Socio medical determinants

2. Sensitive indicators/ Socio economic factors of
children are:
1. The state of Health
2. Nutrition
3. Mortality
The Under –Five Mortality Rate (U5MR) is
considered to have close correlation with
these socio economic factors

3.  Of the U5MR of 85, deaths within the first
year (IMR) comprise about 60
 Of these 60, about 40 happens within the
first month of life (NMR).
 Child mortality refers to the deaths of
children between the ages of 1 year and 5
years (i.e., excluding IMR)

4.  Poverty
 Children from poor families or neighborhoods are more likely
than other children to have serious health problems.
 Low birth weight
 Poor nutrition and smoking during pregnancy are common
causes of low birth weight.
 These babies have higher rates of rehospitalization, growth
problems, child sickness, learning problems,
and developmental delays.
 Babies born with a low birth weight are at increased risk of
dying in the first year of life.
 Chronic diseases such as asthma
 Poor housing quality and exposure to secondhand smoke are
contributing factors.

5.  Obesity and high blood pressure
 Poor neighborhoods may not have safe playgrounds, parks, or
organized sports for children. All of these things are barriers to
a healthy body weight.
 Increased accidental injuries
 Living in a home that is not safe and in a dangerous
neighborhood puts children at greater risk of violence.
 Lack of school readiness
 Poor children are less likely to participate in organized
activities and often do not have enough supplies or books in
the home.
 Low parental education and single parent families are complex
factors that may interfere with school readiness.
 Note : NFHS II confirms that in households with low standard
of living, the neonatal mortality is two times, the post-neonatal
mortality is three times and 1-4 year child mortality is five times
that of households with high standard of living

6.  Toxic stress
 Being poor is stressful. It causes damage to the
brain and to a child's overall physical and
mental health into adulthood.
 Adverse Childhood Experiences (ACEs)
 Violence in the home, having a parent in jail,
and emotional neglect increase the amount of
toxic stress children face.
 Children in poverty are more likely to have
these experiences than those living above the
poverty line.

7.  Gender
 women are the bearers and main care-givers of
all children.
 So the women’s own health and well being
pertains directly to the health of the new born as
well as her ability to give care in the vital initial
years of life when the child is most vulnerable
and sets the foundations for her entire future in
terms of growth and development.
 The health of the woman before during and after
pregnancy relates directly to the birth weight of
the children she bears.

8.  The prevalence of low birth weight in India is
close to 30 % and this in turn has a direct
bearing on neonatal morbidity and mortality as
well as adult chronic diseases like heart
diseases and diabetes.
 It is well established that exclusive breast
feeding for a period of 6 months contributes
significantly to the normal growth and
development of the new born and also prevent
malnutrition and killer diseases like diarrhea
and pneumonia.

9.  Breast feeding and weaning also play an
important role in child’s growth and
development but this need proper and full
time attention of mother as well as family
members.

10.  Women’s literacy levels are known to be one of
the most important determinants with a positive
correlation with child survival.
 The NFHS II confirms that all components of
child mortality are observed to decline with
increasing maternal education.
 All child mortality rates are higher amongst
illiterate mothers compared to mothers who had
completed high school education.

11.  The infant mortality rate for children of
illiterate mothers is one and a half times the
rate for children of mothers who are literate,
and is two and a half times the rate for
children whose mothers have at least
completed high school.

12.  A major underlying factor of disease and death
amongst children is the situation of chronic
hunger and malnutrition.
 Poverty and gender work mostly through the
creation of malnutrition.
 About one third of our children are born already
compromised with low birth weight.
 This combined with poor breast feeding
practices and complementary feeding practices
due to lack of support and information, results in
one in two children being malnourished and
stunted.

13.  The resulting vulnerability to disease further
reinforces malnutrition which in turn creates
further vulnerability to disease setting up a
vicious cycle leading ultimately to death in
many cases.
 More than 50% of deaths amongst children
have malnutrition as an underlying factor.

14.  Not breast feeding can increase the risk of
death up to 6 times from diarrhea and up to
2.4 times from pneumonia in babies under 6
months and 2 times in babies aged 6-23
months.
 According to the analysis by Child Survival
Series by Lancet (2003), breastfeeding was
identified as the single most effective
preventive intervention, which could prevent
13 % to 16 % of all childhood deaths.

15.  Adequate complementary feeding between 6
months to 24 months could prevent an
additional 6 % of deaths.
 16 % of neonatal deaths could be saved if all
infants were breastfed from day 1, and 22 %
if breastfeeding started within the first hour.

17. To prevent children from dying, the health care
services provide and facilitate:
 Adequate Antenatal Care
 Safe Delivery
 Immunization
 Regular Growth Monitoring
 Effective health education of care-givers
 Management of common childhood
diseases.

18.  Facilities for care of Grade III and Grade IV
malnutrition
 Intensive care for sick child etc.

19.  Systems for food security, integrated
systems of care such as the ICDS, system
for access to safe water and sanitation, all
have a major role in being able to prevent
child mortality.

20.  Culture plays a significant role in all aspects
of child care and its impact is most obvious
in health and nutrition related practices
around child birth, infant and young child
feeding, and use of indigenous forms of
medicine.
 Caste is one of the determinants of poverty
and lack of ‘power’ and children below 3
years of age in Scheduled tribes and
Scheduled castes are twice as likely to be
malnourished than children in other groups.

21.  Regional insurgency (vidroh; against
government authority) also creates an
atmosphere of violence and insecurity in which
children survive.
 Children who require special measures to
ensure protection and promotion of their rights:
1. Children of migrant families
2. Children of women in prison
3. Children without adult protection such as-
Street Children or children in post Disaster
situations.

22.  Thus it is clear that while the immediate
cause of mortality in childhood is usually
disease, the underlying factors point to
serious issues of socio-economic
circumstances and inequalities.

23. Thank You