BALLABGARH HDSS, INDIA
Site Map
Fig 1: Geographical map of Ballabgarh HDSS
BALLABGARH HDSS SITE DESCRIPTION
Introduction
Geography of the HDSS area
Ballabgarh is located in Faridabad district of State of Haryana in India and situated between 28o 25' 16" North latitude and 77o 18' 28" East longitude. It is bound by Union Territory of Delhi (National Capital) to the north, Gurgaon district of Haryana State on the west and State of Uttar Pradesh on eastern & southern sides. It is about 35 kms from Delhi by road on Delhi-Mathura National Highway-2 and is also well connected through Delhi-Mathura double track broad-gauge line of the Northern Railway and North-Central Railways.
As per the 2001 national census the total population of Ballabgarh town is nearly150,000.The total population covered directly by Ballabgarh HDSS is 82933 as on 31st December, 2006. It comprises exclusively of rural population from 28 villages with overall population density of 1620 persons / per square kilo meter. The predominant castes (social hierarchical groupings characteristic of India) of the region are Jats, Rajputs, Pandits and Scheduled castes. Ballabgarh DSS experiences four distinct seasons: winter, autumn, summer and rainy season, each on an average lasting for 4 months. The main economic activity of majority of the population is agricultureor agriculture dependent trades. Main crops grown are wheat, sugarcane, millets etc.
HDSS SITE Profile
Ballabgarh HDSS site is also known as Comprehensive Rural Health Services Project (CRHSP), which was started in 1961 with the help of Rockefeller Foundation. It is run by the All India Institute of Medical Sciences (AIIMS), New Delhi in active collaboration with the State government of Haryana. The All India Institute of Medical Sciences is a premier centre of excellence in the field of medical education and health care in India. Its mandate is for setting standard in teaching, training and health care at all three level of health care. CRHSP joined INDEPTH Network in 2003 and since then has been actively collaborating with the Network.
The objectives of the project are:
- To demonstrate a model health care delivery system including demographic surveillance
- To set a standard in teaching, training of nursing students, under-graduates, interns and post graduate medical students.
- Identification and carrying out priority operational research to help address needs of country.
Under this project there are two Primary Health Centres (PHC) and one secondary level hospital at Ballabgarh. The two PHCs, Dayalpur and Chhainsa are situated 10 and 20-kilometer respectively from Ballabgarh. The area served by these two PHCs is also referred to as the Intensive Field Practice area (IFPA) of the project (Fig- 2) which comprises of 28 villages and 12 sub-centers. The Intensive Field Practice Area of the project caters to a population of 82933 and 9584 households as on 31st December 2006. Each PHC has 6 sub-centers, which in turn covers a population ranging from 5000-8000 each. A team of male and female health workers manage each of the sub-centers and providesthe health care in these villages.
Ballabgarh HDSS data collection and processing
Every household in the field practice area is visited once every fortnight by either of the health workers and relevant health information and vital statistics is collected in addition to delivery of routine health care as per the guidelines of national health programs. The male workers are given the responsibility of registration of vital events. The female workers register the women in the antenatal period and follow them up until delivery. The male workers register births during their domiciliary visit. Subsequently, the newborn is followed up for immunization. The male workers identify all deaths during the house visits. A verbal autopsy is conducted for every death in the study area, using a structured interview schedule which has been prepared separately for 0-28 days, 29 days –5 years and for more than 5 year of age. The verbal autopsy tool has been developed by HDSS Ballabgarh and used by male health workers. In addition to routine data collection, an annual census is done in the months of December to January to update the records. All information collected is updated once a month in a computerized management information system (MIS) at Ballabgarh Civil hospital, the site headquarters.
Computerised Health Information Management and Evaluation System (CHIMES):
The computerised data management system was introduced in the Comprehensive
Rural Health Services Project Ballabgarh in February 1988. Data pertaining to various health services provided in the area are stored in different databases. Demographic database contains complete demographic data of the population covered by the project. Maternal and Child Health services related data are stored in specific databases such as Antenatal Care and under- five file which is designed for recording this information. Health services in this area are provided by trained male and female multipurpose workers. All the houses are visited alternately by the male and female worker every fortnight for the delivery of health care services including maternal and child health activities. All married women between 15 to 45 years are allotted a record each in the Eligible Couples file. Any woman who is identified to bepregnant by the MPWs is provided a record in the Antenatal file. Newborns are provided one record each in the under fives file. Any individual who dies is removed from the demographic file and his/her details are transcribed into the death file. Every individual in the project area has been assigned an identification number called the unique number. The unique number comprises of codes for project area, primary health centre, village, house number, family number and individual number. This number is present in all the files and serves to access data from any other file and thus links up all the databases. Health workers come to the project head quarters at Ballabgarh once in a month to update the data on the computer database there. After data entry, they go back with a printed “work plan”, which lists out the various activities to be carried out for the month. Besides the work plan, the MIS also generates other reports such as ANC list, Immunization list etc. The software was initially developed in DBASE. Now a new software has been developed in Visual Basic and the existing data converted into Microsoft Access database.
