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Presenter: Majid Salman Mohamed
0719 115 786


group members


✓ Define Family and community.
✓ Roles of each family member.
✓ Parents- education, occupation, hobbies.
✓ Effects of single parent on child health.
✓ Relations among family members.
✓ Siblings- number, health.
✓ Family size.
✓ Housing factors that affect health of the child (rickets, accidents).
✓ Residence (environment)- security, population density(falls, rickets,
sharps and dangerous things).
✓ Cultural practices (child raring practices, food for children)


Despite a reduction in under-5 mortality worldwide a substantial number of
children die because they do not have access to simple life-saving interventions.
Families and communities are on the front line of care for their children.
However, to play this role effectively, families need support, knowledge and
skills to provide essential care for babies and young children.

To address this need, WHO and UNICEF have developed the Integrated
Management of Childhood Illness (IMCI) protocol, which aims to reduce death,
illness and disability, and to promote improved growth and development
among children under five years of age. One of the components of the IMCI is
improving family and community health practices. It is therefore crucial that
the family and community are seen as an integral part of child health.


definitions FAMILY: “People related by marriage, birth, consanguinity or

legal adoption, who share a common kitchen and financial
resources on a regular basis.” – Journal of Family Medicine &
Family Care, Rohit Sharma, Feb 2013.

COMMUNITY: “A group of people with diverse characteristics who

are linked by geographic or social ties, share common
perspectives, and engage in joint action in geographical locations
or settings. They exhibit some awareness of their identity as a
group, and share common needs and a commitment to meeting
them.” – American Public Health Association, Dec 2001.


role of family
So far, the major evidence that maternal care can
significantly influence human infant development has come
from situations of maternal deprivation (e.g., institutions).
Numerous studies confirm the detrimental effects of
maternal deprivation on many aspects of development.
(Dennis, 1960; Pringle and Bossio, 1958; Pringle and Tanner, 1958; Goldfarb, 1945).

1. Physical well-being: Ensuring adequate antenatal and

postnatal care, proper feeding practices including
breast feeding, complimentary feeding and older child
nutrition, encouraging proper hygiene within the family
to combat infectious disease, seeking medical attention
in a timely manner and ensuring safety of the home as
primary prevention for accidental injuries, protecting
from physical, psychological and other harm.

2. Mental well-being: As the primary agents of child

socialization, influence their behaviours and attitudes.
Educate the child and provide an environment that the
child can thrive intellectually.


role of family
3. Social well-being: Encouraging and positively
reassuring the child to help in developing a healthy self
esteem. Be a good role model and provide a reference
for social conduct and discipline.

The role of the mother is one of greatest importance.

Providing mothers with access to education, income
earning opportunities, maternal and child health care
gives them and their children the best chance of survival
and quality development.

The mother is the initial person the child looks up to and

forms an emotional bond with. Her health and well –
being is of great importance to ensure the well being of
the child.


role of family
The father’s relationship with his child’s health care
provider is likely to begin in the early childhood years
and can grow over time to a long term relationship. Early
encounters with pediatricians may occur as prenatal visits,
visits in the newborn nursery, or any number of the well-
or acute-care visits. Fathers have been shown to be
involved prenatally by attending health care visits and
assisting their pregnant partners; regardless of marital
status, the vast majority of fathers are present at their
child’s birth. Fathers have even been noted to have
Couvade syndrome, wherein they experience insomnia,
restlessness, and excess weight gain during their partner’s
1. Physical well-being: supporting the mother in seeking
proper and adequate antenatal and postnatal care,
encouraging and supporting proper feeding practices
in the family unit, advocating for hygiene and
cleanliness in the home, supporting and financing health
seeking behavior.


role of family
2. Mental well-being: Interaction and social play with
fathers during the infancy period also tends to be more
stimulating, vigorous, and arousing for the infant. These
high-intensity interactions with fathers may encourage
children’s exploration and independence.

3. Social well-being: being involved in the child’s

upbringing; this will lead to nurturing of an emotionally
secure human being who is able to relate well with their
peers and the larger society. Also, the child is more likely
to be a better parent therefore propagating a cycle of
socially healthy children.

Having a father move out of the house by 3 years of age

was associated with infant temperament (i.e. irregular
schedule, difficult infant behavior.


role of family
Number of siblings: There are several advantages to
having siblings - playmates and first friends; early
milestone development; assistance with schoolwork;
security and support. However having many siblings can
pose disadvantages – increasing difficulty in attending to
the individual needs of the child, uneven distribution of
intrahousehold resources including food, overcrowding
and respiratory health problems; and lower levels of
hygiene and sanitation.

