NUTRITIONAL STATUS OF THE COMMUNITIES IN THE RURAL AREAS - Current Scenario Dr.G.N.V.Brahmam Dy. Director (Sr. Gr.), HoD, Division of Community Studies, National Institute of Nutrition, (I.C.M.R.) Jamai-Osmania (P.O.), Hyderabad –

“Nutrition monitoring is the measurement of the changes over time in the nutritional status of a population or a specific group of individuals” -- WHO, 1984 Nutrition Monitoring is essential - to assess the type, magnitude & distribution of nutrition problems in the community, - to evolve policies and to formulate & implement programmes for the prevention and control of malnutrition and - to evaluate on-going nutrition programmes to assess their impact and to initiate corrective steps needed, if any.

NUTRITIONAL SURVEILLANCE “ TO WATCH OVER NUTRTION IN ORDER TO MAKE DECISIONS WHICH WILL LEAD TO IMPROVEMENT IN NUTRITION IN POPULATIONS”. NUTRITIONAL SURVEILLANCE METHODS PROVIDE REGULAR INFORMATION ABOUT NUTRITION IN POPULATION; THEY DRAW DATA FROM MOST SUITABLE SOURCES THAT ARE ALREADY AVAILBLE, INCLUDING SURVEYS AND ADMINISTATIVE DATA. THE UNDERTAKING OF ADHOC INVESTIGATIONS CAN ALSO BE INCLUDED IN NUTRITIONAL SURVEILLANCE. FAO/WHO/UNICEF EXPERT COMMITTEE (1976) AND ELABORATED UPON BY MASON et al, 1984

HOUSEHOLD FOOD SECURITY: Ability of the Household to access food which is culturally acceptable and adequate in terms of quality, quantity and safety for all members of the household throughout the year, in order to ensure active and healthy life HOUSEHOLD FOOD INSECURITY: Presently or potential inability to consume food which is adequate, having all the nutrients essential for a healthy and productive life.

NNMB was established in the year 1972, under the aegis of ICMR in the States of :  ANDHRA PRADESH  KARNATAKA  KERALA  TAMIL NADU  MAHARASHTRA  MADHYA PRADESH  ORISSA  UTTAR PRADESH  GUJARAT AND  WEST BENGAL

OBJECTIVES OF NNMB  To collect, on a continuous basis, on representative segments of population in each of the States, data on dietary pattern and nutritional status by adopting standardized and uniform procedures and techniques, and  To evaluate periodically, the ongoing national nutrition programmes, to identify their strengths and weaknesses and recommend appropriate corrective measures.

ICMR NIN - CRL STEERING COMMITTEE 10 State Units ORGANIZATION CHART OF NNMB STAFF / UNIT Medical Officer Nutritionist Social Worker Field Attendant Driver

INVESTIGATIONS  Household demographic & socio-economic particulars,  Dietary intakes of households / individuals,  Anthropometry viz., Heights, weights, MUAC & Skinfold at Triceps,  Clinical examination for prevalence of signs of nutritional deficiencies and  Village level information such as population, agricultural production, nutritional & other developmental programmes.

SAMPLING DESIGN VILLAGES:  Sub-sample of NSSO sample frame of Consumer Expenditure survey carried out once in five years – to get better spatial distribution. HOUSEHOLDS  Cluster sampling method INDIVIDUALS  All individuals from the selected HHs.  Sub-sample by systematic random sampling procedure SAMPLE SIZE Computed to arrive at State level estimates

HIGHLIGHTS OF NNMB SURVEYS  Coverage of rural, tribal & urban communities,  Repeat surveys in rural communities during , 88-90, and 96-97, covering same villages,  Repeat surveys among tribal communities during & ,  Study of physiologically vulnerable groups such as adolescent girls, elderly etc.,  Assessment of MNDs such as IDA, VAD & IDD by covering adequate sample sizes to arrive at State level estimates, and  Evaluation National nutrition programmes

NUTRITIONAL STATUS OF THE RURAL POPULATIONS NNMB Tech. Rep. #24, 2006

SOCIO ECONOMIC PROFILE OF HOUSEHOLDS (%)

SOCIO ECONOMIC PROFILE OF HOUSEHOLDS (Contd..)

Average Daily Food Intake (% RDA) among 1-3 Year Children : By Gender Percent RDA

Average Daily Food Intake (% RDA) among 4-6 Year Children : By Gender Percent RDA

Average intake of Food stuffs (as % of RDA) Among Adults (Sedentary): By Gender Percent of RDA

Median Intake of Nutrients (as % RDA) Among 1-3 year children : By gender Percent of RDA

Median Intake of Nutrients (as % RDA) Among 4-6 year children : By gender Percent of RDA

Median Intake of Nutrients (as % RDA) Among Adults (sedentary): By Gender Percent of RDA

Distribution (%) of Children according to Protein - Calorie Adequacy

Distribution (%) of Adults according to Protein - Calorie Adequacy Status

Distribution (%) of Households according to Protein - Calorie Adequacy Status

INTRAFAMILY DISTRIBUTION OF DIETARY ENERGY IN RURAL INDIA

Distribution (%) of Households According to Dietary Energy Adequacy Status of Adults Vs Children DIETARY ENERGY INTAKEAGE GROUP ADULT MALE ADULT FEMALE CHILD PRE- SCHOOL AGE ADOLES-CENT BGBGBG : Adequate - : Inadequate ;  2 : 308.6, p<0.001 ENERGY INADEQUACY Source: NNMB- 2006

