IntroductionSlums are defined by the UnitedNations Organizations as “a building or group of buildings and areacharacterized by overcrowding, deterioration in sanitary conditions, or absenceof facilities and amenities, which because of these conditions or any of themendanger the health, safety or morals of its inhabitants or the community”Comparativeslum statistics from India revealed that percent of slum dwellers marginallydecreased from 24 (in 2001) to 22 percent (in 2011), while absolute numbersincreased from 52 million to 65 million 1. An earlier report from UN-HABITAThighlights that the urban poor, especially the slum dwellers in developingcountries, 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 inslums have a poor quality of life. The lack of basic services affects them themost. 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 childrenunder 5. Leading causes of death in children under-5 years are preterm birthcomplications, pneumonia, birth asphyxia, diarrhoea and malaria (WHO 2013)4 Every year, more than 1.4 millionchildren die from diarrhoea and pneumonia. (UNICEF-Nov 2016)5. 5.6 million Childrenunder the age of 5 years died in 2016. This translates into 15,000 under-fivedeaths per day (WHO 2013)6.
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Shockingly,in many parts of the world a child dies every 35 seconds of pneumonia; every 60seconds, another child dies of diarrhoea. (Unicef-Nov 2016)7.More than half ofthese early child deaths are due to conditions that could be prevented or treatedwith access to simple, affordable interventions . Children’s food habit and health status are directed by household’ssocio-economic condition.
Also, children are susceptible to environmentalsanitation while they are found most of the time playing around or spendingoutside environment which is very unhygienic.Slums located adjacent to large open drains have agreater incidence of diarrhoea and other water-borne diseases 8. The urbanhealth infrastructure in India is neither appropriate nor adequate, and has notreally been able to meet the needs of the urban population, especially the poor9Theunhealthy physical environment of slum leads to sickness, demanding forcontinuing medical treatment and treatment at government hospitals is apparentlycheaper, but is inconvenient to the slum residents (because of time loss inwaiting for the treatment and often, indifferent attitude of the medical staff)instead; they prefer more expensive private treatment.
Out of pocket expenditureas percent of total expenditure on health was 62% in 2014 (UNICEF, WHO 2015)10 Asper NFHS -3, the prevalence of diarrhoea in Chhattisgarh was 11.3% in childrenof U5 age got diarrhoea, of which 68.3% took ORS while only 26.8% of childrenreceived Zinc from any health facility. The prevalence of symptoms of ARI was2.3% in urban area of which 78.
6% of them were taken for health facility. Accordingto 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 healthfacility on the other hand 5.2% of children who had prevalence of ARI only77.3% were taken for treatment.
The treatment seeking behaviour was found to be18.4% for Govt facility while 78.6% was seen towards Private health facility.
Withgreater investment from governments and partners, pneumonia and diarrhoea – twopreventable and treatable childhood illnesses – can be overcome, contributingto the achievement of the Sustainable Development Goals, specifically to theGoal 3 target of ending preventable child deaths. Since 2000, the rate of careseeking 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 arestill significant disparities in care seeking for symptoms of pneumonia betweenthe richest and poorest households, across all regions. However, there has beenimportant progress to close the urban/rural gap in care seeking during thistime (Unicef- Nov 2016) 11 Literature review Healthychildren are the foundation of robust economies and thriving communities; theyare the lifeblood of sustainable development. Every year, more than 1.4 millionchildren die from diarrhoea and pneumonia in settings like slums.
For mostchildren around the world, pneumonia and diarrhoea are easily prevented andmanaged illnesses with simple and effective interventions and rarely lifethreatening. InIndia, ICDS, which covers a population of approximately 28 million12, has apoor reach in urban areas, with only 278 urban ICDS projects out of 4348projects13. In2011-12, only about 1.2 percent of the total expenditure under NRHM was on urbanfamily welfare services 14. It is seen that overall, investment on urbaninfrastructure and especially improvements in access for urban poor is verynegligible in the Family Welfare outlay of the Ministry of Health and Family Welfare,Government of India.
15 Severalstudies have examined various aspects of slums and come out with diversefindings Astudy done in Raipur slum in 2012 showed that the incidence of respiratorydiseases like fever, viral infection, tuberculosis, skin diseases, diseases ofthe kidney and urinal diseases were high in the slums. The most conspicuous andhighest degrees of incidence could be noticed for some special diseases: theincidence of tuberculosis was ten times higher in the slums than in the city asa whole, viral infections were 2.5 times higher, respiratory diseases 1.
4times,heart and circulatory system about 10 times and allergic diseases 1.9 timeshigher.16 Udani Pekha H17 had conducted a study in the urban slumswhich were under an ICDS block in Bombay, to find out the morbidity pattern andnutritional status of pre-school children of these slums. 12 out of 25 slumswere randomly selected for the study. It was found that upper respiratory tractinfection, scabies and physical and mental disabilities were some of theleading diseases in these slum children. A Study done in Delhi slum in 2009 showed the overallmorbidity prevalence of 15.
