THIRUVANANTHAPURAM: It may not come as a rude surprise to many, but Kerala no longer figures on top of the list of States which are making rapid advancements on the health front.

If the preliminary findings in the latest National Family Health Survey (NFHS 3) are anything to go by, all major health indicators for the State are now sliding down, a clear indication that Kerala has been resting on the glory of its past achievements for far too long.

The key findings for Kerala from NFHS 3 show poor performance by the State as far as two key areas are concerned: immunisation and child nutrition.

The percentage of `totally vaccinated children' or children between 12-23 months who have received all recommended vaccines in the State is now just 75 per cent.

This is a slide by more than five per cent from the last NFHS (NFHS 2, `98-99) figures, which was 80 per cent.

Universal phenomenon

However, the drop in immunisation cover seems to be a universal phenomenon, with Tamil Nadu showing a drop from 89 per cent during NFHS 2 to 81 per cent in NFHS 3; Maharashtra showing a drop from 78 per cent to 59 per cent and Himachal Pradesh going from 83 per cent to 74 per cent.

As far as trends in children's nutritional status are concerned, most of the other States seems to have made gains but in Kerala, the percentage of children under three years of age who are too thin for their height has gone up from 11 per cent to 16 per cent.

The percentage of children under three years who are underweight has also gone up from 27 to 29 per cent.

Anaemia is another major problem that the State has totally failed to tackle.

If the percentage of children in the 6-35 months age group who are anaemic was 43.9 in the last NFHS, the figure currently stands at 55.7 per cent.

The percentage of women in the 15-49 age group who are anaemic is 32.3 per cent as against 22.7 per cent in the last survey.

Anaemia during pregnancy can be a dangerous condition but the percentage of pregnant women in the 15-49 age group who are anaemic in the State has also gone up from 20.3 per cent during NFHS 2 to 33.1 per cent in NFHS 3.

NFHS 3 shows that infant mortality rate in Kerala is still the lowest in the country at 15 (15 infant deaths per 1,000 live births). In NFHS 2, the figure was 16.

However, infant mortality shows a slight upward trend from 16 to 18 per 1,000 live births in urban areas as per the latest survey, which should be investigated thoroughly.

Major implications

Another key finding of NFHS 3, which could have major implications for the State's morbidity pattern in future, is the rapid upward trend in the percentage of obese or overweight men and women. Kerala now has the second largest population of obese adults in the country, after Punjab.

The percentage of overweight or obese women in the 15-49 age group is a whopping 34 per cent, while that of men is 24.3 per cent.

The last NFHS put the percentage of obese women in the State at 20.6 per cent. This is the first time that base line data for men is being registered in any NFHS.

Shift in focus

"The health indicators that we take so much pride in has been the result of long years of consistent fieldwork by our health workers, who ensured community participation in all health programmes. In the later years, the focus on field programmes slackened and as the public health system failed to raise itself to the expectations of people, the people's response to public health initiatives also came down," said a public health activist.

The State still enjoys the lowest infant mortality rate (15 per 1,000 live births), the total fertility rate is below two and institutional deliveries are almost 100 per cent.

No major gains

However, what is significant from the NFHS 3 findings is that Kerala has not made any gains on the health front in the past few years, while several States like Andhra Pradesh, Tamil Nadu, Himachal Pradesh have been surging ahead.

"Our health indicators have not improved but rural States like Himachal Pradesh have gone ahead of us and now comes third if we were to rate the health system," said a Health Department official.

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