Baseline Survey On Child and Related Maternal Health Care-State Report - Bihar-493 - 1

NIPI Baseline Survey report for the state of Bihar
BASELINE SURVEY ON
CHILD AND RELATED
MATERNAL HEALTH CARE
State Report - Bihar
Prepared For:
Norway India Partnership Initiative,

New Delhi
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. CONTENTS ........................................................................................... Page Number
Baseline Summary Indicator (Jehanabad) ................................................................................. 8

Baseline Summary Indicator (Nalanda) ...................................................................................... 8
Baseline Summary Indicator (Sheikhpura) ................................................................................ 9
Chapter 1 Introduction ................................................................................................................ 10
1.1 Background of NIPI ....................................................................................................... 10

1.2 Research Objectives ..................................................................................................... 11
1.3 Study Phases ................................................................................................................ 11
1.4 Study Area ..................................................................................................................... 11
1.5 Ongoing health related programs in Bihar .................................................................... 12
1.6 Profile of Bihar & NIPI Districts ..................................................................................... 12
1.6.1 Profile of Bihar ............................................................................................................... 12
1.6.2 Profile of Nalanda District .............................................................................................. 13
1.6.3 Profile of Jehanabad District ......................................................................................... 15
1.6.4 Profile of Sheikhpura District ......................................................................................... 16
1.7 Survey Design ............................................................................................................... 18
1.7.1 Sampling strategy at District level ................................................................................. 18
1.7.2 Sample size detemination in NIPI baseline study ......................................................... 19
1.7.3 Sampling procedure ..................................................................................................... 19
1.8 Quantitative and Qualitative instruments ...................................................................... 20

1.8.1 Quantitative data collection ........................................................................................... 20
1.8.2 Qualitative data collection ............................................................................................. 22
1.9 Recruitment, training and Field work ............................................................................. 23
1.9.1 Recruitment of the field staff.......................................................................................... 23
1.9.2 Translation of the schedules and Pre-testing ................................................................ 23
1.9.3 Field Training & Data collection Manuals ...................................................................... 23
1.10 Quality assurance processed adopted during baseline field survey ............................. 24
1.10.1 Quality assurance adopted during the training ............................................................. 24
1.10.2 Productivity and on field scrutiny ................................................................................... 24
1.10.3 Role of Supervisor ......................................................................................................... 24
1.10.4 Quality assurance visits by the central teams ............................................................... 25
1.10.5 Monitoring visits by NIPI team ....................................................................................... 25
1.10.6 Other quality control measures ..................................................................................... 25
1.11 Data Processing ............................................................................................................ 25
1.12 Achieved Sample .......................................................................................................... 25
1.13 Report Structure ............................................................................................................ 26
Chapter 2 Household Characteristics ....................................................................................... 27
2.1 Household demographic profile .................................................................................... 27

2.2 Socio-economic profile of household ............................................................................ 29
2.3 Education level of the household population ................................................................ 30
2.4 Household characteristics ............................................................................................. 31
2.5 Household possessions ................................................................................................ 35
2.6 Funds allocation and utilization ................................................................................ 39
Chapter 3 Characteristics of Survey Respondents.................................................................. 40
3.1 Background characteristics ........................................................................................... 40

3.2 Exposure to mass media ............................................................................................... 41
3.3 Employment Status ....................................................................................................... 42
3.4 Age at marriage and first cohabitation .......................................................................... 44
CONTENTS (contd…)

Page No.
Chapter 4 Maternal Health .......................................................................................................... 46
4.1 Preamble ..................................................................................................................... 476

4.2 Antenatal Care ............................................................................................................ 476
4.2.1 Pregnancy registration and ANC provider ................................................................... 476
4.1.2 Timing and number of ANC ........................................................................................... 49
4.1.3 Components of Antenatal Care ..................................................................................... 50
4.1.4 Health problems and treatment seeking behaviour during pregnancy ......................... 54
4.2 Delivery Care ................................................................................................................. 57
4.2.1 Influence of background characteristics choice of place of delivery ............................. 58
4.2.2 Arrangement and cost of transport ................................................................................ 59
4.2.3 Institutional delivery ....................................................................................................... 60
4.2.4 Janani Suraksha Yojana (JSY) ..................................................................................... 63
4.2.5 Training and capacity building of ASHAs ...................................................................... 64
4.3 Home delivery ............................................................................................................... 66
4.4 Post natal care .............................................................................................................. 70
Chapter 5 Newborn Care ............................................................................................................. 72
5.1 Preamble ....................................................................................................................... 72

5.2 Infant mortality ............................................................................................................ 72
5.3 Child mortality ............................................................................................................. 73
5.4 Birth weight .................................................................................................................... 73
5.5 Neonatal checkups...................................................................................................... 74
5.6 Breastfeeding practices and supplementation ........................................................ 75
Chapter 6 Child Morbidity and Treatment ................................................................................. 80
6.1 Prevalence of illness in children under study ................................................................ 80

6.1.1 Point prevalence of child morbidity ............................................................................... 81
6.1.2 Period prevalence of child morbidity ............................................................................. 81
6.1.3 Awareness of Diarrheoa ................................................................................................ 82
6.1.4 Treatment of Dirrahoea ................................................................................................. 82
6.2 Acute Respiratory Infection ........................................................................................... 83
6.2.1 Knowledge about pneumonia ........................................................................................ 83
6.3 Fever ............................................................................................................................. 84
6.3.1 Illness with fever and cough and treatment seeking behaviour .................................... 84
6.3.2 Feeding practices during illness with fever/cough ........................................................ 86
6.3.3 Care seeking practices during illness with fever .......................................................... 86
Chapter 7 Child Immunization .................................................................................................... 88
7.1 Preamble ..................................................................................................................... 898

7.2 Vaccination coverage .................................................................................................. 898
Chapter 8 Status of Health Facilities ......................................................................................... 95
8.1 Status of District hospital (DHs) .................................................................................... 95

8.1.1 Physical Infrastructure ................................................................................................... 95
8.1.2 Availabillity of human resources .................................................................................... 95
8.1.3 Services Delivered by District Hospitals .................................................................. 96
8.1.4 A Monitoring and Supervision Activities .................................................................. 96
8.1.5 Equipment ..................................................................................................................... 96
8.2 Status of Community Health Centre (CHCs)................................................................. 96

8.2.1 Infrastructure ................................................................................................................. 97
8.2.2 Availability of Human Resource ................................................................................ 97
Page No.
8.2.3 Trainings Status of CHC Staff .................................................................................... 97
8.2.4 Investigation Facility ................................................................................................... 97
8.2.5 Labor Room and Operation Theatre .......................................................................... 98
8.2.6 Storage Facility............................................................................................................ 98
8.2.7 Laboratory .................................................................................................................... 98
8.2.8 Physical Facilities ....................................................................................................... 98
8.2.9 Furniture/Instrument ................................................................................................... 98
8.2.10 OT Equipments ............................................................................................................ 98
8.2.11 Cold Equipments ......................................................................................................... 98
8.2.12 Vaccines and Prophylactic Drugs ............................................................................. 98
8.2.13 Essential Services ....................................................................................................... 99
8.2.14 Maternal and Child Health Services .......................................................................... 99
8.3 STatus of Primary Health Centre (PHCs) .................................................................. 99

8.3.1 Infrastructure ............................................................................................................... 99
8.3.2 Availability of Human Resources ............................................................................ 100
8.3.3 Training Status of PHC Staff .................................................................................... 100
8.3.4 Stock of Vaccines and Prophylactic Drugs ............................................................ 100
8.3.5 Equipment .................................................................................................................. 100
8.4 Status of Sub Centre (SCs) ...................................................................................... 101
8.4.1 Availability of Human Resource at SCs .................................................................. 101
8.4.2 Training Status in SCs .............................................................................................. 101
8.4.3 Physical Infrastructure ............................................................................................. 101
8.4.4 Staying facility of ANM ............................................................................................. 102
8.4.5 Furniture Availability................................................................................................. 102
8.4.6 Availability of Equipment ......................................................................................... 102
8.4.7 Availability of Essential Kits .................................................................................... 102
8.4.8 Labor Room ............................................................................................................... 102
8.4.9 Availability of Specific Services .............................................................................. 102
8.4.10 Monitoring and Supervision Activities .................................................................... 103
ANNEXURE TABLES…………………………………………………………………………104

LIST OF TABLES
Table 1.1: Key Health Indicators of the State

Table 1.1a: District wise Key Health Indicators of NIPI Districts
Table 1.2: Coverage by Target Group and Research Technique (State Level)
Table 1.3: Coverage by Target Group and Research Technique (District Level)
Table 1.4: Coverage by Target Group and Research Technique (Block level)
Table 1.2: District wise sample coverage status
Table 2.1: Household population by age and sex, Bihar, NIPI-08

Table 2.2: Household population by age and sex, Jehanabad, NIPI-08
Table 2.3: Household population by age and sex, Nalanda, NIPI-08
Table2.4: Household population by age and sex, Sheikhpura, NIPI-08
Table 2.5: Household Composition, NIPI-08
Table 2.7: Household family size by religion, NIPI-08
Table 2.8: Education attainment by location of PSU in terms of years of schooling, NIPI-08
Table 2.9: Type of house, NIPI-08
Table 2.10: Source of drinking water, NIPI-08
Table 2.11: Drinking water storage and filtration practices, NIPI-08
Table 2.12: Sanitation facility, NIPI-08
Table 2.13: Cooking environment, NIPI-08
Table 2.14: Ownership of immovable assets, NIPI-08
Table 2.15: Main source of household income, NIPI-08
Table 2.15a: Household Wealth Index, NIPI-08
Table 2.16: Financial Access, NIPI-08
Table 3.1: Age distribution of women respondents, NIPI-08

Table 3.2: Distribution of women respondents by Religion and ethnicity, NIPI-08
Table 3.3: Education status of women respondents, NIPI-08
Table 3.4: Media habits, NIPI-08
Table 3.5: Frequency of exposure, NIPI-08
Table 3.6: Employment status of eligible women by background characteristics, NIPI-08
Table 3.7: Membership in SHGs and mahila mandals, NIPI-08
Table 3.8: Age at first cohabitation, NIPI-08
Table 3.9: Relationship between age of first cohabitation and education and economic status of
respondent, NIPI-08
Table 4.1: Percentage of pregnancies registered vs. key background variables, NIPI-08
Table 4.2: Received ANC Card, NIPI-08
Table 4.3: Incidence of receiving ANC during last pregnancy, NIPI-08
Table 4.4: Place of ANC, NIPI-08
Table 4.5: ANC provider, NIPI-08
Table 4.6: Number of ANC received and timing of ANCs received, NIPI-08
Table 4.7: Proportion of eligible women having received different components of ANC care, NIPI-
08

Table 4.8: Nature of ANC service received, NIPI-08

Table 4.9: TT injections vs. number of ANCs, NIPI-08
Table 4.10: Knowledge about health problems during pregnancy, NIPI-08
Table 4.11: Incidence of health problems during pregnancy, NIPI-08
Table 4.12: Nature of health problems faced during last pregnancy, NIPI-08
Table 4.13: Percentage of women who sought advice for heath problem during pregnancy, NIPI-08
Table 4.14: Person persuaded for treatment during pregnancy, NIPI-08
Table 4.15: Place of delivery v/s age of respondent, NIPI-08
Table 4.16: Place of delivery v/s years of schooling, NIPI-08
Table 4.17: Place of delivery v/s number of live children, NIPI-08
Table 4.18: Place of delivery v/s economic status of respondents‟ household, NIPI-08
Table 4.19: Average transportation expenses (In Rupees), NIPI-08
Table 4.20: Nature of Institutional delivery, NIPI-08
Table 4.21: Cost incurred in institutional delivery, NIPI-08
Table 4.22: Problem experienced during delivery by women of different age groups, NIPI-08
Table 4.23: Nature of advice received after delivery by source, NIPI-08
Table 4.24: Mothers perception about environment of health facility and behaviour of staff, NIPI-08
Table 4.25: Awareness about JSY, NIPI-08
Table 4.26: Number of ASHA‟s trained, NIPI-08
Table 4.27: Accompaniment of ASHA during Institutional delivery, NIPI-08
Table 4.28: Duration of stay of the mother at health facility after delivery, NIPI-08
Table 4.29: Reason for home delivery, NIPI-08
Table 4.30: Home delivery Practices, NIPI-08
Table 4.31: Person who conduct delivery at home, NIPI-08
Table 4.32: Reasons behind choosing a specific person to conduct the delivery, NIPI-08
Table 4.33: The delivery process, NIPI-08
Table 4.34: Cost incurred in home delivery, NIPI-08
Table 4.35: Nature of advice received, NIPI-08
Table 4.36: Timings of First Post Natal Care, NIPI-08
Table 5.1: Trends in Infant Mortality Rate in Bihar and India

Table 5.2: Trends in Child Mortality Rate in Bihar and India
Table 5.2a: Recorded weight of baby, NIPI-08
Table 5.2b: Mother‟s perception about adequacy of size of newborn, NIPI-08
Table 5.3: Timing of first neonatal check-up, NIPI-08
Table 5.4: Timing of first neonatal check-up by Districts, NIPI-08
Table 5.5: Breastfeeding practices, NIPI_08
Table 5.6: Initiation of breastfeed and gender of child, NIPI-08
Table 5.7: Initiation of breastfeed and education of mother, NIPI-08
Table 5.8: Initiation of breastfeed and number of live children including index child, NIPI-08
Table 5.9: Feeding of prelacteal liquids, NIPI-08
Table 5.10: Period of exclusive breastfeeding by background variables, NIPI-08
Table 5.5: Breastfeeding practices, NIPI-08

Table 6.1: Prevalence of illness in children under study, NIPI-08

Table 6.2: Prevalence of illness in children under study (as per NFHS)
Table 6.3: Point prevalence of diarrhoea and illness, NIPI-08
Table 6.3: Period prevalence of diarrhea, NIPI-08
Table 6.4: Advice received from ANM or health worker, NIPI-08
Table 6.5: Place of treatment, NIPI-08
Table 6.6: Proportion of mothers aware of the term pneumonia, NIPI-08
Table 6.7: Prevalence of ARI during 2 Weeks prior to survey
Table 6.7: Treatment of Pneumonia, NIPI-08
Table 6.8: Incidence of fever and cough among children in last 2 weeks prior to the survey date
contact, NIPI-08
Table 6.9: Duration of treatment sought during illness, NIPI-08
Table 7.1: Percent of households having vaccination cards on the day of survey, NIPI-08
Table 7.2: BCG and Polio „0‟ coverage by background variables, NIPI-08
Table 7.3: Polio vaccine coverage by background variables, NIPI-08
Table 7.4: Child Immunisation Coverage in NIPI Districts, Bihar
Table 7.5: DPT vaccine coverage by background variables, NIPI-08
Table 7.6: Coverage of Measles vaccine and Vitamin A by background variables, NIPI-08
Table 7.6a: Immunization coverage – all basic vaccines, NIPI-08
Table 7.7: Place of immunisation received, NIPI-08
Table 7.8: Problems faced by mother/community in vaccinating the child, NIPI-08

LIST OF FIGURES
Figure 4.1: Percent of Mothers who received three or more antenatal checkups - NFHS
Figure 4.2: Percent of Mothers who consumed IFA for 90 days and Received 2 or more TT during
Pregnancy
Figure 4.3: Institutional delivery and births assisted by health personnel
Figure 6.1: Type of practices to be followed if child gets diarrheoa
Figure 6. 2: Awareness of symptoms of pneumonia
Figure 6.3: Preventive measures taken for avoiding child sickness

FACT SHEETS
BIHAR
District: JEHANABAD
Baseline Summary Indicators
Indicator Total %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 86 36
Mothers who had at least 3 Ante-Natal Care visits during the last pregnancy 197 39.6
Total number of deliveries (home plus institutional) 1260 NA
Institutional deliveries 833 66.1
Average Retention period (hours) in case of institutional delivery 26 NA
Post natal care provided to mother and neonates - Children had check-up within 24 hours after delivery
131 10.4
(based on last live birth)
Post natal care provided to mother and neonates -Children had check-up within 10 days after delivery
217 17.2
Mothers who received post natal care within 48 hours of delivery of their last child 23 39
Referral done for mothers with illness and complications during pregnancy 354 69.4
Children with Diarrhoea in the last two weeks who received ORS 34.8
Children with Diarrhoea in the last two weeks who were given treatment 13 56.5
Children with acute respiratory infection/fever in the last two weeks who were given treatment 64 77.1
Children (age 6 months above) exclusively breastfed 222 28.4
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 157 51
New born Babies immunized with zero dose polio and BCG 4 44.4
New born Babies – breastfed within 1 hour of birth 247 20.2
Newborn with birth weight taken after delivery at home 10 2.3
District: NALANDA
Indicator Total %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 47 42.70
Average Retention period (hours) in case of institutional delivery 30.6 NA
Post natal care provided to mother and neonates - Children had check-up within 24 hours after
120 9.2
delivery (based on last live birth)
207 15.8
Mothers who received post natal care within 48 hours of delivery of their last child 10 45.5
Referral done for mothers with illness and complications during pregnancy 406 64.5
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 123 48
New born Babies immunized with zero dose polio and BCG 1 12.5

District: SHEIKHPURA
Indicator Total %
Mothers registered in the first trimester when they were pregnant with last live birth/still birth 20 51.3
Average Retention period (hours) in case of institutional delivery 28.7 NA
Post natal care provided to mother and neonates - Children had check-up within 24 hours after
230 18.1
delivery (based on last live birth)
310 34.4
Mothers who received post natal care within 48 hours of delivery of their last child 25 36.8
Referral done for mothers with illness and complications during pregnancy 379 80
Children (12-23 months) fully immunized (BCG, 3 doses each of DPT, and Polio and Measles) 125 55.6
New born Babies immunized with zero dose polio and BCG 2 100

CHAPTER 1
INTRODUCTION
1.1 Background of NIPI
As per the Millennium Development 4 Goals (MDG), India has to reduce its Child Mortality
Rate (CMR) by two-thirds between 1990 and 2015. It implies that India has to reduce its
under five mortality rates to 38 per 1000 live births by 2015 to achieve the MDGs (UNICEF,
SOWC 2008). However, the office of the registrar general of India has recently cautioned that,
after a rapid decline during 1980-90, the IMR in India has stagnated since 1993 at the level of
72 [GoI 2000] This means that the programs which addressed the problem of child mortality
(reproductive and child health program, immunization program, ICDS) were no longer
effective in further reducing the IMR, and a larger proportion of infant deaths were now
contributed by neonatal deaths because this component is influenced little by the current
programs [GoI 2000]. India has made progress in the reduction of child mortality with the
average annual rate of reduction in U5 mortality between 1990 and 2006 being around 2.6
per cent.
If India is to reach the MDG Goal of 38 by 2015, the average annual rate of reduction over the
next nine years must be far higher, or around 7.6 per cent. (Source: UNICEF, SOWC 2008)
Efforts of Norway India Partnership Initiative
For India‟s success in achieving Millennium Development Goal four (MDG 4), Norway-India
Partnership Initiative (NIPI) is a collaboration towards the reduction of child mortality in Indian
states. Norway and India have agreed to collaborate towards achieving MDG 4 based on
commitments made by the prime ministers of the two countries.
The NIPI intends to provide an up-front, catalytic and strategic support to accelerate the
implementation of National Rural Health Mission (NRHM 2005-2012) in five states that
comprise 40% of India‟s total population and account for around 60% of child deaths viz.,
Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan and Orissa and evolve multiple partners,
including UNICEF and WHO. About 2.4 million children under the age of five die every year in
India, of which 1.4 million die in the 5 NIPI focus states. These states pose an enormous
challenge in implementation because of the socio-economic factors, large inequalities, weak
health system and poor program management capacity.
The initiative aims to achieve measurable outcomes in line with the fourth ''millennium
development goals'' (MDG-4) including a sustained routine immunization coverage rate at 80
per cent or more from 2007 onwards and saving an additional 0.5 million under-5 children
each year from 2009.
The Norway India Partnership Initiative will focus on four core areas in the five high-
prevalence states
 Strengthening the National Rural Health Mission, by supporting an independently

managed enabling network and facilitating delivery of MDG-4 related services
 Testing and introduction of new ways of scaling up quality services by community
health workers (ASHAs) at the village level in the five states including their support
needs and referral requirements

 Involving the private sector in the delivery of MDG 4 related services at all levels
 Exploring and providing upfront catalytic financial and strategic support for new
opportunities under the NRHM-MDG-4 related activities
Purpose of this Survey
NIPI is planned to test some innovative ideas and provide various inputs to the existing RCH
programs under NRHM. These interventions are expected to have impact on the service
delivery and outcome.
In order to achieve the monitoring and evaluation objectives, the initiative will have a
comprehensive baseline assessment on child and related maternal health care in the four
NIPI focus states.
1.2 Research Objectives
The present baseline survey on child and related maternal health care has the following
objectives:
1. Identifying gaps in the existing service delivery mechanism to reduce infant mortality
and to improve maternal health
2. Assessment of Needs and opportunities at various levels
3. Developing benchmark indicators for the implementation of the project
1.3 Study Phases
This current baseline study comprises of three phases, viz.,
1 Review of available literature on child health and related maternal health, desk
research and field review to identify information gaps
2 Collection of data on the identified gaps (not limited to) by using qualitative and
quantitative research techniques
3 Dissemination of study findings and summary report generation
The Phase 1 of NIPI Baseline survey was conducted during the year 2008 in the month of
February- March. In Phase 1, information about child and related maternal health care was
collected through desk research and interviews were conducted with the health functionaries
and other stakeholders at state and district levels.
In Phase 2, the survey was conducted during December 2008 and January 2009. For Phase
2, interviews were conducted at block and village level with the service providers and block
officials who cater to the needs of child and maternal activities. The study states were Orissa,
Madhya Pradesh, Bihar and Rajasthan. This report contains the detailed findings for the state
of Bihar.
1.4 Study area
In this baseline survey, the data were collected from the three NIPI focus districts; Nalanda,
Jehanabad and Seikhpura and relevant information from the State level. The districts
selected by NIPI in consultation with the State NRHM for implementation of the interventions.

1.5 Ongoing health related programs in Bihar
In order to improve the implementation of several child and related maternal health activities,
certain programs are ongoing currently such as of Janani Evam Bal Suraksha Yojana,
Reproductive and Child Health Care Services, Anemia Control Programme, Vitamin – A
Supplementation Programme, NRHM, Routine Immunization & Pulse Polio, Mamta and
IMNCI (Integrated Management of Neonatal Childhood) program.
1.6 Profile of Bihar and NIPI Districts
1.6.1 Profile of Bihar
Bihar is located in the eastern part of the country (between 83°-30' to 88°-00' longitude). It is
an entirely land–locked state, although the outlet to the sea through the port of Kolkata is not
far away. Bihar lies mid-way between the humid West Bengal in the east and the sub humid
Uttar Pradesh in the west which provides it with a transitional position in respect of climate,
economy and culture. It is bounded by Nepal in the north and by Jharkhand in the south. The
Bihar plain is divided into two unequal halves by the river Ganga which flows through the
middle from west to east.
According to the 2001 Census, Bihar had a population of 82.8 million, of which around 43.1
million is composed of males and 39.7 million is composed of females.
There are 38 districts in Bihar, of which three districts namely Jahanabad, Nalanda and
Sheikhpura are selected by NIPI for specific intervention programs.
The literacy rate is 47.53 percent for the state of Bihar as a whole with 60.32 percent of males
and 33.57 percent of females being literate. According to 2001 census, Patna records the
highest literacy rate of 63.82 percent while the district of Kishanganj records the lowest
literacy rate of 31.02 percent.
The 2001 census data has revealed that the population density for the state of Bihar is 880
persons per sq. km, the density being highest in the district of Patna (1471 persons/sq.km)
and lowest in the district of Kaimur (382 persons/sq.km). The decadal growth rate for the year
1991-01 stands at 28.43 percent, with Sheohar district recording the highest growth rate of
36.16 percent and Nalanda district records the lowest of 18.64 percent. Table 1.1 presents
the key health indicators for the state of Bihar as well as the three selected districts of
Nalanda, Jehanabad and Sheikhpura.
Table 1.1: Key Health Indicators of the State
Key Indicator Bihar Nalanda Jehanabad Sheikhpura

3+ ANC visit 26.4 15.0 20.0 23.0
ANC At least 1 TT injection 58.4 50.0 54.5 83.5
Received 100+ IFA 9.3 5.5 6.9 5.7
DPT (all 3) 54.2 65.1 55.1 49.2
Child
Measles 49.9 69.1 63.9 49.3
Immunization
Full 41.4 54.2 47.2 38.3
Delivery
Institutional Births 27.7 39.3 42.5 41.6
Characteristics
Source: DLHS-3, 2007-08
1.6.2 Profile of Nalanda District
Nalanda is one of the important districts of

Bihar with an area of 2367 sq.km and a
population of over two million. Bihar Sharif
is the district headquarters and the district
is flanked by two important rivers namely
Phalgu and Mohane. The decadal growth
rate for the year 1991-01 was estimated to
be 18.6 percent, the lowest for all the states
of Bihar. The sex-ratio of the district is
recorded at 915 females per 1000 male
population. The percentage of SC & ST
population stands at 19.4 percent and 0.02
percent respectively, which is much less
compared to the other districts of Bihar. A marked disparity is noted between male and
female literacy rates, the latter being only 39.6 percent compared to the former (66.9%).

DLHS-2 DLHS-3 NIPI BASELINE

INDICATORS
(2002 - 04) (2007 - 08) (2008 - 09)
MATERNAL HEALTH Total Rural Total Rural Total Rural

Mothers registered in the first trimester when they 37.40%
- - 25.0 22.1 42.70
were pregnant with last live birth/still birth (%)
Mothers who had at least 3 Ante-Natal care visits
14.0 13.1 25.2 22.2 38.5 36.6
during the last pregnancy (%)
Mothers who got at least one TT injection when they
29.7 27.9 50.0 47.2 95.3 95.30
were pregnant with their last live birth / still birth (%)
Institutional births (%) 27.3 23.4 39.3 34.5 58.6 57.7
Delivery at home assisted by a doctor/nurse
7.5 8.3 7.0 6.2 20.6 17.9
/LHV/ANM (%)
Mothers who received post natal care within 48
- - 27.9 24.2 45.5 42.9
hours of delivery of their last child (%)
CHILD IMMUNIZATION AND VITAMIN A
SUPPLEMENTATION
Children (12-23 months) fully immunized (BCG, 3
19.0 19.8 54.2 53.2 48 48.9
doses each of DPT, and Polio and Measles) (%)
Children (12-23 months) who have received BCG
46.4 46.4 88.0 88.6 97.3 96.9
(%)
Children (12-23 months) who have received 3 doses
30.7 29.9 62.8 62.4 73.8 73.8
of Polio Vaccine (%)
Children (12-23 months) who have received 3 doses
35.1 28.9 65.1 64.5 71.9 72.9
of DPT Vaccine (%)
Children (12-23 months) who have received Measles
25.5 25.0 69.1 69.2 66.8 68
Vaccine (%)
Children (9-35 months) who have received at least
- - 59.4 58.5 41 43.1
one dose of Vitamin A (%)
Children (above 21 months) who have received
- - 10.4 11.5 13.1 13.5
three doses of Vitamin A (%)
TREATMENT OF CHILDHOOD DISEASES
(Children under 3 years, based on last two
surviving children)
Children with Diarrhoea in the last two weeks who
0.0 0.0 45.3 46.2 44.6 42.6
received ORS (%)
9.4 0.0 86.6 86.1 76.4 77.3
were given treatment (%)
Children with acute respiratory infection/fever in the
- - 80.9 79.5 82.5 86.4
last two weeks who were given treatment (%)
Children had check-up within 24 hours after delivery
- - 28.0 25.4 9.1 8.3
(based on last live birth) (%)
Children had check-up within 10 days after delivery
- - 28.0 25.0 15.80% 14.10%
CHILD FEEDING PRACTICES (Children under 3

years)
Children breastfed within one hour of birth (%) - - 30.2 31.6 8.5 8.90
Children (age 6 months above) exclusively breastfed
- - 20.7 20.9 22.5 17.6
(%)
Children (6-24 months) who received solid or
- - 87.0 87.8 51.50 50.90
semisolid food and still being breastfed (%).

1.6.3 Profile of Jehanabad District
Jehanabad is located on the

confluence of two small rivers called
Dardha and Yamunaiya. It is the
heartland of Magadh and the local
dialect is called Magahi. The area is
developing now and the services
sector is gaining ground in the district.
Jehanabad town is the administrative
headquarter of this district. This district
is a part of Magadh division and is only
45 km nearby Patna, the state capital.
The decadal growth rate for the year
1991-01 was estimated to be 28.6
percent, which is more or less the
same as the state growth rate. The sex-ratio of the district is recorded at 928 females per
1000 male population. The percentage of SC & ST population stands at 18.4 percent and
0.02 percent respectively, which is much less compared to the other districts of Bihar. A
marked disparity is noted between male and female literacy rates, the latter being only 40.1
percent compared to the former (70.9%).

INDICATORS (2002 - 04) (2007 - 08) (2008 - 09)
Total Rural Total Rural Total Rural

MATERNAL HEALTH
Mothers registered in the first trimester when they were
- - 26.7 27.0 36 35.6
pregnant with last live birth/still birth (%)
Mothers who had at least 3 Ante-Natal care visits during
18.7 18.3 30.6 31.2 39.6 39.2
the last pregnancy (%)
Mothers who got at least one TT injection when they
30.0 29.3 54.5 54.4 98.6* 98.5
were pregnant with their last live birth / still birth (%)
Delivery at home assisted by a doctor/nurse /LHV/ANM
11.9 12.0 10.6 10.3 31.6 30.4
(%)
Mothers who received post natal care within 48 hours of
- - 31.0 31.5 39 39
delivery of their last child (%)

SUPPLEMENTATION
Children (12-23 months) fully immunized (BCG, 3 doses
14.1 14.0 47.2 46.3 51 50.7
each of DPT, and Polio and Measles) (%)
Children (12-23 months) who have received BCG (%) 36.8 36.8 85.4 87.2 98.7 98.6
Children (12-23 months) who have received 3 doses of
21.5 21.3 48.7 49.9 73.1 72.9
Polio Vaccine (%)
Children (12-23 months) who have received 3 doses of
26.1 27.2 55.1 56.4 71.1 71.5
DPT Vaccine (%)
Children (12-23 months) who have received Measles
19.4 19.9 63.9 65.0 63.6 63.5
Vaccine (%)
Children (9-35 months) who have received at least one
- - 66.0 66.9 41.2 41
dose of Vitamin A (%)
Children (above 21 months) who have received three
- - 9.2 9.9 13.7 15.6
doses of Vitamin A (%)
TREATMENT OF CHILDHOOD DISEASES (Children
under 3 years, based on last two surviving children)
0.0 0.0 13.6 13.4 34.8 34.8
received ORS (%)

Children with Diarrhoea in the last two weeks who were

given treatment (%) 100.0 100.0 74.7 77.7 56.5 56.5
Children with acute respiratory infection/fever in the last

- - 72.6 72.5 77.1 76.5
two weeks who were given treatment (%)
Children had check-up within 24 hours after delivery
- - 29.8 30.0 10.4 10.7
Children had check-up within 10 days after delivery 17.20 17.70
- - 31.0 31.8
CHILD FEEDING PRACTICES (Children under 3

years)
Children (age 6 months above) exclusively breastfed
- - 10.9 11.4 28.4 25.7
(%)
Children (6-24 months) who received solid or semisolid
- - 84.5 84.0 41.4 39.7
food and still being breastfed (%).
1.6.4 Profile of Sheikhpura district
Sheikhpura district is spread over an

area of 689 sq.km. Its headquarters is
Sheikhpura. The district is divided
into six blocks namely Ariari,
Sheikhpura, Barbigha,
Ghatkusumbo, Chebara and
Shekhopur Sarai. Paddy, wheat and
lentils are the main crops. The
Ganges, Mohane, Harohar and Kiul
are the important rivers that pass
through the districts. The population of
the district is a little over 5 lakhs, with a decadal growth rate for the year 1991-01 being 25.0
percent. The sex-ratio of the district is recorded at 920 females per 1000 male population.
The percentage of SC & ST population stands at 19.7 percent and 0.04 percent respectively,
which is much less compared to the other districts of Bihar. A marked disparity is noted
between male and female literacy rates, the latter being only 34.1 percent compared to the
former (62.6%).

INDICATORS (2002 - 04) (2007 - 08) (2008 - 09)
Total Rural Total Rural Total Rural
MATERNAL HEALTH
Mothers registered in the first trimester when they were
- - 42.9 43.4 51.3 48.6
pregnant with last live birth/still birth (%)
Mothers who had at least 3 Ante-Natal care visits during the
22.2 21.1 43.2 43.4 40.7 39.5
last pregnancy (%)
Mothers who got at least one TT injection when they were
33.2 31.9 83.5 84.2 98.5 98.4
pregnant with their last live birth / still birth (%)
Delivery at home assisted by a doctor/nurse /LHV/ANM (%) 9.2 7.8 5.0 4.2 8.2 7.8
Mothers who received post natal care within 48 hours of
- - 44.1 45.0 36.8 28.8
delivery of their last child (%)

SUPPLEMENTATION
Children (12-23 months) fully immunized (BCG, 3 doses each
19.1 20.0 38.3 41.3 55.6 55.4
of DPT, and Polio and Measles) (%)
Children (12-23 months) who have received BCG (%) 50.0 50.0 74.5 73.2 95.10 95.1

Children (12-23 months) who have received 3 doses of Polio

25.5 27.4 48.3 49.8 70.2 69.6
Vaccine (%)
Children (12-23 months) who have received 3 doses of DPT
26.7 31.3 49.2 50.9 72.9 72.8
Vaccine (%)
Children (12-23 months) who have received Measles Vaccine
27.4 30.2 49.3 50.7 67.6 65.8
(%)
Children (9-35 months) who have received at least one dose
- - 49.3 51.0 42.7 41.3
of Vitamin A (%)
Children (above 21 months) who have received three doses
- - 8.0 9.2 19.2 14.7
of Vitamin A (%)
TREATMENT OF CHILDHOOD DISEASES (Children under
3 years, based on last two surviving children)
Children with Diarrhoea in the last two weeks who received
67.4 61.7 24.5 25.8 25.9 25.8
ORS (%)
Children with Diarrhoea in the last two weeks who were given
79.1 75.4 80.2 82.9 76.3 83.1
treatment (%)
Children with acute respiratory infection/fever in the last two
- - 76.2 77.5 93.1 93
weeks who were given treatment (%)
Children had check-up within 24 hours after delivery (based
- - 39.4 40.2 18.1 17.2
on last live birth) (%)
Children had check-up within 10 days after delivery (based on 24.40 23.70
- - 41.3 42.3
last live birth) (%)
CHILD FEEDING PRACTICES (Children under 3 years)

Children (age 6 months above) exclusively breastfed (%) - - 12.5 12.9 29.9 26.8
Children (6-24 months) who received solid or semisolid food
- - 82.5 82.5 58.4 57.5
and still being breastfed (%).
Table 1.1a: District wise Key Health Indicators of NIPI Districts
Districts
Indicators
Nalanda Jehanabad Shiekhpura
Maternal Health Total Total Total

Mothers registered in the first trimester when they
25.0 42.9 26.7
were pregnant with last live birth/still birth (%)
Mothers who had at least 3 Ante-Natal care visits
25.2 43.2 30.6
during the last pregnancy (%)
Mothers who got at least one TT injection when
they were pregnant with their last live birth / still 50.0 83.5 54.5
birth (%)
Institutional births (%) 39.3 41.6 42.5
Delivery at home assisted by a doctor/nurse
7.0 5.0 10.6
/LHV/ANM (%)
Mothers who received post natal care within 48
27.9 44.1 31.0
hours of delivery of their last child (%)
Child Immunization and Vitamin A
Supplementation
Children (12-23 months) fully immunized (BCG, 3
54.2 38.3 47.2
doses each of DPT, and Polio and Measles) (%)
Children (12-23 months) who have received BCG
88.0 74.5 85.4
(%)
Children (12-23 months) who have received 3
62.8 48.3 48.7
doses of Polio Vaccine (%)

Children (12-23 months) who have received 3

65.1 49.2 55.1
doses of DPT Vaccine (%)
Children (12-23 months) who have received
69.1 49.3 63.9
Measles Vaccine (%)
Children (9-35 months) who have received at
59.4 49.3 66.0
least one dose of Vitamin A (%)
Children (above 21 months) who have received
10.4 8.0 9.2
three doses of Vitamin A (%)
Treatment of Childhood Diseases (Children
under 3 years, based on last two surviving
children)
Children with Diarrhoea in the last two weeks
45.3 24.5 13.6
who received ORS (%)
Children with Diarrhoea in the last two weeks
86.6 80.2 74.7
who were given treatment (%)
Children with acute respiratory infection/fever in
80.9 76.2 72.6
the last two weeks who were given treatment (%)
Children had check-up within 24 hours after
28.0 39.4 29.8
delivery (based on last live birth) (%)
Children had check-up within 10 days after
28.0 41.3 31.0
delivery (based on last live birth) (%)
Child Feeding Practices (Children under 3
years)
Children breastfed within one hour of birth (%) 30.2 10.5 18.6
Children (age 6 months above) exclusively
20.7 12.5 10.9
breastfed (%)
Children (6-24 months) who received solid or
87.0 82.5 84.5
semisolid food and still being breastfed (%).
Source: DLHS-3, 2007-08
1.7 Survey Design
In Phase II, the sampling frame took into consideration district, village, and household units.
The target population included was women who gave birth within the past two years, as these
are the main beneficiaries of the interventions to be provided by NIPI and the outcome
indicators needed for the study was generated by interviewing them.
Note: The sampling strategy given below describes the methods of selecting the respondents
from a study district.
1.7.1 Sampling strategy at district level
We used a two-stage stratified cluster sampling technique for the selection of respondents
(women who gave birth during the past two years) in this study. We covered 50 PSUs from
each of the study districts. The number of clusters covered in a district was allocated
according to the proportion of rural and urban population in the district. At the first stage,
number of rural PSUs/villages was selected using probability proportional to size (PPS)
sampling technique. Within the PSU/village, selection of the eligible respondents was done
using systematic random sampling approach.
Similarly the allocated number of urban PSUs/wards was selected using probability
proportional to size (PPS) sampling technique. Within the PSU/ward selection of the eligible
respondents was done using systematic random sampling approach. The 2001 Census list of
towns/cities and villages of the study districts served as the sampling frame for the selection
of PSUs. As the selection of the respondents is done randomly using two-stage sampling
strategy each individual member of the target group of respondents in the district had an
equal chance of inclusion in the survey.
Inclusion Criteria
- Households with currently married women who delivered a child in last two
years or who were pregnant in the last two years.
- Oral informed consent of the selected respondent
1.7.2 Sample size determination in NIPI Baseline study

The following formula was used to determine the sample size required in a district:
nD
 2 P(1  P) Z1  P1 (1  P1 )  P2 (1  P2 ) Z1  
2
2
Where:
D = Design effect
P1 = the estimated proportion at the time of the baseline survey;
P2 = the proportion at end line such that the quantity (P2 - P1) is the size of the magnitude of
change it is desired to be able to detect;
P = (P1 + P2) / 2;
Z1- = the z-score corresponding to the probability with which it is desired to be able to
conclude that an observed change of size (P2 - P1) would not have occurred by chance; and
Z1- = the z-score corresponding to the degree of confidence with which it is desired to be
certain of detecting a change of size (P2 - P1) if one actually occurred.
 =0.05 (Z1- = 1.96); =0.20 (Z1-=0.84); D = 2
With a power of 80 percent and with 5% precision, the sample size required at 95%
confidence is obtained for different variable values for both Bihar and Rajasthan. We
considered 3 variables namely, IMR, NMR and percentage deliveries taken place in
institutions.
The objective of NIPI program is to act as a catalyst in the process, which leads to reduction
in infant and neonatal mortality. The objective of NIPI intervention is not to reduce infant
mortality directly. So using IMR or NMR for the calculation of sample size is not ideal.
Percentage of institutional deliveries is an indicator of the improvement in service delivery,
which will have direct bearing on the survival of newborn. Taking a bigger sample size has
implications on cost and time. So a sample size of 1200 was decided for each district, which
provided us statistically viable estimates for most of the indicators under consideration.

