A study to explore the determinants of child health in Melghat, Maharashtra

Background: Melghat is the hilly forest region of 312 small villages, known as one of the most underdeveloped regions in Maharashtra. The employment in Melghat is exploitative, enslaving and gender discriminatory. An estimated 5,000 tribal children died of malnutrition in Melghat in 92-97. Objectives: To find out situation of child mortality in Melghat and investigate any under reporting, and explore determinants of child health qualitatively. Material and Methods: The study was conducted in five PHC areas of Melghat area namely Sadrawadi, Bairagad, Dulghat Rly, Tembursonda and Hatru. Data on vital statistics was collected for April-July 2008 and corresponding period for year 2007. Line listing of all child deaths occurring during the period was done to find any under reporting. Verbal and social autopsy of deaths was done including social autopsy in one PHC village to find out underlying factors responsible for such deaths. Data was analysed using ATLAS. ti 5.5 and ANTHROPAC 4.98 to form matrix of socio-cultural-economic factors. Results: A total of 73 U6 deaths and 911 live births were reported from the study area. Thus the U6MR for the area is 80.1 for this period compared to 66.9 for corresponding period of previous year. Therefore, according to the vital statistics, U6MR in Melghat was not higher compared to other parts of the country, if under reporting is not there. Further, neonatal deaths accounted only 39.7% of U6MR. Improper childrearing practices, poor diet intake by pregnant women, early marriages, poor spacing of children, lack of health education and awareness, adequate income and purchasing power reasons for the precarious state of child health. Conclusions: Increasing awareness regarding govt. policies such as NREGA and JSY alongwith an effort to popularize the public infrastructure and harping at the cycle of poverty-illiteracy-lack of information will accelerate development in ghat area.