Bhutanese children born today have 91.6 percent chance of surviving till the age of five while only 0.25 percent of mothers die during births, according to the National Health Survey 2000.The survey results were released after months of research and detailed analysis by the health department, with technical support from the Central Statistical Organisation (CSO).
Improvement in critical health indicators like population growth, under-five, infant and maternal mortalities, contraceptive prevalence rate and trained birth attendance were some of the major achievements of the last six years. The last health survey was held in 1994.
While past health surveys were conducted after every 10 years, Kado Zangpo of Research and Epidemiology Section said that the 2000 survey was carried out to update the existing information and gauge the past progress as part of the departments periodic assessment and to get an accurate basis for the Ninth Plan preparation.
According to the survey report, the population growth rate has reduced from 3.1 percent in 1994 to 2.5 percent in 2000. The report attributes the achievement to a vigorous advocacy campaign launched on reproductive health issues like family planning, mother and child care, nutrition and STD/AIDS, covering 19 dzongkhags till date, under Her Majesty Ashi Sangay Choden Wangchucks initiative as UNFPA Goodwill Ambassador.
Similarly, maternal mortality rate had reduced to 2.55 per 1000 live births, down from 3.8 in 1984. But given a small number of maternal deaths reported, the report cautioned on standard errors associated with it. Trained birth attendance- one key indicator relevant for maternal mortality reduction- has risen to 23.66 percent, up from 15.1 percent in 1994. Home (78.3 percent) was found to be still the common place for delivery, followed by hospitals (18.9 percent) and BHUs. Only 4.7 percent of home deliveries were attended by trained health workers, followed by mother/mother-in-laws, husbands, other in-laws and by Village Health Workers (VHW).
Infant and under-five mortality rates are 60.54 and 84.05 for every 1000 live births respectively. Crude death rate is 8.64 per 1000 population, with diseases of lungs heading the list followed by cardiovascular disorder, old age, diarrhoea/dysentery, TB, accident and poisoning. Pneumonia and diarrhoea/dysentery are two major causes of childs death at 21 percent and 13.3 percent respectively. About 42 percent mothers practiced exclusive breastfeeding for children.
While 95 percent of women in general and 93.6 percent of women in reproductive age group (15-49) have heard of family planning, the contraceptive prevalence rate is only 30.7 percent, still up from 18.8 percent in 1994, thus reporting 32.1 percent knowledge and practice gap.
About 78.2 percent of villages have access to health services within two hours walking distance, 89.01 percent within three hours, and 3.7 percent beyond six hours. Before the start of the present plan, a rapid assessment has shown that about 90 percent had access to health centre.
The survey of clean drinking water supply- an important component of primary health care- has shown overall coverage of 77.8 percent. Safe drinking water is defined as water either from a piped or a protected spring source available to the households within 50 m vertical height or 100 m horizontal distance.
The urban access to safe drinking water is 97.5 percent and 73.3 percent for rural areas. On sanitation coverage, 88.0 percent households reported having a latrine, but only 1.5 percent reported as actually not using it.
Of health seeking pattern, 22 percent treated themselves or did nothing, and 78 percent sought advice from third party, of which 83 percent consulted modern health services. It was found that most people adopted two health care strategies at the same time. While 31 percent went to traditional practitioners or a lama, only 11 percent made use of the advices. Only 62 percent made use of the modern health care systems.
Peoples health seeking behaviour tends to be affected by distance to health centres, and there are some statistical differences among regions. Difference was also found between urban (84%) and rural (80%) respondents.
The sex ratio at birth is 106.6 males per 100 females, and 94.7 males per 100 females for whole population, while population under 15 years of age is 39.13 percent, and 40.11 percent between 15-44.
There is an improvement in over-all dependency ratio from 91.7 percent in 1994 to 77.4 percent. Dependency, as proportion of population under 15 and over 65 years of age, is an important indicator as it reflects the economic burden the young and old people place on the working population, the report adds.
Calculated separately, the child dependency is 67.9 percent and 9.4 percent for the aged people. The net primary school enrollment rate- defined as proportion of all those children aged between 6-12 years currently in school- is 57 percent, lower then education departments gross enrollment rate of 72 percent. The report cautions that net is not the same as gross enrollment ratio since many over-aged and even under-aged children get enrolled.
The occupation survey (15-64 years) revealed that 66 percent are farmers, 7.6 percent household workers, 6.9% students, 5.4 percent government employees, 3.8 percent private business, 2.8 percent gomchens/monks, 1.9 percent armed forces, 1.0 percent unemployed adults and the rest are in undefined category.
Of marital status, 65.4 percent of males were found to be married against females 65.7 percent . 27.8% males were single against 21.6% females, while 0.7% males are separated, 0.9% divorced, 5.2% widowed, against females 1.2% separated, 2.7% divorced, and 8.7% widowed.
The report recommended that rather than conducting difficult and costly nation-wide survey, a better surveillance and improved health information system could yield equal result. It also recommended the establishment of special social centres (sentinel sites) to generate important health indicators, including research to assess the determinants of respiratory infection in children. The review of programme strategy was also recommended.
Started in March 2000, the survey enumerated 12,711 households with 68,847 members, of which 11,010 (15.99 %) were urban. The average number of individuals per household is 5.42, with 5.6 in rural and 5.5 in urban areas. Out of 202 geogs, 100 geogs of 10500 households for rural areas, and 250 areas (2500 households) of urban centres were surveyed.
It was carried out by more than 80 health trained enumerators through a set of preset, structured questionnaires on seven schedules covering information on health facilities, safe drinking water, sanitation, reproductive health, peoples health care seeking behaviours, mortalities, age, sex, marital status, occupation and some general information on other indicators.
Contributed by KES Kirby