NFHS-5 (Assam).pptx

NFHS-5 with special reference to Assam

1. NFHS-5 with Special Reference to Assam Mostaque Ahmed , PGT Dept. of Community Medicine, Gauhati Medical College & Hospital, Guwahati 1

2. Introduction National Family Health Survey (NFHS) is a large scale, multi-round survey conducted in a representative sample of households in India. NFHS was initiated in the year 1990. NFHS-1 in 1992-93 NFHS-2 in 1998-99 NFHS-3 in 2005-06 NFHS-4 in 2015-16 NFHS-5 in 2019-21 2

3. NFHS Goal   Each successive round of the NFHS has had two specific goals:  a) to provide essential data on health and family welfare needed by the Ministry of Health and Family Welfare and other agencies for policy and programme purposes, and b) to provide information on important emerging health and family welfare issues. 3

4. Conducted by: Ministry of Health and Family Welfare GOI. Nodal agency: International Institute For Population Sciences (IIPS) Mumbai. Funding: - United States Agency for International Development(USAID), - The United Kingdom Department for International Development - The Bill and Melinda Gates Foundation(BMGF), - United Nations Children’s Fund(UNICEF), - United Nations Population Fund (UNFPA) and - The MacArthur Foundation and - Government of India. Technical assistance: International Classification of Functioning, Disability and Health(ICF) USA with financial support from USAID (For NFHS-5). Assistance for HIV Component: National AIDS control organization (NACO) and National AIDS Research Institute (NARI), Pune. 4

5. The National Family Health Survey 2019-21 (NFHS-5), the fifth in the NFHS series, provides information on population, health, and nutrition for India and each state/union territory (UT). Components of NFHS-5: Population and household profile Characteristics of Adults ( age 15-49 years) Fertility Infant and child mortality Maternal and child health Reproductive health Nutrition Anaemia Utilization and quality of health and family planning services 5

6. NFHS-5 includes some new topics in comparison to NFHS-4, such as- Preschool education, Disability, Access to a toilet facility, Death registration, Bathing practices during menstruation, and Methods and reasons for abortion The scope of clinical, anthropometric, and biochemical testing (CAB) has also been expanded to include measurement of waist and hip circumferences, and the age range for the measurement of blood pressure and blood glucose. 6

7. HIV testing has been dropped. It gives information up to district level except information about sexual behaviour; husband’s background and woman’s work; HIV/AIDS knowledge, attitudes and behaviour; and domestic violence, which are available only at the state/union territory (UT) and national level. Information collected on 19 languages using Computer Assisted Personal Interviewing (CAPI) Eligibility criteria : Woman age: 15- 49 Man age: 15-54 7

8. Provide high-quality data on health and family welfare and emerging issues in this area Setting benchmarks and examining the progress of health sector over the time Providing evidence for the effectiveness of ongoing programmes Also help in identifying the need for new programmes and the groups that needs essential services 8 Objectives:

9. Sampling Design: 9 For Rural Area Sub-stratified into smaller substrata Stratification based on Village size, percentage of SC/ ST population and literacy rate of woman age >6 years From each PSU, a fixed number of 22 households per cluster are selected using systemic random sampling Villages are selected as Primary Sampling Unit (PSU)

10. Sub-stratified into smaller substrata Census enumeration blocks (CEB) is selected as Primary Sampling Unit(PSU) From each PSU, a fixed number of 22 households per cluster are selected using systemic random sampling Primary Sampling Unit (PSU) are sorted according to ST/SC population For Urban Area 10

11. Data about some important indicators: NFHS-5 India Assam Sex ratio of the total population (females per 1,000 males) 1020 1012 Total fertility rate (children per woman) 2.0 1.9 Neonatal mortality rate (per 1,000 live births) 24.9 22.5 Infant mortality rate (IMR) 35.2 31.9 Under-five mortality rate 41.9 39.1 11

12. India Assam Sex ratio at birth for children born in the last five years (females per 1,000 males) 929 964 Total unmet need(%) 9.4 11 Unmet need for spacing(%) 4 4 Mothers who had at least 4 antenatal care visits (%) 58.1 50.7 Mothers who had an antenatal check-up in the first trimester (%) 70 63.8 Institutional births (%) 88.6 84.1 Children age 12-23 months fully vaccinated 76.4 66.4 12

