Review Of Literature Evolution Of Child Health Services In India Health Essay

Published: 2021-07-15 09:55:05
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The care of Children has been in existence from the beginning of civilization. In India, during Vedic period in Manu Samhita, have been mentioned about the rules and regulation for personal health & hygienic rituals at the time of birth. Approximately around 400 years back, Charaka and Sushrutha (the ancient physicians) have described the care of mother and child and advocated sound principles for their care.
In 1932, Maternity and Child Welfare Bureau was established under Indian Red Cross society. In 1946, Bhore Committee in its recommendation gave high priority to Child Health Services and for developing them as an integral part of general health services.
In 1975, systems of ICDS laid foundations for convergence of child health services at the anganwadi centres at village level covering basic services to children below 6 years. After successful eradication of smallpox in the year 1976, the expanded programme of Immunization (EPI) was launched, this became ultimately Universal Immunization Programme (UIP) in 1985. UIP was further continued by launching Child Survival and Safe Motherhood Programme in the year 1992.
Concept of New born and Child Health
To achieve the goals of NRHM, the department of health & family welfare is implementing the following health programs.
Essential New Born Care
Universal Immunization Programme (UIP)- carried out against sic vaccine preventable diseases.
Control of deaths due to acute respiratory infections (ARI)
Control of diarrhoeal diseases
Provision of home based neonatal care to address the issue of the neonates (infants for the first 28days of life)
Facility based New Born Care: Sick Newborn Care Units (SNCUs) are being set up at district hospitals, with newborn care corners and stabilization units at Community Health Centres, so that the inpatient care for sick borns are accessible and available 24X7 in atleast one centre in each district.
Prevention and treatment of micronutrient deficiencies, namely Vitamin A: the programme aims to decrease the prevalence of vitamin A deficiency to the level at which they cease to be a public problem. The activities undertaken are health and nutrition education, vitamin A supplementation, early detection and prompt treatment of vitamin A deficiencies.
Exclusive breast feeding: Breastfeeding is one of the most important determinants of child survival, birth spacing, and prevention of childhood infections. Exclusive breastfeeding for six months has many benefits for the infant and the mother. Chief among these is protection against gastro-intestinal infections which is observed not only in developing but also in industrialized countries. Early initiation of breastfeeding, within one hour of birth, protects the newborn from acquiring infections and reduces newborn mortality. The risk of mortality due to diarrhoea and other infections can increase in infants who are either partially breastfed or not breastfed at all. (WHO).
Breast milk is also an important source of energy and nutrients in children 6 to 23 months of age. It can provide one half or more of a child's energy needs between 6 and 12 months of age, and one third of energy needs between 12 and 24 months. Breast milk is also a critical source of energy and nutrients during illness and reduces mortality among children who are malnourished. (WHO)
9. Complementary feeding is defined as the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk. The target age range for complementary feeding is generally taken to be 6 to 24 months of age, even though breastfeeding may continue beyond two years .
10. Nutrition and development:
In the long-term, early nutritional deficits are linked to impairments in intellectual performance; work capacity, reproductive outcomes and overall health during adolescence and adulthood. Thus, the cycle of malnutrition continues, as the malnourished girl child faces greater odds of giving birth to a malnourished, low birth weight infant when she grows up.
Poor breastfeeding and complementary feeding practices, coupled with high rates of infectious diseases, are the principal proximate causes of malnutrition during the first two years of life. For this reason, it is essential to ensure that caregivers are provided with appropriate guidance regarding optimal feeding of infants and young children.
11. Integrated Management of neonatal and childhood illness (IMNCI) strategy encompasses a range of interventions to prevent and manage the commonest and major newborn childhood conditions which cause death among newborn and under five children.
Review of studies done on Infant care and rearing practices:
Infant mortality rate is universally regarded not only as a most important indicator of the health status of a community but also of the level of living of people in general and effectiveness of Maternal and Child health (MCH) services in particular.
