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: BHOPAL<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 />
- Bhopal 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 – 4<br />
1.1 Pr<strong>of</strong>ile <strong>of</strong> Bhopal 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 4<br />
3.1.3 Selection <strong>of</strong> Households 5<br />
3.2 Investigations 5<br />
3.2.1 Household demographic and socioeconomic 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 – 19<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 />
1.<br />
2.<br />
3.<br />
4.<br />
5.<br />
6.<br />
7.<br />
Name<br />
Mr. ARUN KUMAR SHARMA<br />
Mr. MUKESH KUMAR REKHWAL<br />
Mr. AVINASH RAI<br />
Mr. KUNDAN MISHRA<br />
Mr.SACHIN PAREY<br />
Mr. NIMESH KUMAR<br />
Mr. SEVAKRAM GORE<br />
FIELD INVESTIGATORS<br />
Sl.No.<br />
1.<br />
2.<br />
3.<br />
Name<br />
Mr. DONGAR KUMAR VERMA<br />
Ms. ASHMA JAHAN<br />
Mr.OMPRAKASH NATH<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) 18,36,784<br />
Sex Ratio 896<br />
Population density (per sq km) 663<br />
Percent <strong>of</strong> Schedule caste 14.0<br />
Percent <strong>of</strong> Schedule Tribes 3.3<br />
Literacy status (%) 75.1<br />
Female literacy (%) 66.7<br />
SAMPLE CHARACTERISTICS<br />
HHs surveyed (n) 396<br />
Average Family size (n) 5.9<br />
Average per capita monthly <strong>in</strong>come (Rs) 1176<br />
COMMUNITY (%)<br />
Scheduled Caste 25.5<br />
Scheduled Tribe 9.3<br />
TYPE OF FAMILY (%)<br />
Nuclear 52.0<br />
Extended Nuclear 19.2<br />
Jo<strong>in</strong>t 28.8<br />
LITERACY STATUS (%)<br />
Father 79.3<br />
Mother 59.3<br />
LAND HOLDING (% HHs)<br />
Land less Families 51.8<br />
Marg<strong>in</strong>al Farmers 9.8<br />
Small Farmers 12.6<br />
Large Farmers 25.8<br />
(Contd… 2)<br />
.<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong> < 5 <strong>year</strong> Children Bhopal Dt. - Madhya Pradesh
RESULTS AT A GLANCE (Contd…2)<br />
MAJOR OCCUPATION OF HOUSEHOLD<br />
Percent<br />
Labourers 57.1<br />
Cultivators 25.7<br />
Land Lords -<br />
Artisans -<br />
Service 9.6<br />
Bus<strong>in</strong>ess 6.1<br />
TYPE OF HOUSE<br />
Kutcha 22.0<br />
Semi-Pucca 68.4<br />
Pucca 9.6<br />
SOURCE OF DRINKING WATER<br />
Open well 2.5<br />
Tube well 90.4<br />
Tap 2.3<br />
HOUSEHOLD ELECTRICITY 91.4<br />
PRESENT AND USING SANITARY LATRINE 21.2<br />
IODINE CONTENT OF COOKING SALT<br />
0 ppm 7.6<br />
DELIVERY CONDUCTED BY<br />
RESULTS AT A GLANCE (Contd…3)<br />
BREAST FEEDING AND COMPLEMENTARY FEEDING<br />
Percent<br />
M.O. PHC 53.2<br />
TBA/ANM/LHV 18.0<br />
Pvt. Doctor 10.8<br />
Untra<strong>in</strong>ed Dai/Others 17.1<br />
Low birth weight (% <strong>in</strong>fants) 4.8<br />
Initiate <strong>of</strong> Breast feed<strong>in</strong>g (hours)<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 (
had done their ANC registration early i.e., < 16 weeks <strong>of</strong> gestation. About 76% <strong>of</strong> the<br />
pregnant women received IFA tablets dur<strong>in</strong>g pregnancy, <strong>of</strong> which 39% received ≥90<br />
tablets and about 24% reported that they consumed ≥90 tablets. About 79% <strong>of</strong><br />
deliveries were <strong>in</strong>stitutional took place either <strong>in</strong> govt (69.4%) or private (9.9%)<br />
hospitals. About 64% <strong>of</strong> deliveries were conducted either by a Medical <strong>of</strong>ficer, PHC<br />
(53.2%) or doctors at private hospitals (10.8%). Birth weight was recorded <strong>in</strong> about<br />
71% <strong>of</strong> <strong>in</strong>fants, while records were available for about 38% <strong>of</strong> <strong>in</strong>fants. As per the<br />
records, about 5% <strong>of</strong> new born babies had birth weight <strong>of</strong>
to 3.6%) among 24-59 months <strong>children</strong>, while the prevalence <strong>of</strong> ARI was higher<br />
among <strong>children</strong> aged 12-23 months. The prevalence <strong>of</strong> fever was lower (9.5%) among<br />
<strong>children</strong> aged 36-47 months. About 72% <strong>of</strong> the mothers <strong>in</strong> general, reported that they<br />
consult private practitioner, while 28% went to PHC, when 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> Bhopal district <strong>of</strong> Madhya Pradesh<br />
State 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> Bhopal District<br />
Bhopal district is a district <strong>of</strong> Madhya Pradesh state <strong>in</strong> central India. The city<br />
<strong>of</strong> Bhopal serves as its adm<strong>in</strong>istrative headquarters. Bhopal district is bounded by<br />
the district <strong>of</strong> Guna to the north, Vidisha to the northeast, Raisen to the east and<br />
southeast, Sehore to the southwest and west and Rajgarh to the northwest. As <strong>of</strong><br />
the census taken <strong>in</strong> 2001, the district has a total population <strong>of</strong> 18, 36,784 people.<br />
