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25,2 23,6
33,5
76,6
17,721,5
2,6
38,2
18,3
34,4
70,8
30,3
18,9
2,6
Children stunted (%)1,2,^
Children wasted (%)1,2,^
Children underweight (%)1,2,^
Children with any anemia (%)1,^^
Chronic energy deficiency in women (%)1
Children with birthweight
<2500gms (%)2,3
Adults who are obese in the district (%)1
Puri Odisha^Children aged <5years; ^^Children aged 0-‐59 months
Source: Data source provided on Page 4
50,9% 49,1%
15,6% 84,4%
19,1% 0,4% 80,5%
Puri, OdishaDISTRICT NUTRITION PROFILE
Page 1
THE STATE OF NUTRITION IN PURI
DISTRICT DEMOGRAPHIC PROFILETotal Population16,98,730
MALE FEMALE
RURALURBAN
SC ST OTHERS
CHANGES OVER TIMEOdisha
(Children aged <5 years)Puri
(Children aged < 5 years)
2005-‐06 (NFHS-‐3)
2013-‐14 (RSOC)
2002-‐04 (DLHS-‐2)
2014(CAB)
Stunting 42.4% 38.2% No data 25.2%
Wasting 20% 18.3% No data 2.6%
Underweight 39.5% 34.4% 24.5% 33.5%
CHILDREN STUNTED1
CHILDREN WASTED1
CHILDREN UNDERWEIGHT1
25.2%
23.6%
33.5%
THE PREVALENCE OF UNDERWEIGHT HAS INCREASED IN THE DISTRICT BETWEEN 2002 AND 2014
Puri ranks 301thamongst 599 districts in India(District Development Index)13
Insert map here
85,4
37,2
46,8
81,7
13,1
89,183,4
78,7
30,7
55,5
25,8
68,8 68,6
14,0
87,2
58,3
Early initiation of breastfeeding (%)
Exclusive breastfeeding (%)
Children (6-‐8 mo) who received any solid/semi solid food in the last 24
hours (%)
Children who achieve minimum diet diversity (%)
Full immunization coverage (%)
Children (6-‐35mo) who got vitamin A supplementation
(%)
Children suffering from diarrhoea (%)
Children <5 years with diarrhoea treated with ORS
(%)
Women aware of danger signs of pneumonia (%)
Page 2
Child undernutrition is caused by inadequacies in food, health and care for infants and young children, especially inthe first two years of life (immediate causes). Inadequate food, health and care arise from food insecurity, unsanitaryliving conditions, low status ofwomen, and poor health care (underlying causes). These are, in turn, caused by socialinequity, economic challenges, poor political will and leadership to address these causes (basic causes). Interventionsto address undernutrition must address thesemultiple causes of undernutritionand do so in an equitablemanner.
IMMEDIATE CAUSES OF UNDERNUTRITION
Areas for action:
Data challenges:
IMMEDIATE CAUSESBreastfeeding, nutrient rich foods, and eating routineFeeding and caregiving practices, parenting stimulation
Low burden of infectious diseases
Optimum fetal and child nutrition and development
WHAT FACTORS CAUSE UNDERNUTRITION? 4
UNDERLYING CAUSESFood security: availability, economic access and use of foodFeeding and caregiving resources (maternal, household and
community level)Access to and use of health services, a safe and hygienic environment
BASIC CAUSESKnowledge and evidencePolitics and governance
Leadership, capacity and financial resourcesSocial, economic, political, and environmental context
(national and global)
The most crucial period for child nutrition is from pre-‐pregnancy to the second year of life2
HOW CAN NUTRITION IMPROVE?
ADOLESCENT & MATERNAL HEALTH1,3,5
DISEASE BURDEN3IMMUNIZATION & SUPPLEMENTATION3
INFANT AND YOUNG CHILD FEEDING2,3
0102030405060708090
100
Age of child (in months)
Percentage of child stunting (%)
Window of opportunity
Too late
No Data
No Data
98,3 100,0
84,5
98,0 97,6
78,4
Women with access to at least 1 antenatal care coverage (%)
Any anemia among pregnant women (%)
Any anemia among adolescent girls (%)
Puri Odisha
• Very poor rates of exclusive breastfeeding, which need urgent attention
• No district level data available on children’s diets• Alarming levels of anaemia among pregnant women and
adolescent girls
• Out-‐dated data; poor availability of data on key immediate determinants of under nutrition from national surveys
• Where data are available, indicator definitions are non-‐standardized and often differ from World Health Organisation recommendations
1,2
83,2
21,0
76,2
4,412,1 11,9
73,6
18,3
76,6
7,5
Girls married when <18years old (%)
Ever married women/mothers who completed
primary school (%)
Women who completed
secondary school (%)
Women's ownership of land
(%)
Access to improved drinking water sources (%)
Access to improved sanitation facilities
(%)
Open defecation (%)
Child stool disposal in a sanitary manner (%)
Households who washed hands with soap before a meal
(%)̂
76,1 69,497,7
23,3
86,0 84,8
46,863,7
50,870,6
52,4
94,6
66,945,0
Adult literacy rate (%)7 Births attended by skilled health personnel
(%)6
Household has access to Anganwadi worker
(%)6
Household has access to a Sub-‐Health Centre
(%)6
Household has access to primary/middle
