Published in IIPS Mumbai, ENVIS center, Volume 2, No. 1-2, March 2005

 

Water and Child morbidity in Indian states

By C.P.Prakasam1 & Sharad Narveker2

Water:

Water considered as liquid gold available in abundant in nature. Water is primarily derived from “water cycle” initiation from the evaporation of ocean, forming clouds, and as soon as the cooling effect is produced by lower temperature, returns to the earth as snow, dew or hail. Thus, condensed water from the air is the primary source of natural water supply and returns to ocean through rivers.

 

Water is regarded as man’s best friend in the physical environment. It is required for life process, for the proper functioning of the organs. Beyond its importance for human consumption, it is required for domestic purposes such as cooking, washing and bathing and for many other services (see box

1: Water services).

 

Providing safe drinking water for human consumption is an important public health concern. World wide, the lack of clean water for drinking, cooking and washing, and the lack of sanitary waste disposal are the cause for over 12 million deaths a year. About 1.2 billion people are at risk because they lack access to safe fresh water. According to Indian standard code of water supply drainage and sanitation committee, 30 gallons per capita per day for residence is required and provided with water carriage system of sanitation. Even though Public Health and sanitation department takes proper measures in providing safe drinking water, still water pollution causes major health problems in the community. A promiscuous discharge of domestic and industrial wastes (to the water) causes water pollution. As a result available water asset deteriorates in physical, biological and bacteriological characteristics. Further due to rapid industrialization and urbanization have created serious water pollution problems not only along the major rivers but also small streams and lakes in the country. The community waste in the form of sewage and silage contain putrescible organic matter and pathogenic organisms, which causes Diarrhoea and other diseases (see box 2:Waterborne diseases). In this paper an investigation is made to find out the distribution of the water borne disease (Diarrhoea) in Ten selected States in India from NFHS-2 data and the determinants for Diarrhoeal morbidity among children in two states viz: Orissa and Madhya Pradesh where prevalence of Diarrhoeal morbidity was high among children.

 

Diarrhoea (water borne disease):

Diarrhoea caused by bacteria (Ecoli, Shigella, Cholera, Samonella, Campylobactor, Yersinia, Cereus), and by Protoza (Amoeaba, Giardia, Parasites like Trichuris, Strongyloides) affects all age groups and both sexes. But child population under five years suffers from an average 12 attacks of Diarrhoea before reaching age five than other age groups. Child with Diarrhoea remains sick and looses one percent of the body weight, leading to death with dehydration. Rota viral infection is common in children between 6 months to 2 years. Most of the outbreak is below 5 years. Diarrhoeal diseases occur due to poor environmental hygiene of water and food (see box 3).

 

Water based disease transmission by drinking contaminated water is responsible for significant out breaks of faeco-oral diseases such as cholera and typhoid and Diarrhoea, viral hepatitis-A, cholera, dysentery and dracunculiasis (see Fig: 1 Diseases due to Poor Water, Sanitation & Hygiene).

 

 

1. Professor, Department of Public Health & Mortality,

2.Medical Consultant, International Institute for Population Sciences, Deonar, Mumbai-400 088 POPULATION ENVIS CENTRE 2 Vol.2, No.1-2, March,2005, IIPS, Deonar-400


 

 

 

 

 

 

 

Determinants of Diarrhoea:

 

National Family Health Survey (IIPS: NFHS-2 1998-1999) collected data on children suffering from Diarrhoea in past two weeks from the survey time period. Information from NFHS-2 has been collected on percent children suffering from Diarrhoea (any) and Diarrhoea with blood. Mothers of children born during the three years preceding the survey (NFHS-2) were asked if their children suffered from Diarrhoea during the past two weeks and cross-classified by age of the child, Standard living Index (SLI), Source of Drinking water, and disinfection of water for the selected states. For the present study ten major states were selected viz: Andhra Pradesh, Bihar, Gujarat, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Orissa, Rajasthan and Tamil Nadu (see Table 1).

