Dala - Final report -20.04.16.pdf
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Community Health Learning Programme (CHLP) 2015 – 16
Dala Akor Khar Phanbuh
A
Report
On
Community Health Learning
‘Bricks of learning, wall of change’
1
Content
Title
Page No
Acknowledgement -------------------------------------------
4 -5
Introduction -------------------------------------------------
6
A Journey to SOCHARA ---------------------------------
7
Bricks of learning, wall of change -----------------------
8
My learning goals --------------------------------------------
9
Chapter-1 Learning from Collectives---------------------------10 - 18
i.
Insight learning
ii.
Balloonist view
iii.
Understanding on health
iv.
Tap turner off
v.
Paradigm shift
vi.
Health for all
vii.
Communitisation and Community Action for Health
viii.
Down-up and up-down approach:
ix.
Social determinants of health
x.
Intersectoral collaboration:
xi.
Axioms
xii.
Social vaccine:
xiii.
Understanding community
xiv.
Equity versus equality
2
xv.
Appropriate technology
xvi.
Globalization
xvii.
Research
Chapter- 2: Presentations------------------------------------------20
i. Journal club
ii. Field work presentation
Chapter-3: Games---------------------------------------------------20
(a) Power walk
(b) Monsoon game
Chapter-4 Inner Learning---------------------------------------- 21-22
i.
Johari window
ii.
Communication
Chapter-5: Organisations visited --------------------------------23 -35
i.
CHESS
ii.
Foundation for Revitalisation of Local Health Traditions (FRLHT)
iii.
CHC, Kolar, Bhopal
iv.
An orientation at Ekta-Parishad
v.
Madhya Pradesh Vigyan Committee
vi.
Protest conducted by Ekta Parishad:
vii.
District hospital, Bhopal
viii.
Sambhavna Trust
ix.
Tamia, Madhya Pradesh
Chapter-6 : Learning by doing ---------------------------------- 36- 40
Chapter- 7: Case studies -------------------------------------------41- 46
Chapter-8: Overall learning experiences ---------------------- 47- 52
3
Chapter- 9: Filed Study --------------------------------------------53- 85
Annexures --------------------------------------------------------------86-97
Annexure A: Survey Guide
Annexure B: Consent form:
Annexure C: Withdrawal of consent:
Annexure D: Participants Information Sheet
4
Acknowledgement
First and foremost I wish to express my sincere gratitude to Almighty God for guiding and giving
me strength and wisdom and courage throughout the period in CHLP.
This whole year of fruitful and constructive learning experiences would not have been possible
without the help and support of many bricks of people.
I would like to extend my gratitude to SOCHARA and my co-fellow travellers (CHLP 2015-2016).
First, I extend my heartfelt appreciation to Dr. Ravi Narayan and Dr. Thelma Narayan for inspiring
me in many ways and for their continuous hard work and efforts in achieving their vision, which
I am able to be a part of.
Sincere appreciation goes to my supervisor Janelle De Sa Fernandes who is my friend, my guide
and my philosopher, who has sacrificed and helped me throughout the needed times.
I would like to thank Mr. Kumar KJ for his guidance and support and my extended gratitude for
Mr. SJ Chander and Mr. As Mohammad for being an encourager at all times. My gratitude is
extended to all the CHLP staffs Dr. Rahul ASGR, Anusha, IM Prahlad, Prasanna Saligrama,
Adithya Pradyumna, Victor Fernandes, Maria Dorthy Stella.
Last but not the least I would like to express my gratitude to Kamalamma, Vijaya, Hari Prasad,
Tulsi Chetry and Joseph M.S.
I would greatly like to thank the CPHE staffs, Bhopal, without which my field experiences would
not be possible, Dr. Ravi D’Souza who is my mentor, a guide and a friend with whom I had a
tremendous learning, I greatly enjoy his valuable company of sharing knowledge and would
always cherish the inputs I received. Nidhi Shukla, who is a wonderful friend and my guide,
without her guidance and support my field experiences would be very limited. Dhirendra Arya and
5
Sayed Ali for their continuous guidance and support. My extensive appreciation to Sangeeta for
serving every day the tasty and energising tea and Bhagirath for taking care of my stay in Bhopal.
I also want to express my gratitude to all the people whom I met that have inspired and impacted
me personally and to everyone who was involved in data collection.
Finally I would like to thank my family; my parents for their constant love, support and
encouragement.
6
Introduction
A journey begins....
I came from Shillong, which is the capital city of Meghalaya. Shillong is also known as the
“Scotland of the East”. Shillong is situated at the average altitude of 4,908 feet (1,491m) above
sea level. Meghalaya in Sanskrit means ‘abode of clouds’. The wettest places in the world are also
located here. The area of the State is 22429 sq. km with 11 districts with the population of
29,66,889 according to 2011 census.
I was born and brought up in Shillong. Presently my parents are retired from the government sector,
both my siblings are married and working in the government sector. My parents were graduates,
and being raised in such a family has given me encouragement to follow my aspirations.
The year that had changed me completely was 2008, which gave my life a U-turn and thereby had
helped me to rediscover myself to walk in the path of humanity; I could say that I am here because
of the change. After 2008, I started to have a desire to do something for society and to help people.
I had an opportunity to join MSW (Master of Social Work) which opened the door for me to be in
the social work field.
After my MSW, I had an opportunity to teach social work in Shillong for 1 year. The whole year
I had wonderful learning and exposures that had given me certain boldness and confidence. But I
still had desires to do something more in life, as I wasn’t satisfied with what I was doing. With my
parents’ support and trust they had in me, this opened another door to join SOCHARA, though far
from home more than 2000 km. I had my MSW friends who joined SOCHARA; through them I
came to know about CHLP (Community Health Learning Program) which encouraged me to join
SOCHARA.
7
A journey to SOCHARA...
Journey in SOCHARA is like sitting on a boat along with my other co- fellows rowing together
against the current of the water; the current is the knowledge I learnt throughout my educational
journeys. Being with the other co-fellows rowing together every day and dependent on one
another’s strength, this had greatly impacted my insight learning.
Rowing together with the guidance of SOCHARA has helped me to understand the strong winds,
strong waves and the challenges in the outside boat. Rowing together had helped me in building
and developing my intra personal skills and confidence to row the boat forward.
Inside the boat, there is a community established that share common interest and a diverse culture
and background, building a bond of friendship and overall sharing and building a community
among ourselves.
I never thought that my life would be changed through SOCHARA. Experiencing SOCHARA is
one of the best that happened to me, SOCHARA to me is like a gardener that plant seed, taking
care by giving fertilizers and manure and by watering everyday with practical inputs and
reflections and nurturing the seeds until it turn into beautiful flowers blooming together
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‘Bricks of learning, wall of change’
A house to be good and long lasting it should be built on a strong foundation. It should be also
constructed with strong and well shaped bricks with the right mixture of concrete. Bricks are like
inputs I received everyday from other co-fellows, facilitators and field experiences, inputs includes
personal, insight reflections and insight learning.
To be able to have a concrete wall, brick by brick has to be joint, which every one come together
and contributes in building a wall with varieties of information, ideas and arguments on issues
from all the fellows which led to open minds and productive growth which greatly helped in
beautifying the wall.
By the end of SOCHARA, looking at the wall that was built there has been a massive change
before and after the making of the walls.
9
My learning goals
1. To acquire the insight learning on community health
2. To learn and acquire knowledge regarding community health and other health related
programmes
3. To acquire practical knowledge and skills in community health approach
4. To understand the different kinds of problems existing in the community and to understand
more in depth on the diversity of the different Indian communities
5. To be able to understand more about the different problems on the status of women and
their role towards the society
6. To learn more on the effects and importance of maternal and child health
7. To understand and to learn more on health promotion and disease prevention
8. To become a trained scholar activist
9. To acquire deeper knowledge in conducting research
10. To acquire skills in documentation
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Chapter- 1
Learning from the collectives
Insight learning
Before coming to SOCHARA, though I had a master’s qualification in social work, after coming
to SOCHARA I felt the knowledge I learnt was limited. At first after joining SOCHARA, I felt
very uncomfortable to open up and to share my thoughts; throughout my educational journey I did
not get much encouragement and a platform to share my thoughts and opinions. As the days pass
by in SOCHARA, I started to get used to the environment of speaking and sharing thoughts and
through it; it gave me more confidence to speak and exchange thoughts that has given me
understanding in-depth on many perspectives and dimensions of reality. SOCHARA has given
me the platform to express myself and to listen to different arguments and opinions on issues.
Through everyday inputs and reflections on many perspectives as a community approach, it has
helped me to create a shift from many perspectives to the community health approach.
Balloonist view
Working with the community, focus must be widened and broadened beyond any specific issue or
problem, the whole community needs to be focused. Standing on a balloon and viewing from top
at the whole community in a holistic approach.
In order to tackle community problem, the community itself need to be tackled first, that’s why
research, community participation is important.
Understanding on health
According to World Health Organisation (WHO) “Health is a state of complete physical, mental
and social well being and not merely the absence of disease or infirmity”.
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The definition has helped me understand deeper that health is not just physical part of the body but
also the inner part that includes the mind and the psychological and the relationship towards the
environment, not just being physically healthy but also to be well. Physical health is equally
important as the mental, social and spiritual aspects.
Being healthy doesn’t confine only within the walls of hospital or any health care but it is more
and goes beyond the walls of hospitals and medicines. These days health has become
commercialised and that has also blinded many lay people to think health is all about medicines
and hospitals. Curative part is also important but in today’s context, curative is encouraged and is
focused more by the health system. Prevention and promotion is equally important with the
curative part, if prevention and promotion is concentrated on more, it implies the curative will
decrease.
The first step of wellbeing is health and health is a fundamental right to all individuals without any
distinction of race, religion, political beliefs, economic or social condition. In today’s context, after
68 years of independence, health as a fundamental right for some sections in the society still
remains a dream. One of the barriers that created failure to achieve the right is the prevalence of
caste system, a silent killer that still divides the society and there are also other challenges that
prevent people to attain their rights. Right to health doesn’t mean only the right to be healthy but
it also requires the government or the public authorities to put in place the policies and action plan
which is available, accessible, affordable, and acceptable to the people.
Tap turner off
This was the first concept that I remember that was greatly convincing and has made me to have a
clear understanding on how to tackle health problems by not concentrating in the bio medical
alone. My background is non medical and for me it has made me to understand better and help me
to get the insight understanding on how to look on the other factors that affects by analysing
through SEPCE (SOCIAL, ECONOMICAL, POLITICAL, CULTURAL, and ECOLOGICAL)
factors of any particular problem and try to close the gap or address the cause.
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Paradigm shift
I came to SOCHARA with a predefined perspective about health; I had limited knowledge on
health since I am from a non medical background. To me the concept of health lies within the
boundaries of hospitals and medicines. In the first few sessions in CHLP has started shaping me
and the process of refining started to take place, new perspectives towards health made me more
clear from the daily sessions and reflections.
I have a background on social work; social work is somehow related to community health. I being
a social worker, I had different perspectives on community in achieving objectives and goals. After
attending many sessions and reflections and field learning in CHLP, the perceptions that I used to
have about health or community and community health has given me a new lens to see and to have
a deeper understanding Paradigm shift has taken place in helping me to focus on the SEPCE and
to look at different levels from the individual level, family level, community level and to national
level.
The Paradigm Shift
Focus
Individual
Dimensions
Physical/ Pathological
Technology
Drugs /Vaccines
Type of Service
Providing / Dependence
Creating/Social Marketing
Community
Psychosocial, Cultural, Economic, Political,
Ecological
Education and Social Processes
Enabling /Empowering / Autonomy building
Link with people Patient as Passive Beneficiary Community as active participant
Molecular Biology
Research
Pharmaco- therapeutics
Clinical Epidemiology
Socio-epidemiology, Social Determinants,
Health Systems, and Social policy
Health for all
13
‘Health for all’ is a vision which 134 countries attended and by representatives of 67 United
Nations Organisations in the Alma Ata Declaration in order to achieve by 2000 A.D. The
declaration focus is on improving primary health care. After 2000 A.D. ‘health for all’ has not
been achieved, there were many obstacles and challenges that the countries faced and one of the
reasons was the economic crisis that the poor countries could not concentrate on improving the
health status of its people. Privatisation became stronger and wider since then and gradually health
has started to become a commodity, in order to get health one has to buy.
In order to achieve health for all, here turning off the tap plays a role in implying the removal of
obstacles to health, which is elimination of ignorance, malnutrition, disease, unsafe drinking water,
unhygienic surroundings, poor housing, proper sanitation, etc. To have a more people oriented
vision, health services needs to be decentralised, to promote health education, to create awareness
on precaution and prevention of illness or disease, allow traditional health care, to make people
known on different medicinal plants that are available locally. Community participation or
communitisation plays an important role in achieving health for all and by all.
Communitisation and Community Action for Health
India after independence has a long struggle towards “health for all” today after 2000, India still
struggles in achieving health for all. In 2005, the National Rural Health Mission (NRHM) started
a programme focusing on the equitable, affordable and quality health care. NRHM is the first
programme that focuses on the grass root level and working directly with the people through
“communitisation”. Communitisation of the health system is one of the five pillars of NRHM, The
term “Communitisation” basically is a process of the people, by the people, that helps in enabling
the community people to own- up the health system and to empower them to know and to be aware
of their own rights and responsibilities and to have autonomy over health.
Communitisation in health is a process that helps to bridge the gaps between the health system and
the people. It is an ongoing process that involves community participation to work together to take
action against any issues which directly or indirectly affects health, through this process it
strengthen the sense of the “we feeling” among the people
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Communitisation involves research about the existing problem that affects directly or indirectly
the health of the people, which thereby action needs to be taken for tackling or solving the problem.
Here the role of communitisation that involves community participation, community ownership,
community involvement, community building, plays an important part in achieving the objectives
and goals. Through communitisation pave a way to sustain and people would be enabled and
empowered and they themselves would be aware on their own rights and responsibilities towards
health and to have autonomy and to demand their rights over health.
