Saturday, Jan 18, 2003
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Tamil Nadu
By R. Sujatha
There was drastic fall in the IMR until 1990 in rural areas, but in the last decade the decline was from 68 to 57 owing to the fall in the birth rate in the State. During the same period, it fell from 42 to 38 in urban areas. "Access to emergency care, universal vaccination programmes and prevention of diseases have contributed to the fall in the rate", S. Jayam, former president of the National Neonatology Forum, has said. The rate has stabilised. The State has a fully equipped mobile neonatal intensive care unit, first of its kind in the country, besides good middle-level emergency care for mother and child. Over 80 per cent of expectant mothers were anaemic and undernourished. They were prepared neither emotionally nor mentally for motherhood. Systematised emergency care for mother and child was introduced only in 1993 in taluk and district hospitals. Though hospitals had facilities for mother care, medical equipment was not manufactured indigenously until 1981. Vaccination against Rubella, a disease affecting the brain, vision, hearing, growth and heart, was unheard of and a generation of girls had not been vaccinated for the disease. Until recently, the vaccine had to be imported. Now, it was indigenously produced and available at Rs. 30. The vaccine must be administered to girls between nine and 16 or before marriage. Paediatrics as a subject was introduced in the MBBS only five years ago after much lobbying with the Indian Council of Medicine. Officials of the Reproductive and Child Health project said only 85 per cent of births were in hospitals. Foeticide and juvenile sex ratio in some districts also contributed to the IMR. Lack of skilled attendants, education and accessibility to a medical care centre could also influence the mortality rate, they said. Dr. Jayam said the recommended minimum intake for a pregnant woman was 1,500 calories a day, but most women consumed only 800 calories. The haemoglobin count in a healthy person was 12. Even a count of 11 was anaemic. If it fell to eight, blood transfusion had to be given during childbirth. The Government was supplying iron tablets in rural areas but women either due to carelessness, social taboos or wilful ignorance were denying themselves of the nourishment, which resulted in low birth weight of babies. Two thirds of IMR was owing to neonatal mortality as a newborn was most vulnerable during the first 28 days.
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