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| Last Updated:: 13/08/2019

Health

                    Health status is generally measured in terms of mortality indicators like Death rate, Infant mortality rate and expectation of life at birth among others. Mortality indicators shows that health status of Kerala is far advanced and higher than the all India average and is even comparable with developed countries. This outstanding progress of health status is achieved through widespread growth of the three systems of medicine in public, private, co-operative sectors combined with people's health awareness. The basic health indicators of Kerala and India are given in below. Though Kerala has attained better health care indicators, the people are now facing the problem of high morbidity both from communicable and non- communicable diseases.Kerala is having the highest number of health care institutions as per the 1991 census. About 26% of total health care institutions in India are located in Kerala.Basic Health Indicators  2009 , 2011 and 2013

 

                  Kerala has made significant gains in health indices such as high life expectancy, low infant mortality rate, birth rate, and death rate. The State must ensure that these gains are sustained. Besides, the State also needs to address problems of life style diseases (Non Communicable Diseases) like diabetes, hypertension, coronary heart disease, cancer and geriatric problems. Increasing incidences of communicable diseases like chikungunya, dengue, leptospirosis, swine flu are also a major cause of concern. Besides, there are new threats to the health scenario of the State, like mental health problems, suicide, substance abuse and alcoholism, adolescent health issues and rising number of road traffic accidents. The health status of the marginalised communities like adivasis and fishing workers is also poor compared to that of the general population. To tackle these, concerted and committed efforts with proper inter sectoral co-ordination is essential.

 

  • District wise details of health care institution, beds and waste generation are given here         
  • The district wise distribution of health care institutions in the state is given here                                                  

                 Health Indicators of Kerala: Comparative figures of major health and demographic indicators at the State and National level are given below:

 

 

Demographic, socio-economic and health profile of Kerala as compared to India

Sl. No.

Indicators

Kerala

India

 

Total population (in crore) (Census 2011)

3.34

121.06

Decadal Growth (per cent) (Census 2011)

4.9

17.7

Sex Ratio (Census 2011)

1084

943

Child Sex Ratio (Census 2011)

964

919

1

Birth Rate #

14.3

20.4

2

Death Rate #

7.6

6.4

 

Male

8.5

6.8

Female

6.7

5.9

3

Natural Growth Rate #

 

6.8

14

4

Infant Mortality Rate #

 

10

34

 

Male

9

33

Female

11

36

5

Neo Natal Mortality Rate*

6

24

6

Perinatal Mortality Rate*

10

23

7

Child Mortality Rate*

2

9

8

Under 5 mortality Rate*

11

39

9

Early Neo-natal Mortality Rate*

4

18

10

Late Neo-natal Mortality Rate*

2

5

11

Post Neo-natal Mortality Rate*

4

11

12

Death Rate*

   
 

(a) Children (0-4)

2.3

9.4

(b) Children (5-14)

0.2

0.6

(c) Persons (15-49)

2.5

3.1

(d) persons (60 and above)

43.5

41.9

(e) Per cent of death receiving medical attention*

   
 

Government

41.6

28.5

Private

35.8

17.7

Qualified professional

15.7

33.8

Untrained/others

6.9

20.1

13

Still Birth Rate*

6

4

14

Total Fertility Rate*

1.8

2.3

15

General Fertility Rate*

51.1

74.4

16

Total Marital Fertility Rate*

3.8

4.8

17

Gross Reproduction Rate*

0.8

1.1

18

Female mean age at effective marriage##

   
 

(a) Below 18

16.9

16.8

(b) 18-20

19.2

19.1

(c) Above 21

24.5

24.0

(d) All age

23.2

22.1

Sl. No.

Indicators

Kerala

India

19

Couple Protection Rate ##

31.8

40.4

20

Maternal Mortality Ratio**

46

130

21

Expectancy of Life at Birth***

75.1

68.7

 

Male

72.2

67.4

Female

77.9

70.2

**Special Bulletin on MMR 2014-16/***SRS Life Table 2012-16
## Health and Family Welfare Statistics in India 2017
Source: # SRS 2017 September/* SRS Statistical Report 2016

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                 

 

 

 

 

Nipah Virus Disease Outbreak in Kerala 2018

 

            The disease surveillance system has been functioning extremely well in Kerala, with a robust mechanism for early recognition of any communicable disease of epidemic potential, with quickest response to control and prevent its spread. This aspect has been proved once again with the recent incident of detection in the Districts of Kozhikode and Malappuram and prompt response to the first ever Nipah virus disease outbreak in the State which started in May 2018. This has been appreciated by various experts in the field of communicable disease surveillance and control, including GoI and World Health Organisation (WHO).