Surveillance for Demographic and Health Information (SUDEHI)
In order to document the behavioural changes occurring in the community, behavioural surveillance has been started since this year. It is called Surveillance for Demographic and Health Information (SUDEHI). It has three modules, one each related to Maternal & Child Health, Household level information and Individual level information. It covers behaviours related to all major parameters for health from sanitation to lifestyle and health seeking. Currently it is planned to repeat these surveys on a two yearly intervals. This information will be used to plan appropriate interventions in the project area.
Curative services in the PHC:
The PHC has daily out -patient services, for management of common ailments in the primary care level. Essential drugs are provided to the patients free of cost. Each subcentre runs a clinic once a week, which is attended by a doctor. Besides, doctors are available round the clock to provide emergency services in the PHCs.
Field supervision and quality control:
The MPWs are supervised by the health assistants. The health assistants carry out concurrent supervision along with the health workers during their field visit for 5% of houses, and also cross check 5% of houses which the MPWs have visited in their previous visits. Besides, the medical officer also supervises the overall functioning of the workers. A regular review of the work done by the health workers is carried out in monthly meetings which are conducted in both the PHCs. Any deficiency or difficulties faced by the workers or supervisors is discussed in these meetings.
3. Health and Demographic Indicators
- Level of education - 70.2 % of above 6 year population are literate
- Religion - Mainly Hindu (90.5.%), Muslims 9.45%.)
- House characteristics - Almost all are pucca houses
- Access to water - 80.6 % within or near to house.
- Sanitation and electricity - 100 % electrification and 38% sanitary latrines
- Population Density: 1620 persons / square per kilo meter
- Seasonality: 4 seasons (winter, autumn, summer and rainy season)
- Main economic activity: Agriculture
Fig 1. Age Pyramid of Ballabgarh HDSS population
Table 1: Mortality Indices for Ballabgarh HDSS: 2004-2006.
Mortality Indicators / 2004( n = 79645) / 2005
( n = 81011) / 2006
( n = 82933)
Crude Death Rate / 6.9 / 6.1 / 6.8
Neonatal Mortality Rate* / 24.8 / 17.7 / 23.0
Infant Mortality Rate* / 55.8 / 45.9 / 46.5
Under 5 Mortality Rates* / 83.0 / 66.9 / 69.3
* Per thousand live births
Figure - 2. Neo -natal and Infant Mortality rate in CRHS Project Ballabgarh (1981-2006)
Table 2. Fertility related indicators of Ballabgarh HDSS
Year / 2004 / 2005 / 2006Crude Birth Rate (CBR) / 25.1 / 24.6 / 24.3
Sex Ratio at Birth (Females per 1000 male) / 901 / 825 / 748
Mean (S.D.) Age of Marriage (males) / 22.6± 2.9 / 23.3±3.0 / 25.1±3.1
Mean Age (S.D.) of Marriage (females) / 20.4±3.3 / 21.5±3.5 / 21.9±3.4
Mean Age (S.D.) of females at first Child / 21.6 / 23 / 23
Spacing 1st-2nd child / 2.9 / 3.0 / 3.0
GFR / 99.7 / 97.6 / 95.9
TFR / 3.22 / 3.16 / 2.88
GRR / 1.4 / 1.3 / 1.1
Minimum Dataset
MortalityPerson Years / Deaths / Basic vital statistics
Age / Both sexes / Male / Female / Both sexes / Male / Female / Rates
<1 / 2008 / 1146 / 862 / 93 / 40 / 53 / Crude birth rate
1-4 / 7679 / 4181 / 3498 / 36 / 16 / 20 / Total fertility rate
5-9 / 9575 / 5206 / 4369 / 8 / 4 / 4 / Crude death rate
10-14 / 9355 / 5075 / 4280 / 5 / 2 / 3 / Neonatal mortality rate
15-19 / 9365 / 4942 / 4423 / 12 / 9 / 3 / Post neonatal mortality rate
