Nutrition Surveillance System (NSS) in ICDS

The need for Nutrition Surveillance in ICDS

Reduction of malnutrition in India between

1998-99(NFHS-2) and 2005-06 (NFHS-3)

INDIA

NFHS-3 2005-06)NFHS-2 1998-99)

% of Underweight Children (0-3 years)

Less than 30%

30% - 40%

More than 40%

21.7

15.5

(35.3) 18.8

20.1

19.8Tripura(37.3)

(28.6)

21.3

53.2

52.2

51.550.8

50.3

48.146.7

45.3

44.8

41.6

38.6

34.2

31.5

24.736.5

36.3

29.2

(21.5)

21.2

17.3

35.8 23.7

19.5

14.2Tripura(35.2)

42.9

21.3

47.8

54.9

54.6)57.9

39.5

41.636.8

37.6

32.7

41.6

33.3

29.8

25.9

2731.1

31.7

24.0

29.7

NFHS-3 results on the Nutritional Status of children have some surprises in store for the discerning observer. Chart indicates that the reduction in incidence of malnutrition underweight) on an all–India basis was hardly about 2.3% between NFHS-2 (1998-99) and NFHS-3 (2005-06), while in Tripura, the same was 2.1%

% reduction in malnutrition between NFHS-2 and NFHS-3

India Tripura30

35

40

45

42.7

37.3

40.4

35.2

NFHS-2 NFHS-3

During the same period, the states which focused to expose malnutrition, the silent killer, reduced malnutrition by highest percentage.

The reduction was as high as 12.1% in Maharashtra followed by 10.2 % in Orissa. Both the states had adopted strategies to tackle malnutrition after nutrition surveillance revealed pockets of high malnutrition.

India Maharashtra Orissa30

35

40

45

50

55

42.7

44.8

50.3

40.4

32.7

39.5

NFHS-2 NFHS-3

Reduction Rate %)

2.3% 12.1% 10.2%

Percentage of under-3 yrs. underweight children

% reduction in malnutrition between NFHS-2 and NFHS-3

NFHS-3 (2005-06) revealed that more than 40% children of India are malnourished

0

10

20

30

40

50

60 57

.9

54

.9

54

.6

47

.8

41

.6

41

.1

40

.4

39

.5

37

.6

35

.2

33

.3

32

.7

29

.8

25

.9

21

.2

Regular ICDS Monthly Progress Report MPR) gave no indication of this scenario

Existing ICDS monitoring system

Data Flow in ICDS

Sector

Anganwadi Centre

Sector Level Compilation

District

State

NationProject Level CompilationProject

Data Capture and Data Flow for Process Monitoring

Data captured at AWC level

Data once again manually compiled at Supervisor level for individual AWC

Supervisor’s compilation report for a Sector

Project level compilation..

The data is further compiled in the MPR forms in 5 copies manually within a very short time span of (5-7days) by the CDPO office staff or Supervisor and flows to the higher levels.

CDPO’s compiled report for a Project.

Limitation of the System A lot of time is wasted in capturing the data at AWC level and then again at Supervisor level manually and thereby incurring huge Paper works and considerable man-hours.

Pockets of malnutrition within an ICDS Project remain un-seen.

Severely malnourished children, needing urgent therapeutic intervention are sometimes left unattended by health care system. In the present system current month's data can't be compared with the previous months' figures. So, progress cannot be measured.

Chances of error increase as the compilation is done within a very short time span.

Many valuable information is lost as the data is collated at Project level.

Loss of valuable Data…

Sector Supervisor)

Child Population ….

