A STUDY ON
‘HAZARDS OF BABYHOOD STAGE IN THE CONTXT OF NEPAL’
DR BAIKUNTHA SUBEI
In recent years though there has been great
emphasis in cross cultural validity and application of Psychological
principles, psychology still is blamed to be culture bound and culture blind.
Most of the researches are done in developed western countries having different
and advanced socio-cultural ,religious and economic condition focusing in their
problem. Those problem may be of very
little relevance or severity of problem may be very different in varieties of
dimensions for other countries, specially if the country differ significantly
in socioeconomic and other different aspects of life styles.
One
such topic which vary much from country
to country or one culture to another is Hazards in different stages of life
span. This difference is more widened in early stages of life like prenatal,
Infancy, and babyhood stage (sometimes called early stages of life) where
quality of life and available health care facilities are of great detrimental
values.
Literally,
baby means very young child. To many people baby suggests a helpless individual
and some use infancy and babyhood level interchangeably. For systematic study
of development, the babyhood stage after the extreme helplessness of immediate
postnatal or infancy stage is called babyhood stage. There has been growing
trend of using term ‘toddler’ to the baby of second year. A toddler is a baby,
whose helplessness is decreased and has achieved enough body control to be
relatively independent. Babyhood, the period from end of second week to second
birth day, is the foundation age. So it is an especially hazardous stage of
life. The hazards may be physical, psychological or both.
Mortality,
serious illnesses and accidents, malnutrition, foundation of obesity, bad
physiological habit formation are major physical hazards.
Common
psychological hazards are problems
in motor development due to excessive
parental pressure, speech hazards ( no stimulation , no good model to imitate)
emotional hazard, social hazards, play
hazards, hazards in understanding ,hazards in morality, family relationship hazard(divorce, failure
of attachment, over protectiveness, inconsistent training, child abuse),
hazards in personality development.
Some
hazards have both physical and psychological repercussions. For example,
excessive crying is both physically and psychologically damaging to the baby
and to the home atmosphere. It leads to gastrointestinal disturbances ,night
waking, and general nervousness. It also affect baby’s relation with other
family member unfavorably.
In
the first year of babyhood, physical hazards are more numerous and serious than
psychological ones, while the reverse is
true for second year.
From
above it can be inferred that hazards in babyhood stage of life are related to
-Socioeconomic status of the family
-Parents education and their parenting style.
-Family environment .
-cultural , religious and other beliefs and
schemas and practices.
-Health care facilities and other needs that
are available in nurturing.
Most
of the Nepalese societies are still rural, undeveloped, uneducated and poor
societies having numerous hazardous traditional
beliefs, and superstitions. Early
marriages multiple births ,lack of knowledge of even basic health and hygiene
measures, malnutrition, lack of accessible
health care facilities or
negative attitudes towards them are some reasons which alarmingly
intensify the hazards in early
stages of life of Nepalese child.
Rationale of the study
Information
available regarding hazards of babyhood stage as is true for others are derived
so predominantly from other socio-cultural backgrounds that we should be
cautious in applying it, as it is, for description, explanation and prediction
of developmental course of Nepalese babies. There may be other developmental
hazards or severity of hazards may be somewhat different in Nepalese context.
This small study will be a minor step in getting Nepalese scenario of hazards
of babyhood stage.
Objectives
General objectives- This study aims to
assess status of developmental hazards of few Nepalese babies by knowing
parenting style, skills and other relevant information from their parents.
Specific objectives-
1. Developmental hazards of few Nepalese babies
will be assessed by getting information from their parents.
2. The findings will be analyzed and compared
with other information available to see whether Nepalese socio-cultural context
can have some effects on those hazards.
Limitations of the
study
This
study primarily is done for a partial fulfillment of an academic course So this
may be compromised in many respects, Especially in numbers and technique of
sampling used to see the hazards of
babyhood stage in Nepalese context.
Literature
review
Ghai,
Gupta, and Paul (2003) summarizes following information related to hazards of
babyhood stage.
- Environment experiences of
the baby during postnatal life determine the pace and pattern of growth and development. These
factors include nutritional status, exposure to chemical agents, trauma, residua of infections,
maternal metabolic disorders, social factors, emotional factors, cultural
factors. Growth of babies suffering from protein energy malnutrition, anemia,
and vitamin deficiency state is retarded. Persistent or recurrent diarrhea and
respiratory tract infections are common causes of growth impairment.
- Development of babies
may be impaired due to a variety of factors. These include prenatal maternal
illness like infections and use of drugs, bad obstetric history such as
previous miscarriages or stillbirths, perinatal factors such as obstetric
complications, social factors, established diseases including chromosomal abnormalities
and others.
- Methods of child
rearing and infant feeding in the community are determined by cultural habits
and conventions. There may be religious taboos against consumption of
particular types of foodstuffs. These affect the nutritional state and growth
performance of babies.
- Children of certified
mentally subnormal mothers have lower IQ than the average but the outlook is
not as gloomy as it was once thought.
- Growth potential of children of different
racial groups is different to a varying extent.
- Smaller newborn
babies are more likely to attain lower height and weight.
- Children from
families with high socio-economic level usually have a superior nutritional
state. They suffer from fewer infections because of more hygienic living conditions.
