NFHS-5 with special reference to Assam

1. NFHS-5 with Special Reference to Assam
Mostaque Ahmed ,
PGT
Dept. of Community Medicine,
Gauhati Medical College & Hospital,
Guwahati
1

2. Introduction
• National Family Health Survey (NFHS) is a large scale, multi-
round survey conducted in a representative sample of
households in India.
• NFHS was initiated in the year 1990.
 NFHS-1 in 1992-93
 NFHS-2 in 1998-99
 NFHS-3 in 2005-06
 NFHS-4 in 2015-16
 NFHS-5 in 2019-21
2

3. NFHS Goal
• Each successive round of the NFHS has had two specific goals:
a) to provide essential data on health and family welfare
needed by the Ministry of Health and Family Welfare and other
agencies for policy and programme purposes, and
b) to provide information on important emerging health and
family welfare issues.
3

4. • Conducted by: Ministry of Health and Family Welfare GOI.
• Nodal agency: International Institute For Population Sciences (IIPS) Mumbai.
• Funding:
- United States Agency for International Development(USAID),
- The United Kingdom Department for International Development
- The Bill and Melinda Gates Foundation(BMGF),
- United Nations Children’s Fund(UNICEF),
- United Nations Population Fund (UNFPA) and
- The MacArthur Foundation and
- Government of India.
• Technical assistance: International Classification of Functioning, Disability and Health(ICF) USA
with financial support from USAID (For NFHS-5).
• Assistance for HIV Component: National AIDS control organization (NACO) and National AIDS
Research Institute (NARI), Pune.
4

5. • The National Family Health Survey 2019-21 (NFHS-5), the fifth in the NFHS
series, provides information on population, health, and nutrition for India and
each state/union territory (UT).
• Components of NFHS-5:
 Population and household profile
 Characteristics of Adults ( age 15-49 years)
 Fertility
 Infant and child mortality
 Maternal and child health
 Reproductive health
 Nutrition
 Anaemia
 Utilization and quality of health and family planning services
5

6. • NFHS-5 includes some new topics in comparison to NFHS-4,
such as-
- Preschool education,
- Disability,
- Access to a toilet facility,
- Death registration,
- Bathing practices during menstruation, and
- Methods and reasons for abortion
• The scope of clinical, anthropometric, and biochemical testing
(CAB) has also been expanded to include measurement of waist
and hip circumferences, and the age range for the measurement
of blood pressure and blood glucose.
6

7. • HIV testing has been dropped.
• It gives information up to district level except information about
sexual behaviour; husband’s background and woman’s work;
HIV/AIDS knowledge, attitudes and behaviour; and domestic
violence, which are available only at the state/union territory (UT)
and national level.
• Information collected on 19 languages using Computer
Assisted Personal Interviewing (CAPI)
• Eligibility criteria: Woman age: 15- 49 Man age: 15-54
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8. • Provide high-quality data on health and family welfare and
emerging issues in this area
• Setting benchmarks and examining the progress of health
sector over the time
• Providing evidence for the effectiveness of ongoing
programmes
• Also help in identifying the need for new programmes and the
groups that needs essential services
8
Objectives:

9. Sampling Design:
9
For Rural Area
Sub-stratified into smaller
substrata
Stratification based on Village
size, percentage of SC/ ST
population and literacy rate of
woman age >6 years
From each PSU, a fixed number
of 22 households per cluster
are selected using systemic
random sampling
Villages are selected as Primary
Sampling Unit (PSU)

10. Sub-stratified into
smaller substrata
Census enumeration blocks
(CEB) is selected as Primary
Sampling Unit(PSU)
From each PSU, a fixed number
of 22 households per cluster are
selected using systemic random
sampling
Primary Sampling Unit
(PSU) are sorted
according to ST/SC
population
For Urban Area
10

11. Data about some important indicators: NFHS-5
India Assam
Sex ratio of the total population
(females per 1,000 males)
1020 1012
Total fertility rate (children per
woman)
2.0 1.9
Neonatal mortality rate (per 1,000
live births)
24.9 22.5
Infant mortality rate (IMR) 35.2 31.9
Under-five mortality rate 41.9 39.1
11

