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The Mothers’ Meeting is being organized by the Mobile Medical Team also known asTribal Health, comprises of 2 ANMs and 1 Medical Doctor. 24 viillages are covered in a yearin four Districts - they are Bishnupur District, Thoubal District, Imphal East and Imphal West.Awarness programs are conducted called Mothers’ Meeting once a month in each village. TheMeeting is only for young mothers’ below 40 yrs in which certain topics are discussed &intereaction with the participants are done. The popular topics are Breast Feeding , Antenatalcheck-up, ORS and contraceptives etc. These type of programs have helped in creatingawarness among the villlage women. The main objectives of this Mothers’ Meeting are:

1. To Reduce Maternal Mortality Ratio.2. To Reduce Infant Mortality Rate.3. To make the women know the importance of using Family Planning Methods.The Mothers’ Meeting starts with a prayer and a round of introductions from the participants

and the State Team. Discussions are started on the topics like breast feeding, Antenatalcheck-up, contraceptives and ORS. Disscusions on the importance of breast feeding etc isalso done. Regarding the use of contraceptions of both temporary and permanent methods,the participants of around 30 women are given full knowledge with main emphasis given onoral contraception pills (Mala-N)and Condoms. As dairrhoea is very common among the infantsand children, the importance of ORS and how to prepare both home available fluids and ORSpackages are taught to them. One of the most important topic that we usually talk about isimportance of ANC check up. We try to motivate all pregnant women to go for ANC and theprecautions that should be taken like T. T injection, 100 days Iron folic Acid tab, good nutritionand registration of pregnancy to the nearest health centre for safe delivery.

Finally, as a kind of feedback, the participants are requested to ask many personalhealth problems faced by them like how to control unwanted pregnancy, STD, etc. Advices aregiven on the necessary steps to be taken and if there is a serious problem, we advise them togo to a nearby Health Center.

By:Sovarani and Mala(ANMs, Tribal Health)

MOTHERS’ MEETING

Small family is a happy family

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( Reaching the interiors )

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4 Ante – Natal Check – up is a must

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TOBACCO USERS AMONGST TEENAGERSIN MANIPUR:

A Survey study in two urban schools.Dr. Sucheta Sinam, Deputy Director, NRHM

Background

Tobacco is responsible for an estimated3 million annual deaths in 1990s and it isexpected to rise to 10 million deaths in 2020s.70% of these deaths are expected to occurin developing countries1. It has been foundthat 30 to 40 % of the 2.3 billion childrenand teenagers in the world would becomesmokers in early adult life. The most susceptibleperiod for initiation of tobacco use in India isduring adolescence and early adulthood i.e.,in the age group15-24 years2. In developingcountry like India, health consequences oftobacco uses has posed a major public healthproblem with huge loss of lives prematurelyand placing a great financial burden on thegovernment. To this end adolescent youths viz,college/higher secondary school students inthe prime of their lives and vulnerable totobacco addiction are selected for targetedpopulation study.

In Manipur, no study has been done forsocial, economical and behavioral variablesleading to tobacco addiction.Hence thebehavioral pattern of tobacco uses and theirknowledge, attitude and practice towardstobacco uses amongst the beginners inadolescent youths in two randomly selectedurban schools was studied with the help of wellstructured questionnaire.

Methology

The present study is cross sectional surveyof 100 students from two schools. These schoolswere selected randomly from the ImphalEducational Institutions and all students within theage group of 16-20 years were selected. Thetool used for the survey is pre-tested semi-structural questionnaire consisted of questionsthat elicited responses for the knowledge,attitude and practice towards tobacco uses.

Photo: Briefing the questionnaire to the students

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Showing occupation-wise distribution of parents

Plan your family – for a better tomorrow

4Practice towards tobacco use

Parameters No. of PercentageRespondents

Uses of tobacco Yes 35 35No 43 43No response 22 22

Duration below 1 month 5 51 - 6 months 9 96 months - 1 year 7 71 year & above 5 5No response 74 74

Type of tobacco uses Pan(#zarda) 14 14Cigarette 13 13Khaini 1 1Cigarette+Pan(#zarda) 6 6Cigarette+Khaini 1 1No response 65 65

Reason for initiation Mouth freshness 3 3For curiosity 14 14Insisting by friend 1 1For depression 1 1Time passing 1 1No specific 2 2No response 78 78

Addiction Yes 4 4No response 96 96

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Majority of the parents/guardians werefarmers. The point prevalence of tobaccousers amongst teenage school students ofManipur is high. And most of the participantswere aware of the harmful effects of thetobacco but that doesn't deter them fromusing tobacco. So knowledge is there butpractice is wanting. The main reason for usingtobacco was curiosity. Both smokeless andsmoking types are used but girls use smokelesstypes only. Average duration of uses is 4.5months indicating level of addiction is low andbehavioral therapy alone can make them quitthe habit.

