1. Adventures afar
Andrea Kieffer

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

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

4. 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

5. 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 Available at: Accessed March 30, 2018

7. So… how are we doing?
Child Mortality. Our World in Data Available at: Accessed March 30, 2018.

8. 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

9. 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 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 episodes/child-year (1162 child/years)
Respiratory infections caused 58.3 and diarrheal disease 18.4% of the illnesses. 

10. 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 if she registers with the Village Health program before 20 weeks completes antenatal visits
Additional if she gives birth in a hospital
additional when the baby has received the 3 doses of DPT, Hepatitis - B and Polio vaccine for the child as per the time schedule

11. Dr. Muthulakshmi Reddy program

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

14. 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

15. references
Child Protection Scheme | Ministry of Women & Child Development | GoI. Wcdnicin Available at: protection-scheme. Accessed March 30, 2018.
SOCIAL WELFARE DEPT | Chief Minister’s Girl Child Protection Scheme. Tnsocialwelfareorg Available at: protection-scheme. Accessed March 30, 2018.
SOCIAL WELFARE DEPT | Cradle Baby Scheme. Tnsocialwelfareorg Available at: 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): doi: /tropej/fmp116.
Varma S. Now, majority of families have 2 or less kids - Times of India. The Times of India Available at: or-less-kids/articleshow/ cms. Accessed March 30, 2018.

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

17. Rural life

18. Rural life cont

19. Cultural Experience
Wedding crashers!!!

20. Strangers or guests?

22. Pics!

23. College hill

24. Taj mahal

25. Holi!

26. Hospital hill

27. Pondicherry beach