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3 models of Under Fives Clinics were tried successively at the Malavani Health Center beginning in 1978. Malavani is a village with a population of abourt 70,000 near the city of Bombay (India). In each model mothers were given a Road to Health Card for each child. Model I was a center-based model. The venue was the same center where outpatient departments were located for the convenience of the mothers. The staff comprised 1 pediatrician from the staff of the K.E.M. Hospital and rotating interns posted for 1 month at a time. Enrollment and follow-up of the children were done in the outpatient department. Model II, a subcenter-based model established in 1980, 5 satellite subcenters located in the community were established. The permanent staff consisted of a medical officer, a medico-social worker, and a records assistan. A detailed record of each child was maintained at the subcenter. The medico-social worker held group discussions with the attending mothers and an attempt was made to understand their views and beliefs about child care before trying to educate them. Model III, a community-based model, was established in April 1983. The staff was partly permanent (a medico-social worker, a student nurse, and local community health volunteer) and partly temporary (rotating interns). The staff visited different areas of Malavani village by rotation. An attempt was made to visit each area at least once in 2 months. Detailed recors were maintained as in Model II. In all models, the children were weighed at each visit. They were given oral polio and triple vaccines. Mothers were advised on foods to feed the children to improve nutrition and were given simple recipes and cooking demonstrations. An attempt was made to evaluate the regularity of attendance, weight gain in children, and immuniation coverage. With Model I 450 babies were registered in 6 months but only 48 of them were brought for further follow-up; only 21 of them completed primary immunization. 2034 babies were registered under Model II over a 2-year period. Of these, 1280 attended the clinic regularly for follow-up and completed the course of primary immunization. A striking feature was the weight gain in 1011 children. The number of family planning users increased significantly from 237 at the time of clinic registration to 384 after a few months. 856 babies were registered in 6 months under Model III and 764 attended regularly for follow-up. 613 of the 764 children gained weight and all 764 completed the primary course of immunization. The deficiencies of the center-based model, Model I, are evident. Models II and III proved effective in improving the care of children under 5.

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100% oral polio vaccine coverage was sought through household visits by health center personnel in a slum area in northwestern Bombay. Children up to and including 3 years of age comprised the target population. In the 2 1/2-year period following initiation of the vaccination campaign in September 1980, 83% of children in the target population were covered and no cases of paralytic poliomyelitis were reported from the area. This coverage rate of 83% stands in contrast with the 64% rate obtained in Bombay's Ward B, a residential area for middle and upper-income people, and the 70% rate in Ward E, another slum district where household visits were not conducted. This experience demonstrates that it is possible to abolish paralytic poliomyelitis through adequate vaccination coverage even in slum areas located in the middle of highly endemic areas. Experience further demonstrated that it is not necessary to withhold oral polio vaccine from children with minor illnesses such as diarrhea or immediately before or after breastfeeding. These 2 contraindications have in the past increased the difficulty of obtaining adequate vaccine coverage rates among young children.

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The role of involving prospective fathers in the care of pregnant women attending the Mother Craft Clinic of the Malavani Health Center in Bombay, India was evaluated. Beginning in October 1982, pregnant women attending the Clinic were requested to ask their husands to meet the resident medical officer of the center who was available on the premises of the Center on all days and evenings including the holidays. 1 of the medico-social workers explained to the women the reason and the need for their husbands coming and meeting the doctor at the Center. The outcome of the maternal health care program for the 270 women whose husbands were invited and came (Group 1) was compared with the outcome of the same program, under the same roof, for 405 women whose husbands could not be invited (Group 2). The husbands who attended the center were educated individually and in groups about their role in nutrition and health of their wives during pregnancy and their responsibility in subsequent child rearing. The physiology of pregnancy, complications of pregnancy, and the possible ways and means of preventing the complications were explained in detail. The husbands were also told to encourage their wives to attend the antenatal clinic of the center as often as possible. There was no difference in the socioeconomic, educational, cultural, and religious background of the 2 groups of women who were similar in parity distribution. The main difference between the 2 groups was a significantly lower perinatal mortality in Group 1. Only 60 of the 405 Group 2 women were considered eligible for postpartum sterilization (para 3 and higher). In contrast, 41 of the 270 Group 1 women were considered eligible for postpartum sterilization and 110 women accepted. The excess of those who accepted over those who were eligible came form the lower paras. This effort confirms that the involvement of prospective fathers is possible and pays good dividends even in an uneducated and low socioeconomic connumity such as that in Malavani.

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