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Health Status of
India
Dr. Muhammedirfan H. MominAssistant Professor
Community Medicine Department
Government Medical College, Surat.
5,000 year old ancient
civilization
325 languages spoken
18 official languages
>1 Billion population.
Worlds largest
democracy.DR IRFAN MOMIN
Largest English speaking
nation
in the world.
3rd largest standing army
force
2nd largest pool of
scientists and engineers in
the World.
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India is a union of 28 states and
7 union territories.
DR IRFAN MOMIN
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Urban and Rural Population in Gujarat in
2011
DR IRFAN MOMIN
The Measurement of Health Status
Disease FrequencyCasesPrevalence rate Incidence rateDeaths
◦ Case Fatality RateDisability adjusted life years:Years of life lost to premature death
and years lived with disability adjusted for the severity of the disability.One DALY is one lost year of healthy
DR IRFAN MOMIN
The Measurement of Health Status Disease Distribution
By time, place person Seasons, geographic area and age, sex,
caste, religion, ethnicity etc.
Determinants of Disease
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Human Development Index (HDI)
1. Life expectancy at birth.
2. Education index.
3. GDP index.
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Human Development Index (HDI)
- 2011 Rankings Very High Human Development 01-47
High Human Development 48-94
Medium Human Development 95-141
Low Human Development 142-169
1 = Norway
4 = United States
101 = China
134 = India
187 = CongoDR IRFAN MOMIN
Health Problems
Classification
1) Communicable diseases
2) Non Communicable
diseases
3) Nutritional problems
4) Environmental Sanitation
5) Medical Care problem
6) Population ProblemsDR IRFAN MOMIN
Demographic issues or
population problems
• Population-1,21 ,01,93,422
• Density of population – 382 per
sq.km.
• 17.5% of world population is in
India.
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• Gujarat
• Population – 6,03,83,628
(5% of India)
• Density – 308 per sq. km.
• Gujarat 10th on population
• 26 Districts
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Total Rural Urban
Birth Rate1 22.5 24.1 18.3
Death Rate1 7.3 7.8 5.8
Natural Growth Rate1 15.2 16.3 12.5
Infant Mortality Rate1 50 55 34
Sex-ratio 940 947 926
Population in 0-6
age group
13.12 14.11 10.93
Child sex-ratio 914 919 902
Literacy rate 74.04 68.91 84.98%
India
(1=SRS 2011)DR IRFAN MOMIN
Total Rural Urban
Birth Rate1 22.3 23.8 19.9
Death Rate1 6.9 7.7 5.6
Natural Growth Rate1 15.4 16.1 14.3
Infant Mortality Rate1 48 55 33
Sex-ratio 918 947 880
Population in 0-6 age
group
12.41 13.49 10.96
Child sex-ratio 886 906 852
Literacy rate 79.31 73 87.58
Gujarat
(1=SRS 2011)DR IRFAN MOMIN
Statistics for Surat Municipal Corporation
*CENSUS 2011 Surat City
SEX RATIO 758 / 1000 Male*
CHILD SEX RATIO 813 / 1000 Boys*
CRUDE BIRTH RATE 18.25 / 1000 population
CRUDE DEATH RATE 4.37 / 1000 population
INFANT MORTALITY RATE 16.08 / 1000 live births
MATERNAL MORTALITY
RATE0.41 / 1000 live births
LITERACY RATE 89.03 %*
MALE 92.76 %*
FEMALE 84.05 %*DR IRFAN MOMIN
States literacy rate 2011
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Sex ratio
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Sex-ratio (Adult)
- 940
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Sex-ratio
India - 940
Gujarat – 918
Surat Dist-788
Surat city– 758
Sex-ratio at 0-6 age group
India – 914
Gujarat – 886
Surat city- 813
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Sex-ratio (0-6 yrs)
- 914
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Sex-ratio 2011
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Child (0-6years) Sex-ratio 2011
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Sex Ratio & Child Sex-Ratio
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Rank
in 2011District
