A NON-GOVERNMENTAL VOLUNTARY APPROACH

TO CHILD HEALTH:

ANNUAL “DHADAK MOHIM” CAMPAIGN AT MELGHAT







Department of Preventive and Social Medicine,

B.J.Medical College, Pune.



Category: UG







ABSTRACT:

Category : UG

Session : Oral

Title : A NON-GOVERNMENTAL VOLUNTARY APPROACH TO CHILD

HEALTH: ANNUAL “DHADAK MOHIM” CAMPAIGN AT MELGHAT

Authors : 1. Parkhe A. A. *

2. Agavane V. M. *

3. S. Marella **


Institute : Department of Preventive and Social Medicine,

B.J.Medical College, Pune.


Aim of “Dhadak Mohim” is to develop an effective volunteer based model to prevent child mortality because of malnutrition during crucial period of monsoon in Melghat


In order to assess status of malnutrition 293 children from 6 villages between the ages of 0 to 5 years were examined. Anthropometrical measurements were taken before the intervention. Grading was done as per IAP classification. I and II grade children were kept under surveillance. III and IV grade malnourished children were given blanket treatment and supplementary feeding and frequently monitored. After intervention grading was done again. Using Paired T Test to analyze the data results were found to be very significant. (t=7.9232 and p<0.001)


It can be concluded from findings that, child mortality due to malnutrition and related causes can easily be prevented by basic health care, health education, driven by medical students on voluntary basis and does not require any complicated procedure or monetary intensive mechanism.


[* III/IV M.B.B.S]

[** MO. RHC. Mahabaleshwar]


  1. INTRODUCTION


Every child born on this earth has the Right to Live. Being totally dependent upon others for its survival it is the most vulnerable. It therefore is the duty of every citizen to take a moral pro-active role in ensuring that the best environment and inputs are given to each child.

A task force was appointed by Government of Maharashtra to look into the problem of child mortality in 1998 and its report was published in year 2001 titled “KOVALI PANGAL”. Conclusions drawn in this report are a real eye-opener.

According to this Report [Ref. 1]:

1. About 1.95 lakh children die every year in Maharashtra.

2. Mortality rates

Melghat

CMR : 127

IMR : 90

All Maharashtra

CMR : 83

IMR : 68

3. Causes of Mortality and Morbidity

Malnutrition is cause of 25.2% death during 1 to 5 Years and also predisposes children to mortality from diarrhea, pneumonia and other infectious diseases.

4. Average distance to health provider in Melghat

PHC – 22km


According to statistics announced by Government there were more than 5000 deaths in Melghat during 1992-1997.

Working in Melghat with a focus to reduce child mortality and malnutrition thus came as a natural response. This gave birth to “Melghat Mitra”. After lot of study and discussion with an experts “Melghat Mitra” decided to start annual “Dhadak Mohim” to Melghat.




IMPORTANT ASPECTS OF CAMPAIGN

Aim of “Dhadak Mohim”:

To develop an effective volunteer based model to prevent child mortality because of malnutrition during crucial period of monsoon in Melghat.

Objectives:

  1. To reduce deaths due to preventable causes among the under-fives of Melghat

  2. To improve the nutritional status of the children.

  3. To make health care a felt need for the population

  4. To improve the state of hygiene of the people and improve environmental sanitation.


Monsoon makes them vulnerable:


[Graph 1]: CMR Trends over Year (1999-2000)

Ecology of Malnutrition specific to Melghat concludes that monsoon compounds the number problems and increases child mortality. Hence monsoon was considered the appropriate period to work on preventing child death.


Campaign Planning:

The planning did not go with preconceived rigid notions. Openness was maintained to respond to changes on the ground. 6 villages were selected for the campaign by the permanent team in Melghat on the basis of poor health standards and access to health services.


Selected Villages:

1)Pipliya 2)Tembru 3)Khari

4)Borda 5)Rahu 6)Hilda (Base-Camp)


Appeal was put up in medical colleges from Pune for volunteers. 78 (64 medicos and 14 non-medicos) volunteers responded. Then, volunteers were sent from 14th July to 10th September 2005 in total 8 batches. Each batch worked for 7 days.

Each of the medical students was assigned a village, where they would work daily having primary responsibility of implementing plan, collecting data and reporting back to team leader, interns and permanent staff. The intern was to act as an adviser and all decisions regarding medical complaints were finally his or approved by him. One day overlap enabled previous batch to have a detailed hand-over of problems in every house to next batch.


Batch Composition:

Each batch was composed of at least 1 intern, 6 medical students and 1 group leader (Experienced Volunteer).

Training Sessions:

Volunteers were given 5 hours of training by Pediatrician. The training covered an introduction to tribal life in Melghat, ecology of Malnutrition, work guidelines, treatment and health education protocols.



B. METHODOLOGY


Spectrum of Intervention

If one looks at various intervention options one sees two extremes: The legacies of Hygiea and Panacea.

On one hand we have health education – time consuming, needing generations to have an effect - the best way of improving the health status of a population and at the other end treatment – medications and other curative or palliative interventions - sometimes temporary but nevertheless efficient in alleviating morbidity and reducing mortality.


Any interventional plan must take all possible measures into account as mentioned in spectrum.


Field Work:


1. Health surveillance of all under 5:

1.1: A primary survey of all under 5 children was carried out using a specialized proforma . It included

All children were graded for malnutrition according to* IAP classification based upon ICMR data.


