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OJHAS Vol. 9, Issue 3:
(Jul - Sep, 2010) |
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| Impact of Prenatal
checkups of Mothers and Immunization of children on the Health Status of
Children (0-3 years) - A Study in Rural areas of Aligarh
District, Uttar Pradesh. |
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Farzana Alim,
Chairman, Department of Home science, Aligarh Muslim University, Aligarh, U.P.,
Farhat Jahan,
Research
scholar, Department of Home science, Aligarh Muslim University, Aligarh, U.P. |
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Address For Correspondence |
314, Wadi–e-Ismail, Doharra,
P.O. Quarsi, Aligarh – 202002,
Uttar Pradesh, India.
E-mail:
jahanfarhat23@yahoo.in |
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Alim F, Jahan F. Impact of Prenatal
checkups of Mothers and Immunization of children on the Health Status of
Children (0-3 years) - A Study in Rural Areas of Aligarh
District, Uttar Pradesh. Online J Health Allied Scs.
2010;9(3):10 |
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Submitted: May 26, 2010;
Suggested revision: Jul 30, 2010; Resubmitted: Sep 20, 2010; Accepted:
Sep 29, 2010; Published: Oct 15, 2010 |
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| Abstract: |
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Background
and objectives: A survey based study on rural areas
of Aligarh District was conducted to assess the prenatal checkups pregnant
women and its effects on health status of children between the age of
(0-3 years), and immunization received by children and its effects
on their health status. Methods:
Five hundred children from five villages of rural areas of Aligarh
District were randomly selected. For the purpose of the study, a self
prepared structured interview schedule was used. To get the qualitative
information of the study anthropometric measures include height weight
were used for assessing growth pattern of the child. The stepwise analysis
of two variables height for age and weight for age was done on the basis
of Water low’s and Gomez’ classification. To examine the relationship
between Health Status of the child and selected variable that affects
Health Status of children, Chi-square test was employed. Results:
Based on Gomez’ classification out of 88% mothers who did not go for
prenatal ups majority 80% of children were underweight, and 80% of children
who did not receive immunization majority 60% were underweight. Based
on Waterlow’s classification majority 68% of children were stunted
whose mother did not go for prenatal checkups and 50% of their children
were stunted who did not receive immunization. Conclusion:
Majority of children were stunted whose mother did not go for prenatal
checkup and the children who did not receive immunization.
Key Words: Prenatal checkups; Stunted growth; Underweight; Immunization
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Prenatal testing
can provide valuable information about the baby’s health. Blood tests
and imaging studies to screen for common conditions are routine in most
pregnancies. Simple screening tests and ultrasound tests do not pose
any threat to the mother or the unborn child. Prenatal care is essential
in ensuring the overall health and wellness of both the mother and child.
The first prenatal care visit can be stressful for women because the doctors
generally gather a lot of information, in order to make sure that the
pregnancy can be as problem free as possible. A change in the demographic
scenario is being witnessed in developing countries like India. There
are indications that family size is declining. Accordingly, the profile
of pregnant women also seems to be changing. It is important to document
such changes in order to give feedback to the planners. Recently, Government
of India has launched Reproductive and Child Health-II (RCH-II) programme.1 Reproductive and Child Health (RCH)
Programme aims at reducing maternal mortality to less than 100 by 2010. The major interventions include essential obstetric care and
the RCH Programme aims at providing at least 3 antenatal checkups during
which weight and blood pressure check, abdominal examination, immunization
against tetanus, iron and folic acid prophylaxis as well as anemia
management are provided to the pregnant women. Under the RCH programme,
emergency obstetric care, 24-hour delivery services at primary health
centers and safe abortion services are also provided. The government
has launched a Janani Suraksha Yojana (JSY) to deal with the issues involved
in pregnancy and child care. It is a centrally sponsored scheme aimed
at reducing maternal and infant mortality rates, and increase institutional
deliveries in below poverty line (BPL) families. The JSY, which falls
under the overall umbrella of National Rural Health Mission, covers
all pregnant women belonging to households below the poverty line, above
19 years of age and up to two live births. One
of its main focuses is on the quality of prenatal care. It is also vital
to document the existing quality of prenatal care in various parts of
India. Such information helps in indirectly gauging the progress and
impact of the program. Children
being the pillar of the nation are primary victims of malnutrition. The
convention on the right of the child, adopted by the General Assembly
on 20 November 1989, brought together, for the first time, all rights
that were related to the survival, development, protection and participation
of the children. It states that countries “shall ensure to the maximum
extent possible the survival and development of the child”. Against this
background this study was done with an objective to establish a relationship
between health status of children to the prenatal checkups of their mother and
immunization received by the children.
Objectives:
- To assess the prenatal
checkups pregnant women and its effects on health status of children.
- Immunization received
by children and its effects on their health status.
