Orissa Health Problem_dr Nihar

MAJOR HEALTH PROBLEMS OF ORISSA By Dr Nihar Ranjan Ray Orissa is a high focus state for its culture, heritage, rich with minerals and diseases as well. It has rated as one of the measurable state so far the health care is concerned. Badly affected by the poverty, illiteracy, natural disasters Orissa registered very poor health indicators as per the WHO reports. Its state with a population of 3.68 crores, comprising of 85% rural habitants, with 22% Scheduled Tribe and 16.5% Scheduled Caste population. From a lot of health issues I need to focus the following topics with bird vision felling their importance and seriousness. Infant mortality Infant Mortality Rate (IMR) is only 53 per 1,000 live births in urban areas as compared to 76 in rural areas, only 26.4 per cent of tribal children are immunized when compared to 43.7 per cent among the general population in the State and anemia is very high of 61.2 per cent among women. The State needed to arrest the malnutrition trend as early as possible. "The level of malnutrition in the State is quite high. Over 30 per cent of children are severely malnourished. As per the latest survey, 40.7 per cent under age of 3 are underweight, 45 per cent are stunted and 19.5 per cent are wasted. About 65 per cent of children aged between 6 and 35 months are anemic. Maternal mortality rate One woman dies every seven minutes from complications related to pregnancy and child birth in India and in Orissa nine women die everyday for the same reasons. The MMR in the state has come down from 367 per one lac (100,000) child births in 1993 to 358 deaths per one lac births in 2003 which is a very negligible drop. In fact there has not been any significant reduction in the rate of maternal deaths in the last few years and this is a worrying factor, said participants at the "Know Your Entitlements" organized here to coincide with the National Safe Motherhood Day. The White Ribbon Alliance-Orissa in collaboration with Department of Health and Family Welfare, government of Orissa, Unicef and UNFPA organized the workshop. With a view to curb this problem by minimizing maternal death rate, the White Ribbon Alliance for Safe Motherhood unites individuals, organizations and communities who are committed towards increasing public awareness on this issue and promote Safe Motherhood. This year, the Central government declared, "Know your Entitlement" as the theme of the National Safe Motherhood Day. The objective was to generate awareness amongst women and family members on their entitlements under various schemes and policies taken up by the government. Several NGO's working in the health sector across the state including the Nehru Yuva Kendra which has trained 12,000 youths for the purpose participated in the workshop here today. Flood ravaged Orissa Floods cause health problems in Orissa: Oxfam India has warned that 8.5 million people affected by July's floods are facing serious health threats. 78 870 cases of diarrhoea have occurred, resulting in 41 deaths; 124 cases of jaundice were reported, with two deaths. 300 people have been bitten by snakes, leading to 22 deaths. Malaria Malaria is the foremost public health problem of Orissa contributing 23% of malaria cases, 40% of Plasmodium falciparum cases and 50% of malaria deaths in the country. The tribal population are badly affected by the Malaria. More than 60% of tribal population of Orissa live in highrisk areas for malaria. Though the tribal communities constitute nearly 8% of the total population of the country, they contribute