Anganwadi Centers AWW)

Below 6 mnths (Male & Female)6mnths – 1 yr (Male & Female)1 yr – 2 yrs (Male & Female)2 yrs – 3 yrs (Male & Female)3 yrs – 4yrs (Male & Female)4 yrs – 5 yrs (Male & Female)5 yrs – 6 yrs (Male & Female)

Below 6 mnths (Male & Female)6mnths – 1 yr (Male & Female)1 yr – 3 yrs (Male & Female)3 yrs – 6 yrs (Male & Female)

Project

CDPO) Below 6 mnths 6mnths – 1 yr1 yr – 3 yrs 3 yrs – 6 yrs

Government of India (Format-II)

0 - 6 yrsMPR

Data lost ………… as it moves up

West Tripura Initiative..

AWC level data capturing from 1771 rural/tribal/urban AWCs of the State.

The data has started revealing pockets of malnutrition along with age/sex break-up, this is leading to focussed intervention by the functionaries and communities.

West Tripura Initiative..

Activities completed…

• Design and development of NSS version 1.0 with old GoI MPR by Riddhi

• Training of CDPOs and Supervisors on above system

• Design and development of NSS version 2.0 with new GoI MPR by Riddhi

• Training of CDPOs and Supervisors on above system

• Data Entry by CDPOs in the new system

What AWC level Data reveals ?

Nutrition Surveillance SystemWest Tripura

www.westtripura.nutritiongis.org

District level MPR

Nutritional Status of children out of children weighed)

GoI 78 column Report Generation

Generates monthly report for submitting to GoI

All AWCs are visible in the web

All AWCs are visible in the web

Data Analysis• Graphical

• Spatial

Ranirbazar Agartala II Agartala I Hezamara Mohanpur Mandwih Dukli70

75

80

85

90

95

100

105

100

88.7587.06

83.1982.32 82.16

77.3

Project wise Percentage Normal Children(May 2013)

Dukli Mohanpur Mandwih Hezamara Agartala I Agartala II Ranirbazar0

5

10

15

20

25

20.04

17.61 17.34 16.81

12.89

11.01

0

Project wise Percentage Moderate Underweight Children(May 2013)

Dukli Mandwih Agartala II Mohanpur Agartala I Hezamara Ranirbazar0

0.5

1

1.5

2

2.5

3

2.66

0.5

0.240.07 0.05 0 0

Project wise Percentage Severe Underweight Children(May 2013)

Motivated functionaries have taken charge of the new system

Spatial Analysis

District map showing ICDS projects

Mohanpur

Hezamara

Mandwih

Agartala-II

Agartala-II

Dukli

Jirania

District map showing 1771 Anganwadi Centres

Individual AWCs are now visible along with

nutritional status of children

%age of moderately underweight children (0-5 yrs.), May, 2013

Less than 15%

Between 15% to 20%

Above 20%

Mohanpur 16.4)

Hezamara 17.3)

Mandwih 16.8)

Agartala-II 11.3)

Agartala-II13)

Dukli 20.45)

Jirania Data yet to be received)

Mohanpur 0.09)

Hezamara 0)

Mandwih 0.46)

Agartala-II 0)

Agartala-II0.08)

Dukli 2.83)

Jirania Data yet to be received)

0%

Between 0% to 1%

Above 1%

%age of severely underweight children (0-5 yrs.), May, 2013

Disaggregated data analysis through Project level system

ICDS Project : Mandwih, West Tripura

Project Mandwih: Dashboard on AWC reporting status

Project Mandwih showing Anganwadi Centres

AWCs having more than 5 moderately underweight children (0-5 yrs.)

Pockets of malnutrition are now visible

AWCs having 1 or more severely underweight children (0-5 yrs.)

Severely underweight children are now visible through the system

Focused action plan will now lead to rapid reduction of malnutrition

Imm

ediate Action

Tracking every child by name forScaling Up Nutrition (SUN)

2nd phase of Nutrition Surveillance:

The Janani initiative:

1000 Days Care for every child (-9 months to 2 years of age)

Improper care during first 1,000 days -9 months to 2 years) of the child i.e. the period from pregnancy upto a child’s 2 years after birth, leads to...

High morbidity, Stunting and Poor Survival

Why?

