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Child morbidity status in AP

Low birth weight prevalence Anaemia among children

1. Low birth weight prevalence

A birth weight of less than 2500 gm is considered less favorable for the survival and well-being of a newborn. Low birth weight babies face higher risks of dying than do babies of normal birth weight. World Health Organization defined Low birth weight as "birth of less than 2500 gm. irrespective of gestational age" [WHO, ICD, 1975]. Several, often interrelated, conditions are associated with low birth weight, including socio-economic status, ethnicity, maternal nutrition, the environment and health status. Birth weight is governed by two major processes: duration of gestation and intrauterine growth rate. Low birth weight is thus caused by either a short gestation period or Intrauterine growth retardation (IUGR) or a combination of both (Krama,1987).

Unfortunately, precise estimates of low birth weight prevalence in AP is hard to get. The two NFHS asked women about the weight of babies born to them within the last three years. According to NFHS-2 in Andhra Pradesh (Table 1), more than half (56%) of babies in the three years preceding the survey were not weighed at birth. The proportion not weighed is 31% in urban areas and 64% in rural areas. Even for babies that were weighed, some mothers did not remember the weight. Clearly, the major problem is lack of accurate estimate of the low birth weight prevalence. Among children for whom birth weights are reported, 19% weighed less than 2.5 kilograms. The proportion weighing less than 2.5 Kg is slightly higher in rural areas (20%) than in urban areas (16%).

Table 1: Percentage of births by birth weight according to residence in AP
Birth weight	Rural		Urban		Combined
Birth weight	1992-93	1998-99	1992-93	1998-99	1992-93	1998-99
<2.5kg	1.7	6.5	9.2	9.6	3.6	7.3
2.5 kg +	4.1	25.8	28.2	50.8	10.1	32
Don't know/missing	6.7	3.4	18.4	8.9	9.6	4.8
Not weighed	87.4	64.3	44.2	30.7	76.7	55.9
Source: NFHS-1 p-153 table: 9.6, NFHS-2 p-188, table: 8.9

2. Anaemia among children

Anaemia is a serious concern for young children because it can result in impaired cognitive performance, behavioural and motor development, coordination, language development and scholastic achievement, as well as increased morbidity from infectious diseases (Seshadri, 1997). One of the most vulnerable groups is children age 6-24 months (Stoltzfus and Dreyfuss, 1998).

Table 2: Percentage of children having anaemia in AP 1998-99
Age of the child	Any anaemia	Mild anaemia	Moderate anaemia	Severe anaemia
6-11 months	68.4	23.7	44	0.6
12-23 months	75.2	23.2	45.8	61
24-35 months	71.1	22.4	44.4	4.4
Mother's anaemia status
Not anaemic	68.4	25.1	40.8	2.4
Mildly anaemic	74.8	22.5	47.3	4.9
Moderately anaemic	80.9	19.2	54.7	8.1
Residence
Urban	69.5	23.2	44.4	1.9
Rural	73.3	23	45.1	5.2
Source: NFHS-2 (AP) p-167 table- 7.11

Several groups of children have particularly high levels of moderate to severe anaemia. There is a strong positive relationship between the anaemia status of mothers and prevalence of anaemia among children. Figure 1 shows the prevalence of anaemia among children. Overall, nearly 72% of the children have some level of anaemia, including 23% who are mildly anaemic (10.0-10.9g/dl), 45% who are moderately anaemic (7.0-9.9g/dl), and 4% who are severely anaemic (less than 7.0 g/dl) according to NFHS-2. Figure 1 shows prevalence of anaemia among neighboring states of Andhra Pradesh. Kerala is having 43.9 percent and Maharastra is having 76 percent.

Figure 1: Prevalence of childhood anaemia in AP and neighboring states.

Source: NFHS (2) India p-273, table-7.19

3. Childhood cluster of diseases

The common child morbidities are Acute Respiratory tract infection (ARI), Diarrhoea, cough, fever etc. Acute Respiratory infection (ARI), primarily pneumonia, is a major cause of illness among infants and children and the leading cause of childhood mortality throughout the world (Murray and Lopez, 1996). Early diagnosis and treatment with antibiotics can prevent a large proportion of ARI deaths.

