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BASELINE SURVEY ON

CHILD AND RELATED


MATERNAL HEALTH CARE

Revised Report – ORISSA

Prepared For:

Norway India Partnership Initiative,


New Delhi

Client Contact:

Mr P.K. Hota

TNS Consultant:
Sandeep Ghosh
TNS India Private Limited
7th Floor, Block 4-B
DLF Corporate Park, DLF City
Phase –III, MG Road
Gurgoan 122002
India
e: sandeep.ghosh@tns-global.com

Project No: 193318

August , 2009
NIPI Baseline Report – Orissa

CONTENTS
Page No.

Baseline Summary Indicators viii – ix

Chapter 1 Introduction 1

1.1 Background of NIPI 1


1.2 Research Objectives 2
1.3 Study Phases 2
1.4 Study Area 2
1.5 Ongoing health related programs in Orissa 2
1.6 Profile of Orissa and NIPI Districts 3
1.6.1 Profile of Orissa 3
1.6.2 Profile of Angul District 6
1.6.3 Profile of Jharsuguda District 8
1.6.4 Profile of Sambalpur District 10
1.7 Survey Design 12
1.7.1 Sampling strategy at District level 12
1.7.2 Sample size determination for NIPI Baseline survey 12
1.7.3 Sampling procedure 13
1.8 Quantitative and Qualitative instruments 14
1.8.1 Quantitative data collection 14
1.8.2 Qualitative data collection 15
1.9 Recruitment, Training and Field work 17
1.9.1 Recruitment of the field staff 17
1.9.2 Translation of the questionnaires and pre-testing 17
1.9.3 Field Training & Data collection Manuals 17
1.10 Quality assurance processes adopted during baseline field survey 18
1.10.1 Quality assurance processes adopted during the training 18
1.10.2 Productivity and on field scrutiny 18
1.10.3 Role of Supervisor 18
1.10.4 Quality assurance visits by the central teams 18
1.10.5 Monitoring visits by NIPI team 19
1.10.6 Other quality control measures 19
1.11 Data Processing 19
1.12 Report Structure 20

Chapter 2 Household Characteristics 21

2.1 Household demographic profile 21


2.2 Socio-economic profile of household 23
2.3 Education level of the household population 24
2.4 Household characteristics 26
2.5 Household possessions 29
2.6 Funds Allocation and Utilisation 32

Chapter 3 Characteristics of Survey Respondents 34

3.1 Background characteristics 34


3.2 Exposure to mass media 35
3.3 Employment Status 36
3.4 Age at marriage and first cohabitation 37

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NIPI Baseline Report – Orissa

Chapter 4 Maternal Health 39

4.1 Preamble 39
4.2 Antenatal Care 39
4.2.1 Pregnancy registration and ANC provider 39
4.2.2 Timing and number of ANC 42
4.2.3 Components of Antenatal Care 43
4.2.4 Health problems and treatment seeking behaviour during pregnancy 46
4.3 Delivery Care 49
4.3.1 Influence of background characteristics choice of place of delivery 50
4.3.2 Arrangement and cost of transport 52
4.3.3 Institutional delivery 52
4.3.4 Janani Suraksha Yojana (JSY) 55
4.3.5 Training and capacity building of ASHA‘s 56
4.3.6 Home deliveries 58
4.4 Postnatal care 63
4.5 Maternal Mortality 64

Chapter 5 Newborn Care 65

5.1 Preamble 65
5.2 Infant Mortality 65
5.3 Child Mortality 65
5.4 Birth weight 66
5.5 Neonatal checkups 67
5.6 Breastfeeding and supplementation 68

Chapter 6 Child Morbidity and Treatment 73

6.1 Prevalence of illness in children under study 73


6.1.1 Point prevalence of diarrhea and illness 73
6.1.2 Period prevalence of child morbidity 74
6.1.3 Awareness of Diarrheoa 74
6.1.4 Treatment of Dirrahoea 75
6.2 Acute Respiratory Infection 76
6.2.1 Knowledge about pneumonia 76
6.3 Fever 77
6.3.1 Illness with fever and cough and treatment seeking behaviour 77
6.3.2 Feeding practices during illness with fever/cough 78
6.3.3 Care seeking practices during illness with fever 79

Chapter 7 Child Immunization 81

7.1 Preamble 81
7.2 Vaccination coverage 81

Chapter 8 Status of Health Facilities 88

8.1 Introduction 88
8.2 Status of District hospital (DHs) 88
8.2.1 Physical Infrastructure 88
8.2.2 Staff in Position 88
8.2.3 Laboratory facility and other infrastructure at District hospital 88
8.2.4 Availability of Beds 88
8.2.5 Operation Theater 89
8.2.6 Neonatal equipments and Nursery services 89

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NIPI Baseline Report – Orissa

8.2.7 Emergency Obstetric Care and MCH facility 89


8.3 Status of Community Health Centre (CHCs) 89
8.3.1 Infrastructure 89
8.3.2 Staff Position 89
8.3.3 Training 90
8.3.4 Equipment 90
8.3.5 MCH services 90
8.3.6 IPH standards 90
8.4 Status of Primary Health Centre (PHCs) 90
8.4.1 Physical Infrastructure/facilities 90
8.4.2 Staff position 91
8.4.3 Operation Theater and Labour room 91
8.4.4 Equipment (Drug Kits) 91
8.4.5 Furniture 91
8.4.6 IPH Standards 91
8.5 Status of Sub Centre (SCs) 92
8.5.1 Coverage of SCs 92
8.5.2 Staff 92
8.5.3 Training 92
8.5.4 Regular Supply of Contraceptives and Vaccines 92
8.6 Health Management Information System 92
8.7 Funds Allocation and Utilisation 93

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NIPI Baseline Report – Orissa

LIST OF TABLES
Page No.

Table 1.1: Key Health Indicators of the State 4


Table 1.2: Coverage by Target Group and Research Technique (State Level) 16
Table 1.3: Coverage by Target Group and Research Technique (District Level) 16
Table 1.4: Coverage by Target Group and Research Technique (Block level) 16
Table 1.5: Achieved sample 19
Table 1.6: Achieved sample for facility survey 19
Table 1.7: Achieved sample for Qualitative, 20
Table 2.1: Percent distribution of household population by age, sex and residence, All NIPI 21
districts, Orissa , NIPI-08
Table 2.2: Percent distribution of household population by age, sex and residence, District 22
Angul, Orissa, NIPI-08
Table 2.3: Percent distribution of household population by age, sex and residence, District 22
Jharsuguda, Orissa, NIPI-08
Table2.4: Percent distribution of household population by age, sex and residence, District 23
Sambalpur, Orissa, NIPI-08
Table 2.5: Household Composition, NIPI-08 23
Table 2.6: District wise percent distribution of household population by religion & caste/tribe, 24
and mean household size, Orissa, NIPI-08
Table 2.7: Household family size by religion, NIPI-08 24
Table 2.8: Education attainment by gender of household member in terms of years of 25
schooling, NIPI-08
Table 2.9: Education attainment by location of PSU in terms of years of schooling, NIPI-08 25
Table 2.10:Type of house, NIPI-08 26
Table 2.11:Source of drinking water, NIPI-08 26
Table 2.12:Drinking water storage and filtration practices, NIPI-08 27
Table 2.13:Sanitation facility, NIPI-08 28
Table 2.14:Cooking environment, NIPI-08 29
Table 2.15:Ownership of immovable assets, NIPI-08 29
Table 2.16:Main source of household income, NIPI-08 30
Table 2.16a:Household Wealth Index, NIPI-08 32
Table 2.17:Bank account, NIPI-08 32
Table 3.1: Age distribution of women respondents, NIPI-08 34
Table 3.2: Distribution of women respondents by Religion and ethnicity, NIPI-08 34
Table 3.3: Education status of women respondents, NIPI-08 35
Table 3.4: Media habits, NIPI-08 35
Table 3.5: Frequency of exposure, NIPI-08 36
Table 3.6: Employment status of eligible women by background characteristics, NIPI-08 37
Table 3.7: Membership in SHGs and mahila mandals, NIPI-08 37
Table 3.8: Age at first cohabitation, NIPI-08 38
Table 3.9: Relationship between age of first cohabitation and education and economic status of 38
respondent, NIPI-08
Table 4.1: Percentage of pregnancies registered vs. key background variables, NIPI-08 39
Table 4.2: Received ANC Card, NIPI-08 40
Table 4.3: Incidence of receiving ANC during last pregnancy, NIPI-08 40
Table 4.4: Place of ANC, NIPI-08 41
Table 4.5: ANC provider, NIPI-08 41
Table 4.6: Number of ANC received and timing of ANCs received, NIPI-08 43
Table 4.7: Proportion of eligible women having received different components of ANC care, 44
NIPI-08
Table 4.8: Nature of ANC service received, NIPI-08 44
Table 4.9: TT injections vs. number of ANCs, NIPI-08 46
Table 4.10: Knowledge about health problems during pregnancy, NIPI-08 46

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NIPI Baseline Report – Orissa

Table 4.11: Incidence of health problems during pregnancy, NIPI-08 47


Table 4.12: Nature of health problems faced during last pregnancy, NIPI-08 48
Table 4.13: Percentage of women who sought advice for heath problem during pregnancy, 48
NIPI-08
Table 4.14: Person persuaded for treatment during pregnancy 48
Table 4.15: Place of delivery v/s age of respondent, NIPI-08 50
Table 4.16: Place of delivery v/s years of schooling, NIPI-08 51
Table 4.17: Place of delivery v/s number of live children, NIPI-08 51
Table 4.18: Place of delivery v/s economic status of respondents‘ household, NIPI-08 51
Table 4.19: Average transportation expenses, NIPI-08 52
Table 4.20: Nature of Institutional delivery, NIPI-08 52
Table 4.21: Cost incurred in institutional delivery, NIPI-08 53
Table 4.22: Problem experienced during delivery by women of different age groups, NIPI-08 53
Table 4.23: Nature of advice received after delivery by source, NIPI-08 53
Table 4.24: Mothers perception about environment of health facility and behaviour of staff, 54
NIPI-08
Table 4.25: Awareness about JSY, NIPI-08 55
Table 4.26: Number of ASHA‘s trained 57
Table 4.27: Accompaniment of ASHA during Institutional delivery 57
Table 4.28: Duration of stay of the mother at health facility after delivery 58
Table 4.29: Reason for home delivery 58
Table 4.30: Home delivery practices 60
Table 4.31: Person who conduct delivery at home 61
Table 4.32: Reasons behind choosing a specific person to conduct the delivery 61
Table 4.33: The delivery process 62
Table 4.34: Cost incurred in home delivery 62
Table 4.35: Nature of advice received 63
Table 4.36: Timings of first postnatal care 63
Table 4.37: Number of times PNC received 64
Table 4.38: Maternal Mortality in Orissa and India 64
Table 5.1: Trends in Infant Mortality Rate of Orissa and India 65
Table 5.2: Trends in Under Five Mortality Rate for Orissa and India 66
Table 5.2a: Recorded weight of baby 66
Table 5.2b: Mother‘s perception about adequacy of size of newborn 67
Table 5.3: Timing of first neonatal check-up 67
Table 5.4: Time of first neonatal check-up by Districts 68
Table 5.5: Breastfeeding practices 68
Table 5.6: Initiation of breastfeed and gender of child 69
Table 5.7: Initiation of breastfeed and education of mother 70
Table 5.8: Initiation of breastfeed and number of live children including index child 70
Table 5.9: Feeding of prelacteal liquids 70
Table 5.10: Period of exclusive breastfeeding by background variables 71
Table 6.1: Prevalence of illness in children under study 73
Table 6.2: Prevalence of illness in children under study 73
Table 6.3: Point prevalence of child morbidity 74
Table 6.3a: Period prevalence of diarrhoea 74
Table 6.4: Advice received from ANM or health worker 75
Table 6.5: Place of treatment 75
Table 6.6: Proportion of mothers aware of the term pneumonia 76
Table 6.7: Prevalence of ARI during 2 Weeks prior to survey 77
Table 6.7: Treatment of pneumonia 77
Table 6.8: Incidence of fever and cough among children in last 2 weeks prior to survey contact 77
Table 6.9: Duration of treatment sought during illness 78
Table 7.1: Percent of households having vaccination cards on the day of survey, NIPI-08 81
Table 7.2: BCG and Polio ‗0‘ coverage by background variables, NIPI-08 82
Table 7.3: Polio vaccine coverage by background variables 83

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NIPI Baseline Report – Orissa

Table 7.4 : Child Immunisation Coverage in NIPI Districts, Orissa 83


Table 7.5: DPT vaccine coverage by background variables 84
Table 7.6: Coverage of Measles vaccine and Vitamin A by background variables 84
Table 7.6a: Immunization coverage – all basic vaccines 85
Table 7.7: Place of immunisation received 86
Table 7.8: Problems faced by mother/community in vaccinating the child 86
Table 7.9: Dropout rate 87

LIST OF FIGURES Page No.

Figure 4.1: Registration of pregnancies by type of facility 40


Figure 4.1a: Percent of Mothers who received three or more antenatal checkups 42
Figure 4.2: Percent of Mothers who consumed IFA for 90 days and Received 2 or more TT 43
during Pregnancy
Figure 4.3 : Institutional delivery and births assisted by health personnel 49
Figure 4.4 Place of Delivery 50
Figure 5.1 Time of Initiation of Breastfeeding 69
Figure 6.1: Type of practices followed if child gets diarrheoa 74
Figure 6. 2: Awareness of symptoms of pneumonia 76
Figure 6.3: Preventive measures taken for avoiding child sickness 79

ANNEXURE Page No.

A1: Household possession – NIPI Districts 95


A2: Type of health schemes- NIPI Districts 96
A3: Education Attainments vs age of respondent 96
A4: Frequency of reading a newspaper or magazine vs. key background variables 96
A5: Frequency of listening to the radio vs. key background variables 97
A6: Frequency of watching television vs. key background variables 98
A7-Employment Status 98
A8 Children ever born vs. age of mother 99
A9 Treatment seeking behaviour 100
A10 Diarrhea practices 101
A11Quantity of food and drinks taken while having fever 102
A12- Advice received from sources & duration of treatment for illness 103
A13- Child having health problem during illness 103
A14- Problems faced during availing treatment for illness 104
A15- Medicines taken during illness 104
A16 – Money spent on treatment while having illness 105
A17 : Child Feeding Practices and Nutritional Status of Children 105
A18:Indicators of Nutritional Status in Orissa and NIPI Districts, DLHS- RCH, 2002-03 105
A19: Funds distribution by district (April 2005-Dec2007) 106
A20: Fund s Utilisation status as on 31.12.07 -Angul 106
A21: Fund Utilisation Status as on 31.12.07 –Sambalpur 107
A22: Funds Utilisation Status as on 31.12.07 - Jharsuguda 107
District Hospitals (A22-A23)
A22: Availability of human resource (clinical) 108
A23: Availability of human resource (paramedic) 108
A24: Investigative and Laboratory services 108
A25: Physical Infrastructure 109
A26: Waste Disposal 109
A27: Communication Facilities 109
A28: Residential Facility For The Medical Staff 110
A29: Other Physical Facilities 110
A30: Wards And Beds 110

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NIPI Baseline Report – Orissa

A31: OT Equipments 110


A32: Delivery Suit Unit 111
A33: Labour Ward And Neo Natal Equipment For Nursery Ward 111
Community Health Centres (A34-A55)
A34: Availability Of Clinical Human Resource (Clinical) 112
A19: Availability Of Para Medical 112
A20: Training For MO 113
A21: Training Of Para Medical Staff 113
A22: Investigative Facility 113
A23: Physical Infrastructure 114
A24: Waste Disposal 114
A25: Communication Facilities 114
A26: Residential Facility For The Medical Staff 115
A27: Labour Room And Operation Theatre 115
A28: Storage Facilities 115
A29: Laboratory 115
A30: Physical Facilities 116
A31: Furniture / Instrument 116
A32: OT Equipments 117
A33: Laboratory Equipments 117
A34: Cold Equipments 118
A35: Vaccine 118
A36: Prophylactic Drugs 118
A37: Essential Services 118
A38: MCH Services 119
A39: Other Functions And Services 119
Primary Health Centres (A40- A50)
A40: Availability Of Human Resource 120
A41: Type Of Training Received In 5 Years 120
A42: Training Received In Last 5 Years 120
A43: Special skill training received in last 5 years 121
A44: Availability Of Physical Infrastructure 122
A45: Electricity, Toilet And Waste Disposal Availability 122
A46: Communication, Quarters, Operation Theatres Facility 122
A47: Physical Facilities 123
A48: Availability Of Selected Furniture/ Instrument 123
A49: Availability Of Equipments 124
A50: Availability Of Services 126
Sub Centres (A51 – A59)
A51: Availability of Staff at Sub-center District wise 126
A52: Training attended by SC staff 126
A53: Furniture available at sub center 129
A54: Availability of Equipment 129
A55: Availability of Essential Kits (with equipments) 130
A56: Labour room availability 131
A57: Availability of specific service & Other Services 131
A58: Monitoring and Supervision activity 132
A59: Maternal and Newborn Deaths in the sub center area 132

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NIPI Baseline Report – Orissa

FACT SHEETS

District: ANGUL
Baseline Summary Indicators
Indicator Total %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 563 52.3
Mothers who had at least 3 Ante-Natal Care visits during the last pregnancy 670 62.3
Total number of deliveries (home plus institutional) 1161
Institutional deliveries 760 65.5
Average Retention period (hours) in case of institutional delivery 51
Post natal care provided to mother and neonates - Children had check-up within 24 hours after delivery 327 28.2
(based on last live birth)
Post natal care provided to mother and neonates -Children had check-up within 10 days after delivery 433 37.3
(based on last live birth)
Mothers who received post natal care within 48 hours of delivery of their last child 116 10.0
Referral done for mothers with illness and complications during pregnancy 232 73.7
Children with Diarrhoea in the last two weeks who received ORS 32 50.8
Children with Diarrhoea in the last two weeks who were given treatment 47 74.6
Children with acute respiratory infection/fever in the last two weeks who were given treatment 78 54.2
Children (age 6 months above) exclusively breastfed 270 30.6
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 229 60.9
New born Babies immunized with zero dose polio and BCG 192 51.1
New born Babies – breastfed within 1 hour of birth 684 59.2
Newborn with birth weight taken after delivery at home 24 6.0

District: SAMBALPUR
Baseline Summary Indicators
Indicator Total %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 617 53.5
Mothers who had at least 3 Ante-Natal Care visits during the last pregnancy 938 81.1
Total number of deliveries (home plus institutional) 1176
Institutional deliveries 920 78.2
Average Retention period (hours) in case of institutional delivery 78
Post natal care provided to mother and neonates - Children had check-up within 24 hours after 615 52.3
delivery (based on last live birth)
Post natal care provided to mother and neonates -Children had check-up within 10 days after delivery 803 68.3
(based on last live birth)
Mothers who received post natal care within 48 hours of delivery of their last child 535 45.5
Referral done for mothers with illness and complications during pregnancy 407 87.2
Children with Diarrhoea in the last two weeks who received ORS 48 54.5
Children with Diarrhoea in the last two weeks who were given treatment 73 83.0
Children with acute respiratory infection/fever in the last two weeks who were given treatment 103 57.5
Children (age 6 months above) exclusively breastfed 408 47.8
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 350 77.6
New born Babies immunized with zero dose polio and BCG 253 56.1
New born Babies – breastfed within 1 hour of birth 788 67.9
Newborn with birth weight taken after delivery at home 58 22.7

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NIPI Baseline Report – Orissa

District: JHARSUGUDA
Baseline Summary Indicators
Indicator Total %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 553 47.4
Mothers who had at least 3 Ante-Natal Care visits during the last pregnancy 986 84.6
Total number of deliveries (home plus institutional) 1186
Institutional deliveries 907 76.5
Average Retention period (hours) in case of institutional delivery 63
Post natal care provided to mother and neonates - Children had check-up within 24 hours after delivery (based 453 38.2
on last live birth)
Post natal care provided to mother and neonates -Children had check-up within 10 days after delivery (based 637 37.5
on last live birth)
Mothers who received post natal care within 48 hours of delivery of their last child 210 17.8
Referral done for mothers with illness and complications during pregnancy 231 83.1
Children with Diarrhoea in the last two weeks who received ORS 51 53.1
Children with Diarrhoea in the last two weeks who were given treatment 69 94.6
Children with acute respiratory infection/fever in the last two weeks who were given treatment 85 55.9
Children (age 6 months above) exclusively breastfed 411 48.2
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 377 84.2
New born Babies immunized with zero dose polio and BCG 192 42.9
New born Babies – breastfed within 1 hour of birth 767 65.2
Newborn with birth weight taken after delivery at home 123 45.4

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NIPI Baseline Report – Orissa

Chapter 1
Introduction
1.1 Background of NIPI

As per the Millennium Development 4 Goals (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 rate to 38 per 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)

Efforts of Norway India Partnership Initiative

For India‘s success in achieving Millennium Development Goal four (MDG 4), Norway-India
Partnership Initiative (NIPI) is collaboration 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 immunisation 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

 Strengthening the National Rural Health Mission, by supporting an independently


managed enabling network and facilitating delivery of MDG-4 related services
 Testing and introduction of new ways of scaling up quality services by community health
workers (ASHAs) at the village level in the five states including their support needs and
referral requirements
 Involving the private sector in the delivery of MDG 4 related services at all levels
 Exploring and providing upfront catalytic financial and strategic support for new
opportunities under the NRHM-MDG-4 related activities

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NIPI Baseline Report – Orissa

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

1.2 Research Objectives

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

1.3 Study Phases

This current baseline study comprises of three phases, viz.,

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
3 Dissemination of study findings and summary report generation

The Phase 1 of NIPI Baseline survey was conducted during the year 1998 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 Orissa.

1.4 Study Area

In this baseline survey, the data were collected from the three NIPI focus Districts; Angul,
Jharsuguda and Sambalpur and relevant information from the State level. The Districts selected
by NIPI in consultation with the State NRHM for implementation of the interventions.

1.5 Ongoing health related programs in Orissa

In order to improve the implementation of several child and related maternal health activities,
certain programs are ongoing programs currently such as of Janani Suraksha Yojana, Janani
Express, Yashoda, Mamta Divas, Pustikar Diwas and IMNCI (Integrated Management of
Neonatal Childhood) program.

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NIPI Baseline Report – Orissa

1.6 Profile of Orissa and NIPI Districts

1.6.1 Profile of Orissa

Orissa is a state located on the east coast of India, by the Bay of Bengal. It was established on 1
April 1936 as a province in British India and consists predominantly of Oriya speakers. 1 April is
therefore celebrated as Utkal Divas (Orissa Day).

Orissa is the ninth largest state by area and the eleventh largest by population. Oriya is the
official and most widely spoken language. Orissa has a relatively unindented coastline (about 480
km long) and lacks good ports, except for the deepwater facility at Paradip. The narrow, level
coastal strip, including the Mahanadi River delta supports the bulk of the population. The interior
of the state is mountainous and sparsely populated.

Orissa is predominantly an agricultural state, although it has been changing rapidly. Paddy is the
main crop of the state. Other crops, including pulses, oil seed, jute, mustard, turmeric and
sugarcane, are also extensively cultivated. Orissa is one of the maritime states of India, and it has
a long coastline.

According to the 2001 Census, Orissa had a population of 36.7 million, accounting for 4 percent
of the total population of India. Population density is lower in Orissa than in India as a whole (236
compared with 325 persons per square kilometre).

There are 30 Districts in Orissa —In Orissa, three Districts namely Angul, Jharsuguda and
Sambalpur are selected by NIPI for specific intervention programs.

The following chart provides a view of the trend of gross state domestic product of Orissa at
market prices estimated by Ministry of Statistics and Programme Implementation, GoO with
figures in millions of Rupees.

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NIPI Baseline Report – Orissa

Year Gross State Domestic Product


1980 37,080
1985 68,230
1990 109,040
1995 271,180
2000 387,280

Orissa's gross state domestic product for 2004 is estimated at $18 billion in current prices.
Following India's independence, Orissa has not been a focus of investment by the central
government, causing its infrastructure and educational standards to lag behind the rest of the
nation. For instance, only about 20% of the road network is paved. In rural areas over 65% of the
population have no access to safe drinking water.

Orissa is connected to India through roads, railways, airports, and seaports. Bhubaneswar is well
connected by air, rail and road with the rest of India. The Biju Patnaik airport is being expanded to
accommodate wide bodied aircraft.

According to the 2001 census of India, the total population of Orissa is 36,706,920, of which
18,612,340 (50.89%) are male and 18,094,580 (49.11%) are female, or 972 females per 1000
males. This represents a 16.25% increase over the population in 1991. The population density is
236 per km² and 85.01% of the people live in rural areas and 14.99% live in urban areas.
34,726,129 of the population are Hindu, 897,861 are Christian, 761,985 are Muslim, 17,492 are
Sikhs, 9,863 are Buddhist, and with the remainder belonging to other religions.

The literacy rate is 63.61% with 75.95% of males and 50.97% of females being literate. The
proportion of people living below the poverty line in 1999–2000 was 47.15% which is nearly
double the all India average of 26.10%. Scheduled Castes and Tribes form 16.53% and 22.13%
of the population state, constituting 38.66% of the State population.

Data of 1996–2001 showed the life expectancy in the state was 61.64 years, higher than the
national value of years. The state has a birth rate of 23.2%, a death rate of 9.1 %, an infant
mortality rate of 65 per 1000 live birth and a maternal mortality rate of 358 per 1,00,000 live births
. Orissa has a HDI of 0.579 in 2004.

Table 1.1: Key Health Indicators of the State

Birth Rate SRS-2003 23


SRS-2004 22.7
SRS-2005 22.3
Trends in Fertility (TFR) N.F.H.S.-I 2.9
N.F.H.S.-II 2.5
N.F.H.S.-III 2.4
Trends in Contraceptive Prevalent Rate N.F.H.S.-I 36%
N.F.H.S.-II 47%
N.F.H.S.-III 51%
Contraceptive Prevalence Rate (Modern Methods) N.F.H.S.-I 35%
N.F.H.S.-II 40%
N.F.H.S.-III 45%
Trend in Contraceptive Prevalence Rate N.F.H.S.-I 3%
Modern Spacing Methods (IUD, Pills and Condom) N.F.H.S.-II 5%
N.F.H.S.-III 11%
Women with 2 Children Who Want No More Children (%) N.F.H.S.-I 61%
N.F.H.S.-II 69%
N.F.H.S.-III 82%
Women with 2 Daughters Who Want No More Children N.F.H.S.-I 33%
(%) N.F.H.S.-II 35%
N.F.H.S.-III 53%

4
NIPI Baseline Report – Orissa

ANC registration-Trend in Antenatal Care (Any)-% of N.F.H.S.-I 64%


women who received ANC N.F.H.S.-II 81%
N.F.H.S.-III 87%
Trend in Antenatal Care (3 ANC visits)-% of women who N.F.H.S.-I 35%
received 3 ANC visits N.F.H.S.-II 48%
N.F.H.S.-III 61%

Trends in Institutional N.F.H.S.-1 14% (2004-05 CNAA 37%


Delivery Report)
N.F.H.S.-2 23% (2005-06 CNAA 37%
Report)
N.F.H.S.-3 39% (2006-07 CNAA 46.3%
Report)
Trends in Vaccination Coverage N.F.H.S.-I 36%
N.F.H.S.-II 44%
N.F.H.S.-III 52%
Percentage of Children Age 12-23 Months Received BCG N.F.H.S.-I 63%
N.F.H.S.-II 85%
N.F.H.S.-III 84%
Percentage of Children Age 12-23 Months Received 3 N.F.H.S.-I 57%
Polio N.F.H.S.-II 68%
N.F.H.S.-III 65%
Percentage of Children Age 12-23 Months Received N.F.H.S.-I 40%
Measles N.F.H.S.-II 54%
N.F.H.S.-III 67%
Percentage of Children Age 12-23 Months Received 3 N.F.H.S.-I 56%
DPT N.F.H.S.-II 62%
N.F.H.S.-III 68%
Immunization Coverage (% of children age 12-23 months N.F.H.S.-I 36%
received BCG+3 Polio+3 DPT+ Measles) N.F.H.S.-II 44%
N.F.H.S.-III 52%
N.F.H.S.-II 48%
N.F.H.S.-III 41%

Infant Mortality Rate (I.M.R.)


SRS NFHS
2003 83 N.F.H.S.-I 112
2004 77 N.F.H.S.-II 81
2005 75 N.F.H.S.-III 65

Complete ANC
N.F.H.S.-I 35%
N.F.H.S.-II 48%
N.F.H.S.-III 61%

Safe Delivery
(2004-05 CNAA Report) 86%
(2005-06 CNAA Report) 86%
(2006-07 CNAA Report ) 88.39%

Post Natal Check-up


N.F.H.S. – III 38%

(Maternal Mortality Rate) MMR


Year Orissa India
SRS-1998 367 407
SRS-2003 358 301

5
NIPI Baseline Report – Orissa

1.6.2 Profile of Angul District

Angul District is a centrally located District in the state of Orissa. This District covers a
geographical area of 6232 square kilometers and is situated in the central part of Orissa.

Angul District is the site for many big


industries like National Aluminum
Company (NALCO), Mahanadi
Coalfields Limited (MCL), National
Thermal Power Corporation (NTPC),
Heavy water Plant, Talcher, Indian
Aluminum Product Ltd. The District of
Angul also provides proper education
to all the inhabitants. Several schools,
colleges, technical and medical
institutions are established in this
District to help the locals derive
maximum benefits out of it. The District
covers a geographical area of 6232
square kilometers and supports a
population of about 11.40 lakhs. It is
although new but strategically most
advanced District because it gives
highest return of revenue to the Government due to vast coal mines located within its boundaries.

The District has a a population of 11,39,341 as per 2001 census (Males - 5,86,903, Females -
5,52,438) with a population density of 179 per km². Angul, the District headquarters is about 150
kilometers from the state capital Bhubaneswar. It is situated on the National Highway No 42,
making it well accessible from all parts of the state.
The District Head Quarter Hospital (DHH) at Angul, three sub-divisional hospitals at Talcher,
Athamallik & Pallahara, one UGPHC, one CHC, 27 PHCs (N) cater to the health care need of the
people. There are also nine Ayurvedic & eight Homeopathic dispensaries.

Public Sector Units working in the District, namely NALCO, MCL & NTPC also have their own
health institutions, which mostly cater to their employees. NALCO has established one hospital.
NTPC has established two hospitals, one at Kaniha & the other at Talcher. MCL has established
one Hospital and eight dispensaries at Talcher coalfields. Rengali Multi Purpose Project (RMP)
authorities maintain two hospitals, one at Rengali & the other at Samal.

A Zilla Swasthya Samittee (ZSS) has been formed under the chairmanship of the Collector for
management and development of Medical wing and oversee implementation of National Health
Programmes. A scheme called five diseases treatment scheme (Panchabyadhi) started in July
2002 to cover five most common diseases namely Respiratory Tract Infection, Malaria, Scabies,
Leprosy & Diarrhoea. All medicines required for treatment of these diseases is provided free of
cost at govt. health institutions.

Reproductive & Child Health (RCH) Program is being implemented in this District since 1994.
One health sub centre has been established for every 5000 population in rural area.
Immunization, registration of pregnancy, care of pregnant women, popularization of family welfare
measures, & measures for reduction of infant mortality are some of the important activities under
RCH care. All these services are provided through health sub-centre. Registration of birth is done
at PHC level. Apart from routine immunization activities, pulse polio Immunization is being done
in a campaign made on National immunization Days since 1995. Vit ―A‖ supplementation
campaign is being done since March 1999.

6
NIPI Baseline Report – Orissa

FACT SHEET, DISTRICT - ANGUL, ORISSA


DLHS – 2 DLHS – 3 Baseline
Indicators (2002 – 04) (2007 – 08) (2008 – 09)
Maternal Health: Total Rural Total Rural Total Rural
Mothers registered in the first trimester when they were
- - 57.3 53.3 52.3 50.5
pregnant with last live birth/still birth (%)
Mothers who had at least 3 Ante-Natal Care visits
51.2 44.4 60.4 55.4 62.3 59.5
during the last pregnancy (%)
Mothers who got at least one TT injection when they
78.6 75.8 91.2 89.7 99.9 99.7
were pregnant with their last live birth / still birth (%) #
Institutional births (%) 37.1 29.4 40.7 35.4 65.5 63.3
Delivery at home & other places assisted by a
8.0 6.0 11.5 11.3 - -
doctor/nurse /LHV/ANM(%)
Mothers who received post natal care within 48 hours of
- - 97.9 97.4 10.0 10.1
delivery of their last child (%)
Child Immunization and Vitamin A supplementation:
Children (12-23 months) fully immunized (BCG, 3 doses
53.6 57.2 62.0 60.5 60.9 60.1
each of DPT, and Polio and Measles) (%)
Children (12-23 months) who have received BCG (%) 89.0 89.9 97.3 97.0 98.4 98.1
Children (12-23 months) who have received 3 doses of
64.1 68.6 85.6 85.1 88.8 88.2
Polio Vaccine (%)
Children (12-23 months) who have received 3 doses of
72.6 73.6 74.9 73.3 88.8 87.9
DPT Vaccine (%)
Children (12-23 months) who have received Measles
70.9 69.3 89.2 89.0 62.5 61.6
Vaccine (%)
Children (9-35 months) who have received at least one
- - 78.3 80.5 - -
dose of Vitamin A (%)
Children (above 21 months) who have received three
- - 29.1 30.8 - -
doses of Vitamin A (%)
Treatment of childhood diseases (children under 3
years based on last two surviving children)
Children with Diarrhoea in the last two weeks who
62.2 51.1 49.1 49.3 50.8 51.8
received ORS (%)
Children with Diarrhoea in the last two weeks who were
64.1 68.7 62.4 62.0 74.6 73.2
given treatment (%)
Children with acute respiratory infection/fever in the last
- - 48.0 44.8 54.2 51.8
two weeks who were given treatment (%)
Children had check-up within 24 hours after delivery
- - 22.2 18.3 28.2 25.5
(based on last live birth)(%)
Children had check-up within 10 days after delivery
- - 21.7 20.2 37.3 34.8
(based on last live birth) (%)
Child feeding practices (Children under 3 years)
Children breastfed within one hour of birth (%) - - 47.5 43.8 59.2 -
Children (age 6 months above) exclusively breastfed
- - 24.9 24.8 30.6 -
(%)
Children (6-24 months) who received solid or semisolid
- - 87.6 87.3 - -
food and still being breastfed (%).
Problems faced during pregnancy (% of Mothers) - - - - 27.1 28.5
Post Delivery Retention Period of Mother at Health
- - - - 19.3 18.4
Facility (average in hours)
Age at first cohabitation / Average age of marriage - - - - 18.6 18.5

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NIPI Baseline Report – Orissa

1.6.3 Profile of Jharsuguda District

Jharsuguda is a District in Orissa with Jharsuguda town as its headquarter. This region is rich in
coal and other mineral reserves. Of late, many small and medium scale iron and steel units have
been set up in the vicinity of Jharsuguda town, giving impetus to the industrial growth of the
District.

The District comprises five blocks,


primary being Lakhanpur,Kolabira
,Laikera,Kirmira and Jharsuguda.
Jharsuguda District has three
urban agglomerations,
municipalities of Jharsuguda town
and (Brajrajnagar) and
municipality of Belpahar.

Brajrajnagar is an industrial town,


being of the prime location for
Open Cast Coal Mine of
Mahanadi Coalfields Limited.
Brajrajnagar also boasts of a large
scale paper mill, i.e., Orient Paper
Mills of the Birla Group of
Industries. However, this mill has
been defunct for more than a
decade now

During the re-organisation of the Garhajat States in 1936 under the British, Jharsuguda formed a
st
part of Sambalpur District. The new District of Jharsuguda came into existence on 1 April, 1994
and was created by amalgamation of the er stwhile Jamindars of Rampur, Kolabira, Padampur &
Kudabaga; Jharsuguda Town is the head quarters of the new District.

As of 2001 India census, Jharsuguda had a population of 75,570. Males constitute 52% of the
population and females 48%. It has an average literacy rate of 69%, higher than the national
average of 59.5%: male literacy being 77% and female literacy at 60%. It is a one of the rich
Districts in mineral wealth, especially coal and is one of the most industrialized Districts of Orissa.

Jharsuguda town is situated at the Western end of Orissa on the State High way No. 10. It is
situated at a distance of 515 K.M. from Calcutta and 616 Km. from Nagpur.

Jhasuguda is a new District, which came into existence on 1st April-94. Previously the District HQ
Hospital was a Sub-Divisional Hospital under the erstwhile-undivided Sambalpur District. All the
constraints common to a new Districts persists here as well.

There is one Dist. Headquarter Hospital, 4 old PHCs and 14 new PHCs and 2 CHCs. There is
one government hospital at Belpahar and 63 SCs.

There are 3 other hospitals under the Health department and 4 more outside the purview of the
H&FW Department, viz.
 E.S.I. Hospital, Brajrajnagar
 O.S.A.P. Hospital, Jharsuguda
 E.S.I. Dispensary, Jharsuguda
 Railway Hospital, Jharsuguda

8
NIPI Baseline Report – Orissa

FACT SHEET, DISTRICT - JHARSUGUDA, ORISSA


DLHS – 2 DLHS – 3 Baseline
Indicators (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 live birth/still birth (%) - - 49.9 38.9 47.4 37.3
Mothers who had at least 3 Ante-Natal Care visits
during the last pregnancy (%) 56.3 55.4 65.8 64.4 84.6 82.7
Mothers who got at least one TT injection when they
were pregnant with their last live birth / still birth (%) # 93.3 92.8 97.3 99.1 99.6 99.8
Institutional births (%) 37.2 25.8 65.1 57.8 76.5 75.1
Delivery at home & other places assisted by a
doctor/nurse /LHV/ANM(%) 37.2 39.6 40.7 40.0 - -
Mothers who received post natal care within 48 hours
of delivery of their last child (%) - - 94.0 91.8 17.8 15.1
Child Immunization and Vitamin A
supplementation:
Children (12-23 months) fully immunized (BCG, 3 71.1 67.8 78.3 75.9 84.2 87.9
doses each of DPT, and Polio and Measles) (%)
Children (12-23 months) who have received BCG (%) 95.4 94.6 97.9 98.2 98.4 99.0
Children (12-23 months) who have received 3 doses 84.5 84.2 88.4 85.3 96.0 97.6
of Polio Vaccine (%)
Children (12-23 months) who have received 3 doses 84.5 84.2 82.1 78.6 96.0 97.2
of DPT Vaccine (%)
Children (12-23 months) who have received Measles 78.0 77.7 93.7 94.5 86.2 89.7
Vaccine (%)
Children (9-35 months) who have received at least - - 78.3 76.2 - -
one dose of Vitamin A (%)
Children (above 21 months) who have received three - - 30.5 24.9 - -
doses of Vitamin A (%)
Treatment of childhood diseases (children under 3
years based on last two surviving children)
Children with Diarrhoea in the last two weeks who 50.2 55.9 52.2 60.5 53.1 50.8
received ORS (%)
Children with Diarrhoea in the last two weeks who 72.0 81.3 53.0 63.7 71.9 73.8
were given treatment (%)
Children with acute respiratory infection/fever in the - - 67.0 80.4 55.9 52.4
last two weeks who were given treatment (%)
Children had check-up within 24 hours after delivery - - 49.3 46.5 38.2 32.1
(based on last live birth)(%)
Children had check-up within 10 days after delivery - - 46.1 46.8 53.7 49.2
(based on last live birth) (%)
Child feeding practices (Children under 3 years)
Children breastfed within one hour of birth (%) - - 48.0 52.5 65.2 -
Children (age 6 months above) exclusively breastfed
- - 46.5 54.2 48.2 -
(%)
Children (6-24 months) who received solid or - - 91.8 95.5 - -
semisolid food and still being breastfed (%).
Problems faced during pregnancy (% of Mothers) - - - - 23.4 18.7
Post Delivery Retention Period of Mother at Health - - - - 32.7 32.3
Facility (average in hours)
Age at first cohabitation / Average age of marriage - - - - 19.5 19.5

9
NIPI Baseline Report – Orissa

10
NIPI Baseline Report – Orissa

In addition, there are 3 Public Sector undertaking hospitals, viz. Central Hospital, M.C.Ltd, Ib
Thermal Hospital and Rampur Colliery Hospital. The TATA group also has a hospital called the
Tata Refractories Hospital.
The same health programs running in Angul District are running here as well. A snapshot of the
health status of Jharsuguda district is given below.

