CHAPTER-IV - Shodhganga : a reservoir of Indian theses...

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CHAPTER-IV

SOCIO-ECONOMIC AND ENVIRONMENTAL

PROFILE OF PRESCHOOL CHILDREN IN

RURAL AREAS OF KASARAGOD DISTRICT

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CHAPTER-IV

SOCIO-ECONOMIC AND ENVIRONMENTAL PROFILE OF PRESCHO OL

CHILDREN IN RURAL AREAS OF KASARAGOD DISTRICT

4.1 Introduction

Malnutrition of preschool children is a serious problem in developing

countries. Malnutrition is associated with poverty and disease. So, the three factors,

viz. malnutrition, poverty and disease, are interlinked in such a way that each

contributes to the presence and sustained effect of the other. Due to poverty, a

significant portion of the population is unable to procure enough food and ultimately,

they become malnourished and vulnerable to diseases like diarrhoea and parasitic

infection. These often result from poor sanitation and drinking water facilities.

Frequent attacks of diarrhoea and parasitic infection due to the poor health status of

children and poor sanitary conditions ultimately lead to further aggravation of disease

(Dasgupta et al, 2005). The Government of India has taken some measures to increase

access to food. Firstly, the Public Distribution System (PDS) provides some staple

foods such as food grains and sugar at a controlled price (Nawani, 1994). Secondly,

people working on building projects or maintaining public infrastructure are often paid

in food grains. The third step is nutrition intervention programmes of ICDS.

The future of a nation is linked with the well being of its children, which

depends to a considerable extent on their nutritional status. In this sense, the nutritional

status of children may be considered representative of the level of development of a

nation. Nutrition as a whole, and particularly of children, is the outcome of a complex

interaction of a broad range of physical and cultural factors. To develop a rational

policy for solving the nutritional problems of children, it is important to have a precise

knowledge of the magnitude of the problem and its related factors. Most of all, it is

necessary to know whether malnutrition of children is determined by entirely socio-

economic factors or part by other factors. This chapter broadly divided into two

sections. The first section covers brief description of the profile of the study area and

second section covers the socio-economic and environmental profile of the preschool

children in rural areas of Kasaragod district in Kerala.

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4.2 Profile of Study Area

Kasaragod became part of Kerala following the reorganization of states and

formation of Kerala in November 1, 1956. The Kasaragod Taluk was formerly in the

Kannur District. Kasaragod is the 14th district of Kerala formed on 24th may 1984 after

carving out a portion from the Kannur district and this district is the northern most

district of Kerala State. It has an area of 1961.30 sq. km with a population of 12,03,

342 (Census, 2001). It has two taluks, four blocks, 39 Panchayaths and two

municipalities. Parameters like density of population, occupational structure, health,

educational and communication facilities, distribution of ration shops, availability of

electricity to the residential houses, density of roads, and types of houses were

considered for the identification of backwardness. Kasaragod is one of the backward

districts of Kerala. Within the district, there are variations in natural conditions and

socio-economic and demographic conditions. Some areas in the district are well

developed and the others are in poor condition. Kasaragod consists of the hill tracts

villages in the eastern side and coastal villages in the western side. Kasaragod is

typically a multilingusitc district where more than five languages have been identified

including Malayalam, Kannada, Konkani, Marathi, Tulu etc as their home tongue.

Kerala is predominately an agricultural state with 73 percent of the population living in

rural areas. North Kerala has been one of the most backward areas in the state of

Kerala and Kasaragod ranks lowest as far as the state average is concerned in various

socio- economic and health-nutrition indicators.

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Kasaragod is one of the backward districts of Kerala with some areas in the

district are well developed and the others are in poor condition. The performance of

public health care system has been too pathetic in the district that rural poor are

compelled to knock at the profit minded private health care providers for meeting their

health needs. The quality of public health care services in the district is reported to be

very poor which substantially reduced the number of health care visits to primary

health centers and other public medical institutions. Kasaragod is the only district in

Kerala which reported less than 7.5 beds per ten thousand population and less than five

beds per ten square kilometers area. Taking advantage of this, private health sector is

Table 4.1 General characteristics of Kasaragod district

Variables Kasaragod General characteristics Geographical Area (Sq.Kms.) 1992 Share of state’s area (%) 5.1 Number of taluks 2 Development blocks 4 Revenue Villages 75 Municipalities 2 Panchayaths 39 Post offices 234 Telephone Exchanges 46

Economy Real per capita income ($ PPP) 2777 Share of Net state domestic product(NSDP) Primary (%) 30.3 Secondary (%) 25.0 Tertiary (%) 44.8 Employment

Work participation rate (%) 34.7 Cultivator’s workers (%) 4.8 Agricultural labourers (%) 10.0 Workers in household (%) 12.0

Other workers (%) 73.2 Infrastructure Area served per post office(sq.km) 8.5 Population served per post office(no.) 5120 Telephone connections per sq.km 22 Telephone per 1000 population 59 Road length per 100 sq.km 43.3

Source: Human Development Report-2005, Government of Kerala.