Bottom-up and top-down approach:
‘Health for all’ still remains a struggle, with the weak public health system; it worsens the health
status, though little improvements had been achieved after independence. In order to have an
effective or improved health status, public health system should have two approaches: top-down
approach and bottom-up approach. Both are equally necessary to have an effective public health
services, at the bottom level, the prevalent challenges would be heard from the community level
to the top level where policy would been made and so as the implementations from the top would
reached to the people at the community level.
Decentralisation is one of the examples of bottom-up approach, where all the decisions making
can be made at the down or the community level.
Social determinants of health
The social determinants of health are an important concept in community health that helped me to
reflect on the underlying factors to look, learn, to understand and not to have a quick conclusion.
This concept has helped me to develop deeper understanding at ground reality at the community
level in my field work area.
SEPCE (Social, Economic, Political, Cultural, and Ecological) analysis is one of the ways to
understand the social determinants of health. Health is a dependant on SEPCE factors, if any of
these factors get affected, then health directly or indirectly, will be affected. For example: Consider
malnutrition. Malnutrition is like the tip of an iceberg which is visible where many underlying
15
factors are the real problems. For example, less knowledge of feeding practices of the mother, poor
sanitation, unsafe drinking water, poor housing, etc impact the nutritional status of a child.
Intersectoral collaboration:
Health directly or indirectly relate with other departments, health cannot be separate or isolated
from the rest but to work in collaboration with other departments in order to achieve better health
and ultimately ‘health for all’. In health planning, other departments should be included like
departments of education, public health; engineering, public works, etc need to collaborate with
each other, as the work of one department affects the other. There is a quotation about health that
states how health affects everything:
‘Health is not everything, but without health, everything is nothing’ (cited from Schopenhauer,
German philosopher, 1788-1860).
Axioms
Axioms are the statements or ideas that are believed to be true at the community level as one of
the community approaches to achieve health for all. They help to relate with reality at the grass
root level of the community, involving the community to participate, to make their own decisions
and help the community to have ownership over their right to health. The axioms of community
health also include intersectoral collaborations, decentralise decision making at the community
level, promoting and building community and strengthen the health system so that ‘health for all’
would be achieved.
Social vaccine:
If there is an epidemic prevalent in the community, bio medically speaking, vaccines are given to
strengthen the immunity of the people for future defence. So in the similar way, in community
health, vaccines can also be given socially where it focuses on the social determinants of health in
order to strengthen the immunity and would help in preventing and defending against any type of
disease in the future which includes malnutrition, infant mortality rate, HIV etc.
16
There are so many things that through social vaccines which have helped to prevent or eradicate
problems. Social vaccine is an idea that helps to turn the tap off which focuses on the root cause
of the problem rather than using a ‘mop the floor’ approach. An example of social vaccine is giving
life skills education and to build healthy relationship for preventing HIV and another example of
social vaccine for malaria is preventing mosquito breeding and promoting bed nets which is not
just by providing medicines to the people affecting.
Understanding community
I have had the exposure working with the community in the previous years as a part of my
educational course. SOCHARA has made me realise the importance of the attitude and behaviour
while being with the people in the community. It has also helped me learn more on the importance
of how to go with an unprejudiced and open mind, humility to accept, listen and learn from the
community.
Community is more than the physical aspects; community is a concept where people together share
common beliefs, culture, acceptance, etc. In future it has also made me realise the importance of
people; if working in any projects, the ultimate targets should not only be the success of the project
but the sustainability and people’s ownership of the project.
There is a Chinese proverb by Lao Tzu, where Dr. Ravi Narayan mentioned to us in the collectives
that has greatly inspired and impacted my approach towards the community:
Go to the people
Live with them
Love them
Learn from them
Start with what they know
Build on what they have
Equity vs. equality
17
Equality is the approach that I before believed in having, getting or giving equal treatment which
is fair and unbiased with no favouritism base on gender, socially, economically. After the
understanding on the concept of ‘equity’, I was deeply convinced and motivated, I found myself
now replacing equality with equity. Equity is more than treating equally; it means treating
unequally in order to be equal. Equity means reaching the people who are unreached.
Appropriate technology
In community health, using an appropriate technology is highly needed in helping to solve the
problems. Here appropriate technology plays a major role in helping to solve the problem as it is
scientifically effective, culturally acceptable, and economically feasible.
An example of appropriate technology is what we have seen at FRLHT, where a spiral of copper
coil is used to purify the drinking water. The copper coil that cost Rs 600/- approximately which
is one of the simplest and cheapest ways to purify water which doesn’t require any energy to
function and which last a lifetime and is easy to use in a rural household. It helps in purifying water
just by keeping the coil in any water container for overnight. In most parts of the rural India, many
villages still struggle to access safe drinking water; the copper coil would be an appropriate
technology to meet this need of the people.
Globalisation
Globalisation is the processes of building a global village where all countries connect with each
other, taking trade into an open market. It is one of the terms that I have been continuously hearing
throughout the sessions which I started to feel uncomfortable with, upon knowing the negative
impacts of globalisation which directly and indirectly affect health. In today’s world, the ill effects
of this phenomenon have a control over the people especially in matters of health where as a result
health has become a costly dream for the poor.
Research
SOCHARA has opened up more ideas and has educated me on the implications of a research study.
I have gained a deeper understanding of the importance of ethics in research that protects the rights,
18
confidentiality and dignity of the respondents; as well as the knowledge translation of the data
collected.
Another new term I was introduced to during the sessions was regarding a new model of
conducting research. It is participatory research and participatory action research. Participatory
research is a type of research where community also take part within the research study whereas
participatory action research is an action oriented research where community participation is
involved together for action.
19
Chapter- 2
Presentations
i.
Journal club
Journal club discussions provide a forum for discussion where certain articles and research studies
were presented. The journal club, has helped me gain a deeper understanding on different
researched issues and has given me a new dimension to critically reflect from and to analyse; it
has helped me understand the importance of critical thinking.
ii.
Field work presentation
We have 3 field works and 3 presentations. All my co-fellows have travelled to different field areas
covering many states. During the field work presentations, all my co-fellows would give
presentations about their own field experience, representing varieties of cultures, beliefs,
demographies etc. It’s like bringing the entire field experiencing of all the fellows under one roof
and has given many dimensions on understanding more of community and community health
approaches.
20
Chapter- 3
Games
i.
Power walk:
It is also called as games of division; it was a privilege for me to able to play this game, which has
given me a deeper understanding of how it is to be a person from the lower caste and lower class.
A person who is a female and a dalit is most likely to be at the lowest level in the hierarchy, females
can never go ahead, and if caste changes there would be a lot of future changes in the person’s
circumstances.
ii.
Monsoon game
Another game of division, monsoon game is an experiential game that one has to experience while
playing, it’s not just a game It makes one realise and feel the existing conditions of the landless
farmers who struggle for survival
21
Chapter- 4
Inner Learning
Johari window:
Johari window has made me realise the borderline of the things I know, the things I don’t know
but others know, and also the things that I know and others don’t know. There are certain things
that we are conscious about and those that are in our sub conscious and the things we know and
there are things we don’t. Johari window explains to us the public life, Secret life or the private
life, the unknown life and the blind life.
Communication:
Communication session has tremendously impacted me personally; all the sessions I attended have
helped me to rediscover myself on the capacities that helped me to come out.
Life is all about relationships and to maintain or build relationships, communication is greatly
necessary. Communication is important to realise the importance to build communication within
us (intrapersonal) and with others as well (interpersonal). Communication also plays an important
role in community involvement and participation by creating interest in them. We should
remember there are 3 types of people in the community:- the visual (seeing is truth), auditory
(hearing is truth) and kinestetic (feeling is truth)
There were some important points that struck me
•
Communication helps in building relationships
•
The process of learning is absorbed through our 5 senses or the gateways i.e., through eyes we
see, ears we hear, tongue we taste, hands by touch and nose by smell
•
To be able to solve problems by 90%, we need to sharpen our senses by exercising it daily and
by allowing data to enter and decreasing deletion and generalisation. When senses are
sharpened, 95% of our right brain is sharpened
•
The importance of active listening and listening to understand
•
Importance of positive strokes that help in motivating lives
22
•
Importance of voice modulation
•
In arguments always separate a person and an issue
•
There is a great ability on ourselves which there is no difference from any famous people and
us, all the brain sizes are the same, but what is the difference is the inputs we receives.
•
In order to experience change in behaviour, the impact has to go to the unconscious level
•
It has helped me to understand our own behaviour for changed, when knowledge goes to the
unconscious level, a person will experience change.
•
To overcome the fear is to focus, to involve and to have clarity on the goal by practicing it
many times
•
Listening skills: SOLER and UPISE
i.
S: to Sit straight
ii.
O: Openness with no preconceived notion
iii.
L: Lean forward
iv.
E: Empathy
v.
R: Relax
i.
U: listen to Understand
ii.
P: listen with Participation or listen Patiently with no interruption
iii.
I: listen and to show Interest by having eye contact, verbal acknowledgement, head nod
and body orientation
iv.
S: listen to Support and to avoid arguments
v.
E: listen with Empathy
23
Chapter - 5
Organisations visited
CHESS
Attending CHESS workshop has helped me have a
deeper understanding on the problems or the impacts
of coal mining, in the workshop, groups of people
came from different communities and those who
were also working in the coal mining affected areas.
It was an eye opener for me to hear stories from the
people representing different communities affected by coal mining and how the environment was
polluted and how the people were more affected.
Foundation for Revitalisation of Local Health Traditions (FRLHT)
It was a privilege for me to visit FRLHT campus. It
was a first time for me to have an exposure which is
close to nature, I greatly appreciate the work of
revitalising the traditional medicines, in today’s world
where we are so caught up with the advancement of
Allopathic medicines that we almost forgot the simple
home remedies that our grandparents once depended
on. In CHLP I learned 3 public health system, and here I had learnt that there should be 4 tier
system which home and community should be the first place of the health system which would
help the people to become the providers not the receivers and would solve 30-40% of health
problems. Then if the health problems are not solved then the people can be refer to go to PHC,
CHC or other health care for treatment.
Traditional medicines and the strategies used by the traditional healers are not kept track, I found
that documentation and proper orientation and training is greatly needed to preserve the traditional
24
knowledge. It is also necessary to recognise the traditional healers so that they can be a part of the
health delivery systems thereby taking back health services to the villages.
FRLHT also encourages community participation in reviving the traditional medicines at the
community level; they also promote appropriate technology by using copper coil for safe drinking
water at the community level.
Visited CHC, Kolar, Bhopal
Visiting CHC was my first time; the CHC is located in Kolar, Bhopal. , I was surprised to see the
size of it. It was a huge structure compared to
what I had seen in Meghalaya. The CHC was
clean and newly constructed.
The CHC covers 2 PHC (Primary Health
Centre) covering 85 villages with a population
of 65000 rural populations and 131000 urban population having 40 beds (30 beds in general ward
and 10 beds in emergency). The departments it
includes are gynaecology, paediatric, surgery,
NRC (Nutritional Rehabilitation Centre). The
facilities they have were x-ray, dressing and
injection, pharmacy, pathology, labour room,
operation theatre, medicine storage room, and
kitchen. There were many people in the OPD
and mostly were women but men were few. There
Pic:: Interacting with doctor, CHC
were many people in a queue waiting to enter in all the 7 medical doctors and 1 Unani doctor. I
saw inequality that the Unani doctor was being room wise. All the Allopathic doctors have a
separate consultation room near the entrance on the ground floor whereas the Unani room was at
the first floor which was far corner from the public eyes. The room was small and has to pass
through a small room to reach the Unani cabin.
25
When it comes to the maternity ward, there were two wards i.e. normal delivery and caesarean.
Women with normal delivery were more compared to women who had caesarean which have
smaller number of beds still have empty or unoccupied beds.
There was also NRC (Nutritional Rehabilitation
Centre) where curative approach was made by the
government towards the severe malnourished
children. It’s being taken care of and looked after
by one feeding demonstrator cum counsellor and
one ANM (Auxiliary Nurse Midwife). According
to this programme, counselling to the parents is provided on child care and therapeutic food is
given to the children for 14 days and after their discharge 4 follow up will be done to all the
children which either anganwadi or the ASHA can bring the children to the centre.
Pic:: Pictures taken before admitting and
during the follow ups
Visiting an orientation at Ekta-Parishad
The meaning of Ekta-Parishad is unity forum. Ekta Parishad is a people’s movement; it was started
from Madhya Pradesh by RajGopal in 1991.
Discussion about Gandhi had been everywhere
where RajGopal didn’t want to end up discussing
about Gandhi but he also wanted to practice his
style and principles. Chambel (a junction of
Madhya Pradesh, Uttar Pradesh, and Rajasthan) it
is a well known place for violence, RajGopal chose Chambel and work with the gangs. After
working with this group of people, they finally surrendered all their armaments. So RajGopal
found out the root cause of the violence issues are
Pic:: Ekta Parishad
associated with land so he decided to focus to work
on land issues. If there are no land issues, more than 70% violence will be reduced. The movement
focuses on 2 things: organizing a series of youth camp (to train and empower) and foot march.
Foot march has played an important role in capturing the attention of the government in order to
26
achieve their goal. In 1999, a foot march of 3,500km was made where after, the government of
Madhya Pradesh declared a task to discuss on land issues and thereafter around 3.5 lakhs of people
got land. Ekta Parishad as a non violence organization believes in more dialogues which fight for
injustice of the marginalized people and at the same time talk to the government and to fight against
the government. Through Ekta Parishad, people also had a platform that they could address their
problems they faced, could participate and contribute in many levels. They played a big role in
communitisation, which motivated the people and the youth to create a sense of unity and
responsibility to fight for their own land and their problems.
Ekta Parishad is a national movement which
followed the Gandhi approach of non violence;
it has created a great impact on the people’s
lives. The approach of Ekta Parishad was very
simple but has an effective consequence in
changing the policy by the government.
And thereafter we visited the Mahatma Gandhi
Pic:: Inside Mahatma Gandhi museum
museum where they displayed his journey as a
freedom fighter. There also other freedom fighters along displaying their visits to Madhya Pradesh.