1.6.4 Profile of Sambalpur District

Sambalpur is a municipality in the western region of Orissa. It is the headquarters of Sambalpur


District. Sambalpur derives its name from that of the Goddess Samaleswari; an incarnation of
Shakti, who is regarded as the reigning deity of the region. Sambalpur lies at a distance of 321
km from the capital city of Bhubaneswar.

Sambalpur District lies between 20 40 N and 22 11 N latitude, 82 39 E and 85 15 E longitude with


a total area of 6,702 Sq. Km's. As of 2001 India census, Sambalpur had a population of 154,164.
Males constitute 52% of the population and females 48%. Sambalpur has an average literacy rate
of 66%, higher than the national average of 59.5%: male literacy is 74%, and female literacy is
58%. The place is famous for its globally renowned textile bounded patterns and fabrics; locally
known as Baandha. In the past Sambalpur has been a great centre of diamond trade. Apart from
textiles, Samabalpur has a rich tribal heritage and fabulous forestlands.

Sambalpur serves as the gateway to the beautiful Western part of Orissa. It is the divisional head
quarters of the Northern administrative division of the State - also a very important commercial
and Educational center. Presently, Sambalpur is the break-bulk city between the states of
Chhattisgarh and Orissa.

Most of the villages of the District are inaccessible during the rainy season. Presence of a number
of nallas without bridges cuts off the villages from the nearby roads. The District is served by
National Highway No.6, National Highway No.42, Major District roads and a section of South
Eastern Railways. Rural electrification has been extended to 63.6% of the villages of the District.
Telecommunication Network is not adequate to cater to the needs the people in the rural areas.
Drinking water facilities are available in villages mostly from the sources of tubewells.

The health infrastructure available with the District is as follows:


District Headquarters Hospital - 1
Sub-divisional Hospital - 2
J.P. Maternity Hospital - 1
P.H.C - 2
UGPHC - 1
CHC - 5
Sub – Centres - 162
PHC (N) - 26

11
NIPI Baseline Report – Orissa

FACT SHEET, DISTRICT - SAMBALPUR, ORISSA


DLHS – 2 DLHS – 3 Baseline
Indicators (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 live birth/still birth (%) - - 57.1 48.2 53.5 50.5
Mothers who had at least 3 Ante-Natal Care visits
during the last pregnancy (%) 66.1 56.4 67.4 58.0 81.1 79.2
Mothers who got at least one TT injection when they
were pregnant with their last live birth / still birth (%) # 91.9 91.8 98.0 97.6 99.9 100.0
Institutional births (%) 44.3 30.6 56.6 45.8 78.2 75.1
Delivery at home & other places assisted by a
doctor/nurse /LHV/ANM(%) 24.7 25.8 28.6 27.4 - -
Mothers who received post natal care within 48 hours of
- - 95.5 97.3 45.5 35.7
delivery of their last child (%)
Child Immunization and Vitamin A supplementation:
Children (12-23 months) fully immunized (BCG, 3 doses 65.9 69.1 70.5 75 77.6 77.5
each of DPT, and Polio and Measles) (%)
Children (12-23 months) who have received BCG (%) 97 97.9 98.7 98.2 97.8 97.5
Children (12-23 months) who have received 3 doses of 83.5 85.5 82 83.4 91.6 93.5
Polio Vaccine (%)
Children (12-23 months) who have received 3 doses of 86 88 81.8 82.2 91.6 93.2
DPT Vaccine (%)
Children (12-23 months) who have received Measles 73.6 72.3 86 88.1 80.5 80.3
Vaccine (%)
Children (9-35 months) who have received at least one - - 77.6 76.9 - -
dose of Vitamin A (%)
Children (above 21 months) who have received three
- - 41.9 43.2 - -
doses of Vitamin A (%)
Treatment of childhood diseases (children under 3 years based on last two surviving
children)
Children with Diarrhoea in the last two weeks who 39.9 43.3 62.2 56.6 54.5 46.6
received ORS (%)
Children with Diarrhoea in the last two weeks who were 88.6 80.1 54.6 53.5 83 77.6
given treatment (%)
Children with acute respiratory infection/fever in the last
- - 60.9 57.8 57.5 48.1
two weeks who were given treatment (%)
Children had check-up within 24 hours after delivery - - 47.1 39 52.3 43.2
(based on last live birth)(%)
Children had check-up within 10 days after delivery - - 45 40.4 60.6 68.3
(based on last live birth) (%)
Child feeding practices (Children under 3 years)
Children breastfed within one hour of birth (%) - - 49.9 48.6 67.9 -
Children (age 6 months above) exclusively breastfed
- - 58 57.8 47.8 -
(%)
Children (6-24 months) who received solid or semisolid - - 95.2 94.9 - -
food and still being breastfed (%).
Problems faced during pregnancy (% of Mothers) - - - - 39.7 36.7
Post Delivery Retention Period of Mother at Health - - - - 49.1 48.2
Facility (average in hours)
Age at first cohabitation / Average age of marriage - - - - 19.2 19.0

12
NIPI Baseline Report – Orissa

1.7 Survey Design

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.

1.7.1 Sampling strategy at District level

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.

- Oral informed consent of the selected respondent

1.7.2 Sample size determination for NIPI Baseline survey


The following formula was used to determine the sample size required in a District:

nD
 2 P(1  P) Z1  P1 (1  P1 )  P2 (1  P2 ) Z1  
2

2
Where:

D = Design effect

P1 = the estimated proportion at the time of the baseline survey;

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;

13
NIPI Baseline Report – Orissa

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.

 =0.05 (Z1- = 1.96); =0.20 (Z1-=0.84); D = 2

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 Madhya Pradesh and Orissa. We considered 3
variables namely, IMR, NMR and percentage deliveries taken place in institutions.

The following table provides the sample size required at District level

Sample Size
Source of Indicator State D p1 P2 Live Households Including
data births 20% non-
response
NFHS3 IMR Orissa 2 0.091 0.0455 1441 7067 8481
NFHS3 IMR MP 2 0.094 0.047 1392 6825 8189
NFHS3 NMR Orissa 2 0.046 0.023 2958 14505 17407
NFHS3 NMR MP 2 0.045 0.0225 3027 14840 17808
NFHS3 % Inst deliveries Mean 2 0.26 0.19 1003* 1204*
*1200 pregnant women

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.

1.7.3 Sampling procedure

Primary sampling units

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 was 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 was then selected
by adding the sampling interval to the cumulative population of villages/wards.

Listing of eligible women in a PSU

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.

14
NIPI Baseline Report – Orissa

As per the suggestion from TAC, sample size was recalculated using the variable ‗percentage of
children fully immunised‘. Attached excel sheet provides the estimate. After adjusting for design
effect and non-response, the sample size achieved was 1200.

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 propose 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 sample size proposed and in each segment, confidence limit, precision and achieved sample
size are given in the grid below.

Segment Sample Size Confidence Precision* Achieved


proposed Limit sample size
Neonates (0-28 days) 136 95% 10% 232
Infant including neonates 550 95% 5% 1586
Children 12-23 months 600 95% 5% 1786
*The assumption is that the estimate of the indicator is 50%

Assuming that the crude birth rate was 30 per 1000 population (equivalent to 200 households,
assuming household size of 5), we got 2-3 neonates per 200 households. We listed a maximum
of 400 households in each village so that required numbers of mothers of neonates were
available for interview in each village. If village size was less than 400 households, pooling of
village(s) adjacent to the selected village with the selected village was done to make sure that the
village size is at least 400 households

Since the crude birth rate in urban areas was comparatively lower, we listed minimum 500
households in urban areas. Segmentation of wards was done in such a way that each segment
had 500 households.

1.8 Quantitative and Qualitative instruments

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.

1.8.1 Quantitative data collection

As part of Quantitative survey we conducted cross-sectional survey based on the WHO and
UNICEF Rapid Assessment Procedure.

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:

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NIPI Baseline Report – Orissa

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.
The details of questionnaires are as follows:

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 durables goods in the household.

Women Questionnaire: Women questionnaire is designed to collect information from currently


married women 15-45 years who gave birth in last two years.
The women questionnaire covered the following sections:

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

Facility Questionnaire: The information collected at District hospital, Community Health Centre,
Public Health Centre and Sub- Centre on the availability of functionality of human resource
(clinical /paramedical), physical infrastructure/ facilities, training to staff, equipments and services
provided.

1.8.2 Qualitative data collection


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.

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NIPI Baseline Report – Orissa

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 Officer 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
ASHAs of the surveyed PSUs IDI 50 150
AWWs of the surveyed PSUs IDI 50 150
PRI leader IDI 50 150
VHSC IDI 50 150
ANM IDI 25 75
ANM FGD 3 9
BEE IDI 5 15
BMO IDI 5 15
CDPO IDI 5 15
LHV IDI 5 15

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NIPI Baseline Report – Orissa

1.9 Recruitment, Training and Field work

1.9.1 Recruitment of the field staff

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.

For the quantitative baseline survey in a state, we recruited 15 teams. Each team comprised 1
supervisor 5 female investigators and 1 field editor per state. With a productivity of four
interviews for investigator per day the quantitative survey of 6000 interviews per state we
completed in 30 days and an additional 10 days was completed for travel between the PSUs.
Thus Quantitative part of the survey was completed in around one and half months of time.

For listing the eligible respondents in a PSU we recruited a team of one person for listing and one
for mapping. Like this we recruited 20 such teams. Each team listed a PSU in two days time.
Thus a state with 201 PSUs covered by such 20 teams in a month‘s time including travel between
the PSUs.

For conducting IDIs component of the Qualitative survey, we recruited 5 teams. Each team
comprised of four male interviewers and one male supervisor. The male interviewers did IDIs of
ASHAs, AWWs, PRIs and ANMs. Supervisors conducted interviews with block and District level
officials. With a productivity of 2 IDIs per investigator per day the 760 component of the survey
was completed in a month‘s time.

1.9.2 Translation of the questionnaires and pre-testing

All the qualitative and quantitative instruments of the present study were translated into regional
languages by TNS 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.

1.9.3 Field Training & Data collection Manuals

Intensive training was given to the recruited personnel by TNS INDIA, regarding the nature of
interviews and specific skills required for eliciting data. We conducted a 8day training session for
the qualitative and quantitative teams. The training sessions was 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.

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NIPI Baseline Report – Orissa

1.10 Quality assurance processes adopted during baseline field survey

1.10.1 Quality assurance processes adopted during the training

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
immunisation 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.

1.10.2 Productivity and on field scrutiny

Data collection was done by two teams; one team for the quantitative data and one for the
qualitative data. On an average 4 quantitative interviews were conducted by one member of the
Quantitative survey team in a day for this study. Similarly one member of the Qualitative data
collection team conducted 2 qualitative interviews in a day. At any given point of time of the
survey period, the interviewers did not exceed the productivity limit to ensure quality and
complete data collection.

The supervisors allotted the households to the interviewers based on the Household listing
prepared by the Listing team. All the interviews were scrutinized by the field editors and
supervisors in the village itself to check for the logical flow and consistencies in the responses.
This was done with the help of field interviewers to approach the respondents in case of any data
inconsistencies.

One field executive and one field coordinator was responsible for the data collection in each
state. The field executives visited all the teams in the first 10 days of data collection. This has
helped in identifying and plugging the initial problems and to ensure smooth and quality data
collection further.

1.10.3 Role of Supervisor

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.

1.10.4 Quality assurance visits by the central teams

The survey teams were visited by the central survey coordination team members on field to check
the process and quality of data collection.

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NIPI Baseline Report – Orissa

1.10.5 Monitoring visits by NIPI team

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.

1.10.6 Other quality control measures

In order to control quality, we adopted rigorous checks such as spot checks, back checks and
accompaniment interviews. We adopted 10% back checks to ensure whether the correct
households were covered or not and 15% were 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.

―Here, we would like to mention that TNS follows the ISO 9000 standards in its data collection
procedures, which is an indication of the importance we assume to the quality of fieldwork.‖

1.11 Data Processing

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.

The analysis was undertaken in consultation with DRS and NIPI program officers.

Table 1.5: Achieved sample

District
All NIPI Districts
Angul Jharsuguda Sambalpur
Rural Urban Rural Urban Rural Urban Rural Urban Total
N N N N N N N N N
PSU 44 6 32 18 36 14 112 38 150
No. of women 1,022 139 770 416 843 333 2,635 888 3,523

Table 1.6: Achieved sample for facility survey

Target Group Total sample size per state Total achieved


DH 3 3
CHC 3 3
PHC 18 20
SC 90 90

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NIPI Baseline Report – Orissa

Table 1.7: Achieved sample for Qualitative,

Target Group Research Total sample size Total achieved


Technique per state
ASHAs of the surveyed PSUs IDI 150 117
AWWs of the surveyed PSUs IDI 150 116
PRI leader IDI 150 112
VHSC IDI 150 91
ANM IDI 75 64
BMO IDI 15 9
CDPO IDI 15 10
LHV IDI 15 31

1.12 Report Structure

NIPI Baseline Report for Orissa consists of 8 Chapters including this one. Chapter -2 gives
Orissa‘s household characteristics including demographic and socio economic profile,
educational level of household population and household possession. Subsequent chapter 3
presents background characteristics of surveyed respondents which include age at marriage and
at first cohabitation, exposure to mass media and employment status of surveyed women.
Similarly chapter 4, 5, 6 & 7 presents information on maternal and child related health indicators
including information on ANC, delivery, PNC, child mortality & morbidity, and child immunization.
Chapter - 8 deals with the information on public health facility infrastructure present in all 3
sample which includes District hospital, Public Health Centre, Community Health Centre and Sub
Centre. All these chapters are supported by qualitative inputs and summary observations that
emerged at the time of survey.

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NIPI Baseline Report – Orissa

Chapter 2
Household Characteristics

2.1 Household demographic profile

This section presents the demographic characteristics of the sample households across urban
and rural areas in the three Districts of Orissa. The variables covered include age-specific
distribution of the household population by nature of the primary sampling unit as well as gender
of family member.

Table 2.1: Percent distribution of household population by age, sex and residence, All NIPI districts,
Orissa , NIPI-08

Age All NIPI Districts - Orissa Rural Urban


Total Male Female Total Male Female Total Male Female
% % % % % % % % %
0-4 25.7 26.5 24.9 25.8 26.9 24.8 25.2 25.5 24.9
5-9 8.6 7.5 9.7 8.7 7.5 9.9 8.4 7.6 9.2
10-14 4.2 3.5 4.9 4.2 3.6 4.9 4 3.1 4.9
15-19 4 2.9 5.1 4.1 2.9 5.2 3.9 2.8 4.9
20-24 12.2 6.4 17.8 12.2 6.2 17.9 12.2 6.8 17.4
25-29 13.9 14 13.7 13.5 13.8 13.3 14.9 14.7 15.1
30-34 9.6 13.9 5.5 9.2 13.4 5.3 10.5 15.3 5.9
35-39 5.2 7.8 2.6 5.1 7.8 2.5 5.3 7.8 2.9
40-44 2.2 3 1.4 2.2 2.9 1.6 2.1 3.2 1
45-49 2.2 1.9 2.5 2.2 1.9 2.5 2.1 1.7 2.4
50-54 2.6 2 3.2 2.7 2.2 3.1 2.4 1.3 3.4
55-59 2.9 2.4 3.3 2.9 2.5 3.3 2.9 2.4 3.4
60+ 6.7 8.2 5.4 7.2 8.4 5.7 6.1 7.8 4.6
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total # of HH 20957 10256 10701 15477 7545 7932 5480 2711 2769
Sex Ratio 1043 1051 1021
NIPI- 08

According to Census of India 2001, the sex ratio across the Orissa state was at 972 females per
1000 males. However NIPI survey consistently shows the sex ratio across urban and rural areas
is in favour of the female, which is contrary to the sex ratio of Orissa. The possible explanation
could be that the Districts chosen for this survey were relatively moderately developed ones
which are subject to out-migration, as against more developed Districts which witness large scale
first generation in-migration from rural areas for employment purposes. This thought is consistent
with the fact that sex ratio is more even in the urban sample as compared to the rural sample
where the bias in favour of female members is even more pronounced. Apart from this, as per the
sampling methodology, only those households were selected where mothers of 0 to 23 months
children are available, hence those households having no eligible mothers or having only male
members are omitted.

So far as the sex ratio of children (0-6 years) is concerned, as per census 2001, there are 927
females per 1000 males in India, whereas it is 953 in Orissa. Of the three NIPI districts, Anugul
has the lowest child sex ratio (937) followed by Jharsuguda (949) and Sambalpur (937).

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NIPI Baseline Report – Orissa

Table 2.2: Percent distribution of household population by age, sex and residence, District Angul,
Orissa, NIPI-08

Age Angul Rural Urban


Total Male Female Total Male Female Total Male Female
% % % % % % % % %
0-4 25.1 26.6 23.7 25.2 26.5 23.9 24.9 27 22.6
5-9 9.8 8.5 11.1 10 8.6 11.3 8.5 7.5 9.5
10-14 4.3 3.6 5.1 4.5 3.8 5.3 3 2.7 3.4
15-19 4.7 3 6.3 4.6 3 6.2 5.2 3.2 7.4
20-24 11.8 6.3 17.2 11.8 6.4 17 11.8 5.6 18.4
25-29 13.4 13.8 12.9 13 13.5 12.5 16.3 16.3 16.3
30-34 9.3 13.1 5.6 9.2 12.9 5.5 10.2 14.1 6.1
35-39 5.1 7.8 2.4 5 7.9 2.2 5.4 7.5 3.2
40-44 2.1 2.7 1.5 2.1 2.7 1.6 1.9 2.9 0.8
45-49 2.4 1.9 2.8 2.3 1.9 2.7 3 2.4 3.7
50-54 2.4 1.9 2.9 2.6 2.1 3 1 0.5 1.6
55-59 3 2.6 3.3 3 2.5 3.5 2.5 2.7 2.4
60+ 6.6 8.2 5.2 6.7 8.2 5.3 6.3 7.6 4.6
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total # of HH 6764 3361 3403 5973 2950 3023 791 411 380
Sex Ratio 1012 1025 925

Table 2.3: Percent distribution of household population by age, sex and residence, District
Jharsuguda, Orissa, NIPI-08

Age Jharsuguda Rural Urban


Total Male Female Total Male Female Total Male Female
% % % % % % % % %
0-4 25.4 25.2 25.6 25.9 26 25.8 24.5 23.7 25.2
5-9 7.7 6.9 8.4 7.4 6.1 8.6 8.1 8.2 8.1
10-14 4.2 3.3 5.1 4.2 3.6 4.8 4.2 2.8 5.5
15-19 3.7 3.1 4.3 3.6 3.1 4 3.9 3 4.8
20-24 12.7 7.3 17.7 12.5 7 17.6 12.9 7.8 17.9
25-29 14.8 15.2 14.5 14.3 14.6 14 15.8 16.2 15.3
30-34 9.2 13.6 5.2 9 13.4 5 9.6 13.9 5.4
35-39 5.1 7.6 2.8 5.3 7.7 3 5 7.6 2.4
40-44 2 2.6 1.4 2.1 2.6 1.6 1.8 2.5 1
45-49 2.1 1.8 2.4 2.2 2.1 2.3 2 1.4 2.6
50-54 2.8 2 3.6 3 2.4 3.5 2.6 1.4 3.9
55-59 3.3 2.7 3.8 3.1 2.7 3.5 3.5 2.8 4.3
60+ 7 8.7 5.2 7.4 8.7 6.3 6.1 8.7 3.6
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total # of HH 7218 3495 3723 4552 2177 2375 2666 1318 1348
Sex Ratio 1065 1091 1023

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NIPI Baseline Report – Orissa

Table2.4: Percent distribution of household population by age, sex and residence, District
Sambalpur, Orissa, NIPI-08

Age Sambalpur Rural Urban


Total Male Female Total Male Female Total Male Female
% % % % % % % % %
0-4 26.4 27.8 25.1 26.5 28 25.1 26.2 27.2 25.3
5-9 8.5 7.1 9.8 8.4 7.3 9.5 8.7 6.7 10.5
10-14 4 3.4 4.5 3.9 3.3 4.4 4.3 3.7 4.8
15-19 3.7 2.5 4.9 3.9 2.5 5.2 3.3 2.4 4.1
20-24 12.1 5.5 18.4 12.4 5.4 19.2 11.4 5.9 16.5
25-29 13.4 13 13.7 13.4 13.4 13.4 13.2 11.9 14.4
30-34 10.2 15 5.7 9.6 13.9 5.4 11.9 17.7 6.4
35-39 5.3 8.1 2.8 5.1 8 2.4 5.8 8.2 3.6
40-44 2.5 3.6 1.4 2.4 3.3 1.5 2.7 4.4 1.2
45-49 2.1 1.9 2.3 2.2 1.9 2.5 1.8 1.8 1.7
50-54 2.6 2 3.1 2.5 2.2 2.9 2.6 1.6 3.5
55-59 2.5 2 2.9 2.6 2.2 3 2.1 1.7 2.4
60+ 6.7 8.1 5.4 7.1 8.6 5.5 6 6.8 5.6
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total HH 6975 3400 3575 4952 2418 2534 2023 982 1041
Sex Ratio 1051 1048 1060

The demographic trend across the three Districts was very similar with 25-28% being children
below age of 5 years, 6-8% being elderly (beyond 60 years) and around 50-55% being in the
working age group of 15 – 59 years.

2.2 Socio-economic profile of household

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.

Table 2.5: Household Composition, NIPI-08


Type of Angul Jharsuguda Sambalpur Total
House Rura Urba Tota Rura Urba Tota Rura Urba Tota Rura Urba Tota
l n l l n l l n l l n l
% % % % % % % % % % % %
Joint/extended 46.9 47.8 47.0 52.5 52.4 52.5 46.8 46.0 46.6 48.5 49.3 48.7
Nuclear 53.1 52.2 53.0 47.5 47.6 47.5 53.2 54.0 53.4 51.5 50.7 51.3
Category of household
BPL 40.7 13.0 37.6 20.3 14.3 18.2 32.7 20.2 29.1 32.2 16.4 28.2

In line with the growing trend in India where economic compulsions are forcing more and more
joint family structures to break up into nuclear families, here too we find that there are more
nuclear families within the sample than joint or extended. The only exception to the trend is the
District of Jharsuguda where, in percentage terms, the situation is almost reverse.

As far as economic categorization was concerned, it was verified through the type of ration card
given to a particular household whether or not the same falls under Below Poverty Line category
or otherwise. Assuming true BPL households would be quite categorical in ensuring that they do
own a BPL identity card/ration card for the simple reason that the ensuing benefits in the present
political regime is far too lucrative, the poverty rate in the three Districts combined stands at
28.2%. The relatively more backward District in that sense is Angul with the highest poverty rate
while Jharsuguda appears to be relatively more developed. Consistently, the rural poverty rate is
more than double that of its urban counterpart.

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NIPI Baseline Report – Orissa

Table 2.6: District wise percent distribution of household population by religion & caste/tribe, and
mean household size, Orissa, NIPI-08
Type of House Angul Jharsuguda Sambalpur Total
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Religion
Hindu 99.8 99.3 99.8 98.9 93.1 96.9 97.4 96.2 97.1 98.8 95.2 97.9
Muslim 0.1 0.1 0.7 5.1 2.3 0.3 3.3 1.2 0.4 3.6 1.2
Sikh 0.7 0.1 0.9 0.3 0.1 0.3 0.2 0.0 0.6 0.2
Christian 0.4 0.9 0.6 2.2 0.3 1.6 0.8 0.5 0.7
Other 0.1 0.1 0.0 0.0
Caste/Tribe
SC 24.6 28.5 25.1 18.8 15.4 17.7 24.8 16.5 22.5 23.0 17.8 21.7
ST 20.7 4.4 18.8 37.7 19.8 31.6 38.6 25.8 35.0 31.5 19.8 28.6
OBC 39.7 43.8 40.1 36.2 39.3 37.2 29.0 33.3 30.2 35.1 37.6 35.7
General 15.0 23.4 16.0 7.4 25.6 13.5 7.6 24.4 12.3 10.4 24.8 13.9
Average number of usual members
Mean 5.6 5.7 5.6 5.7 6.1 5.8 5.3 5.5 5.4 5.5 5.8 5.6
Total HH 1070 138 1208 804 435 1239 927 367 1294 2801 940 3741

Overwhelmingly, the sample households were of Hindu faith, with a 5% share of Muslim
households only in urban Jharsuguda. Other Backward Communities (OBC) and Schedule Tribe
(ST) were the dominant social groups accounting for 36% and 29% of the households
respectively. The third major social group was Schedule Castes with the general or forward
castes being a relative minority in these Districts.

Table 2.7: Household family size by religion, NIPI-08

Angul Jharsuguda Sambalpur All Districts

Rural Urban Rural Urban Rural Urban Rural Urban


Religion N Mean N Mean N Mean N Mean N Mean N Mean N Mean N Mean
Hindu 1068 5.6 137 5.6 795 5.7 405 6.1 903 5.3 353 5.5 2766 5.5 895 5.8
Muslim 1 5 - - 6 6 22 7 3 5 12 6.8 10 4.9 34 6.9
Christian - - - - 3 4.3 4 5.3 20 5.4 1 6 23 5.2 5 5.2
Jain - - - - - - - - - - - - - - - -
Sikh - - 1 18 - - 4 5.5 1 4 1 5 1 4 6 7.7
Others 1 8 - - - - - - - - - - 1 8 - -

The average household size varied between 6.1 in urban Jharsuguda to 5.3 in rural Sambalpur.

2.3 Education level of the household population

The level of educational attainment of different members of the households (staring with the age
of 5 years) has been analysed on the basis of location of the PSU and gender of the household
member. The findings are presented below.

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NIPI Baseline Report – Orissa

Table 2.8: Education attainment by gender of household member in terms of years of schooling,
NIPI-08
Angul Jharsuguda Sambalpur State Total
Male Femal Total Male Femal Total Male Femal Total Male Femal Total
e e e e
Years of % % % % % % % % % % % %
schoolin
g
No 23.9 42 33.1 15.4 29.6 22.7 23.5 38 31.1 20.8 36.4 28.8
schooling
< 5 years 20.8 19 19.9 17.4 19 18.2 17.4 17.9 17.7 18.5 18.6 18.6
complete
5-7 years 20.7 15.9 18.2 17.6 18 17.8 20 18 18.9 19.4 17.3 18.3
complete
8-9 years 15.7 12.4 14 17.6 13.7 15.7 17.1 12.7 14.8 16.8 13 14.8
complete
10-11 7.5 5.9 6.6 14 9.4 11.5 8 6 7 9.9 7.1 8.5
years
complete
12 or 11.4 4.8 8.2 18 10.3 14.1 14 7.4 10.5 14.6 7.6 11
more
years
complete
Total 100. 100.0 100. 100. 100.0 100. 100. 100.0 100. 100. 100.0 100.0
0 0 0 0 0 0 0
Total # of 2468 2595 5063 2616 2770 5386 2456 2676 5132 7540 8041 1558
members 1

Consistently across all Districts, illiteracy was higher among females. It may also be noted that
even though the level of illiteracy was lowest in Jharsuguda District (it may be recalled that it also
had the highest development profile), the differences between genders is most stark in this
District.

Overall, illiteracy was around 29% and the proportion of persons having completed their basic
education (at least 5 years) was 52.6%.

Women members having completed their secondary level of education (10 years or more) were
proportionately higher in Jharsuguda (19.7%) as against Angul (10.8%) or Sambalpur (13.4%).

Table 2.9: Education attainment by location of PSU in terms of years of schooling, NIPI-08
Angul Jharsuguda Sambalpur State Total
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
Years of % % % % % % % % % % % %
schooling
No 35.1 18.7 33.1 24.8 19.2 22.7 35 21.4 31.1 32 19.9 28.8
schooling
< 5Years 20.4 16.3 19.9 19.3 16.3 18.2 17.7 17.6 17.7 19.2 16.8 18.6
complete
5-7 Years 18.4 17 18.2 19.6 14.8 17.8 19.3 17.9 18.9 19 16.2 18.3
complete
8-9 Years 13.6 16.5 14 16.5 14.3 15.7 15.2 13.8 14.8 15 14.4 14.8
complete
10-11 5.9 12.5 6.6 9.9 14.3 11.6 5.7 10 7 7 12.5 8.5
Years
complete
12 or more 6.6 19 8.2 9.9 21.1 14 7.1 19.3 10.5 7.8 20.2 11
years
complete
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 4469 594 5063 3372 2014 5386 3639 1493 5132 11480 4101 15581
members

26
NIPI Baseline Report – Orissa

As expected, illiteracy was consistently higher in the rural areas of all three Districts as against
their urban counterpart. Overall, 32% of the members of the rural sample households had no
formal schooling while this was much lower in the urban areas (19.9%).

2.4 Household characteristics

This section elucidates the nature of the sampled households by issues pertaining to
environmental sanitation and hygiene. The parameters considered include type of housing,
sources of drinking water, method of storage of drinking water, water treatment, availability of
toilet facility, nature of fuel used for cooking, availability of a chimney in the kitchen and whether
the house has a separate room for cooking as against cooking being done within the confines of
the residential quarters.

Table 2.10: Type of house, NIPI-08


Total No. of
Kaccha Semi Kaccha Pucca Total
HH
Rural 62.8 16.1 21.1 100 1070
Angul Urban 30.4 25.4 44.2 100 138
Total 59.1 17.1 23.8 100 1208
Rural 69.8 18 12.2 100 804
District Jharsuguda Urban 30.6 33.1 36.3 100 435
Total 56 23.3 20.7 100 1239
Rural 71.1 19.4 9.5 100 927
Sambalpur Urban 27 36 37.1 100 367
Total 58.6 24.1 17.3 100 1294
NIPI Rural 67.5 17.7 14.7 100 2801
Baseline Urban 29.1 33.1 37.8 100 940
Survey Total 57.9 21.6 20.5 100 3741
Orissa
Rural 69.5 18.9 11.6 100 28991
DLHS-3 Urban 27.2 27.8 45 100 4170
Total 64 20.2 15.8 100 33161
Source: DLHS3, NIPI-08

As expected, the majority of the houses in rural areas were of kaccha construction (non-
permanent nature of walls, floor and roof) while the situation was the reverse for urban locations.
The practice of having any one or two of the three basic components made of permanent
construction materials seems to be quite prevalent, especially in urban Jharsuguda and urban
Sambalpur, where over a third of the sample lived in such houses.

As per DLHS 3, about 64% people were living in Kaccha houses while NIPI survey reports a
slightly less percentage (58%) of people living in kaccha houses. It may be safely concluded that
the sample drawn from across the three Districts was not affluent in nature.

Table 2.11: Source of drinking water, NIPI-08


District
Orissa
Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Piped into dwelling 0.1 18.1 2.2 0.9 11.5 4.6 0.2 12.3 3.6 0.4 12.8 3.5
Piped to yard 0.3 20.3 2.6 1.5 13.8 5.8 1.1 29.4 9.1 0.9 20.9 5.9
Public tap 4.3 30.4 7.3 3.1 14.5 7.1 4.4 27.5 11 4 21.9 8.5
Tube well 44.6 26.8 42.5 75.6 28.5 59.1 66.6 25.6 54.9 60.8 27.1 52.3
Protected well 12.1 2.9 11 7.5 6.9 7.3 6.7 1.9 5.3 9 4.4 7.8
Unprotected well 33 1.4 29.4 9 23.9 14.2 19.5 1.9 14.5 21.6 12 19.2
Protected spring 0.5 0 0.4 0.2 0.1 0.1 0.8 0.3 0.2 0.4 0.3
Unprotected spring 1.4 0 1.2 0.9 0.5 0.7 0.5 0.4 1 0.2 0.8
Surface water 3.7 0.1 3.4 1.5 0.2 1.1 0.9 0.6 0.9 2.1 0.3 1.7
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 No. of HH 1070 138 1208 804 435 1239 927 367 1294 2801 940 3741

27
NIPI Baseline Report – Orissa

Majority of the households depended on tube wells for …I spent „untied funds‟ of NRHM
their drinking water in rural areas, especially in program…we built and repaired
Jharsuguda and Sambalpur. However, a fairly large
roads…built toilets…dug
segment living in rural Angul actually sourced their
tubewells… - Muralidhar Churia,
drinking water from unprotected wells (33%), which is an
Sarpanch Village Charpalli, Block
area of concern. Overall, 21% of the rural sample drew Dhankuda, Sambalpur
drinking water from this source. In urban areas, more
options were available and it was observed that people
had access to piped water at home, within residential compound or from a public tap. The piped
water facility seems to be most developed in Angul District, followed by Sambalpur. It has yet to
be made available in a significant way in Jharsuguda.

Table 2.12: Drinking water storage and filtration practices, NIPI-08


District
Orissa
Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Usual method of storage of drinking water
Covered Bucket 51.1 63.0 52.5 60.2 70.1 63.7 62.5 60.8 62.0 57.5 65.4 59.5
Covered Earthen 13.3 21.0 14.2 21.6 19.8 21.0 17.5 22.6 18.9 17.1 21.1 18.1
Pot
Open Container 12.1 13.8 12.3 11.7 6.0 9.7 6.6 6.8 6.6 10.2 7.4 9.5
Open Bucket 20.9 1.4 18.7 6.0 3.4 5.1 12.1 1.9 9.2 13.7 2.6 10.9
Don't store 1.5 1.3 0.2 0.2 0.2 0.1 0.8 0.3 0.7 0.4 0.6
Others 1.0 0.7 1.0 0.2 0.5 0.3 1.3 7.1 2.9 0.9 3.1 1.4
Method adopted to make water safer to drink*
Boil 12.2 22.5 13.4 10.9 36.6 19.9 11.9 19.6 14.1 11.7 27.9 15.8
Use Alum 0.1 0.7 0.2 0.7 0.5 0.6 0.2 0.3 0.3
Add Bleach/ 4.6 1.4 4.2 1.2 0.7 1.0 0.9 0.3 0.7 2.4 0.6 2.0
Chlorine Tablets
Strain Through a 1.0 0.9 7.8 7.1 7.6 2.3 1.9 2.2 3.4 4.0 3.6
Cloth
Use Water Filter 2.4 3.6 2.6 4.5 16.6 8.7 2.7 13.4 5.7 3.1 13.4 5.7
(Ceramic/Sand/
Composite/ etc.)

District
Orissa
Angul Jharsuguda Sambalpur
Rur Urba Tota Rura Urba Tota Rura Urban T Rur Urban T
al n l l n l l ot al ot
al al
% % % % % % % % % % % %
Use Electronic 0.7 15.2 2.3 1.9 5. 3.1 0.9 6. 2.4 1.1 7. 2.6
Purifier 5 3 2
Let it Stand and 0.2 0.7 0.2 1. 0.4 0.2 0. 0.4 0.1 1. 0.3
Settle 1 8 0
Other 0.1 0.1 0.1 0.1 0.2 0.2 0.1 0.1
Do not treat/filter 79.5 60.1 77.3 74.1 43 63.5 81.9 59 75.6 78.8 52 72.1
.9 .7 .4
Total 100. 100.0 100.0 100. 10 100.0 100. 10 100. 100.0 10 100.
0 0 0. 0 0. 0 0. 0
0 0 0
Total No. of HH 1070 138 1208 804 43 1239 927 36 1294 2801 94 3741
5 7 0
* Multiple response questions

28
NIPI Baseline Report – Orissa

The usual method of storage of drinking water was …last two years NRHM „untied funds‟
in a covered vessel (bucket or earthen pot). This have been well spent…all roads have
was consistent across all three Districts. Correct been repaired…all facilities of drinking
storage practice was observed to be relatively water have been augmented…new
higher in urban areas than rural. sources of drinking water found… -
Surya Kanti Sethy, Woman Sarpanch,
The most common filtration/purification process Village Badmal, Block Redhakhol,
was boiling, whether it is urban or rural locations. Sambalpur
In urban areas of Jharsuguda and Sambalpur,
there is a practice of using filters (ceramic/sand/composite), but not so in Angul, where the
greater acceptability was that of electronic purifiers.

However, what is perhaps more important to understand is that the majority across all three
Districts did not do anything to filter or treat the drinking water that they store and consume. The
situation is worse in rural households (75-80%) as compared to urban households (45-60%).

Table 2.13: Sanitation facility, NIPI-08


District
Orissa
Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Flush to Piped 0.5 0 0.4 1 1.4 1.1 1.1 3.5 1.8 0.8 2 1.1
Sewer System
Flush to Septic 3.4 11.6 4.3 3.5 31 13.2 2.3 13.1 5.3 3 21.2 7.6
Tank
Flush to Pit 2.6 24.6 5.1 3.5 18.9 8.9 2.6 24.8 8.9 2.9 22 7.7
Latrine
Flush to 0.6 0 0.5 0.5 0.2 0.4 0.1 0.5 0.2 0.4 0.3 0.4
somewhere else
Flush Don't know 0.1 0.1 0 0 0 0 0 0 0 0 0
Ventilated 1.4 1.4 1.4 1 0.7 0.9 0.4 0.3 0.4 1 0.6 0.9
improved pit
Pit latrine with 3.6 11.6 4.6 2 2.5 2.2 0.9 4.1 1.8 2.2 4.5 2.8
slab pit
Pit latrine without 1.4 7.2 2.1 0.2 0.2 0.2 0 0.5 0.2 0.6 1.4 0.8
slab
Twin Pit 0.7 1.4 0.7 0.4 0.5 0.4 0 0.4 0.4 0.4
Dry toilet 0.1 0.1 0.2 0.2 0.2 0 0.3 0.1 0.1 0.2 0.1
No Facility 84.8 42 79.9 81.7 44.1 68.5 92.4 48.8 80.1 86.4 45.6 76.2
Public Facility 0.7 0 0.7 6 0.2 4 0.2 2.5 0.9 2.2 1.1 1.8
Other 0.1 0.2 0.1 0 0.1 0 0 1.6 0.3 0 0.7 0.2
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 No. of HH 1070 138 1208 804 435 1239 927 367 1294 2801 940 3741
Source: NIPI 08

According to DLHS-3 nearly


83.1% of households had …people of my area are facing problems of
reported that they had no malaria…loose motion…vomiting…all due to poor
access to toilet facility. NIPI sanitation and unhealthy conditions…there is lack of
baseline survey of 3 districts doctors and medicines… - Basanti Pradhan, Woman
reveals that 76% of the Sarpanch, Village Kolabira, Block Kolabira, Jharsuguda
households had no access to a
toilet facility, implying that open defecation was the prevalent practice in these three Districts
(NIPI 08). Only in Jharsuguda District, there was a significant number of availability of flush
latrines, but that too only in the urban areas (50.1%)

29
NIPI Baseline Report – Orissa

Table 2.14: Cooking environment, NIPI-08


District
Orissa
Angul Jharsuguda Sambalpur
Rural Urba Tota Rura Urba Tota Rura Urba Total Rura Urba To
n l l n l l n l n tal
Fuel used for cooking
Electricity 0.5 21.7 2.9 2.9 12 6.1 2.3 19.6 7.2 1.7 16.4 5.4
LPG 2.2 15.9 3.8 2.7 20 8.8 1.6 22.3 7.5 2.2 20.3 6.7
Biogas 0.2 0.2 2 2.3 2.1 0.6 7.1 2.5 0.9 3.8 1.6
Kerosene 0.1 0.1 1.4 0.5 1 6.5 1.9 0.4 2.8 1
Coal 11. 32.6 14.2 12.8 41.1 22.8 0.8 1.6 1 8.5 24.5 12.5
9
Charcoal 0.7 0.1 2 3.9 2.7 0.6 1.9 0.9
Wood 84. 29.1 77.8 75.5 20.2 56.1 94.2 41.7 79.3 85 29.9 71.1
1
Dung 0.3 0.2 0.7 0.4 0.3 1.2 0.5 0.4 0.4 0.4
Agricultural waste 0.7 0.7 0.2 0.1 0.3 0.4
Cooking done under a chimney
Yes 0.8 0.7 1.0 0.7 0.9 0.3 0.3 0.3 0.7 0.4 0.6
No 99. 100.0 99.3 99.0 99.3 99.1 99.7 99.7 99.7 99.3 99.6 99.4
2
Separate room used as a kitchen
Yes 49. 68.1 51.7 52.4 70.1 58.6 54.9 65.4 57.9 52.2 68.0 56.1
6
No 50. 31.9 48.3 47.6 29.9 41.4 45.1 34.6 42.1 47.8 32.0 43.9
4
Total 10 100.0 100. 100. 100.0 100. 100. 100.0 100. 100. 100.0 100.0
0.0 0 0 0 0 0 0
Total No. of HH 10 138 1208 804 435 1239 927 367 1294 2801 940 3741
70

Firewood was the most commonly used cooking fuel across the rural areas of all three Districts
while in the urban areas, it appears to be a mixture of coal (32.6%), wood (29%) and electric
stove (21.7%) in Angul District, coal (41%), wood and LPG (20% each) in Jharsuguda, and coal
(41.7%), LPG (22.3%) and electricity (20%) in Sambalpur.

