Introduction

Slums are defined by the United
Nations Organizations as “a building or group of buildings and area
characterized by overcrowding, deterioration in sanitary conditions, or absence
of facilities and amenities, which because of these conditions or any of them
endanger the health, safety or morals of its inhabitants or the community”

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Comparative
slum statistics from India revealed that percent of slum dwellers marginally
decreased from 24 (in 2001) to 22 percent (in 2011), while absolute numbers
increased from 52 million to 65 million 1. An earlier report from UN-HABITAT
highlights that the urban poor, especially the slum dwellers in developing
countries, is as badly off, if not worse off, than their rural counterparts 2

 

Health is a major economic issue for slum residents.
Living conditions in slums have a direct impact on people’s health. Children in
slums have a poor quality of life. The lack of basic services affects them the
most. Children are most disadvantaged in slums. Sadly, their physical,
emotional and intellectual growth is stunted from a very early age 3.
Diarrhoea and pneumonia are thus seen as the leading childhood killers;
together, they are responsible for almost one quarter of all deaths in children
under 5. Leading causes of death in children under-5 years are preterm birth
complications, pneumonia, birth asphyxia, diarrhoea and malaria (WHO 2013)4 Every year, more than 1.4 million
children die from diarrhoea and pneumonia. (UNICEF-Nov 2016)5. 5.6 million Children
under the age of 5 years died in 2016. This translates into 15,000 under-five
deaths per day (WHO 2013)6. Shockingly,
in many parts of the world a child dies every 35 seconds of pneumonia; every 60
seconds, another child dies of diarrhoea. (Unicef-Nov 2016)7.More than half of
these early child deaths are due to conditions that could be prevented or treated
with access to simple, affordable interventions . Children’s food habit and health status are directed by household’s
socio-economic condition. Also, children are susceptible to environmental
sanitation while they are found most of the time playing around or spending
outside environment which is very unhygienic.

Slums located adjacent to large open drains have a
greater incidence of diarrhoea and other water-borne diseases 8. The urban
health infrastructure in India is neither appropriate nor adequate, and has not
really been able to meet the needs of the urban population, especially the poor
9

The
unhealthy physical environment of slum leads to sickness, demanding for
continuing medical treatment and treatment at government hospitals is apparently
cheaper, but is inconvenient to the slum residents (because of time loss in
waiting for the treatment and often, indifferent attitude of the medical staff)
instead; they prefer more expensive private treatment. Out of pocket expenditure
as percent of total expenditure on health was 62% in 2014 (UNICEF, WHO 2015)10

 

As
per NFHS -3, the prevalence of diarrhoea in Chhattisgarh was 11.3% in children
of U5 age got diarrhoea, of which 68.3% took ORS while only 26.8% of children
received Zinc from any health facility. The prevalence of symptoms of ARI was
2.3% in urban area of which 78.6% of them were taken for health facility.

 

According
to DLHS 3, In Raipur 57.6% of women was aware of childhood diarrhoeal diseases.
4.1% of children where found suffering from diarrhoea of which 96.8%  was given treatment or taken to health
facility on the other hand 5.2% of children who had prevalence of ARI only
77.3% were taken for treatment. The treatment seeking behaviour was found to be
18.4% for Govt facility while 78.6% was seen towards Private health facility.

 

With
greater investment from governments and partners, pneumonia and diarrhoea – two
preventable and treatable childhood illnesses – can be overcome, contributing
to the achievement of the Sustainable Development Goals, specifically to the
Goal 3 target of ending preventable child deaths. Since 2000, the rate of care
seeking for symptoms of pneumonia has increased by only 8 percentage points –
from 55 per cent in 2000 to 63 per cent in 2015. Within countries, there are
still significant disparities in care seeking for symptoms of pneumonia between
the richest and poorest households, across all regions. However, there has been
important progress to close the urban/rural gap in care seeking during this
time (Unicef- Nov 2016) 11

 

Literature review

 

Healthy
children are the foundation of robust economies and thriving communities; they
are the lifeblood of sustainable development. Every year, more than 1.4 million
children die from diarrhoea and pneumonia in settings like slums. For most
children around the world, pneumonia and diarrhoea are easily prevented and
managed illnesses with simple and effective interventions and rarely life
threatening.

 

In
India, ICDS, which covers a population of approximately 28 million12, has a
poor reach in urban areas, with only 278 urban ICDS projects out of 4348
projects13.

 

In
2011-12, only about 1.2 percent of the total expenditure under NRHM was on urban
family welfare services 14. It is seen that overall, investment on urban
infrastructure and especially improvements in access for urban poor is very
negligible in the Family Welfare outlay of the Ministry of Health and Family Welfare,
Government of India. 15  

 

Several
studies have examined various aspects of slums and come out with diverse
findings

 

A
study done in Raipur slum in 2012 showed that the incidence of respiratory
diseases like fever, viral infection, tuberculosis, skin diseases, diseases of
the kidney and urinal diseases were high in the slums. The most conspicuous and
highest degrees of incidence could be noticed for some special diseases: the
incidence of tuberculosis was ten times higher in the slums than in the city as
a whole, viral infections were 2.5 times higher, respiratory diseases 1.4times,
heart and circulatory system about 10 times and allergic diseases 1.9 times
higher.16

 

Udani Pekha H17 had conducted a study in the urban slums
which were under an ICDS block in Bombay, to find out the morbidity pattern and
nutritional status of pre-school children of these slums. 12 out of 25 slums
were randomly selected for the study. It was found that upper respiratory tract
infection, scabies and physical and mental disabilities were some of the
leading diseases in these slum children.