13. India Assam Children age 12-23 months fully vaccinated 83.8 71.8 Children age 12-23 months who received most of their vaccinations in a public health facility (%) 94.5 95.6 Children age 12-23 months who received most of their vaccinations in a private health facility (%) 4.2 2.3 Births delivered by caesarean section 21.5 18.1 Children under 5 years who are stunted (height-for-age) 35.5 35.3 13

14. India Assam Children under 5 years who are wasted (weight-for-height) (%) 19.3 21.7 Children under 5 years who are severely wasted (weight-for-height) (%) 7.7 9.1 Children under 5 years who are underweight (weight-for-age) 32.1 32.8 Children under 5 years who are overweight (weight-for-height) 3.4 4.9 14

15. India Assam Children age 6-59 months who are anaemic (<11.0 g/dl) 67.1 68.4 Non-pregnant women age 15-49 years who are anaemic (<12.0 g/dl) 57.2 66.4 Pregnant women age 15-49 years who are anaemic (<11.0 g/dl) 52.2 54.2 All women age 15-49 years who are anaemic 57 65.9 All women age 15-19 years who are anaemic 59.1 67 Men age 15-49 years who are anaemic (<13.0 g/dl) 25 36 Men age 15-19 years who are anaemic (<13.0 g/dl) 31.1 39.6 15

16. Comparisons: NFHS 4 V/S NFHS 5 NFHS 4 NFHS 5 Total sample size Approx 6,01,509 households Approx 6,36,699 households Total Districts covered in India 640 707 Total Districts covered in Assam 27 33 Duration in Assam From 6 th Nov 2015 to 31 st March 2016 Completed in 5 months From 17 th June, 2019 to 21 st Dec 2019 Completed in 7 months Conducted by Nielsen India Pvt. Ltd. Nielsen India Pvt. Ltd. Sample Size in Assam 24,542 households 30,119 household Male : Female 4,191: 28,447 (1:7) 4,973: 34,979 (1:7) 16

17. Household Composition: India Assam NFHS -4 Assam NFHS-5 Rural : Urban Population - 84:16 84:16 Household headed by woman 14.6% 14% 15% Population <15 yr. age 28.6% 30% 28% Population > 65 yr. age 6.6% 5% 5% Female per 1000 male 991 993 1012 Birth registration 80% 94% 96% 17

18. Household characteristics India NFHS 4 Assam NFHS 4 Assam NFHS 5 Pucca House 56% 25% 33.3% Electricity 88% 78% 93% No sanitary facility 39% 11% 4% Clean fuel 44% 25% 42% Improved drinking water 90% 84% 86% Water treatment - 48% 53% Toilet Facility 48% 47.7% 96% 18

19. Assam Scenario: Percentage Pucca House increases from 25% to 33.3% : Indicates better implementation of Pradhan Mantri Awas Yojana (PMAY). Household Electricity increase from 78% to 93%: Under Pradhan Mantri Sahaj Bijli Har Ghar Yojana ( SAUBHAGYA) scheme started in 2017. Till march 2019, 17 lakhs houses are electrified. Swachh Bharat Mission and Pradhan Mantri Ujjwala Yojana for improved toilet facility and clean fuel to maximum household in Assam. 19

20. Literacy Rate 20

21. 21 Never been to School Completed School up to 12 yrs.

22. Fertility Trend: India NFHS 4 Assam NFHS 4 Assam NFHS 5 Teenage Pregnancy 8% 14% 12% Birth Interval between two pregnancy 32 month 42.3 month 46 month Next child within 3 years of previous child - 39% 33% 22

23. Assam Scenario: Key barriers in preventing teenage pregnancy in Assam : Child marriage ( 31.8% from 30.8%) Low level of education of parents as well as early married couples Lack of education I naccessibility to contraception and health information A utonomy over decision-making among woman 23

24. Total Fertility Rate 24

25. 25 The replacement level for TFR 2.1 has been achieved in 19 out of 22 states except Manipur (2.2) Meghalaya (2.9) Bihar (3.0)

26. Family Planning India NFHS 4 Assam NFHS 4 Assam NFHS 5 Contraceptive Prevalence rate ( Woman 15-49 yr.) 54% 52% 61% Knowledge of Emergency Contraceptive use - 42% 51% Use of modern family planning methods 48% 37% 45% Female sterilization 36% 10% 9% Unmet needs for woman 13% 14% 11% 26

27. Few Facts… In NFHS 5, Overall Contraceptive Prevalence Rate (CPR) has increased in most states/ UTs with highest in Himachal Pradesh and West Bengal (78%). Unmet needs for family planning declining in most of States/UTs in NFHS 5 except Meghalaya and Mizoram . 27