 

Diarrhoea is the second most important killer of children under five, more especially in the age group 6 months to one year. Deaths due to acute Diarrhoea are most often caused by dehydration due to loss of water and electrolytes. In this study the major determinants of Diarrhoea are age of the child, standard living index, source of drinking water, method of purification of water at household level has been analyzed of the selected states. Information about morbidity of the child (less than 36 months old) has been collected on “Self reporting” method by the mother/household. The reported information has its own limitations and with added advantages. To find out the contributory factors influencing Diarrhoeal morbidity among children, Logit regression analysis has been used to the NFHS-2 data for the selected states: Orissa and Madhya Pradesh

 

• Age of the Child:

As discussed earlier Diarrhoeal morbidity found to be more among children and among them of age less than one year of age. Hence, percent of children suffering from Diarrhoea of 1-5 months, 6-11 months, 12-23 months and 24-35 months for the selected states has been listed in Table 1. Results show that large percentage of children in the age 6-11 months found to have Diarrhoea that other group. Around 36 percent children in the age group 6-11 months suffer from Diarrhoea (any) in Madhya Pradesh followed by 34.9 percent in Orissa, 30 percent in Maharashtra, 29 percent in Gujarat, 26 percent in Rajasthan and less than 25 percent in Tamil Nadu, Andhra Pradesh, Bihar. Diarrhoeal morbidity found to be least in Karnataka followed by Kerala in the age group 611 months of the child (Table 1).

 

Diarrhoeal morbidity with blood found to be more in Orissa (5.9), Madhya Pradesh (5.7),Followed by Rajasthan (4.7) and Bihar (3.4) in the age group 12-23 months of the child. Percent Children with Diarrhoeal morbidity with blood found to be much less (less than 1.5 percent) in Gujarat, Kerala and Karnataka (Table 1).

 

• Standard Living Index (SLI):

Standard living Index (SLI) calculated on the basis of 11 indicators viz: House type, Toilet facilities, Source of lighting, Main fuel for cooking, source of drinking water, separate room for cooking, ownership of house, ownership of agricultural land, ownership of irrigated land, ownership of livestock, ownership of durable goods. Composite index score range from 0-14 for a low SLI to 15-24 for a medium SLI and 25-67 for a high SLI (NFHS-2), which gives level of living, and it has a bearing on the health of the child. SLI clearly shows the different strata of standards of living in the society. Percentage of Diarrhoeal morbidity according to SLI is given in Table 1. High percent suffer from Diarrhoea (any) in Orissa (30.4) with Low SLI followed by Maharashtra (26.8), Rajasthan (23.2), Gujarat (22.1) and other states showed less than 20 percent. Similarly it has been observed that Diarrhoeal morbidity with blood found to be reported more in Low SLI households in Madhya Pradesh (5.5) Orissa (5.4) followed by Rajasthan (4.8). Kerala and Karnataka stand low in Diarrhoeal morbidity with blood (Table 1).

 

• Source of Drinking Water:

Source of drinking water is the major contributory factor for Diarrhoeal morbidity. Hence percent children suffer from Diarrhoea whose source of drinking water was “piped water” followed by Madhya Pradesh (28.3) and Rajasthan (20.6). It has been observed that percent children with Diarrhoea (any) and with blood found to be more in Orissa, Madhya Pradesh followed by Maharashtra with all sources of water (Piped water, Hand Pump and Well water). This clearly indicates that the water is not potable water in these states.

 

 

 

 

 

 

 

Table: 1:Percent of children suffering with Diarrhoea (any) and with blood in selected Indian states: NFHS-2 data

 

Andhra

Bihar

Gujarat

Karnataka

Kerala

Madhya

Maharashtra

 Orissa

 

 

Rajasthan

 

Tamil

 

Pradesh

 

 

 

 

Pradesh

 

 

 

 

 

 

Nadu

Determinants

Any

With

Any

 With

Any

 With

Any

 With

Any

 With

Any

 With

Any

 With

Any

 

 With

 

Any

 With

 

Any

 With

 

 

Blood

 

Blood

 

Bloo

 

Blood

 

Blood

 

Blood

 

Blood

 

 

Blood

 

 

Blood

 

 

Bloo

 

 

 

 

 

 

d

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d

Age of the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

child

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1-5 months

12.5

0.6

14.0

0.8

20.2

1.4

12.5

0.0

6.4

1.1

17.4

2.1

27.4

1.1

20.8

 

0.0

 

16.3

0.8

 

8.6

0.7

6-11 months

23.5

1.2

23.7

4.0

29.1

1.4

18.1

0.9

12.6

0.0

36.0

4.2

30.1

1.4

34.9

 

