Community-based survey report shows malaria prevalence is what differentiates high mortality districts from low mortality ones
Malaria is the leading cause of death among children in Chhattisgarh, according to the findings of a community-based survey in the state. Even among older people, it is one of the leading causes of death, says the draft report of community-based monitoring for 2012-13. Low birth weight and severe malnutrition along with pneumonia and diarrhoea were the other leading causes of death among children, says the report made available on the state website recently.
The report is the result of community-based monitoring (CBM) and was compiled in May this year. CBM in health services is one of the components of the National Rural Health Mission (NRHM), meant to enhance community participation in health sector. The state has engaged village health sanitation and nutrition committees (VHSNCs) in this exercise.
The CBM report reveals that the mosquito-borne disease is biggest challenge for state; VHSNCs have reported more than 2,400 malaria-related deaths. Since VHSNCs have reported only 25 per cent of total deaths, the actual number of malaria deaths in the state could be even higher (see death reporting percentage). The same holds true for other causes of mortality.
Malaria, in fact, seems to be the one factor that differentiates high mortality districts—Sarguja, Jashpur, Dantewada—from low mortality districts—Durg and Kanker. Malaria accounts for 2 per cent deaths in Durg district, whereas it accounts for 12 per cent of the total deaths reported from Sarguja. Malaria, diarrhoea and tuberculosis (TB) together account for 5 per cent of the deaths in Durg whereas these account for 21 per cent of deaths in Dantewada.
This report analyses nearly 40,000 rural deaths that were recorded by VHSNCs during the year 2012. These deaths constitute 25 per cent of total number of deaths expected according to crude death rate of the state.
|Death reporting percentage
||Expected Rural Deaths
|1-12 age group Death
|1-5 year age group Deaths
|Note: Expected Rural Deaths are based on mortality rates given in Annual Health Survey (AHS) 2010
||Most Common Cause
||Other Significant Cause
||Low birth weight, Pneumonia
|1 month to 12 months
||Diarrhoea, Severe malnutrition
|1 year to 5 year
|5 to 14 years
|14 to 49 years
|49 to 60 years
||Malaria, TB, Accidents, suicide
|60 to 70 years
|Above 70 years
||Malaria, accident, TB
Report highlights official apathy
Chhattisgarh, a state which has shown great eagerness to outsource diagnostic services along with other health facilities, has clearly failed to monitor its available facilities, if one were to go by the findings of the report (also see Chhatisgarh stalls PPP project to outsource diagnostic facilities). The CBM report says that only 47 per cent of deliveries are conducted by auxiliary nurse and midwives ANMs in sub health centres. These ANMs charge money for providing drugs and conducting deliveries at home, says the report.
The report further says that only 60 per cent doctors are available at the primary health centres (PHCs) regularly; only 62 per cent female doctors visit PHCs under fixed days’ service. The report says that only 60 per cent PHCs have facilities of delivery during the night.
The annual health report of the state offers some more insight. It admits that number of referrals related to sick newborns is very low. Implementation of Janani Shishu Suraksha Karyakram (JSSK) is also abysmal. Around 40 per cent delivery patients reaching community health centres (CHCs) and district hospitals did not get free transport and around half of the JSSK patients had to pay user charges. The report admits that benefit under JSSK was not available to majority of the ante-natal cases coming to CHCs and district hospitals. Rashtriya Suraksha Bima Yojana (RSBY) is also poorly implemented in the state.
“Last year the state faced huge crisis of basic malaria medicine like chloroquine and ACT. So, if the government wants to control the disease, it must equip its drug centres. The government should check the gap of demand and supply immediately, if it wants to control the disease,” says a health activist in Raipur.
A major problem in providing healthcare in the state is that the doctors posted in rural areas are not skilled enough. They need training on dealing with emergencies. Timely detection of diseases is also very important to control mortality, the activist said.