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playing a crucial role in the provision of health care services in the district. However,

in terms of medical institutions, bed, medical and para-medical personnel, the private

sector has been much below the state average. Private and public health care

infrastructure in the district is relatively ill-equipped and inter-district differences in

physical and social health infrastructure are more widespread and it has increased the

geographic or regional health inequality in Kerala (DHS, 2008; DLHS-3, 2007-08).

Health infrastructure inequalities are very much visible in the district compared to

other districts in Kerala. Kasaragod is the only district where two taluks have the

lowest health infrastructure facilities in the state (Government of Kerala 2001, 2008,

Narayana and Kurup 2000, Asokan 2005, Kasaragod district plan document 2000).

4.3 Demographic Profile of Kasaragod

In recent period, Kerala’s population has been growing at a much slower rate than

the population of India as a whole, at 0.93 percent during 1991-2001, which is the

lowest among major Indian States. But Kasaragod district it was very high at 1.23

percent. The overall sex ratio in Kerala has been favourable to females and has been

the most widely discussed indicator of women’s status. The ranking of the States in

terms of life expectancy at birth has always put Kerala on top.

Table 4.2 Demographic Profile of Kasaragod Demographic Profile Kerala Kasaragod Population (in lakh) 318.39 12.03 Area (sq.km) 38,863 1992 Decadal growth rate 0.93 1.23 Sex ratio 1058 1047 Life expectancy 74.6 75.7 Density of population 819 604 Literacy rate 90.92 85.17 Male 94.20 90.84 Female 87.86 79.80 Urban population 27.0 19.42 Rural population 73.0 80.58 SC population 9.7 7.5 ST population 1.1 2.5 Child sex ratio 962 962

Source: Human Development Report-2005, Government of Kerala.

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4.4 Human development and Deprivation indices of Kasaragod

HDI measures the average achievements in three basic dimensions of human

development. As per UNDP, these dimensions are life expectancy at birth, adult

literacy rate and a decent standard of living, as measured by GDP per capita. Kerala

ranks first among States in India in the Human development index 2001, but its per

capita income lagged behind the all-India average till recently. Kasaragod is one of the

backward districts in Kerala which ranks 11th in HDI. The Gender-related

Development Index (GDI) adjusts the average achievement to reflect the inequalities

between men and women in human development. Kasaragod district stands at 8th rank

in GDI. The index of deprivation measures deprivation in the four basic necessities of

well being such as quality of housing, access to water, good sanitation and electricity

lighting. Overall index of deprivation is 37.6 percent and their corresponding rank of

index of deprivation is at 10. All these indices clearly reveal that human development

and deprivation indices do not provide a rosy picture of Kasaragod district.

Table 4.3 Human development and Deprivation indices of Kasaragod Human development and Deprivation indices Kasaragod

Human development index (HDI) 0.760 HDI rank 11 Gender related development index(GDI) 0.744 GDI rank 8 Index of deprivation (overall) 37.6 Scheduled caste 62.7 Scheduled tribes 61.3 Others 34.1 Index of Deprivation (Overall) 10

Source: Human Development Report-2005, Government of Kerala

4.5 Health care system in Kasaragod

The public health care system in Kasaragod is relatively poor judged in terms

of infrastructure, health personnel and quality of health care services in relation to the

corresponding state averages. The district public allopathic health care institutions

comprised of a district hospital, a taluk hospital, a rural hospital, five community

health centres and 46 primary health centres, two leprosy control units, one TB centre,

two bi-weekly dispensaries and one mobile dispensary unit. Most of the primary health

care centres are functioning at a sub-optimum level mainly due to lack of medical and

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para-medical personnel and inadequacy of even the essential drugs. Kasaragod is the

only district in Kerala which reported less than 7.5 beds per ten thousand population

and less than five beds per 10 sq.km.area (DHS, 2001). Private sector plays an

important role in the provision of health care services in the district. Most of the

patients prefer private health care services available not only within the district but

also at Mangalore, a border city in the neighbouring state of Karnataka, located at a

distance of only 50 km from the Kasaragod district head quarters and one of the major

private health care centres in south India.

A relatively higher proportion of the patients prefer public health care sector in

Kasaragod district compared to the state average. In Kasaragod district, the private

sector also plays a significant role in providing health care services. There are only 12

private hospitals in the district with a bed capacity of more than 50. At the same time,

it may be noted that, there is not even a single super specialty hospital in the district

which is a common feature of almost all districts in the rest of Kerala.

Table 4.4 Government allopathic medical institutions in Kasaragod and Kerala: Rural and urban comparison Type of health facilities

Unit

Kerala Kasaragod State Average Urban Rural Total Urban Rural Total

Hospitals No. 80 63 143 2 1 3 10.21 Beds 25151 6782 31933 401 32 433 2280.93

Community health centre

No. 8 97 105 0 5 5 7.5 Beds 11750 3240 4415 0 163 163 315

Primary health centre

No. 8 935 943 0 46 46 67.36 Beds 10 5205 5215 0 143 143 372.50

Dispensaries No. 13 41 54 0 3 3 3.86 Beds 68 108 176 0 0 0 12.57

TB clinics/ centres

No. 13 8 21 0 1 1 1.50

Beds 216 24 240 0 0 0 17.14

Leprosy control unit

No. 1 14 15 0 2 2 1.07

Total No. 123 1158 1281 2 58 60 9.15 Beds 26620 15359 41979 401 338 739 2998.50

Source: DHS, 2001.

