Afairly reliable index for the determination of health status in a community is the prevailing infant mortality rate. However, it is difficult to obtain data pertaining to it on a regular basis, so we may draw our inferences from maternal or neonatal mortality rates. Presently, the mortality during infancy appears to follow the following pattern. If 100 babies die below one year out of 1000 babies born alive, 50 babies die in the first 4 weeks. Out of these 25 babies die in the first 1 week, and 12 - 13 will die in first 24 hours.
It has been observed that deaths occurring during prenatal or neonatal period are due to factors operating during pregnancy, child birth and soon after that, whereas those in the post-neonatal period or thereafter are generally due to environmental factors. The mortality during infancy and early childhood has no doubt declined appreciably as a result of a variety of factors like better health care services; rise in the standard of living improved literacy levels; flood of information disseminated by mass media etc. In other words, it may be said that the fall in death rates could be attributed to the efforts made in health as well as non-health sectors.
The factors which played dominant roles in bringing about positive changes in the health sector include the following:

• Qualitative and quantitative improvement in maternal and child health services through health institutions in private and public sectors, both in urban and rural areas.
• Domiciliary deliveries by trained hands in rural areas.
• Massive immunization efforts against Vaccine Preventible Diseases.
• Oral rehydration therapy in the management of diarrhoeal diseases.
• Control of acute respiratory infections.
• Promotion of breast-feeding e.g. baby-friendly hospital initiative.
• Growth monitoring on a regular basis.
• Nutrition education and provision of nutritional supplements to vulnerable groups.
• Family spacing.

The efforts in the field of environmental sanitation, including the provision of safe drinking water and vector control, have not made much headway, otherwise the impact on mortality rates would have been much more impressive by now. Nevertheless all the above mentioned measures, directly or indirectly, helped in survival of children and mothers in a big way. Thus the parents today have a good reason to be convinced that children born to them have much better chances of survival.
In this situation, a question arises as to whether it is just enough for a child to survive or he/she should be assured of enjoying the optimum level of health too. It has been observed that many more children survive now than they used to previously, but most of them keep on suffering from one ailment or the other during childhood. This puts a strain on the economy of the parents besides causing an avoidable depletion of scarce resources. In other words, the resources which could be used for health promotion are being deviated away for health restoration. At the same time, a perpetually ill child adversely affects the socioeconomic conditions of the parents as well. So we must seriously focus our attention on measures necessary for child survival as well as for optimum physical and mental development of the child so that it grows up to adulthood with full potentials. For this purpose an effort is to be made in the beginning itself i.e. at the stage when conception takes place because a weak mother will obviously give birth to a weak child and such a child will start life with a handicap and will be at risk throughout the childhood.

Root Causes
Mothers suffering from malnutrition, severe anaemia, chronic diseases (tuberculosis, heart diseases, diabetes), having repeated pregnancies, early marriage and early pregnancy (teenage), suffering from iodine deficiency disorders etc. are bound to give birth to physically impaired and mentally retarded offsprings. Many instances can be quoted.
A child suffering from malnutrition (PEM) will be at risk to other infections. Likewise a child with Vit. A deficiency will have defective vision and will lag behind in the learning process. He will also be more prone to common ailments like diarrhoeal diseases and acute respiratory infections. Children with physical disabilities (blindness due to injury or Vit.A deficiency), lameness due to Polio, with congenital defects in heart, with brain damage following measles, meningitis, head injury or iodine deficiency disorders; are all common sights. These instances can be multiplied, where a child has somehow survived but failed to enjoy optimum health in life.
Naturally the question arises as to what should be done to remedy the situation. Half-hearted approaches bring forth only partial results. So whatever is being done for preventing the avoidable deaths in infancy and early childhood will have to be continued vigorously, besides taking some additional measures. Extensive and intensive antenatal and postnatal care is to be carried out. It is a known fact that earlier a pregnant mother is brought under the purview of MCH services lesser are the chances of damage being done to her and the foetus. As such, home visiting is to be systematically and effectively carried out so that no pregnant mother is left uncovered by these services.

Suggested Measures

• Marriage/genetic counselling before marriage to avoid possibility of congenital defects.
• Female literacy to be further improved so that the mother is well informed about herself and the baby to be cared. Later on as a mother-in-law, she will be able to guide her daughter-in-law.
• Avoiding early marriage and teenage pregnancies.
• Family spacing is to be propagated so that birth interval between children is increased.
• Promotion of breast feeding and proper weaning. Growth monitoring of the child with the active involvement of the mother.
• Early diagnosis and treatment of diseases so that disability is avoided or minimized.
• Nutrition education about locally available foods.
• Creation of awareness about the benefits of iodized salt and nutrition supplements like Vit.A and iron.
• Intensive health education efforts by all members of the health team in all situations.
• Despite all the afore-mentioned measures, some children will develop physical and mental disabilities. Such children will have to be suitably rehabilitated.

Rehabilitation
Rehabilitation of the child who has managed to survive but left physically and/or mentally disabled, to a varying degree, is equally important otherwise it will be a burden on the parents and society at large. The rehabilitation aims to change a non-productive individual to a productive and useful one so that he is socially adjusted, mentally comforted and vocationally competent. Thus he will become a useful member of the society. In other words, disabled children have to be made self-reliant and not left to their fate.

Rehabilitation in various forms

a) Medical Rehabilitation. It involves restoration of function by exercise/surgery/physiotherapy (e.g. injuries, polio, burns, leprosy).

b) Vocational Rehabilitation. This means restoration of capacity to earn livelihood, school for the blind, provision of aids, change of job).

c) Psychological Rehabilitation. This involves counselling to boost up the module cured leprosy case, blindness etc.

d) Social Rehabilitation of leprosy patients.

The objective of the entire effort is that all the people in the world should enjoy a level of health that will enable them to lead a socially and economically productive live. This is what the slogan of WHO "Health for All by 2000 AD" is all about.

While striving hard towards this end, we have to look beyond the survival of children and ensure that they become adults with full potential so as to contribute optimally to the society.

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