NFHS Subject Reports
The NFHS Subject Reports are based on secondary analysis of data from the
1992-93 and 1998-99 National Family Health Surveys (NFHS) in India. The series
is copublished by the International Institute for Population Sciences (IIPS) in
Mumbai and the East-West Center.
The NFHS surveys collected information from nearly 90,000 Indian women on a
range of demographic and health topics. Conducted under the auspices of the
Indian Ministry of Health and Family Welfare, they provide national and
state-level estimates of fertility, infant and child mortality, family planning
practice, maternal and child health, and the utilization of services available
to mothers and children. IIPS conducted the surveys in cooperation with
consulting organizations and population research centres in India. The East-West
Center and ORC Macro provided technical assistance, and the United States Agency
for International Development (USAID) provided financial support.
Despite the Indian Government's vigorous Oral Rehydration Therapy (ORT)
Programme, conducted for more than a decade, very few children who fall ill with
diarrhoea are treated with ORT or increased fluids. Many of the children who
receive treatment from a health facility or provider are given unnecessary, and
sometimes harmful, antibiotics and other antidiarrhoeal drugs, but not ORT.
These findings indicate a lack of awareness of proper treatment of diarrhoea not
only among mothers but also among health-care providers. The analysis shows
clearly, however, that mother's exposure to radio, television, and cinema
increases awareness and use of ORT.
Results from these two studies indicate that, despite a
vigorous Oral Rehydration Therapy Programme in India for more than a decade,
knowledge and use of ORT to treat childhood diarrhoea remain quite limited. Very
small percentages of children who fall sick with diarrhoea are treated with oral
rehydration salt (ORS) packets, recommended home solution (RHS), or increased
fluids, despite the fact that 61 percent of these children receive treatment
from a health facility or provider. In the NFHS, among children born 1-47 months
before the survey who had diarrhoea in the last two weeks, 18 percent were given
ORS and 19 percent were given RHS. Considered together, only 31 percent were
given ORS or RHS.
Among those who receive treatment from a health facility or
provider, a very large proportion (94 percent) are treated with antibiotics or
other antidiarrhoeal drugs, contrary to WHO recommendations that drugs not be
used to treat diarrhoea in young children. The use of drugs is common among both
public- and private-sector providers but is more common in the private sector.
The analysis indicates that the electronic mass media are
effective in increasing awareness and use of ORT. Women regularly exposed to the
media are much more likely than unexposed women to know about ORS packets and to
use ORS or RHS. This result is valid even after controlling for the effects of a
number of potentially confounding variables by holding them constant. Results
also indicate some discrimination against girls in the use of ORS.
These findings suggest that both mothers and health-care
providers are not well informed about the proper treatment of childhood
diarrhoea. There is clearly a need to strengthen education programmes for
mothers and to provide supplemental training to health-care providers,
emphasizing the importance of increased fluid intake and discouraging the use of
unnecessary and often harmful drugs. The Oral Rehydration Therapy Programme also
needs to address the problem of gender discrimination in the treatment of
diarrhoea. In all these efforts, the mass media can help.
This
paper is a subject study using data from the 1992-93 National Family
Health Survey (NFHS-1), carried out by the Indian Ministry of Health and
Family Welfare. It uses the data to gauge knowledge and behaviour relating
to the use of Oral Rehydration Therapy (ORT) for the treatment of
diarrhoea, a major cause of juvenile illness and death in India. The study
focuses on women who gave birth during the 4 years before the NFHS-1
survey. The study also attempts to link ORT practices and knowledge to
media exposure. While the Indian government has been actively promoting
ORT use through an extensive media campaign, this study does not attempt
to create direct linkages to that effort but, rather, evaluates the impact
of media exposure in the broader sense. Nevertheless, the authors believe
that the study reflects on the overall impact and effectiveness of the
government's ORT campaign.
The NFHS covered 25 states representing
99% of India’s population. Data were collected from a nationally
representative sample of 89,777 ever-married women age 13-49 residing in
88,562 households. This report is based on data for the 38,161 women
covered by the NFHS who gave birth during the 4 years before the survey
and on data for the 4,558 children born in the period 1-47 months before
the NFHS who were ill with diarrhoea during the 2 weeks before the survey.
A lengthy explanation details the rational for weighting procedures and
the inclusion of all control variables.
The study begins with an
assessment of the potential scope of media exposure. Researchers found
that 39% of women access radio at least once a week, 27% watch television
once a week, and 14% go to the cinema hall or theatre at least once a
month. 48% are regularly exposed to at least one form of electronic mass
media. 52% are not exposed on a regular basis. Women aged 20-29 are less
likely to be unexposed to any media (49%) than those aged 13-19 (52%) or
those aged 30-49 (62%). The rural-urban divide is even more pronounced,
with 61% or rural women not being exposed to any coverage, as opposed to
only 23% of urban women. There were also significant regional
differences.
According to the report, 43% of women giving birth 4
years before the survey knew about ORS packages, ranging from 20%
knowledge to greater than 70%. The unadjusted figures show that women who
are exposed to electronic mass media are significantly more likely to know
about ORS packets than those who are not; for example, 56% of exposed
women knew about ORS compared to only 32% of unexposed women. The
difference of ORS knowledge among rural residents who had been exposed was
slightly greater (12% diff.) than among urban residents (9%
diff.).
