Household Survey for the Assessment of Nutrition and ...

Household Survey for the Assessment of Nutrition and Education Status

(JANSAHAS)

2012

Table of Contents

Abbreviations and Acronyms ..................................................................................................... 4

Summary ............................................................................................................................................. 5

1. Background ............................................................................................................................. 14

1.1Introduction .......................................................................................................................... 14

1.2 The Study ............................................................................................................................. 15

1.2.1 Objectives .................................................................................................................... 16

1.2.2 Methodology ............................................................................................................. 16

1.2.3 Target Groups ............................................................................................................ 17

1.2.4 A brief profile of Study Area and Coverage ................................................ 17

2. Household Profiles ................................................................................................................. 18

2.1 Introduction ........................................................................................................................ 18

2.2 Demographic Profile and Household Characteristics ....................................... 18

2.3 Age and Sex-wise distribution of Population ...................................................... 25

2.4 Beneficiaries of Government Schemes ................................................................... 28

2.5 Mortality and Morbidity ................................................................................................ 32

3. Nutritional Status of Women and Children ................................................................. 36

3.1 Nutritional Status of Women ...................................................................................... 36

3.1.1 Pregnant Women ..................................................................................................... 39

3.1.2 Mothers of children up to the age of two years ....................................... 42

3.2 Nutritional Status of Children (below 5 years) .................................................... 44

3.3 Factors Associated with Malnutrition Status of Children ............................... 49

3.3.1 Factors responsible for malnutrition in children younger than 2 years

.................................................................................................................................................... 49

3.3.2 Social and other related factors associated with malnutrition ............ 55

Household Survey for the Assessment of Nutrition and Education status(JANSAHAS

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4. Risk Factors Associated With Malnutrition of Children .......................................... 75

4.1 Introduction ........................................................................................................................ 75

4.2 Risk factors for Children below two years ............................................................ 75

4.3 Risk factors for Children up to 5 years of age.................................................... 76

4.4 Pattern of Malnutrition by age .................................................................................. 78

5. Educational Status of Children .......................................................................................... 98

5.1 Introduction ........................................................................................................................ 98

5.2 Children out of School .................................................................................................. 99

5.3 School Profile and School Management Committees ................................... 102

6. Salient Findings and Recommendations ..................................................................... 104

6.1 Introduction ...................................................................................................................... 104

6.2 Salient findings and recommendations ................................................................ 104

Abbreviations and Acronyms AAY Antodya Ahar Yojna APL Above Poverty Line BPL Below Poverty Line BMI Body Mass Index CED Chronic Energy Deficiency CHS Community Health Centre DLHS District Level Household and Facility Survey DRCSC Development Research Communication and Services Centre FAO Food and Agricultural Organization of the United Nations FIHI Fight Hunger First Initiative GDP Gross Domestic Product GHI Global Hunger Index GOI Government of India IASDS Institute of Applied Statistics and Development Studies ICDS Integrated Child Development Services IFPRI International Food Policy Research Institute LBW Low Birth Weight MDM Mid Day Meal Scheme MNREGA Mahatma Gandhi National Rural Employment Guarantee Act NFHS National Family Health Surveys of India NTFP Non Timber Forest Product OBC Other Backward Castes ORS Oral Re-hydration Solution PDS Public Distribution System PHC Primary Health Centre SC Scheduled Castes ST Scheduled Tribes

Nutrition and Education Census by Jan Sahas

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Summary The study “Household Survey for the Assessment of Nutrition and Education Status” is a component of the ‘ Baseline Studies on Food Nutrition and Education Status’ being undertaken by Welthungehilfe Regional Office South Asia’s ‘Fight Hunger First’ initiative. Nine partner organizations were engaged in this study. Jansahas carried out survey in four blocks of four districts viz., Pawai (Panna district), Jhirnaya (Khargone district), Pandhana(Khandawa district) and Sonkatch (Dewas district). A total of 30 villages (of 19 Panchayats) located in Sokatch, Pandhana, Jhirnaya and Pawai blocks were covered. All the households of this area were viewed as the target groups. A total of 7,339 (1,938 Sonkatch, 2,085 Pandhana, 1,831 Jhirniya, 1,485 Pawai) households were covered in the study. Institute of Applied Statistics and Development Studies (IASDS) provided support in conducting the survey, analysis of data collected, presentation of findings and production of report with focus on findings and recommendations based on technical support from a nutritionist. The main objectives of this survey was to collect the relevant data for reporting on (a) stunting rates of children below five years (b) Maternal and child mortality rates (c) School enrolment and drop out rates of children between the age groups of 5 to 14 years. Block-wise summary is as under. Sonkatch A total of 1,938 households were covered in the study. The target groups comprised pregnant mothers/ mothers of children younger than 2 years. children 0-59 months, Children over 5 to 14 years. For nutritional component, the main target groups studied were pregnant women/ mothers of children younger than 2 years and children 0-2years. For educational aspect, the target group comprised of children in the age group of 5 to 14 years The findings revealed that the total population was 9,139 (5,293 males, 3,846 females). Of these 5,430 (3,017 males, 2,323 females) were above 18 years of age. The population comprised of sizable proportion of old people (over 50 years). Most of the families predominantly belonged to Scheduled Castes (36.3%) and General (39.4%). The overall sex ratio was 726 females per thousand males, which is rather on the lower side. Major sources of income were reported to be wage labor and farming. The population of children (up to 5years) was reported to be only 11.6 %. The child female: male sex ratio however was 690 that is very much less than overall sex ratio and is a matter of concern. Major source of water was observed to be tube-well and open wells. More than 38 % of the population had no education (29.4 %males, 47.9 % females). Among the literates 28.6 % had studied up to primary level,18.1 % had studied up to middle level while 11.4% of the population studied up to high school and only 3.6


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% had studied beyond high school. Illiteracy amongst females is much higher than amongst males. During last 12 months 44 deaths out of total population of 9,139 were reported amounting to 4.8 deaths per thousand. Out of the total deaths reported 41.9 % were due to ageing, 7 % deaths during delivery/pregnancy, and 11.6 % due to chronic illness. Neonatal deaths accounted for 9.1 % deaths reported Infant deaths accounted for 13.6 % deaths. Of the total population under study 29.3 % were reported to be chronically ill, 16.7 % were malnourished and all the respondents were reported to have at least one disease. Here also, we have multiple responses. In 15.2 % villages, School Management Committees (SMC) existed. In 62.1 % cases the SMCs met every month. Average distance from school to villages was noted to be between 1-2 km. 69.7 % schools were having toilets. In 47.4 % schools separate toilets for girls were provided. Drinking water was provided in 54.1 % schools and 88.9 % schools served MDM. School profile clearly indicates very poor facilities. 88.7 % of households were registered in the MNREGA scheme. On an average 3.6 persons per household took part in the MNREGA. Only 0.7 % got job for entitled 100 days. 3.9 % received jobs for 1-30days, 2.4 % for 31-60 days while 0.7 % received jobs for 61-99 days. 92.3 % did not get a job even for a day. 94.7 .% Pregnant women were in the age groups of 18-30 while 5.3 % were in 31-<40 years of age. Nutritional status of women was assessed using both anthropometric measurements and some observed symptoms, particularly for pregnant women. The indicators considered for malnutrition are Body Mass Index (BMI) and Mid Upper Arm Circumference (MUAC). Women with BMI<18.5 were considered to be underweight. Women having MUAC<21 cm were also considered malnourished. For pregnant women only MUAC was used. Based upon MUAC measurement, 8.1 % were found to be undernourished. Of the total pregnant women, 94.7 % were registered with ICDS. 78.9 % pregnant women, registered with ICDS availed the support services only once and 21.1 % two times. Among the mothers of children under twos, 25.8 % women in the age group 18-30 years were having low BMI. This percentage was 22.6 for mothers above 30 years. 98.8 % of mothers of under twos were registered with ICDS and 92.4 % availed support services only once and 7.6 % two times . Birth weight of 31.3 % children was younger than 2.5 kg. In this study 64.1 % children were found to be stunted with 49.3 % being severely stunted and 14.8 % moderately stunted. In the underweight category 50.5 % were underweight of which 26.6 % children were severely underweight and 24.5 % were moderately underweight. Regarding wasting, 23 % were wasted. Of these, 12.6 % children were found to be severely wasted and 10.4 % moderately wasted.


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MUAC of 11 % children was found to be below the WHO recommended cut of 11.5 cm for detecting severe acute malnutrition (SAM). As per the WHO recommendation, MUAC is advised to be used for identifying SAM children. Of these SAM children, 93.7 % children were registered with ICDS and 60.1 % were recipient of ration. 64.4 % of children 6-36 months took food packets from Anganwadis to home. Nutritional level of children was very low as per the prevalence of stunting, under-weight and wasting. The factors associated with under-nutrition were caring practices, prevalence of disease, hygiene, affiliation of child with social groups and mothers’ literacy status. Statistical analysis has shown that there is a very high level of association between child’s affiliation to social groups and prevalence of underweight. Statistical analysis has also revealed that stunting is associated with literacy status of mothers. Logistic regression analysis has revealed that for children up to 2 years, diseases and complementary feeding have emerged as risk factors for stunting; for underweight the risk factors are child’s age, diseases and complementary feeding and for wasting the risk factor is BMI of mothers. For children up to 5 years, for stunting, the child’s age and complementary feeding have emerged as risk factors; for underweight only child’s age has emerged as risk factor and none of the factors (child’s age, disease and complementary feeding) has emerged as risk factor for wasting. About 9.9 % children were out of school. Working children, absence of teachers and poor quality of teaching were cited as main reasons for drop out. Educational scenario was noted to be rather grave. The drop out rate was highest in class 1. High drop out rate at lower classes is a matter of concern. Pandhana A total of 2,085 households were covered in the study. The target groups comprised pregnant mothers/ mothers of children younger than 2 years. children 0-59 months, Children over 5 to 14 years. For nutritional component, the main target groups studied were pregnant women/ mothers of children younger than 2 years and children 0-2years. For educational aspect, the target group comprised of children in the age group of 5 to 14 years The findings revealed that the total population was 9,237 (4,826 males, 4,411 females). Of these 4,658 (2,323 males, 2,335 females) were above 18 years of age. The population comprised of sizable proportion of old people (over 50 years). Most of the families predominantly belonged to Scheduled Tribes (90.1%). The overall sex ratio was 914 females per thousand males, which is rather on the lower side. Major sources of income were reported to be wage labor and farming. The population of children (up to 5years) was reported to be only 12.7 %. The child female: male sex ratio however was 865 that is very much less than overall sex ratio


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and is a matter of concern. Major source of water was observed to be tube-well and open wells. More than 65 % of the population had no education (59.4%males, 70.9 % females). Among the literates 22.5 % had studied up to primary level,8.3 % had studied up to middle level while 3.4% of the population studied up to high school and only 0.7 % had studied beyond high school. Illiteracy amongst females is much higher than amongst males. During last 12 months 34 deaths out of total population of 9,237 were reported amounting to 3.7 deaths per thousand. Out of the total deaths reported 12.1 % were due to ageing, 6.1 % deaths during delivery/pregnancy, and 51.5 % due to chronic illness. Neonatal deaths accounted for 5.9 % deaths reported Infant deaths accounted for 5.9 % deaths. Of the total population under study 30 % were reported to be chronically ill, 25 % were malnourished and all the respondents were reported to have at least one disease. Here also, we have multiple responses. 78.4 % of households were registered in the MNREGA scheme. On an average 2.5 persons per household took part in the MNREGA. Only 0.1 % got job for entitled 100 days. 2.2 % received jobs for 1-30days, 0.3% for 31-60 days. 97.4 % did not get a job even for a day. 90 .% Pregnant women were in the age groups of 18-30 while 6.3 % were in 31-<40 years of age. Nutritional status of women was assessed using both anthropometric measurements and some observed symptoms, particularly for pregnant women. The indicators considered for malnutrition are Body Mass Index (BMI) and Mid Upper Arm Circumference (MUAC). Women with BMI<18.5 were considered to be underweight. Women having MUAC<21 cm were also considered malnourished. For pregnant women only MUAC was used. Based upon MUAC measurement, 24.4 % were found to be undernourished. Of the total pregnant women, 94.7 % were registered with ICDS. . 85.7 % pregnant women, registered with ICDS availed the support services only once and 14.3 % two times.. Among the mothers of children under twos, 37.7 % women in the age group 18-30 years were having low BMI. This percentage was 42.8 for mothers above 30 years. In the category of mothers below 18 years all the women were having low BMI. 93 % of mothers of under twos were registered with ICDS and 95 % availed support services only once and 5 % two times . Birth weight of 2.2 % children was younger than 2.5 kg. In more than 92 % cases no records were available. In this study 55.2 % children were found to be stunted with 39.9 % being severely stunted and 15.3 % moderately stunted. In the underweight category 56.8 % were underweight of which 31.9 % children were severely underweight and 24.9 % were moderately underweight. Regarding wasting, 39 % were wasted. Of these, 25 % children were found to be severely wasted and 14 % moderately wasted.


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MUAC of 6.3 % children was found to be below the WHO recommended cut of 11.5 cm for detecting severe acute malnutrition (SAM). As per the WHO recommendation, MUAC is advised to be used for identifying SAM children. Of these SAM children, 70.8 % children were registered with ICDS and 80.8 % were recipient of ration. 38 % of children 6-36 months took food packets from Anganwadis to home. Nutritional level of children was very low as per the prevalence of stunting, under-weight and wasting. The factors associated with under-nutrition were caring practices, prevalence of disease, hygiene, affiliation of child with social groups and mothers’ literacy status. In this block since almost all children belonged to ST category, no statistical analysis could carried out for establishing association of malnutrition with caste affiliation. No association was observed between mother’s literacy status and malnutrition in children. Logistic regression analysis has revealed that for children up to 2 years, for stunting child’s age has emerged as risk factor; for underweight all the four factors (child’s age, disease, complementary feeding and BMI of mothers) have emerged as risk factors and for wasting, child’s age and BMI of mothers are risk factors. For children up to 5 years, all the three factors (child’s age, disease and complementary feeding) have emerged as risk factors for stunting, for underweight child’s age has emerged as risk factor and for wasting the risk factor is child’s age. About 33.9 % children were out of school. Working children, was cited as main reason for drop out. Educational scenario was noted to be rather grave. The drop out rate was highest in class 1. High drop out rate at lower classes is a matter of concern. Jhirnaya A total of 1,831 households were covered in the study. The target groups comprised pregnant mothers/ mothers of children younger than 2 years. children 0-59 months, Children over 5 to 14 years. For nutritional component, the main target groups studied were pregnant women/ mothers of children younger than 2 years and children 0-2years. For educational aspect, the target group comprised of children in the age group of 5 to 14 years The findings revealed that the total population was 8,816 (4,673 males, 4,143 females). Of these 4,144 (2,224 males, 1,920 females) were above 18 years of age. The population comprised of sizable proportion of old people (over 50 years). Most of the families predominantly belonged to Scheduled Tribes (96.5%) The overall sex ratio was 887 females per thousand males, which is rather on the lower side. Major sources of income were reported to be wage labor and farming.


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The population of children (up to 5years) was reported to be only 17 %. The child female: male sex ratio however was 939. Major source of water was observed to be tube-well and open wells. More than 65 % of the population had no education (61.7%males, 69.2 % females). Among the literates 24.1 % had studied up to primary level,5.9 % had studied up to middle level while 2.6% of the population studied up to high school and only 0.4 % had studied beyond high school. Illiteracy amongst females is much higher than amongst males. During last 12 months 49 deaths out of total population of 8,816 were reported amounting to 5.6 deaths per thousand. Out of the total deaths reported 20.8 % were due to ageing, 12.5 % deaths during delivery/pregnancy, and 25 % due to chronic illness. Neonatal deaths accounted for 12.2 % deaths reported Infant deaths accounted for 18.3 % deaths. Of the total population under study 41.2 % were reported to be chronically ill, 23.5 % were malnourished and all the respondents were reported to have at least one disease. Here also, we have multiple responses. 68.2 % of households were registered in the MNREGA scheme. On an average 3.8 persons per household took part in the MNREGA. No one got job for entitled 100 days. 3.3 % received jobs for 1-30days, 0.4 % for 31-60 days. 96.3 % did not get a job even for a day. 87.3.% Pregnant women were in the age group of 18-30 while 9.5 % were in 31-<40 years of age. Nutritional status of women was assessed using both anthropometric measurements and some observed symptoms, particularly for pregnant women. The indicators considered for malnutrition are Body Mass Index (BMI) and Mid Upper Arm Circumference (MUAC). Women with BMI<18.5 were considered to be underweight. Women having MUAC<21 cm were also considered malnourished. For pregnant women only MUAC was used. Based upon MUAC measurement, 4.8 % were found to be undernourished. Of the total pregnant women, 96.8% were registered with ICDS. 95.7 % pregnant women, registered with ICDS availed the support services only once and 4.3 % two times. Among the mothers of children under twos, 45.6 % women in the age group 18-30 years were having low BMI. This percentage was 40.7 for mothers above 30 years. More than 98 % mothers of under twos were reported to be registered with ICDS. About 91 % mothers availed the services only once and 8.7 % twice. Birth weight of 6.9 % children was younger than 2.5 kg. In more than 80 % cases no records were available. In this study 62.8 % children were found to be stunted with 43.2 % being severely stunted and 15.6 % moderately stunted. In the underweight category 59.1 % were underweight of which 36.3 % children were severely underweight and 22.8 % were moderately underweight. Regarding wasting, 36.2 % were wasted. Of these, 18.9 % children were found to be severely wasted and1 17.2 % moderately wasted.


