Family and Community Aspects in Growth and Development

Nuri Purwito AdiCommunity Medicine DepartmentFMUI

WHO definition of health, 1948Health is a state of complete physical, mental and social well-being, not merely absence of disease or infirmity

UU RI, No.23 tahun 1992 Being Healthy means well physical, mental and social function so that everyone can live socio-economic productively

Late adulthoodMiddle adulthoodMiddle & Late childhoodEarly childhoodInfancyPrenatal periodAdolescenceEarly adulthoodPeriods of developmentBiological processesSocio-emotional processesCognitive processes

Factors influence growth & developmentIntrinsic - geneticExtrinsic EnvironmentDiseases from other peopleMothers condition (prenatal period)

PersonalbehaviorPsycho-socio-EconomicEnvironmentHuman biologyPhysicalenvironmentThe Mandala of HealthA model of human ecosystemculturecommunitylifestyleworkSickcaresystemHuman-Made Environmentbiospherespiritbodymindfamily

Health statusenvironmentbehaviorgeneticsHealth servicesThe concept of Bloom

AGENTS:physicschemistrybiologic-physiologic-psychologic

ENVIRONMENTHOSTDISEASEGordon & Le Richt

The individual Sex Age Health etcMicrosystemSchoolPeersNeighborhood play areaFamilyHealth servicesChurch groupMesosystemExosystemExtended familyNeighborsLegal servicesSocial welfare servicesMass mediaFriends of familyMacrosystemAttitudes & ideologies of the cultureChronosystemPatterning of environmental events & transitions over the life course; sociohistorical conditionsTimeEcological Theory of DevelopmentSantrock JW, Life-span development. 7th ed. p. 42

GENEPUBERTY :Physical, Social,Emotional,BehaviorActivities &LifestyleEnergy &Metabolism

Nutrition

Hormones &BiochemicalFAMILY & ENVIRONMENTEthnic

Child UpbringingRelationshipFriends

Stress

Dietary habit

The Influence of Family on Health & DiseaseGenetic influencesThe family is crucial in child developmentSome families are more vulnerable to illness than othersInfectious disease spreads in familiesThe family is important in recovery from illnessFamily factors affect morbidity & mortality of family member itself.

Prenatal periodMaternal characteristicsMothers age NutritionEmotional states & stressMaternal diseases & conditions Rubella, Syphilis, Herpes, HIVDrugs (incl. tobacco & alcohol)

Prenatal periodEnvironmental hazardsRadiationPesticidesPollutants and wastes (CO, mercury & lead)ToxoplasmosisHeat

Familys influenceParenting styles

Cultural, ethnic & social class variations in families

Sibling relationships & birth order

Marital relationshipChild behavior & developmentParentingInteraction between children & their parents:Santrock JW, Life-span development. 7th ed. p. 172

The family life cycle Source: Duvall 197722.53.57781510-151. Newly married couple2.Newborn children3. The family with young children4. The family with school-agechildren5. Family with adolescent6. Launching family7. Middle age parents to retire time8. Family in later years

The changing family in a changing societyWorking mothersDivorce Depressed parents

Other factorsPeer relationsProvide source of information and comparison about the world outside the familyPlayIncreases affiliation with peersReleases tensionAdvances cognitive developmentIncreases explorationProvides a safe environmentTelevision

TelevisionPositive influencePresenting motivation and education programsIncrease information about the world beyond the child environmentProviding models of positive social behaviorNegative influenceTaking children away from homeworkMaking them passive learningTeaching stereotypes (repeated negative /information behaviorProvide violent models of aggressionPresenting unrealistic views of the world

Health problems of children in Indonesia

Causes of death in under-five children (developing countries)

Infant Mortality Rate (IMR) and Under-five Mortality Rate (U5MR)SDKI 1991, 1994 and 1997 Source: Sumantri, et.al 2000

Chart1

67.85745.7

97.481.358.2

SDKI-91

SDKI-94

SDKI-97

Kematian/1000 LH

Sheet1

TahunGNP/Cap($US)

1988450

1989440

1990500

1991570

1992610

1993670

1994740

1995880

1996980

19971110

1998680

1999670

2000703

YearUrbanRuralUrban+Rural

197638.7940.3740.08

197830.8433.3833.31

198029.0428.4228.56

198128.0626.4926.85

198423.1421.1821.64

198720.1416.1417.42

199016.7514.3315.08

199313.4513.7913.67

19969.7112.311.34

199814.4320.0817.86

199913.9618.3716.64

19998.8913.611.72

Tahun SurveiIMRU5MR

SDKI-9167.897.4

SDKI-9457.081.3

SDKI-9745.758.2

Sheet1

GNP/Cap($US)

Tahun

$US

Sheet2

Urban

Rural

Urban+Rural

Year

% poor

Sheet3

SDKI-91

SDKI-94

SDKI-97

Kematian/1000 LH

Source: End Decade Goal Report, 2000 Low birth-weight Infant Proportion from various sources: 1990-2000

Severe and Moderate Mal-nutrition in Under-five Children, Susenas 1989-2000 Source: Direktorat Gizi Masyarakat, 2001

Chart1

6.331.17

7.2328.34

11.5620.02

10.5119

8.1118.25

7.5317.13

Gizi Buruk

Gizi Kurang

Tahun Survei

persen menurut BB/U

Sheet1

WAZ2000

FrequencyPercentValid PercentCumulative Percent

Valid

Children RightsTo be born after conceptionTo get adequate food and health care To be loved and protectedTo get educationTo have opportunities to play and recreationFor those who are disabled; rights to get special careTo become functional individual

