Frontiers in Social Pediatrics HPS Sachdev, AK Patwari
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1Frontiers in Social Pediatrics2
3Frontiers in Social Pediatrics
Second Edition
Editors AK Patwari MD MNAMS FIAP FAMS Professor and Head Department of Pediatrics Hamdard Institute of Medical Sciences & Research and HAH Centenary Hospital Hamdard University New Delhi, India HPS Sachdev MD FIAP FAMS FRCPCH Senior Consultant Pediatrics and Clinical Epidemiology Sitaram Bhartia Institute of Science and Research New Delhi, India
4
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Frontiers in Social Pediatrics
First Edition: 1998
Second Edition: 2016
9789385891663
Printed at
5Dedicated to
The memory of Late Dr Panna Choudhury,
a tireless crusader for child health.
Our professional association with him and
his invaluable contribution to this venture
will be perpetual source of inspiration.6
7Contributors
  • Aashima Dabas MD
  • Assistant Professor
  • Department of Pediatrics
  • University College of Medical Sciences and
  • Guru Tegh Bahadur Hospital (GTB)
  • New Delhi, India
  • Abhishek Vijay Raut MD DNB (SPM)
  • Assistant Professor
  • Dr Sushila Nayar School of Public Health
  • (Incorporating the Department of Community Medicine)
  • Mahatma Gandhi Institute of Medical Sciences (MGIMS)
  • Wardha, Maharashtra, India
  • Ajay Kalra MD
  • Former Professor of Pediatrics
  • SN Medical College
  • Agra, Uttar Pradesh, India
  • AK Patwari MD MNAMS FIAP FAMS
  • Professor and Head
  • Department of Pediatrics
  • Hamdard Institute of Medical Sciences & Research and
  • HAH Centenary Hospital, Hamdard University
  • New Delhi, India
  • Alexis Aplasca MD
  • Assistant Professor
  • Department of Pediatrics and Psychiatry
  • Virginia Commonwealth University
  • Virginia, USA
  • Anju Seth MD
  • Professor
  • Department of Pediatrics
  • Deputy Programme Director
  • Pediatric Centre of Excellence (HIV)
  • Kalawati Saran Children's Hospital
  • Lady Hardinge Medical College
  • New Delhi, India
  • Anshu MD MNAMS MHPE
  • Professor
  • Department of Pathology
  • Mahatma Gandhi Institute of Medical Sciences
  • Wardha, Maharashtra, India
  • Anu Thukral MD DM
  • Assistant Professor
  • Department of Pediatrics
  • WHO Collaborating Centre for Training and Research in Neonatal Care
  • ICMR Centre for Advanced Research in Newborn Health
  • All India Institute of Medical Sciences
  • New Delhi, India
  • Anuradha V Khadilkar MD(Ped) DCH(Lon)
  • Growth and Endocrine Unit
  • Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI)
  • Jehangir Hospital
  • Pune, Maharashtra, India
  • Anura Kurpad MD DNB PhD
  • Professor and Head
  • Department of Physiology
  • St John's Medical College
  • Head, Division of Nutrition
  • St John's Research Institute
  • Bengaluru, Karnataka, India
  • Arun Gupta MD FIAP
  • Regional Coordinator
  • International Baby Food Action Network (IBFAN) Asia
  • Delhi, India
  • Bhavna Dhingra MD DNB
  • Assistant Professor
  • Department of Pediatrics
  • All India Institute of Medical Sciences
  • Bhopal, Madhya Pradesh, India
  • 8Chandra Mohan Kumar MD MAMS
  • Professor
  • Department of Pediatrics
  • Hamdard Institute of Medical Sciences & Research and
  • HAH Centenary Hospital, Hamdard University
  • New Delhi, India
  • Chiara Servili MD MPH
  • Medical Officer
  • Focal Point—Child and Adolescent Mental Health Evidence
  • Research and Action on Mental and Brain Disorders (MER)
  • Department of Mental Health and Substance Abuse World Health Organization
  • Geneva, Switzerland
  • Harish Chellani MD
  • Professor and Consultant
  • Department of Pediatrics
  • Vardhman Mahavir Medical College and
  • Safdarjung Hospital
  • New Delhi, India
  • JP Kapoor MD
  • Director
  • Directorate of Family Welfare
  • Department of Health & Family Welfare
  • Government of Delhi
  • Jagdish Chandra MD
  • Director Professor and Head
  • Department of Pediatrics
  • Programme Director
  • Pediatric Centre of Excellence (HIV)
  • Kalawati Saran Children's Hospital
  • Lady Hardinge Medical College
  • New Delhi, India
  • Jennifer Beard PhD MPH MA
  • Department of Global Health & Centre for
  • Global Health and Development
  • Boston University School of Public Health
  • Massachusetts Avenue
  • Boston, USA
  • Jyoti Joshi MD
  • Deputy Director and Lead - AEFI surveillance and vaccine safety
  • Immunization Technical Support Unit
  • Ministry of Health and Family Welfare
  • Public Health Foundation of India
  • New Delhi, India
  • Kamal Kumar Singhal MD
  • Assistant Professor
  • Department of Pediatrics
  • Kalawati Saran Children's Hospital
