COORDENADAS INTERNAS

Lastly, susceptibility to infections in the early stages of life for under-five children must be emphasized. Interaction between age and number of children under five suggests that younger children up to two years were at greater risk of contracting infections leading to fever than children aged three to four. Overall, as seen in Figure 6.13, the risk for all children in the three age groups drops significantly for children in households with a maximum of three or more under-five children suggesting again that the drop in the susceptibility of infections was associated with the older of the three or more children under the age of five. Children in households with three or more under-five children were perhaps living in households which maintained an environment and lifestyle more conducive to child health and their survival.

Within the category of households with only one child below the age of five, children aged one or two years were at greater risk (5.94) of contracting fever than those aged three or four years followed by children aged 0-1 year, the risk factor for whom was considerable at 5.04. These children most probably belonged to younger mothers whose inexperience and low level of knowledge about childhood illnesses led to their children s greater susceptibility to infections. Also, these children, as discussed earlier, being the most vulnerable group were generally more likely to contract respiratory infections due to winter during which the information on morbidity was collected.

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Figure 6.13 Risk of respiratory infection by age of child and number of under-5 children

Child's age

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Number of undcr-5 children

Source: Child Health Survey, Rawalpindi, 1992.

Within the category of two children below the age of five, children aged 0 to 1 year were at the greatest risk (3.15) of contracting fever. The risk drops to an equal ratio of about 1.50 for children of ages two and 3-4 years compared with children in the reference category. Likewise, in households with at least three children below the age of five, older children of ages 3-4 years were at the lowest risk, with the odds of about 0.98. Lower risk of contracting infection for children in households with three or more children was associated with older children who had survived the earlier vulnerable period during which the child is most susceptible to specific childhood illnesses and being less stronger is susceptible to infections in general.

6.7. Summary

In the four weeks preceding the survey, 27 per cent of the children below the age of five had contracted diarrhoea and 45 per cent had an incident of fever. Out of these, 65 per cent of the children who had fever also suffered from diarrhoea during the same period of four weeks of observation. The main effects for both diarrhoea and fever reflect the synergy of infections. Children who suffered from a gastro-intestinal ailment were more likely to suffer from fever. Likewise, children having suffered from fever during the same period of four weeks were at the greatest risk of contracting diarrhoea.

Children who had ever suffered from an immunizable or a serious illness, like measles or pneumonia, were at a greater risk of contracting both diarrhoea and fever than children who suffered from non-fatal ordinary, seasonal or common ailments, such as diarrhoea, fever or other minor illnesses. The results suggest that these children were perhaps those with a weak immune system who suffered from malnutrition and as a consequence were easily susceptible to various infections resulting in frequent illness. The probability of contracting an illness, either diarrhoea or fever, was largely dependent on the age of the child. Children aged one year or less were at a greater risk of contracting both gastrointestinal or respiratory infections than older children below the age of five years.

The type of toilet facility in the household was statistically significantly associated with both the incidence of diarrhoea and fever in the univariate models. In the multivariate analysis, however, its significant effect was obtained for the incidence of diarrhoeal infections only. The effects demonstrate that children living in households with a toilet without a flush tank attached to it were more likely to contract diarrhoea than children living in households with a flush attached to the toilet. Although both types of toilets were attached to the sewerage system, the differential by the type of toilet emerged more as a result of the proper drainage of the waste, the frequency with which it was used and cleaned and generally maintaining a hygienically clean environment. Further, the results revealed that regardless of the type of toilet, children born to educated mothers, as well as older mothers aged 30 to 39 years, were less likely to contract the infection than children belonging to illiterate and younger mothers.

The other important covariates of morbidity, namely, the total number of under-five children, the number of children dead in the household, possession of a television, religion and the sex of the child were statistically significantly associated with the incidence of fever only. Children living in households with three or more children under the age of five were less likely to contract fever than children in households with one child below the specified age. The results indicate that children in households with three or more children under five were the older ones and were at a lower risk of contracting infections. Also, households with only one child below the age of five were those where the other children may have died and the greater probability of contracting fever amongst the living was the result of exposure to similar household environment and maternal child caring and rearing abilities which resulted in the death of the other children.

The higher odds of getting fever was significantly associated with the number of children dead in the household. The main effects revealed that children living in households where there had been a previous death, ranging from one to six, were at a greater risk of contracting a respiratory infection than children in households where all children ever born had survived. The effects indicate familial differences in child morbidity and highlight the importance of both disease and death clustering.

The possession of a television had a positive effect on the health of the child. Children living in households with a television were at a considerably lower risk of falling ill than children belonging to households without a television set. The lower probability of contracting infection was attributed to the m other’s enhanced ability to care for the child as a result of the propagation of health information regularly broadcast on television. The odds of getting fever amongst children born in Christian families was lower than for children living in Muslim families. The factors contributing to the better health of the Christian children were considered to be associated with the greater mobility outside the home which added to the mothers’ knowledge and general awareness and enabled them to make greater use of various health and other resources.

There was no difference in the death risk ratios by the sex of the child nor was the sex differential apparent by the incidence of diarrhoea. However, the effects of the multiple classification for the incidence of fever show marked differences for the male and female children under observation. In line with the biological disadvantages associated with the higher risks of death for male children, male children were at a greater risk than female children of contracting infections leading to fever. The results point to a non-discriminatory attitude of the mothers in terms of child caring and rearing.

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