The study by S. Dass and S. Remadevi, titled Environmental factors influencing the persistence of Malaria in Valiyathura area of Thiruvananthapuram City has highlighted the persistence of malaria and the environmental factors influencing it in an urban fringe. The study was conducted in the malaria-infested coastal area of Valiyathura in Thiruvananthapuram district. The important variables included in the study are physical and socio-cultural environment and provision of health services and utilisation, the outcome variable being malaria cases. Both qualitative and quantitative methods were used for collecting data, namely focus group discussions, key informant interviews, and semi-structured questionnaire. The data collection took place in early 1997.
Vector studies isolated Anopheles stephensi as the only vector responsible for transmission of malarial infection in these areas. With respect to parasitic species, the majority of infections were due to Plasmodium vivax. The potential breeding places included wells, overhead tanks, and stagnant water collections on roofs during rains. Socio-economic status, often reported as a risk factor for malaria, is found to have little significant relation to the persistence of the disease in the study area.
The new strategies implemented as an integrated package of parasitic and vector control in a systematic manner, have proved to be quite effective. This approach seems to have changed the attitude of the population towards treatment and control of malaria. Parasitic control and vector operations were important ingredients of the new strategy. The various activities undertaken under the parasitic control scheme were fortnightly domicilliary surveillance, rapid fever survey, mass and contact survey, 14 days' domicilliary treatment under comparison, and follow-up of positive cases. Meanwhile, the vector control operations included pyrethran space spray, thermal fogging, DDT spray, and larviciding of breeding places and including unused wells.
The success of this new strategy is reflected in drastic reduction in the number of new cases. Hence it is essential to continue the activities as a short-term measure. However, preventive strategies have to be developed and executed for long-term control. The study recommends a continuous surveillance system to prevent long-term focal outbreaks of malaria in the future.
V. Raman Kutty, C. R. Soman, and K. Vijaya Kumar have investigated the Pattern of helminthic infestation in schoolchildren of Thiruvananthapuram district. Helminthic infestation by Ascaris lumbricoides (roundworm), Necator americanus (hookworm), Trichuris trichura (whipworm), and pinworm used to be almost universal in Kerala since the 1930s. Several factors must have contributed to lower the prevalence of helminthic infestation such as improved environmental sanitation, widespread use of toilets, and higher levels of education among the public resulting in increased awareness of the need for personal hygiene. In this study an attempt is made to test the hypothesis that improved environmental sanitation has brought about a reduction in the prevalence of helminthic infestation among children in different geophysical locations.
Two schools from each geophysical location were randomly sampled for the study. After a preliminary meeting with the parents to explain the purpose of the study, stool samples were collected from each student and examined by formol ether concentration technique. A questionnaire was administered to obtain information on the socio-economic and environmental conditions of the household. This enabled cross-classification of ova stools with different attributes. The overall presence of any type of ova was 57.4 per cent; the highest figure, 77.7 per cent, was in coastal schools; in highland school it was 63.8 per cent and in midland schools 51.8 per cent. Urban schoolchildren recorded the lowest prevalence, 27 per cent. Environmental factors and socio-behavioural attributes could explain this gradient. Among the different types of ova, roundworm was the one that showed the greatest prevalence followed by whipworm and pinworm. All the children with worm ova in stools were given helminthic medication. The study recommends control of helminthic infestation through medical and health education measures.
Mortality due to Leptospirosis has been on the rise in Kerala in the past few years. The study by Punnen Kurien titled A study of the epidemiology of Leptospirosis in Kerala with special emphasis on the role of rodents examines the patterns in which the disease spreads. Data from the various medical colleges and public health centres in Kerala indicate that deaths due to Leptospirosis exceeded 400 in the year 1998. However, the actual number of cases reported is said to be above 6,000. Rodents, especially rats and mice are the principal reservoirs of the leptospires. In Kerala, bandicoots are the most abundant rats in the agricultural fields.
