CENTRE FOR LEARNING RESOURCES, PUNE Surguja Suposhan Abhiyan Baseline Study – March 2013 State Health Resource Centre, Chhattisgarh This document is a report of the Fulwari baseline study conducted in Surguja district of Chhattisgarh, undertaken for the State Health Resource Centre (SHRC), Chhattisgarh in order to provide a baseline status of a) health and nutrition of and b) health care services and practices for, pregnant women and children in the age group of 0-3 years. UNICEF facilitated the study and provide a grant to support it.
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CENTRE FOR LEARNING RESOURCES, PUNE
Surguja Suposhan Abhiyan Baseline Study – March 2013
State Health Resource Centre, Chhattisgarh
This document is a report of the Fulwari baseline study conducted in Surguja district of Chhattisgarh, undertaken for the State Health Resource Centre (SHRC), Chhattisgarh in order to provide a baseline status of a) health and nutrition of and b) health care services and practices for, pregnant women and children in the age group of 0-3 years. UNICEF facilitated the study and provide a grant to support it.
TRAINING ................................................................................................................................................... 24
8.1.3 Caste category..................................................................................................................... 48
8.1.4 Household Income ............................................................................................................... 49
8.1.5 Primary source of livelihood ................................................................................................ 51
8.1.6 Access to NREGA benefits ................................................................................................... 53
8.1.7 BPL card status .................................................................................................................... 55
8.1.8 Ration card status ............................................................................................................... 56
4
8.1.9 Geographical location – the seven blocks ........................................................................... 58
8.1.10 Mother’s profile ................................................................................................................... 60 8.1.10.1 Mother’s education status ............................................................................................................................ 60 8.1.10.2 Mother’s age at marriage ............................................................................................................................. 62 8.1.10.3 Maternal work hours .................................................................................................................................... 63
STATUS OF COVERAGE AND USAGE OF HEALTH AND NUTRITION SERVICES FOR CHILDREN .......................................... 65
8.1.12 Vaccination and supplements ............................................................................................. 65
8.1.13 Access to National Health Insurance Program (NHIP) ........................................................ 66
STATUS OF HEALTH AND NUTRITION PRACTICES FOR CHILDREN ............................................................................ 66
8.1.14 Health .................................................................................................................................. 67 8.1.14.1 Incidence and treatment of common illnesses amongst children ................................................................ 67 8.1.14.2 Weight monitoring ........................................................................................................................................ 75
8.1.15 Nutrition .............................................................................................................................. 76 8.1.15.1 Breast feeding and weaning practices .......................................................................................................... 76 8.1.15.2 Frequency of food intake and food composition .......................................................................................... 78
STATUS OF PSYCHOSOCIAL CARE PRACTICES FOR CHILDREN.................................................................................. 83
HEALTH AND NUTRITION SERVICES AND PRACTICES FOR PREGNANT AND LACTATING WOMEN .................................... 87
8.1.17 Health and nutrition services: ............................................................................................. 88 8.1.17.1 Registering the pregnancy ............................................................................................................................ 88 8.1.17.2 Ante natal care (ANC) services ...................................................................................................................... 88 8.1.17.3 Institutional delivery ..................................................................................................................................... 89 8.1.17.4 Post partum care (PPC) services ................................................................................................................... 90 8.1.17.5 Supplementary nutrition ............................................................................................................................... 91 8.1.17.6 Access to National Health Insurance Program .............................................................................................. 91
8.1.18 Practices: Health and nutrition ........................................................................................... 91 8.1.18.1 Nutrition........................................................................................................................................................ 91 8.1.18.2 Presence of kitchen gardens ......................................................................................................................... 92 8.1.18.3 Workload of pregnant women, duration of resting ...................................................................................... 92
APPENDIX 1: PROFILE OF RESPONDENTS: PREGNANT WOMEN ........................................................................... 102
APPENDIX 2: HEALTH AND NUTRITION SERVICES AND PRACTICES FOR PREGNANT AND LACTATING WOMEN ............... 109
APPENDIX 3: HYGIENE RELATED PRACTICES - PREGNANT WOMEN ...................................................................... 115
APPENDIX 4: HYGIENE RELATED PRACTICES – MOTHERS OF CHILDREN AGED 0-3 YEARS ......................................... 117
APPENDIX 5: PRACTICES FOR TREATMENT OF DIARRHEA FOR 0-6 MONTH OLDS .................................................... 119
APPENDIX 6: PRACTICES FOR TREATMENT OF FEVER FOR 0-6 MONTH OLDS ......................................................... 121
APPENDIX 7: PRACTICES FOR TREATMENT OF COLD AND COUGH FOR 0-6 MONTH OLDS ......................................... 122
APPENDIX 8: PRACTICES FOR TREATMENT OF DIARRHEA FOR 6 - 36 MONTH OLDS ................................................ 123
APPENDIX 9: PRACTICES FOR TREATMENT OF FEVER FOR 6 - 36 MONTH OLDS ...................................................... 125
APPENDIX 10: PRACTICES FOR TREATMENT OF COLD AND COUGH FOR 6 - 36 MONTH OLDS ................................... 126
APPENDIX 11: DETAILS OF WEIGHT MONITORING OF CHILDREN AGED 0-3 YEARS .................................................. 127
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APPENDIX 12: BREAST FEEDING PRACTICES (0-6 MONTH OLDS) ........................................................................ 130
APPENDIX 13: AGE OF FULWARIS ON SURVEY DATE ........................................................................................ 131
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LIST OF TABLES
TABLE 1: BLOCK WISE SAMPLE SIZES OF FULWARI HAMLETS AND NON-FULWARI HAMLETS............................................ 17
TABLE 2: ACTUAL SAMPLE SIZE COVERED ACROSS RESPONDENT CATEGORIES ..................................................................... 18
TABLE 3: SUMMARY OF INDICATORS TO BE STUDIED AND METHODS OF DATA COLLECTION ............................................................... 19
TABLE 4: WHO STANDARDIZED FLAG LIMITS FOR Z SCORES ....................................................................................................... 20
TABLE 5: RESPONDENTS' OWNERSHIP OF HOUSEHOLD ASSETS .................................................................................................. 31
TABLE 6: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON Z SCORES ...................................................................................... 36
TABLE 7: DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS .......................................................................................... 42
TABLE 8: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND WAZ VALUES-FW HAMLETS ..................... 42
TABLE 9: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND WAZ VALUES-NFW HAMLETS ................................... 42
TABLE 10: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND WAZ VALUES-OVERALL .......................................... 42
TABLE 11: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND WHZ VALUES ....................................... 43
TABLE 12: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON AGE GROUPS AND HAZ VALUES ....................................................... 43
TABLE 13: DISTRIBUTION OF CHILDREN BASED ON GENDER ............................................................................................. 43
TABLE 14: DISTRIBUTION OF CHILDREN BASED ON GENDER AND AGE ............................................................................... 44
TABLE 15: AGE CATEGORY-WISE GENDER BASED T-TEST OUTPUTS FOR FW AND NFW HAMLETS .................................................... 47
TABLE 16: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON GENDER AND WAZ VALUES ............................................................. 47
TABLE 17: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON GENDER AND WHZ VALUES ............................................................. 47
TABLE 18: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON GENDER AND HAZ VALUES .............................................................. 47
TABLE 19: DISTRIBUTION OF RESPONDENTS BASED ON CASTE CATEGORY ........................................................................... 48
TABLE 20: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON CASTE CATEGORIES AND WAZ VALUES ............................................... 49
TABLE 21: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON CASTE CATEGORIES AND WHZ VALUES ............................................... 49
TABLE 22: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON CASTE CATEGORIES AND HAZ VALUES ................................................ 49
TABLE 23: DISTRIBUTION OF RESPONDENTS BASED ON MONTHLY HHI BRACKET ............................................................... 50
TABLE 24: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON HOUSEHOLD INCOME AND WAZ VALUES ............................................ 50
TABLE 25: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON HOUSEHOLD INCOME AND WHZ VALUES ............................................ 51
TABLE 26: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON HOUSEHOLD INCOME AND HAZ VALUES ............................................. 51
TABLE 27: DISTRIBUTION OF RESPONDENTS BASED ON PRIMARY SOURCE OF LIVELIHOOD ................................................. 52
TABLE 28: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON PRIMARY SOURCE OF LIVELIHOOD AND WAZ VALUES ............................ 52
TABLE 29: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON PRIMARY SOURCE OF LIVELIHOOD AND WHZ VALUES ............................ 53
TABLE 30: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON PRIMARY SOURCE OF LIVELIHOOD AND HAZ VALUES ............................. 53
TABLE 31: DISTRIBUTION OF RESPONDENTS BASED ON NREGA CARD STATUS ................................................................. 54
TABLE 32: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON NREGA CARD STATUS AND WAZ VALUES ............................................ 54