Addressing needs of mothers/children necessitates an innovative approach that calls for convergence and collaboration of different departments, as well as community awareness.

A look at one such initiative..

“e-Janani”

A Mother-Child Dyad Care Initiative by the Government of Tripura

e-JananiA combination of Mobile Telephony and Server

based computer program

Mandwih

Real Time Tracking of allPregnant Mothers and Children

Bringing Focus to those at RISK

Registration

Delivery

PNC

ANC 1ANC 2

ANC 3

ANC 4

ANC 5

From Registration to Delivery110 data fields are collected for a mother

over a period of 1 year

Proper capturing, storing and timely access to this information can save many lives

Helping frontline health workers MPWs and Anganwadi workers) to deliver timely and quality services to pregnant Women and children

e-Janani

e-Janani helps in converging H & FW and ICDS initiatives

Data flow from MPWs

Data flow system in Health

Voice Data capturing by MPWs of Mandwih Block

Data flow from AWWs

AWC Register Entry by Worker

Monthly data entry from CDPO office to NIC

Server

Server at NIC Server at Riddhi

Analysis of Health & ICDS Data

Data flow system in ICDS

Converging data through e-Janani

Activities completed…• Design and development of new format for Health and ICDS

data capturing

• Survey and geo-referencing of Health & ICDS facilities by Riddhi

• Development of data entry system for Health & ICDS by NIC

• Procurement and distribution of Android mobile phone to ANMs by H&FW

• Installation and training on real time mobile application by Riddhi

• Training of data transcriber at PHC level by Riddhi

• Development of online analysis tool by Riddhi

• Linkage between mother-child and health & ICDS

Analysis of Data received so far….

Common linking field (e-RoR) is being worked out by individual departments. Till that time, instead of COHORT tracking, individual mother and child tracking has already started

Analysis on following dataset:

Mother’s data received from Health System

Child’s data received from Health System

Pregnant Mother’s data received from ICDS System

Nursing Mother’s data received from ICDS System

Child’s data received from ICDS System

Health

Mother 2091

Child 5830

Child with Mother MCTS ID 20

ICDS

Pregnant Mother 946

Nursing Mother 176

Child 4363

Child with Mother ID 2

Data received from NIC’s serverAs on 5th July 2013

Dashboard analysis of Mother’s ANCin Mandwih Block as on 5th July 2013

108

71

1 34

1276

ANC 1 ANC 2

Services in time Services Awaited Services delayed or not taken

Mother Code Mother's name PHC Name Sub Center Name Date Range

160100300311300004 Babita Debbarma Borakha PHC Patni Sub-centre) 03-01-2013 - 27-03-2013

160100300511300010 Sabita Debbarma Borakha PHC Rajchantai Sub-centre) 07-02-2013 - 01-05-2013

160100300811300001 Swarnalaxmi Debbarma Mandai PHC Ashigarsh Sub-centre) 03-06-2012 - 25-08-2012

160100301011300009 Rebika Debbarmma Mandai PHC Brigudas Bari Sub-centre) 30-12-2012 - 23-03-2013

160100301011300013 Kalpana Rupini Saha) Mandai PHC Brigudas Bari Sub-centre) 05-11-2012 - 27-01-2013

160100301211300003 Malani Debbarma Mandai PHC Laxmipur Sub-centre) 14-12-2012 - 07-03-2013

160100301211300007 Dipali Debbarmma Mandai PHC Laxmipur Sub-centre) 12-02-2013 - 06-05-2013

160100301211300008 Biswarani Debbarmma Mandai PHC Laxmipur Sub-centre) 28-12-2012 - 21-03-2013

160100301711300013 Pratima Debbarma Borakha PHC Kathiram Sub-centre) 18-01-2013 - 11-04-2013

160100301811300002 Namita Debbarma Borakha PHC Binankobra Sub-centre) 04-02-2013 - 28-04-2013

160100301811300005 Anjana Debbarma Borakha PHC Binankobra Sub-centre) 08-01-2013 - 01-04-2013

160100301911300003 Khajani Debbarma Borakha PHC Borakha MCH Sub-centre) 16-12-2012 - 09-03-2013

List of 12 Mothers who missed their second ANC

Dashboard analysis of individual Mothers of Mandwih Sub Centre

Total Mothers: 40 mothersSuchitra Debbarma

Suchitra Debbarma’s dashboard showing delayed ANCs

High-Risk Factor

MCISID ID Child Name BCG Status

Polio 0 Status

Hep B1 Dose

DPT 1st Dose

Polio 1st

DoseHepB1 Dose

DPT 2 Dose

Polio 2 Dose

1601002102120013 Sunita Debbarma

1601002102120014 Sanjoy Debbarma

1601002102120029 Sunita Debbarma

1601002102120030 Sanjoy Debbarma

160100300621300004 Anjuman Aktar

160100300621300005 Tanbir Ahammad

160100300621300006 Imran Hussain

160100301721200283 kuhina Debbarma

160100301821300001 Pitor Debbarma

160100301821300005 Kokthai Debbarma

Dashboard analysis of individual child on ImmunizationWakhinagar Sub Centre

Services in time Services Awaited Services delayed or not taken

  ALERT ALARM        

Sl. No Mother Id Mother Name ANC 2 ANC 3

Expected Delivery Date Address

1 160100300711300001 Baijanti Debbarma 01-04-2013 - 23-06-2013

24-06-2013 - 15-09-2013

10-10-2013 Mandai

2 160100300711300002 Sumita Debbarma 03-02-2013 - 27-04-2013

28-04-2013 - 20-07-2013

14-08-2013 Baludhum Para

3 160100300711300003 Lucy Debbarma 20-03-2013 - 11-06-2013

12-06-2013 - 03-09-2013

28-09-2013 Nakshirai Para

4 160100300711300004 Lilata Debbarma 18-02-2013 - 12-05-2013

13-05-2013 - 04-08-2013

29-08-2013 Deb Charan Para

5 160100300711300005 Reshmi Debbarma 15-04-2013 - 07-07-2013

  24-10-2013 Mandai

6 160100300711300006 Patal Debbarma 27-02-2013 - 21-05-2013

22-05-2013 - 13-08-2013

07-09-2013 Mandai

Work PlanList of services fall due from 1-7-2013 to 8-7-2013

Mandwih Sub-Centre

0.6

95.5

3.9

Below 18 Years Between 18 to 35 Years Above 35 Years

Analysis on Mother’s age registered in MCTS

Age Group % Mothers

Below 18 Years 0.6

Between 18 to 35 Years 95.5

Above 35 Years 3.9

Indicator (%)

Home Delivery 29.2

Institution 70.8

Analysis on Delivery Place

29.2

70.8

Home Delivery Institution

Child’s data received from ICDS System

Indicator (%)

Female 47.5

Male 52.5

Sex Ratio 905

Analysis on Gender wise number of Children

47.552.5

Female Male

Indicator Absolute (%)

Weight Information Received 2165 49.6

Weight Information yet to be Received 2198 50.4

Low Birth Weight Children out of Weighed children

180 8.3

Analysis on Birth Weight of Children

49.650.4

Weight Information Received

Weight Information not Received

Indicator Absolute (%)

Children Weighed 1023

Normal 901 88.1

Moderate 112 10.9

Severe 10 1.0

Analysis on Nutrition Status of Children

88.1

10.91

Normal Moderate SevereICDS Data as on May 2013

Borakha 5)

Mandainagar 17)

Kai Rai 3)

Vrigudasbari 2)

Gram Panchayats having Severe Malnourished childrenMay 2013

Indicator Absolute (%)

No 4194 96.1

Yes 170 3.9

Analysis on Disability observed in the children

96.1

3.9

No Yes

Thank You