A STUDY ON ‘HAZARDS OF BABYHOOD STAGE IN THE CONTXT OF NEPAL’- A RESEARCH

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.