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4.6 Health and Nutrition indicators of Kasaragod

According to DLHS-3 survey (2007-08) reveals that 80 percent of children age

12-23 months in rural Kerala is fully vaccinated against six major childhood illnesses:

tuberculosis, diphtheria, pertussis, tetanus, polio, and measles. 100 percent of children

have received a BCG vaccination, 94.2 percent of children 12-23 months have

received 3 doses of DPT vaccines and children 12-23 months received 3 doses of polio

vaccine in Kasaragod. In Kerala there has been a decrease in full vaccination coverage

from 80 percent in 1998-99 to 75 percent in 2005-06. The decline in full immunization

coverage has been accompanied by a decrease in the coverage of almost all vaccines.

Table 4.5

Health and Nutrition indicators of Kasaragod

Health and Nutrition indicators 2001

Infant mortality rate (per 1000 births) 10

Life expectancy at birth (years) 75.7

Crude birth rate (per 1000 population) 18.9

Total fertility rate (per women) 1.9

Full antenatal care (%) 75.4

Institutional deliveries

Public (%) 11.1

Private (%) 88.8

Complete immunization (%) 87.4

Low birth weight (%) 15

Suicide rate (per lakh population) 24.0

Number of beds (per lakh population) 77

Source: human Development Report-2005, Government of Kerala.

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Table 4.6 Child Immunization in Kerala and Kasaragod

Child Immunization

Kerala Kasaragod

Total Rural Total Rural

Children 12-23 months fully immunized (%) 79.5 80.3 84.5 90.1 Children 12-23 months not received any vaccination (%)

0.5 0.6 -- --

Children 12-23 months who have received BCG vaccine (%)

99.1 00.0 100.0 100.0

Children 12-23 months who have received 3 doses of DPT vaccine (%).

87.1 87.4 93.6 94.2

Children 12-23 months who have received 3 doses of polio vaccine (%)

86.6 86.4 93.6 94.2

Children 12-23 months who have received measles vaccine (%)

87.9 88.1 93.0 92.9

Children (age 9 months and above) received at least one dose of vitamin A supplement) (%)

68.1 68.5 58.7 59.4

Source: DLHS-3 Survey-2007-08

Treatment of Childhood diseases in Kasaragod

Overall, 67.4 percent of children undertook diarrhoea treatment through public

health facility and 43 percent of children used ORS for the same in rural Kerala. But in

Kasaragod district it was only 34.6 percent and 69.3 percent respectively. In the case

of child feeding practices under 3 years, 81.2 percent of children are breastfed within

one hour of birth in Kasaragod as against in 66.9 percent in rural Kerala.

Table 4.7 Treatment of Childhood diseases in Kasaragod

Treatment of childhood diseases (Children under 3 years) Kerala Kasaragod

Total Rural total Rural Children with Diarrhoea in the last two weeks who received ORS (%)

45.1 43.0 34.1 37.6

Children with Diarrhoea in the last two weeks who were given treatment (%)

78.6 76.5 62.9 69.3

Children with acute respiratory infection/fever in the last two weeks who were given treatment (%)

86.7 86.8 86.7 91.8

Child feeding practices (Children under 3 years) (%) Children under 3 years breastfed within one hour of birth 65.3 66.9 80.0 81.2 Children age 6-35 months exclusively breastfed for at least 6 months

22.3 23.5 22.4 21.5

Children age 6-9 months receiving solid/semi-solid food and breast milk

84.6 85 91.1 91.3

Source: DLHS-3 Survey-2007-08

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Parameters like density of population, occupational structure, health,

educational and communication facilities, availability of electricity to the residential

houses, density of roads, and types of houses were considered for the identification of

backwardness. All these indicators are poor in Kasaragod district especially in rural

areas. Health and nutritional indicators are poor compared to state average and health

infrastructure inequality is very glaring in the district compared to other districts in

Kerala. Kasaragod is the only district where the two taluks have the lowest health

infrastructure facilities.

4.8 Socio-Economic and Environmental profile of Preschool children This section attempts to provide a socio-economic and environmental profile

of preschool children in rural areas of Kasaragod district including the basic economic

assets, basic amenities and basic communications with the outside world. Based on

these three dimensions a deprivation index is constructed. Different studies reveal that

household deprivation status has strongly influenced the child nutritional status among

preschoolers (Srinivasan and Mohanty 2004, Srinivasan et al 2007). The present study

used in each of these dimensions is on a binary scale. For the first dimension, they are

(1) whether the household has semi-pucca/kutcha or pucca house (2) whether the

household has some land. For the second dimension,(3) whether the household has

electricity and (4) whether the household has drinking water facilities in the residence;

and for the third dimension, (5) whether there is at least one literate adult member in

the household, and (6) whether the household has a radio/ a TV or newspapers. The

total score is an addition of the six variable scores and ranges from 0 to 6. The lower

the score, higher the level of deprivation, 0 being the absolute level of deprivation and

6 indicating no deprivation on the selected variables.

