national nutrition monitoring bureau dr.g.n.v.brahmam dy. director, field division, national...
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NATIONAL NUTRITION MONITORING BUREAU
Dr.G.N.V.Brahmam Dy. Director, Field Division,
National Institute of Nutrition, (I.C.M.R.)
Jamai-Osmania (P.O.),
Hyderabad – 500 007.
“Nutrition monitoring is the measurement of the changes over time in the nutritional status of a population or a specific group of
individuals” -- WHO, 1984Nutrition Monitoring is essential
- to assess the type, magnitude & distribution of
nutrition problems in the community,
- to evolve policies and to formulate & implement
programmes for the prevention and control of
malnutrition and
- to evaluate on-going nutrition programmes to
assess their impact and to initiate corrective
steps needed, if any.
NNMB was established in the year 1972, under the aegis of ICMR in the States of :
ANDHRA PRADESH
KARNATAKA
KERALA
TAMIL NADU
MAHARASHTRA
MADHYA PRADESH
ORISSA
UTTAR PRADESH
GUJARAT AND
WEST BENGAL
OBJECTIVES OF NNMB
To collect, on a continuous basis, on
representative segments of population in each of
the States, data on dietary pattern and nutritional
status by adopting standardized and uniform
procedures and techniques, and
To evaluate periodically, the ongoing national
nutrition programmes, to identify their strengths
and weaknesses and recommend appropriate
corrective measures.
ICMR
NIN - CRL
STEERING COMMITTEE
10 State Units
ORGANIZATION CHART OF NNMB
STAFF / UNIT
Medical OfficerNutritionistSocial WorkerField AttendantDriver
INVESTIGATIONS
Household demographic & socio-economic
particulars,
Dietary intakes of households / individuals,
Anthropometry viz., Heights, weights, MUAC &
Skinfold at Triceps,
Clinical examination for prevalence of signs of
nutritional deficiencies and
Village level information such as population,
agricultural production, nutritional & other
developmental programmes.
SAMPLING DESIGN
VILLAGES:
Sub-sample of NSSO sample frame of Consumer Expenditure survey carried out once in five years – to get better spatial distribution.
HOUSEHOLDS
Cluster sampling method
INDIVIDUALS
All individuals from the selected HHs.
Sub-sample by systematic random sampling procedure
SAMPLE SIZE
• Computed to arrive at State level estimates
HIGHLIGHTS OF NNMB SURVEYS
Coverage of rural, tribal & urban communities,
Repeat surveys in rural communities during 1975-
79, 88-90, and 96-97, covering same villages,
Repeat surveys among tribal communities during
1985-87 & 1998-99,
Study of physiologically vulnerable groups such
as adolescent girls, elderly etc.,
Assessment of MNDs such as IDA, VAD & IDD by
covering adequate sample sizes to arrive at State
level estimates, and
Evaluation National nutrition programmes
NUTRITIONAL STATUS OF THE RURAL POPULATIONS (2001 - 02)
SOCIO ECONOMIC PROFILE OF HOUSEHOLDS (%)
10.5
21.5
31.936.1
0
20
40
60
SC ST BC Others
COMMUNITY
29.3
60.4
10.3
0
20
40
60
Kutcha Semi-Pucca Pucca
TYPE OF HOUSE
45.0
36.0
9.6 9.4
0
20
40
60
No Land MarginalFarmers
SmallFarmers
LargeFarmers
LAND OWNERSHIP
18.322.0
26.433.3
0
20
40
60
Agri. Lab Other Lab Cultivators Others
OCCUPATION
SOCIO ECONOMIC PROFILE OF HOUSEHOLDS (Contd..)
43.3
34.0
10.7 12.0
0.0
10.0
20.0
30.0
40.0
50.0
<300 300-600 600-900 >=900
PER CAPITA INCOME / MONTH (%)
53.1
29.8
13.8
3.3
0
10
20
30
40
50
60
Illiterate 1-8 std. 9-12 std. College
FEMALE LITERACY (%)
26.2
55.7
67.4
0
20
40
60
80
Sanitary Latrine SeparateKitchen
Electrification
BASIC AMENITIES (%)
26.1
32.4
39.5
1.1 0.90
10
20
30
40
50
OpenWell
TubeWell
Tap Pond Stream
SOURCE OF DRINKING WATER (%)
Food Intake (% RDA) among 1-6 Years Children
30.0
36.728.0
33.320.4
24.0180.0
230.093.3
85.018.0
15.051.5
34.380.4
77.7
0.0 50.0 100.0 150.0 200.0
Sugar & Jaggery
Fats & Oils
Milk & Milk Prod.