TABLE 33: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON NREGA CARD STATUS AND WHZ VALUES ............................................ 54
TABLE 34: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON NREGA CARD STATUS AND HAZ VALUES ............................................. 54
TABLE 35: DISTRIBUTION OF RESPONDENTS BASED ON BPL CARD STATUS ....................................................................... 55
TABLE 36: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON BPL CARD STATUS AND WAZ VALUES ................................................. 55
TABLE 37: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON BPL CARD STATUS AND WHZ VALUES ................................................. 56
TABLE 38: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON BPL CARD STATUS AND HAZ VALUES .................................................. 56
TABLE 39: DISTRIBUTION OF RESPONDENTS BASED ON RATION CARD STATUS ................................................................... 57
TABLE 40: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON RATION CARD STATUS AND WAZ VALUES ............................................ 57
TABLE 41: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON RATION CARD STATUS AND WHZ VALUES ........................................... 57
TABLE 42: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON RATION CARD STATUS AND HAZ VALUES ............................................ 57
TABLE 43: BLOCK WISE DISTRIBUTION OF RESPONDENTS ACROSS FW AND NFW HAMLETS .............................................. 58
TABLE 44: PERCENTAGE DISTRIBUTION OF CHILDREN ACROSS BLOCKS BASED ON WAZ VALUES .......................................................... 59
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TABLE 45: PERCENTAGE DISTRIBUTION OF CHILDREN ACROSS BLOCKS BASED ON WHZ VALUES .......................................................... 59
TABLE 46: PERCENTAGE DISTRIBUTION OF CHILDREN ACROSS BLOCKS BASED ON HAZ VALUES ........................................................... 59
TABLE 47: DISTRIBUTION OF RESPONDENTS BASED ON EDUCATIONAL PROFILE ................................................................. 60
TABLE 48: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S EDUCATIONAL STATUS AND WAZ VALUES ........................... 61
TABLE 49: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S EDUCATIONAL STATUS AND WHZ VALUES ............................ 61
TABLE 50: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S EDUCATIONAL STATUS AND HAZ VALUES ............................. 62
TABLE 51: DISTRIBUTION OF RESPONDENTS BY AGE AT MARRIAGE ................................................................................... 62
TABLE 52: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S AGE AT MARRIAGE AND WAZ VALUES ................................. 63
TABLE 53: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S AGE AT MARRIAGE AND WHZ VALUES ................................. 63
TABLE 54: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MOTHER’S AGE AT MARRIAGE AND HAZ VALUES .................................. 63
TABLE 55: DISTRIBUTION OF RESPONDENTS BASED ON MATERNAL WORKING HOURS ........................................................ 64
TABLE 56: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MATERNAL WORKING HOURS AND WAZ VALUES .................................. 64
TABLE 57: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MATERNAL WORKING HOURS AND WHZ VALUES .................................. 65
TABLE 58: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON MATERNAL WORKING HOURS AND HAZ VALUES................................... 65
TABLE 59: STATUS OF VACCINATION OF CHILDREN IN THE AGE GROUP 6-36 MONTHS IN FW AND NFW HAMLETS .............................. 66
TABLE 60: DURATION OF IRON SYRUP INTAKE......................................................................................................................... 66
TABLE 61: INCIDENCE OF ILLNESSES OVER LAST 15 DAYS - CHILDREN AGED 0-6 MONTHS .............................................. 67
TABLE 62: INCIDENCE OF ILLNESSES OVER LAST 15 DAYS -CHILDREN AGED 6 MONTHS - 3 YEARS.................................... 68
TABLE 63 : STATUS OF CHILDREN’S WEIGHT MONITORING......................................................................................................... 76
TABLE 64: FOOD COMPOSITION - CHILDREN 6 MONTHS - 3 YEARS ............................................................................................ 80
TABLE 65: PREVALENCE OF KITCHEN GARDENS .................................................................................................................. 80
TABLE 66 PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON KITCHEN GARDEN STATUS AND WAZ VALUES........................................ 81
TABLE 67: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON KITCHEN GARDEN STATUS AND WHZ VALUES ...................................... 81
TABLE 68: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON KITCHEN GARDEN STATUS AND HAZ VALUES ....................................... 81
TABLE 69: PSYCHOSOCIAL STIMULATION DURING BATHING TIME ................................................................................................ 83
TABLE 70: PSYCHOSOCIAL STIMULATION DURING MEAL TIME .................................................................................................... 84
TABLE 71: PSYCHOSOCIAL STIMULATION DURING SLEEP TIME .................................................................................................... 85
TABLE 72: PSYCHOSOCIAL STIMULATION DURING FREE TIME ..................................................................................................... 86
TABLE 73: PSYCHOSOCIAL STIMULATION DURING TOY TIME....................................................................................................... 87
TABLE 74: STATUS OF USAGE OF ANC SERVICES BY LACTATING MOTHERS AND PREGNANT WOMEN .................................................... 88
TABLE 75: TYPE OF DELIVERY - LACTATING WOMEN / MOTHERS OF 0-6 MONTHS OLDS ..................................................... 89
TABLE 76: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON TYPE OF DELIVERY AND WAZ VALUES ................................................. 90
TABLE 77: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON TYPE OF DELIVERY AND WHZ VALUES ................................................ 90
TABLE 78: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON TYPE OF DELIVERY AND HAZ VALUES ................................................. 90
TABLE 79: FOOD COMPOSITION - PREGNANT WOMEN ............................................................................................................ 91
TABLE 81: COMPARATIVE PROFILE OF RESPONDENTS ON SELECT DEMOGRAPHIC INDICATORS ........................................................... 99
TABLE 82: VARIATION IN DISTRIBUTION OF WAZ ACROSS SELECT DEMOGRAPHIC INDICATORS BETWEEN FW AND NFW HAMLETS ......... 99
TABLE 83: VARIATION IN ADOPTION OF SUGGESTED HEALTH AND NUTRITION PRACTICES BETWEEN FW AND NFW HAMLETS ............... 100
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LIST OF FIGURES
FIGURE 1: AGE DISTRIBUTION OF RESPONDENTS .................................................................................................................... 26
FIGURE 2: RESPONDENT’S AGE AT MARRIAGE ........................................................................................................................ 26
FIGURE 3 : CASTE PROFILE OF RESPONDENTS ......................................................................................................................... 27
FIGURE 4: YEARS OF EDUCATION RECEIVED BY RESPONDENTS ................................................................................................... 27
FIGURE 5: RESPONDENT DISTRIBUTION BY NUMBER OF PREGNANCIES ........................................................................................ 28
FIGURE 6: RESPONDENT DISTRIBUTION BY NUMBER OF CHILDREN ............................................................................................. 28
FIGURE 7: TOTAL HOUSEHOLD MONTHLY INCOME.................................................................................................................. 29
FIGURE 8: HOUSEHOLD'S ACCESS TO AND STATUS OF AVAILING NREGA BENEFITS ....................................................................... 29
FIGURE 9 : HOUSEHOLD'S PRIMARY SOURCE OF LIVELIHOOD ..................................................................................................... 30
FIGURE 10: HOUSEHOLD'S BPL CARD STATUS ....................................................................................................................... 30
FIGURE 11: RATION CARD STATUS OF HOUSEHOLDS ............................................................................................................... 30
FIGURE 12: RESPONDENT DISTRIBUTION BY TYPE OF HOUSE ..................................................................................................... 31
FIGURE 13: RESPONDENT DISTRIBUTION BY OWNERSHIP OF HOUSE ........................................................................................... 31
FIGURE 14: COOKING FUEL USED ........................................................................................................................................ 32
FIGURE 15: PLACE OF COOKING .......................................................................................................................................... 32
FIGURE 16: USE OF SMOKELESS CHULHA .............................................................................................................................. 32
FIGURE 17: SOURCE OF DRINKING WATER ............................................................................................................................ 32
FIGURE 18: TOILET FACILITY AVAILABLE TO RESPONDENTS ....................................................................................................... 33
FIGURE 19: RESPONDENTS' ACCESS TO ELECTRICITY ................................................................................................................ 33
FIGURE 20: OVERALL DISTRIBUTION OF WAZ AGAINST WHO STANDARDS ............................................................................ 37
FIGURE 21: OVERALL DISTRIBUTION OF WHZ AGAINST WHO STANDARDS ............................................................................ 38
FIGURE 22: OVERALL DISTRIBUTION OF HAZ AGAINST WHO STANDARDS ............................................................................. 39
FIGURE 23: DISTRIBUTION OF WAZ AGAINST WHO STANDARDS IN FW HAMLETS ................................................................. 40
FIGURE 24: DISTRIBUTION OF WAZ AGAINST WHO STANDARDS IN NFW HAMLETS ............................................................... 41
FIGURE 25: GENDER WISE DISTRIBUTION OF WAZ AGAINST WHO STANDARDS FOR ALL HAMLETS ............................................ 44
FIGURE 26: GENDER WISE DISTRIBUTION OF WAZ AGAINST WHO STANDARDS - FW HAMLETS ............................................... 45
FIGURE 27: GENDER WISE DISTRIBUTION OF WAZ AGAINST WHO STANDARDS - NFW HAMLETS ............................................ 46
FIGURE 28: AVERAGE WAZ BY CASTE CATEGORIES.................................................................................................................. 48
FIGURE 29: DISTRIBUTION OF WAZ BASED ON HOUSEHOLD INCOME - FULWARI .......................................................................... 50
FIGURE 30: DISTRIBUTION OF WAZ BASED ON HOUSEHOLD INCOME - NON FULWARI ................................................................... 50
FIGURE 31: AVERAGE WAZ BASED ON PRIMARY SOURCE OF LIVELIHOOD ...................................................................................... 52
FIGURE 32: AVERAGE WAZ BY NREGA CARD STATUS ............................................................................................................ 53
FIGURE 33: AVERAGE WAZ BY BPL CARD STATUS ................................................................................................................. 55
FIGURE 34: RATION CARD STATUS WISE AVERAGE WAZ .......................................................................................................... 56
FIGURE 35: BLOCK WISE AVERAGE WAZ ............................................................................................................................... 58
