KARACHI: Depression, anxiety and helplessness have been found common in more than 70 per cent mothers of children suffering from nutritional neglect, it emerged on Wednesday.

A team of doctors arrived at this conclusion after examining 658 children suffering from nutritional neglect and their mothers at the Dow University of Health Sciences and Civil Hospital Karachi, for their research titled Psychosocial Determinants of Nutritional Neglect in a Developing Country, which has recently been published in the College of Physicians and Surgeons’ journal.

Like mothers, children were also found to have a high incidence of psychological problems. An alarming finding of the research, however, was of high incidence of inherited diseases in poor families, as 25 per cent siblings were found to have inherited diseases and chronic illnesses. Four per cent of siblings were handicapped.

“Large family size, poor socio-economic status of families, domestic violence, illiteracy, addiction in parents, maternal depression and anxiety disorders have emerged as the most consistent factors resulting in child neglect,” the research report stated.

The study was conducted at the paediatrics department of DUHS and CHK by experts led by Dr Aisha Mehnaz, Dr Nusrat Shah, Dr Ashfaq Mala and Dr Krishan Rai.

Of the 658 children examined, 75 per cent were below five years while nearly half of them were girls. Children below two years were 47pc. Only 77 children were examined for a psychological assessment.

“Other determinants of nutritional neglect were a large family size (family of more than five members) 84pc; young mothers 60pc; uneducated parents (67pc fathers and 77pc mothers were illiterate); poor income (77pc families were earning less than Rs7,000 a month),” the study stated.

It also found high use non-nutritive substance in families; cigarette smoking was found in 16pc, beetle nut chewing 9pc, smokeless tobacco 5pc, tobacco snuffing 6pc, biri (local unfiltered cigarette) 13pc and waterpipe smoking 2pc.

“In 23pc families, more than one type of substance abuse was present. Overall, tobacco smoking (all types) was identified in 50pc families whereas father was found to be the user of these substances in 81pc cases. Older siblings were using these substances in 7pc cases,” it stated.

The psychological problems identified in children were also found to be very high; aggression (80pc), rebellious behavior (75pc), lack of confidence (70pc), lack of social interaction (70pc) and paranoid tendencies (60pc). More than one psychological problem was identified in the same child.

Domestic violence

The study also found increasing incidence of domestic violence; verbal abuse by husband was reported by 63pc; in-laws were found to be verbally abusing the mothers in 30pc cases and fathers in 7pc cases, respectively.

“Seventy-seven per cent husbands also physically abused their wives. In 30pc cases, in-laws provoked their son to physically abuse the wife. Brother and sister in-laws were the provocateurs in 11pc cases,” the study added.

Psychological indicators identified in all mothers; depression (70pc), anxiety (73pc), helplessness (70pc), displaced aggression (50pc) and insecurity (36pc).

In 189 out of 658 mothers, there were profound psychological problems; the underlying factors identified in these mothers were financial problems (100pc) unemployment in family (50pc), conflict with husband (70pc), financial problems with domestic violence (60pc) and addiction (40pc).

Citing other studies, the research pointed out that poverty and large family size were the most detrimental factors behind child neglect especially nutritional neglect globally.

According to the study, nutritional neglect if it occurs at an early age can delay brain development which can be responsible for cognitive and psychological problems manifested by social and behavioural problems. This neglect can lead to malnutrition which is one of the leading causes of mortality and morbidity in children below five years in Pakistan.

Local nutritional programmes failed to address the problem because the root causes such as poverty, illiteracy and socioeconomic deprivation had been largely ignored, the study pointed out.

“There is substantial evidence that poor health and nutrition affects children’s development. Intervention is needed at multiple levels, as isolated intervention will not produce desirable results,” it concluded.

Published in Dawn, June 5th, 2014