Assessment of Nutritional Status of under Five year Rural children in ...
Assessment of Nutritional Status of under Five year Rural children in ...
Assessment of Nutritional Status of under Five year Rural children in ...
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<strong>Assessment</strong> <strong>of</strong> <strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong><br />
<strong>under</strong>-five <strong>year</strong> rural <strong>children</strong> <strong>in</strong> the Districts <strong>of</strong><br />
Madhya Pradesh State<br />
District: BETUL<br />
Morena<br />
Bh<strong>in</strong>d<br />
Sheopur<br />
Gwalior<br />
Datia<br />
Shivpuri<br />
Neemuch<br />
Mandsaur<br />
Ratlam Ujja<strong>in</strong><br />
Jhabua<br />
Indore<br />
Dhar<br />
Alirajpur<br />
Rajgarh<br />
Shajapur<br />
Dewas<br />
Sehore<br />
Guna<br />
Harda<br />
Bhopal<br />
Ashok<br />
Nagar<br />
Vidisha<br />
Raisen<br />
Hoshangabad<br />
Tikamgarh<br />
Sagar<br />
Narsimhapur<br />
Chh<strong>in</strong>dwara<br />
Chhatarpur<br />
Panna<br />
Damoh<br />
Seoni<br />
Jabalpur<br />
Katni<br />
Mandla<br />
Satna<br />
Umaria<br />
D<strong>in</strong>dori<br />
Rewa<br />
Shahdol<br />
Sidhi<br />
Anuppur<br />
S<strong>in</strong>grauli<br />
Barwani<br />
Khargone<br />
Khandwa<br />
Betul<br />
Balaghat<br />
Burhanpur<br />
NATIONAL INSTITUTE OF NUTRITION<br />
Indian Council <strong>of</strong> Medical Research<br />
Hyderabad – 500 007<br />
2011
<strong>Assessment</strong> <strong>of</strong> <strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong> <strong>under</strong><br />
<strong>Five</strong> <strong>year</strong> <strong>Rural</strong> <strong>children</strong> <strong>in</strong> the Districts <strong>of</strong><br />
Madhya Pradesh State<br />
- Betul District<br />
G.N.V.Brahmam<br />
K.Venkaiah<br />
A.Laxmaiah<br />
I.I.Meshram<br />
K.Mallikharjuna Rao<br />
Ch.Gal Reddy<br />
Sharad Kumar<br />
M.Rav<strong>in</strong>dranath<br />
K.Sreerama Krishna<br />
National Institute <strong>of</strong> Nutrition<br />
Indian Council <strong>of</strong> Medical Research<br />
Hyderabad – 500 007<br />
2011
CONTENTS<br />
Page No.<br />
ACKNOWLEDGEMENTS<br />
PROJECT STAFF<br />
RESULTS AT GLANCE<br />
EXECUTIVE SUMMARY<br />
i - iii<br />
1. INTRODUCTION 1 - 3<br />
1.1 Pr<strong>of</strong>ile <strong>of</strong> Betul District 3<br />
2. OBJECTIVES 4<br />
2.1 General Objective 4<br />
2.2 Specific objectives 4<br />
3. METHODOLOGY 4 - 7<br />
3.1 Sampl<strong>in</strong>g Design 4<br />
3.1.1 Sample size 4<br />
3.1.2 Selection <strong>of</strong> Villages 5<br />
3.1.3 Selection <strong>of</strong> Households 5<br />
3.2 Investigations 5<br />
3.2.1 Household socioeconomic and demographic Particulars 5<br />
3.2.2 Anthropometry 5<br />
3.2.3 Cl<strong>in</strong>ical exam<strong>in</strong>ation 5<br />
3.2.4 History <strong>of</strong> Morbidity 6<br />
3.2.5 Maternal Particulars 6<br />
3.2.6 Infant and Young child feed<strong>in</strong>g practices 6<br />
3.2.7 Coverage <strong>of</strong> <strong>children</strong> <strong>under</strong> various health & nutrition<br />
<strong>in</strong>tervention Programmes 6<br />
3.2.8 Spot test<strong>in</strong>g <strong>of</strong> household cook<strong>in</strong>g salt for Iod<strong>in</strong>e 6<br />
3.3 Recruitment, tra<strong>in</strong><strong>in</strong>g, standardization <strong>of</strong> field Investigators and<br />
data collection<br />
3.4 Quality Control 7<br />
3.5 Data Analysis 7<br />
4. RESULTS 7 - 18<br />
4.1 Coverage 7<br />
4.2 Household Socio-economic and Demographic particulars 7<br />
4.2.1 Community 7<br />
4.2.2 Type <strong>of</strong> family 8<br />
4.2.3 Family size 8<br />
4.2.4 Literacy status <strong>of</strong> father 8<br />
4.2.5 Literacy status <strong>of</strong> mother 8<br />
6<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
4.2.6 Household landhold<strong>in</strong>g 8<br />
4.2.7 Major occupation <strong>of</strong> Father 8<br />
4.2.8 Major occupation <strong>of</strong> Mother 8<br />
4.2.9 Per capita monthly <strong>in</strong>come 8<br />
4.3 Household Physical facilities 9<br />
4.3.1 Type <strong>of</strong> house 9<br />
4.3.2 Household amenities 9<br />
4.4 Iod<strong>in</strong>e content <strong>of</strong> Cook<strong>in</strong>g salt 9<br />
4.5 Maternal characteristics 9<br />
4.5.1 Age and parity <strong>of</strong> mother 9<br />
4.5.2 Particulars <strong>of</strong> last Pregnancy (mothers <strong>of</strong>
ACKNOWLEDGEMENTS<br />
We express our s<strong>in</strong>cere thanks to Mr. B.R. Naidu, I.A.S, Pr<strong>in</strong>cipal Secretary,<br />
and Smt. T<strong>in</strong>oo Joshi, I.A.S, and Dr. Loveleen Kacker, I.A.S, past Pr<strong>in</strong>cipal<br />
Secretaries, Women and Child Development & Social Justice Department,<br />
Government <strong>of</strong> Madhya Pradesh for provid<strong>in</strong>g us an opportunity to carry out this<br />
study.<br />
Our thanks are due to Ms. Kam<strong>in</strong>i Chauhan I.A.S, Deputy Secretary, Dr.<br />
Anupam Rajan, Director and Shri. Akshaya Srivatsav, Jo<strong>in</strong>t Director, Women and<br />
Child Development Department, Government <strong>of</strong> Madhya Pradesh for their support<br />
dur<strong>in</strong>g the study.<br />
We are also thanksful to Shri. Gulshan Bamra, former Director, and Sri Praveen<br />
Kumar Gangrade, former Jt. Director, Women and Child Development Department,<br />
Government <strong>of</strong> Madhya Pradesh, and their colleagues for extend<strong>in</strong>g their cooperation and<br />
help <strong>in</strong> the execution <strong>of</strong> this study.<br />
The <strong>in</strong>frastructural & logistic support extended by Pr<strong>of</strong>. S.K. Trivedi,<br />
Executive Director, Mr. Gokul pal, Research Officer and their colleagues at Indian<br />
Institute <strong>of</strong> Development Management (IIDM), Bhopal is gratefully acknowledged.<br />
Our thanks are also due to UNICEF-Madhya Pradesh and UNICEF-New Delhi<br />
for their support by provid<strong>in</strong>g anthropometric equipment for use <strong>in</strong> this study.<br />
The help and support provided by the Districts Project Officers, Child<br />
Development Project Officers, Supervisors, Anganwadi Workers (AWWs) and<br />
ASHA worker (Health functionaries) <strong>of</strong> the concerned districts <strong>in</strong> the execution <strong>of</strong><br />
the survey, is gratefully acknowledged.<br />
Our s<strong>in</strong>cere thanks to the entire field staff for their commitment and<br />
s<strong>in</strong>cere efforts <strong>in</strong> the collection <strong>of</strong> data.<br />
We grateful to Dr. B. Sesikeran, Director, N.I.N and Dr. Vishwa Mohan<br />
Katoch, Director-general, I.C.M.R, and Secretary, Department <strong>of</strong> Health Research,<br />
M<strong>in</strong>istry <strong>of</strong> Health and Family Welfare, GoI, for their constant support and<br />
encouragement.<br />
We also thank Mr. G.Manohar Reddy, Research Officer, Mr. R. Raghunath<br />
Babu, Technical Assistant, Mrs. G.Madhavi, Technician, Ms. D.Sarala & G.Madhavi<br />
Tabulators, NNMB-CRL, and Ms. D. Balamani, Ms. D. Saritha & Ms. M. Venkata<br />
Ramanamma, Punch Operators, and Mrs. L. Rajeswari & Mr. M. Shashi Kumar Reddy,<br />
Data Entry Operators for their technical help.<br />
We are also thankful to Mr. G. Hanumantha Rao, and Mrs. G. Prashanthi,<br />
Personal Assistants for their secretarial assistance.<br />
Last but not least, we are extremely grateful to the community for their<br />
unst<strong>in</strong>t<strong>in</strong>g cooperation, without which the study would not have been completed<br />
successfully.<br />
Authors
PROJECT STAFF<br />
RESEARCH ASSISTANTS<br />
Sl.No.<br />
Name<br />
1. Mr. Arun Kumar Sharma<br />
2. Mr. Mukesh Kumar Rekhwal<br />
3. Mr. Av<strong>in</strong>ash Rai<br />
4. Mr. Kundan Mishra<br />
FIELD INVESTIGATORS<br />
Sl.No.<br />
Name<br />
1. Mr. Dongar Kumar Verma<br />
2. Ms. Ashma Jahan<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
RESULTS AT GLANCE
RESULTS AT A GLANCE<br />
DISTRICT PROFILE<br />
Total population (2001 Census) 13,94,421<br />
Sex Ratio 965<br />
Population density (per sq km) 139<br />
Percent <strong>of</strong> Schedule caste 10.6<br />
Percent <strong>of</strong> Schedule Tribes 39.4<br />
Literacy status (%) 66.9<br />
Female literacy (%) 56.1<br />
SAMPLE CHARACTERISTICS<br />
HHs surveyed (n) 395<br />
Average Family size (n) 6.0<br />
Average per capita monthly <strong>in</strong>come (Rs) 860<br />
COMMUNITY (%)<br />
Scheduled Caste 7.3<br />
Scheduled Tribe 55.3<br />
TYPE OF FAMILY (%)<br />
Nuclear 48.1<br />
Extended Nuclear 14.7<br />
Jo<strong>in</strong>t 37.2<br />
LITERACY STATUS (%)<br />
Father 64.0<br />
Mother 56.4<br />
LAND HOLDING (% HHs)<br />
Land less Families 42.3<br />
Marg<strong>in</strong>al Farmers 18.7<br />
Small Farmers 17.2<br />
Large Farmers 21.8<br />
.<br />
(Contd… 2)<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong> < 5 <strong>year</strong> Children<br />
Betul Dt.- Madhya Pradesh
RESULTS AT A GLANCE (Contd…2)<br />
MAJOR OCCUPATION OF HOUSEHOLD<br />
Percent<br />
Labourers 69.8<br />
Cultivators 18.5<br />
Land Lords -<br />
Artisans 0.3<br />
Service 4.1<br />
Bus<strong>in</strong>ess 3.5<br />
TYPE OF HOUSE<br />
Kutcha 50.9<br />
Semi-Pucca 43.3<br />
Pucca 5.8<br />
SOURCE OF DRINKING WATER<br />
Open well 5.1<br />
Tube well 71.6<br />
Tank 10.9<br />
HOUSEHOLD ELECTRICITY 92.2<br />
PRESENT AND USING SANITARY LATRINE 19.0<br />
IODINE CONTENT OF COOKING SALT<br />
0 ppm 1.5<br />
DELIVERY CONDUCTED BY<br />
RESULTS AT A GLANCE (Contd…3)<br />
Percent<br />
M.O. PHC 21.3<br />
TBA/ANM/LHV 56.6<br />
Pvt. Doctor 6.6<br />
Untra<strong>in</strong>ed Dai/Elders 13.9<br />
Low birth weight (% <strong>in</strong>fants)<br />
BREAST FEEDING AND COMPLEMENTARY FEEDING<br />
Initiate <strong>of</strong> Breast feed<strong>in</strong>g (hours)<br />
Nil<br />
EXECUTIVE SUMMARY
Executive Summary<br />
Undernutrition cont<strong>in</strong>ues to be a major public health problem <strong>in</strong> the develop<strong>in</strong>g<br />
countries, <strong>in</strong>clud<strong>in</strong>g India, the most vulnerable groups are women and young<br />
<strong>children</strong>. Proper nutrition helps <strong>in</strong> adequate growth and development <strong>in</strong> <strong>children</strong>,<br />
which is basic requirement for human development. The <strong>under</strong>nutrition has multifactorial<br />
<strong>in</strong> aetiology and its determ<strong>in</strong>ants <strong>in</strong>clude both food and non-food factors.<br />
Accord<strong>in</strong>g to the recent reports <strong>of</strong> NFHS-3 (2005-06), the prevalence <strong>of</strong><br />
