Child survival and maternal health-seeking behaviour : a case study in Rawalpindi, Pakistan

This study investigated factors associated with child survival in an area in Rawalpindi, one of the largest cities of Pakistan. Within a conceptually integrated framework, the research was conducted by using demographic and anthropological methods to examine processes and mechanisms whereby a link is established between child morbidity and mortality and its covariates. Controlling for the socio-economic status as a determinant of child health, the study population was limited to a lower income stratum. Three sets of data were obtained to gather quantitative and qualitative information from 341 ever-married women, aged 1539 years, who had borne at least one child in the five years preceding the survey conducted during the first half of 1992. Further qualitative information was collected through indepth interviews with 20 mothers and 20 health care providers. Within a homogeneous environment where all households had equal access to healthrelated and other facilities, the results suggest that non-economic factors like maternal health-seeking behaviour were related to high child morbidity and mortality. Results of the proportional hazards model analysis on 1301 index children revealed that the cultural norm of bearing a large number of children was the most significant correlate of child mortality. In order of significance, this was followed by contraceptive use, current age of the mother, age at marriage and the hygienic conditions of the household. Analysis of the morbidity data, measured by the incidence of diarrhoeal and respiratory infections, was based on a total of 616 children born within the five years before the time of interview. The results showed that synergy of infections was associated with child illhealth. Depending on the age, children who had ever suffered from fatal illnesses including immunizable diseases were susceptible to repeated attacks of illness. The pattern supported the argument that these children generally had lower immunity and this together with inappropriate feeding practices, perhaps led to malnutrition, and hence a cycle of repeated illnesses. The study revealed clustering of child morbidity and mortality, largely attributed to differing maternal child caring and rearing abilities. The results suggest that prevalence among mothers of unhygienic practices and lack of appropriate knowledge about disease could be the prime factors associated with higher incidence of childhood diseases. Traditional belief systems about the causes and transmission of diseases, in the absence of modern knowledge and awareness, may deter mothers from making appropriate use of the modern methods of treatment and prevention. The results showed marked differences in the health care practices and abilities of the educated and uneducated mothers. It appeared that attainment of formal education exposed women to health and other sources of knowledge and enhanced their ability to make better use of the facilities which were equally accessible to the entire study population. With altered attitudes, perceptions and beliefs, these women experienced fewer child births and deaths. Overall, children of these mothers had a greater probability of survival as a result of the advantages associated with better child caring abilities.