DISTRICT NUTRITION PROFILE Supaul, Bihar DISTRICT DEMOGRAPHIC PROFILE1 Total Population 2,229,076 51.8% 48.2% MALE FEMALE 4.7% 95.3% URBAN RURAL Supaul ranks 473rd amongst 599 15.9% 0.5% 83.7% 2 SC ST OTHERS districts in India DISTRICT DEVELOPMENT INDEX (2015) THE STATE OF NUTRITION IN SUPAUL3,4,5 48,1% CHILDREN 72.4 STUNTED 63.5 48.1 48.3 43.4 43.9 No Data 20,9% 38.6 CHILDREN 30.4 WASTED 20.9 20.8 9.5 6.6 43,4% 0.6 Children stunted Children wasted Children Children with any Women Children with Adults who are CHILDREN (<5 yr) (%) (<5 yr) (%) underweight anemia underweight (BMI birthweight obese in the UNDERWEIGHT NFHS 4 (2015-2016) NFHS 4 (2015-2016) (<5 yr) (%) (0-59 mo) (%) <18.5) <2500gms district NFHS 4 (2015-2016) NFHS 4 (2015-2016) (15-49 yr) (%) (0-2 mo) (%) (18-59 yr) (%) NFHS 4 (2015-2016) CHHNS 7 (2015) CAB (2014) Supaul Bihar CHANGES OVER TIME IN ANEMIA3,5,6,7 97.6 78.0 80.7 63.5 PREVALENCE OF 99.3 ANEMIA AMONGST 63.1 CHILDREN UNDER-SIX No Data 81.4 DECREASED IN THE DISTRICT BETWEEN !2002 AND 2016 DLHS 2 (2002-2004)^ NFHS 3 (2005-2006)^^ CAB (2014)^^ NFHS 4 (2015-2016)^^ ^Children aged 0-71 months Supaul Bihar ^^Children aged 0-59 months Page 1 13 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 10 Percentage of child stunting of child stunting Percentage (%) 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 the first two years of life (immediate causes). Inadequate food, health and care arise from food insecurity, unsanitary living conditions, 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 these multiple causes of undernutrition and do so in an equitable manner. IMMEDIATE CAUSES OF UNDERNUTRITION IMMUNIZATION & INFANT AND YOUNG CHILD FEEDING3 DISEASE BURDEN3 SUPPLEMENTATION3 75.3 68.3 65.9 61.7 62.3 53.5 45.2 34.9 37.1 30.7 25.3 17.6 7.3 9.3 10.4 3.4 2.4 2.5 Children breastfed Children exclusively Children who Children who Children with full Children who got Children suffering Children with Children showing within one hour of breastfed received any achieve minimum immunization vitamin A from diarrhoea in diarrhoea treated symptoms of ARI birth (0-6 mo) (%) solid/semi solid diet diversity coverage supplementation the last 2 weeks with ORS (<5 yr) (%) (<3 yr) (%) NFHS 4 (2015-2016) food in the last 24 (6-23 mo) (%) (12-23 mo) (%) (9-59 mo) (%) (<5 yr) (%) (<5 yr) (%) NFHS 4 (2015-2016) NFHS 4 (2015-2016) hours NFHS 4 (2015-2016) NFHS 4 (2015-2016) NFHS 4 (2015-2016) NFHS 4 (2015-2016) NFHS 4 (2015-2016) (6-8 mo) (%) NFHS 4 (2015-2016) ADOLESCENT & MATERNAL HEALTH3,5 Areas for action: 99.8 99.2 • Poor state of infant and young child feeding: Very few infants are breastfed within on hour of birth, few are exclusively 63.9 breastfed for six months and diet diversity rates are poor 58.3 • Immunization and vitamin A supplementation rates, can be further improved 32.4 34.6 • Less than half of women in the district, report having received ANC in the first trimester • Alarming levels of anaemia among adolescent girls Women who received Anemia among Anemia among Data challenges: ANC in the first pregnant women adolescent girls trimester (15-49 yr) (%) (10-19 yr) (%) (15-49 yr) (%) NFHS 4 (2015-2016) DLHS 2 (2002-2004) • Where data are available, indicator definitions are non- NFHS 4 (2015-2016) standardized and often differ from World Health Organisation recommendations Supaul Bihar Page 2 UNDERLYING CAUSES OF UNDERNUTRITION WOMEN’S STATUS3 WATER, SANITATION AND HYGIENE1,4,7 99.9 98.2 88.4 75.8 73.3 56.9 49.6 35.9 39.1 No Data 25.2 22.8 20.8 18.3 21.2 15.8 18.8 13.4 18.6 12.2 Women who are Women who Girls married 15-19 year old Total unmet needHouseholds with Households with Households Households Households literate completed 10 or when <18 years women who are for family access to access to practicing open disposing of child washing hands (15-49 yr) (%) more years of old mothers or planning improved improved defecation (%) stool in a sanitary with soap before schooling (20-24 yr) (%) pregnant methods among drinking water sanitation manner (%) meals (%)^ NFHS 4 (2015-2016) (15-49 