Community Medicine Statistics Cards:

Solutions by MBBS Gang

TOPICS COVERED WITH FORMULAE USED IN CARD NUMBERS:
Statistical Averages – S-1, S-13, S-17
Statistical Averages will include Mean, Median and Mode.
Sum of Observations
Mean =
Number of Observations

Median = Middle − most observation after arranging in ascending order

n+1
= th observation for odd n;
2
n n
� th observation + � + 1� th observation�
= 2 2 for even n
2

Mode = Most frequently occuring observation

Crude Birth Rate – S-2 = S-11, S-6, S-12 [CBR in India in 2021-2022 is 17 per 1000 MYP]
No. of live births in an area in a year
Crude Birth Rate (CBR) = x 1000
Total Mid − Year Population

Still Birth Rate – S-3 [SBR for India in 2021-2022 is 13.9 per 1000 births, acc. To UNICEF]
Still Births (Foetal deaths weighing > 1000 g at birth) during the year
SBR = x 1000
Total Live + (Stillbirths weighing > 1000 g at birth) during the year

Neonatal Mortality Rate – S-4 [NNMR for India in 2021-2022 is 22 per 1000 live births.]
No. of neonatal deaths
Neonatal Mortality Rate (NNMR) = x 1000
Total no. of live births in the same year
Sex Specific Death Rates – S-16, S-19, S-21
No. of deaths in a particular sex in a year
Sex Specific Death Rates = x 1000
Mid − year population of that sex in that year

Pie Chart – S-5, S-8

Amount / Percentage contributed by Factor
Degree occupied by Factor in Pie = x 360°
Total Amount (or 100%) from All Factors

Arrange the factors in descending order of value / degrees occupied and plot the pie.

Bar Diagram – S-23, S-32

First, arrange the observations in descending order of value. Then plot a nice bar
diagram. The bars and the space between the bars should be of equal width.

STATISTICAL AVERAGES – S-1, S-13, S-17

Card S-1:
The mid-arm circumferences (in cm) of 20 children aged 4 months are given below:
14, 13, 10, 11, 10, 12, 14, 11, 14, 12, 12, 10, 11, 13, 12, 12, 11, 13, 12, 12
Calculate the statistical averages.

Ans S-1:
Statistical Averages will include Mean, Median and Mode.
Sum of Observations
Mean =
Number of Observations
Median = Middle − most observation after arranging in ascending order
n+1
= th observation for odd n;
2
n n
� th observation + � + 1� th observation�
= 2 2 for even n
2
Mode = Most frequently occuring observation
Observations: 14, 13, 10, 11, 10, 12, 14, 11, 14, 12, 12, 10, 11, 13, 12, 12, 11, 13, 12, 12
Count the frequency of each number by using bars (I) in the table everytime the number
appears in the series. Eg. 3 times = III.
5 times is represented by crossing off 4 bars. = IIII + = IIII.
Number 10 11 12 13 14 Total
Frequency III (3) IIII (4) IIII II (7) III (3) III (3) (20)

Now, arrange the mid-arm circumference observations in ascending order to get:

10, 10, 10, 11, 11, 11, 11, 12, 12, 12, 12, 12, 12, 12, 13, 13, 13, 14, 14, 14
Sum of observations =
10 x 3 + 11 x 4 + 12 x 7 + 13 x 3 + 14 x 3 = 30 + 44 + 84 + 39 + 42
= 30 + 40 + 4 + 80 + 4 + 30 + 9 + 40 +2
= (30+40+80+30+40) + (4+4+9+2) = (220) + (19) = 239
Therefore, Mean = 239 /20 = 11.95
Median of 20 observations (after arranging in ascending order) = [value of n/2th + (n/2
+1)th observation] / 2 = [20/2th observation + (20/2 +1)th observation]/2 = [ 10th observation
+ 11th observation] /2
The 10th observation is 12. Also, the 11th observation is 12.
Therefore, Median = (12+12)/2 = 12.
Mode is the value of the most frequently occurring observation.
Since 12 occurs 7 times (followed by 11, which occurs 4 times), the mode is 12.
Hence, Mean = 11.95, Median = 12, Mode = 12.

