Baseline Study

Study Background
  • One of India’s targets under Millennium Development Goal (MDG) 4 is to reduce Infant Mortality Rate (IMR) by two-thirds between 1990 and 2015.
  • As per the objective of ‘Save the Children’, an international children’s welfare organization, to safeguard children and their rights, it is working in close association with Reckitt Benckiser to target the devastating global death rate in children under five from diarrhoea, through a unique approach of combining innovative technology with expertise in implementing life-saving programmes  since 2013.
  • This report makes a remarkable and compelling argument for tackling 2nd leading killer of children under age 5, i.e. Diarrhoea after pneumonia, reflecting a broader trend of uneven progress in reducing child mortality.  
  • As per the community based studies, more than 300 million episodes of acute diarrhoea occur every year in India in children below five years of age.

 

The chief objective of the study is:
  • To understand the attribution of the proposed intervention in terms of the change in diarrhoea incidence rate.
  • To understand the status of households (HHs) in project areas with respect to the WHO 7 point plan for comprehensive diarrhoea control.

 

Methodology
  1. The study was carried out in six states of India i.e. Uttarakhand and Jharkhand (Rural), Uttar Pradesh and Bihar (Rural and Urban) and Delhi and West Bengal (Urban) using a Quasi-Experimental Design, wherein, a before-after two-group (treatment group and control group) has been selected which would enable us to attribute the change of the intervention after the endline has been conducted.
  2. The study used technology (netbooks) for data collection during the study round to ensure not only the timely collection of the data but also the quality of data.
Observations

 

Socio Economic Profile
  • Majority of the respondent population either classified themselves as OBC or SC, a significant population also belonged to the general category & the ST representation was the maximum.
  •  Almost five out of 10 (HH) heads were involved in wage employment activities & large no. of respondents fell in the Below Poverty Line (BPL) who did not possess any Ration Card.
  • Standard of Living states that Project areas are slightly better off than the control areas.

 

Diarrhoea Management
  • More than half of the respondents are unaware of the major cause of diarrhoea and regard the child getting weak as the critical symptom for diarrhoea.
  • Consumption of commercially available oral rehydration solution (ORS) is the highest ranking treatment practice in people’s opinion with a slightly higher proportion of respondents in treatment group.
  • Most of the respondents believed that incidence of diarrhoea are seen mostly in summer and a child less than six months of age or more suffering from diarrhoea should be given less than the normal amount of breast milk.

 

Fluid Replacement to prevent dehydration
  • A little more than three-fourths of all respondents had heard of ORS usage in diarrhoea treatment mainly from doctors, including other professional medical officers like Registered Medical Practitioners (RMPs) etc.
  • ORS is mostly obtaining from Pharmaceuticals, medical shops (those that are not located in Government hospitals).
  • The major barrier in obtaining ORS is the unavailability at times and high price of ORS.
  • Knowledge related to usage of zinc supplementation (for both tablets and syrups) is quite poor across all areas.

 

Profile of children suffering from Diarrhoea
  • Out of all diarrhoea cases, 50.8 per cent were found in the project areas, whereas, the remaining 49.2 per cent were found in the control areas.
  • Most of the diarrhoea children were more than 12 months of age and 6 of 10 diarrhoea children came from rural areas.

 

Treatment followed for children suffering from diarrhoea
  • 7 out of 10 diarrhoea children less than six months of age were given less than normal breast milk during the time they were suffering from diarrhoea, also reduced quantity of complimentary feeding.
  • Relatively more children in control areas were prescribed or given ORS as compared to the project areas.
  • Zinc coverage (either in the form of tablets or syrups ) was witnessed to be abysmally poor with not even 10 per cent children.

 

Immunization
  • Availability & administration of rotavirus is still in its nascent stage across all the six states.
  • Measles coverage amongst children aged 12-24 months of age is steadily good and first dose coverage of Vitamin-A was around 60 per cent.

 

Breastfeeding
  • Status of early breastfeeding initiation was only followed by a little over 3 out of 10 respondents.
  • Amongst children falling in the age bracket of 6-9 months, around 42 per cent were being currently breastfed along with being given any complimentary food.

 

Hand washing
  • People across all six states display a consistently strong positive attitude towards handwashing.
  • More than 50% elicited affirmative response to hand washing after defecation and after cleaning child’s faeces whereas the issues “before eating food” and “before feeding children” was least in number i.e. nearly 30 per cent.

 

Safe Drinking Water
  • Point of use water treatment at home is not practiced by a majority of the respondents. Slightly higher proportion of households (HHs) claim to privately own their drinking water source & Hand pump is the most common source of drinking water used by the respondent HHs.
  • The majority of the respondents responded affirmatively to using covered water storage vessels and bottles.

 

Community Wide Sanitation Promotion
  • More than 50% of the respondents don’t have toilet ownership except West Bengal (71.7%) and Jharkhand (15.7%).
  • Almost Half the households go for open defecation except Jharkhand (more than 80%) & West Bengal (only about 15%).
  • Most respondents stated that the biggest impediment they face in constructing their own toilet is lack of money. In fact, in Delhi & West Bengal, lack of space for building a toilet is a major barrier in owning a toilet.
  • Nearly 4 out of 10 respondents reported to have child faeces being disposed out in the open.

 

Communication
  • The chief message the mothers would like to receive regarding diarrhoea management revolves around the steps they need to take in order to prevent diarrhoea (3 in 10) and feeding practices that need to be adopted for a child suffering from diarrhoea (2 in 10).

Most of the mothers/caregivers responded in favour of television as a medium of communication. Almost 7 out of 10 respondents stated Private Doctors as the major category of health service providers that are considered as the most trusted.