FIGURE 36: DISTRIBUTION OF WAZ BASED ON MOTHER’S EDUCATION STATUS - FULWARI................................................................ 61
FIGURE 37: DISTRIBUTION OF WAZ BASED ON MOTHER’S EDUCATION STATUS - NON FULWARI ...................................................... 61
FIGURE 38: DISTRIBUTION OF WAZ BASED ON MOTHER’S MARRIAGE AGE - FULWARI ..................................................................... 62
FIGURE 39: DISTRIBUTION OF WAZ BASED ON MOTHER’S MARRIAGE AGE - NON FULWARI ............................................................ 62
FIGURE 40: DISTRIBUTION OF WAZ BASED ON MATERNAL WORKING HOURS- FULWARI ................................................................... 64
FIGURE 41: DISTRIBUTION OF WAZ BASED ON MATERNAL WORKING HOURS - NON FULWARI ......................................................... 64
FIGURE 42: INCIDENCE OF ILLNESSES OVER LAST 15 DAYS - CHILDREN AGED 0-6 MONTHS ............................................................ 67
FIGURE 43: INCIDENCE OF ILLNESSES OVER LAST 15 DAYS -CHILDREN AGED 6 MONTHS - 3 YEARS ................................................... 67
FIGURE 46: FLUID INTAKE DURING DIARRHEA - 6 MONTHS TO 3 YEARS ....................................................................................... 69
FIGURE 47: MILK INTAKE DURING DIARRHEA - 6 MONTHS TO 3 YEARS ....................................................................................... 69
FIGURE 48: FOOD INTAKE DURING DIARRHEA - 6 MONTHS TO 3 YEAR OLDS ................................................................................ 69
FIGURE 49: FLUID INTAKE DURING FEVER- 0-6 MONTHS.......................................................................................................... 71
FIGURE 50: MILK INTAKE DURING FEVER- 0-6 MONTHS .......................................................................................................... 71
FIGURE 51: FLUID INTAKE DURING FEVER- 6 MONTHS TO 3 YEARS ............................................................................................ 72
FIGURE 52: MILK INTAKE DURING FEVER- 6 MONTHS TO 3 YEARS ............................................................................................. 72
FIGURE 53: FOOD INTAKE DURING FEVER- 6 MONTHS TO 3 YEARS ............................................................................................ 72
FIGURE 54: FLUID INTAKE DURING COLD AND COUGH- 0-6 MONTHS ......................................................................................... 74
FIGURE 55: MILK INTAKE DURING COLD AND COUGH- 0-6 MONTHS .......................................................................................... 74
FIGURE 56: FLUID INTAKE DURING COLD AND COUGH - 6 MONTHS TO 3 YEARS .......................................................................... 74
FIGURE 57: MILK INTAKE DURING COLD AND COUGH - 6 MONTHS TO 3 YEARS ........................................................................... 74
FIGURE 58: FOOD INTAKE DURING COLD AND COUGH - 6 MONTHS TO 3 YEARS .......................................................................... 75
FIGURE 59: TIME OF FIRST BREAST FEEDING OF A NEWBORN .................................................................................................... 77
FIGURE 60: STATUS OF COLOSTRUM BEING GIVEN TO NEW-BORNS ........................................................................................... 78
FIGURE 61: INFANTS AGED 0-6 MONTHS - GIVEN FOOD OTHER THAN MOTHER'S MILK IN LAST 1 MONTH ..................................... 78
FIGURE 62: INFANTS AGED 0-6 MONTHS BEING BREASTFED BY MOTHER ................................................................................... 78
FIGURE 63: TIME OF STARTING COMPLEMENTARY NUTIRTION .................................................................................................. 78
FIGURE 64: FREQUENCY OF EATING - CHILDREN AGED 6 MONTHS - 3 YEARS ............................................................................... 79
FIGURE 65: FREQUENCY OF ADDING OIL TO FOOD - CHILDREN AGED 6 MONTHS - 3 YEARS ........................................................... 79
FIGURE 66: AVERAGE WAZ BY KITCHEN GARDEN STATUS ........................................................................................................ 80
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1 EXECUTIVE SUMMARY
This study of nutritional status and health and nutrition practices, including the use of relevant health services,
prevalent in Surguja district was undertaken by Centre for Learning Resources to provide a base-line for the
Fulwari programme, in Surguja. This programme is conceived as a community-led, government-supported el-
ement of the Surguja Suposhan Abhiyan. With technical and implementation support from State Health Re-
source Centre (SHRC), village mothers run community creches, called Fulwaris, which provide 3 hot meals a
day and care and attention for about 7 hours to children under 3 years.
This baseline study was undertaken to assess the nutritional status of the under-3 children in the district, to
assess the adoption of recommended nutritional, health-care and psychosocial practices for them and access
and usage of health and nutrition services by pregnant and lactating women.
The study was conducted in 80 fulwari hamlets and 50 non-fulwari ones. The average age of the fulwari on the
day of the survey was 56 days. Height and weight data on all the relevant children in the selected hamlets was
collected. In addition, various demographic variables and healthcare, nutritional and psycho-social practices
were studied for a smaller subset of the children as well as for a sample of pregnant women. WHO Child
Growth standards were used to establish nutritional status and link it to the demographic and practice variables.
The study concludes that malnutrition is significant and pervasive in Surguja, with the average weight-for-age
z-score at -1.85 (“Moderate Malnutrition” category begins at -2.00). When analysed based on various demo-
graphic indicators, the differences were mostly small. However, significant differences emerged between fulwari
and non-fulwari hamlets, with the average resident in the non-fulwari hamlet better off than in the fulwari
hamlet. Moreover, the differences between the better off and the not-so-well-off were markedly more stark in
fulwari hamlets than in the non-fulwari ones, suggesting that the fulwaris were finding their target hamlets
reasonably well. And while the fulwaris had been established too recently to warrant any firm conclusions, it
did seem that in the fulwari hamlets, the awareness of desirable health-care practices was somewhat higher.
The study also suggests that the awareness of beneficial health and nutritional practices is fairly high but not
universal. While vaccination and supplementary nutrition practices seem well-adopted, the adoption of other
practices is weaker and suggests the need for attention to a behaviour change effort. Relatively little attention
is paid by parents to stimulating the psycho-social capacities of children; awareness of the value of complex
talk, versatile toys and self-reliant activities needs to be enhanced through appropriate parenting education.
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2 INTRODUCTION
The Fulwari baseline study conducted in Surguja district of Chhattisgarh was undertaken for the State Health
Resource Center (SHRC), Chhattisgarh in order to provide a baseline of status of a) health and nutrition of and
b) health care services and practices for, children in the age group of 0-3 years. This baseline data will be used
for assessing the impact and effectiveness of SHRC’s recent health intervention, the community crèches inter-
vention called the Fulwari program. The study was coordinated by the Center for Learning Resources, Pune.
The study was part-funded by UNICEF.
Socio-demographic context
2.1.1 Malnutrition in India
As per the National Family Health Survey 3 (NFHS 3), carried out in 2005-06, 40% of children in India under
the age of three years are underweight for their age. The study puts the number of stunted children under the
age of three, i.e. children who are too short for their age, at 45%. On a third critical indicator of child health,
the measure of weight to height, 23% of children under three years fail to meet the normal standards and suffer
from what is called wasting. The World Bank puts it into perspective in the global context, “Rates of malnutrition
among India’s children are almost five times more than in China, and twice those in Sub-Saharan Africa.”1
High prevalence of malnutrition in children aged up to three years is a grave concern as studies show that the
damage caused to the physical, psychosocial and brain development of the child in these early stages is accu-
mulative and largely irreversible. It reduces their chances of survival, reduces their immunity and makes them
more susceptible to illnesses, adversely affects their ability to learn and to continue in school at later stages in
life.
2.1.2 Location of the study: Chhattisgarh State
Chhattisgarh is a relatively young Indian state, which was carved out of Madhya Pradesh in November 2000. It
is one of India’s most resource-rich states: it has large reserves of coal, iron ore, tin, dolomite, limestone and
bauxite; it produces 15% of the country’s steel and 20% of its cement and is one of the few Indian states with
a comfortable electricity situation. 12% of India's forest cover falls in Chhattisgarh: 44% of the State's land is
under forests and wood, tendu leaves, honey and lac are significant forest resources. It is identified as one of
the richest bio-diversity habitats. One third of Chhattisgarh's total population of nearly 25 million is tribal,
living mostly in the thickly forested areas in the North and South. (http://cg.gov.in/profilenew/profile1.htm )
Female literacy rate as per the 2011 national census was 60.5%, an approximately 100% rise over the last decade,
and male literacy according to the same survey stands at 81.4% which is marginally higher than India's average.
Chhattisgarh’s sex ratio is 991 while its child sex ratio is 964, considerably higher than the national sex ratio of
914.
1 (Helping India Combat Persistently High Rates of Malnutrition – World Bank article -
However, child health indicators remain a significant challenge for Chhattisgarh. The ratio of underweight
children, under the age of 5, in Chhattisgarh is more than 40%.. A World Bank report states, “Six states - Bihar,
Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan, and Uttar Pradesh - account for over half of India’s malnutrition cases.”
More than 70% of the state’s children are anaemic2. The infant mortality rate (IMR) in Chhattisgarh was 51,
the sixth-highest of the 20 large states in the country and above the national average of 473. Of this, neonatal
mortality rate stands at 35 and post neonatal mortality rate at 16. The under 5 mortality rate (U5MR) was 61,
the seventh highest among large states, compared to the national average of 594.
2.1.3 Location of the study: Surguja District
Surguja is a northern district of Chhattisgarh sharing borders with four other states, Jharkhand, Orissa, Madhya
Pradesh and Uttar Pradesh. The high-lands of Surguja district have peculiar 'pat formations' – highlands with
small tablelands. As per NFHS-3 its population is approximately 2.3 million of which nearly 90% is rural; 54.6%
of the total population is tribal. Children under the age of 6 years constitute 16.53% of the total population and
the child sex ratio is 967 which is marginally higher than the state sex ratio. While it is rich in mineral and forest
resources, agriculture forms the main source of livelihood with more than 80% of the population being culti-
vators or agricultural labourers.
As per Chhattisgarh’s Annual Health Survey Bulletin 2011-12, Surguja’s IMR is 55, compared to the state IMR
of 50. However, this similarity hides a rather alarming deterioration of mortality rates with children’s ages.
Surguja’s neo-natal mortality rate (children dying within a month of birth) is 31, lower than the state level of
35. However, it has the highest post-neonatal mortality rate (PNMR) (children dying after a month but before
one year of birth) of 24 among all Chhattisgarh districts, much higher than the state’s PNMR of 16. Similarly,
U5MR, at 96 for Surguja, is the highest of all districts in the state; the state value is 66. Clearly, the care of
children under five in Surguja presents significant challenges for the community as well as the state govern-
ment5.