The efforts of government to enhance child welfareTargeting and providing health care, especially for poor families with certain indicators. Providing special services such as extra/suplement food for under-weight under-five children and pregnant mothers. Providing maternity care for pregnant women through enforcement of village midwivesRevitalization of posyandu to maintain its activities in growth monitoring of babies and under-five children

Advocate local governments to always target adequate allocation to area which were high risk in nutrition and health problemsPromoting to increase education and basic health servicesDevelop health maintenance program for communitiesDevelop and strengthen monitoring and evaluation system (surveillance) based on the local demands, mostly to improve local policy of health services and nutritionThe efforts of government to enhance child welfare

Thank you

****There are 3 factors related to health : Biological, Cognitive and behaviour, and Socio Emotional and environment. Those factors related also to the period human development from prenatal to late adulthood*Those factors explained earlier can also be seperated into 2 factors : intrinsic (inside our body) and ekstrinsik (outside our body) eg. Environment, disease from other people, and the mothers condition especially in prenatal period

*Factors related to the human health and child growt n development also can be defined according to the MOH. That the health/GD can be influenced by ..

*Mr Bloom also make another major factors just like I said plenary session. That health and G/D is influenced by .*Which concept you want to use is up to you, the important thing there are many factors related to G/D, not only physical condition, but also mental, behavior and environment.

Mr Gordon and Lericht made another factors such as agent which are consist of , environment, and the host (human condition) can influence health also.Which concept you want to use is up to you, the important thing that you must remember that there are mulifactors influence human health/growth/development which are physical condition, mental/behaviour, environment. Our role as health provider included in environment

*From those kinds of concept explained earlier, Mr Santrock tried to compile it into these picture. This picture can be found in Life Span development 7th ed p.42. We already gave this book to the intl class to be copied for you.He mentioned that the individual health are influence by sex, age, health (inside the individuals body). The Outside of the body can be separeted into microsystem, mesosystem, ecosystem, and macro system. Included in microsystem are Extended from the microsystem such as the environment between micro and acosystem is called mesosytem which meant the interaction between microsystem and exosystem. Exosystem itself can be affected by macrosystem which are .Above of all there is chronosystem which is timely dependent of making the pattern of environmental events & transision ; sociohistorical condition. By this explanation, we can understand why the health status of each countries is different. *How family affected the child health ? Genetic is a very known factors related to the family. Because children is the reproductive outcome from marriage which will becoming family in the future, so the role of the family is very crucial in children development. The family condition and environment are some factors influencing the child development. Children and another family member can get sick from other family member who got infectious disease. The role of caregiver from one of family member also the important factors for child development and illness recovery. So, it is understandable that family factors can effect the morbidity and mortality of the family member it self*What factors influence prenatal period ? Maternal characteristic such as mothers age of marriage and/or pregnancy. Is she ready or not for becoming a mom ? The nutrition of mother especially during pregnancy can effect the baby development while he still inside his mothers uterus. The emotional states and stress of mother can effect the connection, interaction, between mother and child and that can effect the adequacy of baby stimulation and baby feeding. The disease during pregnancy such as rubella, syphilis, herpes, and HIV also smoking and alcohol habit during pregnancy can disturbed the development of the baby congenital malformation live birth more effort to take care of plus feeling ashamed inadequacy childbearing.

*Environmental hazard such as.. also affect the baby in prenatal period. *The parenting styles such as authoritarian, neglectful, indulgent, can effect the child development especially effect psychological side of the child. Cultural, ethnic, and social class influence the behavior/habit in the family effect health. Sibling relationship and birth order also effect adequate interaction among family member. *The marital relationship effect parenting style. Parenting style effect the child behavior and development. If the child is adult already and have unhealthy behavior and development, that can effect his marital relationship in the future and effect parenting from his parents. The marital relationship of the parents also effect the child behavior and development. *After 2 people got married, they will have their own family and life cycle. Each family life cycle have its own health risk. Example the health risk for newly married couple is infertility. After having a new born baby, more money and energy to spend, and the risk of abnormal development of the baby. The family with young children had risk of unhealthy exposure for their children because the child already had interaction with other environment and started to play outside their house which can be infectious to them. The family with school age children and adolescent had risk of their children to become drug user or other unhealthy behavior with their friends. The launching family until family in later years mostly effect adult health so it wont be discussed in this session. *Changing society can also change the character of the family. Previous time, the wife only be the house wife who stay nicely at home, take care of the children, cooking, and welcoming her husband. But now days, because of the increase price in the market, women emansipation, it is not enough for the father only to become resource income. So, the mom must work as well to get additional income. The mum and dad spend less time at home but more in office, meeting new people and new environment made the risk of inadequate affection among family member from husband to wife viseversa and from parents to child viseversa. This kind of condition make divorce rate higher and more depressed single parents afterwards effect the child development *Although the parents already provide adequate childbearing, but other factors can disturb the child development. Information and interaction outside the house made the children compare the world outside their family. Social and healthy interaction increases affiliation, release tension, giving advance cognitive development (such as being able to compete and being sportive with other), increase the children exploration and provides a safe haven. Television can be good and bad for the children.***WHO health report 2005 record neonatal death was the most frequent cases of death under 5 yo. The rest are *An old data from 1991, 1994, 1997 record. The under 5 yo mortality rate is bigger than infant mortality rate. Although showing decreases number of death, but still high comparing to other country. *Low birth weight infant proportion various from 6.6 % up to 16.1 %. And the line show increases number each year.*Severe and moderete malnutrion still the problem for Indonesia. Many factors influence it but one factor for sure is socioeconomic problems. Here we can see the decrease number of moderate malnutrion but unfortunately may be theyve become severe malnutrion because increase number severe malnutrion from time to timet. **Because the future of a country is in the hand of their young generation, so the government had effort to enhance child welfare, such as : **