study of malnutrition among under-6 children of sheopur district...
TRANSCRIPT
Study of malnutrition among under-6
children of Sheopur district with special focus on Saharia tribe
Project Report
Atal Bihari Vajpayee Institute of Good Governance
& Policy Analysis
Project Report
Study of malnutrition among under-6 children
of Sheopur district
with special focus on Saharia tribe
Atal Bihari Vajpayee Institute of Good Governance
& Policy Analysis
Project Team
Under the Guidance of
Akhilesh Argal, Director, AIGGPA
Madan Mohan Upadhyay, Principal Advisor,
Centre for Social Sector Development, AIGGPA
Project Coordinator
Richa Sharma, Deputy Advisor, State Health Resource Centre (SHRC),
Centre for Social Sector Development, AIGGPA
Consulant
Anil Mishra
Research Associate
Manisha Chouhan
Index S.No Particulars Page No
Executive Summary 1
1 Introduction 4
1.1 Understanding Malnutrition 5
1.2 About Sheopur 7
1.3 Karahal Block 8
1.4 Introduction to Saharia tribe 8
2 Objectives and methodology 9
2.1 Objectives of the study 10
2.2 Key stakeholders involved 10
2.3 Interaction with Saharia community at
Institute
11
2.4 Methodology and sampling 12
2.5 Data collection 13
2.6 Limitations of the study 14
3 Data analysis 15
3.1 Socio-Economic Parameters 15
3.2 Hygiene related aspects 23
3.3 Food habits in the community 25
3.4 Family Planning related issues 28
3.5 Pregnancy and childcare related aspects 30
3.6 Action taken during common childhood
illnesses
35
3.7 Services of Anganwadi 39
3.8 Vaccination 41
3.9 Nutrition Rehabilitation Centre 43
3.10 Alcohol and consumption of tobacco 44
3.11 Observation during field visit 44
3.12 MNREGA in the district and Karahal 48
4 Findings against key objectives 50
5 Recommendations 57
References 68
Annexures 70
Abbreviations and Acronyms
ANM Auxiliary Nurse Midwife
ASHA Accredited Social Health Activist
AWC Anganwadi Centre
AWW Anganwadi Worker, Anganwari Karyakarta
BPL Below Poverty Line
CSR Corporate Social Responsibility
ICDS Integrated Child Development Services
IFA Iron Folic Acid
MUAC Mid Upper Arm Circumference
NFHS National Family Health Survey
NRC Nutrition Rehabilitation Centre
NRHM National Rural Health Mission
POSHAN PM’s Overarching Scheme for Holistic Nourishment
WASH Water, Sanitation and Hygiene
WCD
Women and Child Development
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 1
Executive Summary
Childhood under nutrition is an important area of concern in India. Children with Severe
Acute Malnutrition (SAM) have nine times higher risk of dying than well-nourished
children.With appropriate nutritional and clinical management, many of such deaths can be
prevented.Malnutrition among children is actually a manifestation of many other socio-
economic and cultural factors. General poverty coupled with lack of assured employment
round the year is the major issue which needs to be looked into. Generally there is a tendency
among the planners and administrators to look into malnutrition as a health related issue and
accordingly the interventions also focus on it. The main livelihood and poverty gets missed
out. All this necessitate that the problem is dealt with in a more comprehensive and multi-
disciplinary approach.
Sheopur is a predominantly tribal district with the Saharia being the major tribe residing
mostly in Karahal block of the district. This study has been planned in order to understand the
causal factors of malnutition in the area and thereby devising a context specific strategy to
combat this problem. On account of various parameters of deprivation, Karahal block in
Sheopur district was chosen as focal area for the study.
In order to develop an understanding of the issues faced by the Saharia community,
men and women from the Saharia community in Sheopur district were invited to Bhopal and
discussion was held on various aspects like climate in the region, livelihood opportunities,
drinking water etc to get an overall view.After getting an understanding of the overall
situation a detailed questionnaire was developed .The sample comprised of 200 families of
Saharia community and 200 Non-Saharia .Four local female field investigators who were
residents of the Sheopur district were involved in collection of data by means of the
questionnaire.
It was found that overall the children from the Saharia community had almost twice
the incidence of malnutrition the Non-Saharia community.Illiteracy in the block is very high,
73 % of the Saharias and 65 % of the Non-Sahariia respondents were illiterate. 90% the
Saharia community respondents worked as labourers while it was 48% for Non- Saharia.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 2
Migration is a very significant aspect of the community in the area. It has an impact on the
uptake of the health and other ICDS, nutrition, vaccination related facilities in the area. This
breaks the continuity of the service delivery. Migration also reflects on the lack of livelihood
related options available in the area. Overall 34% of the households migrated to neighbouring
places for work. However among the Saharia households approximately 56% migrated for
work while only 12% of those from Non-Saharia households migrated for work. Though
women were adviced to consume additional food during pregnancy, it was found that
additional food consumption was up to a maximum of 3-6 months.The most common
illnesses reported for diarrhoea,fever and common-cold.
Saharia is notified as the Primitive Tribe Group (PTG) in Madhya Pradesh.It is
strongly recommended that the government should have a higher allocation for PTG
predominant blocks. It is also proposed that the quota of MNREGA allocation for 100 days
may be increased to 150 -200 days in the year for the next 5 years in Sheopur district.The
possibility of introducing a crash program for the next 4-5 years needs to be explored in order
to address livelihood related problem and nutrition requirement in the region. Approximately
60 % of the area of Sheopur district is under forest cover. Collecting tendu patta is one of the
commonly used forest based source of livelihood for the people in this area. Forests also
provide a range of marketable products like Resins (gum), Bahera, Nagar motha, Edible
gond, Satawar, Mahua etc. Many of the locally collected medicinal herbs fetch a good price
in open markets but the tribal people end up selling these products to the intermediaries at
abysmally lower prices. The support for marketing and value addition by creating processing
facilities would enhance the income in the community.It is recommended that a special plan
is drawn by the MFP cooperative federation, which has the resources, to identify all
marketable Minor Forest Products and create Self Help Groups (SHGs) for them. Such SHGs
should be empowered to scientifically harvest, process and sell at competitive prices to the
larger markets outside Karahal.
With effect from December 2017 onwards the Government has initiated a cash
assistance scheme of Rs 1,000 per month to each of the families of special backward
scheduled tribes (STs) as part of its efforts to eliminate malnutrition among the communities.
The amount of Rs 1000 per month is being provided to special backward ST communities,
including Saharia, Baiga and Bharia, to address the problem of malnutrition among them. The
amount is being deposited in the bank account of the woman head of the family to be used for
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 3
buying nutritious food items. This initiative of the Government is likely benefit the
community in addressing the problem of malnutrition among Saharia and other tribes also.
The focus should be on expanding access to primary education in this region .There is a
need for expansion of health care services in the affected area including reproductive and
child care, pre and post-natal care, vaccination etc. Intensive health awareness in the target
group of expectant mothers / adolescents needs to be launched in the campaign mode through
women and child development department and health and family welfare department.
The district of Sheopur is identified under Phase –I of the Poshan Abhiyaan
programme. It is the flagship programme of the Ministry of Women and Child Development
(MWCD),which ensures convergence with various programmes.It lays emphasis on the first
1000 days of the child, which includes the nine months of pregnancy, six months of exclusive
breastfeeding and the period from 6 months to 2 years to ensure focused interventions on
addressing under nutrition.
It is recommended that increased allocation of PDS be given to families having
severely underweight children and for and SAM children discharged from Nutrition
Rehabilitation Centres. Intensive monitoring is required at all levels including District
Collector, CEO Zilla Panchayat, Saharia Vikas Pradhikaran, Chief Medical Officer, Block
Medical Officer, Staff at Nutrition Rehabilitation Centre, Community Health Centre, Primary
Health Centre, ANMs, ASHA Karyakarta, Anganwadi Karyakarta etc need work in co-
ordination towards the aim of reducing malnutrition in the area. This will ensure that the
problem of malnutrition is addressed properly in the region. Looking into the level of
illiteracy in the regio and to address the specifics needs of the tribal community in local
languages resource is available in the form of Vanya radio station to enhance community
participation. It focuses on programs centred on tribal lifestyle, culture, society, traditions,
folk resources etc. Radio station Vanya located in Sesaipura (Sheopur) provides a great
window of opportunity as it makes programmes in Saharia dialect which is easily understood
by the community. This communication medium may be used more agressively to
communicate information on other aspects including hygeine, health, livelihood etc to the
community.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 4
Chapter 1
Introduction
Childhood under nutrition is an important public health and
development challenge in India and such children have significantly higher risk of mortality
besides increased risk of death and diseases, this also leads to growth retardation and
impaired psychosocial and cognitive development. Children with Severe Acute Malnutrition
(SAM) have nine times higher risk of dying than well-nourished children1. In India, the
prevalence of SAM among children remains high despite overall economic growth1.
The National Family Health Survey-4 for India revealed that 7.5 percent of all
children under-five years of age are severely wasted (weight-for-height) 2
. With appropriate
nutritional and clinical management, many of such deaths can be prevented. Strong evidence
exists on synergy between under nutrition and child mortality due to common childhood
illnesses including diarrhoea, acute respiratory infections, malaria and measles. From the
perspective of health sector, the most important intervention is promotion of appropriate
infant and young child feeding and nutrition practices and related maternal under nutrition.
Malnutrition among children is actually a manifestation of many other socio-economic and
cultural factors. General poverty coupled with lack of assured employment round the year is
the major issue which needs to be looked into.
Generally there is a tendency among the planners and administrators to look into
malnutrition as a health related issue and accordingly the interventions also focus on it. The
main livelihood and poverty gets missed out. All this necessitate that the problem is dealt
with a more comprehensive multi-disciplinary approach.
Globally approximately 52 million children under 5 years are wasted and 70 percent
of them are in Asia3. Worldwide approximately 5 million children die every year due to
causes linked directly or indirectly to undernutrition4. Household allocation of scarce family
resources too affects child health. Children born with low birth weight are more likely to be
exposed to the risk of experiencing malnutrition as they grow up, and are also likely to have
high mortality risk5.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 5
1.1 Understanding malnutrition
Malnutrition is a general term. It most often refers to under nutrition resulting from
inadequate consumption, poor absorption or excessive loss of nutrients, but the term can also
encompass over-nutrition, resulting from excessive intake of specific nutrients. An individual
will experience malnutrition if the appropriate amount of, or quality of nutrients comprising
for a healthy diet are not consumed for an extended period of time.
Impact of under nutrition
Children suffering from under nutrition begin their lives with a significant disadvantage. As
mentioned above, child malnutrition significantly contributes to under-five mortality as
undernourished children have increased susceptibility to infections and hence frequent
episodes of illness and longer recovery period.
Without treatment, children who are affected by moderate or severe acute
malnutrition during the critical stage of life between conception and age 2, if not provided
with timely and quality care, will find it difficult to achieve their full potential. Scientific
evidence has shown that beyond the age of 2-3 years, many effects of chronic under nutrition
are irreversible. This means that to break the intergenerational transmission of poverty and
under nutrition, children at risk must be reached during their first two years of life1.
Anthropometry is a widely used, inexpensive and non-invasive measure of the general
nutritional status of an individual or a population group. The three commonly used
anthropometric indices are:
Weight-For-Age (WFA).
Length-For-Age or Height-For-Age (HFA).
Weight-For-length or Weight-For-Height (WFH).
Types of under nutrition
The above three indices are used to identify three nutrition conditions: underweight, stunting
and wasting, respectively. Each of the three nutrition indicators is expressed in standard
deviation units (Z-scores) from the median of the reference population based on which under
nutrition may be further classified as moderate or severe.
Underweight: Underweight, based on weight for-age, is a composite measure of stunting
and wasting and is recommended as the indicator to assess changes in the magnitude of
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 6
malnutrition over time.
Stunting: Failure to achieve expected height/length as compared to healthy, well-nourished
children of the same age is a sign of stunting. Stunting is an indicator of linear growth
retardation that results from failure to receive adequate nutrition over a long period or
recurrent infections. This in turn affects economic productivity at national level. A stunted
child has a height-for-age Z-score that is at least two standard deviations (-2SD) below the
median for the WHO Child Growth Standards.
Wasting: Wasting represents a recent failure to receive adequate nutrition and may be
affected by recent episodes of diarrhoea and other acute illnesses. Wasting indicates current
or acute malnutrition resulting from failure to gain weight or actual weight loss. Causes
include inadequate food intake, incorrect feeding practices, disease, and infection or, more
frequently, a combination of these factors. Wasting in individual children and population
groups can change rapidly and shows marked seasonal patterns associated with changes in
food availability or disease prevalence to which it is very sensitive. A wasted child has a
weight-for-height Z-score that is at least two standard deviations (-2SD) below the median
for the WHO Child Growth Standards.
Severe Acute Malnutrition (SAM): Severe acute malnutrition is defined by very low
weight-for-height/length (Z- score below -3SD of the median WHO child growth standards),
a mid-upper arm circumference <115 mm, or by the presence of nutritional oedema.
Diagnostic criteria for SAM in children aged 6–60 months
Indicator Measure Cut-off
Severe
wasting
Weight-for-height < -3SD
Severe
wasting
MuAC (Mid Upper
Arm Circumference)
< 115mm
Bilateral
oedema
Clinical sign
-------
SAM increases significantly the risk of death in children under five years of age. It can be an
indirect cause of child death by increasing the case fatality rate in children suffering from
common illnesses such as diarrhoea and pneumonia. Children who are severely wasted are 9
times more likely to die than well-nourished children1.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 7
Mechanism of measurement of under nutrition
According to the National Family Health Survey (NFHS-4, 2015-16) 55% of children in
Sheopur District under are of five years were underweight (low weight for age ) while the
same for Madhya Pradesh was 42.8% and 35.7 % at all India level. Further details on various
parameters under NFHS 4 are at Annexure 1. The problem of malnutrition is more acute in
the Sheopur district of Madhya Pradesh as compared to the National average and the overall
status of the same in Madhya Pradesh and thus is the focus area for the study.
1.2 About Sheopur
Sheopur is situated on the western part of the state. It is surrounded by Rajasthan’s Sawai-
Madhopur in the west, Kota in the south-west and Bara in the south whereas Shivpuri and
Morena in the east and the north respectively. It extends from 250 15’ to 250 45’ north
latitude and 760 22’ to 77022’ east longitude. Its geographical area is 6606 sq. km. The total
forest area of Sheopur is 3949 sq. km which is 59.79% to the total area (6606 sq. km) of the
district. Out of the 607 villages, only 180 villages are connected by road. The proportion of
Scheduled Tribes to the total population of Sheopur is 23.5% while the proportion of
Scheduled Caste population to the total population of Sheopur is 15.8 %. Majority of the
population of Sheopur (84.4%) lives in rural areas6.
