Nagaland cuts infant mortality rates; most children lack immunization

• IMR reduced from 38% in 2005-06 to 29% in 2015-16

• 2.4% mothers received full antenatal care

• 29.9% mothers received JSY assistance

• 35.7% children aged 12-23 months were fully immunized  

Moa Jamir
Dimapur | April 3

In the last decade (2006-2016), Nagaland has managed to cut down Infant Mortality Rate (IMR) by nine points – from 38% in 2005-06 to 29% in 2015-16.

  IMR measures the number of deaths per 1,000 live births below the age of one.  

During the same period, the under-five mortality rate (U5MR) in Nagaland nearly halved from 65% to 37% during the same period.  

In these, Nagaland fared much better than the national average of 41% IMR and 50% U5MR. But child and maternal care conditions remain grim with the State lagging behind the national average in most indicators.  

The data was published in the Nagaland fact-sheet of the National Family Health Survey 2015-16 (NFHS-4), the largest-ever assessment of India’s health and family welfare indicators released recently.  

The survey provides decadal status of population, health and nutrition for India and each State / Union Territory. The last survey, NFHS -3, was carried out in 2005-06.  

Overall, the performance of the State shows a marked improvement from the data captured a decade ago, but some areas of concern exist, as in the instance that most of the deaths in Nagaland (78.38%) below the age of five occurred during neo-natal stage (under one year of age).  

Maternal Care in sorry state

The prevalence of high IMR despite having high literacy rate, an indicator of improved health status for other states, could be attributed to the maternal care during pregnancy and after pregnancy.  

For instance, numbers of mothers receiving full antenatal care (at least four antenatal visits, at least one tetanus toxoid (TT) injection and iron folic acid tablets or syrup taken for 100 or more days) for last birth in five years before the survey was a measly 2.4% while mothers who received postnatal care from a doctor/nurse/LHV/ANM/midwife/other health personnel within 2 days of delivery was just 22.3%.  

Among others, consumption of folic acid for 100 days or more during pregnancy was found only in 4.4% of women.  

The national average for pregnant mothers receiving full antenatal care is 21.0% while the percentage for with postnatal care was 62.4%.  

Despite grand initiatives by the government to promote institutional delivery under Janani Suraksha Yojana (JSY), severe bottlenecks seems to plague the delivery system as only 29.9% mothers received financial assistance for institutional birth in Nagaland State.

Postnatal care remains a big concern as the survey highlighted that the number of children born at home but taken to a health facility for check-up within 24 hours of birth was an astounding 0.1% - or just one child in absolute terms.  

Number of children receiving a health check up after birth from doctor/nurse/LHV/ANM/midwife/other health personnel within two days of birth was only 1.6%.  

Child Immunization

According to the survey, the percentage of children aged 12-23 months receiving full immunization (BCG, measles and 3 doses polio and DPT) was just 35.7%. While it was an improvement from the last survey (21%), Nagaland State is nearly halfway below the national level of 62%.  

Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis while DPT is a class of combination vaccines against three infectious diseases: diphtheria, pertussis, and tetanus.  

Individually, BCG remains the most sought after vaccine with 68.4% receiving it while protection against measles and DPT were lowest with only 50.4% and 52.0% of the children aged 12-23 months receiving them respectively.  

Even for the mass-promoted polio vaccine, only 52.5% of children had received three full doses according to the survey.  

Children remain most vulnerable to Hepatitis with only 45.6% of children aged 12-23 months receiving three doses of Hepatitis B vaccine.  

The national average for children receiving BCG, Polio, DPT and Measles immunization were 91.9, 72.8, 78.4 and 81.1 respectively, way above Nagaland.  

Fewer stunted, wasted children than decade ago

Regarding the nutritional status of children, 28.6% of the children below the age of 5 were categorised as ‘stunted’ – suffering from growth retardation as a result of poor diet or recurrent infection. The World Health Organisation defined it as a long-term nutritional deprivation which often results in delayed mental development, poor school performance and reduced intellectual capacity.  

At the same stage, 11.2% of the children were also bracketed as ‘wasted’ or a symptom of acute undernutrition as a consequence of insufficient food intake or a high incidence of infectious diseases. It impairs the functioning of the immune system and can lead to increased severity and duration of susceptibility to infectious diseases.  

However, it was an improvement from a decade ago as the number of children categorised as ‘stunted’ and ‘wasted’ were 38.8% and 13.3% respectively. Nearly 17% of the children below the age of 5 were ‘underweight’.  

It may be noted that the NFHS-4 fieldwork for Nagaland State was conducted from March 2016 to October 2016 by the Research & Development Initiative (RDI) which gathered information from 11,213 households, 10,790 women and 1,440 men from all districts.