1.7.3 Sampling procedure
Primary sampling units
The allocated number of villages/wards (PSUs) within a district was selected using Probability
proportionate to size (PPS) technique and by involving all the villages/wards in the district.
The sampling interval was obtained by dividing the total cumulative population of the district
by the total number of villages/wards. All villages/wards were listed in one column, their
corresponding population in another column and the cumulative population in yet another
column. A random start of villages/wards was included and was done by selecting a random
number between 1 and the maximum number in the sampling interval. The remaining
villages/wards were then selected by adding the sampling interval to the cumulative
population of villages/wards.
Listing of eligible women in a PSU
Each selected PSU was initially listed for the identification of eligible respondents (woman
who delivered a baby in the last two years or woman who was pregnant in the last two years).
After listing the eligible respondents in a PSU, from each PSU we covered 24 eligible
respondents using systematic random sampling approach. It implies that from each PSU we
have information about 24 pregnancies irrespective of their outcome and from a district, we
have information about 24x50=1200 pregnancies at baseline. Thus we covered a total sample
size of 3600 pregnancies in a state.
As per the suggestion from TAC, sample size was recalculated using the variable „percentage
of children fully immunised‟. Attached excel sheet provides the estimate. After adjusting for
design effect and non-response, the sample size achieved was 1200.
As suggested by earlier by TAC, it was decided to cover 1200 samples of children in the age
group of 12-23 months, 600 infants (in less than one year) and all the neonates (0-28 days) in
the PSU. With the understanding of covering 10 percent of the samples, a sample size of 24
children/respondents per PSU was worked out with 10 percent of over sampling to avoid the
risk of unresponsive candidates.
With a sample size of 24 children aged 0-23 months per PSU, we got one neonate per PSU
resulting in a total sample size of 50 neonates in the study. In order to get statistically robust
estimates of indicators of newborn care practices and contacts by health worker, a sampling
size of 136 was derived. So with the propose quota sampling wherein, from each PSU, we
selected 2-3 neonates (<1 month), 9-10 children of 1-11 months and 12 children of 12-23
months. This sample size was adequate to get an estimate of the indicator under
consideration with 95% confidence, 10% precision and a design effect of 2.
Proposed Sample Confidence Precision Achieved Sample Size of

Size per district Limit State
Neonates (0 – 28 days) 136 95% 10% 429
Infants including neonates 550 95% 5% 1599
Children 12-23 months 600 95% 5% 1919
1.8 Quantitative and Qualitative methods
The baseline data needed for the present study was obtained by using qualitative and
quantitative data collection techniques and the target groups for the surveys were different
stakeholders who were the beneficiaries and the implementers of the maternal and child
health care interventions in the selected study districts and the states.

1.8.1 Quantitative data collection
As part of Quantitative survey we conducted cross-sectional survey based on the WHO and
UNICEF Rapid Assessment Procedure.
Questionnaires
Information on various indicators pertaining to MCH was collected that would assist policy
makers and program managers to formulate and implement the goals set for NIPI program.
The household and woman questionnaire was developed in the lines of NFHS survey
questionnaires. TAC steering committee had reviewed and made necessary modifications in
one of the Questionnaires: Women Questionnaires. These questionnaires were discussed
and finalized in training cum workshop during the first week of November 2008
All the questionnaires were bilingual, with questions in both regional and English language,
the details of which are as follows:
Household Questionnaires: The household questionnaire lists all usual residents in sample
household including visitors who stayed in the household the night before the interview. For
each listed household member, the survey collected basic information on age, sex and
education. Information was also collected on the household characteristics such as main
source of drinking water, type of toilet facility, source of cooking fuel, religion and caste of
household head and ownership of other durable goods in the household.
Women Questionnaire: Women questionnaire is designed to collect information from currently

married women 15-45 years who gave birth in last two years. The women questionnaire
covered the following sections:
Section I: Women characteristics: In this section the information collected on age, educational
status and birth and death history of biological children including still birth, induced and
spontaneous abortions.
Section II: In this section the questionnaire collect information only from the women who had
live birth, still birth, spontaneous or induced abortion during last two years preceding the
survey date. The information on whether women received antenatal and postpartum care,
who attended the delivery and the nature of complication during pregnancy for recent births
were also collected.
Section III: Institutional Delivery: This section gives information about women who went to
health facility for delivery, mode of transport arranged for delivery, assistance provided by
ASHA, experience of health problems during the time of delivery and advises given by health
practitioners on newborn care practices.
Section IV: Home Delivery: This section covers the information about deliveries conducted at
home, place used for home delivery, health personnel attended to conduct the delivery, clean
practices adopted for delivery, check up conducted by ASHA
Facility Survey Questionnaires:Under facility survey, District Hospitals, Community

Health Centres (CHCs), Primary Health Centres (PHCs), and Sub-Centres (SCs) are
covered in each of the NIPI intervention district. For each of the health facility, a
separate questionnaire was designed and information was collected in the following
areas:
 Availability of Human Resources

 Training
 Investigative & Laboratory services
 Availability of Infrastructure
 Residential Facility for Staff
 Equipments
 Availability of drugs
In each of the facility, various information under above mentioned heads was
collected keeping in mind the IPHS guidelines. In each district, District Hospital, one
CHC, 6 PHCs and 30 SCs were decided to cover to get a fair understanding of the
status of health facilities in the district.
1.8.2 Qualitative data collection
As part of Qualitative study, in-depth interviews (IDI) were conducted with various
stakeholders involved in maternal and newborn care issues at village, block, district and state
level. The purpose of qualitative study was to assess the input, process and output indicators
of the interventions proposed. It may be noted that the main purpose of quantitative survey
was to understand the different aspects of program delivery and management as a
facilitating/debilitating factor to contain mortality levels of infants and P/L mothers.
Qualitative study was carried out through In-depth interview of various health
functionaries/stakeholders in a state, district and block level. Various stakeholders covered at
the state, district, block and village levels along with the proposed sample size have been
mentioned in the tables below.
Table 1.2: Coverage by Target Group and Research Technique (State Level)
Target Group Research Per Per

Technique district state
Health/ FW/RCH Director IDI 2 6
NRHM-PMU/ Mission Director IDI 1 3
ICDS-PD/ Commissioner IDI 1 3
NGO Coordinator IDI 1 3
PO - Immunisation IDI 1 3
Consultant – Child Health IDI 1 3
PO – Planning/SPM IDI 1 3
DD-Statistics IDI 1 3
Finance Officer IDI 1 3
State IEC Officer IDI 1 3

Table 1.3: Coverage by Target Group and Research Technique (District Level)

DM/DC IDI 1 3
CMHO IDI 1 3
DIO IDI 1 3
DIECO IDI 1 3
NRHM-DPM IDI 1 3
DAM IDI 1 3
MIS Officer IDI 1 3
RKS IDI 1 3
ICDS-PO IDI 1 3
NGO IDI 1 3
Provider Association – IMA, Pvt Doctor Association, Nurses Association IDI 1 3
District hospital, Civil Surgeon IDI 1 3

Table 1.4: Coverage by Target Group and Research Technique (Block level)
ASHAs of the surveyed PSUs IDI 50 150
AWWs of the surveyed PSUs IDI 50 150
PRI leader IDI 50 150
VHSC IDI 50 150
ANM IDI 25 75
ANM FGD 3 9
BEE IDI 5 15
BMO IDI 5 15
CDPO IDI 5 15
LHV IDI 5 15
1.9 Recruitment, training and Field work
1.9.1 Recruitment of the field staff
For this baseline household survey, supervisors and interviewers from the respective states
were recruited, with relevant background and previous experience in similar large-scale social
research studies. We recruited graduates only for the job of Supervisors and Interviewers and
with the fix minimum experience in social surveys for interviewers as 2 years and for
supervisors as 5 years. The qualitative survey was monitored by a researcher who has
previous experience in handling such surveys.
1.9.2 Translation of the questionnaires and pre-testing
All the qualitative and quantitative instruments of the present study were translated into
regional languages by DRS panel of expert translators. The translated schedules were
translated back into English and variations if any will be sorted out.
All the prepared instruments were pre-tested on eligible respondents by the local
investigators from study states. All the questions were assessed for consistency, comfort of
the investigator to enquire and the respondent‟s convenience to respond.
The instruments were modified according to the feedback from pre-testing. Then the
instruments were sent for printing. We printed the required number of instruments + 10%
more to be used in training and field practice.
1.9.3 Field Training & Data collection Manuals
Intensive training was given to the recruited personnel by DRS INDIA, regarding the nature of
interviews and specific skills required for eliciting data. We conducted a 4-day training
session for the qualitative and quantitative teams. The training sessions were held at
respective states.
Training sessions included introductory session on the study objectives, target groups,
importance of the study and implications of the study findings. The methods were used to
impart the training including lectures, discussion, role-play, demonstration interview, mock
interview, field practice interview etc.

1.10 Quality assurance processes adopted during baseline field survey
1.10.1 Quality assurance processes adopted during the training
The members of survey team were selected from the study states that were involved in data
collection in the previous RCH surveys and qualitative data collection.
Training on Quantitative and Qualitative questionnaires was conducted at the state level by
the senior researchers from Delhi accompanied by the field coordinators to ensure the
content and quality of training. Apart from discussing the questionnaires and other important
sessions on immunization and newborn care practices were discussed. During the training,
each question item and the mode of administering the question were discussed.
Training was followed by 1-day field practice by the teams, which was monitored by Senior
Researcher to ensure the quality of field work and consistencies in the questionnaires.
The state level NIPI Program Officers also made special spot checks to facilitate the quality of
the training.
1.10.2 Productivity and on field scrutiny
Data collection was done by two teams; one team for the quantitative data and one for the
qualitative data. On an average 4 quantitative interviews were conducted by one member of
the Quantitative survey team in a day for this study. Similarly one member of the Qualitative
data collection team conducted 2 qualitative interviews in a day. At any given point of time of
the survey period, the interviewers did not exceed the productivity limit to ensure quality and
complete data collection.
The supervisors allotted the households to the interviewers based on the Household listing
prepared by the Listing team. All the interviews were scrutinized by the field editors and
supervisors in the village itself to check for the logical flow and consistencies in the
responses. This was done with the help of field interviewers to approach the respondents in
case of any data inconsistencies.
One field executive and one field coordinator was responsible for the data collection in each
state. The field executives visited all the teams in the first 10 days of data collection. This has
helped in identifying and plugging the initial problems and to ensure smooth and quality data
collection further.
1.10.3 Role of Supervisor
During the fieldwork, the field supervisor was responsible for planning and executing the data
collection. The supervisor was responsible in informing the block level officers and service
providers in the PSUs about the purpose of the field teams‟ visit to the place and seeks their
cooperation. This helped the field teams in conducting data collection smoothly.
If there were any issues in terms of quality or completeness of data collection by the field
executives, the supervisors immediately informed field coordinators and hence adequate
measures were taken without any delay.

1.10.4 Quality assurance visits by the central teams
The survey teams were visited by the central survey coordination team members on field to
check the process and quality of data collection.
1.10.5 Monitoring visits by NIPI team

Members from NIPI team (NIPI Secretariat and NIPI State Offices) visited some of the survey
teams during survey and assessed the process of data collection and completeness of data.
1.10.6 Other quality control measures
In order to control quality, we adopted rigorous checks such as spot checks, back checks and
accompaniment interviews. We adopted 10% back checks to ensure whether the correct
households were covered or not and 15% accompanied audit norm to ensure the
questionnaire is being administered as per the instructions in the training. These were the
quality control checks adopted by supervisors, field executives and researchers during their
field visits. The field executives and researchers visited the field in such a way that one or the
other was in the field during the entire data collection period.
As a practice of quality control for any social research study the supervisor accompanied 20%
of the interviews.
1.11 Data Processing
The hard copies of the collected forms were collected at the Central coordination office at
Delhi. All the forms were screened again for the completeness. The collected raw data was
entered in Cs Pro keeping in view the objectives of the study. Double data entry was done for
20% of the data. The data entered were correlated with the house listing to cross check the
index candidates and also the other related parameters.
Analysis for various pre-identified indicators and other program relevant indicators was
generated in SPSS program.
The analysis was undertaken in consultation with TNS and NIPI program officers.
1.12 Achieved Sample
Table 1.5 below gives the district-wise coverage status for the state of Bihar.
Table 1.5: District wise Sample Coverage Status

Per District
Research Tools Target Jehanabad Nalanda Sheikhpura Bihar
Household Survey
Household 1200 1298 1332 1317 3947
Women 1200 1263 1308 1372 3843
Facility Survey
District Hospital 1 1 1 1 3
PHC 6 6 6 6 18
CHC 1 0 1 1 2
SC 30 30 30 30 90
Qualitative Discussions
Per District
Research Tools Target Jehanabad Nalanda Sheikhpura Bihar
IDI with ANMs 25 25 25 25 75
IDI with ASHAs 1 per village 46 43 42 131
IDI with AWW 1 per village 47 43 42 132
FGD with PRI 50 43 50 50 143
IDI with BMO 5 5 4 5 14
IDI with LHV 5 5 5 5 15
IDI with CDPO 5 5 5 4 14
IDI with BEE 5 5 5 5 15
1.13 Report Structure
NIPI Baseline Report for Bihar consists of 8 Chapters including this one. Chapter -2 gives
Bihar‟s household characteristics including demographic and socio economic profile,
educational level of household population and household possession. Subsequent chapter 3
presents background characteristics of surveyed respondents which include age at marriage
and at first cohabitation, exposure to mass media and employment status of surveyed
women. Similarly chapter 4, 5, 6 & 7 presents information on maternal and child related
health indicators including information on ANC, delivery, PNC, child mortality & morbidity, and
child immunization. Chapter - 8 deals with the information on public health facility
infrastructure present in all 3 sample which includes District hospital, Public Health Centre,
Community Health Centre and Sub Centre. All these chapters are supported by qualitative
inputs and summary observations that emerged at the time of survey.

CHAPTER 2
HOUSEHOLD CHARACTERISTICS
2.1 Household demographic profile
This section presents the demographic characteristics of the sample households across urban and
rural areas in the three Districts of Bihar. The variables covered include age-specific distribution of the
household population by nature of the primary sampling unit as well as gender of family member.
Table 2.1: Household population by age and sex – Bihar, NIPI-08
All NIPI Districts - Bihar Rural Urban

Age Total Male Female Total Male Female Total Male Female
% % % % % % % % %
0-4 24.4 24.4 24.3 24.3 24.3 24.2 25.1 25.3 24.9
5-9 14.3 14.1 14.4 14.4 14.4 14.4 13.5 12.1 14.8
10-14 7.7 7.8 7.5 7.6 7.8 7.5 7.9 8.4 7.4
15-19 5.7 5.5 5.9 5.6 5.3 5.9 5.9 6.3 5.6
20-24 8.9 5.7 12.1 8.9 5.7 12.0 9.1 5.6 12.5
25-29 10.2 9.3 11.0 10.1 9.3 10.9 10.8 9.8 11.8
30-34 7.4 9.0 5.9 7.4 8.9 6.0 7.4 9.8 5.1
35-39 4.6 5.9 3.4 4.6 5.9 3.5 4.7 6.1 3.3
40-44 2.7 3.2 2.1 2.7 3.2 2.1 2.7 3.3 2.0
45-49 2.7 2.4 3.1 2.7 2.4 3.1 2.7 2.3 3.2
50-54 2.7 2.8 2.7 2.7 2.8 2.7 2.7 2.6 2.8
55-59 2.6 2.2 3.0 2.6 2.2 3.0 2.2 1.9 2.6
60+ 6.1 7.8 4.6 6.3 7.9 4.7 5.2 6.5 3.9
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total HH
29,143 14,370 14,773 25,824 12,731 13,093 3,319 1,639 1,680
Members
Sex Ratio 1,028 1,028 1,025
According to Census of India 2001, the sex ratio across the Bihar state was at 919 females
per 1000 males. However NIPI survey consistently shows the sex ratio across urban and rural
areas is in favour of the female, which is contrary to the sex ratio of Bihar. The possible
explanation could be that the Districts chosen for this survey were relatively moderately
developed ones which are subject to out-migration, as against more developed Districts
which witness large scale first generation in-migration from rural areas for employment
purposes. This thought is consistent with the fact that sex ratio is more even in the urban
sample as compared to the rural sample where the bias in favour of female members is even
more pronounced. Apart from this, as per the sampling methodology, only those households
were selected where mothers of 0 to 23 months children are available, hence those
households having no eligible mothers or having only male members are omitted.
So far as the sex ratio of children (0-6 years) is concerned, as per census 2001, there
are 927 females per 1000 males in India, whereas it is 942 in Bihar. Of the three NIPI
districts, Jehanabad has the lowest child sex ratio (916) followed by Nalanda (941)
and Sheikhpura (954).

Table 2.2: Household population by age and sex – JEHANABAD, NIPI-08
JEHANABAD Rural Urban

% % % % % % % % %
0-4 24.6 24.1 25.0 24.4 24.0 24.8 27.2 25.9 28.6
5-9 13.5 13.3 13.8 13.5 13.2 13.7 14.9 15.1 14.7
10-14 7.1 7.2 6.9 7.0 7.3 6.8 7.4 6.0 8.7
15-19 5.8 5.4 6.1 5.9 5.5 6.4 2.8 3.6 2.0
20-24 9.3 6.0 12.5 9.3 5.9 12.6 8.9 6.8 11.1
25-29 10.7 10.1 11.2 10.6 10.1 11.1 11.9 10.4 13.5
30-34 7.6 9.2 6.0 7.5 8.9 6.0 9.9 13.1 6.7
35-39 5.0 6.5 3.5 5.0 6.5 3.5 4.6 6.0 3.2
40-44 2.6 3.1 2.1 2.7 3.2 2.2 1.6 2.0 1.2
45-49 2.6 2.3 2.9 2.6 2.3 2.9 2.2 2.0 2.4
50-54 2.7 3.0 2.3 2.7 3.1 2.3 2.2 2.0 2.4
55-59 2.6 2.0 3.2 2.7 2.1 3.2 1.6 1.6 1.6
60+ 6.0 7.7 4.4 6.1 7.8 4.4 4.8 5.6 4.0
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total HH
9,075 4,511 4,564 8,572 4,260 4,312 503 251 252
Members
Sex Ratio 1,012 1,012 1,004
Table 2.3: Household population by age and sex – NALANDA, NIPI-08
NALANDA Rural Urban

% % % % % % % % %
0-4 23.9 24.1 23.6 23.8 23.9 23.7 24.4 25.7 23.1
5-9 14.3 14.4 14.3 14.5 14.9 14.1 13.1 10.6 15.5
10-14 8.2 8.4 8.0 8.1 8.0 8.2 8.9 10.8 7.1
15-19 5.7 5.7 5.6 5.5 5.6 5.5 6.4 5.8 6.9
20-24 8.5 5.6 11.4 8.4 5.5 11.1 9.7 6.1 13.2
25-29 10.3 9.1 11.4 10.3 9.1 11.4 10.3 9.4 11.3
30-34 7.3 8.9 5.8 7.4 9.1 5.9 6.5 7.8 5.1
35-39 4.5 5.2 3.7 4.5 5.2 3.8 4.5 5.7 3.3
40-44 2.6 3.2 2.1 2.6 3.2 2.0 3.0 3.4 2.6
45-49 3.0 2.5 3.6 3.0 2.4 3.5 3.5 3.2 3.8
50-54 2.8 2.9 2.6 2.8 2.9 2.6 2.8 3.4 2.3
55-59 2.6 2.1 3.0 2.7 2.2 3.1 2.1 1.4 2.9
60+ 6.4 7.9 4.9 6.6 8.0 5.2 4.9 6.8 3.2
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total HH
10,211 5,024 5,187 8,894 4,373 4,521 1,317 651 666
Members
Sex Ratio 1,032 1,034 1,023

Table2.4: Household population by age and sex – SHEIKHPURA, NIPI-08
SHEIKHPURA Rural Urban

% % % % % % % % %
0-4 24.7 25.0 24.4 24.6 25.0 24.2 25.1 24.8 25.3
5-9 14.9 14.6 15.2 15.2 15.0 15.4 13.4 12.5 14.3
10-14 7.7 7.9 7.5 7.8 8.0 7.6 7.2 7.1 7.3
15-19 5.6 5.3 5.9 5.4 4.9 6.0 6.6 7.6 5.6
20-24 9.0 5.4 12.3 9.0 5.6 12.3 8.6 4.7 12.3
25-29 9.6 8.8 10.4 9.4 8.6 10.2 10.9 10.0 11.7
30-34 7.4 8.9 5.9 7.4 8.6 6.2 7.4 10.3 4.6
35-39 4.5 6.0 3.1 4.5 5.9 3.1 4.9 6.5 3.4
40-44 2.8 3.4 2.2 2.8 3.3 2.3 2.7 3.7 1.8
45-49 2.5 2.3 2.7 2.6 2.5 2.7 2.2 1.5 2.9
50-54 2.7 2.4 3.1 2.7 2.4 3.1 2.8 2.2 3.4
55-59 2.6 2.3 2.8 2.6 2.3 2.8 2.5 2.4 2.6
60+ 6.0 7.7 4.4 6.1 7.9 4.3 5.6 6.6 4.6
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Total HH
9,857 4,835 5,022 8,358 4,098 4,260 1,499 737 762
Members
Sex Ratio 1,039 1,040 1,034
The demographic trend across the three Districts was very similar with 24-25% being children
below age of 5 years, 6% being elderly (beyond 60 years) and around 47-48% being in the
working age group of 15 – 59 years.
2.2 Socio-economic profile of household
This section looks at the profile of sample households in terms of type of familial structure, its
economic status as per Government of India nomenclature specified through the type of
ration card ownership, religious affinity, caste, and the number of household members.
JAHANABAD NALANDA SHEKIPURA Total

Type of Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
House % % % % % % % % % % % %
JOINT 55.8 52.7 55.6 60.2 57.8 59.9 48.1 44.2 47.5 54.8 50.8 54.3
NUCLEAR 44.2 47.3 44.4 39.8 42.2 40.1 51.9 55.8 52.5 45.2 49.2 45.7
Going by the national trend, three in five households in India are nuclear. Nuclear households
are defined as households that are composed of a married couple or a man or a woman living
alone or with married unmarried children (biological, adopted or fostered), with or without
unrelated individuals. According to the survey findings in NIPI Baseline Household survey,
54.3 percent of all the households live in joint families while 45.7 percent are nuclear families.
This trend is somewhat different from the national level information as a higher proportion of
our sample population is from the rural areas and it has been found that proportion of nuclear
households is less in rural areas than the urban areas.

Jehanabad Nalanda Sheikhpura All NIPI Districts

RURAL URBAN RURAL URBAN RURAL URBAN RURAL URBAN Total
% % % % % % % % %
Religion
Hindu 94.2 75.7 97.8 85.9 95.6 86.5 95.8 84.6 94.5
Muslim 5.7 24.3 1.8 14.1 4.4 13.5 4.0 15.4 5.4
Christian 0.1 0.3 0.1 0.2 0.2
Caste
SC 31.6 35.1 31.2 35.7 33.2 26.5 32.0 31.4 31.9
ST 1.9 2.7 1.8 0.5 2.6 0.9 2.1 1.1 2.0
OBC 56.0 59.5 55.3 54.1 49.9 62.8 53.8 58.9 54.4
General 10.6 2.7 11.7 9.7 14.3 9.8 12.1 8.6 11.7
Average number of usual members
Mean 7 6.8 7.75 7.12 7.58 6.97 7.44 7 7.38
Total
1224 74 1147 185 1102 215 3473 474 3947
HH
Overwhelmingly, the sample households were of Hindu faith, with a 5% share of Muslim
households. Other Backward Communities (OBC) and Schedule Caste (SC) were the
dominant social groups accounting for 54% and 32% of the households respectively. The
third major social group was general or forward castes with schedule tribes being a relative
minority in these Districts.
Table 2.7: Household family size by religion, NIPI-08

RURAL URBAN RURAL URBAN RURAL URBAN RURAL URBAN
Religion N Mean N Mean N Mean N Mean N Mean N Mean N Mean N Mean
Hindu 1153 7.0 56 7.1 1122 7.8 159 7.2 1053 7.6 186 6.9 3328 7.4 401 7.1
Muslim 70 7.1 18 5.9 21 7.3 26 6.7 48 8.3 29 7.3 139 7.5 73 6.8
Christian 1 9.0 4 6.0 1 8.0 6 6.8
Total 1224 7.0 74 6.8 1147 7.8 185 7.1 1102 7.6 215 7.0 3473 7.4 474 7.0
The average household size varied between 5.9 to 9..
2.3 Education level of the household population
The level of educational attainment of different members of the households (starting with the age of 5
years) has been analysed on the basis of location of the PSU and gender of the household member.
The findings are presented below.

Table 2.9: Education attainment by location of PSU in terms of years of schooling, NIPI-08
Urba Urba Urba Urba
Rural Total Rural Total Rural Total Rural Total
Years of n n n n
schooling % % % % % % % % % % % %
No
48.7 46.7 48.6 53.3 48.3 52.7 57.7 44.3 55.7 53.2 46.3 52.4
schooling
<1 or not
0.7 0.5 0.7 0.8 1.4 0.9 1.5 2.1 1.6 1.0 1.6 1.1
attended
1 to 4 9.8 12.0 9.9 10.5 11.2 10.6 12.3 11.9 12.2 10.8 11.7 10.9
5 to 7 10.8 6.8 10.6 10.2 9.2 10.1 9.2 12.7 9.8 10.1 10.5 10.2
8 to 9 8.9 12.6 9.1 8.5 6.9 8.3 5.3 7.7 5.7 7.6 8.1 7.6
10 to 11 13.9 10.4 13.7 10.3 9.5 10.2 8.7 9.5 8.9 11.0 9.7 10.9
12 or
7.2 10.9 7.4 6.3 13.4 7.2 5.2 11.6 6.2 6.3 12.2 6.9
More
100. 100. 100. 100. 100. 100.
Total 100.0 100.0 100.0 100.0 100.0 100
0 0 0 0 0 0
Total #
of 6,47 6,84 6,77 7,77 6,30 7,42 19,55 22,04
366 996 1,123 2,485
member 8 4 8 4 0 3 6 1
s
Above table depicts the district-wise rural – urban educational stature of the head of the
households. A large proportion of the population continues to have little or no education at all
and this proportion is much higher in the rural areas than the urban areas. About 52 percent
of all the households is not endowed with the light of education, the proportion being 46.3
percent for urban areas and 53.2 percent for rural areas. Around 11 percent of the total
households have studied up to primary level, 8 percent have done middle level schooling
while another 11 percent have studied up to secondary level. Only 7 percent of the
households have gone for higher education, the proportion of urban households being twice
than the rural households in this case. Among the three districts, the percentage of illiterates
is found to be most in Sheikhpura compared to the other two districts of Jahanabad and
Nalanda.
2.4 Household characteristics

This section elucidates the nature of the sampled households by issues pertaining to
environmental sanitation and hygiene. The parameters considered include type of housing,
sources of drinking water, method of storage of drinking water, water treatment, and
availability of toilet facility, nature of fuel used for cooking, availability of a chimney in the
kitchen and whether the house has a separate room for cooking as against cooking being
done within the confines of the residential quarters.
Table 2.10: Type of house, NIPI-08
Kaccha Semi pucca Pucca Total Total # of HH
Rural 35.7 52.0 12.3 100 1224
Jehanabad Urban 16.2 54.1 29.7 100 74
Total 34.6 52.1 13.3 100 1298
Rural 26.5 51.5 22.0 100 1147
Nalanda Urban 13.0 43.2 43.8 100 185
Total 24.6 50.4 25.0 100 1332
Rural 42.3 34.2 23.5 100 1102
Sheikhpura Urban 20.9 32.1 47.0 100 215
Total 38.8 33.9 27.3 100 1317
Rural 34.8 46.2 19.1 100 3473
NIPI Baseline
Urban 17.1 39.9 43.0 100 474
Survey
Total 32.6 45.4 21.9 100 3947

Rural 47.1 41.6 11.3 100 42828

DLHS 3 Urban 19.5 31.4 49.1 100 4311
Total 44.6 40.6 14.8 100 47139
Throwing light on the type of housing, as per DLHS 3, about 45% people were living in
Kaccha houses while NIPI survey reports a considerably less percentage (33%) of people
living in kaccha houses. About 45 percent people reside in semi-pucca houses while the rest
21.9 percent live in pucca houses. It is noted here that proportion of households residing in
pucca houses is much more (43.0%) in the urban region as compared to its rural counterpart
(19.1%). The district-wise rural-urban distribution of the type of housing of the sampled
households is depicted in Table 2.7.
Table 2.11: Source of drinking water, NIPI-08
Jahanabad Nalanda Sheikhpura Bihar

Rur Urba Tota Rur Urba Tota Rur Urba Tota Rur Urba Tota
al n l al n l al n l al n l
Source % % % % % % % % % % % %
Piped into
0.2 2.7 0.3 1.8 9.2 2.9 0.4 5.1 1.1 0.8 6.3 1.4
dwelling
Piped to
0.6 1.4 0.6 1.2 5.4 1.8 3.6 2.8 3.5 1.8 3.6 2.0
yard
Public tap 4.3 0 4.1 0.8 4.9 1.4 2.8 6.5 3.4 2.7 4.9 2.9
Tube well 91.3 89.2 91.1 87.2 64.3 84.0 86.4 66.5 83.1 88.4 69.2 86.1
Protected
1.2 2.7 1.3 0.9 1.6 1.0 0.8 5.1 1.5 1.0 3.4 1.3
well
Unprotect
2.2 4.1 2.3 7.6 14.1 8.5 5.7 13.5 7.0 5.1 12.2 6.0
ed well
Protected
0 0 0 0.3 0 0.3 0 0 0 0.1 0 0.1
spring
Unprotect
0.2 0 0.2 0.1 0 0.1 0.1 0.5 0.2 0.1 0.2 0.1
ed spring
Rain water 0 0 0 0 0.5 0.1 0 0 0 0 0.2 0.0
Surface
0.1 0 0.1 0 0 0 0.2 0 0.2 0.1 0 0.1
water
Other 0 0 0 0.1 0 0.1 0 0 0 0.0 0 0.0
Total 100. 100. 100. 100. 100. 100. 100. 100.
100.0 100.0 100.0 100.0
0 0 0 0 0 0 0 0
Total # of 1,22 1,29 1,14 1,33 1,10 1,31 3,47 3,94
74 185 215 474
HH 4 8 7 2 2 7 3 7
Respondents to the household questionnaire were asked for the main source of drinking
water for the household and their usual method of storage. Table 2.11 presents the percent
distribution of households by source of drinking water, both in the rural and urban regions in
the three districts of Jehanabad, Nalanda and Sheikhpura. It is seen that majority of the
households (86.1 percent) drink water from the Tube Well, while around 6 percent
households have their source of drinking water from unprotected wells. The percentage of
urban population drinking water from unprotected wells is comparatively higher at 12.2
percent.

Table 2.12: Drinking water storage and filtration practices, NIPI-08

Jehanabad Nalanda Sheikhpura Total
Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Usual method of storage of drinking water
Covered
4.8 16.2 5.5 18.6 14.1 17.9 56.6 66.5 58.2 25.8 38.2 27.3
bucket
Covered
6.6 2.7 6.4 8.2 10.8 8.6 6.1 0.5 5.2 7.0 4.9 6.7
earthen pot
Open container 1.9 4.1 2.0 7.9 11.9 8.5 0.6 0.5 0.6 3.5 5.5 3.7
Open bucket 32.5 21.6 31.9 18.5 17.8 18.4 17.9 13.0 17.1 23.2 16.2 22.4
Don't store 53.1 55.4 53.2 44.4 42.2 44.1 16.9 19.5 17.3 38.7 34.0 38.2
Other 1.1 0 1.0 2.4 3.2 2.6 1.9 0 1.6 1.8 1.3 1.7
Method adopted to make water safer to drink
Boil 1.0 2.7 1.1 0.7 3.8 1.1 3.1 6.5 3.6 1.6 4.9 2.0
Use Alum 0.2 0 0.2 0.1 1.6 0.3 0 0 0 0.1 0.6 0.2
Add Bleach /
0 0 0 0.3 0 0.2 0.3 0.5 0.3 0.2 0.2 0.2
Chlorine tables
Strain Through
0.1 0 0.1 0 0 0 0.4 1.9 0.6 0.1 0.8 0.2
a Cloth
Use Water
Filter ( Ceramic
/ Sand 0.1 1.4 0.2 0.2 0.5 0.2 0.4 0 0.3 0.2 0.4 0.2
/Composite
/etc. )
Use Electronic
0.1 0 0.1 0 0 0 0 0 0 0.0 0 0.0
Purifier
Let it Stand
and Settle 0.1 0 0.1 1.2 0.5 1.1 0 0 0 0.4 0.2 0.4
Other 0.3 1.4 0.4 0.8 0 0.7 0 0 0 0.4 0.2 0.4
Respondents were also asked about the storage practices used by the households for storing
drinking water. 38.2 percent of all the households did not care to store the drinking water
while 27.3 percent stored water in covered buckets, 6.7 percent used covered earthen pots
for storage purposes, while around 25 percent kept water in open containers. It is seen that
urban households are more likely to storing water in covered buckets than the rural
households. Table 2.12 shows the percent distribution of rural and urban households using
different storage practices.
All the households were asked whether they treat their drinking water before actually
consuming it. The treatment of water ranges from boiling it to using alum, adding bleach /
chlorine tablets, straining the water through a cloth, using water filter or electronic purifiers.
Urban households are somewhat more likely than rural households to treating drinking water.
Boiling and straining water through a cloth are the most commonly used methods for treating
drinking water (Table 2.12).

Table 2.13: Sanitation facility, NIPI-08
JAHANABAD NALANDA SHEIKHPURA Total

% % % % % % % % % % % %
Flush to
piped
1.3 5.4 1.5 0.5 0.5 0.5 1.5 3.7 1.8 1.1 2.7 1.3
sewer
system
Flush to
septic tank 9.9 21.6 10.6 12.9 40.0 16.7 9.6 35.3 13.8 10.8 35.0 13.7
Flush to Pit
1.5 4.1 1.6 2.3 7.6 3.0 1.7 4.7 2.2 1.8 5.7 2.3
latrine
Flush to
somewhere 0.2 0 0.2 0.8 1.1 0.8 0.3 0.5 0.3 0.4 0.6 0.4
else
Flush Don't
0.2 0 0.2 1.3 2.7 1.5 0 0.5 0.1 0.5 1.3 0.6
Know
Ventilated
improved 0.7 0 0.7 0.1 0.5 0.2 0.1 0 0.1 0.3 0.2 0.3
Pit
Pit latrine
2.2 1.4 2.2 2.0 2.7 2.1 2.1 4.7 2.5 2.1 3.4 2.3
with slab
Pit latrine
without 0.8 0 0.8 1.2 2.7 1.4 0.5 1.4 0.7 0.9 1.7 1.0
slab
Twin Pit 0.1 0 0.1 0.1 0 0.1 0.1 0.9 0.2 0.1 0.4 0.1
Dry toilet 0.5 12.2 1.2 0.5 1.6 0.7 0 0.5 0.1 0.3 2.7 0.6
No facility 81.3 47.3 79.4 76.2 40.0 71.2 84.0 47.9 78.1 80.5 44.7 76.2
Public
facility 1.4 8.1 1.8 1.1 0.5 1.1 0.1 0 0.1 0.9 1.5 1.0
OTHER 0 0 0 0.9 0 0.8 0 0 0 0.3 0 0.3
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total No.
of HH 1,224 74 1,298 1,147 185 1,332 1,102 215 1,317 3,473 474 3,947
According to DLHS-3 nearly 83.1% of households had reported that they had no access to toilet facility.
NIPI baseline survey of 3 districts reveals that 76.2% of the households had no access to a toilet
facility, implying that open defecation was the prevalent practice in these three Districts (NIPI 08).
Rural areas share a higher percentage of households without toilet facility (80.5%) than the
urban areas (44.7%). Overall, 22 percent of households have improved toilet facilities that are
not shared by anyone else. Improved toilet facilities include toilet facilities with a flush or a
pour flush connected to sewer system, septic tank or pit latrine, a ventilated improved pit
latrine, a pit latrine with slab or without slab. If a household has any one of these toilet
facilities but needs to share them with other households, that household is considered not to
have an improved toilet facility. Urban households are three times as likely as rural
households having access to improved toilet facilities. The most commonly used toilet facility
both in the rural and urban areas is the system that flushes to a septic tank.

