1. Data Analysis Gujarat 2010 K.K.PANCHAL Additional Director(VS)

2. Demographic Profile Area (Sq. km) 196024 Total Population (2011) (‘000) 60383 % of Urban Population 42.6 Literacy Rate-2011 79.3 Sex Ratio, 2011 918 Sex Ratio in 0-6 age group 886 Sex Ratio in 0 age group,2001 census 859 Decadal Growth Rate 19.2 % of SC Population-2001 7.1 % of ST Population-2001 14.8 Literacy Rate in SCs-2001 70.5 Literacy Rate in ST-2001 47.7 Birth Rate SRS 2009 22.3 Death Rate SRS 2009 6.9 IMR SRS 2009 44 MMR SRS 2007-2009 148 Sex Ratio at Birth SRS 2008 898 Sex Ratio in 0-4 age group SRS 2008 883 No. of inhabited Villages 18066 Village Panchayat 13753 N.Panchayat/Municipalities 172 Municipal Corporation 7 No. of Reporting Unit –Rural 18131 No. of Reporting Unit - Urban 162

3. Registration Units - Urban Units: 162 & Rural Units: 18131

4. Vital Events Trends

5. Trend in receipt of returns YearRuralUrbanOverall 200497.398.597.4 2005100.0 200698.8100.098.8 2007100.0 2008100.0 2009100.0 2010100.0

6. Trend in Registration of vital events 2009 2010 % increase over 2009 Live Births 13458611327404-1.4 Deaths 3179853236891.8 Infant Deaths 95788954-6.5 Maternal Deaths 321151-53 Still Births 779183857.6

7. Trends in Vital Registrations YearRegistration Trend Birth (%) Death (%) 200484.264.0 200589.264.8 200696.773.9 200797.775.4 2008102.479.4 2009103.279.7 2010101.880.2

8. Birth Registration by Time Time of Registration 20052006200720082009 2010 Within time95.193.594.794.694.594.3 Within 21 to 30 days 2.42.72.32.62.5 After 30 days but within one year 1.82.71.81.71.82.0 After one year0.71.11.21.11.2

9. Birth Registration by Time - Rural Time of Registration 200520062007200820092010 Within time 94.793.693.893.793.292.9 Within 21 to 30 days 2.32.52.82.62.9 After 30 days but within one year 2.02.62.12.22.32.5 After one year 1.01.31.41.51.61.8

10. Birth Registration by Time - Urban Time of Registration200520062007200820092010 Within time95.493.395.595.395.495.2 Within 21 to 30 days2.52.92.02.1 2.3 After 30 days but within one year 1.62.81.6 1.51.6 After one year0.51.0 0.8

11. Percent Birth Registration by Time, Sex and Residence - 2010 Time of RegistrationRuralUrbanCombined Male Within time92.895.394.3 Within 21 to 30 days2.92.32.5 After 30 days but within one year2.51.62.0 After one year1.80.81.2 Female Within time92.995.294.3 Within 21 to 30 days2.82.32.5 After 30 days but within one year2.51.72.0 After one year1.80.81.2 Combined Within time92.995.294.3 Within 21 to 30 days2.92.32.5 After 30 days but within one year2.51.62.0 After one year1.80.81.2

12. Crude Birth Rates

15. District wise CBR Based on Registration -2010

16. %age Distribution of Birth Registered by type of Medical Attention – CRS 2010

17. Institutional Delivery by type – CRS 2010

19. Birth Registration by Birth order- CRS, 2010 Rural Urban

20. Children by level of Mother’s Education 2+ Children 3+ Children

21. Crude Death Rates

23. Death Registered by Medical Attention - 2010

24. Percent Death Registration by Time, Sex and Residence -2010 Time of RegistrationRuralUrbanCombined Male Within time 94.288.291.5 Within 21 to 30 days 2.02.52.2 After 30 days but within one year 2.87.54.9 After one year 1.11.61.3 Female Within time 94.188.091.1 Within 21 to 30 days 2.12.62.4 After 30 days but within one year 2.77.75.1 After one year 1.21.61.4 Combined Within time 94.188.291.3 Within 21 to 30 days 2.02.62.3 After 30 days but within one year 2.77.65.0 After one year 1.11.61.4