As far as cooking under a chimney was concerned, the concept just did not exist in any of the
study Districts.

Overall, and separately for the three Districts individually as well, there was a separate kitchen in
around half of the rural locations. The same was around 70% in the urban households, implying
that in the rural households, the inhabitants were at a higher risk of suffocation resulting from the
cooking smoke than from the urban households.

2.5 Household possessions

This section primarily deals with ownership status of the place of residence, main occupation of
earning members, ownership of agricultural land, allied information on financial inclusion, viz.
bank and health insurance access and finally, household level asset ownership.

Table 2.15: Ownership of immovable assets, NIPI-08

District
Orissa
Angul Jharsuguda Sambalpur
Rura Urba Tota Rura Urba Tota Rura Urba Tota Rura Urba Tota
l n l l n l l n l l n l
% % % % % % % % % % % %
House owned or rented
Own 97.8 64.5 94.0 89.8 56.6 78.1 96.0 64.6 87.1 94.9 60.9 86.3

30
NIPI Baseline Report – Orissa

Rented 2.2 35.5 6.0 10.2 43.4 21.9 4.0 35.4 12.9 5.1 39.1 13.7
Ownership of Agricultural land
Yes 55 38 53 55 44 51 51 24 43 54 35 49
No 45 62 47 45 56 49 49 76 57 46 65 51
Total 100. 100.0 100. 100. 100.0 100. 100. 100.0 100. 100. 100.0 100.
0 0 0 0 0 0 0 0
Total No. of 1070 138 1208 804 435 1239 927 367 1294 2801 940 3741
HH
Nearly all residents of rural areas lived in their own house (owner occupancy was as high as
95%). In urban areas, the rental concept is more pronounced and around 40% people did live on
rent. The trends are very similar across Angul and Sambalpur, with Jharsuguda having more
people staying on rent than the rest.

Table 2.16: Main source of household income, NIPI-08


District
Orissa
Angul Jharsuguda Sambalpur
Rura Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
l
% % % % % % % % % % % %
Cultivation 24.5 8 22.6 26.7 2.5 18.2 27.4 3 20.5 26.1 3.5 20.4
Agri. labour 23.9 8 22.1 7.1 2.8 5.6 9.3 0 6.6 14.2 2.4 11.3
Allied primary 1.8 0 1.6 4.7 0.2 3.1 0.5 0.3 0.5 2.2 0.2 1.7
sector activities
Manufacturing 0.8 1.4 0.9 1 0.7 0.9 1.3 2.7 1.7 1 1.6 1.2
Construction 1.6 2.2 1.7 11.4 17.5 13.6 27.9 21.5 26.1 13.1 16.8 14.1
Petty Trader 3.9 5.1 4.1 2.6 7.1 4.2 3.1 5.4 3.8 3.3 6.2 4
Artisan 2.5 10.9 3.5 1 3.2 1.8 0.5 3.3 1.3 1.4 4.4 2.2
Business 5.3 9.4 5.8 5.6 12.4 8 5.3 17.7 8.8 5.4 14 7.6
Salaried job 11.7 42.8 15.2 13.9 43.4 24.3 6 32.7 13.6 10.5 39.1 17.7
Other labour 23.1 11.6 21.7 23.9 10.2 19 17.5 12.5 16.1 21.4 11.3 18.7
Others 0.9 0.6 0.8 2.1 1.3 1.2 0.9 1 1.2 0.5 1.1
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 HH 1070 138 1208 804 435 1239 927 367 1294 2801 940 3741

In the rural areas of all three Districts, cultivation …last two years particularly there has
accounted for the main income source for not been improvement in condition of
more than a quarter of the households. This people…health situation also
observation is very much in line with many improving…after NREGP financial
economic surveys which show a clear trend in status of people increasing…number
decline in the earnings from agriculture and the of educated people also increasing… -
need for large scale supplementation from either Lambodar Pradhan, Sarpanch, Village
local level labour activities or migration in search Dangarpara, Block Jujumana, Sambalpur
of jobs to other states.

The situation is similar here as well. Next to farming, 35.6% of rural households had reported that
their main source of livelihood was agriculture labour and other labour activities, and if one
considers most jobs in the construction industry would be un-skilled daily waged, the proportion is
even higher. Like the rest of India, only around 10% of the families were securing their earning
from salaried employment. The trends are quite similar across all the three study Districts.

In the urban areas, there is a preponderance of salaried employment across both public and
private sectors (to the tune of nearly 40%). There were some labour activities as well, including
those in the construction sector. Around 10% of the households were into business.

Household level asset ownership, instead of being investigated at an individual asset level, has
been taken together to construct a household wealth index (HWI). We have considered the data
records of all the households in the state. The selected assets/ indicators for the construction of
index were: ( Annexure A1)

31
NIPI Baseline Report – Orissa

1. Whether using toilet used


2. Type of fuel used for cooking
3. Ownership of Mattress
4. Ownership of Mosquito net
5. Ownership of Chair
6. Ownership of Table
7. Ownership of Pressure cooker
8. Ownership of Radio/ transistor
9. Ownership of Watch or clock
10. Ownership of Sewing machine
11. Ownership of Electricity
12. Ownership of Electric fan
13. Ownership of Television
14. Ownership of Refrigerator
15. Ownership of Computer
16. Ownership of Mobile phone
17. Ownership of Land phone
18. Ownership of Water pump
19. Ownership of Thresher
20. Ownership of Tractor
21. Ownership of Car/ Jeep
22. Ownership of Two wheeler/ Four wheeler
23. Ownership of Bus/ truck
24. Ownership of Cot/ bed
25. Ownership of Bicycle
26. Ownership of animal drawn chart

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 of 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 (electricity, LPG, biogas and kerosene) then the household is awarded a score
of 1, otherwise it is given a 0 score.

The next 24 indicators were considered directly from the ownership. If a household owned one
particular asset, then it was given a score of 1 for that asset, otherwise 0. This procedure first
standardized the indicator variables (calculating z-scores); then the factor coefficient scores
(factor loadings) were calculated; and finally, for each household, the indicator values were
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 5 variables due to their low or negative effect on index. Based
on the remaining 21 variables, in the Principal Component Analysis the components with Eigen
values greater than 1 were explaining a variation of around 60.9% in the data, with the first
component explaining 35.9% of variation.

32
NIPI Baseline Report – Orissa

Wealth index quartiles Percent of women


Quintile 1 48.7
Quintile 2 13.9
Quintile 3 11.6
Quintile 4 10.1
Quintile 5 15.7
Total 100.0

The proportion of households belonging to each quintile, across urban and rural areas of the
three Districts is as follows:

Table 2.16a: Household Wealth Index, NIPI-08

Wealth Index District


Orissa
Angul Jharsuguda Sambalpur
Rura Urba Total Rura Urba Total Rura Urba Total Rura Urba Total
l n l n l n l n
% % % % % % % % % % % %
Lowest 65.4 23.9 60.7 45.6 17.9 35.9 61.1 19.3 49.2 58.3 19.4 48.5
Second 10.3 13.8 10.7 16.7 13.3 15.5 14 18.8 15.4 13.4 15.5 13.9
Middle 8.2 3.6 7.7 15.3 13.1 14.5 11.7 13.6 12.2 11.4 11.9 11.5
Fourth 7.9 18.1 9 12.3 17.2 14 6.1 13.1 8.1 8.6 15.7 10.4
Highest 8.2 40.6 11.9 10.1 38.5 20.1 7.1 35.2 15.1 8.3 37.5 15.7
Total 100.0 100.0 100. 100.0 100.0 100. 100.0 100.0 100. 100.0 100.0 100.
0 0 0 0
Total # of 1070 138 1208 804 435 1239 927 367 1294 2801 940 3741
HH

In terms of asset ownership by households, it may be observed that the majority of the
households in the rural areas belonged to the lowest quintile (45-65%) while it was more or less
the reverse in the urban areas (with 35-40% in the highest quintile). In line with what we had
observed regarding the poverty rate, here too the households of Jharsuguda appeared to be
more affluent than either Angul or Sambalpur.

Table 2.17: Bank account, NIPI-08


District
Orissa
Angul Jharsuguda Sambalpur
Rura Urba Total Rura Urba Total Rura Urba Total Rura Urba Total
l n l n l n l n
% % % % % % % % % % % %
Member having bank account
YES 24.0 52.9 27.3 36.2 61.4 45.0 20.4 45.0 27.4 26.3 53.7 33.2
NO 75.0 46.4 71.7 61.7 37.7 53.3 79.0 54.5 72.0 72.5 45.5 65.7
DK 1.0 0.7 1.0 2.1 0.9 1.7 0.6 0.5 0.6 1.2 0.8 1.1
Total 100. 100.0 100. 100. 100.0 100. 100. 100.0 100. 100. 100.0 100.
0 0 0 0 0 0 0 0
Any member covered with insurance
YES 2.4 18.8 4.3 1.5 14.7 6.1 7.1 8.4 7.5 3.7 12.9 6
NO 96.8 78.3 94.7 96.9 84.1 92.4 92.2 91 91.9 95.3 86 93
DK 0.8 2.9 1 1.6 1.2 1.5 0.7 0.6 0.6 1 1.2 1
Total 100. 100.0 100. 100. 100.0 100. 100. 100.0 100. 100. 100.0 100.
0 0 0 0 0 0 0 0
Total No. of 1070 138 1208 804 435 1239 927 367 1294 2801 940 3741
HH

In India, the overall banking penetration as on 2007 was 44%. The situation in the study Districts
was even worse with only 33% of households had any member with a bank account. Bank
penetration was relatively higher in Jharsuguda District as compared to the others.

33
NIPI Baseline Report – Orissa

Across all three Districts, insurance coverage was very low, even in the urban areas. Among
those who were covered, the significant contributor seems to have been ESI coverage for factory
workers and public sector employees. (AnnexureA2)

2.6 Funds Allocation and Utilisation

Details regarding funds allocated and utilised for different activities under NRHM are presented.

Till December 2007, in Angul, about four fifth of the money disbursed to them was spent, while in
Sambalpur about half of the funds allocated were utilised. Thus complete utilisation of the funds
allocated or received is an area that needs attention.

The fund utilization status for different activities in Angul District shows that all the allocated
money was spent for setting up infrastructure in the District Programme Management Unit
(DPMU), while only 7 percent was spent on training of programme managers. About three fourth
of the amount allocated for immunisation was spent indicating partial utilisation of the allocated
funds.

The fund utilization in Sambalpur District (till December 2007) shows about half of the amount
allocated for different heads under IMNCI training was spent. In case of immunisation, about two
third of the amount allocated for the financial year was spent till December 2007.

Fund utilization in Jharsuguda (Annexure 21) shows that about two third of the funds allocated for
immunization was spent, while more than four fifth of the fund allocated for JSY was utilized.

Summary observation

The three Districts have three distinct profiles


 Sambalpur was reported as primarily a rural District
 This District was found to have most remote villages where accessibility was impinging on
delivery of health services
 Angul was the District reported to be nearest to state capital
 This District was reportedly in comparison most ―urbanized‖
 This District had large concentration of ‗heavy‘ industries
 There was consequently concentrations of semi-urbanized ‗slum‘ settlements
 Jharsuguda District in contrast to the above two was most remote from state capital
 This District nevertheless was hub of commercial activity
 This District was centered around traditional ‗wholesale‘ market town complex
 This District also was traditionally a ‗railway‘ junction area, well connected by rail and road to
neighbouring states and other parts of India
 This District was relatively more ‗urbanised‘ than Sambalpur but not as much as Angul
 While Angul had marked ‗industrial‘ profile Jharsuguda was profiled as a ‗trading-commercial‘
outpost

…people of my area suffer from number of infectious


diseases… malaria… diarrhea…and other such sicknesses are
very rampant…proper transport facilities is need of the
hour…if only my people could reach doctor and access
medicines on time…I also provide them with jeep… - Baikuntha
Pradhan, Village Ghanapur, Block Kishore nagar, Angul

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NIPI Baseline Report – Orissa

35
NIPI Baseline Report – Orissa

Chapter 3
Characteristics of Survey Respondents

3.1 Background characteristics

This section provides details of the background characteristic of the eligible women (currently
married women, who delivered babies in last two years, aged 15-49) who were part of the survey
process. The section looks at their demographic and social characteristics in terms of age,
religion, ethnicity, number of years of schooling and education of husband.

Table 3.1: Age distribution of women respondents, NIPI-08

District
Total
Angul Jharsuguda Sambalpur
Age Group % % % %
15-18 3.5 0.6 1.9 2.0
19-21 22.3 15.7 17.7 18.5
22-25 38.5 42.0 42.3 41.0
26-30 26.0 30.4 26.4 27.6
31-40 9.1 11.0 11.2 10.5
41-49 0.6 0.3 0.5 0.4
Number of women 1,161 1,186 1,176 3,523

65-70% of the interviewed women were in the age bracket of 22 – 30 years. Very few (2%) were
actually at or below the legal age of marriage. Only around 10% of the sample consisted of
currently married women aged above 30 years.

Table 3.2: Distribution of women respondents by Religion and ethnicity, NIPI-08

District
Total
Angul Jharsuguda Sambalpur
Religion % % % %
Hindu 99.7 97.0 97.1 97.9
Muslim 0.1 2.2 1.2 1.2
Sikh 0.1 0.3 0.2 0.2
Christian 0.5 1.5 0.7
Other 0.1 0.0

Caste/tribe
Schedule Caste 24.6 17.8 23.1 21.8
Schedule Tribe 19.4 30.4 35.1 28.3
OBC 40.3 37.3 29.7 35.8
General caste 15.7 14.5 12.1 14.1
Number of women 1,161 1,186 1,176 3,523

The eligible women interviewed were almost entirely of Hindu faith. They were mostly from OBC
families (35.8%) or STs (28.3%). Around a fifth was SCs and the minority in this case was
general castes.

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NIPI Baseline Report – Orissa

Table 3.3: Education status of women respondents, NIPI-08

District
Total
Angul Jharsuguda Sambalpur
Education (Years of Schooling) % % % %
No education 40.1 24.5 34.8 33.1
<5 7.2 8.5 9.5 8.4
5-7 16.8 18.6 18.4 17.9
8-9 19.6 19.1 17.1 18.6
10-11 8.5 13.4 9.5 10.5
12 & Above 7.8 15.9 10.7 11.5
Number of women 1,161 1,186 1,176 3,523

Female literacy was highest in Jharsuguda (75.5%) and lowest in Angul (60%). However, it must
be said that these percentages are far above the all India average. Majority of the women in our
th
survey sample seem to have educated beyond primary level (5 grade) but not completed
th
secondary education (10 grade). Around 30% of the sample in Jharsuguda had received at least
10 years of formal education while this was 20% in case of Sambalpur and around 16% for Angul
District. The District wise relationship between education and age of respondent has been
provided in Annexure Table A1.

The husbands were far more educated than their spouses with average literacy being 77.8%
(both read and write).

3.2 Exposure to mass media

The following section explores the extent to which the target population has access to various
mass media sources, the frequency of access and the types of programs that are preferred. This
section also looks at the extent to which maternal and child care messages have been sourced
from the media as well as inter personal contacts during social events, the level of acceptability of
these messages and the impact of the same on behaviour.

This section looks at media habits of the respondents in terms of readership, listenership and
viewership. It also looks at frequency of exposure by key background variables viz. age of
respondent, their completed level of education, and finally, by their family‘s position in the
Household Wealth Index.

Table 3.4: Media habits, NIPI-08


Angul Jharsuguda Sambalpur All Districts
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Read the newspaper* 20.4 57.1 26.3 21.0 38.8 27.5 17.8 40.6 25.2 19.8 42.4 26.4
Listen to the radio 15.8 16.5 15.8 13.8 17.8 15.2 15.1 8.7 13.3 15.0 14.2 14.8
Watch TV 39.3 80.6 44.3 63.8 85.3 71.3 48.3 85.9 58.9 49.3 84.8 58.3
Exposure to cinema 8.1 13.7 8.8 2.9 13.2 6.5 1.2 8.4 3.2 4.4 11.5 6.2
* Among those who can read

Overall, only 26% of the women who were literate read a newspaper every day. This was much
lower if one looks only at the rural areas. As far as radio listernership was concerned, the
situation is even worse, with only 15% women listening to the radio regularly. This is very much in
line with the NRS 2006 findings.

On the other hand, television viewer ship enjoys by far the largest penetration among the women
respondents with 58% women reporting that they watch television regularly. This is as high as
84% in urban areas and nearly 50% in rural areas. Television thus emerges as the most viable
communication medium for outreach in the study Districts. Here it may be stated that the

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NIPI Baseline Report – Orissa

exposure to either of the media was positively correlated with the Household Asset Index status
of the household in which the women live.

It is quite clear that the culture of going out to watch a movie did not exist in any of the three
Districts, even in the urban areas. Hence, this does not present itself to be a suitable medium to
be used for communication purposes.

Table 3.5: Frequency of exposure, NIPI-08

Almost At least Less than a Not at all Total


every day once a week week
Frequency of reading 8.7 9.2 8.5 73.6 100.0
newspaper and magazine
Frequency of listening to 5.1 5.4 4.3 85.2 100.0
the radio
Frequency of watching 43.5 9.2 5.6 41.7 100.0
television

We had already seen that even among literates, the practice of reading a newspaper or magazine
was limited with 73.6% claiming not to be doing so.

Radio listenership was again rather infrequent with 85.2% stating they do not listen to the radio at
all. Only television viewers seem to be accessing this medium with the degree of regularity
(43.5% watch almost every day) required for making this a viable alternative channel for
communicating key health messages. (Annexure 4, 5, 6)

3.3 Employment Status

Out of the 1161 interviewed women in Angul District, only 245 (or 21%) had any independent
source of income. In line with the age distribution of the sample in Angul District, most of these
women were between 22 – 30 years of age (62%).

Similarly, out of the 1176 interviewed women in Jharsuguda District, only 141 (or 12%) had any
independent source of income. In line with the age distribution of the sample in Jharsuguda
District, most of these women were between 22 – 30 years of age (77%).

Finally, out of the 1186 interviewed women in Sambalpur District, 347 (or 29%) had any
independent source of income. In line with the age distribution of the sample in Sambalpur
District, most of these women were between 22 – 30 years of age (68%).

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NIPI Baseline Report – Orissa

Table 3.6: Employment status of eligible women by background characteristics, NIPI-08

Angul Jharsuguda Sambalpur Total


Any source of Any source of Any source of Any source of
income income income income
Yes Yes Yes Yes Yes Yes Yes Yes
Age Group N % N % % % % %
15-18 9 3.7 7 2.0 16 2.2
19-21 39 15.9 12 8.5 51 14.7 102 13.9
22-25 80 32.7 64 45.4 135 38.9 279 38.1
26-30 73 29.8 45 31.9 103 29.7 221 30.2
31-40 40 16.3 19 13.5 48 13.8 107 14.6
41-49 4 1.6 1 0.7 3 0.9 8 1.0
Total # of earning women 245 100.0 141 100.0 347 100.0 733 100.0
Years of schooling
No education 174 71 50 35.5 164 47.3 388 52.9
Below 5 21 8.6 13 9.2 42 12.1 76 10.4
5-7 28 11.4 30 21.3 65 18.7 123 16.8
8-9 15 6.1 17 12.1 38 11 70 9.5
10-11 2 0.8 20 14.2 18 5.2 40 5.5
12 & above 5 2.1 11 7.7 20 5.7 36 4.9
Total # of earning women 245 100.0 141 100.0 347 100.0 733 100.0

The second part of this table needs to be interpreted in conjunction with Table 3.3. It may be
recalled that overall, 33% of the responding women were illiterate. However, these 33%
accounted for 53% of the total number of earning women in the sample. Again, 22% of the
th
sampled women were educated till their 10 standard and beyond. But, this relatively highly
qualified segment contributed to only 10.3% of the total earning women in the sample. This
analysis clearly implied that in Districts of Orissa, the propensity to work and earn is not a function
of educational attainment and qualifications, but rather other compulsions such as hunger and
poverty. (Annexure A7)

Table 3.7: Membership in SHGs and mahila mandals, NIPI-08

Member of any SHG/Mahila Mandal


Angul Jharsuguda Sambalpur 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
% % % % % % % % % % % %
Yes 26.9 10.8 25.0 26.5 14.7 22.3 20.0 9.0 16.9 24.6 11.9 21.4
No 73.1 89.2 75.0 73.5 85.3 77.7 80.0 91.0 83.1 75.4 88.1 78.6
Tota 1022 139 1161 770 416 1186 843 333 1176 2635 888 3523
l

Overall, a little over a fifth of the respondents were members of local SHG and/or mahila
mandals. The data seems to be indicating that such membership was primarily a rural
phenomenon.

3.4 Age at marriage and first cohabitation

In many parts of India, there exists the practice of the child bride staying at home for some time
(this could vary from a few days to a few years) before she moves into her husband‘s residence.
There can be many social-cultural reasons behind this but the more import aspect of this issue is
that the day she moves in with her husband, it is marked with festivities known as ‗gauna‘. Health
research has, for all practical purposes, always taken the date of ‗gauna‘ to be of more relevance
for cohabitation purposes than the actual date of marriage.

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NIPI Baseline Report – Orissa

Taking 18 years to be the legal age of marriage for women, the proportion of women who had
actually cohabitated below that age in each of the three Districts is as follows. Table 3.8 shows
the highest percentage of cohabitation of girls in Orissa stands between 15-18 years.

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NIPI Baseline Report – Orissa

Table 3.8: Age at first cohabitation, NIPI-08

District Total
Angul Jharsuguda Sambalpur N %
Age At Cohabitation (in Years) N % N % N %
15-18 652 56.2 478 40.3 535 45.5 1,665 47.3
19-21 361 31.1 455 38.4 437 37.2 1,253 35.6
22-25 119 10.2 214 18.0 166 14.1 499 14.2
26-30 27 2.3 36 3.0 34 2.9 97 2.8
31-40 2 0.2 3 0.3 4 0.3 9 0.1
Total 1,161 100 1,186 100 1,176 100 3,523 100

Across all three Districts, for the majority of woman, the age at first cohabitation seems to have
been 15-18 years, followed by 19-21 years. More women in Angul (56%) seem to have
cohabitated at a younger age than the other two Districts.

The question now is, does age at first cohabitation get influenced by the education level of the
women concerned or the economic well- being of her household? The following table elaborates.

Table 3.9: Relationship between age of first cohabitation and education and economic status of
respondent, NIPI-08
Rural Urban Total
N Mean Median N Mean Median N Mean Median
Education No schooling 963 18.3 18.0 202 18.2 18.0 1,165 18.2 18.0
of
<5 244 18.4 18.0 53 18.2 18.0 297 18.3 18.0
respondent
5-7 500 19.0 19.0 132 18.6 18.0 632 18.9 18.0
8-9 496 19.2 19.0 159 18.7 18.0 655 19.1 19.0
10-11 237 19.9 20.0 133 19.9 20.0 370 19.9 20.0
12 & above 195 21.6 21.0 209 22.5 22.0 404 22.1 22.0
Household Lowest 1,543 18.4 18.0 166 18.4 18.0 1,709 18.4 18.0
Wealth
Second 354 19.4 19.0 138 18.3 18.0 492 19.1 19.0
Index
Middle 305 19.7 19.0 107 18.8 18.0 412 19.4 19.0
Fourth 218 19.9 20.0 139 19.4 19.0 357 19.7 20.0
Highest 215 20.6 20.0 338 21.1 20.0 553 20.9 20.0
Total 2,635 19.0 19.0 888 19.6 19.0 3,523 19.1 19.0

It is clear from the above table that more educated women tend to delay getting married and
thereby cohabitate at a more advance and mature age than those who are illiterate. In our
sample, the median age of cohabitation of illiterate women was 18 years while that of those
th
educated beyond the 10 standard was 20 – 22 years. Similarly, women belonging to a higher
economic profile married/cohabited 2 years later than those who were illiterate (18 years).

41
NIPI Baseline Report – Orissa

Chapter 4
Maternal Health
4.1 Preamble

Maternal health care is a concept that encompasses family planning, preconception, prenatal,
and postnatal care. Goals of preconception care can include providing education, health
promotion, screening and interventions for women of reproductive age to reduce risk factors that
might affect future pregnancies. Antenatal care is the comprehensive care that women receive
and provide for themselves throughout their pregnancy. Women who begin prenatal care early in
their pregnancies have better birth outcomes than women who receive little or no care during
their pregnancies. Postnatal care issues include recovery from childbirth, concerns about
newborn care, nutrition, breastfeeding, and family planning.

4.2 Antenatal Care

Antenatal care or ANC is the care of a pregnant woman during the time in the maternity cycle that
begins with conception and ends with the onset of labor. This particular section of this chapter will
deal with the issues of pregnancy registration, ANC provider, timing and number of ANC
received, components of ANC received, and awareness of pregnancy complications by mothers
and health problems and treatment seeking behaviour during last pregnancy.

4.2.1 Pregnancy registration and ANC provider

Table 4.1: Percentage of pregnancies registered vs. key background variables, NIPI-08

Angul Jharsuguda Sambalpur All Districts


Age Group % % % %
15-18 91.4 100.0 94.7 90.0
19-21 91.9 99.4 98.3 96.2
22-25 95.1 99.0 98.6 97.6
26-30 90.0 99.0 95.8 95.3
31-40 83.5 99.1 93.8 92.4
41-49 60.0 100.0 75.0 75.0
Years of schooling
None 86.5 97.6 95.1 92.1
<5 91.7 100.0 100.0 97.6
5-7 95.8 100.0 98.4 98.3
8-9 95.4 98.4 98.2 97.3
10-11 97.6 99.3 98.9 98.1
12 & above 93.5 100.0 95.3 96.5
HH Wealth Index
Lowest 89.6 97.2 96.7 94.0
Second 94.4 98.7 100.0 98.6
Middle 97.4 100.0 100.0 100.0
Fourth 94.4 97.1 92.6 95.2
Highest 93.3 100.0 94.7 96.8
Total 1,064 1,174 1,142 3,380

Overall, 91.6% of the pregnancies in Angul Districts were registered, while this was as high as
99% in Jharsuguda District and 97.1% in Sambalpur. Of the total registered pregnancies, about
92 percent were registered with government health facilities while the rest 8 percent registered
with private health institutions.

42
NIPI Baseline Report – Orissa

Figure 4.1: Registration of pregnancies by type of facility

100
5.4
7.2 7.8
10.6
Percent
90
92.8 94.6
92.2
89.4

80
Angul Jharsuguda Sambalpur ORISSA
Private facility Government facility

Most of the last pregnancies which occurred among women aged 19-30 years were registered
across all three Districts but it may be interesting to note that there was a sharp drop in
pregnancy registration among older women as well as those who became pregnant at a very
young age, probably more so if there age was below the legal limit for marriage.

A general trend was that more literate women tended to get their pregnancy registered than those
who were illiterate. Women from relatively affluent families did register their pregnancies more
than those who were poorer.

Table 4.2: Received ANC Card, NIPI-08


Received Angul Jharsuguda Sambalpur All Districts
ANC Card Yes Yes but Yes Yes but Yes Yes but Yes Yes not
Seen not seen Seen not seen Seen not seen Seen seen
% % % % % % % %
Total 68.5 18.0 87.1 10.6 85.0 13.4 80.5 13.9

94.4% of the interviewed women had claimed that they had an ANC card while this could be
physically verified for only 80.5% of them. Availability of the ANC card was lowest in Angul District
and much higher (98%) in the other two Districts.

Table 4.3: Incidence of receiving ANC during last pregnancy, NIPI-08


ANC Angul Jharsuguda Sambalpur All Districts
received Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % %
Yes, went to 89.7 99.3 90.9 97.3 98.3 97.6 93.4 98.5 94.8 93.1 98.5 94.5
health facility
Yes, health 2.1 0.0 1.8 0.9 0.3 0.7 4.5 0.0 3.2 2.5 0.1 1.9
personnel
visited home
No 8.2 0.7 7.3 1.8 1.4 1.7 2.1 1.5 2.0 4.4 1.4 3.6
Total N 938 138 1,076 759 410 1,166 825 328 1,153 2,519 876 3,395
Overall, most women seem to have gone in for some form of ANC service during their last
pregnancy. The non-compliance is less than 2% in case of urban areas and below 5% in case of
rural areas. Only in rural areas of Angul District was there any significant non-compliance issue
(8.2%).

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NIPI Baseline Report – Orissa

Table 4.4: Place of ANC, NIPI-08,

Place of ANC (multiple response) District


Total
Angul Jharsuguda Sambalpur
% % % %
Government/ Municipal Hospital 25.3 23.5 36.0 28.2
CHC/ Rural Hospital 13.1 10.4 15.4 12.9
PHC 15.4 17.3 23.2 18.7
Sub Center/ANM 8.1 8.7 11.8 9.6
AWW/AWC 22.0 15.0 11.3 16.0
NGO/Trust Hospital/Clinic 0.3 0.9 0.3 0.5
Govt. Ayush Hospital/Clinic 0.2 0.2 0.3 0.2
Private Ayush Hospital/Clinic 2.2 2.7 0.9 1.9
Private Hospital/ Clinic 13.6 23.2 16.9 18.1
Total 100 100 100 100
Total # of women 1055 1158 1115 3328

Across all the three Districts, the most frequented source of ANC was the government/municipal
hospital, followed by the local PHC. Private hospitals/clinics were also a significant source
(18.1%), especially in Jharsuguda. This was followed by local consultation in the form of AWW.

Table 4.5: ANC provider, NIPI-08

Who provided ANC (multiple response) District


Total
Angul Jharsuguda Sambalpur
% % % %
Government Doctor 51.9 57.0 75.5 61.6
ANM/Nurse/Midwife/LHV 31.4 25.4 31.8 29.5
ASHA 15.6 7.7 20.9 14.7
Private Doctor 17.0 29.1 18.2 21.6
Dai 0.1 0.1 0.1
Anganwadi/ICDS Worker 17.3 11.1 15.1 14.4
Any Other 0.8 5.1 2.6 2.9
Total of women 1076 1166 1153 3395

Among those who went in for ANC services either by visiting the service facility or having
someone visiting their home, in the majority cases the care was provided by the government
doctor (61.6%). This was followed by the ANM/burse/midwife/LHV (nearly 30%), private doctors
(21.6%) and a similar share being contributed by the ASHA and the AAW (14%). The trend was
very similar across all three Districts.

Organizational issues affecting program implementation

There was found a case for conflict of interest and overlapping of effort and time spent between
ASHA, ANM and AWW.
…ASHA help me in home visit…I give
medicines to her to give to villagers…I
In respondent reports it was gathered that
rectify her work…I shall give suggestion
ANM was the ‗outsider‘ service provider that we two must always work
visiting once in a while and ―locally‖ available together…ASHA listen to me and learn
service providers, particularly the AWW and from me… - Bilasini Nayak, ANM, Village
the ASHA, in particular were carrying out the
Banharpuli, Block Lakhanpur, Jharsuguda
NRHM work.

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NIPI Baseline Report – Orissa

In a District like Jharsuguda, the ANM considered ASHA as ‗junior‘ partner and the local person
to carry out her ―instructions‖.

Case Study: District Sambalpur


 In Sambalpur District there was incidence of ANMs staying quite some distance from
their appointed villages
 Commuting was a major problem being faced by ANMs
 As the case in other Districts here too there was high workload by way of paper work and
maintenance of records
 The only major ‗health‘ work the ANMs could contribute in was immunization
 There was criticality regarding ASHAs but conflict of interest was reportedly less than that
in Jharsuguda
 The reason may lie in the fact that since ANMs were not in a position to visit their villages
regularly, major portion of their work was being done by the ASHAs

There was witnessed greater support mechanism between ASHA and ANM in this District

Details of relationship between place of ANC/service providers and critical background variables
(age, education and economic status of respondents) have been provided in the Annexure
Tables.

4.2.2 Timing and number of ANC

Antenatal care indicators show a better picture in Orissa compared to all India, though the figures
are still low. About three fifth of the pregnant women had at least three antenatal checkups during
their last pregnancy.

Figure 4.1a: Percent of Mothers who received three or more antenatal checkups

60.9
70
51
60 48
44 44
50 34.9
40
30
20
10
0
NFHS-1 NFHS-2 NFHS-3

Orissa India

As per DLHS-3, in Jharsuguda (65.8%) and Sambalpur (67.4%) districts, nearly two-third of the
pregnant women had at least 3 antenatal care visits during their last pregnancy as against Angul
district, where the corresponding figure was 60 percent.

Table 4.6: Number of ANC received and timing of ANCs received, NIPI-08

45
NIPI Baseline Report – Orissa

Angul Jharsuguda Sambalpur All Districts


Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
Number of ANC % % % % % % % % % % % %
visits and timing
Received one ANC 4.1 2.9 3.9 2.6 1.5 2.2 3.3 2.7 3.1 3.4 2.2 3.1
Received two ANC 35.5 15.2 32.9 9.8 10.2 9.9 16.8 10.4 15 21.7 11.1 18.9
Received three ANC 25.4 19.6 24.6 19.6 13.9 17.6 21.7 19.8 21.2 22.4 17 21
Received four and 34 62.3 37.7 63.1 74.1 67 57.5 66.2 59.9 50.4 69.2 55.3
more ANC
Don't Know 1 0 0.9 4.9 0.3 3.3 0.7 0.9 0.8 2.1 0.5 1.7
Number of months pregnant at 1st ANC
<4 50.5 64.5 52.3 37.3 66.1 47.4 50.5 61 53.5 46.6 63.9 51
4-5 43.8 35.5 42.8 54.2 32 46.4 45.5 35.1 42.5 47.5 33.7 43.9
6-7 3.5 0 3.1 4.1 1.7 3.3 2.2 3 2.4 3.3 1.9 2.9
8+ 1.6 0 1.4 2 0 1.3 1.6 0.6 1.3 1.6 0.2 1.3
Don't Know 0.6 0 0.4 2.4 0.2 1.6 0.2 0.3 0.3 1 0.3 0.9
Total 938 138 1076 756 410 1166 825 328 1153 2519 876 3395

NIPI-08 baseline survey clearly reveals that more than 80 percent of the pregnant women had at
least 3 antenatal checkups during their last pregnancy (85 percent and 81 percent) in Jharsuguda
and Sambalpur districts while in Angul District, only 62 percent women reported the same.

Subsequently in NIPI Phase II survey, most of the women who had gone in for ANC during their
last pregnancy had received 2 or more ANC checkups. Consistently across all Districts, the
propensity to get more ANC checkups was more in urban areas than in the rural areas. Nearly all
th
the women had received their first ANC within the 5 month of their pregnancy. Around 50% had
received it within their first trimester itself. The findings are consistent across all three Districts.

4.2.3 Components of Antenatal Care

This section looks at the types of ANC services received by pregnant women. It further
investigates whether the proportion of eligible women who had gone in for ANC had received
antenatal care as per the prescribed medical norms. This includes at least 2 TT injections and 90
day+ of IFA tablets consumptions.

Figure 4.2: Percent of Mothers who consumed IFA for 90 days and Received 2 or more TT during
Pregnancy

Orissa India

83.3
90 76.3
80
70
60
50 33.8 23.1
40
30
20
10
0
Consumed IFA for 90 Received 2 or more TT
days injections

46
NIPI Baseline Report – Orissa

Consumption of IFA continuously for 90 days is considered vital for the survival of mothers and
children, but the figures for Orissa are very low (though better than India). More women (83.3%)
in Orissa received 2 or more TT injections during pregnancy as compared to all India (76.3%) at
the time of NFHS-3 (2005-06).

According to DLHS-3, 98% women received at least one TT injection during last pregnancy in
Sambalpur followed by Jharsuguda (97%) and Angul (91%). It is interesting to note that the
percentage of women received at least one TT injection is higher in rural areas (99%) of
Jharsuguda in comparison to total district‘s coverage while in the other two districts, rural
coverage is lower than total coverage of women received one TT injection.

Table 4.7: Proportion of eligible women having received different components of ANC care, NIPI-08

Angul Jharsuguda Sambalpur All Districts


% % % %
At least 2 + TT injection 89.7 93.3 94.0 92.3
Took IFA for 90 days + 29.0 57.3 49.6 45.4

Table 4.7 shows that the incidence of women having received at least 2 TT injections is almost
double that of those who told IFA tablets for at least 90 days. This situation is consistent across
all three Districts.

