SOCIETY FOR HEALTH AND DEMOGRAPHIC SURVEILLANCE
Pathfinding for better living
ANNUAL REPORT
2011
Society for Health & Demographic Surveillance Swasthya Bhavan. GN , Sector V. Salt Lake Kolkata-700092
FIELD OFFICE : 2nd Floor, Gole Market, Chaitali More, P.O- Suri, Birbhum, West Bengal, INDIA Ph. 03462 250371 Email: [email protected] Website : www.shds.in
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The Hon’ble Chairperson & Members of the General body Society for Health and Demographic Surveillance
Respected madam and members,
It’s with pleasure that I present this report before you for the third time since the society started crawling in 2008. It had been a non conventional and challenging task that we had put before ourselves . I would like to point out that when we started. , we did not have an example before us in this country to learn the nuances of the job– development of a population laboratory that a Health and Demographic Surveillance syatem(HDSS) is . It’s all conviction and sheer hard work of the workers of the society that we can now claim that West Bengal has got the most organized (if not the only!) and systematically maintained population lab , that’s a dream for health planners , social scientists and researchers in biological sciences. The data base and the ware house that has been developed and is being maintained is likely to provide a matrix for intersectoral cross talk amongst academics as well as the government departments for different activities pertaining to health care and human development in the years to come . We must express our greatfulness to the department of Health and Family Welfare , Government of West Bengal for planning and funding such a venture , which no other state Government is doing till now . Health in a HDSS should be looked like flower in a garden- in its’ natural habitat. The natural habitat of a population lab are the people residing in the households and also the surrounding community. I may mention here that our initial years (we began reaching people towards end of 2008) of went in developing the parlance – the art and craft of winning the confidence of the people. For the people in our households, geting involved continuously in an endeavor that does not pay back in immediate material terms is a culture that required lot of pursuation , conviction and devotion of our workers . I salute their effort and the society is now deeply rooted in each of the households of the project where our workers are treated like relatives. Another crucial factor had been setting the cultural tune of the workers in the art of immaculate data collection. This has become even more important today when respect to data quality and sanctity is not very high in the system, as a whole. I may politely mention that our systematic cross checks had been successful in getting rid of the malady of putting in some scribbles called “data”. Till 2010 end (2009 -2010), we had to organize, consolidate, learn – delearn and learn again. I can assure you that this phase is over and since 2011 middle , we are onto more focused research. We expect that in 2012, we will come out with several publications. An important achievement had been that the Birbhum Population Project (BIRPOP) that the society is engaged in, has started attracting attention globally – although we are yet to crystallize the collaborations. Public Health Foundation of India (PHFI) has expressed their willingliness for collaborative international project . The translational health Sciences & technology Institute (THSTI - DBT) , New Delhi has also verbally expressed their desire to work with us. In the state, we are already working in collaborations with scientists of IPGME&R and NIBMG , Kalyani. The social scientists of the Institute of Development studies, Kolkata had been of immense help from the very beginning , as had been scientists of Indian Statistical Institute (ISI) . We have a strong research review committee chaired by Prof. V I Mathan and an ethics committee chaired by Prof. Partha Pratim Majumdar. Both the committees had been guiding our research – although we could not organize a research review committee meeting in 2011. We are extremely grateful to them. We have received a grant of Rs. 22,90,000 from NRHM , Government of West Bengal for development of a public health biomedical research lab in the fields. The requisite steps have been taken and we hope to develop that very soon. We have also received a grant for a research project from NRHM and one is expected from Department of Science and Technology, Government of West Bengal. We are expecting that in the coming years we will be able to generate more extramural grants for research – while the Department of health and Family welfare, Government of West Bengal supports the core structure . I am aware of and wish to express our significant limitations till now – in no unclear terms. Some of them are mentioned below : 1. The first scientific publication using the SHDS data base has been published by scientists of IPGME&R in a very high impact journal – HEPATOLOGY. We need to produce publications in greater numbers . Publications are the best way to market this unique endeavor of the Government. 2. We are yet to catch attention of more scientists of the state – who can use this lab as a site for their research . The BIRPOP can also be used as a centre for public health education and training by Medical colleges. 3. There is still deficiency in the part of integration with the mainstream health care delivery and public health system – although we are trying utmost to bridge this gap. 4. We also need to aquire membership of the global forum of the HDSS s – INDEPTH , which we have not been done so far. I hope the members will critically evaluate the achievements , take stock of the limitations and provide guidance for the future activities and programs . I express again my thanks to the workers of the society – all engaged in contract for six months – whose hard labour and sincereity is engraved in each line of this report . My regards to hon’ble chairperson and the members . Thanking you
Abhijit Chowdhury Member Secretary Society for Health and Demographic Surveillance 21 st February , 2012. Kolkata.
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Contents Page No.
Governing Body Research Review Committee Ethics Committee Towards An Impact …………………………………. 4-8 BIRPOP Project Team ………………………………. 9 Project Geography…………………………………. .. 10 Sampling Methodology ……………………………. . 11-12 Project Work Flow Structure with Time Plan . ……… 13 Village General Information Collection Survey ……. 14 Data Collection on vital events (birth, death, ` marriage, migration)…………………………………. 15-19 Survey of Maternal and Child Health ……………….. 20-22 Verbal Autopsy on death events …………………….. 23-25 Smoking & smokeless tobacco survey ……………… 26-27 Village Hygiene Awareness Survey (Four Blocks) …. 28 DETAILED Socio-demographic and health survey … 29-32 Quality Control, Health Care Assistance Service & Future perspective……………………………………. 33-34 How Do We Look Forward in Future.……………….. 35
ABBREVIATIONS SHDS Society for Health & Demographic Surveillance. HH Household RC Research Co-ordinator SM Survey Manager DM Data Manager DOTS Directly Observed Treatment Short Course Chemotherapy MDT Multi Drug Therapy Cl Cluster
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TOWARDS AN IMPACT
In order to derive population based health and socio-economic information, the need for a population laboratory had been recognized as a global necessity. There had been several such attempts in developing countries, beginning with MATLAB in Bangladesh and Framingham in United States . India is in a socio economic and demographic transition . The health care priorities of the country are changing . On one hand we have still have a significant burden of communicable disease , some of which are emerging and “re”emerging posing new challenges. In addition , a broad range of non communicable diseases (NCD s )- once considered a burden of the affluent western nations- are evolving . While the basic biology of such health conditions are same globally , many of these have social , economic and lifestyle correlates that vary regionally and influenced by cultural and ethnic factors . In addition , all these characteristics also keep on changing over a period of time. Catching the dynamics of such interactions over a time frame can provide clues to biology , economic impact of the health problem and guide health planning- prioritization and resource allocation. In this backdrop , it was felt that we need to have a well defined cohort of people who will be observed and analyzed in a scientific manner over a period of time. The Government of West Bengal have initiated this project called “Health and Demographic Surveillance System” in 2008 . This has initially been set out for a project duration of five years.
Vision: To create an institution which improve the pursuit of knowledge and culture for innovations in population based health research aimong at better health services.
Mission: Develop, test and promote realistic solutions guiding planning of major public health problems of West Bengal and India while improve the understanding of natural history and biology of diseases of public health priority.
