Professional Documents
Culture Documents
BASELINE SURVEY ON
CHILD AND RELATED
MATERNAL HEALTH CARE
Revised Report
Prepared For:
Client Contact:
Mr P.K. Hota
Director, NIPI,
NIPI Secretariat
11 – Golf Links,
New Delhi - 110003
August , 2009
CONTENTS
Page No.
Fact Sheets…………………………………………………………………………………………………..7
Chapter 1 Introduction ..................................................................................................................... 9
Page No.
Chapter 8 Status of Health Facilities ......................................................................................... 82
Annexure Tables……………………………………………………………………………..90
LIST OF TABLES
Table 1.1: Key Health Indicators of the state
Table 1.2: Coverage by Target Group and Research Technique (State Level)
Table 1.3: Coverage by Target Group and Research Technique (District Level)
Table 1.4: Coverage by Target Group and Research Technique (Block level)
Table 1.5: District wise sample coverage status
Table 2.1: Household population by age and sex, Rajasthan, NIPI-08
Table 2.2: Household population by age and sex, District Alwar, NIPI-08
Table 2.3: Percent distribution of household population by age, sex and residence, District
Bharatpur, NIPI-08
Table 2.4: Household population by age and sex, District Dausa, NIPI-08
Table 2.5: Household composition, NIPI-08
Table 2.6: Household composition, NIPI-08
Table 2.7: Education attainment by gender of household member in terms of years of schooling,
NIPI-08
Table 2.8: Educational attainment by location of PSU in terms of years of schooling, NIPI-08
Table 2.9: Type of house
Table 2.10: Source of Drinking Water
Table 2.11: Drinking water storage and filtration practices, NIPI-08
Table 2.12: Sanitation Facility, NIPI-08
Table 2.13: Cooking Environment, NIPI-08
Table 2.14: Ownership of Immovable Assets, NIPI-08
Table 2.15: Main Source of Household Income, NIPI-08
Table 2.16: Household Wealth Index, NIPI-08
Table 2.17: Financial Access, NIPI-08
Table 3.1: Age distribution of women respondents, NIPI-08
Table 3.2: Distribution of Women Respondents by religion and ethnicity, NIPI-08
Table 3.3: Education status of women respondents, NIPI-08
Table 3.4: Frequency of Exposure , NIPI-08
Table 3.5: Employment Status of eligible women by background characteristics, NIPI-08
Table 3.6: Membership in SHGs and Mahila mandals, NIPI-08
Table 3.7: Age at first cohabitation, NIPI-08
Table 4.1: Percentage of pregnancies registers vs. key background variables, NIPI-08
Table 4.2: Received ANC Card
Table 4.3: Incidence of receiving ANC during last pregnancy, NIPI-08
Table 4.4: Place of ANC
Table 4.5: ANC Provider, NIPI-08
Table 4.6: Number of ANC received and timing of ANCs received, NIPI-08
Table 4.7: Proportion of eligible women having received different components of ANC care, NIPI-
08
Table 4.8: Nature of ANC services received, NIPI-08
Table 4.9: TT injections vs. number of ANCs, NIPI-08
Table 4.10: Knowledge about health problems during pregnancy, NIPI-08
Table 4.11: Incidence of Health Problems during pregnancy, NIPI-08
Table 4.12: Nature of health problems faced during last pregnancy, NIPI-08
Table 4.13: Percentage of women who sought advice for health problem during pregnancy, NIPI-
08
Table 4.14: Person persuaded for treatment during pregnancy
Table 4.15: Place of delivery v/s age of respondents, NIPI-08
Table 4.16: Place of delivery v/s years of schooling, NIPI-08
Table 4.17: Place of Delivery v/s number of live children, NIPI-08
Table 4.18: Place of Delivery v/s economic status of respondent‟s household, NIPI-08
Table 4.19: Average Transportation Expenses, NIPI-08
Table 4.20: Nature of Institutional Delivery, NIPI-08
Table 4.21: Cost Incurred on Institutional Delivery
Table 4.22: Problems experienced during delivery by woman of different age groups, NIPI-08
Table 4.23: Nature of advice received after delivery by source, NIPI-08
Table 4.24: Mother‟s perception about environment of health facility and behavior of staff
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NIPI Baseline Survey report for the state of Rajasthan
LIST OF FIGURES
Figure 4.1: Percent of Mothers who received three or more antenatal checkups
Figure 4.2: Percent of Mothers who consumed IFA for 90 days and Received 2 or more TT during
Pregnancy
Figure 4.3: Institutional delivery and births assisted by health personnel
Figure 6.1: Type of practices to be followed if child gets diarrheoa
Figure 6. 2: Awareness of symptoms of pneumonia
Figure 6.3: Preventive measures taken for avoiding child sickness
FACT SHEETS
RAJASTHAN
District: ALWAR
Baseline Summary Indicators
Indicator N %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 703 69.1
Mothers who had at least 3 Ante-Natal Care visits during the last pregnancy 472 49.3
Total number of deliveries (home plus institutional) 1281 NA
Institutional deliveries 803 46.4
Average Retention period (hours) in case of institutional delivery 34.4 NA
Post natal care provided to mother and neonates - Children had check-up within 24 hours after delivery (based
622 48.4
on last live birth)
Post natal care provided to mother and neonates -Children had check-up within 10 days after delivery (based on
706 54.9
last live birth)
Mothers who received post natal care within 48 hours of delivery of their last child 50 41.7
Referral done for mothers with illness and complications during pregnancy 752 78.1
Children with Diarrhoea in the last two weeks who received ORS 32 18.8
Children with Diarrhoea in the last two weeks who were given treatment 100 58.8
Children with acute respiratory infection/fever in the last two weeks who were given treatment 105 77.2
Children (age 6 months above) exclusively breastfed 301 38.6
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 89 60.5
New born Babies immunized with zero dose polio and BCG 1 33.3
New born Babies – breastfed within 1 hour of birth 261 20.8
Newborn with birth weight taken after delivery at home 26 5.4
District: BHARATPUR
Baseline Summary Indicators
Indicator N %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 546 50.20
Mothers who had at least 3 Ante-Natal Care visits during the last pregnancy 472 49.3
Total number of deliveries (home plus institutional) 1329 NA
Institutional deliveries 851 53.1
Average Retention period (hours) in case of institutional delivery 23.9 NA
Post natal care provided to mother and neonates - Children had check-up within 24 hours after delivery (based
675 50.7
on last live birth)
Post natal care provided to mother and neonates -Children had check-up within 10 days after delivery (based on
858 64.7
last live birth)
Mothers who received post natal care within 48 hours of delivery of their last child 30 37.5
Referral done for mothers with illness and complications during pregnancy 866 71.4
Children with Diarrhoea in the last two weeks who received ORS 41 29.9
Children with Diarrhoea in the last two weeks who were given treatment 95 69.9
Children with acute respiratory infection/fever in the last two weeks who were given treatment 51 83.6
Children (age 6 months above) exclusively breastfed 430 51.7
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 84 64.6
New born Babies immunized with zero dose polio and BCG 2 100
New born Babies – breastfed within 1 hour of birth 412 31.9
Newborn with birth weight taken after delivery at home 12 2.5
District: DAUSA
Baseline Summary Indicators
Indicator N %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 664 55.80
Mothers who had at least 3 Ante-Natal Care visits during the last pregnancy 565 47
Total number of deliveries (home plus institutional) 1315 NA
Institutional deliveries 934 71
Average Retention period (hours) in case of institutional delivery 32.8 NA
Post natal care provided to mother and neonates - Children had check-up within 24 hours after delivery (based
670 50.5
on last live birth)
Post natal care provided to mother and neonates -Children had check-up within 10 days after delivery (based on
858 64.7
last live birth)
Mothers who received post natal care within 48 hours of delivery of their last child 28 33.3
Referral done for mothers with illness and complications during pregnancy 1046 86.4
Children with Diarrhoea in the last two weeks who received ORS 56 30.3
Children with Diarrhoea in the last two weeks who were given treatment 129 70.1
Children with acute respiratory infection/fever in the last two weeks who were given treatment 103 92.8
Children (age 6 months above) exclusively breastfed 384 45.2
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 104 69
New born Babies immunized with zero dose polio and BCG 2 50
New born Babies – breastfed within 1 hour of birth 717 54.4
Newborn with birth weight taken after delivery at home 10 2.6
CHAPTER 1
INTRODUCTION
As per the Millennium Development Goal 4 (MDG), India has to reduce its Child Mortality Rate (CMR)
by two-thirds between 1990 and 2015. It implies that India has to reduce its under five mortality rates to
38 er 1000 live births by 2015 (UNICEF, SOWC 2008) to achieve the MDGs. However, the office of the
registrar general of India has recently cautioned that, after a rapid decline during 1980-90, the IMR in
India has stagnated since 1993 at the level of 72 [GoI 2000] This means that the programs which
addressed the problem of child mortality (reproductive and child health program, immunization
program, ICDS) were no longer effective in further reducing the IMR, and a larger proportion of infant
deaths were now contributed by neonatal deaths because this component is influenced little by the
current programs [GoI 2000]. India has made progress in the reduction of child mortality with the
average annual rate of reduction in U5 mortality between 1990 and 2006 being around 2.6 per cent.
If India is to reach the MDG Goal of 38 by 2015, the average annual rate of reduction over the next
nine years must be far higher, or around 7.6 per cent. (Source: UNICEF, SOWC 2008)
For India‟s success in achieving Millennium Development Goal four (MDG 4), Norway-India
Partnership Initiative (NIPI) collaborated towards the reduction of child mortality in Indian states.
Norway and India have agreed to collaborate towards achieving MDG 4 based on commitments made
by the Prime Ministers of the two countries.
The NIPI intends to provide an up-front, catalytic and strategic support to accelerate the
implementation of National Rural Health Mission (NRHM 2005-2012) in five states that comprise 40%
of India‟s total population and account for around 60% of child deaths viz., Uttar Pradesh, Bihar,
Madhya Pradesh, Rajasthan and Orissa and evolve multiple partners, including UNICEF and WHO.
About 2.4 million children under the age of five die every year in India, of which 1.4 million die in the 5
NIPI focus states. These states pose an enormous challenge in implementation because of the socio-
economic factors, large inequalities, weak health system and poor program management capacity.
The initiative aims to achieve measurable outcomes in line with the fourth ''millennium development
goals'' (MDG-4) including a sustained routine immunization coverage rate at 80 per cent or more from
2007 onwards and saving an additional 0.5 million under-5 children each year from 2009.
The Norway India Partnership Initiative will focus on four core areas in the five high-prevalence states
NIPI is planned to test some innovative ideas and provide various inputs to the existing RCH programs
under NRHM. These interventions are expected to have impact on the service delivery and outcome. In
order to achieve the monitoring and evaluation objectives, the initiative will have a comprehensive
baseline assessment on child and related maternal health care in the four NIPI focus states.
This baseline study is conducted during the year 2008-2009 in three phases (each phase covered
three Districts from NIPI states) in 12 Districts. For the study in 2 states (MP and Orissa ) Taylors &
Nielsen Sofreys (TNS Pvt. Ltd) was designated as research agency and for 2 states (Bihar and
Rajasthan) Development & Research Society (DRS) was designated as research agency,
additionally, TNS Pvt Ltd was also assigned the Executive Summary report of findings from all 4 states
The present baseline survey on child and related maternal health care has the following objectives:
1. Identifying gaps in the existing service delivery mechanism to reduce infant mortality and to
improve maternal health
2. Assessment of Needs and opportunities at various levels
3. Developing benchmark indicators for the implementation of the project
1 Review of available literature on child health and related maternal health, desk research and
field review to identify information gaps
2 Collection of data on the identified gaps (not limited to) by using qualitative and quantitative
research techniques
The Phase 1 of NIPI Baseline survey was conducted during the year 2008 in the month of February-
March. In Phase 1, information about child and related maternal health care was collected through
desk research and interviews were conducted with the health functionaries and other stakeholders at
state and district levels.
In Phase 2, the survey was conducted during December 2008 and January 2009. For Phase 2,
interviews were conducted at block and village level with the service providers and block officials who
cater to the needs of child and maternal activities. The study states were Orissa, Madhya Pradesh,
Bihar and Rajasthan. This report contains the detailed findings for the state of Rajasthan.
In this baseline survey, the data were collected from the three NIPI focus districts; Alwar, Bharatpur
and Daus and relevant information from the State level. The districts are selected by NIPI in
consultation with the State NRHM for implementation of the interventions.
In order to improve the implementation of several child and related maternal health activities, certain
programs are ongoing currently such as of Janani Suraksha Yojana, Yashoda and IMNCI (Integrated
Management of Neonatal Childhood) program.
Rajasthan is the largest state of the Republic of India in terms of area. It encompasses most of the
area of the large, inhospitable Great Indian Desert (Thar Desert), which has an edge paralleling the
Sutlej-Indus river valley along its border with Pakistan. The reghion borders Pakistan to the west,
Gujrat to the south-west, Madhya Pradesh to the southeast, Uttar Pradesh and Haryana to the
northeast and Punjab to the north. Rajasthan covers an area of 3,42,269 sq.km, the largest for any
Indian state.
The state capital is Jaipur, which is famous to the world as the “Pink City”, attracting foreigners from all
over the globe to have a glimpse at its rich heritage. Rajasthan‟s economy is primarily agricultural and
pastoral. Wheat and barley are cultivated over large areas, as are pulses, sugarcane and oilseeds.
Cotton and tobacco are the major cash crops. Rajasthan is also the biggest wool-producing state in
India and main opium producer and consumer.
According to the 2001 Census, Rajasthan had a population of 56.5 million, of which around 13.2 million
dwell in the urban areas, while 43.3 million live in the rural areas.
There are 33 districts in Rajasthan, of which three districts namely Alwar, Bharatpur and Dausa are
selected by NIPI for specific intervention programs.
The literacy rate is 61.03% for the state of Rajasthan as a whole with 75.70% of males and 43.85% of
females being literate. The 2001 census data has revealed that the population density for the state is
165 persons per sq. km, which is quite low as compared to the national average. The sex-ratio for the
state is 921 females per thousand male population. Table 1.1 presents the key health indicators for the
state of Rajasthan as well as the three selected districts of Alwar, Bharatpur and Dausa.
Alwar district is situated in the north-east of Rajasthan between 27 4‟ and 28 4‟ north latitudes and
76 7‟ and 77 13‟ east longitudes. It is bounded on the north and north-east by Gurgaon district of
Haryana State and Bharatpur district and on the north-west by Mahendragarh district of Punjab State,
on the south-west by Jaipur district and on the south by Sawai Madhopur and Jaipur district. The total
area of the district is 8380 sq kms. The district headquarters is located at Alwar.
As of 2001India census, Alwar had a population of 29, 90,862. Males constitute 53% of the population
and females 47%. Alwar has an average literacy rate of 73%, higher than the national average of
59.5%; with 59% of the males and 41% of females literate. 13% of the population is under 6 years of
age. Sex Ratio is 887 females per 1000 males.
The health infrastructure available with the district is as follows:
District Headquarters Hospital - 1
City Dispensaries - 5
P.H.C - 70
CHC - 24
NIPI
DLHS-2 DLHS-3
INDICATORS BASELINE
(2002 – 04) (2007 – 08)
(2008-09)
Maternal Health Total Rural Total Rural Total Rural
Mothers registered in the first trimester when they were pregnant with last
- - 21.7 18.9 69.1 67.1
live birth/still birth (%)
Mothers who had at least 3 Ante-Natal Care visits during the last
23.7 20.8 14.4 11.5 49.3 44.1
pregnancy (%)
Mothers who got at least one TT injection when they were pregnant with
62.3 58.9 36.7 34.2 90.9 89.9
their last live birth / still birth (%) #
Institutional births (%) 22.2 15.0 45.9 42.7 46.4 46.3
Delivery at home & other places assisted by a doctor/nurse /LHV/ANM (%) 14.5 9.7 10.6 10.1 8.5 8.6
Mothers who received post natal care within 48 hours of delivery of their
- - 28.3 25.9 41.7 41.9
last child (%)
Child Immunization and Vitamin A supplementation:
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and
23.5 20.9 25.1 24.3 60.5 58.8
Polio and Measles) (%)
Children (12-23 months) who have received BCG (%) 67.6 59.5 75.7 73.9 97.3 96.6
Children (12-23 months) who have received 3 doses of Polio Vaccine (%) 36.6 35.5 55.6 55.8 81.6 79.0
Children (12-23 months) who have received 3 doses of DPT Vaccine (%) 34.5 32.4 28.5 26.6 79.6 77.3
Children (12-23 months) who have received Measles Vaccine (%) 39.0 33.6 54.7 51.3 63.3 62.2
Children (9-35 months) who have received at least one dose of Vitamin A
- - 30.4 28.6 50.3 48.7
(%)
Children (above 21 months) who have received three doses of Vitamin A
- - 12.5 12.1 8.2 7.4
(%)
Treatment of childhood diseases (children under 3 years based on
last two surviving children)
Children with Diarrhoea in the last two weeks who received ORS (%) 28.0 21.0 22.3 19.3 13.2 13.3
Children with Diarrhoea in the last two weeks who were given treatment
51.6 54.0 38.1 37.9 58.8 58.5
(%)
Children with acute respiratory infection/fever in the last two weeks who
- - 57.3 54.2 77.2 75.8
were given treatment (%)
Children had check-up within 24 hours after delivery (based on last live
- - 29.7 27.3 53.7 52.0
birth)(%)
Children had check-up within 10 days after delivery (based on last live
- - 27.9 25.9 54.9 52.9
birth) (%)
Child feeding practices (Children under 3 years)
Children breastfed within one hour of birth (%) - - 35.8 34.3 20.8 21.2
Children (age 6 months above) exclusively breastfed (%) - - 40.3 41.9 20.4 16.7
Children (6-24 months) who received solid or semisolid food and still being
- - 90.1 90.2 41.1 38.9
breastfed (%).
Bharatpur district lies in the north-eastern part of the state. It forms boundaries with Gurgaon district of
Haryana in the north and north-east. Dhaulpur district lies in the south and Sawai Madhopur, Dausa
and Alwar district in its west. It shares common boundaries with the district Dausa in south-west and
district Alwar in the North-West. Bharatpur is also being called as Lohagarh.The population of the
district is nearly 2.10 million, with a population density of 414 persons per sq.km. The literacy rate
stands at 64.24 percent, which is higher in comparison to the state literacy rate (61.03%). The total
working population is 27.05 percent, which is composed of both main workers and marginal workers.
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NIPI Baseline Survey report for the state of Rajasthan
Dausa is situated in the eastern part of Rajasthan. It is bound in the north by Alwar district, in the south
by Sawai Madhopur district, in the west by Jaipur district and in the east by Bharatpur district. The
population of the district is nearly 1.30 million, with a population density of 384 persons per sq.km. The
literacy rate stands at 62.75 percent, which is higher in comparison to the state literacy rate (61.03%).
The total working population is 30.70 percent, which is composed of both main workers and marginal
workers. Dausa district lies at 26 52 N latitude and 76 20 E longitude with a total area of 2, 950 Sq.
Km's. As of 2001 India census, Dausa had a population of 13, 16,790.
