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ANNUAL HEALTH SURVEY FACT SHEET First Updation round(2011-12) KEY FINDINGS Dr. C. Chandramouli Registrar General & Census Commissioner, India.

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Presentation on theme: "ANNUAL HEALTH SURVEY FACT SHEET First Updation round(2011-12) KEY FINDINGS Dr. C. Chandramouli Registrar General & Census Commissioner, India."— Presentation transcript:

1 ANNUAL HEALTH SURVEY FACT SHEET First Updation round( ) KEY FINDINGS Dr. C. Chandramouli Registrar General & Census Commissioner, India

2 “ Reproductive health and rights are integral to sustainable development and poverty reduction. Investing in universal access to reproductive health is crucial investment in healthy societies and a more sustainable future”. – Ban Ki-moon, Secretary-General, UN on World Population Day, 2012

3 “ Working for the survival and the well being of women and girls is a human right imperative. And in order to take advantage of women’s full potential in the development of their nations, they must be able to plan their lives and families.” – Babatunde Osotimehin, Executive Director, UNFPA on World Population Day, 2012

4 “ There should be an Annual Health Survey of all districts which could be published/monitored and compared against benchmarks” - Dr. Manmohan Singh, Prime Minister of India – In the meeting of National Commission of Population, 2005

5 AHS provides key indicators on Reproductive and Child Health at District level in 8 EAG States and Assam Vital inputs for evidence based intervention and monitoring

6 OBJECTIVE OF AHS  AHS yields a comprehensive, representative and reliable dataset on core vital indicators including composite ones like IMR, MMR and TFR along with their co-variates (process and outcome indicators) at the district level and maps changes therein on an annual basis.  These benchmarks help in better and holistic understanding and timely monitoring of various determinants on well-being and health of population particularly Reproductive and Child Health.

7 Coverage : Annual Health Survey

8 Indicators under AHS In all, 161 indicators are available from AHS : Fertility- 13 Sex Ratio- 3 Marriage- 5 Mortality- 7 Mother & Child Care- 63  Ante Natal Care: 11  Delivery Care: 8  Post Natal Care: 5  Janani Suraksha Yojana (JSY): 3  Immunization: 8  Vitamin A & Iron Supplements: 2  Birth Weight: 2  Childhood Disease: 6  Birth Registration: 2  Breastfeeding & Supplementation: 12  Awareness in Mothers: 4 Abortion- 6 Family Planning Practices- 15 Disability- 1 Morbidity- 19 Personal Habits:adults-4 Housing & HH Characteristics- 13 Others- 12

9 Indicators under AHS Contd… Under 1 st phase of release, following 9 indicators have already been released in the Bulletin :  Crude Birth Rate (CBR)  Crude Death Rate (CDR)  Infant Mortality Rate (IMR)  Neo-Natal Mortality Rate (NNMR)  Under Five Mortality Rate (U5MR)  Maternal Mortality Ratio (MMR)  Sex Ratio at Birth (SRB)  Sex Ratio (0-4 years) and  Sex Ratio (All ages) Remaining indicators are being released under present phase of dissemination.

10 Five Core Themes Covered The presentation focuses on results pertaining to 5 core themes: Total Fertility Rate Family Planning: Current Usage & Total Unmet Need Ante Natal Care Delivery & Post Natal Care Immunization and Breast Feeding Practices

11 KEY FINDINGS  Improvement has been noticed in most of the indicators as compared to Baseline.  Replacement level of TFR 2.1 has been achieved in only 29 out of 284 AHS districts whereas in Baseline it was 20 districts.  In 145 districts, on an average a woman bears more than 3 children.  More than half of currently married women aged years are not using any method of family planning in Bihar.

12 KEY FINDINGS  Female Sterilization continues to remain the most dominant method of family planning among the modern methods across all AHS States except Assam.  At least 12.6% currently married women are yet to meet their family planning requirement (Unmet Need) across all AHS States. This was 20.0% in Baseline.  Despite wider penetration of `Any ANC’, the coverage under ‘first trimester ANC’ as well as ‘3 or more ANCs’ needs further improvement.

