Introduction:
The health of children is reflective of the overall health of the nation. Maternal and child health are crucial measures of progress in developing nation. Health in early life may have substantial effects on health and wellbeing throughout the entire life course.[1] Health of the children depends on several factors like mother`s health and behaviour, numbers of children in the household, place of birth and socio economic characteristics.[2,3] Several other factors that contribute to children’s exposure to health hazards include malnutrition, poverty, family instability, poor housing conditions, lack of health care facilities etc. In India, child health program was launched in 1997 to improve the ante-natal care, institution deliveries with trained health workers and post-natal mother health as well as the child health care services.[4] It is said that poverty is detrimental to the health of both mother and baby.[5] Family income is related linearly to children’s overall health.[6] Women from many communities around the world do not have the required knowledge of reproductive rights and child health. Female education is the key factor in improving the overall health and hygienic conditions of any country.[7] Low parental education and growing up in a single-parent family increase the likelihood that children will experience poor health outcomes.[8,9] Nearly 3 million babies die every year during their first month of life in low income and middle income countries, many of those deaths and morbidities are due to easily preventable causes.[10] Family planning plays a major role in reducing maternal and newborn morbidity and mortality.[11] Family planning saves live and can improve the health of women, children and society as a whole.[12]
With above background, present study deals with the health of the children in association with socio-economic status of the mothers.
Materials and Methods
Sikkim is a small and beautiful multi ethnic state located in the eastern Himalayas. The state is divided into four districts, namely North, West, East and South with total population of 6,07,688. Lepcha, Bhutia and Nepali are the three major ethnic groups of Sikkim having its own distinct culture, language and traditions. The present study was conducted on health of the Nepalese children and its association with maternal socioeconomic conditions of Lingmoo village, South Sikkim. The term ‘Lingmoo’ means to assemble for meeting. The Nepali communities living in Lingmoo village are mostly Chettri, Sharma, Kami, Damai, Rai and Limboo people. The entire data on health of the children was collected from 251 married women aged between 18 to 60 years through interviews using structured schedules. The data on pregnancy history of the mother, total number of conception, number of live birth, number of death after birth, age at death, cause of death etc. were collected through in depth interview from each of the married women. Data on overall health of the children, health check up, vaccination, polio drops and overall health care was collected from each mother through interview. Data on breast feeding, problems during breast feeding, semi-solid food consumption and support for government initiative for two child scheme was recorded. Special attention was also made to collect data on socio-economic parameter like occupation, household income, household expenditure, educational attainment of the married women. The data on income was divided into three groups-high income group (above 75th percentile), middle income group (between 50th-75th percentile) and low income group (below 50th percentile). The educational qualification of the married women was divided as illiterate (those who did not go to school), primary (those who attained class I to class V), secondary (those who studied up to class X) and higher secondary and above (those who studied above class X). Occupations of the women are divided into housewife, government employees and others. Other occupations include self employment, social workers, businesswomen etc.
The data were analyzed using MS-Excel for the present research. The data were analysed statistically to understand the child health. The health of the children are also analysed in relation with the socio-economic conditions of the mothers. In order to test the level of significance for various analyses, chi-square test was used.
Results
The frequency of breast feeding of children for twelve months above and up to eleven months was 78.9 percent and 21.1 percent respectively (Table-1). During the initial stage of breast feeding, 16.3 percent of children had problem while breast feeding and 83.7 percent of children did not have problem while breast feeding. The maximum number of children eats semi solid food after six months (71.7%) than after one year (28.3%). The higher frequencies of children are provided with polio drops (88.4%) and immunization (91.2%). The Table further shows that maximum number of mothers support government’s two children plan (97.2%).