NIPI
DLHS-2 DLHS-3
INDICATORS BASELINE
(2002 – 04) (2007 – 08)
(2008-09)
Maternal Health Total Rural Total Rural Total Rural
Mothers registered in the first trimester when they were pregnant with
- - 25.2 23.6 55.80
last live birth/still birth (%) 55.10
Mothers who had at least 3 Ante-Natal Care visits during the last
27.9 27.9 22.1 20.5 43.5 47.0
pregnancy (%)
Mothers who got at least one TT injection when they were pregnant
62.8 61.6 47.1 45.9 92.4 92.1
with their last live birth / still birth (%) #
Institutional births (%) 38.1 35.1 60.3 58.9 56.0 55.8
Delivery at home & other places assisted by a doctor/nurse /LHV/ANM
14.4 13.7 12.0 11.9 9.0 8.3
(%)
Mothers who received post natal care within 48 hours of delivery of
- - 44.7 42.2 33.3
their last child (%) 33.3
Child Immunization and Vitamin A supplementation:
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT,
19.0 16.0 48.0 47.3 69.3
and Polio and Measles) (%) 79.1
Children (12-23 months) who have received BCG (%) 54.9 52.3 87.3 87.9 99.3 99.3
Children (12-23 months) who have received 3 doses of Polio Vaccine
27.4 25.2 73.3 74.2 83.3 86.3
(%)
Children (12-23 months) who have received 3 doses of DPT Vaccine
27.6 25.5 53.2 52.5 82.0 84.9
(%)
Children (12-23 months) who have received Measles Vaccine (%) 36.1 34.0 66.4 66.2 69.3 71.9
Children (9-35 months) who have received at least one dose of Vitamin
- - 40.6 39.2 56.0 59.0
A (%)
Children (above 21 months) who have received three doses of Vitamin
- - 22.6 22.6 7.2 7.3
A (%)
Treatment of childhood diseases (children under 3 years based
on last two surviving children)
Children with Diarrhoea in the last two weeks who received ORS (%) 19.9 19.0 29.8 30.3 13.9 13.2
Children with Diarrhoea in the last two weeks who were given
50.6 48.9 65.5 64.9 70.1 67.7
treatment (%)
Children with acute respiratory infection/fever in the last two weeks
- - 62.9 61.7 92.8
who were given treatment (%) 91.2
Children had check-up within 24 hours after delivery (based on last live
- - 46.1 44.0 62.1 60.0
birth)(%)
Children had check-up within 10 days after delivery (based on last live
- - 44.5 42.2 64.7 62.3
birth) (%)
Child feeding practices (Children under 3 years)
Children breastfed within one hour of birth (%) - - 40.0 38.8 54.4 54.0
Children (age 6 months above) exclusively breastfed (%) - - 29.2 29.2 28.6 25.6
Children (6-24 months) who received solid or semisolid food and still
- - 91.8 91.8 47.9 47.0
being breastfed (%).
In Phase II, the sampling frame took into consideration district, village, and household units. The target
population included was women who gave birth within the past two years, as these are the main
beneficiaries of the interventions to be provided by NIPI and the outcome indicators needed for the
study was generated by interviewing them.
Note: The sampling strategy given below describes the methods of selecting the respondents from a
study district.
We used a two-stage stratified cluster sampling technique for the selection of respondents (women
who gave birth during the past two years) in this study. We covered 50 PSUs from each of the study
districts. The number of clusters covered in a district was allocated according to the proportion of rural
and urban population in the district. At the first stage, number of rural PSUs/villages was selected using
probability proportional to size (PPS) sampling technique. Within the PSU/village, selection of the
eligible respondents was done using systematic random sampling approach.
Similarly the allocated number of urban PSUs/wards was selected using probability proportional to size
(PPS) sampling technique. Within the PSU/ward, selection of the eligible respondents was done using
systematic random sampling approach. The 2001 Census list of towns/cities and villages of the study
districts served as the sampling frame for the selection of PSUs. As the selection of the respondents is
done randomly using two-stage sampling strategy each individual member of the target group of
respondents in the district had an equal chance of inclusion in the survey.
Inclusion Criteria
- Households with currently married women who delivered a child in last two
years or who were pregnant in the last two years.
nD
2 P(1 P) Z1 P1 (1 P1 ) P2 (1 P2 ) Z1
2
2
Where:
D = Design effect
P2 = the proportion at end line such that the quantity (P2 - P1) is the size of the magnitude of change it
is desired to be able to detect;
P = (P1 + P2) / 2;
Z1- = the z-score corresponding to the probability with which it is desired to be able to conclude that
an observed change of size (P2 - P1) would not have occurred by chance; and
Z1- = the z-score corresponding to the degree of confidence with which it is desired to be certain of
detecting a change of size (P2 - P1) if one actually occurred.
With a power of 80 percent and with 5% precision, the sample size required at 95% confidence is
obtained for different variable values for both Bihar and Rajasthan. We considered 3 variables namely,
IMR, NMR and percentage deliveries taken place in institutions.
The objective of NIPI program is to act as a catalyst in the process, which leads to reduction in infant
and neonatal mortality. Percentage of institutional deliveries is an indicator of the improvement in
service delivery, which will have direct bearing on the survival of newborn. Taking a bigger sample size
has implications on cost and time. So a sample size of 1200 was decided for each district, which
provided us statistically viable estimates for most of the indicators under consideration.
Sampling procedure
The allocated number of villages/wards (PSUs) within a district was selected using Probability
proportional to size (PPS) technique and by involving all the villages/wards in the district. The sampling
interval was obtained by dividing the total cumulative population of the district by the total number of
villages/wards. All villages/wards were listed in one column, their corresponding population in another
column and the cumulative population in yet another column. A random start of villages/wards was
included and was done by selecting a random number between 1 and the maximum number in the
sampling interval. The remaining villages/wards were then selected by adding the sampling interval to
the cumulative population of villages/wards.
Each selected PSU was initially listed for the identification of eligible respondents (woman who
delivered a baby in the last two years or woman who was pregnant in the last two years). After listing
the eligible respondents in a PSU, from each PSU we covered 24 eligible respondents using
systematic random sampling approach. It implies that from each PSU we have information about 24
pregnancies irrespective of their outcome and from a district, we have information about 24x50=1200
pregnancies at baseline. Thus we covered a total sample size of 3600 pregnancies in a state.
As suggested by earlier by TAC, it was decided to cover 1200 samples of children in the age group of
12-23 months, 600 infants (in less than one year) and all the neonates (0-28 days) in the PSU. With the
understanding of covering 10 percent of the samples, a sample size of 24 children/respondents per
PSU was worked out with 10 percent of over sampling to avoid the risk of unresponsive candidates.
With a sample size of 24 children aged 0-23 months per PSU, we got one neonate per PSU resulting in
a total sample size of 50 neonates in the study. In order to get statistically robust estimates of
indicators of newborn care practices and contacts by health worker, a sampling size of 136 was
derived. So with the proposed quota sampling wherein, from each PSU, we selected 2-3 neonates (<1
month), 9-10 children of 1-11 months and 12 children of 12-23 months. This sample size was adequate
to get an estimate of the indicator under consideration with 95% confidence, 10% precision and a
design effect of 2.
The baseline data needed for the present study was obtained by using qualitative and quantitative data
collection techniques and the target groups for the surveys were different stakeholders who were the
beneficiaries and the implementers of the maternal and child health care interventions in the selected
study districts and the states.
As part of Quantitative survey we conducted cross-sectional survey based on the WHO and UNICEF
Rapid Assessment Procedure.
1.7.1.1 Questionnaires
Information on various indicators pertaining to MCH was collected that would assist policy makers and
program managers to formulate and implement the goals set for NIPI program. TAC steering
committee had reviewed and made necessary modifications in one of the Questionnaires: Women
Questionnaires. These questionnaires were discussed and finalized in training cum workshop during
the first week of November 2008
All the questionnaires were bilingual, with questions in both regional and English language.
Household Questionnaires: The household questionnaire lists all usual residents in sample
household including visitors who stayed in the household the night before the interview. For each listed
household member, the survey collected basic information on age, sex and education. Information was
also collected on the household characteristics such as main source of drinking water, type of toilet
facility, source of cooking fuel, religion and caste of household head and ownership of other durable
goods in the household.
Section I: Women characteristics: In this section the information collected on age, educational status
and birth and death history of biological children including still birth, induced and spontaneous
abortions.
Section II: In this section the questionnaire collect information only from the women who had live birth,
still birth, spontaneous or induced abortion during last two years preceding the survey date. The
information on whether women received antenatal and postpartum care, who attended the delivery and
the nature of complication during pregnancy for recent births were also collected.
Section III: Institutional Delivery: This section gives information about women who went to health facility
for delivery, mode of transport arranged for delivery, assistance provided by ASHA, experience of
health problems during the time of delivery and advises given by health practitioners on newborn care
practices.
Section IV: Home Delivery: This section covers the information about deliveries conducted at home,
place used for home delivery, health personnel attended to conduct the delivery, clean practices
adopted for delivery, check up conducted by ASHA
Under facility survey, District Hospitals, Community Health Centres (CHCs), Primary Health Centres
(PHCs), and Sub-Centres (SCs) are covered in each of the NIPI intervention district. For each of the
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health facility, a separate questionnaire was designed and information was collected in the following
areas:
In each of the facility, various information under above mentioned heads was collected keeping in mind
the IPHS guidelines. In each district, District Hospital, one CHC, 6 PHCs and 30 SCs were decided to
cover to get a fair understanding of the status of health facilities in the district.
As part of Qualitative study, we conducted in-depth interviews (IDI) with various stakeholders involved
in maternal and newborn care issues at village, block, district and state level. The purpose of
qualitative study was to assess the input, process and output indicators of the interventions proposed.
It may be noted that the main purpose of quantitative survey was to understand the different aspects of
program delivery and management as a facilitating/debilitating factor to contain mortality levels of
infants and P/L mothers.
Qualitative study was carried out through In-depth interview of various health
functionaries/stakeholders in a state, district and block level.
Table 1.2: Coverage by Target Group and Research Technique (State Level)
Target Group Research Per Per
Technique district state
Health/ FW/RCH Director IDI 2 6
NRHM-PMU/ Mission Director IDI 1 3
ICDS-PD/ Commissioner IDI 1 3
NGO Coordinator IDI 1 3
PO - Immunisation IDI 1 3
Consultant – Child Health IDI 1 3
PO – Planning/SPM IDI 1 3
DD-Statistics IDI 1 3
Finance Officer IDI 1 3
State IEC Officer IDI 1 3
Table 1.3: Coverage by Target Group and Research Technique (District Level)
Target Group Research Per Per
Technique district state
DM/DC IDI 1 3
CMHO IDI 1 3
DIO IDI 1 3
DIECO IDI 1 3
NRHM-DPM IDI 1 3
DAM IDI 1 3
MIS Offficer IDI 1 3
RKS IDI 1 3
ICDS-PO IDI 1 3
NGO IDI 1 3
Provider Association – IMA, Pvt Doctor Association, Nurses IDI 1 3
Association
District hospital, Civil Surgeon IDI 1 3
Table 1.4: Coverage by Target Group and Research Technique (Block level)
Target Group Research Per Per
Technique district state
For this baseline household survey, supervisors and interviewers from the respective states were
recruited, with relevant background and previous experience in similar large-scale social research
studies. We recruited graduates only for the job of Supervisors and Interviewers and with the fix
minimum experience in social surveys for interviewers as 2 years and for supervisors as 5 years. The
qualitative survey was monitored by a researcher who has previous experience in handling such
surveys.
All the qualitative and quantitative instruments of the present study were translated into regional
languages by DRS panel of expert translators. The translated schedules were translated back into
English and variations if any will be sorted out.
All the prepared instruments were pre-tested on eligible respondents by the local investigators from
study states. All the questions were assessed for consistency, comfort of the investigator to enquire
and the respondent‟s convenience to respond.
The client modified the instruments according to the feedback provided by us. Then the instruments
were sent for printing. We printed the required number of instruments + 10% more to be used in
training and field practice.
Intensive training was given to the recruited personnel by DRS, regarding the nature of interviews and
specific skills required for eliciting data. We conducted a 4-day training session for the qualitative and
quantitative teams. The training sessions were held at respective states.
Training sessions included introductory session on the study objectives, target groups, importance of
the study and implications of the study findings. The methods were used to impart the training include
lectures, discussion, role-play, demonstration interview, mock interview, field practice interview etc.
The members of survey team were selected from the study states that were involved in data collection
in the previous RCH surveys and qualitative data collection.
Training on Quantitative and Qualitative questionnaires was conducted at the state level by the senior
researchers from Delhi accompanied by the field coordinators to ensure the content and quality of
training. Apart from discussing the questionnaires and other important sessions on immunization and
newborn care practices were discussed. During the training, each question item and the mode of
administering the question were discussed.
Training was followed by 1-day field practice by the teams, which was monitored by Senior Researcher
to ensure the quality of field work and consistencies in the questionnaires.
The state level NIPI Program Officers also made special spot checks to facilitate the quality of the
training.
During the fieldwork, the field supervisor was responsible for planning and executing the data
collection. The supervisor was responsible in informing the block level officers and service providers in
the PSUs about the purpose of the field teams‟ visit to the place and seeks their cooperation. This
helped the field teams in conducting data collection smoothly.
If there were any issues in terms of quality or completeness of data collection by the field executives,
the supervisors immediately informed field coordinators and hence adequate measures were taken
without any delay.
The survey teams were visited by the central survey coordination team members on field to check the
process and quality of data collection.
Members from NIPI team (NIPI Secretariat and NIPI State Offices) visited some of the survey teams
during survey and assessed the process of data collection and completeness of data.
In order to control quality, we adopted rigorous checks such as spot checks, back checks and
accompaniment interviews. We adopted 10% (or 20%) back checks to ensure whether the correct
households were covered or not and 15% accompanied audit norm to ensure the questionnaire is
being administered as per the instructions in the training. These were the quality control checks
adopted by supervisors, field executives and researchers during their field visits. The field executives
and researchers visited the field in such a way that one or the other was in the field during the entire
data collection period.
As a practice of quality control for any social research study the supervisor accompanied 20% of the
interviews.
The hard copies of the collected forms were collected at the Central coordination office at Delhi. All the
forms were screened again for the completeness. The collected raw data was entered in Cs Pro
keeping in view the objectives of the study. Double data entry was done for 20% of the data. The data
entered were correlated with the house listing to cross check the index candidates and also the other
related parameters.
Analysis for various pre-identified indicators and other program relevant indicators was generated in
SPSS program.
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The analysis was undertaken in consultation with TNS and NIPI program officers.
Table 1.5 below gives the district-wise coverage status for the state of Rajasthan.
CHAPTER 2
This chapter reflects on the demographic and socio-economic characteristics of the households in the
district level Baseline Household survey about child health and related maternal care, for Norway India
Partnership Initiative (NIPI) in the state of Rajasthan and describes the key household characteristics
that provides a basis to the understanding of the socio-economic status of the area, focusing on the
basic demographic parameters like sex-ratio, religious status, educational attainment etc.
Information was collected from all usual residents as well as visitors who stayed in the selected
households the night before the household interview. Usual residents or visitors staying at the
household on the night before the scheduled survey together form the de facto population while on the
other hand, usual residents, irrespective of whether they stayed in the household on the previous night
or not, form the de jure population. These two types of population will differ from each other due to
temporary population movements. In this report, unless otherwise stated, all the tables are based on de
facto population.
Age and sex are basic demographic characteristics that play an important role in the study of any
baseline survey related to family health and welfare. Table 2.1 shows the percent distribution of
household population by residence, age and sex in the three selected districts of Alwar, Bharatpur and
Dausa in the state of Rajasthan. The variables covered include age-specific distribution of the
household population by nature of the primary sampling unitas well as gender of family member.
Table 2.2: Household population by age and sex, District Alwar, NIPI-08
ALWAR Rural Urban
Age Total Male Female Total Male Female Total Male Female
% % % % % % % % %
0-4 26.7 27.7 25.6 26.9 27.9 26.0 25.0 26.7 23.3
5-9 10.7 9.7 11.7 11.0 9.8 12.1 9.0 9.1 8.9
10-14 4.4 3.5 5.2 4.6 3.9 5.2 3.0 1.2 4.9
15-19 4.9 4.2 5.7 5.2 4.4 6.1 3.0 2.8 3.2
20-24 14.3 10.3 18.3 14.4 10.3 18.3 14.2 10.2 18.5
25-29 14.3 16.8 11.9 13.9 16.6 11.2 17.1 17.9 16.3
30-34 5.9 7.8 4.1 5.7 7.5 4.0 7.3 9.8 4.5
35-39 2.7 3.5 1.9 2.5 3.3 1.8 3.9 5.1 2.6
40-44 2.4 1.7 3.1 2.4 1.7 3.1 2.4 1.8 3.0
45-49 3.7 3.3 4.1 3.8 3.5 4.1 3.5 2.6 4.3
50-54 3.5 3.9 3.1 3.3 3.7 2.9 4.8 5.1 4.5
55-59 2.2 2.5 1.8 2.0 2.3 1.7 3.4 4.0 2.6
60+ 4.2 4.9 3.5 4.3 5.1 3.5 3.4 3.5 3.2
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total HH
8,332 4,155 4,177 7,234 3,586 3,648 1,098 569 529
Members
Table 2.3: Household population by age and sex, District Bharatpur, NIPI-08
BHARATPUR Rural Urban
Age Total Male Female Total Male Female Total Male Female
% % % % % % % % %
0-4 27.5 28.6 26.5 27.9 28.7 27.0 25.8 28.0 23.7
5-9 12.2 11.3 13.1 12.5 11.7 13.2 10.7 8.9 12.4
10-14 5.3 4.7 5.8 5.5 4.8 6.2 4.2 4.1 4.3
15-19 4.9 4.0 5.8 5.0 4.4 5.5 4.5 2.0 6.9
20-24 13.8 9.7 17.6 13.8 9.7 17.8 13.6 10.0 17.0
25-29 13.0 15.2 10.9 12.5 14.7 10.3 15.5 17.6 13.5
30-34 6.0 8.0 4.1 5.9 7.9 3.9 6.8 8.8 5.0
35-39 3.2 4.2 2.2 3.2 4.2 2.1 3.3 4.2 2.3
40-44 1.6 1.9 1.4 1.6 1.7 1.5 1.8 2.6 1.0
45-49 2.4 2.0 2.8 2.5 2.2 2.8 2.1 1.3 2.9
50-54 2.5 2.4 2.6 2.4 2.2 2.5 3.1 3.1 3.2
55-59 2.6 2.5 2.6 2.6 2.6 2.7 2.3 2.3 2.2
60+ 5.0 5.5 4.6 4.8 5.1 4.4 6.3 7.0 5.7
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total HH
8,247 4,049 4,198 6,839 3,366 3,473 1,408 683 725
Members
Table 2.4: Household population by age and sex, District Dausa, NIPI-08
DAUSA Rural Urban
Age Total Male Female Total Male Female Total Male Female
% % % % % % % % %
0-4 26.6 27.9 25.3 27.1 28.3 25.8 23.0 24.7 21.3
5-9 11.8 10.7 13.0 12.0 10.8 13.3 10.2 9.8 10.5
10-14 4.5 3.6 5.4 4.5 3.6 5.4 4.4 3.8 5.1
15-19 5.6 4.8 6.4 5.7 4.8 6.5 5.1 4.4 5.9
20-24 13.2 9.8 16.6 13.4 10.1 16.5 12.1 7.3 16.9
25-29 14.1 15.6 12.7 13.9 15.5 12.3 15.8 15.9 15.6
30-34 6.5 9.3 3.8 6.3 8.9 3.8 8.5 12.6 4.4
35-39 2.3 3.3 1.3 2.3 3.3 1.2 2.8 3.8 1.9
40-44 1.7 1.3 2.0 1.6 1.2 2.0 1.9 1.5 2.3
45-49 3.2 2.5 3.8 3.1 2.5 3.8 3.4 2.5 4.2
50-54 3.2 3.4 3.1 3.2 3.4 3.0 3.5 3.1 3.8
55-59 2.7 2.7 2.7 2.5 2.6 2.5 4.6 4.2 5.1
60+ 4.5 5.1 3.8 4.4 5.0 3.9 4.7 6.5 3.0
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total HH
8,627 4,277 4,350 7,675 3,799 3,876 952 478 474
Members
This section looks at the profile of sample households in terms of type of familial structure, its economic
status as per Government of India nomenclature specified through the type of ration card ownership,
religious affinity, caste, and the number of household members.
