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Second Update of Annual Health Survey
Mar 11, 2014

All major health indicators in the country’s worst-performing states are showing a gradual improvement over the years but inter-state variations persist, according to the second update of the Annual Health Survey (AHS).

Bageshwar in Uttarakhand has reported minimum Crude Birth Rate (CBR) of 14.7 while Dhemaji in Assam has reported the minimum Crude Death Rate (CDR) of 4.5 as per the findings of the Annual Health Survey (AHS) in 284 districts of 9 states. The CBR which is measure of live births per 1000 population was maximum at 40.9 in Shrawasti in Uttar Pradesh. CBR in rural areas of districts is generally higher than that in urban areas. CDR which denotes number of deaths per 1000 population was also maximum in Shrawasti at 12.6. Further, rural death rate in districts is significantly higher than the corresponding urban death rate. Low female death rates have also been observed as compared to male death rates.

Infant Mortality Rate (IMR) which denotes the number of infant deaths (age below one year) per 1000 live births has been reported to be minimum at 19 in Rudraprayag while in Shrawasti it was maximum at 103. Six districts namely Purbi Singhbhum and Dhanbad (Jharkhand) and Chamoli, Rudraprayag, Pithoragarh and Almora (Uttarakhand) have already achieved the UN Millennium Development Goal (MDG)-4 National target of 28 by 2015. Another 4 districts viz. Bokaro and Ranchi (Jharkhand) and Bageshwar and Nainital (Uttarakhand) are in closer vicinity. Female infants in districts experience a higher mortality than male infants. IMR in rural areas of districts is significantly higher than that in urban areas.

Neo-Natal Mortality Rate (NNMR) measures the number of infant deaths (age below 29 days) per 1,000 live births. Rudraprayag has reported the minimum NNMR at 11 while Balangir in Orissa, the maximum at75. Out of every 10 infant deaths 6-7 pertain to Neo Natal Deaths. Rural NNMR in districts is significantly higher than the urban.

Under-5 Mortality Rate (U5MR) which denotes the number of children who died before reaching their fifth birthday per 1,000 live births has been reported in Pithoragarh district of Uttarakhand as minimum at 24 and maximum in Kandhmal district of Orissa at 145. More number of females in districts die before reaching age 5 years as compared to their counterparts. In all, 7 districts viz. Pithoragarh, Almora, Rudraprayag, Chamoli, Nainital and Bagheswar (Uttarakhand) and Purbi Singhbhum (Jharkhand) have already achieved the MDG -4 National target of 42 by 2015. Another 10 districts viz. Dhanbad, Bokaro, Kodarma, Hazaribagh and Giridih (Jharkhand) and Kota (Rajasthan) and Champawat, Udham Singh Nagar, Dehradun and Uttarkashi (Uttarakhand) are in closer vicinity. Rural U5MR in districts is significantly higher than the urban.

In order to facilitate direct intervention, the Maternal Mortality Ratio (MMR) measuring the proportion of maternal deaths per 1,00,000 live births has been published for a group of districts. The grouping of districts has been done on the basis of existing administrative divisions (Commissionraits) in the respective AHS States. In all, there are 62 such divisions across 9 AHS States. Among these divisions, the minimum MMR of 183 has been reported for Kumaon Division in Uttarakhand and the maximum 451 in Faizabad Division in UP.

Sex Ratio at Birth (SRB) defined as the number of female live births per 1,000 male live births has been reported the lowest at 764 in Pithoragarh district of Uttarakhand and the maximum 1030 in Moradabad district of Uttar Pradesh. SRB in rural areas of districts is generally higher than in urban areas.

The survey has been implemented in all the 284 districts in 8 Empowered Action Group States which include Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan and in Assam for a three year period of 11th Five Year Plan. It has been designed to yield benchmarks of core vital and health indicators at the district level on fertility and mortality; prevalence of disabilities, injuries, acute and chronic illness and access to health care for these morbidities; and access to maternal, child health and family planning services. The objective is to monitor the performance and outcome of various health interventions of the Government including those under National Rural Health Mission (NRHM) at closer intervals through benchmark indicators.

These nine States, which account for about 48 percent of the total population in the country, 60 per cent of births, 71 per cent of infant deaths, 72 per cent of under-5 deaths and 62 per cent of maternal deaths.

Importantly, 100 districts account for 52 per cent of under-5 mortality rate whereas it was 63 at the baseline. In U5MR, 15 districts—Pithoragarh, Almora, Rudraprayag, Chamoli, Nainital, Bagheswar, Dehradun and Champawat (Uttarakhand) and Purbhi Singhbum, Hazaribagh, Dhanbad, Bokaro, Girdih, Deoghar and Kodarma (Jharkhand)—have already achieved the MDG national level target of 42. During the first update and baseline, there were 12 and 7 districts. Champawat, Hazaribagh, Dhanbad, Bokaro, Kodarma (first update), Giridih, Deoghar and Dehradun (second update) are new additions.

Another 11 districts—Ranchi and Garhwa (Jharkhand); Durg (Chhattisgarh); Udham Singh Nagar and Pauri Garhwal (Uttarakhand); Dhemaji and Kamrup (Assam); Indore (M.P.); Kota (Rajasthan); Jharsuguda (Odisha); and Patna (Bihar)—are in closer vicinity. Chhattisgarh and Bihar recorded the highest fall (7), while UP and Uttarakhand recorded the lowest (3) from the baseline to the second update round.


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