DISTRICTDISTRICT NUTRITION NUTRITION PROFILE PROFILE Ad Hyderabad|Telangana DISTRICT DEMOGRAPHIC PROFILE1 5 Total Population 39,00,000 6 M1 Census 2011 Male Female 751.2%Fe0 Census 2011 48.8% 8 U # Census 2011 9UrbanRu0 Census 2011 Rural #100.0%SC0 Census 2011 0.0% # ST0 Census 2011 SC# O 1ST Census 2011 Others Hyderabad ranks 21 amongst 599 6.3% 92.5% # In1.2%#0 districts in India² THE STATE OF NUTRITION IN HYDERABAD UNDERNUTRITION3 100 Hyderabad Telangana

75TeHyderabad # St ##NFHS4 54.9 54 50 %# W##NFHS4 NO DATA # U ##NFHS4 16.8 25 15.7 14.1 12.9 # An##NFHS4 NO DISTRICT LEVEL DATA # Lo0##RSOC # An##NFHS4Stunting Wasting Underweight Anemia Low birth weight Anemia among Women with body (among children <5 (among children <5 (among children <5 (among children <5 (<2500 g) women of mass index <18.5 # W##NFHS4years) years) years) years) reproductive age kg/m2 # BMPOSSIBLE##NFHS4 POINTS OF DISCUSSION (WRA) # BM##NFHS4 ƒ How does the district perform on stunting, wasting, underweight and anemia among children under the age of 5? # Hƒ ##WhatNFHS4 are the levels of anemia prevalence and low body mass index among women? # Hƒ ##WhatNFHS4 are the levels of overweight/obesity and other nutrition-related non-communicable diseases in the district? # H 79NFHS4 OVERWEIGHT/OBESITY & NON-COMMUNICABLE DISEASES (15-49 y)4 # 100H 68NFHS4

75

47.9 % 50 33.7 24.1 25 12.3 9 8.3 0 BMI >25 kg/m2 BMI >25 kg/m2 High blood pressure High blood pressure High blood sugar High blood sugar among women among men among women among men among women among men (15-49 years) (15-49 years) (15-49 years) (15-49 years) (15-49 years) (15-49 years)

1Data source 1 (see Page 2) 3Data source 3 (see Page 2) 2Data source 2 (see Page 2) 4Data source 3 (see Page 2) Page 1 HOW CAN NUTRITION IMPROVE? WHAT FACTORS CAUSE UNDERNUTRITION1? The most crucial period for child nutrition is from pre- pregnancy to the second year of life

Optimum fetal and child nutrition and development

NUTRITION SPECIFIC IMMEDIATE DETERMINANTS INTERVENTIONS Breastfeeding, nutrient rich foods, Service delivery to mothers caregiving practices and infants along the Low burden of infectious diseases continuum of care, access to health facilities

INTERVENTIONS THAT AFFECT UNDERLYING AND BASIC UNDERLYING AND BASIC DETERMINANTS DETERMINANTS Women’s status, sanitation and Women's empowerment, hygiene, food security, socio sanitation, agriculture and economic conditions social safety net programs

Child undernutrition is caused by inadequacies in food, health and care for infants and young children, especially in the first two years of life (immediate determinants). Mothers’ and infants’ access to nutrition-specific interventions can influence these immediate determinants.

At the household and community level, women’s status, household food security, hygiene and socio economic conditions further contribute to children’s nutrition outcomes (underlying and basic determinants). Interventions such as social safety nets, sanitation programs, women’s empowerment and agriculture programs have the potential to improve nutrition by addressing underlying and basic determinants.

DATA SOURCES

1. Census of India. 2011. Accessed June 6, 2015. www.censusindia.gov.in/pca/default.aspx 2. US-India Policy Institute. 2015. District Development and Diversity Index. Accessed July 2, 2015. 0 http://www.usindiapolicy.org/updates/general-news/225-district-development-and-diversity-index-report 3. International Institute for Population Studies. 2015-2016. National Family Health Survey (NFHS-4); Key Findings from NFHS-4. Telangana. Accessed May 1, 2016. http://rchiips.org/NFHS/TG.shtml 4. Black et al. 2013. “Maternal and Child Undernutrition and Overweight in Low-Income and Middle-Income Countries”. The Lancet 382 (9890), 427-451 5. Ministry of Statistics and Program Implementation, Government of India. 2011-2012. Household Consumption Expenditure, National Sample Survey Office (NSSO) 68th Round. Accessed January 30, 2016. . http://mospi.nic.in/sites/default/files/publication_reports/Report_no558_rou68_30june14.pdf Ministry of Statistics and Program Implementation, Government of India. 2011-2012. Employment and Unemployment Survey, National Sample Survey Office (NSSO) 68th Round. Accessed January 30, 2016. http://mospi.nic.in/sites/default/files/publication_reports/nss_report_554_31jan14.pdf Stephan Rebernik. 2012.

