11

SAMPLE SAMPLE REGISTRATION REGISTRATION

SYSTEM SYSTEM IN INDIAIN INDIA

Experience of Verbal Experience of Verbal AutopsyAutopsy

22

Sample Registration Sample Registration System (SRS)System (SRS)

SRS initiated by the Office of the SRS initiated by the Office of the Registrar General, India in 1964-65 on Registrar General, India in 1964-65 on a pilot basis and became operational a pilot basis and became operational on full scale from 1969-70.on full scale from 1969-70.

One of the largest continuous One of the largest continuous demographic household sample demographic household sample survey in the world covering 1.2 million survey in the world covering 1.2 million households and 6.3 million population.households and 6.3 million population.

33

SRS is a dual reporting system with SRS is a dual reporting system with continuous and retrospective recording of continuous and retrospective recording of events by two independent functionaries. events by two independent functionaries.

The main objective of SRS is to provide The main objective of SRS is to provide reliable annual estimates of birth and death reliable annual estimates of birth and death rates at the State and National level rates at the State and National level separately for rural and urban areas.separately for rural and urban areas.

SRS also provides data for estimating SRS also provides data for estimating Infant Mortality Rate (IMR), Total Fertility Infant Mortality Rate (IMR), Total Fertility Rate (TFR), Maternal Mortality Rate and Rate (TFR), Maternal Mortality Rate and other measures of fertility and mortality.other measures of fertility and mortality.

44

Sample designSample design The sample design adopted for SRS is a uni-The sample design adopted for SRS is a uni-

stage stratified simple random sample without stage stratified simple random sample without replacement.replacement.

Stratification in rural areaStratification in rural area: In rural area, each : In rural area, each district within a State has been divided into two district within a State has been divided into two strata viz. strata-1: villages with population less strata viz. strata-1: villages with population less than or equal 1500 and strata-2: villages with than or equal 1500 and strata-2: villages with more than 1500 population.more than 1500 population.

Stratification in urban areaStratification in urban area: In urban areas : In urban areas stratification has been done on the basis of the stratification has been done on the basis of the size of towns/cities. The towns/cities are size of towns/cities. The towns/cities are grouped into six size classes.grouped into six size classes.

55

A simple random sample of A simple random sample of enumeration block is selected without enumeration block is selected without replacement from each of the size replacement from each of the size classes of towns/cities in each State/Ut.classes of towns/cities in each State/Ut.

The sample unit in rural areas is a The sample unit in rural areas is a village or a segmented village whereas village or a segmented village whereas in urban area, it is a census in urban area, it is a census enumeration block.enumeration block.

66

Estimation ProcedureEstimation Procedure The estimates of population, live births, The estimates of population, live births,

deaths and infant deaths are obtained deaths and infant deaths are obtained using unbiased method of estimation.using unbiased method of estimation.

The annual estimates of births, deaths The annual estimates of births, deaths and infant mortality rates are based on and infant mortality rates are based on about 1,50,000, 50,000 and 10,000 about 1,50,000, 50,000 and 10,000 reported number of sample births, reported number of sample births, deaths and infant deaths respectively at deaths and infant deaths respectively at the national level.the national level.

77

INFANT MORTALITY

• Infant mortality is the most sensitive index of the level of socio-economic development and the quality of life. It is commonly used for monitoring and evaluating population and health programmes and policies.

• Infants (less than one year) and early childhood (less than five years) deaths still form a large fraction of the total deaths (all ages).

• In India one out of every fifth death is of infant and a total of about 1.8 million infants are dying annually (based on IMR of 2002) as compared to 2.6 million in 1971.

• The proportion of infant deaths among early childhood deaths is much higher and is over 70 per cent.

88

Decadal Trend of IMR in IndiaDecadal Trend of IMR in India Significant decline in IMR during the last three Significant decline in IMR during the last three

decades. The present level of IMR is about decades. The present level of IMR is about one-half as compared to 1971.one-half as compared to 1971.

The decades of 1970’s and 1990’s have The decades of 1970’s and 1990’s have witnessed a decline of more or less of similar witnessed a decline of more or less of similar order (10-11 per cent). The decline was order (10-11 per cent). The decline was gradual during 1991-2000 as compared to gradual during 1991-2000 as compared to 1971-80. 1971-80.

During 1981-90, the decline in IMR was During 1981-90, the decline in IMR was steeper, compared to preceding and steeper, compared to preceding and succeeding decade, and was about 17 per succeeding decade, and was about 17 per cent.cent.

99

COMPARATIVE DECLINE IN DECADAL IMR(Based on three years moving average)

80

85

90

95

100

105

1 2 3 4 5 6 7 8

Year

IMR

Inde

x 1971-80

1981-90

1991-00

1010

State - ScenarioState - Scenario The decadal IMR vary considerably from one The decadal IMR vary considerably from one

State to another ranging from Kerala(51) to State to another ranging from Kerala(51) to UP(176) during 1971-80, Kerala(28) to UP(176) during 1971-80, Kerala(28) to UP(135) during 1981-90, and Kerala(15) to UP(135) during 1981-90, and Kerala(15) to Orissa(104) during 1991-2000.Orissa(104) during 1991-2000.

The lowest levels of IMR have been recorded The lowest levels of IMR have been recorded by Kerala, Karnataka and Maharashtra during by Kerala, Karnataka and Maharashtra during the decade of 70’s and by Kerala, the decade of 70’s and by Kerala, Maharashtra and Punjab in that order during Maharashtra and Punjab in that order during the last two decades. the last two decades.

The highest levels of IMR have been retained The highest levels of IMR have been retained by UP, MP and Orissa with some changes in by UP, MP and Orissa with some changes in inter-se positions. inter-se positions.

1111

Sub-State level VariationsSub-State level Variations

The existing sample size of SRS does not The existing sample size of SRS does not allow small area estimation of IMR or allow small area estimation of IMR or mortality analysis by socio-economic mortality analysis by socio-economic status. IMR varies widely from one-region status. IMR varies widely from one-region to another. Thus, reduction in average to another. Thus, reduction in average IMR in a State does not provide a IMR in a State does not provide a complete picture of mortality decline, complete picture of mortality decline, necessitating identification of high necessitating identification of high mortality prone areas and planning mortality prone areas and planning innovative strategy for its reduction. innovative strategy for its reduction.

1212

IMR estimates - regional level, M.P.(Based on three years moving average)

0

20

40

60

80

100

120

140S

outh

Wes

tern

Mal

wa

Pla

teau

Chh

atis

garh

Nor

ther

n

Mad

hya

Pra

desh

Sou

thC

entr

al

Cen

tral

Vin

dhya

1995-97

1996-98

1997-99

1313

1414

Boundary, State/U.T . . .Boundary, International . . .

(INDIA)New Moore I.

AFGHANISTAN

E

I N D I A

BENGALOF

BAY

INDIRA POINT

A N D A M A N S E A

(INDIA)Barren I.

(INDIA)Narcondam I.

(BURMA)Coco Is.

O C E A NI N D I A N

LANKASRI

S E AA R A B I A N

(BURMA)MYANMAR

BANGLADESH

BHUTAN

EAST OF GREENWICH

KILOMETRES

500400300200100050100

o

o

o

o

o

o

o

o8

12

16

20

24

28

32

36

o o o o o o72 8076 84 88 92

o

o

o

o

o

o

o

o

16

8

12

20

24

28

32

36

oo96

oo928884

oooo80767268

Boundary, Natural Divisions . . .

INDIA

C Government of India copyright, 2003.The territorial waters of India extend into the sea to a distance oftwelve nautical miles measured from the appropriate base line.

Based upon Survey of India map with permission of the Surveyor General of India.

NATURAL DIVISION WISEINFANT MORTALITY RATE (RURAL) 1997-99

50.0 AND BELOW50.1 - 60.060.1 - 70.0

70.1 - 80.080.1 AND ABOVEDATA NOT AVAILABLE

INFANT MORTALITY RATEBY NATURAL DIVISION

1515

IMR - ComponentsIMR - Components The categorisation of IMR into neo-natal and Post The categorisation of IMR into neo-natal and Post

neo-natal rates helps in refining the strategies for neo-natal rates helps in refining the strategies for combating the infant mortality.combating the infant mortality.

During the last decade (1991-99), the average During the last decade (1991-99), the average contribution of the neo-natal and post neo-natal contribution of the neo-natal and post neo-natal mortality to IMR has been recorded about two-third mortality to IMR has been recorded about two-third and one-third respectively. and one-third respectively.

Over the three decades the decline in neo-natal Over the three decades the decline in neo-natal and post-natal mortality is 37 per cent and 60 per and post-natal mortality is 37 per cent and 60 per cent. cent.

Higher share of neo-natal mortality in IMR coupled Higher share of neo-natal mortality in IMR coupled with lower decline and higher percentage of non-with lower decline and higher percentage of non-institutional deliveries (about 75 per cent) suggest institutional deliveries (about 75 per cent) suggest strategies targeting especially the neo-natal deaths strategies targeting especially the neo-natal deaths and providing medical facilities for non-institutional and providing medical facilities for non-institutional deliveries and home care of neo-nates.deliveries and home care of neo-nates.

1616

Proportion of IMR, NMR and PNMR(Based on average rate during 1991-99)

Post-natal mortality rate

18%

Neo-natal mortality rate

32%

Infant mortality rate

50%

1717

Components of neo-natal mortalityComponents of neo-natal mortality The categorisation of neo-natal mortality The categorisation of neo-natal mortality

(<29 days) into early (<7 days) and late (<29 days) into early (<7 days) and late (7-28 days) neo-natal mortality (7-28 days) neo-natal mortality facilitates in refining the strategies for facilitates in refining the strategies for reducing IMR.reducing IMR.

Early neo-natal deaths constitute a Early neo-natal deaths constitute a major chunk of deaths of neo-nates and major chunk of deaths of neo-nates and infants, and is as high as three-fourth of infants, and is as high as three-fourth of neo-natal deaths and one-half of all neo-natal deaths and one-half of all infant deaths.infant deaths.

1818

Trends in early and late neo-natal mortality during the 90's

60

65

70

75

80

85

90

95

100

105

1990-9

2

1991-9

3

1992-9

4

1993-9

5

1994-9

6

1995-9

7

1996-9

8

1997-9

9

Ind

ex

ra

te

Earlyneo-natal Lateneo-natal

1919

The decline in late neo-natal is 5 times The decline in late neo-natal is 5 times more than early neo-natal during the more than early neo-natal during the last decade.last decade.

The early neo-natal has remained more The early neo-natal has remained more or less stagnant depicting a low annual or less stagnant depicting a low annual decline of about 0.5 per cent.decline of about 0.5 per cent.

Interventional strategies appears to Interventional strategies appears to have very little impact on early neo-have very little impact on early neo-natal as compare to late neo-natal.natal as compare to late neo-natal.

2020

Maternal MortalityMaternal Mortality Data on Maternal Mortality is available :Data on Maternal Mortality is available :

National Family Health Survey (NFHS)National Family Health Survey (NFHS)• NFHS-1 (1992-93) : 424 NFHS-1 (1992-93) : 424 • NFHS-2 (1998-99): 540 NFHS-2 (1998-99): 540

(maternal deaths per 100,000 live births)(maternal deaths per 100,000 live births) Sample Registration System (SRS)Sample Registration System (SRS)

• SRS (1997) : 408SRS (1997) : 408• SRS (1998) : 407SRS (1998) : 407

Estimates have large sampling fluctuations due to Estimates have large sampling fluctuations due to inadequate sample size (based on about 600 maternal inadequate sample size (based on about 600 maternal deaths in SRS).deaths in SRS).

The available estimates indicates that about 100,000 The available estimates indicates that about 100,000 women in India die every year from causes related to women in India die every year from causes related to pregnancy and child birth.pregnancy and child birth.

The finding suggests : anti-natal care for all pregnant women The finding suggests : anti-natal care for all pregnant women and deliveries take place under hygienic conditions.and deliveries take place under hygienic conditions.

2121

Revision of SRS sampling frame-2004Revision of SRS sampling frame-2004 10-yearly based on recent results of Census10-yearly based on recent results of Census

• To make necessary modification in the sampling To make necessary modification in the sampling designdesign

• To give wider representation of populationTo give wider representation of population• To overcome the difficulties/limitations in the existing To overcome the difficulties/limitations in the existing

schemescheme• To meet the additional requirementsTo meet the additional requirements

Enhancing the scope of SRSEnhancing the scope of SRS Rationalisation of SRS formsRationalisation of SRS forms

Better netting of eventsBetter netting of events User friendlyUser friendly Easy for scanningEasy for scanning Streamlining the systemStreamlining the system

2222

Features of the New SRSFeatures of the New SRS Apart from reliable estimates at the state and national Apart from reliable estimates at the state and national

levels for birth rate and death rate separately for rural levels for birth rate and death rate separately for rural and urban areas, the new SRS will provide vital rates at and urban areas, the new SRS will provide vital rates at NSS Natural Division level (which is a group of NSS Natural Division level (which is a group of contiguous districts) for rural areas. contiguous districts) for rural areas.

It will also provide reliable estimates of IMR at NSS It will also provide reliable estimates of IMR at NSS Natural Division level for rural areas.Natural Division level for rural areas.

Use of female literacy as a stratifying factor.Use of female literacy as a stratifying factor. Separate estimates for four metros viz. Delhi, Kolkata, Separate estimates for four metros viz. Delhi, Kolkata,

Chennai & Mumbai.Chennai & Mumbai. Introduction of Verbal Autopsy instrument for Introduction of Verbal Autopsy instrument for

determining the cause specific mortality by sex and age. determining the cause specific mortality by sex and age. The sample size of new SRS is enhanced from 6671 to The sample size of new SRS is enhanced from 6671 to

7597 units, covering about 1.4 million households and 7597 units, covering about 1.4 million households and over 7 million population.over 7 million population.

2323

Enhancing the scope of dataEnhancing the scope of data• Morbidity dataMorbidity data• Family planning practices dataFamily planning practices data• Data on abortionData on abortion• Personal habits – use of pan, tobacco, alcohol, food habits: Personal habits – use of pan, tobacco, alcohol, food habits:

veg/non-vegveg/non-veg• Birth history of all currently married women in reproductive spanBirth history of all currently married women in reproductive span• Data on reasons of migration Data on reasons of migration • Data on school attendance (up to 16 years)Data on school attendance (up to 16 years)• Data on disabilityData on disability

Introduction of VA forms for recording structured Introduction of VA forms for recording structured information and narrative for determining the cause information and narrative for determining the cause specific mortality by sex and age.specific mortality by sex and age.

• Verbal Autopsy (VA) is an investigation of train of events, Verbal Autopsy (VA) is an investigation of train of events, circumstances, symptoms and signs of illness leading to death circumstances, symptoms and signs of illness leading to death through an interview of the relatives or associates of the deceased.through an interview of the relatives or associates of the deceased.

2424

Introduction of Unique Identification Introduction of Unique Identification CodeCode

One of the significant modification One of the significant modification proposed is introduction of unique proposed is introduction of unique identification code. This will result in :identification code. This will result in :

easy storage and retrieval of dataeasy storage and retrieval of data aggregation at different levelsaggregation at different levels Cross-classification of various determinants Cross-classification of various determinants

with fertility and mortality indicatorswith fertility and mortality indicators Cohort studiesCohort studies

2525

Status of new SRSStatus of new SRS

The Baseline Survey for the new SRS is in The Baseline Survey for the new SRS is in progress since Nov’2003.progress since Nov’2003.

The urban Baseline Survey has been completed The urban Baseline Survey has been completed in most of the states and the rural is in progress.in most of the states and the rural is in progress.

It is expected to complete the Baseline Survey It is expected to complete the Baseline Survey by March’2004.by March’2004.

The effective date for the new SRS frame is 1The effective date for the new SRS frame is 1stst January’2004.January’2004.

The first report based on new sample containing The first report based on new sample containing vital rates for 2004 would be available in 2005. vital rates for 2004 would be available in 2005.

2626

TARGETSTARGETS The National Population Policy has set the targets of The National Population Policy has set the targets of

reduction in IMR to 30 and MMR to 100 by 2010.reduction in IMR to 30 and MMR to 100 by 2010. The goal is to achieve 53 per cent decline in IMR The goal is to achieve 53 per cent decline in IMR

from its present level of 64 in 2002 in next 8 years. from its present level of 64 in 2002 in next 8 years. For MMR the target is to achieve 75 per cent decline For MMR the target is to achieve 75 per cent decline from its present level of around 400 by 2010. The from its present level of around 400 by 2010. The appropriate strategies to achieve the above goals appropriate strategies to achieve the above goals have been formulated.have been formulated.

To monitor the impact of these strategies in To monitor the impact of these strategies in reduction of IMR and MMR, there is need for an reduction of IMR and MMR, there is need for an appropriate evaluation system.appropriate evaluation system.

Whether the existing SRS will continue to be Whether the existing SRS will continue to be appropriate to map the decline in IMR and MMR? If appropriate to map the decline in IMR and MMR? If not, then what more is expected from SRS. not, then what more is expected from SRS. Suggestions are welcome.Suggestions are welcome.

2727

CAUSESCAUSES

OF OF

DEATH DEATH

IN IN

SRSSRS

2828

Importance of Causes of Death DataImportance of Causes of Death Data Data on causes of death are useful for Data on causes of death are useful for

health planners, administrators, and health planners, administrators, and medical professionals:medical professionals: To identify the public health importance of different To identify the public health importance of different

diseases.diseases. To make a decision on allocation of resources for To make a decision on allocation of resources for

controlling various diseases.controlling various diseases. To evaluate trends in causes of mortality over time in To evaluate trends in causes of mortality over time in

order to assess the impact of national health order to assess the impact of national health programmes.programmes.

To analyse the socio-economic, demographic and life To analyse the socio-economic, demographic and life style factors that are associated with the deaths due style factors that are associated with the deaths due to various diseases.to various diseases.

2929

DATA ON CAUSES OF DEATHDATA ON CAUSES OF DEATH

The data on causes of death is available from the The data on causes of death is available from the medically certified deaths occurring in hospitals medically certified deaths occurring in hospitals whether public or private covered under the scheme whether public or private covered under the scheme of ‘Medical Certification of Causes of Death’. It has of ‘Medical Certification of Causes of Death’. It has its own limitations. its own limitations.

Different stages of implementation in different states and uts.Different stages of implementation in different states and uts. Selected areas-only urban Selected areas-only urban Selected hospitals Selected hospitals

(Does not provide cause of death profile at state level (Does not provide cause of death profile at state level for all urban deaths)for all urban deaths)

The “Survey of Causes of Death (Rural) ” has been The “Survey of Causes of Death (Rural) ” has been integrated with SRS from 1999 to cover all deaths integrated with SRS from 1999 to cover all deaths occurring in a nationally representative sample both occurring in a nationally representative sample both in rural and urban areas.in rural and urban areas.

3030

Inadequacies in Causes of Death DataInadequacies in Causes of Death Data

Cause of death mainly the respondent Cause of death mainly the respondent perception.perception.

Instruments and procedures not well Instruments and procedures not well developed. developed.

The cause of death assigned by the SRS The cause of death assigned by the SRS Supervisor based on symptoms list.Supervisor based on symptoms list.

No physician review was involved.No physician review was involved. SRS Supervisors not fully trained.SRS Supervisors not fully trained.

3131

Cause of Death Assignment by Health Professional

Cause of Death Assignment by Health Professional

Verbal Autopsy Activities

Part Time Enumerator

Continuous recording of birth/death events

Supervisors

Half yearly retrospective survey

Collection of the circumstances, symptoms and signs of illness and Narrative in

VA forms

Quality Check10% Re-sample in the field

by independent Re-Sample Teams

Inform households about the conduct of VA

Cause of Death Cause of Death Assignment by Assignment by Health ProfessionalHealth Professional

3232

Initiatives in SRSInitiatives in SRS To improve the data on causes of death in SRS the To improve the data on causes of death in SRS the

following initiatives were taken in recent past:following initiatives were taken in recent past: Development of VA FormsDevelopment of VA Forms

• Forms were developed based on the existing Forms were developed based on the existing experience of WHO, Chinese Surveillance System experience of WHO, Chinese Surveillance System and other international and national studies.and other international and national studies.

Type of Forms : incl. Structured & NarrativeType of Forms : incl. Structured & Narrative • Neo-Natal Form Neo-Natal Form • Childhood Form Childhood Form • Adult FormAdult Form• Maternal Death FormMaternal Death Form

3333

Initiatives in SRSInitiatives in SRS

Conduct of pre-tests of VA Forms in various Conduct of pre-tests of VA Forms in various regions regions

Review of the results of pre-test by eminent Review of the results of pre-test by eminent epidemiologist/researchers epidemiologist/researchers

Refinements in VA Forms based on the feed-Refinements in VA Forms based on the feed-backback

Preparation of VA Instruction Manuals Preparation of VA Instruction Manuals Standardized sandwich training to 800 RG Standardized sandwich training to 800 RG

Supervisors on VA methods by leading Supervisors on VA methods by leading institutionsinstitutions

3434

Initiatives in SRSInitiatives in SRS Premier Institutes like CGHR (University of Premier Institutes like CGHR (University of

Toronto), NIMHANS (Bangalore), PGI Toronto), NIMHANS (Bangalore), PGI (Chandigarh), ICMR, TIFR (Mumbai), Medical (Chandigarh), ICMR, TIFR (Mumbai), Medical colleges of India, ERC (Chennai), have been colleges of India, ERC (Chennai), have been identified in all the major States as long term identified in all the major States as long term technical partners with SRS for :technical partners with SRS for :

Training/Refresher Training to RGI Staff on verbal Training/Refresher Training to RGI Staff on verbal AutopsyAutopsy

Conducting VA in 10 percent resample unitsConducting VA in 10 percent resample units Assignment of causes of deaths (double Assignment of causes of deaths (double

assignment)assignment) Quality ControlQuality Control Epidemiological analysesEpidemiological analyses

3535

Initiatives in SRSInitiatives in SRS Re-samplingRe-sampling

Objective- 10% of VAs for each SRS Objective- 10% of VAs for each SRS Supervisor will be checked by Supervisor will be checked by collaborating institutions for training collaborating institutions for training feedbackfeedback

Identification of operational problems Identification of operational problems and possible remedial measures: and possible remedial measures:

Physician codingPhysician coding 100% double coding, 100% double coding, Reconciliation with another physicianReconciliation with another physician Adjudication of disagreementsAdjudication of disagreements

3636

Preliminary results of VA on Causes of DeathPreliminary results of VA on Causes of Death

Causes of death (using WHO groupings)Causes of death (using WHO groupings) MaleMale FemaleFemale TotalTotal

I. Communicable diseases, maternal and I. Communicable diseases, maternal and perinatal conditions and nutritional perinatal conditions and nutritional deficienciesdeficiencies

3232 4141 3636

II. Non- communicable conditionsII. Non- communicable conditions 3939 3131 3636

III. Injuries III. Injuries 1010 55 88

IV. ILL-definedIV. ILL-defined 1919 2222 2020

All causesAll causes 100100 100100 100100

3737

Preliminary results of VA on Causes of Death - Preliminary results of VA on Causes of Death - Communicable diseases, maternal and peri-natal Communicable diseases, maternal and peri-natal

conditions and nutritional deficienciesconditions and nutritional deficiencies

(in numbers)(in numbers)

MaleMale FemaleFemale TotalTotal

Causes of death (using WHO groupings)Causes of death (using WHO groupings)

Tuberculosis Tuberculosis 7272 5555 127127

Other infectious diseases Other infectious diseases 6363 6767 130130

HIV HIV 44 00 44

Diarrhoeal diseases Diarrhoeal diseases 116116 187187 303303

Childhood-cluster diseases Childhood-cluster diseases 3434 3737 7171

Respiratory infections Respiratory infections 8181 101101 182182

Maternal conditions Maternal conditions -- 5252 5252

Peri-natal conditionsPeri-natal conditions 170170 112112 282282

Nutritional deficiencies Nutritional deficiencies 1919 3232 5151

TotalTotal 559559 643643 12021202

3838

Preliminary results of VA on Causes of Death – Preliminary results of VA on Causes of Death – Non-communicable conditionsNon-communicable conditions

WHO GroupingWHO Grouping MaleMale FemaleFemale TotalTotal

CardiovascularCardiovascular 244244 152152 396396All CancersAll Cancers 7474 5757 131131Other non-Other non-communicablecommunicable

227227 154154 381381

Respiratory diseasesRespiratory diseases 177177 124124 301301

TotalTotal 722722 487487 12091209

3939

Preliminary results of VA on Causes of Death – Preliminary results of VA on Causes of Death – InjuriesInjuries

WHO GroupingWHO Grouping MaleMale FemaleFemale TotalTotal

Unintentional injuriesUnintentional injuries 146146 5959 205205

Self-inflicted injuriesSelf-inflicted injuries 1212 1919 3131

Other intentional Other intentional injuriesinjuries

2828 33 3131

TotalTotal 186186 8181 267267

4040

Present Scenario & Future PlansPresent Scenario & Future Plans All the SRS Surveyors have been trained All the SRS Surveyors have been trained

and re-trained in the art of canvassing VAand re-trained in the art of canvassing VA The VA has been introduced in all the The VA has been introduced in all the

states/uts. as an integral component of states/uts. as an integral component of SRSSRS

The preliminary results for two Half Yearly The preliminary results for two Half Yearly Surveys (2Surveys (2ndnd HYS, 2002 & 1 HYS, 2002 & 1stst HYS, 2003) HYS, 2003) were presented in Trivandrum Workshopwere presented in Trivandrum Workshop

The results suggest that VA would result in The results suggest that VA would result in generating cause specific mortality by age, generating cause specific mortality by age, sex and other risk factors on a continuous sex and other risk factors on a continuous basis.basis.

4141