Details about Sheopur district and its population etc are at Annexure 2.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 8
1.3 Karahal Block
There are three blocks in Sheopur district namely: Vijaypur, Sheopur and Karahal. Karahal
block in Sheopur is the focus for the purpose of this study. This block has the highest
population of Scheduled Tribes (rural 63.08%) of the total population of the block.
21.53 % of population of Karahal block is cultivators while the percentage is (51.56
%) in Vijaypur block of the district. 62.63 % of the population in Karahal is engaged as
agricultural laborers6.Detail of block wise status (within Sheopur district ) on various
parameters as mentioned in district census handbook are available in Annexure 3.
1.4 The Saharia tribe
Madhya Pradesh is the tribal heartland of India. Among the 3 primitive tribal groups found
in Madhya Pradesh Saharia tribe is the largest one with 75.76 % of the total PTGs population
of Madhya Pradesh. (Source: Website of Tribal Welfare Dept. Govt of M.P.). The
sporadically concentration of Saharia are not only limited by political boundary in Madhya
Pradesh, but also their dispersals are located in Rajasthan, Andhra Pradesh, Orissa, Bihar and
rarely in West Bengal.
The early history of origination of Saharia is not exactly clear. Etymological point of view
expresses that the word ‘Sahria’ is the combination of two independent words like “Sa’
(companion) and ‘Haria’ (tiger) which mean companion of tiger. Most of the Saharia are
dependent on ecology which plays an important role in forming their economic structure
(Mandal, 1998)7. The past economic history implies that they traditionally practiced shifting
cultivation, hunting, gathering, pastoralism, etc. and sometimes also adopted nomadic life
(Prabhu, 1983)8 but in present time, most of the Saharias have become daily wage earner
instead of their traditional way of occupation (Singh, 1994)9. Most of them are landless and
poverty stricken. Roti is considered as their staple food. But sometimes, due to unavailability
of wheat, they consume roots, tubers, leaves, etc. too which are collected from the nearby
forests. They are very much addicted to drink local wine. Their area usually faces shortage of
water. Their poor food habits contribute to their malnutrition, especially among children and
pregnant mothers, which lead to increased susceptibility to morbid conditions10
.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 9
Chapter 2
Objectives and Methodology
Sheopur is a predominantly tribal district with the Saharia being the major tribe residing
mostly in Karahal block of the district. Geographical isolation, unique cultural practices, low
female literacy, poor health seeking behaviour has subjected this population to a wide
spectrum of health problems in the form of both communicable and non communicable
diseases. Amongst these health problems, malnutrition in young children is the most pressing
one. The past few years have seen growing concern of government towards malnutrition in
general and tribal areas in particular. Certain deaths of children were reported to have
occurred due to malnutrition in the district. In order to understand the causal factors
and thereby devising a context specific strategy to combat this problem, a study was
assigned by the Health Department to this Institute on the issue of malnutrition among
under 6 children in the district with a special focus on Saharia tribe. On account of
various parameters of deprivation, Karahal block in Sheopur district was chosen as
focal area for the study.
In the past years several initiatives have been taken by the Central and the State Government
to curb malnutrition in general which include:
Integrated Child Development Services (ICDS) Scheme- key measures include regular
weight monitoring for early identification of growth faltering, nutritional supplementation in
the form of take home ration for under 6 children and lactating mothers, meal provision, iron
folic acid supplementation, Vitamin A supplementation, Nutrition counselling of mothers,
early referral to Nutrition Rehabilitation centre (NRC) if severe acute malnutrition or
medical complications arise.
Health Services- Antenatal, Intranatal and postnatal services, breastfeeding counselling and
support, immunization services, early detection and referral if required for common
childhood ailments including diarrhoea and acute respiratory infections.
Supplementation of Iron and Folic Acid to adolescent girls in schools to stall the
intergenerational cycle of malnutrition.
Mid Day Meal scheme for school going children.
Potable water supply
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 10
Assured Public distribution system.
Various other livelihood programs like MNREGA.
However, it is a long process with requirement of consistent efforts and there is always a
scope of learning and improving. This study aims to understand the determinants of
malnutrition in Saharia tribe of Sheopur.
2.1 Objectives of the study
1. To understand the underlying causes of malnutrition among the children in the study area.
It includes the following components.
a. To assess the socio cultural and economic status, means of livelihood, status of family and
food security situation in the study area.
b. To assess coverage of basic child health services like immunization, supplementary
nutrition, deworming, iron and folic acid supplementation, treatment of common ailments,
use of ORS and Zinc during diarrhoea, treatment of Acute Respiratory Infections etc in
children from Saharia and Non-Saharia families
c. To assess the knowledge, attitude and practice of the family regarding the infant, the young
child's nutrition and common childhood illnesses.
d. To assess the uptake of key maternal health services like Antenatal, intra-natal and
postnatal services and the ICDS centres in the study area.
2. To evaluate utilization of NRC services and relevance of its geo-physical location for
serving the high burden areas.
2.2 Key Stakeholders involved
Children from 0 to 6 yrs of age in Sheopur District
Families in the area having children of the age group 0-6 years
Health facilities in the district, including Nutrition Rehabilitation Centre
ICDS centres in the district
NRCs in the District
District Administration and associated departments
Rural Development Department, Govt of MP
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 11
2.3 Interaction with Individuals of Saharia community from Sheopur
district at AIGGPA
In order to develop an understanding of the issues faced by the Saharia community, men and
women from the Saharia community in Sheopur district were invited to the AIGGPA at
Bhopal. The discussion was held on various aspects like climate in the region, livelihood
opportunities, drinking water and nutrition and health related aspects to get an overall view of
the problem of malnutrition which is affecting the life of the children. This pre-study
discussion which was done in order to develop an understanding of the issues faced by them
which could help to plan the study in a better way.
The following issues emerged from this discussion:-
Livelihood related issues
Majority of them worked as labourers with land ownership in the range of 1 to 4 Bigah. The
main crops grown by them were Wheat, Mustard etc.
They usually work as agricultural labour during the sowing and harvesting season which is
for about 3 months in a year. Tendu Patta collection also provides them employment
through forest department which carries out the plucking operations and pays them wages
for that. They also collect various medicinal herbs that are sold in the local market.
Migration is common in the region – during lean seasons they move out to neighbouring
area in search of work as agricultural labourers.
Some families have domesticated animals like Cows or Hen (usually 2-5 per family). The
cows are not in good health and usually give milk only a few months of the year. They also
rear Hen in the household and sell their chicks in the market. During summers the eggs get
spoilt due to excess heat.
It is a rocky terrain with chronic scarcity of water and tap water is not readily available.
Hand pumps are the common source of drinking water which at times the water is not very
clean.
Nutrition and other aspects
Majority of the community are illiterates.
They suffer from various infections that result in diseases.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 12
They get wheat from ration shop and some families grow vegetables. They also eat eggs at
times.
Child care related aspects
The average number of children per family in the community is 4 to 5.
108 ambulances services are available but the villages being in remote areas where road
access is not very good so they face problems during the rainy season.
At times, the marriage of girls in the Saharia community takes place before the age of 18
years.
2.4 Methodology and sampling
Karahal block having a population of 1,29,884 (as per 2011 census) was the focus of this
study. This block was selected as it is among the worst affected area in context to Severe
Acute Malnutrition (SAM).
When it is not possible to study an entire population but the population is known, a
smaller sample is taken using a purposive sampling technique. Slovin’s formula allows
researchers to sample the population with a desired degree of accuracy. This was used to
calculate the sample size. A confidence level of 95% was taken,
Slovin's formula is: n = N / (1 + Ne2)
Where: n = Number of samples, N = Total population e = Error tolerance
The Slovin’s formula was calculated as follows:
n = 129884/1+129884(0.05*0.05) =399
Using it, a sample of 400 children was taken from Karahal block. A child was eligible to be
enrolled in the study if he/she is more than one year and less than six years of age at the time
of collection of data. The study team did preferential selection of families having a SAM
child who was admitted in the health facility/NRC in the last three years to assess the patient
perspective of NRC functioning.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 13
The study was designed as to enable the understanding of key factors that are specific
to the study population and may be playing a contributory or causal role in the childhood
malnutrition. The study intends to analyze the socio-cultural practices followed in the region
in Saharia families with those who are Non-Saharia. In order to do that the study was initiated
with a hypothetical consideration that there are probably, some factors; to which Saharia
families and children are getting exposed which is making Saharia children more vulnerable
to undernourishment. Keeping this hypothetical consideration in mind, a comparative element
was introduced in the study to help the project team draw comparison.
To eliminate bias in the village selection process, approach use was ‘Probability
Proportionate to Size’ (PPS) sampling. A 30-cluster approach for section of villages was
used. Within selected villages, to randomize household selection in a systematic manner,
segmentation of each village in 4 parts was done and two Saharia families and two Non-
Saharia families with children under more than one year of age but less than six years of age
were selected from each segment, with preferential selection of family having a severely
malnourished child (if not, then any malnourished child).
The sample taken for the purpose of the study comprises of 200 families from the
Saharia community and compares the same against 200 families of Non-Saharia families.
Efforts were done to include 100 families each of Saharia –malnourished, Saharia –normal,
Non –Saharia –malnourished and Non- Saharia –normal from the same area.
Village selection was done based on secondary data received from the office of
Collector, Sheopur. Primary data for socio-economic, cultural and food security aspects
besides data about Knowledge, attitudes and practices (KAP) was collected through specially
designed questionnaires. The KAP was administered to the mothers while general
information was collected from any adult member of the household, preferably the head of
the household. Details of village selection are available in Annexure 4.
2.5 Data Collection
For selection of households in the villages, the interviewers visited the Anganwadi and
identified the households which have children between 1 and 6 years of age. A household that
currently had a severely malnourished child in the stated age group in preceding 3 calendar
years was preferentially selected. The process of identification of household of household for
the purpose for the purpose of the study is given in Annexure 5.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 14
Four local female field investigators who were residents of the Sheopur district
were identified for the purpose. The information was gathered about the youngest child in the
family in the age group 1 to 6 years called the index child for the purpose of the study. This
was done to be able to understand the child feeding practices, age at which complementary
feed was introduced to the child and certain other parameters like immunization etc. The
youngest child was chosen as the index child for the purpose of the study because the parents
are likely to recall information regarding care during pregnancy, immunization, services
taken from the Anganwadi etc easily for the youngest child.
During the collection of data from the village a total of 87 families of children
suffering with malnutrition could be identified from the Saharia community and 42 families
of children from the Non - Saharia community from the selected villages could be identified
and included in the survey. The survey was conducted on 200 Saharia and 200 Non-Saharia
families in the community.
2.6 Limitations of the study
The study is mainly based on primary data. There is a risk that because of the presence or
influence of the interviewer in a face-to-face interaction, the interviewer might unknowingly
bring out an untrue response to sensitive questions, e.g. the respondent may craft an answer to
please the interviewer instead of answering truthfully or the interviewer might record a verbal
response incorrectly because the statement is not interpreted correctly. Nevertheless, efforts
were made to minimize the possibility of error as the field investigators, for the purpose of
the study, were local from this area only.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 15
Chapter 3
Data Analysis
Overall the children from the Saharia community had almost twice the incidence
of malnutrition than those who did not belong to the Saharia community. Thus the
findings on certain important parameters were analyzed at overall level of for the population
surveyed and also for the respective respondents of the Saharia and the Non-Saharia
community. The findings of the study are based on the responses received on various
parameters such as size of the family, number of children, livelihood related aspects, their
understanding related to health aspects etc. The findings are as under:
3.1 Socio- Economic Parameters:
Family type: Overall 84 % of the households covered under the study lived in a nuclear
family and the 16 % belonged to a joint family. Among the respondents Saharia households,
86 % of the Saharia households lived in a nuclear family while approximately 82 % of the
respondents from the Non-Saharia community lived in nuclear family.
Level of literacy in the household: The Saharia community has a higher percentage of
illiterate population than the Non-Saharia .Among the Saharia community, approximately 73
% of the respondents were illiterate while approximately 65 % of the Non – Saharia were
illiterate. Overall 69 % of the respondents were illiterate.
Graph 1: Level of literacy among the households
illiterate
69%
5th
10%
8th
10%
12th
9%
Graduate
1% Post
Graduate
1%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 16
Graph 2: illiterates among Saharia and Non-Saharias
Opinion of the community on how many children a couple should have: 52 % of the
respondents were of the opinion that a couple should have three or more children.
Graph 3: Opinion of the community on the number of children a couple should have
Actual number of children in the family: Out of the households covered in the survey, 17
% had one child only, 31 % had two children overall 52 % of the households had 3 or more
showing the poor awareness about family planning in this region. When the same was
analyzed at the community level, 60 % of the Saharia households had 3 or more children
while 44 % of the Non-Saharia household surveyed had 3 or more children.
73 %
65 %
69 %
60
62
64
66
68
70
72
74
Saharia Non- saharia Overall
One
1%
Two
47% Three
40%
Four
11%
More than
four
1%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 17
Graph 4: Actual number of children per couple at the community level
Graph 5: Saharia and Non-Saharia families having 3 or more children
Occupation: Approximately 69 % of the respondents worked as labourers , 21 % in
agriculture , almost 10% followed other occupation (collecting tendu patta ,selling milk,
teacher , petty employment , shopkeeper , selling Gums and Medicinal Herbs and taking care
of the cattle).When the same was analyzed among Saharia and Non-Saharias , huge majority
(90%) of the respondents from the Saharia community worked as labourers while only 48 %
among the Non- Saharia worked as labourers.
One
17%
Two
31% Three
27%
Four
16%
Five
5%
Six
3%
Seven
1%
60%
44%
52%
0
10
20
30
40
50
60
70
Saharia Non- saharia Overall
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 18
Graph 6: Occupation at the community level
Graph 7: Saharias and Non-Saharias working as labourers
Caste classification: 63 % of the respondents in the study belonged to the scheduled tribe, 27
% to other backward classes, 8 % to scheduled caste and only 2 % of belonged to the general
category.