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MUAC of 8.5 % children was found to be below the WHO recommended cut of 11.5 cm for detecting severe acute malnutrition (SAM). As per the WHO recommendation, MUAC is advised to be used for identifying SAM children. Of these SAM children, 73.9 % children were registered with ICDS and 70 % were recipient of ration. 48.8 % of children 6-36 months took food packets from Anganwadis to home. Nutritional level of children was very low as per the prevalence of stunting, under-weight and wasting. The factors associated with under-nutrition were caring practices, prevalence of disease, hygiene, affiliation of child with social groups and mothers’ literacy status. In this block since almost all children belonged to ST category, no statistical analysis could carried out for establishing association of malnutrition with caste affiliation. No association was observed between mother’s literacy status and malnutrition in children. Logistic regression analysis has revealed that for children up to 2 years, for stunting none of the factors (child’s age, disease, complementary feeding and BMI of mothers) has emerged as risk factor; for underweight complementary feeding and BMI have emerged as risk factors and for wasting all the four factors have emerged as risk factors. For children up to 5 years, all the three factors (child’s age, disease and complementary feeding) have emerged as risk factors for stunting; for underweight the risk factors are child’s age and diseases and for wasting none of the factors has emerged as risk factor. About 28.9 % children were out of school. Working children, was cited as main reason for drop out. Educational scenario was noted to be rather grave. The drop out rate was highest in class 3. High drop out rate at lower classes is a matter of concern. Pawai A total of 1,485 households were covered in the study. The target groups comprised pregnant mothers/ mothers of children younger than 2 years. children 0-59 months, Children over 5 to 14 years. For nutritional component, the main target groups studied were pregnant women/ mothers of children younger than 2 years and children 0-2years. For educational aspect, the target group comprised of children in the age group of 5 to 14 years The findings revealed that the total population was 5,790 (3,061 males, 2,729 females). Of these 3,306 (1,694 males, 1,612 females) were above 18 years of age. The population comprised of sizable proportion of old people (over 50 years). Most of the families predominantly belonged to Scheduled Castes (39.7%) and OBC (31%) The overall sex ratio was 891 females per thousand males, which is rather on the lower side. Major sources of income were reported to be wage labor and farming.


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The population of children (up to 5years) was reported to be only12.8 %. The child female: male sex ratio however was 866. Major source of water was observed to be tube-well and open wells. More than 44 % of the population had no education (38.1%males, 50.1 % females). Among the literates 23.5 % had studied up to primary level,18.3 % had studied up to middle level while 11.36% of the population studied up to high school and only 2.8 % had studied beyond high school. Illiteracy amongst females is much higher than amongst males. During last 12 months 23 deaths out of total population of 5,790 were reported amounting to 4 deaths per thousand. Out of the total deaths reported 13 % were due to ageing, and 25 % due to chronic illness. Neonatal deaths accounted for 13% deaths reported Infant deaths accounted for 26 % deaths. Of the total population under study 85 % were malnourished and all the respondents were reported to have at least one disease. Here also, we have multiple responses. 54.8 % of households were registered in the MNREGA scheme. On an average 3 persons per household took part in the MNREGA. 4.7 got job for entitled 100 days. 16.8 % received jobs for 1-30days, 17.5 % for 31-60 days and 5.9 % from 61-99days. 55.1 % did not get a job even for a day. 80.% Pregnant women were in the age group of 18-30 while 13.8 % were in 31-<40 years of age. Nutritional status of women was assessed using both anthropometric measurements and some observed symptoms, particularly for pregnant women. The indicators considered for malnutrition are Body Mass Index (BMI) and Mid Upper Arm Circumference (MUAC). Women with BMI<18.5 were considered to be underweight. Women having MUAC<21 cm were also considered malnourished. For pregnant women only MUAC was used. Based upon MUAC measurement, 6.5 % were found to be undernourished. Of the total pregnant women, 80 % were registered with ICDS. 90.5 % pregnant women, registered with ICDS availed the support services only once and 9.5 % two times. Among the mothers of children under twos, 30.4 % women in the age group 18-30 years were having low BMI. This percentage was 34.8 for mothers above 30 years. More than 85 % mothers of under twos were reported to be registered with ICDS. About 97.1 % mothers availed the services only once and 2.9 % twice. Birth weight of 17.3 % children was younger than 2.5 kg. In more than 26 % cases no records were available. In this study 65.4 % children were found to be stunted with 51.4 % being severely stunted and 14 % moderately stunted. In the underweight category 59.1 % were underweight of which 36.3 % children were severely underweight and 22.8 % were moderately underweight. Regarding wasting, 47.8 % were wasted. Of these, 19.8 % children were found to be severely wasted and1 28 % moderately wasted.


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MUAC of 5.7 % children was found to be below the WHO recommended cut of 11.5 cm for detecting severe acute malnutrition (SAM). As per the WHO recommendation, MUAC is advised to be used for identifying SAM children. Of these SAM children, 79.3 % children were registered with ICDS and 62 % were recipient of ration. 50.4 % of children 6-36 months took food packets from Anganwadis to home. Nutritional level of children was very low as per the prevalence of stunting, under-weight and wasting. The factors associated with under-nutrition were caring practices, prevalence of disease, hygiene, affiliation of child with social groups and mothers’ literacy status. None of the indicators of malnutrition were found to be associated with child’s affiliation with social groups and literacy status of mothers. Logistic regression analysis has revealed that for children up to 2 years, for stunting, diseases, complementary feeding and BMI of mothers have emerged as risk factors; for underweight the risk factor is disease while for wasting, BMI has emerged as risk factor. For children up to 5 years, all the three factors (child’s age, disease and complementary feeding) have emerged as risk factors for stunting; for underweight risk factors are child’s age and diseases and for wasting the risk factors are diseases and complementary feeding. About 9.1 % children were out of school. Children taking care of other children, was cited as main reason for drop out. Educational scenario was noted to be rather grave. The drop out rate was highest in 33.3 % each in classes 1,3 and 4. High drop out rate at lower classes is a matter of concern.

1. Background

1.1Introduction

Hunger and malnutrition are global phenomenon. As per the FAO estimates, there were 925 million hungry people in the World during the year 2010. China and India account for 40 % population of the hungry people. In order to rank the countries on the basis of prevalence of hunger, Global Hunger Index (GHI) was developed by IFPRI. GHI includes three indicators of hunger (i) proportion of children that are food energy deficient as per FAO estimates (ii) proportion of underweight children below five years of age as per WHO estimates and (iii) Under five mortality rate as per UNICEF estimates. Even though as per IFPRI1 (2008) estimates hunger index for India has fallen from 34 % in 1990 to 23 % in 2008 yet it continues to be in the category of nations where hunger is alarming. Further, its score is poorer than that of Sub-Saharan countries whose GDP is much lower than that of India. IFPRI (2008) prepared hunger index of 17states of India covering about 95 % population. Out of these 17 states, 12 states fell in the ‘alarming’ category with Madhya Pradesh in ‘extremely alarming category’. With the exception of Punjab, Kerala, Andhra Pradesh, Assam and Haryana, all other states were in ‘alarming category’ of hunger. A natural consequence of hunger is malnutrition. Under the present socio economic scenario of the country the victims are women and children. Pregnant women and mothers of children of younger than 2 years suffer on account of poor nutrition, lack of proper medical facilities, lack of anti natal and post natal care. Children bear the brunt of poor food intake, undernourished mothers, lack of proper preventive practices like immunization etc. Under five mortality rate, reported as deaths per thousand, was 74.3 (NFHS-III2). IFPRI (2008) estimated that prevalence of calorie undernourishment was 20 % at country level. The cut off used by IFPRI was 1,632 Kcal/day, Body mass index (BMI) is widely used to measure nutritional status BMI is a combination of height and weight and is calculated by dividing weight in kilograms by height in meters squared. A value below 18.5 indicates chronic energy deficiency (CED) in adults which is a result of low calorie intake and other nutrients below the requirement. According to the XI Plan, Volume2 (Planning Commission, 2008) in 2005, about 33 % population had BMI below 18.5. For children below 5 years of age, indicators for assessing nutritional status are (i) Stunting (too short for age) (ii) Underweight (too less weight for age) and (iii) Wasting (too thin for height). These are described in details at relevant sections of the report. As per NFHS-III estimates, at all India level, 38.4 % children are stunted, 45.9 % underweight and 19.1 % wasted.

1 IFPRI(2008) India State Hungry Index: Comparison of Hunger across States.eds. P.Menon, A.

Deolalikar and A. Bhalla, New Delhi:IFPRI,14 October

2 NFHS-III fact Sheet


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From the above discussions it is clear that health and nutritional scenario is not good in spite of economic growth that has taken place during last two decades. Further, there is need to study the causal and underlying factors at block and village levels, specially the underdeveloped ones. Realizing the rights and potentials of underprivileged classes of the society, Welthungerhilfe, initiated a program ‘Fight Hunger First Initiative’ (FHFI) together with national and international partners on a common platform in a bid to address lack of food and nutrition security among the rural poor. FHFI taking a comprehensive programmatic approach aims at making systems accountable towards the poor. It puts conscious focus on the poor, marginalized sections of the society living in remote villages of tribal and backward districts through Area Based Approach; it promotes a systematic way of building evidence through uniform monitoring systems and well established base line methodologies. Strengthens people’s institutions following the framework of Citizen’s rights. Taking a multi-sect oral approach, it encourages pilots on improved farming systems, better care of severely acute malnourished children at community level and building capacities of decentralized governance structures such as School Management Committees and village health committees. It focuses on building collective voices through federated structures of people at sub-district (block) level and by creating/associating with rights based networks at State and National level. The aims of the initiative are as under: To significantly improve key indicators related to food, income and nutrition security through long term intervention together with partner NGOs. To achieve convergence with government schemes and departments. To strengthen collaboration efforts among the partners on aspects related to capacity building, advocacy and fund raising.

1.2 The Study

The study “Household Survey for the Assessment of Nutrition and Education Status” is a component of the ‘Baseline Studies on Food Nutrition and Education Status’ is undertaken by Welthungehilfe Regional Office South Asia’s ‘Fight Hunger First’ initiative. Nine partner organizations were engaged in this study. Jansahas carried out survey in four blocks of four districts viz., Pawai (Panna district), Jhirnaya (Khargone district), Pandhana(Khandawa district) and Sonkatch (Dewas district). Jan Sahas Social Development Society is a social and community based organization that is committed to protection and promotion of human rights and development of socially excluded communities through abolishing all kinds of slavery, social exclusion, atrocities and all forms of discrimination based on caste, class and gender. Jan Sahas works on a range of issues to realize its mission. The organization is working in the rural and urban areas of 7 district of Madhya Pradesh and also working through fellowship program in 72 districts of 4 states (Madhya Pradesh,


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Uttar Pradesh, Rajasthan and Maharashtra) of north India. Through its networking and collaborative initiatives the organization is involved in national level policy and advocacy initiatives. constituents Institute of Applied Statistics and Development Studies (IASDS) provided support in conducting the survey, analysis of data collected, presentation of findings and production of report with focus on findings and recommendations based on technical support from a nutritionist.

1.2.1 Objectives

Main objectives of the survey were to collect the relevant data for reporting on a) stunting rates of children below five years (b) Maternal and child mortality rates (c) School enrolment and drop out rates of children between the age groups of 5 to 14 years. Even-though the objective (a) as per the TOR refers to ‘stunting rates of children’ only, data were also collected on weight of children and information was analyzed for informing on ‘underweight’ and ‘wasting’ rates of children. This was considered important since the Government of India (GOI) is using the underweight data in the ICDS program while the wasting and MUAC data is used for the management of severe acute malnutrition (SAM) cases by the health sector.

1.2.2 Methodology

Scope of field Investigation; The survey was carried out in study area with the objective to ascertain nutritional and educational status of women and children. The survey is expected to provide an insight into possible causative factors of under-nutrition and recommend possible follow up actions. Population under study: Entire population of study area was viewed as target group. For nutritional purposes, pregnant women and mothers of children up to the age of 2 years and children up to 5 years of age were considered. For educational purpose, children in the age group 5-14 years were considered. Tools utilized in the study: As a first step a training program was organized for the organizations at Welthungerhilfe Office to apprise them of the objectives of the study. Study areas were decided mutually by organizations and Welthungerhilfe. Keeping in view the objectives of the survey a questionnaire was prepared for collecting information. The enumerators were trained to collect anthropometric measurements. The data collected was entered in excel sheets and sent to IASDS for analysis and report writing. Besides routine analysis statistical tools like Chi-square test for independence of attributes and logistic regression to identify risk factors of malnutrition were applied. Data were analyzed using MS-Excel and SPSS 10.


17

1.2.3 Target Groups

As mentioned above main objectives of the study were studying the nutritional and educational status. Keeping these objectives in view the target groups comprised of the following categories. Pregnant women / Mothers of children younger than 2 years, Children below five years. Children between 5 to 14 years. For nutritional component, the main target groups studied were pregnant women/ Mothers of children younger than 2 years and children below five years. For educational aspect, the target group comprised children in the age group of 5 to 14 years

1.2.4 A brief profile of Study Area and Coverage

Devas, Khargone and Dewas districts are located in in south west direction of Madhya Pradesh while Panna district is located in north east. District Panna belongs to hilly terrain of the state. Khargone and Khandwa districts are located in Narmada valley while Dewas is partly in Narmada valley and partly in Malwa Plateau. Jhirniya block consists of 76 Gram Panchayats and 129 villages. Major social group comprises of ST population. In Pandhana there are 88 Gram Panchayats and 128 villages.. Major social group is ST. Pawai block consists of 82 Gram Panchayats and 179 villages. Major social group is OBC. Sonkatch block consists of 65 Gram Panchayats. A total of 30 villages (of 19 Panchayats) located in Sokatch, Pandhana, Jhirniya and Pawai blocks were covered. All the households of this area were viewed as the target groups. A total of 7,339 (1,938 Sonkatch, 2,085 Pandhana, 1,831 Jhirniya, 1,485 Pawai) households were covered in the study.


18

2. Household Profiles

2.1 Introduction

In this chapter an attempt has been made to review demographic and social characteristics of house holds in the study area. An understanding of demographic and social characteristics of population under study helps in identifying the underlying causes of under-nutrition in women and children. Indicators like social groups, sources of income, availability of water, medical facilities, rural infrastructure and educational facilities help in identifying the possible causes of under-nutrition and ultimately, possibly their solutions.

2.2 Demographic Profile and Household Characteristics

This section is devoted to various aspects of demographic and household characteristics of the households in the study area. Social Groups Table 2.1 presents demographic profile and household characteristic of the house holds under study. Sonkatch A total of 1,938 households were surveyed. In 97.2 % cases the households were headed by males. The average family size noted was 4.7 with 2 females per household. Overall sex ratio was 726 females per thousand males which less than overall sex ratio at district level which is 924 females per thousand males as per AHS3 report 2010-11.Corresponding sex ratio among children (0-5 years) is 690; this is a matter of very serious concern. The Scheduled Castes (36.3%) and General (39.4%) are major social groups of the population.

3 Annual Health Survey (2010-11): Fact Sheet


19

Table 2.1: Demographic Profile and Household Characteristics

Demographic Profile and Household Characteristics

%

Household headed by Sonkatch Pandhana Jhirnaya Pawai

Male 97.2 95.9 94.1 95.4 Female 2.8 4.1 5.9 4.6

Average Family Size 4.7 4.4 4.8 3.9 Average female members in a family 2.0 2.1 2.3 1.8 Overall Sex Ratio 726 914 887 891 Child Sex Ratio (0-5 years) 690 865 939 866 Social Group

Scheduled Caste 36.3 3.2 1.2 39.7 Scheduled Tribe 6.9 90.1 96.9 4.6 OBC 17.4 0.8 1.5 31.0 General 39.4 5.9 0.4 24.7

Source of Drinking Water (Multiple Response)

Piped Water 0.3 2.4 0.5 30.9 Pond/ River 0.1 3.3 5.2 1.0 Open Well 15.0 58.7 47.1 23.6 Tube Well 85.7 30.6 77.0 44.5 Any Other 0.6 6.2 5.5 0.1 Source of Income of Household (Multiple Response)

Farming 67.8 71.5 62.7 53.8 Wage Labor 52.5 83.6 98.0 63.3 Livestock 11.5 2.2 2.2 0.3 Fishing 0.2 0.1 0.3 1.0 Small business 0.9 1.1 0.7 2.2 Government employment 1.7 0.9 1.7 2.2 Seasonal migration 0.2 44.7 56.2 0.7 Others 0.2 1.1 0.3 0.1 Primary Source of Income

Farming 59.8 41.9 15.1 37.9 Wage Labor 38.6 54.1 80.5 51.0 Livestock 0.3 0.1 0.1 0.1 Fishing 0.0 0.1 0.1 0.0 Small business 0.2 0.4 0.2 1.0 Government employment 1.0 0.4 0.5 1.9 Seasonal migration 0.1 2.6 3.4 8.1


20

Others 0.1 0.5 0.1 0.0 Base: Total households surveyed 1,938 2,085 1,831 1,485 Pandhana A total of 2,085 households were surveyed. In 95.9 % cases the households were headed by males. The average family size noted was 4.4 with 2.1 females per household. Overall sex ratio was 914 females per thousand males which is less than overall sex ratio at district level (Khandwa or East Nimar) which is 988 females per thousand males as per AHS4 report 2010-11.Corresponding sex ratio among children (0-5 years) is 865.This is a matter of very serious concern. The Scheduled Tribes (90.1%) is major social group of the population. Jhirnaya A total of 1,831 households were surveyed. In 94.1% cases the households were headed by males. The average family size noted was 4.8 with 2.3 females per household. Overall sex ratio was 887 females per thousand males which is less than overall sex ratio at district level (Khangone or West Nimar) which is 926 females per thousand males as per AHS5 report 2010-11.Corresponding sex ratio among children (0-5 years) is 939. The Scheduled Tribes (96.5%) is major social group of the population. Pawai A total of 1,485 households were surveyed. In 95.41% cases the households were headed by males. The average family size noted was 3.9 with 1.8 females per household. Overall sex ratio was 891 females per thousand males which is less than overall sex ratio at district level which is 908 females per thousand males as per AHS6 report 2010-11.Corresponding sex ratio among children (0-5 years) is 866. This is a matter of very serious concern. The Scheduled Castes (39.7%) and OBC (31%) are major social group of the population. Fig. 2.1 displays composition of social groups in study area.