Health of siblings: Having a chronically ill sibling is

considered a stressful life event and predicts higher levels
of depressive symptoms in the fit child. Siblings may also
act as a portal through which communicable diseases such
as chicken pox, Upper and lower respiratory tract
infections and infectious gastroenteritis enter a household.


education, occupation &

hobbies of parents
Parental Education: Parents with a higher level of education have better health seeking behavior; they are
more informed on available services, feeding practices as well as hygiene. Educated mothers tend to have
healthy child spacing behaviour.

The effect of father’s education on infant and child mortality appears to be about one half that of the
mother’s education. (
The highest under-5 mortality rate by education is among those born to mothers with an incomplete primary
education (63 deaths per 1,000 live births). Children in these households experience both the highest
postneonatal and child mortality (20 and 22 deaths per 1,000 live births). –The Kenya Demographic and
Health Survey 2014, page 116

Parental Occupation: Parents with better paying jobs are able to afford better healthcare services as well
as better nutrition in quality and quantity. Parents involved in illegal activities as their means of livelihood
serve as poor role models for the children and provide early exposure o such activities for example an illicit


education, occupation &

hobbies of parents
A study done in rural India showed there are considerable differences in the mortality experience of
children according to the educational attainment of their parents. In general, the mortality differentials
between those with no education and those with a moderate amount of education are small, but for all 3
measures of education, children with the most educated parents experience substantially lower levels of
mortality. Those households where the mother has had some education tend to have lower female than male
mortality rates, i.e., children of both sexes born into those households experience lower levels of mortality
than do children born into households where neither parent or only the father is educated, but female
children do particularly well. Parental Hobbies: Practices within families and communities are usually passed
down to the younger generations, it is therefore important that parents maintain healthy hobbies that the
child can emulate.
Also, some hobbies tend to make parents absent from crucial stages of their child’s upbringing.
For example studies have shown that children of parents with alcohol abuse/dependence are at increased
risk of negative outcomes such as violence, family separation, teenage pregnancy, substance use problems,
mental health problems and poor academic performance.


effects of single parent

on child health
Social scientists have found that children growing up in single-parent
families are disadvantaged in comparison to their counterparts in two-
biological parent families. Many of these problems are directly related to
the poor economic condition of single-parent families. The effects can be
divided into positive and negative effects:

Positive effects
Strong parent child bonding due to undivided attention.
Early independence and maturity
Learn to share responsibilities
Less exposed to parental conflict


effects of single parent

on child health
Negative effects
Financial constrains lead to inadequate provision of nutrition health care
Low parenting quality (lack maternal or fatherly care), lack role models
Children often develop emotional imbalances as low self esteem
Reduced time spent between parent and child.
Child is at higher risk of developing antisocial behaviour

Lower socioeconomic status in homes where there is only one parent also
predisposes the children to malnutrition as their food choices are limited in
quality and quantity. Study done in 2013 showed children with single
mothers showed an increased risk regarding parent-reported poor health
status (boys: odds ratio (OR) 1.39, girls: 1.73), psychological problems
(boys: 1.90, girls: 1.58), overweight (only boys: OR 1.23) and asthma [only
girls: OR 1.90].


relations among family

Good family relations have positive health outcomes. These include physical
health as children feed better when they are happy, better school
performance and emotional stability

Poor/ bad family relations have negative health outcomes for the child in
the family. Non accidental child injury usually occurs in the setting of poor
family relations and such injury deteriorates a child’s physical health; mental
health by causing stress and probable depression; and social health by
predisposing them to have poor relations with their peers and future
families. Children of divorced parents have earlier sexual debut and higher
emergency room usage.


number & health of

Economic, demographic and sociological as well as epidemiological
literature has raised concerns regarding the well-being and life chances of
children raised in large families.
According to the resource dilution model, in larger families the parental
financial support as well as personal attention are distributed across a
larger number of siblings, and therefore the parental investments per each
child may be lower.
Parents face trade-offs between the quantity and “quality” of children
when making decisions regarding the size of their family, with the key
“quality” dimensions defined as education attainment and health.
Stronger effects of family size can be expected in poorer families or
families of lone parents whose resources of time and income are more


size of the family

The size of a family impacts the health of its members either directly by
overcrowding and sanitation or indirectly through increased economic
burden on the providers. ‘Shorter birth intervals have been demonstrated to
be associated with higher mortality, both during and after infancy. Kenya
follows suit with a strong association as well during neonatal, postneonatal,
and child portions of life. Babies born after the shortest birth intervals, less
than two years, are nearly twice as likely to die (83 deaths per 1,000 live
births) as babies born after three (42 deaths per 1,000 live births) or four or
more years (44 deaths per 1,000 live births)’
– Kenya Demographic and Health Survey 2014, page 116.