The Total area <strong>of</strong> District is 2772 Sq.km, with a population density <strong>of</strong> 663/sq.km. The<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
district has a Sex Ratio <strong>of</strong> 896. Bhopal has an average literacy rate <strong>of</strong> 75.1%, higher<br />
than the national average <strong>of</strong> 59.5%; with 82.6% <strong>of</strong> the males and 66.7% <strong>of</strong> females<br />
were literate.<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>
3.1.3 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>
3.2.4 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>
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> 396 households from 20 villages were covered for the present study<br />
(Table 1). A total <strong>of</strong> 463 <strong>children</strong> (Boys:249; Girls:214)
4.2.2 Type <strong>of</strong> family<br />
Fifty two percent <strong>of</strong> the households were nuclear families, while jo<strong>in</strong>t and<br />
extended nuclear families accounted for 29% and 19% respectively.<br />
4.2.3 Family size<br />
The average family size was 5.9. About 36% <strong>of</strong> the HHs had family size <strong>of</strong> 1-4<br />
members, 55% <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 79% <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, 5% had school<strong>in</strong>g <strong>of</strong> 6 th -7 th class, 43% studied up<br />
to 8 th -10 th class, 7% 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 59% <strong>of</strong> the mothers <strong>of</strong> the <strong>in</strong>dex <strong>children</strong> were literates. About 29% <strong>of</strong><br />
them had an education level <strong>of</strong> 1-5 th class, 4% studied up to 6 th -7 th class, 22% had<br />
school<strong>in</strong>g <strong>of</strong> 8 th -10 th class, 3% studied upto <strong>in</strong>termediate, while 2% were educated<br />
upto graduation or above.<br />
4.2.6 Household landhold<strong>in</strong>g<br />
About 52% <strong>of</strong> households did not posses any agricultural land. About 10%<br />
were marg<strong>in</strong>al farmers (
4.3 Household Physical facilities<br />
4.3.1 Type <strong>of</strong> house<br />
About 68% <strong>of</strong> the houses were semi-pucca <strong>in</strong> nature, while 22% were kutcha<br />
and 10% 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 (90.4%), followed by<br />
open well (2.5%) and tap (2.3%). Majority (93.9%) <strong>of</strong> HHs were us<strong>in</strong>g firewood, while<br />
6% were us<strong>in</strong>g LPG for cook<strong>in</strong>g. About 91% <strong>of</strong> the houses were electrified. About<br />
one fifth (21.2%) <strong>of</strong> the HHs were us<strong>in</strong>g sanitary latr<strong>in</strong>e. About 59% <strong>of</strong> the HHs had<br />
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 />
(92.2%) were us<strong>in</strong>g free flow<strong>in</strong>g salt. About 91% <strong>of</strong> HHs were us<strong>in</strong>g adequately<br />
iodized (≥15 ppm) salt, 1% samples had
for not avail<strong>in</strong>g ANCs were ‘not aware <strong>of</strong> the need’ (18.2%), ‘loss <strong>of</strong> wage’s’ (6.1%), and<br />
‘ANCs not held <strong>in</strong> the village’, ‘place is not accessible’, ‘no faith’ and ‘tim<strong>in</strong>gs are<br />
<strong>in</strong>convenient’ (3% each).<br />
About 76% <strong>of</strong> pregnant women received IFA tablets, mostly from AWW (45.4%) or<br />
ANM (15.2%). About 39% received ≥90 tablets, while 24% consumed ≥ 90 tablets<br />
dur<strong>in</strong>g the pregnancy. Nearly 91% <strong>of</strong> the mothers reportedly received TT immunization.<br />
About 79% received two doses <strong>of</strong> TT, while 12% 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’ (9.1%) and ‘No faith’ / fear <strong>of</strong><br />
gett<strong>in</strong>g pa<strong>in</strong> (3% each).<br />
4.5.3 Particulars <strong>of</strong> last Delivery (Mothers hav<strong>in</strong>g
(Fig.1). About 95% percent <strong>of</strong> the mothers <strong>in</strong>terviewed reportedly fed colostrum to<br />
the newborn.<br />
0-5 month <strong>in</strong>fants<br />
About 52% <strong>of</strong> the <strong>in</strong>fants, below 6 months were solely breastfed, while about<br />
39% received water <strong>in</strong> addition to breast milk and 9% 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 />
None <strong>of</strong> the <strong>in</strong>fants aged 6-11 months were solely breast fed. About 14%<br />
received water <strong>in</strong> addition to breast milk, while 86% 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 (100.0%), about 8% 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 (85.9%), the complementary feed<strong>in</strong>g was <strong>in</strong>itiated at<br />
