CURRENT STATUS OF HEALTH IN INDIA
Item
- Title
- CURRENT STATUS OF HEALTH IN INDIA
- extracted text
-
CURRENT STATUS OF HEALTH IN INDIA
All
Prof. K. Ramachandran
India Institute of Medi . I Sciences
New Delhi
During
the
1st
four
decades
and more
since
the
attainment
of
political independence much effort has
been
expended
in India in attempting to improve the health status
of the people.
There have been some notable successes
like
the eradication of Smal1 Pox and Plague.
Life expectancy at
birth has
increased
from about 32 years at
the
time
of
independence
to
about 58 years curretnly.
At
the
policy
making
level
a commitment to health as a social
goal
with
emphasis on equality of health service for ail social
groups
in the coutry,
has emerged.
However, a detailed examination
of available information on mortality, morbility, delivery of
health
services and development of health manpower and their
deployment
reveals that the picture of health status in
the
country is not as rosy as it seems on the surface.
i'lor ta 1 i ty in
India
There
has been a continuing decline in the Crude
Death
Rate
(CDR) in India since 1921-31.
It was estimated
to be
36.3 per 1000 population for rural and urban areas
combined
during the decade 1921-31.
It declined to 19.0 during 196171.
Since 1971, estimates of CDR are available for rural and
urban areas sepeately from the Sampling Registration Scheme
of the Registrar General of • India.
Table 1 presents
3-year
moving averages of CDR for the major states of India and for
the country by rural and urban areas for three chosen periods
during 1971 to 1988.
Both the rural and urban rates show .a
continuing decline during this period.
However, the rural
dealth rates
are
substantially higher in ail
the States
barring
the singular exception of Kerala in 1986-88 with a
rural rate slightly lower than the urban dealth rate.
There
is fair
degree of homogeneity between the States
in
urban
death rates
but
the rural dealth rates
show considerable
heterogeneity.
The rates for 1988 presented in Table 2 also
show this clearly.
Populous states of noth India like Uttar
Pradesh, -Rajasthan, Bihar and Madhya Pradesh have rural death
rates substantially higher than the national rural average of
11.8.
The urban-rural differential is unacceptably high
in
these states in absolute terms.
1
Age and Sex specific Death Rate.;
Table 3
presents
the SRS estimates of
age
and
sex
specifTc"-deaith rates for 1SB5 (latest year for whicn
sucn
information is available).
There are striking differences in
the mortality experiences of males and
females.
Below
10
years of age.
the deaith rates in femals.
both in urban and
in rural areas,
are clearly higher than those in males.
All
available information on anthropometric measurements in India
in new born children clearly shows that female children
at
birth do not have any health disadvantage compared
to
male
children.
If anything, the female child is shlightly better
off
compared to male children at birth in weight and height.
The inference,
therefore, is inescapable that the family and
social environment in the early years of growth of the female
chi id is adverse.
The
deaith rates become equal for the two sexes in
the
rural areas in the 10-14 year age group.
In Urban areas for
the same age group,
females have a suggestively lower
death
rate compared to males.
However, in the first two decades of
the female reproductive period from 15 to 34 years of age the
female deaith rates are distinctly higher by 25 to 50% in the
rural
areas compared to males.
in the urban areas,
the
female disadvantage in mortality experience is
confined
to
15-24 years only.
In the 30-34 year age group
in
urban
areas, the female death rate is substantially lower than that
of males.
Beyond 35 years of age, the females enjoy a lower
death rate compared to males.
The heavy toll of deaith child
bearing
takes
in women reflects very poorly on
the
health
system particularly in the rural sector.
Infant Mor ta1i ty Rate
Tab 1es
4 to 7 present different aspects
of
infant
mortality
in India.
Tab 1 e 4 presents the infant mortality
rate
(1HR)
by sex in the major states of
India
in
1985
contrasting tham with CDR for the same year.
The States fall
cate8or-es with reference to I HR in males and females.
In U.tar praoesh.
Haryana,
Himachal Pradesh and Punjab
the
female
infant mortality is higher than that in males.
The
absolute difference in I HR of males and females in the first
3 states mentioned above are higher
than
in Punjab.,
In
Bihar,
Rajasthan,
Madhya Pradesh,
Tamil Nadu,
Gujarat and
Maharashtra the
I MRs
males
and females
are
closely
similar,
through
i n the
first
3 states
the
are
cons iderab1y higher than the national
average
for
males
and
f ema i es.
in the remaining States,
the
I
MR
in
females
is
lower than in males.
Kerala has the lowest infant mortality
rates of 34/1000 live births
'•“j in urban areas and 28/1000
1 ive
births
in rural areas.
It is interesting to note that
the
CDRs do not show the same
relative picture that the IMRs show
in the different states.
2
Tab 1e 5 presents the IHRs,
CBR (birth rates) and CDR of
the major States of India for 1988.
The IHRs are arranged in
the
table in decreasing order of magnitude.
Barring Punjab
and Himachal pradesh. the North Indian States show high IHRs.
It
is also interesting to note that the IHRs do not
show
a
high positive
conelation with the CBRs.
The
rural
IHRs,
barring
Kerala,
are substantially
higher than
the
urban
rates.
Table 6 presents the average neonatal and post neonatal
mortality
rates
for
the major states of
India at
three
selected
3-year
periods between 1970 and 1965.
The
post
neonatal mortality rates, except in the cast of Haryana, show
a clear
and substantial decline during the
period.
The
neonatal
nortality rates also show a decline in most
Stares
but
the
relative declines are smaller.
Table 7 shows
the
estimated early neonatal and late neonatal mortality rates in
the country as a whole during 1971 to 1985.
These have to be
taken as only rough and neady estimates, since they have been
obtained
by
subtracting still birth rates
from perinatal
mortality
rates.
Still birth rates are generally estimated
imprecisely
in India,
particularly,
in rural
India.
The
rural
rates are substantially higher again compared to urban
areas.
Hatena1 Hor ta1itv Rate:
Tab 1es 8 to 11 attempt to present the maternal mortality
experience in India.
Data on maternal mortality are grossly
inadequate
in India and hence the attempt here is to present
merely a qualitative picture of maternal
mortality
without
laying
claim
to
present ’ point
estimates
of
acceptable
precision of maternal mortality experience.