Table 2.14: Cooking environment, NIPI-08

Rura Urba Rura Urba Rura Urba Rura Urba
l n Total l n Total l n Total l n Total
% % % % % % % % % % % %
Fuel used for cooking
Electricity 0 0 0 0 0 0 0.1 0 0.1 0.0 0 0.0
LPG 2.0 18.9 2.9 1.7 23.8 4.8 1.5 20.9 4.6 1.7 21.7 4.1
Biogas 0.2 0 0.2 0.2 1.1 0.3 0.2 0 0.2 0.2 0.4 0.2
Kerosene 0.1 0 0.1 0.1 1.6 0.3 0 0.5 0.1 0.1 0.8 0.2
Coal 1.2 17.6 2.2 0.6 7.6 1.6 0.5 22.3 4.0 0.8 15.8 2.6
Charcoal 0.5 0 0.5 0.2 1.1 0.3 0 0.5 0.1 0.2 0.6 0.3
Wood 13.4 9.5 13.2 11.4 7.6 10.9 9.3 10.2 9.4 11.4 9.1 11.1
Dung 68.8 48.6 67.6 65.4 49.7 63.2 57.7 35.8 54.1 64.2 43.2 61.6
Agricultura
13.6 5.4 13.2 19.5 7.6 17.9 30.0 9.3 26.7 20.8 8.0 19.3
l wastes
Other 0.2 0 0.2 0.9 0 0.8 0.8 0.5 0.8 0.6 0.2 0.6
Cooking done under chimney
YES 1.2 1.4 1.2 0.8 4.3 1.3 0.6 0.5 0.6 0.9 2.1 1.0
NO 98.8 98.6 98.8 99.2 95.7 98.7 99.4 99.5 99.4 99.1 97.9 99.0
Separate room used as a kitchen
YES 12.6 20.3 13.0 12.0 34.1 15.1 24.8 31.6 25.9 16.3 30.8 18.0
NO 87.4 79.7 87.0 88.0 65.9 84.9 75.2 68.4 74.1 83.7 69.2 82.0
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total No. 1,29 1,33 1,31 3,94
of HH 1,224 74 1,147 185 1,102 215 3,473 474
8 2 7 7
To study the potential for exposure to cooking smoke from solid fuels, NIPI Baseline
household survey collected information on the type of fuel used by the household for cooking
purposes, the place where the cooking is done and whether cooking is done under a chimney
or not. According to survey findings, around 61.6 percent households use dung cakes for
cooking purposes. The proportion of rural households using dung is much more at 64.2
percent compared to 43.2 percent of urban households. A majority of urban households
(21.7%) use LPG for cooking purposes compared to just 1.7 percent of rural households
using LPG. A good proportion of urban households also use coal in the open (15.8%), thus
exposing them to severe health hazards. Few households are also found to use Biogas,
kerosene oil, wood or agricultural wastes for cooking their food (Table 2.14).
Overall, these data show the vast majority of rural households using solid fuels for cooking. In
both rural and urban areas, 99 in 100 households cook on an open fire, without diverting the
smoke through a chimney. Another important aspect that requires mention here is the
provision of a separate kitchen for cooking. 82 percent of the households do not have a
separate kitchen for cooking purposes, leading to an unhygienic and unhealthy atmosphere.
However, 30.8 percent urban households have a separate kitchen as compared to 16.3
percent of rural households, again spelling out the disparity between rural and urban
standards of living (Table 2.14).
2.5 Household Possessions
This section primarily deals with ownership status of the place of residence, main occupation of earning
members, ownership of agricultural land, allied information on financial inclusion, viz. bank and health
insurance access and finally, household level asset ownership.
Table 2.15: Ownership of immovable assets, NIPI-08

% % % % % % % % % % % %
House owned or rented
Own 97.4 85.1 96.7 98.2 86.5 96.5 98.2 89.3 96.7 97.9 87.6 96.7
Rented 2.6 14.9 3.3 1.8 13.5 3.5 1.8 10.7 3.3 2.1 12.4 3.3
Ownership of agricultural land
YES 43.1 21.6 41.9 38.8 18.9 36.0 45.3 13.5 40.1 42.4 16.9 39.3
NO 56.9 78.4 58.1 61.2 81.1 64.0 54.7 86.5 59.9 57.6 83.1 60.7
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total
no. of 1,224 74 1,298 1,147 185 1,332 1,102 215 1,317 3,473 474 3,947
HH
Table 2.15 presents information on the ownership of the household. A vast proportion of
households, around 96.7 percent, own a house and this percentage is higher in rural areas
(97.9%) than the urban counterparts (87.6%). The proportion of households dwelling at
rented houses is much higher in the urban areas (12.4%) than the rural areas (2.1%).
Information on ownership of agricultural land by households is given in Table 2.15. Around

39.3 percent of all the households own agricultural land. Actually, these households depend
on the parcels of land for their living. However, the proportion of rural households owning
agricultural land is much more at 42.4 percent than the urban households, 16.9 percent of
who only have their own agricultural land.
Table 2.16: Main source of household income, NIPI-08

JEHANABAD NALANDA SHEIKHPURA Total
Rura Urba Tota Rura Urba Tota Rura Urba Tota Rura Urba Tota
l n l l n l l n l l n l
% % % % % % % % % % % %
Farming 24.4 10.8 23.7 27.4 7.6 24.6 29.4 5.6 25.5 27.0 7.2 24.6
Agriculture
labor 44.0 16.2 42.4 40.3 22.2 37.8 26.6 7.9 23.5 37.2 14.8 34.5
Livestock 0.7 4.1 0.8 0.7 1.6 0.8 0.9 0.5 0.8 0.7 1.5 0.8
Mining 0.7 0 0.6 0.3 0 0.2 6.9 5.6 6.7 2.5 2.5 2.5
Manufacturin
3.3 18.9 4.2 0.2 0 0.2 0.3 0.9 0.4 1.3 3.4 1.6
g
Construction 1.0 0 0.9 0.2 0 0.2 0.2 0 0.2 0.5 0 0.4
Petty trader 2.4 17.6 3.2 6.7 3.2 6.2 3.2 11.6 4.6 4.1 9.3 4.7
Artisan 2.0 2.7 2.0 1.3 0.5 1.2 0.5 0.9 0.5 1.3 1.1 1.2
Business 5.1 8.1 5.3 3.7 18.4 5.8 3.3 31.6 7.9 4.1 22.8 6.3
Service 7.5 16.2 8.0 5.3 16.2 6.8 6.4 10.2 7.0 6.4 13.5 7.3
Other 9.0 5.4 8.8 13.9 30.3 16.2 22.5 25.1 22.9 14.9 24.1 16.0
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total No. of 1,22 1,29 1,14 1,33 1,10 1,31 3,47 3,94
HH 74 185 215 474
4 8 7 2 2 7 3 7
The occupational profile of the households surveyed in the three districts of Jehanabad,
Nalanda and Sheikhpura in the state of Bihar varies from agriculture – related activities like
farming, livestock rearing to manufacturing, construction – related activities, business, service

etc. A majority of the households (around 60%) depend on agriculture – related activities for
earning their livelihood, the proportion being much higher in the rural areas. The three
districts under focus show very little variation in terms of occupational profile of the
households, majority of them being engaged in the agricultural sector. Around 16.0 percent of
the sampled households are engaged in service in various Government as well as private
sectors, with the percentage of urban households being more in this case (24.1%). Around
4.1 percent of rural households base their living as artisans, compared to 22.8 percent for the
urban areas. A handful of population makes their living working in the mining sector or doing
petty business activities. Table 2.16 gives an insight into the household occupation of the
surveyed population.
Household level asset ownership, instead of being investigated at an individual asset level,
has been taken together to construct a household wealth index (HWI). We have considered
the data records of all the households in the state. The selected assets/ indicators for the
construction of index were: ( Annexure A1)
1. Whether using toilet used

2. Type of fuel used for cooking
3. Ownership of Mattress
4. Ownership of Mosquito net
5. Ownership of Chair
6. Ownership of Table
7. Ownership of Pressure cooker
8. Ownership of Radio/ transistor
9. Ownership of Watch or clock
10. Ownership of Sewing machine
11. Ownership of Electricity
12. Ownership of Electric fan
13. Ownership of Television
14. Ownership of Refrigerator
15. Ownership of Computer
16. Ownership of Mobile phone
17. Ownership of Land phone
18. Ownership of Water pump
19. Ownership of Thresher
20. Ownership of Tractor
21. Ownership of Car/ Jeep
22. Ownership of Two wheeler/ Four wheeler
23. Ownership of Bus/ truck
24. Ownership of Cot/ bed
25. Ownership of Bicycle
26. Ownership of animal drawn chart
Calculation procedure
The first 2 indicators are derived from collected information from the available information as
follows:

a) Toilet facility used – If a household is having an improved toilet facilities then it is

given a score of 1, otherwise it is given a 0 score.
b) Fuel used for cooking – If a household is using modern forms of fuel for cooking
purposes (electricity, LPG, biogas and kerosene) then the household is awarded a
score of 1, otherwise it is given a 0 score.
The next 24 indicators were considered directly from the ownership. If a household owned
one particular asset, then it was given a score of 1 for that asset, otherwise 0.
This procedure first standardized the indicator variables (calculating z-scores); then the factor
coefficient scores (factor loadings) were calculated; and finally, for each household, the
indicator values were multiplied by the loadings and summed to produce the household‟s
index value. In this process, we used only factors of first component. The resulting sum is
itself a standardized score with a mean of zero and a standard deviation of one.
Using these 26 reconstructed variables we have carried out Principal component analysis. In
the process of PCA we have dropped 2 variables due to their low or negative effect on index.
Based on the remaining 24 variables, in the Principal component analysis the components
with antigen values greater than 1 are explaining a variation of around 53% in the data, with
the first component explaining 27% of variation.
Wealth index quartiles Percent of women

Quintile 1 53.0
Quintile 2 14.6
Quintile 3 11.8
Quintile 4 10.7
Quintile 5 9.9
Total 100.0
The proportion of households belonging to each quintile, across urban and rural areas of the three
Districts is as follows:
Table 2.16a: Household Wealth Index, NIPI-08
Wealth JEHANABAD NALANDA SHEIKHPURA Total

Index
% % % % % % % % % % % %
Lowest 55.0 29.7 53.5 50.7 37.8 48.9 60.7 34.4 56.4 55.4 35.0 53.0
Second 13.6 10.8 13.5 16.3 10.3 15.5 15.2 13.5 14.9 15.0 11.8 14.6
Middle 12.3 18.9 12.7 13.9 8.1 13.1 8.5 14.9 9.6 11.6 12.9 11.8
Fourth 10.7 17.6 11.1 10.3 15.7 11.0 8.8 16.3 10.0 10.0 16.2 10.7
Highest 8.3 23.0 9.2 8.8 28.1 11.5 6.8 20.9 9.1 8.0 24.1 9.9
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total No.
of HH 1,224 74 1,298 1,147 185 1,332 1,102 215 1,317 3,473 474 3,947
Table 2.16 presents the population separated into wealth quintiles by rural – urban residence.
53 percent of the population is in the lowest wealth quintile while only 9.9 percent of the
population is in the highest wealth quintile. The distribution of the population across wealth
quintiles shows considerable variation across rural and urban areas. While 35.0 percent of
the urban households is found to be in the lowest wealth quintile, the corresponding figure for
the rural households stand at 55.4 percent. Similarly, while only 8 percent of the rural
households lie in the highest wealth quintile, the figure is almost three times for the urban
households, that is, 24.1 percent. The second, middle and the fourth wealth quintiles are
more or less evenly distributed across the rural and urban populations.
Table 2.17: Financial Access, NIPI-08

% % % % % % % % % % % %
Member having bank account
YES 22.4 21.6 22.3 27.7 38.9 29.3 15.5 27.4 17.5 22.0 31.0 23.1
NO 74.9 78.4 75.1 69.6 55.7 67.6 84.1 70.7 81.9 76.1 66.0 74.9
DK 2.7 0 2.5 2.7 5.4 3.1 0.4 1.9 0.6 2.0 3.0 2.1
Any member covered with insurance
YES 4.0 4.1 4.0 2.3 8.1 3.1 1.1 2.8 1.4 2.5 5.1 2.8
NO 91.7 95.9 92.0 96.5 88.1 95.3 98.3 97.2 98.1 95.4 93.5 95.2
DK 4.2 0 4.0 1.2 3.8 1.6 0.6 0 0.5 2.1 1.5 2.0
Total 100 100 100 100 100 100 100 100 100 100 100 100
Total
No. 1,224 74 1,298 1,147 185 1,332 1,102 215 1,317 3,473 474 3,947
of HH
In India, the overall banking penetration as on 2007 was 44%. The situation in the study
Districts was even worse with only 23% of households had any member with a bank account.
Bank penetration was relatively higher in Nalanda District as compared to the others.
Only a very small proportion of households are covered under a health insurance scheme
(2.8%). The percentage is slightly higher in the urban areas (5.1%) than the rural households
(2.5%). Generally, any member of the households employed with the Central Government,
are covered under Central Government Health Insurance Scheme. A small proportion of
households are also covered under Employees State Insurance Scheme.
2.6 Funds Allocation and Utilisation
Details regarding funds allocated and utilised for different activities under NRHM are
presented.
Till December 2007, in Jehanabad, about four fifth of the money disbursed to them was
spent, while in Nalanda about one fifth of the funds allocated were utilised. Thus complete
utilisation of the funds allocated or received is an area that needs attention (Annexure 1).

Chapter 3
Characteristics of Survey Respondents
3.1 Background Characteristics
This section provides details of the background characteristic of the eligible women (currently
married women, who delivered babies in last two years, aged 15-49) who were part of the
survey process. The section looks at their demographic and social characteristics in terms of
age, religion, ethnicity, number of years of schooling and education of husband.
Table 3.1: Age distribution of women respondents, NIPI-08
Age Group DISTRICT Total

Jehanabad Nalanda Sheikhpura
% % % %
15-18 4.0 2.1 3.5 3.2
19-21 18.9 15.2 17.7 17.3
22-25 33.7 36.5 33.3 34.5
26-30 29.2 29.7 29.6 29.5
31-40 13.7 15.3 14.7 14.6
41-49 0.5 1.1 1.2 0.9
Number of women 1,263 1,308 1,272 3,843
The overall age distribution of female respondents shows that the percentage of respondents
is lowest (3 percent) in the age group of 15 – 18 years which gradually increases and peaks
at 35 percent in the age group of 22 – 25 years, followed by a decline to the lowest of one
percent in the age group of 41 – 49 years. A similar trend can be observed when a district
wise analysis is made. Both district wise and overall, the highest number of respondents (35
percent) belonged to the age group of 22 – 25 years with the next largest number (30
percent) belonging to the age group of 26 – 30 years.
Table 3.2: Distribution of women respondents by Religion and ethnicity, NIPI-08

Religion % % % %
Hindu 93.1 96.2 94.1 94.5
Muslim 6.8 3.5 5.8 5.4
Christian 0.1 0.3 0.1 0.2
Caste/Tribe
Schedule Caste 31.8 31.9 32.1 31.9
Schedule Tribe 1.9 1.6 2.4 2.0
OBC 56.2 55.1 52.0 54.4
None of them 10.1 11.4 13.5 11.7
Number of women 1,294 1,312 1,315 3,921
The eligible women interviewed were almost entirely of Hindu faith. They were mostly from
OBC families (54.4%) or SCTs (31.9%).

Table 3.3: Education status of women respondents, NIPI-08
DISTRICT

Education (Years of
schooling) % % % %
No Education 60.8 63.9 71.5 65.4
<5 2.9 2.8 3.1 2.9
6-7 11.2 9.1 7.5 9.2
8-9 9.3 8.4 5.8 7.8
10-11 12.4 10.7 7.9 10.3
12 & Above 3.6 5.1 4.3 4.3
Number of women
1,263 1,308 1,272 3,843
Out of the total women surveyed maximum i.e. 65 percent had no education at all.
Educational Attainment when analyzed by age of the respondent, it can be observed that
overall, in the age group of 19 – 21, among those who have attained some education,
majority (11.5 percent) completed standard eleven and another 11 percent completed
standard 7. In the age group of 41 – 49, as high as 97 percent of women attained no
education and the rest i.e. 3 percent attained education up to class twelve or more.
District wise analysis shows that in Sheikhpura, in the age group of 41 – 49 years 7 percent of
women have completed education upto class twelve or more whereas in the other two
districts Jahanabad and Nalanda, it is nil. Of the women who are not educated at all, status of
Sheikhpura, is not as good as the other two districts, where for every age group, except 41 –
49, there is a higher percentage of women having „no education‟.
As expected, overall urban women fare better than rural women in educational achievement
at almost all the levels. When seen district wise, rural Shekipura has more percentage (74%)
of illiterate women than the other two districts whereas in the urban area, it‟s Jahanabad.
The husbands were far more educated than their spouses with average literacy being 61%
(both read and write).
3.2 Exposure to mass media
The following section explores the extent to which the target population has access to various
mass media sources, the frequency of access and the types of programs that are preferred.
This section also looks at the extent to which maternal and child care messages have been
sourced from the media as well as inter personal contacts during social events, the level of
acceptability of these messages and the impact of the same on behaviour.
This section looks at media habits of the respondents in terms of readership, listenership and
viewership. It also looks at frequency of exposure by key background variables viz. age of
respondent, their completed level of education, and finally, by their family‟s position in the
Household Wealth Index.

Table 3.4: Media habits, NIPI-08
Jehanabad Nalanda Sheikhpura Bihar

Frequency
of reading
the 30.7 46.2 31.5 31.7 58.3 36.4 22.5 35.2 25.6 29.1 46.5 31.7
newspape
r
Frequenc
y of
12.6 30.9 13.5 15.2 44.6 19.3 10.5 40.5 15.3 12.8 40.7 16.1
watching
television
Listening
to the 18.7 22.1 18.8 13.3 18.5 14.1 11.9 20 13.2 14.8 19.7 15.4
radio
Go to 6.2 13.2 6.6 5.5 12.5 6.5 0.7 3.5 1.2 4.2 8.6 4.8
cinema
Overall, only 31.7% of the women who were literate read a newspaper. This was much lower
if one looks only at the rural areas. As far as radio listenership was concerned, the situation is
even worse, with only 15.4% women listening to the radio. This is very much in line with the
NRS 2006 findings.
Television viewership was also not encouraging with only 16% viewership..
It is quite clear that the culture of going out to watch a movie did not exist in any of the three
Districts, even in the urban areas. Hence, this does not present itself to be a suitable medium
to be used for communication purposes.
Table 3.5: Frequency of exposure, NIPI-08

Almost every At least once a Less than once
day week a week Not at all Total
Frequency of reading
newspaper and magazine
6.0 5.9 19.8 68.3 100.0
Frequency of listening to the
radio 6.0 3.5 5.9 84.6 100.0
Frequency of watching
television 8.0 3.4 4.7 83.9 100.0
We had already seen that even among literates, the practice of reading a newspaper or
magazine was limited with 68.3% claiming not to be doing so.
Radio listenership and TV viewership was again rather infrequent with 84.6% and 83.9%
stating they do not listen to the radio and watch TV at all respectively.
3.3 Employment Status
Out of the 1263 interviewed women in Jehanabad District, only 474 (or 37.5%) had any
independent source of income. In line with the age distribution of the sample in Jehanabad
District, most of these women were between 22 – 30 years of age (63%).

Similarly, out of the 1308 interviewed women in Nalanda District, only 406 (or 31%) had any
independent source of income. In line with the age distribution of the sample in Nalanda
Finally, out of the 1272 interviewed women in Sheikhpura District, only 624 (or 49%) had any
independent source of income. In line with the age distribution of the sample in Sambalpur
Table 3.6: Employment status of eligible women by background characteristics, NIPI-08

Any source of Any source Any source
Any source of income income of income of income
YES YES YES YES
Age Group N % N % N % N %
15-18 17 4 10 2 21 3 48 3
19-21 68 14 42 10 100 16 210 14
22-25 136 29 134 33 190 30 460 31
26-30 162 34 138 34 185 30 485 32
31-40 88 19 77 19 121 19 286 19
41-49 3 1 5 1 7 1 15 1
Total # of earning
474 100 406 100 624 100 1,504 100
women
Years of schooling
No education 375 79 314 77 533 85 1,222 81
Below 5 7 1 7 2 18 3 32 2
5-7 32 7 30 7 22 4 84 6
8-9 24 5 23 6 17 3 64 4
10-11 28 6 20 5 22 4 70 5
12 & above 8 2 12 3 12 2 32 2
Total # of earning
474 100 406 100 624 100 1,504 100
women
The second part of this table needs to be interpreted in conjunction with Table 3.3. It may be
recalled that overall, 65.4% of the responding women were illiterate. However, these 65.4%
accounted for 81% of the total number of earning women in the sample. This analysis clearly
implied that in Districts of Orissa, the propensity to work and earn is not a function of
educational attainment and qualifications, but rather other compulsions such as hunger and
poverty. (Annexure A7)
Table 3.7: Membership in SHGs and mahila mandals, NIPI-08
DISTRICT
Total
JAHANABAD NALANDA SHEIKPURA
N % N % N % N %
YES 20 2 17 1 15 1 52 1
NO 1,243 98 1,291 99 1,257 99 3,791 99
Total 1,263 100.0 1,308 100 1,272 100 3,843 100
The respondent women were also asked if they are a member of any SHG or Mahila Mandal.
It was observed that a negligible percentage of women, i.e 1.3 percent responded in the
affirmative.

3.4 Age at marriage and first cohabitation
In many parts of India, there exists the practice of the child bride staying at home for some
time (this could vary from a few days to a few years) before she moves into her husband‟s
residence. There can be many social-cultural reasons behind this but the more important
aspect of this issue is that the day she moves in with her husband, it is marked with festivities
known as „gauna‟. Health research has, for all practical purposes, always taken the date of
„gauna‟ to be of more relevance for cohabitation purposes than the actual date of marriage.
Taking 18 years to be the legal age of marriage for women, the proportion of women who had
actually cohabitated below that age in each of the three Districts is as follows. Table 3.8
shows the highest percentage of cohabitation of girls in Bihar stands between 15-18 years.
Table 3.8: Age at first cohabitation, NIPI-08

DISTRICT Total
JEHANABAD NALANDA SHEIKHPURA
Age at cohabitation (in Years) N % N % N % N %

15-18 999 79 1,038 79 981 77 3,018 79
19-21 209 17 225 17 209 16 643 17
22-25 42 3 38 3 67 5 147 4
26-30 12 1 7 1 14 1 33 1
31-40 1 0 1 0 2 0
Total 1,263 100 1,308 100 1,272 100 3,843 100
Across all three Districts, for the majority of woman, the age at first cohabitation seems to
have been 15-18 years, followed by 19-21 years.
The question now is, does age at first cohabitation get influenced by the education level of the
women concerned or the economic well-being of her household? The following table
elaborates.
Table 3.9: Relationship between age of first cohabitation and education and economic status of
respondent, NIPI-08
Education RURAL URBAN Total

of the
Respondent N Mean Median N Mean Median N Mean Median
No
2259 16.72 16 254 17.15 17 2513 16.76 16
Education
<5 100 16.88 17 11 17.09 17 111 16.9 17
6-7 313 16.98 17 42 17.55 18 355 17.05 17
8-9 256 17.18 17 45 18.36 18 301 17.35 17
10-11 340 17.96 18 56 18.59 18 396 18.05 18
12 & Above 123 19.08 19 44 20.23 20 167 19.38 19
Wealth
N Mean Median
Index
RURAL URBAN Total RURAL URBAN Total RURAL URBAN Total
Lowest 1873 162 2035 16.74 17.09 16.77 16 17 16
Second 503 52 555 16.84 17.81 16.93 17 18 17
Middle 396 59 455 17.31 17.92 17.38 17 18 17
Fourth 343 74 417 17.39 17.7 17.45 17 18 18
Highest 276 105 381 18.03 18.82 18.24 18 18 18

It is clear from the above table that more educated women tend to delay getting married and
thereby cohabitate at a more advance and mature age than those who are illiterate. In our
sample, the median age of cohabitation of illiterate women was 16 years while that of those
educated beyond the 10th standard was 18 – 19 years. Similarly, women belonging to a
higher economic profile married/cohabited 2 years later than those who were illiterate (18
years).

Chapter 4
Maternal Health
4.1 Preamble
Maternal health care is a concept that encompasses family planning, preconception,

prenatal, and postnatal care. Goals of preconception care can include providing education,
health promotion, screening and interventions for women of reproductive age to reduce risk
factors that might affect future pregnancies. Antenatal care is the comprehensive care that
women receive and provide for themselves throughout their pregnancy. Women who begin
prenatal care early in their pregnancies have better birth outcomes than women who receive
little or no care during their pregnancies. Postnatal care issues include recovery from
childbirth, concerns about newborn care, nutrition, breastfeeding, and family planning.
4.2 Antenatal Care
Antenatal care or ANC is the care of a pregnant woman during the time in the maternity cycle
that begins with conception and ends with the onset of labor. This particular section of this
chapter will deal with the issues of pregnancy registration, ANC provider, timing and number
of ANC received, components of ANC received, and awareness of pregnancy complications
by mothers and health problems and treatment seeking behaviour during last pregnancy.
4.2.1 Pregnancy registration and ANC provider
Table 4.1: Percentage of pregnancies registered vs. key background variables, NIPI-08
Jahanabad Nalanda Sheikhpura All district

Age Group % % % %
15-18 16.0 14.3 8.9 13.0
19-21 18.1 8.0 3.1 10.0
22-25 20.0 9.4 3.1 10.8
26-30 17.6 7.5 2.1 9.0
31-40 20.2 7.5 3.2 10.0
41-49 50.0 6.7 6.7 13.9
Years of schooling
No Education 18.5 8.1 2.6 9.3
<5 27.8 11.1 0.0 12.6
5-7 24.8 7.6 1.1 12.7
8-9 15.4 8.2 8.1 11.0
10-11 14.8 12.1 6.0 11.6
12 & Above 24.4 4.5 3.6 9.6
HH wealth index
Lowest 15.6 7.9 3.1 8.8
Second 27.8 7.1 2.1 11.7
Middle 20.1 13.3 3.3 13.0
Fourth 21.8 5.5 3.9 10.6
Highest 20.7 9.4 3.4 11.0
Total 1,263 1,308 1,272 3843
Pregnancy registration is a major issue in Bihar with only one tenth registrations. It was
lowest in Sheikhpura where only 3% pregnancies was registered with any health facilities.

Table 4.2: Received ANC Card, NIPI-08
Received Jehanabad Nalanda Sheikhpura All districts

ANC card
N % N % N % N %
Yes seen 76 31.8 12 10.9 12 30.8 100 25.8
Yes but not
116 48.5 59 53.6 21 53.8 196 50.5
seen
76.3% of the interviewed women had claimed that they had an ANC card while this could be
physically verified for only 25.8% of them. Availability of the ANC card was lowest in Nalanda
District..
Table 4.3: Incidence of receiving ANC during last pregnancy, NIPI-08
ANC Jehanabad Nalanda Sheikhpura All Districts

received
% % % % % % % % % % % %
Yes, went
to health 38.0 23.5 37.2 43.3 55.4 45.0 31.8 36.5 32.5 37.8 42.3 38.3
facility
Yes,
health
personnel 2.4 0 2.3 2.3 0.5 2.1 3.4 2.0 3.1 2.7 1.1 2.5
visited
home
No 59.6 76.5 60.5 54.4 44.0 52.9 64.8 61.5 64.3 59.5 56.6 59.2
Total N 1192 68 1260 1124 184 1308 1072 200 1,272 3388 452 3840
NFHS trends of antenatal care in Bihar are more or less stagnant in terms of ANC visits. It
has marginally improved from 15.9 per cent during NFHS-2 to 16.9 per cent in NFHS-3 while
at the all-India level; it improved from 44 per cent to 51 per cent during the same period. NIPI
baseline shows the increase in ANC with 38.3 % women visiting health facility. In Nalanda 45
percent women visited any health facility for ANC compared to about 38 and 33 percent
women visited health facility in Jahandbad and Sheikhpura respectively. Only 2-3 percent
women reported that heath personnel visited their home for ANC. Hence, most (about 60%)
women did not have contact with any health facility nor any health personnel visited their
home during their pregnancy. Visit to health facility for antenatal check-up increases with the
increase in education and wealth index and decreases with increase in age and number of
living children. It is interesting to note that the visit of health personnel to home for ANC
decreases with the increase in education of mother and wealth index of household.
(Annexure)

Table 4.4: Place of ANC, NIPI-08
District
All Districts
Place of ANC (Multiple response) % % % %
Government/ municipal hospital 7.9 17.8 15.2 13.9
CHC/ Rural hospital 1.5 0.8 0.7 1.0
PHC 21.3 9.8 15.2 15
Subcentre/ ANM 14.7 4.9 14.3 10.7
AWC/AWW 8.3 3.4 4.6 5.3
NGO/Trust hospital / clinic
0.4 0.5 0.2 0.4
Govt. AYUSH hospital / clinic 1.7 0.5 0.8
Private AYUSH hospital / clinic 1.5 6.1 10.1 5.8
Private hospital / clinic 44.8 56 42.8 48.7
Total No. of women 469 589 414 1,472
It is important to note that a large number of women (54.9%) in the study districts of Bihar go
to private health facilities (Pvt. Hospital/Clinic, Pvt. AYUSH Hospital/Clinic, NGO/Trust
Hospital/Clinic) for ANC. In Nalanda, 62.6 percent women gone to private hospital/clinic for
ANC followed by Sheikhpura (53.1%) and Jahanabad (46.7%). The other preferred health
facilities for women for ANC are PHC (15%), Govt. District Hospital (14%) and Sub Centre
(10.7%).
“Yeh log sarkari suvidha par vishwas nahi karte hain. Kuchh log private suvidha mein hi
jaate hain” (These people do not trust government facility. Some people go to private
facility only). -- Kumari Archana, ASHA, Tihri Village, Nalanda
Table 4.5: ANC provider, NIPI-08
District
Total
Who provided ANC Jahanabad Nalanda Sheikhpura
(multiple response) % % % %
Government Doctor 20.1 19.2 17.2 18.9
ANM/ Nurse/ Midwife/LHV 35.1 38.5 44.7 39.2
ASHA 13.5 4.2 17.8 11.1
Private doctor 38.8 45.1 47.8 43.9
Dai 2.0 1.1 1.1 1.4
Anganwadi / ICDS worker 4.2 3.6 3.7 3.8
No one 81.9 85.9 66.5 79.0
Other 2.2 2.3 0.7 1.8
Total # of women 498 616 454 1,568
As it is clear from the above discussion that women in Bihar prefer private health facilities,
therefore ANC is mostly provided by private doctor (44%) and ANM/Nurse/Midwife is provided
ANC to nearly 39 percent women. About 19 percent women received ANC by a government
doctors. ASHAs were also providing some ANC related care in around 11 percent women.
This fact has also been supported by a number of ASHAs during qualitative discussions.
Organizational issues affecting program implementation
There was found a case for conflict of interest and overlapping of effort and time spent
between ASHA, ANM and AWW.

In respondent reports it was gathered that ANM was the „outsider‟ service provider visiting
once in a while and “locally” available service providers, particularly the AWW and the ASHA,
in particular were carrying out the NRHM work.
Case Study: District Jehanabad

 In Jehanabad District there was incidence of ANMs staying quite some distance from
their appointed villages
 Same ANM was in-charge of more than one sub-center
 Commuting was a major problem being faced by ANMs
 As the case in other Districts here too there was high workload by way of paper work
and maintenance of records
 The only major „health‟ work the ANMs could contribute in was immunization
Details of relationship between place of ANC/service providers and critical background

variables (age, education and economic status of respondents) have been provided in the
Annexure Tables.
4.1.2 Timing and number of ANC
NFHS trends of antenatal care in Bihar are more or less stagnant in terms of ANC visits. It
has marginally improved from 15.9 per cent during NFHS-2 to 16.9 per cent in NFHS-3 (Fig.
4.1) while at the all-India level; it improved from 44 per cent to 51 per cent during the same
period.
Figure 4.1: Percent of Mothers who received three or more ANC - NFHS
60
51
50 44
40
30
20 15.9 16.9
10
0
NFHS 2 NFHS 3
Bihar India
As per DLHS-3, in Jehanabad around 43.2% of the pregnant women had at least 3 antenatal
care visits during their last pregnancy follwed by Shiekhpura (30.6%) and Nalanda ((25.2%).

Table 4.6: Number of ANC received and timing of ANCs received, NIPI-08
Jehanabad Nalanda Sheikhpura BIHAR
Number
of ANC
visit and
timing % % % % % % % % % % % %
Recived
18.3 23.8 18.7 18.7 17.8 18.0 30.2 33.0 30.8 21.7 23.3 21.9
one ANC
Recived
41.1 31.0 40.4 42.5 38.1 41.6 29.2 22.0 27.3 38.3 32.2 37.1
two ANC
Recived
39.2 45.2 39.6 36.6 40.6 38.5 39.5 44.0 40.7 38.3 42.5 39.5
three ANC
Don't
1.5 1.4 2.1 3.5 1.9 1.1 0.9 1.1 1.6 2.0 1.5
Know
Number of months pregnant at first ANC
<4 42.7 51.2 42.4 47.6 48.5 48.7 55.4 60.6 56.2 48.0 52.4 48.9
4-5 31.5 28.6 31.5 22.3 26.7 23.1 26.0 23.9 25.3 26.6 26.3 26.4
6-7 20.1 16.7 20.7 21.1 18.3 19.7 11.4 11.0 11.7 18.1 15.9 17.7
8+ 3.5 2 3.4 6.5 4.0 6.2 6.1 3.7 5.7 5.3 3.5 5.2
Don't
2.1 1 2.0 2.5 2.5 2.3 1.1 0.9 1.1 2.0 1.8 1.9
Know
Total 482 16 498 511 105 616 377 77 454 1370 198 1,568
NIPI-08 baseline survey clearly reveals that about 40 percent women registered their
pregnancy before 4th month of pregnancy and 34 percent registered during 4th and 5th month
of pregnancy in the state. The timings of pregnancy registration in the districts are more or
less similar.
Nearly two-fifth (39.5%) received 3 ANCs, while one-fifth of the women (21.9%) received only
one ANC during last pregnancy. More women received 3 ANCs in urban areas (42.5%) as
compared to rural areas (38.3%). No significant variation between the study districts was
observed.
Educated women received more number of ANCs compared to less or not educated women
for their most recent pregnancy, and the likelihood of receiving 3ANC declines sharply with
number of living children and increases with the wealth index.
4.1.3 Components of Antenatal Care
This section looks at the types of ANC services received by pregnant women. It further
investigates whether the proportion of eligible women who had gone in for ANC had received
antenatal care as per the prescribed medical norms. This includes at least 2 TT injections and
90 day+ of IFA tablets consumptions.

