Deciphering the nutrition scenario: the HUNGaMA Initiative

28 February 2012New Delhi

Context

• The last time data was collected on child nutrition was 2005-06 (NFHS 3)

• There is no recent district-level data available on child nutrition (the last one was DLHS 2002-04)

• DLHS 2002-04 did not report data on stunting• The currently available data does not capture the

mothers’ voice

Decision to create a HUNGaMA .....

Impetus: Current measures of hunger and malnutrition in India are too outdated and inaccessible to sound the alarm, drive productive policy change, or support communities facing daunting malnutrition challenges

Objective: Implement a rapid nutrition status survey capturing key data for children across worst-hit areas, with the goal of raising awareness and expanding the advocacy toolkit for citizens, implementers, and policymakers

Intention: Positive change through more urgent, targeted, and informed policies and resource allocation at all levels

HUNGaMA = a “stir” (Hindi) = HUNGer and MAlnutrition

Survey principles

• Realtime – provide up-to-date and rapid turnaround information on child nutrition status across worst-hit areas

• Simple – capture key nutrition indicators with simple procedures

• Investigative – ask focused questioned to mothers on their feeding & caring practices and the realities they face

• Granular – provide district-level estimates, giving a richly textured picture of nutrition levels across India

Survey geography

100 “worst” rural districts using a provisional index developed by Unicef

• Uttar Pradesh – 40• Bihar – 22• Jharkhand – 13• Madhya Pradesh – 11• Rajasthan – 9• Orissa – 5

12 “best” rural districts using UNICEF Index, taking two from each of Kerala, Tamil Nadu, and Himachal Pradesh, and one from each of the six “worst” states above

Survey data

• Nutrition – Weight, height, age, mid-upper arm circumference (MUAC), oedema

• General Household – Parents’ education, caste, religion, type of home, ownership of assets, access to services

• Mother’s Voice – Infant and child feeding and caring practices

• Status of ICDS Centre – Information on Anganwadi worker, equipment, food, attendance, growth monitoring

• Village indicators – Facilities and services available

HUNGaMA Survey Coverage…States Districts Children Mothers HHs AWCs AWWS

Bihar 23 (38) 24,072 15,373 24072 642 461

Jharkhand 14 (24) 13,310 9,124 13301 396 280

MP 12 (50) 11,186 6,954 11186 338 268

Orissa 6 (30) 5,427 4,220 5427 174 138

Rajasthan 10 (33) 11,319 7,683 11319 284 232

UP 41 (71) 38,227 26,022 38227 1138 664

HP 2 (12) 1,507 1,228 1507 60 58

Kerala 2 (14) 1,922 1,780 1922 60 51

Tamil Nadu 2 (29) 2,123 1,636 2123 57 55

112 109,093 74,020 109,084 3,149 2,207

Note: Parenthesis indicates total number of districts in the state

The Citizens’ Alliance against Malnutrition

Principal donors

Avantha Foundation

Mahindra & Mahindra Ltd.

Soma Enterprise

Ltd.

13 August 2011

Key findings

Nutritional Status in 100 Focus Districts

as per HUNGaMA Survey(parenthesis indicates national figures-NFHS-3)

Nutritional Measure% Severe (<-3 SD)

% Moderate(<-2SD to <-3 SD)

% of Malnutrition Children (< -2SD)

Wasting (Weight-for-Height)

3.3(6.4)

8.0(13.4)

11.3(19.8)

Underweight (Weight-for-Age)

16.4(15.8)

25.9(26.7)

42.3(42.5)

Stunting (Height-for-Age)

34(23.7)

24.8(24.3)

58.8(48)

-4 -3 -2 -1 0

Moderate malnutrition

Severe malnutrition

In 100 Focus Districts • Prevalence (%) of child underweight has decreased from 53 to

42% (AARR 2.9%)

• Prevalence of child stunting is 59%

• Low birth weight is an important risk factor for malnutrition

• Socio-economic status of household has significant effect on children’s nutrition status

• Girls’ nutrition advantage over boys fades over time

• 92 % mothers have never heard the word malnutrition

• 51 % mothers did not give colostrum to the newborn

• Less than half the mothers do exclusive breastfeeding

• 11% mothers use soap to wash hands before a meal

Key Takeaways

• Prevalence (%) of child underweight has decreased from 53 to 42% (AARR 2.9%)

• 92 % mothers have never heard the word malnutrition

• 95% Anganwadi Workers know the word malnutrition

• 51 % mothers did not give colostrum to the newborn

• Less than half the mothers do exclusive breastfeeding

The HUNGaMA so far…….

• Continuous support from the Citizens’ Alliance against Malnutrition, comprising young parliamentarians from across political parties

• National release of the report by Hon’ble Prime Minister of India in January 2012

• Invitation from Planning Commission to review the Inter-ministerial group’s note on ICDS Restructuring

• Continuous media focus on issue of child malnutrition since release of report

• Naandi team invited by organisations across states to partner in data collection and implementation

Next Steps

Immediate action after the HUNGaMA

• Work in 3 districts

• Share global best practices

• Continue high decibel advocacy