20-24 / 8602 / 4387 / 4215 / 18 / 10 / 8 / Infant mortality
25-29 / 6562 / 3646 / 2916 / 20 / 14 / 6 / Child mortality rate(1-4)
30-34 / 6531 / 3536 / 2995 / 14 / 9 / 5 / Underfive mortality
35-39 / 5424 / 3057 / 2367 / 17 / 14 / 3 / Crude rate of natural increase
40-44 / 4707 / 2423 / 2284 / 23 / 16 / 7 / In-migration rate
45-49 / 3461 / 1812 / 1649 / 18 / 13 / 5 / Outmigration rate
50-54 / 2797 / 1427 / 1370 / 26 / 17 / 9 / Growth rate
55-59 / 2161 / 1060 / 1101 / 29 / 18 / 11
60-64 / 1832 / 849 / 983 / 34 / 23 / 11
65-69 / 1396 / 672 / 724 / 58 / 28 / 30
70-74 / 933 / 445 / 488 / 45 / 26 / 19
75-79 / 615 / 325 / 290 / 40 / 20 / 20
80-84 / 289 / 143 / 146 / 27 / 21 / 6
85+ / 188 / 101 / 87 / 24 / 17 / 7
83480 / 44433 / 39047 / 547 / 317 / 230
Cause of death by broad age groups
Age group
Cause / <1 / 1-4 / 5-14 / 15-44 / 45-64 / 65-84 / 85+ / Total
Malaria / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Infectious diseases / 16 / 4 / 4 / 17 / 21 / 13 / 2 / 77
Maternal causes / 0 / 0 / 0 / 3 / 0 / 0 / 0 / 3
Senility / 0 / 0 / 0 / 0 / 5 / 74 / 20 / 99
Fever Unsp. / 2 / 2 / 1 / 2 / 2 / 4 / 0 / 13
Heart Disease / 3 / 1 / 0 / 9 / 14 / 15 / 0 / 42
Cancer / 0 / 0 / 0 / 12 / 15 / 9 / 0 / 36
Diabetic / 0 / 0 / 0 / 0 / 2 / 5 / 0 / 7
Other causes / 72 / 29 / 8 / 61 / 48 / 50 / 2 / 270
93 / 36 / 13 / 104 / 107 / 170 / 24 / 547
Fertility
Age / Women / Births (both) / Male / Female
15-19
20-24
30-34
35-39
40-44
45-49
2004 / 2005 / 2006
Population / 79645 / 81011 / 82933
Births / 1970 / 1979 / 1997
CBR / 24.73 / 24.43 / 24.07968
CDR / 6.82 / 6.07 / 6.6
CDR-Males / 7.13 / 6.65 / 7.19
CDR-females / 6.47 / 5.42 / 5.93
NNMR / 25.38 / 20.21 / 23.03
IMR / 55.33 / 45.98 / 46.56985
Life expectancy
Age grp / death / survive / total / qx / expec surv / person year / beyond t / expect of life
0-1 / 93 / 1915 / 2008 / 0.04631474 / 100000 / 96757.97 / 7698212 / 76.98212
1-4 / 36 / 7643 / 7679 / 0.00468811 / 95368.5 / 381488.9 / 7601454.032 / 79.70611
5-9 / 8 / 9567 / 9575 / 0.00083551 / 94921.4 / 474408.9 / 7219965.149 / 76.06254
10-14 / 5 / 9350 / 9355 / 0.00053447 / 94842.1 / 474083.9 / 6745556.28 / 71.12406
15-19 / 12 / 9353 / 9365 / 0.00128137 / 94791.4 / 473653.5 / 6271472.406 / 66.16075
20-24 / 18 / 8584 / 8602 / 0.00209254 / 94670 / 472854.6 / 5797818.916 / 61.24243
25-29 / 20 / 6542 / 6562 / 0.00304785 / 94471.9 / 471639.5 / 5324964.333 / 56.36561
30-34 / 14 / 6517 / 6531 / 0.00214362 / 94183.9 / 470414.9 / 4853324.841 / 51.53029
35-39 / 17 / 5407 / 5424 / 0.00313422 / 93982 / 469173.8 / 4382909.927 / 46.63561
40-44 / 23 / 4684 / 4707 / 0.00488634 / 93687.5 / 467292.9 / 3913736.151 / 41.77438
45-49 / 18 / 3443 / 3461 / 0.00520081 / 93229.7 / 464936.3 / 3446443.247 / 36.96723
50-54 / 26 / 2771 / 2797 / 0.00929567 / 92744.8 / 461568.8 / 2981506.989 / 32.14742
55-59 / 29 / 2132 / 2161 / 0.01341971 / 91882.7 / 456330.9 / 2519938.22 / 27.4256
60-64 / 34 / 1798 / 1832 / 0.01855895 / 90649.7 / 449042.4 / 2063607.363 / 22.76465
65-69 / 58 / 1338 / 1396 / 0.04154728 / 88967.3 / 435595.6 / 1614565.011 / 18.14785
70-74 / 45 / 888 / 933 / 0.04823151 / 85270.9 / 416072.8 / 1178969.437 / 13.82616
75-79 / 40 / 575 / 615 / 0.06504065 / 81158.2 / 392594.5 / 762896.6008 / 9.400118
80& above / 51 / 426 / 477 / 1 / 75879.6 / 370302 / 370302 / 4.880125
Total / 547 / 82933 / 83480 / 7698212
Contact Details of HDSS Ballabgarh:
Dr Anand Krishnan
Comprehensive Rural Health Service Project (CRHSP)
Centre for Community Medicine, AIIMS,
Ballabgarh, Faridabad -121004
Haryana, India
Ph No: +91 129 2241362
Fax No: +91 129 2211227