Rch ii baseline survey-report

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RCH-II, NRHM, IIHFW, Reproductive and child health, Andhra Pradesh

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Rch ii baseline survey-report

  1. 1. Baseline Survey on Reproductive and Child Health (RCH-II) Andhra Pradesh Key Findings P. Satya Sekhar V. Umadevi N.V. Rajeswari Ch.V.S. Sitarama Rao Commissionerate of Family Welfare GoAP., Hyderabad – 500 095 Indian Institute of Health and Family Welfare Vengalrao Nagar, Hyderabad – 500 038 September, 2007
  2. 2. CONTENTS Acknowledgements i Organizations involved in Field Work iii Objectives 2 Antenatal Care 3 Components of Antenatal Checkups 6 Problems Self Reported by Mothers 7 Delivery Care 8 Complications/Problems during Delivery 10 Post Natal Care 10 Birth Weight of Newborn 11 Breast feeding and supplementation 12 Child Morbidity and Treatment Patterns 14 Child Immunization 15 Infant Mortality 17 Reproductive Health Problems 19 RCH-II Intervention Programme Janani Suraksha Yojana 20 Free Travel by the Public Transportation by Pregnant Women 21 Round-the-Clock MCH Centre 22 Women Health Volunteer Scheme (ASHA) 22 Conclusions 23 Notes 27 References 28
  3. 3. Fact Sheet Andhra Pradesh 29 Coastal Andhra Region Srikakulam 37 Vizianagaram 45 Visakhapatnam 53 East Godavari 61 West Godavari 69 Krishna 77 Guntur 85 Prakasam 93 Nellore 101 Rayalaseema Region Kurnool 109 Anantapur 117 Kadapa 125 Chittoor 133 Telangana Region Ranga Reddy 141 Hyderabad 149 Nizamabad 157 Medak 165 Mahabubnagar 173 Nalgonda 181 Warangal 189 Khammam 197 Karimnagar 205 Adilabad 213
  4. 4. i ACKNOWLEDGEMENTS India, as one of the signatory countries of ICPD Plan of Action has been implementing the Reproductive and Child Health program since early 1997. The RCH-I recorded marginal contribution in the State’s efforts to improve MCH indicators. The RCH-II program adopted mission mode by using performance, benchmarking and accountability tools and meeting long term health and population outcome goals. Until now analysis of health status at the district and regional levels has been primarily based on a single indicator, viz., infant mortality. In this backdrop, the State Government had undertaken the Baseline survey to understand the reproductive health status at the district level. The present Baseline Survey of Reproductive and Child Health (RCH-II) was successfully completed thanks to the efforts and involvement of numerous organizations and individuals at different stages of the survey. The conduct and analysis of this large-scale survey by the nodal agency required the cooperation and support of many people for its successful completion. Although it is not possible to acknowledge each and every one associated with the survey by name, some persons yet deserve special mention. First of all, we would like to thank Dr. C.B.S. Venkataramana, IAS, Former Commissioner (Family Welfare) and Ex-Officio Principal Secretary to Government (HM & FW) and Mr. Anil Punetha, IAS, Present Commissioner (Family Welfare) and Ex-Officio Secretary to Government (HM & FW) for their keen interest right from the beginning of the project and for conducting several meetings to review the progress of the project. Special thanks are due to Dr. K. Balasubramanian, Consultant and Former Director, Centre for Media Studies, Hyderabad, who continued to take an active interest in the project and provided timely guidance and support. We wish to express our thanks to Dr. C. Sulochana, Additional Director, Dr. R. Gopalakrishna Rao, Joint Director, Dr. M.S. Srinivasa Rao, Joint Director and Mr. B. Brahmanandam, Deputy Director (Demography) of the Commissionerate of Family Welfare for providing useful comments to finalise the survey instruments and Fact Sheet in dissemination workshop.
  5. 5. ii Special mention and thanks are due to Dr. KVR Subrahmanyam and Mr. R. Madhav Reddy of the Population Research Center, Andhra University, Visakhapatnam for their participation as Resource Persons in the investigators training. The hard work put in by the eleven research agencies (field investigators and supervisors) in collecting data in about 1300 villages and 980 urban blocks of Andhra Pradesh is gratefully acknowledged. Thanks are due to all District Medical and Health Officers (DM & HOs) for providing assistance during the field operations. We appreciate the immense help received from the computer staff (Mr. PVSN Kumar and Mr. Wajahat Ali) of IIHFW for developing the software package and carrying out the arduous task of data cleaning, data entry, data processing and preparation of tables. We also thank Mr. D. Srinivasa Rao, Mrs. Sivaranjani and Mr. G. Vara Prasad for their help in data analysis and finalization of district Fact Sheet. Finally, we would like to record a note of appreciation for all eligible women and the household respondents who spent their valuable time in responding to the survey questionnaire and extending co-operation to us to complete the field work. - Authors
  6. 6. iii BASELINE SURVEY ON REPRODUCTIVE AND CHILD HEALTH (RCH-II) ANDHRA PRADESH Nodal Agency : Indian Institute of Health and Family Welfare Vengalrao Nagar, Hyderabad – 500 038 Andhra Pradesh Principal Coordinator : Dr. P. Satya Sekhar Coordinators : Dr. V. Uma Devi Dr. N.V. Rajeswari Mr. Ch.V.S. Sitarama Rao ORGANIZATIONS INVOLVED IN FIELD WORK Sl. No. Field Organization Districts 1. Administrative Staff College, Hyderabad Bella Vista, Hyderabad West Godavari, Kurnool, Krishna, Hyderabad 2. AMR- A.P Academy of Rural Development Rajendra Nagar, Hyderabad Anantapur, Chittoor 3. Centre for Economic and Social Studies Begumpet, Hyderabad Khammam, Warangal 4. Centre for Media Studies 65 Jubilee Hills, Hyderabad Karimnagar, Adilabad 5. Economics Dept, University of Hyderabad Gatchibowli, Hyderabad Mahabubnagar 6. Indian Institute of Health and Family Welfare Vengalrao Nagar, Hyderabad Medak, Nizamabad 7. Institute of Health Systems HACA Bhavan, Hyderabad Nellore, Prakasam, Kadapa 8. Nizam Institute of Medical Sciences Panjagutta, Hyderabad Ranga Reddy 9. Population Research Centre, Andhra University Visakhapatnam Srikakulam, Vizianagaram 10. SWC Consulting, Golkonda Cross Roads Hyderabad Visakhapatnam, East Godavari 11. THRIVE, Volunteers for Rural Health & Education Nalgonda Nalgonda, Guntur
  7. 7. 1 Baseline Survey on Reproductive and Child Health (RCH-II) Andhra Pradesh Key Findings Promotion of maternal and child health has been one of the most important objectives of the Family Welfare Programmes in India. Different interventions initiated in the past, such as Maternal and Child Health, Universal Immunization Programme (UIP), Child survival and Safe Motherhood (CSSM) emphasized either on antenatal period of pregnant women or on child immunization and childhood diseases but little stress was laid on natal care and effective safe motherhood aspects. After ICPD (1994), MDG (2000) a greater emphasis in Reproductive and Child Health has been placed the need to have safe delivery attended by a health personnel, need for postnatal checkup, development of round the clock hospitals with blood banks and blood storage in order to attend complicated deliveries. Only better access, availability and quality health services to vulnerable groups can reduce the maternal mortality ratio and infant mortality rate and effect a rise in institutional deliveries. The Reproductive and Child Health (RCH-II) interventions like one Accredited Social Health Activist (ASHA) per 1000 population, Janani Suraksha Yojana (JSY), Emergency Health Transport of pregnant women for delivery, Free Bus Pass to pregnant women to visit a PHC for antenatal checkup and Round-the-clock Mother and Child Health Center and other innovative state-specific strategies were initiated since late 2005 under the National Rural Health Mission (NRHM) in line with the initiatives of the Government of India for reducing Infant mortality rate and Maternal mortality ratio. Responding to the growing need for data at district-level, the Indian Institute of Health and Family Welfare (IIHFW), with the funding from Commissionerate of Family Welfare, Government of Andhra Pradesh, conducted household survey at the district level to obtain information on a number of policy relevant indicators relating to reproductive and child health. The survey covered an overall sample of 59,117 households (where woman gave a child birth [alive or dead] since January/Sankranti 2004 to the date of survey 1 ) and interviewed about 59,000 currently married women in reproductive age period (15-49) in the state. In each of the 23 districts surveyed, about 2500 households were selected randomly and around an equal number of eligible women were interviewed.2 Immunization particulars of all children under 2 years of age were also obtained from mother or principal care takers of children. The field work of the survey was conducted during July-October 2006 by eleven reputed research organizations in the state. The projections carried out by the National Commission on Population, 2006 has also emphasized that the number of people in
  8. 8. 2 15-54 years will increase from 463 million in 2001 to 558 million by 2011, indicating the growing number of women, married women and deliveries. The number of married women (couples) aged 15-49 also increase between the period 2001-2011, indicating the need for further strengthening and extension of RCH services to all sections of people in the coming decades. Objectives The main objectives of the baseline study were: 1. to provide district level data on the key maternal and child health indicators such as infant mortality rate, ANC coverage, delivery care, postnatal care, breastfeeding practices, prevalence of diarrhea and child immunization coverage 2. to identify regional imbalances in the current status of health and utilization of reproductive and child health services 3. to formulate district specific interventions and for allocation of more resources in the lagged and low performing districts The highlights provide the broad findings of RCH indicators for all 23 districts and also for the State as a whole by aggregating the district figures an exercise highly useful for decentralized planning of services at district level. The survey results provide key policy relevant indicators namely infant mortality rate, antenatal care coverage, delivery care, postnatal care, breastfeeding practices, prevalence of diarrhea and ARI, contraceptive use, child immunization and awareness of interventional programmes - Janani Suraksha Yojana (JSY), Women Health Volunteer Programme (WHV), Free Bus Pass to Pregnant Women, Round the Clock MCH Centres etc. Highlights of the findings of the survey are presented in the following paragraphs. Empirical studies in India and abroad have established that the recently delivered mothers are self selected for their higher potential fertility in future years. The main objective of the Baseline study has been to Details of Sample Coverage No. of HHs interviewed in the state Total - 59117 Rural - 33746 Urban - 25371 No. of Eligible women Interviewed in the state Total - 59378 Rural - 33902 Urban - 25476 No. of Live births (during Sankranti / Jan 2004 to the date of Survey) Total - 65341 Rural - 37237 Urban - 28104
  9. 9. 3 measure the infant mortality, neonatal mortality rate at district level and coverage rates of prenatal, natal and postnatal care. The services of both Government (PHC / Sub-centre) and private institutions are extensively utilized by the recently delivered mothers and pregnant women. Hence the baseline survey adopted Birth based approach and collected information from respondents. This approach allowed us to analyze the information on 65,000 live births that occurred during the period from January/Sankranti 2004 to the date of survey. In other words, the survey covered about 1200-1300 children in each district based on births (with an exposure of child before completing one year of age in estimating Infant mortality rate). Antenatal Care Antenatal Care (ANC) includes pregnancy related care provided by any health personnel in a medical institution or at home by health staff. It is widely believed that utilization of antenatal care services contributes to improved maternal health, because the visits include advice on correct diet, the provision of IFA tablets, and tetanus toxoid injection to pregnant women in addition to medical care. Utilization of antenatal care is universal in the state and across background characteristics (Social group, Mother’s education, Household assets measured as Standard of Living Index). Nearly ninetyfour percent of mothers received 3 ANC checkups. The two lowest coverage rates of 83-85 percent were reported from Anantapur and Kurnool districts. About 94 percent of mothers received at least one ANC from a MBBS Doctor. Eight out of ten (82 percent) mothers in Kurnool and Anantapur received at least one ANC from a MBBS doctor. Four antenatal check-ups one each during third, sixth, eighth and ninth month of pregnancy have recommended as the minimum and necessary [Park, 2002]). In the end-line evaluation, the survey has to incorporate the number of ANC visits by specific months and number of visits to MBBS doctors in order to assess outcome indicators. The number of antenatal checkups and the timing of the first check-up are important for health of the mother and outcome of the pregnancy. The median number of ANC visits in the state has been 5.8 visits (5.0 visits in rural and 6.0 in urban areas). The median number of weeks a mother availed of first antenatal care was 12 weeks i.e. only 50 percent of mothers initiated ANC care in the 12th week of their pregnancy. This has to be improved substantially by the end of project period.
