Performance of a Community-Based Health and Nutrition-Education Intervention in the Management of Diarrhoea in a Slum of Delhi, India
Pahwa, Smriti, Kumar, Geeta Trilok, Toteja, G. S., Journal of Health Population and Nutrition
Diarrhoea is a leading cause of mortality of children aged less than five years (under-five children) globally. More than 1.5 million under-five children still continue to die each year due to acute diarrhoea (1). The number of these deaths can be substantially reduced by simple remedies, such as rehydration with oral rehydration salt (ORS) and fluids available in the home, continued feeding during diarrhoeal episode, and breastfeeding. However, less than 40% of children with diarrhoea in developing countries receive the recommended treatment, a trend which has made very little progress in the last decade (2,3). As per the National Family Health Survey (NFHS) in India, 48% of children suffering from diarrhoea received oral rehydration therapy (ORT) (4). Thus, diarrhoea is one of the big public-health challenges, particularly in the unhygienic environment of rapidly-growing urban slums. While, on one hand, effective addressing of the health issues of the urban poor may take some time, the urgency of attempting immediate simple interventions is being realized (5,6). One such attempt was made by the authors of this paper.
A community-based health and nutrition-education intervention focusing on several factors influencing child health in urban slums was carried out in Delhi, India. Diarrhoea received special emphasis in the intervention because not only do the maximum number of child deaths due to diarrhoea occur in India but it is also a major child-health issue in urban slums of the country (7,8). Although it is known that knowledge, attitudes and practices (KAPs) of mothers play a crucial role in terms of childhood diarrhoea, community-based interventions to improve these aspects are few. The present paper describes the intervention in terms of community-based approaches developed for educating mothers and their impact on some aspects of management of diarrhoea addressed in the intervention.
MATERIALS AND METHODS
A community-based health and nutrition-education intervention study was conducted in an urban slum in Delhi, India. It involved the creation of a model for imparting health and nutrition education to mothers on various issues critical to the health of their children. Issues, such as infant-feeding practices, counselling on general diet for better nutritional status with special reference to vitamin A deficiency (VAD) (9), personal hygiene, and diarrhoea, were addressed. The present paper describes the intervention in terms of the approaches developed and their impact on diarrhoea-related aspects that were, inter alia, covered during the study.
The study was conducted in a slum cluster located at Kirti Nagar area in West Delhi. The cluster is densely populated with approximately 7,000 jhuggis (small dwelling units, mostly single-room structures, made up of mud or concrete or a mixture of both, each of them not exceeding more than 15 square yards in area). The cluster is further divided into various subclusters, mostly referred to as camps. The constitution of these camps is similar in terms of demographic profile of the resident population. Inhabitants of the cluster are migrants from the eastern part of the country and from the neighbouring states. They are predominantly Hindus (96.2%) and live in nuclear families (76.8%) as opposed to joint families (23.2%). As against 41% illiteracy in the study population, 79.9% of women who formed the target sample for the study were illiterate; the majority (69.7%) of them were aged less than 29 years.
Two areas--one treated as control (hereinafter referred to as control area) and the other used for intervention (referred to as intervention area)--were purposively selected from the two extreme ends of the slum (Fig. 1) to ensure minimal interaction between the subjects belonging to the control and intervention groups. These two slum subclusters--Jawahar camp (intervention area) and Harijan camp with Chuna Bhatti (control area, although a part of the same slum) were separated by a distance of approximately 2-3 km. …