With its commitment to reproductive Health, Government of India (GoI) too has launched the Reproductive and Child Health (RCH) program since October 1997. GoI is interested in critical evaluation of the program implementation and out come. As the program is decentralized at district level, district level performance needs to be assessed. In light of this, district level household survey was undertaken in fifty percent of the districts in the country. Broadly the study focuses on Maternal and Child Health and Contraception. Attempt has also been made to understand the awareness of reproductive tract infection/sexually transmitted infection and HIV/AIDS among males and females.
The summary finding form the District Level Household Survey conducted in Kishanganj district is presented in the key indicators. In Kishanganj district, the survey was carried out in 1036 household consisting of 726 households in rural areas and 310 households in urban areas. The total population covered in the survey was 5,673 with a sex ratio of 106 males per 811 females.
A total of 1054 eligible women (all currently married women age 15-44 years who were usual residents of the selected household or visitors who stayed in the household night before the interview and whose marriage were consummated) were interviewed. The numbers of husbands of eligible women interviewed from these households are 423. The district has a major concentration of Muslim population (58 percent) followed by Hindu population (41 percent). Further, 14 percent populations belong to Scheduled caste/tribe and 28 percent to other backward class.
The majority of population (86 percent) utilizes hand pump or bore well for the purpose of drinking water. About 82 percent were living in kachcha houses and only 10 percent were living in pucca houses, and more than four-fifth (83 percent) population have low living of standard. The mean age at marriage for boys who got married since January 1st, 1999 was 22.9 years and for girl was 18.6 years. The percentage of boys and girls marrying before legal age at marriage were 28 percent and 43 percent respectively. Based on statistics collected on vital events, the average Crude Death Rate (CDR) was 5.7 per 1000 population of the district. The neonatal mortality and post neonatal mortality were 57.30 and 22.59 respectively.
The infant mortality was 79.89 and child mortality was 18.76. The under five-mortality rate was 98.66 in Kishanganj district. Major illness for which data were collected showed the prevalence rate of partial blindness for male was 4391 and females was 4971 ; while for both the sexes it was 4662 per one hundred thousand population. Similarly, prevalence rate of complete blindness was 496 for male as against 751 for female and for both the sexes were 615. The prevalence rate of Tuberculosis and Malaria were 564 and 585 respectively in the district.
As far as the use of iodized salt is concerned, 17 percent of the households of this district used cooking salt that contains minimum recommended 15 ppm or higher level of iodine and only about 27 percent households used salt that is not iodized at all. The households, which used inadequately iodized salt, constitute 55 percent in Kishanganj district. The background characteristics of women indicate a high illiteracy (76 percent) level; only eight percent of them had 10 or more years of schooling. The consummation of marriage below 18 years is quite high (61 percent) as compared to those consummating at age 18 years and above (38 percent). The mean number of children ever born and surviving to a woman in the age group 15-44 years was 4.16 and 3.58 children respectively. The cohort fertility in terms of completed family size (age group 40-44years) was 6.25 and the children surviving are 5.43 per woman, thus, indicating and average child loss of 0.8 children in the district.
The average number of children in the reproductive span age 15-44 depicted as Total Fertility Rate (TFR) stands at 4.1 The average annual births per thousand populations during the three years period preceding the survey in the form of Crude Birth Rate (CBR) was 28.1 The contribution of birth order 3 and above to total births is highest, which forms nearly 65 percent. The incidence of still birth (1.7 percent) and of induced abortion (0.2 percent) is rather small but that of spontaneous abortion is relatively high (3.2 percent) in the district.
The utilization of Antenatal services (ANC) is not very encouraging in the district. Twenty eight percent of the women received any ANC services that had live/still birth since January 1st, 1999. The Doctors (26 percent) were the main ANC provider followed by ANM/Nurse/LHV (1.4 percent). It is mentioned that only one percent of the women received these services at the doorstep.
About eight percent of women availed of ANC services from government health facilities while 20 percent received at private health facilities. Only 12 percent of the women had undergone at least three check-ups during their pregnancy and 16 percent had made first visit in their first trimester. Eighteen percent of the pregnant women were given iron and folic acid (IFA) tablets and among them nine percent consumed it one IFA tablet daily, while eight percent women consumed two or more IFA tablet per day. Only two percent of women were received100 or more IFA tablets.
Tetanus Toxide (TT) injection protects the mothers and her baby against tetanus. About 57 percent of women had taken two or more TT injection during their pregnancy period. Overall a full ANC package of at least one TT injection, received a minimum of 100 IFA tablets and at least 3 ANC visits were received by only one percent of the pregnant women. Only 14 percent of the total deliveries were recorded as institutional delivery; eight percent of institutional deliveries were conducted at government health institutions and remaining six percent were at private health institutions.
