1. N UTRITION IN G UJARAT Group 2 Dr.Chintan patel Dr.Shushant kathorvala Dr.Madhu kumar enjamuri Dr. Bhavik kansagara Dr.Hemsinh Rathode Dr.Pradip Bhuriya

2. INTRODUCTION India has made considerable progress in child nutrition outcomes, however, have been highly variable across the states. Although all of the states operate under a similar national policy and programmatic environment. Purpose of this Policy Notes is to examine the trends in undernutrition in Gujarat and to document trends in the major determinants of nutrition and the coverage of key nutrition and health interventions. Gujarat 6% area, 5% population of India 60 million people 43% urban population Good in Economy, Infrastructure, Industrialization and governance (?) Challenge of child and maternal under nutrition NFHS-4

3. Stunting 51.7 % to 38.5% LBW: 22% to !9.5 EBF : 48% to 56% Anemia in women 55.3% to 54.9% Wasting in children 18.7 % to 26.4% Severe wasting: 5.8% to 9.5% Trends

4. S TUNTING Inter district variation 23% to 51% Sabarkantha highest 51%

5. A NEMIA More than 50% except in Surat 9 district 60%

6. W ASTING Range 16% to 43% Vadodara 16% Dang highest 43%

7. SEVERE WASTING Sever wasting Rajkot lowest 3.7% Dang Highest 18.9%

8. EXCLUSIVE BREAST FEEDING Prevalence Range 34% to 80 % 10 district higher than 50% Complementary feeding for Infants : A Major concern as it has declined in decade 54% to 49% Only 5 % children ( 6 to 23 months ) Receivers adequate diet

9. I MMEDIATE DETERMINANTS OF NUTRITION IN G UJARAT (2006 TO 2016) low BMI (<18.5) in women declined from 36.3 % to 27.2 %. Early initiation of breastfeeding has improved from 27.8 % in 2006 to 50 % in 2016. Proportion of children with diarrhea declined (from 13.1 %to 8.4 %). Proportion of children with acute respiratory infection (ARI) decline from 4.7 to 1.4 percent for the same time period.

10. COVERAGE OF N UTRITION SPECIFIC INTERVENTION Improvement in coverage of all interventions Coverage of food supplementation increased for pregnant women (19 to 49 %), lactating women (12 to 49 %) and children (40 to 70 %) IFA consumption in pregnancy increased 25 to 37 %. Proportion of children receiving vitamin A raised substantially 15 to 71 %, and children with diarrhoea received ORS) also increased from 28 to 46 %. Proportion of children were fully immunized increased slightly (45 % to 50 %).

11. S TATUS OF UNDERLYING DETERMINANT OF NUTRITION Increase in the proportion of women literacy (64 to 73 %) proportion of women >10 years of education (24 % to 33 %). Early marriage in girls drop considerably from 39 % to 25% In 2016, >90 percent of households have access to improved drinking water. Access to electricity 89 % in 2006 reaching 96 %, Access to improved sanitation facilities improved from 44 % to 64 % of households. The proportion of households practicing open defecation has declined over time, but still remains high at nearly 40 percent

12. I MPLICATIONS AND R ECOMMENDATION To achieve SDG target 2025 on nutrition, the state should set own targets and continue to invest in sustaining adequate delivery of those intervention targeting: First 1000 days In Gujarat, special emphasis is needed on maternal care during pregnancy and on supporting adequate infant and young child complementary feeding practice. On underlying determinants, women’s education, early marriage and sanitation need urgent attention. Alongside investments in improving early nutrition, it is also important to consider the challenge of non-communicable diseases: Double Duty Actions These suggest that Gujarat needs to develop a strong strategy to simultaneously address under nutrition and emerging non- communicable diseases related to nutrition. Special focus to under performing district and blocks.