2 National Family Health Survey 3 (2005-06), Ministry of Health and Family Welfare
3 Sample Registration System 2010
4 Sample Registration System 2010
5There appear to be some inconsistencies between SRS 2010 and numbers reported in Chhattisgarh Health Survey Bulletin 2011-12 for 2010. These might be due to reporting data without differentiating between Surguja divided and undivided. These have been ignored for the purpose of this discussion; they do not alter the thrust of the argument.
14
3 FULWARI PROGRAM
These challenges and the urgent need for action led SHRC to identify Surguja as the pilot location for their
fulwari program. As conceived, it is a community-run and government-supported intervention which is a part
of the Zila Panchayat’s Surguja Suposhan Abhiyan aimed at battling the widespread malnutrition (47% of children
are underweight) prevalent amongst children in Chhattisgarh. Mothers from poor families have a lot of work-
load which also involves going for work outside home. Thus, poverty creates two kinds of factors that increase
child malnutrition among the poor: a) lack of access to high nutrition foods b) lack of availability of adequate
amount of time for child feeding and care. Fulwaris are community run crèches that attempt to address these
two issues by providing a place where mothers can leave their children in good care for 7-10 hours where the
children receive the attention they require and eat at least 3 hot meals a day. Moreover, recognizing the critical
importance of psychosocial stimulation during the early years of the child, both for increasing the nutritional
intake of the child, and for holistic development, the crèche also aims to enhance the quality of psychosocial
care by mothers.
The fulwari program is based on what is known as the ‘Caregivers Group Model’ which has been implemented
by international NGOs in Malawi in Africa. This model involves creating a group of caregivers from the com-
munity who take primary responsibility for improving the health and nutrition status of children less than 3
years of age. In Surguja, Fulwaris are run by the local community through a group of mothers. Also, parents
(or grandparents) having children (below the age of three years) in each habitation and pregnant women are
brought together into a group. Formation, coordination and activities of this group are facilitated by the
Mitanin. These meetings provide the Mitanin an opportunity to interact with this critical set of families on child
care issues.
The technical and implementation support for running the fulwaris is being provided by the State Health Re-
source Center (SHRC), Chhattisgarh. The program is being piloted by SHRC in Surguja district in 300 hamlets
across the district. Direct cash assistance is provided by the Zila Panchayat to the mothers’ groups (through the
Gram Panchayats). (The state government has announced its intention to expand the programme to 85 blocks
across the state).
The key activities targeted towards and undertaken by the mother’s group of the fulwari are:
Running community crèches to focus on needs of children below 3 years of age: Zila Panchayat provides an average
fund of Rs. 50,000 per annum per habitation to run the community crèches. The grant is given to
Gram Panchayat which in turn issues it to the mothers’ group in instalments. At least 80% of the grant
is meant to be utilized to provide wholesome hot cooked food to children, pregnant and lactating
women. The rest is utilized to equip the crèche with essential utensils, toys, mosquito nets, mats etc.
The crèche is run for at least 7 hours a day. The timings are decided by the community in the Village
Health, Nutrition and Sanitation Committee (VHNSC) meetings. It thus makes it possible for mothers
to go for work while leaving their 6 month-3 year old children at the fulwari. The place or building for
setting up the fulwari is also decided by the community. It is usually part of a private house voluntarily
given for the purpose by the resident.
The focus is on children under the age of 3 years, who require interventions complementing the exist-
ing strategy of giving them dry Ready to Eat Take Home Rations and growth monitoring (through
ICDS) and immunization (through VHND).
15
Educating caregivers on appropriate nutrition, physical health care and psychosocial care for 0-3 year olds: The crèche
brings together the Caregivers group as the food for their children acts as an incentive. Here, desirable
practices of food preparation and child feeding are demonstrated to them. Mitanins provide counsel-
ling to families regarding child feeding and healthcare practices. SHRC also aims to use this crèche as
a medium to educate mothers about appropriate caregiving practices that enhance the psychosocial
development of children.
Promoting kitchen gardens in caregiver homesteads: The caregivers’ group is encouraged to develop kitchen
gardens as this will help provide fruits and vegetables which are an important source of nutrition.
Backyard poultry is also promoted for similar reasons.
Other activities of the fulwari include promoting various livelihood initiatives in the hamlets.
16
4 OBJECTIVES OF THE STUDY
This baseline study focuses on the key parameters which shape the activities of the Fulwari program. These are
nutritional status of children; nutritional, physical care and psychosocial care of children; and, adoption of
nutritional and health care services by pregnant and lactating women. Based on these parameters, the following
aims shaped the study.
1. To assess the nutritional status of children in the age group of 0-3 years.
2. To assess the extent to which parents of 0-3 year olds engaged in recommended nutritional practices,
physical health care practices and psychosocial care practices.
3. To assess the status of access and usage of recommended health and nutrition services by pregnant
women and lactating women.
17
5 STUDY DESIGN
Sampling
It was decided that the overall sample would comprise two groups of hamlets, one where fulwaris were being
established and another where they weren’t. Accordingly, this baseline study was conducted in 130 hamlets. Of
these, fulwaris in 80 had started and the mean age of fulwaris, i.e. the period between the commencement of
fulwari operations and the date of survey was 56 days. (For more details refer to Appendix 13). There were no
fulwaris in the other 50.
The block-wise sample size of the fulwari hamlets (FW) was based on the proportion of fulwari hamlets it had
out of the total of 300 fulwari hamlets. Similarly the block-wise sample size of the non-fulwari hamlets (NFW)
was based on the proportion of non-fulwari hamlets it had out of the total of 2765 such hamlets.
While the baseline design split the sample between hamlets where fulwaris existed and those where they didn’t,
it is unlikely that the non-fulwari locations will function as control locations. The intention is for fulwaris to be
opened wherever the local communities ask for them. It is, therefore, very likely that over the project period,
the hamlets which are not currently classified as fulwari hamlets will also establish them. Moreover, even if they
don’t, the likelihood that practices followed in the fulwari hamlets will diffuse into the neighbouring hamlets is
too great to allow the NFW to be treated as control locations. At the baseline stage, however, they have pro-
vided a sense of the differences in characteristics between the locations where the early adoption of fulwaris
has happened vs others (see the section “Conclusions”).
TABLE 1: BLOCK WISE SAMPLE SIZES OF FULWARI HAMLETS AND NON-FULWARI HAMLETS
Block Udaipur Batauli Lundra Lakhanpur Ambikapur Mainpath Sitapur Total
Block-wise non-fulwari hamlets sample size
NFW hamlets 273 390 415 439 551 368 329 2765
% split of NFW ham-
lets
10 14 15 16 20 13 12 100
Sample size on NFW
hamlets
5 7 8 8 10 7 5 50
Block-wise fulwari hamlets sample size
FW hamlets 62 32 50 49 29 32 46 300
% split of FW ham-
lets
21 11 17 16 10 11 15 100
Sample size of FW
hamlets
15 8 13 8 11 13 12 80
Total sample ham-
lets
20 15 21 16 21 20 17 130
18
After the block-wise sample sizes were determined, non-fulwari hamlets were selected through a purposive
random sampling from a list of hamlets, stratified at the block level. The randomly selected sample was modified
to provide for geographical spread across the block. Fulwari hamlets where fulwaris were inaugurated after 15th
Dec 2012 were considered (except two in Lundra) and those inaugurated most recently were selected. This was
done in order to minimize contamination of data due to changes in the nutrition, practices and services status
that might have already taken place due to the fulwari operations.
In each sample habitation, data for nutritional status i.e. height, weight and age was collected for all the children
in the habitation in the age group of 0-3 years. Data for understanding the status of nutrition, physical health
care and psychosocial care practices and adoption health related services was collected from six respondents
per habitation. Of the six respondents, two were pregnant women who were selected randomly from the hab-
itation. The other four respondents constituted of mothers, one each, of children aged birth-6 months, 6
months – 1 year, 1-2 years and 2-3 years. These four respondents were selected randomly out of the age-based
stratification of mothers of all children between birth to 3 years.
Table 2: ACTUAL SAMPLE SIZE COVERED ACROSS RESPONDENT CATEGORIES
Respondent category Data collected Actual sample size surveyed – FW hamlets
Actual sample size surveyed – NFW hamlets
Actual sample size
surveyed- overall
Children under the age of
three years
Height, weight and
age data through di-
rect screening
1036 662 1698
Mother / primary care-
taker of infants less than
6 months old – mostly lac-
tating women
Demographic infor-
mation, health and
nutrition practices
and psychosocial
care practices
69 41 110
Mother / primary care-
taker of infants aged be-
tween 6 and 12 months
66 46 112
Mother / primary care-
taker of children aged be-
tween 1-2 years
80 50 130
Mother / primary care-
taker of children aged be-
tween 2-3 years
77 50 127
Pregnant women Demographic infor-
mation, health and
nutrition practices
132 79 211
19
Methods
5.1.1 Data collection methods and instruments
Data for the study was collected through a structured interview and through direct screening of children. Direct
screening was used to collect height and weight data of all the children under the age of three years in a sample
hamlet. All the questions in the structured interview were closed ended. Some of the questions permitted mul-
tiple responses, while others permitted only one possible response. The height and weight were measured using
standardized instruments. Children’s height was measured in a recumbent position, using an infantometer.
TABLE 3: SUMMARY OF INDICATORS TO BE STUDIED AND METHODS OF DATA COLLECTION
Indicators Sources of data Sample Methods
Nutritional status :
Height, Weight, Age
Direct Measurement of
Height and Weight;
Age reported by par-
ent/caregiver
All children 0-3 years in the
habitation
Direct Screening
Health and nutrition ser-
vices and practices
(dealing with diarrhea,
respiratory infection, fe-
ver, vaccination, feed-
ing)
Mother / primary care-
giver in absence of mother
Four children per habita-
tion (one each in age cate-
gories 0-6, 7-12, 13-24, 25-
36 months) selected ran-
domly out of the age-strat-
ified lists of all 0-3 years
children
Interview
Psychosocial care prac-
tices
Mother / primary care-
giver in absence of mother
Common sample for Pre-
ventive and curative
measures and Psychoso-
cial care
Interview
The interview questions could broadly be divided into 3 sections:
1. Demographic information: This included information about the respondent and her family like her age,
years of education, caste and economic status (source of livelihood, monthly income, BPL status,
household assets etc.)
