Burden of Diseases in Himachal :

Himachal Pradesh is a hilly state located in the north- west of the country (Himalayas). The land with wide variations in altitudes ranging from low hills to high mountains with lakes and flowing rivers. Himachal Pradesh is one of the three leading states in India on the basis of 4 indicators. 1) LIfe expectancy 2) Literacy rate 3) Sex Ratio 4) Lower BPL % age. Based upon sex ratio, female literacy and life expectancy women are favourably placed in the State. Due to the large rural population and hostile geographic and weather conditions, the State is still backward and poor in terms of economy.Burden of Diseases in state as discussed below :

Communicable diseases: Himachal Pradesh population suffers from 3 major groups of communicable diseases :

1) Respiratory problem bronchitis, Tuberculosis, ARI 

2) Water and Food borne diseases. Diarrhoea, dysentery, amoebiosis, worm infestation, hepatitis, entrifever

3) contact diseases such as skin diseases, RTI, STDS including HIV/AIDS.

Tuberculosis: Remains the major killer in the state. As many as 14,000 patients are diagnosed with TB and put on treatment in the state every year. The Himachal government has set a target to become the first tuberculosis-free state of the country by 2023 under Mukhyamantri Kshay Rog Nivaran Yojna (MMKRNY). In this way majority of tuberculosis cases would be detected at the earliest and given very effective short term supervised treatment.

 Leprosy: The problem of Leprosy was quite high in the state.  The prevalence rate of leprosy during 2017-18 was 0.19 as compared to national average of 0.66. Similarly, the annual new case detection rate was 1.76, which was much higher than the national indicator of 1.02. The “Sparsh” leprosy awareness campaign started on the martyrdom day of Mahatma Gandhi on January 30 and culminate on October 2, 2019. According to government sources Himachal had reached the elimination stage of leprosy as the prevalence rate is less than one case per 10,000 population.

 Malaria:  Malaria prevalence is less in Himachal as compared to other states of the country. State has 98 cases of malaria in the state and malaria mosquitoes are prevalent between June to September in Hamirpur, Una, Solan, Kangra, Bilaspur and Mandi districts of the state. The problem of malignant malaria is negligible. The state falls under category-I where less and one case per thousand population was at risk. Giving stress on IEC (Information Education Communication ) activities, suggested to impart health education in educational institutions, Anganwadi centres and PRIs. Sanitation measures should be ensured in the high focal areas like slum areas, industries and factories etc. besides imparting training to Anganwadi and Asha workers about preliminary diagnosis of malaria.

The State has made malaria modifiable disease on Ist March 2018 and it is mandatory to all the public health institutions including private sector health institutions to list each positive malaria case.It is adviced to cover stagnant water, pots of water used by animals to drink water properly, further suggested to fogging of the area where density of mosquitoes is high besides taking measures to remove the stagnated water. The Himachal Pradesh government is aiming to eradicate malaria from the State by 2020.

 Diarrhoea: It is responsible for a large number of infant deaths. NFHS-2 has estimated as 31% among children under age 3 years. The prevalence of parasitic infection in children below 14 years was at 13.8%.

 RTI/STDs: The problem of RTI  (Reproductive Tract Infections )  /STD is also quite high in the state.  : Sexually transmitted infections (STIs) majorly affect the reproductive age group and results into dire consequences like ano-genital cancer, ectopic pregnancy, foetal wastage, infertility and premature death. Additionally, STIs are associated with increased risk of transmission of Human immunodeficiency Virus (HIV). The state of Himachal Pradesh, India has approximately 35, 14,500 (50%) sexually active population with 2, 10,870 (6%) prone for risky behavior. The aim is to provide STI services to 35% ( n = 73,805) of this population; 33% ( n = 24,355) coverage through designated STI clinics under National AIDS Control Program and the rest 67% ( n = 49,449) through National Rural Health Mission. Monitoring and analysis of data collected will provide valuable insights into the prevailing STI disease pattern.

HIV-AIDS: Himachal Pradesh is also affected with HIV-AIDS epidemic.  The cases of AIDS are increasing in the State. Currently, the official number of the people living with HIV/AIDS (PLWH) is around 5700 in Himachal.

The government said the awareness campaign should be intensified in schools and colleges including organisation of skits, street shows, which are effective ways of communicate to the masses.The education department will work in close coordination with the health department to provide special facility to educate all children living with HIV-positive. HP AIDS Control Society also organized a Red Ribbon fair on the Ridge along with flagging-off a half marathon. The State government on January 22, 2018, launched the nutrition scheme for children living with HIV-positive in Himachal Pradesh. The launch was announced by Chief Minister  during an awareness campaign organised by the HP State AIDS Control Society to mark the National Youth Day.

The purpose is to deliver nutritional supplement and boost immunity of around 400 HIV positive youth up to the age of 18 years. In addition, it aims to enable them to lead a normal and healthy life. The government has made it mandatory for every expectant mother to go through the HIV test. It would prevent passing on of the virus to the baby in case the mother is HIV-positive. Further, there is a dire need to initiate massive awareness campaigns about this disease up to rural areas. The Non-profit Organizations (NGOs) and individuals will have to come forward and supplement the efforts of the health department in creating awareness.

Non Communicable diseases:

 Nutritional problems : As per nutritional survey conducted by women and social welfare department, Government of India covered 10 districts of state. 0.5% of infants were found to be suffering from Marasmus. 81% of children suffered from mild to moderate malnutrition and 4% from severe degree of malnutrition. 8% of adults suffered from chronic energy deficiency. Goitre was the major nutritional deficiency disorder 2-13% in various groups. Delayed weaning in more than 85% of children and very low exclusive breast feeding among new born 36%. As per NFHS-2, 40% women and 67% children are suffering from anaemia, which is high and warrants focussed attention.

 Iodine deficiency : Being a sub Himalayan belt Goitre is still a nutritional deficiency disorder. Prevalence of Goitre was high up to 1974. (una 41.2%, Solan 39.9% in 1959 and Shimla 41.6% in 1974) has come down to 2-13% in 1996 for various age groups. As per survey carried out by women and social welfare department prevalence of Goiter in Chamba was 14.25% in 1999. During 1999- 2000, 117699 samples of salt were analysed out of which only 78 samples were found to be without Iodine.

  Reproductive and child Health Programme : Family Planing: Providing contraceptive services, resulting in adoption of small family norm by a large number of families is being given by required emphasi. The state has performed creditably well. The proportion of institutional births has almost doubled over the last decade — from 43.1% to 76.4%. However, the overall achievement still remains lower than the India average, and there are considerable district level differences. Both infant mortality as well as under-five mortality reductions in the last decade have been slow. 

Maternal and Reproductive Health : The important elements of the reproductive health  programme are: 1) provision of antenatal care including atleast three antenatal visits. Iron prophylaxis for antenatal and lactating mothers, two doses of tetanus toxoid vaccine detection and treatment of anaemia in mothers, management and referral of high risk pregnancies. 2) Encouragement of institutional deliveries or home deliveries assisted by health trained personnel. 3) provision of postnatal care including at least three postnatal visits. 4) Identification and management of reproductive tract and sexually transmitted infections.

Anaemia among Women :  Anaemia usually results from a nutritional deficiency of Iron and B12 and some other nutrients. This type of anaemia is commonly referred to as Iron deficiency anaemia. Iron deficiency is the most wide spread form of malnutrition in the world affecting more than two billion people. Anaemia may have detrimental effects on the health of women and children and may become an underlying cause of maternal mortality and perinatal mortality.

Himachal has also emerged as one of the worst performing states in terms of management of anaemia among women of reproductive age. The state experienced a rise of more than 10 percentage points in anaemia in the last decade. Anaemia among pregnant women also showed a 12 percentage point increase. The total unmet need of family planning doubled in the state over the last decade. The proportion of women reporting current use of any modern method of family planning went down drastically from 72.6% in 2005-06 to 52.1% in 2016.

Anaemia among children : Anaemia is a serious concern for young children because it can result in impaired cognitive performance behavioural and motor development coordination, language development as well as increased morbidity from infection diseases one of the most vulnerable group in children age 6-24 months.

      Himachal’s health and nutrition challenges are compounded by severe human resource constraints in the public sector. The earlier gains of the state are at the risk of being wiped out, as demonstrated by the regression in immunisation and anaemia as well as the glacial improvements in child mortality. There is a need to identify districts — talukas if possible — which need enhanced focus in terms of health and nutrition interventions. In short, Himachal’s reputation as the health success story is under grave threat.

 It is a comparatively richer state, with a GSDP per capita similar to Gujarat, Tamil Nadu and Kerala. The State Commission of Health, constituted in 2014 with prominent experts as members, focused on developing inter-sectoral strategies required to address environmental, nutritional and social determinants of health as a part of the overall development of the state, among other things.