 

A Study done in Delhi slum in 2009 showed the overall
morbidity prevalence of 15.4%. It was 14.7 % and 16.3% for males and females. The
reported higher morbidity prevalence and the illiteracy status are
significantly associated. Diseases of the respiratory system appear to be very
high among slum dwellers. 18

 

To determine the magnitude of
morbidity related to diarrhoea among children under 5 years of age, a study was
carried out in 4 slum areas of Delhi in May-June 1984. Of the 3645 children
surveyed, 963 (26.4%) had suffered from 1 or more new episodes of diarrhoea in
the 2 weeks preceding the survey. This suggests a mean annual incidence of diarrhoea
in the slums of Delhi of 7.9 episodes/child, with an average duration of 3.9
days/episode. The incidence of diarrhoea was highest in children of 7-12 months
of age (13.6 episodes/year). In 24.2% of the diarrhoea episodes, the families
sought no medical help. 54.5% of cases were treated by private practitioners,
21% were seen at hospitals, and 0.3% were treated with home remedies. Only
20.2% of mothers of children with diarrhoea were familiar with oral rehydration
therapy, despite the easy accessibility of information about this treatment in
the slum areas. Among the mothers with knowledge of oral rehydration, 47.9%
used it for all diarrhoea episodes, 33.0% used it for selected episodes, and
19.1% had never used it. Children with grade 2 or 3 malnutrition also showed a
higher incidence of diarrhoea. Among the socioeconomic parameters, diarrhoea
was positively associated with low female income and illiteracy on the part of
the mother.19

 

A study on diarrheal diseases of Delhi slums (by Bhatnagar
and Dosajs, 1986) revealed that the incidence of diarrhoea averaged 8 episodes
per child per year. And in 1988 Bhatnagar20 and his team documented that
maximum sickness was registered in slums having the poorest sanitary conditions.
Important correlates of morbidity were identified as low educational level,
poor hygienic status of the family, poor environmental sanitation and low
per-capita income.

A study on health seeking
behaviour in urban slum showed that relative importance of governmental
institutions falls and private institution rises with an increase in income.
However this is not true in case of urban slum dwellers 21

 

The direct cost of medical care
for having at least one person in the household with diarrhoea was 205 rupees.
Other direct costs brought total expenses to 291 rupees. Adding an average loss
of 55 rupees per household from lost wages and monetising lost productivity
from homemakers gave a total loss of 409 rupees per household. During the
5-week study period, this community lost an estimated 163 600 rupees or 3635 US
dollars due to diarrhoeal illness.22

Slum-dwelling children are more
malnourished, have lower immunisation rates and higher rates of measles, are
more susceptible to diarrhoeal illness due to V. cholerae and suffer from
severe dehydration more often than children from non-slum areas.23

 

 

Rationale of the Study

 

As the studies on morbidity of
Under-5 children residing in Slums are limited, this study may help us to find
the burden of health problems and factors associated with treatment seeking
behaviour adopted by the parents of the Under-5 children in Raipur (CG). This
study will be major step for further research and could describe the morbidity
profile of Under-5 children and the need for addressing this problem to enable
these Under-5 children to live in a healthy and productivity life.

 

Aim of the study

 

The aim of the study will be to find
out the morbidity pattern for selected major childhood diseases for Under 5
children and the treatment seeking behaviour by the parents of the slum. Additionally, this study will also try to find out the
disease pattern and its relation with socioeconomic, hygienic and environment
factors along with the financial burden on the parents living in urban slum.

 

Objectives

 

1.     
To assess the health problems with respect to respiratory
and diarrhoeal diseases

2.     
To understand the treatment seeking behaviour.

3.     
To estimate the average cost of health expenditure by the
parents of the children’s living in slums of Raipur.

 

Study Type

 

Cross-sectional study in urban slums
of Raipur across a period of 3 to 4 months.

 

Sampling Method

 

The
subjects will be chosen on convenient or snow bowling sampling technique.

 

Sample Size

 

The
sample size considered for this study will be around 180 to 200.

 

Inclusion

Parents
with atleast 1 child below 5 year of age who has suffered Respiratory or GIT disease

Parents
living atleast during last 6 month in the slum

Morbidity
pattern in during past 3 months to include

 

Exclusion

Parents
refusing to participate in study

Not
a resident of the slum

 

 

Sampling Procedure

Raipur city has total 154 slums in which 135 slums are
declared formally by the government located in various places within the city
boundary. Purposive sampling will be done to select slums and then selection of households in the
selected slum will be done by systematic random sampling within the slum.

 

Data Collection Method 

Data will be collected from parents of children’s
using semi structured interview schedule.

Ethical Consideration

Voluntary participation of respondents will be
considered. Respondents have given a freedom to participate in the study
willingly without any force. The voluntary informed consent will be taken from
the participant after explanation of the procedure and purpose of the study.
Ethical standards will be followed by researcher while doing study as well
taking care of all the possibilities of risk of harm not to get to the
respondents by participating in the study. Researcher will ensure surety about
the confidentiality and privacy of all the data and identity.

An approval letter from the district
health/administration will be taken to carry out the study.

Data Analysis Plan

Data analysis will be done
using SPSS software.. Codes will be
prepared appropriately and data entry will be ensured accordingly. Frequencies
and percentages will be determined for analysis Chi square test and Independent’t’ test will be carried out.

 

Result

Out
of the total respondents interviewed from the slum. Major morbidity in past
three months in the children’s with respect to respiratory and gastrointestinal
infections will be assessed.  The pattern
with percentage of children taken for seeking treatment will be known. The
average total cost of health care expenditure during hospitalization will be
assessed.

Chi
square models will help indicate if there will be a significant association
between age of children and morbidity status. It can also help to rule out
association between monthly income of parents and place of seeking treatment
for their children.

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