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Number of Downlaods: 25

Published Date: Apr 1, 1998

Socio-Environmental & Behavioural Correlates of Child Morbidity in Pakistan (R-10)

Jennifer Bennett, SDPI


Empirical evidence to determine the health status of children aged less than five years was gathered from an area in Rawalpindi, one of the large cities of Pakistan. Of the total 1301 children ever born to 341 ever-married women aged 15-39, morbidity data was limited to the cohort of 616 children who were below the age of five at the time of the survey conducted in the first half of 1992. Two separate variables, diarrhoea and fever, were used as dependent variables to measure the overall incidence of gastro-intestinal and respiratory infections and to ascertain the pattern of morbidity.

Multivariate hazards model analysis showed that synergy of infections, prior immunizable or a serious illnesses contracted, the type of toilet facility, measuring the hygienic living conditions, familial differences in child health, access to sources of knowledge, and susceptibility to contracting infections by age of the child were the major covariates of child morbidity. Overall, the amalgamation of both quantitative and qualitative information led to the conclusion that child health is an outcome of and largely dependent on enhanced knowledge of the causes of the transmission of major childhood diseases, and more importantly, the type of curative and preventive measures adopted by the mother to affect child health. Maternal education was found to be the major contributory factor in raising health-related knowledge and awareness for improved child health.

As is known, except for accidental causes, death is almost always preceded by a shorter or longer episode of illness. The types of illnesses contracted are largely a function of the age at which vulnerability to certain infections is at its maximum. For example, children below the age of five years, the focus of this study, are most susceptible to various immunizable and other communicable diseases. These diseases are preventable but, if proper and timely curative measures are not taken, can put the child at a fatal risk. Although causes of child mortality vary from country to country, it is generally accepted that infectious, parasitic and respiratory diseases, combined with nutritional deficiency, play a major role in determining the mortality levels in most developing countries (United Nations, 1982). Hull and Rhode (1980) estimated that the synergistic triad of malnutrition, diarrhoea, and acute respiratory infections accounted for 64-68 per cent of all infant deaths and 73-80 per cent of all deaths under the age of five in Java. In tropical African countries nearly all children suffer from malaria and at least one million children die from it each year (United Nations, 1982). In Pakistan, almost all studies suggest that the major contributors to child mortality are gastro-intestinal, parasitic, and respiratory diseases and malnutrition (Awan, 1986; Rukanuddin and Farooqui, 1988; Ahmed, Bhatti and Bicego, 1992). According to statistics, the high incidence of infective and parasitic diseases, dysenteries, malaria and tuberculosis together with malnutrition resulted in 73 per cent of the infant deaths (Irfan, 1986). Nutrition Division (1988) figures show that 48 per cent of all Pakistani children were malnourished, 10 per cent severely malnourished and around 65 per cent anaemic. The Pan-American Health Organization study of 35,000 infant and child deaths in Latin America reported that 57 per cent of all deaths had malnutrition as the underlying or associated cause (Puffer and Serrano, 1973).

The fact that much emphasis has been laid on malnutrition in association with other diseases is because the two work both as cause and effect of each other. Protein-energy malnutrition is the most important nutrition-related problem in the developing world (WHO, 1971). It renders infants and children vulnerable particularly to respiratory and gastro-intestinal infections and affects their immune status (Keusch and Katz, 1979); it often results in prolonged suffering (Black, Brown and Becker, 1984) which in turn adversely affects the nutritional status.

Almost all childhood gastro-intestinal, respiratory and other communicable infections can easily be contracted from the physical environment both at home and in the surrounding areas. The persistence, exacerbation, elimination or prevention of these diseases largely depends on the preventive and curative measures adopted, which in turn depend on mothers’ hygienic awareness and behaviour, and knowledge about the causes, transmission and prevention of these diseases. On the other hand, the type of preventive and curative measures adopted depend on the mother’s perception and beliefs about the causes of the disease. The age of the mother and the survival of the child during early infancy are considered to be correlated with the biological factors but at the same time can largely be a function of the abovementioned factors. In many traditional societies, like that in Pakistan, women give birth to children at home which may expose the newborn to unhygienic conditions for confinement. Much of the likely exposure to life-threatening diseases such as tetanus, caused by severing the umbilical cord with an unsterilized knife, or other cutting device, can be avoided if the mother knows about hygiene and the cause and transmission of disease.

In investigating the reasons for high levels of morbidity amongst children less than five years in Pakistan, this study aimed at: first, determining the overall level of disease incidence, especially of gastro-intestinal and respiratory infections in the study area; second, identifying some of the major covariates of child morbidity; and third, to tease out some of the mechanisms whereby a relationship is established between these illnesses and its covariates.