In Table
6 the maternal mortality rates for the
rural
areas
of the major States of India have been derived using
the available statistics provided by the Survey of Causes of
health carried
out by the Registrar General
of
India’s
office.
Approximately
1% of all rural dealt are reported
to be
due
to child birth and
pregnancy
in
India.
This
percentage, however, shows considerable variation between the
states.
Using
the percent of deaths due to pregnancy and
child birth,
and the consponding CDR and CBR for the states,
the maternaly mortality rates have been estimated.
The over
all
maternal mortality rate (per 1000 live births) comes out
to be 3.6. Utta Pradesh tops the list with a reate of 7.1 and
Punjab has a low rate of 0.6 Kerala probably has a lower rate
still.
Tables 9
to 1i present different aspects
of
maternal
mortality
in Anantapur
district
- a relatively backward
district
of Andhra Pradesh.
The data were collected through
a detailed hospital cum community survey of maternal
dealths
during
1984-85
by Dr.
Jagdish C Bhatia, of
the
Indian
institute
of Management,
Bangalore.
The picture is indeed
3
deeply disturbing if not frightening.
The overall
maternal
mortality
rate is a whopping 8.3 per 1000 live births.
Not
only that.
it is 11.62 and 13.27 in the 30-34 and 35-39 year
age group,
respectively.
Nearly half of ail dealths in the
age group of 15-29 are due to maternal mortality.
it
is
interesting to note here the maternal
mortality
rates
in some of the developed Asian and Western
countries.
It is 0.6 in Sriianka,
0.44 in China. 0.16 in Japan, 0.08 in
USA
and
0.09
in U.K.
Our rural
maternal
mortality
is
probably
about 15 times more than what it should be
for
an
Asian country.
It is probably 60 to 80 times more than that
in
developed countries of the West.
The number of maternal
dealths in rural India in a day is probably equal to maternal
deaths
in
all
the developed countries of the
world
in
a
month.
Tab 1 e
10
presents a more grim picture in terms of
the
association
of maternal mortality to poverty and
remoteness
of
rural
areas.
In
less developed villages the
rate
is
higher than 15 per 1000 live births.
In remote villages, it
is
nearly 10.
Table 11,
shows that obstetric care
is
of
abysmally
poor
quality
in the rural areas - 43.5%
of
all
maternal deaths occur on the day of delivery.
T a b1e
12
presents
the
attendance
at
delivery
by
untrained
people in rural areas of the country as
estimated
by
the
SRS.
Over
70% of al 1 births in
rural
India
are
attended to by untrained people.
The achievement reported by
the Government of India of having training at least 1 dal per
village
does
not
seem to be the answer
to
this
colossal
tragedy taking place in the rural areas.
Figures
1 and 2 and Table 13
presented from
the
ICHR
study
on Evaluation of Quality of Maternal and Child
Health
and Family Planning Services in the
rural areas published in
1989
clearly
point
to the gross inadequacy
of
elementary
antenatal and intranatal care in rural India.
Causes of Death:
Tab 1es
14
and
15 present selected data on
causes
of
death
in
rural India in 1986 and 1987 culled out
from
the
report
of
Survey of Causes of dealth (rural)
1987
of
the
Registrar
General
of
India.
Tuber culosis,
P reumoni a,
Anaemia.
Gastroenteritis,
Dysentry
and
Typhoid
together
account for nearly 20% of all dealths.
In fact, even to day
communicable
diseases account for nearly 40% of al 1
dealths
in
the
country.
In
pre-school
children
some
of
these
diseases take a very heavy toll of death
as can be seen from
Table 15.
4'
k recent study by UNICEF (Delhi) on Diarrhoea in rural
India,
shows that 12%' of preschool children had diarrhoea on
the
day
of
the survey.
This increased to
16%
when
the
reference
period
was two weeks Immediately
proceeding
the
survey
date
and 48% had an episode of
diarrhoea
when
the
reference
period
was
2
months.
Of
the
5310
household
surveyed in this study 23% had experienced at least one child
dea i t h.
Nutri t ion Status;
Table
16 ■ presents the change in undernutrition
during
1975 to 1969 in rural Indian children of 1 to 5 years of
age
from
7
States
in which the National
Nutrition
Monitoring
Burea
has carried out a survey of the same villages in
1989
which were earlier surveyed in 1975.
in quantitative
terms
the
reductions
shown
in
this table
should
be
taken
as
provisional
only
since
the second phase of the
survey
in
independant samples of villages in these States is yet to
be
completed.
However,
barring
Gujarat and Orissa the
other
states
show
a
marked
decline
in
severe
degrees
of
malnutrition.
The
giri
children show greater
improvement
than the boys!
Table 17 presents the results of a survey of tribai boys
and
girls
in the 1-5 year age group in
these
same
states
during
1985-87.
The
prevalence
of
moderate
and
serve
malnutrition is very high in all these 7 states.
It
may
be relevant here to mention the finding on
the
occurance of low birth weight rates in a recent
multicentric
study
on
"risk
approach to MCH" sponsored by the
ICMR
in
Chandirarh,
Delhi,
Jaipur,
Gwalior,
Lucknow,
Pune
and
Varanasi.
In
rural
areas
surrounding
these
places
the
incidence
of
low birth weight babies varied between
33
to
41%.
Tab 1e
1B
presents
the
prevalence
of
Vitomin
A
deficiency
signs
in
rural areas of
Tamila Nadu,
Andhra
Pradesh.
Orissa and Gujarat.
In preschool children, except
in Gujarat,
the prevalence ranged between 5 to 10% h the
5-11 year old children in all the four STates the
prevalence
was high.
Commun i cab 1e Diseases Horb i d i ty:
Tables 19 and 20 present the current situation in regard
to
three
major
communicable diseases covered
by
national
programmes.
The progress in the control of Tuberculosis
of
Lung
is
very disappointing.
Both case detection and
case
holding rates for the required duration of Chemotherapy
have
to
improve
markedly if this disease is to be controlled
in
the next decade or so.
We have to keep in mind the potential
danger
of
Tuberculosis becoming rampant in the
country
if
AIDS spreads as feared.
