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Indian Pediatr 2013;50: 408-410 |
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Newborn Care Practices and Health Seeking
Behavior in Urban Slums and Villages of
Anand, Gujarat
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Archana S Nimbalkar, Vivek V Shukla, +Ajay
G Phatak and +Somashekhar M
Nimbalkar
From the *Department of Pediatrics, Pramukhswami
Medical College, Karamsad and +Central Research Services, Charutar
Arogya Mandal, Karamsad, Gujarat, India.
Correspondence to: Prof Somashekhar Nimbalkar,
Department of Pediatrics, Shri Krishna Hospital,
Karamsad, Gujarat 388 325, India.
Email: [email protected]
Received: February 15, 2012;
Initial review: February 21, 2012;
Accepted: July 06, 2012.
PII: S097475791200157
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Health status of neonates in urban slums has not been studied in
smaller towns. A questionnaire was administered to 154 families of
10 urban slums of Anand (population - 197351) and 160 families from
6 villages of Anand district. The socioeconomic and education status
of the slum dwellers versus rural participants were significantly
lower (P<0.001). Antenatal care (79.9 vs 94.4%, P<0.001),
hospital delivery (82.5 vs 93.8%, P=0.002), neonatal
follow-up (27.9 vs 78.8%, P<0.001), health seeking
(56.5 vs 91.3%, P<0.001), essential newborn care and
exclusive breastfeeding (6.5 vs 85.6%, P<0.001) were
also lower in urban slums, as compared to villages, Care seeking was
low in urban slums, Hindus and illiterate mothers. Health care and
socioeconomic status of neonates in slums of smaller cities is
poorer than in surrounding villages.
Key words: Newborn care, Urban slum, India.
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Infant and neonatal mortality rates have declined
in India but are relatively higher in urban slums and rural areas [1].
About one-third of India’s urban population resides in slums and
squatters and this is expected to rise [2]. Urban health care indicators
are better than rural areas but these numbers disregard the differences
between urban rich and poor slum dwellers [3]. The government of India
has an elaborate and variably functioning healthcare delivery system in
the rural areas. Urban slum areas lack such healthcare systems. Urban
slums were compared to surrounding rural areas for aspects related to
newborn care and care seeking. Such comparisons will put in context the
poor status of newborn health and health seeking in slums of even
smaller cities and give direction to policy making in the future.
Methods
Anand district consists of 8 talukas, 10 cities and
350 villages with a population of 2,090,276 (national average is
1,890,927). Anand city, with a population of 197,351 (national average
450,839), ranks 233 rd in 497
cities in India [4].
Families with infants <9 months were included through
door to door survey following informed consent. Total of 156 families
(more than 90% of eligible families) in slums were approached. Two
families refused participation. Village survey followed and 160 families
were recruited across 6 villages selected by random process from
eligible 27 villages with >30 estimated deliveries per year.
Bilingual (English, Gujarati) questionnaire prepared
by investigators was validated and pre-tested. Health workers
administering the questionnaire were trained and monitored by
investigators. Care seeking behavior was present if mother had taken at
least one antenatal care (ANC) and one neonatal follow up. Families were
contacted a day prior to survey to ensure completeness of data. Study
was conducted from May 2011 to September 2011. Institutional Human
Research Ethics Committee granted approval.
Baseline data were expressed by frequencies,
proportions and mean (SD). Associations were calculated between relevant
nominal variables using chi-square test. Multivariable logistic
regression was applied to determine individual effect of factors
influencing health seeking behavior and hospital delivery status.
Analysis was carried out using SPSS 14 (SPSS Inc. USA).
Results
Gender distribution of participants was similar
across study areas. Most mothers from slums were illiterate (44.2%)
whereas 83.7% mothers from villages had at least primary education.
Socioeconomic status and living conditions of the village participants
were better than the slum participants (Web Table I).
Healthcare utilization, antenatal care, hospital
delivery, neonatal follow up, health seeking behavior was better in
village participants. Harmful cultural practices like administration of
non-essential syrups, and Kajal application in eye were more
common in slum participants, whereas substance application over
umbilicus was more common in village participants. Bathing baby at birth
was equally prevalent (31.2% vs 32.5%) whereas bottle feeding was
not very common (8.6% vs. 12.5%) (Table I).
TABLE I Mother and Child Health Care Determinants
Variable Name |
Slum
|
Village |
|
N=154 |
N=160 |
|
n(%) |
n(%) |
Home delivery†
|
27 (17.5) |
10 (06.3) |
ANC taken* |
123(79.9) |
151(94.4) |
Neonatal follow up*
|
Not done |
62 (40.3) |
6 (03.8) |
To unqualified practitioner |
49 (31.8) |
28 (17.6) |
To pediatrician |
43 (27.9) |
126(78.8) |
If hospital delivery whether it was |
Government hospital |
29 (22.8) |
41 (27.3) |
Non govt. hospital |
98 (77.2) |
109(72.7) |
If ANC taken from |
Government hospital |
26 (21.2) |
25 (16.5) |
Non govermental hospital |
97 (78.8) |
126(83.4) |
Non essential syrups administered*
|
50 (32.5) |
5 (03.0) |
Substance applied over umbilicus* |
7 (04.6) |
30 (22.1) |
Bottle feeding |
13 (08.6) |
20 (12.5) |
Kajal application in eyes# |
55 (35.7) |
36 (22.5) |
Bathing baby at birth |
48 (31.2) |
52 (32.5) |
* <0.001; # <0.05; †<0.01. |
Early essential newborn care and exclusive breast
feeding were better followed in village participants. (Table
II). There was no difference in knowledge about neonatal danger
signs. Only 2.8 % of total participants had complete knowledge about
neonatal danger signs. More than 50 % of the participants were not aware
of a single danger sign (data not shown).
