JAC : A Journal Of Composition Theory ISSN : 0731-6755

CHILD HEALTH CARE STATUS IN OF - A CASE STUDY

D.PARAMESWARAN, Ph.D. Research Scholar PG & Research Department of Economics Government Arts College (Autonomous) Salem – 636 007, Tamil Nadu Abstract

India is home to the largest child population in the world. Being healthy is a valuable achievement in itself. Healthy persons are capable of utilizing economic opportunities available in the society in a better way than others. Motherhood is the supreme fulfillment in women’s life. Many women die in the process of child birth in many countries of the world, especially in developing countries. Children suffer most when mother dies, as children whose mother died, are three times more likely to receive less health care and also more likely to die. The event of maternal death is a concern to the family, children, community, state and nation as it affects the national productivity. A structured interview schedule was used to elicit information and data from the selected respondents. By conducting personal interviews and discussion with the mothers of the child data were obtained.

Key words: Women health, child care, health care, maternal death, women empowerment, etc.

1. Introduction

India is home to the largest child population in the world. The Constitution of India guarantees fundamental rights to all children in the country and empowers the State to make special provisions for children. The Directive Principles of State Policy specifically guide the State in securing the tender age of children from abuse and ensuring that children are given opportunities and facilities to develop in a healthy manner in conditions of freedom and dignity. The State is responsible for ensuring that childhood is protected from exploitation and moral and material abandonment.

2. Concept of heath

The word health is derived from the old English word ‘Hal’ meaning hale, whole healed, sound in mind, and limb. There is no such single concept of health, which is acceptable to all. According to Webster’s New Dictionary health is ‘the

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condition of being sound in body, mind or spirit especially freedom from physical disease and pain’. Optimum health is the highest stage of sound health and everyone should be endeavoring to attain this level. Being healthy is a valuable achievement in itself. Healthy persons are capable of utilizing economic opportunities available in the society in a better way than others. Hence, at the international level, the Universal Declaration of Human Right established a breakthrough in 1948, by stating in Article 25, ‘Every one has the right to a standard of living adequate for the health and well-being of himself and his family.’

3. Maternal and child health: Global scenario

Complications of pregnancy and child birth are the leading cause of death and disability among women of reproductive age in developing countries. The millennium development goals call for reducing the maternal mortality rates by 75 per cent between 1990 and 2015, but few countries and no developing country region on average will achieve this target. They die because they are poor, malnourished and weakened by disease and lack of accessibility to trained health worker and modern medical facilities. In poor countries the life time risk of maternal death may be more than 200 times greater than for women in Western Europe and North America (World Bank, 2012).

Table 1 Health Indicators among Selected Countries in 2018

Maternal Infant Mortality Life Expectancy Mortality Rate Total Fertility Country Rate (IMR/1 000 M/F (in years) (MMR/1000 Rate (TFR) Live- Births) Live- Births) India 58 63.9/66.9 301 2.9 China 32 70.6/74.2 56 1.72 Japan 3 78.9/86.1 10 1.35 Republic of 3 74.2/81.5 20 1.19 Korea Indonesia 36 66.2/69.9 230 2.25 Malaysia 9 71.6/76.2 41 2.71

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Vietnam 27 69.5/73.5 130 2.19 Bangladesh 52 63.3/65.1 380 3.04 Nepal 58 62.4/63.4 740 3.40 Pakisthan 73 64/64.3 500 3.87 Srilanka 15 72.2/77.5 92 1.89

4. Maternal and child health status: Indian scenario

India’s health indicators are almost at the same level as the average of low income economies. India compares unfavorably even with low income countries in terms of availability of health infrastructure and its utilization, as well as the overall disease burden. From among the 10.8 million under five (infant and child) death per year in the world, 2.4 million (22.2 per cent) are in India (Black, Morris and Bryce 2003). Death of children below age 5 is associated with socio- economic characteristics and it is higher in rural areas as against urban areas. Poor self-assessed health tends to be concentrated among women who are poor and belong to deprived ethnic or racial groups.

5. Review of literature

Kateja (2001) reported that Rajasthan does not perform fairly well on the human development front. Concentrating on the health and education will not only lower infant mortality rate but also improve the overall social development in the State. Hence, supporting public services such as primary health care and basic education must be the top most priority of the state government.

Goel (2005) highlights the importance of family planning as an instrument for the promotion of health. He states that the family planning and health are intimately related. Family planning can promote women’s health through the prevention of unwanted pregnancies, limiting number of births and proper spacing, timing of births and foetal health. It also promotes the health of the child through the reduction of child mortality and promotion of the child development.