<strong>under</strong>weight, stunn<strong>in</strong>g and wast<strong>in</strong>g (
done their ANC registration early i.e., < 16 weeks <strong>of</strong> gestation. About 94% <strong>of</strong> the<br />
pregnant women received IFA tablets dur<strong>in</strong>g pregnancy, <strong>of</strong> which 41% received ≥90<br />
tablets and about 33% reported that they consumed ≥90 tablets. About 84% <strong>of</strong><br />
deliveries were <strong>in</strong>stitutional took place either <strong>in</strong> govt (75.4%) or private (8.2%)<br />
hospitals. About 28% <strong>of</strong> deliveries were conducted by a Medical <strong>of</strong>ficer, PHC (21.3%)<br />
or doctors at private hospitals (6.6%). Birth weight was recorded <strong>in</strong> about 84% <strong>of</strong><br />
<strong>in</strong>fants, while records were available for only negligible proportion (1.6%) <strong>of</strong> <strong>in</strong>fants.<br />
Majority (94.3%) <strong>of</strong> the mothers fed colostrum to their newborns. About 31%<br />
<strong>of</strong> mothers <strong>in</strong>itiated breastfeed<strong>in</strong>g with<strong>in</strong> an hour <strong>of</strong> delivery and 47% did so with<strong>in</strong> 1-<br />
3 hours <strong>of</strong> delivery. Only about 6% <strong>in</strong>itiated after 24 hours <strong>of</strong> delivery. Pre-lacteal<br />
feeds such as glucose/sugar water, pla<strong>in</strong> water, honey, etc. were given <strong>in</strong> 9% <strong>of</strong><br />
<strong>in</strong>fants.<br />
About 13% <strong>in</strong>fants, aged 6-11 months were exclusively breastfed even<br />
without water for 6 months and breastfeed<strong>in</strong>g was cont<strong>in</strong>ued up to 2 <strong>year</strong>s <strong>in</strong> a<br />
majority <strong>of</strong> <strong>children</strong>.<br />
About one fourth (23.5%) <strong>of</strong> 6-12 months <strong>children</strong> received complementary<br />
feed<strong>in</strong>g at 6 months <strong>of</strong> age, while 38% <strong>in</strong>fants received after 6 months <strong>of</strong> age. About<br />
22% <strong>of</strong> <strong>in</strong>fants did not receive any complementary feed<strong>in</strong>g.<br />
Of the 6-12 months <strong>in</strong>fants, majority (70.6%) received home made semisolids<br />
as complementary feeds, while 44% and 37% received cow/buffalo milk and home<br />
made solids respectively. About 54% were receiv<strong>in</strong>g such foods at least 3 times a<br />
day. Among 12-35 months <strong>children</strong>, about 1% were solely breastfed and 66%<br />
received complementary foods <strong>in</strong> addition to breast milk, while 34% were completely<br />
weaned. Majority <strong>of</strong> the <strong>children</strong> were receiv<strong>in</strong>g home made semi solids (90.6%) or<br />
solids (77.8%) or cow/buffalo milk (68.9%). About 89% were receiv<strong>in</strong>g such foods at<br />
least 3 times a day.<br />
About 98% <strong>of</strong> <strong>children</strong> were completely immunized and about 1% were not<br />
immunized. About 78% <strong>of</strong> 9-17 months <strong>children</strong> and 88% <strong>of</strong> 18-59 months <strong>children</strong><br />
received at least one dose <strong>of</strong> Vitam<strong>in</strong> A dur<strong>in</strong>g the preced<strong>in</strong>g <strong>year</strong>. About 73% <strong>of</strong> 18-<br />
59 months <strong>children</strong> received the stipulated two doses <strong>of</strong> vitam<strong>in</strong> A.<br />
About 34% <strong>of</strong> <strong>children</strong> reportedly had one or more morbidities such as fever,<br />
ARI and diarrhoea dur<strong>in</strong>g the preced<strong>in</strong>g fortnight. The prevalence fever and<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
diarrhoea was lower among 24-35 and 36 <strong>children</strong>, respectively, while the<br />
prevalence <strong>of</strong> ARI was lower among <strong>in</strong>fants aged. About 89% <strong>of</strong> the mothers <strong>in</strong><br />
general, reported that they consult private practitioner, while 9% went to PHC, when<br />
their <strong>children</strong> fall sick.<br />
The overall prevalence <strong>of</strong> <strong>under</strong>nutrition (
1. INTRODUCTION<br />
India, <strong>in</strong> the past few decades, has witnessed rapid progress <strong>in</strong> terms <strong>of</strong><br />
<strong>in</strong>dustrialization and agricultural production. Yet malnutrition, especially<br />
<strong>under</strong>nutrition cont<strong>in</strong>ues to be a major problem <strong>of</strong> public health significance <strong>in</strong> the<br />
country. It is a major contributor to high rates <strong>of</strong> childhood mortality, maternal<br />
mortality and morbidities <strong>in</strong> the community 1 . Though, poverty is a major <strong>under</strong>ly<strong>in</strong>g<br />
cause, scores <strong>of</strong> other factors such as socio-demographic, socio-cultural and lifestyle<br />
practices contribute significantly to the problem <strong>of</strong> malnutrition.<br />
Prevalence <strong>of</strong> low birth weight, ma<strong>in</strong>ly due to <strong>in</strong>trauter<strong>in</strong>e growth retardation<br />
cont<strong>in</strong>ues to be high, which is attributable to maternal <strong>under</strong>nutrition. This is further<br />
aggravated by <strong>in</strong>appropriate <strong>in</strong>fant and young child feed<strong>in</strong>g practices, such as<br />
discard<strong>in</strong>g <strong>of</strong> colostrum, delayed <strong>in</strong>itiation <strong>of</strong> breast feed<strong>in</strong>g, early or delayed<br />
<strong>in</strong>itiation <strong>of</strong> complementary feed<strong>in</strong>g and sub-optimal complementary feed<strong>in</strong>g<br />
practices <strong>in</strong> terms <strong>of</strong> type <strong>of</strong> feed, quantity and frequency.<br />
It has been found that non-exclusive breast feed<strong>in</strong>g <strong>in</strong> the first six months <strong>of</strong><br />
life results <strong>in</strong> 1.4 million deaths and 10% <strong>of</strong> the disease burden among <strong>in</strong>fants and<br />
young <strong>children</strong> every <strong>year</strong> <strong>in</strong> the develop<strong>in</strong>g countries 2 . It is also estimated that about<br />
10-15% <strong>of</strong> <strong>under</strong> five <strong>year</strong> deaths <strong>in</strong> resource poor countries could be prevented by<br />
achiev<strong>in</strong>g 90% <strong>of</strong> exclusive breast feed<strong>in</strong>g alone 3 and 22% <strong>of</strong> neonatal deaths could<br />
be prevented if breast feed<strong>in</strong>g is <strong>in</strong>itiated with<strong>in</strong> the first hour <strong>of</strong> birth 4 .<br />
About 21% <strong>of</strong> global deaths and DALYs (Disability Adjusted Life Years) <strong>in</strong><br />
<strong>children</strong> younger than 5 <strong>year</strong>s are attributed to stunt<strong>in</strong>g, severe wast<strong>in</strong>g and<br />
<strong>in</strong>trauter<strong>in</strong>e growth retardation. Long term consequences <strong>of</strong> <strong>under</strong>nutrition dur<strong>in</strong>g the<br />
early stages <strong>of</strong> child growth and development <strong>in</strong>clude likelihood <strong>of</strong> short stature <strong>in</strong><br />
adult life, low educational achievements, giv<strong>in</strong>g birth to smaller <strong>children</strong>, lower<br />
economic status and reduced physical work capacity and productivity <strong>in</strong> adulthood 5 .<br />
Further, the country is pass<strong>in</strong>g through a phase <strong>of</strong> rapid socio-economic<br />
transition lead<strong>in</strong>g to over nutrition <strong>in</strong> certa<strong>in</strong> segments <strong>of</strong> the population, especially <strong>in</strong><br />
the urban communities. Chang<strong>in</strong>g lifestyles and dietary habits are contribut<strong>in</strong>g to<br />
<strong>in</strong>crease <strong>in</strong> the prevalence <strong>of</strong> overweight/obesity among <strong>children</strong> and young adults<br />
expos<strong>in</strong>g them to the risk <strong>of</strong> chronic degenerative disorders such as hypertension,<br />
Type 2 diabetes, coronary artery disease, stroke, cancers etc <strong>in</strong> the later part <strong>of</strong> life.<br />
More over <strong>under</strong>nutrition dur<strong>in</strong>g early childhood can lead to overweight/obesity <strong>in</strong><br />
adulthood, a risk factor for diet related chronic diseases 6 .<br />
The major nutritional problems <strong>of</strong> public health significance <strong>in</strong> the country are,<br />
prote<strong>in</strong> energy malnutrition (PEM), vitam<strong>in</strong> A deficiency (VAD), iron deficiency<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
anaemia (IDA) and iod<strong>in</strong>e deficiency disorders (IDD). Preschool <strong>children</strong>, adolescent<br />
girls, women <strong>of</strong> reproductive age group, elderly, those belong<strong>in</strong>g to socioeconomically<br />
backward groups such as scheduled caste and schedule tribe<br />
communities, communities resid<strong>in</strong>g <strong>in</strong> chronically drought affected rural areas are<br />
nutritionally the most vulnerable segments <strong>of</strong> the populations.<br />
Several nutrition programmes have been designed and are be<strong>in</strong>g<br />
implemented <strong>in</strong> India, through respective State Governments, dur<strong>in</strong>g the past few<br />
decades for the prevention and control <strong>of</strong> both macro and micronutrient malnutrition<br />
<strong>in</strong> the population. They <strong>in</strong>clude supplementary feed<strong>in</strong>g through ICDS, distribution <strong>of</strong><br />
iron and folic acid tablets, massive dose vitam<strong>in</strong> A supplementation, Mid-day meal<br />
programme etc. Also, several poverty alleviation and developmental programmes<br />
are be<strong>in</strong>g implemented by central and State governments, for the overall<br />
socioeconomic development <strong>of</strong> the communities. In addition, Public Distribution<br />
System and TPDS are striv<strong>in</strong>g to provide essential commodities at affordable price,<br />
especially to those below poverty l<strong>in</strong>e throughout the <strong>year</strong>, all over the country, to<br />
ensure household food security.<br />
Children, who are subjected to socio-economic and dietary constra<strong>in</strong>ts dur<strong>in</strong>g<br />