Roots & Tubers
Other Veg.
Green Leafy Veg.
Pulses
Cereals 1-3 Yrs.4-6 Yrs.
Percent RDA
Average intake of Food stuffs (as % of RDA) by Adult Males and Females
56.7
45.735
60
56.767
150
13895
125
4518
8565
99.4
94.8
0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0
Sugar & Jaggery
Fats & Oils
Milk & Milk Prod.
Roots & Tubers
Other Veg.
Green Leafy Veg.
Pulses
Cereals Females
Males
Percent of RDA
Median Intake of Nutrients (as % RDA) by Children
37.533.3
70.057.5
30.028.5
66.766.7
15.512.4
35.033.3
45.030.2
60.856.9
87.381.4
0.0 25.0 50.0 75.0 100.0 125.0
Vitamin C
Niacin
Riboflavin
Thiamin
Vitamin A
Iron
Calcium
Energy
Protein1-3 Yrs.4-6 Yrs.
Percent of RDA
Median Intake of Nutrient (as % RDA) By Adult Males and Females - Sedentary
72.582.5 118.3
101.354.5
50.0 122.2
108.316.0
20.338.3
50.086.0
105.0
97.488.4
90.290.8
0 25 50 75 100 125
Vitamin C
Niacin
Riboflavin
Thiamin
Vitamin A
Iron
Calcium
Energy
ProteinMales
Females
Percent of RDA
Distribution (%) of children according to Protein - Calorie Adequacy
31.0
28.6
31.5
62.0
62.5
46.9
7.0
8.9
21.6
0 20 40 60
P+ C+
P+ C-
P- C-
1-3 Yrs
4-6 Yrs
7-9 Yrs
Distribution (%) of Adults according to Protein - Calorie Adequacy Status
87.8
79.7
5.8
12.8
5.1
6.9
1.3
0.6
0 20 40 60 80 100
P+ C+
P+ C-
P- C-
P- C+Males
Females
Distribution (%) of Pre-school children according to Gomez Classification
8.79.2
43.4 43.341.5 41.1
6.4 6.4
0
20
40
Normal Mild Moderate Severe
Boys
Girls
Per
cen
t
Prevalence (%) of Undernutrition Among 1-5 yr children According to SD Classification (<Median -
2SD) By Gender
61.5 62.2
48.6 50.0
22.9 22.0
0
20
40
60
Underweight Stunting Wasting
BoysGirls
Per
cen
t
Distribution (%) of Adults by BMI Grades
37.439.3
56.952.5
5.78.2
0
20
40
60
CED Normal Over Weight
Males
Females
Per
cen
t
30.423.0
20.616.3
68.662.4
58.856.4
0
20
40
60
80
< Median - 3SD < Median - 2SD
STSCBCOthers
24.020.3
14.9
64.059.8
47.4
0
20
40
60
80
< Median - 3SD < Median - 2SD
KutchaSemi PuccaPucca
25.218.2
15.711.4
64.959.2
51.2
43.3
0
20
40
60
< Median - 3SD < Median - 2SD
< 300300 - 600600 - 900>=900
24.721.316.113.3
65.2 59.955.3
47.6
-10
10
30
50
70
< Median - 3SD < Median - 2SD
I lliterateUpto 8th9 - 12 Std.College
UNDERWEIGHT (%) BY SOCIO-ECONOMIC VARIABLESBY COMMUNITY BY TYPE OF HOUSE)
BY MONTHLY PCI BY FEMALE LITERACY
INTRA-FAMILY DISTRIBUTION OF DIETARY ENERGY IN RURAL INDIA
DIETARY ENERGY AGE GROUP
Adult Male
Adult Female
Child Pre-
school (n=1696)
School age
(n=2356)
Adole- scents
(n=1406)
+ + + 31.1 47.3 61.6
+ + - 42.9 27.4 13.2
+ - + 1.4 1.4 2.1
+ - - 4.2 2.2 1.4
- + + 2.9 4.7 7.3
- + - 9.3 8.8 6.2
- - + 1.0 1.2 2.2
- - - 7.2 7.0 6.0
Child Inadequacy 63.6 45.4 26.8
Distribution (%) of Households According to Dietary Energy Adequacy Status of Adults and Children (1996-97)
+ : Adequate - : Inadequate ; 2 : 308.6 , p<0.001
31.0 31.0
25.4
42.9
19.0
7.0
0
10
20
30
40
50
Per
cen
t
All Adequate Adult Adequate& PreschoolInadequate
All Inadequate
1975-80
1996-97
Distribution (%) of Households According Dietary Energy Adequacy Status of Adults & Pre-school Child
-- Time Trends
NUTRITIONAL STATUS OF THE RURAL POPULATIONS – TIME TRENDS
Average Intake of Foodstuffs (per CU/day) as % of RDI by Period of Survey
78.3
81.790.0
37.522.5
20.0
67.5
80
85.0
97.8102
109.8
0 50 100 150
O.Veg.
