Adventures afar Andrea Kieffer

Who I am MS4 Internal medicine residency Interest in lifelong commitment to global health and health policy We shall see where this goes….

Where I went Core rotation: Free travel Vellore, tamil nadu India Chennai, Jaipur, agra, aleppi

Why I went Population of India: 1.324 billion! 17.4% of the world Gain a better understanding of global health needs Compare healthcare priorities between developing and developed nations

Topic of Interest: Assessing epidemiological changes of family-planning decisions Dinner with dr. Ruby and dr . Mani, discussion over changing Indian population For the first time in the country's recorded history, more than half the families do not have more than two children, according to Census 2011 data released in march 2018 2018: 54% of married women reported having two or less children. Avg 2.69 children/ married woman 2001: 46.6% avg 3.03 children/married woman Varma S. Now, majority of families have 2 or less kids - Times of India. The Times of India. 2018. Available at: https://timesofindia.indiatimes.com/india/Now-majority-of-families-have-2-or-less-kids/articleshow/51217075.cms. Accessed March 30, 2018

So… how are we doing? Child Mortality. Our World in Data. 2018. Available at: https://ourworldindata.org/child-mortality. Accessed March 30, 2018.

Storeygard, Balk, Levy and Deane (2008) assembled a data-set that looks at the sub-national distribution of infant mortality.17 The data set covers over 10,000 national and subnational units worldwide

Assessing epidemiology of family-planning decisions 2010 Study in journal of tropical pediatric medicine: Burden of Illness in the First 3 Years of Life in an Indian Slum (march 2002 to sept 2006) 20–25% of urban households in India live in slums. 40–50% of them are below the poverty line morbidity and mortality in a cohort of 452 children followed up from 0 to 3 years of age Mortality: 5/452 =1.1% Avg morbidity rate was 11.26 episodes/child-year (1162 child/years) Respiratory infections caused 58.3 and diarrheal disease 18.4% of the illnesses. 

Interventions at different levels State: Dr. Muthulakshmi Reddy Memorialhttp://kpmbphc.blogspot.com/2012/01/new-dr- muthulakshmi-reddy-maternity.html This is a program that offers help for mothers and babies up to two pregnancies. mother gets Re. 4000.00 if she registers with the Village Health program before 20 weeks completes antenatal visits Additional 4000.00 if she gives birth in a hospital additional 4000.00 when the baby has received the 3 doses of DPT, Hepatitis - B and Polio vaccine for the child as per the time schedule

Dr. Muthulakshmi Reddy program

Interventions cont national: Janani Suraksha Yojana program https://en.wikipedia.org/wiki/Janani_Suraksha_Yojana launched on 12 April 2005 by the Prime Minister of India A100% centrally sponsored scheme integrates cash assistance with delivery and post-delivery care

Conclusions More data collection should be done to assess what percent of women benefit from these programs Monetary incentive works Family sizes in India are decreasing Women in 2011 have 2.69 children on average In 2001 they had 3.03 From changing cultural trends coupled with healthier children

references Child Protection Scheme | Ministry of Women & Child Development | GoI. Wcdnicin. 2018. Available at: http://wcd.nic.in/schemes/child- protection-scheme. Accessed March 30, 2018. SOCIAL WELFARE DEPT | Chief Minister’s Girl Child Protection Scheme. Tnsocialwelfareorg. 2018. Available at: http://www.tnsocialwelfare.org/pages/view/chief-minister-s-girl-child- protection-scheme. Accessed March 30, 2018. SOCIAL WELFARE DEPT | Cradle Baby Scheme. Tnsocialwelfareorg. 2018. Available at: http://www.tnsocialwelfare.org/pages/view/cradle-baby- scheme. Accessed March 30, 2018. Gladstone B, Das A, Rehman A et al. Burden of Illness in the First 3 Years of Life in an Indian Slum. J Trop Pediatr. 2009;56(4):221-226. doi:10.1093/tropej/fmp116. Varma S. Now, majority of families have 2 or less kids - Times of India. The Times of India. 2018. Available at: https://timesofindia.indiatimes.com/india/Now-majority-of-families-have-2- or-less-kids/articleshow/51217075.cms. Accessed March 30, 2018.

Clinical Experience Nursing home visits while at CHAD Visited 20 families in 4 towns newborn baby well-childs, respiratory illnesses, seizures, psychiatric complaints

Rural life

Rural life cont

Cultural Experience Wedding crashers!!!

Strangers or guests?

Pics!

College hill

Taj mahal

Holi!

Hospital hill

Pondicherry beach