Sex- ratio Rank
in 20012011 2001
01 The Dangs 1007 987 02
02 Tapi 1004 996 01
03 Dohad 986 985 04
24 Kachchh 907 942 10
25 Ahmadabad 903 892 25
26 Surat 788 810 26DR IRFAN MOMIN
The Measurement of Health Status
Maternal mortality rate
◦The number of women who die
as a result of childbirth and
pregnancy related complications
per 100,000 live births in a given
year
DR IRFAN MOMIN
Maternal Mortality Ratio
• India – 212 per 1,00,000 live births
• Gujarat – 148 per 1,00,000 live births
Source – Special bulletin on MMR in India (SRS) June 2011
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The Measurement of Health Status
Infant mortality rate◦The number of deaths in infants under 1 year per 1,000 live births for a given year
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Infant Mortality Rates
611
27
64
79
655757
DR IRFAN MOMIN
Infant Mortality Rate
7985
56
6873
47
5762
42
Urban Rural Total
NFHS-1 NFHS-2 NFHS-3
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4550
54
28
53
NFHS-1 NFHS-2 NFHS-3 Urban Rural
Marital StatusPercent of women age 20-24 married by
age 18
NFHS-3
DR IRFAN MOMIN
Desire for No More Children
among Women with 2 Children
908372
8876
6661
47
37
NFHS-1 NFHS-2 NFHS-3
2 sons 1 son and 1 daughter 2 daughters
Diseases
DR IRFAN MOMIN
Leading contributor in global diseases
1990
1.Lower Rasp. Infec.
2.Diarrhoea
3.Prenatal condition
4.Unipolar major depression
5.IHD
6.Stroke
7.TB /HIV
8.Measles
9.Road traffic Injury
10.Congenital
2020
1.IHD
2.Major Depression
3.Road Traffic Injury
4.Stroke
5.COPD
6.Lower Resp. Inf.
7.TB
8.Perinatal condition
9.Diarrhea Diseases
10.HIV
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Top ten risk factors leading to Disease,
Disability or Death
1. Underweight
2. Unsafe sex
3. Unsafe water & sanitatio
4. Indoor smoke & solid fuels
5. Zinc Deficiency
6. Iron Deficiency
7. Vitamin A Deficiency
8. High blood pressure
9. Tobacco use
10. High cholesterol
1. Tobacco
2. High blood pressure
3. Alcohol
4. High cholesterol
5. High BMI
6. Low Fruits and Veg Intake
7. Physical inactivity
8. Illicit Drugs
9. Unsafe sex
10. Iron Deficiency
Poorest countries Developed countries
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Trends in Global Deaths 2002-30
Source: World Health Statistics 2007DR IRFAN MOMIN
Major causes of death in children under 5 with
disease-specific contribution of undernutrition
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COMMUNICABLE DISEASES
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Diseases Eradicated
Small pox
Guinea worm
Polio
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Small pox
It was endemic in 33 countries in 1967
The last indigenous case in India
occurred on 17th may 1975 in Bihar.
In April 1977 India was declared small
pox free.
The worlds last case occurred in Somalia
(Africa) on 26 October 1977.
The WHO declared on 8 May 1980 that
small pox has been eradicated.
DR IRFAN MOMIN
Guinea worm or
Dracunculosis Zero Incidence has been maintained
since August 1996 in India
In February 2000, India has been certified
by WHO for the elimination of Guinea
worm Disease and on 15th February 2001
WHO declared India as “Guinea worm
Disease free”.
DR IRFAN MOMIN
0
250
500
750
1000
1250
1500
1750
2000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*
Wild poliovirus cases, India
P1 wild P3 wild
* data as on 2 March 2012
1 WPV case in 2011 compared to 42 in
2010
1735
397
139212
1487
203127
62
648
83 75 8018 1
0
250
500
750
1000
1250
1500
1750
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*
WPV1 cases, India, 1998 - 2011
Year
* data as on 2 March 2012
Location of wild poliovirus cases by type,
India
State P1 P3 Total
West Bengal 1 1
Total 1 1
WPVs
Onset of
paralysis -
13 January
Howrah,
West
Bengal
* data as on 2 March 2012
2011*
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Polio
Last case occurred in 13th January
2011 in West Bengal.