Infant mortality rate and Crude birth rate:
Crude Birth rate (CBR) and IMR in developed countries is much lower than developing countries; in United States CBR is 13.29/1000 mid-year population and IMR is 6.06/1000 live births and in United Kingdom CBR is 12.29/1000 mid-year population and IMR is 4.62/1000 live births; while in Russia CBR is 11.05/1000 mid-year population and IMR is 10.08/1000 live births [3]
In Asia, newborns’ survival chances are better in Japan as compared to Pakistan, India and Bangladesh. In Japan CBR is 7.31/1000 mid-year population and IMR is 2.78/1000 live births, in Indonesia CBR is 25.34 and IMR is 19.34, in Malaysia CBR is 21.08 and IMR is 15.2, in Singapore CBR is 8.05 and IMR is 2.32 and in India CBR is 21.8/1000 mid-year population and IMR is 44/1000 live births.[3]
There is a wide disparity in CBR and IMR, among the states in India and also between rural and urban areas. In Uttar Pradesh CBR is 27.8/1000 mid-year population in total, in which rural area constitutes about 28.8/1000 mid-year population and IMR is 57/1000 live births in total, and in rural area 60/1000 live births, in Rajasthan CBR is 26.2/1000 mid-year population in total, rural area constitutes about 27.4/1000 mid-year population and IMR is 52/1000 live births in total and in rural area is about 57/1000 live births. Few states shows improved CBR and IMR like in Kerala CBR is `15.2/1000 mid-year population in total, in rural area 15.4/1000 mid-year population and IMR is 12/1000 live births in total, 13/1000 live births in rural area. In Tamil Nadu CBR in total is 15.9/1000 mid-year population, in rural area is 16/1000 mid-year population and IMR is 22/1000 live births in total and in rural area is 24/1000 live births. In Puducherry CBR is 16.1/1000 mid-year population in total, 16.4/1000 mid-year population in rural area and IMR is 19/1000 live births in total, 21/1000 live births in rural area.
Institutional delivery:
Institutional delivery rate in Puducherry was 99.1 % in general and 97.4% in rural area (DLHS-3) whereas in India was 47% in total & 37.9 % in rural area. Around 0.8% in total and 2.6% in rural population were delivered in home in Puducherry. [10] In India around 52.3% in general and 61.3/% in rural area were delivered in home. Compared to this, institutional delivery rate countrywide was 40.7 % and 31.1% in general and in rural area respectively (NFHS-3) [5]
Moran AC et al conducted a study on Newborn care practices among slum dwellers in Dhaka, Bangladesh. From the study , the most of the women gave birth at home (84%) and women who had knowledge about drying the baby (64%), wrapping the baby after birth (59%), and cord care (46%).
Baqui A.H el al 2007 conducted in rural Uttar Pradesh on new born care practices reported more than 37% of the infants umbilical were applied with turmeric powder, mustard oil, ash, mud or talcum powder after cutting it. Majority of the infants were not dried immediately after delivery, and most of the time these babies were dried after the delivery of placenta [16]
Bhanderi et al 2007 concluded that, out of 190 women who have delivered a baby in last one year, 97 delivered in private hospitals (51.05%) and 56 (29.5%) at government health facilities in Gujarat. Institutional delivery rate was 86.3%. Caesarean section (CS) rate among all deliveries was 15.3%.
Dasgupta et al 2006 showed that in Birbhum district of West Bengal, 51.88% deliveries took place at Government health facilities. Private health facilities catered to 9.69%. 37.81% deliveries were conducted at home. However two deliveries took place at transit. More than one- fifth deliveries (20.63%) were assisted by untrained dais. Trained birth attendants provided assistance only in 13.76% deliveries. Other trained persons such as ANMs, Government doctors and private doctors provided assistance during the delivery at the rate of 27.81%, 25.94% and 7.50% respectively.
Breast feeding and Complementary feeding:
Kamudoni P et al 2007 conducted a study on Infant feeding practices in the first 6 months and associated factors in a rural community in Norway. The researcher reported that 157 rural mother-infant pairs were obtained. Early breastfeeding less than one hour after delivery) was practiced among 68.2% of the rural mothers. Colostrum was given by 96% of the sampled mothers. Exclusive breastfeeding rates in the sample at 2, 4, and 6 months were 39.1%, 27.5%, and 7.5%, respectively. At 4 months, exclusive breastfeeding was 4.7 % among rural mothers. Living in the rural area and giving birth outside a health facility, were risk factors for stopping exclusive breastfeeding before 6 months [13].