The study explores the specific causes of the yearly recurring outbreak of Leptospirosis in Kerala in the context of epidemiology and environment. It also aims at identifying the rodent species involved in the epidemic. The relationship between rodent population density in the villages and towns of the State and the disease outbreaks will also be examined. Moreover, the existing preventive measures including hygienic and rodent control practices in the study areas are being assessed.A very high rate of the epidemic was observed in the district of Kottayam and the adjoining areas of Alappuzha. Methods used include study of environmental factors, identification of carrier species, population estimate studies, and preventive measures in practice. Both qualitative and quantitative methods are being made use of. The study is being conducted in all the seasons of the year to ensure proper coverage.
Data on reported Leptospirosis cases in all the five medical colleges of the State have been collected. Based on the highest number of cases, five localities were selected namely, Arpookkara in Kottayam, Chennampallipuram in Alappuzha, Sreekaryam in Thiruvananthapuram, Avanoor in Thrissur, and Chevayur panchayat in Kozhikode. Baseline data, resource map, and incidence map of each area have been prepared. Socio-economic survey on victims and survey on current preventive measures have started. About 600 persons were surveyed during the reported period. Identification of carrier species and population estimation studies through macroagglutination and microagglutination tests will be taken up. Awareness seminars were arranged in all the five study areas with the co-operation of local bodies, health authorities, and agricultural officers.
Diarrhoeal disease among children under five is the subject of inquiry by K. R. Thankappan. Studies have shown that Kerala has the highest rates of diarrhoea. Diarrhoea was reported to be one of the major causes of morbidity in most of the studies. It is believed that household practices and water quality and diarrhoea are interlinked. Hence this study focuses on quality of drinking water and household practices to ascertain the incidence of diarrhoea morbidity, particularly among children under the age of five. The study hypothesises that water quality affects the household practices, which in turn determines morbidity outcomes. Two panchayats, one each from Kerala and Tamil Nadu, were selected to form the experimental-control area of the study. A baseline survey to determine the households, in which under-5 children are present, was conducted, followed by a detailed survey of the households.
The study by T. P. Kunhikannan and K. P. Aravindan was an attempt to observe the Changes in health status during the decade, 1987-'97. It is basically a re-survey of the 1987 survey on household morbidity and expenditure levels based on a two-weeks' recall. The study examines the changes that have taken place in the socio-economic and health status of the households during the decade. It has also raised a few issues for discussion in the context of decentralisation and the People's Plan Programme.
The study has come out with the following findings: Cardiovascular diseases accounted for a large share among chronic diseases causing mortality. In general, it is the chronic and degenerative diseases and accidents, which accounted for a large proportion of deaths. Suicides also show a disturbing upward trend. The water-borne diseases have shown, however, a drastic fall, perhaps due to improved health care and hygiene behaviour of the population and improved water and sanitation conditions.
Other associated factors that account for the reduction in water-borne diseases are immunisation coverage, improvement in nutritional status of children, and high rates of breast-feeding. Institutional childbirth is almost 100 per cent. There is associated low IMR and a low pre-natal mortality rate. On the other hand, caesarean sections registered a substantial increase from 11.9 per cent in 1987 to 21.4 per cent in 1996. However, the problem of low birth weight of babies remains.
Expenditure on childbirth is on the rise and there is rampant corruption, lack of supplies, and fleecing of the poor by the system. Expenditure per morbid person per episode has registered a hike from Rs 16.56 to Rs 165.22 during 1987-1996, an increase of 898 per cent. The per capita medical expenditure also rose from Rs 92 to Rs 548.86, an increase of 517 per cent. The study shows the high degree of mediflation during the period, the victims of which are undoubtedly the poorer sections of the population.
The study on Socio-economic status, health status, and health expenditure pattern of fishermen community of Kozhikode district by T. P. Mubaracksani, aims at collecting scientific data on an area which has received scant research attention. It is expected that the study would shed light also on the processes, which keep these communities perpetually in deprivation. Madhavi Panda attempts to examine the linkages between high morbidity levels and the lifestyles of individuals, with particular reference to non-communicable diseases caused primarily by lifestyles.
The study is titled Lifestyles and morbidity among adults in rural Kerala. The State occupies the centrestage of the debate on the phenomenon of low mortality and high morbidity. The health status of the people of Kerala has attracted the attention of researchers of all disciplines who try to identify the underlying factors in longevity and other vital parameters. More recently, the high morbidity syndrome accompanying the low mortality status has opened up new space for further exploration. Studies have shown that early social development accompanied by several cultural factors have accounted for the high life expectancy. The causes for high morbidity remain, however, unexplained. The present study attempted to understand the phenomenon in new light. By examining the socio-economic status and the lifestyle patterns of the population and their morbidity patterns simultaneously, the study foregrounds certain key research issues.