Card S-13
Pulse Rate per minute for 15 students are as follows:
73, 71, 73, 69, 63, 71, 69, 80, 82, 68, 78, 68, 78, 71, 83
Calculate the Statistical Averages.
Ans S-13:
Statistical Averages will include Mean, Median and Mode.
Sum of Observations
Mean =
Number of Observations
 Median = Middle − most observation after arranging in ascending order
n+1
= th observation for odd n;
2
n n
� th observation + � + 1� th observation�
= 2 2 for even n
2
Mode = Most frequently occuring observation
Arranging the pulse rate observations in ascending order we get,
63, 68, 68, 69, 69, 71, 71, 71, 73, 73, 78, 78, 80, 82, 83
Sum of observations =
63+ 68 + 68 + 69 + 69 + 71 + 71 + 71 + 73+ 73+ 78+ 78 + 80 + 82 + 83
= 60+60+60+60+60 + (3+8+8+9+9) + 70+70+70+70+70 + (1+1+1+3+3) + 80+80+80+80+80
+ (-2-2+0+2+3)
= 60 x5 +70 x5 +80x5 +(37) + (9) + (1) = (60+70+80) x 5 + 47 = 210 x 5 + 47
= 1050 + 47 = 1097
Therefore, Mean = 1097 / 15 = 73.133
Median of 15 observations (after arranging in ascending order) = value of (n+1)/2th
observation = (15+1)/2 = 16/2 = 8th observation.
The 8th observation is 71. Therefore, Median = 71.
Mode is the value of the most frequently occurring observation.
Since 71 occurs 3 times (followed by 68,73 and 78, which occur 2 times), the mode is 71.
Hence, Mean = 73.133, Median = 71, Mode = 71

Card S-17
The systolic blood pressure (in mm of Hg) of 16 adult persons are as follows:
128,120,126,118, 132,118,124,116, 120,112,112,120, 134,110,108,120.
Find out the statistical averages.
Ans S-17:
Statistical Averages will include Mean, Median and Mode.
Sum of Observations
Mean =
Number of Observations
 Median = Middle − most observation after arranging in ascending order
n+1
= th observation for odd n;
2
n n
� th observation + � + 1� th observation�
= 2 2 for even n
2
Mode = Most frequently occuring observation
Observations: 128,120,126,118, 132,118,124,116, 120,112, 112,120, 134,110,108,120.
Find the minimum and maximum SBP values. Here, min = 108, max = 134.
Count the frequency of each number by using bars (I) in the table everytime the number
appears in the series. Eg. 3 times = III.
5 times is represented by crossing off 4 bars. = IIII + = IIII.
Number 108 110 112 116 118 120 124 126 128 132 134 Total
Frequency I (1) I (1) II (2) I (1) II (2) IIII (4) I (1) I (1) I (1) I (1) I (1) (16)

Now, after arranging the systolic blood pressure observations in ascending order, we
get:
108,110,112,112, 116,118,118,120, 120,120,120,124, 126,128,132,134
Sum of observations =
108+110+112+112+116+118+118+120+120+120+120+124+126+128+132+134
= (110-2) + 110 + (110+2) + (110+2) + (110+6) + (120-2) + (120-2) + 120 + 120 + 120 + 120 +
(120+4) + (120+6) + (130-2) + (130+2) + (130+4)
= (110+110+110+110+110) + (120+120+120+120+120+120+120+120) + (130+130+130) +
(-2+2+2+6-2-2+4+6-2+2+4)
= (110 x 5 + 120 x 8 + 130 x 3) + (2+6+6+4)
= (550 + 960 + 390) + 18
= (1900) + (18)
Therefore, Mean = 1918/16 = 119.875
Median of 16 observations (after arranging in ascending order) = [value of n/2th + (n/2
+1)th observation] / 2 = [16/2th observation + (16/2 +1)th observation]/2 = [ 8th observation
+ 9th observation] /2
The 8th observation is 120. Also, the 9th observation is 120.
Therefore, Median = (120+120)/2 = 12.
Mode is the value of the most frequently occurring observation.
Since 120 occurs 4 times (followed by 112 and 118, which occur 2 times), the mode is 120.
Hence, Mean = 119.875, Median = 120, Mode = 120.