Seema and Khairunnisa Begum (2008) studied child rearing practices among the tribals in villages of Nanjungud Taluk in Karnataka State. The study

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reveals that allopathic and herbal medication was in common use among these tribals. The tribals are experiencing radical change in their views and practices. Although they continue to live in secluded areas, urbanization has made an impact on their practices and livelihood, which also includes child rearing practices.

Rejumoni Sarma (2010) examined the cultural practices and their effect on reproductive health condition of the two Tiwa villages of Morigaon district, Assam. It is observed that the food habit, income, individual hygiene, methods of sanitation, traditional way of delivery, poor communication system and their cultural belief play a key role in their reproductive health status.

Srinivasan and Dhandapani (2012) pointed out women’s health in India and key challenges in health sector. According to them, biological and social factor affect women’s health. Women’s health is also affected by fertility, education, utilization of health care services, cultural factors and working status of women. Infant and maternal mortality are decreasing, but slowly. The study also states that developing countries are faced with an unfinished health agenda of problems like malnutrition, increasing prevalence of chronic and cardiovascular diseases resulting from an ageing population.

6. Statement of the problem

Motherhood is the supreme fulfillment in women’s life. Many women die in the process of child birth in many countries of the world, especially in developing countries. Children suffer most when mother dies, as children whose mother died, are three times more likely to receive less health care and also more likely to die. The event of maternal death is a concern to the family, children, community, state and nation as it affects the national productivity. Children, the asset of the nation, are highly influenced by the health of their mothers.

7. Objectives of the study

This study is carried out on the basis of the following objectives,

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1. To examine the perception about maternal and child health care services among inhabitants of the study area.

2. To bring out the health status of the children in the selected blocks of Salem district.

3. To identify the causes for child health ailments in the study area.

8. Selection of the study area

The present study is focusing on Salem district in the state of Tamil Nadu. Based on the data collected from the Census of India 2011, District Hand Book, Salem the total population of Salem district is 34,82,056 out of which male is 17,81,571 and female is 17,00,485. The district is divided into 20 blocks for the administrative purpose. Out of which 4 blocks are selected for the study. Salem and blocks stands highest in terms of female population with 3,80,866 and 86,671 respectively. On the contrary, Konganapuram and blocks with least female population in the district with 30,485 and 19,245 respectively.

9. Methodology

The study is based on both secondary and primary data collected from the selected members of the selected blocks in the Salem district. The field survey has been designed in such a way that it is objective and unbiased. After selecting the four blocks in terms of female population their total numbers of households have been taken in to account. The total numbers of households of the selected four blocks are: Salem (21,851), Omalur (48,894), Konganapuram (18,529), and Yercaud (10,772). Since, the total population is too vast in the selected blocks the number of respondents have been selected in such a way in order to obtain equal representation of the selected blocks have been given in the below table.

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Table 2 Selection of the Sample Size Total no Total Name of the Total no of households 5 % from the Total no of Female Blocks Households divided by population Samples Population 10 Salem 2,185/5x100 3, 80,866 21,851/10 2,185 109 =109 Omalur 4,887/5x100 86,671 48,894/10 4,887 244 =244 Konganapuram 1,852/5x100 30,485 18,529/10 1,852 93 =93 Yercaud 1,077/5x100 19,245 10,772/10 1,077 54 =54 500

As revealed in the above table the total number of households in the selected blocks is divided by 10 and the values are obtained. From the obtained value, 5 per cent of the population was taken as samples by using proportionate random sampling method to obtain the sample size. Hence, sample size is 500.

10. Method of data collection

The present study in based on the data collected from the selected respondents in Salem district. Hence, utmost care was exercised to collect the data from the study area. A structured interview schedule was used to elicit information and data from the selected respondents. By conducting personal interviews and discussion with the mothers of the child data were obtained.

11. Framework of analysis

The collected data were classified, coded and tabulated for analysis. The statistical tools like percentage, mean, standard deviation, and co-efficient of variation were used for descriptive analysis. Analysis of variance and chi-square test were used to test the hypothesis formulated. In order to determine the health status of the children in the study area with appropriate variables the multiple linear regression model has been employed.