Figure 4.2: Percent of Mothers who consumed IFA for 90 days and Received 2 or more TT
during Pregnancy
90
80 76.3
73.2
70
60
50
40
30
23.1
20
9.7
10
0
Consumed IFA for 90 days Received 2 or more TT injection
Bihar India
Consumption of IFA continuously for 90 days is considered vital for the survival of mothers
and children, but the figures for Bihar are very low (lower than India). 73.2% women in Bihar
received 2 or more TT injections during pregnancy at the time of NFHS-3 (2005-06).
According to DLHS-3, 83.5% women received at least one TT injection during last pregnancy
in Jehanabad followed by Sheikhpura (54.5%) and Nalanda (50%).
Table 4.7: Proportion of eligible women having received different components of ANC care,
NIPI-08
Jehanabad Nalanda Sheikhpura All Districts
% % % %
At least 2+ TT injection 91.6 89.1 89.2 89.9
Took IFA for 90 days+ 16.9 16.6 16.5 16.6
Overall, only 17 percent of women consumed IFA tablets at least for 3 months. Proportion of
women consumed IFA tablets in Jahanabad, Nalanda and Sheikhpura were similar; 16.9,
16.6 and 16.5 percent respectively. Consumption of IFA tablets for at least 3 months in urban
areas of the study districts varied from 17 percent in Jahanabad to 25 percent in Sheikhpura.
IFA tablets were mostly consumed by young (age 19-30) as well as by those mothers having
up to 4 living children.
Most (90%) of women received two or more tetanus toxoid (TT) injections during pregnancy
for their most recent birth. In urban areas of all the three study districts, 90 percent mothers
received 2 or more TT injections during their most recent birth. In rural areas, 2 or more TT
injections received by more than 85 percent women of all the three districts. It indicates the
awareness and selective preference of TT injections over ANC checkup.
“Mein kam-se-kam yeh sunishchit karti hoon ki garbhvati mahila ne garbhavastha ke dauraan TT ki
do suin lagwali hein” (I at-least make sure that the pregnant woman have received 2 doses of
tetanus toxoid during pregnancy).
Reena Kumari, ASHA, Sultani Village, Jahanabad

Discussions with ASHAs reveal that they give emphasis on 2 strokes of TT injection during
pregnancy and motivate women for institutional delivery. They also help pregnant women in her
registration, counsel them about diet, proper rest, ANC check-ups etc. but they feel that their prime
responsibility is 2 injections of tetanus toxoid and delivery in an institution.
Anganwadi Workers (AWW) also consider 2 doses of tetanus toxoid and providing advice about
nutrition supplementation or providing supplementary food to pregnant women are the two most
important tasks. They feel that other ANC related activities such as home visits, providing IFA
tablets, conducting periodic check-ups are not so important because few of them mentioned about
these activities when they were asked to tell about their pregnancy related activities.When asked
what all advises given by them to pregnant women, most of them mentioned two doses of TT, taking
nutritious food and proper rest. Few AWW mentioned about consumption of IFA tablets as an advice
to pregnant women.
ANMs reported to carry out a number of activities, majority of them mentioned ANC, TT injection,
IFA supplementation, delivery advice as the key activities for pregnant women. Conducting 3
check-ups during pregnancy, providing knowledge about danger signs of pregnancy etc. are not
among the important activates they are generally carrying out for pregnant women.
Table 4.8: Nature of ANC service received, NIPI-08

JEHANABAD NALANDA SHEIKHPURA BIHAR
ANC
component
s received
% % % % % % % % % % % %
Weight
32.6 31 32.1 52.6 53.5 53.7 43.8 55 46.7 43.1 49.1 44.8
measured
Blood
pressure 52.5 53.6 52.4 55.8 52 55.2 46.2 55 48.9 52 53.2 52.5
checked
Urine tested 48.5 60.7 48.8 47.8 52 48.9 57 68.8 61 50.6 58.5 52.4
Blood tested 40.5 47.6 40.4 42.1 51 44.3 52.5 70.6 57.3 44.4 55.7 46.8
Abdomen
examined 52.1 59.5 52.4 63 71.3 64.4 62.9 71.6 65.4 59.1 68.9 60.9
Delivery
date 33 33.3 32.7 30 38.6 31.8 34.2 56 39 32.2 42.3 34.2
declared
Received
advice on
care during 20.3 25 20.7 31.4 45 33.9 38.2 50.5 41.2 29.4 42.3 31.8
pregnancy
period
Received
advice on
20.7 17.9 20.9 28.5 27.7 28.9 18.8 23.9 20.5 23.1 24.6 23.9
danger signs
of pregnancy
Received
advice on 18 26.2 18.5 37.2 33.7 36.9 31.3 37.6 32.4 28.9 33.2 29.7
delivery care
Breast
feeding 11.4 6 11 20.3 18.8 20.1 30.5 25.7 30.6 20 18 20.3
advice
New born
9.5 7.1 9.2 13.1 18.8 14 19.9 18.3 20.5 13.7 16.2 14.3
care advice
Total 482 84 498 513 202 616 377 109 454 1372 395 1568
The above table provides details of the nature of ANC received by the pregnant mothers
during their last pregnancy. Among women who received antenatal care for their most recent
birth, 61 percent had an abdominal examination, 53 percent had their blood pressure
checked, and 45 percent had their weight measured. Blood and urine tests were conducted
for 47 and 52 percent of women, respectively. Expected date of delivery and advice for
delivery was given to nearly one-third of women. Women in urban areas receiving better
antenatal care services with compared to rural areas. District wise data on antenatal care
services shows that Sheikhpura has better ANC services in comparison to Nalanda and
Jahanabad.
During pregnancy, awareness about required diet, danger signs of pregnancy and delivery
care are very important for safe motherhood. NIPI baseline survey collected information
whether women received advice on diet, danger signs of pregnancy, delivery care, breast
feeding and newborn care. Fifty-eight percent received advice on diet, followed by delivery
care (29.7%), danger signs of pregnancy (23.9%), breast feeding (20.3%), and newborn care
(14.3%). In urban areas more women are likely to get advice on pregnancy, delivery and
newborn care than their rural counterpart. Data reveals that in Nalanda and Sheikhpura, more
women are receiving advice on these aspects than Jahanabad.
Common Advises given by AWW during pregnancy:
TT ki suyi le, samay par jaanch karwaye, poshtic aahaar le aur aaraam karen.(Take tetanus toxoid,
nutritious food, rest and timely go for check-up) AWW, Jahanabad, Bihar
Khane pine ke liye dhiyaan de aur do ghante aaraam Karen.(Take care of food and take rest for two
hours) AWW, Sheikhpura, Bihar
Achha bhojan karne aur saf safai ka dhyan rakhe.(Eat good food and take care of hygiene) AWW,
Jahanabad (Bihar)
“Teekakaran, garbh theharne se lekar prasav tak ki dekhbhaal aur jaankari dete hain. Garbhvati
mahila ko paushtik ahaar lene ki salah dete hain aur samay samay par jaanch karane ki salah dete
hain. Mahila ko hospital le kar jate hain aur sath mein rehte hain. Saari jaanch hone par saath mein
lautte hain” (ASHA gives counseling and help women from the start of the pregnancy till child birth,
about nutritious food, regular checkups, accompany her during delivery and stay with her,
immunization of mother and child)_ Kumari Archana, ASHA, Village Tiuri, Nalanda,
A typical ANM‟s load of “paper” work
With minor variations these were the minimum “paper work” an ANM was supposed to do.
Nature of ANM intervention therefore became primarily that of being facilitator to more „local‟
service providers like the ASHA and the AWW.
 Maintain a host of „registers‟ and report cards
 Respondent ANMs were aware that they were the first tier of official information and data
gathering regime
 Respondents narrated the whole gamut of paper work maintained by them, which
included
 Birth register
 Death register
 ANC report card
 Blood slides report card
 Stock distribution register
 CSM report card
 New born register
 PNC report card
 JSY register
 Survey register
 IUD register
 Cash Book
 VHSC register
 NRHM register
 Vaccine register
 Mamta register
 Condom register
 Motivation register
 Minor treatment register
 Today diary
 Respondents had to maintain in addition Report schedules running into 156 column data
sheets, which they had to update regularly to be submitted with District officials
The HMIS information is collected at the grassroots by ANM. She sends the report to PHC
level. From PHCs data is sent to Block. At the block level the data is compiled and data sheet
is prepared to be sent to District HQ
The ANM was involved in a number of roles; she was in fact the nodal person for more
comprehensive area coverage and guide to „locally‟ available service providers, based in
individual villages, viz., the ASHAs and the AWWs.
This multiplicity of roles and overextension of service area impinged on quality of service
provided.
Table 4.9: TT injections vs. number of ANCs, NIPI-08

One TT Two TT
% %
Received one ANC 46.8 10.6
Received two ANC 27.0 37.9
Received three + ANC 26.2 51.5
The above table makes it quite obvious that there is a positive relationship between the
number of TT injections received and the number of ANC services availed. Across both urban
and rural areas, one can see that the incidence of having received 2 or more TT injections
increases steadily as one progresses from one ANC to 2 or 3 and more ANCs.
4.1.4 Health problems and treatment seeking behaviour during pregnancy
This section looks at the general level of awareness among the women respondents
regarding the types of complications/health problems that can occur during pregnancy. It also
looks at the incidence of occurrence of health problems during last pregnancy as well as
explores the details of treatment seeking behaviour.

Table 4.10: Knowledge about health problems during pregnancy, NIPI-08
JEHANABAD NALANDA SHEIKHPURA BIHAR

Pregnancy complication N % N % N % N %
Don't Know 203 40.8 142 23.1 58 12.8 403 25.7
Vaginal bleeding 119 23.9 108 17.5 139 30.6 366 23.3
Convulsions 113 22.7 273 44.3 160 35.2 546 34.8
Prolonged Labour 100 20.1 180 29.2 174 38.3 454 29.0
Swelling of hand and feet 172 34.5 276 44.8 261 57.5 709 45.2
Other 21 4.2 32 5.2 43 9.5 96 6.1
Personnel who told about these complication
Health personnel / doctor 56 11.2 147 23.9 92 20.3 295 18.8
ANM/ nurse / midwife/ LHV 18 3.6 137 22.2 68 15.0 223 14.2
ASHA 19 3.8 35 5.7 52 11.5 106 6.8
Other health 2 0.3 4 0.9 6 0.4
Other person DAI / TBA 1 0.2 4 0.6 1 0.2 6 0.4
Anganwadi / ICDS worker 3 0.6 10 1.6 7 1.5 20 1.3
Family 221 44.4 222 36.0 207 45.6 650 41.5
Other 1 0.2 1 0.2 7 1.5 9 0.6
Total 498 100.0 616 100.0 454 100.0 1,568 100.0
During their contacts with health workers, pregnant women are expected to be told about
danger signs of pregnancy complications and where they should go if they have pregnancy
complications. Women who received antenatal care were asked whether they know what the
pregnancy complications are. Forty-five percent women knew about swelling of hand & feet,
35 percent knew about convulsions, 29 percent knew about prolonged labour and 23 percent
were aware about vaginal bleeding as the danger signs of pregnancy. In Jahanabad, 41
percent women did not know about any danger sign during pregnancy followed by Nalanda
(23%) and Sheikhpura (13%).
A considerable number of women (42%) reported that they came to know about danger signs
of pregnancy complications from their families. About one fifth of mother came to know from
doctor and around 14 percent received information from ANM/Nurse/Midwife/LHV.
Table 4.11: Incidence of health problems during pregnancy, NIPI-08

DISTRICT
JAHANABAD NALANDA SHEKIPURA All district
N % N % N % N %
YES 598 47.5 779 59.6 714 56.1 2,091 54.5
NO 662 52.5 529 40.4 558 43.9 1,749 45.5
Total # of
women 1,260 100.0 1,308 100.0 1,272 100.0 3,840 100.0
Women were also asked whether they have faced any health problem during most recent
pregnancy, 55 percent in the state accepted that they had some health problem. More women
reported to have health problem in Nalanda (60%) followed by Sheikhpura (56%) and
Jahanabad (48%).

Table 4.12: Nature of health problems faced during last pregnancy, NIPI-08
DISTRICT All Districts

JAHANABAD NALANDA SHEKIPURA
N % N % N % N %
Swelling of Hands & Feet 388 64.9 341 43.8 274 38.4 1,003 48.0
Paleness 56 9.4 77 9.9 16 2.2 149 7.1
Visual Disturbances 77 12.9 125 16.0 161 22.5 363 17.4
Excessive Bleeding 22 3.7 37 4.7 10 1.4 69 3.3
Convulsions 75 12.5 262 33.6 112 15.7 449 21.5
Abnormal Position of
25 4.2 12 1.5 12 1.7 49 2.3
Foetus
Weak or No Movement of
46 7.7 140 18.0 198 27.7 384 18.4
Foetus
Total 598 100.0 779 100.0 714 100.0 2,091 100.0
The pregnancy related health problems most commonly reported by women are swelling of
hands and feet (48%), convulsions (22%), weak or no movement of fetus (18%), and visual
disturbances (17.4%). In all the districts, swelling of hands and feet is the most common
health problem during pregnancy.
Table 4.13: Percentage of women who sought advice for heath problem during pregnancy, NIPI-
08
Jahanabad Nalanda Sheikhpura Bihar

% % N % % N % % N % % N
YES 43.0 42.9 41.1 47.6 56.5 48.5 38.9 40.4 39.6 42.5 43.2 42.6
NO 57.0 57.1 58.9 52.4 43.5 51.5 61.1 59.6 60.4 57.5 56.8 57.4
Total # of
549 119 598 677 209 777 581 171 714 1801 273 2074
women
Of the total women suffered with health problem during pregnancy, nearly 43 percent sought
treatment and about 60 percent of them visited private health facility and consulted doctor for
treatment. In urban areas, 62 percent women attended private health facility for problems
during pregnancy.
Eleven percent women visited govt, hospital and 9 percent went to sub centre for seeking
treatment. Other than doctor, ANM is the commonly consulted health personnel by the
women.
Table 4.14: Person persuaded for treatment during pregnancy

Rur Urba Tot Rur Urba Tot Rur Urba Tot Rur Urba Tot
al n al al n al al n al al n al
% % % % % % % % % % % %
ANM 4.7 2 4.9 5.6 4.2 4.8 5.3 7.2 5.7 5.2 4.6 5.1
ASHA 9.7 9.8 9.3 3.4 1.7 3.2 13.7 4.3 11 8.3 4.2 7.3
DAI 0.4 0.4 0.9 0.8 0.4 2.9 1.1 0.6 0.8 0.8
MOTHER IN LAW 23.3 31.4 24 14.3 10.2 14.3 8.8 7.2 8.8 15.4 13.9 15.2
HUSBAND 50.4 47.1 49.6 43.8 53.4 46.7 53.1 68.1 56.9 48.5 56.3 50.7
FRIENDS /
22.9 23.5 23.2 30.4 24.6 27.9 23.9 15.9 21.9 26.3 21.8 24.7
RELATIVES
OTHER 3.8 2 3.7 2.2 5.9 2.9 3.1 2.9 3.2 2.9 4.2 3.2

Total # of women 236 51 246 322 118 377 226 69 283 784 238 906
Overwhelmingly, it was the husband (51%) who had persuaded the woman to go in for
treatment of complication experienced during the pregnancy period. This is fairly consistent
across all three Districts and it is also consistent that the role of the husband was more
pronounced in urban households than the rural households. The role of the ANM and ASHA
seems to have been relatively limited.
Discussions were done with ASHA to know about the complications faced by mothers
during pregnancy. Most of the ASHA said that swelling of arms and feet is the most
common symptoms followed by yellowness of body and weakness. When women are
found at high risk they are taken to hospital by ASHA.
Similar discussions with AWW reveals that AWW usually look for factors like anemia and
swelling of body parts in the pregnant mothers that can lead be dangerous to mothers.
AWW if encounter a high risk case they soon refer the mother to the nearest doctor/public
hospital/PHC/CHC or provide them with IFA tablets and syrup.
4.2 Delivery Care
One of the important thrusts of the program is to encourage deliveries under proper hygienic
conditions (delivering under clean conditions, washing hands with disinfectant before delivery,
etc.) and under the supervision of qualified/ experience health professional. For each live/still
birth during two years preceding the survey, we had asked the women place of delivery, who
assisted during the deliveries in case of home deliveries, characteristics of delivery and any
problems that occurred during the delivery process. This section provides the details.
Figure 4.3: Institutional delivery and births assisted by health personnel
60
48.3
50 42.4
40.7
40 33.6
30.9
30 24.8
22
20 14.8
10
0
NFHS - 3 NFHS - 2 NFHS - 3 NFHS - 2
Bihar India
Institutional Delivery Birth Assisted by health personnel
According to NFHS, trend reports the percentage of women delivered in health facility has
steadily increased in both all India and Bihar. In Bihar, institutional deliveries were only 14.8%
in 1998-99 (NFHS 2), which has increased by 9% in 2005-06 (NFHS3). Assistance of trained
health personnel during delivery is critical in maternal and child survival. A steady increase
was also noted in the number of pregnancies assisted by health personnel in both Bihar and
India. When compared to all India, Bihar is still lagging behind in terms of both institutional
delivery and births assisted by health personnel. (Figure 4.3)

At juxtaposed a recent DLHS3 reported institutional deliveries at 27.7% while NIPI Phase II
survey also clearly indicates that the trend has increased to nearly 40% of all deliveries,
which took place in government hospitals (61.6% in institutions), while only 38.4% took place
at home.
4.2.1 Influence of background characteristics choice of place of delivery
The following section explores the relationship between the place of last delivery and critical
background variables, viz. age of respondent, her education level, child‟s birth order and
standard of living level of her household based on Asset Ownership Index.
Table 4.15: Place of delivery v/s age of respondent, NIPI-08

Institutional Home Total
Govt. Home
Hospital NGO Private In-laws Parental Others Other All Births
Age % % % % % % % N
15-18 57 46.3 0 0.0 24 19.4 22 17.7 18 14.5 2 1.6 0 0.0 123 100.0
19-21 279 42.1 0 0.0 175 26.4 103 15.6 91 13.8 11 1.7 4 0.6 662 100.0
22-25 514 38.8 4 0.3 321 24.3 284 21.4 169 12.8 29 2.2 4 0.3 1325 100.0
26-30 464 40.9 1 0.1 220 19.4 293 25.8 123 10.9 32 2.8 2 0.2 1134 100.0
31-40 211 37.7 0 0.0 76 13.5 191 34.1 53 9.4 22 3.9 5 0.9 560 100.0
41-49 15 42.8 0 0.0 6 16.0 13 35.2 2 5.1 0 0.0 0 0.0 36 100.0
Total 1540 40.1 5 0.1 822 21.4 906 23.6 456 11.9 96 2.5 15 0.4 3840 100.0
Nearly 40 percent women reported the place of delivery as government health facility, 21.4
percent women visited private health facility for delivery. Of the total home deliveries, 23.6
percent took place in in-laws home, 11.9 percent in Parental home and nearly 2.5 percent
took place in others home. The preferences for health facility by mothers for the delivery do
not have relation with the age of mothers.
“Pehle logon ko aspatal par vishwas nahi tha par ab log aspatal mein jana jyada pasand
karte hain, vajah chahe paisa ho ya vishwas, logon ka fayda ho raha hai” (Earlier people
used to not trust hospitals but now scene is changing as more and more people are going
for institutional deliveries, the reasons may be money or their trust on hospitals for a safe
delivery) ASHA, Nalanda (Bihar)
Table 4.16: Place of delivery v/s years of schooling, NIPI-08

Govt. Home
Hospital NGO Private In-laws Parental Others Other All Births
Educational Status % % % % % % % N
No Education 1056 42.1 1 0.0 367 14.6 682 27.2 315 12.5 79 3.1 10 0.4 2511 100.0
<5 48 43.0 0 0.0 18 16.3 27 24.5 19 17.3 0 0.0 0 0.0 111 100.0
5-7 136 38.2 0 0.0 101 28.5 67 18.9 46 13.0 4 1.1 2 0.6 355 100.0
8-9 111 36.8 3 1.0 104 34.7 48 16.0 28 9.2 6 2.0 1 0.3 301 100.0
10-11 140 35.5 0 0.0 143 36.2 69 17.4 37 9.4 4 1.0 2 0.5 395 100.0
12 & Above 49 29.5 1 0.6 89 53.2 13 7.6 11 6.6 3 1.8 0 0.0 167 100.0
Total 1540 40.1 5 0.1 822 21.4 906 23.6 456 11.9 0.3 0.0 15 0.4 3840 100.0

Data reveals that deliveries in health facilities and home do not have any relation with the
education of the mothers while the preference for private institutional delivery also increases
with education of the pregnant mother.
Table 4.17: Place of delivery v/s number of living children, NIPI-08

Delivery at
Govt
place(Public Home
) NGO Private In-laws Parental Others Other All Births
Birth
order % % % % % % % N
0. 55 28. 34 18. 22 11. 3 1. 0. 192 100.
39.2
1-2 755 2 1 2 7 8 1 6 7 6 9 9 5 7 0
0. 20 15. 34 26. 16 12. 3 3. 0. 128 100.
41.5
3-4 534 3 2 2 7 0 4 6 9 9 0 3 2 7 0
0. 10. 21 34. 10. 2 3. 0. 100.
40.3 626
5+ 253 0 0 68 9 8 9 64 2 1 4 3 5 0
154 0. 82 21. 90 23. 45 11. 9 2. 1 0. 384 100.
40.1 5
Total 0 1 2 4 6 6 6 9 6 5 5 4 0 0
The hypothesis that younger women having their first child would rather have a risk free
institutional delivery rather than have it at home while more experienced women with children
can afford to think otherwise is more or less validated in the above table. Institutional
deliveries come down from 67% for women with 1-2 live children to 55.4% for those who had
more than 2.
Table 4.18: Place of delivery v/s economic status of respondents‟ household, NIPI-08

Delivery at
Home
Govt NGO Private In-laws Parental All Births
Others
place(Public) Other
Wealth Index % % % % % % % N
Lowest 841 41.3 1 0.0 307 15.1 562 27.6 262 12.9 55 2.7 6 0.3 2034 100.0
Second 243 43.8 1 0.2 104 18.7 116 20.9 67 12.1 18 3.2 6 1.1 555 100.0
Middle 172 37.9 0 0.0 124 27.3 94 20.7 51 11.2 11 2.4 2 0.4 454 100.0
Fourth 150 36.1 1 0.2 131 31.5 81 19.5 47 11.3 5 1.2 1 0.2 416 100.0
Highest 134 35.2 2 0.5 156 40.9 53 13.9 29 7.6 7 1.8 0 0.0 381 100.0
Total 1540 40.1 5 0.1 822 21.4 906 23.6 456 11.9 96 2.5 15 0.4 3840 100.0
The generic trend was that women with lower economic profile tended to favour having
deliveries at government facilities as against those who belonged to better off households and
could afford private treatment.
4.2.2 Arrangement and cost of transport
In more than 70 percent cases, family members, relatives/friends made the arrangement for
transport. Husbands are also playing an important role in arranging transport particularly in
urban areas for delivery. A significant number of ASHA‟s made arrangement of transport in
rural areas of Sheikhpura (18.3%), and Jahanabad (8.4%)..
On an average, the cost of transport worked out to be as follows:

Table 4.19: Average transportation expenses (in Rupees), NIPI-08

Jahanabad Nalanda Sheikhpura Total
N N N N N N N N N N N N
N 789 44 833 648 117 765 635 134 769 2072 295 2367
Mean 213 171 207 187 155 173 250 186 235 217 169 206
On an average cost incurred on transportation is less than Rs. 300 in all the districts. In urban
areas average cost of transportation varies from Rs.155/- to Rs.186/- while in rural areas it
varies from Rs.187/- to Rs.250/- in the study districts.
4.2.3 Institutional delivery
This section elaborates on issues dealing with nature of delivery and attending service
provider, incurred costs, health problems/complications experienced during delivery, nature of
advice received post delivery and from whom, and finally, opinion on quality of service and
facility standards.
Table 4.20: Nature of Institutional delivery, NIPI-08
Jahanabad Nalanda Sheikhpura BIHAR

Rura Urba Tota Rura Urba Tota Rura Urba Tota Rura Urba
Total
l n l l n l l n l l n
Who
conducted % % N % % N % % N % % N
the
delivery
Governmen
t Doctor 15.6 17.6 15.2 13.6 13.9 14.1 15.9 15.0 15.7 15.1 15.2 15.0
Private
Doctor 23.2 27.5 24.0 17.4 19.7 18.7 11.8 15.5 12.5 17.9 20.4 18.5
ANM 60.8 54.2 60.4 68.5 65.6 66.7 71.8 69.5 71.4 66.6 63.9 66.0
Other 0.4 0.7 0.4 0.5 0.8 0.5 0.5 0.0 0.4 0.4 0.5 0.4
Type of Delivery
Normal 79.7 76.5 79.5 85.6 81.1 84.2 89.6 83.4 88.3 84.6 80.7 83.9
Caesarian 12.5 17.0 13.0 9.9 10.7 10.6 7.1 12.3 8.5 10.0 12.8 10.7
Assisted 7.7 6.5 7.6 4.5 8.2 5.2 3.3 4.3 3.3 5.4 6.5 5.4
Total 2,36
789 44 833 648 117 765 635 134 769 2,072 295
7
Above table clearly reveals that the person actually performing the delivery was primarily an
ANM (66%) followed by private doctor (18.5%) and government doctor (15%). The trend is
similar across the districts and locality. While most deliveries were normal, incidence of
caesarian deliveries was more in urban areas. Around 5% of the deliveries across both urban
and rural areas were assisted deliveries.

Table 4.21: Cost incurred in institutional delivery1, NIPI-08

Rupees Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
<500 12.2 6.8 11.9 12.8 10.3 12.4 18.9 19.4 19.0 14.4 13.9 14.4
500-1000 45.4 54.5 45.9 47.1 37.6 45.6 50.2 40.3 48.5 47.4 41.4 46.6
1001-1500 9.0 6.8 8.9 8.2 1.7 7.2 6.5 4.5 6.1 8.0 3.7 7.4
1501-2000 12.0 11.4 12.0 10.0 22.2 11.9 10.1 8.2 9.8 10.8 14.2 11.2
2001-2500 3.2 0.0 3.0 3.1 3.4 3.1 1.7 1.5 1.7 2.7 2.0 2.6
2501-3000 2.9 9.1 3.2 2.9 5.1 3.3 2.0 6.7 2.9 2.7 6.4 3.1
3001-4000 2.4 2.3 2.4 1.9 3.4 2.1 2.2 4.5 2.6 2.2 3.7 2.4
4001-5000 3.0 2.3 3.0 2.9 5.1 3.3 2.0 2.2 2.1 2.7 3.4 2.8
5001 + 9.9 6.8 9.7 11.1 11.1 11.1 6.3 12.7 7.4 9.2 11.2 9.4
Total 789 44 833 648 117 765 635 134 769 2072 295 2367
Survey also tried to get an idea about the cost incurred on institutional delivery including
transportation cost. More than half (52.6%) of the mothers spent less than Rs.500 on
institutional delivery; another 42 percent mothers spent Rs. 501 to 1000 and 5 percent
mothers spent Rs.1001-1500 on institutional delivery. Data reveals that delivery expenses in
rural areas are more than urban areas.
Table 4.22: Problem experienced during delivery by women of different age groups, NIPI-08
Institutional Delivery
Premature Excessive Prolonged Obstructed Breech
Other Total
labour bleeding labour labour presentation
N % N % N % N % N % N % N
15-18 56 69.1 11 13.6 31 38.3 10 12.3 3 3.7 2 2.5 81
19-21 262 57.8 56 12.4 176 38.9 95 21.0 22 4.9 25 5.5 453
22-25 478 57.0 89 10.6 320 38.1 169 20.1 42 5.0 39 4.6 839
26-30 425 62.1 64 9.4 233 34.1 124 18.1 47 6.9 25 3.7 684
31-40 163 56.4 26 9.0 86 29.8 48 16.6 8 2.8 10 3.5 289
41-49 13 61.9 2 9.5 7 33.3 4 19.0 0 0.0 0 0.0 21
Premature labour was one of the major problems experienced by almost 60% of the women
respondents had faced problems. This is consistent across the age groups. Prolonged labour
was problem faced by a thirdof the respondents across all age groups.
Table 4.23: Nature of advice received after delivery by source, NIPI-08
Jehanabad Total
Ward
Doctor Nurse ANM Others
attendant N
% % % % %
New born care practices 57.7 29.2 0.7 9.5 2.9 100
Breast Feeding practices 54.0 25.6 1.7 13.6 5.1 100
Advice related to Immunization 54.7 23.6 1.9 15.5 4.3 100
Advice related to-Routine check up 66.0 26.0 6.0 2.0 100
Advice related to-Spacing method 64.1 15.4 2.6 17.9 100
Any other advice 71.4 28.6 100
1
Government Hospital
Nalanda Total
N
% % % %
New born care practices 48.6 34 16.5 0.9 100
Breast Feeding practices 42.9 37.4 16.7 3 100
Advice related to Immunization 48.3 26.9 22.8 2.1 100
Advice related to-Routine check up 54 24 18 4 100
Advice related to-Spacing method 62.5 28.1 6.3 3.1 100
Any other advice 50 50 100
Sheikhpura Total
N
% % % %
New born care practices 36.9 39.4 23.6 100
Breast Feeding practices 61.2 26.2 12.6 100
Advice related to Immunization 30 40 29.5 0.5 100
Advice related to-Routine check up 58.5 22.6 18.9 100
Advice related to-Spacing method 66.7 18.5 14.8 100
Any other advice 100 100
Women who delivered in the health facility were asked whether they were given any advice
on new-born care or anything else before discharge, around 34 percent women received
advice. Most of the mothers who received advice from doctors were given advice about
spacing method (64%) followed by routine checkup (60%), breastfeeding practices (51%),
newborn care (47%) and immunization (43%). Nurses mostly provided advice about newborn
care (35%), breastfeeding practices (31%), and immunization (31%). ANM gave more
importance to immunization (23%) followed by newborn care and breastfeeding practices. It
clearly shows that focus of the doctors is on spacing method and routine checkup, whereas
newborn care and immunization are the prime focus of nurse and ANM respectively. Not
much variation observed among the study districts from the state average.
Table 4.24: Mothers perception about environment of health facility and behavior of staff, NIPI-
08
DISTRICT
Service and Total
Jehanabad Nalanda Shiekhpura
staff in the
health facility % % % %
Cleanliness of the ward/labour room
Very poor 2.8 1.7 2.0 2.2
Poor 7.3 7.8 13.9 9.6
Average 45.3 36.9 18.3 33.8
Good 42.4 43.1 54.4 46.5
Very good 1.7 10.5 8.8 6.8
DK/CS 0.6 2.6 1.1
Environment of the health facility
Very poor 2.9 0.5 1.7 1.7
Poor 8.2 8.6 2.7 6.5
Average 30.6 33.7 29.0 31.1
Good 54.3 42.9 55.7 51.0
Very good 3.8 14.1 8.2 8.6
DK/CS 0.2 0.1 2.7 1.0
DISTRICT
Service and Total
Jehanabad Nalanda Shiekhpura
staff in the
health facility % % % %
Behaviour of the staff in health facility
Very poor 6.1 1.2 2.3 3.3
Poor 5.5 7.6 4.3 5.8
Average 26.8 32.9 27.3 28.9
Good 57.5 42.1 53.6 51.2
Very good 3.6 15.8 9.9 9.6
DK/CS 0.5 0.4 2.6 1.1
Total 833 765 769 2,367
In order to understand the perception of mothers about environment of health facility, a five
point scale is used to rate the perception about general cleanliness, toilets availability and
cleanliness and behaviour of staff. In Sheikhpura, 63 percent women perceived that
cleanliness of ward and labour room is good and very good while in Nalanda and Jahanabad,
54 and 44 percent women perceived the same respectively. Toilets availability and
cleanliness have been rated good and very good by 55 percent women in Sheikhpura
followed by Nalanda (47%) and Jahanabad (40%). Regarding behaviour of staff and overall
perception of mothers about the environment in health facility, Sheikhpura relatively better
rated in comparison to Nalanda and Jahanabad. Hence it indicates that environment of health
facilities in Sheikhpura is relatively better in all respect when compared to Nalanda and
Jahanabad health facilities.
“Mere center par kisi bhi prakar ki suwidha nahi hai, na hi pani ki, na ane jane ki , na hi
kuch samaan hai, na rehne ke liye quarter hai” ( Not a single facility is available at my
center for delivery) ANM, Jahanabad (Bihar)
4.2.4 Janani Suraksha Yojana (JSY)
Janani Suraksha Yojana (JSY) under the overall umbrella of National Rural Health Mission
(NRHM) integrates the cash assistance with antenatal care during the pregnancy period,
institutional care during delivery and immediate post-partum period in a health centre by
establishing a system of coordinated care by field level health worker. The JSY is a 100
percent centrally sponsored scheme. The vision of the scheme is to reduce overall maternal
mortality ratio and infant mortality rate and to increase institutional deliveries in BPL families.
In Bihar, JSY is named as JBSY (Janani Avam Bal Surraksha Yojana) and it focuses on
immunization of newborn along with institutional delivery. JBSY in Bihar has been
implemented for both the categories of families i.e. BPL and APL. In order to assess the
knowledge about JSY among mothers, they were asked whether they are aware of JSY.
Table 4.25: Awareness about JSY, NIPI-08
All Districts Total
YES NO All Births
N % N % N %
Age
15-18 81 65.9 42 34.1 123 100.0
19-21 446 67.3 217 32.7 663 100.0
22-25 869 65.5 458 34.5 1327 100.0
26-30 752 66.3 382 33.7 1134 100.0
31-40 369 65.9 191 34.1 560 100.0
All Districts Total

YES NO All Births
N % N % N %
41-49 27 75.0 9 25.0 36 100.0
Year of schooling
No Education 1650 65.7 863 34.3 2513 100.0
<5 74 66.7 37 33.3 111 100.0
5-7 237 66.8 118 33.2 355 100.0
8-9 212 70.4 89 29.6 301 100.0
10-11 263 66.4 133 33.6 396 100.0
12 & Above 108 64.7 59 35.3 167 100.0
Nature of PSU
RURAL 2236 65.9 1155 34.1 3391 100.0
URBAN 308 68.1 144 31.9 452 100.0
Wealth Index
Lowest 1317 64.7 718 35.3 2035 100.0
Second 393 70.8 162 29.2 555 100.0
Middle 306 67.3 149 32.7 455 100.0
Fourth 279 66.9 138 33.1 417 100.0
Highest 249 65.4 132 34.6 381 100.0
Total N 2544 66.2 1299 33.8 3843 100.0
Of the 3843 interviewed mothers in Bihar, two-third was aware about JSY. In Sheikhpura,
74%, Nalanda, 67% and Jahanabad 58% of the women were aware about JSY.
“Janani Suraksha yojana ke amal mein an eke baad tikakarana hone laga hai aur
delivery aspatal mein hone lagi hain” (After the implementation of JSY, immunization and
institutional deliveries has increased) AWW, Jahanabad (Bihar)
General „working conditions‟, as per narration of ASHA respondents

 There was not much interference from PRI or other Community leaders
 There were certain local customs like rinsing new born in musterd oil
 Cooperation from ANM, LHV and AWW, but not satisfactory
 Respondents reported supervision and monitoring of their work by ANM
 Respondents directly report to ANMs and follow order from them
 Respondents aware about danger signs and symptoms of anemia and malaria
 The respondents usually not equipped with a medicine box containing
 Village health days were not found to be regular in most places
 ANM and Community Leaders sometimes called for meetings attended by ASHA
 Respondents were not aware about any village level health plan
4.2.5 Training and capacity building of ASHA‟s
Under NRHM, ASHA‟s have been appointed in almost every village of the country. Main
purpose of their appointment is to provide basic advice or help households in relation to ante
natal, natal and post natal care, newborn care, immunization and family planning. In order to
have a proper understanding of all these aspects, five training modules have been designed
for them and every ASHA is supposed to get training in all these modules. As per the data
provided by DPMU, all the ASHA‟s received training in Module-1. In Module-2, training was
not started at the time of survey..
Table 4.26: Number of ASHA‟s trained
Total ASHAs to be
Round 1 Training in
District Recruited & Round 2 Training 07-08
the year 05-06
Selected
Ongoing in
Target Selected Target Completed Target Completed
phases
Jehanabad 769 769 769 Completed 769 Not yet started NA
Nalanda 1980 1980 1980 Completed 1980 Not yet started NA
Sheikhpura 444 439 439 Completed 444 Not yet started NA
Table 4.27: Accompaniment of ASHA during Institutional delivery, NIPI-08

All Districts
Rural Urban Total
N % N % N %
Did the ASHA accompny you?
YES 995 48 101 34.4 1068 45.1
NO 941 45.4 131 44.5 1056 44.6
NOT APP 139 6.7 62 21.1 244 10.3
Total 2,072 100 295 100 2,367 100
If no did she reach later on?
YES 126 13.4 12 10 135 12.8
NO 814.04 86.6 104.4 90 920.832 87.2
Total 940 100 116 100 1,056 100
Why did ASHA not accompny you?
We did not inform her 589 72.4 81 75.6 667 72.4
We informed but she refused to come along 85 10.4 7 6.4 89 9.7
She was not present in the village or she was not well 68 8.4 6 6 74 8
DONT KNOWN 44 5.4 7 6.4 56 6.1
other 28 3.4 6 5.6 35 3.8
Total 814 100 107 100 921 100
Accredited Social Health Activist (ASHA) supposed to accompany pregnant women for
institutional delivery under JSY. Women were asked whether they were accompanied by
ASHA and did ASHA reach later on, if not accompanied. Fifty-six percent institutional
deliveries in Sheikhpura, 41 percent in Jahanabad and 38 percent in Nalanda are
accompanied by ASHA. Ten percent women in Sheikhpura, 11 percent in Nalanda and 10
percent in Jahanabad reported that ASHA did not accompany for delivery but reached later
on to health facility for the same.
While asking the reason of not accompaniment of ASHA from mothers, 84 percent in
Sheikhpura and 71 percent in Nalanda and about 67 percent in Jahanabad reported that they
did not inform to ASHA. Around 10 percent women informed ASHA about delivery but she
refused to come along. Eight percent women mentioned ASHA was not present in the village
or she was not well as the reason of not accompaniment for delivery.
During the discussions with ASHA about the reasons for not accompanying pregnant
women to institution for delivery. Maximum gave the reason that mothers do not inform
them at the time of delivery and women want to go with their family member.

