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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 33-40

Study of morbidity pattern of under 5-year children in Jaipur


Department of Kaumarbhritya-Balroga, National Institute of Ayurveda, Jaipur, Rajasthan, India

Date of Submission26-Aug-2020
Date of Decision01-Oct-2020
Date of Acceptance18-Oct-2020
Date of Web Publication26-Mar-2021

Correspondence Address:
Nisha Kumari Ojha
Department of Kaumarbhritya-Balroga, National Institute of Ayurveda, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_5_20

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  Abstract 


Objectives: Early childhood under 5 years of age is a period of life with a high level of morbidity. Respiratory, gastrointestinal, and other infections are the most common morbidities in this age group. The present study aims to find out the morbidity pattern of under-5-year children in Jaipur and estimate the association between and also determine the factors affecting these conditions. Methods: A cross-sectional study was conducted on 1007 under 5-year children based on a duly prepared survey pro forma. Mothers and head of family of children between under5 years of age were enquired about the morbidity in the past 3 months. Results: In the present study, cough (34.4%), fever (27.7%), nutrition anemia (24.8%), malnutrition (22.8%), flu (19.5%), hard stool (18.8%), and diarrhea (11.1%) were common morbidities observed among under-five children. The following variables were significantly associated (P < 0.05) with the variable “morbidity:” age (year), height (cm), head circumference (cm), vaccination scar, duration of breastfeeding, birth order, and poor general hygiene. Conclusion: There was an association between morbidity and age, height, head circumference, vaccination duration of breastfeeding, and poor hygiene and no relationship found between socioeconomic status and other factors such as amenities, education of parents, and family size.

Keywords: Childhood, morbidity, survey


How to cite this article:
Sharma V, Ojha NK. Study of morbidity pattern of under 5-year children in Jaipur. J Ayurveda 2021;15:33-40

How to cite this URL:
Sharma V, Ojha NK. Study of morbidity pattern of under 5-year children in Jaipur. J Ayurveda [serial online] 2021 [cited 2021 Apr 13];15:33-40. Available from: http://www.journayu.in/text.asp?2021/15/1/33/311918




  Introduction Top


Children are the most crucial component of our population, not only due to their significant numbers, but also because foundation for the adult life is laid during these formative years. For the proper development of a child, adequate nutrition, absence of disease, and a healthy psychosocial development are vital. Frequent morbidities in children lead to inappropriate development. Furthermore, a child deprived of proper health care during these most sensitive years remains confined of the opportunity of growing into a normal human being, and the damage done in the first few years could be irreversible through their later life. The morbid conditions are more prevalent in the urban slum children who are exposed to various risk factors such as overcrowding, poor nutrition, and unhygienic conditions. The major morbidities reported in under-five children include pneumonia, influenza, diarrhea, protein energy malnutrition, tuberculosis, and anemia.

Pneumonia is the largest infectious cause of death in children worldwide. The prevalence of acute respiratory tract infection in India is 3%, and in Rajasthan, it is 2.1%. Nearly 13% of children under age of 5 years were affected with fever in India in 2015–2016.[1] Diarrhea is the second leading cause of death in under 5-year-old children and is responsible for death around 5 lakh children every year in the world.[2] The prevalence of diarrhea is 9%[3] in India and 7.4% in Rajasthan according to the National Family Health Survey (NFHS) in 2015.[1] Diarrhea is a leading cause of malnutrition in children under 5 years of age. In 2015, 39.1%, 23.0%, 8.3%, and 36.7% of children under age of 5 years were stunted, wasted, severely wasted, and underweight, respectively, in Rajasthan.[4] In 2019, pediatric tuberculosis, case finding using molecular diagnostic tests were 11% in Rajasthan.[5] The prevalence of anemia (<11.0 g/dl) in under 5-year age children is 58% in India and 60.3% in Rajasthan.[1]

Government of India has also made profound efforts to improve the overall health of under 5-year age children. Even so, independent studies are also imperative to validate the findings of the above sources. In addition, knowledge of health status in children is of prime importance to enrich the quality of health services. With this background, the present study is undertaken with the following aims and objectives:

Aims and objectives

  1. To find out the morbidity pattern of under 5-year children in Jaipur
  2. To find out the correlates of the study.


Study design

This was a descriptive cross-sectional study.