CRUDE BIRTH RATE – S-2 = S-11, S-6, S-12

Card S-2:
In a town in Hoogly District, the mid-year population was 2,00,000 for 2016. In 2016,
there were 6050 live births, 110 still births, 250 deaths within one week after birth, 480
deaths in the first month of life and 750 deaths in the first year of life.
Calculate the Crude Birth Rate and give your comments.
Ans S-2:
No. of live births in an area in a year
Crude Birth Rate (CBR) = x 1000
Total Mid − Year Population
Since Numerator (N) is not a part of Denominator (D), CBR is a Ratio.
CBR for India in 2021-2022 is 17 per 1000 mid-year population. [UN World Population
Prospects Report 2022]
Live Births in town in Hoogly in 2016 = 6050.
No. of live births in town in Hoogly in 2016
Crude Birth Rate (CBR) = x 1000
Total Mid − Year Population of town in Hoogly
6050 6050
or, CBR = x 1000 = = 30.25
200000 200
≈ 30 per 1000 mid-year population
CBR of the town in Hoogly (30 per 1000) is higher than the national average value of 17
per 1000.

Card S-6:
From a survey conducted in Domjur Block of Howrah, the following information were
obtained in the year 2016:
 Total Population 4,50,000
Total Births 9200
Still Births 200
Death under 4 weeks of age 450

Calculate the Crude Birth Rate and give your comments.

Ans S-6:
No. of live births in an area in a year
Crude Birth Rate = x 1000
Total Mid − Year Population
Since Numerator (N) is not a part of Denominator (D), CBR is a Ratio.
CBR for India in 2021-2022 is 17 per 1000 mid-year population.
[UN World Population Prospects, 2022]
Live Births = Total Births – Still Births = 9200-200 = 9000
No. of live births in Domjur in 2016
Crude Birth Rate (CBR) = x 1000
Total Mid − Year Population of Domjur
9000 900
or, CBR = x 1000 = = 20
450000 45
= 20 per 1000 mid-year population
CBR of Domjur (20 per 1000) is in line with the national average value of 17 per 1000 mid-
year population.

Card S-11 [same as Card S-2]

In a town with a mid-year population of 2,00,000, there were 6050 live births, 110 still
births, 250 deaths within one week after birth, 480 deaths in the first month of life and
750 deaths in the first year of life. Calculate the Crude Birth Rate and give your
comments.
Ans S-11:
No. of live births in an area in a year
Crude Birth Rate (CBR) = x 1000
Total Mid − Year Population
Since Numerator (N) is not a part of Denominator (D), CBR is a Ratio.
CBR for India in 2021-2022 is 17 per 1000 mid-year population.
[UN World Population Prospects, 2022]
Live Births in the town in 2016 = 6050.
No. of live births in the town in 2016
Crude Birth Rate (CBR) = x 1000
Total Mid − Year Population of the town
6050 6050
or, CBR = x 1000 = = 30.25
200000 200
≈ 30 per 1000 mid-year population
CBR of the town (30 per 1000) is greater than the national average value of 17 per 1000.

Card S-12
The mid-year population of Siliguri was 6,67,450 in 2016, out of which 3,47,400 were
males. Total male and female deaths were 1737 and 2000 respectively. Total birth
recorded were 3942 out of which 142 were still births. Neonatal deaths were 204 and
post-neonatal deaths were 252.
Calculate the Crude Birth Rate for Siliguri. Give your comments.

