58 RJMCHN Mission 5 Nutrition 59 60 | NUTRITION Overview Children under six years of age require appropriate nutrition and adequate care in order to reach their full growth and development potential. Under nutrition jeopardizes children’s survival, health, growth and development, and it slows national progress towards development goals. The nutrition situation in Maharashtra is slightly better than the national average and the state has demonstrated a notable reduction of 27% in the underweight prevalence of children under three years between NFHS-2 and NFHS-3. The establishment of a State Nutrition Mission will further contribute towards addressing child under nutrition in the state. The Integrated Child Development Services (ICDS)45 programme provides nutrition and health services for children under six years, pregnant and lactating women, as well as preschool activities for children age 3-5 years. Village Health and Nutrition Day (VHND) and services of ASHA46 is also contributing in improving nutritional status of child and mothers. Mid Day Meal (MDM) programme is also provides cooked meal to school going children and is contributing to improving their nutritional status. ©UNICEF/NYHQ2005-2395/Anita Khemka NUTRITION | 61 ICDS programme in Maharashtra Status of Anganwadi Centers (AWC) (as on April,2011) Status of human resources Sanctioned Functioning Percentage of Sanctioned Filled post Percentage of functioning post filled posts AWC 97,462 93,115 95.54 CDPO 553 379 68.54 Mini AWC 10,724 8,957 83.52 ACDPO 119 119 100.00 Supervisor 3,898 3,273 83.97 Number of beneficiaries in Anganwadi Centers (as on April,2011) AWW 97,462 90,533 92.89 AWW for mini 10,724 7,834 73.05 Source: ICDS, MPR, Supplementary Nutrition Pre Primary AWC April 2011, www.icds. Helper 97,462 86,192 88.44 6 Months to 3 31,47,792 3 to 6 years 31,77,275 gov.in years • Vacancies are higher in management and supervisory level positions. 3 to 6 years 31,99,326 Pregnant & 11,79,076 Trends in budget provisions for child nutrition, Government of Maharashtra Nursing Mother Source: ICDS, MPR, April 2011, www.icds.gov.in , Maharashtra • 553 ICDS projects (364 rural,104 urban and 85 tribal) have been sanctioned in the state and almost all are functional. Source: Budget in brief, 2011-12, Government of Maharashtra (Rs. in Crore) * Revised, $Estimated • Significant improvement in budget for child nutrition observed during the last three years. • Budget increased by 80% from 2009-10 to 2011-12. Nutrition’s share in the total budget also improved and reached 1.48% ( 2011-12 ) from 1.04% (2009-10). 62 | NUTRITION Percentage of children who received Colostrum/Khees 47, 2007-08 Index No. of districts Less than 80% 05 80-90% 21 More than 90% 09 Source: DLHS, 2007-08 • 86.1% children received colostrum/khees in the state. • No significant difference exist across social groups. However, the percentage is www.hetv.org slightly lower in lowest wealth index group , tribal districts and Nashik division. NUTRITION | 63 Percentage of children who started breastfeeding within one Percentage of children (age 6-35 months) exclusively hour of birth (children under 3 years), 2007-08 breastfed for at least 6 months48, 2007-08 Index No. of districts Less than 25% 08 25-35% 11 35-45% 07 More than 45% 09 Source: DLHS, 2007-08 Nandurbar 37.7 Gondiya • In Maharashtra 34.7% children (age 6-35 months) had been exclusively breastfed. Nagpur 56.7 Dhule Amravati 60.8 Bhandara • This percentage was lower in districts of Aurangabad division. 42.2 Jalgaon 62.4 44.3 Akola Wardha 61.8 Buldana 60.2 68.4 • Disparities exist among districts. It is the lowest (16.4%) in Ratnagiri and highest Nashik Washim 48.8 Yavatmal Chandrapur 54.4 Aurangabad 50.6 58.3 63.1 40.0 (54.8%) in Wardha. Thane Jalna Hingoli Mumbai 57.4 52.6 46.4 Parbhani Gadchiroli (Suburban) Ahmadnagar 49.7 49.6 48.8 Bid 62.3 Nanded 49.5 Mumbai Pune 45.3 Index No. of districts 50.6 58.1 Latur Raigarh 46.0 Less than 45% 05 53.9 Satara Solapur 55.9 43.1 Osmanabad 45-55% 16 Ratnagiri Sangli 65.4 55-65% 11 45.4 50.5 More than 65% 03 Sindhudurg Kolhapur 74.0 50.8 Source: DLHS, 2007-08 • 52.7% children started breastfeeding within one hour of birth. No significant difference exist across the areas, social groups and wealth indices. • P ercentage of children who started breastfeeding within one hour of birth is slightly lower in tribal districts and in Nashik division. 