6 months <strong>of</strong> age <strong>in</strong> about 74% <strong>of</strong> <strong>in</strong>fants, while 8% received after 6 months <strong>of</strong> age<br />
(Fig. 2). The commonly used complementary foods <strong>in</strong>cluded home made semisolids<br />
(78.2%), followed by cow/buffalo milk (73.1%) and home made solids (67.9%),<br />
(Table 11).<br />
The foods generally <strong>in</strong>cluded <strong>in</strong> the complementary feeds were cereals &<br />
millets (85.9%), pulses (79.5%), fats & oils (74.4%), milk & milk products (70.5%),<br />
fruits (57.7%), other vegetables & Green leafy Vegetables (44.9% each) and roots &<br />
tubers (50%). About 63% <strong>of</strong> the <strong>children</strong> received at least 3 complementary feeds per<br />
day, while 23% received 2 feeds a day. About 77% <strong>of</strong> mothers fed the <strong>in</strong>fants with<br />
their hand, while 4% mothers used spoon to feed the child. In about 4% <strong>of</strong> cases, the<br />
<strong>in</strong>fants consumed foods themselves with their hands. The feed<strong>in</strong>g was supervised<br />
mostly by the mother (85.9%) (Table 12).<br />
4.6.2.2 12-35 month <strong>children</strong><br />
About 60% <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 40% were completely weaned. The type <strong>of</strong> food be<strong>in</strong>g currently<br />
given <strong>in</strong>cluded home made semi solids (97.5%), home made solids (93.7%) and<br />
cow/buffalo milk (85.8%). The most commonly used food groups <strong>in</strong>cluded, cereals &<br />
millets (99.5%), pulses (98.5%), fats & oils (97.1%), fruits (88.7%), other vegetables<br />
(87.7%), milk & milk products (85.8%), GLV and roots & tubers (83.3% each), eggs<br />
(26.5%) and flesh foods (18.1%). About 35% <strong>of</strong> the <strong>children</strong> were fed ≥ 4 times a<br />
day, 56% were fed 3 times a day, while 9% were fed ≤ 2 times a day. About 59% <strong>of</strong><br />
the <strong>children</strong> consumed food themselves with their hands, while 40% were fed by<br />
their mothers by hand. In most <strong>of</strong> the cases, feed<strong>in</strong>g was supervised by their<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
%<br />
70<br />
60<br />
50<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 />
61.3<br />
40<br />
30<br />
20<br />
10<br />
0<br />
17.1<br />
11.7<br />
9<br />
0.9<br />
=24 Hrs<br />
70<br />
60<br />
Fig.2 Distribution (%) <strong>of</strong> 6-11 months Children accord<strong>in</strong>g to Age <strong>of</strong><br />
Initiation <strong>of</strong> Complementary Feed<strong>in</strong>g<br />
%<br />
74.3<br />
50<br />
40<br />
30<br />
20<br />
10<br />
3.9<br />
7.7<br />
14.1<br />
0<br />
mothers (91.7%), followed by elder sibl<strong>in</strong>gs (3.4%) and ground parents (0.5%)<br />
(Table 13).<br />
4.6.3 Care <strong>of</strong> the Child<br />
About 10% <strong>of</strong> the mothers carried their <strong>children</strong> to the work-spot. While 14%<br />
stated that they were cared either by their older sibl<strong>in</strong>gs (7.3%) or by their <strong>in</strong>-laws<br />
(6.3%) (Table 14).<br />
4.6.4 Personal Hygiene<br />
About 11% <strong>of</strong> mothers washed their hands with soap before feed<strong>in</strong>g the child.<br />
The soap was used by 55% <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 (97.4%) <strong>of</strong> the <strong>children</strong> were fully immunized and only<br />
about 3% were partially immunized. About 98-100% 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 (89.7%), followed by AWW record (7.7%) and mother & child<br />
protection card (1.7%) The major reasons for not immunized or partially immunized<br />
are ‘not <strong>of</strong>fered’ (1.7%) and ‘time/place not known/<strong>in</strong>convenient’ (0.9%).<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 92% <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 80% among 9-17 months and 95% among<br />
18-59 months <strong>children</strong>. About 39% <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 56% 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 />
(89.9%), mostly either by ANM (63.1%) or AWW (28.6%). 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’ (46.3%), ‘mother was busy’<br />
(2.1%) and ‘time and place not convenient’ (0.5%).<br />
4.6.9 Coverage for Iron and Folic acid tablets Supplementation<br />
About 14% <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 (9.4%) or ANM (4.5%). Only 2.3% received ≥<br />
90 IFA tablets, while 2% consumed ≥ 90 tablets (Table 20).<br />
4.7 <strong>Nutritional</strong> status <strong>of</strong> <strong>children</strong> (
Fig. 3 Coverage (%) <strong>of</strong> 12-24 months Children for Immunization <strong>under</strong><br />
Universal Immunization Program (UIP)<br />
%<br />
100<br />
90<br />
98.3 98.3 98.3<br />
98.3 100 100 100 98.3<br />
97.4<br />
80<br />