The museum has amazed me with different kinds of pictures displayed that showed and described
the life journey of Gandhi, the pictures displayed were excellent but everything was written in
Hindi which was a hindrance to my learning.
Visited to Madhya Pradesh Vigyan Committee
Madhya Pradesh Vigyan Committee was started in 1984 after the gas tragedy that took placed in
the same year, the organization focused on the post gas tragedy where it organized people to help
the victims who were infected by the methyl isocyanate gas affected and the local people who
inhaled the poisoned air that affected their lungs and their health. The organization also gave
27
support to the health sector in order to improve
the health system. It also focused on the problems
based on environmental issues which also they
conducted survey and prepared a report after the
gas tragedy
The organization has a training centre, which
gives training in different kinds of agriculture activities. It also helped the people in Karhal,
Madhya Pradesh in promoting and marketing the products produced by the tribal people like the
honey. The organisation also works mainly with
Pic:: MPVS
the tribal communities and promoting sustainable livelihood and for conservation of the
environment and its cycle. My colleagues and I met the staff of the organisation where we had a
discussion about the tribal issues. In some tribal areas, a huge amount of money had been spent by
the government to bring development and improve the status of the tribal. And at the end of the
project there was little or no change at all and also there were cases found that many people could
have earned and generated the money for their livelihood, but since they have no saving accounts
they misused the money in alcohol intake and also they would try to finish all the money before
they sleep.
One of the most interesting parts from the discussion was the role and importance of honey bees
and beekeeping. Honey bee is a significant insect for pollination and for forest ecology,
traditionally they burn the hives and extract the
honey and therefore they destroy the population of
honey hives. There’s a technology introduced to
extract honey without damaging a honey hives.
This technology has helped in preventing the bees
and their hives from being destroyed. Honey plays
an important role in the ecosystem where if the
honey hives are destroyed then the population of the honey bees also would be reduced where it
would affect direct and indirectly the ecosystem. The honey bees play an important role in
pollination where many plants depend on them for
Pic:: Beal fruit and products like Honey and beal
drinks
28
their reproduction and if the honey bees are less or destroyed it would affect the production in
plants and agriculture.
In the discussion, I also learnt that a fruit called ‘Beal’ also has a great nutritional and medicinal
property; it’s very good for the prevention of diarrhoea and millets also are a very good source of
nutrition. The people having access to these fruits, would not prefer to eat these fruits but would
prefer to get medicated which they thought is more effective but didn’t know its side effects.
In getting funds, MPVS preferred to get funds from Indian based funding agency, according to
them they said that the International funding agencies gave funds easily but these funding agencies
has their own targets and objectives. The funds that the MPVS got were from the Indian funding
agencies, in the discussion they clearly mentioned they first identify the local needs of the people
then they would decides the projects before approaching any funding agency from an Indian
funding agencies who would support the project.
Visited Protest conducted by Ekta Parishad:
Ekta Parishad conducted a programme for protesting
land rights; we visited the programme where more
than hundred people were gathered. The programme
was in Hindi which was difficult for me to
understand in depth about the problems of the
farmers but it was a privilege to be able to witness
the participation of the farmers in the gathering and
Pic: Meeting conducted by Ekta Parishad
how the people came together for a purpose in sharing
their own problems relating to land issues.
It was first times for me seeing farmers from different places came together in one place and
address their own problems. It’s also good to observe that they were encouraged to shared and
speak publically.
29
Visited district hospital, Bhopal
District hospital is a secondary level health care to the people. The district hospital is located at
the heart of the city; people would come for treatment from within Bhopal and outside Bhopal.
The hospital looked busy with people who were standing in a queue in the OPD (Out Patient
Department). We had a brief interaction with one of the doctors where we got brief information
about the hospital where the average number of patients who come for OPD everyday is around
1500-2000 per day and per year the number goes to around 7 lakhs. The staffs compose of 65
doctors and around 500 other staffs. There are different departments which includes 4 Operation
theatre, blood bank, maternity ward, a newly constructed emergency and OPD setup, dialysis unit,
ENT (Ear Nose and Throat), ortho department, eye clinic, AIDS (Acquired Immuno Deficiency
Syndrome) clinic, adolescent clinic, family planning unit, hematology, biochemistry etc.
We got the permission to walk and visit the
hospital where the counsellor of Family
planning department accompanied us and took
us all over the hospital. She was very friendly
and helpful. We visited NRC (Nutrition
Rehabilitation Centre), it has 10 beds overall
and it is a place to rehabilitate the children from
Pic: NRC
2 months to 5 years who suffer from severe
malnutrition. These children would come from anganwadi, CHC (Community Health Centre) or
from OPD. There are 2 screening being done if the child has
medical complications (like diarrhoea, pneumonia, etc) then they
will be taken to phase-I where treatment would be given to them
and if the child is normal then they will be taken to phase-II.
Regular feeding is focused on the children where daily assessment
on their heights and weights in the chart which would be taken in
order to see the changes for 14 days and then there would be
follow ups after the discharge.
Pic: Iceberg-only 1/4th of the body mass is visible
30
I observed the NRC though is clean but it looked congested, the mothers also could give full
attention to their children since she have nothing to do, I can also say that in NRC the mothers
have the time to spend their time with their child. NRC is good to have for an immediate cure but
it doesn’t give any solution to eradicate malnutrition since it is only a curative providers but not
taking any preventing measures though counselling is also given to the parents in order to help the
child to grow. But since malnutrition has so many hidden factors that only a very few areas of the
problem is visible. So treating the visible part of the problem wouldn’t help to eradicate
malnutrition, in order to treat malnutrition there are so many things that needs to analyse first and
that needs to be addressed and that needs to be solve
We then visited blood bank where we could interact with a staff where he explain to us about the
blood bank, in the blood bank, safe blood is taken from a healthy volunteer
(age from 18- 60 years). Blood bank is like a bank where blood is being
deposited and also being used to give to patients in need. The blood would be
taken for 350 ml and is kept at a temperature between 2o-8o Celsius. There
are different types of blood group-A, B, AB and O which was place
differently inside a refrigerator, a pre-testing is taken which test is made to
find out any presence of any blood transfusion diseases like malaria, hepatitis
B, AIDS etc. before giving the blood to any patient. Cross matching is also
made in order to find out if there is a reactions or not when the blood
of the patient is mixed with other blood.
Pic: A baby manikin is
displayed for giving training
We visited the milk bank; it was my first time I am
hearing about milk bank. It was really interesting for me
to learn about it. The milk bank is also like a bank where
milk is being deposited by the mothers by using the pump
machine. Milk is being taken from their mothers to feed
the same children who are not well who were admitted in
the ward to SCNU (Special Care Newborn Unit). The
Pic: A refrigerator for storing milk
babies are admitted with complications like prematurity or any other complications during delivery
31
or they have to get some special treatment. Milk is kept for 8 hours in a room temperature but it
can extent to 3 day kept at a low temperature and then the milk would be discarded.
We lastly visited a training centre which gave training in enhancing and updating the skills
of the ANM (Auxiliary Nurse Midwife), GNM (General Nurse Midwife) and to doctors as well.
They also gave training on how to give an immediate care to a new born baby and also how to do
child delivery.
Visited Sambhavna Trust
Sambhavna Trust started after the gas tragedy which took place in
Bhopal, on 2 December 1984, Sambhavna Trust existed due to the
gas tragedy which had caused many deaths by a poisonous gas that
came out from the factory. The factory is located about 400 meters
from the organisation which was set up in around 1969-70. The
factory started as a production facility for the pesticides to sell
mainly to the cotton growing districts in Madhya Pradesh, one of the
chemical the factory is making is methyl isocyanate (MIC). Though
the factory is located in Bhopal but it was control from USA which
was run by the company name Union Carbide India Limited, which
59% of the company shares was held by the American company and everything was controlled by
the US Corporation. The USA Corporation made the design of the plant, and also the design of the
waste of the plant. In America there is a similar factory which used to produce MIC which the
material was used was stainless steel but the design of the Bhopal plant was very differently, which
was used with the mild steel. Then there were additional safety features in the American factory
which was not in Bhopal factory. And one big difference was the tank which MIC was kept, in the
America tanks which were used were much smaller whereas in Bhopal was larger, in case if it
leaks, if it’s in a small tank, only a small amount will be leaked but if it’s in a big tank then a big
amount would leak and they wanted to cut down the cost which reduced to 25-30%. MIC has to
be kept at less than 0o degree temperature but the company had stop to use the refrigeration unit in
1982 in order to cut down the cost which turn out to be one of the major cause.
32
In September 1984, in Bhopal there was a small leak which
happened where the gas came out from the factory plant of the US
company on the mid night of 2nd of December 1984, there was a
leakage from the MIC tank and the gas came out for about 100 feet
high. The gas got mixed with air which then formed into cloud,
the thick and heavy cloud spread the nearby areas and also moved
towards the city, the first affected community was Jay
Prakashnagar which was in front of the factory. The place was
quiet and calm, there was neither warning nor sirens, then people
started to woke up from their sleep after being exposed, they
started choking with tears in their eyes and coughing. People
were not aware what was happening and was helpless, they
Pic: The effects of the gas in the post
gas tragedy
started running away to get help towards the hospital, which
they ran in the same direction along with the gas. People were clueless of what was happening
with their bodies and many died on spot. The number of people who were exposed to the gas was
half a million.
The government on the other hand looked like it tried to support and cover the Union Carbide
company. The affected people got a very few amount of compensation of rupees of 25000/- which
they had already spent more than the amount. There was so injustice being done to the affected
people in many areas. The sad thing to know was that there was no action taken against the
company.
Sambhavna Trust work with
the people in their health
related issues where it gave
treatment to the gas affected
people by treating them with
Ayurveda which is the natural
remedies and only to get an
Pic: Hair oil and Massage oil being made
immediate cure, Allopathy is
33
provided. The purpose of providing Ayurveda medicines was to detoxify the chemicals from the
body with the herbal medicinal plant. The medicines were made inside the centre and also there
was a botanical garden which has 150 species of medicinal plants to use in making medicines.
Exploring inside the botanical garden, was
exciting and surprised to find out the plants which
I had seen in my native place was actually were
effective medicines. I feel most of the plants has
an effective medicinal properties but only one
thing we don’t use it is the ignorance and we are
not aware of its uses.
Pic: A botanical garden
Visited Tamia, Madhya Pradesh
Tamia is a small town which has many tribal populations of 90%, it is one of the blocks located in
Chhindwara district, Madhya Pradesh. Its landscape is beautiful and is mostly hilly and has the
highest village with 1200 m above sea level.
We were able to visit many areas under Tamia
block; there are 90% of tribal population which
mainly includes Bharia and Gond. We had an
opportunity to visit the primitive tribe called the
Bharia tribe in Cidholi, entering inside the village,
having narrow roads, the houses mostly made of
mud which looks clean from outside and are close with one another. The socio-economic status of
the Bharia community is below poverty line, their education levels also are low, they mostly
engage in agriculture. The people are friendly, living a very simple lifestyle. There are a number
of government services they receives which I observed, there’s an anganwadi centre by Integrated
Child Development Scheme (ICDS), there’s also a road constructed by Mahatma Gandhi National
Rural Employment Guarantee Act (MGNREGA), toilets by Total Sanitation Scheme (TSS).
Though a few developments have reached the people, but there is still a big gap of differences in
regarding their standard living.
34
There’s a specific place in the community where the Bharia community would keep the statues
made of clay of the expired people as their remembrance for their own family members who have
expired.
As like the other tribal people, in the Bharia tribe, the women also have tattoos in their both hands.
But now in the present generation, using tattoos is declining, with the coming of higher education,
the girls don’t prefer anymore to have tattoos in their hands. They believe after dying, the tattoo
also will go along with the spirit.
The health system under Tamia block has levels which includes: 1 Community Health Centres
(CHC) and 4 Primary Health Centres (PHC) in Dela khari, Chindi, Chawalpani, Gaildubba (not
functioning), 1 PHC covers 5-10 sub centres
With the help of Dr. Vijay Singh, the medical officer of Tamia block who was abled to give time
with us for a brief discussion and also was able to get permission to visit the Community Health
Centres (CHC).
The CHC was close due to the Dussehra festival, which surprised me, which accordingly any
public health care supposedly should be 24x7, except in delivery ward and NRC remained open.
There are 2 separate CHC buildings, the old building looked old, dusty and unhygienic. The
patient’s charter was not found, the list of 107 medicines in CHC was hung. There are less staffs
under the CHC including the doctors, the medical officers has to do multi task works and so as the
other staffs. I observed there were hardly 30 beds according to the Indian Public Health Standards
(IPHS) where there were 8 beds in the general ward, in the old building and 10 beds in labour ward
and 10 beds in Nutritional Rehabilitation Centre (NRC).
There is no operation theatre and neither a surgeon, if any surgery or a caesarean needs to be
conducted, it is being referred to the next level in the health system i.e., district hospital.
The CHC has less facilities with less staffs, covering more than 1,00,000 population is still have
many loop holes, and many poor and under privilege people are very much dependent on the health
system that the government offered.
35
We also visited the bottom most in the health system i.e., the Sub Health Centre in Dhusavani
village. The centre covers 5 villages with 5000 population having 5 Accredited Social Health
Activist (ASHA). The sub centre looks small and clean and so as the Auxiliary Nurse Midwifery
(ANM). In the centre it provides services like Ante Natal Check up (ANC), Post Natal Check up
(PNC), immunisation, identification of anaemia, malaria, leprosy and tuberculosis, and other
minor sickness like cough, fever, cold, diarrhoea, worm infections, institutional infections, etc. It
is also acts as a referral services that refers to the nearest PHC/CHC.