  10. 10. 4 The number of antenatal check-ups and the timing of the first check-up are important for health of mother and outcome of the pregnancy. The NRHM identified the proportion of women registered in first trimester as a process indicator of reproductive and child health. Sixtythree percent of women registered first antenatal check-up in the first trimester (60 percent in rural areas and 67 percent in urban areas). Districts reporting lower than 35 percent of ANC registration in first trimester are Mahabubnagar and Ranga Reddy in Telangana region. More than half of the women in scheduled caste and tribe (56 percent) sections registered in the first trimester. The findings highlight that the need to educate the pregnant women regarding the importance of early registration and motivate them for more than 4 visits in third, sixth, eighth and ninth months of pregnancy. In order to reach the target of 95 percent by 2010, special emphasis and efficient monitoring are required. Nine out of ten mothers received 2 or more doses of tetanus toxoid injection across background variables. 63% 95% 34.8 35.8 63.0 82.7 94.8 0 20 40 60 80 100 Ranga Reddy Mahabubnagar State Vizianagaram Visakhapatnam 50 1000 ANC Registration in First Trimester Target Baseline Percent 63% 95% 52.8 57.5 56.4 67.3 59.7 63.0 0 20 40 60 80 Low SLI S.T S.C Urban Rural Total 50 1000 ANC Registration in First Trimester Target Baseline Percent
  11. 11. 5 Nutritional deficiencies in women are often exacerbated during pregnancy because of the additional nutrient requirements for foetal growth (NFHS-2, 1998- 99). For each birth during the reference period, the base-line survey collected information on whether the mother received or purchased IFA tablets or syrup during pregnancy. About half (54 percent) of mothers received 100 IFA tablets or syrup supplied by ANM or purchased from the market. The IFA coverage was also lower in rural areas (52 percent) than in urban areas (56 percent). The percentage of mothers who consumed all the IFA tablets (supplied/purchased) during ANC was only 33 percent. Marginal variations are observed across background variables (Social group, Rural/urban and BPL groups) under RCH-II project. It is necessary to improve the management of supply of IFA tablets. Counseling is essential to increase the consumption of all IFA tablets as anaemia during pregnancy has been one of the major causes for low birth weight. According to NFHS-3 (2005- 06) survey about 39 percent (46 percent in rural and 36 percent in urban areas) indicated lower IFA consumption in the reference period of 90 days or more during pregnancy. The RCH-II programme needs to emphasize the advantages of IFA to pregnant women and evolve strategies to overcome the problem. Studies showed that anemia may be one of the important causes for low birth weight of babies delivered. 54% 95% 32.3 32.4 54.0 75.1 80.6 0 20 40 60 80 100 Ranga Reddy Kurnool State Nellore East Godavari 50 1000 Women received/purchased 100 or more IFA tablets Target Baseline Percent 33.2% 95% 16.5 18.1 33.2 49.8 55.5 0 10 20 30 40 50 60 Nellore Kadapa State Guntur Anantapur 50 1000 Women Consumed All IFA tablets Target Baseline Percent
  12. 12. 6 More than 75 percent of mothers reported the supply of 100 IFA tablets in East Godavari, Nellore and Srikakulam districts but on the other hand, just one-third of mothers received 100 IFA tablets in Ranga Reddy and Kurnool districts. However those who consumed all tablets/syrup in the above districts are 29% in East Godavari, 38% in Srikakulam districts and 17% in Nellore respectively. The effectiveness of antenatal check-ups in ensuring safe motherhood depends in part on the tests and measurements done and advice provided to pregnant women during check-ups. About 90 percent of mothers reported that they received at least once the general services like weight measurement, blood pressure examination, urine examination and abdominal examination as a part of antenatal checkup at the state level. Marginal variations are observed across background variables. Components of Antenatal Checkups The effectiveness of antenatal check-ups in ensuring safe motherhood depends in part on the tests and measurements done during and advice provided to pregnant women during antenatal check-ups. Among the births that occurred during survey period for which mothers received antenatal check-ups, about 89-93 percent of mothers had an abdominal examination, weight measurement, blood pressure examination as a part of the antenatal checkup. Marginal variations are reported across background variables. Majority of mothers were advised /counseled by health personnel (public and Private sector) during their entire pregnancy period about newborn care, breast feeding practice, family planning, expected date of delivery and need to have a delivery at a medical institution. About seventysix percent of mothers were advised on expected date of delivery, having delivery in a hospital and on breast feeding practices. About half of the mothers reported that they were informed by the health personnel on the danger Women advised/counseled at least once 60.8 77.0 50.7 76.0 76.0 0 10 20 30 40 50 60 70 80 90 100 Family Planning Breastfeeding Practices Information on danger signs of Pregnancy To have delivery in a Hospital Expected Date of Delivery Percent
  13. 13. 7 signs of pregnancy (Anaemia, short stature, hypertension etc). Six out of ten mothers received advice on family planning. The proportion who received advice on different topics varied little by background characteristics like education of mother, social group and economic group (BPL and SLI). Problems Self Reported by Mothers Eligible women delivered in the reference period were asked to report any pregnancy related problems. The information presented here was based on woman’s self report and should be interpreted with care. The problems most commonly reported are excessive fatigue/anemia (36 percent) followed by swelling of legs, body or face (24 percent). The population projections of Andhra Pradesh indicate an increase in number of women in 15-44 years in the coming years from 202 lakhs in 2001 to 239 lakhs in 2011 and beyond due to past decadal population momentum. Hence the findings suggest that, there is a need to cater to the needs of currently married women in the next decade by extending quality RCH services like early registration, promoting delivery at a medical institution, information on danger sings of high risk pregnancy, advice on breast feeding and family planning in order to achieve set goals by 2010 and beyond. Overall, only 46 percent of the mothers had received full ANC care, i.e. two doses of TT injection, the required number of IFA tablets and at least 3 ANC visits during their pregnancy period. The study indicates that health workers have to educate women on the importance of all components of ANC and provide them quality services. The urban areas recorded slightly higher full ANC coverage (49 percent) as compared to 44 percent in rural areas. 46.5% 95% 1000 Women received full ANC (2 TT + IFA 100 tablets + 3 ANC) Target Baseline 25.8 26.2 46.5 67.1 68.6 0 20 40 60 80 Kurnool Ranga Reddy State Visakhapatnam Nellore Percent
  14. 14. 8 The full ANC coverage was above 60 percent in the districts Srikakulam, Visakhapatnam, East Godavari, Guntur and Nellore. Special emphasis is required in the districts namely Kurnool, Ranga Reddy, Mahabubnagar, Nalgonda and Warangal districts which recorded below 35% of full ANC coverage. Delivery Care Encouraging deliveries in proper hygienic conditions under the supervision of trained health professional has been one of the major goals of NRHM for reduction in MMR and IMR. Investing more funds to increase institutional deliveries in low performing districts without quality health delivery system may yield lower results for the resources spent under NRHM. About 76 percent of births during the reference period of survey were delivered in health facility and less than one-fourth of the mothers (24 percent) were delivered at home. Overall, 82 percent of deliveries were attended by doctors or nurses/ midwives. Institutional deliveries increased from 49.8 percent in 1998-99 (NFHS-2) to 69 percent (based on last 2 births in the 3 years before the survey) in 2005-06 (NFHS-3) and reached 76 percent in 2005-06. The log- linear trend regression equation fitted to the institutional deliveries indicates that institutional deliveries could reach 90 percent by the end of 2010 as per the Goals set by the Government of Andhra Pradesh. The district differentials indicate that an overwhelming majority of mothers had availed institutional deliveries in all districts except in Rayalaseema region. The first two NFHS surveys conducted in the state during 1992 and 1998 indicated higher proportion of private institutional deliveries as compared to deliveries conducted in public institutions (refer to deliveries of women in 15-49 years in the last three years reference period). The period exactly coincides with the implementation of CSSM programme in Indian states with marginal impact Trends in Institutional Deliveries in Andhra Pradesh 76.0 32.9 49.8 61.4 63.7 69.0 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 1992 (NFHS-1) 1998 (NFHS-2) 2002-04(DLHS) 2003 (EC- Survey) 2005-06 (NFHS-3) 2006 (Baseline) Percent
  15. 15. 9 on improving institutional deliveries conducted in public hospitals. One possible explanation for higher private institutional deliveries during the period was the improvement in socio-economic factors, availability of nursing homes in majority of towns in the state. However, Balasubramanian and Satya Sekhar (2004) in the Eligible Couple and Child Immunization study indicated that the deliveries in public sector institutions improved due to implementation of ICPD initiatives and RCH interventions. The baseline survey strengthens the argument and public sector is playing a crucial role in delivery care in the state. Mothers who had child birth at home indicated the following reasons for not seeking institutional delivery care: - Not necessary and not customary : 33% - Costs too high in a health facility : 7% - Lack of transport to shift : 5% - Lack of time to reach a health facility : 28% More than a quarter (27 percent) of deliveries were either by caesarian or other interventions. The percentage of mothers who underwent caesarian section was 23 percent in rural and 32 percent in urban areas. Only 21 percent of mothers belonging to Scheduled caste and Scheduled Tribe underwent caesarian sections. The top five districts that recorded the highest caesarian section deliveries were Warangal (48%), Karimnagar (47%), Hyderabad (37%), Khammam (36%) and Nizamabad (35%). Highly developed districts in Telangana region reported higher proportion of caesarian section deliveries whereas it was below 30 percent in West Godavari, Krishna and East Godavari districts of Coastal Andhra region. Caesarian Section Percent of births by Caesarian Section Top 5 districts Warangal - (47.8) Karimnagar - (46.8) Hyderabad - (36.7) Khammam - (36.2) Nizamabad - (35.2) Bottom 5 districts East Godavari - (17.5) Kurnool - (16.0) Anantapur - (11.8) Chittoor - (11.3) Visakhapatnam - ( 9.4) State Average Total : 26.5 Rural : 22.6 Urban : 31.6 S.C : 22.0 S.T : 18.4 BPL : 24.1
  16. 16. 10 Complications/Problems during Delivery Out of those who had reported complications/ problems during last delivery 14.1 percent had premature labour, 9.8 percent had obstructed labour, 9.9 percent prolonged labour, 6.9 percent excessive bleeding and 2.4 percent breach presentation. The percentages were marginally lower in urban areas as compared to rural areas and also higher among background characteristics. Post Natal Care Health of a mother and her new born child depends not only on the health care she received during her pregnancy and delivery, but also on continued care that she and the infant received during first few weeks after delivery. Three out of four mothers who delivered in a medical institution availed postnatal checkup within one week of birth. Sixty percent of non institutional births were followed up by a post natal checkup within one week of delivery (59 percent in rural and 63 percent in urban areas) either the mother visited the health facility or a health personnel visited the home. Among non-institutional deliveries, mothers percentage who availed postnatal check-up within two months was 64 percent (64 percent in rural and 67 percent in urban areas). 64.1% 95.2 93.8 20.1 64.1 25.2 0 20 40 60 80 100 Kadapa Anantapur State Khammam Warangal 50 1000 Postpartum check-up within two months in Non-institutional deliveries Target Baseline Percent Contrary to the expectation, mothers are less likely to have received post natal checkup even though they have had continuous interaction with health provider through their pregnancy and delivery at medical institution or at home. Six out of ten (64 percent) of scheduled caste and scheduled tribe mothers who delivered at home availed post natal care within one week of delivery.
