CHAPTER-IV PROFILE OF THE STUDY REGIONshodhganga.inflibnet.ac.in/bitstream/10603/35004/11/11...Community Health Centre, Peravoor. There are six hospitals including one District Hospital

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CHAPTER-IV

PROFILE OF THE STUDY REGION

The present study is envisaged to cover the Kannur1 district in the state of

Kerala2 in the Union of India3. Kannur district derived its name from the location of its

headquarter at Kannur town. The old name ‘Cannanore’ is the anglicized form of the

Malayalam word Kannur.

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1 Kannur district is one of the 14 districts in the state of Kerala, India. Kannur district is bounded by Kasargod district to the north, Kozhikode district to the south and Wayanad district to the south-east. To the east the district is bounded by the Western Ghats, which forms the border with Karnataka state. The Arabian Sea lies to the west. (http://en.wikipedia.org/wiki/kannur_district) 2 Kerala is an Indian state located on the Malabar coast of south-west India. It was formed on 1 November 1956 by the States Reorganisation Act by combining various Malayalam speaking regions. The state is bordered by Karnataka to the north and northeast, Tamilnadu to the east and south, and the Arabian Sea on the west. (http://en.wikipedia.org/wiki/kerala) 3 India, officially the Republic of India is a country in South Asia. Bounded by the Indian Ocean on the south, the Arabian sea on the south-west, and the Bay of Bengal on the south-east, it shares land borders with Pakistan to the west, Chinal, Nepal and Bhutan to north-east and Burma and Bangladesh to the east. (http://en.wikipedia.org/wiki/India)

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Kannur district came into existence as an administrative unit on 1-1-1957,

when the erstwhile Malabar district and Kasargod taluk of Madras state were

reconstituted into three revenue districts, Kannur, Kozhikode and Palakkad.4

4.1. Basic Features:

4.1.1. Area, location and general boundaries:

Kannur district lies between latitudes 11 degree 40 minutes to 12 degree

48 minute North and longitudes 74 degree 52 minutes to 76 degree 07 minutes East. The

district is bound by the Western Ghat in the East (Coorg district of Karnataka state),

Kozhikode and Wayanad districts in the South, Lakshadweep Sea in the West and

Kasargod, the northern most district of Kerala, in the north. The district has a total area

of 2,966 sq.k.m.

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4 Kannur district came into existence as an administrative unit on January 1, 1957, when

the erstwhile Malabar district and Kasargod thaluk od Madras state were reconstituted

into three revenue districts, viz; Kannur, Kozhikod and Palakkad. At the time of its

formation, the district consisted of seven taluks, viz; Kasaragod, Hosdurg, Thaliparamba,

Kannur, thalassery, North Wayanad and South Wayanad. Subsequently, the south

Wayanad taluk was included in Kozhikode district with effect from 15 March 1957.

Later, on first November 1980, Wayanad district was formed carving out South Wayanad

and North Wayanad taluks. The two northern most taluks of Kannur district, viz;

Kasargod and Hosdurg were separated on 24 May 1984 for the formation of Kasargod

district. (http://keralam.org/Kannur)

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Map of Kerala and Kannur

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4.1.2. Climate:

The district has humid climate with an oppressive hot season from March

to the end of May. This is followed by the South West Monsoon which continues till the

end of September. October and November form the post monsoon or retreating monsoon

season. The North East monsoon which follows extends up to the end of February,

although the rain generally ceases after December.

4.1.3. Natural Resources:

Minerals:

China clay is found in abundance in Thaliparamba and Kannur taluks of

Kannur district. The district is endowed with rich deposits of clay, laterite, lignite,

ilmenites, monazite, zirion and Thorianite. Other minerals discovered recently are

sillimanite, iron, bauxite and limeshell.

Water:

Kannur district is endowed with a fine rive system. With a length of 110

k.m., the Valapattanam River, which originates from the Western Ghats is the longest

river in the district. Other rivers in the district are: Valiapuzha, Aralampuzha, Kuppam

river, Anjarakandy,Thalassery, Ramapuram and Perumba.