Overall, 30% (adj.) of exposed women had ever used ORS
packets, compared to only 23% among those not exposed. This difference was
even more evident when the analyses included ORS and recommended homemade
solution (RHS) therapies. Of those mothers with children who were ill 2
weeks before the survey, 36% of those with exposed administered either ORS
or RHS, compared with only 27% who were not exposed. The difference
between exposed and unexposed mothers who ever used of ORS packets within
urban areas is relatively limited (33% exposed to 31% unexposed) but in
rural areas the variance was more pronounced (29% of those exposed versus
22% of those unexposed).
One noteworthy finding was that media
exposure had a far more significant impact on the administration of
ORS/RHS to boys than it did to girls. The difference exposed/unexposed
when it came to girls was only a 4% increase, while for boys it amounted
to a 13% increase. The authors suggest the need for further inquiry and
strategies to combat this significant bias. Among children receiving
treatment for diarrhoea, public health facilities or providers were more
likely to recommend ORS or RHS (45% of the time) than those from
private-sector (37% of the time).
In conclusion, the authors
suggest that despite the governmental campaign, ORT knowledge and use
remains comparatively limited. Only 43% of women who gave birth in the
previous 4 years knew about ORS, and a full 69% of children who were ill
in the 2 weeks preceding the survey were given neither ORS nor RHS
therapy. These findings indicate an overall lack of knowledge amongst both
mothers and many health care providers. Nevertheless the analysis,
demonstrates that electronic mass media are effective in increasing
awareness and usage of ORT. Based on the Abstract of the full report,
researchers would agree: "These findings indicate a lack of awareness of
proper treatment of diarrhoea not only among mothers but also among
health-care providers. There is clearly a need to strengthen education
programmes for mothers and to provide supplemental training to health-care
providers, emphasizing the importance of increased fluid intake and
continued feeding and discouraging the use of drugs. The Oral Rehydration
Therapy Programme also needs to address the problem of discrimination
against girls in the use of ORS packets. The results of this study
indicate that the mass media can help in these efforts."
Description
This
study examines the use of electronic mass media to
educate women in India about oral rehydration
therapy (ORT). This type of therapy can support
child survival by preventing diarrhoea, which
organisers say accounts for "a significant portion
of childhood mortality in India". The study is
based on data from India's 1992-93 National Family
Health Survey (NFHS). The NFHS covered 25 states
(including Delhi), representing 99% of India's
population.
This government programme aims
at educating mothers and other community members
about the causes, symptoms, and treatment of
diarrhoea. It instructs them to increase fluids,
continue feeding, and recognise danger signs.
Dissemination of these messages has been
accomplished through radio and television messages
on home treatment of diarrhoea using Oral
Rehydration Salt (ORS) and Recommended Home
Solution (RHS); longer documentaries are shown in
cinema halls. A number of community-level
activities, such as films, drama and song
performances, exhibitions, group meetings, and
training camps, are intended to educate rural
people about major public health issues, including
ORT.
Rationale
Excerpts from
the study follow:
"Results indicate that,
despite a vigorous Oral Rehydration Therapy
Programme for more than a decade, knowledge and
use of oral rehydration therapy remain quite
limited. Very small percentages of children who
fall ill with diarrhoea are treated with ORS, RHS,
or increased fluids, despite the fact that many of
these children receive treatment from a health
facility or provider. Many of the children who are
treated by a health facility or provider are given
unnecessary, and sometimes harmful, antibiotics
and other antidiarrhoeal drugs but not ORS or RHS.
The proportion receiving inappropriate treatment
is slightly higher among children who are treated
in the private sector."
"The analysis
indicates that mother's exposure to electronic
mass media increases awareness and use of oral
rehydration therapy. Women who are regularly
exposed to radio, television, or cinema are much
more likely than are unexposed women to know about
ORS packets and to use ORS or RHS to treat
childhood diarrhoea. In rural areas,
community-level mass media and group educational
activities also have positive effects on knowledge
and use of ORS and RHS, independent of mother’s
exposure to electronic mass media and other
demographic and socioeconomic
variables."
"The results show some
discrimination against girls in the use of ORS.
These findings indicate a lack of awareness of
proper treatment of diarrhoea not only among
mothers but also among health-care providers.
There is clearly a need to strengthen education
programmes for mothers and to provide supplemental
training to health-care providers, emphasizing the
importance of increased fluid intake and continued
feeding and discouraging the use of drugs. The
Oral Rehydration Therapy Programme also needs to
address the problem of discrimination against
girls in the use of ORS packets. The results of
this study indicate that the mass media can help
in these
efforts."
Contact
Information
International Institute for
Population Sciences
Govandi Station
Road
Deonar, Mumbai - 400 088, India
Tel.:
91+22+2556 3254/55/56
Fax: 91-22-556-3257
[email protected]
[email protected]
OR
East-West
Center
Program on
Population/Publications
1601 East-West
Road
Honolulu, Hawaii 96848-1601, USA
Fax:
1-808-944-7490
[email protected]
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