Ans S-12:
No. of live births in an area in a year
Crude Birth Rate = x 1000
Total Mid − Year Population
Since Numerator (N) is not a part of Denominator (D), CBR is a Ratio.
CBR for India in 2021-2022 is 17 per 1000 mid-year population.
Live Births = Total Births – Still Births = 3942-142 = 3800
No. of live births in Siliguri in 2016
Crude Birth Rate (CBR) = x 1000
Total Mid − Year Population of Siliguri
3800 380000 76000 76000 7600 1520 1520
or, CBR = x 1000 = = ≈ = = ≈
667450 66745 13349 13350 1335 267 266
2 x 2 x 2 x 2 x 5 x 19 2 x 2 x 2 x 5 40 5
= = = = 5 ≈ 5.7
2 x 7 x19 7 7 7
= 5.7 per 1000 mid-year population
CBR of Siliguri (5.7 per 1000) is much less with the national average value of 17 per 1000
mid-year population.
 STILL BIRTH RATE – S-3
Card S-3:
In a town in Hoogly District, the mid-year population was 2,00,000 for 2016. In 2016,
there were 6050 live births, 110 still births, 250 deaths within one week after birth, 480
deaths in the first month of life and 750 deaths in the first year of life.
Calculate the Still Birth Rate and give your comments.
Ans S-3:
Still Births (Foetal deaths weighing > 1000 g at birth) during the year
SBR = x 1000
Total Live + (Stillbirths weighing > 1000 g at birth) during the year
Since Numerator (N) is a part of Denominator (D), SBR is a Rate.
SBR for India in 2021-2022 is 13.9 per 1000 births. [UNICEF]
No. of Still Births in Hoogly in 2016
Still Birth Rate (SBR) = x 1000
Total No. of Live Births + Still Births in Hoogly in 2016
110 110 10
or, SBR = x 1000 = x 100 = x 100 = 17.85
6050 + 110 616 56
≈ 17.9 per 1000 mid-year population
SBR of Hoogly (17.9 per 1000) is more than the national average value of 13.9 per 1000.

NEONATAL MORTALITY RATE – S-4

Card S-4:
In a town in Hoogly District, the mid-year population was 2,00,000 for 2016. In 2016,
there were 6050 live births, 110 still births, 250 deaths within one week after birth, 480
deaths in the first month of life and 750 deaths in the first year of life.
Calculate the Neonatal Mortality Rate and give your comments.

Ans S-4:
Neonatal mortality is death within 28 completed days or a month from birth.
No. of neonatal deaths
Neonatal Mortality Rate (NNMR) = x 1000
Total no. of live births in the same year
Numerator (N) is a part of Denominator (D) and Multiplier is NOT 100, so NNMR is a Rate.
NNMR for India in 2021-2022 is 22 per 1000 live births. [SRS 2019 Data]
No. of neonatal deaths in 2016 = No. of deaths within one week of birth (Early Neonatal
Mortality) + deaths within the first month (Late Neonatal Mortality) = 250 + 480 = 730.
No. of Neonatal Deaths in Hoogly
Neonatal Mortality Rate (NNMR) = x 1000
Total no. of Live Births in Hoogly in 2016
730 730 146
or, NNMR = x 1000 = x 100 = x 100 = 120.67
6050 605 121
≈ 121 per 1000 live births.
NNMR of Hoogly (121 per 1000) is much higher than India’s average (22 per 1000 LBs).

PIE CHART – S-5, S-8

Card S-5:
In Uluberia Sub-Division Hospital, Howrah, total number of admissions in different
departments in March 2016 were as follows:
Department Admissions
Medicine 3000
Surgery 2000
Gynae-Obs 3500
Others 1500
Present the above data with the help of a pie diagram.
Ans S-5:
First, arrange the observations in descending order of value.
Then, calculate the degree of pie from the given amounts by using:
Amount / Percentage contributed by Factor
Degree occupied by Factor in Pie = x 360°
Total Amount (or 100%) from All Factors
Then plot a nice pie chart.
Admissions in various departments in Descending Order:
Gynae-Obs (3500) > Medicine (3000) > Surgery (2000) > Others (1500)
Total Admissions = 3500 + 3000 + 2000 + 1500 = 10000
 Degree occupied by Gynae − Obs in Pie
Admissions contributed by Gynae − Obs 3500
= x 360° = x 360°
Total Admssions in all Depts. 10000
7
= x 360° = 7 x 18° = 126°
20
Admissions contributed by Medicine
Degree occupied by Medicine in Pie = x 360°
Total Admssions in all Depts.
3000 3
= x 360° = x 360° = 3 x 36 ° = 108°
10000 10
Admissions contributed by Surgery
Degree occupied by Surgery in Pie = x 360°
Total Admssions in all Depts.
2000 1
= x 360° = x 360° = 72 °
10000 5
Admissions contributed by Others
Degree occupied by Others in Pie = x 360°
Total Admssions in all Depts.
1500 3
= x 360° = x 360° = 3 x 18° = 54°
10000 20

Admissions in Various Departments

Others, 1500

Gynae-Obs,
3500

Gynae-Obs
Medicine
Surgery
Surgery, Others
2000

Medicine,
3000
Card S-8
Causes of Maternal Mortality in Bagnan Block of Howrah were obtained from a survey.
They were as follows:
PPH – 25%
APH – 15%
Anaemia – 20%
Sepsis – 15%
Obstructed Labour – 10%
Pre-eclampsia and Eclampsia – 15%
Draw a Pie Diagram from the above-mentioned data.