Is high morbidity the result of greater awareness of health problems? Is self-perceived morbidity higher than clinically diagnosed morbidity? Is high morbidity linked to changing lifestyles? (Modernisation bringing about changes in diet, alcohol consumption, smoking habits, etc?) The major finding of the study is that socio-economic factors are important in lifestyles and morbidity. In fact, socio-economic factors are far more important than lifestyles for reduction in morbidity. High morbidity in Kerala is found to be due to poverty and poor living conditions which, in turn, lead to poor lifestyles and thereby to poor health.
Kerala has enjoyed a progressive reduction in mortality followed by a marked reduction in fertility. At present it has a crude birth rate and a crude death rate comparable to those of developed countries. However, not much is known about the latest morbidity scenario in Kerala. The National Sample Survey (1973-'74) was one of the first credible exercises to throw light on the morbidity situation in the country.
It disclosed that Kerala's morbidity rate is one of the highest in the country. Since then, Kerala has come to present a picture of having the lowest mortality and disability rates, coexisting with one of the highest morbidity rates - a situation called 'the low mortality and high morbidity syndrome'. The enquiry into Morbidity incidence, prevalence, consequences and associates by P. Krishnaswamy becomes relevant in this context.
The study aims at calculating the prevalence rates of all discernible diseases and examining the association of these diseases with age and gender parameters. Survey method is envisaged for collection of data. Eight panchayats are purposively chosen - four each from the Travancore, Cochin, and Malabar areas. About 500 households with proportionate representation to all the wards in the panchayats will be selected. The incidence rates, prevalence rates, person-days lost, and financial costs are to be calculated. Information on household characteristics and socio-economic and demographic characteristics will be collected to help correlate factors associated with morbidity types.
The study by S. Anitha is titled A base-line study to assess the reproductive health status and needs of the sex workers community. It attempts to examine the reproductive health of sex workers in Thiruvananthapuram City. The whole gamut of issues ranging from unwanted pregnancies, abortions and abortion practices, contraceptive prevalence, STD/RTI prevalence, STD/RTI management practices and reproductive morbidity are proposed to be discussed. The sex workers being a highly vulnerable high-risk category would provide an understanding and the status quo of the problem. The study also envisages exploring the socio-cultural contexts of the sex workers for greater understanding of the factors that have thrown them to their present plight.
Training of the investigators was undertaken as a first step, taking into account the highly sensitive nature of the project. The choice of the investigators was done carefully by assessing their attitude towards the theme, research aptitude in general and most important, willingness to work among sex workers and in the reproductive health theme. The investigators were trained as to how to collect data and how to elicit information, in investigations into sensitive issues. Interacting with sex workers was itself a daunting task, for which investigators had to be carefully trained at the office and in the field. A detailed literature survey was done to review the methodologies being followed in other disciplines and other projects for collecting qualitative information. The questionnaire method would also be used for gathering data. The data collection is currently underway.
An issue relating to maternal and child health is being investigated by V. Raman Kutty. The project Why low birth weight is still a problem in Kerala - a preliminary investigation focuses on the high proportion of low birth weight babies in Kerala. The principal aim of the study is to identify the maternal, environmental, and socio-economic factors contributing to low birth weight of babies born to women registered in the antenatal, outpatient department of SAT Hospital, Thiruvananthapuram.
The SAT Hospital is one of the premier institutions for women and children in the State and the clientele is drawn from different socio-economic strata. Women who register for antenatal check-up are selected and followed up till childbirth. The questionnaire method is used for data collection and the aspects on clinical details, laboratory investigations on haemoglobin values, drugs prescribed, and anthropometric measurements are collected separately. Demographic details such as age of mother, parity and birth interval, and socio-economic details are also collected with the help of questionnaire. A second haemoglobin test will be done during a subsequent visit when a woman is near term. When the woman gives birth, birth weight of the baby will also be noted using a sensitive balance. Other anthropometric measurements will be noted. Only full-term single deliveries including caesarean sections will be included in the study.