13  Poor performance of full ANC is primarily due to low IFA consumption.  Universal coverage of JSY remains a concern even in better performing States like Odisha, MP & Rajasthan.  Seven out of every 10 deliveries are ‘safe’ in Madhya Pradesh, Rajasthan, Odisha and Assam. KEY FINDINGS

14 At least 1 in 7 mothers has not received any PNC among all the AHS States, in Assam it is 1 in 3 mothers. In full immunization, even the better performing States like Uttarakhand, Chhattisgarh and Rajasthan fall short by percentage points in achieving universal coverage. Percent of traditional method in any method of family planning is more than 20% in 4 States namely, Uttar Pradesh, Assam, Jharkhand & Odisha. KEY FINDINGS

15 55 districts are hotspots (57 in baseline) i.e. common in top 100 districts in IMR and top 25 Administrative Divisions (111 districts) in MMR. Performance of Hot Spot Districts DISTRICTS FALLING IN BOTH TOP 100 IMR AND DISTRICTS OF TOP 25 MMR UP - 31 Bihar -1 Odisha -1 MP -16 Assam- 6

16 State wiseTFR of Hot Spot Districts

17 State wise Full ANC of Hot Spot Districts

18 State wise Immunization in Hot Spot Districts

19 State wise Institutional Delivery in Hot Spot Districts

20 TOTAL FERTILITY RATE (TFR) TFR is the average number of children born to a woman during her entire reproductive span. Uttarakhand & Odisha and UP & Bihar continue to remain two extremes of the spectrum.

21 TOTAL FERTILITY RATE (TFR) Total Fertility Rate State State valueDistrict with Minimum TFRDistrict with Maximum TFRRange First updation BaselineFirst UpdationBaselineFirst UpdationBaseline First Updation Baseline Assam Kamrup (2.0), Nalbari (2.0) Kamrup (2.0), Nalbari(2.0) Hailakandi (3.9) Hailakandi (4.2) Bihar Patna (2.7) Patna (2.8) Sheohar (4.6) Sheohar (4.7) 1.9 Chhattisgarh Koriya (2.4), Kanker (2.4), Durg (2.4) Koriya (2.4) Kawardha (3.7) 1.3 Jharkhand Purbi Singhbhum (2.2) Purbi Singhbhum (2.4) Pakaur (3.9) Lohardagga (4.0) Madhya Pradesh 3.1 Bhopal (2.1) Indore (2.2) Shivpuri(4.4) Shivpuri (4.5) 2.3 Odisha2.3 Anugul (1.9), Bargarh (1.9), Jharsuguda (1.9) Jharsuguda (2.0) Baudh (3.5) Boudh (3.7) Rajasthan Kota (2.5) Kota (2.6) Barmer (4.5) Barmer (4.7) Uttar Pradesh Kanpur Nagar (2.2) Kanpur Nagar (2.3) Shrawasti (5.8) Shrawasti (5.9) 3.6 Uttarakhand Pithoragarh (1.7), Bageshwar (1.7) Pithoragarh (1.7) Haridwar (2.9) Haridwar (3.1) Within a State, the minimum variability of 1.2 is reported in Uttarakhand and the maximum of 3.6 in Uttar Pradesh whereas in Baseline it was 1.3 in Chhattisgarh and 3.6 in Uttar Pradesh respectively. Across 284 districts in 9 AHS States, it ranges from 1.7 in Pithoragarh and Bageshwar to 5.8 in Shrawasti. In Baseline this varied from 1.7 in Pithoragarh (Uttarakhand) to 5.9 in Shrawasti (UP)- a variability of more than 4 children.

22 TOTAL FERTILITY RATE (TFR) 29 districts have already achieved the replacement level of 2.1 whereas it was 20 in baseline. Frequency distribution of TFR in terms of No. of Districts in each State State and aboveGrand Total Assam7 (3)14 (16)2 (3)0 (1)23 Bihar0 (0)1 (1)28 (26)8 (10)37 Chhattisgarh0 (0)14 (12)2 (4)0 (0)16 Jharkhand0 (0)9 (8)9 (10)0 (0)18 Madhya Pradesh1 (0)19 (15)22 (25)3 (5)45 Odisha12 (10)17 (18)1 (2)0 (0)30 Rajasthan0 (0)18 (16)12 (13)2 (3)32 Uttar Pradesh0 (0)14 (9)45(48)11 (13)70 Uttarakhand9 (7)4 (5)0 (1)0 (0)13 All States29 (20)110 (100)121 (132)24 (32)284