Table 4.8: Nature of ANC service received, NIPI-08

ANC Angul Jharsuguda Sambalpur All Districts


components Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
received % % % % % % % % % % % %
Weight measured 65.2 84.8 67.8 89.4 87.1 88.6 88.2 96.0 90.5 80.0 90.1 82.6
Blood Pressure
51.8 65.9 53.6 79.5 87.6 82.3 80.8 83.5 81.6 69.6 82.6 73.0
checked
Urine tested 54.4 80.4 57.7 75.9 80.7 77.6 71.3 85.4 75.3 66.4 82.4 70.5
Blood tested 55.4 73.2 57.7 73.3 84.6 77.3 73.2 84.8 76.5 66.6 82.9 70.8
Abdomen
60.7 76.1 62.6 81.9 90.7 85.0 87.2 91.5 88.4 75.7 88.7 79.1
examined
Delivery date
55.2 79.7 58.4 70.1 84.6 75.2 79.9 88.1 82.2 67.8 85.2 72.3
declared
Delivery advice
51.3 72.5 54.0 64.9 82.7 71.2 71.0 84.8 74.9 61.8 81.8 67.0
given
Received advice
on care during 70.6 88.4 72.9 69.2 88.0 75.8 79.5 91.2 82.8 73.1 89.3 77.3
pregnancy period
Received advice
on danger signs of 41.4 47.1 42.1 45.1 74.4 55.4 45.8 66.8 51.8 43.9 67.2 50.0
pregnancy
Received advice
51.8 69.6 54.1 67.1 81.7 72.2 69.2 82.3 72.9 62.1 80.0 66.7
on delivery care
Breast feeding
52.6 86.2 56.9 61.0 69.0 63.8 66.5 72.6 68.3 59.7 73.1 63.1
advice
New Born Care
38.0 59.4 40.7 50.1 63.7 54.9 57.5 69.8 61.0 48.0 65.3 52.5
advice
Family planning
22.2 23.2 22.3 30.2 61.2 41.1 26.1 37.5 29.3 25.8 46.3 31.1
advice
Total 938 138 1076 756 410 1166 355 328 1153 2519 876 3395

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 abdomen examination. Nearly a similar number had received advice
on care during pregnancy period. Consistently, …the village can improve if both ASHA
more women in the urban areas had received and ANM can work amicably together…
different components of ANC than their rural - Swalo nag, ANM, Village Baghmunda,
counterparts. Across all three Districts, the Block, Lakhanpur, Jharsuguda
features those were conspicuous by their

47
NIPI Baseline Report – Orissa

absence advice on new born care, family planning advice, etc. Surprisingly, only 44% in rural
areas and 67% in the urban areas had reported that they had not receive any advice on danger
signs during pregnancy.

A typical ANM‟s load of “paper” work

With minor variations these were the minimum ―paper work‖ an ANM was supposed to do. Nature
of ANM intervention therefore became primarily that of being facilitator to more ‗local‘ service
providers like the ASHA and the AWW.
 Maintain a host of ‗registers‘ and report cards
 Respondent ANMs were aware that they were the first tier of official information and data
gathering regime
 Respondents narrated the whole gamut of paper work maintained by them, which included
 Birth register
 Death register
 ANC report card
 Blood slides report card
 Stock distribution register
 CSM report card
 New born register
 PNC report card
 JSY register
 Survey register
 IUD register
 Cash Book
 VHSC register
 NRHM register
 Vaccine register
 Mamta register
 Condom register
 Motivation register
 Minor treatment register
 Today diary
 Respondents had to maintain in addition Report schedules running into 156 column data
sheets, which they had to update regularly to be submitted with District officials

The HMIS information is collected at the grassroots by ANM. She sends the report to PHC level.
From PHCs data is sent to Block.At the block level the data is compiled and data sheet is
prepared to be sent to District HQ

The ANM was involved in a number of roles; she was in fact the nodal person for more
comprehensive area coverage and guide to ‗locally‘ available service providers, based in
individual villages, viz., the ASHAs and the AWWs.

This multiplicity of roles and overextension of service area impinged on quality of service
provided.

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NIPI Baseline Report – Orissa

Table 4.9: TT injections vs. number of ANCs, NIPI-08

One TT Two TT Two and More ANC


% % %
Rural Received one ANC 48.8 12.5 8.6
Received two ANC 27.6 40.6 17.4
Received three + ANC 23.6 46.9 74.0
Urban Received one ANC 37.8 4.0 5.8
Received two ANC 24.4 28.6 11.5
Received three + ANC 37.8 67.4 82.7
Total Received one ANC 46.8 10.6 7.8
Received two ANC 27.0 37.9 15.9
Received three + ANC 26.2 51.5 76.2

The above table makes it quite obvious that


there is a positive relationship between the …as NRHM madam I am present in
number of TT injections received and the vaccine centre to give vaccine to
number of ANC services availed. Across both mother and child…I do check up of
urban and rural areas, one can see that the pregnant mother… - Purnima Tanty,
incidence of having received 2 or more TT ANM, Village Bhurkamunda, Jharsuguda
injections increases steadily as one
progresses from one ANC to 2 or 3 and more ANCs.

4.2.4 Health problems and treatment seeking behaviour during pregnancy

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 behaviour.

Table 4.10: Knowledge about health problems during pregnancy, NIPI-08


Pregnancy Angul Jharsuguda Sambalpur NIPI States
Complication Rural Urba Total Rural Urba Total Rural Urba Total Rural Urba Tota
n n n n l
% % % % % % % % % % % %
Don't Know 12.7 13.8 12.8 20.0 5.9 15.0 17.1 10.1 15.1 16.3 8.7 14.3
Vaginal Bleeding 12.9 8.7 12.4 10.4 15.4 12.2 12.4 13.4 12.7 12.0 13.6 12.4
Convulsions 18.9 21.0 19.1 16.0 11.0 14.2 13.7 12.8 13.4 16.3 13.2 15.5
Prolonged Labour 23.8 23.9 23.8 20.4 17.8 19.5 24.6 21.0 23.6 23.0 20.0 22.2
Swelling of Hands 78.1 74.6 77.7 66.4 85.9 73.2 63.2 69.8 65.0 69.7 78.1 71.9
and Feet
Personnel who told about these complication
Health Personnel 16.6 32.6 18.7 16.5 42.4 25.6 29.8 56.1 37.3 20.9 46.0 27.4
/Doctor
ANM/Nurse/Midwif 14.3 3.6 12.9 25.1 8.5 19.3 29.1 16.2 25.4 22.4 10.6 19.4
e/LHV
ASHA 8.6 3.6 8.0 10.4 4.4 8.3 27.6 10.4 22.7 15.4 6.5 13.1
Other Health 0.1 0.1 0.3 0.2 0.3 1.2 2.1 1.5 0.5 0.9 0.6
Personnel
Other Person 0.3 0.3 0.1 0.2 0.2 0.4 0.3 0.3 0.3 0.2 0.3
Dai/TBA
Aganwadi/ICDS 14.8 13.0 14.6 11.5 19.5 14.3 15.3 6.7 12.8 14.0 13.7 13.9
Worker
Home 52.0 53.6 52.2 29.1 37.8 32.2 27.4 38.1 30.4 37.1 40.4 37.9
Any Other 3.2 0.7 2.9 4.1 0.5 2.8 1.3 1.5 1.4 2.9 0.9 2.4
Total 938 138 1076 756 410 1166 825 328 1153 2519 876 3395

49
NIPI Baseline Report – Orissa

Most of the women seemed to have been aware …I am taking care of more than 7000
of swelling of hands and feet as a tangible population…women are going to
pregnancy complication, perhaps because they hospital for delivery…they are quite
would have experienced t first hand. Apart from aware after ASHA intervention… -
this, no more than a fifth of the respondents Rukmani Sahoo, ANM, Village
were actually aware of any other symptom. 16% Dangarpara, Block Jujumra, Sambalpur
women claimed not to have had any knowledge
about any of the complications during
pregnancy.

Most of the eligible women seemed to have come to know about complications from home (38%)
and from health personnel at service locations where they had gone in for ANC (27%).

ANM problems related to location, transport and reach affecting impact and program
design issues
 Respondents opined that since now there was high degree of institutional delivery and IMR-
MMR was going down allied with high degree of awareness generation
 Respondents said that they had to cover large areas and huge populations
 In rural areas there was certain variation th
…I am 12 pass…have 19 years
in functioning of ANM as per their experience…I am living in Sambalpur, not in
location sub-centre village…I go by bus…takes me
 ANM situated in the sub-centre village 45 minutes…seven villages under me with
 ANM situated in the block 5000 population – Minakhi Pujhari, ANM,
 ANM not in sub-centre village Block Bangan, Sambalpur
 ANM situated in remote village reporting
to block or sub-centre

Table 4.11: Incidence of health problems during pregnancy, NIPI-08

Angul Jharsuguda Sambalpur All Districts


Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Yes 29.3 17.4 27.8 19.0 32.7 23.8 36.8 48.2 40.1 28.2 35.6 30.1
No 70.7 82.6 72.2 81.0 67.3 76.2 63.2 51.8 59.9 71.8 64.4 69.9
Total # of women 938 138 1076 756 410 1166 825 328 1153 2635 888 3523

30% of the women in our sample had experienced some sort of health problems during their last
pregnancy. In the Districts of Jharsuguda and Sambalpur, more urban women faced problems
than their rural counterparts but the situation was reverse in Angul District. The incidence of
health problems during pregnancy was more pronounced in Sambalpur District (40%) than the
others.

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NIPI Baseline Report – Orissa

Table 4.12: Nature of health problems faced during last pregnancy, NIPI-08
District
All Districts
Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Tota
l
% % % % % % % % % % % %
Swelling of 58.1 70.8 59.0 32.6 47.0 39.6 44.0 39.9 42.6 47.3 45.3 46.7
hands & feet
Paleness 2.1 1.9 2.1 1.5 1.8 12.3 13.3 12.6 6.3 7.3 6.6
Visual 14.4 12.5 14.3 5.6 2.2 4.0 13.6 10.1 12.4 12.4 7.0 10.8
disturbances
Excessive 10.7 8.3 10.5 5.6 4.5 5.0 5.8 4.4 5.4 7.7 4.7 6.8
bleeding
Convulsions 12.7 12.5 12.7 2.1 7.5 4.7 13.3 12.0 12.8 10.9 10.1 10.7
Abnormal 2.7 12.5 3.5 0.7 5.2 2.9 4.5 3.8 4.3 3.1 5.1 3.7
position of
foetus
Weak or no 6.5 16.7 7.3 13.2 8.2 10.8 15.5 19.0 16.7 11.6 14.2 12.4
movement of
foetus
Total 291 24 315 144 134 278 309 158 467 744 316 1060

As mentioned earlier, the relatively higher awareness of swelling of hands and feet could be
result of having experienced this complication first-hand, the above table validates this
assumption. Apart from this, awareness and experience regarding other symptoms were
observed to be quite low.

Table 4.13: Percentage of women who sought advice for heath problem during pregnancy, NIPI-08
Angul Jharsuguda Sambalpur All Districts
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Yes 72.5 87.5 73.7 84.7 81.3 83.1 85.4 90.5 87.2 80.2 86.4 82.1
No 27.5 12.5 26.3 15.3 18.7 16.9 14.6 9.5 12.8 19.8 13.6 17.9
Total # of women 291 24 315 144 134 278 309 158 467 744 316 1060

Of all the 1061 women who had reported to have faced any complications during pregnancy, a
little over 80% had consulted someone regarding their problem. The usual places of consultation
…in the village there are no facilities for had been government/municipal hospital (45%),
weak children and new born babies… - followed by private hospital/clinic (39%) in urban
Padmini Mehar, ASHA, ward no.18, Block areas and government hospital (28%), private
Lakhanpur, Jharsuguda hospital/clinic (23%) and PHC/CHC (22%) in
case of rural areas.

Overwhelmingly (92%), it was the doctor who was the health personnel consulted when the
pregnant women went to a facility for a checkup for complications.

Table 4.14: Person persuaded for treatment during pregnancy


Angul Jharsuguda Sambalpur All Districts
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
ANM 7.7 7.0 11.5 0.9 6.5 21.7 2.8 15.0 14.6 1.8 10.6
ASHA 11.5 10.4 5.7 5.5 5.6 33.1 11.9 25.6 19.9 8.4 16.3
DAI 0.9 0.4 0.4 0.2 0.2 0.4 0.2
Mother-in-law 6.2 4.8 6.1 4.9 8.3 6.5 16.3 20.3 17.7 10.4 14.3 11.6
Husband 63.2 100.0 66.5 71.3 78.9 74.9 57.4 61.5 58.9 62.3 71.4 65.2
Friends/ 15.8 14.3 13.9 11.9 13.0 20.5 24.5 21.9 17.5 17.6 17.5
Relatives
Others 4.8 4.3 8.2 2.8 5.6 1.9 4.2 2.7 4.2 3.3 3.9
Total number 209 21 230 122 109 231 2 143 406 594 273 867
of women

51
NIPI Baseline Report – Orissa

Overwhelmingly, it was the husband (65%) who had …I feel sorrow for ASHA
persuaded the woman to go in for treatment of complication …she is doing so much
experienced during the pregnancy period. This is fairly work…she should be given
consistent across all three Districts and it is also consistent salary, cycle and mobile…
that the role of (she can be made an ANM)…
… Government has banned filling up the husband - Manju Dash, ANM, Village
of vacant positions. Only ASHA posts was more Haldipali, Block Kuchinda,
are completely filled up in this district. pronounced in Sambalpur
One person has to cover up big urban
territory, which results in deterioration households than the rural households. The role of
of quality in service delivery. the ANM and ASHA seems to have been relatively
Adequate manpower is needed limited except for the District of Sambalpur where
…CMHO, Sambalpur, Angul they did seem to have played a role with around
15-25% of the pregnant women.

4.3 Delivery Care

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.

Figure 4.3 : Institutional delivery and births assisted by health personnel

60.0
46.4 48.3
50.0 40.7 42.4
38.7
40.0 33.4 33.6 33.0
30.0 26.1
22.6
19.0
20.0 14.1
10.0
0.0
NFHS-3 NFHS-2 NFHS-1 NFHS-3 NFHS-2 NFHS-1

Orissa India

Institutional Deliveries Births assisted by health personnel

According to NFHS, trend reports the percentage of women delivered in health facility has
steadily increased in both all India and Orissa. In Orissa, institutional deliveries were only 14% in
1992-93 (NFHS1), which has become almost three fold to 39% in 2005-06 (NFHS3). Assistance
of trained health personnel during delivery is critical in maternal and child survival. A steady
increase was also noted in the number of pregnancies assisted by health personnel in both
Orissa and India. When compared to all India, Orissa is still lagging behind in terms of both
institutional delivery and births assisted by health
personnel. (Figure 6.4) …in the last two years ASHAs have
started maintaining records…do
At juxtaposed a recent DLHS-3 reported institutional home visits…I also sometimes
deliveries at 44.3% while NIPI Phase II survey also accompany her…women now go to
clearly indicates that the trend has increased to her…she takes them to hospital for
nearly 58% of all deliveries, which took place in delivery… - Surekha Sahoo, AWW,
government hospitals (73.5% in institutions), while Village Bandha bahal, Block lakhanpur,
only 26% took place at home. Jharsuguda

52
NIPI Baseline Report – Orissa

53
NIPI Baseline Report – Orissa

Figure 4.4 Place of Delivery

65
70 58
60 54 54
50
Percent

40 35

30 22 24 22 26

20 13 16
11
10
0
Angul Jharsuguda Sambalpur ORISSA

Government facility Private facility Home and others

As per the NIPI-08 baseline, Sambalpur district showing a highest percentage (78%) of
institutional deliveries (government + private) followed by Jharsuguda (76%) and Angul (65%).
Data reveals that in Sambalpur, more number of women (65%) is going for institutional deliveries
in government hospitals in comparison to other two districts whereas in Jharsuguda percentage
of institutional deliveries in private hospitals (22%) is highest among three NIPI districts.

4.3.1 Influence of background characteristics choice of place of delivery

The following section explores the relationship between the place of last delivery and critical
background variables, viz. age of respondent, her education level, child‘s birth order and standard
of living level of her household based on Asset Ownership Index.

Table 4.15: Place of delivery v/s age of respondent, NIPI-08


Institutional Home Total
Govt Hospital Private In-laws Parental Other All Births
places
Age N % N % N % N % N % N %
15-18 47 67.1 6 8.6 8 11.4 9 12.9 0 0.0 70 100
19-21 428 65.5 82 12.6 86 13.2 57 8.7 0 0.0 653 100
22-25 869 60.4 242 16.8 218 15.2 106 7.4 3 0.2 1438 100
26-30 533 55 163 16.8 187 19.3 82 8.5 5 0.4 969 100
31-40 155 42 58 15.7 100 27.1 54 14.6 1 0.6 369 100
41-49 3 21.4 1 7.1 5 35.7 5 35.8 0 0.0 14 100
Total N 2035 57.9 552 15.7 604 17.2 313 8.9 9 0.3 3513 100

The trend in the data clearly indicates that the younger generation preferred to have their
deliveries in an institution while the older women preferred to have their deliveries at home. One
of the explanations for such a trend was that while for many of the elder women this pregnancy
was one of the several she has already had and hence they felt that it could be handled from
home, for the younger lot, this was the first pregnancy and they did not want to risk it.

54
NIPI Baseline Report – Orissa

Table 4.16: Place of delivery v/s years of schooling, NIPI-08


Educational Institutional Home Total
Status Govt Hospital Private In-laws Parental Other All Births
places
N % N % N % N % N % N %
None 582 50 40 3.4 345 29.6 188 16.1 7 0.9 1165 100
<5 198 66.7 18 6.1 53 17.8 27 9.3 297 100
6-7 429 67.9 60 9.5 96 15.2 46 7.3 1 0.1 632 100
8-9 427 65.2 113 17.1 80 12.2 32 4.9 1 0.6 655 100
10-11 222 60 112 30.3 21 5.8 12 3.9 370 100
12+ 177 43.8 210 51 9 2.2 8 3 404 100
Total 2035 57.9 548 15.6 604 17.2 313 8.9 9 0.3 3513 100

The preference for institutional deliveries is strong among all women irrespective of her literacy
level. However, with literacy, the
…maximum deliveries now in hospital…this is propensity to deliver at home comes
due to JSY…but some mothers still fear to go to down quite drastically (from 45.7% for
hospital…some do not find transport…main illiterate women to 9% or lower for
reason is Rs.1400/- given to mother…no delivery those who have passed their 10
th

facility in sub-center…refer to Jharsuguda standard.


hospital… - Sureswari Magar, ANM, Village Talpatia,
Jharsuguda Again, the preference for private
institutional delivery also increases
with education of the pregnant mother.

Table 4.17: Place of delivery v/s number of live children, NIPI-08


Institutional Home Total
Birth Govt Hospital Private In-laws Parental Other places All Births
Order N % N % N % N % N % N %

1-2 1628 62.1 501 19.1 311 11.9 167 6.37 5 0.53 2621 100
3-4 341 47.8 47 6.6 220 30.9 102 14.3 2 0.4 713 100
5+ 66 34.9 4 2.1 73 38.6 44 23.3 2 1.1 189 100
Total 2035 57.8 552 15.7 604 17.1 313 8.88 9 0.26 3523 100

The hypothesis that younger women having their first child would rather have a risk free
institutional delivery rather than have it at home while more experienced women with children can
afford to think otherwise is more or less validated in the above table. Institutional deliveries come
down from 81% for women with 1-2 live children to 52% for those who had more than 2.

Table 4.18: Place of delivery v/s economic status of respondents‟ household, NIPI-08
Institutional Home Total
Wealth Govt Hospital Private In-laws Parental Other All Births
Index places
N % N % N % N % N % N %
Lowest 970 56.8 63 3.7 425 24.9 244 14.3 4 0.3 1709 100
Second 338 68.7 49 10.0 76 15.4 27 5.5 2 0.4 492 100
Middle 292 70.9 49 11.9 51 12.4 17 4.1 2 0.7 412 100
Fourth 209 58.5 101 28.3 33 9.3 14 3.9 357 100
Highest 226 40.9 290 52.4 19 3.4 11 2.4 1 0.9 553 100
Total 2035 57.8 552 15.7 604 17.1 313 8.9 9 0.3 3523 100

55
NIPI Baseline Report – Orissa

The generic trend was that women with lower economic profile tended to favour having deliveries
at government facilities as against those who belonged to better off households and could afford
private treatment.

4.3.2 Arrangement and cost of transport

Family members, usually the husband, had the responsibility of arranging the transport for taking
the pregnant woman to the health institution.

On an average, the cost of transport worked out to be as follows:

Table 4.19: Average transportation expenses, NIPI-08

DISTRICT
Total
Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
N 623 97 720 492 279 771 585 253 838 1,700 629 2,329
Mean 472.5 347.6 455.7 719.3 389.8 600.1 572.0 210.6 462.9 578.2 311.2 506.1
Median 400.0 300.0 350.0 600.0 300.0 500.0 500.0 130.0 400.0 500.0 200.0 400.0

There are wide variations in the transportation incurred both across urban and rural areas as well
as across Districts. The urban-rural differences are most stark across Jharsuguda and Sambalpur
Districts which range from as high as Rs.600 in Jharsuguda rural to as low as Rs.130 in
Sambalpur urban. The differences are far more modest in Angul District. The cost of
transportation was in general highest in Jharsuguda (Rs.500) and lowest in Angul (Rs.350).

4.3.3 Institutional delivery


…people are coming forward for
This section elaborates on issues dealing with institutional deliveries…from 2007 to
nature of delivery and attending service March 2008…I have known 55
provider, incurred costs, health deliveries…of these 31 were “home”…I
problems/complications experienced during have not accompanied…24 deliveries
delivery, nature of advice received post delivery were in hospital…which I
and from whom, and finally, opinion on quality of accompanied… - Mamata Nath,
service and facility standards. Chhelipara, Block Angul, Angul

Table 4.20: Nature of Institutional delivery, NIPI-08

Angul Jharsuguda Sambalpur


Rural Urban Total Rural Urban Total Rural Urban Total
Who conducted the delivery % % % % % % % % %
Government Doctor 72.8 38.9 67.8 74.4 59.3 68.9 87.5 61.3 79.3
Private Doctor 14.8 39.8 18.6 16.6 37.4 24.2 8.7 27.5 14.6
ANM / Nurse 11.3 19.5 12.5 8.7 3.3 6.9 3.8 10.8 6
Other 1.1 1.8 1.1 0.3 0 0.4 0.1
Type of Delivery
Normal 78.8 69.9 77.5 78 61.7 72.1 71.6 60.6 68.2
Cesarean 11.3 27.4 13.7 13.7 21.6 16.5 13 24 16.4
Assisted 9.9 2.7 8.8 8.3 16.7 11.4 15.4 15.4 15.4
Total N 647 113 760 578 329 907 633 287 920

In line with where the delivery actually took place, the person actually performing the delivery was
primarily a government doctor in rural areas and government and private doctors in urban areas.
While most deliveries were normal, incidence of caesarian deliveries was more in urban areas.
Around 15% of the deliveries across both urban and rural areas were assisted deliveries.

56
NIPI Baseline Report – Orissa

1
Table 4.21: Cost incurred in institutional delivery , NIPI-08

Rupees Angul Jharsuguda Sambalpur All District


Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
N 641 107 748 558 324 882 622 279 901 1,821 710 2,531
Mean 3,212 5,118 3,484 3,880 4,847 4,235 3,647 4,714 3,977 3,565 4,835 3,921
Median 2,000 2,000 2,000 2,000 2,000 2,000 2,000 2,200 2,000 2,000 2,000 2,000

The average (or mean) cost …now people are more aware…they go for hospital
incurred on institutional deliveries delivery…yes there are problems…yes doctors are
came to around Rs.3921, while the begging for money… - Kumari Pradhan, Block
median value was Rs.2000. The Chendipada, Angul
differences between urban and rural
areas were quite pronounced across all the Districts even though the median value was exactly
the same. The biggest difference in rural and urban costs was observed in Angul District where
the difference is nearly Rs.2000.

Table 4.22: Problem experienced during delivery by women 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 22 25.6 11 12.8 20 23.3 30 34.9 3 3.5 0 86 100.0
19-21 157 23.8 59 9.0 171 25.9 221 33.5 41 6.2 10 1.6 659 100.0
22-25 331 24.8 122 9.2 305 22.9 489 36.7 64 4.8 22 1.6 1333 100.0
26-30 207 25.7 81 10.0 190 23.5 277 34.3 40 5 12 1.5 807 100.0
31-40 66 25.5 26 10.0 48 18.5 102 39.4 11 4.2 6 2.4 259 100.0
41-49 1 33.3 1 33.3 1 33.4 3 100.0

Obstructed labour was one of the


major problems experienced by “…many times we have to take decision on our
almost a third of the women own…and go out to look for ANM and AWW…most
respondents had faced problems. often we are the first person to know about health
This is consistent across the age problems…and we have to take steps of…either
groups. Prolonged labour and give medicines or refer patient to doctor on our
premature labour were problems own…” – Sushma Muduli, ASHA,Village Talpatia,
faced by a quarter of the Block Laxmanpur, Jharsuguda
respondents across most age
groups.

Table 4.23: Nature of advice received after delivery by source, NIPI-08


Advice Angul Total
Doctor Nurse ANM Others %
% % % %
New born care practices 77.0 13.9 4.6 4.5 100.0
Breast Feeding 77.6 13.0 5.2 4.2 100.0
Immunization 78.7 10.2 6.6 4.5 100.0
Routine check up 83.7 8.4 3.4 4.5 100.0
Spacing method 77.6 9.6 7.2 5.6 100.0

1
Government Hospital

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NIPI Baseline Report – Orissa

Advice Jharsuguda
Doctor Nurse Ward ANM Others Total
attendant
% % % % % %
New born care practices 71.3 21.6 0.5 4.4 2.3 100.0
Breast Feeding 70.1 25.0 0.5 4.1 2.4 100.0
Immunization 71.1 34.0 0.3 5.0 1.8 100.0
Routine check up 78.4 19.0 0.3 2.7 1.4 100.0
Spacing method 69.1 70.0 1.2 3.9 2.7 100.0
Any other advice 50.0 21.0 100.0
Advice Sambalpur
Total
Doctor Nurse ANM Others
% % % % %
New born care practices 75.7 20.7 2.6 1.0 100.0
Breast Feeding 74.2 57.0 2.7 1.0 100.0
Immunization 75.7 75.0 2.7 1.0 100.0
Routine check up 79.4 20.0 1.7 0.3 100.0
Spacing method 81.8 2.9 1.4 100.0
Any other advice 60 1.0 10 100.0

75-80% of the respondents had confirmed that they had received advice post delivery of their
child and the nature of advice included newborn care practices, breast feeding, immunization,
routine checkup and spacing methods to be adopted to delay the next child. It was mostly the
resident doctor who imparted the advice. The only exception was that nurses in Sambalpur
Districts seem to have been fairly active in giving advice as well, but largely confined to issues of
immunization and breastfeeding.

Table 4.24: Mothers perception about environment of health facility and behaviour of staff, NIPI-08

Services and staff in District


Total
the health facility Angul Jharsuguda Sambalpur
% % % %
Very Poor 1.6 0.8 0.5 0.9
Poor 2.5 1.5 1.2 1.7
Average 14.7 16.2 8.5 13
Good 72.4 65.8 78.6 72.3
Very Good 8.4 14.2 11.2 11.4
DK/CS 0.4 1.5 0.7
Environment of the health facility
Very Poor 0.8 0.6 0.3 0.5
Poor 1.1 1.4 0.7 1.0
Average 25.0 19.1 10.4 17.7
Good 64.1 62.6 78.4 68.7
Very Good 8.7 16.2 10.2 11.9
DK/CS 0.3 0.1 0.2
Behaviour of the staff in health facility
Very Poor 0.8 0.7 0.3 0.6
Poor 1.1 1.3 0.9 1.1
Average 19.5 13 11.5 14.4
Good 68.2 68.7 75.5 71
Very Good 10.1 16.3 11.8 12.8
DK/CS 0.3 0.1
Total N 760 907 920 2587

Mothers who had had their delivery in a health facility were asked to provide their opinion on the
quality of healthcare that they received. Whether it be the issue of service and staff of the facility

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NIPI Baseline Report – Orissa

concerned, or the overall environment of the facility in terms of cleanliness ambiance, or the issue
of behaviour of staff, the general opinion was that ‗good‘ (as reported by 66-75% of respondents).
The mothers in Sambalpur by and large were more satisfied than those from Angul and
Jharsuguda.

4.3.4 Janani Suraksha Yojana (JSY)

The following section looks


…maximum deliveries now in hospital…this is due to
at general awareness levels
JSY…but some mothers still fear to go to hospital…some
regarding the scheme and
do not find transport…main reason is Rs.1400/- given to
whether it is influenced by
mother…no delivery facility in sub-center…refer to
the background
Jharsuguda hospital… - Sureswari Magar, ANM, Village
characteristics of the eligible
Talpatia, Jharsuguda
woman.

Table 4.25: Awareness about JSY, NIPI-08

All Districts Total


Yes No All Births
N % N % N
Age
15-18 59 84.3 11 15.7 70 100.0
19-21 564 86.4 89 13.6 653 100.0
22-25 1228 85.1 215 14.9 1443 100.0
26-30 818 84.0 156 16.0 974 100.0
31-40 290 78.6 79 21.4 369 100.0
41-49 9 64.3 5 35.7 14 100.0
Years of schooling
No schooling 915 78.5 250 21.5 1165 100.0
<5 248 83.5 49 16.5 297 100.0
5-7 538 85.1 94 14.9 632 100.0
8-9 579 88.4 76 11.6 655 100.0
10-11 331 89.5 39 10.5 370 100.0
12 & Above 357 88.4 47 11.6 404 100.0
Nature of PSU
Rural 2176 82.6 459 17.4 2635 100.0
Urban 792 89.2 96 10.8 888 100.0
Wealth Index
Lowest 1388 81.2 321 18.8 1709 100.0
Second 427 86.8 65 13.2 492 100.0
Middle 362 87.9 50 12.1 412 100.0
Fourth 314 88.0 43 12.0 357 100.0
Highest 477 86.3 76 13.7 553 100.0
Total N 2968 84.2 555 15.8 3523 100.0

Overall, 84.2% of the women respondents were aware


of the JSY program. The data reveals that more …main cause of hospital delivery
number of younger women were aware of the program is mother getting Rs.1400/-…and
than those who were in their 40s. The propagation of vehicle charges…with this money
the program does not seem to have been influenced they eat „protein‟ food and remain
by education level of the respondent and illiterates and healthy…but vehicle not available
literates alike were both aware of JSY in large on time and many women give
numbers. Awareness level in urban areas (89.2%) was birth on way… - Susubati Swain,
slightly higher than rural areas (82.6%). The ANM, Village Bhikampali, Block
differences in awareness among women belonging to Lakhanpur, Jharsuguda

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NIPI Baseline Report – Orissa

the lowest and highest wealth ownership class were quite marginal. This speaks well for the
overall effort of popularizing JSY as it seems to have penetrated all walks of life.

General „working conditions‟, as per narration of ASHA respondents


 There was not much interference from PRI or other Community leaders
 There were certain local customs like rinsing new born in turmeric and oil
 Cooperation from ANM, LHV and AWW, but not satisfactory
 Respondents reported supervision and
monitoring of their work by ANM …I had taken 16 days training last
 Respondents reported ANM commented on month…senior doctors and CDMO
their work and regularly checked their gave training…I received Rs.2850/-
‗diaries‘ and ‗records‘, it were the ASHAs after one week of the training… -
who were seen to be the last rung of Kishori Bisu, Village Rajpur, Block
information-data gathering and reporting Jharsuguda.
hierarchy
 Respondents reported ANMs told them ―what to do‘ and ―what not to do‖
 In the scheme of things ASHAs and ANMs were not found to be working as
complementing each others‘ work but rather as ANMs being senior ‗officials‘ conducting
and directing efforts of ASHAs
 Respondents aware about danger signs and symptoms of anemia and malaria
 The respondents usually equipped with a medicine box containing

1. Paracetamol
2. ORSS … We are conducting 2-3 days training
3. Chloroquine programme for ASHAs all over the District for
4. Betadine their capacity building. For Medical Officer
5. Surgical gauze regular up gradation training happens. Also
6. Cotton LHV/ SBA training, immunization training
7. Oral contraceptive pill and training for Nursing staff take place
8. Vitamin A continuously…..DMHO Sambalpur
9. Leprosy tablet

The contents and nature of the medicine box varied over area. The places near to block or
District town had better equipped ASHA medicine box, since they were replenished regularly
as per the accounts given by respondents themselves.
 Respondents also provided First Aid to children and infants
 Village health days were not found to be …ANM madam is inspecting my work
regular in most places whether I am working properly or not…I
 ANM and Community Leaders give my report to ANM madam…she
sometimes called for meetings attended analyse my report and tell me if there is
by ASHA any mistake in my work… - Bhanumati
 Respondents could not narrate Boi, ASHA, Village Pandiripather, Block
definitively about any village level health Jharsuguda.
plan

4.3.5 Training and capacity building of ASHA‟s

Under NRHM, ASHA‘s have been appointed in almost every village of the country. Main purpose
of their appointment is to provide basic advice or help households in relation to ante natal, natal
and post natal care, newborn care, immunization and family planning. In order to have a proper
understanding of all these aspects, five training modules have been designed for them and every
ASHA is supposed to get training in all these modules. As per the data provided by DPMU, about
78 percent ASHA‘s received training in Module-1 in Angul district followed by Smbalpur (67.9%)

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NIPI Baseline Report – Orissa

and Jharsuguda (52.9%). In Module-2, nearly one-third ASHA‘s are trained in Smbalpur while in
case of other 2 NIPI districts, a little over one-fifth ASHA‘s are trained.

Table 4.26: Number of ASHA‟s trained

Total Module 1 Module 2


District
Target Selected Number Percent Number Percent
Angul 1032 1032 804 77.9 228 22.1
Jharsuguda 568 567 300 52.9 120 21.2
Sambalpur 917 917 623 67.9 294 32.1
Orissa 35324 34251 20392 59.5 12715 37.1
(Source: District Programme Management Unit)

Table 4.27: Accompaniment of ASHA during Institutional delivery

All Districts
Rural Urban Total
N % N % N %
Did the ASHA accompany you?
Yes 1184 63.7 238 32.6 1422 55.0
No 604 32.5 399 54.7 1003 38.8
NA 70 3.8 92 12.7 162 6.2
Total 1858 100.0 729 100.0 2587 100.0
If no, did she reach later on?
Yes 128 21.2 49 12.3 177 17.6
No 476 78.8 350 87.7 826 82.4
Total N 604 100.0 399 100.0 1003 100.0
Why did ASHA not accompany you?
1) We did not 277 58.2 258 73.7 535 64.8
inform her
2) We informed 59 12.4 30 8.6 89 10.8
but she refused
to come along
3) She was not 79 16.6 36 10.3 115 13.9
present in the
village
4) Don't Know 30 6.3 11 3.1 41 5.0
5) Any Other 31 6.5 15 4.3 46 5.5
Total N 476 100 350 100.0 826 100.0

In 55% of the cases the ASHA had accompanied the …ASHA take pregnant women to
pregnant women to the hospital. In 17.6% of the case, medical centre…do
she had arrived later on. This essentially implies that in delivery…ANM „didi‟ do
72.6% of the cases, the pregnant women were attended immunization…help in health
by the ASHA in the institution. meeting, mothers‟ meeting and
home visit… - Gauri Dohuri,
However, it may also be noted that the absence of the AWW, Ward no. 6, Jharsuguda
ASHA was not really her conscious choice as in most
cases (64.8%), she was not informed that the patient was being taken to the facility. In less than
25% of the cases was she not present in the village at that time or she refused to accompany the
pregnant woman.

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NIPI Baseline Report – Orissa

Table 4.28: Duration of stay of the mother at health facility after delivery

Stay of Angul Jharsuguda Sambalpur All Districts


Mother Rura Urba Tota Rura Urba Tota Rura Urba Tota Rura Urba Tota
s l n l l n l l n l l n l
% % % % % % % % % % % %
<=6 Hrs 49.1 33.6 46.8 29.9 19.5 26.1 11.7 7 10.2 30.4 16.7 26.6
7-12 12.4 0.9 10.7 9.3 10.9 9.9 6.6 5.6 6.3 9.5 7.3 8.9
Hrs
13-23 1.2 1.1 1.2 2.1 1.5 1.4 1.4 1.4 1.3 1.5 1.4
Hrs
1-2 22.1 23.9 22.4 30.8 36.2 32.7 34.6 39.4 36.1 29.1 35.5 30.9
Days
3-6 7 11.5 7.6 16.6 13.7 15.5 28.6 29.3 28.8 17.3 19.5 17.9
Days
Week of 8.2 30.1 11.4 12.2 17.6 14.3 17.1 17.3 17.2 12.4 19.5 14.3
More

Most of the women in Angul District seem to have stayed in the health facility for a period of less
than 6 hours. For those who stayed longer, it was either for a day or two, or stayed for a long
stretch of time due to various complications. This phenomenon is true for both urban and rural
areas of the District.

For the other two Districts, the average duration of stay post delivery seems to have been 1-2
days in Jharsuguda and 1-6 (32%) days in Sambalpur (64%).

4.3.6 Home deliveries

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 actual 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.

Table 4.29: Reason for home delivery


Reasons District
All NIPI Districts
(multiple Angul Jharsuguda Sambalpur
responses) Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Costs too 45.6 23.1 44.1 15.3 11.0 26.9 27.1 4.3 23.0 33.2 11.0 29.5
much
Facility not 0.5 0.0 0.5 0.0 2.4 100.0 0.5 0.0 0.4 0.4 1.3 0.5
open
Too far 30.8 0.0 28.8 16.4 4.9 73.4 22.9 0.0 18.8 25.1 2.6 21.4
No trust on 1.9 0.0 1.8 1.1 1.2 26.6 0.0 0.0 1.2 0.6 1.1
facility
No one to 11.5 3.8 11.0 6.9 13.4 100.0 16.7 4.3 14.5 11.8 9.1 11.3
company
Did not get 24.1 46.2 25.6 31.2 53.7 70.1 29.5 58.7 34.8 27.3 53.9 31.7
time
No female 0.3 0.0 0.3 0.0 0.0 29.9 0.0 0.0 0.0 0.1 0.0 0.1
provider at
facility
Husband/ 2.7 7.7 3.0 0.5 6.1 100.0 4.3 0.0 3.5 2.6 4.5 2.9
family not
gave
permission
Not 23.3 34.6 24.1 43.9 23.2 100.0 18.1 32.6 20.7 26.9 27.9 27.1
necessary
No customary 0.5 0.0 0.5 1.6 0.0 0.7 0.5 2.2 0.8 0.8 0.6 0.8
Any Other 4.0 7.7 4.3 5.3 3.7 100.0 8.6 4.3 7.8 5.6 4.5 5.4
Total 373 26 399 189 82 271 9 46 256 772 154 926

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NIPI Baseline Report – Orissa

In rural areas, people preferred home deliveries either


…I have known seven
because they perceived institutional deliveries to be
deliveries…of these five were
prohibitively expensive (33.2%), did not get time to plan for
in “home”…I was not
the trip to the hospital (27.3%), felt it unnecessary because
present…two deliveries I
alternate arrangement at home was equally good if not
assisted and were in
better (26.9%) and facility too far to make the trip (25.1%).
hospital… - Puspalata Pradhan,
In urban areas, the reasons were more polarized with 54%
ASHA, Saradhapur, Block Angul,
preferring home deliveries to institutional deliveries
Angul
because of the time issue (emergency delivery) and 28%
feeling that they didn‘t feel the necessity.

The trends across the three Districts were similar except for the fact that the cost issue was a
major determinant in Angul rural.