ANTHROPOMETRY

Distribution (%) of Pre-school children according to Gomez Classification – By Age Group Percent

Distribution (%) of Pre-school children according to Gomez Classification - By Gender Percent

Prevalence of Undernutrition among <5 years children according to Weight for Age (IAP classification) Faulty BFFaulty Complemen tary feeding

Prevalence (%) of Undernutrition Among 1-5 yr Children According to SD Classification (<Median - 2SD) : By Age Group Percent

Prevalence (%) of Undernutrition Among 1-5 yr children According to SD Classification (<Median - 2SD): By Gender Percent

Distribution (%) of Adults by BMI Grades Percent

PREVALENCE (%) OF UNDERWEIGHT (< Median - 2SD) BY SOCIO-ECONOMIC VARIABLES BY COMMUNITYBY TYPE OF HOUSE) BY MONTHLY PCIBY FEMALE LITERACY P<0.001

PREVALENCE (%) OF STUNTING (< Median - 2SD) BY SOCIO-ECONOMIC VARIABLES BY COMMUNITYBY TYPE OF HOUSE) BY MONTHLY PCIBY FEMALE LITERACY P<0.001

PREVALENCE (%) OF WASTING (< Median - 2SD) BY SOCIO-ECONOMIC VARIABLES BY COMMUNITYBY TYPE OF HOUSE) BY MONTHLY PCIBY FEMALE LITERACY NS P<0.001 NS

MICRO-NUTRIENT DEFICIENCIES NNMB-MND SURVEYS (Tech. Report # 23)

Pooled: 0.7 < 0.5 %  0.5 % Kerala 0 Tamil Nadu 0.5 Karnataka 0.8 Andhra Pradesh 1.2 Maharashtra 1.4 Madhya Pradesh 1.2 Orissa 0.3 West Bengal 0.6 Prevalence (%) of Bitot spots among 1 - <5 year children

Per cent Prevalence (%) of Bitot Spots in 1 - <5 Yrs. Children by Community Prevalence (%) of Bitot Spots in 1 - <5 Yrs. Children by Occupation Prevalence (%) of Bitot Spots in 1 - <5 Yrs. Children by Family Size Prevalence (%) of Bitot Spots in 1 - <5 Yrs. Children by Female Literacy Status Ag. Labour Other Labour Cultivators Artisans Service Business

Distribution (%) of 1- 5 Yr. Children with Blood Vit. A Levels of < 20  G/dL, Median Dietary Intake of Vit. A (as % RDA) and Extent of Coverage for Suppl. of Massive Dose Vit. A – By State STATES Blood Vitamin A < 20  g/dL Dietary Intake of Vitamin A < 50% of RDA Receipt of Massive Dose Vitamin A 1 or 2 Doses No. of Doses OneTwo Kerala Tamil Nadu Karnataka AP Maharashtra MP Orissa West Bengal Pooled

Mean ±SE Prevalence (%) of Anaemia by Age, Gender & Physiological Groups > 6 months < 6 months

Pooled: 3.9 < 5 % > 5 % Kerala 0.6 Tamil Nadu 0 Karnataka 1.9 Andhra Pradesh 3.8 Maharashtra 12.2 Madhya Pradesh 4.3 Orissa 0.1 West Bengal 9.0 Prevalence (%) of IDD among 6 - <12 Year Children

Per cent of Households consuming salt having adequate Amount (>=15 ppm) of Iodine * By spot test Per cent STATES

NUTRITIONAL STATUS - TIME TRENDS

Average Intake of Foodstuffs (per CU/day) as % of RDI by Period of Survey Percent

Average Intake of Foodstuffs (per CU/day) as % of RDI by Period of Survey (contd.) Percent

Average Intake of Nutrients (per CU/day) as % of RDI by Period of Survey Percent

Average Intake of Nutrients (per CU/day) as % of RDI by Period of Survey (Contd.)

Distribution (%) of Households According Dietary Energy Adequacy Status of Adults & Pre-school Child -- Time Trends %

Distribution (%) of Households According to Dietary Energy Adequacy Status of Adults Vs Children DIETARY ENERGY INTAKE AGE GROUP ADULT MALE ADULT FEMALE CHILD PRE- SCHOOL AGE ADOLESCENT : Adequate - : Inadequate ;  2 : 308.6, p<0.001 ENERGY INADEQUACY Source: NNMB- 2006

Distribution (%) of Households with Protein Calorie adequacy Percent

Distance Charts for Heights and Weights for Males and Females - Andhra Pradesh Height (Cm) Weight (Kg) Age (Yrs)

Distribution (%) of Pre-school children (1-5 Yrs) According to Gomez Classification Percent

Distribution (%) of Children by Undernutrition and Period of Survey Percent UNDERNUTRITION (< Median - 2SD)

Distribution (%) of Adult Males according to BMI Grades by Period of Survey Percent BMI <18.5BMI:18.5 – 25.0BMI: >=25.0

Distribution (%) of Adult Females according to BMI Grades by Period of Survey Percent BMI <18.5BMI:18.5 – 25.0BMI: >=25.0

Prevalence (%) of Nutritional deficiency signs among Preschool Children Percent

Dist- ricts Northern North- Eastern EasternCentralSouthern PREV.CurrentPREV.CurrentPREV.CurrentPREV.CurrentPREV.Current Prevalence of Total Goitre (%) in Select Districts of Different Regions of the Country :[National IDD survey (40 districts) 2003