Comprehensive Nutrition Survey in Maharashtra 2012 -Dr. Prashant Ghodam Moderator: Dr. P R Deshmukh

Introduction Rajmata Jijau Mother Child Health & Nutrition Mission with UNICEF (2005-10) International Institute for population sciences (IIPS),Mumbai is nodal agency. In phase-II (2011-15) focus on most vulnerable children: poorest & socially disadvantaged.

Objectives To assess the nutritional status of children under 2 years and feeding practices. To assess the nutritional status of mother, food intake, services received during pregnancy & level of decision making. Household characteristics and household food security.

Methodology Sampling method Sample size of total 3000 children, 1500 urban & 1500 rural. Multistage stratified sampling procedure. 1st stage selection of Primary Sampling Units (100 PSU) with probability proportion to population size. 2nd stage random selection of households (15) with at least one child under two years. In urban 3 stages, 1st selection of wards, 2nd Census Enumeration Blocks (100 CEBs as PSU) & 3rd household (15). Total 2630 household.

Methodology Questionnaires 1. Household: age, sex, marital status, literacy, drinking water, toilet, source of lighting, type of cooking fuel, ownership of livestock /lands. Use of ICDS, PDS and food security- lack of food, lack of food of households choice, food sufficiency, frequency of hunger. Hand washing, use of salt and iodine.

Methodology 2. Mother’s Quest.:- Exposure to media, decision making & involvement in CBOs like SHG, pregnancy, fertility, ANC care, food intake, nutritional status, tobacco use/ alcohol. 3. Child’s Quest.:- birth date, birth order, sex, outcome of pregnancy, breast feeding status, frequency of breastfeed, complementary foods, birth weight, immunisation, feeding practices during illness, safe disposal of child’s stool.

Household characteristics Sr.no. Household characteristics (%) Rural Urban Total 1 Live in a ‘pucca’ house 22.4 56.7 38.7 2 Households that have electricity 92.0 99.0 95.3 3 Households that use drinking water from an ‘improved’ source 86.4 98.6 92.2 4 Households that use piped drinking water 48.4 91.5 68.8 5 Households that have access to toilet facility 39.3 77.2 62.0 6 Households that practice hand washing with soap 68.3 83.1 75.3 7 Households that have BPL or Antodaya ration cards 33.6 11.6 23.2

Maternal nutrition and health Sr.no. Indicators for mothers (%) Rural Urban Total 1 20-24aged who were married < 18 yrs 34.1 23.7 30.0 2 registered their pregnancy during the first trimester 74.1 78.0 75.9 3 at least 3 ANC visits in the last pregnancy 85.1 94.5 89.6 4 Consumed IFA for 90 days or longer during last pregnancy 53.1 63.3 57.9 5 had an institutional delivery23 82.6 94.3 88.1 6 received supplementary food from the anganwadi center during last pregnancy and lactation 84.6 21.1 54.8 7 Body Mass Index (BMI) <18.5 40.7 22.6 31.9 8 height below 145 cm 10.9 10.3 10.7

Trends in the nutritional status of children < 2 yrs, 2006-2012

Nutritional status of children 0-23 months, by Region (2SD)

Nutritional status of children 0-23 months, by Region (3SD)

Nutritional status of children Prevalence of malnutrition in children by age, 2012

Prevalence of malnutrition in children by social group, 2012

Coverage of infant and young child feeding practices

Key findings Findings when compared with NFHS-3 (2005-06) estimates. There is impressive reduction in prevalence of stunting over last 6 years from 39% to 23.3%. Wasting decreased from 19.9 to 16.3 & Underweight from 29.6 to 22.6 Nutritional status of children from urban area was better than rural area. Out of six divisions children in Pune fared better in terms of there nutritional status whereas children from Nashik & Amaravati were worse off. Prevalence of stunting ,Wasting & underweight children reduced with an increased in the socioeconomic status of household. The prevalence of stunting, wasting & underweight amongst the children increased with an increased in food insecurity.

Key findings Higher order children i.e. third born or higher were more likely to be undernourished Low birth weight babies were more likely to be stunted, wasted & undernourished The children’s nutritional status varied with mother’s nutritional status. children born to short and thin mothers were more likely to be undernourished, The nutritional status of children improved with an increase in mothers educational attainment. There were large proportion of institutional deliveries in the state however breast feeding was initiated within an hour of birth for only 62% , indicating a gap in promotion & support of timely initiation of breast feeding by health personal. It was much higher in rural areas.

References Comprehensive Nutrition Survey of Maharashtra Report (CNSM), 15th November, 2013, Available from : http://www.iipsindia.org/cnsm_report.htm

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