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Year : 2005  |  Volume : 30  |  Issue : 3  |  Page : 78-80

Social Audits for Community Action: A tool to Initiate Community Action for Reducing Child Mortality

Department of Social & Preventive Medicine, S.N. Medical College, Agra-282 002., India

Date of Web Publication7-Aug-2009

Correspondence Address:
D Nandan
Department of Social & Preventive Medicine, S.N. Medical College, Agra-282 002.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-0218.42853

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Research question : (i) What is the community's perception (assessment & analysis) of causes underlying neonatal, infant and under five deaths? (ii) What action does the community take thereafter? Objectives : To stimulate the community to assess and analyze the causes and underlying social delays responsible for neonatal, infant and under five deaths in their villages and subsequently take collective action to prevent these deaths in future using Social Audits for Community Action (SACA). Design : Retrospective Participatory study. Setting : Rural community development blocks, district Agra, Uttar Pradesh. Material and Methods : SACA were conducted in a total of 152 villages of Fathehpur Sikri and Bichpuri blocks of district Agra, U.P. One SACA was conducted in each of the 211 anganwadi catchment areas, wherein 10-15 women from different socio­clusters of the community participated in a participatory discussion on issues pertaining to number of births and deaths of children less than five years of age in the last one-year. Results : 7656 live births and 749 under-five deaths were reported during the year 2002. The neonatal, infant and under-five mortality rate was 39.4, 73.5 and 85 per 1,000 live births respectively. Hypothermia, pneumonia, birth asphyxia, prematurity and low birth weight emerged as major causes of neonatal deaths. Majority of deaths of infants and children 1-5 years of age were found to have occurred due to severe malnutrition and diarrhoea. The community realized that majority of deaths occurred because of the delay in recognition of the seriousness of problem, delay in taking decision to seek appropriate care and delay in arranging transport/money. Subsequently, behaviour change communication strategies were re-defined to help community assess signs of illness and take preparedness measures to prevent child deaths in future. Conclusion : Strategies like dialoguing with the community using social audits for community action is a more useful and cost effective approach for initiating behaviour change at community level.

Keywords: Social Audits, Social Delays, and Child Mortality

How to cite this article:
Nandan D, Misra S K, Jain M, Singh D, Verma M, Sethi V. Social Audits for Community Action: A tool to Initiate Community Action for Reducing Child Mortality. Indian J Community Med 2005;30:78-80

How to cite this URL:
Nandan D, Misra S K, Jain M, Singh D, Verma M, Sethi V. Social Audits for Community Action: A tool to Initiate Community Action for Reducing Child Mortality. Indian J Community Med [serial online] 2005 [cited 2020 Nov 24];30:78-80. Available from: https://www.ijcm.org.in/text.asp?2005/30/3/78/42853

   Introduction Top

The neonatal, infant and under five mortality rates in Uttar Pradesh (rural) are as high as 56.6, 91.7 and 129.5 per 1,000 live births [1] . Although studies have reported medical causes underlying deaths of children less than five years of age, growing body of evidence suggests that social causes/delays influence the multi-causality under-five death spectrum [2] . These social delays include : (i) delay in recognition of seriousness of the problem; (ii) delay in taking decision to seek appropriate care; (iii) delay in arranging transport/money to reach the nearest health facility and (iv) delay in receiving appropriate care at health facility. Hence, for effectively addressing child mortality through appropriate Behaviour Change Communication strategies, medical and social causes need to be viewed and addressed together.

It has been repeatedly demonstrated that communities can make deep and lasting contributions to their own health and well-being and, through example and imitation, to the health and well being of other communities. Thus, if the community is stimulated to participate in group dialogue & action to assess the social and medical causes of deaths they would possibly by group effort, think to devise simpler strategies to prevent them and take action as well to increase control over and to improve their health [3] . Social Audits for Community action can enable the community to achieve the foresaid objective.

   Methodology Top

Study Area : The study was conducted in all the 152 villages of two selected community development blocks viz. Bichpuri and Fatehpur Sikri of district Agra, Uttar Pradesh.

Data Collection : Initially of all the anganwadi centers of 152 villages in two selected blocks were listed and one SACA was conducted in each of the anganwadi catchment area. In each anganwadi area SACA were conducted as participatory discussions with community members. The process encompassed Triple 'A' approach (Assessment, Analysis & Action) with the following steps:

In the first step, for Assessment, the group was asked to recall the total number of childbirths in their respective socio­cultural clusters in the last one year.

The second step, involved Analysis of the causes of deaths by the community members. The community group reported in 'local terminology' the causes of death and the symptoms & signs of illness during the illness and at the time of child death, which were recorded in 'verbatim'. This was followed by interpretations of the social delays (i.e. recognition of the problem, taking decision to seek advice, arranging transport/ money, or receiving appropriate care at a health facility) by community members lying behind each of these deaths.

In the third step during each SACA (in all anganwadi areas) discussions related to action that needs to be taken for preventing these deaths were also done. Herein participants were asked regarding the preventive measures that could have been taken at family and community level for preventing child's death.

Data Analysis : Verbatim responses of the community members noted down at the time of SACA were free and analyzed by the investigators. On the basis of signs and symptoms revealed by the community, medical causes were interpreted by medical staff of Department of S.P.M., S.N. Medical College, Agra.