5
The
Leprosy control front looks more hopeful
with
the
introduction of multi-drug therapy.
In the next 10 years or
so.
it should be possible to cut down the current prevalence
of leprosy in the country by about 80%.
The
resurgence of Malaria since 1971,
though contained
in
a
number of states in India,
shows an increase
in
six
STates as presented in Table 20.
In
addition to these,
it is estimated
that
currently
over
360 million people in India are exposed to the risk
of
Filasis.
There
are 25 million microfilaria camiers and
19
million
diseased
persons.
Japanese
encephalitis,
though
affecting relatively small numbers, has shown sharp increases
in
Uttar Pradesh,
West Bengal,
Gujarat and Madhya
Pradesh
during
1988.
The case fatality
in this disease is
quite
high.
In
1988,
16834 cases of meningits most of which was
meningococal were reported with 3304 healths.
Non-Communicable o iseases:
Tab 1es 21 and 22 present information on o selected
noncommunicable
diseases.
Goitre
is no long confined to
the
sub-Himalayan
regions as revealed by the recent ICMR
survey
of Goitre.
Large numbers of people,
may be a third of
the
Indian
people,
are
exposed
to
the
risk
of
Iodine
deficiency
diseases.
The
prevalence of cretinism in
some
areas is very high.
It is indeed unfortunate that in
spite
of
technology
for
preventing this
disease
being
readily
available, we have not succeeded ih controlling it.
Information
on Cancer is yet confined to selected areas
mostly
urban,
in the country through population
based
and
hospital
based
cancer
registries
started
by
ICMR.
The
available
figures
do indicate that cancer can no longer
be
ignored as a major public health problem.
Blindness
prevalence rates
are quite high and even
in
this
the
females and rural areas show a higher
prevalence.
It
is estimated that more than half of blindness
prevalence
is due to cataract.
It is also estimated that over
70% of
blindness
are
surgically
curable.
Varying
estimates
of
blindness incidence due to vitamin A deficiency in
preschool
children in India are reported in the literature ranging from
20,000/- cases
per year to 40,000/- cases per year.
In any
case.
vitamin A deficiency in preschool children is a public
health
problem
of
importance
that
needs
to
be
tackled
expeditiously and more effectively than at present.
Another
problem
of
public
health importance in the
area
of
noncommunicable
diseases
is
Mental
illness.
A
recent
multicentric
study
on severe mental morbidity sponsored
by
the
ICMR
reports the prevalence to be of the
order
of
1%
which
would
mean a prevalence figure of 8 million cases
of
severe mental morbidity.
6
Heal th
infrastructure and Hea1 th Manpower :
India has truly built up'a vast health infrastructure in
the rural areas of the country.
Official statistics indicate
that
the objective of having a subcentre for 5000 people
in
rural areas and 3000 for hilly and tribal areas and a primary
health
centre
for every 30,000 population
is
very
nearly
achieved.
However,
independent evaluations by the ICHR and
the National Institute of Health and Family Welfare present a
disappointing
picture.
The
NIHFW’s
National
Review
of
immunisation Programme,
carried out recently shows that only
45%
of
the
districts
had
a
subcentre
for
every
5000
population.
The
ICHR HCH evaluation study
indicates
that
only 13.6% of the 198 primary health centres surveyed by them
covered
less
than 40000 population.
More than 70% of
the
primary
health centres were looking after more
than
80,000
people.
A
fifth
were,
in fact,
looking after more
than
150.000
people!
It
seems
that
the
large
functional
infrastructure
claimed to have been created in
the
country
oniy
exists largely on paper.
The huge investment made
in
this
direction
needs to be utilised much more
efficiently
than at present.
In
the area of health manpower also there is an
urgent
need
for improvement.
The ratio of male to
female
multi
purpose
worker which is at present 1:1.6 needs to be brought
to
equality
by
recruiting more
male
workers.
The
male
workers
are also still designated variously as "
small
pox
workers”,
"vaccinators", "Tracloma workers" (for purpose of
salary
dispersal) and many of them function as
'unipurpose’
workers.
This
needs to be corrected immediately.
The HPW
scheme should be implemented as envisaged originally.
No
delineable
pattern
has emerged for
the
Community
Health Centre which is a crucial link in the chain of
helath
infrastructure
planned.
This
should form the
kingpin
of
‘rural
health
care’
taking cases of
first
referrals
f
curative
.care
as
well
as
providing
the
direction
and
leadership
for public health and
prevent i ve/'promot i ve
care
for the 4 PHC’s under its jurisdiction.
The present imbalance in the doctor/nurse ratio needs to
be
speedily
corrected.
The
more than
4
lakh
registered
medical practioners of the Indigenous System of medicine need
to be given an honorable place in the health system.
In summary, it is no exaggeration to say that the health
scene
in
the country is really grim even after 40 years
of
independence.
It
is being increasingly realised now
that
the
goal of good health for the people of India can only
be
reached
through
a
process
that
is
mu 111-dimentiona1
encompassing
appropriate
universal
education,
better
environmental
management
both at
home
and
outside.
we 1 1
integrated
social
services,
an acceptable
minimum
living
7
standard
and,
of
acceptable quality!
course,
hea1 th
and
medical
care
of
The message from svon the limited data presented in this
paper
is loud and clear.
The medical model of health widen
merely concentrates on the use of technological resources
in
freeing
man from clinically identifiable disease or disorder
is at its best an inadequate and at its worst an uneconomical
and
unproductive approach for the improvement of the
health
of
a people.
The medical model has to be tempered
by
the
social
model of health which as mentioned earlier approaches
the goal of good health through a mu 1ti-dimentiona1
process.
Health
development
has
to become an integral part
of
the
socio-economic developmental process.
8
SELECTED 3 YEAR MOVING AVERAGES OF
DEATH RATES/1000 DURING 1971 TO 19S8
Urban
Rural
State.
71-73
78-80 86-88 71-73 78-80 86-88
Arunachal Pd.