 

              All contacts of the confirmed/probable cases including the health care providers of various health facilities were listed out, monitored for their health status daily, samples were tested in probable cases, and continuously monitored till they came out of the maximum incubation period. Central surveillance unit and Ministry of Health (MoH) were informed on a daily basis the sequence of events. Expert teams from Delhi, Chennai, Pune and Manipal reached the District for onsite assistance and evaluation of activities. The observations to identify the possible source of infection were on par with the experience on Nipah outbreaks in Malaysia and Bangladesh, as well as north eastern parts of West Bengal, where the prominent reservoir hosts were fruit eating bats.

 

           The disease was previously reported from Asian countries like Malaysia and Bangladesh from 1998 onwards and also recurrent outbreaks have been reported from parts of West Bengal in India from 2001 onwards. But in South India, this was the first instance, and Kerala’s disease surveillance system could detect the outbreak in shortest possible time. The outbreak response activities undertaken by Kerala’s health system contained the outbreak in a shortest time of 10 days, though we lost 16 very precious lives during the period. The administrative leadership, the political commitment, community’s cooperation and the health systems resilience have contributed to this remarkable outbreak response.

 

Major Health Problems in Kerala

 

Communicable Diseases:

 

               Kerala is witnessing an increasing burden of communicable and non-communicable diseases. Although the State has been successful in controlling a number of communicable diseases earlier, the emergence of dengue, chikungunya, leptospirosis, malaria, hepatitis, H1N1, in recent years has led to considerable morbidity and mortality. Instances of vector borne diseases like dengue, malaria, Japanese encephalitis, scrub typhus etc. have seen a marked increase in many Districts. Water borne infections like different kinds of diarrhoeal diseases, typhoid and hepatitis are showing persistence in many Districts. Cholera has surfaced in many Districts after few years of relative low incidence. Vaccine preventable diseases like diphtheria and whooping cough are yet to be eliminated despite years of effort.

 

Dengue:

 

                   Dengue fever, which surfaced in Kerala as early as 1998, has now become the single largest vector borne disease. Till 2015, the disease was more prevalent in Districts like Thiruvananthapuram, Kollam, Kottayam, Pathanamthitta, Kozhikode and Malappuram. But in 2017, all the Districts reported Dengue in large numbers. Districts located at higher altitudes were having low prevalence, but all others showed high incidence. The main reason for this wide spread distribution is believed to be due to the changes in the environmental factors causing proliferation of the dengue vector-Aedes mosquitoes. These mosquitoes, which in the earlier days seen more in rural settings have now spread to urban areas also.

 

Leptospirosis:

 

                 Leptospirosis is another emerging public health challenge faced by the State. Considered as a rare disease in the early 1980’s, it has now spread to all Districts. In 2012-13 a major epidemic of the disease occurred, affecting most of the northern Districts, following which the disease has become endemic in Kerala. The disease is initially a rodent borne infection, spread through urine of the infected rodents, and the consequent contamination of the environment is the factor responsible for the disease. Over the years, the disease has been reported in many domestic animals like cows, dogs, pigs etc. and thus has become an occupational risk for those engaged in agriculture works. People, who have been involved in cleaning of stagnant canals and drains were reported to have contracted the disease. More recently the mortality due to leptospirosis is also on the rise, and joint efforts of veterinary and animal husbandry departments are essential for effective control of this disease. Out of the 1098 leptospirosis cases reported in 2015, 43 deaths were reported. The number of cases increased to 1,710 with 35 deaths in 2016. In 2017, a total of 1,408 cases were confirmed resulting in 80 deaths. In 2018, there were 625 cases and 30 deaths reported upto September 2018.