12. India Assam
Sex ratio at birth for children born in the last
five years (females per 1,000 males)
929 964
Total unmet need(%) 9.4 11
Unmet need for spacing(%) 4 4
Mothers who had at least 4 antenatal care
visits (%)
58.1 50.7
Mothers who had an antenatal check-up in the
first trimester (%)
70 63.8
Institutional births (%) 88.6 84.1
Children age 12-23 months fully vaccinated 76.4 66.4
12

13. India Assam
Children age 12-23 months fully vaccinated 83.8 71.8
Children age 12-23 months who received most of
their vaccinations in a public health facility (%)
94.5 95.6
Children age 12-23 months who received most of
their vaccinations in a private health facility (%)
4.2 2.3
Births delivered by caesarean section 21.5 18.1
Children under 5 years who are stunted (height-
for-age)
35.5 35.3
13

14. India Assam
Children under 5 years who are
wasted (weight-for-height) (%)
19.3 21.7
Children under 5 years who are
severely wasted (weight-for-height)
(%)
7.7 9.1
Children under 5 years who are
underweight (weight-for-age)
32.1 32.8
Children under 5 years who are
overweight (weight-for-height)
3.4 4.9
14

15. India Assam
Children age 6-59 months who are anaemic (<11.0 g/dl) 67.1 68.4
Non-pregnant women age 15-49 years who are
anaemic (<12.0 g/dl)
57.2 66.4
Pregnant women age 15-49 years who are anaemic
(<11.0 g/dl)
52.2 54.2
All women age 15-49 years who are anaemic 57 65.9
All women age 15-19 years who are anaemic 59.1 67
Men age 15-49 years who are anaemic (<13.0 g/dl) 25 36
Men age 15-19 years who are anaemic (<13.0 g/dl) 31.1 39.6
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16. Comparisons: NFHS 4 V/S NFHS 5
NFHS 4 NFHS 5
Total sample size Approx 6,01,509
households
Approx 6,36,699
households
Total Districts covered in India 640 707
Total Districts covered in Assam 27 33
Duration in Assam From 6th Nov 2015 to
31st March 2016
Completed in 5
months
From 17th June, 2019
to 21st Dec 2019
Completed in 7 months
Conducted by Nielsen India Pvt. Ltd. Nielsen India Pvt. Ltd.
Sample Size in Assam 24,542 households 30,119 household
Male : Female 4,191: 28,447 (1:7) 4,973: 34,979 (1:7)
16

17. Household Composition:
India Assam NFHS -4 Assam NFHS-5
Rural : Urban Population - 84:16 84:16
Household headed by woman 14.6% 14% 15%
Population <15 yr. age 28.6% 30% 28%
Population > 65 yr. age 6.6% 5% 5%
Female per 1000 male 991 993 1012
Birth registration 80% 94% 96%
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18. Household characteristics
India NFHS 4 Assam NFHS 4 Assam NFHS 5
Pucca House 56% 25% 33.3%
Electricity 88% 78% 93%
No sanitary facility 39% 11% 4%
Clean fuel 44% 25% 42%
Improved drinking
water
90% 84% 86%
Water treatment - 48% 53%
Toilet Facility 48% 47.7% 96%
18

19. Assam Scenario:
• Percentage Pucca House increases from 25% to 33.3% : Indicates
better implementation of Pradhan Mantri Awas Yojana (PMAY).
• Household Electricity increase from 78% to 93%: Under Pradhan
Mantri Sahaj Bijli Har Ghar Yojana ( SAUBHAGYA) scheme started in
2017. Till march 2019, 17 lakhs houses are electrified.
• Swachh Bharat Mission and Pradhan Mantri Ujjwala Yojana for
improved toilet facility and clean fuel to maximum household in
Assam.
19

20. Literacy Rate
86% 83% 82%
68% 72% 72%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
India NFHS 4 Assam NFHS 4 Assam NFHS 5
Male Female
20

21. 12%
14% 13%
30%
21%
23%
28%
23%
19%
22%
15%
17%
0%
5%
10%
15%
20%
25%
30%
35%
Male Female
India NFSH 4 Assam NFSH 4 Assam NFSH 5 India NFSH 4 Assam NFSH 4 Assam NFSH 5
21
Never been to School Completed School up to 12 yrs.