The study assumes increasing importance in the light of the growing threat to the public distribution system and the possible reduction in the calorie intake among a large section of the poor population. The project is currently under way. The project being undertaken by S. Srilatha , closely related to the abovesaid theme, is titled Assessing the quality of antenatal care in the Thiruvananthapuram district. Recognising the quality of antenatal care is important for the outcome of pregnancy. The birth weight of babies is surprisingly low in Kerala and it is on these premises that the quality of antenatal care is placed under scrutiny. The study adopts a prospective cohort and the reference population will be antenatal mothers in the district. The study aims to estimate the expenditure incurred in connection with childbirth. The subjects will be drawn from the government hospitals.
The study by T. Jayakrishnan titled Study of iodine-related problems among schoolchildren, aims at determining the prevalence of goitre among schoolchildren below the age of 14 and seeks causative factors for the incidence of goitre. Attempt is being made to identify mothers' knowledge, and attitudes towards and practice of iodised salt. A survey among 1,000 children from three geophysical locations judged in terms of the distance from the sea has been conducted for realising the objectives. Secondary data on the theme are collected from the Kannur District Panchayat office and the other grama panchayats.
A screening camp was conducted at the Pariyaram school where 210 students were screened. Similar screening camps were conducted at Perumpadava where 190 students attended and at Madayi where 161 students participated. Salt samples of various brands were collected from different retailers and analysed for iodine content. The results are being analysed. The findings of the study are expected to aid better management of goitre and creation of greater awareness among the population. Visual impairment is a debilitating handicap that is usually ignored as a research area. The project titled Epidemiology of preventable blindness in Kerala - a micro-level study of 20,000 schoolchildren by Mohan Raj Nair, is a positive step in this direction. The United Nations estimates that there are about 42 million visually impaired persons in the world of which 9 million live in India. Nearly 90 per cent of all blindness is curable. Nearly 77 per cent of the blindness is surgically curable and 11 per cent can be cured without surgery. This leaves only a comparatively small proportion that cannot be cured.
The National Nutrition Monitoring Bureau has identified malnutrition as a single major cause of blindness in the country. Although childhood blindness is not a grave public health problem per se in Kerala, there exist very little data on the dimensions of preventable causes of blindness in the State. The causes of blindness among children are Vitamin-A deficiency, cataract, trauma, glaucoma, squint, refractive errors, and allergic conditions. The present study involving 20,000 schoolchildren will provide some crucial information for local level planning. Knowledge of the extent of visual impairment in schoolchildren is imperative to raise the consciousness of the policy planners and society at large.
This epidemiological study of schoolchildren has the potential to motivate larger prospective studies and influence planners at various levels to deal with blindness and prevention of malnutrition. The specific objectives of the study are to estimate prevalence of ophthalmic conditions that might lead to blindness in later life such as refractive errors, squint, congenital and developmental cataracts, xerophthamia and other ophthalmic conditions. The factors associated with preventable ophthalmic conditions and the strategies for enhancing the levels of awareness of the children, their families, and teachers about the preventable nature of most causes of blindness, will also be discussed.
The sample schools are selected from the Parassala sub-district of the Neyyattinkara educational district. There are 56 schools in the district and a majority of them are government schools. It is found that the mobile ophthalmic unit of the medical college has not reached these remote areas and hence the choice of this area for study.Screening of over 10,000 schoolchildren in 42 schools has been completed. The children examined include those from classes I-VII in aided and government lower primary and upper primary schools. More than 1800 children were suspected to have eye problems by the optometrists and were referred to the local eye hospital. However, only 900 of the children actually went for the detailed check-up. To increase the diagnosis of the children, an ophthalmic surgeon was requested to assist the children who had not sought detailed examination. The final rate of diagnosis of referrals rose from 46 per cent to 82 per cent in 22 schools.
Referral children are still coming to the local CSI Hospital for investigations. A few children with rare and/or complicated eye problems are undergoing CT scans/tests and are being consulted by super-specialists for diagnosis and treatment at SUT Hospital, Thiruvananthapuram. Children confirmed to have problems like squint and cataracts and require surgical correction have been assured free treatment. The impact of the massive screening and educational intervention has been significant. About 400 children who had refractive errors have received spectacles at a nominal cost. The study is nearing completion.