 

Chikungunya:

 

Chikungunya is a newcomer among the vector borne infections. This disease believed to have originated in the remote islands in Arabian Sea in 2005-06 spread rapidly over whole of Kerala within the next two years, affecting more than 80 per cent of our population. Fortunately, the disease is fading out, and has resulted in life long immunity for the affected population, a blessing in disguise. The past two years have seen only sporadic cases in Kerala, annual total being less than 200 cases and no deaths. Here again the vector responsible for disease transmission is the Aedes mosquitoes. Since both dengue and chikungunya are transmitted by same mosquito, and also since the same mosquitoes are responsible for transmission of the potential threat of Zika virus disease and Yellow fever, the State should be vigilant in future. In 2014, out of the 139 cases of chikungunya reported, 106 were from Thiruvananthapuram. In 2015, 104 cases were reported and 99 were from Thiruvananthapuram District alone, while it was 90 and 67 respectively in 2016-17. It was 54 and 41 respectively in 2017-18. In 2018-19 (upto September) 37 cases reported in which 33 from Thrissur District. A total of 20,46,455 viral fever cases were reported in Kerala during 2014 and in 2015 it was 19,25,690 cases. It was15,41,441 cases in 2016-17 and rose to 34,17,698 in 2017-18. In 2018-19 (upto September), the number of reported cases are 17,86,250. The details of District-wise patients treated for chikungunya and viral fever during 2017-18 and 2018-19 (upto September) is given below: 

 

District-wise Patients treated for Chikungunia and Viral Fever (Nos.)

Sl.No.

District

Chickungunia

Viral Fever

   

2017-18

2018-19
(up to August 15)

2017-18

2018-19
(up to August 15)

1

2

3

4

5

6

1

Thiruvananthapuram

41

3

411375

168673

2

Kollam

0

0

255287

125822

3

Pathanamthitta

0

0

94956

59118

4

Alappuzha

0

0

175441

89798

5

Kottayam

0

0

112268

59121

6

Idukki

0

0

95510

53097

7

Ernakulam

0

0

211316

112843

8

Thrissur

0

33

281800

142889

9

Palakkad

1

0

348590

161456

10

Malappuram

0

0

498581

278415

11

Kozhikode

1

0

331755

174333

12

Wayanad

6

0

194390

96293

13

Kannur

5

1

276785

152638

14

Kasaragod

0

0

129914

111754

 

Kerala

54

37

3417968

1786250

Source: Directorate of Health Services

 

Malaria:

 

                 Malaria, another vector borne disease, transmitted by Anopheles mosquitoes has been a major public health challenge for our country for the past many decades. Various national programs targeting its elimination have met with limited success. Though Kerala had eliminated the disease in early 1970s, Malaria has now reemerged as a public health challenge. The problem is recently aggravated due to the presence of large scale population movement from malaria endemic states. Proportion of falciparum malaria, the more severe form of the disease is slowly on the rise in Kerala. Though elimination of indigenous form of Malaria has been included in the SDG targets by the State, the issues in its fulfillment are many. Rapid urbanisation, extensive infrastructure development in many Districts, uncontrolled construction works in urban area, and climate related changes in life cycle of mosquitoes are all big hurdles in the attainment of the SDG goals. Annual cases of malaria in Kerala are less than 2,000 and the number of deaths reported is also very low, but the major issue here is the increase in foci of indigenous malaria. Thiruvananthapuram, Kollam, Kozhikode, Malappuram, and Kannur Districts have pockets of indigenous malaria over the past few years. Kasaragod District is persistently having high number of malaria, over many years, because of its proximity to the highly endemic Districts of Karnataka. Movement of fishermen along the western coast of our State is a potential threat for spread of malaria along the coastal Districts. The incidence of malaria in 2017 is 1,192 and two death were reported. In 2018 number of cases is 551 and no death was reported.

 

Japanese Encephalitis (JE):

 

                 This is a form of encephalitis, an inflammatory disease of brain and its coverings, and is also a mosquito borne infection. Due to the presence of large paddy fields, Kerala is also at risk of this disease, as the virus responsible for the disease is spread by Culex mosquitos, which are bred abundantly in water logged areas like paddy fields. The peculiar nature of the Culex mosquito to breed in contaminated water also, increases the potential threat in other areas as well. Role of migratory birds in transmission of JE is an extra risk for Kerala, because our State has many attractive sanctuaries for migratory birds. But since there is an effective vaccine against JE, we can be optimistic in its control programme, by strengthening the JE vaccination.

