Dr. Laishram Ladusingh
International Institute for Population Sciences, Mumbai
Child Health in India
Very recently National Report and unit level data of National Family Health Survey-4 (NFHS-4) have been released making various health indicators of 640 districts public. Progress towards healthy India is evident from the fact that stunting (low height-for-age) and underweight (weight-for-age) among children under five years have decline respectively from 48% to 38.4% and from 42.5% to 35.7% during the period of NHFS-3 (2005-06) to NHFS-4 (2015-16). All states in the country including EAG states of Rajasthan, Madhya Pradesh, Jharkhand, Bihar and Uttar Pradesh, Assam, Jharkhand and Chhattisgarh have witnessed declining trend in the level of childhood malnutrition. Levels of stunting and underweight among children less than five years in the districts of India are shown in Maps 1 and 2 respectively.
It is apparent, the prevalence level of stunting is below 23% in few districts of Kerala, Tamil Nadu and Karnataka, and level of childhood stunting is also low in some districts of the western, northern, eastern and north-eastern states. Higher level of child malnutrition are concentrated in districts of Uttar Pradesh, Bihar and in few districts of Assam, Rajasthan, Madhya Pradesh, Maharashtra, Gujarat, Karnataka, Telengana, Odhisha, Chhattisgarh and Jharkhand.
Similar spatial pattern of underweight among children is also notice as in the case of stunting among children. Level of underweight among children is quite low (less than 25%) in districts of Southern, Northern, eastern and north-eastern states of Kerala, Karnataka, Tamil Nadu, Punjab, Haryana, Himachal Pradesh, Odhisha, Arunachal Pradesh, Nagaland, Manipur, Mizoram, Meghalaya and Tripura . In some of the districts of Rajasthan, Karnataka, Odhisha, West Bengal, Jharkhand, Chhattisgarh, Madhya Pradesh and Uttar Pradesh the concentration of high level of underweight among children are evident from Map 2.
Childhood immunization is a vital component of child health as it prevents children from various infectious diseases. Vaccines which help in preventing childhood diseases are polio, measles, diphtheria, whooping cough, tetanus, and Haemophilus influenzae type b (Hib). A child in 12-23 months is considered fully immunized if the child received BCG and Measles vaccines, and 3 doses of each of Polio and DPT.
Coverage of full immunization of children in India has substantially increased from 43.5% to 62% during the period NFHS-3 (2005-06) to NFHS-4 (2015-16). As a matter of fact the coverage in most of the states in the country is above the national average. More than 50% of children aged 12-23 months are fully immunized in three fourth of all the districts in India as shown in Map 3. Only in few districts of Rajasthan, Arunachal Pradesh, Uttar Pradesh, Bihar, Maharashtra, Madhya Pradesh and Gujarat full immunization coverage of children is below the half-way mark.
The following table shows by states the level of stunting, underweight and full immunization of children and also number of districts below and above the respective state average.
The level of stunting among children below five years is between 23%-43% in most of the districts and high (more than 43%) in some of the districts of Bihar, Rajasthan, Uttar Pradesh and Madhya Pradesh. In terms of inter district variation within states in almost half of the districts of Bihar (18 districts), Madhya Pradesh (23 districts), Assam (16 districts), Jharkhand (14 districts) and Uttar Pradesh (40 districts), Maharashtra (15 districts), Odisha (14 districts) and West Bengal (9 districts) the level stunting among children is below the respective state average. Similar is the situation of inter district variation in the level of underweight among children as in nearly half of the districts of Bihar (17 districts), Madhya Pradesh (23 districts), Maharashtra (15 districts), Odisha (13districts), Rajasthan (13 districts) and Uttar Pradesh (33 districts) is below their respective state average. In the case of full immunization of children the coverage in more than half of the districts of Indian states are above their respective state average.
India has made great achievement in ensuring the health of next generations. In view of vast geographical area, states with diverse socio-cultural beliefs and practices and large number of children the progress is laudable.