ORIGINAL ARTICLE

Assessment of Morbidity Profile of Under-Five Children in a Rural Area of West Bengal

Debasis Paramanik*, Shibani Datta**, Provasis Pal*, Senjuti Chowdhury*, Jimutbahan Murmu* Suma Nayek*

*Junior Resident, Department of Public Health Administration, All India Institute of Hygiene & Public Health, Kolkata
** Professor, Department of Public Health Administration, All India Institute of Hygiene & Public Health, Kolkata

Corresponding Author: Dr Debasis Paramanik
Email: iamdrdebasis@gmail.com



ABSTRACT

Background & Objectives:Morbidity rates are very high among the under-five children specifically in developing countries. The morbidity data are mostly hospital based. The present study was conducted with the objectives to study morbidity profile of under-five children and to find out association between childhood morbidity and socio-demographic factors as well as feeding practices if any.

Methods:The study was conducted in Singur Block, Hooghly, West Bengal among the under-five children. Two villages named Kaliara (1623) & Paltagarh (2384) were selected by Probability Proportion to Size-With Replacement (PPS-WR) method. Two villages were subdivided into hamlets & total enumeration of the randomly selected hamlets was done and information was collected by interviewing the mother, examination of the child and record review.

Results:Among the study population, 54% were boys and the rest were girls (n=101). The prevalence of morbidity among boys was 80% while among girls it was 71.7% (p>0.05). Majority of the children (92%) belonging to 24-35 months age group were morbid in comparison to other age groups (p>0.05). The prevalence of morbidity was found to be maximum among Schedule Tribe (90.91%,p>0.05). Morbidity was more among the children staying at kutchha houses (p<0.05).ARI was the most frequent morbidity. Morbidity was found to be less in exclusively breast fed children (p<0.05)

Conclusion:Improved literacy status among the mothers ,better housing condition and adequate knowledge of exclusive breast feeding may help to reduce the morbidity among under-five children.

Key words:rural area, under-five, morbidity, ARI



Introduction:

The measurement of morbidity is complex and the usual source of morbidity data are national surveys or published studies. A significant proportion of the morbidity outcome can be prevented with a few interventions that are accessible, affordable and deliverable without complex technology.

According to NFHS-3 data, 5.8 % of under-5 children in India suffered from ARI (13% in West Bengal) in the two weeks preceding the survey and it was 6% in rural India. Likewise 14.9% of that age group had fever in last two weeks (15.1% in rural India) . According to the same data, 9% under-5 children suffered from any form of diarrhoea in the last two week period. Among under-5 children in India, 69.5% were found to be anaemic (61% in West Bengal) and it was 71.5% in rural India.1 With this background, the present community based study was an attempt to find out the prevalence of morbidity among under five children and its association with various socio-demographic factors as well as feeding practices if any, in Singur, Hooghly.



Methodology

This was a cross sectional community based observational study from October 2014 to March 2015. Two villages- Paltagarh and Kaliara were selected randomly from 64 villages in the rural field practice area of All India Institute of Hygiene & Public Health, Kolkata. Complete enumerations of seven randomly selected hamlets from each of the two villages were done by house to house visit and a total of 101 under-five children were included in the study among which 55 were boys and 46 were girls.Data was collected by interview, clinical examination, and review of records using a predesigned, pretested and structured schedule.

Interview was conducted with the care givers preferably the mother, using the schedule. Information regarding their socio-demographic and economic characteristics, morbidity pattern in last two weeks, health seeking behaviour during illnesses along with dietary pattern were obtained. Clinical examination, anthropometric measurements including length /height, weight and mid upper-arm circumference were taken.



Results and discussion



Table 1: Distribution of Socio-demographic profile of the study population (N=101)

Variables

Frequency     

 %

1.Sex

Male

55

54.5

 

Female

46

45.5

2.Age group

0-11 months

31

30.7

 

12-23 months

25

24.8

 

24-35 months

13

12.9

 

36-47 months

14

13.9

 

48-59 months

18

17.7

3. Religion

Hindu

99

98.0

 

Muslim

2

2.0

4. Social group

SC

14

13.9

 

ST

11

10.9

 

OBC

6

5.9

 

Others

70

69.3

5. SES class

I

0

0.0

 

II

7

6.9

 

III

29

28.7

 

IV

52

51.5

 

V

13

12.9



Table: 2 Distribution of different types of morbidity in the study population (N=101)*

Type of morbidity

Number

Percentage

ARI

39

38.6

Diarrhoea

13

12.8

Fever

6

5.9

Vomiting

1

1.0

Skin disease

13

12.8

Worm infestation

15

14.9

E.N.T. problem

1

1.0

CHD

1

1.0

Dental caries

10

9.9

Pallor

28

27.7

Under nutrition (wt/age)

28

27.7


*Multiple response

Table 3: Association of morbidity with different socio-economic factors (N=101)

 

Variables

Presence of morbidity

p value

Yes (%)

No (%)

Sex-

Male
Female

 

44 (80.0)
33 (71.7)

 

11 (20.0)
13 (28.3)

 

0.3313

Age (months)

0-11
12-23
24-35
36-47
48-59

 

21 (67.7)
20 (80.0)
12 (92.3)
10 (71.4)
14 (77.8)

 

10 (32.3)
5 (20.0)
1 (7.7)
4 (28.6)
4 (22.2)