District Alwar is found to be continuing with the old trend of Joint families which in the other two districts
is found to be almost equivalent to the percentage of nuclear families. Going by the national trend,
three in five households in India are nuclear. Nuclear households are defined as households that are
composed of a married couple or a man or a woman living alone or with married unmarried children
(biological, adopted or fostered), with or without unrelated individuals. According to the survey findings
in NIPI Baseline Household survey, 52.1 percent of all the households live in joint families while 47.9
percent are nuclear families. This trend is somewhat different from the national level information as a
higher proportion of our sample population is from the rural areas and it has been found that proportion
of nuclear households is less in rural areas than the urban areas.
About one-fourth (27%) of the households in India have a BPL card. It has been found during the
present survey that 16.9 percent of the population lives below the poverty line, which is quite low,
compared to the national average. The proportion of BPL households is comparatively higher in rural
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areas (18.2%) than the urban areas (9.0 percent). Another important aspect is that around 27.8 percent
of all the households do not possess any card, the proportion being much higher for the urban
households (30.8%). 8.9 percent of the population were of the opinion that they live below the poverty
line but they do not possess any BPL card. Table 2.5 presents district-wise rural-urban information on
the category of households.
The distribution of households by religion (determined here by the religion of the head of the
household) is more or less similar to the national pattern with the majority of the population belonging
to the Hindu community (Table 2.4). Around 86.3 percent of the selected households are Hindus in the
district of Alwar, while the figure stands at 85.0 percent for Bharatpur and 94.9 percent for Dausa. The
proportion of Muslim population stands at 13.2 percent, 14.2 percent and 4.8 percent respectively for
the districts of Alwar, Bharatpur and Dausa.
Based on the caste / tribe status of the head of the household, around one-third (29.5%) of the
households belong to the Scheduled Caste (SC) category, while around 11.9 percent population is
Scheduled Tribes (ST). A sizeable proportion of households (43.9%) come from the Other Backward
Caste (OBC) community, while 14.8 percent of households belong to none of the three above-
mentioned castes. The district-wise rural-urban caste distribution is depicted in Table 2.4.
Education plays an important role in the progress of an individual‟s mind and country. Ignorance and
poverty are major speed-breakers in a swift developing country and can be easily overcome through
imparting proper education. Education is not only one of the most important socio-economic factors
that is known to significantly influence individual behavior and attitudes, but educational attainment is a
fundamental indicator of a country‟s level of human capital development.
Table 2.7: Education attainment by gender of household member in terms of years of schooling,
NIPI-08
ALWAR BHARATPUR DAUSA STATE TOTAL
FEMA FEMA FEMA FEMA
Years of Schooling TOTAL MALE TOTAL MALE TOTAL MALE TOTAL MALE
LE LE LE LE
% % % % % % % % % % % %
No Schooling 37 23 51 41 24 56 37 21 53 38 23 53
< 5Years complete 10 10 11 12 12 12 12 11 13 11 11 12
5-7 Years complete 14 13 14 12 13 12 13 13 14 13 13 13
8-9 Years complete 14 16 11 14 18 10 14 17 11 14 17 11
10-11 Years complete 11 17 6 10 15 4 10 16 5 10 16 5
12 or more years
14 21 7 11 18 5 13 22 5 13 20 6
complete
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total of Members 6,111 3,004 3,107 5,978 2,891 3,087 6,331 3,082 3,249 18,420 8,977 9,443
Consistently among al Districts, illiteracy has been observed to be highest among females. The State
average for illiteracy stands at 37 percent, almost similar to that for District Dausa and Alwar. The stark
difference in illiteracy among genders is witnessed in all the districts thereby reaffirming the backward
social practices in the state of Rajasthan.
Table 2.8: Educational attainment by location of PSU in terms of years of schooling, NIPI-08
ALWAR BHARATPUR DAUSA Total
RURAL URBAN Total RURAL URBAN Total RURAL URBAN Total RURAL URBAN Total
Years of
Schooling % % % % % % % % % % % %
No Education 40.8 15.3 37.3 42.8 29.6 40.5 39.1 23.9 37.3 40.8 23.5 38.4
<1 or not attented 1.0 1.1 1.0 1.3 1.6 1.3 1.2 1.0 1.2 1.2 1.3 1.2
1 to 4 9.5 8.1 9.4 10.9 9.2 10.6 11.1 10.2 11.0 10.5 9.2 10.3
5 to 7 14.1 9.8 13.5 12.6 11.8 12.5 13.4 11.3 13.2 13.4 11.0 13.0
8 to 9 13.5 13.7 13.5 14.1 14.4 14.2 14.1 12.4 13.9 13.9 13.6 13.9
10 to 11 10.9 14.8 11.4 9.4 10.8 9.6 9.9 12.7 10.2 10.0 12.6 10.4
12 or More 10.2 37.2 13.9 9.0 22.7 11.4 11.2 28.5 13.2 10.2 28.9 12.8
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total # of
5288 823 6111 4933 1045 5978 5598 733 6331 15819 2601 18420
members
The table above depicts the district-wise rural – urban educational stature of the head of the
households. A large proportion of the population continues to have little or no education at all and this
proportion is much higher in the rural areas than the urban areas. 38.4 percent of all the households
are not endowed with the light of education, the proportion being 23.5 percent for urban areas and 40.8
percent for rural areas. Around 10.3 percent of the total households have studied up to primary level,
26.9 percent have done middle level schooling while another 10.4 percent have studied up to
secondary level. Only 12.8 percent of the households have gone for higher education, the proportion of
urban households being nearly thrice than the rural households in this case. Among the three districts,
the percentage of illiterates is found to be most in Bharatpur compared to the other two districts of
Alwar and Dausa.
Access to basic amenities such as proper housing, safe drinking water and sanitation, clean cooking
fuel, separate hygienic kitchen etc is not only an important measure of the socio-economic status of the
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household, but is also fundamental to the health of the members. In this section, type of houses the
respondents reside in is discussed followed by their access to safe drinking water, sanitation facilities
and use of a proper kitchen. Information on household characteristics is based on questions answered
by the respondents of the household questionnaire and in the case of type of housing, through
interviewer observations.
Throwing light on the type of housing, it has been seen that 14.2 percent of the sampled households
reside in kuccha houses, 36.7 percent reside in semi-pucca houses while the rest 49.1 percent live in
pucca houses. It is noted here that proportion of households residing in pucca houses is much more
(83.5%) in the urban region as compared to its rural counterpart (43.7%). The district-wise rural-urban
distribution of the type of housing of the sampled households is depicted in the above table.
Respondents to the household questionnaire were asked for the main source of drinking water for the
household and their usual method of storage It is seen that majority of the households (53.8 percent)
drink water from the Tube Well, while around 1.7 percent households have their source of drinking
water from unprotected wells. The percentage of rural population drinking water from unprotected wells
is comparatively higher at 11.9 percent.
Respondents were also asked about the storage practices used by the households for storing drinking
water. Around 71.0 percent of households use covered earthen pots for storage purposes, while
around 19.1 percent kept water in covered buckets. It is seen that urban households are more likely to
storing water in covered buckets than the rural households. The treatment of water ranges from boiling
it to using alum, adding bleach / chlorine tablets, straining the water through a cloth, using water filter
or electronic purifiers. Urban households are somewhat more likely than rural households to treating
drinking water.
The proportion of households without toilet facilities is much higher at 81.1 percent, as compared to the
national average of 56 percent population. Overall, 17.7 percent of households have improved toilet
facilities that are not shared by anyone else. Improved toilet facilities include toilet facilities with a flush
or a pour flush connected to sewer system, septic tank or pit latrine, a ventilated improved pit latrine, a
pit latrine with slab or without slab. If a household has any one of these toilet facilities but needs to
share them with other households, that household is considered not to have an improved toilet facility.
Urban households are three times as likely as rural households having access to improved toilet
facilities.
To study the potential for exposure to cooking smoke from solid fuels, NIPI Baseline household survey
collected information on the type of fuel used by the household for cooking purposes, the place where
the cooking is done and whether cooking is done under a chimney or not. According to survey findings,
around 62.9 percent households use wood for cooking purposes. The proportion of rural households
using wood is much more at 67.4 percent compared to 34.6 percent of urban households. A majority of
urban households (56.0%) use LPG for cooking purposes compared to just 5.2 percent of rural
households using LPG. A very small proportion of rural households also use coal in the open (0.2%),
thus exposing them to severe health hazards. Few households are also found to use Biogas, kerosene
oil, dung or agricultural wastes for cooking their food.
Overall, these data show the vast majority of rural households using solid fuels for cooking. In both
rural and urban areas, 99 in 100 households cook on an open fire, without diverting the smoke through
a chimney. Another important aspect that requires mention here is the provision of a separate kitchen
for cooking. 62.1 percent of the households do not have a separate kitchen for cooking purposes,
leading to an unhygienic and unhealthy atmosphere. However, 62.5 percent urban households have a
separate kitchen as compared to 34.0 percent of rural households, again spelling out the disparity
between rural and urban standards of living (Table 2.7).
In order to assess the living standard of the population, NIPI Baseline Household survey collected
information on household ownership of nineteen different types of durable goods and five different
modes of transportation, possession of a bank account and coverage by a health scheme.
Of the items asked about, only a few are owned by a majority of the households: a mattress (86.9%), a
cot / bed (98.2%), a watch / clock (86.6%). Various forms of media or communication are owned by just
a handful of population. Around 48.6 percent of the households have access to a television, 30.9
percent have a radio, 60.7 percent have a mobile phone and only 12.0 percent have other (non-mobile)
telephones. Computers are owned by only 5.7 percent of all the households but the figure stands at
12.8 percent for all urban households. In general, households in rural areas are much less likely to
have consumer goods than the urban areas. A considerable proportion of both rural and urban
households possess a water pump (19.8%). Threshers and tractors are owned by 4.7 percent and 8.0
percent of the households respectively.
Nearly all residents of rural areas lived in their own house, the owner occupancy being as high as 98.2
percent. Even in urban areas, the average for all Districts comes out to be very less at 11 percent.
Information on ownership of agricultural land by households shows that around 64.8 percent of all the
households own agricultural land. Actually, these households depend on the parcels of land for their
living. However, the proportion of rural households owning agricultural land is much more at 71.0
percent than the urban households, 25.8 percent of who only have their own agricultural land.
In the rural areas of all the three Districts, farming and agriculture account for the main source of
income for majority of households. Apart from that, Job service comes out to be the next highest
source of household income, thus affirming the fact that education and the modern times are
encouraging people to change their traditional occupations and accept new jobs.
Only a very small proportion of households are covered under a health insurance scheme (6.9%). The
percentage is slightly higher in the urban areas (15.6%) than the rural households (5.5%). Generally,
any member of the households employed with the Central Government, are covered under Central
Government Health Insurance Scheme. A small proportion of households are also covered under
Employees State Insurance Scheme. Tables 2.13 & 2.14 throw light on the households covered under
any form of health insurance and their types.
To construct the wealth index, all the data records of women have been considered in the state. The
selected assets/ indicators for the construction of index are:
Calculation Procedure
The first 2 indicators are derived from collected information from the available information as follows:
a) Toilet facility used – If a household is having an improved toilet facilities then it is given a score
1, otherwise it is given a 0 score.
b) Fuel used for cooking – If a household is using modern forms of fuel for cooking purposes then
the household is awarded a score of 1, otherwise it is given a 0 score.
The next 24 indicators are considered directly from the ownership. If a household has that particular
asset then it is given a score of 1 for that asset, otherwise 0.
This procedure first standardizes the indicator variables (calculating z-scores); then the factor
coefficient scores (factor loadings) are calculated; and finally, for each household, the indicator values
are multiplied by the loadings and summed to produce the household‟s index value. In this process, we
used only factors of first component. The resulting sum is itself a standardized score with a mean of
zero and a standard deviation of one.
Using these 26 reconstructed variables we have carried out Principal component analysis. In the
process of PCA we have dropped 8 variables due to their low or negative effect on index. Based on the
remaining 18 variables, in the Principal component analysis the components with integer values
greater than 1 are explaining a variation of around 55% in the data, with the first component explaining
33% of variation.
Total 100.0
Nationally, two in five households have a bank account or an account with the post – office. The trend
is found to be more or less similar in our present household survey with 41.5 percent of all the
households possessing a bank account or have a savings account in the post – office. Urban
households, as expected, enjoy a higher share in terms of possession of a bank account than the rural
households. Another important aspect that needs to be mentioned here is that 2.1 percent of the
respondents have no idea whether any member of the household possesses a bank account or not.
CHAPTER 3
CHARACTERTISTICS OF SURVEY RESPONDENTS
The health, nutrition, and demographic behaviors of women vary by their own characteristics, such as
age, marital status, and caste, as well as the economic characteristics of their households, such as
wealth status. Additionally, education and media exposure are also important catalysts for health and
demographic change. Socio economic differentials are of particular concern for the population and
health policies of the Government of India that seek to improve the health of all population groups,
including minorities and vulnerable groups.
The present chapter presents a profile of the demographic and socio economic characteristics of de
facto female respondents from the districts of Alwar, Bharatpur and Dausa in Rajasthan who were
identified as eligible respondents for the study, after a listing of households for selection of women
under 3 categories viz.,
The characteristics of respondents are profiled in some detail in the remainder of this chapter, and
include characteristics such as age, residence, education, marital status and economic status that
furnish the basis for socio-demographic analyses in subsequent chapters.
Table 3.1 presents the percentage distribution of female respondents by age, residence and wealth
index. The overall age distribution of female respondents shows that the percentage of respondents is
lowest (3 percent) in the age group of 15 – 18 years which gradually increases and peaks at 42 percent
in the age group of 22 – 25 years, followed by a decline to the lowest of one percent in the age group
of 41 – 49 years. A similar trend can be observed when a district wise analysis is made. Overall, the
highest number of respondents (42 percent) belonged to the age group of 22 – 25 years with the next
largest number (25 percent) belonging to the age group of 26 – 30 years.
Caste/Tribe
The majority of the eligible women interviewed were from the Hindu faith with a little chunk (13 percent)
belonging to the Muslim religion. OBC families were found to be the largest group, the second being
the Schedule caste.
Table 3.3 shows that of the total women surveyed in the age group of 15 – 18 years, 49 percent had no
education at all which is almost similar for the age groups of 19 – 21 (45%) and 22 – 25 years (50%). In
the age group of 26 – 30, 31 – 40 and 41 – 49, this percentage is 58 percent, 76 percent and 94
percent respectively. When analyzed district wise, it can be observed that in the districts of Bharatpur
and Dausa, 100 percent of women in the age group of 41 – 49 and 86 percent of women in the same
age group from Alwar have no education. This shows that in this age group, women from Alwar are
more literate compared to the other two districts.
The distributions of women by wealth index shows that the proportion (42 percent) of women is in the
lowest wealth quintile. Only 11 percent women are in the fourth wealth quintile while it has again
marginally increased to 15 percent in the highest wealth quintile. The situation is more or less similar
across all the districts.
In this study, exposure to print and electronic media (Radio & Television) was measured by asking
women about the frequency (almost every day; at least once a week; less than once a week; or not at
all) with which they read a newspaper or magazine, watch television or listen to the radio, (Table 3.3.1).
In addition, the respondents were also asked whether they „usually go to a cinema hall or theatre to
see a movie. Women who do not read a newspaper or magazine, watch television, or listen to the radio
at least once a week, or see a movie at least once a month are considered as not regularly exposed to
any media. The tables shows that in Rajasthan, in comparison to the other age groups, the lowest and
highest studied age group of 15 – 18 years and 31 to 40 years, the women are not much exposed to
the print or electronic media, which implies that there may be some socio cultural problems for women
of these age groups due to which they are deprived of this.
Though in today‟s time television is the most common form of media in both rural and urban areas,
Radio also holds a place of importance in most of the households especially in the rural areas. The
same table shows that the age group of 22 -25 years are quite active radio listeners. As high as 52
percent of women in this age group are regular radio listeners. If we see this against the education
level of the respondent, we find that 30 percent with education level of 12 and above are regular radio
listeners. The next highest percentage of 22 percent with no education at all are also regular radio
listeners. The table also highlights that a very high percentage (60 percent) of women with no
education at all do not listen to the radio at all which shows that women with no education are deprived
of exposure to the radio. This also shows just how much the factor of education affects women‟s
exposure to the media.
The ability of a country‟s economy to provide gainful employment to its population is an important
aspect of the country‟s level of development. Paid employment of women, in particular, has been
recognized as important for achieving the goal of population stabilization in India (Ministry of Health
and Family Welfare, 2000). However, the empowering effects of employment for women in particular
are likely to depend on their occupation, the continuity of their workforce participation, and whether
they earn income.
Table 3.5 gives the percent distribution of women by their age group, educational level and residence.
It can be seen that overall about 33 percent of women in the age group of 41 – 49 years are earning
whereas as high as 88 percent of women aged 22 – 25 years are not earning anything. The same thing
when analyzed district wise, it can be observed that in comparison to Alwar and Dausa, where only 29
percent and 20 percent of women in the age group of 41 – 49 years are earning something, it is 50
percent in the case of Bharatpur. Likewise in the age group of 15 – 18 years, we can see a higher
percentage (24 percent) of women of Bharatpur earning something in comparison to the other 2
districts of Alwar and Dausa which is 7 percent and 14 percent respectively. This shows that in
comparison to the other two districts, women aged 15 – 18 years from Bharatpur starts earning earlier
and its Bharatpur again which also has more percentage of women earning at the age group of 41 – 49
years.
Analyzing this by education level of the women, we find that overall higher the educational attainment
of women, there is a gradual decline in the percentage of women earning something, except for the
women having completed twelve or more years of education which again shows an increased
percentage. The same is the case for every individual district. This shows that a higher percentage of
women who have completed standard five or less and those who have completed standard twelve or
more are earning something. As far as women with no education are concerned, the overall and district
wise percentages of earning women do not show any significant difference.
When analyzed by residence, overall there is not much difference among the rural and urban earners
but when observed district wise, in Bharatpur (Rural – 17 %, urban –19 %) and Dausa (Rural – 16 %,
urban –14%) slight differences are seen between the two.
The women respondents were also asked if they are a member of any SHG or Mahila Mandal. It was
observed that a negligible percentage of women, i.e 1.1 percent responded in the affirmative. In Alwar,
only 0.4 percent, in Bharatpur, only 0.8 percent and in Dausa, 2.1 percent are member s of any SHG or
In Many parts of India, there exists the practice of the child bride staying at home for some time before
she moves into her husband‟s residence. There are many socio-cultural reasons behind this but the
more important aspect of this issue is that the day she moves in with her husband, is marked with
festivities and is know as “gauna”. Health research has, for all practical purposes, always taken the
date of gauna to be of more relevance for cohabitation purposes than actual date of marriage. Overall,
it is observed that a very high percentage of women (64 percent) started to live with their husband
when still in their teens, specifically 15 – 18 years. Further, only about 28 percent of women started
living with their husband at the age of 19 – 21 years. A similar kind of situation was observed in both
the districts of Alwar and Bharatpur where there were more than 60 percent cases of women who
started living with their husbands when still in their teens. In Dausa however, the figure under this
category was less than 60 percent, i.e. 59 percent.