28. Few Facts.. Female sterilisation continues to dominate as the modern method of contraception in states like Andhra Pradesh (98%), Telangana (93%), Kerala (88%), Karnataka (84%), Bihar (78%) and Maharashtra (77%). Male engagement in family planning continues to be limited and disappointing as seen by the low uptake of condoms and male sterilization across states. According to NFHS 5, Lowest use of public health sector as a source for modern contraception in Tripura (40%) followed by Assam (41%) and Highest in Madya Pradesh (86%) 28

29. Assam Scenario: Contraceptive prevalence rate (CPR) and Use of modern family planning methods increase in NFHS 5, Assam: amendment of Population and Women Empowerment Policy, 2019 by Govt of Assam. Unmet needs for woman is decreased but still not able to achieve the desired goal of 10%. Decreased female sterilization methods due to unsatisfactory family planning services in Assam. According to survey by Govt. of India , 21.4% health workers not talked to female non users about family planning methods. 29

30. Infant and Child mortality (per thousand live births) 30 India NFHS 4 Assam NFHS 4 Assam NFHS 5 India NFHS 4 India NFHS 4 India NFHS 4 India NFHS 4 Assam NFHS 4 Assam NFHS 4 Assam NFHS 5 Assam NFHS 5

31. Assam Scenario Reasons for decrease in IMR, NMR and U5MR in Assam- Strenuous efforts to provide essential newborn care at Govt health institutes. promoting institutional delivery among the poor pregnant wom an. Proper training of health officers for mother care and childhood infection management. Increase immunization coverage. Boat clinic and MMU services to Riverine and Char areas. Intensified health services to tea garden areas. 31

32. Maternal Health India NFHS 4 Assam NFHS 4 Assam NFHS 5 Received ANC from health professionals 79% 83% 85% Pregnancy registered 85% 94% 97% MCP card present 89% 96% 99% ANC in 1 st trimester 59% 55% 64% At least 4 ANC visit completed 51% 46.4% 64% IFA for 100 days/180 days 30%/ 32%/ 44.1%/26% Protected against Neonatal tetanus 89% 90% 95% 32

33. Delivery care India NFHS 4 Assam NFHS 4 Assam NFHS 5 Institutional delivery 79% 71% 84% Assisted by Health personal 81% 74% 86% Post natal care within 2 days 27% 58% 69% 33

34. Assam Scenario: Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), Boat Clinic and Tribal RCH programme for Riverine and Char areas, Village Health Sanitation and Nutrition Day (VHSND) under NHM all contribute towards improved ANC coverage. I nstitutional delivery rates have significantly improved reaching the mark near to around 90%, which hints towards proper utilization of Janani Suraksha Yojana ( JSY), Janani Shishu Suraksha Karyakaram (JSSK) schemes. 34

35. Child Vaccination and Vitamin A supplementation 35

36. Assam Scenario Lack of information among parents is one of the major causes of drop out in the vaccination coverage. L iteracy level of parents had important role for better immunization Coverage. Inaccessibility to health care facilities in few areas. Failure of health system to mobilize uneducated parents towards vaccination. 36

37. Childhood Diseases India NFHS 4 Assam NFHS 4 Assam NFHS 5 Children with symptoms of ARI taken to health facility 78% 47% 51% Children with Diarrhoea taken to health facility 68% 51% 54% Practise of ORS 51% 52% 69% Zinc supplementation 20% 22% 28% 37

38. ICDS service utilization India NFHS 4 Assam NFHS 4 Assam NFHS 5 Age <6 years service utilization in Anganwadi Center (AWC) overall 54% 56% 66% Supplementary food 48% 54% 65% Health check up 40% 43% 56% Early childhood care 38% 44% 54% Growth monitoring 43% 39% 52% Immunization 40% 29% 35% 38

39. Nutritional status of children ( age < 5 years) 39

40. Assam Scenario Reasons behind failure to correct malnutrition : Early Marriage( 31.8%) and Teen age pregnancy(12%) Low investment in girl’s health and education Inadequate birth planning Failure of POSHAN Abhiyaan to meet its desired goals. Reported lack of funding to ICDS scheme Effect of COVID pandemic (Schools and AWCs getting closed) 40