Based on the deprivation score a household deprivation score (HDS) is

constructed. HDS-I includes those which have no above six possessions or have one or

two possessions; it indicates ‘moderate deprivation’ (MD). HDS-II includes three or

four possessions; they indicate ‘just above deprivation’ (JAD). HDS-III includes five

or six items which indicate ‘well above deprivation’ (WAD). This simple measure of

deprivation at the household level showed health-nutrition conditions and income

levels are highly correlated.

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Table 4.8 Household Deprivation Score Components

Household deprivation score HDS-I HDS-II HDS-III Total Type of House Pucca 8 (2.0) 21 (5.2) 121

(30.2) 150 (37.5)

Semi-Pucca/Kutcha 36 (9.0) 160 (40.0)

54 (13.5) 250 (62.5)

Landholding status of households Have some land 29 (7.2) 155

(38.8) 175 (43.8)

359 (89.8)

No land 15 (3.8) 26 (6.5) 0 (0) 41 (10.2) Electricity House is electrified 38 (9.5) 163

(40.8) 173 (43.2)

374 (93.5)

House is not electrified 6 (1.5) 18 (4.5) 2 (0.5) 26 (6.5) Drinking Water Facilities Own arrangement within the residence

13 (3.2) 91 (22.8) 154 (38.5)

258 (64.5)

No arrangement within the residence 31 (7.8) 90 (22.5) 21 (5.2) 142 (35.5) Adult Literacy Presence of adult literate 36 (9.0) 178

(44.5) 174 (43.5)

388 (97.0)

No adult literate 8 (2.0) 3 (0.8) 1 (0.2) 12 (3.0) Access of Media At least one of these 31 (7.8) 160

(40.0) 163 (40.8)

354 (88.5)

No radio/TV/newspapers 13 (3.2) 21 (5.2) 12 (3.0) 46 (11.4)

Total 44 (11.0)

181 (45.2)

175 (43.8)

400 (100.0)

Source: Survey data, Figures in parenthesis indicate percentages.

Table 4.8 indicates household deprivation scores of families of preschool

children in rural areas of Kasaragod district. Type of house is a good index of

economic status of the household. In the district 62.5 percent of households have semi-

pucca/kutcha houses. HDS-I group has 9 percent of kutcha/semi-pucca houses and

HDS-II group has 40 percent of kutcha/semi-pucca houses.

Landholding status of household is another indicator of household deprivation

score. HDS score categorized in to- having some land and no land. While 89.8 percent

of the households have some land, the remaining 10.2 percent of households have no

land. Those who do not have land in HDS-I is 3.8 percent, in HDS-II it is 6.5 percent

and nobody in HDS-III group. Around 93.5 percent of the households have electricity

facilities available in the household. According to DLHS-3 (2007-08) survey, rural

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Kasaragod has 87.8 percent electrified households. The survey finding is higher than

that of the DLHS-3 survey.

Rural areas of the district has about 64.5 percent of households getting own

arrangement of drinking water facilities within the residence. Based on the HDS score,

7.8 percent, 22.5 percent and 5.2 percent have no arrangement with in the household

in HDS-I, HDS-II and HDS-III respectively. It indicates that better drinking water

facilities are available within the household. In the case of adult literacy, about 97

percent of the adult males in the households surveyed were literate. Among the

literates, about 9 percent came from HDS-I, 44.5 percent in HDS-II and 43.5 percent

in HDS-III group.

Access to media like radio, TV or newspapers is another indicator of measuring

the household deprivation status. The survey found that while 11.2 percent of

household do not have radio/TV/newspapers, 88.5 percent of families have at least one

of these. According to DLHS-3 survey in Kasaragod, 59.9 percent have television,

50.5 percent have a mobile phone and 14 percent have a motorized bicycle.

4.9 Socio-Economic Background

Socio-economic background of the family is a powerful essential determinant

of health and well-being of its members especially children (Geetha and Madura

Swaminathan, 1996; Ray et al, 2000; NNMB, 2002; Kapil, 2001; Lakshmi and Priya,

2004). The details in this respect are under the following heads.

4.9.1 Family Details of Preschool children

Table 4.9 Family details of the Preschool children Sl.no Household Deprivation

Score HDS-I HDS-II HDS-III Total

1. 2.

3.

