Dr. Shiban Ganju, during the meeting has explained about SAM, How SAM is working in villages impact of SAM Gadag and also spoke about future plan of SAM at Gadag.
Future Programs are:
- Health Survey (Annual check for all)
- Communicable Disease, preventt the preventable
- Data Degitization., E Health card for all
- Non Communicable Disease.
The Save A Mother Foundation (SAM), launched in 2008, has made
significantimpact on health seeking behaviourin four districts of three states in India. From its initial focus on maternal mortality reduction with behaviouralchange, SAM has included infant and child mortality reduction, population stabilisationand tuberculosis control in its services.
SAM has developed an ‘Effective Social Persuasion” (ESP) Program for social behaviour change. The program includes social health behaviour change through intensive community mobilization, capacity building, training of village volunteers, community meetings, house calls and training of community leaders to become self-sufficient.
SAM has replicated its earlier success of Amethi in other districts: Gadag in Karnataka, Nizamabad in Telangana and Jaunpur district in UP. Recently SAM started a new program to reduce mortality among children under 5 years in urban slums of Varanasi city.
SAM has been able to achieve 90% reduction in maternal mortality and 67% reduction in infant mortality in all its districts at an annual cost of 15 Rupees per capita population. The NGO, run by a professional staff, is data driven. It has a transparent accounting system and a demonstrable record of achievement of goals. SAM employs approximately 80 people and also works a field force of over 27,000 volunteers. SAM works in close cooperation with government public health programs.
SAM gets financial support from different donors:
- Population stabilization program in Amethi district with financial support of Population Foundation of India, New Delhi.
- Maternal Child Health program in Gadag with financial support of Deshpande Foundation.
- Maternal health program in Jaunpur district with financial support of EK Soch Sandbox.
- Maternal Child Health program in Nizamabad with the support of SAM Foundation USA.
- Reduction of under 5 years child mortality in urban slums of Varanasi city with SAM USA.
SAM believes social behaviour change is the least expensive method of reducing disease burden in a community. SAM has worked in 1500 villages since 2008, with an effort to develop healthcare solution for the poor – solutions which are simple, sustainable and scalable.
By Gulab Nath Yadav, Manager Projects, SAM
SAM has been running a Population Stabilization Program (PSP) in Amethi district since 2013. The program covers approximately 1.2 million people (12 Lakhs) and is funded by the Population Foundation of India
SAM has developed a low cost, replicable model for population stabilization by using effective social persuasion techniques through community activists and with the use of persuasive technology.
SAM has shown that intensive training at the community level can lead to adoption of best family planning practices. The cornerstone of success is repetitive delivery of key health messages. Volunteer health activists create their own culturally-specific slogans, songs and training materials. Key health messages relayed through multiple training courses have transformed health outcomes, promoted health-seeking behaviour amongst women and abolished harmful practices that have been in existence for centuries.
The program objectives achieved the following objectives by December 2018:
- Developed a cadre of over 29000 trained voluntary health activists.
- To decrease unmet need, SAM established a supply chain and a network of village based contraceptive suppliers, who sell to the community below the market price.
The program had multiple targets:
- Double the contraceptive acceptance rate compared to
- Decrease the unmet need
ofcontraception by fifty percent. Decreasein numberof girls marrying below the legal age of eighteen.
- Increase in
birthinterval of 36 months and more.
PSP Program achievements till December 2018
Details Percentage of Eligible Couples 1 Target Couples Contacted by SAM staff 90% 2 Total No. of target Couples using contraceptives 62% (was 10% at the beginning) 3 Girls marriage beyond 18 years of age 99%
The PSP program will be phased out in a planned manner and handed over to community leaders. SAM will observe from outside for a minimum of 3 months to ensure continuity and intervene when needed.
Glimpses’ of Population Stabilization Program in Amethi district.