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Disease does not occur in
IndiaYellow Fever
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Communicable Diseases
Malaria
Tuberculosis
Leprosy
Diarrhea
ARI
HIV
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Malaria
Cases 1.52 million
(0.12%)
Deaths 924
PF % 49.56
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Tuberculosis
Global Rank 1
Incidence ( all
cases)
170
/100,000/year
Incidence ( new
sp)
75 /100,000/year
Prevalence
( all cases)
185/ 100,000
(0.18 %)
TB mortality 24 /100,000/
year DR IRFAN MOMIN
Diarrhea
Pathogen % of Cases
Viruses Rotavirus 15-25
Bacteria Escherichia coli 10-20
Shigella 5-15
Compylobactor jejuni 10-15
Vibrio Cholerae 01 5-10
Salmonella 1-5
Protozoan
s
Cryptosporidium 5-15
No Pathogen found 20-30DR IRFAN MOMIN
Cholera
Cases 3482
Deaths 12
Case Fatality
Rate
0.34%
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Typhoid Fever
Endemic in India
Cases 1.03 million
( 10 lac)
Deaths 421
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Amoebiasis
Prevalence 15%
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Hookwarm Infection
Heavily infected areas are
Assam,
West Bengal,
Bihar,
Orissa,
Andhra Pradesh,
Tamilnadu,
Kerala,
Maharashtra.
More than 200 million people are infected in India
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Dengue Haemorrhagic Fever
CASES 15,509
DEATHS 89
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Japanese Encephalitis
Cases 4482
Deaths 774
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Leptospirosis
Occurs in
South Gujarat,
Kerala,
Maharashtra,
Andaman Nicobar.
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Plague
Epidemic in 1994 in Surat
Epidemic in 2004 in Uttarakashi
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Tetanus
Cases 2051
Deaths 160
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Neonatal Tetanus
Cases 889
Deaths 31
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Global Leprosy Situation
LEPROSY HAS BEEN
ELIMINATED FROM THE
WORLD
DR IRFAN MOMIN
Leprosy: 6 top countries
•6 top endemic countries: India,
Brazil, Myanmar, Madgascar,
Mozambique, Nepal contribute
85% of global case load:
(69% from India)
• 91% of global case new cases
(81% from India)DR IRFAN MOMIN
Leprosy
India achieved leprosy elimination in
December 2005
By the end of march 2009, prevalence
rate of Leprosy was 0.72 cases per
10,000 population.
DR IRFAN MOMIN
Trend of Leprosy Prevalence & Annual New Case Detection (ANCDR) Rates
0.740.720.84
1.3
25.9
20.0
13.7
10.9
8.45.9 5.8 5.5
4.23.75.35.3
2.43.2
1.171.2
1.42.3
5.95.57.0
8.9
5.65.14.64.95.76.4
6.25.9
4.43.3
0
5
10
15
20
25
30
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Year (March End)
Pre
va
len
ce
& A
NC
DR PR
ANCDR
DR IRFAN MOMIN
Five endemic states are as follows:
1. Bihar
2. Chattisgarh
3. Jharkhand
4. Chandigarh
5. West Bengal
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State wise Contribution New Leprosy Cases - year 2007-08
Uttar Pradesh,
22.54,
23%
Bihar,
13.83,
14%
West Bengal,
9.84,
10%
Maharashtra,
9,
9%
Andhra Pradesh,
7.3,
7%
Chhattisgarh,
5.67,
6%
Gujarat,
5.25,
5%
Jharkhand,
.94, 5%
Madhya Pradesh,
4.4,
4%
Tamilnadu,
4,
4%
Orissa,
4.13,
4%
Karnataka,
3.28,
3%
Delhi,
0.97,
1%
Others,
4.85,
5%
Contribution by six states 20.8% pop & 34.5% new cases
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Navsari
Valsad –2. 18
Dang – 4.26
Surat-1. 39
Narmada- 1.26Bharuch
Vadodara – 1.10
PM
2.22
Dahod-2.25
P.R.- 0.87
2.77
2. 04
Endemicity of Leprosy –
March.09
> 5
2 - 3
1 - 2
< 1
P.R.