2. Health and nutrition services and practices: Questions in this section explored aspects like food habits of the
mother and child, prenatal and post natal health practices, occurrence of common illnesses like diar-
rhea, fever and cold and practices for treating them.
3. Psychosocial care practices: This section explored the kind of stimulation and care the child receives for his
/ her psychosocial development. These questions are address four specific activities in the course of
the child’s daily like: bathing time, meal time, sleeping time and free time. It also examines the kind of
toys used by the caregivers, as toys are a crucial means of stimulation for the child.
20
The first section was common across respondent categories. For the second section i.e. health and nutrition
services a common interview tool was used for collecting data regarding children aged 6 months to a year and
a different questionnaire was used for infants aged 0-6 months. This was to capture more appropriately the
unique health care practices for breastfeeding children. The third section i.e. psychosocial care practices was
customized for each age category. Similar practices and aspects were explored but information sought varied in
the degree of detail and complexity. A separate interview tool was developed to collect relevant information
related to pregnant women. This broadly included antenatal care practices and services, access to and attitude
towards institutional delivery services etc. The questionnaires used are attached as Appendix 14.
The data was gathered by a two member investigating team supported by the SHRC network of District and
block coordinators, Mitanin Trainers and Mitanins. On an average a hamlet was covered in 2 days while in
exceptional circumstances it took three days.
5.1.2 Data analysis
World Health Organisation (WHO) Child Growth Standards (CGS) provides reference curves for three differ-
ent types of measurement. Weight for Age curves help identify “Underweight” children, Height for Age curves
“Stunted” children and Weight for Height curves “Wasted” children. In each case, the severity of under-nutri-
tion is measured by the z-score, a measure of the number of standard deviations a particular child is from the
median reference.
The Z scores for the entire population which included the 479 respondents, for whom detailed information
was collected, were calculated using WHO Anthro, World Health Organization’s software for analysis of nu-
tritional surveys. WHO has set standardized lower and upper standard deviation boundaries flag limits for
identifying any extreme or potentially incorrect z-score values for each indicator.
TABLE 4: WHO STANDARDIZED FLAG LIMITS FOR Z SCORES
Indicator Lower SD Upper SD
WAZ -6 +5
HAZ -6 +6
WHZ -5 +5
Values beyond these limits have been excluded when undertaking t-tests and generating scatter diagrams for
analysis.
5.1.2.1 STATISTICAL TOOLS USED
The analysis aims to a) assess the nutritional status of children, b) assess the status of health and nutrition
practices and services and c) explore the possible relationships or their absence between the nutritional status
of children and various socioeconomic variables.
1. For (a), we have used statistical measures like the average Z scores, standard deviation of the Z scores
and their frequency distribution in different ranges (Z score <-3, Z score < -2 etc.).
21
2. For (b), we have mostly used frequency distributions to understand degree of prevalence or absence
of certain practices and to understand the extent to which specific services are available and are being
used or not.
3. For (c), we have
a. Used scatter diagrams to represent the relationship between continuous variables like house-
hold income, mother’s age at marriage and WAZ. Had the scatter diagrams revealed any sig-
nificant relationships, we would have used regression analysis to characterise them but no such
relationships were observed.
b. Compared average and standard deviation of WAZ for categories like different blocks, ration
card status and poverty line status to determine whether any variations exist across these cat-
egories and whether they indicate any possible relationships between these variables and the
children’s nutritional status as represented by WAZ.
c. In addition, used the T-test for variables which had only two categories like poverty line status
and gender or in cases where there were two dominant categories like STs and OBCs in caste.
The analyses involving height, weight, age, gender and location of children have been run on the data of 1687
of the 1698 children who were directly screened for collecting this information. (11 children were excluded
from analysis as their WAZ values lie outside the WHO standardized flag limits for z scores (For flag limits,
please refer to Table 4)). Rest of the analyses use data collected from mothers of 479 children (0-6 month: 110,
Status of psychosocial care practices for children
To understand the nature of psychosocial care being received by the child, the most and least common practices
of spending time with the child were extracted for each age group.
TABLE 69: PSYCHOSOCIAL STIMULATION DURING BATHING TIME
Bathing Time
0 to 6 months 6 to 12 months 1 to 2 years 2 to 3 years
FW NFW FW NFW FW NFW FW NFW
25% 24% Sing songs while bathing the child 11% 11%
While bathing, let the child pour water on his / her own 27% 40%
Ask the names of different body parts 23% 24%
Let the child dress and comb on his / her own
26% 34%
Bathing the baby with older children in the family 29% 33%
Give the child various things to play with while bathing 29% 36%
Name things like mug, wa-ter, bucket 24% 48%
Give the child various things to play with while bathing
86% 85% Talk while mas-saging the baby 42% 28%
Talk to the child like name various body parts 37% 28%
Apply soap on her own 35% 42%
Let the child play in water
39% 43% Let the child hold the mug 34% 44%
Allow to play in water 37% 36%
Give the child time to bathe on his/ her own
42% 35% Let the child play in water 39% 60%
Give toys to play in water 41% 50%
Apply soap on her own
62% 68% Talk to the child 76% 82%
Be with the child when s/he is bath-ing
73% 82% Be with the child 90% 88%
Talk to the child while bathing him / her
Both for FW and NFW hamlets, the table above indicates a high score for activities ‘talking to the child’ for
the youngest and the oldest age group and a moderate score for the two age groups in the middle. There is also
a clear high score for ‘being present while the child is bathing’ for children between 1 to 2 and 2 to 3 years.
While there is clear evidence that mothers themselves are present while bathing the children and that there is
some talk, the quality of the talk seems to remain at a basic or functional level. For instance, more complex
conversations which are necessary for cognitive stimulation, like ‘talking about parts of the body’ or ‘naming
things around’ received a low or moderate score. Similarly, other cognitively stimulating activities, like ‘playing
with water or toys’ during bathing or ‘encouraging independent pouring of water, applying soap’ received mod-
erate scores. The table also indicates that active stimulation during bathing is made available more for the last
two older age groups.
84
TABLE 70: PSYCHOSOCIAL STIMULATION DURING MEAL TIME
Meal Times
0 to 6 months 6 to 12 months 1 to 2 years 2 to 3 years
FW NFW FW NFW FW NFW FW NFW
28% 27%
Hum while breastfeed-ing the child 41% 30%
Talk to the child while cooking 24% 34% Wean 18% 12%
Teach the child how to serve food
59% 71% Talk to the child 59% 35%
Let the child hold eata-bles 33% 36%
Ask the child about her food prefer-ences 28% 26%
Take the child's help while prepar-ing for meals
78% 71% Caress the child 55% 65%
Eat with the entire family at least once a day 56% 56%
Talk to the child like what's for lunch today 37% 56%
Ask for the child's food preferences
84% 78% Look at the child 80% 78%
Talk to the child while feeding him / her 58% 70%
Eat with the entire family at least once a day 41% 54%
Encourage the child to name and ask for various foods / food items
72% 74%
Encourage the child to eat on her own 41% 50%
Talk to the child like what's there for dinner
45% 56%
Teach the child how to break bread and eat with dal / vege-tables
60% 76%
Eat with the entire family at least once a day
85% 92%
Encourage the child to eat on his / her own
The scores for ‘meal times’ across FW and NFW hamlets show a largely similar trend as well. During meal
times interestingly, talking to the child had a high score in the first two age groups, and the score reduced to a
moderate level in the subsequent two age groups. Like at bathing time, during meal times as well more complex
conversations necessary for cognitive development like “what’s for dinner’ have a moderate score only. Simi-
larly, other activities for stimulating the child’s cognitive development like ‘taking the child’s help in the kitchen’,
received a low score. Correspondingly, in the later two age groups, independent eating had a high score. It may
imply that as the child begins to feed him/herself more independently, active conversation or engagement with
the child reduces. However, in both the higher age groups, the practice of eating together does prevail and gets
a moderate and high score.
85
TABLE 71: PSYCHOSOCIAL STIMULATION DURING SLEEP TIME
Sleep Time
0 to 6 months 6 to 12 months 1 to 2 years 2 to 3 years
FW NFW FW NFW FW NFW FW NFW
32% 39% Sing lullabies 45% 41% Sing lullabies 19% 24%
Asking the child about her day 13% 6%
Getting the child into the habit of brush-ing before sleeping
38% 34% Play for some-time 56% 63%
Play for some-time 41% 50% Sing lullabies 13% 14%
Taking the child's help in making the bed
54% 56% Talk to the child 83% 91%
Sleep next to the child 46% 40% Tell stories 23% 26% Sing lullabies
97% 85% Sleep next to the baby 46% 44%
Get the child used to being put to sleep by various family mem-bers 23% 36%
Asking the child about her day
81% 90%
Put the baby to sleep in a safe place 70% 70%
Play with the child for sometime 45% 54%
Listen to the child's stories
51% 56%
Get the child used to being put to sleep by various family members
60% 76% Play with the child
Activities around sleep time reveal that singing to the children is not a very common activity as it was low or
moderate in the first three age groups and low in the last age group. However, playing with the child was
reported as an activity adopted by many mothers and thus gets a high score in the last two age groups and
moderate in the first and second age groups. Talk and stories were at a moderate score. In the first two age
groups, the practice of sleeping next to the child is common and shows high scores.