22. Fertility Trend:
India NFHS 4 Assam NFHS
4
Assam
NFHS 5
Teenage Pregnancy 8% 14% 12%
Birth Interval
between two
pregnancy
32 month 42.3 month 46 month
Next child within 3
years of previous
child
- 39% 33%
22

23. Assam Scenario:
Key barriers in preventing teenage pregnancy in Assam:
• Child marriage (31.8% from 30.8%)
• Low level of education of parents as well as early married couples
• Lack of education
• Inaccessibility to contraception and health information
• Autonomy over decision-making among woman
23

24. Total Fertility Rate
2.2
2.2
1.9
1.75 1.8 1.85 1.9 1.95 2 2.05 2.1 2.15 2.2 2.25
Assam
India
NFHS 5 NFHS 4
24

25. 25
The replacement level for
TFR 2.1 has been achieved in
19 out of 22 states except
Manipur (2.2)
Meghalaya (2.9)
Bihar (3.0)

26. Family Planning
India NFHS 4 Assam NFHS 4 Assam NFHS 5
Contraceptive Prevalence
rate
( Woman 15-49 yr.)
54% 52% 61%
Knowledge of Emergency
Contraceptive use
- 42% 51%
Use of modern family
planning methods
48% 37% 45%
Female sterilization 36% 10% 9%
Unmet needs for woman 13% 14% 11%
26

27. Few Facts…
• In NFHS 5, Overall Contraceptive Prevalence Rate (CPR) has
increased in most states/ UTs with highest in Himachal Pradesh
and West Bengal (78%).
• Unmet needs for family planning declining in most of States/UTs in
NFHS 5 except Meghalaya and Mizoram.
27

28. Few Facts..
• Female sterilisation continues to dominate as the modern method
of contraception in states like Andhra Pradesh (98%), Telangana
(93%), Kerala (88%), Karnataka (84%), Bihar (78%) and
Maharashtra (77%).
• Male engagement in family planning continues to be limited and
disappointing as seen by the low uptake of condoms and male
sterilization across states.
• According to NFHS 5, Lowest use of public health sector as a
source for modern contraception in Tripura (40%) followed by
Assam (41%) and Highest in Madya Pradesh (86%)
28

29. Assam Scenario:
• Contraceptive prevalence rate (CPR) and Use of modern family
planning methods increase in NFHS 5, Assam: amendment of
Population and Women Empowerment Policy, 2019 by Govt of
Assam.
• Unmet needs for woman is decreased but still not able to achieve
the desired goal of 10%.
• Decreased female sterilization methods due to unsatisfactory
family planning services in Assam. According to survey by Govt. of
India, 21.4% health workers not talked to female non users about
family planning methods.
29

30. Infant and Child mortality (per thousand live births)
41
50
30
48
57
32.8
32
39
22.5
0
10
20
30
40
50
60
IMR U5MR NNMR 30
India
NFHS
4
Assam
NFHS
4
Assam
NFHS
5
India
NFHS
4
India
NFHS
4
India
NFHS
4
India
NFHS
4
Assam
NFHS
4
Assam
NFHS
4
Assam
NFHS
5
Assam
NFHS
5

31. Assam Scenario
Reasons for decrease in IMR, NMR and U5MR in Assam-
• Strenuous efforts to provide essential newborn care at Govt health
institutes.
• promoting institutional delivery among the poor pregnant woman.
• Proper training of health officers for mother care and childhood
infection management.
• Increase immunization coverage.
• Boat clinic and MMU services to Riverine and Char areas.
• Intensified health services to tea garden areas.
31

32. Maternal Health
India NFHS
4
Assam NFHS
4
Assam NFHS 5
Received ANC from health
professionals
79% 83% 85%
Pregnancy registered 85% 94% 97%
MCP card present 89% 96% 99%
ANC in 1st trimester 59% 55% 64%
At least 4 ANC visit completed 51% 46.4% 64%
IFA for 100 days/180 days 30%/ 32%/ 44.1%/26%
Protected against Neonatal
tetanus
89% 90% 95%
32

