Child Survival
In our programme villages, child survival has improved steadily over the years. The infant mortality rate has reduced from 86 / 1000 live births to the current 29.5 / 1000 live births, which is significantly lower than the current rate for rural Chhattisgarh which is at 59/1000 live births (SRS Bulletin, October 2009, Rural IMR). We have achieved this through sustained efforts in various aspects of maternal and child health.
The improved reach of antenatal services has enabled us to prevent malaria in pregnant women, thus increasing the birth weight of newborns. In 2009, we were able to get birth weights of 88% of newborns, and 80% of them weighed over 2.5 kg. Antenatal services have also enabled us to detect those with risk factors that can be addressed during pregnancy (like severe anaemia or pregnancy induced hypertension), and also those who need to deliver in an institution (eg abnormal presentation; rheumatic heart disease; multiple pregnancy).
The steep fall in the neonatal mortality rate has been the result of improved care provided to newborns at the community level and early identification and treatment of illnesses; as well as prompt referral to a facility when required. All our health workers, as well the TBAs we work with know the importance of warmth and breastfeeding in newborn care. Postnatal visits are made for the first ten days by the village health worker, who checks whether the baby is feeding well, and looks for signs of infection. Ensuring a clean delivery, as well as improved cord care, have reduced the incidence of neonatal sepsis.
Deaths By Age
A comparison of the ages of death between 2003 and 2009 shows a significant reduction in the proportion of deaths among those between 5 and 60 years of age, and a larger proportion of deaths among those who are older (over 60 years).
Deaths due to preventable causes seem to be reducing, if we assume that most deaths below 60 years should be preventable. The largest gain in survival is among the economically productive age group of 16 to 60 years: deaths among this group have reduced from 40% of all deaths to 27% of deaths.
The negative side of this is that there could be less care sought for older members of the family due to economic constraints. We have seen this sometimes where the family of an elderly patient took them home choosing not to get them treated, even if the condition was treatable. The decision to spend money and time on an economically unproductive member of the family is difficult to make in the face of already overwhelming poverty.