Mental health is an area that has not received adequate research attention. Praveenlal has initiated a project in this direction. The project titled Family suicides in Kerala - an exploratory study into patterns, determinants, and consequences explores and analyses the causes of family suicide. Kerala is one of the States that have the highest suicide rates in the country. Moreover, the prevalence of family suicide as a phenomenon has been found in Kerala alone. Suicide of entire families is a recent phenomenon and has been on the rise. The annual suicide rate in Kerala is 27/1,00,000 population while the national figure is 8/1,00,000 population. The objectives of the study are to collect information regarding the causes of family suicide from FIRs of the police, and from the survivors and the remaining family members, neighbours, and informants. Attempt will be made also to explore the impact of family suicide on the survivors and the remaining family members. The coping styles and mechanisms the survivors use to come out of the shock will also be looked into.
Details about suicide will be collected from the forensic departments of Thrissur Medical College and district hospitals of Ernakulam, Malappuram, and Palakkad. About 50 cases would be identified and studied in detail, after the collection of preliminary information about the cases. The magnitude of the problem, the methods of suicide adopted, and the suspected reasons for committing suicide will be studied. A semi-structured interview schedule has been developed by modifying the tools used in similar studies.
Preliminary data collection is over. Details of suicides in Kerala from 1972 onwards have been collected from the State Crime Records Bureau, Thiruvananthapuram. Efforts were made to gather details of suicides reported in a leading newspaper (Malayala Manorama) for a period of 3 months. Details were collected from forensic records of Thrissur Medical College. Tools for the study include the Locator index, specially designed for the study, Life Events Inventory, Family Integration Inventory, and Personality details based on the Mayer-Gross Proforma, Mental Illness Possibility, and Impact on Survivor. Details of nine family suicides were collected. Places of domicile were visited and information gathered from survivors or neighbours. The project is still on.
A mental health problem may assume a dangerous dimension when subjected to social stigma. This is the subject of inquiry by Sharmila. The project is titled An inquiry into the nature of social stigma encountered by individuals who had a past experience of mental defect. Society harbours a variety of prejudices against mentally ill persons and more so when they are in the recovery stage. They are not given a full chance to recuperate from the sickness. The study therefore investigates the nature of stigma and social consequences of stigma associated with mental illness. Stigma manifests itself in explicit forms as in the case of derogatory labelling. Stigma therefore complicates life of the stigmatised person. The focus of the study is to identify the factors that constitute stigma and identify personal and social conditions that reduce stigma. A case study method is adopted for the study that will enable collection of in-depth data on the inter-relationship and social interactions. The cases would comprise persons with a history of at least one psychiatric breakdown. The study is in progress.
A study by Smitha Menon examines the Socio-economic profile of patients discharged from mental health centre. Mentally ill persons have been suffering from stigma and indignity though mental disorders can be diagnosed and with appropriate treatment brought under control. It is estimated that severe forms of mental disorders affect about two per cent of the population in India. To understand the problems of the mental patients, it is important to look into the socio-economic status and pattern of admission of patients at the Mental Health Centre. The Mental Health Centre (MHC), Oolampara, is one of the three centres in the State providing premium psychiatric care to all sections of the society, regardless of income, caste or religion. Relevant data are being collected form this centre. The actual number of persons discharged from the MHC, in January 1999 is 208, out of which 152 were male and 56 were female. A detailed case study of five patients and an intensive analysis of their socio-economic conditions are on.
The study by P. Usha titled Supporting systems and certain behaviour problems of pre-schoolchildren in Malappuram district, examines the behaviour problems of children from a novel perspective. Kerala has one of the largest number of supporting institutions for pre-schoolchildren. In the age of fast life and modernisation, working women and non-working women are finding difficulties in fulfilling their roles as parents, providers, disciplinarians, and nurturers. The study is focusing on the behavioural problems of children vis-…-vis supporting systems. Supporting systems include anganwadis, kindergartens, and pre-schools and nurseries. The objective of the study is to compare the behaviour of pre-schoolchildren with the type of the supporting system, mothers' work status, and sex of the child.