Religion Hindu 35 (8.8) 118

(29.5) 123 (30.8)

276 (69.0)

Christian 0 (0) 23 (5.8) 16 (4.0) 39 (9.8) Muslim 9 (2.2 ) 40 (10.0) 36 (9.0) 85 (21.2) Caste OBC 16 (4.0) 113

(28.2) 108 (27.0)

237 (59.2)

SC/ST 27 (6.8) 35 (8.8) 6 (1.5) 68 (17.0) Others 1 (0.2) 33 (8.2) 61 (15.2) 95 (23.8) Type of family Joint 16 (4.0) 83 (20.8) 87 (21.8) 186 (46.5) Nuclear 28 (7.0) 98 (24.5) 88 (22.0) 214 (53.5)

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4. Family size 1-4 5-7

16 (4.0) 76 (19.0) 73 (18.2) 165 (41.2) 14 (3.5) 67 (16.8) 65 (16.2) 146 (36.5)

>=8 14 (3.5) 38 (9.5) 37 (9.2) 89 (22.2) Total 44

(11.0) 181 (45.2)

175 (43.8)

400 (100.0)


The family details of preschool children were collected and presented in table

4.9 which found that 69 percent of preschool children in the study area are from Hindu

religion, 21.2 percent Muslims and remaining from Christians. On the basis of Caste-

wise classification, 59.2 percent belongs to other backward castes (OBC). It also found

that 46.5 percent preschool children families followed joint family system and 53.5

percent followed nuclear families. Based on the family size classification, 41.2 percent

comprises of 1-4 family members, 36.5 percent 5-7 family members and 22.2 percent

more than or equal to eight family members.

4.9.2 Age and Sex- wise details

Table 4.10 Age wise and Sex wise details of sample population Household Deprivation Score HDS-I HDS-II HDS-III Total 1.

2.

Age of children (Monthly wise) 0-12 months 5 (1.2) 20 (5.0) 13 (3.2) 38 (9.5) 13-24 months 5 (1.2) 12 (3.0) 34 (8.5) 51 (12.8) 25-36 months 6 (1.5) 38 (9.5) 31 (7.8) 75 (18.8) 37-48 months 16 (4.0) 59 (14.8) 61 (15.2) 136 (34.0) 49-60 months 10 (2.5) 41 (10.2) 30 (7.5) 81 (20.2) 61-71 months 2 (0.5) 11 (2.8) 6 (1.5) 19 (4.8) Sex of children Male 26 (6.5) 96 (24.0) 87 (21.8) 209 (52.2) Female 18 (4.5) 85 (21.2) 88 (22.0) 191 (47.8)


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Age and sex-wise details of children are showed in the table 4.10. Age of the

children was assessed by the date of birth records maintained by the Anganwadi

workers in the ICDS (Integrated Child Development Schemes). Based on monthly

classification of Preschool children’s age, the study reveals that 34 percent children

included in 37-48 months category. On the basis of sex-wise classification, 52.2

percent are males.

4.9.3 Education status of Parents

Table 4.11 Educational status of Parents Household Deprivation Score HDS-I HDS-II HDS-III Total 1. 2.

Education Status of Father Illiterate 2 (0.5) 5 (1.2) 5 (1.2) 12 (3.0) Primary 23 (5.8) 95 (23.8) 54 (13.5) 172 (43.0) High school 12 (3.0) 45 (11.2) 71 (17.8) 128 (32.0) Higher secondary 0 (0) 14 (3.5) 31 (7.8) 45 (11.2) Graduation and above 7 (1.8) 22 (5.5) 14 (3.5) 43 (10.8) Education status of Mother Illiterate 0 (0) 15 (3.8) 0(0) 15 (3.8) Primary 26 (6.5) 87 (21.8) 62 (15.5) 175 (43.8) High school 14 (3.5) 71 (17.8) 76 (19.0) 161 (40.2) Higher secondary 4 (1.0) 5 (1.2) 29 (7.2) 38 (9.5) Graduation and above 0(0) 3 (0.8) 8 (2.0) 11 (2.8)


Education status of parents is worked out in table 4.11. According to the study,

43 percent of fathers have primary education and 32 percent have high school

education and 10.8 percent only have graduation and professional education. On the

education status of mother, the study found that 43.8 percent of them have primary

education and 40.2 percent have high school education and only 2.8 percent have

graduation and above education.

4.9.4 Occupational status of Parents

With regard to the occupational status of parents, agricultural labour included

29.2 percent and 25.5 percent in others category which included gulf jobs, self-

employment etc. Among occupational class 15.5 percent belonged to employed class

and 16.5 percent were artisans. As far as the mother’s occupational status is concerned

56.2 percent were housewives. Among the mothers who were wage earners, 18.5

percent were engaged in agricultural labour and 10.5 percent undertook tailoring as

source of income (table 4.12). According to the study, 29.2 per cent of fathers and 18.5

95

per cent of mothers were engaged in agriculture based occupation. NSSO (1997) also

reported that there were a number of persons depending on agriculture related jobs for

their livelihood in the rural areas of Kerala, and the spread as well as the depth of

hunger were found to be higher in the cereal deficit state. It was also observed that

female workers were proportionately less in number than males, and even those who

work also engaged in their houses and tailoring works.