23 Frequency Distribution of change in TFR in Terms of No. Districts in Each State State Decreased by 0.1 Decreased by 0.2 Decreased by 0.3 Decreased by 0.4 Decreased by 0.5 or more Increased Remained Same Total Uttarakhand Rajasthan Uttar Pradesh Bihar Assam Jharkhand Odisha Chhattisgarh Madhya Pradesh Total TOTAL FERTILITY RATE (TFR)

24 229 districts have recorded less TFR than the baseline estimates and 47 districts remained same. 8 Districts have recorded increase in TFR viz. Indore (M.P.), Baghpat, Budaun, Bulandshahar, Gonda, Lalitpur, Pilibhit and Rampur (U.P.) 8 Districts have recorded maximum decrease in TFR viz. Sehore(M.P.), Basti, Deoria, Gorakhpur, Kaushambi, Kushinagar, Maharajganj, Siddharthnagar (U.P.)

25 TOTAL FERTILITY RATE (TFR) Baseline First Updation Replacement level of TFR

26 Family Planning: Current Usage  Current usage of any method varies from 43.0 in Bihar to 66.4 in Rajasthan whereas it was 37.6 in Bihar to 64.5 per cent in Rajasthan in Baseline.  Contraceptive Prevalence Rate (CPR) is the percentage of currently married women aged yrs who are using any method of contraception (modern/traditional).

27 Family Planning: Current Usage  Within a State, the least variation is reported in Uttarakhand and the most, in Odisha whereas in Baseline it was Uttarakhand and Uttar Pradesh respectively.  At district level, current usage of family planning ranges from 29.8 in Baudh (Odisha) to 89.1 in Hanumangarh (Rajasthan)- a variability of 3 times-whereas in Baseline it varied from 21.9 in Sitapur (UP) to 79.2 in Ganganagar (Rajasthan) exhibiting a variability of 4 times. Any Method of Family Planning (%) State State ValueDistrict with Minimum FPDistrict with Maximum FPRange First Updation baseline First Updation baseline First Updation baseline First Updation baseline Assam Dhubri (45.1) Dhubri (33.2) Kamrup (76.0) Lakhimpur (67.6) Bihar Nawada (31.5) Siwan (26.0) Supaul (60.8) Muzaffarpur (52.2) Jharkhand Gumla (39.0) Paschimi Singhbhum (32.7) Hazaribagh (69.8) Dhanbad (61.9) Madhya Pradesh Sidhi (44.6) Sidhi (45.9) Damoh (75.7) Damoh (74.9) Chhattisgarh Dantewada (33.4) Kawardha (68.2) Dhamtari (68.7) Odisha Baudh (29.8) Kandhamal (28.6) Baleshwar (78.1) Baleshwar (73.4) Rajasthan Jaisalmer (53.3) Dhaulpur (49.0) Hanumangarh (89.1) Ganganagar (79.2) Uttar Pradesh Sitapur (33.8) Sitapur (21.9) Jhansi (74.4) Jhansi (74.1) Uttarakhand Haridwar (56.2) Haridwar (53.7) Pithoragarh (78.2) Dehradun (67.1)

28 Family Planning: Current Usage Frequency distribution of current usage in terms of number of districts in each State State & aboveTotal Districts Assam0 (0)2 (3)15 (20)6 (0)23 Bihar0 (4)29 (31)8 (2)0 (0)37 Chhattisgarh0 (0)3 (7)13 (9)0 (0)16 Jharkhand0 (0)7 (13)11 (5)0 (0)18 Madhya Pradesh0 (0)1 (2)40 (40)4 (3)45 Odisha1 (1)8 (9)16 (19)5 (1)30 Rajasthan0 (0)0 (1)21 (24)11 (7)32 Uttar Pradesh0 (3)20 (24)44 (42)6 (1)70 Uttarakhand0 (0) 6 (13)7 (0)13 All States1 (8)70 (90)174 (174)39 (12)284  As high as 71 districts are reporting less than 50% current usage of any method of family planning whereas in Baseline it was 98.  39 districts feature in 70% & above category whereas in Baseline it was only 12 districts.  29 out of 37 districts of Bihar have reported less than 50% usage of any method of family planning. In Baseline it was 35 districts.