K. K. Preetha has undertaken a study on Health problems of the elderly in a selected panchayat (Muthalamada panchayat, Palakkad district) with emphasis on their common ailments. A primary health centre, seven family counselling centres under the India Population Project, two ayurvedic dispensaries, and one home dispensary cater to the needs of 35,000 persons spread over 67 sq. km of plains and 300 sq. km of forest area. There exists very little reliable information on health services and health status of their population. The area suffers from acute shortage of drinking water and poor sanitation conditions. Most of the employed people work in the unorganised sector that has little social security cover. Literacy rate of the women in the study area is below the State average. The area thus provides all the conditions for ill health to prevail.
To assess health status, information was collected about prevalence of disease within the reference period of two weeks prior to the date of interview, past illness, type of treatment and medication, morbidity experience, health care institutions consulted, and expenses on health care. Details of personal habits that is likely to have a bearing on health also were collected. The inquiry, conducted in three stages, takes into its ambit all the elderly persons of the panchayat. The first stage of the inquiry was a questionnaire-based survey to identify persons with health problems. This included basic medical tests. The second stage involved the organisation of medical camps for examination of persons with health problems by qualified physicians. In the third stage, which is being implemented, specialised doctors will examine, if necessary, persons with chronic health problems.
Epidemiological survey of the prevalence and nature of chronic neurological disability in the elderly is the subject of the project by Lally Alexander. Amongst the diseases that lead to chronic disability in the elderly, neurological diseases rank high. With Kerala leading all the States in the proportion of the elderly population, it is expected that disability would also be more prevalent in Kerala. Most cases of strokes, dementia, and Parkinsonism occur at old age, causing varying degrees of mental and physical disabilities. They are not only common but also increase with age, contribute significantly to the global burden of the disabilities, are expensive to treat, and add to the financial and emotional burden of the families which provide most of the caring for them. Hence it is important to pay attention to the neurological disorders in order to minimise the extent of the disability among the elderly. Scant information is available about the incidence and prevalence and the complex needs of the various neurological diseases of elderly patients. The study therefore makes an attempt at estimating the prevalence and nature of common neurological diseases that cause significant disability to the elderly (aged 60 years and above) both in rural and urban Thiruvananthapuram. It is also an attempt to investigate the socio-psychological and economic impact of neurological illness and disability in the elderly. The extent of utilisation of health services by the affected people would provide a complete picture of the problem.
A community-based epidemiological survey to determine the prevalence of neurological disorders in the elderly is being conducted in two phases, covering the rural and the urban areas. A house-to-house survey by a team of trained social workers among 1500 persons will be carried out and those suspected with dementia, stroke, epilepsy, and Parkinsonism will be followed up for detailed analysis by a team of specialists. An interview schedule will be utilised for data collection. The study is in progress and is currently in the data collection phase.
K. R. Rani's interest in the topic emerges from her experience as a practising physician. She notes that many of the health problems of the aged are detected at an advanced stage preventing the possibility of comprehensive treatment. Her study on Unreported needs of home-bound old people aims, therefore, at identifying the extent and nature of problems, reported and unreported, among the elderly in her study area. The inquiry includes medical as well as social needs in an effort to identify the socio-economic factors associated with disability among the aged. She also attempts to assess the attitudes and perceptions of the family towards the elderly. Socio-economic determinants of the health of the elderly are seen at three levels: individual, household, and community. At the individual level are economic endowments, activities, traditions, norms, and attitudes. Factors at the household level include amenities, ownership factors, family goals, and relationships. Infrastructure, access to health care, and cost of materials and services are factors at the community level. The study is being conducted in Sreekaryam and Pallichal panchayats of Thiruvananthapuram district. The researcher has selected a sample of 100 elderly persons for her inquiry that has two parts: a medical examination and a socio-economic survey.
Elderly women form a vulnerable group in terms of health-related social and economic characteristics. Among the elderly, there are far more widows than widowers and social attitudes towards widows continue to be negative. In 1991 while only 15 per cent of elderly men was widowers, 54 per cent of elderly women was widows. In her project, Socio-economic conditions, morbidity pattern, and social support among the elderly women in a rural area, R. S. Sarasakumari examines the socio-economic conditions of elderly women, their health status, including perceived morbidity, in different socio-economic groups and awareness and utilisation of different social support systems of governmental and non-governmental agencies. The study is being conducted in two wards of Sreekaryam panchayat in Thiruvananthapuram district. Through random sampling the researcher has selected 150 elderly women for the study. To collect information, she is using a descriptive semi-structured interview schedule.