We also visited the anganwadi centre which was nearby the sub centre, anganwadi centre is a place
which is often visited, but this anganwadi centre surprised me inside and outside, in all over the
walls I found colourful walls with beautiful artistic paintings in it. Apart from the paintings,
everywhere looks clean including the children, there were around 10-15 children and I found the
children were busy colouring and playing with toys. They look well nourished compared to the
other anganwadi centre I had been. This anganwadi functions well like the other anganwadi centres
which provides supplementary food, immunisation and health checkups for pregnant and lactating
mothers, preschool educating etc. I observed the anganwadi centre is a good example to all the
other anganwadi centres
36
Chapter-6
Learning by doing
Bricks of actions, Wall of change
37
Sunset view, Bhopal
Bhopal is the capital city of Madhya Pradesh which is located in central India and is known as the
City of Lakes for its various natural as well as artificial lakes and is also one of the greenest cities
in India. Madhya Pradesh has 51 districts. Bhopal total population is 23,68,145 (Census 2011).
The sex ratio (females per 1000 males) is 931 according to census 2011. Bhopal is under Bhopal
Municipal Corporation that spread over an area of 285.88 km2.
Bhopal was founded by Raje Bhoj in the 11th century but the present city was established by an
Afghan soldier, Dost Mohammed (1707-40). Once upon a time Bhopal was once ruled by Begums
for more than 100 years and it was a princely state until India got independence. Bhopal is divided
into 2 major areas: the old and the new city: Berasia and Huzur, Huzur, is more urbanized with
nearly 90 % of its population residing in urban areas. Most of Berasia subdivision is rural
comprising of nearly 285 villages. Minority religious groups together comprise close to 26% of
38
the district’s population. In terms of their population share, Muslims constitute the principal
community among the religious minorities of Bhopal.
Now Bhopal is a growing and a fast city, advancement and development in and around the city
increased. Road connectivity and public transportation is well developed in and around Bhopal.
There is also a large scale of working population both in the public and private sector. Population
too is growing attracting people coming from outside Bhopal and also outside Madhya Pradesh.
With such advancement in the city, like any other big cities, there are also many slums in and
around Bhopal, notified and unnotified slum. In Bhopal, presently there are more than 300 slums
in Bhopal, one of the slums in Bhopal called the 12 (Twelve) number slum located at the south
east Bhopal where I was placed for my field work
Bhopal is a developed and a beautiful city that attracts many tourists including myself, on the other
side of the city there’s an unpleasant view where slums were located.
Throughout my educational journey and educational exposure I had experienced before, all were
incomparable with the experiences and exposure I had during the field works. I was placed in
Bhopal, experiencing Bhopal has given me a wonderful experience that helps me to think, reflect,
to grow and an insight inputs. The experiences have helped me in experiencing more at the bottom
grass root level, understanding more of the ground reality level and as well from the balloonist
view. Through the collective sessions had helped me to go to the community with an empty mind
with no prejudice and from the Chinese proverb which greatly inspired me when working with the
community
Go to the people
Live with them
Love them
Learn from them
Start with what they know
Build on what they have
39
The stay in Bhopal was pleasant and comfortable and on the other side of the coin to think
about the people I worked with was not very pleasant to look at the place they stay. The people
have no proper housing with semi kutcha houses and with extremely small or no space infront of
their house, the road are also very narrow which was not properly constructed. The drainage system
was not constructed well where many areas the drain overflows through the road; there was no
proper garbage disposal. Most of the houses do not have toilets and so they have to do open
defecation outside in the open air, there were some areas around multi buildings which were
constructed under a scheme JNNURM (Jawaharlal Nehru National Urban Renewal Mission)
which had attract people to do open defecation. Some people were least bothered to construct
toilets since they don’t have space to construct and also they have been used to going for open
defecation. There were also so many animals that people rear like goats, chicken and cows these
animals also added to make the surroundings unhealthier by producing bad smell to the air, covered
the roads by their faeces, and also the flies would sit and surround these animals.
The picture of the area and its surroundings were not suitable to look at but the people had been
staying there for decades and were used to the environment. I observed many men would gamble
outside at the road side, most of the men were unemployed and depend on their wife for earnings.
I observe very few girls would go out from their houses and most of the children were playing
outside in the road ways which they are prone to the dusty and unhygienic environment.
The first slum I focused was Gulabnagar, overall, like any other slums, Gulabnagar too has a
similar characteristics as like the other slums in any part of the country, which is overcrowded,
small houses and narrow road etc. In Gulabnagar slum, it consisted people of diverse culture and
community from within Madhya Pradesh and as well as from the other states as well. The roads
are narrow and cemented; the houses are small having 1-3 rooms and are joined and attached to
the each other. The community people are much socialised, most of the time the women would sit
together and chat with one another and as well as the men.
Like any other slums, Gautamnagar and Indranagar also had similar characteristics that include
improper housing, improper water and sanitation facilities and other necessary amenities.
40
My second field work, I focused in Indranagar where geographically was bigger than Gulabnagar,
I observed it was more crowded with people and houses and many people were poorer than in
Gulabnagar.
Differences between anganwadi centre in Gulabnagar and Indranagar
At the anganwadi centre in Gulabnagar had one medium size room and one small room for
washing, there was no toilet facilities and there was no tap water. The roof was low and during
day time, it was extremely hot to stay inside, there was a small free space outside the centre where
most of the services provided in the anganwadi centre were conducted outside which included
seating of children, immunization day. The qualification of the anganwadi worker was highly
qualified holding a post graduate in sociology, due to her qualification she was holding; I found
she was more aware on her role and responsibilities and was alert the things happening around.
She also was very helpful in providing information and would willingly share her registers. In my
2 months observations, apart from immunisation day and weight monitoring I observed other
activities that held that included godhbharai, giving supplementary food for the pregnant women,
lactating mothers and adolescence girls.
In the anganwadi centre at Indranagar, had a medium size room, the room was congested and
looked unhygienic. There was no toilet and no water tap, water had to be fetch from outside, the
anganwadi worker was very active but she had less time in spending with children, she had other
works like filling her registers, attending meetings regularly, meeting the mothers etc. The
anganwadi networked quite well where she gets help and gives help from and to the other
anganwadi worker nearby Indranagar.
41
Chapter- 7
Case studies
In my field work, it had helped me more by doing, my focus was on nutrition, I received many
inputs from my mentor Dr. Ravi D’Souza. In the field I encountered different children who were
normal and as well as undernourished.
The child named was Raju, he had 2 siblings a brother aged of 9 years and a sister of 4 years. The
family was a big size family and they were expecting another new member into their family. The
family income came only from the father who was a daily labour who worked outside Bhopal and
his mother was a home maker, there were days that the family had nothing to eat when the father
didn’t come home as expected. The family was very poor. The children mainly depend on the
supplementary food from the anganwadi centre, the children were not going to school and the
anganwadi centre was the only school for them. His mother wasn’t able to take care of herself, at
the time she was 11 month pregnant and was underweight with just 37kg. After delivery, Raju still
needs a lot of attention and care; he was left with no primary care from the mother and the care
and attention he used to get got diverted to his new born sibling.
The overall nutritional status of Raju, from the social determinants of health approach was that the
malnutrition is just the outcome which was like a tip of the iceberg, other factors underneath that
impact the nutritional status that led to the child to be malnourished. Nutrition was not the only
factor that caused him to become malnourished, there were many other factors that affected him
to be malnourished. Raju was malnourished, he frequently fell ill and because he was
malnourished, his immune system also was deteriorating and because of the low immunity, his
body didn’t have much capacity to fight against any infections. Malnutrition, Immunity and
infection is like a cycle, malnutrition leads to many infections due to low in immunity, and also
sometimes occurrence of infections also leads to malnutrition
The environment played an important role in affecting Raju health, the surrounding was
unhygienic and flies were everywhere. Raju frequently fell ill either by having cold or diarrhoea,
and he was severely malnourished, the food habits and the unhealthy environment affected his
42
immune system also. Because of the low immunity, his body didn’t have much capacity to fight
against any infections. Malnutrition, Immunity and infection is like a cycle, malnutrition leads to
many infections due to low in immunity, and also sometimes occurrence of infections also leads
to malnutrition
Malnutrition
Infection
Reduced immunity
Malnutrition also closely linked with poverty, the family was poor to afford the basic necessities
on life
The intervention:
I made an intervention by feeding 1 severely malnourished child under the guidance of Dr. Ravi
D’Souza, the duration of the intervention was 1 months where feeding and growth monitoring was
used daily. The child named was Raju, he had been admitted to NRC (Nutritional Rehabilitation
Centre) and he was still severely malnourished, there was no difference. Through him, I could
clearly see that the program implemented by the government is a top down approach and it is a
floor mopping approach though it was a good initiative taken by the government, but it there are
many loop holes on it and has failed to eradicate malnutrition from the community. NRC itself is
not an appropriate technology approach where therapeutic food was given to the children and when
the child goes back to their home, malnutrition?, social vaccines, curative
For 1 kg of a child
1
100 ml milk
2
10 gms atta
3
10 gms sugar/gur
4
5 gms oil
Time
8 times daily
43
Method
Mixed the milk, atta and sugar, add to flame, stir it, then add oil, continuous stir for
atleast 3-4 minutes, serve it.
Before the intervention, the starting weight was 5.7 kg, the food prepared needed to be given 7-8
times in a day and nothing else. I also found out the mother also feed him other food which was
uncovered and unhygienic, I observed there was a lack of co operation from the mother since
mother plays an important role in child care and feeding practices. Intervening Raju was more
difficult, when his weight started to increased he would get sick like loose motion, fever or cough
where he also lose his appetite and this was how his weight either went down or became stagnant.
Raju was 1 year and 11 months with 5.7 kg, he looked very different from the other children, his
face was bigger than his body, had a big belly and thin legs. He had not walked yet, his facial
expression too tells something about his own well being, he often cries, and hardly smiled.
Meera background:
Meera, 1 year 7 months who was also severely malnourished with 5.7 kg, accordingly at her age
the ideal weight is 8.5 kg she had 5 siblings and she was the youngest in the family. Her father was
a seasonal labourer and her mother was a home maker. The family size was large and the income
was insufficient to support the entire household, the family was very poor and stay in one room.
The surrounding was very unhygienic with many flies all over the place; the environment plays a
very important role besides good nutritious food in keeping the child healthy with clean
environment and good sanitation system. Interacting with the mother, she prefer to have many
children because they had the fear that only few of them would survive, her sister-in-law who lived
nearby who had 7 children, by the time they reached 5 years old all her children died due to
malnutrition and other diseases that affected them.
Her mother was surprised that she never gain weight inspite of feeding her at home, theoretically,
if a child doesn’t gain weight it is one of the signs of malnutrition, she either couldn’t walked or
had a proper speech, she was always sat idle. Her situation was similar with Raju, she frequently
44
fell ill like diarrhoea, cough and fever which making her body weight growth to become stagnant.
The anganwadi worker had insisted several times to Gindi to go to the NRC to get admitted for
Meera but she was not willing to go since she had to look after the other 5 children. The father
hardly shared any responsibilities in child care, he only provided financial support like the basic
requirements to the family, she herself too was uneducated and lived in a quite patriarchy family
environment since her husband would never allow her to go out. All her life she had been living
all her life within the four walls of the house where her husband never allow her to go out since
traditionally wives were not allowed to go out of the house except during emergency which needs
to be taken to the any health care centre.
She herself was underweight and had multiple deliveries in the past, all her 6 children were
delivered at home, she had no or little knowledge about the importance of family planning, she
took the pills very irregular which she received from the anganwadi.
Sita background:
Another severely malnourished child named, Sita, 7 months old with 3 kg. I met her and her mother
in the anganwadi centre. We visited her house which was located at the most corner side. As we
walked towards the house, the road became more narrow and more unhygienic, passing through
many better houses and slowly reached few houses made of plastic rags and one of the houses was
Sita’s house which was located at the end of the lane, the condition of Sita house was more
unexpected to see which was made with just sheets of plastics and plastic rags with many holes on
it. The house was closely located nearby a big dumping garbage site, the site was unpleasant and
a foul smell came from the site, there were also pigs inside the dumping site and it was also the
site of open defecation for the people living nearby the area. Inside the house, there’s a small single
room with less utensils and no furniture to keep the utensils. The hygiene and cleanliness was
lacking in the house environment and there was also a bad smell that came from the dumping site.
There were plenty of flies and mosquitoes inside the house that could cause high chances of faecooral route illnesses.
45
All the social determinants of health were lacking which was like a big giant that obstruct the entire
family towards achieving health. The condition of the house was not suitable for anyone to stay
there, first the condition of the house which could lead to many diseases and second the location
of the house itself.
Sita sister, Shuhi, a 3 year old, has a very cute face, she can neither speak nor walk, the anganwadi
worker told that when she was young, she was severely malnourished exactly like the present
situation of Sita. Evaluating such situation, severely malnutrition at the early age of a child have
high risk that affecting physical and mentality growth of a child which could be temporary or even
permanently. In Shuhi case, though there were many factors that her past history could also lead
her to the present situation or it could be genetically but since myself as a lay person I could not
detect or identify the correct reason.
The responsibility to take care of the child should be shared by both the parents; I observed in Sita
at her severe condition, the mother only was responsible for her care. When she needs to take her
sick child to the hospital she needs to either asked permission or tell beforehand to the father. Like
it happened when Parvati took Sita to the hospital for the 3rd follow-up for NRC and the father was
very disappointed that she didn’t tell him beforehand. Patriarchy attitude was still very much
relevant in many families, where the women could not take any decisions without informing their
husbands.
There were times I observed the mother was a bit stubborn and ignorant for taking care of her sick
child, she was a bit careless and didn’t listen to what the anganwadi and the ASHA was telling and
directing her. Which before Sita she had also lost her own 7 months son who was severely
malnourished and was sick at the same time, the brother who suffered from diarrhoea and also
severely malnourished was taken medicine to a private clinic doctor and was not able to save him.
Parvati had also finished operating vasectomy and didn’t take proper care for Sita when she too
had severe diarrhoea for 3 days, where on the previous day she went to the district hospital with
ASHA for the NRC follow up, but she didn’t inform the either the ASHA or the doctor about her
daughter having diarrhoea.
