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Facts for Life saves lives!

What is Facts for Life?

Every year, nearly 11 million children die from preventable causes before reaching their fifth birthday. Millions more survive only to face diminished futures, unable to develop to their full potential.

Many of these deaths can be avoided if parents and caregivers understand what to do when illness strikes and how to recognize the danger signs that signal the need for medical help. Facts for Life presents, in simple language, the most authoritative information about practical, effective and low-cost ways to protect children's lives and health. Everyone has the right to know this information.

English  |  Hindi

• Is there a right age to have a baby?

• What can I do when my baby cries?

• Can a working mother successfully breastfeed?

• How helpful is a joint family in bringing up children?

• How should we handle our fussy eater?

• Is my child ready for toilet-training?

• Are vaccines safe?

• When is the right age for sex education?

• How can I raise a happy child?

• Are drugs overprescribed for childhood illnesses?

• How should we handle our teenager?

• What should I do in a medical emergency?

Documentation
The following documents describe the sample and methods used to construct the standards and present the final charts.

WHO Child Growth Standards: Methods and development
Acta Paediatrica Supplement
Chart catalogue | en español

Indicators
The following links provide access to the first and second set of the WHO child growth standards (0-60 months):

:: Length/height-for-age
:: Weight-for-age
:: Weight-for-length
:: Weight-for-height
:: Body mass index-for-age (BMI-for-age)
:: Head circumference-for-age
:: Arm circumference-for-age
:: Subscapular skinfold-for-age
:: Triceps skinfold-for-age
:: Motor development milestones

WHO Child Growth Standards - Methods and development
Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age
pdf 26.6 mb - 336 pages

In 1993 the World Health Organization (WHO) undertook a comprehensive review of the uses and interpretation of anthropometric references. The review concluded that the NCHS/WHO growth reference, which had been recommended for international use since the late 1970s, did not adequately represent early childhood growth and that new growth curves were necessary. The World Health Assembly endorsed this recommendation in 1994. In response WHO undertook the Multicentre Growth Reference Study (MGRS) between 1997 and 2003 to generate new curves for assessing the growth and development of children the world over.

The MGRS combined a longitudinal follow-up from birth to 24 months and a cross-sectional survey of children aged 18 to 71 months. Primary growth data and related information were gathered from 8440 healthy breastfed infants and young children from widely diverse ethnic backgrounds and cultural settings (Brazil, Ghana, India, Norway, Oman and USA). The MGRS is unique in that it was purposely designed to produce a standard by selecting healthy children living under conditions likely to favour the achievement of their full genetic growth potential. Furthermore, the mothers of the children selected for the construction of the standards engaged in fundamental health-promoting practices, namely breastfeeding and not smoking.

Global Strategy for Infant and Young Child Feeding
WHO - UNICEF
pdf 440 kb - 37 pages

WHO and UNICEF jointly developed the Global Strategy for Infant and Young Child Feeding to revitalize world attention to the impact that feeding practices have on the nutritional status, growth and development, health, and thus the very survival of infants and young children.

The Global Strategy is based on the evidence of nutrition’s significance in the early months and years of life, and of the crucial role that appropriate feeding practices play in achieving optimal health outcomes. Lack of breastfeeding – and especially lack of exclusive breastfeeding during the first half-year of life – are important risk factors for infant and childhood morbidity and mortality that are only compounded by inappropriate complementary feeding. The life-long impact includes poor school performance, reduced productivity, and impaired intellectual and social development.

Community-based management of severe acute malnutrition

A Joint Statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children’s Fund

Severe acute malnutrition remains a major killer of children under five years of age. Until recently, treatment has been restricted to facility-based approaches, greatly limiting its coverage and impact. New evidence suggests, however, that large numbers of children with severe acute malnutrition can be treated in their communities without being admitted to a health facility or a therapeutic feeding centre.

The community-based approach involves timely detection of severe acute malnutrition in the community and provision of treatment for those without medical complications with ready-to-use therapeutic foods or other nutrient-dense foods at home. If properly combined with a facility-based approach for those malnourished children with medical complications and implemented on a large scale, community-based management of severe acute malnutrition could prevent the deaths of hundreds of thousands of children.