P. A. Suresh, attempt to conduct An epidemiological survey of developmental language disorders and hearing disability among schoolchildren in Kerala. It aims at examining the syndrome of 'learning disability and language disorders' in new light and providing a new sense of direction to combat the disability. It also endeavours to identify children and adolescents having various types of developmental disorders, formulate a rehabilitation programme, and train adequate number of speech therapists and occupational therapists. One of the key features of the programme is the help to parents and teachers for the early detection and management of these disorders and the development of adequate remedial measures.
The study was undertaken in two phases: the first phase involved a household survey comprising 10 panchayats from the districts of Thrissur, Malappuram, and Palakkad. A team of trained social workers collected the information and a team comprising a neurologist, a speech pathologist, a linguist, a psychologist, and a social worker studied the cases. The objective of the study was to identify the children with learning disabilities and to make an assessment of the prevalence of developmental language disorders. The second phase involved a Statewide survey among schoolchildren from standards I to X, covering eight districts of the State. A detailed investigation of the cases with disability as identified in phase I, was undertaken. Detailed clinical history documentation followed by detailed systematic evaluation including neurological evaluation, speech and language analysis, and psychometric analysis. The results indicate that out of the 659 cases identified, 484 (73 per cent) had developmental language disorders and learning disability. The study concluded that conditions leading to speech and language disorders occur in at least 10 per cent of the child population.
Learning disability of different types reported in the Western literature is common to our population too. These disorders were found across all class groups. More importantly, there is a lack of awareness on the part of parents about these disorders in their children and the need for their rehabilitation. The study recommends an interdisciplinary approach for the management of the disorders and the designing of alternative education programmes and intervention strategies. The study also underlines the need to investigate the causative and etiological factors of the disorders.
The disorders of the nervous system have been on the rise in Kerala, manifesting themselves in different ways. Several studies are being undertaken to focus on these problems. A study by Y. V. Geetha titled Intervention programmes for children with Cerebral Palsy and mental retardation - a multidisciplinary approach, focuses on childhood communication disorders namely mental retardation and cerebral palsy. The study purports to identify children with cerebral palsy and mental retardation and provide remedial measures to them in terms of surgical and therapeutic services. Efforts to provide intensive parent counselling and guidance and mainstreaming in regular school will be undertaken by early intervention and teacher training. The survey method will be adopted for identification of the children. The implications of the study are that through early identification and intensive rehabilitation programmes, many of the children who are on the fringe of cerebral palsy and mental retardation, could be successfully mainstreamed into society. Those who are severely affected can also be trained to improve their self-help skills, communication skills, and general health status.
Another project in this field by P. Dwivedi, focuses on School-based rehabilitation of the learning-disabled - a multidisciplinary intervention programme. The principal objectives of the study are to develop a school-based rehabilitation programme for the learning disabled. This entails development of locally standardised assessment material for identification of children with learning disability and construction of an index of children using the assessment tools. Development of training material for use with identified index children, and identification of resource teachers and equipping them with skills and training material will be undertaken for remedying the learning disabilities in the indexed children. This could be realised by selecting schools from both rural and urban locations. The identification of the schools and resource persons, and development of assessment tools is undertaken in the first phase. Children belonging to the age group of 6 to 16 are chosen (n=3000) from among the schools. Data will be collected with the help of standardised test batteries. The project is in progress.
Disability is not a problem for the individual in question alone; it has significant effects on the family and the society at large. A study initiated by M. Kandamuthan explores the Economic and social effects of the disabled child in the family. The project seeks to establish whether disability affects families' financial condition and how it affects the family in other ways. Specifically it seeks to estimate the strength of association between childhood disability and economic status of the family. It would also estimate the cost of caring for the disabled child at home, in hospital, in institutions, etc.