25. District wise level of Death Registration 2009 and 2010

26. District wise CDR based CRS–2010

27. Sex Ratio at Birth

28. Sex Ratio at Birth, Comparison with SRS & CRS YearSRS EstimatesAs per CRS 12003 Total862835 Rural876855 Urban827813 22005 Total855824 Rural876842 Urban807806 32007 Total891879 Rural915881 Urban848877 42008 Total898883 Rural922886 Urban856881 52009 Total904905 Rural929907 Urban859904 62010 TotalNA902 RuralNA920 UrbanNA890

34. Medical certification of cause of death

35. Importance of Mortality data Impact of health services in community – Deciding priorities Access the effectiveness of health programme Detect changes in mortality pattern Scientific base for Medical Research Evaluation of Health Indicators

36.  Based on provision of Registration of Birth and Death Act 1969  Part of Civil Registration System, operational in many states in the beginning of 70s.  Based on ICD 10 of WHO  National List of Mortality 21 Major Groups (chapter), 3 volumes and structure of coding pattern is alphanumeric of ICD 10. MEDICAL CERTIFICATION OF CAUSE OF DEATH

37. However, the implementation and coverage of MCCD scheme is not uniform at all levels. The office of the Registrar General, India is reviewing proper implementation of MCCD scheme along with the implementation of RBD Act. Medical Certification of Cause of Death (Cont..)

38. The Registration of Births and Deaths Act, 1969 came into force in the state of Gujarat from 01-04-1970. With the introduction of Gujarat Registration of Births and Deaths Rules, 1973 from 18-04-1973, all civil surgeons and medical officers of referral hospitals were intimated to introduce the certification of death as per prescribed Performa under the rule. Medical Certification of Cause of Death In Gujarat

39.  Medical Certification of Cause of Death under Civil Registration System has got statutory backing under sections 10(2) and 10(3) of the Registration of Births & Deaths Act, 1969.  The Act also incorporates a clause (section 17(1)(b)) about the confidentiality of the information on cause of death, forbidding to disclose this in any extract provided from the registration records. Legal Provisions

40. Section 10(2): In any area, the state Govt. having regard to the facilities available therein in this behalf, may require that a certificate as to the cause of death shall be obtained by the Registrar from such person and in such form as may be prescribed.

41. Section 10(3): Where the state Govt. has required under subsection 10(2) that a certificate as to the cause of death shall be obtained, in the event of the death of any person who during his last illness, was attended by a medical practitioner, the medical practitioner shall, after the death of that person, forthwith, issue cause of death certificate according to best of his/her knowledge and experience, without charging any fee, to the person required under this Act to give information concerning the death. Legal Provisions

42. Section 17(1)(b): Subject to any rules made in this behalf by the State Govt. including rules relating to the payment of fees and postal charges, any person may obtain an extract from such registrar relating to any birth or death; provided that no extract relating to any person, shall disclose the particulars regarding the cause of death as entered in the register.

43. Legal Provisions  Under Section 23(3) of the RBD Act, any Medical Practitioner who neglects or refuses to issue a certificate under section 10(3) and any person who neglects or refuses to deliver such certificate shall be punishable with fine, which may extend to fifty rupees.

44. Status of MCCD in Gujarat The MCCD scheme has initially been implemented at four teaching hospitals- Ahmedabad, Vadodara, Surat and Jamnagar. Later Rajkot and Bhavnagar included in the scheme. Currently apart from above all six medical college, all municipal corporation reports MCCD data. And From 2009 all 27 district hospitals are going to report MCCD data. Presently we are in phase III of the training schedule. Means training of CHC’s doctors and coders with sub district hospitals. Then letter on PHC’s doctors and some of remaining private doctors will train.

