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Poor Maternal Heath Care in Rural Districts: an Attempt to Identify High Priority Districts of Bihar, India

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Poor Maternal Heath Care in Rural Districts: an Attempt to Identify High Priority Districts of Bihar, India ORIGINAL ARTICLE pISSN 0976 3325│eISSN 2229 6816 Open Access Article www.njcmindia.org Poor Maternal Heath Care in Rural Districts: An Attempt to Identify High Priority Districts of Bihar, India Kishor P Brahmapurkar1 Financial Support: None declared ABSTRACT Conflict of Interest: None declared Copy Right: The Journal retains the copyrights of this article. However, re- Background: As per NFHS-4, the percentage of mothers who had production of this article in the part or full antenatal care was lowest, 03 % in rural Bihar compared to all total in any form is permissible with other states. So, the present study was the analysis of districts for due acknowledgement of the source. the differences among factors related to the maternal health care with the objective to identify high priority districts among total 38 How to cite this article: districts in Bihar. Brahmapurkar KP. Poor Maternal Heath Care in Rural Districts: An At- Materials and Methods: The study was carried out from the data tempt to Identify High Priority Dis- of 38 districts of Bihar available from NFHS-4. High priority dis- tricts of Bihar, India. Ntl J Community tricts were included if the districts had full ANC below 03 % and Med 2017; 8(2):79-83. had three or more than three favorable/unfavorable attributes be- low/above the findings for rural Bihar respectively . Author’s Affiliation: 1Associate Professor, Department of Results: Out of 38 districts 14 high priority districts were identi- Community Medicine, L.B.R.K.M. fied. 5 districts in Tirhut, all districts in Purnia and 2 districts in Government Medical College, Bastar, Munger Division were with high women’s illiteracy and high per- Chhattisgarh, India centage of child marriages in women and higher adolescent preg- nancy. Correspondence: Kishor Parashramji Brahmapurkar Conclusions: Rural Bihar had poor maternal health care with 14 [email protected] high priority districts which needs corrective measures to im- prove. Sarva Shiksha Abhiyan (SSA) needs to be properly imple- Date of Submission: 01-02-17 mented to improve educational status of women. There is need for Date of Acceptance: 23-02-17 Date of Publication: 28-02-17 stern application of Prohibition of Child Marriage Act, 2006. Keywords: Maternal health care, Bihar, High priority Districts, Antenatal care, Adolescent pregnancy INTRODUCTION and neonatal endurance. Antenatal visits with trained health providers (doctors, nurses or mid- Maternal health care refers to the health care of wives) can make certain a pregnancy gets off to a women during pregnancy, childbirth and the superior start. 3 Antenatal visits must offer quality postpartum period. 1 services to be effective which includes 8 interven- As per WHO, globally, 64% of pregnant women tions like tetanus toxoid (TT) injection, measure- acknowledged the suggested minimum of four an- ment of blood pressure, iron folic acid tablets dis- tenatal care visits or more during the time period tribution, taking blood and urine sample, preven- of 2007-2014. 2 Health problems during pregnancy tion from malaria by insecticide-treated bed-nets can be prevented, noticed and taken care of during (in malaria endemic areas) and counseling on recommended minimum of four antenatal visits, pregnancy complications and HIV . 3 including interferences such as tetanus toxoid vac- As per the results from the first phase of the Na- cination, screening and treatment for infections, tional Family Health Survey (NFHS-4), 2015-16 re- and identification of warning signs during preg- leased in January 2016 for 18 states, the percentage nancy with skilled health workers. 2 of mothers who had full antenatal care [at least Antenatal visits and trained attendance at birth are four antenatal visits, at least one tetanus toxoid essential for healthy pregnancies, safe deliveries (TT) injection and iron folic acid tablets or syrup National Journal of Community Medicine│Volume 8│Issue 2│Feb 2017 Page 79 Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816 taken for 100 or more days] was lowest, 03 % in ru- skilled birth attendance (SBA) and postnatal care of ral Bihar as compared to all other states 4, 5, 6. mother within two days of delivery. The unfavora- ble attributes were child marriages among women So, the present study was the analysis of districts and anemia in pregnancy. for the differences among factors related to the ma- ternal health care with the objective to identify As per Census 2011, Bihar was the second most high priority districts among total 38 districts in populated state with population of 104.1 million. [7] Bihar. 