Figure 2.1: Composition of Social Groups in Study Area





21

36.3

3.2 1.2

39.7

6.9

90.1 96.9

4.6

17.4

0.8 1.5

31 39.4

5.9 0.4

24.7

0 10 20 30 40 50 60 70 80 90

100

Sonkaich Pandhana Jhirnya Pawai

Blocks

% Scheduled Caste Scheduled Tribe OBC General


22

Water Resources Tube-wells and open wells are main sources of water in this area. Fig.2.2 displays the composition in the four blocks under study. Here we find multiple responses as there can be more than two sources of water in the area.

Figure 2.2: Available water resources in Study Area (Multiple response)

0.32.40.5

30.9

0.13.35.2

1

15

58.7

47.1

23.6

85.7

30.6

77

44.5

0.66.25.5

0.10

10

20

30

40

50

60

70

80

90

Percent

Piped Water Pond/ River Open Well Tube Well Any Other

Source of Water

Sonkaich

Pandhana

Jhirnya

Pavai

Sources of Income-Migration Sonkatch Farming (67.8%) and wage labor (52.5%) are main sources of income in this area. In 0.2 % cases seasonal migration was reported out of a total population under study. Table 2.2 provides details of migration. Total 74 seasonal migrations out of 1,938 households were reported. On an average 2.5 persons migrated seasonally from each of the household from where migration was reported. Migration for 3-6 months was highest. Most proffered places of migration were Indore and other places of Madhya Pradesh.


23

Table 2.2: Details of Migration

Details of Migration %

Sonkach Pandhana Jhirniya Pawai Families seasonally migrated 3.8 54.8 62.7 20.9 Average family members migrated 2.5 2.5 2.9 2.8 Duration of Migration Below 3 months 26.1 17.0 24.7 8.8 3-6 months 42.0 63.7 53.6 27.7 6 months – 1 year 31.9 19.3 20.6 62.5 More than 1 year 26.1 17.0 1.2 1.0 Place of Migration Bediya 0.0 27.3 11.7 0.0 Dewla 27.0 0.3 3.1 0.0 Dhangaon 1.4 7.2 5.8 0.6 Delhi 0.0 0.0 0.0 53.7 Pune 0.0 2.8 2.1 0.0 Indore 23.0 26.2 19.3 1.6 Other districts of M.P. 24.3 25.5 36.6 20.6 Other (Gujarat, Rajasthan, Orissa, Gurgaon, Maharashtra etc.)

24.3 10.7 21.4 23.5

Base : Total migrated 74 1,142 1,149 311 Pandhana Farming (71.5%) and wage labor (83.6%) are main sources of income in this area. In 44.7 % cases seasonal migration was reported out of a total population under study. Table 2.2 provides details of migration. Total 1,142 seasonal migrations out of 2,085 households were reported. On an average 2.5 persons migrated seasonally from each of the household from where migration was reported. Migration for 3-6 months was highest. Most preferred places of migration were Indore and other places of Madhya Pradesh. Jhirnaya Farming (62.7%) and wage labor (98%) are main sources of income in this area. In 56.2 % cases seasonal migration was reported out of a total population under study. Table 2.2 provides details of migration. Total 1,149 seasonal migrations out of 1,831 households were reported. On an average 2.9 persons migrated seasonally from each of the household from where migration was reported. Migration for 3-6 months was highest. Most preferred places of migration were Indore and other places of Madhya Pradesh. Pawai Farming (53.8%) and wage labor (63.3%) are main sources of income in this area. In 0.7 % cases seasonal migration was reported out of a total population under


24

study. Table 2.2 provides details of migration. Total 311 seasonal migrations out of 1,485 households were reported. On an average 2.9 persons migrated seasonally from each of the household from where migration was reported. Migration for 6months-1 year was highest. Most preferred places of migration were Delhi and other places of Madhya Pradesh. Educational Level Information about the educational level of the population above 6 years of age was gathered. Details of educational levels in study area are given in Table 2.3. Sonkatch More than 38 % of the population had no education (29.4 %males, 47.9 % females). Among the literates 28.6 % had studied up to primary level,18.1 % had studied up to middle level while 11.4% of the population studied up to high school and only 3.6 % had studied beyond high school. Illiteracy amongst females is much higher than amongst males.

Table 2.3: Educational level component of population

Literacy of population (greater than 6 years)

Sonkach Pandhana

Male Female Both Male Female Both Illiterate 29.4 47.9 38.7 59.4 70.9 65.1 Literate 70.6 52.1 61.3 40.6 29.1 34.9 Educational Level Primary 32.3 24.8 28.6 28.1 16.9 22.5 Middle 19.7 16.5 18.1 8.1 8.5 8.3 High School 15.6 7.2 11.4 3.1 3.7 3.4 Above high school 2.9 3.6 3.3 1.3 0.0 0.7 Literacy of population (greater than 6 years)

Jhirniya Pawai

Male Female Both Male Female Both Illiterate 61.7 69.2 65.3 38.1 50.1 44.1 Literate 38.3 30.8 34.7 61.9 49.9 55.9 Educational Level Primary 25.8 22.4 24.1 21.8 25.2 23.5 Middle 9.1 5.9 7.5 20.6 16.0 18.3 High School 2.6 2.5 2.6 16.9 5.7 11.3 Above high school 0.8 0.0 0.4 2.6 3.0 2.8 Pandhana More than 65 % of the population had no education (59.4%males, 70.9 % females). Among the literates 22.5 % had studied up to primary level,8.3 % had studied up to middle level while 3.4% of the population studied up to high school and only 0.7 % had studied beyond high school. Illiteracy amongst females is much higher than amongst males.


25

Jhirnaya More than 65 % of the population had no education (61.7%males, 69.2 % females). Among the literates 24.1 % had studied up to primary level,5.9 % had studied up to middle level while 2.6% of the population studied up to high school and only 0.4 % had studied beyond high school. Illiteracy amongst females is much higher than amongst males. Pawai More than 44 % of the population had no education (38.1%males, 50.1 % females). Among the literates 23.5 % had studied up to primary level,18.3 % had studied up to middle level while 11.36% of the population studied up to high school and only 2.8 % had studied beyond high school. Illiteracy amongst females is much higher than amongst males.

2.3 Age and Sex-wise distribution of Population

Sonkatch Table 2.4a displays age and sex-wise distribution of population under study.A total population of 9,139 was under study that consisted of 5,293 males and 3,846 females. It may be observed from the table that population under 5 accounts for 11.6 % of total population. The proportion of children below one year is also very small (1.8%). The population of 9,139 under study consisted of 5,340 adults; 3,017 males and 2,323 females. The proportion of people in higher age group (≥50 years) was 16 %.

Table 2.4a: Population distribution by age and sex-Sonkatch

Population distribution by age and sex (%)- Sonkach

Age Group

Male Female

Total

N % N % N % Children Below 1 year 97 1.8 68 1.8 165 1.8 1 to below 3 Years 200 3.8 126 3.3 326 3.6 3-5 Years 329 6.2 238 6.2 567 6.2 6-14 Years 1,144 21.6 766 19.9 1,910 20.9 15-18 Years 506 9.6 325 8.5 831 9.1 19-25 Years 748 14.1 557 14.5 1,305 14.3 26-49 Years 1,446 27.3 1,123 29.2 2,569 28.1 50 Years 823 15.6 643 16.7 1,466 16.1 Base : Total population 9,139 Note: Total females of 15-49 years 2,005


26

Pandhana Table 2.4b displays age and sex-wise distribution of population under study.A total population of 9,237 was under study that consisted of 4,826 males and 4,411 females. It may be observed from the table that population under 5 accounts for 12.7% of total population. The proportion of children below one year is also very small (1.5%). The population of 9,237 under study consisted of 4,658 adults; 2,323 males and 2,335 females. The proportion of people in higher age group (≥50 years) was 9.9 %.

Table 2.4b: Population distribution by age and sex (%)- Pandhana

Population distribution by age and sex (%)- Pandhana

Age Group

Male Female

Total

N % N % N % Children Below 1 year 71 1.5 70 1.6 141 1.5 1 to below 3 Years 211 4.4 184 4.2 395 4.3 3-5 Years 347 7.2 290 6.6 637 6.9 6-14 Years 1,365 28.3 1,093 24.8 2,458 26.6 15-18 Years 509 10.5 439 10.0 948 10.3 19-25 Years 602 12.5 544 12.3 1,146 12.4 26-49 Years 1,281 26.5 1,317 29.9 2,598 28.1 50 Years 440 9.1 474 10.7 914 9.9 Base : Total population 9,237 Note: Total females of 15-49 years 2,300 Jhirnaya Table 2.4c displays age and sex-wise distribution of population under study. A total population of 8,816 was under study that consisted of 4,673 males and 4,143 females. It may be observed from the table that population under 5 accounts for 17 % of total population. The proportion of children below one year is also very small (2.3%). The population of 8,816 under study consisted of 4,144 adults; 2,224 males and 1,920 females. The proportion of people in higher age group (≥50 years) was 9.1 %.


27

Table 2.4c: Population distribution by age and sex (%)- Jhirniya

Population distribution by age and sex (%)- Jhirniya

Age Group

Male Female

Total

N % N % N % Children Below 1 year 98 2.1 108 2.6 206 2.3 1 to below 3 Years 232 4.9 250 6.0 482 5.5 3-5 Years 442 9.5 366 8.8 808 9.2 6-14 Years 1,259 26.9 1,113 26.9 2,372 26.9 15-18 Years 418 8.9 386 9.3 804 9.1 19-25 Years 629 13.5 513 12.4 1,142 12.9 26-49 Years 1,174 25.1 1,034 25.0 2,208 25.0 50 Years 421 9.1 373 9.0 794 9.1 Base : Total population 8,816 Note: Total females of 15-49 years 1,933 Pawai Table 2.4d displays age and sex-wise distribution of population under study. A total population of 5,790 was under study that consisted of 3,061 males and 2,729 females. It may be observed from the table that population under 5 accounts for 12.8 % of total population. The proportion of children below one year is also very small (1.9%). The population of 5,790 under study consisted of 3,306 adults;1,694 males and 1,612 females. The proportion of people in higher age group (≥50 years) was 14.3 %.

Population distribution by age and sex (%)- Pawai

Population distribution by age and sex (%)- Pawai

Age Group

Male Female

Total

N % N % N % Children Below 1 year 53 1.7 55 2.0 108 1.9 1 to below 3 Years 125 4.1 107 3.9 232 4.0 3-5 Years 218 7.1 181 6.6 399 6.9 6-14 Years 640 20.9 523 19.2 1,163 20.1 15-18 Years 331 10.8 251 9.2 582 10.1 19-25 Years 454 14.8 371 13.6 825 14.2 26-49 Years 856 28.0 798 29.2 1,654 28.6 50 Years 384 12.5 443 16.2 827 14.3


28

Base : Total population 5,790 Note: Total females of 15-49 years 1,420 Fig. 2.3 displays age and sex-wise distribution of population of study area.

Figure2.3: Age and sex-wise distribution of Population in Study Area

0

5

10

15

20

25

30

35

Male

Fem

ale

Tota

l

Male

Fem

ale

Tota

l

Male

Fem

ale

Tota

l

Male

Fem

ale

Tota

l

Sonkatch Pandhana Jhirnaya Pavai

Blocks

Perc

en

t <1Yr

1-<3Yr

3-5Yr

6-14Yr

15-18Yr

19-25Yr

25-49Yr

≥50 Yr

2.4 Beneficiaries of Government Schemes

Access to livelihood and food availability is very important component of proper nutrition and food security. We have in this study tried to assess the benefits of three Govt. schemes namely; Public distribution system (PDS) or ration card scheme, Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA) Scheme and Mid-Day Meals (MDM). Table 2.5 contains all the details of beneficiaries of these schemes. Sonkatch PDS Of all the households 95.3 % reported to have some kind of ration cards. All of these possessed one card and no one possessed more than one card. Of the card holders only 0.2 % received ration within one week, 19.9 % in one month and 79.8 % never received ration. This reveals a very poor scenario of Public Distribution System (PDS). Distribution of number of family members covered under PDS varied from 2 (16.1%) to 4 (24.1%) In more than 21 % cases this number exceeded 5. MNREGA 88.7 % of households were registered in the MNREGA scheme. On an average 3.6 persons per household took part in the MNREGA. Only 0.7 % got job for entitled 100


29

days. 3.9 % received jobs for 1-30days, 2.4 % for 31-60 days while 0.7 % received jobs for 61-99 days. 92.3 % did not get a job even for a day. Mid Day Meals (MDM) 88.9 % schools reported to have provided MDM to children. 1.Dal, Rice 2.Dal,Roti3.Dal, Roti, Vegetable4.Dal,Roti, Rice, Vegetable5. Rice kheer, Puri6. Roti, Vegetable were served in MDM. No supplements like eggs, meat or fish seems to have been provided.


30

Table 2.5: Government Schemes Beneficiaries

Government Schemes Beneficiaries

%

Household Ration Cards (Multiple Response) Sonkach Pandhana Jhirniya Pavai AAY 8.1 7.2 8.6 12.9 BPL 11.8 64.2 40.0 57.5 APL 75.5 10.5 27.6 12.8 With No Card 4.7 18.2 23.9 16.9 percentage of households with

One Card 100.0 99.8 99.9 99.9 More than one card 0.0 0.2 0.1 0.1 Subsidized food last received

Within week 0.2 2.9 2.0 1.8 Within month 19.9 81.3 84.3 77.8 Never received 79.8 15.8 13.6 20.3 Family members covered in PDS card

One 1.8 2.7 3.1 6.5 Two 16.1 25.0 22.8 24.4 Three 13.7 13.4 13.5 16.1 Four 24.1 15.9 15.2 17.8 Five 21.6 17.0 19.8 15.6 More than five 22.6 25.9 25.6 19.6 NREGA

Households with NREGA Job card 88.7 78.4 68.2 54.8

Members of households registered in NREGA

One 3.3 4.5 6.0 10.9 Two 28.1 66.5 25.0 42.5 Three 15.5 13.5 13.7 14.7 More than three 53.1 15.5 55.3 31.9

Average number of members registered 3.6 2.5 3.8 3.0 Number of days received job in a year

0 days 92.3 97.4 96.3 55.1 1-30 days 3.9 2.2 3.3 16.8 31-60 days 2.4 0.3 0.4 17.5 61-99 days 0.7 0.0 0.0 5.9 100 days 0.7 0.1 0.0 4.7 Mid Day Meal


31

Mid day meal provided in school

Yes 88.9 94.0 97.4 96.1 No 11.1 6.0 2.6 3.9 Meals provided 1.Dal, Rice

2.Dal, Roti 3. Dal, Roti, Vegetable 4.Dal,Roti, Rice, Vegetable 5. Rice kheer, Puri 6. Roti, Vegetable

Pandhana PDS Of all the households 81.8 % reported to have some kind of ration cards. 99.8 % of these possessed one card and 0.2 % possessed more than one card. Of the card holders only 2.9 % received ration within one week, 81.3 % in one month and 15.8 % never received ration. This reveals a very poor scenario of Public Distribution System (PDS). Distribution of number of family members covered under PDS varied from 2 (25%) to 4 (15.9%) In more than 25.9 % cases this number exceeded 5. MNREGA 78.4 % of households were registered in the MNREGA scheme. On an average 2.5 persons per household took part in the MNREGA. Only 0.1 % got job for entitled 100 days. 2.2 % received jobs for 1-30days, 0.3% for 31-60 days. 97.4 % did not get a job even for a day. Mid Day Meals (MDM) 94 % schools reported to have provided MDM to children. 1.Dal, Rice 2.Dal,Roti3.Dal, Roti, Vegetable4.Dal,Roti, Rice, Vegetable5. Rice kheer, Puri6. Roti, Vegetable were served in MDM. No supplements like eggs, meat or fish seems to have been provided. Jhirnaya PDS Of all the households 76.1 % reported to have some kind of ration cards. 99.9% of these possessed one card and 0.1 % possessed more than one card. Of the card holders only 2 % received ration within one week, 84.3 % in one month and 13.6 % never received ration. This reveals a very poor scenario of Public Distribution System (PDS). Distribution of number of family members covered under PDS varied from 2 (22.8%) to 4 (15.2%) In more than 25.6 % cases this number exceeded 5. MNREGA 68.2 % of households were registered in the MNREGA scheme. On an average 3.8 persons per household took part in the MNREGA. No one got job for entitled 100 days. 3.3 % received jobs for 1-30days, 0.4 % for 31-60 days. 96.3 % did not get a job even for a day.


32

Mid Day Meals (MDM) 97.4 % schools reported to have provided MDM to children. 1.Dal, Rice 2.Dal,Roti3.Dal, Roti, Vegetable4.Dal,Roti, Rice, Vegetable5. Rice kheer, Puri6. Roti, Vegetable were served in MDM. No supplements like eggs, meat or fish seems to have been provided. Pawai PDS Of all the households 83.1 % reported to have some kind of ration cards. 99.9% of these possessed one card and 0.1 % possessed more than one card. Of the card holders only 1.8 % received ration within one week, 77.8 % in one month and 20.3 % never received ration. This reveals a very poor scenario of Public Distribution System (PDS). Distribution of number of family members covered under PDS varied from 2 (24.4%) to 4 (17.8%) In more than 19.6 % cases this number exceeded 5. MNREGA 54.8 % of households were registered in the MNREGA scheme. On an average 3 persons per household took part in the MNREGA. 4.7 got job for entitled 100 days. 16.8 % received jobs for 1-30days, 17.5 % for 31-60 days and 5.9 % from 61-99days. 55.1 % did not get a job even for a day. Mid Day Meals (MDM) 96.1 % schools reported to have provided MDM to children. 1.Dal, Rice 2.Dal,Roti3.Dal, Roti, Vegetable4.Dal,Roti, Rice, Vegetable5. Rice kheer, Puri6. Roti, Vegetable were served in MDM. No supplements like eggs, meat or fish seems to have been provided.