Table 4.28: Duration of stay of the mother at health facility after delivery, NIPI-08
% % % % % % % % % % % %
<=6 Hrs 26.7 24.2 26.9 19 16.8 18.2 11 9.1 10.5 19.5 16.3 18.8
7-12 Hrs 23.6 25.5 23.6 24.5 18 23.4 23.6 29.4 24.7 23.9 23.6 23.9
13-23 Hrs 4.4 4.6 4.3 2.3 1.6 2.2 4.4 3.7 4.3 3.8 3.1 3.6
1-2 Days 34.6 34.6 34.3 42.6 47.1 43.5 49.4 47.1 49 41.7 43.8 42.1
3-6 Days 8.4 9.2 8.4 9.4 11.9 9.5 10.6 10.7 10.7 9.4 10.8 9.5
Week of More 2.3 2 2.4 2.2 4.5 3.1 0.9 0.8 1.8 2.4 2.1
Total 789 44 833 648 117 765 635 134 769 2,072 295 2,367
Under JSY, every mother is supposed to stay in the health facility for a minimum period of 48
hours for optimal care and qualify as JSY beneficiary. Due to increase in demand and non
availability of required infrastructure facilities, government relaxed the norm from 48 hours to
24 hours. Survey revealed that in spite of 24 hours minimal norm, a considerable percentage
(43%) of mothers has been discharged within 12 hours. Thirty-five percent mothers in
Sheikhpura, 42 percent in Nalanda and 51 percent in Jehanabad were discharged within 12
hours of delivery.
4.3 Home Delivery
This section deals with the details of home delivery cases, including reasons behind choosing
to have the baby delivered at home and not in an institution, the actually place where the
delivery took place and whether it is influenced by the background of the pregnant mother to
be, the person who actually conducted the delivery and finally, why was this person chosen to
begin with.
Out of 3843 women interviewed in three districts, 1458 women delivered at home. So, overall
39 percent of mothers delivered at home. In Nalanda, 41 percent mothers delivered at home
followed by Sheikhpura (39%) and Jehanabad (34%).
Table 4.29: Reason for home delivery, NIPI-08

Reason (multiple
response) Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban Total
% % % % % % % % % % % %
Costs too much 15.5 9.7 14.8 19.6 16.2 18.9 18.7 18.1 18.5 18 14.8 17.6
Facility not open 2.2 2.2 2.1 4.1 2 3.7 6 8.4 6.4 4.1 3.7 4.2
Too far/ No
11.5 6.5 10.8 25.8 17.6 23.2 18.9 8.4 17.5 19.1 12 17.6
transportation
Don't trust
facility/poor quality 3 1.1 2.8 2.3 10.1 4.7 3.7 6 4.2 3 6.5 4
service
No one to
19.7 20.4 19.3 26 21.6 24.7 15.2 14.5 14.9 20.5 19.4 19.8
accompany
Did not get time/no
32.7 37.6 32.5 28.1 24.3 27.3 32.8 26.5 31.1 31.1 28.7 30.1
time
No female
1 2.2 0.9 0.9 0.7 0.9 0.9 2.4 1.2 0.9 1.5 1
provider at facility
Husband/family
12.7 14 13.2 7.9 8.1 8.4 5.8 6 6 8.7 9.3 9
did not allow
Not necessary 25.9 20.4 25.9 24.9 24.3 25.6 28.9 36.1 30.5 26.6 26.2 27.4
Not customary 4.7 2.2 4.5 3 5.4 3.4 5.5 7.2 6 4.4 4.9 4.6
Other 7.7 15.1 7.8 4.3 4.1 3.9 6.9 8.4 6.8 6.2 8.3 6
Total 401 401 425 401 401 535 401 401 498 401 401 1458

As it has been mentioned above, nearly two-fifth of the total surveyed women delivered at
home. They were also asked the reasons why they did not deliver in the health facility. Thirty
percent women mentioned they did not have time to go to health facility, 27 percent feel that
delivery in institution is not necessary, 18 percent women cited non-availability of
transportation facility and another 20 percent reported no body was there to accompany for
delivery as the main reason of home delivery. The most important reason emerging in all the
districts for not going to health facility for delivery is did not get time. During qualitative
discussions, it has come out that people generally do not prefer to go to health facility if they
feel that there is no serious problem or any complication to pregnant women. Non availability
of transportation also emerged as an important reason during qualitative discussions.
“Sadak athva yatayat suvidha na hone ke karan abhi bhi gharon mein prasav hote
hain” (Lack of proper roads and transport leads to home deliveries) AWW, Jehanabad
(Bihar)
Table 4.30: Home delivery Practices, NIPI-08
All Districts
On the ground
with clean On the ground On the cot On the cot
clothes/plastic without with clean without Don‟t
underneath clothes/plastic clothes/plastic cloth/plastic remember Other
N % N % N % N % N % N %
Year of schooling
No Education 501 46.6 166 15.4 255 23.7 60 5.6 11 1.0 83 7.7
<5 26 56.5 2 4.3 16 34.8 1 2.2 1 2.2
5-7 55 47.0 10 8.5 37 31.6 4 3.4 11 9.4
8-9 43 52.4 6 7.3 26 31.7 7 8.5
10-11 46 41.8 8 7.3 39 35.5 6 5.5 1 0.9 10 9.1
12 & Above 8 29.6 2 7.4 13 48.1 1 3.7 3 11.1
Wealth Index
Lowest 407 46.3 142 16.2 201 22.9 51 5.8 9 1.0 69 7.8
Second 98 48.8 17 8.5 62 30.8 5 2.5 2 1.0 17 8.5
Middle 78 50.0 16 10.3 38 24.4 9 5.8 0 0.0 15 9.6
Fourth 60 45.1 11 8.3 47 35.3 4 3.0 0 0.0 11 8.3
Highest 36 40.4 8 9.0 38 42.7 3 3.4 1 1.1 3 3.4
Location of PSU
RURAL 608 46.7 178 13.7 328 25.2 67 5.1 12 0.9 110 8.4
URBAN 71 45.8 16 10.3 58 37.4 5 3.2 5 3.2
Total N 679 46.6 194 13.3 386 26.5 72 4.9 12 0.8 115 7.9
Survey also tried to capture the various prevailing practices in relation to home delivery. For a
safe delivery at home, besides trained health personnel, hygienic environment and sterilized
equipments are a must. Women who delivered at home were asked about the place used for
delivery at home and personnel involved in conducting the delivery.
Table 4.30 shows that a large number of home deliveries occurring on the ground with clean
clothes/plastic underneath. A sizeable proportion of home deliveries are conducted on the cot
with clean clothes/plastic. But still 13 percent deliveries taken place on the ground without any
cloth/plastic which is a matter of concern. Women belonging to lowest education level, lowest
wealth quintile have the higher percentages of deliveries happening on the ground without

clothes/plastic underneath. In Urban areas, considerable percentages (38%) of deliveries

occurring on the cot with clean cloth/plastic. (Table 4.2.16a)
Table 4.31: Person who conduct delivery at home

R U T R U T R U T R U T
Delivery specification % % % % % % % % %
Personnel Conducted Delivery
Mid wife 3.2 3.2 3.1 3.6 5.4 4.1 0.7 2.4 1 2.5 4 2.7
Trained dai 23.2 20.4 23.8 12.4 14.2 13.1 5.5 2.4 4.8 13.4 13 13.4
Untrained dai 64.3 65.6 63.3 78.9 72.3 77.6 89.8 86.7 90 78.1 74.1 77.6
ASHA 2.7 1.1 2.8 0.9 0.7 0.7 1.2 2.4 1.4 1.5 1.2 1.6
ANM 4 7.5 4.7 1.9 7.4 3.4 1.6 6 2.4 2.5 7.1 3.4
Family member 13.7 4.3 12.9 3.8 5.4 3.6 3.7 12 4.4 6.8 6.8 6.6
Relatives friends 6.7 2.2 6.4 1.1 0.9 2.3 8.4 3.4 3.2 2.8 3.4
Other 0.5 1.1 0.5 0.2 0.3 0.1
Total 401 24 425 469 66 535 433 65 498 1303 155 1458
Women were also asked about the personnel who conducted the delivery, in rural as well as
urban areas of study districts, nearly 4/5th (77.6%) deliveries are conducted by untrained dai
and a little over one-tenth (13.4%) deliveries are conducted by trained dai. ASHA has also
taken part in some deliveries (1.6%). In Jahanabad, Nalanda, and Sheikhpura 24, 13 and 5
percent deliveries are conducted by trained dai.
Reason of choosing particular person to conduct delivery at home was also asked and past
experience of the person (36%) and past record of conducting safe deliveries (30%) are the
two important reasons mentioned. Person being economical (9%) and recommended by
somebody (8%) are the other reasons expressed for choosing the person to conduct home
delivery. (Table 4.32)
Table 4.32: Reasons behind choosing a specific person to conduct the delivery, NIPI-08

Delivery Specification R U T R U T R U T R U T
% % % % % % % % % % % %
Why did you choose the person to conduct delivery?
28. 20. 28. 21. 23. 22. 58. 48.
58 36 29 36.4
Past experience 9 4 9 1 6 1 7 2
11. 12. 15. 13.
13 4.7 0.9 2.4 1 9.7 6.2 8.9
Economical 8 2 1 6
33. 32. 33. 38. 43. 17. 16. 17. 33.
40 29.9 30.3
Safe delivery 2 3 2 6 9 6 9 5 6
10. 14.
9.7 9.2 4.5 4.7 4.9 8.8 8.8 7.5 9 7.5
Reliable 8 5
Behavior of the service 14. 17.
1.5 6.5 2.4 14 2.3 2 6.6 9.9 6.5
provider 9 6
11. 10. 16. 10.
10 4.5 3.4 4.1 9.7 7.9 9.3 8.2
Recommended 8 4 9 7
Other 3.7 6.5 3.8 1.3 2 1.3 2.1 1.2 2 2.3 3.1 2.3
130 145
401 24 425 469 66 535 433 65 498 155
Total 3 8

Table 4.33: The delivery process, NIPI-08
All Districts
Specifications Rural Urban Total
% % %
Was she/he contacted before the labor pain started?
YES 71.2 67.6 71.4
NO 27.1 27.8 27
DONT KNOWN 1.7 4.6 1.6
Did she/he mention the requirements before attending the delivery?
YES 61.4 58.4 60.5
NO 35.9 39.7 37
DONT KNOWN 2.7 1.8 2.5
Did the person who attended the delivery wash his/her hands before attending the delivery?
YES 68.4 66.7 69.3
NO 13.8 13.3 13.6
DONT KNOWN 17.8 20.1 17.1
What was used for washing?
WATER ONLY 54.3 36.6 51.9
SOAP 43.7 61.1 46
ASH/MUD 0.3 0.5 0.4
CANT SAY/DONT KNOWN 1.7 1.9 1.7
Total 891 119 1010
Seventy-one percent women reported that the person who conducted the delivery was
contacted before. Of the persons contacted, around 61 percent mentioned requirements
before attending the delivery. It is important to note that around 30 percent persons who
attended the delivery did not wash hands before attending the delivery. Among those who
washed hands, less than half (46%) used soap for washing hands and the remaining used
water only.
On discussions with ASHA, she also gave various points that should be kept in mind
during delivery like proper hygiene, use of new blade, nails of dai should be cut, place of
delivery should be clean, hands should be clean and use clean clothes.
Table 4.34: Cost incurred in home delivery, NIPI-08

Amount (in Rs.) R U T R U T R U T R U T
% % % % % % % % % % % %
< 500 39.3 40.7 37.9 36.1 32.2 35.6 55.2 57.5 55.1 43.6 41.1 43
500 - 1000 52.7 49.4 53.3 54.9 58.7 55.2 32.9 31.3 32.7 46.7 49 46.8
1001 - 1500 4 4.9 4.5 3.5 1.4 3.1 2.4 5 2.9 3.3 3.3 3.4
1501 - 2000 2.8 3.7 2.9 3.5 4.2 3.8 6.2 5 6.2 4.2 4.3 4.4
2001 - 2500 0.3 1.2 0.5 0.7 1.4 0.8 1.2 1 0.7 1 0.8
> 2500 0.9 0.8 1.3 2.1 1.5 2.1 1.3 2.1 1.5 1.3 1.5
Total 351 24 375 457 65 522 420 63 483 1228 152 1380
So far as the amount spent on home deliveries are concerned, 43 percent spent less than
Rs.500/- and another 47 percent spent between Rs.500 – 1000. In Sheikhpura, expenditure
on most of the home deliveries (55%) was less than Rs.500/- while in Jahanabad and
Nalanda, it was between Rs.500/ - to Rs.1000/- in more than fifty percent cases.
Table 4.35: Nature of advice received, NIPI-08
Person who conducted delivery Jahanabad Nalanda Sheikhpura BIHAR

given Advises on: (in %) (in %) (in %) (in %)
3 most common advises
New born care practices 28.8 34.4 29.6 31.2
Breast feeding Practices 39.3 40.3 36.6 38.8
Immunization 9.6 6.6 15.5 10.5
No Advice Given 39.1 36.1 43.3 39.4
Majority of persons (61%) who conducted home deliveries given advises to mothers
regarding some of the important aspects. About 31 percent mothers received advice on new
born care practices, 39 percent received on breastfeeding practices and 11 percent received
on immunization. A considerable number of mothers (39%) did not receive any advice.
4.4 Postnatal Care
The health of a mother and newborn child depends not only on the health care she receives
during her pregnancy and delivery, but also on the care she and the infant receive during the
first few weeks after delivery. Postnatal care check-ups soon after the delivery are particularly
important for births that take place in non-institutional settings. Recognizing the importance of
postnatal check-ups, government programme (RCH) recommends three postnatal visits.
A large proportion of maternal and neo-natal deaths occur during the 48 hours after delivery.
Hence safe motherhood programmes have increasingly emphaisized the importance of
postnatal care, recommending that all women receive a check up within first two days of
delivery. The World Health Organisation (WHO) recognizes several „crucial moments when
contact with the health system/informed caregiver could be instrumental in identifying and
responding to needs and complications‟ (WHO, 1998). It is most important to have the first
postnatal check-up within a few hours of delivery. Another important time for a postnatal
check-up is six weeks (42 days) after the delivery. By this time, a woman‟s body should
generally have returned to its per-pregnancy state. To assess the extent of postnatal care
check-ups, women were asked whether any health personnel check on her health after last
delivery.
Table 4.36: Timings of First Post Natal Care, NIPI-08

DISTRICT
All Districts
% % % % % % % % % % % %
<4 Hrs 0.2 0.2 0.4 0.3 0.2 0.0 0.2
4-23 Hrs 0.6 0.5 0.3 0.3 0.3 1.0 1.8 1.1 0.6 0.6 0.7
1-2
1.9 1.8 0.8 0.5 0.8 1.5 4.6 2.0
Days 1.4 1.6 1.5
3-41
1.6 1.5 0.3 0.3 0.2 1.8 1.1 1.7
Day 1.2 0.4 1.1
>41
0.1 0.1
Days 0.0 0.0 0.0
DK/CS 0.6 0.4 0.5 0.5 0.5 0.5 0.4 0.5 0.1 0.5
No
95.1 99.6 95.4 98.1 99.0 98.3 94.9 92.5 94.5
Checkup 96.0 97.2 96.1
Total 1,192 68 1,260 1,124 184 1,308 1,072 200 1,272 3,388 452 3,840

A majority of women (96%) did not receive any postnatal check-up after their most recent
birth within 2 months of delivery. Only 4 percent of women received a health check-up within
two months of delivery.
Among the small number of mothers who received postnatal care, ANM/Nurse/ Midwife
checked 57 percent mothers and doctors checked 33 percent mothers. About one third (31%)
of mothers attended Primary Health Centre (PHC) for postnatal check up followed by Private
Hospital/clinic (21%), and Govt. Hospital (20%). Around 15 percent received post partum care
at home.
Out of the total women received PNC, 14 percent received PNC in the government hospital,
27 percent in PHC and 18 percent received in private hospital and they delivered in the same
health facilities. About 4 percent women delivered in the private health facility but they
received PNC in government hospital. Another 3 percent women received first PNC in PHC
while they delivered in private hospital. In most of the cases women received PNC at the
same place where they delivered. In few cases, women delivered in private health institution
and received PNC in government health facility while negligible number of women received
PNC in private health facility after delivering in a government institution. (Table in Annexure)

Chapter 5
Newborn Care
5.1 Preamble
The majority of newborn problems are specific to the perinatal period. They cause not only
deaths but also substantial morbidity and disability. These problems are the result of poor
maternal health, inadequate care during pregnancy, inappropriate management and poor
hygiene during delivery, lack of newborn care and discriminatory care. Death among newborn
infants is so frequent that it is accepted as routine by many families and community members.
If a mother dies during childbirth, her baby has smaller chance of survival, and if survives is at
high risk for neglect, malnutrition and morbidity. Keeping this in view, government has
launched nationwide programme for the care of pregnant women as well age newborns.
During this survey, we attempted capturing some important issues related to newborn health
and family practices from the mothers. Newborn care related information were also collected
form service providers and program managers. This chapter presents the findings related to
newborn care.
Discussions with ASHA reveal that usually mothers are advised to breastfeed the
children exclusively till 6 months from delivery. Though there is a myth prevailing in the
society of not giving first milk to the child but as told by ASHA they are taking due steps
to spread awareness about the importance of first milk and breastfeeding to the mothers.
Anganwadi workers also carried out various activities in VNHD where they counsel
mothers about breastfeeding and exclusive breastfeeding for 6 months. They were of the
view because of the various programs related to MCH in last 2 years there has been
slight increase in the practice of giving colostrums to children in the state and as a result
there has been decrease in the occurrence of diseases in children.
5.2 Infant Mortality
In 1998-99, the IMR was 78 per 1000 live births in Bihar compared to 68 for all India (NFHS-
2). According to the latest NFHS-3 (2005-06) the figure for BIhar is 62 per 1000 live births.
SRS 2006 estimates the IMR of Bihar to be 61 per 1000 live births (Table 5.1).


Infant Mortality Rate
Source/Year
Bihar India
NFHS 2 ( 1998-99 ) 78 68
NFHS 3 ( 2005-06) 62 57
SRS 2000 62 71
SRS 2003 60 60
SRS 2006 61 57
NRHM Goal by 2010 45
Source: NFHS 2 and 3, SRS Bulletin (1997), SRS (2000, 2003, 2006)
5.3 Child Mortality
Under 5 mortality (U5MR) in Bihar as per NFHS-3 is 848 per 10000 live births, one of the
highest in India.
Under 5 Mortality Rate

Source/Year
Bihar India
NFHS 2 ( 1998-99 ) 105.1 95
NFHS 3 ( 2005-06) 84.8 75
SRS 2000
SRS 2003
SRS 2006
NRHM Goal by 2010 < 50 < 50
Direct estimates of infant and child mortality indicators at district level are not available,
though estimates using census data on children ever born and children surviving are
available but are inconsistent and not reliable. Hence this data is not presented in this report.
The District Level Household Survey (DLHS 2002-03) does not provide district level infant
and child mortality estimates. Thus no reliable estimate of infant and child mortality is
available at the district level.
5.4 Birth Weight
Low birth babies are at higher risk of the mortality

..We are not supplied with any weighing and morbidity. To avert the risk and provide
machine, how we can take the weight.
appropriate care, it is necessary to identify these
ANM, Jehanabad (Bihar)
high risk babies by taking weight soon after birth
…Five years ago we had received and provision of appropriate care. In the case of
weighing machine. Now it is not functional institutional deliveries, most of the babies are
and it is not replaced instead of repeated weighed after birth. But in the case of home
complain. ANM, Sheikhpura (Bihar) deliveries, it is not so. During this survey we have
captured the birth weight of the babies delivered
at home to explore the process of weighing these
babies under the existing mechanism.

Incidence of weighing baby after birth is reported very rare in Bihar. Out of total home
deliveries only 1.4 percent was reportedly weighted and out of those one-third had a card with
weight recorded on it. In another one-third cases mother were able to recall the weight and in
rest of the cases they were not able to recall also. Out of the eight babies who had weight
card half of them were low birth baby with a birth weight below 2.5 kilograms. Since the
number of weighed babies was low, further analysis may not give relevant findings or clear
picture of the situation.
The information from FGD with ANM and in-depth interview with ANMs, ASHAs and Angan
Wadi Workers revealed that most of them were not equipped with weighing machine. It
appears to be a major reason for low rate of weighing babies delivered at home. The health
workers were identifying the low birth weight baby by the physical appearances of the babies.
Table 5.2a: Recorded weight of baby, NIPI-08

<2.5 >=2.5 <2.5 Kg >=2.5 <2.5 >=2.5 <2.5 >=2.5
Kg Kg Kg Kg Kg Kg Kg
N % N % N % N % N % N % N % N %
Total number of women - - 57. 42. - - - -
(8) 4 3
1 100 1 9 4 50 4 50
In all NIPI districts, 1453 mothers gave their answer about the question on size of the
newborn to recall their baby‟s size at birth while 78 from them couldn‟t answer. It can be
observed that most of the mothers stated size of the newborn either average or larger than
average. None from the mothers stated that their baby‟s size was less than average/ normal.

Size of the baby Rural Urban Rural Urban Rural Urban Rural Urban
N % N % N % N % N % N % N % N %
Smaller than average
Larger than the 21. 25. 10 21. 2 33. 10 24. 1 20. 22. 26.
average 85 6 6 0 2 8 2 8 8 7 3 0 295 7 41 6
Average 29 74. 1 62. 33 70. 3 56. 31 72. 4 75. 72. 10 65.
2 1 5 5 1 7 7 9 5 1 9 4 938 2 1 6
Can not define 12.
17 4.3 3 5 35 7.5 6 9.2 14 3.2 3 4.6 66 5.1 12 7.8
Total 39 2 46 6 43 6 129 15
4 100 4 100 8 100 5 100 7 100 5 100 9 100 4 100
5.5 Neonatal Checkups
First check of the baby after delivery is very crucial for overall assessment, exclusive
breastfeeding and appropriate care. The study has collected the information regarding first
health checkup, contact with care provider within ten days of birth and vaccination within one
month of birth for all babies either delivered at hospital or home.

RURAL URBAN Total

N % N % N %
<6 Hrs 365 10.8 111 12.2 433 11.3
6-23 Hrs 40 1.2 11 1.2 48 1.2
1-2 Days 128 3.8 20 2.2 145 3.8
3-4 Day 45 1.3 21 2.3 57 1.5
5-6 Days 12 0.4 1 0.1 12 0.3
Week or more 34 1.0 7 0.8 39 1.0
No Checkup 2767 81.6 742 81.3 3109 80.9
Total 3391 100 913 100 3843 100
First health checkup within ten days after birth was reported very low in Bihar. Nearly four-fifth
(81%) of babies did not have contact with any health worker in first 10 days after birth. Only
11 percent of babies had contact with any health worker in first 24 hours after birth. About 19
percent of babies had contact with any health worker in first 10 days after birth. The variation
in these figures across the 3 study districts was minimal. Rural - urban variation in this
practice was not evident except the urban area of Jehanabad district where little more than 90
percent babies were not checked. (Table 5.3 & 5.4)
JEHANABAD NALANDA SHEIKHPURA

RURAL URBAN RURAL URBAN RURAL URBAN
N % N % N % N % N % N %
<6 Hrs 114 9.5 8 3.2 82 7.3 46 11.7 169 15.8 57 21.0
6-23 Hrs 14 1.2 2 0.8 11 1.0 6 1.5 15 1.4 3 1.1
1-2 Days 57 4.8 2 0.8 28 2.5 8 2.0 43 4.0 10 3.7
3-4 Day 19 1.6 2 0.8 15 1.3 14 3.6 11 1.0 5 1.8
5-6 Days 2 0.2 5 0.4 5 0.5 1 0.4
Week or
5 0.4 1 0.4 18 1.6 6 1.5 11 1.0
more
No
984 82.3 233 94.0 965 85.9 314 79.7 818 76.3 195 72.0
Checkup
Total 1195 100 248 100 1124 100 394 100 1072 100 271 100
Sheikhpura district of Bihar registered best performer among all surveyed districts where 28
percent neonatal received checkup in urban area while 24 percent in rural areas. At the same
time in other districts its ranges between 6-20 percent.
5.6 Breastfeeding and Supplementation
Breastfeeding is one of the main pillars of newborn care. Educating mothers on correct
breast-feeding practices and child nutrition is very important component of newborn care. In
this survey, we explored breastfeeding practices among the eligible women, the attitude and
practice pertaining to feeding of prelacteal liquids and period of exclusive breastfeeding and
introduction of supplementary feeding.

Table 5.5: Breastfeeding practices, NIPI-08

RURAL URBAN RURAL URBAN RURAL URBAN
N % N % N % N % N % N %
Ever breastfed
Yes 1158 96.9 243 98 1070 95.2 384 97.5 1029 96 262 96.7
No 37 3.1 5 2 54 4.8 10 2.5 43 4 9 3.3
1195 100 248 100 1124 100 394 100 1072 100 271 100
Anybody helped in initiating the breast feeding
Yes 720 62.2 131 53.9 605 56.5 174 45.3 437 42.5 79 30.2
No 438 37.8 112 46.1 465 43.5 210 54.7 592 57.5 183 69.8
1158 100 243 100 1070 100 384 100 1029 100 262 100
Sources helped in initiating breastfeed
Government
Doctor
14 1.9 1 0.8 9 1.5 4 2.3 7 1.6 2 2.5
Private Doctor 51 7.1 17 13 40 6.6 12 6.9 35 8 8 10.1
Nurse 77 10.7 13 9.9 81 13.4 19 10.9 67 15.3 16 20.3
ANM/ASHA/LHV 67 9.3 7 5.3 98 16.2 22 12.6 42 9.6 7 8.9
Dai 62 8.6 19 14.5 47 7.8 14 8 49 11.2 9 11.4
Mother/ Mother-
in-law
341 47.4 52 39.7 204 33.7 71 40.8 182 41.6 27 34.2
Friends/Relatives 104 14.4 22 16.8 126 20.8 32 18.4 52 11.9 10 12.7
Others 4 0.6 3 0.7
720 100 131 100 605 100 174 100 437 100 79 100
Initiation of the breastfeeding immediately after the birth is beneficial for both the infant as
well as the mother. More than 96 percent of women in Bihar had ever breastfed their children.
Little more than half of the mothers received help from somebody in initiation of
breastfeeding. Rural-Urban analysis shows that in rural area more women had received help
in initiation of breastfeeding as compared to urban area.
Around two third mothers received support from non-trained persons like mother/mother in-
law, friends and Dais. Little more than one tenth of the mothers received support from nurse
and similar proportion had received it from ANM/ASHA. Role of government doctors in
initiation of breastfeeding were found to be negligible with only 2 percent mothers had
received help from them. District wise rural-urban analysis is almost in line with the state.
(Table 5.5)
Eligible mothers from the survey stated that initiation of breastfeeding practices has taken
place during an hour after delivery and before completion of three days from delivery. Around
13 percent women started breast feeding the child within one hour of delivery.
In Bihar around 61 percent of women have delivered in health institutions. In the health
institutions doctor/nurse/ANM attending on the delivery is expected to advise women to start
breastfeeding immediately after the birth of the child. However, in Bihar the percent of the
women initiating breastfeeding within one hour of childbirth is substantially less than the
proportion of institutional deliveries, suggesting that even in health institutions also early
initiation of breastfeeding was not ensured.
In-depth interview with ANMs, ASHAs and Anganwadi Workers revealed that the customary
practices for breastfeeding is prominent in the region and varies from village to village.
Though; some of the ANMs revealed that they counsel women on breastfeeding practices but
most of them were unable to do so and busy with their paper work. ASHAs are more close to

mothers than any other health workers in rural areas and they counsel them on breast
feeding practices like give mother‟s first milk to the child, exclusive breast feeding up to six
months, mother‟s milk enhances the immunity of the child etc. but change in customary
system will take some time.
Mother’s milk is good for child but people think that giving mother’s milk to the child at first will not
be good for mothers’. Some time mother was not able to lactate immediately after birth.
ASHA, Sheikhpura
In coming tables and analysis we will discuss about the timings for initiation of breastfeeding
by various background variables.
There is no much difference or impact of the gender of child on initiation of breastfeeding.

Gender of Immediately within Same day after an 1-3 days After 3 days
child an hour of birth hour of birth
% % % %
Boy 11.9 35.9 45.2 6.2
Girl 14.3 34.4 44.3 5.8
From the table 5.7 it can be observed that even education of mother was not a determinant of initiation
of breastfeeding.

Education of Immediately within Same day after an 1-3 days After 3 days
mothers an hour of birth hour of birth
% % % %
No Education 12.3 35.0 46.1 5.7
<5 11.4 30.5 42.9 14.3
5-7 15.0 28.5 49.7 5.3
8-9 11.6 39.2 39.9 7.2
10-11 17.2 39.1 37.5 5.0
12 & Above 13.5 38.0 41.7 6.7
Number of live children including index of child is also not a determinant of initiation of
breastfeeding.
Immediately within Same day after an 1-3 days After 3 days
an hour of birth hour of birth
% % % %
1-2 12.5 35.9 43.6 7.0
3-4 14.4 34.6 45.3 4.8
5+ 11.9 34.0 47.2 5.5
Exclusive breastfeeding is very important for the well being of child. But there are many
prevalent practices in the families and communities regarding giving prelacteal feeds.
It appears that about three fourth of the newborn babies were given some top milk (other than
the breast milk) before initiating breastfeeding. District wise analysis shows that around 81
percent of children in Sheikhpura, 71 percent in Nalanda and 65 percent in Jehanabad were
given milk other than their mother‟s milk before initiation of breastfeeding. A sizable
proportion of babies were given other liquids like plain water, sugar water or local home made
liquids before initiating breastfeeding. Very small proportions (only 3%) of babies were
initiated on exclusive breastfeeding. In Jehanabad, the prelacteal feeding practice is very
different from other two districts. This may be due to the population composition and
associated rituals. (Table 5.9)
“kuch matayen pehle doodh ko fek deti hain lekin hum samjhate hain ki aap pehla doodh
ko gaar kar chammach se zaroor pilayen kyunki veh bacche ke liye bahut paushtik hota
hai” (Mothers usually discard the colostrum but we (AWW) make them understand that
they should feed the child with the first milk as it is very nutritious for the child) AWW,
Jahanabad (Bihar)

JEHANABAD NALANDA SHEIKHPURA All Districts
Rural Urban Rural Urban Rural Urban Rural Urban
N % N % N % N % N % N % N % N %
Exclusively
13 2.3 3 3.2 16 3.3 5 2.6 15 2.6 2 1.1 44 2.7 10 2.2
breastfeed
Milk (other than 117
368 65.5 54 58.1 349 72.7 135 69.2 458 79.7 148 85.1 72.7 337 72.9
breast milk) 5
Plain water 78 13.9 5 5.4 30 6.3 12 6.2 19 3.3 9 5.2 127 7.9 26 5.6
Sugar or glucose
58 10.3 10 10.8 45 9.4 37 19 20 3.5 9 5.2 123 7.6 56 12.1
water
Sugar-salt-water
2 0.4 2 2.2 2 0.4 1 0.2 5 0.3 2 0.4
solution
Fruit juice 2 0.4 1 1.1 16 3.3 18 1.1 1 0.2
Infant formula 1 0.2 1 0.1
Tea 3 0.5 1 1.1 2 0.3 1 0.6 5 0.3 2 0.4
Honey 3 0.5 4 4.3 10 1.7 1 0.6 13 0.8 5 1.1
Janam ghutti 3 0.6 2 0.3 5 0.3
Other 34 6 13 14 19 4 6 3.1 48 8.3 4 2.3 101 6.2 23 5
Total (N) 562 93 480 195 575 174 1617 462
In the table 5.10 we looked at the proportion of mothers who had exclusively breastfed by
background variables i.e. gender of the child, age and education of mothers, number of live
children, location of PSU and wealth index. For this analysis, only mothers of children beyond
6 months of age were considered and all mothers who were currently breastfeeding but had
children who were younger were not considered.
The situation of exclusive breastfeeding practices is not very encouraging in Bihar. Among
the infants aged more than 6 months, around 27 percent of children were exclusively
breastfed up to 6 months after birth and rest mothers (about 73%) discontinued exclusive
breastfeeding within 6 months.
Exclusivity of breastfeeding was not influenced by educational status of women, locality of

residence of women, birth order of the child or economic status of the family. But exclusive
breastfeeding is highest (38.6%) among young mothers (15 to 18 years of age) and lowest
(16.7%) among oldest mothers. In fact, education of mother, economic profile of family and
number of live children, there seems to have been no significant correlation or trend but
mothers residing in urban areas are having slightly lower proportion of discontinuation of
exclusive breastfeeding before six months of children‟s age.

Background variables < 6 months 6 months and more months
Boys 908 73.9 320 26.1
Girls 813 72.2 313 27.8
Total 1721 73.1 633 26.9
Age of the Respondent (in Years)
15-18 35 61.4 22 38.6
19-21 281 73.6 101 26.4

Background variables < 6 months 6 months and more months

22-25 599 73.1 220 26.9
26-30 508 73.0 188 27.0
31-40 283 74.1 99 25.9
41-49 15 83.3 3 16.7
Total 1721 73.1 633 26.9
Years of schooling
No schooling 1113 73.2 408 26.8
<5 44 73.3 16 26.7
5-7 157 69.5 69 30.5
8-9 137 72.1 53 27.9
10-11 196 77.2 58 22.8
12 & Above 74 71.8 29 28.2
Total 1721 73.1 633 26.9
Number of Live Children
1-2 858 72.9 319 27.1
3-4 582 73.7 208 26.3
5+ 281 72.6 106 27.4
Total 1721 73.1 633 26.9
Location of PSU
Rural 1527 73.6 549 26.4
Urban 194 69.8 84 30.2
Total 1721 73.1 633 26.9
Wealth Index
Lowest 909 73.9 321 26.1
Second 251 71.3 101 28.7
Middle 205 73.0 76 27.0
Fourth 186 73.8 66 26.2
Highest 170 71.1 69 28.9
Total 1721 73.1 633 26.9
Summary Observation
Incidence of weighing baby after birth is reported very rare in Bihar. Reason for the same
revealed from FGD with ANM and in-depth interview with ANMs, ASHAs and Anganwadi
Workers where they stated that most of them were not equipped with proper weighing
machine for weight measurement of the newborn.
It is important to mention that first health checkup within ten days after birth was reported very
low in Bihar. At the same time around two third mothers received support from non-trained
persons like mother/mother in-law, friends and Dais while there should be more involvement
from ANM/ASHA/ AWW.
In Bihar the percent of the women initiating breastfeeding within an hour of childbirth is
substantially less than the proportion of institutional deliveries, suggesting that even in health
institutions also early initiation of breastfeeding was not ensured. ASHAs are more close to
mothers than any other health workers in rural areas and they counsel them on breast
feeding practices like give mother‟s first milk to the child, exclusive breast feeding up to six
months, mother‟s milk enhances the immunity of the child etc.
However, Accredited Social Health Activist (ASHA), Anganwadi Worker (AWW) and Auxiliary
Nurse Midwife (ANM) etc are the personnel who contact/ stays/visit in the community and
interact with general population as compare to other health care provider. Though they know
community very well so that they can give more awareness to the people and eliminate the
barriers more effectively if they receive adequate training periodically and as well as provide
them incentives.

CHAPTER – 6
CHILD MORBIDITY AND TREATMENT

Diarrhea and Acute respiratory infections have been globally identified as posing major
threats to survival of children under the age of five. This is also true for India, where these two
diseases have been the major causes behind infant mortality. Prevention as well as effective
treatment of these diseases depends on a host of individual, household and community level
behavioural factors. One of the objectives of this study is to estimate the role played by such
factors in determining the utilisation of formal health care to cure diarrhea and certain
respiratory illnesses plaguing newborn. The Reproductive Child Health programme includes
components like treatment of diarrhea and ARI and health education to mothers on
management of Diarrhea and danger signs of ARI. The paramedical and medical staffs are
trained to diagnose the cases of pneumonia among the children and treat the cases of
pneumonia and diarrhea. All the government health institutions are supplied with the
medicines necessary for the treatment of pneumonia and diarrhea. The major findings of the
study are as follows:
6.1 Prevalence of illness in children under study
The following section looks at the prevalence of child morbidity and to know about the same
few questions has been asked from eligible mothers about incidences of diarrhoea and fever
of children in last two weeks prior to the survey date.
Table 6.1: Prevalence of illness in children under study, NIPI-08
Indicator Jehanabad Nalanda Sheikhpura All NIPI Districts

Rural Urban Rural Urban Rural Urban Rural Urban Total
% % % % % % N % N % N %
% of children with diarrhoea in last two weeks
Yes 1.9 1.2 5.9 6.1 6.1 7.4 154 4.5 47 5.1 175 4.6
% of children with fever in last two weeks
Yes 6.8 4.8 17.6 19.0 10.6 9.2 393 11.6 112 12.3 443 11.5
Table 6.1 depicts that around 4.6 percent of children were suffering from diarrhea and it is
lowest among the children of Jehanabad (1.9% for rural and 1.2 for urban). About twelve
percent of children were suffering from fever also and again Jehanabad secured lowest
proportion of children with fever (6.8% for rural and 4.8 for urban). At the state level there is
no much difference in the prevalence of diarrhoea and fever but both are more in urban areas
than rural counterpart.
As per NFHS-3 estimates, in Bihar 6.8 percent of children had ARI in past two weeks prior to
the survey while national average was 5.8 percent. After NFHS-1 prevalence of diarrhoea in
Bihar became down (17.7 percent) from national average of 19.2 percent while for NFHS-3
the data in not available.