70<br />
60<br />
50<br />
40<br />
30<br />
20<br />
10<br />
0<br />
BCG DPT1 DPT2 DPT3 OPV1 OPV2 OPV3 Measles Full Imm. Partial<br />
Imm.<br />
2.6<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 />
12<br />
Wt (Kgs)<br />
8<br />
4<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 />
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 />
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 />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
9<br />
10<br />
Age (Months)<br />
11<br />
12-17<br />
18-23<br />
24-29<br />
30-35<br />
36-41<br />
42-47<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
differences observed <strong>in</strong> the prevalence <strong>of</strong> <strong>under</strong>weight, stunt<strong>in</strong>g and wast<strong>in</strong>g were<br />
not statistically significant.<br />
Literacy status <strong>of</strong> father<br />
The literacy statue <strong>of</strong> the father was found to be significantly associated with<br />
<strong>under</strong>weight and stunt<strong>in</strong>g status <strong>of</strong> their <strong>children</strong>. The prevalence <strong>of</strong> <strong>under</strong>weight and<br />
stunt<strong>in</strong>g was significantly (p
Fig.11 Prevalence (%) <strong>of</strong> Undernutrition among
Fig.13 Prevalence (%) <strong>of</strong> Undernutrition among
higher (71.4% and 64.3% respectively) than those who were cultivators (50% each)<br />
or housewife’s (51.5% and 43.2% respectively) The prevalence <strong>of</strong> wast<strong>in</strong>g was<br />
significantly (P
Fig.15 Prevalence (%) <strong>of</strong> Undernutrition ` among
among <strong>children</strong> from HHs us<strong>in</strong>g firewood (56.4%)as compared to those HHs us<strong>in</strong>g<br />
other fuel for cook<strong>in</strong>g (46.7%)<br />
Electrification<br />
The prevalence <strong>of</strong> <strong>under</strong>weight and stunt<strong>in</strong>g was relatively higher among<br />
<strong>children</strong> from HHs hav<strong>in</strong>g electricity (56.4% and 48.1% respectively), compared to<br />
those HHs not hav<strong>in</strong>g electricity (48.7% and 43.6% respectively), while on the other<br />
hand the prevalence <strong>of</strong> wast<strong>in</strong>g was higher among <strong>children</strong> from HHs do not have<br />
electricity (30.8%) than HHs with electricity 24.1%) However, the differences<br />
observed <strong>in</strong> the prevalence <strong>of</strong> <strong>under</strong>weight, stunt<strong>in</strong>g and wast<strong>in</strong>g were not<br />
statistically 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 (48%, 39.4%<br />
and 22% respectively), compared to those not us<strong>in</strong>g or not hav<strong>in</strong>g sanitary latr<strong>in</strong>es<br />
(57.9% , 50.1% and 25.3% respectively), however, the differences observed <strong>in</strong> the<br />
prevalence <strong>of</strong> wast<strong>in</strong>g was marg<strong>in</strong>al when compared to <strong>under</strong>weight and stunt<strong>in</strong>g.<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 />
(53.2%; 44.3% and 23.4% respectively), compared to those who do not have<br />
separate kitchen (59.7%, 53.0% and 26.5% 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 and wast<strong>in</strong>g was marg<strong>in</strong>ally higher (49.4% and<br />
27.6% respectively) among <strong>children</strong> with history <strong>of</strong> morbidity (such as fever, diarrhoea,<br />
respiratory <strong>in</strong>fections etc) <strong>in</strong> the preced<strong>in</strong>g fortnight , compared to those <strong>children</strong> with<br />
no history <strong>of</strong> morbidity (46.8% and 22.9% respectively), while the prevalence <strong>of</strong><br />
<strong>under</strong>weight was comparable between groups (56% each).<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
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 82% <strong>of</strong> pregnant women had <strong>under</strong>gone antenatal check-up and 91%<br />
received TT immunization <strong>in</strong> the Bhopal 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 Bhopal district, about 79%<br />
deliveries took place either <strong>in</strong> PHC/ Government (69.4%) or Private hospitals<br />
(9.9%).Sixty four percent <strong>of</strong> deliveries were conducted by medical doctors, while<br />
18% were conducted by tra<strong>in</strong>ed personnel, like TBA / ANM / LHV. This f<strong>in</strong>d<strong>in</strong>g is<br />
encourag<strong>in</strong>g and such practices to be strengthened further.<br />
Even though birth weights were recorded <strong>in</strong> about 71% <strong>of</strong> the newborns, but the<br />
records were available for 38% <strong>of</strong> them only. As per the records, about 5% <strong>of</strong> the<br />