5.3

 

26.2

3.7

 

24.3

3.6

12-23months

16.2

1.9

20.8

3.4

21.2

1.3

15.4

0.7

16.2

1.2

25.6

5.7

27.4

2.1

34.0

 

5.9

 

22.6

4.7

 

14.8

1.7

24-35 months

10.2

1.7

14.1

3.2

13.5

1.2

10.4

1.0

  8.5

1.0

17.5

4.1

19.5

1.7

21.5

 

4.5

 

16.3

3.5

 

11.0

1.2

SLI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Low

17.5

2.5

18.3

3.0

22.1

2.2

14.7

1.2

11.1

1.2

21.8

5.5

26.8

1.7

30.4

 

5.4

 

23.2

4.8

 

16.9

2.0

Medium

14.5

1.0

17.9

2.9

21.5

1.0

15.0

0.4

12.3

1.0

24.7

3.8

25.8

1.8

25.8

 

4.1

 

19.2

3.5

 

13.5

1.8

High

11.5

0.6

12.4

2.2

13.6

1.0

9.5

0.9

10.5

0.5

23.1

3.1

21.6

1.1

23.3

 

0.5

 

17.3

1.5

 

10.4

0.6

Source of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Drinking

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

water

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Piped water

14.2

1.3

13.4

1.7

18.2

1.4

14.5

0.6

15.3

1.5

28.3

4.5

26.8

1.5

29.5

 

0.0

 

20.6

2.8

 

14.9

1.8

Hand Pump

14.4

1.4

18.0

3.1

26.1

1.9

13.3

0.8

-

-

22.3

4.6

21.1

1.7

27.2

 

5.8

 

17.6

4.0

 

10.9

0.8

Well water

17.1

2.3

18.7

2.8

17.9

0.7

9.9

1.5

11.0

0.8

20.7

3.3

24.4

2.5

28.9

 

3.4

 

19.0

3.1

 

16.4

2.4

Other*

-

-

-

-

10.7

0.0

-

-

-

-

29.7

10.5

-

-

30.5

 

3.9

 

30.9

9.3

 

15.0

3.1

Purification

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of water

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Staining by

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

cloths

15.5

1.2

23.0

5.5

19.3

1.3

17.0

0.0

-

-

24.7

3.5

20.9

1.9

32.9

 

-

 

21.6

3.8

 

20.3

0.0

Alum

-

-

14.0

2.3

-

-

-

-

11.2

1.3

28.7

2.3

26.0

-

-

 

5.6

 

-

-

 

-

-

Water filter

12.8

0.0

6.2

0.0

-

-

-

1.0

17.5

0.0

7.7

0.0

16.1

1.9

16.0

 

0.0

 

-

-

 

18.0

1.1

Boiling

13.3

0.0

25.3

8.0

15.7

3.5

16.1

1.0

8.4

0.9

24.3

1.7

26.4

0.3

23.2

 

3.5

 

-

-

 

15.9

1.4

Electronic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Purifier

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

 

-

 

-

-

 

-

-

Nothing

15.6

1.9

17.6

2.8

23.8

1.7

14.6

0.9

13.3

0.8

22.8

5.0

-

-

-

 

-

 

-

-

 

-

-

Other

-

-

-

-

-

-

13.1

-

-

-

23.9

3.7

26.4

1.5

28.0

 

4.6

 

18.6

3.2

 

13.4

2.1

Total

15.0

1.5

17.7

2.9

19.7

1.3

13.9

0.7

11.6

0.9

23.4

4.3

25.4

1.7

28.1

 

4.5

 

19.8

3.4

 

14.4

1.7

* Surface water, Ground water

 

 

 

 

 

 

 

 
 

 

•     Purification of water

Many studies have suggested that boiling the water would kill the bacteria and boiled water is suitable for drinking. It has been observed that Diarrhoeal morbidity is found to be more among the children from Madhya Pradesh, Maharashtra, and Orissa state compared to other states in this study (Table 1). Availability of water in these states may have other mineral contents, which would contaminate water.  Therefore Necessary public health measures should be taken to purify the water.