This survey
based study was conducted in five villages of Jawan block of Aligarh
district. A total of 500 children were selected on the basis of study
purposive random sampling. The study was conducted during January
2008-May2008. A self prepared structured interview schedule was used
to get the qualitative information. For the purpose of the study women
were interviewed to know the type of prenatal checkups used during pregnancies;
for assessing growth pattern of the child anthropometric measures including
height and weight were used. The stepwise analysis of two variables
height for age and weight for age was done on the basis of Waterlow’s
and Gomez’s classification. To examine the relationship between health
status of the child and selected variable that affects health status
of children, Chi-square test was employed.
Health status
was assessed on the basis of height and weight, measured through anthropometric techniques. Weight for
age and height for age was calculated and children were classified
into different grades of malnutrition according to Gomez’s and Waterlow’s
classification.
Classification by Gomez et al:
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Normal : >90% of standard weight for age.
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Grade I malnutrition:
89%-75% of standard weight for age.
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Grade II malnutrition:
74%-60% of standard weight for age.
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Grade III malnutrition:
<60% of standard weight for age.2
Classification
by Waterlow:
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Normal: >95%
of height for age.
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Mildly impaired:
87.5%-95% height for age.
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Moderately
impaired: 80%-87.5% height for age.
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Severely impaired:
<80% height for age.2
Prenatal
checkups: These include the antenatal care of women during pregnancy.
The primary aim of prenatal checkups is to achieve at the end of the
pregnancy, a healthy baby. Ideally this should begin after the conception
and continue throughout pregnancy. Prenatal checkups comprise of variety
of preventive measures during pregnancy including regular checkups,
tetanus toxoid (TT) injections, and delivery care. Child health is correlated
with the birth weight and birth weight is correlated with weight gain
of mother during pregnancy. On an average, normal healthy woman gains
about 12 Kg of weight during pregnancy. Through prenatal checkups expected
mother has been advised to take balanced and adequate diet during pregnancy
for herself and for foetus.3 The NFHS-2 (1998-1999) shows that antenatal care, TT and IFA
supplementation have a bearing on the birth of a normal child.4
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Table 1:
Percentage distribution of mothers who went/ did not go for prenatal
checkups |
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Prenatal
checkups |
Number |
Percentage |
| Went for
prenatal checkups |
60 |
12 |
|
Did not go |
440 |
88 |
| Total |
500 |
100 |
The present study revealed that a majority (88%)
of women did not avail or access prenatal checkups during pregnancy
and only small percentage (12%) went for prenatal check-ups. It has been
observed that antenatal check-ups are
much more common among more literate and educated mothers. A study
by NFHS-2 (1998-1999) revealed that in rural Bihar and Jharkhand,
where the proportion of illiterate mothers in the population is high,
only about one in four in Bihar and one in three in Jharkhand reported
receiving any antenatal check-up in either survey; in contrast, between
73 and 90 percent of mothers who have completed high school or above
reported at least one antenatal check-up visit.4
In Maharashtra, more than three-fourths of illiterate mothers reported
receiving antenatal care, this percentage declined somewhat in the follow-up
survey. In Tamil Nadu, differentials in antenatal care by education
were negligible and antenatal care has become almost universal for all
population subgroups. Similarly, antenatal care is essentially universal
among mothers with a high school education or higher in Maharashtra,
and among all educational subgroups in Tamil Nadu. Similar differentials
were evident by state when caste/tribe differentials in antenatal care
were considered. In a study by Gangadharan K
(2005) in urban sample, ANC coverage was 100% and in slum
it was 95.9%.5 Another study by Singh
et al (2007) in North India reported that the coverage of 3 ANC was 35% only.6
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Table 2:
Percentage distribution of health status (weight) of children according to
mother who went/ did not go for prenatal checkups (Gomez's classification
weight for age) N=500 |
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Prenatal
checkups |
Health status
of children |
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Normal |
Underweight |
Total |
| No |
(%) |
No |
(%) |
No |
(%) |
| Went
for checkups |
35 |
7 |
25 |
5 |
60 |
12 |
| Did not
go |
40 |
8 |
400 |
80 |
440 |
88 |
| Total |
75 |
15 |
425 |
85 |
500 |
100 |
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χ2=20.08 at d.f 1; P>0.05 |
Based
on Gomez’s classification, of 88% mothers who did not go for prenatal
checkups, majority (80%) of their children were underweight. On the other
hand, out of 12% mothers who went for prenatal checkups, majority (35/60) of
children were having normal weight for age, suggesting that children were under
weight whose mothers did not go for prenatal check-ups (Table 2).