new born babies had birth weight <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 17% <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. Though, this figure is comparable to that reported by the NFHS-3 for<br />
the State (16%), <strong>in</strong>dicates the need for educat<strong>in</strong>g, the mothers for <strong>in</strong>itiation <strong>of</strong><br />
breastfeed<strong>in</strong>g with<strong>in</strong> an hour <strong>of</strong> delivery. Pre-lacteals were given <strong>in</strong> about 14% <strong>of</strong> the<br />
newborns only. Practiced <strong>of</strong> giv<strong>in</strong>g pre-lacteals to new born to be discouraged,<br />
because pre-lacteal feeds might harm the immature gut <strong>of</strong> the child, especially if they<br />
are contam<strong>in</strong>ated. The delayed <strong>in</strong>itiation <strong>of</strong> breasted feed<strong>in</strong>g observed <strong>in</strong> the district<br />
is a matter <strong>of</strong> concern and requires due attention because, early <strong>in</strong>itiation <strong>of</strong> breast<br />
feed<strong>in</strong>g is the primary determ<strong>in</strong>ant <strong>of</strong> maternal milk production and secretion.<br />
Avoidance <strong>of</strong> other fluids or foods is essential to optimize breast milk <strong>in</strong>take by the<br />
newborn. Most <strong>of</strong> the other fluids or foods are less nutritious than breast milk and<br />
therefore, if displacement occurs, the <strong>in</strong>fant may be at a nutritional disadvantage<br />
even if prepared hygienically 19 . In many communities, it is traditionally believed that<br />
colostrum is unhealthy and therefore is harmful to the baby. However <strong>in</strong> the present<br />
study, colostrum was given by 95% <strong>of</strong> mothers which is good for the child’s health<br />
and nutrition and such desirable practices should be encouraged further <strong>in</strong> the<br />
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, about<br />
74% <strong>of</strong> the <strong>in</strong>fants aged 6-11 months received complementary foods at 6 months <strong>of</strong><br />
age. This type <strong>of</strong> desirable feed<strong>in</strong>g practices should be encouraged.<br />
In the present study, about 14% <strong>of</strong> <strong>in</strong>fants did not receive any complementary<br />
foods up to 1 <strong>year</strong> <strong>of</strong> age, while about 8% have receiv<strong>in</strong>g the same anywhere<br />
between 7 to 12 months <strong>of</strong> age. The mothers to be educated to <strong>in</strong>troduce<br />
complementary feeds from 6 th months <strong>of</strong> age, as breastmilk alone is not sufficient to<br />
meet the grow<strong>in</strong>g nutritional needs <strong>of</strong> <strong>in</strong>fant. The complementary foods be<strong>in</strong>g given<br />
mostly <strong>in</strong>cluded, home made semi solids, cow/buffalo milk and home made solids.<br />
The frequency <strong>of</strong> feed<strong>in</strong>g was at least 3 times <strong>in</strong> 63% <strong>of</strong> the <strong>in</strong>fants. Effective<br />
immunization programme aga<strong>in</strong>st the common communicable diseases are required<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
for the majority <strong>of</strong> the susceptible populations particularly <strong>in</strong> the develop<strong>in</strong>g<br />
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 />
(97.4%) 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<br />
9-59 months, every 6 months. It was observed that about 80% <strong>of</strong> <strong>children</strong> between<br />
9-17 months 95% <strong>children</strong> between 18-59 months received at least one dose vitam<strong>in</strong><br />
A dur<strong>in</strong>g previous one <strong>year</strong>. Only about 39% <strong>of</strong> 18-59 months <strong>children</strong> received the<br />
suggested two doses dur<strong>in</strong>g the preced<strong>in</strong>g one <strong>year</strong>, <strong>in</strong>dicates the poor coverage<br />
which has to be strengthened further. The coverage <strong>of</strong> <strong>children</strong> for iron-folic acid<br />
supplementation was only about 14% while negligible proportion <strong>of</strong> <strong>children</strong> (2.3%)<br />
received ≥ 90 tablets and 2% consumed ≥ 90 tablets, which <strong>in</strong>dicates weak<br />
education component. There is a need to strengthen the service delivery and<br />
monitor<strong>in</strong>g mechanisms for these programmes.<br />
The common morbidities such as ARI, fever and diarrhoea were reported by the<br />
mothers. The prevalence <strong>of</strong> diarrhoea was lower (2.3% to 3.6%)among <strong>children</strong><br />
between 24 to 59 months group, while the ARI was higher (17.1)% <strong>in</strong> 12-23 months<br />
group. The prevalence <strong>of</strong> fever was lower (10%) among <strong>children</strong> <strong>of</strong> 36-47 months<br />