Study period

The study period was 6 months (July 2, 2019–January 1, 2020).

Target and study population

The ward number 68, 85, and 87 was selected randomly on the basis of areas situated nearby the location of the National Institute of Ayurveda. Out of which 1007 children of age under 5 years were randomly selected for the study.

Sample size = 1007

Age group

Birth to 5 years of either sex.

Inclusion criteria

  1. Children under 5 years of age of either sex
  2. Children with complaints of illness.


Exclusion criteria

  1. Children above 5 years of age
  2. Parents or care taker not willing to participate in the trial.



  Methods Top


In this study, 1007 children under the age of 5 years were selected by house-to-house visit areas attached to the National Institute of Ayurveda in Jaipur city. A detailed interview schedule consisting of three parts was done.

1st part

This part focused on the basic facilities available in the study area along with the basic information regarding ongoing national health programs related to nutrition and immunization in the study area was obtained.

2nd part

In this part, interview was done to assess the family profile. Details of socioeconomic status, family size, educational status, and food consumption pattern of the family were collected. This part was addressed to head of the family.

3rd part

This part consisted of detailed information regarding the child. The information was taken from the mothers. Details of dietary intake, activity, and morbidity pattern were recorded. The examinations were carried out using a designed pro forma. Major questions in the pro forma included immunization, history of any acute illness during the past 3 months, physical examination, and general profile of family, socioeconomic status, and the literacy status of the parents.

Questionnaires/survey format

Two survey questionnaires were designed in Hindi and English languages.

  1. Household questionnaire
  2. Rapid evaluation questionnaire


Anthropometry

Digital scale was used to measure the weight of children and the height. Head circumference, midarm circumference, and chest circumference of children measured with the plastic tape. Before the initiation of trial, consent was obtained from a parent or an adult responsible for the child.

Patient information and consent/assent form

Before trial-related activity, the principal investigator gave the patient verbal and written information about the trial in the form; the participant/parents(s)/guardian(s) read and understood and a voluntary signed consent of the parent was obtained.

Data documentation and analysis

All information regarding study was properly documented, carefully handled, and meticulously stored to ensure its accurate interpretation and verification. Observations documented during the study were analyzed, and findings were evaluated by using statistical methods to establish the findings.

Statistical analysis – analysis of the results was done using the statistical method – Chi square test, odds ratio, Fisher's exact test, Mann–Whitney U-Test, and P value.

IEC approval

The study was approved by IEC order no. IEC/ACA/2018/68. Dated. 11-05-2018.

CTRI registration

Before the start of trial, the study was applied for registration in CTRI with reference number REF/2019/06/026660, and in June 2019, the trial was registered to CTRI with Registration No. CTRI/2019/06/01994.


  Observations and Results Top


The mean age (Year) was 3.28 ± 1.54. Five hundred and seventeen (51.3%) of the participants were male and 490 (48.7%) of the participants were female [Table 1].
Table 1: Summary of socioeconomic details

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The mean weight (Kg) was 11.71 ± 2.8, and the mean height (cm) was 90.19 ± 31.17. The mean BMI (kg/m2) was 14.83 ± 3.37. The mean head circumference (cm) was 46.58 ± 2.77. The mean chest circumference (cm) was 48.23 ± 3.66. The mean midarm circumference (cm) was 13.35 ± 0.76 [Table 2].
Table 2: Summary of anthropometry

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Nine hundred and twenty (91.4%) of the participants had vaccination scar. The mean birth weight (kg) was 2.69 ± 0.34.55. Two hundred and forty-four (24.2%) of the participants had a duration of breastfeeding: <3 months. Two hundred and seventy-three (27.1%) of the participants had a duration of breastfeeding: 3–6 months. Four hundred and ninety (48.7%) of the participants had a duration of breastfeeding: >6 months. Fifty-four (5.4%) of the participants had poor general hygiene [Table 3]. Mothers, who were the main care taker of their children, were quite aware of the importance of breast feeding (96.7%) and health (96.8%) [Table 4]. This shows that an aware mother can look after the needs and care of their child's nutrition as well as their health.
Table 3: Summary of birth and development history