Table-1: Breast feeding, problem during breast feeding, semi-solid food, polio drops and immunization of the children |
Variables |
N(251) |
Percentage |
| Breast feeding |
1-11 months |
53 |
(21.1%) |
12+months |
198 |
(78.9%) |
| Problem of breast feeding |
Yes |
41 |
(16.3%) |
No |
210 |
(83.7%) |
| Semi solid food |
After 6 months |
180 |
(71.7%) |
After 1 year |
71 |
(28.3%) |
| Polio drop |
Yes |
222 |
(88.4%) |
No |
29 |
(11.5%) |
| Immunization |
Yes |
229 |
(91.2%) |
No |
22 |
(8.8%) |
| Support Govt.'s Two Children Plan |
Yes |
244 |
(97.2%) |
No |
7 |
(2.8%) |
Table 2 shows the relationship between live birth and infant mortality in relation with mothers’ socioeconomic conditions. The infant mortality rate was higher among mothers who belong to middle income group (3.7%) followed by low income group (2.8%) and high income group (2.5%). The higher frequency of infant mortality was found more or less the same among mothers who are illiterate (3.4%) and primary education (3.3%). The frequencies of infant mortality among mothers who attained secondary and higher secondary education were 2.3 percent and 1.9 percent respectively. In relation with mother’s occupation, infant mortality was found only among mothers who are housewives (3.6%). The Table further shows that the frequency of live birth was higher among mothers from low income group (94.9%), secondary education (94.5%) and other occupations (100%). The frequency of live birth was more or less the same between women who are housewives (90.6%) and government employees (90.4%).
Table 2: Live birth and infant mortality in relation with mothers’ socioeconomic status |
Socioeconomic variables |
Total pregnancy |
Live birth |
Infant mortality |
Significance level |
Income level |
Low |
395 |
375(94.9%) |
11(2.8%) |
Χ2 =0.12;df=2; P>0.05 |
Middle |
162 |
146(90.1%) |
6 (3.7%) |
High |
161 |
132(81.9%) |
4(2.5%) |
Educational level |
Illiterate |
266 |
238(89.5%) |
9(3.4%) |
Χ2 =0.53;df=3; P>0.05
|
Primary |
181 |
163(90.1%) |
6(3.3%) |
Secondary |
220 |
208(94.5%) |
5(2.3%) |
Higher secondary |
51 |
44(86.3%) |
1(1.9%) |
Occupation |
Housewife |
638 |
578(90.6%) |
21(3.6%) |
Χ2 =2.17;df=2; P>0.05 |
Government employee |
52 |
47(90.4%) |
0(0.0%) |
Others |
28 |
28(100.0%) |
0(0.0%) |
Table 3 shows that the frequency of health check up of the children was higher in income family (96.9%) followed by low income (94.9%) and middle income family (92.4%). Similarly, the maximum number of children given vaccination (98.5%) and polio drop (98.5%) was found among higher income families. The higher frequency of health check up for children was found more or less the same among mothers who attained secondary education (96.0%) and primary education (95.6%). Whereas, the frequency of vaccination (92.9%) and polio drop (95.6%) given to the children was higher among mothers who attained primary education. In relation with mother’s occupation, the maximum percentage of health check up given to the children was found the same among mothers who are government employees (100.0%) and other occupations (100.0%). The frequency of vaccination given to the children was also found higher among mothers who are government employees (100.0%). Table further shows that the higher frequency of polio drop given to the children was found the same among government employees (100.0%) and other occupations (100.0%).
Table 3: Health check-up, vaccination and polio drops of children in relation with mothers’ socioeconomic status |
Socioeconomic variables |
No. of mothers |
Health check-up |
Vaccination |
Polio drop |
Significance level |
Income level |
Low |
119 |
113(94.9%) |
105(88.2%) |
105(88.2%) |
Χ2 =0.78;df=2; P>0.05 |
Middle |
66 |
61(92.4%) |
61(92.4%) |
61(92.4%) |
High |
66 |
64(96.9%) |
65(98.5%) |
65(98.5%) |
Educational level |
Illiterate |
56 |
53(94.6%) |
50(89.3%) |
50(89.3%) |
Χ2 =0.18;df=2; P>0.05
|
Primary |
68 |
65(95.6%) |
65(95.6%) |
65(95.6%) |
Secondary |
100 |
96(96.0%) |
91(91.0%) |
91(91.0%) |
Higher secondary |
27 |
24(88.9%) |
25(92.6%) |
25(92.6%) |
Occupation |
Housewife |
221 |
208(94.1%) |
202(91.4%) |
201(90.9%) |
Χ2 =0.58;df=2; P>0.05 |
Government employee |
19 |
19(100.0%) |
19(100.0%) |
19(100.0%) |
Others |
11 |
11(100.0%) |
10(90.9%) |
11(100.0%) |
Table 4 shows the overall health of the children in relation with mothers’ socioeconomic conditions. The overall good health of the children was significantly higher in high income group (89.4%) followed by low income group (73.9%) and middle income group (72.7%). In relation with mother’s educational level, the overall good health of the children was higher among those who attained higher secondary and above education (85.2%). This was followed by children whose mothers attained primary education (83.8%), secondary (81.0%) and illiterate (60.7%). Table further shows that the higher frequency of overall good health of the children was found the same between mothers who are government employees (100.0%) and other occupations (100.0%). The frequency of overall good health of the children whose mothers are housewife was 74.7 percent.