Discussion

The short study of 100 students agedbetween 16 to 20 years in the urban areaof Imphal focusing on their behavioral patternof tobacco uses has shown many interestingnew findings and deep insights in their socialbehavior. Though the study was done in anurban area, the students are from both urbanand rural areas as indicated indirectly by theoccupation of parents, 23% being farmers.Majority of the parents are farmers isexplained by the fact that majority of studentsmigrate from rural areas for better studyfacilities in urban area. Hence, it can beinterpreted that the student participantscovered both rural and urban areas ofManipur. In addition, majority of the studyparticipants (80%) did not respond to theinformation about their parent's income. Thismay be because of the social custom ofManipur where children are not disclosedabout family financial matters.

The findings are analyzed for the socialand behavioral variables that led to the highincidence of tobacco consumption in youngage school life. There were 35 candiddisclosures of tobacco users in one form oranother. That means there is 35% tobaccousers in the age range studied. This highpercentage in the young age group is keeping

in line with the pattern seen in other north eaststates2. States of Mizoram, NagalandMeghalaya and Arunachal Pradesh are havinghigher tobacco consumption rate in the agecategory studied (>50 to 61%).

However, overall the duration of uses ison an average less than 6 (average 4.5 months)months. Hence, it is a crucial stage whereintervention with counseling or behavioraltherapy can stop the tobacco users frombecoming addicted later in life. Anotherinteresting finding that has come into light isthat > 90% of the users want to quit the habitand willing to take medical help if need be.

Conclusions

That point prevalence of tobacco usersamongst teenage school students of Manipuris high.

Both smokeless and smoking types are usedbut girls use smokeless types only.

Second hand/passive smokers prevalenceis also high specially in the families.

Cause of using tobacco is mainly out ofcuriosity (experimental).

Awareness level of harmful effects oftobacco is high but that doesn't deter themfrom using tobacco. So knowledge is therebut practice is wanting.

Average duration of uses is 4.5 monthsindicating level of addiction is low andbehavioral therapy alone can make themquit the habit.

Parental involvement and family behavioraltherapy are required since many of themare also tobacco users.

Large size sample population study iswarranted in this age group byincorporating other variates like race,ethnicity, religion cultures, sex and influenceof media etc for definite conclusions.

References:

1. Report on Tobacco Control in India,

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Ministry of Health and Family Welfare,Govt.of India.

2. Report on Tobacco Control in India-K.Srinath Reddy and Prakash C.Gupta.

3. Correlates of tobacco use amongstadolescents in 2 schools-A Kotwal RThakur, T Sethi (IMJ of Science-2005)

4. Tobacco use amongst children inKarnataka, G. Gururaj, N. Girish. IJP2007; 74 : 41-44

5. W.warren. tobacco use among youth: across country comparison, the Globalyouth survey collaborative group, Tob.Control special report 2002;11:252-270

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Wahengbam Imo SinghState Community Mobilizer, RRC for NE States

A Story With A Difference(Accredited Social Health Activist)

This story is of an ASHA who hasperformed above and beyond the calls ofduty. She has not only mobilzed andaccompanied pregnant women for deliveries,but also regularly donated blood wheneverneed arose thus saving the lives of severalmothers.

This is an example setting and inspiringstory about an ASHA named Mrs Tababi Devi,who belongs to Meitram Awang Leikai ofImphal West District,Manipur.

To give a brief introduction, Mrs. W.Tababi Devi is an ASHA who has been workingfor NRHM, Manipur since the year 2006. Sheis someone who in her course of work hasdeveloped a good rapport with the peoplein the community by her compassionate anddedicate nature of working by trying to helpand reach out to as many people as possible.She is someone who takes pride and joy inher work and feels that she has contributedsomething meaningful for her community andconsiders herself very fortunate in life forbeing able to help others. To quote her in herown words " I feel being blessed by peoplefor helping them is the gift of god.I wouldlove to help more beneficiaries if needed toin future".

ASHAs are required to accompanypregnant women for Antenatal Check-up,institutional delivery etc. However over andbeyond the call of duty while listening to thehelpless cries of the pregnant women she hadaccompanied for deliveries, she felt sheneeded to take a call and do something forthese women.That was when she volunteeredand offered to donate her blood. She feelsthat donating blood during those times hadbeen very important events in her life as awoman and as an ASHA. As she was too poorfinancially to help these pregnant ladies, she

was glad that at least by donating much neededblood she could helpthem in their times ofneed. She recollectedand shared herexperiences of thetime she donatedblood for a pregnntmother inOctober,2009 andnother was inFebruary,2011. On both occasions the familieswere desperate for help as the bleeding wasnot stopping in both the delivering mothers.Fortunately, the blood group of Mrs TababiDevi matched the blood group of the deliveringmothers and she could donate the muchneeded blood during that crucial times. Thesekind and humane gestures have marked herout wherever she has gone and made herknown and loved among the staff of theinstitution. Her sincerity and dedication are alsoclearly reflected in her work. Recently, shewas awarded the Best ASHA of Imphal WestDistrict.

On being quiried about the various trainingsbeing given by NRHM and other facilities forASHAs under NRHM, she expressed that thevarious training have helped her tremendouslyin fulfilling her roles and responsibilities as anASHA. However,she highlighted ,there areissues (including JSY) that need to be addressedby competent authorities for the over-all wellbeing of the people in her locality.

