PATTERN OF MORBIDITIES AND HEALTH

SEEKING BEHAVIOR OF UNDER-FIVE

CHILDREN IN RURAL AREAS

Roll no:
Reg no:
Session: 2014-2015

DEPARTMENT OF COMMUNITY MEDICINE

ARMED FORCES MEDICAL COLLEGE
DHAKA CANTONMENT

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 DEPARTMENT OF COMMUNITY MEDICINE
ARMED FORCES MEDICAL COLLEGE
BANGLADESH UNIVERSITY OF PROFESSIONALS

This research project Pattern of morbidities and health seeking

behavior of under-five children is submitted to the Department of
Community Medicine, Armed Forces Medical College under
Bangladesh University of Professionals in partial fulfillment of the
requirement of the course of Community Medicine, second
professional MBBS Examination for the session 2014-2015.

Roll no:
Reg no:
Session: 2014-2015
Armed Forces Medical College, Dhaka

Board of Examiners:
External Internal

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PATTERN OF MORBIDITIES AND HEALTH SEEKING
BEHAVIOR OF UNDER-FIVE CHILDREN
SECOND PROFESSIONAL MBBS EXAMINATION
MAY, 2017

Roll no:
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Session: 2014-2015

Signature of the Guides: Signature of the cadet:

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 ACKNOWLEDGEMENT

First off all, we are grateful to almighty ALLAH, who with his
merciful blessings has been given us the golden opportunity, patience,
strength, skills and resources to carry out this research project
successfully.
In the whole process of conducting the study and writing of this report
many people helped us in many different stages directly or indirectly.
We would like to express our heartiest gratitude for their help and
support in making this study properly.
We would like to thank Brig Gen Mohammed Ali, Professor and Head
of Department of Community Medicine, Armed Forces Medical
College, for his kind approval of this important subject as the topic of
our research study. We all cadet are so much delighted to get him as
our group teacher. He inspired in every step of our research; showed
the right way to go. From the beginning to ending he was with us as
shadow of the help, as an advisor to make a successful group work.
He also guided us smoothly and cordially throughout the whole
research work starting with preparation of research protocol to the
writing of this report and especially successful collection, checking,
compilation and analysis of the data.
We are also grateful for his valuable guidance and continuous support
to make our dream successful which at time seems to be impossible
without his effort.
We all cadet are very much grateful to Lt. Co Maksumul Hakim and
Lt. Col. Latifa Rahman, Associate professor of Community Medicine
for their valuable guidance and continuous support to make our dream
successful which at time seems to be impossible without her effort.

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We would like to thank CGO Mehedi Hasan Jewel, MSC,
Entomologist, Department of Community Medicine and other
teachers for their assistance in different aspect of the study at
different times. We would also like to thank Dr. Afsa Afroz Mouri,
Lecturer, Department of Community Medicine for their guidance and
co-operation.
We would like to extend our thanks to the staff of the Department of
Community Medicine for their full co-operation with whole process.
This research would not have been possible unless the respectable
population of the study area provided us with the necessary
information. Their friendly cooperation, enthusiastic participation and
spontaneous assistance have made this effort to success. We thank
them for their patience participation and warm hospitality.
Finally, we thank all the mothers of child of under-five age for
participating in this research project. We are especially grateful to
those, who have contributed actively in the writing of this report and
their valuable helping hand towards a successful completion of this
project.

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 CONTENTS
Page no.
Chapter -1: Introduction

1.1 Introduction 01
1.2 Background Information of the Study 04
1.3 Justification of the Study 06
1.4 Research Question 08
1.5 Objectives 08
1.6 List of Key Variables 08
1.7Operational Definition 10
1.8Limitation of study 12

Chapter-2: Literature Review 13

Chapter-3: Methods and Materials 22

Chapter-4: Results 25

Chapter-5: Discussion 52

Chapter-6: Conclusion and Recommendation 56

6.1 Conclusion 57

6.2 Recommendation 58

References xi

Annexure xiv

Questionnaire xiv
Photos of Survey xxi

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Ta Title Page
b
l
e
No.
1. Distribution of respondents according to their age group 27
2. Educational status of the mother of under 5 children 29
3. Educational status of the fathers of under 5 children 30
4. Distribution of the respondents by their occupation 31
5. Distribution of the respondents by their husband's occupation 32
6. Distribution of family according to family members 34
7. Distribution of the respondents according to house types 35
8. Distribution of the respondents by monthly family income 36
9. Distribution of the number of under five children of the 40
respondents
(age wise)
10. Distribution of children according to weight during birth 42
11. Distribution of types of illness of the child 46
12. Distributions of the respondents by health seeking behavior 49
for their
Children
13. Distribution of cause why people prefer this type if 50
treatment
14. Types of health facilities in the community 54
15. Distribution of child according to their mid upper arm 55
circumference (MUAC)

LIST OF TABLES

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 LIST OF FIGURES

Fig Title Pa
u g
r e
e
N
o
.
1. Distribution of the respondents according to their 28
religion
2. Distribution of the respondents according to type of family 33

3. Distribution of the respondents child upto 5 years age 38

4. Distribution of under five children according to gender 39

5. Distribution of weight taken of child after birth 41

6. Distribution of Immunization status of children 43

7. Distribution of child suffering from any illness for the last 3 45

months
8. Health seeking measures taken for the diseased child 47

9. Distribution of reasons for not taking treatment 48

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10. Frequency of illness of under five children 51

11. Hospitalization of child after getting sick 52

12. Types of hospitals where children were admitted after 53

sickness

ABSTRACT
This study presents a cross sectional type of descriptive study conducted in
villages of Mohishashi at Dhamrai upazilla, Dhaka District and Balihati at
Saturia upazilla, Manikganj district.Sample size was 330 obtained by non-
purposive sampling technique. The aim of the study was to find the pattern of
morbidities and health seeking behavior of under five children. The study
wasconducted using verbal autopsy using a preformed close ended structural
questionnaire.

In order to achieve the goal it was focused on some of the key factors that may
be closely related with the pattern of morbidities and treatment seeking
behaviour. Factors involved the socio demographic factors that are present in

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close proximity to the child including the parents' information, household
structure and familial structure. Preliminary information pertaining to the child
came next which involved a brief recollection of information such as age, sex,
birth weight and immunization records. Lastly it was observed information
related to the treatment details received by the child in previous illness.

