Evidence of improved nutritional status of children in a comprehensive health care project.

Abstract

An attempt was made evaluate an innovative health project which has recongnized the need for newer approaches. The Jamkhed project in Maharashtra State India adopted a comprehensive approach and uses part-time village health workers (VHWs) to prevent detect and correct malnutrition by educating and encouraging the community meet its own nutrition needs. An evaluation of the nutritional status of children under age 5 was carried out in 2 project villages--Rajury and Pimparkhed--and a control village--Jawalke. The control village has not been exposed the activities of the project. The choice of villages was random. A random sample of 200 children was selected. Measurements of weight (kg) upper arm circumference (cm) and the Shakir strip (3) on all children were carried out. Clinical symptoms signs and nutritional deficiency syndromes were recorded together with a history of immunization. Health education sessions were held and the equipment used was presented the project. A response rate of 95% was achieved. Nearly 2/3 of the children in Pimparkhed (65%) and Rajury (67%) carried weight charts. Despite difficulty with the use of these charts the VHWs used them intelligently and the charts became a comprehensive record of a childs health in the villages served by the project. The weights of all children were arbitrarily divided into well nourished (above the 5th centile) or ill nourished (below the 5th centile). Of the children in Rajury (project) 24% and in Pimparkhed (project) 22% were found above the 5th centile. Weights of only 7% of the children in Jawalke (control village) were above this centile. The difference between each of the project villages and the control village was significant. The number of chilren who fell in the green part of the Shakir strip in each project village was almost twice that in the control village. There were twice as many children in the red in Jawalke as in either of the project villages. The prevalence of marasmus in the control village was significantly higher than in the project villages. 40% of the low caste children were found be malnourished in Jawalke compared 20% in Pimparkhed and 32% in Rajury. Breastfeeding was found be universal practice in the 3 villages and it accounted for the absence of differences in the nutritional status of children 0-12 months old. There was a statistically significant difference in the reported use of family planning methods between project and control villages.