 

0.4800

Social group-

SC
ST
OBC & Others

 

9(64.3)
10(90.9)
58(76.3)

 

5 (35.7)
1 (9.0)
18 (23.7)

 

0.2995

 

SES class-

I+II+III
IV+V

 

28 (77.8)
49 (75.4)

 

8 (22.2)
16 (24.6)

 

0.78

Type of family
Joint
Nuclear

 

39(67.2)
38(88.4)

 

19(32.8)
5(11.6)

 

0.013

Type of house
Kutcha
Semi pucca
Pucca

 

17(89.5)
41(87.2)
19(54.3)

 

2(10.5)
6(12.8)
16(45.7)

 

0.0007

Type of latrine
Nil
Water seal
Others

 

15(75.0)
48(72.7)
14(93.3)

 

5(25.0)
18(27.3)
1(6.67)

 

0.236

Exclusive breast feeding

 ≥ 6 months
< 6 months

 

36 (67.9)
41 (85.4)

 

17 (32.1)
7 (14.6)

 

0.039



In this study,it was found that ARI was the most frequent morbidity (38.6%) present in the study population followed by under nutrition (27.7%), pallor (27.7%), worm infestation (14.9%), skin disease (12.8%) and diarrhoea (12.8%) respectively.

Gupta S. et al in rural area of Jammu observed that morbidities among under-five children (excluding chronic conditions) in decreasing order of incidence were acute respiratory infections (47.26%), diarrhoeal diseases (30.10%), skin infections and fever2.

In this study morbidity among children was 76.2% (boys - 80%, girls – 71.7%). There was no statistically significant difference among the morbidity profile between two genders (OR=1.57, p =0.33). Whereas females suffered more episodes of illness (5.6 episodes/ child/year) compared to males (4.0 episodes per child per year) documented by Sanjana Gupta et al in a study in a rural area of Jammu2. On the other hand Lakshmi J A et al3 and Mittal A4, observed more episodes among males as compared to females in their studies among under five children. However, Ukey UU mentioned that the probability of under reporting of morbidity in females should also be considered5.

Majority of the children (92%) belonging to 24-35 month age group were morbid, the difference of morbidity in different age groups was not statistically significant (p=0.48). According to NFHS-3 data, ARI (8.1%), fever (21.1%) and diarrhoea (18.1%) were mainly found in 6-11 month age group. Study of Kutty VR et al in rural Kerala in 1992, showed that the incidence of various diseases initially increased as per the age, and declined after 3 years of age6.

The prevalence of morbidity was found to be maximum in ST (90.9%) and least in SC (64.3%) category (p=0.299). According to NFHS 3 data morbidity was found to be maximum in other caste and least in ST category, but diarrhea was most common in OBC category (9.5%) and least in other caste (8.6%).

Morbidity was found marginally more (77.8%) among the children from upper socio-economic class (I+II+III) (p=0.78, OR=1.14).It was observed that morbidities were more in nuclear (88.4%) families (p=0.0136, OR=3.7).

Morbidities were more in the kutchha houses compared to pucca and semipucca houses and the difference was statistically significant (p=0.0007).

In the present study, 52.5% children were exclusively breastfed. Morbidity was found to be less in exclusively breast fed children (p=0.039, OR=2.78). Bele SD et al in 2011 reported significant association between lack of exclusive breast feeding and occurrence of diarrhoea (p= 0.008), ARI (p= 0.03) while no association was observed with other infections7.

CONCLUSION



The present study highlighted that ARI is the most common morbidity among under five children followed by pallor and malnutrition. The sociodemographic variables which has got significant association with morbidity are kuccha house, low maternal education ,low socioeconomic status and lack of exclusive breast feeding . Improved literacy status among the mothers ,better socioecomic condition and adequate knowledge of exclusive breast feeding can reduce the problem in future.



Reference:

  1. Govt. of India. MoHFW. National Family Health Survey (NFHS-3). 2005-06. Volume I. September 2007. http://dhsprogram.com/pubs/pdf/frind3/00frontmatter00.pdf accessed on 28 may 2015.

  2. Gupta S, Jamwal DS, Kumar D, Gupta SK. Morbidity among Under Five Children in a Rural Area of Jammu. Journal of Medical Education and Research. Vol. 14 No. 2, April - June 2012.

  3. Lakshmi JA, Begum K, Saraswathi G, Prakash J. Influence of Nutrition and Environment on Morbidity Profile of Indian Preschool Children. Mal J Nutr 11(2): 121-132, 2005.

  4. Mittal A, Singh J, Ahluwalia SK. Effect of maternal factors on nutritional status of 1-5-year-old children in urban slum population. Indian J Community Med. 32(4):264-267, 2007.

  5. Ukey UU, Chitre DS. Morbidity Profile of Pre-School Children in an Urban Slum Area. Indian Medical Gazette; August 2012.

  6. Kutty VR, Vijayakumar K, SonamCR.Pattern of morbidity in pre-school children in rural Kerala. J Trop Pediatr. 1992 Jun;38(3):141

  7. Bele SD, Bodhare TN, Valsangkar S, Budaraju S, Saboth KP. The effect of Exclusive Breastfeeding on Acute Respiratory Tract Infection and Diarrhea during Infancy in a rural area. Indian Journal Of Maternal And Child Health. 2011 Jan‐Mar; 13(1): [9] p.