This is due to the fact that mothers attention is shifted to care of the younger
child at he expense of the older, but still dependent child. It can be
hypothesized that this is because the mothers body does not fully recover
nutrients before the next pregnancy.
Housing factors 18

Physical structure H20 & Sanitation Location

A ‘leaky’ house can lead to dampness and Increasing sanitation coverage above The Location of housing also have public
mould which may result in various forms of 70% has a large impact on reducing child health implications in informal settlements
respiratory illnesses and allergic reactions. deaths from diarrhoea and other causes. or slums. If housing is located on
The use of building materials such as ( floodplains or hillsides, near sources of
asbestos and lead based paint increases ws-events/sanitation-coverage-and-child-
exposure to these toxic substances. Use of traffic, industrial activity, solid waste
health/en/) dumps or vector breeding sites public
inflammable or weak material such as
wood, plastic or cardboard – particularly health and especially the children’s health
common in urban slums- poses increased will be affected directly (for example
risk of through sanitation) or indirectly through
injuries.( access to food and education.
en/) Good housing should enable access (
to sunlight exposure to prevent Vitamin D Crowded neighbourhoods with
deficient Rickets. limited access to adequate amounts of
sunlight exposure predispose children to

Building design No. of rooms Affordability

The number of rooms used for sleeping Building design will influence exposure to Lack of affordable housing for low income
provides an indication of the extent of disease vectors such as mosquitoes. households may mean diverting family
crowding in households. Overcrowding Inadequate ventilation especialy in the resources from expenditure on food,
increases the risk of contracting infectious context of overcrowding will cause education or health towards housing
diseases such as acute respiratory exposure to different pollutants and needs.
infections and skin diseases, which pathogens. Poor lighting or heating will (
particularly affect children and the elderly influence both physical and mental health
population. (Kenya Demographic and as well as participation in activities such as
Health Survey 2014, page 14) education.

• A study show in 2017 showed that children in densely
populated urban areas across Africa were at increased
residence risk of infection with P.falciparum Malaria.
(ENVIRONMENT) Population dense areas however attract social amenities
which include hospitals which are within a shorter radius from
• Security: Secure neighbourhoods provide positive peer home areas.
interactions for children, there are reduced rates of non ‘Coverage is highest in the Central (90 percent) region and
accidental injuries and violent acts such as child rape. lowest in the North Eastern region, where only 51 percent of
• Population density : Population density affects child children are fully immunised. Eleven percent of children in North
health by affecting sanitation; the spread of communicable Eastern have not received any of the recommended
diseases and coverage and sharing of health services. High immunisations, as compared with 2 percent or less in the other
population density areas such as informal settlements have regions’
higher prevalence of diarrhoeal diseases and -(The Kenya Demographic and Health Survey, 2014 – page
communicable diseases such as TB. 143)

In case of inadequate food in the households , the children do

not get enough. These children are at higher risk of malnutrition.


cultural practices As a case study, The Malawian rite of passage involves man
initiating young girls into sexual activity as part of a rite of
passage. This is just one example where communal mores and
norms are reinforced by communities which violate human rights
whereby children and women bear to brunt.
Culture refers to the ideas, customs, and social behavior of a
particular people or society. These customs and practices can have This happens in many ways:
an impact on the health of children within those who practice them.
young girls are forced into early sexual debut and unprotected
Child raring practices. In many communities circumcision is considered sex and are at risk of contracting HIV;
a mark of initiation into adulthood. However, Female gential female genital mutilation causes health complications for girls
mutilation has been shown to have adverse effects on the health of and women around sexual health and pregnancy;
female children. It is a violation of girls’ and women’s rights. child marriages result in childbearing which often has negative
( effects on their health and the child they carry;
mutilation/) In settings of poverty, many of these children suffer from
Universal declaration of Human Rights, 1948 malnutrition. This complicates maternal and child health; and,
In the long term, many of these women have poor physiological
Food for children. In the Maasai community, fathers are given and mental health outcomes.
preferential treatment over the women and children, they are served
first and in large amounts leading to poor intra-household food
J.Rosenberg, WB Wilcox, 2006: The Importance of Fathers in the Healthy Development of Children
Kenya Demographic and Health Survey 2014/2015;KNBS,MOH,NACC, NCPD
Household and Community IMCI Summary Document, CORE GROUP,2001
Thank you