Table 6.2: Prevalence of illness in children under study (as per NFHS)
Bihar India
Indicator NFHS-3 NFHS-2 NFHS-1 NFHS-3 NFHS-2 NFHS-1
(2005-06) (1998-99) (1992-93) (2005-06) (1998-99) (1992-93)
Prevalence of ARI during two weeks
6.8 21.7 4.3 5.8 19.3 6.5
prior to survey
Prevalence of Diarrhoea during two
- 17.7 13.7 9.0 19.2 10.0
weeks prior to survey
6.1.1 Point prevalence of child morbidity
Table 6.3 is showing the overall diarrhoea point prevalence rate (at the time of survey) among
children who had diarrhoea and other illness in past two weeks prior to the survey. At the time
of survey 14.5 percent children were currently suffering with diarrhoea that faced diarrhoea in
last weeks from the survey date. Also, more than 50 percent of children were suffering with
fever or cough or both illnesses at the survey time who faced these illness within past two
weeks prior to the survey.
Table 6.3: Point prevalence of diarrhoea and illness, NIPI-08
Morbidity JEHANABAD NALANDA SHEIKHPURA All NIPI Districts

% % % % % % % % %
Diarrhoea 23.1 23.1 16.4 20.0 14.5
Fever only 23.2 26.1 35.5 25.4 22.2 25.3 29.4 25.0
Cough only 20.7 12.8 14.0 16.7 14.8 5.9 14.4
Both fever and cough 13.4 100 17.7 6.5 11.4 16.7 15.0 13.7 12.1
6.1.2 Period prevalence of child morbidity
Overall the period prevalence rate (last 2 weeks prior to the survey contact) was 4.6%, which varied
between 4.5 percent in rural areas and 5.1 percent in urban areas. The period prevalence levels were
highest in Sheikhpura (6.1% rural and 7.4% urban) and lowest in Jehanabad district (5.5% and 5.0%
respectively).
Table 6.3: Period prevalence of diarrhoea, NIPI-08

% % % % % % N % N % N %
% of children with diarrhoea in last two weeks
Yes 1.9 1.2 5.9 6.1 6.1 7.4 154 4.5 47 5.1 175 4.6
No 97.3 98.4 92.3 92.4 93.1 92.6 3199 94.3 859 94.1 3629 94.4
DK 0.8 0.4 1.8 1.5 0.8 38 1.1 7 0.8 39 1.0
Total 100.0 100.0 100.0 100.0 100.0 100.0 3391 100.0 913 100.0 3843 100.0

6.1.3 Awareness of Diarrhoea

Figure 6.1: Type of practices followed if child gets diarrhoea
35
26.9
30
34.9
25
16
20 13.7 13.1 14.3
15
8
10
5
0
GIVE ORS SALT AND SUGAR SOLUTION

CONTINUE NORMAL FOOD CONTINUE BREASTFEEDING
GIVE PLENTY OF FLUIDS ANY OTHER
DONT KNOWN
Almost 35 percent mothers given ORS to their children during diarrhoea about 27 percent
mothers were stated to continue breastfeeding when child gets diarrhoea. Sixteen percent
mothers stated that they don‟t know what to do when a child gets diarrhoea while earlier they
have reported their child had diarrhoea in past two weeks prior to the survey date.
6.1.4 Treatment of Diarrhoea

Table 6.4: Advice received from ANM or health worker, NIPI-08
All NIPI Districts
Rural Urban Total
N % N % N %
Yes 52 33.8 14 29.8 59 33.7
No 102 66.2 33 70.2 116 66.3
Total 154 100 47 100 175 100
Around one third of the women whose child was suffered with diarrhea in last two weeks were
counseled by ANM/health workers towards the treatment of diarrhoea.
Table 6.5: Place of treatment, NIPI-08

Total
NIPI DISTRICTS
Place of treatment
JEHANABAD NALANDA SHEIKHPURA N %
N % N % N %
Government/municipal
hospital 0 0.0 0 0.0 2 3.3 2 1.6
Government dispensary 0 0.0 0 0.0 1 1.6 1 0.8
Uhc/uhp/ufwc 0 0.0 0 0.0 1 1.6 1 0.8
Chc/ rural hospital 0 0.0 0 0.0 0 0.0 0.0
PHC 0 0.0 0 0.0 4 6.6 4 3.1
Sub center 1 7.7 1 1.8 1 1.6 3 2.3
Govt.ayush hospital/clinic 0 0.0 0 0.0 0 0.0 0 0.0
Private ayush
hospital/clinic 1 7.7 20 36.4 9 14.8 30 23.3
Private Hospital/ Clinic 7 53.8 25 45.5 30 49.2 62 48.1
Other 5 38.5 9 16.4 14 23.0 28 21.7
13 55 61 129

From table 6.5 it can be seen that private and other health facilities are the main places for
treatment of children with diarrhoea. Percentages of government facilities are negligible as
compare to its other counterparts.
6.2 Acute Respiratory Infection
During the survey, we attempted to capture the issues related to awareness and treatment
practices for Acute Respiratory Infection (ARI). The awareness level in urban areas was
found to be higher than rural areas for all the three study districts.
6.2.1 Knowledge about Pneumonia
Table 6.6: Proportion of mothers aware of the term pneumonia, NIPI-08

% % % % % % N % N % N %
Yes 71 68.5 85.8 84.3 81.5 86.7 2686 79.2 737 80.7 3068 79.8
No 29 31.5 14.2 15.7 18.5 13.3 705 20.8 176 19.3 775 20.2
Total 100 100 100 100 100 100 3391 100 913 100 3843 100
Around 80 percent of the mothers were aware about the features of ARI (pneumonia) in
which about two third were aware about wheezing/whistling followed by chest in-drawing
(53.3%), rapid breathing (47.5%), difficulty in breathing (42%) and pain in chest and
productive cough (32%). Findings are almost similar across the districts.
Figure 6.2: Awareness of Symptoms of Pneumonia

Difficulty in breathing
80
Chest in drawing
70
60 Not able to drink or take a feed
50 Excessively drowsy and difficult to keep

awake
40 Pain in chest and productive cough
30
Condition gets worse than before
20
Wheezing/whistling
10
0 Rapid breathing
Rural Urban Total Others
Figure 6.2 shows the awareness among women on the different features of Acute Respiratory
Infection. Less than 10 percent of mothers reported that not able to drink or take a feed, excessive
drowsy and difficult to keep awake, condition gets worse than before etc can be the symptoms of
Pneumonia.
Table 6.7: Prevalence of ARI during 2 Weeks prior to survey

Bihar India
Indicator NFHS-3 NFHS-2 NFHS-1 NFHS-3 NFHS-2 NFHS-1
(2005-06) (1998-99) (1992-93) (2005-06) (1998-99) (1992-93)
Prevalence of ARI during two weeks
6.8 21.7 4.3 5.8 19.3 6.5
prior to survey
Source: NFHS 2 and 3 (fact sheets)

On an average, 29 percent of children have ever suffered from pneumonia in the 3 study
districts. The prevalence of pneumonia is highest in Nalanda (35.9%) and lowest in
Jehanabad (20.3%). Its prevalence in urban areas is lower than the rural areas across the
study districts. Prevalence of Pneumonia at the state level was 28.5% (ever suffered) while it was
27.3% in the urban areas and 29.1 percent in rural areas.
Among those who had suffered from pneumonia; about 93 percent had consulted someone
for the treatment. Most common source of treatment was qualified doctors in case of more
than three fourth children followed by UMP/RMP (14.8%) and Chemists (4.3%). In Jehanabad
and Sheikhpura, more UMP/RMP was consulted in comparison to Nalanda where around 90
percent children had taken treatment from qualified doctors. Visit to qualified doctors for
treatment of Pneumonia is prominent in urban areas as compared to the rural counterparts
(table 6.7).
Table 6.7: Treatment of Pneumonia, NIPI-08

Sought treatment
N % N % N % N % N % N % N % N % N %
Yes 221 88.4 29 78.4 393 94.5 132 93.6 306 95.3 69 97.2 920 93.2 230 92.4 1021 93.2
No 29 11.6 8 21.6 23 5.5 9 6.4 15 4.7 2 2.8 67 6.8 19 7.6 74 6.8
Total 250 100.0 37 100.0 416 100.0 141 100.0 321 100.0 71 100.0 987 100.0 249 100.0 1095 100.0
Percentage distribution of women who seek treatment by

Doctor 131 59.3 16 55.2 349 88.8 128 97.0 210 68.6 60 87.0 690 75.0 204 88.7 784 76.8
ANM/NURSE/LHV 2 0.9 3 0.8 11 3.6 2 2.9 16 1.7 2 0.9 18 1.8
Trained dai 1 0.5 1 3.4 1 0.1 1 0.4 1 0.1
Untrained dai 1 0.5 2 0.7 3 0.3 3 0.3
UMP/RMP 50 22.6 2 6.9 31 7.9 3 2.3 66 21.6 7 10.1 147 16.0 12 5.2 151 14.8
Relatives/ friends 8 3.6 3 10.3 4 1.0 5 1.6 17 1.8 3 1.3 17 1.7
Chemist/ medical
28 12.7 7 24.1 4 1.0 1 0.8 11 3.6 43 4.7 8 3.5 44 4.3
shop
Ayush practitioner 2 0.5 1 0.3 3 0.3 3 0.3
Total 221 100.0 29 100.0 393 100.0 132 100.0 306 100.0 69 100.0 920 100.0 230 100.0 1021 100.0
6.3 Fever
Fever is one of the three significant child morbidities; hence the survey covered the series of
questions related to fever i.e. its prevalence within two weeks prior to the survey, duration and
treatment seeking behavior.
6.3.1 Illness with Fever and Treatment Seeking Behavior
Table 6.8: Incidence of fever and cough among children in last 2 weeks prior to the survey
contact, NIPI-08
% % % % % % N % N % N %
Yes 6.8 4.8 17.6 19.0 10.6 9.2 393 11.6 112 12.3 443 11.5
No 91.9 95.2 81.3 78.4 89.2 90.8 2968 87.5 791 86.6 3366 87.6
DK 1.3 1.1 2.5 0.2 30 0.9 10 1.1 34 0.9

Total 100.0 100.0 100.0 100.0 100.0 100.0 638 100.0 168 100.0 712 100.0
Around one tenth (11.5%) of children had suffered from fever in two weeks prior to the survey
in both rural and urban areas. In Nalanda district more children from urban areas suffered
with fever/cough in past two weeks prior to the survey date.
Table 6.9: Duration of treatment sought during illness, NIPI-08

All NIPI Districts
Rural Urban Total
N % N % N %
2 days ago 188 29.5 39 23.2 203 28.5
3 - 4 days ago 95 14.9 26 15.5 107 15.0
5 - 6 days ago 89 13.9 25 14.9 100 14.0
Week or more than a week 266 41.7 78 46.4 302 42.4
Total 638 100.0 168 100.0 712 100.0
More than 41 percent of children had suffered from their bought of fever/cough for at least one week
and 71% had suffered for more than 3 days.
Approximately 28 percent mothers with children suffered with fever/ cough reported that their
children had chest congestion while 34.5 percent children had both chest congestion and
runny nose. More than 41 percent mothers reported that their children had runny nose only
during illness with fever/ cough.
Treatment seeking behavior in case of fever is quite common. Around 85 percent children
with fever had taken advice or treatment from any source. Sheikhpura had highest proportion
(93.1%) of children with fever taking advice or treatment. Most (79.8%) of the children had
received advice or treatment after 2 days of start of symptoms. Major source of the advice or
treatment for children with fever was private doctors in two third of cases followed by
UMP/RMP. Advice or treatment from government sources was negligible.
When it comes to availing medicines, 45 percent cases received it from qualified doctors
followed by chemists (26.4%) and UMP/RMP (19.6%). Medicines from UMP/RMP were
received mainly in rural areas. Families approached more UMP/RMP in Jehanabad and
Sheikhpura for medicines whereas more families approached qualified doctors in Nalanda for
the same.
ASHA with her medicine kit at „service‟ of ANM
 Respondent ASHAs aware about danger signs and symptoms of Anaemia, Malaria, Pneumonia
and Diarrhoea.
 Respondents also provided First Aid to children and infants
 The respondents were usually equipped with a medicine box containing
 Paracetamol
 ORS
 Chloroquine
 Betadine
 Surgical Gauze
 Cotton
 Oral Contraceptive Pill
 Vitamin A
 Leprosy medicine

It was the usual case to find multiple service providers in the same area, viz., ASHA and AWW, yet
much left to be desired of the help received by mothers and infants.
While AWW was busy with taking care of the children under her supervision, ASHA was not aware of
any emergency that might have come to notice of AWW.
And it was vice versa, when ASHA came to know of any critical case, she also waited for ANM to refer
her case to, with AWW remaining in the dark
6.3.2 Feeding Practices during Illness
Almost 50 percent children during illness with fever received somewhat less or much less
liquids than normal days while 35 percent continued as normal days. At the same time 5.4
percent mothers stopped giving liquids to the children during fever/cough of children.
In around one fourth (27%) of the children the feeding practice remained unchanged during
fever. About 40 percent of children received somewhat less feeding than the previous
amount. Around 3 percent children were stopped feeding during illness and another 11
percent were never given food during illness.
6.3.3 Care Seeking Practices during Illness with fever
This section will provide insights at various facets of treatment and preventive measures
having been taken, money spent on treatment and problems faced if any in getting the
desired treatment for the child. Overall, 90% of the mothers had confirmed that their child was
being given medicines for their illness. 35.6% had conformed that they had started giving
medicines within 24 hours of detecting the illness.
Figure 6.3: Preventive measures taken for avoiding child sickness
100
90
80
70
60
50
40
30
20
10
0
Rural Urban Total
Mosquito Net Purified Drinking Water Keep the baby covered Others
Among mothers who had taken their child to a health facility/health care provider for
treatment/diagnosis, in both rural and urban areas they reported that they had not faced any
problem in the process.
Sixty percent mothers in each rural and urban area had to spend more than Rs.200 for
treatment of their child. Less than 3 percent of mothers reported that they didn‟t spend any
money at all.

Summary Observation
As per recent national level survey estimates morbidity among children is low in the state or
closer to the national level but it important to mention that those who suffered with an illness
in past two weeks prior to the survey date many of them were suffering with illness to the
survey date. Though mothers had treatment of their children but going out for treatment is late
and it can be dangerous for baby‟s life.
Only 35 percent children with diarrhoea received ORS while 16 percent mothers with children
had diarrhoea in past two weeks from survey date revealed that they don‟t know what to do
when child gets diarrhoea.
Respondents utilizing government health care facilities are very low or negligible which not
only costs extra on population from low economic strata but also push them to visit quacks
and practicing home remedy in any illness.
Almost 80 percent mothers stated that they are aware about Pneumonia but when we looked
into awareness about symptoms of Pneumonia their awareness level is inadequate. Due to
inadequate awareness of mothers, children received much less or somewhat less intake of
liquids and food than normal days which can lead to weaker health.
Above mentioned situations demand that there be some unified and concerted effort on part
of all service providers.

Chapter 7
Child Immunization
7.1 Preamble
The immunization of children against six serious but preventable diseases namely,
tuberculosis, diphtheria, pertusis, poliomyelitis and measles is the main component of the
child survival programme. As part of the National Health Policy, the National Immunization
Programme is being implemented on a priority basis. The Government of India initiated the
expanded Programme on Immunization (EPI) in 1978 with the objective of reducing morbidity,
mortality and disabilities among children from six diseases.
The universal Immunization Programme(UIP) was introduced in 1985-86 with the objective of
covering at least 85 percent of all infants against six vaccine preventable diseases by 1990.
This scheme was been introduced in every District of the country. The standard immunization
schedule developed for the child immunization programme specifies the age at which each
vaccine should be administrated and the number of doses to be given. Routine vaccinations
received by infants and children are usually recorded on a vaccination card that is issued for
the child.
7.2 Vaccination coverage
This section provides the coverage details of different vaccinations including Polio „0‟, BCG,
Polio „1‟, „2‟ and „3‟, Measles and Vitamin A and whether or not coverage varies across
Districts, by sex of the child, by location of the PSU, by the child‟s birth order or even by the
education of the mother. For this analysis, we had taken children who were 12-23 months of
age and the evidence is entirely through service records, i.e. Immunization card available with
the household concerned.
Table 7.1: Percent of households having vaccination cards on the day of survey, NIPI-08
Jehanabad Nalanda Sheikhpura BIHAR

Source of information
N % N % N % N %
Yes (card seen) 650 50.7 492 38.0 484 37.8 1626 42.1
Yes (card not seen) 550 42.9 683 52.7 681 53.2 1914 49.6
No card 83 6.5 121 9.3 115 9.0 319 8.3
Total 1283 100 1296 100 1280 100 3859 100
Overall about 42% children in the three districts had a vaccination card available. Vaccination
cards for about 51% of the children were available on the day of survey in Jehanabad, while
in Nalanda and Sheikhpura about 37% of children had vaccination cards.
In order to have some degree of reliability and accuracy in the study findings, the vaccination
cards constitute the source of the data in this study.
The following sections in this chapter presents analysis of vaccine coverage among children,
aged 12 months or more, for whom vaccination card was available and seen on the day of
survey.

Table 7.2: BCG and Polio „0‟ coverage by background variables, NIPI-08
BCG Polio 0
Districts N % N %
Jahanabad 304 98.7 98 31.8
Nalanda 249 97.3 22 8.6
Sheikhpura 214 95.1 67 29.8
BIHAR 767 97.2 187 23.7
Sex of the Child
Boy 404 97.6 94 22.7
Girl 363 96.8 93 24.8
Location of PSU 0
RURAL 677 97.1 165 23.7
URBAN 90 97.8 22 23.9
Birth order of child
1 197 99 36 18.1
2 to 3 303 96.8 77 24.6
4 to 5 165 95.4 41 23.7
6+ 100 98 32 31.4
Years of schooling
No education 487 96.6 121 24
Below 5 20 100 6 30
5 to 7 78 98.7 18 22.8
8 to 9 68 98.6 20 29
10 to 11 88 96.7 20 22
12 & above 26 100 2 7.7
In all the sampled districts as high as 97 percent children received BCG but Polio „0‟ coverage
was near about 24%. The coverage of Polio „0‟ was highest in Jehanabad (31.8%) but much
lower in Nalanda (8.6%).
Coverage of Polio 0 was marginally higher among girls than boyss but not significantly slow to
conclude in favour of any gender bias in coverage. Polio 0 coverage in urban and rural areas
are almost same.
Table 7.3: Polio vaccine coverage by background variables, NIPI-08
Polio 1 Polio 2 Polio 3

Districts N % N % N %
Jahanabad 289 93.8 254 82.5 225 73.1
Nalanda 248 96.9 211 82.4 189 73.8
Sheikhpura 204 90.7 176 78.2 158 70.2
BIHAR 741 93.9 641 81.2 572 72.5
Sex of the Child
Boy 383 92.5 336 81.2 306 73.9
Girl 358 95.5 305 81.3 266 70.9
Location of PSU
RURAL 652 93.5 565 81.1 504 72.3
URBAN 89 96.7 76 82.6 68 73.9
Birth order of child 0 0 0
1 191 96 165 82.9 148 74.4

Polio 1 Polio 2 Polio 3

2 to 3 293 93.6 259 82.7 229 73.2
4 to 5 159 91.9 137 79.2 120 69.4
6+ 96 94.1 78 76.5 73 71.6
Years of schooling
No education 475 94.2 408 81 366 72.6
Below 5 17 85 15 75 15 75
5 to 7 73 92.4 65 82.3 55 69.6
8 to 9 66 95.7 57 82.6 50 72.5
10 to 11 84 92.3 72 79.1 65 71.4
12 & above 26 100 24 92.3 21 80.8
The incidence of Polio 1, 2 and 3 having been given to the index child is very high and with little
variations across background variables.
Table 7.4: Child Immunisation Coverage in NIPI Districts, Bihar
BIHAR Jahanabad Nalanda Sheikhpura

% % % %
All Basic Vaccinations

41.4 38.3 54.2 47.2
BCG 81.5 74.5 88 85.4
POLIO3 53.1 48.3 62.8 48.7
DPT3 54.4 49.2 65.1 55.1
MEASLES 54.2 49.3 69.1 63.9
percentage received at least
one dose of Vitamin A 49.9 49.3 59.4 66
BCG and measles and 3 doses of polio and DPT
Source: District Level Household Survey (2007-2008)
DLHS3 shows that nearly more than half of the children received all three doses of DPT
vaccination in Bihar while equal doses of DPT was recorded in Sheikhpura (55.1%) .
Consequently a slightly lower coverage of DPT vaccination was observed in Jehanabad (all
three doses of DPT vaccination.) (See table 7.4).
Table 7.5: DPT vaccine coverage by background variables, NIPI-08
DPT 1 DPT 2 DPT 3

% % %
Jahanabad 88.6 83.1 71.1
Nalanda 91.4 82.8 71.9
Sheikhpura 92.9 85.8 72.9
BIHAR 90.7 83.8 71.9
RURAL 91.1 84.5 72.3
URBAN 88 78.3 68.5
The rural urban difference in coverage of DPT was observed to be minimal.

Table 7.6: Coverage of Measles vaccine and Vitamin A by background variables, NIPI-08
Measles Vit. A
Districts % %
Jahanabad 63.6 41.2
Nalanda 66.8 41
Sheikhpura 67.6 42.7
BIHAR 65.8 41.6
Sex of the Child
Boy 64 40.3
Girl 67.7 42.9
Localtion of PSU
RURAL 65.6 41.8
URBAN 67.4 40.2
Birth order
1 68.8 42.2
2 to 3 64.2 41.5
4 to 5 63.6 39.9
6+ 67.6 42.2
Years of schooling
No education 66.5 40.7
Below 5 75 50
5 to 7 58.2 38
8 to 9 60.9 36.2
10 to 11 70.3 49.5
12 & above 65.4 50
There was no considerable variation in coverage of measles vaccine and Vitamin A, not only
across Districts but also across different background characteristics of the mother.
Incidence of full coverage did not vary significantly with the location of the PSU. It also did not
vary much with the gender of the index child.
Vaccination for each type of vaccine is much higher in urban areas than in rural areas except
for the vaccine of DPT in which rural areas shows higher percentage of vaccination. As per
general perception and also supported by NFHS survey, it has been found that boys receive
better services than their female counterparts but interestingly in the study districts, girls have
received more vaccination than boys. There are only 48.6 percent of boys against 54.4
percent girls who received some vaccination. Barring few cases, girls are receiving more
vaccines in comparison to boys.
At the state level, in Bihar it has been found that the coverage of „any vaccination‟ and that of
„individual vaccination‟ is higher in case of the first child and it decreases with the increase in
birth order. But a contrast is observed with the variation of the family size. The coverage is
higher in the families with 6 or more children than in the families with 2 to 5 children.
With the use of maternal health care services, a strong positive relationship exists between
mother‟s education and children‟s vaccination coverage. There has been increase in the
percentage of „any vaccination‟ with the increase in the level of education among mothers.
Mothers who have attained 12 years of education got her children 100% vaccinated for one or
the other vaccine. The coverage is low in the families with women having no education than
the literate women. In Jahanabad not much difference has been found in the percentage of
vaccination of children on the basis of education level of mothers.
There are considerable inter-district differentials in the coverage rates for different
vaccinations and for children receiving all vaccinations. The percentage of children who are
fully vaccinated ranges from 48 percent in Nalanda to 56 percent in Sheikhpura. The situation
is in contrast when individual vaccines are seen district wise. In Sheikhpura which is showing
highest percentage (56%) of children vaccinated for all basic vaccines, the percentage of
children receiving vaccines for BCG and Polio is much less than the other two districts of
Nalanda and Jahanabad.
During discussion with ASHA it was revealed that their main responsibility is to check for
the complete immunization of children in the village. They visit home to home for checking
and registering children for the immunization as registration is the best way to keep a track
of immunization of children in the village. According to ASHAs “Muskan” program has also
helped in increasing the level of immunization.
When ANM were asked about their responsibilities towards newborn, maximum said that
immunization of children is their prime responsibility. They were also of the view that to
reduce maternal and child mortality, immunization of all mothers and children is must.
According to ANM the constraints faced by them regarding distribution of vaccines are lack
of cotton and medicines, lack of supply of DPT vaccine and vaccination not available for
few months and because of these reasons they fail to reach the people on time.
Discussion with AWW reveals that they consider immunization of mothers and children as
their main responsibility. They said that still there are many people who deny getting the
pregnant women and children vaccinated and for this AWW advice people by home visits,
spread information in the village, gather people at AWC and educate them.
Table 7.6a: Immunization coverage – all basic vaccines
All Basic Vaccination

District
N %
Jahanabad 157 51
Nalanda 123 48
Sheikhpura 125 55.6
All basic vaccines cover the following:
 BCG
 DPT 1, 2 and 3
 OPV 1, 2 and 3
 Measles
NFHS-3 shows that a third (32.8 percent) of the children of 12-23 months were fully
immunised in Bihar. The immunisation figures for Bihar are worse than the national average.
It is also noted that there is a steady increase in the immunisation coverage over the last two
decades.

Overwhelmingly, NIPI baseline survey shows that the full immunization coverage varied
considerably among the three program Districts with Shiekhpura having the best performance
(55.6%) and Nalanda having the worst (48%).
Table 7.7: Place of immunization received, NIPI-08
Place of Receiving most of the Jehanabad Nalanda Sheikhpura BIHAR

vaccinations N % N % N % N %
In Laws Home 9 1.6 9 1.6 51 9.4 69 4.1
Parent's Home 22 3.8 19 3.4 43 7.9 84 5.0
Other Home 2 0.3 3 0.5 19 3.5 24 1.4
Govt. / Municipal Hospital 9 1.6 35 6.3 14 2.6 58 3.5
Govt. Dispensary 3 0.5 2 0.4 1 0.2 6 0.4
UHC/UHP/UFWC 2 0.3 2 0.4 1 0.2 5 0.3
CHC/Rural Hospital 4 0.7 2 0.4 6 0.4
PHC 43 7.4 64 11.5 40 7.4 147 8.8
Sub Centre 117 20.2 49 8.8 66 12.2 232 13.8
NGO/Trust Hospital/Clinic 2 0.3 6 1.1 4 0.7 12 0.7
Govt./Ayush Hospital/Clinic 7 1.3 1 0.2 8 0.5
Pvt. Hospital/Clinic 4 0.7 9 1.6 13 0.8
Other 88 15.2 109 19.5 80 14.8 277 16.5
Total N 579 100.0 558 100.0 541 100.0 1678 100.0
Outreach of the programmes and availability of the health services at an accessible place is
of utmost importance in delivering a quality service. When interviewed with mothers about the
place where they get their child vaccinated, varied responses came out from the three
districts. In Jehanabad (20%) and Sheikhpura (12%) sub center was the most common place
for women to bring their children for vaccination, where as in Nalanda, it was PHC where
(11.5%) most of children got vaccinated. In - law‟s home and parent‟s home were next
common places in Sheikhpura where their children get vaccinated. It was an altogether
different scenario in Nalanda where most of the children were vaccinated in either SC (9%),
PHC (11.5%) or government hospital (6%). Taking Bihar as a whole, PHC (9%) and SC
(14%) were most common, and the next common places were in law‟s home (4%) and
parent‟s home (5%).
Table 7.8: Problems faced by mother/community in vaccinating the child, NIPI-08
DISTRICT
Total Total Total
N % N % N %
No time from daily wage work 300 23.8 349 26.7 319 25.1
Distance of Health Facility/ Vaccination
Centre 286 22.6 243 18.6 235 18.5
Irregular presence of health professional
125 9.9 142 10.9 97 7.6
Non- availability of vaccines 112 8.9 184 14.1 55 4.3
DONT KNOWN 93 7.4 63 4.8 185 14.5
NO PROBLEM FACED 566 44.8 561 42.9 562 44.2
OTHER 8 0.6 8 0.6 9 0.7
43-45% mothers did not see problems in vaccinating their child.

Dropout Rates
In all the three districts, there is considerable drop from the first to the third dose both for DPT
and polio, and in almost every district fewer children have received measles vaccines (highest
in Jehanabad with 34% drop out rate) than any of the other vaccinations except polio 0.
Sheikhpura has witnessed highest drop out rate in Polio 1 vaccine (6%) where as Jahanabad
has shown the greatest drop out rate in the first vaccine of DPT (10%)
The study reveals that the immunization coverage in the three districts of Bihar is very low.
Ignorance and illiteracy among the mothers and population as a whole leads to the low level
of immunization of children. Of the three districts Nalanda hold the bottom position in
vaccination coverage.
“Striyan bukhar ke karan bacchon ko tika nahi lagvati hain…..ghar ane se rokti
hain………aur jansankhya adhik hone ke karan kaam dhang se nahi ho pata hai…”
(Women do not get their child vaccinated because of the fear of fever and they even
deny ANMs to come their home and the area with each ANM is too large to cover) ANM,
Shiekhpura (Bihar)
“Manjhi, mushar jati ke log teekakaran se mana karte hain” (the people of manjhi and
mushar caste restrict their children from getting vaccinated) ANM, Jahanabad (Bihar)

Chapter 8
Status OF Health Facilities
8.1 Status of District Hospital (DHs)
In the hierarchical health care system of the Government of India in a district, the district
hospital is the apex body, which provides specialized health care services to people on
subsidized costs. Every district is expected to have a district hospital. The information
collected and analyzed in this section relates to 3 district hospitals of Bihar.
8.1.1 Infrastructure
Physical infrastructure was fair for all the three study district hospitals. All three had a
separate government building with 24 hour water supply.
All the district hospitals had three phase electricity connection. But the standby facility in the
form of generator was available in two hospitals only.
All the three district hospitals had functional toilet facility separately for male and female.
Telephone facility was available in all the district hospital but all section of the hospital did not
have a telephone facility in two DHs. All the DHs had at least one vehicle and one
ambulance.
Personal computer was available in only two district hospitals with NIC terminal but only one
had access to internet facilities.
Two DHs had Integrated Counseling and Testing Centre (ICTC) in place.
In all the three DHs quarter for medical superintendent and doctors were available and most
of them were residing on the quarters. Quarters for nurses were available in only one DH.
Display boards, separate registration counter and pharmacy was present in all the DHs.
Out Patient Department (OPD) rooms were available only in two DHs.
Ward wise separation was available in all DHs. But child and newborn care related wards was
available only in two DHs.
Aseptic and clean labour room, Delivery room and examination and preparation room was
available in all the DHs. While neo natal room, sterilization room and sterile store room was
present in two DHs only.
Operation Theatre (major) was available in all the three DHS while emergency OT/family
welfare OT was available in two DHs only.

8.1.2 Availability of Human Resource
On an average there is 11 lakh populations in the district. As per the IPHS guidelines, for
such a population, there should be 200-300 beded hospital. For a smallest size of sub-district
hospital (31-50 bedded), there should be 22 doctors and 49 para medical staff in place. But
the situation is quite alarming in all the districts and none of the district hospital is meeting
requirements as per IPHS guidelines.
All the district hospitals had medical superintendent, specialist (medicine), specialist
(surgery), obstetrician/gynecologist and anesthetist. Pediatrician was positioned in two DHs
only. Pathologist, dermatologists and radiologists were positioned in only one DH.
On an average around 7 nurses were posted in a DH on which 6 were working in obstetric

department.
8.1.3 Services Delivered by District Hospitals
Investigative and laboratory services were very poor in all the DHs. Only X-ray facility was
available in all the DHs but ultrasound facility was not present. Stool analysis, sputum,
pregnancy, ELISA for HIV test, RA factor test, VDRL test and ECG facilities were available in
two DHs only.
OPD, emergency and referral services were present in all three DHs.
24 hour delivery services including normal and assisted deliveries, emergency obstetric
services including cesarean sections, ANC, INC, PNC, newborn care services and child care
including immunization were available in all three district hospitals.
8.1.4 Monitoring and Supervision Activities
All three district hospitals had conducted medical audit in the last year. All of them reported
that they monitor the activities of sub-centre and PHCs through regular meetings and also
monitor the national health programme. Their work was monitored by Rogi Kalyan Samittee.
8.1.5 Equipment
Baby incubator/ warming units, phototherapy unit, episiomy kit and forceps delivery kit were
available in two district hospitals only.
None of the DHs reported having room warmer, Foetal Doppler, CTG monitor, vacuum
extractor metal and silastic vacuum extractor.
8.2 Status of Community Health Centre (CHCs)
Though not designated as such, community health centers are also first referral units where
referral cases from lower level health care establishments are sent. The CHCs have to take
care of these cases besides their usual health care activities. In three study districts of Bihar
only two CHCs were found (Jehanabad did not have CHC), so the section deals with a total of
2 CHCs.

A Designated government building was available for all 2 CHCs, and all of them had 24 hour
water supply. Regular supply of electricity was available in all 2 CHCs and standby facility in
the form of generator was available in all 2 CHC. Each CHCs had functional toilet facility
separately for male and female.
Telephone facility was available in each CHCs. Personal Computers were available in one
CHC. Ambulance was available in both the CHCs.
Only one CHC had intercom facility.
Residential facility for General Surgeon was available in 2 CHCs. Only at one CHC residential
facility for the Physician and Obstetrician/Gynecologist was available.
8.2.2 Availability of Human Resource
There was less than the required number of Specialists available in all CHCs.
There was only two General Surgeon available in CHCs, 6 Physicians, one pediatrician, 2
General Medical Officers in total for both the CHCs.
There was no Obstetrician/Gynecologists, anesthetist and Eye Surgeon either in position or

on contract in any of the CHCs.
1 Public Health Nurse were available and 6 ANMs in position with 16 ANM on Contractual
basis in position.
At least one staff doctor/nurse/LHV/ANM at CHC was available for 24 hours in only one CHC.
No Gynecologist and Anesthetist were available on call basis in emergency at both the CHC.
8.2.3 Trainings Status of CHC Staff
Training statistics for the Medical Officers of CHC in the last 5 years was as below:
4 Medical Officers had received training on non-scalpel vasectomy training.
Two MO had received HIV/AIDS prevention and cure training as well.
One MO had received integrated management of neonatal and childhood illness training.
Training for Para-Medical staff included:
3 Para-medical personnel received Skilled Birth Attendant training. Two of them received
training on IMNCI.
8.2.4 Investigation Facility

ECG, X-Ray and ultrasound facility was available in both the CHCs.
8.2.5 Labor Room and Operation Theatre
All the two CHCs surveyed had Labor Room and Operation theatre available at the CHC
premises.
8.2.6 Storage Facility
Only one CHC had separate room for drug storage and separate waiting area for the patients
in the OPD of the CHC.
8.2.7 Laboratory
Operational Laboratory was present in both the CHCs of Bihar. Blood storage facility was not
available in any of the CHCs.
8.2.8 Physical Facilities
Total number of functional beds available in all CHCs was 30 averaging 15 beds per CHC.
There are separate wards for males and females in all the CHCs.
8.2.9 Furniture/Instrument
Examination Table, Delivery table, Bedside Screens, B.P Instruments are available in both
the CHCs. Stretcher or Trolley was available in only 1 CHC.
8.2.10 OT Equipments
Boyles Apparatus was available in only one CHC. Oxygen Cylinder 660 liters with regulator
and mask was in one CHC. Emergency Drug tray, IUD insertion kit and Normal Delivery kit
were available in both the CHCs.
8.2.11 Cold Equipments
Large and small deep freezers were available and also in functional condition in both the
CHCs. Walk in coolers and freezers were also available in 2 CHCs.
8.2.12 Vaccines and Prophylactic Drugs
All vaccines, namely BCG, DPT, OPV, DT, Tetanus Toxoid and Measles were available in
both the CHCs of the state.
IFA tablets, Vitamin A syrup, ORS packets was also available at both the CHCs. Tablets
Cotrimaxazole was also available at both the CHCs.

8.2.13 Essential Services
Essential Services like OPD services, 24 hour Emergency Services, Referral Services were
available in all the CHCs.
Blood Storage facility was not available at any of the surveyed CHCs.
8.2.14 Maternal and Child Health Services
Both the CHCs had MCH services like Antenatal care, Intra-natal Care. Postnatal Care and
Newborn Care was available at only one CHC.
24-hour delivery services including normal and assisted deliveries was available in both the
CHCs and Emergency Obstetric Care including C-section was available in only one CHC.
Child care services including Immunization and facilities under Janani Suraksha Yojana were
provided at both the CHCs. MTP facility was being provided by only one CHC surveyed.
8.3 STATUS OF PRIMARY HEALTH CENTRE (PHCs)
The primary health centers have the major responsibility of providing both preventive and
curative health care services in the area. This includes delivery of reproductive child health
services, such as antenatal care and immunization in addition to routine inpatient and out
patient services. Compared to DHs and sub-divisional Hospitals, PHCs are accessible to a
larger population. However, just the availability of PHCs is not sufficient for the effective
delivery of these services. They should also have essential infrastructure, staff, equipment
and supplies. This section presents the status of the 18 PHCs surveyed in three districts of
Bihar with respect to the availability of selected infrastructure, staff, equipment and supplies,
besides training of medical and Para-medical staff.
In all the study districts of Bihar around 89 percent of the PHCs function from their own
building.
In around 94 percent PHCs had functional toilet facility available in which 72 percent had
separate toilet for male and female.
Around one third of PHCs in Bihar had tapped water supply and strikingly 6 percent do not
had water supply at all. Those having water supply about 83 percent had regular supply.
Around 28 percent of PHCs function without electricity. Those having electricity none of them
had regular power supply. Around 83 percent of PHCs had standby facility of generator.
In around 71 percent PHCs labour room and Operation Theater was available and same was
functional also.
About 83 percent PHCs telephone facility was available. 67 percent PHCs had personnel
computers in which 66 percent had NIC terminal and 39 percent having access to internet
facility.