The findings reveal that the majority of the children 217(62%) becomes ill less
than 3 times a year and cough, cold and fever had most commonly affected in
315(58.01%) cases. Among the diseased children 340(97.14%) had received
treatment for their illness. Variety of healthcare facilities is available in the
community. Hospital/clinic had been available most often account to
277(65.95%). Here, 190(45.23%) cases selected this facility due to effective and
safe treatment, followed by easily available 181(43.09%). Majority of children
340(97.14%) had received treatment for their illness. And a few number of
parents 10(2.86%) did not seek any treatment for their children and thought that
the illness may get cured without medicine.

The immunization status of children was 349(99.71%).256 (73.14%) children

was completely immunized and 93(26.57%) was incomplete. This is an
excellent example of health status of the children in rural areas of Bangladesh
though there is still space for improvement.

Another excellent example shows that children 220 (62.86%) had not been
hospitalized since birth for any reason. Among the children who were admitted,
74 children out of 130 (37.14%) had been admitted into governmental hospitals
after being sick.

This study indicates that the health seeking behaviour of the parents of under
five children in rural area of Bangladesh is satisfactory. But to improve the
health status and health seeking behaviour of parents of under five children
proper policy and its implementation is utmost necessary.

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 Chapter-1

INTRODUCTION

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 INTRODUCTION
Bangladesh- here from the dawn of our birth we are cursed with poverty .The
biggest victims of a poverty stricken country are its children. Bangladesh has
had a dismal track record when it has come to kids health. According to latest
UNICEF report the mortality rate of children under 5 stands at an alarming 48.5
per 1000 live birth. Malnutrition, pneumonia, diarrhea, malaria, measles,
injuries are contributing to the high rate of neonatal deaths in the country.1
Nearly one-half of all children below the age of five years are either
underweight or stunted. The poor child health care facilities in the country
means that most of these children are not vaccinated exposing them to the
threats of life threatening diseases. But the matter of hope is that the mortality
has come down from 94 in 1990 to 52 in 2007(Bangladesh Demography and
Health Survey report). A childs world centers on the home, school and the local
community. There should be healthy places where children can thrive and
remain protected from diseases. However, it is stated that 8.1 million children
aged 0-5 years old die every year from diseases linked to the environments in
which they live, learn and play. 2

Children's development consists of several interdependent domains, including

sensory-motor, cognitive, and social-emotional, all of which are likely to be
affected due to poverty, poor health, nutrition, and deficient in care. 3 The
discrepancy of Bangladesh's rural children between their current developmental
levels and what they would have achieved in a more nurturing environment with
adequate stimulation and nutrition indicates the degree of loss of potential. 1 In

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later childhood these children will subsequently have poor levels of cognition
and education, both of which are linked to later earnings. Furthermore,
improved parental education, particularly of mothers, is related to reduced
fertility and improved child survival, health, nutrition, cognition, and education.
Thus the failure of children to fulfill their developmental potential and achieve
satisfactory educational levels plays an important part in the intergenerational
transmission of poverty. In countries such as Bangladesh with a large proportion
of such children, national development is likely to be affected.

Mothers and children constitute the priority group. In sheer number, they
comprise approximately 71.14% of the population of the developing countries,
many of the complex risk factors affect their health and lead to morbidities. 4The
condition of the rural areas of Bangladesh has been analyzed and it has been
assessed that it is unsuitable for many of the developing children in the aspect of
reiterating morbidities which strikes with paralyzing effects to a child's growth.
The poor service of proper sanitation, water supply and many other factors lead
to a formation of an environment which leads to the engenderment of various
hurtful diseases as in diarrhea, dysentery, helminthiasis, typhoid fever, and
poliomyelitis.

The rural areas of Bangladesh thrive and live based upon the culture which was
instituted into the areas long ago. It was a time in which the basic healthcare
ideology had been very different than what it is today. The arcane healthcare
professional still exist today in the rural areas in the form of many healers, non-
allopathic (homeopathic) doctors and allopathic non-qualified practitioners. 5
This type of culture sets the mindset of the parents into seeking medical advice
or help from unqualified persons leading to an aggravated form of the current
illness in children. This course of action made by the parents may lead to the
loss of golden time period in which the ill stricken child can receive proper

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treatment and may also reduce the child's success of combating the disease
leading to death. It is true that many factors such as climate, geographic and
ethnic factor play some role in a child's wellbeing, however, the socio-economic
condition, hygiene, sanitation, culture, proper medical and health care facilities,
and education can be allotted to a child's productive health and development as
well.

The young children between the ages of one and five are an integral part of the
nations arsenal. These children are the future leaders and the care takers of the
nation. Any nation thinking otherwise will share its part of distraught and doom.
The investment in child health is a direct entry point to the social developments,
productivity and better quality of life. Many children are left to die before the
age of five due to a common disease as in diarrhoea, respiratory infections, or
diseases which are prevented with substantial ease are not being able to be
prevented.6There needs to be a better concept of healthcare in the rural areas in
order to arrest unwanted and unacceptable child mortality. Bangladesh has
shown some improvement as far as child health care is concerned but
Bangladesh has a long way to go to achieve the minimum nutritional and other
health level in children.
Bangladesh has already met the target of reducing under 5 mortality rate against
the target 48 per 1000 live births in 2015.It has already achieved 44 per 1000
live births in 2011.The successful programmes for immunization, control of
diarrhoeal diseases and vitamin A supplementation are considered to be most
significant contributors to the decline in child and infant deaths along with
potential effect of overall economic and social development.
Despite these improvements there are challenges ahead. While the mortality
rates have improved, major inequalities among the population still need to be
administered. Childhood injuries especially drowning have emerged as a

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considerable public health problem responsible for a full quarter of the deaths
among under 5 children.

BACKGROUND
Most of the people of Bangladesh live under the line of poverty. Children
mortality and morbidity is one of the stricken features in this regard. This topic
has received many interests through the eyes of various people and organization
of world including Bangladesh. According to the BDHS report 2010 ,the infant
morbidity rate 37 deaths per 1000 live birth and under five children mortality
rate is 52 per 1000 which is hardly acceptable to the rest of the world. 7

To improve the condition of nation, this rate has to be improved with the
conscious eye of the government and various health care facilities of
Bangladesh achieved significant success in this field. However this mortality
rate remained high at 65 per 1000 live birth (according to the statistics of 2007
BDHS) which reduced to 52 per 1000 live birth in 2010 (according to the
statistics of 2010 BDHS). On survey, we got that most prevalent cause of death
of under five is due to the serious infection other than confirmed ARI (18%) or
diarrhoea(30%).

Children come with fever which is the easily recognizable sign who are
suffering from serious infection like typhoid fever, bacteremia, septicemia,
meningoencephalitis. Two significant factors that have the most contribution to
the high rate of child mortality in developing countries are poor rate of seeking
health care from trained care providers and delay in seeking this care. Several
other studies have been conducted in Bangladesh to understand health care
seeking behavior for under five children health. Most of these were related to

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ARI and were undertaken in rural areas. Little information available to
determine the health seeking behavior in rural area from trained provider.