The question now is, does age at first cohabitation get influenced by the education level of the qomen
concerned or the economic well-being of her household? The following table elaborates.
The number of children a woman has ever borne is a cohort measure of fertility. Because it reflects
fertility in the past, it provides a somewhat different picture of fertility levels, trends, and differentials
than do period measures of fertility such as the CBR and the TFR. Table 3.6.1 shows the percent
distribution of all women by the number of children ever born (CEB).
Eighty Four percent of all women age 15 – 18 have already had a child. This shows that early child
bearing is fairly common in Rajasthan. For women age 41 – 49, the number of children ever born is of
particular interest because these women have virtually completed their childbearing. Among all women,
92 percent have reached the end of child bearing with more than 4 children ever born.
The same thing when analyzed by education level of the women it can be observed that, women who
have attained 12 or more years of education, 52 percent have only one child, followed by 37 percent
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NIPI Baseline Survey report for the state of Rajasthan
having two,8 percent having three and only 3 percent having four or more than four children. In the
case of women with no education, 33 percent have four or more than four children while only about 18
percent has only 1 child.
When analyzed by wealth index, as expected we can find that 31 percent of births to women in
households in the lowest wealth quintile were of order four or higher, compared with just 8 percent of
births to women in households in the highest wealth quintile.
CHAPTER 4
MATERNAL HEALTH
Antenatal registration is a key event in the care of the pregnant mothers. In order to have proper and
timely antenatal care, registration of pregnancy is a must. In Bharatpur and Dausa 85 and 84 percent
women visited any health facility for ANC respectively compared to about 71 percent women visited
health facility in Alwar. About 7 percent in Dausa, 5 percent in Bharatpur and 4 percent women in Alwar
reported that heath personnel visited their home for ANC. Hence, about 14 percent on an average did
not have contact with any health facility nor any health personnel visited their home during their
pregnancy. In Alwar, one out of four women did not have any contact with any health facility or health
personnel during pregnancy. Visit to health facility for antenatal check-up increases with the increase in
wealth index and decreases with increase in age and number of living children. It is interesting to note
that the visit of health personnel to home for ANC decreases with the increase in education of mother
and wealth index of household.
Table 4.1: Percentage of pregnancies registers vs. key background variables, NIPI-08
ALWAR BHARATPUR DAUSA Rajasthan
% % % %
Age Group
15-18 78.6 80.0 93.0 84.3
19-21 83.7 84.1 93.3 86.9
22-25 82.5 81.3 90.8 84.8
26-30 75.3 82.2 89.7 82.6
31-40 64.3 79.2 84.4 76.8
41-49 57.1 66.7 80.0 66.7
Years of Schooling
No Education 68.2 80.3 86.9 79.1
<5 87.5 90.0 96.4 92.2
5-7 84.6 82.4 94.1 87.3
8-9 88.3 83.2 93.2 88.3
10-11 94.6 87.8 97.7 93.6
12 & Above 94.6 83.5 97.5 92.2
HH Wealth Index
Lowest 68.1 80.3 87.9 79.5
Second 80.4 82.7 91.4 85.5
Middle 83.7 84.2 92.2 86.6
Fourth 88.2 80.7 92.9 87.0
Highest 90.8 84.1 95.9 90.2
Total 1018 1087 1191 3296
It is important to note that in Rajasthan, health workers like ANM/Nurse/Midwife/LHV are quite
effective, as nearly 4 out of five (82%) women visiting them for ANC. About 16.5 percent women
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NIPI Baseline Survey report for the state of Rajasthan
received ANC by a government doctors. ASHAs and AWW were also providing some ANC related care
in around 6 and 7percent women respectively.
The presence of an ANC card could be verified from only 30 percent women. Availability of ANC card
was the lowest for Bharatpur district with Dausa leading the way with more than 40 percent.
Overall, most women have gone in for some form of ANC service, whether its going to the health
facility or a health personnel visiting them at home.
Across all the three Districts, the most frequented source of ANC was the Sub-Center or the ANM
followed by Anganwadi worker. Private Hospitals/Clinics were also an important source especially in
Alwar (15 percent).
Among all the women who went in for ANC services either by visiting the service facility or having
someone visiting them at home, in majority cases the care has been provided by the ANM, Nurse or
LHV. Government doctors do not play an important role in the provision of ANC to the women. Majority
of the women have also stated that they were not provided ANC by anyone.
60
52
50
43.8
41.2
40
Rajasthan
30
23.6 India
20
10
0
NFHS-2 NFHS-3
As per DLHS-3, in Alwar (23.7%) and Dausa (27.9 %) districts, slightly more than one-fifth of the
pregnant women had at least 3 ANC visits or more during their last pregnancy as against Bharatpur
district where the corresponding figure was 21.7 percent.
Table 4.6: Number of ANC received and timing of ANCs received, NIPI-08
ALWAR BHARATPUR DAUSA Total
Rura Urba Tota Rura Urba Tota Rura Urba Tota Rura Urba Tota
l n l l n l l n l l n l
Number of ANC
visits % % % % % % % % % % % %
and timing
Received one ANC 16.4 12.0 15.3 7.4 5.4 6.8 12.1 7.1 11.2 11.7 8.0 10.8
Received two ANC 38.9 23.9 34.9 56.3 48.3 54.0 43.3 28.1 40.8 46.5 34.1 43.9
Received three ANC 44.1 64.1 49.3 35.7 46.3 38.7 43.5 64.1 47.0 41.0 57.7 44.7
Don't Know 0.6 0.5 0.6 0.5 1.1 0.7 1.0 0.8 0.2 0.7
Number of months
pregnant at 1st ANC
<4 61.5 72.1 64.2 47.7 51.7 48.8 51.9 59.8 53.1 53.2 60.6 54.7
4-5 30.6 24.3 28.6 43.7 44.3 43.6 36.3 31.7 35.8 37.3 33.9 36.5
6-7 5.7 2.8 5.2 7.2 3.4 6.3 8.9 7.1 8.7 7.4 4.5 6.8
8+ 1.4 0.8 1.4 0.9 0.3 0.7 1.6 0.7 1.4 1.3 0.6 1.2
Don't Know 0.7 0.6 0.5 0.3 0.5 1.2 0.7 1.1 0.8 0.4 0.7
120 107 120 285
N 803 154 957 977 226 127 507 3361
3 4 1 4
NIPI-08 baseline survey clearly reveals that the women who had more than 3 Antenatal care visits
during pregnancy come to be a little less than half of the total number. This is indicative of higher levels
of awareness of women regarding maternal health practice. For Bharatpur it has come out to be 38.7
percent, way higher than the DLHS-3 findings. Consistently across all Districts the propensity to get
more ANC check-ups was higher in Urban areas than the rural areas. Nearly all the women had
th
received their first ANC by the 5 month of their pregnancy and these findings are constant across all
three districts.
Important elements of antenatal care include examination of the pregnant mother, provision of iron
supplementation and two doses of tetanus toxoid vaccine. Nutritional deficiencies in women are often
exacerbated during pregnancy because of the additional nutrient requirements of foetal growth. Iron
deficiency anemia is the most common micronutrient deficiency in the world. It is major threat to safe
motherhood and to the health and survival of infants.
For the most recent birth during two years preceding the survey, information regarding use of IFA
tablets was collected. Overall, only 13 percent of women consumed IFA tablets at least for 3 months.
Proportion of women consumed IFA tablets in Alwar, Bharatpur and Dausa were 15.3, 14.1 and 10.6
percent respectively. Consumption of IFA tablets for at least 3 months in urban areas of the study
districts varied from 26 percent in Bharatpur to 11 percent in Dausa. IFA tablets were mostly consumed
by young (age 19-30) as well as by those mothers having up to 4 living children.
According to DLHS-3, 65.5 percent in Bharatpur received at least one TT followed by 63 percent in
Dausa and the lowest at 62 percent women in Alwar.
Table 4.7: Proportion of eligible women having received different components of ANC care,
NIPI-08
ALWAR BHARATPUR DAUSA ALL DISTRICTS
% % % %
2 or more TT 90.9 93.4 92.4 92.4
Took IFA for 90 or more Days 15.3 14.1 10.6 13.2
More than 90 percent women received two or more tetanus toxoid (TT) injections during pregnancy for
their most recent birth. In urban areas of all the three study districts, more than 95 percent mothers
received 2 or more TT injections during their most recent birth. In rural areas, 2 or more TT injections
received by 9 out of 10 women of all the three districts. It indicates the awareness and selective
preference of TT injections over ANC checkup. (Table 4.1.9 & 10)
Discussions with ASHAs reveal that they give emphasis on spreading awareness about
proper hygiene and nutrition during the time of delivery. They also help pregnant women in
4.1.2 Antenatal Care
her registration, Services
arranging and Awareness
transport, proper about Pregnancy
rest, ANC Complications
check-ups, accompanying mother
for institutional delivery etc. It was found that in Rajasthan, ASHAs are performing their
The effectiveness of antenatal care in ensuring safe motherhood depends on the assessments and the
advices given as part of antenatal care. Baseline survey collected information on thisgo
responsibilities quite well but many families do not inform them when they to institution
important aspect
of antenatal care by asking women who received antenatal care whether they received each in
for delivery for their additional benefit. ASHA’s absence is the main problem many
of several
villages
types of Rajasthan.
of service or information at any time as part of their antenatal care. All of these measurements
and tests are part of essential obstetric care or are required for monitoring high risk pregnancies.
Anganwadi
Among womenWorkers (AWW)
who received consider
antenatal nutrition
care for their advice
most and food
recent provision
birth, andhad
69 percent immunization
their weight
measured, 57 percent
as their prime hadfeel
job. They an that
abdominal examination
other ANC and 56 percent
related activities such ashad theirvisits,
home bloodproviding
pressure
checked. Blood and urine tests were conducted
IFA tablets, conducting periodic check-ups forare not so important because few ofdelivery
49 percent of women. Expected date of them
th
and
mentioned about these activities when they women.
advice for delivery was given to nearly 2/5 of were askedWomen to intellurban areas
about receiving
their better
pregnancy
antenatal care services with compared to rural areas. District wise data on
related activities. Few AWW mentioned about consumption of IFA tablets as an advice to antenatal care services
shows that Dausa has relatively better ANC services in comparison to Bharatpur and Alwar.
pregnant women.
The above table provides details of the nature of ANC received by the pregnant mothers during their
last pregnancy. It may be noted that the most common ANC components received were measurement
of weight and advice regarding diet. There is a slight rural-urban variation and women in the urban
areas have received slightly different components of ANC than their rural counterparts.
Samay par khana khaye, khane mein paushtik ahar lein, bhari saman na uthaye, samay
par jaanch karwaye, tetnus ka teeka lein, folic acid aur iron ka tablet time se lein aur
aaraam karen.(Take nutritious food meals on time, do not lift heavy weights, take TT
injection, folic acid and iron tablets on time, rest and timely go for check-up) ASHA,
Dausa, Rajasthan
Har do ghante par kuchh khayen, samay par doctor se janch karwayen aur doctor ki salah
menein.(Take food on every two hours, get tested by doctors on time and and follow the
advice of doctor) AWW, Alwar, Rajasthan
The above table makes it quite obvious that there is a positive relationship between the number of TT
injections and the number of ANC visits and its visible across both urban and rural areas.
This section looks at the general level of awareness among the women respondents regarding the
types of complications/health problems that can occur during pregnancy. It also looks at the incidence
of occurrence of health problems during last pregnancy as well as explores the details of treatment
seeking behavior.
Most of the women seemed to have been aware of swelling of hands and feet as a pregnancy
complication, perhaps because they may have experienced it first hand or heard about it from others.
Apart from this, a little more than a fifth of the respondents were aware of Vaginal Bleeding as a health
problem during pregnancy. Most of the eligible women seemed to have come to know about these
complications from the ANM/Nurse/LHV (51.1%) and from family members (26.4%).
23 percent of women in our sample had experienced some sort of health problems during their last
pregnancy. In the Districts of Alwar and Dausa more urban women faced problems than their rural
counterparts but the situation was reverse in Bharatpur.
Table 4.12: Nature of health problems faced during last pregnancy, NIPI-08
ALWAR BHARATPUR DAUSA ALL DISTRICT
Pregnancy
Rura Urba Tota Rura Urba Tota Rura Urba Tota Rura Urba Tota
complicatio
l n l l n l l n l l n l
n
% % % % % % % % % % % %
Swelling of 62.1 56.3 60.8 64.1 65.5 64.3 62.4 63.3 62.5 62.8 60.6 62.5
hands & Feet
Paleness 12.5 4.7 10.8 25.2 17.2 24.3 17.8 18.4 17.9 18.5 12.0 17.5
Visual
10.3 14.1 11.1 7.3 6.9 7.2 10.6 2.0 9.4 9.5 8.5 9.3
Disturbances
Excessive
6.3 12.5 7.6 8.1 6.9 8.0 11.2 8.2 10.8 8.8 9.9 9.0
Bleeding
Convulsions 15.6 28.1 18.4 17.9 10.3 17.1 11.6 14.3 11.9 14.7 19.7 15.5
Abnormal
Position of 5.4 12.5 6.9 3.4 10.3 4.2 10.9 8.2 10.5 7.0 10.6 7.5
Foetus
Weak or No
Movement of 5.4 12.5 6.9 7.3 6.9 7.2 21.5 18.4 21.0 12.4 13.4 12.5
Foetus
Others 25.0 51.6 30.9 27.8 31.0 28.1 30.4 28.6 30.1 28.0 39.4 29.8
Total 224 64 288 234 29 263 303 49 352 761 142 903
As mentioned earlier, the relatively higher awareness of swelling of hands and feet could be a result of
having experienced this complication first-hand, and the above table validates the assumption. Apart
from this awareness and experience regarding other symptoms were observed to be quite low. The
pregnancy related health problems most commonly reported by women are swelling of hands and feet
(62%), paleness (17%), Convulsions (15%), weak or no movement of foetus (13%), and visual
disturbances (9%). In all the districts, swelling of hands and feet is the most common health problem
during pregnancy.
Table 4.13: Percentage of women who sought advice for health problem during pregnancy,
NIPI-08
ALWAR BHARATPUR DAUSA Rajasthan
RURA URBA Tota RURA URBA Tota RURA URBA Tota RURA URBA Tota
L N l L N l L N l L N l
% % % % % % % % % % % %
67. 65. 74.
64.3 66.7 63.5 58.2 73.0 77.1 67.5 80.3 69.5
YES 7 3 2
32. 34. 25.
35.7 33.3 36.5 41.8 27.0 22.9 32.5 19.7 30.5
NO 3 7 8
Total no. of
221 64 285 230 29 259 300 49 349 751 142 893
women
On asking, who persuaded women to go to health facility for treatment, 36 percent women said their
husband persuaded followed by friends/relatives (29.1%), ANM (25%) and mother in law (14.5%).
Discussions were done with ASHA to know about the complications faced by mothers
during pregnancy. Most of the ASHA said that swelling of face and feet is the most
common symptoms followed by anemia and weakness.
Similar discussions with AWW reveals that AWW usually look for factors like anemia and
swelling of body parts in the pregnant mothers that can lead be dangerous to mothers.
AWW if encounter a high risk case they soon advice the mother to get the help from
doctor. They also provide them with IFA tablets.
In majority cases it was found that it was the husband (36%) who persuaded the woman to go in for
treatment during pregnancy for any kind of complication. This finding is fairly consistent among all the
three districts. Bharatpur is the only district where the ANM comes second close to the husband as a
counselor.
One of the important thrusts of the program is to encourage deliveries under proper hygienic conditions
(delivering under clean conditions, washing hands with disinfectant before delivery, etc.) and under the
supervision of qualified/ experience health professional. For each live/still birth during two years
preceding the survey, we had asked the women place of delivery, who assisted during the deliveries in
case of home deliveries, characteristics of delivery and any problems that occurred during the delivery
process. This section provides the details.
As per DLHS-3, the institutional deliveries for the state of Rajasthan comes out to be 45.5 percent
whereas NIPI-Baseline-08 has put the the Institutional Deliveries at 65 percent.
No age-group wise preference for Institutional or Home delivery is apparent for the findings which are
quite generalized for all the age-groups.
Institutional deliveries, particularly in private sector facilities, increase sharply with the mother‟s
education and with household wealth index. With regard to deliveries at home, the proportion of
deliveries decreases with the mother‟s education.
When asked to women who advised them to go to health facility for delivery, about 45 percent reported
they were advised by ANM/Nurse/Midwife followed by doctor (23.9%) and ASHA (6.7%). A
considerable proportion of women (23.1%) mentioned that they have not been advised by any body or
th
any one to go to institution for delivery. In Bharatpur, nearly 3/4 women were advised by
ANM/Nurse/Midwife whereas in Alwar and Dausa 35 and 29 percent women were advices by them.
Women with higher educational status are more inclined to go in for Institutional delivery irrespective of
the type of PSU, whether rural or urban. Women with less or no education at all are seen going for
Home deliveries.
The hypothesis that younger women having their first child would rather have a risk free institutional
delivery rather than have it at home is not quite validated with the findings, as the findings are quite
generalized for all the groups of women in the above table. In Home deliveries it is starkly clear that
women with more than 3-4 children go in for Home Delivery than Institutional delivery.
Table 4.18: Place of Delivery v/s economic status of respondent’s household, NIPI-08
Institutional Home Total
Wealth IN LAWS PARENTAL
Index GOVERNMENT NGO PRIVATE HOME HOME OTHER All Births
N % N % N % N % N % N % N %
Lowest 820 49.2 0 0.0 155 9.3 623 37.4 29 1.7 33 2.0 1667 100.0
Second 368 53.4 2 0.3 84 12.2 215 31.2 7 1.0 10 1.5 689 100.0
Middle 317 56.0 0 0.0 72 12.7 161 28.4 8 1.4 6 1.1 566 100.0
Fourth 229 53.0 1 0.2 80 18.5 111 25.7 7 1.6 4 0.9 432 100.0
Highest 304 53.2 2 0.4 155 27.1 106 18.6 3 0.5 1 0.2 571 100.0
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NIPI Baseline Survey report for the state of Rajasthan
Total 2038 51.9 5 0.1 546 13.9 1216 31.0 54 1.4 54 1.4 3925 100.0
The general trend that has been witnessed is that women with lower economic profile tend to have
deliveries at government facilities as against those who belonged to better income households and
could afford to go to Private Institutions for delivery.
“Pehle log ko hospital nahin jana chahte the par jab se hospital mein deliveri ke liye paisa
milne laga hai tab se ve vahan jyada jane lage hain. Abhi sarkari hospital ke dekh rekh
mein bhi badlaw aaya hai. Pahle doctor log rogi par kam dhyan dete the ab jyada de rahe
hain. Sadk ki suvidha bhi pahle se jyada ho gayee hai isliye bhi ab hospital jana aasan ho
gaya hai” (Earlier people do not go to hospitals but after introduction of money factor for
institution delivery they are going to hospitals. Earlier doctors were not so careful towards
patients but not they are giving much attention. Due to improved road connectivity now
women are more able to go to the health facility for delivery) ASHA, Bharatpur
(Rajasthan)
In nearly 77 percent cases, family members made the arrangement for transport. A significant
percentage of Husbands (30%) arranging transport in urban as well as rural areas for delivery. ASHA‟s
are not playing any significant role in the arrangement of transport. Only 4 percent women reported that
ASHA arranged transport.
On an average cost incurred on transportation is Rs. 248 in all the districts. In urban areas average
cost of transportation varies from Rs.101/- in Bharatpur to Rs.194/- in Dausa while in rural areas it
varies from Rs.223/- in Bharatpur to Rs.304/- in Dausa in the study districts.
