An integrated community based approach in undergraduate medical teaching of maternal and child health--an experiment.SS Mathur, VR Bhalerao, R Gorey
Department of Preventive and Social Medicine, Seth G.S. Medical College, Parel, Bombay.
The batch of 147 undergraduate medical students (Group I) were trained in maternal and child health (MCH) by allotting them families study wherein either pregnant lady or a new born child was present. The students were made to follow up these mothers and their children for three years on periodic basis by paying home visits and motivating the mothers to attend under five clinic in the community. The students educated the mother regarding child rearing with the help of medical teacher. Another batch of 140 undergraduate medical students (Group II) who did not undergo such community based training but only didactic lectures in MCH were studied as control. The knowledge and attitudes of students in both the groups were tested and compared and significantly higher knowledge and favourable attitude were found in Group I. The attendance of patients of Group I in under five clinics was compared with other children who were not adopted by medical students. The comparison was made between their weight gain, immunizational status and episodes of illness. The beneficiaries in students families had better, attendance and immunizational coverage, more weight gain and less episodes of illness. The difference was found to be statistically significant.
Keywords: Child Health Services, Child, Preschool, Clinical Clerkship, Curriculum, Education, Medical, Undergraduate, methods,Female, Human, India, Infant, Infant, Newborn, Maternal Health Services, Pregnancy,
The classroom lectures or the bed-side clinics in the wards do not take into account the total factors, which have bearing on health and disease. This calls for new approaches in the training of the medical student in the area of maternal and child health in its total perspective, not only in the area of medical care but also sensitive to the political, economical and environmental factors. Hence the need for a community based teaching system,,,,,,.
We studied impact of such training programme in our undergraduate medical students and the beneficiary MCH population. The present paper discusses the methodology and results.
A batch of 147 students of batch passing 1st MBBS and entering clinical training in November were allotted 100 pregnant women or recently delivered post-natal mother and child. They followed up the same women and their children in their II MBBS during their PSM term for two months. They also followed them from their other speciality terms once a month. The child was registered by the student in under five's clinic situated in the community where specialists in Pediatrics examined the children and taught them on their allotted babies. This period covered the babies immunization age except for measles. After passing of II MBBS, the students in their third MBBS once again followed up the same mother, child, after a gap of about 8 months in the toddler stage, which is also equally crucial and vulnerable age of the children.
Therefore, this provided the student the learning situations on pregnancy, parturition, neonates and toddlers
The families allotted to students were from Naigaon Community, which has been adopted by Seth GS Medical College, primarily for the purpose of orientation of the students towards Community Medicine and is located near the college and inhabits mainly lower middle class population of 25,000.
A Control group of 140 students was taken from the batch, who were not allotted such mothers and children. The knowledge and attitudes of the study group and the control group were tested by giving them a test of similar questions on MCH The test paper consisted of practical questions on pregnancy, special care groups, immunization, nutrition, customs and beliefs, religious, ethnic groups etc. and marks were given out of hundred.
A second test was given on attitudes of the two groups and similarly marks were given.
The impact on children beneficiaries was studied by comparing the children of the study group students and 90 control children coming to the under fives clinic but not allotted to any student, the regularity of the visits, gain in weight, episodes of illnesses, immunizations, compared between the two groups.
1. Gain in Knowledge: (Shown in [Table - 1]. The gain in practical knowledge due to community based integrated MCH programme of the study group students was significantly higher to the control group of non-family students.
Of the study group students, 27.8% had favourable attitude, 53.7% were indifferent and 18.3% not favourable, while among the non-family students showed 37% favourable, 47% indifferent and 15.7% not favourable attitude. The different in attitude between the two groups is not significant.
Impact on beneficiary children:
1. Attendance of mother and children in the clinic
The difference in attendance between the student and non-student family is highly significant, shown in [Table - 3].
2. Gain in weight in under fives clinic children : 79.59% of students family babies showed consistent weight gain as compared to the consistent weight gain in 53.33% of the non- student family babies, while declining weight was seen in 6% of student family babies, whereas it was 22% in the non-student family babies, which is highly significant [Table - 4]
3. Immunizational status of the two groups showed difference, which was also highly significant, as seen in [Table - 5].
The difference between the two groups were highly significant, as shown in [Table - 6].
This showed the impact of individual or group health education to the mothers by the students. The knowledge of non-student family mothers was significantly less as seen in [Table - 7].
Maternal and child health cannot be viewed in isolation. The internal and external environment has far reaching effects on health. The student can understand only if he is exposed to the community based teachings. By following up the same mother and child the student learns to keep family records. Home visits give him the knowledge about housing, sibling, over-crowding, economic status, hygiene, environment etc. A good house visit is very informative. Social and cultural factors can influence the growth patterns, speech, weight, height, motor activities and psychological development of the child.
Secondly, the assessment of the student can be done through his performance in the field practice area. The technology of health education by the student is improved because of the diverse local situations presented to him helped by his teacher. Tremendous impact on health can be produced merely by education of mothers by the students on oral rehydration, breast feeding, weaning foods, diet, growth chart, immunizations, prevention of accidents etc. In such training the health is viewed through the eyes of community. Thus the integrated community based approach in training of the under graduates for maternal and child health gives better understanding of the subject.
Our grateful thanks to the Dean, Seth GS Medical College and King Edward Memorial Hospital, for giving all the facilities.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7]