Joint statement
English 392kb | French 755kb

Press release
English | French | Spanish | Russian | Arabic | Chinese

Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers
pdf 1.2 mb - 68 pages

Malnutrition remains one of the most common causes of morbidity and mortality among children throughout the world. Approximately 9% of children below 5 years of age suffer from wasting (weight-for-height below 22 standard deviations (,22 SD) of the National Center for Health Statistics (NCHS)/WHO reference values) and are at risk of death or severe impairment of growth and psychological development.

This manual is based on The treatment and management of severe protein–energy malnutrition, which was published by WHO in 1981. Since then, many advances have been made in the treatment of severe malnutrition. An improved oral rehydration salts (ORS) solution has been developed for the treatment of dehydration. Advances in knowledge of the physiological roles of micronutrients have led to improved dietary management during the initial phase of treatment. It has been shown that physical and psychological stimulation, as well as care and affection, are necessary during the rehabilitation phase in order to prevent retardation of growth and psychological development.

This manual provides guidelines for the treatment of severely malnourished children (below 5 years of age) in hospitals and health centres. The treatment of severely malnourished adolescents and adults is also briefly considered. The manual is intended for health personnel working at central and district level, including physicians, nurses, midwives and auxiliaries.

Repositioning Nutrition as Central to Development
A Strategy for Large-Scale Action - 2006
pdf 1.6 mb - 272 pages - original at World Bank site

Persistent malnutrition contributes not only to widespread failure to meet the first Millennium Development Goal—to halve poverty and hunger—but also to meet other goals related to maternal and child health, HIV/AIDS, education, and gender equity. Underweight prevalence among children is the key indicator for measuring progress on nonincome poverty, and malnutrition remains the world’s most serious health problem—as well as the single largest contributor to child mortality. Nearly one-third of children in the developing world are underweight or stunted, and more than 30 percent of the developing world’s population suffers from micronutrient deficiencies. Moreover, new malnutrition problems are emerging: the epidemic of obesity and diet-related noncommunicable diseases is spreading to the developing world, and malnutrition is linked to the HIV/AIDS pandemic.

Repositioning Nutrition as Central to Development: A Strategy for Large-Scale Action makes the case that development partners and developing countries must increase investment in nutrition programs. This case is based on evidence that the scale of the problem is very large and that nutrition interventions are essential for speeding poverty reduction, have high benefit-cost ratios, and can improve nutrition much faster than reliance on economic growth alone. Moreover, improved nutrition can drive economic growth. The report proposes to the international development community and national governments a global strategy for accelerated action in nutrition.

Counting on Communication: The Uganda Nutrition and Early Childhood Development Project - 2005 - World Bank Working Paper No. 59
pdf 3.2 mb - 56 pages - original at World Bank site

Counting on Communication is part of the World Bank Working Paper series. These papers are published to communicate the results of the Bank’s ongoing research and to stimulate public discussion. This publication is the first in a series of Working Papers sponsored by the Development Communication Division (DevComm) of the World Bank’s External Affairs Vice-Presidency. This series is designed to share innovations and lessons learned in the application of strategic communication in development projects. Together with other donors, NGOs, and private sector partners, DevComm seeks to mainstream the discipline of development communication in development practice.

The Uganda Nutrition and Early Childhood Development Project was one of DevComm’s first projects to demonstrate the valueadded of strategic communication. The strategic communication component developed for this project included the use of formative research about values and attitudes with respect to child rearing, in order to develop and test effective messages. The communication strategy was developed in a highly participatory manner and included nurturing a team of champions for the project among policymakers, district officials, community leaders, and grassroots organizations to advocate for the project. It also included two-way communication activities developed to address the practices and behaviors that would need to be changed in order for the project to be successful, rather than merely disseminating messages based on assumptions of project benefits.

World Bank Working Papers are available individually or by subscription, both in print and online.

To work with community members in urban slums to achieve improvements in maternal and newborn care practices and care seeking.

To work with municipal health service providers to strengthen decentralised primary care:

• To achieve provision of high quality antenatal and postnatal care at health posts.
• To encourage continuous quality improvement in maternal and neonatal services at maternity homes and hospitals and along the referral chain.

To test replicable and scaleable models of interventions to improve maternal and newborn health.

Methods
The initiative’s primary strategies are to encourage change through participation, self-sustaining group activities, ownership, and appreciative inquiry. The first phase of the initiative will run for 4 years. For the purposes of management and evaluation the package will be organised into three components. Within each component, strategies will be devised by groups convened to plan interventions to improve maternal and neonatal health. Intervention will take place at a number of levels, from community to tertiary.