Labourer
69%
Agriculture
21%
Other
10%
0
10
20
30
40
50
60
70
80
90
Saharia Non- saharia Overall
Saharia 90 %
Non- saharia
48 %
Overall 69 %
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 19
Graph 8: Caste category at the community level
Migration: Migration is a significant social aspect of the region and it has an impact on the
uptake of the health and other ICDS, nutrition, vaccination related facilities in the area. This
breaks the continuity of the service delivery. Migration also reflects on the lack of livelihood
related options available in the area. Overall 34 % of the household mentioned that they
migrated to neighbouring places for work. However among the Saharia households
approximately 56 % migrated for work while only 12 % of those from Non-Saharia
households migrated for work.
Graph 8: Percentage of Saharias and Non –Saharias who migrated for work
Land Holding: Approximately 52% of the respondents had some land. Among Saharia only
for 39% of the respondents had land holding while among the Non-Saharia 65 % of the
respondents had land holding.
Scheduled
Caste
8%
Scheduled Tribe
63%
Other Backward
Classes
27%
General
2%
56%
12%
34%
0
10
20
30
40
50
60
Saharia Non- saharia Overall
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 20
Graph 9: Land holding among Saharia and Non-Saharia
Among those who had land, 75 % were marginal farmers, 19 % of them were small farmers
only 3 % were medium farmers while another 3 % were large farmers.
For the purpose of the study the following approximation was used:
Land holding less than 2.5 acre were considered marginal farmers, holding in the range 2.5
to 5 acre were considered small farmers and land in the range 5 acre to 10 acre were
considered medium farmers .Land holding greater than 10 acre were considered large
farmers.
Graph 10: Land holding at the community level
The major crops are grown during the Rabi and Kharif season. It was found that in some
cases they grow one crop on certain portion of land and another crop on the remaining
portion of land.
0
10
20
30
40
50
60
70
Saharia Non- saharia
Overall
39%
65%
52%
0 10 20 30 40 50 60 70 80
Marginal
farmers
Small
farmers
Medium
farmers
Large
farmers
75%
19 %
3% 3%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 21
Kharif season: Urad dal, rice, bajara and soyabean were the commonly grown crop during
the kharif season.
Rabi crop: Wheat was the major crop during rabi season with 67 % of the land owners
growing wheat, 8 % grew chana, 1 % rice and 3 % mustard. There were some cases where
they did not grow any crop on the land during the Rabi season.
Domestic Animals: Almost 42 % of the respondents had domestic animals. In some cases
more than one animal was domesticated by them. Among animals, cow and buffalo were the
most common, followed by goat and hen.
Graph 11: Domestic Animals
However amongst those who had cow ,majority belonged to the Non-Saharia commuinty.
Only almost 10 % of the surveyed Saharia households had cow.
Annual family income: An effort was done to know the annual income of the household.
Huge majority around 91 % of the respondents mentioned their annual family income was
less than Rs 50,000
0
5
10
15
20
25
30
35
Cow Buffalo Goat Hen
34%
16%
5% 3%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 22
Graph 12: Annual family income per annum in rupees
BPL card: Almost 65% of the respondents had BPL card. 77% of the respondents from the
Saharia community had BPL card while 52% of the respondents from the Non- Saharia
community had BPL card.
Graph 13: BPL card holders among Saharia and Non-Saharia
0
10
20
30
40
50
60
70
80
90
100
upto 50000 50001-1 lac > 1 lac >2 lacs
91%
7% 1% 1%
Saharia, 77 %
Non -Saharia,
52 %
Overall, 65 %
0
10
20
30
40
50
60
70
80
90
Saharia Non -Saharia Overall
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 23
3.2 Hygiene related aspects:
An effort was done to identify the commonly used source of drinking water in the community
and the practice followed, if any, for the treatment of water before using it for drinking. They
were asked about the practices they follow regarding washing their hands after defecation.
They were also asked about their practice regarding cutting nails, brushing the teeth and
frequency of brushing the teeth.
Source of drinking water: The respondents were asked about the source of drinking water
used by them. 48% of the mentioned that they used tube well water whereas 37% took water
from the hand pump, 6% used water from uncovered well, and 3% of the respondents used
water from covered well. Only 3% of the respondents have facility of piped drinking water.
Graph 14: Source of drinking water
About 10 % of the respondents mentioned that they found the water they used for drinking
was visibly dirty.
Treating drinking water before usage: 91 % of the respondents did not do anything extra to
purify the water. Only 4% added chlorine tablets to the water, 4 % cleaned the water with a
cloth, only 1 % of the respondents added alum powder (fitkari) to the water for cleaning the
same.
0
10
20
30
40
50
Open
well
Covered
well
Hand
Pump
Boring Water
from
pond
Piped
Water
6 % 3 %
37 %
48 %
2%
3%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 24
Graph 15: Treating drinking water before usage
Washing hands after defecation: Attempt was made to know if the community is aware of
the importance of washing hands after defecation. 96% of the respondents mentioned that
they are aware of the importance of washing hands post defecation. However, when asked
about how they washed their hands post defecation, 46% of the respondents mentioned that
they washed hands with soap and water, while 34% used water and ash, approximately 10%
washed their hands with plain water and another 10% wash their hands with mud and water .
Graph 16: Practice of washing hands after defecation
Frequency of brushing of teeth: 96% of the respondents mentioned that they brush their
teeth only once a day (on waking up in the morning).
0 10 20 30 40 50 60 70 80 90
100
Filtering
the water
with cloth
Boiling Adding
fitkari
Adding
chlorine to
water
Nothing
4% 0 1% 4%
91%
0
10
20
30
40
50
With plain
water
With water
and soil
With ash
and water
Soap and
water
10% 10%
34%
46%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 25
Graph 17: Frequency of brushing teeth
Practice regarding cleaning the teeth: 89% of the respondents used brush and toothpaste,
10 % of the respondents used twigs of neem tree (Azadirachta Indica) while 1 % of the
respondents cleaned their teeth with their fingers only.
Graph 18: Practice regarding cleaning of teeth
3.3 Food habits in the community:
Daily food habits: Almost all the respondents reported consumption of rotis on a daily basis,
while 72% of the respondents included dal in their daily diet. Only 30% of the respondents
consumed vegetables on a regular basis while 17 % of them consumed rice and 9% of the
respondents reported regular consumption of milk.
0
20
40
60
80
100
Once daily in
morning
Twice daily in
morning and
at night
Thrice daily One daily at
night
Once in a
while but not
daily
96 %
1% 0
3 %
0
0
10
20
30
40
50
60
70
80
90
With brush and
toothpaste
With neem twigs Cleaning of teeth
with fingers
89%
10 %
1%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 26
Graph 19: Daily food items consumed at the community level
Food consumption pattern among the Saharia and Non –Saharia community: On
comparison it was found that only 24 % of the Saharia households consumed vegetables on a
regular basis while this percentage among the Non-Saharia was 37%. Only 11% of the
households of Saharia community consume rice on regular basis while this percentage among
the Non-Saharia was 23%. Approximately 35 % of the respondents mentioned that they
consumed milk at least sometime. The consumption of milk was also found to be much lower
among the Saharia families (11% in Saharia against 60 % in Non- Saharia).
Graph 20: Consumption of vegetables among Saharia and Non-Saharia
0
10
20
30
40
50
60
70
80
90
100
Rice Dal Roti Vegetables Milk
17%
72%
100%
30%
9%
24%
37%
30%
0
5
10
15
20
25
30
35
40
Saharia Non- saharia Overall
vegetables
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 27
Graph 21: Consumption of rice among Saharia and Non-Saharia
Graph 22: Milk consumed at least sometime among Saharia and Non-Saharia
Consumption of milk, egg and meat in the family: Milk is a good source of calcium while
eggs are a good source of protein. It is essential to identify the pattern of consumption of
milk, eggs and meat in the family to get a fair idea of the overall nutrition position in the
households. Consumption of milk was found to be very low among the Saharia community as
compared to their Non-Saharia counterparts. Only 6% of the respondents consumed eggs.
17% of the respondents consumed hen’s meat while 7% of the respondents consumed the
meat of goat.
Efforts were made to further analyze the daily food consumption patterns in terms of bowls
per day out of the respondents who reported consumption of rice, dal and vegetables. While
only about 30% of the respondents reporting consuming vegetables on a daily basis only 13%
of the same consumed 3-4 bowl of vegetable per day. The quantity of food intake also
depends on the size of the bowl. An effort was further done to analyze the size of the bowl of
11%
23%
17%
0
5
10
15
20
25
Saharia Non- saharia Overall
rice
11%
60%
35%
0
10
20
30
40
50
60
70
Saharia Non- saharia TOTAL
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 28
in which food was consumed on a regular basis 42% of the respondents used small size bowl,
41% of the respondents used a medium size bowl while only 17% of the respondents used
large size bowl on a regular basis.
Roti consumption pattern per day among the families was as under:
Average number of Rotis
eaten per person per day
Number of respondents Approximate Percentage
2-3 18 5 %
4-5 57 14%
6-7 64 16 %
8-9 147 37 %
10-12 114 28 %
Total 400 100 %
Recommended Dietary Allowance: It is essential to have a balanced diet for overall well
being of the individual. A balanced diet contains all essential (macro and micro) nutrients in
optimum quantities and in appropriate proportions that meet the requirements. The
recommended daily allowance of Balanced diet for Adults is available in the Dietary
Guidelines for Indians- A Manual published by National Institute of Nutrition, Indian
Council of Medical Research; Hyderabad (Enclosed as Annexure 6).It is evident from the
details of dietary pattern in the community that dietary needs of the community are not being
fulfilled.
Also given the fact that overall consumption of vegetables is low and the consumption of
milk, eggs and meat is meagre at the community level and and that tribal population is in
general prone to chronic energy deficiency they are more likely to suffer with Protein Energy
Malnutrition(PEM)11
.
3.4 Family planning related aspects:
Family planning: To know the level of awareness, the respondent women were asked about
the various methods of family planning. An unusual feature that was noticed here was the
usage of water extracted after boiling black pepper (kali mirch) or black cumin (jeera) for the
purpose of family planning. The respondents were also asked if they are using any method of
family planning. Almost 75% of the respondents mentioned that they are not using any
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 29
method of family planning. Among the respondent women who resorted to family planning
technique the commonly used techniques were operation and birth control pill. The usage of
family planning methods was found to be even lower among the Saharia community at
approximately 22%.
Graph 23: Any method of family planning used among Saharia and Non-Saharia
Age at the time of marriage and child birth related responses: The respondents were
asked about their opinion what should be the age of a girl at the time of marriage. 95 % of the
respondents felt the ideal age of marriage for girls should be 18 years or above while the
balance 5% felt that the girls should be married before the age of 18 years. Similar question
was asked about boy’s age. 90 % of the respondents felt the ideal age of marriage for boys
should be 21 years or above and only 10% felt that the boys should be married when they are
in the age group 18-21 years. Approximately 20 % of the respondent women mentioned that
they got married before attaining the age of 18 years.
Graph 24: Girl’s age at the time of marriage
22%
28%
25%
0
5
10
15
20
25
30
Saharia Non- saharia Overall
0
10
20
30
40
50
16 year 17 year 18 year 19- 21
years
Did not
respond
2%
18%
41%
13 %
26 %
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 30
Approximately 28 % of the respondent women from the Saharia community mentioned that
they were less than 18 years of age before marriage.
Graph 25: Age of the girl less than 18 years at time of marriage
3.5 Pregnancy and childcare related aspects:
Care during pregnancy: The respondents were asked whether they were aware of the need
for taking care during pregnancy. Further the respondents were asked about the care
/precautions actually taken by them during pregnancy. This was done in order to compare the
awareness with the practice actually followed.
Graph 26: Comparison of knowledge of precautions/care to be observed during
pregnancy and the care actually taken during pregnancy
28%
13%
20%
0
5
10
15
20
25
30
Saharia Non- saharia Overall
<18 years …
0 10 20 30 40 50 60 70 80 90
100 83
94 94 93 94
78
64 53
64
92 86 88 88
70
55
42
Knowledge of precautions/ care to be taken during pregnancy
Care /precautions actually taken during pregnancy
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 31
83% of respondents felt that they need to take adequate rest while only 64% of the
respondent’s actually took adequate rest during pregnancy. While only 53% of respondents
felt they should abstain from heavy work during pregnancy, actually only 42% of the women
refrained from doing heavy work during pregnancy.
The most commonly used service of the Anganwadi by the pregnant women and the lactating
mothers was the service of food. A question was asked to the respondents if they consumed
the take home ration themselves or shared the same with the family. 79% of the respondents
mentioned that they ate the take home ration themselves and gave it to their children. 8% of
the respondents shared the take home ration with the family and about 13% of the
respondents did not respond to this question. Respondents were asked if they had an abortion
during pregnancy, 3% of the respondents had an abortion during pregnancy.
Nutrition and care for the pregnant women and lactating mothers: It is essential that the
maternal nutrition should also be balanced, fresh and preferably home-made and there should
not be any unscientific restrictions. Optimal nutrition of adolescent girls, pre-pregnant
women and pregnant mothers is critical to growth, foetal well-being and to prevent
malnutrition in the postnatal period.
Information was gathered if there is a practice of giving additional nutrition for the pregnant
women and lactating mothers in the family. Only 68 % of the women actually followed the
advice of consuming additional / special diet during pregnancy or as lactating mothers.
Graph 27: Additional / Special diet taken by women during pregnancy / by lactating
mothers among the Saharia and Non-Saharia
65%
72%
68%
60
62
64
66
68
70
72
Saharia Non- saharia Overall
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 32
65 % of the mothers belonging to the Saharia community took some additional/special diet
during pregnancy or while they were breast feeding the baby. Among the women who
consumed certain additional eatables during pregnancy and while they were feeding the baby
with breast milk, 40% of the respondents consumed additional fruits, 34% took additional
vegetables, and 14 % took additional milk while 12% increased the quantity of the daily food.
However it was noticed that the additional food consumption was up to a maximum of
3-6 months only.
Graph 28: Additional eatables consumed by pregnant women / lactating mothers
Graph 29: Quantity and frequency of consumption of additional food by pregnant
women/ lactating mothers (value in percentage)
Fruits, 40%
Vegetables,
34%
Poshak Aahar,
12%
Milk, 14%
0
20
40
60
80
100
100-250
gm
250-500
gm
1-2 kg 1-2 time 3-4 time 1-2
months
3-6
months
Qty /day times/day for how many
months
48 40
12
66
34
89
11
28
69
3
27
73
13
87 81
19
0
100
0
34
66
82
10 8
100
0
18
82
Fruits 40% Vegetables 34% Poshak Aahar 12% Milk 14%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 33
Infant feeding practices : Infant and young child feeding practices such as initiation of
breast feeding, feeding of colostrums, duration of exclusive breast feeding upto the child
reached the age of 6 months and particulars of complementary feeding in terms of age of
initiation, the type of complementary food and frequency of feeding was assessed. In
addition, information on socio-cultural aspects of infant and young child feeding practices by
mothers was also collected. For the well being of the child it is essential to feed the
colostrums. 92 % of the respondents said they fed the child with colostrums after birth while
8 % of the respondents started feeding the child after throwing the initial colostrum.