Ameer AJ et al 2008 were conducted a study on knowledge, attitudes and practices of Iraqi regarding breastfeeding in Baghdad (Iraq). The findings of the study are majority of the women (73.1%) initiated breastfeeding early after delivery, 92.9% believed colostrum was good for their baby and 64.6% breastfed on demand. However, knowledge was lacking about full exclusive breastfeeding until 6 months postpartum, signs of good positioning and latch-on and the correct to introduce supplements. Nearly 35% believed that breast milk was not enough for their infants [15]
According to DLHS-3 conducted in India in 2007-08, newborns breastfed within one hour of delivery was 40.5% in general and 39.5% in rural area, while children aged 0-5 months exclusively breastfed were 46.8% in general and 48.1% in rural area. Complementary feeding given after 6 months of age is about 57.1% in general and 56.5% in rural area [10]
According to DLHS-3 conducted in Puducherry in 2007-08, newborns breastfed within one hour of delivery was 70.5% in general and 67.2% in rural area, while children aged 0-5 months exclusively breastfed were 60.6% in general and 66% in rural area. Complementary feeding given after 6 months of age is about 69.4% in general and 75.3% in rural area [10] .
According to NFHS-3, in India newborns breastfed within one hour of delivery were 23.4% in general and 21.5% in rural area and children (0-5 months) exclusively breastfed were 46.3% in general and 48.3% in rural areas. Complementary feeding given after 6 months of age is about 55.8% in general and 53.8% in rural area [5].
According to NFHS-3, in Tamil Nadu newborns breastfed within one hour of delivery were 55.3% in general and 52.3% in rural area and children (0-5 months) exclusively breastfed were 33.3% in general and 40.5% in rural areas. Complementary feeding given after 6 months of age is about 77.9% in general and 72.4% in rural area [5]
Madhu et al 2009 reported that in rural Bangalore, 44% of the mothers initiated breast feeding within 30 mins with home delivery and 38% with caesarean section. A total of 19 % of the mothers in this study did not breast feed even after 24 hours after delivery. Only 40% of the mothers did the exclusive breast feeding until 6 months and started weaning after 6 months. 53% of the mothers prematurely started weaning the child and majority of the mothers started weaning at the age of 3 to 4 months.
Das et al 2008 conducted study in a rural block of West Bengal; the study shows that breast feeding was initiated with in half-an hour in 42.4% of infants. In 25.5% of infants, it was initiated between half-an-hour to one hour and in 32.1 % beyond one hour. The practices of pre-lacteal feeding were found to be highly prevalent (78.2%).
Khan et al 2009 in their study in periurban areas of Aligarh, Uttar Pradesh, reported that first fee was given within 6 hours after birth in 66.7% of newborns in institutional delivery compared with 46.8% in home delivery. Overall 53.2% of newborns were breast fed within 6 hours of birth and pre-lacteal feeds were given to 45.7% of the infants.
RJ Yadav and P Singh (2004) conducted a study on knowledge, attitude and practices of mothers of breast-feeding in Bihar. The study reported that 29% of mothers started breast-feeding within 24 hours. About one-third mothers discarded the colostrum’s. Most of the mothers breast-fed their child up to more than one year. About 55% of mothers introduced supplements to their infants between six to twelve months. Rice was the main supplement given to children. The main reasons for earlier starting of supplements were insufficiency of mother's milk.
Sinhababu A et al conducted a community-based study during June-July 2008 to assess the infant- and young child-feeding practices in Bankura district, West Bengal, India. In total, 647 children aged less than two years selected through revised 40-cluster sampling using the indicators of the Integrated Management of Neonatal and Childhood Illness and World Health Organization. The proportions of infants with early initiation of breastfeeding (13.6%) and exclusive breastfeeding less than six months (57.1%) and infants who received complementary feeding at the age of 6-8 months (55.7%) were low. Appropriate feeding as per the IMNCI protocol was significantly less among infants aged 6-11 months (15.2%).
Dongre AR et al conducted a cross-sectional study was undertaken in surrounding 23 villages of Kasturba Rural Health Training Centre, Anji.. The study results are most of the deliveries 94 (94.9%) took place in the healthcare facilities. Majority 61 (61.6%) newborn babies had received breastfeeding within half an hour. About half of the mothers had any of the feeding problems like feeding less than eight times in 24 h, giving any other food or drinks or is low weight for age.