Ans S-8:
First, arrange the observations in descending order of value.
Then, calculate the percentage of pie from the given percentage by using:
Amount / Percentage contributed by Factor
Degree occupied by Factor in Pie = x 360°
Total Amount (or 100%) from All Factors
Then plot a nice pie chart.
Causes of Maternal Mortality in Descending Order:
PPH (25%) > Anaemia (20%) > APH (15%) = Sepsis (15%) = Pre-eclampsia and Eclampsia (15%)
> Obstructed Labour (10%)
25% 1
Degree occupied by PPH in Pie = x 360° = x 360° = 90°
100% 4
20% 1
Degree occupied by Anaemia in Pie = x 360° = x 360° = 72°
100% 5
Degree occupied by APH 𝑜𝑜𝑜𝑜 Sepsis 𝑜𝑜𝑜𝑜 Pre − Eclampsia and Eclampsia in Pie
15% 3
= x 360° = x 360° = 3 x 18° = 54°
100% 20
10% 1
Degree occupied by Obstructed Labour in Pie = x 360° = x 360° = 36°
100% 10
 Causes of Maternal Mortality
PPH
Obstructed
Labour
10%
PPH
25%
Anaemia

Pre-Eclampisa
and Eclampsia APH
15%

Sepsis

Pre-Eclampisa
and Eclampsia
Sepsis
15%
Obstructed
Labour

APH Anaemia
15% 20%

SEX SPECIFIC DEATH RATES – S-16, S-19, S-21

Card S-16
The mid-year population of Siliguri was 6,67,450 in 2016, out of which 3,47,400 were
males. Total male and female deaths were 1737 and 2000 respectively. Total birth
recorded were 3942 out of which 142 were still births. Neonatal deaths were 204 and
post-neonatal deaths were 252.

Calculate Male Sex Specific Death Rate of the city.

Ans S-16:
No. of deaths in a particular sex in a year
Sex Specific Death Rates = x 1000
Mid − year population of that sex in that year
Therefore,
Male Sex Specific Death Rates
No. of deaths in males in Siliguri in 2016
= x 1000
Mid − year population of that males in Siliguri in 2016
1737 17370
or, Male Sex Specific Death Rates = x 1000 = =5
347400 3474
= 5 per 1000 mid-year population

Card S-19
From a survey conducted in Bagnan Block of Howrah, the following information were
obtained in the year 2016:
Male Female Total
Mid-Year
80,000 70,000 1,50,000
Population
No. of Deaths 800 700 1500
Live Births 2975 3025 6000

Find the Female Sex Specific Death Rate.

Ans S-19:
No. of deaths in a particular sex in a year
Sex Specific Death Rates = x 1000
Mid − year population of that sex in that year
Therefore,

Female Sex Specific Death Rates

No. of deaths in females in Bagnan in 2016
= x 1000
Mid − year population of that females in Bagnan in 2016
700
or, Female Sex Specific Death Rates = x 1000 = 1000/100 = 10
70000
= 10 per 1000 mid-year population
Card S-21
From a survey conducted in Bagnan Block of Howrah, the following information were
obtained in the year 2016:
Male Female Total
Mid-Year
80,000 70,000 1,50,000
Population
No. of Deaths 800 700 1500
Live Births 2975 3025 6000

Find the Sex Specific Death Rate and give your comments.