Ranchi Low Birth Weight Project - Study Protocol
Reducing Incidence of Low Birth Weight using a Community based Life Cycle Strategy

Krishi Gram Vikas Kendra, Child In Need Institute, Social Initiatives Group, ICICI Bank
pdf 805 kb - 16 pages

The Ranchi Low Birth Weight Project is a quasi-experimental action research study to evaluate the effectiveness of life-cycle based community level behavioural interventions in reducing the incidence of low birth weight and improving maternal and child health in Ranchi district of Jharkhand state in India.

Aims

Low birth weight (LBW) and childhood malnutrition continue to be major public health problems in India. It is well recognised that maternal and child health services as well as a range of behavioural factors need to work synergistically to break the intergenerational cycle of malnutrition and improve these key indicators which determine long term prosperity and productivity of a nation. Both on the partners' and other experiences in India and elsewhere, interventions in the Ranchi LBW project aim to improve maternal and infant health outcomes by addressing a range of medico-social and behavioural determinants of low birth weight. The study envisages implementing and evaluating the additive effects of community level behavioural interventions in bringing about positive improvements in maternal and infant health outcomes in an area where mandated public health and related services are ensured.

The International Food Policy Research Institute has released its new Global Hunger Index, an innovative and enhanced approach for measuring hunger in developing and transitional countries. The index reveals hunger hotspots, shows which countries and regions have improved over time, and demonstrates the links between hunger and violent conflict.

Understanding the Links between Agriculture and Health (a collection of 16 briefs)

The prevalence of child undernutrition in India is among the highest in the world, nearly double that of Sub-Saharan Africa, with dire consequences for morbidity, mortality, productivity and economic growth. Drawing on qualitative studies and quantitative evidence from large household surveys, this book explores the dimensions of child undernutrition in India and examines the effectiveness of the Integrated Child Development Services (ICDS) program, India's main early child development intervention, in addressing it. Although levels of undernutrition in India declined modestly during the 1990s, the reductions lagged behind those achieved by other countries with similar economic growth. Nutritional inequalities across different states and socioeconomic and demographic groups remain large. Although the ICDS program appears to be well-designed and well-placed to address the multi-dimensional causes of malnutrition in India, several problems exist that prevent it from reaching its potential. The book concludes with a discussion of a number of concrete actions that can be taken to bridge the gap between the policy intentions of ICDS and its actual implementation.

Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism

Online Versions: aa.org  | anonpress.org

It's more than a book. It's a way of life. Alcoholics Anonymous-the Big Book-has served as a lifeline to millions worldwide. First published in 1939, Alcoholics Anonymous sets forth cornerstone concepts of recovery from alcoholism and tells the stories of men and women who have overcome the disease. With publication of the second edition in 1955, the third edition in 1976, and now the fourth edition in 2001, the essential recovery text has remained unchanged while personal stories have been added to reflect the growing and diverse fellowship. The long-awaited fourth edition features 24 new personal stories of recovery. Key features and benefits ·the most widely used resource for millions of individuals in recovery ·contains full, original text describing AA program ·updated with 24 new personal stories

Alcoholics Anonymous (AA) is an informal meeting society for recovering alcoholics whose primary purpose is to stay sober and help other alcoholics achieve sobriety.AA suggests that alcoholics follow its program and abstain from alcohol in order to recover from alcoholism, and share their experience, strength, and hope with each other that they may solve their common problem.AA was the first twelve-step program and has been the model for similar recovery groups like Narcotics Anonymous. Al-Anon/Alateen are programs designed to provide support for relatives and friends of alcoholics. The organization was named after its primary guidebook Alcoholics Anonymous, also known as The Big Book. Although AA is not for everyone, there is growing evidence supporting the effectiveness of AA as a treatment for alcoholism.