their critical <strong>year</strong>s <strong>of</strong> growth and development, end up as adults with small body size.<br />
Such adults may be apparently healthy, but there is evidence to suggest that their<br />
productivity and earn<strong>in</strong>g capacity are impaired (Satyanarayana and Naidu, 1977 7 ).<br />
Repeat surveys by National Nutrition Monitor<strong>in</strong>g Bureau (1999 8 ) <strong>in</strong> eight States<br />
revealed that, despite very little or no change <strong>in</strong> the dietary <strong>in</strong>takes <strong>of</strong> rural population<br />
over a period <strong>of</strong> time, there was a decrease <strong>in</strong> the prevalence <strong>of</strong> severe forms <strong>of</strong><br />
<strong>under</strong>nutrition among young <strong>children</strong> with concomitant <strong>in</strong>crease <strong>in</strong> normal grades.<br />
However, the proportion <strong>of</strong> <strong>children</strong> with mild to moderate <strong>under</strong>nutrition rema<strong>in</strong>ed<br />
similar. Recent survey carried out by NNMB (2006 9 ) <strong>in</strong> the rural areas <strong>of</strong> n<strong>in</strong>e States<br />
revealed that about 40% <strong>under</strong> 5 <strong>year</strong> <strong>children</strong> were <strong>under</strong>weight, 45% were stunted<br />
and 20% were wasted. The correspond<strong>in</strong>g figures for the State <strong>of</strong> Madhya Pradesh<br />
were, 46%, 59% and 24% respectively.<br />
Accord<strong>in</strong>g to NFHS-3 10 , <strong>in</strong> the State <strong>of</strong> Madhya Pradesh, 60% <strong>of</strong>
ecommended several action programmes <strong>in</strong> its National Plan <strong>of</strong> Action on Nutrition<br />
(1995) 12 . Though, the Government <strong>of</strong> India and the respective State Governments<br />
have been implement<strong>in</strong>g several health, nutrition <strong>in</strong>tervention and developmental<br />
programmes through its National Nutrition Policy and National Plan <strong>of</strong> Action on<br />
Nutrition for overall improvement <strong>of</strong> health and nutrition status <strong>of</strong> the community, the<br />
prevalence <strong>of</strong> <strong>under</strong>nutrition cont<strong>in</strong>ues to be significantly high.<br />
The type and magnitude <strong>of</strong> <strong>under</strong>nutrition may vary from district to district,<br />
depend<strong>in</strong>g on geographical and agro-climatic conditions and therefore, warrant<br />
region-specific <strong>in</strong>terventions. In order to devise and implement area specific<br />
<strong>in</strong>tervention strategies and to monitor their impact over a period, it is necessary to<br />
generate data base at district level.<br />
In this context, the Government <strong>of</strong> Madhya Pradesh is contemplat<strong>in</strong>g to<br />
develop State Nutrition Policy and develop plan <strong>of</strong> action for implementation, <strong>in</strong> order<br />
to improve the nutritional status <strong>of</strong> the communities. Therefore, at the request <strong>of</strong> the<br />
Department <strong>of</strong> Women & Child Development, Government <strong>of</strong> Madhya Pradesh, the<br />
National Institute <strong>of</strong> Nutrition carried out survey <strong>in</strong> all the follow<strong>in</strong>g 50 districts <strong>of</strong> the<br />
State, to assess the nutritional status <strong>of</strong> <strong>under</strong> 5 <strong>year</strong> <strong>children</strong> and <strong>in</strong>fant and young child<br />
feed<strong>in</strong>g practices.<br />
Sl. No. District<br />
Sl.<br />
Sl.<br />
Sl.<br />
Sl.<br />
District<br />
District<br />
District<br />
No<br />
No.<br />
No<br />
No<br />
District<br />
1 Alirajpur 11 Ch<strong>in</strong>dwara 21 Indore 31 Neemuch 41 Shadol<br />
2 Anuppur 12 Damoh 22 Jabalpur 32 Panna 42 Shajapur<br />
3 Ashokngar 13 Datia 23 Jhabua 33 Raisen 43 Sheopur<br />
4 Balaghat 14 Dewas 24 Katni 34 Rajgarh 44 Sidhi<br />
5 Barwani 15 Dhar 25 Khandwa 35 Ratlam 45 S<strong>in</strong>grauli<br />
6 Betul 16 D<strong>in</strong>dori 26 Khargone 36 Rewa 46 Shivpuri<br />
7 Bh<strong>in</strong>d 17 Guna 27 Mandla 37 Sagar 47 Tikamgarh<br />
8 Bhopal 18 Gwalior 28 Mandsaur 38 Sathna 48 Ujja<strong>in</strong><br />
9 Burhanpur 19 Harda 29 Morena 39 Sehore 49 Umaria<br />
10 Chhatarpur 20 Hoshangabad 30 Narsimhapur 40 Seoni 50 Vidisha<br />
The results <strong>of</strong> the study carried out <strong>in</strong> Betul district <strong>of</strong> Madhya Pradesh State<br />
dur<strong>in</strong>g February-August 2010, is presented <strong>in</strong> this report.<br />
1.1 Pr<strong>of</strong>ile <strong>of</strong> Betul District<br />
Betul is one <strong>of</strong> the southern districts <strong>of</strong> Madhya Pradesh, ly<strong>in</strong>g almost wholly on the<br />
satpura plateau. Betul occupies nearly the whole width <strong>of</strong> satpura range between the<br />
valley <strong>of</strong> Narmada on the north and the bearer pla<strong>in</strong>s on the south. It forms the<br />
sourthern most part <strong>of</strong> Bhopal Commissioners Division. Betul district derives its<br />
name from the small town <strong>of</strong> Betul Bazar, located about 5 kms south <strong>of</strong> Badnur, the<br />
headquarters <strong>of</strong> the district. Betul district is bounded on north by Hoshangabad, on<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
the south by Amaraoti <strong>of</strong> Maharastra, on the east by chh<strong>in</strong>dwara and on the west by<br />
the district <strong>of</strong> Harda and Khandwa. The district extends between 21 o – 22 and 22 o –<br />
24 degrees North Latitude and between 77 o – 10 and 78 o – 33 degrees East<br />
Longitude and forms a compact shape, almost a square with significant projection<br />
towards East and west. As <strong>of</strong> the census taken <strong>in</strong> 2001, the district has a total<br />
population <strong>of</strong> 13, 94,421 people spread <strong>in</strong> around 1328 villages. The Total area <strong>of</strong><br />
District is 10043 Sq.km, with a population density <strong>of</strong> 139/sq.km. The district has a<br />
Sex Ratio <strong>of</strong> 965. Betul has an average literacy rate <strong>of</strong> 66.9%, higher than the<br />
national average <strong>of</strong> 59.5%; with 77.3% <strong>of</strong> the males and 56.1% <strong>of</strong> females were<br />
literate. Betul topography is predom<strong>in</strong>antly hilly.<br />
2. OBJECTIVES<br />
2.1 General Objective<br />
The general objective <strong>of</strong> the study was to assess the health and nutritional<br />
status <strong>of</strong>
3.1.2 Selection <strong>of</strong> Villages<br />
For the purpose <strong>of</strong> survey, <strong>in</strong> each district, a total <strong>of</strong> 20 villages were selected,<br />
us<strong>in</strong>g systematic random procedure, cover<strong>in</strong>g all the taluks/blocks based on<br />
Population Proportion to Size <strong>of</strong> the village.<br />
3.1.3 Selection <strong>of</strong> Households<br />
In each <strong>of</strong> the selected villages, a total <strong>of</strong> 20 households (HHs) hav<strong>in</strong>g at<br />
least one <strong>in</strong>dex child <strong>of</strong>
3.2.3 Cl<strong>in</strong>ical exam<strong>in</strong>ation<br />
All the <strong>children</strong> covered for anthropometry were exam<strong>in</strong>ed cl<strong>in</strong>ically for the<br />
presence <strong>of</strong> signs <strong>of</strong> nutritional deficiency.<br />
3.2.4 History <strong>of</strong> Morbidity<br />
Information on history <strong>of</strong> morbidity among the <strong>children</strong> such as fever,<br />
respiratory <strong>in</strong>fection, diarrhoea etc., if any, dur<strong>in</strong>g the preced<strong>in</strong>g 15 days <strong>of</strong> visit was<br />
collected.<br />
3.2.5 Maternal Particulars<br />
Maternal particulars such as parity, antenatal care, TT immunization, receipt<br />
<strong>of</strong> IFA tablets, particulars <strong>of</strong> delivery and record<strong>in</strong>g <strong>of</strong> birth weight were collected on<br />
mothers <strong>of</strong>
pr<strong>of</strong>iciency <strong>in</strong> local language were recruited, tra<strong>in</strong>ed and standardized <strong>in</strong> various<br />
survey methodologies, by the scientists from the National Institute <strong>of</strong> Nutrition. All<br />
the survey <strong>in</strong>struments (pr<strong>of</strong>ormae) were developed, translated <strong>in</strong>to h<strong>in</strong>di vernacular<br />
and pre-tested before be<strong>in</strong>g used <strong>in</strong> the survey. Data was collected <strong>in</strong> each district<br />
by two teams.<br />
3.4 Quality Control<br />
Random checks were carried out by scientists from NIN, periodically by<br />
revisit<strong>in</strong>g the households surveyed by the field staff, to ensure quality <strong>of</strong> data<br />
collection.<br />
3.5 Data Analysis<br />
The data was scrut<strong>in</strong>ized and entered <strong>in</strong>to the computers as soon as it was<br />
received at NIN. The data clean<strong>in</strong>g was done by carry<strong>in</strong>g out range and consistency<br />
checks. Descriptive and analytical statistics <strong>of</strong> the data were carried out us<strong>in</strong>g SPSS<br />
W<strong>in</strong>dows version 15.0. Appropriate statistical tools were used wherever needed.<br />
4. RESULTS<br />
4.1 Coverage<br />
A total <strong>of</strong> 395 households from 20 villages were covered for the present study<br />
(Table 1). A total <strong>of</strong> 454 <strong>children</strong> (Boys:232; Girls:222)
4.2.2 Type <strong>of</strong> family<br />
About 48% <strong>of</strong> the households were nuclear families, while jo<strong>in</strong>t and extended<br />
nuclear families accounted for 37% and 15% respectively.<br />
4.2.3 Family size<br />
The average family size was 6.0. About 33% <strong>of</strong> the HHs had family size <strong>of</strong> 1-4<br />
members, 58% <strong>of</strong> HHs had 5-9 members and 9% <strong>of</strong> HHs had ≥10 members <strong>in</strong> the<br />
family.<br />
4.2.4 Literacy status <strong>of</strong> father<br />
About 64% <strong>of</strong> the fathers <strong>of</strong> the <strong>in</strong>dex <strong>children</strong> were literates. About 19% had<br />
an education level <strong>of</strong> 1-5 th class, 7% had school<strong>in</strong>g <strong>of</strong> 6 th -7 th class, 25% studied up<br />
to 8 th -10 th class, 8% studied up to <strong>in</strong>termediate, while 5% had graduation or above.<br />
