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Southern States
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Andhra Pradesh-Hyderabad
State's infant mortality rate alarmingly high
By Y. Mallikarjun
While the IMR declined from 31 to 14 per cent in the other Southern States in the last 10 years, the decline in Andhra Pradesh was only 10 per cent. The IMR has declined from 57 to 49 (14 per cent) in Tamil Nadu, 16 to 11 (31 per cent) in Kerala, 77 to 58 (25 per cent) in Karnataka and about 18 per cent all over India from 80 to 66 during the same period.
The disturbing aspect is that Andhra Pradesh is not only lagging behind the other southern States in the tempo of decline, but the IMR more or less remained static around 66 per 1000 births, Prof. K. Balasubramanian, a demographic expert working with the Indian Institute of Health and Family Welfare told The Hindu here.
Another aspect, which needs the immediate attention of any interventional programme, is the high IMR in rural areas. Of every 100 infant deaths, as many as 74 occurred in the rural areas. "If we have to design any interventional programme, we have to concentrate on rural areas because of the magnitude of the problem in terms of number," he observed. Out of every one lakh infant deaths, about 84,000 are from rural areas.
An equally disturbing aspect is that about 70 per cent are neo-natal deaths (infants dying within 30 days of birth) and of them, about 80 per cent are early neo-natal deaths (within first week). In other other words, about 54 per cent of infant deaths were occurring in a week's time. The main factors responsible for neo-natal deaths are pre-term births and low birth weight. "Therefore any intervention should take care of both mother and the baby." Birth injury, asphyxia and sepsis at the time of delivery are the other causes for neo-natal deaths.
Prof. Balasubramanian also attributed the high percentage of home-based deliveries (around 42 per cent) in Andhra Pradesh as the other cause for the high IMR rate. With regard to post-natal deaths, Acute Respiratory Infection (ARI) was responsible for about 20 per cent of them, followed by diarrhoea, measles, malnutrition and others. He said that effective ante-natal, post-natal and new born care would help in preventing neo-natal deaths. Besides long-term measures like improving literacy, reducing poverty and sustaining good environmental conditions would ensure that infant mortality is reduced.
Terming as "ambitious" Andhra Pradesh's projections of achieving an IMR rate of 15 per 1,000 live births by 2020, he said that if the same trend continues, it would take at least 50 years for Andhra Pradesh to reach the current level of Kerala (16/1000) where institutional births (hospital deliveries) are 90 per cent, coupled with other socio-economic factors such as high female literacy, higher marriage age and good health infrastructure. "IMR is one indicator which tells about the social, economic and health development of a region or country." He said that lowest recorded IMR rate was 2.5 per 1,000 live births in Singapore, followed by Japan (3). The IMR rate ranges from 5 to 10 for most developed countries.
He said that strong interventional programmes are needed for Andhra Pradesh to achieve better results in reducing the IMR.
A senior health official admitted that Andhra Pradesh is faltering in reducing the IMR rate due to ineffective implementation of the interventional programmes. Though well planned interventions such as having 470 round-the-clock PHCs, Sukhibhava scheme (under which a pregnant woman is given Rs.300 for hospital delivery) and Arogya Raksha (providing medical insurance coverage upto Rs. 20,000 for five years) have been launched, the lack of medical and paramedical staff, absence of proper referral system to provide care for high risk mothers and very little coordination among the higher echelons in the health department are some of the main reasons for Andhra Pradesh lagging behind.
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