The New Nation - Internet Edition

Shobha Shukla

GDM is defined as a transient abnormality of carbohydrate/ glucose intolerance of variable intensity - a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy. Women with this condition are at an increased risk of diabetes in future, as are their children and the following subsequent generations.

Thus an important public health priority in the prevention of diabetes is to address maternal health during ante and post partum period. Primary prevention will most likely reverse or halt the trend of increasing diabetes cases. Keeping this in mind, the World Diabetes Foundation (WDF) has been funding the project Diabetes in Pregnancy - Awareness and Prevention (DIPAP), run by diabetologists at Dr V Seshiah's Diabetes Care and Research Institute at Chennai, working with the Tamil Nadu government in India.

There is no current national data regarding GDM. But on the basis of a community based study carried out in the Government Maternity Hospital , Chennai, it was found that the prevalence of GDM in urban, semi urban and rural areas was 17.8%, 13.8% and 9.9% respectively. Greater incidence in urban areas could be attributed to a more mechanized and sedentary life style coupled with increased maternal age.

The morning of 27th November 2008 was bleak indeed, what with the terrorists indulging in inhuman and senseless killings in Mumbai and cyclone Nisha playing havoc with normal life in Chennai. But somehow we managed to reach the government hospital of Chennai Municipal Corporation at Saidapet. This is one of the several hospitals where the DIPAP project has been running successfully since 2004.

It really lifted my low spirits to see about 20 women who had braved the inclement weather to be there for screening/ follow up action for GDM. The two lab technicians, Vimala and Radhi, appointed by the project managers, were busy taking the blood samples for glucose monitoring.

Uma Bhaskar, a 29 year old mother of two kids was all praises for the project team. She was a high risk patient due to her obesity and was diagnosed with GDM during her first pregnancy, 4 years ago in a private clinic.

But did not follow it up, till she came to this hospital two years ago during her 2nd pregnancy. She had to be administered insulin during pregnancy and is still on oral medication, along with diet control.

She comes for regular checkups and feels that likes of her have benefited immensely from this programme.

21 year old Gayatri, mother of a one year old daughter, travels 21 km. to reach this hospital. She was referred to this hospital for an ultra sound scan and diagnosed with GDM during routine screening. However, she was able to control her condition through diet control and regular walking, and did not require medication. She remarked with a grin that now she was eating less sweets and felt better equipped to manage her condition, thanks to DIPAP.

Dr Madhuri Balaji, who is closely associated with this project, spoke of the main problems faced during implementation of the project:

(i) lack of awareness in pregnant women about GDM;

(ii) failure of the women to follow up with subsequent check ups (the first checkup should be done around 12 weeks of gestation, with follow up screenings during 24th and 30th weeks). This may happen due to relocation of the woman to her mother's house for delivering her first child, as is customary. Or, if it is her second pregnancy, then she cannot afford the long wait at the hospital with a small child in tow;

(iii) diet and other controls may not be followed once the pregnancy period is over. The woman has other things to care about now and her well being comes last in the family.

The medical officer in charge of this hospital Dr Shanthi Viveka, was all praises was this laudable effort of WDF, as were the other nursing staff. They felt that the project has benefited everyone.

But they were a little wary as to what would happen once WDF disassociated itself with the project. She cited shortage of hospital staff as well as poor infrastructure, as possible impediments in continuing with the mandatory screening of pregnant women all over the state.

WDF has thus successfully implemented a system which screens and controls gestational diabetes. It has been able to initiate a change in health policies in the region to the extent that it has now become mandatory to screen all pregnant women for GDM in Tamilnadu.

But it remains to be seen how well the government will implement it through its own resources all over the state. Also,this example is worth emulating in other parts of the country too.

Jamayet Ali

Palong (spinach) is a small, erect, leafy, succulent, glabrous annual herb with alternate, petioled leaves or reduced or no stem, cultivated as a leaf vegetable all over the country. It is popular because of its adaptability to varying soil and climatic condition and high nutritional value. Palong is a cold season crop. It can be grown pure or as a mixed crop with peas, cabbage and comparatively longer-duration. It is sown during September-November. This vegetable prefers an average monthly temperature of 15-19 degree but the growth is good even at 10 to 15 degree. The cool and short days are ideally suited for putting out a good leafy growth. With the onset of long and hot days, it starts flowering and seeding. It prefers a rich, well-watered and friable soil and shady condition. When grown on sandy soils, it needs a substantial supply of humus and nitrogen The plant can thrive even on saline soils. Growth is however restricted on acidic soils.