Ans S-21:
No. of deaths in a particular sex in a year
Sex Specific Death Rates = x 1000
Mid − year population of that sex in that year
Therefore,
Male Sex Specific Death Rates
No. of deaths in males in Bagnan in 2016
= x 1000
Mid − year population of that males in Bagnan in 2016
800
or, Male Sex Specific Death Rates = x 1000 = 1000/100 = 10
80000
= 10 per 1000 mid-year population

Female Sex Specific Death Rates

No. of deaths in females in Bagnan in 2016
= x 1000
Mid − year population of that females in Bagnan in 2016
700
or, Female Sex Specific Death Rates = x 1000 = 1000/100 = 10
70000
= 10 per 1000 mid-year population
 BAR DIAGRAM – S-23, S-32
Card S-23
Infant Mortality per 1000 live births for different countries are as given below:
Country IMR
Bangladesh 120
India 90
Pakistan 100
Sri Lanka 20
Afghanistan 210
Indonesia 40

Represent the above data with a suitable diagram and give your comment.
Ans S-23:
First, arrange the IMR observations in descending order of value. Then plot a nice bar
diagram.
Afghanistan (210) > Bangladesh (120) > Pakistan (100) > India (90) > Indonesia > Sri Lanka
(20)

IMR of Countries (in Descending Order)

250

210
200
IMR (per 1000 live births)

150
120
100
100 90

50 40
20

0
Country
Afghanistan Bangladesh Pakistan India Indonesia Sri Lanka
IMR for the World in 2022 is 27 per 1000 live births. Sri Lanka’s IMR is less than the global
average, while Indonesia’s IMR is close to the average.
India, Pakistan and Bangladesh have higher IMR compared to the global average, with
Afghanistan having extremely high IMR values.
[The actual IMRs for 2022 are Sri Lanka – 5.9, Indonesia – 19.5, Bangladesh – 24.3, India –
27, Afghanistan – 44.9 (? Before Taliban invasion), Pakistan – 54]

Card S-32
Draw a simple Bar Diagram with the following data:
Type of Total No. of
Leprosy Patients
Tuberculoid 83
Borderline 39
Lepromatous 43
Total 155
Ans S-32:
First, arrange the observations in descending order of value. Then plot a nice bar
diagram using Tuberculoid (83) > Lepromatous (43) > Borderline (39).
The bars and the space between the bars should be of equal width.

Type of Leprosy
90 83
80
70
60
50 43
39
40
30
20
10
0 1

Tuberculoid Lepromatous Borderline

IMR:
Key Features:
- IMR for India in 2021-2022 is 27 per 1000 live births. [UN World Population Prospects 2022]
- Infant mortality accounts for 18% of total deaths in India
- Most Common Cause of IMR in India: Low Birth Weight (LBW) and prematurity
- Most Common Cause of IMR in World: Pneumonia

Public health importance:

- Most important indicator of health status of a community
- Most important indicator of level of living and
- Most important indicator of effectiveness of MCH services in general
- Second best indicator of socioeconomic development
One of the best predictors of state failure

Factors Affecting IMR

Likely factor affecting infant mortality in contemporary India is inadequate prenatal care
and infrequent attendance at delivery
Factors Affecting Infant Mortality Rate (IMR):