86
TABLE 72: PSYCHOSOCIAL STIMULATION DURING FREE TIME
Free Time
0 to 6 months 6 to 12 months 1 to 2 years 2 to 3 years
FW NFW FW NFW FW NFW FW NFW
19% 29%
Use differ-ent voices and sounds while talking to the child 30% 26%
Respond to the sounds made by the child 30% 36%
Encourage the child to mimic others 21% 18%
Let the child re-peat songs after you
26% 29% Sing to the child 45% 30%
Play peek-a-boo with the child 49% 60%
Play hide and seek 26% 26%
Let the child imi-tate sounds of fa-miliar animals and talk about them
28% 41%
Encourage the child to hold your finger 39% 41%
Let the child play with and touch pets 51% 38%
Let them play with and touch pets 47% 38%
Take the child's help in small chores like get a glass of water
32% 34% Make differ-ent sounds 42% 48%
Make differ-ent sounds 66% 68%
Talk while play-ing 53% 52%
Play hide and seek
42% 49%
Play with the child with a rattle and talk to the child 67% 65%
Take the child outdoors and point out vari-ous things like flowers, but-terflies etc. 73% 82%
Take the child outdoors and point out vari-ous things to the child 54% 64%
Encourage the child to play with other children his / her age
54% 56% Tickle the child 68% 61%
Call the child by his / her name 73% 90%
Take the child to visit neigh-bours and en-courage her to talk to every-one 64% 76%
Take the child to visit neighbours and encourage her to talk to everyone
68% 56%
Do exercises for arms and legs 64% 72%
Talk to the child while playing with him / her 69% 80%
Talk while play-ing
77% 78%
Take the child outdoors and point out various things to the child
Again, similar scores were reported for FW and NFW hamlets. The above table indicates that not many mothers
of the youngest infants spend their free time with their child, whereas as the child grows older, a high percentage
of mothers reported ‘taking the child out and showing things’ or ‘encouraging the child to talk to neighbours’
in the older two age groups. Majority of them also referred to talking to the child while playing during free
time. However, several forms of simple play like ‘making sounds’ , ‘hide and seek’ etc were reported only by a
moderate number of parents.
87
TABLE 73: PSYCHOSOCIAL STIMULATION DURING TOY TIME
Toys
0 to 6 months 6 to 12 months 1 to 2 years 2 to 3 years
FW NFW FW NFW FW NFW FW NFW
23% 22% Make a doll for the baby 27% 30%
Make a doll for the child 23% 22%
Play games in-volving jump-ing 26% 32%
Give the child lock and keys to play with
35% 24% Rattle 41% 54% make a ball for the child 29% 32%
Play with lock and key 31% 46%
Make a mud house in a cor-ner of the house and give him / her old house-hold things to play with
42% 32% Make a ball for the baby 47% 48% Utensils 35% 58%
Organize uten-sils one inside the other 42% 58%
Organize uten-sils one inside the other
36% 34%
Toys that make different sounds 53% 48%
Toys that make different sounds 42% 52%
Let children play in the mud / sand with ob-jects like bot-tles, boxes, sieves etc. 44% 56%
Show picture books and talk to the child
43% 46%
Put in and take out objects from a basket 50% 52%
Play games that involve running and jumping
44% 32%
Buy toys which have to be pulled 53% 56%
Give the child empty bottles and boxes to play in the mud near the house.
63% 64%
Give plastic bottles to open and close the bottle cap
The table indicates no high score in any age group, neither for FW nor for NFW hamlets. However, a wide
range of ‘makeshift’ toys receive a moderate score across all age groups. Creative and stimulating toys are
clearly missing across all age group.
Health and nutrition services and practices for pregnant and lactating women
The section discusses the status of health and nutrition services and practices for pregnant and lactating women.
As mentioned earlier, 211 pregnant women (132 from FW and 79 from NFW hamlets) were interviewed and
mothers of infants aged 0-6 months (n=110, 69 from FW and 41 from NFW hamlets) have been considered
for the lactating women section. Ante natal care services, post natal care services, institutional delivery and
nutritional practices for lactating women have been discussed under this section. While more services and prac-
tices for pregnant women have been discussed here like number of hours they work, do they register the preg-
nancy or not etc.
88
8.1.17 Health and nutrition services:
8.1.17.1 REGISTERING THE PREGNANCY
81% of the pregnant women from FW hamlets and 87% from NFW hamlets reported have registered this
pregnancy. In FW hamlets, 52% of the women reported consulting the Mitanin confirmation of the pregnancy,
31% consulted the anganwadi worker, 10% consulted a doctor and 8% consulted a nurse while no data is
available for 9% of the respondents. In NFW hamlets, a much lesser proportion of women; 38% only consulted
the Mitanin for confirming this pregnancy, while 30% consulted the anganwadi worker and 14% consulted a
doctor. For more details refer to appendix 2.
8.1.17.2 ANTE NATAL CARE (ANC) SERVICES
43% of the pregnant women from FW hamlets and 38.6% from NFW hamlets reported not having undergone
a single ANC till now. Since 25% of lactating women from FW hamlets and 20% from NFW hamlets gave no
response it is difficult to comment on the status of lactating women’s access to and usage of ANC checkups.
For more details please refer to appendix 2.
A look at the ANC services availed by pregnant women shows that tetanus injection was the most availed
service with 75% pregnant women from FW hamlets and 82% from NFW hamlets receiving it. Next in line
was intake of iron tablets wherein 71% pregnant women from FW hamlets sand 73% from NFW hamlets
reported taking iron tablets. Of these more than 10% respondents from FW and NFW hamlets did not respond
to how many iron tablets they had taken till now and thus it is difficult to comment on this aspect. However
from available data, although nearly a third of pregnant women in FW and NFW hamlets reported being in the
third trimester of their pregnancy, only 3 and 1% FW and NFW respondents respectively reported taking the
advised dosage of more than 100 iron tablets. 17% from FW hamlets reported taking the iron syrup and 14%
from NFW reported the same. The only other service availed by more than 70% women is weight monitoring
by pregnant women from NFW hamlets. All other services were availed by approximately 50% r lesser women.
Amongst lactating women as well, intake of iron tablets and tetanus injection are the most availed services with
more than 70% women availing the service. Weight monitoring is the next most availed service with 72% FW
respondents and 63% NFW respondents availing it. All other services were availed by nearly 50% or lesser
women with abdominal examination being the least availed service. For more details refer to appendix 2.
TABLE 74: STATUS OF USAGE OF ANC SERVICES BY LACTATING MOTHERS AND PREGNANT WOMEN
ANC service availed Pregnant women Lactating mothers
FW NFW FW NFW
Pregnancy test 51% 51% 55% 46%
Weight monitoring 59% 73% 72% 63%
Measure Blood pressure 39% 43% 30% 49%
Urine test 44% 49% 42% 49%
Blood test 47% 56% 54% 63%
Abdominal examination 38% 56% 29% 37%
Iron tablets 71% 73% 70% 83%
Tetanus injection 75% 82% 81% 90%
No response 13% 5% 10% 5%
89
Most women (23% from FW and 48% from NFW hamlets), were motivated for an ANC check-up by the
Mitanin. Other key influencers, motivating more than 10% of women each for the ANC check up were the
anganwadi worker and the women’s mother-in-law and husband. In FW hamlets most (more than 20% each)
ANC checkups were conducted by the Nurse/ANM and the doctor while 14% women went to a private doctor
for their ANC check-up. In NFW hamlets 30% of the ANC checkups were conducted by a govt. Doctor while
more than 10% respondents reported that their ANC check-up was conducted by a nurse/ANM and a private
doctor.
40.9% of the pregnant women from FW hamlets and 35.4% from NFW hamlets reported that they had received
advice on possible complications that could arise during the pregnancy while data was not available for nearly
9% of the respondents.
8.1.17.3 INSTITUTIONAL DELIVERY
Only 4% lactating women from FW and 7% from NFW hamlets reported that their last delivery was a caesar-
ean. 57% of the lactating mothers from FW hamlets and 63% from NFW hamlets reported that their last
delivery was an institutional delivery i.e. they delivered in a government. or a private hospital. A very small
proportion (1% form FW hamlets and 5% from NFW hamlets) reported having assisted home based deliveries
i.e. they delivered at home with the assistance of a doctor or an ANM. As many as 42% respondents from FW
hamlets and 32% from NFW hamlets reported having home-based-unassisted deliveries.
56% of the pregnant women from FW hamlets said they were planning institutional deliveries while two thirds
said the same from NFW hamlets. 38.6% from FW hamlets and 26.5% from NFW hamlets were yet to decide
and 3.5% from FW and 5% from NFW hamlets were not planning institutional deliveries. In FW hamlets the
biggest reason (5% respondents) for not choosing institutional delivery was that the distance to the medical
facility was prohibitive. Another 3% cited cultural issues and ‘other’ reasons while 2% said it was too expensive.
These numbers for NFW hamlets were even smaller.
Table 75: TYPE OF DELIVERY - LACTATING WOMEN / MOTHERS OF 0-6 MONTHS OLDS
Type of delivery FW (n) FW (%) NFW (n) NFW (%) All (n) All (%)
Institutional (in hospital) 39 57% 26 63% 65 59%
Assisted home based delivery (when delivery at home assisted by doctor or ANM
1 1% 2 5% 3 3%
Home based delivery without medical assis-tance
29 42% 13 32% 42 38%
Total 69 100% 41 100% 110 100%
90
TABLE 76: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON TYPE OF DELIVERY AND WAZ VALUES
Type of delivery FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Institutional de-livery
46% 26% 46% 27% 46% 26%
Assisted home based deliveries
100% 0% 0% 0% 33% 0%
Unassisted home based deliveries
48% 17% 46% 31% 48% 21%
TABLE 77: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON TYPE OF DELIVERY AND WHZ VALUES
Type of delivery FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Institutional de-livery
11% 6% 25% 8% 17% 7%
Assisted home based deliveries
0% 0% 0% 0% 0% 0%
Unassisted home based deliveries
31% 3% 25% 8% 29% 5%
TABLE 78: PERCENTAGE DISTRIBUTION OF CHILDREN BASED ON TYPE OF DELIVERY AND HAZ VALUES
Type of delivery FW NFW ALL
Mod. & Sev.