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Table. No.4.1

Kannur District – at a Glance

Kannur 2011 2001

Area Sq. Km 2966 2966

Population

Male

Female

2,525,637

1,184,012

1,341,625

2,408,956

1,152,817

1,256,139

Population growth 4.84% 6.98%

Density/Km 852 812

Proportion to Kerala population 7.56% 7.57%

Sex ratio ( per 1000) 1133 1090

Child sex ratio(0-6 age) 962 962

Average literacy 95.41% 92.59%

Male literacy 97.54% 96.13%

Female literacy 93.57% 89.40%

Total child population (0-6 age)

Male population (0-6 age)

Female population (0-6 age)

265,276

135,189

130,087

279,803

142,625

137,178

Source: Kannur: Census Report 2001 & 2011

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4.2. Demographic Features:

4.2.1. Population:

According to 2011 census, there are 2,525,637 people in the district, out of

which 1,184,012 are males and 1,341,625 are females. As per 2001 census, there were

24, 08,956 people in the district, out of which 11, 52,817 are males and 12, 56,139 were

females. The sex ratio of the district is 1133 in 2011 while in 2001 it was 1090. There

are265, 276 children in the 0-6 age group while in 2001 it was 2, 70,200 children, out of

which135, 189 are male (1, 38,169 in 2001) children and 130,087 are female children

(1, 32,037 in 2001). This shows decline in the proportion of children in the district. The

growth rate of population is 4.84 in 2011 while it was 6.98 in 2001. The density of

population is 852 per sq. k.m. in 2011. (812 in 2001)

4.2.2. Literacy:

The district is known for its high level of literacy. It has95.41% (92.59%

in 2001) literacy according to 2011 census. Males’ literacy rate is 97.54% (96.13%in

2001) and females’ literacy rate is 93.57% (89.40% in 2001). In the district, males’

literacy is higher than females’ literacy. Also there is improvement in female literacy rate.

(Kannur, Census 2001 & 2011)

4.3. Agriculture:

Majority of the population of the district are dependent directly of

indirectly on agriculture for their livelihood. The main crops grown in the district are

paddy, coconut, pepper, cashew, tapioca, areca nut and plantation crops like rubber.

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Paddy occupies the largest area among annual crops. Next to paddy,

coconut is the most important crop in the district, next being cashew nut. Among spices

pepper occupies an important place. Rubber is the most important industrial cash crop.

among the plantation crops.

4.4. Industry:

Kannur has had its industrial importance from very early days. Being

blessed with a variety of factors such as good soil, salubrious climate, rich forests,

enormous fishing potentials, minerals as well as infrastructure facilities like road, rail,

inland water, transport etc. the district offers ample scope for the development of

industries.

Nevertheless, Kannur is an industrially backward district in the state.

There is only one major and five mini industrial estates in the district. The district also

has twelve medium scale industries. Handloom industry is the most important and the

largest in the district. In 1968, the Kerala State Handloom Development Corporation

popularly known as HANVEEV was started for the effective development of the

handloom industry in the state with its headquarters at Kannur.

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4.5. Infrastructures:

4.5.1 Economic Infrastructure:

Transport:

The West Coast road from Mahe to Talapady is the backbone of the road

system in Kannur district. This is part of the National Highway. Thalassey-Coorg road

and Thalassery- Mysore road are the other important roads.

Thalassery, Kannur and Azhikkal are the minor ports in the district. The

nearest airport is at Kozhikode.

Railways:

The railway plays a vital role in the district in the transportation of man

and materials. The railway line runs through Kannur for 57 kms. There are 13 railway

stations in Kannur district. The biggest station in Kannur district is Kannur. Thalassery

and Payyannur are the other two major stations in the district. This portion of the railway

line is the Managalore-Shoranur section of Palakkad Division of the Southern Railway.

Electricity:

There are 6 110 k.v. substations, one 220 k.v. substations and five 66 k.v.

substation in the district. There is no major power project in the district and the main

source of electric power is the Kuttiyadi Hydro Electric Project in Kozhikode district.

Electricity has reached all panchayats in the district.

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Communication:

There are two postal divisions in Kannur district and they are Kannur

postal division and Thalassery postal division.

The pioneering venture in the field of Malayalam journalism is associated

with Kannur district, thanks to Dr.H.Gundert who started two newspapers from

Thalassery in 1847 namely Rajyasamacharam and Paschimodayam. With the advent of

modern electronic communication technology, the major dailies in the state namely

Mathrubhumi, Malayala Manorama, Deepika, Deshabhimani and Chandrika have started

their units here in recent years.

4.5.2 Social Infrastructure:

4.5.2.1.Education:

In the fourteenth and fifteenth centuries, during the regime of the Kolathiri

Rajas5, Thaliparamba was renowned all over Kerala as a seat of learning, enlightenment

and culture. In the early days, the Ezhuthupallies6 under the Ezhuthachan or village

school master provided facilities to pupils to acquire elementary education. The

beginning of western education in the district may be traced back to the middle of the

sixteenth century.

__________________________________________________________________ 5 Kolathiri Raja was the title by which the senior most male along the matrilinjeal line of the Kolathunadu Royal Family was styled.(Sreedhara Menon, 1978, Cultural Heritage of Kerala: An introduction, p:16) 6 Ezhuthupallies were the parallel system of village schools or pial schools that were intended for the education of the non-brahmin students. The village schools were considered as one of the best organizations in ancient times in Kerala society. The ezhuthupallies functioned in each kara or village under the ezhuthachan or Asan. (Sreedhara Menon, 1978, Cultural Heritage of Kerala: An Intrduction, p:12)

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In 2011, there are three Kendriya Vidyalas, 171 high schools, 366 U.P

schools, 733 L.P schools in the district. The District Institute of Educational Training

(DIET) working at Palayad near Thalassery co-ordinates in service teacher training

programmes in the district. In the higher education field, there are 11 Arts and Science

Colleges, 71 Higher Secondary Schools, 16 vocational Higher Secondary Schools, four

Technical High Schools, five Teacher Training Centres and three Poly Technics. The

district has a Govt. Engineering College at Thaliparamba, a Govt. Ayurveda College at

Kannur and a medical college at Pariyaram.

4.5.2.2. Health:

There are 116 health care institutions functioning in the district under

Modern Medicine providing 2,768 beds. There are eight Government Hospitals including

one District Hospital at Kannur, one General Hospital at Thalassery and one Taluk

Hospital at Taliparamba. There are four First Referral Units with facilities for Emergency

Obstetric Care (EOC) and neo natal resuscitation. There are 865 Mahila Seva Sangam

Units, 408 Sub Centres, 72 Mini Primary Health Centres, seven Block Primary Health

Centres and seven Community Health Centres. Facilities for Medical Termination of

Pregnancy (MTP) are available at all hospitals, at four Community Health Centres and

nine Block Primary Health Centres. Postpartum Centres are attached to five hospitals.

(District Medical Office, Kannur, 2009)

There is one Govt. School of Nursing and one Junior Public Health Nurse

Training School in the District. The District T.B. Centre is situated adjacent to the District

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Hospital. Three Non Filarial Control Programme Units are at Kannur, Thaliparamba and

Thalassery.

There is a District Food Inspector’s Office and five Regional Food

Inspector’s Offices are functioning in the District. Dispensaries are functioning at KAP

Battalion and Central Jail, Kannur. Also there is a district Mobile Dispensary at

Taliparamba. District Medical Store is at Kannur. Tribal Mobile Unit is attached to

Community Health Centre, Peravoor.

There are six hospitals including one District Hospital and 61 dispensaries

in Ayurvedic and 40 Homeopathic institutions in the government sector.

4.6. Historical background of Medical and Public Health Services in the District:

As in other districts of Kerala, the Ayurvedic system of medical treatment

has prevailed in this district also from time immemorial. Each town and village had its

Ayurvedic Vaidyan who carried on the practice of medicine and earned a comfortable

living.

Civil hospitals sprang up in the district in the middle of the last century.

By the time, Municipalities were constituted in 1866; Cannanore and Tellicherry had

already their public hospitals. These were placed under the control of the Municipalities,

government paying the salaries of the Medical Officers out of provincial funds. The

Kasargod hospital was opened on October 6, 1873, the Manjeswaram Dispensary on

December 4, 1892. In the meantime, with a view to improving the facilities for medical

treatment Govt. Took over the management of the Tellicherry Hospital in 1920 and two

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years later offered to pay the salaries of the Medical Officers employed in certain

municipal towns and taluk quarters. The policy of taking over the administration of

hospitals was continued by the Govt. in future years also. (Menon, 1972:32)

4.6.1 Vital Statistics:

The work of registration of vital statistics in the rural areas of the District

was from the earliest known times attended by the adhikari while in the municipal towns

it was done by a special agency. With the establishment of Public Health Department in

Madras State in 1925, there was some improvement in registration works. A statement of

births, deaths and infant deaths together with their rates for each of the years from 1959-

60 to 1963-65 is given below.

Table 4.2

Births, deaths, infant deaths etc and their rates for the years from 1959-1964

Year

Births

Birth

Rate(‘000)

Deaths

Death

Rate(‘000)

Infant

Deaths

Infant Death Rate

(per ‘000)

1959-60 61,465 33.44 16,993 11.04 3,159 61.38

1960-61 46,432 29.75 15,375 9.85 2,361 50.85

1961-62 56,923 30.07 16,281 9.08 2,797 51.87

1962-63 45,608 26.37 14,093 8.10 2,043 44.52

1963-64 48,521 25.69 14,558 7.77 2,212 45.59

Source: Kerala District Gazetteers, Cannanore, 1972.

Since the registration works were on the beginning the births and deaths as

shown in the above table are likely to be much below the actual figures.

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4.6.2 Chief Diseases of the district:-

The chief diseases of the district in early sixties were Tuberculosis,

Typhoid, Dysentry, Diphtheria, Menigococal infection, Rabies, Infective Hepatitis,

Malnutrition, Anaemia, Heart diseases, Pneumonia, Gastro enteritis and diseases of

pregnancy and child birth.

Apart from these, Filariasis, Syphilis, Influenza, Bronchitis, Whooping,

Cough, Malaria,Opthalmia, Unethritiws, Myagia, Dental diseases, measles, chicken-pox,

small-pox and intestinal worms also were among the common diseases. (District Medical

Office, Kannur, 2009)

4.6.3 Organization of the Health Services Department:

The District Medical Officer of Health, Cannanore, was the chief

executive of the Health Services Department in the District. He was in charge of both the

Medical and Public Health Wings. The hospitals and dispensaries of the district were

under the control of the District Medical Officer of Health. In 1963-64, there were 44

medical institutions in the district under the control of the District Medical Officer of

Health. They included five hospitals, 27 dispensaries, nine primary health centres, one

TB. Sanatorium and two Leprosy centres.

The District Medical Officer of Health was assisted by the Assistant

District Medical Officer of Health in matters pertaining particularly to public health. The

Assistant District Medical Officer was assisted by a Public Health Inspector. For the

registration of births and deaths, there were six taluk Health Inspectors, otherwise known

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as Taluk Registrars of Birth and Deaths. They were under the direct control of the

District Medical Officer. Moreover, there were health inspectors attached to the Primary

Health Centres. The Medical Officer of the Primary Health Centre exercises control over

them. (Menon, 1972)

4.6.4 Private Hospitals and Dispensaries:

In the early years of the formation of the district, there were not many

private nursing homes and dispensaries in this district under the management of qualified

doctors and physicians. The only private hospital worth mentioning was the Vellad St.

Joseph’s Mission Hospital, Naduvil, Cannanore.

4.6.5 Indian Medical Association, North Malabar Branch:

The north Malabar branch of the Indian Medical Association started

functioning in October 1952. It has its headquarters at the place where the secretary for

the year lives. The aims of the association were to promote a spirit of comradeship

among the practioneers of allopathy, and to organize monthly clinical meetings, lectures

by specialists in various subjects and discussions on subject of professional interest etc. in

co-operation with the Govt. and local bodies.

4.6.6 Indigenous Hospitals and Dispensaries:

The Department of Indigenous Medicine maintained three ayurveda

hospitals and 16 ayurveda dispensaries. The ayurveda hospitals were located at

Cannanore, Payyannur and Tellicjerry. In addition, there were 14 grants-in-aid ayurvedic

dispensaries, one govt. homeo dispensary and subsidized rural dispensaries in the district.

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4.6.7 Maternity, Child Welfare and Family Planning:

Maternity, child welfare and family planning activities were carried on

under the auspices of the Department of Health Services as well as of voluntary social

service organizations. The maternity and child welfare services and family planning

programmes were being carried on as two distinct programmes till 1964-65. In that year

the Maternity and Child Health services were integrated. With the family planning

programme, all the maternity and child health centres were renamed as Family Welfare

Sub-Centres.

The Family Welfare sub centres function under the Primary Health

Centres. The staffs attached to the sub-centres attended maternity and child welfare

activities and give advice on family planning. There were family planning clinics in all

the govt. hospitals of the district and in almost all dispensaries. There were 12 Family

Welfare Centres in the District under the Department. The municipalities and

panchayaths also run maternity and child health centres in this district.

4.6.8. Nutrition:

The diet of the vast majority of people in the district consisted mainly of

Cereals and other starchy foods with little of body building food content. This has caused

widespread mal-nutrition, undernourishment and deficiency diseases, particularly among

women and children,. In subsequent years, the govt. had taken several steps with a view

to achieve higher standards of nutrition among the people. The Applied Nutrition

Programme started in the Taliparamba Block in 1963 was a major step in this direction.

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The Primary objective of the programme was to help women in rural area who were

expecting or nursing a baby, pre-school children and school going children to improve

their diets. (Menon, 1978:16)

From the foregoing analysis it is clear that the district has a comparatively

good atmosphere in the field of health care infrastructure and facilities in the early years

of its formation itself. The foundation of health facilities, laid down even before the

formation of Kerala state expanded prodigiously during the subsequent years. But in

recent years, Kannur district is famous for many communicable diseases like

leptospirosis, dengu fever and other insect borne viral fevers etc. Even if Kannur had

evolved a very strong foundation and structure in health care scenario, this frequent visit

of communicable disease is a threat to the health of our people. It is on this background

that the researcher is interested to analyze the various issues of health care utilization in

this particular region.

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