Table 4.12 Occupation status of Parents Household Deprivation Score HDS-I HDS-II HDS-III Total Occupation of Father Agricultural labourer 18 (4.5) 66 (16.5) 33 (8.2) 117 (29.2) Owner cultivator 2 (0.5) 12 (3.0) 15 (3.8) 29 (7.2) Artisans 6 (1.5) 29 (7.2) 31 (7.8) 66 (16.5) Employed class 7 (1.8) 23 (5.8) 32 (8.0) 62 (15.5) Business 0 (0) 6 (1.5) 18 (4.5) 24 (6.0) others 11 (2.8) 45 (11.2) 46 (11.5) 102 (25.5) Occupation of Mother House wife 19 (4.7) 98 (24.5) 108 (27.0) 225 (56.2) Agricultural labourer 14 (3.5) 34 (8.5) 26 (6.5) 74 (18.5) Domestic servant 7 (1.8) 23 (5.8) 6 (1.5) 36 (9.1) Tailoring 4 (1.0) 17 (4.2) 21 (5.3) 42 (10.5) Employed class 0 (0) 9 (2.2) 14 (3.5) 23 (5.7) Source: Survey data, Figures in parenthesis indicate percentages.

4.9.5 Housing condition of families of Preschool children

The housing conditions were studied and are presented in table 4.13. In spite of

their poor economic situation it is interesting to note that 87.8 percent were residing at

home of their own and 12.2 percent in rented house. While 51.2 percent of the families

of preschool children possess home with 3-4 rooms, 33.5 percent of possess home with

1-2 rooms. Families of 43.2 percent of preschool children lived in tiled houses and

majority of these were constructed with the help of various government plans.

Provision of toilet facilities is a must for people’s healthy living. Separate bathroom

were noticed only in 65.5 percent and separate sanitary latrine in 87.8 percent families.

Most of the 58.2 percent of families were using firewood and 25.5 percent used LPG

as cooking fuel.

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Table 4.13 Housing Condition of the families of Preschool children Sl.no Particulars Number (%) 1. 2. 3. 4.

5 6. 7.

8.

9.

House ownership Own house 351 (87.8) Rented house 49 (12.2) Ration card BPL 120 (30.0) APL 233 (58.2) No ration card 47 (11.8)

No.of rooms 1-2 134 (33.5) 3-4 205 (51.2) >=5 61 (15.2) Type of roof Thatched 21 (5.2) Tiled 173 (43.2) Concrete 206 (51.5) Type of floor Mud 43 (10.8) Cemented 297 (74.2) tiled 60 (15.0) Bathroom Own bathroom 262 (65.5) No own bathroom 138 (34.5) Sanitary latrine Sanitation facility 351 (87.8) No sanitation facility 49 (12.2) Kitchen Separate kitchen 297 (74.2) No separate kitchen 103 (25.8)

Cooking fuel Firewood 233 (58.2) Kerosene 6 (1.5) LPG 102 (25.5) All 59 (14.8)


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4.10 Personal habits and Hygiene practices

Undesirable habits like alcoholism, smoking, drug abuse etc among family

members, especially head of the family, tend to reduce their purchasing power and

create food insecurities. Such habit creates health problems including liver problems

and cancer. Unhealthy personal habits prevailing among the families of preschool

children are presented in table 6.7. Among these families, 36.75 percent is addicted to

alcohol and 24 percent to cigarette or beedi habits. Tobacco chewing and cigarette or

beedi smoking were rampant in families of scheduled caste and scheduled tribes.

Continuous uses of drugs or alcohol were witnessed among 38.25 percent of the

families of preschool children. Only negligible percentage of families was found to use

drugs or alcohol on an occasional basis.

Table 4.14 Personal habits of preschool children’s families Sl.no Particulars Numbers (%) 1. 2.

Type of drugs used Betel/tobacco and lime 21(5.25) Tobacco 7 (1.75) Cigarette/beedi 96 (24.0)

Alcohol/toddy 147 (36.75) Frequency of use Almost all days 153 (38.25) Weekly 43 (10.75) Occasionally 67 (16.75) Rarely 8 (2.0)


4.11 Hygienic Practices

Environmental hygiene considerably affects the health and nutritional status of

the whole community (Ali, 1987). The data on the hygienic practices of the preschool

children in the study area were discussed under the four heads as follows: Hygiene in

the house and its surroundings, water hygiene, food hygiene and personal hygiene.

4.11.1 Hygiene in the house and its Environment

From the table 4.15, it is obvious that 53 percent of families undertake cleaning

their house and its surroundings on an alternate day basis. While 17.25 percent

undertake irregular cleaning, 1.75 percent of families are least bothered about these

activities. According to the survey, 30.75 percent families undertake cleaning of their

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house on a daily basis, 56 percent on weekly and 13.25 percent only on occasional

basis.

While studying the methods of waste disposal of these families, it was found

that majority of 55.25 percent dump it in one place and 41.25 percent followed the

most inappropriate method of ‘throwing the waste carelessly’. The safe method of

waste disposal such as ‘burying’ was adopted only by 3.50 percent of preschool

children families. Drainage facilities were also found to be lacking in 91.5 percent of

families. Some recent studies reported that lack of drainage facilities might lead to

mosquito breeding, which may cause health disasters like malaria, chickungunia,

dengue fever and other diseases in many parts of Kerala (Trehan,2004;

Thankappan,2007; Ekbal 2006).

Table 4.15 Hygiene in the house and its Environment Sl.no Particulars Number (%) 1.

2.

3.

4.

5.