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Table 3:
Percentage distribution of health (height) of children according to
prenatal checkups of mothers (Waterlow’s classification)
N=500 |
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Prenatal checkups |
Health Status
of children |
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Normal |
Stunted |
Total |
|
No
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(%) |
No |
(%) |
No |
(%) |
| Went
for checkups |
30 |
6 |
30 |
6 |
60
|
12 |
| Did
not go |
100 |
20 |
340 |
68 |
440 |
88 |
| Total |
130 |
26 |
370 |
74 |
500 |
100 |
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χ2=5.31 at d.f 1; P>0.05 |
Based on Waterlow’s
classification Out of 88% mothers who did not go for prenatal checkups
majority 68% children were stunted. Out of 12% mothers who went for
prenatal checkups majority 6% of the children were normal height for age,
suggesting that more children were stunted whose mothers did not go for prenatal
check-ups. (Table 3)
Immunization
of children: Regarding the Immunization of children below 3 years, the respondents
were asked about the type of vaccination given to the children before attaining one year of age, including BCG+ Oral
polio, DPT, Polio three doses, and measles. The NFHS-2(1998-1999)
reveals that for Kerala 96.2% of children had taken BCG and 84.6% had
taken measles vaccines, but the full dose was taken only by 79.7% of
the children.4
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Table 4:
Percentage distribution of Children
who receive/ did not receive immunization. |
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Immunization
of children |
No |
Percentage |
| Received |
100 |
20 |
|
Did not receive |
400 |
80 |
| Total |
500 |
100 |
The data form
our study shows
that only 20% of children had received all the vaccination and 80% of
children did not receive vaccination. When the respondents were
asked the reason for non vaccination of their children, respondents in
the lower socioeconomic status revealed that they were not aware about
the doses. Some of the women informed that the child was ill during
the due period of vaccination and in certain cases they deliberately
avoided the vaccination. Certain women avoided polio vaccination for
their children by fearing its side effects. A study by Gangadharan shows that only 80% of the urban and 77%
of slum respondents had given all the vaccination to the children.5
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Table 5:
Percentage distribution of health status (weight) of children according to
immunization they received /not receive (Gomez's classification weight for age). N=500 |
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Immunization of mother during
pregnancy |
Health Status
of children |
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Normal |
Underweight |
Total |
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No
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(%) |
No |
(%) |
No |
(%) |
| Received |
30 |
6 |
70 |
14 |
100
|
20 |
| Did
not receive |
100 |
20 |
300 |
60 |
400 |
80 |
| Total |
130 |
26 |
370 |
74 |
500 |
100 |
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χ2=0.49 at d.f
1; P<0.05 |
Based on Gomez's
classification, out of 20% of children who received immunization, majority of children were
underweight. Out of 80% children who did not receive immunization during
pregnancy only 20% of them were having normal weight for age, suggesting that immunization
of children has no effect on their health status (weight).(Table 5)
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Table 6:
Percentage distribution of health status (Height) of children according
to Immunization they received /not receive
(Waterlow’s classification) N=500 |
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Immunization Status
of children |
Health Status
of children |
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Normal |
Stunted |
Total |
|
No |
(%) |
No |
(%) |
No |
(%) |
| Received |
35 |
7 |
65 |
13 |
100 |
20 |
| Did not
received |
150 |
30 |
200 |
50 |
400 |
80 |
| Total |
185 |
37 |
315 |
63 |
500 |
100 |
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χ2=0.04 at d.f 1; P< 0.05
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Based on Waterlow’s
classification, out of 20% children who received immunization, majority
were having low weight for age. Out of 80% children
who did not receive immunization, 30% were having normal weight for age,
suggesting that immunization status of children has no
effect on their health status.(Table 6)
Further, according to Gomez’ classification, majority of the children were underweight
with most falling on Grade III malnutrition category. This means that
malnutrition was very prominent on the basis of weight for age. According
to Waterlow’s classification, majority of children were stunted.
The study brings
out salient findings that could be help to improve health of children.
This is because although malnutrition manifests itself on an individual
level, it has a bearing on the development of the nation. Awareness
of women assumes especial significance in the Indian context because
the problem of malnutrition in Indians is mainly due to ignorance, poverty
and lack of knowledge regarding the issue. The mother who has a knowledge
regarding the prenatal diagnosis has a positive effect on the health
status of the children whereas immunization of children has no impact on
their health status. It is therefore very important to first know the awareness
level of the mother than to communicate the message regarding the improvement of
the health status of children. The various approaches suitable for
reaching the mothers are:
- Individual contacts
through home visits.
- Group contacts through
simple talks, demonstrations and discussion.
- Nukkad drama and
use of traditional song for imparting relevant education more to older
group who influence the young age group.
- Taneja
DK. Health Policies and programs in
India. 5th ed. Doctors Publication (Regd.): Delhi; 2005.
- Khanna K. A Text
Book of Nutrition and Dietetics. Phoenix Publishing House Pvt. Ltd,
New Delhi. 1997. p 159-166.
- Park K. Textbook
of Preventive and Social Medicine.
18th Edition. Banarsidas Bhanot Publisher Jabalpur. 2005.
p 344.
- National Family
Health Survey-2, India (1998-99). International Institute of Population
Sciences; Mumbai
- Gangadharan K. Utilization
of Health Services in Urban Kerala- A socio economic study. Serials
Publications. New Delhi. 2005. pp 280-281, 305-316.
- Singh A, Arora AK. The Changing Profile of Pregnant Women and Quality of Antenatal Care in Rural North India. Indian Journal of
Community Medicine. April 2007;32(2)
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