To prevent the morbidity of children, the most efficient way is to give

importance on the basic health care undertaken by the parents. The behavior
stables as in safe stool disposal, adequate hand washing, and food preparation
have a massive effect in reducing the chance of incidence and spreading
diarrhoea. Some other hygiene practices like water quality treatment, sanitation
and other health educations in the administration of ORS in the case of
diarrhoea stricken child can lead to a maximum chance of maintaining a happy
and healthy child. 9

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 JUSTIFICATION
The causative factor of childhood mortality and morbidity are multiple
including but not exclusively those with illness, disease, biological cause,
consideration of cultural, psychological, social and political factor present in the
physical environment where the child lives is important. This premise has been
expanded in many different areas such as medical, child psychology and
sociology and now forms a fundamental part of great deal of social science
research and practice. Knowledge or causes of death among children under five
is important because it pertains to policy and programmes. In this study, the
cause of death in children in a developing and low income country such as
Bangladesh, placed risk factors within an analytical framework or including the
interaction among socio-economic, cultural, environmental and biomedical
factors. The framework focuses the factors or determinants according how
direct the impact of the determinant was on the risk of death i.e. the proximity
of the risk posed to children.

In the rural areas, most of the parents seek traditional rather than modern
medical facilities and sometime seek that when symptoms worse. Given these
difficulties, approach is to estimate models that mainly focus on factors that are
mostly underlying determinants of morbidity and mortality, some might also be
considered intermediate determinants. The most important covariate included in
this analysis is the geographic location where the child lives that includes

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features of the wider socio-cultural and political context affecting both the child
and his/her care givers. Other selected socio-demographic variables available in
the data grouped as individual childs characteristics, mothers characteristics,
household economic level and communitys characteristics, information about
distributor of common disease and their health seeking pattern will help to
identify the magnitude of health problem of children, deciding priority of action
to solve the problem. It will also help in identifying characteristics of the
disease, elucidating causal factors and providing proper guidance for health care
service delivery. Findings of the study will not reflect the comprehensive picture
of disease pattern in the community but give a scenario part of a community
regarding extensive study that may load the policy makers and health
professionals for planning and modification of health care system and also
developing a system of continuous monitoring and evaluation of services. By
this, the improvement of health status of the under 5 children will occur and
ultimate goal will be achieved.

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 RESEARCH QUESTION
What are the patterns of morbidities and health seeking behavior of under-5
children?

OBJECTIVES
General Objective:

To find out the type of morbidity pattern among under-5 children in a rural area
and health seeking behavior of the mother of that under 05 children.

Specific Objectives:

To find out the type of morbidity under 5 children.

To know the health seeking behavior of the parents for under 5 children.
To determine the socio-demographic factors of under 5 children.

VARIABLES
Socio-demographic Variables

Age

Religion

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 Level of education of parents

Occupational status of parents

Family type and number of members

Household structure

Monthly income of the family

Variable Related to Morbidity

Age of the child

Sex of the child
Birth weight
Vaccination status of child

Variables related to Health Seeking Behavior

Frequency of illness
Types of illness
Attitude of health seeking behavior
Choice of healer
Health service facilities of the community
Mid Upper Arm Circumference (MUAC)

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 OPERATIONAL DEFINITIONS
Respondents:

Mothers of having at least one child less than 5 year of age and living in the
stated rural area are the respondents.

Morbidity:

The disease conditions of the children up to 5th year of age as perceived by the
parents are termed as morbidity of under-5 children.

Behavior:

It is the response of a person to any stimulus.

Health seeking behavior:

The behavior shown by an individual to get rid of the illness is called health
seeking behavior.

Health seeking behavior of mothers:

Action taken by the mother to deal with illness of their children is called health
seeking behavior of the mother.

Illiterate:

A person having no formal education; in the context of Bangladesh, a person

who cannot read or write is called illiterate.

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Housewife:

Women exclusively engaged in their own household activities are called

housewives.

Business:

Person who earn mainly from own monetary investment is called businessman.

Day Laborer:

Person who is earning livelihood on daily wage basis in exchange of physical

labor as in rickshaw puller and field worker is called day laborer.

Monthly Family Income:

The income waged in a day is consolidated for 30 days in case of day laborer is
the monthly income for the family. Otherwise a person in family drawing
monthly salary from the employer is his or her monthly income.

Faith Healer:

The person, who gives medical aid through Tabeez and other magico-religious
manner, is called faith healer.

Traditional Medicine:

The medicine that are persisting in the society from the ancient period but
cannot be explained scientifically, are called Traditional medicine.

Immunization:

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The process by which immunizing agents are introduced into the body from
production of antibody to prevent disease especially tuberculosis, diphtheria,
whopping cough, tetanus, hepatitis-B, meningitis, poliomyelitis and measles, is
called immunization.

LIMITATIONS OF STUDY

Due to time constraints a small sample size was considered and this may
not represent the whole population of Bangladesh.

Socio-cultural barrier hampered effective verbal communication was not

established very well with the respondents.

The information given by the respondents was subjective according to

their judgment. Some data like income, expenditure, education, duration
of illness etc. may not be exact because all females were interviewed,
who had less idea about family expenditure. Same difficulty arises in case
of illiterate respondents.

Sampling procedure was purposive. The sample size of study might not
reflect the whole rural population of Bangladesh.

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 Chapter-2

REVIEW
OF
LITERATURE

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 REVIEW OFLITERATURE
The staples of the morbidities among children, below 5 years of age in
developing country are communicable diseases such as diarrhoeal diseases and
respiratory infections along with some related incidents.
Diarrhoeal Disease:
Diarrhoea is defined as the passage of three or more loose or liquid stools per
day (or more frequent passage than is normal for the individual). Frequent
passing of formed stools is not diarrhoea, nor is the passing of loose, "pasty"
stools by breastfed babies. The majority of the episodes last less than a week
and only 10% of the cases may become persistent (more than 14 days).
Diarrhoea is usually a symptom of an infection in the intestinal tract, which can
be caused by a variety of bacterial, viral and parasitic organisms. Infection is
spread through contaminated food or drinking-water, or from person-to-person
as a result of poor hygiene. Diarrhoeal disease is the second leading cause of
death in children under five years old, and is responsible for killing around 760,
000 children every year. Diarrhoea can last several days, and can leave the body
without the water and salts that are necessary for survival. Children who are
malnourished or have impaired immunity as well as people living with HIV are
most at risk of life-threatening diarrhoea. According to WHO 2013 statistics, in
1990 the 25% of countries with the highest prevalence averaged 32 underweight
children in every 100 children under-five years of age. In 2011, this declined to
24 for every 1000 children under five years of age, representing a 24% decline.
Most people who die from diarrhoea actually die from severe dehydration and
fluid loss, hence with minimal intervention such as oral rehydration can mean
the difference between losing and saving a child.10