Objectives of the Society:
o To plan, organize, develop and maintain a health and demographic surveillance system (HDSS ) that will help providing information for health planning and human development in West Bengal. o To carry out research in area pertaining to health strategy, policy and interventions , useful in the context of the West Bengal. o To facilitate population based research in different diseases and health conditions as may be deemed to be priorities, from time to time. o To generate health awareness and capacity building of the staffs as well as target population to prevent diseases. o To establish scientific collaboration and cross talk with national and international forums relevant in population and health research. o To ensure scientific excellence in data generation , maintenance ethical standards and dissipation of the gathered information.
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GOVERNING BODY OF THE SOCIETY
1. Ms. Mamata Banerjee – Hon’ble Chief Minister, West Bengal and Minister in Charge, Department of Health and Family Welfare – Chairperson
2. Shri Sanjay Mitra IAS – Principal Secretary, Department of Health and Family Welfare, Government Of West Bengal – Vice Chairperson
3. Prof (Dr) Sushanta Banerjee – Director of Medical Education & E.O secretary, Department of Health and Family Welfare, Government Of West Bengal . Member
4. Dr. Biswa Ranjan Satpathi – Director of Health Services & E.O secretary, Department of Health and Family Welfare, Government Of West Bengal . Member
5. Mr. Dilp Ghosh IAS , Director, Strategic Planning and Sector Reforms Cell & Secretary , Department of Health and Family Welfare, Government Of West Bengal . Member
6. Mr. PK Ghosal . Executive Director, State Family Welfare Samity, West Bengal – Member
7. Mr. S N Roy Choudhury – Finance Officer, State Family Welfare Samity. – Treasurer
8. Prof. Partha Pratim Majumder – Director, National Institute of Bio Medical Genomics – Member
9. Dr. G B Nair – Executive Director , Translational Health sciences and Technology Institute, New Delhi – Member
10. Prof. Amal Santra – Professor, Centre for Liver Research, Department of Hepatology, School of Digestive and Liver Diseases, IPGME&R – Member.
11. Dr. Dhruba Jyoti Ghosh – Scientist, Centre for studies in Social sciences, Kolkata – Member.
12. Chief Medical Officer , Birbhum – Invited Member
13. Dr. Abhijit Chowdhury . Professor & Head, Department of Hepatology, School of Digestive and Liver Diseases, IPGME&R – Member Secretary.
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RESEARCH REVIEW COMMITTEE
1. Prof. V I Mathan – Scientist, Chennai – Chairman
2. Prof. Partha Pratim Majumder – Director, National Institute of Bio Medical Genomics , Member.
3. Dr. Samiran Panda – Scientist, National Institute of cholera and Enteric Diseases, Kolkata – Member.
4. Dr.Dilip Mahalanabish – Scientist, Society for Applied Studies, Kolkata – Member .
5. Dr. Achin Chakravorty – Development and Health Economist, Institute of Development studies, Kolkata. - Member
6. Dr. G B Nair - Executive Director , Translational Health sciences and Technology Institute , New Delhi – Convenor
ETHICS COMMITTEE
1. Prof. Partha Pratim Majumder – Director , National Institute of Bio Medical Genomics- Chairman
2. Prof. Malay Ghosh – Professor & Head , Deaprtment of Hematology , NRS Medical College , Kolkata – Member
3. Prof. Nirod Baran Debnath – Professor , Deaprtment of Medicine , NRS Medical College , Kolkata – Member .
4. Dr. Soma Banerjee – Associate Professor , Centre for Liver Research , Department of Hepatology, School of Digestive and Liver Diseases, IPGME&R – Member .
5. Md . Hanif Kaba Mujawar - National Institute of Bio Medical Genomics, Kalyani – Member .
6. Mr. Satya brata Mandal - Lawer , Kalyani – Member
7. Shri Sarathi Das – Teacher , Suri, Birbhum – Member
8. Mrs. Susmita Mukhopadhyay – Social Scientist, Indian Statistical Institute , Kolkata – Member
9. Dr. Abhijit Chowdhury – SHDS . Member Secretary
Page 6 ORGANOGRAM
Governing Body
Secretary cum Project Director
Field Director ------Medical Coordinator (2)
Research Coordinator
Survey Manager Office Assistant Social Worker Data Manager (1) (1) (1) (1)
Field Monitor Data Entry Operator Office Attendant (1) (8) (3)
Surveyor (44)
Villagers (157 mouzas)
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“BIRPOP” PROJECT TEAM
Sl Name Designation 1 Dr.Abhijit Chowdhury Project Director 2 Dr. Sunil Bhaumik Field Director 3 Dr. Anamitra Barik ResearchCoordinator 4 Dr. Saibal Majumdar Medical Coordinator 5 Dr. Kajal Chatterjee Medical Coordinator
Total staff strength at Suri Branch office is 60. Details are given below:
Manpower Profile of SHDS, Suri Office Manpower Profile of SHDS, Suri Office Sl Block Cl No Name of Employee Designation Sl Block Cl No Name of Employee Designation 1 Ashoke Gorain Survey Manager 31 Rajnagar 9 Sima Das Bhakta Surveyor 2 Saikat Majumdar Data Manager 32 Rajnagar 10 Manisha Mondal Surveyor 3 Mrinmoy Das Office Assistant 33 Rajnagar 11 Piyali Roy Surveyor 4 Biswajit Sen Social Worker 34 Md. Bazar 12 Namita Mardi Surveyor 5 Jagannath Das Office Attendent 35 Md Bazar 13 Sravanti Mondal Sureyor 6 Chandan Mukherjee Field Monitor 36 Md. Bazar 14 Sohada Begum Surveyor 7 Snehansu Ghoshal Field Monitor 37 Md. Bazar 14.1 Mustakima Khatun Surveyor 8 Sadhan Kumar Sen Field Monitor 38 Md. Bazar 14A Srabani Sadhu Surveyor 9 Chanchal Banerjee Field Monitor 39 Md. Bazar 15 Jaba Gorai Surveyor 10 Uday Chatterjee Field Monitor 40 Md. Bazar 16 Samapti Chandra Surveyor 11 Manas Banerjee Field Monitor 41 Md. Bazar 17 Nur Nehar Begam Surveyor 12 Partha Ghosh Field Monitor 42 Md. Bazar 18 Iva Chatterjee Surveyor 13 Radha Ballav Chatterjee Field Monitor 43 Md. Bazar 19 Kanika Mondal Surveyor 14 Subrata Kumar Chaudhuri Data Entry Operator 44 Md. Bazar 19A Pratima Nayek Surveyor 15 Pradip Ghosh Data Entry Operator 45 Md. Bazar 20 Tuktuki Pal Surveyor 16 Joydeep Bandyopadhyay Data Entry Operator 46 Md. Bazar 20.1 Priyanka Mukherjee Surveyor 17 Suri 1 Madhumita Singh Surveyor 47 Md. Bazar 21 Rekha Chatterjee Surveyor 18 Suri 1.1 Purnima Das(Mondal) Surveyor 48 Sainthia 22 Daymoy Pal Surveyor 19 Suri 2 Soumi Banerjee Surveyor 49 Sainthia 23 Tripti Biswas Surveyor 20 Suri 3 Husnera Khatun Surveyor 50 Sainthia 24 Fatema Khatun Surveyor 21 Suri 4 Mabia Khatun Surveyor 51 Sainthia 25 Latika Das Surveyor 22 Suri 4A Subhodra Mukherjee Surveyor 52 Sainthia 26 Isanur Iman Surveyor 23 Suri 5 Hasi Sen Surveyor 53 Sainthia 27 Parimal Gorai Surveyor 24 Suri 5A Sanghamitra Das Surveyor 54 Sainthia 28 Subodh Gorai Surveyor 25 Suri 6 Mithu Das Surveyor 55 Sainthia 29 Ruparani Mondal Surveyor 26 Suri 6A Pratima Roy Surveyor 56 Sainthia 30 Kakali Pramanik Surveyor 27 Rajnagar 7 Pinku Swarnakar Surveyor 57 Sainthia 31 Chandana Saha Surveyor 28 Rajnagar 7.1 Sonali Mishra Surveyor 58 Sainthia 32 Joyashree Pal Surveyor 29 Rajnagar 8 Subhra Dutta Surveyor 59 Sainthia 33 Mousumi Singh Surveyor 30 Rajnagar 8A Subhra Acharya Surveyor 60 Sainthia 34 Sadai Bagdi Surveyor
Page 9 PROJECT GEOGRAPHY
No of No of Name of Block Mouza Village
Suri 1 35 59 Rajnagar 17 62
Md. Bazaar 48 112
Sainthia 57 118 Total 157 351
Area (square Block kilometer [km 2]:) Suri -1 28.03 Md Bazaar 119.99 Rajnagar 76.12 Sainthia 38.22
Block :- Suri – 1 ( Name of Mouzas against Cluster ) Cluster No: - 1, Kamalpur, Cluster No: - 1, Lambodarpur, Cluster No: - 1, Tilpara, Cluster No: - 1, Bansjore, Cluster No: - 2, Panuria, Cluster No: - 2, Bhurkuna, Cluster No: - 2, Kochujore, Cluster No: - 3, Junidpur, Cluster No: - 3, Itagoria, Cluster No: - 3, Choto Alunda, Cluster No: - 3, Baro Alunda, Cluster No: - 4, Kakuria, Cluster No: - 4, Kukhudihi, Cluster No: - 4, Dhalla, Cluster No: - 4A, Changuria, Cluster No: - 4A, Adda, Cluster No: - 4A, Abdarpur, Cluster No: - 5, Araipur (Laldighi), Cluster No :- 5, Brajergram, Cluster No :- 5, Kalipur, Cluster No :- 5A, Karidhya, Cluster No :- 6, Chhora, Cluster No :- 6, Chormura, Cluster No :- 6, Lakhindarpur, Cluster No :- 6, Govindapur, Cluster No :- 6A, Nagari, Cluster No :- 6A, Pathar Chapri.
Block :- Rajnagar (Name of Mouzas against Cluster) Cluster No: - 7, Lauberia, Cluster No: - 7, Aligarh, Cluster No: - 7, Tabadumra, Cluster No: - 7, Muradganj, Cluster No: - 8, Ragnagar, Cluster No: - 8A, Ragnagar Part, Cluster No: - 8, Shankarpur Part, Cluster No: - 7, Gangmuri, Cluster No: - 9, Gulalgachi, Cluster No: - 9, Parashia, Cluster No: - 9, Tantipara, Cluster No: - 10, Laujor, Cluster No: - 10, Kundira, Cluster No: - 10, Kanmora, Cluster No: - 10, Haripur, Cluster No: - 11, Balarampur, Cluster No: - 11, Chandrapur, Cluster No: - 11, Madhaipur, Cluster No :- 11, Patadanga
Block: - Md. Bazar , (Name of Mouzas against Cluster)) Cluster No: - 12, Hatgachia, Cluster No: - 12, Chanda, Cluster No: - 12, Jethia, Cluster No: - 12, Chakaipur, Cluster No: - 13, Haridaspur, Cluster No: - 13, Kapasdanga, Cluster No: - 13, Dhamra, Cluster No: - 13, Ganpur, Cluster No: - 14, Alinagar, Cluster No: - 14, Sonthsal, Cluster No: - 14, Dighalgram, Cluster No: - 14A, Ban Bataspur, Cluster No: - 14A, Baltuti, Cluster No: - 14A, Sekeddaha, Cluster No: - 14A, Makdamnagar, Cluster No: - 15, Tetul Beria, Cluster No: - 15, Kabilnagar, Cluster No :- 15, Nischintapur, Cluster No :- 15, Palan, Cluster No :- 16, Baliharpur, Cluster No :- 16, Kasistha, Cluster No :- 16, Sarenda, Cluster No :- 16, Debagram, Cluster No :- 16, Deucha, Cluster No :- 16, Bahadurganj, Cluster No :- 17, Usha, Cluster No :- 17, Rautara, Cluster No :- 17, Kaijuli, Cluster No :- 17, Md.Bazar, Cluster No :- 17, Maulpur, Cluster No :- 18, Lohabazar, Cluster No :- 18, Komarpur, Cluster No :- 18, Rajyadharpur, Cluster No :- 18, Kharia, Cluster No :- 19, Anargoria, Cluster No :- 19, Puranagram, Cluster No :- 19, Heruka, Cluster No :- 19A, Sahanagar, Cluster No :- 19A, Kabilpur, Cluster No :- 20, Kulkuri, Cluster No :- 20, Bishnupur, Cluster No :- 20, Kharia – Nimdaspur, Cluster No :- 20, Baidyanthpur, Cluster No :- 20, Charicha, Cluster No :- 20, Raghunathpur, Cluster No :- 20, Birpur, Cluster No :- 20, Sukna, Cluster No :- 21, Seherakuri, Cluster No :- 21, Khairakuri, Cluster No :- 21, Maladanga
Block: - Sainthia , (Name of Mouzas against Cluster)) Cluster No: - 22, Harisara, Cluster No: - 22, Rarkenada, Cluster No: - 22, Salchapra, Cluster No: - 22, Amua, Cluster No: - 23, Deriapur, Cluster No: - 23, Baidyapur, Cluster No: - 23, Kunkuri, Cluster No: - 23, Rangaipur, Cluster No: - 24, Bengra, Cluster No: - 24, Bhalian, Cluster No: - 24, Mathpalsa, Cluster No: - 24, Mahisadahari, Cluster No: - 25, Derpur, Cluster No: - 25, Hatora, Cluster No: - 25, Barasangra, Cluster No: - 25, Nanubazar, Cluster No: - 26, Dakshin Seur, Cluster No: - 26, Uttar Amarpur, Cluster No :- 26, Kherua, Cluster No :- 26, Pariharpur, Cluster No :- 26, Balsunda, Cluster No :- 27, Mallickpur, Cluster No :- 27, Uttar Banagaon, Cluster No :- 27, Uttar Bamnigaon, Cluster No :- 27, Uttar Tilpara, Cluster No :- 27, Dahira, Cluster No :- 27, Markola, Cluster No :- 28, Harpalsa, Cluster No :- 28, Phulur, Cluster No :- 28, Uttar Sija, Cluster No :- 28, Jiui, Cluster No :- 29, Kanturi, Cluster No :- 29, Deoash, Cluster No :- 29, Mitrapur, Cluster No :- 29, Uttar Kanaipur, Cluster No :- 29, Bataspur, Cluster No :- 30, Kagas, Cluster No :- 30, Paschim Sahapur, Cluster No :- 30, Paschim Naoapar, Cluster No :- 30, Bharmakol, Cluster No :- 31, Kuchighata, Cluster No :- 31, Kusumdihi, Cluster No :- 31, Bhagawatipur, Cluster No :- 32, Iswarpur, Cluster No :- 32, Juita, Cluster No :- 32, Kusumjatra, Cluster No :- 32, Kurumsaha, Cluster No :- 32, Palasdanga, Cluster No :- 33, Purba Siur, Cluster No :- 33, Paharpur, Cluster No :- 33, Ikra, Cluster No :- 33, Banjita, Cluster No :- 34, Bholagaria, Cluster No :- 34, Rasaipur, Cluster No :- 34, Panrui, Cluster No :- 34, Lebra, Cluster No :- 34, Digha
Page 10 SAMPLING METHODOLGY
Birbhum was selected initially in view of the fact that some population based studies have been carried out in this district earlier.
STEP 1 . Selection of Blocks from Birbhum district:
Four blocks were selected purposively, taking into consideration: (i) socio-economic status (ii) urbanization status (iii) relative proportions of tribal and caste populations (iv) availability of infrastructure for the conduct of survey.
The following table provides the number of households in the selected blocks (Data from Census of India, 2001):
STATE DISTRICT LEVEL BLOCK NAME Total No. of HHs in Block West Bengal Birbhum C.D. BLOCK Suri - I 20047 West Bengal Birbhum C.D. BLOCK Rajnagar 14470 West Bengal Birbhum C.D. BLOCK Mohammad Bazar 27805 West Bengal Birbhum C.D. BLOCK Sainthia 36014 TOTAL 98336
STEP 2 . From logistical and cost considerations, it was decided that a total of approximately 12,000 households would be sampled from these 4 blocks for the formation of the cohort.
STEP 3 . We adopted the principle of probability proportional to size (i.e., total number of households) for allocation of the number of households to be selected from each block. Using this principle, the distribution of the number of households to be selected from each block was:
Block Name No. of HHs to be selected from Block Suri - I 2446 Rajnagar 1766 Mohammad Bazar 3393 Sainthia 4395 TOTAL 12000
STEP 4. Detailed data from Census of India, 2001, pertaining to these blocks were gathered. Appropriate portions of these data were used for allocating the numbers of households to be sampled from villages within these blocks.
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STEP 5. For logistical reasons, it was decided that sampling of households will be confined only to villages in which >200 households reside. The following table provides the distribution of the total number of villages and the number of villages of size > 200 households.
Total no. of No. of v illages with Block villages >200 households Suri - I 104 29 Rajnagar 89 18 Mohammad Bazar 138 50 Sainthia 216 57
STEP 6 . The number of households to be selected from each village of size > 200 households were thus decided . A probability proportional to size (i.e., number of households in village) scheme was used for allocation of the numbers of households to be sampled from the villages.
STEP 7 . Sampling of households from within a village will be done using a circular systematic sampling scheme.
There are 157 mouzas in our project area. Total no of village is 351. The whole mouzas are divided into 40 clusters and one surveyor looks after one cluster. There are 8 field monitors and each field monitor (on an average) guides and supervises the activity of 5 surveyors.
Salient features of study population
Total Surveyed Household 13053 Total Targeted Population 59395 Average Member of Household 4.55 Total Male Population 30325 Total Female Population 29070 Sex Ratio all ages 959 % of Household Head belong to Hindu Religion 70.37 % of Household Head belong to Muslim Religion 28.99 % of Household Head belong to Christian Religion 0.55 % of Male Population (all ages) 51.05 % of Female Population (all ages) 48.95 Household heads belong to General 50.42 Household heads belong to OBC 6.16 Household heads belong to SC 33.6 Household heads belong to ST 9.77
Page 12 PROJECT WORK FLOW STRUCTURE WITH TIME PLAN
Work Flow Time Flow Planned Routine Activity Collection of data on birth, death, marriage and migration in SHDS sample HH. Tracking on ANC, PNC, Still birth & Abortion in all HH in targeted villages. Verbal Autopsy on Death events(0 to 28 days, 29 days -14 yrs Throughout the Year & 15 yrs & above) SHDS sample HH. Health care & referral facilities at villages and Suri sadar hospital for non sample & sample HH. Regular house visit & interaction by the surveyors at field. Programmatic and focused Surveys in the Year Survey on smoke & smokless tobacco among Sample HHs. January 2011 –March 2011 Survey on village hygiene awareness(5-9 years of children) March 2011 –April 2011 both sample & non sample HHs. Village information survey & village social & resource April 2011 –May 2011 mapping. Stool collection from malnourished children for metagenomic analysis in collaboration with NICED, Kolkata Pilot phase survey on socio-economic aspects and morbidity Sep. 2011 – Nov 2011 status among selected non sample HH.
Cl 26 Md IsanurIman When I visited the house of Chandra Basak for “1 st phase enumeraton survey” (HH No 300), one of them attacked me with a stick after taking country liquor. Some of the villagers even threatened me to stop the survey. After this incident I convinced everybody about the aims of the society. At present I have no problem.
Page 13 Village General Information Collection Survey
We completed another survey which is the collection of general information of all SHDS sample villages. It includes land and its use, water sources, irrigation facility, road and other communication facility, education and health facility, access to govt. health care services, local practitioner, market and credit facility, cooperative society, drug shop availability, cable connection and other modern facilities and village drainage system etc. It was conducted in the month of April-May 2011.
The objectives of collecting this information were to create a data base of the sample villages in which the selected households belong. It will definitely help us to understand the overall village environments in which the householders spend its lives. These social determinants of health will help us to understand the health of the target population .
Some survey findings :
Total Sample Village : 351 Information collected : 351
Informations are kept in the office library for future use of reference.
Cl 22 Dayamoy Pal Mr. Sankar Thakur of HH no.142 of Bagdanga village was suffering from high blood pressure but it was unknown to him. At the time of Anthropometric measurement survey I checked his BP and found it is quite high. I advised him to attend the hospital immediately. He then visited the Santhia Rural Hospital, got checked up and gone through doctor’s aqdvice. Now he is comfortable as his BP got normalized.
Page 14 Data Collection on vital events (birth, death, marriage, migration )
Vital Events Survey has been started on October 2010. It is being continued through regular data collection. Vital events survey includes Birth, Death, Marriage and Migration related informations.
Objectives behind: • To know the yearly status of birth, death, marriage and migration among SHDS sampled HH. • To know the causes and status of maternal mortality in SHDS sampled villages.
During the interview an adult household member is asked about demographic events e.g. births, deaths, marriages, in and out migrations, antenatal cares within the household. All information is recorded in the “household register (HR) “, and on formats which record each type of event. Surveyors report their work on a weekly basis to a field monitor, who brings the completed work to a weekly office meeting. All household visits and events are recorded in a database system. Any inconsistencies which cannot be resolved from the formats are sent back to the field team for correction. Mid Year Population of 2011 : 59798
Year 2010 2011 Crude Birth Rate 13.24 12.16 Crude Death Rate 5.50 6.17 Sex Ratio 959 959
Analysis of birth in the year of 2009 – 2011 Table No: - 1
Total Year baby Male Female born 2009 704 365 339 2010 798 402 396 2011 727 381 346
Table No: - 2 Nature of Delivery Normal Forceps Cesarean Year Delivery Delivery Delivery 2009 625 15 64 % 88.78 2.13 9.09 2010 682 27 88 % 85.57 3.39 11.04 2011 651 10 66 % 89.55 1.38 9.08
Nature of Delivery
800 600 400 200 0 Normal Forceps Cesarean Delivery Delivery Delivery
2009 2010 2011
Page 15 Table No: - 3
Place of Delivery
At Nursing Not Year PHC BPHC RH Sub. Div SH MC Others home home available
2009 203 50 102 9 28 266 3 39 4 0 % 28.84 7.10 14.49 1.28 3.98 37.78 0.43 5.54 0.57 0.00 2010 235 63 95 14 22 307 1 53 6 2 % 29.45 7.89 11.90 1.75 2.76 38.47 0.13 6.64 0.75 0.25 2011 182 41 63 28 25 338 7 34 8 1 % 25.03 5.64 8.67 3.85 3.44 46.49 0.96 4.68 1.10 0.14
Place of Delivery
400 350 300 250 200 150 100 50 0 At home PHC (2) BPHC (3) RH (4) Sub. Div SH (6) MC (7) Nursing Others (9) Not (1) (5) home (8) available
2009 2010 2011
Cl -17 Nurhehar Begam One of the householders, Naima Bibi of HHno.755 went to a gynaecologist in his private chamber for her ANC check up; who advised her to abort the child .She was in distress. I visited her and advised to attend the health sub centre and informed the concerned ASHA to tackle the situation. Now she is attending the sub centre regularly and taking medicines and fine now.
Page 16 Analysis of marriage in the year of 2009 – 2011
Table No: - 1
Total Year Marriage 2009 456 2010 802 2011 825
Table No: - 2
Percentage Educational Status 2009 2010 2011 Illiterate 14.25 11.72 10.67 Literate without formal education 0 0.25 0.24 Below primary 12.06 9.1 6.30 Primary 34.21 32.42 31.27 Middle school (8 pass) 20.18 21.45 23.88 Secondary school (Madhyamik) 10.53 14.59 14.42 Higher Secondary school 5.26 5.86 8.00 Diploma /Certificate course 0.22 0.37 0.48 Graduate 2.41 3.24 4.00 PG & above 0.88 1 0.73
Cl 10 Manisha Mondal Dhobona is a remote village located in tribal dominated Rajnagar block. The villagers were mostly dependent on local quack and untrained dai for delivery. The delivery of first child of Munni Pandit, the wife of Chootu Pandit was done at the village. But at the time of 2 nd issue, I started PNC surveillance throughout. I convinced them to ensure delivery at the govt. hospital. Now both mother and child are safe and well.
Page 17 Analysis of Migration
Table No: - 1 Type of Migration
Category of Type of migration 2011 Total migration Single Partial Entire Migration Out 631 770 212 1,613 Migration In 489 131 20 640 Total 1,120 901 232 2,253
Table No: - 2 Status of Migration
Total members Out migration In-migration Year of Migration Total members Male Female Total members Male Female 2009 2573 2259 1352 907 314 51 263 % 100 59.85 40.15 100 16.24 83.76 2010 2148 1635 774 861 513 65 448 % 100 47.34 52.66 100 12.67 87.33 2011 2253 1613 621 992 640 136 504 % 100 38.50 61.50 100 21.25 78.75
Table No: - 3 Reasons from Out-migration
Total members of Family Work Housing Not Year Education Marriage Out-migration related related related available 2009 2259 313 1223 125 333 253 12 % 100 13.86 54.14 5.53 14.74 11.2 0.53 2010 1635 222 744 93 109 448 19 % 100 13.58 45.5 5.69 6.67 27.4 1.16 2011 1613 693 226 194 71 418 11 % 100 42.96 14.01 12.03 4.40 25.91 0.68
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Table No: - 4 Reasons for In-Migration
Total members Family Work- Housing Not Year Education Marriage of Migration In related related related available 2009 314 45 33 2 9 225 0 % 100 14.33 10.51 0.64 2.87 71.66 0 2010 513 75 11 16 10 399 2 % 100 14.62 2.14 3.12 1.95 77.78 0.39 2011 640 143 33 38 32 394 0 % 100 22.34 5.16 5.94 5.00 61.56 0.00
Table No: - 5 Educational Status
Percentage Educational Status 2009 2010 2011 Illiterate 13.78 18.09 16.37 Literate without formal education 0.8 0.2 0.37 Below primary 12.13 13.33 14.82 Primary 24.45 24.62 23.56 Middle school (8 pass) 14.44 12.94 13.58 Secondary school (Madhyamik) 8.45 8.84 7.63 Higher Secondary school 7.93 6.01 4.28 Diploma /Certificate course 0.94 0.4 0.31 Graduate 6.32 3.23 3.72 PG & above 2.6 1.25 0.99 Not available 8.16 11.09 14.38
Cl 11 Piyali Roy In Balarampur village, one household member (HH No 938), Dipu Bagdi, wife of Raghu Bagdi has not attended the subcentre for antenatal check ups.I spent few hours with her to discuss the importance of regular ANC.She got convinced and underwent for 4 ANCs & full immunization.She gave birth to a healthy baby at the BPHC later on.
Page 19 SURVEY OF MATERNAL AND CHILD HEALTH
One of the core activities of SHDS is ANC & PNC tracking and abortion care. A detailed tracking format has been designed and surveyors collect continuous data on the subject matter.
Objectives of ANC • Promote and maintain the physical, mental and social health of mother and baby by providing education on nutrition, personal hygiene and birthing process • Detect and manage complications during pregnancy, whether medical, surgical or obstetrical. • Develop birth preparedness and complication readiness plan. • Help prepare mother to breastfeed successfully, experience normal puerperium, and take good care of the child physically, psychologically and socially.
Age wise pregnancy distribution
Age Group Number %
15.27 < 19 Years 820 19 to 35 Year 4511 83.99 36 and above 26 0.48 Not available 14 0.26
Total 5371 100.00
Birth Order
Birth Order Number % 1 2541 47.31 2 2034 37.87 3 552 10.28 4 144 2.68
5 and above 71 1.32 Not available 29 0.54 Total 5,371 100.00
Immunization status of pregnant mothers
Immunization Number % Immunization not done 263 4.90 Immunization 1 times 1686 31.39
Immunization 2 times 3380 62.93
0.19 Immunization 3 times 10 Not available 32 0.60 Total 5371 100.00
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Number of ANCs done
Mothers who have Number of mothers % completed no. of ANC 1 Time 766 25.16 2 Times 931 30.58 3 Times 808 26.54 > 3 Times 349 11.47 Not available 190 6.24 Total 3,044 100.00
Not done Investigation Done/taken Not available /not taken / facilities (percent) (percent) (percent) Blood Grouping 44.74 50.05 5.21 Haemogobin 79.53 17.55 2.92 Urine Sugar 63.65 33.7 2.66 Urine for Protein 61.41 35.94 2.66 IFA tablets>100 12.12 82.37 5.51% BP measurement 65.35 30.91 3.74 Weight measurement 61.72 37.96 0.32
Outcome of mother
Outcome of Mother Number %
Healthy 2809 92.28
Eclampsia 31 1.02
Complicated 124 4.07
Death 4 0.13 NA 76 2.50 Total 3044 100.00
Cl 6 Mithu Das One household member Manoj Marandi, in tribal area of Bhaluka village was suffering from Low back pain. For the last few years, he is unable to perform his normal household activities and use to lie down in his bed throughout the day. Then I discussed the matter with FM.Subsequently RC visited the house and diagnosed it to be a case of caries spine which occurred due to an untreated tubercular infection. Now the patient has been registered at the local DOT centre & started taking ATDs. He is better now
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CHILD HEALTH
Initiation of Breast Feeding Status of prelacteals
Withi n > 1 to 24 1 - 3 > 3 days Taken Not Not 1 hour hrs. days Prelacteals taken available 68.60 14.05 2.48 14.88 13.5 71.63 14.88
Outcome of baby Neonatal (0 to 28 days) Death
Outcome of Underlying cause of death % Baby % Birth Asphyxia 59.09 Less than 1.5 Aspiration Pneumonitis 9.09 kg 7.16 Prematurity / low birth weight 18.18 1.5 to 2.4 Kg 17.36 Meconium Aspiration Syndrome 4.55 Live Birth(>=2.5 Meningitis 4.55 kg) 60.33 Pneumonia/A.R.I. 4.55 Abortion 6.61 Still Birth 1.93 N/A 6.61 Total 100
Child (29 days to 14 Years) Death Underlaying Cause of Death (Total Percentage death 27) Pneumonia/A.R.I. 25.93 Drowning 22.22 Acute Appendicitis/ Acute Abdoment 7.41 Meningitis 7.41 Thalassaemia 3.70 Diarrhoea 3.70 Road Traffic Accident 3.70 Falls 3.70 Brain Tumour 3.70 Guillain Barre Syndrome 3.70 Unknown fever 3.70 Stab injury 3.70 Suicidal burns 3.70 Accidental asphyxia 3.70
Cl 18 Iva Chatterjee Mr Bodhan Murmu of Komarpur village was diagnosed with Tuberculosis. One day when the doctors from Suri Sadar hospital were counseling him and other family members before starting treatment, the family members rejected their advice. The doctors then requested me to motivate him to take medicines. Then I started to visit the family more frequently and convince his wife first, then the patient and finally the patient realized the need of regular drug intake. Now he is taking regular drugs through DOTS.
