Indicus Analytics: Infant deaths lack a solution

Despite health schemes, management of diarrhoea remains a cause for concern

Diarrhoea is one of the leading causes of morbidity and mortality in children below five years of age worldwide. According to data from the Registrar General of India, diarrhoeal disease accounts for 23 per cent of deaths in children in India. Since deaths from acute diarrhoea are mostly caused by dehydration, they can be prevented through oral rehydration therapy.

The government has been promoting the use of oral rehydration salts (ORS) by way of increasing awareness and distributing free packets. However, its use is not as widespread as it should be. According to the DLHS-3 estimates of 2007-08, 12 per cent of the children surveyed had diarrhoea in the two weeks preceding the survey and while about 71 per cent of them had been given some form of treatment, only about half had been given ORS.

Instances of treating diarrhoea with ORS are very low in rural areas; while 68.9 per cent of the children in rural India were given treatment during diarrhoea, merely 30.7 per cent of them were given ORS. Figures are slightly higher in urban India with 43.8 per cent of children being treated with ORS for diarrhoea. Apart from the urban bias, children whose mothers had ten or more years of education and who were in the highest two wealth quintiles were more likely to get ORS treatment. (Click here for chart)
 

LEARNING DISABILITY Education increases use of ORS by mothers
Mother’s education level	Percentage of  children with diarrhoea who were given
Non-literate	23.6
Less than 5 years schooling	34.7
5-9 years schooling	39.3
10 or more years	52.3
Source: DLHS-3 2007-08

 

NO FIRST USE The use of oral rehydrating solution (ORS) to treat diarrhoea remains low
	DLHS-3 (2007-08)

TotalRuralUrban Children with diarrhoea in the last 2 weeks who received ORS (%)34.230.743.8 Children with diarrhoea in the last 2 weeks who were given treatment (%)70.668.975.4 Source: DLHS-3

Diarrhoea management is found to be poor in most states. ORS treatment was given to more than 60 per cent of the diarrhoea-affected children in just three states and one Union Territory — Himachal Pradesh, Arunachal Pradesh, Goa and Andaman & Nicobar Islands. In 2001, the Ministry of Health and Family Welfare created Empowered Action Group (EAG) states to give special attention to states like Bihar, Jharkhand, Orissa, Rajasthan, Uttar Pradesh, Uttarakhand, Madhya Pradesh and Chhattisgarh. These EAG states with high under-five mortality and infant mortality rates also have poor diarrhoea management practices. According to 2007-08 DLHS-3 estimates, in Uttar Pradesh just 17.3 per cent of the children suffering from diarrhoea were given ORS. The situation in Bihar and Jharkhand is also bad with less than a quarter of the diarrhoea-affected children given ORS. Similarly, diarrhoea management is low in the other EAG states with figures ranging from 30 per cent to 49 per cent. Among these states, Orissa is the best performer where about 49 per cent of the diarrhoea-affected children were given ORS solution. In addition, the EAG states, despite their poor health indicators and high prevalence of diarrhoeal disease have not really improved since the previous DLHS survey in 1998-99. Uttar Pradesh and Rajasthan marginally improved coverage by one to two percentage points, while the cover of ORS in Jharkhand and Chhattisgarh worsened. Within this group, Uttarakhand and Bihar stand out as states with the highest improvement, though Bihar continues to trail in overall ORS coverage.

Despite health schemes, management of diarrhoea continues to be a cause for concern across the country. ORS, of course, is the prescribed treatment that works towards preventing deaths from diarrhoea, but there are many other measures that need to be accelerated as well like improving hygiene practices and sanitation facilities that will go a long way in reducing the incidence of diarrhoea itself.

Indian States Development Scorecard is a weekly feature by Indicus Analytics that focuses on the progress in India and the states across various socio-economic parameters
sumita@indicus.net