UN has resolved the MDG in year 2000 in millennium development summit in New York, which the health related goal are at centre point and the main MDG at point 4 was resolved by 189 countries that by 2015 they will reduce the Child mortality by 2/3rd by taking baseline the 1990 data(1).
India was also one of 189 countries who resolved to achieve the target. India is an enormously big country in term of its size & population 2nd after China; there are different geographical conditions are prevailing in the country. The population of India in exponential phase & more than 75% population is depends on the agriculture & in spite of upward trend in the economic (from 2.5% in 2OOO to7% in O7)(2)& agricultural growth (2.5% per annum)(2) there is markedhealth inequalities present in the urban & rural India(3), in term of high IMR, majority of 2.1 million infant deaths annually(1,3) mostly in rural part.
Infant mortality rate is regarded as an important & sensitive indicator of the health status of the community. It also reflects the general standard of the living of the people and effectiveness of intervention for improving maternal & child health in the country. Compared to other indicators like crude birth rate, maternal mortality rate and under five mortality rate etc, this indicator has always been accorded greater importance by the public health specialists because infant mortality is the single largest category of mortality. Moreover, deaths during infancy are due to particular mix of diseases and conditions to which adult population is less exposed and less vulnerable. Changes in specific health intervention affect IMR more rapidly and directly and it may change more dramatically than the crude death rate in a population (4-6).
As about 50% of the infant deaths occur within neonatal period, it is imperative that specific components of ante natal, intra natal & post natal services needs to be strengthened to make an impact on IMR in high burden states of India(7,8).
Rajasthan is the biggest state of the country in term of geographical area & geographically the terrain is also difficult in the most of the part because of desert (Bikaner, Jaisalmer, Barmer etc.) & on other hand irrigated area like Hanumangarh, Sriganganagar, Kota, Bundi etc. The IMR of the state currently is 57 per 1000 live birth (7-11) but in the deserted districts & tribal area it is as high as 72 & in some districts like Hanumangarh it is 41 per 1000 live birth (7-11). In Bikaner district there was increase noticed in DLHS 2 from DLHS 1 but declined reported in DLHS 3 on the other hand in Hanumangarh district improvement reported in all successive DLHS surveys(7). The high IMR of the state is contributed to its difficult geographical conditions, high NMR, it is believed that due to sex selection (as sex ratio is advert to female) more female infanticides are practiced in the state, second big issue is early age of marriage & conception as mean age of marriage in rural girl is 17.1 in comparison to urban where mean age is 20 years, more than 52% female have 2 or more deliveries before the age of 20 to 24 in rural area, only 51 % female had at least one injection of TT during pregnancy, only 14% female has 100 IFA tablets during pregnancy in rural, only 27% female in rural area have adequate ANC checkups, 46% children received full immunization in rural, in rural nearly 60% children not receiving breast milk within one hour of delivery, 65% children are on exclusive breast feeding up to 5 month of age, only 26% children have ORS in diarrhoea in rural Rajasthan & while only 67.8% children access to treatment in acute respiratory infection.
In Rajasthan there was improvement is noticed in each health indicators but the improvement in IMR not reflecting the overall improvement. The cause of particularly high infant and child mortality in Rajasthan relative mortality in older age is unexplained. It is not clear whether they are due to certain child specific diseases or health conditions or malnutrition or whether the health care practices that exist for adults do not exist to the same extent and effectiveness for the infants and the children (7-11).
We are aware that there is historical relationship between the income and mortality during economic development can be highly variable yet it is puzzling that Bihar & MP are the two states where per capita GNP is lower than Rajasthan but still IMR is lower in these state in compare to Rajasthan (11).
Aim and objectives: Research on the infant and child death in developing & developed countries has generally concentrated on intermediate variable affecting child health through their medico physiological effect.
Socioeconomic environmental factors & level of technology have also been focus of the study. Generally a positive and significant relationship has been found, in many studies, between the total numbers of pregnancies, a woman has had, the total number of her children, the number of member of house hold and infant mortality. There are many socioeconomic variables having relationship with IMR. The manner in which these variables affects the mortality and the way they are interconnected with cultural practices, national & global policies and ideologies, however left unexplained. It has been remarked that even though they have received a great deal of research attention the socioeconomic determinants remain a black box to this day.
With the above consideration in the mind my research will be aimed at the specific problem of identifying cultural practice & conditions that may be reason for the higher than expected IMR in the state of Rajasthan. I want to study both the implication of national policies and the local cultural factors operating together to determine-
Methodology:
Sampling: I am purposing to select the two districts for primary data collection these are Bikaner & Hanumangarh. I am selecting these districts because of diversity in the socioeconomic status, cultural factors, health seeking behaviors & geography as District Bikaner is primarily deserted district & sharing international border with Pakistan while Hanumangarh is primarily a irrigated district & sharing its border with developed state of India like Haryana & Punjab.
In both districts the sample will be selected by randomization & proportionally distributed in Rural & urban area.
The primary research methodology will be to carry out in-depth interviewing & observation based research for the limited number of households. I also want to generalize the findings for the community involved and to present these numerically. Therefore I purpose to choose a combination of methods that will allow me both to have a rich personal historical insight into the micro world and daily lives of individual women and their families and also that will enable me to quantify the findings. For the study period I am selecting year 2008 data. I am aware of the difficulties and the mistakes involved in the capturing accurate information by the one year time period questions.
In order to gain insight into cultural issues along with precise and comparable data for the all families I will take the subsample of all originally selected households with the help of one in four samples. Before making the systemic selection I will enrich the selection in favor of families with recent infant mortality. The purpose is to be sure to have enough representation of mortality as well as survival to be able to study variation. As infant mortality is also indicative of other problems of early childhood the subsequent in depth interview questionnaire will not be limited to questions about infancy alone, but detailed questions will be asked about all children born and their survival or death early in life.
To explore the relevance of the cultural factors detail information will be collected during in depth interviewing from all selected households. Further different variables will be identifying from collected the data & through multiple regression analysis I will try to find most influential factors affecting infant mortality.
primary data for the year 2008 of infant mortality from record of Health institutes, ICDS department report from districts of Bikaner & Hanumangarh in Rajasthan & during field visit in selected area try to find out unreported infant deaths followed by interviewing (on prepared questionnaire) the health officials, selected health workers, selected PHC doctors & families (during field visit) followed by analysis of collected data & available data to know the various reasons associated with IMR & to know the hurdles in the reduction of IMR.
Ethical considerations: Before conducting the interview with the family the purpose of the study & its usefulness will be explained to the family & after obtaining consent only interview will takes place. An application has already given for ethical approval from ethical committee of Sardar Patel medical college Bikaner for using the hospital data.
Timetable:
References:
