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A STUDY TO “ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME AMONG RURAL POPULATION REGARDING THE KNOWLEDGE OF BIRTH AND DEATH REGISTRATION” IN SELECTED AREA OF KODLAPURA, MADHUGIRI TALUK, TUMKUR DIST.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
MR. SANJAY JOSEPH
COMMUNITY HEALTH NURSING
MADHUGIRI SRI RAGHAVENDRA INSTITUTE OF NURSING SCIENCES

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

PROFORMA FOR THE REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / Mr. SANJAY JOSEPH
I year M.Sc. Nursing
Madhugiri Sri. Raghavendra Institute of Nursing Sciences, Shankar Matt Road, Raghavendra Colony, Madhugiri- 572132, Tumkur dist.
2. / NAME OF THE INSTITUTION / Madhugiri Sri. Raghavendra Institute of Nursing Sciences
3. / COURSE OF STUDY AND SUBJECT / I year M.Sc. Nursing
Community Health Nursing
4. / DATE OF ADMISSION TO COURSE
5. / TITLE OF THE TOPIC / A STUDY TO ‘’ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME AMONG RURAL POPULATION REGARDING THE KNOWLEDGE OF BIRTH AND DEATH REGISTRATION” IN SELECTED AREA OF KODLAPURA, MADHUGIRI TALUK, TUMKUR DIST.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION:

Vital Statistics are the demographic indicators which help in identifying areas that need policy and programmed investigations setting near and far-term goals and deciding properties, besides understanding them in an integrated structure.

Vital statistics includes indicators such as birth rate, death rate, and natural growth rate, life expectancy at birth, morbidity, mortality and fertility rates.1

Registration of vital events keeps a continuous check on demographic changes. If registration of vital events is complete and accurate, it can serve as liable sources of health information.2

The necessity for a complete, up to date, and reliable data on vital events hardly needs emphasis. These data are a pre-requisite for socio-economic planning and to evaluate the effective implementation of various programmes. In particular, they are the cornerstone of public health systems today. The chief sources for data on vital events in India are Civil Registration System (CRS), Sample Registration System (SRS) and Population Census. The Population census remains the main source of information on population and a host of population characteristics. However, the census, being a decennial exercise, does not provide the measure of population change from year to year. The measures of fertility and mortality derived from the Census are centered on the midpoint of the decade and as such do not provide information on annual change. Of the other two sources of vital statistics for getting the vital rates on a regular basis, the SRS has been designed to provide reliable estimates at National and State Level. The possibility of getting robust estimates of vital rates at district and Sub-district level, on annual basis, through sample survey is ruled out on account of prohibitively large sample size and variety of resultant factors such as controlling of non sampling errors etc. CRS is thus the only source for providing vital rates at district and sub district level; rather a complete CRS system can provide these rates at all administrative levels. 17

Reliable vital statistics based on births and deaths are necessary for population health assessment, epidemiological research, and health planning and programme evaluation. Civil registration is considered as the optimal source of statistics on vital events (i.e. births and deaths). The national authority for civil registration in India is the Office of the Registrar-General and Census Commissioner, under the Ministry of Home Affairs. Registration is, however, decentralized to India’s 29 states and 6 union territories. In theory, India’s registration system provides a good basis for overall coordination, direction, technical guidance and standards for birth and death statistics, but the reality is vastly different. For the period 2000–2006, birth registration in India was 41% and death registration was < 25%, 1 with large regional differences. Poor registration rates are due to constraints in both the Government system (supply-side) and the general population (demand-side).3

The importance of birth registration and the need of Birth certificate do not end merely with childhood; it is a record that is very much a need during education, for employment, for marriage and for that matter for everything.

As per the Report of the Working Group on Birth and Death (2001), at national level approximately 55% of the births and 46% of the deaths are being registered. The level of registration varies substantially across the States. Some of the States such as Goa, Gujarat, Jammu and Kashmir, Karnataka, Kerala, Maharashtra, Mizoram, Punjab and Tamil Nadu and all the Union Territories except Dadra and Nagar Haveli have achieved above 90% registration of births while some of the States such as Andhra Pradesh, Assam, Bihar, Manipur, Meghalaya, Rajasthan and Uttar Pradesh are able to register less than 50% of the births only. In the rest of the States, levels of birth registration is in the range of 50-90 percent.4

6.1 NEED FOR THE STUDY

“Legal identity” refers to a human being’s legal (as opposed to physical) personality. Legal identity allows persons to enjoy the legal system’s protection and to enforce their rights or demand redress for violations by accessing state institutions such as courts and law enforcement agencies. Proof of legal identity consists of official, government-issued and recognized identity document, documents that include basic information attesting to the holder’s identity and age, status, and/or legal relationships. Without these proofs of one’s legal identity, persons find it difficult to exercise and enforce their rights, or obtain benefits and opportunities provided by the state. Consequently, “legal identity” can be construed narrowly to refer to official, government-issued identity documents that prove one’s status as a person who can exercise rights and demand protection under the law.

In the government sector, registration is given low priority and there is an attitude of blaming the victim, ascribing low levels of vital event registration to “cultural reasons/ignorance “. In the community, low registration was due to lack of awareness about the importance of and procedures for registration.1

A descriptive cross-sectional survey was conducted in 2003 in Oke-Oyi town in Kwara State, to examine the awareness, attitude and practices of birth and death registration in a semi-urban community in the Middle Belt of Nigeria. Of the 302 respondents interviewed in the households, 288 (97.6%) were aware that births are supposed to be registered. However, only 94(32%) were aware that deaths were supposed to be registered. Also, majority of the respondents 195 (81.9%) of respondents knew there is a difference between birth registration and obtaining a birth certificate.

The presentation included a synthesis of recent country-specific vital registration assessments, in terms of variations in the institutional frameworks for vital registration, coverage and quality of recording causes of death, and the current status of reporting mortality statistics by SEAR countries. This thesis enabled an understanding of the magnitude and determinants of the problem in data availability in each country, and set the stage for deliberations in later sessions towards revising solutions towards improving mortality statistics at country level.6

Vital statistics are the major data source for health and demographic study and research undertakings. Universities and training institutions are the major vital statistics data users for a variety of academic and operational research projects that benefit government and non-government policy and programme implementing institutions. However, due to the absence of complete and useable civil registration and vital statistics data in Africa, these academic and training institutions are primarily using modeling and extrapolation techniques that are highly dependent on assumptions and complex mathematical methods.16

The investigator during his posting observed the limited knowledge of rural population regarding the birth and death registration. The investigator during his past experience observed the village people are not aware of the importance of registration of vital events. The people do not know where to register birth and death events and when to register and how to register. This being a major problem among rural population, henceforth the investigator personally felt that there is need for above studies and statistics and was inspired in selection of this dissertation.

6.2 REVIEW LITERATURE:

6.2.1: A study was conducted to determine the existing process of vital events registration. Samples from 2, 81,500 population of sub district of Andrapradesh were examined. The study revealed that, Equity stratifies such as gender, socioeconomic status and geography affect vital event Registration rates in communities; Voluntary organizations can facilitate government–society interaction and help to increase local vital event registration.3

6.2.2: A study was conducted in a semi-urban settlement in the Middle-Belt of Nigeria to determine awareness, attitude and practice of birth and death registration. Samples of Three hundred and two heads of households were interviewed. The study showed that awareness of birth registration was high in the study population and the awareness of death registration is however very low. The studies revealed the importance of conducting further studies to identify ways forward towards improving birth and death registration.5

6.2.3: A study was focused on understanding the awareness, attitudes, and practices of death registration, in urban and rural parts of Kosovo. The study revealed that only 60 percentage of the death were registered and there is a need for more coordination between religious, health and government institutions, when it comes to informing the population about the requirement to register the facts of death.7

6.2.4: A study was done to determine the Impact of the universal birth registration campaign before the universal birth registration campaign was launched in 2005the number of births registered (including both adults and children) was 656,935. 67% of children under one were registered.Following the campaign in 2008, the number of births registered (including both adults and children) had grown to 6, 83,286. 51% of children under one were registered. The fall in percentage registered reflects the switch from manual to automated systems, which necessitated the retraining of staff and volunteers and affected the rate of coverage.8

6.2.5: To determine the impact of Universal Birth Registration Campaign an End Line Survey was conducted in Andhra Pradesh, Rajasthan and Karnataka between January and March 2010.The survey result show that there has been a significant increase in the awareness level amongst the target groups about birth registration and its importance in the project areas of all three states. It is heartening to find that the actual levels of birth registration have risen very satisfactorily as compared to the levels at the time of the baseline/ situational analysis study. From abysmal levels of around 20%, the current registration levels in the implementation areas of the three states are now well above 80%.9

6.2.6: The study was done to assess the quality of mortality data from the registration system of Thailand. The study takes advantage of the Kanchanaburi Project by comparing the deaths found in the annual censuses to those recorded in the civil registration system in order to measure the level of under-registration. The age and sex pattern of death registration found in this study might be useful information in adjusting the data from this source. Moreover, this study also pointed out a possible gap between the multiple steps of death registration, from notifying the death to officially registering it. This finding suggested a hypothesis to be further tested.10

6.2.7 A study was mooted for a rapid assessment to examine issues involved in the current systems of Birth Registration and the current approach to its promotion. In two group discussions held at Kosmanda and Nawagoan panchayat of Kawardha district the women from 13 villages who attended, did not know who registers birth, where is the registration form sent and from where the birth certificate comes and within how many days registration should be done. Similar is the case in Shaliabhatta panchayat of Korba district where both male and female villagers did not know about the birth registration procedure and process of getting certificate. Panch, Sarpanch, ANM and teachers who attended the focal group discussions did however have the knowledge that they have to get the registration done within 21 days and they also know that if 21 days are over then they have to pay a fee. But the women present in the meeting did not know paying fee was also a part of the registration11

6.2.8 The study was conducted at Boteti district in the central part of Botswana with a population of more than 45,000 (Botswana Impact Survey, 2004), to assess the extent of birth registration. The Study was conducted in four places in Boteti namely, Orapa, Letlhakane, Mopipi and Rakops. Under-fives were selected as the target population of the study. Participants were selected by convenience sampling. Sixty participants were interviewed using face to face interview for illiterate parents/guardians and structured questionnaire for literates. The study revealed that 51 (85%) women delivered at health facilities, while 9 (15%) delivered at home, 35 (58%) of the babies were registered for birth, and 25 (42%) were not. 44 (73%) of the respondents had knowledge of birth registration and 16 (27%) had no knowledge. Barriers to birth registration were identified and included lack of knowledge, poor socio-economic status, penalty fee, cultural beliefs and minority population. Annual birth registration campaigns, use of media community involvement were identified to be measures that can be used to improve birth registrations. This study shows that the extend of birth registration in Boteti is low since 85% births were delivered at the institutional facility and 15% at home but only 58% births were registered. This implies that children are denied their right to birth registration.12

6.2.9 A study was done to evaluate mortality statistics from the District Municipal Corporation, south Karachi for the year 1995 to 1998. Total number of death reported was 7480. Of these 28% were female and 72% were male. The cause of death statement was non-specific in 49% of the death. This data will have limited use in research of health planning. It reveals essential to emphasize the importance of the death certification process to the medical profession.13

6.2.10 A case study in rural Indonesia was conducted to assess the Utility of local health registers in measuring perinatal mortality. Field activities were conducted in 23 villages, covering a total of 1759 deliveries that occurred in 2007. Perinatal mortality outcomes were 23 stillbirths and 15 early neonatal deaths, resulting in a perinatal mortality rate of 21.6 per 1000 live births in 2007. Inadequate awareness and supervision, and alternate workload were cited by local midwives as factors resulting in inconsistent data reporting.14