We have recently initiated training of rural women as health and nutrition entrepreneurs and community mobilizers (HNEM) in five villages of Medak district in Andhra Pradesh. The chosen villages have population of 500-1000, very low female literacy, and no ICDS. The HNEMs serve as human resource in the community and advise on preventive care, particularly maternal and child health and nutrition, identify at-risk cases for referral, treat minor ailments, assist the MPHW, and record births (with birth weight), and deaths with age and cause. The community pays them for their service. Prior to initiating the training, survey of health problems and health care seeking practices was done in winter of 1997, among all available mothers with pre-school children aged 6-60 months (sample size 289) using a structured questionnaire. A morbidity survey on the same cohort of children was repeated in monsoon of 1998. The latter was a benchmark survey for future impact assessment.

The common ailments in mothers were backache and joint pains (27.9%), respiratory illness and fever (37.5%), reproductive problems (27.3%) and gastrointestinal disorders (3%). In children the prevalence of common morbidities in the two seasons–winter and monsoon were: diarrheas-2.7% and 27.9%, respiratory illnesses-38% and 58.7%, and skin problems-5.2% and 11.9%, respectively. A special educational campaign on environmental sanitation and hygiene before the onset of monsoon may be of help in this context.

Over 90% women had undergone atleast one antenatal check-up by a private doctor in the block headquarter, Narsapur, 5-10 km away, and had received tetanus injections. Majority consumed iron folic acid tablets. Over 60% of the deliveries were conducted at home. Adverse practices such as consuming less food and food taboos during pregnancy, initiation of breastfeeding from day 3, discarding excess water (‘ganji’) from cooked rice were reported by almost 50% mothers suggesting scope for nutrition education.

Among children aged 6-60 months, 20% had moderate and severe malnutrition as judged by IAP classification using NCHS standards. This is lower than the average reported for Andhra Pradesh in the NNMB surveys(1). The prevalence of malnutrition was significantly higher in girls than boys, in children under two years of age than those above 2 years of age, and among those who had other pre-school siblings. The prevalence of vitamin A defi-ciency as judged by Bitot’s spots was 4.5%. Immunization coverage was over 92%, indicating marked improvement over an earlier observation in the same area(2). Immunization was the focus of MPHW’s monthly visits. Most mothers continued to breastfeed/feed their children during episodes of diarrheas. Home made fluids like tea, sago, and rice water were given rather than commercial ORS or salt-sugar solution. The community welcomed the idea of one of their women being trained and agreed to utilize her services against payment. They were however disappointed when told that HNEM will not give injections.

The survey has identified health and nutrition problems and positive and negative aspects of health practices in the community. Preference for private doctors despite a Community Health Center at Narsapur is noteworthy, and suggests that the community does not mind paying a small fee if they are satisfied.

From the pattern of morbidities observed it appears that a trained health functionary from the village armed with a medical kit, and institutional support may help to prevent/reduce the suffering of women and children through appropriate advice and treatment. Till such time that rural transport improves, ‘dai’ training is necessary. In villages serviced by the ICDS, training of anganwadi workers as HNEMs can be considered.

The financial support from the Department of Women and Child Development and the Department of Science and Technology, Government of India is gratefully acknowledged.

Mahtab S. Bamji,
P.V.V.S. Murthy,
K.V.S. Ravi Kumar,
D. Bhargavi,
Devyani Dangoria,
Dangoria Charitable Trust,
Hyderabad, India.

1. Nutrition status of rural population. Report of National Nutrition Monitoring Bureau. National Institute of Nutrition, Hyderabad, India, 1996.

2. Bamji MS, Thimayamma BVS. Impact of womens work on maternal and child nutrition. Ecol Food Nutr (in Press).