In Rural areas, most of the institutional deliveries (86.1%) were normal vaginal delivery or assisted
vaginal delivery (1.1%). Caesarian deliveries were 12.5 percent. Nearly four-fifth (83.9%) deliveries
occurred in the study districts were normal and about 15 percent were caesarian and the rest were
assisted in urban areas. Highest number of normal deliveries (90%) observed in Dausa and highest
number of caesarian deliveries (20.6%) occurred in Alwar. In rural as well as in urban areas, nearly 50
percent deliveries were conducted by ANM. In urban and rural areas, after ANM, more deliveries are
conducted by govt. doctors followed by private doctors.
Total no of
664 139 803 667 184 851 823 112 935 2154 435 2589
women
Survey also tried to get an idea about the cost incurred on institutional delivery including transportation
th
cost. More than 2/5 women spent any where between Rs. 500 – 1500 on institutional delivery;
another 26 percent women spent Rs. 1501 to 2500. More than Rs.5000/- have also been spent on
delivery by around 9 percent women and around 3 percent women also spent less than Rs.500/- on
delivery. Data reveals that delivery expenses in urban areas are more than rural areas.
Table 4.22: Problems experienced during delivery by woman of different age groups, NIPI-08
Premature Excessive Prolonged Obstructed Breech
Other Total
Labour Bleeding Labour Labour Presentation
YES YES YES YES YES YES YES
Age N % N % N % N % N % N % N %
15-18 37 62.7 5 8.5 10 16.9 6 10.2 1 1.7 0 0.0 59 100
19-21 268 54.4 38 7.7 83 16.8 87 17.6 13 2.6 4 0.8 493 100
22-25 544 54.3 60 6.0 211 21.1 151 15.1 28 2.8 8 0.8 1,002 100
26-30 304 51.5 42 7.1 126 21.4 99 16.8 14 2.4 5 0.8 590 100
31-40 98 58.3 15 8.9 32 19.0 21 12.5 2 1.2 0 0.0 168 100
41-49 4 57.1 0 0.0 1 14.3 2 28.6 0 0.0 0 0.0 7 100
Premature Labor has been found to be the major problem experienced by women during delivery,
being faced by more than a half of the women respondents. Less than one-fifth of the women also
faced Prolonged Labor and Obstructed Labor.
Most of the mothers who received advice from Nurse were given advice about spacing method (72.5%)
followed by routine checkup (69.9%), Immunization (68.5%), breastfeeding practices (67.5%), and
newborn care (64.1%). Doctors mostly provided advice about newborn care (29%), breastfeeding
practices (27.8%), and routine check-up (26.7%).
BHARATPUR
Advice DOCTOR NURSE WARD ATTENDANT ANM Total
% % % % %
New born care practices 21.6 68.3 0.3 9.9 100.0
Breast Feeding 25.4 70.6 0.4 3.7 100.0
Immunization 18.6 75.4 0.0 6.0 100.0
Routine check up 21.2 72.7 0.0 6.1 100.0
Spacing method 21.0 74.6 0.0 4.3 100.0
Any other advice 46.7 53.3 0.0 0.0 100.0
DAUSA
Advice DOCTOR NURSE WARD ATTENDANT ANM Total
% % % % %
New born care practices 32.1 64.6 0.7 2.6 100.0
Breast Feeding 29.1 67.3 0.8 2.8 100.0
Immunization 29.3 66.3 1.5 3.0 100.0
Routine check up 27.9 69.8 0.6 1.7 100.0
Spacing method 26.0 66.1 1.6 6.3 100.0
Any other advice 9.1 91 0.0 0.0 100.0
In order to understand the perception of mothers about environment of health facility, a five point scale
is used to rate the perception about general cleanliness, toilets availability and cleanliness and
behaviour of staff. In Dausa, 31.4 percent women perceived that cleanliness of ward and labour room
is good and very good while in Bharatpur and Alwar, only 27.4 and 23.8 percent women perceived the
same respectively. Toilets availability and cleanliness have been rated good and very good by 29.7
percent women in Dausa followed by Bharatpur (22.9%) and Alwar (21.6%). Regarding behaviour of
staff and overall perception of mothers about the environment in health facility, Dausa relatively better
rated in comparison to Bharatpur and Alwar. Hence it indicates that environment of health facilities in
Dausa is relatively better in all respect when compared with other two study NIPI intervention districts.
Table 4.24: Mother’s perception about environment of health facility and behavior of staff, NIPI-
08
Janani Suraksha Yojana (JSY) under the overall umbrella of National Rural Health Mission (NRHM)
integrates the cash assistance with antenatal care during the pregnancy period, institutional care
during delivery and immediate post-partum period in a health centre by establishing a system of
coordinated care by field level health worker. The JSY is a 100 percent centrally sponsored scheme.
The vision of the scheme is to reduce overall maternal mortality ratio and infant mortality rate and to
increase institutional deliveries in BPL families. In Rajasthan, JSY has been implemented for both the
categories of families i.e. BPL and APL. In order to assess the knowledge about JSY among mothers,
they were asked whether they are aware of JSY.
Of the 3942 interviewed mothers in Rajasthan, around 83 percent was aware about JSY. In Dausa, 87
percent, Bharatpur, 86 percent and Alwar 77 percent of the women were aware about JSY. Mothers
mentioned AWW, ASHA and ANM are equally responsible for providing information about JSY to
villagers. In Dausa, 44 percent mothers received information about JSY from AWW whereas in
Bharatpur, 57 percent and in Alwar 43 percent women received information from ANM and ASHA
respectively.
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paise bhi kam lagte hain”(After the implementation of JSY there has been increase in
the institutional delivery and cost incurred for delivery has also gone down)..ASHA,
Dausa (Rajasthan)
NIPI Baseline Survey report for the state of Rajasthan
Among those women who delivered at home, 72.9 percent in Dausa, 69.2 percent in Alwar and 67.9
percent in Bharatpur were aware about JSY. Hence, despite having knowledge about JSY, a
considerable number of women delivered at
While asking the reason of not accompaniment of ASHA from mothers, nearly 88 percent in Dausa and
89 percent in Bharatpur and about 84 percent in Alwar reported that they did not inform to ASHA.
Around 2 percent women informed ASHA about delivery but she refused to come along. Seven percent
women mentioned ASHA was not present in the village or she was not well as the reason of not
accompaniment for delivery.
“Janani suraksha yojana ke antargat yadi ASHA ke saath delivery ke liye mahila jati hai
to use 1400 rupye milte hain aur yadi ASHA saath nahin jaati hai to use 1700 rupaye
milte hain. Isiliye mahilayen ASHA ko saath lekar nahin jana chahti hain”(in JSY if
ASHA accompanies the women for delivery to the institution the women get Rs. 1400
and if they go alone then they get Rs1700. that is the reason they do not inform ASHA
for accompaniment). ASHA, Dausa, Alwar & Bharatpur (Rajasthan)
Under JSY, every mother supposed to stay in the health facility for a minimum period of 48 hours for
optimal care and qualify as JSY beneficiary. Due to increase in demand and non availability of required
infrastructure facilities, government relaxed the norm from 48 hours to 24 hours. Survey revealed that
in spite of 24 hours minimal norm, a considerable percentage (40%) of mothers has been discharged
within 12 hours. Fifty percent mothers in Bharatpur, 38 percent each in Alwar and 32.6 percent in
Dausa were discharged within 12 hours of delivery.
Nearly half (59%) of the women reported that ASHA stayed with them for less than a day. In all the 3
study districts ASHAs staying with 30 -35 percent mothers for 1 – 2 days.
Table 4.28: Duration of stay of the mother at health facility after delivery, NIPI-08
ALWAR BHARATPUR DAUSA RAJASTHAN
Stay of
Mothers RURAL URBAN Total RURAL URBAN Total RURAL URBAN Total RURAL URBAN Total
% % % % % % % % % % % %
<=6 Hrs 22.1 12.9 18.9 34.5 24.2 31.6 20.5 11.7 19.1 25.3 16.2 23.2
7-12 Hrs 16.3 21.1 17.8 16.9 21.9 18.4 13.1 14.7 13.5 15.3 19.1 16.5
13-23 Hrs 0.0 0.5 0.1 0.6 0.9 0.6 0.1 0.4 0.2 0.2 0.6 0.3
1-2 Days 44.0 45.9 44.5 38.2 40.6 39.4 49.2 49.4 49.2 44.2 45.4 44.5
3-6 Days 15.4 18.2 16.4 7.8 10.5 8.1 15.9 21.6 16.6 13.2 16.8 13.8
Week of
2.2 1.4 2.2 1.9 1.8 1.9 1.1 2.2 1.4 1.7 1.8 1.8
More
Mothers were also asked whether they have received any cash incentive after institutional delivery
(govt. institutions). About 29 percent mothers reported to have received cash incentive in rural areas
and 26 percent received in urban areas of the study districts.
“JSY scheme achi hai, kam se kam paise ke lalach mein hi log hospital mein delivery
karwate hain” (the JSY scheme is good, atleast people go for institutional delivery to avail
the incentive attached with it) ANM, Dausa (Rajasthan)
This section deals with the details of home delivery cases, including reasons behind choosing to have
the baby delivered at home and not in an institution, the actually place where the delivery took place
and whether it is influenced by the background of the pregnant mother to be, the person who actually
conducted the delivery and finally, why was this person chosen to begin with.
Out of 3843 women interviewed in three districts, 1336 women delivered at home. So, overall 34.1
percent of mothers delivered at home. In Alwar, 37.3 percent mothers delivered at home followed by
Bharatpur (36%) and Dausa (28.8%).
As it has been mentioned above, nearly one-third of the total surveyed women delivered at home. They
were also asked the reasons why they did not deliver in the health facility. Forty nine percent women
mentioned going to health facility for delivery is not necessary and another 25 percent mentioned they
did not have time to go to health facility, 13 percent feel that cost of delivery is too much, 9 percent
women sited non availability of transportation facility and another 9 percent reported no body was there
to accompany for delivery as the main reasons of home delivery. The most important reasons
emerging in all the districts for not going to health facility for delivery are not necessary and did not get
time.
During qualitative discussions, it has come out that people generally do not prefer to go to health
facility if they feel that there is no serious problem or any complication to pregnant women. Non
availability of transportation also emerged as an important reason during qualitative discussions.
Don't trust
facility/poor 2.5 0.9 2.3 1.6 1.5 4.2 2.5 4.2 2.7 1.0 2.6
quality service
No one to
5.6 7.9 5.9 7.2 6.5 7.1 15.3 10.1 15.1 9.0 8.0 9.0
accompany
Did not get
18.5 26.3 18.9 23.0 19.4 22.7 35.1 32.9 34.7 25.0 25.6 24.8
time/no time
No female
provider at 2.3 0.9 2.3 1.4 0.9 1.3 1.1 1.3 1.1 1.6 1.0 1.6
facility
Husband/famil
8.3 10.5 7.6 5.6 3.7 5.5 8.6 2.5 8.2 7.5 6.0 7.0
y did not allow
Not necessary 57.6 54.4 56.3 47.9 57.4 48.1 43.2 38.0 42.4 50.0 51.2 49.4
Not customary 13.9 22.8 15.9 18.8 19.4 20.6 11.4 24.1 14.1 14.9 21.9 17.1
Other 6.7 8.8 6.8 2.6 3.7 2.5 0.8 0.8 3.5 4.7 3.5
Total 432 39 471 430 46 476 359 18 377 1221 103 1324
“Normal dard hua aur aspatal le jane ki tayari mein ghar par hi ho jata hai.” (Because of
the untimely delivery and lack of preparations in advance many deliveries happen at
home) ANM...Bharatpur (Rajasthan)
Survey also tried to capture the various prevailing practices in relation to home delivery. For a safe
delivery at home, besides trained health personnel hygienic environment and sterilized equipments is a
must. Women who delivered at home were asked about the place used for delivery at home, ventilation
condition of room and personnel involved in conducting the delivery.
This has clearly come out from the data that women from rural locations, with no education and lowest
wealth index, did not follow the standard precautionary measures during the delivery.
Women were also asked about the personnel who conducted the delivery, in rural as well as urban
areas of study districts, more than two-fifth deliveries are conducted by untrained dai (46%) and a
similar proportion of deliveries are conducted by trained dai (41%) also. In Alwar, Bharatpur and
Dausa 49, 31 and 43 percent deliveries are conducted by trained dai.
On asking about the condition of the room where delivery was taken place, about 54 percent women
reported there was proper ventilation, around 60 percent women perceived that the light was adequate
and 58 percent said that floor was clean. In Alwar, the condition of the rooms (i.e. ventilation, adequacy
of light and cleanliness of floor) where delivery was conducted was relatively better than the rooms of
other two districts.
Table 4.32: Reasons behind choosing a specific person to conduct the delivery, NIPI-08
ALWAR BHARATPUR DAUSA RAJASTHAN
Specification Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Why did you choose the person to conduct delivery
Past experience 40.3 32.5 38.6 28.8 22.2 29.2 37.0 41.8 37.4 35.3 31.2 34.9
Economical 2.1 5.3 2.3 1.2 1.9 1.5 8.9 5.1 8.8 3.8 4.0 3.9
Safe delivery 50.9 45.6 49.9 28.6 28.7 28.8 41.8 43.0 41.6 40.4 38.9 40.0
Reliable 4.6 10.5 5.7 18.4 17.6 17.4 6.1 5.1 5.8 9.9 11.6 10.0
Behavior of the
0.9 5.3 2.1 10.5 13.9 10.7 1.4 2.5 1.9 4.4 7.6 5.1
service provider
Recommended 0.9 0.9 1.1 12.6 15.7 12.4 4.7 2.5 4.5 6.1 6.6 6.1
Other 0.2 0.2 0.1 0.1
Total 432 39 471 430 46 476 359 18 377 1221 103 1324
Reason of choosing particular person to conduct delivery at home was also asked and past experience
of the person (35%) and past record of conducting safe deliveries (40%) are the two important reasons
mentioned. Person being economical, reliable and recommended by somebody are the other reasons
expressed for choosing the person to conduct home delivery.
At the time of delivery person who is conducting delivery needs to take certain essential precautions.
Questions pertaining to these precautions were asked. Of the total women who delivered at home, 14
percent reported using of Disposable Delivery Kit (DDK) by health personnel. Nearly two-third women
observed new-born baby was immediately wiped, dried and wrapped without being bathed. The
practice of using clean cloth to wrap the baby and clean blade to cut the cord is quite prevalent as
reported by 81 and 90 percent women respectively. Practice of using sterile/boiled thread to tie the
cord is also prevalent to some extent. Only 57 percent women observed the health personnel doing the
same. On asking what was applied on the cut cord, 35 percent mentioned powder followed by Oil
(21%) and medicine (11%). About 27 percent reported nothing was applied on the cut cord. About 32
percent mothers reported that the child was given bath between 1 – 12 hours and another 34 percent
mothers reported that the child was given bath after 24 hours of birth.
Did the person who attended the delivery wash his/her hands before attending the delivery?
YES 75.6 74.1 76.4
NO 12.5 14.0 12.7
DONT KNOWN 11.9 12.0 11.0
RAJASTHAN
Specification Rural Urban Total
% % %
What was used for washing?
WATER ONLY 13.3 13.0 13.8
SOAP 85.2 83.4 84.6
ASH/MUD 0.3 0.4 0.3
CANT SAY/DONT KNOWN 1.2 3.1 1.3
Total 923 88 1011
So far as the amount spent on home deliveries are concerned, 45 percent spent less than Rs.500/- and
another 44 percent spent between Rs.500 – 1000. In Bharatpur, expenditure on most of the home
deliveries (57%) was less than Rs.500/- while in Alwar and Dausa, it was between Rs.500/ - to
Rs.1000/- in 41 percent and 57 percent cases.
Majority of persons (71%) who conducted home deliveries gave advises to mothers regarding some of
the important aspects. About 41 percent mothers received advice on new born care practices, 40
percent received on breastfeeding practices and 21 percent received on immunization. A considerable
number of mothers (29%) did not receive any advice.
The health of a mother and newborn child depends not only on the health care she receives during her
pregnancy and delivery, but also on the care she and the infant receive during the first few weeks after
delivery. Postnatal care check-ups soon after the delivery are particularly important for births that take
place in non-institutional settings. Recognizing the importance of postnatal check-ups, government
programme (RCH) recommends three postnatal visits.
“Chatri mata ko khana nahi diya jata, chai bhi kali di jati hai jisse mata aur bacche ke
swasth par vipreet prabhav padta hai “( Mother is not given anything to eat, black tea is
given her to drink which is harmful to both mother and the new born) …ASHA,
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Alwar
Page 64 of 123
(Rajasthan)
NIPI Baseline Survey report for the state of Rajasthan
RAJASTHAN
ALWAR BHARATPUR DAUSA TOTAL
N % N % N % N %
1 29 24.2 46 57.5 39 46.4 114 40.1
Number of Visits 2 47 39.2 16 20.0 18 21.4 81 28.5
3+ 44 36.7 18 22.5 27 32.1 89 31.3
Total 120 100.0 80 100.0 84 100.0 284 100.0
A large proportion of maternal and neo-natal deaths occur during the 48 hours after delivery. Hence
safe motherhood programmes have increasingly emphasized the importance of postnatal care,
recommending that all women receive a check up within two days of delivery. The World Health
Organization (WHO) recognizes several „crucial moments when contact with the health
system/informed caregiver could be instrumental in identifying and responding to needs and
complications‟ (WHO, 1998). It is most important to have the first postnatal check-up within a few hours
of birth. Another important time for a postnatal check-up is six weeks (42 days) after the birth. By this
time, a woman‟s body should generally have returned to its per-pregnancy state. To assess the extent
of postnatal care check-ups, women were asked whether any health personnel check on her health
after last delivery.
A very less number of women (40.1%) have received only 1 postnatal check-up and lesser than that
have received 3+ Postnatal Checkups (31.3%).
CHAPTER 5
NEWBORN CARE
5.1 Preamble
The majority of newborn problems are specific to the perinatal period. They cause not only deaths but
also substantial morbidity and disability. These problems are the result of poor maternal health,
inadequate care during pregnancy, inappropriate management and poor hygiene during delivery, lack
of newborn care and discriminatory care. Death among newborn infants is so frequent that it is
accepted as routine by many families and community members. If a mother dies during childbirth, her
baby has smaller chance of survival, and if survives she is at high risk for neglect, malnutrition and
morbidity. Keeping this in view, government has launched nationwide programme for the care of
pregnant women as well age newborns.
During this survey, an attempt was made to capture some important issues related to newborn health
and family practices from the mothers. Newborn care related information was also collected from
service providers and program managers. This chapter presents the findings related to newborn care.
For decades, Rajasthan has been one of the infamous states with high Infant Mortality Rate. But in the
last few years a positive change has been witnessed and the mortality rates have reduced
considerably.
Table 5.2: Trends in Under five mortality Rate for Rajasthan and India
Direct estimates of infant and child mortality indicators at district level are not available, though
estimates using census data on children ever born and children surviving are available but are
inconsistent and not reliable. Hence this data is not presented in this report. The District Level
Household Survey (DLHS 2002-03) does not provide district level infant and child mortality estimates.
Thus no reliable estimate of infant and child mortality is available at the district level.
Low birth weight babies are at higher risk of the infant mortality. To avert the risk and provide timely
treatment it is necessary to identify these high risk babies by taking weight soon after birth and
provision of appropriate care. In the case of institutional deliveries, most of the babies are weighed
after birth. But in the case of home deliveries, it is not so. During this survey the birth weight of the
babies delivered at home has been captured to explore the process of weighing these babies under the
existing mechanism.
