DISTRICT NUTRITION PROFILE Rayagada, Odisha DISTRICT DEMOGRAPHIC PROFILE

Total Population9,67,911(In Lakhs)

48,8% 51,2% MALE FEMALE

15,2% 84,8% URBAN RURAL Rayagada ranks 465th 14,4% 56,0% 29,6% amongst 599 districts in India SC ST OTHERS (District Development Index)13 THE STATE OF NUTRITION IN RAYAGADA 48.5% CHILDREN 70,8 STUNTED1 66,7

53,9 48,5

30.6% 38,2 34,4 30,6 CHILDREN 28,1 30,3 1 21,9 WASTED 18,3 18,9

1,5 2,6 53.9% Children stunted Children wasted Children Children with any Chronic energy Children with Adults who are CHILDREN (%)1,2,^ (%)1,2,^ underweight anemia (%)1,^^ deficiency in birthweight obese in the UNDERWEIGHT1 (%)1,2,^ women (%)1 <2500gms (%)2,3 district (%)1 ^Children aged <5 years; ^^Children aged 0 -59 months Source: Data source provided on Page 4 Rayagada Odisha

CHANGES OVER TIME Odisha Rayagada THE PREVALENCE OF (Children aged <5 years) (Children aged < 5 years) UNDERWEIGHT HAS 2005-06 2013-14 2002-04 2014 (NFHS-3) (RSOC) (DLHS-2) (CAB) INCREASED IN THE Stunting 42.4% 38.2% No Data 48.5% DISTRICT BETWEEN Wasting 20.0% 18.3% No Data 30.6% 2002 AND 2014 Underweight 39.5% 34.4% 48.0% 53.9%

Page 1 4 HOW CAN NUTRITION IMPROVE? WHAT FACTORS CAUSE UNDERNUTRITION? The most crucial period for child nutrition is Optimum fetal and child nutrition and development from pre-pregnancy to the second year of life2 IMMEDIATE CAUSES 100 Breastfeeding, nutrient rich foods, and eating routine 90 Feeding and caregiving practices, parenting stimulation 80 Low burden of infectious diseases 70 60 UNDERLYING CAUSES Food security: availability, economic access and use of food 50 Feeding and caregiving resources (maternal, household and 40 community level) 30 Access to and use of health services, a safe and hygienic environment Window of Too late 20 opportunity

Percentage of child stunting (%) 10 BASIC CAUSES 0 Knowledge and evidence Politics and governance Leadership, capacity and financial resources Social, economic, political, and environmental context Age of child (in months) (national and global) Child undernutrition is caused by inadequacies in food, health and care for infants and young children, especially in thefirst two years of life (immediatecauses). Inadequate food, health and care arise from food insecurity, unsanitary livingconditions, low status of women, and poor health care(underlying causes). These are, in turn, caused by social inequity, economic challenges, poor political will and leadership to address these causes(basic causes). Interventions to address undernutrition must address thesemultiplecausesof undernutritionand do so in an equitable manner. IMMEDIATE CAUSES OF UNDERNUTRITION

INFANT AND YOUNG CHILD FEEDING2,3 IMMUNIZATION & DISEASE BURDEN 3 SUPPLEMENTATION 3

92,3 87,2 78,7 74,3 68,8 68,6 No Data No Data 65,0 58,3 55,5 52,9

37,1 34,9 30,7 25,8

14,0 9,2

Early initiation of Exclusive Children (6-8 mo) Children who Full immunization Children (6-35mo) Children suffering Children <5 years Women aware of breastfeeding (%) breastfeeding (%) who received any achieve minimum coverage (%) who got vitamin A from diarrhoea (%) with diarrhoea danger signs of solid/semi solid diet diversity (%) supplementation treated with ORS pneumonia (%) food in the last 24 (%) (%) hours (%)

Areas for action: ADOLESCENT & MATERNAL HEALTH1,3,5

98,2 98,0 100,0 97,6 • Poor rates of exclusive breastfeeding and immunization 91,8 coverage 78,4 • No district level data available on children’s diets • Alarming levels of anaemia among pregnant women and adolescent girls Data challenges: • Out-dated data; poor availability of data on key immediate determinants of under nutrition from national surveys Women with access to Any anemia among Any anemia among at least 1 antenatal pregnant women (%) adolescent girls (%) • Where data are available, indicator definitions are non- care coverage (%) standardized and often differ from World Health Organisation recommendations Rayagada Odisha Page 2 UNDERLYING CAUSES OF UNDERNUTRITION

WOMEN’S STATUS3,6 WATER, SANITATION AND HYGIENE7,8,9

80,8 83,7 73,6 76,6 No Data No Data No Data No Data No Data No Data No Data

18,3 12,7 8,4 12,1 11,9 4,4 7,5

Girls married when Ever married Women who Women's Access to improved Access to improved Open defecation Child stool disposal Households who <18years old (%) women/mothers completed ownership of land drinking water sanitation facilities (%) in a sanitary washed hands with who completed secondary school (%) sources (%) (%) manner (%) soap before a meal primary school (%) (%) (%)^ ^Data based on rural population only