64 | NUTRITION Percentage of children aged 12-35 months who received at Household using adequately iodized salt, 2005-06 least one dose of Vitamin A, 2007-08 61.0 Source: NFHS, 2005-06 • 61% households are using adequately iodized salt, the usage is similar to that in 1998-99. • The usage is significantly low in rural areas, SC and ST social groups and lowest wealth index group. Index No. of districts Less than 65% 05 65-75% 07 75-85% 12 More than 85% 11 Source: DLHS, 2007-08 • 74.9% children aged between 12-35 months received at least one dose of Vitamin A. No significant differences exist across areas and sex but differences are notable in social groups and wealth index groups. • Percentage of children aged between 12-35 months who received at least one dose of Vitamin A is significantly lower in Nashik division and Washim district. • Only 29.3% children between 12-35 months received 3-5 doses. NUTRITION | 65 Percentage of women (15-49 years ) having Body Mass Index (BMI)49 less than 18.5, 2005-06 Source: NFHS, 2005-06 • 36.2% women (15-49 years) have a Body Mass Index (BMI) less than 18.5. • The concentration of such women is significantly higher in rural areas, ST social group and lowest wealth index group. RJMCHN Mission 66 | NUTRITION Prevalence of any type of anaemia 50 among women Prevalence of any type of anaemia among children (15-49 years), 2005-06 (6-59 months), 2005-06 Source: NFHS, 2005-06 Source: NFHS, 2005-06 • 48.4% women (15-49 years) suffered from any type anaemia, the percentage is • 63.4% children (6-59 months) suffer from anaemia. Anaemia prevalence is similar to 1998-99. significantly higher in lowest wealth index group. • Anaemia prevalence is slightly higher in rural areas, ST social group and lowest wealth • Prevalence of any type of anaemia among children (6-35 months) slightly improved index. between 1998-99 to 2005-06 ( 76% to 72.2%). NUTRITION | 67 Nutritional status51,52,53 of children under three years of age, 2005-06 India and Maharashtra, 2005-06 NFHS-2 and NFHS-3, Maharashtra Source: NFHS, 2005-06 Source: NFHS, 2005-06 • In Maharashtra, the nutritional status of children under three years of age is better • There has been an improvement in all the three nutrition indicators from NFHS-2 to than the national average whereas the status of underweight children is significantly NFHS-3. The reduction in proportion of underweight children is significant. lower. 68 | NUTRITION Prevalence of stunting51 (moderate and severe ) Prevalence of underweight53 (moderate and severe ) among children under five years, 2005-06 among children under five years, 2005-06 Source: NFHS, 2005-06 Source: NFHS, 2005-06 • 46.3% children are stunted and this figure is significantly higher among SC and ST • 37 .0% children are underweight and it is significantly higher in rural areas, ST social social groups and lowest wealth index group. group and lowest wealth index group. • Stunting prevalence increases with increasing age. It was 10.4% for children in the • Underweight prevalence increases with age. It was 29.7% for children in age group age group 6-11 months but 26.3 % for children in the age group 36-47 months. 6-11 months but 42.8% for children in age group 48-59 months. NUTRITION | 69 Prevalence of undernutrition among children Underweight prevalence (moderate55 and severe56 ) among under two years, 2005-06 children under five years, April 2011 • As per ICDS data of April, 2011, a total of 83,34,555 children in the age group of 0-6 years are in the catchment areas of Anganwadi center (AWCs), while as per Census 2011, the total population in 0-6 age group is 12,84,83,75. • A total 63,85,854* children in the 0-5 age group (76.62% of total surveyed children) were weighed in April, 2011 and distribution of children is as follows : Project Normal Moderately Severely Total children Under Weight Under Weight weighed Rural 35,85,547 7,62,754 87,605 44,35,906 Tribal 6,46,496 2,39,527 39,895 9,25,918 Urban 7,19,339 2,78,182 26,509 10,24,030 Grand Total 49,51,382 12,80,463 1,54,009 63,85,854 • 12,80,463 children are moderately and 1,54,009 children are severely underweight in Source: NFHS, 2005-06 the state (Total underweight children: 14,34,472). • Nutritional status in the state may have improved over the years in aggregate, but * Information of 54 projects was not available for April 2011, hence information for these blocks has been taken 67% children under two years are still undernourished54. from the previous months. Source: ICDS, MPR, April 2011, www.icds.gov.in . 70 | NUTRITION Underweight prevalence (moderate and severe) Underweight prevalence (moderate and severe) among among children under five years, April 2011 children under five years by districts and talukas, April 2011 Index No.