  17. 17. 11 Out of those mothers who received post natal checkup, about 77 percent (71 percent in rural and 84 percent in urban) received checkup from M.B.B.S doctor. Around 67 percent of scheduled caste and scheduled tribe mothers availed of post natal checkup from a doctor. Across districts the postnatal care below 40 percent were recorded in Kurnool, Kadapa and Anantapur districts. There is urgent need to have a total coverage of postnatal checkup by a MBBS Doctor or a trained medical professional in order to reduce the Neonatal mortality rate by the end of the NRHM project period. New interventions and packages need to be introduced with better monitoring of local health personnel by the PHC medical officer. Mothers have to be educated through IEC campaigns on the importance of postnatal care. Birth Weight of New Born Irrespective of primary causes, over 2/3 of neonatal deaths occur among infants who weighed less than 2500 grams at birth. The low birth weight may be due to poor nutritional status, hypertension, anaemia, malaria and other infections during pregnancy. Among social and economic factors, low maternal education, pregnancy at young age, frequent pregnancies and poor care during pregnancy add greatly to the risk of low birth weight. About 77 percent of infants were weighed at birth. Nearly half (49 percent) of the newborn were weighed at births in Kurnool district. More than 85 percent of children weighed at birth are in Hyderabad (urban) Visakhapatnam, Chittoor, Nizamabad and Warangal districts. The proportion of Low Birth Weight in Andhra Pradesh NA 23.3% NA MICS * (2000) 0.4%NA Percent of children weighed less than 1500 grams 17.0%7.3% Percent of children weighed less than 2500 grams 76.9%39.0%Percent of Children weighed at birth Baseline + (2006) NFHS-2 (1998-99) MICS * : Includes all children below age 5 years + : Subject to reporting errors by mothers Birth Weight Measurement Percent of children weighed at birth Above 85% Hyderabad (91.1) Visakhapatnam (87.8) Nizamabad (87.3) Warangal (87.0) Chittoor (85.4) _____________________________________________________________ 70 % to 84% Nellore (84.4) Nalgonda (84.4) Adilabad (82.5) Khammam (82.4) Kadapa (82.2) Karimnagar (82.0) Guntur (81.8) Krishna (81.4) East Godavari (75.7) Ranga Reddy (74.2) Medak (73.7) West Godavari (71.9) ______________________________________________________________ Below 70% Vizianagaram (68.3) Anantapur (67.0) Prakasam (64.3) Srikakulam (62.2) Mahabubnagar (61.6) Kurnool (49.8) ______________________________________________________________ State Average Total: 76.9 Rural: 69.9 Urban: 86.1
  18. 18. 12 infants weighed at birth was 70 percent in rural and 86 percent in urban areas. About 70 percent of scheduled caste and scheduled tribe mothers reported that their infants were weighed at birth. Less than 70 percent of newborns were weighed at birth in the districts of Vizianagaram, Srikakulam, Prakasam, Anantapur, Kurnool and Mahabubnagar Slightly less than one fifth (17.5) of newborn babies weighed less than 2500 grams in the state (18 percent in rural and 16 per cent in urban areas). About 19 per cent of newborns among scheduled caste and scheduled tribe communities weighed less than 2500 grams. As compared to the UNICEF MICS study (2000), the proportion of low birth weight babies reduced from 23 percent to 17 percent between 2000 and 2006. Developed districts namely Krishna, West Godavari and Chittoor recorded about 20-23 percent of low birth weight babies which was higher than state average. Backward districts namely Visakhapatnam, Kurnool which recorded lower than state average may require further insights and explanation. With the WHV (ASHA) in every village and collaborative work with AWWs and ANMs, there is further scope to weigh all the new born babies. Appropriate strategies to improve nutritional status and identification of high risk pregnancies require immediate attention to further reduce low birth weight in newborn babies in the state. Breast feeding and Supplementation The Government of India recommends that breast feeding should begin immediately after childbirth and that infants should be exclusively breastfed for the first four months of life. It is recommended that colostrums the first milk, should be given to infants because it provides natural immunity and important nutrients. 23.6 21 19.7 17 14.1 13.6 12.8 0 5 10 15 20 25 West godavari Chittoor Krishna State Nizamabad Kurnool Visakhapatnam There is a 11 point differential between the highest and lowest district level children’s birth weight less than 2500 grams Percent of children with birth weights less than 2.5 kgs
  19. 19. 13 Breast feeding is nearly universal in Andhra Pradesh and four-fifths (81 percent) of all infants born in the reference period preceding the survey had been breastfed. Breastfeeding was lower in urban areas (76 percent) than in rural areas (84 percent). More than 85 percent of mothers among SC and ST and lower SLI breastfed their infants. Initiation of breastfeeding immediately after childbirth is important because it benefits both mother and the infant. It is recommended that the first breast milk (colostrum) should be given to the child rather than squeezed out from the breast and discarded. Less than one-third mothers (28 percent) mothers squeeze the first milk from the breast before they start breast feeding their babies (31 percent in rural and 26 percent in urban areas). The recorded percentage was higher among Scheduled caste (30 percent) and Scheduled tribe (35 percent) respectively. A substantial proportion (38-42 percent) of women squeeze out the first milk containing colostrum from the breast before breastfeeding their infants in Srikakulam, Vizianagaram, Guntur, Nalgonda and Ranga Reddy districts. One-third (32 percent) of infants in the state were reported to be breastfed within one hour of birth. Less than one-fifth of infants were reported to be breastfed within one hour in Ranga Reddy, Nalgonda, Kadapa, Medak and Mahabubnagar districts. The Baseline survey results reveal the urgent need for an intensive IEC campaigns on the importance of breastfeeding immediately after birth and colostrum feeding in all campaigns undertaken under NRHM. More than half (54 percent) of infants were breastfed exclusively for four months. About 34-49 percent of mothers reported exclusive breast feeding for four months in Vizianagaram, Visakhapatnam, East Breast fed within one hour of birth 10.3 31.8 22.4 0 5 10 15 20 25 30 35 RCH Baseline Survey NFHS-3 (2005-06) NFHS-2 (1998-99) 31.8 50.2 76.5 15 16.7 0 20 40 60 80 100 Mahabubnagar Medak, Kadapa State Vizianagaram Visakhapatnam Percent Percent 54.4% 90% 33.9 35.2 41.4 54.4 74.5 79.5 0 20 40 60 80 100 Hyderabad Warangal Visakhapatnam State Kadapa Anantapur 50 1000 Infants Exclusively Breastfed Atleast Four Months Target Baseline Percent
  20. 20. 14 Godavari, Chittoor, Hyderabad, Nizamabad, Mahabubnagar and Warangal districts. Mean time after birth when baby was put to breast was 3.6 hours (3.2 hours in rural and 4.1 hours in urban) At the age 6-9 months, all infants should be given solid or mushy food in addition to breast milk to provide sufficient nutrients. However, only 61 percent of children age 6-9 months (58 percent in rural and 66 percent in urban) received the recommended combination of breast milk and solid or mushy food. WHO recommended an outcome indicator namely continued breast feeding for one year for children in 12-15 months age who are still breastfed. The survey revealed that about eightynine percent of infants were breastfed for more than one year (92 percent in rural and 86 percent in urban). The practice of breastfeeding within one hour of birth was lower among the mothers who had not received ANC (27 percent) as compared to mothers with 3 or more ANC visits (32 percent). Child Morbidity and Treatment Patterns An attempt has been made to arrive at the proportion of children who suffered from diarrhoea and Acute Respiratory Infection (ARI). Mothers of children born since January/Sankranti 2004 till the date of survey were asked if their infants suffered from diarrhoea and ARI during the two weeks preceding the survey, and if so, the type of treatment given. Early diagnosis and treatment with antibiotics can prevent a large proportion due to ARI/pneumonia. During the two weeks preceding the survey, 18.2 percent of children under two and half years (January/Sankranti 2004 to Survey date) had symptoms of Acute respiratory infection (cough accompanied by fast breathing). The NFHS-2 (1998-99) reported that 19 percent of children under age three years in Andhra Pradesh suffered from ARI. Only 32.5 percent of the women are aware of danger signs of pneumonia (30 percent in rural areas and 35 percent in urban areas). About 31-32 percent of mothers among SC and ST community are aware of pneumonia. Higher awareness of ARI (more than 35 percent) were recorded in Kurnool (37%), Chittoor (38%), Ranga Reddy (36%), Hyderabad Urban (43%) and more than 50 percent in Khammam and Nalgonda districts.
  21. 21. 15 The important danger signs of pneumonia as reported by mothers were ‘difficulty in breathing’ (76 percent), ‘wheezing/whistling’ (41 percent), ‘Pain in the chest and productive cough with fever’ (40 percent) and ‘Chest in-drawing’ (35 percent). About 12 percent of children suffered from diarrhea (12 percent in rural areas and 11 percent in urban areas) in the two-week period before the interview. Due to seasonal variations in the prevalence of diarrhea, this cannot be assumed to reflect the situation throughout the year. Knowledge and use of Oral Rehydration Salt (ORS) packets for the treatment of diarrhea was not widespread. Children with diarrhea in the previous two weeks who received ORS were 49 percent (47 percent in rural and 51 percent in urban areas) as compared to 36 percent reported in the NFHS-3 (2005-06) survey (based on the information on the last 2 births in the 3 years before the survey). The use of antibiotics and other anti-diarrhoeal drugs is not generally recommended for the treatment of childhood diarrhea. About 86 percent of children who had diarrhea in the last two weeks were treated through pills and syrup, and 34 percent received an injection. Marginal variations were reported between rural and urban and background variables. Across the districts, the usage of ORS by mothers was below 35 percent in Krishna, Mahabubnagar and Nalgonda districts respectively. Under the NRHM, there is a need for intensive and effective IEC campaigns on diarrhea disease emphasizing the importance of ORT, increased fluid intake and continued feeding and discouraging the use of drugs/injections. Child Immunization Immunization particulars of children under 2 years were obtained from mothers or principal care takers. Children in the age span 12-23 months who received BCG, three doses of DPT and OPV and measles are considered to be fully immunized. Coverage of full immunization was 80 percent or more in the coastal districts with the exception of Nellore (79 percent) and Prakasam (77 percent). In the Rayalaseema region, Kurnool reached 87 percent, whereas Kadapa, Anantapur and Chittoor reached a coverage level of around 71-80 percent. In the Telangana region, immunization coverage varied from 73-77 percent in the districts of Mahabubnagar and Adilabad to 90 percent in Khammam district. In
  22. 22. 16 the district of Hyderabad, which is entirely urban, the coverage of full immunization was 82.7 percent. For the state as a whole, the coverage of full immunization was 82.7 percent. As compared to the Eligible Couple and Child Immunization Survey (IIHFW, 2004), full immunization coverage has become more uniform throughout the state and among different back ground variables. The full immunization among Scheduled caste and Scheduled tribe communities was lower (78 percent) than the state average. The utilization level of individual vaccines was higher than the percentage fully vaccinated. Ninetyeight percent of children had been vaccinated against tuberculosis, 92 percent received all three doses of polio, same percentage received all three doses of DPT injections and 88 percent had all three doses of Hepatitis-B injection. The measles vaccine coverage was 88 percent at the state level. The coverage rate of full immunization was comparatively better among children (87 percent) of literate mothers than in children (76 percent) of illiterate mothers. Percentage of children (12-23 months) fully immunized (BCG+DPT(1-3)+OPV(1-3)+Measles) Coverage rates 85% or more Krishna (92.3) Khammam (90.2) West Godavari (88.7) Guntur (88.0) Kurnool (87.2) Warangal (86.7) Karimnagar (86.9) Srikakulam (86.0) Medak (84.5) ________________________________________________________________ Coverage rates 75% to 84% Vizianagaram (84.3) Visakhapatnam (83.9) Hyderabad (82.9) East Godavari (82.7) Ranga Reddy (80.7) Nalgonda (80.2) Chittoor (76.4) Nellore (79.7) Kadapa (79.7) Prakasam (77.3) Adilabad (76.8) ________________________________________________________________ Coverage rates <75% Mahabubnagar (72.8) Anantapur (71.3) ____________________________________________________________ State Average Total : 82.7 Rural : 81.5 Urban : 84.2 S.C : 80.2 S.T : 72.8 BPL : 82.5 The dropout rate from DPT3 to measles declined from 9 percent in Eligible Couple and Child Immunization Survey, 2003 to below 5 percent in the Baseline survey (2006). Child Immunization 84.2 57.2 81.5 42.9 82.7 46.0 Baseline 2006 NFHS-3 73.470.371.4EC 2003 % Fully immunized4. 90.087.388.5 Baseline 2006 30.521.124.4EC 2003 % received Hep – B3 vaccine3. 88.188.588.3 Baseline 2006 EC 2003 Baseline 2006 EC 2003 78.076.877.3 % received measles vaccine2. 60.058.659.2 50.245.947.4% of children whose vaccination card that was shown to the interviewer 1. UrbanRuralTotalChild Immunization Sl. No.