29 Family Planning: Current Usage CURRENT USAGE OF ANY METHOD OF FAMILY PLANNING (%) BaselineFirst Updation Dist. with > 60% Usage

30 Share of sterilization in any modern method of family planning (%) Assam Uttar Pradesh JharkhandBiharOdishaUttarakhandRajasthanChhattisgarh Madhya Pradesh Female35.1 (35.3)50.4 (55.0)74.3 (76.3)81.2 (86.7)69.7 (68.4)51.9 (58.7)77.1 (76.7)87.4 (92.3)81.8 (83.6) Male0.8 (0.6)0.5 (0.6)1.4 (1.2)0.8 (0.9)0.4 (0.7)3.0 (2.8)0.7 (0.7)1.8 (2.0)1.5 (1.7) Family Planning: Current Usage FEMALE STERILIZATION (%)

31 Unmet Need for Family Planning  Unmet need of Family Planning broadly means requirement of Family Planning methods among Currently Married Women but not using any method of Family Planning.  Total unmet need varies from a minimum of 12.6% in Rajasthan to 33.5% in Bihar. In Baseline it varied from 19.6% in Rajasthan to 39.2% in Bihar.  Unmet need for Family Planning is a crucial indicator for assessing the future demand for Family Planning services / supplies.

32 Unmet Need for Family Planning Total Unmet need (%) State State Value District with Minimum unmet needDistrict with Maximum unmet needRange First Updation baselineFirst UpdationbaselineFirst Updationbaseline First Updation baseline Assam Kamrup (8.4) Sibsagar (15.3) Karimganj (33.6) Dhubri (42.9) Bihar Patna (20.2) Patna (24.6) Katihar (46.5) Kishanganj (52.5) Jharkhand Hazaribagh (13.2) Bokaro (18.2) Gumla (33.2) Godda (42.8) Madhya Pradesh Datia(14.4) Dewas(14.4) Jabalpur (14.3) Sidhi(38.3) Rewa (34.2) Chhattisgarh Dhamtari (13.9) Dhamtari (14.5) Dantewada (48.7) Bastar (36.0) Odisha Kendujhar (9.7) Baleshwar (6.1) Baudh (45.3) Boudh (48.3) Rajasthan Jhunjhunun (3.1) Ganganagar (10.0) Jaisalmer (28.1) Dhaulpur (32.4) Uttar Pradesh Jhansi (12.7) Mahoba (15.1) Sultanpur (48.1) Sitapur (61.3) Uttarakhand Dehradun (12.8) Dehradun (16.8) Almora (27.4) Haridwar (29.2)  The minimum variability within a State is in Uttarakhand and the maximum in Odisha whereas in Baseline it was in Uttarakhand and in Uttar Pradesh respectively.  Jhunjhunun (3.1) in Rajasthan and Dantewada (48.7) in Chhattisgarh are the two extremes across 284 districts. In Baseline it was Baleshwar (6.1) in Odisha and Sitapur (61.3) in Uttar Pradesh.

33 Unmet Need for Family Planning Frequency distribution of unmet need in terms of number of districts in each State State & aboveTotal Districts Assam16 (6)7 (16)0 (1)0 (0)23 Bihar0 (0)29 (20)8 (17)0 (0)37 Chhattisgarh3 (4)12 (12)1 (0)0 (0)16 Jharkhand5 (2)13 (13)0 (3)0 (0)18 Madhya Pradesh12 (18)33 (27)0 (0) 45 Odisha14 (12)13 (15)3 (3)0 (0)30 Rajasthan26 (16)6 (16)0 (0) 32 Uttar Pradesh23 (9)42 (52)5 (8)0 (1)70 Uttarakhand6 (2)7 (11)0 (0) 13 All States105 (69)162 (182)17 (32)0 (1)284  In 105 out of 284 districts, the total unmet need for family planning is below 20%. It was 69 in Baseline.  Bihar and Uttar Pradesh continue to dominate in 40% & above category.

34 Unmet Need for Family Planning BaselineFirst Updation TOTAL UNMET NEED FOR FAMILY PLANNING (%) Unmet need of <=20

35 Mean Age at Marriage- Female Mean Age at Marriage is based on the marriages taken place during Mean age at marriage of females varies from 20.1 in Bihar to 22.4 years in Odisha whereas in Baseline it was 19.7 in Bihar & Rajasthan to 22.0 years in Uttarakhand.

36 Marriages among Females below Legal Age (18 yrs) Based on marriages taken place during Varies from 2.3% in Uttarakhand to 16.5% in Bihar whereas in Baseline it was 3.0% in Uttarakhand to 21.9% in Rajasthan.

