SURVEY DESIGN : A baseline survey was carried
out in Salem and South Arcot districts of Tamil Nadu
which were covered under the Danish International Development Agency
(DANIDA) Health Care Project. This work was entrusted to the National
Tuberculosis Institute (NTI), Bangalore, which had more than twenty
years experience in conducting large scale surveys in the health
sector. Overall guidance was provided by a Steering Committee under
the Chairmanship of Director (Evaluation), Ministry of Health and
Family Welfare, Government of India. The baseline survey of the
demographic-cum-socio economic features, health status and utilization
of health services was considered necessary to provide bench
mark data on the beneficiaries. Equally important was to have basic
information on the rural health care delivery system so that the
inputs could be directed towards factors that needed strengthening
and the benefits accruing maximized. The rural area of Salem and
South Arcot districts were bifurcated into two strata. Stratum
I consisted of all villages in which a Primary Health Centre
(PHC) or sub-centre was located and the remaining villages constituted
Stratum II. A sample of 40 villages were selected. The equal
number of villages were allocated in each stratum, proportional
to its share of the total rural population of the district. The
selection of villages was made with probability proportional to
size (population) of the villages, after stratification by size.
Every fifth household was selected on a systematic random sample
basis from each village. Thus, 2,000 households were selected in
each district and 4,000 in the project area. In all, eight questionnaires
were prepared for the baseline survey-four for collection of information
from PHCs, Medical Officers of PHCs, Field Health Workers (FHW)
and Trained Birth Attendants (Dais) and the remaining four viz.,
Household Schedule, Morbidity Schedule, Eligible Women Schedule
and Children Schedule from the selected households. The field work
was carried out during July to November 1983 by twenty investigators
specially recruited and trained by NTI under the close supervision
of five experienced Social Investigators of the Institute. Keeping
in mind the importance of high coverage, the field teams put in
lot of efforts and thereby succeeded in collecting information
from 99.7% of the 4,000 households selected for the survey.
Method of data collection for MOs was through a pretest questionnaire,
for PHC through a questionnaire-cum-interview schedule, for FHW
and Dai through interview schedule and village appraisal was done
through group discussion (group consisted of village officials,
informal leaders, members representing different castes, classes
and women). The collected data after careful scrutiny by the statistical
staff of the Institute was analysed, tabulated and reported.
FINDINGS: I. Socio-economic features:
a) Literacy : Nearly half of the population of age five or more
were illiterate. SC/ST population had more illiterates (58.9%) than
"others" (45.8%) and had less who had school education
of any level. Percentage of literates without schooling was negligible.
There were no literate females in 53.8% of households (60.5% among
SC/ST). In 24.9% of the households the highest level of female education
was I to V standard and 17.7% VI to X standard. b) Employment:
In the labour force of age group of 15-49 years, about 60% were
employed. Employment among older persons was 53.5%. Children of
10-14 years of age, 6.3% were employed. This was about five times
higher in Salem compared to South Arcot. Out of these employed,
45.2% were general labourers, 23% agricultural labourers and 20.6%
artisans. Child agricultural labourers were more among females.
The large percentage of persons who are not fully occupied for the
whole year (about three-fourths of those aged 15-49 years and a
substantial proportion of the elderly persons and grown up children)
could be mobilised during their slack periods to carry the message
of better health and hygiene as well as of the small family norm
and thereby improving their financial condition also to some extent.
c) Assets: About half of households did not possess any land
and about 30% had less than two acres. Those not possessing any
land were more among SC/ST (67.6%). Productive assets were not possessed
by 65% of the households. d) Living conditions: Cowdung smeared
floors were most common (65%) followed by cement floor (25%). This
was more common in South Arcot (76%) compared to Salem (51%). Kerosene
was used for lighting by 69% and electricity by 29%. Most of the
households used foraged firewood (68%) for cooking. Almost all households
(96.0%) let out used water into open place. Household waste was
thrown into open yard by 65.0% and 34.6% used manure pit. Open field
was used for human waste disposal by 98.4%. Provision of better
sanitation arrangements and education for their utilisation needs
to be taken up on large scale. The most common pests were mosquitoes
(88%), flies and ants (76%), rats (40%) and cockroaches (27%). Nearly
all (89%) did nothing to control these pests. The reason for this
have to be investigated and suitable steps taken to remedy the situation.
e) Staple diet: Main type of food was rice (50%), ragi (30%)
and millets (20%). f) Major problems: The major common problems
were non- availability of water (54%), health facility (49%)
and transport (26%). All the three were mentioned by more households
in Salem. More SC/ST households mentioned non- availability of "water"
and "transport".