 

•     Contributory factors determining Diarrhoea: To know the contributory factors determining Diarrhoeal morbidity among children less than 36 months, Logit regression has been applied. Among the ten states listed in Table 1, Orissa and Madhya Pradesh found to have high Diarrhoeal morbidity. Hence the determinants in these two states have been analyzed. The list of variables considered for Logit analysis were: Background variables: Mother’s Literacy, Age of the child, SLI; Intermediate variables: Source of Drinking water, Purification of water and with dependent variable: Child with Diarrhoea (any). All these variables have been measured in terms of yes/no or low/medium/ high (Table 2). The odds (Expected β) for the state Orissa and Madhya Pradesh has been given in Table 3.

 

Logit regression analysis shows that the risk of Diarrhoeal morbidity among children found to be more with “No pipe water”, “not purifying water” in Orissa and Madhya Pradesh. From the Logit analysis it was evident that water supplied through pipe (assuming Municipal water supply) and purified at home will reduce Diarrhoeal morbidity among children.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 2: List of Variable selected for analysis to determine the influence on Diarrhoeal morbidity in Orissa and Madhya Pradesh state: NFHS-2.

Determants

Code

Frequency and Percentage

 

 

 

Orissa

Madhya Pradesh

 

Age of the child

Less than one year

0

462 (33.7)

  940 (35.9)

 

More than one year

1

907 (66.3)

1677 (64.1)

 

SLI

Low

0

747 (54.6)

  932 (35.6)

 

Medium

1

483 (35.3)

1264 (48.3)

 

High

2

139 (10.1)

  421 (16.1)

 

Source of Drinking Water

Piped water

1

 140 (10.2)

  904 (34.5)

 

Not piped water (other)

0

1229 (89.8)

1713 (65.5)

 

Purification of water

No: Purification

0

1080 (78.9)

1940 (74.1)

 

Yes: Purification

1

  289 (21.1)

  677 (25.9)

 

Mother’s literacy

Illiterate

0

766 (56.0)

1777 (67.9)

 

Literate < middle

1

342 (25.0)

 442 (16.9)

 

Middle +

2

261 (19.0)

 398 (15.2)

 

Dependent Variable Diarrhoea (any)

No

0

987 (72.1)

1971 (75.3)

 

Yes

1

382 (27.9)

  595 (22.7)

 

 

 

 

 

 

 

Table. 3: Logit regression analysis of the Environmental factors influencing Diarrhoea morbidity in Orissa and Madhya Pradesh NFHS-2 data

Determinants

Orissa

Madhya

 

 

 

 

 Pradesh

 

 

 

Exp

SE

Exp

SE

 

 

(β)

 

(β)

 

 

Age of the Child

 

≤ 1 year (ref)

1.000

 

1.000

 

 

> 1 year

1.018

0.12 8

1.258

0.096

 

SLI

 

 

 

 

 

Low (ref)

1.000

 

1.000

 

 

Medium

1.111

0.27 1

1.091

0.168

 

High

0.981

0.25 5

1.249

0.151

 

Source of Drinking Water

 

No Piped water (ref)

1.000

 

1.000

 

 

Piped Water

0.766

0.21 2

0.717*

0.114

 

Purification of water

 

No: Purification

1.000

 

1.000

 

 

Yes: Purification

0.921

0.16 1

0.954

0.100

 

Mother’s Literacy

 

Illiterate

1.000

 

1.000

 

 

Literate < middle

1.648 *

0.21 5

0.956

0.155

 

Middle +

1.864* *

0.21 2

1.051

0.171

 

Constant

0.317

 

0.325

 

 

-2 log likelihood

1608.3

 

2759.9

 

 

 

00

 

54

 

 

100 * R Square

13

 

11

 

 

 

 

 

 

 

 

 *P<.05 **P<.01

 

• Conclusions:

 

NFHS-2 data analysis is based on the information given by mother of children born during the three years preceding the survey and were asked questions whether their children suffered from Diarrhoea during the past two weeks. Analysis based on self-reporting information should be crosschecked by the clinical examination is another dimension of research topic. In this study analysis bring out information that children under one year and water supplied through pipe and purified at home will reduce Diarrhoeal morbidity.

 

Reference:

1.IIPS and ORC Marco (1998-1999): National Family Health Survey-2 , Andhra Pradesh, Bihar, Gujarat, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Orissa, Rajasthan and Tamil Nadu.