old. The plausible reasons for this could be due to the prevail<strong>in</strong>g undesirable <strong>in</strong>fant<br />
and young child feed<strong>in</strong>g practices coupled with non-receipt <strong>of</strong> appropriate health<br />
care management.<br />
Consumption <strong>of</strong> adequately (≥15 ppm) Iodised salt is very high <strong>in</strong> the district<br />
91.4%, 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 56%, 48% and 25%<br />
respectively. It was observed that the <strong>under</strong>weight status <strong>of</strong> <strong>children</strong> deteriorated as<br />
age advances especially from six months onwards. The prevalence <strong>of</strong> stunt<strong>in</strong>g was<br />
lower 33.4% and 23.1% among <strong>children</strong> <strong>in</strong> 6-11 and36-47 months groups<br />
respectively, when compared to other age groups (50% to 60%), while the<br />
prevalence <strong>of</strong> wast<strong>in</strong>g were lower <strong>in</strong> 0-5 (18.2%) and 36-47(13.1%) months groups<br />
respectively, while this was ranged between 25% to 29% respectively. The current<br />
prevalence <strong>of</strong> <strong>under</strong>nutrition, <strong>in</strong> all its three forms <strong>in</strong> the district was either lower or<br />
comparable, when compared to the figure reported for the State <strong>of</strong> Madhya Pradesh<br />
by NFHS-3 (2007). The prevalence <strong>of</strong> <strong>under</strong>weight was higher, while the stunt<strong>in</strong>g<br />
was lower, when compared to the figure reported by NNMB (2006). While the<br />
<strong>Nutritional</strong> <strong>Status</strong> <strong>of</strong>
prevalence <strong>of</strong> wast<strong>in</strong>g was comparable. Probably, Attention has to be given towards<br />
factors such as, early <strong>in</strong>itiation <strong>of</strong> breast feed<strong>in</strong>g, <strong>in</strong>itiation <strong>of</strong> complementary foods at<br />
an appropriate age, energy and nutrient density <strong>of</strong> the complementary foods given,<br />
the frequency and variety <strong>of</strong> foods <strong>of</strong>fered, hygiene aspects <strong>of</strong> food preparation,<br />
personal hygiene, the amount <strong>of</strong> breast milk consumed at different stages <strong>of</strong><br />
complementary feed<strong>in</strong>g, the frequency <strong>of</strong> breastfeed<strong>in</strong>g and <strong>in</strong>appropriate<br />
complementary feed<strong>in</strong>g dur<strong>in</strong>g and after illness, to br<strong>in</strong>g down the prevalence <strong>of</strong><br />
<strong>under</strong>nutrition further <strong>in</strong> the district.<br />
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 .<br />
The study revealed significant association between nutritional status and<br />
different socio-economic and demographic variables, which <strong>in</strong>dicate significantly<br />
higher rates <strong>of</strong> <strong>under</strong>weight among, <strong>children</strong> <strong>in</strong> SC & ST communities, from nuclear<br />
& extended nuclear families, <strong>of</strong> illiterate parents and mothers be<strong>in</strong>g <strong>in</strong>volved <strong>in</strong><br />
labour. Similarly, higher prevalence <strong>of</strong> stunt<strong>in</strong>g was observed among <strong>children</strong> <strong>of</strong> ST<br />
& SC communities, from nuclear &extended nuclear families, <strong>of</strong> illiterate parents,<br />
HHs do not possess any agriculture land, parents <strong>in</strong>volved <strong>in</strong> labour, HHs with PCI<br />
<strong>of</strong> Rs 600-900 and liv<strong>in</strong>g <strong>in</strong> kutcha houses, while significantly higher proportion <strong>of</strong><br />
wasted <strong>children</strong> was found <strong>in</strong> families, where mother was <strong>in</strong>volved <strong>in</strong> cultivation.<br />
Promotion <strong>of</strong> better <strong>in</strong>fant and young child feed<strong>in</strong>g and health care practices is<br />
needed for improv<strong>in</strong>g the health and nutritional status <strong>of</strong> young <strong>children</strong>.<br />
Strengthen<strong>in</strong>g <strong>of</strong> exist<strong>in</strong>g National Nutrition Programmes viz ICDS supplementation,<br />
distribution <strong>of</strong> IFA tablets/syrup to preschool <strong>children</strong> is essential.<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) 396<br />
Under 5 <strong>year</strong> <strong>children</strong> for anthropometry<br />
463<br />
(Boys 249, Girls 214)<br />
Children below 12 months 111<br />
Children 12-35 months 204<br />
Children 36-59 months 148<br />
Spot test<strong>in</strong>g <strong>of</strong> HHs salt for iod<strong>in</strong>e 396<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 396<br />