41. Nutritional status of adult (age 15-49 years) 41 Body Mass Index ( < 18.5 kg/m 2 ) Body Mass Index ( ≥ 25 kg/m 2 ) Woman Man Woman Man India NFHS 4 23% 20% 21% 19% Assam NFHS 4 26% 21% 13% 13% Assam NFHS 5 18% 13% 15% 16%

42. Anaemia among Children and Woman India NFHS 4 Assam NFHS 4 Assam NFHS 5 Children age 6-59 months 58% 36% 68% Non-pregnant woman ( 15-49 yrs.) 53% 46% 66% Pregnant woman age ( 15- 49 yrs.) 50.4% 45% 54% 42

43. Assam Scenario Early Marriage( 31.8%) and Teen age pregnancy(12%) low compliance of IFA supplementation. I nadequate awareness coupled with poor access to IFA supplements. I nadequate training of frontline health workers. I nadequate counselling and awareness created among pregnant woman and woman with child bearing age groups. H igh magnitude of undernutrition and infectious diseases among tea garden population of Assam. 43

44. Comprehensive Knowledge of HIV/AIDS among Adults (15-49 yrs ) 44

45. Tobacco use and Alcohol consumption among adults ( age ≥ 15 Yrs.) Using any kind of Tobacco Using any kind of Alcohol Woman Man Woman Man India NFHS 4 7% 45% 1% 29% Assam NFHS 5 22% 52% 7.3% 25% 45

46. S pousal violence Karnataka ( Highest 44.4% from 20.6%) Sikkim Maharashtra Himachal Pradesh Assam 46

47. Critical Review by Experts… Proper implementation of Swachh Bharat Mission and Pradhan Mantri Ujjwala Yojana for improved toilet facility and clean fuel to maximum household in the country. Flagship initiative of Mission Indradhanush able to get its desired goal, as the increase in full immunization coverage is observed as expected in many states and UTs in NFHS-5 compared to NFHS-4. 47

48. I nstitutional delivery rates have significantly improved reaching the mark near to around 90 percent, which hints towards proper utilization of Janani Suraksha Yojana ( JSY), Janani Shishu Suraksha Karyakaram (JSSK) schemes. Women’s empowerment indicators improved across all the States/UTs included in Phase 1 NFHS-5 in regard to women receiving more than 10 years of education or having a bank account. 48

49. The worsening of nutritional status ( 13-16 out of 22 states) among under 5 children shows that enough efforts were not made for prevention and management of malnutrition in almost all states and UTs in the country. Govt Flagship programme , Poshan Abhiyan with ambitious goal of achieving a Kuposhan Mukt Bharat failed to correct malnutrition of under 5 children in the country. Declined in e arly initiation of breastfeeding and practicing of prelacteal feeds clearly indicates in non-adherence to Infant Milk Substitute (IMS) act 49

50. L ake of funds affects health schemes. Eg : Poor infrastructure, insufficient funds to ICDS program leads to poor quality of Supplementary Nutrition Programme (SNP). Due to economic slowdown and stagnation in wages of the poor over the last few years, the NFHS-5 results are most likely an indication of the fact that people’s ability to access good quality nutrition has reduced. 50

51. The NFHS-5 further showed that almost all States/UTs have recorded a drastic rise in the percentage of children under five years who are overweight. It is most likely due to unhealthy food habits, reduced physical activity , as per the Union Health Ministry. (Highest in Ladakh 13.4%). 51

52. New area of interest for strengthening existing programmes : Expanded domains of child immunization Components of micro-nutrients of children Menstrual hygiene Frequency of alcohol and tobacco use Non Communicable diseases additional components Expanded age ranges for measuring hypertension and diabetes (age ≥ 15yr) 52

53. an increase in the prevalence of anaemia among young children, adolescents, pregnant women, non-pregnant women and men in most of the states. For both women and men, there is a lot of variation in the high or very high random blood glucose levels across States/UTs. Men are more likely to have slightly higher blood glucose levels in the range of high or very high compared to women. The percentage of men with high or very high blood glucose is highest in Kerala (27%) followed by Goa (24%). Prevalence of elevated blood pressure (hypertension) among men is somewhat higher than in women. 53

54. References: International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS 4), 2015-16: India: Vol 1. Mumbai: IIPS International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS 5), 2019-21: India: Vol 1. Mumbai: IIPS National Family Health Survey (NFHS 4), India, 2015-16: Assam. Mumbai: IIPS www.nfhsindia.org www.mohfw.nic.in [email protected] ICMR: India Nhm.gov.in assam 54

55. THANK YOU 55