The NFHS-4 health report card of 13 states and two Union Territories reveals improvement in child health but also indicates the need for more measures for further development. A compilation of some interesting findings from the report
Aligning proper mother and child care has been a long-term objective for India and the first phase of NFHS 4 survey showcases that the country is improving in child health and nutrition. But the progress showcased amongst the 13 states and two Union Territories is uneven as they are fairly rapid in some fields, and slow in others.
The large-scale, multi-round survey’s first phase was conducted in a representative sample of households in Andhra Pradesh, Bihar, Goa, Haryana, Karnataka, Madhya Pradesh, Meghalaya, Sikkim, Tamil Nadu, Telangana, Tripura, Uttarakhand, West Bengal and two Union Territories of Andaman and Nicobar Islands as well as Puducherry.
IMR: On a gradual decline
The survey also noted a reduction in the infant mortality rate (IMR), by 16 points over the last 10 years. The ratio declined from 54 deaths per 1000 live births in 2005-06 to 41 deaths per live births in 2015-16. The IMR has dropped by more than 20 percentage points in Tripura, West Bengal, Jharkhand, Arunachal Pradesh, Rajasthan and Odisha. The under-five mortality rate has also decreased from 74 in the last NFHS (2005-06) to 50 in the current one – revealing a 24-point reduction in deaths.
At 99.9 per cent in both urban and rural areas, Kerala has the highest institutional births in the country. Tamil Nadu is a close second with 99.2 per cent institutional births in urban areas and 98.7 per cent in rural areas. But both states do not fare greatly when it comes to initiating breastfeeding within one hour of birth. At 64 per cent, Kerala is below Goa’s average of 73 per cent. Similarly, Maharashtra with 90 per cent institutional deliveries has 57.5 per cent for early initiation of breastfeeding compared to Tamil Nadu’s nearly 55 per cent.
The overall institutional births conducted at hospitals and health institutions increased by 40 percentage points, from 38.7 per cent during the last NFHS to 78.9 per cent this survey. The Empowered Action Group (Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Rajasthan, Madhya Pradesh, Chhattisgarh and Odisha) and Assam, saw an increase of more than 40 percentage points.
However, more babies have been delivered through caesarian than through normal delivery, indicating a push, especially by private players, towards C-sections. The nationwide average on the number of caesarians conducted has increased from 8.5 per cent of all deliveries in NHFS 3 to 17.2 per cent in NFHS 4.
Although the survey indicates a slight improvement, the country still needs to take large strides when it comes to IMR which stands at 41 currently, while comparatively poorer countries like Bangladesh ranks 31 and Nepal stands at 29 while African countries like Rwanda and Botswana is at 31 and 35 respectively. India’s under-five mortality (50) is substantially worse than its poorer neighbours, such as Nepal (36) and Bangladesh (38) and Bhutan (33).
Though it has reduced infant deaths by 48 per cent over 23 years, from 79 in 1992-93 to 41 in 2015-16, India is far from the 2015 millennium development goal — set in consultation with the United Nations — of an IMR of 27.
Rise in immunisation
As for immunisation, 62 per cent of Indian children between the ages of 12 and 23 months were fully immunised –for BCG, measles, and three doses each for polio and diphtheria and tetanus — up from 43.5 per cent in 2005-06. At least six out of 10 children have received full immunisation in 12 of the 15 states/ Union Territories. In Goa, West Bengal, Sikkim, and Puducherry more than four-fifths of the children have been fully immunised. Since the last round of NFHS, the coverage of full immunisation among children has increased substantially in the States of Bihar, Madhya Pradesh, Goa, Sikkim, West Bengal and Meghalaya.
When it comes to full immunisation coverage among children aged between 12-23 months, it varies widely among states. For example, Chhattisgarh had the highest IMR (54), and Madhya Pradesh the highest under-five mortality (65) in the country, while Kerala’s IMR (6) and under-five mortality (7) rates were the lowest. Mizoram was the only state to report an increase in infant mortality- from 34 deaths per 1,000 live births in 2005-06 to 40 in 2015-16.
As many as 90.7 per cent of children were immunised in public health facilities, compared with 82 per cent in 2005-06; children immunised in private facilities dropped from 10.5 per cent in 2005-06 to 7.2 per cent.
–
–
–
–
Improving health statistics
The proportion of children under the age of five who reported suffering from diarrhoea in the two weeks preceding the survey was nearly constant over the decade with 9.2 per cent in 2015-16 compared to nine per cent in 2005-06. However, the proportion of children with diarrhoea who received the recommended treatment of oral rehydration salts (50.6 percent) doubled compared to a decade ago (26 per cent). Increased awareness about common childhood diseases and recommended treatment among parents, dipped diarrhoea-affected children from (67.9 per cent) compared to 2005-06 (61.3 per cent).
There was a 10 percentage point decrease in stunted children low height-for-age below age five: From 48 per cent in 2005-06 to 38.4 per cent in 2015-16. Also a seven-percentage-point decrease was seen in children under five who were underweight (low weight-for-age), from 42.5 percent in 2005-06 to 35.7 per cent in 2015-16.
Fewer children between age of 59 months to six years suffered from anaemia in 2015-16, (58.4 per cent) compared to 69.4 percent in 2005-06. However, the proportion of children under five who were wasted — low weight-for-height — increased from 19.8 per cent to 21 per cent. The number of severely wasted children increased from 6.4 per cent to 7.5 per cent.
Another highlight of the survey was that the overall sex ratio at birth was marginally improved slightly from 914 females to 1000 males in 2005-06, to 919 in 2015-16. Chhattisgarh had improved from the national average ratio of 977, Haryana marked the highest improvement from 762 to 836. This was again led by Kerala which has the highest sex ratio (1047).
While the overall contraception usage has decreased by two percentage points from NFHS-3 to NFHS-4, pills and condom usage have shown increasing trend. There is, however, a vast gender disparity in sterilisation with the national average standing at 0.3 per cent for males and 36 per cent for females.
(Compiled by Prathiba Raju)