4.2.5 Literacy status <strong>of</strong> mother<br />
About 56% <strong>of</strong> the mothers <strong>of</strong> the <strong>in</strong>dex <strong>children</strong> were literates. About 16% <strong>of</strong><br />
them had an education level <strong>of</strong> 1-5 th class, 6% studied up to 6 th -7 th class, 28% had<br />
school<strong>in</strong>g <strong>of</strong> 8 th -10 th class, 4% studied upto <strong>in</strong>termediate, while 3% were educated<br />
upto graduation or above.<br />
4.2.6 Household landhold<strong>in</strong>g<br />
About 42% <strong>of</strong> households did not posses any agricultural land. About 19%<br />
were marg<strong>in</strong>al farmers (
4.3 Household Physical facilities<br />
4.3.1 Type <strong>of</strong> house<br />
About half <strong>of</strong> the houses (50.9%) were kutcha houses, while 43% were semi<br />
pucca and 6% were pucca <strong>in</strong> nature (Table 3).<br />
4.3.2 Household amenities<br />
The major source <strong>of</strong> dr<strong>in</strong>k<strong>in</strong>g water was from tube well (71.6%), followed by<br />
tap (10.9%) and open well (5.1%). Majority (94.7%) <strong>of</strong> HHs were us<strong>in</strong>g firewood,<br />
while 3% and 2% <strong>of</strong> HHs us<strong>in</strong>g LPG and Bio-gas respectively for cook<strong>in</strong>g. About<br />
92% <strong>of</strong> the houses were electrified. About one fifth (19.0%) <strong>of</strong> the HHs were us<strong>in</strong>g<br />
sanitary latr<strong>in</strong>e. About 27 <strong>of</strong> the HHs had separate kitchen facility.<br />
4.4 Iod<strong>in</strong>e content <strong>of</strong> Cook<strong>in</strong>g salt<br />
The distribution <strong>of</strong> HHs accord<strong>in</strong>g to iod<strong>in</strong>e content <strong>of</strong> cook<strong>in</strong>g salt as estimated<br />
by spot test<strong>in</strong>g kit is presented <strong>in</strong> Table 4. It was observed that almost all the HHs<br />
(99.7%) were us<strong>in</strong>g free flow<strong>in</strong>g salt. About 94% <strong>of</strong> HHs were us<strong>in</strong>g adequately<br />
iodized (≥15 ppm) salt, 5% samples had
major reasons for not avail<strong>in</strong>g ANCs were ‘not aware <strong>of</strong> the need’ (9.3%), ‘loss <strong>of</strong><br />
wage’s’ (7.4%), ‘ANCs not held <strong>in</strong> the village’ and place is not accessible (5.6% each)<br />
and ‘no faith’ and ‘tim<strong>in</strong>gs are <strong>in</strong>convenient’ (3.7% each).<br />
About 94% <strong>of</strong> pregnant women received IFA tablets, mostly from AWW (50%) or<br />
ANM (40.7%). About 41% received ≥90 tablets, while only 33% consumed ≥ 90 tablets<br />
dur<strong>in</strong>g the pregnancy. Nearly 96% <strong>of</strong> the mothers reportedly received TT immunization.<br />
About 89% received two doses <strong>of</strong> TT, while 7% received one dose only. The ma<strong>in</strong><br />
reason for not avail<strong>in</strong>g TT was ‘not aware <strong>of</strong> the need’ (3.7%).<br />
4.5.3 Particulars <strong>of</strong> last Delivery (Mothers hav<strong>in</strong>g
%<br />
70<br />
60<br />
50<br />
40<br />
30<br />
Fig.1 Distribution (%) <strong>of</strong> 0-11 months Children accord<strong>in</strong>g to<br />
Time <strong>of</strong> Initiation <strong>of</strong> Breastfeed<strong>in</strong>g (BF)<br />
31.1<br />
46.8<br />
20<br />
10<br />
11.5<br />
4.9<br />
5.7<br />
0<br />
0-5 month <strong>in</strong>fants<br />
About 61% <strong>of</strong> the <strong>in</strong>fants, below 6 months were solely breastfed, while about<br />
35% received water <strong>in</strong> addition to breast milk and 4% received complementary foods<br />
<strong>in</strong> addition to breast milk before 6 months <strong>of</strong> age (Table 11).<br />
6-11 months <strong>in</strong>fants<br />
Only about 3% <strong>of</strong> the 6-11 months <strong>in</strong>fants were solely breast fed. About 19%<br />
received water <strong>in</strong> addition to breast milk, while 77% received complementary foods<br />
<strong>in</strong> addition to breast milk. (Table 11). Of those who were currently receiv<strong>in</strong>g water or<br />
complementary foods <strong>in</strong> addition to breast milk (95.6%), about 13% were solely<br />
breast fed even without water up to six months. Of those who were currently<br />
receiv<strong>in</strong>g complementary foods (76.5%), the complementary feed<strong>in</strong>g was <strong>in</strong>itiated at<br />
6 months <strong>of</strong> age <strong>in</strong> about 24% <strong>of</strong> <strong>in</strong>fants, while 38% received after 6 months <strong>of</strong> age<br />
(Fig. 2). The commonly used complementary foods <strong>in</strong>cluded home made semisolids<br />
(70.6%), followed by cow/buffalo milk (44.1%), home made solids (36.8%),<br />
commercial baby foods (8.8%) and formula milk (5.9%) (Table 11).<br />
The foods generally <strong>in</strong>cluded <strong>in</strong> the complementary feeds were cereals &<br />
millets (73.5%), pulses (67.6%), fats & oils (66.2%), fruits (35.3%), milk & milk<br />
products (33.8%), other vegetables & roots & tubers (16.2% each) and green leafy<br />
vegetables (11.8%). About 54% <strong>of</strong> the <strong>children</strong> received at least 3 complementary<br />
feeds per day, while 16% received 2 feeds a day. About 56% <strong>of</strong> mothers fed the<br />
<strong>in</strong>fants with their hand, while about 2% used spoon to feed the child. In about 13% <strong>of</strong><br />
cases, the <strong>in</strong>fants consumed foods with their hands. The feed<strong>in</strong>g was supervised<br />
mostly by the mother (69%), father or grand parents (2.9%) (Table 12).<br />
4.6.2.2 12-35 month <strong>children</strong><br />
About 66% <strong>of</strong> the <strong>children</strong> were currently receiv<strong>in</strong>g complementary foods <strong>in</strong> addition<br />
to breast milk, while 34% <strong>of</strong> the <strong>children</strong> were completely weaned and about 1% were<br />
solely breast fed. The type <strong>of</strong> food be<strong>in</strong>g currently given <strong>in</strong>cluded home made semi<br />
solids (90.6%), home made solids (77.8%) and cow/buffalo milk (68.9%). The most<br />
commonly used food groups <strong>in</strong>cluded, cereals & millets (98.1%), pulses (97.6%<br />
each), fats & oils (95.8%), fruits (84.9%), other vegetables (79.2%), GLV (78.8%),<br />
roots & tubers (72.2%), milk & milk products (70.3%), eggs (31.1%) and flesh foods<br />
(20.8%). About 38% <strong>of</strong> the <strong>children</strong> were fed ≥ 4 times a day, 51% were fed 3 times<br />
a day, while 10% were fed ≤ 2 times a day. About 66% <strong>of</strong> the <strong>children</strong> consumed<br />
food themselves with their hands, while 33% were fed by their mothers by hand. In<br />
most <strong>of</strong> the cases, feed<strong>in</strong>g was supervised by their mothers (76.9%), followed by<br />
grand parents (10.4%) and elder sibl<strong>in</strong>gs (4.2%) (Table 13).<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
4.6.3 Care <strong>of</strong> the Child<br />
About 14% <strong>of</strong> the mothers carried their <strong>children</strong> to the work-spot. While 29%<br />
stated that they were cared either by their <strong>in</strong>-laws (19.9%) or by the older sibl<strong>in</strong>gs<br />
(9.3%) (Table 14).<br />
4.6.4 Personal Hygiene<br />
About 3.0% <strong>of</strong> mothers washed their hands with soap before feed<strong>in</strong>g the child.<br />
The soap was used by 70% <strong>of</strong> mothers to wash their /child’s hand after defecation<br />
(Table 14).<br />
4.6.5 History <strong>of</strong> Morbidity<br />
The particulars <strong>of</strong> morbidity dur<strong>in</strong>g preced<strong>in</strong>g fortnight among
4.6.7 Coverage for Immunization <strong>under</strong> UIP<br />
The particulars <strong>of</strong> coverage <strong>of</strong> 12-24 months <strong>children</strong> for immunization <strong>under</strong><br />
Universal Immunization Programme (UIP) dur<strong>in</strong>g the first <strong>year</strong> <strong>of</strong> life are provided <strong>in</strong><br />
Table 18 and Fig. 3. Majority (97.6%) <strong>of</strong> the <strong>children</strong> were fully immunized and only<br />
about 2% were partially immunized. About 97-99% received polio, DPT & BCG<br />
vacc<strong>in</strong>es, while 98% received measles vacc<strong>in</strong>ation. Major source <strong>of</strong> this <strong>in</strong>formation<br />
was from parents (95.2%), followed by mother & child protection card (3.2%) The<br />
major reasons for not immunized or partially immunized are ‘not <strong>of</strong>fered’ and<br />
‘time/place not known/<strong>in</strong>convenient’ (0.8% each).<br />
4.6.8 Coverage for Massive dose <strong>of</strong> Vitam<strong>in</strong> A Supplementation<br />
The National programme on Prevention and control <strong>of</strong> bl<strong>in</strong>dness due to Vitam<strong>in</strong><br />
A deficiency envisages that all the <strong>children</strong> between 9 to 60 months should receive<br />
biannual massive dose <strong>of</strong> vitam<strong>in</strong> A. The particulars <strong>of</strong> coverage <strong>of</strong> <strong>children</strong> for<br />
massive dose vitam<strong>in</strong> A dur<strong>in</strong>g the previous one <strong>year</strong> are provided <strong>in</strong> Table 19. In<br />
general, about 85% <strong>of</strong> 9-59 months <strong>children</strong> reportedly received at least one dose <strong>of</strong><br />
vitam<strong>in</strong> A, while the coverage was about 78% among 9-17 months and 88% among<br />
18-59 months <strong>children</strong>. About 73% <strong>of</strong> 18-59 months <strong>children</strong> received the stipulated 2<br />
doses dur<strong>in</strong>g preced<strong>in</strong>g one <strong>year</strong>, while about 14% received a s<strong>in</strong>gle dose <strong>of</strong> vitam<strong>in</strong><br />
A. In a majority <strong>of</strong> cases, the massive dose vitam<strong>in</strong> A was adm<strong>in</strong>istered at AWC<br />
(82.9%), mostly either by ANM (58.4%) or AWW (26.5%). The major reasons for nonreceipt<br />
<strong>of</strong> massive dose <strong>of</strong> Vitam<strong>in</strong> A were, ‘not <strong>of</strong>fered’ (14.5%), ‘unaware <strong>of</strong> the need<br />
(2.1%) and time and place not convenient (1.1%).<br />
4.6.9 Coverage for Iron and Folic acid tablets Supplementation<br />
About 46% <strong>children</strong> <strong>of</strong> 12-59 months reportedly received IFA tablets dur<strong>in</strong>g<br />