A sample of severely disabled children below 15 years of age, registered under the community-based rehabilitation programme at the Department of Physical Medicine, Medical College, will be included in the sample. A matching control group in terms of age and sex will be chosen from the children residing next door. A comparative picture will be drawn on the economic aspects, including loss of earnings and average expenditure on children, etc. The study is under way and is in the data collection phase. The expected output of the project is useful for understanding the travails of the parents of the disabled child and the effects of intervention by State in terms of financial assistance.
Usha Kandaswamy in her project titled Participatory approach to voluntary blood donation programmes in the community, attempts to study the blood banks in Thiruvananthapuram. She examines issues relating to blood donors and the demand for and supply of safe blood to patients, by analysing the attitudes and perceptions of patients, medical officers, blood bank officials and drug inspectors, on blood donors, blood donor programmes, and the prevailing system of blood procurement. The study is being undertaken in two phases. The first phase has been completed. It included a survey of hospitals and blood banks relating to the problems faced by patients and relatives in arranging for blood donors, and the attitudes and needs of all stakeholders for helping to evolve and strengthen a community voluntary donor base.
The results showed that arrangement of blood donors is a serious problem faced by the patients and their relatives. The voluntary blood donation scheme is not functioning efficiently. Lack of trained staff, equipment, steady power supply, and networking among blood banks are the other problems identified in the study. Co-ordinated blood bank activity is totally absent. Comprehensive data on supply of blood are also lacking. There is therefore the need for regular blood donor motivation and awareness programmes.
The second phase of the study is in progress in the Vilappil panchayat of Peyad in Thiruvananthapuram district. This phase entails a participatory approach to augment the voluntary blood donor programmes. The programme has been launched in the community with the full participation of the panchayat committee. Two workshops were conducted for the selected community leaders. The work is being done on a ward-to-ward basis. The community is being involved at each stage to ensure participation of all concerned in the programme. The survey includes a health status assessment and creation of a blood donor base in the community. Blood donor forums are formed to keep track of the eligible donors in the locality and their documentation. The ultimate objective of the programme is to create a model panchayat in which the community takes care of its own blood needs. The sustainability of the programme is being looked at from different angles. The field investigations and the analysis of data are completed. The report is awaited.
C. Brahmaputran attempts to examine the state of health-promoting behaviours in Palakkad district. He aims at analysing the influence of health-promoting behaviours on health status of both the deprived and the privileged sections of people in the area. An account of health practices, both traditional and modern, will also be prepared. The study is expected to assist policymakers for anticipating, predicting, and promoting health behaviours. The variables include the psychological categories and the health-promoting behaviours. The study is in the data collection phase wherein 10 households from each ward of the panchayat are chosen as the sample.
The study by Umarul Farook titled Human behavioural practices related to urban mosquitogenic conditions is an interesting inquiry. Mosquitoes are known to be transmitters of several diseases namely malaria, filariasis, dengue, Japanese encephalitis, etc. The known species are Culex, Anopheles, and Mansonia that find suitable breeding sites in the habitats of Kerala. The important premise of the study is that it is man who creates these innumerable breeding places for the mosquitoes and human behavioural practices that aid their fast multiplication. Water supply, drainage of waste, and sewage of human excreta are the most important ecological factors favouring the mosquitogenic conditions in urban environment. Water storage practices are directly related to the potential breeding of Aedes mosquitoes and Anopheles mosquitoes. Open drainage system and faulty sewerage systems often lead to stagnation of organic polluted water. This becomes the ideal breeding place for Culex mosquitoes. The careless disposal of plastic bags, etc., leads to storage of water in peri-domestic areas and public places that become a breeding place for Aedes. In this sense, the mosquitogenic conditions are man-made.
The Thiruvananthapuram Corporation area is notorious for filariasis; and preliminary observations show that it is due to the laxity on the part of the authorities in proper garbage disposal and sewerage. The Corporation has initiated programmes to create awareness about mosquito control but has achieved little. The study therefore attempts to assess the level of awareness of people in mosquito bionomics and mosquitogenic conditions. It is also interested in appraising the mosquito control measures practised by the people and those implemented by the Corporation authorities. Survey method will be used for the collection of data. The study would form an important information document for the Corporation authorities and help in successful planning and implementation of the future mosquito control programmes.