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Verbal autopsy on death events
The Verbal Autopsy on Death Cases has been started in December 2010 among the SHDS sampled HH which is still continuing..
Objectives of the Verbal Autopsy
• To know the history and causes of death as stated by the persons associated with the death person of SHDS sampled HH • To know the background information i.e treatment, type of death, source of money, referral facility, awareness, age, caste and occupational background of the death case . From January 2011, the verbal autopsy-trained surveyors will try to elicit information on the cause of all deaths. They will interview bereaved relatives within 14-30 days after the death. The interview will follow a structured questionnaire about the circumstances of the death, the signs and symptoms in the illness leading to the death, and the action taken. This information will be coded to give likely causes of death in broad categories .VA utilizes the sequence of signs and symptoms on the deceased person prior to death. The interview was carried out by the surveyors on the relatives\persons, preferably those who were present at the time of death. It includes either open-ended description of illness that led to death or modular questions leading to disease symptoms or combination of both.
• VERBAL AUTOPSY (VA), a two step procedure
– Data collection : interview of bereaved relatives to collect information on symptoms experienced by deceased before death, using some form of survey instrument
– COD assignment : methods include – physician review of VA data – ICD certification, coding, and tabulation – computerised algorithms for population fractions
Table-1
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Table-2 Adult (15 Years & above) Underlying cause of death COPD (Chronic Obstructive Pulmonary Desease) 55 17.19 Hypertensive Heart Disease 65 20.31 Thalassaemia 1 0.31 Drowning 1 0.31 Diarrhoea 5 1.56 Road Traffic Accident 9 2.81 Coronary/ Ischaemic Heart Disease 14 4.38 Acute Appendicitis/ Acute Abdoment 1 0.31 Asphyxia 1 0.31 Railway Accident 3 0.94 Falls 3 0.94 Cirrhosis of liver/ Chronic Liver Disease 15 4.69 Squamous Cell Carcinoma of left leg 1 0.31 Rheumatic Heart disease 3 0.94 Diabetes Mellitus 10 3.13 Senility 19 5.94 Unknown 23 7.19 Malnutrition 3 0.94 Cancer of Pharynx 1 0.31 Physical Assault 1 0.31 Carcinoma Head of Pancreas 1 0.31 Tuberculosis 19 5.94 Brain Tumour 2 0.63 Liver Cancer 3 0.94 Lightning 3 0.94 Hip Fracture 2 0.63 Cancer of Larynx 1 0.31 Cancer of Cervix 3 0.94 Suicidal poisoning 3 0.94 Suicidal hanging 9 2.81 Electrocution 2 0.63 Leukaemia 4 1.25 Post Partum Haemorrhage 1 0.31 Exterrnal haemorrhoids 1 0.31 Surgery/Surgical exploration 2 0.63 Cancer of ovary 2 0.63 Bronchogenic carcinoma 4 1.25 Snakebite 2 0.63 Chronic renal failure 4 1.25 Malaria 1 0.31 Gunshot injury 1 0.31 Oral cancer 2 0.63 Pancreatitis 1 0.31 Chronic kidney disease 1 0.31 Stab injury 1 0.31 Suicidal burns 2 0.63 Anal fissure 1 0.31 Cancer stomach 1 0.31 Pulmonary Embolism 2 0.63 Seizure disorder/Epilepsy 2 0.63 Accidental asphyxia 1 0.31 Congenital Heart Disease 2 0.63 Total 320 100
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Table-3 Underlying cause of Death
Underlying Cause of Dealth (Adult 15 Years and above)
70
60
50
40
30
20
10
0 Cancer Malaria Senility Suicidal Surgical Asphyxia Unknown Diarrhoea Accidental Malnutrition Tuberculosis Thalassaemia Cardiomyopathy Diabetes Mellitus Diabetes Chronic renal failure renal Chronic Pulmonary Embolism Pulmonary Chronic kidney disease kidney Chronic Disease Liver Alcoholic Desease) Rheumatic Heart disease Heart Rheumatic Congenital Heart Disease Heart Congenital Post Partum Haemorrhage Partum Post Hypertensive Heart Disease Heart Hypertensive Coronary/ Ischaemic Heart Disease Heart Ischaemic Coronary/ COPD (Chronic Obstructive Pulmonary (ChronicObstructive COPD Cirrhosis of liver/ Chronic Liver Disease Liver Chronic of liver/ Cirrhosis
Table-4 Total deaths at a glance
Overall deaths No. of Patient Adult 320 Child 27 Neonatal 22 Total 369
Still Birth – 20.
Cl 5 Hasi Sen One household member (HH No 1792) of my cluster, Fagu Das was suffering from leprosy. Though he tried to conceal the fact due to social stigma, but he confessed everything to me. Then I have referred the patient to the local PHC. At present he is better than before & taking MDT.
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Smoking & smokeless tobacco survey
The period of smoking and smokeless tobacco survey was from Nov. 2010 to April 2011. It also helped to generate awareness among the targeted population in this issue. A significant no. of persons has left the smoking during and after the completion of the survey.
Objectives of the Survey: • To know the prevalence rate of smoking and smokeless tobacco among SHDS sampled HH(age group->14) • To know the status of passive smoking among SHDS sampled HH.