II. Demographic profile: The estimated
rural population of 64 lakhs in the project area at the time of
the survey (second half of 1983) compared favourably with that of
60 lakhs from the 1981 census. Of the population of age 15 years
or more, 67.9% were currently married and 21.5% never married. The
birth rate for 1982 is estimated to be 30.0 per thousand population
as compared to SRS estimate of 27.7 for Tamil Nadu. The birth rate
was higher in South Arcot and in Stratum II. The birth rate among
SC/ST was higher in both strata of both the districts. About 98%
of total births were live births. Fertility was highest in the age
group 20-24 years (254) followed by 25-29 years (206) and 30-34
years (143). It was higher in South Arcot for 25-29 years, 30-34
years and 40-44 years as compared to Salem. The death rate for 1982
is estimated to be 11.0 per 1000 population. The infant mortality
rate for 1982 is estimated to be 34 per 1000 live births compared
with census. This gross under estimate may probably be due to some
reservation or reluctance to report infant deaths possibly due to
practice of infanticide by some sections of the population. As stated
earlier, the proportion of child deaths out of total deaths was
nearly double among females as compared to males. Of the eligible
women (currently married and of age 15-49 years), 22.1% were in
age group 25-29 years, 20.6% in 20-24 years, 18.0% in 30-34 years
and 16.3% in 35-39 years. Thus, 42.7% were in the age group of 20-29
years with the highest fertility. Almost all eligible women had
only one marriage. They had married more frequently at the age of
15-17 years (46.0%) followed by 18-20 years (32.7%). While 11.7%
of the eligible women had no child. 38.8% had the first child at
18-20 years and 28.0% at 15-17 years. At the time of the survey
about one tenth of the eligible women were pregnant.
III. Morbidity: During the month prior to
the survey 15.4% were sick (22.2% in South Arcot and 10.6% in Salem).
Among the common diseases during the three months prior to the survey,
fever/flu was mentioned by 27.9%. Common cold/cough together with
conditions affecting the respiratory system were reported by 22.6%
and occupied second position. Conditions affecting the digestive
and excretory systems (including stomach ache) were mentioned by
only 13.4%. This is quite surprising since only 23.3% of the households
used tap water for drinking. The 70% of households who used ground
water for drinking were apparently getting water without contamination.
About 42% of the sick persons did not seek treatment. This
proportion was more in South Arcot (47%) compared to Salem (33%).
The reasons for such a large proportion of the sick persons not
seeking treatment needs to be investigated. While 39% of those who
sought treatment did so from Government Health Institutions, 34%
went to private doctors/institutions. More than half did not spend
any money on treatment. About one fifth spent less than Rs.50/ and
7.3% between Rs.50/ and Rs.100/ . Tuberculosis prevalence rate
was 5.3 per 1000 population and is well within the expected
range obtained from sophisticated and costly prevalence surveys.
Among the tuberculosis cases, nearly 90% had cough for 15 days or
more. More than 95% of the cases had taken action to relieve their
symptoms and the vast majority had gone to Government Health Institutions.
Some tuberculosis cases had visited more than one type of health
institutions in search of treatment. These findings are also quite
similar to those obtained from sociological investigations in the
field of tuberculosis. Prevalence rate of leprosy was 1.8 per
1000. The disease was more common in South Arcot (2.7) compared
to Salem. When anyone is sick, 61.5% of the households go to Government
doctor, 81.3% among SC/ST against 55.0% among "others".
Services of private doctors were availed by 35.7% (16.9% among SC/ST
compared to 41.9% among "others"). About 60% travel 5
kms or more to get treatment from Government or private doctor.
The main reason for going to Government doctor was free treatment
(75.4%). Only 15.0% felt that the treatment by Government doctor
was good compared to 81.2% who considered that treatment by private
doctor was good. Among various facilities available within 3 kms,
29.7% of households utilised the services of doctor of modern medicine,
26.1% of homeopath and 13.2% vaidya. Among those who had availed
services at Government hospitals or PHC, 63.0% and 68.7% respectively
had no difficulty. The more frequent difficulty mentioned was "long
waiting time". During the two months prior to the survey, 53.5%
of the households were visited by female health workers. More households
were visited in South Arcot and among SC/ST. Family Planning:
About one third of the births were attended by relative or friend,
19.4% by untrained Dai, 17.4% by doctor. Among currently pregnant
women, only 32.2% had registered for ante natal care. About 60%
were not given any dose of tetanus toxoid, while 15.4% got one dose
and 10.7% two doses. Less than half of currently pregnant women
had received iron and folic acid. About two thirds of the deliveries
were conducted at home (73.9% in South Arcot compared to 56.5% in
Salem and 77.3% among SC/ST against 62.2% among "others").
About one fourth of the mothers were assisted by doctors at the
time of delivery, 27.0% by Dais, 9% by Female Health Workers and
35.7% by others. Help by Dais was more common in South Arcot. Currently
married women of age 15-49 years (eligible women) were 161 per 1000
population. Nearly three fourths of them were illiterate (82.4%
among SC/ST compared to 69.3% among "others"). About one
fifth of the eligible women had tried to prevent pregnancy, the
vast majority by using family planning methods. Though efforts to
prevent pregnancy were comparatively more among literates, the difference
was quite small. Those with 3 or 4 children more often tried to
prevent pregnancy. This is not likely to have much impact on curbing
of population growth. About 65% of those sterilised were below 30
years of age and the mean age of sterilisation was 27.9 years
(27.3 years in Salem compared to 28.7 years in South Arcot). About
half of the sterilisations were done soon after delivery, percentage
of sterilised steadily decreased with increasing age of youngest
child. More than three fourths felt that there was no advantage
or disadvantage in having a large family. While 10.5% felt that
large family led to more income, 8.5% felt that it was a burden.
Among the family planning methods, male and female sterilisation
were known to 94.0% and 95.8% respectively. Nearly half of the eligible
women stated that they have not seen the red triangle in PHC/SHC.
Those who have seen and understood the message formed only a small
proportion. About two thirds of the eligible women did not know
that abortion can be done at Government hospitals and 71% did not
know that it can be had free of cost.
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