Respiratory Tract Infection:

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The disease burden for Acute Respiratory Infections (ARI) is estimated at 94
037 000 DALYs (WHO, 2002) and 3.9 million deaths (WHO, 2002). ARI are
among the leading causes of death in children under 5 years but diagnosis and
attribution are difficult and uncertain. A further complication is that community
studies of childhood mortality depend largely on verbal autopsies, which can be
very unreliable for the diagnosis of ARI. Another difficulty is that ARI are often
associated with other life-threatening diseases such as measles. A study reports
that 62% of all deaths is attributable to ARI but most of these were associated
with measles. When measles deaths are excluded the proportion falls to 24%.
Better estimates of burden of childhood pneumonia are needed and should be
given high priority. A recent meta-analysis study demonstrates that throughout
the world 1.9 million (95% CI 1.6-2.2 million) children died from ARI in 2000,
70% of them in Africa and Southeast Asia. The proportion of deaths directly
attributable to ARI declines from 23% to 18% and then 15% as under-5
mortality declines from 50 to 20 and then to 10/1000 per year.11

Child Care and Nutrition:

Both childcare and nutrition allots to the growth of a child in physical,

emotional and cognitive ways. The steps that are taken in this category have an
impact on all throughout the child's life. Also, different aspect of providing of
food also has an impact on the child. Four aspects of feeding behavior from
caregiver are recognized as important which include: adapting the feeding
method to the child's psychomotor abilities, being affectionate or ware towards
child, creating a satisfactory feeding situation, which are not distracting the
child and last but not least the timing of feeding (including feeding frequently
and when the child is hungry). Following the basic aspects of childcare and
nutrition can export a fruitful outcome for both the child and parents likewise.1

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Breastfeeding:

It has profound impact on a childs survival, health, nutrition and development.

Breast milk provides all of the nutrients, vitamins and minerals an infant needs
for growth for the first six months, and no other liquids or food are needed. In
addition, breast milk carries antibodies from the mother that help combat
disease. The act of breastfeeding itself stimulates proper growth of the mouth
and jaw, and secretion of hormones for digestion and satiety. Breastfeeding
creates a special bond between mother and baby and the interaction between the
mother and child during breastfeeding has positive repercussions for life, in
terms of stimulation, behavior, speech, sense of wellbeing and security and how
the child relates to other people. 5 Breastfeeding also lowers the risk of chronic
conditions later in life, such as obesity, high cholesterol, high blood pressure,
diabetes, and childhood asthma and childhood leukemia. Studies have shown
that breastfed infants do better on intelligence and behavior tests into adulthood
than formula-fed babies.

UNICEF supports countries to implement the priority actions outlined in the

Global Strategy for Infant and Young Child Feeding. The focus in countries is
on five major areas:

1. National level: ensuring that not only is appropriate policies and

legislation in place but that these are implemented and enforced. This
includes support for:

Development and implementation of national infant and young child

feeding policies and strategy frameworks,
Development and implementation of programme plans to operationalize
the strategy,

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 Development and enforcement of appropriate legislation (such as
the International Code of Marketing of Breast milk Substitutes and
maternity protection legislation).
Encouraging and facilitating strategic public and private partnerships with
other international and country-level actors for improvement of infant and
young child nutrition.

2. Health system level: support is provided to implement

interventions in the health system, such as the Ten Steps to Successful
Breastfeeding and the Baby-Friendly Hospital Initiative (BFHI),
curricula, training and support of health workers and health information
systems. Resources, jointly produced with the World Health
Organization, include the BFHI training course and an Integrated Course
on IYCF Counseling.

3. Community level: support is provided for community-based

nutrition and mother support activities involving for example community
health workers, lay counselors and mother to mother support groups.

4. Communication and advocacy activities on breastfeeding are

also a key component of UNICEF support. World Breastfeeding Week is
an annual advocacy event celebrated around the world with support from
UNICEF, WHO and other partners.

5. IYCF in especially difficult circumstances: UNICEF supports

interventions to address infant feeding in emergencies and infant feeding
in the context of HIV/AIDS.

A study was undertaken to assess the pattern of rand the reported

neonatal morbidity and the care-seeking behavior for neonates in rural
Bangladesh. Data were collected from 511 women who had live births

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 during January 1996 August 1998 in four rural sub districts, which are
the field sites of the Operations Research Project of the International
Center for Diarrhoeal Disease Research, Bangladesh.12A structured
questionnaire was used to collect information from the mothers who were
interviewed in their homes. Forty-nine percent of the neonates were
reported to have suffered from some kind of morbidity. Fever was the
most common morbidity reported in the study population (21 percent),
followed by breathing difficulty (11 percent). Birth order, complication
during pregnancy, and/or delivery and death of a sibling were found to be
significantly associated with reported neonatal morbidity. Eight-seven
percent of the mothers sought care for their new born. Some were taken
to several different providers, the commonest being homeopaths (38
percent) and village doctors (37 percent). Seventeen percent were taken
to trained provider and only 5 percent to get formal facilities. Seeking
care from trained providers was found to be associated with gender of the
neonate, birth order, and antenatal care of the mother from trained
providers, father's education and monthly expenditure of the family.
Results of this study suggest that efforts should be made to raise
community aware regarding neonatal morbidity, the importance of
seeking care from trained personnel, the availability of services for these
conditions.