Biological Factors:
- Birth Weight (BW): IMR is greater with BW < 2.5 kg and > 4.0 kg
- Age of Mother: IMR is greater in age < 19 years and >35 years
- Birth Order: IMR is greater for birth order 1 and least for 2; it increases from birth order
3 onwards.
- Birth Spacing: IMR reduces with wider birth spacing
- Multiple Births: IMR increases in multiple births
- Family Size: IMR increases as family size increases
- High Fertility: IMR increases with high fertility
Economic Factors:
- Socio-economic Status (SES): IMR higher in lower SES
Cultural and Social Factors:
- IMR higher in early weaning and bottle-fed infants living in poor hygienic conditions
- Religion and caste: IMR is affected by patterns, habits, customs, child care, etc.
- Early marriages: IMR higher in teen age pregnancy
Other Factors:
- Sex of the child: IMR girls > IMR boys
- Quality of mothering: IMR low in good quality of mothering
- Quality of health care: IMR high in improper obstetric and pediatric care
- Maternal education: IMR low in mother with high literacy rate
- Broken family: IMR higher
- Illegitimacy: IMR higher
- Brutal habits and customs: IMR high (Not feeding colostrum, applying cow-dung to
umbilical-stump, faulty feeding practice)
- Untrained dai: High IMR
- Bad environmental sanitation: High IMR
Causes of Infant Mortality
Neonatal mortality (0-4 weeks) Post-neonatal mortality (1 - 12 months)
- Low birth weight, Prematurity - Diarrheal diseases
- Birth injuries - ARI
- Sepsis - Other communicable diseases
- Congenital anomalies - Malnutrition
- Hemolytic disease of newborn - Congenital anomalies
- Placenta/ cord conditions - Accidents
- Diarrhoeal diseases
- ARI
- Tetanus
Prevention and Control of IMR
General measures Specific mother-related measures
- Improved socioeconomic - Efficient antenatal care:
conditions TT, IFA, AN visits
- Increased female literacy - Detect high risk mother,
- Safe water supply appropriate referral
- Improvement in sanitation levels - Insufficient intranatal care
- Prevent early marriages - Management of delivery
- Delay first child birth complications
- Mother craft classes - Management of post-partum
- Health Education of mothers: complications
• Infant feeding practices
• Infant weaning practices Specific infant-related measures
• Child rearing practices - Essential care of newborn
- Special care of at-risk infants
- ORS in diarrhoea
- Growth monitoring
- Breastfeeding practices
- Immunization
- Family planning

UM5R:
U5MR for India in 2022-2023 is 30.6 per 1000 live births. [UNICEF 2023]
*UNICEF – United Nations [International] Children’s [Emergency] Fund
Causes of U5MR:
Neonatal causes: Other causes:
- Prematurity (Most common cause) - Post-neonatal causes
- Intrapartum complications - Pneumonia
(Asphyxia) - Congenital anomalies
- Neonatal sepsis - Diarrhea
- Congenital anomalies - Malaria
- Pneumonia - Injuries
- Neonatal tetanus - HIV/ AIDS
- Measles
Neonatal conditions lead to 37% of total U5MR or CMR (Child Mortality Rate):
- Infections
- Preterm Births
- Asphyxia
Prevention and Control of U5MR

• Short-term measures:
- Fertility control:
- Promotion of contraceptive measures
- Improve health of mothers
- Increase birth weight of newborns
- Responsible parenting, care
- Facilitate breast feeding, appropriate weaning

• Infection control:
- Universal immunization against common VPDs
- Management of common alimentary and respiratory infections at PHC level
- Implementation of National health programs
- Malnutrition control:
- Regular growth monitoring
- Appropriate modifications in dietary intake
- Nutritional supplementation

• Long- term measures:

- Fertility control
- Population stabilization
- Balanced socio- economic development
- Increased production, consumption, distribution of food products
- Environmental sanitation, Vector control
- Elimination of adverse socio-cultural practices like child neglect, child abuse, gender
discrimination
MMR:
MMR for India is 97 per 1 Lac Live Births
MMR for West Bengal is 105 per 1 Lac Live Births
(From Special Bulletin 2018-2020, released in Nov 2022)
Causes of MMR:
Causes of MMR (globally): Causes of MMR (India):
Hemorrhage (25%) Hemorrhage (38%)
Indirect causes (20%) Other conditions (34%)
Infection Sepsis
Unsafe abortion Abortion
Eclampsia Obstructed Labour
Obstructed Labour Hypertensive disorders

RHIME – Representative, re-sampled, routine household interview of mortality, with

medical evaluation:
It is a new method for MMR cause estimation introduced in India from 2003 SRS
RHIME is an enhanced form of verbal autopsy

Prevention and Control of MMR

• Primary Healthcare Approach:
 Develop functional relationship with birth attendants in area: Need base training
and support, skill development
 Conveyance facilities at PHC for referral of high-risk cases
 Quality Maternal Health Care –
- Efficient antenatal care: Early registration, regular ante-natal visits, detection and
referral of high-risk mothers, antenatal advice, antenatal services (TT, IFA tablets)
- Efficient intranatal care: Safe delivery (5 cleans), danger signal identification,
institutional delivery
- Efficient postnatal care: Postnatal check-ups, promotion of early ambulation,
provision of emergency care by blood transfusion.