FOOD SECURITY10 SOCIO ECONOMIC CONDITIONS7,1 0,1 1

51,8 51,1 50,5 45,7 48,5 45,8 42,4 43,0 37,8 37,8 36,7

32,9 No Data 27,2

Household share of Household share of Households in the Below Poverty Line Households ownership Households living in a Access to electricity (%) expenditure on food food expenditure on district involved in households (%) of agricultural land (%) permanent house (%) (%) cereals (%) agriculture (%) Rayagada Odisha

Areas for immediate action: • Very high rates of open defecation; critical need to increase access to improved sanitation facilities • High rate of underage marriage among girls, high level of households living below the poverty line • Very few households live in a permanent house and have access to electricity Data challenges: • Difficult to compare indicators of water, sanitation and hygiene over time as census data do not provide data on child stool disposal or on hand washing • No data available for several indicators of women’s status

BASIC CAUSES OF UNDERNUTRITION

100,0 83,7 94,6 63,7 70,6 66,9 50,8 52,4 42,1 45,0 45,0 21,4 20,9 0,0

Adult literacy rate (%)7 Births attended by Household has access Household has access Household has access Households who Households availing skilled health personnel to Anganwadi worker to a Sub-Health Centre to primary/middle demanded and received banking services (%)7 (%)6 (%)6 (%)6 school (%)6 work through NREGA (%)10 Rayagada Odisha

• Per capita gross district domestic product of Rayagada ranked 17th amongst 30 districts of Odisha 12 • Improved access required to skilled birth attendants and sub health centres • Action needs to be taken to improve adult literacy and access to NREGA work • No data available on indicators of governance and political will to address nutrition Page 3 WHAT WILL IT TAKE TO IMPROVE NUTRITION IN RAYAGADA? NDO - POSHAN/IFPRI Source:

Possible district-level actions to support nutrition:

Data sources 1. Census of India. 2014. Clinical, Anthropometric & Bio-chemical (CAB) survey. http://www.censusindia.gov.in/2011census/hh-seri es / HH- 2/Odisha%20CAB%20Sample%20Characteristics%202014.pdf 2. UN ICEF. 2 0 1 3 -2014. Rapid Survey on Children (RSoC). http://wcd.nic.in/RSOC/21.RSOC_Odisha.pdf 3. Census of India. 2012-20 13 . Annual Health Survey. http://www.censusindia.gov.in/vital_statistics/AHSBulletins/AHS_Bulletin_2012_13/Odisha/Odisha.pdf 4. Robert E Black, Cesar G Victora, Susan P Walker, Zulfiqar A Bhutta, Parul Christian, Mercedes de Onis, Majid Ezzati, Sally Grantham-McGregor, Joanne Katz, Reynaldo Martorell, Ricardo Uauy, and the Maternal and Child Nutrition Study Group. 2013. “Maternal and Child Undernutrition and Overweight in Low-Income and Middle-Income Countries”. The Lancet 382 (9890), 427-45 1 5. District Level Household Survey on Reproductive and Child Health (DLHS-2), 2002-04, India. International Institute for Population Studies. (IIPS). 2006. District Level Household Survey on Reproductive and Child Health (DLHS-2), 2002-04, India: Nutritional Status of Children and Prevalence of Anemia among Children, Adolescent Girls and Pregnant Women. Mumbai: IIPS. Octo b er 2 8 , 2 01 5, www.rchiips.org/pdf/rch2/National_Nutrition_Report_RCH-II.pdf 6. International Institute for Population Studies (IIPS). 2010. District Level Household Survey and Facility Survey (DLHS-3), 2007-08 , In di a, Od i sh a . Mumbai: IIPS. Accessed October 28, 2015, www.rchiips.org/pdf/rch3/report/UP.pdf 7. Census of India. 2011. Houselisting an d Ho u si n g C en su s Da ta . Accessed October 28, 2015, www.censusindia.gov.in/2011census/hlo/HLO_Tables.html 8. National Family Health Survey (NFHS-3), 2005-06, India. Mumbai: International Institute for Population Studies. 9. HUNGaMA: Fighting Hunger & Malnutrition : the HUNGaMA Survey Report. 2011. Naandi Foundation. 10. Author’s estimates based on Household Consumption Expenditure, National Sample Survey Office (NSSO) 68th Round, 20 11 -12 . Ministry of Statistics and Program Implementation. Government of India. 11. Planning Commission. 2013. Press note on poverty estimates, 2011-12. Government of India. Accessed Octo b er 2 8 , 2015. http://planningcommission.nic.in/news/pre_pov2307.pdf 12. Government of Odisha. Economic Survey (2014-15). Accessed Octo b er 2 8 , 2 01 5, http :/ / www.odisha.gov.in/pc/Download/Economic_Survey_2014-15.pdf 13. Us-India Policy Institute. 2015. District Development and Diversity Index. Accessed Octo b er 2 8 , 2015, http://www.usindiapolicy.org/updates/general -news/225- district-development-and-diversity-index-report

This District Nutrition Profile was developed by the Public Health Resource Network (PHRN), Odisha for POSHAN. Version: 23-08-2016