25% of the total malaria cases and 15% of total P.falciparum cases. Various epidemiological studies and malariometric surveys carried out in tribal population including primitive tribes reveal a high transmission of P.falciparum in the forest regions of India, because malaria control in such settlements has always been unattainable due to technical and operational problems. In a specific study conducted in undivided Koraput district, it was observed that the district is endemic for malaria and is hyperendemic in top hills where Bondo primitive tribes are residing. Diarrhoeal Disorders Water-borne communicable diseases like gastrointestinal disorders including acute diarrhoea are responsible for a higher morbidity and mortality due to poor sanitation, unhygienic conditions and lack of safe drinking water in the tribal areas of the country. In a cross sectional study conducted by RMRC, Bhubaneswar in 4 primitive tribes of Orissa, the diarrhoeal diseases including cholera was found to occur throughout the year attaining its peak during the rainy season .Generally the infants ,preschool children and adolescent groups are mostly affected. Micronutrient Deficiency Orissa is very much infamous for starvation death cases. Micronutrient deficiency is closely linked with nutritional disorders and diarrhoea. Deficiency of essential dietary components leads to malnutrition, protein calorie deficiency and micronutrient deficiencies (like vit A, iron and iodine deficiency). Vitamin A deficiency in the form of Bitot's spot, conjunctival xerosis and night blindness was observed Skin Infection Skin problems like scabies is a major health problem amongst the rural population of orissa and the problem is much worse in the primitive tribes because of overcrowding and unhygienic living conditions as also close contacts and lack of health awareness. In a study conducted by the RMRC, Bhubaneswar. Intestnal Paracitism Intestinal protozoan and helminthic infestations are the major public health problems and were observed in Most of these infections are due to indiscriminate defecation in the open field, bare foot walking and lack of health awareness and hygiene. The problem enhances in the rainy season. These are preventable with repeated administration of anti-helminthic and protozoal treatment at 4 months interval which can be used effectively in national parasitic infection control program.

HEALTH INDICATORS OF ORISSA The Total Fertility Rate of the State is 2.6. The Infant Mortality Rate is 73 and Maternal Mortality Ratio is 358 (SRS 2001 - 03) which are higher than the National average. The Sex Ratio in the State is 972 (as compared to 933 for the country). Comparative figures of major health and demographic indicators are as follows: Table I: Demographic, Socio-economic and Health profile of Orissa State as compared to India figures S. No. Item Orissa India

1 Total population (Census 2001) (in million) 36.80 1028.61 2 Decadal Growth (Census 2001) (%) 16.25 21.54 3 Crude Birth Rate (SRS 2007) 21.9 23.5 4 Crude Death Rate (SRS 2007) 9.3 7.5 5 Total Fertility Rate (SRS 2006) 2.6 2.9 6 Infant Mortality Rate (SRS 2007) 73 57 7 Maternal Mortality Ratio (SRS 2001 - 2003) 358 301 8 Sex Ratio (Census 2001) 972 933 9 Population below Poverty line (%) 47.15 26.10 10 Schedule Caste population (in million) 6.08 166.64

11 Schedule Tribe population (in million) 8.15 84.33 12 Female Literacy Rate (Census 2001) (%) 50.5 53.7

Table II: Health Infrastructure of Orissa Particulars Required In position shortfall Sub-centre 7283 5927 1356 Primary Health Centre 1171 1279 Community Health Centre 292 231 61 Multipurpose worker (Female)/ANM at Sub Centres & PHCs 7206 6768 438 Health Worker (Male) MPW(M) at Sub Centres 5927 3392 2535 Health Assistant (Female)/LHV at PHCs 1279 726 553 Health Assistant (Male) at PHCs

1279 168 1111 Doctor at PHCs 1279 1353 Obstetricians & Gynaecologists at CHCs 231 NA NA Physicians at CHCs 231 NA NA Paediatricians at CHCs 231 NA NA Total specialists at CHCs 924 NA NA Radiographers 231 8 223 Pharmacist 1510 1984 Laboratory Technicians 1510 311 1199 Nurse/Midwife 2896 637 2259 (Source: RHS Bulletin, March 2007, M/O Health & F.W., GOI)

Health Institution Medical College-6 District Hospitals-32 Referral Hospitals City Family Welfare Centre Rural Dispensaries Ayurvedic Hospitals-8 Ayurvedic Dispensaries-624 Unani Hospitals Unani Dispensaries-9 Homeopathic Hospitals Homeopathic Dispensary-603 Conclusion Despite the above said problems we have to make our stands strong to fight against the disease, poverty, illiteracy and natural as well as the man made disasters(Naxlite problem).Now under the able leadership of Mr Naveen Pattnaik Orissa has registered record foreign investment as well as an appreciable economical growth. Now it is time to flex our muscles and brain to expedite our development in health care system. Orissa is doing well in the influence of NRHM .Orissa has many a miles to go to improve its health indicators that needs a lot of patience, composure and brain storming. Dr.Nihar Ranjan Ray Dt.29th july 2008