Population Stabilization Program Achievements – SAM Amethi
Period – January 2015 to December 2015
Details of Activities No. of Activities Organised Total Participants in the activities Block level Association Meeting organised 147 7392 No. of cluster Level Association Meetings organised 123 3005 No. of Open Meeting organised 2961 35823 Village Health & Nutrition Day observed by SAM 1338 8573 No. of Arogya Sakhi training organised 1032 26173 No. of Swasthya Sakhi training organised 14 480 No. of Rogi Kalyan Samiti meeting organised 7 129 No. of Magic show organised in the program villages 238 28500 approx. District level orientation on PSP interventions 01 24 No. of Block level orientation 09 245 ICDS Meetings 26 468 No. of CHC/PHC visit 38 1176 Total No. of target/ Eligible couples are using different modern contraceptives 8542 Condom 4421 (52%) Coper T 104 (1.2%) Multi load 132 (1.5) Mala N 1063 (12.44%) Saheli (Weekly Tablet) 704 (8%)
Period : January 01, 2016 To December 2016
Details Phased out GP Percentage Non Phase out Percentage 1 Total Population Covered in the program GP 2 Total No. of Target Couples 3 Total No. of Target Couples Contacted 34620 4 Total No. of Target Couples using contraceptives 15208 43% a Condom 12141 79.83% b Oral Pills (Mala N) 1317 8.65% c Saheli (weekly Oral Pills) 1398 9.19% d IUCD 352 2.31% 5 Total No. of Eligible Couples 6 Total No. of Eligible Couples contacted 58211 7 Total No. of Eligible couples using modern contraceptives 28388 48.76% a Condom 18437 64.94% b Oral daily Pills 3975 14% c Saheli Weekly Pills 4494 15.83% d IUCD 938 3.30% e Sterlisation female 544 1.91% 8 % of Depot holders having modern contraceptives 2619/2226 84.99% 9 % of Asha having modern contraceptives 1142/805 70.49%
Period: January 2017 to December 2017
1. District: Amethi.
- Total number of Blocks : 12.
- Total No. of Gram Panchayat: 360
- Population coverage : 12 Lakhs approx.
2. District: Jaunpur:
- Total No. of Blocks: 2.
- Total No. of Revenue Villages: 100.
- Population Coverage: approx. 100000.
- Double the contraceptive acceptance rate.
- Decrease the unmet need of contraceptive.
Sub – Objective:
- Delay in girls marriage, not before 18 years of legal age.
- Delay in 1st pregnancy and keep 3-5 years gap between 1st and 2nd child birth.
Maternal and Child Health..
- Reduction in maternal and Infants mortality.
- To Improve
healthand nutritional status of womenand children.
- Building capacity of key stake holders on maternal & child health issues.
T.B. Eradication Program:
- Minimise the T.B. prevalence in the Amethi district.
- Reduction in death due to TB disease.
- Ensure 100% sputum test and treatment of T.B. at Govt. hospital through DOTs .
- Prevention from T.B. disease
- Community Mobilization.
- Capacity Building
- Developing community volunteers/ Change Agents (Arogya Sakhi, Swasthya Sakhi)
- Strengthening of Depot holders and network of Social Market
- System Strengthening through participation in VHND, CHC visits and orientation of health and ICDS officials and RKS meetings
- Strategic Alliance with other NGOs , working in the same program area.
Achievement So For period: (Jan. 2017 to December 2017)
- Developed a team of Arogya Sakhi: approx. 30000.
- Developed a team of Swasthya Sakhi: 2000.
- Depot Holders: 292.
- Increase in Modern Contraceptives uses among
Target & Eligible couples: 53%
Decreasein Unmet Need from: 10.8% to 2.2% as per base in 2014 and End line survey in 2016. linesurvey
- Increase in Institutional deliveries: 99%
- Increase in Girls marriage > 18 years: 95%.
Total pregnantwomen: 38062.
- Total Pregnant women contacted: 21961.
- Total No. of live birth: 17052
Decreasein Infant Mortality Rate: 3 ( 42/1000 live birth.) Decreasein Maternal Mortality rate: 53 ( 9 / 100000 live birth.)
- IMR of U.P. as per Annual Health Survey
- MMR of U.P. as per Annual health survey
- IMR of Amethi as per annual health survey 2012-13: 45.
- MMR of Amethi as per annual health survey 2012-13: 364.