Figure 2.4: Job days in MNREGA

0

10

20

30

40

50

60

70

80

90

100

Percent

0 days 1-30 days 31-60 days 61-99 days 100 days

Job days

Sonkaich

Pandhana

Jhirnya

Paval

2.5 Mortality and Morbidity

Table 2.6 describes mortality and morbidity details of the population during the last 12 months.


33

Sonkathch Mortality—Neonatal and Infant Mortality During last 12 months 44 deaths out of total population of 9,139 were reported amounting to 4.8 deaths per thousand. Out of the total deaths reported 41.9 % were due to ageing, 7 % deaths during delivery/pregnancy, and 11.6 % due to chronic illness. Neonatal deaths accounted for 9.1 % deaths reported Infant deaths accounted for 13.6 % deaths. Morbidity Of the total population under study 29.3 % were reported to be chronically ill, 16.7 % were malnourished and all the respondents were reported to have at least one disease. Here also, we have multiple responses.

Table 2.6: Mortality and Morbidity Details

Mortality and Morbidity Details Mortality percentage

Sonkach Pandhana Jhirniya Pavai

Households reported deaths during last 12 months

2.3 1.6 2.7 1.5

Sex of the deceased Male 65.9 52.9 44.9 52.2 Female 34.1 47.1 55.1 47.8 Per Thousand Population Total Death Rate 4.8 3.7 5.6 4.0 Reason for death percentage Aged 41.9 12.1 20.8 13.0 During Pregnancy/Delivery 7.0 6.1 12.5 0.0 Chronic Illness 11.6 51.5 25.0 43.5 Specific diseases/symptoms 27.9 21.2 20.8 30.4 Others (Suicide, Road Accident, Death during Surgery etc.)

25.6 15.2 22.9 26.1

Deaths reported in last 12 months Neonatal (younger than 28 days) 9.1 5.9 12.2 13.0 Infants (Children below 1 year) 13.6 5.9 18.3 26.0 Children under 5 years of age 15.9 17.6 32.7 34.8 Member more than 5year of age 84.1 82.4 67.3 65.2 Base: Total Deaths Reported 44 34 49 23 Morbidity Observations (Multiple Response) Chronically Ill 29.2 30.0 41.2 0.0 Malnourished 16.7 25.0 23.5 85.0 Other Diseases (Pain in hand, back and leg, Sinus, Skin diseases, Heart disease, Kidney

54.2 35.0 35.3 15.0


34

problems, Blood Pressure etc.) Persons with Only one disease 100.0 100.0 100.0 100.0 Two diseases 0.0 0.0 0.0 0.0 More than two diseases 0.0 0.0 0.0 0.0 Population with any disease 0.2 0.1 0.2 0.3 Pandhana Mortality—Neonatal and Infant Mortality During last 12 months 34 deaths out of total population of 9,237 were reported amounting to 3.7 deaths per thousand. Out of the total deaths reported 12.1 % were due to ageing, 6.1 % deaths during delivery/pregnancy, and 51.5 % due to chronic illness. Neonatal deaths accounted for 5.9 % deaths reported Infant deaths accounted for 5.9 % deaths. Morbidity Of the total population under study 30 % were reported to be chronically ill, 25 % were malnourished and all the respondents were reported to have at least one disease. Here also, we have multiple responses. Jhirnaya Mortality—Neonatal and Infant Mortality During last 12 months 49 deaths out of total population of 8,816 were reported amounting to 5.6 deaths per thousand. Out of the total deaths reported 20.8 % were due to ageing, 12.5 % deaths during delivery/pregnancy, and 25 % due to chronic illness. Neonatal deaths accounted for 12.2 % deaths reported Infant deaths accounted for 18.3 % deaths. Morbidity Of the total population under study 41.2 % were reported to be chronically ill, 23.5 % were malnourished and all the respondents were reported to have at least one disease. Here also, we have multiple responses. Pawai Mortality—Neonatal and Infant Mortality During last 12 months 23 deaths out of total population of 5,790 were reported amounting to 4 deaths per thousand. Out of the total deaths reported 13 % were due to ageing, and 25 % due to chronic illness. Neonatal deaths accounted for 13% deaths reported Infant deaths accounted for 26 % deaths. Morbidity Of the total population under study 85 % were malnourished and all the respondents were reported to have at least one disease. Here also, we have multiple responses.


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36

3. Nutritional Status of Women and Children

3.1 Nutritional Status of Women

The study focuses on assessment of nutritional status based on anthropometric measurements and some observed symptoms, particularly for pregnant women. The indicators considered for malnutrition were Body Mass Index (BMI7) and Mid Upper Arm Circumference (MUAC8). Women with BMI<18.5 were considered to be undernourished.. Women (including pregnant women) having MUAC<21 cm were also classified as malnourished. In this study women have been categorized into two categories (i) pregnant women (ii) Mothers of children up to the age 2 of years. In the following sections we describe the various aspects pertaining to nutrition of women. For pregnant women, only MUAC data is reported. Table 3.1 presents the nutritional and the related details of pregnant women and mothers of children blow 2 years of age.

Table 3.1: Particulars of Pregnant Women/ Mothers of children up to 2

years

Particulars of Pregnant Women/ Mothers of children up to 2 years

percentage


Pregnant women 9.0 25.8 58.0 33.9 Mother of babies 89.3 72.1 40.4 66.1 Both 1.7 2.1 1.6 0.0 Base : Total surveyed

Pregnant 32 88 215 65 Mother of babies 316 246 150 127 Both 6 7 6 0 Pregnant Women Age of pregnant women

Below 18 years 0.0 0.0 0.9 0.0 18- 30 years 94.7 90.5 87.3 80.0 31- below 40 years 5.3 6.3 9.5 13.8 40 years and above 0.0 3.2 2.3 6.2

7 BMI is a combination of height and weight and is calculated by dividing weight in kilograms

by height in meters squared. A value below 18.5 indicates chronic energy deficiency ( CED)

8 MUAC is a measure of under-nutrition in adults MUAC<21 cm is considered as severe

under-nutrition. For pregnant women it is not very strong indicator.


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MUAC of pregnant women

Younger than 21 cm 8.1 24.4 4.8 6.5 21 cm and above 91.9 75.6 95.2 93.5

Pregnant women registered in ICDS 94.7 90.5 96.8 80.0


38

Table 3.1 (Continued)

Pregnant women availing other Support Services

50.0 36.8 62.4 64.6

Types of services availed (Multiple Response)

Trained Birth Attendant 26.3 54.3 65.2 69.0 ASHA 89.5 51.4 39.1 28.6 Other 5.3 8.6 0.0 11.9 Number of services availed by pregnant women

One 78.9 85.7 95.7 90.5 Two 21.1 14.3 4.3 9.5 More than two 0.0 0.0 0.0 0.0 Pregnant women with specific symptoms (Multiple Response)

Pale nail color 0.0 58.3 81.4 56.2 White/Light pink color in inner lining of lower eyelid

50.0 50.0 86.0 56.2

Breathlessness 25.0 8.3 13.9 12.5 Oedema 0.0 0.0 11.6 6.2 Severely malnourished 25.0 16.7 9.3 13.9 Others 0.0 0.0 7.0 11.1 Base :Total pregnant women 38 95 221 65 Mother of Children up to the age of 2 years

Age

Below 18 years 0.0 0.8 0.6 0.0 18- 30 years 89.4 85.0 81.4 81.1 Above 30 years 10.6 14.3 18.0 18.8

MUAC

Younger than 21 cm 3.4 30.4 5.0 7.3 21 cm and above 96.6 69.6 95.0 92.7

BMI

Below 18 years

Underweight <18.5 - 100.0 0.0 - Normal weight 18.5–24.9 - 0.0 100.0 - Overweight 25.0–29.9 - 0.0 0.0 - Obese ≥30 - 0.0 0.0 -

18- 30 years

Underweight <18.5 25.8 37.7 45.6 30.4 Normal weight 18.5–24.9 70.0 57.8 53.5 66.7 Overweight 25.0–29.9 2.6 3.5 .9 2.9 Obese ≥30 1.5 1.0 0.0 0.0


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Above 30 years

Underweight <18.5 22.6 42.8 40.7 34.8 Normal weight 18.5–24.9 64.5 51.4 59.3 56.5 Overweight 25.0–29.9 9.7 2.9 0.0 8.7 Obese ≥30 3.2 2.9 0.0 0.0


Mothers registered in ICDS 98.8 93.3 98.1 85.8 Mothers availing Other Support Services

94.4 71.1 80.8 81.9

Types of services availed (Multiple Response)

Trained Birth Attendant 18.1 55.0 65.1 82.7 ASHA 89.1 46.1 41.3 19.2 Other 0.3 1.7 2.4 1.0 Number of services availed by Mothers

One 92.4 95.0 91.3 97.1 Two 7.6 5.0 8.7 2.9 More than two 0.0 0.0 0.0 0.0 Special Observations of Mothers (Multiple Response) ( MultipleResponses

Pale nail color 70.0 89.5 83.7 43.9 White/Light pink color in inner lining of lower eyelid

60.0 57.9 74.4 56.1

Breathlessness 10.0 0.0 30.2 4.9 Odema 10.0 0.0 11.6 2.4 Severely Malnourished ( continuous sickness /thinness / paleness)

30.0 10.5 9.3 24.9

Others 10.0 0.0 2.3 16.6 Base: Total mother of Children of younger than 2 years

322 253 156 127

Mothers below 40 kg 9.5% (30 out of 316)

21.5% (53 out of 246)

24.7% (37 out of 150)

10.2% (13 out of 127)

3.1.1 Pregnant Women

Sonkatch In the population under study, the number of females in the age group 15-49 years was 2,005. Out of these 38 were found to be pregnant (1.9%). More than 94 % pregnant women were in the age-group 18-30 years. The percentage for pregnant women below 18 years could be an underestimate as women very often did not know their correct age or at times gave incorrect response as they are aware of the


40

defined legal age of marriage was 18 years and were therefore cautious while giving the response. Nutritional Status 8.1 % pregnant women recorded MUAC less than 21 cm indicating malnutrition. Pregnant women with specific symptoms (Multiple Responses) Symptoms of illness observed amongst pregnant women were breathlessness, oedema and severe malnutrition.. Details shown in Fig 2.2 are based on observations of symptoms such as oedma. Breathlessness, nail color etc. Utilization of Support Services Of the total pregnant women, 94.7 % were registered with ICDS. Services like trained birth attendants (26.3%) and ASHA (89.5%) were utilized. Pregnant women received Antenatal care (ANC) services under the health programme. 78.9 % pregnant women, registered with ICDS availed the support services only once and 21.1 % two times. Pandhana In the population under study, the number of females in the age group 15-49 years was 2,300. Out of these 95 were found to be pregnant (4.1%). More than 90 % pregnant women were in the age-group 18-30 years. The percentage for pregnant women below 18 years could be an underestimate as women very often did not know their correct age or at times gave incorrect response as they are aware of the defined legal age of marriage was 18 years and were therefore cautious while giving the response. Nutritional Status 24.4 % pregnant women recorded MUAC less than 21 cm indicating malnutrition. Pregnant women with specific symptoms (Multiple Responses) Symptoms of illness observed amongst pregnant women were breathlessness, oedema and severe malnutrition.. Details shown in Fig 2.2 are based on observations of symptoms such as oedma. Breathlessness, nail color etc. Utilization of Support Services Of the total pregnant women, 90.5 % were registered with ICDS. Services like trained birth attendants (54.3%) and ASHA (51.4%) were utilized. Pregnant women received Antenatal care (ANC) services under the health programme. 85.7 % pregnant women, registered with ICDS availed the support services only once and 14.3 % two times. Jhirnaya In the population under study, the number of females in the age group 15-49 years was 1,933. Out of these 221 were found to be pregnant (11.4%). More than 87 % pregnant women were in the age-group 18-30 years. The percentage for pregnant women below 18 years could be an underestimate as women very often did not


41

know their correct age or at times gave incorrect response as they are aware of the defined legal age of marriage was 18 years and were therefore cautious while giving the response. Nutritional Status 4.8 % pregnant women recorded MUAC less than 21 cm indicating malnutrition. Pregnant women with specific symptoms (Multiple Responses) Symptoms of illness observed amongst pregnant women were breathlessness, oedema and severe malnutrition.. Details shown in Fig 2.2 are based on observations of symptoms such as oedma. Breathlessness, nail color etc. Utilization of Support Services Of the total pregnant women, 96.8% were registered with ICDS. Services like trained birth attendants (65.1%) and ASHA (39.1%) were utilized. Pregnant women received Antenatal care (ANC) services under the health programme. 95.7 % pregnant women, registered with ICDS availed the support services only once and 4.3 % two times. Pawai In the population under study, the number of females in the age group 15-49 years was 1,420. Out of these 65 were found to be pregnant (4.6%). About 80 % pregnant women were in the age-group 18-30 years. The percentage for pregnant women below 18 years could be an underestimate as women very often did not know their correct age or at times gave incorrect response as they are aware of the defined legal age of marriage was 18 years and were therefore cautious while giving the response. Nutritional Status 6.5 % pregnant women recorded MUAC less than 21 cm indicating malnutrition. Pregnant women with specific symptoms (Multiple Responses) Symptoms of illness observed amongst pregnant women were breathlessness, oedema and severe malnutrition.. Details shown in Fig 2.2 are based on observations of symptoms such as oedma. Breathlessness, nail color etc. Utilization of Support Services Of the total pregnant women, 80 % were registered with ICDS. Services like trained birth attendants (69%) and ASHA (28%) were utilized. Pregnant women received Antenatal care (ANC) services under the health programme. 90.5 % pregnant women, registered with ICDS availed the support services only once and 9.5 % two times.


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3.1.2 Mothers of children up to the age of two years

Sonkatch There were 322 mothers of children younger than 2 years in the entire population. Of these mothers, 6 were reported to be pregnant also. Both MUAC and BMI were utilized to assess their nutritional status (non-pregnant women). As mentioned earlier, BMI<18.5 and MUAC <21cm are indicative of malnutrition. Almost 89.4 % of the mothers were in the age group of 18-30 years. Nutritional Status : For nutritional status BMI was considered with cut-off BMI<18.5.Among the mothers of children under twos, 25.8 % women in the age group 18-30 years were having low BMI. This percentage was 22.6 for mothers above 30 years. Mothers with Specific Symptoms: Symptoms like breathlessness, odema and malnourishment were observed in the mothers of under twos. For categorizing mothers as severely undernourished, continuous sickness and physical appearance like thinness and paleness of body were taken into consideration. Utilization of Support Services: More than 98.8 % mothers of under twos were reported to be registered with ICDS. Health services were availed by 94.4% registered mothers. The services availed were trained birth attendants (18.1%) andASHA (89.1%).More than 92.4 % mothers availed the services only once and 7.6% twice. Pandhana There were 253 mothers of children younger than 2 years in the entire population. Of these mothers, 7 were reported to be pregnant also. Both MUAC and BMI were utilized to assess their nutritional status (non-pregnant women). As mentioned earlier, BMI<18.5 and MUAC <21cm are indicative of malnutrition. Almost 85 % of the mothers were in the age group of 18-30 years. Nutritional Status : For nutritional status BMI was considered with cut-off BMI<18.5.Among the mothers of children under twos, 37.7 % women in the age group 18-30 years were having low BMI. This percentage was 42.8 for mothers above 30 years. In the category of mothers below 18 years all the women were having low BMI. Mothers with Specific Symptoms: Symptoms like breathlessness, odema and malnourishment were observed in the mothers of under twos. For categorizing mothers as severely undernourished, continuous sickness and physical appearance like thinness and paleness of body were taken into consideration.


43

Utilization of Support Services: More than 93 % mothers of under twos were reported to be registered with ICDS. Health services were availed by 71.1.4% registered mothers. The services availed were trained birth attendants (55%) andASHA (46.1%).About 95 % mothers availed the services only once and 5 % twice. Jhirnaya There were 156 mothers of children younger than 2 years in the entire population. Of these mothers, 6 were reported to be pregnant . Both MUAC and BMI were utilized to assess their nutritional status (non-pregnant women). As mentioned earlier, BMI<18.5 and MUAC <21cm are indicative of malnutrition. Almost 81 % of the mothers were in the age group of 18-30 years. Nutritional Status : For nutritional status BMI was considered with cut-off BMI<18.5.Among the mothers of children under twos, 45.6 % women in the age group 18-30 years were having low BMI. This percentage was 40.7 for mothers above 30 years. Mothers with Specific Symptoms: Symptoms like breathlessness, odema and malnourishment were observed in the mothers of under twos. For categorizing mothers as severely undernourished, continuous sickness and physical appearance like thinness and paleness of body were taken into consideration. Utilization of Support Services: More than 98 % mothers of under twos were reported to be registered with ICDS. Health services were availed by 80.8 % registered mothers. The services availed were trained birth attendants (65.1%) and ASHA (41.3%).About 91 % mothers availed the services only once and 8.7 % twice. Pawai There were 127 mothers of children younger than 2 years in the entire population. None of these mothers, were reported to be pregnant . Both MUAC and BMI were utilized to assess their nutritional status (non-pregnant women). As mentioned earlier, BMI<18.5 and MUAC <21cm are indicative of malnutrition. Almost 81 % of the mothers were in the age group of 18-30 years. Nutritional Status : For nutritional status BMI was considered with cut-off BMI<18.5.Among the mothers of children under twos, 30.4 % women in the age group 18-30 years were having low BMI. This percentage was 34.8 for mothers above 30 years. Mothers with Specific Symptoms: Symptoms like breathlessness, odema and malnourishment were observed in the mothers of under twos. For categorizing mothers as severely undernourished, continuous sickness and physical appearance like thinness and paleness of body were taken into consideration.