46
There was a time, we found Shuhi sitting alone outside at the corner of her house where her mother
went to anganwadi to get vaccination for Sita, at first we waited for Parvati at the house for 15
minutes, and we then went to search her in the nearby place where we found her at the anganwadi
centre. Parvati responsibilities became double in taking care of both her daughters at the same
time, where Shuhi could not walk. Though the mother could not carry both to the anganwadi, she
should leave Shuhi to any care taker which she shouldn’t leave alone. The environment itself was
not safe; there is a high chance of child abuse in future in such situations.
The family was facing great poverty, since the father is the only bread winner in the family and he
was a daily labourer earning 3000-4000/month, the only source which all the family members
depended on. With a very low income the family also could not afford to take a better rented house
but had no choice.
47
Chapter-8
Overall learning experiences
Working with the slum had given me the excitement and levels of frustration of the reality to see
people in helpless conditions. Slum is a place that people did not choose to stay but were deprived
by many circumstances.
The government had taken steps to help people by constructing multi storey buildings for the slum
dwellers through the scheme JNNURM (Jawaharlal Nehru National Urban Renewal Mission)
where the people need to pay rupees of 1,50,000. Few families had started shifting to the multi
storey buildings; there was a big difference in their hygienic conditions before and after the
shifting. There were few pockets of families who could not afford to pay for the multi storey
buildings which they just waited for the government to displace them. The government approach
was neither equitable nor affordable
•
Communication bridge
Language gap, but with the help and commitment of the staff of CPHE, through their effort
of translating and communicating there was an extensive learning from my field
experiences that contributed to my knowledge and my personal learning.
•
Mother responsibilities
Existence of nuclear family was very common; I observed the wife alone had to take all
the roles and responsibilities alone in care taking and upbringing the children. The family
entirely depends on her capacities and abilities in shaping it. In most families, at the family
level, the role of the father was limited to providing financial support. Women were left
alone in managing everything by themselves with their own capacities. A double burden
was added more to the women who worked as domestic workers which made it more
difficult in coping with the work inside and outside the house.
•
Proper care and attention equally needed
Mother has a great role in child rearing; she has a main person who takes care of her
children. In a patriarchal society she is expected to take care of her children as well as her
48
entire family. Many a times she is the only care giver for her children and has no help from
her husband.
•
Education plays an important role
Working with uneducated mothers added more difficulties regarding medicines, many
times I found out they have no knowledge and would give wrong medicines and wrong
dose to their sick child, and they could not identify the right medicines when kept with
other different medicines. Here women played an important role in upbringing in childcare
but there is a big mountain that blocks her if she could not read and write.
•
Importance of education
Education is a powerful weapon that can change things. Comparing the mothers who had
education with the mothers who did not have any education, I found out that the families
conditions of the educated mothers were much better than the families of mothers with no
education at all.
•
Prescription of iron tablets is ineffective
Anaemia is one of the sickness that women suffered, though women got iron tablets either
from the anganwadi or from any government health care, they hardly took it regularly
though the tablets have to be taken daily on a specific duration. Women skipped iron tablets
due to its side effects like nausea. Anaemia still remains a problem
•
Intersectoral collaboration
The health system and other governmental approaches like the anganwadi centre and
PHC/Civil Dispensary need to collaborate with each other and the community.
•
NRC not the solution at the community level
NRC is a government intervention in order to able to reduce the child mortality throughout
the state and it focuses on treating and providing nutritional care, it provides nutritional
therapeutic food for the child and also gives treatment for the sick children.
49
The therapeutic food given in the NRC was brought and packed by the government, the
ingredients was unknown to the mothers, this made more difficult for them to get the exact
recipe for their children after their discharged from NRC. The food in the NRC should be
provided the food which would be available locally; there are many local food recipes that
would help in improving the weight of the child which are affordable and accessible.
Through which the child would not have to be readmitted to NRC.
According to the procedure of NRC there would be 14 days intervention, if the child
doesn’t reached to its normal weight within the targeted days, the child would be released
and the child would continue to be malnourished. I had personally encountered 2 children
who still remained severely malnourished after NRC.
NRC functioned as a floor mopper and when the child is released, the same child who was
once a victim of being severely malnourished, would relapse back since the child had to go
back home to the same environment and same conditions. In the NRC, the mother, being
the care taker, had full time and concentration in taking care and to feed the child all the
time, which usually at home she would also had other responsibilities or other works to do.
Though NRC has also a good intentions which acts on the curative part, though to some
extent is also very necessary but in the community health approach other strategies like the
positive deviance could be apply, positive deviance is a home base or a community
approach where the mothers of the nourished would share their experiences in child care
and would also demonstrate the food practices to the mothers of the undernourished
children.
There are so many other factors which are underlying underneath unsolved and that the
NRC is not the solution to the poor people especially
•
Anganwadi the main source for the poor families
Anganwadi centre played an important role in providing services and in detecting
malnutrition and other medical and social problems by giving importance to food, nutrition
and vaccination, and by giving counselling to the mothers about mother-child care, etc.
50
Supplementary food was provided for children under 5 years old. Families, who were
economically poor, primarily depended on the food from anganwadi for their breakfast and
lunch. Educational activities at the anganwadi acted as the only school for the children who
had no formal education.
Though changes has taken place over a decades and after long years of providing
supplementary food; the state still holds a high number of children of malnutrition in the
country (42.8% of children under the age of 5 years, according to NFHS-4).
Every month many children from Indranagar and the nearby area were registered to NRC
(Nutritional Rehabilitation Centre) which I personally encountered 4 children who were
freshly admitted to NRC and many others were under the follow up of NRC. This scenario
still indicates the poor condition of many children struggling to get a better and healthy
living.
•
Malnutrition remains a struggle
Though the supplementary food is provided at the anganwadi centre, severe malnutrition
still remains in the pockets of the society, sometimes it remains hidden due to several
reasons (I found out the number of severely malnourished exceeds the number which the
anganwadi shared, by using the growth chart I found out the number of severely
malnourished children were 12 but the anganwadi said there were only 3 severely
malnourished children) and sometimes due to the unsuccessful services at the NRC.
Whatever the reasons may be, severe malnutrition will still remain a problem unless the
social determinants of health are tackled first starting at the family level to community level
to state level.
•
Multiple deliveries
Due to poverty and unplanned pregnancies, it affects the child care process; all the children
were not being looked after or taken proper care of by the mother since the mother has to
51
focus more on her little one. The rest of the children were left with less attention and less
care which in the process affects the entire family.
•
Pregnancy after sterilisation
Sterilisation is one of the methods of family planning used. The government has targets for
sterilisation which the ANM has to meet, at the community level the ASHA and the
anganwadi worker is made to meet the targets. There were two cases I encountered; women
became pregnant after getting sterilised which also lead to unplanned pregnancy.
•
Food alone doesn’t cure malnutrition
After the intervention, I realised food alone doesn’t eradicate malnutrition, there are other
factor also need to be addressed like the social determinants that direct and indirectly
affects health like safe drinking water, proper sanitation, proper housing, sufficient
household income etc.
•
Children being left vulnerable
I encountered, one 3 year old girl who couldn’t walk was left alone outside the house near
the garbage dumping site, she was all alone and the area around was quiet, in any such
situations there might be a high chance of child abuse when no one is not around.
Later I found the mother was in the anganwadi centre getting immunisation for her 7 month
old second child, since the mother was all alone to take care for her two children and
couldn’t handle to carry both her children.
•
Poverty remains
Poverty is one of the greatest barriers that affect poor people. Poverty is one of the factors
that impact nutritional status.
Overall the community people face many problems in sanitation, space, gambling, garbage,
drainage system, etc. Going there as a community health fellow, it’s a very good exposure for
52
learning, though the situation that people face are not good to see. Looking through the community
health lens, there are so many social health determinants that looks like the tip of an iceberg, which
are still lacking and that are necessary to the people.
Community health approach is a slow process to see change in a community though it is possible
to bring change. Comparing to the rural area, in slum areas, it is more difficult to get a community
participation and involvement; it would take years to see change, since health is a broad area where
health covers sanitation, education, housing etc. As a fellow traveller, CHLP gave me good
exposure to such challenges that helped in equipping me for more challenges ahead.
53
Chapter- 9
Field Study
Bricks in findings to bring change
54
Proposed research title:
A study on factors affecting the nutritional status of children 0-5 years of age in Indranagar,
Bhopal, Madhya Pradesh
General objective:
To understand the relationship between maternal knowledge and practice regarding nutrition, and
the nutritional status of children between 0-5 years of age in Indranagar, Bhopal.
Specific Objectives:
•
To understand the literacy status of mothers of children aged 0-5 years
•
To document the knowledge of mothers on child feeding practices
•
To document the knowledge and practices of mothers on diarrhoea prevention and
management
•
To document the utilisation of anganwadi nutritional / health awareness services
Definitions and scope of study:
•
Health Literacy:
“Has been defined as the cognitive and social skills which determine the motivation and
ability of individuals to gain access to, understand and use information in ways which
promote and maintain good health. (WHO Centre for Health Development, 2004)
•
Maternal health literacy:
“the cognitive and social skills that determine the motivation and ability of women to gain
access to, understand, and use information in ways that promote and maintain their health
and that of their children” (Renkert & Nutbeam, 2001)
•
Nutritional status of children:
“The nutritional status of a child is usually described in terms of anthropometry, i.e. body
measurement, such as weight, in relation to age or height, which is reflective of the degree
of underweight or wasting of that child.” (Ghouwa Ismail & Shahnaaz Suffla, 2003)
55
•
Malnutrition:
“A broad term commonly used as an alternative to ‘undernutrition’, but which technically
also refers to overnutrition. People are malnourished if their diet does not provide adequate
nutrients for growth and maintenance or if they are unable to fully utilize the food they eat
due to illness (undernutrition). They are also malnourished if they consume too many
calories (overnutrition) (United Nations Children’s Fund” [UNICEF], 2012).
•
Infant and young child feeding (IYCF):
“Term used to describe the feeding of infants (less than 12 months old) and young children
(12–23 months old). IYCF programmes focus on the protection, promotion and support of
exclusive breastfeeding for the first six months, on timely introduction of complementary
feeding and on continued breastfeeding for two years or beyond” (UNICEF, 2012).
•
Diarrhoea prevention and management:
“Loose stool which take the shape of container at frequency of 3 or more episodes in 24
hours.”
•
Anganwadi services through ICDS:
“The Integrated Child Development Services (ICDS) scheme integrates several aspects of
early childhood development and provides supplementary nutrition, immunisation, health
check-ups, and referral services to children below six years of age as well as expecting and
nursing mothers. Additionally, it offers non-formal pre-school education to children in the
3-6 age group, and health and nutrition education to women in the 15-45 age group” (Indian
for Financial Management and Research, IFMR)
Background
56
Nutrition as defined by the World Health Organisation (WHO) is “the intake of food, considered
in relation to the body’s dietary needs. Good nutrition – an adequate, well balanced diet combined
with regular physical activity – is a cornerstone of good health. Poor nutrition can lead to reduced
immunity, increased susceptibility to disease, impaired physical and mental development, and
reduced productivity.” (World Health Organisation [WHO], 2015)
Nutrition has a significant influence on growth and development, particularly during early
childhood, which later impacts all aspects of health as overall physical, mental, emotional and
social well being (WHO, 1946) throughout life (Ministry of Women and Child Development).
Good nutrition can prevent or alleviate common diseases and their symptoms (Yeasmin, 2008).
Poor nutrition or malnutrition accounts for both undernutrition and overnutrition; and relates to
deficiencies, excesses or imbalances in energy, protein and nutrient ingestion (Ministry of Women
and Child Development).
Significance in Child Development:
Malnutrition has significant negative impacts on child development and children are generally the
first to show symptoms of non availability of food (Faraj, 2005). Malnutrition can result in high
morbidity and mortality among young children owing to their lowered resistance to disease
(Badrialaily, 2008). Furthermore, malnutrition has been found to affect brain development in
children. Studies show that 70% of a child’s brain develops in utero while the remaining 30% is
developed by the age of three (Singh, 2004). Increased nutritional requirements for growth and
development leave children most vulnerable from conception to three years of age (Anonymous
2003). Malnutrition increases the risk of poor physical and cognitive growth, learning and
educational outcomes (Mora, J. O., & Nestel, P. S., 2000, Faraj, 2005)
The Indian and Madhya Pradesh Context:
Malnutrition is widespread in developing countries. India faces malnutrition as one of the most
serious and large scale health problems. According to some facts about Indian children and their
nutritional status presented by UNICEF and sourced from India’s National Family Health Survey
(NFHS-3 2005-2006): India has the highest number of low birth weight babies per year at an
57
estimated 7.4 million; 20% of children under five years of age suffer from wasting due to acute
undernutrition; 43% children under 5 years of age are underweight and 48% have stunting due to
chronic undernutrition (UNICEF, Nutrition, NFHS-3-IN). According to NFHS-3, in Madhya
Pradesh in particular, 58% of children under the age of 5 years are undernourished (State planning
commission, 2012).
In relation to childhood malnutrition, improvement of nutrition in infants and young children,
especially during the first two years of life, is imperative in reducing mortality. Furthermore,
nutrition problems are closely related to over-all health problems, and are both closely linked to
the environment of the home and community (Cameron. et al. 1983). Higher child malnutrition
has been attributed to inadequate women’s nutrition, feeding and caring practices for young
children. These factors are closely related to women’s social status, early marriage, low weight at
pregnancy, multiple deliveries and their lower level of education (Saxena, anonymos ; UNICEF,
Nutrition).
Infant and Child Feeding Practices:
Appropriate feeding practices during infancy and childhood are essential for health and
development (ref: Saha, Frongillo, Alam, Arifeen, Persson, and Rasmussen, 2008). Infant feeding
practices include exclusive breastfeeding, the timely and appropriate introduction of
complementary feeding to children around six completed months of age, and continued
breastfeeding alongside other foods for children until two years of age and beyond. All these
practices are essential. UNICEF quotes that only 20% of children age 6-23 months are fed
appropriately according to all three recommended practices for infant and young child feeding
(UNICEF, Nutrition).
Diseases related to nutrition usually have multiple causes which include poverty, food habits,
infections, and lack of knowledge. Therefore addressing nutrition alone without other social
determinants fails to prevent malnutrition (Cameron et al., 1983).