  • Lady Hardinge Medical College
  • New Delhi, India
  • Karanveer Singh MD
  • Nutrition Specialist
  • The United Nations Children's Fund (UNICEF)
  • New Delhi, India
  • Late Panna Choudhury MD FIAP
  • Formerly Consultant
  • Department of Pediatrics
  • Lok Nayak Jai Prakash Narayan Hospital
  • New Delhi, India
  • Mahesh Baldwa MD LLM PhD (Law) MBA
  • Pediatrician and Sociomedicolegal Thinker
  • Former Assistant Professor
  • Department of Pediatrics
  • TN Medical College & Nair Hospital
  • Mumbai, Maharashtra, India
  • Malcolm Bryant MBBS MPH
  • Department of Global Health and
  • Centre for Global Health and Development
  • Boston University School of Public Health
  • Massachusetts Avenue
  • Boston, USA
  • Meenu Singh MD FCCP FIAP
  • Professor
  • Department of Pediatrics
  • Advanced Pediatrics Centre
  • Postgraduate Institute of Medical Education and Research
  • Chandigarh, India
  • Mercedes de Onis MD PhD
  • Coordinator
  • Growth Assessment and Surveillance Unit
  • Department of Nutrition for Health and Development
  • World Health Organization
  • Geneva, Switzerland
  • Namita Padvi MD DNB
  • Assistant Professor
  • Department of Pediatrics
  • TN Medical College & Nair Hospital
  • Mumbai, Maharashtra, India
  • 9Narendra K Arora MD FIAP FAMS
  • Executive Director
  • The INCLEN Trust International
  • New Delhi
  • Naveen Sankhyan MD DM
  • Associate Professor
  • Department of Pediatrics
  • Advanced Pediatric Center
  • Postgraduate Institute of Medical Education & Research
  • Chandigarh, India
  • Neha Sareen MSc
  • Research Scientist
  • Department of Human Nutrition
  • All India Institute of Medical Sciences
  • New Delhi, India
  • Nishant Jaiswal MBBS
  • Scientist C
  • ICMR Advanced Centre for Evidence-based Child Health
  • Department of Pediatrics
  • Advanced Pediatrics Centre
  • Postgraduate Institute of Medical Education and Research
  • Chandigarh, India
  • P Ramesh Menon MD
  • Assistant Professor of Pediatrics (CTVS)
  • All India Institute of Medical Sciences
  • New Delhi, India
  • Piyush Gupta MD FIAP FNNF FAMS
  • Professor
  • Department of Pediatrics
  • University College of Medical Sciences
  • Delhi, India
  • Praveen Kumar MD
  • Professor
  • Department of Pediatrics
  • Lady Hardinge Medical College and
  • Kalawati Saran Children's Hospital
  • New Delhi, India
  • Preeti Singh MD
  • Assistant Professor
  • Department of Pediatrics
  • Kalawati Saran Children's Hospital
  • Lady Hardinge Medical College
  • New Delhi, India
  • Pritam Roy MD
  • Senior Resident
  • Department of Community Medicine
  • Postgraduate Institute of Medical Education and Research
  • Chandigarh, India
  • RN Srivastava FRCP (Ed) FIAP FAMS
  • Advisor
  • Indian CANCL (Child Abuse and Child Labour) Group
  • Former Professor
  • Department of Pediatrics
  • All India Institute of Medical Sciences
  • New Delhi, India
  • Rajeev Seth MD FIAP FAAP (USA)
  • Director and Head
  • Department of Pediatrics
  • Rockland Hospital
  • Chairman
  • Indian Child Abuse Neglect & Labour (ICANCL) Group
  • New Delhi, India
  • Rajesh Kumar MD
  • Professor
  • Department of Community Medicine
  • Postgraduate Institute of Medical Education and Research
  • Chandigarh, India
  • Rajesh Mehta MD FIAP
  • Medical Officer
  • Child and Adolescent Health
  • South-East Asia Regional Officer of WHO
  • New Delhi, India
  • Rakesh Lodha MD
  • Additional Professor
  • Department of Pediatrics
  • All India Institute of Medical Sciences
  • New Delhi, India
  • 10S Aneja MD FIAP
  • Director Professor
  • Department of Pediatrics
  • Chief, Division of Pediatric Neurology,
  • Kalawati Saran Children's Hospital and
  • Lady Hardinge Medical College
  • New Delhi, India
  • Sainath Banerjee PhD
  • Chief of Party
  • Population Foundation of India
  • (Health of the Urban Poor Program)
  • New Delhi, India
  • Sakshi Sachdeva MD
  • Senior Resident
  • Department of Pediatrics
  • University College of Medical Sciences
  • Delhi, India
  • Sangeeta Yadav MD
  • Director, Professor and Head
  • Department of Pediatrics
  • Maulana Azad Medical College and
  • Lok Nayak Jai Prakash Narayan Hospital
  • New Delhi, India
  • Sanjiv Kumar MD DNB MBA FAMS
  • Executive Director
  • National Health Systems Resource Centre
  • National Health Mission
  • Ministry of Health & Family Welfare
  • New Delhi, India
  • Email: drsanjivkumardixit@gmail.com
  • Satish Pandya MD FIAP PGDAP PGDGC
  • Consultant Pediatrician and Counselor
  • Varun Children Hospital and Kalpanam Counseling Centre
  • Vadodara, Gujarat, India
  • Shoba Suri PhD
  • Policy and Programme Coordinator