- Total T.B. patients
under gonefor treatment
Since Jan- Dec. 2017: 452
- Total Patients Cure: 295
- Total Drop out during treatment: 16
- Total Patient died during treatment: 10
- Still under treatment: 131
Period : January 01, 2018 To December 2018
Details Phased Out GP Percentage Non Phase Out Percentage 1 Total Population Covered in the program GP 165537 672045 2 Total No. of Target Couples 4005 14529 3 Total No. of Target Couples Contacted 3607 90% 12501 86% 4 Total No. of Target Couples using contraceptives 2226 62% 6161 50% a Condom 1208 54% 3544 58% b Oral Pills (Mala N) 533 24% 1370 22% c Saheli (weekly Oral Pills) 384 17% 992 16% d IUCD 101 4.5% 255 4% 5 Total No. of Eligible Couples 12063 52416 6 Total No. of Eligible Couples contacted 10658 88% 44206 84% 7 Total No. of Eligible couples using modern contraceptives 6661 62% 21082 48% a Condom 3617 54% 12255 58% b Oral daily Pills 1703 26% 4900 23% c Saheli Weekly Pills 940 14% 2847 14% d IUCD 236 4% 661 3% e Sterlisation female 165 2.5% 419 2% 8 % of Depot holders having modern contraceptives 99% 99% 9 % of Asha having modern contraceptives 96% 96%
Nitesh Jangir and Nachiket Daval have come up with radical innovations to address the challenge of 53 percent deaths among children under the age of 5 years due to infections.
The launched a firm called CEO Labs. They have designed two devices; Saans—a low-skill, low-cost, neonatal Continuous Positive Airway Pressure (CPAP) device and VAPCare- an intelligent secretion management device to prevent ventilator-associated pneumonia (VAP).
“On a night shift at the hospital we saw an auto come into the emergency department. Three people came out of the auto carrying a new-born. The doctor’s started the medical procedure immediately but they couldn’t save the baby,” Nachiket tells digital magazine The Better India.
The friends later found out that the baby had been a premature who suffered complications due to severe lack of oxygen. Lack of appropriate medical support at the hospital where the baby had been delivered, and the time it took to transfer the baby to another hospital proved fatal for the infant.
In a country where about half of the children born are, at the most, 5-10 km away from a care centre, the number of babies who die due to lack of medical facilities is staggering.
Sometimes deliveries may not always be in a hospital with respiratory support systems for premature babies. In some cases, well-equipped ambulances may do the needful but what of those who cannot afford to wait for an ambulance or where the ambulance too, is does not have the necessary equipment?
“Currently, all neonatal CPAP machines (including bubble CPAPs) require electrical power or compressed gases to function—neither of which is easily available in primary care centres, or during transport in low-resource settings,” says the COEO team.
Saans is the world’s first neonatal CPAP device that can be powered in multiple ways – through direct source electricity (including a vehicle’s electrical supply), a rechargeable battery, compressed gas, or even manual air pumping.
When there is a power cut, as is very frequent in many parts of India and Saans can be operated manually with the help of a standard Bag Valve Mask bag (BVM) (a manual resuscitator) fixed to it. The system, patented by COEO, converts a variable flow of the BVM bag to a continuous and controlled airflow.
Saans, which took over three years testing and finalisation, has already started showing results. Nitesh shares a story which has a permanent place in the team’s heart.
“We deployed a Saans device to a low-resource hospital in Kolar, Karnataka. This hospital has a high volume of premature births but lacks infrastructure to support the existing CPAP machines. A few days after we gave them the device, we got a message from the doctor saying that there was a premature baby admitted to the hospital,” says Nitesh.
The doctor said that they had tried everything they could to save the baby. When nothing else worked, they tried Saans and the baby’s condition improved within two hours. At night, during a power cut, the device continued to work thanks to its manual settings.
“The doctor messaged saying that the baby survived because of Saans and he congratulated the whole team for developing the device.”
Picture Caption – A Low-skill, low cost, neonatal Continuous Positive Airway Pressure (CPAP) device
The article adapted from an article in The Better India, March 1. 2019
As soon as you know that you are pregnant, there is an unmistakable glow in your skin.