Cleaning the yard Once a day 112 (28.0) Alternate day 212 (53.0) Not regularly 69 (17.25) Not at all 7 (1.75) Cleaning the house Daily 123 (30.75) Weekly 224 (56.0) Occasionally 53 (13.25) Waste disposal Dumping in one place 221 (55.25) Throwing carelessly 165 (41.25) Burying 14 (3.50) Drainage facilities Yes 34 (8.5) No 366 (91.5) Pets allowed inside the house Yes 20 (5.0) No 67 (16.75) Not bothered 313 (78.25)


Pet animals or birds are often the carriers of various diseases. Allowing them to

stay inside house will affect household hygienic condition which will have its toll on

the small children in the family. While 78.25 percent families are not bothered about

this, only 5 percent families allow the pets animals inside and 16.75 percent did not

allow them to stay inside house.

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4.11.2 Water Hygiene practices

Table 4.16 Practices related to Water hygiene Sl.no Particulars Number (%) 1. 2.

Sources of Water Private well 268 (67.0) Public well 11 (2.8) Public tap 50 (12.5) Neighboured well 67 (16.8) Others 4 (1.0) Protection of Water source Latrine/bathroom is away from water source --- Well is covered and protected 153 (38.25) Water in well is purified regularly --- Water is boiled before drinking 234 (58.5) Drinking water is kept in covered containers 297 (74.25)


The survey also studied the safe drinking practices prevailing in these families.

Bharadwaj (1990) opined that among the basic amenities, drinking water is most

essential, since 80 percent of all diseases are directly related to poor drinking water

and unhygienic conditions. As obtained from the table 4.16, private well was the main

source of water for 67 percent of preschool children’s families. At the same time, 16 .5

percent of families used neighboured well, 12.5 percent families public tap and 2.8

percent accessed public well. Regarding the safety aspects of drinking water, 74.25

percent of the families of preschool children took precautions by storing drinking

water in covered containers. Water is boiled before drinking by 58.5 percent families

and 38.25 percent families covered thoroughly their well.

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4.11.3 Food Hygiene practices

Food hygiene practices of households of preschool children were also taken

into consideration and it is presented in table 4.17.

Washing vegetables before cutting was undertaken by 72.25 percent families

and 59.5 percent washed their hands before handling foods. On the other hand, food is

stored in covered containers by 67.75 percent and food items are cleaned before

storage 59.25 percent of families.

Personnel hygiene primarily affects the health of all individuals. Daily bathing

were undertaken by 13.25 percent, 45.75 percent on weekly and 17.2 percent on

alternate days in the case of preschool children. Soap was used as a cleaning material

by 62.75 percent of preschool children. Use of herbs was also reported among 26.25

percent of preschool children and 28.25 percent of preschool children regularly

brushed their teeth. Brush and tongue cleaner were also used by 53.75 percent

children. While 52.5 percent wash hands before and after food, 19.25 percent washed

after food.

4.12 Healthcare Management

Health care management and the practices prevailing among the families of

preschool children were assessed and the same is discussed in two heads: availability

and use of health care facilities, and health awareness and practices.

Table 4.17 Food hygiene practices of households of preschool children Sl.no Particulars Number (%) 1. 2. 3. 4. 5. 6.

Raw vegetables are washed before cutting 289 (72.25) Hands are washed before handling foods 238 (59.5) Washing Utensils Before and after use Immediately after use Only before next meal

292 (73.0) 12 (3.0) 96 (24.0)

Food is stored in covered containers 271 (67.75) Food items are cleaned before storage 237 (59.25) Kitchen is cleaned daily 135 (33.75)


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4.12.1 Availability and use of health care facilities

Health of the families of preschool children in rural areas of Kasaragod district

was assessed by collecting the details pertaining to the availability of doctors,

accessibility to primary health centres, mother’s attendance in the camps, classes

regarding health and hygiene, health and nutrition awareness and practices of mothers.

The details are shown in table 4.18.

As obtained from the table 4.12, 100 percent accessibility to primary health

centres (PHC) was reported in study area, whereas availability of doctors in these

centres was only 82.25 percent. Both medical camp and health awareness classes on

health and nutrition were conducted in these areas, medical camp attendance was

found to be very low at 27.25 percent compared to class attendance at 46.55 percent.

These classes were organized by ICDS, PHC and social workers.

4.12.2 Mother’s Health and Nutritional awareness

Mother’s health and nutrition awareness were revealed in table 4.19. While

65.2 percent women were married between 18 to 25 years, only 21.8 percent women

married below 18 years. At the time of pregnancy, the pregnant women need good

attention. In the study area, 89.5 percent of mother’s get better antenatal care and at the

time of delivery 12.8 percent of women face some health complications and this lead

to the caesarian. At the time of delivery 20.8 percent of children were facing low birth

weight (LBW) problems. As per the study, 96 percent deliveries were reported in

hospital and only 4 percent at home. Normal deliveries were reported at 75.3 percent.