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Table 4: Summary of family history

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The variable total under-five children were not normally distributed (Shapiro–Wilks Test: P = <0.001) [Chart 1]. Common morbidity features were found in the present study in children as shown in [Chart 2]. In the present study, cough (34.4%), fever (27.7%), nutrition anemia (24.8%), malnutrition (22.8%), flu (19.5%), hard stool (18.8%), and diarrhea (11.1%) were common morbidities observed among under-five children. Association between morbidities and different parameters are shown in [Table 5].
Table 5: Association between morbidity and parameters

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  Discussion Top


Age

Maximum 132 (98.51%) participants were found morbidities in 0–1 years of age, 161 (90.45%) participants in 1–2 years, 157 (90.23%) participants in 2–3 years, 170 (86.29%) participants in 3–4 years, and 287 (88.58%) participants were found morbidities in 4–5 years of age. On statistical analysis, relation between age and morbidity was found significant (P < 0.05) [Table 5]. Data indicate that maximum morbidities are found in 0–1 year age because early childhood is a period of life with a high level of morbidity. The development of immunity is one of the factors implicated in this process. The child's immune system has to adapt itself to the many viruses and other pathogens circulating in the environment. Globally, 2.5 million children died in the 1st month of life in 2018 – approximately 7000 newborn deaths occur every day with about one-third dying on the day of birth.[6]

Immunization status

Morbidity was found to be higher 834 (90.7%) in children, who were immunized as compared to those who were fully unimmunized (83.90%) as immunized children were more participants in the present study. There was a significant difference between the various groups in terms of the distribution of morbidity [Table 5].

Breastfeed duration

Out of total 1007 survey participants, 224 (91.8%) morbidities were found in the duration of breastfeeding <3-month participants, 227 (83.2%) in 3–6 months, and maximum 456 (93.1%) morbidities were found in a duration of breastfeeding >6 months participants. On statistical analysis, relation between breastfeed duration and morbidity was found significant (P < 0.05) [Table 5]. Breastfeeding contributes sensory and cognitive development and protect the infant against infections and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhea or pneumonia and helps for a quicker recovery during illness. However, the current study does not support this theory and reason may be other predisposing factors such as lower socioeconomic status, overcrowded area, poor hygiene, contaminated water, and food.[7]

Birth order

Out of total 1007 survey participants, 447 (95.11%) participants were found morbidities in first birth order participants, 422 (84.74%) in 2nd order, and 38 (97.43%) participants were found morbidities in 3rd and more than third birth order participants. On statistical analysis, the relation between birth order and morbidity was found significant (P < 0.05) [Table 5].

In the present study, participants of third or more than third birth order were found with higher morbidities. The result was different from many studies. Interpretation of the results of birth order studies is difficult. Many theories have tried to explain the findings of differences in this respect. Prenatal maternal conditions, sibling influence, and family economics have been suggested.[8] The current finding similar to India's, 2005–2006 NFHS-3 where last born (i.e. fourth and higher-order births) are at the worst risk. However, in the postneonatal period, first borns are not as vulnerable, but the risk increases steadily with the addition of successive births, and last born are at much greater risk, even worse than those in the neonatal period.[9]

General hygiene

Out of 54 participants with poor hygiene status, 53 (98.1%) presented with morbidities. Chi-square test was used to explore the association between “morbidity” and “poor general hygiene.” There was a significant difference between the various groups in terms of distribution of morbidity [Table 5].