In Guatemala, a study was conducted among 146 rural women about their
health seeking behaviour for common illness of their young children, like
diarrhoea, fever, cough and worms. The mothers generally seek help and
treatment advice from an older woman in family and did so more often for
diarrhoea (82%) and fever (64%) for cough (43%) and worm (28%) secondly
they obtained advice in pharmacy and from a drug seller. Professional help at a
medical service (8-23%); traditional help were hardly consulted (0-3%). In case

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of self-medication, the women predominantly took western drugs, about 80% in
diarrhoea and fever and above 50% in cough. Herbs and traditional remedies
were used in cough (27% herbs) and in worms (58 extra remedies).
Geographical or financial accessibility could not explain the low utilization of
the Western health care system. The acceptability of public services was poor as
the security clinic did not prescribe the potent modern drugs that mothers
preferred for the treatment of childhood symptoms, especially for complicated
illness.13

In Bangladesh, A three year study was conducted at Rajshahi Medical College

in 3 years study disease at pediatric and infectious disease unit, showed that
9459 patients were admitted in pediatrics unit and 503 in infectious disease unit
in 3 years study period. All patients were between 0-13 years. In pediatric unit
evidence of Diarrhoeal diseases were in most (41.43%) and respiratory diseases
were in second position (26.5%) out of all admissions. Infections found in 6%
cases and Helminthiasis (4.3%) cases. Other diseases found were nutritional
disorders, meningitis, acute glomerular nephritis, thalassaemia, rheumatic fever
and encephalitis.14

In Bangladesh, for very young infants with respiratory infections ideal treatment
assumed to be spiritual rather than medical, allopathic treatment is considered
after worsening of symptoms. A study conducted by Bhuiya A. on socio-
economic and demographic influence upon the heath seeking behaviour of
infants suffered from Acute Respiratory Tract infections and 7% from diarrhoeal
diseases, 86% of the neonates received some form of treatment. Majority of
them sought treatment from Homeopaths (31%) and non-qualified allopath
(28%). Only 14% of them received modern allopathic treatment.15

In Bangladesh another study was conducted at Bogra Mission Hospital, Bogra,

Bangladesh among 528 children (0-12 years). The study showed that among all

19
admitted cases common diseases were gastroenteritis (50%); Pneumonia
(20.8%); Skin infections (6.3%); Kwashiorkor (3%); and abdominal pain
(2.9%); Out of them 73 (14%) were under one year of age.16

Narayangonj district, Bangladesh, Chowdhury M.S. conducted a study among

children (0-15 years) in eight villages of the district. The study showed that
majority of them suffered from malnutrition (50.24%). Other common illness
found as gastroenteritis (23.47%); helminthiasis (33.35%); respiratory diseases
(27%); skin diseases (20.47%); dental problems (15.36%) and chronic
suppurative otitis media (10.76%).17

In Jamaica, a study conducted by Willma baily among the children admitted

into public and private hospitals in Kingston metropolitan area, showed that
nearly 41% of the children were treated for respiratory disorders. The most
important disease in this group was asthma and pneumonia. Following that are
non-infectious and parasitic diseases and major distribution in this group was
gastroenteritis.18

In Sudan, a prospective epidemiological study was conducted in a village

community Khartoum during 1977-1979 to find out the morbidity patterns of
under five children of 293 under five children in 310 households were followed
up for two years. The household was visited twice monthly and information of
the disease pattern was collected. Cough, fever and diarrhoea were found to be
the commonest cause of morbidity.19

In Nairobi, a study was conducted to investigate factors that influence morbidity

and health seeking decisions in an urban slum community. Data were collected
and the results showed that the factors that influenced morbidity were the
childrens ethnicity and type of toilet facility. Predictors for seeking health care
were the severity of illness, survival of father and mother, mother's education,

20
work status and wealth class. The conclusions drawn show that by enhancing
access to health care services, socio-economic status is decreasing the disease
burden among children in slum settlements.20

In Nigeria, a study on spatial analysis of risk factors for childhood morbidity

revealed in recent Demographic and Health Surveys (DHS) from Sub Saharan
Africa (SSA) indicate a decline in childhood vaccination coverage but a high
prevalence of childhood diarrhoea, cough and fever. According to Nigerian
DHS, impact of geographical factors and other important risk factors on
diarrhoea, cough and fever was observed. In addition, children from mothers
with higher levels of education and those from poor households had a
significantly lower association with diarrhoea; children delivered in hospitals,
living in urban areas or from mother having received parental visits had a
significantly lower association with fever.21

21
 Chapter-3

METHODS
AND
MATERIALS

22
 METHODS AND MATERIALS

Study Design

This study was descriptive type of cross sectional study and respondents were
selected purposively from the mothers having under-five children in a rural
community.

Study Place

The study place was Village Mohishashi of Dhamrai upazilla, Dhaka District
and
Village Balihati of Saturia upazilla, Manikganj district.

Study Period

The study was conducted from a period of 25th November to 30th November
2016. First there was creation of a framework, collection of data, analysis of
data and finally presentation of the concise version of the overall report.

Study Population

Total 330 mothers having under-five children in rural community in Dhamrai

upazilla of Dhaka district were the study population. Irrespective of age of rural
mothers who had under-five children were included in the study.

Inclusion Criteria

1. All rural mothers who had under-five children.

2. Children below 5 years of age were included in this study from the
study place.

3. Mentally and physically sound persons were included in this study.

4. People who had participated voluntarily were included in this

study.

23
Exclusion Criteria

1. Anyone unwilling to participate in the study

2. Children having age more than 5 years were excluded in this study

3. Physically disabled, psychiatric disordered children and their mothers

were excluded from the study.

Sampling Procedure

Purposive sampling was done. Rural mothers of the study place who were
available at home during data collection and fulfilling the above mentioned
inclusion criteria were selected interview.

Sample size

Total 330 mothers having under-5 children were interviewed.

Data Collection Technique

Face to face interview by pretested semi structured questionnaire. A brief

introduction was given verbally to each respondent by the researchers. At the
beginning of the interview the purpose and importance of the study was
explained to each respondent. The questionnaire was filled up by the researcher
during interview.

Data Collection Instruments

A semi-structured interview questionnaire was developed in both English and

Bengali. The questionnaire was developed using the selected variables
according to specific objectives.

Data Processing and Analysis

The data was checked, verified and edited daily. After checking and rechecking
data was processed by using Microsoft office package program. The frequency
range consistency was checked. Data was coded and recorded to create new
variables. Accuracy of data was ensured by defining range, limits and valid
values of all variable.

24
 Chapter-4

RESULTS

25
 Section 1

SOCIO-DEMOGRAPHIC
INFORMATION

26
 Table No 1: Distribution of the respondents
according to age

Mean= 25.65 years SD 1.19 years

The table shows distribution of the age of the respondents and the
majority of respondents 172 (52.12%) are between the age 18-25.

27
 Figure No 1: Distribution of respondent according
to Religion

29%

Islam Hindu
71%

The pie-chart shows the religion of respondents and majority of the

population of respondents were Muslim 234(70.91%) and rest were Hindu
96(29.09%).

28
 Table No 2: Educational status of the mother of
under five children

The table shows the educational status of the mother of under five children
summing up to 330 respondents. Out of the respondents the majority of the
mothers 138(41.82%) had attended class VI-X.

29
Table No 3: Educational status of the husband of the
mother of under five children

The table shows the educational status of the father of under five
children and the majority of the fathers had an educational status
between class VI-X amounting up to 119(36.06%).