575 pages - Alcoholics Anonymous World Services; 4 Revised edition (February 10, 2002) - English
ISBN-10: 1893007162, ISBN-13: 978-1893007161

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Knowledge and Use of Oral Rehydration Therapy for Childhood Diarrhoea in India: Effects of Exposure to Mass Media

Results from these two studies indicate that, despite a vigorous Oral Rehydration Therapy Programme in India for more than a decade, knowledge and use of ORT to treat childhood diarrhoea remain quite limited. Very small percentages of children who fall sick with diarrhoea are treated with oral rehydration salt (ORS) packets, recommended home solution (RHS), or increased fluids, despite the fact that 61 percent of these children receive treatment from a health facility or provider. In the NFHS, among children born 1-47 months before the survey who had diarrhoea in the last two weeks, 18 percent were given ORS and 19 percent were given RHS. Considered together, only 31 percent were given ORS or RHS.

Among those who receive treatment from a health facility or provider, a very large proportion (94 percent) are treated with antibiotics or other antidiarrhoeal drugs, contrary to WHO recommendations that drugs not be used to treat diarrhoea in young children. The use of drugs is common among both public- and private-sector providers but is more common in the private sector.

The analysis indicates that the electronic mass media are effective in increasing awareness and use of ORT. Women regularly exposed to the media are much more likely than unexposed women to know about ORS packets and to use ORS or RHS. This result is valid even after controlling for the effects of a number of potentially confounding variables by holding them constant. Results also indicate some discrimination against girls in the use of ORS.

These findings suggest that both mothers and health-care providers are not well informed about the proper treatment of childhood diarrhoea. There is clearly a need to strengthen education programmes for mothers and to provide supplemental training to health-care providers, emphasizing the importance of increased fluid intake and discouraging the use of unnecessary and often harmful drugs. The Oral Rehydration Therapy Programme also needs to address the problem of gender discrimination in the treatment of diarrhoea. In all these efforts, the mass media can help.

Audience:

K.V. Rao, Vinod K. Mishra, and Robert D. Hetherford

National Family Health Survey Subject Reports
Number 10 - November 1998

55 pages - pdf 160 kb

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Gender Differences in Treatment-seeking Behaviour during Common Childhood Illnesses in India: Does Maternal Education Matter?

Gender inequalities, in one form or the other, with considerable contextual differences, are ubiquitous and all-pervasive in South Asia. In health, these are manifested in differences in mortality (observed by overall sex-ratio) in almost every country in this region. India is no exception in this regard. Discrimination and gender gaps have been observed even in early years of life. Beside other factors, discriminatory treatment-seeking practices among children during the post-neonatal and later childhood period probably contribute to this.

There are numerous studies which have established the positive effect of maternal education on child health and survival. But there are contradictory evidences that whether maternal education reduces gender bias in treatment-seeking behaviour or not and the debate over it remains inconclusive.

By using National Family and Health Survey (NFHS-2), 1998-99, the present study observed that the gender bias in treatment seeking behaviour does exist among illiterate and middle school educated women when child is affected by acute respiratory infections and reduces considerably among higher educated mother.

In case of diarrhoea no evidence of gender differences in treatment seeking behaviour has been found statistically irrespective of the level of maternal education, even after controlling all other spatial, demographic and socioeconomic factors.

Audience:

Saswata Ghosh
Research Scholar, Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi India.

18th European Conference on Modern South Asian Studies
University of Lund, Sweden
6-9 July, 2004

National Family Health Survey Subject Reports
Number 10 - November 1998

17 pages - pdf 193 kb

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Maharashtra State - Health Status
in English - html version

66 pages - pdf 8.2 mb

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Maharashtra State - Health Status
in Marathi

Audience:

2002

67 pages - pdf 2 mb

Health and Healthcare in Maharashtra
A Status Report - 2005

Maharashtra has been in the forefront of healthcare development in the country. It was among the first states to decentralize primary healthcare administration through Zilla Parishads as early as1961. Further, under the Minimum Needs Program Maharashtra was again one of the first states to achieve the norms mandated for primary health centres, subcentres and Rural Hospitals. The state also has the largest private health sector in India whose reach is quite extensive.

While Maharashtra is today also the most affluent state in the country with the highest per capita income, and contributes over 15% of the country’s national income and 40% of the tax revenues, it continues to have high levels of poverty and inequalities which get reflected in health outcomes which are not the best in the country. Thus Maharashtra has to still struggle with malnutrition deaths, child mortality and maternal mortality levels not commensurate with its economic position in the country, declining child sex-ratios, low and declining levels of public health spending and investments, high levels of vacant positions of doctors at PHCs and CHCs, and low levels of access to various health services like antenatal care, complete child immunization, institutional deliveries etc.


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