56 percent PHCs had access to at least one vehicle for transporting patients during
emergency.
Only 89 percent of PHCs had in-patient facilities. On an average 11 bed was available at the
PHCs where inpatient facility available. 61 percent PHCs had separate wards for male and
female.
8.3.2 Availability of Human Resources
All the surveyed PHCs had one medical officer in position. While only 38 percent PHCs had
a lady medical officer.
79 percent PHCs having LHV/health assistants in position while all PHCs; having
ANM/female health workers.
Only half of the PHCs had male health assistants. And same proportion; having laboratory
technicians.
8.3.3 Training Status of PHC Staff
83 percent PHCs had organized at least one training programme in last one year. Main topic
of training was Pulse Polio training; ASHA‟s training and training for ANM/male health
workers.
Around 72 percent medical officers had received training on Integrated Management of

Neonatal and Childhood Illness followed by Skilled Birth Attendant training (67%), Integrated
Skill Development Training for 12 days (55%), MTP training (39%), NSV (33%), RTI/STI
(33%) and management of obstetric complication training (28%).
8.3.4 Stock of Vaccines and Prophylactic Drugs
Almost all the surveyed PHCs in Bihar reported having some stock of BCG, DPT, TT and
OPV. About 94 percent having Measles and 78 percent had some stock of DT vaccines. All
the PHCs who had stock were receiving it regularly.
All the PHCs reported having some stock of ORS while 78 percent had IFA and 72 percent
had Vitamin A solution stock. All the PHCs who had stock were receiving it regularly.
8.3.5 Equipment
Around 89 percent PHCs had examination table available followed by delivery table (83%),
Bedside screen (55%) and stretcher on trolley (28%)
78 percent PHCs had weighing machine, 72 percent had normal delivery kit 33 percent had
infant resuscitation bag with mask, 17 percent had equipment for assisted vacuum delivery,
50 percent had equipment for assisted forceps delivery. Vacuum aspiration and baby
warmer/incubator was available in 28 percent PHCs

8.4 Status of Sub Centre (SCs)
Sub-centers are most peripheral health institutions catering to the health care needs of the
rural population. It is the most peripheral contact point between the Primary Health Care
system and the community. It is manned by one multipurpose worker (male) and one
multipurpose worker (female)/ANM. This section presents the findings of 90 SCs from three
districts of Bihar.
8.4.1 Availability of Human Resource at SCs
Around 98 percent SCs had an ANM/Female Health Worker. Only around 26 percent SCs
had a Male Health Worker and an Additional ANM on a Contractual basis was present in
about 49 percent SCs.
8.4.2 Training Status in SCs
The ANM/Female Health Worker was asked about the Training received by them in the last 5
years. The following information was obtained:
Integrated Skill Development Training for 12 days (RCH-1) was attended by 56 percent
ANMs. 99 percent ANMs also attended training for Immunization and around 44 percent had
attended IMNCI training. Skilled Birth Attendant training was received by 56 percent ANMs.
The details of trainings received by Male Health Workers (MHW) are given below:
52 percent MHWs received training on Integrated Skill Development for 12 days (RCH-1).
Training on Immunization was imparted to 87 percent MHWs. Only 17 percent MHWs
received training on IMNCI.
8.4.3 Physical Infrastructure
A Designated Government building was available for the SC in 30 percent cases. In case of
the SC functioning in a non-government building, 77 percent such SCs are located in a rented
building.
Water Supply: 17 percent of the SCs didn‟t had a water supply at all. Out of the SCs with
water supply, 77 percent had a Hand Pump and 16 percent had a well available. 71 percent
SCs had 24 hour water supply available.
Power Supply: 71 percent SCs did not had any electricity connection. In 13 percent SCs
there was only Occasional power supply, and only 13 percent SCs had regular power supply.
Toilet Facility: Only around one third SCs had a functional toilet facility available.
Communication Facility: Only around one percent SCs had a Government provided
Telephone or Mobile facility.

8.4.4 Staying facility of ANM
Only in 4.4 percent cases it was found that the ANM was residing in the quarter attached to
the SC.
8.4.5 Furniture Availability
Examination Table was available in 37 percent SCs and out of these it was functional in
around 94 percent SCs. Labor Table was available in 11 percent SCs and functional in 90
percent of these SCs. In one tenth SCs Bedside screens were available and functional.
8.4.6 Availability of Equipment
Instrument Sterilizer was available in 39 percent SCs and functional in 89 percent of these
SCs. Auto Disposable Syringes were available in 88.6 percent SCs and functional in 99
percent of these. Blood Pressure Instrument was available in 48.9 percent SCs and functional
in 77.3 percent of these SCs. An Adult Weighing machine was available in 48 percent SCs
and was functional in 81 percent of these SCs. 48 percent SCs had Infant Weighing Machine,
and it was functional at 84 percent SCs. Haemoglobinometer was available at 10 percent SCs
and functional at 56 percent of these. Around 72 percent SCs had Vaccine Carriers available
but 98.5 percent of them are functional.
8.4.7 Availability of Essential Kits
Drug Kit-A was available in the 14.4 percent SCs. 44.4 percent SCs had IFA tablets available
and Vitamin A Syrup was available with 74 percent ANMs.
ORS packets were available at 70 percent SCs and 21 percent SCs had Disposable Delivery
Kits.
8.4.8 Labor Room
Only one-tenth SCs reported having a labor room and in of these 67 percent labor rooms
were used for deliveries.
8.4.9 Availability of Specific Services
70 percent SCs are visited by a Doctor at least once a month and in 39.7 percent of these
cases the day and time of this visit was fixed. In half of cases the SC was visited by Health
Assistant (Male) or LHV at least once a week.
Around 84 percent SCs provide Antenatal Care (TT, IFA tablets, Weight and B.P check). 24
hour facility for referral of complicated cases of pregnancy/delivery was available at 18
percent SCs. In 47 percent cases the ANM reported to had accompanied the woman in labor
to the referred care facility at the time of referral.
8.4.10 Monitoring and Supervision Activities
40 percent ANMs reported to had prepared the SC Plan for this year. 85 percent surveyed
SCs had Registers, 83 percent had reports and 80 percent had Immunization Cards in
enough quantity and 59 percent had enough ANC Cards.
In 78 percent of SCs Training of Traditional/Skilled Birth Attendants and ASHA was done. 82
percent ANMs reported to had co-ordinated their services with AWWs, ASHA, PRI and
Village Health and Sanitation Committee.
Proper maintenance of records and registers was being done by 97 percent of ANMs at their
respective SCs.
The scheme of ASHA was being implemented in 96 percent SCs.

Annexure
A21 – A33
District Hospitals
A1: Household possession - NIPI Districts
DISTRICTS
RURA URBA Tota RURA URBA Tota RURA URBA Tota RURA URBA Tota
L N l L N l L N l L N l
% % % % % % % % % % % %
Mattress 44.4 60.8 45.4 45.7 48.1 46.0 57.4 67.0 59.0 49.0 58.6 50.1
Mosquito
net
61.9 78.4 62.9 54.9 61.1 55.8 44.6 61.4 47.4 54.1 63.9 55.3
A cot/bed 95.6 93.2 95.5 94.5 95.7 94.7 90.2 94.9 91.0 93.5 94.9 93.7
A chair 42.3 63.5 43.5 42.0 53.5 43.6 32.2 54.9 35.9 39.0 55.7 41.0
Table 29.0 58.1 30.7 26.9 43.8 29.3 16.0 32.6 18.7 24.2 40.9 26.2
Pressure
cooker
13.5 31.1 14.5 16.3 42.7 20.0 11.6 36.3 15.6 13.8 38.0 16.7
Radio or
transistor
22.2 28.4 22.6 22.2 25.9 22.7 15.5 19.5 16.2 20.1 23.4 20.5
Watch or
clock
43.7 63.5 44.8 59.1 70.8 60.7 45.4 72.6 49.8 49.3 70.5 51.9
Sewing
machine
14.0 31.1 14.9 15.8 34.6 18.4 10.5 20.9 12.2 13.5 27.8 15.2
Electricity 11.5 56.8 14.1 28.2 72.4 34.3 25.6 63.7 31.8 21.5 66.0 26.8
Electric fan 7.9 36.5 9.6 15.3 60.5 21.6 12.3 54.0 19.1 11.7 53.8 16.8
Television 7.8 31.1 9.1 12.3 40.0 16.1 9.2 38.1 13.9 9.7 37.8 13.1
Refrigerator 1.1 6.8 1.5 2.2 10.8 3.4 0.8 5.6 1.6 1.4 7.8 2.2
Computer 2.6 1.4 2.5 2.8 5.9 3.2 2.2 3.7 2.4 2.5 4.2 2.7
Mobile
phone
23.4 35.1 24.1 23.1 41.1 25.6 24.6 44.2 27.8 23.7 41.6 25.8
Any Other
type of 3.1 8.1 3.4 4.4 10.8 5.3 3.9 5.6 4.2 3.8 8.0 4.3
telephone
A water
pump
6.5 1.4 6.2 11.3 8.6 11.0 6.8 5.1 6.5 8.2 5.9 7.9
Thresher 4.9 2.7 4.8 5.8 0.5 5.0 3.8 0.5 3.3 4.8 0.8 4.4
Tractor 2.5 0.0 2.3 4.7 2.2 4.4 3.4 0.9 3.0 3.5 1.3 3.2
Bicycle 29.9 24.3 29.6 23.6 27.0 24.1 30.0 33.5 30.6 27.9 29.5 28.1
An animal
drawn cart
2.5 4.1 2.5 2.5 0.5 2.3 2.5 1.9 2.4 2.5 1.7 2.4
A car/Jeep 0.8 1.4 0.8 0.6 1.1 0.7 0.6 1.4 0.8 0.7 1.3 0.8
Two
wheeler/ 3.4 2.7 3.4 3.6 7.6 4.1 4.1 8.4 4.8 3.7 7.2 4.1
motorbike
A Bus /
Truck
0.7 0.0 0.6 0.4 0.0 0.4 0.5 0.9 0.6 0.5 0.4 0.5
A2: Type of health schemes- Wealth Index NIPI Districts

DISTRICTS
RURAL URBAN Total RURAL URBAN Total RURAL URBAN Total RURAL URBAN Total
Wealth
Index % % % % % % % % % % % %
Lowest 55.0 29.7 53.5 50.7 37.8 48.9 60.7 34.4 56.4 55.4 35.0 53.0
Second 13.6 10.8 13.5 16.3 10.3 15.5 15.2 13.5 14.9 15.0 11.8 14.6
Middle 12.3 18.9 12.7 13.9 8.1 13.1 8.5 14.9 9.6 11.6 12.9 11.8
Fourth 10.7 17.6 11.1 10.3 15.7 11.0 8.8 16.3 10.0 10.0 16.2 10.7
Highest 8.3 23.0 9.2 8.8 28.1 11.5 6.8 20.9 9.1 8.0 24.1 9.9
N 100 100 100 100 100 100 100 100 100 100 100 100

Total
number 1,224 74 1,298 1,147 185 1,332 1,102 215 1,317 3,473 474 3,947
of HH
A3: Education Attainments vs age of respondent
NIPI State wise Education

RURAL
Year of
Age of the Respondent(in Years)
Schooling Total
15-18 19-21 22-25 26-30 31-40 41-49
N % N % N % N % N % N % N %
No
Education 76 69% 334 57% 706 60% 701 71% 412 82% 30 100% 2259 67%
<5 4 4% 27 5% 33 3% 25 3% 11 2% 0 0% 100 3%
5-7 8 7% 65 11% 135 12% 82 8% 23 5% 0 0% 313 9%
8-9 13 12% 60 10% 108 9% 58 6% 17 3% 0 0% 256 8%
10-11 10 9% 70 12% 154 13% 86 9% 20 4% 0 0% 340 10%
12 &
Above 0 0% 29 5% 41 4% 36 4% 17 3% 0 0% 123 4%
Total 111 100% 585 100% 1177 100% 988 100% 500 100% 30 100% 3391 100%
URBAN
Year of Total
15-18 19-21 22-25 26-30 31-40 41-49
Schooling
N % N % N % N % N % N % N %
No
Education 8 67% 45 58% 70 47% 82 56% 44 73% 5 83% 254 56%
<5 0 0% 6 8% 3 2% 2 1% 0 0% 0 0% 11 2%
5-7 1 8% 8 10% 13 9% 15 10% 5 8% 0 0% 42 9%
8-9 2 17% 7 9% 17 11% 15 10% 4 7% 0 0% 45 10%
10-11 1 8% 6 8% 28 19% 18 12% 3 5% 0 0% 56 12%
12 &
Above 0 0% 6 8% 19 13% 14 10% 4 7% 1 17% 44 10%
Total 12 100% 78 100% 150 100% 146 100% 60 100% 6 100% 452 100%
TOTAL
Year of Total
15-18 19-21 22-25 26-30 31-40 41-49
Schooling
N % N % N % N % N % N % N %
No
Education 84 68% 379 57% 776 59% 783 69% 456 81% 35 97% 2513 65%
<5 4 3% 33 5% 36 3% 27 2% 11 2% 0 0% 111 3%
5-7 9 7% 73 11% 148 11% 97 9% 28 5% 0 0% 355 9%
8-9 15 12% 67 10% 125 9% 73 6% 21 4% 0 0% 301 8%
10-11 11 9% 76 12% 182 14% 104 9% 23 4% 0 0% 396 10%
12 &
Above 0 0% 35 5% 60 5% 50 4% 21 4% 1 3% 167 4%
Total 123 100% 663 100% 1327 100% 1134 100% 560 100% 36 100% 3843 100%

A4:Frequency of reading a newspaper or magazine vs key background variables
Almost every At least once a Less than a

Not at all Total
Print Media day week week
% % % % %
Age Group
15-18 2.5 0.0 3.4 3.1 2.9
19-21 17.5 20.5 16.0 23.3 21.4
22-25 41.3 43.6 41.8 41.1 41.4
26-30 27.5 25.6 31.9 24.8 26.4
31-40 11.3 9.0 6.8 7.7 7.8
41-49 0.0 1.3 0.0 0.0 0.1
Total 100.0 100.0 100.0 100.0 100
Year of schooling
<5 1.3 0.0 3.4 11.1 8.3
5-7 11.3 15.4 19.4 31.1 26.7
8-9 17.5 19.2 22.8 23.3 22.6
10-11 31.3 39.7 36.1 27.0 29.8
12 & Above 38.8 25.6 18.3 7.5 12.6
Total 100.0 100.0 100.0 100.0 100
Total number of women 229 135 226 3253 3843
A5: Frequency of listening to the radio vs key background variables

Not at all Total
% % % % %
Age Group
15-18 3.9 0.7 3.5 3.2 3.2
19-21 20.5 20.7 20.4 16.7 17.3
22-25 40.2 44.4 42.5 33.2 34.5
26-30 23.1 28.1 24.3 30.4 29.5
31-40 12.2 5.9 8.4 15.5 14.6
41-49 0.0 0.0 0.9 1.0 0.9
Total 100.0 100.0 100.0 100.0 100.0
Year of schooling
No Education 22.7 23.7 22.6 73.1 65.4
<5 0.9 3.7 4.9 2.9 2.9

5-7 10.5 18.5 18.6 8.1 9.2
8-9 15.7 12.6 21.2 6.1 7.8
10-11 32.3 26.7 21.2 7.3 10.3
12 & Above 17.9 14.8 11.5 2.5 4.3
Total 100.0 100.0 100.0 100.0 100.0
Standard of living Index
Lowest 14.0 26.0 20.0 59.6 53.0
Second 7.5 14.5 11.1 15.3 14.4
Middle 11.1 11.5 21.7 11.4 11.8
Fourth 20.5 22.1 22.8 8.8 10.9
Highest 46.9 26.0 24.4 4.9 9.9

A5: Frequency of listening to the radio vs key background variables

Not at all Total
% % % % %
Total 100.0 100.0 100.0 100.0 100.0
Total number of women 307 131 180 3225 3843.0
A6: Frequency of watching Television vs key background variables
At least once a
Almost every day Less than a week Not at all Total
Print Media week
% % % % %
Age Group
15-18 2.3 3.8 3.3 3.3 3.2
19-21 18.2 22.9 21.1 16.7 17.3
22-25 41.0 38.9 41.1 33.4 34.5
26-30 29.3 24.4 26.7 29.9 29.5
31-40 8.5 9.9 7.2 15.8 14.6
41-49 0.7 0.0 0.6 1.0 0.9
Total 100 100 100 100 100.0
Year of schooling
No Education 17.6 38.2 20.6 73.6 65.4
<5 0.7 3.8 4.4 3.0 2.9

5-7 12.1 14.5 17.8 8.3 9.2
8-9 14.7 11.5 22.2 6.2 7.8
10-11 29.0 19.8 28.9 7.1 10.3
12 & Above 26.1 12.2 6.1 1.9 4.3
Total 100 100 100 100 100
Standard of living Index
Lowest 14.0 26.0 20.0 59.6 53.0
Second 7.5 14.5 11.1 15.3 14.4
Middle 11.1 11.5 21.7 11.4 11.8
Fourth 20.5 22.1 22.8 8.8 10.9
Highest 46.9 26.0 24.4 4.9 9.9
Total 100.0 100.0 100.0 100.0 100
Total number of
307 131 180 3225 3843
women

A 7- Employment Status of women

Any source of Income Any source of Income Any source of Income Any source of Income
Yes Yes Yes Yes Yes Yes Yes Yes
Age Group N % N % N % N %
15-18 17 4 10 2 21 3 3 3
19-21 68 14 42 10 100 16 14 19
22-25 136 29 134 33 190 30 31 37
26-30 162 34 138 34 185 30 32 28
31-40 88 19 77 19 121 19 19 12
41-49 3 1 5 1 7 1 1 1
Total 474 100 406 100 624 100 100 100
Education and years of schooling
No
375 79 314 77 533 85 81 55
education
Below 5 7 1 7 2 18 3 2 3
5-7 32 7 30 7 22 4 6 12
8-9 24 5 23 6 17 3 4 10
10-11 28 6 20 5 22 4 5 14
12 & above 8 2 12 3 12 2 2 6
Total 474 100 406 100 624 100 100 100
Residence
Rural 466 84 351 77 570 84.8214 82.6087 76.34286
Urban 86 16 104 23 102 15.1786 17.3913 23.65714
Total 552 100 455 100 672 100 100 100

A8 : Children ever born vs. age of mother
Districts
JAHANABAD
Age of the
Respondent(in Number of Children Ever Born
Years)
1 2 3 4 5 6 7 8 9
N % N % N % N % N % N % N % N % N %
15-18 44 88% 5 10% 0 0% 0 0% 1 2% 0 0% 0 0% 0 0% 0 0%
19-21 143 60% 65 27% 24 10% 5 2% 1 0% 0 0% 1 0% 0 0% 0 0%
22-25 99 23% 160 38% 106 25% 39 9% 14 3% 5 1% 1 0% 2 1% 0 0%
26-30 26 7% 53 14% 101 27% 86 23% 42 11% 45 12% 13 4% 2 1% 1 0%
31-40 6 4% 7 4% 30 17% 33 19% 40 23% 21 12% 19 11% 9 5% 4 2%
41-49 1 17% 0 0% 0 0% 0 0% 1 17% 0 0% 2 33% 0 0% 2 33%
Total 319 25% 290 23% 261 21% 163 13% 99 8% 71 6% 36 3% 13 1% 7 1%
NALANDA
Age of the Number of Children Ever Born
Respondent(in
Years) 1 2 3 4 5 6 7 8 9
N % N % N % N % N % N % N % N % N %
15-18 18 64% 8 29% 1 4% 0 0% 1 4% 0 0% 0 0% 0 0% 0 0%
19-21 116 58% 53 27% 23 12% 4 2% 1 1% 0 0% 2 1% 0 0% 0 0%
22-25 141 30% 154 32% 104 22% 54 11% 9 2% 10 2% 1 0% 2 0% 1 0%
26-30 27 7% 85 22% 114 29% 78 20% 53 14% 20 5% 2 1% 5 1% 2 1%
31-40 1 1% 8 4% 19 10% 28 14% 36 18% 49 25% 22 11% 21 11% 8 4%
41-49 1 7% 0 0% 0 0% 0 0% 2 13% 2 13% 4 27% 2 13% 1 7%
Total 304 23% 308 24% 261 20% 164 13% 102 8% 81 6% 31 2% 30 2% 12 1%
Sheikhpura
Age of the Number of Children Ever Born
Respondent(in
Years) 1 2 3 4 5 6 7 8 9
N % N % N % N % N % N % N % N % N %
15-18 32 71% 11 24% 2 4% 0 0% 0 0% 0 0% 0 0% 0 0% 0 0%
19-21 116 52% 77 34% 24 11% 6 3% 0 0% 0 0% 1 0% 1 0% 0 0%
22-25 113 27% 130 31% 103 24% 52 12% 18 4% 6 1% 0 0% 2 1% 0 0%
26-30 35 9% 63 17% 85 23% 92 25% 50 13% 33 9% 11 3% 3 1% 1 0%
31-40 5 3% 3 2% 17 9% 21 11% 48 26% 34 18% 22 12% 23 12% 5 3%
41-49 0 0% 1 7% 1 7% 1 7% 5 33% 2 13% 2 13% 1 7% 1 7%
Total 301 24% 285 22% 232 18% 172 14% 121 10% 75 6% 36 3% 30 2% 7 1%

A9:Treatment seeking behaviour

Salt and Continue Give
Continue Dont
Give ors sugar normal plenty of Any other
breastfeeding known Total
solution food fluids
N % N % N % N % N % N % N %
15-18 2 50.0 0 0.0 0 0.0 0 0.0 0 0.0 1 25.0 2 50.0 4
19-21 4 13.8 3 10.3 6 20.7 11 37.9 2 6.9 2 6.9 8 27.6 29
22-25 26 48.1 7 13.0 5 9.3 11 20.4 6 11.1 7 13.0 6 11.1 54
26-30 18 31.6 6 10.5 5 8.8 20 35.1 4 7.0 9 15.8 7 12.3 57
31-40 8 29.6 6 22.2 5 18.5 5 18.5 2 7.4 6 22.2 4 14.8 27
41-49 3 75.0 2 50.0 2 50.0 0 0.0 0 0.0 0 0.0 1 25.0 4
Total 61 34.9 24 13.7 23 13.1 47 26.9 14 8.0 25 14.3 28 16.0 175
Education of the Respondent
No
38 31.7 13 10.8 17 14.2 33 27.5 10 8.3 17 14.2 23 19.2 120
Education
<5 1 20.0 2 40.0 1 20.0 2 40.0 0 0.0 1 20.0 1 20.0 5
5-7 6 50.0 4 33.3 1 8.3 4 33.3 1 8.3 0 0.0 1 8.3 12
8-9 5 45.5 2 18.2 0 0.0 3 27.3 1 9.1 1 9.1 1 9.1 11
10-11 7 35.0 1 5.0 3 15.0 4 20.0 1 5.0 5 25.0 2 10.0 20
12 &
4 57.1 2 28.6 1 14.3 1 14.3 1 14.3 1 14.3 0 0.0 7
Above
Total 61 34.9 24 13.7 23 13.1 47 26.9 14 8.0 25 14.3 28 16.0 175
Number of Living Children
1-2 22 27.8 9 11.4 12 15.2 22 27.8 6 7.6 8 10.1 17 21.5 79
3-4 26 45.6 8 14.0 5 8.8 15 26.3 6 10.5 11 19.3 4 7.0 57
5+ 13 33.3 7 17.9 6 15.4 10 25.6 2 5.1 6 15.4 7 17.9 39
Total 61 34.9 24 13.7 23 13.1 47 26.9 14 8.0 25 14.3 28 16.0 175
LOCALITY
RURAL 53 34.4 21 13.6 21 13.6 45 29.2 12 7.8 22 14.3 20 13.0 154
URBAN 8 38.1 3 14.3 2 9.5 2 9.5 2 9.5 3 14.3 8 38.1 21
Total 61 34.9 24 13.7 23 13.1 47 26.9 14 8.0 25 14.3 28 16.0 175
Wealth Index
Lowest 35 35.4 13 13.1 15 15.2 30 30.3 5 5.1 15 15.2 15 15.2 99
Second 5 22.7 1 4.5 2 9.1 4 18.2 2 9.1 6 27.3 5 22.7 22
Middle 12 46.2 5 19.2 3 11.5 9 34.6 4 15.4 1 3.8 2 7.7 26
Fourth 7 43.8 4 25.0 1 6.3 2 12.5 2 12.5 1 6.3 2 12.5 16
Highest 2 16.7 1 8.3 2 16.7 2 16.7 1 8.3 2 16.7 4 33.3 12
Total 61 34.9 24 13.7 23 13.1 47 26.9 14 8.0 25 14.3 28 16.0 175

A10 : Diarrhoea Practices

N % N % N % N % N % N % N % N % N %
Continued the breastfeeding/other feedings when child had diarrhoea
Yes 9 69% 9 69% 36 71% 2 50% 39 72% 4 57% 84 71% 6 55% 90 70%
No 3 23% 3 23% 14 28% 2 50% 13 24% 2 29% 30 25% 4 36% 34 26%
Not Applicable 1 8% 1 8% 1 2% 0 0% 2 4% 1 14% 4 3% 1 9% 5 4%

Total 13 100% 13 100% 51 100% 4 100% 54 100% 7 100% 118 100% 11 100% 129 100%
Liquids given to drink during Diarrhoea
Much less 1 7.7% 1 2% 0 0% 14 26% 0 0% 16 14% 0 0% 16 12%

Some less 6 46% 21 41% 3 75% 18 33% 4 57% 45 38% 7 64% 52 40%
About the same 22 43% 1 25% 11 20% 3 43% 33 28% 4 36% 37 29%
more 4 31% 2 4% 0 0% 4 7% 0 0% 10 9% 0 0% 10 8%
Nothing to drink 2 15% 4 8% 0 0% 2 4% 0 0% 8 7% 0 0% 8 6%
Don't know 1 2% 0 0% 5 9% 0 0% 6 5% 0 0% 6 5%
Total 13 100% 51 100% 4 100% 54 100% 7 100% 118 100% 11 100% 129 100%
Food given to eat during Diarrhoea
Much less 2 15% 3 6% 0 0% 13 24% 0 0% 18 15% 0 0% 18 14%
Some less 6 46% 21 41% 1 25% 16 30% 4 57% 43 36% 5 46% 48 37%
About the same 1 8% 18 35% 1 25% 11 20% 1 14% 30 25% 2 18% 32 25%
more 1 8% 3 6% 0 0% 5 9% 0 0% 9 8% 0 0% 9 7%
Nothing to drink 3 23% 5 10% 2 50% 2 4% 2 29% 10 9% 4 36% 14 11%
Don't know 1 2% 0 0% 7 13% 0 0% 8 7% 0 0% 8 6%

Total 13 100% 51 100% 4 100% 54 100% 7 100% 118 100% 11 100% 129 100%
Mothers given advice to give ORS during Diarrhoea
Yes 3 23% 20 39% 4 100% 25 46% 4 57% 48 41% 8 73% 56 43%
No 10 77% 31 61% 0 0% 29 54% 3 43% 70 59% 3 27% 73 57%
Total 13 100% 51 100% 4 100% 54 100% 7 100% 118 100% 11 100% 129 100%
Personnel adviced for ORS
Governmenmt Doctor 0 0% 1 25% 4 16% 0 0% 4 8% 1 13% 5 9%
Private Doctor 3 100% 15 75% 3 75% 19 76% 3 75% 37 77% 6 75% 43 77%

ANM/ASHA/LHV 1 4% 0 0% 1 2% 0 0% 1 2%
Nurse 2 10% 0 0% 2 4% 0 0% 2 4%
Friends/Relatives/ Family
0 0% 1 25% 0 0% 1 13% 1 2%
Memebers
Others 3 15% 0 0% 1 4% 0 0% 4 8% 0 0% 4 7%
Total 3 100% 20 100% 4 100% 25 100% 4 100% 48 100% 8 100% 56 100%
Place of getting ORS
ASHA 0 0% 1 25% 1 4% 0 0% 1 2% 1 13% 2 4%
ANM 1 5% 0 0% 1 4% 0 0% 2 4% 0 0% 2 4%
Govt.Dispencery 1 4% 0 0% 1 2% 0 0% 1 2%
UHC / UHP / UFWC 1 4% 0 0% 1 2% 0 0% 1 2%
PHC 1 5% 0 0% 1 2% 0 0% 1 2%
Private AYUSH 2 10% 0 0% 1 4% 0 0% 3 6% 0 0% 3 5%
Private hospital 9 45% 2 50% 12 48% 2 50% 21 44% 4 50% 25 45%
Medical/ chemist shop 3 100% 6 30% 1 25% 7 28% 2 50% 16 33% 3 38% 19 34%
Other 1 5% 0 0% 1 4% 0 0% 2 4% 0 0% 2 4%
Total 3 100% 20 100% 4 100% 25 100% 4 100% 48 100% 8 100% 56 100%

A-11 Quantity of food and drink taken while having fever

N % N % N % N % N % N % N % N % N %
Much
11 14% 0 0% 7 4% 2 7% 17 15% 2 12% 35 9% 4 8% 39 9%
Less
Some
23 28% 0 0% 75 38% 16 52% 59 52% 12 71% 157 40% 28 56% 185 42%
what less
About the
20 25% 0 0% 100 51% 11 36% 22 19% 2 12% 142 36% 13 26% 155 35%
same
More 11 14% 2 100% 7 4% 0 0% 6 5% 0 0% 24 6% 2 4% 26 6%
Nothing to
10 12% 0 0% 5 3% 1 3% 8 7% 0 0% 23 6% 1 2% 24 5%
Drink
Don't
6 7% 0 0% 4 2% 1 3% 2 2% 1 6% 12 3% 2 4% 14 3%
Know
Total 81 100% 2 100% 198 100% 31 100% 114 100% 17 100% 393 100% 50 100% 443 100%
Quantity of food given during illness
Much
14 17% 0 0% 8 4% 1 3% 33 29% 3 18% 55 14% 4 8% 59 13%
Less
Some
26 32% 0 0% 72 36% 18 58% 52 46% 10 59% 150 38% 28 56% 178 40%
what less
About the
19 24% 0 0% 80 40% 5 16% 14 12% 1 6% 113 29% 6 12% 119 27%
same
More 5 6% 2 100% 8 4% 1 3% 2 2% 0 0% 15 4% 3 6% 18 4%
Stopped
3 4% 0 0% 5 3% 1 3% 4 4% 0 0% 12 3% 1 2% 13 3%
food
Never
12 15% 0 0% 21 11% 5 16% 7 6% 3 18% 40 10% 8 16% 48 11%
gave food
Don't
2 3% 0 0% 4 2% 0 0% 2 2% 0 0% 8 2% 0 0% 8 2%
know
Total 81 100% 2 100% 198 100% 31 100% 114 100% 17 100% 393 100% 50 100% 443 100%

A 12 Advice received from sources & duration of treatment for illness

N % N % N % N % N % N % N % N % N %
Advice or Treatment
Same Day 21 13.7 1 4.5 2 1 1 1.5 9 4.8 6 11.8 32 5.8 8 5.7 38 6.3
2 days ago 114 74.5 19 86.4 175 83.7 56 82.4 153 81.8 37 72.5 442 80.5 112 79.4 482 79.8
3 - 4 days ago 11 7.2 2 9.1 15 7.2 4 5.9 18 9.6 6 11.8 44 8 12 8.5 49 8.1
5 - 6 days ago 6 3.9 12 5.7 4 5.9 5 2.7 1 2 23 4.2 5 3.5 26 4.3
week or more than a week

1 0.7 5 2.4 3 4.4 2 1.1 1 2 8 1.5 4 2.8 9 1.5
ago
Total 153 100 22 100 209 100 68 100 187 100 51 100 549 100 141 100 604 100
Advice receiveed from sources during illness
GOVERNMENT/
2 3.2 2 1.2 1 1.8 2 1.9 6 1.8 1 1.1 6 1.6
MUNICIPAL HOSPITA
GOVERNMENT
1 1.6 1 0.6 1 1.8 1 0.9 3 0.9 1 1.1 3 0.8
DISPENSARY
CHC/ RURAL HOSPITAL 1 0.9 1 0.3 1 0.3
UMP/RMP 19 30.6 3 30 24 14 5 8.8 31 29.2 4 17.4 74 21.8 12 13.3 74 19.7
PHC 2 1.9 1 4.3 2 0.6 1 1.1 2 0.5
SUB CENTER 2 1.2 2 1.9 1 4.3 4 1.2 1 1.1 4 1.1
NGO/ TRUST HOSPITAL 1 0.6 1 1.8 1 0.3 1 1.1 1 0.3

GOVT. AYUSH
1 0.9 1 0.3 1 0.3
HOSPITAL/CLINIC
PRIVATE AYUSH
1 1.6 60 35.1 10 17.5 6 5.7 67 19.8 10 11.1 69 18.4
HOSPITAL/CLINIC
PRIVATE HOSPITAL/
32 51.6 7 70 71 41.5 35 61.4 50 47.2 14 60.9 153 45.1 56 62.2 182 48.5
CLINIC
HOME 1 1.6 5 2.9 2 3.5 5 4.7 3 13 11 3.2 5 5.6 15 4

OTHER 6 9.7 5 2.9 2 3.5 5 4.7 16 4.7 2 2.2 17 4.5
Total 62 100 10 100 171 100 57 100 106 100 23 100 339 100 90 100 375 100

A 13- Child Having health problem during illness

N % N % N % N % N % N % N % N % N %
Chest only 11 13.6 33 16.7 20 26.7 24 21.1 6 24.0 68 17.3 26 23.2 80 18.1
Nose only 31 38.3 7 58 88 44.4 23 30.7 43 37.7 12 48.0 162 41.2 42 37.5 183 41.3
Both 34 42 5 42 63 31.8 23 30.7 41 36.0 6 24.0 138 35.1 34 30.4 153 34.5
Don‟t know 3 3.7 3 1.5 2 2.7 5 4.4 1 4.0 11 2.8 3 2.7 11 2.5
Other 2 2.5 11 5.6 7 9.3 1 0.9 14 3.6 7 6.3 16 3.6
Total 81 100 12 100 198 100.0 75 100.0 114 100.0 25 100.0 393 100.0 112 100.0 443 100.0

A 14- Problem faced during availing treatmnet for illness

N % N % N % N % N % N % N % N % N %
Doctor came
17 1.4 20 1.8 5 1.3 23 2.1 5 1.8 60 1.8 10 1.1 63 1.6
late
Long Waiting
21 1.8 5 2 46 4.1 12 3 34 3.2 16 5.9 101 3 33 3.6 117 3
time
Long Queue
8 0.7 3 1.2 63 5.6 15 3.8 23 2.1 5 1.8 94 2.8 23 2.5 100 2.6
of patients
Non
availability of 5 0.4 1 0.4 47 4.2 23 5.8 31 2.9 4 1.5 83 2.4 28 3.1 99 2.6
medicines
Too Far/ No
27 2.3 7 2.8 92 8.2 23 5.8 45 4.2 6 2.2 164 4.8 36 3.9 171 4.4
Transportation
Don't Trust
Facility/Poor
1 0.1 36 3.2 14 3.6 7 0.7 44 1.3 14 1.5 50 1.3
Quality
Services
No One To
10 0.8 2 0.8 18 1.6 7 1.8 11 1 3 1.1 39 1.2 12 1.3 42 1.1
Accompany
Any others (pl
1 0.1 1 0.4 4 0.4 1 0.3 1 0.4 5 0.1 3 0.3 6 0.2
Specify)
NO
27 2.3 2 0.8 21 1.9 15 3.8 40 3.7 12 4.4 88 2.6 29 3.2 108 2.8
PROBLEM
Total 1195 100 248 100 1124 100 394 100 1072 100 271 100 3391 100 913 100 3843 100
Was there any problem in getting these medications
Yes 19 24% 0 0% 99 50% 8 26% 26 23% 3 18% 144 37% 11 22% 155 35%
No 60 74% 2 ### 98 50% 23 74% 87 76% 14 82% 245 62% 39 78% 284 64%
Don't Know 2 3% 0 0% 1 1% 0 0% 1 1% 0 0% 4 1% 0 0% 4 1%
Total 81 100% 2 ### 198 100% 31 100% 114 100% 17 100% 393 100% 50 100% 443 100%

A 15- Medicine taken during illness

N % N % N % N % N % N % N % N % N %
Yes 56 69.1 7 58 182 91.9 70 93.3 112 98.2 25 100 350 89.1 102 91.1 399 90.1
No 25 30.9 5 42 15 7.6 4 5.3 2 1.8 42 10.7 9 8 43 9.7
Total 81 100 12 100 198 100 75 100 114 100 25 100 393 100 112 100 443 100
Duration of first medicines given after fever
Same
29 51.8 3 43 42 23.1 20 28.6 49 43.8 12 48 120 34.3 35 34.3 142 35.6
day
Next day 18 32.1 1 14 66 36.3 39 55.7 49 43.8 13 52 133 38 53 52 157 39.3
Two
days
5 8.9 2 29 69 37.9 10 14.3 11 9.8 85 24.3 12 11.8 88 22.1
after
nfever
Three
days
1 1.8 1 14 2 1.1 1 1.4 1 0.9 4 1.1 2 2 4 1
after
fever
Four or
more
days 3 5.4 2 1.1 1 0.9 6 1.7 6 1.5
after
fever
Don‟t
1 0.5 1 0.9 2 0.6 2 0.5
know
Total 56 100 7 100 182 100 70 100 112 100 25 100 350 100 102 100 399 100
A 16- Money spent on treatment while having illness

Rural Urban Rural Urban Rural Urban Rural Urban
N % N % N % N % N % N % N % N %
No
money 12 6.6 2 8 4 1.7 7 7.5 1 0.4 17 2.6 9 4.8
spent
<100 35 19.2 3 12 57 24.2 23 24.7 31 12.5 14 20.3 123 18.5 40 21.4
101-200 39 21.4 2 8 48 20.3 12 12.9 39 15.7 10 14.5 126 18.9 24 12.8
201-300 36 19.8 3 12 44 18.6 15 16.1 49 19.8 14 20.3 129 19.4 32 17.1
301 -
41 22.5 10 40 49 20.8 28 30.1 81 32.7 23 33.3 171 25.7 61 32.6
500
501-
15 8.2 4 16 27 11.4 5 5.4 36 14.5 7 10.1 78 11.7 16 8.6
1000
>1000 4 2.2 1 4 7 3 3 3.2 11 4.4 1 1.4 22 3.3 5 2.7
Total 182 100 25 100 236 100 93 100 248 100 69 100 666 100 187 100

TableA21: AVAILABILITY OF HUMAN RESOURCE (CLINICAL)

Bihar
In Position On contract
Medical Superintendent 3 0
Specialist (Medicine) 2 1
Specialist (Surgery) 3 0
Obstetrician / Gyneacologist 3 0
Pediatrician 2 0
Anesthetist 3 0
Pathologist / Microbiologist 1 0
Radiologist 1 0
Dermatologist / Vanerologist 1 0
N=3
Table A23: AVAILABILITY OF HUMAN RESOURCE

Bihar
Nurses 22 0
Nurse working in OBS-GYNIC department 18 0
ANM / PHN 18 0
Technicians 4 2
Radiographer 3 0
Pharmacist 7 1
N=3
Table A24: AVAILABILITY OF INVESTIGATIVE AND LABORATORY SERVICES