33. Delivery care
India NFHS 4 Assam
NFHS 4
Assam
NFHS 5
Institutional delivery 79% 71% 84%
Assisted by Health
personal
81% 74% 86%
Post natal care within 2
days
27% 58% 69%
33

34. Assam Scenario:
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), Boat
Clinic and Tribal RCH programme for Riverine and Char areas,
Village Health Sanitation and Nutrition Day (VHSND) under NHM all
contribute towards improved ANC coverage.
• Institutional delivery rates have significantly improved reaching the
mark near to around 90%, which hints towards proper utilization of
Janani Suraksha Yojana(JSY), Janani Shishu Suraksha
Karyakaram (JSSK) schemes.
34

35. Child Vaccination and Vitamin A supplementation
62%
65.50%
47%
51%
66%
58%
0% 10% 20% 30% 40% 50% 60% 70%
India NFHS 4 Assam NFHS 4 Assam NFHS 5
Child age 12-23
months fully
immunized
Completed Vit A
supplementation
35

36. Assam Scenario
• Lack of information among parents is one of the major
causes of drop out in the vaccination coverage.
• Literacy level of parents had important role for better
immunization Coverage.
• Inaccessibility to health care facilities in few areas.
• Failure of health system to mobilize uneducated parents
towards vaccination.
36

37. Childhood Diseases
India NFHS 4 Assam
NFHS 4
Assam NFHS
5
Children with symptoms
of ARI taken to health
facility
78% 47% 51%
Children with Diarrhoea
taken to health facility
68% 51% 54%
Practise of ORS 51% 52% 69%
Zinc supplementation 20% 22% 28%
37

38. ICDS service utilization
India NFHS 4 Assam NFHS
4
Assam NFHS
5
Age <6 years service
utilization in Anganwadi
Center (AWC) overall
54% 56% 66%
Supplementary food 48% 54% 65%
Health check up 40% 43% 56%
Early childhood care 38% 44% 54%
Growth monitoring 43% 39% 52%
Immunization 40% 29% 35%
38

39. Nutritional status of children ( age < 5 years)
38%
21%
36%
36%
17%
30%
35%
22%
33%
STUNTED WASTED UNDERWEIGHT
India NFHS 4 Assam NFHS 4 Assam NFHS 5
39

40. Assam Scenario
Reasons behind failure to correct malnutrition:
• Early Marriage( 31.8%) and Teen age pregnancy(12%)
• Low investment in girl’s health and education
• Inadequate birth planning
• Failure of POSHAN Abhiyaan to meet its desired goals.
• Reported lack of funding to ICDS scheme
• Effect of COVID pandemic (Schools and AWCs getting closed)
40

41. Nutritional status of adult (age 15-49 years)
41
Body Mass Index ( <
18.5 kg/m2)
Body Mass Index ( ≥ 25
kg/m2)
Woman Man Woman Man
India NFHS 4 23% 20% 21% 19%
Assam NFHS
4
26% 21% 13% 13%
Assam NFHS
5
18% 13% 15% 16%

42. Anaemia among Children and Woman
India
NFHS 4
Assam
NFHS 4
Assam
NFHS 5
Children age 6-59 months 58% 36% 68%
Non-pregnant woman ( 15-49
yrs.)
53% 46% 66%
Pregnant woman age ( 15- 49
yrs.)
50.4% 45% 54%
42

43. Assam Scenario
• Early Marriage( 31.8%) and Teen age pregnancy(12%)
• low compliance of IFA supplementation.
• Inadequate awareness coupled with poor access to IFA
supplements.
• Inadequate training of frontline health workers.
• Inadequate counselling and awareness created among pregnant
woman and woman with child bearing age groups.
• High magnitude of undernutrition and infectious diseases among
tea garden population of Assam.
43