  23. 23. 17 The percentage of children in 12-23 months who were not immunized at all remained at 1.1 percent having declined from 2.3 percent reported in Eligible Couple and Child Immunization Survey (Balasubramanian and Satya Sekhar, 2004). There is a need to identify and convert partial immunization cases to complete immunization in moping up Annual Census Surveys as proposed in the RCH-II PIP document (CFW, 2005). Further, the dropout rate declined from 24 percent from 2003 to 17 percent in the present baseline survey. At the district level, full immunization coverage was almost on par with the PATH study conducted in 2005 by the Government of Andhra Pradesh. Infant Mortality Infant mortality rate is a sensitive indicator of the socio- economic development of any country/region. This rate reflects the quality of life and is also used for monitoring and evaluating population and health related programmes and policies. The Sample Registration System is the only source in the country providing time series estimates of IMR on an annual basis for India and its states. The Millennium Development Goals (MDG, 2000) and the national and state population policies set the target of 30 per 1000 live births by 2010. The availability of IMR data at district level and by social group provides ample information for preparation of district health action plans. The baseline survey adopted birth based approach methodology to estimate infant mortality rate at district level. The infant mortality rate was worked out based on the probabilities of dying before first birthday. IMR was calculated based on all births occurred during January 2004 to July 2005 but not surviving till their first birth day. The neonatal mortality rates (the probabilities of dying in the first month of life) for all districts of Andhra Pradesh are also worked IMR – Trends in Andhra Pradesh Need to accelerate Decline 46 26 30 75 72 66 52 20 30 40 50 60 70 80 1989-91 1994-96 1999-01 2003-05 2010 2015 Log-Linear trend fitted to the data R2 = .953 Rr = .949, F=261.2 77.981 -1.189 t Triennial averages 58 52% 30% 26.4 36.3 32.7 52.8 65.0 72.0 40.3 62.3 55.3 92.9 111.0 0 20 40 60 80 100 120 Hyderabad West Godavari Krishna State Medak Mahabubnagar Rural Urban BPL group Scheduled Caste Scheduled Tribe 1000 Infant Mortality Rate (per 1000 live births) Target Baseline Districts
  24. 24. 18 out. The total number of births within 12 months of age varied from 1390 in Anatapur district to 1876 in Chittoor district. The neonatal mortality comprises about 70 percent of all infant deaths in the state. One in 16 infants in rural areas and one in 26 infants in urban areas die before celebrating their first birth day. The baseline survey estimated IMR as 52.2 deaths per 1000 live births in 2005 which is on par with the SRS estimate of 57 per 1000 live births in 2005 and 53 per 1000 live births as reported by NFHS-3 (2005-06) study. Trend analysis of infant mortality over the period 1989-91 to 2003-05 indicates that special emphasis and effective monitoring of different RCH-II interventions are required to bring down IMR to 30 per 1000 live births by 2010 and 26 per 1000 live births by 2015. The reduction in IMR in Andhra Pradesh mostly depends on the reduction of high IMR levels in rural areas and among Scheduled caste and Scheduled tribe categories. Districts which recorded the highest infant mortality rate between 72-63 deaths per 1000 live births were in Mahabubnagar, Medak, Adilabad, Nizamabad, Nalgonda and Khammam districts in Telangana regions, Srikakulam and Vizianagaram districts in Coastal Andhra and Anantapur in Rayalaseema region. 36.9% 15% 20.3 20.5 21.3 36.9 48.0 52.5 43.2 28.6 38.2 59.5 70.6 0 10 20 30 40 50 60 70 80 Hyderabad Krishna West Godavari State Nizamabad Mahabubnagar Rural Urban BPL group Scheduled Caste Scheduled Tribe 1000 Neonatal Mortality Rate (per 1000 live births) Target Baseline Districts 50 Infant Mortality Rate (All births since January 2004 to July 2005) IMR above 60 (per 1000 live births) Mahabubnagar (72) Medak (65) Adilabad (64) Nizamabad (63) Nalgonda (63) Srikakulam (62) Vizianagaram (60) Anantapur (60) Khammam (60) ______________________________________________ IMR between 50 to 60 (per 1000 live births) Kurnool (58) Visakhapatnam (52) Warangal (52) Kadapa (51) Prakasam (50) Karimnagar (50) ______________________________________________ IMR below 50 (per 1000 live births) Nellore (48) Chittoor (46) East Godavari (45) Ranga Reddy (44) Guntur(42) West Godavari (36) Krishna (33) Hyderabad (26) ______________________________________________ State Average Total : 52.2 Rural : 62.2 Urban : 39.1
  25. 25. 19 The most challenging part of infant mortality is the large proportion of neonatal deaths contributing to 60-70 percent of all infant deaths. This stresses the need to increase the efforts in order to meet the IMR goal of NRHM by allocating higher number of CEMONC and BEMONC centers with quality delivery care from specialist medical personnel. Rural infant mortality rates are considerably higher than urban infant mortality rates. Infant mortality seems to be relatively higher among infants of scheduled castes and scheduled tribes. Neonatal and infant mortality declined substantially with increase in the household standard of living. Male infants have a higher risk of dying than female infants. The infant mortality rate decline consistently with increasing education of mother as expected, ranging from a high of 99.2 deaths per 1000 live births for illiterate mothers to a low of 14.2 deaths per 1000 live births for mothers who have had high school and above education. Reproductive Health problems In order to assess the prevalence of reproductive tract infection among respondents a few questions were put in privacy during interview time. Respondents were assessed whether they contacted a disease through sexual contact, experienced bad smelling, and abnormal genital discharge or had a genital sore or ulcer. Sixteen percent of respondents reported reproductive tract infection. Higher prevalence was reported in Medak, Nizamabad and Ranga Reddy districts. As per RCH-II norms, it is required to reduce the RTI incidence to a half from its current level and this needs special emphasis. 16% 8% 2.9 4.7 16.0 26.5 29.6 35.1 0 10 20 30 40 Kurnool Kadapa State Ranga Reddy Nizamabad Medak 50 1000 Reproductive Tract Infections* (halved by end of RCH-II) Target Baseline Percent * Women who contacted a disease through sexual contact, experienced bad smelling abnormal genital discharge and had a genital sore or ulcer. Infant Mortality Rate in Andhra Pradesh by Background Characteristics 52.2 39.1 62.2 92.9 111 85.1 55.3 20 30 40 50 60 70 80 90 100 110 120 Total U rban Rural S.C S.T Low SLI BPL RCH-II Baseline Survey, 2006 Based on births occurred during January 2004 to July 2005 before a child completing one year
  26. 26. 20 Women who sought advice/treatment for RTI problems were only 46 percent (48 percent in rural and 45 percent in urban areas). No variation was recorded between background variables. Majority of women availed of the services from private sector and NGO as compared to Government doctor/health personnel. 46.6% 30.0 30.8 46.6 55.0 57.2 58.2 0 20 40 60 80 Anantapur Kurnool State Kadapa Visakhapatnam Karimnagar 1000 Women seeking Advice/Treatment for RTI Problem Baseline Percent RCH-II Intervention Programme The Department of Family Welfare, Government of Andhra Pradesh has formulated various interventions under NRHM (Reproductive and Child Health Project- II). The major objectives of these interventions are to improve health conditions of women and children and increase institutional deliveries. Some of the interventions which are being implemented in the state are (1) Janani Suraksha Yojana (2) Free Bus Pass to Pregnant Women (3) Women Health Volunteer (ASHA / WHVs) and (4) Round the Clock Mother and Child Health Centre. Information was collected from all the respondents about the awareness of these RCH-II interventions initiated under NRHM. Janani Suraksha Yojana Government of India launched the scheme ‘Janani Suraksha Yojana’ in modification of the National Maternity Benefit Scheme. This 100 percent centrally sponsored scheme provides Rs.700/- as an incentive to all women (both in rural and urban areas) aged 19 Knowledge of Janani Suraksha Yojana Scheme (District wise) Above 76% Khammam (81.3) Srikakulam (80.7) Vizianagaram (79.9) West Godavari (77.9) Prakasam (76.1) _________________________________________________ 65% to 75% Medak (74.3) Nizamabad (71.8) Chittoor (71.6) Nalgonda (71.1) Guntur (71.0) Visakhapatnam (66.3) Mahabubnagar (65.8) Krishna (65.2) Kadapa (65.2) _________________________________________________ Below 65% Warangal (62.2) Anantapur (51.7) Karimnagar (50.1) Ranga Reddy (49.6) East Godavari (48.0) Kurnool (41.8) Adilabad (38.3) Nellore (33.4) Hyderabad (21.9) _________________________________________________ State Average Total : 61.6 Rural: 65.6 Urban: 56.3
  27. 27. 21 years and more, women belonging to households below poverty line are eligible for availing the benefit. The Government of Andhra Pradesh added Rs.300/- (under Sukhibhava Scheme) and used to release Rs.1000/- to the beneficiary About 62 percent of mothers were aware of the JSY intervention. The awareness levels appear to be better in rural areas (65 percent) as compared to urban areas (56 percent). Out of those women aware of JSY scheme, about 31 percent have benefited from the scheme. Among the beneficiaries, 17 percent of mothers faced problems in realizing the scheme incentive. Extensive IEC activities are required to propagate the benefits of the scheme to the public and consistent and timely flow of funds will definitely improve the institutional deliveries among vulnerable groups in the state. Districts which reported below state average were East Godavari and Nellore from Coastal Andhra region, Anantapur and Kurnool from Rayalaseema region and Ranga Reddy, Karimnagar, Adilabad from telangana region. Free Travel by the Public Transportation by Pregnant Women Every pregnant woman will have to have at least one antenatal checkup by PHC medical officer for screening of high-risk cases and receive advice for institutional delivery. The scheme provides for free travel by the public transportation for pregnant women from their village to the nearest PHC or FRU help in achieving the goal. Twentyseven percent of respondents were aware of the free bus pass scheme (35 percent in rural areas and 18 percent in urban areas) and 21 percent availed the facility at state level. The proportion aware of free bus pass facility to pregnant women varied from 10 percent in East Godavari district and more than 40 percent in West Godavari, Kadapa and Khammam districts. Knowledge of Free Bus Pass to Pregnant Women Scheme Top 5 districts Khammam - (43.5) West Godavari - (43.1) Kadapa - (40.4) Krishna - (38.5) Nizamabad - (36.8) Bottom 5 districts Karimnagar - (16.8) Ranga Reddy - (16.5) Nellore - (14.6) Adilabad - (12.0) East Godavari - (10.0) State Average Total : 27.5 Rural : 34.9 Urban :17.6 S.C : 31.2 S.T : 28.2 BPL :28.2
  28. 28. 22 Round-the-Clock MCH Centre In order to promote institutional deliveries at PHCs, the existing 470 units of 24 hour Maternal and Child Health Centers have to ensure the availability of one basic emergency obstetric care facility per 1,00,000 rural population in the state. The intervention was initiated under RCH-I programme and strengthened in RCH-II. Less than one-fifth (15 percent) of respondents indicated the awareness of a RCMCHC in their village/ Mandal. The awareness level was below seven percent in West Godavari, Vizianagaram, Guntur, Kadapa and Warangal districts. Among those who visited the MCH centre, only one-third (34 percent) of respondents or their relatives visited the RCMCMC for services particularly at night time. Out of the respondents or their relatives who visited RCMCHC at night time, about 77 percent received services from hospital staff. Women Health Volunteer Scheme (ASHA) The Woman Health Volunteer scheme (ASHA under the NRHM) has been one of the major interventions introduced under RCH-II. This scheme seeks to identify, train and position women health volunteers in the Gram Panchayat in the state to act as health resource persons-of-first-resort in all maternal and child health matters in the villages and act as link-persons between the community and the service providers in the village. Out of 52,000 volunteers, more than half of the ASHAs were functioning in different districts. An evaluation of the scheme strengthens the programme which is powered by the AP Government. A quarter (24 percent) of respondents were aware of the WHV scheme in their villages. Excluding Hyderabad urban district, the awareness of WHV was reported to be below 15 percent in Nellore, Kurnool, Kadapa, Khammam, and Adilabad districts. Knowledge of Round the Clock Mother & Child Health Centers Top 5 districts Nizamabad - (43.8) Mahabubnagar - (35.2) Visakhapatnam - (29.9) Srikakulam - (29.7) Prakasam - (24.7) Bottom 5 districts West Godavari - (7.0) Warangal - (7.0) Kadapa - (5.1) Vizianagaram - (4.9) Guntur - (3.7) State Average Total : 14.5 Rural : 13.0 Urban : 16.4 S.C : 13.6 S.T : 10.5 BPL : 14.7
  29. 29. 23 Conclusions Responding to the growing need for generating district-level data, Indian Institute of Health and Family Welfare (IIHFW), with the funding from Commissionerate of Family Welfare conducted the household survey at district level to obtain the baseline information on a number of policy relevant indicators relating to Reproductive and child health. The log frame of sampling, methodology, questionnaire preparation, training of investigators, analysis was carried out by the Nodal agency (IIHFW) and the data collection and data entry undertaken by eleven research agencies in Andhra Pradesh. It is also proposed to conduct mid-term and end line surveys in order to assess the impact of various interventions formulated under NRHM and in particular on RCH-II interventions. The population projections for Andhra Pradesh indicate that the women in 15-49 year would increase from 209 to 239 lakhs between 2001 and 2011. Hence there will be a continuous and sustainable demand for the reproductive and child health services in the years to come. The conclusions of the study are given below. The interventions introduced require intertwining of direct and indirect interventions to achieve NRHM goals of IMR and MMR. The quality care health facilities in CEMONC and BEMONC centres with efficient blood banks and broad storage centres in the mandals of different districts (with high IMR and MMR) are crucial. The indirect interventions like Emergency health transport, Free bus pass to pregnant women, Janani suraksha yojana and ASHA programme will be effective only if health care delivery system are strengthened. The success of direct and indirect interventions will be crucial for the overall health care delivery of NRHM/RCH services. 1. Three ANC checkups is Universal across regions and background variables. 2. About sixtythree percent of mothers received ANC in the first trimester of their pregnancy. Districts indicating lower than 35 percent of ANC in the first trimester Knowledge of Women Health Volunteer Scheme (District wise) Above 35% Mahabubnagar (53.2) Visakhapatnam (52.1) Chittoor (41.9) Nizamabad (37.8) _________________________________________________ 20% to 34% Srikakulam (33.6) Krishna (30.1) Vizianagaram (28.8) Warangal (28.3) West Godavari (26.4) Ranga Reddy (25.6) Guntur (24.7) East Godavari (24.3) Medak (22.1) Prakasam (20.8) _________________________________________________ Below 20% Anantapur (17.9) Karimnagar (16.7) Kadapa (13.1) Khammam (11.7) Adilabad (11.0) Nalgonda (10.4) Nellore (9.3) Kurnool (7.2) Hyderabad (2.6) _________________________________________________ State Average Total : 23.9 Rural : 31.5 Urban : 13.8 S.C : 27.0 S.T : 27.9 BPL : 25.4
  30. 30. 24 were Mahabubnagar and Ranga Reddy districts. In order to reach 95 percent of target by the end of project period, strengthening of monitoring by PHC medical officer and substantial improvement in low performing districts are essential. 3. Even though 94 percent of mothers received at least one ANC from a MBBS doctor, there is a need to increase the AN checkups to a minimum of four by a MBBS doctor in the months of third, sixth, eighth and ninth months as per the Safe Motherhood norms. 4. Slightly more than a half (54 percent) of mothers received/ purchased IFA tablets. There is a need to streamline the supply of IFA tablets from district level to sub-centre village. Less than 40 percent of mothers in Warangal, Mahabubnagar, Ranga Reddy and Kurnool districts had received/ purchased 100 or more IFA tablets during the pregnancy pertaining to the last child. 5. About half of mothers received/purchased IFA tablets at state level but the consumption was below 33 percent. Marginal variations were reported across background variables. Mother’s education, standard of living and occupation do not appear to have played any role in consuming of IFA tablets. 6. Eightynine percent of mothers received the general services (weight measurement, blood pressure, blood examination and abdominal checkup) at least once during ANC. 7. About seventysix percent of mothers were advised on expected date of delivery, having delivery in a hospital and on breastfeeding practices. Only a half of the mothers reported receiving advice/ counseling from health personnel on the danger signs of pregnancy. More emphasis has to be given to these aspects during IEC activities by the field level staff and PHC personnel. 8. Less than a half (46 percent) of mothers received full ANC care, i.e. two doses of TT injection, required number of IFA tablets and at least 3 ANC visits during their pregnancy period. There is a need to strengthen the full ANC coverage in the districts of Kurnool, Ranga Reddy, Mahabubnagar, Nalgonda and Warangal districts. 9. About 76 percent of mothers delivered in a health facility and 82 percent of deliveries were attended by a doctor or nurse/midwives 10. The survey results point to the need to a) strengthen the JSY, Free bus pass to pregnant women and other RCH interventions and b) improvement of institutional deliveries in low performing districts.