Table 4: Overall health of the children in relation with mothers’ socioeconomic status |
Socioeconomic variables |
No. of mothers |
Overall health |
Significance level |
Good |
Not Good |
Income level |
Low |
119 |
88(73.9%) |
31(26.1%) |
Χ2 =7.11;df=2; P<0.05 |
Middle |
66 |
48(72.7%) |
18(27.3%) |
High |
66 |
59(89.4%) |
7(10.6%) |
Educational level |
Illiterate |
56 |
34(60.7%) |
22(39.3%) |
Χ2 =7.99;df=3; P<0.05 |
Primary |
68 |
57(83.8%) |
11(16.2%) |
Secondary |
100 |
81(81.0%) |
19(19.0%) |
Higher secondary |
27 |
23(85.2%) |
4(14.8%) |
Occupation |
Housewife |
221 |
165(74.7%) |
56(25.3%) |
Χ2 =9.78;df=2; P<0.05 |
Government employee |
19 |
19(100.0%) |
0(0.0%) |
Others |
11 |
11(100.0%) |
0(0.0%) |
Discussion
Pregnancy and childbirth are normal physiological and social processes that carry health risks and require health care.[11] Pregnant women need to supply proper supplementary foods and medicines for her health as well as her children. Mother's milk is considered as the best food for the infants. Most of the mothers in the Lingmoo village feed their children with breast milk for more than one year and starts feeding semi-solid foods to their infants after six months from birth. North-East Indian states show very good practices of breast feeding and provide supplementary foods at the right age of 6 to 9 months.[13] Prolonged breast feeding helps to extend period of postpartum infertility and the length of birth intervals.[14] Maximum number of mothers took their children for polio drops and immunization in the public health centres in the present study. Immunization not only benefits the individual child, but it also benefits the society as a whole by preventing the spread of disease to those who are not immunized.[14]
The higher percentage of infant mortality rate is found more or less the same between the illiterate and primary educated mothers. Study further indicates that there is decrease in infant mortality rate with increasing educational levels of the mothers. Infant mortality is widely used as an indicator of public health, the quality of health services, distribution of wealth, and the general standard of living in a society.[15,16] Overall infant mortality rate is slightly low among Nepali children (3.6%) in present study as compared to different population like Khasi (4.2%), Goro (5.2%) and Dhur Gond (5.9%).[4,17] The infant mortality rate and under-five year mortality rate have been used as measures of children's well being.[13] The infant mortality rate shows fluctuation in different income levels. It shows higher rate among the children belonging to middle income family in the present study. In case of occupational levels, the higher rate of infant mortality is found among mothers who are housewives. Women in the higher income families can afford and provide all basic facilities like good education, health care, nutrition and so on. Further, educated women are likely to be more knowledgeable about nutrition, hygiene and health of the children.[18]
Children in the developing countries continue to face an onslaught of diseases and death from largely preventable factors.[19] Infancy and child care are important factors for a healthy living after birth. It is necessary to provide children with proper medical care, health check up, regular polio drops and vaccination. Lack of or incomplete vaccination remain the causes of millions of preventable child deaths each year in low/middle-income countries.[20] Proper immunization can easily prevent serious morbidity and mortality. Health check up for children is more or less the same among married women who are illiterate, primary education and secondary education. The high income families show higher frequency of health check up, vaccination and polio drops for their children in the present study. In different occupational groups, mothers who are government employees and other occupations show higher frequency of health check up, vaccination and polio drops for their children. Housewife mothers are quite often busy with their daily household chores and some of them are engaged in the seasonal irrigation works in the present study. This could be the reason why housewife mothers could not get enough time to take their children to health centres. Low immunization status is high in children whose parents were either illiterate or of low socioeconomic group.[21] Children whose parents are well-educated, wealthy or living in urban areas have a higher probability to be immunized against vaccine preventable diseases.[22,23]
In conclusion, the present study highlights the health of the children in association with mothers’ socioeconomic conditions. The overall health of the children is relatively good in the present study. Maximum number of mothers beast feed their infants and provide semi solid food after six months from birth. Most of the children in the village are provided polio drops and proper immunization. Socioeconomic conditions of the mothers show positive association with overall health of the children. Better socioeconomic mothers can relatively afford and provide better nutrition, medical facility as well as more awareness for health and hygiene.