The respondents were asked if the children were given exclusive breast milk for the initial 6
months. 78% of the respondents gave exclusive breast milk to the babies while 21% of
the respondents gave water also in addition to mother’s milk. Only one percent of the
respondents gave other milk (mixed with water) in addition to mother’s milk.
Information was also gathered regarding the frequency of feeding the child to know if the
child gets sufficient nutrition. 47 % of the respondents fed the child whenever the child cried
for food, about 36 % of the respondents fed the child up to 4-5 times a day 7 % of the
respondents fed the child with breast milk 2-3 times while only 10 % of the respondents fed
the child every 2-3 hours during day and night also
Graph 30: Frequency of breastfeeding the index child
0
10
20
30
40
50
When ever
the child
cried for milk
2-3 times a
day
4-5 times a
day
Every 2-3
hours during
day / night
47%
7%
36%
10%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 34
Initiation of semi-solid food: As the child grows it is essential to introduce semi-solid food
at the right age so that the growth of the child is not hampered. The general norm for the age
for introduction of semi-solid food for the child is around 6 months of age. Information was
gathered regarding their opinion on the right age of initiation of other semi-solid food
Graph 31: Opinion at community level on right age for introduction of complementary
feed
Majority of the respondents introduced complementary feed to the child when the child
was around 6-7 months of age.
Graph 32: Actual age of child when complementary feed was introduced
0
5
10
15
20
25
30
35
40
2-4
months
4-5
months
5-6
months
6-7
months
7-8
months
After 8
months
Age of the child in months
0 3 %
23%
40%
22%
12%
0
10
20
30
40
50
60
5 months 6 months 7 months 8 months
3%
51%
26%
20%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 35
97 % of the respondents reported that they continued to give breast milk to the baby even
after the introduction of complementary feed. The respondents were further asked till what
age did they continued to give breast milk to the baby. 42% of the respondents continued to
feed the baby with breast milk up to the age of 2 years, while 34% continued till the child was
one and half years of age. 14% of the respondents continued to give breast milk up to the age
of one year, while 1% of the respondents continued doing so up to the age of eight months.
Graph 33: Age of the child till when feeding of breast milk was continued
According to the Infant and Young Child Feeding Guidelines, 2016 published by the Indian
Academy of Paediatrics, after the child reached six months of age introduction of optimal
complementary feeding should be practiced preferably with energy dense, home-made food.
Breastfeeding should be continued minimum for 2 years and beyond12
. However, in almost
49 % of the cases feeding of breast milk to the child was not continued till the child reached
two years of age. Thus it is essential to encourage the optimal feeding practices for the
children at the community level.
3.6 Action taken during childhood illnesses
One of the parameter for health and overall well being is absence of disease. An effort was
made to analyze the frequency of illness reported at the community level. The most
commonly reported illness were: fever, diarrhoea and common cold. The highest number of
0
5
10
15
20
25
30
35
40
45
continued
upto 8
months
continued
upto 1 year
continued
upto 1 and
half years
continued
upto2 to 3
years
continued
upto 3 to 4
years
1%
14%
34%
42%
10%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 36
respondents (83%) mentioned that the child suffered from diarrhoea during the past one year,
this was followed by fever (79 %) and common cold (45%). Efforts were also made to view
further the frequency of occurrence of the illness. Majority of the children suffered with the
above mentioned illnesses on an average 2-5 times in a year.
The members from the Saharia community reported marginally higher incidence of illness as
compared to Non-Saharia, 86 % of the respondents of the Saharia community mentioned that
the children suffer from diarrhoea/ vomiting, while 42 % of respondents mentioned that their
children suffer with common cold while 76 % of the respondents from the Saharia
community that their children suffered with fever.
Graph 34: Common illness reported with annual frequency
An effort was further made to analyze the treatment/options exercised by respondents when
the children fell ill. Multiple responses were taken from the respondents as it is possible that
an individual may take more than one course of action during illness. 34% of the respondents
mentioned that they normally do not take much attention of common illness like fever,
diarrhoea and common cold the children get cured in some time. As high as 39% of the
respondents mentioned that they opted for jhad-phoonk practices while 21% of the
respondents used home remedies (gharelu nuska) for medication.
0
5
10
15
20
25
30
35
40
45
1-2 time 2-3 time 3-4 time 4-5 time 5-8 time
times / 1 year
13
32 31
17
7 5
44
32
16
3
12
27 26
18 17
Fever 79% Diarrhoea 83% Common cold 45%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 37
Graph 35 : Action taken by the respondents during illness of the child
The children in the community frequently suffer with diarrhoea, information was collected on
what practices are followed in the community when the children suffer from diarrhoea.
Multiple responses were collected from the respondents. Approximately 84 % of the
respondents gave ORS to the children. The major source of getting ORS was ASHA/
Anganwadi karyakarta. Almost 57% of the respondents gave the children a solution of water
salt and sugar. Approximately 20% of the respondents used local herbs for the purpose of
treatment of diarrhoea.
0 10 20 30 40 50 60 70
Use home remedies
Jhad Phoonk
Show the child to ANM
Show the pateint to the only doctor available in
the village
ASHA/ ANM do not visit the village regularly so
have to take the patient out of village for …
Take the child to Sub -centre/ PHC/CHC
Take the child to district hospital
Take the child to private hospital
Do nothing
21
39
54
47
34
49%
56%
63%
34%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 38
Graph 36: Action taken and feeding restrictions when child suffers with diarrhoea
Graph 37: Source from which ORS was obtained
0
10
20
30
40
50
60
70
80
90
8% 8% 8%
41% 42%
33% 30%
57%
20%
84%
0 10 20 30 40 50 60 70 80 90
70%
86%
65%
27%
31%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 39
The respondents were also asked what action was taken when the child suffered with
respiratory or other illnesses. Multiple course of action is taken in such circumstances. The
responses were as under:
Graph 38: Action taken when child suffered with respiratory illness
Information was also gathered if they used any of the practices like witchcraft (jadu-tona) or
other course of action taken when the child fell ill, since multiple course of action can be
taken in such circumstance, multiple responses were taken from the respondents. 41% of the
respondents went for jhad-phoonk, 28 % of the respondents showed the child to any
baba/phakeer, 28 % took the child to any religious place while 17 % of the respondents used
the practices of witchcraft. The respondents from Saharia community marginally higher
inclination towards such practices.
3.7 Services of the Anganwadi
An effort was made to identify the awareness about the services of the Anganwadi centre.
The respondents showed a very high degree of awareness towards the services provided by
the Anganwadi. About 93 % of the respondents from Saharia community and 86 % of the
0 10 20 30 40 50 60 70
Did nothing
Took the child to ANM
Tried gharelu nuska, jadi-booti,kada etc
Consulted the ASHA
Took the child to Private doctor
Took the child to anganwadi
Adopted jhad-phoonk practices
Took the child to Govt hospital / centre
Took the child to private hospital
Used the medicine available at home which …
Admitted the child in a health facility
1%
61%
19%
66%
64%
56%
41%
50%
44%
12%
6%
Action taken when child suffered with respiratory
illness
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 40
respondents from the Non-Saharia community sent their children to Anganwadi centres. The
facility of nutritional food is one of the most significant facilities that is the first recall among
the services provided by the anganwadi. The Take home ration (THR) is one of the
mechanisms used in the anganwadi to ensure that nutritional food is available to the pregnant
and lactating women. An effort was done to identify if the take home ration was actually
consumed by the pregnant women and the children or did they share the same with the
family. 79 % of the respondents said they consumed the take home ration themselves and
shared the same with their children.
A feedback was taken from the respondents regarding the quality of service provided by the
anganwadi. The overall response was favourable.
Graph 39: Feedback on services of the Anganwadi
Measurement of weight of the child on regular basis: The weight of index child was taken
every month in 62 % of the cases while 26 % of the respondents mentioned that the growth of
weight of the index child was monitored 8-10 times in a year. Overall 88% of the respondents
mentioned that the weight of the child was regularly monitored by the Anganwadi.
0
10
20
30
40
50
60
6%
56%
34%
5% 0 0
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 41
Graph 40: Frequency of measurement of weight of the child by the Anganwadi in a year
An effort was done to identify the action taken when it is noticed that the child is not growing
well. Since mutiple course of action is taken is such circumstances, responses under the same
were mapped. The responses were as under .Though the respondents used options like
consulting the ASHA/ Anganwadi karyakarta or the nurse, it seems a lot of time and effort is
also wasted in the processes like: tie amulet (tabeez) to the child, visiting quack doctor etc.
Graph 41: Action taken at the community level if the child is not growing well/ is weak
0 10 20 30 40 50 60 70
Every
month
8-10
times
6-7 times 4-5 times 2-3 times Do not
know
62%
26%
1% 1% 2% 8%
0 20 40 60 80
Consult elders in the family
Do puja for the proper growth of child
Take the child to a quack
Tie amulet (tabeez) to the child
Consult ANM
Consult private doctor
Take the child to ASHA/Anganwadi
karyakarta
Take the child to PHC/ CHC/ District
hospital
37%
50%
24%
35%
68%
61%
72%
42%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 42
3.8 Vaccination/ Immunization of children:
While 81 % of the respondents mentioned that they have got their children vaccinated 19%
mentioned that they could not get the children vaccinated.
Graph 42: Vaccination /Immunization among Saharia and Non-Saharia
Overall 81 % of the respondents mentioned that they got their children immunized however
only 70 % of the respondents from the Saharia community got their children vaccinated.
Effort was done to look at the vaccination card to verify the actual status of vaccination. The
vaccination card was available with only in 37 % of the cases. It was found that there was
lack of continuity in the schedule of vaccination and the vaccination was not completed
properly in majority of the cases. Therefore even in cases where it has been reported that
vaccination has taken place, there is a problem that complete vaccination as per schedule
has not been adhered to. The common reasons for being unable to get the children
vaccinated were migration to other places for work, they had gone to the field for work as
agricultural labourer, the mother of the child had gone to maternal home and in certain cases
the AWW/ANM would not come to the village on time as the village was in remote location.
Graph 43: Vaccination card available among Saharia and Non- Saharia
70%
91% 81%
0
20
40
60
80
100
Saharia Non- saharia Overall
34%
40%
37%
30
32
34
36
38
40
42
Saharia Non- saharia Overall
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 43
Graph 44: Reason why vaccination was incomplete
Anaemia: When the respondents were asked if they got the medicine to control anaemia
among adolescent girls and pregnant women, almost 90 % of the respondents mentioned that
they received such medicine.
Iron and Folic Acid (IFA) Prophylaxis (Action taken to prevent anaemia): Iron and Folic
acid is given to children via the Anganwadi centre. About 93 % of the respondents from
Saharia community and 86 % of the respondents from the Non-Saharia community sent their
children to Anganwadi centres. Majority of the respondents who sent the children to
Anganwadi were aware about the iron and folic acid (IFA) being provided to the children at
the Anganwadi centre.
Deworming: Almost 77 % of the respondents mentioned that deworming medicines were
given to the children
3.9 Nutrition Rehabilitation Centre (NRC):
About 15 % of the respondents reported to have availed the facility of Nutrition
Rehabilitation Centre. Almost all of the respondents who availed the services of NRC
responded stating that the NRC was overall clean, the nurse and staff took good care of them,
and they also received formula feed for the child and good meals for the attendant. Majority
of the respondents who availed the services of NRC mentioned that the services of NRC were
ANM /
Anganwari
karyakarta does
not come on
time
14%
We go to field
for majdoori
35%
Migration/
went out of
the village
51%
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 44
good. The respondents were also asked if they received the money on account of loss in
wages from the NRC. Majority (86 %) of those respondents who were admitted in the NRC
received the money on account of loss of wages during admission to NRC. Though the
nutrition rehabilitation centre provides an effective mechanism to ensure that the mother and
the child are taken care of and the weight and other parameters of the child are regularly
monitored, there is still a risk of relapse after being discharged from the NRC 13
.
3.10 Alcoholism and consumption of tobacco:
About 71 % of total households surveyed spent at least some portion of the expenditure on
alcohol or tobacco. The problem of alcohol and consumption of tobacco was found to be very
high among the Saharia community with approximately 83 % of the Saharia respondents
spending at least some amount regularly on a monthly basis on alcohol/tobacco products
while approximately 59 % of the households from Non-Saharia community reported
spending at least some amount on amount regularly on a monthly basis on alcohol/tobacco
products.
Graph 45: Alcoholism and Consumption of tobacco among Saharia and Non-Saharia
3.11 Observations during the field visit:
During the course of visit to Karahal block it was observed that some of the hand-pumps and
taps were broken also the overall cleanliness in the villages was not very good with children
were found playing in unclean surroundings, there was lack of connectivity and water logging
in certain places and animal excreta.
83%
59% 71%
0
20
40
60
80
100
Saharia Non- saharia Overall
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 45
Discussion was held with D.P.O Mahila Evam Bal Vikas to know in detail about the
initiatives taken in the district to monitor the problem of malnutrition in the district. Duties
have been assigned to various staff members of the government departments to visit
respective anganwadi and report about the facility and functioning of the Anganwadi along
with suggestions for improvement. The same was found to be in practice. Monitoring of the
malnutrition related issue was done by including this issue in Time-Limit (T/L) meeting.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 46
Occupation and other issues: The major season of earning is at the time of sowing of seeds
and also at the time of reaping the produce. They also go to the forest to collect tendu patta
and gum .The problem of alcoholism was also reported by the community. Certain issues are
found regarding quality of water available in the community. The problem of eating pan-
masala was found among men and women also .The eldest sibling was found to be available
taking care while the mother would go to the forest for collecting firewood, tendu patta, herbs
etc.
Visit to Anganwadi: Visit was undertaken to Anganwadi. Immunization was done on 3rd
Tuesday of every month. Initially a meal of sattu was given to the children. Anganwadi
registers were maintained and the children were checked to verify their weight and the mid
upper arm circumference was measured to identify the cases suffering with severe and acute
malnutrition. (SAM). The meal of puri and kheer was provided. The take home ration was
also distributed. The anganwadi had sufficient supply of Take home ration and ORS.