Scheduled Tribe 9.3<br />
Scheduled Caste 25.5<br />
Backward Community 54.8<br />
Others 10.4<br />
Nuclear 52.0<br />
Extended Nuclear 19.2<br />
Jo<strong>in</strong>t 28.8<br />
1 -4 36.4<br />
5 – 9 54.5<br />
10 9.1<br />
Average Family Size 5.9<br />
Literacy status <strong>of</strong> Father<br />
Literacy status <strong>of</strong> Mother<br />
Illiterate 18.7<br />
Read & write 1.5<br />
1 – 5 Class 19.2<br />
6 – 7 Class 4.8<br />
8 – 10 Class 43.2<br />
Intermediate 7.3<br />
Graduate & above 4.8<br />
NA 0.5<br />
Illiterate 40.4<br />
Read & write 0.3<br />
1 – 5 Class 29.3<br />
6 – 7 Class 4.0<br />
8 – 10 Class 21.7<br />
Intermediate 2.5<br />
Graduate & above 1.8<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 396<br />
Nil 51.8<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 396<br />
Kutcha 22.0<br />
Semi Pucca 68.4<br />
Pucca 9.6<br />
Open Well 2.5<br />
Tube Well 90.4<br />
Tap 2.3<br />
Others 4.8<br />
Firewood 93.9<br />
Kerosene 0.5<br />
Bio- Gas -<br />
LPG 5.6<br />
Household electricity present 91.4<br />
Sanitary Latr<strong>in</strong>e<br />
Present and <strong>in</strong> use 21.2<br />
Present and not <strong>in</strong> use 0.8<br />
Absent 78.0<br />
Separate Kitchen Present 58.6<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 396<br />
Powdered salt 0.5<br />
Rock Salt 7.3<br />
Free-flow<strong>in</strong>g 92.2<br />
0 ppm 7.6<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 33<br />
Undergone Antenatal check-up (ANC)<br />
Total number <strong>of</strong> ANCs<br />
Yes 81.8<br />
No 18.2<br />
One 6.1<br />
Two 9.1<br />
Three 33.3<br />
Four 21.2<br />
≥ five 12.1<br />
NA 18.2<br />
Undergone First ANC at (Weeks <strong>of</strong> gestation)<br />
Place <strong>of</strong> ANC<br />
ANC conducted by<br />
< 8 weeks 18.2<br />
9- 12 weeks 15.2<br />
13- 16 weeks 36.3<br />
17-20 weeks 6.1<br />
21-24 weeks 3.0<br />
≥24 weeks 3.0<br />
NA 18.2<br />
Home -<br />
AWC 24.2<br />
PHC/CHC 18.2<br />
Taluk/Dist.hospital 15.2<br />
Private Cl<strong>in</strong>ic 24.2<br />
NA 18.2<br />
ANM 33.4<br />
Medical Officer 24.2<br />
Pvt. Doctor 24.2<br />
NA 18.2<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 33<br />
Physical Exam<strong>in</strong>ation 78.8<br />
Weight Record<strong>in</strong>g 78.8<br />
Ur<strong>in</strong>e Test 60.6<br />
Haemoglob<strong>in</strong> Estimation 63.6<br />
Blood pressure measurement 63.6<br />
Health & Nutrition advise given dur<strong>in</strong>g ANC<br />
If yes, what advise*<br />
Yes 78.8<br />
No 3.0<br />
Not availed ANC 18.2<br />
To attend for regular checkups 78.8<br />
To consume more GLVs 75.8<br />
To consume more Vegetables & fruits 75.8<br />
To take IFA tablets for 100 days 75.8<br />
Reasons for not avail<strong>in</strong>g ANCs*<br />
Others 33.3<br />
Not aware <strong>of</strong> the need 18.2<br />
No faith 3.0<br />
No ANC held <strong>in</strong> the village 3.0<br />
Tim<strong>in</strong>gs are <strong>in</strong>convenient 3.0<br />
Place is not accesssible 3.0<br />
Loss <strong>of</strong> wages 6.1<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 />
TT Immunization received<br />
If yes, No. <strong>of</strong> doses<br />
Reasons for not receiv<strong>in</strong>g TT<br />
Percent<br />
n 33<br />
Yes 90.9<br />
No 9.1<br />
One dose 12.1<br />
Two doses 78.8<br />
Not received 9.1<br />
Not aware <strong>of</strong> the need 9.1<br />
No faith 3.0<br />
Fear <strong>of</strong> gett<strong>in</strong>g pa<strong>in</strong> 3.0<br />
* Multiple responses<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 33<br />
Yes 75.8<br />
No 24.2<br />
ANM 15.2<br />
AWW 45.4<br />
MO-PHC 9.1<br />
Private Doctor 6.1<br />
Not received 24.2<br />
30-60 9.1<br />
60-90 6.1<br />
≥90 39.4<br />
Do not Know 21.2<br />
NA 24.2<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 463<br />
First 31.3<br />
Second 34.6<br />
Third 16.4<br />
Fourth 9.9<br />
Fifth and above 7.8<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<br />
<strong>in</strong>terval between last two births<br />
Interval between last two births(months)<br />
Percent<br />
n 318<br />
Table – 10<br />
Distribution (%) <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 78<br />
Foods generally <strong>in</strong>cluded <strong>in</strong> home made complementary foods*<br />
Cereals & Millets 85.9<br />
Pulses 79.5<br />
Green Leafy Vegetables 44.9<br />
Other Vegetables 44.9<br />
Roots & Tubers 50.0<br />
Fruits 57.7<br />
Milk & milk products 70.5<br />
Eggs 7.7<br />
Meat & Chicken 3.8<br />
Fats & Oils 74.4<br />
Number <strong>of</strong> complementary feeds per day<br />
Mode <strong>of</strong> complementary feed<strong>in</strong>g<br />
2 23.1<br />
3 51.2<br />
4 10.3<br />
5 1.3<br />
Not yet started 14.1<br />
Mother with spoon 3.8<br />
Mother with hand 77.0<br />
Self with spoon -<br />
Self by hand 3.8<br />
Feed<strong>in</strong>g bottle 1.3<br />