Table 4.18 Availability and use of health care facilities Sl.no Particulars Number (%) 1. Availability of Doctors 329 (82.25) 2. Accessibility to PHC 400 (100.0) 3. Attending Medical camps 109 (27.25) 4. Attending classes 186 (46.50) 5. Organized by:

ICDS workers Social workers PHC/Heath workers

163 (40.75) 105 (26.25) 132 (33.0)


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Table 4.19 Mother’s health and Nutritional awareness Particular Number (%) Age at marriage of women < 18 years 87 (21.8) 18-25 years 261 (65.2) 25-30 years 52 (13.0) Antenatal care at the time of pregnancy No 42 (10.5 ) Yes 358 (89.5) Any health problem at the time of delivery No 349 (87.2) yes 51 (12.8) Underweight at the time of delivery No 317 (79.2) Yes 83 (20.8) Place of child birth

Home 16 (4.0) Hospital 384 (96.0) Type of delivery Normal 302 (75.3) Caesarian 98 (24.4) Use of iodized salt No 177 (44.1) Yes 223 (55.6) Child care Mother 323 (80.5) Mother-in- law 68 (17.0) Others 9 (2.2) Nutritional awareness score Low 102 (25.5) Medium 285 (71.2) High 13 (3.2)


Health and nutritional awareness of mother is an important for child care and

child nutrition. Iodized salt is used by 55.6 percent of mothers in their food pattern.

Child care at home is crucial factor for their development. While 80.5 percent of

mothers undertake this responsibility themselves, 17 percent of mother-in-laws and

only 2.2 percent others look after kids in the absence of mother. Nutritional awareness

score (NAS) of mother is constructed on the basis of six questions related to the

attitudes and nutrition awareness of the mother. These answers in a binary scale. If

‘yes’ is assigned to one and otherwise is zero. Nutritional awareness score is

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categorized into three; low, medium and high NAS. Low NAS their corresponding

score ranges from 0 to 1, medium NAS ranges from 2 to 4 and high NAS ranges from

5 to 6. The high NAS indicates that the better nutritional and health awareness of

mother in study area. Among them, 25.5 percent as low NAS, 71.2 percent as medium

NAS and 3.2 percent as high NAS.

4.12.3 Health awareness and AWC benefits

In study area, 8.8 percent families have a distance of less than 1 km to their

primary health centre. For 33.8 percent it is 1-2 km, 34.2 percent it is 2-4 km and for

23.2 percent it is greater than 4 km. While 83 percent of families of preschool children

received ICDS benefits and 84.2 percent of preschool children received various

services from Anganwadi centres (AWC). AWC provided supplementary food for 34

percent preschool children daily, 15.8 percent at least once in a week and 20.2 percent

at least once in a month.

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Table 4.20 Health awareness and AWC benefits Particular Number (%) Distance to the Health centre < 1 km 35 (8.8) 1-2 km 135 (33.8) 2 -4 km 137 (34.2) > 4 km 93 (23.2) Beneficiary of ICDS No beneficiary 68 (17.0) Beneficiary 332 (83.0) Any service from an AWC No 63 (15.8) Yes 336 (84.2) Frequency of receiving supplementary food from an AWC Not at all 41 (10.2) Almost daily 136 (34.0) At least once a week 63 (15.8) At least once a month 81 (20.2) Rarely 79 (19.8) Frequency of receiving health checkups from an AWC Not at all 9 (2.2) At least once a week 118 (29.5) Rarely 273 (68.2) Frequency of going to an AWC for early childhood care (36-71 months) Not at all 50 (12.5) Regularly 135 (33.8) Occasionally 113 (28.2) Rarely 102 (25.5) Attending Health & nutrition education classes for mother Not at all 18 (4.5) At least once a month 14 (3.5) At least once in three months 117 (29.2) Rarely 158 (39.5) Don't know 93 (23.2)


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Anganwadi centre’s health checkup services were received by 68.2 percent

preschool children and 29.5 percent at least once in a week. Among the 36-71 months

age group children, 33.8 percent would go regularly to an anganwadi centre (AWC)

for early childhood care, 28.2 percent on occasionally and 25.5percent rarely. ICDS

and AWC also witness 29.2 percent mothers’ participation in various health and

nutrition education classes.

4.13 Conclusion

This study found that socio-economic, hygienic practices and health care

management variables have a significant influence on the children’s nutritional status

in rural areas of Kasaragod district in Kerala. High socio-economic and good

environmental conditions were the most important factors associated with the lower

prevalence of malnutrition. In general, malnutrition starts in the womb and may extend

throughout the life cycle. Malnutrition remains a silent emergency in rural areas in

Kerala, though the state government had made significant progress in the past several

decades in improving the health and nutrition of its people particularly preschool

children. The overall nutritional status in rural areas in Kerala is at reasonable level

through the various nutritional intervention programmes. But still the most vulnerable

group of children suffers from various forms of malnutrition. This study revealed that

children from the household of low economic status have the high rates of

malnutrition. This is due to food insecurity in these households which negatively

impacts the nutritional status of children in particular, and other household members in

general. Therefore measures should include government action to support the

vulnerable sections, and to bring about a rapid economic growth at the national level

and grass root level. To this effect, it is important to develop community based

interventions giving priority to deprived sections as a short term solution.

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Appendix

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Hosdurg taluk: rural areas of Kasaragod district

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