Madhya Pradesh
Rajasthan
Uttar Pradesh
Bihar
Orrissa
Assam
Gujarat
Sikkim
Andhra Pradesh
20.9
18.1
17.6
22.9
16.2
18.5
18.1
17.0
NA
17.0
17.1
16.3
14.9
18.6
15.3
14.9
12.1
13.5
NA
13.5
Meghalaya
Haryana
Tamil Nadu
Himachal Pradesh
Karnataka
West Bengal
Jammu & Kashmir
Punjab
Tripura
Goa
Manipur
Kerala
Nagaland
NA
11.9
16.9
15.1
14.2
NA
11.6
12.4
14.0
9.9
8.0
9.1
NA
12.2
12.4
13.4
11.2
12.0
12.8
11.1
10.5
10.7
8.5
7.0
7.0
7.0
INDIA
17.4
14.2
-
16.1
14.9
13.3
15.1
13.7
13.3
12.3
11.3
11.8
10.7
NA
10.9
9.6
13.5
9.5
11.0
9.7
11.9
NA
10.3
NA
9.3
9.2
11.5
7.8
9.3
7.2
10.1
NA
7.9
3.8
8.8
8.2
9.8
8.3
7.6
7.8
8.4
5.7
7.2
10.6
9.7
10.7
9.1
9.5
9.5
8.7
8.7
9.5
8.3
6.7
6.1
5.9
NA
8.3
8.8
6.9
7.9
NA
6.6
9.1
8.0
5.8
6.6
7.8
NA
5.4
8.3
8.7
6.1
7.1
7.0
6.1
8.0
6.2
6.4
4.7
6.6
NA
3.9
7.0
7.3
5.9
6.6
6.4
6.3
6.9
6.7
6.4
5.0
6.6
2.3
12.0
9.9
8.6
7.5
TAftLEZ
ESTIMATED ANNUAL DEATH RATES/1000
FOR 1988*
RURAL
URBAN
Arunachal Pradesh
Madhya Pradesh
Rajasthan
Uttar Pradesh
Bihar
Orissa
Assam
Gujarat
18.1
15.3
14.9
14.0
13.0
12.7
12.0
11.7
4.3
9.6
8.5
9.3
8.1
7.0
7.6
9.0
Sikkam
Andhra Pradesh
Meghalaya
Haryana
11.1
10.6
10.5
10.4
5.5
7.2
2.7
7.3
Tamil Nadu
Himachal Pradesh
Karnataka
West Bengal
Jammu & Kashmir
Punjab
Tripura
Goa
Manipur
Kerala
Nagaland
10.2
9.9
9.5
9.3
9.0
8.8
8.5
8.4
7.2
6.2
5.7
7.1
5.0
6.9
5.7
5.9
7.2
4.6
6.7
5.3
6.7
1.7
11.8
7.5
STATE
INDIA
Provisional SRS figures
3
ESTIMATED AGE AND SEX
SPECIFIC DEATH RATES- 1985
URBAN
RURAL
AGE
( Years )
MALE
FEMALE
MALE
FEMALE
41.1
3.7
45.3
4.8
19.4
1.4
22.1
1.9
14
2.0
2.1
1.2
0.9
- 19
- 24
- 29
- 34
2.0
2.8
3.1
3.5
3.1
4.2
4.1
4.4
1.3
1.8
(2.0
(3.1
1.8
2.4
1.8)
2.2)
35 - 39
40 - 44
45 - 49
50 - 54
65 - 59
60 - 64
66 - 69
70 & Over
4.3
7.2
10.2
15.0
23.1
37.4
50.6
106.2
4.2 .
6.4
7.3
11.1
16.3
28.4
40.2
94.2
3.8
5.6
8.1
15.0
21.0
34.4
40.9
99.1
2.6
3.8
7.0
9.2
14.1
26.3
30.1
82.0
ALL AGES
12.9
13.1
8.0
7.6
0-4
1
i
i
i
i
1
i
1
1
l
1
1
15
20
25
30
G>
LD
1
10 -
.
7a cbi-'S 4- •
ESTIMATED IMR AND CDR BY SEX
1985*
STATE
CDR
I M R
MALE
FEMALE
MALE
FEMALE
Uttar Pradesh
Haryana
Himachal Pradesh
Punjab
132
78
77
67
153
93
92
76
14.9
8.8
10.6
9.4
16.8
9.5
10.4
8.3
Bihar
Rajasthan
Tamil Nadu
Gujarat
:■
Maharashtra
Madhya Pradesh
104
107
80
97
68
123
107
109
83
99
68
122
14.1
13.1
9.7
11.0
8.7
14.1
15.9
13.3
9.3
10.7
8.1
14.2
Karnataka
Kerala
Andhra Pradesh
Orissa
Assam
West Bengal
Jammu & Kashmir
72
• 34
86
137
116
80
97
67
- 28
79
126
105
67
71
9.2
7.7
10.8
14.2
13.7
9.7
10.1
8.3
5.4
9.8
13.8
12.6
9.4
9.4
96
98
INDIA
SQs
1
I
ESTIMATED INFANT MORTALITY RATES,
BIRTH RATES AND DEATH RATES, 1988’
URBAN
RURAL
i
STATE
IMR
BR
DR
IMR
BR
DR
Uttar Pradesh
Madhya Pradesh
Orissa
Rajasthan
Gujarat
Assam
Bihar
Haryana
Andhra Pradesh
Tamil Nadu
132
127
127
111
101
101
100
96
87
84
38.0
38.2
32.2
33.9
29.8
33.2
38.1
34.8
27.0
23.2
14.0
15.3
12.7
14.9
11.7
12.0
13.0
10.4
10.6
10.2
79
83
70
67
64
67
70
64
63
51
31.9
30.9
26.1
27.7
28.0
23.7
30.4
29.4
26.0
21.1
9.3
9.6
7.0
8.5
9.0
7.6
8.1
7.3
7.2
7.1
Karnataka
Himacha! Pradesh
Jammu & Kashmir
West Bengal
Maharshtra
Punjab
Kerala
83
81
76
76
76
63
30 ■_
30.1 32.7
35.0
31.8
31.3
28.9
19.6
46
9.5
9.9
41
54
9.0
43
9.3
10.1 49
8.8 59
6.2 X co
Cm Om
24.9
22.5
23.6
18.7
25.6
27.5
21.2
6.9
5.0
5.9
5.7
6.5
7.2
6.7
102
32.8
11.8 61
26.0
7.5
INDIA
Neonatal and Post-neonatal Mortality Rates in Major States of India
1970-72, 1976-78 and 1983-85*
Neonatal Mortality Rate
Post-neonatal Mortality Rate
ate
1970-72
1976-78
1983-85
1970-72
1976-78
1983-85
rilia
71.8
78.2
64.4
61.1
50.5
37.7
rilhra Pradesh
65.9
83.3
54.8
45.7
38.0
24.4
s;am
84.1
73.1
70.9
49.6
45.9
30.3
jjarat
80.3
80.3
66.8
61.4
55.0
36.3
ryana
42.6
64.0
49.5
38.7
47.3
42.7
mnachal
adesh
60.7
48.7
40.9
61.0
61.0
43.7
rmmu and
shmir
36.1
42.0
50.9
34.9
25.7
26.9
rrnataka
59.0
54.2
46.8
36.0
30.5
24.6
irala
37.1
29.6
22.0
23.0
18.7
9.00
idhya Pradesh
76.8
77.4
74.2
68.2
65.6
48.7
lharashtra
62.4
57.7
50.6
39.0
33.0
23.9
•issa
2JL.0.