30
 Table No 4: Distribution of the respondents by their
occupation

The table shows the distribution of the respondents by their occupation

and out of the total respondents 303(91.82%) of the respondents were
housewives.

31
Table No 5: Distribution of the respondents by their
husbands occupation

The table shows distribution of the respondents by their husbands

occupation and the majority of the husbands 168(50.91%) had an
occupation involving business.

32
 Figure No 2: Distribution of respondents according to
type of family

160
140
120
100
80 142 Family
137
60
40 51
20
0
single joint extended

The figure shows the distribution of the number of respondents according

to type of family and the majority of the families 142(43.03%) are
single family.

33
 Table No 6: Distribution of family according to their
family members

The table shows the distribution of respondents according to their family

members and the majority of the families lived in a household which
consisted of 4-6 members and approximated 187(56.67%) families.

34
 Table No 7: Distribution of respondents by house type

The table shows the distribution of the respondents according to house

types in which they live in and the major portion of the respondents
approximately 137(41.52%) families live in Semi-pucca house.

35
Table No 8 : Distribution of the respondent by monthly
income

Mean= 9803.03 Taka

The table shows the distribution of the respondents by monthly

income and out of the 330 respondents,121(36.67%) of the
respondents had a monthly income between 5000-10,000 Taka.

36
 Section-2

INFORMATION ABOUT
CHILD AND CHILD
RELATED SD 615.84 Taka

37
Figure 3: Distribution of the number of respondents child up
to 5 years age

100.00%

80.00%

60.00%
85.46%
40.00%

20.00% 14.24%
0.30%
0.00%
1 2 3

The figure shows the distribution of the number of respondents child

up to 5 years and the majority 282(85.46%) is number of 1child.

38
 Figure No 4: Distribution of under five children
according to gender

Male Female

47% 53%

The pie-chart shows sons and daughters of the respondents having the
age of under five and the frequency of males 191(57.88%) are at a
higher rate.

39
 Table No 9: Distribution of the age number of under
five children of the respondents

The table shows the distribution of the number of under five children of
the respondents (age wise) and the majority of them had children
between 4-5 years accounting to 80(24.24%).

40
Figure No 5: Distribution of weight taken of the child after
birth

YES NO

25%

75%

The pie-chart shows distribution of weight taken of the child after

birth and most of the children 248(75.15%) had measured their
weight after birth.

41
Table No 10: Distribution of child according to their birth
weight

The table shows the distribution of child according to their weight

during birth and most of the children 133(40.30%) was in between
>2.5 kg during birth.

42
 Figure No 6: Immunization status of the children

85.1
5%
(281)

Complete Incomplete

The figure shows the immunization status of children was 100%.

Among them 281(85.15%) children was completely immunized and
49(14.85%) was incompletely immunized.

43
 Section-3

INFORMATION RELATED
TO HEALTH SEEKING
BEHAVIOR OF
CHILDREN

44
Fig No 7: Children Suffering from illness within last 03
months

YES NO

The pie-chart shows the distribution of the children suffering from

illness within last 03 months and 195(59.09%)children had been
indeed sick in the past 03 months.

45
 Table No 11: Distributions of types of illness

The above table shows the type of illness that affected the most of the
children 118(60.51%) and cough & cold had most commonly affected
in cases.

46
Fig No 8: Health seeking Measure taken for the diseased child

YES NO

This pie-chart shows the measures taken for the diseased children
and majority of the children 316(95.76%) had received treatment for
their illness.

47
Figure No 9: Distribution of reasons for not taking
treatment

May be cure without medicine Others

The pie chart shows the reasons for which the respondents did not
seek any treatment and majority of the respondents 12(85.71%)
thought that it may be cured without medicine.

48
 Table No 12: Distributions of the respondents by health
seeking behavior for their children

The above table shows the distribution by health care seeking behavior for
their children . The highest responses 117(35.46%) were towards
Hospital/Clinic.

49
 Table No 13: Distributions of cause why people
prefer this type of treatment

The above multiple response table shows the distribution of the

respondents by reason for choosing the particular treatment for health
care seeking behaviour for their children . The majority responses
139(42.12%) were towards easily available.

50
Figure No 10: Frequency of illness of the under 5 children

300

250

200

150 Frequency of illness

100

50

0
3 time/yr 4-6 time/yr >6 time/yr

The bar diagram shows frequency of illness of the under five

children. The majority of the children 254(76.97%) become
ill less than 3 times a year.

51
Figure No 11: Hospitalization of children after getting sick

20%

YES NO

80%

The pie-chart shows hospitalization of children after getting sick and

most of the children 265(80.30%) had not been hospitalized since birth
for any reason.

52
 Figure No 12: Types of hospital where children were
admitted after sickness

The bar diagram shows distribution of hospital in which sick children were
admitted and majority of the children 53(81.54%) admitted into
governmental hospitals after being sick.

53
 Table No 14: Types of health facilities in the
community

The table shows the types of health facilities in the community and
government doctor had been available most often account to 199(60.30%).

54
Table No 15: Distribution of children according to their Mid
Upper Arm Circumference (MUAC)

The table shows the distribution of children according to their mid

upper arm circumference and the majority of the children 157(47.58%)
had a measurement of more than 13.5 .

55
 Chapter-5

DISCUSSION

56
 DISCUSSION
Every structural phenomenon has a necessity for a strong foundation and a
country is no different. The strongest foundation of a nation are its children who
unfortunately constitute a vulnerable that is a special risk group because at this
stage of development, there is a greater risk of developing morbidities. These
morbidities rely on many complex integrating but potentially preventable
factors.

