India – Anganwadis (government sponsored child-care and mother-care centers) and medical surveillance in informal settlements

Anganwadis have a role to play

PUNE: A network of approximately 1,203 anganwadi workers, spread across the length and breadth of city’s slums, is lying untapped.

These angandwadi workers say that if they are given basic training, they can work as counsellors and create awareness about the H1N1 contagion among the slum dwellers.

“Anganwadi workers should be given some kind of formal training. With this, we can at least spread basic awareness about the symptoms of the flu among slum dwellers during our home visits. Besides, knowledge about a few precautionary measures can make a huge difference in containing the spread in slums,” said Prema Ghadge, project officer of Dapodi-Bopodi project. The Dapodi-Bopodi ICDS project has around 86 such anganwadi workers operating in slums of Vishrantwadi, Lohegaon, Dapodi, Bopodi and Sangamwadi, said Ghadge.

The death of 35-year-old Shabana Shaikh from Kashewadi slums in Bhavani Peth on Wednesday has underscored the need for extensive awareness and exhaustive medical surveillance of the 560 slums scattered across the city. Corporators have asked the administration to carry out medical surveillance of these slums on top priority since 42 per cent of the population of the city live in these slums.

Every anganwadi worker is responsible for 1,000 slum dwellers. “An anganwadi worker is supposed to visit five families in slums every day. The major focus of their work is to look after pregnant women and malnourished children and maintain their record. Moreover counselling family members on these health parameters is also a prime area of their routine work,” said Ghadge.

When asked about the need and benefits of such training, Ghadge said, “Anganwadi workers are just 10 class passed. They are trained in particular health issues like pregnancy and malnutrition. That’s why they should be given formal training about the basic aspects of the H1N1 influenza.”

“An anganwadi worker is a known face among the slum dwellers. That’s why a training given to them about the H1N1 influenza can make a lot of difference,” said Dilip Sarda, president of the city unit of Indian Medical Association (IMA).

“All the information that we are disseminating among slum dwellers about the H1N1 influenza is either through television or newspapers. A formal training in this regard would prove helpful,” said Ashwini Kamble, child development project officer (CDPO), Shivajinagar.

Yojna Shinde, the CDPO of Ghorpadi-Kondhwa, agreed that a formal training will help them in doing their job better. “Anganwadi has a huge resource which can be tapped in this state of emergency. There are 152 anganwadi workers under me and the total population of the areas that come under me is roughly 1.5 lakh. There are about seven other officers like me with approximately equal population. That means we have access to a very large population. Though at our own level also we are planning to invite an expert or a medical officer to talk to people living in slums in the coming week,” said Shinde.

Commenting on the need for a basic training course, Mahendra Gaikwad, project officer of the Hadapsar project said, “A basic training seminar would not take more than two hours. But it can be of great help and it is the need of the hour.” Around 167 anganwadis come under the Hadapsar project. They collectively cater to a population of roughly 1.7 lakh people. If the flu spreads across these slums, it will become very difficult to contain it, said Gaikwad.

Vijay Taware, project officer of the Kothrud project said, “We have been educating two employees in each of the 136 anganwadis in swine flu that come under the kothrud project. We have given them basic information about the disease, how it spreads and how it can be prevented. However, whatever we have told them is what we see on the television or read in the newspapers. We are no doctors or experts to train these people. Hence, a formal training, even if a basic one given by an expert can be of a lot of help.”

Seconding the idea of a basic training on H1N1 influenza for these anganwadi workers, Suvarna Pawar, who looks after the slums of Bhavani peth said, “More than 1 lakh 35 thousand slum dwellers come under my supervision. And there are 133 anganwadis to look after them. Giving all the anganwadi workers some sort of training regarding the disease is the easiest way of spreading awareness among these people as they are in regular contact with the people of these slums.

She further added, “Under the ICDS scheme, we have been spreading awareness about other diseases like malaria, tuberculosis and dengue. But since H1N1 is a new disease, we ourselves did not know much about it. Hence, a training course can be of a lot of help as then these people will be able to counsel a large number of people.”