(<-2SD) Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Mod. & Sev. (<-2SD)
Severe (<-3SD)
Institutional de-livery
47% 18% 52% 20% 49% 19%
Assisted home based deliveries
0% 0% 0% 50% 0% 33%
Unassisted home based deliveries
34% 17% 31% 23% 33% 19%
8.1.17.4 POST PARTUM CARE (PPC) SERVICES
Just over 20% of the lactating women from both FW and NFW hamlets reported having undergone a PPC
check-up within a month of their last delivery. In FW hamlets, 9% reported undergoing one PPC check up and
13% reported undergoing more than one PPC check-up. For NFW hamlets, 15% underwent one PPC check-
up and 10% underwent more than one PPC check-up. PPC checkups were conducted by a doctor for approx.
20% of the women in FW and NFW hamlets. 17% women from FW hamlets and 15% from NFW hamlets
underwent the PPC check-up at the government hospital. 45% lactating women from FW hamlets and 20%
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from FW hamlets reported that they faced health problems after their last delivery. For details please refer to
appendix 2.
8.1.17.5 SUPPLEMENTARY NUTRITION
More than 80% of the pregnant women from FW and NFW hamlets reported being registered at the anganwadi
and approx. 68% from both FW and NFW reported visiting the anganwadi in the week prior to the survey.
Out of the 68% women (91 from FW and 54 from NFW) who visited the anganwadi in the previous week,
72.5% (66) from FW hamlets and 83.33% (45) reported receiving the ready-to-eat take-home-ration. Thus only
50% of the total FW respondents and 57% of the total NFW respondents received the ready-to-eat take-home-
ration.
8.1.17.6 ACCESS TO NATIONAL HEALTH INSURANCE PROGRAM
61.36% of the pregnant women from FW hamlets and 60.76% from NFW hamlets reported that they were
covered under the National Health Insurance Program.
8.1.18 Practices: Health and nutrition
8.1.18.1 NUTRITION
The findings of this section are based on responses regarding the food intake of lactating mothers and pregnant
women on the day prior to the survey date.
As was the case for children aged 6 – 36 months, for pregnant women also, rice is the most dominant compo-
nent of their daily diet followed by pulses, green vegetables and potatoes. The consumption of pulses, green
vegetables and pulses was low with these not being available to almost 30-50% of the respondents. Also as seen
in case of 6-36 months category of children, dal was consumed by markedly more women in FW hamlets (72%)
than in NFW hamlets (56%) and the same is true for consumption of eggs wherein 17% of pregnant women
in FW hamlets consumed egg, only 4% reported the same from NFW hamlets. In both groups, more than 90%
of the women reported no intake of meat, fish, milk/curd and fruits.
TABLE 79: FOOD COMPOSITION - PREGNANT WOMEN
Food Once Twice More than Twice Not at all
FW NFW FW NFW FW NFW FW NFW
Rice 6% 1% 37% 53% 55% 43% 2% 3%
Dal 25% 25% 27% 19% 20% 11% 28% 44%
Green Vegetable 27% 14% 25% 37% 18% 11% 30% 38%
Potatoes 20% 29% 20% 22% 10% 6% 50% 43%
Other Vegetables 14% 16% 4% 6% 1% 1% 81% 76%
Egg 14% 3% 2% 1% 0% 0% 83% 96%
Meat 3% 5% 0% 0% 0% 0% 97% 95%
Fish 4% 6% 0% 0% 1% 0% 95% 94%
Milk / Curd 4% 3% 2% 0% 0% 0% 95% 97%
Fruits 8% 4% 3% 3% 0% 0% 89% 94%
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A similar trend is revealed by data on food consumption by lactating women. Rice was reported to be consumed
by 84% women from FW hamlets and 66% from NFW hamlets. Pulses, green vegetable and potatoes were not
available to 40 to 70% lactating women in both FW and NFW hamlets with the numbers being worse for NFW
hamlets for all three. Approx. 80% women did not have any other vegetables and 93% did not have eggs as a
part of their meals. While in FW hamlets, more than 90% women did not consume meat, fish, milk/curd and
fruits, the same number for NFW hamlets was 100%.
TABLE 80: FOOD COMPOSITION - LACTATING MOTHERS
Food Once Twice More than twice Not at all
FW NFW FW NFW FW NFW FW NFW
Rice 7% 7% 32% 27% 45% 32% 16% 34%
Dal 26% 22% 17% 15% 14% 2% 42% 61%
Green Vegetable 22% 15% 20% 17% 10% 2% 48% 66%
Potatoes 25% 22% 13% 10% 4% 2% 58% 66%
Other Vegetables 12% 7% 7% 10% 0% 2% 81% 80%
Egg 6% 7% 1% 0% 0% 0% 93% 93%
Meat 6% 0% 1% 0% 0% 0% 93% 100%
Fish 9% 0% 0% 0% 0% 0% 91% 100%
Milk / Curd 0% 0% 3% 0% 0% 0% 97% 100%
Fruits 0% 0% 1% 0% 0% 0% 99% 100%
8.1.18.2 PRESENCE OF KITCHEN GARDENS
79% of the pregnant women from FW hamlets and 77% from NFW hamlets reported having a kitchen garden
in at least one of the seasons (winter, monsoon and summer).
8.1.18.3 WORKLOAD OF PREGNANT WOMEN, DURATION OF RESTING
These findings are based on the number of working and resting hours on the day prior to the survey, as reported
by the respondents. The working hours include household chores; work done outside and inside the house,
farming and other livelihood activities.
In FW hamlets, 18% of the women reported working more than 8 hours, which is the recommended outer
limit for pregnant women. Most women (42%) worked for 2-4 hours and another 27% reported working for
5-7 hours. In NFW hamlets a similar trend was observed with 17% women reporting working for more than 8
hours while 48 and 29% reported working for 2-4 hours and 5-7 hours respectively. Also 22% pregnant women
from FW hamlets and 19% from NFW hamlets reported that they were involved in outdoors work as well. As
many as 30% FW respondents and 27% NFW respondents reported that their work regularly involved lifting
of heavy weights. For more details refer to appendix 2.
Nearly three quarters of women both from FW and NFW hamlets got, as recommended, 8 or more hours or
rest at night. While 9 and 6% from FW and NFW hamlets respectively got less than 6 hours of rest at night.
Except for those for whom no data is available, all women reported getting at least an hour’s rest during the
day.
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9 CONCLUSIONS
Summary of Key Findings
Demographic parameters
FW - Relationship between WAZ scores and demographic factors
NFW - Relationship between WAZ scores and demographic factors
Reference
Overall Average WAZ score is -1.86. Z score <-2sd for 45% children.
Average WAZ score is -1.82. Z score <-2sd for 43% children.
Table 6: Percentage distribution of chil-dren based on z scores
Age Over 40% malnourished in each age group.
Over 40% malnourished in each age group except for a much lower propor-tion in the 7-12 month category.
Tables 8 & 9: Per-centage distribution of children based on age groups and WAZ values-FW & NFW habitations
Gender Overall small and significant differences Overall no significant differences
Table 15: Age cate-gory-wise gender based t-test outputs for FW and NFW hab-itations
Caste
ST is the most dominant caste group (68.5%) followed by OBCs (24%)
ST is the most dominant caste group (60.4%) followed by OBCs (30%)
Table 19: :Distribu-tion of respondents based on caste cate-gory
Moderate and significant difference be-tween STs and OBCs. STs WAZ scores are weaker.
Small differences between STs and OBCs. Differences not significant.
HHI 24% reported monthly HHI of less than Rs. 1,000
12.3% reported monthly HHI of less than Rs. 1,000
Table 23: Distribution of respondents based on monthly HHI bracket
Our data shows no direct relationship with HHI
Our data shows no direct relationship with HHI
Figure 29 & 30 Distri-bution of WAZ based on household income - FW and NFW
WAZ is below -2SD for 49% of those with HHI < Rs. 1,000
WAZ is below -2SD for 39% of those with HHI < Rs. 1,000
Table 24: Percentage distribution of chil-dren based on household income and WAZ values
WAZ is below -2SD for 17% of those with HHI > Rs. 5,000
WAZ is below -2SD for 38% of those with HHI > Rs. 5,000
Livelihood Farming (83%) and daily wage work (67%) are dominant sources of livelihood
Farming (83%) and daily wage work (55%) are dominant sources of liveli-hood
Table 27: Distribution of respondents based on primary source of livelihood
Small and statistically not significant dif-ference between farming and daily wage occupations.
Small and statistically not significant difference between farming and daily wage occupations.
Moderate and statistically significant dif-ference between NREGA and Non NREGA holders.
Small differences between NREGA and Non NREGA holders.. Differences not significant.
NREGA benefit WAZ is below -2SD for 65% of non-NREGA card holders
WAZ is below -2SD for 42% of non-NREGA card holders
Table 32: Percentage distribution of chil-dren based on NREGA card status and WAZ values
94
Small, not significant differences be-tween BPL card holders and non card holders.
Moderate and statistically significant differences between BPL card holder and non card holders. Card holders are weaker.
BPL card sta-tus
Amongst those without BPL cards, WAZ score for 50% children is below -2 SD and for 21%, WAZ is less than -3 SD
Amongst those without BPL cards, WAZ score for 36% children is below -2 SD and for 11%, WAZ is less than -3 SD
Table 36: Percentage distribution of chil-dren based on BPL card status and WAZ values
Medium and statistically significant dif-ference between APL and BPL as well as APL and non-ration card holders.
Medium and not significant differences between various ration card status cat-egories.
Ration card status
57% of those without ration cards and 30% of APL card holders fall in the mod-erate malnourishment category
37% of those without ration cards and 47% of APL card holders fall in the mod-erate malnourishment category
Table 40: Percentage distribution of chil-dren based on ration card status and WAZ values
Geographical location (blocks)
Lakhanpur has the highest average WAZ and Mainpath has the lowest with the difference being medium.
Batauli has the highest average WAZ and Mainpath has the lowest with the difference being large.