Incidence of weighing baby after birth is extremely rare in Rajasthan. Out of total home deliveries only
4 percent babies were reportedly weighed and out of them 93 percent mothers had a card with weight
recorded on it. In three cases there was no card available with them and neither could they recall the
baby‟s weight. Out of the 41 babies who had weight card 43 percent of them were low birth weight
baby with a birth weight below 2.5 kilograms . With 96 percent babies not weighed after birth in case of
home deliveries, raises a serious issue of Low-Birth Weight (LBW) babies not being identified and
given the importance it deserves.
Weighing machine is not working since last two years and nobody is ready to hear my
complaints. I cannot buy a machine from my pocket for the sake of job. If government will provide
machine then we are ready to take weight. Till now baby determined on the basis of size. –
ANM, Dausa (Rajasthan)
The information from FGD with ANM and in-depth interview with ANMs, ASHAs and Anganwadi
Workers revealed that most of them were equipped with weighing machine and weighed the babies in
order to identify LBW babies. Due to in-availability of weighing machine with all health personnel, a few
of them rely on the physical appearance to identify LBW babies, which is an inadequate method.
Certain steps like advising the pregnant mother regarding nutrition and exclusive breastfeeding are
also taken by these health personnel.
AVERAGE 304 74.7 15 60.0 340 71.0 38 57.6 320 72.1 50 75.8 964 72.5 103 65.6
CANNOT
THE 17 4.2 3 12.0 36 7.5 6 9.1 14 3.2 3 4.5 67 5.0 12 7.6
DEFINE
TOTAL 407 100.0 25 100.0 479 100.0 66 100.0 444 100.0 66 100.0 1,330 100.0 157 100.0
“Mahilayen baccho ka vajan lene se mana karti hain wo kehti hain ki vajan lene se
bacchon ka vajan ghatta hai” (Mothers in village believe that the weight of the child
decreases with weighing so they do not get their child weighted). ANM, Bharatpur
(Rajasthan)
5.5 Neonatal Checkups
First check of the baby after delivery is extremely crucial for overall assessment, exclusive
breastfeeding and appropriate care. The study has collected the information regarding first health
checkup, contact with care provider within ten days of birth and vaccination within one month of birth
for all babies either delivered at hospital or home. Average 47 percent respondents in the three districts
have reported first health checkup of the new-born within six hours of birth. Close to two fifth (41%) of
babies did not have contact with any health worker in first 10 days after birth for the state of Rajasthan.
The district with the lowest percent of new-borns with no contact with the health personnel for the first
ten days of life was Alwar. 60 percent of babies did have contact with any health worker in first 10 days
after birth and this includes around 50 percent babies who had contact with health personnel within the
first 24 hours after birth. The variation in these figures across the 3 study districts was minimal. Rural -
urban variation in this practice was not much evident.
District wise analysis indicates that across all the three districts the timing of first neonatal checkup
within 6 hours happens for less than one half of the interviewed mothers. It is highest for Bharatpur with
46.6 percent neonates receiving a check-up within 6 hours. The highest percent of neonates going
without check-up were found in District Alwar where 45 percent neonates were not checked within 6
hours.
Breastfeeding is one of the main pillars of newborn care. Educating mothers on correct breast-feeding
practices and child nutrition is an important component of newborn care. In this survey, the breast
feeding practices among the index children was explored.
Initiation of breastfeeding immediately after the birth is beneficial for both the infant as well as the
mother. About 98 percent women in Rajasthan had ever breastfed their child. Approximately 65
percent of the mothers received help from somebody in initiation of breastfeeding. District analysis
shows that in Alwar and Bharatpur greater number of women had received help in initiation of
breastfeeding as compared to Dausa.
Role of government doctors in initiation of breastfeeding was found to be very low with the highest
being 5 percent in Bharatpur. Around 36 percent of the mothers received support from nurse and
ANM/ASHA. Mother or mother-in-law, friends and relatives were responsible for initiation of
breastfeeding in about one-fourth of the mothers.
SAME DAY
IMMEDIATELY,
AFTER AN AFTER 3 STILL NOT
WITHIN AN HOUR OF 1-3 DAYS
HOUR OF DAYS BREASTFED
BIRTH…
BIRTH..…
% % % % %
It is quite clear from the above table that the gender of the child did not have any influence on the time
of initiation of breastfeeding.
Education does not come out to be a major determinant in initiation of breastfeeding as is evident from
the above table.
Around 36 percent women started breast feeding the child within one hour of delivery and another 44
percent started after one hour but on the same day. About 19 percent of the women started breast
feeding after the first day, and of these, 3.7 percent started after three days of birth. Initiation of breast
feeding within one hour of delivery, for girl child (44.7 percent) was lower than boys (55.3%) indicating
the gender preferences.
In Rajasthan around 65 percent of women have delivered in health institutions. In the health institutions
doctor/nurse/ANM attending on the delivery is expected to advise women to start breastfeeding
immediately after the birth of the child. However, in Rajasthan the percent of the women initiating
breastfeeding within one hour of childbirth is substantially less than the proportion of institutional
deliveries, suggesting that even in health institutions also early initiation of breastfeeding was not
ensured.
In-depth interview with ANMs, ASHAs and Anganwadi Workers revealed that the customary practices
for breastfeeding are not very prominent in the region, with mostly mothers not feeding colostrum to the
child after birth. Though; some of the ANMs revealed that they counsel women on breastfeeding
practices but the facts don‟t support these claims. ASHAs are more close to mothers than any other
health workers in rural areas and they counsel them on breast feeding practices like feeding colostrum
to the child, exclusive breast feeding up to six months, mother‟s milk enhances the immunity of the
child etc. but change in customary system will take some time. The role of Anganwadi Workers (AWW)
is quite limited to distribution of Supplementary Nutrition and gathering mothers and children for
Immunization at the Anganwadi Centre.
“Gramin logon ki manyata hai ki maan ka pratahm doodh bekar hota hai, isliye wo us
doodh ko nahi pilate” ( Rural people believe that the first milk is not of any use so they
discard that and do not feed that to child)… AWW, Dausa (Rajasthan).
“Maa ko salah dete hain ki bacche ko 6 mahine tak apna doodh pilaye aur koi dravya
ahaar na dein” ( We advice mothers to exclusively breastfeed child for 6 months and to
not give any other liquid)…ASHA, Lakshmangarh, Alwar (Rajasthan)
Exclusive breastfeeding is very important for the well being of child. But there are many prevalent
customary practices in the families and communities regarding giving prelacteal feeds. During this
survey we attempted to capture this practice.
It appears that about three fourth of the newborn babies were given some top milk (other than the
breast milk) before initiating breastfeeding. District wise analysis shows that around 17 percent of
children in Dausa, 13 percent in Alwar and 9 percent in Bharatpur were given milk other than their
mother‟s milk before initiation of breastfeeding. A sizable proportion of babies were given other liquids
like plain water, sugar water or local home made liquids before initiating breastfeeding. Very small
proportions (only 5 percent in Rajasthan) of babies were initiated on exclusive breastfeeding. In Alwar,
the prelacteal feeding practice is a little different from other two districts, with 37 percent of babies
being fed honey after birth. This may be due to the population composition and associated rituals.
Dausa leads the way with tea being given to 31 percent babies before initiating breastfeeding.
Exclusive breastfeeding up to six months after birth is required for the healthy growth of the baby.
Analysis below is based on the response of mothers whose child is above six months of age and
currently breastfeeding.
The situation is not very encouraging in Rajasthan with only 4.8 percent mothers exclusively
breastfeeding the child. In Districts Bharatpur has the highest percentage of approximately 11 percent
mothers who breastfeed their child exclusively. Among the infants aged more than 6 months,
approximately 45 percent children were exclusively breastfed up to 6 months after birth. District wise
analysis showing almost similar pattern; except in Bharatpur where this figure went greater than 50
percent (51.7).
Exclusivity of breastfeeding was not influenced by educational status of women, locality of residence of
women, birth order of the child or economic status of the family. But exclusive breastfeeding is highest
(42.8 percent) among young mothers (22 to 25 years of age) and lowest (0.4 percent among oldest
mothers (41 to 49 years of age).
The mothers who were not breastfeeding their child at the time of survey were asked about the period
of initiation of supplementary food to the child.
During the discussion with ASHA it was reveled that they prime activities performed by
her for the new born includes advising about breastfeeding and suggesting her to
breastfeed the child in one hour interval.
Some ASHAs also told that the people in their village follow some rituals like newborn
should not be breastfeed just after delivery, newborn should not take bath, outsiders
should not be allowed in the house, and child should be given sweet water.
Anganwadi workers were also interviewed about the awareness programs practices by
them for new born care. According to many of the AWW the programs are mainly aimed
to sensitize the mothers about colostrum feeding, exclusive breastfeeding for 6 months.
Development & Research Services Pvt Ltd Page 72 of 123
NIPI Baseline Survey report for the state of Rajasthan
CHAPTER – 6
Diarrhoea and Acute respiratory infections have been globally identified, as posing major threats to the
survival of children under the age of five. This is also true for India, where these two diseases, have
been the major causes behind infant mortality. Prevention as well as effective treatment of these
diseases depends on a host of individual, household and community level behavioral factors. One of
the objectives of this study is to estimate the role played by such factors in determining the utilization of
formal health care to cure diarrhea and certain respiratory illnesses plaguing newborn. The
Reproductive Child Health programme includes components like treatment of diarrhea and ARI and
health education to mothers on management of Diarrhea and danger signs of ARI. The paramedical
and medical staffs are trained to diagnose the cases of pneumonia among the children and treat the
cases of pneumonia and diarrhea. All the government health institutions are supplied with the
medicines necessary for the treatment of pneumonia and diarrhea. The major findings of the study are
as follows:
The table below presents that overall the diarrhoea point prevalence rate (at the time of the survey
contact) was 20.7 % while only cough is at 14%.
Around 21 percent of children were suffering from diarrhea at the time of survey. Diarrhea prevalence
was lowest among the children of Dausa during the survey period. About 17 percent of children were
suffering from fever, 14 percent from cough and 62 percent from both fever and cough during the
survey period.
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About 43.9 percent of the women whose child suffered from diarrhea in last two weeks were counseled
by ANM/health workers towards the treatment of the disease. The counseling was higher in Dausa
(50%) than the other two districts.
About two-third of the children who had suffered with diarrhea had received advice or treatment from
any source. District wise response is in line except Alwar, where only 58.8 percent of children had got
advice or treatment for diarrhea. Table 6.1 shows the places of diarrhea treatment in Rajasthan, which
are mainly private sources for around 38 percent children.
Those who had suffered from pneumonia; about 96 percent of them had consulted someone for the
treatment. Most common source of treatment was qualified doctors in case of more than three fourth
children followed by ANM / Nurse / LHV (14.8%) and Chemists (6.2%). Visit to qualified doctors for
treatment of pneumonia is prominent in urban areas as compared the rural counterparts .
As per DLHS-2, the percentage of children aged 0-35 months with diarrhoea during the two weeks
preceding the survey was 35.5 per cent in Bharatpur, 20 per cent in Dausa and 14.7 per cent in Alwar.
Number of children with diarrhoea treated with ORS was the highest in Alwar (43.3 per cent) followed
by Dausa (21.4 per cent) and Bharatpur (7.6 per cent). Data reveals that mothers in Alwar are relatively
well aware about the treatment of diarrhoea as compared to other two districts.
Treatment seeking behavior in case of fever/cough is quite common. Around 84 percent children with
fever/cough had taken advice or treatment from any source. Dausa had highest proportion (92.8%) of
children with fever/cough taking advice or treatment. Most (80.3%) of the children had received advice
or treatment after 2 days of start of symptoms. Major source of the advice or treatment for children with
fever/cough was private doctors in about 41 percent of cases followed by CHC/Rural hospital. Advice
or treatment from government sources was negligible
The following section shows the percentage of women who sought treatment whose child suffered from
diarrhoea and source of treatment, according to place of residence and availability of health facility in
program Districts.
Around 90 percent of the children had taken drugs for the illness. Bharatpur is showing the lowest
(80.3%) and Dausa is highest (97.3%) among the districts in taking medicines for the illness. Around
53.1 percent children had taken medicines for the fever next day of the occurrence followed by same
day (36.5%) and two days after fever (7.6%).
Around 90 percent of the mothers were aware about the danger signs of pneumonia in which about 45
percent were aware about wheezing/whistling followed by chest in-drawing (59%), rapid breathing
(46.5%), difficulty in breathing (67.3%) and pain in chest and productive cough (21.4%). Findings are
almost similar across the districts.
100
Aware about features of Pneumonia Wshistling
90 Chest indrawing Rapid breathing
Difficulty in breathing Pain in chest
80 Not able to take feed Others
70 Difficult to keep awake Condition gets worse than before
60
50
40
30
20
10
0
In majority of cases children were taken to a qualified doctor for treatment of Pneumonia, followed by
ANM/LHV.
6.3 Fever
6.3.1 Illness with fever and cough and treatment seeking behavior
Table 6.9: Incidence of fever and cough among children in last 2 weeks prior to survey contact,
NIPI-08
Alwar Bharatpur Dausa All NIPI Districts
Rural Urban Rural Urban Rural Urban Rural Urban Urban
% % % % % % N % N % N %
Yes 11.2 7.4 4.8 4.3 7.6 9.1 268 7.9 67 6.9 308 7.8
No 88.3 92.6 95.2 94.5 92.1 89.9 3124 91.9 895 92.4 3622 91.9
Total 100 100 100 100 100 100 623 100.0 172 100.0 724 100.0
Around 8 percent of children had suffered with fever and cough in two weeks prior to the survey in both
rural and urban areas. Among those who had fever and cough, around 41 percent children had it since
more than one week and 28 percent had been caught with it since last two days.
When it comes to medication, around 16 percent had faced problems in getting it form different
sources. The source of medication used for the treatment was qualified doctors in 55 percent cases
followed by chemists (22.4%) and ANM/Nurse/LHV (14.3%). Medicines from ANM/Nurse/LHV were
mainly sought in rural areas. The district of Bharatpur shows the highest percentage of consultation
with ANM/Nurse/LHV (32.8%) compared to the other two districts of Alwar and Dausa.
The children who had an illness with fever/cough, he/she did breathe faster than usual with short, rapid
breaths or have difficulty breathing in around 68 percent of cases. These symptoms were more in rural
areas than urban. Around 35 percent of children had problems of runny nose, 14 percent had problem
in chest and around 47 percent had both.
Treatment seeking behavior in case of fever/cough is quite common. Around 84 percent children with
fever/cough had taken advice or treatment from any source. Dausa had highest proportion (92.8%) of
children with fever/cough taking advice or treatment. Most (80.3%) of the children had received advice
or treatment after 2 days of start of symptoms. Major source of the advice or treatment for children with
fever/cough was private doctors in about 41 percent of cases followed by CHC/Rural hospital. Advice
or treatment from government sources was negligible.
“Aniyamit aur asantusht ahaar, bacchon mein bimari aur mrityu ke mukhya karan hai”
(Irregular and nutrition less diet are the main reasons of children that lead to morbidity
and mortality)…ANM, Rajasthan
For prevention of the child from the diseases like diarrhea, Malaria and pneumonia most (49.1%) of the
respondents were keeping the baby covered followed by using mosquito nets (9.5%) and using purified
drinking water (28.4%). A very small proportion (3.1%) of respondents used other methods to prevent
their child from these diseases.
Feeding practices during fever/cough shows that around half of the children given the same amount of
liquid to drink what they were taking prior to the illness followed by somewhat less (35%) than the
previous amount.
CHAPTER 7
IMMUNIZATION
7.1 Preamble
Universal immunization of children against the six vaccine preventable diseases (namely tuberculosis,
diphtheria, whooping cough, tetanus, polio and measles) is crucial for reducing infant and child
mortality. Differences in vaccination coverage among subgroups of the population are useful for
programme planning and targeting resources to areas most in need. Additionally, information on
immunization coverage is important for monitoring and evaluation of the Expanded Programmes on
Immunization (EPI).
NIPI Baseline Survey collected information on immunization coverage for all living children born during
two years‟ period preceding the survey. According to the guidelines developed by the World Health
Organization (WHO), Children are considered fully immunized when they have received a vaccination
against tuberculosis (BCG), three doses of diphtheria, whooping cough (pertussis), and tetanus (DPT)
vaccine; three doses of the poliomyelitis (polio) vaccine; and one dose of the measles vaccine by the
age of 12 months. BCG should be given at birth or at first clinical contact, DPT and polio require three
vaccinations at approximately 6, 10 and 14 weeks of age, and measles should be given at or soon after
reaching 9 months of age.
The immunization schedule for children is given in Table 7.1 presented below:
9 months Measles,
Yellow fever*
Evidently, there is a wide gap of 38% in the data based on vaccination card and recall method. While
as per vaccination cards about 24% children received the vaccination, as per recall approach the
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percentage of such children had been at the level of 62%. In order to have some degree of reliability
and accuracy in the study findings, the data based on vaccination cards constitute the service data of
the study.
The following section presents analysis of vaccination coverage given to children, aged one year or
more, for whom vaccination card was available.
Children who received BCG, measles and three doses each of DPT and polio (excluding polio 0) are
considered to be fully vaccinated. Based on information obtained from a card , 65% of children of age
12-23 months are fully vaccinated in Rajasthan, with all basic vaccines, with Dausa district showing
highest percentage of children (69%) receiving all basic vaccination and 3 percent (Rajasthan) who did
not receive any vaccination. Here Bharatpur (1.2%) has least percentage of no vaccination and Alwar
with highest percentage of 4.5 percent.
Coverage for BCG, DPT and polio (except polio 0) vaccinations is much higher than for “all
vaccinations”.
DPT and Polio vaccinations are given at the same time as part of the routine immunization programme.
The study also reveals that polio vaccine has coverage of about 81 percent children which is at par
with the percentage of children (80%) receiving DPT 3. Not all children who begin the DPT and polio
vaccination series complete them.
The incidence of Polio 1,2 and 3 having been given to the index child is very high and with little
variations across background variables. The difference between the percentages of children receiving
the first and third doses is almost 14 percentage points both for polio and DPT. Sixty seven percent of
children of age 12-23 months have been vaccinated against measles. The relatively low percentages of
children vaccinated with the third doses of polio, DPT and that of measles are mainly responsible for
the low proportion of children fully vaccinated.
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Vaccination for each type of vaccine is much higher in urban areas than in rural areas, which clearly
depicts the better services and low level of ignorance among people in former than the rural area. As
per general perception and also supported by NFHS survey, it has been found that boys receive better
services than their female counterparts. There are70 percent of boys against 57 percent girls who
received some vaccination. Barring few cases, boys have received more vaccines in comparison to
girls.
At the state level, in Rajasthan it has been found that the coverage of „any vaccination‟ and that of
„individual vaccination‟ is higher in case of the first child and it decreases with the increase in birth
order. In the families consisting of only one living child, the percentage of immunization for all basic
vaccines is 69 percent , where as it is found to be 47 percent for the families who had more than 6
children.
With the use of maternal health care services, a strong positive relationship exists between mother‟s
education and children‟s vaccination coverage. In Rajasthan not much difference is observed in the
level of immunization with respect to the level of education. On one side it is showing only 60 percent
immunization coverage for illiterate women which is quite acceptable as the ignorance level is high in
illiterate people, but when we see the mother‟s who has attained education of 5-7 or 10-12 years, the
immunization coverage of children remain at a lower level of around 61 percent.
Table 7.4 given below shows vaccination coverage rates for each recommended vaccination and the
percentage of girl or boy receiving that vaccine in the three study districts.