37 MARRIAGES AMONG FEMALES BELOW LEGAL AGE (BELOW 18 YEARS) % Marriages among Females below Legal Age (18 yrs)

38 Any ANC exceeds 80% in all AHS States. ANC in 1 st trimester: 46.5% in UP & Bihar to 70% in Chhattisgarh & Madhya Pradesh. In Baseline, this was 40% in UP & Bihar to 65% in Chhattisgarh & Madhya Pradesh. Mothers receiving 3 or more ANCs: UP-32.5% to Odisha-78.5%. This was UP-29.6% to Odisha-76.0 % in Baseline. Mothers who consumed IFA 100 days or more: 8.1% in UP to 26.0% in Odisha. It was 6.5% in UP to 23.8% in Chhattisgarh in Baseline. Low performance in IFA consumption is the main reason for sluggish full ANC: 5% in UP to 22.7% in Odisha. In Baseline, 3.9% in UP to 19.5% in Chhattisgarh. Ante Natal Care (ANC)

39 Full Ante Natal Check-up Full ANC comprise 3 or more ANC, at least one TT injection and consumption of IFA for 100 or more days. Uttar Pradesh reports the minimum coverage of 5.0 % and Odisha, the maximum 22.7 whereas in Baseline it was 3.9% in Uttar Pradesh & 19.5% in Chhattisgarh.

40 Full Ante Natal Check-up Mothers who had Full Antenatal Check-up (%) State State ValueDistrict with Minimum valueDistrict with Maximum valueRange First Updation Baseline First Updation Baseline First Updation Baseline First Updation Baseline Assam Dhubri (4.0) Dhubri (2.1) Dibrugarh (25.2) Jorhat (18.2) Bihar Samastipur (2.0) Madhepura (2.4) Patna (13.8) Patna (16.4) Jharkhand Garhwa (5.0) Garhwa (3.6) Purbi Singhbhum (32.1) Purbi Singhbhum (31.6) Madhya Pradesh Sheopur (1.9) Sheopur (1.8) Indore (32.1) Balaghat (30.8) Chhattisgarh Kawardha (11.5) Korba (10.9) Dhamtari (42.6) Dhamtari (34.5) Odisha Jajapur (13.4) Jajapur (5.4) Jagatsinghapur (43.5) Jagatsinghapur (36.0) Rajasthan Karauli (3.0) Karauli (1.7) Jaipur (19.7) Jaipur (19.5) Uttar Pradesh Balrampur (0.9) Balrampur (0.6) Jhansi (17.9) Kanpur Nagar (14.8) Uttarakhand Rudraprayag (3.8) Rudraprayag (3.7) Dehradun (29.7) Dehradun (22.7) Bihar has reported the minimum variability among the districts in a State compared to Chhattisgarh reporting the maximum. It was Bihar and Odisha in Baseline. Balrampur (0.9), less than 1% coverage and Jagatsinghapur (43.5), the maximum coverage of full ANC. In Baseline also the position was same with values 0.6 and 36.0 respectively.

41 Full Ante Natal Check-up Frequency distribution of full ANC in terms of number of districts in each State State < & above Total Districts Assam1 (6)9 (7)7 (6)3 (4)2 (0)1 (0)23 Bihar15 (17)18 (17)4 (2)0 (1)0 (0) 37 Chhattisgarh0 (0) 6 (4)2 (4)3 (5)5 (3)16 Jharkhand0 (3)7 (7)6 (4)3 (3)1 (0)1 (1)18 Madhya Pradesh5 (7)10 (11)11 (10)7 (7)6 (6)6 (4)45 Odisha0 (0)0 (3)4 (7)7 (10)9 (3)10 (7)30 Rajasthan6 (7)16 (16)8 (7)2 (2)0 (0) 32 Uttar Pradesh45 (52)17 (15)6 (3)2 (0)0 (0) 70 Uttarakhand1 (2)2 (7)5 (2)3 (1)1 (1)1 (0)13 All States73 (94)79 (83)57 (45)29 (32)22 (15)24 (15)284  73 out of 284 districts report less than 5% coverage of full ANC whereas in Baseline it was 94.  24 districts reported 25% & above coverage of full ANC. In Baseline it was only 15 districts.