Figure 35: Block wise average WAZ
Mother’s qualification
Our data shows no direct relationship with HHI
Our data shows no direct relationship with HHI
Figure 36 & 37 Distri-bution of WAZ based on mother’s educa-tion status - FW and NFW
In case of 50% respondents with no edu-cation, children's WAZ is below -2 SD
In case of 44% respondents with no ed-ucation, children's WAZ is below -2 SD
Table 48: Percentage distribution of chil-dren based on mother’s educational status and WAZ val-ues
In case of 33% respondents with more than 12 years of education,, children's WAZ is below -2 SD
In case of 40% respondents with more than 12 years of education,, children's WAZ is below -2 SD
Mother’s age of marriage
Our data shows no direct relationship with mother's marriage age
Our data shows no direct relationship with mother's marriage age
Figure 38 & 39: Distri-bution of WAZ based on mother’s marriage age - FW & NFW
Maternal work hours
Our data shows no direct relationship with maternal working hours
Our data shows no direct relationship with maternal working hours
Figure 40 & 41: Distri-bution of WAZ based on mother’s marriage age - FW & NFW
Health Ser-vices
Supplemen-tary Nutrition
71% went to the anganwadi to collect ready to eat, 88% of them received it
67% went to the anganwadi to collect ready to eat, 90.8% of them received it
Vaccination and Supple-ments
BCG, polio and DPT : over 90%; measles over 80 %.
BCG and polio : over 90%; DPT just un-der 90%, measles over 80 %.
Table 59: Status of vaccination of chil-dren in the age group 6-36 months in FW and NFW hamlets
Possibility of fever termed as the key rea-son for not availing immunization
Possibility of fever termed as the key reason for not availing immunization
NHIP 65.5% have access 58.15% have access
Health-Nutri-tional Prac-tices
95
Incidence and treatment of illnesses
Cold and cough was most prevalent. Cold and cough was most prevalent. Figure 42 & 43: Inci-dence of illnesses over last 15 days - children aged 0-6 months & 7-36 months
Treatment for 0 to 6 months, Treatment for 0 to 6 months,
diarrhea: 29% increased mother’s milk and 41 % stopped other fluids.
diarrhea: None increased mother’s milk and 33 % stopped other fluids.
Cold-cough: 10% increased mother’s milk and 52% stopped other fluids
Cold-cough: 15% increased mother’s milk and 45% stopped other fluids
Figure 54 & 55: Fluid & milk intake during cold and cough- 0-6 months
Treatment for 6 to 36 months, Treatment for 6 to 36 months,
diarrhea: 10 % increased fluids, 15% in-creased milk intake, 39% reduced food intake. Tendency to reduce milk and flu-ids along with food.
diarrhea: 19 % increased fluids, 7% in-creased milk intake, 48% reduced food intake. Tendency to reduce milk and fluids along with food.
Figure 46, 47 & 48: Fluid, milk & food in-take during diarrhea - 6 months to 3 years
Fever: 24% gave normal fluids, 30% gave normal levels of milk, 11% gave normal levels of food. Tendency to reduce in-take.
Fever: 33% gave normal fluids, 43% gave normal levels of milk, 28% gave normal levels of food. Tendency to re-duce intake.
Figure 51, 52 & 53: Fluid, milk & food in-take during fever- 6 months to 3 years
Cold and Cough: 33% gave normal levels of fluids, 35% gave normal levels of milk, 25% gave normal levels of food. Ten-dency to reduce intake.
Cold and Cough: 39% gave normal lev-els of fluids, 52% gave normal levels of milk, 38% gave normal levels of food. Tendency to reduce intake.
Figure 56, 57 & 58: Fluid, milk & food in-take during cold and cough - 6 months to 3 years
Weight moni-toring
Of the 56% mothers who reported on monitoring their child’s weight, 76% were informed that their children’s weight was normal.
Of the 38% mothers who reported on monitoring their child’s weight,83% were informed that their children’s weight was normal.
Table 63 : Status of children’s weight monitoring
Breast feeding and weaning practices
99% mothers reported breast feeding their child, and 61% breastfed within the first hour.
98% mothers reported breast feeding their child, and 71% breastfed within the first hour.
Figure 59: Time of first breast feeding of a newborn & figure 62: infants aged 0-6 months being breast-fed by mother
86% are given colostrum. 85% are given colostrum. Figure 60: Status of colostrum being given to newborns
Complementary nutrition started at the age of 6 months or later by 65% mothers.
Complementary nutrition started at the age of 6 months or later by 68% mothers.
Figure 61: Time of starting complemen-tary nutrition
Food composi-tion and fre-quency of in-take
32% children between 6 months to 3 years had 3 meals and 27% had four meals a day. 13% less than the recom-mended 3 meals. 53% don’t add oil.
27% children between 6 months to 3 years had 3 meals and 23% had four meals a day. 19% less than the recom-mended 3 meals. 70% don’t add oil.
Figure 64: Frequency of eating - children aged 6 months - 3 years & figure 65: fre-quency of adding oil to food - children aged 6 months - 3 years
Rice is taken more than twice a day by 78% children.
Rice is taken more than twice a day by 66% children.
96
24% don't get any pulses. Nearly 40% children did not get any green vegetables and potato, and more than 70 % children don’t get eggs and other vegetables, and more than 90% children did not consume meat, fish, milk/curd and fruits.
30% to 60% children did not get any pulses, green vegetables, and potato, and more than 70 % children don’t get other vegetables, and more than 90% children did not consume egg, meat, fish, milk/ curd and fruits.
Table 64: Food com-position - children 6 months - 3 years
Kitchen gar-dens
97% reported having a kitchen garden in at least one season.
97% reported having a kitchen garden in at least one season.
Table 65: Prevalence of kitchen gardens
Psychosocial Care and stim-ulation
Bathing prac-tices
Mothers are available during bathing, and talk to the child. Talking happens more at a functional level. More stimu-lating activities like play, complex talk are much less visible.
Mothers are available during bathing, and talk to the child. Talking happens more at a functional level. More stimu-lating activities like play, complex talk are much less visible.
Table 69: Psychoso-cial stimulation dur-ing bathing time
Only one activity of ‘talking to the child’ was practiced by a large majority of peo-ple in three different age groups.
Only one activity of ‘talking to the child’ was practiced by a large majority of people in three different age groups.
Other activities of stimulation while pre-sent, were followed only by a moderate number.
Other activities of stimulation while present, were followed only by a mod-erate number.
Mealtime practices
Talking to the child is more prevalent in the younger age group.
Talking to the child is more prevalent in the younger age group.
Table 70: Psychoso-cial stimulation dur-ing meal time
In the later two age groups, eating to-gether takes place, but conversation seems to reduce.
In the later two age groups, eating to-gether takes place, but conversation seems to reduce.
Most activities enhancing psychosocial stimulation were followed by a moderate number of respondents.
Most activities enhancing psychosocial stimulation were followed by a moder-ate number of respondents.
Sleeping prac-tices
For the first two age groups, singing, play and talk are adopted by moderate num-ber of participants.
For the first two age groups, singing, play and talk are adopted by moderate number of participants.
Table 71: Psychoso-cial stimulation dur-ing sleep time
Play is an important stimulation activity reported by a high number of respond-ents of the later two age groups.
Play is an important stimulation activity reported by a high number of respond-ents of the later two age groups.
Other stimulation activities fall in a low or moderately adopted category.
Other stimulation activities fall in a low or moderately adopted category.
Free time practices
For the first two age groups, several kinds of activities were reported by moderate or low number of respondents.
For the first two age groups, several kinds of activities were reported by moderate or low number of respond-ents.
Table 72: Psychoso-cial stimulation dur-ing free time
In the second age group, a high percent-age of mothers reported playing.
In the second age group, a high per-centage of mothers reported playing.
Playing and taking the child outdoors, talking to neighbors was also an activity reported by high percentage in the older two age groups. Playing was reported by a moderate percentage of mothers.
Playing and taking the child outdoors, talking to neighbors was also an activity reported by high percentage in the older two age groups. Playing was re-ported by a moderate percentage of mothers.
97
Use of toys A wide range of makeshift toys and games is visible, however only by a mod-erate percentage of mothers across all age groups.
A wide range of makeshift toys and games is visible, however only by a moderate percentage of mothers across all age groups.
Table 73: Psychoso-cial stimulation dur-ing toy time
Health-Nutri-tion Services for Pregnant & Lactating Women
Access and usage
Pregnancy registration
81% registered their pregnancy. 87% registered their pregnancy.
ANC care Amongst pregnant women, tetanus in-jection and iron tablets were most com-monly availed by more than 70% women. Most other services were availed by about 50% or less.
Amongst pregnant women, tetanus in-jection and iron tablets were most commonly availed by more than 70% women. Most other services were availed by about 50% or less.
Table 74: Status of usage of ANC ser-vices by lactating mothers and preg-nant women
Amongst lactating women, more than 70% women availed of iron tables. Most other services were availed by much fewer women, mostly below 50%.
Amongst lactating women, more than 70% women availed of iron tables amd tetanus injections. Most other services were availed by much fewer women, mostly below 50%. Abdominal exami-nation was the least availed service.
Institutional Delivery
57% women had institutional deliveries, and 42% reported having unassisted de-liveries at home. Those with medically assisted home-based deliveries were marginal.
63% women had institutional deliver-ies, and 32% reported having unas-sisted deliveries at home. Those with medically assisted home-based deliver-ies were marginal.
Table 75: Type of de-livery - lactating women / mother of 0-6 months olds
56% pregnant women were planning in-stitutional deliveries
38.6% pregnant women were planning institutional deliveries
PPC Only 23% women had availed of PPC ser-vices while 45% reported facing health problems post delivery
Only 25% women had availed of PPC services
Appendix 2: Health and nutrition services and practices for pregnant and lactat-ing women
Supplemen-tary nutrition
Only 50% of the total respondents re-ceived ready-to-eat take-home-ration.
Only 57% of the total respondents re-ceived ready-to-eat take-home-ration.
NHIP 61.36% of the women were covered un-der the NHIP
60.76% of the women were covered under the NHIP
Health-Nutri-tion Practices for Pregnant and Lactating Women
Status of adoption/implementation of practices
Nutrition Rice-intake was most common both, amongst pregnant and lactating women
Rice-intake was most common both, amongst pregnant and lactating women