the preced<strong>in</strong>g <strong>year</strong>, either from AWW (27.7%) or ANM (17.8%). Only about 2%<br />
received ≥ 90 IFA tablets, while only 1.2% consumed ≥ 90 tablets (Table 20).<br />
4.7 <strong>Nutritional</strong> status <strong>of</strong> <strong>children</strong> (
%<br />
100<br />
Fig. 3 Coverage (%) <strong>of</strong> 12-24 months Children for Immunization <strong>under</strong><br />
Universal Immunization Program (UIP)<br />
90<br />
80<br />
99.2<br />
97.6 97.6 97.6<br />
99.2 99.2 99.2<br />
98.4<br />
97.6<br />
70<br />
60<br />
50<br />
40<br />
30<br />
20<br />
10<br />
1.6 0.8<br />
0<br />
BCG DPT1 DPT2 DPT3 OPV1 OPV2 OPV3 Measles Full Imm. Partial<br />
Imm.<br />
No Imm.<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
4.7.2 <strong>Nutritional</strong> anthropometry<br />
4.7.2.1 Mean Weight and Height<br />
The mean weight and heights <strong>of</strong>
20<br />
16<br />
Fig.4 Distance charts for Weights - Boys<br />
Median Wt - WHO Standards<br />
Mean Wt - Current Study<br />
Wt (Kgs)<br />
12<br />
8<br />
4<br />
0<br />
0<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
9<br />
10<br />
11<br />
12-17<br />
18-23<br />
24-29<br />
30-35<br />
36-41<br />
42-47<br />
48-53<br />
54-59<br />
Age (Months)<br />
20<br />
16<br />
Fig.5 Distance charts for Weights - Girls<br />
Median Wt - WHO Standards<br />
Mean Wt - Current Study<br />
Wt (Kgs)<br />
12<br />
8<br />
4<br />
0<br />
0<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
9<br />
10<br />
11<br />
Age (Months)<br />
12-17<br />
18-23<br />
24-29<br />
30-35<br />
36-41<br />
42-47<br />
48-53<br />
54-59<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
120<br />
100<br />
Fig.6 Distance charts for Heights - Boys<br />
Meadian Ht-WHO standards<br />
Mean Ht -Current Study<br />
80<br />
Ht (Cms)<br />
60<br />
40<br />
20<br />
0<br />
0<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
9<br />
10<br />
11<br />
12-17<br />
18-23<br />
24-29<br />
30-35<br />
36-41<br />
42-47<br />
48-53<br />
54-59<br />
Age (Months)<br />
120<br />
100<br />
Fig.7 Distance charts for Heights - Girls<br />
Meadian Ht-WHO standards<br />
Mean Ht -Current Study<br />
80<br />
Ht (Cms)<br />
60<br />
40<br />
20<br />
0<br />
0<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
9<br />
10<br />
11<br />
Age (Months)<br />
12-17<br />
18-23<br />
24-29<br />
30-35<br />
36-41<br />
42-47<br />
48-53<br />
54-59<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Fig.8 Prevalence (%) <strong>of</strong> Undernutrition among
Wast<strong>in</strong>g<br />
The overall prevalence <strong>of</strong> wast<strong>in</strong>g (
Fig.10 Prevalence (%) <strong>of</strong> Undernutrition among
Literacy status <strong>of</strong> father<br />
The nutritional status <strong>of</strong> <strong>children</strong> was not significantly associated with literacy<br />
status <strong>of</strong> father. The prevalence <strong>of</strong> <strong>under</strong>weight and stunt<strong>in</strong>g was marg<strong>in</strong>ally higher<br />
among <strong>children</strong> <strong>of</strong> illiterate fathers (45.2% and 40.8% respectively), compared to<br />
those <strong>of</strong> ‘literate’ (42.4% and 36.9% respectively). The prevalence <strong>of</strong> wast<strong>in</strong>g was<br />
comparable (around 21% each) between groups (Fig. 11).<br />
Literacy status <strong>of</strong> mother<br />
The prevalence <strong>of</strong> <strong>under</strong> weight and stunt<strong>in</strong>g was relatively higher among<br />
<strong>children</strong> <strong>of</strong> illiterate mothers (46.0% and 42.4% respectively) compared to those <strong>of</strong><br />
‘literate’ (41.0% and 34.8% respectively). However, the prevalence <strong>of</strong> wast<strong>in</strong>g was<br />
about 3% more among <strong>children</strong> <strong>of</strong> illiterate mothers (22.7%), compared to those <strong>of</strong><br />
literate (19.9%). (Fig.12). However, none <strong>of</strong> the differences were found to be<br />
statistically significant.<br />
Household possession <strong>of</strong> land<br />
The prevalence <strong>of</strong> wast<strong>in</strong>g was observed to be significantly (P
Fig.11 Prevalence (%) <strong>of</strong> Undernutrition among
Fig.13 Prevalence (%) <strong>of</strong> Undernutrition among
was marg<strong>in</strong>ally higher among labours (23.2%) compared to ‘cultivators’ and<br />
housewives / others’ (about 20% each).<br />
Per Capita Income (Rs.)<br />
The prevalence <strong>of</strong> <strong>under</strong>weight among
Fig.15 Prevalence (%) <strong>of</strong> Undernutrition among
hav<strong>in</strong>g electricity (42.4% and 37.6% respectively), while the prevalence <strong>of</strong> wast<strong>in</strong>g<br />
was comparable between groups (about 21% each). However, the differences<br />
observed <strong>in</strong> the prevalence <strong>of</strong> <strong>under</strong>weight and stunt<strong>in</strong>g was not statistically<br />
significant.<br />
Presence/use <strong>of</strong> Sanitary Latr<strong>in</strong>e<br />
Though not statistically significant, the prevalence <strong>of</strong> <strong>under</strong>weight, stunt<strong>in</strong>g<br />
and wast<strong>in</strong>g was lower among those households us<strong>in</strong>g sanitary latr<strong>in</strong>es (34.8%,<br />
32.6% and 18.5% respectively), compared to those not us<strong>in</strong>g or not hav<strong>in</strong>g sanitary<br />
latr<strong>in</strong>es (45.3% , 39.5% and 21.8% respectively).<br />
Separate Kitchen<br />
The prevalence <strong>of</strong> <strong>under</strong>weight, stunt<strong>in</strong>g and wast<strong>in</strong>g though not statistically<br />
significant, was relatively lower among <strong>children</strong> from HHs hav<strong>in</strong>g separate kitchen<br />
(36.8%; 32.8% and 16.8% respectively), compared to those who do not have<br />
separate kitchen (45.6%, 40.1% and 22.8% respectively).<br />
History <strong>of</strong> Morbidity dur<strong>in</strong>g preced<strong>in</strong>g fortnight<br />
The prevalence <strong>of</strong> stunt<strong>in</strong>g was significantly (p
5. DISCUSSION AND CONCLUSIONS<br />
Accord<strong>in</strong>g to NFHS-3 survey, about 80% <strong>of</strong> the pregnant women had<br />
<strong>under</strong>gone ANC <strong>in</strong> the state <strong>of</strong> Madhya Pradesh. The present study revealed that<br />
about 83% <strong>of</strong> pregnant women had <strong>under</strong>gone antenatal check-up and 96%<br />
received TT immunization <strong>in</strong> the Betul district <strong>of</strong> Madhya Pradesh 10 . National<br />
population policy 2000 envisaged that about 80% <strong>of</strong> deliveries should be Institutional<br />
and 100% should be conducted by tra<strong>in</strong>ed personnel 16 . In Betul district, about 84%<br />
deliveries took place either <strong>in</strong> Government (75.4%) or Private hospitals (8.2%).<br />
About 28% were conducted by medical doctors, while 57% were conducted by<br />
tra<strong>in</strong>ed personnel, like TBA / ANM / LHV. This f<strong>in</strong>d<strong>in</strong>g is encourag<strong>in</strong>g and such<br />
practices to be strengthened further.<br />
Even though birth weights were recorded <strong>in</strong> about 84% <strong>of</strong> the newborns, but the<br />
records were available only for 2% <strong>of</strong> them. The birth weight <strong>of</strong> an <strong>in</strong>fant is the s<strong>in</strong>gle<br />
most important determ<strong>in</strong>ant <strong>of</strong> new born survival and <strong>in</strong> develop<strong>in</strong>g countries, low<br />
birth weight <strong>in</strong>fants are at <strong>in</strong>creased risk <strong>of</strong> be<strong>in</strong>g malnourished at one <strong>year</strong> <strong>of</strong> age,<br />
become victims <strong>of</strong> “<strong>in</strong>fection-malnutrition cycle” which leads to further stunt<strong>in</strong>g and<br />
impaired growth and development 17 . In addition, <strong>children</strong> born with <strong>in</strong>trauter<strong>in</strong>e<br />
growth retardation are at a higher risk <strong>of</strong> develop<strong>in</strong>g overweight/obesity and<br />
associated chronic degenerative disorders dur<strong>in</strong>g adulthood 6 . Though, 84%,<br />
deliveries took place at <strong>in</strong>stitutions like, PHC /subcentres / Government hospitals /<br />
private hospitals, the discharge summary sheet, which conta<strong>in</strong>s the recorded<br />
<strong>in</strong>formation <strong>of</strong> birth weight <strong>of</strong> the new born were not available at HHs. S<strong>in</strong>ce, birth<br />
weight is very important <strong>in</strong> determ<strong>in</strong><strong>in</strong>g the postnatal growth <strong>of</strong> the <strong>in</strong>fant, delivery<br />
and birth weight monitor<strong>in</strong>g system <strong>in</strong> ICDS to be strengthened further. Efforts have<br />
to be made, to provide one baby balance for each AWW, to record the birth weight <strong>of</strong><br />
the new born, born <strong>in</strong> her village as early as possible. AWWs have to be <strong>in</strong>structed<br />
further to visit houses <strong>of</strong> mothers, delivered at hospitals at the earliest, to gather<br />
<strong>in</strong>formation about birth weight from discharge summary sheet provided by the<br />
hospital authorities to the patient for ma<strong>in</strong>tenance at AWC.<br />
Infant and young child feed<strong>in</strong>g practices have a significant impact on child<br />
health and survival. Appropriate feed<strong>in</strong>g <strong>in</strong>clud<strong>in</strong>g early and exclusive breastfeed<strong>in</strong>g<br />
and optimal complementary feed<strong>in</strong>g practices such as right time <strong>of</strong> <strong>in</strong>itiation, right<br />
type and quantity <strong>of</strong> complementary foods and frequency <strong>of</strong> complementary feed<strong>in</strong>g<br />
is important for proper physical growth and mental development <strong>of</strong> the child. In its<br />
policy statements, the American Academy <strong>of</strong> Paediatrics (1997) 18 stated that the<br />
mother’s milk is uniquely superior for <strong>in</strong>fant feed<strong>in</strong>g.<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Epidemiological research showed that mother’s milk and breastfeed<strong>in</strong>g <strong>of</strong><br />
<strong>in</strong>fants provides advantages with regard to general health, growth and development<br />
while significantly decreas<strong>in</strong>g risk for a large number <strong>of</strong> acute and chronic diseases.<br />