Situating JSY in its Socio-Economic context (as narrated by health service providers,
community leaders and local officials)

Case Study: District Angul

 The District of Angul is relatively more urban when compared to Sambalpur


 There is greater density of population
 There is incidence of migrant population from other Districts as well as other states
 The District has a marked ―industrial‖ profile
 There is incidence of labour colonies and slums
 Number of deliveries happen outside the purview of ASHA intervention
 In comparison to Jharsuguda and Sambalpur where ASHA respondents reported high
incidence of institutional delivery, albeit reportedly due to cash incentive, in this District there
are still numbers of ―home‖ delivery reported by ASHA
 The high incidence of ―home‖ delivery can be seen as deliveries not accompanied by ASHA
and being independent of JSY, mainly done in private facilities by migrant population who
due to ‗domicile‘ or ‗residence proof‘ factors can not avail of JSY
 ASHA initiative impact in this District is varied and qualified by number of factors
 High density of population
 Urban nature of settlements
 ANM outreach relatively more comprehensive
 Easy access to rudimentary ‗private‘ health facilities
 Parts of District near to Orissa state capital
 Migrant nature of population qualifies the ―home approached‖ and ―community based‖ health
service delivery system of the ASHA initiative
 Respondents report they are not able to form ‗rapport‘ with local people as they are mostly
migrant and hence the ―homely‖ health service they want to give is not delivered
 Households prefer to take care of health issues on their own rather entrust mother and child
to an ―unknown‖ ASHA
 Respondents reported problems in nature of their work regarding their honorarium
 Reason may lie in the fact that the District is urban, industrialized and there is a network of
―private‖ clinics and nursing homes

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.

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NIPI Baseline Report – Orissa

Women reported Following Angul (%) Jharsuguda Sambalpur ORISSA(%)


was done at the time of last (%) (%)
delivery
On the ground with clean
30.1 17.0 23.0 24.3
clothes/plastic underneath
On the ground without
59.6 21.8 31.3 40.7
clothes/plastic.
On the cot with clean
1.8 53.9 36.7 26.7
clothes/plastic
On the cot without cloth/plastic 1.5 6.3 8.2 4.8
Don‘t remember 1.0 0.0 0.0 0.4
Others 6.0 1.0 0.8 3.1

Data reveals that only one out of four home deliveries occurring on the ground (24.3%) with clean
clothes/plastic underneath. Nearly similar proportion of home deliveries are also conducted on the
cot (26.7%) with clean clothes/plastic. But a significant proportion (40.7%) of deliveries taken
place on the ground without any cloth/plastic which is a matter of serious concern. Jharsuguda
practicing relatively better home delivery practices followed by Sambalpur and Angul.

Table 4.30: Home delivery practices

All NIPI Districts


On the ground On the ground On the cot On the cot Don‟t Other
with clean without with clean without remember
clothes/plastic clothes/plastic clothes/plastic cloth/plastic
underneath
% % % % % %
Years of schooling
No schooling 53.3 67.1 47.4 61.4 75 69
<5 10.2 7.2 11.3 2.3 0 3.4
5-7 18.7 11.9 17.4 22.7 0 10.3
8-9 10.7 10.1 17 9.1 25 13.8
10-11 4.9 2.9 4 2.3 0
12 & above 2.2 0.8 2.9 2.3 0 3.5
Location of PSU
Rural 80.9 84.4 83.4 81.8 100.0 89.7
Urban 19.1 15.6 16.6 18.2 0.0 10.3
Wealth Index
Lowest 72.9 80.3 61.1 68.2 75 75.9
Second 10.7 8.5 15.8 18.2 25 3.4
Middle 6.2 4.8 12.6 11.4 0 6.9
Fourth 5.3 4.5 5.7 2.2 0 10.3
Highest 4.9 1.9 4.8 0 0 3.5
Total N 225 377 247 44 4 29

As shown in the table 4.29 about home delivery practices, 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.

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NIPI Baseline Report – Orissa

Table 4.31: Person who conduct delivery at home

Delivery District
All NIPI Districts
Specification Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Person Conducted Delivery
Mid Wife/LHV 1.3 0.0 1.3 2.1 0.0 13.8 2.9 0.0 2.3 1.9 0.0 1.6
Trained Dai 2.9 0.0 2.8 12.7 15.9 0.3 17.6 21.7 18.4 9.3 14.9 10.3
Untrained Dai 5.9 0.0 5.5 20.6 28.0 0.0 19.0 4.3 16.4 13.1 16.2 13.6
ASHA 2.9 0.0 2.8 4.2 7.3 4.1 3.3 0.0 2.7 3.4 3.9 3.5
ANM 0.5 0.0 0.5 10.1 0.0 100.0 0.5 2.2 0.8 2.8 0.6 2.5
Family Member 63.0 76.9 63.9 25.4 15.9 28.3 35.7 32.6 35.2 46.4 31.2 43.8
Relatives/friends 25.5 30.8 25.8 10.6 14.6 0.7 13.8 23.9 15.6 18.7 20.1 18.9
Any Other 4.3 0.0 4.0 19.0 25.6 0.7 11.4 15.2 12.1 9.8 18.2 11.2
Total 373 26 399 189 82 271 8 46 256 772 154 926

Overwhelmingly in Angul District it was a family member/other relatives who performed the
delivery at home. This is across both urban and rural areas. The role of the dai (trained or
untrained) was observed to be minimal. On the other hand, in Jharsuguda and Sambalpur the
role of the Dai seems to have been as prominent as the family members with 25-35% of the
deliveries having been conducted by them in urban and rural areas respectively.

Table 4.32: Reasons behind choosing a specific person to conduct the delivery

Specification District
All NIPI Districts
Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Why did you choose the person to conduct delivery
Past 42.6 50 43.1 34.9 30.5 35.3 27.6 41.3 30.1 36.7 37 36.7
Experience
Economical 10.2 7.7 10 4.8 6.1 4.9 1.9 2.2 2 6.6 5.2 6.4
Safe Delivery 25.2 34.6 25.8 38.1 42.7 38.6 61.4 41.3 57.8 38.2 40.9 38.7
Reliable 8.3 7.7 8.3 5.3 13.4 3.6 3.3 13 5.1 6.2 12.3 7.2
Behaviour of 6.7 0 6.3 0.5 2.4 4.5 1.4 0 1.2 3.8 1.3 3.3
the service
provider
Recommended 2.9 0 2.8 3.2 2.4 0.3 1 0 0.8 2.5 1.4 2.3
Others 4.1 0 3.7 13.2 2.5 12.8 3.4 2.2 3 6 1.9 5.4
Total 373 26 399 189 82 271 8 46 256 772 154 926

The above table clearly indicates that across all three Districts and across both urban and rural
areas, the choice of a person to make the delivery is taken on the basis of past experience (37%)
or because it is clearly perceived that their experience would result in a safe delivery (39%).

The following section looks at the different steps followed during the delivery process at home by
the person who delivered the baby.

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NIPI Baseline Report – Orissa

Table 4.33: The delivery process

Specification All NIPI Districts

Rural Urban Total


% % %
Was she/he contacted before the labor pain started?
Yes 60.0 74.7 62.4
No 39.1 24.0 36.6
Don't know 0.9 1.3 1.0
Did she/he mention the requirements before attending the delivery?
Yes 45.9 47.2 46.2
No 25.0 17.0 23.1
Don't know 29.1 35.8 30.7
Did the person who attended the delivery wash his/her hands before attending the delivery?
Yes 62.7 60.4 62.3
No 26.2 22.7 25.6
Don't know 11.1 16.9 12.1
What was used for washing?
Water only 30.0 20.4 28.4
Soap 67.4 79.6 69.3
Don't know 2.3 0.0 1.9
Other 0.4 0.0 0.4
Total 484 93 577

rd
In nearly 2/3 of the instances of home deliveries, the person who had to make the delivery
happen was contacted before the labour pain had started. This was considerably higher in the
urban areas (75%) as compared to the rural areas (60%).

For all those women who could recall about the issue, most had reported that the healthcare
provider told her/family members the requirements for the delivery before attending the
household.
rd
Once again, 2/3 of the women respondents who had home deliveries could recall that the
delivery attendant did wash his/her hand before undertaking the delivery but a quarter could
clearly recall that this was not the case. Soap and water was most often used for washing and the
majority confirmed this.

Table 4.34: Cost incurred in home delivery

Rupees Angul Jharsuguda Sambalpur All District


Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
N 270 24 294 134 78 212 171 38 209 575 140 715
Mean 255 164 248 552 520 540 473 266 435 389 390 389
Median 100 100 100 500 300 400 200 200 200 200 200 200

The average (or mean) cost incurred on institutional deliveries came to around Rs.3921, while the
median value was Rs.200. The differences between urban and rural areas were not quite
pronounced in any of the Districts.

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NIPI Baseline Report – Orissa

Table 4.35: Nature of advice received

(multiple response) All Districts


Rural Urban Total
N % N % N %
New born care practices 408 52.5 97 61.0 505 54.0
Breast Feeding practices 489 62.9 104 65.4 593 63.4
Immunization 148 19.0 34 21.4 182 19.4
Routine check up 26 3.3 19 11.9 45 4.8
Spacing method 27 3.5 11 6.9 38 4.1
Any Other 2 0.3 2 0.2
No Advice was given 218 28.1 41 25.8 259 27.7

In a little over a quarter of the cases, advice was not given immediately after delivery by the
attendants. Considering that in most cases a formally trained attendant did not conduct the
delivery, receiving wrong advice from them is certainly an area of concern. This is all the more so
because 63% of the mothers had reported that they were advised on breastfeeding practices and
54% on new born care practices. Both issues are very critical during the postpartum phase and it
is advisable for the program to take cognizance of the fact that it has to ensure that even informal
and untrained attendants need to be well aware of medically sound advice.

4.4 Postnatal care

Under this section, the responding women were tested for the timing of their first PNC checkup,
number of times PNC was received, type of service provider and place where the PNC was
provided.

Table 4.36: Timings of first postnatal care

Timings District
All NIPI Districts
of First Angul Jharsuguda Sambalpur
PNC Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
<4 Hrs 8.3 7.2 8.2 11.9 21.4 15.2 24.8 52.0 32.5 14.6 30.7 18.7
4-23 Hrs 0.8 0.7 0.7 0.5 0.6 3.2 9.0 4.8 1.5 3.6 2.0
1-2 days 1.0 2.2 1.1 2.5 1.0 2.0 7.7 9.6 8.2 3.6 4.4 3.8
3-41 4.0 4.3 4.1 6.6 2.7 7.2 2.4 5.9 5.8 2.8 5.1
days 5.2
>41 0.0 0.0 0.0 2.1 0.5 0.4 0.0 0.3 0.8 0.2 0.6
days 1.5
DK/CS 0.5 0.0 0.4 0.1 0.0 0.1 1.0 0.0 0.7 0.5 0.4
No 85.4 86.3 85.5 76.1 74.0 55.6 27.0 47.5 73.2 58.2 69.4
Checkup 75.3
Total 1020 139 1159 767 411 1178 939 333 1176 2630 883 3513
*NIPI survey 08

An overwhelming a similar trend in DLHS-3 and NIPI survey showed that nearly 70% of all
responding mothers had reported that they had not received any PNC checkup. This figure was
73% in rural areas and 58% in urban areas.

There were District level variations as well. In Sambalpur urban, more than 50% had reported to
have had a PNC checkup within 4 hours of delivery and only 27% had reported not having had
any checkup.
The situation was just the reverse for rural Sambalpur. The situation in Angul was dismal with as
high as 85-86% of respondents across both urban and rural areas had reported not having
received any PNC. The situation in Jharsuguda was also bad with 75% reporting no PNC.

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NIPI Baseline Report – Orissa

Table 4.37: Number of times PNC received

PNC All NIPI Districts …I help ASHA in home visit…after


delivery…serious cases I give
Rural Urban Total medicines…I also refer important
% % % matters to ANM… - Manjulata Nayak,
1 45.0 40.9 43.6 AWW, Village Chipilima, Block Dhankuda,
2 27.9 21.4 25.7 Sambalpur
3+ 27.1 37.7 30.7
Total 706 369 1075

As given in table 4.36, less than half had received only 1 PNC but this was by and large the
majority category. Over a third had received 3 or more PNCs and around a quarter had received
only two.

Most of the PNC was provided by the healthcare personnel/doctor and in this regard, there was
marginal difference between urban and rural areas (88 - 95%) and Angul (63% each) but quite a
difference in Jharsuguda District (96 - 73%). The roles of the ANM/nurse/midwife in providing
PNC seem to have been confined to the District of Angul alone.

The PNC checkup either took place a government hospital, PHC or a private clinic. In less than
10% of the case was the PNC administered at home by trained personnel coming over.

4.5 Maternal Mortality

Maternal Mortality Ratio (MMR) in India stood at 301 per 1,00,000 live births, while the figure for
Orissa was 358 (Table 2.1c). The table shows that three surveys conducted between 1997 and
2003 show a declining trend in MMR in India whereas it is fluctuating in the case of Orissa.

Table 4.38: Maternal Mortality in Orissa and India

2 3
Source Maternal Mortality Rate Maternal Mortality Ratio
India Orissa India Orissa
1997-1998 Retrospective MMR
34.8 29.7 398 346
Survey
1999-2001 SRS Prospective
31.2 36.7 327 424
Household Survey
2001-2003 Special Survey of
27.4 29.5 301 358
Deaths
Source: Maternal mortality in India: 1997-2003: Trends, causes and risk factors (2004): Registrar General of India, New
Delhi

2
Maternal mortality rate is defined as number of maternal deaths per 1,00,000 living women in the 15-49 years age group

3
Maternal mortality ratio is defined as number of maternal deaths per 1,00,000 live births to women in the 15-49 years
age group

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NIPI Baseline Report – Orissa

Chapter 5
Newborn Care
5.1 Preamble

Care provided during the perinatal and neonatal periods is critical to ensuring the health of
mother and baby. Maternal health and newborn health are inextricably linked. Newborn Care
comprises: (a) Basic preventive newborn care such as care before and during pregnancy, clean
delivery practices, temperature maintenance, eye and cord care, and early and exclusive
breastfeeding on demand day and night; (b) Early
detection of problems or danger signs (with priority …I am higher secondary pass…I have
for sepsis and birth asphyxia) and appropriate been ANM for last 14 years…I am
referral and care-seeking. situated in my own village…my village
is also the one with sub-centre…I take
In this chapter, besides examining the trends of all responsibility in outreach station…I
infant mortality and child mortality rate, we shall also take all responsibility of ASHA and JSY
discuss about birth weight, neo-natal check-up and fund…I was trained by Dr. Behera of
understanding of breastfeeding practices among Kishore Nagar…it was intensive
women in the program Districts of Orissa. training…about breast feeding…about
new born care…but more training is
required… - Rukuni Prusty, ANM, Village
5.2 Infant Mortality Parasumal, Block Kishore Nagar, Angul

Historically, Orissa is a high infant mortality rate (IMR) state compared to other states of India,
though Infant Mortality Rate has declined drastically during the last two decades.

In 1992-93, the IMR was 112 per 1000 live births in Orissa compared to 79 for all India (NFHS-1).
According to the latest NFHS-3 (2005-06) the figure for Orissa was 65 per 1000 live births. SRS
2006 estimates the IMR of Orissa to be 73 per 1000 live births (Table 2.1a).

Table 5.1: Trends in Infant Mortality Rate of Orissa and India

Infant Mortality Rate


Source/Year
Orissa India
NFHS1 (1992-93) 112 79
NFHS2 (1998-99) 81 68
NFHS3 (2005-06) 65 57
SRS 1997 96 71
SRS 2003 83 60
SRS 2006 73 57
NRHM Goal by 2012 50 45
Source: NFHS 2 and 3, SRS Bulletin (1997), SRS (2003), SRS (2006) & State PIP (2007-08)

5.3 Child Mortality

Under 5 mortality (U5MR) in Orissa as per NFHS-3 is 91 per 1000 live births, one of the highest
in India, but U5MR has declined by about 30 percent since NFHS-1.

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NIPI Baseline Report – Orissa

Table 5.2: Trends in Under Five Mortality Rate for Orissa and India

Under 5 Mortality Rate


Source/Year
Orissa India
NFHS1 (1992-93) 131 109
NFHS2 (1998-99) 104 95
NFHS3 (2005-06) 91 75
NRHM Goal by 2012 <50 <50
Source: NFHS 2 and 3, State PIP (2007-08)

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.

One of the concern areas is the difference of indicator values from different data sources. For
example SRS figure for infant mortality in Orissa is 73 whereas, NFHS-3 (2005-06) shows an IMR
of 65.

5.4 Birth weight

It was confirmed by 76.6% of the eligible women


…I am involved in matters of respondents that their last child was not weighed
children…children are immunized at birth. The situation was the same across
…every month weight is checked and all urban and rural areas. Out of these 205 cases
rd th
3 and 4 grade new born are given where the mother could recall that weight was
THR (fortified food)…if any child falls ill measured, there were only 105 cases where this
I give medicines… - Purnabasi Sahu, could be validated through the card available
ASHA, Village Sindurpang, Block Manesar, with the household. The recorded birth weight of
Sambalpur the children as elicited through the card is
tabulated below. Since the number of cases was
limited, a decentralised analysis by background variables has not been attempted.

Table 5.2a: Recorded weight of baby

Angul Jharsuguda Sambalpur All Districts


<2.5 >=2.5 <2.5 Kg >=2.5 <2.5 >=2.5 <2.5 Kg >=2.5
Kg Kg Kg Kg Kg Kg
N % N % N % N % N % N % N % N %
*Total number of 5 33. 1 66. 1 20. 4 79. 8 21. 2 78. 2 22. 8 77.
women 3 0 7 1 8 2 2 6 9 4 4 9 1 1
 Women who showed cards.

DLHS-2 (DLHS-3 data not available) shows that about two fifth of the children in Orissa were
underweight (weight for age <-2SD), while about 15 percent were severe underweight (weight for
age <-3SD). Angul and Jharsuguda Districts follow the same pattern as of the state (Annexure
18). But the reported underweight for Jharsuguda was much lower (only 10%) and its correctness
needs to be checked. At juxtapose, NIPI Baseline Survey reported that out of the 105 cases
where the weight could be verified from the card, 22.9% were less than 2.5 kg in weight while the
rest were 2.5 kg or more. The trend is fairly similar across all three Districts where babies
weighing at least 2.5 kg ranged between 66% and 79%.

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NIPI Baseline Report – Orissa

Table 5.2b: Mother‟s perception about adequacy of size of newborn


Angul Jharsuguda Sambalpur All NIPI Districts
Size of the Rural Urban Rural Urban Rural Urban Rural Urban
baby N % N % N % N % N % N % N % N %
Smaller than 99 26.4 7 26.9 37 19.3 12 13.8 45 21.4 6 13 181 23.3 25 15.7
average
Larger than 120 32 7 26.9 57 29.7 40 46 56 26.7 6 13 233 30 53 33.3
the average
Average 149 39.7 12 46.2 96 50 34 39.1 106 50.5 33 71.7 351 45.2 79 49.7
Can not define 7 1.9 2 1 1 1.1 3 1.4 1 2.3 12 1.5 2 1.3
Total 375 100.0 26 100.0 192 100.0 87 100.0 210 100.0 46 100.0 777 100.0 159 100.0

We have already ascertained that very few babies were actually weighed at birth. However, the
research did give the opportunity to the eligible mothers to recall and record whether they though
the size of the newborn was smaller, larger or as per average.

It can be seen from the table above that overall, although nearly 50% of the mothers across
urban and rural locations thought that their babies were of average or normal size, it may be
worthwhile to note that more than a fifth of the rural mothers and around 15% of the urban
mothers did admit that they perceived their baby to be smaller than average at birth.

5.5 Neonatal checkups

Table 5.3: Timing of first neonatal check-up

Rural Urban Total


N % N % N %
<6 Hrs 823 31.2 504 56.8 1327 37.7
6-23 Hrs 49 1.9 19 2.1 68 1.9
1-2 Days 161 6.1 60 6.8 221 6.3
3-4 Day 45 1.7 13 1.5 58 1.6
5-6 Days 60 2.3 12 1.4 72 2
Week or more 96 3.6 18 2 114 3.2
DK/CS 12 0.5 1 0.1 13 0.4
No checkups 1389 52.7 261 29.3 1650 46.9
Total base 2635 100 888 100 3523 100

Over 52% in rural areas and nearly 30% in


urban areas had reported that neonatal …every mother is told about balanced
checkups did not take place in case of their diet…every mother should be aware of
newborn. In rural areas, a little over 30% of the importance of giving sufficient breast
mothers did report that neonatal checkups did feed to child…we know that any new
take place and it happened within the first 6 born below 2.5 kg weight is LBW…there
hours of childbirth. Similarly, in urban areas, a should also be proper weight according
little over 56% of the mothers did report that to age of child… - Bibhuti Meher, ASHA,
neonatal checkups did take place and it Ward no.2, Block Ramaguda, Jharsuguda
happened within the first 6 hours of childbirth.
Therefore, it is quite apparent that in the
program District neonatal checkups either did not happen or happened within the first 6 hours of
birth.

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NIPI Baseline Report – Orissa

Table 5.4: Time of first neonatal check-up by Districts


Angul Jharsuguda Sambalpur
Rural Urban Rural Urban Rural Urban
N % N % N % N % N % N %
<6 Hrs 252 24.7 65 46.8 225 29.2 198 47.6 346 41 241 72.4
6-23 Hrs 9 0.9 1 0.7 22 2.9 8 1.9 18 2.1 10 3
1-2 Days 34 3.3 8 5.8 35 4.5 23 5.5 92 10.9 29 8.7
3-4 Day 10 1 17 2.2 10 2.4 18 2.1 3 0.9
5-6 Days 14 1.4 2 1.4 33 4.3 10 2.4 13 1.5
Week or more 27 2.6 1 0.7 45 5.8 8 1.9 24 2.8 9 2.7
DK/CS 10 1 2 0.3 1 0.2
No checkups 666 65.1 62 44.6 391 50.8 158 38.1 332 39.6 41 12.3
Total base 1022 100 139 100 770 100 416 100 843 100 333 100

District wise analysis seems to indicate that the


situation in rural Angul is quite bad with 65% of …I have great help from ASHA…but to
mothers indicating no checkups. The situation is increase reach and develop more
also bad in rural Jharsuguda where 50% of awareness and create more cooperation
mothers had claimed likewise. In fact, the urban another staff (government supported) is
situation in both Districts is also quite dismal, with required… - Gayatri Chakrabarti, ANM,
nearly 45% of mothers and 38% of mothers Village Bajrakote, Block Kaniha, Angul
respectively indicating no checkups for their
newborns. The situation in Sambalpur District is
marginally better, at least in the urban locations
where only 12% had reported no checkups and 72% had reported the first check-up within 6
hours of delivery.

5.6 Breastfeeding and supplementation

This section looks at breastfeeding practices among the eligible women, the attitude and practice
pertaining to feeding of prelacteal liquids and period of exclusive breastfeeding and introduction
of supplementary feeding.

Table 5.5: Breastfeeding practices


Angul Jharsuguda Sambalpur
Rural Urban Rural Urban Rural Urban
Did you breastfeed your N % N % N % N % N % N %
child?
Yes 1018 99.6 138 99.3 763 99.1 414 99.5 832 98.7 329 98.8
No 4 0.4 1 0.7 7 0.9 2 0.5 11 1.3 4 1.2
Total 1022 139 770 416 843 333
Anybody helped in initiating the breastfeeding
Yes 709 69.6 83 60.1 535 70.1 345 83.3 704 84.6 309 93.9
No 309 30.4 55 39.9 228 29.9 69 16.7 128 15.4 20 6.1
Total 1018 138 763 414 832 329
Sources helped in initiating breastfeed
Government Doctor 240 33.9 25 30.1 150 28 155 44.9 280 39.8 140 45.3
Private Doctor 64 9 35 42.2 50 9.3 95 27.5 53 7.5 54 17.5
Nurse 51 7.2 5 6 118 22.1 34 9.9 103 14.6 51 16.5
ANM/ASHA/LHV 86 12.1 4 4.8 111 20.7 4 1.2 118 16.8 6 1.9
Dai 7 1 1 1.2 4 0.7 12 3.5 16 2.3 5 1.6
Mother/ Mother-in-law 185 26.1 10 12 70 13.1 32 9.3 105 14.9 35 11.3
Friends/Relatives 64 9 1 1.2 25 4.7 11 3.2 21 3 17 5.5
Others 12 1.7 2 2.5 7 1.4 2 0.5 8 1.1 1 0.4
Total 709 83 535 345 704 309

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NIPI Baseline Report – Orissa

Status in terms of child feeding practices in Orissa …I went to a training at


was recorded better than the country as a whole Jharsuguda…MO, BEE and BPO
and there is improvement since NFHS-2 in the discussed infant and pregnant woman
state. About 54% of the children below 3 years health issues…no…this training was
were breastfed within one hour of birth during not sufficient…we are „first health
NFHS-3. While NIPI Baseline Survey indicates worker‟…so we need more
that nearly all interviewed women had breastfed training…we should be trained in new
their child. Majority of the women (from 2/3 to
rd
born care also… -Purnabasi Jena,
94%) had admitted that someone had helped them AWW, Ward no.7, Block Lakhanpur,
out in initiating breastfeeding. Many sources have Jharsuguda.
been responsible for this initiation. In rural areas, it
has been primarily the government doctor (no doubt the same doctor who had performed the
delivery), the ANM/ASHA/LHV (12-20%) or the mother/mother-in-law or nurse.

In urban areas it has primarily been the private or government doctors, because of the
preponderance of institutional deliveries.

So far as the time of initiation of breastfeeding is concerned, baseline data reveals that of the total
mothers who have ever breastfed their child, 64 percent started breastfeeding within one hour of
birth and nearly one-fourth (23%) breastfed their child after one hour but on the same day in all
the three districts together. District wise analysis shows that Sambalpur has the highest
percentage (68%) of mothers who started breastfeeding their child within one hour of birth
followed by Jharsuguda (65%) and Angul (59%).

Figure 5.1 Time of Initiation of Breastfeeding

65 68
70 64
59
60
50
Percent

40
30 24 24 23
20
17
20 11 12 13
10
0
Angul Jharsuguda Sambalpur ORISSA
Within one hour after birth
After one hour but within same day
Mothers who have ever breastfed their child
After more than 24 hours

At this juncture, it would be worthwhile to see whether or not time of initiation of breastfeeding
was influenced by various background characteristics of the mother. The following section
elaborates.

Table 5.6: Initiation of breastfeed and gender of child

Immediately within Same day after an 1-3 days After 3 days


an hour of birth hour of birth
% % % %
Boy 63.7 22.1 11.1 2.3
Girl 63.4 23 9 3.4

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NIPI Baseline Report – Orissa

It is quite clear that gender of the child did not have any influence on the time of initiation of
breast milk.

Table 5.7: Initiation of breastfeed and education of mother

Immediately within Same day after an 1-3 days After 3 days


an hour of birth hour of birth
% % % %
No schooling 59.3 26.9 11.2 2.6
<5 65.8 16.6 13.9 3.7
5-7 67.3 22 7.8 2.9
8-9 66.9 20.8 9.4 2.9
10-11 65.8 22.3 10.3 1.6
12 & Above 65.6 19.6 9.9 4.9

From the above table it is quite clear that even education of mother was not a determinant of
initiation of breastfeeding.

Table 5.8: Initiation of breastfeed and number of live children including index child

Immediately within Same day after an 1-3 days After 3 days


an hour of birth hour of birth
% % % %
1-2 64.2 0.3 10.5 3.2
3-4 65.0 0.4 8.7 1.4
5+ 59.4 0.5 11.8 3.7

The conclusion here is in the same lines as the before. There is no relationship between the birth
order of the index child and the time of initiation of breastfeeding.

Table 5.9: Feeding of prelacteal liquids

Angul Jharsuguda Sambalpur All Districts


Rural Urban Rural Urban Rural Urban Rural Urban
N % N % N % N % N % N % N % N %
Exclusively breastfeed 6 3.4 20 27.8 4 4.3 30 8.8
Milk (other than breast milk) 43 24.7 3 17.6 16 22.2 27 47.4 30 31.9 4 9.3 89 26.2 34 29.1
Plain water 16 9.2 4 5.6 4 7 4 4.3 24 7.1 4 3.4
Sugar or glucose water 13 7.5 3 17.6 3 4.2 2 3.5 3 3.2 4 9.3 19 5.6 9 7.7
Gripe water 1 1.4 1 1.1 1 2.3 2 0.6 1 0.9
Sugar-salt-water solution 6 3.4 1 5.9 3 4.2 3 5.3 4 4.3 1 2.3 13 3.8 5 4.3
Infant formula 23 13.2 9 52.9 17 23.6 16 28.1 31 33 17 39.5 71 20.9 42 35.9
Tea 1 1.1 1 0.3
Honey 44 25.3 3 4.2 2 3.5 7 7.4 1 2.4 54 15.9 3 2.6
Janam ghutti 1 1.1 1 0.3
Other 23 13.3 1 6 5 6.8 3 5.2 8 8.3 15 34.9 36 10.5 19 16.1
Total 174 17 72 57 94 43 340 117

Milk other than breast milk (usually goat‘s milk) and infant formula were being given to neonates
by nearly a third of the mothers as part of prelacteal feed. In some locations (viz. rural Angul,
there was also a practice of feeding honey. Overall, it was observed that the practice of
introducing prelacteal liquids was practiced in both urban and rural locations.

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NIPI Baseline Report – Orissa

Table 5.10: Period of exclusive breastfeeding by background variables

< 6 months 6 months and more months


Boys 687 56.0 539 44.0
Girls 580 54.4 486 45.6
Total 1267 55.3 1025 44.7
Age of the Respondent (in Years)
15-18 21 65.6 11 34.4
19-21 234 59.2 161 40.8
22-25 504 52.9 448 47.1
26-30 368 56.4 285 43.6
31-40 134 53.4 117 46.6
41-49 6 66.7 3 33.3
Total 1267 55.3 1025 44.7
Years of schooling
No schooling 447 58.4 319 41.6
<5 121 59.6 82 40.4
5-7 214 52.8 191 47.2
8-9 243 56.4 188 43.6
10-11 124 51.5 117 48.5
12 & Above 118 48.0 128 52.0
Total 1267 55.3 1025 44.7
Number of Live Children
1-2 936 55.1 763 44.9
3-4 264 55.6 211 44.4
5+ 67 56.8 51 43.2
Total 1267 55.3 1025 44.7
Location of PSU
Rural 971 55.5 778 44.5
Urban 296 54.5 247 45.5
Total 1267 55.3 1025 44.7

Wealth Index
Lowest 653 57.4 484 42.6
Second 170 53.6 147 46.4
Middle 129 50.8 125 49.2
Fourth 140 59.1 97 40.9
Highest 175 50.4 172 49.6
Total 1267 55.3 484 44.7

In this section, we looked at the proportion of mothers who had exclusively breastfed their child
for a period of at least 6 months. For this analysis, only mothers of children beyond 6 months of
age were considered and all mothers who were currently breastfeeding but had children who
were younger were not considered.

Overall, a higher proportion of mothers had discontinued exclusive breastfeeding before 6 months
(55.3%) than those who had continued beyond 6 months (44.7%).

However, the gender of the index child was not a differentiator as far as duration of exclusive
breastfeeding was concerned. In fact, for all other background variables, viz. location of PSU,
education of mother, economic profile of family and number of live children, there seems to have
been no significant correlation or trend.

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NIPI Baseline Report – Orissa

Summary observations

It ca be said that there exists across various services an overlap of service providers. While it was
recognised by respondents of various sections, that ANMs formed the backbone of NRHM
activities, there was some lacunae in role-responsibility demarcation of the ASHA and AWW.

In Districts like Jharsuguda and Angul where urban settlement pattern was more pronounced,
there was difficulty in placing ―community‖ based service providers like the ASHA in their right
context. ASHA service for urban milieu was found, due to number of reasons achieving lower
results.

However, in urban and low ―community‖ based service oriented scenario ANM functionality was
found to have been little impacted. In fact in situations where ASHA or AWW was found limited in
their role, ANM was functioning quite satisfactorily.

As regards new born care it was found that AWWs were better suited to deliver these services in
conjunction with ANM.

It has already been stated that ANM as ‗outside‘ agency more often than not functions through
‗local‘ operatives like the ASHA or the AWW.

In situations of urban demographic profile and migrant population scenario, AWW was more
suited as ‗local‘ partner of ANM than ASHA, who in any case had little role in a ―non-community‖
service context.

ASHA role moreover has been overly qualified by their ―commission‖ basis work and in a situation
where ‗other‘ private health options are open; they have anyway very little by way of incentive to
participate in service. AWW on the other being salaried and at par with ANM in government
scheme of things, from a managerial point of view, form a more natural ally of ANM.

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NIPI Baseline Report – Orissa

Chapter 6
Child Morbidity and Treatment

This chapter provides details of the incidence of diarrhoea, ARI and fever, both period prevalence
as well as point prevalence. It also explores the treatment seeking behaviour of the mothers at
the time of illness and the nature of feeding practices during the incidence.

6.1 Prevalence of illness in children under study

The following section looks at the prevalence of child morbidity (diarrhoea and fever in last two
weeks) at the day of visit by the survey team.

Table 6.1: Prevalence of illness in children under study

Indicator Angul Jharsuguda Sambalpur All NIPI Districts


Rural Urban Rural Urban Rural Urban Rural Urban Total
% % % % % % N % N % N %
% of children with diarrhoea in last two weeks
Yes 5.5 5.0 8.4 7.5 6.9 9.0 179 6.8 68 7.7 247 7.0
% of children with fever in last two weeks
Yes 13.4 5.0 10.6 16.8 16.0 13.2 354 13.4 121 13.6 475 13.5

As according to NFHS-3, prevalence of ARI among children in India was about 6 percent while it
was about 3 percent in Orissa. Similarly for NIPI Baseline survey (NIPI 08), prevalence of ARI
among children in Orissa was reported slightly higher of 13.5 %.

About one tenth of the children less than 5 years of age had diarrhoea during the two weeks prior
to the survey at all India level while State wise figures for diarrhoea prevalence are not yet
available from NFHS-3. During NFHS-1 and 2, prevalence of diarrhea was higher than all India
average. However NIPI Baseline Survey was reported to be slightly better with about 7% of
children less than 2 years of age had diarrhoea during the two weeks prior to survey. (Table 6.1
and Table 6.2)

Table 6.2: Prevalence of illness in children under study


Orissa India
Indicator NFHS-3 NFHS-2 NFHS-1 NFHS-3 NFHS-2 NFHS-1
(2005-06) (1998-99) (1992-93) (2005-06) (1998-99) (1992-93)
Prevalence of ARI during two
2.8 22.5 10.4 5.8 19.3 6.5
weeks prior to survey
Prevalence of Diarrhoea during two
- 28.1 21.4 9.0 19.2 10
weeks prior to survey
Source: NFHS 2 and 3 (fact sheets)

6.1.1 Point prevalence of diarrhea and illness

Table 6.3 presents that overall the diarrhoea point prevalence rate (at the time of the survey
contact) was 0.7 % while illness with cough slightly higher of 1.8%.

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NIPI Baseline Report – Orissa

Table 6.3: Point prevalence of child morbidity

Morbidity Angul Jharsuguda Sambalpur All NIPI Districts


Rural Urban Rural Urban Rural Urban Rural Urban Total
% % % % % % % % %
Diarrhoea 0.9 1.4 0.5 0 0.7 1.2 0.7 0.7 0.7
Fever only 2.5 0 0.5 1.7 0.9 0.9 1.4 1.1 1.4
Cough only 1.4 0.7 0.9 3.8 2.6 1.5 1.6 2.5 1.8
Both fever and cough 2.2 1.4 1.0 0.5 1.3 1.5 1.6 1.0 1.4

6.1.2 Period prevalence of child morbidity

The period prevalence rate for diarrhoea among children was calculated as part of this study.
Overall the period prevalence rate (last 2 weeks prior to the survey contact) was 7%, which varied
between 6.8% in rural areas and 7.7% in urban areas. The period prevalence levels were highest
in Jharsuguda (8.4% rural and 7.5% urban) and lowest in Angul District (5.5% and 5.0%
respectively).

Table 6.3a: Period prevalence of diarrhoea

Angul Jharsuguda Sambalpur All NIPI Districts


Rural Urban Rural Urban Rural Urban Rural Urban Total
% % % % % % N % N % N %
% of children with diarrhoea in last two weeks
Yes 5.5 5.0 8.4 7.5 6.9 9.0 179 6.8 68 7.7 247 7.0
No 94.5 95.0 91.6 92.5 93.0 91.0 2455 93.2 820 92.3 3275 93.0
DK 0.1 1 0.0 1 0.0
Total 100.0 100.0 100.0 100.0 100.0 100.0 2635 100.0 888 100.0 3523 100.0

6.1.3 Awareness of Diarrheoa

Figure 6.1: Type of practices followed if child gets diarrheoa

53
60

50

40 29.1
30

10.9 14.2
20 10.9
4.9 6.1
10

Do not Know Give plently of fluids Salt and sugar solutions


Continue Normal food Any Other (Specify) Continue Breastfeeding
Give ORS

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NIPI Baseline Report – Orissa

Around 29% of mothers had continued to breastfeed during this process. Around 11% had made
their own salt and sugar solution and given to the child.

The propensity to give ORS to a child suffering from diarrhoea does not seem to increase with the
education of the mother as the data does not capture any definitive trend in usage.

6.1.4 Treatment of Dirrahoea

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.

Table 6.4: Advice received from ANM or health worker


All NIPI Districts
Rural Urban Total
N % N % N %
Yes 83 46.4 31 45.6 114 46.2
No 96 53.6 37 54.4 133 53.8
Total 179 100.0 68 100.0 247 100.0

Out of the 247 cases of diarrhoea in the previous 2 weeks prior to the survey contact, only 114
cases (46.2%) where the ANM or any other health worked had given advice on what needs to be
done in terms of treatment.

Table 6.5: Place of treatment


Place of Diarrhoea Treatment NIPI states
Rural Urban Total
N % N % N %
Government /Municipal 27 20.1 14 25.5 41 21.7
Government Dispensary 2 1.5 0 0 2 1.1
CHC/ Rural hospital 20 14.9 6 10.9 26 13.8
PHC 25 18.7 2 3.6 27 14.3
SC 7 5.2 0 0 7 3.7
Govt. AYUSH/Clinic 1 0.2 0 0 1 0.5
Private Ayush Hospital Clinic 7 5.2 7 12.7 14 7.4
Private Hospital/Clinic 27 20.1 21 37.3 48 25.4
Other 22 14.1 6 10 28 12.1
Total 134 100.0 55 100.0 189 100.0

According to NFHS-3, more than half (58.6%) of the children in Orissa were taken to a health
facility when they had diarrhoea in the two weeks prior to the survey. While NIPI baseline survey
reveals that the usual place for diarrhoea treatment was the government hospital. In nearly 70%
of the instances, the treatment was sought after a day or two since the beginning of the incident.

Some of the other observations pertaining to action taken during diarrhoea were as follows:
 3/4th of the women had not discontinued breastfeeding while their child was suffering from
diarrhoea. (Annexure A10)
 During the incidence, most mothers either reduced the amount of liquid given to the child or
continued to give them the same amount as normally done. (Annexure A10)
 Food intake was also reduced with 61% mothers saying they did so.
 125 out of the189 mothers whose children had diarrhoea had been given advice on treatment
and in most cases it constituted of importance of taking ORS. In most cases the advice was
given by the government doctor or the ANM/ASHA/LHV. (Annexure A10)

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NIPI Baseline Report – Orissa

6.2 Acute Respiratory Infection

6.2.1 Knowledge about pneumonia

An attempt was made to understand the awareness level of term pneumonia, and mothers
awareness on symptoms of pneumonia. This is presented in the table 6.5 and figure 2.