  31. 31. 25 11. More than a quarter (27 percent) of deliveries were either caesarian or other interventions. Twentyone percent of mothers belonging to Scheduled caste and Scheduled tribe underwent Caesarian section. Highly developed districts in Telangana region reported higher proportion of caesarian section deliveries as compared to the West Godavari, Krishna and East Godavari districts of Coastal Andhra region. 12. Ninety percent of mothers who delivered in a medical institution availed post natal checkup within one week of birth. Only sixty percent of non institutional births were followed up by a post natal checkup within one week of delivery (59 percent in rural and 63 percent in urban). 13. Out of those mothers who received post natal checkup, about 77 percent received checkup from MBBS doctor. Keeping the high neonatal mortality in the state, there is a need to strengthen the monitoring of the field health functionaries to educate the pregnant mothers during ANC counseling. 14. With the WHV in every village and collaborative work with AWWs and ANMs, it is possible to increase the proportion of newborns weighed from 70 percent at state level. The low birth weight (below 2500 grams) reduced from 23 percent to 17 percent during 2000-2006 period. It is surprising to note that the developed districts of Krishna, West Godavari and Chittoor recorded higher proportion of newborns with low birth weight than the state aggregate. 15. About 21 percent of mothers squeeze out the first milk from the breast before they start breast feeding their babies. One-third of the infants were reported to be breastfed within one hour of birth. Less than 20 percent of infants were reported to have been breastfed within one hour in Ranga Reddy, Nalgonda, Kadapa, Medak and Mahabubnagar districts. 16. More than a half (54 percent) of infants were breastfed exclusively for four months. Among infants in age 6-9 months, only 61 percent received the recommended combination of breast milk and solid or mushy food. 17. The full immunization (BCG + OPV 1-3 + DPT 1-3 + Measles) at the state level recorded 82.7 percent. The inter-district variations of full immunization were marginal. 18. Infant mortality rate was calculated based on all births that occurred during January 2004 to July 2005 and not surviving till their first birth day. Neonatal mortality accounts for 70 percent of infant deaths that occurred in the reference
  32. 32. 26 period. The reduction in infant mortality depends on reduction in neonatal mortality among rural, Scheduled caste and Scheduled tribe categories. 19. There is a need to increase the efforts in order to meet the IMR goal of NRHM by allocating higher number of CEMONC and BEMONC centers with quality delivery care from specialist medical personnel. 20. Male infants have higher risk of dying than female infants. The infant mortality rate declines consistently with increasing education of mother 21. Sixtytwo percent of mothers were aware of the Janani Suraksha Yojana scheme. The awareness is more in rural areas (66 percent) as compared to urban areas (56 percent). The awareness was 63 percent among Scheduled caste and 62 percent in Scheduled tribe. Out of those women who were aware of JSY scheme, only a half (31 percent) benefited from the scheme. Among the beneficiaries, 17 percent of mothers faced problems in realizing the incentive. 22. Twentyseven percent (35 percent in rural and 18 percent in urban) of respondents were aware of the free bus pass scheme and 21 percent availed the benefit. 23. A quarter (24 percent) of respondents were aware of the WHV scheme in their villages. Excluding Hyderabad urban district, the awareness of WHV was reported below 15 percent in Nellore, Kurnool, Kadapa, Khammam, and Adilabad districts.
  33. 33. 27 Notes: 1. Empirical research studies (Srinivasan and Rajaretnam, IDPAD study, 2006) indicated that the recently delivered mothers are self-selected for higher potential fertility. Women who have recently delivered (within one year) have 35% high fertility in the future years as compared to other women who have not recently delivered. Majority of these women demand the services related to reproductive and child health and family planning services. 2. Sampling Details The sampling adopted a two-stage stratified systematic random sampling method. In the first stage, primary sampling units or clusters (Villages in rural areas and blocks in urban areas) were selected by probability proportional to size (PPS) method. The second stage involved the selection of secondary sampling units, i.e. households within each selected cluster. Rural sampling A list of villages in the district with their population from the 2001 census served as the sampling frame in rural areas. A sample size of between 25-28 households was thought to be adequate to represent the village population. Accordingly it was decided to select 60 villages and 25 households in each selected village in order to achieve a minimum sample of 1800 households on the assumption that the non-response rate would be around 10%. All villages in the district were classified into three strata based on 2001 census population figures. Stratum 1 : population < 1500 Stratum 2 : population 1500 – 2500 Stratum 3 : population > 2500 It was decided to exclude all small villages with population size of less than 100 from the frame. Sample villages were allocated to three strata (20 villages from each stratum) using PPS method. Selection of Households A house-listing operation was carried out in each of the selected village prior to the data collection, which provided the necessary frame for the selection of households. All households with eligible women (i.e., women who delivered birth during the last two years and all currently pregnant women) were identified. This provided the necessary frame for the selection of households. A complete house listing was carried out in the villages with the estimated households of up to 500. In case of villages with the estimated number of households above 500, the village was divided into 3 or more number of segments of about same size and 2 segments selected randomly. Lastly, with systematic random sampling procedure, a sample of 25 households was selected from each of the sample villages to arrive at the required number of households in rural areas of the district. Urban sampling A three stage systematic random sampling design was used to obtain urban sample of households, the wards being the unit of selection at first stage, census enumeration blocks at the second stage and households within the selected block at the third stage. All wards in the district according to 2001 census frame were arranged and 20 wards will be selected by PPS method. Two blocks from each of the selected wards were selected again by PPS method. All the households in the selected blocks were listed and 25 households in each block were selected by systematic random sampling method.
  34. 34. 28 The survey was designed and conducted by the collaborating institute namely the Indian Institute of Health and Family Welfare, Hyderabad, under the guidance of the Commissionerate of Family Welfare. Eleven research agencies with experience in conducting health surveys were selected by the Commissionerate of Family Welfare. The Log frame of the survey, initiation of background seminars, preparation and finalization of questionnaires, printing and supply to the research agencies, training of 320 investigators from 11 research agencies, development of software and data entry training were undertaken by Indian Institute of Health and Family Welfare (Nodal Agency). The data CDs after data entry were brought back to IIHFW and scrutinized for data inconsistencies, data validation, data cleaning and final data preparation was done using EPI-Info and SPSS Package. The analysis and preparation of Fact Sheet for all districts were submitted in record time of 5 months to the funding agency for policy interventions. Household Standard of Living Index (SLI) The household standard of living index (SLI) has been calculated by summing the individual scores assigned to each of the household items: 4 for car; 3 each for TV, telephone, motor cycle/scooter; 2 each for fan/radio/transistor, sewing machine, bicycle, water pump, bullock cart, thresher; type of house (4 for pucca, 2 for semi-pucca and 1 for kachcha type); ration card (4 for pink card, 2 for white card and o for no card). Index scores range from 0-14 for a low SLI (13.1%), 15-23 for a medium SLI and 24 and above for a high SLI. References Balasubramanian, K and P. Satya Sekhar (2004), Sample Survey of Eligible Couples and Child Immunization Coverage in Andhra Pradesh: Fact Sheet-2003, (Mimeo), Indian Institute of Health and Family Welfare, Hyderabad. International Institute for Population Sciences (1995): National Family Health Survey (1992- 93), Andhra Pradesh State. International Institute for Population Sciences, Mumbai. International Institute for Population Sciences (1995): National Family Health Survey (1998- 99), Andhra Pradesh State. International Institute for Population Sciences, Mumbai. International Institute for Population Sciences (2006): ‘Key Findings for Andhra Pradesh from NFHS-3’ (Fact Sheet). Park (2002), Text Book of Preventive and Social Medicine (17th edition), M/S Banarsidas Bhanot Publishers, Jabalpur PATH (2005), Andhra Pradesh Progress in Immunization Performance, Government of Andhra Pradesh. Srinivasan K, C.P. Prakasam, T. Rajeretnam and Puruhit Praharaj (2006), Expanding Basic Maternal and Child Health Services: An Operations Research Project with Birth-based Approach, International Institute for Population Sciences, Mumbai.