A survey on “comparison between the malnourished children and nourished children” had been
conducted in Indranagar, Bhopal, by the researcher during the last field visit. Poverty and health
58
literacy were found to be among the major factors affecting the nutritional status of the children.
Other direct and indirect social determinants that were highlighted included safe drinking water,
sanitation, etc.
Maternal Health Awareness:
Poor maternal health prior to pregnancy (perinatal) contributes determining facts in pre and post
natal child health (Mora et al., 2000). Short birth intervals are associated with higher levels of
undernutrition (UNICEF, Nutrition) In addition, better nutrition and child survival have been
shown to be related to higher maternal education (Mora et al., 2000). UNICEF also highlights that
the percentage of children who are severely underweight is almost five times higher among
children whose mothers have no education than among children whose mothers have 12 or more
years of schooling (UNICEF, Nutrition). Maternal health literacy is therefore understood to play
an important role in childhood malnutrition.
Anganwadi Services:
Anganwadi centres under the ICDS were introduced to provide educational and nutritional support
for children up to 6 years of age. Services also extend to adolescent girls, pregnant and lactating
mothers. UNICEF reports that only one third (33%) Indian children receive any service from an
anganwadi centre; less than 25% receive supplementary foods through ICDS; and only 18% have
their weights measured in an AWC (UNICEF, Nutrition).
Keeping the reported statistics and previous field observations in mind, the proposed aim of the
study is to explore the relevance of maternal health awareness and other social determinants in
childhood malnutrition.
Methodology
Study Design
59
The proposed research included a cross-sectional study that helped in identify and in understanding
some of the factors affecting the nutritional status in children aged 0-5 years from among the slumbased population of Indranagar, Bhopal. The study was primarily utilising both the quantitative
and qualitative methods. Data collection methods involved one to one survey interviews with 65
mothers, 2 in-depth interviews and 2 FGD (focus group discussion) using questionnaires to address
educational status, socio-economic status, health awareness and social and cultural aspects
impacting the nutritional status in children
.
Study population:
The target population of this study will be the mothers of children from 0-5 years of age in
Indranagar, PCnagar, Miranagar, Bhopal.
Sample size and sampling techniques:
Sample size: The sample size will be 65 mothers for conducting survey, 2 in-depth interviews,
and 2 FGD, malnutrition status will be identified through growth monitoring records from the
respective anganwadis and verified by weighing the children during home visits.
Sampling technique:
The study will be used stratified random sampling
Methods of Data collection:
Data collection from the anganwadi:
A list of children with growth monitoring status was obtained from the Anganwadi that helped in
identifying the nourished and malnourished children within the respective slums. It was done using
after obtaining appropriate permission for the same and confidentiality would be maintained
throughout the study.
Data collection from the study population:
60
Schedule: The study will have a schedule where data will be collected using a list of structured
questions for survey and in-depth interview. Unstructured questions would be used for focus group
discussion (FGD)
Interview: Quantitative and qualitative data will be collected for data collection
Inclusion
Study population will include: Mothers of the malnourished children chosen for the study and
mothers of the nourished children chosen for the study.
Ethical consideration
Risks and Benefits
The study does not include any immediate potential risks to the respondents.
The respondents will benefit from the research as findings of the study will be shared with them
to provide them with an understanding of the factors affecting their children’s nutritional status
and overall health. Awareness about essential child feeding practices will be also shared with the
respondents.
Consent
Respondents would be requested for written consent after providing them the oral and written
explanation of what the study entails, the respondent’s role, confidentiality and the risks and
benefits of the study in the form of the participant’s information sheet and consent form as attached
in the annexure B. These will also be translated into Hindi (language spoken by the community).
The respondents will be informed of their right to withdraw from the study at any time they feel
necessary.
Confidentiality
•
All participants in the study including the Anganwadi worker (AWW), translator
(placement organisation) and researcher will be required to sign a confidentiality statement
in agreement to protecting the identity of all respondents and their children included in the
61
study. The confidentiality statement is attached in Annexure B (Will also be translated into
Hindi).
•
All respondent-identifiable information will be made anonymous when sharing the
findings of the study.
Dissemination
•
The research findings will be translated and shared with the respondents and other
participants (AWW) in the study.
•
The research study and findings will be further disseminated and circulated to SOCHARA
Bangalore, and to SOCHARA Bhopal in the form of a written report.
62
Results
The study was conducted in Indranagar, Bhopal, Madhya Pradesh, 24 respondents participated
during the survey through questionnaire, the data collection was taken during the month of October
and November, 2015.
The results from the study were:
Table 1: Educational status of the mothers
Mothers education status Frequency Percent
Literate
6
25.00%
Illiterate
18
75.00%
Total
24
100.00%
In the data collected, 6 (25%) mothers were literate who had formal education and there were 18
(75%) mothers who were illiterate i.e. who had no formal education.
Table 2: Nutritional status of the children surveyed
Nutritional status Frequency Percent
Green
11
45.83%
Yellow
9
37.50%
Red
4
16.67%
Total
24
100.00%
According to the data collected, 11 (45.83%) of the children were normal or nourished which
indicated in green colour, where the other two colours that includes under malnourished i.e. The
yellow and red were 9 (37.50%) and 4 (16.67%).
Type of family Frequency Percent
Nuclear
15
62.50%
Joint
9
37.50%
Total
24
100.00%
63
According to the table, 15 (62.50%) of the respondents lived in a nuclear family, whereas the rest
of the respondents lived in a joint family.
Table 3: Types of houses surveyed
Type of house Frequency Percent
Kutcha
11
45.83%
Semi kutcha
12
50.00%
Pucca
1
4.17%
Total
24
100.00%
According to the table, half of the respondents lived in a semi kutcha houses i.e. 12 (50%) whereas
only one family of the respondents lived in a pucca house which had just sifted to the multi storey
buildings
Table 4: Years of resettlement of the respondents
Years of resettlement Frequency Percent
Less than one year
1
4.17%
1 to 5
1
4.17%
6 to 10
5
20.83%
11 to 20
5
20.83%
Entire life
12
50.00%
Total
24
100.00%
According to the table, half of the respondents i.e. 12 (50%) have been staying in the same area
for their entire life whereas the rest of the respondents have stayed in the slum area
Table 5: Respondents social category
Social category
Frequency Percent
Schedule caste
14
58.33%
Schedule tribe
3
12.50%
64
Other backward caste 6
25.00%
Other caste
1
4.17%
Total
24
100.00%
According to the table, more than half of the respondents i.e. 14 (58.33%) belonged to schedule
caste and the rest of the respondents belonged to the other social categories follows by OBC with
6 (25%).
Table 6: Husband occupation
Husband occupation Frequency Percent
Self employed
4
16.67%
Daily wage
9
37.50%
Seasonal wage
4
16.67%
Monthly wage
7
29.17%
Total
24
100.00%
According to the table, 9 (37.50%) of the husbands of the respondents worked as daily wagers, 7
(29.17%) gets monthly wages and whereas the rest earned as daily wages and seasonal wages.
Table 7: Mothers occupation
Mothers occupation Frequency Percent
Home maker
13
54.17%
Domestic worker
11
45.83%
Total
24
100.00%
According to the table, 13 (54.17%) of the mothers were home makers and the rest were domestic
workers.
Table 8: Household economic category
Economic category
Frequency Percent
Below poverty line (BPL)
2
8.33%
65
Above poverty line (APL) 10
41.67%
Antodaya
3
12.50%
Not available
9
37.50%
Total
24
100.00%
According to the table, the economic status of the respondents were mostly APL with 10 (41.67%)
and the rest of the respondents were antodaya with just 3 (12.5%) and BPL with just 2 (8.33%)
and there were 9 respondents did not have any type of card due to recent separating to a nuclear
family.
Table 9: Total number of children
Total child Frequency Percent
1
7
29.17%
2
7
29.17%
3
5
20.83%
4
4
16.67%
6
1
4.17%
Total
24
100.00%
According to the table, many mothers had few children where 7 mothers had 1 child and another
7 mothers had 2 children and there was a mother who had 6 children.
Table 10: Type of cooking fuel used by the respondents
Type of cooking fuel Frequency Percent
Firewood
5
20.83%
LPG
19
79.17%
Total
24
100.00%
According to the table, there were still families who depend on the firewood for cooking with 5
(20.83%) whereas the rest depend on LPG gas.
Table 11: Separate kitchen availability
66
Separate kitchen Frequency Percent
Yes
4
16.67%
No
20
83.33%
Total
24
100.00%
According to the table, there were many families who did not have any separate kitchen with 20
(83.33%) and only 4 (16.67%) of the families had separate kitchen who lives in newly constructed
multi storey buildings.
Table 12: Present and used toilets by the respondents
Present and use toilet Frequency Percent
Yes
13
54.17%
No
11
45.83%
Total
24
100.00%
According to the table, 13 (54.17%) of the families have separate and usable toilet whereas the
rest still depend on open defacation.
Table 13: Source of drinking water
Main source of water in the household Frequency Percent
Receive public water
24
100.00%
Total
24
100.00%
According to the table, all the families receive public water from the government tank trucks which
comes 2-3 times in a week.
Table 14: Mothers attended all the ante natal checkups
Attended all the 4 ante natal check-up Frequency Percent
Yes
22
91.67%
No
2
8.33%
Total
24
100.00%
67
According to the table, 2 (8.33%) mothers did not complete all the main 4 ante natal check up
during pregnancy whereas the rest completed all the antenatal checkups.
Table 15: Colostrum fed to the child
Colostrum fed Frequency Percent
Yes
20
83.33%
No
4
16.67%
Total
24
100.00%
According to the table, 20 (83.33%) children were fed colostrums.
Table 16: During lactating, received supplementary food from anganwadi centre
Received supplementary food from anganwadi during lactating
period
Frequency Percent
Yes
24
100.00%
Total
24
100.00%
According to the table, all the mothers received supplementary food from the anganwadi centres
during lactating period.
Table 17: Place of child delivery
Where was the child born Frequency Percent
Government hospital
15
62.50%
Private hospital
2
8.33%
Home delivery
7
29.17%
Total
24
100.00%
According to the table, 15 (62.50%) mothers delivered their children in the government hospital
and 7 (29.17%) mothers had their delivery at home.
Table 18: Children immunisation
68
Fully immunised Frequency Percent
Yes
24
100.00%
Total
24
100.00%
According to the table, all 24 children were fully immunised.
Table 19: Disposal of faeces
Throw faeces
Frequency Percent
Dropped into toilet latrine
8
33.33%
Rinse/washed away in open area
3
12.50%
Rinsed/washed away in drainage system
1
4.17%
Disposed somewhere in the dumping garbage 9
37.50%
Use toilet
3
12.50%
Total
24
100.00%
According to the table, 9 (37.50%) mothers throw the faeces of their child in the dumping garbage,
where 9 (37.50%) disposed somewhere in the dumping garbage.
Table 20: Washing hands before feeding
Frequency Percent
Cum. Percent
Yes
19
79.17%
79.17%
Sometimes
5
20.83%
100.00%
Total
24
100.00% 100.00%
Wash hand before feeding
According to the table, 19 (79.17%) mothers washed their hands before feeding their child
Table 21: Washing hands after used of latrine
Wash after use of latrine Frequency Percent
Cum. Percent
69
Yes
18
75.00%
75.00%
Sometimes
6
25.00%
100.00%
Total
24
100.00% 100.00%
According to the table, 18 (75%) mothers wash hands after used of latrines
Table 22: Breastfed less than 6 months
Stopped breastfeeding less than6months Frequency Percent
Cum. Percent
Yes
8
33.33%
33.33%
No
16
66.67%
100.00%
Total
24
100.00% 100.00%
According to the table, 8 (33.33%) children were not breastfed less than 6 months
Table 23: Breastfed more than 7 months
Stopped breastfeeding after 7 months 2 years Frequency Percent
Cum. Percent
No
14
66.67%
66.67%
Yes
7
33.33%
100.00%
Total
21
100.00% 100.00%
According to the table, 7 (33.33%) children were not breastfed after 7 months
Table 24: Exclusive breastfeeding given
Exclusive breastfeeding given Frequency Percent
Cum. Percent
Less than 1 month
3
12.50%
12.50%
2-3 months
2
8.33%
20.83%
4-6 months
14
58.33%
79.17%
More than 6 months
5
20.83%
100.00%
Total
24
100.00% 100.00%
According to the table, 19 children were not exclusively breastfed
70
Table 25: Introduction of weaning
Introduction of weaning Frequency Percent
Cum. Percent
Less than 6 months
7
29.17%
29.17%
More than 6 months
17
70.83%
100.00%
Total
24
100.00% 100.00%
According to the table, 7 children weaning was given less than 6 months
Table 26: Frequency of food duration
Meals given in a day Frequency Percent
Cum. Percent
3 times
5
20.83%
20.83%
4 times
15
62.50%
83.33%
More than 5 times
4
16.67%
100.00%
Total
24
100.00% 100.00%
According to the table, 5 children were given food 3 times in a day and 15 children were given 4
times and 4 children were given more than 5 times
Table 27: Mothers knowledge on nutritious food
Information of nutritious food Frequency Percent
Cum. Percent
Yes
17
70.83%
70.83%
No
7
29.17%
100.00%
Total
24
100.00% 100.00%
According to the table, 17 mothers have basic knowledge on nutritious food
Table 28: Mothers knowledge on the cause of diaahoea
Has knowledge about the cause of diarrhoea Frequency Percent
Cum. Percent
Yes
9
37.50%
37.50%
A little bit
5
20.83%
58.33%
No
6
25.00%
83.33%
71
Teething
4
16.67%
100.00%
Total
24
100.00% 100.00%
According to the table, 9 mothers had basic information on the causes of diarrhoea, and 5 mothers
had a little knowledge, 6 mothers had no knowledge on the cause of diarrhoea and 4 mothers said
diarrhoea is causes due to teething
Table 29: Uses of ORS during diarrhoea
Use ors during diarrhoea Frequency Percent
Cum. Percent
No
4
16.67%
16.67%
Yes
20
83.33%
100.00%
Total
24
100.00% 100.00%
According to the table, 20 mothers gave ors when their child felt sick
Table 30: Children under 5 years receive food from the anganwadi centre
Receive food from anganwadi centre Frequency Percent
Cum. Percent
Regularly
19
79.17%
79.17%
Irregular
1
4.17%
83.33%
Never receive
4
16.67%
100.00%
Total
24
100.00% 100.00%
According to the table, 19 mothers received food from the anganwadi centre
Table 30: Children under 5 years receive medicines from the anganwadi centre
Receive medicines from anganwadi centre Frequency Percent
Cum. Percent
Regularly
18
75.00%
75.00%
Irregular
5
20.83%
95.83%
Never receive
1
4.17%
100.00%
Total
24
100.00% 100.00%
According to the table, 18 mothers regularly received medicines from the anganwadi centre
72
Table 31: Mothers gets support from the anganwadi worker
Get anganwadi support No Yes
Diarrhoea
9
15
Breastfeeding
6
18
Healthy eating
5
19
Hand washing
10
14
Complementary feeding
9
15
Growth chart
12
12
Hygiene
8
16
De worm
7
17
Malnutrition
10
14
Junk food
14
10
According to the table above, out of 24 mothers, 14 of the mothers gets less awareness on the
impacts of junk food, 12 mothers gets less support in awareness from the anganwadi centre on
growth chart of weight to age. Many of the mothers, 14 out of 24 mothers gets awareness on how
to feed the child with nutritious food.
