Introduction

The health of the child is the outcome of cumulative effect of various factors which include biological, socio-economic, environmental, parental factors etc. Socio-economic status plays a significant role in child health. Socio-economic determinants such as poverty, low education level and limited access to basic amenities contribute to higher child mortality rates.[1] Children from disadvantage backgrounds may face higher risks of under-nutrition, poor access to health care and inadequate living conditions.[2] Factors such as maternal education, rural-urban disparities, family income, poor nutritional status, completion of immunization programs and health-seeking behavior can influence child mortality.[3] Breast feeding, proper nutrition, hygienic practices and timely initiation of supplementary foods can significantly influence a child's health and development.[4] Studies have shown that higher levels of maternal education are associated with lower child mortality rates.[5] The size of the child at birth including birth weight and gestational age is an important determinant of child mortality.[6] Child nutrition outcomes are recognized as key indicators for tracking the nutrition and health status of children.[7]

Under this background, the present study was conducted to understand the child health and its association with maternal socio-economic conditions among the Adivasi children of Jorhat district of Assam.

Materials and Methods

Assam, a state located in the North-Eastern part of India not only known for its scenic natural beauty and biodiversity but also has a unique identity for producing best quality tea. Tea Industry is the backbone of Assam economy. Adivasi population also known as tea tribe or tea garden community is an integral part of Assam and Assam’s tea industry. In Assam, the term ‘Adivasi is usually referred to the emigrant tea garden laborers along with their present generation whose ancestors were previously mobilized by colonial planters in the nineteenth century.[8] They constitute approximately 1/5^th of the State’s population. Assam has a total population of 31.2 million and the tea garden communities constitute around 18 to 20 percent (approximately 6.5 million) of the total population.

For present study, seven tea garden areas of Jorhat district were randomly selected for data collection. Data on child health and maternal socio-economic conditions were collected from 409 married women who have at least a child less than five year of age through interviews using structured schedules. Data on birth weight, breast feeding practices, illness, immunization, overall health of the child was collected from each mother through interview. Data on socio-economic conditions like occupation, household income, and educational attainment were collected from each mother. The data on income was divided into three groups such as high income (above 75^th percentile), middle income group (between 50^th-75^th percentile) and low income group (below 50^th percentile). The educational level of the married women was divided as lower primary (those who attained class I to class V), upper primary (those who attained class VI to class IX) and secondary and above (those who studied up to class X and above). Occupations of the married women were divided into permanent tea garden worker, daily wage earner and housewife. Permanent tea garden workers enjoy housing facilities, weekly ration, primary medical care, paid maternity leave and some other bonus.

Anthropometric measurements were collected to assess the nutritional status of children. Anthropometric measurements such as weight and height were collected from children aged 1 to 5 years using standard equipments and procedures. The Child Growth Standards were used to calculate the z scores for stunting-height for age (HAZ), underweight-weight for age (WAZ) and wasting-weight for height (WHZ).[9] According to WHO recommendations, a child is considered stunting when his or her HAZ<-2SD from the reference population median. A child whose WAZ<-2SD from the reference population median is considered as underweight and a child whose WHZ<-2SD from the reference population median is considered as wasting. The data were analyzed using MS-Excel for the present research. The health of the children was also analyzed in relation with the socio-economic conditions of the mothers. In order to test the level of significance, chi-square test was used.

Results

Table 1 show that the frequency of the children who had normal birth weight (between 2.5kg and 4.5kg) and low birth weight (less than 2.5kg) was 61.37 percent and 38.63 percent respectively. 53.54 percent of the children were breastfed within 1^st hour of birth and 46.45 percent of the children were breastfed after 1^st hour of birth. Only 26.65 percent of the children were exclusively breastfed while the higher frequency of children (73.35%) was not exclusively breastfed. The table further shows the frequency of children who had illness during the preceding fortnight from the day of interview was 13.93 percent. The prevalence of underweight, stunting and wasting among the children was 36.67 percent, 40.59 percent and 14.42 percent respectively.

Table 2 shows the association of children’s malnutrition and maternal socio-economic conditions. The prevalence of underweight was significantly (Χ²=18.63;df=2; p<0.05) higher among the children whose mothers belong to low income group (42.86%), followed by middle income group (41.80%) and the high income group (18.36%). The frequency of stunting was also significantly (Χ²=28.98;df=2;p<0.05) higher among the children whose mothers belong to low income group (48.68%), followed by middle income group (46.72%) and the high income group (17.35%). Further, the significantly (Χ²=6.16; df=2; p<0.05) higher frequency of wasting was found among the children from low income group (17.99%), followed by middle income group (14.75%) and the high income group (7.14%). The higher frequency of underweight was found among the children whose mothers attained secondary and above education (41.00%), followed by mothers who attained upper primary education (35.88%) and lower primary education (31.94%). The frequency of stunting was higher among the children who mothers attained secondary and above education (47.00%), followed by mothers who attained lower primary education (40.43%) and upper primary education (38.17%). The higher frequency of wasting was found among the children whose mothers attained secondary and above education (16.00%), followed by mothers who attained upper primary education (15.27%) and lower primary education (6.38%). The prevalence of underweight was higher among the children whose mothers are housewives (40.62%), followed by permanent tea garden workers (29.82%) and daily wage earners (29.82%). The frequency of stunting was highest among the children whose mothers are daily wage earners (42.97%), followed by housewives (38.54%) and permanent tea garden workers (33.33%). The higher frequency of wasting was found among the children whose mothers are daily wage earners (15.23%), followed by housewives (13.54%) and permanent tea garden workers (12.28%).

