Early child health in Lahore, Pakistan: IV. Child care practices

Abstract

Child care practices and hygiene measures were studied at 6 months of age in a longitudinally followed cohort of 1476 infants born between September 1984 to March 1987 in four socio-economically different areas in and around Lahore, Pakistan. Although, 76-98% of the mothers looked after their infants during health and 96-98% during a diarrhoeal illness, child care practices and hygiene measures differed significantly between the four areas. During a diarrhoeal episode, the mothers from the upper middle class took timely medical help, fed ample food and Oral Rehydration Salts (ORS) to the sick infants and provided uncontaminated food to them in clean surroundings. The mothers from the village and the periurban slum took their sick child, mostly after the second day of illness, to a doctor, but preferred home remedies. Fourteen percent of the mothers in the village and 6% in the periurban slum did not seek any medical help at all. One-third of the families, from these two areas, fed food to children 12 hours after cooking; the surroundings of the child were dirty with large numbers of flies present throughout the year, though the food was commonly kept covered with a lid. We constructed a simple measure of the surroundings of the child, rated as dirty, medium or clean; it was found to be associated to both parental illiteracy and child growth, but not with housing standard. The main conclusion is that any attempt to improve child-care practices and the hygienic environment for the child, should focus on maternal literacy and simple health messages.

Flies and water as reservoirs for bacterial enteropathogens in urban and rural areas in and around Lahore, Pakistan

“…Salmonella (5-3%) and campylobacter (26%) were also present. Incidence of diarrhoea in the UM class was reported to be less in Lahore [15], which could probably be associated with specific hygiene measures and child care practices of this class [17]. It appeared to be in agreement with the studies on specific behaviours such as water handling, food handling, hand washing and the importance of their role in promoting the transmission of enteric pathogens [1,28].…”

“…Indiscriminate disposal of human and animal exereta in open spaces was observed in all the three areas of our study [17]. Toilets were non-existent in the village and periurban slum.…”

“…It was observed that large numbers of flies are present throughout the year in all areas of our study, though more in the village and the periurban slum. In cooler months like January and February, the density of flies is comparatively less [17]. In the few studies available, it has been elucidated that the housefly acts as a mechanical vector, transmitting enteropathogens, thus causing diarrhoeal disease [8,12,24].…”

“…A prospectively followed population representing four levels of urbanization [14] was selected; a village, situated in the suburbs of Lahore, about 40 km from the centre of the city, a periurban slum, a mud hut area situated at the periphery of the main city, an urban slum area which is located in the centre of the city, and an upper middle class (UM class) area, scattered around the centre of Lahore. The socio-economic characteristics, level of education and standard of living of the four areas are shown in Table 1 and have been described in detail elsewhere [14,16,17].…”

Irrigation water as a source of drinking water: is safe use possible?

“…Diarrhoea was defined as a 24‐h period with three or more non‐bloody loose stools or one or more bloody loose stool. Whenever possible the wife of the head of household was interviewed because most of the diarrhoea episodes were expected among children and in Pakistan the mothers are always the caregivers when the child is ill ( Zaman et al . 1993 ).…”