In the present study, breastfeed<strong>in</strong>g was the common practice among the mothers.<br />
However, only about 31% <strong>of</strong> the mothers reportedly <strong>in</strong>itiated breastfeed<strong>in</strong>g with<strong>in</strong> an<br />
hour <strong>of</strong> delivery. This figure is much higher than that reported by the NFHS-3 for the<br />
State (16%). Pre-lacteals were given <strong>in</strong> about 9% <strong>of</strong> the newborns only. This type <strong>of</strong><br />
practice to be encouraged further, because pre-lacteal feeds might harm the<br />
immature gut <strong>of</strong> the child, especially if they are contam<strong>in</strong>ated. The delayed <strong>in</strong>itiation<br />
<strong>of</strong> breasted feed<strong>in</strong>g observed <strong>in</strong> the district is a matter <strong>of</strong> concern and requires due<br />
attention because, early <strong>in</strong>itiation <strong>of</strong> breast feed<strong>in</strong>g is the primary determ<strong>in</strong>ant <strong>of</strong><br />
maternal milk production and secretion. Avoidance <strong>of</strong> other fluids or foods is<br />
essential to optimize breast milk <strong>in</strong>take by the newborn. Most <strong>of</strong> the other fluids or<br />
foods are less nutritious than breast milk and therefore, if displacement occurs, the<br />
<strong>in</strong>fant may be at a nutritional disadvantage even if prepared hygienically 19 . In many<br />
communities, it is traditionally believed that colostrum is unhealthy and therefore is<br />
harmful to the baby. However <strong>in</strong> the present study, colostrum was given by 94% <strong>of</strong><br />
mothers which is good for the child’s health and nutrition and such desirable<br />
practices should be encouraged further <strong>in</strong> the district.<br />
Breast milk can contribute significantly as a source <strong>of</strong> energy, fat, high quality<br />
prote<strong>in</strong> and micronutrients, especially when the quality <strong>of</strong> available complementary<br />
food is low (Academy <strong>of</strong> Educational Development, 1999 19 ). WHO 20 and UNICEF<br />
(1993a 21 ) recommends that complementary feed<strong>in</strong>g should be <strong>in</strong>itiated immediately<br />
after 6 months <strong>of</strong> the <strong>in</strong>fant’s age and breastfeed<strong>in</strong>g should be cont<strong>in</strong>ued well <strong>in</strong>to<br />
the second <strong>year</strong> <strong>of</strong> life and for longer duration, if possible. In the present study, only<br />
about 16% <strong>of</strong> the <strong>in</strong>fants aged 6-11 months received complementary foods before 6<br />
months <strong>of</strong> age. This type <strong>of</strong> desirable feed<strong>in</strong>g practices should be discouraged.<br />
There is <strong>in</strong>sufficiency <strong>of</strong> breastmilk or lactation failure.<br />
The <strong>in</strong>itiation <strong>of</strong> complementary feed<strong>in</strong>g was unduly delayed. About 62% <strong>of</strong><br />
the 6-11 months <strong>children</strong> were gett<strong>in</strong>g complementary feeds, while about 24%<br />
started receiv<strong>in</strong>g the same at the age <strong>of</strong> 6 months. The mothers to be educated to<br />
<strong>in</strong>troduce complementary feeds from 6 th months <strong>of</strong> age, as breastmilk alone is not<br />
sufficient to meet the grow<strong>in</strong>g nutritional needs <strong>of</strong> <strong>in</strong>fant. The complementary foods<br />
be<strong>in</strong>g given mostly <strong>in</strong>cluded, home made semi solids, cow/buffalo milk and home<br />
made solids. The frequency <strong>of</strong> feed<strong>in</strong>g was at least 3 times <strong>in</strong> 54% <strong>of</strong> the <strong>in</strong>fants.<br />
Effective immunization programme aga<strong>in</strong>st the common communicable diseases are<br />
required for the majority <strong>of</strong> the susceptible populations particularly <strong>in</strong> the develop<strong>in</strong>g<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
countries, where<strong>in</strong> the risk <strong>of</strong> disability or death from preventable <strong>in</strong>fectious diseases<br />
is a matter <strong>of</strong> concern. Therefore, coverage <strong>under</strong> universal immunization<br />
programme should be 100%. It has been observed <strong>in</strong> this study, most <strong>of</strong> the <strong>children</strong><br />
(97.6%) were fully immunized.<br />
The programme for prevention <strong>of</strong> bl<strong>in</strong>dness due to vitam<strong>in</strong> A deficiency<br />
envisages distribution <strong>of</strong> massive dose vitam<strong>in</strong> A to all the <strong>children</strong> aged between 9-<br />
59 months, every 6 months. It was observed that about 78% <strong>of</strong> <strong>children</strong> between 9-<br />
17 months and 85% to 90% <strong>children</strong> between 18-59 months received at least one<br />
dose vitam<strong>in</strong> A dur<strong>in</strong>g previous one <strong>year</strong>. Only about 73% <strong>of</strong> 18-59 months <strong>children</strong><br />
received the suggested two doses dur<strong>in</strong>g the preced<strong>in</strong>g one <strong>year</strong>, with lower<br />
coverage <strong>in</strong> 18-35 months group (65.7%), compared to 36-59 months group (82.5%).<br />
The coverage <strong>of</strong> <strong>children</strong> for iron-folic acid supplementation was about 46%, while<br />
negligible proportion <strong>of</strong> <strong>children</strong> (1.8%) received ≥ 90 tablets and about 1%<br />
consumed ≥ 90 tablets which <strong>in</strong>dicates weak education component. There is a need<br />
to strengthen the service delivery and monitor<strong>in</strong>g mechanisms for these<br />
programmes.<br />
The common morbidities such as ARI, fever and diarrhoea were reported by the<br />
mothers. The prevalence <strong>of</strong> fever and diarrhoea was lower among <strong>children</strong> between<br />
24 to 47 months group, while the ARI was lower <strong>in</strong> 0-5 months group. The plausible<br />
reasons for this could be due to the prevail<strong>in</strong>g undesirable <strong>in</strong>fant and young child<br />
feed<strong>in</strong>g practices coupled with non-receipt <strong>of</strong> appropriate health care management.<br />
Consumption <strong>of</strong> adequately (≥15 ppm) Iodised salt is very high <strong>in</strong> the district<br />
94%, compared to National figure (51%) and for the State (36%) (NFHS-3).<br />
<strong>Nutritional</strong> status <strong>of</strong> <strong>in</strong>fants and young <strong>children</strong> is not only a vital health issue, but it is<br />
also central to susta<strong>in</strong>able growth and development <strong>of</strong> the child 22 .In the present<br />
study, the prevalence <strong>of</strong> <strong>under</strong>weight, stunt<strong>in</strong>g and wast<strong>in</strong>g was 43%, 38% and 21%<br />
respectively. It was observed that the nutritional status <strong>of</strong> <strong>children</strong> deteriorated as<br />
age advances especially from six months onwards. The current prevalence <strong>of</strong><br />
<strong>under</strong>nutrition, <strong>in</strong> all its three forms <strong>in</strong> the district was lower, when compared to the<br />
reported for the State <strong>of</strong> Madhya Pradesh by NFHS-3 (2007) and NNMB (2006).<br />
Probably, Attention has to be given towards factors such as, early <strong>in</strong>itiation <strong>of</strong> breast<br />
feed<strong>in</strong>g, <strong>in</strong>itiation <strong>of</strong> complementary foods at an appropriate age, energy and nutrient<br />
density <strong>of</strong> the complementary foods given, the frequency and variety <strong>of</strong> foods<br />
<strong>of</strong>fered, hygiene aspects <strong>of</strong> food preparation, personal hygiene, the amount <strong>of</strong> breast<br />
milk consumed at different stages <strong>of</strong> complementary feed<strong>in</strong>g, the frequency <strong>of</strong><br />
breastfeed<strong>in</strong>g and <strong>in</strong>appropriate complementary feed<strong>in</strong>g dur<strong>in</strong>g and after illness, to<br />
br<strong>in</strong>g down the prevalence <strong>of</strong> <strong>under</strong>nutrition further <strong>in</strong> the district.<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
The 21% <strong>of</strong> global deaths and DALYs (disability adjusted life <strong>year</strong>s) <strong>in</strong> <strong>children</strong><br />
younger than 5 <strong>year</strong>s old are attributed to stunt<strong>in</strong>g, severe wast<strong>in</strong>g and <strong>in</strong>trauter<strong>in</strong>e<br />
growth retardation. Long term consequences <strong>of</strong> <strong>under</strong>nutrition dur<strong>in</strong>g the early<br />
stages <strong>of</strong> child growth and development <strong>in</strong>clude, likelihood <strong>of</strong> short stature <strong>in</strong> adult<br />
life, low educational achievements, giv<strong>in</strong>g birth to smaller <strong>children</strong>, lower economic<br />
status and reduced physical work capacity and productivity <strong>in</strong> adulthood 17 . The study<br />
revealed significant association between nutritional status and different socioeconomic<br />
variables, which <strong>in</strong>dicate higher rates <strong>of</strong> <strong>under</strong>nutrition <strong>in</strong> the households,<br />
where labour was the ma<strong>in</strong> occupation <strong>of</strong> the parents, with kutcha and semi-pucca<br />
type <strong>of</strong> house <strong>in</strong> nature, other than tap/tube well as source <strong>of</strong> dr<strong>in</strong>k<strong>in</strong>g purpose and<br />
presence <strong>of</strong> morbidity among <strong>children</strong> dur<strong>in</strong>g preced<strong>in</strong>g fifteen days. Promotion <strong>of</strong><br />
better <strong>in</strong>fant and young child feed<strong>in</strong>g and health care practices is needed for<br />
improv<strong>in</strong>g the health and nutritional status <strong>of</strong> young <strong>children</strong>.<br />
Last but not the least, there is a need to augment the programmes for <strong>in</strong>come<br />
generation to enhance household food and nutrition security.<br />
- o0o -<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
REFERENCES<br />
1. de Onis M, Blossner M, Borghi E, Frongillo EA, Morris R. Estimates <strong>of</strong> global<br />
prevalence <strong>of</strong> childhood <strong>under</strong>weight <strong>in</strong> 1990 and 2015. JAMA 2004;<br />