Smoking & Smokeless tobacco Survey
Total Male Female Total Male Female Percent Percent Percent Total Surveyed Family Member 38479 19400 19079 100 50.42 49.58 Total Current Smoker 8859 8285 574 100 93.52 6.48 Total Current Passive Smoker 14626 3915 10711 100 26.77 73.23 Total Current Smokeless tobacco User 9175 5382 3793 100 58.66 41.34
Percentage of current smokers and smokeless tobacco users
Current Smoker amongst Interviewed Persons 23.02 Current Smoker amongst Male Interviewed 42.71 Persons Current Smoker amongst Female Interviewed 3.01 Persons Current Passive Smoker amongst Interviewed 38.01 Persons Current Passive Smoker amongst Male Interviewed 20.18 Persons Current Passive Smoker amongst Female 56.14 Interviewed Persons Total Current Smokeless tobacco User amongst 23.84 Interviewed Persons Total Current Smokeless tobacco User amongst 27.74 Male Interviewed Persons Total Current Smokeless tobacco User amongst 19.88 Female Interviewed Persons
Status on smoking related survey
Total Male Current Smoker Total Male Female Percent Percent Female Percent Biri Use 8035 7482 553 91.41 85.12 6.29 Cigarette Use 307 297 10 3.49 3.38 0.11 Both (Biri & Cigarette) Use 426 424 2 4.85 4.82 0.02 Others Use 22 19 3 0.25 0.22 0.03 Total 8790 8222 568 100 93.54 6.45
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Health problems perceived by the smokers
Health problems Total Male Female Total Percent Male Percent Female Percent Dry cough 978 897 81 46.2 42.37 3.83 Productive cough 508 461 47 24 21.78 2.22 Chest pain 288 264 24 13.6 12.47 1.13 Chest with back pain 164 145 19 7.75 6.85 0.9 Bad breath 19 18 1 0.9 0.85 0.05 Others 160 150 10 7.56 7.09 0.47 2117 1935 182 100 91.41 8.6
Health Problems
1200
1000
800
600
400
200
0 Dry cough Productive Chest pain Chest with Bad breath Others cough back pain
Smokeless Tobacco Use
• As per as smokeless tobacco use is concerned, 33.54 % male take khaini & 25.17 % female take Gul/ Guraku. • The higher consequences of use of smokeless tobacco are tooth decay for both male (26.77%) & female (29.36%).
Impac t: A significant no. of families including sample and non sample HH have left the habit of smoking & smokeless tobacco during the Survey.Some of the householders were found to cut down their tobacco consumption. Surveyors were able to generate awareness quite successfully among the householders regarding harmful after-effects of smoking.
Cl 9 Sima Bhakta When I started the “smoking and smokeless tobacco related survey”, I have seen that most of the villagers are unaware of the harmful effects of tobacco. One household member (HH No 1221) at Tantipara village near Hattala para, Sri Prabananda Goswami was addicted to Panmasala (5000) and taken 20-22 Packets per day. As a result, he was suffering from oral infection. I have advised him not to take Panmasala and to leave the habit. He has taken my advice and he has left the habit and is cured totally from oral infection.
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Village Hygiene and sanitation Awareness Survey of Four Blocks
The survey was done within the age group 5-9 years or preferably the school students up to Class V. The field testing & Village Hygiene Awareness Survey was started on March 2011 and completed on April 2011. The analysis was completed on last week of April 2011.
A combined drug therapy and behavioral modification intervention package to the primary school children (5-9yrs) to reduce anemia prevalence – worm burden – diarrhea episodes, delivered in the community through a school based approach along with involvement of the teachers – self help groups – panchayats – ICDS workers in the supportive campaign – is likely to have an impact on physical growth and cognitive development of children and may be sustainable through social marketing.
Assessment of haemoglobin, iron status , height – weight – skin fold thickness,worm burden in stool, recording episodes of diarrhea in previous two weeks and cognitive performance will be done at baseline and at one and two years.
Primary outcome measures will be alterations in anemia prevalence, changes in prevalence of iron deficiency, worm burden, dirrheal episodes, linear growth and cognitive performance with the intervention. Secondary outcome variable will be sustainability of the behavioral modification intervention.
Using soap indicates usage of soap after defaecation and before taking food. Using chappal means wearing it during open field defaecation.
Findings of Village Hygiene Awareness Ennumeration Survey
Table 1 Total Total Boys & Household Girls Total Boys Total Girls 22555 28039 14510 13529 Percentage 100 51.75 48.25
Table 2 Using chappal Using soap Using sanitary latrine 12,690 45.26 5015 17.89 4021 14.34
Cl 19 Kanika mondal Two daughters of Mr Subrata Mondal of Angargoria village were suffering from worm infestation and indigestion. During village hygiene awareness survey, I visited the house and told them to wash hands with soap before eating and after defecation and wear chappal all the times. I advised her mother to look over whether children are practicing it or not. Few weeks later I visited the house again for follow up & they gave thanks and replied with smiling face that her children are well now.
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Detailed Socio-demographic and health Survey
At the inception of the BIRPOP , we undertook a socio demographic survey. While that had provided significant insights for our activity planning, it was soon realized that an even more in depth assessment of these parameters is necessary. Hence, this survey had been planned beginning in mid-2011. At the outset, a pilot phase was undertaken for standardization of the instrument.
Pilot phase on socio-economic survey & morbidity status among nonsample households(pilot phase completed). The pilot has been completed among 220 households among non-sample households (in Dec. 2011). The reasons behind the choosing of non-sample households are to test the questionnaire in unknown houses with a view to get the actual findings. The final questionnaire has been developed and is now going to be put into operational survey( March – June,2012 ) . Some findings from the Pilot Survey
Table-1 Status of surveyed HHs
Total HH Total Total Total Survey Member Male Female 220 1158 563 595 % 100.00 48.62 51.38
Table-2 Religion
Hindu Muslim Christian Others Total HH HH HH HH HH 220 166 53 1 0 % 75.45 24.09 0.45 0.00
Table-3 Main source of drinking water
Tube well/ Pacca Kachcha River/ Total Tap Tank/Pond Others Hand Well Well Cannel Pump 220 29 175 11 0 1 1 3 % 13.18 79.55 5.00 0.00 0.45 0.45 1.36
Table-4 Water purification before use
Total Yes No 220 18 202 % 8.18 91.82
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Table-5 Distance of drinking water source Out side Out side House House In House Total Blank but 100 but above mtr. 100 mtr. 27 155 37 219 1
Table-6 Type of latrine Sanitary Total No latrine Pit well Others Latrine 220 166 14 39 1 % 75.45 6.36 17.73 0.45
Table-7 Type of housing Total Pucca Semi pucca Kuchha 220 48 55 117 % 21.82 25.00 53.18
Table-8 Land Possession Range(Katha) Total % 0(landless) 124 56.62 1 - 30 29 13.24 31-70 20 9.13 71-100 14 6.39 >100 32 14.62 219 100
Table-9 Expenditure of the respondent on food items during last month of his/her house(in percentage)
Others (Sugar, Vegetables Salt, Telephone Milk/Milk Cooking & leafy spices or Mobile Total Cereals Pulses products oil greens Fruits Fish/Meat/Egg etc.) Fuel/Electricity bill Expenditure 28.1 4 4.08 6.04 12.64 3.92 12.82 14.92 9.74 3.74 100
Table-10 Expenditure of the respondent on non food items during last one year of his/her house (in percentage)
Cloths / Hospital Social Total Education Entertainment Luxury Shoes expenses program Expenditure
16.49 9.64 35.63 3.38 19.29 15.57 100.00
Table-11 Expected expenditure of the respondent on health related causes of his/her house (in percentage)
Hospital Regular Others Total Child birth admission treatment expenses Hospital
Page 30 expenses expenses
54.10 6.26 23.73 15.92 100.00
Table-12 Literacy status Yes No Total 716 277 993 72.10 27.90 100.00
Table-13 Health Insurance Yes No Total 147 981 1128 13.03 86.97 100.00
Table-14 Predominant disorders diagnosed based on reported symptoms / complains (recall period 30 days)
