48.0

14.1

39.3

69.4

30.7

19.9

3.6

38.2

18.3

34.4

70.8

30.3

18.9

2.6

Sundergarh Odisha ^Children aged <5years; ^^Children aged 0-59 months Source: Data source provided on Page 4

50.7%

49.3%

35.3%

64.7%

9.2%

50.7%

40.1%

Sundergarh, OdishaDISTRICT NUTRITION PROFILE

Page 1

THE STATE OF NUTRITION IN SUNDERGARH

DISTRICT DEMOGRAPHIC PROFILETotal Population 20,93,437

MALE FEMALE

RURALURBAN

SC ST OTHERS

CHANGES OVER TIMEOdisha

(Children aged <5 years)Sundergarh

(Children aged < 5 years)

2005-06 (NFHS-3)

2013-14 (RSOC)

2002-04 (DLHS-2)

2014 (CAB)

Stunting 42.4% 38.2% No data 48.0%

Wasting 20.0% 18.3% No data 14.1%

Underweight 39.5% 34.4% 51.9% 39.3%

CHILDREN STUNTED1

CHILDREN WASTED1

CHILDREN UNDERWEIGHT1

48.0%

14.1%

39.3%

THE PREVALENCE OF UNDERWEIGHT HAS DECREASED IN THE DISTRICT BETWEEN 2002 AND 2014

Sundergarh ranks 328th amongst 599 districts in India

(District Development Index)13

(In Lakhs)

Women with access to at least 1 antenatal care coverage (%)

Any anemia among pregnant women (%)

Any anemia among adolescent girls (%)

98.4 100.0

81.3

98.0 97.6

78.4

Sundergarh Odisha

76.5

31.0

82.9

71.3

15.1

91.1

46.0

78.7

30.7

55.5

25.8

68.8 68.6

14.0

87.2

58.3

Page 2

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

Areas for action:

Data challenges:

IMMEDIATE CAUSESBreastfeeding, nutrient rich foods, and eating routine

Feeding and caregiving practices, parenting stimulationLow burden of infectious diseases

Optimum fetal and child nutrition and development

WHAT FACTORS CAUSE UNDERNUTRITION? 4

UNDERLYING CAUSESFood security: availability, economic access and use of foodFeeding and caregiving resources (maternal, household and

community level)Access to and use of health services, a safe and hygienic environment

BASIC CAUSESKnowledge and evidencePolitics and governance

Leadership, capacity and financial resourcesSocial, economic, political, and environmental context

(national and global)

The most crucial period for child nutrition is from pre-pregnancy to the second year of life2

HOW CAN NUTRITION IMPROVE?

ADOLESCENT & MATERNAL HEALTH1,3,5

DISEASE BURDEN3IMMUNIZATION & SUPPLEMENTATION3

INFANT AND YOUNG CHILD FEEDING2,3

< 3 3-5 6-8 9-11

12-14

15-17

18-20

21-23

24-36

37-48

49-60

0102030405060708090

100

Age of child (in months)

Perc

enta

ge o

f chi

ld s

tunti

ng (%

)

Window of opportunity

Too late

No D

ata

No D

ata

• Very poor rates of exclusive breastfeeding, which need urgent attention

• No district level data available on children’s diets• Alarming levels of anaemia among pregnant women and

adolescent girls

• Out-dated data; poor availability of data on key immediate determinants of under nutrition from national surveys

• Where data are available, indicator definitions are non-standardized and often differ from World Health Organisation recommendations

2.5

75.3

25.9

72.0

4.412.1 11.9

73.6

18.3

76.6

7.5

64.152.0 54.5

72.7

100.086.2

57.163.750.8

70.652.4

94.6

66.945.0

Sundergarh Odisha

46.4 42.5 40.434.1

100.0

47.248.5

37.845.8

32.9

50.542.4 43.0

Sundergarh Odisha

SOCIO ECONOMIC CONDITIONS7,10,11

Page 3

UNDERLYING CAUSES OF UNDERNUTRITION

BASIC CAUSES OF UNDERNUTRITION

No D

ata

No D

ata

No D

ata

No D

ata

No D

ata

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

FOOD SECURITY10

No D

ata

^Data based on rural population only

Areas for immediate action: • Very high rates of open defecation; critical need to increase awareness about washing hands with soap and

ensuring access to using improved sanitation facilities• Food insecurity, especially diet quality, is a challenge that can holdback improvements in nutrition• Very few households 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

• Per capita gross district domestic product of Sundergarh ranked 6th amongst 30 districts of Odisha 12

• Access to skilled health personnel during child delivery is very limited and few households avail banking services• 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

No D

ata

No D

ata

No D

ata

Data sources 1. Census of India. 2014. Clinical, Anthropometric & Bio-chemical (CAB) survey. http://

www.censusindia.gov.in/2011census/hh-series/HH-2/Odisha%20CAB%20Sample%20Characteristics%202014.pdf 2. UNICEF. 2013-2014. Rapid Survey on Children (RSoC). http://wcd.nic.in/RSOC/21.RSOC_Odisha.pdf 3. Census of India. 2012-2013. 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), 427-451

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. October 28, 2015, 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, India, Odisha. Mumbai: IIPS. Accessed October 28, 2015, www.rchiips.org/pdf/rch3/report/UP.pdf

7. Census of India. 2011. Houselisting and Housing Census Data. Accessed October 28, 2015, www.censusindia.gov.in/2011census/hlo/HLO_Tables.html8. 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, 2011-12. Ministry of Statistics and Program

Implementation. Government of India.11. Planning Commission. 2013. Press note on poverty estimates, 2011-12. Government of India. Accessed October 28, 2015. http://

planningcommission.nic.in/news/pre_pov2307.pdf12. Government of Odisha. Economic Survey (2014-15). Accessed October 28, 2015, http://www.odisha.gov.in/pc/Download/Economic_Survey_2014-15.pdf13. Us-India Policy Institute. 2015. District Development and Diversity Index. Accessed October 28, 2015,

http://www.usindiapolicy.org/updates/general-news/225-district-development-and-diversity-index-report

This District Nutrition Profile was developed by PHRN, Odisha for POSHAN. This version, dated 17-12-2015 is a draft intended for use in a district-level workshop in Sundergarh, and will be revised following workshop discussions.

WHAT WILL IT TAKE TO IMPROVE NUTRITION IN SUNDERGARH?

Possible district-level actions to support nutrition:

Sour

ce: P

OSH

AN/IF

PRI-N

DO