During discussion with ASHA it was revealed that their main responsibility is to check for
the complete immunization of children in the village. They consider immunization card as
the best means to ensure immunization of children. They also visit home to home for
checking and registering children for the immunization as registration is the best way to
keep a track of immunization of children in the village. To improve the immunization
coverage in their area the ASHAs take women and children every month to PHC/CHC for
immunization.
Discussion with AWW reveals that they consider immunization of mothers and children as
their main responsibility. They said that still there are many people who deny getting the
pregnant women and children vaccinated and for this AWW advice people by home visits,
spread information in the village, gather people at AWC and educate them.
Table 7.6: Coverage of Measles vaccine and Vitamin A by background variables, NIPI-08
MEASLES Vitamin A Total
N % N % N %
Alwar 93.051 63.3 73.941 50.3 147 100
Bharatpur 91 70 82.03 63.1 130 100
Dausa 103.95 69.3 84 56 150 100
RAJASTHAN 287.798 67.4 239.974 56.2 427 100
Sex of Child
Boy 182.979 72.9 149.094 59.4 251 100
Girl 105.072 59.7 90.992 51.7 176 100
Locality
RURAL 233.064 66.4 190.944 54.4 351 100
URBAN 55.024 72.4 49.02 64.5 76 100
Living Children
1 89.027 70.1 76.962 60.6 127 100
2 to 3 147.92 68.8 127.065 59.1 215 100
4 to 5 42.98 61.4 31.01 44.3 70 100
6+ 7.995 53.3 4.995 33.3 15 100
Education
No education 124.068 63.3 99.96 51 196 100
Below 5 4.998 83.3 3 50 6 100
5 to 7 41.984 65.6 38.976 60.9 64 100
8 to 9 60 75 51.04 63.8 80 100
10 to 11 27.016 61.4 20.02 45.5 44 100
12 & above 30.007 81.1 27.01 73 37 100
There are considerable variations in coverage of measles and Vitamin A, not only across Districts but
also across different background characteristics of the mother. The coverage of Measles vaccine and
Vitamin A in District Bharatpur is the highest from among all the districts. The difference in the
coverage does not vary significantly with the location of the PSU and no stark difference has been
observed.
During discussions with ANM they suggested for mobile vaccination to cater to larger mass
and increase the coverage area of immunization. ANM, Bharatpur (Rajasthan)
BCG
DPT 1, 2 and 3
OPV 1, 2 and 3
Measles
The above table shows the place at which most of childhood vaccinations received in program Districts
were other health facilities. About 6% of children were immunized at the government and municipal
hospital. Further, among the children immunized, 32% of them were immunized from the Sub Centre,
12% from Public Health Center and 8 % from Community Health Centre/ Rural hospital. The
percentage or children receiving vaccination from the Private hospital/clinic in the overall program
Districts is very low.
In all the three districts, there is considerable drop from the first to the third dose both for DPT and
polio, and in almost every district fewer children have received measles vaccines (highest drop out rate
of 34% is found in Alwar) than any of the other vaccinations except polio 0. There is not much
difference in the drop out rates of first dose of polio and DPT among districts. But a wide gap has been
administered between the first and third doses of polio and DPT. Alwar has shown the highest drop out
percentage of 15 percent in the first and the third dose of DPT and Bharatpur showed highest
percentage of drop out percentage(18%) in DPT 1 and DPT 3 cases.
The main reasons given by mothers for not giving any vaccination to the children ware as follows:
The study reveals that the immunization coverage in the three districts of Rajasthan is low and this
leads to high morbidity and mortality rates among infant and children in the state. Lack of awareness,
Ignorance and illiteracy among the mothers and population as a whole are some of the reasons which
lead to the low level of immunization of children. Of the three districts Alwar hold the bottom position in
vaccination coverage
Mev ki striyan bukhar ke dar se bacchon ko teeka nahi lagwati hain aur ghar ane se bhi
mana kar deti hain. ( Mothers do not prefer immunization because of the fear of fever and
they even tell AWW not to come to their home)….AWW, Dausa (Rajasthan)
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CHAPTER 8
In the hierarchical health care system of the Government of India in a district, the district hospital is the
apex body, which provides specialized health care services to people on subsidized costs. Every
district is expected to have a district hospital. The information collected and analyzed in this section
relates to 3 district hospitals of Rajasthan.
8.1.1 Infrastructure
Physical infrastructure was fair for all the three study district hospitals. All three had a designated
government building with 24 hour water supply. All the district hospitals had three phase electricity
connection and the standby facility in the form of generator was available in all the hospitals. All the
three district hospitals had functional toilet facility separately for male and female.
Telephone facility was available in all district hospitals but all section of the hospital does not had a
telephone facility in two hospitals. Personal Computers were also available in all District Hospitals. All
the DHs had at least one vehicle and one ambulance. 10 Ambulance were available for the 3 District
Hospitals in total.
All the District Hospitals also had an established Integrated Counseling and Testing Centre.
Residential Facility for Medical Superintendent was available in only one District Hospital and
Residence for Doctors and Specialist was available at two District Hospitals.
An aseptic and clean Labor Room was available in all District Hospitals and currently in use as well.
Delivery room was present in only 2 District Hospitals and in use as well. Neo-Natal room was present
in 2 District Hospitals but currently it was in use in only one District Hospital.
General Medicine Ward was available in all the District Hospitals with an average 60 number of beds in
each District Hospital. General Surgery Ward was also available in all District Hospitals with an
average of 56 beds in each District Hospital. Antenatal Care Ward and Post-partum Care Ward were
available in only one District Hospital with an average of 3 beds each. Postnatal Care Ward was
present in 2 District Hospitals with average 31 beds each.
All the District Hospitals had one Medical Superintendent in position. In total for all District Hospitals
there were at least one of the following available, i.e. 5 Specialist (Medicine), 6 Specialist (Surgery), 8
Obstetrician/Gynecologists, 6 Pediatricians, 2 Dermatologists, 6 Ophthalmologists, 25 General Duty
Doctors, 4 AYUSH physicians and 3 Blood Bank Officers.
No permanent Anesthetist was available at any of the District Hospitals. Only two District Hospitals had
the services of a contractual anesthetist. Only 2 District Hospitals had the services of a permanent
Pathologist and Radiologist was available only at one District Hospital.
There were 146 total nurses in position at the 3 District Hospitals. On an average each District Hospital
has 49 nurses available. There were 33 Nurses working in Obs-Gynae Department, averaging 11
nurses per District Hospital.
The Laboratory Services which were available at all the 3 District Hospitals were:
Urine and Stool Analysis, Sputum analysis, Tests for Blood Sugar, Blood Urea, Blood Creatinin,
Pregnancy. Coomb‟s test, WIDAL, ELISA, Rh factor, VDRL tests were also available. ECG, 2D-ECHO,
X-Ray, Ultrasound were also available at all District Hospitals. Fully operational blood bank and blood
donation facility was also available at all District Hospitals.
Hematology, Pap smear, Histopathology and Stress Test (TMT) were available only in one District
Hospital and a fully functional Physiotherapy Unit was also present in one District Hospital only.
In all the District Hospitals, there was availability of Obstetrician/Gynecologists for 24 hours. Nurse was
also available for 24 hours in Obs/Gynae Department in all the District Hospitals.
In all the 3 District Hospitals, OPD Services, Emergency Services (24 Hours), Referral Services were
available.
Separate room for Sterilization and X-Ray was also available in all the 3 District Hospitals.
All the three District Hospitals had MCH services like Antenatal care, Intranatal Care, Postnatal Care
and Newborn Care.
24-hour delivery services including normal and assisted deliveries and Emergency Obstetric Care
including C-section were available in all the District Hospitals.
All District Hospitals also provide Child care services including Immunization, MTP facility and facilities
under Janani Suraksha Yojana.
Medical Audits had been conducted in all the three District Hospitals. Rogi Kalyan Samiti (RKS) has
been established in all District Hospitals and also monitors the work regularly.
Monitoring and Supervision of activities of PHCs and SCs was also done through regular meetings in
all District Hospitals.
8.1.5 Equipment
Elective OT-Major was present in all District Hospitals. Only two District Hospitals had Emergency
OT/Family Welfare OT, ENT/Ophthalmology OT and Orthopedic OPD.
Phototherapy Unit, Emergency Resuscitation Kit for baby and Forceps Delivery Kit was available in all
the District Hospitals and all were functional as well.
Baby Incubator, Radiant warmer, Fetal Doppler, CTG Monitor and Delivery Kit were available at only 2
District Hospitals and were functional at all of them.
All the three District Hospitals provide Nutrition services, organize school health programmes,
HIV/AIDS control programmes.
Certain behavior change communication programmes were also organized by all District Hospitals.
Though not designated as such, community health centres are also first referral units where referral
cases from lower level health care establishments are sent. The CHCs have to take care of these
cases besides their usual health care activities. In three study districts of Rajasthan there were 4 CHCs
so the section deals with a total of 4 CHCs.
8.2.1 Infrastructure
A Designated government building was available for all 4 CHCs, and only 2 of them had 24 hour water
supply. Regular supply of electricity was available in only 2 CHCs and standby facility in the form of
generator was available in only one CHC. Only three CHCs had functional toilet facility with 2 of them
having facility separately for male and female.
Telephone facility was available in 3 CHCs. Personal Computers were available in 2 CHCs. Ambulance
was available in 3 CHCs.
Residential facility for General Surgeon was available in 2 CHCs. Only at one CHC residential facility
for the Physician and Obstetrician/Gynecologist was available.
There was less than the required number of Specialists available in all CHCs.
There was only one General Surgeon available in one CHC, 2 Physicians, 2
Obstetrician/Gynaecologists, one Anaesthetist and 10 General Medical Officers in total for all the
CHCs.
There was no Pediatrician and Eye Surgeon either in position or on contract in any of the CHCs.
2 Public Health Nurse were available, 7 ANMs in position with 3 ANM on Contractual basis and 3 Staff
Nurse in position.
At least one staff doctor/nurse/LHV/ANM at CHC was available for 24 hours in all the CHCs and a
Gynecologist and Anesthetist was available on call basis in emergency in only one CHC.
Training statistics for the Medical Officers of CHC in the last 5 years was as below:
2 Medical Officers had received training on Emergency Obstetric Care including C-Section and Mini
laprotomy training.
One MO had received Newborn Care training as well.
All the four CHCs surveyed had Labor Room and Operation theatre available at the CHC premises.
All the four CHCs had separate room for drug storage and separate waiting area for the patients in the
OPD of the CHC.
8.2.7 Laboratory
Operational Laboratory was present in 3 CHCs of Rajasthan. Blood storage facility was not available in
any of the CHCs.
Total number of functional beds available in all CHCs was 64 averaging 16 beds per CHC. There were
separate wards for males and females in all the CHCs.
8.2.9 Furniture/Instrument
Examination Table, Delivery table, Bedside Screens, B.P Instruments were available in all the CHCs.
Stretcher or Trolley was available in only 2 CHCs.
8.2.10 OT Equipments
Boyles Apparatus was available in all the CHCs. Oxygen Cylinder 660 liters with regulator and mask,
Emergency Drug tray and Normal Delivery kit were available in 3 CHCs.
Equipment for neo-natal resuscitation was available in 2 CHCs. IUD insertion kit was available in all the
CHCs.
Large and small deep freezers were available and also in functional condition in 3 CHCs. Walk in
coolers and freezers were also available in 2 CHCs.
All vaccines, namely BCG, DPT, OPV, DT, Tetanus Toxoid and Measles were available in all the CHCs
of the state.
IFA tablets, Vitamin A syrup, ORS packets was also available at all the CHCs. Tablets Cotrimaxazole
was also available at all the CHCs.
Essential Services like OPD services, 24 hour Emergency Services, Referral Services were available
in all the CHCs.
Blood Storage facility was not available at any of the surveyed CHCs.
All the four CHCs had MCH services like Antenatal care, Intranatal Care, Postnatal Care and Newborn
Care.
24-hour delivery services including normal and assisted deliveries was available in all the CHCs and
Emergency Obstetric Care including C-section was available in only 2 CHCs.
Child care services including Immunization were provided at 3 CHCs. MTP facility and facilities under
Janani Suraksha Yojana were being provided by all the CHCs surveyed.
The Primary Health Centres have the major responsibility of providing both preventive and curative
health care services in the area. This includes delivery of reproductive child health services, such as
antenatal care and immunization in addition to routine inpatient and out patient services. Compared to
DHs and Sub-divisional Hospitals, PHCs are accessible to a larger population. However, just the
availability of PHCs is not sufficient for the effective delivery of these services. They should also have
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essential infrastructure, staff, equipment and supplies. This section presents the status of the 18 PHCs
surveyed in three districts of Rajasthan with respect to the availability of selected infrastructure, staff,
equipment and supplies, besides training of medical and para-medical staff.
8.3.1 Infrastructure
In all the study districts of Rajasthan around 83 percent of the PHCs function from a designated
Government building.
In around 94 percent PHCs had functional toilet facility available in which 39 percent had separate
toilet for males and females.
Around 44 percent of PHCs in Rajasthan had tapped water supply and all the PHCs had regular water
supply in the form of Piped water, Tube/Bore Well and Hand Pump.
Around 6 percent of PHCs function without electricity. Those having electricity 16 percent of them had
regular power supply. Two-thirds of the PHCs had Occasional Power supply. Standby facility of
generator was available at around 28 percent of PHCs.
In around 72 percent PHCs labor room and in 33 percent of these Operation Theater was available and
same was functional as well.
About 83 percent PHCs telephone facility was available. 17 percent PHCs had personal computers in
which 6 percent had NIC terminal and 11 percent having access to internet facility.
6 percent PHCs had access to at least one vehicle for transporting patients during emergency.
Only 89 percent of PHCs had in-patient facilities. On an average 5 beds were available at the PHCs
where inpatient facility available. 28 percent PHCs had separate wards for male and female.
All the PHCs surveyed had an Examination Table available in the centre. 89 percent of them had a
Delivery Table and Bed-side Screen as well. Only 54 percent PHCs reported to having a Stretcher or
Trolley. Waiting bench for patients was available in 78 percent of the PHCs.
94 percent of the surveyed PHCs had one medical officer in position. While only 11 percent PHCs had
a lady medical officer.
94 percent PHCs having LHV/Health assistants in position and the same number of PHCs had
ANM/female health workers.
Less than half of the PHCs (44%) had male health assistants. But 94 percent PHCs had laboratory
technicians in position.
89 percent PHCs had organized at least one training programme in last one year.
The Main topics covered in these trainings were Pulse Polio, ASHA‟s training and training for
ANM/Male health workers.
The information collected from the Medical Officers (MO) regarding their training in the last five years
yielded the following information:
55 percent MOs had received training on Vector Borne Disease Control Programme, Directly Observed
Treatment-Short Course and Immunization.
About 50 percent MOs had received Reproductive Tract Infection/Sexually Transmitted Infection
(RTI/STI) training. One-thirds of the MOs were also trained in Integrated Management of Neo-natal and
Childhood Illnesses, Skilled Birth Attendant and Integrated Skill Development.
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94 percent PHCs were stocked with BCG, DPT, OPV, Measles and Tetanus vaccines. Diptheria-
Tetanus vaccine was available at 89 percent of the PHCs. All the PHCs had a regular supply of the
vaccines.
All the PHCs reported to having full stock of Iron Folic Acid (IFA) Tablets. Vitamin A syrup and Oral
Rehydration Solution (ORS) solution was available at 94 percent PHCs. 89 percent PHCs also had
Cotrimaxazole available. All the PHCs had a regular supply of the above-mentioned Prophylactic
Drugs.
8.3.5 Equipment
Normal Delivery Kits were available in 89 percent PHCs. 83 percent PHCs had a weighing machine.
Only one-fifth PHCs were equipped with Infant Resuscitation Bag with mask, Equipment for Assisted
Vacuum Delivery and Assisted Forceps Delivery.
In Cold Equipments, 90 percent of the PHCs had Small Deep Freezers and two-thirds had a Large
Deep Freezer. Vaccine Carriers were available in 94 percent of PHCs.
Two-thirds of the PHCs had Chemical for Hb estimation, Light and Binocular Microscope available.
94 percent PHCs were providing Out-Patient Department (OPD) Services to the patients and Referral
Services were being provided by 83 percent PHCs.
Ante-natal Care services and Medical termination of Pregnancy (MTP) services were available at 89
percent of the PHCs. 83 percent PHCs were providing Post-Natal and New born care services.
78 percent facilities also provided Intra-Natal Care and facilities under Janani Suraksha Yojana. Facility
for normal delivery for 24 hours was available at one-third PHCs and 44 percent PHCs also had Facility
for internal examination for gynecological conditions.
Sub-centers are most peripheral health institutions catering to the health care needs of the rural
population. It is the most peripheral contact point between the Primary Health Care system and the
community. It is manned by one multipurpose worker (male) and one multipurpose worker
(female)/ANM. This section presents the findings of 83 SCs from three districts of Rajasthan.
All the SCs had an ANM/Female Health Worker working on a regular basis. Only 12 percent SCs had a
Male Health Worker and an Additional ANM on a Contractual basis was present in less than 5 percent
SCs.
The ANM/Female Health Worker was asked about the Training received by them in the last 5 years.
The following information was obtained:
Integrated Skill Development Training for 12 days (RCH-1) was attended by 54 percent ANMs. Two-
third ANMs also attended training for Immunization and only one-third had attended IMNCI training.
Skilled Birth Attendant training was received by 57 percent ANMs.
The details of trainings received by Male Health Workers (MHW) were given below:
62.5 percent MHWs received training on Integrated Skill Development for 12 days (RCH-1). Training
on Immunization was imparted to 87.5 percent MHWs. Only one-fourth MHWs received training on
IMNCI.
A Designated Government building was available for the SC in 75 percent cases. In case of the SC
functioning in a non-government building, 60 percent such SCs were located in a society building and
one-fourth were located in a rented building.
Water Supply: Two-thirds of the SCs don‟t had a water supply at all. Out of the SCs with water supply,
45 percent had a Hand Pump and one-tenth had a well available. Only one-fourth SCs had 24 hour
water supply available.
Power Supply: 62 percent SCs do not had any electricity connection. In 29 percent SCs there was
only Occasional power supply, and only 7.5 percent SCs had regular power supply.
Toilet Facility: Only 40 percent SCs had a functional toilet facility available.
Communication Facility: Only one-fourth SCs (25.4 percent) had a Government provided Telephone
or Mobile facility.
In 15 percent cases it was found that the ANM was residing in the quarter attached to the SC.
Examination Table was available in 83.6 percent SCs and out of these it was functional in around 96
percent SCs. Labor Table was available in 42 percent SCs and functional in 78.6 percent of these SCs.
In 22.4 percent SCs Bedside screens were available, but were functional in only half of these SCs.
Instrument Sterilizer was available in 45 percent SCs and functional in 76.7 percent of these SCs. Auto
Disposable Syringes were available in 89.6 percent SCs and functional in 95 percent of these. Blood
Pressure Instrument was available in 95.5 percent SCs and functional in 93.8 percent of these SCs. An
Adult Weighing machine was available in 95.5 percent SCs and was functional in 90.6 percent of these
SCs. 91 percent SCs had Infant Weighing Machine, and it was functional at 95 percent SCs.
Haemoglobinometer was available at 60 percent SCs and functional at 70 percent of these. All the SCs
had Vaccine Carriers available but they were functional in only 98.5 percent of them.
Drug Kit-A was available in the majority of SCs i.e. 56.7 percent cases. 91 percent SCs had IFA tablets
available and Vitamin A Syrup was available with 86.6 percent ANMs.