42 Full Ante Natal Check-up Baseline First Updation MOTHERS WHO HAD FULL ANTENATAL CHECK UP (%)

43 Ante Natal Check-up MOTHERS WHO RECEIVED ANY ANTENATAL CHECK-UP (%) BaselineFirst Updation MOTHERS WHO RECEIVED ANY ANTENATAL CHECK-UP (%) 90% and above coverage

44 Ante Natal Check-up MOTHERS WHO HAD ANTENATAL CHECK UP IN FIRST TRIMESTER (%) BaselineFirst Updation Above 50 % coverage

45 Ante Natal Check-up Baseline First Updation MOTHERS WHO RECEIVED 3 OR MORE ANTENATAL CARE (%)

46 Institutional Delivery

47 Institutional Delivery: Ranges from 40.4% in Chhattisgarh to 79.7% in MP. In Baseline it was 34.9% in Chhattisgarh & 76.1% in MP. More than 85% of total births have taken place in Govt. Institutions in Madhya Pradesh & Odisha and it is more than 60% in remaining States except Jharkhand. In Baseline also, the situation was same except for Uttarakhand, which stood at 63% from 59% in Baseline. Jharkhand continues to remain the only State where more than 50% of the births are taking place in Private Hospitals. Balrampur (UP) recorded the least 22.2% institutional delivery whereas Puri(Odisha) the most 94.0%, showing a variability of more than 4 times. In Baseline, Balrampur was in the least category with 16.8% and Indore(MP),the highest with 92.5%.

48 Institutional delivery is below 60% in 141 districts whereas it was 170 districts in baseline. INSTITUTIONAL DELIVERY (%) Balrampur, UP Puri, Odisha

49 Safe Delivery Safe delivery comprise institutional deliveries and domiciliary deliveries assisted by doctor/nurse/ANM/LHV. Safe Delivery: 51.8% in Jharkhand to 85.9% in Madhya Pradesh. It was 47.1% in Jharkhand & 82.2% in MP.

50 Safe Delivery Safe Delivery (%) State State ValueDistrict with Minimum ValueDistrict with Maximum ValueRange First Updation BaselineFirst UpdationBaselineFirst UpdationBaseline First Updation Baseline Assam Hailakandi, Karimganj (41.4) Karimganj, Hailakandi (34.8) Sibsagar (89.9) Sibsagar (88.2) Bihar Sitamarhi (36) Sheohar (30.2) Patna (81.4) Munger (80.4) Jharkhand Pakaur (31.8) Pakaur (24.8) Purbi Singhbhum (71.9) Purbi Singhbhum (69.0) Madhya Pradesh Dindori (55.4) Dindori (45.5) Indore (97) Indore (96.3) Chhattisgarh Surguja (41.6) Surguja (32.6) Kanker (75.8) Kanker (69.4) Odisha Malkangiri (48) Nabarangpur (35.6) Puri (94.7) Puri (92.7) Rajasthan Jaisalmer (55.5) Jaisalmer (48.6) Baran (93.6) Jaipur (92.2) Uttar Pradesh Balrampur (30) Balrampur (22.0) Jhansi (90.1) Jhansi (89.4) Uttarakhand Tehri Garhwal (49.4) Tehri Garhwal (43.1) Nainital (81.4) Nainital (79.5) Uttarakhand has exhibited the least variability among districts of a State and Uttar Pradesh, the most, the same as in Baseline. Balrampur (UP) & Indore (MP) continue to remain the minimum and maximum in safe delivery.

51 Safe Delivery Frequency distribution of safe delivery in terms of No. of districts in each State State< & above Total Districts Assam0 (0)3 (2)11 (12)9 (9)0 (0)23 Bihar0 (0)6 (12)22 (19)9 (6)0 (0)37 Chhattisgarh0 (0)4 (9)9 (7)3 (0)0 (0)16 Jharkhand0 (3)11 (9)6 (6)1 (0)0 (0)18 Madhya Pradesh0 (0)0 (1)5 (5)27 (29)13 (10)45 Odisha0 (0)2 (3)4 (5)20 (20)4 (2)30 Rajasthan0 (0)0 (1)5 (8)25 (21)2 (2)32 Uttar Pradesh0 (4)12 (20)40 (39)17 (7)1 (0)70 Uttarakhand0 (0)1 (3)8 (7)4 (3)0 (0)13 All States0 (7)39 (60)110 (108)115 (95)20 (14)284 About 1/7 th of the districts have reported less than 50% of the safe deliveries. It was 1/4 th in baseline. Out of 20 districts reporting 90% & above safe deliveries, 13 districts belong to Madhya Pradesh. It was 10 for MP in Baseline.