  35. 35. 29 BASELINE SURVEY ON REPRODUCTIVE AND CHILD HEALTH (RCH-II), ANDHRA PRADESH 2006 ANDHRA PRADESH FACT SHEET INDICATOR TOTAL RURAL URBAN SC ST SLI(Low) BPL Sample Population • Number of households interviewed 59117 33746 25371 13128 4371 7724 45119 • Number of eligible women interviewed1 59378 33902 25476 13162 4385 7745 45302 • Number of live births2 65341 37237 28104 14467 4856 8485 49895 • Population in the sample 310881 179111 131770 13128 4371 59117 239544 Population and Household Characteristics3 • Mean household size 5.2 5.3 5.1 5.1 5.0 5.2 5.3 • Percent of pucca houses 48.5 37.1 63.6 42.9 31.8 5.8 45.5 • Percent of households with separate kitchen 54.8 46.0 66.4 42.9 37.1 18.3 52.7 • Percent of households with electricity 91.8 88.2 96.5 88.1 76.1 54.8 91.6 • Percent of households using piped water as main source of drinking 94.2 91.3 98.1 94.6 90.2 89.6 94.1 • Percent of households using cleaner cooking fuels (LPG, Electricity and Kerosene) 38.6 16.0 68.6 26.5 18.9 1.5 34.3 • Percent of households with no toilet / latrine facility 49.5 71.9 19.8 60.3 70.8 94.0 53.1 • Percent of households with white ration card 76.3 78.5 73.4 82.4 74.5 73.0 - • Percent of scheduled caste households 22.2 25.8 17.4 - - 33.0 24.0 • Percent of scheduled tribe households 7.4 9.9 4.1 - - 17.9 7.2 • Percent of backward caste households 46.9 46.9 46.9 - - 39.6 48.0
  36. 36. 30 INDICATOR TOTAL RURAL URBAN SC ST SLI(Low) BPL Maternal Health Care4 • Percent of mothers received any ANC 96.8 95.3 98.7 96.1 92.7 91.1 96.6 • Percent of mothers received at least 3 ANC checkups 93.6 91.5 96.4 91.5 87.3 85.1 93.3 • Percent of mothers registered in first trimester 63.0 59.7 67.3 56.4 57.5 52.8 61.8 • Percent of women received check up at least once by a M.B.B.S doctor 94.3 92.1 97.3 93.0 88.6 86.0 94.1 • Percent of mothers received 2 or more TT injections 95.3 95.0 95.7 94.4 91.6 91.7 95.3 • Percent of mothers received 100 or more IFA tablets 54.0 52.4 56.0 51.4 53.5 50.2 54.1 • Percent of mothers consumed all the IFA tablets received 33.2 32.5 34.1 30.7 31.6 31.8 32.4 Components5 of Antenatal Checkup/Advice • Weight measured 96.2 95.2 97.6 95.6 93.1 91.7 96.1 • Blood pressure checked 95.4 93.7 97.6 94.5 91.2 89.4 95.2 • Blood sample examined 94.2 92.1 96.9 92.8 89.5 87.1 93.9 • Urine sample examined 93.3 91.2 96.0 92.0 88.6 86.3 93.0 • Abdomen examined 95.4 94.2 96.9 94.5 91.9 90.7 95.2 • Informed about expected date of delivery 76.1 75.0 77.6 73.2 70.8 68.3 75.4 • Advised to have delivery in a health facility 76.6 77.7 75.2 75.8 70.8 73.1 76.7 • Advised about proper nutrition during pregnancy 87.8 88.4 87.0 87.1 84.5 85.6 87.5 Percent of Women Reporting health complications • Worms in intestines 3.1 3.5 2.4 3.3 4.5 3.1 3.1 • Difficulty of vision during day light 2.6 2.9 2.1 2.8 6.0 3.5 2.6 • Suffered from night blindness 2.2 2.8 1.4 2.9 4.7 3.8 2.3 • Suffered with convulsions but not due to fever 4.0 4.3 3.6 3.9 6.0 4.6 3.9 • Swelling of legs, body or face 24.4 24.1 24.9 24.5 29.3 23.0 24.0 • Felt excessive fatigue/anemic 36.0 35.5 36.7 38.0 36.6 32.3 36.0
  37. 37. 31 INDICATOR TOTAL RURAL URBAN SC ST SLI(Low) BPL Percent of women received advise/counseling at least once on the following aspects: • About additional diet 94.2 93.8 94.7 93.8 93.2 91.3 94.0 • Necessity of adequate rest / sleep 90.6 90.6 90.5 90.5 90.5 87.5 90.5 • Information about danger signs of pregnancy 50.7 51.0 50.3 50.7 44.6 48.7 50.9 • About breast feeding practice 77.0 76.6 77.7 76.3 76.1 74.2 76.7 • Need to keep the new born warm 67.0 67.6 66.2 66.7 67.3 66.4 66.6 • About cleanliness during delivery time 67.5 68.1 66.6 68.1 64.0 66.3 67.2 • About family planning 60.8 59.5 62.5 60.6 54.7 56.3 61.0 Delivery Care6 • Percent of deliveries in public hospitals 34.7 33.1 36.7 39.0 34.5 33.3 36.7 • Percent of deliveries in private hospital/NGO/Trust/Clinic 41.3 34.1 50.8 32.2 25.1 22.9 37.7 • Percent of domiciliary/Other deliveries 24.1 32.8 12.5 28.8 40.4 43.7 25.6 Percent of women who had • Normal delivery 72.7 76.6 67.5 77.4 80.8 84.6 75.1 • Caesarian section 26.5 22.6 31.6 22.0 18.4 14.7 24.1 • Other intervention 0.8 0.8 0.9 0.6 0.8 0.7 0.8 • Safe deliveries7 81.6 74.2 91.4 76.7 67.6 63.7 80.5 Main reason reported by women for not going to health facility for delivery8 • Not necessary 31.1 31.8 28.2 30.9 25.3 27.2 30.5 • Not customary 1.3 1.2 1.7 1.1 1.4 1.4 1.2 • Costs too high in a health facility 7.4 7.6 6.7 7.4 9.5 10.6 7.6 • Too far/Inconvenient 2.3 2.3 2.2 2.4 2.6 2.0 2.2 • Transport not available 5.1 5.9 2.1 4.2 11.8 7.1 5.2
  38. 38. 32 INDICATOR TOTAL RURAL URBAN SC ST SLI(Low) BPL • Poor quality service 1.6 1.6 1.9 2.2 2.1 2.9 1.5 • Due to lack of time to reach a health facility 28.2 27.5 31.0 31.1 21.0 25.6 28.0 • Husband/Family did not allow 0.6 0.6 0.5 0.9 0.6 0.6 0.6 • Family felt better care at home 19.7 18.9 22.7 17.5 22.4 19.8 20.4 • Lack of knowledge 1.2 1.3 1.2 1.1 2.6 1.4 1.3 • Other 1.4 1.3 1.7 1.2 0.8 1.4 1.4 Use of Safe delivery practices9 • Disposable delivery kit 44.6 44.4 45.6 46.3 49.6 40.2 44.2 • Clean blade to cut umbilical cord 91.3 91.5 90.8 92.5 90.4 91.6 91.4 • Baby immediately wiped dry and wrapped without being bathed 80.0 80.0 79.8 82.1 82.6 80.7 79.6 Percent of women reported complications / problems during last delivery • Pre-term labour 14.1 16.3 11.1 15.4 20.8 17.9 14.1 • Excessive bleeding 6.9 7.7 5.7 7.2 13.0 8.3 6.7 • Prolonged labour 9.9 10.2 9.6 10.0 9.7 9.1 9.7 • Obstructed labour 9.8 9.4 10.3 8.3 8.1 6.4 9.3 • Breach birth 2.4 2.3 2.7 2.3 2.3 1.9 2.4 Birth Weight • Percent of children weighed at birth 76.9 69.9 86.1 72.7 65.0 56.4 75.4 • Percent of children weighed less than 2500 grams at birth 17.0 17.6 16.3 19.1 16.9 22.8 17.2 • Percent of children weighed less than 1500 grams at birth 0.4 0.3 0.5 0.4 0.4 0.5 0.4 Post natal Checkup • Percent of mothers received first postnatal checkup within a day 87.6 83.4 93.1 85.9 84.3 75.8 86.7 • Percent of mothers received first postnatal checkup within a week 90.2 86.8 94.8 88.9 89.1 80.5 89.6
  39. 39. 33 INDICATOR TOTAL RURAL URBAN SC ST SLI(Low) BPL • Among those with post partum checkups (non-institutional births) 1. Percent seen within one week of birth 60.3 59.5 63.1 60.2 73.4 56.6 60.4 2. Percent of mothers received post partum checkup within 2 months of birth 64.2 63.5 66.9 64.8 75.8 60.5 64.3 • Out of those women who received post natal check up, percent of women received checkup from a doctor 76.9 71.0 84.1 73.6 60.8 61.9 75.5 Breast Feeding Practices • Percent of children ever breastfed 98.0 98.3 97.7 98.5 98.3 98.6 98.1 • Percent of children who were currently breastfed 80.6 83.8 76.3 84.4 85.0 86.1 81.5 • Percent of children started breastfeeding within half an hour 11.7 12.1 11.3 14.0 14.8 12.1 12.4 • Percent of neonates started breastfeeding within one hour of birth 31.6 32.8 30.0 35.7 37.0 33.8 33.0 • Percentage of children started breastfeeding within one day of birth 68.5 68.2 68.8 72.6 73.9 66.8 69.3 • Percentage of children whose mother squeezed out the first milk from breast 28.5 30.7 25.7 28.7 33.0 34.7 28.7 • Percent of children exclusively breastfed for 4 months 54.4 56.5 51.6 57.6 54.2 58.0 55.2 Childhood Diseases (Diarrhoea and ARI)10 • Percent of children who had diarrhea during last two weeks prior to the survey 11.7 11.9 11.4 11.5 12.2 11.7 11.5 • Among the children who had diarrhea in the past two weeks, percentage received 1. Oral rehydration therapy (ORS packet) 48.8 47.4 50.6 49.0 43.5 41.6 48.9 2. Gruel made from rice or other cereal 14.4 15.2 13.1 13.3 17.2 13.6 14.5 3. Pill / syrup 85.9 84.6 87.5 84.5 81.7 82.7 86.6 4. Injection 34.0 36.8 30.4 35.9 39.2 35.5 34.8 5. Intravenous (I.V / Drip / Bottle) 8.2 8.8 7.4 8.5 11.7 9.5 7.7
  40. 40. 34 INDICATOR TOTAL RURAL URBAN SC ST SLI(Low) BPL • Percent women aware of danger signs of Pneumonia 32.5 30.4 35.2 31.0 32.2 25.1 31.2 • Percent of children suffering from Pneumonia during last two weeks preceeding the survey 18.2 18.0 18.3 18.4 20.6 18.1 17.8 Child Rights Indicators • Percent of births registered with civil authority 57.0 52.7 62.6 54.8 47.1 41.9 56.7 • Percent of births possessing birth certificates 46.2 40.3 53.9 44.5 34.2 31.4 45.4 • Percent of children with vaccination card shown to interviewer 59.1 58.4 60.0 57.3 54.2 51.6 59.0 Child Immunization Among Children Age 12-23 months • Percent received BCG 98.1 98.1 98.1 97.9 95.6 95.3 98.1 • Percent received OPV 1 97.9 98.1 97.7 98.0 95.8 95.8 97.9 • Percent received OPV 2 96.8 97.0 96.5 96.7 93.9 94.1 96.8 • Percent received OPV 3 92.1 91.6 92.8 91.4 86.1 85.9 92.1 • Percent received DPT 1 97.9 98.1 97.6 97.9 95.4 95.5 97.9 • Percent received DPT 2 96.5 96.8 96.2 96.4 93.1 93.4 96.5 • Percent received DPT 3 92.2 91.8 92.9 91.6 86.2 86.3 92.2 • Percent received Hepatitis- B1 97.0 97.1 96.8 97.1 93.4 94.3 97.0 • Percent received Hepatitis- B2 94.9 95.0 94.8 94.9 90.6 91.3 94.8 • Percent received Hepatitis- B3 88.3 87.1 89.9 87.3 81.1 81.2 88.3 • Percent received Measles vaccine 87.9 88.0 87.8 85.8 81.6 82.2 87.7 • Percent fully immunized (BCG + OPV 1-3 + DPT 1-3 + Measles) 82.7 81.5 84.2 80.2 72.8 73.6 82.5 • Percent received Vitamin A dose at least once 87.0 87.6 86.2 86.9 83.3 82.7 87.1
  41. 41. 35 INDICATOR TOTAL RURAL URBAN SC ST SLI(Low) BPL Pregnancy11 • Percent of current pregnancies among currently married women (CMW ) interviewed 12.5 12.6 12.3 12.4 11.8 11.9 12.6 • Number of currently pregnant women 4149 2408 1741 933 312 540 3178 1. Percent of pregnant women below 20 weeks of pregnancy 34.1 34.6 33.5 36.5 36.5 36.7 33.8 2. Percent of pregnant women 20-32 weeks of pregnancy 57.0 65.4 57.8 55.3 54.2 54.1 57.0 3. Percent of pregnant women 33+ weeks of pregnancy 8.9 9.0 8.7 8.1 9.3 9.3 9.2 Contraceptive Use • Percent of CMW using any method of contraception 43.2 42.8 43.8 42.0 38.8 39.9 43.8 • Percent of CMW using permanent method of contraception 41.3 41.5 40.9 40.3 37.8 39.5 42.2 • Percent of CMW using spacing method of contraception 1.9 1.3 2.9 1.6 1.0 0.5 1.6 • Place of providing sterilization services 1) Govt. hospital 78.8 84.1 71.5 84.6 87.5 91.2 81.8 2) Private hospital/NGO/Trust hospital/clinic/other 21.2 15.9 28.5 15.4 12.5 8.8 18.2 Childhood Mortality • Neonatal Mortality rate 36.9 43.2 28.6 59.5 70.6 57.5 38.2 • Post neonatal mortality rate 15.9 19.0 11.8 33.4 40.3 27.6 17.1 • Infant mortality rate 52.8 62.3 40.4 92.9 111.0 85.1 55.3 Awareness of Health Interventions under RCH-II12 Percent of women who are aware of • Janani Suraksha Yojana 61.6 65.6 56.3 62.8 62.0 59.0 63.0 • Rural Emergency Health Transport System 13 10.6 12.1 8.4 10.0 7.9 5.5 9.9 • Free Bus Pass to Pregnant Women 27.5 34.9 17.6 31.2 28.2 26.5 28.2 • Women Health Volunteer Scheme 23.9 31.5 13.8 27.0 27.9 26.9 25.4 • Round-the-Clock-Mother and Child Health Centre 14.5 13.0 16.4 13.6 10.5 11.9 14.7
  42. 42. 36 INDICATOR TOTAL RURAL URBAN SC ST SLI(Low) BPL Reproductive Tract Infections14 • Percent of women who contracted a disease through sexual contact 7.4 8.3 6.3 8.0 9.4 8.7 7.5 • Percent of women who experienced a bad smelling abnormal genital discharge 12.6 13.7 11.1 12.8 16.4 14.6 12.7 • Percent of women who had a genital sore or ulcer 2.2 2.4 1.8 2.5 3.1 2.6 2.2 • Percent of women who had any one of the above three problems 16.1 17.8 14.0 16.8 20.4 18.4 16.4 Of those who had RTI problem • Percent of women who sought advice / treatment 46.6 47.6 45.0 46.0 45.8 46.0 46.3 Source of taking advice or treatment • Government doctor 29.9 29.2 31.2 32.5 45.1 40.5 31.3 • NGO worker 16.8 16.5 17.2 15.1 12.5 12.8 16.0 • Private doctor 38.1 35.2 43.3 33.0 26.5 29.8 36.5 SC : Scheduled Caste ST : Scheduled Tribe SLI(Low) : Standard of Living Index Lower group BPL : Below Poverty Level (white ration card) households Notes 1) Eligible women are those who had a delivery during the period from January/Sankranti, 2004 to the date of survey. 2) Live births occurred during the period from January / Sankranti 2004 to the date of survey. 3) The estimates do not represent the district since the sample was not drawn from the general population 4) Based on last pregnancy of all eligible women. 5) Based on last pregnancy of all eligible women. 6) Based on last delivery of all eligible women. 7) Deliveries attended by Doctor/ Nurse/ Mid-wife/ANM. 8) Based on non-institutional deliveries. 9) Percentages based on all domiciliary deliveries. 10) Based on children born during the period from January / Sankranti 2004 to the date of survey. 11) Based on all eligible women who are currently married. 12) Based on all eligible women interviewed. 13) Based on all eligible women from four districts Mahbubnagar, Nizamabad, Kurnool and Cuddapah districts. 14) Based on all eligible women.