Table 3 shows the relationship between mother’s socioeconomic conditions and birth weight of the children. The slightly higher frequency of low birth weight was found among the children from middle income group (41.80%), followed by low income group (39.68%) and high income group (32.65%). The significantly (Χ²=25.74; df=2; p<0.05) higher frequency of low birth weight was found among the children whose mothers attained lower primary education (72.34%), followed by upper primary education (35.11%) and secondary and above education (32.00%). The frequency of low birth weight was found higher among children whose mothers are daily wage earners (41.80%), followed by permanent tea garden workers (40.35%) and housewives (29.17%).

Table 4 shows the overall health of the children in relation with mother’s socioeconomic conditions. The overall good health of the children was found significantly (Χ²=34.01; df=2; p<0.05) higher among the middle income group (80.32%), followed by high income group (79.59%) and low income group (52.91%). The overall good health was significantly (Χ²=13.88; df=2; p<0.05) higher among the children whose mothers attained secondary and above education (75.00%), followed by upper primary education (68.70%) and lower primary education (44.68%). The overall good health of the children was higher among children whose mothers are daily wage earner (70.31%), followed by permanent tea garden workers (63.16%) and housewives (62.50%).

Discussion

In the present study, 38.63 percent of newborns had low birth weight which is a matter of concern because low birth weight is strongly associated with peri-natal morbidity and increased risk of long-term disability¹.[10] The COVID-19 pandemic has exacerbated these challenges, leading to increase economic and social stress.[11] It also reduces access to adequate prenatal care, maternal follow-ups and essential supplements resulting in a higher incidence of LBW newborns during the lockdown period.[12]

A systematic review published in 2015 reported that late initiation of breastfeeding after the first hour of life is associated with an increased risk of neonatal death.[13] According to the findings of the present study, 53.54 percent of children breastfed within 1^st hour of birth which means almost a half of the children were at an increased risk of neonatal death.

Brown et al. (2012) shows that exclusive breastfeeding is one of the factors that can substantially reduce under 5 year child mortality rate.[14] Exclusive breastfeeding is one of the factors that can substantially reduce under 5 year child mortality rate. World Health Organization recommends exclusive breastfeeding for six months, and the continuation of breastfeeding alongside solid foods for up to two years.[15] In the present study, it is found that only 26.65 percent of children are exclusively breastfed. One of the reasons behind this can be maternal occupations. Among the Adivasi people of Assam, active participation of women in earning livelihood is noted and tea industry being an informal sector, most of the women could not get paid maternity leave. Hence, due to economic hardship, they have to go outside to work leaving behind their children at home. This may be one of the reasons for lower frequency of exclusively breastfed children.

Under-nutrition accounts for approximately half of all deaths among children less than five year of age.[16] Childhood under-nutrition has a long lasting effect over the life cycle such as cognitive impairment, lower educational attainment, higher vulnerability to chronic diseases, and declining productivity as well as earnings.[17,18] Present study shows the prevalence of underweight, stunting and wasting as 36.67 percent, 40.59 percent and 14.42 percent respectively. According to National Family Health Survey-5, the prevalence of underweight, stunting and wasting were 32.1 percent, 35.5 percent and 19.3 percent respectively at national level. The comparison with the national level depicts the existing disparities in the improvement of nutritional status across the country. A study conducted among the tea garden population had found high prevalence of underweight among children and thinness among adults.[19] The financial circumstances of families play an important role in predicting the malnutrition of the children as increased financial power enable people in spending money toward the ideal nutritional requirement of their families.[20] A significant association is found between the nutritional status and income group in the present study. Maternal educational level is also found to have statistically significant association with birth weight and overall good health of the children in the present study. Studies have shown that higher levels of maternal education are associated with lower under-five mortality rates.[5]

Conclusion

The present study has highlighted the undernutrition challenges faced by the Adivasi children of Assam. The economic plight along with health disparities is a matter of concern among the Adivasi population who primarily depends on the tea gardens and lives in the tea estates. Mother being the prime care giver, plays a significant role in the health outcome of her children. Therefore, efforts should be made to empower women because educated and financially empowered women have the potential to bring up healthy children using the available resources more efficiently.

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