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12. Analysis and interpretation

Table 3 Age wise classification of the Respondents

Age (years) Name of the Total 18-28 28-38 38-48 48-58 Above 58 Block No. % No. % No. % No. % No. % No. %

Salem 18 25.71 39 23.49 35 22.88 13 17.11 4 11.43 109 21.80 Omalur 36 51.43 78 46.99 65 42.48 45 59.21 20 57.14 244 48.80 Konganapuram 11 15.71 28 16.87 35 22.88 11 14.47 8 22.86 93 18.60 Yercaud 5 7.14 21 12.65 18 11.76 7 9.21 3 8.57 54 10.80 Total 70 100 166 100 153 100 76 100 35 100 500 100 Source: Primary Data

Age is a crucial factor which determines the possibility of fertility of the women respondents. In this study, different age groups of the women respondents have been classified out of the 109 samples taken from . 18 (25.71%) respondents belong to age group between 18 – 28 years, 39 (23.49%) respondents belong to the age group 28-38 years, 35 (22.88%) respondents from the age group between 38-48 years and about only 4 (11.43%) respondents belong to the age group above 58 years. Majority of the respondents lie in the category between 28- 38 years. Similarly all the other three blocks age wise classification of the women respondents is given. Women between the age group 28-38 years stand highest with 166 respondents out of 500 Total samples.

Table 4 Educational Qualification of the Sample Respondents

Number of Education Percentage Respondents Illiterate 24 4.8 Primary school 224 44.8 SSLC 124 24.8 H.Sc 102 20.4 Graduate 26 5.2 Total 500 100 Source: Primary Data

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Educational qualification of the respondents is one of the crucial determinants of the standard of living of the respondents. Out of 500 samples, 24 (4.8%) respondents are illiterate, 224 (44.8%) respondents have gone up to primary school level, 123 (24.8%) sample respondents studied up to SSLC, 102 (20.4%) respondents have finished H.Sc and 26 (5.2%) respondents are graduates. It is obvious that the majority of the respondents have primary education. At the same time the percentage of illiterate also very meager, due to effective implementation of the education policy of the government.

Table 5

Status of Antenatal checkup during last pregnancy

Yes No Total Block No. % No. % No. % Salem 86 22.28 23 20.18 109 21.80 Omalur 187 48.45 57 50.00 244 48.80 Konganapuram 73 18.91 20 17.54 93 18.60 Yercaud 40 10.36 14 12.28 54 10.80 Total 386 100.00 114 100 500 100 Source: Primary Data

Making antenatal check up during the pregnancy period is obviously secure and safe thorough which the complications in the delivery may be avoided. Problem with the pregnant women can be diagnosed and cured well in relevance. Otherwise it will lead to complicated pregnancy. Taking the , 40 (10.36%) respondents have done antenatal check up during their last pregnancy and the remaining 14 (12.38%) respondents have not done antenatal check up.

Table 6 Health Services Obtained At least once during the Pregnancy

Kongana Salem Omalur Yercaud Total Block puram No % No. % No. % No. % No % Tetanus injection 4 3.67 18 7.38 4 4.30 3 5.56 29 5.80 Irontablets/syrup 18 16.51 29 11.89 10 10.75 10 18.52 67 13.40 Weight check-up 18 16.51 45 18.44 12 12.90 5 9.26 80 16.00 Blood/ Urine tests 23 21.10 56 22.95 19 20.43 10 18.52 108 21.60

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Blood pressure 14 12.84 35 14.34 18 19.35 8 14.81 75 15.00 Hb test 26 23.85 53 21.72 23 24.73 15 27.78 117 23.40 Overall physical 6 5.50 8 3.28 7 7.53 3 5.56 24 4.80 examination Total 109 100 244 100 93 100 54 100 500 100 Source: Primary Data

During the pregnancy period various kinds of examinations and tests for the carrying mother should be carried out in order to ensure the above of complication at the time of delivery. Taking the Yercand Block, 3 (5.56%) respondents have taken Tetanus injection, around 10 (18.52%) respondents were advised to take iron tablets/syrup, about 5 (9.26%) of the respondents have checked their weight, 10 (18.52%) respondents have undergone blood / urine tests, 8 (14.81%) respondents have checked their blood pressure, 15 (27.78%) of the respondents have done HB test, and 6 (5.50%) respondents have undergone over all physical examination. It is apparent that the maximum respondents have taken Hb test to avoid anemia so as to avoid complicated pregnancy.

Table 7 Opinion about Role of Regular Checkup in Reducing Risk of Mortality

Yes No No idea Total Name of the Block No. % No. % No. % No. %

Salem 89 20.89 15 25.42 5 33.33 109 21.80 Omalur 212 49.77 28 47.46 4 26.67 244 48.80 Konganapuram 80 18.78 10 16.95 3 20.00 93 18.60 Yercaud 45 10.56 6 10.17 3 20.00 54 10.80 Total 426 100.00 59 100.00 15 100.00 500 100 Source: Primary Data

Women and child mortality may be avoided by having regular health check-ups during the pregnancy period. The opinions of respondents over this issue are presented in Table 9. In Salem Block, out of 109 total samples around 89 (20.89%) respondents have accepted this and 15 (25.42%) respondents have not agreed with this. Out of total 500 samples collected, 426 respondents have agreed that the regular check up reduces the risk of mortality the remaining 59 respondents have not agreed and around 15 respondents have said “No Idea”.