  • International Baby Food Action Network (IBFAN) Asia
  • Delhi, India
  • Subodh Sharan Gupta MD DNB (MCH) DNB (SPM)
  • Professor (Social Pediatrics)
  • Dr Sushila Nayar School of Public Health
  • (Incorporating the Department of Community Medicine)
  • Mahatma Gandhi Institute of Medical Sciences (MGIMS)
  • Wardha, Maharashtra, India
  • Sugandha Arya MD
  • Assistant Professor
  • Department of Pediatrics
  • Vardhman Mahavir Medical College and
  • Safdarjung Hospital
  • New Delhi, India
  • Sumathi Swaminathan PhD
  • Associate Professor
  • Division of Nutrition
  • St John's Research Institute
  • Bengaluru, Karnataka, India
  • Email: sumathi@sjri.res.in
  • Suresh Kumar Dalpath MBBS MHSc (Public Health) FNNF
  • Deputy Director
  • Child Health State Immunization Officer
  • National Rural Health Mission (NRHM)
  • Haryana, India
  • Sushila Baldwa MD
  • Consultant
  • Baldwa Hospital
  • Mumbai, Maharashtra, India
  • Suvasini Sharma MD DM
  • Assistant Professor
  • Department of Pediatrics
  • Lady Hardinge Medical College
  • New Delhi, India
  • T Jacob John FRCPE PhD DSc FAMS FNA
  • Retired Professor and Head
  • Departments of Clinical Virology and Clinical Microbiology
  • Christian Medical College
  • Vellore, Tamil Nadu, India
  • Tanu Anand MD
  • Assistant Professor
  • Department of Community Medicine
  • North Delhi Municipal Corporation Medical College and
  • Hindu Rao Hospital
  • New Delhi, India
  • Tarun Dua MD MPH
  • Medical Officer
  • Programme for Neurological Diseases and
  • Neuroscience Evidence
  • Research and Action on Mental and Brain Disorders (MER)
  • Department of Mental Health and Substance Abuse
  • World Health Organization
  • Geneva, Switzerland
  • 11Tarundeep Singh MD
  • Assistant Professor
  • Department of Community Medicine
  • Postgraduate Institute of Medical Education and Research
  • Chandigarh, India
  • Tejinder Singh MD FIAP MHPE
  • Professor, Vice Principal
  • Department of Pediatrics
  • Christian Medical College
  • Ludhiana, Punjab, India
  • Uma Agrawal
  • Secretary
  • Indian Child Abuse Neglect & Labour (ICANCL) Group
  • Retired Head
  • Department of Pediatrics
  • Kasturba Hospital
  • New Delhi, India
  • Umesh Kapil MD FAMS
  • Professor
  • Public Health Nutrition
  • Department of Human Nutrition
  • All India Institute of Medical Sciences
  • New Delhi, India
  • V Jithesh MBBS MPH
  • Assistant Director
  • Department of Health Services
  • District Medical Office (Health)
  • Mananthavady, Wayanad, Kerala, India
  • Vaman V Khadilkar MRCP(UK)
  • Growth and Endocrine Unit
  • Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI)
  • Jehangir Hospital
  • Pune, Maharashtra, India
  • Varinder Singh MD FRCPCH
  • Professor
  • Department of Pediatrics
  • Kalawati Saran Children's Hospital
  • Lady Hardinge Medical College
  • New Delhi 110001
  • Varsha Gupta MD
  • Government Medical College
  • Kota, Rajasthan, India
  • Vijay Kumar MD
  • Executive Director
  • SWACH Foundation, Panchkula
  • Former Director
  • Communicable Diseases
  • WHO-South East Asia Regional Office
  • New Delhi, India
  • Vinod Kumar Paul MD PhD FIAP FAMS
  • Professor and Head
  • Department of Pediatrics
  • WHO Collaborating Centre for Training and
  • Research in Neonatal Care
  • ICMR Centre for Advanced Research in Newborn Health
  • All India Institute of Medical Sciences
  • New Delhi, India
  • Vipin M Vashishtha MD
  • Consultant Pediatrician
  • Mangla Hospital & Research Center
  • Bijnor, Uttar Pradesh, India
12
13Preface to the Second Edition
In the new millennium medical literature in India and the neighboring countries has grown exponentially with numerous topical books authored by leading experts from the subcontinent. These valuable productions, relevant to the health needs in low and middle income countries, are now slowly but steadily replacing or complementing the ‘gold standard’ western textbooks. This has provided a unique opportunity to our undergraduate and postgraduate students to tap the locally generated and relevant experience to guide their practice and education. Understandably, the students are mesmerized and more attracted to clinical topics, which form the bread and butter of their everyday practice. However, social and environmental factors also play a vital role in health and disease. Therefore, apart from keeping abreast with the clinical and research developments, the students need to meaningfully connect with our people, get sensitized to the ground realities and peculiarities of our society and be prepared to confront these issues for holistic promotion of health, and prevention and treatment of diseases.