88.7 % of population of Bihar resided in rural area. 7 So, the present study was conducted by compar- ing indicators of maternal health care for districts MATERIALS AND METHODS of Bihar as compared to rural Bihar as from data The study was carried out from the secondary data available from National Family Health Surveys-4 of 18 States available from National Family Health (2015-2016) to identify high priority districts. 5, 6 Surveys-4 (2015-2016). 5, 6 The study had used publicly-available database NFHS-4 fieldwork for Bihar was carried out with available on the website of the following organiza- information from 36,772 households, 45,812 wom- tion: the National Family Health Survey -4 and en, and 5,431 men and survey schedules, collection Census 2011 data 4, 5, 6, 7.Because publicly-available of information were available in factsheets of con- database was used in this analysis, no ethical ap- cerned state and district. 5, 6 proval was sought. Operational procedure to identify high priority Permission was obtained from International Insti- districts: The districts with full antenatal coverage tute for Population Sciences, Mumbai to use their below 03 % and who had three or more than three data for study purpose. favorable/unfavorable attributes below/above the Full antenatal care was defined as at least four an- findings for rural Bihar respectively were included tenatal visits, at least one tetanus toxoid (TT) injec- in high priority districts. tion and iron folic acid tablets or syrup taken for The favorable attributes for maternal health care 100 or more days. 5 were women’s education, institutional delivery, Table 1: Distribution of districts in Bihar to identify high priority districts for maternal health care among districts with full ANC less than 03 % Full Women's Child Skilled birth Institutional PNC Anemia in State/Districts ANC Literacy Marriage in attendant Delivery within 2 Pregnancy (%) (%) women (%) (SBA) (%) (%) days (%) (%) Bihar [Rural %] (88.7) 3.0 46.3 40.9 69.0 62.7 41.1 58.0 Madhepura (95.9)* 0.7 29.7¶ 58.5¶ 63.1¶ 59.8¶ 36.3¶ 58.2¶ Sheohar (95.7)* 0.9 40.4¶ 48.2¶ 60.1¶ 52.9¶ 35.2¶ 45.3 Champaran[E] (92.1)* 1.0 44.0¶ 39.7 59.0¶ 47.0¶ 21.2¶ 49.4 Begusarai(80.8) 1.1 47.3 55.0¶ 79.8 77.1 56.5 46.7 Nalanda(84.1) 1.2 44.8¶ 49.4¶ 83.4 78.8 57.1 52.5 Kaimur(96.0) 1.2 58.0 31.7 82.8 79.7 55.7 63.2¶ Muzaffarpur(90.1)* 1.3 51.7 35.0 65.2¶ 61.7¶ 23.9¶ 54.6 Purnia(89.5)* 1.6 35.6¶ 36.9 59.6¶ 59.2¶ 44.8 72.9¶ Samastipur(96.5) 1.6 49.3 50.4¶ 74.9 72.9 33.6¶ 56.4 Rohtas(85.6) 1.8 62.6 30.3 84.1 82.1 59.0 67.0¶ Araria(94.0)* 1.9 36.6¶ 45.7¶ 61.5¶ 51.2¶ 43.4 60.4¶ Katihar(91.1)* 2.0 36.4¶ 39.7 54.7¶ 49.1¶ 37.8¶ 58.6¶ Khagaria(94.8) 2.0 41.8¶ 47.4¶ 76.8 70.9 55.6 55.9 Nawada(90.3)* 2.1 43.2¶ 44.5¶ 68.7¶ 65.0 50.5 51.8 Champaran [W] (90.0)* 2.2 39.5¶ 38.2 70.7 63.9 26.2¶ 62.5¶ Arwal(92.6) 2.2 54.2 38.9 70.5 69.8 50.4 57.9 Darbhanga(90.3)* 2.3 40.9¶ 43.5¶ 59.8¶ 46.9¶ 24.1¶ 61.0¶ Lakhisarai(85.7)* 2.3 50.7 43.4¶ 66.6¶ 63.9 42.9 58.3¶ Jamui(91.7)* 2.5 42.8¶ 51.9¶ 64.2¶ 58.0¶ 39.5¶ 46.5 Kishanganj(90.5)* 2.6 32.2¶ 24.3 58.4¶ 41.7¶ 40.1 60.5¶ Sitamarhi(94.4)* 2.7 36.2¶ 50.5¶ 48.0¶ 37.9¶ 39.4¶ 68.9¶ *High priority districts= Full ANC < 3 % and who had three or more than three favorable/unfavorable attributes below/above the findings for rural Bihar respectively. Favorable attribute below the findings for rural Bihar and unfavorable attribute above the findings for rural Bihar. National Journal of Community Medicine│Volume 8│Issue 2│Feb 2017 Page 80 Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816 RESULTS had the lowest percentage of ANC check-up in first trimester of pregnancy, 18.9 % followed by Among 38 districts of Bihar 21 districts had full Champaran (East), 22.3 %. Four ANC visit was ANC coverage below 03 %.The districts were com- lowest, 7.7 % in Purnia district followed by pared for women’s literacy, skilled birth attendant Dharbhanga and Madhepura district. Coverage of (SBA) at the time of delivery, percentage of institu- TT immunization during pregnancy was lowest in tional delivery and postnatal care (PNC) to mother Champaran (East), 80.4 % and consumption of IFA within two days of delivery as favorable indicator.
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