REFUGEE

: With an estimated infant mortality rate (IMR) of 35 per 1,000 live births in Tamil Nadu, the State is among the better performers when compared to its counterparts in the rest of the country. For, the national IMR is 55, with Madhya Pradesh, Orissa and Uttar Pradesh faring the worst with IMRs of 72, 71 and 69, respectively, according to the Union government’s SRS bulletin put out in October 2007.
A recent study released by the State Planning Commission threw up some very interesting figures on child health in Tamil Nadu. Called the District Human Development Reports, the study focused on five districts: Tiruvannamalai, Sivaganga, Cuddalore, Nagapattinam and Dindigul.
According to the study, in 2000, the under-five mortality in the State was 60 per 1,000 live births. In Dindigul district, the current underfive mortality is quite low. For example, in Natham block in the district, under-five mortality was 24.9 between 2002 and 2004, but dropped to just 3.4 in 2006. Besides, in Kodaikanal, underfive mortality was zero in 2006-2007. In Cheyyar block of Tiruvannamalai district, the underfive death count in 2002-2003 was 66 per 1,000.
Within a year, the figure came down to 58.
Lower the IMR, higher is the quality of life.
More than being just an indicator of the status of health, nutrition and caring accessible to infants below one year of age, the IMR denotes the general wellbeing of the society.
In 1970, the IMR of Tamil Nadu was at 125 per 1,000 births. It came down to 51 by 2000 and 35 in 2007. The country’s IMR in 2007 stood at 55 per 1,000 live births. But in Sivagangai, the IMR recorded was just 19.63 deaths per 1000 births. This shows Sivagangai has gone well ahead of the State’s and country’s IMRs. Devakottai and Sackottai in Sivagangai recorded IMR of 13.08 and 13.25 respectively during this period. Interestingly, heavily urbanised blocks like Mayiladuthurai and Nagapattinam reported highest IMRIs. In Nagapattinam, the IMR rate for 2003 was 30.2.
Like IMR, Still Birth Rate (SBR) is one of the important indicators in human development.
Malnutrition of the expectant mothers and their poor health status are the primary reasons for SBR.
Dindigul district has achieved progress in tackling SBR rates. It declined steadily from 2001 and stood at 16.03 per 1,000 live births in 2006. Similarly, Palani, which had a high incidence of 32.49 SBRs, successfully brought it down to 19.27. Sivagangai again is better placed in SBR with only 6.33 SBRs per 1,000 births.
In Tiruvannamalai district, the SBR was 25.68 in 2004. The main reasons cited for this high an SBR were asphyxia, low birth weight, prematurity and congenital heart diseases. But now the district has succeeded in bringing it down to 11.3. The districts where still birth rates still remain high include Perambalur( 21.1), Pudukkotai(20.8) Theni(19.9) and Madurai (18.8). In Cuddalore, the SBR was 16.80 in 2005. The blocks - Kammapuram, Virudhachalam, Keerapalayam, Annagramam and Nallur - recorded higher SBR than the State average between 2000 and 2005.
Crude Birth Rate (CBR), another indicator of human development, has been declining in Tamil Nadu. The CBR declined from 31.4 to 19.3 per cent between 1971 and 2000, with the second period of decline in CBR observed after mid- 1980s. Dindigul district is a fine example for fluctuation in the CBR. A series of data for six years from 2001 to 2007 for various blocks shows that Guziliyamparai block of Dindigul experienced severe fluctuation. In 2003, Dindigul block showed CBR rate of 20.1, but in the following years it declined steadily to 17.5 per 1,000 births in 2006. Among the 14 blocks in Dindigul district, CBR is low in Thoppampatti block, a highly rural area.
In Tamil Nadu, the decline in death rate has not been as impressive as the decline in birth rates. From 14.4 in 1971, it has only come down to 7.9 per 1,000 in 2000. For example, Kodaikanal block of Dindigul district recorded a CDR of just 4.09 in 2006. Among the 14 blocks, Reddiarchatram had the highest crude death rate of 8.9 in 2004 and 7.8 in 2006.
'South Asia accounts for 32% of under-5 deaths'
CHENNAI: South Asia accounted for 32 per cent of the world’s under-five deaths in 2008, according to a study by the Inter-agency Group for Child Mortality Estimation (IGME) published in Lancet.
Although the under-five mortality rate has declined by 39 per cent since 1990, the rate of progress toward Millennium Development Goal 4 remains insufficient, the study said.
The Millennium Development Goal 4 (MDG 4) calls for a two-thirds reduction in the mortality rate among children under the age group of five years between 1990 and 2015.
About 75 per cent of the world’s under-five deaths in 2008 took place in only 18 countries. Half of the deaths occurred in only five countries - India, Nigeria, Democratic Republic of the Congo, Pakistan and China. And India and Nigeria together account for nearly one-third of the total number of under-five deaths worldwide (21 per cent and 12 per cent, respectively), the study adds.
Africa and Asia combined represent 93 per cent of all under-five deaths (51 per cent and 42 per cent, respectively), according to the study.
Since 1990, the global under-five mortality rate has declined by 28 per cent from 90 deaths per 1,000 live births to 65 in 2008. The total number of under-five deaths in the world has declined from 12.5 million in 1990 to 8.8 million in 2008. The highest rates of mortality in children under five continue to occur in sub-Saharan Africa.
There, in 2008, one in seven children (144 per 1,000 live births) died before their fifth birthday; the highest levels were in Western and Central Africa where one out of six children die before five years (169 per 1,000 live births).
There is an urgent need for the global health community to refocus on pneumonia and diarrhoea as two of the three most important causes of under-five mortality; new tools, such as vaccines against pneumococcal pneumonia and rotaviral diarrhoea, might provide much needed momentum and an entry point for the revitalisation of comprehensive programming against these diseases, says the Lancet paper.
The IGME is formed by experts at UNICEF, WHO, the World Bank, the UN Population Division (UNPD), and members of the academic community. The IGME aims to source and share data on child mortality, to improve estimation methods, and to produce consistent estimates on the levels in child mortality worldwide.