44

Utilization of Support Services: More than 85 % mothers of under twos were reported to be registered with ICDS. Health services were availed by 81.9 % registered mothers. The services availed were trained birth attendants (82.7%) and ASHA (19.2%).About 97.1 % mothers availed the services only once and 2.9 % twice.

3.2 Nutritional Status of Children (below 5 years)

Nutritional status of children as measured by anthropometric measurements can be assessed from height for age (stunting), weight for age (underweight) and weight for height (wasting) indicators. Each of these indices provides different information about nutritional status. These three indicators are expressed as standard deviation units (z-scores) from the median using the new WHO growth standards. As per these criteria, children who fall more than -2 standard deviation (sd) below reference median are undernourished and those -3SD below reference median are severely undernourished. Underweight or weight for age is a composite measure which measures chronic and acute malnutrition. Stunting or Height-for-age index measures linear growth retardation among children and is a measure of long term effects of malnutrition. Wasting, the weight for height measure is an index reflecting body mass in relation to body length. Wasting is also used to detect cases of severe acute malnutrition (SAM) –i.e. children with -<-3SD of the median being severely wasted or suffering from severe acute malnutrition (SAM ). Block-wise details are presented below. Sonkatch Birth weight of 31.3 % children was younger than 2.5 kg. In this study 64.1 % children were found to be stunted with 49.3 % being severely stunted and 14.8 % moderately stunted. In the underweight category 50.5 % were underweight of which 26.6 % children were severely underweight and 24.5 % were moderately underweight. Regarding wasting, 23 % were wasted. Of these, 12.6 % children were found to be severely wasted and 10.4 % moderately wasted. MUAC of 11 % children was found to be below the WHO recommended cut of 11.5 cm for detecting severe acute malnutrition (SAM). As per the WHO recommendation, MUAC is advised to be used for identifying SAM children. Of these SAM children, 93.7 % children were registered with ICDS and 60.1 % were recipient of ration. 64.4 % of children 6-36 months took food packets from Anganwadis to home. The details are given Table 3.2a.


45


46

Table 3.2a: Age Wise Prevalence of Malnutrition in Children (%)-Sonkatch

Age Wise Prevalence of Malnutrition in Children (%)- Sonkatch

Age in months

Height for Age (Stunting)

Weight for Age (Underweight)

Weight for Height (Wasting)

Below - -3SD

Below -2SD

Normal

Below --3SD

Below - 2SD

Normal

Below - -3SD

Below -2SD

Normal

3 -5 months

51.1 11.1 37.8 17.8 28.9 53.3 13.3 2.2 84.4

6-11 months

55.6 14.8 29.6 21.0 22.2 56.8 8.6 12.3 79.0

12-35 months

51.1 15.0 33.9 27.5 24.6 47.9 12.1 10.5 77.3

36-47 months

45.0 18.6 36.4 30.7 24.3 45.0 11.4 8.6 80.0

48-59 months

44.1 13.7 42.2 29.2 24.8 46.0 16.8 13.7 69.6

Overall 49.3 14.8 35.8 26.6 24.5 49.0 12.6 10.4 77.0 Pandhana Birth weight of 2.2 % children was younger than 2.5 kg. In more than 92 % cases no records were available. In this study 55.2 % children were found to be stunted with 39.9 % being severely stunted and 15.3 % moderately stunted. In the underweight category 56.8 % were underweight of which 31.9 % children were severely underweight and 24.9 % were moderately underweight. Regarding wasting, 39 % were wasted. Of these, 25 % children were found to be severely wasted and 14 % moderately wasted. MUAC of 6.3 % children was found to be below the WHO recommended cut of 11.5 cm for detecting severe acute malnutrition (SAM). As per the WHO recommendation, MUAC is advised to be used for identifying SAM children. Of these SAM children, 70.8 % children were registered with ICDS and 80.8 % were recipient of ration. 38 % of children 6-36 months took food packets from Anganwadis to home. The details are given Table 3.2b.


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Table 3.2b: Age Wise Prevalence of Malnutrition in Children (%)-Pandhana

Age Wise Prevalence of Malnutrition in Children (%)- Pandhana

Age in months




Below - -3SD

Below -2SD

Normal

Below --3SD

Below - 2SD

Normal

Below - -3SD

Below -2SD

Normal

3 -5 months

23.9 7.5 68.7 7.5 16.4 76.1 22.4 20.9 56.7

6-11 months

50.0 15.0 35.0 36.7 31.7 31.7 18.3 10.0 71.7

12-35 months

42.8 15.8 41.4 35.4 20.4 44.2 25.3 11.9 62.8

36-47 months

41.9 19.1 39.0 30.9 26.5 42.6 21.3 14.7 64.0

48-59 months

35.1 17.3 47.6 40.0 35.5 26.5 32.4 15.7 51.9

Overall 39.9 15.3 44.7 31.9 24.9 43.2 25.0 14.0 61.0 Jhirnaya Birth weight of 6.9 % children was younger than 2.5 kg. In more than 80 % cases no records were available. In this study 62.8 % children were found to be stunted with 43.2 % being severely stunted and 15.6 % moderately stunted. In the underweight category 59.1 % were underweight of which 36.3 % children were severely underweight and 22.8 % were moderately underweight. Regarding wasting, 36.2 % were wasted. Of these, 18.9 % children were found to be severely wasted and1 17.2 % moderately wasted. MUAC of 8.5 % children was found to be below the WHO recommended cut of 11.5 cm for detecting severe acute malnutrition (SAM). As per the WHO recommendation, MUAC is advised to be used for identifying SAM children. Of these SAM children, 73.9 % children were registered with ICDS and 70 % were recipient of ration. 48.8 % of children 6-36 months took food packets from Anganwadis to home. The details are given Table 3.2c


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Table 3.2c: Age Wise Prevalence of Malnutrition in Children (%)- Jhiranya

Age Wise Prevalence of Malnutrition in Children (%)- Jhiranya

Age in months




Below - -3SD

Below -2SD

Normal

Below --3SD

Below - 2SD

Normal

Below - -3SD

Below -2SD

Normal

3 -5 months

41.8 3.8 54.4 22.8 13.9 63.3 17.7 7.6 74.7

6-11 months

35.5 28.9 35.5 30.3 21.1 48.7 17.1 9.2 73.7

12-35 months

46.5 17.1 36.4 39.4 21.7 38.8 22.9 18.0 59.0

36-47 months

42.5 28.8 34.7 36.8 26.4 36.8 17.1 15.5 67.4

48-59 months

43.4 26.0 30.6 43.4 27.7 28.9 15.6 26.0 58.4

Overall 43.2 19.6 37.2 36.3 22.8 41.0 18.9 17.2 63.9 Pawai Birth weight of 17.3 % children was younger than 2.5 kg. In more than 26 % cases no records were available. In this study 65.4 % children were found to be stunted with 51.4 % being severely stunted and 14 % moderately stunted. In the underweight category 59.1 % were underweight of which 36.3 % children were severely underweight and 22.8 % were moderately underweight. Regarding wasting, 47.8 % were wasted. Of these, 19.8 % children were found to be severely wasted and1 28 % moderately wasted. MUAC of 5.7 % children was found to be below the WHO recommended cut of 11.5 cm for detecting severe acute malnutrition (SAM). As per the WHO recommendation, MUAC is advised to be used for identifying SAM children. Of these SAM children, 79.3 % children were registered with ICDS and 62 % were recipient of ration. 50.4 % of children 6-36 months took food packets from Anganwadis to home. The details are given Table 3.2d.


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Table 3.2d: Age Wise Prevalence of Malnutrition in Children (%)- Pawai

Age Wise Prevalence of Malnutrition in Children (%)- Pawai

Age in months




Below - -3SD

Below -2SD

Normal

Below --3SD

Below - 2SD

Normal

Below - -3SD

Below -2SD

Normal

3 -5 months

26.1 13.0 60.9 39.1 21.7 39.1 30.4 8.7 60.9

6-11 months

41.0 7.7 51.3 17.9 23.1 59.0 10.3 12.8 76.9

12-35 months

55.0 15.0 30.0 23.6 26.4 50.0 9.3 12.1 78.6

36-47 months

52.2 23.9 23.9 17.4 29.3 53.3 8.7 7.6 83.7

48-59 months

58.0 10.2 31.8 11.4 35.2 53.4 10.4 5.7 84.1

Overall 51.4 14.0 34.5 19.8 28.0 52.2 11.6 9.4 79.0 As per NFHS-III report, at state level, prevalence of stunting was 39.9 %, and that of underweight and wasting was 60.3 % and 33.3 % respectively.

3.3 Factors Associated with Malnutrition Status of Children

In this section we describe the possible factors contributing to under-nutrition in children below 5 years. Some of these factors have direct bearing on the nutritional status of children below the age of 2 years. We describe and discuss these in sequel.

3.3.1 Factors responsible for malnutrition in children younger than 2 years

Caring practices, diseases and hygiene are some of the factors that have direct impact on the health and nutritional status of children younger than 2 years of age. These are described below. Caring Practices: There are two components in this category viz., infant feeding and complementary feeding. For infants, the timing of initiation of breast feeding to newly born child as well as continued exclusive breast feeding (no water) for the first 6 months of life is reported to have positive association with reducing mortality and improving nutritional status. Timely introduction of complementary feeding, frequency of feeding and density of nutrients in the food has a significant association with nutritional status. Prevalence of diseases: Prevalence of diseases accelerates the process of malnutrition. Hygiene: Type of houses, toilet facilities and drinking water are major components of hygiene and sanitation and play significant role in the well being or otherwise of children. We now describe the scenario of these factors as they exist in the study area.


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Sonkatch (a)Caring practices Infant feeding: In our study 51.9 % women practiced breastfeeding and in 50.2 % cases breastfeeding was initiated within 1-2 hours of birth. In 51 % cases the breastfeeding in the first 3 days was practiced indicating feeding of colostrums was followed.. Table 3.3 gives details of duration of breastfeeding.. In 0- 6 months age group, the practice of exclusive breast feeding was reported to be 13.2 %. In 86.8 % cases, exclusive breastfeeding continued beyond six months of birth.

Table 3.3: Child Feeding Practices and Food Consumption

Child Feeding Practices and Food Consumption Children aged <5years

percentage

Sonkach Pandhana Jhirniya Pavai Breast Feeding (BF) Brest Feeding Practiced 51.9 37.8 54.6 63.6 Immediately after birth (within 1-2 hours) 50.2 33.6 39.0 52.7 Continued breast feeding for first three days 51.0 37.0 52.0 61.8 Base : Total responded 628 633 735 338 Duration of Exclusive Breast Feeding in months Below 1 month 0.8 0.0 0.9 0.0 1-< 3 months 5.4 5.6 2.5 5.0 3 - <6 months 7.0 32.4 40.6 10.6 6 months or above 86.8 62.0 55.9 84.4 Complementary food (CF) CF given 20.8 18.0 21.8 43.8 Age at which CF initiated Below 4 months 2.5 4.1 3.3 5.1 4-5 months 1.3 23.6 21.6 11.6 6-7 months 15.7 54.1 57.3 49.3 > 7 months 80.5 18.2 17.8 34.1 Frequency of CF feeding per day Up to 3 times 92.8 28.3 96.9 19.4 4-6 times 7.2 71.7 3.1 80.6 >= 7 times 0.0 0.0 0.0 0.0

Complementary feeding: The present study reveals that in more than 80 % cases the complementary feeding was given after 7 months of age. Table 3.4 shows that the major items of complementary food were wheat/rice (daily 81.6%, weekly 15.3%, monthly 3.1.9%) followed by Dal ( daily 39 %, weekly 18.9 %, monthly 42.1 %), milk (daily 31%, weekly 32%, monthly 31.6%), oil/ghee (daily 14.7%, weekly 27%, monthly 10.5%), green vegetables (daily 14.6%, weekly 33.9%, monthly 13.2%) and eggs, meat, fish, chicken( daily 3.2%, weekly 10.2%, monthly 26.3.3%). In 57 % cases iodized salt was consumed daily. Here also, we have multiple responses.


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Table 3.4: Food Consumption Frequency of Complementary Foods

(Multiple Responses)

:Food Consumption Frequency of Complementary Foods (Multiple Response)

%

Sonkach Pandhana

Daily Weekly Monthly Daily Weekly Monthly

Rice/ Wheat 81.6 15.3 3.1 88.3 11.7 0.0 Dal 39.0 18.9 42.1 75.6 14.6 9.8 Milk

31.0 32.2 31.6 42.9 15.2 7.0

Oil/ Ghee 14.7 27.1 10.5 3.0 28.5 68.5 Eggs, meat fish, chicken

3.2 10.2 26.3 2.6 27.8 55.2

Green vegetables

14.6 33.9 13.2 3.9 66.9 24.5

Fruit

11.4 33.9 26.3 1.3 55.6 32.9

Iodized salt 57.0 27.1 15.8 81.2 10.6 7.7 Others 1.3 0.0 0.0 0.6 0.0 2.1

%

Jhirniya Pavai

Daily Weekly Monthly Daily Weekly Monthly

Rice/ Wheat 93.7 4.5 1.8 92.0 5.6 1.7 Dal 85.9 4.5 0.9 88.8 4.2 7.0 Milk

18.4 16.9 9.3 25.7 34.1 13.5

Oil/ Ghee 4.7 9.1 45.1 16.6 30.5 26.2 Eggs, meat fish, chicken

2.0 72.7 18.6 3.7 9.6 24.8

Green vegetables

4.3 86.8 6.5 12.8 72.5 14.7

Fruit

3.5 78.5 13.0 2.7 28.7 29.8

Iodized salt 80.4 12.4 0.5 82.4 3.0 2.8 Others 1.6 0.4 36.3 2.1 2.4 36.9 b) Prevalence of diseases: Symptoms like hair color(33.7%), skin problems(0.5%), inflated belly(1.5%), fatigue(95 %)) , chronic diarrhea(0.5%) and mouth ulcers(1%) were observed in children . Other diseases such as prolonged fever, dysentery, skin scar etc. accounted for 3 % cases.


52


53

Table 3.5: Nutritional Status of Children (Special Symptoms Observed)

Nutritional Status of Children (Special Symptoms Observed)

percentage


Hair Color 33.7 13.1 26.4 14.9 Skin Problems 0.5 5.5 3.1 5.8 Inflated Belly 1.5 18.6 33.7 29.8 Fatigue 95.0 48.2 56.7 52.9 Chronic Diarrhea 0.5 4.5 3.1 10.7 Swelling in both feet 0.0 0.0 0.0 0.0 Mouth ulcer 1.0 1.5 4.2 5.0 Night Blindness 0.0 0.5 0.8 0.0 Bitots Spots 0.0 0.0 0.0 0.0 Other illness as prolonged fever, dysentery, skin scar

3.0 33.2 1.9 33.9

Children With

One symptom 65.3 81.9 74.3 61.2 Two symptoms 34.2 12.1 17.6 27.3 More than two symptoms 0.5 6.0 8.0 11.6 (c ) Hygiene: Type of houses, toilet facilities and drinking water are major components of hygiene and sanitation . The study revealed that almost the entire population resided in kuthcha houses with no toilet facilities. Further there was scarcity of drinking water. All these seem to result in frequency of gastro-intestinal infections such a diarrhea resulting in loss of nutrients and setting up a cycle of illness-loss of nutrients-poor appetite –poor food intake and under-nutrition. Poor hygiene and poor water appears to be primary contributing causes of poor nutritional status. Pandhana (a)Caring Practices Infant Feeding: In our study 37.8 % women practiced breastfeeding and in 33.6 % cases breastfeeding was initiated within 1-2 hours of birth. In 37 % cases the breastfeeding in the first 3 days was practiced indicating feeding of colostrums was followed.. Table 3.3 gives details of duration of breastfeeding.. In 0- 6 months age group, the practice of exclusive breast feeding was reported to be 38 %. In 62 % cases, exclusive breastfeeding continued beyond six months of birth. Complementary Feeding: The present study reveals that in more than 54.1 % cases the complementary feeding was given between 6-7 months of age. Table 3.4 shows that the major items of complementary food were wheat/rice (daily 88.3%, weekly 11.7%) followed by Dal ( daily 75.6 %, weekly 14.6%, monthly 9.8 %), milk (daily 42.9%, weekly 15.2%, monthly 7%), oil/ghee (daily 3%, weekly 28.5%, monthly