When contacted M S Devnikar, additional municipal commissioner of PMC said, “It is true that this network of anganwadi workers can be roped in effectively to check the spread of H1N1 influenza in slums. Earlier, we have taken some steps to educate them. We will definitely extend them proper training in the next few days.”

Agreeing to it, Sanjay Maskar, deputy CEO of Zilla Parishad said, “It is true that these anganwadi workers should be given formal training about the H1N1 influenza. Earlier, we have conducted a few camps in the districts. Now, we will conduct their formal training and give them clear cut information regarding the basic aspects of the dreaded infection.” There are 4316 anganwadi workers in Pune district, added Maskar.

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H1N1 Concerns in Africa’s Informal Settlements

Fewer than ten H1N1 cases are confirmed in Africa, but health experts worry the disease may spread in the continent’s crowded slums.

The World Health Organization has reported that the H1N1 swine flu virus has now sickened just shy of 60,000 people. That’s the number of confirmed cased worldwide. Of those, fewer than 10 are in Sub-Saharan Africa. Yet the US Centers for Disease Control and Prevention fears Africa could be hit hard by the pandemic. The CDC watches for new diseases in Africa, and it’s keeping a close eye on the continent’s crowded slums.

Africa’s largest slum is a place called Kibera. More than a million people live in this shantytown on the edge of Kenya’s capital. It’s a sprawling area of open sewers amid a sea of tin roof shacks. Inside one shack, Yunus Mohamed interviews a young mother. Mohamed asks in Swahili if anyone in the household has been sick in the past two weeks. Mohamed is a community interviewer with a program run by the CDC and Kenya’s Medical Research Institute.

There are seven family members at this residence. They live together in two rooms. One of the children has a cough and a fever. Mohamed takes the girl’s temperature. The girl was tested at the hospital. She has a seasonal flu. The program Mohamed works for provides medical care for residents, but he is not here to treat the family’s illnesses. He’s here to collect data to help monitor for new diseases that may be spreading through the community. It would be hard to find worse conditions for good health. There is no running water and few here have access to electricity. The slum is an incubator for illness.

Dr. Robert Breiman heads the CDC’s Global Disease Detection Division in Kenya. Right now, his team is watching closely for swine flu: “In places where people are crowded into cramped quarters, and there are issues of sanitation and hygiene, the potential for a virus to be moved easily from person to person is larger. ”

“We’ve even seen evidence of a rise in seasonal influenza which we see every year.It moves through a community like Kibera within weeks instead of months or longer. So if you had some sort of doomsday pathogen that’s particularly harmful introduced into a place like this, the potential to spread to endanger other communities, and it’s one of the reasons we are doing this work in a place like this.”

Now, swine flu has not turned out to be a doomsday pathogen. So far, it has generally caused mild illness around this world. But in Kibera, more than 10 percent of adults are HIV positive.

And Harvard epidemiologist Marc Lipsitch says the disease could look very different among those with HIV.: “One reason to be concerned about that is that HIV positive people are at much higher risk of bacterial pneumonia, especially pneumococal pneumonia. Those pneumonias are often secondary complications of influenza infection as well.”

Lipsitch says it’s critical that medical workers keep an eye on how swine flu behaves if it arrives in a place like Kibera. The crowded conditions and poor health services might provide an environment where the virus could mutate in dangerous ways.

“There is definitely concern that this virus could become more virulent. Whether the vulnerable populations will be the locus of that is a complete unknown. I do think that the concern about either to virulence or to drug resistance or both are very serious ones and need to be monitored closely.”

The CDC is monitoring closely for any signs of swine flu. But CDC worker Yunus Mohamed says it can be hard to spot a new disease in a place where every day he sees serious symptoms: “Coughing, difficulties in breathing, pneumonia, diarrhea, yellow fever, yellow eyes, fever.”

Mohamed says swine flu is a serious concern — but in a place where malaria, tuberculosis, and AIDS are rampant, it’s just one more disease to worry about.

Source – PRI