Child development in India

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Every parent wants their children to grow up healthy. Mother and Child - New Delhi - India (12770541934).jpg
Every parent wants their children to grow up healthy.

Child development in India is the Indian experience of biological, psychological, and emotional changes which children experience as they grow into adults. Child development has a significant influence on personal health and, at a national level, the health of people in India.

Contents

Children constitute a significant part of the national disease burden of India. [1] Environmental health problems such as Pollution-related diseases, challenges with a water supply, and sanitation in India are difficult to fix and greatly affect children. [1] Many children in India miss vaccination and consequently acquire infectious diseases that vaccines could have prevented.

40% of children in India experience malnutrition or stunted growth due to lack of access to healthy meals. [2] India has a success story in the Midday Meal Scheme, which feeds 100 million children daily.

Early childhood development

Early childhood is the period up to the age of six. [3] Other definitions extend ECD to age eight to account for changes that occur during a child's transition into primary level education. [4] Children can develop brain damage in the absence of healthy conditions. [5] [6]

Child development markers

Common markers used by researchers and experts in the statistical examination of childhood development include, age, income, and locality. This show marked differences in the India context.

Age

First 1000 days

The first 1000 days is a concept in child development, that recommends planning to give a child the best possible start in their first 1000 days after birth. [7] The general recommendation for babies is that they should breastfeed soon after birth to get colostrum. [7] Some factors which prevent mothers from giving colostrum to their newborns include maternal health challenges, including the risk of maternal mortality and social taboo. [7]

After a child is born, regular access to primary care from a doctor improves health outcomes. [8] Young children visiting a doctor get vaccinated. [8] Children in families that are much poor are less likely to access the care they need. [8]

Pre-adolescence

Preadolescence is the period where early childhood ends, and puberty begins. Girls at this time need education and preparedness to do menstrual hygiene management. [9] A 2020 study reported that half of the girls in India get their first information about menstruation after their first period. [9] Girls who are prepared for this have better development outcomes. [9]

Optimal child development starts before conception and is dependent on adequate nutrition for mother and child, protection from threats, provision of learning opportunities, and caregiver interactions that are stimulating, responsive, and emotionally supportive. [10] The first 1000 days are considered crucial because of the adaptability of children's brains during this period and because reversing early deficits becomes more difficult as children grow older. [11]

Optimal development in early childhood can be disrupted by various adversities concerning a child's environments and relationships with caregivers. These adversities vary in intensity and range from violence in the home, neglect, abuse, lack of opportunity for play and cognitive stimulation, and parental ill-health. [12] [13] Exposure to multiple adversities poses a cumulative detrimental burden to a child's wellbeing, especially in low- and middle-income communities. [14] [15]

In 2008, there were an estimated 158 million children under the age of six in India. Generally, these children suffered from poor nutrition and healthcare. [16] Around one in ten Indian children experience diarrhoea and almost one in six experience fever. Half of children younger than three were deprived of full immunisation. [17]

Inequalities in child health and development

Childhood development is considered a key factor in achieving the ambitious global Sustainable Development Goals. [18] 45% of Indian under-threes experience stunting, a measure of chronic malnutrition. [19]

Prevalent factors in child underdevelopment

Nutrition

A 2017 study reported that 57% of newborns in their first 1000 days in India transition on time from breastfeeding to nutritious solid food; 48% get their meals frequently enough; 33% have enough food variety for nutrition, and 21% get overall adequate meals. [20]

India's Midday Meal Scheme has been a major success for school-age children, which provides a daily hot healthy meal to 100 million children. [21] Current trends in the program are adapting the meals based on research to meet more specific nutrition needs. [21]

Since the 1970s, India has had programs to prevent vitamin A deficiency, but this problem is much less nowadays. [22] [23] Vitamin D deficiency is a challenge that the government is addressing with food fortification. [24]

Poverty

Children in poverty experience health problems which children in families with more money will not have. In general, any sort of health problem is worse for someone without immediate access to healthcare. Medical problems which have poverty as a cause include issues in oral health. [25] Kerala organized poverty reduction programs and, after that, had better children's health. [2] Various commentators have examined the Kerala model as an example of what might work elsewhere in India. [2]