1 Data source 4 (see Page 2) Page 2 TeHyderabad IMMEDIATE DETERMINANTS OF UNDERNUTRITION # Ea# # NFHS4 # Ex# # NFHS4 INFANT AND YOUNG CHILD FEEDING1 DISEASE BURDEN2 # Ti # # NFHS4 100 Hyderabad Telangana # Ad# # NFHS4 100 # D 8 7 NFHS4 75 # O # # NFHS4 75 # Zi # # NFHS4 % 50 # Ac2 3 NFHS440.8 % 50 26.1 25 25 NO DISTRICT LEVEL DATA LEVEL DISTRICT NO NO DISTRICT LEVEL DATA NO DISTRICT LEVEL DATA NO DISTRICT LEVEL DATA 6.9 2.6 0 0 Early initiation of Exclusive Timely introduction Adequate Diarrhea in the last Oral Rehydration Zinc during Acute Respiratory breastfeeding breastfeeding of complementary diet 2 weeks Salts during diarrhea Infection in foods diarrhea the last 2 weeks POSSIBLE POINTS OF DISCUSSION ƒ What are the levels of timely initiation of breastfeeding (within one hour of birth), exclusive breastfeeding (for the first 6 months), and timely initiation of complementary feeding (at 6 months of age)? ƒ What percentage of 6-23 month olds receive an adequate diet (4 or more food groups, and minimum meal frequency)? What can be done to improve breastfeeding and complementary feeding? ƒ How does the prevalence of diarrhea and ARI in the district compare to the state average? How can ORS use be improved? COVERAGE OF NUTRITION-SPECIFIC INTERVENTIONS PRENATAL AND DELIVERY CARE3 99.9 94.4 97.2 100 90.4 92.9 82.3 85.8 73.1 75TeHyderabad # Pr##RSOC %# M50# # NFHS4 NO DATA # An# # NFHS4NO DATA 25

# ≥4# # NFHS4 NO DISTRICT LEVEL DATA DATA LEVEL DISTRICT NO # A0# # NFHS4 # Co# # NFHS4Pregnancy Mother and Antenatal Care ≥4 ANC visits ANC - Neonatal Consumed Supplementary Institutional Skilled Birth registered registered Child Protection (ANC) visit tetanus Iron Folic Acid (IFA) food delivery birth # Su##RSOC Card - first trimester ≥100 days… - pregnancy attendant # In ##NFHS 4 # Sk##NFHS 4 POSTNATAL AND EARLY CHILDHOOD CARE4 # Bi100##NFHS 4 # N # # NFHS4 73.9 75 71.3 # Vi ##RSOC # Ja # 9 NFHS4 % 50 NO DATA NO DATA NO DATA # Su##RSOC NO DATA NO DATA # Fu25# # NFHS4

10.6 DATA LEVEL DISTRICT NO DATA LEVEL DISTRICT NO DATA LEVEL DISTRICT NO NO DISTRICT LEVEL DATA DATA LEVEL DISTRICT NO # Vi # # NFHS4 9.3 # Pe##RSOC0 Newborn check- Visited by Primary Janani Suraksha Supplementary Full immunization Vitamin A in the Pediatric IFA Deworming Supplementary # D ##RSOCup Health Worker Yojana availed food last 6 months food # Su##RSOC - lactation - children

POSSIBLE POINTS OF DISCUSSION ƒ How does the district perform on health and nutrition interventions along the continuum of care: does it adequately provide b oth prenatal and postnatal services to its women of reproductive age, pregnant women, new mothers and new-borns? ƒ What percentage of households have access to health and ICDS services?

1Data source 3 (see Page 2) 3Data source 3 (see Page 2) 2DataTe sourceHyderabad 3 (see Page 2) 4Data source 3 (see Page 2) Page 3 # W# # NFHS4 UNDERLYING AND BASIC DETERMINANTS OF UNDERNUTRITION # W# # NFHS4 # G # # NFHS4 WOMEN’S STATUS1 WATER, SANITATION AND HYGIENE2 Hyderabad Telangana # To1007 # NFHS4 100 90.5 # H # # NFHS479.8 73.2 # H #75 # NFHS4 75 # O # 1 Census 2011 58.4 # %H ##NSS50 % 50 # H ##NSS # H #0NSS25 25 10.5 10.7 # H #3NSS 0.8 # H ##NFHS0 4 0 Women who are Women with Girls married Total unmet need Households with Households using Open defecation # H # # Censusliterate 2011 ≥10 years of before the for an improved improved sanitation # H 72NSS education age of 18 family planning drinking-water source facility methods among # D ## POSSIBLE POINTS OF DISCUSSION WRA # Stƒ# How can the district increase rates of women’s literacy, and reduce early marriage? # Toƒ##How does the district perform on providing drinking water and sanitation to its residents? Since sanitation and hygiene play an important role in improving nutrition outcomes, how can all aspects of sanitation be improved? ƒ How does the district fare on food security? FOOD SECURITY3 SOCIO-ECONOMIC CONDITIONS4 100 100 100 91.4

75 75

% 50 % 50 37.4

26.5 25 25 #VALUE! 0 2.7 1.5#VALUE! 0 0 Household share Household share Households Household Households with Households Households below of expenditure on of food expenditure involved ownership electricity living in a poverty line food on cereals in agriculture of agricultural land pucca house

INTERVENTIONS THAT AFFECT BASIC AND UNDERLYING DETERMINANTS5 TeHyderabad # H # # NFHS4100 # H ##NSS 75 # H # # Census 2011 58.9 # H #0NSS 49.8 % 50

24 25

0 0 Households with member Households with access Households availing Households who covered by health insurance to Public Distribution System of banking services demanded and received work through NREGA POSSIBLE POINTS OF DISCUSSION ƒ How can social programs that address underlying and basic determinants be strengthened? ƒ What are some of the major development challenges in the district? This District Nutrition Profile was prepared by: Nitya R. George, Abhilasha Vaid, Phuong Hong Nguyen, Rasmi Avula and Purnima Menon. Technical support for production was provided by iTech Mission Private Limited (iTM) 1Data source 3 (see Page 2) 3Data source 5 (see Page 2) 5Data source 1,3,5 (see Page 2) 2Data source 1, 3 (see Page 2) 4Data source 1, 5 (see Page 2) Page 4