Lastly, she emphasized that despite allodds there had been no stopping for her inher attempts to perform her duties and herefforts to help the people of her locality. Sheis truly someone from which not only otherASHAs but we all as human beings have a lotto learn from and try to emulate.

Fully immunize your baby before first B’day

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MONITORING CUM SUPPORT VISIT REPORTBY STATE TEAM AT DISTRICT/BLOCK LEVEL

Dr. K. Rajo SinghJt. Director, Family Welfare

State Nodal Officer – ASHA, GoM

Wahengbam Imo SinghState Community Mobilizer,

RRC for NE States

Background:

The 1st round District / Block ASHA trainingon Modules 6th & 7th started from the monthof February 2011 and has been completed inall the districts. The State formed a Monitoringcum Support unit which included the State ASHAtrainers. According to the schedules submittedby Districts to the State, the State MonitoringTeam visited 2/3 training sites in each districtto give inputs and technical support foreffective training program.

Main Key points of ASHA 6th & 7th

Modules training:

1. ASHA Modules 6th and 7th cover topicssuch as Newborn and Maternal Health, Childhealth and nutrition and infectious diseases suchas Malaria, TB etc.

2. These Modules are knowledge as wellas skill based.

3. Many Common illnesses of new bornand child health could be managed at home ifidentified early.

4. ASHA will also be trained on birthpreparedness that would contribute towardssafe delivery.

5. The modules focus on earlyidentification of problems related to Maternal,Newborn and Child Health and takingappropriate action.

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6. Moreover, these will also contributetowards improving Maternal, Newborn andChild Health especially in difficult / inaccessibleareas.

The State Team members:1. Dr. K. Rajo Singh, Jt. Director FW/SNO – ASHA2. Mr. Nongyai, Regional Coordinator, RRC, Guwahati3. W. Imo Singh,State Community Mobilizer, RRC, Manipur4. Dr. K. Latashori, State Facilitator, RRC, Manipur5. Miss Sandhya, Deputy Director (Finance) NRHM6. Mrs. Moirangthem Memcha, State ASHA trainer7. Mrs. T. Helena, State ASHA trainer

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AYUSH – an alternative method for you

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Some grey areas in the districts whichrequire attentions are:

1. Funds are required to be disbursedfrom District to Block level for conducting theASHA training. However, in Bishnupur district,this guideline was not followed.

2. In Senapati district, untrained trainerswere utilized as district trainers.

3. In some training sites, the District Trainerswere found to be unpunctual.

4. More than the targeted sizes ofparticipants present in some training sites ofImphal - East and Thoubal District.

5. Most of the DPMU officials arerequired to be present in the training sites

when the State team visited the districts. but,this was not so when then State Team visited.

6. Participants (ASHAs) were found to beless at Noney Primary Health Center, Traininghall, Tamenglong.

7. The training schedules are supposed tobe distributed to the trainees (ASHAs).However, this was not done so in 90% o fthetraining sites.

Some good points that need appeciation:

1. Demostration materials usedeffectively in CCP and UKL districts.

2. All the topics circulated from the Stateto the districts are covered during the training.

3.Participatory methods of training usedin the sessions by the participants.

4. Group work, Recap sessions andindividual presentations were conducted inalmost all the training sites.

5. in Chakpikarong training site, the BlockProgram Management Unit did a good job inconducting the training smoothly in two batchessimultaneously with good number ofparticipants.

Interaction with the ASHAs during thetraining:

1. In Nambol Training site, participants(ASHAs) expressed that the additional ASHAsdid not get their ID card.

2. ASHAs expressed that they are notrecognized by the State and Regional Hospitalmedical staffs when they accompany pregnantwomen for institutional deliveries.

3. At Khongjom PHC training site, theASHAs expressed that they are yet toreceive Rs.600 as JSY incentive for escorting

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Leprosy is curable

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/ accompanying pregnant mother and insteadthey are being given Rs.200/-.

4. No regular drug kit refilling has beendone.Recommendations from the State team:

1. The number of participants should notbe more than 30.

2. ASHA modules training fund should becompulsorily disbursed from District to Block.

3. Lunch and drinking water should beprovided to all the participants during thetraining period. It was found that in sometraining sites, no lunch was provided especiallyin Nambol Training sites.

4. Districts should submit training reportto the State once the 1st round ASHA Module6th & 7th is completed within a month.

5. All the districts should submit theirtraining schedules at least a week ahead tothe state so as to enable the State Team tovisit the training sites.

6. All DPMUs officials shouldcoordinate effectively with District MissionDirector and DFWOs for better andeffective ASHAs training program.

7. Only trainers who have been trainedat State level should be the district/blocktrainers.

8. Topics which are suggested by thestate only should be taught at the districts.

9. Training schedule should bedistributed to all the trainees, so that thetrainees may mentally prepare for the nextday’s topics.

10. Observer cum documenter duringthe training period should be arranged bythe DPMUs/BPMUs.

Finally, the State Monitoring cum SupportTeam would like to thank all the districtsand block officials for their hospitality andextending their valuable cooperation duringour visit to the respective districts /blocks.