Environmental health

Children in India are significantly affected by environmental health problems. [1] Challenges such as air pollution, water pollution, health effects of pesticides, and sanitation require government-level planning to fix and are challenging to address. [1]

Urbanisation in India has been increasing more quickly than many cities can develop. [26] There is a great disparity in access to healthcare within cities, depending on the money a person has. [26]

Vaccination

Of all countries, India has the highest number of deaths of children under age five. [27] Most of these deaths are from vaccine-preventable diseases. [27] If children in India got vaccines, then their health and lives would be improved. [27]

Ideally, all children would get their vaccinations on time. The BCG vaccine against tuberculosis and leprosy 31% of children get it on time, and 87% get it by age 5. [27] For DPT vaccine against diphtheria, pertussis, and tetanus, 19% get it on time and 63% by age 5. [27] For the meningococcal vaccine against meningococcal disease, 34% get it on time, and 76% get it by age 5. [27]

Children in slums more often lack vaccine protection. [28]

Other societal issues

Various difficult and social issues are related to child development in India. Poverty presents particular challenges for street children in India, [29] child workers in India, [30] and children trafficked in India. [31] Children's health matters related to gender include gender inequality in India, [32] female infanticide in India, [33] and certain aspects of child marriage in India. [34]

Regional variation

A 2012 nutrition study in Maharashtra found that household and family access to food was less of a problem, but having a variety of nutritious food was a challenge to address. [35]

A report on Haryana recommended access to cleaner-burning fuel to improve children's health through improved household aid quality. [36]

Society and culture

A 2017 study reported that India's government has policy and delivery systems that are favorable for achieving improvements in child nutrition. [37] The challenges are financing such social programs, researching to keep them on track, and urban capacity to grow programs. [37]

Private sector impact

The efforts of several privately funded organizations, including the Aga Khan Foundation, have positively impacted ECD in India. [38]

Related Research Articles

<span class="mw-page-title-main">BCG vaccine</span> Vaccine primarily used against tuberculosis

Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB). It is named after its inventors Albert Calmette and Camille Guérin. In countries where tuberculosis or leprosy is common, one dose is recommended in healthy babies as soon after birth as possible. In areas where tuberculosis is not common, only children at high risk are typically immunized, while suspected cases of tuberculosis are individually tested for and treated. Adults who do not have tuberculosis and have not been previously immunized, but are frequently exposed, may be immunized, as well. BCG also has some effectiveness against Buruli ulcer infection and other nontuberculous mycobacterial infections. Additionally, it is sometimes used as part of the treatment of bladder cancer.

<span class="mw-page-title-main">Vaccination</span> Administration of a vaccine to protect against disease

Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating the body's adaptive immunity, they help prevent sickness from an infectious disease. When a sufficiently large percentage of a population has been vaccinated, herd immunity results. Herd immunity protects those who may be immunocompromised and cannot get a vaccine because even a weakened version would harm them. The effectiveness of vaccination has been widely studied and verified. Vaccination is the most effective method of preventing infectious diseases; widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the elimination of diseases such as polio and tetanus from much of the world. However, some diseases, such as measles outbreaks in America, have seen rising cases due to relatively low vaccination rates in the 2010s – attributed, in part, to vaccine hesitancy. According to the World Health Organization, vaccination prevents 3.5–5 million deaths per year.

<span class="mw-page-title-main">Diarrhea</span> Loose or liquid bowel movements

Diarrhea, also spelled diarrhoea or diarrhœa in British English, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.

<i>Rotavirus</i> Specific genus of RNA viruses

Rotavirus is a genus of double-stranded RNA viruses in the family Reoviridae. Rotaviruses are the most common cause of diarrhoeal disease among infants and young children. Nearly every child in the world is infected with a rotavirus at least once by the age of five. Immunity develops with each infection, so subsequent infections are less severe. Adults are rarely affected. There are nine species of the genus, referred to as A, B, C, D, F, G, H, I and J. Rotavirus A, the most common species, causes more than 90% of rotavirus infections in humans.

<span class="mw-page-title-main">Malnutrition</span> Medical condition

Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues and form. Malnutrition is not receiving the correct amount of nutrition. Malnutrition is increasing in children under the age of five due to providers who cannot afford or do not have access to adequate nutrition.