Patel A et al was conducted a study on poor feeding practices in early childhood contribute to the burden of malnutrition and infant and child mortality in Nagpur. The sample consisted of 20,108 children aged 0 to 23 months from the National Family Health Survey India 2005-06.Only 23.5% of mothers initiated breastfeeding within the first hour after birth, 99.2% had ever breastfed their infant, 89.8% were currently breastfeeding, and 14.8% were currently bottle-feeding. Among infants under 6 months of age, 46.4% were exclusively breastfed, and 56.7% of those aged 6 to 9 months received complementary foods.
Immunization:
According to DLHS-3, in India fully immunized children (12-23 months) were 54% totally and 50.4% in rural area and children who had received BCG vaccination in total were about 86.7% and 85.2% in rural area. Children who had received polio vaccination in total were 66% and 63.1% in rural area. Children who had received DPT, 3 doses in total were 63.5% and 60.1% in rural area; measles in total were 69.5% and 66.5% in rural area. Children who had received vitamin A drops in past 6 months were 54.5% in total and 52% in rural area
According to DLHS-3, in Puducherry fully immunized children (12-23 months) were 83.5% totally and 96.1% in rural area and children who had received BCG vaccination in total were about 96.6% and 100% in rural area. Children who had received polio vaccination in total were 88.9% and 98.7% in rural area. Children who had received DPT, 3 doses in total were 88.6% and 97.4% in rural area; measles in total were 94.2% and100% in rural area. Children who had received vitamin A drops in past 6 months were 75.9% in total and 66.8% in rural area. [10].
According to NFHS-3, in India fully immunized children (12-23 months) were 43.5% totally and 38.6% in rural area and children who had received BCG vaccination in total were about 78.1% and 75.1% in rural area. Children who had received polio vaccination in total were 78.2% and 76.5% in rural area. Children who had received DPT, 3 doses in total were 55.3% and 50.4% in rural area; measles in total were 58.8% and 54.2% in rural area. Children who had received vitamin A drops in past 6 months were 24.9% in total and 24.2% in rural area.
According to NFHS-3, in Tamil Nadu fully immunized children (12-23 months) were 80.9% totally and 83.7% in rural area and children who had received BCG vaccination in total were about 99.5% and 99.3% in rural area. Children who had received polio vaccination in total were 87.8% and 89.6% in rural area. Children who had received DPT, 3 doses in total were 95.7% and 97% in rural area; measles in total were 92.5% and 93.3% in rural area. Children who had received vitamin A drops in past 6 months were 44.8% in total and 41.1% in rural area [5]
Sharma et al 2009 in a slum of Surat shows that immunization coverage was highest for BCG (75.1%) and lowest for measles (29.9%). Coverage for DPT 3 and OPV3 was almost same (48.6% and 47. 9%). Only 28.9% received Vitamin A supplements at the time of measles vaccination.
Gupta et al 2007 conducted a study in East Delhi; shows that the complete doses of immunization were received by 80% of the children. The coverage levels of immunization were BCG (94.1%), DPT3 (88.2%), polio (89.3%) and measles (79%).
Diarrhoea:
According to DLHS-3, in India children who suffered with diarrhoea and sought advice/treatment were 70.6% in general and 68.9% in rural area10]. According to DLHS-3, in Puducherry children who suffered with diarrhoea and sought advice/treatment were 58.0% in general and 70.7% in rural area10] . According to NFHS-3, in India children who suffered with diarrhoea and taken to a health facility were 61.5% in general and 60.2% in rural area [5]. According to NFHS-3, in Tamil Nadu children who suffered with diarrhoea and taken to a health facility were 60.1% in general and 71.4% in rural area.
Acute respiratory tract infection (ARI):
According to DLHS-3, in India 77.4% of the total and 75% children in rural area sought advice/treatment during ARI or fever [10]. According to DLHS-3, in Puducherry 88.3% of the total and 84.8% children in rural area sought advice/treatment during ARI or fever [10]
According to NFHS-3, countrywide 70.5% of the total and 67.5% children in rural area with ARI or fever were taken to a health facility [5]. According to NFHS-3 in Tamil Nadu 80.5% of the total and 73.1% children in rural area with ARI or fever were taken to a health facility
Nutrition and development
According to HUNGaMA report (2011) in India, 58.8% of the under 5 years children are moderately or severely stunted (Height-for-Age <-2 SD), 42.3% are moderately or severely underweight (Weight-for-Age < -2 SD) and 11.4% are moderately or severely wasted (Weight-for-Height < -2 SD) .
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