- The velocity of
growth may alter in different seasons and is usually higher in spring and low
in summer months. Infections and infestations are common in hot and humid
climate.
Collier, Longmore, and Scaly (2004) mention that encouraging breast
feeding, monitoring
development, immunization, overseeing growth, parental support, education and reassurance
about normal childhood events to the parents, talking to the child , helping to
establish good interpersonal relationship promote health of baby and reduce
hazards.
NDHS
(2001) revealed following information relevant to hazards of early stages of
life.
Status of mothers
Literacy among women 35%
Mean Height of women 150.2 cms
Mean weight 46 kilograms
Mean BMI 20.3
BMI less than 18.5 27%
Night blindness during pregnancy 20%
Median age at first marriage 16.6 years
Adolescent pregnancy ages 15 to 19 21%
Total Fertility Rate 4.1 births per woman
Maternal mortality 539 per 100,000 live births
(NFHS, 1996)
Pregnancy outcomes
Live births 92%
Still births 2%
Spontaneous abortion 5%
Induced abortion 1%
Birth interval
Less than 24 months 23%
More than 24 months 67%
Infant/Child Mortality
Under 5 mortality 91 deaths per 1000 live births
Infant mortality 64 deaths per 1000 live births
Neonatal mortality 39 deaths per 1000 live births
Perinatal mortality 47 deaths per 1000 pregnancies
Antenatal care
Doctor 17%
Nurse or ANM 11%
Health Assistant or AHW 11%
VHW 6%
MCHW 3%
TBA <1%
No one 51%
TT vaccination
None 45%
One 9%
Two + 45%
Micronutrient during pregnancy
Intake of iron & folic acid during pregnancy
None 77%
Less than 60 days 14%
90 days and more 6%
Place of delivery
Health facility 9%
Home 89%
Assistance during delivery
Doctors 8%
Nurse or ANM 3%
MCHW <1%
TBA 23%
Relative or friends 55%
No one 9%
Use of CHDK 9%
Received postnatal care 21%
No postnatal care 79%
Mother received Vitamin A capsule
within 2 months postpartum 10%
Breast feeding
Percentage ever breast fed 98%
Breast fed within one hour of birth 31%
Breast fed within one day of birth 65%
Percentage receiving prelacteal feed 41%
Exclusively breast fed till 6 months of age 68%
Complementary food introduced by 6 months of age
10%
Neonatal(within 4 weeks of birth) mortality by socioeconomic and
demographic characteristics
Socioeconomic
and demographic characteristics NMR
Urban
36.6
Rural
48.5
Mountain
64.9
Hill
41.9
Terai
49.7
Eastern
Region 50.5
Central
Region 48.4
Western
Region 39.1
Mid-western
40.5
Far-western
64.4
Mother
with no education 51.6
Mother
with primary education 41.2
Mother
with some secondary education 31.3
SLC
and above 8.8
Male
newborn 52
Female
newborn 43.3
Mother
less than 20 years at birth 71.2
Mother
between 20 to 29 years at birth 40.3
Mother
between 30 to 39 years at birth 42.8
First
birth order 56.8
Second
and third birth order 44.1
Forth
to sixth birth orders 39.7
Seven
+ birth orders 63.0
Birth
size small / very small 58.1
Birth
size average or larger 32.4
Methodology
This
is a small cross sectional study using self prepared structured questionnaire
and case history interview.
Sampling-Purposive samples of
one of the parents of baby will be used.
Sample size and
inclusion criteria-Sample size will be at least 100. Parents having baby of the
age between two weeks to two years at present will be included in the study.
Data collection tools-self prepared
questionnaire were used as data collection tool which is attached in appendix
section. Case history interview was also carried out in two cases to have
in-depth information on the topic.
Results……
Discussion…
Conclusion
Physical
hazards seem higher among babies of uneducated mothers and parents having blue
color jobs. But Psychological hazards are almost equal or may be even higher in
some respects among babies of educated parents and having good jobs. May be
educated parents are holding few improper or distorted psychological beliefs
with their own meaning that they are taking better care. For example comparing
excessively their babies with others, fulfilling each kind of and every demand
of babies.
There
is no hazard at all due to lack of immunization. All parents were well aware
about the benefits of immunization. Only mild hazard is there among very few (10%) babies due to lack of
breast feeding because their mother thinks breast feeding is optional.
In
Nepal, though trend is improving now, generally female babies have higher
hazard than for male baby due to socio-cultural and religious values. For
example, female baby may not get as nutritious food and stimulating environment
as male baby , which are significant hazards for babyhood stage. But in these
studied cases no such fact could be established.
It
can be concluded that, despite the poor economy and rural population, Nepalese
people comparatively have better health consciousness and average hazard for
babyhood stage. . In this study mean birth weight was found to be 3.3 kg which
is significantly higher than mean birth weight for India (2.7kg).
Recommendation
Nature
and severity of hazard for babyhood stage are different for different
backgrounds to which baby belongs. This small study is not sufficient to
portray all the pictures, so further study with large samples in this topic is
necessary. From this study it can be gleaned that Nepalese parents are not
sufficiently aware of parenting skills, especially in psychological part. So
awareness and knowledge should be in parenting skills by all possible means.