52 SAFE DELIVERY (%) Safe Delivery

53 Janani Suraksha Yojana Mothers availing JSY: 19.9% in Jharkhand to 69.3% in MP. It was 14.6% in Jharkhand to 61.6% in Odisha in Baseline.

54 Janani Suraksha Yojana MOTHERS WHO AVAILED FINANCIAL ASSISTANCE FOR DELIVERY UNDER JSY (%)

55 Abortion Varies from 2.1% in Chhattisgarh to 7.6% in Assam, in Baseline too these two States were at the extremes. Across 284 districts in 9 AHS States, it ranges from 0.7% in Jaisalmer(Rajasthan) Kanker & Dantewada(Chhattisgarh), to 19.6% in Jorhat(Assam).

56 Abortion Varies from 2.6 in Assam to 3.3 in Chhattisgarh. Across 284 districts in 9 AHS States, it ranges from 2.0 in Sheopur (Madhya Pradesh) to 5.4 in Rayagada (Odisha) & Jaisalmer (Rajasthan).

57 Abortion Abortion taking place in institution varies from 32.0% in Chhattisgarh to 73.9% in Assam. Across 284 districts in 9 AHS States, it ranges from 12.4% in Kishanganj (Bihar) to 100% in Jaisalmer (Rajasthan).

58 Abortion Varies from 41.8% in Chhattisgarh to 76.4% in Assam. Across 284 districts in 9 AHS States, it ranges from 19.6% in Madhepura (Bihar) to 100% in Rayagada (Odisha) and Jaisalmer (Rajasthan) – a variability of 5 times. More than 50% of the abortion is performed by skilled health personnel in all the States except Chhattisgarh.

59 Post Natal Care Mothers receiving PNC within 48 hrs of delivery varies from 59.6% in Assam to 80.0% in Odisha. It was 57.0 in Assam and 74.5% in Odisha in Baseline. At least 1 in every 7 mothers did not receive any post natal check up across all AHS States. The situation was 1 in 5 in baseline.

60 Post Natal Care MOTHERS WHO AVAILED POST-NATAL CHECK UP WITHIN 48 HRS. OF DELIVERY (%)

61 Post Natal Care MOTHERS WHO DID NOT RECEIVE ANY POST-NATAL CHECK UP (%)

62 New Born Check up New born checked up within 24 hrs of birth exceeds 50% in all AHS States. Across the 284 districts, as high as 246 districts reported more than 50% coverage. It varies from 57.6% in Bihar to 79.7% in Odisha whereas in Baseline it was 52.6% in Bihar and 74.9 in Odisha. Across 284 districts in 9 AHS States, it ranges from 32.2 in Karimganj(Assam) to 92.6 in Bargarh(Odisha). In Baseline, this varied from 24.2 in Karimganj & Hailakandi (Assam) to 92.9 in Allahabad(Uttar Pradesh).

63 New Born Check up NEW BORNS WHO WERE CHECKED UP WITHIN 24 HRS. OF BIRTH (%)

64 Full Immunization Children are considered fully immunized when they have received vaccination against Tuberculosis, 3 doses of DPT & Polio and 1 dose of measles. All States except Uttar Pradesh continue to remain having received at least half of their children aged months fully immunized. Uttar Pradesh & Uttarakhand continue to remain minimum & maximum in children fully immunized.

65 Full Immunization Children aged months Fully Immunized (%) State State ValueMinimumMaximumRange First Updation BaselineFirst UpdationBaselineFirst UpdationBaseline First Updation Baseline Assam Dhubri (39.2) Dhubri (29.9) Dibrugarh (85.5) Dibrugarh (83.8) Bihar Kishanganj (26.6) Madhubani (82.8) Samastipur (83.9) Jharkhand Giridih (43.0) Giridih (28.0) Lohardaga (86.5) Purbi Singhbhum (82.7) Madhya Pradesh Umaria (27.1) Jhabua (23.8) Indore (83.2) Indore (77.6) Chhattisgarh74.1 Surguja (52.8) Surguja (55.3) Kanker (94) Kanker (93.2) Odisha Rayagada (17.7) Rayagada (11.9) Kendrapara (84.9) Kendrapara (82) Rajasthan Dhaulpur (41.5) Dhaulpur (37.4) Hanumangarh (95.9) Hanumangarh (91.4) Uttar Pradesh Bahraich (21.6) Etah (13.5) Saharanpur (72.2) Basti (73.8) Uttarakhand Haridwar (59.6) Haridwar (55.3) Pithoragarh (87.6) Pithoragarh (87.5) The variability among the districts within a State ranges from 28.0% in Uttarakhand to 67.2% in Odisha, it was 32.2% in Uttarakhand to 70.1% in Odisha in Baseline. Across all 284 districts, Rayagada of Odisha continue to remain the minimum. However the maximum is observed in Hanumangarh of Rajasthan. In Baseline the maximum was in Kanker of Chhattisgarh.