   Results and Discussion Top

One Social Audit for Community Action was conducted in all 211 anganwadi centers of 152 villages (including hamlets) of the two selected community development blocks. In all a total of 7656 live births and 749 under-five deaths were revealed in the period between April' 2001 to March' 2002. Of the total deaths, 40.2%, 34.8% and 24.8% deaths were found to be neonatal, infant (1-<12 months) and childhood (1-5 years of age), respectively. NFHS-II data also suggests that neonatal deaths contribute to 46% of all infant deaths [1] . Community-­based studies also report conjectural findings [3],[4] . In the present study, neonatal, infant and under-five mortality rates were revealed as 39.4, 73.5 and 85 per 1,000 live births respectively.

The cause of neonatal, infant and under five deaths as revealed through verbatim responses are delineated in [Table 1],[Table 2],[Table 3]. These are discussed below :

I. Medical Causes :

a) Neonatal Mortality :
In the present study, low birth weight (17.6%), prematurity (16%), birth asphyxia (13.5%), hypothermia (12.6%) and pneumonia (12.6%) emerged as chief medical causes of neonatal deaths [Table 1]. Earlier community based studies have reported sepsis (52%), birth asphyxia (20%) and prematurity (15%) as primary causes of neonatal mortality in rural Indian homes [4],[5] . In the present study, hypothermia contributed to 12.6% of neonatal deaths. These findings are conjectural to the community-based studies by Bang et al (Maharashtra) and Kumar et al (Ambala) who reported significant hypothermia (<95 O F) in 17% and 19% of rural homes respectively [4],[7] .

b) Infant and under-five mortality : Malnutrition was assessed as a contributing factor in nearly 60% of deaths in children for which infectious diseases is an underlying cause. The incidence of severe malnutrition amongst young children has though declined over the past decade in Uttar Pradesh however still remains a problem of public health significance [1],[8] . In the present study, the chief causes of deaths of infants and children under-five years of age as revealed by social audits were severe malnutriton and diarrhoea respectively

II. Community's Analysis of the Social Causes of under five deaths

In the present study, the social causes/delays for under-five mortality as emerged following discussions with the community during the SACAs' are presented in [Table 4]. It can be evinced that majority of neonatal, infant and under five deaths occurred because of the delay in recognition of the seriousness of problem and arranging for timely transportation. Verbatim responses in this context of a mother of a sick infant with diarrhoea, which is self-explanatory of current practices was-'kuch din tak to bacchae ko ghar par hi dekhtae rahae, jab baccha sust para hua tha aur khaal sikur gayi to doctor kae paas lae kar gaye'.

III. Action taken by the community after social audits

Social Audits for Community Action cycle is complete only when the community after their self-assessment and analysis of child deaths takes 'collective action' for prevention of these deaths and in this regard, SACA differs from a verbal autopsy of under-five deaths. In the present study following the social audits for community action the community realized and demanded for the need to be aware to identify danger signs of child illnesses.

   Conclusion Top

Participatory Strategies like Social Audits for Community Action that use dialoguing with the community to assess and analysis their present situation, to trigger need for change and take collective action to improve their situation is more useful and cost effective approach. First, it is less time consuming than other methods and focuses on behaviour change at community level. If carried out on ongoing basis, it can also be used as a monitoring tool for child and maternal mortality and secondly, it can be a tool for assessing the training needs and IEC needs of community mobilizers to guide behaviour change promotion in appropriate maternal and child health behaviors. It an also increase the accountability of health services and strengthen local action to promote the involvement of health and other sectors for health development. However, more research needs to be carried out to compare the reliability of data collection using tool as compared to other methods.

   Acknowledgements Top

We would like to acknowledge UNICEF, Lucknow for providing financial support to community based Maternal Child Health and Nutrition (MCHN) Project at Agra. The study could not have been completed without the generous and willing cooperation of the communities in the project villages, and untiring commitment of project staff and postgraduate students of Department of Social and Preventive Medicine, S.N. Medical College, Agra.

   References Top

1.Internatinal Institute of population sciences. National Family Health survey 1998-1999 (Uttar Pradesh). Mumbai, India: International Institute of population Sciences-urban-rural disaggregated data as per standard of living Index, Environmental Health Project-USAID, India, 2003.  Back to cited text no. 1    
2.Ross SRR. Promoting quality maternal and newborn care: A reference manual for program managers. CARE, 1998: pp 3.9.  Back to cited text no. 2    
3.Dutt D, Srinivasa DK. Impact of maternal and Child health stragegy on child survival in a rural community of Pondicherry. Indian Pediatr 1997; 34 (9) : 785-92.  Back to cited text no. 3    
4.Bang AT, Bang RA, Baitule S, Deshmukh M, Reddy MH. Burden of morbidities and unmet need for health care in rural neonates-a prospective observational study in Gadchiroli, India. Indian Pediatr 2001; 38:952-965.  Back to cited text no. 4  [PUBMED]  
5.Hirve S and Ganatra B. A. prospective cohort study on the survival experience of under five children in rural western India. Indian Pediatr 1997;34: 995-10001.  Back to cited text no. 5    
6.Garg SK, Mishra VN, Singh JV, Bhatnagar M, Chopra H, Singh RB. Neonatal mortality in Meerut district. Indian J Med. Sci. 1993 Sep; 47 (9):222-5.  Back to cited text no. 6    
7.World Health Organizaiton. Essential Newborn Care. Report of a technical working group (25-29 April, 1994). Geneva, 196: 1-3.  Back to cited text no. 7    
8.World Health Organization Global Forum For health research: a foundation for improving child health. Geneva: WHO, 202. www.who.int/child-adolescent-health/new publications.  Back to cited text no. 8    


  [Table 1], [Table 2], [Table 3], [Table 4]

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