1.2: Blanket/Presumptive Treatment [Ref. 2] of All Infections:

All malnourished children were treated for common infections found routinely in them.

Septran : Sub-clinical UTI

Mebendazole : De-worming

Metronidazole : Giardiasis

Chloroquine : If fever


They were also given megadose of Vit A & Vit D.

After seven days hematinics was given.


1.3: All under 5 were observed throughout the monsoon visiting their homes daily. Any infection or infestation was treated then and there. Diarrhoea and Pneumonia was also treated according to respective National Programmes.[3,4]


1.4: Cases needing indoor care were shifted to nearby PHC or RH.


2. Food Habits

Information was collected regarding the food habits of people. This helped in understanding and suggesting weaning food.

3. Basic Health Care

The adult OPD was never the main objective but gains importance as it helped to establish a rapport with the populace and to establish credibility as being doctors or medical persons.


4. Nutrition supplementation

Supplementary feeding in the form of “sattu” & “chikki” was given to severe and moderately malnourished children.

5. Health Education

Health education was the backbone of campaign. Experts from the field were consulted to decide the modes.

The focus was given on:

  1. Personal Hygiene

  2. Environmental Sanitation

  3. Breast Feeding

  4. Weaning

  5. Ways of Transmission Of disease e.g. Flies, their hazards.

  6. ORS making

  7. Sponging

  8. Ante-natal care

  9. Scabies

10)Counseling regarding unhealthy traditional practices like “damma“.


Scabies was decided as a model disease to be eradicated using a combination of health education and treatment because Scabies is rampant in this area and is related to personal hygiene, and has a high nuisance value.


Modes used in Health Education:


C. OBSERVATIONS:

Following graphs shows an age-wise distribution of malnutrition grades among children.

[Graph 2]: Pre and Post Grading According to Age Group




Following Table [No. 1] shows the transition of children from severe grade to the comparatively less severe grade because of the intervention conducted during the campaign.

[Table 1]: Positive Grade Transitions




D. RESULTS

Application of ‘Paired T Test’:


As the same child was weighed before and after campaign, two sets of readings over same patient made paired t test, statistical test of choice. It is clearly seen from the table that statistical difference between pre & post campaign was highly significant.


[Table -3]: Application of ‘Paired T Test’

“Campaign’s success is more than which can be put up in terms of statistics & inferences. It was an enlightening experience for all those involved and generations will be impacted with the very small voluntary deed.”




E. DISCUSSION


Child mortality

A combination of initial empirical presumptive treatment and rigorous follow-up of the children has led to the remarkable fact of zero under-five mortality in the villages.


Malnutrition

The reasons we have found for the high prevalence of malnutrition are

  1. poverty

  2. faulty food habits – constituents and proportions of the diet

  3. inadequate health care

  4. lack of education

  5. infectious diseases

It was found that this approach helped to upgrade the nutrition levels of the children. Potential death due to malnutrition was also controlled. A door to door doctor besides maintaining the assiduous follow-up is able to convince people of the need to get their children treated in the first place.


Sattu and Chikki are foods that are very suitable to the task of supplementation. At this point the volunteers agree and then make sure once again that hygiene is maintained and insist that the mother feed home food in their presence. This ensures that these stay supplements. The data on malnutrition reaching the government is being modified and compiling year on year data and round the year follow up is maintained by ‘Melghat Mitra’.

This data will provide

a] further support for campaign’s assertion and

b] Refinery base for future.

Malnutrition is a social economic and health problem which needs to solved by integrating all related fields.


Adverse local practices

Customs like treatment of all diseases with "damma" are already disappearing in families.

The role of government

The government has provided and is continuing to provide money, manpower and infrastructure. But this infrastructure is not being used completely to fight against Malnutrition.


Economic activity

Number of non-medico volunteers from background like law, agriculture, education and engineering contributed in improvement of all their economic activities. They acted as Primordial Prevention Arm.


Work in the future

Campaign will continue this work and take it to it’s conclusion using all voluntary means.


The medical fraternity

An experience like this is vital for every budding doctor and indeed even those jaded by years of urban OPD. Our highest calling is the alleviation of the sufferer’s pain. This endeavor does just that.




F. CONCLUSIONS:


  1. Small teams of medical volunteers with the support of motivated lay-persons working in batches for defined periods in a defined area of responsibility are an effective means to decrease the burden of malnutrition.

  2. Child mortality due to malnutrition and related causes can easily be prevented by basic health care, health education and does not require any complicated procedure or monetary intensive mechanism.

  3. Effective work in tribal areas needs - a scientific approach, humanitarian outlook and spirit of voluntary work. With appropriate social and financial support our model can be replicated for any tribal area.

  4. PSM departments of medical colleges adopting tribal areas and then sending students, interns and some senior staff for guidance during epidemiologically proven crucial periods can greatly contribute to alleviation of children's suffering.



G. REFERENCES


[1] Dr. Abhay Bang and Child Death Study Group(2001), report ‘Kovali Pangal’


[2] Dr. S. R. Daga, D.V. Gosavi, V.G. Bela, ‘Management of Severely Malnourished Children’, Published in INTERNATIONAL CHILD HEALTH: A Digest of Current Information.


[3] Ghai O.P., ‘Book of Pediatrics’, 6th Edition.


[4] Park, ‘Book of Preventive and Social Medicine’, 18th Edition.