<span class="mw-page-title-main">Vulimiri Ramalingaswami</span> Indian pathologist

Vulimiri Ramalingaswami was an Indian medical scientist, pathologist and medical writer. His pioneering research on nutrition got him elected to the National Academy of Sciences, Russian Academy of Medical Sciences and the Royal Society of London.

<span class="mw-page-title-main">Vaccine hesitancy</span> Reluctance or refusal to be vaccinated or have ones children vaccinated

Vaccine hesitancy is a delay in acceptance, or refusal, of vaccines despite the availability of vaccine services and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using certain vaccines but not others. The scientific consensus that vaccines are generally safe and effective is overwhelming. Vaccine hesitancy often results in disease outbreaks and deaths from vaccine-preventable diseases. Therefore, the World Health Organization characterizes vaccine hesitancy as one of the top ten global health threats.

<span class="mw-page-title-main">Global health</span> Health of populations in a global context

Global health is the health of the populations in the worldwide context; it has been defined as "the area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide". Problems that transcend national borders or have a global political and economic impact are often emphasized. Thus, global health is about worldwide health improvement, reduction of disparities, and protection against global threats that disregard national borders, including the most common causes of human death and years of life lost from a global perspective.

Enterotoxigenic Escherichia coli (ETEC) is a type of Escherichia coli and one of the leading bacterial causes of diarrhea in the developing world, as well as the most common cause of travelers' diarrhea. Insufficient data exists, but conservative estimates suggest that each year, about 157,000 deaths occur, mostly in children, from ETEC. A number of pathogenic isolates are termed ETEC, but the main hallmarks of this type of bacterium are expression of one or more enterotoxins and presence of fimbriae used for attachment to host intestinal cells. The bacterium was identified by the Bradley Sack lab in Kolkata in 1968.

<span class="mw-page-title-main">Stunted growth</span> Reduced growth rate in human development

Stunted growth, also known as stunting or linear growth failure, is defined as impaired growth and development manifested by low height-for-age. It is a primary manifestation of malnutrition and recurrent infections, such as diarrhea and helminthiasis, in early childhood and even before birth, due to malnutrition during fetal development brought on by a malnourished mother. The definition of stunting according to the World Health Organization (WHO) is for the "height-for-age" value to be less than two standard deviations of the median of WHO Child Growth Standards. Stunted growth is usually associated with poverty, unsanitary environmental conditions, maternal undernutrition, frequent illness, and/or inappropriate feeding practice and care during early years of life.

A public health intervention is any effort or policy that attempts to improve mental and physical health on a population level. Public health interventions may be run by a variety of organizations, including governmental health departments and non-governmental organizations (NGOs). Common types of interventions include screening programs, vaccination, food and water supplementation, and health promotion. Common issues that are the subject of public health interventions include obesity, drug, tobacco, and alcohol use, and the spread of infectious disease, e.g. HIV.

The Global Coalition Against Child Pneumonia exists to raise global awareness about the deadly toll of the number 1 killer of children - pneumonia. Every year 155 million children under 5 get sick and 1.6 million lose their lives to pneumonia, more than all child deaths combined from AIDS, malaria and measles. Almost all of these child deaths occur in developing countries with most concentrated in just seven - India, China, Democratic Republic of Congo, Ethiopia, Nigeria, Pakistan and Afghanistan.

<span class="mw-page-title-main">Rotaviral gastroenteritis</span> Medical condition

Rotavirus gastroenteritis is a major cause of severe diarrhoea among infants and young children globally. It is caused by rotavirus, a genus of double-stranded RNA virus in the family Reoviridae. The diarrhea tends to be watery and is frequently accompanied by fever, vomiting and abdominal pain. By the age of five, nearly every child in the world has been infected with rotavirus at least once. However, with each infection, immunity develops, and subsequent infections are less severe; adults are rarely affected. There are five species of this virus, referred to as A, B, C, D, and E. Rotavirus A, the most common, causes more than 90% of infections in humans.