291:2600-6.<br />
2. Black,RE, Allen LH, Bhutta ZA etal. Meternal and child <strong>under</strong>nutrition: global<br />
and regional exposures and health consequencies. Lancet 2008; 371: 243-260<br />
3. Jones G, Steketee RW, Black RE etal. How many child deaths can we prevent<br />
this <strong>year</strong> Lancet 2003; 362: 65-71.<br />
4. Edmond KM, Zandoh C, Quigley MA etal. Delayed breast feed<strong>in</strong>g <strong>in</strong>itiation<br />
<strong>in</strong>creases risk <strong>of</strong> neonatal mortality. Pediatrics 2006; 117: e380-e386.<br />
5. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Ritcher L and Sachdev HS.<br />
Maternal and child <strong>under</strong>nutrition: Consequences for adult health and human<br />
capital. The Lancet 2008; 371:340-57.<br />
6. Barker DJP, Osmond C, Forsen TJ, Kajantie E, Eriksson JG. Trajectories <strong>of</strong><br />
growth among <strong>children</strong>who have coronary Events as Adults. N Eng J Med<br />
2005; 353:1802-9<br />
7. Satyanarayana K., Naidu AN., Chatterjee B., Rao BSN. Body size and work<br />
output. Am. J. Cl<strong>in</strong>. Nutr. 1977; 30:322-325.<br />
8. National Nutrition Monitor<strong>in</strong>g Bureau: Report <strong>of</strong> Second Repeat Survey –<br />
<strong>Rural</strong>. NNMB Tech. Rep. No. 18, 1999.<br />
9. National Nutrition Monitor<strong>in</strong>g Bureau. Diet and nutritional status <strong>of</strong> rural<br />
population. NNMB Tech. Rep. No.24, National Institute <strong>of</strong> Nutrition (ICMR),<br />
Hyderabad, 2006<br />
10. National Family Health Survey 2005-06.<br />
11. M<strong>in</strong>istry <strong>of</strong> Human Resource Development, Government <strong>of</strong> India, National<br />
Nutrition Policy, New Delhi: Department <strong>of</strong> Women and Child Development,<br />
1993.National Plan <strong>of</strong> action<br />
12. M<strong>in</strong>istry <strong>of</strong> Human Resource Development, Government <strong>of</strong> India, National Plan<br />
<strong>of</strong> Action on Nutrition, New Delhi: Food and Nutrition Board, Department <strong>of</strong><br />
Women and Child Development, 1995.<br />
13. Jelliffee D.B. <strong>Assessment</strong> <strong>of</strong> nutritional status <strong>of</strong> community. WHO Monograph<br />
series No.53, 1966.<br />
14. World Health Organization. Measur<strong>in</strong>g change <strong>in</strong> nutritional status, WHO,<br />
Geneva, 1983.<br />
15. WHO Multicentre Growth Reference Study Group. WHO Child Growth<br />
Standards based on length/height, weight and age. Acta Paediatr Suppl 2006;<br />
450:76-85.<br />
16. www.who<strong>in</strong>dia.org/EIP/policy/population...<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
17. Black RE, L<strong>in</strong>dsay HA, Bhutta ZA, Caulfield LE, Mercedes de Onis, Majid<br />
Ezzati, Col<strong>in</strong> Mathers, Juan Rivera. Meternal and child <strong>under</strong> nutrition: Global<br />
and regional exposures and health consequences. Maternal and child <strong>under</strong><br />
nutrition study group. The Lancet, 2008; 371:340-357.<br />
18. American Academy <strong>of</strong> Paediatrics. Breast-feed<strong>in</strong>g and the use <strong>of</strong> Human milk<br />
American Academy <strong>of</strong> Paediatrics, Work Group on Breastfeed<strong>in</strong>g. Pediatr<br />
1997; 100:1035-1039.<br />
19. Academy <strong>of</strong> educational development. Recommended feed<strong>in</strong>g and dietary<br />
practices to improve <strong>in</strong>fant and maternal nutrition. L<strong>in</strong>kages – Improv<strong>in</strong>g<br />
nutrition and reproductive health. 1999.<br />
20. The optimal duration <strong>of</strong> exclusive breast-feed<strong>in</strong>g. Report <strong>of</strong> an Expert<br />
Consultation, WHO, Geneva, 2001.<br />
21. UNICEF. Breast feed<strong>in</strong>g facts <strong>of</strong> life. UNICEF (1993a).<br />
22. Dewey KG, He<strong>in</strong>ig MJ, Nommsen LA, Lonnerdal B. Adequacy <strong>of</strong> energy <strong>in</strong>take<br />
among breast-fed <strong>in</strong>fants <strong>in</strong> the DARLING study: relationship to growth<br />
velocity, morbidity and activity levels. Davis Area Research on Lactation, Infant<br />
Nutrition and Growth. J Pediatr.1991; 119:538-47.<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
TABLES
Table - 1<br />
Particulars <strong>of</strong> Coverage<br />
Particulars<br />
Coverage (n)<br />
Socio-economic particulars (HHs) 395<br />
Under 5 <strong>year</strong> <strong>children</strong> for anthropometry<br />
454<br />
(Boys: 232; Girls: 222)<br />
Children below 12 months 122<br />
Children 12-35 months 212<br />
Children 36-59 months 120<br />
Spot test<strong>in</strong>g <strong>of</strong> HHs salt for iod<strong>in</strong>e 395<br />
Infant & young child Feed<strong>in</strong>g Practices<br />
Mothers with
Table - 2<br />
Socio-economic Pr<strong>of</strong>ile <strong>of</strong> the Households <strong>of</strong> Index <strong>children</strong><br />
Community<br />
Type <strong>of</strong> Family<br />
Family Size<br />
Particulars<br />
Percent<br />
n 395<br />
Scheduled Tribe 55.3<br />
Scheduled Caste 7.3<br />
Backward Community 30.1<br />
Others 7.3<br />
Nuclear 48.1<br />
Extended Nuclear 14.7<br />
Jo<strong>in</strong>t 37.2<br />
1 -4 32.7<br />
5 – 9 58.2<br />
10 9.1<br />
Average Family Size 6.0<br />
Literacy status <strong>of</strong> Father<br />
Literacy status <strong>of</strong> Mother<br />
Illiterate 35.5<br />
Read & write -<br />
1 – 5 Class 18.7<br />
6 – 7 Class 7.3<br />
8 – 10 Class 25.1<br />
Intermediate 7.6<br />
Graduate & above 5.3<br />
NA 0.5<br />
Illiterate 43.6<br />
Read & write 0.5<br />
1 – 5 Class 15.7<br />
6 – 7 Class 5.6<br />
8 – 10 Class 27.8<br />
Intermediate 4.3<br />
Graduate & above 2.5<br />
(Contd….)<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Table – 2 (Contd…)<br />
Socio-economic Pr<strong>of</strong>ile <strong>of</strong> the Households <strong>of</strong> Index <strong>children</strong><br />
Particulars<br />
Extent <strong>of</strong> HH landhold<strong>in</strong>g (Acres)<br />
Major Occupation <strong>of</strong> Father<br />
Major Occupation <strong>of</strong> Mother<br />
Per capita monthly <strong>in</strong>come (Rs)<br />
Percent<br />
n 395<br />
Nil 42.3<br />
Marg<strong>in</strong>al farmers
Table - 3<br />
Physical facilities <strong>of</strong> the Households<br />
Type <strong>of</strong> house<br />
Particulars<br />
Source <strong>of</strong> Dr<strong>in</strong>k<strong>in</strong>g Water<br />
Type <strong>of</strong> Cook<strong>in</strong>g Fuel<br />
Percent<br />
n 395<br />
Kutcha 50.9<br />
Semi Pucca 43.3<br />
Pucca 5.8<br />
Open Well 5.1<br />
Tube Well 71.6<br />
Tap 10.9<br />
Stream or River 1.5<br />
Others 10.9<br />
Firewood 94.7<br />
Kerosene 0.5<br />
Bio-gas 1.8<br />
LPG 3.0<br />
Household electricity present 92.2<br />
Sanitary Latr<strong>in</strong>e<br />
Present and <strong>in</strong> use 19.0<br />
Present and not <strong>in</strong> use 2.5<br />
Absent 78.5<br />
Separate Kitchen Present 26.6<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Table – 4<br />
Distribution (%) <strong>of</strong> HHs accord<strong>in</strong>g to use <strong>of</strong> Iodized salt and iod<strong>in</strong>e content<br />
Type <strong>of</strong> salt used<br />
Iod<strong>in</strong>e content<br />
Particulars<br />
Percent<br />
n 395<br />
Powdered salt 0.0<br />
Crystal Salt 0.3<br />
Free-flow<strong>in</strong>g 99.7<br />
0 ppm 1.5<br />
Table - 6<br />
Particulars <strong>of</strong> last pregnancy <strong>of</strong> mothers <strong>of</strong> < 6 months <strong>children</strong><br />
Particulars<br />
Percent<br />
n 54<br />
Undergone Antenatal check-up (ANC)<br />
Total number <strong>of</strong> ANCs<br />
Yes 83.3<br />
No 16.7<br />
One 9.3<br />
Two 24.0<br />
Three 46.2<br />
Four 1.9<br />
≥ five 1.9<br />
Not availed ANC 16.7<br />
Undergone First ANC at (Weeks <strong>of</strong> gestation)<br />
Place <strong>of</strong> ANC<br />
≤ 8 weeks -<br />
9- 12 weeks 27.8<br />
13- 16 weeks 42.5<br />
17-20 weeks 7.4<br />
>20 weeks 5.6<br />
Not availed ANC 16.7<br />
Home -<br />
AWC 38.8<br />
Sub-centre -<br />
PHC/CHC 9.3<br />
Taluk/Dist.hospital 14.8<br />
Private Cl<strong>in</strong>ic 20.4<br />
Not availed ANC 16.7<br />
ANC conducted by<br />
ANM/LHV 57.4<br />
Medical Officer 5.6<br />
Pvt. Doctor 20.3<br />
Not availed ANC 16.7<br />
( Contd..)<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Table – 6 (Contd…)<br />
Particulars <strong>of</strong> last pregnancy <strong>of</strong> mothers <strong>of</strong> < 6 months <strong>children</strong><br />
Particulars<br />
Components <strong>of</strong> ANC*<br />
Percent<br />
n 54<br />
Physical Exam<strong>in</strong>ation 61.1<br />
Weight Record<strong>in</strong>g 77.8<br />
Ur<strong>in</strong>e Test 48.1<br />
Haemoglob<strong>in</strong> Estimation 59.3<br />
Blood pressure measurement 63.0<br />
Health & Nutrition advise given dur<strong>in</strong>g ANC<br />
Yes 75.9<br />
No 7.4<br />
Not availed ANC 16.7<br />
If yes, what advise*<br />
To attend for regular checkups 66.7<br />
To consume more GLVs 66.7<br />
To consume more Vegetables & 63.0<br />
fruits<br />
To take IFA tablets for 100 days 75.9<br />
Others 9.3<br />
Reasons for not avail<strong>in</strong>g ANCs*<br />
Not aware <strong>of</strong> the need 9.3<br />
Loss <strong>of</strong> wages 7.4<br />
No faith 3.7<br />
No ANC held <strong>in</strong> the village 5.6<br />
Tim<strong>in</strong>gs are <strong>in</strong>convenient 3.7<br />
Place is not accessible 5.6<br />
Others 7.4<br />
TT Immunization receiv<strong>in</strong>g<br />
Yes 96.3<br />
No 3.7<br />
If yes, No. <strong>of</strong> doses<br />
One dose 7.4<br />
Two doses 88.9<br />
Not received 3.7<br />
Reasons for not receiv<strong>in</strong>g TT *<br />
Not aware <strong>of</strong> the need 3.7<br />
* Multiple responses ( Contd..)<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Table – 6 (Contd…)<br />
Particulars <strong>of</strong> last pregnancy <strong>of</strong> mothers <strong>of</strong> < 6 months <strong>children</strong><br />
Particulars<br />
Received IFA tablets<br />
IFA tablets received from<br />
No. <strong>of</strong> IFA tablets received<br />
No. <strong>of</strong> IFA tablets consumed<br />
Percent<br />
n 54<br />
Yes 94.4<br />
No 5.6<br />
ANM 40.7<br />
AWW 50.0<br />
MO-PHC 3.7<br />
Not received 5.6<br />
Table –7<br />
Particulars <strong>of</strong> last Delivery <strong>of</strong> mothers <strong>of</strong>
Table - 8<br />