75.8
82.4
59.3
59.9
47.3
injab
21.0
64.8
41.7
89.6
45.2
30.8
ujasthan
70.4
79.4
68.0
52.6
61.9
45.3
lami 1 Nadu
54.0
63.9
57.1
65.6
42.1
25.3
55.4
76.5
80.6
95.2
—
Source: Sample Registration System, 1970-75, 1976-78, 1983, 1984, 1985 Registrar General of
ndia, Ministry of Home Affairs, Government of India, New Delhi.
ttar Pradesh
93.7
97.8
Estimated Rates of Perinatal Mortality, Still births, Early and Late Neonatal
Mortality Rates - India 1971-1985
Perinatal Mortality
Rate
Stillbirth
Rate
Early Neonatal
Rate*
Year
Late Neonatal
Rate**
Rural
Urban
Rural
Urban
Rural
Urban
Rural
Urban
1971
56.7
35.6
18.3
12.9
38.4
22.7
42.2
22.7
1972
53.3
36.6
18.5
14.4
34.8
22.2
41.8
22.7
1973
53.3
37.4
18.0
15.1
35.3
22.3
36.8
25.2
1974
55.1
36.3
17.9
12.5
37.2
23.8
38.5
17.2
1975
58.8
36.1
18.6
12.5
40.2
23.6
44.1
22.6
1976
76.6
76.6
43.7
18.7
57.9
32.6
25
16
1977
69.5
69.5
16.8
8.7
52.7
26.7
35
15
1978
67.9
67.9
33.5
16.0
51.9
23.2
33
15
1979
63.1
38.7
13.3
9.1
49.8
29.6
28
13
1980
59.8
35.3
12.0
7.9 -
47.8
27.4
28
12
1981
58.8
31.5
11.4
6.2
47.4
25.3
28
13
1982
57.7
33.1
9.8
5.2
47.9
27.9
25.0
’10.9
1983
57.7
35.4
9.4
8.4
48.3
27.0
25.3
12.3
1984
58.3
35.7
■ 11.0
7.9
47.3
27.8
24.9
11.9
1985
52.4
30.4
10.8
8.9
41.6
21.5
25.0
11.8
*
**
By subtracting Still birth Rate from Perinatal Mortality Rate.
By subtracting Early Neonatal Mortality Rate from Neonatal Mortality Rate.
o LaJVO- *
S
S .
M M R(PER 1000 LB)!N RURAL 3NDJA FOR 1987 *
ESTIMATED USING SURVEY OF CAUSES OF DEATHS St
—
CDR
STATE
MATERNAL
DEATHS AS
% OF ALL
DEATHS
CBR
ESTIMATED
MATERNAL
MORTALITY
RATE
I
UP.
HP
BIHAR
MP.
RAJASTHAN
ORISSA
HARYANA
GUJARAT
AP.
MAHARASHTRA
TAMIL NADU
J.& K.
KARNATAKA
16.6
8.7
13.6
14.6
12.6
13.7
9.4
10.8
10.7
9.6
11.1
8.0
9.7
1.8
2.0
1.4
1.3
1.3
1.0
1.6
0.8
0.6
0.6
0.4
0.6
0.3
39.3
31.4
37.3
37.6
36.3
31.6
35.4
31.6
30.9
30.2
24.1
32.6
29.9
7.1
5.6
6.1
6.1
4.5
4.3
4.0
2.7
2.0
1.9
1.8
1.5
1.6
PUNJAB
KERALA
8.5
6.1
0.2
NEGLIGIBLE
28.9
21.6
0.6
-
INDIA
12.0
1.0
33.7
3.6
1
II
5
5
]
3
1
•
j
MATERNAL MORTALITY IN RURAL AREAS
OF ANANTAPUR DIST.(ANDHRA) 1984 - 85
AGE GROUP
(YEARS)
M M R
(PER 1000
LIVE BIRTHS)
% OF MATERNAL
DEATHS TO ALL
DEATHS IN AGE
rir.z'M
!D
*<^1 I
W1
1
19
7.96
47.6
20 - 24
8.26
53.3
29
7.02
49.4
30 - 34
11.62
41.4
- 39
13.27
35.4
3.61
7.9
15
25
35
-
-
-
40 - 44
45
- 49
2.71
1.1
15
- 49
8.30
38.4
1
* SOURCE : A STUDY OF MATERNAL MORTALITY IN
ANANTAPUR DISTRICT BY DR. JAGDISH
C.BHATIA, IIM , BANGLORE
IO
MATERNAL MORTALITY IN RELATION TO STATUS
OF VILLAGE IN ANANTAPUR DIST. 84-85
DEVELOPMENT
STATUS OF
VILLAGE
IPOORLY
JSOMEWHAT
t
37.6%
ADEQUATELY
HIGHLY
62.4%
r M M R
(/WOO LB)
TYPE OF VILLAGE^ M M R
ACCORDING TO
V[000 lb)
HEALTH FACILITY \
21.66
PHC HQ
4.S2
16.23
SUB CENTRE HQ
7.60
S.03
6 KM FROM PHC
9.70
6.W