Table 6.6: Proportion of mothers aware of the term pneumonia

Angul Jharsuguda Sambalpur All NIPI Districts


Rural Urban Rural Urban Rural Urban Rural Urban Total
% % % % % % N % N % N %
Yes 11.0 26.6 39.4 51.0 14.1 27.3 534 20.3 340.00 38.3 874 56.0
No 89.0 73.4 60.6 49.0 85.9 72.7 2101 79.7 548.00 61.7 2649 44.0
Total 100 100 100 100 100 100 2635 100 888 100 3523 100

Apart from Jharsuguda where


“…many times we have to take decision on our
around 43% of the mothers were
own…and go out to look for ANM and AWW…most
aware of the term pneumonia (51%
often we are the first person to know about health
in urban areas), in the other two
problems…and we have to take steps of…either
Districts awareness was much
give medicines or refer patient to doctor on our
lower, ranging between 13 and
own…” – Sushma Muduli, ASHA, Village Talpatia,
18%. The awareness in rural areas
Block Laxmanpur, Jharsuguda
in general was very low, as low as
11% in Angul District.

Figure 6. 2: Awareness of symptoms of pneumonia

90
80 Difficulty in Breathing

70 Chest Indrawing
60 Not able to take feed
50 Exclusive Drowsy
40 Pain in chest
30 Condition gets worst
20 Wheezing
10 Rapid Breathing
0 Others
Rural Urban Total

Of those who were aware of pneumonia, most (77%) knew that it was accompanied by difficulty
in breathing, pain in the chest (56.4%) and not able to take feed (36%).

Prevalence of ARI has reduced considerably from 19.3% to 5.8% in India during NFHS-2 and
NFHS-3. In Orissa, it has reduced from 22.5% to 2.8% during the same time period.

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NIPI Baseline Report – Orissa

Table 6.7: Prevalence of ARI during 2 Weeks prior to survey

Orissa India
Indicator NFHS-3 NFHS-2 NFHS-1 NFHS-3 NFHS-2 NFHS-1
(2005-06) (1998-99) (1992-93) (2005-06) (1998-99) (1992-93)
Prevalence of ARI during two
2.8 22.5 10.4 5.8 19.3 6.5
weeks prior to survey
Source: NFHS 2 and 3 (fact sheets)

Prevalence of pneumonia in rural areas of the program Districts combined was 3.9% (ever
suffered) while it was 3.3% in the urban areas.

Overwhelmingly almost everyone had consulted a qualified doctor for treatment of their child.
(see the table below)

Table 6.7: Treatment of pneumonia

Angul Jharsuguda Sambalpur All Districts


Sought treatment
Rural Urban Rural Urban Rural Urban Rural Urban Total
N % N % N % N % N % N % N % N % N %
Yes 39 81.3 4 8.3 36 64.3 17 30.4 21 72.4 5 17.2 96 72.2 26 19.5 122 91.7
No 4 8.3 1 2.1 2 3.6 1 1.8 2 6.9 1 3.4 8 6.0 3 2.3 11 8.3
Total 43 89.6 5 10.4 38 67.9 18 32.1 23 79.3 6 20.7 104 78.2 29 21.8 133 100
Percentage distribution of women who seek treatment by
Doctor (MBBS) 37 86.0 4 9.3 36 67.9 17 32.1 20 76.9 5 19.2 93 76.2 26 21.3 119 97.5
ANM/Nurse/LHV 1 2.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1 0.8 0.0 0.0 1 0.8

Chemist shop 1 2.3 0.0 0.0 0.0 0.0 0.0 0.0 1 3.8 0.0 0.0 2 1.6 0.0 0.0 2 1.6
Total 39 90.7 4 9.3 36 67.9 17 32.1 21 80.8 5 19.2 96 78.7 26 21.3 122 100

6.3 Fever

6.3.1 Illness with fever and cough and treatment seeking behaviour

Table 6.8: Incidence of fever and cough among children in last 2 weeks prior to survey contact

Angul Jharsuguda Sambalpur All NIPI Districts


Rural Urban Rural Urban Rural Urban Rural Urban Total
% % % % % % N % N % N %
Yes 13.4 5.0 10.6 16.8 16.0 13.2 354 13.4 121 13.6 475 13.5
No 86.6 95.0 89.4 83.2 84.0 86.8 2,281 86.6 767 86.4 3,048 86.5
Total 100 100 100 100 100 100 2,635 100.0 888 100.0 3,523 100.0

The period prevalence rate for fever/cough among children was calculated as part of this study.
Overall the period prevalence rate (last 2 weeks prior to the survey contact) was 13.5%, which
varied between 13.4% in rural areas and 13.6% in urban areas. The period prevalence levels
were highest in Jharsuguda urban (16.8%) and lowest in Angul District urban (5%).

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NIPI Baseline Report – Orissa

Table 6.9: Duration of treatment sought during illness

All NIPI Districts


Rural Urban Total
N % N % N %
2 days ago 71 20.1 23 19.0 94 19.8
3 - 4 days ago 59 16.7 38 31.4 97 20.4
5 - 6 days ago 55 15.5 8 6.6 63 13.3
Week or more than a week 169 47.7 52 43.0 221 46.5
354 100.0 121 100.0 475 100.0

Nearly half of the children had suffered from their bought of fever/cough for at least one week and
80% had suffered for more than 3 days. (Annexure A12)

36% of the mothers had reported that during this period, their child had chest congestion while
33% had reported that they had both chest congestion as well as a runny nose. Only 16% had
reported of runny nose as the only outward manifestation of the ailment.( Annexure A13)

In 78% of the cases, the medicine for treatment came from the doctor himself/herself while only
around 9% had procured the medicine directly from the chemist shop. (Annexure A12)

85% had reported that they did not face any problem in procuring the prescribed medicine.

ASHA with her medicine kit at „service‟ of ANM

 Respondent ASHAs aware about danger signs and symptoms of


anaemia
malaria
pneumonia
diarrhoea
 Respondents also provided First Aid to children and infants
 The respondents were usually equipped with a medicine box containing
 paracetamol
 Ors
 Chloroquine
 Betadine
 surgical gauze
 cotton
 Oral contraceptive pill
 Vitamin A
 Leprosy tablet

It was the usual case to find multiple service providers in the same area, viz., ASHA and AWW,
yet much left to be desired of the help received by mothers and infants.

While AWW was busy with taking care of the children under her supervision, ASHA was not
aware of any emergency that might have come to notice of AWW.

And it was vice versa, when ASHA came to know of any critical case, she also waited for ANM to
refer her case to, with AWW remaining in the dark

6.3.2 Feeding practices during illness with fever/cough

68% of the mothers in the rural areas had reported that they had reduced liquid intake for their
child during their bout of illness with fever/cough, while 26% had not done so. This was similar in

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NIPI Baseline Report – Orissa

urban areas where 65% of the mothers had reported reducing liquid intake for their child.
(Annexure A11)

The situation with food intake was almost exactly similar. Here 66% of the mothers in the rural
areas had reported that they had reduced food intake for their child during their bout of illness
with fever/cough, while 26% had not done so. This was similar in urban areas where 63.5% of the
mothers had reported reducing food intake for their child. (Annexure A11)

6.3.3 Care seeking practices during illness with fever

The following section looks at various facets of treatment …there should be stock of medicines
and preventive measures having been taken, money spent in sub-centre…all vaccines should
on treatment and problems faced if any in getting the always be in stock…the BP and
desired treatment for the child. Overall, 85% of the weight machine should be in working
mothers had confirmed that their child was being given order…- Bilasini Nayak, ANM, Village
medicines for their illness. 77% had conformed that they Banharpuli, Block Lakhanpur,
had started giving medicines within 24 hours of detecting Jharsuguda
the illness. (Annexure A15)

Figure 6.3: Preventive measures taken for avoiding child sickness

70
60
50
40
30
20
10
0
Rural Urban Total

Mosquito Net Purified Drinking Water Keep the baby covered Others
Among those families who had taken their child to a
“…there is no fund or advance health facility/health care provider for
separately for us to conduct our treatment/diagnosis, 68% in the rural areas and 88% in
day to day activities, …if we are the urban areas had reported that they had not faced
given funds we can manage it very any problem in the process. (Annexure A14)
well, …only meetings are held but
we are given no funds to mange 48% in rural areas and 42% in urban areas had spent
on our own…” – Sandhyarani between Rs.200 to less than Rs.100 for treatment of
Nayak, ASHA, Village their child. 31% in rural areas and 37% in urban areas
Burokhamunda, Block Jharsuguda. had spent between Rs.201 and Rs.500. The rest had
either spent more or not spent any money at all.
(Annexure A16)

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NIPI Baseline Report – Orissa

Summary observation

The nature of emergency health situations faced by mothers and new born by way of disease and
other morbidity issues, demand that there be some unified and concerted effort on part of all
service providers.

As has already been seen that lack of coordination at the village level health workers often leads
to available medical help not reaching the mother and child.

The role of ASHAs particularly in the rural areas needs to be made more comprehensive and
inclusive. This service provider must be pulled out of its fast attaining stigma of being
―commission‖ based health worker.

Regular salary and some fund assistance could make the ASHA village level dedicated single
point health ‗vendor‘ for numerous health initiatives and true ‗junior‘ partner of the ANM. This
latter health service in this preset study time and again expressed the desire to be treated as a
quasi medical professional and not just as a nurse or ‗qualified‘ ―dai‘.

Augmenting the prestige and role responsibility of the ANM in conjunction with regularisation of
the services of ASHA can go a long way in ensuring reliable and steady health services to the
people.

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NIPI Baseline Report – Orissa

Chapter 7
Child Immunization

7.1 Preamble

The immunisation of children against six serious but preventable diseases namely, tuberculosis,
diptheria, pertusis, poliomyelitis and measles is the main component of the child survial
programme. As part of the National Health Policy, the National Immunization Programme is being
implemented on a priortiy basis. The Government of India initatied the expanded Programme on
Immunisation (EPI) in 1978 with the objective of reducing morbidity, mortality and disabilties
among children from six diseases.

The universal Immunisation Programme(UIP) was introduced in 1985-86 with the objective of
covering at least 85 percent of all infants agaisnt six vaccine prevalentable diseases by 1990.
This scheme was been introduced in every District of the country.The standard immunisation
schedule developed for the child immunization programme specifies the age at which each
vaccine should be administrated and the number of doses to be given. Routine vaccinations
received by infants and children are usually recorded on a vaccination card that is issued for the
child.

7.2 Vaccination coverage

This section provides the coverage details of different vaccinations including Polio ‗0‘, BCG, Polio
‗1‘, ‗2‘ and ‗3‘, Measles and Vitamin A and whether or not coverage varies across Districts, by sex
of the child, by location of the PSU, by the child‘s birth order or even by the education of the
mother. For this analysis, we had taken children who were 12-23 months of age and the evidence
is entirely through service records, i.e. Immunization card available with the household
concerned.

Table 7.1: Percent of households having vaccination cards on the day of survey, NIPI-08

Angul Jharsuguda Sambalpur All Districts


Rural Urban Rural Urban Rural Urban Rural Urban Total

% of Vaccination card N % N % N % N % N % N % N % N % N %
at the time of survey
Yes (card seen) 700 66.7 117 83.6 621 79.3 354 83.1 691 79.9 281 82.4 2,012 74.6 752 82.9 2,764 76.7
Yes (card not seen) 213 20.3 19 13.6 134 17.1 62 14.6 148 17.1 54 15.8 495 18.4 135 14.9 630 17.5
No card 136 13.0 4 2.8 28 3.6 10 2.3 26 3.0 6 1.8 190 7.0 20 2.2 210 5.8
Total # of children 1,049 100. 140 100 783 100. 426 100.0 865 100 341 100.0 2,697 100.0 907 100 3,604 100

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NIPI Baseline Report – Orissa

Table 7.2: BCG and Polio „0‟ coverage by background variables, NIPI-08

BCG Polio 0
Districts N % N %
Angul 370 98.4 184 48.9
Jharsuguda 441 98.4 256 57.1
Sambalpur 441 97.8 198 43.9
Sex of the Child
Boy 658 98.2 350 52.2
Girl 594 98.2 288 47.6
Location of PSU
Rural 921 98.2 421 44.9
Urban 331 98.2 217 64.4
Births order of Child
1 545 98.6 292 52.8
2-3 558 98.1 271 47.6
4-5 119 98.3 57 47.1
6+ 30 93.8 18 56.3
BCG Polio 0
Years of schooling of mother N % N %
No schooling 396 96.8 183 44.7
<5 120 98.4 49 40.2
5-7 211 99.1 102 47.9
8-9 247 98.8 122 48.8
10-11 133 98.5 77 57.0
12 & above 145 99.3 105 71.9

In all the sampled districts as high as 98 percent children received BCG but Polio ‗0‘ coverage
was near about 50%. The coverage of Polio ‗0‘ was highest in Jharsuguda (57%) but much lower
in Sambalpur (44%) and Angul (49%).

Coverage of Polio 0 was marginally higher among boys than girls but not significantly slow to
conclude in favour of any gender bias in coverage. Polio 0 coverage in urban areas is a good 20
percentage points more than in rural areas.

The birth order has not had any influence on coverage of either vaccines but the education of
mother seems to be definitely influenced by it with coverage of Polio 0 steadily increasing with the
number of years of schooling undergone by the mother.

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NIPI Baseline Report – Orissa

Table 7.3: Polio vaccine coverage by background variables

OPV 1 OPV 2 OPV 3


Districts N % N % N %
Angul 364 96.8 353 93.9 334 88.8
Jharsuguda 440 98.2 438 97.8 430 96.0
Sambalpur 444 98.4 433 96.0 413 91.6
Sex of the Child
Boy 661 98.7 647 96.6 621 92.7
Girl 587 97.0 577 95.4 556 91.9
Location of PSU
Rural 919 98.0 904 96.4 872 93.0
Urban 329 97.6 320 95.0 305 90.5
Birth order of Child
1 541 97.8 532 96.2 520 94.0
2-3 557 97.9 545 95.8 519 91.2
4-5 120 99.2 117 96.7 109 90.1
6+ 30 93.8 30 93.8 29 90.6
Years of schooling
None 394 96.3 383 93.6 357 87.3
<5 122 100.0 118 96.7 114 93.4
5-7 209 98.1 202 94.8 196 92.0
8-9 248 99.2 248 99.2 242 96.8
10-11 134 99.3 133 98.5 132 97.8
12 & above 141 96.6 140 95.9 136 93.2

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. Relatively speaking, there is a coverage leakage of OPV
3 to the tune of 11.2% in Angul and around 8.4% in Sambalpur District.
Table 7.4 : Child Immunisation Coverage in NIPI Districts, Orissa

Orissa Angul Jharsuguda Sambalpur


Full immunisation 62.4 62 78.3 70.5
BCG 94.2 97.3 97.9 98.7
Polio 3 78.8 85.6 88.4 82
DPT 3 74.3 74.9 82.1 81.8
Measles 81.1 89.2 93.7 86
Percentage received at least one dose of 71.6 78.3 78.3 77.6
Vitamin A
BCG and measles and 3 doses of polio and DPT
Source: District Level Household Survey (2007-2008)

DLHS-3 shows that nearly three fourth of the children received all three doses of DPT vaccination
in Orissa while equal doses of DPT was recorded in Jharsuguda (82%) and Sambalpur (82%).
Consequently a slightly lower coverage of DPT vaccination was observed in Angul (all three
doses of DPT vaccination.) (See table 7.4).

As compared to Phase II, DPT coverage is also fairly high but drops progressively from dose 1 to
dose 3. Once again, highest coverage was observed in Jharsuguda (even DTP 3 coverage was
96%) and lowest was in Angul District. In fact, dropout was also observed to be the highest in
Angul (from 96.6% dose 1 to 88.8% dose 3).

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NIPI Baseline Report – Orissa

Table 7.5: DPT vaccine coverage by background variables

DPT 1 DPT 2 DPT3


Districts N % N % N %
Angul 363 96.5 351 93.4 334 88.8
Jharsuguda 440 98.2 437 97.5 430 96.0
Sambalpur 443 98.2 433 96.0 413 91.6
Rural 917 97.8 902 96.2 869 92.6
Urban 329 97.6 319 94.7 308 91.4

The rural urban difference in coverage of DPT was observed to be minimal.

Table 7.6: Coverage of Measles vaccine and Vitamin A by background variables


Measles Vitamin A
Districts N % N %
Angul 235 62.5 205 54.5
Jharsuguda 386 86.2 365 81.5
Sambalpur 363 80.5 345 76.5
Sex of the Child
Boy 526 78.5 490 73.1
Girl 458 75.7 425 70.2
Location of PSU
Rural 720 76.8 691 73.7
Urban 264 78.3 224 66.5
Births order of Child
1 452 81.7 403 72.9
2-3 427 75.0 412 72.4
4-5 84 69.4 80 66.1
6+ 21 65.6 20 62.5
Years of schooling of mother
Illiterate 273 66.7 258 63.1
<5 93 76.2 91 74.6
5-7 163 76.5 159 74.6
8-9 200 80.0 183 73.2
10-11 123 91.1 112 83.0
12 & above 132 90.4 112 76.7

There was considerable variance in coverage of measles vaccine and Vitamin A, not only across
Districts but also across different background characteristics of the mother. For both measles and
Vitamin A, the performance of Angul District was poor (62.5% measles vaccine coverage and
54.5% Vitamin A coverage). In comparison, the coverage of both in Jharsuguda and Sambalpur
were close to 80% or above.

Incidence of full coverage did not vary significantly with the location of the PSU except for the fact
that coverage of Vitamin A in urban areas was a good 7 percentage points lower than rural. It
also did not vary much with the gender of the index child.

Interestingly, the coverage did vary with birth order with mothers for whom this was the first child
tended to be more particular about immunization coverage (81.7% measles vaccine coverage
and 73% Vitamin A coverage) than those for whom this was the fourth child or more (69.4% and
62.5% respectively). This essentially implies that younger mothers tend to be more aware of
immunization routines and took their child for vaccination more regularly than those who were
older.

Coverage also varied significantly with education of mother with only 67% of the illiterate mothers
th
having children with measles vaccine as against mothers who were educated beyond the 10
standard (over 90% coverage).

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NIPI Baseline Report – Orissa

Table 7.6a: Immunization coverage – all basic vaccines

Districts N %
Angul 229 60.9
Jharsuguda 377 84.2
Sambalpur 350 77.6

All basic vaccines cover the following:

 BCG
 DPT 1, 2 and 3
 OPV 1, 2 and 3
 Measles

NFHS-3 shows that more than half (52 percent) of the


children of 12-23 months were fully immunised in Orissa. …JSY very useful in our
The immunisation figures for Orissa are better than the area…sometimes mothers do
national average. It is also noted that there is a steady not call me…they go on their
increase in the immunisation coverage over the last two own to hospital…mothers get
decades. Rs.1000/- for delivery…for this
JSY very popular…I am however
always with ANM madam in
Overwhelmingly, NIPI baseline survey shows that the full immunization program… -
immunization coverage varied considerably among the Pramila Kashyap, ASHA, Ward no.
three program Districts with Jharsuguda having the best 3, Jharsuguda
performance (84.2%) and Angul having the worst (60.9%).

Incidence of full coverage did not vary significantly with the location of the PSU with rural
coverage being 74.7% and urban, 75.7%. It also did not vary much with the gender of the index
child with the differences between full immunization coverage of a boy and a girl child being only
2.4% in the entire sample of children who were 12 to 23 months of age.

Interestingly, the coverage did vary with birth order with mothers for whom this was the first child
tended to be more particular about immunization coverage (79% coverage) than those for whom
this was the fourth child or more (67.8% to 62.5%). This essentially implies that younger mothers
tended to be more aware of immunization routines and took their child for vaccination more
regularly than those who were older.

Coverage also varied with education of mother with only 65% of the illiterate mothers having
th
children fully immunized as against mothers who were educated beyond the 10 standard (87-
90% coverage).

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NIPI Baseline Report – Orissa

Table 7.7: Place of immunisation received


Place of vaccination Angul Jharsuguda Sambalpur NIPI Districts

N % N % N % N %
In- Laws Home 10 6.9 4 3 14 2.8
Parents Home 1 0.5 2 1.4 3 0.6
Other Home 1 0.7 1 0.2
Government/Municipal Hospital 5 2.3 9 6.3 16 11.9 30 6.1
Government Dispensary 2 1.4 1 0.7 3 0.6
UHC/UHP/UFWC 2 1.4 1 0.7 3 0.6
CHC/Rural hospital 1 0.5 4 2.8 2 1.5 7 1.4
PHC 5 2.3 7 4.9 14 10.4 26 5.3
Sub Center 18 8.4 29 20.1 49 36.6 96 19.5
NGO/Trust hospital/Clinic 1 0.7 1 0.2
Govt/AYUSH.Hospital/ Clinic 1 0.5 1 0.2
Private hospital/Clinic 8 3.7 6 4.2 7 5.2 21 5.1
Other 176 81.8 71 56.1 40 33 287 60.2
Total 215 100.0 144 100.0 134 100.0 493 100

Table 7.7 shows the place at which most of childhood vaccinations received in programe Districts
were other health facilities. About 6% of children were immunized at the government and
municipal hospital. Further, among the children immunized, 20% of them were immunized from
the Sub Centre, 5% from Public Health Center and 2 % 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.

Table 7.8: Problems faced by mother/community in vaccinating the child

DISTRICT
Angul Jharsuguda Sambalpur
Total Total Total
N % N % N %
No time from daily wage work 42 3.6 11 0.9 31 2.6
Distance of Health Facility/ Vaccination Centre 88 7.6 41 3.5 47 4
Irregular presence of health professional 20 1.7 29 2.4 14 1.2
Non- availability of vaccines 12 1 38 3.2 60 5.1
Don't Know / Can‘t say 82 7.1 19 1.6 42 3.6
No Problem Faced 922 77.4 1,043 87.1 987 82.9
Any other 22 1.6 16 1.3 7 0.6
Total 1,161 100.0 1,186 100.0 1,176 100.0
Multiple responses

Despite less than optimal coverage, the mothers did not perceive to be facing in problem in getting their
child vaccinated. To a small extent, distance to health facility was cited as a deterrent in Angul.

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Summary Observation: Role of ASHA in Immunization enhanced in ‗urban‘ context

There was some distinction between ‗rural‘ ASHA and those functioning in ‗urban‘ settlements.
 The latter had more of a role in assisting the ANM, since the ANMs themselves were well positioned
and easily accessible to the people in urban areas.
 The major roles were that of arranging for immunization camps and maintain certain ‗birth‘ and
‗pregnancy‘ diaries and registers.
 Accompaniment with mother for institutional delivery and involvement in ANC or PNC work was limited

Table 7.9: Dropout rate

OPV2 – OPV1 OPV3 – OPV2 DPT2 – DPT1 DPT3 – DPT2


% % % %
Angul -5.1 -5.1 -4.6 -4.6
Jharsuguda -1.8 -1.8 -1.5 -1.5
Sambalpur -4.4 -4.4 -4.4 -4.4

The incidence of immunization coverage was incumbent upon mobilisation actually effected on
days of ‗camps‘. It has been observed that ANM being the nodal agency and that she had to
function through help and support garnered from ‗local‘ service providers. Though figures for
Sambalpur and Angul coincide but reasons for their respective rates of drop out are very different.

In Sambalpur, distance and remoteness of village sub-centres was a major factor affecting
government initiatives.

In Angul the semi-urban nature of the District and heterogeneity of population was important
along with the fact that the District was nearest to state capital, Bhubaneswar, and there were a
number of ‗other‘ private options available outside the government initiative.

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NIPI Baseline Report – Orissa

Chapter 8
Status of Health Facilities and Health Management Information
System (HMIS)
8.1 Introduction

The Ministry of Health and family welfare, Government of India was implementing Maternal and
New born Care program in the country. Under this program a range of maternal and newborn
care services were being provided through a network of government health facilities. The
program also aims to strengthen health infrastructure in terms of trained staff, equipment and
supplies to enable the facilities to provide good quality MNC services.

The purpose of facility survey, NIPI intervention Districts were to understand the status of health
facilities at all the levels.

8.2 Status of District hospital (DHs)

In the hierarchical health care system of the Government of India in a District, the District hospital
was the apex body, which provides specialized health care services to people on subsidized
costs. Every District was expected to have a District hospital. The information collected and
analyzed in this section relates to 3 District hospitals of Orissa.

8.2.1 Physical Infrastructure

Physical infrastructure was comparatively good for the 3 NIPI District. All three had a separate
government building with 24-hour water supply. All the District hospitals had three-phase
electricity connection. But the standby facility in the form of generator was available only in two
hospitals. All the three District hospitals had functional toilet facility separately for male and
female.

In two hospitals not all sections of the hospital were connected by phone. All the DHs had at least
one vehicle and one ambulance.

8.2.2 Staff in Position

Senior doctors, specialists, GY/OB and anesthetist were in position in all the District hospitals.
While number of general duty doctors and junior doctors was insufficient.

Similarly most of the sanctioned posts of various staff, such as staff nurses, ANM and Midwife for
conducting deliveries were filled and available at the time of interview.

8.2.3 Laboratory facility and other infrastructure at District hospital

The investigative and laboratory facility were available in all the District hospitals. Apart from this
two X-ray and ultrasound facilities were also available in all 3 Districts.

8.2.4 Availability of Beds

In all, there were 7 wards in three DH, number of wards vary between all District hospitals. There
were about 250 beds in 3 hospitals. These were 98 in Angul, 62 in Jharsuguda and 90 in
Sambalpur. The maximum number of beds found in a single unit was 30 beds. In other hospitals
the number of beds varies between 41 in one and 105 in another hospital. All the hospitals had
separate female and pediatric wards. The occupancy rate of maternity beds was quite high in
past 6-7 month; this may be because of JSY or increase in awareness level of general

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community. On the other hand the occupancy rate of pediatric beds was very low in past 6
months.

8.2.5 Operation Theater

OT was available for major surgeries and separate Labour rooms for conducting deliveries.

8.2.6 Neonatal equipments and Nursery services

Data was collected on the ground status about availability of critical child health units and nursery
facility available in the Districts hospitals. Incubator, radiant warmer and emergency resuscitation
kit was available in all the hospitals for newborn care.

8.2.7 Emergency Obstetric Care and MCH facility

All the District hospitals had 24-hour obstetrician/gynecological, amethyst, nurse available for
emergency obstetrics services, along with this all the hospitals provide 24 hours surgical
intervention.

All the District hospitals had essential facility available for normal and assisted delivery, other
gynecological disorders and treatment for low birth weight children.

As given in Indian Public Health Standards (IPHS) all the District hospitals have sufficient number
of human resources (both clinical and paramedical). The operation theater and labour rooms are
adequate and have all essential instruments.

All the laboratories are working in proper way as per IPH standards.

For details of facility survey conducted among District Hospitals in all three NIPI Districts, please
refer to Table A6 – A17 given in Annexure Tables.

8.3 Status of Community Health Centre (CHCs)

Though not designated as such, community health centres were also first referral units where
referral cases from lower level health care establishments were sent. The CHCs had to take care
of these cases besides their usual health care activities. One CHC from each District was
selected for the study.

8.3.1 Infrastructure

All the three CHCs were in the government building with regular supply of water and electricity.
All the CHCs had functional toilet facility separately for men and women.

8.3.2 Staff Position

In the all the CHCs, General surgeon, Physician, GYOB and General Medical officer were in
position. Along with them public health program managers were also found in place.

Similarly staff nurses, ANM and midwife were in position and on contract also. Post of
pharmacist, radiographer and dresser were filled with adequate number of staff. Staff and ANM
were available around the clock, while gynecologist and anesthetist were available on call in case
of emergency.

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8.3.3 Training

In last five years staff from all the CHCs received training on various topics like NSV, HIV/ AIDS
prevention, new born care and integrated management of neonatal and childhood illness.

8.3.4 Operation Theatre (OT) and Equipment

Availability of all essential equipments required for surgical and non-surgical treatment was also
investigated as part of the facility survey and the result are provided in the Annexure to this
report.

8.3.5 MCH services

All the CHCs had 24 hours obstetrician/gynecological, amethysts, nurses available for emergency
obstetrics services, along with this all the hospitals provide 24 hours surgical intervention.

All CHCs organized regular ANC, PNC and Child immunization camps, apart from this treatment
for other gynecological disorder and MTP was also available for women.

8.3.6 IPH standards

As per IPHS all CHCs are working in proper ways, number of human resources (clinical and
paramedical staff) adequate in numbers. There is shortfall of essential instrument and medicine
was observed during the survey.

The condition of labour rooms and OT were good, all the CHCS have lab facility as the IPHS
norms.

For details of facility survey conducted among CHCs in all three NIPI Districts, please refer to
Table A18 – A39 given in Annexure Tables.

8.4 Status of Primary Health Centre (PHCs)

The primary health centres had 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 in patient and out patient services.
Compared to DHs and sub-divisional Hospitals, PHCs were accessible to a larger population.
However, just the availability of PHCs was not sufficient for the effective delivery of these
services. They should also have essential infrastructure, staff, equipment and supplies.

In all the NIPI intervention Districts of Orissa, 20 PHCs were covered under the survey.

8.4.1 Physical Infrastructure/facilities

Except one PHC all the surveyed PHCs had their own buildings, out of 20, 17 PHCs had pucca
buildings, whereas remaining 3 had semi pucca buildings respectively.

Almost in all the PHCs there was supply of water for 24 hours. In all 12 PHCs got supply of water
through own bore well, while in remaining PHCs water was provided by block irrigation
department.

Regular supply of electricity was observed in 15 PHCs, while 3 PHCs received 12 hours of
electricity supply. However 2 PHCs had no electricity connection.

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NIPI Baseline Report – Orissa

16 PHCs had toilets facility; out of this 7 PHCs had separate toilets for male and female. The
remaining PHCs did not have this facility. Among the PHCs most of the units had pit toilets.

8.4.2 Staff position

The survey also assessed the availability of medical and paramedical staff of various categories
and their service training status. It was found that most of the sanctioned posts of medical officers
in all the PHCs were filled. In all 3 medical officers each from 20 across PHCs got training on
Integrated Skill Development training under RCH program, and one MO each from the 20 PHCs
received training on medical termination of pregnancy.

Public health nurses and Staff nurses were in position in 13 PHCs, while ANM were found in
position in 9 PHCs. Most of them received in –service training during the last 5 years in IUD
insertion, MTP and skill birth attendant. 6 male health workers in all PHCs were found in position
at the time of survey.

8.4.3 Operation Theater and Labour room

Operation Theater was available and functional in 11 PHCs, while 15 PHCs had separate well-
equipped Labour room facility. In 4 PHCs fumigation was being done regularly. Separate ANC
clinic, was available in 16 PHCs respectively and in all these PHCs rooms were being utilized for
the purpose they were meant for.

8.4.4 Equipment (Drug Kits)

It was found that Kit A, B, C and D had been available and functional in 5 PHCs only. Kits for
essential obstetric care were supplied in 4 PHCs respectively. Normal delivery kit and vacuum
assisted delivery kit was found in 18 and 13 PHCs respectively. Incubator was available in only
one PHC.

The immunization vaccines such as BCG, DTP, OPV measles, DT and TT were available in
sufficient quantity in all the PHCs. These were directly procured from the concerned CHCs by
ANM on the day of immunization.

Prophylactic drugs and other items such as IFA tablets, vitamin A (syrup), ORS packets and
contrimaxazole tablets were available in sufficient quantity in all the 20 PHCs. The supply of
these items was reported to be regular. ANM directly procure these from the concerned CHCs
and distribute them further in their respective areas.

8.4.5 Furniture

Essential furniture like, examination table, delivery table, wheel chair, stretcher trolley was
available in 14 out of 20 PHCs, while oxygen trolley was available in 11 PHCs only. However 17
PHCs had iron beds available for in-patient, though the numbers of beds was not sufficient in any
of the PHC.

8.4.6 IPH Standards

As we know PHCs are basic public health units for rural community, where people get treatment
from trained medical professionals. The surveyed PHC‘s did not have sufficient number of staffs.
The medicine and medical instruments were inadequate in numbers.

Most of PHCs have Labour rooms as per IPHS, but absence of electricity is major concern.

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NIPI Baseline Report – Orissa

For details of facility survey conducted among PHCs in each NIPI District, please refer to Table
A40 – A50 given in Annexure Tables.

8.5 Status of Sub Centre (SCs)

Sub-centers were the most peripheral health institutions catering to the health care needs of the
rural population. It was the most peripheral contact point between the Primary Health Care
system and the community. It was manned by one multipurpose worker (male) and one
multipurpose worker (female)/ANM. This section presents the findings of 90 SCs from three
Districts of Orissa.

8.5.1 Coverage of SCs

Total of 90 SCs were surveyed for the study, in which 44 SC were in government building, 10 in
rented building and remaining 36 were in rent free panchayat building. Only 50 % of SCs had
regular water and electricity supply.

8.5.2 Staff

All the surveyed SCs had ANM, female health worker and male health workers; most of the
ANMs were serving from 5 to 10 year in particular area. As part of regular activities all the ANMs
went for regular visits in the villages for immunization and for ANC and PNC checkups.

It was found that only 15 % of ANMs were residing in the sub center village.

8.5.3 Training

Almost all the Sub center staff had received training on DOTs, Immunization, plus polio,
integrated management of neonatal and childhood illnesses (IMNCI) instruction and VBDCP.

8.5.4 Regular Supply of Contraceptives and Vaccines

Regular supply of essential medicines, vaccine and contraceptives were observed in almost all
the sub centers. It was reported by most of the ANMs that they personally had to visit CHC for
collection of vaccine a day before immunization day.

ORS and other medicine were available in 85% of the Sub centers, while delivery kit was
available only in 20 % of the sub centers. A separate Labour room was available only in 15 % of
the sub centers.

For details of facility survey conducted among SCs in each NIPI District, please refer to Table
A51 – A59 given in Annexure Tables.

8.6 Health Management Information System

This is one of the activities of NRHM that needs to be strengthened in Orissa. Districts have
started using the HMIS formats provided under the NRHM, but the compliance of this is not up to
the mark in the NIPI districts. Computers are provided at the block level, which are mostly
functioning, as reported by the district officials. Utilisation of data for monitoring purposes is
another neglected area. In fact, there is no major initiative for monitoring of different activities
taken place in the districts.

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NIPI Baseline Report – Orissa

In NIPI districts, separate registers for immunisation, untied fund, action plan, HMIS, TB (DOTS),
Leprosy, malaria, Filaria, accounting records, etc are maintained at the district level. The records
maintained by ANM include immunisation, JSY, Malaria, MDT, TB, EC register, contraceptive
register, action plan, ANC, etc.

The information is collected at the grassroots by ANM. She sends the report to PHC level. From
PHCs data will be sent to Block. At the block level the data will be compiled and a data sheet will
be sent to the district HQ.

8.7 Funds Allocation and Utilisation

In this section, details regarding funds allocated and utilised for different activities under NRHM
are presented.

Till December 2007, in Anugul, about four fifth of the money disbursed to them was spent, while
in Sambalpur about half of the funds allocated were utilised. Thus complete utilisation of the
funds allocated or received is an area that needs attention.

The fund utilization status for different activities in Anugul district shows that all the allocated
money was spent for setting up infrastructure in the District Programme Management Unit
(DPMU), while only 7 percent was spent on training of programme managers. About three fourth
of the amount allocated for immunisation was spent indicating partial utilisation of the allocated
funds.

The fund utilization in Sambalpur district (till December 2007) shows about half of the amount
allocated for different heads under IMNCI training was spent. In case of immunisation, about two
third of the amount allocated for the financial year was spent till December 2007.

Fund utilization in Jharsuguda (Table 8.1) shows that about two third of the funds allocated for
immunization was spent, while more than four fifth of the fund allocated for JSY was utilized.

Table 8.1: Funds Utilisation Status as on 31.12.07 - Jharsuguda

Item Funds disbursed Funds


Percent
(Rs) utilised (Rs)
Training for Programme management. 20,000 - -
Workshop seminars & trainings of deployed
15,000 6,500 43.3
staff
SBA training of SN at DHH/PHC/CHC 680,400 - -
Cost of setting of centres under SBA training 15,000 - -
Logistic support 32,000 32,000 100
DPMU infrastructure 305,000 305,000 100
Orientation training on RKS 13,250 - -
Sub-Total for Training & capacity building 1,080,650 343,500 31.8
JSY 9,631,794 8,331,214 86.5
Immunisation 23,803,760 15,652,677 65.8
Source: * Financial and Physical progress report (2007-2008), Health Deptt., Govt. of Orissa

The Facility Survey (DFID) provides information on availability of funds with FRUs. More than
half of the FRUs have funds for operating ambulances, while more than one third have funds for
running generator. Thus in majority of the FRUs, funds are not available for running ambulance
and generator. It is good to note that the RKS funds are used for maintenance of generator, hiring
referral transport and purchase of drugs (Table 8.2).

