Maternal and child health service utilization and its relation with physical growth and development of infant: a community based study in rural Belgaum, India

Abstract

Pregnancy and childbirth are special opportunities in women‟s lives, and their families. Although these are natural physiological process, they become complicated risks for every woman. The consequences are observed on both mothers and babies. The United Nations Fund for Population Activities in 2011 estimated that 210 million women become pregnant every year. Out of which, 86.66 percent belongs to developing countries. Moreover, almost a half million women die every year during pregnancy and delivery. India covers 20 percent and 25 percent of global maternal and child mortality respectively. About 40 percent of mothers experience general complications, whereas 15 percent bear life-threatening problems due to pregnancy and childbirth. Similarly, malnutrition is the underlining cause of 50 percent deaths among the world over children. Additionally, 46 percent of children less than three years of age are underweight, one third are stunted and one fifth are wasted. Most of such problems can be prevented if women get access to safe motherhood services. Hence, health care services targeting mothers and children might be an effective health intervention for safer and healthier outcomes. Meanwhile, acceptance and utilization of the services are crucial in averting the deaths and in promoting health of the mothers and children. Objectives: To find out the maternal and child health service utilization pattern and its relation to the growth and development of the infants. Materials and methods: A community based cross-sectional study was carried out among 630 mothers–infant pairs during August 2012 to January 2013 in the rural areas of Belgaum district, Karnataka, India. A two staged 30 cluster sampling technique was used. Data was collected through interview using pre-tested structured questionnaire and anthropometric measurement tools. Voluntary informed consent was taken before carrying out the study. Analysis of data was performed using SPSS-20 version and WHO anthrop. Statistical methods like percentage, mean, standard deviation, Chi-square test, correlation and Odds Ratio were applied. The criterion for statistical significance was set at the value of P<0.05. Results: Out of 630 participants, 54.6 percent were 20-24 years of age, 61.6 percent had secondary education, 89.8 percent were housewives and 91.6 percent were Hindus. About 69.7 percent were from joint families and three-fifths were residing ≤6 Km. away from health service facilities. About 94.8 percent were registered for Antenatal care (ANC) and 85.7 percent had made ≥3 ANC visits. Almost two third of the mothers had registered for ANC in the first trimester of pregnancy. About 93.7 percent had an institutional delivery and 78.7 percent were normal deliveries. About 98.4 percent of the infants were fed colostrums and 78.3 percent fed the first milk within ½ an hour. Nearly three-quarters (73%) of babies among ≥ 6 months were found to be exclusive breast fed. Economic status (P=0. 01), age of the mother (P=0. 03), family size (P=0. 02), ANC service use (P=0. 03), and awareness (P=0. 02) were found to be significant factors affecting the utilization of institutional delivery services. Similarly, 92 percent of the mothers had utilized at least one kind of postnatal service. Almost three-fifths met with nurse/health-workers at least three times, four-fifths received advices on breast/nipple care, 92.5 percent about breast feeding and 67.9 percent about postnatal exercise. Almost 89 percent of those received the advices on nutrition education and 85 percent received the advice related to uterus care. About 18.8 percent of the infants were underweight, 37.9 percent stunted and 19.6 percent wasted. Nearly two percent of the infants were found to be delayed in development of their recommended milestones. Various birth outcomes like birth weight and gestational age had a significant role in physical growth of infants. Complete ANC visits, TT injection, iron and folic acid tablets intake and full antenatal care service utilization had significant association with better height for age and weight for height. The ANC service utilization, home visits by health workers during the postnatal period, art/methods of breastfeeding, health services like an initiation of breastfeeding, colostrum feeding, exclusive breastfeeding and treatment of diarrhea had statistically significant association with the different developmental milestones of the infants (P<0.05). Conclusion Antenatal care, intranatal care and postnatal care service utilization by the mothers in this study was better than average services of India. Age (20-35 years), family income (I and II class), knowledge/awareness on safe delivery and childbirth, family size (Joint family) was the significant factors affecting ANC service utilization and the institutional delivery services. Similarly, maternal education, socioeconomic status (I and II class), knowledge/awareness and place of delivery were found to be the significant factors affecting postnatal care (PNC) service utilization. Furthermore, mother‟s education, family income, occupation, parents, ANC and PNC service utilized by mothers had a significant relation to proper utilization of child health services. Complete ANC service utilization had significant positive impact on height for age and weight for height of the infants. Similarly, ANC service utilization, exclusive breastfeeding and the treatment of diarrhea had a significant role in the timely development of infants. Efforts have to be made to ensure that the maternal and child health services reach to the mothers of younger age, poor socioeconomic status, nuclear family and uneducated communities. There is the need to bring awareness amongst the mothers about these services.