Table 32: Method of feeding
How do you feed the child Yes No
Hand
15
9
Bottle
2
22
Cup
0
24
Spoon
3
21
Self
10
14
According to the table, out of 24, 15 mothers fed their children with hand and 10 children ate by
themselves.
Table 33: Suffers from any sickness for the last 1 year
Suffering for the last 1 year No Yes
73
Fever
6
18
Diarrhea
15
9
Rashes
20
4
Common cold
9
15
Cough
13
11
Difficult in breading
24
0
Malaria
24
0
Vomit
19
5
Worm infestation
21
3
Pneumonia
23
1
According to the table, 18 out of 24 children had suffered fever in the last one year, 9 children
suffered diarrhoea.
Table 34: Comparison of the mother’s education status with their children nutritional status
Nutritional status
Mothers education status
Green
Red
Yellow
Total
Literate
3
0
3
6
Row%
50.00%
0.00%
50.00%
100.00%
Illiterate
8
4
6
18
Row%
44.44%
22.22%
33.33%
100.00%
Total
11
4
9
24
Row%
45.83%
16.67%
37.50%
100.00%
In the table it shows literate mothers doesn’t have any severely malnourished children and also
illiterate mothers have nourished children with 44.44 %.
Table 35: Comparison of the mother’s education status with their children which colostrums were fed
Colostrums fed
Mothers education status Colostrums fed Does not fed colostrums Total
Literate
6
0
6
Row%
100.00%
0.00%
100.00%
74
Illiterate
14
4
18
Row%
77.78%
22.22%
100.00%
Total
20
4
24
Row%
83.33%
16.67%
100.00%
In this table, there are many factors that led the children not to drink the colostrums that were
encountered, 4 children of the mothers who are illiterate colostrums were not fed
Table 36: Comparison of the children nutritional status with children whom colostrums were fed
Colostrums fed
Nutritional status Colostrums fed Does not fed colostrums Total
Green
9
2
11
Row%
81.82%
18.18%
100.00%
Col%
45.00%
50.00%
45.83%
Yellow
8
1
9
Row%
88.89%
11.11%
100.00%
Col%
40.00%
25.00%
37.50%
Red
3
1
4
Row%
75.00%
25.00%
100.00%
Col%
15.00%
25.00%
16.67%
Total
20
4
24
Row%
83.33%
16.67%
100.00%
Col%
100.00%
100.00%
100.00%
According to the table, 20 (83.33%) children were fed colostrums and their present nutritional
status were 9 nourished children, 8 moderate children and 3 severely malnourished children
whereas there were 4 children that colostrum was not being fed.
Table 37: Comparison of the mother’s education status with the children where exclusive
breastfeeding given
Exclusive breastfeeding given
75
Mothers education Less than 1 Less than 3 4-6
More than 6
status
month
months
months
months
Literate
0
0
4
2
6
Percentage
0.00%
0.00%
66.67%
33.33%
100.00%
Illiterate
3
2
10
3
18
Percentage
16.67%
11.11%
55.56%
16.67%
100.00%
Total
3
2
14
5
24
Percentage
12.50%
8.33%
58.33%
20.83%
100.00%
Total
According to the table, from the total number of 24 children, the numbers of the children of the
literate mothers who receive 4 to 6 months of exclusive breastfeeding were 4 (66.67%) and 2
(33.33%) of the children of the literate mothers receive exclusive breastfeeding till they reach more
than 6 months.
The numbers of the children of the illiterate mothers who does not receive exclusive breastfeeding
or in less than 1 month were 3 in number (16.67%), 2 (11.11%) children of the illiterate mothers
receive exclusive breastfeeding till they attain 3 months, 10 (55.56%) the children of the illiterate
mothers receive exclusive breastfeeding when they attained 4 to 6 months exclusive breastfeeding
and 3 (16.67%) children of the literate mothers receive exclusive breastfeeding till they reach more
than 6 months.
Table 38: Comparison of the mother’s education status with the mothers knowledge on the cause
of diarrhoea
Has knowledge about the cause of diarrhoea
Has
Has a little Does not have Due
knowledge
knowledge
any knowledge
tooth
Literate
4
0
1
1
6
Row%
66.67%
0.00%
16.67%
16.67%
100.00%
Col%
44.44%
0.00%
16.67%
25.00%
25.00%
Illiterate
5
5
5
3
18
Row%
27.78%
27.78%
27.78%
16.67%
100.00%
Col%
55.56%
100.00%
83.33%
75.00%
75.00%
Mothers education status
to
Total
76
Total
9
5
6
4
24
Row%
37.50%
20.83%
25.00%
16.67%
100.00%
Col%
100.00%
100.00%
100.00%
100.00%
100.00%
According to the table, 9 (37.50%) had knowledge on the cause of diarrhoea where 4 literate
mothers had the knowledge about the cause of diarrhoea, and 5 (27.78%) illiterate mothers has
knowledge about the cause of diarrhoea.
5 (20.83%) mothers had a little knowledge on the factors causing diarrhoea, where 5 (20.83%)
illiterate mothers had a little knowledge on the factors causing diarrhoea.
6 (25%) did not have any knowledge on the cause of diarrhoea which constitute 1(16.67%) literate
mother and 5 (27.78%) illiterate mothers and there were 4 mothers took diarrhoea due to tooth
growth which constitute 1 (16.67%) and 3 illiterate mothers.
Table 39: Comparison of the mother’s education status with hand washing before feeding
Wash hand before feeding
Mothers education status Does hand washing Sometimes does hand washing Total
Literate
6
0
6
Row%
100.00%
0.00%
100.00%
Col%
31.58%
0.00%
25.00%
Illiterate
13
5
18
Row%
72.22%
27.78%
100.00%
Col%
68.42%
100.00%
75.00%
Total
19
5
24
Row%
79.17%
20.83%
100.00%
Col%
100.00%
100.00%
100.00%
According to the table, 19 (79.17%) mothers washed hands before feeding their children which
includes 6 literate mothers and 13 illiterate mothers, and 5 (20.83%) illiterate mothers sometimes
washed hands before feeding their children.
Table 40: Comparison of the mother’s education status with hand washing after latrine used
77
Wash hands after use of latrine
Mothers education status Yes
Sometimes
Total
Literate
6
0
6
Row%
100.00%
0.00%
100.00%
Col%
33.33%
0.00%
25.00%
Illiterate
12
6
18
Row%
66.67%
33.33%
100.00%
Col%
66.67%
100.00%
75.00%
Total
18
6
24
Row%
75.00%
25.00%
100.00%
Col%
100.00%
100.00%
100.00%
According to the table, 18 (75%) mothers washed hands after the use of latrine with 6 literate
mothers and 12 illiterate mothers, whereas 6 illiterate mothers sometimes washed their hands right
after using of latrines.
Table 41: Comparison of the mother’s education status with disposal of faeces
Throw faeces
Mothers
Dropped
Rinsed/washed
into
Rinse/wash
toilet
ed away in drainage
re
latrine
open area
system
garbage
Literate
4
0
0
1
1
6
Row%
66.67%
0.00%
0.00%
16.67%
16.67%
100.00%
Col%
50.00%
0.00%
0.00%
11.11%
33.33%
25.00%
Illiterate
4
3
1
8
2
18
Row%
22.22%
16.67%
5.56%
44.44%
11.11%
100.00%
Col%
50.00%
100.00%
100.00%
88.89%
66.67%
75.00%
Total
8
3
1
9
3
24
Row%
33.33%
12.50%
4.17%
37.50%
12.50%
100.00%
Col%
100.00%
100.00%
100.00%
100.00%
100.00% 100.00%
education
status
away
Disposed
in somewhe Use
in toilet
Total
78
According to the table, 8 (33.33%) mothers throw the faeces in the toilet latrine which included 4
literate mothers and 4 illiterate mothers. 3 (12.5%) mothers rinse or wash away the faeces in an
open area and 9 (37.5%) mothers disposed the faeces in the garbage which includes 8 illiterate
mothers and 1 literate mother.
Table 42: Comparison of the mother’s occupation with children nutritional staus
Nutritional status
Mothers occupation Green
Yellow
Red
Total
Home maker
5
5
3
13
Row%
38.46%
38.46%
23.08%
100.00%
Col%
45.45%
55.56%
75.00%
54.17%
Domestic worker
6
4
1
11
Row%
54.55%
36.36%
9.09%
100.00%
Col%
54.55%
44.44%
25.00%
45.83%
Total
11
9
4
24
Row%
45.83%
37.50%
16.67%
100.00%
Col%
100.00% 100.00% 100.00% 100.00%
According to the table, 11 (45.83%) were nourished children where 6 mothers worked as domestic
workers and 5 mothers were home makers whereas 4 (16.67%) children were severely nourished
where 3 mothers were home makers and 1 was working as domestic worker.
Table 43: Comparison of the mother’s education status with mothers knowledge on nutritious
food
Information of nutritious food
Mothers education status Yes
No
Total
Literate
5
1
6
Row%
83.33%
16.67%
100.00%
Col%
29.41%
14.29%
25.00%
Illiterate
12
6
18
79
Row%
66.67%
33.33%
100.00%
Col%
70.59%
85.71%
75.00%
Total
17
7
24
Row%
70.83%
29.17%
100.00%
Col%
100.00%
100.00%
100.00%
According to the table, 17 (70.83%) mothers had basic information on the nutritious food which
includes 5 literate and 12 illiterate mothers and the rest of 7 (29.17%) mothers did not have basic
knowledge on nutritious food.
Table 44: Comparison of the children nutritional status with mothers basic information on
nutritious food
Mothers basic information on nutritious food
Nutritional status Yes
No
Total
Green
7
4
11
Row%
63.64%
36.36%
100.00%
Col%
41.18%
57.14%
45.83%
Yellow
8
1
9
Row%
88.89%
11.11%
100.00%
Col%
47.06%
14.29%
37.50%
Red
2
2
4
Row%
50.00%
50.00%
100.00%
Col%
11.76%
28.57%
16.67%
Total
17
7
24
Row%
70.83%
29.17%
100.00%
Col%
100.00%
100.00%
100.00%
According to the table, 17 (70.83%) mothers had basic information on nutritious food which the
children nutritional status includes 8 moderate 7 nourished and 2 red and there were 7 (29.17%)
mothers who did not have any basic information on nutritious food.
80
Table 45: Comparison of the mother’s education status with awareness received on malnutrition
Receive awareness on malnutrition
Mothers education status No
Yes
Total
Literate
2
4
6
Row%
33.33%
66.67%
100.00%
Col%
22.22%
28.57%
26.09%
Illiterate
7
10
17
Row%
41.18%
58.82%
100.00%
Col%
77.78%
71.43%
73.91%
Total
9
14
23
Row%
39.13%
60.87%
100.00%
Col%
100.00%
100.00%
100.00%
According to the table, there were 14 (60.87%) mothers who received awareness from the
anganwadi worker where 4 were literate and 10 were not illiterate.
Table 46: Comparison of the children nutritional status with the awareness received on
malnutrition
Receive awareness on malnutrition
Nutritional status No
Yes
Total
Green
6
5
11
Row%
54.55%
45.45%
100.00%
Col%
66.67%
35.71%
47.83%
Yellow
2
6
8
Row%
25.00%
75.00%
100.00%
Col%
22.22%
42.86%
34.78%
Red
2
3
5
Row%
25.00%
75.00%
100.00%
Col%
11.11%
21.43%
17.39%
81
Total
10
14
24
Row%
39.13%
60.87%
100.00%
Col%
100.00%
100.00%
100.00%
According to the table, 14 (60.87%) mothers received awareness from the anganwadi worker
which includes the nutritional status of the children where 5 were nourished, 6 were moderate and
3 were severely malnourished whereas 9 mothers did not receive any awareness from the
anganwadi worker regarding malnutrition.
Table 46: Comparison of the children nutritional status with the frequency of food given
Meals given in a day
Nutritional status 3
4
<5
Total
Green
1
9
1
11
Row%
9.09%
81.82%
9.09%
100.00%
Col%
20.00%
60.00%
25.00%
45.83%
Yellow
2
4
3
9
Row%
22.22%
44.44%
33.33%
100.00%
Col%
40.00%
26.67%
75.00%
37.50%
Red
2
2
0
4
Row%
50.00%
50.00%
0.00%
100.00%
Col%
40.00%
13.33%
0.00%
16.67%
Total
5
15
4
24
Row%
20.83%
62.50%
16.67%
100.00%
Col%
100.00% 100.00% 100.00% 100.00%
According to the table, 9 (81.82%) children who were being fed 4 times in a day were more
nourished.