45. Medical certified deaths reported 2002- 10

46. Units200220032004200520062007200820092010 AHMEDABAD*47274933362750251476217212184551907419057 VADODARA*261930063130206930293001538771176943 SURAT*540958816349857680337394172121675318626 JAMNAGAR*151816321375130921781748178523715104 RAJKOT*170622221950239725983281285165178379 BHAVNAGAR*17431693162117641610187067614832929 KARMSAD--------577 DIST. HOSP.**-----616497356254489 CHC--------1077 TOTAL177191936718052221403221035122512485894067181 * = INCLUDE DATA OF MUNICIPAL CORPORATION AREA & PRIVATE HOSPITAL ** = INCLUDE ALL DIST. HOSPITAL DATA Year wise deaths covered under MCCD 2002 to 2010

47. AGE AND GENDER WISE DISTRIBUTION OF DEATHS Age Group MaleFemaleTotal Nos.% ageNos.% ageNos.% age <1 39189.5270210.566209.8 1 – 4 7821.96712.614532.2 5 – 14 10972.68223.219192.9 15 – 24 26996.523719.250707.5 25 – 34 37849.124919.662759.3 35 – 44 504412.223536.1739711.0 45 – 54 641315.5270810.5912113.6 55 – 64 645715.6296911.3942614.0 65 – 69 32687.918467.151147.6 70+ 791619.1687126.61478622.0 Total 41378100.025803100.367181100.0

48. SIX major causes of deaths 2005 to 2010 MG Major Categories of ICD10200520062007200820092010 IX Diseases of the Circulatory System (I00-I99) 16.8822.6420.6620.5020.9218.62 I Certain Infectious and Parasitic Diseases (A00-A99) 21.0118.6816.4114.3613.4914.66 X Diseases of the Respiratory System (J00-J99) 4.145.676.316.069.4610.52 XVI Certain Conditions Originating in the Peri natal Period (P00-P99) 11.7910.158.506.606.485.93 XIX Injury, Poisoning, and certain other Consequences of External Causes (S00-T98) 12.704.6710.316.345.777.10 XVIII Symptoms, Signs and Abnormal Clinical and Laboratory Findings- Not classified Else where (R00-R99) 16.7817.2014.2825.6924.1323.29

49. Leading cause of deaths according to Major categories MCCD, 2010

50. I Certain Infectious and Parasitic Diseases XVI Certain condition originating in the perinatal period IX Diseases of circulatory system XVIII Symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified X Diseases of the respiratory system XIX Injury, poisoning and certain other consequences of external causes

52. INFANT DEATHS <1 YEARS (SPECIFIC CAUSE OF MORTALITY)-2010 INFANT DEATHS <1 YEARS (SPECIFIC CAUSE OF MORTALITY)-2010

53. COMPERISION OF CERTAIN CONDITION ORIGINATING IN THE PERINATAL PERIOD (<1YEAR) CERTAIN CONDITION ORIGINATING IN THE PERINATAL PERIOD (P00-P96) 200820092010 NO.% % % SLOW FETAL GROWTH, FETAL MALNUTRITION AND IMMATURITY (P05-P07) 180253.30131334.3794123.6 BIRTH TRAUMA (P10-P15)20.06170.45140.35 HYPOXIA,BIRTH ASPHYXIA AND OTHER RESPIRATORY CONDITIONS (P20-P28) 97728.90133735.00164541.29 HAEMOLYTIC DISEASES OF FETUS AND NEW BORN (P55) 100.30150.39350.88 OTHER PERINATAL JAUNDICE (P58-P59)80.2480.2150.12 ALL OTHER CONDITIONS ORIGINATING IN THE PERINATAL PERIOD (P00-P04,P08,P29-P54,P56-P57,P60- P96) 58217.21113029.58135433.98

54. Thanks Challenges only accelerate the development Journey.