First because of the hormonal changes and second because of the happiness it brings.
There are a lot of changes that happen in your body in the course of pregnancy.
Lets talk about the changes in the skin, from head to toe.
- Hair has 3 phases, the growing phase, the resting phase and the dropping phase. So in pregnancy, the hair goes into the resting phase and so you do not see much of hair fall unless you have some deficiency which can be treated. But once you deliver, a couple of months later the hair goes automatically into the dropping phase, which is normal.
- Do wash your hair often if its oily.
- Don’t wash too often if its dry.
– Avoid chemical treatments like permanent straightening, curling, ironing etc.
- Hair can get dry if you have a thyroid deficiency, it can get oily too depending on the hormonal levels.
- Acne or pimples may increase which is again hormonal. Not all acne treatment, whether oral or topical is safe in pregnancy. consulting a dermatologist is a must to know what can be used to treat Acne.
- Do as told by your doctor.
- Don’t try un prescribed medicines on your own.
- Avoid picking or pinching your acne as it can leave scars.
- Small, red veins can appear on the face, neck and arms because of the increased blood volume and hormone.
- These don’t need treatment unless cosmetically disfiguring.
- May disappear later.
- Multiple skin tags can appear on the neck, chest, back, below the breasts and groin. These have to be removed by a doctor by doing electro cautery if they are big or causing irritation due to friction.
- Do not interfere with these lesions.
- Get them removed by your Dermatologist.
- Increased pigmentation is very common in pregnancy due to the increase in the naturally occurring melanin. Seen as darker colour of the nipples, breasts, inner thighs, a dark line in the abdomen called the Linea Nigra, Melasma or the pigmentation on the face, nose and cheeks called the mask of pregnancy. All this slowly resolves in months after delivery.
- Do not try bleaching or depigmenting creams and avoid contact allergies.
- They fade away after delivery.
- Stretch marks or striae gravidarum as it is called, are seen due to the stretching of the skin on the breast, abdomen, buttocks and thighs. They start off as reddish lines when they are new and later turn to silvery or white lines. These are hard to treat as once they appear they do not disappear as the stretched skin or the elastic tissue does not come back to normal.
- Moisturize your skin well to avoid over stretching.
- They are not due to scratching.
- Varicose veins may be seen in the legs because of the increased weight and also the pressure of the uterus which deceases the blood flow to the legs.
- Consult a Vascular surgeon, if there are big veins and swelling in the legs.
- You may have to wear stocking if advised.
- Cell mediated immunity is depressed during normal pregnancy, this accounts for increased severity and frequency of skin infections. Bacterial, Viral or Fungal infections may occur or increase if they are already present. This needs immediate treatment as these infections can spread widely and also affect the baby as it can be transmitted through the placenta.
Most often Bacterial infections will have pus and pain and has to be treated with antibiotics that are safe in pregnancy.
- Do not try to squeeze the pus out as you may spread the infection further.
- Keep yourself clean and hygienic.
Fungal infections occur in the areas where you sweat most, like under the arms, below the breast, inner thighs, in between the toes and also on the body surface areas, these will cause intense itching, and continuous scratching can lead to secondary bacterial infection.
- Bathe everyday and twice a day in summer if you sweat more.
- Wear cotton and comfortable clothes.
- Keep your nails trimmed.
- Avoid self medication.
Viral infections like warts, Molluscum contagiosum etc need immediate treatment to avoid spread to the baby.
- Do not neglect these lesions as there are no symptoms.
- A lot of other inflammatory skin conditions/ pregnancy dermatoses are specific to pregnancy and need immediate treatment, though they are benign and resolve after delivery, like
- Early onset
– prurigo of pregnancy
– pruritic folliculitis
b) Late onset
- PUPPP- pruritic urticarial papules and plaques of pregnancy
- Pemphigoid gestationis
- Pruritus gravidarum – pregnancy jaundice
Meet your doctor immediately if you have
severitching, rashes, water bubbles, pain full or pus filledskin lesions, fever with a rash, on the abdomen or anywhere on the body.
Dr T S Vidya
Consultant Sagar Hospitals
Skin & Cosmetic Clinic, Bangalore.