Hygiene is a set of practices performed to preserve health. According to the World Health Organization, hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases. Hygiene is a concept related to cleanliness, health, and medicine. It is as well related to personal and professional care practices. In medicine and everyday life settings, hygiene practices are employed as preventative measures to reduce the incidence and spreading of disease. Hygiene practices vary, and what is considered acceptable in one culture might not be acceptable in another. In the manufacturing of food, pharmaceutical, cosmetic and other products, and good hygiene is a critical component of quality assurance. Poor domestic and personal hygiene practices can help the transmission of disease-causing germs: directly by the fecal-oral route, or by person to person or pet to person contact indirectly by vectors coming into contact with people or their food, people breathing in airborne droplets of moisture which contain germs or eating contaminated food.[10],[11],[12]


  Conclusion Top


Childhood morbidities are major cause of mortality and poor growth and development in children in developing countries like India. In the present study, cough (34.4%), fever (27.7%), nutrition anemia (24.8%), malnutrition (22.8%), flu (19.5%), hard stool (18.8%), and diarrhea (11.1%) were common morbidities observed among under-five age children. The following variables were significantly associated (P < 0.05) with the variable “morbidity:” age (year), height (cm), head circumference (cm), vaccination scar, duration of breastfeeding, birth order, and poor general hygiene. Low socioeconomic status, poor hygiene, illiteracy, less sanitary facilities, and incomplete immunization were found as the chief predisposing factors of poor immunity in areas along with poor nutrition. Further extensive study is needed to authenticate the result of the current study, with larger samples and precise assessment criteria.

Financial support and sponsorship

This study was financially supported by the National Institute of Ayurveda, Jaipur.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
National Family Health Survey-4, 2015-16 State Fact Sheet Rajasthan. Available from: http://rchiips.org/NFHS/pdf/NFHS4/RJ_FactSheet.pdf. [Last accessed on 2020 Jun 29].  Back to cited text no. 1
    
2.
World Health Organization. Children: Fact Sheet. World Health Organization; 02 May, 2017. Available from: https://www.who.int/news-room/fact-sheets/detail/diarrhoea. [Last accessed on 2018 May 02].  Back to cited text no. 2
    
3.
National Family Health survey-4, 2015-16 India. Available from: http://rchiips.org/NFHS/factsheet_NFHS-4.shtml. [Last accessed on 2020 Jun 29].  Back to cited text no. 3
    
4.
National Family Health Survey-4, 2015-16 State Fact Sheet Rajasthan. Available from: http://rchiips.org/NFHS/pdf/NFHS4/RJ_FactSheet.pdf. [Last accessed on 2020 Jun 14].  Back to cited text no. 4
    
5.
Revised National TB Control Programme, Annual Report, India TB Report 2019. Available from: https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg. [Last accessed on 2019 May 15].  Back to cited text no. 5
    
6.
Who Newborn Fact Sheets Reducing Mortality. Available from: https://www.who.int/health-topics/newborn-health. [Last accessed on 2020 May 08].  Back to cited text no. 6
    
7.
van den Bosch WJ, Huygen FJ, van den Hoogen HJ, van Weel C. Morbidity in early childhood, sex differences, birth order and social class. Scand J Primary Health Care 1992;10:118-23.  Back to cited text no. 7
    
8.
Mishra SK, Ram B, Singh A, Yadav A. Birth order, stage of infancy and infant mortality in India. J Biosoc Sci 2018;50:604-25.  Back to cited text no. 8
    
9.
Activity Guide Book 2018 & 2019 Health, Hygiene and Sanitation, Sub-Theme-II. Available from: http://astec.gov.in/ncsc/agb 2 heath.pdf. [Last accessed on 2020 Jun 08].  Back to cited text no. 9
    
10.
Australian Government, Department of Health. Available from: https://www.health.gov.au/internet/publications/publishing.nsf/Content/ohp-enhealth. [Last accessed on 2020 Apr 10].  Back to cited text no. 10
    
11.
Centre for Disease Control and Prevention, Water, Sanitation & Environmentally-Related Hygiene. Available from: https://www.cdc.gov/healthywater/hygiene/disease/index.html. [Last accessed on 2020 Apr 17].  Back to cited text no. 11
    
12.
de Vinck- Baroody OD, Major NE. Comorbidities in developmental disorders. J Develop Behav Pediat 2011;32:626.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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