Anganwadi at Karahal block, Sheopur
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 47
Community Health Centre and Nutrition Rehabilitation Centre at Karahal: Visit was also
undertaken Community Health Centre and Nutrition Rehabilitation Centre at Karahal. At the
time of the visit about 35 patients were admitted in the NRC which had a capacity of 20 beds.
Arrangement for beds was made from the neighbouring chatrawaas. The weight of the child
is taken at the time of admission and growth graph is maintained. The child is put to the
prescribed diet. The facility also provided food for the mothers (including daliya, dal, roti,
rice and vegetables) two times a day.
During discussion with the members of the community it was understood that they go for
migration during harvesting during the months of February to April every year. This leads to
depletion in their nutrition status. The Anganwadi and the NRC have to work harder towards
improving their nutrition status.
Nutrition Rehabilitation Centre – Karahal Block, Sheopur
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 48
Food being served at Nutrition Rehabilitation Centre Karahal block, Sheopur
During discussion with a mother admitted at the NRC it was known that she had gone a
neighbouring village for wheat harvesting for two months. They also go to the jungle to
collect local gums. There are two varieties of gums that they collect form the forest. The gum
(rubber) is collected as a sap from the trees. It is sold for Rs 200 per Kg approximately. It was
informed that the women have made a self help group for the same. They also collect another
type of Gum (edible) from the forest which they sell for Rs 150-200 per kg. The detail of
items commonly gathered from the forest and sold are as under:
Commonly available Forest
Product
Rate at which it is sold
Gum resins (rubber) Rs 200 per kg
Gum resins(edible) Rs 150-200 per kg
Kamarkas Rs 300 per Kg
Amla Rs 50-60 per kg
3.12 MNREGA in the district:
An effort was done to analyze the impact of MNREGA in the state and district. The data for
the same was downloaded from the MNREGA website regarding the district wise households
to whom work was provided during the financial year 2016-17.
Employment was provided via MNREGA to approximately 28 lakh house-holds via
MNREGA during the financial year 2016-17. Sheopur district ranks at number 36 among all
the 51 districts of Madhya Pradesh in terms of employment provided to the households. The
Karahal block has the highest (63.08 %) of the population of Scheduled Tribes (rural)
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 49
population among the total population of the block, thus an analysis was done of the
livelihood provided under MNREGA for each of the block in Sheopur district.
Out of 35,238 households to which employment was provided via MNREGA in year
2016-17 for the Sheopur district, approximately 18 % of households of Karahal block got
employment under MNREGA.
On analysis of block wise households who demanded for work month wise under
MNREGA and comparing the same with the work under MNREGA given to them month
wise during financial year 2016-17, 81% of those who demanded work from Vijaypur Block
were given work under MNREGA, however only 63% of those who demanded work from
Karahal Block were given work under MNREGA (Details are available in Annexure 7).
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 50
Chapter 4
Findings against objectives of the study
The overall objective of the study was to understand the underlying causes of
malnutrition among the children in the study area.
It was found that the children from a Saharia household were almost twice more prone
to the problem of malnutrition than their Non-Saharia counterparts. This vulnerability
is due to their poor economic conditions.
The findings against each of the objective are as under:
Objective 1(a): To assess the socio cultural and economic status, means of livelihood,
status of family and food security situation in the study area.
On analysis of the main occupation among people residing in the district it was found that
only 21.53% of population of the Karahal block is cultivators while the percentage of
workers involved in cultivation is as high as 51.56% in the Vijaypur block of the Sheopur
district. The majority of the population of the Karahal block 62.63 % is engaged as
agricultural labourers.
There is a very high percentage of ST population in the area and the level of literacy is also
very low. Almost 73% of the respondents from the Saharia community were illiterate
and almost 65 % of the respondents from the Non- Saharia community were illiterates.
Approximately 84 % of the respondents live in nuclear family. Though overall 69% of the
respondents worked as labourers, when the same was analyzed at the community level, huge
majority (90%) the respondents from the Saharia community worked as labourers while 48%
among the Non- Saharia worked as labourers.
Approximately 52% of the respondents had some land. But among Saharia community
only 39% of the respondents had some land while among the Non-Saharia community
approximately 65 % of the respondents had land. However approximately 75% of those
who had land were marginal farmers .Huge majority around 91% of the respondents
mentioned their annual family income was less than Rs 50,000.
Migration is a very significant aspect of the community in the area. It has an impact on the
uptake of the health and other ICDS, nutrition, vaccination related facilities in the area. This
breaks the continuity of the service delivery. Migration also reflects on the lack of livelihood
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 51
related options available in the area. Overall 34% of the household migrated to
neighbouring places for work. However among the Saharia households approximately
56% migrated for work while only 12% of those from Non-Saharia households
migrated for work.
Almost 65% of the respondents had BPL card. On analysis between the Saharia and Non-
Saharia community it was found that 77% of the respondents from the Saharia community
had BPL card while 52 % of the respondents from the Non- Saharia community held BPL
card. Approximately 56 % of the respondents from the Saharia community had three or more
children.
Daily food consumption at the community level: Almost all the respondents reported
consumption of Rotis on a daily basis, while 72% of the respondents included Dal in their
daily diet. Only 30% of the respondents consumed vegetables on a regular basis while only
17 % of them consumed Rice and 9% of the respondents reported regular consumption of
milk. Approximately 35 % of the respondents mentioned that they consumed milk at least
sometime. Consumption of milk, egg and meat in the family: Milk is a good source of
calcium while eggs are a good source of protein. It is essential to identify the pattern of
consumption of milk, eggs and meat in the family to get a fair idea of the overall nutrition
position in the households. Consumption of milk was found to be very low among the Saharia
community as compared to their Non-Saharia counterparts. Only 6% of the respondents
consumed eggs. 17% of the respondents consumed hen’s meat while 7% of the respondents
consumed the meat of goat.
Food consumption pattern among the Saharia and Non –Saharia community: When
comparison was done among the Saharia and Non-Saharia households, it was found that only
24 % of the Saharia households consumed vegetables on a regular basis while this percentage
among the Non-Saharia was 37%. Only 11% of the households of Saharia community
consume Rice on regular basis while this percentage among the Non-Saharia was 23%. The
consumption of milk was also found to be much lower among the Saharia families (11% in
Saharia against 60 % in Non- Saharia).
Objective 1(b) : To assess coverage of basic child health services like immunization,
supplementary nutrition, deworming, iron and folic acid supplementation, treatment of
common ailments, use of ORS and Zinc during diarrhoea, treatment of Acute
Respiratory Infections etc in children from Saharia and Non-Saharia families
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 52
A comparative picture of the healthcare structure in Sheopur is given below:
Name of
Block
Number of
Community
Health
Centre
Number of
Primary
Health
Centre
Sanctioned
post at
PHC/
actually
posted
ANM
sanctioned
for the
block /
actually
posted
ASHA
sanctioned
for the
block
Nutrition
Rehabilitation
Centre
Vijaypur 1 3 27/12 31/24 246 NRC ,
Vijaypur
Karahal 1 1 7/4 26/19 130 NRC. Karahal
Sheopur 1 6 39/24 33/29 240 NRC ,
District
Hospital ,
Sheopur
Immunization: Information was gathered whether the children were vaccinated for
common illnesses. While 81 % of the respondents mentioned that they have got their children
vaccinated while 19 % mentioned that they could not get the children vaccinated. However
only 70 % of the households among the Saharia community got their children vaccinated.
The common reasons for being unable to get the children vaccinated were:
palayan or migration
they had gone to the field for work as agricultural labourer
the mother of the child had gone to maternal home
In certain cases the AWW / ANM would not come to the village on time as the village
was in remote location.
Effort was done to look at the vaccination card to verify the actual status of vaccination. The
vaccination card was available with only in 37 % of the cases. It was found that there was
lack of continuity in the schedule of vaccination and the vaccination was not completed
properly in majority of the cases. Therefore even in cases where it has been reported that
vaccination has taken place but there is a problem that complete vaccination as per schedule
has not been adhered to.
Supplementary nutrition: 68 % of the women actually followed the advice of consuming
additional food during pregnancy and while they were feeding the baby with breast milk
during pregnancy .Among the 68% of the women who consumed certain additional eatables
40% of the respondents consumed additional fruits, 34 % took additional vegetables, and
14% took additional milk while 12% increased the quantity of the daily food. However it was
noticed that the additional food consumption was up to a maximum of 3-6 months and not
during the entire period of pregnancy to be continued while feeding the child as well.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 53
Majority of the respondents introduced complementary feed to the child when the child was
around 6-7 months of age.
Deworming: Almost 77 % of the respondents mentioned that deworming medicines were
given to the children
Anaemia: When the respondents were asked if they got the medicine to control anaemia
among adolescent girls and pregnant women, almost 90 % of the respondents mentioned that
they received such medicine.
Iron and Folic Acid (IFA) Prophylaxis (Action taken to prevent anaemia): Iron and Folic
acid is given to children via the Anganwadi centre. About 93 % of the respondents from
Saharia community and 86 % of the respondents from the Non-Saharia community sent their
children to Anganwadi centres. Majority of the respondents who sent the children to
Anganwadi were aware about the iron and folic acid (IFA) being provided to the children at
the Anganwadi centre.
Frequency of illness among children: One of the parameter for health and overall well
being is absence of disease. An effort was made to analyze the frequency of illness reported
at the community level. The most commonly reported illness were: fever, diarrhoea and
common cold. The highest number of respondents (83%) mentioned that the child suffered
from diarrhoea during the past one year, this was followed by fever (79 %) and common cold
(45%). Efforts were also made to view further the frequency of occurrence of the illness.
Majority of the children suffered with the above mentioned illnesses on an average 2-5 times
in a year. The members from the Saharia community reported marginally higher incidence of
illness as compared to Non-Saharia 86 % of the respondents of the Saharia community
mentioned that the children suffer from diarrhoea/ vomiting, while 42 % of respondents
mentioned that their children suffer with sardi/ khansi and 76 % of the respondents from the
Saharia community that their children suffered with fever.
Action taken when child fell ill: An effort was further made to analyze the treatment /
options were exercised by respondents when the children fell ill .Multiple responses were
taken from the respondents as it is possible that an individual may take more than one course
of action during illness. 34% of the respondents mention that they normally do not take much
attention of common illness like fever, diarrhoea, and common cold and they children get
cured in some time. As high as 39% of the respondents mentioned that they opted for jhaad-
phoonk practices while 21% of the respondents used home remedies for medication.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 54
Action taken when child suffered with diarrhoea: The children in the community
frequently suffer with diarrhoea, information was collected on what practices are followed in
the community when the children suffer from diarrhoea. Multiple responses were collected
from the respondents. Approximately 84 % of the respondents gave ORS to the children. The
major source of getting ORS was ASHA/ AWW .Almost 57 % of the respondents gave the
children a solution of water salt and sugar. Approximately 8 % of respondents mentioned that
they gave small quantity of opium to the child suffering from diarrhoea while approximately
20 % of the respondents used jadi-booti for the purpose of treatment of diarrhoea.
Action taken when child suffered with respiratory infections: The respondents were also
asked what action was taken when the child suffered with respiratory or other illnesses.
Multiple course of action is taken in such circumstances. Approximately 50 % respondents
took the child to Public Health Centre or Community Health Centre while 44 % showed the
child private facility.
Objective 1(c): To assess the knowledge, attitude and practice of the family regarding
the infant, the young child's nutrition and common childhood illnesses.
68 % of the women actually followed the advice of consuming additional food during
pregnancy and while they were feeding the baby with breast milk during pregnancy .Among
the 68% of the women who consumed certain additional eatables, 40% of the respondents
consumed additional fruits, 34 % took additional vegetables, and 14% took additional milk
while 12% increased the quantity of the daily food. However it was noticed that the
additional food consumption was up to a maximum of 3-6 months and not during the entire
period of pregnancy to be continued while feeding the child as well.
The respondents were asked whether they were aware of the need for taking care during
pregnancy .Further the respondents were asked about the care /precautions actually taken by
them during pregnancy. This was done in order to compare the awareness with the practice
actually followed. 83% of respondents felt that they need to take adequate rest while only
64% of the respondent’s actually took adequate rest during pregnancy. While only 53% of
respondents felt they should abstain from heavy work during pregnancy, actually only 42% of
the women refrained from doing heavy work during pregnancy.
92 % of the respondents said they gave initial colostrum to the children. 78% of the
respondents gave exclusive breast milk to the babies up to the age of 6 months while 21% of
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 55
the respondents gave water also in addition to mother’s milk. Only one percent of the
respondents gave milk (mixed with water) from outside in addition to mother’s milk.
47% of the respondents fed the child whenever the child cried for food, about 43 % of the
respondents fed the child up to 4-5 times a day while only 10 % of the respondents fed the
child every 2-3 hours during day and night also. Majority of the respondents mentioned that
the child was 6 to 7 months of age when complementary food was introduced.
Information was also gathered if they used any of the practices like witchcraft or other course
of action taken when the child fell ill, since multiple course of action can be taken in such
circumstance, multiple responses were taken from the respondents. 41% of the respondents
went for jhad-phoonk, 28 % of the respondents showed the child to any baba/phakeer, 28 %
took the child to religious places while 17 % of the respondents used the practices of
witchcraft.The respondents from Saharia community have marginally higher inclination
towards such practices.
Objective 1(d): To assess the uptake of key maternal health services like antenatal,
intra-natal and postnatal services and the ICDS centres in the study area.
The respondents showed a very high degree of awareness towards the services provided by
the Anganwadi. The facility of nutritional food is one of the most significant facility that is in
the first recall among the services provided by the Anganwadi. The take home ration (THR)
is one of the mechanisms used in the Anganwadi to ensure that nutritional food is available to
the pregnant and lactating women. An effort was done to identify if the take home ration was
actually consumed by the pregnant women and the children or did they share the same with
the family. 79 % of the respondents said they consumed the Take home ration themselves and
shared the same with the children. A feedback was taken from the respondents regarding the
quality of service provided by the Anganwadi. The overall response was favourable with 56
% of the respondents saying that the services of Anganwadi were good and another 34 %
mentioned that the services provided by the Anganwadi were average.
Objective 2: To evaluate utilization of NRC services and relevance of its geo-physical
location for serving the high burden areas.
