RIHFWK - Regional Institute of Health & Family Welfare, Kashmir

Studies and Surveys

One of the most important drawbacks of our health system has been complete lack of any base-level data. It is a pity that despite commendable advances in health delivery at the primary, secondary and tertiary levels, our health planning has largely depended on assumptions and presumptions. We have, undoubtedly been able to conduct well-received research in clinical areas but when it comes to the basic data we are deficient in all spheres. This is one of the reasons that we do not know the real status of our health, disease and mortality. Most of the times our main sources of reference have been Sample Registration Surveys (SRS), Nation Family Health Surveys (NFHS), the Rapid Household Surveys (RHS), or the Indian Council of Medical Research –sponsored projects. Because of the inherent lacunae in such surveys (NFHS 1998-99 data is so different from that generated by the RCH-Rapid Household Survey 1999), most experts here have been skeptical to rely on these.

Comprehensive Family Health Survey:

Paucity of reliable data on various aspects of public health was amply discussed with the Director Health Services Kashmir, Dr. Muzaffar Ahmed, who managed to mobilize a modest budget for surveys and studies for the first time and a cell was established in the Directorate of Health Services, housed in the Regional Institute of Health Dhobiwan, to collect the base-level data about mortality, morbidity, and health-related behaviours etc in different parts of the State. A detailed survey protocol was devised for a comprehensive family health survey all over the Jammu and Kashmir State. Unlike the Studies and Surveys previously undertaken by different government or non-governmental organizations, which are urban-based or institutional, the first survey undertaken by our Institute was in the remote, and the most backward, district of Kashmir, ie Kargil. There, the survey was undertaken by 2-teams of the Regional Institute of Health in the 3 most populated blocks, Kargil, Sankoo and Drass, from 13 th October 2000 to 27 th October 2000. A total of 1000 households were surveyed to collect information about the health and health awareness of all the members including adults, adolescents, under fives and infants. The aims and objectives of this field-based, house-to-house, comprehensive survey which is to cover whole province are:

To assess the socio-demographic, socio-cultural and socio-economic status of the population.
To assess the morbidity and disability profile of the members of the household.
To determine the knowledge, belief, attitude and practice-pattern of the adult members with respect to their health and behaviour.
To study the knowledge, attitudes and practices of population about various national programmes.
K.A.B.P study of the adult family members about HIV/ AIDS.
To assess the utilization pattern, utility, satisfaction, effectiveness and efficiency of various services offered to the consumers.
To assess disease profile of the under-fives and the treatment-seeking behaviour of the parents for self and children
To determine the immunization status of the 12 – 23 month-old children.
To determine the feeding practices of the infants and young children.
To assess prevalence of reproductive-tract (RTI)infections among married women, and their health-seeking behaviours and practices for such problems.
To determine the health condition of the geriatric population .

The same 18-page protocol is being utilized for surveying households in other districts of the State. The comprehensiveness of the survey is ascertained through inclusion of various ethnic groups - Ladakhis, Tibetians, Gujjars, etc-, and for increasing the comparative usefulness slum-dwellers, migrants, fishermen etc are also being surveyed. The data is analyzed concurrently and already 9 reports have been published or presented in national and international fora.

Adolescent Health Survey

Teenage is a period of dramatic physical, physiological, biochemical and psychological upheaval. The development agenda set by hormonal alterations is shaped by socio-cultural factors while the child slowly moves towards adulthood. This inevitable, yet big transition, has its own problems and complications.

While various studies have been undertaken among the pre-school and school children, rarely any has been attempted on adolescents in Kashmir. Consequently, the health status and the awareness level of adolescents about various health-related problems is almost unknown, although we have realized from our clinical and epidemiological experience that many health problems, physical as well as psychological, are very common among them. Adolescent girls are especially vulnerable, because of conservatism, gender-discrimination and anticipation of future motherhood. A study was taken up by our Institute to find out the health and nutritional status of adolescent girls in Kashmir, and in the first phase adolescents studying in higher secondary were surveyed. The study was started from the Govt Girls Institution Kothibagh, and till now 27 girls higher secondary schools have been surveyed in Srinagar, Budgam, and Pulwama districts. It is envisaged to cover the randomized sample in all the 14 districts of the Jammu and Kashmir State.

We are very thankful to the Director School Education Kashmir, the Chief Education Officers of district Srinagar, Budgam, and Pulwama, and all the Principals of the higher secondary schools surveyed till date, without whose kind cooperation we would not have been able to perform the study. It was, however, unfortunate that the Principal of one elite private school could not be persuaded to permit study in her school which would provide the comparative data for future reference from well-fed adolescents in Kashmir. In fact, her lack of understanding and logic surprised our best motivators, some of whom are now working in the World Health Organization. We are hopeful that the authorities in the Education Department will understand the significance of school health studies for the health and welfare of our children and adolescents and will extend full cooperation in this joint effort for the betterment of our children’s health.

Junior School Health Surveys

A study has been initiated to assess the health and nutritional status of primary school children in Kashmir. This age group is especially vulnerable to micronutrient deficiencies and infections, and forms the designated survey group for survey of iodine deficiency disorders in areas where prevalence is not very high (as in our Province now). Prevalence of IDD has been found to be high in certain blocks of Anantnag, Pulwama, Kupwara and Srinagar. Kangan is one such block, where IDD had been especially high 1-2 decades back, but now prevalence has certainly reduced. The primary school health survey was begun in July 2001 in Kangan block, which is an endemic area for IDD and is at the same time inhabited by the backward ethnic group of Gujjars. It was followed in the year 2002 by similar surveys in Pulwama district which are currently on. The data is currently being analyzed, and partly ready for presentation and publication in peer-reviewed journals in India.

Awareness Studies Among the Health Professionals

Extent of knowledge about various emerging and re-emerging diseases, new health and welfare programmes, and the newly introduced skills is crucial to devising methodology and revising the content of training curricula. The Institute has already conducted the following awareness studies among medical officers of the districts:

Awareness of medical officers about Hepatitis B
Awareness level of medical officers about acute respiratory infections
Awareness level of medical officers about diarrhoea and its management
Awareness of medical officers about R. C. H programme
Awareness level of medical officers about disability and its management in the periphery

Knowledge, attitude and practice studies on ARI and HIV/ AIDS have also been undertaken among various paramedics of the Province. All the studies are in different stages of analysis and results are expected soon. The results of the KAP studies are aimed to be published in medical journals for perusal of the researchers all over India.

Prevalence Study of STI/RTI among Married Females

Reproductive infection is a common occurrence among the married women; the National Family Health Survey (NFHS-II 1998-99) found a prevalence of about among the Kashmiri women of reproductive age. An ominous problem is that the reproductive tract infection is largely asymptomatic in women; the more regretful aspect, however is that even when the infection is symptomatic the patient does not seek medical treatment. Consequently, there is a long duration between the onset of infection and receiving of proper treatment which results in severe reproductive morbidity and even mortality. The woman suffers in silence.

Table XIV: RTI/STI Reported During 2003-04: Kashmir Valley

Total 25,807
Trichomoniasis 5,000
Gonorrhoea 165
Anogenital warts 108
Anogenital herpes 109
Syphilis 23
Others 20,402

In order to assess the prevalence and nature of reproductive infection, our Survey and Study section undertook a comprehensive survey in Parts of District Pulwama where clinical examination was followed by laboratory investigations. The data is being analysed; however, preliminary statistics revealed that in some places up to 80% of married women in the reproductive age group fitted the operational definition of RTI. The study is being extended to other districts in the next year.