GLV
Pulses
Cereals
1975-771988-901996-97
Percent
Average Intake of Foodstuffs (per CU/day) as % of RDI by Period of Survey (contd.)
70.0
96.776.7
60.065.0
70.0
57.361.3
77.3
88.082.0
112.0
0 50 100 150
Sug&J ag.
Fats&Oils
Milk&MP
Roots&Tub.
1975-771988-901996-97
Percent
Average Intake of Nutrients (per CU/day) as % of RDI by Period of Survey
88.9
97.1107.9
130.3
141.3
151.5
86.9
94.1
96.9
89.597.3
102.5
0 50 100 150
Iron
Calcium
Energy
Protein
1975-791988-901996-97
Percent
100.092.5
97.5
79.488.8
91.9
64.364.3
57.1
100.0108.3
125.0
50.047.0
41.0
0 50 100 150
Vitamin C
Niacin
Riboflavin
Thiamin
Vitamin A
1975-791988-901996-97
Percent
Average Intake of Nutrients (per CU/day) as % of RDI by Period of Survey (Contd.)
Distribution (%) of Households with Protein Calorie adequacy
79.5
83.5
77.9
47.6
53.3
57.8
0 50 100
Protein
Calorie
1975-791988-901996-97
Percent
Distance charts for Heights and Weights for Males and Females - Andhra Pradesh
Males
60
80
100
120
140
160
180
200
< 1
2 +
4 +
6 +
8 +
10 +
12 +
14 +
16 +
18 +
20-2
5
30-3
5
40-4
5
50-5
5
60 &
ab
ove
1975 - 19791988 - 19901996 - 1997NCHS Std.
Females
60
80
100
120
140
160
180
200
< 1
2 +
4 +
6 +
8 +
10 +
12 +
14 +
16 +
18 +
20-2
5
30-3
5
40-4
5
50-5
5
60 &
ab
ove
1975 - 19791988 - 19901996 - 1997NCHS Std.
Males
0
20
40
60
80
100
< 1
2 +
4 +
6 +
8 +
10 +
12 +
14 +
16 +
18 +
20-2
5
30-3
5
40-4
5
50-5
5
60 &
ab
ove
1975 - 19791988 - 19901996 - 1997NCHS Std.
Females
0
20
40
60
80
100
< 1
2 +
4 +
6 +
8 +
10 +
12 +
14 +
16 +
18 +
20-2
5
30-3
5
40-4
5
50-5
5
60 &
ab
ove
1975 - 19791988 - 19901996 - 1997NCHS Std.