Distribution (%) <strong>of</strong> < 60 months <strong>children</strong> accord<strong>in</strong>g <strong>of</strong> Birth order<br />
Birth order<br />
Percent<br />
n 454<br />
First 35.9<br />
Second 34.8<br />
Third 15.9<br />
Fourth 8.1<br />
Fifth and above 5.3<br />
Table - 9<br />
Distribution (%) <strong>of</strong> < 60 months <strong>children</strong> hav<strong>in</strong>g sibl<strong>in</strong>gs accord<strong>in</strong>g to <strong>in</strong>terval<br />
between last two births<br />
Interval between last two births(months)<br />
Percent<br />
n 291<br />
Table - 10<br />
Distribution (%) <strong>of</strong> =24 5.7<br />
Yes 94.3<br />
No 5.7<br />
Child could not suck 0.8<br />
Elders advice 1.6<br />
Others 3.3<br />
NA 94.3<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Table - 11<br />
Distribution (%) <strong>of</strong> <strong>in</strong>fants (
Table - 12<br />
Distribution (%) <strong>of</strong> 6-11 months Children accord<strong>in</strong>g to Feed<strong>in</strong>g Practices<br />
Feed<strong>in</strong>g Practices<br />
Percent<br />
n 68<br />
Foods generally <strong>in</strong>cluded <strong>in</strong> home made complementary foods*<br />
Cereals & Millets 73.5<br />
Pulses 67.6<br />
Green Leafy Vegetables 11.8<br />
Other Vegetables 16.2<br />
Roots & Tubers 16.2<br />
Fruits 35.3<br />
Milk & milk products 33.8<br />
Eggs 7.4<br />
Fats & Oils 66.2<br />
Number <strong>of</strong> complementary feeds per day<br />
1 7.4<br />
2 16.2<br />
3 41.1<br />
4 8.8<br />
5 4.4<br />
Not yet started 22.1<br />
Mode <strong>of</strong> complementary feed<strong>in</strong>g<br />
Mother with spoon 1.5<br />
Mother with hand 55.8<br />
Self with spoon 7.4<br />
Self by hand 13.2<br />
Not yet started 22.1<br />
Supervision <strong>of</strong> complementary feed<strong>in</strong>g by<br />
Mother 69.1<br />
Father 5.9<br />
Grand parents/sibl<strong>in</strong>gs 2.9<br />
Not yet started 22.1<br />
* Multiple responses<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Table - 13<br />
Distribution (%) <strong>of</strong> 12-35 months Children accord<strong>in</strong>g to Feed<strong>in</strong>g Practices<br />
Feed<strong>in</strong>g Practices<br />
Percent<br />
n 212<br />
Children solely breast fed 0.5<br />
Children currently Breast fed + complementary feed<strong>in</strong>g 65.5<br />
Weaned 34.0<br />
Age <strong>of</strong> <strong>in</strong>itiation complementary feed<strong>in</strong>g<br />
Type <strong>of</strong> food currently be<strong>in</strong>g given*<br />
=10 months 1.4<br />
Not yet started 0.5<br />
Cow/buffalo milk 68.9<br />
Formula milk 0.5<br />
Commercial baby food 3.8<br />
Home made semi-solids 90.6<br />
Home made solids 77.8<br />
Not yet started 0.5<br />
Foods generally <strong>in</strong>cluded <strong>in</strong> home made foods*<br />
Cereals & Millets 98.1<br />
Pulses & legumes 97.6<br />
Green Leafy Vegetables 78.8<br />
Other Vegetables 79.2<br />
Roots & Tubers 72.2<br />
Fruits 84.9<br />
Milk & milk products 70.3<br />
Eggs 31.1<br />
Flesh foods 20.8<br />
Fats & Oils 95.8<br />
Not yet started CF 0.5<br />
* Multiple responses ( Contd….)<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Table – 13 (Contd…)<br />
Distribution (%) <strong>of</strong> 12-35 months Children<br />
Accord<strong>in</strong>g to Feed<strong>in</strong>g (CF) Practices<br />
Feed<strong>in</strong>g Practices<br />
Number <strong>of</strong> complementary feeds per day<br />
Mode <strong>of</strong> feed<strong>in</strong>g complementary food<br />
Supervision <strong>of</strong> complementary feed<strong>in</strong>g by<br />
Percent<br />
n 212<br />
≤2 10.4<br />
3 50.9<br />
≥4 38.2<br />
Not yet started CF 0.5<br />
Mother with spoon 0.5<br />
Mother with hand 32.5<br />
Self with spoon 0.5<br />
Self by hand 66.0<br />
Not yet started CF 0.5<br />
Mother 76.9<br />
Elder Sibl<strong>in</strong>gs 4.2<br />
Grand parents 10.4<br />
Others 8.0<br />
Not yet started CF 0.5<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Table – 14<br />
Distribution (%) <strong>of</strong> mothers <strong>of</strong> 0- 59 months Children accord<strong>in</strong>g to<br />
Care <strong>of</strong> the child and personal Hygiene<br />
Particulars<br />
Care <strong>of</strong> the child when mother goes out for work<br />
Age group (months)<br />
Table – 15<br />
Prevalence (%) <strong>of</strong> the Morbidity among 0- 59 months <strong>children</strong> dur<strong>in</strong>g previous<br />
fortnight by age groups<br />
Age Group<br />
(months)<br />
n Fever Diarrhoea ARI<br />
At least one<br />
morbidity<br />
0-5 54 20.4 11.1 13.0 25.9<br />
6-11 68 19.1 23.5 22.1 42.6<br />
12-23 125 22.4 14.4 20.0 39.2<br />
24-35 87 10.3 5.7 19.5 27.6<br />
36-47 85 12.9 4.7 21.2 29.4<br />
48-59 35 25.7 8.6 20.0 31.4<br />
Pooled 454 17.8 11.5 19.6 33.5<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Table – 16<br />
Distribution (%) <strong>of</strong> mothers <strong>of</strong> 0- 59 months Children accord<strong>in</strong>g to<br />
Care <strong>of</strong> the child dur<strong>in</strong>g Sickness<br />
Particulars<br />
Personnel generally consulted dur<strong>in</strong>g illness <strong>of</strong> the child<br />
Morbidity dur<strong>in</strong>g previous fortnight<br />
Age group (months)<br />
Table - 17<br />
Participation (%) <strong>in</strong> ICDS supplementation programme<br />
(6- 59 months <strong>children</strong>)<br />
Particulars<br />
Age group (months)<br />
6-35 36-59 6-59<br />
n 280 120 400<br />
Participat<strong>in</strong>g 84.3 95.0 87.5<br />
Regular 70.4 85.8 75.0<br />
Irregular 13.9 9.2 12.5<br />
Not participat<strong>in</strong>g 15.7 5.0 12.5<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Table -18<br />
Distribution (%) <strong>of</strong> 12- 24 months <strong>children</strong> accord<strong>in</strong>g to Coverage for<br />
Immunization <strong>under</strong> UIP<br />
Immunization Particulars<br />
Percent<br />
n 125<br />
Received all vacc<strong>in</strong>es ( Fully Immunized) 97.6<br />
Partially immunized 1.6<br />
Do not know 0.8<br />
Reasons for no / <strong>in</strong>complete immunization<br />
BCG 99.2<br />
DPT1 97.6<br />
DPT2 97.6<br />
DPT3 97.6<br />
OPV1 99.2<br />
OPV2 99.2<br />
OPV3 99.2<br />
Measles 98.4<br />
Time or place not known or <strong>in</strong>convenient 0.8<br />
Source <strong>of</strong> <strong>in</strong>formation<br />
Not <strong>of</strong>fered 0.8<br />
NA 98.4<br />
Mother & child protection card 3.2<br />
Parents 95.2<br />
Others 1.6<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Table - 19<br />
Distribution (%) <strong>of</strong> 9- 59 months Children Accord<strong>in</strong>g to receipt <strong>of</strong> massive<br />
dose vitam<strong>in</strong> A dur<strong>in</strong>g previous one <strong>year</strong><br />
Particulars<br />
Receipt <strong>of</strong> massive dose vitam<strong>in</strong> A<br />
Age group (months)<br />
9-17 18-35 36-59 9-59<br />
n 110 143 120 373<br />
Yes 78.2 89.5 85.8 85.0<br />
No 16.3 4.9 4.2 8.1<br />
Do not remember 5.4 5.6 10.0 7.0<br />
No. doses vitam<strong>in</strong> A<br />
Place <strong>of</strong> adm<strong>in</strong>istration<br />
One 78.2 23.8 3.3 33.3<br />
Two 0.0 65.7 82.5 51.7<br />
Not received 16.3 4.9 4.2 8.1<br />
Do not remember 5.4 5.6 10.0 7.0<br />
Home 0.0 0.0 0.8 0.3<br />
AWC 75.5 87.4 84.2 82.9<br />
SC 2.7 2.1 0.8 1.9<br />
Not received/do not remember 21.8 10.5 14.2 15.0<br />
Massive dose vitam<strong>in</strong> A adm<strong>in</strong>istered by<br />
AWW 16.4 28.7 33.3 26.5<br />
ANM 61.9 60.8 52.5 58.4<br />
LHV 0.0 0.0 0.0 0.0<br />
Not received/do not remember 21.8 10.5 14.2 15.0<br />
Reasons for not receiv<strong>in</strong>g/<strong>in</strong>complete massive dose vitam<strong>in</strong> A<br />
Unaware <strong>of</strong> need 5.4 1.4 0.0 2.1<br />
Not <strong>of</strong>fered 10.1 24.5 6.7 14.5<br />
Time or place not convenient 0.9 1.4 0.8 1.1<br />
Mothers was busy 0.0 1.4 0.0 0.5<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
Table - 20<br />
Distribution (%) <strong>of</strong> 12-59 months Children accord<strong>in</strong>g<br />
to receipt <strong>of</strong> Iron & folic acid tablets<br />
Particulars<br />
Received IFA tablets<br />
IFA tablets received from<br />
Number <strong>of</strong> IFA tablets received<br />
No. <strong>of</strong> IFA tablets consumed<br />
Age group (months)<br />
12-35 36-59 12-59<br />
n 212 120 332<br />
Yes 42.9 50.8 45.8<br />
No 57.1 49.2 54.2<br />
ANM 18.4 16.7 17.8<br />
AWW 24.5 33.3 27.7<br />
Private Doctor - 0.8 0.3<br />
Not received 57.1 49.2 54.2<br />
Table - 21<br />
Prevalence (%) <strong>of</strong> nutritional deficiency signs among 0 - 59 months <strong>children</strong><br />
Cl<strong>in</strong>ical signs<br />
Age groups (Months)<br />
0-11 12-35 36-59 0-59<br />
No <strong>of</strong> <strong>children</strong> exam<strong>in</strong>ed 122 212 120 454<br />
NAD 100.0 99.0 95.0 98.3<br />
Emaciation 0.0 0.5 0.0 0.2<br />
Angular stomatitis 0.0 0.0 0.8 0.2<br />
Dental caries 0.0 0.5 4.2 1.3<br />
NAD: No Abnormality Detected<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
n<br />
Table -22<br />
Mean Height and weight <strong>of</strong> 0-59 months Children by age group and gender<br />
BOYS<br />
GIRLS<br />
Age<br />
Height (cm) Weight (kg) n Height (cm) Weight (kg)<br />
(Months)<br />
Mean ± SD Mean ± SD Mean ± SD Mean ± SD<br />
2 49.0 0.71 3.3 0.35
Table - 23<br />
Distribution (%) <strong>of</strong> 0-59 months Children accord<strong>in</strong>g to nutritional status by<br />
SD Classification: By Age group<br />
Age<br />
Group<br />
(months)<br />
n<br />
Severe<br />
(
Table -24<br />
Distribution (%) <strong>of</strong> 0- 59 months Children accord<strong>in</strong>g to nutritional status by<br />
SD Classification*: By Gender<br />
<strong>Nutritional</strong> <strong>Status</strong><br />
Gender<br />
n<br />
Table -25<br />
Distribution (%) <strong>of</strong> 0- 59 months Children by <strong>Nutritional</strong> status accord<strong>in</strong>g to SD<br />
Classification: By Socio-demographic variables<br />
Particulars<br />
1. Community<br />
n<br />
Weight for age Height for age Weight for height<br />
Table -25 (Contd...)<br />
Distribution (%) <strong>of</strong> 0- 59 months Children by <strong>Nutritional</strong> status accord<strong>in</strong>g to SD<br />
Classification: By Socio-demographic variables<br />
Particulars<br />
n<br />
Weight for age Height for age Weight for height<br />
Table – 25 (Contd…)<br />
Distribution (%) <strong>of</strong> 0- 59 months Children by <strong>Nutritional</strong> status accord<strong>in</strong>g to<br />
SD Classification: By Socio-demographic variables<br />
Particulars<br />
n<br />
Weight for age Height for age Weight for height<br />