82
Discussions:
This study was conducted to find out the different possible factors that affects the nutritional status
of the children (0-5 years old) in Indranagar, Bhopal, Madhya Pradesh. A cross section study was
conducted. The main purpose of this study was to understand the relationship between maternal
knowledge and practice and the nutritional status of children. This study was quantitative study
using a structured questionnaire. According to the study, 65 respondents needed to be covered
which would include the mixed method i.e., quantitative and qualitative which would cover the
survey, in-depth interview and focus group discussion. The study did not go according to the plan,
due to various reasons where qualitative study was not able to cover. Unavailability of anganwadi
worker for several days, shifting of people to their new house where it was difficult to track them,
it was during festive season the study had to be paused for a while, language also added more
burden which made more difficult.
In Bhopal, the female literacy is 76.5 (Census 2011), but in Indranagar many women or mothers
were still illiterate, education impacts the nutritional status in a child to some extent. The literacy
rate of the mothers were 6 (25%) and 3 of them had normal nourished children whereas the
illiterate mothers were 18 (75%) and their children were undernourished. But when it comes to
nutritional knowledge, the illiterate mothers had basic information on nutritious food.
In the findings, almost half of the respondents were housewives and half were working as domestic
workers, few mothers who were working have less time to spend with their children, but the data
I collected showed that mothers who work as domestic workers had nourished children.
There were 11 (45.83%) nourished children and 13 undernourished children, according to the data
collected the average frequency of food intake was 4 times daily of the children. Though the
frequency of food given were given at an average of 4 times but there were still many children
who were undernourished, we could see that there were also many other factors contributing to the
nutritional status of the children which food alone doesn’t cause or eradicate malnutrition, there
are also other social determinants that contributes to the nutritional status of the children like
having a clean environment, safe drinking water etc
83
All the literate mothers fed colostrums to their children, whereas 4 mothers who were not educated
did not feed colostrums to their children. There were multiple factor that they were not able to fed
colostrums, one mother did not have breast milk, one child was too sick that he did not drink breast
milk and the two children were the mothers were ignorant to fed colostrums.
Colostrum is not the only factor contributing to the nutritional status where there were 2 nourished
and 2 undernourished children which colostrums was not being fed.
4 literate mothers had the knowledge on the cause of diarrhoea and 1 literate mother did not know
the root cause of diarrhoea. Whereas 5 illiterate mothers had the knowledge, 5 mothers had a little
knowledge and 5 did not have any knowledge on the root cause of diarrhoea. According to the
findings, having education somehow made a difference on the knowledge of the mothers on the
cause of diarrhoea.
Hand washing before food also impacts health status of the child and it also link with diarrhoea,
out of 24, 5 illiterate mothers hardly wash hands regularly before feeding their children
In the table 34, it shows that mother’s educational status impacts the nutritional status of the child,
according to the findings, the literate mothers have no severely malnourished children, which
education somehow impact their awareness level and knowledge in food practices and child
rearing.
84
Conclusion and recommendations:
Child malnutrition still remains a public health problem, the study has helped me in gaining a
deeper understanding of the data but more importantly beyond the data which had given me insight
leaning through interactions and a lot of things that the community had taught me in the journey
of my field exposure. Through my research it has helped me in identifying the underlying issues
that I was not been able to identify earlier. I found out by using the growth chart, the number of
severely malnourished children were 12 which the anganwadi told there were only 3 severely
malnourished children. It was also an eye opener for me that there are chances of other things
happening that need to be alert.
The main purpose of this research study was to understand how the literacy status of the mothers
impacts the nutritional status of their children. Through conducting my research it has helped me
gaining understanding and a need to apply the ethical aspects for the protection of the respondents
and well as the researcher.
85
Limitations of the study:
1. There was a language barrier in communication, which an interpreter was needed to
interpret and to communicate
2. Most children were not able to trace out due to shifting of houses to new multi story
buildings
3. Wasn’t able to collect the required number of sample size
4. During the data collection, festive season
5. The sample size is to small for quantitative study
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Annexure A
Survey Guide
Demographic details:
Respondent
1.
no.____________________
Respondent
2.
name:______________________
Age:___________
3.
Don’t know___________
Religion______________________________
4.
Education
5.
status:
• Can you read and write: Both read and write[ ] Read only[ ] Cannot read and write[ ]
• Highest
class
obtained:_________________________________-
___________________________
Types
6. of Family?
(a) Nuclear [ ] (b) Extended Nuclear [ ] (c) Joint [ ]
Type
7. of house
(a) Kutcha [ ] (b) Semi-Pucca [ ] (c) Pucca [ ]
Years
8. of resettlement
(a) Less than one year (b) 1 to 5 years (c) 6 to 10 years (d) 11 to 15 years (e) 16 to 20 years (f) Entire
life
Social
9. category:
(a) SC [ ] (b) ST[ ] (c) OBC [ ] (d) OC [ ]
Status
10. of occupation:
Husband’s occupation:
• Self employed[ ] Daily wages worker [ ] Seasonal wages worker [ ] Specify____________
• Number of hours of work per day:______________
Mother’s occupation:
• Home maker [ ] Domestic worker [ ] Daily wages worker [ ] Seasonal wages worker [ ]
• Number of hours of work per day:______________
Economic
11.
category: Type of ration card
(a) Red card/BPL [ ] (b) Blue card/APL [ ] (c) Yellow card/Antodaya [ ] (d) NA [ ]
Family
12. income:
(a) Daily:____________________________________________________
87
(b) Monthly:__________________________________________________
Family structure:
Number
13.
of pregnancies ________________________
Number
14.
of deliveries_______________________
Number
15.
of children:
Male[____] Female[____]
Household environment general:
Type
16. of cooking fuel:
(a) Firewood [ ] (b) Kerosene [ ] (c) Bio gas [ ] (d) LPG [ ]
Separate
17.
kitchen:
(a) Yes [ ] (b) No [ ]
Present
18. and Using Sanitary Latrine
(a) Yes [ ] (b) No [ ]
Latrine at house [ ] Open defecation [ ]
Main
19. source of water in the household
(a) Public tap [ ]
(b) Hand pump [ ]
(c) Rain water [ ]
(d) Government Water tanker [ ]
(e) Private water tanker [ ]
(f) Others (specify) ___________________________________________________
Mother’s health
Did
20.you attend all the 4 ante natal check up?
(a)Yes [ ] (b)No[ ]
Did
21.you receive supplementary food from anganwadi during lactating period?
(a) Yes[ ] (b) No[ ]
Child’s details
Child’s
22. name:_______________________________________________________
Birth
23. weight:__________________________
Child’s
24. age: _____________________
Where
25. was the child born?
88
Government hospital[
] (b) Private hospital[
] (c) Clinic[
] (d) Home[
] (e)
Others_____________________
Was
26. your child born prematurely?
(a)Yes [ ] (b)No [ ], If yes, which month _______Weeks___________
Has
27.the child fully immunised according to the age?
(a) Yes (b) No
If
no,
why?
________________________________________________________________________
Hygiene and sanitation
Do
28.you wash hands before feeding the child?
(a) Yes [ ] Sometimes [ ] No [ ]
Do
29.you wash your hands regularly washed with soap after use of latrine?
(a) Yes [ ] (b) Sometimes [ ] (c) No [ ]
If30.
the child does not use toilet, where did you dispose your child’s feces the last time he/she defecated
(a) Dropped into toilet latrine [ ]
(b) Rinse/washed away in open area [ ]
(c) Rinsed/washed away in drainage system [ ]
(d) Disposed somewhere outside [ ]
(e) Buried [ ]
(f) Other ____________________________________________________
Child’s feeding practice
Was
31. colostrums fed to the child?
(a) Yes [ ] (b) No [ ]
Do
32.you still breastfeed now?
(a) Yes [ ] (b) No [ ]
If no, till when did you stop? __________Year __________Months
Was
33. exclusive breastfeeding given till which month?
(a) Less than 1 month [ ] (b) less than 3 months [ ] (c) 4-6 months [ ] (d) more than 6 months [ ]
(e) specify___________________
What
34. milk did the child drink, if not breastfed?
(a)
Cow's
Milk
[
]
(b)
Other,
please
specify
_______________________________________________
How
35. do you feed the child?
89
(a) Hand [ ] (b) Bottle [ ] (c) cup [ ] (d) Spoon [ ] (d) Others_________________________________
After
36. which month old, do you introduce weaning food?
[_____________]months
How
37. many times in a day do you give food to your child?
>2meals [ ] 3meals [ ] 4meals [ ] <5meals [ ]
Do
38.you know about non nutritious food which affects the child?
(a) Yes (b) No
If
yes
which
type
of
food?_____________________________________________________________
Child’s health
Does
39. your child suffer from diarrhoea regularly?
(a) Once a week [ ] (b) Twice a week [ ] (c) 2-3 times a month [ ] (d) others_____________________
According
40.
to you, what can cause diarrhoea?
Due to dirt around [ ]
Due to uncovered food [ ]
Due to flies [ ]
Others _______________________________________________________________________
What
41. do you do when your child gets diarrhoea
(a) ORS [ ]
(b) Home solution of water salt and sugar [ ]
(c) Self medication [ ]
(d) Go to doctor [ ]
(e) Others__________
Do
42.you have any records of sickness of the child in the last one year? Yes/No
If yes, what was the sickness?(multiple choices)
(a) Fever [ ]
(b) Diarrhoea [ ]
(c) Skin rash [ ]
(d) Common cold [ ]
(e) Cough [ ]
(f) Difficult breathing [ ]
(g) Malaria [ ]
(h) Vomiting [ ]
90
(i) Worm infection [ ]
(j) Others, specify ____________________
Anganwadi services
Do
43.you receive food from anganwadi?
(a)Regularly [ ] (b)Irregular[ ] (c)Never receive[ ]
Do
44.you receive medicines from the anganwadi?
(a) Regular[ ] (b) Irregular[ ] (c) Never receive[ ]
Supplementary
45.
food receive
Food items
Quantity
Period Receive
What
46. awareness do you get from the anganwadi? (more than one option can be marked)
Yes
No
Diarrhoea
Breastfeeding
Healthy eating
Hand wash
Complementary feeding
Growth Chart
Hygiene
De worm infestation
Malnutrition
Junk food
Other
________________________________
Additional
information:
_______________________________________________________________
91
Annexure B
Consent form:
Title: A study on factors affecting the nutritional status of children 0-3 years of age in Indranagar,
Bhopal, Madhya Pradesh
I have read and understand the participation information sheet (or it has been read to me). I
understand that it includes me for taking part in an interview. I have been explained the purpose
and the way of the study. I have been informed that there will be no direct benefits for me. I
understand that the information I will provide is confidential and will not be disclosed to any other
party or in any reports that could lead to my identification. I also have been informed that the data
from study can be used for preparing reports and the reports will not contain my name or
identification characteristics. I have been provided with the name and contact details to whom I
can contact. All my questions have been answered to my satisfaction. I had enough time to decide
whether I am going to participate or not. I know that I am participating as a volunteer and I can
step out of the programme whenever I want and it is not necessary to give an explanation. I know
that research team will see my details. I give consent for my details to be used for the research
purposes mentioned in this form. All information regarding consent and purpose of the study has
been explained to me in the language I understand. I provide consent to the following:
Yes
No
Participation in the in-depth interview
Audio-recording of the in-depth interview
Publishing of words/sentences spoken in interview
verbatim
Name of participant: ______________________________________
Date:
________________________________________________
Signature or LTI
Place: ________________________________________________
92
Annexure C
Withdrawal of consent:
I hereby wish to WITHDRAW my consent to participate in the study described above and
understand that such withdrawal WILL NOT endanger my relationship with the Institute of Public
Health
Name of participant: ______________________________________
Date: ________________________________________________
Signature or LTI
Place: ________________________________________________
93
Annexure D
Participants Information Sheet:
My name is Dala Akor KharPhanbuh. I am a student of the Community Health Learning
Programme (CHLP) in an NGO called SOCHARA (Society for Community Health Awareness
Research and Action) in Bangalore. As a part of this programme, I am conducting a research study
along with SOCHARA-CPHE in order to understand more about the factors affecting the
nutritional status of children. I would like to kindly request your permission to participate in this
study.
This note provides an explanation of the nature of the research. This sheet may contain words that
you do not understand. If there is anything you need clarity on, please feel free to ask me. At the
end of this information sheet you will find my contact details
Nutrition has a significant influence on growth and development, particularly during early
childhood, which later impacts all aspects of health as overall physical, mental, emotional and
social well being. Where the nutritional status is like an indicator that refers to the physical being
of child in weight and height.
There are many factors that impact the nutritional status of a child that can either lead to
malnutrition or obesity. I want to know more about the various factors that impact the growth and
development in a child.
I would like to ask you few questions about the past and current situations of your child which will
also includes your awareness, child feeding practices and the services you receive from anganwadi
centre. Your answers will be very important in helping us to understand the underlying factors that
impact child nutritional status.
Some of the questions are very personal and if you do not feel comfortable to answer you can
refuse them. Your participation in this study is voluntary and you can withdraw at any time you
do not need to give any reasons for not answering the question.
94
The interview will be around 20-30 minutes along with your permission; I will also record the
whole interview. If you are not comfortable with this, please let me know I will write instead of
recording and with your consent your words will be copied exact for the purpose of creating a
report. I assure you that everything will be confidential and your identity will be protected. All
confidential data will be handling only by me.
All the information are used only for research purpose.
You are not receive any resource of benefits for participating in this study but the information that
you provide might help us to give you suggestion maintain healthy life.
For more information or clarification:
Dr. Ravi D'Souza,
S J Chander
Consultant
Programme Officer
Centre for Public Health & Equity,
School Of Public Health Equity And Action
(SOPHEA)
E-8/74 Basant Kunj,
No. 359, 1st Main, 1st Block, Koramangala,
Bhopal 462039,Madhya Pradesh State, India.
Bengaluru – 560 034 Karnataka, India
E-mail: ravids@sochara.org
Email: chc@sochara.org; Web: www.sochara.org
Telephone: (0755) 2561511
Phone: +91-80-25531518, 25525372
Thank you for your time. This sheet is for you.
95
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