There is a considerable gap between the existing scientific developments in the field of medicine and what can be or is translated to the underprivileged sections of our society. National Health Programs are the primary links between the tremendous progress made in low cost, feasible and effective technology and the community. Several cost-effective interventions of immense public health importance are being implemented through these health programs. Our students should not merely confine themselves to the teaching hospital settings but also familiarize themselves with the health services available to the vast majority of our population.
The first edition of Frontiers in Social Pediatrics was conceived and produced in 1998 in response to the urgent felt need for such a monograph, particularly for the postgraduate students in pediatrics and community medicine. This book was very well received and became an essential companion for most of these students. However, substantial advances have occurred in this field since then including the launch of new national programs and modifications of existing interventions. This second edition is intended to diligently update the subject information and complement the contents with topics of practical value while dealing with patients. Almost all the earlier chapters have been extensively revised and new topical subjects introduced. The contents have been organized into following sections: Evolution of Social Pediatrics in India; Neonatal, Child and Adolescent Health; Nutrition; Everyday Practice; Legal Rights and Vulnerable Children; Clinical Epidemiology and Research; and National Health Programs. Apart from the postgraduate students in Pediatrics and Community Medicine, the contents will also interest policy makers and allied professionals involved in child care.
This book has emanated from the dedicated efforts of a group of distinguished contributors who promptly responded to our call, despite constraints of their busy schedules. The meticulousness of the publisher in ensuring the high quality and expeditious production deserves appreciation.
We sincerely hope that this second edition too fulfils the objectives with which it was conceived and retains the niche that was carved out by the first edition.
AK Patwari
HPS Sachdev14
15Preface to the First Edition
Medical literature in India and the neighboring countries has made a spectacular progress during the last decade with the availability of numerous topical books contributed by authors from the subcontinent. This has provided an opportunity to our undergraduate and postgraduate students to learn from the tremendous clinical experience generated from this part of the world over the years. However, it is generally felt that the training of medical students is mostly didactic, and disease oriented. Social and environmental factors too play a vital role, both in health and disease. Therefore, apart from keeping up with the latest scientific developments, the students need to know our people, get sensitized to the ground realities and peculiarities of our society and be prepared to tackle these issues to treat disease and promote health. Students find it difficult to have an access to such teaching material which is available in abundance in Social Sciences.
There is a considerable gap between the existing scientific developments in the field of medicine and what is readily available to the underserved sections of the society. National Health Programs are the primary links between the tremendous progress made in low cost, feasible and effective technology and the community. Several cost effective interventions of immense public health importance are being implemented through these health programs. Students of medicine should not restrict themselves to the four walls of large hospital setting only. They also need to know about the health services available to more than 80% of our population.
Frontiers in Social Pediatrics is conceived in response to the urgent felt need for such a teaching material, particularly for the postgraduate students in pediatrics and community medicine. Certain chapters will also interest policy makers and allied professionals involved in child care.
This monograph has emanated from the dedicated efforts of a group of distinguished contributors who promptly responded to our call, despite constraints of their busy schedules. The diligence of the publisher in ensuring the high quality and expeditious production deserves appreciation.
We sincerely hope that the volume fulfils the objectives with which it was conceived.
AK Patwari
HPS Sachdev161718192021222324