  43. 43. 37 BASELINE SURVEY ON REPRODUCTIVE AND CHILD HEALTH (RCH-II), ANDHRA PRADESH 2006 DISTRICT: SRIKAKULAM FACT SHEET INDICATOR TOTAL RURAL URBAN SC ST SLI (Low) BPL Sample Population • Number of households interviewed 2515 1509 1006 332 94 439 2192 • Number of eligible women interviewed1 2575 1536 1039 341 97 443 2242 • Number of live births2 2870 1716 1154 374 112 490 2500 • Population in the sample 14097 8320 5777 1731 507 2515 12187 Population and Household Characteristics3 • Mean household size 5.61 5.51 5.74 5.21 5.39 5.61 5.56 • Percent of pucca houses 49.3 44.4 56.7 31.0 34.0 3.4 45.8 • Percent of households with separate kitchen 69.8 66.6 74.7 56.0 53.2 31.7 67.7 • Percent of households with electricity 89.6 86.7 93.9 76.8 71.3 49.2 88.7 • Percent of households using piped water as main source of drinking 80.2 70.7 94.5 83.1 74.5 79.5 79.3 • Percent of households using cleaner cooking fuels ( LPG, Electricity and Kerosene) 28.0 14.0 49.0 11.4 16.0 1.1 21.9 • Percent of households with no toilet / latrine facility 72.5 87.3 50.4 85.8 91.5 98.9 78.9 • Percent of households with white ration card 87.2 92.3 79.4 91.6 89.4 93.2 - • Percent of scheduled caste households 13.2 13.6 12.6 - - 25.5 13.9 • Percent of scheduled tribe households 3.7 4.7 2.3 - - 9.3 3.8 • Percent of backward caste households 70.1 72.4 66.6 - - 60.8 71.4
  44. 44. 38 INDICATOR TOTAL RURAL URBAN SC ST SLI (Low) BPL Maternal Health Care4 • Percent of mothers received any ANC 97.4 96.5 98.7 95.3 82.5 92.8 97.2 • Percent of mothers received at least 3 ANC checkups 93.1 91.3 95.9 90.0 87.6 85.3 92.4 • Percent of mothers registered in first trimester 81.6 78.3 86.5 79.0 67.0 68.9 80.6 • Percent of women received check up at least once by a M.B.B.S doctor 96.4 95.1 98.3 93.8 79.4 91.0 96.0 • Percent of mothers received 2 or more TT injections 98.4 99.1 97.4 97.1 96.9 97.3 98.3 • Percent of mothers received 100 or more IFA tablets 72.3 70.0 75.8 69.7 61.8 61.9 71.1 • Percent of mothers consumed all the IFA tablets received 37.7 39.2 35.4 30.6 46.1 34.5 36.3 Components5 of Antenatal Checkup/Advice • Weight measured 96.4 96.1 96.9 95.6 91.5 92.5 96.0 • Blood pressure checked 94.3 92.5 96.9 91.4 85.1 88.6 93.7 • Blood sample examined 94.6 93.4 96.5 92.0 84.0 89.0 94.2 • Urine sample examined 95.6 94.3 97.5 93.8 87.2 92.0 95.1 • Abdomen examined 96.7 95.7 98.3 93.8 91.5 92.0 96.3 • Informed about expected date of delivery 88.4 85.9 92.1 83.4 71.3 77.2 87.2 • Advised to have delivery in a health facility 88.3 85.9 91.9 86.7 69.1 79.7 87.3 • Advised about proper nutrition during pregnancy 92.5 91.2 94.5 89.6 80.9 87.2 91.8 Percent of Women Reporting health complications • Worms in intestines 0.9 1.2 0.3 0.9 1.0 1.6 0.9 • Difficulty of vision during day light 0.6 0.7 0.4 0.3 0.0 0.7 0.6 • Suffered from night blindness 0.5 0.7 0.4 0.3 1.0 0.5 0.6 • Suffered with convulsions but not due to fever 1.3 1.3 1.3 1.8 1.0 1.1 1.4 • Swelling of legs, body or face 10.9 12.2 8.9 15.5 9.3 6.8 10.9 • Felt excessive fatigue/anemic 14.4 17.3 10.1 13.8 7.2 11.3 14.8
  45. 45. 39 INDICATOR TOTAL RURAL URBAN SC ST SLI (Low) BPL Percent of women received advise/counseling at least once on the following aspects: • About additional diet 96.8 97.8 95.3 96.5 99.0 97.5 96.9 • Necessity of adequate rest / sleep 93.2 93.9 92.1 91.5 95.9 93.0 93.1 • Information about danger signs of pregnancy 63.9 60.3 69.2 58.7 66.0 61.4 62.6 • About breast feeding practice 77.4 76.3 79.1 75.4 67.0 76.5 77.1 • Need to keep the new born warm 68.1 65.6 71.8 66.0 59.8 63.9 67.4 • About cleanliness during delivery time 71.3 68.8 75.0 69.8 58.8 67.3 70.7 • About family planning 68.4 66.4 71.3 66.3 54.6 66.1 68.4 Delivery Care6 • Percent of deliveries in public hospitals 28.4 25.7 32.4 28.2 22.7 22.8 29.0 • Percent of deliveries in private hospital/NGO/Trust/Clinic 31.2 25.8 39.3 23.5 20.6 17.8 27.3 • Percent of domiciliary/Other deliveries 40.4 48.6 28.3 48.4 56.7 59.4 43.7 Percent of women who had • Normal delivery 72.3 74.6 68.8 78.6 83.5 84.7 74.1 • Caesarian section 23.1 19.4 28.6 18.5 14.4 13.3 21.1 • Other intervention 4.6 6.0 2.6 2.9 2.1 2.0 4.8 • Safe deliveries7 73.0 66.2 83.2 64.2 53.6 55.8 70.6 Main reason reported by women for not going to health facility for delivery8 • Not necessary 23.8 23.3 25.2 19.4 16.4 23.6 23.1 • Not customary 1.3 1.6 0.7 1.2 1.8 2.7 1.4 • Costs too high in a health facility 9.1 8.7 10.2 10.3 14.5 16.7 9.3 • Too far/Inconvenient 2.1 2.1 2.0 2.4 7.3 2.3 2.0 • Transport not available 3.2 3.9 1.4 3.6 0.0 2.7 3.1
  46. 46. 40 INDICATOR TOTAL RURAL URBAN SC ST SLI (Low) BPL • Poor quality service 0.5 0.4 0.7 1.2 0.0 0.8 0.4 • Due to lack of time to reach a health facility 28.1 25.3 35.0 29.1 16.4 18.3 28.2 • Husband/Family did not allow 0.6 0.7 0.3 0.6 1.8 0.4 0.5 • Family felt better care at home 28.4 31.5 20.4 30.9 38.2 28.5 29.0 • Lack of knowledge 0.1 0.0 0.3 0.0 0.0 0.4 0.1 • Other 2.8 2.4 3.7 1.2 3.6 3.8 2.9 Use of Safe delivery practices9 • Disposable delivery kit 23.4 21.7 27.6 20.6 21.8 16.3 23.1 • Clean blade to cut umbilical cord 92.7 94.4 88.4 94.5 96.4 91.6 92.8 • Baby immediately wiped dry and wrapped without being bathed 56.1 53.5 62.6 55.8 60.0 54.8 56.1 Percent of women reported complications / problems during last delivery • Pre-term labour 3.3 2.9 3.8 3.5 4.1 2.3 3.2 • Excessive bleeding 4.6 5.3 3.6 5.9 1.0 0.9 5.0 • Prolonged labour 6.7 7.0 6.4 7.0 4.1 4.7 6.5 • Obstructed labour 17.4 18.4 15.8 12.6 11.3 10.4 16.8 • Breach birth 1.6 1.4 2.0 2.9 2.1 1.8 1.5 Birth Weight • Percent of children weighed at birth 62.2 54.6 73.5 55.4 46.4 41.5 59.1 • Percent of children weighed less than 2500 grams at birth 16.7 18.6 14.7 18.5 11.9 24.4 17.9 • Percent of children weighed less than 1500 grams at birth 1.0 1.0 0.9 1.1 4.8 1.7 1.1 Post natal Checkup • Percent of mothers received first postnatal checkup within a day 78.9 74.8 85.0 71.6 67.0 65.0 77.4 • Percent of mothers received first postnatal checkup within a week 83.0 79.9 87.6 77.4 74.2 68.8 81.7
  47. 47. 41 INDICATOR TOTAL RURAL URBAN SC ST SLI (Low) BPL • Among those with post partum checkups (non-institutional births) 1. Percent seen within one week of birth 62.5 61.7 64.6 57.0 58.2 51.0 62.2 2. Percent of mothers received post partum checkup within 2 months of birth 65.8 65.5 66.3 59.4 60.0 54.4 65.7 • Out of those women who received post natal check up, percent of women received checkup from a doctor 69.8 63.4 78.5 64.8 56.2 55.4 67.6 Breast Feeding Practices • Percent of children ever breastfed 99.0 99.1 98.7 98.8 99.0 98.6 99.1 • Percent of children who were currently breastfed 77.1 81.5 70.6 82.5 83.3 86.5 79.9 • Percent of children started breastfeeding within half an hour 14.0 17.3 9.2 16.9 18.8 16.5 14.6 • Percent of neonates started breastfeeding within one hour of birth 36.8 38.7 33.9 49.3 52.1 40.0 37.7 • Percentage of children started breastfeeding within one day of birth 58.9 58.7 59.2 72.4 77.1 61.8 59.0 • Percentage of children whose mother squeezed out the first milk from breast 37.6 37.1 38.3 40.1 45.8 41.0 38.3 • Percent of children exclusively breastfed for 4 months 50.6 55.0 44.1 61.1 57.3 59.0 52.1 Childhood Diseases (Diarrhoea and ARI)10 • Percent of children who had diarrhea during last two weeks prior to the survey 19.0 17.1 21.8 16.1 20.6 17.2 18.8 • Among the children who had diarrhea in the past two weeks, percentage received 1. Oral rehydration therapy (ORS packet) 62.6 65.4 59.3 45.5 60.0 52.6 61.8 2. Gruel made from rice or other cereal 14.1 15.2 12.8 14.5 5.0 6.6 14.0 3. Pill / syrup 94.0 93.2 95.0 93.5 94.7 84.8 93.9 4. Injection 37.8 38.9 36.7 50.0 42.1 39.4 39.4 5. Intravenous (I.V / Drip / Bottle) 6.0 9.0 2.8 10.9 0.0 7.6 6.1 • Percent women aware of danger signs of Pneumonia 19.7 22.5 15.5 17.3 10.3 14.9 19.2 • Percent of children suffering from Pneumonia during last two weeks preceeding the survey 15.6 13.2 19.2 15.0 11.3 14.4 15.9
  48. 48. 42 INDICATOR TOTAL RURAL URBAN SC ST SLI (Low) BPL Child Rights Indicators • Percent of births registered with civil authority 69.9 71.1 68.0 66.5 65.1 62.8 68.8 • Percent of births possessing birth certificates 49.4 46.9 53.1 50.1 49.5 48.0 48.0 • Percent of children with vaccination card shown to interviewer 64.0 63.8 64.4 62.4 57.8 62.6 63.6 Child Immunization Among Children Age 12-23 months • Percent received BCG 99.2 99.7 98.7 98.4 100.0 98.8 99.1 • Percent received OPV 1 98.7 99.5 97.8 96.9 97.3 98.8 98.7 • Percent received OPV 2 97.8 98.6 96.6 96.1 97.3 98.3 97.6 • Percent received OPV 3 89.4 93.3 84.3 86.0 94.6 90.8 89.6 • Percent received DPT 1 98.9 99.7 98.0 97.7 97.3 98.8 98.9 • Percent received DPT 2 98.0 98.8 96.9 97.7 94.6 98.3 98.0 • Percent received DPT 3 89.9 93.6 85.0 86.8 91.9 91.3 90.2 • Percent received Hepatitis- B1 97.5 98.6 96.0 96.1 97.3 98.3 97.3 • Percent received Hepatitis- B2 96.2 97.2 94.8 96.1 94.6 98.3 96.1 • Percent received Hepatitis- B3 86.4 90.9 80.5 84.5 86.5 87.9 86.7 • Percent received Measles vaccine 94.4 95.5 93.0 90.7 91.9 92.5 95.1 • Percent fully immunized (BCG + OPV 1-3 + DPT 1-3 + Measles) 86.0 90.2 80.5 82.2 89.2 86.0 86.7 • Percent received Vitamin A dose at least once 88.9 88.1 89.9 86.0 89.2 88.9 89.8 Pregnancy11 • Percent of current pregnancies among currently married women (CMW ) interviewed 15.9 15.9 15.9 17.4 12.3 12.7 16.0 • Number of currently pregnant women 203 124 79 34 7 28 178 1. Percent of pregnant women below 20 weeks of pregnancy 31.0 31.5 30.4 26.5 28.6 21.4 28.7 2. Percent of pregnant women 20-32 weeks of pregnancy 60.1 58.1 63.3 55.9 71.4 64.3 61.8 3. Percent of pregnant women 33+ weeks of pregnancy 8.9 10.5 6.3 17.6 0.0 14.3 9.6
