Calidad de Vida Percibida de personas con Enfermedad Renal Crónica

The first group of determinants are identified under the theme of inappropriate care which includes as minor roots having too many children, working children, an inappropriate caregiver and having diseases (Figure 5-5). Working children are children who have to go out and earn money for the household. An inappropriate caregiver is defined by participants as a young child, an old grand-mother, a working mother or a sick mother.

malnourished inappropriate care too many children inappropriate caregiver working children working mother Insufficiant revenue Lack of access to health care (family planning) diseases lack of access

to heath care flooding inappropriate food

mother sick too many children alternate caregiver too young or too old

Figure 5-5: Conceptual framework for inappropriate care

5.5.1.1.1 Too many children

A popular understanding among pregnant women and community health workers is that a child becomes malnourished because he has too many brothers and sisters. Most of the participants believe that having two children, one boy and one girl is ‗good‘. While the average number of children for the participants is 2, some of them had up to 6 children probably taking into account the high risk of mortality that they are exposed to. In fact, this policy has been promoted by the Bangladeshi government as ‗the happy family‘ in order to advocate for family planning and

Bangladesh? gender balance. Participants refer to families with many children as ‗not happy family‘. Because of the number of children, they suggest that parents cannot provide proper care and let them grow without attention, guidance and rules. They are also unable to provide adequate physical comfort, „they all sleep together on

the floor‟ or „they sleep in a dirty place‟. Not having a bed and sleeping on the floor

is a characteristic identified as symbolising the poorest of the poor in the slums. Pregnant women believe large families to happen because of a lack of access to health care and family planning. In contrast, community health workers report that family planning is available for women who desire it through various organizations but that some women are not willing to take contraception because they don‘t like the effect that it has on their body or simply because they want a son if they already have daughters. In Bangladesh, having a son compared to a daughter is often preferred because of the dowry that the bride‘s parents have to pay to the groom‘s family before and often after a marriage (Amin and Mariam 2008, Chowdhury and Bairagis 1990, Edlund 1999). Sons are also most likely later on to bring income to the household and therefore to support aging parents because of a patrilineal family structure (Kabir et al. 2002, Rashid 2006).

5.5.1.1.2 Working children

Most of the participants perceive that a child who works becomes malnourished because there is no money for him/her to go to school. The value of education is perceived mainly by community health workers, who are generally literate themselves, to be the key for obtaining a good job and getting out of poverty. These school age children (5 years old and older) are pushed in poor families to bring income to the households. „The poor children can‟t go to the school...they

collect paper to make money‘. These children become malnourished because their

jobs are physically demanding, such as collecting paper, begging on the street, or selling items to car drivers on the road. They stay outside the whole day in the heat and sun and frequently have to skip meals or eat only roti (flat bread).

Some mothers report not being able to afford to pay the small monthly school fees (approximately less than 1 GBP) and struggling to buy a school uniform. In families with many children, it is common that only one child goes to school while the others work. Children are also reported to start working when the mother definitively stops working in garment factories. Mothers report stopping work after

Bangladesh? a few years because of the difficulty of the job, which results in her older children commencing work to compensate for the decrease in revenue.

5.5.1.1.3 Inappropriate caregiver

A common idea is that neglect by sick mothers or working mothers leads to the child becoming malnourished. As participants note, ‗she [the mother] works and

has to leave them alone all day long‟. If she has an infant, she keeps him

suspended in a hammock made of a scarf while she works outside. They explain further that some mothers lock their children in their room while they are out or leave the youngest ones under the care of the eldest child. Alternate caregivers such as young children or old grand-mothers are common in the slums. These caregivers are typically inappropriate because they often lack the skills, the knowledge and/or the physical capacity to properly take care of IYCs.

Participants stress that mothers in the slums are often sick suffering from various diseases, anaemia, headache, stomach ache, respiratory infections. They feel weak and exhausted and therefore lack the physical energy and motivation to provide adequate care to their children leading to poor health and malnutrition. In female headed households, women who are mainly divorced, especially face difficulties in bringing income to the household while taking care of children. While the children‘s father, who frequently has remarried and may have more children with his second wife, may contribute a small part of the household income, the major burden of income generation and household tasks is carried by the mother. Men tend to play a limited role in caring for the children as caring tasks tend to be gender specific and remain the women‘s duties. However women report frequently finding support from neighbours and help in looking after children when needed.

5.5.1.1.4 Diseases

Participants report children to be malnourished because they suffer from various diseases including diarrhoea, scabies, ―polio‖35_{, pneumonia, asthma, anaemia, lack}

of iodine, and worms, with diarrhoea and scabies being the two most frequently cited diseases. ―Polio‖ (disability) is associated with a lack of access to health care.

35

Polio has been eradicated in Bangladesh since 1990, Here participants meant physical malformation or handicap.

Bangladesh? Children who do not use the latrines in the slums but defecate on the bamboo

pataton36 _{(Figure 4-3 in Chapter 4) path [outside the latrines] are assumed to be}

suffering from diarrhoea which is an indication of being malnourished. Participants explain that a child who suffers from diarrhoea, will lose weight quickly and will become weak because he cannot eat properly and the food eaten will ‗go through

its body too quickly‟. Alternatively, participants report that a child could have

diarrhoea because he/she defecates outside the latrines, an indication of not having proper hygiene practices. Participants identify flooding as a cause of diarrhoea because of the polluted water used for bathing and drinking. Scabies and pneumonia are noted as being especially common in the slums during the rainy season. As one participant mentioned for scabies, „this is during flooding…the child

is malnourished, he has scabies (khajli hoy)… and cannot have proper bath‟. Finally

respondents identify a child to be malnourished because he/she has worms. They explain this is because he/she eats too many misti (sweet), eats with dirty hands and walks bare foot. ‗His stomach becomes big and he suffers from stomach

ache…he needs to go often to toilets…if it‟s not treated, he will become skinny

(sukna hobe)‘.