarrheal diseases constituted 69.7% in the 1–4 age group. This study shows how a strong referral service built into medical care with preventive and promotive methods can reduce the underfives mortality.

There were 1092 deliveries in 1982 at CRHS project, Ballabgarh. Of these 643 had antenatal care (study group) and 439 did not receive minimum antenatal care (study group) and 439 did not receive minimum antenatal care (control group). The mean birth weights in study and control groups were 2·84 and 2·71 kg respectively and the difference was statistically not significant. The percentage of births with less than 2500 gm was 19·9 and 28·7 per cent respectively in study and control groups. This difference was highly significant. The still birth rate, first week mortality rate and perinatal mortality rate were 16·8, 12·46 and 29·0 in study group and 63·8, 48·66 and 109·3 in control group giving evidence regarding the benefit of antenatal care in reducing perinatal mortality.

This study was conducted to determine the optimum dose of supplemental iron for prophylaxis against pregnancy anemia. One hundred and ten pregnant women were randomly allocated to three groups: Group A receiving equivalent of 60 mg, group B 120 mg and Group C 240 mg, elemental iron as ferrous sulphate daily; the content of folic acid was constant in all the three groups (0.5 mg). These women had at least consumed 90 tablets in 100 +/- 10 days. Blood was drawn at the beginning and at the end of the treatment. Fifty percent were anemic (less than 11 g/100 ml). The hemoglobin levels rose similarly in all groups and the differences were statistically not significant. Fifty-six percent had depleted iron stores (serum ferritin value less than 12 micrograms/l) at the beginning of the study. Following therapy a statistically significant increase in iron stores was observed in group B and C as compared to group A. The difference between group B and C was not significant. The side effects increased with increasing doses of iron; 32.4%, 40.3% and 72% in group A, B and C respectively. Based on these findings, the authors advocate that optimum dose of iron should be 120 mg instead of 60 mg as is currently being used in the National Nutritional Anemia Prophylaxis Programme.

The authors attempt to identify factors affecting the infant mortality rate in India using data on registered births and deaths among a rural population of about 35,000 in Dayalpur in 1975.