 

Water Borne Diseases:

 

                     There was a decrease in Acute Diarrhoeal Diseases (ADD) in 2018 compared to previous years. There was a considerable decrease in typhoid in 2018, but death due to suspected Hepatitis increased. The main reason for waterborne diseases is attributed to the unavailability of safe drinking water in many parts of the District especially in tribal and coastal areas. Unhygienic drinking water sources like wells, pump houses, water supplied through tanker lorry, leaks in public water supply pipes and the consequent mixing of foul water with drinking water, dumping of wastes including sewage in water sources, use of commercial ice in preparation of cool drinks, habit of unsafe water in preparation of welcome drinks etc. are some reasons for spread of water borne diseases. Health Department has formulated a yearlong action plan called “Jagratha” which will be implemented from November 2017 to December 2018 for prevention and control of communicable diseases.

 

HIV/AIDS:

 

                        It is estimated that around 24 lakh people in India are currently living with HIV source. Kerala State Aids Control Society is the pioneer organisation in the State working with the objective of controlling the spread of HIV as well as strengthening the State’s capacity to respond to HIV/AIDS. The society was formed to implement the National Aids Control Programme in the State. The prevalence rate of the State continues to decline from 0.21 per cent in 2008-09 to 0.13 in 2010-11 and 0.05 per cent in 2017. In Kerala, the prevalence of HIV/AIDS is 0.41 per cent (4.95 per cent in 2011) among injecting drug users (IDU) which is 6.26 per cent at national level. It is 0.23 per cent (0.36 per cent in 2011) among men having sex with men (MSM) which is 2.69 per cent at national level and 0.10 per cent (0.73 per cent in 2011) among Female Sex Workers (FSW) which is 1.56 per cent in India in 2017 (Source: Kerala State AIDS Control Society). In transgender, HIV prevalence rate in Kerala is 0.16 per cent which is 3.14 per cent at national level. HIV prevalence among migrants in India is 0.51 per cent. (Source: Kerala State AIDS Control Society)

 

Prevalence of Major Communicable Diseases:  A comparative analysis of the prevalence of major communicable diseases is given here. 

 

Non-Communicable Diseases (NCD):

 

              Common non-communicable diseases causing great threat to a healthy life are diabetes, hypertension, cardio vascular diseases, cancer and lung diseases. Unless interventions are made to prevent and control non-communicable diseases, their burden is likely to increase substantially in future, due to ageing population and changes in life style. Considering the high cost of medicines and longer duration of treatment, this constitutes a greater financial burden to low income groups. Rampant modernisation and urbanisation, drastic lifestyle changes, heavy dependency on alcohol and tobacco, affinity for white collar jobs, unhealthy eating patterns, low priority for physical exertion, high levels of stress in all strata of population are some of the reasons contributing to the prevalence of non-communicable diseases in the State.

 

            In India, it is estimated that 42 percent of total death are due to NCDs. In Kerala, the situation is more serious as more than 52 percent of the total death between the productive age group of 30 and 59 is due to NCD. Hypertension, diabetes mellitus, cardio vascular diseases, stroke and cancer are the major non communicable diseases seen in Kerala. Studies show that 27 percent of Kerala adult males are having diabetes mellitus compared to 15 per cent at national level. 19 per cent of adult female population is diabetic compared to 11 percent in India. Genetic predisposition, dietary habits and sedentary lifestyle are considered to be the reason for this phenomenon. 40.6 percent of adult males and 38.5 percent of adult females are hypertensive compared to 30.7 percent and 31.9 percent at national level. Incidents of obesity, hyper lipedemia, heart attack and stroke are also high. Cancer mortality is extremely high in males in Kerala compared to national average.

 

Health Indicators Definitions  

 Prevalence of principal communicable diseases during 2013-2017(up to October)

⇒ 100 Core Health Indicators

                                

Source: Economic Review 2011-2018