yr) (%) (%) women sources (%) facilities (%) Census (2011) NFHS 4 (2015-2016) (15-49 yr) (%) NFHS 3 (2005-2006) CHHNS 7 (xxxx) NFHS 4 (2015-2016) NFHS 4 (2015-2016) NFHS 4 (2015-2016) NFHS 4 (2015-2016) NFHS 4 (2015-2016) FOOD SECURITY 9 SOCIO ECONOMIC CONDITIONS 1,9,14,15 62.3 66.2 53.2 50.9 46.6 49.4 48.1 34.8 34.1 29.4 22.4 16.4 11.5 11.6 Household share of Household share of Households in the Households Below Household ownership Households living in a Household access to expenditure on food food expenditure on district involved in Poverty Line (%) of agricultural land (%) pucca house (%) electricity (%) (%) cereals (%) agriculture (%) NSS 68th round (2011-2012) NSS 68th round (2011-2012) Census (2011) Census (2011) NSS 68th round (2011-2012) NSS 68th round (2011-2012) NSS 68th round (2011-2012) Supaul Bihar Areas for immediate action: • Less than half of women in the district are literate • Early marriage of girls less than 18 years is highly prevalent; early marriage is related to poor health and nutrition outcomes for mothers and babies • Very high rates of open defecation; critical need to increase awareness about washing hands with soap and ensuring access to improved sanitation facilities • Food insecurity, especially diet quality, is a challenge that can hold back improvements in nutrition • Very fe households lie i a pucca house ad hae access to electricity Data challenges: • Outdated data on open defecation • No district-level data on child stool disposal BASIC CAUSES OF UNDERNUTRITION1,8,9 93.8 91.7 50.4 57.2 46.4 41.9 44.4 16.0 Adult literacy rate (%) Households with access to primary/middle Households who demanded and received Households availing banking services (%) Census (2011) school (%) work through NREGA (%) Census (2011) DLHS 3 (2007-2008) NSS 68th round (2011-2012) Supaul Bihar • Per capita gross district domestic product of Supaul ranked 37th amongst 38 districts of Bihar in 2011-1215 • Bihars per capita icoe raked last amongst 32 major States/UTs in India in 2011-1216 • Action needs to be taken to improve adult literacy which is low • No data available on indicators of governance and political will to address nutrition Page 3 EVALUATION OF HEALTH AND NUTRITION SCHEMES3,4,8,9,12 95.8 90.8 86.8 91.7 61.1 63.8 35.4 32.7 31.0 No No Data 11.5 8.2 9.4 11.7 Institutional deliveries Home births attended by New born received check up Households (with 12-23 mo Households with access to Households with access to a Households that received (Women 15-49 yr) (%) skilled health personnel within 24 hours of child) with an Anganwadi worker (%) Sub-Health Centre (%) financial assistance for NFHS 4 (2015-2016) (Women 15-49 yr) (%) birth/discharge (%) immunization/MCP card (%) DLHS 3 (2007-2008) DLHS 3 (2007-2008) delivery and childcare (%) NFHS 4 (2015-2016) RSOC (2013-2014) CHHNS 7 (2015) CHHNS 7 (2015) Areas for immediate action: 78.3 • Access to skilled health personnel and Sub-Health Centres is very limited 43.5 40.3 43.9 • Very few households receive financial assistance for delivery No No Data 21.7 and child care • Less than half of the eligible households receive any take home Households that receive any Women who received THR Households with access to take home ration (%) during pregnancy (%) PDS (%) ration CHHNS 7 (2015) RSOC (2013-2014) NSS 68th round (2011-2012) Data challenges: • Lack of data on assessing the implementation of government Supaul Bihar schemes FLW visits4 Last Trimester^ Within 1 week of delivery* Within 24 Less than Equal to More than Less than Equal to More than hours of recommended recommended recommended recommended recommended recommended delivery Bihar 9,4% 9,4% 17,8% 29,1% 4,9% 5,2% 33,4% Supaul 4,6% 5,1% 7,4% 26,0% 1,8% 2,5% 27,0% ^2 recommended visits; *3 recommended visits Data sources 1. Census of India. 2011. Primary Census Abstract. Accessed June 6, 2015, www.censusindia.gov.in/pca/default.aspx Census of India. 2011. Houselisting and Housing Census Data. Accessed March 18, 2015, www.censusindia.gov.in/2011census/hlo/HLO_Tables.html 2.