TABLE II Essential and General Newborn Care
Variable and Response |
Slum
|
Village |
|
N=154 |
N=160
|
|
n(%) |
n(%)
|
Baby dried immediately#
|
132(85.7) |
153(95.6) |
When was breastfeeding started# |
|
|
within half hour |
90(58.4) |
113(70.6) |
1 h to 2 h |
38(24.7) |
21(13.1) |
3 h to 6 h |
3(01.9) |
1(0.6) |
After 6 h |
0
|
3(1.9) |
2nd day onwards |
13(8.4) |
16(10.0) |
3rd day onwards |
10(6.5) |
6(3.8) |
Baby recieved Kanagroo
|
|
|
mother care* |
1(0.6) |
28(17.5) |
Handwashing done before
|
|
|
handling baby* |
5(3.2) |
118(73.8) |
Mother and child kept together |
150(97.4) |
148(92.5) |
Baby was clothed properly |
131(85.1) |
137(85.6) |
Baby exclusively breast fed for 6
months* |
10(6.5) |
137(85.6) |
* P<0.001; # P<0.05. |
Multiple logistic regression model revealed that
lack of care seeking behavior was common in Slums (Odds Ratio 6.08,
95% CI 3.11,11.89, P<0.0001), Hindus (OR 8.71, 95% CI 1.11,68.07,
P=0.04) and Illiterate mothers (OR 4.71, 95% CI 2.06,10.80, P<0.0001).
The predictive value of the model was good (81.2% correct
classification). Home deliveries were more common if ANC was not taken
(OR 9.08, 95% CI 3.89, 21.20, P<0.0001) and if mother’s education
was restricted to primary education (OR 8.97, 95% CI 1.96,41.11, P=0.01).
The predictive value of this model was very good (90.1% correct
classification).
Discussion
Present study reveals wide socioeconomic gap between
slums and villages. This gap exists even for a smaller town with a
population smaller than the national average for a city. There is lack
of properly functioning and structured healthcare delivery system in
urban slums vis-ŕ-vis affluent urban and rural areas [5-7].
Proximity of the slums to two multispecialty
hospitals and smaller private hospitals did not improve utilization of
services. Urban slum dwellers are ignorant about their health needs and
also lack attitude for seeking healthcare. There is lack of basic
sanitation (72%) and water supply facility (44.8%) in most slum
residents as seen earlier [8, 9]. Healthcare acceptability of government
infrastructure was low in both areas in contrast to earlier studies
[10].
Neonatal follow-up and care of infants requiring
medical attention was provided by unqualified personnel or not taken in
72% of slum areas. Similar results were found in a multicentre study
[11]. Exclusive breastfeeding till 6 months was given in 6.5% of slum
participants vs 85.6 % in village participants. This was similar to a
previous study from Gwalior [12]. Education of immediate health care
providers and mothers in basic neonatal care is required in urban slums
as similar provisions exist in villages under various government efforts
[11]. Bathing baby at birth is equally prevalent in slums and villages
at 31.8% which is much lower than slums in Dhaka or Lahore (86%)
[13,14]. Bottle-feeding is equally prevalent in both slum (8.6%) and
village participants (12.5%), which is much lower than seen in the
Gwalior study [12].
This study describes a wide gap in newborn practices
in slums of a smaller town with better practices in surrounding
villages. Slum dwellers were 6 times less likely to seek care. Not
taking ANC and being illiterate was associated with home deliveries. A
single district study is a limitation of this study but similar gaps
between rural and urban health settings are likely in rest of Gujarat as
well as India. Detailed assessment of reasons for poor health care
seeking behavior is required. Policy planners need to plan for urban
slums while allocating funding for health in urban areas.
Acknowledgments: Ms Madhu Patidar for preliminary
exploratory analysis of the data and Dr Shyamsundar Raithatha for
coordinating and assisting with data collection,
Contributors: AN: designed the study, refined the
questionnaire and wrote the paper; VS: designed the questionnaire,
managed data collection and wrote the paper; AP: analyzed the data,
interpreted the results and critically reviewed and wrote the paper; SN:
conceived the study, designed the study, modified questionnaire, planned
the analysis and provided critical inputs in the write-up. He will act
as guarantor for the study. All authors approved the final version of
the manuscript.
Funding: None; Competing interests:
None stated.
What This Study Adds
•
Villages have better access to neonatal health care than
urban slums even within smaller geographical areas.
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