Bihar
Yes
Haematology 1
Urine analysis 1
PAP SMEAR 1
SPUTUM 2
HISTOPATHOLOGY 1
MICROBIOLOGY 1
BLOOD UREA 1
BLOOD CREATINEN 1
PREGNANCY TEST 2
COOMB‟S TEST 1
ELISA FOR HIV TEST 2
VDRL TEST 2
ECG 2
2D-ECHO 1
X-RAY 3
ULTRASOUND 0
FULLY OPERNATIONAL BLOOD BANK 1
BLOOD DONATION FACILITY 1
N=3

Table A25: AVAILABILITY OF PHYSICAL INFRASTRUCTURE

Bihar
Yes
DH is within the block head quarter 3
Designated government building available for the DH 3
Water supply for 24 hours 3
Three- Phase connection 3
Standby facility (generator/invertors) available in working condition 2
Functional toilet facility available 3
Separate toilets for males and females 3

N=3
Table A26: AVAILABILITY OF WASTE DISPOSAL

Bihar
Yes
Incineration 1
Autoclaving / Microwaving 0
Shredder 1
Needle and Syring destroyer 1
Any other 1
N=3
Table A27: AVAILABILITY OF COMMUNICATION FACILITIES

Bihar
Yes
Telephone facility available in all section 1
Personal Computer available 2
NIC Terminal available at DH 2
Access to internet facility available at DH 1
DH outsourcing data compilation and tabulation work 3
Ambulance 5
Jeep 3
Car 0
Whether CSSD is there in DH 1
Critical care area 1
Integrated counseling and testing centre(ICTC) 2
N=3

Table A28: AVAILABILTY OF RESIDENTIAL FACILITY FOR THE MEDICAL STAFF

Bihar
STAYING IN
AVAILABLE
QUARTER
Yes Yes
Doctors and Specialist 3 2
Other Nurses 1 1
Other staff 0
N=3
Table A29: AVAILABILITY OF OTHER PHYSICAL FACILITIES

Bihar
Yes
Prominent display boards regarding service availability in
3
local language at DH
Separate registration counter in DH 3
Pharmacy for drug dispensing and drug storage at DH 2
Any suggestion / complaint box kept at DH 2

OPD rooms / cubicles at CHC 2
Pharmacy of drug storage and drug dispensing at DH 3
N=3
Table A30: AVAILABILITY OF WARDS AND BEDS

Bihar
AVAILABLE Total number of

Male Female
beds
Yes
Pediatric ward 2 8 0 0
Inrensive medicine care unite 3 3 0 0
Post operetive ward 3 6 3 3
Labour room 3 3 0 0
Ante Natal care ward 3 3 0 0
PNC ward 2 3 0 0
Post partum ward 2 0 0 0
N=3
Table A31: OT EQUIPMENTS

Bihar
AVAILABLE Currently in use
Yes Yes
ElectiveOT-Major 3 3
Emergency OT / Familt welfare OT 2 2
Opthalmology / ENT OT 2 2
Orthopedic OPD 3 3
N=3

Table A32: AVAILABILTY OF DELIVERY SUIT UNIT

Bihar
AVAILABLE Currently in use
Yes Yes
Labour room (Aseptic and clean) 3 3
Delivery room 3 3
Neo-natal room 2 2
Delivery suit unit including facility of accommodation
Examination and prepretion room 3 3

Labour room (Aseptic and clean) 3 3
Delivery room 3 3
Neo natal room 2 2
Scrubbing room 2 2
N=3
Table A33: AVAILABILTY OF LABOUR WARD AND NEO NATAL EQUIPMENT FOR NURSERY WARD
Bihar
AVAILABLE
Number FUNCTIONAL
Yes
Baby incubator 2 2 2
Phototherapy unit 2 2 2
Emergency resuscitation kit baby 1 1 1
Radiant warmer 1 1 1
Room warmer 0 0 0
Foetal doppler 0 0 0
CTG monitor 0 0 0
Delivery Kit 1 5 3
Episiotomy Kit 2 3 3
Forceps delivery Kit 2 3 2
Crainotomy 1 1 1
Vacuum extractor metal 0 0 0
Silastic vaccum extractor 0 0 0
N=3

A34 – A55
Community Health Centres
Table A34 - AVAILABILITY OF HUMAN RESOURCE (CLINICAL)

Bihar
Obstetrician /Gynecologist 0 0
Pediatrician 1 0
Anesthetist/ trained MO 0 0
General Medical Officer 2 0
N=2
AVAILABILITY OF HUMAN RESOURCE
Auxiliary Nurse Midwife (ANM) 6 16
Staff Nurse 42 0
Nurse/ Midwife 4 0
Lab. Technician 1 1
Radiographer 0 0
OPD Attendant 0 0
OT Attendant 1 0
N=2
Table A35: AVAILABILITY OF PARA MEDICAL

Bihar
Yes
At least one staff doctor/ nurse/LHV/ANM at CHC available round the clock 1
Gynecologist and Anesthetist /Trained Anesthetist available on call in case of

0
emergency
N=2
Table A36: NUMBER OF MEDICAL OFFICER RECEIVED TRAINING IN THE SURVEYED CHC‟s
Bihar
Last 5 Years Ever
Non Scalpel Vasectomy(NSV) training 4 0
Minilaprotomy Training 0 0
HIV/AIDS Prevention, Care and Support training 2 0
Emergency Obstetric Care(including C-Section) training 0 0
Newborn Care training 0 0

Basic Emergency Obstetric Care training 0 0
Integrated Management of Neonatal and Childhood Illnesses training 1 0
Medical Termination of Pregnancy (MTP) training 0 2
N=2
Table A37: NUMBER OF PARA MEDICAL STAFF RECEIVED TRAINING IN

THE SURVEYED CHC‟s
Bihar
Last 5 Years Ever
Reproductive Tract Infection /Sexually
0 0
Transmitted Infection (RTI/STI) training
Integrated Management of Neonatal and
2 0
Childhood Illnesses (IMNCI) training

Skilled Birth Attendant training 3 0

Electro Cardiogram (ECG) training 0 0
Ultra Sound training 0 0
N=2
Table A38: NUMBER OF CHC‟s WHERE PARTICULAR

INVESTIGATIVE FACILITIES AVAILABLE
Bihar
PERSONNEL Available
No
ECG facility 2
X- Ray facility 2
Ultrasound facility 2
Table A39: AVAILABILITY OF PHYSICAL INFRASTRUCTURE

Bihar
Yes
CHC is within the block head quarter 2
Designated government building available for the CHC 2
Main source of water supply (BOREWELL) 2
Water supply for 24 hours 2
Regular Power supply 2
Occasional power supply 2
Standby facility (generator/invertors) available in
2
working condition
Functional toilet facility available 2
Separate toilets for males and females 2
Laundry facility available at CHC 2
N=2
Table A40: AVAILABILTY OF WASTE DISPOSAL

Bihar
Yes
Incineration 0
Autoclaving / Microwaving 0
Shredder 0
Needle and Syring destroyer 1
Any other 1
No specific facility 0
N=2
Table A41: AVAILABILITY OF COMMUNICATION FACILITIES

Bihar
Yes
Telephone facility available in CHC 2
CHC has intercom facility 1
Whether CHC has Personal Computer 1
NIC Terminal available at CHC 0
Access to internet facility available at CHC 1
Ambulance 2
Jeep 2
Car 0
CHC have access to vehicle for transporting
2
patients during emergency
N=2

Table A42: AVAILABILITY OF RESIDENTIAL FACILITY FOR THE MEDICAL

STAFF
Bihar
STAYING IN
AVAILABLE
QUARTER
Yes Yes
General Surgeon 1 1
Obstetrician /Gynecologist 0 0
Pediatrician 0 0
Anesthetist 0 0
Staff Nurse 1 1
N=2
Table A43: AVAILABILITY OF LABOUR ROOM AND OPERATION

THEATRE
Bihar
CURRENTLY
AVAILABLE
IN USE
Yes Yes
Labour Room 2 2
Operation Theatre 2 2
N=2
Table A44:AVAILABILTY OF STORAGE FACILITIES

Bihar
Yes
Whether CHC has separate room for drug
1
storage
Separate waiting area for the patients in the
1
OPD of CHC
N=2
Table A45:AVAILABILITY OF LABORATORY

Bihar
Yes
Operational laboratory in the CHC 2
Blood Storage Facility there in the CHC 0
N=2
Table A46: AVAILABILITY OF PHYSICAL FACILITIES

Bihar
Yes
Prominent display boards regarding service
2
availability in local language at CHC
Separate registration counter in CHC 2
Pharmacy for drug dispensing and drug
1
storage at CHC
Any suggestion / complaint box kept at CHC 0
OPD rooms / cubicles at CHC 2
If yes number of OPD room 3
Separate waiting area in OPD for patients at
1
CHC
Minor OT in the CHC 2
Injection Room and Dressing Room in the CHC 2
Emergency Room / Casualty room in the CHC 1
Patient Services 2
Total Number of functional beds in each CHC 30

Separate wards for males and females there in

1
the CHC
Number of functional beds for Male 10
Number of functional beds for Female 16
Number of functional Pediatric beds 4
N=2
Table A47: AVAILABILITY OF FURNITURE / INSTRUMENT

Bihar
AVAILABLE FUNCTIONAL
Yes Yes
Delivery Table 2 2
Bed Side Screen 2 2
Saline stand 2 1
Wheel chair 0 0
Stretcher on trolley 1 1
Oxygen cylinder with regulator and Mask 2 2
BP Instrument 2 2
Instrument trolley 1 1
Instrument tray 2 2
N=2
Table A48: AVAILABILITY OF OT EQUIPMENTS

Bihar
Yes Yes
Boyles Apparatus 1 1
Cardiac monitor 1 1
Ventilator 1 1
Horizontal high pressure sterilizer 1 1
Vertical high pressure sterilizer 2/3 drum
0 0
capacity
Shadow less lamp ceiling track mounted 0 0
Shadow less lamp pedestal for minor OT 1 1
Oxygen Cylinder 660 Ltrs with regulator and
1 1
Mask
Nitrous oxide cylinder 1780 Ltrs 0 0
Hydraulic operation table 0 0
Emergency drug tray 2 2
IUD Insertion Kit 2 2
Normal Delivery Kit 2 2
Equipment for Neo-Natal Resuscitation 0 0
Standard Surgical Set-I 0 0
Standard Surgical Set-II Instrument 0 0
CHC Standard Surgical Set III 0 0
Standard Surgical Set IV 1 1
Standard Surgical Set V 0 0
Standard Surgical Set VI 0 0
Equipments for Anesthesia 1 1
Equipments for laboratory test and blood
0 0
transfusion.
Materials Kit for blood Transfusion 0 0
Equipment for Radiology 0 0
N=2

Table A49: AVAILABILTY OF LABORATORY EQUIPMENTS

Bihar
Yes Yes
Binocular microscope with oil immersion 2 2
Refrigerator 2 2
Stool transport carrier 0 0
Centrifuge 0 0
Rapid Diagnostic Kit for Typhoid 0 0
Rapid test kit for faecal contamination 0 0
Blood culture bottles with broth 0 0
Cold Box 2 2
Rapid Plasma Reagin (RPR) test kits for
0 0
syphilis
Kits for ABO blood grouping 0 0
HIV test kits 0 0
N=2
Table A50: AVAILABILITY OF COLD EQUIPMENTS

Bihar
Yes Yes
Walk in cooler 2 2
Walk in freezer 2 2
ILR Large 1 1
ILR Small 2 2
Deep freezer Large 2 2
Deep freezer Small 2 2
N=2
Table A51: AVAILABILITY OF VACCINE

Bihar
AVAILABLE SUPPLY REGULAR
Yes Yes
BCG 2 2
DPT 2 2
OPV 2 2
MEASELES 2 2
DT 2 2
TT 2 2
N=2

Table A52: AVAILABILITY OF PROPHYLACTIC DRUGS

Bihar
Available
Yes
IFA Tablets 2
Vitamin A Solution 2
ORS Packets 2
Contramaxazol 2
N=2
Table A53: AVAILABILITY OF ESSENTIALSERVICES AND

AVERAGE DAILY OPD ATTENDANCE
Bihar
Yes
OPD Services 2
Emergency Services (24 Hours) 2
Referral Services 2
Blood Storage Facility 0
X ray room 2
Average Daily OPD Attendance (MALE) 190
Average Daily OPD Attendance(FEMALE) 190
N=2
Table A54: AVAILABILITY OF MCH SERVICES

Bihar
Yes
24-hour delivery services including normal and
2
assisted deliveries
Emergency Obstetric Care including
1
Caesarean Sections
Ante-natal care 2
Intra-natal care (24 - hour delivery services
2
both normal and assisted)
Post-natal care 1
New born Care 1
Child care including immunization 2
MTP facility 1
Facilities under Janani Suraksha Yojana 2
Antenatal clinics organized regularly 1
Facility for normal delivery available for 24 hours 2
Facility for internal examination for
1
gynecological conditions available at the CHC
Treatment for gynecological disorders like
leucorrhoea, menstrual disorders available at 0
the CHC
Facility for MTP (abortion) available at the CHC 0
Treatment for anemia given to both pregnant
0
as well as non-pregnant women
Low birth weight babies managed at the CHC 1
Fixed immunization day
BCG and Measles vaccine given regularly in
2
the CHC
Treatment of children with pneumonia available
1
at the CHC
Management of children suffering from
diarrhea with severe dehydration done at the 1
CHC
N=2

Table A55: AVAILABILITY OF OTHER FUNCTIONS AND

SERVICES
Bihar
Yes
Nutrition services 1
School Health programmes 1
Promotion of safe water supply and basic
1
sanitation
HIV/AIDS control programmes
Rogi Kalyan Samiti (RKS) monitor your work
2
regularly
N=2
A56 – A67
Primary Health Centres
Table A56: Availability of Human Resources

In Position
Bihar
JAHANABAD NALANDA SHEIKHPURA Total Perecntage
Medical officer 6 6 6 18 100
Lady Medical officer 3 3 1 7 38
AYUSH Medical
officer 1 1 0 2 11
Medical officer
contractual 6 5 5 16 89
Staff Nurse 5 3 5 13 72
Pharmacist 3 5 4 12 67
LHV / Health
Assistant 4 6 4 14 79
Male health Assistant 4 2 3 9 50
Laboratory Technician 5 2 5 9 50
ANM / Female healthy
worker 6 6 6 18 100
Additional staff Nurse
/ ANM (Contractual) 6 5 5 16 89
Class IV employee 6 6 6 18 100
N=18
Table A57: Any training Received in 5 Years

Any training Bihar
programme was
organized at PHC last
year JAHANABAD NALANDA SHEIKHPURA Total Perecntage
What were the
trainings organized
(N=15)
PULSE POLIO
TRAINING 5 5 5 15 100
TRAINING OF ASHA 4 5 5 14 93
TRAINING FOR
ANM/MALE HEALTH
WORKER 3 2 3 8 53
N=18
Table A58: Training Received by any Medical Officer in Last 5 years
Integrated skill development training Last 5 year 4 3 3 10

for 12 days Ever 0 0 0
Vector Born Disease Control Last 5 year 4 1 4 9
Programme (VBDCP) training Ever 0 0 0
Directly Observed Treatment- Short Last 5 year 6 4 3 13
Course (DOTS) training Ever 0 0 0
Last 5 year 6 6 5 17
Immunization training
Ever 0 0 0
NSV –Non Scalpel Vasectomy Last 5 year 3 1 2 6
training Ever 0 0 0
MTP- Medical Termination of Last 5 year 3 2 3 7
Pregnancy training Ever 0 1 0
Last 5 year 3 1 1 5
Minilap training
Ever 0 0 0
Reproductive Tract Last 5 year 3 2 1 6

Infection/Sexually Transmitted
Ever 0 0 0
Infection(RTI/STI) training
Management of obstetric Last 5 year 2 2 1 5
complications ( BEmOC - Basic
Emergency Obstetric Care) training Ever 0 0 1
IMNCI- Integrated Management of Last 5 year 4 5 4 13
Neonatal and Childhood Illnesses
training Ever 0 0 0
Last 5 year 6 2 4 12
Skilled Birth Attendant training
Ever 1 0 0
N=18
Table A59: Availability of Physical Infrastructure
Designated government building

Yes 5 5 6 16
available for the CHC
PHC is in rented building Yes 1 1 0 2
N=18 Yes
Pipe Yes 2 0 1 3
Bore well / Tube well Yes 0 1 2 3
Hand pump Yes 5 5 4 14
Well Yes 0 0 0 0
No water supply Yes 0 1 0 1
Is there regular water supply Yes 6 5 4 15
N=18
Table- A60: Electricity, Toilet and Waste Disposal Availability
Regular Power supply Yes 0 0 0 0

Occasional Power supply Yes 2 3 3 8
Power cut in summer only Yes 0 1 0 1
Regular power cut Yes 2 1 1 4
No electricity Yes 2 1 2 5
Standby facility of generator
Yes 5 4 6 15
available in working condition
N=18 Yes
Functional Toilet facility available Yes 6 6 5 17
Separate toilet facility for male

Yes 6 1 6 13
and female
N=18 Yes
Bury in Pit Yes 0 4 0 4
Thrown in common / Public
Yes 1 2 0 3
disposal pit
Thrown outside PHC compund Yes 3 2 3 8
Thrown inside PHC compund Yes 1 1 0 2
Burning Yes 1 4 2 7
Any other Yes 0 0 1 1
N=18
Table A61: Communication, Quarters, Operation theatres facility

Total
JAHANABAD NALANDA SHEIKHPURA
Telephone facility available in

Yes 5 5 5 15
PHC

Whether CHC has Personal

Yes 5 4 3 12
Computer
NIC Terminal available at PHC Yes 4 3 5 12
Access to internet facility

Yes 2 3 2 7
available at PHC
PHC have access to vehicle for
transporting patients during Yes 5 2 3 10
emergency
Complaint box / suggestion box
Yes 5 2 1 8
kept at PHC
N=18
Available: Medical officer Yes 5 4 3 12
Whether Residing: Medical
Yes 2 2 3 7
officer
Available: Pharmacist Yes 3 2 2 7
Whether Residing: Pharmacist Yes 2 1 1 4
Available: LHV Yes 3 3 3 9
Whether Residing: LHV Yes 1 2 2 5
Available: Staff Nurse Yes 4 1 2 7
Whether Residing: Staff Nurse Yes 2 1 2 5
Available: Labour Room Yes 5 4 5 14
Currently in Use: Labour Room Yes 5 4 5 14
Available: Operation Theatre Yes 4 4 6 14
Currently in Use: Operation
Yes 4 4 5 13
Theatre
Table:A62 Availability of Physical Facility
PHC have in-patient facility Yes 6 5 5 16

Number of functional beds in PHC
Yes 60 48 62 170
(N=16)
Separate wards for male and female Yes 3 4 4 11
Number of functional beds for male Yes 14 20 20 54
Number of functional beds for

Yes 26 29 32 87
female
Number of pediatric beds Yes 2 11 0 13
N=18
Table:A63: Availability of Selected Furniture / Jahanabad Nalanda Sheikhpura Total

Instrument
Available 6 5 5 16
Examination Table
Functional 6 5 5 16
Available 5 5 5 15
Delivery Table
Functional 5 5 5 15
Available 4 5 4 13
Foot Step
Functional 4 5 4 13
Available 4 4 2 10
Bed Side Screen
Functional 4 4 2 10
Available 6 4 4 14
Stool for Patients
Functional 6 3 4 13
Available 2 1 3 6
Saline stand
Functional 2 1 3 6
Available 6 6 6 18
Wheel chair
Functional 4 6 6 16
Available 4 1 0 5
Stretcher on trolley
Functional 4 1 0 5
Available 6 4 4 14
Oxygen trolley
Functional 5 4 4 13
Available 0 1 2 3
Height measuring stand
Functional 0 1 2 3
Available 5 5 5 15
Iron Bed
Functional 5 4 5 14
Available 3 4 2 9
Bed side locker
Functional 3 4 2 9
Available 4 4 4 14
Dressing trolley
Functional 4 4 4 12
Available 2 1 0 3
Mayo trolley
Functional 1 0 0 1
Available 5 5 4 14
Instrument cabinet
Functional 5 3 4 12
Available 4 2 3 9
Instrument trolley
Functional 4 2 3 9
Available 4 4 6 14
Bucket
Functional 4 4 6 14
Available 4 3 6 13
Attendant stool
Functional 4 3 6 13
Available 4 3 5 12
Instrument tray
Functional 4 3 5 12
Available 6 6 6 18
Chair
Functional 6 6 6 18
Available 5 4 6 15
Wooden table
Functional 5 4 6 15
Available 5 2 5 12
Swab rack
Functional 4 1 3 8
Available 4 3 6 13
Mattress
Functional 4 3 5 12
Available 3 2 2 7
Pillow
Functional 3 2 1 6
Available 5 4 5 14
Waiting bench for patient
Functional 5 4 5 14
Available 4 1 5 10
Medicine cabinet
Functional 4 1 5 10
Available 1 1 2 4
Side rail
Functional 1 1 2 4
N=18
Table:A64: Availability of Equipments

Available 5 3 1 9
Kit A Drugs (sub-centre)
Functional 5 3 1 9
Available 5 2 1 8
Kit B Drugs (sub-centre)
Functional 4 2 1 7
Available 2 2 1 5
Kit C Equipments (sub-centre)
Functional 1 2 1 4
Available 1 0 3 4
Kit D Equipments (PHC)
Functional 0 0 3 3
Available 2 2 3 7
Kit of Essential obstetric care drugs (PHC)
Functional 1 2 3 6
A:New Born Care:
Infant resuscitation bag with mask Available 0 3 3 6

Functional 0 3 3 6
Available 4 5 5 14
Weighing machine
Functional 4 5 5 14
Available 3 2 3 8
Paddle operated suction machine
Functional 3 2 3 8
Available 2 2 2 6
Mounted lamp with bulb
Functional 2 2 1 5
Available 4 3 3 10
Baby Bassinet
Functional 4 3 3 10
B: Other Equipments
Available 4 4 5 13
Normal Delivery Kit
Functional 4 4 5 13
Available 0 2 1 3
Equipment for assisted vacuum delivery
Functional 0 2 1 3
Available 4 3 2 9
Equipment for assisted forceps delivery
Functional 4 3 1 8
Equipment for New Born Care and Available 5 3 2 10
Neonatal Resuscitation Functional 5 3 2 10
Standard Surgical Set (for minor Available 3 3 2 8
procedures like episiotomies stitching) Functional 3 2 2 7
Available 2 1 2 5
Equipment for Manual Vacuum Aspiration
Functional 2 0 2 4
Available 2 2 1 5
Baby warmer/incubator.
Functional 2 1 1 4
N=18
Table:A65: Availability of Vaccines / Drugs
C:Vaccines
Available 6 6 6 18
BCG
Regular supply 6 6 6 18
Available 6 6 6 18
DPT
Available 6 6 6 18
OPV
Available 5 6 6 17
MEASELES
Available 5 5 4 14
DT
Available 6 6 6 18
TT
N=18
D:Prophylactic Drugs
Available 5 6 3 14
IFA Tablets
Available 4 5 4 13
Vitamin A Solution
Available 6 6 6 18
ORS Packets
Available 5 5 4 14
Contramaxazol
N=18

Table:A66: Availability of Equipments
E: Cold Chain Equipments

Available 5 2 2 9
ILR Large
Functional 5 2 2 9
Available 4 5 4 13
ILR Small
Functional 4 4 4 12
Available 3 3 3 9
Deep freezer Large
Functional 3 2 2 7
Available 4 3 4 11
Deep freezer Small
Functional 4 3 3 10
Available 6 4 4 14
Cold Box
Functional 6 4 4 14
Available 6 6 6 18
Vaccine carrier
Functional 6 6 6 18
N=18
F: Requirement of the Lab
Available 2 2 2 6
Chemical for Hb estimation
Functional 1 1 2 4
Reagent strips for urine albumin and urine sugar Available 0 2 1 3
analysis Functional 0 2 1 3
Available 1 2 0 3
Rapid Plasma Reagin (RPR) test kits for syphilis
Functional 1 1 0 2
Reagents for peripheral blood smear examination Available 2 2 1 5
for MP Functional 1 1 1 3
Available 0 1 0 1
Residual chlorine in drinking water testing strips
Functional 0 1 0 1
Available 1 1 0 2
Centrifuge
Functional 0 1 0 1
Available 4 3 4 11
Light Microscope
Functional 4 3 3 10
Available 4 3 0 7
Binocular Microscope
Functional 4 3 0 7
N=18
Table A67 - Availability of Services
A: Essential Services
OPD Services Yes 6 5 6 17
Emergency Services (24 Hours) Yes 4 5 6 15
Referral Services Yes 6 5 5 16
Average Daily OPD Attendance
Males 37 24 31 92
Females 22 42 31 95
N=18
Ante-natal care Yes 6 6 6 18
Intra-natal care (24 - hour delivery services
Yes 4 4 5 13
both normal and assisted)
Post-natal care Yes 6 3 5 14
New born Care Yes 4 3 5 12
Child care including immunization Yes 6 6 6 18
MTP facility Yes 3 1 3 7
Facilities under Janani Suraksha Yojana Yes 6 4 6 16
Antenatal clinics organized regularly Yes 5 4 5 14

Facility for normal delivery available for 24

Yes 4 4 5 13
hours
Facility for internal examination for
gynecological conditions available at the Yes 3 3 1 7
PHC
Treatment for gynecological disorders like
leucorrhoea, menstrual disorders available Yes 4 2 3 9
at the PHC
Facility for MTP (abortion) available at the
Yes 1 1 2 4
PHC
Treatment for anemia given to both
Yes 3 4 5 12
pregnant as well as non-pregnant women
Low birth weight babies managed at the
Yes 2 3 4 9
PHC
Fixed immunization day Yes 6 2 6 14
BCG and Measles vaccine given regularly
Yes 6 6 6 18
in the PHC
Treatment of children with pneumonia
Yes 4 3 6 13
available at the PHC
Management of children suffering from
diarrhea with severe dehydration done at Yes 5 4 6 15
the PHC
N=18

A68 – A79
Sub-Centres
Table A 68: Availability of Human Resources
District
Total
ANM/Female health Worker YES 96.7 100.0 96.6 97.8
Additional ANM (Contractual) YES 43.3 54.8 48.3 48.9
N=90
Table A69: Training received by ANM / Female health worker

District
Total
Integrated skill development training for 12 LAST 5 YRS 51.7 64.5 50.0 55.7
days (RCH-I)
EVER 7.1 63.6 35.7 33.3
Directly Observed Treatment Short course LAST 5 YRS 89.7 58.1 46.4 64.8
(DOTS) training
EVER 0.0 46.2 20.0 29.0
LAST 5 YRS 100.0 96.8 100.0 98.9
EVER 100.0 50.0 83.3 77.8
Integrated Management of Neonatal and LAST 5 YRS 37.9 51.6 P 44.3

Childhood Illnesses (IMNCI) training EVER 11.1 33.3 12.5 18.4
LAST 5 YRS 48.3 45.2 75.0 55.7
Skilled Birth Attendant training
EVER 0.0 47.1 42.9 28.2
N=90
Table A70: Training received by Male health worker

District
Total
Integrated skill development training for 12 LAST 5 YRS 40.0 60.0 62.5 52.2
days (RCH-I) EVER 100.0 100.0 100.0 100.0
LAST 5 YRS 90.0 100.0 75.0 87.0
EVER 0.0 100.0 0.0 25.0
Integrated Management of Neonatal and LAST 5 YRS 30.0 20.0 0.0 17.4
Childhood Illnesses (IMNCI) training EVER 14.3 25.0 0.0 10.5
N=90
Table A71: Physical Infrastructure-Q3.1-Q3.4

District
Total
Designated government building available
YES 36.7 16.1 37.9 30.0
for the subcentre
Government building YES 16.7 8.0 25.0 12.8
Rented building YES 68.4 73.1 94.1 77.4
Rent free YES 6.7 13.6 0.0 10.0
Society building YES 11.1 4.0 0.0 6.4
School building NO 100.0 100.0 100.0 100.0
ANM House YES 0.0 4.0 0.0 2.1
Type of water supply
Piped YES 0.0 3.2 3.4 2.2
Bore well YES 10.0 3.2 6.9 6.7
Hand pump YES 83.3 61.3 86.2 76.7
Well YES 6.9 24.1 16.7 15.6
No water supply YES 10.3 14.3 44.4 16.7
24 hour water supply YES 80.0 61.3 72.4 71.1

N=90
Table A72: Physical Infrastructure

District
Total
Regular power supply YES 6.7 12.9 20.7 13.3
Occasional power supply YES 6.9 12.9 19.2 12.8
Power cut in summers YES 0.0 3.2 0.0 1.2
Regular power cut YES 6.7 9.7 4.8 7.3
No electricity connection YES 82.8 63.3 65.5 70.5
Functional toilet facility available YES 26.7 45.2 24.1 32.2
Waste disposal
Bury in pit YES 0.0 25.8 6.9 11.1
Thrown in common / Public disposal pit YES 0.0 6.5 6.9 4.4
Thrown outside SC compound YES 40.0 16.1 51.7 35.6
Thrown inside SC compound YES 10.0 3.2 6.9 6.7
Burning YES 16.7 41.9 6.9 22.2
Sub- Centre has Government provided
YES 0.0 0.0 3.4 1.1
Telephone /Mobile phone facility
ANM residing in the quarter attached to the
YES 6.7 3.2 3.4 4.4
sub centre
N=90
Table A73: Availability of selected furniture

District
Total
Available 50.0 35.5 24.1 36.7
Examination Table
Functional 93.3 90.9 100.0 93.9
Available 6.7 9.7 17.2 11.1
Labour Table
Functional 100.0 100.0 80.0 90.0
Available 3.3 6.5 6.9 5.6
Foot Step
Functional 0.0 50.0 100.0 60.0
Available 36.7 51.6 69.0 52.2
Cupboard with lock and key
Functional 72.7 100.0 100.0 93.6
Available 10.0 9.7 10.3 10.0
Bedside Screen
Functional 100.0 100.0 100.0 100.0
N=90
Table A74: Availability of Equuipment

District
Total
Available 23.3 64.5 27.6 38.9
Instrument Sterilizer
Functional 100.0 95.0 62.5 88.6
Available 70.0 93.5 96.6 86.7
Auto Disposable (AD) Syringes
Functional 95.2 100.0 100.0 98.7
Available 53.3 74.2 55.2 61.1
Hub Cutter (OBSERVE)
Functional 37.5 87.0 56.3 63.6
Available 36.7 74.2 34.5 48.9
B.P. Instrument
Functional 81.8 87.0 50.0 77.3
Available 26.7 67.7 24.1 40.0
Stethoscope
Functional 100.0 95.2 71.4 91.7
Available 40.0 71.0 31.0 47.8
Weighing machine (adult)
Functional 83.3 86.4 66.7 81.4
Available 33.3 74.2 34.5 47.8
Weighing machine (infant)
Functional 70.0 91.3 80.0 83.7
Available 3.3 9.7 17.2 10.0
Haemoglobinometer
Functional 100.0 66.7 40.0 55.6

Available 0.0 6.5 6.9 4.4

Foetoscope
Functional 0.0 50.0 50.0 50.0
Available 3.3 16.1 3.4 7.8
SIMS Speculum
Functional 100.0 100.0 100.0 100.0
Available 66.7 80.6 69.0 72.2
Vaccine Carrier
Functional 100.0 96.0 100.0 98.5
N=90
Table A75: Availability of Essential Kits

District
Total
Drug Kit -A YES 16.7 12.9 13.8 14.4
Drug Kit -B YES 6.7 0 0 2.2
Drug Kit -C YES 3.3 0 0 1.1
IFA Tablets YES 33.3 71.0 27.6 44.4
Vitamin A Solution YES 63.3 93.5 65.5 74.4
ORS Packets YES 70.0 74.2 65.5 70.0
Cotrimaxazole tablet (Pediatric) YES 30.0 45.2 41.4 38.9
Disposal Delivery KIt YES 23.3 19.4 20.7 21.1
N=90
Table A76: Labour Room-SERVICES PROVIDED
District
Total
Sub-Centre is having a labour room YES 6.7 6.5 17.2 10.0
If labour room is present, are deliveries YES 100.0 50.0 60.0 66.7
carried out in the labour room SOMETIMES 0.0 50.0 0.0 11.1
6 50.0 50.0 0.0 25.0
10 0 50.0 0.0 12.5
Number of deliveries were conducted in 15 50.0 0.0 0.0 12.5
the last three months 50 0 0.0 25.0 12.5
55 0 0 25.0 12.5
105 0 0 50.0 25.0
N=90
Table A77: Availability of specific service & Other Services
District
Total
Doctor visit the Sub-centre at least once in
YES 50.0 77.4 82.8 70.0
a month
Day and time of this visit fixed YES 20.0 37.5 54.2 39.7
Antenatal care (Inj. T.T, IFA tablets, weight
and BP checkup) provided by those in the YES 73.3 87.1 93.1 84.4
Sub centre
Facility for referral of complicated cases of

pregnancy / delivery available at Sub YES 6.7 6.5 41.4 17.8
centre for 24 hours
ANM/any trained personnel accompany

the woman in labour to the referred care YES 30.0 58.1 51.7 46.7
facility at the time of referral
Immunization services as per Government

YES 93.3 96.8 100.0 96.7
schedule provided by the Sub-centre

ORS for prevention of diarrhea and

YES 63.3 74.2 79.3 72.2
dehydration available in the Sub-centre
N=90
Table A78: Monitoring and Supervision Activities

District
Total
Immunization card YES 96.7 58.1 86.2 80.0
ANC card YES 66.7 41.9 69.0 58.9
Any othre YES 0.0 66.7 100.0 87.5
Training of traditional/Skilled birth
YES 70.0 93.5 69.0 77.8
attendants and ASHA
Coordinated services with AWWs, ASHA,

Village Health and Sanitation Committee, YES 86.7 93.5 65.5 82.2
PRIs
Coordination and supervision of activities

YES 93.3 96.8 96.6 95.6
of ASHA
Scheme of ASHA implemented in Sub

YES 93.3 100.0 93.1 95.6
Centre
Any woman from the Sub- Centre villages

die during pregnancy, delivery or during six
YES 23.3 6.5 24.1 17.8
weeks after delivery since 1 April 2007 to
31 March 2008
N=90
Table A79: Morbidity

District
Total
<3 85.7 94.4 100.0 94.3
Number of such maternal deaths, since 1
3 to 5 0 5.6 0 2.9
April 2007 to 31 March 2008
6 to 8 14.3 0 0 2.9
RECORD AVAILABLE YES 18.2 5.3 53.8 23.3
<3 60.0 94.4 76.9 80.5
Number of newborn deaths, since 1 April
3 to 5 40.0 5.6 15.4 17.1
2007 to 31 March 2008
6 to 8 0.0 0.0 7.7 2.4
REORD AVAILABLE YES 60.0 5.3 78.6 41.9
N 10 19 14 43
Number of infant deaths, since 1 April <3 100.0 100.0 88.9 97.0
2007 to 31 March 2008 >12 0.0 0.0 11.1 3.0
ANY OTHER YES 0.0 66.7 100.0 87.5
N=90

Baseline Survey On Child and Related Maternal Health Care-State Report - Bihar-493 - 1

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Baseline Survey On Child and Related Maternal Health Care-State Report - Bihar-493 - 1

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NIPI Baseline Survey report for the state of Bihar

State Report - Bihar

Norway India Partnership Initiative,

DRS Pvt. Ltd.

GVL Narsimha Rao

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. CONTENTS ........................................................................................... Page Number

Baseline Summary Indicator (Jehanabad) ................................................................................. 8

Chapter 1 Introduction ................................................................................................................ 10

1.1 Background of NIPI ....................................................................................................... 10

1.8 Quantitative and Qualitative instruments ...................................................................... 20

Chapter 2 Household Characteristics ....................................................................................... 27

2.1 Household demographic profile .................................................................................... 27

Chapter 3 Characteristics of Survey Respondents.................................................................. 40

3.1 Background characteristics ........................................................................................... 40

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Chapter 4 Maternal Health .......................................................................................................... 46

4.1 Preamble ..................................................................................................................... 476

Chapter 5 Newborn Care ............................................................................................................. 72

5.1 Preamble ....................................................................................................................... 72

Chapter 6 Child Morbidity and Treatment ................................................................................. 80

6.1 Prevalence of illness in children under study ................................................................ 80

Chapter 7 Child Immunization .................................................................................................... 88

7.1 Preamble ..................................................................................................................... 898

Chapter 8 Status of Health Facilities ......................................................................................... 95

8.1 Status of District hospital (DHs) .................................................................................... 95

8.2 Status of Community Health Centre (CHCs)................................................................. 96

8.3 STatus of Primary Health Centre (PHCs) .................................................................. 99

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Table 1.1: Key Health Indicators of the State

Table 2.1: Household population by age and sex, Bihar, NIPI-08

Table 3.1: Age distribution of women respondents, NIPI-08

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Table 4.8: Nature of ANC service received, NIPI-08

Table 5.1: Trends in Infant Mortality Rate in Bihar and India

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Table 6.1: Prevalence of illness in children under study, NIPI-08

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1.1 Background of NIPI

Efforts of Norway India Partnership Initiative

 Strengthening the National Rural Health Mission, by supporting an independently

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Purpose of this Survey

1.2 Research Objectives

1.3 Study Phases

This current baseline study comprises of three phases, viz.,

3 Dissemination of study findings and summary report generation

1.4 Study area

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1.5 Ongoing health related programs in Bihar

1.6 Profile of Bihar and NIPI Districts

1.6.1 Profile of Bihar

Sheikhpura are selected by NIPI for specific intervention programs.

Table 1.1: Key Health Indicators of the State

Key Indicator Bihar Nalanda Jehanabad Sheikhpura

1.6.2 Profile of Nalanda District

Nalanda is one of the important districts of

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DLHS-2 DLHS-3 NIPI BASELINE

MATERNAL HEALTH Total Rural Total Rural Total Rural