66 Full Immunization Frequency distribution of Full Immunization in terms of number of districts in each State State & above Total Districts Assam0 (1)4 (4)14 (14)5 (4)0 (0)23 Bihar1 (1)2 (2)18 (23)16 (11)0 (0)37 Chhattisgarh0 (0) 6 (6)9 (9)1 (1)16 Jharkhand0 (1)2 (4)9 (7)7 (6)0 (0)18 Madhya Pradesh3 (2)8 (14)26 (24)8 (5)0 (0)45 Odisha5 (8)9 (7)2 (6)14 (9)0 (0)30 Rajasthan0 (0)3 (4)9 (10)19 (17)1 (1)32 Uttar Pradesh6 (11)30 (31)31 (20)3 (8)0 (0)70 Uttarakhand0 (0) 1 (2)12 (11)0 (0)13 All States 15 (24)58 (66)116 (112)93 (80)2 (2) districts are below 50% level of full immunization whereas it was 90 in Baseline. Only 2 districts 1 each from Chhattisgarh & Rajasthan continue to remain in 90% & above category.

67 Constituents of full immunization

68 Full Immunization CHILDREN AGED MONTHS FULL IMMUNIZED (%)

69 Vitamin A Supplementation to Children At least every 2 nd child aged 6-35 months has received Vitamin A supplement in all AHS States except Uttar Pradesh where it is every 3 rd child, the same as in Baseline. Across 284 districts in 9 AHS States, it ranges from 16.2 in Shrawasti(Uttar Pradesh) to 88.5 in Udaipur(Rajasthan). In Baseline, it varied form 15.1 in Shrawasti to 91.3 in Lohardaga(Jharkhand). Across the 284 districts,193 districts have reported more than 50 % coverage.

70 CHILDREN (AGE 6-35 MONTHS WHO RECEIVED VITAMIN A DOSE DURING LAST SIX MONTHS (%) Vitamin A Supplementation to Children

71 IFA Supplement to Children IFA supplement to children aged 6-35 months during last 3 months ranges from 10.9% in Rajasthan to 38.7% in Chhattisgarh. It was 9.4% in Rajasthan to 37.7% in Chhattisgarh in Baseline. Situation merit attention across all AHS States however it is quite alarming in Rajasthan, Uttar Pradesh & Uttarakhand.

72 CHILDREN (AGE 6-35 MONTHS WHO RECEIVED IFA TABLETS/SYRUPS DURING LAST 3 MONTHS (%) IFA Supplement to Children

73 Breast Feeding Practices  Bihar & UP and Assam & Odisha continue to remain two extremes of the spectrum.

74 CHILDREN UNDER 3 YEARS BREASTFED WITHIN 1 HOUR OF BIRTH (%) Breast Feeding Practices

75 Children exclusively breastfed for at least 6 months ranges from 19.4% in UP to 49.9% in Chhattisgarh whereas it was 17.7% in UP to 47.5 % in Chhattisgarh in Baseline.

76 Breast Feeding Practices CHILDREN AGED 6-35 MONTHS EXCLUSIVE BREASTFED FOR AT LEAST SIX MONTHS (%)

77 Some Additional Facts  Among AHS States:-  4 out of the 5 top States in female literacy and full ANC coverage are common.  57 districts are common in top 100 districts in female literacy and full ANC.  3 out of the 5 top States in female literacy also exist among 5 States with least MMR.  Top 5 States in full immunization coverage are the same who have the least NNMR & IMR.  3 out of the 5 top States in exclusive breast feeding practice also exist among 5 States with minimum NNMR.

78 The fieldwork for 2 nd updation round is over and the indicators on vital rates reflecting the change vis-à-vis baseline and first updation round surveys are likely to be released shortly. A Component of Clinical-Anthropometric & Bio-chemical (CAB) Test on a sub-sample basis is in progress in the AHS States. WAY FORWARD

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