Not yet started 14.1<br />
Supervision <strong>of</strong> complementary feed<strong>in</strong>g by<br />
* Multiple responses<br />
Mother 85.9<br />
Grand parents -<br />
Not yet started 14.1<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 204<br />
Children solely breast fed -<br />
Children currently Breast fed + complementary feed<strong>in</strong>g 59.8<br />
Weaned 40.2<br />
Type <strong>of</strong> food currently be<strong>in</strong>g given*<br />
Cow/buffalo milk 85.8<br />
Formula milk -<br />
Commercial baby food -<br />
Home made semi-solids 97.5<br />
Home made solids 93.1<br />
Not yet started -<br />
Foods generally <strong>in</strong>cluded <strong>in</strong> home made foods*<br />
Cereals & Millets 99.5<br />
Pulses & legumes 98.5<br />
Green Leafy Vegetables 83.3<br />
Other Vegetables 87.7<br />
Roots & Tubers 83.3<br />
Fruits 88.7<br />
Milk & milk products 85.8<br />
Eggs 26.5<br />
Flesh foods 18.1<br />
Fats & Oils 97.1<br />
Not yet started CF -<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 204<br />
≤2 8.8<br />
3 55.9<br />
≥4 35.3<br />
Not yet started CF -<br />
Mother with spoon 1.0<br />
Mother with hand 40.2<br />
Self with spoon -<br />
Self by hand 58.8<br />
Not yet started CF -<br />
Mother 91.7<br />
Father -<br />
Elder Sibl<strong>in</strong>g 3.4<br />
Grand parents 0.5<br />
Others 4.4<br />
Not yet started CF -<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<br />
previous fortnight by age groups<br />
Age Group<br />
(months)<br />
n Fever Diarrhoea ARI<br />
At least one<br />
morbidity<br />
0-5 33 21.2 9.1 9.1 27.3<br />
6-11 78 29.5 11.5 12.8 44.9<br />
12-23 117 29.9 14.5 17.1 48.7<br />
24-35 87 24.1 2.3 11.5 35.6<br />
36-47 84 9.5 3.6 14.3 21.4<br />
48-59 64 18.8 3.1 10.9 31.3<br />
Pooled 463 22.9 7.8 13.4 36.7<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 282 148 430<br />
Participat<strong>in</strong>g 86.1 98.0 90.2<br />
Regular 28.7 80.4 46.5<br />
Irregular 57.4 17.6 43.7<br />
Not participat<strong>in</strong>g 13.8 2.0 9.8<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 117<br />
Received all vacc<strong>in</strong>es ( Fully Immunized) 97.4<br />
Partially immunized 2.6<br />
Not immunized -<br />
Reasons for no / <strong>in</strong>complete immunization<br />
BCG 98.3<br />
DPT1 98.3<br />
DPT2 98.3<br />
DPT3 98.3<br />
OPV1 100.0<br />
OPV2 100.0<br />
OPV3 100.0<br />
Measles 98.3<br />
Unaware <strong>of</strong> need -<br />
Time & place not known/ <strong>in</strong>convenient 0.9<br />
Source <strong>of</strong> <strong>in</strong>formation<br />
Not <strong>of</strong>fered 1.7<br />
Fully immunized 97.4<br />
Mother & child protection card 1.7<br />
Immunization card 0.9<br />
Parents 89.7<br />
AWW record 7.7<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 />
No. <strong>of</strong> doses <strong>of</strong> vitam<strong>in</strong> A<br />
Place <strong>of</strong> adm<strong>in</strong>istration<br />
Age group (months)<br />
9-17 18-35 36-59 9-59<br />
N 81 156 148 385<br />
Yes 80.2 91.7 98.6 91.9<br />
No 17.3 4.5 1.4 6.0<br />
Do not remember 2.5 3.8 0.0 2.1<br />
One 80.2 53.2 58.1 60.8<br />
Two 0.0 38.5 40.5 31.2<br />
Not received 17.3 4.5 1.4 6.0<br />
Do not remember 2.5 3.8 0.0 2.1<br />
Home 1.2 0.6 0.0 0.5<br />
AWC 77.8 89.8 96.6 89.9<br />
SC 1.2 1.3 2.0 1.6<br />
Not received/do not remember 19.8 8.3 1.4 8.1<br />
Massive dose vitam<strong>in</strong> A adm<strong>in</strong>istered by<br />
AWW 26.0 30.1 28.4 28.6<br />
ANM 54.2 61.6 69.5 63.1<br />
LHV 0.0 0.0 0.7 0.3<br />
Not received/do not remember 19.8 8.3 1.4 8.1<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 1.2 0.0 0.0 0.3<br />
Not <strong>of</strong>fered 9.9 52.6 59.5 46.3<br />
Time or place not convenient 1.2 0.6 0.0 0.5<br />
Mothers was busy 3.7 3.2 0.0 2.1<br />
Others 1.2 1.3 0.0 0.8<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 />
No. <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 204 148 352<br />
Yes 13.7 14.2 13.9<br />
No 86.3 85.8 86.1<br />
ANM 4.9 4.1 4.5<br />
AWW 8.8 10.1 9.4<br />
MO-PHC - - -<br />
Not received 86.3 85.8 86.1<br />
Table - 21<br />
Prevalence (%) <strong>of</strong> nutritional deficiency signs among 0 - 59 months<br />
<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 111 204 148 463<br />
NAD 100 98.0 95.3 97.6<br />
Hair. discoloured - 0.5 - 0.2<br />
Emaciation - 0.5 - 0.2<br />
Night Bl<strong>in</strong>dness(XN) - - 0.7 0.2<br />
Knock Knees or Bow legs - - 0.7 0.2<br />
Dental caries - 1.0 3.4 1.5<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 />
1 50.8 0.0 3.5 0.0
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 />
Underweight (Weight for Age)<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<br />
SD 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<br />
SD 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 />
Weight for age Height for age Weight for height<br />
Particulars n