4%. It was 14.7 % and 16.3% for males and females. Thereported higher morbidity prevalence and the illiteracy status aresignificantly associated. Diseases of the respiratory system appear to be veryhigh among slum dwellers.
18 To determine the magnitude ofmorbidity related to diarrhoea among children under 5 years of age, a study wascarried out in 4 slum areas of Delhi in May-June 1984. Of the 3645 childrensurveyed, 963 (26.4%) had suffered from 1 or more new episodes of diarrhoea inthe 2 weeks preceding the survey.
This suggests a mean annual incidence of diarrhoeain the slums of Delhi of 7.9 episodes/child, with an average duration of 3.9days/episode. The incidence of diarrhoea was highest in children of 7-12 monthsof age (13.6 episodes/year). In 24.
2% of the diarrhoea episodes, the familiessought 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. Only20.2% of mothers of children with diarrhoea were familiar with oral rehydrationtherapy, despite the easy accessibility of information about this treatment inthe 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, and19.
1% had never used it. Children with grade 2 or 3 malnutrition also showed ahigher incidence of diarrhoea. Among the socioeconomic parameters, diarrhoeawas positively associated with low female income and illiteracy on the part ofthe mother.19 A study on diarrheal diseases of Delhi slums (by Bhatnagarand Dosajs, 1986) revealed that the incidence of diarrhoea averaged 8 episodesper child per year. And in 1988 Bhatnagar20 and his team documented thatmaximum 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 lowper-capita income.A study on health seekingbehaviour in urban slum showed that relative importance of governmentalinstitutions 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 carefor 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 lossof 55 rupees per household from lost wages and monetising lost productivityfrom homemakers gave a total loss of 409 rupees per household. During the5-week study period, this community lost an estimated 163 600 rupees or 3635 USdollars due to diarrhoeal illness.22Slum-dwelling children are moremalnourished, have lower immunisation rates and higher rates of measles, aremore susceptible to diarrhoeal illness due to V. cholerae and suffer fromsevere dehydration more often than children from non-slum areas.23 Rationale of the Study As the studies on morbidity ofUnder-5 children residing in Slums are limited, this study may help us to findthe burden of health problems and factors associated with treatment seekingbehaviour adopted by the parents of the Under-5 children in Raipur (CG). Thisstudy will be major step for further research and could describe the morbidityprofile of Under-5 children and the need for addressing this problem to enablethese Under-5 children to live in a healthy and productivity life. Aim of the study The aim of the study will be to findout the morbidity pattern for selected major childhood diseases for Under 5children and the treatment seeking behaviour by the parents of the slum.
Additionally, this study will also try to find out thedisease pattern and its relation with socioeconomic, hygienic and environmentfactors along with the financial burden on the parents living in urban slum. Objectives 1. To assess the health problems with respect to respiratoryand diarrhoeal diseases2. To understand the treatment seeking behaviour.3.
To estimate the average cost of health expenditure by theparents of the children’s living in slums of Raipur. Study Type Cross-sectional study in urban slumsof Raipur across a period of 3 to 4 months. Sampling Method Thesubjects will be chosen on convenient or snow bowling sampling technique. Sample Size Thesample size considered for this study will be around 180 to 200. InclusionParentswith atleast 1 child below 5 year of age who has suffered Respiratory or GIT diseaseParentsliving atleast during last 6 month in the slumMorbiditypattern in during past 3 months to include ExclusionParentsrefusing to participate in studyNota resident of the slum Sampling ProcedureRaipur city has total 154 slums in which 135 slums aredeclared formally by the government located in various places within the cityboundary. Purposive sampling will be done to select slums and then selection of households in theselected slum will be done by systematic random sampling within the slum. Data Collection Method Data will be collected from parents of children’susing semi structured interview schedule.Ethical ConsiderationVoluntary participation of respondents will beconsidered.
Respondents have given a freedom to participate in the studywillingly without any force. The voluntary informed consent will be taken fromthe participant after explanation of the procedure and purpose of the study.Ethical standards will be followed by researcher while doing study as welltaking care of all the possibilities of risk of harm not to get to therespondents by participating in the study.
Researcher will ensure surety aboutthe confidentiality and privacy of all the data and identity.An approval letter from the districthealth/administration will be taken to carry out the study.Data Analysis PlanData analysis will be doneusing SPSS software.
. Codes will beprepared appropriately and data entry will be ensured accordingly. Frequenciesand percentages will be determined for analysis Chi square test and Independent’t’ test will be carried out.
ResultOutof the total respondents interviewed from the slum. Major morbidity in pastthree months in the children’s with respect to respiratory and gastrointestinalinfections will be assessed. The patternwith percentage of children taken for seeking treatment will be known. Theaverage total cost of health care expenditure during hospitalization will beassessed.Chisquare models will help indicate if there will be a significant associationbetween age of children and morbidity status. It can also help to rule outassociation between monthly income of parents and place of seeking treatmentfor their children.