54

68.5%), green vegetables (daily 3.9%, weekly 66.9%, monthly 24.5%) and eggs, meat, fish, chicken( daily 2.6. %, weekly 27.8%, monthly 55.2%). In 81.2 % cases iodized salt was consumed daily. Here also, we have multiple responses. Consumption of fruits is negligible on daily basis. (b) Prevalence of diseases: Symptoms like Hair color(13.1%), skin problems (5.9%), Inflated belly(18.6%) and fatigue (48.2%)) , were observed in children. Other diseases such as prolonged fever, dysentery, skin scar etc. accounted for 33.2 % cases. (c ) Hygiene: Type of houses, toilet facilities and drinking water are major components of hygiene and sanitation . The study revealed that almost the entire population resided in kuthcha houses with no toilet facilities. Further there was scarcity of drinking water. All these seem to result in frequency of gastro-intestinal infections such a diarrhea resulting in loss of nutrients and setting up a cycle of illness-loss of nutrients-poor appetite –poor food intake and under-nutrition. Poor hygiene and poor water appears to be primary contributing causes of poor nutritional status. Jhirnaya (a)Caring Practices Infant Feeding: In our study 54.6 % women practiced breastfeeding and in 39 % cases breastfeeding was initiated within 1-2 hours of birth. In 52 % cases the breastfeeding in the first 3 days was practiced indicating feeding of colostrums was followed.. Table 3.3 gives details of duration of breastfeeding.. In 0- 6 months age group, the practice of exclusive breast feeding was reported to be 44 %. In 55.9 % cases, exclusive breastfeeding continued beyond six months of birth. Complementary Feeding: The present study reveals that in more than 57 % cases the complementary feeding was given between 6-7 months of age. Table 3.4 shows that the major items of complementary food were wheat/rice (daily 93.7%, weekly 4.5%, monthly 1.8%) followed by Dal ( daily 85.9 %, weekly 4.5%, monthly 0.9%), milk (daily 18.4%, weekly 16.9%, monthly 9.3%), oil/ghee (daily 4.7%, weekly 9.1%, monthly 45.1%), green vegetables (daily 4.3%, weekly 86.8%, monthly 6.5%) and eggs, meat, fish, chicken( daily 2. %, weekly 72.7%, monthly 6.5%). In 80.4 % cases iodized salt was consumed daily. Here also, we have multiple responses. Consumption of fruits is negligible on daily basis. (b) Prevalence of diseases Symptoms like Hair color(26.4%), skin problems (3.1%), Inflated belly(33.7%) and fatigue (56.7%)) , were observed in children. Other diseases such as prolonged fever, dysentery, skin scar etc. accounted for 1.9 % cases. (c ) Hygiene: Type of houses, toilet facilities and drinking water are major components of hygiene and sanitation . The study revealed that almost the entire


55

population resided in kuthcha houses with no toilet facilities. Further there was scarcity of drinking water. All these seem to result in frequency of gastro-intestinal infections such a diarrhea resulting in loss of nutrients and setting up a cycle of illness-loss of nutrients-poor appetite –poor food intake and under-nutrition. Poor hygiene and poor water appears to be primary contributing causes of poor nutritional status. Pawai (a)Caring Practices Infant Feeding: In our study 63.6 % women practiced breastfeeding and in 52.7 % cases breastfeeding was initiated within 1-2 hours of birth. In 61.8 % cases the breastfeeding in the first 3 days was practiced indicating feeding of colostrums was followed.. Table 3.3 gives details of duration of breastfeeding.. In 0- 6 months age group, the practice of exclusive breast feeding was reported to be 15.6 %. In 84.4 % cases, exclusive breastfeeding continued beyond six months of birth. Complementary Feeding: The present study reveals that in more than 49.3 % cases the complementary feeding was given between 6-7 months of age. Table 3.4 shows that the major items of complementary food were wheat/rice (daily 92%, weekly 5.6 %, monthly 1.7%) followed by Dal ( daily 88.8 %, weekly 4.2%, monthly 7%), milk (daily 25.7%, weekly 34.1%, monthly 13.5%), oil/ghee (daily 16.6%, weekly 30.5%, monthly 26.2%), green vegetables (daily 12.8%, weekly 72.5%, monthly 14.7%) and eggs, meat, fish, chicken( daily 3.7 %, weekly 9.6%, monthly 24.8%). In 82.4 % cases iodized salt was consumed daily. Here also, we have multiple responses. Consumption of fruits is negligible on daily basis. (b) Prevalence of diseases Symptoms like Hair color(14.9%), skin problems (5.8%), Inflated belly(29.8%) and fatigue (52.9%)) , were observed in children. Other diseases such as prolonged fever, dysentery, skin scar etc. accounted for 33.9 % cases. (c ) Hygiene: Type of houses, toilet facilities and drinking water are major components of hygiene and sanitation . The study revealed that almost the entire population resided in kuthcha houses with no toilet facilities. Further there was scarcity of drinking water. All these seem to result in frequency of gastro-intestinal infections such a diarrhea resulting in loss of nutrients and setting up a cycle of illness-loss of nutrients-poor appetite –poor food intake and under-nutrition. Poor hygiene and poor water appears to be primary contributing causes of poor nutritional status.

3.3.2 Social and other related factors associated with malnutrition

Some of the factors that are not directly responsible, but have significant impact on nutritional status of children are, social group to which the child belongs, literacy


56

status of mothers ,infrastructure available in the area and welfare schemes of GOI. These are discussed subsequently Social Groups and malnutrition; In our country in spite of very serious efforts by GOI to uplift the Scheduled Castes (SC), Scheduled Tribes (ST and Other Backward Classes (OBC), the persons belonging to these categories of society continue to be deprived. The benefits of development have not percolated to lower strata of the society. It is therefore expected that children belonging to these groups are likely to be more prone to malnutrition than the children belonging to general category. In this study an attempt has been made to study the possible association between nutritional status of children and its membership to social groups. Sonkatch Table 3.6a provides details of caste-wise nutritional status of children under study

Table 3.6a: Caste-wise nutritional status of children-Sonkatch

Social Groups

Children in various categories of malnutrition - Sonkach Stunting Underweight Wasting Severe Moderate Normal Total Severe Moderate Normal Total Severe Moderate Normal Total

SC 144 47 100 291 79 81 131 291 44 34 213 291 ST 48 12 23 83 31 20 32 83 10 8 65 83 OBC 70 17 38 125 35 53 57 125 13 10 102 125 General 117 38 114 269 59 54 156 269 30 28 211 269 Total 379 114 275 768 204 208 376 768 97 80 591 768

In order to establish the association between malnutrition and social group affiliations, Chi-square test for goodness of fit was applied for all the three indicators to test the hypothesis that the ‘prevalence of malnutrition is independent of caste affiliation’. The analysis revealed that ‘underweight’ is associated with the caste affiliation of the child. The coefficient of association was 0.84. Figure 3.1 depicts caste-wise prevalence of underweight in Sonkatch. It can be seen that prevalence of underweight is much higher in SC, ST and OBC categories than that in General category.


59

Figure 3.1: Caste-wise prevalence of Under-weight in Sonkatch

27.127.8

45.1

37.3

24.1

38.6

28

42.4

29.6

21.920.1

58

26.524.5

49

0

10

20

30

40

50

60

Percent

SC ST OBC General Total

Caste

Severe

Moderate

Normal

Pandhana Table 3.6b provides details of caste-wise nutritional status of children under study

Table 3.6b: Caste-wise nutritional status of children-Pandhana

Social Groups

Children in various categories of malnutrition - Pandhana Stunting Underweight Wasting Severe Moderate Normal Total Severe Moderate Normal Total Severe Moderate Normal Total


It can be seen that entire population of children was dominated by ST (94%). In view of this no comparison is meaningful and hence no statistical analysis was carried out. Jhirnaya Table 3.6c provides caste-wise nutritional status of children under study.

Table 3.6c: Caste-wise nutritional status of children-Jhirnaya

Social Groups

Children in various categories of malnutrition - Jhirniya Stunting Underweight Wasting Severe Moderate Normal Total Severe Moderate Normal Total Severe Moderate Normal Total


It can be seen that entire population of children was dominated by ST (98%). In view of this no comparison is meaningful and hence no statistical analysis was carried out. Pawai Table 3.6d provides caste-wise nutritional status of children under study.

Table 3.6d: Caste-wise nutritional status of children-Pawai

Social Groups

Children in various categories of malnutrition - Pawai Stunting Underweight Wasting Severe Moderate Normal Total Severe Moderate Normal Total Severe Moderate Normal Total


In order to establish the association between malnutrition and social group affiliations, Chi-square test for goodness of fit was applied for all the three indicators to test the hypothesis that the ‘prevalence of malnutrition is independent of caste affiliation’. All the indicators were found to be independent of caste affiliation of children. Mother’s literacy and malnutrition of children: Awareness about the care practices required for children plays a very significant role in maintaining proper nutritional status of children. It is therefore necessary that the parents specially the mothers should be educated. Thus, literacy status plays a very significant role in the well being of children. In this study an attempt has been made to study the association of mother’s literacy status of with malnutrition of children. In the study area since literacy status of females is very low, the mothers have been categorized in ‘literate’ and ‘illiterate’ categories and the association between nutritional status of children has been studied. Sonkatch Table 3.7a presents nutritional status of children vis-à-vis mother’s literacy status in the study area.


66

Table 3.7a: Malnutrition in Children vis-à-vis Mother’ literacy status-Sonkatch

Mother literacy Children in various categories of malnutrition - Sonkatch Stunting Underweight Wasting Severe Moderate Normal Total Severe Moderate Normal Total Severe Moderate Normal Total

Illiterate Mother 223 44 141 408 112 95 201 408 51 41 316 408 Literate Mother 156 70 134 360 92 93 175 360 46 39 275 360 Total 379 114 275 768 204 188 376 768 97 80 591 768

In order to establish the association between malnutrition and literacy status of mothers, Chi-square test for goodness of fit was applied for all the three indicators to test the hypothesis that the ‘prevalence of malnutrition is independent of mother’s literacy status.’ Statistical analysis revealed that stunting is associated with literacy status of mothers. Coefficient of association was 0.85. Figure 3.2 displays prevalence of stunting vis-à-vis literacy status of mothers. It can be observed that prevalence of stunting is much higher in children of illiterate mothers.

Figure 3.2: Prevalence stunting vis-à-vis mother’s literacy status-Sonkatch

54.7

10.8

34.5

43.3

19.4

37.3

49.3

14.8

35.9

0

10

20

30

40

50

60

Percent

Illiterate Literate Total

Literacy Status

Severe

Moderate

Normal

Pandhana Table 3.7b presents nutritional status of children vis-à-vis mother’s literacy status in the study area.

Table 3.7b: Malnutrition in Children vis-à-vis Mother’ literacy status-Pandhana

Mother literacy Children in various categories of malnutrition - Pandhana Stunting Underweight Wasting Severe Moderate Normal Total Severe Moderate Normal Total Severe Moderate Normal Total

Illiterate Mother 260 101 293 654 216 163 275 654 166 97 391 654 Literate Mother 48 17 52 117 30 29 58 117 27 11 79 117 Total 308 118 345 771 246 192 333.0 771 193 108 470 771

In order to establish the association between malnutrition and literacy status of mothers, Chi-square test for goodness of fit was applied for all the three indicators to test the hypothesis that the ‘prevalence of malnutrition is independent of mother’s literacy status. All the indicators were found to be independent of literacy status of mothers. Jhirnaya Table 3.7c presents nutritional status of children vis-à-vis mother’s literacy status in the study area.

Table 3.7c: Malnutrition in Children vis-à-vis Mother’ literacy status-Jhirnaya

Mother literacy

Children in various categories of malnutrition - Jhirnaya Stunting Underweight Wasting Severe Moderate Normal Total Severe Moderate Normal Total Severe Moderate Normal Total

Illiterate Mother 331 158 284 773 277 178 318 773 140 137 496 773 Literate Mother 49 14 43 106 42 22 42 106 26 14 66 106 Total 380 172 327 879 319 200 360 879 166 151 562 879

In order to establish the association between malnutrition and literacy status of mothers, Chi-square test for goodness of fit was applied for all the three indicators to test the hypothesis that the ‘prevalence of malnutrition is independent of mother’s literacy status. All the indicators were found to be independent of literacy status of mothers. Pawai Table 3.7d presents nutritional status of children vis-à-vis mother’s literacy status in the study area.

Table 3.7d: Malnutrition in Children vis-à-vis Mother’ literacy status-Jhirnaya

Mother literacy

Children in various categories of malnutrition - Jhirnaya Stunting Underweight Wasting Severe Moderate Normal Total Severe Moderate Normal Total Severe Moderate Normal Total

Illiterate Mother 108 30 79 217 45 60 112 217 24 23 170 217 Literate Mother 105 28 64 197 37 56 104 197 24 16 157 197 Total 213 58 143.0 414 82 116 216.0 414 48 39 327 414

In order to establish the association between malnutrition and literacy status of mothers, Chi-square test for goodness of fit was applied for all the three indicators to test the hypothesis that the ‘prevalence of malnutrition is independent of mother’s literacy status. All the indicators were found to be independent of literacy status of mothers. Rural Infrastructure and malnutrition: Rural infrastructure like health, educational facilities, road connectivity and availability of water etc. contribute significantly to well being of children. In the study area health facilities do not seem to be adequate adequate as per GOI norms. The status of nutrition of children is very poor. It is therefore necessary to investigate the working of these facilities such as proper staff, availability of medicines and facilities for immunization etc. As for availability of water, tube-wells and ponds are major sources of water. These are certainly health hazards and contribute significantly to malnutrition. GOI schemes: As mentioned in chapter 2 schemes like PDS, MNREGA and MDM are meant for general up-liftment of the poor. In the study area it was observed that functioning of PDS is not proper as there is no regularity in distribution of ration. This needs to be strengthened. Performance of MNREGA is also much below expectation, as many members fail to get a job even for a day and very small proportion gets job for 100 promised days. The quality of food supplied under MDM scheme also needs to be examined. Proper livelihood leads to proper nutrition and therefore it is necessary to strengthen these schemes and proper monitoring mechanism be developed to improve the situation Though the enrollment in ICDS is very high, the quality of services is questionable. It is quite evident from the large scale under-nutrition prevalent in the survey area that the quality of supplementary food is poor as it is unable to provide the desired result. Other services like Nutrition and Health Education, health check-up and referral are also questionable with the large number of children suffering from diseases.


75

4. Risk Factors Associated With Malnutrition of Children

4.1 Introduction

Among various factors associated with the malnutrition of children we have examined four factors namely (i) child’s age and (ii) diseases (iii) complementary feeding (iv) BMI of mothers using, logistic regression technique. Risk factors have been examined separately for children younger than 2 years and all children below 5 years. For children younger than 2 years all the four factors have been included in the analysis while for children up to 5 years only first three factors are included as anthropometric measurements were carried out only for mothers of 2 years old children. This procedure has the added advantage that it evaluates the impact in terms of their relative risks (factor loading). The analysis was carried out for all the indicators of malnutrition. The analysis included only severe cases of under-nutrition.

4.2 Risk factors for Children below two years

Child’s age, though a continuous variable was also taken in the binary form of 6-11 months versus others up to 23 months of age. The factors were regrouped into broad categories and were converted into binary codes to run the analysis.

Table 4.1: Risk factors used for logistic regression for Children younger

than 2 years

Binary form of Variables

Variables

Child’s Age Children of 6-11 months (1), others up to 23 months of age (0) Diseases Any disease (1), Others (0) Complementary feeding

Children who were introduced to complementary feeding at 4-6 months (0), Others (1)

BMI Children of mothers with BMI<18.5 (1), Others (0). The results are presented in Tables 4.2 A factor loading 2.81 for diseases in stunting in Sonkatch indicates that a diseased child is 2.81 times at risk of being stunted than a healthy child. In Sonkatch, diseases and complementary feeding have emerged as risk factors for stunting; for underweight the risk factors are child’s age, diseases and complementary feeding and for wasting the risk factor is BMI of mothers. In Pandhana, risk factors for stunting is child’s age; for underweight all the four factors have emerged as risk factors and for wasting, child’s age and BMI of mothers are risk factors.


76

Table 4.2: Risk Factors and their Loading for the Children Up to 2 years of

age

In Jhirnaya, for stunting none of the factors has emerged as risk factor; for underweight complementary feeding and BMI have emerged as risk factors and for wasting all the four factors have emerged as risk factors. In Pawai, for stunting, diseases, complementary feeding and BMI of mothers have emerged as risk factors; for underweight the risk factor is disease while for wasting, BMI has emerged as risk factor.

4.3 Risk factors for Children up to 5 years of age

In this category, analysis was carried out for children in the age group 12-35 months versus others. All the variables as in previous category except BMI were used in this analysis.

Table 4.3: Risk factors used for logistic regression for Children up to 5

years

Binary form of

Variables

Variables

Child’s Age Children of 12-35 months (1), others (0)

Diseases Any disease (1), Others (0)

Complementary

feeding

Children who were introduced to complementary feeding at 4-

6 months (0), Others (1)

Risk Factor Risk Factors and their Loading for children up to 2 years Sonkach Pandhana Stunting Underweight Wasting Stunting Underweight Wasting

Child Age <1 1.06 <1 2.92 1.94 1.20 Disease 2.81 3.49 <1 <1 1.45 <1 Complementary Feeding

1.26 1.27 <1 <1 1.39 <1

BMI <1 <1 1.64 <1 1.00 1.00

Risk Factor Risk Factors and their Loading for children up to 2 years Jhirniya Pavai Stunting Underweight Wasting Stunting Underweight Wasting

Child Age <1 <1 1.12 <1 <1 <1 Disease <1 <1 1.43 3.06 1.34 <1 Complementary Feeding

<1 1.50 1.75 1.10 <1 1.00

BMI <1 2.08 2.45 1.14 <1 1.01


77

The results of logistic regression are presented in Table 4.4. In Sonkatch, for stunting the child’s age and complementary feeding have emerged as risk factors; for underweight only child’s age has emerged as risk factor and none of the factors has emerged as risk factor for wasting. In Pandhana, all the three factors have emerged as risk factors for stunting, for underweight child’s age has emerged as risk factor and for wasting the risk factor is child’s age.

