Table 2 Convergent, mixed and divergent explanatory perspectives on key risk factors for childhood illnesses
Themes | Perceived Risk Factors | Explanations | ||
|---|---|---|---|---|
Community | Community Health Worker | Facility Staff | ||
Convergent | Seasonality | Specific seasonal health problems e.g. diarrhea in monsoon season and pneumonia in winter; fever, cold and cough attributed to seasonal changes. | ||
Lack of attentiveness | Prolonged absence of mother from home; families with many children results in compromised care of infants thus contributing to infections. | |||
Social - Occupational factors | There are some occupations which are specific to certain caste, religion or geographical locality e.g. piggery, poultry, butchery, working in brick kilns. These occupations make families including their children prone to various adverse health conditions. | |||
Mixed | Gender | Girls are stronger by birth and nature hence they fall sick less often. | Girls are stronger than boys but both fall sick equally. Negligence of girl children in the community affect their care. | Negligence of girl children in the community might affect their care. |
Hygiene | Toddlers require close supervision and are more exposed to dirt and mud. | Household level lack of hygienic practices affect the child’s health. | ||
Health of the mother | Mother’s poor health might lead to certain problems in child care but does not necessarily directly cause illness. | Mother’s health during pregnancy and her routines until the baby is breastfeeding determine the child’s health. | Mother’s health problems during pregnancy, e.g. anemia, genetic conditions determine the child’s health. | |
Physical and biological factors of child | Health conditions: Weak (kamjor) children tend to fall sick frequently. Frequent episodes of illness in a child increases the risk of vulnerability. | Health factors: Newborn, birth weight, gestational age at birth and immunization status make children sick. | CHW viewpoint plus hereditary and congenital diseases as risk factors. | |
Environment | Pollution, increased practices of food adulterations, use of chemicals in crops, etc. Improved clean water supply but occasional contamination by sewage makes it unfit for drinking. | Lack of safe and clean drinking water in the community; tendency to use untreated water. | ||
Divergent | Nutritional | Giving thick milk to a baby affects digestion; a child who eats frequently defecates for the whole day. | Complimentary feeding is either initiated early in poor families or later in well-off families. Both these factors make the child at increased risk of malnutrition (kuposhan). | Community practices encouraged by media advertisements like initiation of powdered milk, giving diluted milk and using packaged food/ juices lead to an inadequately nourished child (kuposhit). |
Financial status and literacy | Households with low education often have low resources which can lead to delayed or poor quality care seeking. | Households with low education are difficult to counsel and they are hesitant to accept improved health practices. | Households with financial constraints cannot afford timely and quality care seeking. | |
Location of habitation | Lack of accessibility in terms of distance from health facilities as well as poor transportation conditions, e.g. bad roads, discourage people from prompt care seeking. | Villages that are generally densely populated and are prone to water logging and flood are often predisposed to unhygienic conditions thus leading to outbreaks of many health problems. | The hard to reach geographical areas and poor housing conditions aggravate the risk of falling sick. | |