About 15 % of the respondents reported to have availed the facility of Nutrition
Rehabilitation Centre. Almost all of the respondents who availed the services of NRC
responded stating that the NRC was overall clean, the nurse and staff took good care of them,
they also received formula feed for the child and good meals for the attendant. Majority of
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 56
the respondents who availed the services of NRC mentioned that the services of NRC were
good. The respondents were also asked if they received the money on account of loss in
wages from the NRC. Majority (86 %) of those respondents who were admitted in the NRC
received the money on account of loss of wages during admission to NRC.
The Nutrition Rehabilitation Centre at Karahal block is located adjoining the Community
Health Centre at the Karahal block. Visit was also undertaken Community Health Centre and
Nutrition Rehabilitation Centre at Karahal. At the time of the visit about 35 patients were
admitted in the NRC which had a capacity of 20 beds. Arrangement for beds was made from
the neighbouring chatrawaas. The weight of the child is taken at the time of admission and
weight growth graph is maintained. The child is put to the prescribed diet. The facility also
provided food for the mothers including daliya, dal, roti, rice and vegetables two times a day.
The Nutrition Rehabilitation Centre, Karahal is located adjoining the Community Health
Centre which is beneficial that the services and advice of the doctors at Community Health
Centre can also be used for the benefit of the children. Thus the location of the NRC seems
appropriate. The overall bed occupancy of the NRC was 81 % in the year 2016-17 and 91.4
% during the year 2017-18. Majority of the patients who were referred to the NRC were sent
by the Anganwadi workers. The NRC staff should council the mothers for the planning
procedures which is lacking.
Test for significance: The test for significance of factors affecting malnutrition in the
children of the community was done using chi-square test using p value at 95 % of accuracy
and degree of freedom = 1, cross-tabulation of data was done and the values were determined
using statistical formulas. The following factors were found to have significant impact on
malnutrition among children: households living Below the Poverty line, Occupation as
labourers and migration. Mothers who took some additional food during pregnancy
and while feeding the child with breast milk were able to prevent malnutrition among
their children to a great extent.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 57
Chapter 5
Recommendations
Based on the primary information from questionnaire, analysis of the data received from
different agencies and interactions at field level, the following are the recommendations to
address malnutrition among children in Sheopur district. These are stated under four broad
categories to emphasise inter sectoral co ordination among departments:
1. EXPANDING LIVELIHOOD OPPORTUNITIES
2. BETTER EDUCATION
3. IMPROVED ACCESS TO HEALTH CARE
4. EXTENSION EFFORTS AT COMMUNITY LEVEL
1. EXPANDING LIVELIHOOD OPPORTUNITIES :
(1.1)Creating better employment opportunities for the vulnerable tribal population: It
was found that the children from a Saharia household were almost twice more prone to the
problem of malnutrition than their Non-Saharia counterparts. This vulnerability is due to their
poor economic conditions. There is a need for better targeting of employment programs.
The following table gives a comparative picture:-
Class Illiterate Land holding Working as
labourers
Migration
Saharia 73 % 39 % 90 % 56 %
Non- Saharia 65% 65 % 48% 12 %
The above table clearly brings out the vulnerability of the community on social and economic
parameters.
Saharia is notified as the Primitive Tribe Group (PTG) in Madhya Pradesh. This being
the scenario, it is strongly recommended that the government should have a higher allocation
for PTG predominant blocks. Three tribes of Madhya Pradesh Baiga, Bhariya and Saharia
have been declared specific backward tribes by the Government of India. Their total
population is very small when seen as a ratio of the total population in the state. This sub
group within the larger ST population is facing the most severe challenge of livelihood and
malnutrition. In the study it’s seen that very clearly that the in Poor wage employment
opportunities for Saharias is affecting them in all aspects of their life. Thus the following
interventions can help in different programmes:
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 58
(1.1) MNREGA: The government implements a series of rural development activities to
generate employment for the rural poor and alleviate poverty. MNREGA, which ensures 100
days of employment to all poor adult population in the country, is a significant step in this
regard. There is a need to continue the focus on the same. However, it was found that within
the district the ST dominated Karahal performed poor on availability of funds for MNREGA.
Sheopur district ranks at number 36 among all the 51 districts of Madhya Pradesh in terms of
employment provided to the households. The Karahal block has the highest (63.08 %) of the
population of Scheduled Tribes (rural) population .Out of 35,238 households to which
employment was provided via MNREGA in year 2016-17 for the Sheopur district,
approximately 18 % of households of Karahal block got employment under MNREGA. In the
non ST dominated Vijaypur 81 % of the households who demanded work under MNREGA
got work under MNREGA, while in Karahal block 62% of household who demanded work
under MNREGA got work under MNREGA. Unemployment being higher in Karahal makes
them more vulnerable to migration. The migration in the Karahal block was found to be
generally for duration of about 2-3 months in a year.
It is proposed that the quota of MNREGA allocation for 100 days may be increased to
150 -200 days in the year for the next 5 years in Sheopur district. There are instances
when the MNREGA allocation of days has been increased in certain duration to take care of
the immediate distress like drought. Saharia and other PTGs being a special class needs
preferential allocation so that they could sustain themselves and not take recourse to
migration. It is proposed that the special package under MNREGA should remain at least for
5 years when it can be reviewed again. Thus increased focus on MNREGA will also help to
address the problem of migration to a great extent.
(1.2) Expanding Employment opportunities in rural areas: - The Panchayat and Rural
Development Department Govt of Madhya Pradesh is doing a series of activities for the
benefit of the people living in the area like creation of self-help groups, promotion of
livelihood related activities like animal husbandry, making washing powder, Agarbattis soap,
Sanitary napkins, stitching, making of Dona – Pattal etc .Such activities need to be
strengthened. There are also schemes that provide loan for livelihood generation. These
schemes are carried out by multiple departments targeting different interest groups .These
activities need to done regularly and monitoring of the same is required.
(1.3) National Rural Livelihoods Mission (NRLM): NRLM promotes and supports
collectives towards sustainable livelihoods of the poor (CSLP) around key livelihoods. These
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 59
collectives offer their members access to livelihoods knowledge, skills, technology, market
intelligence, risk management products and credit support through their SHGs and
federations. Support of NRLM may be taken in enhancing livelihood opportunities in the
region.
(1.4) Comprehensive package involving all stakeholders departments for Primitive
Tribe Groups: The possibility of introducing a crash program for the next 4-5 years needs
to be explored in order to address livelihood related problem and nutrition requirement in the
region. Several instances where found where the respondents were aware that it is advised
that certain precautions and care like additional nutritious food to be taken by the pregnant
women , avoid heavy physical labour etc should be taken during pregnancy, however they
were unable to do so in practice. A lot of it has to do with the lack of employment
opportunity in the area. If they are able to get enough food and nutrition such problems are
likely to be minimized. A holistic convergent plan is required, that will include government
departments like the Tribal Welfare Department, Department of Women and Child
development, Department of Health and Family Welfare, Department of Agriculture and
Horticulture, Public Health Engineering Department, Forest department and Panchayat and
Rural Development department. Saharias are the largest group of Primitive Tribe Groups in
Madhya Pradesh .This being a small proportion of the total population, it will not be much of
a burden on funds, this package will not put a big additional burden on them as only the gaps
need to be addressed.
With effect from December 2017 onwards the Government has initiated a cash assistance
scheme of Rs 1,000 per month to each of the families of special backward scheduled tribes
(STs) as part of its efforts to eliminate malnutrition among the communities. The amount of
Rs 1000 per month is being provided to special backward ST communities, including
Saharia, Baiga and Bharia, to address the problem of malnutrition among them. The amount
is being deposited in the bank account of the woman head of the family to be used for buying
nutritious food items. This initiative of the Government is likely benefit the community in
addressing the problem of malnutrition among the Saharia and other tribes also.
(1.5) Identifying and expanding the MFP (Minor Forest Produce) activities in PTGs
areas: Approximately 60 % of the area of Sheopur district is under forest cover. Thus it is
essential to take the benefit of forest economy to the fullest in a comprehensive manner.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 60
Collecting Tendu Patta is one of the commonly used forest based source of livelihood for the
people in this area. This is a seasonal operation done in the months of May and June for only
45 to 50 days in a year. Enhanced efforts are required to be done in co-ordination with the
Minor Forest Produce Development Corporation working in the state.
Forests provide a range of marketable products like resins (gum), bahera, nagar motha, edible
gond, satawar, mahua etc. Many of the locally collected medicinal herbs fetch a good price in
open markets but the tribal people end up selling these products to the intermediaries at
abysmally lower prices. The support for marketing and value addition by creating processing
facilities would enhance the income in the community. This is an activity which is fully
privatized for a long time. This is also resulting in rapid depletion of these medicinal
products. It is recommended that a special plan is drawn by the MFP cooperative federation,
which has the resources, to identify all marketable Minor Forest Products and create Self
Help Groups (SHGs) for them. Such SHGs should be empowered to scientifically harvest,
process and sell at competitive prices to the larger markets outside Karahal.
(1.6)Enhanced focus on agriculture: The study has revealed the average land holding of the
farmers is about one hectare. The farmers belonging to the Saharia Community have a land
holding of less than one hectare on an average. The Karahal block receives less rainfall. Only
12.79 % of the land in the Karahal block is cultivable as a percentage of total area. Thus
enhanced efforts are required to improve the availability of water and increase the cultivable
area.
The land holding status of the focus group needs to be kept in mind while planning a strategy
for agriculture development. The benefits of beneficiaries’ oriented schemes aimed at
enhanced productivity need to be taken up. The department needs to plan a special 3 to 5
years intensive multipronged attack on different fronts i.e. Seeds, Land management,
irrigation, pumps and other water lifting devices, Watershed management, market
development, expanding storage ,farm mechanisation practices etc.
Saharias being a special focus group the State government i.e., the Agriculture Department
should pay special attention to them and other similar marginalized farmers. The land in
Karahal being of not too good quality, the agriculture production enhancement strategy will
have to include Horticulture, Forestry and Agro-Farm Forestry in its mix of practices.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 61
(1.7) Horticulture Crops: There is an urgent need to explore possibility of introduction of
nutritional horticultural crops suitable for the region. According to the report of department
of horticulture, Government of Madhya Pradesh guava, ber, custard-apple (sitaphal) could be
considered a crop under rain fed conditions in the region. Certain other crops recommended
to be grown in the region are seasonal vegetables, coriander, chillies and garlic etc.
2. BETTER EDUCATION
(2.1) Expanding access to Primary education in PTGs areas: It was found that illiteracy in
the sample was quite high. Almost 73 % of the respondents from the Saharia community
were illiterate and almost 65 % of the respondents from the Non- Saharia community were
illiterates.
In spite of presence of schools in the region the overall education situation in the area is not
very encouraging
Block wise
number of
schools
Primary
School
Middle
School
Higher
Secondary
School
High
School
Total Population
Sheopur
Block 326 108 11 18 463
235584
Vijaypur
Block 308 100 11 11 429
215041
Karahal
Block 240 75 9 13 337
129884
Source: Education Portal, Government of Madhya Pradesh
A. Number of girls enrolled in school in the entire district of Sheopur is lesser than the
number of boys registered for education (Source: Education Portal, Government of Madhya
Pradesh, year 2017-18).
B. As illiteracy is the root cause of so many other social issues like poor health / awareness,
poor awareness on safe motherhood, livelihood and related matters. The stark gap should be
plugged in next few years. This will give confidence to general population and empower
them on social issues.
C. An effort for adult education in a drive mode is also needed in the district with special
focus on the Saharia population owing to poor literacy in the region.
3. IMPROVED ACCESS TO HEALTH CARE
(3.1) Enhanced focus on Health and greater convergence with the Women and Child
Development Department: There is a need for expansion of health care services in the
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 62
affected area including health care activities including reproductive and child care, pre and
post-natal care, vaccination etc. to deal with women and health related issues.
The tribal community face certain challenges in terms of exclusion which when added to the
problem of poverty aggravate the problem and adds to further vulnerability. The health
service seeking behaviour is improving while they still suffer with the problem of dealing
with quacks, witchcraft etc even when the child suffers with common illness such as fever or
diarrhoea or respiratory track illnesses. A lot of precious time is wasted in such
circumstances.
A comparative picture of the healthcare structure in Sheopur is given below:
Name of
Block
Number of
Community
Health
Centre
Number
of
Primary
Health
Centre
Sanctioned
post at
PHC/
actually
posted
ANM
sanctioned
for the
block /
actually
posted
ASHA
sanctioned
for the
block
Nutrition
Rehabilitation
Centre
Vijaypur 1 3 27/12 31/24 246 NRC ,
Vijaypur
Karahal 1 1 7/4 26/19 130 NRC.
Karahal
Sheopur 1 6 39/24 33/29 240 NRC ,
District
Hospital ,
Sheopur
It was found that the children born in Saharia families are much higher risk of being
malnourished than among those born in Non – Saharia households, this coupled with their
early marriage makes them vulnerable to anaemia and other childhood illnesses. Therefore, it
is recommended that:
a. Intensive health awareness in the target group of expectant mothers / adolescents
needs to be launched in the campaign mode through women and child development
department and health and family welfare department.
b. Filling up infrastructure gaps – this would mean posting of doctors/ other support staff
at the facilities.
c. Creating new CHC/PHC as per the projected needs. The gaps mentioned above need
to be addressed and bridged by new sanctions, better access would improve the access
to health care for the child and the mothers.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 63
The consumption of additional food by the mother during pregnancy / by lactating
mothers was found to have positive impact in lowering the incidence of malnourishment
thus it is desired that the pregnant women/ lactating mothers be encouraged to take
additional diet and consume the take-home-ration.
Looking into the disease pattern and the frequency at which the children in the community
suffer from common illness like diarrhoea, fever and respiratory infections in the region,
there is an immense need for advocacy and reiteration of optimal practices of health and
nutrition especially infant and young child feeding practices. Also there is an urgent need to
enhance the staff and capacity of the PHC and CHC in the region.
The level of literacy was found to be very poor in the affected area; almost 73 % of the
Saharia respondents were illiterate while 65% of the Non-Saharia respondents were illiterate.
Therefore any IEC literature will not be of much use. There is an urgent need to make use of
mobile vehicle with loudspeakers having announcement regarding health facility and
hygiene, since the personal hygiene was not found to be very good during the course of the
visits undertaken to the area. It is essential that the audio-visual IEC is in local language and
local actors as used for the same. Radio station Vanya located in Sesaipura (Sheopur)
provides a great window of opportunity as it makes programmes in Saharia dialect which is
easily understood by the community. Health related messages could be propagated using his
medium.