References
- Strauss J, Thomas D. Health over the Life Course. In: Schultz TP, Strauss J, Editors. Handbook of Development Economics. Amsterdam, North Holland; 2008, Chp. 54.
- Wasunna A, Mohammad K. Low birth weight babies, socio-demographic and obstetric characteristics of adolescent mothers at Kenyatta National Hospital, Nairoibi. East African Med J. 2002;79(2):543-546.
- Harknett K. Why are Children with married parents Healthier, the case of Pediatric Asthma. Popul Res Polic Rev. 2009;28(3),347-365.
- Chandraker RC, Mitra SM, Bharati P. A Study of Reproductive and Child Health Among the Dhur gond Tribal Community of Mahasamund District, Chhattisgarh, India. Study of Tribes and Tribal. 2009;7(2):97-103.
- WHO. World statistics. 2011. Available at http://www.whoint/whosis/whostat/2011/en.html.
- Case A, Lubotsky D, Paxson C. Economic status and health in childhood: The origins of the gradient. American Econ Rev. 2002; 92:1308-1334.
- WHO. Family Planning: The Unfinished Agenda: Sex and Reproductive health.Geneva: World Health Organisation; 2006.
- Montgomery LE, Kiely JL, Pappas G. The effects of poverty, race and family structure on US children’s health: Data from the NHIS, 1978 through 1980 and 1989 through 1991. American J Publ Heal. 1996;86:1401-1405.
- Bauman LJ, Silver EJ, Stein REK. Cumulative social disadvantage and children’s health. Pediatrics. 2006;117:1321-3128.
- WHO. Global Health Observatory (GHO) data: Neonatal Mortality. World Health Organization; 2017. Available at http://www.who.int/gho/child_health/mortality/neonatal_text/en/ (Accessed 12 April 2020).
- WHO. Mental Health aspect of Women`s Reproductive Health, A Global Review. Geneva: World Health Organization; 2009.
- Mason JE. Identifying Factors of Influence on Family Planning Practices among Rural Haitian Women. 2010. Available at http://d-scholarship.pitt.edu/7071/1/Mason2010etd.pdf
- Lalneizo D, Reddy S. 2010. Health Status of Children in North Eastern States of India. Indian Anthropo Assoc.2010;40(2):37-52.
- WHO. Infant and Young Child Feeding. A tool for Assessing National Practices, policies and Program. Geneva: World Health Organization; 2003.
- Antonowsky A, Bernstein J. Social class and infant mortality. Soc Sci Med. 1977;11:453-70.
- Stockwell EG, Swanson DA, Wicks JW. Temporal variations in the relationship between infant mortality and economic status. Soc Indic Res. 1998;20:217-227.
- Adak DK. Mortality in three tribal population of Shillong. J Hum Ecol. 2001;12:147-152.
- Marthi MG, Guio AN, Dreze J. Mortality, Fertility and Gender bias in India. A district Level analysis. Popu Dev Rev. 1995;21(4):745-782.
- The World Bank. Environmental Health and Child Survival: Epidemiology Economic Experiences, the International Bank for Reconstruction and Development. The World Bank: Washington DC; 2008.
- Hajizadeh M. Socioeconomic inequalities in child vaccination in low/middle-income countries: what accounts for the differences? J Epidemiol Comm Heal.2018;72:719-725.
- Ibnouf AH, Van den Borne HW, Maarse JM. Factors influencing immunization coverage among children under five years of age in Khartoum state, Sudan. South African Fam Pract. 2007;49:14.
- Berkley S, Chan M, Elias C et al. Global vaccine action plan 2011-2020: Decades of Vaccines Collaboration: World Health Organization; 2012.
- Glatman-Freedman A, Nichols K. The effect of social determinants on immunization programs. Hum Vacci Immunother. 2012;8:293-301.
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