Fever Fever Others Cancer Mumps Antrick. Artharitis Diarrhoea Diarrhoea Headache Accidents Dysentery Eye problemEye Skin disease Skin disease Ear infection Dental problems Dental Diabetes mellitis Urenary Urenary infection Nutrition related related Nutrition( BP/ heartBP/ disease Digestive Digestive diseases convulsion/epilepsy Respira toryinfection Nerve related disease(Nerve related weakness,anemea etc. Mental Mental disease/ problem Gynaecological problems Asthama/respiratory trouble. Blood disease( circulatoryHigh
186 105 10 8 7 3 2 2 5 3 4 12 7 2 4 7 7 13 24 16 3 5 2 4
Table-15 Whether taking treatment from nearest government facilities
Yes No Total 126 325 451 27.94 72.06 100.00
Table-16 Cause of not being treated at nearest facilities Cause Total Member % Lack of adequate infrastructure/ no facility 14 4.38 No govt facility at nearest place 39 12.19 Lack of knowledge about govt facility 13 4.06 Doctor is not available 12 3.75 Health worker is not available at govt centre 1 0.31 Medicines are not available 48 15.00 Opening time of govt hospital is not satisfactory 5 1.56 Waiting time is too much 56 17.50 Service not satisfactory 35 10.94 No faith on govt health structure 21 6.56 Others 18 5.63 Doctor is available beside the house 58 18.13 Total 320 100.00
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Table-17 Health facilities availed
RH PHC SDH SGH Total BPHC district Nursing Home Private Hospital Medical College Treatment centre (Districthospital) Govt hospital outside state Private health centre outside GovtHospital outsidedistrict
% 2.34 10.16 0.78 21.88 0.78 43 8 2 4 1 1.56 5 100
Table-18 Treatment related total expenditure Recall 701 701A 701B 701C 701D 701E 701F 701G 701H 701I 701J 701K Period
Total 30 Days 216688 97085 37152 8500 3200 21400 7940 27635 12146 1000 0 0 Expenditure
30 Days Percentage 100 44.8 17.15 3.92 1.48 9.88 3.66 12.75 5.61 0.46 0 0
365 Total 1151085 288720 147075 8500 193550 38850 163150 159630 62930 37680 21500 29500 Days Expenditure 365 Percentage 100 25.08 12.78 0.74 16.81 3.38 14.17 13.87 5.47 3.27 1.87 2.56 Days
701A-Current Income, 701 B-Savings, 701C-By selling stored food grains, 701D-Selling ornaments or land, 701 E-Selling domestic animals, 701 F- Borrowing from relatives, 701 G-Borrowing from others, 701 H-Charity from others, 701 I-Charity from friends/relatives, 701 J-Health Insurance, 701K-Others
Table-19 Contraceptive method used IUD No Female Condom/ Total Pill or Calendar/Rhythm Withdrawal method Sterilization LOOP Nirodh 186 75 73 2 6 9 5 16 100 40.32 39.25 1.08 3.23 4.84 2.69 8.60
Cl 61 Pratima Roy Two months before, when I visited the Chhora village ( at Bhatipara), I have seen an abscess on the neck of a village member Asraf Khan and later the abscess got infected. My colleague Mithu Das and Field Monitor Chandan Mukhopadhyay have also noticed and we have tried to cooperate the patient to take advice from our Research Coordinator.He was diagnosed to be a case of Tubercular lymphadenitis,registered at the local DOT centre & started taking ATDs. He is better now.
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Quality control, Health Care Assistance Service & Future perspective
Data Quality Control
Data quality is assured by all forms being re-checked by field monitors before submission to the office; the subjects of 20 % of forms are re-interviewed by field monitors; and 10 % are re-interviewed by Survey Manager & 5% are re-interviewed by Research Coordinator & Medical Coordinator; 30 % of collected questionnaires are desk checked before computer entry. A database system using Microsoft Access was developed locally to handle the data, but the analysis software is SPSS.
Organization and Management
Nearly 50 households are visited each week by every surveyor. Pregnancies, births, deaths, in and out migrations are recorded as “events” on HR and on special event formats. At the end of the week, completed formats are checked by a field monitor and returned to Suri office for data entry. The data entry is completed during the following week, and any queries arising from inconsistencies in the data are returned to the field for correction.
Weekly FM Review Meeting
Every field monitor meets his/her surveyors at least twice to thrice each week and discussing the problems and guide accordingly. The Survey Manager, Research Coordinator, Field Monitors, and Data Manager meet every Sunday at project office to review the progress and plan for the week and also for capacity building of office staffs & field monitors.
Monthly Staff Review Meeting
In each month the field and office team meet together at Suri where they discuss the progress and problems and sharing experiences each other and drive for find out the suitable strategy for problem solving and management of team work. Staffs also meet every month for capacity building on several survey matters which is being facilitated by the Research Coordinator.
Cl 31 Chandana Saha Chatterjee In kuchuighata village, one female household member (HH No 806) died of snake bite. But the head of the family was unaware about the financial compensation. I assured with my filed monitor about the procedure. Head of the household contacted to local Panchyet and the process regarding compensation is going on. Meanwhile my acceptability to that family increased
Page 33 Health Care Assistance Service at Suri Sadar Hospital
One of our staff has been engaged at the Suri Sadar Hospital as a social worker on regular basis to provide health care assistance to the SHDS sample and non sample household members of the SHDS targeted villages of 4 designated CD blocks of Birbhum district.
The objectives behind the service:
• To establish rapport and provide mental support to the targeted communities and assist them at the right direction in getting proper govt. health care.
• To make aware and guide the patients (remote villagers) to avail the health care facilities available in the sadar hospital.
• To make them understand about the different tiers of health care system and facilities available there to reduce save their money, time and energy.
Achievements during the year: No of Patients advised and discharged from OPD of Suri Sadar hospital: 325 No of Patients admitted at Suri Sadar hospital : 116 No of Patients referred from Suri Sadar hospital : 84 Total no of patients given health care assistance : 525
Health care assistance is being provided in the form of counselling, medicinal advice and proper referral from January 2011 routinely at our society office by our research coordinator (Monday, Tuesday 2.30pm- 4.30pm &Friday, Sunday 10 a.m.-2.30p.m.).Till January187 people from the surveyed area availed the service.Even some DOT defaulters were tracked & put under DOTS.
Cl 7 Pinku Swarnakar In Gangmuri village, one middle aged person named Nabani Chandra She fell ill and nobody was present to attend him. He was penniless& I have arranged for his check up through discussion with our social worker at Suri Sadar Hospital. Necessary lab investigations, ECG & USG were done free of cost. The patient recovered well.
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How Do We Look Forward in Future ? In future we are going to do the following:
1. Collection of health and population related data from rural population in a continuous way. 2. Creation of a data-ware-house based on collected data. 3. Data analysis and identification of the burning health and population related issues that need to work on. 4. Initiate the bio-medical and social research programme. 5. Based on the findings of the bio-medical and social research, we want to find out the cause-effect relationship on various health and population issues. 6. Provide technical assistance to the administrator, policy makers and scholars to prepare pro-people need based health and population planning.
Cl 23 Tripti Biswas The household members are now behaving well. The local health staffs and anganwari workers are respecting me. They enquire about our survey at different times & provide me information about the pulse polio; breast feeding programmes etc. and request me to pass this information to the beneficiaries. I go to the field regularly. The villagers realized that I am coming regularly to meet them and discuss with different issues which assist them, the objective of the society must be honest, and they should help me.
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