>6 KM FROM PHC
9.64
'T'A-ft. L£
MATERNAL DEATHS IN RURAL AREAS OF
ANANTHAPUR DT BY GESTATION AND TIMING
--------------------------n
GESTATION
PERIOD
(WKS)
LESS THAN 25
23
-
35
36 OR MORE
PERCENT OF
MATERNAL
DEATHS
TIMING OF
OCCURENCE
PERCENT OF
MATERNAL
DEATHS
10.4
ANTEPARTUM
17.9
10.3
INTRAPARTUM
12.2
79.3
POSTPARTUM
69.8
43.6 % OF MATERNAL DEATHS
41.9 % OF MATERNAL DEATHS
SEPSIS
ON THE DAY OF DELIVERY
DUE TO HAEMORRHAGE &
BIRTHS ATTENDED SY UNTRAINED PERSONS
IN RURAL AREAS «
% BIRHTS ATTENDED BY UNTRAINED
_
72.8
84.7
39.8
89.6
52.2
83.3
75.4
72.6
83.5
28.5
89.9
51.0
82.8
73.0
70.6
83.3
28.8
88.7
51.6
83.1
73.7
68.8
82.6
28.3
88.7
48.9
80.4
71.8
INDIA
71.1
70.2
69.5
67.5
*
SRS
81.3
79.3
50.0
19.5
65.5
77.2
50.9
14.6
86.2
i
MAHARASHTRA
ORISSA
PUNJAB
RAJASTHAN
,
TAMIL NADU
UTTAR PRADESH
WEST BENGAL
-
66.7
81.7
82.0
53.0
21.5
67.4
78.5
54.6
16.7
87.1
I
68.7
82.2
82.2
53.2
23.0
68.4
79.8
57.8
20.0
87.4
]
ANDHRA PRADESH
73.3
ASSAM
82.4
BIHAR
82.5
GUJARAT
53.9
HARYANA
23.2
HIMACHAL PRADESH 71.0
JAMMU a KASHMIR 78.5
KARNATAKA
58.2
29.7
KERALA
86.6
MADHYA PRADESH
i
1985
i
1984
i
1987
1963
o
9Ol
STATE___ __
ANTENATAL CARE
Registration of Pregnant womera
N o records
<
40 Vo
4 0-^60 Vo
60-<80%
80 V.+
Fig-t.1
JsouyCx ’
ICMP,
Q. E.
antenatal
care
Coverage for Iron/Folic acid
;overag , for TT(FUII dose)
TffB&E=T3^
ANTENATAL CARE AT SUBCENTRE
(FROM RECORDS OF 100 CASES)
ROUTINE EXAM.
Hb
B.P.
URINE
EXAM.
WEIGHT
*J0 FACILITIES
148
165
138
120 .
93
<0 INFORMATION
28
19
35
51
59
DONE
-22
14
25
27
46
total phc's
198
198
198
198
198
I
: \zr* R. Iz V
mcB
S=cw^
PERCENT OF ALL-DEATHS ACCOUNTED FOR BY
SELECTED DISEASES IN RURAL INDIA *
1936
1937
T.B. OF LUNGS 5.3
5.3
PNEUMONIA
4.7
HEART ATTACK
ANAEMIA
3.1
2.9
CANCER
QASTROENTERITIS2.2
1.9
DYSENTERY
1.9
TYPHOID
i---------------------------
5.2
5.5
5.6
2.5
3.1
2.3
1.6
1.8
DISEASES
(iw)
su*'r<^
SOURCE ^CAUSES OF DEATH S(RURALJ/RQ’S OFFICE .
j-ft-feL-E |S~
PERCENT OF DEATHS BY AGE GROUPS IN
SELECTED DISEASES IN RURAL INDIA*
■DISEASES
!
PERCENT DEATHS IN AGE GROUPS
0-4 5 - 14 15 - 24 25 - 34 35 - 44
TB OF LUNGS
PNEUMONIA
HEART ATTACK
ANAEMIA
CANCER
G ASTROENT.
DYSENTERY
TYPHOID
MALARIA
1.7
76,9
0.8
33.4
1.5
44.4
43.0
29.7
2.8
9.7
1.0
8.4
2.9
11.6
12.4
12.3
10.8
7.4
1.6
4.6
4.3
1.9
7.6
6.0
10.8
8.8
■17 ft
2.8
7.1
6.4
6.4
6.0
2.8
6.6
5.4
20.8
1.7
11.2
4.7
14.0
3.3
4.2
7.2
4.4
45+
49.7
8.3
76.3
43.8
73.3
27.2
32.6
29.6
40.9
•
ta^>l e
CHANGE IN UNDER NUTRITION DURING
1975 TO 1989 IN RURA _ INDIAN* 4
1M
-5ye.oP
A6.E'
p «>>*•
YEAR OF
BOYS
GIRLS
STUDY
MODERATESEVERE MODERATE
•x-x-
in
GO
STATE
£ R fc N
.
m
cM1
•KERALA
1975
1989
61.2
55.0
14 3
3.3
46.0
34.4
17.4
2.2
TAMIL NADU
1975
1989
53.9
43.5
12.1
5.8
49.6
49.7
20.2
4.8
KARNATAKA
1975
1989
56.0
61.1
18.0
8.0
55.9
53.4
17.0
10.3
ANDHRA PD.