3 - 5
Gujarat achieved elimination as
on Oct-04DR IRFAN MOMIN
DR IRFAN MOMIN
Situation in Surat:
Leprosy not eliminated from Surat
The prevalence rate 1.44
The new case detection rate 2.57 in the year 2006.
Male:female ratio as 58:42 (2006).
Child cases among new cases of leprosy 12.8% (2006).
Multibacillary cases among new cases 50.1%, 2006.
Grade II disability 1.38% (2006).DR IRFAN MOMIN
HIV
Provisional estimates shows there are
22.7 lakh people living with HIV /AIDS.
Estimated adult HIV Prevalence rate
is 0.28 %
DR IRFAN MOMIN
DR IRFAN MOMIN
Sex
Women
(%)
Men
(%)
Total
(%)
Urban
Rural
0.29
0.18
0.41
0.32
0.35
0.25
India 0.22 0.36 0.28
HIV Prevalence by Residence
and Sex, India
HIV prevalence rate is 60% higher
among males than females and 40%
higher in urban areas than rural areas
HIV
High Prevalence states are
Maharashtra,
Tamilnadu,
Karnataka,
Andhra Pradesh,
Manipur
Nagaland.
DR IRFAN MOMIN
HIV
Groups Prevalence
IDU 9.2
MSM 7.4
FSW 4.9
Migrants 3.6
Truckers 2.5
STD 2.5
ANC 0.5DR IRFAN MOMIN
DR IRFAN MOMIN
AIDS Awareness
94
73
81
46
57
80
Urban Rural Total
Percent of women and men age 15-49 who have
heard of AIDS
Women
Men
Non Communicable Diseases
Ischemic heart
Disease
Prevalence
%
Urban 9.6
Rural 2.7
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Coronary Heart Disease
Indices Urban Rural Total
Prevalen
ce
6.4 2.5 3.7
Death
rate
Per 1000
0.8 0.4
DALY per
100,000
2703.4 986.2DR IRFAN MOMIN
Prevalence ( %) of Hypertension
among adults (> 25 years) , WHO
Male Female
India 23.1 22.6
China 29.8 25.6
Bangladesh 27.4 27.9
Sri Lanka 31.0 26.2
US 17.0 14.2
UK 27.7 19.1
Japan 26.4 16.7DR IRFAN MOMIN
Total
Employees
1493 (100%)
Total
Hypertensive
455 (30.5%)
Known
Hypertensive
197 (13.2%)
RULE OF HALVES
Employees on
regular
Treatment 139
(9.3%)
Employees
having
controlled
Hypertension
71 (4.7%)
DR IRFAN MOMIN
Rheumatic Heart Disease
Prevalence 5-7/1000 in 5-15 years
There are 1 million cases of RHD in
India
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Accidents
World:In developed countries - 57% of male death and 43% of female death in 10-24 yrs are
due to accidents.