44. Comprehensive Knowledge of HIV/AIDS among Adults (15-49 yrs)
21%
9.40%
19.20%
33%
22.50%
25%
0%
5%
10%
15%
20%
25%
30%
35%
India NFHS 4 Assam NFHS 4 Assam NFHS 5
Woman Man
44

45. Tobacco use and Alcohol consumption among adults
( age ≥ 15 Yrs.)
Using any kind of Tobacco Using any kind of Alcohol
Woman Man Woman Man
India NFHS 4 7% 45% 1% 29%
Assam NFHS 5 22% 52% 7.3% 25%
45

46. Spousal violence
• Karnataka ( Highest 44.4% from 20.6%)
• Sikkim
• Maharashtra
• Himachal Pradesh
• Assam
46

47. Critical Review by Experts…
• Proper implementation of Swachh Bharat Mission and Pradhan Mantri
Ujjwala Yojana for improved toilet facility and clean fuel to maximum
household in the country.
• Flagship initiative of Mission Indradhanush able to get its desired goal, as
the increase in full immunization coverage is observed as expected in many
states and UTs in NFHS-5 compared to NFHS-4.
47

48. • Institutional delivery rates have significantly improved reaching the mark
near to around 90 percent, which hints towards proper utilization of Janani
Suraksha Yojana(JSY), Janani Shishu Suraksha Karyakaram (JSSK) schemes.
• Women’s empowerment indicators improved across all the States/UTs
included in Phase 1 NFHS-5 in regard to women receiving more than 10
years of education or having a bank account.
48

49. • The worsening of nutritional status ( 13-16 out of 22 states) among under 5
children shows that enough efforts were not made for prevention and
management of malnutrition in almost all states and UTs in the country.
• Govt Flagship programme, Poshan Abhiyan with ambitious goal of achieving
a Kuposhan Mukt Bharat failed to correct malnutrition of under 5 children
in the country.
• Declined in early initiation of breastfeeding and practicing of prelacteal
feeds clearly indicates in non-adherence to Infant Milk Substitute (IMS) act
49

50. • Lake of funds affects health schemes. Eg: Poor infrastructure, insufficient
funds to ICDS program leads to poor quality of Supplementary Nutrition
Programme (SNP).
• Due to economic slowdown and stagnation in wages of the poor over the
last few years, the NFHS-5 results are most likely an indication of the fact
that people’s ability to access good quality nutrition has reduced.
50

51. • The NFHS-5 further showed that almost all States/UTs have recorded
a drastic rise in the percentage of children under five years who are
overweight. It is most likely due to unhealthy food habits, reduced
physical activity, as per the Union Health Ministry. (Highest in Ladakh
13.4%).
51

52. New area of interest for strengthening existing programmes:
• Expanded domains of child immunization
• Components of micro-nutrients of children
• Menstrual hygiene
• Frequency of alcohol and tobacco use
• Non Communicable diseases additional components
• Expanded age ranges for measuring hypertension and diabetes
(age ≥ 15yr)
52

53. • an increase in the prevalence of anaemia among young
children, adolescents, pregnant women, non-pregnant women
and men in most of the states.
• For both women and men, there is a lot of variation in the high or
very high random blood glucose levels across States/UTs. Men
are more likely to have slightly higher blood glucose levels in the
range of high or very high compared to women.
• The percentage of men with high or very high blood glucose is
highest in Kerala (27%) followed by Goa (24%).
• Prevalence of elevated blood pressure (hypertension) among
men is somewhat higher than in women.
53

54. References:
1. International Institute for Population Sciences (IIPS) and Macro International.
2007. National Family Health Survey (NFHS 4), 2015-16: India: Vol 1.
Mumbai: IIPS
2. International Institute for Population Sciences (IIPS) and Macro International.
2007. National Family Health Survey (NFHS 5), 2019-21: India: Vol 1.
Mumbai: IIPS
3. National Family Health Survey (NFHS 4), India, 2015-16: Assam. Mumbai:
IIPS
4. www.nfhsindia.org
5. www.mohfw.nic.in
6. Nic-mwcd@gov.in
7. ICMR: India
8. Nhm.gov.in assam
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55. THANK YOU
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