  49. 49. 43 INDICATOR TOTAL RURAL URBAN SC ST SLI (Low) BPL Contraceptive Use • Percent of CMW using any method of contraception 49.9 48.6 51.8 41.8 40.6 50.3 49.8 • Percent of CMW using permanent method of contraception 46.8 46.6 47.1 40.0 39.6 49.2 47.8 • Percent of CMW using spacing method of contraception 3.1 2.0 4.8 1.8 1.0 1.1 2.1 • Place of providing sterilization services 1) Govt. hospital 88.9 91.4 85.0 90.4 93.5 96.7 91.1 2) Private hospital/NGO/Trust hospital/clinic/other 11.1 8.6 15.0 9.6 6.5 3.3 8.9 Childhood Mortality • Neonatal Mortality rate 43.0 48.4 35.6 49.5 62.5 69.1 46.0 • Post neonatal mortality rate 19.0 25.3 10.4 49.5 46.9 21.8 20.4 • Infant mortality rate 61.9 73.7 46.0 99.0 109.4 90.9 66.4 Awareness of Health Interventions under RCH-II12 Percent of women who are aware of • Janani Suraksha Yojana 80.7 79.6 82.3 80.9 61.9 77.7 81.5 • Free Bus Pass to Pregnant Women 30.8 39.3 18.2 27.9 27.8 23.9 31.9 • Women Health Volunteer Scheme 33.6 46.2 14.9 36.1 30.9 38.8 35.4 • Round-the-Clock-Mother and Child Health Centre 29.7 26.4 34.5 28.4 27.8 27.8 29.7 Reproductive Tract Infections13 • Percent of women who contracted a disease through sexual contact 5.8 5.9 5.6 7.6 5.2 5.0 6.2 • Percent of women who experienced a bad smelling abnormal genital discharge 7.1 7.7 6.3 7.3 10.3 5.6 7.5 • Percent of women who had a genital sore or ulcer 1.6 2.0 1.0 1.8 3.1 1.1 1.6 • Percent of women who had any one of the above three problems 9.6 10.3 8.7 10.0 12.4 8.1 10.3
  50. 50. 44 INDICATOR TOTAL RURAL URBAN SC ST SLI (Low) BPL Of those who had RTI problem • Percent of women who sought advice / treatment 38.3 35.4 43.3 32.4 41.7 36.1 36.5 Source of taking advice or treatment 1. Government doctor 34.7 30.4 41.0 54.5 60.0 23.1 35.7 2. NGO worker 4.2 5.4 2.6 0.0 0.0 0.0 4.8 3. Private doctor 54.7 55.4 53.8 54.5 20.0 46.2 53.6 SC : Scheduled Caste ST : Scheduled Tribe SLI (Low): Standard of Living Index Lower group BPL : Below Poverty Level (white ration card) households Notes 1) Eligible women are those who have delivery during the period from January/Sankranti, 2004 to the date of survey. 2) Refers to the period from January / Sankranti 2004 to the date of survey. 3) The estimates do not represent the district since the sample was not drawn from the general population. 4) Based on all eligible women. 5) All eligible women who are currently married. 6) Based on last pregnancy of all eligible women. 7) Based on last pregnancy of all eligible women. 8) Based on last delivery of all eligible women. 9) Deliveries attended by Doctor/ Nurse/ Mid-wife/ANM. 10) Based on non-institutional deliveries. 11) Percentages based on all domiciliary deliveries. 12) Based on children born during the period from January / Sankranti 2004 to the date of survey. 13) Based on all eligible women.
  51. 51. 45 BASELINE SURVEY ON REPRODUCTIVE AND CHILD HEALTH (RCH-II), ANDHRA PRADESH 2006 DISTRICT : VIZIANAGARAM FACT SHEET INDICATOR TOTAL RURAL URBAN SC ST SLI (Low) BPL Sample Population • Number of households interviewed 2479 1486 993 299 87 500 2142 • Number of eligible women interviewed1 2479 1486 993 299 87 500 2142 • Number of live births2 2738 1649 1089 330 101 540 2370 • Population in the sample 12867 7825 5042 1525 395 2479 11142 Population and Household Characteristics3 • Mean household size 5.19 5.27 5.08 5.10 4.54 5.19 5.20 • Percent of pucca houses 37.4 32.0 45.4 34.1 27.6 4.8 34.2 • Percent of households with separate kitchen 75.1 71.7 80.2 66.6 54.0 48.4 72.7 • Percent of households with electricity 84.9 79.1 93.6 71.2 49.4 36.6 83.2 • Percent of households using piped water as main source of drinking 92.8 89.1 98.4 92.3 96.6 88.6 92.2 • Percent of households using cleaner cooking fuels ( LPG, Electricity and Kerosene) 31.2 12.3 59.5 17.1 8.0 2.0 24.3 • Percent of households with no toilet / latrine facility 69.9 91.7 37.4 86.0 87.4 98.6 76.5 • Percent of households with white ration card 86.4 94.7 74.0 90.3 90.8 93.4 - • Percent of scheduled caste households 12.1 14.1 9.0 - - 19.4 12.6 • Percent of scheduled tribe households 3.5 4.5 2.0 - - 10.2 3.7 • Percent of backward caste households 73.8 76.4 69.8 - - 68.8 75.4
  52. 52. 46 INDICATOR TOTAL RURAL URBAN SC ST SLI (Low) BPL Maternal Health Care4 • Percent of mothers received any ANC 98.7 98.4 99.1 97.7 92.0 96.2 98.6 • Percent of mothers received at least 3 ANC checkups 93.1 91.9 95.0 88.6 19.5 85.2 92.3 • Percent of mothers registered in first trimester 82.7 80.6 85.9 80.1 75.0 74.6 81.7 • Percent of women received check up at least once by a M.B.B.S doctor 95.6 94.6 97.2 93.6 78.2 88.4 95.5 • Percent of mothers received 2 or more TT injections 98.4 98.5 98.2 98.0 94.3 96.4 98.5 • Percent of mothers received 100 or more IFA tablets 55.6 54.0 58.0 53.2 43.2 47.8 54.0 • Percent of mothers consumed all the IFA tablets received 35.5 32.6 40.1 42.9 42.0 33.8 34.9 Components5 of Antenatal Checkup/Advice • Weight measured 97.7 97.2 98.5 97.0 85.7 94.0 97.5 • Blood pressure checked 97.0 96.1 98.3 94.9 82.1 91.5 96.7 • Blood sample examined 96.6 95.5 98.2 94.6 77.4 90.7 96.2 • Urine sample examined 96.3 95.2 98.0 94.6 72.6 90.1 95.9 • Abdomen examined 96.7 95.9 97.8 95.9 75.0 91.7 96.3 • Informed about expected date of delivery 94.0 92.6 96.0 91.6 71.4 87.5 93.3 • Advised to have delivery in a health facility 94.0 92.2 96.8 93.2 78.6 87.3 93.4 • Advised about proper nutrition during pregnancy 97.6 96.8 98.9 97.3 82.1 93.5 97.4 Percent of Women Reporting health complications • Worms in intestines 0.9 0.7 1.2 0.7 0.0 1.0 1.0 • Difficulty of vision during day light 1.2 1.1 1.3 1.0 2.3 2.8 1.1 • Suffered from night blindness 0.4 0.5 0.3 1.7 1.1 1.4 0.4 • Suffered with convulsions but not due to fever 2.3 2.8 1.5 4.0 10.3 5.0 2.4 • Swelling of legs, body or face 10.7 11.6 9.4 10.4 14.9 13.2 11.0 • Felt excessive fatigue/anemic 23.5 24.9 21.3 14.0 17.2 23.2 24.6
  53. 53. 47 INDICATOR TOTAL RURAL URBAN SC ST SLI (Low) BPL Percent of women received advise/counseling at least once on the following aspects: • About additional diet 99.0 99.3 98.7 99.0 97.7 98.2 99.0 • Necessity of adequate rest / sleep 96.5 95.5 97.9 98.0 95.4 94.4 96.4 • Information about danger signs of pregnancy 68.7 66.9 71.4 70.9 69.0 66.6 68.0 • About breast feeding practice 85.8 84.5 87.9 88.0 88.5 84.4 85.5 • Need to keep the new born warm 84.2 82.4 86.9 86.3 83.9 82.4 83.9 • About cleanliness during delivery time 81.0 78.3 85.2 82.6 75.9 77.2 80.2 • About family planning 85.1 80.9 91.3 88.6 85.1 79.0 84.2 Delivery Care6 • Percent of deliveries in public hospitals 37.7 36.5 39.5 43.5 28.7 35.4 39.2 • Percent of deliveries in private hospital/NGO/Trust/Clinic 30.3 22.2 42.4 15.4 13.8 16.2 26.3 • Percent of domiciliary/Other deliveries 32.0 41.3 18.1 41.1 57.5 48.4 34.5 Percent of women who had • Normal delivery 81.6 86.8 73.8 90.3 93.1 89.8 83.9 • Caesarian section 17.7 12.4 25.8 9.4 6.9 9.4 15.4 • Other intervention 0.6 0.8 0.4 0.3 0.0 0.8 0.7 • Safe deliveries7 80.4 72.6 91.9 72.2 58.6 67.8 78.3 Main reason reported by women for not going to health facility for delivery8 • Not necessary 11.9 11.3 13.9 8.1 6.0 9.1 11.8 • Not customary 1.6 1.1 3.3 1.6 2.0 2.1 1.2 • Costs too high in a health facility 13.2 15.3 6.1 22.8 28.0 23.1 14.1 • Too far/Inconvenient 0.8 0.8 0.6 1.6 4.0 2.1 0.7 • Transport not available 5.8 6.9 2.2 3.3 12.0 8.3 6.2
  54. 54. 48 INDICATOR TOTAL RURAL URBAN SC ST SLI (Low) BPL • Poor quality service 0.9 1.0 0.6 1.6 0.0 1.7 0.9 • Due to lack of time to reach a health facility 32.7 32.0 35.0 33.3 20.0 26.9 33.0 • Husband/Family did not allow 0.0 0.0 0.0 0.0 0.0 0.0 0.0 • Family felt better care at home 30.0 28.7 34.4 26.0 24.0 24.4 29.2 • Lack of knowledge 0.6 0.5 1.1 0.0 2.0 0.8 0.7 • Other 2.5 2.4 2.8 1.6 2.0 1.7 2.2 Use of Safe delivery practices9 • Disposable delivery kit 35.1 33.3 41.1 28.5 30.0 24.8 34.8 • Clean blade to cut umbilical cord 90.0 90.0 90.0 90.2 96.0 88.0 90.0 • Baby immediately wiped dry and wrapped without being bathed 84.0 83.4 86.1 87.8 94.0 79.3 83.9 Percent of women reported complications / problems during last delivery • Pre-term labour 8.0 5.2 12.1 9.0 4.6 9.4 7.4 • Excessive bleeding 1.2 1.3 1.1 0.7 2.3 1.4 1.2 • Prolonged labour 4.0 2.7 5.9 4.3 0.0 1.6 3.4 • Obstructed labour 6.3 4.6 8.9 5.0 0.0 2.2 5.5 • Breach birth 1.7 1.6 1.7 1.0 1.1 1.4 1.6 Birth Weight • Percent of children weighed at birth 68.3 59.1 82.1 63.5 43.7 49.8 65.8 • Percent of children weighed less than 2500 grams at birth 15.1 16.1 14.0 17.0 22.2 20.0 15.9 • Percent of children weighed less than 1500 grams at birth 0.8 0.7 0.9 0.5 0.0 1.3 0.7 Post natal Checkup • Percent of mothers received first postnatal checkup within a day 82.7 79.5 87.6 84.6 77.0 74.8 81.5 • Percent of mothers received first postnatal checkup within a week 85.1 82.1 89.6 86.6 82.8 78.4 84.1

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