IHS
Mission & Goals: |
Groom
Skills,
Gather Evidence and
Generate Knowledge for people's health.
To Improve the
Efficacy,
Quality & Equity
of Health Systems. |
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District
Family Health Survey (DFHS)
2000 |
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A
pilot study in three districts of Andhra Pradesh to estimate IMR,
Fertility & MMR
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Sponsored
By : Commissioner of Family Welfare, Andhra Pradesh.
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Objectives
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The District Family Health
Survey (pilot project) was designed to test the feasibility of
a rapid survey using, as far as possible, existing health care
personnel, to estimate IMR, TFR and MMR for district and sub
district level population aggregates, at regular intervals.
The primary objective of this pilot study was to work out the
design, survey, data analysis and reporting mechanisms of
state wide DFHS system. IMR is a sensitive indicator of child
survival, particularly in populations, where infectious
diseases and malnutrition continue to be a problem. Total and
age specific fertility rate is an important indicator of
population growth rates. MMR is an important indicator of
population trends. With growing emphasis on local area
planning in the field of population studies, there is an
increasing need for estimating fertility, and mortality
indicators at the district level.
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Methodology |
The indirect
methods of estimation such as children ever born technique (CEB)
for estimating IMR & FR and sisterhood survival technique
for estimating MMR were employed. A two-stage proportional
stratification method followed by random selection of clusters
within each strata by probability proportionate to size (PPS)
criteria was used. The target group in the population were
females in the child bearing age group i.e., 12 - 49 years. The
targeted population coverage by the survey (3,50,000) was
distributed proportionately among the 3 selected districts-
Mahaboobagar (Telangana Region), Chittoor (Rayalaseema Region)
and Nellore (Coastal Andhra Region). The large sample population
was selected, as it would yield estimates with higher precision
and narrow 95% confidence intervals. |
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Findings |
Summarized results of the survey
are discussed below.
The population coverage
achieved in DFHS survey is shown in Table 1.
Table-1.
Population Coverage in DFHS-AP, 2000 |
District |
Target |
Achieved |
%
Coverage |
Nellore |
102309 |
60211 |
59 |
Chittoor |
99703 |
72151 |
71 |
Mahaboobnagar |
102886 |
72154 |
70 |
Infant Mortality and Total
Fertility Rates
The estimates arrived at from
the survey are as shown in Table 2. District level estimates
of IMR show significant variation in mortality experienced by
people in different parts of the state. Mahboobnagar, among
the three districts studied, showed very high levels of IMR
compared to the state average. Divisional level estimates
within the Mahboobnagar district shows that one out of its
five divisions has comparatively low IMR and the rest four
divisions have high IMR. Further study of differences in
public health facilities, socioeconomic and literacy
differentials between the revenue divisions may provide
additional insights. Nevertheless, the present study clearly
brings out the need for a more targeted and focused approach
to improve public health status in Mahboobnagar district. Such
targeted approach holds the promise for further improvement of
the mortality situation and IMR at the state level.
Table-2:
District and Divisional estimates of IMR and TFR |
District
/ Division |
IMR |
TFR |
Nellore
Dt.
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79
(46) |
2.13
(3.1) |
Gudur Div.
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92 |
2.03 |
Kavali Div.
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58 |
2.25 |
Nellore Div.
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81 |
2.13 |
Chittoor
Dt. |
65
(60) |
2.17
(3.14) |
Madanapally Div.
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76 |
2.17 |
Chittoor
Div. |
67 |
2.21 |
Tirupati
Div. |
45 |
2.1 |
Mahbubnagar
Dt. |
115
(77) |
2.52
(4.49) |
Gadwal
Div. |
93 |
2.53 |
Mahbubnagar
Div. |
110 |
2.66 |
Narayanpet
Div. |
125 |
2.41 |
Wanaparthy
Div. |
62 |
2.51 |
Nagarkurnool
Div. |
140 |
2.46 |
Figures
in parentheses indicate estimates derived from 1991
Census data using similar methods |
District level estimates of
fertility (TFR) is consistent with the state level trend of
gradually reducing fertility. Comparison of present estimates
with district level estimates of TFR obtained from 1991 census
confirms the trend of declining fertility for each of the
three districts. Between the three districts, the fertility
level in Mahboobnagar is slightly higher.
Maternal Mortality Rate
Table-3:
Indirect estimates of maternal mortality in three
districts of AP. |
Time
location of estimates |
District
- MMR per 100000 live births |
Nellore |
Chittoor |
Mahboobnagar |
Pooled |
12
years ago i.e. around 1988 |
264
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211
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202
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258
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6
year 10 months ago, i.e. around 1993-94 |
248
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651
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169
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321
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5
year 8 months ago, i.e. around 1994-95 |
790
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234
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1,775
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997
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- Source: DFHS-AP
pilot study 2000: Sisterhood data. Indirect
estimation method as in Graham &c., 1989
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Maternal mortality estimates
obtained from this study show some disturbing signs as figures
corresponding to recent period suggest an increase in maternal
mortality rates (Table-3). The MMR in these three districts
has been estimated to have been about 200 to 264 per 100,000
live births about 12 years prior to the survey i.e. around
1988. Indirect estimates for more recent period around 1994-95
suggests an increase in maternal mortality rate. Part of this
increase in more recent estimates could be due to an artifact
of sampling.
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Recommendations |
An
additional component of the DFHS was to study the policy
alternatives for regular estimation of IMR and MMR at the
district and sub district level. The four alternatives namely
- the Civil Registration System, the Sample Registration
System, the Census and the District Family and Health Survey
were studied and the merits and difficulties have been
discussed to gauge the potential for generation of district
and sub district level estimates. Recommendations for the
short, medium and long term are described.
In the short term, DFHS may be
carried out in each district at intervals of 3 - 5 years
depending on availability of funds, as it will provide an
independent source of estimate for cross validation purposes.
As a medium term measure, we
recommend that an SRS like system titled as District Sample
Registration Scheme (DSRS) can be set up by the state with the
help of technical support from a research institution having
skills in demography.
In the long term, efforts
should be made towards increasing the usability of data being
collected through systems in routine operation, such as the
Civil Registration System, the Sample Registration System, and
the Census. Apart from informing on general mortality, the CRS
and SRS provide valuable information on causes of death. The
present coverage of the CRS in AP is only around 40 %, and
compares poorly with that in neighbouring states. The CRS is
the ideal source for estimating fertility and general / cause
specific mortality rates, at whichever level of population
aggregation that is desired, eg State, District or Revenue
Division. Measures to be taken for improving the performance
of the CRS have been listed separately, and should be
implemented without delay.
For estimation of MMR, we
recommend that the Prospective MMR Surveillance System
suggested by us may be organized at least in some districts on
a pilot project basis. |
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Conclusions |
The results reported from this
study have highlighted the need for planning and
implementation of public health programmes in the state and to
put in place a regular system of District Family Health
Surveys, till such time as the vital registration system
improves to provide more accurate statistics. |
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The project was funded by
Commissioner of Family Welfare, Andhra
Pradesh. |
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For details and enquiries write to Satish Kumar |
Updated on17th June, 2002.
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