Hei
gh
t (C
m)
Hei
gh
t (C
m)
Wei
gh
t (K
g)
Wei
gh
t (K
g)
Age (Yrs) Age (Yrs)
Age (Yrs) Age (Yrs)
Distribution (%) of Pre-school children (1-5 Yrs) According to Gomez Classification
5.9
9.98.9
31.6
37.6
40.6
47.543.8
44.3
15.0
8.76.2
0
10
20
30
40
50
Normal Mild Moderate Severe
1975-791988-901996-97
Per
cen
t
Distribution (%) of Children by Undernutrition and Period of Survey
64.1
49.3
67.3
60.1
20.7 22.5
0
20
40
60
Stunting Underweight Wasting
1990-91
2000-01
Per
cen
t
UNDERNUTRITION (< Median - 2SD)
Distribution (%) of Adult Males according to BMI Grades by Period of Survey
55.6
4945.5
42.1
48.450.4
2.3 2.64.1
0
20
40
60
CED Normal Over Weight
1975-791988-901996-97
Per
cen
t
BMI <18.5 BMI:18.5 – 25.0 BMI: >=25.0
Distribution (%) of Adult Females according to BMI Grades by Period of Survey
51.8 49.347.7
44.846.6 46.3
3.4 4.16.0
0
20
40
60
CED Normal Over Weight
1975-791988-901996-97
Per
cen
t
BMI <18.5 BMI:18.5 – 25.0 BMI: >=25.0
Prevalence (%) of Nutritional deficiency signs among Preschool Children
0.1
0.6
1.3
0.7
0.7
1.8
2.1
5.7
5.7
0 1 2 3 4 5 6 7
Marasmus
Bitot Spots
Ang.Stomat.
1975-791988-901996-97
Percent
MICRO-NUTRIENT DEFICIENCIES(2002 – 03)
Pooled: 0.7
< 0.5 %
0.5 %
Kerala0
Tamil Nadu 0.5
Karnataka0.8
Andhra Pradesh 1.2
Maharashtra1.4
Madhya Pradesh1.2
Orissa0.3 West Bengal
0.6
Prevalence (%) of Bitot spots among1 - <5 year children
0.7 0.70.8
0
0.2
0.4
0.6
0.8
1
1.2
NNMB-MND ICMR-MND NNMB-2001
Prevalence (%) of Bitot Spots among 1 - <5 yrs. Children
* WHO cut-off level (0.5%) of Public Health significance
*
Per
cen
t
1.1
1.4
0.50.4
0
0.5
1
1.5
2
ST SC OBC OC
1.0
0.4
0
0.5
1
1.5
2
Illiterate Literate
1.2
0.9
0.60.5 0.4 0.3
0
0.5
1
1.5
2
Agl. Labout OtherLabour
Cultivators Artisans Service Business
0.6
0.90.7
0
0.5
1
1.5
2
<=4 5-7 >=8
Pe
r c
en
tP
er
ce
nt
Pe
r c
en
t
Pe
r c
en
t
Prevalence (%) of Bitot Spots in 1 - <5 Yrs. Children by Community
Prevalence (%) of Bitot Spots in 1 - <5 Yrs. Children by Occupation
Prevalence (%) of Bitot Spots in 1 - <5 Yrs. Children by Family Size
Prevalence (%) of Bitot Spots in 1 - <5 Yrs. Children by Female Literacy Status
Ag. Labour
Other Labour
Cultivators Artisans Service Business
32.5 31.4 30.325.7 22.3
23.7
47 47.2
24.7
43.3
41.7
20.5 20.7
45.5
31.4
3.04.11.81.12.1
Pre-schoolchildren
Adol. 12-14 Yrs. Adol.15-17 Yrs. Preg.women Lact.women
Normal Mild Moderate Severe
10.20.03
11.20.03
11.00.03
9.90.03
10.60.03
Mean ±SE
Prevalence (%) of Anaemia Among Different Physiological and Age Groups
> 6 months < 6 months
Pooled: 3.9
< 5 %
> 5 %
Kerala0.6
Tamil Nadu 0
Karnataka1.9
Andhra Pradesh 3.8
Maharashtra12.2
Madhya Pradesh4.3
Orissa0.1
West Bengal
9.0
Prevalence (%) of IDD among 6 - <12 Year
Children
54.649.9
29.7 29.425.6 24.4
23.3
10.1
31.3
0
10
20
30
40
50
60
70
80
WB KER AP MR TN KAR ORI MP POOLED
Per cent of Households consuming salt having Per cent of Households consuming salt having adequateadequate
Amount (>=15 ppm) of IodineAmount (>=15 ppm) of Iodine
* By spot test
Per
cen
t
STATES