ORS packets were available at 91 percent SCs and 64.2 percent SCs had Disposable Delivery Kits.
Only one-fifth SCs reported having a labor room and in these SCs 42.9 percent deliveries were carried
out in these Labor rooms.
88.1 percent SCs were visited by a Doctor at least once a month and in37.3 percent of these cases the
day and time of this visit is fixed. In 77.6 percent of cases the SC was visited by Health Assistant
(Male) or LHV at least once a week.
All the SCs provide Antenatal Care (TT, IFA tablets, Weight and B.P check). 24 hour facility for referral
of complicated cases of pregnancy/delivery was available at 44.8 percent SCs. In 73 percent cases the
ANM reported to had accompanied the woman in labor to the referred care facility at the time of
referral.
92.5 percent ANMs reported to had prepared the SC Plan for this year. All the surveyed SCs had
Registers, Reports and Immunization Cards in enough quantity and 91 percent had enough ANC
Cards.
In 90 percent of SCs Training of Traditional/Skilled Birth Attendants and ASHA was done. All the ANMs
reported to had co-ordinated their services with AWWs, ASHA, PRI and Village Health and Sanitation
Committee.
Proper maintenance of records and registers was being done by 97 percent of ANMs at their
respective SCs.
The scheme of ASHA was being implemented in 76 percent SCs.
ANNEXURE TABLES
N 100 100 100 100 100 100 100 100 100 100 100 100
Total
number 1,141 181 1,322 1,083 231 1,314 1,204 134 1,338 3,428 546 3,974
of HH
No
76 69% 334 57% 706 60% 701 71% 412 82% 30 100% 2259 67%
Education
<5 4 4% 27 5% 33 3% 25 3% 11 2% 0 0% 100 3%
5 to 7 8 7% 65 11% 135 12% 82 8% 23 5% 0 0% 313 9%
8 to 9 13 12% 60 10% 108 9% 58 6% 17 3% 0 0% 256 8%
10 to 11 10 9% 70 12% 154 13% 86 9% 20 4% 0 0% 340 10%
12 &
0 0% 29 5% 41 4% 36 4% 17 3% 0 0% 123 4%
Above
Total 111 100% 585 100% 1177 100% 988 100% 500 100% 30 100% 3391 100%
URBAN
Age of the Respondent(in Years)
Year of Total
15-18 19-21 22-25 26-30 31-40 41-49
Schooling
N % N % N % N % N % N % N %
No
8 67% 45 58% 70 47% 82 56% 44 73% 5 83% 254 56%
Education
<5 0 0% 6 8% 3 2% 2 1% 0 0% 0 0% 11 2%
5 to 7 1 8% 8 10% 13 9% 15 10% 5 8% 0 0% 42 9%
8 to 9 2 17% 7 9% 17 11% 15 10% 4 7% 0 0% 45 10%
10 to 11 1 8% 6 8% 28 19% 18 12% 3 5% 0 0% 56 12%
12 &
0 0% 6 8% 19 13% 14 10% 4 7% 1 17% 44 10%
Above
Total 12 100% 78 100% 150 100% 146 100% 60 100% 6 100% 452 100%
TOTAL
Age of the Respondent(in Years)
Year of Total
15-18 19-21 22-25 26-30 31-40 41-49
Schooling
N % N % N % N % N % N % N %
No
84 68% 379 57% 776 59% 783 69% 456 81% 35 97% 2513 65%
Education
<5 4 3% 33 5% 36 3% 27 2% 11 2% 0 0% 111 3%
7-May 9 7% 73 11% 148 11% 97 9% 28 5% 0 0% 355 9%
9-Aug 15 12% 67 10% 125 9% 73 6% 21 4% 0 0% 301 8%
11-Oct 11 9% 76 12% 182 14% 104 9% 23 4% 0 0% 396 10%
12 &
0 0% 35 5% 60 5% 50 4% 21 4% 1 3% 167 4%
Above
Total 123 100% 663 100% 1327 100% 1134 100% 560 100% 36 100% 3843 100%
No
6 14 20 17
education 98 16.4 140 18
Below 5 2 12.5 5 25 38 14 100 12
5-7 23 10.7 24 12.8 65 12 193 12
8-9 18 8.4 24 13.4 70 19 188 19
10-11 2 1.8 6 7.3 26 27 76 24
12 & above 20 15.4 15 17.6 1 20 6 33
Total
Residence
Rural 140 13 189 17 196 16 525 15
Urban 65 20 62 19 45 14 172 18
Total
Districts
JAHANABAD
Age of the
Respondent(in Number of Children Ever Born
Years)
1 2 3 4 5 6 7 8 9
N % N % N % N % N % N % N % N % N %
15-18 44 88% 5 10% 0 0% 0 0% 1 2% 0 0% 0 0% 0 0% 0 0%
19-21 143 60% 65 27% 24 10% 5 2% 1 0% 0 0% 1 0% 0 0% 0 0%
22-25 99 23% 160 38% 106 25% 39 9% 14 3% 5 1% 1 0% 2 1% 0 0%
26-30 26 7% 53 14% 101 27% 86 23% 42 11% 45 12% 13 4% 2 1% 1 0%
31-40 6 4% 7 4% 30 17% 33 19% 40 23% 21 12% 19 11% 9 5% 4 2%
41-49 1 17% 0 0% 0 0% 0 0% 1 17% 0 0% 2 33% 0 0% 2 33%
Total 319 25% 290 23% 261 21% 163 13% 99 8% 71 6% 36 3% 13 1% 7 1%
NALANDA
Age of the Number of Children Ever Born
Respondent(in
Years) 1 2 3 4 5 6 7 8 9
N % N % N % N % N % N % N % N % N %
15-18 18 64% 8 29% 1 4% 0 0% 1 4% 0 0% 0 0% 0 0% 0 0%
19-21 116 58% 53 27% 23 12% 4 2% 1 1% 0 0% 2 1% 0 0% 0 0%
22-25 141 30% 154 32% 104 22% 54 11% 9 2% 10 2% 1 0% 2 0% 1 0%
26-30 27 7% 85 22% 114 29% 78 20% 53 14% 20 5% 2 1% 5 1% 2 1%
31-40 1 1% 8 4% 19 10% 28 14% 36 18% 49 25% 22 11% 21 11% 8 4%
41-49 1 7% 0 0% 0 0% 0 0% 2 13% 2 13% 4 27% 2 13% 1 7%
Total 304 23% 308 24% 261 20% 164 13% 102 8% 81 6% 31 2% 30 2% 12 1%
Sheikhpura
Age of the Number of Children Ever Born
Respondent(in
Years) 1 2 3 4 5 6 7 8 9
N % N % N % N % N % N % N % N % N %
15-18 32 71% 11 24% 2 4% 0 0% 0 0% 0 0% 0 0% 0 0% 0 0%
19-21 116 52% 77 34% 24 11% 6 3% 0 0% 0 0% 1 0% 1 0% 0 0%
22-25 113 27% 130 31% 103 24% 52 12% 18 4% 6 1% 0 0% 2 1% 0 0%
26-30 35 9% 63 17% 85 23% 92 25% 50 13% 33 9% 11 3% 3 1% 1 0%
31-40 5 3% 3 2% 17 9% 21 11% 48 26% 34 18% 22 12% 23 12% 5 3%
41-49 0 0% 1 7% 1 7% 1 7% 5 33% 2 13% 2 13% 1 7% 1 7%
Total 301 24% 285 22% 232 18% 172 14% 121 10% 75 6% 36 3% 30 2% 7 1%
About the same 22 43% 1 25% 11 20% 3 43% 33 28% 4 36% 37 29%
more 4 31% 2 4% 0 0% 4 7% 0 0% 10 9% 0 0% 10 8%
Don't know 1 2% 0 0% 5 9% 0 0% 6 5% 0 0% 6 5%
Total 13 100% 51 100% 4 100% 54 100% 7 100% 118 100% 11 100% 129 100%
Food given to eat during Diarrhoea
Much less 2 15% 3 6% 0 0% 13 24% 0 0% 18 15% 0 0% 18 14%
Some less 6 46% 21 41% 1 25% 16 30% 4 57% 43 36% 5 46% 48 37%
About the same 1 8% 18 35% 1 25% 11 20% 1 14% 30 25% 2 18% 32 25%
more 1 8% 3 6% 0 0% 5 9% 0 0% 9 8% 0 0% 9 7%
ANM/ASHA/LHV 1 4% 0 0% 1 2% 0 0% 1 2%
Nurse 2 10% 0 0% 2 4% 0 0% 2 4%
Friends/Relatives/
0 0% 1 25% 0 0% 1 13% 1 2%
Family Memebers
Others 3 15% 0 0% 1 4% 0 0% 4 8% 0 0% 4 7%
Total 3 100% 20 100% 4 100% 25 100% 4 100% 48 100% 8 100% 56 100%
Place of getting ORS
ASHA 0 0% 1 25% 1 4% 0 0% 1 2% 1 13% 2 4%
ANM 1 5% 0 0% 1 4% 0 0% 2 4% 0 0% 2 4%
Govt.Dispencery 1 4% 0 0% 1 2% 0 0% 1 2%
UHC / UHP /
1 4% 0 0% 1 2% 0 0% 1 2%
UFWC
PHC 1 5% 0 0% 1 2% 0 0% 1 2%
Some
23 28% 0 0% 75 38% 16 52% 59 52% 12 71% 157 40% 28 56% 185 42%
what less
About
20 25% 0 0% 100 51% 11 36% 22 19% 2 12% 142 36% 13 26% 155 35%
the same
More 11 14% 2 100% 7 4% 0 0% 6 5% 0 0% 24 6% 2 4% 26 6%
Nothing
10 12% 0 0% 5 3% 1 3% 8 7% 0 0% 23 6% 1 2% 24 5%
to Drink
Don't
6 7% 0 0% 4 2% 1 3% 2 2% 1 6% 12 3% 2 4% 14 3%
Know
Total 81 100% 2 100% 198 100% 31 100% 114 100% 17 100% 393 100% 50 100% 443 100%
Quantity of food given during illness
Much
14 17% 0 0% 8 4% 1 3% 33 29% 3 18% 55 14% 4 8% 59 13%
Less
Some
26 32% 0 0% 72 36% 18 58% 52 46% 10 59% 150 38% 28 56% 178 40%
what less
About
19 24% 0 0% 80 40% 5 16% 14 12% 1 6% 113 29% 6 12% 119 27%
the same
More 5 6% 2 100% 8 4% 1 3% 2 2% 0 0% 15 4% 3 6% 18 4%
Stopped
3 4% 0 0% 5 3% 1 3% 4 4% 0 0% 12 3% 1 2% 13 3%
food
Never
gave 12 15% 0 0% 21 11% 5 16% 7 6% 3 18% 40 10% 8 16% 48 11%
food
Don't
2 3% 0 0% 4 2% 0 0% 2 2% 0 0% 8 2% 0 0% 8 2%
know
Total 81 100% 2 100% 198 100% 31 100% 114 100% 17 100% 393 100% 50 100% 443 100%
TWO DAYS
11 10 1 5.3 5 12.2 1 7.7 5 5.7 2 7.1 21 8.8 4 6.7 21 7.6
AFTER NFEVER
THREE DAYS
1 0.9 1 2.4 2 0.8 2 0.7
AFTER FEVER
FOUR OR MORE
DAYS AFTER 2 1.8 1 2.4 1 1.1 4 1.7 4 1.4
FEVER
DON‟T KNOW 1 5.3 1 2.4 1 0.4 1 1.7 2 0.7
Total 110 100 19 100 41 100 13 100 88 100 28 100 239 100 60 100 277 100
Rajasthan India
NFSH- NFSH- NFSH- NFSH- NFSH-
NFSH- 2(1998- 1(1992- 2(1998- 2(1998- 1(1992-
Indicator 3(2005) 99) 93) 99) 99) 93)
Children under 3 years breastfed 17.15 4.8 7.9 26.5 15.8 9.5
within one hour of birth(%)
Children age 0-5 months exclusively 27.4 53.7 65.9 43.3 25.3 23.2
breastfed(%)
India 20 49 96 49 44 51 43 3
Rajasthan 28.4 58.1 54.4 39.7 2.4 49 43.9 3.3
Alwar 23.6 57.6 51.7 45.4 2.8 36.7 55 8.3
Bharatpur 22.1 45.4 56 34.4 0.6 43.2 44.3 1.1
Dausa 24.6 54.2 45.9 50.4 3.3 50 48.8 1.3
Note: 1. This index is expresses in standard deviation units (SD) from the median pf the international reference
population.2 includes children who are below –3 SD from the international reference population median.3 children aged
0-71 months. * Based on districts surveyed in Phase 1 of DLHS-RCH (2002-04)
A22-A34
District Hospitals
Table A33: AVAILABILITY OF LABOUR WARD AND NEO NATAL EQUIPMENT FOR NURSERY
WARD
Rajasthan
AVAILABLE
Yes Number FUNCTIONAL
Baby incubator 2 10 8
Phototherapy unit 3 6 6
Emergency resuscitation kit baby 3 8 8
Radiant warmer 2 4 4
Room warmer 2 3 3
Foetal doppler 2 4 4
CTG monitor 2 4 3
Delivery Kit 2 30 30
Episiotomy Kit 1 10 10
Forceps delivery Kit 3 5 5
Crainotomy 1 1 1
Vaccume extractor metal 1 2 2
Silastic vaccum extractor 1 2 2
N=3
A34 – A55
Community Health Centres (CHC)
Yes
Telephone facility available in CHC 3
CHC has intercom facility 4
Whether CHC has Personal Computer 2
NIC Terminal available at CHC 4
Access to internet facility available at CHC 4
Ambulance 3
Jeep 1
Car 0
CHC have access to vehicle for transporting
3
patients during emergency
N=4
Yes
Prominent display boards regarding service
3
availability in local language at CHC
Separate registration counter in CHC 4
Pharmacy for drug dispensing and drug storage
2
at CHC
Any suggestion / complaint box kept at CHC 1
OPD rooms / cubicles at CHC 4
If yes number of OPD room 8
Separate waiting area in OPD for patients at
4
CHC
Minor OT in the CHC 4
Injection Room and Dressing Room in the CHC 4
Emergency Room / Casualty room in the CHC 2
Patient Services 4
Total Number of functional beds in each CHC 64
Separate wards for males and females there in
4
the CHC
Number of functional beds for Male 27
Number of functional beds for Female 30
Number of functional Pediatric beds 12
N=4
Yes
IFA Tablets 4
Vitamin A Solution 4
ORS Packets 4
Contramaxazol 4
N=4
Rajasthan
Yes
Nutrition services 3
School Health programmes 4
Promotion of safe water supply and basic
4
sanitation
Disease surveillance and control of epidemics 4
HIV/AIDS control programmes 4
Rogi Kalyan Samiti (RKS) monitor your work
3
regularly
Monitoring and supervision of activities of Sub-
4
Centres and PHCs through regular meetings
N=4
A56 – A64
Primary Health Centres (PHC)
Available 5 7 6 18
Examination Table
Functional 5 6 6
Available 4 6 6 16
Delivery Table
Functional 3 6 6
Available 5 6 5 16
Bed Side Screen
Functional 5 6 5
Available 5 7 5 17
Saline stand
Functional 5 6 5
Available 1 3 3 7
Wheel chair
Functional 1 3 3
Available 2 5 3 10
Stretcher on trolley
Functional 1 5 3
Available 1 4 4 9
Oxygen trolley
Functional 0 4 3
Available 0 2 2 4
Height measuring stand
Functional 0 2 2
Available 3 5 6 14
Dressing trolley
Functional 2 5 6
Available 1 2 2 5
Mayo trolley
Functional 1 1 2
Available 2 1 3 6
Instrument cabinet
Functional 2 1 3
Available 2 3 3 5
Instrument trolley
Functional 2 3 3
Available 4 6 5 15
Instrument tray
Functional 4 6 4
Available 5 5 5 15
Wooden table
Functional 5 5 5
Available 3 1 2 6
Swab rack
Functional 3 1 1
Available 5 5 4 14
Waiting bench for patient
Functional 5 5 4
Available 3 4 2 9
Medicine cabinet
Functional 3 4 2
Available 1 2 0 3
Side rail
Functional 1 2 0
N=18
Available 3 5 3 11
Kit A Drugs (sub-centre)
Functional 3 5 3
Available 2 5 3 10
Kit B Drugs (sub-centre)
Functional 2 5 3
Available 0 4 2 6
Kit C Equipments (sub-centre)
Functional 0 4 2
Available 2 1 3 6
Kit D Equipments (PHC)
Functional 2 1 3
Available 1 5 1 7
Kit of Essential obstetric care drugs (PHC)
Functional 1 5 1
A:New Born Care:
Available 1 3 0 4
Infant resuscitation bag with mask
Functional 1 3 0
Available 4 6 5 15
Weighing machine
Functional 4 6 5
Available 1 3 0 4
Paddle operated suction machine
Functional 1 3 0
Available 0 3 0 3
Mounted lamp with bulb
Functional 0 3 0
Available 0 4 1 5
Baby Bassinet
Functional 0 4 1
B: Other Equipments
Available 3 7 6 16
Normal Delivery Kit
Functional 3 7 6
Available 0 4 0 4
Equipment for assisted vacuum delivery
Functional 0 4 0
Available 0 4 0 4
Equipment for assisted forceps delivery
Functional 0 4 0
Equipment for New Born Care and Neonatal Available 0 5 0 5
Resuscitation Functional 0 5 0
Standard Surgical Set (for minor procedures like Available 1 5 3 9
episiotomies stitching) Functional 1 5 3
Available 0 4 0 4
Equipment for Manual Vacuum Aspiration
Functional 0 4 0
Available 0 1 0 1
Baby warmer/incubator.
Functional 0 1 0
N=18
A65 – A76
Sub Centers (SC)
N=83
Integrated skill development training for LAST 5 YRS 68.2 56.5 36.4 53.7
12 days (RCH-I) EVER 42.9 20.0 35.7 32.3
Directly Observed Treatment Short
LAST 5 YRS 86.4 65.2 90.9 80.6
course (DOTS) training
LAST 5 YRS 81.8 78.3 40.9 67.2
Immunization training
EVER 33.3 73.3 48.1
Intra Uterine Device (IUD) Insertion LAST 5 YRS 71.4 63.6 47.4 61.3
training EVER 42.9 25.0 66.7 48.1
Integrated Management of Neonatal and LAST 5 YRS 9.1 78.3 13.6 34.3
Childhood Illnesses (IMNCI) training EVER 10.0 20.0 5.3 9.1
LAST 5 YRS 59.1 56.5 54.5 56.7
Skilled Birth Attendant training
EVER 11.1 0 0 3.4
EVER-Vector Borne Disease Control
EVER 14.3 5.6 18.8 12.5
Programme (VBDCP) training
N=83
Integrated skill development training for LAST 5 YRS 50.0 66.7 66.7 62.5
12 days (RCH-I) EVER 100.0 100.0 100.0 100.0
Vector Borne Disease Control LAST 5 YRS 100.0 33.3 66.7 57.1
Programme (VBDCP) training EVER 0 100.0 100.0 100.0
Directly Observed Treatment Short
LAST 5 YRS 50.0 66.7 66.7 62.5
course (DOTS) training
LAST 5 YRS 50.0 100.0 100.0 87.5
Immunization training
EVER 0 100.0 100.0 66.7
Intra Uterine Device (IUD) Insertion LAST 5 YRS 0 33.3 66.7 37.5
training EVER 50.0 0 0 20.0
Integrated Management of Neonatal and LAST 5 YRS 0 66.7 0 25.0
Childhood Illnesses (IMNCI) training EVER 100.0 100.0 100.0 100.0
N=83