Acute Respiratory Infection

NFHS-2 found that 19% of children under age 3 in Andhra Pradesh suffered from ARI (cough accompanied by short, rapid breathing). Acute respiratory infections is an important childhood morbidity. Point prevalence of ARI in AP was lower compared to Kerala, Madhya Pradesh and Orissa. Other neighboring states like Tamil Nadu, Karnataka and Maharashtra had lower point prevalence of ARI.

2: Acute Respiratory Infection (Pneumonia) cases among children upto 3 year age in AP and other states, 1998-99

Source: NFHS-2 (India) p-219, Table no: 6.17

In MICS, children with acute respiratory infection (ARI) are defined as those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were due to a problem in a chest, or both the chest and a nasal congestion. 34% under-five children had cough during the two weeks prior to the survey. 16% had experienced cough with rapid breathing, 7% with chest in drawing and 6% had both the symptoms. It was found that children below 12 months are more likely to experience cough with rapid breathing or chest congestion compared to other children.

Diarrhoea

Diarrhoea is the second most important killer of children under five worldwide. Deaths from acute diarrhoea are most often caused by dehydration due to loss of water and electrolytes. Nearly all dehydration related deaths can be prevented by prompt administration of rehydration solutions. According to NFHS-2, 15% of children under age 3 suffered from diarrhoea. Among children age 1-35 months, those age 6-11 months are most susceptible to diarrhoea. Among children age 1-35 months, those age 6-11 months are most susceptible to diarrhoea.

Table 3: Prevalence of ARI and diarrhoea in AP according to NFHS(2) and MICS estimates. 1998-99 & 2000
Background characteristic	ARI		Any diarrhoea
Background characteristic	NFHS(2)	MICS	NFHS(2)	MICS
Age of Child
1-5 months	18.5	33.5	12.5	16.4
6-11 months	19.7	43.8	23.5	28.3
12-23 months	20.6	40	16.2	21.9
24-35 months	17.8	30.9	10.2	9.9
Residence
Urban	16.5	33.4	16.1	13.1
Rural	20.2	33.7	14.7	13.3
Combined	19.3	33.6	15	13.3
Source: NFHS-2 (AP)1998-99 p-137, table: 6.11, MICS (AP) -2000

In the Multiple Indicator Sample Survey mothers/caregivers were asked to report whether their child had diarrhoea during the two weeks prior to the survey. Overall, 13 percent of under-five children had diarrhoea in the two weeks preceding the survey. There was no rural urban difference in the occurrence of diarrhoea. Incidence seemed highest at younger ages (i.e., 0-23 months). MICS also provides information on prevalence of fever and cough among children below five years of age during the two weeks prior to survey. 30% children were reported to have experienced fever. Rural - urban differentials were not much. The Table 4 gives the prevalence of diarrhoea, fever and cough in Andhra Pradesh in the year 2000.

Table 4: Percent of children below five years of age who had diarrhoea during the year preceding the survey. MICS, Andhra Pradesh, 2000
Characteristic	Urban	Rural	Combined
Age of the child
0-5 months	23.5	30.6	25.2
6-11 months	55.5	59.2	56.5
12-23 months	57.9	61	58.9
24-35 months	44.7	37.3	42.5
36-47 months	35.1	23.7	31.9
48-59 months	28.3	31.5	29.2
Source: MICS-2000 Andhra Pradesh

Information regarding occurrence of diarrhoea among children below five years of age during the year preceding the survey was also calculated. 40 percent children had an occurrence of diarrhoea. No difference was observed between rural and urban areas. Children belonging to scheduled castes and tribes were more likely to have experienced diarrhoea compared to other groups. It was observed that young children below six months of age and older children more than 35 months are less likely to experience diarrhoea compared to children age 6-35 months.

The NFHS-2 figures of diarrhoea can be seen in the Figure 3. Prevalence of diarrhoea varies considerably by state. 15% of children under age 3 suffer from diarrhoea in AP.

Figure 3: Percentage of children under 3 years with diarrhoea by state. 1998-99

Source: NFHS-2 (India) p-219, table: 6.17

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Updated by Samatha Reddy Dated: 17/08/2003