The land is carefully prepared by ploughing three or four times, followed by planking. After the soil has been powdered and leveled, the field is divided into plots, and channels for irrigation are laid out. Palong is a shallow-rooted crop and needs ample moisture in the soil. It is a short-season crop and is ready for harvest in 6-8 weeks after sowing. Harvesting is done by cutting the stem just below the lower leaves. This may be done from the time the plants have 5-6 leaves till the seed-stems develop. Instead of removing the whole plant, only the larger leaves are cut an inch above the ground ; the plants continue to produce new foliage which is repeatedly cut. Thus, in all, 3-4 cuttings are taken before the plants begin to grow seed-stocks during the spring. Palong is used in soups and salads. The leaves are reported to be a raw material for the manufacture of chlorophyll. The lipids from leaves are reported to possess anti bacterial properties.

Analysis of the edible portion of palong gave: moisture, 90.8; mineral matter, 1.8; fibre, 0.6; calorie, 30; protein, 3.3; fat, 0.1; carbohydrates, 4 g. /100g; calcium, 98; oxalic acid, 658; magnesium, 84; potassium, 206; iron, 10.9; phosphorus, 21; sodium, 58.5; sulphur, 30; and chlorine, 54mg/100g. Other present in the leaves (dry basis) are: nickel, 0.42; manganese,9.61; molybdenum, 0.08; zinc, 13.53; and strontium, 0.077 mg/100 g. Cobalt (0.007-0.12 mg / 100 g.). Selenium and iodine ( 20.1µg. / 100g.) are also present. Palong is a good source of minerals, vitamin B complex, ascorbic acid and carotene (equivalent to vitamin A); it is also important natural source of vitamin K. The composition of vitamins in the leaves is as follows: vitamin A, 8,470 I.U; thiamine, 0.03; riboflavin, 0.07; nicotinic acid, 0.5; and ascorbic acid, 97mg./100g. Total content of folic acid in spinach is 0.12 mg./ 100g. (free folic acid, 0.05mg./100g.). The content of ascorbic acid is the highest during November-February and least in May. Palong losses as much as 60 per cent of its ascorbic acid when cooked, and 13-34 per cent when frozen and prepared. Amounts of carotene, available from raw and cooked Palong, are reported to be are 45 and 58 per cent respectively. Losses of carotene amount to 12.8 per cent on cooking. Retention iron from raw palong was reported to be 26 and from cooked palong 31 percent in normal young rats. The high content of oxalate in leaves poses a serious nutritional problem because the calcium in diet becomes almost unavailable. Palong (spinach), is therefore, not recommended in the diets of growing children, pregnant women and patients suffering from calcium deficiency. The oxalates can be eliminated by boiling the vegetable for 15 min. and rejecting the water. (Food Processes and Analyses, Mohammad Yunus, BARC Dhaka; Wealth of India, Raw Materials, Vol. X, 12-15)

Properties and Uses: the plant is sweet; cooling, laxative, alexipharmic; useful in diseases of the blood and the brain, asthma, leprosy, biliousness; causes "kapha" (Ayurveda). The leaves are cooling; emollient, wholesome, antipyretic, diuretic, maturant, laxative, digestible, anthelmintic; useful in urinary concretions, inflammation of the lungs and the bowels, sore throat, pain in the joints, thirst, lumbago, cold and sneezing; sore eyes, ringworm, scabies, leucoderma, arrest vomiting, biliousness, flatulence. The seeds are useful in fevers, leucorrhoea, urinary discharges, lumbago, diseases of the brain and of the heart (Yunani). The green plant is given for urinary calculi. The seeds are laxative and cooling; they are used in difficult breathing, inflammation of the liver, and in jaundice. (Indian Medicinal Plants, K.R. Kirtikar & B.D. Basu, Vol. III, 2078-79)

Medicine: The seed is held by mohammadan medical writers to have cooling and laxative properties, and to be efficacious in difficulty of breathing and biliary derangements. The green plant is believed to act as a solvent for urinary calculi.(Dictionary of the Economic Products of India, Watt, Vol. VI, Part-III)

Properties and Uses: green plant is eaten for urinary calculi, and used as a mild laxative, emollient, demulcent, diuretic and astringent. It is also useful in fevers, inflammations of the lungs and bowels. Juice of leaves are used as a gargle in sore throat. Seeds possess laxative and cooling properties, and are used in difficult breathing, inflammation of the liver and in jaundice.

(Medicinal Plants Bangladesh, Abdul Ghani, Second Edition, 388).