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faculty of spatial sciences population research centre
1
Hinke HaismaRosalind Franklin Fellow
Dept DemographyFaculty of Spatial Sciences
University of Groningen
Towards contextually adjusted measures of child growth
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faculty of spatial sciences population research centre
Overview› Child mortality;› Child growth monitoring;› Sen’s capability approach;› Research design;› Some findings:
Demographic Health Survey (India); Ethnography.
April, 2010
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faculty of spatial sciences population research centre
Child mortality› 6.3 million children under the age of five died
in 2013.› Leading causes of death in under-five children
are preterm birth complications, pneumonia, birth asphyxia, diarrhoea and malaria. About 45% of all child deaths are linked to malnutrition.
› Children in sub-Saharan Africa are more than 15 times more likely to die before the age of five than children in developed regions.
April, 2010
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faculty of spatial sciences population research centre
What has been achieved?› Overall, substantial progress has been made
towards achieving Millennium Development Goal (MDG) 4. Since 1990 the global under-five mortality rate has dropped from 90 deaths per 1000 live births in 1990 to 46 in 2013. But the rate of this reduction in under-five mortality is still insufficient to reach the MDG target of a two-thirds reduction of 1990 mortality levels by the year 2015.
April, 2010
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faculty of spatial sciences population research centre
Growth monitoring› Periodic anthropometric measurements;› Universal scale (WHO growth standards – how
children around the world should grow)
April, 2010
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faculty of spatial sciences population research centre
Critique › Biomedical perspective only;› Not sensitive to context;› Mono-dimensional outcomes (anthropometry);
› Has implications for advise to carers;› Calls for interventions that are directed towards
improving the mono-dimensional outcomes rather than focussing on the opportunities and capabilities of people
April, 2010
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faculty of spatial sciences population research centre
Current indicators are not sensitive to context
Netherlands
Tanzania
WHO Growth standard – weight for age (kg)
Mother back to work, grandma babysits
Introduction solid foods/ water
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faculty of spatial sciences population research centre
VIDI research – Normative indicators of child health and nutrition – one size fits all?
› To increase our understanding of biomedical, sociological and anthropological dimensions of children’s growth, aiming to contribute to the development of a new set of indicators that are sensitive to the differences in context in which children live.
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faculty of spatial sciences population research centre
Research translation to policy
› Tailor-made advice to mothers in well-baby clinics (micro-level);
› To develop policies and interventions that are embedded into local circumstances of how people;
› Compare children’s growth between countries by WHO/ UNICEF taking into account differences in context between countries and making (macro-level).
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faculty of spatial sciences population research centre
April, 2010
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faculty of spatial sciences population research centre
Sen’s capability approach
› Amartya Sen, economist, Nobel Prize (1998): Economic growth as mono-dimensional
indicator for development; Replaced by set of indicators for
development, based on capabilities and freedom to achieve what people defined as valuable aspirations in the context they live in;
Implemented by UNDP (multi-dimensional Human Development Index).
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faculty of spatial sciences population research centre
Capability approach in child growth
Endowment (resources)
Conversion factor
Capabilities (freedom/ agency)
Functioning
Availability of food
Child care services
Breastfeeding education
GenderAgeCultural normsValues
Ability to feed
Ability to take proper care
Nutritional status
April, 2010
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faculty of spatial sciences population research centre
Research design› Ethnography of child growth:
Electronic Human Relations Area Files (Yale University) – Shirish Darak;
Tanzania (PhD) – Zaina Mchome;
› Analysis of Demographic Health Survey data: India – Sepideh Yousefzadeh.
April, 2010
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faculty of spatial sciences population research centre
Research questions› What is healthy growth?› What underlies healthy growth?
Endowments (resources); Conversion factors (internal and external); Opportunities and capabilities- Freedom;- Agency.
April, 2010
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faculty of spatial sciences population research centre
Some findings - eHRAF› Growth is development of elementary and
manipulative bodily skills From infancy an attempt is made to mold
the child's features. The ears are pulled outward and the bridge of the nose is pulled upward, to prevent a flat nose (Burman culture, Burma, Southeast Asia)
April, 2010
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faculty of spatial sciences population research centre
› Growth is change in size and strength The age of a child was never calculated by
years, but [growth is assessed]by its size and strength and by the natural episodes of its life (Banyoro, culture, Uganda, Africa)
Traditional Bororo beliefs about the maturation of infants and children concern their growing degree of “hardness”, (Bororo culture, South America)
April, 2010
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faculty of spatial sciences population research centre
› Growth is starting to explore the world and getting ‘sense’ It is during infancy and childhood that
whimsical behavior, even errant behavior, is expected and tolerated of youngsters. Indeed, the mischievous child is often praised for its likeness to Lord Krishna, who was also a consummate prankster and breaker of rules while very young. (Bengali Culture, Asia)
April, 2010
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faculty of spatial sciences population research centre
› Growth is getting accustomed to the surroundings The infant is petted and encouraged by all his
female relatives. When he cries his wishes are usually fulfilled. He becomes accustomed to the presence of people, noise, and light, and under these conditions he falls asleep, wakes, and sucks. As a result, a healthy child does not cry often or long, but is placid, good-natured, and content. He likes attention, and responds to it with a smile.( Lau Fijians Culture, Polyneise)
April, 2010
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faculty of spatial sciences population research centre
Gender differences› It is also recognized that a boy is usually
nursed less than a girl, which also differs from the custom in Artas. The purpose is that though both should be infused with the mother's compassion, the girl is supposed to be imbued with more of it than the boy, and consequently her nursing should be longer (Fellahin Culture, Egypt, North Africa) .
April, 2010
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faculty of spatial sciences population research centre
Some findings - DHSApril, 2010
Preliminary findings Sepideh Yousefzadeh and Femke Hitzert
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faculty of spatial sciences population research centre
International network› International Union of Nutrition Sciences (IUNS)
Task Force: Multi-disciplinary research group;
› Establishing links with WHO/ UNICEF.
April, 2010
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faculty of spatial sciences population research centre
In conclusion› Work in progress:
Further analysis of DHS data; Repeat in other databases, DHS or cohort
data; Ethnography of child growth in Tanzania; In-depth interviews with health professionals
in the Netherlands; (Hopefully) research on contextual factors
influencing child growth in Bangladesh.
April, 2010
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