• Public Health Approach:

 Communicable disease control: TB, HIV, Water-borne diseases, Vector-borne
diseases
  Fertility control: Enhanced contraceptive use, adequate spacing between
successive child births, limitations of family size.
 Anaemia prophylaxis: IFA tablets during Pregnancy in RCH Programme

• Educational approach: Health education regarding,

 Adequate dietary intake in pregnancy and lactation
 Avoidance of drugs, smoking and alcohol intake in pregnancy
 Warning signals, risk factors
 Fertility control mechanisms
 Maternal health services, timely utilization

• Developmental approach: Socioeconomic development

 Empowerment of women
 Rights and equal participation in fertility control

NNMR:
NNMR of India: 22 per 1000 live births [SRS 2019 Data]
Early neonatal mortality (ENNM): Neonatal mortality in first week (1-7 days) of life
Late neonatal mortality (LNNM): Neonatal mortality in first to fourth week (8-28 days) of
life.
Causes of Neonatal Mortality:
(0-4 weeks): Low birth - Conditions of placenta and
weight and prematurity cord
- Birth injury and difficult labor - Diarrheal diseases
- Sepsis - Acute respiratory infections
- Congenital anomalies - Tetanus
- Hemolytic diseases of
newborn

• MCC of NNMR in India is Preterm birth

- MCC of ENNMR: Prematurity and congenital anomalies
- MCC of LNNMR: Infections (diarrhea and tetanus)

• Features of NNMR:
- NNMR (India): 22 per 1000 LB [SRS 2019 Data]
- NNMR is directly related with birth weight and gestational age
- NNMR is higher in boys as compared to girls
CBR:
Crude Birth Rate is the simplest indicator of fertility and is defined as "the
number of live births per 1000 estimated mid-year population, in a given
year". CBR for India in 2023 is 16.95 ≈ 17 per 1000 people
[UN World Population Prospects, 2022]
The crude birth rate is an unsatisfactory measure of fertility because the
total population is not exposed to child bearing. Therefore, it does not give
a true idea of the fertility of a population.

SBR:

Still Birth Rate: The most widespread use of the term is, "death of a foetus
weighing 1000 g (this is equivalent to 28 weeks of gestation) or more"
occurring during one year in every 1000 total births (live births plus
stillbirths). Stillbirth rate is given by the formula:
SBR during a particular year
Stillbirths, i. e. , Foetal deaths weighing > 1000 g at birth
= x 1000
Total Live + Stillbirths, i. e, weighing > 1000 g at birth during the year

SBR for India in 2021-2022 is 13.9 per 1000 births. [UNICEF]

It is a frequent occurrence in the developing countries.
Prevention of SBR involves detection and treatment of:
• Infectious pathology in the course of pregnancy
• High blood pressure and its complications
• Rh Incompatibility
• Diabetes
• Premature rupture of the membrane
Some causes are difficult or impossible to eliminate such as:
• Multiple pregnancies
• Cord anomalies
• Foetal malformations
• Placenta anomalies

CDR:
Crude death rate: The simplest measure of mortality is the ‘Crude Death
Rate’. It is defined as "The number of deaths (from all causes) per 1000
estimated mid-year population in one year, in a given place”. It measures the
rate at which deaths are occurring from various causes in a given
population, during a specified period. This is considered a fair indicator of
the comparative health of the people.
It is important to recognize that the crude death rate summarizes the effect
of two factors:
a. Population composition
b. Age-specific death rates (which reflect the probability of dying)

Crude Death Rates have a major disadvantage, i.e., they lack comparability
for communities with populations that differ by age, sex, race, etc.

Strictly speaking, health should not be measured by the number of deaths

that occur in a community. But in many countries, the crude death rate is the
only available indicator of health. When used for international comparison
the usefulness of the crude death rate is restricted because it is influenced
by the age-sex composition of the population.
Although not a perfect measure of health status, a decrease in crude death
rate provides a good tool for assessing the overall health improvement in a
population.

Specific Death Rate (SDR):

May be cause/disease-specific or group specific (age-specific, s ex- specific,
age- sex specific)
• Help identify particular 'at risk' group(s) for preventive action
• Permit comparison between different causes within same population
No. of deaths from a specific cause in a year
SDR = x 100
Mid − year population