Material and Methods

1.                Materials and Methods

1.1.      Place

This project will be undertaken in Ratnagiri district of Maharashtra. The villages in this district are dispersed in between hills and valleys and are difficult to approach. Public transport facilities are poor and poverty is widespread. This district is divided into 9 Taluka's (revenue divisions). Three villages from each Taluka will be selected using medical statistical method called simple random sampling, lottery technique, so as to avoid selection bias. This selection of villages will be done in the first month of the project. are randomly selected . Thus a total of 27 villages are selected. Map of  Ratnagiri district is attached herewith in Appendix C.

1.2.      Target Population

This is a longitudinal interventional study in which all the children below 10 years of age are included as direct beneficiaries. 15,000 Children of the twenty seven villages of Ratnagiri district  selected for the project between zero to ten years of age group will be examined for signs of Xerophthalmia. 10,800 Women of the villages belonging to 15 to 45 year's age group will receive nutrition education.

1.3.      Time

The project will be carried over a period of 6 years. Of this initial 3 years will be intensive phase and remaining three years will be continuation passive phase.

1.4.         Project Structure

B.K.LWalawalkar Hospital is the sole agency responsible for executing the project.

• The Project Manager will plan and implement the activities of the project in co-ordination with the Project Officer.

• The project  team  will develop  suitable  training  materials  and audio-visual aids  for training.

• The Project  Officer will assist  the  supervisory staff  in conducting  the training  programmes  for field level community health volunteers(CHVs).

• Field Supervisors will be  involved  in  supervising  the  field activities  by regular  visits to the villages. Field Supervisors  will make  frequent  visits  to the  project area  and  guide the CHVs in the field.

• Field Medical Officer will provide curative pediatric outdoor services in the villages.   

 The organization chart of the project is given below:

Note:

The staff will implement the project in the 27 villages of Ratnagiri district in two phases.

Phase 1 is the intensive phase where concentrated activities towards elimination of vitamin A deficiency will be done. This will combine medical component along with the health education component. This phase will last for initial three years of the project. In the next phase known as continuation phase or passive phase only medical component will exist.

1.5.         Inputs

1.5.1.      Personnel Required

1 project manager, 1 project officer, 1 nutrition specialist, 1 field medical officer, 2 field supervisors,  9 community health volunteers and a driver cum assistant.

1.5.2.      Material Required

Vehicle (Van), Office equipment’s including  computer system and ink-jet printers, VCR and TV, Slide projector, Video audio cassettes, Posters, Public address system, deworming medicines, vitamin A solution, general paediatric medicines, weighing scale, and gas, grocery, vegetables and fruits for nutrition demonstrations.

1.6.         Implementation

This will be done by carrying out surveys in anganwadis (nursery), where children of age group between three and six years come for pre-school education. Also children between six and ten years will be surveyed by examination of primary-school children. The children known to be most affected by xerophthalmia fall in between zero and three years of age. This group would be captured by holding meetings in the community for the parents and children and by going from door to door for others. The children with clinical features of vitamin A deficiency will be classified according to the W.H.O. protocol.

W.H.O. Classification of vitamin A deficiency eye disorders:

After the survey is completed the affected children will be dewormed with Pyrantel palmoate. Citamin A will be given orally to these children according to the W.H.O. protocol on Day 1, Day 2 and Day 14. Children below one year of age will receive 1 lac IU whereas all children above this age will receive 2 lac IU per dose. All children will receive prophylactic dose of oral vitamin A at six monthly interval until they complete six years of age.

A medical officer will visit each of the village once a fortnight to carry out general check-up of children and treat accordingly. A meeting will be arranged with the parents of the affected children to explain to them the condition of their child, the necessary treatment, modes of prevention and the dietary intervention required. Nutrition education will be provided in detail explaining to them the best possible use of locally available food stuffs like mangoes, papayas, drumsticks, drumsticks leaves etc.

We will make use of the existing Mahila Mandals (women’s organization) in the area. Education will be provided to each group of females in batches of 25 to 30 women about the causes of vitamin A deficiency, signs and symptoms, treatment, its preventive measures and best possible use of locally available food material.

Incentives such as a cooking competition will be organized in each village based on different recipes rich in vitamin A made from locally available material. Similarly a health quiz will be organized in which the village women will answer the questions related to xerophthalmia. This will be done in an informal way. The data will be collected and fed on computer and analyzed. Prizes will be distributed to the prize winning candidates.

1.7.            Monitoring , Evaluation and Reports for Expected Result 

Community Health Department of B.K.LWalawalkar Hospital will monitor the project and report to the Hindu Society of Ottawa-Carleton, Inc. on a quarterly basis. It will conduct a periodic audit of this project at least once during the first year of implementation and as and when required thereafter. Progress of the project will be recorded and reported on yearly basis. 

1.8.         Other Statistical Indicators for the Selected Villages

1.9.         Self Reliance

The project is expected to be self-reliant after CIDA’s aid ceases. It is expected that the funding may be continued for another three years covering other areas. The success of this project would most likely encourage other NGOs as well as Government sector to undertake similar activities of health education in combination with specific medical activities. The methodology and the results of this project will be used to develop a uniform strategy that could be adopted by the Government for implementation elsewhere.

1.10.    Results Expected – Outputs, Outcomes and Impacts

To assess the efficacy and efficiency of the project , quantitative outputs described above are the minimum expected considering the nature of the inputs provided annually. There will be certain immediate “Outputs” derived by the beneficiaries , while some concrete “Outcomes” would occur over a period of three years, providing measures of success of the project. The “Impact” of the project is expected over a period of 6 years. The expected Outputs, Outcomes and Impacts in the objectives aimed at in this project are tabulated below :

  Executive Summary Project Information Materials & Methods Implementation Schedule Impact Appendix  Current Projects Hospital Trust Donation