This descriptive type of cross sectional study was carried out in Dhamrai
upazilla of Dhaka district and Saturia upazilla of Manikganj district during the
period of 25th to 30th November, 2016. First there was creating of a framework,
which after implementing, data was collected, then analyzed and finally
presented. A total of 330 mothers were selected to be respondents and most of
them were between the ages of 16-25 and majority having Islam as their
religion. As for as the educational status in the household, the average literacy
for the mothers was between class 6-10 and the fathers education level was
mostly found between class 6-10. Among the mothers 95.71% of them were
housewives and majority (41.71%) of the fathers were self employed. Out of the
families, the main types of families were single families (51.11%) and the
majority of the families lived with 4-6 members in their household (58.28%).
The families mainly lived in tin shed (49%) and had an earning level between
10,001 to15,000Tk which was found within the majority of the respondents
(36.28%). Total 276 (78.86%) respondents had only one under 5 children,
73(20.86%) respondents had two under 5 children. Out of all the children, male
percentage is slightly higher than female with males having 77.14% and females
having 61%. Majority of the mothers were between the ages of 16-25 years
(70%) during their first childbirth and most of the child's weight during birth
were >2.5 Kg (52.46%). Out of all the children, 99.71% of them had been

57
immunized and mainly had Mid Upper Arm Circumference above 13.5 cm
(47.14%). In the entire sample size of the children, 85.71% had been indeed
sick in the past 6 months and most common illness being cough, cold and fever
clocking at 58.01% of the children. According to the findings, 97.14% of the ill
stricken children received treatment. The 2.86% did not receive treatment
mainly because the parents thought that the illness will get cured without
medicine. Majority of the respondents (42.34%) went to General Practitionars to
seek treatment for their sick child and most of the respondents responded that
they chose this form of health seeking behavior because it was effective and
safe treatment (32.23%). Majority of the children (62.86%) had not been
hospitalized after being struck with illness. However, those who were admitted
to hospitals, majority of them were admitted into a governmental hospital
(33.43%). Finally according to findings it was deduced that government doctors
were the most common health facilities in the community (49.71%).

The under -five children of my study suffered from cough, cold and fever
(58.01%), Common fever (27.62%), Diarrhoea (11.97%) .In Bangladesh,
another study showed22 that the national data on cause of under five children
morbidities with one third of the children (30%) treated for cough and cold
followed by diarrhoea/dysentery (17%), fever (11%), Pneumonia (9%). In both
the studies it was found that the morbidities by diarrhea and fever almost
similar. Findings of my study are supported by another similar study.22

In our study 97.14% of the diseased children received some form of treatment,
32.95% went to hospital, and 15.67% sought treatment from pharmacy man. A
similar study conducted by Bhuiya A. on socio-economic and demographic
influence upon the heath seeking behavior of infants,86% of the neonates
received some form of treatment. Majority of them sought treatment from

58
Homeopaths (31%) and non-qualified allopath (28%). Only 14% of them
received modern allopathic treatment.19

Our study revealed that most disease prone individuals are those that live in a
household that has a less overall income in contrast to others. It was indicated
that in our study 5.42% of the individuals had less than 5000 BDT per month
and 34.85% of individual had in between 5000-10,000 BDT per month. A
similar study was conducted23 which presented similar finding to that of ours.
This parallel study showed a significant relationship between monthly family
income of the respondents and their health status. Thus our study is consistent
with the finding of that study. 23

In our present study, it was concluded that the majority of the children suffering
from disease was in accord with the evident of their mother having a low
educational status. A similar study was carried out 24on parental health seeking
behavior for childhood illness in Vietnam showed relation between the
perception of illness with the age and education of under five childs mother.
The present study is consistent with the findings of the study carried at
Vietnam.24

59
 Chapter-6

CONCLUSION
AND
RECOMMENDATIONS

60
 CONCLUSION
At the end of our study, our gathered finding give us a vast amount of
information about the related cause of morbidities, health seeking behavior,
behavior of the parents and condition of the under five children. From the first
beat of life, most of the babies begin their journey with a morbid environment
because of unhygienic home delivery which occurs due to lack of availability of
doctor. So that most of the mother are not aware if the babies were born with a
proper weight or low birth weight. Poor housing, low socio-economic condition,
lack of parenteral education, improper breast feeding, lack of weaning practice
are depicted to be significant factors affecting morbidity among the under five
children. Children under five years are mostly suffering from common cold,
fever, cough, diarrhoeal disease, acute respiratory infection etc. But a
satisfactory thing from our survey we noticed that the ratio of health seeking
behavior is now almost reversed back than before.

Even with a lacking an educational status and poor economic background, the
parents are still going to health care professional to seek treatment for sick
children. The positive sign regarding the improvement in health seeking
behavior and health facilities is that EPI immunization has successfully covered
almost all children. The government of Bangladesh is successfully promoting its
health care facilities and by doing so received the MDG award in 2010for
reducing child mortality rate and also in the track to meet the Millennium
Development Goals target in infant and maternal health.

Our combined effort can make a healthy and prosperous Bangladesh where we
can provide our children a healthy shiny smile. We can raise our voice
unanimously with JOHN.W.WHITE, head, founder of Rutherford
institute-Children are the living message we send to a time we will not see.

61
So, let us be outraged, let us be loud and let us be bold about our children.

RECOMMENDATIONS
Build the effective community for improving health seeking behavior of
the mothers of under-five children by raising awareness.

Provide essential services: immunization, ORT, detection, treatment and

referral of ARI, Diarrhoea and other common illnesses through
community outreach and local health facilities according to the plan of
Govt. and non Govt. health services.

There is a need of present time to eradicate the KAP (Knowledge,

Attitude, Practice) gap of the mother of the under 5 children in rural areas
in Bangladesh in health seeking behavior of their children.

Relationship between service providers and people should be improved.

Media should be involved in removing superstitious belief among people.
Establish better communication system to provide health related
information in doorsteps for the mothers.
Enhance empowerment and stable economic for poor mothers.
Involve different NGOs for providing health services at the root level.

REFERENCES
1. "Nutrition." UNICEF. N.p., 13 Jan. 2005. Web. 26 Oct. 2013.
2. WHO. Shape healthy environments for children-the feature of life WHO
Health Day 7 April 2011
3. McGregor, Grantham, S. Developmental Potential in the First 5 Years
for Children Developing Countries. NCBI U.S. National Library of
Medicine, 6 Jan. 2007. Web. 01 Apr. 2014.

62
4. Park, K. Park's Textbook of Preventive and Social Medicine. Jabalpur:
M/S Banarsidas
5. Rashid, K. M., MdKhabiruddin, and SayeedHyder. Textbook of
Community Medicine and Public Health, Dhaka, Bangladesh: RKH,
2004. Print.
6. Kandala, Ngianga. "Malnutrition among Children under the Age of
Five." BMC Public
7. M.M. Rahman: Factors Affecting on Child Survival in Bangladesh: Cox
Proportional Hazards Model Analysis. The Internet Journal of Tropical
Medicine. 2009 Volume 6 Number 1.
8. NusratNajnin 1,2, Catherine M. Bennett 2,3, and Stephen P. Lubdy1,
Inequalities in HEALTH POPUL NUTR 2011 Oct; 29(5): 523-531, ISSN
1606-0997
9. "Evaluation of an Early Childhood Parenting Programme in Rural
Bangladesh." NCBI. U.S.
10."Diarrhoeal Disease." WHO. N.p., Apr. 2013. Web. 26 Oct. 2013.
11."Respiratory Diseases In Children Under 5." Allergy and Asthma
Network Mothers of Asthmatics RSS.N.p.,n.d. Web. 26 Oct. 2013.