school (%)6
Households who demanded and received work through NREGA
(%)10
Households availing banking services (%)7
Puri Odisha
49,1
37,044,0
24,9
49,0 48,754,6
48,5
37,845,8
32,9
50,542,4 43,0
Household share of expenditure on food
(%)
Household share of food expenditure on
cereals (%)
Households in the district involved in agriculture (%)
Below Poverty Line households (%)
Households ownership of agricultural land (%)
Households living in a permanent house (%)
Access to electricity (%)
Puri Odisha
SOCIO ECONOMIC CONDITIONS7,10,11
Page 3
UNDERLYING CAUSES OF UNDERNUTRITION
BASIC CAUSES OF UNDERNUTRITION
No Data
No Data
No Data
No Data
No Data
WOMEN’S STATUS3,6 WATER, SANITATION AND HYGIENE7,8,9
FOOD SECURITY10
No Data
^Data based on rural population only
Areas for immediate action: • Very high rates of open defecation; critical need to increase awareness about washing hands with soap and
ensuring access to using improved sanitation facilities• Food insecurity, especially diet quality, is a challenge that can holdback improvements in nutrition• Very few households live in a permanent house and have access to electricity
Data challenges:• Difficult to compare indicators of water, sanitation and hygiene over time as census data do not provide data
on child stool disposal or on hand washing
• Per capita gross district domestic product of Puri ranked 21th amongst 30 districts of Odisha 12
• Access to skilled health personnel during child delivery is very limited and few households avail banking services• Action needs to be taken to improve adult literacy which is low• No data available on indicators of governance and political will to address nutrition
No Data
Data sources 1. Census of India. 2014. Clinical, Anthropometric & Bio-‐chemical (CAB) survey. http://www.censusindia.gov.in/2011census/hh-‐series/HH-‐
2/Odisha%20CAB%20Sample%20Characteristics%202014.pdf2. UNICEF. 2013-‐2014. Rapid Survey on Children (RSoC). http://wcd.nic.in/RSOC/21.RSOC_Odisha.pdf3. Census of India. 2012-‐2013. Annual Health Survey. http://www.censusindia.gov.in/vital_statistics/AHSBulletins/AHS_Bulletin_2012_13/Odisha/Odisha.pdf4. Robert E Black, Cesar G Victora, Susan P Walker, Zulfiqar A Bhutta, Parul Christian, Mercedes de Onis, Majid Ezzati, Sally Grantham-‐McGregor, Joanne Katz, Reynaldo
Martorell, Ricardo Uauy, and the Maternal and Child Nutrition Study Group. 2013. “Maternal and Child Undernutrition and Overweight in Low-‐Income and Middle-‐Income Countries”. The Lancet 382 (9890), 427-‐451
5. District Level Household Survey on Reproductive and Child Health (DLHS-‐2), 2002-‐04, India. International Institute for Population Studies. (IIPS). 2006. District Level Household Survey on Reproductive and Child Health (DLHS-‐2), 2002-‐04, India: Nutritional Status of Children and Prevalence of Anemia among Children, Adolescent Girls and Pregnant Women. Mumbai: IIPS. October 28, 2015, www.rchiips.org/pdf/rch2/National_Nutrition_Report_RCH-‐II.pdf
6. International Institute for Population Studies (IIPS). 2010. District Level Household Survey and Facility Survey (DLHS-‐3), 2007-‐08, India, Odisha. Mumbai: IIPS. Accessed October 28, 2015, www.rchiips.org/pdf/rch3/report/UP.pdf
7. Census of India. 2011. Houselisting and Housing Census Data. Accessed October 28, 2015, www.censusindia.gov.in/2011census/hlo/HLO_Tables.html8. National Family Health Survey (NFHS-‐3), 2005-‐06, India. Mumbai: International Institute for Population Studies. 9. HUNGaMA: Fighting Hunger & Malnutrition : the HUNGaMA Survey Report. 2011. Naandi Foundation. 10. Author’s estimates based on Household Consumption Expenditure, National Sample Survey Office (NSSO) 68th Round, 2011-‐12. Ministry of Statistics and Program
Implementation. Government of India.11. Planning Commission. 2013. Press note on poverty estimates, 2011-‐12. Government of India. Accessed October 28, 2015.
http://planningcommission.nic.in/news/pre_pov2307.pdf12. Government of Odisha. Economic Survey (2014-‐15). Accessed October 28, 2015, http://www.odisha.gov.in/pc/Download/Economic_Survey_2014-‐15.pdf13. Us-‐India Policy Institute. 2015. District Development and Diversity Index. Accessed October 28, 2015, http://www.usindiapolicy.org/updates/general-‐news/225-‐district-‐
development-‐and-‐diversity-‐index-‐report
This District Nutrition Profile was developed by XXXXXX for POSHAN. This version, dated XX-‐XX-‐XXXX is a draft intended for use in a district-‐level workshop in Puri, and will be revised following workshop discussions.
WHAT WILL IT TAKE TO IMPROVE NUTRITION IN PURI?
Possible district-‐level actions to support nutrition:
Source: POSH
AN/IFPR
I-‐NDO