The Karahal block is one among the 89 tribal blocks identified in Madhya Pradesh. Iron and
Iodised double fortified salt distribution has been initiated in the 89 tribal blocks of Madhya
Pradesh. Increased emphasis should be given on the same as it is likely to tackle the issue of
iron and iodine deficiency in the region.
(3.2) Vaccination: It was observed that in most of the cases the vaccination was incomplete
i.e. vaccination was started however the schedule of vaccination was not adhered to. An
increased effort is required to address this issue in the region. The schedule of vaccination
should be regularly monitored and adhered to.
(3.3) Family Planning: Family Planning initiatives do not seem to be very effective in the
region with almost 75 % of the respondents mentioning that they did not use any method of
family planning .The Saharia community reported even lower inclination towards family
planning with only 22 % of the respondents from the Saharia community adopting methods
of family planning. At the community level also when the respondents were asked about their
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 64
opinion about how many children a couple should have almost 52 % were of the opinion that
a couple should have 3 or more children. In such circumstances it is essential that the AWW,
ASHA , ANM and other functionaries working the region should do more efforts to inform
and encourage the community to adopt family planning practices.
(3.4) Child feeding practices : According to the Infant and Young Child Feeding
Guidelines, 2016 published by the Indian Academy of Paediatrics, after the child reached six
months of age introduction of optimal complementary feeding should be practiced preferably
with energy dense, home-made food. Breastfeeding should be continued minimum for 2 years
and beyond. However, in almost 49 % of the cases feeding of breast milk to the child was not
continued till the child reached two years of age. Thus it is essential to encourage the optimal
feeding practices for the children at the community level.
(3.5) Opportunity under Poshan Abhiyaan: The National Nutrition Mission (NNM) was
set up in December 2017 with a three year budget of Rs.9046.17 Crore commencing from
2017-18. All the States and districts will be covered in a phased manner under the mission.
The district of Sheopur is among the 315 districts identified under Phase –I of the
programme. Total 37 districts of Madhya Pradesh fall under phase-I of the programme.
Poshan Abhiyaan the flagship programme of the Ministry of Women and Child Development
(MWCD), Government of India, ensures convergence with various programmes i.e.,
Anganwadi Services, Pradhan Mantri Matru Vandana Yojana (PMMVY), Scheme for
Adolescent Girls (SAG) of MWCD Janani Suraksha Yojana (JSY), National Health Mission
(NHM), Swachh - Bharat Mission, Public Distribution System (PDS), Department Food &
Public Distribution, Mahatma Gandhi National Rural Employment Guarantee Scheme
(MGNREGS) and Ministry of Drinking Water & Sanitation.
The Poshan Abhiyaan focuses to lay emphasis on the first 1000 days of the child, which
includes the nine months of pregnancy, six months of exclusive breastfeeding and the period
from 6 months to 2 years to ensure focused interventions on addressing under nutrition.
Besides increasing the birth weight, it will help reduce both Infant Mortality Rate (IMR) and
Maternal Mortality Rate (MMR). Additional one year of sustained intervention (till the age of
3 years) would ensure that the gains of the first 1000 days are consolidated. Attention is also
given on children in the age group of 3-6 years for their overall development through the
platform of the Anganwadi Services.
The challenges in the region call for greater convergence in the region among the
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 65
department of Health and Family Welfare and Women and Child Development
department, Government of Madhya Pradesh.
(3.6) Opportunity in Ujwalla scheme: During the course of the field visits, it was observed
that the women would go to forest or walk long distances to get firewood. The women also
face a risk of being attacked or assaulted while they go to the forest alone to collect firewood.
The Ujwalla scheme offers a window of opportunity where by the women would not be
required to go to the forest to collect firewood. This would mean that the women stays at
home relatively longer and contributes to the well-being of the child. The respondents also
mentioned one of the reasons for not getting the children vaccinated was they had to go to the
jungle to get fire wood. This will also improve the vaccination and overall status of the
children.
4. EXTENSION EFFORTS AT COMMUNITY LEVEL
(4.1)Public Distribution System: The Public Distribution System contributes significantly
in the provision of food security. Public Distribution System in the country enables the
supply of food grains to the poor at a subsidized price. The importance of public distribution
system cannot be emphasized enough in an area facing risk of malnutrition. In such
circumstances it becomes increasingly important that we continue to focus on the effective
implementation of the public distribution system. In such circumstances it is recommended
that increased allocation of PDS be given to families having severely underweight children
and for and SAM children discharged from Nutrition Rehabilitation Centres.
(4.2) Involvement at all levels in the monitoring of efforts to reduce malnutrition:
Intensive monitoring is required at all levels including District Collector, CEO Zilla
Panchayat, Saharia Vikas Pradhikaran, Chief Medical Officer, Block Medical Officer, Staff
at Nutrition Rehabilitation Centre, Community Health Centre, Primary Health Centre, ANMs,
ASHA Karyakarta, Anganwadi Karyakarta etc need work in co-ordination towards the aim of
reducing malnutrition in the area. Intensive monitoring would be required to ensure that the
problem of malnutrition is addressed properly in the region.
During the course of field visit to the region it was informed that duties have been assigned to
various staff members of the government departments to visit respective anganwadi and
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 66
report about the facility and functioning of the anganwadi along with suggestions for
improvement. Also, monitoring of the malnutrition related issue was being done by
including this issue in Time-Limit (T/L) meeting. Though it is heartening to know that that
progress on the front of malnutrition is being regularly monitored, there is a felt need for
inclusion of standard monthly monitorable indicators of malnutrition and its corollaries in the
T/L meeting to make the monitoring mechanism more effective.
(4.3) Campaign against substance abuse: The study showed that problem of substance
abuse, consumption of alcohol and tobacco was found among the Saharia community as well
as Non- Saharias:
Problem of consumption of alcohol and tobacco
Saharia 83 %
Non- Saharia 59 %
The problem is more acute among the Saharia community. It is another drain on the limited
income apart for making them vulnerable to diseases and poor health. A campaign needs to
be taken to address this issue. The campaign needs to be supplemented with appropriate
educational and de-addition interventions also. Adult education program should be planned in
the region where special focus should be given to educate the community about good health
practices and the ill effects of alcohol and tobacco there is an urgent need to focus on de-
addiction and counselling of the household’s resident in the region about the ill- effects of
alcohol and usage of tobacco. Local youth who understand the local issues better could be
counselled and involved in the process.
(4.4) Greater use of Vanya radio station: To address the specifics needs of the tribal
community in local languages resource is available in the form of Vanya radio station to
enhance community participation. It focuses on programs centred on tribal lifestyle, culture,
society, traditions, folk resources etc.Radio station Vanya located in Sesaipura (Sheopur)
provides a great window of opportunity as it makes programmes in Saharia dialect which is
easily understood by the community. This communication medium may be used more
aggressively to communicate information on other aspects including hygiene, livelihood etc
to the community.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 67
(4.5) strengthening of infrastructure of roads in the region: The network of roads in the
region is poor with several villages not being connected by proper roads. As mentioned in the
District Census Handbook on Madhya Pradesh – Sheopur Census of India 2011 only 180 out
of the 607 villages in the district were connected by road. Thus it very essential to strengthen
roads and transport facilities in the region. With greater access and road connectivity the
residents of the region will have greater access to health and other services.
(4.6) Banking and Thrift facility: The overall availability of banking and credit facilities in
the region was not very encouraging. Not many commercial / co-operative banks are active in
the region. The presence of Agricultural Credit Societies and banks in Karahal block is even
lower when compared with the other blocks in the district. Thus it is essential that more
Regional Rural Banks and other institutions become active in the region to support income
generation activities in the region.
Name of Block Number of villages Banks Agricultural Credit
Societies
Vijaypur 162 8 14
Sheopur 235 13 33
Karahal 119 2 5
Source: District Census Handbook on Madhya Pradesh – Sheopur
(4.7) Role of NGOs in community development: During the study it was found that Tata
Trust is in touch with the district administration through their NGO Transforming Rural India
and is planning to work in areas of Livelihood, Literacy, Drinking water and forest produce.
This needs to be followed up vigorously by the local administration. There is a great scope of
work from the Corporates who may be willing to work in the region under the domain of
Corporate Social Responsibility. This opportunity need to be explored further by the district
administration for the overall benefit of the people.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 68
References:
1. Operational guidelines on facility based management of children with severe acute malnutrition
by ministry of health and family welfare, Government of India, 2011
2. Dinachandra Singh K, Alagarajan M, Ladusingh L (2015) What Explains Child Malnutrition of
Indigenous People of Northeast India? PLoS ONE 10(6): e0130567
3. United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF-WHO-
World Bank Joint Child Malnutrition Estimates. 2017 (UNICEF, New York; WHO, Geneva; The
World Bank, Washington, DC).
4. Gross R, Webb P. Wasting time for wasted children: severe child undernutrition must be resolved
in non-emergency settings. The Lancet. 2006;367:1209–11.
5. Mishra V, Retherford RD. Does biofuel smoke contribute to anaemia and stunting in early
childhood? International Journal of Epidemiology. 2007;36(1):117–29. pmid:17085456
6. Shaw JCL. Malnutrition in very low birth-weight, pre-term infants. Proceedings of the Nutrition
Society. 1974;33:103. pmid:4477386
7. Kimberly D, Ernst MD, Paula G, Radmacher MS, Salisa T, Rafail RD, et al. Postnatal
Malnutrition of Extremely Low Birth-Weight Infants With Catch-Up Growth Postdischarge.
Journal of Perinatology. 2003;23:477–482. pmid:13679935
8. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, et al. Very Low Birth Weight
Outcomes of the National Institute of Child Health and Human Development Neonatal Research
Network, January 1995 Through December 1996. Pediatrics. 2001;107(1):1–8. pmid:11134427
9. Hack M, Klein NK, Taylor HG. Long-term developmental outcomes of low birth weight infants.
Future Child. 1995;5(1):176–96. pmid:7543353
10. District Census Handbook on Madhya Pradesh – Sheopur Census of India 2011 Series -24 part
XII-A
11. Sankhikiya Sanchhep of MP-2012
12. Jila Sankhikiya Pustika-2011
13. RanRanjan Kumar Biswas and A.K. Kapoor- A Study on Mortality Among Saharia – A Primitive
Tribe of Madhya Pradesh- Anthropologist, 5(4): 283-290 (2003)
14. ManDal, Debabrata: Social and economic sensario of a primitive tribe in Madhya Pradesh: 236-
243. In: Tribal Culture and Identity. Chaturbhuj Sahu (Ed.). Sarup & Sons Publication, New Delhi
(1998).
15. Prabhu, Pradip: Social forestry: An adivasi viewpoint: 134143. In: Towards A New Forest Policy:
People’s Right and Environmental Needs. Walter Fernandes and Sharad Kulkarni (Eds.). Indian
Social Institute, New Delhi (1983).
16. Singh, K.S. : The Scheduled Tribes, Volume – III. Oxford University Press, Delhi (1994).
17. Sethi GR, Sachdev HPS, Puri RK. Women’s health and fetal outcome. Indian Pediatr. 1991;
28:1379-92.
18. Narayanan I, Prakash K, Bala S, Verma RK, Gujral VV. Partial supplementation with expressed
breast-milk for prevention of infection in low-birth-weight infants. Lancet. 1980;2:561-3.
19. Shaw JCL. Malnutrition in very low birth-weight, pre-term infants. Proceedings of the Nutrition
Society. 1974;33:103. pmid:4477386
20. Sanghvi U, Thankappan KR, Sarma PS, Sali N. Assessing potential risk factors for child
malnutrition in rural Kerala, India. Journal of Tropical Pediatrics. 2001;47(6):350–5.
pmid:11827303
21. Bhutia D T. Protein energy malnutrition in India: the plight of our under five children. Journal of
Family Medicine and Primary Care. 2014;3(1):63–7. pmid:24791240
22. Meshram II, Arlappa N, Balakrishna N, Mallikharjuna RK, Laxmaiah A, Brahmam GN. Trends in
the prevalence of undernutrition, nutrient and food intake and predictors of undernutrition among
under five year tribal children in India. Asia Pacific Journal of Clinical Nutrition.
2012;21(4):568–76. pmid:23017315
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 69
Websites:
1. http://nhm.gov.in/images/pdf/programmes/child-
health/guidelines/operational_guidelines_on_fbmc_with_sam.pdf
2. http://www.who.int/tb/advisory_bodies/impact_measurement_taskforce/meetings/prevalence_sur
vey/psws_probability_prop_size_bierrenbach.pdf
3. http://www.mpwcd.nic.in/web/wcd/sc-ic-icds
4. http://www.crida.in/CP-2012/statewiseplans/madhya%20pradesh/MP18-Sheopur-26.6.2012.pdf
5. http://www.mp.gov.in/web/guest/gridregion- Proposed horticulture crop for Sheopur
6. http://www.indianpediatrics.net/aug2016/703.pdf Infant and Young Child Feeding Guidelines,
2016 recommendations by Infant and Young Child Feeding (IYCF) chapter of Indian Academy of
Pediatrics
7. http://mnregaweb2.nic.in/netnrega/state_html/pmsr.aspx?lflag=local&state_code=17&state_name
=MADHYA+PRADESH&fin_year=2016-2017&page=S&Digest=cUGUCP5k5v60KPElvKN1gw
8. http://www.who.int/mediacentre/factsheets/fs292/en/
9. http://www.educationportal.mp.gov.in/Public/Schools/ssrs/State_Schools.aspx?MP=1
10. http://www.icds-wcd.nic.in/nnm/NNM-Web-Contents/RIGHT-MENU/NNM-States-
Districts/NNM-Districts-315-Phase-I.pdf).Total
11. http://www.icds-wcd.nic.in/nnm/NNM-Web-Contents/LEFT-MENU/ILA/ILA-Guidelines-
English.pdf
Footnotes :
1. Operational guidelines on facility based management of children with severe acute malnutrition by
ministry of health and family welfare, Government of India, 2011
2. National Family Health Survey 4 (NFHS 4 )of India
3. United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF-WHO-
World Bank Joint Child Malnutrition Estimates. 2017
4. Gross R, Webb P. Wasting time for wasted children: severe child under nutrition must be resolved
in non-emergency settings. The Lancet. 2006;367:1209–11.
5. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, et al. Very Low Birth Weight
Outcomes of the National Institute of Child Health and Human Development Neonatal Research
Network, January 1995 Through December 1996. Pediatrics. 2001;107(1):1–8. pmid:11134427
6. District Census Handbook on Madhya Pradesh – Sheopur Census of India 2011 Series -24 part XII-
A
7. ManDal, Debabrata: Social and economic sensario of a primitive tribe in Madhya Pradesh: 236-243.
In: Tribal Culture and Identity. Chaturbhuj Sahu (Ed.). Sarup & Sons Publication, New Delhi
(1998).
8. Prabhu, Pradip: Social forestry: An adivasi viewpoint: 134143. In: Towards A New Forest Policy:
People’s Right and Environmental Needs. Walter Fernandes and Sharad Kulkarni (Eds.). Indian
Social Institute, New Delhi (1983).
9. Singh, K.S. : The Scheduled Tribes, Volume – III. Oxford University Press, Delhi (1994).
10. Ranjan Kumar Biswas and A.K. Kapoor- A Study on Mortality Among Saharia – A Primitive
Tribe of Madhya Pradesh- Anthropologist, 5(4): 283-290 (2003)
11. Dietary Guidelines for Indians- A Manual published by National Institute of Nutrition ,
Indian Council of Medical Research , Hyderabad
http://www.ninindia.org/DietaryGuidelinesforNINwebsite.pdf
12. Infant and Young child feeding guidelines 2016,Indian Pediatirics pg 703 Volume 53 August
15,2016 https://www.indianpediatrics.net/aug2016/703.pdf
13. Taneja G, Dixit S, Khatri A K, Yesikar V, Raghunath D, Chourasiya S. A study to evaluate the
effect of nutritional intervention measures on admitted children in selected nutrition rehabilitation
centers of Indore and Ujjain divisions of the state of Madhya Pradesh (India). Indian J Community
Med 2012;37:107-15
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 70
Annexure 1
National Family Health Survey (NFHS-4, 2015-16) malnutrition in India,
MP and Sheopur
Particulars India Madhya Pradesh Sheopur
Percentage of children under age
of five years who are underweight
(low weight for age).
35.7 42.8 55
Percentage of children under five
who are stunted (height for age).
38.4 42 52.1
Percentage of children under five
years of age who are wasted
(weight for height)
21 25.8 28.1
Percentage of these children who
are severely wasted(weight for
height)
7.5 9.2 9
Source: National Family Health Survey 4, 2015-16
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 71
Annexure 2
District Map of Madhya Pradesh
About Sheopur
Climate: The climate here is characterized by a hot summer and general dryness except
during the monsoon and well distributed rainfall in the monsoon season. The winter season
from December to February is followed by summer season from March to mid June. The
period from mid-June to September constitutes the south-west monsoon season. The
succeeding period lasting till the end of November is the post monsoon or retreating monsoon
season. About 83 to 87 percent of the annual rainfall in the district is received during the
south-west monsoon months, (June to September). The spatial variation of rainfall in the
district is not much, July being the rainiest month of the district. After February temperature
increase rapidly till May, which is the hottest month of the year. The mean daily temperature
in May is 40 degree centigrade.
Forest: Forest have vital role in the economy of the district. The total forest area of
Sheopur is 3949 sq. km which is 59.79% to the total area (6606 sq. km) of the district. The
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 72
district has 3006 sq. km of reserved forest. There is vast stock of forest products like Tendu
leaf, Timber wood, Mahua, Harra, Lac, Gum and other herbal and medicinal products. The
forest of Sheopur district can be regarded as dry tropical forests.
Agriculture and Animal Husbandry: The principal Kharif crops traditionally grown
in the district are Jowar, Bajra, Soyabean and Tuar. To some extent Rice is also grown. Main
Rabi crops are Wheat, Barley, Gram, Mustard and Groundnut all of which gained much
importance. Major part of rural population is depending on agriculture and animal husbandry.
Irrigation: Canals originating from the dam built on Chambal river in Kota district of
Rajasthan are the main source of irrigation in the south-west part of the district. The total area
irrigated by canal is 65,672 hectares and tube wells is 2,299 hectares. The economy of the
district is dominated by agriculture.
The decadal growth rate is a vital part of Census operations. This gives an overview of the
percentage of total population growth in a particular decade. The decadal population growth
rate for Sheopur is higher than the population growth rate in Madhya Pradesh.
CENSUS FINDINGS OF SHEOPUR-POPULATION AND ITS DISTRIBUTION
Sr. No. Particulars
Census Year
2001 2011
1 2 3 4
1 Area (in sq. KM.) 6606 6606
2 Number of Tehsils 3 5
3 Number of CD Blocks 3 3
4 Number of Villages 607 582
5 Total Households 96898 146043
Household size 5.8 4.7
6 Total Population 5,59,495 6,87,861
7 Decadal Population Growth (Madhya Pradesh) in % 24.26 20.23
8 Decadal Population Growth (Sheopur) in % 29.7 22.9
9 Proportion of Rural population to total population 84.2 84.4
10 Proportion of Urban population to total population 15.8 15.6
11 Sex Ratio 895 901
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 73
12 Work Participation Rate 41 40.3
13 Literacy Rate 46.4 57.4
14
Age-group wise proportion to total population
0-14 years 43.1 37.6
15-59 years 51.2 56
60+years 5.5 6.3
Age not stated 0.2 0.1
15 Scheduled Castes Population 90420 108391
Proportion of Scheduled Castes to total population 16.2 15.8
16 Scheduled Tribes Population 120482 161448
Proportion of Scheduled Tribes to total population 21.5 23.5
Source: District Census Handbook for Sheopur Year 2011
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 74
Annexure 3
Block wise detail of Sheopur District
There are three blocks in Sheopur district namely: Vijaypur, Sheopur and Karahal. The
Karahal block has the highest population of Scheduled Tribes (rural 63.08%) of the)
population among the total population of the block.
Number and percentage of scheduled castes and scheduled tribes (Rural)
population in Blocks, 2011
SR. No. Name of Block Total
Population
Total
scheduled
castes
population
Total
scheduled
tribes
population
Percentage of
scheduled
castes
population to
total
population
Percentage
of
scheduled
tribes
population
to total
population
1 0001-Vijaypur 215041 38005 44514 17.67 20.7
2 0002-Sheopur 235584 46059 30787 19.55 13.07
3 0003-Karahal 129884 7736 81926 5.96 63.08
Source: District Census Handbook for Sheopur Year 2011
Distribution of villages according to land use , 2011
SR. No. Name of Block Number of
inhabited
villages
Total area (in
Hectares)
Percentage of cultivable area to total
area
1 0001-Vijaypur 162 194241 20.29
2 0002-Sheopur 235 134405.09 66.87
3 0003-Karahal 119 206151.69 12.79
Source: District Census Handbook for Sheopur Year 2011
The Karahal block receives less rainfall. Only 12.79 % of the land in the Karahal block is
cultivable as a percentage of total area.
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 75
Distribution of workers in four major categories of Economic activity-
block wise
Source: District Census Handbook for Sheopur Year 2011
Number % Number % Number % Number %
Persons 215,041 97,967 50,515 51.56 37,456 38.23 534 0.55 9,462 9.66
Males 115,353 59,103 32,337 54.71 19,502 33 317 0.54 6,947 11.75
Females 99,688 38,864 18,178 46.77 17,954 46.2 217 0.56 2,515 6.47
Persons 235,584 90,082 40,952 45.46 39,837 44.22 1,058 1.17 8,235 9.14
Males 122,548 64,116 34,818 54.3 22,655 35.33 536 0.84 6,107 9.52
Females 113,036 25,966 6,134 23.62 17,182 66.17 522 2.01 2,128 8.2
Persons 129,884 55,821 12,019 21.53 34,958 62.63 950 1.7 7,894 14.14
Males 67,459 33,066 9,656 29.2 17,781 53.77 473 1.43 5,156 15.59
Females 62,425 22,755 2,363 10.38 17,177 75.49 477 2.1 2,738 12.03
Name of Block
0001-Vijaypur
Cultivators
Agricultural
Labourers
Household Industry
workers Other Workers
Category of Workers
Persons/
Males/
Females
Total
Population
Total
Workers
(Main+
marginal
Workers
)
0002- Sheopur
0003-Karahal
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 76
Annexure 4
Village Selection
Village selection was carried out following probability proportionate to size (PPS) sampling
approach. Probability proportion to size is a sampling procedure is also used by the World
Health Organization. It is generally used in studies under which the probability of a unit
being selected is proportional to the size of the ultimate unit, giving larger clusters a greater
probability of selection and smaller clusters a lower probability. In order to ensure that all
units (ex. individuals) in the population have the same probability of selection irrespective of
the size of their cluster, each of the hierarchical levels prior to the ultimate level has to be
sampled according to the size of ultimate units it contains, but the same number of units has
to be sampled from each cluster at the last hierarchical level. This method also facilitates
planning for field work because a pre-determined number of individuals are interviewed in
each unit selected, and staff can be allocated accordingly.
It is most useful when the sampling units vary considerably in size because it assures that
those in larger sites have the same probability of getting into the sample as those in smaller
sites, and vice verse. Since the estimated sample of 400 children between the age 1 and 6
years was required for the study, it was decided to draw a sample of 30 villages from the list
of 139 villages in Karahal block. Since most of the villages in this block have a reasonable
percentage of scheduled tribe population and situation of literacy and poverty is almost
homogenous, no further stratification on these criteria was done.
Serial
Number
Name of the village Serial Number Name of the village
1 Jharer 16 Nimania
2 Kalarna 17 Meharbani
3 Bhela 18 Parond
4 Bagbaaj 19 Baragwa
5 Semalda Haveli 20
Goverdha
6 Aavda 21 Goras
7 Malipura 22 Reechhi
8 Verdha 23 Panbada
9 Nimoda Madh 24 Bamori
10 Bawdi Chapa 26 Budhera
11 Vardha Khurd 27 Moraban
12 Bhoorwada 28 Morai
13 Soosbada 29 Sesaipura
14 Chakrampura 30 Piprani
15 KhiriKhiri 30 Sarari Khurd
Sampling interval rounded off -4385, random number generated-3972
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 77
Annexure 5
Data collection and identification of household
In villages Saharia households that have children in the age group 1-6 years were identified
and mapped on the village map. A central point in the village was drawn on a rough map and
two Saharia and two Non-Saharia eligible households were identified. From this centre point
the village was divided into three parts ensuring that all habitations in the confines of the
villages were covered.
For every Saharia household identified to be eligible for the study, closest Non-Saharia
household that is eligible was selected. Focused discussions held with the personnel at the
health facilities - District Hospital, Community Health Centre Karahal and at the NRC. This
was centered on quality and coverage of child health and nutrition services, and their overall
experiences. Discussions were held with the personnel at the health facilities - District
Hospital, Community Health Centre Karahal and at the NRC.
In each segment (including
the central part) effort was
done to identify one Saharia
child who is malnourished,
one Saharia normal child, one
Non-Saharia malnourished
child and one Non-Saharia
child who is normal
Centre: 2 Saharia and 2
Non-Saharia eligible
households
Segment A: 2 Saharia and 2
Non-Saharia eligible
households
Segment B: 2 Saharia and
2 Non-Saharia eligible
households
Segment C: 2 Saharia and 2
Non-Saharia eligible
households
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 78
Annexure-6
Balanced Diet for Adults-Sedentary /Moderate/Heavy Activity
(Number of Portions)
Type Of Work
G/Portio
n
Sedentary Moderate Heavy
Mon Woman Man Woman Man Woman
No. of portions
Cereals &
Millets
30 12.5 9 15 11 20 16
Pulses
30 2.5 2 3 2.5 4 3
Milk &
Milk Products
100 ml 3 3 3 3 3 3
Roots &
Tubers
100 2 2 2 2 2 2
Green leafy
Vegetables
100 1 1 1 1 1 1
Other
Vegetables
100 2 2 2 2 2 2
Fruits
100 1 1 1 1 1 1
Sugar
5 4 4 6 6 11 9
Fat
5 5 4 6 5 8 6
To calculate the days requirement of above mentioned food groups for an individual, multiply
grams per portion with number of portions.
Particulars Prevalence
Infants And Preschool Children (%)
Low Birth Weight 22
# Kwashiorkor/Marasmus <1
# Bitot's Spots 0.8-1.0
Iron deficiency anaemia (6-59 months) 70.0
Underweight (Weight For Age)* (<5 Years) 42.6
# Stunting (Height For Age)* (<5 Years) 48.0
# Wasting (Weight For Height)* 20.0
Childhood Overweight/Obesity
6-30
Particulars Prevalance
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 79
Adults (%)
Chronic Energy Deficiency (BMI<18.5) Among
# Rural Adults Men 33.2
Women 36.0
* Tribal Adults Men 40.0
Women 49.0
Anaemia (%)
# Women (NPNL) 75.2
# Pregnant Women 74.6
Lodine Deficiency Disorders (IDD)
Goiter (Millions) 54
Cretinism (Millions) 2.2
Still Births Due To IDD (Includes Neo Natal Deaths) 90,000
Prevalence Of Chronic Diseases Over Weight/Obesity (BMI>25) (%)
# Rural Adults Men 7.8
Women 10.9
* Tribal Adults Men 2.4
Women 3.2
Urban Adults Men 36.0
Women 40.0
Hypertension
Urban 35.0
#Rural 25.0
Men 25.0
Women 24.0
*Tribal 24.0
Men 25.0
Women 23.0
Diabetes Mellitus (%) (Year 2006)
Urban 16.0
#Rural 5.0
Coronary Heart Disease (%)
Urban 7-9
*Rural 3-5
Cancer Incidence Rate (Per 100,000)
Men 113
Women 123
*<Median-2 SD of WHO Child Growth Standards
#NNMB Rural Survery-2005-06
*NNMB Tribal Survery-2008-09
Source: Dietary Guidelines for Indians- A Manual published by National Institute of
Nutrition, Indian Council of Medical Research Hyderabad
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 80
Annexure 7
Data downloaded from MNREGA website and other websites
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 81
Block wise comparison within the district
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 82
Study of malnutrition among under-6 children of Sheopur district with
special focus on Saharia tribe 2018
Atal Bihari Vajpayee Institute of Good Governance & Policy Analysis, Bhopal 83
Name Population Districts covered
Baiga 1, 31,425(23.86 %) Mandla, Shahdol, Dindori, Umariya,
Anuppur, Balaghat
Saharia 4, 17,171(75.76%) Gwalior, All districts of Chambal Division
Bharia 2,012 (0.37%) Patalkot, District Chhindwara
Source: Website of Tribal Welfare Dept, Govt of Madhya Pradesh