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NIPI Baseline Report – Orissa

Table 8.2: Availability of funds with FRUs

Availability of Funds FRUs


Number Percent
Funds available for operating ambulances 59 48.2
Funds available for running the generator 46 38
Sufficient funds available for JSY beneficiaries 70 57.9
Spending RKS funds for
Purchase of drugs 31 25.6
Hiring referral transport 34 28.1
Maintenance of generator 47 38.8
Total number of FRUs 121 100.0
Source: Facility Survey (2008) DFID

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NIPI Baseline Report – Orissa

Annexure

A1: Household possession – NIPI Districts

District
Orissa
Angul Jharsuguda Sambalpur
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Household Goods

Mattress Yes 31.6 62.3 35.1 17.9 55.9 31.2 19.0 48.8 27.4 23.5 54.0 31.2
No 68.4 37.7 64.9 82.1 44.1 68.8 81.0 51.2 72.6 76.5 46.0 68.8
Mosquito net Yes 58.6 79.0 60.9 74.3 76.1 74.9 64.0 73.6 66.7 64.9 75.5 67.5
No 41.4 21.0 39.1 25.7 23.9 25.1 36.0 26.4 33.3 35.1 24.5 32.5
A cot/bed Yes 67.8 80.4 69.2 79.9 86.0 82.0 76.5 86.6 79.4 74.1 85.4 77.0
No 32.2 19.6 30.8 20.1 14.0 18.0 23.5 13.4 20.6 25.9 14.6 23.0
Chair Yes 49.4 71.7 52.0 55.2 73.1 61.5 42.8 62.7 48.5 48.9 68.8 53.9
No 50.6 28.3 48.0 44.8 26.9 38.5 57.2 37.3 51.5 51.1 31.2 46.1
Table Yes 28.1 60.1 31.8 42.2 63.9 49.8 31.1 55.9 38.1 33.1 60.2 39.9
No 71.9 39.9 68.2 57.8 36.1 50.2 68.9 44.1 61.9 66.9 39.8 60.1
Pressure cooker Yes 20.5 53.6 24.3 24.3 56.6 35.6 14.7 48.0 24.1 19.6 52.8 28.0
No 79.5 46.4 75.7 75.7 43.4 64.4 85.3 52.0 75.9 80.4 47.2 72.0
Radio or Transistor Yes 14.9 19.6 15.4 12.1 16.3 13.6 11.8 10.9 11.5 13.0 14.7 13.4
No 85.1 80.4 84.6 87.9 83.7 86.4 88.2 89.1 88.5 87.0 85.3 86.6
Watch or clock Yes 58.8 85.5 61.8 72.8 88.3 78.2 64.0 87.2 70.6 64.5 87.4 70.3
No 41.2 14.5 38.2 27.2 11.7 21.8 36.0 12.8 29.4 35.5 12.6 29.7
Sewing Machine Yes 4.5 18.1 6.0 10.0 21.6 14.0 8.1 16.3 10.4 7.2 19.0 10.2
No 95.5 81.9 94.0 90.0 78.4 86.0 91.9 83.7 89.6 92.8 81.0 89.8
Electricity Yes 33.9 74.6 38.6 62.9 86.2 71.1 44.9 90.7 57.9 45.9 86.3 56.0
No 66.1 25.4 61.4 37.1 13.8 28.9 55.1 9.3 42.1 54.1 13.7 44.0
An Electric fan Yes 31.3 76.8 36.5 53.2 82.5 63.5 36.7 82.8 49.8 39.4 81.8 50.0
No 68.7 23.2 63.5 46.8 17.5 36.5 63.3 17.2 50.2 60.6 18.2 50.0
Television Yes 24.9 65.9 29.6 50.6 75.9 59.5 36.7 75.2 47.6 36.2 74.1 45.7
No 75.1 34.1 70.4 49.4 24.1 40.5 63.3 24.8 52.4 63.8 25.9 54.3
Refrigerator Yes 7.9 42.0 11.8 10.4 34.3 18.8 6.5 30.5 13.3 8.2 33.9 14.6
No 92.1 58.0 88.2 89.6 65.7 81.2 93.5 69.5 86.7 91.8 66.1 85.4
Computer Yes 0.9 4.3 1.3 2.5 7.4 4.2 1.4 8.2 3.3 1.5 7.2 3.0
No 99.1 95.7 98.7 97.5 92.6 95.8 98.6 91.8 96.7 98.5 92.8 97.0
Mobile phone Yes 22.0 58.0 26.1 31.8 61.8 42.4 19.5 59.4 30.8 24.0 60.3 33.1
No 78.0 42.0 73.9 68.2 38.2 57.6 80.5 40.6 69.2 76.0 39.7 66.9
Any Other type of telephone Yes 4.0 18.1 5.6 3.6 12.6 6.8 4.3 12.8 6.7 4.0 13.5 6.4
No 96.0 81.9 94.4 96.4 87.4 93.2 95.7 87.2 93.3 96.0 86.5 93.6
Water pump Yes 7.2 4.3 6.9 9.8 12.9 10.9 6.3 13.6 8.3 7.6 11.9 8.7
No 92.8 95.7 93.1 90.2 87.1 89.1 93.7 86.4 91.7 92.4 88.1 91.3
Thresher Yes 1.3 0.7 1.2 1.1 0.5 0.9 1.1 0.8 1.0 1.2 0.6 1.0
No 98.7 99.3 98.8 98.9 99.5 99.1 98.9 99.2 99.0 98.8 99.4 99.0
Tractor Yes 1.9 0.7 1.7 3.9 3.0 3.6 2.0 1.4 1.9 2.5 2.0 2.4
No 98.1 99.3 98.3 96.1 97.0 96.4 98.0 98.6 98.1 97.5 98.0 97.6
Bicycle Yes 73.8 73.2 73.8 83.0 76.1 80.5 80.2 74.7 78.6 78.5 75.1 77.7
No 26.2 26.8 26.2 17.0 23.9 19.5 19.8 25.3 21.4 21.5 24.9 22.3
An animal drawn cart Yes 10.0 4.3 9.4 6.2 1.1 4.4 3.3 0.8 2.6 6.7 1.5 5.4
No 90.0 95.7 90.6 93.8 98.9 95.6 96.7 99.2 97.4 93.3 98.5 94.6
A car/Jeep Yes 0.8 2.2 1.0 1.4 3.9 2.3 1.0 4.4 1.9 1.0 3.8 1.7
No 99.2 97.8 99.0 98.6 96.1 97.7 99.0 95.6 98.1 99.0 96.2 98.3
Two wheeler/ motorbike Yes 12.5 49.3 16.7 20.1 44.8 28.8 12.3 34.3 18.5 14.6 41.4 21.4
No 87.5 50.7 83.3 79.9 55.2 71.2 87.7 65.7 81.5 85.4 58.6 78.6

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NIPI Baseline Report – Orissa

A2: Type of health schemes- NIPI Districts

District
Orissa
Angul Jharsuguda Sambalpur
Wealth Index
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Lowest 65.4 23.9 60.7 45.6 17.9 35.9 61.1 19.3 49.2 58.3 19.4 48.5
Second 10.3 13.8 10.7 16.7 13.3 15.5 14.0 18.8 15.4 13.4 15.5 13.9
Middle 8.2 3.6 7.7 15.3 13.1 14.5 11.7 13.6 12.2 11.4 11.9 11.5
Fourth 7.9 18.1 9.0 12.3 17.2 14.0 6.1 13.1 8.1 8.6 15.7 10.4
Highest 8.2 40.6 11.9 10.1 38.4 20.0 7.1 35.1 15.1 8.4 37.4 15.7
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total number of HH 1070 138 1208 804 435 1239 927 367 1294 2801 940 3741

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NIPI Baseline Report – Orissa

A3: Education Attainments vs age of respondent

NIPI state wise education


RURAL
Age of the Respondent (in Years) Total
15-18 19-21 22-25 26-30 31-40 41-49
Years of schooling N % N % N % N % N % N % N %
No schooling 20 33.9 140 27.0 320 30.4 304 43.1 171 59.6 8 72.7 963 36.5
<5 7 11.9 42 8.1 91 8.6 72 10.2 30 10.5 2 18.2 244 9.3
5-7 11 18.6 129 24.9 204 19.4 115 16.3 40 13.9 1 9.1 500 19.0
8-9 15 25.4 137 26.4 232 22.0 97 13.7 15 5.2 496 18.8
10-11 3 5.1 53 10.2 119 11.3 47 6.7 15 5.2 237 9.0
12 & Above 3 5.1 18 3.5 87 8.3 71 10.1 16 5.6 195 7.4
Total 59 100 519 100 1,053 100 706 100 287 100 11 100 2,635 100
URBAN
Age of the Respondent (in Years) Total
15-18 19-21 22-25 26-30 31-40 41-49
Years of schooling N % N % N % N % N % N % N %
No schooling 7 63.6 20 14.9 78 20.0 64 23.9 30 36.6 3 100 202 22.7
<5 10 7.5 17 4.4 17 6.3 9 11.0 53 6.0
5-7 3 27.3 24 17.9 64 16.4 35 13.1 6 7.3 132 14.9
8-9 1 9.1 42 31.3 84 21.5 27 10.1 5 6.1 159 17.9
10-11 24 17.9 63 16.2 33 12.3 13 15.9 133 15.0
12 & Above 14 10.4 84 21.5 92 34.3 19 23.2 209 23.5
Total 11 100 134 100 390 100 268 100 82 100 3 100 888 100
TOTAL
Age of the Respondent (in Years)
15-18 19-21 22-25 26-30 31-40 41-49 Total
Years of schooling N % N % N % N % N % N % N %
No schooling 27 38.6 160 24.5 398 27.6 368 37.8 201 54.5 11 78.6 1,165 33.1
<5 7 10.0 52 8.0 108 7.5 89 9.1 39 10.6 2 14.3 297 8.4
5-7 14 20.0 153 23.4 268 18.6 150 15.4 46 12.5 1 7.1 632 17.9
8-9 16 22.9 179 27.4 316 21.9 124 12.7 20 5.4 655 18.6
10-11 3 4.3 77 11.8 182 12.6 80 8.2 28 7.6 370 10.5
12 & Above 3 4.3 32 4.9 171 11.9 163 16.7 35 9.5 404 11.5
Total 70 100 653 100 1,443 100 974 100 369 100 14 100 3,523 100

A4: Frequency of reading a newspaper or magazine vs. key background variables

Almost At least Less than a Not at all Total


every day once a week
week
Age Group % % % % %
15-18 0.9 1 2.2 1.8
19-21 9.8 17.5 21.5 22.6 20.9
22-25 43.4 45.2 44.5 44.3 44.3
26-30 38.0 26.7 27.5 23.9 25.7
31-40 8.8 9.7 5.5 6.8 7.1
41-49 0.2 0.1
Total 100 100 100 100 100
Years of schooling
<5 1.0 3.7 2 16.3 12.5
5-7 4.4 18.4 12 32.2 26.8
8-9 12.7 24.4 31.5 29.6 27.8
10-11 17.6 19.4 27 13.7 15.7
12 & Above 64.4 34.1 27.5 8.2 17.1
Total 100 100 100 100 100
Total number of women 205 217 200 1736 2358

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NIPI Baseline Report – Orissa

A5: Frequency of listening to the radio vs. key background variables

Almost every At least once Less than a Not at all Total


day a week week
Age Group % % % % %
15-18 2.8 1.6 1.6 2.0 2.0
19-21 24.2 14.6 14.6 18.6 18.5
22-25 39.3 44.3 44.3 41.0 41.0
26-30 23.6 29.2 29.2 27.3 27.6
31-40 10.1 10.4 10.4 10.6 10.5
41-49 0.4 0.4
Total 100 100 100 100 100
Years of schooling
None 18.0 18.2 22.7 35.4 33.1
<5 6.2 7.8 5.3 8.8 8.4
5-7 18.0 16.7 14.7 18.2 17.9
8-9 22.5 24.0 23.3 17.8 18.6
10-11 16.3 14.1 14.7 9.7 10.5
12 & Above 19.1 19.3 19.3 10.1 11.5
Total 100 100 100 100 100
Standard of living index
Lowest 10.1 48.0 64.3 86.6 48.5
Second 16.4 22.5 16.3 9.3 14.0
Middle 20.2 12.9 11.7 2.6 11.7
Fourth 19.7 9.2 4.6 1.1 10.1
Highest 33.7 7.4 3.1 0.5 15.7
Total 100 100 100 100 100
Number of 1,532 325 196 1,470 3,523
women

102
NIPI Baseline Report – Orissa

A6: Frequency of watching television vs. key background variables


Almost every At least once Less than a Not at all Total
day a week week
Age Group % % % % %
15-18 1.3 0.9 3.1 2.8 2.0
19-21 18.0 14.8 21.4 19.5 18.5
22-25 44.7 44.3 35.7 37.0 41.0
26-30 27.4 29.5 27.0 27.6 27.6
31-40 8.4 10.5 11.2 12.5 10.5
41-49 0.1 1.5 0.6 0.4
Total 100 100 100 100 100
No Education 12.1 32.3 36.2 54.6 33.1
<5 6.3 9.2 10.2 10.2 8.4
5-7 16.3 19.7 20.4 19.0 17.9
8-9 24.9 23.1 20.4 10.8 18.6
10-11 17.8 6.8 8.2 4.1 10.5
12 & Above 22.7 8.9 4.6 1.3 11.5
Total 100 100 100 100 100
Standard of living index
Lowest 10.1 48.0 64.3 86.6 48.5
Second 16.4 22.5 16.3 9.3 14.0
Middle 20.2 12.9 11.7 2.6 11.7
Fourth 19.7 9.2 4.6 1.1 10.1
Highest 33.7 7.4 3.1 0.5 15.7
Total 100 100 100 100 100
Number of 1532 325 196 1470 3523
women

A7-Employment Status

Employment status of eligible women


Angul Jharsuguda Sambalpur Total
Any source of income Any source of income Any source of income Any source of
income
Yes Yes Yes Yes Yes Yes Yes Yes
Age Group N % N % % % % %
15-18 9 3.7 7 2.0 2.2
19-21 39 15.9 12 6.5 8.5 51 14.7 13.9
22-25 80 32.7 64 12.9 45.4 135 38.9 38.1
26-30 73 29.8 45 12.5 31.9 103 29.7 30.2
31-40 40 16.3 19 14.5 13.5 48 13.8 14.6
41-49 4 1.6 1 33.3 0.7 3 0.9 1.1
Total number of women 245 100 141 100 347 100 100
Education and Years of schooling
No education 174 71.0 50 17.2 35.5 164 47.3 52.9
Below 5 21 8.6 13 12.9 9.2 42 12.1 10.4
5-7 28 11.4 30 13.6 21.3 65 18.7 16.8
8-9 15 6.1 17 7.5 12.1 38 11.0 9.5
10-11 2 0.8 20 12.6 14.2 18 5.2 5.5
12 & above 5 2.0 11 5.8 7.8 20 5.8 4.9
Total 245 100 141 100 0.0 100
Residence
Rural 241 98.4 126 16.4 89.4 295 85.0 90.3
Urban 4 1.6 15 3.6 10.6 52 15.0 9.7
Total 100 100 100 100
Total number of women 245 141 347 733

103
NIPI Baseline Report – Orissa

A.8 Children ever born vs. age of mother


District
Angul
Age of the Respondent (in Years) Number of Children Ever Born
1 2 3 4 5 6 7 8 9+
N % N % N % N % N % N % N % N % N %
15-18 37 90.2 4 9.8
19-21 186 71.8 58 22.4 12 4.6 2 0.8
1 0.4
22-25 168 37.6 182 40.7 64 14.3 27 6.0
4 0.9 1 0.2 1 0.2
26-30 50 16.6 100 33.1 70 23.2 39 12.9
24 7.9 9 3.0 7 2.3 1 0.3 1 0.3
31-40 7 6.6 13 12.3 25 23.6 19 17.9
16 15.1 9 8.5 10 9.4 5 4.7 1 0.9
41-49 1 16.7 1 16.7 1 16.7 1 16.7 1 16.7
Total 448 357 172 87 46 20 18 7 3 1,158
Jharsuguda
Age of the Respondent (in Years) Number of Children Ever Born
1 2 3 4 5 6 7 8 9+
N % N % N % N % N % N % N % N % N %
15-18 7 100
19-21 146 78.5 33 17.7 6 3.2 1 0.5
22-25 239 48.0 183 36.7 57 11.4 15 3.0 3 0.6 1 0.2
26-30 88 24.4 127 35.2 75 20.8 44 12.2 19 5.3 5 1.4 1 0.3 1 0.3 1 0.3
31-40 15 11.5 31 23.7 20 15.3 21 16.0 24 18.3 9 6.9 9 6.9 2 1.5
41-49 1 33.3 2 66.7
Total 495 374 158 80 47 16 12 3 1 1,186
Sambalpur
Age of the Respondent (in Years) Number of Children Ever Born
1 2 3 4 5 6 7 8 9+
N % N % N % N % N % N % N % N % N %
15-18 20 90.9 2 9.1
19-21 149 71.6 51 24.5 6 2.9 2 1.0
22-25 232 46.6 182 36.5 69 13.9 10 2.0 4 0.8 1 0.2
26-30 54 17.4 101 32.5 89 28.6 38 12.2 17 5.5 11 3.5 1 0.3
31-40 12 9.1 37 28.0 16 12.1 22 16.7 20 15.2 11 8.3 8 6.1 6 4.5
41-49 3 60.0 1 20.0 1 20.0
Total 467 373 180 72 41 26 8 7 2 1,176

104
NIPI Baseline Report – Orissa

A9 Treatment seeking behaviour

Give Ors Salt And Continue Continue Give Any Other Do Not
Sugar Normal Breastfeeding Plenty Of (Specify) Know Total
Solution Food Fluids
N % N % N % N % N % N % N % N %
Age of the Respondent (in Years)
15-18 2 66.7 1 33.3 3 100
19-21 30 53.6 6 10.7 7 12.5 16 28.6 6 10.7 9 16.1 1 1.8 56 100
22-25 56 53.8 12 11.5 9 8.7 31 29.8 4 3.8 16 15.4 6 5.8 104 100
26-30 31 52.5 3 5.1 10 16.9 18 30.5 5 8.5 8 13.6 2 3.4 59 100
31-40 12 48 6 24 1 4.0 7 28 1 4 3 12.0 25 100
Total 131 53 27 10.9 27 10.9 72 29.1 15 6.1 35 14.2 12 4.9 247 100
Education of the Respondent
No Education 43 47.8 9 10.0 12 13.3 23 25.6 9 10.0 15 16.7 4 4.4 90 100.
<5 18 60.0 3 10.0 3 10.0 10 33.3 1 3.3 2 6.7 4 13.3 30 100.
5-7 25 56.8 7 15.9 4 9.1 14 31.8 1 2.3 5 11.4 2 4.5 44 100.
8-9 21 47.7 4 9.1 4 9.1 13 29.5 3 6.8 7 15.9 2 4.5 44 100.
10-11 14 60.9 1 4.3 2 8.7 7 30.4 1 4.3 1 4.3 23 100.
12 & Above 10 62.5 3 18.8 2 12.5 5 31.3 5 31.3 16 100
Total 131 53 27 10.9 27 10.9 72 29.1 15 6.1 35 14.2 12 4.9 247 100
Number of Living Children
1-2 101 53.7 14 7.4 20 10.6 55 29.3 10 5.3 32 17.0 9 4.8 188 100
3-4 27 56.3 10 20.8 4 8.3 15 31.3 5 10.4 2 4.2 2 4.2 48 100
5+ 3 27.3 3 27.3 3 27.3 2 18.2 1 9.1 1 9.1 11 100
Total 131 53.0 27 10.9 27 10.9 72 29.1 15 6.1 35 14.2 12 4.9 247 100
Locality
Rural 89 49.7 20 11.2 19 10.6 47 26.3 13 7.3 28 15.6 11 6.1 179 100.
Urban 42 61.8 7 10.3 8 11.8 25 36.8 2 2.9 7 10.3 1 1.5 68 100
Total 131 53.0 27 10.9 27 10.9 72 29.1 15 6.1 35 14.2 12 4.9 247 100
Wealth Index
Lowest 58 46.4 14 11.2 14 11.2 37 29.6 11 8.8 11 8.8 11 8.8 125 100
Second 27 65.9 7 17.1 6 14.6 9 22.0 2 4.9 9 22.0 41 100
Middle 17 56.7 2 6.7 3 10.0 10 33.3 7 23.3 1 3.3 30 100
Fourth 11 45.8 2 8.3 3 12.5 9 37.5 2 8.3 2 8.3 24 100
Highest 18 66.7 2 7.4 1 3.7 7 25.9 6 22.2 27 100
Total 131 53.0 27 10.9 27 10.9 72 29.1 15 6.1 35 14.2 12 4.9 247 100

105
NIPI Baseline Report – Orissa

A10 Diarrhoea practices

Angul Jharsuguda Sambalpur NIPI state


Rural Urban Rural Urban Rural Urban Rural Urban Total
N % N % N % N % N % N % N % N % N %
Continued Breastfeeding/other feeding when child had diarrhoea
Yes 27 65.9 5 83.3 39 81.3 18 85.7 37 82.2 24 85.7 103 76.9 47 85.5 150 75.2
No 14 34.1 1 16.7 9 18.8 3 14.3 8 17.8 4 14.3 31 23.1 8 14.5 39 100
NA 41 100 6 100 48 100 21 100 45 100 28 100 134 100 55 100 189 18.0
Total 27 65.9 5 83.3 39 81.3 18 85.7 37 82.2 24 85.7 103 76.9 47 85.5 150 75.2
Liquids given to drink during diarrhoea
Much less 7 17.1 3 50.0 6 12.5 6 13.3 4 14.3 19 14.2 7 12.7 26 36.4
Somewhat less 16 39.0 1 16.7 19 39.6 13 61.9 20 44.4 8 28.6 55 41.0 22 40.0 77 10.2
About the same 11 26.8 1 16.7 18 37.5 8 38.1 17 37.8 14 50.0 46 34.3 23 41.8 69 56.4
More 4 9.8 1 16.7 4 8.3 1 3.6 8 6.0 2 3.6 10 10.8
Nothing to eat 3 7.3 1 2.1 2 4.4 1 3.6 6 4.5 1 1.8 7 24.1
Total 41 100 6 100 48 100 21 100 45 100 28 100 134 100 55 100 189 18.3
Food given to eat during diarrhoea
Much less 7 17.1 3 50.0 8 16.7 1 4.8 5 11.1 4 14.3 20
14.9 8 14.5 28 19.6
Somewhat less 18 43.9 2 33.3 22 45.8 14 66.7 18 40.0 8 28.6 58
43.3 24 43.6 82 100
About the same 10 24.4 1 16.7 16 33.3 4 19.0 17 37.8 13 46.4 43
32.1 18 32.7 61 15.6
More 1 2.4 0.7 1 1 36.4
Nothing to eat 5 12.2 2 4.2 1 4.8 5 11.1 3 10.7 12
9.0 4 7.3 16 33.1
Don‘t know 1 4.8 1 1.8 1 13.5
Total 41 100 6 100. 48 100 21 100 45 100 28 100 134 100 55 100 189 1.5
Mothers given advice to give ORS during diarrhoea
Yes 24 58.5 5 83.3 34 70.8 14 66.7 27 60.0 21 75.0 85 63.4 40 72.7 125 26.9
No 17 41.5 1 16.7 14 29.2 7 33.3 18 40.0 7 25.0 49 36.6 15 27.3 64 1.3
Total 41 100 6 100 48 100 21 100 45 100 28 100 134 100 55 100 189 4.2
Personnel advised for ORS
Government Doctor 15 62.5 5 100 8 23.5 5 35.7 13 48.1 9 42.9 36 42.4 19 47.5 55 0.2
Private Doctor 2 8.3 9 26.5 7 50.0 4 14.8 12 57.1 15 17.6 19 47.5 34 100
ANM/ASHA/LHV 6 25.0 5 14.7 1 7.1 5 18.5 16 18.8 1 2.5 17 78.3
Friends/Relatives/ Family Members 1 4.2 6 17.6 7 8.2 7 2.3
Others 6 17.6 1 7.1 5 18.5 11 12.9 1 2.5 12 0.2
Total 24 100 5 100 34 100 14 100 27 100 21 100 85 100 40 100 125 0.2

Place of getting ORS


ASHA 3 12.5 1 2.9 1 3.7 5 5.9 5 0.4
ANM 3 12.5 1 2.9 4 14.8 8 9.4 8 0.2
Government/ Municipal Hospital 2 8.3 5 14.7 2 14.3 1 3.7 5 23.8 8 9.4 7 17.5 15 8.8
CHC/Rural hospital 1 4.2 1 2.9 1 7.1 3 11.1 5 5.9 1 2.5 6 9.5
PHC 1 4.2 2 5.9 4 14.8 1 4.8 7 8.2 1 2.5 8 100
Sub Center 1 2.9 1 3.7 2 2.4 2 14.1
GOVT. AYUSH 1 7.1 1 2.5 1 84.8
Private AYUSH 1 4.2 1 1.2 1 1.1
Private hospital/clinic 9 26.5 4 28.6 4 14.8 1 4.8 13 15.3 5 12.5 18 100
Medical/Chemist shop 9 37.5 5 100 5 14.7 4 28.6 7 25.9 14 66.7 21 24.7 23 57.5 44 14.5
Other shops 4 16.7 9 26.5 2 14.3 2 7.4 15 17.6 2 5.0 17 51.2
Total 24 100 5 100 34 100 14 100 27 100 21 100 85 100 40 100 125 27.2

106
NIPI Baseline Report – Orissa

A11 –Quantity of food and drinks taken while having fever

District
Total
Angul Jharsuguda Sambalpur
Rural Urban Rural Urban Rural Urban Rural Urban Total
N % N % N % N % N % N % N % N % N %
Quantity of drink given during the illness
Much Less 28 20.4 2 28.6 12 14.6 11 15.7 24 17.8 7 15.9 64 18.1 20 16.5
84 0.3
Somewhat Less 70 51.1 3 42.9 50 61.0 38 54.3 57 42.2 18 40.9 177 50.0 59 48.8
236 0.4
About The Same 27 19.7 2 28.6 17 20.7 19 27.1 48 35.6 15 34.1 92 26.0 36 29.8
128 4.0
More 2 1.5 1 1.2 1 1.4 1 0.7 1 2.3 4 1.1 2 1.7
6 100
Nothing To Drink 10 7.3 1 1.2 1 1.4 5 3.7 3 6.8 16 4.5 4 3.3
20 19.9
Don‘t Know 1 1.2 1 0.3 1 100
Total 137 100 7 100 82 100 70 100 135 100 44 100 354 100 121 100 475 0.3
Quantity of food given during the illness
Much Less 22 16.1 2 28.6 12 14.6 11 15.7 16 11.9 6 13.6 50 14.1 19 15.7 69 35.2
Somewhat Less 77 56.2 2 28.6 49 59.8 39 55.7 58 43.0 18 40.9 184 52.0 59 48.8 243 13.6
About The Same 25 18.2 3 42.9 16 19.5 17 24.3 52 38.5 16 36.4 93 26.3 36 29.8 129 100
More 2 1.5 1 1.2 1 0.7 1 2.3 4 1.1 1 0.8 5 1.1
Stopped Food 1 0.7 1 1.2 3 2.2 5 1.4 5 1.1
Never Gave
9 6.6 3 3.7 3 4.3 5 3.7 3 6.8 17 4.8 6 5.0 23 4.8
Food
Don‘t Know 1 0.7 1 0.3 1 0.2
Total 137 100 7 100 82 100 70 100 135 100 44 100 354 100 121 100 475 100

107
NIPI Baseline Report – Orissa

A12- Advice received from sources & duration of treatment for illness

District Total
Angul Jharsuguda Sambalpur
Rural Urban Rural Urban Rural Urban Rural Urban Total
Advice or treatment N % N % N % N % N % N % N % N % N %
Same Day 9 12.7 3 42.9 12 27.9 8 19.0 7 10.8 7 18.4 28 15.6 18 20.7 46 17.3
2 days ago 48 67.6 2 28.6 24 55.8 29 69.0 45 69.2 28 73.7 117 65.4 59 67.8 176 66.2
3 - 4 days ago 9 12.7 2 28.6 7 16.3 4 9.5 10 15.4 1 2.6 26 14.5 7 8.0 33 12.4
5 - 6 days ago 3 4.2 1 1.5 4 2.2 4 1.5
Week or more than a 2 2.8 1 2.4 2 3.1 2 5.3 4 2.2 3 3.4 7 2.6
week ago
Total 71 100 7 100 43 100 42 100 65 100 38 100 179 100 87 100 266 100
Advise received from sources during illness
Government/ 17 23.9 2 28.6 6 14.0 7 16.7 12 18.5 19 50.0 35 19.6 28 32.2 63 23.7
Municipal Hospital
Government 1 1.4 1 2.3 2 1.1 2 0.8
Dispensary
CHC/ Rural Hospital 10 14.1 3 42.9 5 11.6 2 4.8 14 21.5 29 16.2 5 5.7 34 12.8
PHC 23 32.4 1 14.3 9 20.9 2 4.8 17 26.2 4 10.5 49 27.4 7 8.0 56 21.1
Sub Center 4 5.6 2 4.7 1 1.5 7 3.9 7 2.6
NGO/Trust 1 1.4 1 0.6 1 0.4
Hospital/Clinic
Private Ayush 2 2.8 1 14.3 1 2.3 2 4.8 1 1.5 1 2.6 4 2.2 4 4.6 8 3.0
Hospital/Clinic
Private Hospital/ 7 9.9 14 32.6 24 57.1 13 20.0 14 36.8 34 19.0 38 43.7 72 27.1
Clinic
Home 1 2.3 2 4.8 3 4.6 4 2.2 2 2.3 6 2.3
Other 6 8.5 4 9.3 3 7.1 4 6.2 14 7.8 3 3.4 17 6.4
Total 71 100 7 100 43 100 42 100 65 100 38 100 179 100 87 100 266 100

A13- Child having health problem during illness

At the time of illness, child having a problem in the chest or a blocked or runny nose
Angul Jharsuguda Sambalpur All Districts
Rural Urban Rural Urban Rural Urban Rural Urban Total
N % N % N % N % N % N % N % N % N %
Chest 31 22.6 3 42.9 6 7.3 15 21.4 15 11.1 4 9.1 52 14.7 22 18.2 74 15.6
Only
Nose 43 31.4 21 25.6 33 47.1 61 45.2 15 34.1 125 35.3 48 39.7 173 36.4
Only
Both 46 33.6 4 57.1 28 34.1 19 27.1 43 31.9 17 38.6 117 33.1 40 33.1 157 33.1
Don‘t 12 8.8 27 32.9 3 4.3 15 11.1 7 15.9 54 15.3 10 8.3 64 13.5
Know
Other 5 3.6 1 0.7 1 2.3 6 1.7 1 0.8 7 1.5
Total 137 100 7 100 6 7.3 15 21.4 135 100 44 100 354 100. 121 100. 475 100

108
NIPI Baseline Report – Orissa

A14- Problems faced during availing treatment for illness

Angul Jharsuguda Sambalpur Total


Rural Urban Rural Urban Rural Urban Rural Urban Total
N % N % N % N % N % N % N % N % N %
Any problems faced during availing treatment
Doctor came late 8 0.7 3 0.3 1 0.1 4 0.3 2 0.2 15 0.4 3 0.1 18 0.5
Long Waiting time 21 1.8 4 0.3 1 0.1 20 1.7 2 0.2 45 1.3 3 0.1 48 1.4
Long Que of patients 6 0.5 1 0.1 1 0.1 12 1.0 19 0.5 1 0.0 20 0.6
Non availability of medicines 5 0.4 1 0.1 1 0.1 1 0.1 2 0.2 8 0.2 2 0.1 10 0.3
Too Far/ No Transportation 21 1.8 4 0.3 1 0.1 14 1.2 39 1.1 1 0.0 40 1.1
Don't Trust Facility/Poor 3 0.3 1 0.1 2 0.2 4 0.1 2 0.1 6 0.2
Quality Service
No One To Accompany 8 0.7 3 0.3 5 0.4 5 0.4 1 0.1 16 0.5 6 0.2 22 0.6
Any others 9 0.8 2 0.2 1 0.1 11 0.3 1 0.0 12 0.3
No problem 97 8.4 9 0.8 109 9.2 75 6.3 116 9.9 50 4.3 322 9.1 134 3.8 456 12.9
Total 1022 88 139 12.0 770 64.9 416 35.1 843 71.7 333 28.3 2635 74.8 888 25.2 3523 100
Was there any problem in getting these medications
Yes 26 19.0 2 28.6 13 15.9 3 4.3 20 14.8 3 6.8 59 16.7 8 6.6 67 14.1
No 109 79.6 5 71.4 67 81.7 67 95.7 114 84.4 41 93.2 290 81.9 113 93.4 403 84.8
Don't know 2 1.5 2 2.4 1 0.7 5 1.4 5 1.1
Total 137 100 7 100 82 100 70 100 135 100 44 100 354 100. 121 100 475 100

A15- Medicines taken during illness

District
Total
Angul Jharsuguda Sambalpur
Rural Urban Rural Urban Rural Urban Rural Urban Total
N % N % N % N % N % N % N % N % N %
Any medicine taken during illness
Yes 109 79.6 7 100 70 85.4 60 85.7 118 87.4 40 90.9 297 83.9 107 88.4 404 85.1
No 28 20.4 12 14.6 10 14.3 17 12.6 4 9.1 57 16.1 14 11.6 71 14.9
Total 137 100 7 100 82 100 70 100 135 100 44 100 354 100 121 100 475 100
Duration of first medicines given after fever
Same Day 35 32.1 4 57.1 22 31.4 25 41.7 39 33.1 12 30.0 96 32.3 41 38.3 137 33.9
Next Day 49 45.0 1 14.3 24 34.3 29 48.3 55 46.6 17 42.5 128 43.1 47 43.9 175 43.3
Two Days After
13 11.9 11 15.7 4 6.7 14 11.9 3 7.5 38 12.8 7 6.5 45 11.1
Fever
Three Days After
4 3.7 2 28.6 5 7.1 4 3.4 1 2.5 13 4.4 3 2.8 16 4.0
Fever
Four Or More Days
5 4.6 1 1.4 2 1.7 2 5.0 8 2.7 2 1.9 10 2.5
After Fever
Don‘t Know 3 2.8 7 10.0 2 3.3 4 3.4 5 12.5 14 4.7 7 6.5 21 5.2
Total 109 100 7 100 70 100 60 100 118 100 40 100 297 100 107 100 404 100

109
NIPI Baseline Report – Orissa

A16 – Money spent on treatment while having illness

Angul Jharsuguda Sambalpur Total


Rural Urban Rural Urban Rural Urban Rural Urban
N % N % N % N % N % N % N % N %
No money spent 11 8.5 11 8.5 24 10.3 5 4.6 6 16.7 11 7.6 23 8.5 1 2.2
<100 26 20.0 31 28.4 11 15.1 31 22.3 11 20.4 88 23.3 24 17.5
101-200 27 20.8 2 20.0 33 30.3 21 28.8 32 23.0 11 20.4 92 24.3 33 24.1
201-300 16 12.3 1 10.0 10 9.2 15 20.5 24 17.3 7 13.0 50 13.2 23 16.8
301 - 500 32 24.6 1 10.0 13 11.9 16 21.9 23 16.5 10 18.5 68 18.0 28 20.4
501-1000 13 10.0 2 20.0 9 8.3 4 5.5 9 6.5 3 5.6 31 8.2 9 6.6
>1000 5 3.8 2 20.0 4 3.7 4 5.5 7 5.0 3 5.6 16 4.2 9 6.6
Total 130 100.0 10 100.0 109 100.0 73 100.0 139 100.0 54 100.0 378 100.0 137 100.0

A 17 : Child Feeding Practices and Nutritional Status of Children


Orissa India

Indicator
NFHS-3 NFHS-2 NFHS-1 NFHS-3 NFHS-2 NFHS-1
(2005-06) (1998-99) (1992-93) (2005-06) (1998-99) (1992-93)
Children under 3 years breastfed within one hour
54.3 24.9 17.9 24 16 10
of birth (%)

Children age 0-5 months exclusively breastfed (%) 50.2 NA NA 46 NA NA


Children age 6-9 months receiving solid or semi-
67.5 NA NA 56 NA NA
solid food and breast milk (%)

A 18:Indicators of Nutritional Status in Orissa and NIPI Districts, DLHS- RCH, 2002-03

State/District Weight for age Anemia among children Anemia among Pregnant
Women
-3SD1 -2SD2 Mild Moderate 3 Severe Mild Moderate Severe
India 20 49 96 49 44 51 43 3
Orissa 15 43 54 41 3 49 45 4
Anugul 17 46 59 34 5 39 50 7
Jharsuguda 1 10 53 43 3 75 25 0
Sambalpur 21 53 39 54 5 57 39 4
Note: 1. This index is expressed in standard deviation units (SD) from the median of 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)
Source: District Level Household Survey (2003-2004).