1975
1989
56.6
48.7
19.6
11.7
51.2
52.7
24.0
9.4
MAHARASHTRA 975
57.5
29.9
47.0
32.0
1989
59.9
9.4
50.3
9.1
GUJARAT
1975
1989
60.8
51.5
13.1
21.2
53.1
43.5
16.0
22.4
ORISSA
1975
1988
46.2
54.7
11.4
12.8
51.0
61.7
15.0
14.0
|
I
* SOU ACE < INTERIM REPORT Or REPEAT SURVEY PHAS
(1938 - 89 ) Or NNMB
** GOMEZ CLASSIFICATION USING NOHS STANDARDS
UNDER NUTRITION IN PRESCHOOL TRIBAL
BOYS a GIRLS *
GOMEZ CLASSIFICATION USING NCHS STANDARDS
in
i
<
Hl
ni
i
i
3.6
49.3
9.7
KARNATAKA
48.9
31.7
50.6
ANDHRA PRADEI3H
57.2
18.8
49.9
19.2
M A H A R AS H T R A
59.9
15.6
58.0
14.9
GUJARAT
53.5
24.6
42.2
27.2
ORISSA
38.3
28.1
45.7
24.9
WEST BENGAL
55.6
13.3
52.5
15.0
<71
TAMIL NADU
GOMEZ CLASSIFICATION USING HYDERABAD WELL-TO-DO
rsnrM cv-fa ur> a r»r\r*
CHILDREN
STANDARDS
STATE
BOYS
MODERATE SEVERE
GIRLS
SEVERE
MODERATE
KERALA
40.8
8.0
35.8
1.9
■TAMIL NADU
37.3
4.5
28.1
2.3
KARNATAKA
47.8
21.3
44.9
15.6
ANDHRA PRADE-SH
47.4
10.8
33.7
5.8 '
MAHARASHTRA
44.7
8.2
30.6
6.3
GUJARAT
42.2
16.3
31.3
10.7
ORISSA
38.3
18.7
30.8
10.1
WEST BENGAL
40.2
7.7
28.0
5.7
• SOURCE : TRIBAL SURVEY BY NNMB 1985-67
1
;
1
1
1
•?1 A A
11.2
--------
m
ft:
UJ
>
LAI
«
53.7
69.2
(B)
i
i
i
i
i
i
i
i
i
MODERATE
i m
S
o:
i _.i
i
[
i
i
■
■
i
BOYS
MODERATE S
i
I
j STATE
____ __________
| KERALA
CO
(A)
'TfW-G 'S
VITAMIN A DEFICIENCY SIGNS IN RURAL
AREAS* OF FOUR STATES
AGE GROUP
TAMIL NADU
ANDHRA
PRADESH
ORISSA
GUJARAT
-
4
9.9
4.9
6.0
0.7
-
11
•< O Q
10.5
8.4
13.1
12 - 20
5.9
8.9
2.1
1.0
-
5.8
4.3
0.4
3.7
1
5
21
SOURCE : REPORT OF NNMB - NSSO LINKED SURVEY 83-84
' Th-ft»L.£
•.
INFORMATION ON SELECTED COMMUNICABLE
DISEASES COVERED SY NATIONAL PROGRAMMES
i T.ft. of
lunO
'TED PREVALENCE ( > 6 YEARS OF AGE
(a)
(b)
RADIOLOG ICALLY ACTIVE 1.6 % <12.0
SPUTUM POSITIVE
0.4 % ( 3.2
MILLON)
MILLON)
CASE DETECTION IN NATIONAL PROGRAMME
20 % INCREASE OVER 1985 DETECTION RATES. IN 7TH PLAN
ON AVERAGE. ABOUT 16 LAKH NEW CASES/YEAR DETECTED
EFFECTIVENESS OF PROGRAMME
ON CONVENTIONAL ( 18 ~24 MONTHS ) THERAPY
CASE DETECTION
CASE HOLDING
AMEST OF DISEASE
36 % S
35 % !]
75 % |
9.2 %
SHORT COURSE THERAPY INTRODUCED IN 194 DISTRICTS.
DEATH RATES REDUCED BY 40 TO 6-0 % WHERE PROGRAMME
IS EFFECTIVE
[LEPROSY?
NO DISTRICT FREE OF DISEASE.
ENDEMIC (> 5 CASES /1000 POPU. ) IN 196 DISTRICTS
COVERING 430 MILLON
TOTAL ESTIMATED CASES 4.0 MILLON, 0.8 MILLON INFECTIOUS.
MULT! DRUG THERAPY INTORDUCED IN 112 DISTRICTS
COVERING 200 MILLON WITH 2.2 MILLON LEPROSY CASES.
IN DISTICTS THAT HAVE COMPLETED MORE THAN 6 YEARS
OF MDT FALL OF PREVALENCE BY BO %
4
INFORMATION ON SELECTED
NON COMMUNICABLE DISEASES
IODINE DEFICIENCY DISEASES
CONSERVATIVE ESTIMATE :
GIOTRE
:
7.8 %
58 MILLION CASES
CRETINISM
:
0.3 %
2.4 MILLION CASES
MINOR NEUROLOGICAL: 0.9 %
7.2 MILLION CASES
RESULTS OF ICMR TASK FORCE STUDY ( 1983 - 86 )
:
STUDY AREAS
SUB HIMALAYAN
5 DIST.
EXTRA HIMALAYAN
HILLY
3 DIST.
COASTAL
2 DIST.
PLAINS
4 DIST.
J21£IR!^8_fLOR^
%_ GOITRE
2k CRETINISM
£5.8
31.8
20.2
20.0
18.6
2.2
1.1
0.2
0.4
0.1
MAN.DLA
B
WEST MANIPUR S HILLY
N1LGRI
I
34.4
19.8
6.9
2.1
6.1
1.7
SURAT
UCOAST
VISHAKAPATNAM|
22.7
15.8
0.4
0.2
MUZAFFARPUR
DHULE
CENTRAL
{PLAINS
I
33.7
16.5
10.4
1.7
0.1
3.0
MANIPUR
MIRZAPUR
|,
8
6.2
0.3
DISTRICTS
DIBRUGARH
SITAMARI
BAHARAICH
BASTI
GORAKHPUR
it
{ SUB
' HIMALAYAN
0
4
INFORMATION ON SELECTED
NON COMMUNICABLE riidpAC; q
IODINE DEFICIENCY
diseases
CONSERVATIVE ESTIMATE ;
GIOTRE
:
7.3 %
58 MILLION CASES
CRETINISM
:
0.3 %
2.4 MILLION CASES
MINOR NEUROLOGICAL: 0.9 %
7.2 MILLION CASES
RESULTS OF ICMR TASK FORCE STUDY ( 1983 - 86 )