Table 4.4 Risk factors and their loadings for Children up to 5 years

Risk Factor Risk Factors and their Loading

Jhirniya Pavai

Stuntin

g

Underweigh

t

Wastin

g

Stuntin

g

Underweigh

t

Wastin

g

Factor

Loading

Factor

Loading

Factor

Loading

Factor

Loading

Factor

Loading

Factor

Loading

Child Age 1.22 1.32 <1 1.13 1.06 <1

Disease 1.20 2.06 <1 1.08 1.40 1.28

Complementar

y Feeding

1.24 <1 <1 1.07 <1 1.44

In Jhirnaya, all the three factors have emerged as risk factors for stunting; for underweight the risk factors are child’s age and diseases and for wasting none of the factors has emerged as risk factor. In Pawai, all the three factors have emerged as risk factors for stunting; for underweight risk factors are child’s age and diseases and for wasting the risk factors are diseases and complementary feeding.

Risk Factor

Risk Factors and their Loading

Sonkatch Pandhana

Stunting Underweight Wasting Stunting Underweight Wasting

Factor

Loading

Factor

Loading

Factor

Loading

Factor

Loading

Factor

Loading

Factor

Loading

Child Age 1.25 1.53 <1 1.25 1.05 1.19

Disease <1 <1 <1 1.85 1.00 <1

Complementary

Feeding

1.23 <1 <1 1.00 <1 <1


78

4.4 Pattern of Malnutrition by age

All the measures of malnutrition vary from age group to age group. In this section an attempt has been made to study the pattern of prevalence of malnutrition under all the three indicators. Stunting (Height for age): Sonkatch Fig. 4.1a displays age- wise (months) prevalence of stunting. It can be seen that prevalence of severe stunting is much larger than moderate stunting at all points. The prevalence of severe stunting is highest in 6-11 months age group.

Figure 4.1a: Age-wise prevalence of stunting in Children of Sonkatch

51.1

55.6

51.1

45 44.1

49.3

11.1

14.8 15

18.6

13.7 14.8

10

15

20

25

30

35

40

45

50

55

60

3 -5

months

6-11

months

12-35

months

36-47

months

48-59

months

Overall

Age

Perc

en

t

Severe Stunting

Moderate Stunting

Pandhana Fig. 4.1b displays age- wise (months) prevalence of stunting. It can be seen that prevalence of severe stunting is much larger than moderate stunting at all points. The prevalence of severe stunting is highest in 6-11 months age group.

Figure 4.1b: Age-wise prevalence of stunting in Children of Pandhana


79

23.9

50

42.8 41.9

35.1

39.9

7.5

15 15.819.1

17.315.3

5

10

15

20

25

30

35

40

45

50

55

3 -5

months

6-11

months

12-35

months

36-47

months

48-59

months

Overall

Age

Perc

en

t

Severe stunting

Moderate stunting

Jhirnaya Fig. 4.1c displays age- wise (months) prevalence of stunting. It can be seen that prevalence of severe stunting is highest in 12-35 months age group. Prevalence of severe stunting starts from very early age.

Figure 4.1c: Age-wise prevalence of stunting in Children of Jhirnaya

41.8

35.5

46.542.5 43.4 43.2

3.8

28.9

17.1

28.826

19.6

0

5

10

15

20

25

30

35

40

45

50

3 -5

months

6-11

months

12-35

months

36-47

months

48-59

months

Overall

Age

Perc

ent

Severe Stunting

Moderate stunting

Pawai Fig. 4.1d displays age- wise (months) prevalence of stunting. Prevalence of severe stunting starts increasing from very early age. This is highest at 48-59 months.

Figure 4.1d: Age-wise prevalence of stunting in Children of Pawai


80

26.1

41

5552.2

58

51.4

137.7

15

23.9

10.214

0

10

20

30

40

50

60

70

3 -5

months

6-11

months

12-35

months

36-47

months

48-59

months

Overall

Age

pe

rce

nt

Severe Stunting

Moderate Stunting

Intrauterine growth retardation (IUGR) may be a reason for onset of stunting at an early age. Poor nutrition of mother prior and during pregnancy often causes growth retardation of foetus. Under-weight (Weight for age):. Sonkatch Fig.4.2a displays the prevalence of under-weight in children. It can be seen that there is gradual rise in prevalence of severe underweight from very early age. Prevalence is highest at 36-47 months.


81

Figure 4.2a: Age-wise prevalence of underweight in Children -Sonkatch

17.8

21

27.5

30.729.2

26.6

28.9

22.2

24.6 24.3 24.8 24.5

15

17

19

21

23

25

27

29

31

33

3 -5

months

6-11

months

12-35

months

36-47

months

48-59

months

Overall

Age

Perc

en

t

Severe Underweight

Moderate Underweight

Pandhana Fig.4.2b displays the prevalence of under-weight in children. Steep rise is seen in prevalence of severe wasting from 3-5 months to 6-11 months. Highest prevalence is seen at 48-59 months.

Figure 4.2b: Age-wise prevalence of underweight in Children -Pandhana

7.5

36.7 35.4

30.9

40

31.9

16.4

31.7

20.4

26.5

35.5

24.9

0

5

10

15

20

25

30

35

40

45

3 -5

months

6-11

months

12-35

months

36-47

months

48-59

months

Overall

Age

Pe

rce

nt

Severe Underweight



82

Jhirnaya Fig.4.2c displays the prevalence of under-weight in children. Steep rise is seen in prevalence of severe wasting from 3-5 months to 12-35 months. Highest prevalence is seen at 48-59 months.

Figure 4.2c: Age-wise prevalence of underweight in Children -Jhirnaya

22.8

30.3

39.436.8

43.4

36.3

13.9

21.1 21.7

26.4 27.7

22.8

10

15

20

25

30

35

40

45

50

3 -5

months

6-11

months

12-35

months

36-47

months

48-59

months

Overall

Age

Perc

en

t

Severe Underweight


Pawai Fig.4.2d displays the prevalence of under-weight in children. Highest prevalence of severe underweight is seen at 3-5 months. This is serious.

Figure 4.2c: Age-wise prevalence of underweight in Children -Jhirnaya

39.1

17.9

23.6

17.4

11.4

19.821.7

23.1

26.429.3

35.2

28

10

15

20

25

30

35

40

45

3 -5

months

6-11

months

12-35

months

36-47

months

48-59

months

Overall

Age

Pe

rce

nt

Severe Underweight


Under weight begins with the on set of weaning when breast milk is not appropriately complemented with age specific semi solid food. During this period due to the child’s enhanced mobility and new food, chances of infection also increases. The survey data shows that though the children are fed 4-6 times a day


83

the number of children undernourished is also high. It is quite evident from this that the consistency, quality and the density of food is not appropriate. Hence poor diet along with infection increases under weight. Wasting (Weight for Height) Sonkatch Fig.4.3a displays the prevalence of wasting in children. In this case pattern of prevalence is almost similar both for severe and moderate wasting with exception that prevalence is high at 3-5 months for severe wasting. Highest prevalence is seen at 48-59 months.

Figure 4.3a: Age-wise prevalence of wasting in Children-Sonkatch

13.3

8.6

12.111.4

16.8

12.6

2.2

12.3

10.5

8.6

13.7

10.4

0

2

4

6

8

10

12

14

16

18

3 -5

months

6-11

months

12-35

months

36-47

months

48-59

months

Overall

Age

Pe

rce

nt

Severe Wasting

Moderate Wasting

Pandhana Fig.4.3b displays the prevalence of wasting in children. Highest prevalence is observed at 48-59 months both for severe and moderate wasting.

Figure 4.3b: Age-wise prevalence of wasting in Children-Pandhana


84

22.4

18.3

25.3

21.3

32.4

25

20.9

1011.9

14.7 15.714

0

5

10

15

20

25

30

35

3 -5 months 6-11 months 12-35

months

36-47

months

48-59

months

Overall

Age

Perc

en

t

Severe Wasting

Moderate Wasting


85

Jhirnaya Fig.4.3c displays the prevalence of wasting in children. Highest prevalence of severe wasting is seen at 12-35 months. Prevalence for moderate form is at 48-59 months.

Figure 4.3c: Age-wise prevalence of wasting in Children-Jhirnaya

17.7 17.1

22.9

17.115.6

18.9

7.69.2

18

15.5

26

17.2

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36-47

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48-59

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Overall

Age

Pe

rce

nt

Severe Wsating

Moderate Wasting

Pawai Fig.4.3d displays the prevalence of wasting in children. No definite trend is observed in this case.

Figure 4.3d: Age-wise prevalence of wasting in Children-Pawai

30.4

10.3 9.3 8.710.4

11.6

8.7

12.8 12.1

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Moderate Wasting

Wasting is caused due to sudden drop of calorie and protein in the diet. This may be caused by insufficient diet during the weaning stages or infection. The child is normally subjected to both these situations in socio-economically backward


86

communities. Repeated diarrhea, respiratory tract infection, parasite infestation are common causes of anorexia and poor absorption. 4.5 Pattern of Malnutrition by single age basis In order to gain an insight into the pattern of malnutrition, prevalence of malnutrition was studied on single age basis for all three indicators of malnutrition. Table 4.5 presents prevalence of malnutrition on single age basis in study area.

Table 4.5 Prevalence of Malnutrition in Children by Single Age (%)

Prevalence of Malnutrition in Children by Single Age (%) Sonkatch

Age in months


Weight for Age (Underweight) Weight for Height (Wasting)

Below - --3SD Below --2SD Normal Below --3SD Below - 2SD Normal Below - ---3SD Below --2SD Normal 3 months 53.8 7.7 38.5 15.4 30.8 53.8 15.4 7.7 76.9 4 months 47.4 21.1 31.6 21.1 36.8 42.1 21.1 0.0 78.9 5 months 53.8 0.0 46.2 15.4 15.4 69.2 0.0 0.0 100.0 6 months 35.3 29.4 35.3 5.9 23.5 70.6 0.0 17.6 82.4 7 months 62.5 18.8 18.8 37.5 6.3 56.3 12.5 12.5 75.0 8 months 56.3 12.5 31.3 31.3 12.5 56.3 12.5 18.8 68.8 9 months 53.3 6.7 40.0 13.3 40.0 46.7 6.7 6.7 86.7 10 months 60.0 10.0 30.0 20.0 30.0 50.0 10.0 10.0 80.0 11 months 85.7 0.0 14.3 14.3 28.6 57.1 14.3 0.0 85.7 12 months 68.8 6.3 25.0 28.1 28.1 43.8 9.4 9.4 81.3 13 months 57.1 14.3 28.6 42.9 0.0 57.1 14.3 7.1 78.6 14 months 37.5 25.0 37.5 12.5 12.5 75.0 0.0 12.5 87.5 15 months 33.3 11.1 55.6 33.3 44.4 22.2 33.3 22.2 44.4 16 months 83.3 8.3 8.3 50.0 16.7 33.3 8.3 0.0 91.7 17 months 37.5 25.0 37.5 0.0 12.5 87.5 12.5 0.0 87.5 18 months 35.7 32.1 32.1 17.9 21.4 60.7 14.3 7.1 78.6 19 months 50.0 12.5 37.5 37.5 12.5 50.0 37.5 0.0 62.5 20 months 50.0 10.0 40.0 30.0 20.0 50.0 10.0 0.0 90.0 21 months 100.0 0.0 0.0 0.0 33.3 66.7 0.0 0.0 100.0 22 months 25.0 12.5 62.5 37.5 25.0 37.5 37.5 12.5 50.0 23 months 50.0 16.7 33.3 50.0 16.7 33.3 16.7 16.7 66.7


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Prevalence of Malnutrition in Children by Single Age (%) Pandhana

Age in months

Height for Age (Stunting) Weight for Age (Underweight)




89


Prevalence of Malnutrition in Children by Single Age (%)Jhiranya

Age in months





90


Prevalence of Malnutrition in Children by Single Age (%) Pawai

Age in months



Below - --3SD Below --2SD Normal Below --3SD Below - 2SD Normal Below - ---3SD Below --2SD Normal 3 months 30.8 7.7 61.5 53.8 15.4 30.8 38.5 7.7 53.8 4 months 25.0 25.0 50.0 25.0 50.0 25.0 25.0 25.0 50.0 5 months 16.7 16.7 66.7 16.7 16.7 66.7 16.7 0.0 83.3 6 months 25.0 12.5 62.5 0.0 37.5 62.5 0.0 25.0 75.0 7 months 16.7 0.0 83.3 16.7 0.0 83.3 16.7 0.0 83.3 8 months 57.1 0.0 42.9 42.9 28.6 28.6 14.3 0.0 85.7 9 months 37.5 12.5 50.0 25.0 12.5 62.5 0.0 37.5 62.5 10 months 75.0 0.0 25.0 0.0 50.0 50.0 0.0 0.0 100.0 11 months 50.0 16.7 33.3 16.7 16.7 66.7 16.7 0.0 83.3 12 months 68.2 4.5 27.3 45.5 18.2 36.4 18.2 9.1 72.7 13 months 50.0 50.0 0.0 50.0 50.0 0.0 0.0 50.0 50.0 14 months 0.0 0.0 100.0 0.0 50.0 50.0 0.0 50.0 50.0 15 months 22.2 22.2 55.6 0.0 22.2 77.8 0.0 33.3 66.7 16 months 100.0 0.0 0.0 33.3 0.0

66.7 0.0 0.0 100.0

17 months 20.0 20.0 60.0 20.0 40.0 40.0 20.0 20.0 60.0 18 months 100.0 0.0 0.0 0.0 50.0 50.0 0.0 0.0 100.0 19 months 20.0 60.0 20.0 0.0 40.0 60.0 0.0 20.0 80.0 20 months 33.3 66.7 0.0 0.0 0.0 100.0 0.0 0.0 100.0 21 months 100.0 0.0 0.0 0.0 100.0 0.0 0.0 0.0 100.0 22 months 40.0 20.0 40.0 0.0 40.0 60.0 20.0 0.0 80.0 23 months 50.0 0.0 50.0 0.0 25.0 75.0 0.0 25.0 75.0

Stunting Sonkatch Figure 4.4a depicts prevalence of stunting on single age basis. It can be seen that prevalence severe stunting is much higher almost at all points. Further the prevalence is highest at 21 months (100%). This may be an outlier.

Figure 4.4a: Prevalence of stunting by single age basis-Sonkatch

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Pandhana Figure 4.4b depicts prevalence of stunting on single age basis. No definite pattern is noticed in this case. Prevalence of moderate stunting at 22months (100%) seems to be an outlier.

Figure 4.4b: Prevalence of stunting by single age basis-Pandhana

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Jhirnaya Figure 4.4c depicts prevalence of stunting on single age basis. No definite pattern is seen. The prevalence of severe stunting is high from the very beginning.


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Figure 4.4c: Prevalence of stunting by single age basis-Jhirnaya

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Pawai Figure 4.4d depicts prevalence of stunting on single age basis. Highest prevalence of severe stunting is seen at 16, 18 and 21 months.

Figure 4.4d: Prevalence of stunting by single age basis-Pawai

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Underweight Sonkatch Fig. 4.5a depicts prevalence of underweight. No definite pattern is seen. The pattern of prevalence is almost similar for both forms of underweight.


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Figure 4.5a: Prevalence of underweight by single age basis-Sonkatch.

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Pandhana Fig. 4.5b depicts prevalence of underweight. The prevalence of severe underweight is highest at 17 and 21 months(100%). This seems abnormal.

Figure 4.5b: Prevalence of underweight by single age basis-Pandhana

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Jhirnaya Fig. 4.5c depicts prevalence of underweight. No definite pattern is seen in prevalence of underweight in any category.


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Figure 4.5c: Prevalence of underweight by single age basis-Jhirnaya

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Moderarate Underweight

Pawai Fig. 4.5d depicts prevalence of underweight. Prevalence of moderate underweight is seen to be highest at 21 months (100%). This may be an outlier. No definite pattern is seen otherwise.

Figure 4.5d: Prevalence of underweight by single age basis-Pawai

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Wasting Sonkatch


95

Fig.4.6a depicts the prevalence of wasting. No definite pattern in prevalence of either form of underweight is seen in this case as well.

Figure 4.6a: Prevalence of wasting by single age basis-Sonkatch

0

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Moderate Wasting

Pandhana Fig.4.6b depicts the prevalence of wasting. Prevalence of wasting appears to increase with advancing age. The reason could be exposure of child to unhygienic conditions or lack of nutritious food etc.

Figure 4.6b: Prevalence of wasting by single age basis-Pandhana

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Moderate Wasting

Jhirnaya Fig.4.6c depicts the prevalence of wasting. No definite pattern of prevalence of both kinds of wasting is seen.


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97

Figure 4.6c: Prevalence of wasting by single age basis-Jhirnaya

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Pawai Fig.4.6d depicts the prevalence of wasting. In this case prevalence of moderate form of wasting is generally higher than that of severe form. Prevalence of moderate wasting seems to increase with the advance of age.

Figure 4.6d: Prevalence of wasting by single age basis-Pawai

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5. Educational Status of Children

5.1 Introduction

In this study an attempt has been made to investigate the educational status of children in the age-group 5-14 years. Table 5.1 displays class-wise enrollment of children in both the blocks.

Table 5.1: Class-wise enrollment of Children

Children aged >5-14 years (School Enrollment) (Number) Sonkach Pandhana Parameter Male Female Total Male Female Total Total Enrolled 935 761 1,696 718 695 1,413 Class Wise Enrollment 1 class 126 105 231 107 117 224 2 class 122 110 232 137 145 282 3 class 157 107 264 137 145 282 4 class 122 94 216 103 85 187 5 class 151 99 249 109 88 197 6 class 67 88 155 52 61 114 7 class 98 88 186 40 28 68 8 class 68 55 123 24 15 39 9 class 16 13 29 7 11 18 10 class 7 3 11 1 0 1 Children aged >5-14 years (School Enrollment) (Number) Jhirniya Pavai Parameter Male Female Total Male Female Total Total Enrolled 769 740 1,509 426 406 832 Class Wise Enrollment 1 class 158 144 310 71 66 137 2 class 165 162 324 65 66 131 3 class 138 135 271 44 47 91 4 class 105 95 206 54 51 105 5 class 82 87 161 66 60 126 6 class 62 49 122 47 49 96 7 class 36 41 71 28 28 56 8 class 17 22 33 38 34 72 9 class 6 3 12 10 6 16 10 class 0 1 0 3 0 3


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A declining trend was observed in the enrollment in both all the blocks. Fig.5.1 displays this trend.