110
NIPI Baseline Report – Orissa

A 19: Funds distribution by district (April 2005-Dec2007)

Funds Utilised
District Funds Disbursed (Rs)
Amount (Rs) Percent
Anugul 49,262,175 38,323,988 77.8
Sambalpur 48,429,689 26,991,534 55.7
Jharsuguda 23,803,760 15,652,677 65.8
Source: * Financial and Physical progress report (2007-2008)

A20: Fund s Utilisation status as on 31.12.07 -Angul

Item Funds Funds utilised


Percent
disbursed (Rs) (Rs)
Training for Programme managers. All Block M.Os,
Nodal officers of districts, BEE & CDPOs to be
36,000 2,625 7.2
trained including Functionary of Indian Systems of
Medicine
Annual expenditure on workshop seminars &
trainings of deployed staff on community
27,000 5,000 18.5
mobilization, attitudinal change in behaviour and
financial & other management evaluation
2 days orientation at district level for O & G
48,610 - -
specialist, MO I/c etc
SBA training of SN at DHH/PHC/CHC 46.9
680,400 319,017
Cost of setting of centres under SBA training 15,000 - -
IMCI training

Logistic support 85.7


36,500 31,295
DPMU infrastructure 100
285,000 285,000
EMOC Training -
191,100
Orientation training on RKS -
17,925
Sub-Total for Training & capacity building 48.1
1,337,535 642,937
JSY 55.5
400,000 222,000
Immunisation 75.9
4,053,599 3,075,948
Source: * Financial and Physical progress report (2007-2008)

111
NIPI Baseline Report – Orissa

A21: Fund Utilisation Status as on 31.12.07 –Sambalpur

Item Funds
Funds
utilised Percent
disbursed (Rs)
(Rs)
Training for Programme management. All Block MOs,
Nodal officers of districts, BEE & CDPOs to be trained & 36,000 2,625 7.2
Functionary of Indian Systems of Medicine
Annual expenditure on workshop seminars & trainings of
deployed staff on community mobilization, attitudinal
27,000 5,000 18.5
change in behaviour and financial & other management
evaluation
2 days orientation at district level for O & G specialist, MO
48,610 48610 100
I/c etc
SBA training of SN at DH/PHC/CHC 680,400 319,017 46.9
Cost of setting of centres under SBA training 15,000 - -
IMNCI training
Logistic support 36,500 31,295 85.7
DPMU infrastructure 285,000 285,000 100
EMOC Training 191,100 - -
Orientation training on RKS 17,925 - -
Sub-Total for Training & capacity building 1,337,535 642,937 48.8
JSY 270,000 108,521 40.2
Immunisation 2,753,711 1,911,499 69.4
Source: * Financial and Physical progress report (2007-2008)

A22: Funds Utilisation Status as on 31.12.07 - Jharsuguda

Item Funds Funds utilised


Percent
disbursed (Rs) (Rs)
Training for Programme management. All Block
Mos, Nodal officers of districts, BEE & CDPOs to
20,000 - -
be trained & Functionary of Indian Systems of
Medicine
Annual expenditure on workshop seminars &
trainings of deployed staff on community
mobilization, attitudinal change in behaviour and 15,000 6,500 43.3
financial & other management evaluation

SBA training of SN at DHH/PHC/CHC 680,400 - -


Cost of setting of centres under SBA training 15,000 - -
IMNCI training
Logistic support 32,000 32,000 100
DPMU infrastructure 305,000 305,000 100
Orientation training on RKS 13,250 - -
Sub-Total for Training & capacity building 1,080,650 343,500 31.8
JSY 9,631,794 8,331,214 86.5
RKS
Immunisation 23,803,760 15,652,677 65.8
Source: * Financial and Physical progress report (2007-2008)

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NIPI Baseline Report – Orissa

District Hospitals (A22-A23)

Table A22: Availability of human resource (clinical)

Orissa
Personnel In Position On contract
Medical Superintendent 3 0
Specialist (Medicine) 2 0
Specialist (Surgery) 2 1
Obstetrician / Gynecologist 5 0
Pediatrician 4 0
Anesthetist 1 0
Pathologist / Microbiologist 3 0
Radiologist 0 0
Dermatologist / Vanerologist 0 0
Total No. of District hospitals Surveyed 3

Table A23: Availability of human resource (paramedic)

Availability Of Human Resource


Orissa
Personnel In Position On contract
Nurses 47 19
Nurse working in OBS-GYNIC department 6 4
ANM / PHN 3 0
Technicians 17 0
Radiographer 5 0
Pharmacist 11 1
Total No. of District hospitals Surveyed 3

Table A24: Investigative and Laboratory services


Investigative and Laboratory services
Orissa
Yes
Hematology 2
Urine analysis 3
Pap Smear 2
Sputum 3
Histopathology 2
Microbiology 1
Blood Urea 3
Blood Creatinen 3
Pregnancy Test 3
COOMB‘S Test 1
VDRL Test 3
ECG 3
2D-ECHO 2
X-RAY 3
Ultrasound 2
Fully Operational Blood Bank 3
Total No. of District hospitals Surveyed 3

113
NIPI Baseline Report – Orissa

Table A25: Physical Infrastructure


Physical Infrastructure
Orissa
Yes
DH is within the block head quarter 3
Designated government building available for the DH 3
Water supply for 24 hours 3
Three- Phase connection 3
Standby facility (generator/invertors) available in working condition 3
Functional toilet facility available 3
Separate toilets for males and females 2
Total No. of District hospitals Surveyed 3

Table A26: Waste Disposal


Waste Disposal
Orissa
Yes
Incineration 1
Autoclaving / Microwaving 2
Shredder 0
Needle and Syringe destroyer 3
Any other 0
Total No. of District hospitals Surveyed 3

Table A27: Communication Facilities

Communication Facilities
Orissa
Yes
Telephone facility available in all section 3
Personal Computer available 2
NIC Terminal available at DH 3
Access to internet facility available at DH 3
DH outsourcing data compilation and tabulation work 2
Ambulance 8
Jeep 4
Car 0
Whether CSSD is there in DH 2
Critical care area 3
Integrated counseling and testing center (ICTC) 3
Total No. of District hospitals Surveyed 3

114
NIPI Baseline Report – Orissa

Table A28: Residential Facility For The Medical Staff


Residential Facility For The Medical Staff
Orissa
Available Staying In Quarter
Yes Yes
Medical Superintendent 3 2
Obstetrician 3 3
Nurses 2 2
Other staff 2 2
Total No. of District hospitals Surveyed 3

Table A29: Other Physical Facilities


Other Physical Facilities
Orissa
Yes
Prominent display boards regarding service availability in local language at DH 3
Separate registration counter in DH 2
Any suggestion / complaint box kept at DH 3
Pharmacy of drug storage and drug dispensing at DH 3
Total No. of District hospitals Surveyed 3

Table A30: Wards And Beds


Wards And Beds
Orissa
Available Total number
Yes of beds Male Female
Pediatric ward 3 61 0 0
Intensive medicine care unite 1 2 1 1
Post operative ward 3 26 3 23
Labour room 3 2 0 0
Ante Natal care ward 3 16 0 0
PNC ward 2 17 0 0
Post partum ward 3 15 0 0
Total No. of District hospitals Surveyed 3

Table A31: OT Equipments


OT Equipments
Orissa
Available Currently in use
Yes Yes
Elective-Major 3 3
Emergency OT / Family welfare OT 3 3
Ophthalmology / ENT OT 2 2
Orthopedic OPD 3 3
Total No. of District hospitals Surveyed 3

115
NIPI Baseline Report – Orissa

Table A32: Delivery Suit Unit


Table A33: Delivery Suit Unit
Orissa
Available Currently in use
Yes Yes
Labour room (Aseptic and clean) 3 3
Delivery room 2 2
Neo-natal room 3 3
Delivery suit unit including facility of accommodation
Examination and preparation room 3 3
Labour room (Aseptic and clean) 3 3
Delivery room 2 2
Neo natal room 3 3
Scrubbing room 0 0
Total No. of District hospitals Surveyed 3

Table A33: Labour Ward And Neo Natal Equipment For Nursery Ward
Labour Ward And Neo Natal Equipment For Nursery Ward
Orissa
Available Functional

Baby incubator 5 2
Phototherapy unit 3 1
Emergency resuscitation kit baby 15 12
Radiant warmer 3 2
Room warmer 4 0
Foetal Doppler 1 1
CTG monitor 0 0
Delivery Kit 10 10
Episiotomy Kit 7 7
Forceps delivery Kit 2 2
Crainotomy 0 0
Vacuum extractor metal 1 1
Silastic vacuum extractor 3 3
Total No. of District hospitals Surveyed 3

116
NIPI Baseline Report – Orissa

Community Health Centres (A34-A55)


Table A34: Availability Of Clinical Human Resource (Clinical)

Availability Of Clinical Human Resource (Clinical)


Orissa
In On
Position Contract
General Surgeon 0 1
Physician 1 0
Obstetrician /Gynecologist 2 0
Pediatrician 2 0
Anesthetist/ trained MO 0 0
Public Health Programme Manager 0 0
Eye surgeon 0 0
General Medical Officer 2 0
Other specialist (SPECIFY) 2 0
Total No. of CHC‟s Surveyed 3
II. Availability Of Human Resource (Support/Para Medical Staff)
Public Health Nurse (PHN) 0 0
Auxiliary Nurse Midwife (ANM) 3 0
Staff Nurse 6 8
Nurse/ Midwife 0 0
Dresser 0 0
Pharmacist/ Compounder 2 2
Lab. Technician 2 2
Radiographer 0 0
Ophthalmic Assistant 1 0
OPD Attendant 4 1
Statistical Assistant/Data Entry Operator 1 0
OT Attendant 0 0
Registration Clerk 1 0
Any other (SPECIFY) 0 1
Total No. of CHC‟s Surveyed 3

Table A19: Availability Of Para Medical

Orissa
In On
Position Contract
Is at least one staff nurse/LHV/ANM at CHC available round the clock 3
Gynaecologist 2 1
Anaesthetist 3
Total No. of CHC‘s Surveyed 3

117
NIPI Baseline Report – Orissa

Table A20: Training For MO


Orissa
Last Ever
5
years
Non Scalpel Vasectomy (NSV) training 1 0
Minilaprotomy Training 3 0
HIV/AIDS Prevention, Care and Support training 2 1
Emergency Obstetric Care (including C-Section) training 2 0
Newborn Care training 4 0
Basic Emergency Obstetric Care training 3 0
Integrated Management of Neonatal and Childhood Illnesses training 3 0
Medical Termination of Pregnancy (MTP) training 3 1
Anesthesia training to the MO 2 0
Any Other training (SPECIFY) 3 0
Reproductive Tract Infection /Sexually Transmitted Infection (RTI/STI) training 4 0
Blood grouping and cross matching training 1 0
Integrated Management of Neonatal and Childhood Illnesses (IMNCI) training 6 0
Skilled Birth Attendant training 2 0
Electro Cardiogram (ECG) training 0 0
Ultra Sound training 0 0
Anesthesia training to other staff 0 0
Any Other (SPECIFY) 0 0
Total No. of CHC‘s Surveyed 3

Table A21: Training Of Para Medical Staff


Orissa
Last year Ever
Reproductive Tract Infection /Sexually transmitted infection (RTI/STI) training 4 0
Blood grouping and cross matching training 1 3
Integrated Management of Neonatal and Childhood illness (IMNCI) training 6 0
Skilled birth attendant training 2 0
Electro Cardiogram (ECG) training 0 0
Ultra sound training 0 0
Anesthesia training to other staff 0 0
Any other 0 0
Total No. of CHC‟s Surveyed 3

Table A22: Investigative Facility


Available Functional
INVESTIGATIVE FACILITY
ECG facility 0 0
X- Ray facility 1 1
Ultrasound facility 3 0
Total No. of CHC‟s Surveyed 3

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NIPI Baseline Report – Orissa

Table A23: Physical Infrastructure


Yes
CHC is within the block head quarter 3
Designated government building available for the CHC 3
Main source of water supply (piped) 2
Main source of water supply (Hand pump) 1
Water supply for 24 hours 3
Regular Power supply 2
Occasional power supply 0
Standby facility (generator/invertors) available in working condition 2
Functional toilet facility available 3
Separate toilets for males and females 1
Laundry facility available at CHC 0
Total No. of CHC‟s Surveyed 3

Table A24: Waste Disposal


Orissa
Yes
Incineration 1
Autoclaving / Microwaving 1
Shredder 0
Needle and Syringe destroyer 2
Any other 0
No specific facility 0
Outsourcing 2
Total No. of CHC‟s Surveyed 3

Table A25: Communication Facilities


Orissa
Yes
Telephone facility available in CHC 1
CHC has intercom facility 0
Whether CHC has Personal Computer 1
NIC Terminal available at CHC 0
Access to internet facility available at CHC 0
Ambulance 3
Jeep 1
Car 0
CHC have access to vehicle for transporting patients during emergency 3
Total No. of CHC‟s Surveyed 3

119
NIPI Baseline Report – Orissa

Table A26: Residential Facility For The Medical Staff


Orissa
Available Staying In Quarter
Yes Yes
General Surgeon 2 1
Obstetrician /Gynecologist 2 1
Pediatrician 1 1
Anesthetist 0 0
Staff Nurse 3 3
Total No. of CHC‟s Surveyed 3

Table A27: Labour Room And Operation Theatre


Orissa
Available Currently In Use
Yes Yes
Labour Room 3 3
Operation Theatre 3 3
Total No. of CHC‟s Surveyed 3

Table A28: Storage Facilities


Orissa
Yes
Whether CHC has separate room for drug storage 3
Separate waiting area for the patients in the OPD of CHC 1
Total No. of CHC‟s Surveyed 3

Table A29: Laboratory


Orissa

Operational laboratory in the CHC 2


Blood Storage Facility there in the CHC 0
Total No. of CHC‟s Surveyed 3

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NIPI Baseline Report – Orissa

Table A30: Physical Facilities


Orissa
Yes
Prominent display boards regarding service availability in local language at CHC 2
Separate registration counter in CHC 0
Pharmacy for drug dispensing and drug storage at CHC 3
Any suggestion / complaint box kept at CHC 0
OPD rooms / cubicles at CHC 2
If yes number of OPD room 5
Separate waiting area in OPD for patients at CHC 2
Minor OT in the CHC 3
Injection Room and Dressing Room in the CHC 3
Emergency Room / Casualty room in the CHC 1
Patient Services 3
Total Number of functional beds in each CHC 3
Separate wards for males and females there in the CHC 2
Number of functional beds for Male 30
Number of functional beds for Female 14
Number of functional Pediatric beds 18
Total No. of CHC‟s Surveyed 3

Table A31: Furniture / Instrument


Orissa
Available Functional
Yes Yes
Delivery Table 3 3
Bed Side Screen 3 3
Saline stand 3 3
Wheel chair 3 3
Stretcher on trolley 3 3
Oxygen cylinder with regulator and Mask 3 3
BP Instrument 3 3
Instrument trolley 3 3
Instrument tray 3 3
Total No. of CHC‟s Surveyed 3

121
NIPI Baseline Report – Orissa

Table A32: OT Equipments


Orissa
Available Functional
Yes Yes
Boyles Apparatus 2 2
Cardiac monitor 0 0
Ventilator 1 1
Horizontal high pressure sterilizer 1 1
Vertical high pressure sterilizer 2/3 drum capacity 2 1
Shadow less lamp ceiling track mounted 3 3
Shadow less lamp pedestal for minor OT 2 1
Oxygen Cylinder 660 Ltrs with regulator and Mask 1 1
Nitrous oxide cylinder 1780 Ltrs 0 0
Hydraulic operation table 3 3
Emergency drug tray 1 1
IUD Insertion Kit 1 1
Normal Delivery Kit 3 3
Equipment for Neo-Natal Resuscitation 1 1
Standard Surgical Set-I 3 3
Standard Surgical Set-II Instrument 1 1
CHC Standard Surgical Set III 1 1
Standard Surgical Set IV 2 2
Standard Surgical Set V 0 0
Standard Surgical Set VI 0 0
Equipments for Anesthesia 1 1
Equipments for laboratory test and blood transfusion. 0 0
Materials Kit for blood Transfusion 0 0
Equipment for Radiology 1 1
Total No. of CHC‟s Surveyed 3

Table A33: Laboratory Equipments


Orissa
Available Functional
Yes Yes
Binocular microscope with oil immersion 2 2
Refrigerator 2 2
Stool transport carrier 0 0
Centrifuge 3 3
Rapid Diagnostic Kit for Typhoid 1 1
Rapid test kit for faucal contamination 0 0
Blood culture bottles with broth 0 0
Cold Box 2 2
Rapid Plasma Reagin (RPR) test kits for syphilis 1 1
Kits for ABO blood grouping 2 1
HIV test kits 1 1
Total No. of CHC‟s Surveyed 3

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NIPI Baseline Report – Orissa

Table A34: Cold Equipments


Orissa
Available Functional
Yes Yes
Walk in cooler 2 2
Walk in freezer 1 1
ILR Large 2 1
ILR Small 3 3
Deep freezer Large 2 1
Deep freezer Small 3 3
Total No. of CHC‟s Surveyed 3

Table A35: Vaccine


Orissa
Available Supply Regular
Yes Yes
BCG 3 3
DPT 3 3
OPV 3 3
MEASELES 3 3
DT 3 3
TT 3 3
Total No. of CHC‟s Surveyed 3

Table A36: Prophylactic Drugs


Orissa
Available
Yes
IFA Tablets 3
Vitamin A Solution 3
ORS Packets 3
Contrimaxazole 3
Total No. of CHC‟s Surveyed 3

Table A37: Essential Services


Orissa
Yes
OPD Services 3
Emergency Services (24 Hours) 3
Referral Services 3
Blood Storage Facility 3
X ray room 3
Average Daily OPD Attendance (MALE) 126
Average Daily OPD Attendance (FEMALE) 96
Total No. of CHC‟s Surveyed 3

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NIPI Baseline Report – Orissa

Table A38: MCH Services


Orissa
Yes
24-hour delivery services including normal and assisted deliveries 3
Emergency Obstetric Care including Caesarean Sections 2
Ante-natal care
Intra-natal care (24 - hour delivery services both normal and assisted) 3
Post-natal care 3
New born Care 3
Child care including immunization 3
MTP facility 3
Facilities under Janani Suraksha Yojana 3
Antenatal clinics organized regularly 3
Facility for normal delivery available for 24 hours 3
Facility for internal examination for gynecological conditions available at the CHC 3
Treatment for gynecological disorders like leucorrhoea, menstrual disorders 3
available at the CHC
Facility for MTP (abortion) available at the CHC 3
Treatment for anemia given to both pregnant as well as non-pregnant women 3
Low birth weight babies managed at the CHC 3
Fixed immunization day 3
BCG and Measles vaccine given regularly in the CHC 3
Treatment of children with pneumonia available at the CHC 3
Management of children suffering from diarrhea with severe dehydration done at the 3
CHC
Total No. of CHC‟s Surveyed 3

Table A39: Other Functions And Services


Orissa
Yes
Nutrition services 3
School Health programmes 3
Promotion of safe water supply and basic sanitation 3
HIV/AIDS control programmes 3
Rogi Kalyan Samiti (RKS) monitor your work regularly 3
Total No. of CHC‟s Surveyed 3

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NIPI Baseline Report – Orissa

Primary Health Centres (A40- A50)


Table A40: Availability Of Human Resource
District
Angul Jharsuguda Sambalpur Total
N N N N
Medical Officer 6 2 6 14
Lady Medical Officer 2 1 3
AYUSH Medical Officer 6 4 6 16
Medical Officer Contractual 3 3 1 7
Staff Nurse 6 1 2 9
Pharmacist 8 6 6 20
LHV/Health Assistant 6 4 3 13
Male Health Assistant 2 2 2 6
Laboratory Technician 5 1 3 9
ANM/ Female Health Worker 7 3 3 13
Additional Staff
4 0 1 5
Nurse/ANM(Contractual)
Class IV Employee 8 5 6 19
Any Other 2 2 2 6
Total No. of PHC‟s Surveyed 8 6 6 20

TRAINING

Table A41: Type Of Training Received In 5 Years


Number OF PHCs where: Angul Jharsuguda Sambalpur Total
No. No. No. No.
any training programme was organized last year 6 5 5 16
Pulse Polio Training organized last year 0 0 0 0
Training of ASHA organized last year 6 5 4 15
Training for ANM / Male Health Worker organized last year 6 3 5 14
Any other training organized last year 2 2 2 6
Total No. of PHC‘s Surveyed 8 6 6 20

Table A42: Training Received In Last 5 Years

NUMBER OF PHC‟s WHERE TRANING RECEIVED BY ANY MEDICAL OFFICER IN LAST 5 YEARS
Type of Training MO Total
Received Angul Jharsuguda Sambalpur
Training No. No. No. No.
In Last 5
Integrated skill development training for 12 days Year
3 3 3 9
(RCH-1)
Ever 1 2 3
In Last 5
Vector Born Disease Control Programme (VBDCP) Year
4 3 4 11
training
Ever 4 3 2 9
In Last 5
Directly Observed Treatment- Short Course (DOTS) Year
8 5 5 18
training
Ever 0 0 1 1
In Last 5
Year
2 4 1 7
Immunization training
Ever 0 0 2 2
In Last 5
Year
8 6 6 20
NSV-Non Scalpel Vasectomy training
Ever 8 6 6 20

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NIPI Baseline Report – Orissa

In Last 5
Year
1 1 1 3
MTP- Medical Termination of Pregnancy training
Ever 0 1 0 1
Total No. of PHC‟s Surveyed 8 6 6 20

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NIPI Baseline Report – Orissa

Table A43: NUMBER OF PHC‟s WHERE SPECIAL SKILL TRANING RECEIVED BY ANY MEDICAL
OFFICER IN THE LAST 5 YEARS

Type of Training MO Received Angul Jharsuguda Sambalpur Total


Training No. No. No. No.
In Last 5 Year 1 1 1 3
Minilap training
Ever 2 1 2 5
Last 5 year: Reproductive Tract Infection/Sexually In Last 5 Year 0 0 0 0
Transmitted Infection (RTI/STI) training Ever 0 0 0 0
Management of obstetric complications (BEmOC- In Last 5 Year 0 0 0 0
Basic Emergency Obstetric Care) training Ever 0 0 0 0
IMNCI- Integrated Management of Neonatal and In Last 5 Year 0 0 0 0
Childhood Illnesses training Ever 0 0 0 0
In Last 5 Year 0 0 0 0
Skilled Birth Attendant training
Ever 0 0 0 0
Any other training In Last 5
Year 0 0 0 0
Specify

Total No. of PHC‟s Surveyed 8 6 6 20

INFRASTRUCTURE

Table A44: Availability Of Physical Infrastructure


Tota
Angul Jharsuguda Sambalpur l
No. No. No. No.
Is a designated government building available for the PHC 7 6 6 19
Others 1 1
PHC in sub centre building 1 1
Pipe 4 2 6
Bore well/Tube well 4 4 4 12
Hand pump 1 4 1 6
Is there water supply for 24 hours in PHC 7 4 6 17
Total No. of PHC‟s Surveyed 8 6 6 20

Table A45: Electricity, Toilet And Waste Disposal Availability


Tota
Angul Jharsuguda Sambalpur l
No. No. No. No.
Regular power supply 6 4 4 14
Power cut in summer only 2 1 1 4
No electricity connection 1 1 2
Is standby facility of generator/invertors available in working
2 1 3
condition?
Is functional toilet facility available? 6 6 4 16
Is there a separate toilet facilities for males and females? 3 1 3 7
Bury in pit 7 5 4 16
Burning 8 6 6 20
Total No. of PHC‟s Surveyed 8 6 6 20

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NIPI Baseline Report – Orissa

Table A46: Communication, Quarters, and Operation Theatres Facility

Angul Jharsuguda Sambalpur Total


No. No. No. No.
Does PHC has Government provided Telephone /Mobile phone
4 1 2 7
facility?
Whether Personal Computer available or not? 5 1 3 9
Is connectivity to NIC terminal available at PHC? 1 1 2
Is access to Internet facility available at PHC? 3 1 2 6
Does PHC have access to vehicle/ambulance for transporting
2 0 1 3
patients during emergencies
Is there any complaint box/suggestion box kept at PHC? 1 1 2
Available: Medical Officer 7 5 5 17
Whether residing: Medical Officer 5 1 4 10
Available: Pharmacist 6 4 4 14
Whether residing: Pharmacist 5 2 3 10
Available: LHV 5 2 2 9
Whether residing: LHV 4 2 1 7
Available: Staff Nurse 2 0 2 4
Whether residing :Staff Nurse 2 0 2 4
Available separately: Labour Room 7 5 3 15
Currently in use: Labour Room 7 5 3 15
Available separately: Operation Theatre 7 1 3 11
Currently in use :Operation Theatre 6 3 9
Total No. of PHC‟s Surveyed 8 6 6 20

Table A47: Physical Facilities

Angul Jharsuguda Sambalpur Total


No. No. No. No.
Number of PHC‘s having in-patient facility 7 3 3 13
Number of functional beds available in the surveyed PHC‘s 8 6 6 20
Number of PHC‘s having separate wards for males and females 1 1 1 3
Number of functional beds for Male available in surveyed PHC‘s 8 6 6 20
Number of functional beds for Female available in surveyed PHC‘s 8 6 6 20
Number of PHC‘s having functional Pediatric beds 8 6 6 20
Number of PHC‘s having separate room for drug storage 7 6 4 17
Total No. of PHC‟s Surveyed 8 6 6 20

FURNITURE INSTRUMENTS

Table A48: AVAILABILITY AND FUNCTIONAL STATUS OF SELECTED FURNITURE/ INSTRUMENT IN


SURVEYED PHC‟s

Angul Jharsuguda Sambalpur Total


No. No. No. No.
Number of PHC‟s where:
Available 6 5 3 14
Examination Table
Functional 6 5 2 13
Delivery Table Available 7 6 5 18

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NIPI Baseline Report – Orissa

Angul Jharsuguda Sambalpur Total


No. No. No. No.
Number of PHC‟s where:
Functional 7 6 4 17
Available 6 5 4 15
Footstep
Functional 6 5 4 15
Available 6 2 3 11
Bed Side Screen
Functional 5 2 3 10
Available 8 6 6 20
Stool for patients
Functional 8 6 6 20
Available 3 3 1 7
Arm board for adult & child
Functional 3 2 1 6
Available 7 5 6 18
Saline stand
Functional 6 5 6 17
Available 3 2 4 9
Wheel chair
Functional 1 2 4 7
Available 4 0 3 7
Stretcher on trolley
Functional 3 0 3 6
Available 6 2 4 12
Oxygen trolley
Functional 5 2 4 11
Available 0 1 4 5
Height measuring stand
Functional 0 1 4 5
Available 7 5 5 17
Iron bed
Functional 7 5 5 17
Available 5 3 3 11
Bed side locker
Functional 5 3 3 11
Available 4 2 3 9
Dressing trolley
Functional 4 2 3 9
Available 6 4 4 14
Mayo trolley
Functional 6 4 4 14
Available 3 2 2 7
Instrument cabinet
Functional 3 2 2 7
Available 5 3 4 12
Instrument trolley
Functional 5 3 4 12
Available 5 3 4 12
Bucket
Functional 5 3 4 12
Available 5 3 5 13
Attendant stool
Functional 4 3 5 12
Available 7 3 6 16
Instrument tray
Functional 6 3 6 15
Available 8 4 6 18
Chair
Functional 7 3 6 16
Available 7 4 5 16
Wooden table
Functional 6 3 5 14
Available 7 5 6 18
Almirah
Functional 5 4 6 15
Available 2 2 1 5
Swab rack
Functional 2 2 1 5
Available 4 4 5 13
Mattress
Functional 4 3 5 12
Available 4 4 4 12
Pillow
Functional 4 3 4 11
Available 3 3 4 10
Waiting bench for patients / attendants
Functional 3 3 4 10

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NIPI Baseline Report – Orissa

Angul Jharsuguda Sambalpur Total


No. No. No. No.
Number of PHC‟s where:
Available 7 2 4 13
Medicine cabinet
Functional 6 2 4 12
Available 8 6 6 20
Side rail
Functional 8 6 6 16
Available 6 1 4 11
Rack
Functional 6 1 4 11
Available 2 2 1 5
Bed side attendant chair
Functional 2 2 1 5
Available 0 0 1 1
Others
Functional 0 0 1 1
Total No. of PHC‟s Surveyed 8 6 6 20

EQUIPMENTS

Table A49: AVAILABILITY OF EQUIPMENTS AND THEIR FUNCTIONAL STATUS IN SURVEYED PHC‟s
Angul Jharsuguda Sambalpur Total
No. No. No. No.
A. NEWBORN CARE
EQUIPEMENTS
Number of PHC‟s where:
Available 1 0 3 4
Infant resuscitation bag with mask
Functional 1 0 3 4
Available 8 4 6 18
Weighing machine
Functional 8 4 6 18
Available 3 3 3 9
Paddle operated suction machine
Functional 2 3 3 8
Available 2 1 2 5
Mounted lamp with bulb
Functional 2 1 2 5
Available 2 0 3 5
Baby Bassinet
Functional 2 0 3 5
B. OTHER EQUIPMENTS
Number of PHC‟s where:
Available 6 3 4 13
Normal Delivery Kit
Functional 6 3 4 13
Available 2 0 0 2
Equipment for assisted vacuum delivery
Functional 2 0 0 2
Available 4 0 3 7
Equipment for assisted forceps delivery
Functional 3 0 1 4
Equipment for New Born Care and Available 2 0 3 5
Neonatal Resuscitation Functional 2 0 3 5
Standard Surgical Set (for minor Available 7 4 5 16
procedures like episiotomies stitching) Functional 7 4 5 16
Equipment for Manual Vacuum Available 3 0 3 6
Aspiration Functional 3 0 3 6
Available 1 0 0 1
Baby warmer/incubator.
Functional 1 0 0 1
C. COLD CHAIN EQUIPEMENT
Number of PHC‟s where:
Available 2 1 1 4
Ice Lined Refrigerator (Large)
Functional 2 1 1 4
Available 6 5 4 15
Ice Lined Refrigerator (Small)
Functional 6 5 3 14
Available 3 1 2 6
Deep Freezer Large
Functional 3 1 2 6

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NIPI Baseline Report – Orissa

Available 5 5 2 12
Deep Freezer Small
Functional 5 3 2 10
Available 8 5 6 19
Cold Box
Functional 8 4 5 17
Available 8 5 6 19
Vaccine Carrier
Functional 8 5 6 19
D. REQUIREMENT OF THE LAB
Available 2 0 1 3
Chemical for Hb estimation
Functional 2 0 1 3
Reagent strips for urine albumin Available 3 0 0 3
and urine sugar analysis Functional 3 0 0 3
Plasma Reagin (RPR) test kits for Available 1 0 0 1
syphilis Functional 1 0 0 1
Residual chlorine in drinking water Available 6 6 5 17
testing strips Reagents for Functional 6 6 5 17
peripheral blood smear examination
Available 4 1 2 7
Centrifuge
Functional 3 1 2 6
Available 6 5 5 16
Light Microscope
Functional 5 5 5 15
Available 7 4 4 15
Binocular Microscope
Functional 6 4 4 14
E. Vaccines
Availability 8 5 5 18
BCG Supply 7 5 5 17
regular
Availability 8 5 5 18
DPT Supply 7 5 5 17
regular
Availability 8 5 6 19
OPV Supply 7 5 6 18
regular
Availability 6 5 6 17
Measles Supply 6 5 6 17
regular
Availability 8 5 6 19
DT Supply 7 5 6 18
regular
Availability 8 5 6 19
TT Supply 7 5 6 18
regular
F. PROPHYLACTIC DRUGS
Availability 7 5 6 18
IFA Tablets Supply 6 4 6 16
regular
Availability 5 6 6 17
Vitamin A Solution Supply 4 5 6 15
regular
Availability 7 6 6 19
ORS Packets Supply 6 5 6 17
regular
Availability 6 5 6 17
Contrimaxazole Supply 5 4 6 15
regular
Total No. of PHC‟s Surveyed 8 6 6 20

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Table A49: AVAILABILITY OF EQUIPMENTS

Availability 1 0 4 5
Kit A Drugs (sub-centre)
Functional 1 0 4 5
Availability 2 0 4 6
Kit B Drugs (sub-centre)
Functional 2 0 4 6
Availability 1 0 2 3
Kit C Equipments (sub-centre)
Functional 1 0 2 3
Availability 2 0 1 3
Kit D Equipments (PHC)
Functional 2 0 1 3
Kit of Essential obstetric care drugs Availability 1 1 3 5
(PHC) Functional 1 1 3 5
Total No. of PHC‟s Surveyed 8 6 6 20

SERVICES

Table A50: Availability Of Services


District Total
Angul Jharsuguda Sambalpur
Number of PHC‘s where: No. No. No. No.
OPD Services 8 5 6 19
Emergency Services (24 Hours) 7 5 4 16
available
Referral Services 8 5 5 18
a. Average Daily OPD Attendance- 8 6 6 20
Males
b. Average Daily OPD Attendance- 8 6 6 20
Females
B.MCH CARE (SERVICE 0 0 0 0
AVAILABILITY)
Ante-natal care 8 6 5 19
Intra-natal care (24 - hour delivery 7 6 5 18
services both normal and assisted)
Post-natal care 8 6 6 20
New born Care 8 6 6 20
Child care including immunization 8 5 6 19
MTP 2 1 3
Facilities under Janani Suraksha 7 5 4 16
Yojana
Are antenatal clinics organized by 8 5 5 18
the PHC regularly?
Is the facility for normal delivery 7 4 3 14
available in the PHC for 24 hours?
Is the facility for internal 2 0 1 3
examination for gynecological
conditions available at the PHC?
Is the treatment for gynecological 3 0 1 4
disorders like leucorrhoea,
menstrual disorders available at
the PHC?
Is the facility for MTP (abortion) 1 1 2
available at the PHC?
Is treatment for anemia given to 6 4 5 15
both pregnant as well as non-
pregnant women?
Total No. of PHC‟s Surveyed 8 6 6 20

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Sub Centres (A51 – A59)

Table A51: Availability of Staff at Sub-center District wise

Staff at Sub center District Total


Angul Jharsuguda Sambalpur N %
N % N % N %
ANM/Female Health Yes 30 100 29 96.7 28 93.3 87 96.7
Worker No 1 3.3 2 6.7 3 3.3
Total 30 100 30 100 30 100 90 100
Male Health Worker Yes 13 43.3 14 46.7 10 33.3 37 41.1
No 17 56.7 16 53.3 20 66.7 53 58.9
Total 30 100 30 100 30 100 90 100
Part Time Yes 1 3.3 1 3.3 1 3.3 3 3.3
Attendant/Additional No 29 96.7 29 96.7 29 96.7 87 96.7
ANM (Contractual)
Total 30 100 30 100 30 100 90 100

Table A52: Training attended by SC staff

Training Attended by SC District Total


staff Angul Jharsuguda Sambalpur N %
N % N % N %
Last 5 Year Integrated skill 25 83.3 21 72.4 18 64.3 64 73.6
development training for 12
days
Ever: Integrated skill 1 20.0 7 87.5 6 60.0 14 60.9
development training for 12
days
Last 5 YEAR-VBDCP 15 50.0 16 55.2 12 42.9 43 49.4
training
Ever -VBDCP training 1 6.7 4 30.8 1 6.3 6 13.6
Last five years (DOTS) 28 93.3 23 79.3 21 75.0 72 82.8
training
Ever DOTS training 1 50.0 5 83.3 4 57.1 10 66.7
Last 5 year Immunization 25 83.3 22 75.9 23 82.1 70 80.5
training
Ever Immunization training 1 20.0 3 42.9 1 20.0 5 29.4
Last 5 year IUD Insertion 13 43.3 20 69.0 13 46.4 46 52.9
Ever: IUD Insertion 2 11.8 6 66.7 6 40.0 14 34.1
Last 5 years IMNCI training 5 16.7 7 24.1 6 21.4 18 20.7
Ever IMNCI training 4 18.2 3 13.6 7 10.1
Last 5 year Skilled Birth 8 26.7 5 17.2 9 32.1 22 25.3
Attendant training

Ever -Skilled Birth Attendant 0 0.0 2 8.3 1 5.3 3 4.6


training

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Table A53: AVAILABILITY AND FUNCTIONAL STATUS OF FURNITURE AT SUB CENTER

Furniture at Sub Center District Total


level Angul Jharsuguda Sambalpur N %
N % N % N %
Available Examination Table 3 10.0 10 33.3 10 33.3 23 25.6

Functional Examination 1 33.3 9 90.0 7 70.0 17 73.9


Table
Available Labour Table 3 10.0 9 30.0 8 26.7 20 22.2
Functional Labour Table 1 33.3 8 88.9 5 62.5 14 70.0
Available Foot Step 3 10.0 6 20.0 9 10.0
Functional Foot Step 2 66.7 4 66.7 6 66.7
Available Cupboard with lock 4 13.3 11 36.7 22 73.3 37 41.1
and key
Functional Cupboard with 4 100 11 100 21 95.5 36 97.3
lock and key
Available Bedside Screen 3 10.0 3 10.0 6 6.7
Functional -Bedside Screen 3 100 3 100 6 100

Table A54: AVAILABILITY AND FUNCTIONAL STATUS OF EQUIPMENTS IN SURVEYED SC‟s


District Total
Angul Jharsuguda Sambalpur
Equipment N % N % N % N %
AVAILABLE-Instrument
Sterilizer 24 80.0 23 76.7 28 93.3 75 83.3
Yes
FUNCTIONAL-Instrument
Sterilizer 19 79.2 21 91.3 25 89.3 65 86.7
Yes
AVAILABLE-Auto Disposable
(AD) Syringes 28 93.3 25 83.3 26 86.7 79 87.8
Yes
FUNCTIONAL-Auto
Disposable (AD) Syringes 27 96.4 25 100 26 100 78 98.7
Yes
AVAILABLE-Hub Cutter
29 96.7 23 76.7 30 100 82 91.1
Yes
FUNCTIONAL-Hub Cutter
22 75.9 22 95.7 26 86.7 70 85.4
Yes
AVAILABLE-B.P. Instrument
Yes 23 76.7 20 66.7 28 93.3 71 78.9

FUNCTIONAL-B.P. Instrument
Yes 13 56.5 15 75.0 23 82.1 51 71.8

AVAILABLE-Stethoscope
Yes 14 46.7 20 66.7 26 86.7 60 66.7

FUNCTIONAL-Stethoscope
Yes 7 50.0 18 90.0 23 88.5 48 80.0

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NIPI Baseline Report – Orissa

District Total
Angul Jharsuguda Sambalpur
Equipment N % N % N % N %
AVAILABLE-Weighing machine
(adult) 26 86.7 22 73.3 29 96.7 77 85.6
Yes
FUNCTIONAL-Weighing
machine (adult) 22 84.6 20 90.9 27 93.1 69 89.6
Yes
AVAILABLE-Weighing machine
(infant) 25 83.3 19 63.3 27 90.0 71 78.9
Yes
FUNCTIONAL-Weighing
machine (infant) 24 96.0 17 89.5 26 96.3 67 94.4
Yes
AVAILABLE-Hemoglobin meter
Yes 6 20.0 8 26.7 13 43.3 27 30.0

FUNCTIONAL-Hemoglobin
Meter 3 50.0 5 62.5 6 46.2 14 51.9
Yes
AVAILABLE-Fetus scope
16 53.3 15 50.0 22 73.3 53 58.9
Yes
FUNCTIONAL-Fetus
Scope 15 93.8 14 93.3 18 81.8 47 88.7
Yes
AVAILABLE-SIMS Speculum
Yes 23 76.7 21 70.0 28 93.3 72 80.0

FUNCTIONAL-SIMS Speculum
Yes 23 100 21 100 27 96.4 71 98.6

AVAILABLE-Vaccine Carrier
Yes 30 100 30 100 30 100 90 100

FUNCTIONAL-Vaccine Carrier
Yes 30 100 30 100 30 100 90 100

TableA55: Availability of Essential Kits (with equipments)


District Total
Angul Jharsuguda Sambalpur
Essential Kits N % N % N % N %
Drug Kit-A
1 3.3 3 10.0 5 16.7 9 10.0
Drug Kit-B 1 3.3 2 6.7 5 16.7 8 8.9
Drug Kit-C 2 6.7 2 6.7 4 4.4
IFA Tablets 26 86.7 28 93.3 27 90.0 81 90.0
Vitamin A Solution 28 93.3 29 96.7 29 96.7 86 95.6
ORS Packets 26 86.7 19 63.3 30 100 75 83.3
Cotrimaxazole tablet (Pediatric) 10 33.3 3 10.0 10 33.3 23 25.6
Disposal Delivery Kit 17 56.7 12 40.0 12 40.0 41 45.6

Table A56: Labour room availability

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Labour room District Total


Angul Jharsuguda Sambalpur N %
N % N % N %
Whether the Sub-Center is 8 26.7 1 3.3 5 16.7 14 15.6
having a Labour room
Yes
If Labour room is present, 1 12.5 3 60.0 4 28.6
are deliveries carried out in
the Labour room?
Yes
How many deliveries were 7 87.5 1 100 4 80.0 12 85.7
conducted in the last three
months?
Yes

Table A57: Availability of specific service & Other Services

District Total
Angul Jharsuguda Sambalpur
Other Service at Sub center level N % N % N % N %
Does any doctor visit the Sub-center at least
25 83.3 26 86.7 25 83.3 76 84.4
once in a month
Is the day and time of this visit fixed 4 16.0 5 19.2 7 28.0 16 21.1
Are the residents of the village aware of the
timings of the doctor's visit 14 56.0 16 61.5 9 36.0 39 51.3

Does the Health Assistant (male) or LHV visit the


29 96.7 23 76.7 19 63.3 71 78.9
Sub-Center at least once a week
Is the Antenatal care T.T, IFA tablets, weight and
29 96.7 25 83.3 27 90.0 81 90.0
BP checkup) provided by those in the Sub center
Is the facility for referral of complicated cases of
pregnancy / delivery available at Sub center for 25 83.3 30 100 24 80.0 79 87.8
24 hours?
Do the ANM/any trained personnel accompany
the woman in Labour to the referred care facility 28 93.3 30 100 29 96.7 87 96.7
at the time of referral?
Are the Immunization services as per
Government schedule provided by the Sub- 30 100 30 100 30 100 90 100
center?
Is the ORS for prevention of diarrhea and
29 96.7 30 100 30 100 89 98.9
dehydration available in the Sub-center?
Are the contraceptive services like insertion of
Copper-T, distributing Oral contraceptive pills or 29 96.7 30 100 30 100 89 98.9
condoms provided by the Sub center?
Disease surveillance 30 100 29 96.7 30 100 89 98.9
Control of local endemic diseases 30 100 29 96.7 29 96.7 88 97.8
Promotion of sanitation 30 100 28 93.3 30 100 88 97.8
Field visits and home care 30 100 30 100 30 100 90 100
National Health Program including HIV/AIDS
30 100 30 100 30 100 90 100
control program

Table A58: Monitoring and Supervision activity

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District Total
Angul Jharsuguda Sambalpur
N % N % N % N %
Have you prepared the Sub-Center plan for
26 86.7 25 83.3 29 96.7 80 88.9
this year
Registers 30 100 29 96.7 30 100 89 98.9
Reports 30 100 29 96.7 30 100 89 98.9
Immunization Card 30 100 26 86.7 30 100 86 95.6
Anc Card 30 100 29 96.7 30 100 89 98.9
Any Other 5 16.7 7 23.3 6 20.0 18 20.0
Training of traditional/Skilled birth
attendants and ASHA 26 86.7 30 100 30 100 86 95.6

Coordinated services with AWWs, ASHA,


Village Health and Sanitation Committee, 28 93.3 30 100 30 100 88 97.8
PRIs
Coordination and supervision of activities of
28 93.3 30 100 30 100 88 97.8
ASHA
Proper maintenance of records and
30 100 30 100 30 100 90 100
registers
Is there a Village Health Plan / Sub Centre
27 90.0 20 66.7 28 93.3 75 83.3
Plan?
Is the scheme of ASHA implemented in Sub
27 90.0 29 96.7 27 90.0 83 92.2
Centre
Any woman from the Sub- Centre villages
die during pregnancy, delivery or during six
6 20.0 1 3.3 4 13.3 11 12.2
weeks after delivery since 1 April 2007 to 31
March 2008?

Table A59: Maternal and Newborn Deaths in the sub center area

Maternal and New born deaths District Total


Angul Jharsuguda Sambalpur N %
N % N % N %
Number of such maternal deaths, since 1 6 100 1 100 2 100 9 100
April 2007 to 31 March 2008
: RECORD AVAILABLE 6 100 1 100 2 100 9 100
Number of newborn deaths, since 1 April 25 83.3 27 90.0 29 96.7 81 90.0
2007 to 31 March 2008
: RECORD AVAILABLE 29 96.7 30 100 30 100 89 98.9
Number of infant deaths, since 1 April 20 66.7 18 60.0 25 83.3 63 70.0
2007 to 31 March 2008
Total 30 100 30 100 30 100 90 100

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