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Table 8 Determinants of Child Health Status Salem Omalur Konganapuram Yercaud Total Determinants No. % No. % No. % No. % No. % Balanced diet 25 22.94 56 22.95 23 24.73 14 25.93 118 23.6 Supplementary 22 20.18 68 27.87 28 30.11 11 20.37 129 25.8 food Parental care 18 16.51 35 14.34 18 19.35 8 14.81 79 15.8 Sanitary habits 16 14.68 24 9.84 15 16.13 6 11.11 61 12.2 Cleanliness 12 11.01 35 14.34 5 5.38 8 14.81 60 12 Impart health 16 14.68 26 10.66 4 4.30 7 12.96 53 10.6 awareness Total 109 100 244 100 93 100 54 100 500 100 Source: Primary Data

Various determinants like balanced diet, supplementary food given to the children parental care, etc. have been analyzed. Many of the factors are primarily rely on the income of the parents, which means if the income of the parents is high they can afford to provide healthy, wholesome and sumptuous food for their children similarly they would be able to give better medical facilities when they fall in sick. In the selected blocks of Salem district, out of 500 total respondents 118 (23.6%) respondents have agreed balanced diet, 129 (25.8%) of the respondents have said supplementary foods given to the children, 79 (15.8%) samples told parental care over the children, 61 (12.2%) respondents have opined that the sanitary and hygienic habits of the children would bring better health, 60 (12%) respondents agreed with cleanliness of home and surroundings, and 53 (10.6%) of the respondents have told by imparting health awareness to the children we can maintain better health for the children.

Table 9 Distribution of the Diseases Children Suffered very Often

Salem Omalur Konganapuram Yercaud Total Diseases No. % No. % No. % No. % No. % Fever 35 32.11 87 35.66 29 31.18 18 33.33 169 33.80

Cold & cough 24 22.02 92 37.70 28 30.11 15 27.78 159 31.80 Diarrohea 28 25.69 40 16.39 25 26.88 16 29.63 109 21.80 Alergy 12 11.01 10 4.10 5 5.38 2 3.70 29 5.80 fits 6 5.50 7 2.87 2 2.15 1 1.85 16 3.20

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Jaundice 4 3.67 8 3.28 4 4.30 2 3.70 18 3.60 Total 109 100 244 100 93 100 54 100 500 100 Source: Primary Data

Children in the study area would frequently suffer from various diseases due to malnutrition and lack of immunization. Out of 500 total samples, 169 respondents have said their children frequently suffer from fever, 159 respondents said their children suffer from cold and cough, 109 respondents opined their children frequently suffer from diarrhea, 29 respondents said their children suffer from allergy and 18 respondents have said suffered from jaundice. It is evident from the table that maximum children suffering from fever, and secondly from cold and cough.

13. Findings

 Out of 109 samples taken from Salem block, 18 (25.71%) respondents belong to age group between 18 – 28 years, 39 (23.49%) respondents belong to the age group 28-38 years, 35 (22.88%) respondents from the age group between 38-48 years and 4 (11.43%) respondents belong to the age group above 58 years. Women between the age group 28-38 years stand highest with 166 respondents out of 500 samples.

 The majority of the respondents have finished only primary education. At the same time, the percentage of illiterate also very meager, due to effective implementation of the education policy of the government. Universalisation of the primary education was intensively executed.

 In Yercaud Block, 40 (10.36%) respondents have done antenatal check up during their last pregnancy and the remaining 14 (12.38%) respondents have not done antenatal checkup.

 It is apparent that the maximum respondents have taken Hb test to avoid anemia so as to avoid complicated pregnancy.

 Out of total 500 samples, 426 respondents have agreed that the regular check

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up reduces the risk of details the remaining 59 respondents have not agreed.

 Out of 500 respondents, most of the respondents have said their children are suffered frequently from fever, cold and cough than any other ailments.

14. Reference

Goel, S.L. (2005). Population Policy and Family Welfare, Reproductive and Child Health

Rijumoni Sarma (2010). Cultural practices and their effect on reproductive health among the Tiwas of Assam. New Delhi: Aryan Book International, 97-149

Seema, K. N., & Khairunnisa Begum (2008). Child rearing practices among Kurubas and Soliga tribals from South India. Studies of Tribals, 6, 59-62

Srinivasan, K., & Dhandapani, C. (2012). Women health in India. New Delhi: Global Research Publications, 197-205.

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