STUDY AREAS
SUB HIMALAYAN
5 DIST.
EXTRA HIMALAYAN
HILLY
3 DIST.
COASTAL
2 DIST.
PLAINS
4 DIST.
PERSONS EXAMIN ED IN THE 14 DISTRICTS 4.09.923
DISTRICTS
% GOITRE
2L_£a£UN!SK4
£5.8
31.8
20.2
20.0
18.6
2.2
1.1
0.2
0.4
0.1
HILLY
34.4
19.8
6.9
2.1
6.1
1.7
JC0A3T
SURAT
VISHAKAPATNAM j
22.7
15.8
0.4
0.2
I
iPLAINS
•
33.7
16.5
10.4
1.7
0.1
3.0
J
6.2
0.3
DIBRUGARH
SITAMARI
BAHARAICH
BASTI
GORAKHPUR
SUB
HIMALAYAN
MANDLA
WEST MANIPUR
NILGRI
MUZAFFARPUR
DHULE
CENTRAL
MANIPUR
MIRZAPUR
__________________ _ _____ __ ____________ J
INFORMATION ON SELECTED
NON COMMUNICABLE DISEASES
IODINE DEFICIENCY DISEASES
CONSERVATIVE ESTIMATE ;
GIOTRE
:
7.3 %
68 MILLION CASES
CRETINISM
:
0.3 %
2.4 MILLION CASES
MINOR NEUROLOGICAL: 0.9 %
7.2 MILLION CASES
RESULTS OF ICMR TASK FORCE STUDY ( 1983 - 86 )
STUDY AREAS
:
SUB HIMALAYAN
6 DIST.
EXTRA HIMALAYAN
HILLY
3 DIST.
COASTAL
2 DIST.
PLAINS
4 DIST.
persons EXAMINED IN .THE 14 P!STRJ.CTg_.<Q.^3
% GOITRE
% CRETINISM
£6.8
31.8
20.2
20.0
18.6
2.2
1.1
0.2
0.4
0.1
MANDLA
B
WEST MANIPUR § HILLY
NILGRI
&
34.4
19.8
6.9
_2J
6J
1.7
SURAT
IjCOAST
VISHAKAPATNAMl
22.7
16.8
0.4
0.2
I?
PLAINS
:
33.7
16.6
10.4
1.7
0.1
3.0
8
6.2
0-3
DISTRICTS
DIBRUQARH
SITAMARI
BAHARAICH
BAST!
GORAKHPUR
MUZAFFARPUR
DHULE
CENTRAL
MANIPUR
MIRZAPUR
it
SUB
I HIMALAYAN
8
§
----------------L
INFORMATION ON SELECTED
NON COMMUNICABLE DISEASES
CANCERS
RAT E/1,00,000
FEMALES
MALES
TRUNCATED INCIDENCE ( 1986 ) :
(36-64 YRS: WORLD POPU.)
BANGLORE
180.3
282.7
BOMBAY
181.3
226.4
MADRAS
202.7
333.1
LIFE-TIME INCIDENCE RATES (0 - 74 YRS) OF CANCER OF
TONGUE, OESOPHAGUS, STOMACH AND CERVIX ARE HIGHER
COMPARED TO DEVELOPED COUNTRIES. VERY PRONOUNCED
DIFFERENCE SEEN IN CANCER OF CERVIX. THE LIFE-TIME
RISK OF DEVELOPING CANCER OF CERVIX IN BANGLORE ,
BOMBAY AND MADRAS ARE 3.62 %, 2.07 % AND 6.34 %
RESPECTVELY COMPARED TO LESS THAN 1 % IN DEVELOPING
COUNTRIES.
BOTH EYES BLIND- -.PREVELANCE/1000
MALE
FEMALE
URBAN
RURAL
ICMR STUDY
(1971 - 74)
11.02
17.10
11.14
1o,44
NATIONAL SOCIETY
FOR PREVENTION
( 1986 - 88 )
14.20
16.00
10.10
16.30
* VISUAL ACQUITY < 6 / 60 IN THE SETTER EYE
CURRENT BACKLOG FOR SURGERY
MILLION EYES
'VPvtsi-E X-Z •
SELECTED INFORMATION ON INFRASTRUCTURE
AND MANPOWER IN THE RURAL HEALTH SYSTEM*
INSTITUTIONAL INFRASTRUCTURE (31/3/90)
l
1
RURAL
PHC
20,531
CHC
1,852
1,30,000 ;
G
>
I
1.30,390
required: INPOSITION
0>
a>
SUB ClN i Rt:
INPOSITION
ro
; INSTITUTION
TRIBAL
2,705
REQUIRED
A
18,070
AA £
CF W v
2,945
3,h“o5
NA
NA
A CHC ON AVERAGE CATERS TO 3.24 LAKH PEOPLE
A^RAQH^PLL_3ERYED
I
ratio qf male tq female MP
i) (MPW) MALE WORKER
: 7300
ii) (MPW) FEMALE WORKER
: 4971
1:1.6
iii) 1 VILLAGE HEALTH CENTRE : 1466
i * RURAL HEALTH STATISTICS IN INDIA,MARCH 1990
!
DGHS,NEW DELHI
POPULATION (in iooo) COVERED BY
to - ES8
F^'
PHC
-J7) PAb 2-^ '
EXTRACTS FROM NATIONAL REVIEW OF
IMMUNIZATION PROGRAMME
1.
DISTRICTS WITH SUB CENTRES AS PER
OR MORE THAN THE NORM
45.2 %
2.
SUB CENTRES WITH FEMALE RESIDENT
IN THE AREA
76.7 %
•3.
DISTRICTS ACHIEVING MORE THAN 50 %
COVERAGE WITHOUTEASLES(EXCLUDlNG
URBAN UNITS)
40.0 %
DISTRICTS ACHIEVING MORE THAN 60 %
COVERAGE WITH MEASLES(EXCLUDING
URBAN UNITS)
2.9 %
4.
% DISTRICTS ACHIEVING STATED COVERAGES FOR DIFFERENT
VACCINES (EXCL UDI NG URBAN UNITS)
% COVERAGE
< 60
DPT
OPV
ECG
20.0
23.0
40.0
51
- 75
62.9
60.0
54.3
76 - 86
8.6
8.6
2.9
86
8.6
6.6
2.9
- Media
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