DR IRFAN MOMIN
Cancer
World
Every year- 10 million diagnosed
6 million die
Worldwide - Lung Cancer (12.3 %)
Breast Cancer(10.4%)
Colorectal Cancer(9.4%)
Death from cancer - Lung (17.8%)
Stomach (10.4%)
Liver (8.8 %)DR IRFAN MOMIN
Male
most common (by
occurrence)
most common (by
mortality)[12]
prostate cancer (25%) lung cancer (31%)
lung cancer (15%) prostate cancer (10%)
colorectal cancer
(10%)colorectal cancer (8%)
bladder cancer (7%) pancreatic cancer (6%)
non-Hodgkin
lymphoma (5%)
liver & intrahepatic bile
duct (4%)DR IRFAN MOMIN
Female
most common (by
occurrence)
most common (by
mortality)[12]
breast cancer (26%) lung cancer (26%)
lung cancer (14%) breast cancer (15%)
colorectal cancer (10%) colorectal cancer (9%)
endometrial cancer (7%) pancreatic cancer (6%)
non-Hodgkin lymphoma
(4%)ovarian cancer (6%)
DR IRFAN MOMIN
India
3.4 % of all deaths – cancer
7 lakh new cases detected every year
Males - Mouth/oropharynx
oesophagus
stomach
Lower respiratory tract
Females - Cervix
Breast
Mouth/oropharynx
oesophagusDR IRFAN MOMIN
NUTRTIONAL PROBLEMS
Under nutrition
Obesity
Anemia
Vitamin A deficiency
Vitamin B 12 deficiency
Iodine Deficiency Disorders
Zinc Deficiency
DR IRFAN MOMIN
DR IRFAN MOMIN
Trends in Child Nutritional Status
40
23
45 43
20
51
UnderweightWastedStunted
NFHS-3 NFHS-2
Percent of children age under 3 years
(Low-height-for-
age)
(Low-weight-for-
height)
(Low-weight-for-
age)
DR IRFAN MOMIN
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Anaemia among Children
7479 81
72
Total Urban Rural NFHS-2
Percent of children 6-35 months with anemia
DR IRFAN MOMIN
Nutritional Status of Adults
34
9
24
13
55
36
BMI below normal Overweight/Obese Anaemic
Women Men
Percent of women and men age
15-49
DR IRFAN MOMIN
Malnutrition of Women by
Residence and Education
36
25
41 4235 35
25
36
13
24
7 713 14
21
11
0
10
20
30
40
50
60
Total
Urb
an
Rura
l
No e
ducatio
n
<8 yea
rs
8-9
year
s
10+ y
ears
NFH
S-2 to
tal
Underweight Overweight
Percent of women age 15-49
DR IRFAN MOMIN
Malnutrition of Men by
Residence and Education
34
8
27
14
38
5
40
3
38
5
40
6
25
14
0
5
10
15
20
25
30
35
40
45
50
Total
Urb
an
Rura
l
No e
ducatio
n
<8 ye
ars
8-9
year
s
10+ y
ears
Overweight
Underweight
Percent of men age 15-49
?
Vitamin B 12 Deficiency is in increasing trend in Gujarat
DR IRFAN MOMIN
DR IRFAN MOMIN
Child Immunization Trends
62
54
52
42
35
72
63
55
51
42
78
78
55
59
44
BCG
Polio3
DPT3
Measles
All Vaccines
NFHS-1 NFHS-2 NFHS-3
Percent of children age 12-23 months
vaccinated
DR IRFAN MOMIN
Selected Household Characteristics
93
51
83
56
12
26
25
68
45
Electricity
Piped water
Any toilet facility
Urban Rural Total
Percent of households
India’s population to be the largest in the world
India is set to overtake China as the world's most populous nation by
2050.
India’s population is expected to grow from 1.08bn to 1.63bn
people, overtaking China, which is forecast to reach 1.44bn from
1.3bn currently.
India, will also have the highest working population in the World —700 million people out of 1.1 billion
people are young; the young population will continue till 2050.
DR IRFAN MOMIN
Goldman Sachs Report of 1 October, 2003 –
"Dreaming with BRICs: The path to 2050"
India's GDP will reach $ 1 trillion by 2011,
$ 2 trillion by 2020,
$ 3 trillion by 2025,
$ 6 trillion by 2032,
$ 10 trillion by 2038, and
$ 27 trillion by 2050,
becoming the 3rd largest economy after USA and China.
In terms of GDP, India will overtake Italy by the year 2016, France by 2019, UK by 2022,
Germany by 2023, and Japan by 2032.DR IRFAN MOMIN