About 86 percent of the deliveries were home delivery; only seven percent of home deliveries were assisted by trained health personnel (Doctors/ANM/Nurse/TBA). Overall, about 21 percent of the deliveries in this district were safely conducted. Pregnancy related complications were experienced by 28 percent of pregnant women, among these women 34 percent had sought treatment for their problems and only19 percent of them visited the government health facility. Further, 71 percent had delivery complications and 45 percent had reported post-delivery complications. Around46 percent of women sought treatment for their post-delivery problems and 15 percent were visited to government health institutions.
About five percent of the mother breastfed their children within two hours of birth and eight percent initiate it on same day but after 2 hours of birth. A large proportions of mother breastfeed their child either within 3 days or after 3 days. The custom of squeezing out the first breast milk before breastfeeding the child is largely practiced as on the whole of 72 percent of the mother squeezed out their milk before starting to breast feed. Only 3 percent of the mothers were breastfed to their child exclusively stipulated period of 4 months. The Immunization coverage of children in the district was quite low.
The percentage of children (aged 12 months or older at the time of survey) who received Polio - 0 was only three percent. Children who were given 19 percent BCG, 12 percent all three injection of DPT, 11 percent all three drops of Polio and 9 percent measles. Overall, only 9.5 percent of children were fully immunized. Only one percent of children got at least one dose of Vitamin A. Most of the children (77 percent) were immunized at government health facilities and rest of them at private health facilities. Further, among the children immunized at government health facility, 58 percent of them were immunized at government hospital, 9 percent at PHC/CHC and 7 percent at sub-centre. It needs to be mentioned that in rural area 4.2 percent of the children were immunize during the clinics/camps organized in the village. Seventy percent of the women were aware of diarrhea management, and women whose children were suffered from diarrhea, none were given Oral Rehydration Salt (ORS) to their children. About 85 percent of the women were aware of danger signs of pneumonia.
Knowledge of family planning method was widely spread in the district with about cent percent of respondent knowing any modern method, while knowledge for all modern methods was 35 percent. On the other hand, about 52 percent of husbands of eligible women had knowledge about No Scalpel Vasectomy (NSV). The contraceptive prevalence rate (CPR) for the district is 23 percent, which includes three percent of traditional methods. Female sterilization is the most prevalent method of contraception in the district. Nearly 13 percent of all women were currently using this method for family planning. Other methods being currently used, such as Oral Pills (5 percent), IUD (one percent), condoms (1 percent) and male sterilization (0.3 percent) have relatively very low acceptance in the district. The total unmet need as reported by men was 33 percent and by couples was 17 percent. While it was about 31 percent by women. Twelve percent and eleven percent of the current users of female sterilization and pills were informed about the side effects before adopting the method. Around 34 percent of pill users and 18 percent of sterilized women reported some problems due to use of the method. Only 10 percent of the current users of female sterilization reported visited by health worker after adoption of methods of family planning. Further, must of the current users (94 percent) were satisfied with the current use of sterilization.
Health worker at home visited only one percent of the women during three months prior to the survey. It was found that mainly ANM/LHV (86 percent) were visited them, followed by doctors (14 percent), and cent-percent of them expressed satisfaction over the amount of time spent and satisfaction with service/advice given by healthworkers.The level of awareness of RTI/STI was 50 percent among men and 84 percent among women. The response on the source of knowledge indicates that the role of health workers in the spreading the knowledge of RTIs/STIs is marginal. A large proportion of men and women had heard from their relatives or friends.
Forty eight percent of men reported that sexual intercourse was the main source of mode of transmission ofRTIs/STIs while more than half of the women were not aware of it, and about 69 percent of men and 41 percent of women respondents reported that RTIs/STIs was curable disease. The prevalence of at least one symptom of RTIs/STIs among men and women respondents was estimated as 4 percent and 49 percent respectively, and prevalence of at least one menstrual problem and vaginal discharge was estimated as 14 percent and 19percent respectively. Among them, 38 percent of men having symptoms of RTIs/STIs and 24 percent of women having symptoms of vaginal discharge sought treatment, mainly from private health facility. Although the spread of HIV/AIDS is a major concern in India, only 49 percent of men and 22 percent of women have even heard of AIDS in the district. Among respondents who have heard of AIDS, 58 percent men and 77 percent women received information about the disease from television, and 36 percent men and 48 percent women from friends and relatives. Notably, among respondents who have heard of AIDS, about 43 percent men and 23 percent women having misconceptions of spreading of AIDS.
In Kishanganj, only seven percent men and three percent women received information about the AIDS from a health worker. Based on a weight-for-age index, about 53 percent of the children fewer than 6 years of age are underweight in Kishanganj district. About 94 percent of such children suffer from some degree of anemia. Mother's education has somewhat inverse relationship with prevalence of anemia among children. The prevalence of anemia among almost all adolescent girls age 10-19 years are of different degree, mild (27 percent), moderate (50 percent) and severe (22 percent). The prevalence of anemia among adolescent girls is almost cent percent in rural and urban areas and those with any standard of living in Kishanganj district. Ninety two percent of the pregnant women (15-44 year) in the district are found to be anemic. Among those anemic pregnant women, 61 percent mildly and 31 percent are moderately anemic.