Figure 5.1: Class-wise enrollment of Children

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ale

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Perc

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5.2 Children out of School

Table 5.2 describes the class-wise drop out details of children and the reasons for drop out. Sonkatch About 9.9 % children were out of school. Working children, absence of teachers and poor quality of teaching were cited as main reasons for drop out. Educational scenario was noted to be rather grave. The drop out rate was highest in class 1. High drop out rate at lower classes is a matter of concern. Pandhana About 33.9 % children were out of school. Working children, was cited as main reason for drop out. Educational scenario was noted to be rather grave. The drop out rate was highest in class 1. High drop out rate at lower classes is a matter of concern.


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Table 5.2: Children aged >5-14 years (Out of School) (%)

Children aged >5-14 years (Out of School) (%)

Sonkach Pandhana

Male Female Total Male Female Total Never Attended 7.7 10.6 9 33.7 33 33.4 Dropped Out 1.2 0.6 0.9 0.4 0.7 0.5 Total Out of School 8.9 11.2 9.9 34.1 33.7 33.9 Last Class Attended (Dropped Out) 1 class 58.3 40.0 52.9 75.0 85.7 81.8 2 class 16.7 20.0 17.6 0.0 14.3 9.1 3 class 0.0 0.0 0.0 0.0 0.0 0.0 4 class 8.3 20.0 11.8 0.0 0.0 0.0 5 class 16.7 20.0 17.6 0.0 0.0 0.0 6 class 0.0 0.0 0.0 25.0 0.0 9.1 7 class 0.0 0.0 0.0 0.0 0.0 0.0 8 class 0.0 0.0 0.0 0.0 0.0 0.0 Children aged >5-14 years (Out of School) (%)

Jhirniya Pavai

Male Female Total Male Female Total Never Attended 27.0 30.2 28.3 7.2 10.4 8.8 Dropped Out 0.6 0.0 0.6 0.2 0.4 0.3 Total Out of School 27.6 30.2 28.9 7.4 10.8 9.1 Last Class Attended (Dropped Out) 1 class 14.3 - 0.0 0.0 50.0 33.3 2 class 14.3 - 0.0 0.0 0.0 0.0 3 class 14.3 - 100.0 100.0 0.0 33.3 4 class 0.0 - 0.0 0.0 50.0 33.3 5 class 28.5 - 0.0 0.0 0.0 0.0 6 class 28.5 - 0.0 0.0 0.0 0.0 7 class 0.0 - 0.0 0.0 0.0 0.0 8 class 0.0 - 0.0 0.0 0.0 0.0 Reasons of drop out (Multiple Response)

%

Sonkach Pandhana Jhirniya Pavai Children takes care of other children

29.4 0.0 0.0 28.6 Working 17.6 83.3 33.3 0.0 Frequent illness 0.0 0.0 0.0 0.0 Lack of knowledge about enrollment dates

0.0 0.0 0.0 0.0 Absence of teachers 47.0 0.0 0.0 0.0 Poor teaching quality 47.0 0.0 0.0 0.0 Other 5.9 16.7 66.6 71.4


101


102

Jhirnaya About 28.9 % children were out of school. Working children, was cited as main reason for drop out. Educational scenario was noted to be rather grave. The drop out rate was highest in class 3. High drop out rate at lower classes is a matter of concern. Pawai About 9.1 % children were out of school. Children taking care of other children, was cited as main reason for drop out. Educational scenario was noted to be rather grave. The drop out rate was highest in 33.3 % each in classes 1,3 and 4. High drop out rate at lower classes is a matter of concern.

5.3 School Profile and School Management Committees

Table 5.3 describes the profile of schools and school management committees. Sonkatch In 15.2 % villages, School Management Committees (SMC) existed. In 62.1 % cases the SMCs met every month. Average distance from school to villages was noted to be between 1-2 km. 69.7 % schools were having toilets. In 47.4 % schools separate toilets for girls were provided. Drinking water was provided in 54.1 % schools and 88.9 % schools served MDM. School profile clearly indicates very poor facilities. Pandhana In 13 % villages, School Management Committees (SMC) existed. In 57.4 % cases the SMCs met every 3 months. Average distance from school to villages was noted to be between 1-2 km. 89.3 % schools were having toilets. In 88.4 % schools separate toilets for girls were provided. Drinking water was provided in 83.6 % schools and 94 % schools served MDM. School profile clearly indicates very poor facilities.


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Table 5.3: School Profile and School Management Committee

School Profile and School Management Committee

% Villages having School Management Committee (SMC)

Sonkach Pandhana Jhirniya Pavai Yes 15.2 13.0 6.3 12.5 No 74.3 58.1 61.9 34.4 Don’t know 10.5 28.9 31.9 53.1 Frequency of SMC meeting Weekly 0.0 0.0 2.0 0.6 Monthly 62.1 1.2 34.7 59.1 Every three month 11.6 57.4 28.6 0.0 Every six month 3.0 29.8 7.1 4.5 Yearly 3.5 0.8 2.0 0.6 Don’t know 19.7 1.6 25.5 35.1

Distance of school from home (in kms) Below 1 93.3 81.9 77.6 78.5 1-2 5.5 15.2 20.6 15.4 More than 2 1.2 2.8 1.8 6.2 Facilities available in the school Toilets 69.7 89.3 81.2 82.1 Separate toilet for girls 47.4 88.4 18.8 55.5 Drinking water 54.1 83.6 64.7 79.7 Mid day meals 88.9 94.0 97.4 96.1

Jhirnaya In 6.3 % villages, School Management Committees (SMC) existed. In 34.7 % cases the SMCs met every month. Average distance from school to villages was noted to be between 1-2 km. 81.2 % schools were having toilets. In 18.8 % schools separate toilets for girls were provided. Drinking water was provided in 64.7 % schools and 97.4 % schools served MDM. School profile clearly indicates very poor facilities. Pawai In 12.5 % villages, School Management Committees (SMC) existed. In 59.1 % cases the SMCs met every month. Average distance from school to villages was noted to be between 1-2 km. 82.1 % schools were having toilets. In 55.5 % schools separate toilets for girls were provided. Drinking water was provided in 79.7 % schools and 96.1 % schools served MDM. School profile clearly indicates very poor facilities.


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6. Salient Findings and Recommendations

6.1 Introduction

This chapter is devoted to salient findings and recommendations emerging out of these findings. These recommendations if implemented are likely to find solutions for pathetic nutritional scenario.

6.2 Salient findings and recommendations

Table 6.1 provides salient findings and recommendations. These may possibly provide solutions for existing problems, if implemented.

Table 6.1: Salient findings and recommendations

S.No. Finding Recommendation 1 Sex Ratio: In the study area overall sex ratio was 726 females per

thousand males in Sonkatch, 914 in Pandhana, 887 in Jhirnaya and 891 in Pawai. These sex ratios are markedly below the sex ratios at their districts’ levels

Low sex ratio in children is a matter of concern. .Awareness campaign is needed to apprise the population of importance of taking good care of girl child as well.

2 Water Resources: Tube-wells, and open wells are main sources of water in the area. These are likely sources of contaminated water and thus cause health hazards.

There is an urgent need of safe drinking water. Efforts should be made to make piped water available to the residents of the area Promotion TSC and water management

3 Sources of income and migration: Major sources of income are farming and wage labor Holding sizes are small and thus not sufficient to produce the required quantities of food. This leads the people to go for alternative occupations and migration MNREGA: MNREGA that guarantees the registered members 100 days job in a year is not performing to its potential in this area. Of the registered persons only 0.7 to 4.7 % got job for entitled 100 days across the blocks and 55 to 97 % did not get a job even for a day .

There is an urgent need to provide alternative sources of income so that seasonal migration could be minimized. The working of MNREGA needs to be properly monitored Promotion of integrated farming systems and back yard gardening/kitchen gardening.

4

PDS and MDM: Under PDS, distribution of ration is not proper in the sense that people are not receiving rations regularly. As for MDM almost all the schools reported to serve MDM

Working of PDS needs to be monitored. Diet diversity has to be addressed through PDS with the supply of pulse, legumes, soya nuggets, sugar and edible oils on a regular basis along with wheat, rice and kerosene. All members in the family should be issued ration Cards. Weekly rations should be ensured. Even though almost all the schools provide MDM yet the nutritional status of children is not good. It is therefore necessary to ensure that quality food is provided to the children. Strengthening of SMC to be able to ensure good quality


106

of meals.


5 Educational Level: Educational level of population under study is poor. The illiteracy is very high across the blocks. Illiteracy rate varies from 38 to 65 % across the blocks. Illiteracy is high amongst females.

Efforts are required to enhance the educational levels of the people specially the females, as mothers’ literacy level has a bearing on the nutritional status of children. Schools for working adults and house-wives be opened to enhance general level of education.

6 Nutritional Status of pregnant women and mothers of 2 year old children: Nutritional status of both pregnant women and mothers of children younger than 2 years continues to be poor and health infrastructure is not as per GOI norms. Proportion of mothers with low BMI varied from 22 to 100 % across varius age groups in the blocks. The figures are generally higher than the National figure of 36. Further, the women under study had generally one contact for ANC.

Working of health facilities available in the area needs to be investigated and improved. The mothers should be made aware of the facilities and importance of regular check-ups. Adolescent girls health programs – School anaemia control program/SABALA should be strengthened Supplementary nutrition program for mothers – ensure spot feeding Focus on consumption of 100 IFA

7 Nutritional status of children: Nutritional level of children was very low as per the prevalence of stunting, under-weight and wasting. The factors associated with under-nutrition were caring practices, prevalence of disease, hygiene, affiliation of child with social groups and mothers’ literacy status. Statistical analysis has shown that child’s affiliation to social groups and literacy status of mothers. These results however, are not consistent across the blocks.

Besides taking care of children in terms of proper feeding practices and health care, there is a need to improve living conditions of persons belonging to lower stratum of the society in terms of proper employment, educational facilities and medical facilities etc. Promotion of IYCF- skill development of AWW on consistency, density and quality of complementary food.


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8 Risk Factors associated with malnutrition of Children: Logistic regression analysis has revealed that in Sonkatch, for children up to 2 years, diseases and complementary feeding have emerged as risk factors for stunting; for underweight the risk factors are child’s age, diseases and complementary feeding and for wasting the risk factor is BMI of mothers. In Pandhana, risk factor for stunting is child’s age ; for underweight all the four factors (child’s age, disease, complementary feeding and BMI of mothers) have emerged as risk factors and for wasting, child’s age and BMI of mothers are risk factors. In Jhirnaya, for stunting none of the factors has emerged as risk factor; for underweight complementary feeding and BMI have emerged as risk factors and for wasting all the four factors have emerged as risk factors. In Pawai, for stunting, diseases, complementary feeding and BMI of mothers have emerged as risk factors; for underweight the risk factor is disease while for wasting, BMI has emerged as risk factor. For children up to 5 years, logistic regression analysis has revealed that in Sonkatch, for stunting, the child’s age and complementary feeding have emerged as risk factors; for underweight only child’s age has emerged as risk factor and none of the factors has emerged as risk factor for wasting. In Pandhana, all the three factors (child’s age, disease and complementary feeding) have emerged as risk factors for stunting, for underweight child’s age has emerged as risk factor and for wasting the risk factor is child’s age. In Jhirnaya, all the three factors have emerged as risk factors for stunting; for underweight the risk factors are child’s age and diseases and for wasting none of the factors has emerged as risk factor. In Pawai, all the three factors have emerged as risk factors for stunting; for underweight risk factors are child’s age and diseases and for wasting the risk factors are diseases and complementary feeding.

Due care is needed in respect of variables like child’ age, diseases, complementary feeding. Since BMI of mothers has also emerged as contributory factor, it is necessary to take due care of mothers as well Thus, a holistic approach is required to handle nutritional problems of both child and the mother. Health and Family Welfare: Promotion of hand washing Diarrhoea management with ORS and Zinc supplementation Increase coverage of Vita A supplementation (9 doses) Bi annual de worming rounds Promotion of family spacing rather than sterilization


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9 Educational Status of Children: A declining trend is observed in enrollment of children. The drop out rate is higher in lower classes. The major reasons cited were working children and poor quality of teaching.

The emphasis should be to eliminate the menace of child labor. Further, the need is to make schooling an attractive preposition.


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Nutrition and Education Census - Household Questionnaire Date/ Questionnaire Nr:

Block: Panchayat: Village: Questionnaire Filled by:

A. Name head of household SEX (F/M)

No. people living in household1

Please define if household belongs to: 1=SC 2=ST 3=OBC 4=General

Household members Specific Role in Family. Define here: 1= Head of household 2= Wife/husband of head 3= Daughter/son of head 4= Daughter/son in law of head 5= Granddaughter/ son of head 6= Mother/father of head 7=Other relative 8=Widow 9=Disabled-physical/mental

Educational level 1=none 2=primary 3=middle 4=high school 5= above

Specific Observations. Please only give important observations here, e.g. highly malnourished, chronically ill etc.

Name SEX

(F/M)

Birth date Age

1

2

3

4

5

6

7


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B.

(1) Pregnant Women

(2) Mothers of babies2

Please indicate next to the name if person is (1) or (2) or maybe both!

Birth-date

Age MUAC (cm)

Weight (kg) Height (cm)

Registered in ICDS? (y/n)

Have

you taken rations/food packet from anganwadi?

Other Support Services?

1= Trained Birth Attendant

2=ASHA

3= None

4= Others

Special Observations? Please mention malnourishment symptoms of the women if any:

1=Pale nail color;

2=White/light pink color in inner lining of lower eyelid (normal color=red); 3=breathlessness; 4=Oedema;

5= Severely malnourished/sick

6= Others

1

2

3


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C. Children <5 years of age (up to 59 month)

SEX (F/M)

Birth-date Birth weight (kg)

Age (month)

MUAC (cm)

Weight (kg)

Height (cm)

Registered in ICDS? (y/n)

Received food/ rations? (y/n)

Have you taken home rations /food packets from anganwadi?

Special Observations? Please mention malnourishment symptoms of the children if any: 1=Hair color 2=Skin problems 3=Inflated belly 4=Fatigue 5=Chronic diarrhea 6=Swelling in both feet 7= Mouth ulcer 8= Night blindness 9= Bitots spots 10= other illness as prolonged fever, dysentery, skin scar

1

2

3

4


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Food consumption: Breastfeeding (BF)+ complementary food (CF)

BF practiced

(y/n)

BF immediate after birth

(1-2 hours)

(y/n)

BF for first 3 days

(y/n)

How many month do you give only breastfeeding? (month)

CF given

(y/n)

Age when CF starts given (month)

No. of times per day

feeds

given

Food consumed daily

Food consumed once a week

Food consumed once a month

1=Rice/wheat; 2=dal; 3=milk; 4=oil/ghee; 5=Eggs, meat fish, chicken; 6= Green leafy vegetables; 7= Fruits; 8=Iodised salt; 9= Others

1

2

3

4

D. Household members died during last 12 month SEX

(F/M)

Birth-date

Age Date of death

Reason for death? Please specify reasons for death, for instance:

1=Aged

2=During pregnancy/delivery 3=Chronic illnesses

4=Specific diseases/symptoms

5=Others

1

2

3


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E. Children >5-14 years of age

SEX (F/M)

Birth-date Age Enrolled in school (y/n)

Class Attendance3

-should be cross-checked with Teacher: 1= Regular 2=Sometimes absent 3= Often Absent 4=Always Absent

If out-of- school – last class attended

Reasons for out of school 1=Child takes care of other children; 2=Working 3=Frequent illness 4=Lack of knowledge about enrolment dates 5= Absence of teachers 6=Poor quality of teaching 7=Others

Special observations? Only important observations here, e.g. highly malnourished, chronically ill etc.

1

2

3

4

F. Additional questions

Sources of Income of the HH

1= Farming

2= Wage labor

3= Livestock

4=Fishing

5= Small Business

6= Government Employment

7= Seasonal migration

8= Others

Primary Source of Income:

Do you migrate seasonal?

(y/n)

If yes, where?

How many Family Members do migrate?

For how many months/year?

What kind of health centres exist in the area?

1= Sub-centre

2=Primary Health centre

3= Community Health Centre

4=Private

5= Others

How far is the health centre from your home?

(km)

Is the health centre working? (y/n)


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Household source of drinking and cooking water? 1= Piped water 2= Pond/river 3=Open well 4=Tube well

5=Others

Household has:

1=AAY

2= BPL

3= APL

Card

(cross-check with card)

How many family members are covered in the PDS card/s?


Last receipt of subsidized food? Please define:

1= x weeks

2=x month

3= never received

Household has job card in NREGA?

(y/n)

How many members of household are registered in NREGA?


How many days received in 2011? (all members of household)

Is there a School Management Committee in the village?

(y/n/ don’t know)

How regular does the SMC meet?

1= weekly

2= monthly

3= every 3 month

4=every 6 month

5= yearly

6= don’t know

How far is the school from your home?

(km)

Does the school have:

1= Toilets

2= Separate toilets for girls

3= Drinking water

4= Mid-day meals provided

(y/n)

What is provided through Mid-day meals?

1= , 2= , 3= , 4= , 5=

1 Definition of Household as group of people that eat from the same pot/kitchen.

2 Please specify here if it’s 1) a pregnant women or 2) mother of small children only

3 Regular= a child assisting every day the school, sometimes absent=a child that don’t assist once per week the school in a non regular pattern, often absent= a child

that don’t assist School more than two times per week in a regular pattern , always absent= a child that don’t assist school at all

Household Survey for the Assessment of Nutrition and ...

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