12.Amir Mohammad Sayem, Abu Taher Md. SanaullahNury, and Md.

DelwarHossain. Achieving the Millenium Development Goal for Under-
five Mortality in Bangladesh: Current Status and Lessons for Issues and
Challages for Further Improvements, J Health PopulNutr. 2011 April;
29(2): 92-102. INTERNATIONAL CENTRE FOR DIARRHOEAL
DISEASE RESEARCH, BANGLADESH
13.Delgado-E; Soresen S C; Vander-stuyft-P. Health seeking behavious and
self treatment for common child-hood symptoms in rural Guatemala.
Centro de Education e Investigation ensaluden Areas Rurals (CEISAR),
La Antiguh, Guatemala, Ann-soc.Belg-Med-Trop 1994; 74(2): 161-8.
14.Pattern in pediatric and infectious disease unit in Rajshahi Medical
College Hopital, Bangladesh Medical Journal Khulna. 1981; Vol. 144(2);
1-6.

12
15.Bhuiyan A, Souza SD, Socioeconomic and demographic correlates of
child health and mortality in Matlab; women children and health, Dhaka:
International center for diarrhoeal disease research, Bangladesh, Special
publication 35, 1994.
16.Yasuko MZ. Bisease and infant mortality in children at Bogra mission
hospital Bangladesh Journal of child health 1983; Vol 7: 79
17.Chowdhury M S. Pattern of diseases in children, Bangladesh Journal of
Child Health. 1988; Vol. 1:7
18.Bailey, Wilma. 1988. Child Morbidity in the Kingston Metropolitan Area.
19.Karrar ZA, Omer MI, Trop Geogr Med. Morbidity patterns among under
five children in a rural community in Sudan, 1981 Mar; 33(1): 75-8
20.Ndugwa and Zulu, Child morbidity and care-seeking in Nairobi slum
settlements: the role of environmental and socio-economic factors, J
Child Health Care December 2008 vol, 12 no.. 4314-328
21.Kandal N-B, CJi, N Stallard, S stranges Spatial analysis of risk factors for
childhood morbidity in Nigeria 10-04-2010
22.IMCI Newsletter: 2009: MIS-H, DGHS, Dhaka, Bangladesh.
23.NurulAlam*, M. ZahirulHaq and Peter Kim Streatfield, Spatio-temporal
pattern of under-five mortality in Matlab HDSS in rural Bangladesh
Health and Demographic Surveillance Unit, Public Health Sciences
Division, ICDDR, B, Mohakhali, Dhaka, Bangladesh Home >Vol 3
(2010) incl Supplements.
24.BussarawanTeerawichitchainan and James F. Phillips, Ethic Diffferntials
Parental Health Seeking for Childhood Illness in Vietnam, Working paper
no. 03 2007

13


ANNEXURE

Pattern of Morbidities and Health Seeking Behavior of Under-Five

Children
Questionnaire

ID No. Name of the Respondent:

Name of Child:_________________________________

Age of Child:________________

Date:_____________

Village: _Upazilla: District:

Section-1: Socio-Demographic Information

14


1. How old are you? yrs

2. What is your religion?

1) Islam 2) Hindu 3) Christian 4) Buddhist 5) Others (Specify.)

3. What is your educational status?

1) Illiterate 2) I-V 3) VI-X 4) SSC equivalent
5) HSC equivalent 6) Graduate and above

4. What is your husband educational status?

1) Illiterate 2) I-V 3) VI-X 4) SSC equivalent
5) HSC equivalent 6) Graduate and above

5. What is your main occupation?

1) House wife 2) Govt. Service 3) Private Service 4) Self
employment
5) Day labor 6) Agriculture 7) Other (Specify.)

6. What is the main occupation of your Husband?

1) Govt. Service 2) Private Service 3) Business 4) Day labor
5) Agriculture 6) Unemployed 7) Others (Specify..)

7. How many members are there in your family? <4 4-5 7-9
>9

8. What type of house do you live in?

1) Katcha 2) Pucca 3) Semi-pucca 4) Tin-shed

9. What is the monthly income of your family?

<50005001-10000 10001-15000 >150000

Section-2: Information about child and child related

15
 10. Have you any child up-to 5 years? 1 2 3

11. How many son and daughter you have under- five years?
M F F

13.Did you take the weight of the child after birth? 1) Yes
2)No

14. What was the weight of the child during birth?

1) <1.5kg 2) 1.6-2kgs 3) 2.1-2.5kgs 4) >2.5kgs

15. Did you immunize your children?

1) Yes Complete Incomplete
2) No

Section -3: Information related to health seeking behavior of children

16. Did the child suffer from any illness for the last 3 month?
1) Yes 2) No

17. If question 18 yes please mention the name of illness (multiple

response)?
1) Cough & cold 2) Common Fever 3) Diarrhea 4) Skin
Disease
5) Loss of appetite 6) Eye infection 7) Ear infection 8)
Others (Specify)

18. Did you take any measure for the diseased child? 1) Yes 2) No

19. Why didnt you take any measure?

1) Dont know 2) No health center at the locality 3) Bad
communication
4) Health Centre not familiar 5) Non-cooperation of health care
provider 6) Treatment cost high 7) Husband did not allow
8) May cured without medicine 9) others (Specify)

16

20. What type of treatment do you seek usually first for the baby?
1) Spiritualist 2) Traditional healer 3) Traditional medicine
4) PolliChikitsok 5) Pharmacy man (Drug seller) 6)
Homeopath
7) Hospital/Clinic 8) Others (Specify)

21. Why do you prefer this type of treatment?

1) Easy available 2) Effective and safe treatment 3) Low cost
4) Familiar 5) Suggested by others (senior family member, Grandfather,
Paternal uncle)

22. How often are your children suffer from disease?

1) Occasionally (3 time/yr) 2) Often (4-6time/yr) 3) Always
(>6time/yr)

23. Did you hospitalize the baby after getting sick? 1) Yes 2)
No

24. After the sickness of your children at what type of Hospital you
admitted?
1) Govt. hospital 2) Private 3) NGOS

25. What type of health facilities in your community?

1) Nothing 2) Quack/ Pharmacy 3) Homeopath
4) Govt. doctor 5) Private 6) NGOs 7) others (Specify ..)

26. Mid Upper Arm Circumference (MUAC): <12.5 12.5-

13.5

>13.5

Thank you for your kind cooperation.

..

17
 Date: Signature of
data collector

MAP OF STUDY PLACE

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PHOTOGRAPHS OF RFST

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