Past,present and future of Integrated Child Development Services (I.C.D.S.)

India's Integrated Child Development Services (ICDS) was established in 33 projects in 1975 and is spread over 22 states; 67 additional projects were begun in 1977, and over the next 2 years; 100 additional projects were added. By 1991=92, coverage was almost 50% of the country with 2696 projects; the expectation is for 100% coverage by the year 2000. An infrastructure chart identifies the organization and integration between level and social welfare and health departments. Objectives are clearly identified and the departments functionally linked. Linkages are achieved by shared space and activities at various levels. Over the past 17 years, services have included minimum needs programs, integrated rural development and poverty alleviation, national health policy and education policy, universal immunization, and the development of women and children in rural areas. ICDS is sponsored 100% by the status and uniquely relies on the honorary anganwadi worker (AWW), who is a woman, recruited and chosen by the community, aged 21-45 years and middle-school educated. The AWW was responsibility for 2000 households or 1000 persons in rural areas and 700 persons in tribal areas. The AWW is crucial to the functioning of the program and receives an honorarium of Rs. 225-275/month for implementing the ICDs program; AWWs have helpers who are paid Rs. 110/month. Training over a 3-year period is conducted at the Bal Sevika Training Institute by the Indian Council of Child Welfare. Additional health personnel and their role and the number of persons/per area AWWS are responsible for, equipment, and functions are also described. The AWW is responsible for nonformal preschool education, organization of supplementary nutrition feeding, health and nutrition education of women and families, immunization of women and children, treatment and referral of common illnesses, growing monitoring, and community participation. Presently, there are 2506 central sector projects and 190 state sector projects and 250,000 AWWs. The preschool education, health, and nutrition programs are summarized. Future directions will encompass future child and mother development and expansion to cover all 90 districts having a birth rate higher than 39/1000. Lessons learned from the past will be integrated and may involve cost containment, acceleration of development of services, alternative services, and giving mothers more responsibility for improving health and nutrition.     

Effect of sex of preceding child on birth interval

The study aim was to examine the effect on birth spacing of a prior female child's birth. The study site was a rural health center under observation by staff from the Dayanand Medical College in Ludhiana, India. The sample included 73 pregnant women who were grouped by the sex of the preceding child. The results showed that the average birth interval was significantly shorter for women with a preceding birth of a female child. The average interval in weeks was 90.73 weeks + or - 54.46 weeks for the 41 women who had a prior girl child compared to 133.68 weeks for the male child. When the female child was at a parity of one the birth interval averaged 73.36 weeks, compared to 137.2 weeks for a prior parity of one male child. At parity of two, the average birth interval was 106.2 for a prior girl child and 144.38 for a prior male child. At a parity of three, the average birth interval was 88.22 weeks for a prior girl child and 96.5 weeks for a prior male child. At a parity of four, the average birth interval was 87.66 weeks for a prior girl child and 46.0 weeks for a prior male child. The significant effect of having a prior girl child was evident only at a parity of one. The intervals at a parity of two and three were shorter for girls but not significantly different. The recommendation was that young women and women with low parity be targeted for family planning in order to lengthen the birth interval, regardless of the desire for sons.     

Effect of child loss on contraception acceptance

In India, interviews were conducted with 250 couples who had at least 2 living children and at least 1 son so researchers could examine the effect of child loss on contraceptive usage. The interviewees lived in the area served by the rural health center in Pohir. 67 couples had lost a child. The child loss group had an acceptance rate for contraception of 41.7% compared to 44.8% for the group who had not experienced child loss. The difference was insignificant. Caste, literacy, and parity did not affect contraceptive usage. These findings suggest that child loss does not play a crucial role in contraception acceptance. On the other hand, some studies show that it is a barrier to fertility limitation. Additional studies are needed to resolve the issue of child loss and fertility.     

Relation of plasma prolactin to clinical response in schizophrenic patients.

It has been suggested that, if dopamine antagonism is a necessary condition for the antischizophrenic action of neuroleptics, the prolactin response, as an index of dopamine blockade, would correlate with clinical response. Morning prolactin and clinical symptomatology were measured in 15 schizophrenic patients before neuroleptic therapy, and after three and six weeks of high-dose butaperazine or loxapine treatment. Prolactin levels were transiently elevated during the unmedicated admission period, probably reflecting a normal stress response. Prolactin increased in all patients during neuroleptic therapy. There was, however, no correlation between magnitude of prolactin changes and clinical response, probably because the prolactin response achieved a maximum at relatively low doses of neuroleptics.