<span class="mw-page-title-main">Undernutrition in children</span> Medical condition affecting children

Undernutrition in children, occurs when children do not consume enough calories, protein, or micronutrients to maintain good health. It is common globally and may result in both short and long term irreversible adverse health outcomes. Undernutrition is sometimes used synonymously with malnutrition, however, malnutrition could mean both undernutrition or overnutrition. The World Health Organization (WHO) estimates that malnutrition accounts for 54 percent of child mortality worldwide, which is about 1 million children. Another estimate, also by WHO, states that childhood underweight is the cause for about 35% of all deaths of children under the age of five worldwide.

<span class="mw-page-title-main">Non-specific effect of vaccines</span> Unintended side effects of vaccines which may be beneficial or bad

Non-specific effects of vaccines are effects which go beyond the specific protective effects against the targeted diseases. Non-specific effects can be strongly beneficial by increasing protection against non-targeted infections. This has been shown with two live attenuated vaccines, BCG vaccine and measles vaccine, through multiple randomized controlled trials. Theoretically, non-specific effects of vaccines may be detrimental, increasing overall mortality despite providing protection against the target diseases. Although observational studies suggest that diphtheria-tetanus-pertussis vaccine (DTP) may be detrimental, these studies are at high risk of bias and have failed to replicate when conducted by independent groups.

<span class="mw-page-title-main">Otto Herbert Wolff</span> German born medical scientist

Otto Herbert Wolff, was a German born medical scientist, paediatrician and was the Nuffield Professor of Child Health at Great Ormond Street Hospital. Wolff was notable for being one of the first paediatricians in Britain to set up a clinic for obese children. Later research into plasma lipids with Harold Salt pioneered the techniques of lipoprotein electrophoresis. He later conducted research into the role of lipid disturbance in childhood as a precursor of coronary artery disease and his recognition in 1960 of the rare condition of abetalipoproteinaemia. Wolff was also co-discoverer of the Edwards syndrome in abnormal chromosomes.

Mads Melbye is director of the Cancer Institute in Denmark (DCRC). He earned his M.D. degree from University of Aarhus, Denmark, in 1983, and a DMSc degree from the same university in 1988. His thesis work was partly done as a fellow in the epidemiology program (1985–1986) at the National Cancer Institute, NIH, US. After clinical training he became senior investigator in 1989 at the Danish Cancer Registry in Copenhagen, and in 1991 state epidemiologist at Statens Serum Institut (SSI) in Copenhagen. In 1992, Melbye was given a personal chair in infectious disease and cancer epidemiology by the Danish minister for research and education. He founded the Department of Epidemiology Research at SSI and to day this department is one of Europe's largest epidemiology research milieus. From 1998 to 2008 he was foreign adjunct professor at Medical Epidemiology and Biostatistics Branch at Karolinska University in Stockholm. In 2012 he established the Danish National Biobank, which is one of the biggest biobanks in the world today. Same year he became senior vice-president at Statens Serum Institut in Copenhagen and from 2016 till 2020 president and CEO. He is presently professor of medical epidemiology at University of Copenhagen and affiliated with Department of Genetics at Stanford University School of Medicine.

The first 1000 days describes the period from conception to 24 months of age in child development. This is considered a "critical period" in which sufficient nutrition and environmental factors have life-long effects on a child's overall health. While adequate nutrition can be exceptionally beneficial during this critical period, inadequate nutrition may also be detrimental to the child. This is because children establish many of their lifetime epigenetic characteristics in their first 1000 days. Medical and public health interventions early on in child development during the first 1000 days may have higher rates of success compared to those achieved outside of this period.

Joanne Katz is an epidemiologist, biostatistician, and Professor of International Health at the Johns Hopkins Bloomberg School of Public Health. She holds joint appointments in the Departments of Biostatistics, Epidemiology and Ophthalmology. Her expertise is in maternal, neonatal, and child health. She has contributed to the design, conduct and analysis of data from large community based intervention trials on nutritional and other interventions in Indonesia, Philippines, Bangladesh, Nepal and other countries.

Vaccine resistance is the evolutionary adaptation of pathogens to infect and spread through vaccinated individuals, analogous to antimicrobial resistance. It concerns both human and animal vaccines. Although the emergence of a number of vaccine resistant pathogens has been well documented, this phenomenon is nevertheless much more rare and less of a concern than antimicrobial resistance.

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  38. ↑ "Early Childhood Development in India | Aga Khan Development Network". akdn.org. Retrieved 11 June 2020.
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